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: Xxxxxx Xxxxx Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview, TX 75605 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000

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 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: Xxxxxx Xxxxx Xxxx Xxxxxxx Legal Name of Contractor Women's Center Covenant Rehabilitation Hospital of East Texas, Inc. Lubbock LLC Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Trustpoint Rehabilitation Hospital of Lubbock 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. September 22August 19, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxx X Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CFO Title of Authorized Representative Longview0000 Xxxxxxxxx Xxxxxx Xxxxxxx, TX 75605 XX 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxx@xxxxx.xxx N/A Email Address DUNS Number 00-0000000 00-0000000 32057451141 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) N/A n/A Texas Franchise Tax Number Texas Secretary of State Filing Number N/A

Appears in 1 contract

Samples: 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Spring Branch Community Health Center Legal Name of Contractor Women's Spring Branch Community Health Center of East Texas, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Spring Branch Community Health 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. September 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director X. Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxAugust 30, Xxx. 000 2022 Date Signed CEO Title of Authorized Representative Longview, TX 75605 000 X Xxx Xxxxxxx Pkwy S Suite 200 Houston,. Texas 77042 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 same same Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 mtrujillo@sbchc net 149186624 Email Address DUNS Number 00-0000000 00-0000000 13000198705001 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) N/A 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number GC39A5DJYCB5

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx City of Wichita Falls Legal Name of Contractor Women's Center of East Texas, Inc. Wichita Falls Wichita County Public Health district Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) not Applicable 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. September 22October 29, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxxx Xxxxxx 10-29-2021 Title of Authorized Representative Longview, TX 75605 Wichita falls Texas 76366 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 po box 1431 Wichita falls Texas 76366 Mailing Address, if different City, State, Zip Code 0000000000 000 0000000 0000000000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxx xxxxxxxx@xxxxxxxxxxxxxx.xxx 059463133 Email Address DUNS Number 00-0000000 00-0000000 756000714 1760007142 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000756000714 1760007142

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Williamson County and Cities Health District Legal Name of Contractor Women's Center of East Texas, Inc. 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. September 22April 19, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxxxxx Xxxxx Executive Director Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxxx Xxxxxx Executive Director Title of Authorized Representative LongviewRound Rock, TX 75605 78664 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 N/A N/A Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxx.xxxxxxx@xxxxx.xxx 179403910 Email Address DUNS Number 00-0000000 00-0000000 17428969061 17428969061 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number N/A

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. Signature Page Follows Signature Page for HHS Contract Affirmations Authorized representative on behalf of Contractor must complete and sign the following: Xxxxx Xxxxxx Xxxxx Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22April 25, 2021 2022 Signature of Authorized Representative Date Signed Xxxxx Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxxx Xxxxxx 04-25-2022 Title of Authorized Representative Longview, TX 75605 CEO Physical Street Address City, State, Zip Code PO Box 347 Longview0000 Xxxxxx Xxxx Xxxxxxxxx, TX 75605 75503 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 0000 Xxxxxx Xxxx Xxxxxxxxx, TX 75503 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx@xxxxxxx.xxx 000-000-0000 Email Address DUNS Number 00-0000000 00-0000000 xxxxxxx@xxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 000000000 17102591371 Texas Franchise Tax Number Texas Secretary of State Filing Number QPA2Z0LLXK84

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Golden Crescent Regional Planning Commission Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxx Xxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, X Xxxxxxx Xx. Xxx. 000 09/21/2022 been filed. Date Signed Executive director Title of Authorized Representative LongviewVictoria, TX 75605 TX, 77901 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different (000) 000-0000 Phone Number xxxxxxxx@xxxxx.xxx Email Address 74-159720 City, State, Zip Code 0000000000 0000000000 Phone Number (000) 000-0000 Fax Number xxxxxx@xx-xx.xxx 607663622 Email Address 000000000 DUNS Number 00-0000000 00-0000000 17415972045 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) Texas Franchise Tax Number XAQFG51SF2X3 XXX.xxx Unique Entity Identifier (UEI) 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 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: Xxxxxx Xxxxx County MHMR Center Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22October 27, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxXxxxxx X Xxxxxxxxx October 21, Xxx. 000 2021 Title of Authorized Representative LongviewDenton, TX 75605 Texas, 76266 Physical Street Address City, State, Zip Code PO Box 347 Longview2519 Scripture Denton, TX 75605 Texas 76201 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 (000)000-0000 xxxx@xxxxxxxxxx.xxx Email Address DUNS Number 00-0000000 00-0000000 xxxx@xxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000751368151 0

