Wisconsin In-Network Transportation Provider Checklist

TRANSPORTATION AGREEMENT(the “Agreement”)by and betweenLOGISTICARE SOLUTIONS, LLC (“LGTC”)and___________________________ (“Provider”)WHEREAS, LGTC provides transportation brokerage services to eligible Participants(“Participants”) for the provision of non-emergency transportation services in the State ofWisconsin under contract (the “Client Contract”) to certain public agencies and/or privateorganizations (“Client”); andWHEREAS, LGTC wishes to enter into Agreements with qualified transportationcompanies for the provision of high-quality transportation services; andWHEREAS, Provider provides, among other things, non-emergency transportationservices and wishes to enter into this Agreement for the provision of services under the terms andconditions set forth herein;NOW, THEREFORE, in consideration of the mutual covenants and agreements hereinmade, the sufficiency of which is hereby acknowledged, the parties hereto agree as follows:GENERAL TERMS AND CONDITIONS1. Definitions. For purposes of this Agreement and all Exhibits, the following terms have themeanings as defined below:a) “Agreement” shall mean this Transportation Agreement, including all exhibits,and incorporates by reference the Wisconsin LGTC Provider Manual. Provisionsof this Agreement shall prevail in the event of any conflict between thisAgreement and any provision of the Provider Manual.b) “Client” shall mean the party or entity with whom LGTC has a Client Contract.Although the singular form is used “Client” shall be understood as plural in theevent that LGTC is under agreement with more than one party or entity in thestate in which Provider operates.c) “Client Contract” shall mean the agreement between LGTC and any other partyor entity pursuant to which LGTC provides non-emergency transportationmanagement services for covered Participants. Although the singular form is used“Client Contract” shall be understood as plural in the event that LGTC is underWisconsin NET ProgramVersion: March 25 2011Page 1