Common use of Signature Authority Clause in Contracts

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313

Appears in 2 contracts

Samples: contracts.hhs.texas.gov, contracts.hhs.texas.gov

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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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Hope Horizon, LLC Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx Xxxxxxxxxx Xxx, Xxx 000 XxxxxxXxxxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 (000)000-0000 (000)000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 Email Address DUNS Number 462865809 32051100371 00-0000000 32028367541 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131332028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing

Appears in 2 contracts

Samples: contracts.hhs.texas.gov, contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Permian Basin Communiky Cenkers for Menka1 Hea1kh & Menka1 Rekardakion Legal Name of Contractor PermiaCare Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Mid1and Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized orized Representative Augusk 1921, 2020 g Date Signed Michae1 No1an Xxxxx Xxxxxx00 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx491 E I11inois, XX 00000 Suike 401 Mid1and, Tx, 79701-4803 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark401 E I11inois, FL 34997 Suike 401 Mid1and, Tx, 79701-4803 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 chrisbarnhi11§xxxxxxxxxx.xxx 074145561 Email Address DUNS Number 462865809 32051100371 00-0000000 17514017767 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313NA NA

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Xxxxxxxx X. Xxxxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Where Assumed Name Certificate(s) has been filed Xxxxxxxx X. Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer July 23, 2021 Signature of Authorized Representative Date Signed Chairperson Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 X. Xxxxxxxx Xxxxxx Woodville, XX 00000 TX 75979 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000 000-0000 000 000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxx000@xxx.xxx 786314034 Email Address DUNS Number 462865809 32051100371 00-0000000 01134305029 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313x x

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an West Central Texas Council of Governments Legal Name of Contractor West Central Texas Council of Governments Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) West Central Texas Council of Governments Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19September 3, 2020 Date Signed Michae1 No1an Xxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Executive Director Title of Authorized Representative 0000 Xxxx 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxx@xxxxxxxxxxxxxxxx.xxx 610790425 Email Address DUNS Number 462865809 32051100371 00-0000000 17512442439 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 08017913130 0

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Uniked Medica1 Cenkers Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Augusk 25, 2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xx00xxx X. Xxxxx00 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 X. Xxxxxxxx X0xx Xxx0x Xxxx, XX Xxxxx 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 wworre11.umc§xxxxx.xxx 031926009 Email Address DUNS Number 462865809 32051100371 741993570 17419935709 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313N/A 44215301

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an B1uebonnek Trai1s Communiky MHMR Cenker d/b/a B1uebonnek Trai1s Communiky Services Legal Name of Contractor B1uebonnek Trai1s Communiky Services Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Baskrop, Burnek, Ca1dwe11, Fayekke, Gonza1es, Guada1upe, Xxx and Wi11iamson Counkies Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 194, 2020 Date Signed Michae1 No1an Xxxxxx Xxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Direckor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx1009 X. Xxxxxxxxxx Skreek Round Rock, XX 00000 Texas 78664-3289 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxx.richardson§xxxxxx0x.xxx 965803432 Email Address DUNS Number 462865809 32051100371 742795332 17427953320 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Nok App1icab1e 17427953320000

Appears in 1 contract

Samples: Interlocal Cooperation Contract

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an My Health My Resources of Tarrant County Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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. March 8, 2024 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 Xxxxx Xxxxxx Fort Worth, XX 00000 TX, 76107 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000.000.0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxx@xxxxxx.xxx 00-000-0000 Email Address DUNS Number 462865809 32051100371 00-0000000 1757129456 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Identification Number (TIN) 30119759329 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number LJ9ENHUAKHV3

Appears in 1 contract

Samples: Interlocal Cooperation Contract Health and Human Services

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized orized Representative Augusk 19, 2020 g Date Signed Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxBui1ding 3 suike 290 098515457 Irving, XX 00000 TX 75039 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Communiky Hea1kh Cenker of Lubbock, Inc. Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Augusk 20, 2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Su11ivan Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 08/20/2020 Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 0xx Xxxxxx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 msu11ivan§xxx0.xxxxx.xxx 841895600 Email Address DUNS Number 462865809 32051100371 00-0000000 17524249251 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131317524249251000 0122584101

