Laserfiche WebLink
DocuSign Envelope ID: 984F2903-5D63-4284-B7A2-A54B6EAAA057 <br />Washington State <br />CONTRACT <br />HCA Contract No.: K763 <br />{. <br />Health Care .� utharity <br />AMENDMENT <br />Amendment No.: 02 <br />ARCD Dental <br />Services <br />THIS AMENDMENT TO THE CONTRACT <br />is between the Washington State Health Care Authority and <br />the party whose name appears below, and is effective as of the date set forth below. <br />CONTRACTOR NAME <br />CONTRACTOR doing business as (DBA) <br />Kittitas County Public Health <br />Department <br />CONTRACTOR ADDRESS <br />WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) <br />507 North Nanum Street, Suite 102, <br />Ellensburg, WA 98926 <br />WHEREAS, HCA and Contractor previously entered into a Contract for increased utilization of dental <br />services early in life, improved oral health, and Apple Health/Medicaid cost savings and; <br />WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section titled Period of <br />Performance, and; <br />NOW THEREFORE, the parties agree that the Contract is amended as follows. <br />1. Section 3. Special Terms and Conditions. Statement of Work. <br />Changes to Section 3 Statement of work is hereby replaced in its entirety with Attachment 1, <br />2. Section 4. Special Terms and Conditions. Consideration. <br />The maximum consideration is hereby increased by $5075. <br />3. Section 5. Special Terms and Conditions. Term. <br />The period of performance is hereby extended from July 1, 2017 through December 31, 2017. <br />4. Section 6. Special Terms and Conditions. Billing and Payment (a) and (b). <br />Contractor must submit accurate invoices to the following address for all amounts to be <br />paid by HCA via e-mail to: Acctspay@hca.wa.gov. Include the HCA Contract number in <br />the subject line of the email. <br />Invoices must describe and document to FICA's satisfaction a description of the work <br />performed, the progress of the project, and fees. If expenses are invoiced, invoices must <br />provide a detailed breakdown of each type. Any single expense in the amount of $50.00 <br />or more must be accompanied by a receipt in order to receive reimbursement. All <br />invoices will be reviewed and must be approved by the Contract Manager or his/her <br />designee prior to payment. <br />HCA Contract No. K763-02 Page 1 of 12 <br />