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. Signature Page Follows Signature Page for HHS Contract Affirmations Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Any Baby Can of Austin, Inc. Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22filed August 17, 2021 Signature of Authorized Representative Date Signed Xxxxxxx Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CEO/President Title of Authorized Representative Longview0000 Xxxxxxxx Xxxxxx Xxxxxx, TX 75605 Xxxxx 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000.000.0000 000.000.0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx.xxxxxx@xxxxxxxxxx.xxx 827100798 Email Address DUNS Number 00-0000000 00-0000000 742684335 17426843359 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-000000017426843359000 0126900301

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Mario Markinez Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22, 2021 filed Signature of Authorized Representative Augusk 6, 2021 Date Signed Xxxxxx Xxxxx Executive Director Mario Markinez Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Assiskank Direckor Title of Authorized Representative Longview, TX 75605 Xxxxx X. Markinez Assiskank Direckor Physical Street Address City, State, Zip Code PO Box 347 Longview000 X. Xxxxxxx, TX 75605 0xx X0xxx Xxx Xxxxxxx, XX 00000 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Same as above Same as above Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 000-000-0000 000-000-0000 Email Address DUNS Number 00-0000000 00-0000000 mario.markinez§xxxxxxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00000000000 000000000-0000000 00-000000008

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Devoted Health Insurance Company of Texas Legal Name of Contractor Women's Center of East Texas, Inc. 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. September 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxx President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview00000 Xxxxx Xxxxxxx 000, TX 75605 Xxxxx 000 Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview000 Xxxxxxxx Xxxxxx Xxxxxxx, TX 75605 XX, 00000 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 XXxxxxxxx@xxxxxxx.xxx N/A Email Address DUNS Number 00-0000000 00-0000000 18739700419000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx West Centers for MHMR Legal Name of Contractor Women's Center of East Texas, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) West Texas 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. September 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx319 Xxxxxxx October 27, Xxx. 000 2021 Signature of Authorized Representative Date Signed Chief Executive Officer Title of Authorized Representative LongviewBig Spring, TX 75605 Texas 79720 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 00000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxxxxx.Xxxxx@xxxxxxx.xxx (000)000-0000 Email Address DUNS Number 00-0000000 00-0000000 752606169 00671205 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-000000017526061696 N/A

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx El Paso Community MHMR dba Emergence Health Network Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22October 29, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CEO Title of Authorized Representative Longview, 000 X. Xxxx Xxxxx 000 El Paso TX 75605 79901 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 NA Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 000000000 9153514467 Email Address DUNS Number 00-0000000 00-0000000 xxxxxxxxxx@xxxxxxxxx.xxx 078388295 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000na

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Permian Basin Community Centers for Mental Health & Mental Retardation Legal Name of Contractor Women's Center of East Texas, Inc. PermiaCare Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Midland 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. September 22June 6, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Chief Executive Officer Title of Authorized Representative Longview000 X Xxxxxxxx, TX 75605 Xxxxx 000 Xxxxxxx, Xx 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview000 X Xxxxxxxx, TX 75605 Xxxxx 000 Midland, Tx 79701 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxxxxxxx@xxxxxxxxxx.xxx 074145561 Email Address DUNS Number 00-0000000 00-0000000 751401776 17514017767 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number 074145561

Appears in 1 contract

Samples: 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. Signature Page Follows Signature Page for HHS Contract Affirmations Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Community Healthcare Center Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22May 6, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx000 Xxxxxx Xxxxxx Xxxx, XxxXx., Blvd. 000 CEO Title of Authorized Representative LongviewWichita Falls, TX 75605 76301 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxxxx@xxxxx.xxx 958240749 Email Address DUNS Number 00-0000000 00-0000000 17524296443 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00Identification Number (TIN) 1-0000000 00000000000-00000003 1226646-1 Texas Franchise Tax Number Texas Secretary of State Filing Number XKWEAHH9PJP7

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx Legal Name of Contractor Women's Center of East Texas, Inc. Corpus Christi-Nueces 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. September 22, 2021 Signature ignature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Re Xxxxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxDecember 16, Xxx. 000 2021 S presentative Date Signed Director of Public Health Title of Authorized Representative LongviewXxxxxxx Xxxxxxxxx Corpus Christi, TX 75605 78416 Physical Street Address City, State, Zip Code PO Box 347 Longview0000 Xxxxx Xx, CC, TX 75605 78416 Corpus Christi, TX 78416 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 Corpus Christi, TX 78416 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxxxxxx@xxxxxxx.xxx 000-000-0000 Email Address DUNS Number 00-0000000 00-0000000 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000746000574 746000574

