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<br />I':) <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. COOO0316 <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 /> <br />¡ PERFORMING AGENCY: CITY OF SAN MARCOS : <br /> <br />1______-------------------------------------------------------------------------_-__-_1 <br />,-------------------------------------------------------~----------------------------- <br />I 1 <br /> <br />: (PRINT or TYPE) : <br />! Mailing Address: 211 Springtown Way San Marcos TX 78666 00001 <br />: (City) (St) (Zip) I <br />. . <br /> <br />! Street Address: SAME I <br />: (If different) (CIty) (St) (Zip) ! <br />I . <br /> <br />1______-------------------------------------------------------------------------______1 <br />,-------------------------------------------------------------------------------------, <br />¡ I <br />! Authorized ! <br />I Contracting Entity: CITY OF SAN MARCOS I <br />! (If different from PERFORMING AGENCY) ! <br />1______-------------------------------------------------------------------------------, <br />,-------------------------------------------------------------------------------------, <br /> <br />; Vendor Name: CITY OF SAN MARCOS ' <br />i (Must match with vendor identification number shown below) ¡ <br /> <br />! Vendor Addr'ess: 211 Springtown Way San Marcos 1']. It!666__mJOO! <br />: (Must match with vendor identification number shown below) : <br />f ¡ <br />, <br />i State of Texas Vendor Identification No. (14 digits): 17460022381000 ¡ <br />, , <br />i Finance Officer/Contact: Donna Farley ; <br />I ! <br />, , <br />I I <br />; Type of Organization: City ----- ' <br />¡ Designate: .Elementary/secondary school, junior college, senior college/university: <br />, city, county, other political subdivision, council of governments, judicial! <br />¡ district, community services program, individual, or other (define) ; <br />! ".. <br />i Is this a small business No (Yes/No) and/or minority/woman owned ~~ (Yes/No) ¡ <br /> Is this a non-profit business Yes (Yes/No) I <br />, I <br /> <br />: PAYEE AGENCY Fiscal Year Ending Month: SEPTEMBER ¡ <br /> <br />1______-------------------------------------------------------------------------______1 <br />,-------------------------------------------------------------------------------------, <br />, I <br /> <br />¡ SUMMARY OF TRANSACT! ON : ) <br />, <br />, <br />i To provide WIC services to qualified participants. ¡ <br />I I <br />I 1 <br />1 , <br />, , <br />I I <br />¡ ! <br />f- ----~--- I <br /> <br /> <br /> <br />COVER - Page 1 <br />