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DocuSign Envelope ID:527817D2-A523-467C-9535-4049B100BOE1 <br /> ORANGE COUNTY---DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Orange County Public Transit Party/Vendor Contact Person: Theo Letman Contact Phone: <br /> (919) 245-2007 Party/Vendor Address: PO Box 8181 City Hillsborough State: NC Zip: 27278 Department: Social <br /> Services Amount: N/A-State 12gvs directly. Purpose: Nan-Emergency Medicaid Transportation Budget Code(s): <br /> NIA-State pays directly. Vendor #:NIA (NIA if new vendor) Vendor is a BOCC consultant? Yes ❑ No® <br /> Contract Type: {Check one} New ❑ Renewal ® Amendment ❑ Effective Date July 1. 2018 Approved by <br /> Board YesL No® Agenda Date: <br /> This agreement is approved as to tec oocu5igned by: ent: <br /> �bSbtn 5/8/2019 <br /> Department Director's Signature Date: <br /> SAP E198A83B455 <br /> Information Technologies <br /> (Applicable only to hardwareAsaftware 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 Management <br /> This agreement is approved fc----mac,-si­gned ay:'`----ance standards,specifications,and requirements- <br /> 1 7F©CF917E8 0040049 8.USA <br /> Office of Risk Management_ �,DV Date; 5/8/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: Docu5igned by: <br /> 5/9/2019 <br /> Office of the Chief Financial Officer 7�4E51s1ACC1409. Date: <br /> Legal Services <br /> This agreement is approved as tc - oocuSigned by: ncy: <br /> Office of the County Attorney �-ht_�, '°y' - Date: 5/9/2019 <br /> 4035CB8304CA4M <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> 5 <br />