2019-10-23 CC MINUTES PT 2.pdfCINDY MUELLER
CALHOUN COUNTY AUDITOR
Calhoun County Courthouse Annex If
202 S Ann St, Ste B
Port Lavaca TX 77979
(361) 553-4610
TO: RICHARD H. MEYER, COUNTY JUDGE
FROM: AUDITORS OFFICE
DATE: October 16, 2019
RE: AGENDA ITEM — OCTOBER 23, 2019
Please place the following on the October 23, 2019 Commissioners' Court Agenda.
► Consider and take necessary action to approve the specifications and authorize the
County Auditor to advertise for Road Materials and Asphalts, Oils and Emulsions, Bid
Number 2020-03 for the period beginning January 1, 2020 and ending December 31, 2020.
Bids will be due 2:00 PM Wednesday, November 20, 2019 and considered for award on
Wednesday, December 11, 2019.
CALHOUN COUNTY, TEXAS
INVITATION TO BID
ANNUAL SUPPLY CONTRACT FOR
ROAD MATERIALS
AND
ASPHALTS, OILS AND EMULSIONS
Bid Number: 2020-03
Bid Period: January 1, 2020 thru December 31, 2020
BIDS WILL BE RECEIVED UNTIL
2:00 PM, Wednesday. November 20, 2019
ATTHE OFFICE OF
Richard H. Meyer, CountyJudse,
Calhoun County Courthouse,
211 S. Ann St., Suite 301, Port Lavaca, TX 77979
Public Bid Opening will be conducted at 2:00 PM, Wednesday, November 20, 2019 in the
County Judge's office, Calhoun County Courthouse, 3`d Floor, Suite 301, Port Lavaca, Texas
Page 1 of 53
CONTENTS
Invitation To Bid
List of Materials —Road Materials and Asphalts, Oils and Emulsions..........................................................4
Return
GeneralConditions.......................................................................................................................................................................................6-16
Invitation to Bid Form for Road Materials and Asphalts, Oils and Emulsions.....................................23-31
Contact, Billing and Location Information for Calhoun County Precincts...............................................32
33
Certificate of Interested Parties Form 1295 (Sample Copy Only)....................................................................34-35
Certificateof Liability Insurance........................................................................................................................................................36
Certification Regarding Debarment &Suspension and Other Responsibility Matters................37-39
Conflict of Interest Questionnaire Form CICt.......................................................................................................................40-41
HouseBill 89 Verification........................................................................................................................................................................42
Vendor and Order Information Form..........................................................................................................................................44
Current Prices for Road Materials for July 1, 2019 thru December 31, 2019........................................46-SO
Current Prices for Asphalts, Oils and Emulsions for July 1, 2019 thru December 31, 2019.....51-53
Page 2 of 53
INVITATION TO BID
BY ORDER OF the CommissionersCourt of Calhoun County, Texas, sealed was will be received for:
ANNUAL SUPPLY CONTRACT FOR
ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS
Bid Number: 2020-03
Bid Period: January 1, 2020 thru December 31, 2020
BID PACKAGES: May be obtained by contacting the Calhoun County Auditor s Office.
Peggy Hall, Assistant Auditor
Calhoun County Courthouse Annex II
202 S. Ann St., Suite B
Port Lavaca, TX 77979
Phone: 361-553-4610
Email: pessy.hall@calhouncotx.ore
Or on the county's website: www.calhouncotx.org, under Bid Notices and Results
DEADLINE FOR SUBMISSION OF BIDS: By 2:00 PM, Wednesday, November 20, 2019
Return entire Invitation To Bid package (pages 1-53) and al/ required forms.
SUBMISSION OF BIDS:
Sealed bid shall be submitted to:
Richard H. Meyer, County Judge
Calhoun County Courthouse
211 S Ann St, Suite 301
Port Lavaca TX 77979
The outside of the 9 x 12 or larger envelope must be clearly marked:
SEALED BID— ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS —Bid Number: 2020-03
If you send your bid by UPS, FEDEX, etc., the outside of this envelope must be clearly marked:
SEALED BID —ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS —Bid Number: 2020-03
Calhoun County is always very conscious and extremely appreciative of the time and effort a vendor
expends to submit a bid. If you will not be submitting a bid, we would appreciate you indicating on
your "No Bid" response any requirements of this bid request which may have influenced your
decision to "No Bid".
BID OPENING: Public bid opening will be conducted at 2:00 PM, Wednesday, November 20, 2019 in
the County Judge's Office, Calhoun County Courthouse, 3d Floor, Suite 301, Port
Lavaca,Texas
BID AWARD: Award information will be sent to all vendors that submitted a bid regardless if the
vendor was awarded a bid or not. Bid
awards will
be posted on
Calhoun County's
website (www.calhouncotx.ore)under
Bid Notices
and Results as soon as time permits.
Page 3 of 53
LIST OF MATERIALS
ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS
BID NUMBER: 2020-03
BID PERIOD: JANUARY 1, 2020 thru DECEMBER 31, 2020
All materials
shall
meet or exceed "Texas Department of Transportation Current Standard
Specifications for
Construction
and
Maintenance of Highways, Streets and Bridges" and/or Calhoun County
requirements.
ROAD MATERIALS
Bid
Item
#1:
Limestone-3/4 Inch to Dust
Bid
Item
#2:
Item 247, Type A Limestone, Grade 2 [1 %Inch]
Bid
Item
#3:
Item 247, Type A Limestone, Grade 3 [1 %Inch]
Bid
Item
#4:
Item 247, Type B (Flexible Processed Base), Grade 2
Bid
Item
#S
Item 247, Type B (Flexible Processed Base), Grade 3
Bid
Item
#6:
Item 275, Cement
275-2.1, Hydraulic Cement Type 1, Bulk (Pneumatic Tankers, Spreader Bar Needed)
275-2.1, Hydraulic Cement Type 1, 47 Ib. Bag (on Pallets)
Bid
Item
#7
Item
302,
Type
PB, Grade 3 (Pre -Coated Rock)
Bid
Item
#8
Item
302,
Type
PB, Grade 4 (Pre- Coated Rock)
Bid
Item
#9
Item
302,
Type
PE, Grade 3 (Pre -Coated Rock), *Material Source out of
Bid
Item
#10
Item
302,
Type
PE, Grade 4 (Pre -Coated Rock), *Material Source out of
Bid
Item
#11
Item
302,
Type
E, Grade 5, Ice Rock (Non Coated Limestone Only)
Bid
Item
#12
Item
330,
Type
D (Pre -Mix Limestone)
Bid
Item
#13
Item
330
D, Pothole Repair, Limestone Rock Asphalt (LRA)
The material will be used to construct a base course, a surface course, alevel-up course, pothole repair,
or any combination of these courses of the types and grade using acold-mixed material consisting of
native limestone rock asphalt (LRA) aggregate, fluxing material, water.
LRAMlxture-Furnish LRA according to DMS-9210, "Limestone Rock Asphalt (LRA)", Item 330 D per the
Surface Aggregate Classification plans as set forth by TXDOT Standard Specifications for Construction
and Maintenance of Highways, Streets, and Bridges 2014.
No material will be accepted that has been blended and stored on the producer's pad for more than 24
hours prior to loading and shipment.
Bid Item #14 Item 334, Type D, Hot Mix Cold Laid Asphalt Concrete Pavement
Material must meet or exceed Item 334, 4.1.21MF Table #5 Laboratory Mixture Design Properties found
in the Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges.
Bid Item #15 Item 432 Riprap, Section 2.3 Stone Riprap, 12" Limestone
ASPHALTS,
OILS
&EMULSIONS
Item
300, Asphalts, Oils and Emulsions
Bid
Item
#16
Primer Oil
Bid
Item
#17
AC-5
Bid
Item
#18
RC-250 —Temperature must be no lower than 140°
Bid
Item
#19
CRS-2 —Temperature must be no lower than 150°and no higher than 180°
Bid
Item
#20
CRS-2P —Temperature must be no lower than 150°and no higher than 180°
Page 4 of 53
RETURN INSTRUCTIONS
For
Submitting a Bid for
ANNUAL SUPPLY CONTRACT FOR
ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS
Bid Number: 2020-03
Bid Period: January 1, 2020 thru December 31, 2020
Return the follOWlnf; by 2:00 PM, WEDNESDAY0 NOVEMBER 20, 2019
The ENTIRE Invitation To Bid Package (pages 1-53) with all required forms included and or filled out, signed and
dated must be returned by the time and date due.
Check List for submitting your Bid:
Be sure all necessaryforms are included and or completed, signed and dated
Return one original Bid (Pages 1-53) — Be sure to include Form 1295 and copy of Certificate of Liability Insurance
Be sure to complete the following.
If a question or form is not applicable, mark the question or form with NA"
Invitation to Bid Form for Road Materials and Asphalts, Oils and Emulsions (pages 23-31)
Affidavit (page 33)
Certificate of Interested Parties, Form 1295 (pages 34-35)
Form 1295 must be completed online — Copy that is included is Sample Copy Only
Do Not Fill Out Sample Copy, Form 1295 must be completed online.
#1: Vendor's Name, City, State and Country
#2: Calhoun County, Texas
#3: Bid Number: 2020-03; Road Materials and Asphalts, Oils and Emulsions, January 1 thru December 31, 2020
On #4 and #5, complete only the one that applies to your company
#4: Fill in the correct information OR #5: Mark an X in the Box
#6: Fill in the correct information and print
When you print you should see a Certificate Number and Date Filed in the upper right hand box that is marked
"Office Use Only". Be sure that all of #5 is completed and signed. Do not leave out any information.
This form does not need to be notarized. It is now an Unsworn Declaration.
Certificate of Liability Insurance (page 36)
Please provide a copy of your Certificate of Liability Insurance (proof of required coverage)
Once bids area warded, the vendor that is awarded a bid must provide a Certificate of liability Insurance that reflects that
Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured)
Certification Regarding Debarment &Suspension and Other Responsibility Matters (pages 37-39)
Conflict of Interest Questionnaire, Form CIQ (pages 40-41)
House Bill 89 Verification (page 42)
Residence Certification (page 43)
Vender and Order Information Form (page 44)
W-9 (page 45)
Do Not Fold any of the above information.
Bid must be returned in a sealed 9 x 12 or larger envelope clearly marked:
Sealed Bid —Road Materials and Asphalts, Oils and Emulsions —Bid Number: 2020-03
If you send your bid by UPS, FEDEX, etc., the outside of this envelope must be clearly marked:
Sealed Bid — Road Materials and Asphalts, Oils and Emulsions— Bid Number: 2020-03
Submit Sealed Bid to: Richard H. Meyer, County Judge
Calhoun County Courthouse
211 S. Ann St., Suite 301
Port Lavaca, TX 77979
Page 5 of 53
CALHOUN COUNTY, TEXAS
GENERAL CONDITIONS
Read all documents carefully. Follow all instructions. Vendors are responsible for fulfilling all
requirements and specifications.
General Conditions apply to all advertised bids, proposals and/or contracts; however these may be
superseded in whole or in part by the scope, special requirements, specifications or special sections of
Texas Government Code and/or Texas Local Government Code.
Governing Law:
Vendor is advised that the Invitation to Bid, Request for Proposal and/or Contract shall be fully
governed by the laws of the State of Texas and that Calhoun County may request and rely on advice,
decisions and opinions of the Attorney General of Texas and the County Attorney concerning any
portion of the Invitation to Bid, Request for Proposal and/or Contract.
All parties agree that the venue for any litigation arising from this Invitation to Bid, Request for Proposal
and/or Contract shall be held in Port Lavaca, Calhoun County, Texas.
Bid. Proposal and/or Contract Form Completion:
Once a bid, proposal and/or contract is released for bidding, Calhoun County will not answer any
questions except through an addendum that has been approved by Calhoun County Commissioners'
Court or at a mandatory pre -bid meeting.
Fill out, sign, and return to the Calhoun County Judge's Office the required number of bid forms,
proposal forms, and/or contracts, and any other required information by the day and time the bid,
proposal and/or contract is due.
The bid, proposal and/or contract must be signed and dated by an officer (or employee) who is duly
authorized to execute this bid, proposal and/or contract, and that this company, corporation, firm,
partnership or individual has not prepared this bid, proposal and/or contract in collusion with any other
vendor, and that the contents of this bid, proposal and/or contract as to prices, terms or conditions of
said bid, proposal and/or contract have not been communicated by the individual signing nor by any
employee or agent to any other person engaged in this type of business prior to the official opening of
this bid, proposal and/or contract.
The use of liquid
paper or white out
is not acceptable and may result
in the disqualification of the bid,
proposal and/or
contract. If an error
is made, the vendor must draw a
line through the error and initial
each change. All
responses typed or
handwritten in ink must be clear
and legible.
Bid, Proposal and/or Contract Return:
On or before the due date and time, the bidder must return all completed bids, proposals and/or
contracts and required information and copies to the Calhoun County Judge's Office, 211 S. Ann St., 3`d
Floor, Suite 301, Port Lavaca, Texas.
Page 6 of 53
The clock in the Calhoun County Judge's office is the official clock that will be used in determining the
time the bid, proposal and/or contract is received and the time the bid, proposal and/or contract will
be opened. A late delivery with an early postmark will not suffice.
Calhoun County will not be responsible for the delivery of your bid, proposal and/or contract to the
office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to mail,
carrier, etc. Calhoun County does not accept faxed or emailed bids, proposals and/or contracts. If the
vendor would like to confirm the delivery of their bid, proposal and/or contract, the vendor may call
the Calhoun County Judge's office at 361-553-4600. Late bids, proposals and/or contracts will not be
accepted. Bids, proposals and/or contracts received after the deadline will not be opened and shall be
considered void and unacceptable.
Bids, proposals and/or contracts must be submitted in a sealed 9 x 12 or larger envelope, addressed as
follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port
Lavaca, TX 77979.
The outside
of the envelope must be
clearly marked: SEALED
BID (PROPOSAL) and
the name of the bid
or proposal
and bid, proposal and/or
contract number, if any,
must also be clearly
stated.
Withdrawal of BID, Proposal and/or Contract:
A vendor may withdraw their bid, proposal and/or contract before Calhoun County's acceptance of the
bid, proposal and/or contract without prejudice to the vendor, by submitting a written request for its
withdrawal to the Calhoun County Judge and mail or hand deliver to the address the bid, proposal
and/or contract was submitted to.
A bid, proposal and/or contract that were opened are not subject to amendment, alteration, or change
for the purpose of correcting an error in the bid, proposal and/or contract price. Bids, proposals and/or
contracts containing an error may be offered "as is" or withdrawn by the vendor in accordance with
applicable State Laws.
Bid, Proposal and/or Contract Openine and Award:
Vendors are invited to be present at the opening and awarding of the bid, proposal and/or contract.
Governins Forms:
In the event of any conflict between the terms and provisions of these conons and the
specifications, the specifications shall govern. In the event of any conflict of interpretation of any part
of this overall document, Calhoun County's interpretation shall govern.
Addendums:
When specifications are revised, the Calhoun County Auditor's Office will send each bidder that
received a bid, proposal and/or contract package the addendum once it has been approved by Calhoun
County Commissioners' Court. No addendum can be sent out until Calhoun County Commissioners'
Court has approved the addendum.
Page 7 of 53
Hold Harmless Agreement:
The successful vendor shall defend, indemnify and hold Calhoun County and its officers, agents, and
employees harmless from all suits, actions, or for personal injury, death and/or property damage
arising from any cause whatsoever, resulting directly or indirectly from bidder's performance. Vendor
shall procure and maintain, with respect to the subject matter of this bid, proposal and/or contract,
appropriate insurance coverage including, as a minimum, general liability and property damage,
workers' compensation, employers liability and auto insurance with adequate limits to cover vendor's
liability as may arise directly or indirectlyfrom work performed underterms of this bid, proposal and/or
contract. Certification of such coverage must name Calhoun County as an additional insured and be
provided to Calhoun County upon request.
Waiver of Subrogation:
Vendor and vendor's insurance carrier waive any and all rights whatsoever with regard to subrogation
against Calhoun County as an indirect party to any suit arising out of personal or property damages
resulting from vendor's performance under this agreement.
Bonds:
If this bid or proposal requires submission of bid or proposal guarantee and performance bond, there
will be a separate page explaining those requirements. Bids or proposals submitted without the
required bid bond or cashier's checks are not acceptable.
Taxes:
Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes.
Tax exempt forms will be furnished upon request to the Calhoun County Auditor's Office.
Pricing:
Prices for all goods and/or services shall be firm for the duration of this bid, proposal and/or contract
and shall be stated on the bid sheet, proposal and/or contract. Prices shall be all inclusive. All prices
must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and
other charges are to be prepaid by the vendor and included in the bid, proposal and/or contract prices.
If there are any additional charges of any kind, other than those mentioned above, specified or
unspecified, vendor must indicate the items required and their costs or forfeit the right to payment for
such items. Where unit pricing and extended pricing differ, unit pricing prevails.
Inspections:
Calhoun County reserves the right to inspect any items) and/or service location for compliance with
specifications and requirements and needs of the using department before accepting them.
Testing:
Calhoun County reserves the right to test equipment, supplies, materials and goods bid for quality,
compliance with specifications and ability to meet the needs of the user. Should the goods or services
fail to meet requirements and/or be unavailable for evaluation, the bid is subject to rejection.
Page 8 of 53
Material Safety Data Sheets:
Under the "Hazardous Communications Act", commonly known as the "Texas Right To Know Act", a
vendor must provide to Calhoun County with each delivery, material safety data sheets which are
applicable to hazardous substances defined in the Act. Failure of the vendor to furnish this
documentation will be cause to reject any bid, proposal and/or contract applying thereto.
Awards:
Calhoun County reserves the right to award this bid, proposal and/or contract on the basis of lowest
and/or best bid, proposal and/or contract that met specifications in accordance with the laws of the
State of Texas, to waive any formality or irregularity, to make awards to more than one vendor, to
reject any or all bids, proposals and/or contracts and to be the sole judge in determining which bid,
proposal and/or contract will be most advantageous to Calhoun County.
Calhoun County will evaluate and award a bid, proposal and/or contract based on lowest and best bid,
proposal, and/or contract meeting specifications. "Lowest and best bid, proposal and/or contract"
means a bid or offer providing the best value considering associated direct and indirect costs, including
transport, maintenance, reliability, life cycle, warranties and customer service after a sale.
Calhoun County reserves the right to accept and/or reject any/all of the options bid and/or proposed
as it deems to be in the best interest of Calhoun County. An award is final only upon formal execution
by Calhoun County Commissioners' Court.
In the event of
tie
bids,
proposal and/or contracts, the winning bid, proposal and/or contract is
determined per
the
Texas
Local Governmental Code 262.027(b).
Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. Calhoun County does not
discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion,
age or handicapped status in employment or the provision of services. Section 3 Residents, Minority
Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area
firms are encouraged to submit bids, proposals and/or contracts.
Assignment:
The successful vendor may not assign, sell or otherwise transfer this bid, proposal and/or contract
without written permission of Calhoun County Commissioners' Court.
Term of Bids. Proposals and/or Contracts:
If the bid, proposal and/or contract are intended to cover a specific time period, said time will be given
in the specifications and/or instructions.
Bid. Proposal and/or Contract Obligation:
Bids, proposals and/or contracts are awarded only upon formal execution by Calhoun County
Commissioners' Court. If a contract is required, the Calhoun County Judge or other person authorized
by Calhoun County Commissioners' Court must sign the contract before it becomes binding on Calhoun
County. No person is authorized to sign contracts and/or agreements until authorized by Calhoun
County Commissioners' Court.
Page 9 of 53
Delivery:
All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the
specifications. Default in promised delivery (without accepted reasons) or failure to meet
specifications, authorizes Calhoun County to purchase supplies from the next lowest vendor that met
specifications.
Rejections:
Articles not in accordance with samples and specifications must be removed by the vendor at the
bidder's expense.
All disputes concerning quality of supplies, products, and/or services delivered under this bid, proposal
and/or contract will be determined by Calhoun County Commissioners' Court or their designated
representative.
Termination:
Calhoun County reserves the right to terminate the bid, proposal and/or contract for default if the
vendor breaches any of the terms therein, including warranties of vendor or if the vendor becomes
insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of
any other remedies, which Calhoun County may have in law or equity. Default may be construed as,
but not limited to, failure to deliver the proper goods and/or services within the proper amount of
time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or
to meet all other obligations and requirements.
Bids, proposals and/or contracts may be terminated without cause upon thirty (30) days written notice
to either party unless otherwise specified. The vendor or Calhoun County must state therein the
reasons for such cancellation. Calhoun County reserves the right to award cancelled bid, proposal
and/or contract to the next lowest and best vendor that met specifications and is deemed to be in the
interest of Calhoun County.
Delinquent PropertyTaxes:
Calhoun County reserves the right to reject any bid, proposal and/or contract submitted by a vendor
owing delinquent property taxes to Calhoun County, Texas.
If the vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be
grounds for cancellation c, the bidIF V pite anything to the contrary, if the
vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, vendor assigns any
payments to be made under this bid, proposal and/or contract to the Calhoun County Tax Assessor
Collector for the payment of delinquent taxes.
Certificate of Interested Parties —Form 1295
Section 2252.908 was added to the Government Code by the 84th Texas Legislature through adoption
of House Bill 1295.
Senate Bill 255 adopted by the 85' Legislature Regular Session amended the law effective for contracts
entered into or amended on or after January 1, 2018.
Page 10 of 53
Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded
business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric
utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by
Section 121.001 of the Utilities Code.
Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an
authorized representative of the business entity.
The Texas Ethics Commission promulgated rules to implement the law and established an online portal:
https://www.eth ics.state.tx.us/whatsnew/elf_info_form 1295. htm.
The law states that a County may not enter into a contract with a business entity unless a Certificate of
Interested Parties (Form 1295) has been completed and provided to the County at the time the contract
is considered for action by Commissioners' Court.
The term "business entity" includes a sole proprietorship, partnership or corporation (whether profit or or non-profit). The term "contract" includes amendment, extension or renewal of an existing
contract (bids and/or proposals also require Form 1295). The law does not apply to a contract, bid
and/or proposal between the County and another governmental entity or state agency. The county is
required to file Form 1295 with the state within thirty (30) days of approving a contract with a business
entity. Governmental transparency is the objective of the law.
A business entity must generate Form 1295 online. A business entity must use the application at the
Texas Ethics Commission website to enter the required information on Form 1295 and print a copy of
the completed form, which will include a certification of filing that will contain a unique certification
number and date filed in the box marked "Office Use Only" located at the top right hand corner of the
form.
An authorized agent of the
business
entity must sign and complete the bottom portion
of the printed
copy of the form affirming
under the
penalty of perjury
that the completed form is true
and correct.
Calhoun County Commissioners' Court will not consider for action any bid, proposal and/or contract
with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement
declaring the provision of the low under which the business entity is exempt.
No later than thirty (30) days after Calhoun County Commissioners' Court approves a contract or
awards a bid or proposal with a business entity, the County Clerk will file acknowledgement of receipt
of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the
completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges
receipt of the form.
Debarment:
Vendor certifies that at the time of submission of its bid, proposal and/or contract, vendor was not on
the federal government's list of suspended, ineligible or debarred vendor and that vendor has not been
placed on this list between the time of its bid, proposal and/or contract submission and the time of
execution of the bid, proposal and/or contract.
Page 11 of 53
If vendor is placed on this list during the term of the bid, proposal and/or contract, the vendor shall
notify the Calhoun County Auditor. False certification or failure to notify may result in termination of
the bid, proposal and/or contract for default.
Invoices and Payments:
All invoices are subject to approval by the Calhoun County Auditor's Office.
Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice
pertains to and, if applicable, have all necessary backup information needed.
Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal
excise taxes, if applicable.
Invoices that are not billed to Calhoun County to the attention of the County Department that the
invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and
federal excise taxes, if applicable, may be returned to the vendor for corrections. Calhoun County shall
not incur any fees and/or other charges for this request and/or delay in payment of the invoice(s) that
was originally submitted incorrectly.
Payment of all invoices will be made once the purchase order and invoices) are properly and timely
submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each
County department is responsible for submitting their purchase orders for payment to the Calhoun
County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No
payment can be made or mailed out until approved by Calhoun County Commissioners' Court.
Purchase order due dates/times and Commissioners' Court dates/times are subject to change.
Calhoun County's obligation is payable only and solely from funds available for the purpose of this
purchase. Lack of funds shall render the order null and void to the extent funds are not available and
any delivered but unpaid goods will be returned to the seller by the county.
Gratuities:
Calhoun County may, by written notice to the vendor, cancel any order and/or service without liability,
if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise
were offered or given by the vendor, or any agent or representative of the vendor to any officer or
employee of Calhoun County with a view toward securing an order and/or service.
In the event an order and/or service is canceled by Calhoun County pursuant to this provision, Calhoun
County shall be entitled, in addition to any other rights and remedies, to recover or withhold the
amount of the cost incurred by bidder in providing such gratuities.
Warranty Product:
Vendor warrants that products sold and/or services provided Calhoun County shall conform to the
highest commercial and/or professional standards in the industry and laws established by the U.S.
Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health
Administration and OSHA Act of 1970.
Page 12 of 53
In the event products sold and/or services provided do not conform to OSHA Standards, where
applicable, Calhoun County shall return the product for correction or replacement at the vendor's
expense. In the event that services do not conform to OSHA Standards, Calhoun County may
immediately stop the services and seek reimbursement for said services at the vendor's expense. In
the event the vendor fails to make the appropriate correction within a reasonable time, correction
made by Calhoun County shall be at the vendor's expense.
Vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this bid,
proposal and/or contract voidable at the option of Calhoun County.
Vendor warrants that the goods and/or services furnished will conform to the specifications, general
conditions, drawings, and/or descriptions listed in the bid invitation, proposal and/or contract and to
the sample(s) furnished by vendor, if any. In the event of a conflict between the specifications, general
conditions, drawings, and/or descriptions, the specifications shall govern.
All items must be new, in first class condition, unless otherwise specified. The design, strength and
quality of materials must conform to the highest standards of manufacturing practice.
Items supplied under this bid, proposal and/or contract shall be subject to Calhoun County's approval.
Successful vendor shall warrant that all items/services shall conform to the proposed specifications
and/or all warranties as stated in the Uniform Commercial Code and be free from all defects in material,
workmanship and title. Any items found defective or not meeting specifications shall be picked up and
promptly replaced to Calhoun County's satisfaction by the successful vendor at no expense to Calhoun
County,
Cancellation:
Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of
an order and/or services if bidder breaches any of the terms hereof including warranties of vendor, or
if the vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of
cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have
in law or equity. Calhoun County shall not incur any fees and/or other charges related to the
cancellation.
Force Maieure:
Force Majeure means a delay encountered by a party in the performance of its obligations under this
Agreement, which is caused by an event beyond the reasonable control of that party. Without limiting
the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following
types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires,
floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other
labor disputes; and defaults by subcontractors.
In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations
under this Agreement, and the time for performance of any obligations of that party shall be extended
by a period of time necessary to overcome the effects of the Force Majeure, provided that the
foregoing shall not prevent this Agreement from terminating in accordance with the termination
provisions.
Page 13 of 53
If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in
writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the
delay.
Waiver:
No claim or right arising out of a breach of any bid, proposal and/or contract can be discharged in whole
or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is
supported by consideration and is in writing signed by the aggrieved party.
Applicable Law:
To the extent it is applicable, this agreement shall be governed by the Uniform Commercial Code.
Whenever the term "Uniform Commercial Code' is used it shall be construed as meaning the "Uniform
Commercial Code' as adopted in the State of Texas as effective and in force on the date of this bid,
proposal and/or contract. Otherwise, Texas state and federal law shall apply.
Prohibition aeainst Personal Interest in Bids, Proposals and/or Contracts:
No officer or employee of Calhoun County shall have financial interest, direct or indirect, in any bid,
proposal and/or contract with Calhoun County, or shall be financially interested, directly or indirectly,
in the sale to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun
County as an officer or employee. Any willful violation of this section shall constitute malfeasance in
office, and any officer or employee guilty thereof shall be subject to disciplinary action under applicable
laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge,
expressed or implied of the person or corporation contracting with Calhoun County shall render the
bid, proposal and/or contract involved voidable by the Calhoun County Commissioners' Court.
