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