Common use of Signature Authority Clause in Contracts

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Texas Suicide Prevenkion Co11aborakive Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a D.B.A. or ‘doing business as’) N/A Xxxxxx Texas County(s) for Assumed Business Name (d/b/a D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Authorized Representative Augusk 27, 2020 Date Signed Xxxx Xxxxxx Su11ivan Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Direckor Title of Authorized Representative 000 Xxxxxxx 0000 Xxxxxx RichmondXx00x Xxxxx Xxxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondX.X.Xxx 341523 Auskin, TX 77469 78738-1523 Mailing Address, if different City, State, Zip Code 000-000-0000 000Phone Number Fax Number admin§xxxxxxxxxxxxxxxxxxxxxx.xxx 117485241 Email Address DUNS Number 00-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 32071411311 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 32071411311 0803375141 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ATTACHMENT G ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx Xxxxxx Legal Name of Contractor N/A Xxxxx Xxxxxx Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Xxxxx Xxxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX u Xxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April May 12, 2023 Authorized 2022 thorized Representative Date Signed County Judge Assistant City Manager Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX Xxxxxxxx Xxxxxxxx, TX 77469 79101 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 1971 Amarillo, TX 77469 79105 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx.xxxxxx@xxxxxxxx.xxx 065032807 Email Address DUNS Number 746001969 000000000 00-0000000 17560004446014 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 17460000890002 17460000890002 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 NV4JC28TLJL6 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County MHMR Services of Texoma Legal Name of Contractor N/A Texoma Community Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Xxxxx, Xxxxxxx, Xxxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx September 30, 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 9/30/22 Title of Authorized Representative 000 X. Xxxxxxxxxx Xxxxxxx Xxxxxx Richmond, TX 77469 XX Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 x Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxxxxxx.xxx x Email Address DUNS Number 746001969 000000000 xxxxxx@xxxxxxxx.xxx 0068717010000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 17514523608014 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 DAVPPWDHBN7 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Corpus Christi - Nueces County Public Health District Legal Name of Contractor N/A Corpus Christi - Nueces County Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Corpus Christi - Nueces County Public Health District Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12May 25, 2023 2022 Signature of Authorized Representative Date Signed County Judge Interim Director of Health Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxx Xxxx Corpus Christi, TX 77469 Texas 78416 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 NA NA Mailing Address, if different City, State, Zip Code NA NA Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 069457786 Email Address DUNS Number 746001969 000000000 00-0000-000 1-746000574-1 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 NA XXX.xxx Unique Entity Identifier (UEI) Health ATTACHMENT E ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Wilson County, Texas Legal Name of Contractor N/A Wilson County Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Wilson County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx May 5, 2023 Signature of Authorized Representative Date Signed Judge Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxx X. Xxxxxxx, TX 77469 Xx. April 24, 2023 Physical Street Address City, State, Zip Code 0000 0xx Xxxxxx, Xxxxx 000 Xxxxxxx Xxxxxx RichmondFloresville, TX 77469 Tx 78114 Mailing Address, if different City, State, Zip Code 0000 0xx Xxxxxx, Xxxxx 000 Floresville, Tx 78114 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 xxxxxxxx@xxxxxxxxxxxxxx.xxx 088471842 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00000 00000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 00000 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT E‌ Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County City of Amarillo Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of A Xxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 601 S Xxxxxxxx August 12, 2023 Authorized 2021 uthorized Representative Date Signed County Judge Assistant City Manager/CFO Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondAmarillo, TX 77469 79101 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 1971 Amarillo, TX 77469 79105 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx.xxxxxx@xxxxxxxx.xxx 065032807 Email Address DUNS Number 746001969 000000000 00-0000000 17560004446 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 17460000890002 17460000890002 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Magnificak House, Inc. Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a D.B.A. or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative Sepkember 24, 2020 Date Signed Xxxxx Xxxx0xx Campbe11 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Direckor Sk. Xxxxxx Xxxxx / Magnificak Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond3307 Auskin Sk, TX 77469 Houskon, Tx 77004 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 2641 Houskon, TX 77469 Tx. 77252-2641 Mailing Address, if different City, State, Zip Code 000-000-0000 kcampbe11§xxxxxxxxxx.xxx 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 kevincampbe11§magnificakhouses.nek 070886106 Email Address DUNS Number 746001969 000000000 00-0000000 1-23-7003471-7 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits NA 25387801 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ATTACHMENT E ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx Xxxx Legal Name of Contractor N/A Feeding Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx March 1, 2022 Signature of Authorized Representative Date Signed Xxxxx X Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge CEO Title of Authorized Representative 0000 X XX-00, Xxxxx 000 Xxxxxx, XX 00000 Xxxxxxxx Xxxxxx Xxxxxxx Xxxxxx RichmondXxxx, TX 77469 Physical Street Address CityXxxxx, StateXxx Code Xxxxxx, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 NA Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxxxxxxxxx.xxx 5125273624 Email Address DUNS Number 746001969 000000000 xxxxx@xxxxxxxxxxxx.xxx 074943319 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 861K8 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Samaritan Center for Counseling and Pastoral Care, Inc. Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx August 8, 2023 Signature of Authorized Representative Date Signed Xxxxx X. Xxxx Chief Executive Officer Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxxxxx Xxxx.,Xxxx. 0 Xxxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxxxxxx-xxxxxx.xxx 164941098 Email Address DUNS Number 746001969 000000000 00-0000000 30002204722 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 30002204722 0034604001 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 DHW8T8Z3KLB8 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Xxxxxx-Xxxxxx County Mental Health and Mental Retardation Center Legal Name of Contractor N/A Integral Care Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Xxxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx September 1, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge CEO Title of Authorized Representative 000 0000 Xxxxxxx Xxxxxx RichmondAustin, TX 77469 78704-2911 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx.xxxxx@xxxxxxxxxxxx.xxx 5078496213 Email Address DUNS Number 746001969 000000000 741547909 17415479090 Federal Employer Identification Number Texas Identification Number (TIN) Payee ID No. – 11 digits N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Additional Provisions – Grant Funding Version 3.2 Published and Effective – July 2022 Responsible Office1.0 Effective: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas February 2021 Health and Human Services Commission (HHSC) Additional Provisions V.1.0 – Grant Funding Effective: February 2021 TABLE OF CONTENTS 1. TURNOVER PLAN 3 2. TURNOVER ASSISTANCE 3 3. TRADEMARK LICENSE 3 4. TRADEMARK OWNERSHIP 4 5. ELECTRICAL ITEMS 4 6. DISASTER SERVICES 4 7. NOTICE OF A LICENSE ACTION 4 8. EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES 5 9. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT OF A CHILD 5 10. TELEMEDICINE/TELEHEALTH SERVICES 5 11. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 5 12. THIRD PARTY PAYORS 6 13. HIV/AIDS MODEL WORKPLACE GUIDELINES 6 14. MEDICAL RECORDS RETENTION 6 15. INTERIM EXTENSION AMENDMENT 7 16. PROJECT COMMENCEMENT 7 17. DUPLICATION OF FUNDING 8 18. DISCLOSURE PROTECTIONS FOR CERTAIN CHARITABLE ORGANIZATIONS, CHARITABLE TRUSTS, AND PRIVE FOUNDATIONS 8 Health and the Department of State Health Human Services (DSHS). These requirements and conditions are incorporated into the Additional Provisions V.1.0 – Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. Funding Effective: February 2021 ADDITIONAL PROVISIONS The terms and conditions in this document of these Additional Provisions are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal incorporated into and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements made a part of the entity that awarded Grant Contract. Terms included in these Additional Provisions and not otherwise defined have the funds meanings assigned to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including them in HHS Uniform Grant Terms and Contract Standards set forth in Title 34Conditions, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSAttachment C.

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Northeast Texas Public Health District Legal Name of Contractor N/A Northeast Texas Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX May 19, 2022 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxxxx, Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 X. Xxxxxxxx #000 Xxxxx, XX 00000-0000 Xxxxxxxx Xxxxxx Xxxxxxx Xxxxxx RichmondXxxx, TX 77469 Physical Street Address CityXxxxx, State, Zip Xxx Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxx.xxx 144656753 Email Address DUNS Number 746001969 000000000 752254544 17522545445 Federal Employer Identification Number Texas Identification Number (TIN) Nn/A 17460019692 a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 MYCADLKPTXM4 XXX.xxx Unique Entity Identifier (UEI) DocuSign Envelope ID: 5369A510-D824-4EBF-9AAF-2E0CD4D70112 Attachment D Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxx Xxxxxx Legal Name of Contractor N/A Mission Granbury, Inc Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX September 21, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Xxxxxx Executive Director Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxx Xxxx Xxxxx Granbury, TX 77469 Texas 76049 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Xxxxx Xxxx Xxxxxx Xxxxxxx, Texas 76049 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 0000000000 8175796427 Email Address DUNS Number 746001969 xxxxxxx@xxxxxxxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 00-0000000 17527662229 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health FY22-FY23 Residential and Human Nonresidential Services (HHS) Uniform Terms Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000011 Page 5 of 6 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Salaries Contractor: MISSION GRANBURY INC A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Supervises Shelter Program Director, manager and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, non- residential case managers as well as finance manager. Ensures compliance with grant conditions. Provides some direct client support. 1FTE=78%FVP+17%SA+5% Other $ 7,250.00 12 $ 87,000.00 30.00% $ 26,100.00 2 Finance Manager Provides financial oversight ensuring compliance with all applicable federal fiscal policies and state laws and grant accounting regulations. Applicable federal Prepares all accounting and state laws grant budget reports. 0.8FTE=86%FVP+8%SA+6% Other. $ 3,572.00 12 $ 42,864.00 30.00% $ 12,859.20 3 Shelter Program Director Provides oversight for the residential victim shelter and regulations may includethe non-residential victim services program. 1FTE=70%FVP+30%SA $ 4,291.50 12 $ 51,498.00 40.00% $ 20,599.20 4 Shelter Victims Case Manager Manages the daily operation of the shelter, but are not limited tosupervises shelter advocates and provides direct client services. 1FTE=50%FVP+30%SA+20% Other $ 2,933.50 12 $ 35,202.00 16.00% $ 5,632.32 5 IT Specialist/ Operations Manager Provides IT support and ensures the security of the IT system. 1FTE=40%FVP+8%SA+52% Other $ 3,730.30 12 $ 44,763.60 20.00% $ 8,952.72 6 Shelter Advocate Answers 24 hour hotline calls and provides direct services to shelter residents. 1FTE. 100% FVP $ 1,005.34 12 $ 12,064.08 67.00% $ 8,082.93 7 Volunteer Recruiter/Community Resource Recruits and trains volunteers, secures client resources from the community, arranges for public education of victim's needs. 0.75FTE=70%FVP+15%SA+15% Other $ 2,222.87 12 $ 26,674.44 30.00% $ 8,002.33 8 Victim Services Case Manager Provides resources and services to non-residential clients.1FTE=40%FVP+42%SA+Other 18% $ 2,530.67 12 $ 30,368.04 40.00% $ 12,147.22 9 Director of Programs Provides support to non-residential case managers and maintains client files and data base. 1FTE=90%FVP+10% SA 10% $ 4,978.33 12 $ 59,739.96 40.00% $ 23,895.98 10 Case Manager Provides resources and services to non-residential clients. 1FTE=80%FVP+SA 8% +Other 12% $ 2,031.46 12 $ 24,377.52 30.00% $ 7,313.26 11 Case Manager Provides resources and services to non-residential clients. 0.70FTE=80%FVP+20% Other $ 1,599.52 12 $ 19,194.24 20.00% $ 3,838.85 12 Executive Assistant Provides support to the Executive Director, manages human resources and assists with grant compliance. 1FTE=80%FVP+20%SA $ 3,613.85 12 $ 43,366.20 45.00% $ 19,514.79 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: MISSION GRANBURY INC A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 6,655.50 $ 171.00 $ 36.90 $ - $ - $ 247.86 $ - $ - $ 7,111.26 30.00% $ 1,996.65 $ 51.30 $ 11.07 $ - $ - $ 74.36 $ - $ - $ 2,133.38 2 CFR Part 200, Uniform Administrative Requirements, Finance Manager Gross $ 3,279.10 $ 130.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 8,311.00 30.00% $ 983.73 $ 39.00 $ 11.07 $ 1,459.50 $ - $ - $ - $ - $ 2,493.30 3 Shelter Program Director Gross $ 3,939.60 $ 540.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 9,629.36 40.00% $ 1,575.84 $ 216.00 $ 14.76 $ 1,946.00 $ - $ 99.14 $ - $ - $ 3,851.74 4 Shelter Victims Case Manager Gross $ 2,692.95 $ 360.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 7,954.85 16.00% $ 430.87 $ 57.60 $ 5.90 $ 778.40 $ - $ - $ - $ - $ 1,272.77 5 IT Specialist/ Operations Manager Gross $ 3,424.42 $ 140.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,714.18 20.00% $ 684.88 $ 28.00 $ 7.38 $ 973.00 $ - $ 49.57 $ - $ - $ 1,742.83 6 Shelter Advocate Gross $ 922.90 $ 257.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,216.80 67.00% $ 618.34 $ 172.19 $ 24.72 $ - $ - $ - $ - $ - $ 815.25 7 Volunteer Recruiter/Comm unity Resource Gross $ 2,040.59 $ 55.00 $ 36.90 $ - $ - $ - $ - $ - $ 2,132.49 30.00% $ 612.18 $ 16.50 $ 11.07 $ - $ - $ - $ - $ - $ 639.75 8 Victim Services Case Manager Gross $ 2,323.16 $ 400.00 $ 36.90 $ 4,865.00 $ - $ 495.72 $ - $ - $ 8,120.78 40.00% $ 929.26 $ 160.00 $ 36.90 $ 1,946.00 $ - $ 198.29 $ - $ - $ 3,270.45 9 Director of Programs Gross $ 4,570.11 $ 100.00 $ 36.90 $ - $ - $ - $ - $ 4,707.01 40.00% $ 1,828.04 $ 40.00 $ 14.76 $ - $ - $ - $ - $ - $ 1,882.80 10 Case Manager Gross $ 1,864.88 $ 60.00 $ 36.90 $ - $ - $ 495.72 $ - $ - $ 2,457.50 30.00% $ 559.46 $ 18.00 $ 11.07 $ - $ - $ 148.72 $ - $ - $ 737.25 11 Case Manager Gross $ 1,468.36 $ 53.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,558.26 20.00% $ 293.67 $ 10.60 $ 7.38 $ - $ - $ - $ - $ - $ 311.65 Executive Gross $ 3,317.51 $ 151.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,618.27 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Consumable Supplies Contractor: MISSION GRANBURY INC A B C D E Description Justification Cost PrinciplesPercent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Shelter’s food To provide all items required for well-balanced meals o ingredients for well-balanced meals and snacks for children, and Audit Requirements any other reasonable ADA compliant dietary accommodation for Federal Awards; requirements residents who require special medical diets. $ 6,004.80 100.00% $ 6,004.80 2 Shelter's Janitorial/housekeeping supplies To provide all cleaning and janitorial supplies needed to keep the shelter facilities clean for the clients. $ 2,366.11 100.00% $ 2,366.11 3 Office supplies Office supplies such as copy paper, file folders, pens, pencils, paper clips, ink cartridges, batteries, computer accessories & devices such as computer mouse, mouse pads, cords, printer toner, masking tape, envelopes, labeling supplies, binders, file holders, sharpie permanent markers, invisible and masking tape, planners, cabinet filers, name tags, name badges used in the shelter. $ 4,565.38 50.00% $ 2,282.69 4 $ - 0.00% $ - 5 $ - 0.00% $ - 6 $ - 0.00% $ - 7 $ - 0.00% $ - 8 $ - 0.00% $ - 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - 18 $ - 0.00% $ - 19 $ - 0.00% $ - 20 $ - 0.00% $ - 21 $ - 0.00% $ - 22 $ - 0.00% $ - 23 $ - 0.00% $ - DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Supplemental Justification Contractor: MISSION GRANBURY INC Cost Category Item # Justification 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Salaries Contractor: MISSION GRANBURY INC A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Supervises Shelter Program Director, manager and non- residential case managers as well as finance manager. Ensures compliance with grant conditions. Provides some direct client support. 1FTE=78%FVP+17%SA+5% Other $ 7,250.00 12 $ 87,000.00 30.00% $ 26,100.00 2 Finance Manager Provides financial oversight ensuring compliance with all fiscal policies and grant accounting regulations. Prepares all accounting and grant budget reports. 0.8FTE=86%FVP+8%SA+6% Other. $ 3,572.00 12 $ 42,864.00 30.00% $ 12,859.20 3 Shelter Program Director Provides oversight for the residential victim shelter and the non-residential victim services program. 1FTE=70%FVP+30%SA $ 4,291.50 12 $ 51,498.00 40.00% $ 20,599.20 4 Shelter Victims Case Manager Manages the daily operation of the entity that awarded shelter, supervises shelter advocates and provides direct client services. 1FTE=50%FVP+30%SA+20% Other $ 2,933.50 12 $ 35,202.00 16.00% $ 5,632.32 5 IT Specialist/ Operations Manager Provides IT support and ensures the funds to HHS; Chapter 783 security of the Texas Government Code; Texas Comptroller IT system. 1FTE=40%FVP+8%SA+52% Other $ 3,730.30 12 $ 44,763.60 20.00% $ 8,952.72 6 Shelter Advocate Answers 24 hour hotline calls and provides direct services to shelter residents. 1FTE. 100% FVP $ 1,005.34 12 $ 12,064.08 67.00% $ 8,082.93 7 Volunteer Recruiter/Community Resource Recruits and trains volunteers, secures client resources from the community, arranges for public education of Public Accounts’ agency rules (including Uniform Grant victim's needs. 0.75FTE=70%FVP+15%SA+15% Other $ 2,222.87 12 $ 26,674.44 30.00% $ 8,002.33 8 Victim Services Case Manager Provides resources and services to non-residential clients.1FTE=40%FVP+42%SA+Other 18% $ 2,530.67 12 $ 30,368.04 40.00% $ 12,147.22 9 Director of Programs Provides support to non-residential case managers and maintains client files and data base. 1FTE=90%FVP+10% SA 10% $ 4,978.33 12 $ 59,739.96 40.00% $ 23,895.98 10 Case Manager Provides resources and services to non-residential clients. 1FTE=80%FVP+SA 8% +Other 12% $ 2,031.46 12 $ 24,377.52 30.00% $ 7,313.26 11 Case Manager Provides resources and services to non-residential clients. 0.70FTE=80%FVP+20% Other $ 1,599.52 12 $ 19,194.24 20.00% $ 3,838.85 12 Executive Assistant Provides support to the Executive Director, manages human resources and assists with grant compliance. 