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DocuSign Envelope ID: EECFF652- EBBA- 43BD -91 B3- 20B28775BFD8 Contract #68-1016 <br />Chatham Transit Network <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />Department <br />PartyNendor Name: Chatham Transit Network Party/Vendor Contact Person: Anna Testerman Contact Phone: (919) 542 -5136 <br />Party/Vendor Address: PO Box 1032 City Pittsboro State: NC Zip: 27312 Department: Social Services Amount: N/A -State pays directly_. <br />Purpose: Non - Emergency Medicaid Transportation Budget Code(s): N/A -State pqys directly. Vendor #: 53945 (N /A if new vendor) <br />Vendor is a BDCC consultant? Yes ❑ Nog Contract Type: (Check one) New ❑ Renewal Z Amendment ❑ Effective Date July I, <br />2417 Approved by Board Yes❑ No® Agenda Date: <br />This agreement is approved as to tet Do cu Signed by: ,e " 6t& Llent: <br />Eam � <br />Department Director's Signature Date: 8/22/2018 <br />DAEi E19SA83B455... - - -- <br />Information Technologies <br />(Applicable only to hardwarelsofhmare 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 Date: <br />Risk Manay_cnicnt <br />This agreement is approved for sufficienc- - oocusiened ay: -` °�' °ids, specifications, and requirements: <br />QUS& (,b b 8/22/2018 <br />Office of the Risk Management Office Date: <br />7F6GF917E800498. -. <br />Financial Services <br />This instrument has been pre- audited ' ©ocusigned ay' the Local Government Budget and Fiscal Control Act: <br />z 8/23/2018 <br />Office of the Chief Financial Officer 7DaE5 81ACGia09. -. Bate: __ -- <br />This agreement is approved as t DocuSigned by: <br />Office of the County Attorney 4035CB8304CA4A9... <br />Legal Services <br />ncy: <br />Clerk to the Board <br />Date: <br />8/24/2018 <br />— <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Doi loyd a;oranecountyne,ga� <br />The following signature block is for bard 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 />