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TEXAS DEPARTMENT OF HEALTH <br /> 1100 WE§T 49TH §TIIEET <br /> AUSTIN, TEXAS 78756-3199 <br /> <br />STATE OF TEXAS <br /> <br />COUNTY OF TRAVIS <br /> <br />TDH Document No. 7560022067 2004 <br /> <br /> Contract Change Notice No. 0~3 <br /> <br />The Texas Department of Health, ~ere~na~lter re~erre~] to as ~I~IUIltI~ X~I~NUV, did h~t~q~ s~l~l i~t~ ~ o~nt~aot in ruri[ln~ <br />with PARIS-LAMAR COUNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties thereto <br />now desire to amend such contract attachment(s) as follows: <br /> SUMMARY OF TRANSACTION: <br /> ATT NO. 0lA: AC FAM. HEALTH-PRIMARY HEALTH CARE <br /> <br />All tam anti conciitiong not hcrchy ~m~nrl~ r~nmln tn Iull I~'~ antl ~t't~r, <br /> <br />EXECUTED IN DUPLICATE ORIGINALS ON TI-I~ DATES SHOWN. <br /> <br />CITY OF PARIS <br /> <br />Authorized Contracting Entity (type above if different <br />from PERFORMING AGENCY) for and in behalf of: <br /> <br />PERFORMING AGENCY: <br /> <br />RECEIVING AGENCY: <br /> <br />PARIS-LAMAR COUNTY HEALTH DEPARTMENT <br />By: <br /> <br />(Signature of person authorized to sign) <br /> <br /> (Name and Title) <br />Date: ~/ <br /> <br />(PE~gMI~G ~G~Y D~rector. if differ~t ' from[person authorized to sign contract <br /> <br />TEXAS DEPARTMENT OF HEALTH <br /> <br /> (Signature of person'~]thorized to sign*) ' <br /> <br /> Bob Burnette, Director <br /> Procurement and Contracting Services Division <br /> (Name and Title) <br /> <br />Date: F3 J-- ~7 ~ c~ ~ .04 <br /> <br />SC PCSD- Rev. 2/03 <br /> <br />Cover Page 1 <br /> <br /> <br />