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx City of Harlingen Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22, 2021 filed Signature of Authorized Representative Date Signed Xxxxxx o Xxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxSeptember 8, Xxx. 000 2021 f Authorized Representative Date Signed Harlingen Title of Authorized Representative Longview, TX 75605 118 X. Xxxxx 78550 Physical Street Address City, State, Zip Code PO Box 347 Longview000 X. Xxxxx Xxxxxxxxx, TX 75605 Texas 78550 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 78550 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxx@xxxxxxxxxxx.xx 00-000-0000 Email Address DUNS Number 00-0000000 00-0000000 17460010477 Federal Employer Identification Number Texas Payee ID No. 11 digits 00-0000000 00-0000000N/A N/A

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx City of Wichita Falls - Wichita Falls Wichita County Public Health district Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22filed Xxxxx Xxx Xxxxxxxx August 17, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director of Health Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxxx Xxxxxx Title of Authorized Representative Longview, TX 75605 Xxxxxxx Xxxxx Xx 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 0000 Xxxxx Xxxxxx Xxxxxxx Xxxxx Xxxxx Xxxxxxx Xxxxx Xx 00000 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 9407617805 000 000 0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxx.xxxxxxxx@xxxxxxxxxxxxxx.xxx 059463133 Email Address DUNS Number 00-0000000 00-0000000 75600714 17560007142 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-00000001756007142 17560007142

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx COLLIN COUNTY Legal Name of Contractor Women's Center of East Texas, Inc. 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. September June 22, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxx, County Judge Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 County Judge Title of Authorized Representative Longview0000 XXXXXXXXX XXXX MCKINNEY, TX 75605 75071 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 N/A N/A Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 XXXXX@XX.XXXXXX.XX.XX 17560008736 Email Address DUNS Number 00-0000000 00-0000000 17560008736 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number N/A

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. Signature Page Follows Signature Page for HHS Contract Affirmations Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx X. Xxxxx Legal Name of Contractor Women's Center City of East Texas, Inc. Port Xxxxxx 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) 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 22July 5, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxx XXxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 07/05/2022 Title of Authorized Representative Longview, TX 75605 Xxx X. Xxxxxx City Manager Physical Street Address City, State, Zip Code PO Box 347 LongviewPort Xxxxxx, TX 75605 TX, 77640 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000 Xxxxxx Xxxxxx (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxx.xxxxxx@xxxxxxxxxxxx.xxx 137134909 Email Address DUNS Number 00-0000000 xxx.xxxxxx@xxxxxxxxxxxx.xxx 00-0000000 Federal Employer Identification Number Texas Payee ID No. – Identification Number (TIN) 17460018850011 17460018850-11 digits 00-0000000 00-0000000Texas Franchise Tax Number Texas Secretary of State Filing Number EMVNEFYW2KN4

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Maximus US Services, Inc. Legal Name of Contractor Women's Center of East Texas, Inc. 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. September 22Sepkember 13, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxx Xxxxxxx0x Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Counse1 Title of Authorized Representative Longview1891 Mekro Cenker Dr. Reskon, TX 75605 VA 201901 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 N/A Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000.000.0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 carriekhomas§xxxxxxx.xxx N/A Email Address DUNS Number 00-0000000 00-0000000 000-0000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000N/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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Legal Name of Contractor Women's Center City of East Texas, Inc. Abilene 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. September 22, 2021 Signature ignature of Authorized Representative Date Signed Auth Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxXxxxxx Xxxxx October 27, Xxx. 000 2021 S orized Representative Date Signed 10/26/2021 Title of Authorized Representative Longview, TX 75605 City Manager Physical Street Address City, State, Zip Code PO Box 347 Longview000 X 0xx Xxxxxx Abilene, TX 75605 79601 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 P.O Box 60 Abilene, Tx, 79604 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 000-000-0000 000-000-0000 Email Address DUNS Number 00-0000000 00-0000000 xxxxxx.xxxxx@xxxxxxxxx.xxx 081078891 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000756000440 17560004404

