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

Appears in 2 contracts

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

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Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Xxxx X. Xxxxx CEO Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxxxxxXxxxxx, XX 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 00-0000000 32028367541 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing32051100371 0801791313

Appears in 2 contracts

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

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope HorizonFriendship of Women, LLC Inc Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Cameron Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed. September 20, 2021 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 00 X. Xxxxx Road Suite C Executive Director Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, XX 00000 000-000-0000 Physical Street Address City, State, Zip Code P.O. Box 3112 Brownsville, Texas 78523 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000-0000 xxx@xxxxxx.xxx Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxx@xxxxxx.xxx 015229129 Email Address DUNS Number 00-0000000 32028367541 742209659 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing742209659 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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized orized Representative Augusk 17, 2020 g Date Signed Xxxx X. Xxxxx CEO Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 08/17/2020 Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx Xxxx0 XX Xxx0xxxx 0 xxxxx 000 XxxxxxxxxxXxxxxx, XX 00000 Physical Street Address City, State, Zip Code 7108 X. Xxxxxx Hwy Skuark F1 34997 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 00-0000000 32028367541 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Norkh Cenkra1 Texas Counci1 of Governmenks Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Tarrank Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Sepkember 30, 2020 Date Signed Xxxx X. Xxxxx CEO Xxxx0xxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Execukive Direckor Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, XX X0xxx Xxxxx Xx0xxxxxx,Xxxxx 00000 Physical Street Address City, State, Zip Code P.O. Box 5888 Ar1ingkon, TX, 76005-5888 Mailing Address, if different City, State, Zip Code (000)000-000 000 0000 (000)000-000 000 0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 meask1and§xxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 32028367541 17560490124 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing00-000-0000 00-000-0000

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Soukh Texas Fami1y P1anning & Hea1kh Corporakion Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized ed Representative Augusk 24, 2020 g Date Signed Xxxx Xxxxxx X. Xxxxx CEO Zuniga Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Execukive Direckor Title of Authorized Representative 000 X Xxxxxxxxxx 0000 Xxxxx Xxxxx Xx0xxx Xx., Xxx, Xxx 000 Xxxxxxxxxx. 00 Xxxxxx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Same Same Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 MarkhaZuniga§XXXXXX.xxx 012532271 Email Address DUNS Number 00-0000000 32028367541 17417286212 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 N/A - nok a franchise 00308146 - Texas Franchise Tax Number Texas Secretary of State FilingCorporake Charker

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC DALLAS INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor DALLAS INDEPENDENT SCHOOL DISTRICT Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 05/22/2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxx Xxxxxxxx CFO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 0000 X. Xxxxxxx Xxxxxxxxxx, XX Xxxxx 000 Xxxxxx, XX, 00000 Physical Street Address City, State, Zip Code 0000 X. Xxxxxxx Xxxxxxxxxx, Xxxxx 000 Xxxxxx, XX, 00000 Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 XXXXXXXXXX@xxxxxxxxx.xxx 075096347 Email Address DUNS Number 00-0000000 32028367541 756001278 17560012787 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number

Appears in 1 contract

Samples: Texas Health and Human Services

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC P1ainview Foundakion for Rura1 Hea1kh Advancemenk Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Augusk 25, 2020 Signature of Authorized Representative Date Signed Xxxxx Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 8/25/2020 Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx0xx Xxxxxx Xxxx, XX 00000 Physical Street Address City, State, Zip Code P.O. Box 727 Hark, Tx 79043 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 rekka.xxxx§region16.nek 603159554 Email Address DUNS Number 00-0000000 32028367541 17528789609000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing32002238437 01572341010

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC San Patricio County Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed August 4, 2021 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxx August 4,2021 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Xxxxx X. Xxxxx Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, XX 00000 SAn Patricio County Judge Physical Street Address City, State, Zip Code 000 X. Xxxxxx Room 109 Sinton, Texas 78387 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-0000 0000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxx@xxxxxxxxxxxxxxxxxxx.xxx 078490547 Email Address DUNS Number 00-0000000 32028367541 1-74-6002307-4 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing1746002307006 00000

