ESBD_547773_1786134330806_Form 01-Execution of Offer.pdf

This is an Execution of Offer form for Procurement #3202600208, an Open Enrollment for Assistive Technology (AT) Services administered by the State of Texas. The form serves as the official submission document through which applicants agree to provide services as described in the open enrollment solicitation and acknowledge compliance with applicant certifications outlined in Section 1.6 of the solicitation document. Applicants are required to complete organizational information including legal entity name, mailing address, contact information, and business organization type. The signed form must be placed behind Form 1 in the Enrollment Packet as part of the application submission.

The form requires applicants to provide either their Texas Identification Number (TIN) or Federal Tax I.D. Number and specify their business organization type (such as sole proprietorship, partnership, non-profit corporation, or for-profit corporation). An authorized signatory must execute the form with date of signature and printed name. This open enrollment solicitation for Assistive Technology Services targets customers with visual impairments in Texas and allows multiple vendors to enroll through this standardized process rather than a single competitive award.