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Fiscal Federal Funding Accountability and Transparency Act <br />(FFATA) CERTIFICATION <br />For Fiscal Year (FY14) <br />The certifications enumerated below represent material facts upon which DSHS relies when reporting <br />information to the federal government required under federal law. If the Department later determines <br />that the Contractor knowingly rendered an erroneous certification, DSHS may pursue all available <br />remedies in accordance with Texas and U.S. law. Signor further agrees that it will provide immediate <br />written notice to DSHS if at any time Signor learns that any of the certifications provided for below were <br />erroneous when submitted or have since become erroneous by reason of changed circumstances. If the <br />Signor cannot certify aU of the statements contained in this section, Signor must provide written <br />Legal Name of Contractor: <br />FFATA Contact # 1 Name, Email and Phone Number: <br />City of San Marcos <br />Steve Parker, Assistant City Manager <br />Title of Authorized Representative <br />sparkerC@sanmarcostx.gov <br />City Manager <br />512- 393 -8170 <br />Primary Address of Contractor: <br />FFATA Contact #2 Name, Email and Phone Number: <br />630 E Hopkins St <br />Ismael Garcia, Accounting Manager <br />San Marcos, TX 78666 <br />igarciapsanmarcostx.gov <br />512- 393 -8178 <br />ZIP Code: 9- digits Required www.usps.com <br />DUNS Number: 9- digits Required www.ccr.eov <br />718 16 16 16 - 1 6 1 3 1 1 4 <br />0 16 19 14 16 12 18 1 6 1 9 <br />State of Texas Comptroller Vendor Identification Number (VIN) 14 Digits <br />117 14 16 10 10 12 12 13 18 1 1 1 0 1 0 1 0 <br />Printed Name of Authorized Representative <br />Signature of Authorized Representative <br />James R. Nuse, P.E. <br />Title of Authorized Representative <br />Da e <br />City Manager <br />l -2Z <br />-1- <br />Department of State Health Services Form 4734 — June 2012 <br />