Appears in 1 contract

Samples: Interlocal Cooperation Contract

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Strawn Community Animal Rescue Effort Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed August 5, 2021 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 000 Xxxxxx Xxxx Board President Title of Authorized Representative 000 X Xxxxxxxxxx XxxMingus, Xxx 000 Xxxxxxxxxx, XX 00000 TX 76463 Physical Street Address City, State, Zip Code P. o. Box 353 Mingus, TX 76463 Mailing Address, if different City, State, Zip Code (000)000000 000-0000 (000)000000 000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxx0xxxxxx@xxxxx.xxx 060759740 Email Address DUNS Number 00-0000000 32028367541 383788294 32039655793 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingN/A non-profit 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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC NORTHWEST INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 06/18/2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CFO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 Xxxxx Xx. Xxxxxx, Xxx 000 XxxxxxxxxxXX, XX 00000 Physical Street Address City, State, Zip Code PO Box 77070 Fort Worth, TX, 76177-0070 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 Xxxxx Xxxxx Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxxx.xxxxxx@xxxxxx.xxx 613839893 Email Address DUNS Number 00-0000000 32028367541 756003004 17560030045 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number

Appears in 1 contract

Samples: Texas Health and Human Services

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Communiky Counci1 of Greaker Da11as Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Sepkember 10, 2020 Date Signed Xxxx Shar1a X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 X. Xxxxxxxxxxx Xxxx Suike 1000W Da11as, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75247 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 Xxxxxx§xxxxxxxxx.xxx 081744427 Email Address DUNS Number 00-0000000 32028367541 32001766461 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingN/A 008261301

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Michigan Peer Review Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Sepkember 17, 2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Le1and A Babikch, MD MBA Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name PRESIDENT & CEO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx00000 XXXXXXXX XX, Xxx 000 XxxxxxxxxxSUITE 100 Farmingkon Hi11s, XX 00000 MI 48335 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 1babikch§xxxx.xxx 121631113 Email Address DUNS Number 00-0000000 32028367541 00000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 000000000 000000000 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number Health and Human Services (HHS) Uniform Terms and Conditions - Vendor Version 3.0 Published and Effective - November 7, 2019 Responsible Office: Chief Counsel Health and Human Services Uniform Terms and Condition – Vendor V.3.0

Appears in 1 contract

Samples: Signature Document For

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Covenank Hea1kh Syskem Legal Name of Contractor Covenank Medica1 Cenker Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Lubbock Counky Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized o rized Representative Date Signed Xxxx X. Xxxxx CEO X Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name June 25, 2020 Date Signed CFO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, 3615 00xx Xxxxxx Xxxxxxx XX 00000 Physical Street Address City, State, Zip Code PO Box 677044 Da11as TX 75267-7044 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000-0000 Per Deparkmenk Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 jgrigson§xxxxx.xxx B1ank Email Address DUNS Number 00-0000000 32028367541 17527655660 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingB1ank 0148867401

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Andrews Counky Hea1kh Deparkmenk Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) d/b/a Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) d/b/a Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Where Assumed Name Certificate(s) has been filed x x Xxxxxx Makkimoe Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Augusk 4, 2021 ized Representative Date Signed Direckor Title of Authorized Representative 000 X Xxxxxxxxxx XxxX. X. 0xx XX. Xxxxxxx, Xxx 000 Xxxxxxxxxx, XX XX. 00000 Physical Street Address City, State, Zip Code 000 X.X. 0xx XX Xxxxxxx XX. 00000 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000-0000 Xxxxxxx XX. 00000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 000-000-0000 000-000-0000 Email Address DUNS Number 00-0000000 32028367541 gmakkimoe§xx.xxxxxxx.xx.xx 000000000 Federal Employer Identification Number Texas Payee ID No. 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing756000815 756000815

Appears in 1 contract

Samples: Interlocal Cooperation Contract

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC ANAHUAC INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 06/01/2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Mr. Title of Authorized Representative 000 X Xxxxxxxxxx XxxXxxxxxx Xxxxx Dr. Xxxxxxx, Xxx 000 XxxxxxxxxxTX, XX 00000 77514-0369 Physical Street Address City, State, Zip Code PO Box 369 Anahuac, TX, 77514-0369 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxxx@xxxxxxxxxx.xxx 024486722 Email Address DUNS Number 00-0000000 32028367541 746000035 17460000353 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number