Insurance:
Before commencing work, the successful vendor shall be required, at his own expense, to furnish the
Calhoun County Auditor within ten (10) days of notification of award with a certificate of insurance
showing the following insurance coverage to be in force throughout the term of the bid, proposal
and/or contract:
General Liability ($100,000/$300,000 orgreater)
WorkersCompensation (at Statutory Limits)
Employers Liability ($1,000,000 or greater)
Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater)
The certificate must reflect that Calhoun County, Texas is an additional insured on the General Liability
coverageI
Each insurance policy to be furnished by successful bidder shall include, by endorsement to the policy,
a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days
prior to cancellation or upon any material change in coverage.
Page 14 of 53
OSHA Requirements:
Vendor must meet all Federal and State OSHA requirements.
The vendor or contractor hereby guarantees to Calhoun County that all materials, supplies, equipment
and/or services listed on the bid, proposal and/or contract, purchase order or invoice shall conform to
the requirements, specifications and standards promulgated by the U.S. Department of Labor under
the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof.
Protest Procedures:
All protests and disputes will be held in Port Lavaca, Calhoun County, Texas.
Any actual or prospective vendor who believes they are aggrieved in connection with or pertaining to
a bid, proposal and/or contract may file a protest. The protest must be delivered in writing to the
Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award.
The written protest must include:
Name, mailing address and business phone number of the protesting party;
Appropriate identification of the bid, proposal and/or contract being protested;
A precise statement of the reasons for the protest; and
Any documentation or other evidence supporting the protest and any alleged claims.
The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County
Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual
agreement, written verification of the resolution, with specifics on each point addressed in the protest,
will be forwarded to Calhoun County Commissioners' Court.
If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party
may request in writing that the protest be considered by Calhoun County CommissionersCourt.
Applicable documentation and other information applying to the protest will be forwarded to Calhoun
County Commissioners' Court, who will promptly review such documentation and information.
If additional information is required, Calhoun County Commissioners' Court will notify the protesting
party to provide such information. The decision of Calhoun County Commissioners' Court will be final.
Public Information Act:
All governmental information is presumed to be available to the public. Certain exceptions may apply
to the disclosure of the information. Governmental bodies shall promptly release requested
information that is not confidential by law, either constitutional, statutory, or by judicial decision, or
information for which an exception to disclosure has not been sought.
Page 15 of 53
CALHOUN COUNTY AUDITOR
To request information from Calhoun County, please contact:
Cindy Mueller
Calhoun County Auditor
Calhoun County Courthouse Annex II
202 S Ann St, Suite B
Port Lavaca, TX 77979
Phone: 361-553-4610
Fax: 361-553-4614
Email: cindv.mueller@calhouncotx.ore
To request a bid and/or proposal package from Calhoun County, please contact:
Peggy Hall
Assistant Auditor
Calhoun County Courthouse Annex II
202 S Ann St, Suite B
Port Lavaca, TX 77979
Phone: 361-553-4610
Fax: 361-553-4614
Email: pegay.hall@calhouncotx.ora
Bid and/or proposal packages may also be viewed on Calhoun County's website, www.calhouncotx.ors,
under Bid Notices and Results.
Page 16 of 53
SPECIFICATIONS FOR
ROAD MATERIALS AND ASPHALTS, OIL AND EMULSIONS
BY ORDER of the CommissionersCourt of Calhoun County, Texas, sealed bids will be received for
Road Materials and Asphalts, Oils and Emulsions as needed by the Road and Bridge Precincts.
See Contact, Billing and Location Information for Calhoun County Precincts (page 32) for complete
information/location on each Calhoun County Road and Bridge Precinct.
TO BE A VALID BID, THE FOLLOWING MUST BE RETURNED BY THE TIME AND DATE DUE
The entire Invitation To Bid Package (pages 1-53) with all required forms included and/or filled out,
signed and dated.
DEADLINE FOR BID SUBMISSION IS
2:00 PM, Wednesday, November 20, 2019
SUBMISSION OF BIDS
Sealed bid shall be submitted to: Richard H. Meyer, County Judge
Calhoun County Courthouse
211 S. Ann St., Suite 301
Port Lavaca, TX 77979
The outside of the 9 x 12 or larger envelope must be clearly marked:
Sealed Bid — Road Materials and Asphalts, Oils and Emulsions —Bid Number: 2020-03
If you send your bid by UPS,
FEDEX,
etc., the outside of this
envelope
must
be
clearly
marked:
Sealed Bid
— Road
Materials and Asphalts,
Oils and
Emulsions
— Bid
Number: 2020-03
BID TERM
The bid shall be in effect for a period of twelve (12) months beginning January 1, 2020 and ending
December 31, 2020.
In
INFORMATION/REQUIREMENTS
To submit a valid bid, read the entire Invitation To Bid for all required information that must be
included and all required forms that must be filled out, signed and dated and returned.
Calhoun County is always very conscious and extremely appreciative of the time and effort you have
expended to submit a bid. If you will not be submitting a bid, we would appreciate you indicating on
your "NO BID" response any requirements of this bid request which may have influenced your
decision to "NO BID".
Calhoun County is not responsible for errors if the bid forms are handwritten. It is recommended
that all information submitted by the vendor on the bid forms be typed. If handwritten, must be in
ink and legible.
Page 17 of 53
Materials shall meet or exceed "Texas Department of Transportation Current Standard Specifications
for Construction and Maintenance of Highways, Streets and Bridges" and/or Calhoun County
requirements.
A complete list of Road Materials and Asphalts, Oils and Emulsions can be found on page 4.
Vendor may bid any or all materials) for any location.
Vendor must be able to furnish bid items under terms of these specifications and general conditions if
vendor is awarded a bid.
Calhoun County is EXEMPT from all Sales Tax (county, city and state sales tax) and all Federal Excise
Taxes, if applicable.
Pump and
hoses,
if applicable, are to be furnished
by the vendor at no extra charge or shall be
included in
the bid.
Demurrage charges, if applicable, stated separately from the bid price of the material will increase
the amount of the bid price for the material.
Materials bid must be broken down into price per unit and delivery price. The sum total of these will
be used to determine the lowest and best bid.
Vendor will be required to deliver to all jobsites in Calhoun County as directed by the Commissioner
of applicable Calhoun County Precinct.
Jobsite can be road, field location or stockpile at designated Calhoun County locations.
Miles from pit to stockpile and/or jobsite will be shortest legal route.
Delivery shall be FOB Destination to designated Calhoun County Precinct stockpile or jobsites.
A fuel adjustment will be allowed on the delivery price only as fluctuations in diesel prices occur as
listed on http.eia.xov/petroleum/basdiesel, using the Gulf Coast Region. The baseline price
will be the price on this site on November 18, 2019 rounded to the nearest one -hundredth and
thereafter the index will be adjusted and documented on Monday of each week after bids are
accepted.
The allowable fuel adjustment will be calculated by subtracting the baseline price from the posted
price (for the Monday immediately prior to the delivery date of the material), and if the difference is
less than 5 cents no adjustment will be allowed; 5 cents to 9 cents a 1% adjustment to the delivery
price per unit; 10 cents to 14 cents a 2% adjustment to the delivery price per unit; 15 to 19 cents a 3%
adjustment to the delivery price per unit; 20 to 24 cents a 4% adjustment to the delivery price per
unit and so on. A 1% adjustment will be made on the delivery price for every 5 cent increase or
decrease from the baseline price.
Vendor must include a copy of the document that was used to determine delivery price when
invoicing Calhoun County.
Page 18 of 53
Materials shall be ordered in quantities as determined by each Calhoun County Commissioner.
Calhoun County Precincts will put out needed signs and barricades for traffic control.
Calhoun
County Precincts
will accept the
number
of trucks necessary to do a job on a most cost
efficient
basis, which could
require various
numbers
of trucks.
Any Vendor traveling on Calhoun County roads will not exceed its legal gross weight.
Each load shall be weighed on a certified public scale. Truck and trailer shall be weighed empty at
least once on each job run, or when a change is made due to changing truck, trailer, or other. Cost of
weighing shall be paid by the hauler. Driver shall get a material company ticket from pit or location
when loading. A copy of the scale weight ticket, material company ticket and company delivery ticket
shall be given to the Calhoun County employee at the jobsite when load is inspected and dumped.
Calhoun
County Precincts will
supervise the dumping of loads and a
Calhoun County employee will
sign the
delivery ticket. The
Calhoun County Precinct must receive
a copy of the signed delivery
ticket.
Calhoun County shall have the right to pull sample loaded trucks) to a certified scale of Calhoun
County's choice for loaded weight, unload truck(s) and take empty weight on same scale to verify
weights. Calhoun County shall pay for the weighing.
Calhoun County legally accepts the materials after it is unloaded and approved by the Calhoun
County Commissioner of said precinct.
All charges, including freight/handling charges and, if applicable, pump and hoses, must be included
in bid price or clearly stated on bid form. Additional charge listed separately, if any, will increase the
amount of the bid.
Any exceptions and or variations from the specifications in this bid document must be indicated on
the bid form or on a separate attachment to the bid and labeled as such. Exceptions taken and/or
variations made to the specifications and listed on the vendor's bid or separate attachment may void
the bid.
The request for a bid on a material does not guarantee that Calhoun County will purchase this
material during the bid period. Calhoun County does not guarantee to purchase any minimum or
maximum quantities. The materials will only be ordered as needed.
When required, all materials ordered will be delivered to the Calhoun County Precinct within 24
hours from time of order. In the event the vendor is unable to deliver the materials(s) ordered within
24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the
said material(s) from the vendor which submitted the next lowest bid that met specifications and can
deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or
other charges when cancelling an order.
Page 19 of 53
Vendor shall be required to notify Calhoun County in the event of unforeseen delay arising in the
delivery of an order. In the event an order will not arrive at the Calhoun County Precinct at the
designated time, Calhoun County shall have the right to cancel the order or refuse acceptance of the
order. Calhoun County shall not be accessed any penalties, fees and/or other costs due to this
cancellation or refusal.
Calhoun County or the vendor have the right to cancel the delivery of a materials) at any time due to
weather, road conditions and/or machinery breakdown. No penalties, fees and/or other charges will
be billed to Calhoun County if the delivery of a material(s) is cancelled by Calhoun County or the
vendor due to weather, road conditions and/or machinery breakdown.
The County reserves the right to refuse any order delivered for not being in compliance with the
specifications, general conditions and/or the "Hazardous Communications Act", commonly known as
the "Texas Right To Know Act".
The vendor, at the vendor's cost, shall immediately remove the materials) from the Calhoun County
Precinct that are deemed unsatisfactory, and are not in compliance with the specifications, general
conditions and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other
charges will be billed to Calhoun County for the removal of the material(s) from the Calhoun County
Precinct.
Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified
by State and/or Federal Regulations.
Calhoun County reserves the right to conduct random sampling of pre -qualified materials for testing
and to perform random audits of test reports. Calhoun County representatives may sample materials
from the manufacturing plant, terminal, shipping container and any other source they deem
necessary to insure reliability of the materials. If testing will be performed through a third party, the
vendor will be required to allow the third party access to the facilities in order to acquire samples for
testing. Regardless of results of any material(s) test required by Calhoun County, all costs incurred
for such tests shall be paid for by the vendor.
Specifications are not being met if materials are not delivered at the required temperatures.
The award of a bid will be voided if specifications, general conditions and/or instructions within this
Invitation To Bid are not followed. The bid would then be awarded to the vendor which submitted
the next lowest bid that met specifications and all requirements of the Invitation To Bid,
All Calhoun County Precincts handle their own orders; therefore invoices shall be billed to each
Calhoun County Precinct separately.
No other charges, including pump, hoses, and freight/handling changes, may be added to the
awarded bid price when invoiced unless these charges were noted on the bid form or separate
attachment and awarded as such.
All invoices must be billed to Calhoun County to the attention of the Calhoun County Commissioner
and Precinct ordering the material(s).
Page 20 of 53
Bid item number and material description, as stated on the bid form, awarded material bid price per
unit, delivery charge and/or other charge, if any other charge was included in the award, must appear
on all invoices in order to be considered for payment.
Invoices shall be free from sales tax (county, city or state sales tax) and federal excise taxes, if
applicable.
Invoices shall include a copy of the document used to calculate the increase or decrease in the
delivery charge.
Invoices shall include a copy of the delivery ticket that shows confirmation of delivery.
It is understood that Calhoun County Commissioners' Court reserves the right to accept or reject any
and/or all bids for any/or all materials and/or services covered in this bid request and to waive
informalities or defects in bids, or to accept such bids as it shall deem to be most advantageous and
in the best interest of Calhoun County.
Calhoun County Commissioners have the right to reject at any time any material that is undesirable
for either road or jobsite location.
Calhoun County will evaluate and award
bid based
on lowest and
best bid meeting specifications and
all requirements of the Invitation To Bid.
"Lowest
and best" means a bid or offer providing the best
value considering associated direct and
indirect costs, including
transport, maintenance, reliability,
life cycle, warranties and customer service
after a
sale. Calhoun
County reserves the right to accept
and/or reject any/all of the options bid as
it deems
to be in the best
interest of Calhoun County.
Although the cost of materials(s) to be provided is an essential part of the bid, Calhoun County is not
obligated to award a bid (contract) on the sole basis of cost but will award to the vendor considered
to be the best value to the Calhoun County.
The bid award shall be based on, but not necessarily limited to, the following factors:
• Unit price
• Extended price
• Special needs and requirements of Calhoun County
• Delivery
• Compliance in returning and/or including all required forms
• Results of testing samples (if required by Calhoun County)
• Calhoun County's experience with materials bid
• Vendor's past performance record with Calhoun County
If bids are awarded, award information will be mailed and/or emailed to all vendors that submitted a
bid regardless if the vendor was awarded a bid or not. Calhoun County Commissioners' Court and the
County Auditors office work diligently to get this information to the vendors as soon as possible. To
obtain results, or if you have any questions, please contact Peggy Hall, Calhoun County Assistant
Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4610,
oeggy.hall@calhouncotx.org. As time permits, bid awards will be posted on Calhoun County's
website, www.calhouncotx.org, under Bid Notices and Results.
Page 21 of 53
Once bids are awarded by Calhoun County CommissionersCourt, this bid package in its entirety will
be the working contract between Calhoun County and the successful bidder for the period
designated.
Calhoun County or the vendor may cancel this contract at any time for any reason, provided a written
notice is given.
Should there be a change in ownership or management, the bid (contract) shall be cancelled unless a
mutual agreement is reached with the new owner or manager to continue the bid (contract) with its
present provisions and prices.
Vendor understands that Calhoun County is a government entity subject to Texas State and Federal
public information statues. Vendor hereby waives any obligation to the release to the public of any
documents submitted in accordance with the bid.
No person has the authority to verbally alter these specifications or any information within the
Invitation To Bid. Any changes will be made in writing (Addendum approved by Calhoun County
Commissioners' Court) and mailed and or emailed to each vendor that received a bid package.
All disputes or protests will beheld in Calhoun County, Texas.
Page 22 of 53
CALHOUN COUNTY, TEXAS
INVITATION TO BID FORM
ANNUAL SUPPLY CONTRACT FOR
ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS
Bid Number: 2020-03
Bid Period: January 1, 2020 thru December 31, 2020
Vendors' Name &Address
Calhoun County Commissioners' Court is accepting sealed bids for the below Road Materials and Asphalts, Oils
and Emulsions as needed by the Road and Bridge Precincts.
See Contact, Billing and Location Information Informtion for Calhoun County Precincts (page 32) for complete
information and locations on each Calhoun County Road and Bridge Precinct.
Please Type. If handwritten, must be in ink and legible.
See Specifications, General Conditions and Return Instructions for requirements.
ROAD MATERIALS
Bid Item #1: Limestone-3/4 Inch To Dust
Unit Material Price /Delivery Price to County Stockpile and/orlobsite
MATERIAL/ DELIVERY
TOTAL COST MINIMUM ; TypE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit) LOAD/ORDER I (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct4-P
�
Ton
/
Precinct 4-S
;
Ton
/
Remarks:
Bid Item #2: Item 247, Type A Limestone, Grade 2, [1 3/4 Inch]
Unit Material Price / Delivery Price to County Stockpile and/orlobsite
MATERIAL /DELIVERY
TOTAL COST MINIMUM 1 TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit) LOAD/ORDER � (End or welly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
�
Ton
/
Precinct 4-S
'
Ton
/
Remarks:
Page 23 of 53
Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #3: Item 247, Type A Limestone, Grade 3 [13/4 Inch]
Unit Material Price /Delivery Price to County Stockpile and/orJobsite
MATERIAL/ DELIVERY
TOTAL COST MINIMUM ; TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit) LOAD/ORDER ; (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
�
Ton
/
Precinct 4-S
;
Ton
/
Remarks:
Bid Item #4: Item 247, Type B
(Flexible
Processed Base), Grade
2
Unit Material Price
/Delivery
Price to County Stockpile
and/orJobsite
MATERIAL /DELIVERY
TOTAL COST MINIMUM ; TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit) LOAD/ORDER i (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
;
Ton
/
Precinct 4-5
�
Ton
/
Remarks:
Bid Item #5: Item 247, Type B
(Flexible
Processed Base), Grade
3
Unit Material Price
/Delivery
Price to County Stockpile
and/orJobsite
MATERIAL/ DELIVERY
TOTAL COST MINIMUM TYPE OF DELIVERY
LOCATION
Unit
(per Unit)
(per Unit) LOAD/ORDER ; (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
�
Ton
/
Precinct 4-S
;
Ton
/
Remarks:
Page 24 of 53
Invitation To Bid Form-Annual5upply Contract for Raod Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #6: Item 275, Cement
275-2.1, Hydraulic Cement Type 1, Bulk (Pneumatic Tankers, Spreader Bar Needed)
275-2.1, Hydraulic Cement Type 1, 47 Ib Bag (Cost per Pallet) List # of 47 Ib Bags on a Pallet
Unit Material Price /Delivery Price to County Stockpile and/or Jobsite
MATERIAL /DELIVERY
TOTAL COST
MINIMUM � TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Untt)
LOAD/ORDER ; (End or welly Dump)
Precinct 1
Ton
/
_of471b;
Bags on Pallet ;
/
Precinct 2
Ton
/
_of471b;
Bags on Pallet ;
/
Precinct 3
Ton
/
of471b;
Bags on Pallet �
/
Precinct 4-P
;
Ton
/
I
i
_of471b
Bags on Pallet I
/
Precinct 4-S
�
Ton
/
of 471b
I
_
Bags on Pallet I
/
Remarks:
Bid Item #7: Item 302, Type PB, Grade 3 (Pre -Coated Rock)
Unit Material Price /Delivery Price to County Stockpile and/orJobsite
Remarks:
MATERIAL/ DELIVERY
TOTAL COST
MINIMUM � TYPE OP DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit)
LOAD/ORDER ; (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
;
Ton
/
Precinct4-S
;
Ton
/
Page 25 of 53
Invitation To Bid Form -Annual Supply Contract for Rood Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #8: Item 302, Type PB, Grade 4 (Pre -Coated Rock)
Unit Material Price /Delivery Price to County Stockpile and/orJobsite
MATERIAL/ DELIVERY
TOTAL COST
MINIMUM ;TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit)
LOAD/ORDER I (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
�
Ton
/
Precinct 4-S
;
Ton
/
Remarks:
Bid Item #9: Item 302, Type PE, Grade 3 (Pre -Coated Rock)*Material Source out of
Unit Material Price / Delivery Price to County Stockpile and/orJobsite
MATERIAL/ DELIVERY
TOTAL COST
MINIMUM � TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit)
LOAD/ORDER ; (end or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct4-P;
Ton
/
Precinct4-S
�
Ton
/
Remarks:
Bid Item #10: Item 302, Type PE, Grade 4 (Pre -Coated Rock)*Material Source out of
Unit Material Price /Delivery Price to County Stockpile and/orJobsite
Remarks:
MATERIAL/ DELIVERY
TOTAL COST
MINIMUM ; TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit)
LOAD/ORDER i (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P I
Ton
/
Precinct 4-S ;
Ton
/
Page 26 of 53
Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #11: Item 302, Type E, Grade 5, Ice Rock (Non -Coated Limestone Only)
Unit Material Price /Delivery Price to County Stockpile and/orJobsite
MATERIAL/ DELIVERY
TOTAL COST MINIMUM � TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit) LOAD/ORDER I (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Tan
/
Precinct 3
Ton
/
Precinct 4-P ;
Ton
/
Precinct 4-S ;
Ton
/
Remarks:
Bid Item #12: Item 330, Type D (Pre -Mix Limestone)
Unit Material Price /Delivery Price to County Stockpile and/orJobsite
Remarks:
MATERIAL /DELIVERY
TOTAL COST MINIMUM I TYpE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit) LOAD/ORDER ; (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct4-P;
Ton
/
Precinct 4-S
�
Ton
/
Page 27 of 53
Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #13: Item 330 D, Pothole Repair, Limestone Rock Asphalt (LRA)
See Bid Item #15, Page 4, for more information on this material.
Unit Material Price /Delivery Price to County Stockpile and/or Jobsite
MATERIAL /DELIVERY
TOTAL COST
MINIMUM ; TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit)
LOAD/ORDER I (End or Belly Dump)
Precinct
1
Ton
/
Yard3
/
50 Ib Bag
/
Precinct
2
Ton
/
Yard3
/
50 Ib Bag
/
Precinct
3
Ton
/
Yard'
/
50 Ib Bag
/
Precinct
4-P
I
Ton
/
Yard3
/
SO Ib Bag
/
Precinct
4-S
I
Ton
/
Yard'
/
SO lb Bag
/
Remarks:
Bid Item #14: Item 334, Type D Hot Mix Cold Laid Asphalt Concrete Pavement
Material must meet or exceed Item 334, 4.1.21Mf Table #S Laboratory Mixture Design Properties found in the
Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges.
Unit Material Price /Delivery Price to CountYStockpileand/orJobsite
MATERIAL /DELIVERY
TOTAL COST
MINIMUM ; TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit)
LOAD/ORDER � (End or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
;
Ton
/
Precinct 4-5
;
Ton
/
Remarks:
Page 28 of 53
Invitation To Bid Form-Annuo/ Supply Contract for Road Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #15: Item 432, Riprap, Section 2.3 Stone Riprap, 12" Limestone
I Ir,i+ nna+erial Price / nelivery Price to Countv Stockpile and/orJobsite
MATERIAL/ DELIVERY
TOTAL COST
MINIMUM ;TYPE OF DELIVERY
LOCATION
Unit
(Per Unit)
(Per Unit)
LOAD/ORDER I (end or Belly Dump)
Precinct 1
Ton
/
Precinct 2
Ton
/
Precinct 3
Ton
/
Precinct 4-P
;
Ton
/
Precinct 4-S
;
Ton
/
Remarks:
ASPHALTS. OILS AND EMULSIONS
Item 300, Asphalts, Oils and Emulsions
Bid Item #16: Primer Oil
I ini+ Ma+Prial Price / Delivery Price to Countv Stockpile and/orJobsite
Remarks:
MATERIAL/DELIVERY
TOTAL COST
MINIMUM
LOCATION
Unit
(PerUni[)
(Per Unit)
ORDER Demurrage
�$
Per Hour
Precinct 1
Gallon
/
IAfter
_Free Hours
j$
Per Hour
Precinct 2
Gallon
/
;After
_Free Hours
;$
Per Hour
Precinct3
Gallon
/
�AfterFree
Hours
�$
Per Hour
Precinct 4-P
;
Gallon
/
;After_Free
Hours
;$
Per Hour
Precinct 4-S I
Gallon
/
;After
Free Hours
Page 29 of 53
Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #17: AC-5
Unit Material Price / Delivery Price to County Stockpile and/orJobsite
MATERIAL/DELIVERY
TOTAL COST MINIMUM
LOCATION
Unit
(Per unit)
(Per unit) ORDER
Demurrage
;$
Per Hour
Precinct
1
Gallon
/
IAfter
Free Hours
�$
Per Hour
Precinct
2
Gallon
/
;AfterFree
Hours
;$
Per Hour
Precinct
3
Gallon
/
;After
Free Hours
�$
Per Hour
Precinct4-P;
Gallon
/
IAfter_Free
Hours
�$
Per Hour
Precinct4-S;
Gallon
/
;After_Free
Hours
Remarks:
Bid Item #18: RC-250
Temperature must be no lower than 140°
Unit Material Price / Delivery Price to County Stockpile and/orJobsite
Remarks:
MATERIAL/DELIVERY
TOTAL COST
MINIMUM
LOCATION
Unit
(Per unit)
(Per unit)
ORDER
Demurrage
I$
Per Hour
Precinctl
Gallon
/
;After_Free
Hours
;$
Per Hour
Precinct
2
Gallon
/
;After
Free Hours
�$
Per Hour
Precinct
3
Gallon
/
IAfter
Free Hours
�$
Per Hour
Precinct
4-P
;
Gallon
/
;After_Free
Hours
$
Per Hour
Precinct
4-S
�
Gallon
/
;After
Free Hours
Page 30 of 53
Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils &Emulsions -Contract No. 2020-03 -CONTINUED
Bid Item #19: CRS-2
Temperature must be no lower than 150°and no higher than 180°
Unit Material Price /Delivery Price to County Stockpile and/or Jobsite
MATERIAL/DELIVERY
TOTAL COST
MINIMUM
LOCATION
Unit
(Per unit)
(Per unit)
ORDER Demurrage
�$
Per Hour
Precinct 1
Gallon
/
;After
Free Hours
�$
Per Hour
Precinct 2
Gallon
/
;After
Free Hours
�$
Per Hour
Precinct 3
Gallon
/
;After
Free Hours
;$
Per Hour
Precinct 4-P
;
Gallon
/
;After
Free Hours
;$
Per Hour
Precinct 4-S
I
Gallon
/
;After
Free Hours
Remarks:
Bid Item #20: CRS-2P
Temperature must be no lower than 150°and no higher than 180°
Unit Material Price /Delivery Price to County Stockpile and/or Jobsite
MATERIAL/DELIVERY
TOTAL COST
MINIMUM
LOCATION
Unit
(Per unit)
(Per Unit)
ORDER Demurrage
�$
Per Hour
Precinct
1
Gallon
/
IAfter
Hours
_Free
�$
Per Hour
Precinct
2
Gallon
/
IAfter
Free Hours
�$
Per Hour
Precinct
3
Gallon
/
;After
Free Hours
�$
Per Hour
Precinct
4-P
;
Gallon
/
;After
Free Hours
�$
Per Hour
Precinct
4-S
;
Gallon
/
;After
Free Hours
Remarks:
The undersigned affirms that they are duly authorized to execute this bid and that this company,
corporation, firm, partnership, or individual has read the entire Invitation to Bid package and fully
understands and has followed the return instructions, general conditions and specifications.
FAILURE TO SIGN BELOW WILL DISQUALIFY THE BID.
Authorized Signature &Title:
Type Name &Title of Authorized Signature:
Date of Bid:
Exceptions and or Variations from Specifications or additional Notes:
Page 31 of 53
CONTACT, BILLING AND LOCATION INFORMATION
FOR CALHOUN COUNTY PRECINCTS
Calhoun County Precinct 1
Commissioner David Hall
305 Henry Barber Way (by the County Fairgrounds)
Port Lavaca, TX 77979
Office Manager: Angela Torres
Office: 361-552-9242
Fax: 361-553-8734
Location Stockpile: 305 Henry Barber Way, Port Lavaca, TX
Calhoun County Precinct 2
Commissioner Vern Lyssy
5812 FM 1090 (Six Mile)
Port Lavaca, TX 77979
Office Manager: Lesa Jurek
Office: 361-552-9656
Fax: 361-553-6664
Location of Stockpile: 5812 FM 1090, Port Lavaca, TX
Calhoun County Precinct 3
Commissioner Clyde Syma
24627 State Hwy 172 (Olivia)
Port Lavaca, TX 77979
Office Manager: Lynette Adame
Office: 361-893-5346
Fax: 361-893-5309
Location of Stockpile: 24627 State Highway 172, Olivia TX
Calhoun County Precinct 4
Precinct 4-P (Port O'Connor)
Commissioner Gary Reese
Trevor St off of Hwy 185
Port O'Connor, TX 77982
Office Manager: April Townsend
Use same numbers as Seadrift (4-S)
Location of Stockpile — Pct 4-P Barn #3: 93 Trevor Street off of Highway 185, Port O'Connor, TX
Calhoun County Precinct 4
Precinct 4-S (Seadrift)
Commissioner Gary Reese
104 E Dallas St
PO Box 177
Seadrift, TX 77983
Office Manager: April Townsend
Office: 361-785-3141
Fax: 361-785-5602
Location of Stockpile — Pct 4-S Barn #2: 448 Harbor Road, Seadrift TX
Page 32 of 53
STATE OF TEXAS {}
AFFIDAVIT
COUNTY OF CALHOUN {}
The undersigned certifies that the bid prices contained in this bid have been carefully checked and are submitted as
correct and final and if bid is accepted, agrees to furnish any and/or all items upon which prices are offered, at the
prices) and upon the conditions contained in the Specifications and General Conditions.
