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Contractor must submit properly itemized invoices to include the following information, as <br />applicable: <br />HCA Contract number; K763-03 <br />Contractor name, address, phone number; <br />Description of Services; <br />Date(s) of delivery; <br />Net invoice price for each item; <br />Applicable taxes; <br />Total invoice price; and <br />Payment terms and any available prompt payment discount. <br />HCA will return incorrect or incomplete invoices to the Contractor for correction and <br />reissue. The Contract Number must appear on all invoices, bills of lading, packages, and <br />correspondence relating to this Contract. <br />5. Exhibit A, A 1 and A2. ABCD Quarterly Outreach & Case Management Report, is hereby <br />replaced in its entirety with Exhibit A3. <br />6. Exhibit B, B1 and B2. Community Outreach and Coordination of Care Report, is hereby <br />replaced in its entirety with Exhibit B3. <br />7. Exhibit D, D1 and D2. Budget Tool, is hereby replaced in its entirety with Exhibit D3 . <br />8. HCA contact is Janice Tadeo, Dental Program Administrator at Ja n;ce .tadeo@hca .wa .gov <br />9. This Amendment shall be effective July 1, 2017 ("Effective Date"). <br />10. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the <br />Contract. <br />11.AII other terms and conditions of the Contract remain unchanged and in full force and effect. <br />The parties signing below warrant that they have read and understand this Amendment and have <br />authority to execute the Amendment. This Amendment will be binding on HCA only upon signature <br />by HCA. <br />HCA Contract No.K763-02 <br />PRINTED NAME AND TITLE <br />rLoVlh mA, <br />PRINTED NAME AND TI T L <br />AN~~11tSLittArrt:iJ H1rU ~ <br />Ctn~ Lt:GM-oFflli?R <br />Page 2 of 12