Appears in 1 contract

Samples: Texas Health and Human Services

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope HorizonDiscovery Hea1khcare Consu1king Group, LLC Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Sepkember 22, 2020 Date Signed Xxxx X. Xxxxx CEO Fu11er Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Parkner / Shareho1der Title of Authorized Representative 000 X Xxxxxxxxxx Xxx2950 00xx Xxxxxx Xxxxxxx, Xxx 000 Xxxxxxxxxx, XX Xxxxx 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 BrenkF§xxxx.xxx N/A Email Address DUNS Number 00-0000000 32028367541 32033143739 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 32033143739 0800829173 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number Health and Human Services (HHS) Additional Provisions Version 1.0 Effective: November 7, 2019 Medicare Cost Reporting Service Table of Contents 1. HHSC VENDOR ACCESS 1 2. HHSC APPROVAL OF STAFFING 1

Appears in 1 contract

Samples: Signature Document for Health and Human Services Contract

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Uniked Medica1 Cenkers Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Augusk 25, 2020 Signature of Authorized Representative Date Signed Xxxx Xx00xxx X. Xxxxx CEO Xxxxx00 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 X. Xxxxxxxx X0xx Xxx0x Xxxx, Xxx 000 Xxxxxxxxxx, XX Xxxxx 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000) 000-0000 (000)000000) 000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 wworre11.umc§xxxxx.xxx 031926009 Email Address DUNS Number 00-0000000 32028367541 741993570 17419935709 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingN/A 44215301

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Lakes Regional MHMR Center Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed. February 12, 2024 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Executive Director Title of Authorized Representative 000 X Xxxxxxxxxx XxxXxxxxxx Xx Xxxxxxx, Xxx 000 XxxxxxxxxxXX, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxx@xxxxxxxxxxxxx.xxx 112211854 Email Address DUNS Number 00-0000000 32028367541 17528338233 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Identification Number (TIN) 00-0000000 00-0000000 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number 51FB6

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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Ce1eske Xxxxxxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Augusk 9, 2021 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Ce1eske Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Ce1eske Xxxxxxxx CEO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, XX 00000 CEO Physical Street Address City, State, Zip Code 000 Xxx X NOrkh Bay Ciky Tx 77414 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 000 Xxx X Xxxxx Xxx XXxx XX 00000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 000-000-0000 000-000-0000 Email Address DUNS Number 00-0000000 32028367541 charrison§xxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing200537948 12005379487

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope HorizonLongview We11ness Cenker, LLC Inc. Legal Name of Contractor We11ness Poinke Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) A11 Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Augusk 21, 2020 Date Signed Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 0000 X Xxxxxxxxxx Xxx, Xxxxxx00 Xxx 000 XxxxxxxxxxXxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000000) 000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxx.xxxxx§xx00xxxxxxxxxx.xxx 135827421 Email Address DUNS Number 00-0000000 32028367541 1752723993 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingNA 01458284-01

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, CareMeridian LLC Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Augusk 6, 2020 Date Signed Xxxx X. Xxxxx CEO Xxxxxxx Vice Presidenk of Operakions Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, XX 00000 10002 Princess Pa1m suike 320 Tampa FL 33619 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-000 000 0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 Xxxx.Imboden§xxxxxxxxxxxxxxxx.xxx 017392718 Email Address DUNS Number 00-0000000 32028367541 12632212010 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filingn/a 803344129

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC B1uebonnek Trai1s Communiky MHMR Cenker d/b/a B1uebonnek Trai1s Communiky Services Legal Name of Contractor B1uebonnek Trai1s Communiky Services Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Baskrop, Burnek, Ca1dwe11, Fayekke, Gonza1es, Guada1upe, Xxx and Wi11iamson Counkies Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Augusk 4, 2020 Date Signed Xxxx X. Xxxxx CEO Xxxxxx Xxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Execukive Direckor Title of Authorized Representative 000 X 1009 X. Xxxxxxxxxx XxxSkreek Round Rock, Xxx 000 Xxxxxxxxxx, XX 00000 Texas 78664-3289 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxx.richardson§xxxxxx0x.xxx 965803432 Email Address DUNS Number 00-0000000 32028367541 742795332 17427953320 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingNok App1icab1e 17427953320000

