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State of North Carolina, County of Orange <br /> 2 <br /> Appendix C <br /> Certified Statement <br /> Pursuant to G.S. 136-44.27, the North Carolina Elderly and Disabled Transportation <br /> Assistance Program, and pursuant to the Medicaid Transportation Assistance Program, <br /> this is to certify that the undersigned is the duly elected, qualified and acting chairperson of the <br /> Board of County Commissioners of the County of orange North Carolina, <br /> and that the following statements are true and correct: <br /> 1. That the funds received pursuant to GS.1364427 will be used to provide additional transportation services <br /> for the elderly and disabled,exceeding the quantity of trips provided prior to the receipt of these funds. <br /> 2. That the funds received pursuant to G.S.1364427 will not be used to supplant existing Federal,State or local <br /> funds designated to provide elderly and disabled transportation services in the county. <br /> 3. That the funds received pursuant to G.S.136-44.27 will be used in a manner consistent with the local <br /> Transportation Development Plan approved by the NC Department of Transportation and the Board of <br /> Commissioners. <br /> 4. It is understood that all semiannual allocations to the County pursuant to G.S. 136-44.27 subsequent <br /> to the first allocation will be made following the receipt of the progress report for the preceding six months by the <br /> North Carolina Department of Transportation,Public Transportation and Rail Division. <br /> 5. That any interest earned on these funds will be expended in accordance with G.S.136-44.27. <br /> 6. That the funds received pursuant to Section 220 of House Bill 83 will be used to provide additional transportation <br /> services for Medicaid eligible pregnant women and children(ages 0-19),and will be used to satisfy the maintenance <br /> of effort requirement which means the county will increase transportation services above the level in fiscal year 1989-90. <br /> 7. That the funds received pursuant to Section 220 of House Bill 83 will not supplant existing Federal,State,or local <br /> funds designated to provide transportation services for Medicaid eligible pregnant women and children in the county. <br /> 8. That the funds received pursuant to Section 220 of House Bill 83 will be used in a manner consistent with the local <br /> Transportation Development Plan approved by the NC Department of Transportation and the Board of Commissioners. <br /> 9. That the funds received pursuant to Section 220 of House Bill 83 will not be used toward the purchase of capital equipment. <br /> WITNESS my hand and official seal, this eighth day of August 19 94 <br /> Attest: <br /> Certifying Official- Board of County Commissioners <br /> Chairperson• <br /> State of North Carolina County Manager/Administrator <br /> County <br /> Subscribed and sworn to me this day of ' 19—. <br /> (SEAL) <br /> Notary Public <br /> My commission expires <br /> Address <br /> 'Note that the signatures on this statement should be those of four(4)separate individuals. <br /> - n <br />