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx My Health My Resources of Tarrant County Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22March 8, 2021 2024 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CEO Title of Authorized Representative Longview0000 Xxxxx Xxxxxx Fort Worth, TX 75605 TX, 76107 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000.000.0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxx@xxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 00-0000000 1757129456 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification 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 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: Xxxxxx Xxxxx Collin County Mental Health Mental Retardation Center Legal Name of Contractor Women's Center of East Texas, Inc. LifePath Systems Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) 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. September 22February 20, 2021 2024 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CEO Title of Authorized Representative Longview0000 Xxxxxxxx Xxxxx XxXxxxxx, TX 75605 XX 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxx@xxxxxxxxxxxxxxx.xxx 161443783 Email Address DUNS Number 00-0000000 00-0000000 751761911 17517619114 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00Identification Number (TIN) 32051038761 56634201 Texas Franchise Tax Number Texas Secretary of State Filing Number WY9FGNAZ-0000000 00-0000000SNA6

Appears in 1 contract

Samples: Interlocal Cooperation Contract 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Bell County Public Health District Legal Name of Contractor Women's Center of East Texas, Inc. 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. September 22June 8, 2021 2022 Signature of Authorized Representative Date Signed Xxx X. Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 X. 0xx Xx District Director Title of Authorized Representative LongviewTemple, TX 75605 Texas 76501 Physical Street Address City, State, Zip Code PO P.O. Box 347 Longview2149 Temple, TX 75605 Texas 76503 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 x 0 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx@xxxxxxxxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits Identification Number (TIN) 00-0000000 00-000000017460003480 Texas Franchise Tax Number Texas Secretary of State Filing Number H7CSL1E3N6Y5

Appears in 1 contract

Samples: Interlocal Cooperation Contract Department Of

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: Xxxxxx Xxxxx Strawn Community Animal Rescue Effort Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22filed August 5, 2021 Signature of Authorized Representative Date Signed Xxxxx Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxxxx Xxxx Board President Title of Authorized Representative LongviewMingus, TX 75605 76463 Physical Street Address City, State, Zip Code PO P. o. Box 347 Longview353 Mingus, TX 75605 76463 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000 000-0000 000 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxx0xxxxxx@xxxxx.xxx 060759740 Email Address DUNS Number 00-0000000 00-0000000 383788294 32039655793 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00N/A non-0000000 00-0000000profit 801130476

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx WellCare National Health Insurance Company Legal Name of Contractor Women's Center of East Texas, Inc. 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’) 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 Where Assumed Name Certificate(s) has been filed. September 22, 2021 Signature of Authorized Representative 05/27/2022 Date Signed Xxxxxx Xxxxx Executive Director Xxxx X. Xxxxxxx CEO & Plan President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 X. Xxx Xxxxx Blvd Austin, TX 75605 78741 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxx.Xxxxxxx@xxxxxxxxxxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 32067151889 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 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: Xxxxxx Xxxxx Bell County Public Health District Legal Name of Contractor Women's Center of East Texas, Inc. Bell County Public Health District Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) dba Bell 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. September 22, 2021 Signature ignature of Authorized Representative Date Signed Aut Xxxxx Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx000 Xxxxx 0xx Xxxxxx October 28, Xxx. 000 2021 S horized Representative Date Signed Interim Director Title of Authorized Representative LongviewTemple, TX 75605 Texas 76501 Physical Street Address City, State, Zip Code PO Box 347 Longview2149 Temple, TX 75605 Texas 76503 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx@xxxxxxxxxxxxxxxx.xxx 08387-2259 Email Address DUNS Number 00-0000000 00-0000000 17460003480 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000NH23IP922616 17460003480

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx XXXXXXX COUNTY Legal Name of Contractor Women's Center of East Texas, Inc. 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. September 22, 2021 Signature of Authorized Representative Date Signed Authori Xxxxxxx X. Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx100 X. Xxxx, Xxx. 000 2nd Floor October 22, 2021 zed Representative Date Signed Xxxxxxx County Judge Title of Authorized Representative LongviewEdinburg, TX 75605 Texas 78539 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 N/A N/A Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000)000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 countyjudge@co xxxxxxx.xx.xx 103110834 Email Address DUNS Number 00-0000000 00-0000000 746000717 17460007176 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000N/A N/A

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Tarrant County Legal Name of Contractor Women's Center of East Texas, Inc. Tarrant County Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) 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. September 22October 29, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director B. Xxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 100 E Xxxxxxxxxxx County Judge Title of Authorized Representative LongviewFort Worth, TX 75605 Texas 76196 Physical Street Address City, State, Zip Code PO Box 347 Longview000 X Xxxxxxxxxxx Xxxx Worth, TX 75605 Texas 76196 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 N/a Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx 068365220 Email Address DUNS Number 00-0000000 00-0000000 17560011706006 17560011706006 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000N/A N/A