BEFORE ME, the undersigned authority, on this day personally appeared
known to me to be the person whose name is subscribed to the following, who, upon oath says:
I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which
this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line
of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on,
or to influence any person to bid or not to bid thereon.
I affirm that
I am duly authorized
to execute
this
contract,
that this
company, corporation, firm, partnership or
individual has
not prepared this Bid
in collusion
with
any other
Bidder.
I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic
opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in
connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been
communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business
prior to the official opening of this Bid.
Affiant
Printed Name and Title of Affiant
Name of Bidder (Company)
Address
Phone Number
Fax Number
Email Address
SWORN TO AND SUBSCRIBED BEFORE
ME by the
above Affiant,
who,
on oath,
states that the facts contained in the
above are true and correct, this
day of
20
Notary Public in and for
County, Texas
Page 33 of 53
CERTIFICATE OF
INTERESTED PARTIES
FORM 1295
OFFICE USE ONLY
Complete Nos. 1 - 4 and
6 if there are interested parties.
Complete Nos. 1, 2, 3, 5,
and 6 if there are no interested parties.
�`�
1 Name of business entity filing form, and the city, state and country of the business
entity's place of business.
�`
2 Name of governmental entity or state agency that is a party to the contract for
which the form is being filed.
3
Provide the identification number used by the governmental entity or state agency to tfff���kQ
identify the contract,
and provide a description of the services, goods, or other property to be provided ue
contract.
4
City, State, Country
ature of
Interest (check applicable)
Name of Interested Party
(place of business) � �
Controlling
Intermediary
�
5
only if there'
I terestedParty.
❑Check
e
UNSWORN DECiIIQ N
My name is �`
,and my date of birth is
My addre��
,
A-�`j'
(street) (city) (state)
(zip code) (country)
��d�l� under penalty of perjury that
the foregoing is true and correct.
Executed in
County, State of , on the day of
, 20
(month)
(year)
Signature of authorized agent of contracting business entity
(Declarant)
ADD ADDITIONAL PAGES AS NECESSARY
Form provided by Texas Ethics Commission www.elhics.state.tx.us Revised 12/22/2017
Page 34 of 53
Calhoun County, Texas
POLICY OF COMPLIANCE
SECTION 2252.908 TEXAS GOVERNMENT CODE
Approved
by
Commissioners
Court
January
28,
2016
Amended
by
Commissioners
Court
January
31,
2018
BACKGROUND
Section 2252.908 was added to the Government Code by the 84s Texas Legislature through the adoption
of House Bill 1295. The law states that the County may not enter into a contract with a business entity
unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is
considered for action by Commissioner's Court. The term "business entity" includes a sole
proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes
amendment, extension or renewal of an existing contract. The law does not apply to a contract between
the County and another governmental entity or state agency. The county is required to file Form 1295
with the state within 30 days of approving a contract with a business entity. Governmental transparency
is the objective of the law.
Senate Bill 255 adopted by the 85"' Legislature Regular Session amended the law effective for contracts
entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295
requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned
subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the
Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code.
Notarization of Form 1295 has been replaced by an unworn statement under penalty of perjury by an
authorized representative of the business entity.
The Texas Ethics Commission promulgated rules to implement the law and established an online portal
https:i/www.etriles.state,tx,usiwitatsnew/eif info forml295.1,tm. A business entity will generate Form
1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is
executed. Within seven business days, Form 1295 will be available for public viewing on the
Commission's website.
COMPLAINCE
Calkoun County Commissioners Court will not consider for action any contract or bid with a business
entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the
provision of the law under which the business entity is exempt.
No later than 30 days after Commissioner's Court approves a contract or awards a bid with anon -exempt
business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics
Commission,
Page 35 of 53
Vendor must Insert/Attach a copy of Certificate of Liability
Insurance showing proof of coverage required under this
Invitation To Bid Package
** Once bids are awarded, the vendor that is awarded a bid must provide a Certificate of Liability
Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general
liability subject to the conditions of the additional insured. (See General Conditions)
Page 36 of 53
CERTIFICATION REGARDING DEBARMENT & SUSPENSION
AND OTHER RESPONSIBILITY MATTERS
In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of
his / her knowledge and belief, that its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any federal department or agency;
b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offence in connection with obtaining,
attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a
public transaction; violation of federal or state antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving
stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of
this certification.
d. Have not within athree-year period preceding this application /proposal had one or more public
transactions (federal, state, or local) terminated for cause of default.
e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs
(1) (a —d) of this certification.
Name and Title of Authorized Agent
Signature of Authorized Agent
I am unable to certify to the above statements. My explanation is attached.
Page 37 of 53
DEBARMENT & SUSPENSION
Executive Order 12549--Debarment and Suspension
Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986
Comp., p. 189, unless otherwise noted.
By the authority vested in me as President by the Constitution and laws of the United States of America,
and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and
ensure consistency among agency regulations concerning debarment and suspension of participants in
Federal programs, it is hereby ordered that:
Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive
departments and agencies shall participate in a system for debarment and suspension from programs and
activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension
of a participant in a program by one agency shall have government -wide effect.
(b) Activities covered by this Order include but are not limited to: grants, cooperative agreements,
contracts of assistance, loans, and loan guarantees.
(c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements
or mandatory awards, direct awards to foreign governments or public international organizations, benefits
to an individual as a personal entitlement, or Federal employment.
Sec. 2. To the extent permitted by law, Executive departments and agencies shall:
(a) Follow government -wide criteria and government -wide minimum due process procedures when they
act to debar or suspend participants in affected programs.
(b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and
suspended participants in affected programs, participants who have agreed to exclusion from
participation, and participants declared ineligible under applicable law, including Executive Orders. This
information shall be included in the list to be maintained pursuant to Section 5.
(c) Not allow a party to participate in any affected program if any Executive department or agency has
debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party
from participation in an affected program. An agency may grant an exception permitting a debarred,
suspended, or excluded party to participate in a particular transaction upon a written determination by the
agency head or authorized designee stating the reason(s) for deviating from this Presidential policy.
However, I intend that exceptions to this policy should be granted only infrequently.
Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this
Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be
submitted to the Office of Management and Budget for review within four months of the date of the
guidelines issued under Section 6. The Director of the Office of Management and Budget may return for
reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final
regulations shall be published within twelve months of the date of the guidelines.
Page 38 of 53
Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall
monitor implementation of this Order. The Committee shall consist of representatives of agencies
designated by the Director of the Office of Management and Budget.
Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform
the following functions: maintain a current list of all individuals and organizations excluded from
program participation under this Order, periodically distribute the list to Federal agencies, and study the
feasibility of automating the list; coordinate with the lead agency responsible for government -wide
debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and
report periodically to the Director on implementation of this Order, with the first report due within two
years of the date of the Order
Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to
Executive departments and agencies that govern which programs and activities are covered by this Order,
prescribe government -wide criteria and government -wide minimum due process procedures, and set forth
other related details for the effective administration of the guidelines.
Sec. 7. The Director of the Office of Management and Budget shall report to the President within three
years of the date of this Order on Federal agency compliance with the Order, including the number of
exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb
fraud, waste, and abuse.
Implementation in the SRF Programs
A company or individual who is debarred or suspended cannot participate in primary and lower -tiered
covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with
SRF loan funds.
Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly
enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or
voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA
regional office before the capitalization grant is awarded.
A recipient of SRF assistance directly made available by capitalization grants must provide a certification
that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to
participate in the project. Contractors on the project have to provide a similar certification prior to the
award of a contract and subcontractors on the project have to provide the general contractor with the
certification prior to the award of any subcontract.
In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can
render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise
ineligible parties are maintained by the General Services Administration and should be checked by the
SRF agency and all recipients of funds directly made available by capitalization grants to ensure the
accuracy of certifications.
Additional References
C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension.
Page 39 of 53
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
OFFICE USE ONLY
Date Received
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who
has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the
vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental entity not later
than the 7th business day a8er the date the vendor becomes aware of facts that require the statement to be
filed. See Section 176.006(a-1 ), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An
offense under this section is a misdemeanor.
f Name of vendor who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated
completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which
you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information is being disclosed.
Name of Officer
4 Describe each employment or other business relationship with the Iccal government officer, or a family member of the
officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.
Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form
CIQ as necessary.
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,
other than investment income, from the vendor?
Yes � No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction
of the local government officer or a family member of the officer AND the taxable income is not received from the
local governmental entity?
Yes � No
5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or
other business entity with respect to which the local government officer serves as an officer or director, or holds an
ownership interest of one percent or more.
6
this box if the vendor has given the local government officer or a family member of the officer one or more gifts
❑Check
as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).
7
Signature of vendor doing business with the governmental entity Date
Form provided by Texas Ethics Commission www.ethics.state.tx.us RePage140 0� 53
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
Acomplete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/
Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code S 176.001(1-a): "Business relationship" means a connection between two or more parties
based on commercial activity of one of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an
agency of a federal, state, or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public; or
(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and
that is subject to regular examination by, and reporting to, that agency.
Local Government Code & 176.003(a)(2)(A)avd (B):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the 12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor;
(B) has given to the local government officer or afamily member of the officer one or more gifts
that have an aggregate value of more than $100 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code & 176.006(a) and (a-1)
(a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of that local
governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any
gift described by Section 176.003(a-1); or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator
not later than the seventh business day after the later of:
(1) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental
entity; or
(B) submits to the local governmental entity an application, response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity; or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer, or a
family member of the officer, described by Subsection (a);
(B) that the vendor has given one or more gifts described by Subsection (a); or
(C) of a family relationship with a local government officer.
Form provided by Texas Ethics Commission www.etnics.state.[x.us nePage 41 of 53
HOUSE BILL 89 VERIFICATION
CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001
Representative
the undersigned representative of
(hereafter referred to as Company) being an
Company or Business Name
adult over the age of eighteen (18) years of age, verify that the Company named above, under
the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270:
1.
Does not currently boycott the
country of Israel;
and
2.
Will not boycott the country of
Israel during the
term of the contract with Calhoun
County, Texas.
Pursuant to 2270.001, Texas Government Code:
1. 'Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise
taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations
specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled
territory, but does not include an action made for ordinary business purposes; and
2. "Company" means afor-profit sole proprietorship, organization, association, corporation, partnership,
Joint venture, limited partnership, limited liability partnership, or any limited liability company,
including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those
entities or business associations that exist to make a profit.
Signature of Representative
Print Name &Title
Date
State law requires certification from a Company for contracts (which includes contracts formed
through purchase orders) involving goods or services regardless of the amount.
Page 42 of 53
RESIDENCE CERTIFICATION
Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests
Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions
on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below:
Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident.
❑ I certifythat
(4) "Resident bidder' refers to a person whose principal place of
business is in this state, including a contractor whose ultimate
parent company or majority owner has its principal place of
business in this state.
is a "Nonresident Bidder" of Texas
(Company Name)
as defined in Government Code §2252.001 and our principal place of business is
(City and State)
❑ I certify that is a "Resident Bidder' of Texas as
(Company Name)
defined in Government Code §2252.001.
Signature of Authorized Agent
Printed Name and Title of Authorized Agent
Date
Page 43 of 53
VENDOR AND ORDER INFORMATION
Please Type
If handwritten, must be in ink and legible
Vendor Name:
Address:
Remittance Address:
Telephone:
Fax:
Email:
Email(s) to send Bid Information:
Signature of Authorized Representative: _
Printed name of Authorized Rep:
ORDER -CONTACT INFORMATION
Order Contact Name &Title:
Order Contact Telephone:
Order Contact Fax:
Order Contact Emaii:
Page 44 of 53
W�
Request for Taxpayer
Give Form to the
Form ■■
Identification Number and Certification
requester. Do not
(Rev. October 2019)
send to the IRS.
Department of the Treasury
Internal Revenue Service
► Go to tvww.frs.gov/FomtW9 for Instruenons and the latest information.
t Name (as shown on your Interne tax return). Name is required on this line; do not leave this line hlank.
2 Business neme/disregarded entity name, if different from above
`°
3 Check appropriate box for federal tax classlflcatlon of the person whose name is entered on Ilne i. Check only one of the 4 Exemptions (codes appy only to
following seven boxes. certeln enikiea, not individuals; see
n
instmctions on page 3):
o
❑ IndlvltlueVsole prapdetor or ❑ C Corporeticn ❑ S Corporetlon ❑Partnership ❑ TrusVestete
�
single•member LLC Fxempt payee code (IF any)
ai
,�'
❑ Umited llablllry company. Enter thetax clessiflcation(C=C coryoretfon, S=S corporetlon, P=Partnership)►
`0 2
Note: Check the eppropdate box in the Ilne above for the tax classiflcetlon ofthe singie-member owner. Do not check Exemption from FATCA reporting
�
LLC if the LLC is classlfled as a singlamember LLC that Is disregarded from the owner unless the owner of the LLC Is code Pt any)
�
another LLC that la not disregarded tram the owner for U.S. federal tax purposes. Otherwise, asingle-member LLC that
o
Is disregarded from theowner should check the eppropdate box for the tax ciessificadon of its owner.
❑Other (seelnstruclions)► (aypwroeccounaR+tmebaw,wa.ureus)
to
s Address (number, street, and apt. or auks no.) See insW cl(ons. Re rn: � Addre55 Requester's name and address (optionaq
W
6 Clty, state, and ZIP code
7 Ust account number(s)here (optionap
Taxpayer Identification Number (TIN)
Enter your TIN in the eppropdate box. The TIN provided must match the name given on line 1 to avoid Social seeurity number
backup wtthholding. For individuals, this Is generally your social security number (SSN). However, fora � _ m _
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
e. i.lnneflnof:nn m,mher lFlNt If vn„ do not haves a nemher. sea HOW f0 deco
TIN, later. or
Note: If the account Is in more than one name, see the instructions for Ilne 1. Also see What Name and
Number To Gyve the Requester for guidelines on whose number to enter.
Under penalties of peryury, I certgy that:
1. The number shown on this form is my coned taxpayer identffcation number (or I am waiting for a number to be issued to me); and
2,1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3,1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting Is correct.
Certification instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part II, later.
Here
General Instructions
Section references are to the Internal Revenue Coda unless otherwise
noted.
Paiute developments. For the latest information about developments
related to Form W-9 and its Instructions, such as legislation enacted
aker they were published, go to www.frs,gov/FonnWB.
Purpose of Form
An individual or entity (Form W-9 requester) who Is required to file an
information return with the IRS must obtain your cdrrect taxpayer
identification number (TIN) whlah may be your social security number
(SSN), Individual taxpayer identlFlcatidn number (ITIN), adoption
taxpayer Identification number (ATIN), or employer identifcation number
(EIN), to report on an fnformatfon return the amount paid to you, or other
amount reportable on an Information return. Examples of Information
returns include, but are not Ifmited to, the tollowing.
• Fonn 1099-INT (interest earned or paid)
M7i
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of Income, prizes, awards, or gross
proceeds)
• Form 1099-8 (stock or mutual fund sales and certeln other
transactions by brokers)
• Fonn 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1096 (home mortgage interest), 1098-E (student loan interest),
1096-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-8 only if you era a U.S. person Qncluding a resident
alien), to provide your correct TIN.
If ycu do not return Form W-9 to the requester with a TIN, you might
be subject to backup wlthholding. See What is backup withholding,
later.
Cat, No, 70231X Form UU-9 (Rev. 10-2018)
Page 45 of 53
CURRENT PRICES FOR
ROAD MATERIALS
CURRENT AWARDED BID TABULATIONS
FOR THE
CURRENT BID PERIOD
July 1, 2019 thru December 31, 2019
NOTE: Calhoun County is currently in a six (6) month contract.
The material prices are locked in and cannot be increased
during the bid period July 1, 2019 thru December 31, 2019.
Page 46 of 53
CALHOUN COUNTY, TEXAS
. � � �
t �- t
PE`S AGGREGATE
County
Department
Cost per Unit
Awarded
6/19/19
Vendor
Minimum Load/Order and
Type of Deliver Y
Exceptions
Returned All
Required
Information
Precinct 1
$61.47/Ton
X
Vulcan Construction
Materials LLC
(Awarded: Precincts 1, 2,
4-P & 4-S)
24 Tons
End Dump Delivery
Pages 1-9 of
the Bid Form �
1295 �
Info Form �
Affidavit �
W-9
Precinct 2
$62.25/Ton
X
Precinct 3
$63.80/Ton
Precinct 4-P
$62.25/Ton
X
Precinct 4-5
$62.25/Ton
X
Precinct 1
$63.00/Ton
Brauntex Materials lnc
(Awarded: Precinct 3)
24 Tons
End Dump Delivery
Pages 1-9 of
the Bid Form �
1295�
Info Form �
Affidavit
W9�
Precinct 2
$63.00/Ton
Precinct 3
$63.00/Ton
X
Precinct 4-P
$63.00/Ton
Precinct 4-S
$63.00/Ton
:LIMESTONE-3/4INCH TO DUST
County
Department
Cost per Unit
Awarded
6/19/19
Vendor
Minimum Load/Order and
Type of Delivery
Exceptions
Returned All
Required
Information
Precinct 1
$28.70/Ton
X
Quality Hot Mix Inc
(Awarded: All Precincts)
24 Tons
Either End Dum or
P
Belly Dump Delivery
Pages 1-9 of
the Bid Form �
InfoSForm �
Affidavit
w 9 J
Precinct 2
$28.70/Ton
X
Precinct3
$28.70/Ton
X
Precinct 4-P
$28.70/Ton
X
Precinct 4-5
$28.70/Ton
X
Precinct 1
$30.00/Ton
Midtex Materials LLC
Pages 1-9 of
the Bid Form �
1295 �
Info Form
Affidavit
W 9J
Precinct 2
$30.00/Ton
Precinct 3
$30.00/Ton
Precinct 4-P
$31.75/Ton
Precinct 4-S
$30.OD/Ton
Precinct 1
$30.75/Ton
Brauntex Materials Inc
24 Tons
End Dump or
Belly Dump Delivery
Pages 1-9 of
the aid Farm �
1295
Info Form �
Affidavit's
W 9 �
Precinct 2
$30.75/Ton
Precinct 3
$30.75/Ton
Precinct 4-P
$30.75/Ton
Precinct 4-S
$30.75/Ton
Page 47 of 53
BlD TABULATION -ROAD MATERIALS -FOR THE PER10D BEGINNING JULV 1, 2019 AND ENDING DECEMBER 31, 2019
ITEM 247, TYPE A LIMESTONE,' GRADE 2 [13/41NCH]
County
Department
Cost per Unit
Awarded
6/19/19
Vendor
Minimum Load/Order and
Type of Delivery
Exceptions
Returned all
Infor4mac on
Precinct 1
$28.70/Ton
X
Quality Hot Mix Inc
(Awarded: All Precincts)
24 Tons
Either End Dump or
Belly Dump Delivery
pages 1-9 of
the Bid Form �
1295 �
Info Form �
gffidavit�
W-9 �
Precinct 2
$28.70/Ton
X
Precinct 3
$28.70/Ton
X
Precinct 4-P
$28.70/Ton
X
Precinct 4-S
$28.70/Ton
X
Precinct 1
$30.00/Ton
Midtex Materials LLC
pages 1-9 of
the Bid Form �
1295 �
Info Form
Affidavitd
w 9 �
Precinct 2
$30.00/Ton
Precinct 3
$30.00/Ton
Precinct 4-P
$31.75/Ton
Precinct 4-S
$30.00/Ton
Precinct 1
$30.75/Ton
Brauntex Materials Inc
24 Tons
End Dump Dump or
Belly Dump Delivery
Pages 1-9 of
the aid Form �
1295
Info Form �
Affidavit
w 9 J
Precinct 2
$30.75/Ton
PrecinM 3
$30.75/Ton
Precinct 4-P
$30.75/Ton
Precinct 4-5
$30.75/Ton
Precinct 1
$40.00/Ton
Vulcan Construction Materials LLC
22 Tons
Belly Dump Delivery
Pages 1-9 of
the Bid Form �
12951i
Info Form �
Affidavit li
W-9 �
Precinct 2
$41.00/Ton
Precinct 3
$42.00/Ton
Precinct 4-P
$42.00/Ton
Precinct 4-S
$40.00/Ton
ITEM 247,
TYPE A LIMESTONE; GRADE
3 [13/4 INCH]
County
Depanrtment
Cost per Unit
Awarded
6/19/19
Vendor
Minimum Load/Order and
Type of Delivery
Exceptions
Returned All
InforOmiatlon
Precinct i
$28.70/Ton
X
Quality Hot Mix Inc
(Awarded: All Precincts)
24 Tons
Either End Dump or
Bell Dum Deliver
y p y
pages 1-9 of
the Bid Farm �
1295 �
Info Farm �1
Affidavitd
v✓-9 �
Precinct 2
$28.70/Ton
X
Precinct 3
$28.70/Ton
X
Precinct 4-P
$28.70/Ton
X
Precinct 4-S
$28.70/Ton
X
Precinct 1
$30.00/Ton
Midtex Materials LLC
pages 1-9 of
the Bid Form �
1295 �
Info Form
Affidavit
w-9 `1
Precinct 2
$30.00/Ton
Precinct 3
$30.00/Ton
Precinct 4-P
$31.75/Ton
Precinct 4-S
$30.00/Ton
Precinct 1
$30.75/Ton
Brauntex Materials Inc
24 Tons
End Dump or
Belly Dump Delivery
Pages i-9 of
the Bid Form �
1295 �
Info Form
Affidavit J
vy-9�
Precinct 2
$30.75/Ton
Precinct 3
$30.75/Ton
Precinct 4-P
$30.75/Ton
Precinct 4-S
$30.75/Ton
Precinct 1
$40.00/Ton
Vulcan Construction Materials LLC
22 Tons
Belly Dump Delivery
Pages 1-9 of
the Bid Form �
1295 �
Info Form �
Affidavit's
W-9�
Precinct 2
$41.00/Ton
Precinct 3
$42.00/Ton
Precinct 4-P
$42.00/Ton
Precinct 4-5
$40.00/Ton
Page 48 of 53
8/D TABULATION -ROAD MATERIALS -FOR THE PERIOD BEGINNING lUL y 1, 2019 AND ENDING DECEMBER 31, 2019
ITEM 247, TYPE B (FLEXIBLE PROCESSEDBASE), GRADE 2
County
Awarded
Minimum Load/Order and
returned all
Cost per Unit
Vendor
Exceptions
required
Department
6/19/19
Type of Delivery
Information
Precinct 1
NO BIDS RECEIVED
Precinct 2
Precinct 3
Precinct 4-P
Precinct 4-S
ITEM 247, TYPE B (FLEXIBLE PROCESSED BASE), GRADE 3
County
Awarded
Minimum Load/Order and
returned all
Cost per Unit
Vendor
Exceptions
required
Department
6/19/19
Type of Delivery
Information
Precinct 1
NO BIDS RECEIVED
Precinct 2
Precinct 3
Precinct 4-P
Precinct 4-S
ITEM 275, CEMENT
(ROAD MIXED)
ITEM 275-2.1, HYDRAULIC
CEMENT TYPE 1
County
Awarded
Minimum Load/Order and
returned all
Cost per Unit
Vendor
Exceptions
required
Department
6/19/19
Type of Delivery
Information
Precinct 1
NO BIDS RECEIVED
Precinct 2
Precinct 3
Precinct 4-P
Precinct 4-S
ITEM 302, TYPE PE (TOPPING ROCK), GRADE 3, LRA (LIMESTONE ROCK ASPHALT), s
* Material Source out'of
County
Awarded
Minimum Load/Order and
returned All
Cost per Unit
Vendor
Exceptions
required
Department
6/19/19
Type of Delivery
Information
Precinct 1
$59.47/Ton
X
Pages 1-9 of
*Material
the Bid Form �
Precinct 2
$60.25/Ton
X
Vulcan Construction Materials LLC
24 Tons
Source out of
1295 �
Precinct3
$61.80/Ton
X
(Awarded: All Precincts)
End Dump Delivery
Uvalde
Info Form �
Precinct 4-P
$60.25/Ton
X
(Dabney)*
Affidavit
Precinct 4-S
$60.25/Ton
X
W-9 �
ITEM 302, TYPE PE (TOPPING ROCK), GRADE 4, LRA (LIMESTONE ROCK ASPHALT),
* Material Source outiof
County
Awarded
Minimum Load/Order and
returned all
Cost per Unit
Vendor
Exceptions
required
Department
6/19/19
Type of Delivery
Information
Precinct 1
$60.47/Ton
X
Pages 1-9 of
*Material
the Bid form �
Precinct 2
$61.25/Ton
X
Vulcan Construction Materials LLC
24 Tons
Source out of
1z95 �
Precinct 3
$62.80/Ton
X
(Awarded: All Precincts)
End Dump Delivery
Uvalde
Info Form'
Precinct 4-P
$61.25/Ton
X
(Dabney)*
Affidavit �(
Precinct 4-S
$61.25/Ton
X
W-9 �
Page 49 of 53
8/D TABULATION -ROAD MATERIALS -FOR THE PERIOD BEGINNING JULV 1, 2019 AND ENDING DECEMBER 31, 2019
ITEM 330, TYPED (PRE=:MIX LIMESTONE)
County
Awarded
Minimum Load/Order and
Returned All
Cost per Unit
Vendor
Exceptions
Required
Department
6/19/19
Type of Delivery
Information
Precinct 1
$77.47/Ton
X
Pages 1-9 of
the Bid Form J
Precinct 2
$78.25/Ton
X
Vulcan Construction Materials LLC
24 Tons
1295 J
Precinct 3
$79.80/Ton
X
(gwarded: All Precincts)
End Dump Delivery
Info form J
Precinct 4-P
$78.25/Ton
X
Affidavit)
w-9 J
Precinct 4-S
$78.25/Ton
X
ITEM
330 D,
POTHOLE REPAIR, LIMESTONE
ROCK ASPHALT (LRA)
County
Awarded
Minimum Load/Order and
Returned All
Cost per Unit
Vendor
Exceptions
Required
De artment
P
6/19/19
Type of Deliver y
Information
Precinct 1
$96.98/Ton
X
$107.37/cu yd
$11.00/SO lb bag
Pages 1-9 of
Precinct 2
$96.58/Ton
X
$106.91/cu yd
$11.00/SO lb bag
the Bid Farm J
Blades Group LLC
22 Tons
1295 J
Precinct 3
$100.76/Ton
X
dba Road Rescue Asphalt
62 Bags (1 Pallet)
$I11.55/cu yd
J
$11.00/SO lb bag
Info Form
(Awarded: All Precincts)
End Dump Delivery
affidavit J
Precinct 4-P
$B9•SS/Ton
X
$110.20/cu yd
W-9 J
$11.00/501b bag
Precinct 4-S
$99.55/Ton
X
$110.20/cu yd
$11.00/SO Ib bag
ITEM 334,
TYPE
D, HOT MIX COLD LAID ASPHALT'CONCRETE PAVEMENT
County
Awarded
Minimum Load/Order and
Returned All
Cost per Unit
Vendor
Exceptions
Required
De artment
p
6/19/19
Type of Deliver y
Information
Precinct 1
$84.00/Ton
X
Pages i-9 of
Quality Hot Mix Inc
(Awarded: All Precincts)
25 Tons
Either End Dump or
the eid Form J
1z95 J
Info Form J
Precinct 2
$84.00/Ton
X
Precinct 3
$84.00/Ton
X
Precinct 4-P
$84.00/Ton
X
Belly Dump Delivery
Affidavit)
W-9 J
Precinct 4-S
$84.00/Ton
X
Precinct 1
$80.00/Ton
We have changed
oil suppliers far [h
manufacturing of
Pages l-9 of
Precinct 2
$80.00/Ton
24 Tons
Item 334, Type D
Hot Mix Cold Laid
the Bid Form J
1295 J
Precinct 3
$80.00/Ton
Brauntex Materials Inc
End Dump or
Asphalt Concrete,
Info Form J
Belly Dump Delivery
which has
Affidavit)
Precinct 4-P
$80.00/Ton
enhanced the
quality of the
W-9J
Precinct 4-S
$80.00/Ton
fnished product.
