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<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. C3000606 <br /> <br />This contract is between the Texas Department of Health, hereinafter referred to <br />as RECEIVING AGENCY, and the party listed below as PERFORHING AGENCY and <br />includes general provisions and attachments detailing scope(s) of work and <br />special provisions. <br /> <br />6(, <br /> <br />1 <br />I PERFORMING AGENCY: CITY OF SAN MARCOS I <br /> <br />\_____________________________________________________________________________________1 <br />/-------------------------------------------------------------------------------------1 <br />) (PRINT or TYPE) : <br />l Mailing Address: 630 East Hopkins San Marcos TX 78666 6397: <br />I (City) (St) (Zip) I <br />I Street Address: S~~E I <br />l (If dlfferent) (Clty) (st) (Zlp) : <br />1______-----------------------------------------------________________________________1 <br />/-------------------------------------------------------------------------------------/ <br />1 Authorized I <br />t Contracting Entity: I <br />l_____________________~~~_~:~~:::~!_~:~~_~~~~~~~~~_~~~~~~2___________________________) <br />1-------------------------------------------------------------------------------------\ <br /> <br />I Payee Name: CITY OF SAN MARCOS I <br />I (Must match wlth vendor 1dentlflcatlon number shown below) , <br /> <br />I Payee Address: 630 East Hopkins San Marcos TX 78666 6397' <br />( (Must match with vendor 1dent1ficat1on number shown below) \ <br /> <br />: State of Texas Vendor Identification No. (14 digits): 17460022381000 : <br /> <br />l Finance Officer/Contact: William White : <br /> <br />I J <br /> <br />I Type of Organization: City I <br />\ Designate: Elementary/secondary school, Junior college, senior college/university \ <br />I city, county, other political subdivision, cuuncil of governments, judicial I <br />I district, community services program, individual, or other (define) I <br /> <br />I Is this a small business No (Yes/No) and/or minority/woman owned No (Yes/No) r <br />I Is this a non-profit business Yes (Yes/No) --- I <br /> <br />1 PAYEE AGENCY Fiscal Year Ending Month: SEPTEMBER : <br /> <br />1______-----------------------------------------------________________________________1 <br />,-------------------------------------------------------------------------------------1 <br />: SUMMARY OF TRANSACTION: : <br />I I <br />I Contract for public health serVlces. I <br />I I <br />I I <br />I I <br />I I <br />I I <br />I I <br /> <br />COVER - Page 1 <br />