Appears in 1 contract

Samples: Interlocal Cooperation Contract

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Hea1kh Cenker of Soukheask Texas Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Augusk 21, 2020 Signature of Authorized Auth orized Representative Date Signed Xxxx X. Xxxxx CEO Skeven Racciako Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Execukive Direckor Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, X. Xx00xxx Xxxxxxx Xxx 000 Xxxxxxxxxx, XX 00000 Physical Street Address CityCCi1teyv, StateeS1taantde,, Zip Code ZiTpXCo7d7e327 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 sracciako§xxxxx.xxx 360978642 Email Address DUNS Number 00-0000000 32028367541 15625085012 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing15625085012000 800466197

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Texoma Council of Governments Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative September 21, 2020 Date Signed Xxxx X. Xxxxx CEO Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Executive Director Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 Xxxxxxxxx Xxxxx Sherman, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75090 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxxxx@xxxxxx.xxx.xx.xx 000-000-0000 Email Address DUNS Number 00-0000000 32028367541 751292195 17512921952 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 17512921952 17512921952 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number DocuSign Envelope ID: 0B971E91-DD5A-41FA-9E0C-4AAF6543A037 ATTACHMENT K

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Parkland Health & Hospital System Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 ized Representative August 31, 2020 Signature of Authorized Representative Author Date Signed Xxxx Xxxxxxx X. Xxxxx CEO Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name EVP/CFO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 Xxxxx Xxxxx Blvd Dallas, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75235 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxx.xxxxxxxxxx@xxxx.xxx 049046527 Email Address DUNS Number 00-0000000 32028367541 0-00-0000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingN/A N/A

Appears in 1 contract

Samples: Affirmations

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope HorizonCommuniky Hea1kh Cenker of Lubbock, LLC Inc. Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Augusk 20, 2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Michae1 Su11ivan Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 08/20/2020 Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx0000 0xx Xxxxxx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 msu11ivan§xxx0.xxxxx.xxx 841895600 Email Address DUNS Number 00-0000000 32028367541 17524249251 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing17524249251000 0122584101

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope HorizonXxxxxxx X.Xxxxxx Community Health Center, LLC Inc. Legal Name of Contractor Community Health Network Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) All Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative August 24, 2020 Date Signed Xxxx X. Xxxxx CEO Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Executive Office Title of Authorized Representative 00000 Xxxxxxxxx Xxxx , Xxxxx 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, XX 00000 -Houston Texas 77089-5743 Physical Street Address City, State, Zip Code 00000 Xxxxxxxxx Xxxx., Xxxxx 000 Houston, Texas, 77089-5743 Mailing Address, if different City, State, Zip Code (000)000000) 000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxx@xxxxxx.xxx 825062818 Email Address DUNS Number 00-0000000 32028367541 xxxxxx.xxx N/A Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing00-0000000 N/A

Appears in 1 contract

Samples: Affirmations

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Xxxxxx Xxxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed. April 19, 2024 Signature of Authorized Representative Date Signed Xxxx Xxxxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Sr. Manager of Contracts Title of Authorized Representative 000 X Xxxxxxxxxx 0000 Xxxxxx Xxx. Austin, Xxx 000 Xxxxxxxxxx, XX 00000 TX 78712 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxx@xxxxxx.xxxxxx.xxx 170230239 Email Address DUNS Number 00-0000000 32028367541 746000203 37217217217 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Identification Number (TIN) N/A N/A Texas Franchise Tax Number Texas Secretary of State FilingFiling Number V6AFQPN18437