ITEM
432, RIPRAP, SECTION 2.3 STONE
RIPRAP, 12" LIMESTONE'
County
Awarded
Minimum Load/Order and
Returned All
Cost per Unit
Vendor
Exceptions
Requlred
De artment
P
6/19/19
Type of Deliver y
Information
Precinct 1
$50.00/Ton
X
Pages 1-9 of
[he Bid Form J
Precinct 1
$50.00/Ton
X
Brauntex Materials Inc
24 Tons
1295J
Precinct 3
$50.00/Ton
X
(Awarded: All Precincts)
End Dump Delivery Only
Info Farm J
Precinct 4-P
$50.00/Ton
X
Affidavit)
W-9 J
Precinct 4-S
$50.00/Ton
X
Precinct 1
$69.00/Ton
Pages 1-9 of
the Bid Form J
Precinct 2
$69.00/Ton
26 Tons
1295 J
Precinct 3
$69.00/Ton
Midtex Materials LLC
End Dump Delivery
Info Form J
Precinct 4-P
$73.00/Ton
Affidavit)
W-9J
Precnct 4-S
$69.00/Ton
Page 50 of 53
CURRENT PRICES FOR
ASPHALTS, OILS AND EMULSIONS
CURRENT AWARDED BID TABULATIONS
FOR THE
CURRENT BID PERIOD
July 1, 2019 thru December 31, 2019
NOTE: Calhoun County is currently in a six (6J month contract.
The material prices are locked in and cannot be increased
during the bid period July 1, 2019 thru December 31, 2019.
Page 51 of 53
CALHOUN COUNTY, TEXAS
• � •
t �- t
PRIMER OIL
Returned All
County
Cost per Gallon
Demurrage
AWARDED
Vendor
Minimum
Exceptions
Required
Department
6/19/19
Order
Information
Precinct 1
Pages 1-4 of
All prices based on minimum 5,000
Bid Farm J
Precinct 2
$B0.00/Hour
Cleveland Asphalt
gallon load. For smaller quantities
1295 J
Precinct 3
$2.65/Gallon
After 2 Free Hours
X
Products Inc
5,000 Gallons
please call. Diluted loads can not be
Info Form)
Precinct 4-P
returned for credit.
Affidavit)
Precinct 4-S
yv_g J
Precinct 1
Pages 1-4 of
Bid Form J
Precinct 2
$70.00/Hour
Martin Asphalt
1295 J
Precinct 3
$3.01/Gallon
After 2 Free Hours
Company
5,000 Gallons
Info Form)
Precinct 4-P
Affidavit J
Precinct 4-S
y�_g J
AC-S
Returned All
County
Cost per Gallon
Demurrage
AWARDED
Vendor
Minimum
Exceptions
Required
Department
6/19/19
Order
Information
Precinct 1
Pages 1-4 of
Bid Form J
Precinct 2
$70.00/Hour
Martin Asphalt
1295 J
Precinct 3
$2.14/Gallon
x
5,000 Gallons
Info Form)
After 2 Free Hours
Company
Precinct 4-P
Affidavit J
Precinct 4-S
W_g J
Precinct 1
Pages 1-4 of
All prices based on minimum 5,000
Bid Form J
Precinct 2
$g0.00/Hour
Cleveland Asphalt
gallon load. For smaller quantities
1295 J
Precinct 3
$3.00/Gallon
After 2 Free Hours
Products Inc
5,000 Gallons
please call. Diluted loads can not be
Info Form)
Precinct 4-P
returned for credit.
Affidavit)
Precinct 4-5
yy_g J
RC250
Returned All
County
Cost per Gallon
Demurrage
AWARDED
Vendor
Minimum
Exceptions
Required
Department
6/19/19
Order
Information
Precinct 1
Pages i-4 of
Bid Form J
Precinct 2
$70.00/Hour
Martin Asphalt
1295 J
Precinct 3
$2.91/Gallon
After 2 Free Hours
x
Company
5,000 Gallons
Info Form)
Precinct 4-P
Affidavit)
Precinct 4-S
yy_g J
Precinct 1
Pages 1-4 of
All prices based on minimum 5,000
Bid Form J
Precinct 2
$80.00/Hour
Cleveland Asphalt
gallon load. For smaller quantities
1295 J
Precinct 3
$3.55/Gallon
After 2 Free Hours
Products Inc
5,000 Gallons
please call. Diluted loads can not be
Info Form)
Precinct 4-P
returned for credit.
Affidavit)
Precinct 4-S
yy_g J
Page 52 of 53
BID TABULATION -ASPHALTS, OILS AND EMULSIONS -FOR THE PERIOD BEGINNING JULY 1, 2019 AND ENDING DECEMBER 31, 2019
CRS=2
Returned Ail
County
Cost per Gallon
Demurrage
AWARDED
Vendor
Minimum
Exceptions
Required
Department
6/19/19
Order
Information
Precinct 1
Pages 1-4 of
All prices based on minimum 5,000
Bid Form J
Precinct 2
$80.00/Hour
Cleveland Asphalt
gallon load. For smaller quantities
1295 J
Precinct 3
$2.15/Gallon
After 2 Free Hours
X
Products Inc
5,000 Gallons
please call. Diluted loads can not be
Info Form)
Precinct 4-P
returned for credit.
Affidavit)
Precinct 4-S
W-9 J
Precinct 1
Pages 1-4 of
Bid Form J
Precinct 2
$70.OHour
Martin Asphalt
J
Precinct 3
$2.16/Gallon
5,000 Gallons
Info Form)
Info
After 2 Free Hours
Company
Precinct 4-P
Affidavit J
Precinct 4-S
W-9 J
CRS=2P
County
Cost per Gallon
Demurrage
AWARDED
Vendor
Minimum
Exceptions
Returned All
Required
Department
6/19/19
Order
Information
Precinct 1
Pages 1-4 of
Bid Form J
Precinct 2
$70.00/Hour
Martin Asphalt
J
Precinct 3
$2.61/Gallon
X
5,000 Gallons
Info Form)
Info
Alter 2 Free Hours
Company
Precinct 4-P
Affidavit)
Precinct 4-S
W-9 J
Pages 1-4 of
Precinct 1
All prices based on minimum 5,000
Bid Form J
Precinct 2
$80.00/Hour
Cleveland Asphalt
gallon load. For smaller quantities
1295J
Precinct3
$2.75/Gallon
After 2 Free Hours
Products Inc
5,000 Gallons
please call. Diluted loads can not be
Info Form)
Precinct 4-P
returned for credit.
Affidavit)
Precinct 4-S
W-9 J
Page 53 of 53
Commissioners' Court —OCTOBER 23, 2019
15. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 15)
To accept donations to the Calhoun County Library. (see attached) (RM)
RESULT: APPROVED [UNANIMOUS]
MOVER: Gary Reese, Commissioner'Pct 4
SECONDER: Vern Lyssy, Commissioner Pct 2
AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese
Page 13 of 18
Calhoun County Public Library
www.ccllbrary.org
200 W. Mahan I Port Lavaca, TX 77979 Ph: 361.552.7323 Fax: 361.552.5218
The following materials have been donated to the Calhoun County Public
Library System during the month of AUG-SEP 2019
Books Donor
261 Books Unknown
1 Book Brian Courtney
8 Books Seadrift School
2 Books Sherry Campbell
1 Book Mary Belle Meitzen
2 Books Jenny James
2 Books Carrie Atmar
118 Books David Selby
81 Books Judy Anderson
9 Books Zoe Herrera
13 Books Cheryl Marawitz
14 Books Cherise Bludau
37 Books Dolores Miller
1 Book Joshalyn Pfeiffer
31 Books Kevin LeVrier
5 Books Weldon Holmes
34 Books Marie Hawes
2 Books Thomas Stone
12 Books Aerlin Bethany
231 Books Rick Teseny
28 Books Tommy Bailey
1 Book Barry Hunter
2 Books Karl Eikehaug
28 Books Ann Sikes
1 Book Shona Poe
16 Books Robert & Susan Hunt
3 Books Kathleen Leabo
115 Books Mike Fricke
16 Books Troy Duncan
24 Books Lynn Custer
38 Books Nancy Ladshaw
5 Books Jennifer Wright
1 Book Cynthia & George Mitchell Foundation
Paperbacks
657 Paperbacks Unknown
126 Paperbacks Cheryl Marwitz
300 Paperbacks David Selby
12 Paperbacks Seadrift School
1 Paperback Carol Smith
2 Paperbacks Cynthia Medina
2 Paperbacks Patty Rogers
1 Paperback Ronnie Malina
4 Paperbacks Carrie Atmar
2 Paperbacks Margaret Gosnell
1 Paperback Bridgid & Allen Berger
24 Paperbacks Judy Anderson
6 Paperbacks Zoe Herrera
43 Paperbacks Cherise Bludau
636 Paperbacks Rick Teseny
20 Paperbacks Dolores Miller
67 Paperbacks Kevin LeVrier
27 Paperbacks Marie Hawes
1 Paperback Shirley Gordon
8 Paperbacks Thomas Stone
227 Paperbacks Mr. Cormier
285 Paperbacks Aerlin Bethany
2 Paperbacks Charles Willoughby
51 Paperbacks Mr. Miller
1 Paperback Judith Branch
8 Paperbacks Tommy Bailey
13 Paperbacks Bryan Holsey
1 Paperback Barry Hunter
95 Paperbacks Ann Sikes
6 Paperbacks Mark Lucas
3 Paperbacks Kaitlin Dziuk
7 Paperbacks Kathleen Leabo
39 Paperbacks Mike Fricke
2 Paperbacks Troy Duncan
16 Paperbacks Lynn Custer
8 Paperbacks Nancy Ladshaw
18 Paperbacks Jennifer Wright
1 Paperback Susan Wallace
Maaazines
77 Magazines Unknown
2 Magazines Dolores Miller
95 Magazines Rick Teseny
1 Magazine Cynthia Medina
20 Magazines Amy Day
60 Magazines Mike Fricke
14 Magazines Lynn Custer
DVD'S
21 DVD's
Unknown
14 DVD's
Brandon Brubaker
16 DVD's
Dan Heard
7 DVD's
Bo Warren
71 DVD's
Tommy Bailey
2 DVD's
Kathleen Leabo
9 DVD's
Shona Poe
14 DVD's
Mary & Jesse Ortega
Others
5 Binders Unknown
4 Maps Unknown
2 Audio Books Unknown
1 Cassette Tape Unknown
1 VHS Unknown
45 Audio Books Rose Campbell
4 Ink Cartridges Markayla Quirey
1 Can Coffee Stanley Lester
12 Bags of Snacks Texas Credit Corporation
72 Small Bags of Chips Shona Poe
1 Puzzle Book David Selby
2 CD-Roms David Selby
5 VHS David Selby
43 Cassette Tapes David Selby
10 Floppy Discs
2 Calendars
2 Music CD's
155 VHS
1 VHS
1 Music CD
3 Audio Books
2 Home School Spelling Kits
18 8Jrack Tapes
6 VHS
14 Music CD's
1 Color Book
$ 80.00 Donation
$ 10,85 Donation
$ 16.92 Donation
$ 111.75 Donation
$ 20,00 Donation
David Selby
Dolores Miller
A.H. Barnard
A.H. Barnard
Kevin LeVrier
Kevin LeVrier
Kevin LeVrier
Kevin LeVrier
Mike Fricke
Mike Fricke
Lynn Custer
Lynn Custer
Bay Point Property Owners Association
Seadrift Library
Point Comfort Library
Port O'Connor Library
Memorial for Carolyn Fricke
Commissioners' Court —OCTOBER 23, 2019
i6. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 16)
To declare items located in the Calhoun County Public Library declared as
Surplus/Salvage and authorize the Librarian to dispose of same. (see list)
RESULT: APPROVED [UNANIMOUS]
MOVER: David Hall, Commissioner Pct 1
SECONDER: Vern Lyssy, Commissioner Pct 2
AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese
Page 14 of 18
L I
Calhoun County Public Library
www.ccllbrwj.org
200 W, Mahan I Port Lavaca, TX 77979 Ph: 361.552.7323 Fax: 361.552.5218
AUG-SEP 2019
I would like the following items to be declared Surplus/Salvage
1506 Books
2896 Paperbacks
111 Magazines
35 DVD's
4 Ink Cartridges
10 Music CD's
(VHS
313 Audio Books
3 Cassette Tape
2 Homeschooling Kits
1 Puzzle Book
1 CD-ROM
Commissioners' Court —OCTOBER 23, 2019
17, CONSIDER
AND TAKE NECESSARY ACTION (AGENDA ITEM NO.
17)
To declare
items located in the Calhoun County Public
Library declared as
Waste and
authorize the Librarian to dispose of same.
(see list)
(RM)
RESULT: APPROVED [UNANIMOUS]
MOVER: Vern Lyssy, Commissioner Pct 2
SECONDER: David Hall, Commissioner Pct 1
AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese
Page 15 of I8
L t
Calhoun County Public Library
m m.cdihmry.org
200 W. Mahan I Port Lavaca, TX 71979 Ph: 361.552.7323 Fax: 361,552.5218
AUG-SEP 2019
I would like the following items to be declared Waste
30 Books
48 Paperbacks
4 DVD's
119 Magazines
Others
4 Music CD's
1 Color Book
1 8-Track Tape
146 VHS
2 Calenders
4 Port-USB 2.0 Print Server
2 U.S. Robotics Wireless MAXg Access Point
2 Wireless-G Broadband Router
1 Honeywell Voyager MS 9500 Barcode Scanner CN79E4POPG
1 Wi-Fi U.S. Robotics Wireless Access Point 1WBKI9BFOOOA
1 SonicWall 0017C539BE94
1 Dell Monitor CN-036642-7161858R-AKA3
1 Dell Latitude Laptop 1MWWLJI
1 Dell Latitude Laptop JLWWLJ1
1 Standing Metal Mailbox
Commissioners' Court —OCTOBER 23, 2019.
18. Accept reports from the following County Offices:
1. County Clerk's Office — September 2019
2. County Treasurer's Office — August 2019
3. Justice of the Peace, Pct 3 — September 2019
RESULT: APPROVED [UNANIMOUS]
MOVER: Clyde Syma, Commissioner Pct 3
SECONDER: Vern Lyssy, Commissioner Pct 2
AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese
Page 16 of 18
I.tLLil®V 1Y 1.®UtV� 1 g �L` 1SE145
C®U�TY �TRE�iL,S��T�FiRIS P®RT
MONTH OF: AUGUST 2019
EEGlNN/NG
ENDING
FUND
FUND FALANCG
RECEIPTS
DISFUFSBM&NTS
FUND EAJANCE
OPERATING FUNpS:
GENERAL
$ 25,406,673.30
$ 6,394,609,10
$ 6,641,063.63
$ 23,163,218.97
AIRPORT MAINTENANCE
44,897.66
169.36
641.G0
44,S2S.32
APPELLATE JUDICIAL SYSTEM
1,101.47
162.87
-
/,264.34
COASTAL PROTECTION FUND
I,I68,667.28
1,803.34
9,072.00
1,161,400.62
COUNTY AND D[ST COURT TECH FUND
6,627.61
I64,59
-
5,792,20
COUNTY CHILD AHUSE PREVENTION FUND
6I0.22
3.Sb
614.08
COUNTY CHILD WELFARE HOARD FUND
5,466.34
24.45
3,492.79
COURTHOUSE SECURITY
248,202.34
I,947.1i
-
250,L49.43
COURT INITIATED GUARDIANSHIP FUND
9,08I.68
214.03
9,295.71
DIST CLK RECORD PRESERVATION FUND
28,426.16
'956.68
-
28,882.84
CO CLK RECORDS ARCHNE FUND
245,498.19
4,099.24
-
249,697.43
DONATIONS
81,277.03
690.67
527.70
8I,440.20
DRUG/DWI COURT PROGRAM PUND-LOCAL
19,931,59
756.36
-
20,687.95
]UVENILE CASE MANAGER FUND
1G,037.69
1,236,17
345.70
16,928.16
FAMILY PROTECTION FUND
11,382.68
107,38
-
11,490.26
JUVENILE DELINQUENCY PREVENTION FUND
8,839.72
13.66
-
8,853.38
GRANTS
7b0,140.09
45,358,98
59,582.7I
743,916,36
JUSTICE COURT TECFINOLOGY
86,300.66
I,247.99
114.38
87,434.27
]USTICE COURT BUILDING SECURITY FUND
4,394.27
285,47
-
4,679.74
LATERAL ROAD PRECNCT #1
4,382.47
6.77
4,389.24
LATERAL ROAD PRECNCT#2
4,382.48
6,77
-
4,389.2$
LATERAL ROAD PRECINCT #3
4,362.47
6.77
4,389.24
LATERAL ROAD PRECNCT #4
4,382.48
6.77
-
4,389.25
JUROR DONATIONS -HUMANE SOCIETY
2,522.00
IG,00
2,638.00
PRETRIAL SERVICES FUND
78,678.05
321.34
-
78,999.59
LAW LIBRARY
209,366.32
1,416.55
2,084.62
208,697.25
LAW ENF OFFICERS STD. EDUC. (LEOSE)
37,909.82
38.36
-
37,968.38
POC COMMUNITY CENTER
47,765.72
2,123,79
7,127.72
42,761.79
RECORDS MANAGEMENT -DISTRICT CLERK
8,704.43
21931
8,923.96
RECORDS MANAGEMENT -COUNTY CLERK
143,883.79
4,063.81
147,947.60
RECORDS MGMT&PRESERVATION
2I,621.07
1,080.SI
22,701.88
ROAD &BRIDGE GENERAL
I,S33,869.36
33;482.44
1,571,35I.80
6MILE P[ERBOAT RAMP MSUR/MAINT
42,454.60
bS,58
-
42,520.I8
CAPITAL PROD -CHOCOLATE HAYOU BOAT RAMP
49,500.00
148,500.00
198,000.00
CAPITAL PRO7 -RB INFRASTRUCTURE
26,4I7.81
26,417.81
CAPITAL PROJ-AIRPORT RUNWAY 7MPROV
78,472.13
78,472.I3
CAPITAL PROJ-EVENT CENTER
1,433,084.00
I,43S,084.00
CAPITAL PROJ-FIRE TRUCKS &SAFETY EQUIPM
48,309.70
48,509.70
CAPITAL PR07-GREEN LAKE PARK
7,160.74
-
7,160.74
CAPITAL PROJ - HATERRIS PARKBOAT RAMP
20,242.36
20,242.36
CAPITAL PROJ-ODYSSEY CASE MGMT SOFTW
(0.00)
-
(0.00)
CAPTTAL PROJ-PORT ALTO PUBL BEACHSTORM
223,132.38
-
-
223,732.38
CAPITAL PROJ -HURRICANE HARVEY DR-4332 FE
193,670.33
-
15,347.33
178,323.00
CAPITAL PROJ-IMPROVEMENTS-LITTLE LEAGUEP
337,374.33
-
1,140.00
356,234.35
CAPTTAL PROI-HOSPITAL IMPROVEMENTS
-
3,000,000,00
-
3,000,000.00
CAPITAL PROJ-MMC LOANS
3,500,000.00
l00,000.00
3,000,000.00
600,000.00
ARREST FEES
393.83
25 L86
-
646.69
HAILBOND FEES (HB 1940)
30.00
1,200.00
-
I,230.00
CONSOLIDATED COURT COSTS (NEW)
30.00
16,G59.70
-
15,689.70
DNA TESTING FUND
250.00
4L95
-
29L9S
DRUG COURT PROGRAM FUND - STAT6
0.31
726.36
723.87
SUBTOTALS
$ 36,239,130.30
$ 9,769608.45
$ 9,736,947.39
$ 36,271,791.36
Page I of 3
C®���� ���i�s����l� ���®��
MONTH OF:
AUGUST 2019
REGlNMNG
ENDING
FUND
FUND BALANCE•
RECEIPTS
DfSBURSGMENTS
FUND BALANCE
OPERATING FUNDS -BALANCE FORNARD
$ 3G,239,130.30
$
9,769,608.45
$ 9,736,947.39
$
3G,271,791.36
ELECTION SERVICES CONTRACT
90,414.91
115.13
90,530.04
ELECTRONIC FILING FEE FUND
0.00
1,789.64
1,769.64
EMS T[tAUMA FUND
I26.67
1,486,34
-
1,612.91
FMES AND COURT COSTS HOLDING FUND
7,847.31
-
-
7,847.31
INDIGENT CIVIL LEGAL SERVICE
24.30
418.00
-
442.30
lUD(CIAL FUND (SI'. COURT COSTS)
0.00
649.26
549.26
IUDICIAL&COURT PERSONNEL TRAINING FUND
14.49
285.63
-
300.12
JUDICIAL $ALARIE$FUND
0.02
3,660.6I
-
3,660.63
JUROR DONATION -TX CRIME YIGTIMS FUND
296.00
I6.00
-
312.00
IUVENILE PROBATION RESTITUTION
1,000.44
I6I.02
I,061,46
100.00
LIBRARY GIFT AND MEMORIAL
53,I05.22
82.04
-
63,187.26
MISCELLANEOUS CLEARING
85,693.88
536,75
76,571,58
9,679.OS
REFUNDABLE DEPOSITS
2,000.00
-
-
2,000.00
STATE CIVIL FEE FUND
0.00
2,444.75
-
2,444.75
CIVIL JUSTICE DATA REPOSITORY FUND
0.00
22A1
-
22.01
JURY REIMBURSEMENT FEE
0.00
1,313.42
-
I,313,42
SUBTITLEC FUND �
7.77
A,961.84
4,969.6I
SUPP OF GRIM INDIGENT DEFENSE
0.00
654.93
654.93
TIME PAYMENTS
0.06
2,407.47
2,407.62
TRAFFIC LAW FAILURE TO APPEAR
0.00
1,058,62
-.
I,068,62
UNCLAIMED PROPERTY
8,433.21
1,593.51
-
10,026.72
TRUANCY PREVENTION AND DIVERSION FUND
26.27
543.73
-
569.00
BOOT CAMP/J1AEP
JUVENILE PROBATION
147.43
242,367.76
606.41
-
59,808.92
147.43
183, 165.25
$ 36,730,G34.93
$
9,794,335.56
$ 9,874,389.35
$
36,650,581.14
SUBTOTALS
TAXES IN ESCROW
0.00
0.00
0.00
$ 36,730,634.93
$
9,794,335.56
S 9874389.3$
S
36,65058L14
TOTAL OPERATING FUNDS
OTHER FUNDS
D A FORFEITED PROPERTY FUND
26,267.83
8,100.24
-
34,368.07
SHERIFF NARCOTIC FORFEITURES
29,031.37
16, 189,31
1,378,92
43,841.76
CERT OF OB-CRTHBE REF SERIES 2010
493,967.26
3,076,79
459,100.00
37,934.05
CERT OF OB-CRTHOUSE I&S SERIES 2012
673,684.84
4,000A4
634,000,00
43,684.88
CAL. CO. FEES & FMES
148,GG4.G9
I36,19I.93
163,881.72
130,974.90
371606.99
S
167558.31
$ 1248360.64
$
190803.66
TOTAL OTHER CO. FllNDS
MEMORIAL MEDICAL CENTER
GPERATING
I,350,874.52
2,90.4,4b6.98
3,190,574.52
$
1,I04,766.98
INDIGENT HEALTHCARE
9,331.8]
40,377.99
44;739.26
4,970.64
PRNATE WAIVER CLEARING FUND
867.62
350,078.00
-
360,945.62
CLINIC CONSTRUCTION SERIES 2014
149,376.24
57.09
-
149,433.33
NH ASFORD
123,206.50
641,609.99
587,872.20
176,944.29
NH BROADMOOR
84,891.18
522,835.42
d84,140.24
123,586.36
NH CRESCENT
40,524.87
512,879.94
457,716,71
95,688.10
NH FORT BEND
69,I93.61
202,530.76
208,770.70
62,963.67
NH SOLERA
109,248.26
I,046,358.27
668,907.47
586,699.OS
NH GOLDEN CREEK
118,294.06
285,745.Ii
219,974,05
164,065.12
NH SOLERA DACA
0.00
-
0.00
NH ASHFORD DACA
0.00
-
-
0.00
NH BROADMOOR DACA
0.00
-
-
0,00
NH GULF POINTE-PRIVATE PAY
I00.17
38.09
38.06
100.20
NH GULF POINT PLAZA MEDICARE /MEDICAID
9,689.44
37,749.73
20,11 L I7
27,328.00
$ 2,065,598.27
$
6,684,727.37
$ 5,782,844.38
$
2,867,481.26
TOTAL MEMORIAL MEDICAL CENTER FUNDS
DRAINAGE DISTRICTS
N0.6
35,152.26
$
13,43
$ 103.12
$
35,062.56
NO.B
128,7I6.66
223.48
94.88
128,845.26
NO. ]0-MAINTENANCE
168,427.11
98.85
119.G2
166,406.34
NO. II-MAINTENANCE/OPERATING
28G,70I.48
2,074,99
18,941,60
269,834.67
NO II -RESERVE
131,053.20
60.09
131,I03.29
TOTAL DRAINAGE DISTRICT FUNDS
$ 750050.70
$
2,460.84
$ 19,269.22
$
733,252.32
CALHOUN COUNTY WCID #1
OPERATING ACCOUNT
$ 440,674.16
5.32
15,450.79
$
425,228.69
PAYROLL TAX
$ 2,178.29
0.00
143.16
S
2,036.13
$ 442,SS2.45
5.32
15,593.95
$
427,263.82
TOTAL WCID FUNDS
CALHOUN COUNTY PORT AUTHORITY
MAINTENANCE AND OPERATING
$ 8066.14
$
3,200.74
$ 9,827.65
$
1,445.23
CALHOUN COUNTY
FROST BANK
$ 3,660.87
$
$ 5.00
$
3,SS6.87
TOTAL MMC, DR. DIST., NAV. DIST, WCID &FRO
$ 3,270 128.43
$
6,590,394.27
$ 5,827,324.20
S
4,032 998.50
TOTAL ALL FUNDS
S 41,372,369.3$
S
16,662,286.14
$ 16,950,274.19
$
40,974,383.30
Page 2 of 3
COUi�TY TI�EASURERIS IaEPORT
MONTH OF: AUGUST 2019
BANK RECONC/LIATION
LESS: CERT.OPDEP/
FUND
OUTSTNDUDEP/
PLUS: CHECKS
BANK
FUND
BALANCE
OTHER ITEMS
OUTSTAND/NC
BALANCE
OPERATING"
$ 36,650,S8L14
$ 33,022,016.77
$ 219,I3S,I1
$ 3,547,700.48
OTHER
D A FORFEITED PROPERTY FUND
34,368.07
-
-
34,368.07
SHERIFF NARCOTIC FORFEITURES
43,641.76
-
39,87
43,881,63
CERT OF OB-CRTHSE REF SERIES 20I0
37,934.05
3I3.60
-
37,620.45
CERT OF OB-CRTHOUSE I8c$ SERIES 2012
43,684.88
407.28
43,277.60
CAL. CO PEES &FINES
130,974.90
16,394.30
14,273.6I
128,854, / l
MEMORIAL MEDICAL CENTER
OPERATING $
1,104,766.98
0.30
386,Sfi0.03
1,491,326.71
INDIGENT HEALTHCARE
4,970.54
16,389.94
21,360.48
PRIVATE WAIVER CLEARING FUND
350,945.62
-
350,945.62
CLINIC CONSTRUCTION SERIES 20I4
149,433.33
-
149,433.33
NH ASHFORD
176,944.29
-
176,944,29
NH BROADMOOR
123,686.36
-
-
123,586,36
NH CRESCENT
95,668.10
-
95,688.r0
NH FORT BEND
62,953.67
-
62,953.67
NH SOLERA
586,699.05
-
586,699.05
NH GOLDEN CREEK
184,065.12
-
184,065, I2
NH SOLERA DACA
0.00
-
-
0.00
NH ASHFORD DACA
0.00
-
0.00
NH BROADMOOR DACA
0.00
-
0.00
NH GULF POINT PRIVATE PAY
100.20
100.20
NH GULP POINTS PLAZA MEDICARE/MEDICAID
27,328.00
-
27,328.00
DRAINAGE DISTRICT:
N0.6
35,062.56
-
103.12
35,165,68
NO.B
I28,845.26
30.11
94.88
126,890.03
NO. IO MAINTENANCE
I68,406.34
0.01
-
168,406.33
NO. II MAINTENANCE/OPERATING
269,834.87
97, 14
-
269,737.73
NO. 11 AESERVH
131,103.29
-
131,103.29
CALHOUN COUNTY iVCID kl
OPERATING ACCOUNT
425,228.69
-
425,228.69
PAYROLL TAX
2,035.I3
-
2,035.13
CALHOUN COUNTY PORT AUTHORITY
MAINTENANCFIOPERATING****
1,445.23
-.
