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DocuSign Envelope ID:BD69DF46-15CD-49E6-8588-93617FCCFB94 <br /> ATTACHMENT N <br /> OUTCOMES AND REPORTING <br /> Orange County Departm nt of Social Services <br /> By signing and submitting this document, the Contractor certifies that it agrees to the follo ' : <br /> 1. The Contractor agrees to participate in program, fiscal and administrative monitoring and/or audits, <br /> making records and staff time available to Federal, State and County staff. <br /> 2. The Contractor agrees to take necessary steps for corrective action, as negotiated within a corrective <br /> action plan, for any items found to be out of comp]iance with Federal, State, and County laws, regulations, <br /> standards and/or terms of the Contract. <br /> 3. The Contractor agrees that continuation of and/or renewal of this Contract is contingent on meeting the <br /> following requirements. The Contractor agrees to: <br /> A. Adhere to all Federal and State transportation laws &regulations. <br /> B. Transport client(s)to and from medical appointments as requested by the County. <br /> C. Transport approved, authorized client(s)to specified destinations within and outside of Orange <br /> County upon request, on time, and in accordance with arrangements made by the County. <br /> D. Transport clients only to approved destinations. Any additional destinations cannot be provided <br /> without the expressed consent and authorization of the County, <br /> E. Provide services to enrolled participants within three days of a request. <br /> F. Provide critical services on short notice when requested. <br /> G. Coordinate maintenance with private vendors to ensure vehicles are in safe operating order. <br /> B. Discuss the specific situation, and present evidence of cause, with the County prior to <br /> termination of services for any client. <br /> I. Complete the DMA 5124 as part of the annual contract process. <br /> J. Use the provided transportation billing codes on invoices to the County for reimbursement. . <br /> K. Only submit invoices for trips approved by the County. Trips included on invoices that were <br /> not pre-approved will not be reimbursed. <br /> L. Meet on-time pet-formance standards such that no more than 5% of trips should be late for client <br /> drop-off to his appointment per month. Late is defined as past the client's appointment time. <br /> M. Not miss more than one quarter of one percent of all trips during the course of the contract year. <br /> N. Report all no-shows on a daily basis and cancellations on a monthly basis to the County. <br /> 0. Record all client complaints which deal with the matters under the control of Contractor, <br /> including the date of the complaint,the nature of the complaint, and what steps were taken to <br /> resolve the complaint. <br /> P. Provide names of all owners, managers, management entities, and subcontractors. <br /> Q. Report any changes such as insurance provider, business ownership or management. <br /> B. Disclose, at the outset of the contract,upon renewal and upon request, any criminal convictions <br /> or other reasons for disqualifications from participation in Medicare, Medicaid or Title XX <br /> "c o <br /> k�x^� | �5�4o�N�. <br /> sxecutive oirectnr <br /> Signature Title <br /> Chatham Transit Network 8/22/2016 <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> Outcomes (06/04) Page 1 of <br />