Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: 92441102150F468FBA21A3808FA4EECC Status: Sent Subject: New $2,602,223.00; HHS001019500016; Fort Bend County; DSHS/LIDS - IMM/COVID-19 Source Envelope: Document Pages: 67 Signatures: 0 Envelope Originator: Certificate Pages: 2 Initials: 0 Texas Health and Human Services Commission AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 0000 X. 00xx Xx. Austin, TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx IP Address: 167.137.1.16 Record Tracking Status: Original 4/16/2021 7:16:40 PM Holder: Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx Location: DocuSign Signer Events Signature Timestamp X.X. Xxxxxx Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx Xxx xxxxx.xxx@xxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Xxxxx Xxxx.Xxxxx@xxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 4/16/2021 7:37:09 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx Se...
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If Yes, where can this information be found? If No, you must provide the names and total compensation of the top five highly compensated officers. Example: Xxxx Xxxx:500000;Xxxx Xxxx:50000;Xxxx Xxxx:400000;Xxxx Xxxxx:300000;Xxxxx Xxx:300000 Identify contact persons for FFATA Correspondence FFATA Contact Person #1 Name Email Telephone Xxxx Xxx xxxx@xx.xxxxxx.xx.xx (000) 000-0000 FFATA Contact Person #2 Name Email Telephone Xxxxx Xxxxxx-Xxxxxxxx xxxxxxx-xxxxxxxx@xx.xxxxxx.xx.xx (000) 000-0000 As the authorized representative of the Organization, I hereby certify that the statements made by me in this certification form are true, complete and correct to the best of my knowledge. E-Signature Date
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below.
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: 1E291CF281FF4246BB35F5B343394609 Status: Sent Subject: Amending $465,114; 537-18-0172-00001 Corpus Christi-Nueces County PHD A-1; DSHS/CMS/HAZARDS Source Envelope: Document Pages: 34 Signatures: 0 Envelope Originator: Certificate Pages: 2 Initials: 0 Texas Health and Human Services Commission AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 0000 X. 00xx Xx. Austin, TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx IP Address: 167.137.1.16
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. For example: Xxxx Xxxx:500000;Xxxx Xxxx:50000;Xxxx Xxxx:400000;Xxxx Xxxxx:300000; Xxxxx Xxx:300000 Provide compensation information here: Health and Human Services (HHS) Uniform Terms and Conditions - Governmental Entity Version 3.0 Published and Effective - March 1, 2020 Responsible Office: Chief Counsel Table of Contents
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If Yes, where can this information be found? If No, you must provide the names and total compensation of the top five highly compensated officers. Example: Xxxx Xxxx:500000;Xxxx Xxxx:50000;Xxxx Xxxx:400000;Xxxx Xxxxx:300000;Xxxxx Xxx:300000 Identify contact persons for FFATA Correspondence FFATA Contact Person #1 Name Email Telephone Xxxxx Xxxxxx-Xxxxxxxx xxxxxxxxx@xx.xxxxxx.xx.xx (000) 000-0000 FFATA Contact Person #2 Name Email Telephone Xxxx Xxx xxxx@xx.xxxxxx.xx.xx (000) 000-0000 As the authorized representative of the Organization, I hereby certify that the statements made by me in this certification form are true, complete and correct to the best of my knowledge. E-Signature Date Xxxxx Self 07/31/2015 FY16/17 Project Service Delivery Plan Organization Name: Contract Number: Contract Term: Collin County 0000-000000-00 09/01/2015 - 08/31/2017 Program ID: Program Name: RLSS/LPHS RLSS/Local Public Health System-P Local Health Department: COLLIN COUNTY HEALTH CARE SERVICES Contract Term: September 1, 2015 through August 31, 2017 Indicate in this plan how requested Local Public Health Services (LPHS) contract funds will be used to address a public health issue through essential public health services. The plan should include a brief description of the public health issue(s) or public health program to be addressed by LPHS funded staff, and measurable objective(s) and activities for addressing the issue. List only public health issues/programs, objectives and activities conducted and supported by LPHS funded staff. List at least one objective and subsequent required information for each public health issue or public health program that will be addressed with these contract funds. The plan must also describe a clear method for evaluating the services that will be provided, including identification of a specific evaluation standard, as well as recommendations or plans for improving essential public health services delivery based on the results of the evaluation. Complete the table below for each public health issue or public health program addressed by LPHS funded staff. (Make ad...