1,445.23
CALHOUN COUNTY
FROST HANK
3,555.87
-
-
3,555.87
TOTALS
$ 40 974 383.30
$ 33 039 278.51
$ 636 596.46
$ 8 371 701.25
**** THE DEPOSITORY FOR CALHOUN COUNTY WCID IS INTERNATIONAL BANK OF COMMERCE -PORT LAVACA
**** THE DEPOSITORY FOR CALHOUN CO. NAVIGATION DISTRICT IS FIRST NATIONAL BANK -PORT LAVACA
****THE DEPOSITORY FOR CALHOUN COUNTY FROST IS FROST BANK - AUSTIN, TEXAS
THE DEPOSITORY FOR ALL OTHER COONTY FONDS IS PROSPERITY BANK, PORT LAVACA
Coutt costs and fees collected and reported may not be current and up-to-date due tonon-compliance by other county
offices. I hereby certify that the current balances are correct to all monies that have been received by the County
Treasurer as of the date of this report. e"'�� j
��p,�
RHONDA S. KOKENA
COUNTY TREASURER
Page 3 of 3
CALHOUN COUNTY CLERK
MONTHLY REPORT RECAPITUATION
oFRC1A[
PUBLIC
DESC GLCODE
CIVIL
CRIMINAL
REC6ROS
PROBATErTO1A1
DISTRICTATTORNEY FEES 100044020
$ 393,64
93.64
BEER LICENSE 1000,42010
$ 484,00
$ 620.80
$ -
$ 9,780,30
$ 210.0090.00
COUNTYCLERKFEES 1000-4403D
PPFALFROM IP COURTS 1000-44030
$
OUNTY COURT AT LAW RL JURY FEE 1000.44140
URY FEE UTKF44140
$ -
$ -
LECTRONIC FILING FEES FOR&FILINGS 1000-4405B
$ -
$ -
$ -$
-
UDGES EDUCATION FEE 1000.44160
$ -
$ -
$ -
$ 16.0015.00
JUDGE'S ORDER/SIGNATURE 1000.441M
$ 18.00
$ -
$ -
$ 40.00
$ 50.00
SHERIFF'S FEES 1000-44190
$ 76,00
$ 396.77
$ -
$ 100.00
$ 571.77
VISUAL RECORDER FEE 100044250
$ 53.32
$ 53.32
COURT REFPORTER FEE 100044270
$ 76.00
$ -
$ -
$ 45.OD
$ 120.00
RESTITUTION DUE TOOTHERS 100049020
$
$ 140A0
ATTORNEY FEES. COURT APPOINTED 1000 49030
$ 440,00
$ 40.00
APPELLATE FUND(TGC) FEE 2620-44030
$ 25.00
$ 15.00
TECHNOLOGY FUND 2663 44030
$ 62.06
$ 62.06
COURTHOUSE SECURITY FEE 267044030
$ 25.00
$ 46.57
$ 371.00
$ 15.00
$ 457.57
COURT INITIATED GUARDIANSHIP FEE 2672,44030
$ 60.00
$ 60,00
COURT RECORD PRESERVATION FUND 2673-44030
$ 50.00
$ -
$ 30.00
IS CITED
RECORDS ARCHIVE FEE 2675-4403D
$ 34560.00
$ 3,660.00
DRUG & ALCOHOLCOURT PROGRAM 2698 44030-005
$ 249.63
$ 249.63
IUVENILE CASE MANAGER FUND 269944033
$ -
$
$ 45,00
FAMILY PROTECTION FUND 270644030
$ 45.00
IUVENILE CRIME& DELINQUENCY FUND 2715.44030
$0.00
$ '
PRE-TRIAL DIVERSON AGREEMENT 2729-44034
$ -
$ 105,00
$ -
$ 280.00
IAWLI9ARY FEE 2731.44030
$ 175,00
38,00
$ 3,620,00
$ 30658.00
RECORDS MANAGEMENT FEE - COUANYCLENKK 2738 44380
$
$ SODAS
RECORDS MANGEMENT FEE -COUNTY 2739.44030
IS 25,00
$ 349.10
$ 15.00
FINES - COUNTY COURT 2740.45040
$ 4,100.92
$ 41166.02
BONDFORFEITURE 2740.45050
$
$ 2,81
STATE POLICE OFFICER FEES- STATE (DPS)(20%) 7020.20740
$ 2481
CONSOLIDATED COURT COSTS - COUNTY 7070.20610
$ 109.97
$ 109,97
CONSOLIDATED COURT COSTS - STATE 7070-20740
$ 989,73
$ 980.73
JUDICIAL AND COURT PERSONNEL TRAINING -ST 1100%) 750E-20740
$ 25.00
$ -
$ 15.00
$ 40.00
DRUG& ALCOHOL COURT PROGRAM -COUNTY 7390-20610
$ 49.93
$ 40.93
DRUG & ALCOHOL COURT PROGRAM -STATE 7390-20740
$ 199,70
$ 199.70
STATE ELECTRONIC FILING FEE - CIVIL 7403.22887
$ 160.00
$ -
$ 90.00
$ 240.00
STATE ELECTRONIC FILING FEE CRIMINAL 7403-22990
$ 77.69
$ 77.59
EMS TRAUMA - COUNTY (10%) 7405-20610
$ 210.88
$ 216.86
EMS TRAUMA - STATE (90%) 7405-20740
$ 200
$ 24.10
CIVIL INDIGENT FEE -COUNTY 7480.20610
§ 2.50
S 1.50
$ 4.00
CIVIL INDIGENT FEE -STATE 7480.20740
$ 47.60
IS 28,50
$ 76,00
JUDICIAL FUND COURT COSTS 7495-20740
$ 232.74
$ 232.74
JUDICIAL SALARY FUND -COUNTY HOT) 7SUS-20610
$ 7.05
$ 7,95
JUDICIAL SALARY FUND - STATE (90%) 7505-20740
$ 71.53
$ 126.00
$ 71,63
$ 336,00
JUDICIAL SALARY FUND (CIVIL & PROBATE) - STATE 7505.20740-005
1 $ 210.00
TRAFFIC LOCAL (ADMINISTRATIVE FEES) 7538.22884,1000.44359
$ 7.33
$ 7,33
COURT COST APPEAL OF TRAFFIC REG NP APPEAL) 7538-22885
$ -
§ 116.20
BIRTH - STATE 7855-207M
$ 116.20
INFORMAL MARRIAGES - STATE 7955.20782
$ 12.60
$ 12,50
JUDICMLFEE 7855-20786
$ 200,00
$ -
IS 120,00
$ 320.00
FORMAL MARRIAGES -STATE 7855-20798
5 300.00
$ 300.00
NONDISCLOSURE FEE - STATE 7855.20790
$ -
IS
$ -
$ -
$ 0.06
TOTOSECOURT COST - COUNTY (10%) 7856.20610
$ 0.06
$ 0,60
TCLEOSE COURT EDGE - STATE (90%) 7856-20740
$ 0,66
$ 5,30
JURY REIMBURSEMENT FEE-COUNTY(fO% 7857,20610
$ 6.30
JURY REIMBURSEMENT FEE -STATE 190%1 7857.20740
IT 47.74
$ 47474
STATE TRAFFIC FINE - COUNTY (5%) 7860.20610
$ L61
$ 1.01
STATE TRAFFIC FINE - STATE (95%) 7860-70740
$ 30.65
IS 30,65
INDIGENT DEFENSE FEE -CRIMINAL- COUNTY (10%) 7865.70610
$ 2.66
$ 2.66
$ 23.90
INDIGENT DEFENSE FEE - CRIMINAL - STATE (90NL 7865-20740
$ 23.90
$ 154.39
TIME PAYMENT - COUNTY (50%) 7950-20610
$ 154.39
TIME PAYMENT - STATE (50%) 7950-20740
$ 164.39
$ 154.39
RAIL JUMPING AND FAILURE TO APPEAR - COUNTY 7970-20610
$ -
BAILJUMPIHGANDFAILURETOAPPEAR - STATE 7970.20740
$
35.27.
DUE PORT LAVACA PO 9990.99991
$ 36.27
$
DUESEADRIFT PD 9990/9992
$
$
$ 0,43
DUE TO POINT COMFORT PIT 9990-99993
$ OA3
DUE TO TEXAS PARES & WILDLIFE 9990-09994
$ 700.00
$ 700,00
DUE TO TEXAS PARKS& WILDLIFE WATER SAFETY 9990.99995
$ -
DUETOTAOC 9990.99996
$
DUE TO ATTORNEY AD LITEMS 999099997
$
$ 187.00
DUE TO OPERATING/NSF CHARGES/DUE TO OTHERS 7120.20759
1 $ 8.0)
1 $ -
$ 1790
$ -
§ 1,640.90
$ 91664,80
$ 17,930.00
$ 1,031.00
30,274.T0
TOTAL FUNDS COLLECTED
-
$ 30,274,70
$ -
FUNDS HELD IN ESCROW:
M
NT DUE TO TREASURER:
$ 2%352; ff
TOTAL RECEIPTS:
AMOUNT DUE
TO OTHERS:
$ 022,70
8 30,274.70.
U.\9AEPo0.Ts\\IONTNLYNUOIT00. ANo iREASUPER RGPoBis\R019.09]ot9 iPEA9U0.FA PEPOR4B.dz t0118R019
CALHOUN COUNTY CLERK
MONTHLY REPORT RECAPITUATION
:GINNING BOOK BALANCE 8/34/2019 $ 137,656.70
FUND RECEIVED $ 7,000.00
DISBURSEMENTS $ (006.00
ENDING BOOK BALANCE 9/30/2019 E 140,073.70
.LADING BANK BALANCE 9/36/x619 $ 149,400.40
OUTSTANDING DEPOSITS"
OUTSTANDING CHECKS'* $ (9392.70
CD'S
CERTIFICATLS OF OEPOSiTS
DAlelssUed
HELD
BAleuoe
8/3112010
IN TRUST PROSPERITY
Puroilaees/
Interest
OANe
Willidrawals
Balance
0/130119
10440
1/24/2018
S 1;866,62
$
$ 1,066.62
10441
1/24/2018
$ 10,122.04
$ 10,122.84
10442
1/2412018
$ 1,261.50
$ 1,26I.55
10443
112612DIO
$ 1,261.66
$ 1,26/.56
10444
1125/2018
$ 0,527.01
$ 0*527.01
10446
i/26/2016
5 9,b27.01
$ 9,627,01
10446
1/2612018
$ 9,627.01
$ 9,527.01
10449
212/2010
$ 20,032.46
$ 206032.46
10464
3/2/2010
$ 3065/.b8
$ 7.61
E 3,559.17
10455
3/2120/6
S 3551.b6
$ 7.01
$ 31550,17
$
$
TOTALS:
E 70,329.01
$ 15.22
$ -
E 70,244,23
10/10/2019
SubmllLed W." Anne MOaodmen. County Cledc Data
Richard Meyer, CAihoun COunly dodge Dalo
U.WAEPonT6VA0NeiLYNUUrtoR ANe iREA6URER aamRT6110fB.00J01B JREABUaER REPORieJc
UF2
IOfINiOJB
z c t
Y REPORT
10/17/2019 COURT NAME: JUSTICE OF PEACE NO. 3
MONTH OF REPORT: SEPTEMBER
YEAR OF REPORT: 2019
ACCOUNT NUMBER ACCOUNT NAME AMOUNT
CR 1000-001-45013 FINES 51265.80
CR 1000-001-44190 SHERIFF'S FEES 568.17
ADMINISTRATIVE FEES:
DEFENSIVE DRIVING 6.30
0
CHILD SAFETY 0.00
TRAFFIC 118.54
ADMINISTRATIVE FEE 416.60
EXPUNGEMENT FEES 0.00
MISCELLANEOUS 0.00
CR 1000-001-44363 TOTAL ADMINISTRATIVE FEES 604.44
CR 1000-001-44010 CONSTABLE FEES -SERVICE 150.00
CR 1000-001-44063 JP FILING FEES 325.00
CR 1000-001-44090 COPIES / CERTIFIED COPIES 0.00
CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00
CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00
CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00
CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00
CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00
CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00
CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 888.10
TOTAL FINES, ADMIN. FEES & DUE TO STATE $7,801.51
CR 2670-001-44063 COURTHOUSE SECURITY FUND $147,59
CR 2720-001-44063 JUSTICE COURT SECURITY FUND $49.20
CR 2719-001-44063 JUSTICE COURT TECHNOLOGY FUND $196.79
CR 2699-001-44063 JUVENILE CASE MANAGER FUND $220,00
STATE ARREST FEES
DPS FEES 60.78
P&W FEES 3.44
TABC FEES 0.00
CR 7020-999-20740 TOTAL STATE ARREST FEES 64.22
CR 7070-999-20610 CCC-GENERAL FUND 196.80
CR 7070-999-20740 CCC-STATE 13771.17
DR 7070-999-10010 1,967.91
CR 7860-999-20610 STF/SUBC-GENERAL FUND 57.27
CR 7860-999-20740 STF/SUBC-STATE ItO88.22
DR 7860-999-10010 11145.49
CR 7860-999-20610 STF- EST 9/l/19- GENERAL FUND 4.00
CR 7860-999-20740 STF- EST 9/l/19- STATE 96.00
100.00
CR 7950-999-20610 TP-GENERAL FUND 144.91
CR 7950-999-20740 TP-STATE 144.90
DR 7950-999-10010 289.81
Page 1 of 3
MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS
10/17/2019 COURT NAME: JUSTICE OF PEACE NO. 3
MONTH OF REPORT: SEPTEMBER
YEAR OF REPORT: 2019
CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 2.10
CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 39.90
DR 7480-999-10010 42.00
Page 2 of 3
MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS
10/17/2019 COURT NAME: JUSTICE OF PEACE N0.3
MONTH OF REPORT: SEPTEMBER
YEAR OF REPORT: 2019
CR
7865-999-20610
CRIM-SUPP OF IND LEG SVCS-GEN FUND
9.84
CR
7865-999-20740
CRIM-SUPP OF IND LEG SVCS-STATE
88.58
DR 7865-999-10010
98.42
CR
7970-999-20610
TL/FTA-GENERAL FUND
37.28
CR
7970-999-20740
TL/FTA-STATE
74.55
DR 7970-999-10010
111.83
CR
7505-999-20610
JPAY - GENERAL FUND
29,52
CR
7505-999-20740
JPAY - STATE
265.68
DR 7505-999-10010
295,20
CR
7857-999-20610
JURY REIMB. FUND- GEN. FUND
19.68
CR
7857-999-20740
JURY REIMB, FUND- STATE
177.08
150 DR 7857-999-10010
196.76
CR
7856-999-20610
CIVIL JUSTICE DATA REPOS.- GEN FUND
0,40
CR
7856-999-20740
CIVIL JUSTICE DATA REPOS.- STATE
3.63
DR 7856-999-10010
4.03
CR
7502-999-20740
JUD/CRT PERSONNEL TRAINING FUND-STAT
35.00
DR 7502-999-10010
35.00
7998-999-20701
JUVENILE CASE MANAGER FUND
45.04
CR
7998-999-20740
TRUANCY PREVENT/DIVERSION FUND- STAT
45,04
DR 7998-999-10010
90.08
CR
7403-999-22889
ELECTRONIC FILING FEE
70,00
DR 7403-999-10010
70.00
TOTAL (Distrib Req to OperAcct)
$12,925,90
DUE TO OTHERS (Distrib Req Attchd)
CALHOUN COUNTY IS 0.00
DA -RESTITUTION 0.00
REFUND OF OVERPAI 0.00
OUT -OF -COUNTY SER 0,00
CASH BONDS 0.00
PARKS & WILDLIFE FII 192,10
WATER SAFETY FINE' 0.00
TOTAL DUE TO OTHERS $192.10
TOTAL COLLECTED -ALL FUNDS $13,118.00
LESS: TOTAL TREASUER'S RECEIPTS $13,118.00
REVISED 03/04/16 OVER/(SHORT) $0.00
Page 3 of 3
Commissioners' Court — OCTOBER 23, 2019
19, Consider and take necessary action on any necessary budget adjustments.
RESULT: APPROVED [UNANIMOUS]
MOVER: David Hall, Commissioner Pct I
SECONDER: Vern Lyssy, Commissioner Pct 2
AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese
Page 17 of 18
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Commissioners' Court — CCTCBtR 23, 2019
20. Approval of bills and payroll.
Indigent
RESULT: APPROVED [UNANIMOUS]
MOVER: David Hall, Commissioner Pct 1
SECONDER: Vern Lyssy, Commissioner Pct 2
AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese
MMC
RESULT: APPROVED [UNANIMOUS]
MAVPRn nnwirl Nall rnmmicclnnor Prh 1
Syma, Reese
ADJOURNED: 10:30 A.M.
Page 18 of 18
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR -- October 23 2019
TOTALS TO BE APPROVED -TRANSFERRED FROM ATTACHED PAGES
TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 803,64107 i
TOTAL TRANSFERS BETWEEN FUNDS $
TOTAL NURSING HOME UPL EXPENSES $ 757,883.39
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR ---October 23 2019
PAYABLES AND PAYROLL
10/18/2019 Weekly Payables 611,444.44
10/1/2019 Citibank Credit Card -see attached 21643,90
10/18/2019 Ashford -Nursing home insurance payment sent to MMC in error 41975,56
10/18/2019 Solera-Nursing home insurance payment sent to MMC in error 852,50
10/18/2019 Crescent -Nursing home insurance payment sent to MMC in error 61691476
10/18/2019 Gulf Pointe Plaza -Nursing home insurance payment sent to MMC in error 1239580,88
10/18/2019 Goldencreek-Nursing home insurance payment sent to MMC In error 42,428,35
10/18/2019 Accent -insurance payment was in excess of allowable amount 100.89
10/21/2019 McKesson-3406 Prescription Expense 91834,00
10/21/2019 Amerisource Bergen-34013 Prescription Expense l p064,78
Prosperity Electronic Bank Payments
0115-10118/19 Pay Plus -Patient Claims Processing Fee ga n,
TOTAL TRANSFERS BETWEEN FUNDS $
NURSING HOME UPI. EXPENSES
10/21/2019 Nursing Home UPI-Cantex Transfer 507,114,77
10/21/2019 Nursing Home UPI-Nexion Transfer 62,093012
10/21/2019 Nursing Home UPI -HMG Transfer 156,414.64
QIPP/INTEREST CHECKS TO MMC
10/21/2019 Ashford 17,229,90 .
10/21/2019 Broadmoor 21628,05
10/21/2019 Crescent 11920471
10/21/2019 Fort Bend 51507,29
1012112019 Solera . ,.�...,..
TOTAL INTER -GOVERNMENT TRANSFERS $
GRAND TOTAL DISBURSEMENTS APPROVED October 23; 2019 $ 4561,524.38'i
Page ,,.*,:�. .� of 14
OCT 17 2010
MEMORIAL MEDICAL CENTER
11:04 AP Open Invoice List
Due Dates Through: 10130/2019 ap open_involce.template
Vendor# Vendor Name Class Pay Code
10246 ACCENT
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
101419 10/14/20 10/14/20 10/14/20 171,77 0.00 0,00 171.77
PeatAT lcfwj--
Vendor Totals Number Name Gross Discount No -Pay Net
10246 ACCENT 171.77 0.00 0.00 171.77
Vendor# Vendor Name Class Pay Code
11283 ACE HARDWARE 15521
Invoice# / Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net
138342 r/ 10/15/20 10/02/20 10/27/20 23.77 0.00 0.00 23,77 t�
SUPPLIES lAIA&
138365 10/15/20 10/03/20 10/28/20 11.98 0.00 0,00 11.98
SUPPLIES WUjVjV.
Vendor Totals Number Name Gross Discount No -Pay Net
11283 ACE HARDWARE 15521 35.75 0,00 0.00 35.75
Vendor# Vendor Name Class Pay Code
10950 ACUTE CARE INC
Invoice# / Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
26414 ✓ E 09/30120 10/20/20 10/30120 1*400,00 0.00 0,00 1,400.00
RFID FEE
Vendor Total;Number Name Gross Discount No -Pay Net
10950 ACUTE CARE INC ls400.00 0.00 0,00 1,400.00
Vendor# Vendor Name Class Pay Code
A1715 ALCO SALES & SERVICE CO M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net C
2792096IN ✓ 10/16/20 10/07120 10127/20 241.59 0,00 0.00 241.59 l%
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
A1715 ALCO SALES & SERVICE CO 241,69 0,00 0.00 241.59
Vendor# Vendor Name Class Pay Code
A1690 ALCON LABORATORIES, INC. M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
9656612215 ✓ 10/09/20 09/27/20 10/27/20
795.00 0.00 0.00 795.00
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
A1690 ALCON LABORATORIES, INC. 795.00 0,00 0.00 795.00
Vendor# Vendor Name Class Pay Code
10958 ALLYSON SWOPE
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
101619 10/15/20 10/15/20 10/16/20 2,274.75 0.00 0.00 21274.75
CONTRACT EMPLOYEE tg02"(-10I10019i
Vendor Totals Number Name Gross Discount No -Pay Net
10958 ALLYSON SWOPE 2,274.75 0,00 0,00 2,274.75
Vendor# Vendor Name Class Pay Code
A0810 AORN s/ W
Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net /
101519 10/15/20 10/15/20 10/15/20 170.00 0.00 0,00 170.00
file:///C:/UserslmmckissackJcpsi/memmed.cpsinet.com/u8815O/data_5/tmp_cw5report5... 10117/2019
C1048 CALHOUN COUNTY 100,000.00 0,00 0.00 100,000,00
Vendor# Vendor Name Class Pay Code
E1270 CENTERPOINT ENERGY I// W
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
100119 10/16/20 10/01/20 10/16/20 77,84 0,00 0.00 77.84
GAS
Vendor Totals Number Name Gross Discount No -Pay Net
E1270 CENTERPOINT ENERGY 77.84 0.00 0.00 77,84
Vendor# Vendor Name / Class Pay Code
10212 CLINICAL PATHOLOGY LABS r/ ICP
Invoice# Comment Tran Dt Inv Dt Due Dt Check Dw Pay Gross Discount No -Pay Net
2019090 10/14/20 09/30/20 12,243.63 0.00 0.00 12,243,63
LAB SERVICES
Vendor Totals Number Name Gross Discount No -Pay Net
10212 CLINICAL PATHOLOGY LABS 123243.63 0,00 0.00 12,243.63
Vendor# Vendor Name Class Pay Code
C1970 CONMED CORPORATION M
Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net
991771 10/16120 10103/20 10103/20 746.88 0.00 0.00 746,88 1 ,/
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
C1970 CONMED CORPORATION 746,88 0,00 0,00 746.88
Vendor# Vendor Name Class Pay Code
R1050 CULLIGAN OF VICTORIA ✓/ M
Invoice# Comment Tran Dt Inv Dt Due Ot Check D' Pay Gross Discount No -Pay Net
1430270309302019 r/ 10/15/20 09/30/20 10/22/20 214.50 0.00 0.00 214.50
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
R1050 CULLIGAN OF VICTORIA 214,50 0.00 0,00 214.50
Vendor# Vendor Name / Class Pay Code
10368 DEWITT POTH & SON
Invoice# /Comment Tran Dt Inv Dt Due Dt Check D* Pay Gross Discount No -Pay Net
5852490 09130/20 10/01/20 10126/20 17,50 0.00 0,00 17.60
SUPPLIES
5852790 09/30/20 10/01/20 10/26/20 418,28 0,00 0,00 418.28
/SUPPLIES
5853600✓ 10108/20 10/02120 10/27/20 p 4.90 0,00 0.00 4,90
SUPPLIES 6853590 i/ 10/08/20 10/02/20 10/27/20 7,28 0.00 0.00 7.28
/SUPPLIES
5856390 ✓ 10/16/20 10/03/20 10/28/20 31.33 0.00 0,00 31.33
SUPPLIES
5856380 ✓ 10/16120 10/03/20 10/28/20 2.17 0.00 0,00 2.17
SUPPLIES
5857580 v1 10/16/20 10/03/20 10/28/20 73.79 0.00 0,00 73.79
,SUPPLIES
5856730 ✓ 10116/2010/03/2010/28/20 15.17 0.00 0.00 15.17 /
/SUPPLIES
5856740 �/ 10/16/20 10/03/20 10/28/20 46.19 0.00 0.00 46.19 ✓
SUPPLIES /
5853580 v//10/16/20 10/04/20 10/29120 97.12 0.00 0.00 97,12
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SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
10368 DEWITT POTH & SON 713,73 0,00 0.00 713.73
Vendoi# Vendor Name Class Pay Code
11011 DIAMOND HEALTHCARE CORP J/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net i
IN20053158 09/30120 09130/20 10/25/20 19,166,67 0.00 0.00 19,166.67
CARDIAC REHAB SERVICES
IN20053157,/ 09/30/20 09/30/20 10/26/20 31,144.58 0,00 0,00 31,144,58
BEHAVIORAL HEALTH .
Vendor Totals Number Name Gross Discount No -Pay Net
11011 DIAMOND HEALTHCARE CORP 501311.25 0,00 0,00 50,311,26
Vendor# Vendor Name /Class Pay Code
10789 DISCOVERY MEDICAL NETWORK INC ✓
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
MMC101519 10/15/20 10/15/20 10/16/20 136 398.51 0.00 0.00 136,398,51
PRO FEES Oa FK r20aA Qs&%4
Vendor Totals Number Name Gross Discount No -Pay Net
10789 DISCOVERY MEDICAL NETWORKING 136,398.51 0,00 0,00 1363398,51
Vendor# Vendor Name Class Pay Code
11291 DOWELL PEST CONTROL,//
Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net
13857 ✓ 09/30/20 09/30/20 10/25/20 505.00 0,00 0,00 505,00
PEST CONTROL /
13855 09/30/20 09/30/20 10/25/20 105.00 0.00 0.00 105,00 ✓
PEST CONTROL
13854 09/30/20 09/30/20 10/25/20 160,00 0.00 0.00 160.00
/ REFILL MOSQUITO TRAPS /
13856 ✓ 09/30120 09/30/20 10/26/20 260.00 0.00 0.00 260.00 ✓
REFIL MOSQUITO TRAPS .
Vendor Totals Number Name Gross Discount No -Pay Net
11291 DOWELL PEST CONTROL 11030,00 0.00 0.00 1,030.00
Vendor# Vendor Name / Class Pay Code
D1710 DOWNTOWN CLEANERS ✓ W
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
080919 10/16/20 10/14/20 10/24/20 176.80 0,00 0,00 176.80
LAUNDRY
Vendor Totals Number Name Gross Discount No -Pay Net
D1710 DOWNTOWN CLEANERS 176.80 0.00 0.00 176,80
Vendor# Vendor Name Class Pay Code
E0500 EAGLE FIRE & SAFETY INC ✓ M
Invoice# / Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
✓
76029 10/15/20 10109/20 10/09/20 127.00 0.00 - 0.00 127.00 t%
SUPPLIES
Vendor Total: Number Name Gross Discount No -Pay Net
E0500 EAGLE FIRE & SAFETY INC 127.00 0.00 0.00 127,00
Vendor# Vendor Name Class Pay Code
12484 EL CAMPO REFRIGERATION
Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net
58543 r/ 10/16/20 09/11/20 10/11/20 383.75 0.00 0,00 383.75
LABOR/PARTSfTRIP CHARGE .
Vendor Totals Number Name Gross Discount No -Pay Net
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• »p... va a r
12484 EL CAMPO REFRIGERATION 383.75 0.00 0.00 383.75
Vendor# Vendor Name 1 Class
ss Pay Code
11284 EMERGENCY STAFFING SOLUTIONS
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
38444 ✓ 10116/20 10/07120 10/25/20 40,062.50 0.00 0.00 404062.50 �,✓
ER STAFFING SERVICES
Vendor Totals Number Name Gross Discount No -Pay Net
11284 EMERGENCY STAFFING SOLUTIONS 40tO62,50 0.00 0.00 403062,50
Vendor# Vendor Name Class Pay Code .
