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ATTACHMENT B — Scope of Work Federal Tax Id. or SSN 56-2050272 <br /> Contract # 1/21-22 <br /> A. CONTRACTOR INFORMATION <br /> 1. Contractor Agency Name: Christian Healthcare Adult Daycare <br /> 2. If different from Contract Administrator Information in General Contract: <br /> Address <br /> Telephone Number: 919-775-5610 Fax Number: Email: <br /> 3. Name of Program (s): Adult Daycare <br /> 4. Status: n Public ® Private, Not for Profit (1 Private, For Profit <br /> 5. Contractor's Financial Reporting Year January through December <br /> B. Explanation of Services to be provided and to whom (include SIS Service Code): <br /> Service Code 030— One month full-time enrollment: up to 8.5 FTE <br /> Service Code 250 — Transportation to and from Center <br /> C. Rate per unit of Service (define the unit): <br /> 1. If Standard Fixed Rate. Maximum Allowable, (See Rates for Services Chart) <br /> $33.07 per unit per day, one full time enrollment up to 8.5 FTE <br /> $ 1.50 one way, $3.00 per round trip, per day, per unit for transportation <br /> Contingent upon funding <br /> 2. Negotiated County Rate. <br /> County reserves to right to negotiate per unit per day rate and transportation rate <br /> contingent upon funding. <br /> D. Number of units to be provided: 8.5 FTE <br /> E. Details of Billing process and Time Frames; Bills are due by the 5th of the month for <br /> services provided the prior 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 /> (Sig ature of Cou y Authorized Person) (Signature of Contractor) <br /> 5- 161- 20Z.1 y /� �� <br /> (Date Submitted) (Date Submitted) <br /> Contract-Scope of Work (7-2008) Page lof I <br />