Appears in 1 contract

Samples: Interagency 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. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Augusk 20, 2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 08/20/2020 Title of Authorized Representative 000 X Xxxxxxxxxx XxxX. Xxxx0 Xxxx B1dg. 3 Ske 290 Irving, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75039 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 00-0000000 32028367541 mno1an§xxxxxxx.xxx 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Aggie1and Humane Socieky Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed Ju1y 19, 2021 Signature of Authorized Representative Date Signed Kakhy L Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Execukive Direckor Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 Xxxxxxx Xxxx Bryan, Xxx 000 Xxxxxxxxxx, XX 00000 TX 77807 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 nok app1icab1e kbice§xxxxx0xxxxxxxxx.xxx Email Address DUNS Number 00-0000000 32028367541 17421502885 002 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filingnok app1icab1e 53785901

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized orized Representative Augusk 17, 2020 g Date Signed Xxxx X. Xxxxx CEO Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 08/17/2020 Title of Authorized Representative 000 X Xxxxxxxxxx XxxX. Xxxx0 Xxxx B1dg. 3 Ske 290 Irving, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75039 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 00-0000000 32028367541 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope HorizonFamily Crisis Center, LLC Inc. Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed. September 20, 2021 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxxxx Executive Director Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 616 X. Xxxxxx Title of Authorized Representative 000 X Xxxxxxxxxx XxxHarlingen, Xxx 000 Xxxxxxxxxx, XX 00000 TX 78550 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxxxxx@xxxxxxxxxxxxxxx.xxx 164929598 Email Address DUNS Number 00-0000000 32028367541 1-74-2243258-7 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing17422432587 00586501-01

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC The Universiky of Texas ak Auskin Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative December 4, 2020 Date Signed Xxxx X. Xxxxx CEO X Xxxxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Assiskank Direckor, OSP Title of Authorized Representative 000 0000 X Xxxxxxxxxx XxxXxxxxx Xx, Xxx 000 XxxxxxxxxxSTE 3.340 Auskin, XX 00000 TX 78759 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 mark.feakherskon§xxxxxx.xxxxxx.xxx 170230239 Email Address DUNS Number 00-0000000 32028367541 746000203 37217217217 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 37217217217 37217217217 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number Health and Human Services (HHS) Uniform Terms and Conditions - Governmental Entity Version 3.2 Published and Effective - May 2020 Responsible Office: Chief Counsel Table of Contents

Appears in 1 contract

Samples: contracts.hhs.texas.gov

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Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Xxxxxxxx Counky Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) d/b/a Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) d/b/a Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed Signature of Authorized Representative Date Signed Au Xxxx X. Xxxxx CEO Bekh Xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Augusk 3, 2021 thorized Representative Date Signed Hea1kh Services Direckor Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 XxxxxxxxxxXxxxxxx Xxxx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Xxx 000 Xxxxxxx, XX 00000 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 mbess§xxxxxxxxxx.xxx 074204348 Email Address DUNS Number 00-0000000 32028367541 17460000361 17460000361 Federal Employer Identification Number Texas Payee ID No. 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing17460000361 17460000361

Appears in 1 contract

Samples: Interlocal Cooperation Contract

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Xxxxxx Xxxxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Date Signed A Xxxxxx Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Augusk 14, 2020 uthorized Representative Date Signed Chief Financia1 Officer Title of Authorized Representative 000 0000 Xxxxxxx Xxxxxx, Xxx0xxxx X Xxxxxxxxxx Xxx, Xxx 000 XxxxxxxxxxXxxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxx.dar§xxxxxxxxxxxx.xxx none Email Address DUNS Number 00-0000000 32028367541 195970587 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filingnone 17602532875

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Permian Basin Communiky Cenkers for Menka1 Hea1kh & Menka1 Rekardakion Legal Name of Contractor PermiaCare Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Mid1and Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized orized Representative Augusk 21, 2020 g Date Signed Xxxx X. Xxxxx CEO Xxxxxx00 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxxxxxxxx Xxx491 E I11inois, Xxx 000 XxxxxxxxxxSuike 401 Mid1and, XX 00000 Tx, 79701-4803 Physical Street Address City, State, Zip Code 401 E I11inois, Suike 401 Mid1and, Tx, 79701-4803 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 chrisbarnhi11§xxxxxxxxxx.xxx 074145561 Email Address DUNS Number 00-0000000 32028367541 17514017767 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingNA NA

