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State of North Carolina, County of <br /> <br /> Appendix C <br />Certified Statement <br /> <br />Pursuant to G.S. 136-44.27, the North Carolina Elderly and Disabled Transportation <br />Assistance Program, and pursuant to the Medicaid Tmnsi~rtation Axsis~,ance Program, <br />this is to certify that the undersigned is the duly dected, qualified and acffng chairperson of the <br />Board of County Commissioners of the County of , North Carolina, <br />and that the following statements are true and correct: <br /> <br />1. That the funds received pursuant to G.S. 13644.27 will be used to provide additional transportation services <br /> for the elderly and disabled, exceeding the quantity of trips provided prior to the receipt of these funds. <br /> <br />2. That the funds received pursuant to G.5. 136 44.27 will not be used to mpplant existing Federal, State or local <br /> fiands designated to provide elderly and disabled ~ansport~ffon services in the county. <br /> <br />That the funds received pursuant to G.5. 13644.27 will be used in a manner consBtent with the local <br />Tra~sportaOon Development Plan approved by the NC Depa u,ent of Transportation and the Board of <br />Commissioners. <br /> <br />It is tmder~tood that all semiannual ailocafons to the County purmant.to G-q. 1:16 !!.27 subsequent <br />to the ffa~t allocation will be made following the receipt of the progress report for the preceding six months by the <br />North Carolina Depamnent of Transport2ton, Public Transportation and Rail Division. <br /> <br />That any interest earned on these funds will be expended in accordance with G.5. 136-44.27. <br /> <br />That the funds received purrdant to Section 220 of House Bilt 83 will be used to provide additional transportation <br />ser-.-ices for Medicaid eligible pregnant women and children (ages 0-19), and will be used to satisfy the maintenance <br />of ~'ort requirement which means the court,D, will increase transportation services above the levd in ritual year 1989-90. <br /> <br />WITNESS my hand and official seal, this <br /> <br />That 'dne funds received pm-suant to Sec'don *.2.20 of House Bill 83 will not supplant existing Federal, State, or local <br />funds designated to provide transportation services for Medicaid eligible pregnant women and children in the county. <br /> <br />That '~.e funds received pursuant to Section 220 of House Bill 83 will be used in a manner consistent with the local <br />Tran .sporta~on Development Plan approved by the NC Department of Transportation and the Board of Commissioners. <br /> <br />'gnat the f~nds received pursuant t9 5eclion 220 of House Bill 83 ~511 not be used toward the purchase of capital equipment. <br /> <br />day of ,19 <br /> <br />A~est: <br /> <br />Cenifying Offidal ' <br /> <br />Board of County Commissioners <br />Ch airpe~mon ' <br /> <br />State of North Carolina <br /> <br />County <br /> <br />Subscribed and sworn to me this <br /> <br />County Manager/Administrator <br /> <br />day of ,19 <br /> <br />(SEAL) <br /> <br />Notary Public · <br /> <br />My commission expires <br /> <br /> Address <br /> 'Note that the signatures on this statement should be those of four (4) separate individuals. <br /> -9-c~ <br /> <br /> <br />