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BK:00026 PG:0289 <br />ATTACHMENT B — Scope of Work Federal Tax Id. 56- 2172435 <br />Contract # 2/14 -1/15 <br />A. CONTRACTOR INFORMATION <br />1. Contractor Agency Name: Fleming Transportation, Inc. <br />2. If different 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 ® Private, For Profit <br />5. Contractor's Financial Reporting Year January 1 through December 31. <br />B. Explanation of Services to be provided and to whom (include SIS Service Code): <br />Service Code 380 — Medicaid Transportation <br />C. Rate per unit of Service (define the unit): <br />1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) <br />A. See Attachment 3 and Pricing Structure. <br />B. Reimbursement is contingent upon funding. <br />D. Number of units to be provided: Number of individuals to be served varies and <br />requests for service will be determined by medical need, recipient eligibility and <br />availability of funds. <br />E. Details of Billing process and Time Frames; Monthly invoices are due by the first of <br />each month. <br />F. Area to be served /Delivery site(s): Lee County residents who meet eligibility criteria <br />and who are authorized by Lee County Department of Social Services. <br />(Signature of County Authorized Person) <br />(Date Submitted) <br />(Signature of Contractor) <br />(Date Submitted) <br />Contract -Scope of Work (7 -2008) Page lof 1 <br />