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DocuSign Envelope ID:43101116-0328-4364-BE8C-46E75760A1 F2 <br /> ORANGE COUNTY---DEPARTMENT USE ONLY <br /> Department <br /> PartylVendor 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: NIA-State pays directly. Purpose: Non-Emergency Medicaid Transportation Budget Code(s): <br /> NIA-State pays directly. Vendor #:N/A (NIA if new vendor) Vendor is a BOCC consultant? Yes ❑ NoM <br /> Contract Type: (Check one) New ❑ Renewal M Amendment ❑ Effective Date July 1, 2019 Approved by <br /> Board Yes[]No® Agenda Date: <br /> This agreement is approved as to to rDocuSigned by: tent: <br /> W6 <br /> 5 7/9/2019 <br /> 8A83B455 <br /> Department Director's Signature N V l Date: <br /> DAE1E19 <br /> Information Technologies <br /> (Applicable only to hardware/software 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 ft DocuSigned by: ante standards,specifications,and requirements: <br /> Em sa. LQVIA. 6 6/26/2019 <br /> Office of Risk Management7FDCF9176900498. Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> 4 � 7/9/2019 <br /> Office of the Chief Financial Officer 7D4S1ACC1409. Date: <br /> Legal Services <br /> This agreement is approved as t+ DocuSigned by: rcy: <br /> �l,h�J �,mv._ 7/9/2019 <br /> Office of the County Attorney - _ Date. <br /> 4035CB8304CA4A9 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> 5 <br />