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxxxxxx Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 221, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 9/1/2022 Title of Authorized Representative LongviewMechanicsburg, TX 75605 PA 17055 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 XXxxxxxx@Xxxxxxxxxxx.xxx n/a Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number n/a

Appears in 1 contract

Samples: 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Central Texas MHMR Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22February 13, 2021 2024 Signature of Authorized Representative Date Signed Xxxxxx Xxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 2/13/24 Title of Authorized Representative Longview000 Xxxxxxxx Xxxxxx Xxxxxxxxx, TX 75605 XX, 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 PO Box 250 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxx@xxxx.xx 068386523 Email Address DUNS Number 00-0000000 00-0000000 751294432 17512944327 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number CC65R66D88D1

Appears in 1 contract

Samples: Interlocal Cooperation Contract 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Friendship of Women, Inc Legal Name of Contractor Women's Center of East Texas, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Cameron 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. September 2220, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 00 X. Xxxxx Road Suite C Executive Director Title of Authorized Representative Longview, TX 75605 000-000-0000 Physical Street Address City, State, Zip Code PO P.O. Box 347 Longview3112 Brownsville, TX 75605 Texas 78523 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 xxx@xxxxxx.xxx Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxx@xxxxxx.xxx 015229129 Email Address DUNS Number 00-0000000 00-0000000 742209659 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000742209659 17422096598

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx City of Beaumont Legal Name of Contractor Women's Center City of East Texas, Inc. Beaumont Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) 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. September 22May 18, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxx Xxxxxx 5-18-22 Title of Authorized Representative LongviewBeaumont, TX 75605 77705 Physical Street Address City, State, Zip Code PO Box 347 Longview3827 Beaumont, TX 75605 77704 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxx.Xxxxxxxxx@XxxxxxxxXxxxx.xxx 073901118 Email Address DUNS Number 00-0000000 00-0000000 746000278 17460002789 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 17460002789 17460002789 Texas Franchise Tax Number Texas Secretary of State Filing Number jelubu1g59z9

Appears in 1 contract

Samples: Interlocal Cooperation Contract Department Of

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: Xxxxxx Xxxxx MHMR Services of Texoma Legal Name of Contractor Women's Center of East Texas, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Texoma Community 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. September 22October 28, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CEO Title of Authorized Representative Longview315 X. XxXxxx Sherman , TX 75605 75092 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 902 Cottonwood Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 000-000-0000 000-000-0000 Email Address DUNS Number 00-0000000 00-0000000 xxxxxx@xxxxxxxx.xxx 0068717010000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-000000017514523608014

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Community Health Development, Inc. Legal Name of Contractor Women's Center of East TexasCommunity Health Development, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Uvalde 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. September 2226, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director XXXXXX XXXXXXXX Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Chief Executive Officer Title of Authorized Representative Longview000 Xxxxx Xx., Bldg. A Uvalde, TX 75605 78801 Physical Street Address City, State, Zip Code PO Box 347 Longview000 Xxxxx Xx., Bldg. A Uvalde, TX 75605 78801 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxxx@xxxx0xxxxxx.xxx 123922080 Email Address DUNS Number 00-0000000 00-0000000 742269739 17422697395 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 000000000 0065594001 Texas Franchise Tax Number Texas Secretary of State Filing Number NFXBRZFBDQH8

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx HealthSpring Life & Health Insurance Company, Inc. Legal Name of Contractor Women's Center of East Texas, Inc. 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. September 22, 2021 Signature of Authorized Representative 04/24/2022 Date Signed Xxxxxx Xxxxx Executive Director Xxxx X. Xxxx Medicare TX Market President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 Xxxxxx Xxxxxxx Xxxxx, TX 75605 XX 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxx.xxxx@xxxxx.xxx Email Address DUNS Number 00-0000000 00-0000000 12085342983 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) Texas Franchise Tax Number Texas Secretary of State Filing Number

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 Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. Signature Page Follows REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx DALLAS INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor Women's Center of East Texas, Inc. DALLAS INDEPENDENT SCHOOL DISTRICT 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 22, 2021 05/22/2020 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxx CFO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 X. Xxxxxxx Xxxxxxxxxx, TX 75605 Xxxxx 000 Xxxxxx, XX, 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview0000 X. Xxxxxxx Xxxxxxxxxx, TX 75605 Xxxxx 000 Xxxxxx, XX, 00000 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 XXXXXXXXXX@xxxxxxxxx.xxx 075096347 Email Address DUNS Number 00-0000000 00-0000000 756001278 17560012787 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Texas 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Weslaco Regional Rehabilitation Hospital, LLC Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22August 30, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Chief Executive Officer Title of Authorized Representative Longview000 X. Xxxxx Street Weslaco, TX 75605 78596 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 XxxxxXxxxxxx@xxxxxxxxxxxx.xxx n/a Email Address DUNS Number 00-0000000 00-0000000 472675786 n/a Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number n/a

