Common use of REMAINDER OF XXXX INTENTIONALLY LEFT BLANK Clause in Contracts

REMAINDER OF XXXX INTENTIONALLY LEFT BLANK. Authorized representative on behalf of Contractor must complete and sign the following: Texana Center 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 Signature of Authorized Representative August 4, 2020 Date Signed Xxxxxx Xxxxxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Title of Authorized Representative 0000 Xxxxxxx Xxxxxx Xxxxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code 0000000000 Phone Number Fax Number xxxxxx.xxxxxxxxx@xxxxxxxxxxxx.xxx 195970587 Email Address DUNS Number 00-0000000 17602532875 Federal Employer Identification Number Texas Payee ID No. – 11 digits N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Attachment H

REMAINDER OF XXXX INTENTIONALLY LEFT BLANK. Authorized representative on behalf of Contractor must complete and sign the following: Texana Center The Xxxxxx Xxxxxx for Menka1 Hea1kh and IDD 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 thorized Representative Augusk 11, 2020 Signature of Authorized Representative August 4, 2020 Au Date Signed Xxxxxx Xxxxxxxxx Xxxxx Xxxxx CEO Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Title of Authorized Representative 0000 Xxxxxxx Xxxxxx Xxxxxxxxx9401 Soukhwesk Freeway Houskon, XX 00000 Texas 77074 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxxxxxx@xxxxxxxxxxxx.xxx 195970587 xxxxx.xxxxx§XxxXxxxxxXxxxxx.xxx 0208005950000 Email Address DUNS Number 00-0000000 17602532875 17416039505 Federal Employer Identification Number Texas Payee ID No. – 11 digits N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Attachment H

REMAINDER OF XXXX INTENTIONALLY LEFT BLANK. Authorized representative on behalf of Contractor must complete and sign the following: Texana Center Epi1epsy Foundakion of 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 Signature of Authorized Representative August 4Augusk 6, 2020 Date Signed Xxxxxx Xxxxxxxxx Xxxxx Xxxx0xxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Chief Execukive Officer Title of Authorized Representative 0000 Xxxxxxx Xxxxxx XxxxxxxxxXxxxxxxx Xxxx Xx, Xxxxx 000 Xxxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Exk 219 Phone Number Fax Number xxxxxx.xxxxxxxxx@xxxxxxxxxxxx.xxx 195970587 dskah1huk§xxxx.xxx 000-000-0000 dskah1huk§xxxx.xxx 128155053 Email Address DUNS Number 00-0000000 17602532875 Federal Employer Identification Number Texas Payee ID No. – 11 digits N/A N/A Texas Franchise Tax Number Texas Secretary of State Filing Number Attachment H17421410840 00514097-01

REMAINDER OF XXXX INTENTIONALLY LEFT BLANK. Authorized representative on behalf of Contractor must complete and sign the following: Texana The Xxxxxx Center 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 Signature of Authorized Representative August 4, 2020 Date Signed Xxxxxx Xxxxxxxxx Xxx X. Xxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Chief Executive Officer Title of Authorized Representative 0000 Xxxxxxx 000 Xxxxxx XxxxxxxxxXxxx Richardson, XX 00000 TX, 75080 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxxxxxx@xxxxxxxxxxxx.xxx 195970587 xxx.xxxxx@xxxxxxxxxxxxxxx.xxx 00-000-0000 Email Address DUNS Number 00-0000000 17602532875 17512820402 Federal Employer Identification Number Texas Payee ID No. – 11 digits N/A N/A 17512820402 0024191301 Texas Franchise Tax Number Texas Secretary of State Filing Number Attachment H

REMAINDER OF XXXX INTENTIONALLY LEFT BLANK. Authorized representative on behalf of Contractor must complete and sign the following: Texana Center Texas Skake Independenk Living 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 resentative Sepkember 3, 2020 Signature of Authorized Representative August 4, 2020 Rep Date Signed Xxxxxx Xxxxxxxxx X. Xxxxxxxxxxxx Xxxxxx Printed Name of Authorized Representative First, Middle Name or Initial, and Last Name CEO Execukive Direckor Title of Authorized Representative 0000 Xxxxxxx Xxxxxx XxxxxxxxxXxxxx X-00 Xxxxxxxx Xxxx, XXX 000 Xxxxxx, XX 00000 Physical Street Address City, State, Zip Code Mailing Address, if different City, State, Zip Code 0000000000 000-000-0000 Phone Number Fax Number xxxxxx.xxxxxxxxx@xxxxxxxxxxxx.xxx 195970587 xxxxxx§xxxx0x.xxx 00-000-0000 Email Address DUNS Number 00-0000000 17602532875 3115827977 13115827977 Federal Employer Identification Number Texas Payee ID No. – 11 digits N/A N/A 0147358501 Texas Franchise Tax Number Texas Secretary of State Filing Number Attachment HNumber