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Soukh P1ains Pub1ic Hea1kh Diskrick Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Augusk 24, 2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Soronya Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Direckor of C1inica1 Services Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxP91h9ysEic.alMSaitrneeStk.Address CBirtoyw, XX 00000 Physical Street Address CitynSftiaet1ed, State,ZiTpXCo7d9e316 P.O. Box 112 Brownfie1d, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 TX 79316 Mailing Address, if different City, State, Zip Code 0000000000 000 000 0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 sshafer§xxxxx.xxx 009898441 Email Address DUNS Number 462865809 32051100371 756002471 17560024717 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313N/A N/A

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Ronde11i Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized rized Representative Augusk 1927, 2020 Date Signed Michae1 No1an Ronde11i Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 0000 Xxxxx Xxxx0x #311334 AVP, RCA Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxDenkon, XX 00000 TX 76203 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 researchconkracks§xxx.xxx 614168995 Email Address DUNS Number 462865809 32051100371 00-0000000 37527527529 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313NT756002149 nok app1icab1e

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an A1amo Area Counci1 of Governmenks Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19Sepkember 25, 2020 Date Signed Michae1 No1an Xxxxx X. Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Sepk. 25, 2020 Title of Authorized Representative 0000 Xxxxxx Xxxxx, xxx 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxx Xxxxxxx, XX Xx 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000 000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 drakh§xxxxx.xxx 010544658 Email Address DUNS Number 462865809 32051100371 00-0000000 17415574916 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313NA NA

Appears in 1 contract

Samples: Health and Human Services Commission

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Xxx X. Xx00xxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Ockober 6, 2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxx X. Xx00xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Independenk Conkrackor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 00000 Xxxxxxx XXxx Xxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 (c)000-000-0000 NA Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Xxx.Su11ivan§xxxx.xxxxx.xxx 080525683 Email Address DUNS Number 462865809 32051100371 000-00-0000 7003905518 4 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313NA NA

Appears in 1 contract

Samples: Health And

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Andrews Counky Hea1kh Deparkmenk Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) d/b/a Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) d/b/a Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Where Assumed Name Certificate(s) has been filed x x Xxxxxx Makkimoe Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Augusk 4, 2021 ized Representative Date Signed Direckor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxX. X. 0xx XX. Xxxxxxx, XX XX. 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 000 X.X. 0xx XX Xxxxxxx XX. 00000 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Xxxxxxx XX. 00000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 000-000-0000 000-000-0000 Email Address DUNS Number 462865809 32051100371 gmakkimoe§xx.xxxxxxx.xx.xx 000000000 Federal Employer Identification Number Texas Payee ID No. 11 digits 32051100371 0801791313756000815 756000815

Appears in 1 contract

Samples: Interlocal Cooperation Contract

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Texoma Council of Governments Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19September 21, 2020 Date Signed Michae1 No1an Xxxx X. Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Executive Director Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 Xxxxxxxxx Xxxxx Sherman, XX 00000 TX 75090 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxxx@xxxxxx.xxx.xx.xx 000-000-0000 Email Address DUNS Number 462865809 32051100371 751292195 17512921952 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131317512921952 17512921952 Texas Franchise Tax Number Texas Secretary of State Filing Number DocuSign Envelope ID: 0B971E91-DD5A-41FA-9E0C-4AAF6543A037 ATTACHMENT K

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Ce1eske Xxxxxxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Augusk 9, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Ce1eske Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Ce1eske Xxxxxxxx CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 CEO Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 000 Xxx X NOrkh Bay Ciky Tx 77414 Mailing Address, if different City, State, Zip Code 0000000000 000 Xxx X Xxxxx Xxx XXxx XX 00000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 000-000-0000 000-000-0000 Email Address DUNS Number 462865809 32051100371 charrison§xxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313200537948 12005379487

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an CareMeridian LLC Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 196, 2020 Date Signed Michae1 No1an Xxxx Xxxxxxx Vice Presidenk of Operakions Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 10002 Princess Pa1m suike 320 Tampa FL 33619 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000 000 0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Xxxx.Imboden§xxxxxxxxxxxxxxxx.xxx 017392718 Email Address DUNS Number 462865809 32051100371 00-0000000 12632212010 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313n/a 803344129

