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DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E <br /> EXHIBIT"B" <br /> Scope of Services—FY 2020-21 <br /> Outside Agency Performance Agreement <br /> Agency Name: Haven House(MOE Funds) <br /> Program Name: Wrenn House <br /> Funding Award: $19 000 <br /> Outline how the agency will spend Change County's funding award. <br /> Expense Description Amount <br /> Prorated salaries for shelter staff, All positions provide direct service andtor case management to 10 Orange County youth. 15,707 <br /> Prorated fringe benefits to include: FICA,SUTA,401K matah up to 6%,health,disability and Worker's Camp insurance. 3,293 <br /> Program Services <br /> Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. <br /> Shelter stay-Provide safe,supervised short-term shelter to Orange County youth who are in crisis <br /> • Counseling services-Provide counseling services to youth in the shelter(individual,family counseling) <br /> • <br /> Anticipated Outcomes <br /> The Anticipated Results column must include quantifiable results in the form of'riumber of persons/units served within Change <br /> County,only(all Towns and municipalities), <br /> If you use percentages,you must also provide the total number of participants within that measure's description or for an <br /> earlier performance measure. <br /> Performance Measures Anticipated <br /> Results <br /> %/#of youth actively participating in shelter care activities as determined 75% (7,8 <br /> by the service plan out of 10 <br /> youth) <br /> %/#of youth receiving crisis interventions/strategies as intended by the 85% of <br /> program design/service plan youth (8.5 <br /> of 10 youth) <br /> 80% of <br /> %/#of youth successfully or satisfactorily completing services as intended youth (8 of <br /> by the program design/service plan 10 youth) <br /> r( � <br /> Certified by: Title: t ed_'Get Date: <br /> (Pr vider's Electroni Sign ure) <br /> **You will sign this document elec a ly with your performance agreement. <br />