Account Name The Grant will be paid in instalments by the Commonwealth in accordance with the agreed Milestones, and compliance by the Grantee with its obligations under this Agreement.
CONTRACT NAME The name of this contract is Local Health Dept WIC Program - San Xxxx Amendment 2.
Print Name Designation ...................................
Project Name Register ASIC
Secondary Contact Name Please identify the individual who will be secondarily responsible for all TIPS matters and inquiries for the duration of the contract. Xxxxx Xxxxx Secondary Contact Title Secondary Contact Title VP Service Secondary Contact Email Please enter a valid email address that will definitely reach the Secondary Contact. xxxxxx@xxxxxxxxxxxxxxxxxxxx.xxx Secondary Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). Please provide the accurate and current phone number where the individual who will be secondarily responsible for all TIPS matters and inquiries for the duration of the contract can be reached directly. 0000000000 Secondary Contact Fax Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 0000000000 Secondary Contact Mobile Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 7 2812172425 Administration Fee Contact Name Please identify the individual who will be responsible for all payment, accounting, and other matters related to Vendor's TIPS Administration Fee due to TIPS for the duration of the contract. Xxxxx Xxxx Administration Fee Contact Email Please enter a valid email address that will definitely reach the Administration Fee Contact. 9 xxxxx@xxxxxxxxxxxxxxxxxxxx.xxx Administration Fee Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 2 0 7139802880
