R 2016-134-E DSS - Chatham Transit Network for Medicaid transportation

Browse Search

DocuSign Envelope ID: 55869249-DO71-43C6-B9B7-126B43EDD48D ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Chatham Transit Network Party/Vendor Contact Person. Anna Testen-nan Contact Phone: 919-542-5136 Party/Vendor Address: PO Box 1032 City Pittsboro State: NC Zip: 27312 Department: DSS Amount: $10 0_00 Purpose: Medicaid Trgn,�� Budget Code(s): _ Vendor # - (N/A if new vendor) Vendor is a BOCC consultant? Yes 7 NoZ Contract Type: (Check one) New Z Renewal Amendment F-1 Effective Date 07/01/15 Approved by Board YesF_1 No7 Agenda Date: This agreement is approved as to technical form 6ambbd by: Department Director's Signature .� _ (,46v, Date: .. 2/3/2016 i 7N M5----------------- Information Technologies (,4pplicable only to hardwareAqf4vare purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Mana2emen This agreement is approved for sufficiency of insurar6gar!§,,Wid6y:specifications,and requirements: Office of the Risk Management Officer ausa, (,61�6 Date: 2/3/2016 _YFDCF�)ffCT800498---------- ....... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: Office of the Chief Financial Officer Date: 2/3/2016 ______E 1-Ae LeLyal Services qtAj�ord by: This agreement is approved as to legal form and 'R,' Office of the County Attorney Date: 2/3/2016 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion Cd, The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board ------ Date:..