1FTE=80%FVP+20%SA $ 3,613.85 12 $ 43,366.20 45.00% $ 19,514.79 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Fringe Benefits - Employer Paid Portion Contractor: MISSION GRANBURY INC A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 6,655.50 $ 171.00 $ 36.90 $ - $ - $ 247.86 $ - $ - $ 7,111.26 30.00% $ 1,996.65 $ 51.30 $ 11.07 $ - $ - $ 74.36 $ - $ - $ 2,133.38 2 Finance Manager Gross $ 3,279.10 $ 130.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 8,311.00 30.00% $ 983.73 $ 39.00 $ 11.07 $ 1,459.50 $ - $ - $ - $ - $ 2,493.30 3 Shelter Program Director Gross $ 3,939.60 $ 540.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 9,629.36 40.00% $ 1,575.84 $ 216.00 $ 14.76 $ 1,946.00 $ - $ 99.14 $ - $ - $ 3,851.74 4 Shelter Victims Case Manager Gross $ 2,692.95 $ 360.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 7,954.85 16.00% $ 430.87 $ 57.60 $ 5.90 $ 778.40 $ - $ - $ - $ - $ 1,272.77 5 IT Specialist/ Operations Manager Gross $ 3,424.42 $ 140.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,714.18 20.00% $ 684.88 $ 28.00 $ 7.38 $ 973.00 $ - $ 49.57 $ - $ - $ 1,742.83 6 Shelter Advocate Gross $ 922.90 $ 257.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,216.80 67.00% $ 618.34 $ 172.19 $ 24.72 $ - $ - $ - $ - $ - $ 815.25 7 Volunteer Recruiter/Comm unity Resource Gross $ 2,040.59 $ 55.00 $ 36.90 $ - $ - $ - $ - $ - $ 2,132.49 30.00% $ 612.18 $ 16.50 $ 11.07 $ - $ - $ - $ - $ - $ 639.75 8 Victim Services Case Manager Gross $ 2,323.16 $ 400.00 $ 36.90 $ 4,865.00 $ - $ 495.72 $ - $ - $ 8,120.78 40.00% $ 929.26 $ 160.00 $ 36.90 $ 1,946.00 $ - $ 198.29 $ - $ - $ 3,270.45 9 Director of Programs Gross $ 4,570.11 $ 100.00 $ 36.90 $ - $ - $ - $ - $ 4,707.01 40.00% $ 1,828.04 $ 40.00 $ 14.76 $ - $ - $ - $ - $ - $ 1,882.80 10 Case Manager Gross $ 1,864.88 $ 60.00 $ 36.90 $ - $ - $ 495.72 $ - $ - $ 2,457.50 30.00% $ 559.46 $ 18.00 $ 11.07 $ - $ - $ 148.72 $ - $ - $ 737.25 11 Case Manager Gross $ 1,468.36 $ 53.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,558.26 20.00% $ 293.67 $ 10.60 $ 7.38 $ - $ - $ - $ - $ - $ 311.65 Executive Gross $ 3,317.51 $ 151.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,618.27 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Consumable Supplies Contractor: MISSION GRANBURY INC A B C D E Description Justification Cost Percent Applied to HHSC Contract Standards set forth Amount Budgeted to HHSC Contract 1 Shelter’s food To provide all items required for well-balanced meals o ingredients for well-balanced meals and snacks for children, and any other reasonable ADA compliant dietary accommodation for residents who require special medical diets. $ 6,004.80 100.00% $ 6,004.80 2 Shelter's Janitorial/housekeeping supplies To provide all cleaning and janitorial supplies needed to keep the shelter facilities clean for the clients. $ 2,366.11 100.00% $ 2,366.11 3 Office supplies Office supplies such as copy paper, file folders, pens, pencils, paper clips, ink cartridges, batteries, computer accessories & devices such as computer mouse, mouse pads, cords, printer toner, masking tape, envelopes, labeling supplies, binders, file holders, sharpie permanent markers, invisible and masking tape, planners, cabinet filers, name tags, name badges used in Title 34, Part 1, Chapter 20, Subchapter E, Division the shelter $ 4,565.38 50.00% $ 2,282.69 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS$ - 0.00% $ - 5 $ - 0.00% $ - 6 $ - 0.00% $ - 7 $ - 0.00% $ - 8 $ - 0.00% $ - 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - 18 $ - 0.00% $ - 19 $ - 0.00% $ - 20 $ - 0.00% $ - 21 $ - 0.00% $ - 22 $ - 0.00% $ - 23 $ - 0.00% $ - DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Supplemental Justification Contractor: MISSION GRANBURY INC Cost Category Item # Justification 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Xxxxxxxx Xxxxxxx, Emergency Management Coordinator and/or Honorable Judge Xxxx Xxxxxx, County Judge Legal Name of Contractor N/A Xxxxx County Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Xxxxx County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12Xxxx Xxxxxx June 21, 2023 2022 Signature of Authorized Representative Date Signed County Judge Emergency Management Coordinator Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxxxxxx, TX 77469 XX 00000 Physical Street Address 000 X. Xxxx Xxxxxx Mailing Address, if different NA Phone Number 0000000000 Email Address xxxxxxxxxxx@xx.xxxxx.xx.us Federal Employer Identification Number 00-0000000 Texas Franchise Tax Number FSCBBNW43TL5 City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondWaxahachie, TX 77469 Mailing Address, if different 75165 City, State, Zip Code 000-000-0000 000-000-0000 Phone Number NA Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address Y9UHCTLNHKA7 DUNS Number 746001969 000000000 Federal Employer Identification Number 121836055 Texas Identification Number (TIN) N/A 17460019692 Texas Franchise Tax Number 00-0000000 Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.1 Published and Effective – July April 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Brazoria County Health Department Legal Name of Contractor N/A - Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Brazoria County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx epresentative March 28, 2023 Signature of Authorized R Date Signed X.X. "Xxxx" Xxxxxxx, XX. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxx, TX 77469 Xxx 000 Xxxxxxxx, Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxxxxxxxxxxxxx.xxx 040341430 Email Address DUNS Number 746001969 000000000 00-0000000 17460000445 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 17460000445 17460000445 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 N1GLHP8EWHD9 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Ganesh Shivaramaiyer Legal Name of Contractor N/A Dallas County, Texas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Dallas County Health and Human Services Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative June 21, 2023 Date Signed XXXXXX XXXXXXXXXXXXX Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Deputy Director of Finance & Operations Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 XXXXXX XXXXXXXXXXXXX Deputy Director of Finance & Operations Physical Street Address City, State, Zip Code 0000 X Xxxxxxxx Xxxxxxx, Xxxxx 000 Xxxxxxx Xxxxxx RichmondXxxxxx, TX 77469 Xxxxx 00000 Mailing Address, if different City, State, Zip Code N/A N/A Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 xxxxxxxx@xxxxxxxxxxxx.xxx 073128597 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 17560009056005 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 ER74JB3UL5E9 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx X. Xxxxx Legal Name of Contractor N/A Bell County Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of A Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 1227, 2023 Authorized uthorized Representative Date Signed County Judge Director of Finance Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxx Xxxxx Xxxxxx, TX 77469 Xxxxx, 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxx Xxxxx Xxxxxx, TX 77469 Xxxxx, 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxxxxxxxxxxxxxx.xxx 083872259 Email Address DUNS Number 746001969 000000000 00-0000000 1-74-6000348-0 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 H7CSL1E3N6Y5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County The Xxxxxx Center for Mental Health and IDD Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12November 9, 2023 2021 Signature of Authorized Representative Date Signed County Judge CEO Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxxxxxx Xxxxxxx, TX 77469 Xxxxxxx, Xx 00000 CEO Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx.xxxxx@xxxxxxxxxxxxxxx.xxx 020800595 Email Address DUNS Number 746001969 00-0000000 000000000 Federal Employer Identification Number Texas Identification Number (TIN) Payee ID No. – 11 digits N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Angelina County & Cities Health District Legal Name of Contractor N/A Angelina County & Cities Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A same Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX November 2, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 000 Xxxx Xxxxxx 11/2/21 Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondLufkin, TX 77469 Texas 75904 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 same same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxx.xx 023169353 Email Address DUNS Number 746001969 000000000 751244376 17512443767 Federal Employer Identification Number Texas Identification Number (TIN) NPayee ID No. – 11 digits n/A 17460019692 a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier Attachment F ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County XXXXX XXXXXXXXX Legal Name of Contractor N/A XXXXXXXXXX COUNTY CRISIS CENTER INC Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12XXXXX XXXXXXXXX September 27, 2023 2021 Signature of Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 EXECUTIVE DIRECTOR Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondX 0XX XX XXXXX 000 XXXXXX, TX 77469 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 PO BOX 182 BORGER, TX 79008 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 0000000000 8062749528 Email Address DUNS Number 746001969 XXXXXXXXXX@XXXXXXXX0.XXX 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 752592305 17525923052 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier FY22-FY23 Residential and Nonresidential Services Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000017 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Salaries Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Staff supervisor and director of operations, direct service provider, educational/awareness programs. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 55%, SA 45%, with 25% allocated to HHSC. $ 7,641.00 12 $ 91,692.00 25.00% $ 22,923.00 2 Program Director This position is responsible for all grant related reporting and financial duties, data entry, FVNet uploads, direct services, Shelter Advocate supervisor. HHSC budget amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35% with 40% allocated to HHSC. $ 6,765.00 12 $ 81,180.00 40.00% $ 32,472.00 3 Child Adovcate/Prevention Educator This position is responsible for child advocate, prevention educator provdiing awareness to the community, direct services, assist with FVNet and data entry, Bilingual advocate. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 30%, SA 65% with 15% allocated to HHSC. $ 2,792.00 12 $ 33,504.00 15.00% $ 5,025.60 4 Office Assistant This position assists other staff as needed, Bi-lingual advocate, direct services, answering phones, administrative duties, incoming donation. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35%, with 35% allocated to HHSC. $ 1,933.00 12 $ 23,196.00 35.00% $ 8,118.60 5 Shelter Advocate Part time - Bilingual - This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 2,104.00 12 $ 25,248.00 35.00% $ 8,836.80 6 Shelter Advocate Part time - This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 1,500.00 6 $ 9,000.00 35.00% $ 3,150.00 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 7,014.44 $ - $ 42.00 $ 5,000.00 $ - $ - $ - $ - $ 12,056.44 25.00% $ 1,753.61 $ - $ 10.50 $ 1,250.00 $ - $ - $ - $ - $ 3,014.11 2 Program Director Gross $ 6,210.27 $ - $ 42.00 $ 6,300.00 $ - $ - $ - $ - $ 12,552.27 40.00% $ 2,484.11 $ - $ 16.80 $ 2,520.00 $ - $ - $ - $ - $ 5,020.91 3 Child Adovcate/Preve ntion Educator Gross $ 2,563.06 $ - $ 42.00 $ 3,600.00 $ - $ - $ - $ - $ 6,205.06 15.00% $ 384.46 $ - $ 6.30 $ 540.00 $ - $ - $ - $ - $ 930.76 4 Office Assistant Gross $ 1,774.49 $ - $ 42.00 $ - $ - $ - $ - $ 1,816.49 35.00% $ 621.07 $ - $ 14.70 $ - $ - $ - $ - $ - $ 635.77 5 Shelter Advocate Gross $ 1,931.47 $ - $ 43.00 $ - $ - $ - $ - $ - $ 1,974.47 35.00% $ 676.01 $ - $ 15.05 $ - $ - $ - $ - $ - $ 691.06 6 Shelter Advocate Gross $ 688.50 $ - $ 42.00 $ - $ - $ - $ - $ - $ 730.50 35.00% $ 240.98 $ - $ 15.05 $ - $ - $ - $ - $ - $ 256.03 7 Shelter Advocate Gross $ 1,560.60 $ - $ 42.00 $ - $ - $ - $ - $ - $ 1,602.60 35.00% $ 546.21 $ - $ 14.70 $ - $ - $ - $ - $ - $ 560.91 8 Shelter Advocate Gross $ 918.00 $ - $ 42.00 $ - $ - $ - $ - $ - $ 960.00 35.00% $ 321.30 $ - $ 14.70 $ - $ - $ - $ - $ - $ 336.00 9 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 10 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 11 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Other Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 shelter maintenance Daily upkeep/repairs/regular maintenance to shelter facility as needed: extinguisher updates, plumbing, electrical, yard equipment. 50% DV, 50% Sa with 65% allocated to HHSC. $ 5,000.00 65.00% $ 3,250.00 2 shelter security system Shelter facility monitoring system/camera system for safety 24 hours/day. $32.50/month for 12 months with 85% allocated to HHSC. 70% DV, 30% SA. $ 390.00 85.00% $ 331.50 3 shelter cell, phones, internet Phone system, cell phone, internet services necessary for daily running of facility/hotline services. $400/month @ 12 months 70% DV, 30% SA with 50% allocated to HHSC $ 4,800.00 50.00% $ 2,400.00 4 office cell, phones, internet Phone system, 2 cell phones, internet services necessary for daily running of facility. $250/month @ 12 months 70% DV, 30% SA with 48.10% allocated to HHSC $ 2,999.96 48.10% $ 1,442.98 5 office space rental office space rental; $3100/month @ 12 months. 65% DV, 35% SA with 40% allocated to HHSC $ 37,200.00 40.00% $ 14,880.00 6 insurance required insurance costs for agency - liability, auto, D&O, based on previous year's expenses. 75% DV, 30% SA with 50% allocated to HHSC $ 12,500.00 50.00% $ 6,250.00 7 shelter utilities Utility costs for shelter facility - water, gas, electric $510/month; gas $100 monthly average, electric $260 monthly average, water $150 monthly average. 70% DV, 30% SA, with 35% allocated to HHSC. $ 6,120.00 35.00% $ 2,142.00 8 Xerox lease monthly leasing of Xerox copiers (UEI3) for every day administrative needs and for clients needs; $200.00 per month @ 12 months; 75% DV 25% SA WITH 50% ALLOCATED TO HHSC $ 2,400.00 50.00% $ 1,200.00 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY22 Supplemental Justification Contractor: Xxxxxxxxxx County Crisis Center, Inc Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 24 25 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Salaries Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Staff supervisor and director of operations, direct service provider, educational/awareness programs. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 55%, SA 45%, with 25% allocated to HHSC. $ 7,641.00 12 $ 91,692.00 25.00% $ 22,923.00 2 Program Director This position is responsible for all grant related reporting and financial duties, data entry, FVNet uploads, direct services, Shelter Advocate supervisor. HHSC budget amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35% with 40% allocated to HHSC. $ 6,765.00 12 $ 81,180.00 40.00% $ 32,472.00 3 Child Advocate/Prevention Educator This position is responsible for child advocate, prevention educator provdiing awareness to the community, direct services, assist with FVNet and data entry, Bilingual advocate. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 35%, SA 65% with 15% allocated to HHSC. $ 2,792.00 12 $ 33,504.00 15.00% $ 5,025.60 4 Office Assistant This position assists other staff as needed, Bi-lingual advocate, direct services, answering phones, administrative duties, incoming donation. HHSC budgeted amount determined by previous year's allocated amount of time spent on this grant. DV 65%, SA 35%, with 35% allocated to HHSC. $ 1,933.00 12 $ 23,196.00 35.00% $ 8,118.60 5 Shelter Advocate Part time - Bilingual - This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 2,104.00 12 $ 25,248.00 35.00% $ 8,836.80 6 Shelter Advocate Part time -This position answers hotline calls, provides direct services to resident victims 24/7, upkeep of shelter facility and grounds. HHSC budgeted amount determined by previous year's allocated amount. DV 65%, SA 35% with 35% allocated to HHSC. $ 1,500.00 6 $ 9,000.00 35.00% $ 3,150.00 DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Fringe Benefits - Employer Paid Portion Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 7,014.44 $ - $ 42.00 $ 5,000.00 $ - $ - $ - $ - $ 12,056.44 25.00% $ 1,753.61 $ - $ 10.50 $ 1,250.00 $ - $ - $ - $ - $ 3,014.11 2 Program Director Gross $ 6,210.27 $ - $ 42.00 $ 6,300.00 $ - $ - $ - $ - $ 12,552.27 40.00% $ 2,484.11 $ - $ 16.80 $ 2,520.00 $ - $ - $ - $ - $ 5,020.91 3 Child Advocate/Preve ntion Educator Gross $ 2,563.06 $ - $ 42.00 $ 3,600.00 $ - $ - $ - $ - $ 6,205.06 15.00% $ 384.46 $ - $ 6.30 $ 540.00 $ - $ - $ - $ - $ 930.76 4 Office Assistant Gross $ 1,774.49 $ - $ 42.00 $ - $ - $ - $ - $ - $ 1,816.49 35.00% $ 621.07 $ - $ 14.70 $ - $ - $ - $ - $ - $ 635.77 5 Shelter Advocate Gross $ 1,931.47 $ - $ 43.00 $ - $ - $ - $ - $ - $ 1,974.47 35.00% $ 676.01 $ - $ 15.40 $ - $ - $ - $ - $ - $ 691.41 6 Shelter Advocate Gross $ 688.50 $ - $ 42.00 $ - $ - $ - $ - $ - $ 730.50 35.00% $ 240.98 $ - $ 14.70 $ - $ - $ - $ - $ - $ 255.68 7 Shelter Advocate Gross $ 1,560.60 $ - $ 42.00 $ - $ - $ - $ - $ - $ 1,602.60 35.00% $ 546.21 $ - $ 14.70 $ - $ - $ - $ - $ - $ 560.91 8 Shelter Advocate Gross $ 918.00 $ - $ 42.00 $ - $ - $ - $ - $ - $ 960.00 35.00% $ 321.30 $ - $ 14.70 $ - $ - $ - $ - $ - $ 336.00 9 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 10 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - 11 0 Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - 0.00% $ - $ - $ - $ - $ - $ - $ - $ - $ - Gross $ - $ - $ - $ - $ - $ - $ - $ - $ - DocuSign Envelope ID: 3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Other Contractor: Xxxxxxxxxx County Crisis Center, Inc A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 shelter maintenance Daily upkeep/repairs/regular maintenance to shelter facility as needed: extinguisher updates, plumbing, electrical, yard equipment. 50% DV, 50% Sa with 65% allocated to HHSC. $ 5,000.00 65.00% $ 3,250.00 2 shelter security system Shelter facility monitoring system/camera system for safety 24 hours/day. $32.50/month for 12 months with 85% allocated to HHSC. 70% DV, 30% SA. $ 390.00 85.00% $ 331.50 3 shelter cell, phones, internet Phone system, cell phone, internet services necessary for daily running of facility/hotline services. $400/month @ 12 months 70% DV, 30% SA with 50% allocated to HHSC $ 4,800.00 50.00% $ 2,400.00 4 office cell, phones, internet Phone system, 2 cell phones, internet services necessary for daily running of facility. $250/month @ 12 months 70% DV, 30% SA with 48.10% allocated to HHSC $ 2,999.96 48.10% $ 1,442.98 5 office space rental office space rental; $3100/month @ 12 months. 65% DV, 35% SA with 40% allocated to HHSC $ 37,200.00 40.00% $ 14,880.00 6 insurance required insurance costs for agency - liability, auto, D&O, based on previous year's expenses. 75% DV, 30% SA with 75% allocated to HHSC $ 12,500.00 50.00% $ 6,250.00 7 shelter utilities Utility costs for shelter facility - water, gas, electric $510/month; gas $100 monthly average, electric $260 monthly average, water $150 monthly average. 