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Xxxxxxxx X. Xxxxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Signature of Authorized Representative Date Signed Xxxx Where Assumed Name Certificate(s) has been filed Xxxxxxxx X. Xxxxx CEO Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name July 23, 2021 Signature of Authorized Representative Date Signed Chairperson Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 X. Xxxxxxxx Xxxxxx Woodville, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75979 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000 000-0000 (000)000000 000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxxx000@xxx.xxx 786314034 Email Address DUNS Number 00-0000000 32028367541 01134305029 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filingx x

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC The Texas International Institute of Health Professions Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized ized Representative August 24, 2020 g r Date Signed Xxxx X. Xxxxx CEO Xxxxxxx Xxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 08/24/2020 Title of Authorized Representative 0000 Xxxxxxxx Xxxxxx # 000 X Xxxxxxxxxx XxxXxxxxxx,Xxxxx, Xxx 000 Xxxxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxx@xxxxxxxxxxxx.xxx 078808831 Email Address DUNS Number 00-0000000 32028367541 461267820 32049328761 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing0801974770 0801974770

Appears in 1 contract

Samples: Affirmations

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Deep Eask Texas Counci1 of Governmenks Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Date Signed Xxxxxx Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxxxx Xxxxx Augusk 30, 2020 Signature of Authorized Representative Date Signed Execukive Direckor Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx, XX 00000 Lufkin TX 75904 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000-0000 exk. 5264 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 000-000-0000 1hunk§xxxxxx.xxx Email Address DUNS Number 00-0000000 32028367541 1hunk§xxxxxx.xxx 000000000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing00-0000000 17512510011000

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Soukh P1ains Pub1ic Hea1kh Diskrick Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Augusk 24, 2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Soronya Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Direckor of C1inica1 Services Title of Authorized Representative 000 X Xxxxxxxxxx XxxP91h9ysEic.alMSaitrneeStk.Address CBirtoyw, Xxx 000 XxxxxxxxxxnSftiaet1ed, XX 00000 Physical Street Address City,ZiTpXCo7d9e316 P.O. Box 112 Brownfie1d, State, Zip Code TX 79316 Mailing Address, if different City, State, Zip Code (000)000000 000 0000 000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 sshafer§xxxxx.xxx 009898441 Email Address DUNS Number 00-0000000 32028367541 756002471 17560024717 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingN/A N/A

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Xxx X. Xx00xxxx Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Ockober 6, 2020 Signature of Authorized Representative Date Signed Xxxx Xxx X. Xxxxx CEO Xx00xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Independenk Conkrackor Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx00000 Xxxxxxx XXxx Xxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000c)000-000-0000 (000)000-0000 NA Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 Xxx.Su11ivan§xxxx.xxxxx.xxx 080525683 Email Address DUNS Number 000-00-0000000 32028367541 0000 7003905518 4 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingNA NA

Appears in 1 contract

Samples: Health And

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Norkh Texas Behaviora1 Hea1kh Aukhoriky Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Augusk 19, 2020 Date Signed Xxxx X. Xxxxx CEO Caro1 E Lucky Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Title of Authorized Representative 0000 XXX Xxxx, Xxxxx 000 X Xxxxxxxxxx Xxx, Xxx 000 XxxxxxxxxxXx00xx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 c1ucky§xxxxx.xxx 011556147 Email Address DUNS Number 00-0000000 32028367541 17528112695000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 n/a 0521 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number ATTACHMENT E Health and Human Services (HHS) Additional Provisions Version 1.0 Effective: November 7, 2019 CONTENTSARTICLE I. 3

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC A1amo Area Counci1 of Governmenks Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Date Signed Xxxxx X. Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Augusk 31, 2020 Signature of Authorized Representative Date Signed Execukive Direckor Title of Authorized Representative 0000 Xxxxxx Xxxxx, xxx 000 X Xxxxxxxxxx XxxXxx Xxxxxxx, Xxx 000 Xxxxxxxxxx, XX Xx 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 drakh§xxxxx.xxx 010544658 Email Address DUNS Number 00-0000000 32028367541 17415574916 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filingnone none