F1100 FEDERAL EXPRESS CORP. ✓ W
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
675656752 ,/C10/15/20 10/03/20 10/18/20 88.23 0.00 0.00 88.23
SHIPPING
Vendor Totals Number Name Gross Discount No -Pay Net
F1100 FEDERAL EXPRESS CORP. 88.23 0.00 0.00 88.23
Vendor# Vendor Name Class Pay Code
F1400 FISHER HEALTHCARE M
Invoice# Comment Tram Ot Inv Dt Due Dt Check O Pay Gross Discount No -Pay Net
668262WV' S 10/14/20 09/20/20 10/15120 682.43 0.00 0.00 682.43
SUPPLIES !✓
6912615 10/14/20 09/24/20 10/19/20 42.72 0.00 0.00 42.72 v/
/SUPPLIES
7290296 ✓ 10/14/20 09/25/20 10/20/20 6*374.16 0.00 0.00 61374.16
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
F1400 FISHER HEALTHCARE 71099,31 0.00 0.00 7,099.31
Vendor# Vendor Name Class Pay Code
11183 FRONTIER y�
Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net
100219 10/15/20 10/02/20 10/28/20 968.27 0.00 0.00 968.27
PHONES
Vendor Totals Number Name Gross Discount No -Pay Net
11183 FRONTIER 966.27 0.00 0.00 968.27
Vendor# Vendor Name / Class Pay Code
W1300 GRAINGER r/ M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D+Pay Gross Discount No -Pay Net
9302794699 ✓' 09/30/20 09/24/20 10/24/20 111.75 0.00 0.00 111.75
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
W1300 GRAINGER 111.75 0.00 0.00 111.75
Vendor# Vendor Name Class Pay Code
G1210 GULF COAST PAPER COMPANY M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
1739940 ✓/_ 09/30/20 09/25/20 10/25/20 739.55 0.00 0.00 739.55
/SUPPLIES
1742581 ✓ 09/30/20 09/30/20 10/30/20
-13.44
. 0.00
0.00
-13.44
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Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net /
8917 ✓ 10/09/20 09/30/20 10/30120 82,50 0.00 0,00 82.50 4%
CODING SERVICES .
Vendor Totals Number Name Gross Discount No -Pay Net
10804 HEALTHCARE CODING & CONSULTING 82.50 0.00 0.00 82,50
Vendor# Vendor Name Class Pay Code
H0031 HUB CREDIT RECEIVABLES DEPT308
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
085980 / 10/16/20 08/28/20 10/26/20 36,87 0,00 0,00 30.87
SUPPLIES
088710 / 10/16/20 08/28/20 10125/20 32.09 0.00 0.00 32.09
SUPPLIES
094756,/ 10/16/20 08/28/20 10/25/20 46.50 0,00 0,00 46.50
SUPPLIES
004746 10/16/2009/03120.10/25/20 37,98 0,00 0.00 37.98
SUPPLIES
010280 ✓ 10/16/20 09/05120 10125/20 6.34 0.00 0,00 6.34
SUPPLIES
015657 ,/� 10/16/20 09/07/20 10/25/20 11,90 0.00 0,00 11.90 L _
SUPPLIES L.q was 14>•aocua- rr
045000/ 10116/20 09108/20 10/26/20 aU,15' 26?6 0,00 0,00 26 6 Itag
SUPPLIES
067450 j 10116/20 09110/20 10/26/20 30.54 0,00 0.00 30.54
SUPPLEIS
026056 ✓ 10/16/20 09/11/2010/25120 102.90 0.00 0,00 102,90
SUPPLIES
091740 ✓ 106/2009/14/2010/25/20 10.46 0.00 0,00 10.46
SUPPLIES
036269 r✓ 10/16/20 09/15/20 10/25/20 22,42 0.00 0.00 22.42
SUPPLIES
009886 10/16/20 09/17/20 10/25/20 31.11 0.00 0,00 31.11
/SUPPLIES
038144 ✓ 10/16/20 09/22120 10/25/20 52,19 0.00 0.00 5219
/SUPPLIES
054850 r/ 10/16/20 09/22/20 10/25/20 27.73 0100 0.00 27.73
SUPPLIES
058439 10116120 09123/20 10/25/20 17.82 0100 0,00 17.82✓
SUPPLIES
046330 ✓ 10/16/20 09/24/20 10/25/20 22,10 0.00 0.00 22.10
SUPPLIES
062732 ✓ 10/16/20 09/25/20 10/25/20 36,28 0.00 0.00 36.28
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
H0031 HEB CREDIT RECEIVABLES DEPT308 551,49 0,00 0,00 551,49
Vendor# Vendor Name Class Pay Code
10298 HITACHI MEDICAL SYSTEMS
Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net /
PJIN0141692 ✓ 09/23120 09/16/20 10/25/20 81333,33 0.00 0.00 81333.33
SMA FEE
Vendor Totals Number Name Gross Discount No -Pay Net
10298 HITACHI MEDICAL SYSTEMS 81333.33 0,00 0.00 8,333.33
Vendor# Vendor Name Class Pay Code
file:/UC:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5... 10I17/2O19
12868 HOLT CAT V/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
SIE104761010 Z 10/16/20 09/25/20 10/25/20 98,944.00 0.00 0.00 98,944.00
DIESEL GENERATOR--LS'1. Nd by OmKt ravi 1J +ClwX 5
Vendor Totals Number Name Gross Discount No -Pay Net
12868 HOLT CAT 98,944.00 0,00 0,00 98,944.00
Vendor# Vendor Name Class Pay Code
12864 HOUSTON UNIFORM & APPAREL CO, V
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
S17201231301 10/15/2009126/2010/11/20 92,47 0.00 0.00 92,47
HATS FOR DIETARY
Vendor Totals Number Name Gross Discount No -Pay Net
12864 HOUSTON UNIFORM & APPAREL CO. 92,47 0.00 0.00 92,47
Vendor# Vendor Name Class Pay Code
10922 HUNTER PHARMACY SERVICES
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
3599 ,/ 10/15/20 09/30/20 10/20/20 14,115,14 0.00 0.00 14,115.14 rj
PHARM SERVICES
Vendor Totals Number Name Gross Discount No -Pay Net
10922 HUNTER PHARMACY SERVICES 14,115.14 0,00 0,00 14,115A4
Vendor# Vendor Name Class Pay Code
12196 ICU MEDICAL, INC
Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net
2244132 10/09/20 09/26/20 10/26/20 160,00 0.00 0.00 160.00
SAPPHIRE PUMP/BATTERY
Vendor Totals Number Name Gross Discount No -Pay Net
12196 ICU MEDICAL, INC 160.00 0.00 0,00 160,00
Vendor# Vendor Name Class Pay Code
11200 IRON MOUNTAIN
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
BZR881 'e /09/30/20 09/30/20 10/30/20 504.27 0.00 0.00 504.27 �/
SHERD SERVICES
BZR8813 10/09/20 09/30/20 10/30/20 604,27 0,00 0.00 504,27
SHRED SERVICE
Vendor Totals Number Name Gross Discount No -Pay Net
11200 IRON MOUNTAIN 1,008,54 0.00 0.00 1,008.54
Vendor# Vendor Name Class Pay Code
11230 JACKSON & COKER LOCUM TENENS, ✓
Invoice# Comment Tran Dt Inv Dt Due DI Check D Pay Gross Discount No -Pay Net
2034977 10/14/20 10/03/20 10/03/20 846,38 0.00 0,00 846,38 V/
/PRO FEES UONG
426242 ✓ 10/14/20 10/03/20 10/03/20 10,968.75 0.00 0.00 10,968.75
PRO FEES LONG
2035213,// 10/14/20 10/03/20 10/03/20 639,56 0.00 0,00 639,56 ✓
PRE FEES LONG
2035416 ✓ 10114/20 10/09/20 10109/20 807,52 0,00 0,00 807.52
PRO FEES LONG
426551 ✓/10/14/20 10/10/20 10/10/20 10,875.00 0.00 0,00 10,875.00
PRO FEES LONG
2035527✓ 10/14/20 10/10/20 10/10/20 98.24 0,00 0.00 98.24✓
PRO FEES -UONG
file:/!/C:/Users/mmckissack/cpsi/memmed:cpsinet.com/u88150/data_5/tmp_cw5report5... 10/ 17/2019
Vendor Totals Number Name Gross Discount No -Pay
11230 JACKSON & COKER LOCUM TENENS, 24,235.45 0.00 0.00
Vendor# Vendor Name Class Pay Code
M1950 MARTIN PRINTING CO W
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay
74581 10/07/20 09/27/20 10/27/20 324.00 0,00 0.00
APPOINTMENT CARDS w V)fLojasJ Ir kt") slr :fi�k' 9Gunet; n�tn"k� I1
Vendor Totals Number Name col) N3 1961 C4�nl9 tatY�/ Gross Discount No -Pay
M1950 MARTIN PRINTING CO 324.00 0,00 0.00
Vendor# Vendor Name Class Pay Code
M2178 MCKESSON MEDICAL SURGICAL INC ✓
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay
64564738 ,/ 10/14/20 09/22/20 10/07/20 199.82 0.00 0.00
SUPPLIES
Vendor Total: Number Name
Gross
M2178 MCKESSON MEDICAL SURGICAL INC
199.82
Vendor#
Vendor Name Class Pay Code
11141
MEDICAL DATA SYSTEMS, INC. r/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
139589 09/30/20 09/30/20 10/25/20
192,20
COLLECTIONS
139590 >✓ 09/30/20 09/30/20 10/25/20
31312,78
COLLECTIONS
138392 r/ 10/17/20 08/31/20 09/25/20
880,83
COLLECTION EXP BUS OFFIC
138393 ✓ 10/17/20 08/31/20 09/26/20
2,851.91
COLLECTION EXP BUS OFFIC
Vendor Totals Number Name
Gross
11141 MEDICAL DATA SYSTEMS, INC.
71237,72
Vendor# Vendor Name Class Pay Code
M2470
MEDLINE INDUSTRIES INC L,/ M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross
/
1888602266 ✓ 10/09/20 09/30/20 10/25/20
315.64
SUPPLIES
Vendor Totals Number Name
Gross
M2470 MEDLINE INDUSTRIES INC
315.64
Vendor#
Vendor Name Class Pay Code
11976
MID -COAST ELECTRIC SUPPLY, INC
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay
Gross
185698400 10/09/20 09/26/20 10/26/20
385.00
SUPPLIES
Vendor Totals Number Name
Gross
11976 MID -COAST ELECTRIC SUPPLY, INC
385.00
Vendor#
Vendor Name Class Pay Code
M2621
/
MMC AUXILIARY GIFT SHOP ,/ W
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay
Gross
101019 10/15/20 10110/2010110/20
194,75
PAYROLL DIED GIFT SHOP
Vendor Totals Number Name
Gross
M2621 MMC AUXILIARY GIFT SHOP
194.75
Vendor#
Vendor Name Class Pay Code
10536
MORRIS & DICKSON CO, LLC V /
Net
24,235.45
Net
324.00 �/
Net
324.00
Net
199.82
Discount No -Pay Net
0.00 0.00 199,82
Discount No -Pay Net
0.00 0,00 192.20
0.00
0.00
3,312.78
0.00
0.00
880,83
✓
0.00
0.00
2,851.91
Discount No -Pay Nel
0.00 0.00 71237,72
Discount
No -Pay
Net
0.00
0.00
315.64
�/
Discount No -Pay Net
0.00 0.00 315.64
Discount
No -Pay
Net
0.00
0.00
385.00
r,%
Discount No -Pay Net
0.00 0.00 385.00
Discount
No -Pay
Net
0.00
0.00
194.75
Discount No -Pay Net
0.00 0.00 194.75
file:///C:/Users/mmcicissacldcpsi/memmed.cpsinet.com/u881 SOldata_Shmp_cw5report5... 10/17/2019
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
4774841 10114120 10109120 10/19/20 71039.54 0.00 0.00 71039.54.✓
INVENTORY
4775956 10/14/20 10109/20 10119/20 221.08 0,00 0.00 221.08 ,✓
/INVENTORY /
4776186 r/ 10/14/20 10/09/20 10/19/20 936,23 0.00 0,00 936.23
INVENTORY
4776185 ✓ 10/14120 10/09/20 10/19/20 19.30 0.00 0.00 19.30
INVENTORY
4776184 ✓ 10114/20 10109120 10/19/20 41851,88 0.00 0.00 4,851.88 ✓-
INVENTORY
4779861 ,j 10/14120 10/10120 10120/20 407,45 0.00 0.00 407,45 „✓
INVENTORY
4785442 ✓ 10114/2010/1112010121/20 177.01 0.00 0.00 177.01 ✓
INVENTORY
4785443 10/14/20 10/11/20 10/21120 21003.74 0,00 0.00 21003.74
NVENTORY
4785444 10/14/20 10/11/20 10/21/20 240.53 0.00 0.00 240,63
INVENTORY
4769107 ✓ 10/15/20 10/08/20 10/18/20 16.90 0,00 0.00 16.90
INVENTORY
4770636 10115/20 10108120 10/18120 8.99 0.00 0.00 8.99
INVENTORY
4770637✓ 10/15/20 10/08/20 10118/20 1,233.11 0,00 0.00 1,233.11
INVENTORY
4770635 V�' 10/15/20 10/08/20 10/18/20 44,39 0.00 0.00 44,39
INVENTORY
4769106 v1. 10/15/20 10/09/20 10/19/20 94.09 0,00 0,00 94.09 v✓
/INVENTORY
4774228 ✓ 10/15/20 10/0912010/19/20 11650,00 0.00 0.00 11650,00
ACCUMULATOR FEE
Vendor Totals Number Name Gross Discount No -Pay Net
10536 MORRIS 8 DICKSON CO, LLC 18,944.24 0,00 0.00 18,944.24
Vendor# Vendor Name / Class Pay Code
01416 ORTHO CLINICAL DIAGNOSTICS t/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net
1851125210 ,/ 10/14/20 09/16/20 10/16/20 755.37 0,00 0.00 755.37�/
SUPPLIES .
Vendor Total: Number Name Gross Discount No -Pay Net
01416 ORTHO CLINICAL DIAGNOSTICS 755,37 0.00 0,00 755,37
Vendor#Vendor Name Class Pay Code
11069 PABLO GARZA
Invoice# Comment Tram Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
101519 10115120 10115120 10/16/20 1*687.50 0.00 0.00 1,687.50
CONTRACT EMPLOYEE C UIIt- tOINI1°")
Vendor Totals Number Name Gross Discount No -Pay Net
11069 PABLO GARZA 1,687.50 0.00 0.00 11687,50
Vendor# Vendor Name Class Pay Code
P1800 PITNEY BOWES INC ✓ w
Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net
1014032299 tel 10/09/20 09/26/20 10/26/20 207.00 0.00 0.00 207.00
file:///CaUsers/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cwSreport5... 10/17/2019
MACHINE RENTAL ,
Vendor Totals Number Name Gross Discount No -Pay Net
P1800 PITNEY BOWES INC 207.00 0.00 0.00 207.00
Vendor# Vendor Name - Class Pay Code
P2200 POWER HARDWARE ✓ W
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
B50901 10/16/2010/01/2010/11/20 3,49 0.00 0.00 3.49
SUPPLIES
A57078 / 10/15/20 10/01/20 10/11/20 87.65 0,00 0.00 87.65
SUPPLIES ,
B50657 10/15/20 10103/20 10/13120 12.69 0,00 0.00 12.69
SUPPLIES
Vendor Totals Number Name Gross Discount No -Pay Net
P2200 POWER HARDWARE 103,83 0.00 0.00 103.83
Vendor# Vendor Name / Class Pay Code
11932 PRESS GANEY ASSOCIATES, INC. ✓
Invoice# Comment TranDt Inv Dt Due Dt Check O Pay Gross Discount No -Pay Net
IN000403368 % 09/30/20 09/30/20 10/30120 21028,00 0.00 0.00 2,028.00
PT SURVEY
Vendor Totals Number Name Gross Discount No -Pay Net
11932 PRESS GANEY ASSOCIATES, INC. 26028,00 0,00 0.00 21028.00
Vendor# Vendor Name Class Pay Code
11251 RAPID PRINTING LLC ✓ -
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
6620 10/15/20 09/17/20 09/27/20 28.00 0,00 0.00 28,00
/ HOSPITAL CAMPUS POSTER I
6646 10/15/20 09/18/20 09/28/20 56,00 0,00 0.00 56,00
ELEVATOR SIGNS _
Vendor Totals Number Name Gross Discount No -Pay Net
11251 RAPID PRINTING LLC 84,00 0,00 0.00 84.00
Vendor# Vendor Name Class Pay Code
10987 REVCYCLE+,INC. r/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
MLVAC53273 tj 10/09120 10/03120 10/28/20 21410,15 0.00 0.00 23410.15
CODING SERVICES
Vendor Totals Number Name Gross Discount No -Pay Net
10987 REVCYCLE+, INC. 2,410.15 0.00 0.00 21410.15
Vendor# Vendor Name Class Pay Code
11164 RS CLARK & ASSOCIATES, INC
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
252118 l 10116120 07131/20 07/31120 517.15 0.00 0.00 517,15
✓ COLLECTION
Vendor Totals Number Name Gross Discount No -Pay Net
11164 IRS CLARK & ASSOCIATES, INC 517.15 0.00 0.00 517.15
Vendor# Vendor Name Class Pay Code
11252 RX WASTE SYSTEMS LLC
Invoice# Comment Tran Dt Inv Dt Due Dt Check D* Pay Gross Discount No -Pay Net
2223 ,� 09/30/20 10/01/20 10/26/20 235.00 0.00 0,00 235,00
WASTE SERVICES
Vendor Totals Number Name Gross Discount No -Pay Net
11252 RX WASTE SYSTEMS LLC 235,00 0.00 0,00 235.00
Vendor# Vendor Name Class Pay Code
file:///C:lUsers/mmckissacklcpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5... ]0/17/2019
S1800
SHERWIN WILLIAMS r/
W
Invoice# Comment Tran Dt Inv Dt
Due Dt Check DPay Gross
Discount
No -Pay
Net
03780 10/15120 10/04/20 10/19/20
59.53
0.00
0.00
59,53
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
81800 SHERWIN WILLIAMS
59.53
0,00
0,00
59.53
Vendor# Vendor Name
Class Pay Code
S1850
SHIP SHUTTLE TAXI SERVICE ✓ /
W
Invoice# Comment Tran Dt Inv Dt
Due Dt Check D, Pay
Gross
Discount
No -Pay
Net
/
848995 J 10/14/20 10/14/20 10/14/20
10,00
0.00
0,00
10.00
TRANSFER PATIENT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
S1850 SHIP SHUTTLE TAXI
SERVICE
10.00
0,00
0,00
10.00
Vendor# Vendor Name
Class Pay Code
K0536
SHIRLEY KARNEI
Invoice# Comment Tran Dt Inv Dt
Due Dt Check O Pay
Gross
Discount
No -Pay
Net
101519 10/15/20 10/15/20 10/15/20
254,87
0.00
0.00
254.87
CONTRACT EMPLOYEE
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
K0536 SHIRLEY KARNEI
254.87
0.00
0,00
254.87
Vendor#
Vendor Name
Class Pay Code
10936
SIEMENS FINANCIAL SERVICES
Invoice# Comment Tran Dt Inv Dt
Due Dt Check D Pay
Gross
Discount
No -Pay
Net
56381900038634 .% - 10109/20 09/30120
10/24/20
1,333.33
0,00
0,00
11333.33 u%
RENTALLAB
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
10936 SIEMENS FINANCIAL
SERVICES
13333.33
0,00
0,00
1,333.33
Vendor#
Vendor Name /
Class Pay Code
12848
SKILLGIGS INC. ✓
Invoice# Comment Tran Dt Inv Dt
Due Dt Check D Pay
Gross
Discount
No -Pay
Net
21615 10/07/20 09/26/20
10/26/20
21339.19
0.00
0,00
21339.19
ICU NURSE DEE ROWE ( 01
10 . I f )
L
.
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
12848 SKILLGIGS INC.
21339.19
0.00
0.00
2,339.19
Vendor#
Vendor Name
Class Pay Code
11296
SOUTH TEXAS BLOOD & TISSUE CEN �
Invoice# C mment Tran Dt Inv Dt
Due Dt Check D' Pay
Gross
Discount
No -Pay
Net
90048967 09/30/20 09/30/20
10125/20
61430,00
0,00
0.00
61430.00
BLOOD
90048890 ✓/09/30/20 09/30/20
10/25/20
-11840.00
0,00
0.00
-1,840,00
CREDIT
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
11296 SOUTH TEXAS BLOOD
& TISSUE CEN
45590,00
0.00
0.00
41590.00
Vendor#
Vendor Name
Class Pay Code
S2694
STANFORD VACUUM SERVICE ✓
M
invoice# Comment Tran Dt Inv Dt
Due Dt Check Or Pay
Gross
Discount
No -Pay
Net
900062 ,,X 10/14/20 10109120
10/09120
385.00
0,00
0.00
385.00
GREASETRAP
Vendor Totals Number Name
Gross
Discount
No -Pay
Net
S2694 STANFORD VACUUM
SERVICE
385,00
0,00
0.00
385.00
Vendor#
Vendor Name
Class Pay Code
file:/1/C:(Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_S/tmp_cw5report5... ]0/17/2019
T2539 T-SYSTEM, INC ✓ w
Invoice# Comment Tran Dt Inv Dt Due Dt Check D* Pay Gross Discount No -Pay Net
205EV52753 ✓ 09/30/20 09/30/20 10/30/20 41555.00 0.00 0.00 41555,00
TRACKING
205EV52721 09/30/20 09/30/20 10130/20 11144,00 0,00 0,00 11144,00
CLOUD HOSTING
Vendor Totals Number Name Gross Discount No -Pay Net
T2539 T-SYSTEM, INC 51699,00 0,00 0.00 5*699.00
Vendor# Vendor Name Class Pay Code
11944 TALX CORPORATION
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
1000828268 ,% 10/16120 10/08/20 10/08/20 147.47 0,00 0.00 147.47 /
EMPLOYEE VERIFICATIONS
Vendor Totals Number Name Gross Discount No -Pay Net
11944 TALX CORPORATION 147.47 0,00 0,00 147.47
Vendor# Vendor Name Class Pay Code
11140 TEXAS ADVANTAGE COMMUNITY BANK
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
100419 10/16/20 10/04/20 10/04/20 3,690.52 0.00 0.00 3,690.52
LOAN PAYMENT
Vendor Totals Number Name Gross Discount No -Pay Net
11140 TEXAS ADVANTAGE COMMUNITY BANK 3,690.52 0.00 0.00 3,690.52
Vendor# Vendor Name Class Pay Code
12704 TEXAS BURNER & BOILER SERVICES
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
3292 ✓ 09/30/20 09/24/20 10/24/20 21900,00 0,00 0.00 2,900.00
/ BOILER REPAIRS
3298 ✓ 10/15/20 09/30/20 10/30/20 857.86 0,00 0.00 857.86
REPLACES SENSORS
-
Vendor Totals Number Name Gross Discount No -Pay Net
12704 TEXAS BURNER & BOILER SERVICES 3,757.86 0,00 0,00 3,757.86
Vendor# Vendor Name Class Pay Code
11100 THE US CONSULTING GROUP
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
340375958 ✓/10/09/20 10/03/20 10128/20 242,69 0.00 0.00 242,69
TRASH SERVICE
340376961 t/ 10/09120 10103/20 10/28120 11328.95 0,00 0.00 11328.95 t/
TRASH SERVICES
Vendor Totals Number Name Gross Discount No -Pay Net
11100 THE US CONSULTING GROUP 1,571,64 0.00 0.00 1,571.64
Vendor# Vendor Name Class Pay Code
T0801 TLCSTAFFING ✓ w
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
25404 10/16120 10107/20 10/07120 888,83 0.00 0.00 888,83 tell
,/ STAFFING
Vendor Totals Number Name Gross Discount No -Pay Net
T0801 TLC STAFFING 888.83 0900 0.00 888,83
Vendor# Vendor Name Class Pay Code
U1064 UNIFIRST HOLDINGS INC r//
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
440031.24k1- 09130/20 09/30120 10126120 47,15 0.00 0,00 47.15
SIA 06 z 1.) (ILAUNDRY
file://!C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5... 10/17/2019
8400312446 ✓ 09/30/20 09/30/20 10125120 1,234.43 0,00 0.00 11234.43
fi�tt((
LAUNDRY
840031292) 09/30/20 09/30/20 10/25120 65,71 0.00 0.00 65,71
LAUNDRY
8400312765 ✓ 10/08/20 10/03/20 10/28/20 120.39 0,00 0.00 120,39
LAUNDRY
8400312757 v1 10/08/20 10/03120 10/28/20 174.03 0,00 0.00 174.03
LAUNDRY
8400312758 V1 10/08/20 10/03/20 10/28/20 175.83 0,00 0,00 175.83 ✓
LAUNDRY
8400312753 / 10/08/20 10/03/20 10/28/20 18.62 0.00 0.00 18.62
LAUNDRY
8400312791 v1 10/08/20 10/03/20 10128/20 11139.08 0,00 0,00 11139.08 ✓
LAUNDRY
8400312817t✓ 10/08/20 10103/20 10128/20 132.93 0.00 0.00 132.93✓
LAUNDRY
8400312777 10/08/20 10/03/20 10/28/20 91,39 0,00 0.00 91.39 ✓
LAUNDRY
8400312756 ✓ 10/08/20 10/03/20 10/28/20 178.45 0.00 0.00 178.45
LAUNDRY
Vendor Totals Number Name Gross Discount No -Pay Net
U1064 UNIFIRST HOLDINGS INC 3*378.01 0.00 0,00 3,378,01
Vendor# Vendor Name Class Pay Code
U1056 UNIFORM ADVANTAGE i/ W -
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
0770240 09/24/20 09/06/20 10/26/20 -9.97 0.00 0.00 -9.97 t✓
CREDIT INVOICE 10004123
101/
49250 ✓ 10116/20 10/02/20 10117/20 15.97 0,00 0,00 15.97
UNIFORMS
Vendor Totals Number Name Gross Discount No -Pay Net
U1056 UNIFORM ADVANTAGE 6,00 0.00 0.00 6.00
Vendor# Vendor Name Class Pay Code
U2000 US POSTAL SERVICE VZ
Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net
101119 10/15/20 10/11/20 10/11/20 2,200.00 0.00 0.00 2,200.00 v�
POSTAGE
Vendor Totals Number Name Gross Discount No -Pay Net
U2000 US POSTAL SERVICE 21200,00 0.00 0.00 2,200.00
Vendor# Vendor Name Class Pay Code
W1040 WATERMARK GRAPHICS INC ✓ M
Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross Discount No -Pay Net
126834 10/08120 09125/20 10/25/20 23282.90 0.00 0.00 2,282.90
EMPLOYEE SHIRTS 40J
Vendor Totals Number Name Gross Discount No -Pay Net
W1040 WATERMARK GRAPHICS INC 21282.90 0.00 0.00 2,282.90
Vendor# Vendor Name Class Pay Code
11110 WERFEN USA LLC
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net
9110720914 ✓ 10/14/20 09M1120 10/06/20 21545,44 0.00 0,00 21645.44
SUPPLIE
9110728857 / 10/14/20 10/01120 10126120 87.42 0.00 0.00 87.42 LZ
file:///C:/Usershnmckissack/cpsi/memmed.cpsinet.com/u88150idata_5/tmp_cwSreport5... 10/ 17/2019
SUPPLIES
Vendor Totals Number Name
Gross
Discount
No -Pay
11110 WERFEN USA LLC
2,632.86
0,00
0.00
Vendor# Vendor Name
Class Pay Code
10556 WOUND CARE SPECIALISTS
Invoice# Comment Tran Dt/Inv Dt
Due Dt Check D Pay
Gross
Discount
No -Pay
WC800003154 10/15120 10101120
10/30120
10,700.00
0.00
0,00
WOUND CARE
Vendor Total: Number Name
Gross
Discount
No -Pay
10556 WOUND CARE SPECIALISTS
10,700,00
0.00 _
0,00
Report Summary
Grand Totals: Gross
Discount
No -Pay
611,478.31
0.00
0,00
(Q I,UNIcc'i"i WI
611.4'ra�1
3376
26 26
26
A.PYROVNit
ON
OCT 16 2019
COUNTY ikUMTOR
CALIJOUN COUNTY. TEXAS
Nel
2,632.86
Net
10,700.00 /
Net r/
10,700.00
Net
611,478.31
€<S361(0*�
<abwa47
fi�-lS
file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u8 8150/data_S/tmp_cw5repott5... 10/ 17/2019
Cltl
0556709000527279902643900264390031
Company AccountNumber
Payment Date
NewBafanre
MlnlmumAmountDue
EnterAmcum Pafd
10/28/2019
$2, 693.90
$2 643.90
C0001 CALHOUN COUNTY MMC Citibank
RHONDA KOKENA P.O. Box 78025
202 SOUTH ANN STREET PHOENIX, AZ 85062-8025
SUITE A
PORT LAVACA TX 77979-4204
Payment coupon: Please al along perforation and return this portion with your payment. Make check
or money order payable in U.S. dollars on a U.S. bank to Citibank. Include account number on check
or money order. No cash please. Do not staple or tape your check to this coupon.