70% DV, 30% SA, with 35% allocated to HHSC. $ 6,120.00 35.00% $ 2,142.00 8 Xerox copier lease monthly leasing of Xerox copiers (3) for every day administrative needs and Human Services (HHS) Uniform Terms and Conditions for clients needs; $175.00 per month @ 12 months; 75% DV 25% SA WITH 50% ALLOCATED TO HHSC $ 2,400.00 50.00% $ 1,200.00 9 $ - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - DocuSign Envelope ID: Chief Counsel ABOUT THIS DOCUMENT In this document3C55C059-0FAC-4028-9748-5A8F68D3FCC1 Family Violence Program Budget FY23 Supplemental Justification Contractor: Xxxxxxxxxx County Crisis Center, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Inc Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division Category Item # Justification 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxx Xxxxxxxxxx, MD Legal Name of Contractor N/A Bexar County Hospital District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A University Health Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Autho Xx. Xxxxxxx Xxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12February 9, 2023 Authorized 2022 rized Representative Date Signed County Judge Sr. VP Chief Analytics Officer Title of Authorized Representative 000 0000 Xxxxxxx Xxxxxx RichmondXx. Xxx Xxxxxxx, TX 77469 XX, 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 No Fax Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Xxxxxxx.xxxxxxxxxx@xxx-xx.xxx 069446656 Email Address DUNS Number 746001969 000000000 746002164 17460021649 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 32051578295 0801822906 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 JTALGHD9SUH5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 Xxxxxxx Xx September 7, 2023 2021 Signature of Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Xx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 00-0000000 17460019692 Federal Employer Identification Number Texas Identification Number (TIN) Payee ID No. – 11 digits N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Galveston County Health District Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX u Xxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12March 14, 2023 Authorized thorized Representative Date Signed County Judge Executive Director of Public Health Services Title of Authorized Representative 000 Xxxxxxx 0000 X Xxxxxx RichmondX Xxxxx Expressway Texas City, TX 77469 77591 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 939 La Marque, TX 77469 77568-0939 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxx@xxxx.xxx 198751372 Email Address DUNS Number 746001969 000000000 00-0000000 17605214745 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 SK8BQZM1Z5P5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Collin County Mental Health Mental Retardation Center Legal Name of Contractor N/A LifePath Systems Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Collin Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx October 22, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxxxxx Xxxxx McKinney, TX 77469 75069 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxxxxxxxxxxxxx.xxx 161443783 Email Address DUNS Number 746001969 000000000 00-0000000 17517619114 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 32051038761 0056634201 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxx X. Xxxxx Legal Name of Contractor N/A Live Oak County Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative Xxxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 Xxxxxxx Xxxxxx Annex room 10 August 13, 2023 Authorized Representative 2021 Date Signed County Judge Public Health Coordinator Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondGeorge West, TX 77469 Texas 78022 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 670 George West, TX 77469 Texas 78022 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xx.xxxx-xxx.xx.xx 085155679 Email Address DUNS Number 746001969 000000000 17460009701003 NA Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor By submitting this Response, Respondent represents and warrants that the individual signing submitting this Contract Affirmations document and the documents made part of this Response is authorized to sign such documents on behalf of Contractor the Respondent and to bind the ContractorRespondent under any contract that may result from the submission of this Response. Signature Page Follows Authorized representative on behalf of Contractor Respondent must complete and sign the following: Fort Bend County East Texas Border Health Clinic dba Genesis PrimeCare Legal Name of Contractor N/A Respondent Genesis PrimeCare Assumed Business Name of ContractorRespondent, if applicable (d/b/a or ‘doing business as’) N/A Xxxxxxxx, Xxxx, Xxxxx Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx S gnature o ut or zed Representative Date Signed Xxxxx Xxxxxxx Chief Executive Officer Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxx Xxxxx Xxxx. Marshall, TX 77469 Texas 75670-4260 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 1326 Marshall, TX 77469 75671 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx.xxxxxxx@xxxxxxxxxxxxxxxx.xxx 60868360 Email Address DUNS Number 746001969 000000000 00-0000000 30538912 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XLLDXR5196J7 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx Xxxxxxx Legal Name of Contractor N/A Postlethwaite & Xxxxxxxxxxx, APAC Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx April 6, 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 4/6/2022 Title of Authorized Representative 000 Xxxxxxx 0000 Xxxxxx RichmondXxxxx Xxxx, TX 77469 Xxxxx 0000 Xxxxx Xxxxx, XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxx.xxx 096051529 Email Address DUNS Number 746001969 000000000 xxxxxxxx@xxxxx.xxx 17212024453 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 TEYPXNFZ47P3 XXX.xxx Unique Entity Identifier (UEI) Attachment C Exhibit B, HHS Uniform Terms and Conditions -Vendor, Version 3.2 HHS001105000000001 - RFQ External Quality Assurance Review Health and Human Services (HHS) Uniform Terms and Conditions - Grant Vendor Version 3.2 Published and Effective – July 2022 Effective: April 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department Table of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSContents

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxx Xxxxxxx Legal Name of Contractor N/A Xxxxxxx Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX October 21, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 8/24/2021 Title of Authorized Representative 000 Xxxxxx Xxxxxxx Xxxxxx Richmond, TX 77469 Chief Executive Officer Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond0000 Xxxx Xxxxx Tyler, TX 77469 Tx 75702 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 P O Box 4730 Tyler, Tx 75712 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 000 000-0000 000 000-0000 Email Address DUNS Number 746001969 000000000 xxxxxxxx@xxxxxxxxxxxxx.xxx 182925958 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 175128141108005 1-75-1281410-8 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County A Meaning of Life LLC Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A d Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature o uthorized Representative Date Signed Xxxxxxx X Xxxxxx Director 09-15-2021 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 XX Xxxx Xxxxx Street Burleson, TX 77469 76028 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Xxxxxxx.Xxxxxx@xxxx-xxx.xxx Email Address DUNS Number 746001969 000000000 00-0000000 32059198716 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Nu 32059198716 0802361692 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxxx Cherokee Community Enrichment Services Legal Name of Contractor N/A ACCESS Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A XXxxxxxx and Cherokee Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx October 26, 2021 Signature of Authorized Representative Date Signed Xxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge CEO Title of Authorized Representative 000 0000 Xxxxxxx Xxxxxx RichmondJacksonville, TX 77469 Texas 75766 Physical Street Address City, State, Zip Code 000 0000 Xxxxxxx Xxxxxx RichmondJacksonville, TX 77469 Texas 75766 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxxxx-Xxxxxx.xxx 800643157 Email Address DUNS Number 746001969 000000000 1710015201 17524861204 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 752486120 17524861204 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx filed Signature of Authorized Representative Date Signed Xxxxxxx Xxxxxxxxx MPH Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Health Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier Certificate Of Completion Envelope Id: A5DBD287BC214B1A9E39826F3C781313 Status: Sent Subject: HHS001077800001, Corpus Christi-Nueces County Public Health District (UEICOUNTY), Base Contract Source Envelope: Document Pages: 61 Signatures: 0 Envelope Originator: Certificate Pages: 5 Initials: 0 CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 00000 Xxxxxx Xxxxx Xxxx #000 Xxxxxx, XX 00000 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: 160.42.85.11 Record Tracking Status: Original 8/2/2021 3:37:57 PM Holder: CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp Xxxxxxx Xxxxxxxxx MPH XxxxxxxX@xxxxxxx.xxx Health Director Corpus Christi-Nueces County Public Health District Security Level: Email, Account Authentication (None) Electronic Record and Human Services Signature Disclosure: Accepted: 8/2/2021 3:50:58 PM ID: 096941c4-5cca-41ca-8062-fadf8ccbdd97 Xxxxxxx Xxxxxxxxx MPH XxxxxxxX@xxxxxxx.xxx Security Level: Email, Account Authentication (HHSNone) Uniform Terms Electronic Record and Conditions - Grant Version 3.2 Published Signature Disclosure: Accepted: 8/2/2021 3:50:58 PM ID: 096941c4-5cca-41ca-8062-fadf8ccbdd97 Xxxxx Xxxxxxxxxx Xxxxx.Xxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Effective – July 2022 Responsible OfficeSignature Disclosure: Chief Counsel ABOUT THIS DOCUMENT Accepted: 8/2/2021 11:46:13 AM ID: 8e6586d9-b216-4504-9187-3a51cfefadfd Xxxxx Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 8/2/2021 12:17:45 PM ID: d82d1e7c-a072-4b17-a0b9-63d90d3ed840 Xxxx Gruber Xxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 1/3/2021 4:48:45 PM ID: bd2f4497-b4dc-4c51-9974-71b86780cff4 Sent: 8/2/2021 3:45:10 PM Viewed: 8/2/2021 3:50:58 PM In this documentPerson Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Xxxxxxxx Xxxxx Xxxxxxxx.Xxxxx@xxxx.xxxxx.xxx Security Level: Email, Grantees Account Authentication (also referred None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx Xxxxxx Xxxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Xxxxxx xxxxx@xxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 8/2/2021 3:45:10 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxxxx Xxxxxxxxx MPH, Xxxxxxx Xxxxxxxxx MPH, Xxxxx Xxxxxxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to in this document as subrecipients time, DSHS Contract Management Section (we, us or contractorsCompany) will find requirements and conditions applicable may be required by law to grant funds administered and passed-through by both provide to you certain written notices or disclosures. Described below are the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this document are process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact DSHS Contract Management Section: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in addition your email address where we should send notices and disclosures electronically to all requirements listed you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the RFAbody of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will xxxx you for any fees at that time, if any, under which applications for this grant award are accepted, as well as all applicable federal . To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth disclosures in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSelectronic format you may:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County HARDIN COUNTY HEALTH SERVICES Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx orized Representative April 13, 2023 Signature of Auth Date Signed Xxxxx XxXxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXXXX XXXXXX XX Xxxxxxx, TX 77469 Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 SAME SAME Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Xxxxx.XxXxxxxx@Xx.Xxxxxx.TX.US 082012840 Email Address DUNS Number 746001969 000000000 17460015369013 74-600153690 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 CLUMWDLWCLP6 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxx Xxxxxxxx Legal Name of Contractor N/A Crisis Center of the Plains Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx September 27, 2021 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 000 Xxxx 0xx Xxxxxx Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondPlainview, TX 77469 Texas 79072 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPost Office Box 326 Plainview, TX 77469 Texas 79073 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxx@xxxxxxxxx.xxx 948880844 Email Address DUNS Number 746001969 000000000 00-0000000 17519192276 Federal Employer Identification Number Texas Identification Number (TIN) NPayee ID No. – 11 digits n/A 17460019692 a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) FY22-FY23 Residential and Nonresidential Services Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000026 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Salaries Contractor: Crisis Center of the Plains A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Oversees all operations and administration and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,640.00 12 $ 43,680.00 34.23% $ 14,951.66 2 Assistant Director Assist Executive Director in all operations and administration, direct supervision of Advocacy and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,206.67 12 $ 38,480.04 37.49% $ 14,426.17 3 Financial Director Maintains Accounts Receivable/Payables, Bank Statements/Quarterly Reports $ 3,293.33 12 $ 39,519.96 15.62% $ 6,173.02 4 Advocacy Director Oversees advocates in administration and Safe Home, works with survivors/ assists with Legal advocacy with clients. $ 3,033.33 12 $ 36,399.96 19.69% $ 7,167.15 5 Senior Advocate Coordinate Primary presentations work, Advocacy with individuals and recruits and trains volunteers. $ 2,600.00 12 $ 31,200.00 20.92% $ 6,527.04 6 Victims Advocate Coordinate Primary presentations work. Advocacy work with individuals survivors, recuits and trains volunteers through out the year. $ 2,166.67 12 $ 26,000.04 13.22% $ 3,437.21 7 Data Entry-Part Time Data entry clerk on all work with resident and non-resident clients in the Osnium system. $ 866.67 12 $ 10,400.04 76.92% $ 7,999.71 8 Safe Home Director Oversees advocates at Safe Home, reviews all safe home clients files and operations of the safe home. Full time position. Making sure the safe home has maintained compliance with the cleaning and safety of clients during the COVID-19. $ 2,080.00 12 $ 24,960.00 68.29% $ 17,045.18 9 Safe Home Advocate/ Shift Worker/ #1 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 10 Safe Home Advocate/ Shift Worker/ #2 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: Crisis Center of the Plains A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 3,341.52 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 9,311.07 34.23% $ 1,143.80 $ 58.03 $ 37.28 $ 1,788.28 $ 159.79 $ - $ - $ - $ 3,187.18 2 Assistant Director Gross $ 2,943.72 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,913.27 37.49% $ 1,103.60 $ 63.56 $ 40.83 $ 1,958.60 $ 175.00 $ - $ - $ - $ 3,341.59 3 Financial Director Gross $ 3,023.28 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,992.83 15.62% $ 472.24 $ 26.48 $ 17.01 $ 816.04 $ 72.91 $ - $ - $ - $ 1,404.68 4 Advocacy Director Gross $ 2,784.60 $ 169.53 $ 108.90 $ 5,224.32 $ 292.20 $ - $ - $ - $ 8,579.55 19.69% $ 548.29 $ 33.38 $ 21.44 $ 1,028.67 $ 57.53 $ - $ - $ - $ 1,689.31 5 Senior Advocate Gross $ 2,386.80 $ 169.53 $ 108.90 $ 5,224.32 $ 238.92 $ - $ - $ - $ 8,128.47 20.92% $ 499.32 $ 35.47 $ 22.78 $ 1,092.93 $ 49.98 $ - $ - $ - $ 1,700.48 6 Victims Advocate Gross $ 1,989.00 $ 169.53 $ 108.90 $ 5,224.32 $ 277.88 $ - $ - $ - $ 7,769.63 13.22% $ 262.95 $ 22.41 $ 14.40 $ 690.66 $ 36.74 $ - $ - $ - $ 1,027.16 7 Data Entry-Part Time Gross $ 795.60 $ 169.53 $ 108.90 $ - $ - $ - $ - $ - $ 1,074.03 76.92% $ 611.98 $ 130.40 $ 83.77 $ - $ - $ - $ - $ - $ 826.15 8 Safe Home Director Gross $ 1,909.44 $ 169.53 $ 108.90 $ - $ - $ - $ - $ - $ 2,187.87 68.29% $ 1,303.96 $ 115.77 $ 74.37 $ - $ - $ - $ - $ - $ 1,494.10 9 Safe Home Advocate/ Shift Worker/ #1 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 10 Safe Home Advocate/ Shift Worker/ #2 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Other Contractor: Crisis Center of the Plains A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Copier Lease Printing of intakes, protective orders, presentation materials, bookkeeping reports and Human Services (HHS) Uniform Terms grant copies. 265.08 x 12 months=3180.96 HHSC=15.75%, SAPCS=30.93%, OVAG=11.35%, BIPP=7.86%, Unrestricted=34.14% $ 3,177.45 15.75% $ 500.45 2 Fire and Conditions - Grant Version 3.2 Published Security System at Safe Home Safe home security camera and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this documentfire alarm and entry alarm to keep clients secure. 90 x 12 months = 1080.00 HHSC= 46.3%, Grantees (also referred Unrestricted=53.7% $ 1,079.91 46.30% $ 500.00 3 Van- Vehicle Lease This vehicle is used to transport clients to appointments, job interviews and dr appointments. Advocates use the vehicle to travel to out lying counties to present presentations and to attend court hearings. The mileage in this document as subrecipients or contractors) will find requirements the vehicle is approximately 10,500 miles annually. 365.00 x 12 months = 4380.00 $ 4,380.00 100.00% $ 4,380.00 4 Directors and conditions applicable to grant funds administered Officers Insurance Required for the directors and passed-through by both the Texas Health officers. HHSC=33.5%, Unrestricted=66.5% $ 1,791.00 33.50% $ 599.99 5 Property Liability Professional Insurance Property, general and Human Services Commission (HHSC) professional liability coverage. HHSC=34.55%, SAPCS=1.33%, OVAG=6.42%, Unrestricted=57.71% $ 11,286.00 34.55% $ 3,899.31 6 Office Utilities Electricity, water, trash, sewer, gas. HHSC=20.09%, VOCA=23.64%, SAPCS=29.01%, OVAG=10%, BIPP=12.41%, Unrestricted=4.85% $ 8,461.92 20.09% $ 1,700.00 7 Office Telephone Hotline calls & staff use for communications. HHSC=14.79%, VOCA=24.66%, SAPCS=42.31%, OVAG=8.38%, BIPP=8.22%, Unrestricted=1.64% $ 3,042.60 14.79% $ 450.00 8 Office Internet Communication on grants and with law enforcement and the Department judicial system. HHSC=50.01%, VOCA=41.67%, BIPP=5%, Unrestricted=3.32% $ 899.82 50.01% $ 450.00 9 Office Maintenance Maintaining property / building repairs of plumbing, electrical, air conditioning and heating. HHSC=18.06%, SAPSC=50.02%, OVAG=14.45%, BIPP=5.42%, Unrestricted=12.05% $ 2,768.55 18.06% $ 500.00 10 Client Assistance OTC medications, bus tickets, birth certificates, drivers license, state ID and public transportation passes for clients. HHSC=34.12%, Unrestricted 65.88% $ 6,365.00 34.12% $ 2,171.74 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY22 Supplemental Justification Contractor: Crisis Center of the Plains Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Salaries Contractor: Crisis Center of the Plains A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Oversees all operations and administration and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,640.00 12 $ 43,680.00 34.23% $ 14,951.66 2 Assistant Director Assist Executive Director in all operations and administration, direct supervision of Advocacy and Safe Home services and recommends to Board of Directors on all matters requiring action $ 3,206.67 12 $ 38,480.04 37.49% $ 14,426.17 3 Financial Director Maintains Accounts Receivable/Payables, Bank Statements/Quarterly Reports $ 3,293.33 12 $ 39,519.96 15.62% $ 6,173.02 4 Advocacy Director Oversees advocates in administration and Safe Home, works with survivors/ assists with Legal advocacy with clients. $ 3,033.33 12 $ 36,399.96 19.69% $ 7,167.15 5 Senior Advocate Coordinate Primary presentations work, Advocacy with individuals and recruits and trains volunteers. $ 2,600.00 12 $ 31,200.00 20.92% $ 6,527.04 6 Victims Advocate Coordinate Primary presentations work. Advocacy work with individuals survivors, recuits and trains volunteers through out the year. $ 2,166.67 12 $ 26,000.04 13.22% $ 3,437.21 7 Data Entry-Part Time Data entry clerk on all work with resident and non-resident clients in the Osnium system. $ 866.67 12 $ 10,400.04 76.92% $ 7,999.71 8 Safe Home Director Oversees advocates at Safe Home, reviews all safe home clients files and operations of the safe home. Full time position. Making sure the safe home has maintained compliance with the cleaning and safety of clients during the COVID-19. $ 2,080.00 12 $ 24,960.00 68.29% $ 17,045.18 9 Safe Home Advocate/ Shift Worker/#1 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 10 Safe Home Advocate/ Shift Worker/#2 Maintains safety of the survivors living in the Safe home. Develops Safety Plans and service plans with survivors. Check on clients, makes sure no fever and all requirements. Part time position. $ 1,733.33 12 $ 20,799.96 97.00% $ 20,175.96 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Fringe Benefits - Employer Paid Portion Contractor: Crisis Center of the Plains A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Services (DSHS)Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 3,341.52 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 9,311.07 34.23% $ 1,143.80 $ 58.03 $ 37.28 $ 1,788.28 $ 159.79 $ - $ - $ - $ 3,187.18 2 Assistant Director Gross $ 2,943.72 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,913.27 37.49% $ 1,103.60 $ 63.56 $ 40.83 $ 1,958.60 $ 175.00 $ - $ - $ - $ 3,341.59 3 Financial Director Gross $ 3,023.28 $ 169.53 $ 108.90 $ 5,224.32 $ 466.80 $ - $ - $ - $ 8,992.83 15.62% $ 472.24 $ 26.48 $ 17.01 $ 816.04 $ 72.91 $ - $ - $ - $ 1,404.68 4 Advocacy Director Gross $ 2,784.60 $ 169.53 $ 108.90 $ 5,224.32 $ 292.20 $ - $ - $ - $ 8,579.55 19.69% $ 548.29 $ 33.38 $ 21.44 $ 1,028.67 $ 57.53 $ - $ - $ - $ 1,689.31 5 Senior Advocate Gross $ 2,386.80 $ 169.53 $ 108.90 $ 5,224.32 $ 238.92 $ - $ - $ - $ 8,128.47 20.92% $ 499.32 $ 35.47 $ 22.78 $ 1,092.93 $ 49.98 $ - $ - $ - $ 1,700.48 6 Victims Advocate Gross $ 1,989.00 $ 169.53 $ 108.90 $ 5,224.32 $ 277.88 $ - $ - $ - $ 7,769.63 13.22% $ 262.95 $ 22.41 $ 14.40 $ 690.66 $ 36.74 $ - $ - $ - $ 1,027.16 7 Data Entry-Part Time Gross $ 795.60 $ 169.53 $ 108.90 $ - $ - $ - $ 1,074.03 76.92% $ 611.98 $ 130.40 $ 83.77 $ - $ - $ - $ - $ - $ 826.15 8 Safe Home Director Gross $ 1,909.44 $ 169.53 $ 108.90 $ - $ - $ - $ - $ 2,187.87 68.29% $ 1,303.96 $ 115.77 $ 74.37 $ - $ - $ - $ - $ - $ 1,494.10 9 Safe Home Advocate/ Shift Worker/#1 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 10 Safe Home Advocate/ Shift Worker/#2 Gross $ 1,591.20 $ 169.53 $ 108.90 $ 5,224.32 $ 257.40 $ - $ - $ - $ 7,351.35 97.00% $ 1,543.46 $ 164.44 $ 105.63 $ 5,067.59 $ 249.68 $ - $ - $ - $ 7,130.80 DocuSign Envelope ID: 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Other Contractor: Crisis Center of the Plains A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Copier Lease Printing of intakes, protective orders, presentation materials, bookkeeping reports and grant copies. These requirements 265.08 x 12 months=3180.96 HHSC=15.75%, SAPCS=30.93%, OVAG=11.35%, BIPP=7.86%, Unrestricted=34.14% $ 3,177.45 15.75% $ 500.45 2 Fire and conditions are incorporated into Security System at Safe Home Safe home security camera and fire alarm and entry alarm to keep clients secure. 