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Michae1 No1an Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized orized Representative Augusk 19, 2020 g Date Signed Xxxx X. Xxxxx CEO Michae1 No1an Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Chief Execukive Officer Title of Authorized Representative 000 X Xxxxxxxxxx XxxXxxx0 XX Bui1ding 3 suike 290 098515457 Irving, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75039 Physical Street Address City, State, Zip Code 0000 X. Xxxxxx Hwy Skuark, FL 34997 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 mno1an§xxxxxxx.xxx 098515457 Email Address DUNS Number 00-0000000 32028367541 462865809 32051100371 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing32051100371 0801791313

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Signature Page Follows Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC MHMR Services of Texoma Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texoma Community Center Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed. October 28, 2021 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Title of Authorized Representative 000 X Xxxxxxxxxx Xxx315 X. XxXxxx Sherman , Xxx 000 Xxxxxxxxxx, XX 00000 TX 75092 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 902 Cottonwood Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 000-000-0000 000-000-0000 Email Address DUNS Number 00-0000000 32028367541 xxxxxx@xxxxxxxx.xxx 0068717010000 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing00-0000000 17514523608014

Appears in 1 contract

Samples: Grant Agreement

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Michae1 Ronde11i Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized rized Representative Augusk 27, 2020 Date Signed Xxxx X. Xxxxx CEO Michae1 Ronde11i Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 0000 Xxxxx Xxxx0x #311334 AVP, RCA Title of Authorized Representative 000 X Xxxxxxxxxx XxxDenkon, Xxx 000 Xxxxxxxxxx, XX 00000 TX 76203 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 0000000000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 researchconkracks§xxx.xxx 614168995 Email Address DUNS Number 00-0000000 32028367541 37527527529 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingNT756002149 nok app1icab1e

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Jasper Newkon Counky Pub1ic Hea1kh Diskrick Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature S uthorized Representative Augusk 21, 2020 ignature of Authorized Representative A Date Signed Xxxx Xxxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Adminiskrakive Direckor Title of Authorized Representative 000 X Xxxxxxxxxx XxxXxxx Xxxxx Xxxxxx Jasepr, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75951 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 vpaynejncphd§xxxxxx0.xxx 078708416 Email Address DUNS Number 00746001457 1-0000000 32028367541 746001457-8001 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filingn/a n/a

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Xxxx Xxxxx Xx00 Legal Name of Contractor Oukreach Hea1kh Communiky Care Services, LP Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Oukreach Home Care Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized S d Representative Date Signed Xxxx X. Xxxxx CEO Xx00 Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name 000 Xxxxxx Xxxxxxx Augusk 18, 2020 Date Signed CEO Title of Authorized Representative 000 X Xxxxxxxxxx XxxRichardson, Xxx 000 Xxxxxxxxxx, XX 00000 TX 75080-1316 Physical Street Address City, State, Zip Code 000 Xxxxxx Xxxxxxx Richardson, TX 75080-1316 Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 Email Address DUNS Number 00-0000000 32028367541 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingNumber

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Xxxxxx X Xxxxx Legal Name of Contractor United Way of Tarrant County Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative September 24, 2020 Date Signed Xxxx X. Xxxxxx X Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Executive Director, Area Agency on Aging Title of Authorized Representative 0000 Xxxxx Xxxx, Xxxxx 000 X Xxxxxxxxxx Xxx, Xxx 000 XxxxxxxxxxXxxx Xxxxx, XX 00000 0000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000000-000-0000 (000)000000-000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxx.xxxxx@xxxxxxxxxxxxxxxx.xxx 119780914 Email Address DUNS Number 00-0000000 32028367541 1750858360 1750858360 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing539-16-0009-00001 17764001

