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? ? oft c ` and el? 0 Ll? , <br />IQttF.?EE3 t ieS(2' x $,t ¢f " i_ <br />04 <br />x, <br />DEPARTMENT OF STATE HEALTH SERVICES <br />Contractor's Request for Revision (CRR) <br />The Department of State Health Services (DSHS) and City of San Marcos (Contractor) agree to certain terms of <br />Contract No. 2009-030101 (Contract), Program Attachment No. 001 (Program Attachment) in accordance with this CRR, <br />effective the date this document is signed by DSHS or the date specified by DSHS, as follows: <br />Except as provided within this CRR, all other provisions of the Contract remain in effect. In the event of a conflict between <br />the terms of the Contract and the terms of this CRR, this CRR shall control. <br />The Program Attachment is hereby revised as follows: <br />1. Revision Request - Section of Program Attachment to be revised: DSHS Contract Manager Initials: cw <br />Description of the revision requested. Describe any attachments to this form, which shall be incorporated into this <br />document as a part of the Contract: WIC Local Agency 36, City of San Marcos discontinued serving Bastrop Coun <br />effective February 1, 2009. <br />Purpose for change request: Counties are not currently stated in the WIC local agency contract. <br />Effective date of revision, as specified by Department, is February 1. 2009 <br />DEPARTMENT OF STATE HEALTH SERVICES <br />Signature of Authorized Official <br />3- z4-n q <br />Date <br />Bob Burnette, C.P.M., CTPM <br />Director, Client Services Contracting Unit <br />1100 West 49th Street <br />Austin, Texas 78756 <br />(512) 458-7470 <br />Bob. BurnetteO-)dshs.state. tx. us <br />The general rule is that any change to the Contract requires a written Amendment (GP §13.15 (subrecipient]). The only exceptions are those explicitly <br />stated in §13.16 (Contractor's Notification of Change) and §13.17 (Contractor's Request for Revision). <br />Instructions: Two originals of the completed form must be signed by Contractors representative who is authorized to sign contracts on behalf of <br />Contractor, and both original, signed forms must be submitted to the Contract Manager in the Contract Management Unit assigned to the Program <br />Attachment. A separate CRR is required for each Program Attachment to be revised. A fully executed original will be returned to Contractor if approved <br />by the Department. <br />Note: Circumstances of a requested CRR may indicate the need for a Contract Amendment with written justification rather than a CRR. <br />CRR Form EF29-12414 Rev 10.09.07.doc