90 x 12 months = 1080.00 HHSC= 46.3%, Unrestricted=53.7% $ 1,079.91 46.30% $ 500.00 3 Van- Vehicle Lease This vehicle is used to transport clients to appointments, job interviews and dr appointments. Advocates use the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHSvehicle to travel to out lying counties to present presentations and to attend court hearings. The terms and conditions in this document are in addition to all requirements listed mileage in the RFAvehicle is approximately 10,500 miles annually. 365.00 x 12 months = 4380.00 $ 4,380.00 100.00% $ 4,380.00 4 Directors and Officers Insurance Required for the directors and officers. HHSC=33.5%, if anyUnrestricted=66.5% $ 1,791.00 33.50% $ 599.99 5 Property Liability Professional Insurance Property, under which applications general and professional liability coverage. HHSC=34.55%, SAPCS=1.33%, OVAG=6.42%, Unrestricted=57.71% $ 11,286.00 34.55% $ 3,899.31 6 Office Utilities Electricity, water, trash, sewer, gas. HHSC=20.09%, VOCA=23.64%, SAPCS=29.01%, OVAG=10%, BIPP=12.41%, Unrestricted=4.85% $ 8,461.92 20.09% $ 1,700.00 7 Office Telephone Hotline calls & staff use for this grant award are acceptedcommunications. HHSC=14.79%, as well as all applicable federal VOCA=24.66%, SAPCS=42.31%, OVAG=8.38%, BIPP=8.22%, Unrestricted=1.64% $ 3,042.60 14.79% $ 450.00 8 Office Internet Communication on grants and with law enforcement and the judicial system. HHSC=50.01%, VOCA=41.67%, BIPP=5%, Unrestricted=3.32% $ 899.82 50.01% $ 450.00 9 Office Maintenance Maintaining property / building repairs of plumbing, electrical, air conditioning and heating. HHSC=18.06%, SAPSC=50.02%, OVAG=14.45%, BIPP=5.42%, Unrestricted=12.05% $ 2,768.55 18.06% $ 500.00 10 Client Assistance OTC medications, bus tickets, birth certificates, drivers license, state laws ID and regulationspublic transportation passes for clients. Applicable federal and state laws and regulations may includeHHSC=34.12%, but are not limited toUnrestricted 65.88% $ 6,365.00 34.12% $ 2,171.74 DocuSign Envelope ID: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements 6B91390F-F638-440A-BDDF-3B917B61B061 Family Violence Program Budget FY23 Supplemental Justification Contractor: Crisis Center of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division Plains Cost Category Item # Justification 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County HILL COUNTRY COMMUNITY MHMR CENTER Legal Name of Contractor N/A HILL COUNTRY MHDD CENTERS Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx December 27, 2023 Signature of Authorized Representative Date Signed XXXXXXX XXXXXXXXXXX FOR XXX XXXXXX 12/27/2023 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXXXXX XX, TX 77469 XXX 000 XXXXXXXXX, XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxx@xxxxxxxxxxx.xxx 015050839 Email Address DUNS Number 746001969 000000000 00-0000000 17428220176 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 DCHYB866LFF5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxx X. Xxxxx Xx. Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX August 2, 2022 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxx Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge C.E.O. Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxxxx Xx. Xxxxxxxx, TX 77469 Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 Phone Number Fax Number xxxxxx@xxxxxxxxxxxxxxxx.xxx 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 00-0000000 089191733 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 17429191780 17429191780 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 FAD2VQEUNYQ3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Harris County, Texas Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Repr Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 121001 Xxxxxxx 9th Floor December 6, 2023 Authorized Representative 2021 esentative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, Houston TX 77469 77002 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 same same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 same Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 cjograntsnotification@hctx net 072206378 Email Address DUNS Number 746001969 000000000 760454514 76454514 Federal Employer Identification Number Texas Identification Number (TIN) Payee ID No. – 11 digits N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier Attachment F ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Texas Tech University Health Sciences Center Legal Name of Contractor N/A Texas Tech University Health Sciences Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas Tech University Health Sciences Center Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx March 28, 2024 Signature of Authorized Representative Date Signed Xxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge AVP for Sponsored Programs Title of Authorized Representative 000 Xxxxxxx 0000 0xx Xxxxxx RichmondLubbock, TX 77469 79430 Physical Street Address City, State, Zip Code 000 Xxxxxxx 0000 0xx Xxxxxx RichmondLubbock, TX 77469 79430 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 NA Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxxxxxxxxxx@xxxxxx.xxx 609980727 Email Address DUNS Number 746001969 000000000 00-0000000 37397397391007 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 E4Z2NUYUMHF9 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040-0009 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant:, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Xxxxxx Xxxxxx County Public Health District Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 Xxxx Xxxxx Xxxxxx August 18, 2023 2021 Signature of Authorized Representative Date Signed County Judge 08-18-2021 Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondJasper, TX 77469 Texas 75951 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxx Xxxxx Xxxxxx RichmondJasper, TX 77469 Texas 75951 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxxxxxxxx.xxx 078708416 Email Address DUNS Number 746001969 000000000 746001457 17460014578 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 746001457 17460014578 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor By submitting this Response, Respondent represents and warrants that the individual signing submitting this Contract Affirmations document and the documents made part of this Response is authorized to sign such documents on behalf of Contractor the Respondent and to bind the ContractorRespondent under any contract that may result from the submission of this Response. Signature Page Follows Authorized representative on behalf of Contractor Respondent must complete and sign the following: Fort Bend County Xxxxx Xxxxxx-Xxxxxx Legal Name of Contractor N/A Respondent Matagorda County Women's Crisis Center Assumed Business Name of ContractorRespondent, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Authorized Represen ative 02/04/2022 u e of Authori ed Represent Date Signed Xxxxx X. Xxxxxx-Xxxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx 0000 0xx Xxxxxx RichmondXxx Xxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondXX Xxx 0000 Xxx Xxxx, TX 77469 XX 00000 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxxxxxx.xxx 800512840 Email Address DUNS Number 746001969 000000000 00-0000000 00-0000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 174423163199 0069550301 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 800512840 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County N/A Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX ature of Authorized Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12August 29, 2023 Authorized 2022 Sign Representative Date Signed County Judge Executive Director, Interim Title of Authorized Representative 000 0000 Xxx Xxxxxxx Xxxxxx RichmondXxxxxx, TX 77469 Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same Same Mailing Address, if different City, State, Zip Code Same Same Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 n/A Email Address DUNS Number 746001969 000000000 xxxxxx.xxxxxx@xxxx.xxxxx.xxx 078354556 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 36446446449 000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 L667SNCL4135 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.1 Published and Effective – July April 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Outreach Health Community Care Services, LP Legal Name of Contractor N/A Outreach Home Care Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A All Counties in Texas Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX September 7, 2023 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Chief Operating Officer Title of Authorized Representative 000 Xxxxxx Xxxxxxx Xxxxxx RichmondRichardson, TX 77469 75080 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Xxxxxx.Xxxxx@xxxxxxxxxxxxxx.xxx 080303848 Email Address DUNS Number 746001969 000000000 742950392 17429503927 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 32036169517 00000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 PKSRK5YKMWD5 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT F Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Andrews County Health Department Legal Name of Contractor N/A Andrews County Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Andrews County Health Department Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX rized Representative March 21, 2023 Signature of Autho Date Signed Xxxxxx Xxxxxxxx Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond208 N. W. 2nd ST Andrews, TX 77469 Texas, 79714 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondX. X 0xx XX. Andrews, TX 77469 Texas, 79714 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxx@xx.xxxxxxx.xx.us 041817961 Email Address DUNS Number 746001969 756000815 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 756000815 756000815 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 K18FSMULJU17 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Tarrant County Legal Name of Contractor N/A Tarrant County Public Health Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx June 26, 2023 Signature of Authorized Representative Date Signed Judge Xxx X'Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed 000 X. Xxxxxxxxxxx St. Room 5069 County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 County Judge Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond0000 X Xxxx Xx Fort Worth, TX 77469 76196 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 N/A Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx Email Address DUNS Number 746001969 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 DBH1UNN8U5J3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Comal County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Authorized Repre Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 Xxxx Xxxxx August 26, 2023 Authorized Representative 2021 sentative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondNew Braunfels, TX 77469 Texas 78130 Physical Street Address City, State, Zip Code 000 Xxxxxxx X. Xxxxxx RichmondAvenue New Braunfels, TX 77469 Texas 78130 Mailing Address, if different City, State, Zip Code 000-000(000)000-0000 000-000(000)000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xx.xxxxx.xx.xx 098824758 Email Address DUNS Number 746001969 000000000 00-0000000 1-74-60011775-3 Federal Employer Identification Number Texas Identification Number (TIN) NPayee ID No. – 11 digits n/A 17460019692 a 023 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx Xxxxxxxxx Legal Name of Contractor N/A Medina County Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx September 1, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxxxxxxx County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 0000 Xxxxxx X Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, Hondo TX 77469 78861 Physical Street Address City, State, Zip Code 000 Xxxxxxx 0000 Xxxxxx RichmondX Xxxxx, TX 77469 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxxxx@xxxxxxxxxxxxxxxxx.xxx 080272057 Email Address DUNS Number 746001969 000000000 00-0000000 017460011061 Federal Employer Identification Number Texas Identification Number (TIN) Payee ID No. – 11 digits N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxx Xxxxxx Legal Name of Contractor N/A City of Port Xxxxxx Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Jefferson Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12June 7, 2023 Signature of Authorized Representative Date Signed County Judge Director of Health Services Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxx Xxxx Xxxxxx, TX 77469 TX, 77640 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondXxxxxx Port Xxxxxx, TX 77469 TX, 77640 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx.xxxxx@xxxxxxxxxxxx.xxx 137134909 Email Address DUNS Number 746001969 000000000 17460018550-011 00-0000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 1-74-6001855-0 17460018850-11 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 EMVNEFW2KN4 XXX.xxx Unique Entity Identifier (UEI) Contract No. Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel Contract No. ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Comal County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX esentative May 12, 2023 Signature of Authorized Repr Date Signed Judge Xxxxxxx Xxxxxx County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXXXX XXXXX XXX XXXXXXXXX, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 0000 XXXXXX XXXX XXXXX, #000 Xxxxxxx Xxxxxx RichmondXXX XXXXXXXXX, TX 77469 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 XXXXXX@XX.XXXXX.XX.XX 098824758 Email Address DUNS Number 746001969 000000000 00-0000000 1-74-6001775-3 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 NSKCW89H6YS1 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County a Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 121524 S. I-35, 2023 suite 320 September 22, 2022 Signature of Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondAustin, TX 77469 Tx 78704 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 0000, ext. 000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxx.xxx 00-000-0000 Email Address DUNS Number 746001969 000000000 00-0000000 13115827977 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 0147358501 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XUK1FUBXZE22 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Wichita Falls - Wichita County Public Health District Legal Name of Contractor N/A Wichita Falls - Wichita County Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Wichita Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx June 9, 2023 Signature of Authorized Representative Date Signed Xxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Director of Health Title of Authorized Representative 000 0000 Xxxxx Xx. Xxxxxxx Xxxxxx RichmondXxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxx Xx. Wichita Falls, TX 77469 76301 Mailing Address, if different City, State, Zip Code 000-000-0000 940,761.78 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxx.xxxxx@xxxxxxxxxxxxxx.xxx Email Address DUNS Number 746001969 000000000 1-75-6000-714-2000 1-75-6000-714-2000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 1-75-6000-714-2000 1-75-6000-714-2000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 R737LBFW8T13 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Scokk Marquardk Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative Augusk 26, 2021 Date Signed Scokk Marquardk Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12Augusk 26, 2023 Authorized Representative Date Signed County Judge 2021 Title of Authorized Representative 000 Xxxxxxx X Xxxxxx RichmondX0xxx Xxxxx, TX 77469 Xxxxx 000 Xxxxxxxx00x, XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Marquardk§xxxxxxxxx.xxx 00-000-000 Email Address DUNS Number 746001969 000000000 00-0000000 12022906049 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 32044286600 0801427468 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier tt h t C H lth H S i DocuSign Envelope ID: 9D2B1667-1721-4658-96FF-AC06640E9B0F ces (UEIHHS) Uniform Terms and Conditions - Vendor, Version 3.2 HHS0009546 - Psychiatric Services for Residents Civilly Committed Health and Human Services (HHS) Uniform Terms and Conditions - Grant Vendor Version 3.2 Published and Effective – July 2022 Effective: April 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department Table of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSContents

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxx Xxxxxxx Legal Name of Contractor N/A Central Counties Center for MHMR Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Central Counties Services Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx July 1, 2022 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxx 00xx Xxxxxx, XX 00000 Xxxxxxxx Xxxxxx Xxxxxxx Xxxxxx RichmondXxxx, TX 77469 Physical Street Address City, StateXxxxx, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Xxxxxxx.Xxxxxxx@xxx0000.xxx 059057927 Email Address DUNS Number 746001969 741801332 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 000000000 80154715 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 EMWMKFSB4L85 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County The University of TExas at EL Paso Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A El Paso Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx February 11, 2022 Signature of Authorized Representative Date Signed Xxxxxxx X Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 000 X. Xxxxxxxxxx Xxxxxx Vice President for Research Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondEl Paso, TX 77469 Texas 79968 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 N/A N/A Mailing Address, if different City, State, Zip Code (000-) 000-0000 000-000-0000 N/A Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxx.xxx 132051285 Email Address DUNS Number 746001969 000000000 740006813 N/A Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Permian Basin Community Centers for Mental Health & Mental Retardation Legal Name of Contractor N/A PermiaCare Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A PermiaCare Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx July 1, 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX Xxxxxxxx Xxxxxxx, TX 77469 Xx, 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 0000000000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 XXXXXxxxxxxx@xxxxxxxxxx.xxx 074145561 Email Address DUNS Number 746001969 XXXxxxxxxxxx@xxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 KQBSRH72A6P1 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx Xxxxxxxxxxx-Xxx Legal Name of Contractor N/A Xxxxxx Services Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative Date Signed December 19, 2023 Xxxxx Xxxxxxxxxxx-Xxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge President/CEO Title of Authorized Representative 0000 Xxxxxxx Xxxxxx, Xxxxx 000 Xxxxxxx Xxxxxx RichmondXxxxxxx, TX 77469 XX 00000-1341 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code (000-000-0000 000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxx@xxxxxxxxxxxxxx.xxx 170044572 Email Address DUNS Number 746001969 000000000 00-0000000 19424019495 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Not applicable 0004536907 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 SZLZHM4FJCX5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.3 Published and Effective – July 2022 November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxx Xxxxxxxxx Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX October 5, 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Executive Directive Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxxxxxx Xxxxxx, TX 77469 Xxxxx, 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000 000 0000 (000-000-0000 000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxx@xxxxxxxxxx.xxx 148007429 Email Address DUNS Number 746001969 000000000 xxx@xxxxxxxxxx.xxx 17513681514 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 32072007563 17513681514 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 NZCFBZKEA6W8 XXX.xxx Unique Entity Identifier (UEI) Attachment D Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx Xxxx Legal Name of Contractor N/A Alamo Area Council of Governments Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx March 14, 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Xxxxx Xxxx Executive Director Physical Street Address City, State, Zip Code 0000 XX Xxxx 000 Xxxxxxx Xxxxxx RichmondSan ANtonio, TX 77469 78217 Mailing Address, if different City, State, Zip Code 0000 XX Xxxx 000 San ANtonio, TX 78217 Phone Number Fax Number xxxxxxx-xxxxxx@xxxxx.xxx 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 xxxxx@xxxxx.xxx 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 0-00-00000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 M8MHKZAERQN6 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxx Xxxxxxxxx Xxxxxxxxxx Legal Name of Contractor N/A Xxxxxxx Xxxxxxxxx Xxxxxxxxxx Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Xxxxxxxxxx, LLC Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx August 15, 2022 Signature of Authorized Representative Date Signed Xxxxxxx X. Xxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 0000 XXXXXXXX XXXXX Administrator Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondGRAND PRAIRIE, TX 77469 75054 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xx 079259832 Email Address DUNS Number 746001969 000000000 00-0000000 18109753626 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 32058528285 0802310510 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 T8C9GKHLYD33 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Vendor Version 3.2 Published and Effective – July 2022 Effective: April 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department Table of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSContents

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Lakes Regional MHMR Center Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx December 27, 2023 Signature of Authorized Representative Date Signed Xxxx X Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 12/27/23 Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXx Xxxxxxx, TX 77469 XX. 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 749 Terrell, TX 77469 TX. 75160 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxxxxxxxxxx.xxx 112211854 Email Address DUNS Number 746001969 000000000 00-0000000 17528338233 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 17528338233000 17528338233000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 51FB6 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County The University of Texas Health Science Center at San Antonio Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx filed Signature of Authorized Xxxxx X. Xxxxx, CPA Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 120000 Xxxxx Xxxx Drive, 2023 Authorized MSC 7828 September 8, 2021 Representative Date Signed County Judge 09/08/21 Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondSan Antonio, TX 77469 Texas 78229-3900 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same Same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 N/A Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxxxxx.xxx 800772162 Email Address DUNS Number 746001969 000000000 17415860315 17415860315 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 17415860315 17415860315 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Xxxxxx Xxxxxx County Public Health District Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx filed August 3, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxxx Xxxxxxx Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 000 Xxxx Xxxxx Xx Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxx, TX 77469 Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondXxxx Xxxxx Xx Jasper, TX 77469 Texas 75951 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxxxxxxx.xxx 078708416 Email Address DUNS Number 746001969 000000000 746001457 17460014578 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits na na Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxx Xxxxxxx, Xxxxx Xxxxxxx, Xxxxx Xxxxxxxxxx, Xxxxx Xxxxxxxx, Xxxxx Xxxxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (UEIwe, us or Company) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred may be required by law to in this document as subrecipients provide to you certain written notices or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both disclosures. Described below are the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this document are process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact DSHS Contract Management Section: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in addition your email address where we should send notices and disclosures electronically to all requirements listed you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the RFAbody of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will xxxx you for any fees at that time, if any, under which applications for this grant award are accepted, as well as all applicable federal . To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth disclosures in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSelectronic format you may:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Lifetime Independence for Everyone, Inc. Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative 08/02/2023 Date Signed Xxxxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx 0000 Xxxxxx RichmondXxx. Lubbock, TX 77469 Texas 79423 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx.xxxxx@xxxxxxx.xxx 839934742 Email Address DUNS Number 746001969 000000000 00-0000000 17522178353 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 30010837505 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 EYT7D31P5HL6 XXX.xxx Unique Entity Identifier (UEI) Health View Burden Statement ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Northeast Texas Public Health District Legal Name of Contractor N/A Northeast Texas Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx X Xxxxxxx Xx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12May 23, 2023 Signature of Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxx #000 Xxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxx #000 Xxxxx, TX 77469 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxx.xxx 144656753 Email Address DUNS Number 746001969 000000000 752254544 17522545445 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 QYUMYH4V9EK5 XXX.xxx Unique Entity Identifier (UEI) Attachment Health and Human Services (HHS) Uniform Terms and Conditions - Additional Provisions – Grant Funding Version 3.2 Published and Effective – July 2022 Responsible Office1.0 Effective: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas February 2021 Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Additional Provisions V.1.0 – Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited toFunding Effective: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. February 2021 TABLE OF CONTENTSCONTENTS 1. ELECTRICAL ITEMS 3 2. DISASTER SERVICES 3 3. NOTICE OF A LICENSE ACTION 3 4. SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY 4 5. THIRD PARTY PAYORS 4 6. INTERIM EXTENSION AMENDMENT 4 7. NOTICE OF CRIMINAL ACTIVITY AND DISCIPLINARY ACTIONS 5

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Collin County Mental Health Mental Retardation Center Legal Name of Contractor N/A LifePath Systems Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Collin County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx November 28, 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxxxxx Xxxxx XxXxxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxxxxxxxxxxxxx.xxx 161443783 Email Address DUNS Number 746001969 000000000 00-0000000 00-0000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 32051038761 0056634201 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 WY9FGNAZ-SNA6 XXX.xxx Unique Entity Identifier (UEI) ATTACHMENT D Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Bell County Public Health District Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Au Xxxxx X Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 Xxxxx 0xx Xxxxxx August 19, 2023 Authorized 2021 thorized Representative Date Signed County Judge 08/18/21 Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondTemple, TX 77469 Texas 76501 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 2149 Temple, TX 77469 Texas 76503 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxx@xxxxxxxxxxxxxxxx.xxx 08387-2259 Email Address DUNS Number 746001969 000000000 00-0000000 17460003480 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits NH23IP922616 17460003480 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort KP Xxxxxx Xxxx Bend County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX filed May 7, 2021 Signature of Authorized Representative Date Signed X.X. Xxxxxx County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Xx Richmond, TX 77469 Richmond, TX 77469 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Xx 000-000-0000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 00-0000000 17460019692 N/A Federal Employer Identification Number Texas Identification Number (TIN) Payee ID No. – 11 digits N/A 17460019692 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Tralee Crisis Center for Women, Inc. Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx September 17, 2021 Signature of Authorized Representative Date Signed Xxxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 310 X. Xxxxxx Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondPampa, TX 77469 79065 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Xxxxxxxxx.xxxxxx@xxxxx.xxx 00-000-0000 Email Address DUNS Number 746001969 000000000 751971380 17519713808 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 17519713808 70205001 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health FY22-FY23 Residential and Human Nonresidential Services (HHS) Uniform Terms Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000024 DocuSign Envelope ID: 2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22 Salaries Contractor: Tralee Crisis Center for Women, Inc. A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Directs client services, supervises resident and Conditions - Grant Version 3.2 Published non- resident staff, oversees agency operations, manages grants and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this documentcontracts. 1FTE=.59DV, Grantees (also referred to in this document as subrecipients or contractors) will find requirements .40SA, .01OV. DV program split of 20/80 b/w HHSC and conditions applicable to grant funds administered other funding sources $ 4,766.67 12 $ 57,200.04 20.00% $ 11,440.01 2 Assistant Executive Director Manages agency funds, allocates expenses, accounts receivables/payables, payroll functions, supervises volunteer coordinator and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed oversees volunteer program, oversees agency operations in the RFAabsence of Executive Director. 1FTE=.59DV, if any.40SA, under which applications .01OV. DV program split of 20/80 b/w HHSC and other funding sources $ 3,293.33 12 $ 39,519.96 20.00% $ 7,903.99 3 Legal Advocate Intervention, case management, legal assistance, support for this grant award are acceptednon-resident clients. 1FTE=.59DV, .40SA, .01OV. DV program split 20/80 b/w HHSC and other funding sources. $ 2,929.58 12 $ 35,154.96 20.00% $ 7,030.99 4 Advocate 1/Bi-lingual advocate Intervention, case management, bilingual, support for non- resident clients. 1 FTE=.59 DV, .40 SA, .01 OV. DV program funding split 20/80 b/w HHSC and other funding sources $ 2,735.25 12 $ 32,823.00 20.00% $ 6,564.60 5 Advocate 2/Child advocate Intervention, case management, support for adult and child non-resident clients. 1 FTE=.59 DV, .40 SA, .01 OV. DV programing split 20/80 b/w HHSC and other funding sources $ 2,676.00 12 $ 32,112.00 20.00% $ 6,422.40 6 Volunteer Coordinator Recruits, trains and manages direct service and support volunteers, data entry, intervention for non-resident clients as well as all applicable federal needed. 1 FTE=.59 DV, .40 SA, .01 OV. DV program funding split 20/80 b/w HHSC and state laws other funding sources $ 2,919.67 12 $ 35,036.04 20.00% $ 7,007.21 7 Shelter Supervisor Provides resources, support and regulationsdata entry for shelter clients, supervises shelter staff, manages shelter facility. Applicable federal 1 FTE=.89 DV, .11 SA. DV program funding split 47/53 b/w HHSC and state laws other funding sources $ 2,927.00 12 $ 35,124.00 47.00% $ 16,508.28 8 Shelter Advocate 1 Provides resources, support and regulations may includedata entry for shelter clients. 1 FTE=.89 DV, but are not limited to.11 SA. DV program funding split 47/53 b/w HHSC and other funding sources $ 2,461.33 12 $ 29,535.96 47.00% $ 13,881.90 DocuSign Envelope ID: 2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: Tralee Crisis Center for Women, Inc. A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 4,375.80 $ 227.97 $ 27.90 $ - $ - $ - $ 1,716.00 $ - $ 6,347.67 20.00% $ 875.16 $ 45.59 $ 5.58 $ - $ - $ - $ 343.20 $ - $ 1,269.53 2 CFR Part 200Assistant Executive Director Gross $ 3,023.28 $ 159.02 $ 27.90 $ - $ - $ - $ 910.00 $ - $ 4,120.20 20.00% $ 604.66 $ 31.80 $ 5.58 $ - $ - $ - $ 182.00 $ - $ 824.04 3 Legal Advocate Gross $ 2,689.35 $ 139.93 $ 27.90 $ - $ - $ - $ 650.00 $ - $ 3,507.18 20.00% $ 537.87 $ 27.99 $ 5.58 $ - $ - $ - $ 130.00 $ - $ 701.44 4 Advocate 1/Bi- lingual advocate Gross $ 2,510.96 $ 132.23 $ 27.90 $ - $ - $ - $ - $ - $ 2,671.09 20.00% $ 502.19 $ 26.45 $ 5.58 $ - $ - $ - $ - $ - $ 534.22 5 Advocate 2/Child advocate Gross $ 2,456.57 $ 128.08 $ 27.90 $ - $ - $ - $ - $ - $ 2,612.55 20.00% $ 491.31 $ 25.62 $ 5.58 $ - $ - $ - $ - $ - $ 522.51 6 Volunteer Coordinator Gross $ 2,680.26 $ 134.75 $ 27.90 $ - $ - $ - $ - $ - $ 2,842.91 20.00% $ 536.05 $ 26.95 $ 5.58 $ - $ - $ - $ - $ - $ 568.58 7 Shelter Supervisor Gross $ 2,686.99 $ 272.43 $ 27.90 $ - $ - $ - $ - $ - $ 2,987.32 47.00% $ 1,262.89 $ 128.04 $ 13.11 $ - $ - $ - $ - $ - $ 1,404.04 8 Shelter Advocate 1 Gross $ 2,259.50 $ 228.42 $ 27.90 $ - $ - $ - $ 551.72 $ - $ 3,067.54 47.00% $ 1,061.97 $ 107.36 $ 13.11 $ - $ - $ - $ 259.31 $ - $ 1,441.75 9 Shelter Advocate 2 Gross $ 2,203.82 $ 220.95 $ 27.90 $ - $ - $ - $ 650.00 $ - $ 3,102.67 47.00% $ 1,035.80 $ 103.85 $ 13.11 $ - $ - $ - $ 305.50 $ - $ 1,458.26 10 Shelter Advocate 3 Gross $ 2,148.12 $ 216.22 $ 27.90 $ - $ - $ - $ - $ - $ 2,392.24 47.00% $ 1,009.62 $ 101.62 $ 13.11 $ - $ - $ - $ - $ - $ 1,124.35 11 Shelter Advocate 4 Gross $ 2,148.12 $ 216.22 $ 27.90 $ - $ - $ - $ - $ - $ 2,392.24 47.00% $ 1,009.62 $ 101.62 $ 13.11 $ - $ - $ - $ - $ - $ 1,124.35 Shelter Gross $ 2,148.12 $ 216.22 $ 27.90 $ - $ - $ - $ - $ - $ 2,392.24 DocuSign Envelope ID: 2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22 Professional/Contract Services Contractor: Tralee Crisis Center for Women, Uniform Administrative RequirementsInc. A B C D E F G H Contractor Name Description Justification No. of Units Rate of Payment Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Xxxxxx Xxxx, CPA annual audit Annual audit of financial activities, functional expenses and cash flows. One time payment after service performed based on contract. Funding split 20/80 b/w HHSC and other funding sources 1 $ 9,200.00 $ 9,200.00 20.00% $ 1,840.00 2 Xxxxxxx & Associates IT Contract services IT support, monthly computer server/network maintenance, cloud back-up and service. Based on monthly payment of 356.00. Funding split 20/80 b/w HHAS and other funding sources 12 $ 356.00 $ 4,272.00 20.00% $ 854.40 3 New Hope Counseling Contract Counseling Services Professional counseling services for DV victims. Paid monthly @ $75 per hr per client based on contract. Funding split 35/65 b/w HHSC/other 12 $ 375.00 $ 4,500.00 35.00% $ 1,575.00 4 0 $ - $ - 0.00% $ - 5 0 $ - $ - 0.00% $ - 6 0 $ - $ - 0.00% $ - 7 0 $ - $ - 0.00% $ - 8 0 $ - $ - 0.00% $ - 9 0 $ - $ - 0.00% $ - 10 0 $ - $ - 0.00% $ - 11 0 $ - $ - 0.00% $ - 12 0 $ - $ - 0.00% $ - 13 0 $ - $ - 0.00% $ - 14 0 $ - $ - 0.00% $ - 15 0 $ - $ - 0.00% $ - 16 0 $ - $ - 0.00% $ - 17 0 $ - $ - 0.00% $ - 18 0 $ - $ - 0.00% $ - 19 0 $ - $ - 0.00% $ - 20 0 $ - $ - 0.00% $ - 21 0 $ - $ - 0.00% $ - Other Contractor: Tralee Crisis Center for Women, Inc. A B C D E Description Justification Cost PrinciplesPercent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Copier Lease Lease of copy machine for non-resident services based on previous contract year expenditures. Average monthly expenses of $250. funding split 21/79 b/w HHSC and other funding sources $ 3,000.00 21.30% $ 639.00 2 Copier Maintenance service contract for monthly maintenance, ink, toner supplies for office and Audit Requirements shelter copier. Average monthly expenses of $83.33. funding split 20/80 b/w HHSC and other funding sources $ 1,000.00 20.00% $ 200.00 3 Office repairs/maintenance Estimated costs for Federal Awards; requirements repairs/maintenance to non-resident office based on previous year expenses and anticipated costs for FY 2022. Funding split 20/80 b/w HHSC and other funding sources $ 2,000.00 20.00% $ 400.00 4 Office utilities Estimated cost of the entity that awarded the funds electricity, water, sewer and gas for office based on previous contract year expenditures. Average monthly amount of $440.75. Funding split is 20/80 b/w HHSC and other funding sources. $ 5,289.00 20.00% $ 1,057.80 5 Telephone/Communications Estimated cost of telephone service at office facilities based on previous contract year expenditures. Average monthly amount of $401. Funding split is 18/82 b/w HHSC and other funding sources. $ 4,812.00 18.00% $ 866.16 6 Telephone/Communications Estimated cost of on-call cell phone service for on-call staff based on previous contract year expenditures. Average monthly amount of $100. Funding split is 18/82 b/w HHSC and other funding sources. $ 1,200.00 18.00% $ 216.00 7 Security monitoring services Monitoring of fire alarm and security system for office facilities based on previous contract year expenditures. Average monthly expenditure of $30. Funding split 20/80 b/w HHSC and other funding sources $ 360.00 20.00% $ 72.00 8 Internet Services Cost to HHS; Chapter 783 provide internet and wifi services to office facilities for staff and client use. Average monthly amount of the Texas Government Code; Texas Comptroller $43. Funding split is 25/75 b/w HHSC and other funding sources $ 516.00 25.00% $ 129.00 9 Office liability/hazard insurance Estimated annual premium for building insurance for offfice facility based on previous contract year expenditures. Average monthly premium is $452.95 for 9 months plus 25% down payment of Public Accounts’ agency rules (including Uniform Grant 1358.85.Funding split is 18/82 b/w HHSC and Contract Standards set forth in Title 34other funding sources $ 5,435.00 18.00% $ 978.30 10 Board/Officer Employee Insurance Estimated annual premium for Directors and officers coverage, Part 1employee theft/forgery premium based on previous contract year expenditures. Average monthly premium is $240 for 9 months plus 25% down payment of 718. Funding split is 18/82 b/w HHSC and other funding sources $ 2,871.00 18.00% $ 516.78 11 Special Events DVAM activities to raise community awareness of Domestic Violence prevention. Funding split is 20/80 b/w HHSC and other funding sources $ 650.00 20.00% $ 130.00 12 Shelter repairs/maintenance Estimated costs for repairs/maintenance to shelter based on previous year expenses and anticipated costs for FY 2022. Funding split 28/72 b/w HHSC and other funding sources $ 5,400.00 28.00% $ 1,512.00 13 Shelter Internet Services Cost to provide internet and wifi services to shelter facilities for staff and client use. Average monthly amount of $59.25. Funding split is 25/75 b/w HHSC and other funding sources $ 711.00 25.00% $ 177.75 14 Security monitoring services Monitoring of fire alarm and security system for shelter facilities based on previous contract year expenditures. Average monthly expenditure of $35. Funding split 25/75 b/w HHSC and other funding sources $ 420.00 25.00% $ 105.00 15 Shelter liability/hazard insurance Estimated annual premium for building insurance for shelter facility based on previous contract year expenditures. Average monthly premium is $437.95 for 9 months plus 25% down payment of 1313.85.Funding split is 18/82 b/w HHSC and other funding sources $ 5,255.00 18.00% $ 945.90 16 Shelter utilities Estimated cost of electricity, Chapter 20water, Subchapter Esewer, Division 4 cable TV and gas for shelter based on previous contract year expenditures. Average monthly amount of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller $583.33. Funding split is 30/70 b/w HHSC and other funding sources. $ 7,000.00 30.00% $ 2,100.00 17 Telephone/Communications Estimated cost of Public Accounts; telephone service at shelter facilities based on previous contract year expenditures. Average monthly amount of $441.66. Funding split is 20/80 b/w HHSC and the Funding Announcement, Solicitation, or other instrumentfunding sources. $ 5,300.00 20.00% $ 1,060.00 18 vehicle insurance Estimated annual premium for vehicle insurance based on previous contract year expenditures. Average monthly premium is $404.42 for 9 months plus 25% down payment of $1213.25.Funding split is 20/80 b/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSw HHSC and other funding sources $ 4,853.00 20.00% $ 970.60 19 $ - 0.00% $ - 20 $ - 0.00% $ - 21 $ - 0.00% $ - 22 $ - 0.00% $ - 23 $ - 0.00% $ - DocuSign Envelope ID: 2FC21113-8B71-4308-9B97-1489A090C454 Family Violence Program Budget FY22

