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Effective Date: 
5/2017

Documents

 

Instructions

Updated: 5/2017

 

Purpose

Form 2031 provides a mechanism for a resolution to: specify an individual who may negotiate, execute, maintain, amend, renew or request closure of the contract with the Health and Human Services Commission (HHSC); and notify HHSC when the authorized representative has changed.

 

Instructions for HHSC Staff

When to Prepare

Form 2031 is prepared for a:

  • new contract;
  • change of ownership;
  • re-enrollment; and
  • change in authorized representative.

Form Retention

Retain Form 2031 in accordance with the requirements in Health and Human Services System Contract Management Handbook.

 

Instructions for Entity Completing Form 2031

Complete the resolution by filling in the blanks with the following information:

  • The name of the country, state and county in which the resolution is passed.
  • The day, month and year of the meeting.
  • The official name of the legal entity as registered with the Office of the Texas Secretary of State or, if not required to register, the legal name as established in the organic documents of the entity.
  • The city, county and state or province where the meeting was held.
  • The full legal name(s) and title(s) of the person(s) authorized to conduct business with HHSC on behalf of the legal entity.
  • The type of legal entity. If required to register with the Texas Secretary of State, use the type assigned by the Texas Secretary of State.
  • Repeat the official name of the legal entity.
  • Repeat the day, month and year of the meeting.
  • The signature of the secretary or other official of the authorizing authority.
  • Typed or printed name and title of the official of the authorizing authority.
  • The date of notarization.
  • Signature of the notary.
  • Typed or printed name of the notary and the jurisdiction that commissioned the notary.
  • Seal or stamp, if required in the jurisdiction of the notary, and commission expiration date.

Note: Submittal of a Form 2031 supersedes, in its entirety, any previously submitted Form 2031.