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<br />~ <br /> <br />CONTRACT FOR PUBLIC HEALTH SERVICES <br /> <br />TDH DOCUMENT NO 756002206701 <br /> <br />Contract Issued by: TEXAS DEPARTMENT OF HEALTH SB <br />(RECEIVING AGENCY) 1100 WEST 49TH STREET <br /> AUSTIN, TEXAS 78756-3199 <br />Legal Authority to Contract: Chapters 12 and 121, Health and Safety Code. <br />Venue: The provisions of this Contract shall be interpreted in accordance with Texas law. Venue for any court disputes shall be in <br /> Travis County, Texas. <br /> -- ....,_. .- <br />PERFORMING AGENCY NAME: PARIS-LAMAR COUNTY HEALTH DEPARTMENT - , <br />MAILING ADDRESS: P. O. BOX 938 PARIS TX 75460-0938 <br />(City, State, Zip) <br />STREET ADDRESS: 740 SOUTHWEST 6TH. PARIS TX 75460-0000 <br />(City, State, Zip) <br />NAME OF AUTHORIZED <br />CONTRACTING ENTITY: <br />(If different from PERFORMING AGENCY'l <br />PAYEE DATA (If not the same as PERFORMING AGENCY or AUTHORIZED CONTRACTING ENTITY: must be on file with the Texas State <br />Comptroller's Office.): <br />NAME: <br />ADDRESS: <br />State of Texas Vendor Identification No. (14 digits) PAYEE AGENCY Fiscal <br />17560022067001 Year Endin2 Month: Sentember <br />PAYEE BUSINESS INFORMATION FOR STATISTICAL REPORTING: Please check the categories that apply to your business. <br />- Small Business - A corporation, sole proprietorship, or other legal entity formed for the purpose of making -3 profit which is independently <br /> owned and operated and has fewer than 100 employees or has less than $1,000,000 in annual gross receipts. <br />- Historically Underutilized Business (HUB) - A corporation, sole proprietorship. or joint venture formed for the purpose of making a profit-- <br /> in which at least 51 % of all classes of the shares of stock or other equitable securities are owned by one or more persons who have been <br /> historically underutilized (socially disadvantaged) because of their identification as members of certain groups: Black American. Hispanic <br /> American, Asian Pacific American, Native American, and Women. The HUB must be certified by General Services Commission or <br /> another entity. <br /> For Profit Organization <br />SUMMARY OF CONTRACT DOCUMENTATION: - <br /> COVER PAGE I - Receiving and Performing Agency Data GENERAL PROVISIONS <br /> COVER PAGE 2 - Details of Attachment(s) A TT ACHMENT(S) <br /> COVER PAGE 3 - Authorized Sionatures EXHIBITS, IF APPLICABLE <br /> <br />Cover Page 1 <br /> <br />EXHIBIT A <br />