Okaloosa County BOCC — December 2, 2014 — medicaid TO 28.8

TASK ORDER APPROVAL FORM CONTRACT #: CO3-0927-GM TASK ORDER #: 28.8 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 AN CCIM, Executive Director TITLE DATE RECOMMENDED FOR APPROVAL APPROVED BY OKALOOSA COUNTY (Department Director) (Per Purchasing Manual) e $25,000 or less approved by Purchasing Director e Between $25,001 and $50,000 approved by Purchasing Director and County Administrator e —Inexcess of $50,000 approved by the Board. Cpt gst Zh hinlerak SIGNATURE PURCHASING DIRECTOR Growth Management Director TITLE DATE {] / T ‘ios cal 22 lif DATE Cou Y ADNGRISTRATOR (if applicable) CHAIRMAN {if applicable) VEE DATE © 7 DATE 10-24-14A08:44 RCVD Contracted Transportation Services Task Order No. 28 Amendment No. 8 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: January 1, 2014 through February 28, 2015 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 wally Signature and Date Charles K. Windes, Jr., Chairman Approved by Name, Title Signature and Date