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Cherokee County Department of Public Health Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Aut Xxxxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 Xxxxxxx Xxxxxx October 4, 2023 Authorized 2021 horized Representative Date Signed County Judge 08/13/2021 Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondJacksonville, TX 77469 Texas 75766 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 NA NA Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxxxx.xxx 076709013 Email Address DUNS Number 746001969 000000000 00-0000000 17560008546 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Tarrant County Legal Name of Contractor N/A Tarrant County Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Tarrant County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Judge Xxx X’Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12March 13, 2023 2024 Signature of Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxxxxx St. Fort Worth, TX 77469 76196 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxxxxx St. Fort Worth, TX 77469 76196 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 n/a Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxxx.xxx 68365220 Email Address DUNS Number 746001969 000000000 00-0000000 17560011706 Federal Employer Identification Number Texas Identification Number (TIN) Nn/A 17460019692 a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 DBH1UNN8U5J3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County City Of Wichita Falls Texas Legal Name of Contractor N/A Same Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A none Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx June 7, 2022 Signature of Authorized Representative Date Signed Xxxxx Xxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Director of Health Title of Authorized Representative 000 0000 Xxxxx Xxxxxx Xxxxxxx Xxxxx Xx 00000 Xxxxxxxx Xxxxxx RichmondXxxxxxx Xxxx, TX 77469 Physical Street Address CityXxxxx, State, Zip Xxx Code 000 xx xxx 0000 Xxxxxxx Xxxxxx Richmond, TX 77469 Xxxxx XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxx.xxxxxxxx@xxxxxxxxxxxxxx.xxx 059463133 Email Address DUNS Number 746001969 000000000 756000714 17560007142 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 756000714 17560007142 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 R737LBFW8T13 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.1 Published and Effective – July April 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Texas Association Against Sexual Assault, Inc. Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx June 10, 2022 Signature of Authorized Representative Date Signed Xxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge CEO Title of Authorized Representative 0000 Xxxxx Xxxxx Xxxxx, Xxx. 000 Xxxxxxx Xxxxxx RichmondXxxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxx@xxxxx.xxx 958608895 Email Address DUNS Number 746001969 000000000 00-0000000 17519571560 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 32037265165 0065668701 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 KADJXT653Z4 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.1 Published and Effective – July April 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Bluebonnet Trails Community MHMR Center d/b/a Bluebonnet Trails Community Services Legal Name of Contractor N/A Bluebonnet Trails Community Services Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Bastrop, Burnet, Xxxxxxxx, Xxxxxxx, Xxxxxxxx, Xxxxxxxxx, Xxx and Xxxxxxxxxx Counties Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX December 15, 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx 0000 X. Xxxxxxxxxx Xxxxxx RichmondXxxxx Xxxx, TX 77469 Xxxxx 00000-3289 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx.xxxxxxxxxx@xxxxxxxx.xxx 965802432 Email Address DUNS Number 746001969 000000000 742795332 74279533 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 L7N9JCJ5HCX1 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel H ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS.

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Signature Page for HHS Contract Affirmations Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Baylor College of Medicine Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX August 24, 2022 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge One Baylor Plaza Exec. Dir. Sponsored Programs Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondHouston, TX 77469 77030 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondOne Baylor Plaza, MS: BCM310 Houston, TX 77469 77030 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxx@xxx.xxx 051113330 Email Address DUNS Number 746001969 000000000 1741613878A1 00-0000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 17416138786 0025618901 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 FXKMA43NTV21 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxx Xxxxx Legal Name of Contractor NArk-Tex Council of Governments/A Area Agency on Aging Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx February 28, 2022 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 2-27-22 Title of Authorized Representative 000 Xxxxxxx 0000 Xxxxxxxxx Xxxxxx RichmondTexarkana, TX 77469 75503 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxxx.xxx 00-000-0000 Email Address DUNS Number 746001969 000000000 00-0000000 17512933833 Federal Employer Identification Number Texas Identification Number (TIN) Nn/A 17460019692 a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 M6KPW65RAJ91 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Orange, County of Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Aut Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 X. 0xx Xxxxxx August 24, 2023 Authorized 2021 horized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondOrange, TX 77469 Texas 77630 Physical Street Address City, State, Zip Code 000 Xxxxxxx X. 0xx Xxxxxx RichmondXxxxxx, TX 77469 Xxxxx 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxx@xx.xxxxxx.xx.xx 001209753 Email Address DUNS Number 746001969 000000000 746001826 17460018264 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 17460018264 17460018264 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Community Council of Greater Dallas Legal Name of Contractor N/A Community Council of Greater Dallas Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX February 24, 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 X Xxxxxxxxxxx, TX 77469 Xxxxx 0000X Xxxxxx, Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code N/A Phone Number Fax Number xxxxxx@xxxxxxxxx.xxx 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 xxxxxx@xxxxxxxxx.xxx 081744427 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 00-0000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 081744427 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 01/31/2019 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Xxxxxxx County Health Department Legal Name of Contractor N/A Xxxxxxx County Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Xxxxxxx County Health Department Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX November 2, 2021 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 000 Xxxxx Xxxxxx Xxxxxx Health Department Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondSherman, TX 77469 Texas 75090 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same as above Same as above Mailing Address, if different City, State, Zip Code 000-000-0000 Ext. 0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xx.xxxxxxx.xx.us 023322357 Email Address DUNS Number 746001969 000000000 756000969 17560009692 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 00000000000 00000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier Attachment F ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxx Xxxxxx Legal Name of Contractor N/A Mission Granbury, Inc Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX September 21, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Xxxxxx Executive Director Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond0000 Xxxxx Xxxx Xxxxx Granbury, TX 77469 Texas 76049 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Xxxxx Xxxx Xxxxxx Xxxxxxx, Xxxxx 00000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 0000000000 8175796427 Email Address DUNS Number 746001969 xxxxxxx@xxxxxxxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 00-0000000 17527662229 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health FY22-FY23 Residential and Human Nonresidential Services (HHS) Uniform Terms Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000011 Page 5 of 6 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Salaries Contractor: MISSION GRANBURY INC A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Supervises Shelter Program Director, manager and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, non- residential case managers as well as finance manager. Ensures compliance with grant conditions. Provides some direct client support. 1FTE=78%FVP+17%SA+5% Other $ 7,250.00 12 $ 87,000.00 30.00% $ 26,100.00 2 Finance Manager Provides financial oversight ensuring compliance with all applicable federal fiscal policies and state laws and grant accounting regulations. Applicable federal Prepares all accounting and state laws grant budget reports. 0.8FTE=86%FVP+8%SA+6% Other. $ 3,572.00 12 $ 42,864.00 30.00% $ 12,859.20 3 Shelter Program Director Provides oversight for the residential victim shelter and regulations may includethe non-residential victim services program. 1FTE=70%FVP+30%SA $ 4,291.50 12 $ 51,498.00 40.00% $ 20,599.20 4 Shelter Victims Case Manager Manages the daily operation of the shelter, but are not limited tosupervises shelter advocates and provides direct client services. 1FTE=50%FVP+30%SA+20% Other $ 2,933.50 12 $ 35,202.00 16.00% $ 5,632.32 5 IT Specialist/ Operations Manager Provides IT support and ensures the security of the IT system. 1FTE=40%FVP+8%SA+52% Other $ 3,730.30 12 $ 44,763.60 20.00% $ 8,952.72 6 Shelter Advocate Answers 24 hour hotline calls and provides direct services to shelter residents. 1FTE. 100% FVP $ 1,005.34 12 $ 12,064.08 67.00% $ 8,082.93 7 Volunteer Recruiter/Community Resource Recruits and trains volunteers, secures client resources from the community, arranges for public education of victim's needs. 0.75FTE=70%FVP+15%SA+15% Other $ 2,222.87 12 $ 26,674.44 30.00% $ 8,002.33 8 Victim Services Case Manager Provides resources and services to non-residential clients.1FTE=40%FVP+42%SA+Other 18% $ 2,530.67 12 $ 30,368.04 40.00% $ 12,147.22 9 Director of Programs Provides support to non-residential case managers and maintains client files and data base. 1FTE=90%FVP+10% SA 10% $ 4,978.33 12 $ 59,739.96 40.00% $ 23,895.98 10 Case Manager Provides resources and services to non-residential clients. 1FTE=80%FVP+SA 8% +Other 12% $ 2,031.46 12 $ 24,377.52 30.00% $ 7,313.26 11 Case Manager Provides resources and services to non-residential clients. 0.70FTE=80%FVP+20% Other $ 1,599.52 12 $ 19,194.24 20.00% $ 3,838.85 12 Executive Assistant Provides support to the Executive Director, manages human resources and assists with grant compliance. 1FTE=80%FVP+20%SA $ 3,613.85 12 $ 43,366.20 45.00% $ 19,514.79 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Fringe Benefits - Employer Paid Portion Contractor: MISSION GRANBURY INC A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 6,655.50 $ 171.00 $ 36.90 $ - $ - $ 247.86 $ - $ - $ 7,111.26 30.00% $ 1,996.65 $ 51.30 $ 11.07 $ - $ - $ 74.36 $ - $ - $ 2,133.38 2 CFR Part 200, Uniform Administrative Requirements, Finance Manager Gross $ 3,279.10 $ 130.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 8,311.00 30.00% $ 983.73 $ 39.00 $ 11.07 $ 1,459.50 $ - $ - $ - $ - $ 2,493.30 3 Shelter Program Director Gross $ 3,939.60 $ 540.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 9,629.36 40.00% $ 1,575.84 $ 216.00 $ 14.76 $ 1,946.00 $ - $ 99.14 $ - $ - $ 3,851.74 4 Shelter Victims Case Manager Gross $ 2,692.95 $ 360.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 7,954.85 16.00% $ 430.87 $ 57.60 $ 5.90 $ 778.40 $ - $ - $ - $ - $ 1,272.77 5 IT Specialist/ Operations Manager Gross $ 3,424.42 $ 140.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,714.18 20.00% $ 684.88 $ 28.00 $ 7.38 $ 973.00 $ - $ 49.57 $ - $ - $ 1,742.83 6 Shelter Advocate Gross $ 922.90 $ 257.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,216.80 67.00% $ 618.34 $ 172.19 $ 24.72 $ - $ - $ - $ - $ - $ 815.25 7 Volunteer Recruiter/Comm unity Resource Gross $ 2,040.59 $ 55.00 $ 36.90 $ - $ - $ - $ - $ - $ 2,132.49 30.00% $ 612.18 $ 16.50 $ 11.07 $ - $ - $ - $ - $ - $ 639.75 8 Victim Services Case Manager Gross $ 2,323.16 $ 400.00 $ 36.90 $ 4,865.00 $ - $ 495.72 $ - $ - $ 8,120.78 40.00% $ 929.26 $ 160.00 $ 36.90 $ 1,946.00 $ - $ 198.29 $ - $ - $ 3,270.45 9 Director of Programs Gross $ 4,570.11 $ 100.00 $ 36.90 $ - $ - $ - $ - $ 4,707.01 40.00% $ 1,828.04 $ 40.00 $ 14.76 $ - $ - $ - $ - $ - $ 1,882.80 10 Case Manager Gross $ 1,864.88 $ 60.00 $ 36.90 $ - $ - $ 495.72 $ - $ - $ 2,457.50 30.00% $ 559.46 $ 18.00 $ 11.07 $ - $ - $ 148.72 $ - $ - $ 737.25 11 Case Manager Gross $ 1,468.36 $ 53.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,558.26 20.00% $ 293.67 $ 10.60 $ 7.38 $ - $ - $ - $ - $ - $ 311.65 Executive Gross $ 3,317.51 $ 151.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,618.27 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Consumable Supplies Contractor: MISSION GRANBURY INC A B C D E Description Justification Cost PrinciplesPercent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Shelter’s food To provide all items required for well-balanced meals o ingredients for well-balanced meals and snacks for children, and Audit Requirements any other reasonable ADA compliant dietary accommodation for Federal Awards; requirements residents who require special medical diets. $ 6,004.80 100.00% $ 6,004.80 2 Shelter's Janitorial/housekeeping supplies To provide all cleaning and janitorial supplies needed to keep the shelter facilities clean for the clients. $ 2,366.11 100.00% $ 2,366.11 3 Office supplies Office supplies such as copy paper, file folders, pens, pencils, paper clips, ink cartridges, batteries, computer accessories & devices such as computer mouse, mouse pads, cords, printer toner, masking tape, envelopes, labeling supplies, binders, file holders, sharpie permanent markers, invisible and masking tape, planners, cabinet filers, name tags, name badges used in the shelter. $ 4,565.38 50.00% $ 2,282.69 4 $ - 0.00% $ - 5 $ - 0.00% $ - 6 $ - 0.00% $ - 7 $ - 0.00% $ - 8 $ - 0.00% $ - 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - 18 $ - 0.00% $ - 19 $ - 0.00% $ - 20 $ - 0.00% $ - 21 $ - 0.00% $ - 22 $ - 0.00% $ - 23 $ - 0.00% $ - DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY22 Supplemental Justification Contractor: MISSION GRANBURY INC Cost Category Item # Justification 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Salaries Contractor: MISSION GRANBURY INC A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Executive Director Supervises Shelter Program Director, manager and non- residential case managers as well as finance manager. Ensures compliance with grant conditions. Provides some direct client support. 1FTE=78%FVP+17%SA+5% Other $ 7,250.00 12 $ 87,000.00 30.00% $ 26,100.00 2 Finance Manager Provides financial oversight ensuring compliance with all fiscal policies and grant accounting regulations. Prepares all accounting and grant budget reports. 0.8FTE=86%FVP+8%SA+6% Other. $ 3,572.00 12 $ 42,864.00 30.00% $ 12,859.20 3 Shelter Program Director Provides oversight for the residential victim shelter and the non-residential victim services program. 1FTE=70%FVP+30%SA $ 4,291.50 12 $ 51,498.00 40.00% $ 20,599.20 4 Shelter Victims Case Manager Manages the daily operation of the entity that awarded shelter, supervises shelter advocates and provides direct client services. 1FTE=50%FVP+30%SA+20% Other $ 2,933.50 12 $ 35,202.00 16.00% $ 5,632.32 5 IT Specialist/ Operations Manager Provides IT support and ensures the funds to HHS; Chapter 783 security of the Texas Government Code; Texas Comptroller IT system. 1FTE=40%FVP+8%SA+52% Other $ 3,730.30 12 $ 44,763.60 20.00% $ 8,952.72 6 Shelter Advocate Answers 24 hour hotline calls and provides direct services to shelter residents. 1FTE. 100% FVP $ 1,005.34 12 $ 12,064.08 67.00% $ 8,082.93 7 Volunteer Recruiter/Community Resource Recruits and trains volunteers, secures client resources from the community, arranges for public education of Public Accounts’ agency rules (including Uniform Grant victim's needs. 0.75FTE=70%FVP+15%SA+15% Other $ 2,222.87 12 $ 26,674.44 30.00% $ 8,002.33 8 Victim Services Case Manager Provides resources and services to non-residential clients.1FTE=40%FVP+42%SA+Other 18% $ 2,530.67 12 $ 30,368.04 40.00% $ 12,147.22 9 Director of Programs Provides support to non-residential case managers and maintains client files and data base. 1FTE=90%FVP+10% SA 10% $ 4,978.33 12 $ 59,739.96 40.00% $ 23,895.98 10 Case Manager Provides resources and services to non-residential clients. 1FTE=80%FVP+SA 8% +Other 12% $ 2,031.46 12 $ 24,377.52 30.00% $ 7,313.26 11 Case Manager Provides resources and services to non-residential clients. 0.70FTE=80%FVP+20% Other $ 1,599.52 12 $ 19,194.24 20.00% $ 3,838.85 12 Executive Assistant Provides support to the Executive Director, manages human resources and assists with grant compliance. 