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Page 3 <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 five thousand <br />six hundred dollars ($5,600.00) 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. Headstart will transport and supervise children to the Dental Clinic in <br />numbers and at times mutually agreed upon by Headstart and the Dental Clinic. <br />5. Headstart 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. Headstart 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, Headstart 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, Headstart may terminate this agreement; and the Dental Clinic agrees <br />to return to Headstart a pro rata share of the payment for services not <br />provided. <br />