Common use of Signature Page for Amendment No Clause in Contracts

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 Department of State Health Services San Patricio County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900031 Department of State Health Services San Patricio County City of Laredo The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio County▇▇▇▇. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900053 Department of State Health Services San Patricio Victoria County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Victoria County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900039 Department of State Health Services San Patricio County Northeast Texas Public Health District The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio CountyAnderson, ▇▇▇▇, ▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇, ▇▇▇▇, ▇▇▇▇▇, ▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇▇, and ▇▇▇▇. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report the form titl (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900013 Department of State Health Services San Patricio Collin County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Collin County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900005 Department of State Health Services San Patricio County City of Austin The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio County▇▇▇▇▇▇. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900018 Department of State Health Services San Patricio Denton County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Denton County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900028 Department of State Health Services San Patricio Hidalgo County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Hidalgo County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900045 Department of State Health Services City of San Patricio County Antonio The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Bexar County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900020 Department of State Health Services San Patricio County City of El Paso The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio CountyEl Paso. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900055 Department of State Health Services San Patricio County City of Wichita Falls The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio CountyWichita. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900033 Department of State Health Services San Patricio County City of Lubbock The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio CountyLubbock. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900009 Department of State Health Services San Patricio Brazos County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Brazos County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900003 Department of State Health Services San Patricio Andrews County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Andrews County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900010 Department of State Health Services San Patricio County City of Brownwood The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio CountyBrown. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900019 Department of State Health Services San Patricio Ector County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Ector County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900024 Department of State Health Services San Patricio County Hunt county The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Hunt County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900002 Department of State Health Services San Patricio County City of Amarillo The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio County▇▇▇▇▇▇, ▇▇▇▇▇▇▇. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900052 Department of State Health Services San Patricio Uvalde County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Uvalde County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900044 Department of State Health Services San Patricio County City of Port ▇▇▇▇▇▇ The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Jefferson County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.

Signature Page for Amendment No. 1 DSHS Contract No. HHS001324900046 HHS001324900025 Department of State Health Services San Patricio Hardin County The following documents are attached hereto and hereby incorporated into the Contract: Attachment A-1 - Revised FY2024/2025 Statement of Work Attachment C-1 Contract Affirmations, Version 2.3, Effective August 2023 Attachment D-1 HHS Uniform Terms and Conditions Grant, Version 3.3, Effective November 2023 A. Grantee shall perform the activities required under this Contract in the following Texas county(ies): San Patricio Hardin County. B. Grantee will comply with all applicable regulations, standards, and guidelines in effect on the Effective Date of this Grant Agreement and as restated in subsequent amendments, if applicable. C. Grantee will work to improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Grant Agreement to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Grant Agreement; and 4. Developing strategies to improve the delivery of essential public health service(s) to its identified service area(s). D. Grantee will assess, monitor, and evaluate the essential public health activities in accordance with the following standards: 1. National Public Health Performance Standards, approved by the CDC Healthy People 2030 (Healthy People) related goals and objectives; 2. System Agency programmatic grant guidance and performance standards relative to this Attachment A-1 - Revised FY2024/2025 Statement of Work; and 3. Federal, state or local laws or regulations governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this section must be preapproved in writing by System Agency. E. Grantee shall implement its Project Service Delivery Plan ( PSDP ), as stated in its FY2024/2025 Local Public Health Services Application FY2024/2025 Local Public Health Services Application has been approved by System Agency and is incorporated by reference and made part of this Grant Agreement as if fully set forth herein. Any changes to the approved PSDP will require System Agency's written approval. F. Grantee shall submit quarterly performance reports, including a final performance report each fiscal year, that describes progress toward achieving the objectives approved PSDP. The quarterly performance reports must be G. Grantee will maintain an inventory of the following: (1) equipment, (2) supplies defined as Controlled Assets Section 7.4 of Attachment D-1 - HHS Uniform Terms and Conditions - Grant Version 3.3, Effective November 2023) and (3) real property. Grantee will complete an annual cumulative report of the above stated items on Report (Form GC-11) Grantee will submit the Form GC-11, via email, to (1) ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇, and (2) the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. The Form GC-11 must be submitted by no later than October 15th of each State Fiscal Year. H. Grantee will submit Financial Status Reports ( FSRs ) to System Agency, for review and financial assessment biannually. The reporting periods are as follows: 1. September 1st through February 28th (or February 29th, if a leap year); and 2. March 1st through August 31st. The biannual FSRs are to be submitted, by the due dates identified above, to the following email addresses: 1. ▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; 2. ▇▇▇▇▇▇▇▇▇@▇▇▇▇.▇▇▇▇▇.▇▇▇; and 3. The assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. I. Grantee may not begin work or incur charges for FY2024 until System Agency issues a written Notice to Proceed to Grantee, as funding for this Grant Agreement is dependent on the award of both state (General Revenue) and federal grant funds. Notice to Proceed may include an amended or ratified budget which will be incorporated into this Grant Agreement by a subsequent amendment, as necessary. Notwithstanding the preceding, at the discretion of the System Agency, Grantee may be eligible to receive reimbursement for eligible expenses incurred during the period of performance, as defined by 2 CFR §200.309. J. Grantee shall provide notification of budget transfers by submitting a revised Categorical Budget Form that highlights the areas affected by the budget transfer to the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement. ▇▇▇▇▇▇▇ is advised as follows: Contract amendment is required; and 2. After review, the assigned System Agency Contract Representative identified in Section VII, Contract Representatives, of the Grant Agreement shall provide notification of acceptance to Grantee via email, upon receipt of which, the revised budget shall be incorporated into the Contract.