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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 six thousand <br />dollars ($6 000.00) 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: <br />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 />