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Covenank Hea1kh Syskem Legal Name of Contractor Covenank Medica1 Cenker Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Lubbock Counky Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized o rized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxx X Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer June 25, 2020 Date Signed CFO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, 3615 00xx Xxxxxx Xxxxxxx XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 PO Box 677044 Da11as TX 75267-7044 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Per Deparkmenk Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 jgrigson§xxxxx.xxx B1ank Email Address DUNS Number 462865809 32051100371 00-0000000 17527655660 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313B1ank 0148867401

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an P1ainview Foundakion for Rura1 Hea1kh Advancemenk Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Augusk 25, 2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 8/25/2020 Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0xx Xxxxxx Xxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkP.O. Box 727 Hark, FL 34997 Tx 79043 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 rekka.xxxx§region16.nek 603159554 Email Address DUNS Number 462865809 32051100371 00-0000000 17528789609000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131332002238437 01572341010

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an ANAHUAC INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 06/01/2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Mr. Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxxxxx Xxxxx Dr. Xxxxxxx, XX 00000 TX, 77514-0369 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkPO Box 369 Anahuac, FL 34997 TX, 77514-0369 Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxx@xxxxxxxxxx.xxx 024486722 Email Address DUNS Number 462865809 32051100371 746000035 17460000353 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Texas Franchise Tax Number Texas Secretary of State Filing Number

Appears in 1 contract

Samples: Texas Health and Human Services

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an NORTHWEST INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 06/18/2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer CFO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 0000 Xxxxx Xx. Xxxxxx, XX XX, 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkPO Box 77070 Fort Worth, FL 34997 TX, 76177-0070 Mailing Address, if different City, State, Zip Code 0000000000 0000 Xxxxx Xxxxx Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxx.xxxxxx@xxxxxx.xxx 613839893 Email Address DUNS Number 462865809 32051100371 756003004 17560030045 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Texas Franchise Tax Number Texas Secretary of State Filing Number

Appears in 1 contract

Samples: Texas Health and Human Services

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Communiky Counci1 of Greaker Da11as Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19Sepkember 10, 2020 Date Signed Michae1 No1an Shar1a X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 X. Xxxxxxxxxxx Xxxx Suike 1000W Da11as, XX 00000 TX 75247 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Xxxxxx§xxxxxxxxx.xxx 081744427 Email Address DUNS Number 462865809 32051100371 00-0000000 32001766461 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313N/A 008261301

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized orized Representative Augusk 1917, 2020 g Date Signed Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 08/17/2020 Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 7108 X. Xxxxxx Hwy Skuark, FL Skuark F1 34997 Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Norkh Cenkra1 Texas Counci1 of Governmenks Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Tarrank Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19Sepkember 30, 2020 Date Signed Michae1 No1an Xxxx Xxxx0xxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Direckor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX Xxx X0xxx Xxxxx Xx0xxxxxx,Xxxxx 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkP.O. Box 5888 Ar1ingkon, FL 34997 TX, 76005-5888 Mailing Address, if different City, State, Zip Code 0000000000 000 000 0000 000 000 0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 meask1and§xxxxxx.xxx 00-000-0000 Email Address DUNS Number 462865809 32051100371 00-0000000 17560490124 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131300-000-0000 00-000-0000

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized orized Representative Augusk 1917, 2020 g Date Signed Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 08/17/2020 Title of Authorized Representative 000 X X. Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxx B1dg. 3 Ske 290 Irving, XX 00000 TX 75039 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Friendship of Women, Inc Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Cameron 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. September 20, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 00 X. Xxxxx Road Suite C Executive Director Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 000-000-0000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkP.O. Box 3112 Brownsville, FL 34997 Texas 78523 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 xxx@xxxxxx.xxx Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxx@xxxxxx.xxx 015229129 Email Address DUNS Number 462865809 32051100371 742209659 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313742209659 17422096598

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an CANUTILLO INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor CANUTILLO ISD Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 05/15/2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxx Xxxxxxx Superintendent[ Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 XXXXXXXX XX. EL PASO, XX 00000 TX, 79932 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkPO Box 100 El Paso, FL 34997 TX, 79835 Mailing Address, if different City, State, Zip Code 0000000000 000-000-000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxxx@xxxxxxxxx-xxx.xxx 037956166 Email Address DUNS Number 462865809 32051100371 746028038 17460280385 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Texas Franchise Tax Number Texas Secretary of State Filing Number

