Common use of Contractor or Subrecipient Determination Clause in Contracts

Contractor or Subrecipient Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.104, ODHS’ determination is that: Contractor is a subrecipient Contractor is a contractor Not applicable Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: 93.778 EXHIBIT A Part 1 Statement of Work Contract Type: Residential Care Facility Specific Needs Contract Contract Capacity: Not to exceed Contractor’s licensed Residential Care Facility approved capacity of Residents (Individuals) at any one time during the term of this Contract. Governing Administrative Rules: Contractor must adhere to the following governing rules, as applicable, while performing work under this Contract: Residential Care and Assisted Living Facilities Oregon Administrative Rules Chapter 411, Division 054; Medicaid Long-Term Care Service Administrative Rules Chapter 411, Division 015; Specific Needs Services Oregon Administrative Rules Chapter 411, Division 027 and all other applicable state and federal laws. Maple Valley Memory Care 000 XX Xxxxxxxx Xxxxx XxXxxxxxxxx, XX 00000

Contractor or Subrecipient Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.104, ODHS’ determination is that: Contractor is a subrecipient Contractor is a contractor Not applicable Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: 93.778 178075-0/vll Page 2 of 46 ODHS PSK (reviewed by DOJ 8/30/2018) Updated: 3/1/2021 EXHIBIT A Part 1 Statement of Work Contract Type: Residential Care Facility Specific Needs Contract for Memory Care Contract Capacity: Not to exceed Contractor’s licensed Residential Care Facility approved capacity of 13 Residents (Individuals) at any one time during the term of this Contract. Governing Administrative Rules: Contractor must adhere to the following governing rules, as applicable, while performing work under this Contract: Residential Care and Assisted Living Facilities Oregon Administrative Rules Chapter 411, Division 054; Endorsed Memory Care Communities Oregon Administrative Rules Chapter 411, Division 057; Medicaid Long-Long- Term Care Service Administrative Rules Chapter 411, Division 015; Specific Needs Services Oregon Administrative Rules Chapter 411, Division 027 and all other applicable state and federal laws. Maple Valley XxXxxxxx Manor Memory Care 000 XX Xxxxxxxx Xxxxx XxXxxxxxxxxX 00xx Xxx Eugene, XX 00000OR 97405

Contractor or Subrecipient Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.104, ODHS’ determination is that: Contractor is a subrecipient Contractor is a contractor Not applicable Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: 93.778 EXHIBIT A Part 1 Statement of Work Contract Type: Residential Care Facility Specific Needs Contract Contract Capacity: Not to exceed Contractor’s licensed Residential Care Facility approved capacity of 14 Residents (“Individuals”) at any one time during the term of this Contract. Governing Administrative Rules: Contractor must adhere to the following governing rules, as applicable, while performing work under this Contract: Residential Care and Assisted Living Facilities Oregon Administrative Rules Chapter 411, Division 054; Medicaid Long-Term Care Service Administrative Rules Chapter 411, 411 Division 015; Specific Needs Services Oregon Administrative Rules Chapter 411, Division 027 027; Behavior Support Services Administrative Rules Chapter 411, Division 046 and all other applicable state and federal laws. Maple Valley Memory Care 000 Service Address: Our House of Portland, 0000 XX Xxxxxxxx Xxxxx XxXxxxxxxxxStreet, XX 00000Portland, OR 97214

Contractor or Subrecipient Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.104, ODHS’ determination is that: Contractor is a subrecipient Contractor is a contractor Not applicable Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: 93.778 EXHIBIT A Part 1 Statement of Work Contract Type: Residential Care Facility Specific Needs Contract Contract Capacity: Not to exceed Contractor’s licensed Residential Care Facility approved capacity of Residents 18 residents (Individuals) at any one time during the term of this Contract. Governing Administrative Rules: Contractor must adhere to the following governing rules, as applicable, while performing work under this Contract: Residential Care and Assisted Living Facilities Oregon Administrative Rules Chapter 411, Division 054; Medicaid Long-Term Care Service Administrative Rules Chapter 411, 411 Division 015; Specific Needs Services Oregon Administrative Rules Chapter 411, Division 027 and all other applicable state and federal laws. Maple Valley Memory Care Sapphire at Sweet Home 000 XX Xxxxxxxx Xxxxx XxXxxxxxxxxXxxxxxx Xx Sweet Home, XX 00000OR 97386

Contractor or Subrecipient Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.104, ODHS’ determination is that: Contractor is a subrecipient Contractor is a contractor Not applicable Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: 93.778 EXHIBIT A Part 1 Statement of Work Better Living Residential Care Facility (RCF) 00000 XX Xxxxxx Blvd Portland, OR 97236 Contract Type: Residential Care Facility Specific Needs Contract Contract, Complex Medical Contract Capacity: Not to exceed Contractor’s licensed Residential Care Facility approved capacity of 10 Residents (Individuals) at any one time during the term of this Contract. Governing Administrative Rules: Contractor must adhere to the following governing rules, as applicable, while performing work under this Contract: Residential Care and Assisted Living Facilities Oregon Administrative Rules Chapter 411, Division 054; Medicaid Long-Term Care Service Administrative Rules Chapter 411, 411 Division 015; Specific Needs Services Oregon Administrative Rules Chapter 411, Division 027 and all other applicable state and federal laws. Maple Valley Memory Care 000 XX Xxxxxxxx Xxxxx XxXxxxxxxxx, XX 00000.

Contractor or Subrecipient Determination. In accordance with the State Controller’s Oregon Accounting Manual, policy 30.40.00.104, ODHS’ determination is that: Contractor is a subrecipient Contractor is a contractor Not applicable Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: 93.778 EXHIBIT A Part 1 Statement of Work Contract Type: Residential Care Facility Specific Needs Contract Contract Capacity: Not to exceed Contractor’s licensed Residential Care Facility approved capacity of Residents 15 residents (Individuals) at any one time during the term of this Contract. Governing Administrative Rules: Contractor must adhere to the following governing rules, as applicable, while performing work under this Contract: Residential Care and Assisted Living Facilities Oregon Administrative Rules Chapter 411, Division 054; Medicaid Long-Term Care Service Administrative Rules Chapter 411, 411 Division 015; Specific Needs Services Oregon Administrative Rules Chapter 411, Division 027 and all other applicable state and federal laws. Maple Valley Memory Care Firwood Gardens RCF 000 XX Xxxxxxxx Xxxxx XxXxxxxxxxx000xx Xxxxxx Xxxxxxxx, XX 00000