CITIBANK CORPORATE CARD
Company
Credl[Line
Ula
Credit
Credit Line
Cash Advance
Limlt
Available
Cash Line
530, 000.00
$27,356.10
$0.00
$0,00
For customer service call orwrite 1.800.248-4553
Citibank P.O. Box 6125 Sioux
Fails, SO 57117
Send payments to: Citibank P.O.
Box 78025 PHOENIX, AZ 85062-8025
COMPANY SUMMARY
Statement Date
10/0312019
Payment Date
10/28/2019
Previous
Balance
Payment
Allone on
Credits
purchases interest
and Advances Charges
New
Belanca
- $3, 257.69 -
$209.40
$2,853.30
52,643. 90
Purchases $3, 257.64
Company Totals Advances
TOTAL
$3,257.64
- $3,257.64 -
$209,40
$2,853,30
$2,643. 90
The foreign currency conversion rate used to convert your foreign transactions to U.S. dollars includes a service fee of i %assessed to
Citibank by the applicable s business,
association.
your
Is committed a the reduction of paper. Within the Commercial Cards business, you can switch to online statements now s registering
your card on CltiManager at hltpi:ehometherds.ciare saving iCG0 trees each year
rrthroug 1. Thanks to those who already access statements
online, easier.
Online
are saving & Ci trees each Mobile offer
this initiative alone.
Account management made easier. Online statements and
erless offer the access, security, and mobility. Login at
wwLv.lerts t know when
y n and click Go Prea d to under the Statement tab.
Sign-up for small or text message sleds to know when your statement is ready to view. When on the go, access your account and recent
_ activity through your mobile device at www.citimanaller.com/mobile _
CARDMEMBER SUMMARY
____..... _..-__.. previous - Purchases Interest New
Balance Pa merits Credits and Advances Cha es Balance
Purchases $2r045,92
Monthly Advances
Limil:$20,000.o0
TOTAL $2,045.92 $2,045.92
Previous - Purchases Interest New
Balance Payments Credits and Advances Cha a Balance
PUrchases $807. no
Month Advances
UmiMonth 0.00
TOTAL - $209,40 $807,30 $597,98
COMPANY BOOKKEEPING DETAIL
DAYS IN BILLING PERIOD;
Pagel
030
purchases
Gash Ativanws
Peymenl Due:
$2, 693.90
Balance Sublecl
To Interest Charges
>
$0.00
$else
Amount Over Credit Llmil:
$0.00
Penedic sale
>
.0000E
.0000£
Amount Past Due:
$0.00
ANNUAL PERCENTAGE RATE
>
0.00£
0.00%
MINIMUMAMOUNTOUE:
$ 2 , 643,
90
oft
cite®
CompanyAcmunfNumber
Monthly Limit
Monthly Limit
Cash Umll'
Avaliabie Cretlil Llne
INDIVIDUAL CARDHOLDER ACTIVITY
Cash Limit•
Statement Date
10/03/2019
Available Cash Line"
09/03/2019
09/04/2019
55432869246200540627320
INT IN EMERGENCY Nll1NA 972-2358330
T%
5153.00
PI0253191658
09/04/2019
09/05/2019
05134379248600032811304
NPDB NPDB.HRSA.GOV 800-767-6732 VA
$2.00
N64810391
09/13/2019
09/16/2019
05134379257600042485832
NPDB NPDB.HRSA.GOV 800-767-6732 VA
$28.00
N64982864
09/13/2019
09/16/2019
75306379257328400271181
TEXAS OCCUPATIONAL THE 512-4548682
TX
$395.00
09/13/2019
09/16/2019
75306379257326400271371
TEXAS OCCUPATIONAL THE 512-4548682
IS
$135,00
09/20/2019
09/23/2019
05227029263200121206539
ESUTURESCOY 708-478-3513 IL
$61.00
09/20/2019
09/23/2019
5531020926470868703US75
HOLIDAY INN EXP 6 SUIT PORT LAVACA
TX
$134,47
17376031 Arrival: 09-19-19
09/20/2019
09/23/2019
55432869263200507453221
TNT IN EMERGENCY NASA 972-2358330
TX
$61.00
P10256705020
09/25/2019
09/27/2019
55499679269036226220173
WYNDHAM AUSTIN a WOOD'A AUSTIN TX
$250.70
22622077 Arrival: 09-23-19
09/26/2019
09/27/2015
55432869269200935196801
HOTEL 8122479121031 BOOKING WA
$348.90
£69c3c2f726ba2f45
09/26/2019
09/30/2019
55432869270200094746004
SOUTHHES 5262124405846 800-435-9792 TX
$183.96
SVETLIK/JENISE DEPARTURE: 11-13-19
AUS PIN F ABU WN F AUS
05/30/2019
10/01/2019
55432869273200791767359
INT IN EMERGENCY NANA 972-2358330
TX
$126.00
P10258689227
09/30/2019
10/02/2019
55310209274708705062202
HOLIDAY INN EXP 6 SUIT PORT LAVACA
TX
$146.89
17378493 Arrival: 09-29-19
DIANE C MOOlU3
X81L4-R4P,7C-X
Monthly Umlt
Cash Limit'
$20,000.00
$0.00
Sale
Post
Dale
Date
Reference Number
Typo of Activi
Amount
09/05/2019
09/06/2019
05410199249944240006521
AT6T EXECUTIW16199200 AUSTIN TX
$478.00
12903991 Arrival: 09-03-19
09/23/2019
09/24/2019
75418239266079993982789
WEB NETWORKSOLUTIONS 888-6429675
FL
$209,40
09/27/2019
09/30/2019
75410239270080212013921
WEB NETWORKSOLUTIONS 888-6429675
EL
$119.98
09/28/2019
09/30/2019
75410239271080228547275
WEB NETWORKSOLUTIONS 888-6429675
FL
$209.40
CR
TOTAL PURCHASES/ADVANCES/CREDITS
$591,98
•Cash Advance Umit is a podion of yourTolal Monthly Llmil.
"Available Cash Lina is a podion of your Avaliabie Cretlit Llne Page 2 of 2 Continued on next page
Caifii'
0556709800364699700000000000000031
Account Number payment Date New Balance Minimum Amaunt Due EnferRmount Paid
•••• •••• 10/28/2019 $0.00 $0.00
CAALHO N ANGLIN
80UN COUNTY
202 8ANN STREETSUI
SUITE
A
PORT LAVACA TX 77979-4204
Box
o
P.O. Box, 8025
AZ8
PHOENIX AZ 8506241025
Balance
Balance
Pa en(s
and Cordite
New
chage
New
Balance
Credit line
$0,00
$0,00
$0.00
$0,00
$20rOOD,00
For customer service call
or vnite 1-800-2484SS3 Citibank P.O.
Box 6126 Sioux Falls,
SD 57117
Sena payments to: Citibank
P.O. Box 78025
PHOENIX, AZ 85082-8026
Statement Date
10/03/2019
Payment Date
30/28/2019
Aaeunt Number Cash Advance llml(• Available GredBV a pvailabfe Cash Une^
"•• •'•• at $0.00
$20,000.00 $0.00
Sale post
Data Date ReyemaceNumber Typo ofAcOviAmount
*444„•„•«».,"" '•'•'^NOTICE MEMO ITEM(S) LISTED BELOW"`••••`TM"••'•••••'•••^••••'••••••••••+•••••••
09/03/2019 09/04/2019 55432869246200540627320 INT IN EMERGENCY Ill NA 972-2358330 TX A153.00 </
PI0253191658
09/04/2019 09/05/2019 05134379248600032811304 ME NPDB MA-GOV 800-767-6732 VA 42.00
N64010391
09/13/2019 09/16/2029 05134379257600042485032 NPDB NPDD.H1RSA.GOV 800-767-6732 VA /$28.00
N64982864 /
09/13/2019 09/16/2019 75306379257328400271181 TEXAS OCCUPATIONAL THE 512-4548682 TX fy395.00
09/33/2019 09/16/2019 75306379257328400271372 TEXAS OCCUPATIONAL THE 512-4548662 TX V4135.00
09/20/2019 09/23/2029 05227029263200121206539 ESUTURESCOM 708-478-3517 IL // 61.00 t/
09/20/2019 09/23/2019 55320209264709697030575 HOLIDAY INN 8XP 6 SUIT PORT LAVACA TX �ss134.97 v
17376031 - Arrival: 09-19-19
09/20/2019 09/23/2019 55432869263200507453221 INT IN EMERGENCY MANA 972-2358330 TX A$81.00 V
PX0256705020
09/25/2019 09/27/2019 55999679269036226220773 WYNDII M AUSTIN a WOODS AUSTIN TX v$290.70
22622077 Arrival: 09-23-19
ACCOUNTSUMMARY Interest Pa ents andA�ances ChlCredts ATDTnAceLB NewBl0a
ne
$0dee .00
0$0.00 6.0$0.00 $0,00 DAYS IN BILLING PERIOD: 030 Pumbase Cann A4vanr Payment Due: $0,00
Balance Subject To Interest Charges $0.00 $0.00 ' Amount OverCmdll Umll: $0,00
Periodic Rate .DODD% .0000% Amount Past Due: $000
ANNUAL PERCENTAGE RATE .
0,00% 0.00% MINIMUM AMOUNT DUE: $0,00
•CashAdvanreUmiNs a portion ayyaurTofal Crtd/f Une
'•Available Cash Une is a portion otyeurAvaClable Cretlif Une
Pagai all
C do
Account Number
Sale Posl
Dale Dak R
NOTICE MEMO ITEMS) LISTED BELOW
09/26/2019
09/27/2D19
5593286926920D835196801
EOTEL 8122479121031
f69c3c2f72Gba2f45
09/26/2019
09/30/2019
5543286927020ODD4746004
SOOTHWES 5262124405846
SVETLIK/OSHISE
AOS WN F AEQ WN F AOS
09/30/2019
20/01/2019
55432869273200791767359
INT IN EkgitGe CY MM
P10258689227
09/30/2019
10/02/2019
553102092747087OS862202
HOLIDAY INN EXP 6 SUIT
17378493
""""«„"'""""""""""""""""^^•'.""""'•^""""TOTAL
AMOUNT OF MEMO ITEM(S):
SHfement Date
10/03/2019
HOOKING WA
✓$998.90
800-435-9792 TX
V83.96
$1
DEP WORE: 11-13-19
972-2358330 TX
�126, 00
PORT LAVACA TX
Vy346.89
Arrival: 09-29-19
Vo045,92
he foeign canonry wnversion rate usetl to convertyour foreign Irensadi4ns to U.S. dollars Indutles a service lea of i%assessed to Ciabank by the applicable bankaNessodaUon.
Chi is committed to Ne reduCom of paper. NiNin Ne Commerdat Cams business, you ran switch to online 5lalamenls now by regtala ng your Lard on CIIIManagerat
hllpslmame.Cams.dOdlreG.eom/CmerdalCard/Came.hud. Thanks to Was who aimed 9 ass statements online, togelberwe are sating 2,170 Imes each year enough this
initiative alone.
Account management made easier. Online statemerlsS CIUManager Mobile ogef2417 access, sewdly, and mobility. Log In stwumdlimarlagercomfiugin and dick Go Paperless
underthe Statement tab.
Sign-up foremall ortext message alerts to knowwhen youralalement is ready to view. When on the go, accessyour account and recent adlAty through yourmobhedevice at
www,Chimanageocom/mobhe
Cash Advance Umittsa potion olyour7atal Credtf floe
"Available Cash Une /s a potion alyaurAvallable CretlR Une
Page 2 of 2
itPPROVCD
UN
i �} 1019
Ty AUDITOR
S::iI.Ii4UN C(7Ui�i'PY, 7'I::
..J;vIL'1v,L%,JX �r� �� Lvu-sL.« x3jl �.L'1V
at Lit
PURCHASE 0120E+12
Bill. To: 815 X, VMGE%ljA ST,
PORT LAVACA, TX 77979
PHONE: (361) 552-6713
FAX: • (361) 552-03'12
VendorName:
Vendor Address:
Ship To: 815 N. V RGMA, ST.
PORTLAVACA TX77979
PHONE: (361) 552-6713
FA
X: (-3761r) 5524312
i
Vendor Phone#:. Account#
Vendor Fax.#: 7nitiatedBy.
Faun#9?01
AIR 0
it
►'yam► � /.�� � �
�■_
.esr. rreignc Eft. Tota1 Cast TOTAL COST
NOTES: � /,(/�
`
r ' `.oi IQ ? L' h Li �l vVv -4; ! e e� I:_
!�hPi',�#CVGll
Contaoh
Quoted By:
Buyer.
bate:
bivNmamg
B:T.A AdmDir. Clinical Se[viae
j�ALAOUtd
A,YiClY1V.Li1t>1-� lYJ-GLlI.�_f_I..CJ.V l.CtC. /,�
PURCHASE ®RpER
33M To: 91 N, yIIZQINTA ST. Ship To: 815 N. VIROD AST.
PORTLAVACA, TX77979 PORT LAVACA, TX77979
PHONE: (361) 552-6713 PHONE: (361) 552-6713
FAX:(361) 55552-%0�3/I2 �� may , p FAX: (3671) MUM
Vendor Name: (i4�� (GY/yVyC Date: 10 ^ 1
VeadorAddress:
Vendor Phone m Account#
VendorFa$#: WtiatedDy:
n Fomt#9401
/
� 1 � ' � � it
a�
•
; �
�
,
Co�acE
Quoted
$y:
Buyer.
}ash. lFzeight Est. Total Cost
bate:
I Bfi.A
Dept Director,_
Dir.N�ing
Adm.Dir, Maicat
TOTAL COST
Ai'P :fl Cab
C,'AT,IIOUCQ t:OUPl1'1', 1'GXA:1
.. 17vA-P1IM JX � LV,u_..vil.,Za t..,.CN1.c�.Ll
PURCR"E 0 ER
Bill To: 815 N. VTRGmu ST.
PORT LAVACA, TX 77979
PHOM: (361) 552-6713
FAX: (361) 552-0312
VendorNane: ��, �',
VendorAd&ess:
Vendor Phone#:
Vendor Fax,#:
Slop To: 815 N. V RCTM ST.
PORTLA.VACA TX77979
PHGNB: (361) 552-6713
FAX: (361) 5522--0312
Account#
InlfiatedBy:
Foo#9401
• �Ato1iCT�u Bxpause# Depazfinent DelivarTo -
vl
Tine Qiy, CatalogNmmber Description Unit Cost Unit mended
No. Meal. Cost
1
�-t a4Wn 660MS14tdo*
gel
3
4 24UU ;
�UY�t -� �IIUV�O t IA" id, ��„
�Q0• o U
— 2 8 � it o .,
,
5 39bgUU
7 81
_ 25U•iU
8 48"9u
9 12o°(1U
10 61 00 A
-- -......._�. Est. Total Cost
Contact: � Dam;
Quoted By:
Buyer. STA
TOTAL COST � a.Ot"i� •� �
COUNPY AUDT'i t)R
Dept.Director 5.,��ap,�1�nTN'PYTT`.xd5
DiaX=iug--
AdmDir. Clinical Setvioe
Ci kie
0556709800366701900000000000000038
Account Number Payment Date New Balance IE
um Amount Due EnferAmounlPaltl
• •• •••• 10/28/2019 $0.00 $0.00
DIA11E C NOORE RD, Bo
CALNOON COUNTY P,O.EIXt AZ 5
202 5 ANN STREET PNOENIX,AZ 85062-BOYS
SUITE A
PORT LAVACA TX 77979-4204
All
Pmvfous
Balance
Pa a fs
'end Credits
New
Cha es
New
8a/ante
Credit Une
$0,00
$0,00
$0,00
$0,00
$20,000.00
For customer service call orwite 1-800-2484553 Citibank P.O. Box 6125 Sioux Falls, SD 57117
Send payments to: Citibank P.O. Box 78025 PHOENIX, AZ 85062-8025
Aceount Number .Cash Advance ll iP
.... .... r Sn. nn
AvallableCredil tine
Statement Date
10/03/2019
Payment Date
10/28/2019
Ava7rabte Cash Una•'
"""""""""^"""""•"""'•""""""'"•"'^""•'•••'^NOTICE MEMO ITEM(6) LISTED BELOW„""'^""••''•'•'••""""""""""""'^'.,"""'••""'•
09/05/2019 09/06/2019 05410199249944240006521 ATGT EXECOTIVE16199200 AUSTIN TX I,W�.00
12903991 Arrival: 09-03-19
09/23/2019 09/24/2019 75418239266079993902789 WEB NETWORRSOLOTIONS 888-6429675 FL y$ 09.40 V
09/27/2019 09/30/2019 75418239270000212013921 WEB NETWORxSOLUTIONS 888-6429675 PL '� 19.98 V
09/28/2019 09/30/2019 75418239271080228547275 WEB NETWORESOLUTIONS 888-6429675 M W209.40 CR
""""""""""""^""""•""""•""""""""""""TOTAL AMOUNT OF MEMO ITEM(S): $597.98
The (orelgn arrenry conversion mle used to Wmertyour farelen I2nsac8ana to U.S. dollars Indutlas a service fee of I%aseesaetl to Citibank by Ina applleablb bankard Bssoda8on.
CBt is commilletl (o me mtluclion ofpp .Wmin the Commerdai Cards buslness,y99can sv4lch to onlineslalemenls now by fegktedngyourcard on Ci4Managerat
hllps'lmomaeras.dgdireG.�om/Comm¢tclalCamlCards.h(ml. Thanks to those Initiative alone.�alalemenis online, togemerwe am sating 2,t70lrees each yearmrcugh lnis
Account management made easier. Dunn statements &CitlManager Mobile offer24/7 aconseserndty, and mobility. Log In etwww4limanagercaMlogin and click GdPap sin
under the Statement lab.
Sign-up for email or text message alerts to know when your statement is ready to view. When on Nis go, access your account and recent activity through your mobile device at
wumcitimanagerram/moblle y 0
accouNr
DAYS IN BILLING PERIOD: 030
Pe�todm ReheedTo Interest Charges
ANNUAL PERCENTAGE RATE >
Cash Advance Limit is a potion olyoarToml credit Use
"Available CashV eteaporti�n clyowAvailable Cmdif Une
Pumnose Gas A4Vanees
.000n� � ,000a°4
000v. o.00%
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PurchasesandAdvances
Payment Due:
Amount OverCredil Llmtl:
Amaun! Pasl Due:
Jvlv.jv.LIJ.Li� L..wN
PURCHASE OR)ER
BAITO: 815 R TIRGRUA ST. Ship To: 815 N. VIRGINIA ST.
PORT LAVACA,TX77979 PORTLAVACA TX77979
PRONE: (361) 552-6713 13HONE: (361) 552-6713
FAX: (361) 552-0n31�2� hn , FAX: (361)2312
)55/_�0
Vendor Name: l�/�'�° Date:
Vendor Addrom
a
Vendor Pfione #: Account #
VendorFarl#: InhtiatedBy:
FinauW9901
•-=...x,.,,..�. nxpansegF t�epattment Ueliverl'o
T.ane Qty. Cat§logNomber Aesoiiption Unit Cast Unit rmteaded
No.
Meal,
(-rycoCsstt
2
201 ���z.L.
u�oiLl1�
4
SSL f �n'Fi�Vvic-
"p�Vq.i
5
L
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6
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' I (• 10
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,U
9 209 iau -
- 119^98
10
597,5 98
Est. F=eight
Coataot:
Quoted.
$y:
Bnyer.
Est. Total Cost TOTAL COST
A:PPIiOVGL
c
Date:
Dept. Director t1j�'� � `)i11G
Dir.Nmsiog
COUN'rY AD19'OR
AdmDic. C&doaI8cMoe CAT.ii0i7Y CO UM Y. TRXAf3
1�
R�ei$;ie7Ak3� E;93AkXE�`� ,tAJXt 2h`„S_!3'
1023 '
Vendor# Vendor Name
11816 ASHFORDGARDENS
MEMORIAL MEDICAL CENTER
AP Open invoice List
Due Dates Through: 10/3112019
Class Pay Code
0
ap_open_invoice.template
Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay
100919 10/17/20 10/09120 10/31/20 372.06 0.00 0,00
TRANSFER NtAW11ta) VWVIA- jy4jtAV0.41AU p�jv�4 GytR'i eW MWIr 1K tvvw
101519 10/17/20 10/15/20 10/31/20 1 4,603,50 0.00 1 0,00
TRANSFER Wkklf4y1�1 1t1'„L i Yl�itlVAVU'd- y�L'1 t*i �t1 1kVG In CVvw
Vendor Total: Number Name JJ Gross Discount No -Pay
11816 ASHFORD GARDENS 4,975.56 0.00 0.00
Grand Totals:
AUPRO'VEIS
ON
COUNTY hUfl7TTOii
CAT.FiOUN COUNTY, TEYA.F
Net /
372.06 ✓
4,603.50
Net
4,975.56
Report Summary
Gross
Discount
No -Pay
Net
4,975.56
0,00
0,00
4,975.56
file:/!/C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u881501data_Sftmp_cw5report2... ]0/17(2019
OCT 17 2019
10/17/2019
€:nffiW,2* 4'1jotj r Ajt d.L4t1*
MEMORIAL MEDICAL CENTER
AP Open Invoice List
Due Dates Through: 10/3112019
0
a pope n_invoice.template
Vendor# Vendor Name Class Pay Code
11828 SOLERA WEST HOUSTON
Invoice# Comment Tran Dt Inv Dt Due Dt Check U Pay Gross Discount No -Pay Net
100919 10/17/20 10/09/20 10/31/20 852.50 0.00 0.00 852.50
TRANSFER VVYI71V1j hOVKL 1VlSU,VKKjL y-A71 4 e/tt4 eh Vwoj� � IVt twvv .
Vendor Totak Number Name uD Gross Discount No -Pay Net
11828 SOLERA WEST HOUSTON 852.50 0.00 0.00 852.50
Report Summary
Grand Totals: Gross Discount No -Pay Net
852.50 0.00 0.00 852.50
fPPHO�Tt
ON
COUP7TY AVDrrO$
CM IOUN COCIN'CY,TL'itf'-5
file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u8815O/data_5/tmp_cw5report9... 1O/17/2O19
OCT 17 2019
1 affim,&MUd' editor
10:22
Vendor# Ventlor Name
11824 THE CRESCENT
MEMORIAL MEDICAL CENTER
AP Open Invoice List
Due Dates Through: 10/31/2019
Class Pay Code
0
ap_open_invoice.template
Invoice# Comment Tran Dt Inv Dt Oue Dt Check D Pay Gross Discount No -Pay
101519 10/17/20 10116/20 10/31120 4,986.76 0.00 0.00
TRANSFER YU61M hOKL IhSUvd Ol PVVkd CAM U 11LiYJ( IneTW
101519A 10/17/2010/15/2010131/20 1,705.00 0.00 0.00
TRANSFER M&4in5 Nia IhSU3 "t u ' e 60J j, tttiwI4, 'IV( uvvv-
VendorTotals Number Name Gross Discount No -Pay
11824 THE CRESCENT 6,691.76 0.00 0.00
Grand Totals: Gross
6,691.76
APPROVED?
ON
OCT 18 2019
COUM*y AUDIgI Olt
CALHOUN COUNTY,,I f,, 4S
Net
4,966.76
1,705.00 r,/
Net
6,691.76
ReportSummary
Discount No -Pay Net
0.00 0.00 6,691.76
file://!C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5... 10(17/2019
.. u
D/fi o19 1
251t C;43i[Is i A1,440
Vendor# Vendor Name
12696 GULF POINTE PLAZA
MEMORIAL MEDICAL CENTER
AP Open Invoice List
Due Dates Through: 10131/2019
Class Pay Code
0
ap_open_invoice.template
t
.Invoice# Comment Tran Dt Inv 41 Due Dl Check DPay Gross Discount No -Pay
100919A 10/17/20 10109/20 10/31/20 23,757.42 0.00 0.00
TRANSFER NUV/7iVt� 110" IV4SUKUVJ- P�At �tj" ib 1KM(U it Cww-
090919C 10117/20 10109/20 10/31/20 67,351.79 0,00 0,00
TRANSFER �I.tVt WLb yw%NQ-- IVrStWNx1.L PU h&Lit 66pj 4V KtL i K CWUi
100919E 10/17/20 10/09/20 10131/20 9,732.00 0.00 0.00
TRANSFER Vue(" VUWL ivux& KUt iYV q- ,H Kwj+ WKI th Q
100919 10/17/20 10/09/20 10/31/20 51600.00 0,00 0.00
TRANSFER NNW 21M hatu.l JMLk h t-Lt, Staff 4t hWW( ih (,W+1.f�
101519 10/17/20 10/15/20 10131/20 17,139,67 0,00 0,00
TRANSFER A/M)yj hp� WwC- .P jKL4(liA-+ AtV - -j'0 NAW'NAL IVl CW
Vendor Total: Number Name 17 Gross Discount No -Pay
12696 GULF POINTE PLAZA 1230580.88 0.00 0.00
ry
Report Summa
Grand Totals: Gross Discount
123,580,88 0.00
�.P.P27.0'VP.B
OIa
I:i.'l�A�ll:J
COtJPdTyq�ITO$t
CALIIOUN COUNTY, TF
Net
23,757,42
61,351.79
9,732
17,139.67
Net
123,580.88
No -Pay Nel
0.00 123,580.88
file://1C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u8 8150(data_Shmp_cw5report8... 10/ 17(2019
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NIL
CT 17 2019
-, 10/77/20�9
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10:27
MEMORIAL MEDICAL CENTER
AP Open Invoice List
Due Dates Through: 10/31/2019
0
ap_open_invoice.template
Vendor# Vendor Name / Class Pay Code
11836 GOLDENCREEK HEALTHCARE
Invoice# Comment Tran Dt Inv Dt Due Dt Check O Pay Gross Discount No -Pay Net
100919A `'10/17/20 10/09/20 10/31/20 4,1,�5�4.25 0.00 0.00 41154,25
TRANSFER U iqS WOUL )KI Kt1l1 LL p jhtf 'io WG I;tl MOV
100919 10/17/20 10/09/20 10131/20 4,956.19 0.00 0,00 41956.19 t/
TRANSFER t(04jjh[0 hOW& IhCNYkKa p)Kij�2(Aj IIh ]IML, 1K CWVN
101519 10/17/20 10/15120 10/31/20 331317,91 0.00 0,00 33,317,91
TRANSFER NUY1'khy {'10YN2 Ih IR- AeUMvlJ 4AA�f_ At KIN, 1Vl tK*'
Vendor Total: Number Name Gross Discount No -Pay Net
11836 GOLDENCREEK HEALTHCARE 42,428.35 0.00 0,00 42,428.35
Report Summary
Grand Totals: Gross Discount No -Pay Net
42,428.35 0.00 0,00 42,428.35
APPROI
Ora
OCT 18 2019
oOrYNTYnanrs1011
CALFIOUN COUNTY, Tr.S
file:///C:/UsersJmmckissack/cpsi/memmed.cpsinetcom/u88150/data_5/tmp_cwSreport8... ]0/17/2019
ERE CEII/TD
Page 1 of 1
OCT 17 2019
Gn€€wun County AntAtor
10/17/2019 MEMORIAL MEDICAL CENTER 0
12:44 AP Open Invoice List ap_open_invoice.template
Due Dates Through: 10/08/2019
Vendor# Vendor Name / Class Pay Code
10246 ACCENT 1/
Invoice# Comment Tran Dt Inv Dt Due Dt Check D'Pay Gross Discount No -Pay Net
100819 10/17120 10108120 10/08120 100.89 0.00 OAO 100.89
REFUND -PATIENT
Vendor Total; Number Name Gross Discount No -Pay Net
10246 ACCENT 100.89 0.00 0.00 100.89
ReportSummary
Grand Totals: Gross Discount No -Pay Net
100.89 0.00 0.00 100.89
ai3'PROV1;di
ON
OCT 18 2019
COUNTY AUDITOR
CAL11OUN COUNTY, TEXAS
file:///C:/UseYs/mmckissack/cpsi/memmed.cpsinet.com/u88 t 50/data_5/tmp_cw5repolt8... 10/17/2019
REFERENCE NO.
