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<br /> 101 <br /> 101 <br /> TEXAS DEPARTMENT OF HEALTH CONTRACT <br /> 1100 West 49th Street <br /> Austin, Texas 78756-3199 <br /> STATE OF TEXAS <br /> COUNTY OF TRAVIS TDH Document No. C2000484 <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 /> 1 PERFORMING AGENCY: CITY OF SAN MARCOS I <br /> I <br /> 1______-------------------------------------------------------------------------______1 <br /> ,-------------------------------------------------------------------------------------/ <br /> I (PRINT or TYPE) I <br /> , I <br /> I Mailing Address: 630 East Hopkins San Marcos TX 78666 63971 <br /> I ( City) (St) (Zip) I <br /> : Street Address: SAME I <br /> (If dlHerent) (CIty) CSt) (ZIp) 1 <br /> I I <br /> 1______-------------------------------------------------------------------------______1 <br /> ,-------------------------------------------------------------------------------------/ <br /> I Authorized I <br /> , Contracting Entity: I <br /> I (If dlHerent t"rom PERFORMING AGENCY) , <br /> 1______-------------------------------------------------------------------------______1 <br /> 1-------------------------------------------------------------------------------------1 <br /> ¡ Payee Name: CITY OF SAN MARCOS I <br /> (Must match wIth vendor Identlt"lcatlon number shown below) I <br /> I I <br /> J Payee Address: 630 East Hopkins San Marcos TX 78666 6397' <br /> 1 \Mlli3t match wíth vendor identification number shown oelow) : <br /> ¡ State of Texas Vendor Identification No. (14 digits): 17460022381000 I <br /> , <br /> ¡ Finance Officer/Contact: William White I <br /> 1 <br /> I I <br /> I Type of Organization: Cit I <br /> I <br /> I Designate: Elementary/secon ary sc 00 , JunIor co ege, senIor co eðe unIversIty I <br /> 1 city, county, other political subdivision, council of governments, ju icial I <br /> I district, community services program, individual, or other (define) I <br /> : Is this a small business No (Yes/No) and/or minority/woman owned No (Yes/No) I <br /> I <br /> I Is this a non-profit business Yes (Yes/No) --- I <br /> I PAYEE AGENCY Fiscal Year Ending Month: SEPTEMBER \ <br /> , <br /> 1______------------------------------------------------------------------------------_\ <br /> ,-------------------------------------------------------------------------------------, <br /> : SUMMARY OF TRANSACTION: I <br /> I <br /> 1 \ <br /> I Contract for public health services. I <br /> I <br /> , I <br /> 1 I <br /> I I <br /> 1 \ <br /> I I <br /> I I <br /> COVER - Page 1 <br />