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DocuSign Envelope ID: FB28FAE1-FFC6-4AE8-BB72-9CC28168D54E <br /> ATTACHMENT B <br /> SCOPE OF WORK <br /> Orange County Department of Social Services <br /> Federal Tax Id.or SSN <br /> Contract# 68-1019 <br /> A. CONTRACTOR INFORMATION <br /> 1. Contractor Agency Name: Chatham Transit Network <br /> 2. If dierent 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 (X)Private,Not for Profit ( )Private, For Profit <br /> 5. Contractor's Financial Reporting Year July 1,2019 through June 30,2020 <br /> B. Explanation of Services to be provided and to whom(include SIS Service Code): The <br /> Contractor will provide transportation services to client(s)identified by the County. The <br /> Contractor will transport clients to and from medical appointments.The Contractor is required <br /> 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 /> 2.Negotiated County Rate. <br /> $60.20/one way 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 system, rather than through the County.The Contractor must <br /> submit information throw 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 �as�aw <br /> OocuSigned by: <br /> DAE1E196A83B455 1182E36ODC5F52488 <br /> � 't',s aJn, actor) <br /> Nancy Coston,Social Services Director l7/8/2019 . <br /> (Date Submitted) (Date Submitted) <br /> Contract-Scope of Work(06/04) Page Iof 1 <br />