DATE
GROSSAMOUNT
DISCOUNT%
DISCOUNTAMOUNT
00819
10/08/19
100.89
100089
Joi(oil C.—
cl�c�L wry pWaL
CHECK NO, 182826
TOTALS
100.89
TOTALS
100.89
1 A 11• /10
MEMORIAL MEDICAL CENTER •PORT LAvgcA, TEXAs 77s7s
182826
REFERENCE
NO,
DATE
GROSS AMOUNT
DISCOUNT%
DISCOUNTAMOUNT
00819
10/08/19
100.89
100.89
CHECK NO. 182826
TOTALS
100.89
TOTALS
100089
MEMORIAL PROSPERIN RANI( 18 2 8 2 6
68-2265
MEDICAL , 9M1 CENTER 1131
Operating
815 N. Virginia St.
Porgy Lavaca, TX 77979
One Hundred Dollars and Eighty -Nine Cents
PAY
TO THE ACCENT
ORDER PO BOX"952366
OF ST LOUIS,,. NO 63195
10246 182826
DATE AMOUNT
10/17/19 $100009
CALHOUN COUNTY AUDITOR
=100815 10/08/19 100.89 I I I 100.89
ftcK
nc�
CHECK NO, 182780 TOTALS
100.89 100.89
MEMORIAL 88-2265 182780
MEDICAL `4 CENTER 1131
Operating
815 N. Urglnia St. .
Port Lavaca, TX'77979 t:;;• _ 12852 182780
DATE AMOUNT
One Hundred Dollars and Eighty -Nine Cents 10/16/19 $100.89
PAY
TOTHE
ORDER —
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AmensourceBergen°
STATEMENT
AMERISOURCEBERGEN DRUG CORP
• 12727 WEST AIRPORT BLVD
SUGAR LAND TX 77478-6101
866A51.9655
AMERISOURCEBERGEN DRUG CORP
PO Box 905223
CHARLOTTE NC 28290-5223
Number: 58486633 Date: 10-18-2019 1 of 1
WALGREENS #12494 340B
MEMORIAL MEDICAL CENTER
1302 N VIRGINIA ST
PORT LAVACA
TX 77979-2509
ACCOUNT: 1001352841037028186
Not Yet Due:
0.00
Current:
1,064.78
Past Due:
0.00
Total Due:
1,064.78
Account Balance:
1,064.78
I Activity Due Reference Purchase Order Activity Amount
Date Date Number Number Type
10-14-2019 10-25-2019 3028685284 151435 Invoice 694o5 ✓
10-74-2019 10.25.2019 3028685285 15147: Invoice e' 13 r/
10.144019 10-254019 3028745423 1515Tr Invoice t39t r/
10-15-2019 10-25-2019 3028791381 15152' Invoice : 31 r/
10.16.2019 10-25-2019 3028841719 1515" Invoice ia.95
10.17-2019 10.25-2019 3028898202 151554 Invoice 352 33
j. 10-18.2019 10-25-2019 3028958185 1515M Invoice 210 ✓
Thank You for Your Payment I Reminders
Date Payment Number Amount! Due Date Amount
1,04 8.2019 (1.784.97> 10-25Q019 78
Total Due: / fiQb4 788
Terms: 1\
irinnrhv - Pdriov rhim in 7 rinvc
C� �000�0
594°07
-I' APPROVED
0°31 ON
i 6° 5 OCT 2 1 2010
35z°33 +
0 ° 10 T COUNTY AUDITOR
1 0 64 a'? t z. CALUOUN COUM To TEXAS
Memorial Medical Center
Nursing Home UPL
JP
Weekly Cantex Transfer
Prosperity Accounts
10/21/2019
Prevloua
Taeaya
ACCWnt
6etlnNnl AM
Restraint Amounem6e]nnsfened
Nunn Nome Number
"lance 2a sfera3ut nndenlo Penai De mib
Balance to Nm uren Noe
WINROM
20450.10 20,468,10 164,164.03
164,264.03 146,934,11
Sank Bolanm
164,264.03✓
Variance
-
Leave In Balance
100.00
Or to MMC for 43 Interest
Routing Information for Ashland Ocnde
MMC pardon OIPP1
Ashfardfleaffh Can Center UdCo
MMC portion OIPP 2,3,1apse
17,229.90 s/
Mgmen Chase Bank
A0.
Anon...
41.674,76 a/ 41,5]4.]6 �25,916.25 /
53,478.96 ✓ 51,378.96 f1,896.63
15,]99.33 >/15,699.33y 29,360A5
Adjus[ Odante]rnns/erAmt
Bank Balance
Varlen<e
leave In Salaam
Qt0 MMCfof 123Interest
MMC pardon OIPP2,3,tapse
Adjurt 031anceRnnsrerAmt
Dank Bolan«
Va lance
Leave In Salaam
Q t0 MMC far(13 Interest
MMCPOmian Olppl
MMC Portlon OI PP 2,3,tapse
Adj ust BalanceRnnsf<r A mt
Bank B3ience
Variance
leave in Balance
Qto MMC forCHIP Partiori don gIPP 1
MMC portionQIPP 2,3,1apse
146,934.13 a/
226,038.25 /
236,018.25 to..00.00
2,628.05
323,290.20 !/
223,290.20
61,99fi.63
61,996.63
✓
IOo.00
1,930.71
/
y/
29,468.45
29,468.45
W.00
5,50].29
23,861.16
/ ENNNNIMMMM � / Adlust Balan<e/Tnnslerhmt 23,861.16 a/'
101JR21.23 ✓ 98,31839 ✓ 50.026.19 ✓ 60,69563 53p53.36
Bank Balance 60,895 63
Variance •
Leav<In Balance 100.00
Q to MMC for 0Interest
eMMCnotrndun
tuw enn6rmeden
Human Recoup bkenftam MMC 2,]69.44a1 an
3otrmor erN Bmodmaer. MMnmPF2 OIPPl
tbnefa an close
sere centen2nttc MMCpoNon gIPP 2,3,lapx 4,9T2.83
JP Morgan flmredank
A0
Attvun,r /
Adjust Balance/Tnnuer Arm 53,05336 j/
TOTALTRANSPERS 507314r
146>434. 13 I`i
Note, anNSciences clover $s=wnhr transferred to the at 22 3 e 2 9 0 4 2 0 - Approved: \ U'
more 2, Even okmunmal a bore balance df$1w that M&Icdn _ Brand C, Moore, CFO 10/21/2019
59 9 97 5 09 2 APPROVED
23c861D16 + ON
53a053^36 OCT 21 2019
5 0 'l d 1 1 4 4 V1
1ANN weekMTnnalen\t2e UPLTransfer 5ummarylungkOceanat w-21.l9ab. COUNTY. AUDITOR
CALHOU'N COUNP7`a TEX0
1:\NH Weekly Transfers\Bank Dowload WOrksheeU\10t9\Octoher\NH Ban
i
�MMCPORTEON
Paget
Qivp/Camp
WINNESUMMENESEEM
Trans9er
Tnns9er-1
OIPP/UWI 29,Lap58
QPPTI
NHPORTION
10/35/2019 Deposit
-
11,728.00
- 11,720.00
I0/IS/20I9 MANAGMN014U1718 MNS PMNT[O000000W]o093410245647
-
U2.85
122,85
10/15/2019 Amerlinoup TXSCHCCLAIMPMT311033 62881I100o TRN'I.3110376288417526
-
2S,966.74
- 25,966.74
10/15/2019 UNTTEOHEALTHCARE H03UMMPNIT7460034111244" TRN•1.1TR44052634.14
-
14mi
- 1,640A0
l0//5/2019 UHCCOMMUNIWPLHC MPMt746003411910WOTRN'I.20191011137WI
-
30SS9.97
30,359.97
10/15/2019 HEAL" HUMAN SVC HCCIAIMPMT I>46003d1130033TRN•1.0505580)133643
-
190SO7.43
- 19,507A3
10/15/2019 OGNANCC IMPMT33M43618991000013925538TRN•1'19101M9 3324'1
/ 37.31
- 37.31
10/16/2019 Deck WI
141.39-
10/36/2019 CMWIre Domestic WIREDUTASHTORDHLLLTH cagreaNTER LTD
20,326.72✓
'
10/16/2019 ACHOeposit MOUNAHEALTHCARIAOUNAACHW83767942000012
-
34,459,79
34,459,79
17,239190 17,229.90
10/16/20151 ACHOeposllAmerUroup TXSCHCCIAIMPMT 311006765 I11000
-
1,07.78
- - 11697,79
10/16/3019 ACHDeposit UHCCOMMUNtWPLHCCUINIPMT]4600341191000D
-
18,799.80
18,799.80
10/17/2019 AM Depoll UHCCOMMUNOY PLHCCIAIMPMT746003411910000
21,935.65
- 11,835.65
10/17/2019 ACHOapositUHCCommunlHPINCCIAIMPMT2460034119L0000
-
735.00
- 715.00
10/1712019 ACH Depatit UHCCOMMUNUY PL HCCUIMPMT 74600341119100(1
3,544.96
3,644.96
10/18/2019 ACHDeposit UHCWMMUNNYPLHCCIAIMPMT746W)411910000
-
275.52
275.52
10/18/2019 ACH Deposit UHC Community PI HCCIAIMPMT)46003411910000
-
I,430.00
1430.00
10/18/2019 ACH Deposit HEALTH HUMAN SVCHCCIAIMPMT 17460034113005 2
1.043.23
2,043.23
MASUD
1"164.03
✓ 34Ai9,79
I7,229,90 146,934.14
MMCPORTION
DIpP/Comp
IMIRNMENINIMEMEM
Transfer4lut
Tra aler-In
OIPP/mil 2,3,1UPs6
Dip"
NN PORTION
10/15/2019 Deposit
-
3S,423.00
- 15,423.00
10/15/2019 ULNA HCMUMPMT 1669EID43391000013925539 TRN'1'1910IO090043325.1
91300.00
- 91300.00
10/16/2019 Check Y37
142.24
a/
-
10/16/2019CMWire Domestic WIRE OUT CANTER HEALTH CARE CENTERS lit
414432.52-
10/I6/2019 AM Deposit MOLINA HEALTHCAR MOIHAACH M378H 42001
-
5,256.10
5yr6,10
2,6E&OS 20628.05
10/16/2019 ACH Centralia UHC COMMUNITY Pt. HCCUIMPMT 746003411910000
-
20,417.91
- 20,417.91
10/16/2019 ACH Deposit UHC Community HCCWMPMT 746003411910000
-
3083I.50
1 3,831SO
10/17/2019 ACHOeposit UHCCOMMUNUYPLHCCIAIMPMT)46003411910W0
-
3,])&12
- 3*778.12
1011712019 ACH DepositNOMA$ SOLUTION HCCUIMPMT 676157420000105
-
51.58
- 51.58
10/1812019 ACHOeposlt MANAGfANDNU1)18MNSPMNT000110000000429341
10*531.95
- 100531.95
10/1812019 ACHDeposit UHCCOMMUNITYPLHCCIAIMPMT746 MIL910000
-
270A8
- 370.88
10/1812019 AM Deposit NOVOM SOLUTION HCCIAIMPMT 676357420000123
-
156,340.29
156,340.29
10/18/2019 AM Deposit HUMANA INS 00 EEPAYMENT 3908618300005067466
716.92
716.9E
41574.76
225,9t625
SX6110
1,623OS M02WI20
MAMMON
glPv/Eamp
rraMer-Out
Transfer -In
O1PP/Camp1 23•I+Pae
DIPPIR
NHPORTION
10/15/2019 Deposit
-
10,358.97
10,350.97
l0/15/2019 MANAGEANONET3]III MNS PMNT000000000003268410245814
-
6,928.96
6,928.96
10/15/2019 UnitedHeshlicare HCCIAIMPMT 746W3411124384TRN•1'14755617OV141138
I
34D.00
- 340.00
10/15/200 UHCCOMMUNIP)PLHCCUIMPMT746003411910000TRN'1.20191011164W2
-
12,644.15
324644.15
20/16/2019 Check Y67
161.78
-
-
10/16/2019 CM Wire DomwUe WIREOUTCANTEXNEAITH CARECINTERSHI
S14237,18
✓ -
- -
10/16/2019 ACH Deposit MOLINA HUITHCAR MOUNA4CH MOVE" 42000012.
3,84IAI
3,B41A1
1,920,71 1,920.71
10/16/2019 ACH Deposit HUMANA INS CO EEPAYMENT 3908648300005385617
3,586.25
- 3$86.25
10/16/2019 AN Deposit HUMANA INS CO EEPAYMENT 3908"MOK1055381880
-
13,833.45
13,833,45
10/16/2019 ACH DepositHUMAIU INS CO EEPAYMENT 3903"11300005389140
30189.75
- 3,189.75
10/16/2019 ACHDepasitUHCCOMMUNITYMHCC MPMT746 M1191LV00
-
2,341,78
- 2,341.78
10/17/2019 AO Dep UtUMWHeaithcare HCCUIMPMT)46W34111243M
2,818.50
- 20818.50
20/17/2019 AM Deposit UHC COMMUNITY Pl. HCCUIMPMT 746003411910000
1,414.91
1,414.91
10113/2019 ACHMe litUHCCammuniHPi HCCUIMPMT746003411910000
M
. 598.50
/
598.50
51,3)8.96
61,896.63
3,341Ai
1,920,7E 59,975.93
MMCIPORTION
Wv /a4smp
Trnsfer-Out
anJ�
DIPP/Compl 2.3,lapse
OIPPTI
NHPORTION
10/15/2019 MANAGUNONU1718MNSPMM0000000000042"410245823
-
21,60
21.60
20/16/2019 Check 1164
S5.54
10/16/2019 CM Wire Domestic MIRE OUT CANTER HEALTH CARE CENTERS 111
15,643.79
wx -
- -
10/16/2019 AMDeMilt MOUNAHEALTHCARMOUNMCH00837)3542000012
-
IL01437
1101137
5,S07.29 5,507,29-
10/16/2019 MHDeposit VHCCOMMUNITYPLHCCWMPAR74WU11910400
4.800.32
- 4.80132
10/17/2019 ACH Deposit MILE Supplements HCCUIMPMT 746003411]24384
-
1,742.03
1*74103
10/17/2019 ACH Detroit UHC COMMUNTTT Pl. HCCUIMPMT 746013411910003
11,769.93
I1,739.93
]5.69933
29.36645
11,014.5)
SS0).29 23,861.1]
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10/16/2019 CM Wire Dome3114 ORE OUT CANTER HEALTH CARE CENTERS NI
10/16/2019 ACH Deposit MOUNA HMTHCAR MOUNAACH OOB3)84442000012
10/16/2019 ACHOepositAmerlirouPU5CHCC MPMT31104)5614111M
10/16/2019 ACHOepoI[IUHCCOMMUNOy PLHMC IMPMT246WHIl91OW0
1011712019 ACH Oeposlt UnhadHeallM1bare HCCLAIMPMT 246003411124384
10/17/2019 ACHDeposit AARPSopplementa HC IMPMT246W3411124384
10/1)/2019 ACH Deposit URIC COMMUNITY Pl.HCCIAIMPAIT 2460034119100p l
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Page 3
MMCPORTON
g3pP/C9mp
Infer -Out
Transfer -In
QIPP/Compi
9,3,lapse
QIPPTI
NHPORTION
87.75
8T.)5
E -
SOAO
-
SOAO
1 -
,17g55A6
17,4$SAS
296,65
98,052.13
-
-
L945.66
9,945.66
4,972.83
4,972.83
-
88.01
-
89.01
4,725.ss
-
4,725.25
-
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-
6,560A0
4,W3.W
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4,972 83
53,U53 36
MAIN
539,373.55
6L517.53
31,19L7T
507114 )9
` 1012112019
Treasury Cenler
Quick View
DaIP re.00ne-d as of Ocl 21. 2019
Account Number Curront Balance Available Balance Collected Balance Prlor Day Balance
MEMORIAL MEDICAL
CENTER -OPERATING
a MEMORIAL MEDICAL
CENTER - CLINIC SERIES
2014
a WMEMORIAL MEDICAL
CENTER - PRIVATE
WAIVER CLEARING
'4381
MEMORIAL MEDICAL $164,264.03 $172,285.53 S164,26,1.03 S160,51528
CENTER I NH ASHFORD
'4403
MEMORIAL MEDICAL $226,018.25 $229,187.95 S226,018 25 $58,158.21
CENTERINH
BROADMOOR
'4411
MEMORIAL MEDICAL $61,996.63 $70,804.46 $61,99663 $610398.13
CENTER/NH CRESCENT
*4438
MEMORIAL MEDICAL $60,895.63 $634765.63 $60,895-63 $54,995.07
CENTER I SOLERA AT
WEST HOUSTON
'4446
MEMORIAL MEDICAL $29,468.45 $36,398.12 $29,46845 $29,468.45
CENTER I NH FORT BEND
"WRIAL MEDICAL I
NH GOLDEN CREEK
HEALTHCARE
"WO INDIGENT
HEALTHCARE
"R.NH GULF POINTE
PLAZA - PRIVATE PAY
—tv1MC -NH GULF POINTE
PLAZA -
MEDICAREIMEDICAID
indicates re.
�'y`3 cenaraletl On 10/2112U19 a11P
Copynghl 2019 Prosperity Bank,
6
hitps:l/prosperity.olbanking.com/onlineMessenger 111
Memorial Medical Center
Nursing Home UPL
Weekly Nexlon Transfer
Prosperity Accounts
10/21/2019
Previous
Amount to Be
Account Beginning
Pending
Transferredto
Nunln Home Number Balance Transfer-04t /Inenln
/De osks
Toda sBe tnnln Balance
Nursin Home
10,408.62 30,308.62 62,093.12
- -
62,193.12
�62,093.12 /
V
Bank Balance
62,293.12
Variance
Leave In Balance
100.00
Ck to MMC for Q3Interest
QIPPYrl Adjustment
-
Rovrina Inlormotfon For Golden Creek:
Neaten
Health at Golden Creek
Wells Fargo Bonk, N.A.
Be
Accounrw.
Note:Only balances afaver$9,000 will be nonsJened to [he nursing home.
Nate 1: Eoch occount has o base balance af$loB [hot MMC deposited to open account.
1:\NH WeeFIYTrarul<ri\NH UPl Tnmler Summary\3019\(MoberWH DPt Tram(ersummary 1tr11�19.aba
Outsbnding [k to MMC /ar gIPP
AdJust Bolan<e/Trani/erAmt ^61,093.11 ✓:
Approved:
Diane C, Moore. CFO 30(23/2019
�?lri'Y40WLT33
OPT
CO(7NTY AUDTTOR
CALHOUN COUNTY, TEXA,4
MMCPORTION
'
QIPPYRI
NH
Transfer-0ul
Transfer -In
QIPP/Comps AD3 PertodI QIPP/Comp3 QIPP/lapis
QIPPTII
PORTION
3 /15/2019
Deposit
59,907.31
- 591903.31
10/15/2019
TSYS/TRANSHRSE0KC0 SRMT 54369455593691295436"555636917 GC
242.20
10/16/2019
CAe4ke45
24.65
- 242.20
10/16/2019
CM YNa Domestic YARE OOTN6NION HEALTH ATGOLOEN CREEK
10.233.97
✓
,
1011612019
ACN Deposit NOYITAS SOLONOY HCOJ%MPMT 676097 4200UD123
i3943,61 /
- -
394361
1DA08.61✓
62p93.12 ./
6209332
10/2112019
Treasury Center
Quick View
Account Number
�4EhTORIAL MEDICAL
CENTER - OPERATING
"WRIAL MEDICAL
CENTER - CLINIC SERIES
2014
"I"RIAL MEDICAL
CENTER - PRIVATE
WAIVER CLEARING
an
MEMORIAL MEDICAL
CENTER/NH ASHFORD
NWORIAL MEDICAL
CENTERINH
BROADMOOR
t IE ORIAL MEDICAL
CENTER! NH CRESCENT
OPORIAL MEDICAL
CENTER /SOLERA AT
WEST HOUSTON
MEMORIAL MEDICAL.
CENTER/NH FORT BEND
•4454
MEMORIAL MEDICAL /
NH GOLDEN CREEK
HEALTHCARE
"90 INDIGENT
HEALTHCARE
MMC -NH GULF POINTE
PLAZA -PRIVATE PAY
d-NH GULF POINTE
PLAZA-
MEDICARE/MEDICAID
CoFYnghl 2019 Prosperity Bank.
hops://prosperify.olbanking.com/onlineMessenger
Current Balance
Avallabla Balance
Collected Balance
as of Oct 21, 2019 10:
Prior Day Balance
$62,193.12 $74,590.77 562,19312 $60,249.51
indicates re.
'ago generated on t0!21;2015 al t0:
ill
Memorial Mediml Center
Nursing Home UPI.
Weekly HMG Transfer
ProsperitVAccounts
30/21/2019
mm�Nrtedta
mJ "00PON 4t[He+td
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teal u1
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-
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-
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-
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Menec Moore,6o 10(21/)019
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30/16/2019 Uecka4
3011912019 AQI Deposit HEALTH HUMAMS HD NIPMT 174600341130132
MMCPORNON
NH
p TransTer-Ou[ jra0sfer-lIn QIPP/Compl QIPP/Comps QIPP/Comp3 QIPP/lapse OPP TI PORTION
148,918A8 149,918.08
12.54 .
4,190.59 44190.59
12.54 153,108.67 1530108.6T
f2.65 153,30B.6] ss3.108.6)
10/21/2019
Treasury Center
Quick View
Data reported as of Oct 21, 2019
Account Number Current Balance Available Balance Collected Balance Prlor Day Balance
lop
OMEDIC
RIAL MEDICAL -
_—
CENTER - OPERATING
am
MEMORIAL MEDICAL
CENTER - CLINIC SERIES
2014
�ORIAL MEDICAL
CENTER - PRIVATE
WAIVER CLEARING
MEMORIAL MEDICAL
CENTER/NH ASHFORD -
MEMORIAL MEDICAL
CENTER! NH
BROADMOOR
MEMORIAL MEDICAL mw
CENTER/NH CRESCENT
MEMORIAL MEDICAL
CENTER SOLERA AT
WEST HOUSTON
NO
MEMORIAL MEDICAL It
CENTER/NH FORT BEND
�MEPdORIAL MEDICAL /
NH GOLDEN CREEK
HEALTHCARE
CAL CO INDIGENT
HEALTHCARE
'S433
PAMC •NH GULF POINTE
PLAZA • PRIVATE PAY
'S441
MMC-NH GULF POINTE
PLAZA-
MEDICARElMEDICAID
CoUYr�9ht 2019 Prosperity Bank.
hltps:/lprosperity.olbanking.comlonlineMessenger
$100.73
$756,574.64
5100.13
5156,514.64
$700.73
5156,514.64
5700.13
5752,324.05
indicates rer
-'a9a generated on t0i21/2019 al t0'
i/1
MEMORIAL MEDICAL CENTER
CHECK REQUEST
P Memorial Medical Center Operating
Date RP({IIF.SiFd:
A
.AS'PROVT;D
�azv�s
FOR 4CCT. USE ONLY
�In iprest Cash
�A,P Check
�AAail Check to Vendor
�ReLllrn Check to Dept
y ON
E -- OCT 2 1 2019
E COUNPYAUDTTOR
-£ALHOUN COUNTYTPXAS
AMOUNT S17,229.90 G/L NUMBER: 27000012
=XPLANATII?i�!Ashford- To transfer funds for Comp 2,3,Lapse - OIPP payment.
tl uUl'S(I 68 Sarah L. Henderson_____ AUTHORIZED LY
IMEN40RIAL MEDICAL CENTER
CHECK REQUEST
P Memorial Medical Center Operating
Data Requested:
AMOUNT 52,628.05
.(�I'RO'VEi9
ON
aCT 2 1 2019
COUNTY AUDITOR
HOUN COUNTY, TrXAS
10/21/19
FOR. �C�T. USE (iNLY
�In,p%est Cash
1, Check
ail Check to Vendor
oiurn Check Lo Dept
Gil DIUMBER: 21000009
�XPLAMATIQiV: Broadmoor- To transfer funds for Comp 2,3,Lapse - OIPP payment.
�14;JIi;i
L; g!:
Sarah L.
Henderson
HI iHC)Rlitl t: ',
i Ft
MEMORIAL MEDICAL CENTER
CHECK REQUEST
Memorial Medical Center Operating Date Requested: 10/<1/19
FOR ACCT. USE ONLY
—� A-PP13OV.UD nlagv"stCaih
ON
OCTZ 1 2019 Pli aii �Jleck to vendor
�Re:ium Check to Dept
— - - COUNTYAUDTTOR t_—
CALHOUN COUMIY, T1;;;:AS
AMOUNT $1,920.71 G/L NUMBER: 21000010
�i:PLANAilOf�l,. Crescent- To transfer funds for Comp 2,3,Lapse - OIPP payment.
R I:
QUI=SiEO
81
Sarah L.
Henderson
AUTi10ftIZFD
6't:
MEMORIAL MEDICAL CENTER
CHECK REQUEST
P Memorial Medical Center Operating
Date Requested:
10/27I79
A
APPROVED FOR ACCT. USE ONLY
Y ON Ellmprest Cash
E ------ ------- OCT 2 1 2019 ❑A,T Check
Fled Check to Vendor
COUNTYAUDITOR
CALHOUN COUNTY, TEXAS ❑Itc:iurn Check to Dept
AMOUNT 35,507.29 G/L NUMBER: 21000008
`);PLAPIATION: Fort Bent -To transfer funds for Comp 2,3, Lapse • QIPP payment.
REL'?IJES (ED t3Y: Sarah LHenderson
AU II10flIZED BY: ��
MEMORIAL MEDICAL CENTER
CHECK REQUEST
p Memorial Medical Center Operating
Date Requested:
A
10/21/19
FOR ACCT. USE ONLI'
y APPROVED []Inyxest Cash
ON
PA,P Ched
E OCT 2 1 2019Nail Check to Vendor
E COUNTYAUD%TsOR afteturn Check to Dept
CALHOUN COUNTY, TE US
AhgOUN'f $4,972.83 G/L NUMBER: 21000011
F.i(PLAC`IATIOR!: Soles- To transfer funds for Comp 2,3,Lapse - OIPP payment.
iiEQUEG f'i; tiY: Sarah L. Henderson
AUl I10RILEi� BY:
October 23, 2019 2019 APPROVAL LIST - 2019 BUDGET'
COMMISSIONERS COURT MEETING OF
BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE
FICA
MEDICARE
FWH
NATIONWIDE RETIREMENT SOLUTIONS
OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT
TMPA
UNITED WAY OF CALHOUN COUNTY
AT&T MOBILITY
CALVIN ANDERLE * JP2- REIMBURSEMENT FOR CON
CENTERPOINT ENERGY
CITIBANK
CITY OF PORT LAVACA
CPL RETAIL ENERGY
FRONTIER COMMUNICATIONS
GULF COAST HARDWARE * MAINT- PA
HOPE KURTZ * JPl- REIMBUREMENT FOR CONE
PINNACLE PEAK HOLDING CORP dba SETCOM CORP.
STATE FARM * AUDITOR- BOND FOR C. MUELLE
TISD, INC
WHITE TRASH SERVICES
10/23/19
zs $1945964,03
P/R
E
$
50,170.74
P/R
$
11,733.28
P/R
$
36,421.93
P/R
$
3,918.48
P/R
$
2,406.54
P/R
$
336.00
P/R
$
10.00
A/P
$
201.87
EXPENSES A/P
$
916.78
A/P
$
2,122.05
A/P
$
27,706.95
A/P
$
6,280.82
A/P
$
50.61
A/P
$
2,680.69
RT/SUPPLIES A/P
$
647.89
EXPENSES A/P
$
865.30
* RB4- ANTENNAS A/P
$
51.87
R A/P
$
100.00
A/P
$
99.99
A/P
$
1,140.00
TOTAL VENDOR DISBURSEMENTS: $ 3425825.82 ✓
TOTAL AMOUNT FOR APPROVAL: $ 342,825.82 `�
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