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// C-- <br /> Between Wake County Opportunities, Inc . <br /> and Orange County Health Department <br /> Page 2 of 3 <br /> 3. The Dental Clinic will submit a bill in an amount of six thousand <br /> dollars ( $6 , 400 . 00 ) to: Health Coordinator <br /> Wake-Orange and Chatham Head Start <br /> Wake County Opportunities, Inc . <br /> 568 East Lenoir Street <br /> Raleigh, North Carolina 27601 <br /> 4. Headstart will transport and supervise children to the Dental <br /> Clinic in numbers and at times mutually agreed upon by Headstart and the <br /> Dental Clinic. <br /> 5. Headstart agrees to provide automobile liability insurance during <br /> the transport of the children to and from the Dental Clinic; and agrees to <br /> hold the Dental Clinic harmless during such transport. <br /> 6 . Headstart agrees to supply copies of necessary eligibility <br /> determination forms, medicaid cards, medical and dental history, and record <br /> forms (CAP-H.S.-30 ) for the Dental Clinic to provide, document, and bill for <br /> services rendered. <br /> 7 . Upon receipt of a bill from the Dental Clinic, Headstart agrees <br /> to make a check payable to the Dental Clinic of the Orange County Health <br /> Department and address it to: Mr. Daniel B. Reimer, Director <br /> Orange County Health Department <br /> Post Office Box 8181 <br /> Hillsborough, North Carolina 27278 <br /> 8 . In the event that the Dental Clinic shall cease or significantly <br /> reduce the level of service below the objectives set out in section one (1 ) <br /> of the agreement, Headstart may terminate this Agreement; and the Dental <br /> Clinic agrees to return to Headstart a pro rate share of the payment for <br /> services not provided. <br />