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❑ If checked, please submit the following: <br />6 Copies of (insert list of item <br />to the attention of: _(insert name of DOH employee) <br />at _(insert address to which material is sent) <br />9. ALL WRITINGS CONTAINED HEREIN <br />This Agreement and attached Exhibit(s) contains all the terms and conditions agreed upon by <br />the parties. No other understandings, oral or otherwise, regarding the subject matter of this <br />Agreement and attached Exhibit(s) shall be deemed to exist or to bind any of the parties <br />hereto. <br />IN WITNESS WHEREOF, the parties have executed this Exhibit as of the date of last signature <br />below. <br />INFORMATION PROVIDER INFORMATION RECIPIENT <br />State of Washington Department of Health Kittitas County Health <br />Signature <br />Print Name <br />Date <br />Signature <br />Print Name <br />Date <br />Page 18 of 26 <br />09/2017 <br />