Appears in 1 contract

Samples: 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxx X. Xxxxxxxx Legal Name of Contractor Women's Center of East Texas, Inc. Xxx X. Xxxxxxxx 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) 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 22January 14, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxx X. Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Independent Contractor Title of Authorized Representative Longview00000 Xxxxxxx Xxxx Xxxxxx, TX 75605 XX 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 NA Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxx.Xxxxxxxx@xxxx.xxxxx.xxx 080525683 Email Address DUNS Number 00-0000000 00-0000000 526768166 70039055184 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) NA NA Texas Franchise Tax Number Texas Secretary of State Filing Number 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Dallas County, Texas Legal Name of Contractor Women's Center of East TexasDallas County, Inc. 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. September 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director GANESH SHIVARAMAIYER Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxOctober 22, Xxx2021 Representative Date Signed Asst. 000 Director, Finance, Budget & Contracts Title of Authorized Representative Longview0000 X Xxxxxxxx Xxxxxxx Xxxxxx, TX 75605 Xxxxx 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 N/A N/A Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 N/A Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxx@xxxxxxxxxxxx.xxx 073128597 Email Address DUNS Number 00-0000000 00-0000000 17560009056005 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000N/A N/A

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxxxxxx Legal Name of Contractor Women's Center of East Texas, Inc. N/A Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Xxxx 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. September 22, 2021 Signature ignature of Authorized Representative Date Signed Xxxxxx Auth Xxxxx Executive Director Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx712 S. Stagecoach Trail Ste. 300 October 19, Xxx. 000 2021 S orized Representative Date Signed County Judge Title of Authorized Representative LongviewSan Marcos, TX 75605 78666 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 N/A N/A Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 N/A Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 judge.xxxxxx@co xxxx.xx.xx 097494884 Email Address DUNS Number 00-0000000 00-0000000 17460022415 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 N/A 00-0000000

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxxxxxx Xxxxxxx Legal Name of Contractor Women's Central Counties Center of East Texas, Inc. for MHMR Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) 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. September 22February 18, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 2-18-2022 Title of Authorized Representative Longview, TX 75605 000 X 00xx Xxxxxx Temple Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx.xxxxxxx@XXX0000.xxx 059057927 Email Address DUNS Number 00-0000000 00-0000000 17418013320001 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number EMWMKFSB4L85

Appears in 1 contract

Samples: Interlocal Cooperation Contract 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. Signature Page Follows Signature Page for HHS Contract Affirmations Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Angelina County & Cities Health District Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22May 12, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxx Xxxxxx Administrator Title of Authorized Representative LongviewLufkin, TX 75605 Texas 75904 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxx@xxxxx.xx 023169353 Email Address DUNS Number 00-0000000 00-0000000 n/a 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number SWEKQ6X4UVR8

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxxxx X. Xxxxxx Xxxxx Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22, 2021 Signature of Authorized Representative Date Signed filed Xxxxxxxx X. Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxJuly 23, Xxx. 000 2021 Signature of Authorized Representative Date Signed Chairperson Title of Authorized Representative Longview0000 X. Xxxxxxxx Xxxxxx Woodville, TX 75605 75979 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000 000-0000 000 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx000@xxx.xxx 786314034 Email Address DUNS Number 00-0000000 00-0000000 01134305029 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000x 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxx Xxxxxxxxx-Xxxxxx Xxxxx Legal Name of Contractor Women's Center City of East Texas, Inc. el Paso Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) City of 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. September 22May 16, 2021 2022 Signature of Authorized Representative Date Signed Xxxx Xxxxxxxxx-Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Grants Administrator Title of Authorized Representative Longview300 X. Xxxxxxxx El Paso, TX 75605 Texas, 79901 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 same same Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxxx-xxxxxxx@xxxxxxxxxxx.xxx 058873019 Email Address DUNS Number 00-0000000 00-0000000 17460007499000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 17460007499000 17460007499000 Texas Franchise Tax Number Texas Secretary of State Filing Number KLZGKXNFVTL4