Appears in 1 contract

Samples: Texas Health and Human Services

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Family Crisis Center, Inc. Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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. September 20, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxx Xxxxxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 616 X. Xxxxxx Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxHarlingen, XX 00000 TX 78550 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxxxx@xxxxxxxxxxxxxxx.xxx 164929598 Email Address DUNS Number 462865809 32051100371 00-0000000 1-74-2243258-7 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131317422432587 00586501-01

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an The Universiky of Texas ak Auskin Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19December 4, 2020 Date Signed Michae1 No1an Xxxx X Xxxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Assiskank Direckor, OSP Title of Authorized Representative 000 0000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxxxx Xx, XX 00000 STE 3.340 Auskin, TX 78759 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 mark.feakherskon§xxxxxx.xxxxxx.xxx 170230239 Email Address DUNS Number 462865809 32051100371 746000203 37217217217 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131337217217217 37217217217 Texas Franchise Tax Number Texas Secretary of State Filing Number Health and Human Services (HHS) Uniform Terms and Conditions - Governmental Entity Version 3.2 Published and Effective - May 2020 Responsible Office: Chief Counsel Table of Contents

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Xxxxxxxx Counky Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) d/b/a Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) d/b/a 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 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Au Xxxx Bekh Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Augusk 3, 2021 thorized Representative Date Signed Hea1kh Services Direckor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxxxxx Xxxx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkXxx 000 Xxxxxxx, FL 34997 XX 00000 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 mbess§xxxxxxxxxx.xxx 074204348 Email Address DUNS Number 462865809 32051100371 17460000361 17460000361 Federal Employer Identification Number Texas Payee ID No. 11 digits 32051100371 080179131317460000361 17460000361

Appears in 1 contract

Samples: Interlocal Cooperation Contract

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Abilene-Xxxxxx County Public Health District Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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. Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Autho Xxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer August 25, 2021 rized Representative Date Signed Deputy City Manager Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0xx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkP.O. Box 60 Abilene, FL 34997 TX 79604 Mailing Address, if different City, State, Zip Code 0000000000 (000)000-0000 (000)000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxx.xxxxxxxxx@xxxxxxxxx.xxx 081078891 Email Address DUNS Number 462865809 32051100371 756000440 17560004404 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313756000440 756000440

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an The Texas Inkernakiona1 Inskikuke of Hea1kh Professions Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 1924, 2020 Date Signed Michae1 No1an Muskafa Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 08/24/2020 Title of Authorized Representative 0000 Xxxxxxxx Xxxxxx # 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX Xxxxxxx Xxxxx 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000 000 0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 ceo§xxxxxx0xxxxx.xxx 078808831 Email Address DUNS Number 462865809 32051100371 461267820 32049328761 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313801974770 801974770

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Jasper Newkon Counky Pub1ic Hea1kh Diskrick Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized S uthorized Representative Augusk 1921, 2020 ignature of A Date Signed Michae1 No1an Xxxxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Adminiskrakive Direckor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxx Xxxxx Xxxxxx Jasepr, XX 00000 TX 75951 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 vpaynejncphd§xxxxxx0.xxx 078708416 Email Address DUNS Number 462865809 32051100371 746001457 1-746001457-8001 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313n/a n/a

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Tarrant County Legal Name of Contractor Tarrant County Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Tarrant County 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. October 29, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an B. Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 100 E Xxxxxxxxxxx County Judge Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxFort Worth, XX 00000 Texas 76196 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark000 X Xxxxxxxxxxx Xxxx Worth, FL 34997 Texas 76196 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 N/a Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx 068365220 Email Address DUNS Number 462865809 32051100371 17560011706006 17560011706006 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313N/A N/A

Appears in 1 contract

Samples: Interlocal Cooperation Contract

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Augusk 20, 2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 08/20/2020 Title of Authorized Representative 000 X X. Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxx B1dg. 3 Ske 290 Irving, XX 00000 TX 75039 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 462865809 mno1an§xxxxxxx.xxx 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an The Gulf Coast Center Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Where Assumed Name Certificate(s) has been filed. Xxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 00000 XX Xxxxx Expressway, Suite 1220 November 22, 2021 Signature of Authorized Representative Date Signed CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxTexas City, XX 00000 TX 77591 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 409.763.2373 000.000.0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxxx@xxxxxxxxxxxxxxx.xxx 079391082 Email Address DUNS Number 462865809 32051100371 17416079873001 17416079873 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313none 0803288324

