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• � . . <br /> SUB RECIPIENT AGREEMENT <br /> FOR THE <br /> STATE OF ILLINOIS <br /> DEPARTMENT OF HUMAN SERVICES FUNDING <br /> PROJECT SUCCESS of Decatur and Macon County <br /> July 1, 2004 - June 30, 2005 <br /> THIS AGREEMENT, entered this 1 st day of Julv, 2004 by and between the City of Decatur, <br /> Illinois (herein called the "City" and also known as the Provider/Grantee) and Project Success <br /> of Decatur and Macon Countv(herein called the "Sub recipient"). <br /> WHEREAS, the Grantee has applied for and received funds from the Illinois Department of <br /> Human Services, Community Services,Fiscal Year 2005. and <br /> WHEREAS, the City wishes to engage the Sub recipient to assist the City in utilizing such funds; <br /> NOW, THEREFORE, it is agreed between the parties hereto that; <br /> 1. T�$1V� <br /> This Agreement shall be effective July 1, 2004, and shall expire June 30, 2005, unless <br /> extended pursuant to the terms hereof. <br /> 2. T XPAYER ERTIFI ATION(Sub recipient MUST complete) <br /> Under the penalties of perjury,the Sub recipient certifies that 37 1381966 is the sub <br /> recipient's correct Federal Taxpayer ldentification Number/Social Security Number <br /> (Mark One). The sub recipient is doing business as a(please check one). <br /> _Individual _Pharmacy-Non Corporate <br /> _Sole Proprietorship _Nonresident Alien <br /> Partnership _Pharmacy/Funeral Home/Cemetery <br /> �Corporation(includes Not For Profit) Corporation <br /> _Medical Corporation _Tax Exempt/HospitaUExtended Care <br /> _Government Unit Facility <br /> _Estate or Trust <br /> The Sub recipient also certifies that it does and will comply with all provisions of the <br /> Federal Internal Revenue Code, The Illinois Revenue Act, and all rules promulgated <br /> thereunder, including withholding provisions and timely deposits of employee taxes and <br /> unemployment insurance taxes. <br /> 3. PAYMENT <br /> A. The estimated amount payable by the Department of Human Services(DHS)to <br /> the City of Decatur is $60,000.00. The City of Decatur has agreed to accept the <br /> DHS payment for the services rendered as specified in the attachments under the <br /> Local Delinquency Prevention Program The City will provide payment to Project <br />