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. For example: Xxxx Xxxx:500000;Xxxx Xxxx:50000;Xxxx Xxxx:400000;Xxxx Xxxxx:300000; Xxxxx Xxx:300000 Provide compensation information here: REQUEST DOCUMENT XXXXX Contract Change Request Requestor 00000242250 - Xxxxx,Xxxxxxxx Requisition ID 0000067138 Document ID ADH0000000000000000066540 Document Owner 00000242250 - Xxxxx,Xxxxxxxx Contract change request header Agency lead contact for contract changes 00000242250 - Xxxxx,Xxxxxxxx Desired amendment effective date March 12, 2019 Amendment contract number 537-18-0146-00001 Request amendment description Contract Description: The contractor provides activities in their service area in support of the Public Health Emergency Preparedness Cooperative Agreement from the Centers for Disease Control and Prevention and further Strategic National Stockpile program to comply with the Public Health Emergency Preparedness Cooperative Agreements Capabilities-based approach. The Cities Readiness Initiative requirements support the Medical Countermeasure Dispensing, Medical Material Management and Distribution capabilities, and supports medical countermeasure distribution and dispensing for all-hazards events. Contractor Name: Wise County (located in Decatur, TX) Purpose of Amendment: Amendment #2 (Renewal)-The purpose of the amendment is revise current language to the SOW and to renew the contract by adding funding for an additional year through June 30, 2020 to continue the activities for the Public Health Emergency Preparedness Cooperative Agreement for their service area. **This is a $0.00 requisition using FY19 chart field to start the XXXXX contract collaboration process with PCS. This contract crosses fiscal years. Once the FY20 organizational budget is loaded, additional requisitions will be entered to encumber the FY20 funds for the contract. ** Contract amount change: Original Contract Amount: $36,381.00 + Amendment ...
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? N/A If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: N/A Department of State Health Services Contract Management Section Form 4734 – April 2022 HHS Data Use Agreement This Data Use Agreement (“DUA”), effective as of the date the Base Contract into which it is incorporated is signed (“Effective Date”), is entered into by and between a Texas Health and Human Services Enterprise agency (“HHS”), and the Contractor identified in the Base Contract, a political subdivision of the State of Texas (“CONTRACTOR”). PURPOSE; APPLICABILITY; ORDER OF PRECEDENCE
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. For example: Xxxx Xxxx:500,000; Xxxx Xxxx:50,000; Xxxx Xxxx:400,000; Xxxxx Xxx:30,0000 Department of Administrative Services - (000) 000-0000 As the duly authorized representative (Xxxxxx) of the Contractor, I hereby certify that the statements made by me in this certification form are true, complete and correct to the best of my knowledge. Xxxxxx Xxxxx Printed Name of Authorizing Representative Signature of Authorizing Representative TSO Assistant Manager Title of Authorizing Representative Date EXHIBIT E INFORMATION REQUIRED BY 2 CFR § 200.332(a)(1)* Federal Award Identification:
Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. For example: Xxxx Xxxx:500000;Xxxx Xxxx:50000;Xxxx Xxxx:400000;Xxxx Xxxxx:300000; Xxxxx Xxx:300000 Provide compensation information here: REVIEW AND CERTIFICATION OF SOLICITATION, AND ROUTING REQUEST OF PROPOSED CONTRACT New Contract Number Amendment Number Emergency (See Texas Government Code (TGC) Ch. 418; §2155.137 and Texas Administrative Code (TAC) §20.41) New Work Order Number Amendment Number