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC CANUTILLO INDEPENDENT SCHOOL DISTRICT Legal Name of Contractor CANUTILLO ISD Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 05/15/2020 Signature of Authorized Representative Date Signed Xxxx X. Xxxxx CEO Xxxxxxx Superintendent[ Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Title of Authorized Representative 000 X Xxxxxxxxxx Xxx0000 XXXXXXXX XX. EL PASO, Xxx 000 XxxxxxxxxxTX, XX 00000 79932 Physical Street Address City, State, Zip Code PO Box 100 El Paso, TX, 79835 Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxxxxx@xxxxxxxxx-xxx.xxx 037956166 Email Address DUNS Number 00-0000000 32028367541 746028038 17460280385 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingFiling Number

Appears in 1 contract

Samples: Texas Health and Human Services

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Contract Affirmations Signature. Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Heark of Texas Region MHMR Legal Name of Contractor na Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) na Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized ized Representative Augusk 16, 2020 g Date Signed Xxxx X. Xxxxx CEO Danie1 Xxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Augusk 12, 2020 Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx110 S. 00xx Xxxxxx Xxxx, XX 00000 Physical Street Address City, State, Zip Code PO Box 890 Waco, TX 76703-890 Mailing Address, if different City, State, Zip Code (000)000000-0000 (000)000000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 Danie1.Xxxxxxxx§xxxxxxxx.xxx 010470870 Email Address DUNS Number 00-0000000 32028367541 1-741622958-5 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filingna na

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC A1amo Area Counci1 of Governmenks Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Sepkember 25, 2020 Date Signed Xxxxx X. Xxxx X. Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Sepk. 25, 2020 Title of Authorized Representative 0000 Xxxxxx Xxxxx, xxx 000 X Xxxxxxxxxx XxxXxx Xxxxxxx, Xxx 000 Xxxxxxxxxx, XX Xx 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000000 000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 drakh§xxxxx.xxx 010544658 Email Address DUNS Number 00-0000000 32028367541 17415574916 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingNA NA

Appears in 1 contract

Samples: Health and Human Services Commission

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Abilene-Xxxxxx County Public Health District Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. d/b/a or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. d/b/a or ‘doing business as’) Attach Assumed Name Certificate(s) filed with the Texas Secretary of State and Assumed Name Certificate(s), if any, for each Texas County 3/5/2020 Where Assumed Name Certificate(s) has been filed. Signature of Authorized Representative Date Signed Xxxx X. Autho Xxxxx CEO Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name August 25, 2021 rized Representative Date Signed Deputy City Manager Title of Authorized Representative 000 X Xxxxxxxxxx Xxx, Xxx 000 Xxxxxxxxxx0xx Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code P.O. Box 60 Abilene, TX 79604 Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 xxxxx.xxxxxxxxx@xxxxxxxxx.xxx 081078891 Email Address DUNS Number 00-0000000 32028367541 756000440 17560004404 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State Filing756000440 756000440

Appears in 1 contract

Samples: contracts.hhs.texas.gov

Signature Authority. Contractor represents and warrants that the individual signing this Contract Affirmations document is authorized to sign on behalf of Contractor and to bind the Contractor. REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Authorized representative on behalf of Contractor must complete and sign the following: Hope Horizon, LLC Midd1e Rio Grande Deve1opmenk Counci1 Legal Name of Contractor Assumed Business Name of Contractor, if applicable (D.B.A. or ‘doing business as’) Texas County(s) for Assumed Business Name (D.B.A. or ‘doing business as’) Attach Assumed Name Certificate(s) for each County 3/5/2020 Signature of Authorized Representative Augusk 31, 2020 Date Signed Xxxx X. Xxxxx CEO Xx00xxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name Augusk 31, 2020 Title of Authorized Representative 000 X Xxxxxxxxxx XxxXxxx0 Xxxxxxx Xxxxxxx, Xxx 000 Xxxxxxxxxx, XX Xxxxx 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code (000)000-0000 (000)000-0000 Phone Number Fax Number xxxxxxxxx@xxxxxxxxxxxxxx.xxx 041360130 nick.ga11egos§xxxxx.xxx 088482625 Email Address DUNS Number 00-0000000 32028367541 17406661 17416661928 Federal Employer Identification Number Texas Payee ID No. – 11 digits 32028367541 0800789878 Texas Franchise Tax Number Texas Secretary of State FilingN/A N/A

Appears in 1 contract

Samples: Health and Human Services Commission

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