Orange County NC Website
DocuSign Envelope ID: AA1647C8 -B778- 4021- 9E83- EDC4C913A37C <br />Contract #68 -1014 <br />SHl- Orange„ LLC dba The Stratford <br />ORANGE COUNTY— DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: SHI- (}range, LLC dba The Stratford Party/Vendor Contact Person: Cameron Cook Contact Phone: (828) 270 -0656 <br />Party/Vendor Address: 400 2 °d Avenue NW City Hickory State: NC Zip: 28601 Department: Social Services Amount: NIA -State nays <br />directly. Purpose: Non - Emergency Medicaid Transportation Budget Code(s): N/A -State pays directly. Vendor #: N/A (N /A ifnew vendor) <br />Vendor is a BOCC consultant? Yes ❑ NoN Contract Type: (Check one) New.E Renewal ❑ Amendment El Effective Date July_l <br />2018 Approved by Board Yes❑ No® Agenda Date: <br />This agreement is approved as to te1 oacusigned by: <br />Nam w6t& <br />Department Director's Signature <br />DAE1E196R83B455... <br />tent: <br />Information Technologies <br />Date: <br />8/14/2018 <br />(Applicable only to hardwarelsojtware purchases or related services) This agreement has been reviewed and is approved as to <br />information technology content and specifications: <br />Office of the Chief Information Officer <br />Risk Management <br />Date: <br />This agreement is approved for sufficienc roocu5 eyed by: `- s -Pds, specifications, and requirements: <br />aUS& cbvw h 8/13/2018 <br />Office of the Risk Management Officer Date: <br />7FDCF917E800498... <br />This instrument has been pre - audited ' Docusigned ay: <br />Office of the Chief Financial Officer <br />304E5181ACC1409... <br />Financial Services <br />the Local Government Budget and Fiscal Control Act: <br />Legal Services <br />Date: 8/20/2018 <br />This agreement is approved as t - OocuSigned by: ncy_ <br />Office of the +Count Attorney Date: 8/20/2018 <br />4035CB8304CA4A9... <br />Clerk to the hoard <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@aorangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br />Office of the Clerk to the Board Date: <br />Contract - General (07/10) Page 5 of 5 <br />