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<br />, . -. <br /> <br />113 <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 TDH Document No. C4000540 <br /> <br />This contract is bet~een 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 attáchments detailing scope(s) of work and <br />special provisions. <br /> <br />I I <br /> <br />¡ PERFORMING AGENCY: CITY OF SAN MARCOS ) <br /> <br />-------------------------------------------------------------------------------______1 <br />-------------------------------------------------------------------------------------/ <br />(PRINT or TYPE) : <br />! Mailing Address: 630 East Hookins San Marcos TX 78666 6397! <br />¡ (City) CSt) (Zlp) : <br />I Street Address: SAME I <br />) (if dltrerent) (Clty) (~) (Zlp) : <br />\_------------------------------------------------------------------------------______1 <br />/-------------------------------------------------------------------------------------1 <br />I Authorized i <br />! Contracting Entity: I <br />! (Ir dlfrerent tram PERFORMING AGENCY) ! <br />1______-------------------------------------------------------------------------______1 <br />\-------------------------------------------------------------------------------------, <br /> <br />I Payee Name: CITY OF SAN MARCOS <br />: (Mus~ match wlth vendor loentlrlcatlon numoer snown below) : <br /> <br />i Payee Address: 630 East Hookins San Marcos ~ TX 78666 63971 <br />: (Mus~ match wlth vendor ldentlflcatlon number shown below) ¡ <br /> <br />: State of Texas Vendor Identification No. (14 digits): 17460022381000 : <br /> <br />: Finance Officer/Contact: William White : <br />I I <br />~ Type of Organization: City ! <br />; Designate: Elementary/secondary schoo1, Junlor college, senlor colleåe/unlverslty : <br />; city, county, other political subdivision¡ council of governments, ju icial ~ <br />, district, community services program, indlvidual, or other (define) ! <br />. I <br /> <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) , --- i <br />; PAYEE AGENCY Fiscal Year Ending Month: SEPTEMBER : <br />1______-------------------------------------------------------------------------______1 <br />/-------------------------------------------------------------------------------------/ <br /> <br />) SUMMARY OF TRANSACTION: : <br />I i <br />: Contract for public health services. : <br />I / <br />I I <br />I I <br />\ 1 <br />/ / <br />I I <br /> <br /> <br />COVER - Page 1 <br />