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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 Caroltrm Elderly and Dlsabl~ Transportation <br />Assistance Program, and pursuant to the Medicaid Traml~tton Assistance Program, <br />this is to certify that the undersigned is the duly elected, qualified and acting chairperson of the <br />Board of County Commissioners of the County of , North Carolina, <br />and that the following statements are tree and correct: <br /> <br /> i. That the funds received pursuant to G& 136-44.27 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.$. 13644.27 will not be used to supplant exBfing Federal, State or local <br /> funds designated to provide elderly and disabled transportation services in the county. <br /> <br />That the funds received pursuant to G.S. 136-44.27 will be used in a manner consistent with the local <br />Transportation Development Plan approved by the NG Department of Transportation and the Board of <br />Commissioners. <br /> <br />It is understood that all semiannual allocations to the County pursuant to G.5. 136 ~a..27 subsequent <br />to the first allocation will be made following the receipt of the progress report for the preceding slx months by the <br />North Caolina Department of Transportation, Public Transportation and Rail Division. <br /> <br />5. That any interest earned on these funds will be expended in accordance with G& 136-44.27. <br /> <br />That the funds received pursuant to Section 220 of House Bill 83 will be used to provide additional transportation <br />services for Medicaid eligible pregnant women and children (ages 0-19)0 and will be used to satisfy the maintenance <br />of effort requirement which means the county will increase transpo~tton seveices above the level in fiscal year 1989-90. <br /> <br />7. That the funds received put, ant to Section 220 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 /> 8. That the funds received pursuant to Section 220 of House Bill 83 will be used in a manner consistent with the local <br /> Transportation Development Plan approved by the NG Department of Transportation and the Board of Commissioners. <br /> <br /> 9. That the funds received putmant to Section 220 of House Bill 8B will not be ~ toward the pm-chase of capital equipment. <br /> <br />WITNESS my hand and offidal seal, this day of ,19 <br /> <br />Attest: <br /> <br />Ceffifying Offidal ' <br /> <br />Board of Gounty Commissioners. <br />Chairperson ° <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 />(SE ) <br /> <br />Notar~ Public · <br /> <br />My commission expires <br /> Address <br /> *Note that the signatures on this statement should be those of four (4) separate individuals. <br /> <br /> <br />