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Washington State <br />Health Care uthority <br />CONTRACT AMENDMENT HCA Contract No.: K763 <br />ABCD Dental Services <br />Amendment No.: 02 <br />THIS AMENDMENT TO THE CONTRACT 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 CONTRACTOR doing business as (DBA) <br />Kittitas County Public Health <br />CONTRACTOR ADDRESS 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 $4,750. <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 HCA'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 />