Okaloosa County BOCC — September 16, 2014 — TO 28.7 Medicaid Amend 7

TASK ORDER APPROVAL FORM CONTRACT #: €C03-0927-GM TASK ORDER #: 28.7 TASK ORDER AMOUNT: Based on per-member per-month rates set in agreement OFFERED BY CONSULTANT: Okaloosa County Transit FIRM'S NAME Ruth Lovejoy REPRESENTATIVE'S PRINTED NAME SIGNATURE Ss CCIM, Executive Director TITLE RECOMMENDED FOR APPROVAL (Department Director) SIGNATURE Growth Management Director TITLE Bhafiy DATE Zi tm COUNTY ADMINISTRATOR {if applicable} Sez /ry DATE DATE APPROVED BY OKALOOSA COUNTY {Per Purchasing Manual) « $25,000 or less approved by Purchasing Director * Between $25,001 and $50,000 approved by Purchasing Director and County Administrator e =Inexcess of $50,000 approved by the Board. SING DIRECTOR Wo DATE Cfez] 14- CHAIRMAN (if applicable) DATE Contracted Transportation Services Task Order No. 28 Amendment No. 7 Contractor: Okaloosa County Transit (OCT) Contract No.: C03-0927-GM, Agreement for Operation of Okaloosa County Public Transit Task Order Description Provide passenger trips to eligible Medicaid beneficiaries. OCT to provide monthly invoices. Funding is being provided by the following grant and therefore all terms and conditions apply: Grant Program: Medicaid Non-Emergency Transportation Program Granting Agency: Florida Commission for the Transportation Disadvantaged (FDOT) Grant No.: BDN10 Financial Proj Id: 41604318201 Period of Services: September 1, 2014 through December 31, 2014 Cost of Services: Based on per-member per-month rates set in agreement Authorization Okaloosa County Transit (OCT) Okaloosa County Board of County Commissioners (approved in accordance with the Purchasing Policy) Ruth Lovejoy, CCTM, Executive Director Elliot L. Kampert, Director Signature and Date / Signaturé-énd Date | Charles K. Windes, Jr., Chairman Approved by Name, Title Signature and Date