Signature s. This Agreement, the rules and regulations referenced therein, together with the Vendor Guide, contain all terms and conditions agreed upon by the parties. The Vendor agrees that the person with the legal authority to obligate the Vendor has read, understands, and will comply with the terms of this Agreement. The undersigned represents that s/he is an owner or has other legal authority to obligate Vendor. In all instances, the State agency will advise the Vendor of the effective dates of the Agreement. The Vendor shall process WIC transactions only during the period of authorization within the effective dates of the Vendor Agreement. For initial applicants, this Agreement is effective after it has been signed by both parties, training is completed, an on-site preauthorization visit has been conducted in the Vendor’s physical location, and the WIC vendor stamp has been provided and/or the Vendor’s EBT ECR system has been certified. If the Vendor is making reapplication, this Agreement is effective on ____ _or the date signed by the State agency, whichever is later. This Agreement consists of this page and ten previous pages all bearing a revision date of 02/2021. _____ _____ _ Print Authorized Person’s Name and Title SIGNATURE FOR VENDOR _____ _____ Vendor Number (if renewal application) Date Signed The undersigned has authority to sign this Agreement on behalf of the Louisiana WIC Program: _____ SIGNATURE OF STATE AGENCY OFFICIAL Xxxxxxxx Xxxx, JD, MPH Assistant Secretary, Office of Public Health _____ _ Date Signed
