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<br /> <br /> <br />Contract-Scope of Work (7-2008) Page 1of 1 <br />ATTACHMENT B – Scope of Work Federal Tax Id. or SSN 01-0794053 <br /> Contract # 68-1024 <br />A. CONTRACTOR INFORMATION <br />1. Contractor Agency Name: Earle Whitsett dba Whitsett Enterprise <br />2. If different from Contract Administrator Information in General Contract: <br />Address <br /> <br />Telephone Number: Fax Number: Email: <br />3. Name of Program (s): Non-Emergency Medical Transportation (NEMT) <br />4. Status: Public Private, Not for Profit Private, For Profit <br />5. Contractor's Financial Reporting Year July 1, 2023 through June 30, 2024 <br /> <br />B. Explanation of Services to be provided and to whom (include SIS Service Code): <br />The Contractor will provide transportation services to client(s) identified by the County. <br />The Contractor will transport client(s) to and from medical appointments. The Contractor <br />is required to meet all goals and outcomes listed in Attachment O. <br /> <br />C. Rate per unit of Service (define the unit): <br /> <br />1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) <br /> <br />N/A – program allows for contractor to negotiate service rate <br /> <br />2. Negotiated County Rate. <br /> <br />$30.00/one way trip; $60.00/roundtrip <br /> <br />D. Number of units to be provided: <br /> <br />E. Details of Billing process and Time Frames: Billing and reimbursement processes are <br />handled through the NC Tracks system rather than the County. The Contractor must <br />submit the information through NC Tracks in order to receive reimbursement for services <br />provided. <br /> <br /> <br />F. Area to be served/Delivery site(s): Orange, Alamance, Durham, Wake, and Chatham <br />Counties. <br /> <br /> <br />____________________________________ ___________________________________ <br />(Nancy Coston, Social Services Director) (Signature of Contractor) <br /> <br />________________________________ ________________________________ <br />(Date Submitted) (Date Submitted) <br />DocuSign Envelope ID: 4D4C41ED-9F19-4257-801C-59178B514BD4 <br />12/19/202312/22/2023