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DocuSign Envelope ID: 1582AE24-D793-4A66-9311-4472000BOEC3 <br /> Contract#68-2004 <br /> Personalized Patient Home Assistance,Inc. <br /> ATTACHMENT B <br /> SCOPE OF WORK <br /> Orange County Department of Social Services and Orange County Department on Aging <br /> Federal Tax Id. or SSN <br /> Contract# 68-2004 <br /> A. CONTRACTOR INFORMATION <br /> 1. Contractor Agency Name: Personalized Patient Home Assistance, Inc. <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): In-Home Services <br /> 4. Status: ( ) Public ( ) Private,Not for Profit (X)Private, For Profit <br /> 5. Contractor's Financial Reporting Year T July 1, 2015 through June 30, 2016 <br /> B. Explanation of Services to be provided and to whom (include S1S Service Code): The <br /> Contractor will provide employees to perform in-home services for the Department of Social <br /> Services' clients and the Department on Aging's clients, at the level, amount and frequency_ <br /> specified by the social worker in the In-Home Aide Services Plan. SIS Code 042 The <br /> Contractor will provide Level 11 Home Management and Level III Personal Care. The Contractor <br /> 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 /> $14,40/hour <br /> 2. Negotiated County Rate. <br /> D.Number of units to be provided: <br /> I:. Details of Billing process and Time Frames; The County will reimburse the Contractor for <br /> services described in this contract up to the budgetary limits of the contract allotment. The <br /> County will reimburse the Contractor at a rate of 14.40/hour for approved services provided. For <br /> reimbursement the Contractor must submit an on final and two co ies of an invoice by the fifth <br /> of the month for the preceding month's expenditures to the designated County Administrator. All <br /> invoices for the provision of services to the Department of Social Services shall be submitted to <br /> the Administrator for said Department. All invoices for the provision of services to the <br /> Department on Aging shall be submitted to the Administrator for said Department. The County <br /> will reimburse the Contractor monthly upon receipt of a com fete and correctly filed report. <br /> Contract-Scope of Work(06104) Page lof 2 <br />