Common use of INVOICE AND PAYMENT Clause in Contracts

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget for FY 2019

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation X. Xxxxxxx tee will submit requests for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and any supporting documentation shall will be mailed or submitted by fax or electronic mail simultaneously to DSHS the Claims Processing Unit at and the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxxthe addresses in the below table, and to by the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxlast business day of the month following the month in which expenses were incurred or services provided. Department of State Health Services Contract Management Section Email: XXXxxxxxxxx@xxxx.xxxxx.xxx Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAXFax: (000) 000-0000 EMAILEmail: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx B. Grantee will be paid on a cost cost-reimbursement basis and in accordance with the Budget in Attachment B of this Contract. C. DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. Budget Categories Budget DSHS will monitor Xxxxxxx’s expenditures on a quarterly basis. If expenditures are below what is projected in Grantee’s total allocation amount, Grantee’s budget may be subject to a decrease for FY 2019the remainder of the Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds. D. Should Grantee not incur any expenses for a month, Grantee is required to timely submit a “zero” dollar invoice.

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices Vouchers and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.Section. At a minimum vouchers should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. DSHS Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not requireddocumentation. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit Section at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx XXXxxxxxxxx@xxxx.xxxxx.xxx Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B B-4, FY 2023 Budget of this Contract. Organization Name: Fort Bend County Program ID: IMM/LOCALS Contract Number: HHS000103000001 Budget Categories Budget for FY 20192023 September 1, 2022 - August 31, 2023 Personnel $164,575.00 Fringe $93,462.00 Travel $300.00 Equipment $0.00 Supplies $27.00 Contractual $0.00 Other $0.00 Total Direct $258,364.00 Indirect $0.00 Fort Bend County NA 000 Xxxxxxx Xx Richmond, TX 77469-3108 NA 77469-3108 081497075 00-0000000 XX Xxxxxx County Judge May 10, 2022 X NA NA 1. PROGRAM & CONTRACT MANAGEMENT

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget Organization Name: Fort Bend County Program ID: IMM/LOCALS Contract Number: HHS000103000001 Personnel $185,048.00 Fringe Benefits $73,316.00 Travel $0.00 Equipment $0.00 Supplies $0.00 Contractual $0.00 Other $0.00 Total Direct Costs $258,364.00 Indirect Costs $0.00 Total $258,364.00 SUPPLEMENTAL CONDITIONS There are no Supplemental Conditions for FY 2019this Contract that modifies this Contract's HHS Uniform Terms and Conditions.

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency DSHS no later than thirty (30) 30 days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. B. At a minimum invoices should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and. 5. C. Supporting documentation must include receipts include: 1. Receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline fare or mileage as documented by a readily available online mapping service; 2. Receipts for supplies, registration fees and other items ordered and paid; 3. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement; and 4. Paid invoices to contractors for services received. 5. Receipts for meals are not required. B. Grantee X. Xxxxxxx shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. F. DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. DSHS will monitor Xxxxxxx’s expenditures on a monthly basis. If expenditures are below what is projected in Grantee’s total Contract amount, Xxxxxxx’s budget may be subject to a decrease for the remainder of the Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds. Budget Categories Budget for FY 2019DSHS Funds Requested Category Total

INVOICE AND PAYMENT. A. Grantee shall Contractor will request payment monthly by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall will be submitted to System Agency DSHS no later than thirty 30 (30thirty) calendar days after the last day of each month. Documentation shall will be submitted in a format approved by DSHS Immunization Unit.DSHS. Invoices must be detailed and include a line item and breakdown for all services and fees provided by the Contractor. At a minimum, invoices should include: 1. Grantee Contractor name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or number and current Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not requiredreceipts. B. Grantee shall Contractor will request monthly payments using the State of Texas Purchase Voucher (Form B-13) available at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. . C. Voucher and supporting documentation shall will be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxxto: Xxxxx Xxxxxxx, DSHS Contract Manager, at Xxxxx.Xxxxxxx@xxxx.xxxxx.xxx; Contract Management Section, Section at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, XXXXxxxxxxx@xxxx.xxxxx.xxx; and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx D. Contractor will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B B-1 of this Contract. Budget Categories Budget for FY 2019The Contract will be used on an “as needed” basis; therefore, Contractor is not guaranteed a minimum number of orders.

