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DocuSign Envelope ID: EECFF652- EBBA- 43BD- 91B3- 20B28775BFD8 <br />ATTACHMENT B <br />SCOPE OF WORK <br />Orange County Department of Social Services <br />Federal Tax Id. or SSN 56- 1915332 <br />Contract # 68 -1016 <br />A. CONTRACTOR INFORMATION <br />1. Contractor Agency Name: Chatham Transit Network <br />2. If different from Contract Administrator Information in General Contract: <br />Address <br />Telephone Number: <br />Fax Number: Email: <br />3. Name of Program (s): Medicaid Transportation <br />4. Status: ( ) Public (X) Private, Not for Profit ( ) 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 wham (include SIS Service Code): i The <br />Contractor will provide transportation services to clients identified by the Counly. The <br />Contractor will transport client(s) to and from medical appointments. The Contractor is required <br />to meet all goals and outcomes listed to Attachment N. <br />C. hate 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 />$60.20 /one wa y trip <br />D. Number of units to be provided: <br />E. Details of Billing Process and Time Frames: Billing and reimbursement processes will now be <br />handled through the NC Tracks s stem rather than through the Counly. 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 Ware and Chatham Counties <br />EOocuSigned by:: <br />a w6t& <br />DAE1E196A83B455... <br />Nancy Coston, Social Services Director <br />8/22/2018 <br />(Date Submitted) <br />DocuSigned by: <br />1w" 4,54,MaJA, <br />82EMODC5F52488... <br />(Signature of Contractor) <br />8/22/2018 <br />(Date Submitted) <br />Contract -Scope of Work (06/04) Page 1 of 1 <br />