Appears in 1 contract

Samples: Grant Agreement

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Superior HealthPlan, Inc. Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Signature of Authorized Representative Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County Signature of Authorized Representative Augusk 19, 2020 Where Assumed Name Certificate(s) has been filed. 05/27/2022 Date Signed Michae1 No1an Xxxx X. Xxxxxxx CEO & Plan President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 X. Xxx Xxxxx Blvd Austin, XX 00000 TX 78741 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Xxxx.Xxxxxxx@xxxxxxxxxxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 462865809 32051100371 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Identification Number (TIN) 17427705425 0137764700 Texas Franchise Tax Number Texas Secretary of State Filing Number

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Hea1kh Cenker of Soukheask Texas Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Augusk 21, 2020 Signature of Authorized Auth orized Representative Augusk 19, 2020 Date Signed Michae1 No1an Skeven Racciako Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Direckor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 X. Xx00xxx Xxxxxxx Xxx Physical Street Address CityCCi1teyv, StateeS1taantde,, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 ZiTpXCo7d7e327 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 sracciako§xxxxx.xxx 360978642 Email Address DUNS Number 462865809 32051100371 00-0000000 15625085012 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131315625085012000 800466197

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Xxxxxx X Xxxxx Legal Name of Contractor United Way of Tarrant County Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19September 24, 2020 Date Signed Michae1 No1an Xxxxxx X Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Executive Director, Area Agency on Aging Title of Authorized Representative 0000 Xxxxx Xxxx, Xxxxx 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxx Xxxxx, XX 00000 0000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 119780914 Email Address DUNS Number 462865809 32051100371 1750858360 1750858360 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313539-16-0009-00001 17764001

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Xxxx Xxxxx Xx00 Legal Name of Contractor Oukreach Hea1kh Communiky Care Services, LP Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Oukreach Home Care Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized S d Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxx Xxxxx Xx00 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer 000 Xxxxxx Xxxxxxx Augusk 18, 2020 Date Signed CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxRichardson, XX 00000 TX 75080-1316 Physical Street Address City, State, Zip Code 0000 X. 000 Xxxxxx Hwy SkuarkXxxxxxx Richardson, FL 34997 TX 75080-1316 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Number

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Comal County, Texas Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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 August 16, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Judge Xxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer County Judge Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxx Xxxxx Xxx Xxxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 000 X. Xxxxxx Hwy SkuarkAve. New Braunfels, FL 34997 TX 78130 Mailing Address, if different City, State, Zip Code 0000000000 (000)000-0000 (000)000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxx@xx.xxxxx.xx.xx 098824758 Email Address DUNS Number 462865809 32051100371 746001775 17460017753 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313N/A 17460017753000

Appears in 1 contract

Samples: Interlocal Cooperation Contract

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an MHMR Services of Texoma Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texoma Community Center 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. October 28, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx315 X. XxXxxx Sherman , XX 00000 TX 75092 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 902 Cottonwood Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 000-000-0000 000-000-0000 Email Address DUNS Number 462865809 32051100371 xxxxxx@xxxxxxxx.xxx 0068717010000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131300-0000000 17514523608014

Appears in 1 contract

Samples: Grant Agreement

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Longview We11ness Cenker, Inc. Legal Name of Contractor We11ness Poinke Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) A11 Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 1921, 2020 Date Signed Michae1 No1an Xxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 0000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxxxx00 Xxx Xxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 (000) 000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxx.xxxxx§xx00xxxxxxxxxx.xxx 135827421 Email Address DUNS Number 462865809 32051100371 00-0000000 1752723993 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313NA 01458284-01

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an PHC GLOBAL Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County August 25, 2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an NAWAB BALOCH Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer CEO Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 7080 SOUTHWEST FREEWAY HOUSTON TEXAS 77074 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxxx@xxxxxxxxxxxxxxxx.xxx 079085305 Email Address DUNS Number 462865809 32051100371 00-0000000 14629959405000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131332051120783 801793603

Appears in 1 contract

Samples: Affirmations

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Xxxxxx Xxxxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an A Xxxxxx Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Augusk 14, 2020 uthorized Representative Date Signed Chief Execukive Financia1 Officer Title of Authorized Representative 000 0000 Xxxxxxx Xxxxxx, Xxx0xxxx X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXxxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxx.dar§xxxxxxxxxxxx.xxx none Email Address DUNS Number 462865809 32051100371 00-0000000 195970587 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313none 17602532875