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices Vouchers and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.Section. At a minimum vouchers should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. DSHS Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not requireddocumentation. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit Section at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx XXXxxxxxxxx@xxxx.xxxxx.xxx Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B B-4, FY 2023 Budget of this Contract. Organization Name: Collin County Health Care Services Program ID: IMM/LOCALS Contract Number: HHS000119700018 Budget Categories Budget for FY 20192023 Personnel $219,952.00 Fringe $105,577.00 Travel $6,811.00 Equipment $0.00 Supplies $20,762.00 Contractual $0.00 Other $960.00 Total Direct $354,062.00 Indirect $0.00 1. PROGRAM & CONTRACT MANAGEMENT

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices Vouchers and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.. At a minimum vouchers should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and. 5. Supporting documentation must include receipts include: a. Receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. ; b. Receipts for supplies, registration fees and other items ordered and paid. paid for; c. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. ; and d. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxxxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, TX Texas 00000-0000 FAXFax: (000) 000-0000 EMAILEmail: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx C. Grantee will be paid on a cost reimbursement basis and in accordance with the established state fiscal year Budget in Attachment B of this Contract. Fiscal Year 2020 Budget Organization Name: Collin County Health Care Services Program ID: IMM/LOCALS Budget Categories Budget for FY 20192020 Total $354,062.00

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline fare or mileage as documented by a readily available online mapping service. Receipts ; receipts for supplies, registration fees and other items ordered and paid. A ; a copy of the Personnel and Temporary Staff General Xxxxxx Ledger for the period which supports the budget items requesting reimbursement. Paid ; and paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget for FY 2019

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices Vouchers and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.Section. At a minimum vouchers should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. DSHS Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not requireddocumentation. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit Section at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx XXXxxxxxxxx@xxxx.xxxxx.xxx Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B B-4, FY 2023 Budget of this Contract. Organization Name: Fort Bend County Program ID: IMM/LOCALS Contract Number: HHS000103000001 Budget Categories Budget for FY 20192023 Personnel $164,575.00 Fringe $93,462.00 Travel $300.00 Equipment $0.00 Supplies $27.00 Contractual $0.00 Other $0.00 Total Direct $258,364.00 Indirect $0.00 1. PROGRAM & CONTRACT MANAGEMENT

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices Vouchers and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.. At a minimum vouchers should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and. 5. Supporting documentation must include receipts include: a. Receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. ; b. Receipts for supplies, registration fees and other items ordered and paid. paid for; c. A copy of the Personnel and Temporary Staff General Xxxxxx Ledger for the period which supports the budget items requesting reimbursement. ; and d. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Tray Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxxxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 AustinX.X. Xxx 000000 Xxxxxx, TX Xxxxx 00000-0000 FAXFax: (000) 000-0000 EMAILEmail: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx C. Grantee will be paid on a cost reimbursement basis and in accordance with the established state fiscal year Budget in Attachment B of this Contract. Budget Categories Budget for FY 2019.

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.. At a minimum invoices should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget Organization Name: Beaumont Public Health Department Program ID: IMM/LOCALS Contract Number: HHS000102200001 Personnel $92,868.00 Fringe Benefits $65,937.00 Travel $585.00 Equipment $8,796.00 Supplies $5,380.00 Contractual $0.00 Other $5,268.00 Total Direct Costs $178,834.00 Indirect Costs $0.00 Total $178,834.00 There are no Supplemental Conditions for FY 2019this Contract that modifies this Contract's HHS Uniform Terms and Conditions.

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; andand DRAFT 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget Organization Name: Comal County Health Department Program ID: IMM/LOCALS DRAFT Contract Number: HHS000119700005 Personnel $131,322.00 Fringe Benefits $55,855.00 Travel $8,688.00 Equipment $0.00 Supplies $5,000.00 Contractual $0.00 Other $6,610.00 Total Direct Costs $207,475.00 Indirect Costs $0.00 Total $207,475.00 DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT DRAFT SUPPLEMENTAL CONDITIONS There are no Supplemental Conditions for FY 2019this Contract that modifies this Contract's HHS Uniform Terms and Conditions.

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices Vouchers and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.. At a minimum vouchers should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and. 5. Supporting documentation must include receipts include: a. Receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. ; b. Receipts for supplies, registration fees and other items ordered and paid. paid for; c. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. ; and d. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxxxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, TX Texas 00000-0000 FAXFax: (000) 000-0000 EMAILEmail: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx C. Grantee will be paid on a cost reimbursement basis and in accordance with the established state fiscal year Budget in Attachment B of this Contract. Budget Categories Budget for FY 20192020 Total $191,873.00

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx C. Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget for FY 2019

