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DocuSign Envelope ID: AA1647C8 -B778- 4021- 9E83- EDC4C913A37C <br />ATTACHMENT B <br />SCOPE OF WORT{ <br />Grange County Department of Social. Services <br />Federal Tax Id. or SSN 20- 8037463 <br />Contract ## 68 -1014 <br />A. CONTRACTOR. INFORMATION <br />1. Contractor Agency Name: S111- Orange, LLC dba The Stratford <br />2. If decent from Contract Administrator Information in General Contract: <br />Address <br />Telephone Number: Fax Number: Email: <br />3. Name of Program (s): Medicaid Transportation <br />4. Status: ( } Public () Private, Not for Profit (X) Private, For Profit <br />5. Contractor's Financial Reporting Year July 1, 2018 through June 30, 2019 <br />B. Explanation of Services to be provided and to whom (include SIS Service Code): _ The <br />Contractor will rovin ide transportation services to client(, identified by the CouM. The <br />Contractor will transport client(s) to and from medical appointments. The Contractor is required <br />to meet all goals and outcomes listed in Attachment O. <br />C. Rate per unit of Service (define the unit): <br />1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) <br />2. Negotiated County Rate. <br />See rate letter attached. <br />D. Number of units to be provided: <br />E. Details of Billing Process and Time Frames: Billing and reimbursement processes will be <br />handled through the NC Tracks system, rather than through the County. The Contractor must <br />submit information through NC Tracks in order to receive reimbursement for services provided. <br />F. Area to be served/Delivery site(s): Orange, Alamance, Durham, Wake, and Chatham Counties <br />Dom Signed by: <br />N Wou <br />DAE1E196A83B455._ — <br />Nancy Coston, Social Services Director <br />8/14/2018 <br />(Date Submitted) <br />DacuSigned by: <br />C5B3 &67A1C4C44C... <br />(Signature of Contractor) <br />8/14/2018 <br />(Date Submitted) <br />Contract -Scope of Work (46/04) Page lof 1 <br />