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Superior Health Plan, Inc. Legal Name of Contractor Women's Center of East TexasSuperior Health Plan, Inc. 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’) 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 Where Assumed Name Certificate(s) has been filed. September 22, 2021 Signature of Authorized Representative 04/25/2022 Date Signed Xxxxxx Xxxxx Executive Director Xxxx X. Xxxxxxx CEO & Plan President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 X. Xxx Xxxxx Blvd. Austin, TX 75605 Texas 78741 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxx.Xxxxxxx@xxxxxxxxxxxxxxxxxx.xxx 809245525 Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 32058715601 000000000 Texas Franchise Tax Number Texas Secretary of State Filing Number 809245525

Appears in 1 contract

Samples: HHSC 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Oasis at Galleria LLC Legal Name of Contractor Women's Center of East Texas, Inc. NA Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) 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. September 22, 2021 Signature of Authorized Representative 05/24/2022 Date Signed Xxxxxx Xxxxxxx Xxxxx Executive Director Manager Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 Xxxxxx Xxxxx Xx. Xxxxxxx, TX 75605 XX 00000 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 same Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxx@xxxxxxxxx.xxx NA Email Address DUNS Number 00-0000000 00-0000000 32084497612 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) NA 0804558157 Texas Franchise Tax Number Texas Secretary of State Filing Number 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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Deep East Texas Council of Governments Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22March 9, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxx March 9, 2022 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 Xxxxx Xxxxx Lufkin, TX 75605 75904-1929 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxxxxx@xxxxxx.xxx 000-000-0000 Email Address DUNS Number 00-0000000 00-0000000 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) n/a n/a Texas Franchise Tax Number Texas Secretary of State Filing Number EVLDLB7MJ8D9

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Bastrop County Women's Shelter, Inc. Legal Name of Contractor Women's dba Family Crisis Center of East Texas, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Bastrop 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. September 2223, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 000 Xxx Xxxxxx, Xxx. 000 Xxxxxx Xxx Executive Director Title of Authorized Representative LongviewBastrop, TX 75605 78602 Physical Street Address City, State, Zip Code PO P.O. Box 347 Longview736 Bastrop, TX 75605 78602 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx@xxxxxxxxxxxxxxxxxx.xx 00-0000000 Email Address DUNS Number 00-0000000 00-0000000 782895452 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-000000065840101

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Superior HealthPlan, Inc. Legal Name of Contractor Women's Center of East Texas, Inc. 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’) 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 Where Assumed Name Certificate(s) has been filed. September 22, 2021 Signature of Authorized Representative 05/27/2022 Date Signed Xxxxxx Xxxxx Executive Director Xxxx X. Xxxxxxx CEO & Plan President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 X. Xxx Xxxxx Blvd Austin, TX 75605 78741 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxx.Xxxxxxx@xxxxxxxxxxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification 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 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: Xxxxxx Xxxxx Family Support Services of Amarillo, Inc. Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 2216, 2021 Signature of Authorized Representative Date Signed Xxx Xxxxxx Xxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxxxxxxxx 00 Xxxx Chief Executive Officer Title of Authorized Representative LongviewAmarillo, TX 75605 79106 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxxx@xxx-xxx.xxx 807028865 Email Address DUNS Number 00-0000000 00-0000000 17508006420 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000n/a 0010179901

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. Signature Page Follows Signature Page for HHS Contract Affirmations Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Abilene Regional MHMR Center Legal Name of Contractor Women's d/b/a Xxxxx Xxxxxxxx Center of East Texas, Inc. Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Xxxxxx 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. September 22filed August 11, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CEO Title of Authorized Representative Longview0000 X. Xxxxx Street Abilene, TX 75605 Texas 79606 Physical Street Address City, State, Zip Code PO Box 347 Longview0000 X. Xxxxx Street Abilene, TX 75605 Texas 79606 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxx@xxxxxxxxxxxxx.xxx 625999326 Email Address DUNS Number 00-0000000 00-0000000 751377658 0001751377658 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000n/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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxx Xxxxxxxx Legal Name of Contractor Women's Center City of East Texas, Inc. Wichita Falls 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. September 22April 27, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxx Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Xxxxx Xxxxxx Director of Health Title of Authorized Representative Longview, TX 75605 Wichita Falls Texas 76301 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 po box 1431 Wichita Falls Texas 76307-1431 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxx.Xxxxxxxx@xxxxxxxxxxxxxx.xxx 059463133 Email Address DUNS Number 00-0000000 00-0000000 765000714 17560007142 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 756000714 017560007142 Texas Franchise Tax Number Texas Secretary of State Filing Number R737LBFW8T13

