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<br />78 <br /> <br />TEXAS DEPARTMENT OF HEALTH CONTRACT <br />1100 West 49th Street <br />Austin, Texas 78756-3199 <br /> <br />STATE OF TEXAS <br />COUNTY OF TRAVIS <br /> <br />TDH Document No. C9000621 <br /> <br />This contract is between the Texas Department of Health, hereinafter referred to <br />as RECEIVING AGENCY, and the party listed below as PERFORMING AGENCY and <br />includes general provisions and attachments detailjng scope(sJ of work and <br />special pro~isions. Specifical.1y, Gener)al Provisions, ~n~ne pages], Attachmenht ~l'f for all <br />(four a es), and E¥nibit A, {one page, are attachedhepeto ana made a part ereo <br /> <br />I <br />I PERFORMING AGENCY: CITY OF SAN MARCOS : <br />1______-------------------------------------------------------------------------------1 <br />,-------------------------------------------------------------------------------------, <br />I I <br />I I <br />: (PRINT or TYPE) : <br />: Mailing Address: 211 SPRINGTOWN WAY SAN MARCOS TX 78666 00001 <br />I (CIty) (St) (ZIp) I <br />I Street Address: SAME : <br />I (If different) (City) (St) (Zip) I <br />: Authorized Contracting <br />Entity: <br />I (If different from PERFORMING AGENCY) I <br />I T~pe of Organization: NONPROFIT , <br />: (designate individual, corporatIon, partnershIP! nonprofIt organIzatIon, \ <br />I city, county, council of government, special purpose district, local health I <br />I unit, department or distrIct) I <br />: Is this a small business NO (Yes/No) and/or minority/woman owned ~(Yes/No) I <br />I I <br />r I <br />, , <br />I PERFORMING AGENCY Fiscal Year Ending Month: September, \ <br />I Vendor Name: CITY OF SAN MARCOS <br />I (Must match wIth vendor identIfIcatIon number shown below) : <br />I Vendor Address: 211 SPRINGTOWN WAY SAN MARCOS TX 78666 00001 <br />I (Must match with vendor identification number shown oelow) I <br />! State of Texas Vendor Identification No. (14 digits): 17460022381000 I <br />: Finance Officer/Contact: Donna Farley I <br />I I <br />,-------------------------------------------------------------------------------______1 <br />,-------------------------------------------------------------------------------------: <br /> <br />: Summary of Transaction: : <br />I i <br />I TO PROVIDE WIC SERVICES TO QUALIFIED PARTICIPANTS. ¡ <br />I I <br />I I <br />I I <br />I 1 <br />r I <br />I I <br />I I <br />, - I <br />.-------, <br /> <br />urposes. <br /> <br />COVER - Page 1 <br />