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DocuSign Envelope ID:27BE0809-07F1-4358-A397-1F35DD236252 <br /> Contract#68-2009 <br /> Charles House Association <br /> ATTACHMENT B <br /> SCOPE OF WORK <br /> Orange County Department of Social Services <br /> Federal Tax Id. or SSN <br /> Contract# 68-2009 <br /> A. CONTRACTOR INFORMATION <br /> 1. Contractor Agency Name: Charles House Association <br /> 2. If different from Contract Administrator Information in General Contract: <br /> Address <br /> Telephone Number: Fax Number: Email: <br /> 3. Name of Program (s): Adult Day Service <br /> 4. Status: ( )Public ( X ) Private,Not for Profit ( )Private, For Profit <br /> 5. Contractor's Financial Reporting Year July 1 2015 through June 30,2016 <br /> B. Explanation of Services to be provided and to whom(include SIS Service Code): The <br /> Contractor will provide Adult Day Services SIS Code 030 to clients of the Orange Count <br /> Department of Social Services. These services will be provided in accordance with provisions set <br /> forth in Volume IV of the Adult and Family Services Manual Cha ter I1-Adult Dqqy Care <br /> Services. The Contractor is required to meet all goals and outcomes listed in Attachment N. <br /> C. Rate per unit of Service(define the unit): <br /> 1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) <br /> 33.07/dav <br /> 2. Negotiated County Rate. <br /> D. Number of units to be provided: <br /> E. Details of Billing process and Time Frames; The County will reimburse the Contractor for <br /> services described in this contract up to the budg4U limits of the contract allotment. The <br /> County will reimburse the Contractor at a rate of$33.07/day for approved services provided. For <br /> reimbursement the Contractor must submit an original and two col2ies of an invoice by the fifth <br /> of the month for the preceding month's expenditures to the designated County Administrator. <br /> The County will reimburse the Contractor monthly upon receipt of a complete and correctly <br /> _fy filed <br /> report. <br /> The service(s) under contract with the Contractor are services for which a client may voluntarily_ <br /> contribute to the cost. Policies regarding the solicitation and acceptance of voluntaa <br /> Contract-Scope of Work(06104) Page 1 of 2 <br />