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Agreement No.A1CYZ03066 FY.2020 <br /> E�ibit 1 <br /> GRANT AGREEMENT <br /> ,-'yBTq$'. <br /> ���J§ Ca(h�,�;�,'`� . <br /> u t# `; y: <br /> jp�.�y O <br /> t� y }��C ";�) <br /> %�'. .J,.,h: <br /> V"''G28?�:.f96;' <br /> BETWEEN <br /> THE STATE OF ILLINOIS,DEPARTMENT OF HUMAN SERVICES <br /> AND <br /> ILLINOIS PRIMARY HEALTH CARE ASSOCIATION <br /> The Department of Human Services(Grantor or DHS),with its principal office at 100 South Grand Avenue East, <br /> Springfield, IL 62762,and ILLINOIS PRIMARY HEALTH CARE ASSOCIATION(Grantee),with its principal office at <br /> 500 S 9th St Springfield,IL 62701-1924 and payment address(if different than principal office)at <br /> ,hereby enter into this Grant Agreement("Agreement").Grantor and <br /> Grantee are collectively referred to herein as"Parties"or individually as a"Party". <br /> PART ONE—THE UNIFORM TERMS <br /> RECITALS <br /> WHEREAS,it is the intent of the Parties to perform consistent with all Exhibits and attachments hereto <br /> and pursuant to the duties and responsibilities imposed by Grantor under the laws of the state of Illinois and in <br /> accordance with the terms,conditions and provisions hereof. <br /> NOW,THEREFORE,in consideration of the foregoing and the mutual agreements contained herein,and <br /> for other good and valuable consideration,the value,receipt and sufficiency of which are acknowledged,the <br /> Parties hereto agree as follows: <br /> ARTICLE I <br /> AWARD AND GRANTEE-SPECIFIC INFORMATION AND CERTIFICATION <br /> 1.1. DUNS Number;SAM Registration; Nature of Entity. Under penalties of perjury,Grantee certifies <br /> that 188461735 is Grantee's correct DUNS number,that 36-3369241 is Grantee's correct FEIN or <br /> Social Security Number,and that Grantee has an active State registration and SAM registration.Grantee is doing <br /> business as a(check one): <br /> ❑Individual ❑Pharmacy-Non Corporate <br /> ❑Sole Proprietorship ❑ Pharmacy/Funeral Home/Cemetery Corp. <br /> ❑Partnership �Tax Exempt <br /> ❑Corporation(includes Not For Profit) ❑ Limited Liability Company(select <br /> ❑Medical Corporation applicable tax classification) <br /> ❑Governmental Unit ❑P=partnership <br /> ❑Estate or Trust ❑C=corporation <br /> If Grantee has not received a payment from the state of Illinois in the last two years,Grantee must submit a W-9 <br /> tax form with this Agreement. <br /> 1.2. Amount of Agreement.Grant Funds(check one) ❑shall not exceed or 0 are estimated to be <br /> $500,000.00 ,of which $0.00 are federal funds.Grantee agrees to accept Grantor's payment as <br /> State Of Illinois. <br /> GRANT AGREEMENT FISCAL YEAR 2020/1 14 19 <br /> Published Revision: 2019.12.16.1430.54 613 <br /> Page: 1 of 44 <br />