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Atascosa Health Center, Inc., Legal Name of Contractor Women's Center of East Texas, Inc. 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. September 22August 29, 2021 2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 CEO Title of Authorized Representative Longview000 X. Xxxxxxx Pleasanton, TX 75605 Texas, 78064 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Same as Above Same as Above Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 xxxxxx.xxxx@xxxxx.xxx 132954496 Email Address DUNS Number 00-0000000 00-0000000 017420891032 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) N/A 0050005301 Texas Franchise Tax Number Texas Secretary of State Filing Number MW4NM5KU2M81

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Tropical Texas Center for MHMR Legal Name of Contractor Women's Center of East Texas, Inc. Tropical Texas Behavioral Health 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) 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 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx X. Xxxxx Executive Director Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 X. 00xx Xxx XxxxxxXX Xxx 0000 November 2, Xxx. 000 2021 Signature of Authorized Representative Date Signed CEO Title of Authorized Representative LongviewEdinburg, TX 75605 TX, 78539 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 XXXXXXXX@XXXX.XXX 074620667 Email Address DUNS Number 00-0000000 00-0000000 17415655103 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000n/a n/a

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Navarro County Ambulatory Care Association Legal Name of Contractor Women's Center of East Texas, Inc. Navarro County Ambulatory Care Association Assumed Business Name of Contractor, if applicable (d/b/a or ‘doing business as’) Navarro County Ambulatory Care Association 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. September 22, 2021 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx XxxxxxOctober 17, Xxx. 000 2022 Date Signed Executive Director Title of Authorized Representative Longview000 Xxxxx Xxxx Corsicana, TX 75605 Texas 75110 Physical Street Address City, State, Zip Code PO Box 347 Longview518 Corsicana, TX 75605 Texas 75151 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000 000-0000 N/A Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 KY5DDLUDQ94 xxxxxxxxxx@xxxxxxx.xxx Email Address DUNS Number 00-0000000 00-0000000 N/A Federal Employer Identification Number Texas Payee ID No. – 11 digits 00Identification Number (TIN) /00-0000000 00-0000000Texas Franchise Tax Number Texas Secretary of State Filing Number KY5DDLUDQ94

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx WellCare of Texas, Inc Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22, 2021 05/27/2022 Signature of Authorized Representative Date Signed Xxxxxx Xxxxx Executive Director Xxxx X. Xxxxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 X. Xxx Xxxxx Blvd. Austin, TX 75605 78741 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxx.Xxxxxxx@xxxxxxxxxxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification 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 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: Xxxxxx Xxxxx WellCare of Texas, Inc Legal Name of Contractor Women's Center WellCare of East Texas, Inc. Inc 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) 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 22, 2021 Signature of Authorized Representative 04/25/2022 Date Signed Xxxxxx Xxxxx Executive Director Xxxx X. Xxxxxxx CEO & Plan President Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Title of Authorized Representative Longview0000 X. Xxx Xxxxx Blvd. Austin, TX 75605 Texas 78741 Physical Street Address City, State, Zip Code PO Box 347 Longview, TX 75605 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 (000) 000-0000 (000) 000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxx.Xxxxxxx@xxxxxxxxxxxxxxxxxx.xxx 809245525 Email Address DUNS Number 00-0000000 00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000Identification Number (TIN) 32023469722 0800743617 Texas Franchise Tax Number Texas Secretary of State Filing Number 809245525

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. Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Xxxxxx Xxxxx Xxxxxxx Xxxxxxxxx, Director of Public Health Legal Name of Contractor Women's Center of East Texas, Inc. 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) 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 22, 2021 filed Signature of Authorized Representative September 8, 2021 Date Signed Xxxxxx Xxxxx Executive Director Xxxxxxx Xxxxxxxxx MPH Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxx Xxxxxx, Xxx. 000 Health Director Title of Authorized Representative Longview0000 Xxxxx Xx Xxxxxx Christi, TX 75605 78416 Physical Street Address City, State, Zip Code PO Box 347 Longview0000 Xxxxx Xx Corpus Christi, TX 75605 78416 Mailing Address, if different City, State, Zip Code 0000000000 0000000000 000-000-0000 000-000-0000 Phone Number Fax Number xxxxxx@xx-xx.xxx 607663622 Xxxxxxxx@xxxxxxx.xxx 078495025 Email Address DUNS Number 00-0000000 00-0000000 746000585016 Federal Employer Identification Number Texas Payee ID No. – 11 digits 00-0000000 00-0000000746000585 746000585

Appears in 1 contract

Samples: Interlocal Cooperation Contract

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