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DocuSign Envelope ID: FB28FAE1-FFC6-4AE8-BB72-9CC28168D54E Contract468-1019 <br /> Chatham Transit Network <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Chatham Transit Network Party/Vendor Contact Person: Anna Tester-man Contact Phone: 919-542-5136 <br /> Party/Vendor Address: P.O. Box 1032 City Pittsboro State: NC Zip:27312 Department: Social Services Amount:N/A-State nays <br /> directly Purpose:non-emergency medical transportation Budget Code(s):NIA-State pays directly Vendor#53945 (N/A ifnew vendor) <br /> Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective Date July 1, <br /> 2019 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not <br /> been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> N (b&_ 7/8/2019 <br /> Department Director's Signature DAE1E198A83B455 Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br /> already begun or been completed please briefly describe the nature of the emergency condition that was addressed: <br /> Information Technologies <br /> (Applicable only to hardwarelsoftware 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 Mana emeat <br /> This agreement is approved for sufficienc Docusigned by: ' rds,specifications,and requirements: <br /> a�sa �,bb 7/2/2019 <br /> Office of the Risk Management Office 7FDCF9176900498. Date: <br /> Financial Services <br /> This instrument has been pre-audited i DocuSigned by: the Local Government Budget and Fiscal Control Act: <br /> � � 7/8/2019 <br /> Office of the Chief Financial Officer r4E51s,aCc,4os. Date: <br /> Le <br /> Yai Services <br /> This agreement is approved as t Docu Sig ned by: 11cy: <br /> 7/9/2019 <br /> Office of the County Attorney 4035CB8304CA4A0 — bate: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersollia@orangecountync.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 (06/19) Page 4 of 4 <br />