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DocuSign Envelope ID: D843B726-9091-416C-B6AC-7EA85FE2894E <br /> ORANGE COUNTY---DEPARTMENT USE ONLY---HARI) COPY ONLY <br /> Department <br /> Party/Vendor Name: Orange Public Transportation Party/Vendor Contact Person: Peter Murphy Contact Phone: <br /> 919-245-2002 Party/Vendor Address: P.O. Box 8181 City Hjfls� State: NC Zip: 27278 Department: DSS <br /> Amount: $12.75 per way Purpose: Provide medical transportation to cligible Medicaid clients Budget Code(s): <br /> 10400020-760021 Vendor#_ (N/A if new vendor) Vendor is a BOCC consultant? Yes F NoEl Contract <br /> Type: (Check one)New [] Renewal F Amendment 7 Effective Date 07/01/16 Approved by Board YesE] <br /> NoF_j Agenda Date: <br /> This agreement is approved as to technical form ird by: <br /> Department Director's Signature st6w Date: 8/31/2016 <br /> Information Technologies <br /> (Applicable only to hardwaralsQfiware purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer, Date: <br /> Risk Manaizemen <br /> This agreement is approved for sufficiency of insu awbWaQs,specifications,and requirements: <br /> gusa, (hVVtff6 <br /> Office of Risk Management 77JIFE)GF-91­1680() Date�/24/2016 <br /> 498 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> 8/31/2016 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to legal form and su ed by: <br /> Office of the County Attorney Date: 9/1/2016 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> DocuSigned by, <br /> Revised <br /> 0637994B755E477 <br />