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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 Five thousand <br /> two hundred dollars ($5 ,200.00) to: Health Coordinator <br /> Wake-Orange and Chatham Head Start <br /> Wake County Opportunities, Inc. , <br /> 568 East Lenoir St. <br /> Raleigh, N.C. 27601 <br /> 4. Head Start will transport and supervise children to the Dental Clinic in <br /> numbers and at times mutually agreed upon by Head Start and the Dental Clinic. <br /> 5. Head Start agrees to provide automobile liability insurance during the <br /> transport of the children to and from the Dental Clinic; and agrees to hold the <br /> Dental Clinic harmless during such transport. <br /> 6. Head Start agrees to supply copies of necessary eligibility <br /> determination forms, medicaid cards, medical and dental history, and record forms <br /> (CAP-H.S.-30) for the Dental Clinic to provide, document and bill for services <br /> rendered. <br /> 7. Upon receipt of a bill from the Dental Clinic, Head Start agrees to make <br /> a check payable to the Dental Clinic of the Orange County Health Department and <br /> address it to: Mr. Daniel B. Reimer, Director <br /> Orange County Health Department <br /> Post Office Box 8181 <br /> Hillsborough, NC 27278 <br /> 8. In the event that the Dental Clinic shall cease or significantly reduce <br /> the level of service below the objectives set out in section one (1) of the <br /> agreement, Head Start may terminate this agreement; and the Dental Clinic agrees <br /> to return to Head Start a pro rata share of the payment for services not <br /> provided. <br />