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Contract Template <,000 <br />May 2021 <br /> Page 18 <br />REV: 06-16-22 SK <br />Exhibit A1 – Lifeline Transportation Services <br />In consideration of the payments set forth in Exhibit B1, Contractor shall provide the following services: <br />A. Purchase and distribution, Contractor will: <br />1. Purchase SamTrans bus tickets, Clipper Cards, and passes to improve transportation access for <br />low-income families and individuals who are: <br />Participating in self-sufficiency activities or family stability activities <br />Participating in employment-related activities <br />2. Distribute SamTrans bus tickets, Clipper Cards, and passes to clients following the policies and <br />eligibility criteria set by HSA. <br />3. Document all distribution of SamTrans bus tickets, Clipper Cards, and passes to clients and submit <br />quarterly reporting to HSA regarding their distribution, as described below. <br />B. Reporting, Contractor will: <br />1. Submit quarterly reports electronically to AMorales1@smcgov.org, or their designee, by the 20th <br />day following the last day of the quarter. This will serve as supporting documentation for each <br />quarterly invoice. County will have the option to modify reporting requirements by written advance <br />notice of 20 business days. The following three items must be submitted each quarter: <br />a) Report 1: Control Log <br />Using the template distributed by HSA, for each ticket/Clipper Card/pass issued, the Control <br />Log must include the following information: <br />Date issued <br />Bus ticket/Clipper Card/pass serial number <br />Number of tickets/Clipper Cards/passes distributed <br />Client name <br />Recipient signature or initial (by client or staff) <br />Specific purpose – only one checkbox must be selected <br />Staff authorization (name/signature/title) <br />Optional: The Summary Total at the bottom of each page is optional to complete, <br />though it may be helpful for completing the Summary Report detailed below <br />b) Report 2: Summary Report <br />Using the template distributed by HSA, for all tickets/Clipper Cards/passes issued, the <br />Summary Report must include: <br />Number of tickets/Clipper Cards/passes issued per month/period, broken out by type <br />Cost of each ticket/Clipper Card/pass distributed per month/period, broken out by type <br />Total cost of tickets/Clipper Cards/passes distributed per month/period, broken out by <br />type <br />Cumulative cost for all tickets/Clipper Cards/passes distributed per month/period <br />Number of people who received transportation support for employment-related needs <br />per month/period <br />Number of people who received transportation support for self-sufficiency needs per <br />month/period <br />Total number of people who received transportation support per month/period <br />c) Client Success Story <br />A minimum of one client success story must be provided with each LTP invoice. Client success <br />stories must provide basic details about a client and demonstrate the impact of LTP as it relates <br />to either of the activities as described in A.1. above. <br />(End of Exhibit A1) <br />ATTY/AGR.2022.153/County of San Mateo (HSA Contract June 2022) (Page 18 of 37) <br />DocuSign Envelope ID: F5FF63A3-8103-4442-8F5F-F37301405123