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<br />Name of Organization <br />Name of Funded Program <br />Annual Accomplishment Goal <br />I. Total number of unduplicated clients (Santa Ana and Non-Santa Ana Residents) anticipated to be served by the <br />funded ro ram, named above, during the 12-month contract period. <br />Persons <br /> <br /> <br />City of Santa Ana <br />Scope of Work <br /> <br /> <br />II. Number of ONLY unduplicated Santa Ana residents to be served by the funded program, named above, during the <br />12-month contract period. <br />I 1 300 I Persons <br /> <br />Program and Funding Description <br />III. Description of Work - In the space below, describe the program to be funded during the 12-month contract period. <br />What specific activities will be undertaken during the contract period. Please be concise in your response. Only the <br />viewable space will print. <br />The SOS Free Medical and Dental Clinic provides comprehensive and accessible medical and dental care to Orange <br />County residents who are uninsured or underinsured and lack access to more traditional healthcare options. Medical <br />care includes diagnosis, treatment, lab work, prescriptions, education, insurance screening, case management, and <br />access to comprehensive specialty care. Dental care includes fillings, extractions, x-rays, dental hygiene, endodontic <br />treatment, education, case management, insurance screening, and access to comprehensive specialty care. <br />Volunteers and paid staff provide care in a nonjudgemental, culturally appropriate manner. The SOS Free Clinic is <br />also an MSI provider partnering with the County of Orange and Hoag Memorial Hospital Presbyterian. <br /> <br />Residents of the City of Santa Ana travel to SOS because of the daily open access policy, free services, and because <br />SOS provides a wide range of additional services addressing the barriers Santa Ana residents living in poverty face on <br />a daily basis. <br /> <br />Schedule of Performace <br />Estimate the number of ONLY unduplicated Santa Ana residents to be served by the funded program during the 12- <br />month contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served <br />in quarter 1 do not count them again in quarter 2 <br />Quarter 1 : July 1 - September 30 <br />Quarter 2: October 1 - December 31 <br />Quarter 3: January 1 - March 31 <br />Quarter 4: April 1 -June 30 <br /> <br /> <br />Persons <br />Persons <br />Persons <br />Persons <br />1300 Total unduplicated Santa Ana Residents to be served. <br /> <br />Schedule of Invoicing <br />Estimate the amount of grant funds to be requested durin the 12-month contract period on a quarterly basis. <br />Quarter 1: July 1 - September 30 <br />Quarter 2: October 1 - December 31 <br />Quarter 3: January 1 - March 31 <br />Quarter 4: April 1 -June 30 <br /> <br /> <br />$ <br /> <br />Exhibit A <br />Page 1 of 1 <br />