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State of North Carolina, County of <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 <br />this is to certify that the undersigned is the duly elected, qualified and acting chairperson of the <br />. North Carolina, <br />Board of the llowi�tstements are truand County <br />correct: <br />and that <br />1. That the funds received pursuant to G.S. 136-44-27 will be used to provide additional transportation services <br />for the elderly <br />and disabled, exceeding the quantity of trips provided prior to the reosipt of these funds. <br />2. That the funds received pursuant to G.S. 136114.27 will not be used to supplant existing Federal, State or local <br />funds designated to provide elderly and disabled transportation services in the wurnty. <br />3. <br />That the funds received pursuant to G.S. 136114.27 wiIl be u manner consistent and with <br />he eB local <br />°f <br />'Transportation Development Plan approved by the NC Department <br />Commissioners. <br />ursuant to G.S. 136 -4427 subsequent <br />4. It is understood that all semiannual allocations to the County p six months by the <br />to the first allocation will be made followi�cig the receipt of the progress report for the preceding <br />North Carolina Department of Transportation, Public' Transportation and Rail Division. <br />5. That any interest earned on these funds will be expanded in accordance with G.S. 136. 44.27. <br />t to Section 220 f House 1317183 will be used to provide additional transportation <br />6. That the funds received pursuan 0-19), and will be used to satisfy the maintenance <br />services effort for uirm Medicaid wb ch Pregnant the county will increase (transpo�tion services above the level in fiscal year 1989 -90. <br />of e$ort regllirem <br />7. That the funds received pursuant to Section 7.20 f House Bill 83 will not supplant existing Federal, State, and children in the county. <br />or local <br />funds designated to provide transportation services for Medicaid eligible pregnant. women <br />transportation <br />8. That the funds received pursuant to Section tithe NC Department Transportation and the�Board of Commissioners. <br />Transportation Development Plan approved <br />9. That the funds received pursuant to Section 220 f House Bill 83 will not be used toward the purchase of capital equipment. <br />WITNESS my hand and official seal, this <br />day of 19---w- <br />Attest: <br />Certifying Official • <br />State of North Carolina <br />Board of county Commissioners <br />Chairperson • <br />County Manager/Administrator • <br />County <br />Subscribed and sworn to me this <br />day of 19--' <br />(SFAL) Notary Public • <br />My commission expires Address <br />*Note that the signatures on this statement should be those of four (4) separate individuals' <br />