INVOICE AND PAYMENT. A. Grantee shall Contractor will request payment monthly by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall will be submitted to System Agency DSHS no later than thirty (30) calendar days after the last day of each month. Documentation shall will be submitted in a format approved by DSHS Immunization Unit.DSHS. Invoices must be detailed and include a line item and breakdown for all services and fees provided by the Contractor. At a minimum, invoices should include: 1. Grantee Contractor name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or number and current Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not requiredreceipts. B. Grantee shall Contractor will request monthly payments monthlypayments using the State of Texas Purchase Voucher (Form B-13) available at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. . C. Voucher and supporting documentation shall will be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxxto: Xxxxx Xxxxxxx, DSHS Contract Manager at Xxxxx.Xxxxxxx@xxxx.xxxxx.xxx; Contract Management Section, Section at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, XXXXxxxxxxx@xxxx.xxxxx.xxx; and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx D. Contractor will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget for FY 2019The Contract will be used on an “as needed” basis; therefore, Contractor is not guaranteed a minimum number of orders.

INVOICE AND PAYMENT. A. Grantee shall will request payment by preparing an invoice monthly using the State of Texas Purchase Voucher (Form B- 13) and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and The Grantee will submit the Financial Status Report (FSR-269A). Vouchers, supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security numberdocumentation, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall Financial Status Reports should be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and emailed to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxaddresses below. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 AustinX.X. Xxx 000000 Xxxxxx, TX XX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx B-13s and supporting documentation should be sent to: xxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx. FSRs should be sent to: XXXXxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx. B. Subject to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis submission of required and appropriate documentation, and in accordance with applicable law and governing regulations, Grantee will be reimbursed monthly and in accordance with Attachment B, Budget. DocuSign Envelope ID: 3CC0EE2A-B323-4516-A29B-79A8A8FC40D7 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the Budget in Attachment B data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this Contractcollection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Xxxxxxxxxx, XX 00000. Budget Categories Budget As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for FY 2019Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.§§1681- 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U. S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. ARTICLE I. DEFINITIONS AND INTERPRETIVE PROVISIONS 5 1.1 DEFINITIONS 5 1.2 INTERPRETIVE PROVISIONS 7 ARTICLE II. PAYMENT PROVISIONS 8 2.1 PROMPT PAYMENT 8 2.2 ANCILLARY AND TRAVEL EXPENSES 8 2.3 NO QUANTITY GUARANTEES 8 2.4 TAXES 8 ARTICLE III. STATE AND FEDERAL FUNDING 8 3.1 EXCESS OBLIGATIONS PROHIBITED 8

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee Xxxxxxx’s name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline fare or mileage as documented by a readily available online mapping service. Receipts ; receipts for supplies, registration fees and other items ordered and paid. A ; a copy of the Personnel and Temporary Staff General Xxxxxx Ledger for the period which supports the budget items requesting reimbursement. Paid ; and paid invoices to contractors Grantees for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget for FY 20192019 ATTACHMENT D SUPPLEMENTAL AND SPECIAL CONDITIONS

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and; 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline fare or mileage as documented by a readily available online mapping service. Receipts ; receipts for supplies, registration fees and other items ordered and paid. A ; a copy of the Personnel and Temporary Staff General Xxxxxx Ledger for the period which supports the budget items requesting reimbursement. Paid ; and paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx C. Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget for FY 20192019 ATTACHMENT D SUPPLEMENTAL AND SPECIAL CONDITIONS

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Performing Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall will request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and any supporting documentation shall will be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 0000 Xxxx 00xx Xxxxxx P.O. Box X.X. Xxx 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx xxxxxxxx@xxxx.xxxxx.xx.xx, XXXXX.xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid B. System Agency shall pay Performing Agency on a cost reimbursement basis and in accordance with the Budget Attachment B-1, Budget. The clinical reviewers are to be paid $96.00 per hour for professional services. Each clinical reviewer is to be allocated an amount of $76,000.00 each for birth defect activities. Professional services include activities as detailed in Attachment B A-1 to include birth defect case review, training, travel expenses (meals, accommodations, parking, mileage, transportation, etc.), conferences, registration fees, meetings and activities directed by BDESB. C. Performing Agency shall submit an invoice as described in Subsection A above on a monthly basis, reasonably detailing time expended and a description of the nature of the Professional Services rendered. Invoices must be submitted monthly to prevent delays in subsequent months. Performing Agencies that do not incur e invoices. Invoices and all supporting documentation must be emailed to xxxxxxxx@xxxx.xxxxx.xxx, XXXXX.xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx simultaneously. Performing Agency must submit a final close-out invoice no later than 45 days following the end of the term of the Contract. Invoices received more than 45 days following the end of the term of the Contract are subject to denial of payment. D. Performing Agency shall maintain all documentation that substantiates invoices and make the documentation available to System Agency upon request. In the event a cost reimbursed under the Contract is later determined to be unallowable, the Contractor will reimburse System Agency for that cost. E. Performing Agency will submit the Financial Status Report (FSR-269A) at two reporting intervals to XXXxxxxxx@xxxx.xxxxx.xxx during the Contract term. The FSRs will be submitted biannually as outlined below and in alignment with the term of this Contract. Budget Categories Budget for FY 2019The biannual periods are as follows:

