ESBD_548201_1786394625439_Form 01-Execution of Application.pdf

This is an Execution of Application form for the State of Texas related to Procurement #3202600194, an Open Enrollment solicitation for Employment Services. The form serves as the formal agreement by which applicants commit to providing the services outlined in the open enrollment solicitation while agreeing to comply with all applicant certifications specified in Section 1.6 of the solicitation document. Applicants are required to complete organizational information fields including legal entity name, mailing address, phone number, and email address. Additionally, applicants must provide either a Texas Identification Number (TIN) or Federal Tax ID Number and specify their business organization type.

The form requires authorization by an authorized signatory with date of execution and printed name. Applicants are instructed to submit the completed and signed Execution of Application form as the first document in their Enrollment Packet. No specific contract term, renewal options, pricing terms, or other contract-related details are addressed within this execution form itself, as it functions primarily as the application authorization document for the open enrollment process.