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<br /> <br />311 <br /> <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. C5000636 . <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 detailing scope(s) of work and <br />special provisions. <br /> <br />I <br />: PERFORMING AGENCY: CITY OF SAN MARCOS , <br />1_____________________________________________________--------------------------------1 <br />,-------------------------------------------------------------------------------------, <br />l (PRINT or TYPE) : <br />I Mailing Address: 630 East Hopkins San Marcos TX 78666 6397: <br />I (Clty) (~) (Zlp) I <br />Street Address:' SAME I <br />lIT dltterent) lClty) (st) lLlp) : <br />______________________________________________________-------------------------______1 <br />-------------------------------------------------------------------------------------1 <br />Authorized <br />Contracting Entity: <br />lIT dlTterent trom PeRFORMING AGeNCY) I <br />______________________________________________________-------------------------______1 <br />______________________________________________________-------------------------------1 <br />Payee Name: CITY OF SAN MARCOS : <br />lMust match wlth vendor ldentltlcatlon number shown below) I <br />630 East Hopkins San Marcos TX 78666 6397: <br />(Must match wlth vendor ldentlflcatlon number shown oelow) I <br />State of Texas Vendor Identification No. (14 digits): 17460022381000 : <br />Finance Officer/Contact: William White -I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I PAYEE AGENCY Fiscal Year Ending Month: SEPTEMBER : <br />1____---------------------------------------------------------------------------------1 <br />1-------------------------------------------------------------------------------------1 <br />l SUMMARY OF TRANSACTION: : <br />1 I <br />: Contract for public health services. : <br />I 1 <br />I I <br />1 I <br />I I <br />I I <br />I I <br /> <br />Payee Address: <br /> <br />Type of Organization: City <br />Designate: Elementary/secondary school, Junl,or col lege, senlor college/unlverslty <br />city, county, other political subdivision! council of governments, judicial <br />district, community services program, indlviqual, or other (define) <br />Is this a small business No (Yes/No) and/or minority/woman owned No (Yes/No) <br />Is this a non-profit business Yes (Yes/No) --- <br /> <br />COVER - Page 1 <br /> <br />