University and Contractor have executed and delivered this Agreement to be effective as of the Effective Date. UNIVERSITY: CONTRACTOR: THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON By: By: ___________________________ Name: ______________________________ Name: ________________________ Title: ______________________________ Title: __________________________ [Option (Include if Contractor is a corporation.): Attest: ________________________ Corporate Secretary] Attach: EXHIBIT A Scope of Work – EXHIBIT B Schedule – EXHIBIT C Payment for Services – [Option (Include if University is a HIPAA Covered Entity and Contractor will receive, create and/or maintain for or on behalf of University data covered by HIPAA.): EXHIBIT D HIPAA Business Associate Agreement] – [Option (Include if HUB Subcontracting Plan was prepared in connection with the Work covered by this Agreement.): EXHIBIT E HUB Subcontracting Plan] – [Option (Include if federal contract provisions are included in this Agreement.): EXHIBIT ___ Affirmative Action Compliance Program] – [Option: (Include if this Agreement relates to electronic and information resources, including hardware, software or related services.): EXHIBIT ___ Electronic and – Information Resources Environment Specifications] [Option: (Include if this Agreement relates to electronic and information resources, including hardware, software or related services.): EXHIBIT ___ Security – Characteristics and Functionality of Information Resources] Contractor’s [Option: (Include if Contractor will receive, create and/or maintain for or on behalf of University FERPA Data.): EXHIBIT ___ FERPA Confidentiality and Security Addendum] – EXHIBIT A SCOPE OF WORK [Note: Provide a detailed description and break-down of all tasks Contractor is to perform and technical standards for the tasks, if appropriate.]
University and Contractor have executed and delivered this Agreement to be effective as of the Effective Date. UNIVERSITY: CONTRACTOR: THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON By: By: ___________________________ Name: ______________________________ Name: ________________________ Title: ______________________________ Title: __________________________ [Option (Include if Contractor is a corporation.): Attest: ________________________ Corporate Secretary] Attach: EXHIBIT A – Scope of Work EXHIBIT B – Schedule EXHIBIT C – Payment for Services [Option (Include if University is a HIPAA Covered Entity and Contractor will receive, create and/or maintain for or on behalf of University data covered by HIPAA.): EXHIBIT D – HIPAA Business Associate Agreement] [Option (Include if HUB Subcontracting Plan was prepared in connection with the Work covered by this Agreement.): EXHIBIT E – HUB Subcontracting Plan] [Option (Include if federal contract provisions are included in this Agreement.): EXHIBIT ___ – Affirmative Action Compliance Program] [Option: (Include if this Agreement relates to electronic and information resources, including hardware, software or related services.): EXHIBIT ___ – Electronic and Information Resources Environment Specifications] [Option: (Include if this Agreement relates to electronic and information resources, including hardware, software or related services.): EXHIBIT ___ – Security Characteristics and Functionality of Contractor’s Information Resources] [Option: (Include if Contractor will receive, create and/or maintain for or on behalf of University FERPA Data.): EXHIBIT ___ – FERPA Confidentiality and Security Addendum] EXHIBIT A SCOPE OF WORK [Note: Provide a detailed description and break-down of all tasks Contractor is to perform and technical standards for the tasks, if appropriate.]
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