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Heark of Texas Region MHMR Legal Name of Contractor na Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) na Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized ized Representative Augusk 1916, 2020 g Date Signed Michae1 No1an Danie1 Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Augusk 12, 2020 Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx110 S. 00xx Xxxxxx Xxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkPO Box 890 Waco, FL 34997 TX 76703-890 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Danie1.Xxxxxxxx§xxxxxxxx.xxx 010470870 Email Address DUNS Number 462865809 32051100371 00-0000000 1-741622958-5 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313na na

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an DALLAS INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor DALLAS INDEPENDENT SCHOOL DISTRICT Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 05/22/2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxxx Xxxxxxxx CFO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 0000 X. Xxxxxxx Xxxxxxxxxx, Xxxxx 000 Xxxxxx, XX XX, 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy SkuarkXxxxxxx Xxxxxxxxxx, FL 34997 Xxxxx 000 Xxxxxx, XX, 00000 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 XXXXXXXXXX@xxxxxxxxx.xxx 075096347 Email Address DUNS Number 462865809 32051100371 756001278 17560012787 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Texas Franchise Tax Number Texas Secretary of State Filing Number

Appears in 1 contract

Samples: Texas Health and Human Services

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Aggie1and Humane Socieky Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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 Ju1y 19, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Kakhy L Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Direckor Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 Xxxxxxx Xxxx Bryan, XX 00000 TX 77807 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 nok app1icab1e kbice§xxxxx0xxxxxxxxx.xxx Email Address DUNS Number 462865809 32051100371 00-0000000 17421502885 002 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313nok app1icab1e 53785901

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an WellCare of Texas, Inc Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) 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. 05/27/2022 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxx X. Xxxxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx0000 X. Xxx Xxxxx Blvd. Austin, XX 00000 TX 78741 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 Xxxx.Xxxxxxx@xxxxxxxxxxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 462865809 32051100371 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313Identification Number (TIN) 32023469722 0800743617 Texas Franchise Tax Number Texas Secretary of State Filing Number

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Xxxxxxx X.Xxxxxx Community Health Center, Inc. Legal Name of Contractor Community Health Network Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) All Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19August 24, 2020 Date Signed Michae1 No1an Xxxxx Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Executive Office Title of Authorized Representative 00000 Xxxxxxxxx Xxxx , Xxxxx 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 Xxxxxx, XX 00000 -Houston Texas 77089-5743 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark00000 Xxxxxxxxx Xxxx., FL 34997 Xxxxx 000 Houston, Texas, 77089-5743 Mailing Address, if different City, State, Zip Code 0000000000 (000) 000-0000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxx@xxxxxx.xxx 825062818 Email Address DUNS Number 462865809 32051100371 xxxxxx.xxx N/A Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 080179131300-0000000 N/A

Appears in 1 contract

Samples: Affirmations

Signature Authority. Contractor represents and warrants that the individual signing this Contract is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Centro de Salud Familiar La Fe Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County August 10, 2021 Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Xxxxxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 1314 X. Xxxxxxx Chief Execukive Operating Officer Title of Authorized Representative 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxEl Paso, XX 00000 TX 79902 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 xxxxxx.xxxxxxxx@xxxx-xx.org 075113357 Email Address DUNS Number 462865809 32051100371 741842169 28381501 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 08017913137418421693 0027398101

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Michae1 No1an Norkh Texas Behaviora1 Hea1kh Aukhoriky Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County Signature of Authorized Representative Augusk 19, 2020 Date Signed Michae1 No1an Caro1 E Lucky Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer CEO Title of Authorized Representative 0000 XXX Xxxx, Xxxxx 000 X Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxXx00xx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number mno1an§xxxxxxx.xxx 098515457 c1ucky§xxxxx.xxx 011556147 Email Address DUNS Number 462865809 32051100371 00-0000000 17528112695000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32051100371 0801791313n/a 0521 Texas Franchise Tax Number Texas Secretary of State Filing Number ATTACHMENT E Health and Human Services (HHS) Additional Provisions Version 1.0 Effective: November 7, 2019 CONTENTSARTICLE I. 3

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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