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EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOVG'N. <br />CITY OF PARIS <br />Authorized Contracting Entity (type above if different <br />from PERFORMING AGENCY) for and in behalf of: <br />PERFORMING AGENCY NAME: <br />PARIS-LAMAR COUNTY HEALTH <br />DEPARTMENT <br />B y: <br />Date: <br />(Signature of person authorized to sign contracts) <br />(Name and Title) <br />RECOMMENDED: <br />By: A(PRF0RjM1N__GfAGE CY irector, if different <br />from person authorized to sign contract) r <br />RECEIVING AGENCY NAME: <br />DEPARTMENT OF STATE HEALTH <br />SERVICES <br />By: _ <br />(Sign,ature of person authorized to sign contracts) <br />Bob Burnette, Director <br />Procuremen and Contractin Services Division <br />(Name and Title) <br />Date: <br />DSHS Document No: 7560022067A2005 <br />Cover Page 3 <br />