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 Envelope Id: D23FC322396A48C79435AD825B8B130D Status: Sent Subject: HHS001057600012 - Collin County Health Care Services - OHDPP COVID LHD BASE CONTRACT Source Envelope: Document Pages: 46 Signatures: 0 Envelope Originator: Certificate Pages: 5 Initials: 0 CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 00000 Xxxxxx Xxxxx Xxxx #000 Reston, VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: 160.42.85.9 Status: Original 8/13/2021 12:18:16 PM Holder: CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Xxxxx Xxxx XXXXX@XX.XXXXXX.XX.XX County Judge Collin County Security Level: Email, Account Authentication (None) Accepted: 8/13/2021 4:38:03 PM ID: 4b340e2e-5664-4334-ab50-7efe933bb0c9 Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Accepted: 8/13/2021 3:30:23 PM ID: 45407799-2196-4f46-8183-c98460919d12 Xxxxx Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Accepted: 8/13/2021 1:08:30 PM ID: 65f76030-a23c-4e46-89a5-ae26870177a0 Kirk Cole xxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Accepted: 8/13/2021 12:57:16 PM ID: 4be675cb-940b-4c4e-8fa3-1c73f48d94d4 Sent: 8/13/2021 3:07:13 PM Viewed: 8/13/2021 4:38:03 PM Xxxxxxxxx Xxxxxxx xxxxxxxx@xx.xxxxxx.tx.us Security Level: Email, Account Authentication (None) Not Offered via DocuSign Xxxxx Xxxxx xxxxx.xxxxx@xxxx.xxxxx.xxx Contract Manager Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Not Offered via DocuSign CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Not Offered via DocuSign Xxxxx Xxxx xxxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Not Offered via DocuSign Sent: 8/13/2021 3:07:13 PM Viewed: 8/13/2021 3:07:52 PM Sent: 8/13/2021 3:07:12 PM Envelope Sent Hashed/Encrypted 8/13/2021 3:07:13 PM Electronic Record and Signature Disclosure created on: 9/14/2020 7...

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 DocuSign Envelope ID: 7E16DFEF-8D5D-4F17-A65C-E7630F71D691 DocuSign Envelope ID: 7E16DFEF-8D5D-4F17-A65C-E7630F71D691 DocuSign Envelope ID: 7E16DFEF-8D5D-4F17-A65C-E7630F71D691 Requestor 00000242250 - Xxxxx,Xxxxxxxx Requisition ID 0000069171 Document ID ADH0000000000000000068495 Document Owner 00000242250 - Xxxxx,Xxxxxxxx Contract change request header Agency lead contact for contract changes 00000256514 - Xxxxxx,Xxxxxx Xxxxxxx Desired amendment effective date March 25, 2019 Amendment contract number 537-18-0187-00001 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: Fort Bend County (located in Richmond,, 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: $142,618.00 + Amendment #1 Amount: $142,618.00 + Amendment #2 Amount: $142,618.00 = (Total Amount: $427,854.00 + Total Match Amount: $42,786.00) =NEW TOTAL CONTRACT VALUE: $470,640.00 Contract change request details Does the amount change Ye...

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 Xxxxxx X. Sturdivant xxxxxx.xxxxxxxxxx@xxxxxxxxxxxxxxxx.xxx (000) 000-0000 FFATA Contact Person #2 Name Email Telephone Xxxx Xxxxxxxx xxxx.xxxxxxxx@xxxxxxxxxxxxxxxx.xxx (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 Xxxxxx Xxxxxx 06/24/2015 THE DEPARTMENT OF STATE HEALTH SERVICES (DSHS) and FORT BEND COUNTY HEALTH & HUMAN SERVICES ("Contractor"), (each a "Party" and collectively the "Parties") agree to amend Contract ID #0000-000000-00 ("Contract"), which was effective on May 15, 2015. This Contract has not been amended prior to this Amendment. This Amendment will be denominated as Contract No. 0000-000000-00. I. The Parties agree to amend Section 2 of the Contract to increase the total amount of the Contract to ONE HUNDRED EIGHT-NINE THOUSAND FIVE HUNDRED THIRTY-THREE DOLLARS ($189,533.00). II. The Parties agree to amend Section 4 of the Contract to extend the end of the Contract term to June 30, 2017. III. The Parties agree to revise Section 7(A) to read as follows: A. Contractor shall perform activities in support of the Public Health Emergency Preparedness Cooperative Agreement (Funding Opportunity Number CDC-RFA-TP12-12010302SUPP15) under the Grant Title: Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) Cooperative Agreements / PHEP Supplemental for Ebola Preparedness and Response Activities and CFDA # 93.074 from the Centers for Disease Control and Prevention (CDC). This Ebola preparedness and response supplemental funding seeks to support accelerated local public health preparedness planning and operational readiness for responding to ...

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