INVOICE AND PAYMENT. A. Grantee shall will request payment by preparing an invoice monthly using the State of Texas Purchase Voucher (Form B- 13) and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and The Grantee will submit the Financial Status Report (FSR-269A). Vouchers, supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security numberdocumentation, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall Financial Status Reports should be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and emailed to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxaddresses below. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 AustinX.X. Xxx 000000 Xxxxxx, TX XX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx B-13s and supporting documentation should be sent to: xxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx. FSRs should be sent to: XXXXxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx. B. Subject to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx will be paid on a cost reimbursement basis submission of required and appropriate documentation, and in accordance with applicable law and governing regulations, Grantee will be reimbursed monthly and in accordance with Attachment B, Budget. DocuSign Envelope ID: 9E5B8D62-CF04-41C7-8FB7-C6CD4042F562 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the Budget in Attachment B data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this Contractcollection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Xxxxxxxxxx, XX 00000. Budget Categories Budget As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for FY 2019Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.§§1681- 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U. S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. ARTICLE I. DEFINITIONS AND INTERPRETIVE PROVISIONS 5 1.1 DEFINITIONS 5 1.2 INTERPRETIVE PROVISIONS 7 ARTICLE II. PAYMENT PROVISIONS 8 2.1 PROMPT PAYMENT 8 2.2 ANCILLARY AND TRAVEL EXPENSES 8 2.3 NO QUANTITY GUARANTEES 8 2.4 TAXES 8 ARTICLE III. STATE AND FEDERAL FUNDING 8 3.1 EXCESS OBLIGATIONS PROHIBITED 8

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices Vouchers and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.. At a minimum vouchers should include: 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and. 5. Supporting documentation must include receipts include: a. Receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. ; b. Receipts for supplies, registration fees and other items ordered and paid. paid for; c. A copy of the Personnel and Temporary Staff General Xxxxxx Ledger for the period which supports the budget items requesting reimbursement. ; and d. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Tray Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxxxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 AustinX.X. Xxx 000000 Xxxxxx, TX Xxxxx 00000-0000 FAXFax: (000) 000-0000 EMAILEmail: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx C. Grantee will be paid on a cost reimbursement basis and in accordance with the established state fiscal year Budget in Attachment B of this Contract. Budget Categories Budget for FY 2019Organization Name: Fort Bend County Program ID: IMM/LOCALS Contract Number: HHS000103000001 Personnel $189,089.00 Fringe Benefits $69,017.00 Travel $258.00 Equipment $0.00 Supplies $0.00 Contractual $0.00 Other $0.00 Total Direct Costs $258,364.00 Indirect Costs $0.00 Immunization/Locals Program Guidance Document GRANTEE RESPONSIBILITIES Instructions related to each required and suggested activity below can be found in the

INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation tee will submit requests for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit. 1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number; 2. DSHS Contract or Purchase Order number; 3. Dates services were completed and/or products were delivered; and 4. The total invoice amount; and 5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required. B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and any supporting documentation shall will be mailed or submitted by fax or electronic mail simultaneously to DSHS the Claims Processing Unit at and the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxxthe addresses in the below table, and to by the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxxlast business day of the month following the month in which expenses were incurred or services provided. Department of State Health Services Contract Management Section Email: XXXxxxxxxxx@xxxx.xxxxx.xxx Department of State Health Services Claims Processing Unit, MC 1940 0000 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAXFax: (000) 000-0000 EMAILEmail: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx X. Xxxxxxx B. Grantee will be paid on a cost cost-reimbursement basis and in accordance with the Budget in Attachment B of this Contract. C. DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. Budget Categories Budget DSHS will monitor Xxxxxxx’s expenditures on a quarterly basis. If expenditures are below what is projected in Grantee’s total allocation amount, Grantee’s budget may be subject to a decrease for FY 2019the remainder of the Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds. D. Should Grantee not incur any expenses for a month, Grantee is required to timely submit a “zero” dollar invoice.