1FTE=80%FVP+20%SA $ 3,613.85 12 $ 43,366.20 45.00% $ 19,514.79 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Fringe Benefits - Employer Paid Portion Contractor: MISSION GRANBURY INC A B C D E F G H I J K Staff Position FICA & Medicare Workers' Compensation State Unemployment Insurance Health Insurance Life Insurance Dental Insurance Retirement Other - See Supplemental Justification Page Subtotals 1 Executive Director Gross $ 6,655.50 $ 171.00 $ 36.90 $ - $ - $ 247.86 $ - $ - $ 7,111.26 30.00% $ 1,996.65 $ 51.30 $ 11.07 $ - $ - $ 74.36 $ - $ - $ 2,133.38 2 Finance Manager Gross $ 3,279.10 $ 130.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 8,311.00 30.00% $ 983.73 $ 39.00 $ 11.07 $ 1,459.50 $ - $ - $ - $ - $ 2,493.30 3 Shelter Program Director Gross $ 3,939.60 $ 540.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 9,629.36 40.00% $ 1,575.84 $ 216.00 $ 14.76 $ 1,946.00 $ - $ 99.14 $ - $ - $ 3,851.74 4 Shelter Victims Case Manager Gross $ 2,692.95 $ 360.00 $ 36.90 $ 4,865.00 $ - $ - $ - $ - $ 7,954.85 16.00% $ 430.87 $ 57.60 $ 5.90 $ 778.40 $ - $ - $ - $ - $ 1,272.77 5 IT Specialist/ Operations Manager Gross $ 3,424.42 $ 140.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,714.18 20.00% $ 684.88 $ 28.00 $ 7.38 $ 973.00 $ - $ 49.57 $ - $ - $ 1,742.83 6 Shelter Advocate Gross $ 922.90 $ 257.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,216.80 67.00% $ 618.34 $ 172.19 $ 24.72 $ - $ - $ - $ - $ - $ 815.25 7 Volunteer Recruiter/Comm unity Resource Gross $ 2,040.59 $ 55.00 $ 36.90 $ - $ - $ - $ - $ - $ 2,132.49 30.00% $ 612.18 $ 16.50 $ 11.07 $ - $ - $ - $ - $ - $ 639.75 8 Victim Services Case Manager Gross $ 2,323.16 $ 400.00 $ 36.90 $ 4,865.00 $ - $ 495.72 $ - $ - $ 8,120.78 40.00% $ 929.26 $ 160.00 $ 36.90 $ 1,946.00 $ - $ 198.29 $ - $ - $ 3,270.45 9 Director of Programs Gross $ 4,570.11 $ 100.00 $ 36.90 $ - $ - $ - $ - $ 4,707.01 40.00% $ 1,828.04 $ 40.00 $ 14.76 $ - $ - $ - $ - $ - $ 1,882.80 10 Case Manager Gross $ 1,864.88 $ 60.00 $ 36.90 $ - $ - $ 495.72 $ - $ - $ 2,457.50 30.00% $ 559.46 $ 18.00 $ 11.07 $ - $ - $ 148.72 $ - $ - $ 737.25 11 Case Manager Gross $ 1,468.36 $ 53.00 $ 36.90 $ - $ - $ - $ - $ - $ 1,558.26 20.00% $ 293.67 $ 10.60 $ 7.38 $ - $ - $ - $ - $ - $ 311.65 Executive Gross $ 3,317.51 $ 151.00 $ 36.90 $ 4,865.00 $ - $ 247.86 $ - $ - $ 8,618.27 DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Consumable Supplies Contractor: MISSION GRANBURY INC A B C D E Description Justification Cost Percent Applied to HHSC Contract Standards set forth Amount Budgeted to HHSC Contract 1 Shelter’s food To provide all items required for well-balanced meals o ingredients for well-balanced meals and snacks for children, and any other reasonable ADA compliant dietary accommodation for residents who require special medical diets. $ 6,004.80 100.00% $ 6,004.80 2 Shelter's Janitorial/housekeeping supplies To provide all cleaning and janitorial supplies needed to keep the shelter facilities clean for the clients. $ 2,366.11 100.00% $ 2,366.11 3 Office supplies Office supplies such as copy paper, file folders, pens, pencils, paper clips, ink cartridges, batteries, computer accessories & devices such as computer mouse, mouse pads, cords, printer toner, masking tape, envelopes, labeling supplies, binders, file holders, sharpie permanent markers, invisible and masking tape, planners, cabinet filers, name tags, name badges used in Title 34, Part 1, Chapter 20, Subchapter E, Division the shelter $ 4,565.38 50.00% $ 2,282.69 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS$ - 0.00% $ - 5 $ - 0.00% $ - 6 $ - 0.00% $ - 7 $ - 0.00% $ - 8 $ - 0.00% $ - 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - 18 $ - 0.00% $ - 19 $ - 0.00% $ - 20 $ - 0.00% $ - 21 $ - 0.00% $ - 22 $ - 0.00% $ - 23 $ - 0.00% $ - DocuSign Envelope ID: EFDD7697-C8BA-46EC-91EB-65C979C5ED4D Family Violence Program Budget FY23 Supplemental Justification Contractor: MISSION GRANBURY INC Cost Category Item # Justification 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Northeast Texas Public Health District Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Authorize Xxxxxx X. Xxxxxxx, Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12August 18, 2023 Authorized 2021 d Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxx Xxxxx 000 Xxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 same as above same as above Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxx.xxx 144656753 Email Address DUNS Number 746001969 000000000 00-0000000 17522545445 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 00000 00000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows HHS Contract No: HHS001024000004 Page 25 of 230 Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxx "Kit" Xxxxxxxx Legal Name of Contractor N/A Midland County Hospital District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx August 16, 2022 Signature of Authorized Representative Date Signed Xxxxxxx "Kit" Bredimus Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 8-16-22 Title of Authorized Representative 000 Xxxxxxxx Xxxxxxx Xxxxxx RichmondPkwy Midland, TX 77469 TX, 79701 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxx.xxxxxxxx@xxxxxxxxxxxxx.xxx 073149411 Email Address DUNS Number 746001969 000000000 751584559 17515845596 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 - - Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 - XXX.xxx Unique Entity Identifier (UEI) HHS Contract No: HHS001024000004 DSHS XXXXX AGREEPPMagEe 2N6 oTf 230 Attachment E- Uniform Terms and Conditions-- Grant Version 3.0 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ ' agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Atascosa Health Center, Inc. Legal Name of Contractor N/A Atascosa Health Center, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx March 27, 2024 Signature of Authorized Representative Date Signed Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge CEO Title of Authorized Representative 000 X. Xxxxxxx Xxxxxx RichmondXxxxxxxxxx, TX 77469 Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same as above Same as above Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxx-xxx.xxx 132954496 Email Address DUNS Number 746001969 000000000 00-0000000 17420891032 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 0050005301 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 MW4NM5KU2M81 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g filed Signature of Authorized Representative Date Signed XX Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier Certificate Of Completion Envelope Id: E83CB7EE1CCC449A958E5C5B54BADBBE Status: Sent Subject: HHS001084500001, Fort Bend County Health & Human Services, Base Contract Source Envelope: Document Pages: 62 Signatures: 0 Envelope Originator: Certificate Pages: 6 Initials: 0 CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UEIUTC-06:00) Health Central Time (US & Canada) 00000 Xxxxxx Xxxxx Xxxx #000 Reston, VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: 160.42.85.9 Record Tracking Status: Original 8/2/2021 3:09:31 PM Holder: CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp XX Xxxxxx xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Human Services Signature Disclosure: Accepted: 8/2/2021 3:59:58 PM ID: 474773d2-9ba5-441a-b77e-59bd9f48590f XX Xxxxxx xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (HHSNone) Uniform Terms Electronic Record and Conditions - Grant Version 3.2 Published Signature Disclosure: Accepted: 8/2/2021 3:59:58 PM ID: 474773d2-9ba5-441a-b77e-59bd9f48590f Xxxxx Xxxxxxxxxxx xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Effective – July 2022 Responsible OfficeSignature Disclosure: Chief Counsel ABOUT THIS DOCUMENT Accepted: 7/30/2021 2:59:21 PM ID: 9a50a71a-8ec2-438f-a748-369d41aebe51 Xxxxx Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 8/2/2021 12:17:45 PM ID: d82d1e7c-a072-4b17-a0b9-63d90d3ed840 Xxxx Xxxxxx Xxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 8/2/2021 3:50:14 PM Viewed: 8/2/2021 3:59:58 PM Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Kirk Cole Xxxx.Xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 7/16/2021 10:23:16 AM ID: e8bc5df6-0571-4761-8d83-af9fe1c7214a In this documentPerson Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Xxxxxxxx Xxxxx Xxxxxxxx.Xxxxx@xxxx.xxxxx.xxx Security Level: Email, Grantees Account Authentication (also referred None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx Xxxxxx Xxxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Xxxxxx Xxxx.Xxxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 8/2/2021 3:50:14 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: XX Xxxxxx, XX Xxxxxx, Xxxxx Xxxxxxxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to in this document as subrecipients time, DSHS Contract Management Section (we, us or contractorsCompany) will find requirements and conditions applicable may be required by law to grant funds administered and passed-through by both provide to you certain written notices or disclosures. Described below are the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. 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All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this document are process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact DSHS Contract Management Section: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in addition your email address where we should send notices and disclosures electronically to all requirements listed you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the RFAbody of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any, under which applications for this grant award are accepted, as well as all applicable federal . To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth disclosures in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSelectronic format you may:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Xxxxxx Xxxxxx County Public Health District Legal Name of Contractor N/A Xxxxxx Xxxxxx County Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Xxxxxx Xxxxxx County Public Health District Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12March 23, 2023 Signature of Authorized Representative Date Signed County Judge Administrative Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 X Xxxxx Xx Jasper Texas 75951 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 X Xxxxx Xx Jasper Texas 75951 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxxxxxxxx.xxx 078708416 Email Address DUNS Number 746001969 000000000 746001457 17460014578001 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 746001457 746001457 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 DTDKJ98MNHP7 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Lubbock Regional MHMR Center Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX October 6, 2022 Signature of Authorized Representative Date Signed Xxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxx. O Lubbock, TX 77469 Texas 79401 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 2828 Lubbock, TX 77469 Texas 79408 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxxxxxxxxxxx.xxx 098786460 Email Address DUNS Number 746001969 17512976915000 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 TEKNZFR8LLK4 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows DocuSign Envelope ID: 40B8F4E8-197F-4661-8C05-23B4CB8712E4 DocuSign Envelope ID: 40B8F4E8-197F-4661-8C05-23B4CB8712E4 Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Texas A&M AgriLife Extension Services Legal Name of Contractor Nn/A a Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Nn/A a Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative Date Signed July 29, 2023 Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12Associate Director, 2023 Authorized Representative Date Signed County Judge TAMU SRS Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxxxx Parkway, Suite 300 College Station, TX 77469 77845-4375 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 same same Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx@xxxx.xxx 00-000-0000 Email Address DUNS Number 746001969 000000000 00-0000000 35555555552 Federal Employer Identification Number Texas Identification Number (TIN) Nn/A 17460019692 a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 DM2CDWR8LAG3 XXX.xxx Unique Entity Identifier (UEI) Attachment D Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County City of Laredo Legal Name of Contractor N/A City of Laredo Health Department Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Xxxxxxx X. Xxxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 1211, 2023 Authorized Representative Date Signed County Judge Health Director Title of Authorized Representative 000 Xxxxxxx 0000 Xxxxx Xxxxxx RichmondXxxxxx, TX 77469 Xxxxx 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondP.O. Box 4337 Laredo, TX 77469 Texas 78040 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxxx@xx.xxxxxx.xx.xx 618150460 Email Address DUNS Number 746001969 000000000 00-0000000 17460015732021 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 HWX7C56NNUV1 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxx Xxxxxx Legal Name of Contractor NHouston Regional HIV/A AIDS Resource Group, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A The Resource Group Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12March 14, 2023 2022 Signature of Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxxxxx, TX 77469 Suite 100 Houston, Texas 77006 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxx@xxxxxx.xxx 876909847 Email Address DUNS Number 746001969 000000000 760414232 760414232000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 na 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 MXUPMFLE8D58 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxx X Xxxxxx Legal Name of Contractor N/A Twin City Mission, Inc Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX September 23, 2021 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge 0000 X Xxxxxxx Xxx CEO Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondBryan, TX 77469 77801 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondPO Box 3490 Bryan, TX 77469 77805 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxx@xxxxxxxxxxxxxxx.xxx 010801827 Email Address DUNS Number 746001969 000000000 00-0000000 17415336399 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 0026924180 0019982301 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier (UEI) Health FY22-FY23 Residential and Human Nonresidential Services (HHS) Uniform Terms Contracts Amendment 3 Attachment M: Revised FY 2022-2023 Budget Workbooks System Agency Contract No. HHS000380000073 Page 5 of 6 DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY22 Salaries Contractor: Twin City Mission A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Program Director Overall responsibility for operation of the DVS program and Conditions ensuring compliance with all contractual obligations. $ 5,386.33 12 $ 64,635.96 90.00% $ 58,172.36 2 Volunteer Coodinator Responsible for coordination of DVS volunteer program - Grant Version 3.2 Published $ 1,256.66 12 $ 15,079.92 25.00% $ 3,769.98 3 Shelter Monitor FT GG Responsible for answering 24 hour hot line; client intake supervision and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department meeting immediate needs of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed clients in the RFAshelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 4 Shelter Monitor FT DP Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 5 Shelter Monitor PT GP Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 776.00 12 $ 9,312.00 100.00% $ 9,312.00 6 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 7 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 8 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 9 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 10 $ - 100.00% $ - 11 $ - 0.00% $ - 12 $ - 0 $ - 0.00% $ - 13 $ - 0 $ - 0.00% $ - 14 $ - 0 $ - 0.00% $ - 15 $ - 0 $ - 0.00% $ - 16 $ - 0 $ - 0.00% $ - 17 $ - 0 $ - 0.00% $ - 18 $ - 0 $ - 0.00% $ - DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY22 Other Contractor: Twin City Mission A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Postage HHSC program and client mail; $10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 120.00 0.00% $ - 2 Printing Business cards, if anybrochures and other informational material for DVS clients; $129.7858 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,557.43 0.00% $ - 3 Waste Disposal disposal for client shelter; $231.7458 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,780.95 100.00% $ 2,780.95 4 Small tools and equipment needed small tools for client shelter upkeep (vaccum, under which applications cooker, doorbell, etc.); $68.10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 817.21 100.00% $ 817.21 5 Family Assistance direct client assistance (transportation:trolley tickets,parking,fuel, oil, other mass transit/childcare/Diapers & formula/Clothing & Shoes/Eye, Dental and Medical Assistance/ Identification & Birth Certificates/Prescription and Non-Prescription Medications/Pet support food and care/language translation; $ 2,618.00 0.00% $ - 6 Program Vehicles - Fuels and Lubricants Vehicle used for this grant award are accepted, as well as all applicable federal client transport; $44 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 528.00 100.00% $ 528.00 7 Program Vehicles - Maint and state laws and regulationsRepairs Vehicle used for client transport; $50 per month x 12 months; HHSC = 100% Based on Historical Data. Applicable federal and state laws and regulations may include, but are not limited to$ 600.00 100.00% $ 600.00 8 Program Vehicles - Insurance Vehicle used for client transport; $242 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,904.00 100.00% $ 2,904.00 9 Utilities Client shelter/Advocacy Center; $875.5858 per month x 12 months; HHSC = 100% Based on Historical Data. $ 10,507.03 100.00% $ 10,507.03 10 Phone Client shelter/Advocacy Center; $334 per month x 12 months; HHSC = 100% Based on Historical Data. $ 4,008.00 100.00% $ 4,008.00 11 Cell Phone Direct client provider use; $90.1667 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,082.00 100.00% $ 1,082.00 12 Cable TV Client Shelter; $102.545 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 1,230.54 100.00% $ 1,230.54 13 Storage Space Rental Offsite storage for DVS material; $8 per month x 12 months; HHSC = 100% Based on Historical Data. $ 96.00 100.00% $ 96.00 14 Building Repair/Maint-general Client shelter/Advocacy Center; $678.3333 per month x 12 months; HHSC = 40% Based on Historical Data. $ 8,140.00 100.00% $ 8,140.00 DocuSign Envelope ID: 2 CFR Part 200, Uniform Administrative Requirements, 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY22 Supplemental Justification Contractor: Twin City Mission Cost Principles, and Audit Requirements Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Salaries Contractor: Twin City Mission A B C D E F G Staff Position Justification Monthly Salary No. of Months Annual Salary Percent applied to HHSC contract Amount budgeted to HHSC contract 1 Program Director Overall responsibility for Federal Awards; requirements operation of the entity that awarded DVS program and ensuring compliance with all contractual obligations. $ 5,386.33 12 $ 64,635.96 90.00% $ 58,172.36 2 Volunteer Coodinator Responsible for coordination of DVS volunteer program - $ 1,256.66 12 $ 15,079.92 25.00% $ 3,769.98 3 Shelter Monitor FT GG Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the funds shelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 4 Shelter Monitor FT DP Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 2,291.00 12 $ 27,492.00 100.00% $ 27,492.00 5 Shelter Monitor PT GP Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 776.00 12 $ 9,312.00 100.00% $ 9,312.00 6 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 7 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 8 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 9 Shelter Monitor PT Responsible for answering 24 hour hot line; client intake supervision and meeting immediate needs of clients in the shelter; $ 492.16 12 $ 5,905.92 100.00% $ 5,905.92 10 $ - 0 $ - 0.00% $ - 11 $ - 0 $ - 0.00% $ - 12 $ - 0 $ - 0.00% $ - 13 $ - 0 $ - 0.00% $ - 14 $ - 0 $ - 0.00% $ - 15 $ - 0 $ - 0.00% $ - 16 $ - 0 $ - 0.00% $ - 17 $ - 0 $ - 0.00% $ - 18 $ - 0 $ - 0.00% $ - DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Consumable Supplies Contractor: Twin City Mission A B C D E Description Justification Cost Percent Applied to HHSHHSC Contract Amount Budgeted to HHSC Contract 1 Housekeeping supplies supplies for cleaning, bath and floor products; Chapter 783 $113.34 per month x 12 months = $1,360.11; HHSC = 90% Based on Historical Data.. $ 1,360.11 90.00% $ 1,245.52 2 Laundry Supplies supplies to launder shelter linens, sheets, towels, blankets, etc..; $55 per month x 12 months = $660; HHSC = 100% Based on Historical Data. $ 660.00 100.00% $ 660.00 3 Medical Supplies Non-prescription medical items for clients of the Texas Government CodeDVS program; Texas Comptroller of Public Accounts’ agency rules $50 per month x 12 months = $600; HHSC = 100% Based on Historical Data. $ 600.00 100.00% $ 600.00 4 Office Supplies HHSC staff funded office supplies, such as paper, envelopes, pens, pencils, calenders, notebooks, paperclips, etc…$85 per month x 12 months = $1,020; HHSC = 80% Based on Historical Data. $ 1,020.00 80.00% $ 816.00 5 IT Supplies HHSC staff funded supplies, such as printer cartridges, antivirus software, etc….$20 per month x 12 months = $240; HHSC = 100% Based on Historical Data. $ 240.00 100.00% $ 240.00 6 Commercial Supplies supplies for kitchen area such as paper goods, plasticware, food storage containers, etc…$100 per month x 12 months = $1,200; HHSC = 100% Based on Historical Data. $ 1,200.00 100.00% $ 1,200.00 7 Activity Supplies arts and crafts, games for group activities; $41.94 per month x 12 months = $503.35; HHSC = 100% Based on Historical Data. $ 503.35 100.00% $ 503.35 8 $ - 0.00% $ - 9 $ - 0.00% $ - 10 $ - 0.00% $ - 11 $ - 0.00% $ - 12 $ - 0.00% $ - 13 $ - 0.00% $ - 14 $ - 0.00% $ - 15 $ - 0.00% $ - 16 $ - 0.00% $ - 17 $ - 0.00% $ - 18 $ - 0.00% $ - 19 $ - 0.00% $ - DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Other Contractor: Twin City Mission A B C D E Description Justification Cost Percent Applied to HHSC Contract Amount Budgeted to HHSC Contract 1 Postage HHSC program and client mail; $10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 120.00 0.00% $ - 2 Printing Business cards, brochures and other informational material for DVS clients; $129.7858 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,557.43 0.00% $ - 3 Waste Disposal disposal for client shelter; $231.7458 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,780.95 100.00% $ 2,780.95 4 Small tools and equipment needed small tools for client shelter upkeep (including Uniform Grant and Contract Standards set forth in Title 34vaccum, Part 1cooker, Chapter 20doorbell, Subchapter E, Division 4 of the Texas Administrative Codeetc.); the Texas Grant Management Standards $68.10 per month x 12 months; HHSC = 100% Based on Historical Data. $ 817.21 100.00% $ 817.21 5 Family Assistance direct client assistance (TxGMS) developed by the Texas Comptroller of Public Accountstransportation:trolley tickets,parking,fuel, oil, other mass transit/childcare/Diapers & formula/Clothing & Shoes/Eye, Dental and Medical Assistance/ Identification & Birth Certificates/Prescription and Non-Prescription Medications/Pet support food and care/language translation; $ 2,618.00 0.00% $ - 6 Program Vehicles - Fuels and the Funding Announcement, Solicitation, or other instrumentLubricants Vehicle used for client transport; $44 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 528.00 100.00% $ 528.00 7 Program Vehicles - Maint and Repairs Vehicle used for client transport; $50 per month x 12 months; HHSC = 100% Based on Historical Data. $ 600.00 100.00% $ 600.00 8 Program Vehicles - Insurance Vehicle used for client transport; $242 per month x 12 months; HHSC = 100% Based on Historical Data. $ 2,904.00 100.00% $ 2,904.00 9 Utilities Client shelter/documentation under which HHS was awarded fundsAdvocacy Center; $875.5858 per month x 12 months; HHSC = 100% Based on Historical Data. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions$ 10,507.03 100.00% $ 10,507.03 10 Phone Client shelter/Advocacy Center; $334 per month x 12 months; HHSC = 100% Based on Historical Data. TABLE OF CONTENTS$ 4,008.00 100.00% $ 4,008.00 11 Cell Phone Direct client provider use; $90.1667 per month x 12 months; HHSC = 100% Based on Historical Data. $ 1,082.00 100.00% $ 1,082.00 12 Cable TV Client Shelter; $102.545 per month x 12 months ; HHSC = 100% Based on Historical Data. $ 1,230.54 100.00% $ 1,230.54 13 Storage Space Rental Offsite storage for DVS material; $8 per month x 12 months; HHSC = 100% Based on Historical Data. $ 96.00 100.00% $ 96.00 14 Building Repair/Maint-general Client shelter/Advocacy Center; $678.3333 per month x 12 months; HHSC = 40% Based on Historical Data. $ 8,140.00 100.00% $ 8,140.00 DocuSign Envelope ID: 65AC4587-DF67-4CD7-B4F0-CB109997AB62 Family Violence Program Budget FY23 Supplemental Justification Contractor: Twin City Mission Cost Category Item # Justification 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx Xxxxx, Executive Director Legal Name of Contractor N/A Sabine Valley Regional MHMR Center Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Community Healthcore Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx July 1, 2022 Signature of Authorized Representative Date Signed Inman White Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxxxx XX Xxxxxxxx, TX 77469 XX, 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondXX Xxx 0000 Xxxxxxxx, TX 77469 XX, 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 0000000000 0000000000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Xxxxx.xxxxx@xxxxxxxxxxxxxxxxxxx.xxx 069749448 Email Address DUNS Number 746001969 000000000 00-0000000 175-17240176 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 na na Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 NN8HAE49J9U6 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 3.0 Published and Effective – July 2022 August 2021 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Devoted Health Plan of Texas, Inc. Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Authorized Representative Date Signed Xxxxxx Xxxxxxxx President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 00000 Xxxxx Xxxxxxx 000, Xxxxx 000 Xxxxxxx Xxxxxx RichmondXxxxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxxxx Xxxxxx RichmondXxxxxxx, TX 77469 XX, 00000 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 XXxxxxxxx@xxxxxxx.xxx 00-000-0000 Email Address DUNS Number 746001969 000000000 00-0000000 32076223471 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 0803071730 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 N/A XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor By submitting this Response, Respondent represents and warrants that the individual signing submitting this Contract Affirmations document and the documents made part of this Response is authorized to sign such documents on behalf of Contractor the Respondent and to bind the ContractorRespondent under any contract that may result from the submission of this Response. Signature Page Follows Authorized representative on behalf of Contractor Respondent must complete and sign the following: Fort Bend County TransAfrican Development Inc. Legal Name of Contractor N/A Respondent dba Ndando House Assumed Business Name of ContractorRespondent, if applicable (d/b/a or ‘doing business as’) N/A Fort Bend County Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Signature of Authorized Representative Date Signed 12/22/2021 Xxxxxx Xxxxxx-Xxxx Chief Executive Officer Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxxxx Xxxxx Xxxx. #000 Xxxxx Xxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxx@xxxxxxxxxxx.xxx 078349981 Email Address DUNS Number 746001969 000000000 611583739 30246320951 Federal Employer Identification Number Texas Identification Number (TIN) Payee ID No. – 11 digits N/A 17460019692 801528899 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier OE N DocuSign Envelope ID: 7F1DA304-BC25-4227-805A-B41AFC081DDC O. HHS0010736 EXHIBIT C– Assurances - Non-Construction Programs ASSURANCES - NON-CONSTRUCTION PROGRAMS Attachment F OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County MTX Group Inc Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a D.B.A. or ‘doing business as’) N/A NA Texas County(s) for Assumed Business Name (d/b/a D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Signature of Authorized Representative May 13, 2020 Date Signed Das Nobe1 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Chief Execukive Officer Title of Authorized Representative 0000 Xxxxxxx Xxx, XXX 000 Xxxxxxx Xxxxxx RichmondA1bany, TX 77469 NY 12203 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Same same Mailing Address, if different City, State, Zip Code 000-000-0000 000na Phone Number Fax Number das§xxxx0x.xxx 00-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 00-0000000 32068766131 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 32068766131 0803274691 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ATTACHMENT F DATA USE AGREEMENT ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxxxx Xxxxxxx Legal Name of Contractor N/A Central Counties Center for MHMR Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Central Counties Services Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx October 25, 2021 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Executive Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Xxxxxxx Executive Director Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondTemple, TX 77469 76501 Mailing Address, if different City, State, Zip Code 000 Xxxxx 00xx Xxxxxx Xxxxxx, XX 00000 Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 xxxxxxx.xxxxxxx@xxx0000.xxx 0 59 057 927 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 00-0000000 00-0000000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Barrio Comprehensive Family Health Care Center, Inc. Legal Name of Contractor N/A Barrio Comprehensive Family Health Care Center, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A CommuniCare Health Centers Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX April 3, 2024 Signature of Authorized Representative Date Signed Xxxx X. Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge President and CEO Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 Xxxx Xxxxxxxx Xx. Xxx Xxxxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondXxxxx Xx. San Antonio, TX 77469 78216 Mailing Address, if different City, State, Zip Code (000-) 000-0000 (000-) 000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxx@xxxxxxxxxxxxx.xxx 039844741 Email Address DUNS Number 746001969 7417243916 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 17417243916 00048364301 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 MCDDPAH9XZK3 XXX.xxx Unique Entity Identifier (UEI) Health ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040-0009 Expiration Date: 02/28/2025 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and Human Services maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant:, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Xxxxx X. Xxxxx, CEO Legal Name of Contractor N/A North Texas Behavioral Heath Authority Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A NTBHA Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx November 2, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 0000 XXX Xxxx, Xxxxx 000 Xxxxxxx Xxxxxx RichmondXxxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code same Phone Number Fax Number 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 xxxxxx@xxxxx.xxx 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits 00-0000000 17528112695000 Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Northeast Texas Public Health District Legal Name of Contractor N/A Northeast Texas Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx X Xxxxxxx, Xx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12May 23, 2023 Signature of Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxx #000 Xxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxx #000 Tyler, TX 77469 75702 Mailing Address, if different City, State, Zip Code 000-000-0000 9,035,350,036.00 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxx.xxx Email Address DUNS Number 746001969 000000000 752254544 17522545445 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 QYUMYH4V9EK5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County City of Harlingen Legal Name of Contractor N/A City of Harlingen Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A City of Harlingen Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx ized Representative March 27, 2023 Signature of Author Date Signed Xxxxxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge City Manager Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondXxxxxxxx Xxxxxxxxx, TX 77469 Texas 78550 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondXxxx Xxxxx Xxxxxxxxx, TX 77469 Xxxxx 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxxx@xxxxxxxxxxx.xx 069448124 Email Address DUNS Number 746001969 000000000 00-0000000 00-0000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 17460010477 NONE Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 H2ZDRPM1SZX3 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend Medina County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx horized Representative May 2, 2023 Signature of Aut Date Signed Xxxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed Medina County Judge Health Unit Director Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond0000 00xx Xx Xxxxx, TX 77469 Xxxxx, 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond0000 00xx Xx Xxxxx, TX 77469 Xxxxx, 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx xxxxxxx@xxxxxxxx.xxx 080272057 Email Address DUNS Number 746001969 000000000 00-0000000 17460011061 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 TRVPZC6NT9E4 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Northeast Texas Public Health District Legal Name of Contractor N/A Northeast Texas Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx X Xxxxxxx, Xx. Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 1210, 2023 Authorized ed Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxx #000 Xxxxx, TX 77469 XX 00000 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondX. Xxxxxxxx #000 Xxxxx, TX 77469 XX 00000 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxxxx@xxxxxx.xxx 144656753 Email Address DUNS Number 746001969 000000000 752254544 17522545445 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 N/A Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 QYUMYH4V9EK5 XXX.xxx Unique Entity Identifier (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed-through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx filed Signature of Authorized Representative Date Signed Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12, 2023 Authorized Representative Date Signed County Judge Title of Authorized Representative 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx Richmond, TX 77469 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 Email Address DUNS Number 746001969 000000000 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier Certificate Of Completion Envelope Id: B7915258DF92448989481EA52346E145 Status: Sent Subject: HHS001074700001, Collin County HCS, Base Contract Source Envelope: Document Pages: 62 Signatures: 0 Envelope Originator: Certificate Pages: 6 Initials: 0 CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UEIUTC-06:00) Health Central Time (US & Canada) 00000 Xxxxxx Xxxxx Xxxx #000 Reston, VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: 160.42.85.9 Record Tracking Status: Original 7/30/2021 8:36:42 AM Holder: CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp Xxxxx Xxxx XXXXX@XX.XXXXXX.XX.XX County Judge Collin County Security Level: Email, Account Authentication (None) Electronic Record and Human Services Signature Disclosure: Not Offered via DocuSign Xxxxx Xxxx XXXXX@XX.XXXXXX.XX.XX County Judge Collin County Security Level: Email, Account Authentication (HHSNone) Uniform Terms Electronic Record and Conditions - Grant Version 3.2 Published Signature Disclosure: Not Offered via DocuSign Xxxxx Xxxxxxxxxxx xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Effective – July 2022 Responsible OfficeSignature Disclosure: Chief Counsel ABOUT THIS DOCUMENT Accepted: 7/30/2021 2:59:21 PM ID: 9a50a71a-8ec2-438f-a748-369d41aebe51 Xxxxx Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 8/4/2021 7:18:32 AM ID: 3e551597-07bf-4af4-9c03-fe75ae8f8a2d Xxxx Xxxxxx Xxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 8/4/2021 11:33:46 AM Sent: 7/30/2021 9:07:55 AM Resent: 8/2/2021 10:04:52 AM Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Kirk Cole Xxxx.Xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 7/16/2021 10:23:16 AM ID: e8bc5df6-0571-4761-8d83-af9fe1c7214a In this documentPerson Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Xxxxxx Xxxxxx XXXXXXX@XX.XXXXXX.XX.XX Security Level: Email, Grantees Account Authentication (also referred None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxxx Xxxxx Xxxxxxxx.Xxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx Xxxxxx Xxxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 8/4/2021 11:33:47 AM Viewed: 8/4/2021 11:36:18 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 7/30/2021 9:07:55 AM Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxx Xxxxxxxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to in this document as subrecipients time, DSHS Contract Management Section (we, us or contractorsCompany) will find requirements and conditions applicable may be required by law to grant funds administered and passed-through by both provide to you certain written notices or disclosures. Described below are the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this document are process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact DSHS Contract Management Section: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in addition your email address where we should send notices and disclosures electronically to all requirements listed you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the RFAbody of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any, under which applications for this grant award are accepted, as well as all applicable federal . To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth disclosures in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSelectronic format you may:

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Fort Bend County Heart of Texas Region MHMR Center Legal Name of Contractor N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) N/A Heart of Texas Behavioral Health Network Texas County(s) for Assumed Business Name (d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Where Assumed Name Certificate(s) has been filed. g XX Xxxxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name April 12000 X. 00xx Xxxxxx November 3, 2023 2021 Signature of Authorized Representative Date Signed County Judge Chief Executive Officer Title of Authorized Representative 000 Xxxxxxx Xxxxxx RichmondWaco, TX 77469 Texas 76701 Physical Street Address City, State, Zip Code 000 Xxxxxxx Xxxxxx RichmondP.O. Box 890 Waco, TX 77469 Texas 76703-0890 Mailing Address, if different City, State, Zip Code 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 081497075 xxxxxx.xxxxxxxx@xxxxxxxx.xxx 010470870 Email Address DUNS Number 746001969 000000000 00-0000000 1-741622958-5002 Federal Employer Identification Number Texas Identification Number (TIN) N/A 17460019692 Payee ID No. – 11 digits none none Texas Franchise Tax Number Texas Secretary of State Filing Number MJG8N8EPN2L3 XXX.xxx Unique Entity Identifier ASSURANCES - NON-CONSTRUCTION PROGRAMS OMB Number: 4040-0007 Expiration Date: 02/28/2022 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (UEI) Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.2 Published and Effective – July 2022 Responsible Office0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions Certain of these assurances may not be applicable to grant funds administered and passed-through by both your project or program. If you have questions, please contact the Texas Health and Human Services Commission (HHSC) and awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the Department of State Health Services (DSHS)case, you will be notified. These requirements and conditions are incorporated into As the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements duly authorized representative of the entity applicant, I certify that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSapplicant: