2012-10-25
Regular October Term
Held October 25, 2012
THE STATE OF TEXAS
COUNTY OF CALHOUN
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BE IT REMEMBERED, that on this 25th day of October, A.D., 2012 there was begun and holden in the
Commissioners' Courtroom in the County Courthouse in the City of Port Lavaca, said County and State, at 10:00
A.M., a Regular Term of the Commissioners' Court within said County and State, and there were present on this
date the foilowing members of the Court, to-wit:
Michael J. Pfeifer
Roger C. Galvan
Vern Lyssy
Neil Fritsch
Kenneth W. Finster
County Judge
Commissioner, Precinct #1
Commissioner, Precinct #2
Commissioner, Precinct #3
Commissioner, Precinct #4
Thereupon the foilowing proceedings were had:
Commissioner Galvan gave the Invocation and Commissioner Finster led the Pledge to the US Flag and
Commissioner Fritsch led the Pledge to the Texas Flag.
APPOINTMENT TO FILL UNEXPIRED TERM OF JUSTICE OF THE PEACE PRECINCT #4:
Judge Pfiefer:
[Appointing] Peggy Dworaczyk
A Motion to appoint Peggy Dworaczyk to fill the unexpired term of the Justice of the Peace Precinct #4 was
made by Commissioner Fritsch and seconded by Commissioner Finster.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer ail voted in favor.
APPROVE BOND OF NEWLY APPOINTED JUSTICE OF PEACE PRECINCT #4:
Judge Pfiefer:
It Is a simple $1,000 bond: to "faithfuily and impartiaily discharge the duties required by law and promptiy pay
to the entitled party ail money that comes into his/her hands during the term of office."
A Motion to approve the bond of the newly appointed Justice of the Peace Precinct #4 was made by
Commissioner Finster and seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer ail voted in favor.
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Texas
~y
Western Surety Company
Copy
OFFICIAL BOND AND OATH
THE STATE OF TEXAS
County of Calhoun County r
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Prec
KNOW ALL PERSONS BY THESE PRESENTS:
BOND No. 61504686
That we, Peaav Dworaczvk , as Principal. and
WESTERN SURETY COMPANY, a corporation duly licensed to do business in the Stat~- of Texas, as Surety, are held
and bound unto lCountv Judae
I his successors in office,
in the sum of 2 One Thousand and 00/100 DOLLARS ($1. 000.00 ),
for the payment of which we hereby bind ourselves and our heirs, executors and administrators, jointly and severally, by
these presents.
Dated this
25th
day of
October
2012
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the above bounden Principal was on
the 25th day of October 2012 ,duly Appointed
(Elected-Appointed)
Precint County, State of Texas, for
October 2012 .
to the office of Justice of
a term of 2
the Peace in and for 3 Calhoun
year~ commencing on the 25th
County.
day of
NOW THEREFORE, if the said Principal shall well and faithfully perform and discharge all the duties required of
him by law as the aforesaid officer, and shall 4
faithfully amd impartially discharge the duties required by law and promptly pay
to the entitled party all money that comes into his hands during the term of
office.
then thit\91W-!{atiQ~ to be void, otherwise to l'emain in full force and effect.
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" VIpElJ:; He.>~VER, that regardless of the number of years this bond may remain in force and the number of
c ~Ip.'h-41&aY}~~f!!\de against thi~ bond,. the liab~ty of the S~rety shall not be cumulative and the aggregate
lOr the Sur~!:(QX:,~ny and all clarms, SUIts, or actIOns under this bond shall not exceed the amount stated above.
'~~" - ".~,'"
.tWY,;:J;~visiQn of t~ bqi11fimount shall not be cumulative.
~;;~;~<08 _A "~,~::.;.~~ .
~~WDED,::l!'~!W'HER, .that this bond may be cancelled by the iJiIT,\ty by sending written notice to the party to
whorri',ct4{ll~R~~Jl;p~~able stating that, not less than thll.ty (30) da.1sUher after, the Surety's liability hereunder shall
terminate as to subsequent acts of the Pl'incipal. . I. ;Iii
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~~/1?YJ . W&l.1A Principal
COMPANY
By
BURET
rL
Paul T. Bruflat enior Vice President
Form B62~A-1-2010
Page 10f3
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Copy
ACKNOWLEDGMENTOFPRIN~PAL
County of
Calhoun
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THE STATE OF TEXAS
Before me, Michael J a Pfeifer, County Judge on this day, personally appeared
Peggy Dworaczvk ,known to me to be the person whose nameis subscribed to
the foregoing instrument and acknowledged to me that he executed the same for the purposes and consideration therein
expressed.
Given undm' my hand and seal of office at
25th day of October
Port LAvaca
2012
, Texas, this
'-f'tvvukJ () N+-
Calhoun
County, Texas
SEAL
OATH OF OFFICE
(COUNTY COMMISSIONERS and COUNTY JUDGE)
I, , do solemnly swear (or affirm) that I will faithfully execute
the duties of the office of , of the State of
Texas, and will to the best of my ability preserve, protect, and defend the Constitution and laws of the United States
and of this State; and I furthermore solemnly swear (or affirm) that I have not di1'8Ctly nor indirectly paid, offered, or
promised to pay, contributed, nor promised to contribute any money, or valuable thing, or promised any public office or
employment, as a reward for the giving or withholding a vote at the election at which I was elected; and I TIll'thermore
solemnly swear (01' affirm) that I will not be, directly or indirectly, interested in any contract with or claim against the
County, except such contracts or claims as are exp~essly authorized by law and except such warrants as may issue to me
as fees of office. So help me God.
Signed
Sworn to and subscribed before me at
, Texas, this
day of
SEAL
County, Texas
OATH OF OFFICE
(General)
I, Peggy Dworaczvk , do solemnly swear (or affirm) that I will faithfully
execute the duties of the office of Justice of the Peace. Pct. 4 ,of the State of Texas,
and will to the best of my ability Pl'eserve, protect, and defend the Constitution and laws of the United States and of this
State; and I furthermore solemnly swear (or affirm) that I have not directly n~incfu.'ectlY paid, offered, or promised to
pay, contributed, nor promised to contribute any money, or valuable t1p.ng, or ~r mised any public office or employment,
as a reward for the giving or withholding a vote at the election at whic' I v{as 131 ted. So help el God.
Signed, ,'</C'/ I);
Po...-t LA\) A-c A , Texas, this 'd- ~ day of
-~~
('(A. , 'r-Ol.\, tV County, Texas
Sworn to and subscribed before me at
0<: '*0 b<l..<'" , '2..011-
O~H
~",~~~t~~~",~ SUSAN RILEY
A~1k'" ....:-4. Notary Public, State of Texas
~ ~. }..~ My Commission Expires
~"',., ...... 2016
"'}';oj\\.~,," April 18,
11/11U111"
Page 2 of3
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Copy
THE STATE OF TEXAS
County of r.R 1 hOlm
} ss
The foregoing bond of Peggy Dworaczyk
Justice of the Peace.Pct 4inandfor
approved in open Commissioner's Com't.
Calhoun
as
County and State of Texas, this day
ATTEST: -1.,
U~ d/k-~
Clerk
Date f)d'~"'cr iJ.\)
-f\'\A'~(~ \} PfvV-
Cdl(jt.<'V'""
, :J-f)'?--
County Judge,
County Court
County
County, Texas
THE STATE OF TEXAS
County of Calhoun
} ss
I, Anita Fricke , County Clerk, in and for said County, do hereby certify
that the foregoing Bond dated the 7'ith dayof October ,2012 ,withitscertificatesof
authentication, was filed for record in my office the 29th dayof Novmeber ,7012 ,at
1:15 o'clocJeX.M., and duly recorded the 29th day of November 2012 ,at
1 : 15 o'clock l M., in the Records of Official Bonds of said County in Volume 1 , on page
769
WITNESS my hand and the seal of the County Court ofaaid County, at office in Port Lavaca
:'"'jWilJ:wh~: '"""" ",-C~rt '"'Co :::::0
,
Clerk
County
ACKNOWLEDGMENT OF SURETY
(Corporate Officer)
STATE OF SOUTH DAKOTA}
S8
County of Minnehaha.
Before me, a Notary Public, in and for said County and State on this 25th day of
October
2012 ,personally appeared Paul T. Bruflat to me known to be the identical
person who subscribed the name of WESTERN SURETY COMPANY, Surety, to the foregoing instrument as the
aforesaid officer and acknowledged to me that he executed the same as his free and voluntary act and deed, and as the
free and voluntal'Y act and deed of such corporation for the uses and purposes therein set forth.
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, SOUTH DAKOTA , _
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My Commission Expires February 12, 2015
Page 3of3
CINDY MUELLER
COUNTY AUDITOR, CALHOUN COUNTY
COUNTY COURTHOUSE ANNEX I1- 202 S ANN ST
PORT LA V ACA, TEXAS 77979
(361) 553-4610
MEMORANDUM
TO: JUDGE PFEIFER & SUSAN RILEY
COUNTY JUDGE'S OFFICE
FROM: AUDITORS OFFICE - PEGGY HALL
DATE: October 19, 2012
RE: AGENDA ITEM - October 25, 2012
AGENDA ITEM
THURSDAY, OCTOBER 25, 2012
~ Consider and take necessary action to approve specifications and authorize the
County Auditor to advertise for bids for Asphalts, Oils and Emulsions for the
period beginning January I, 2013 and ending June 30, 2013. Bids will be
due Thursday, December 6, 2012 and considered for award on Thursday,
December 13,2012. (CM)
APPROVE SPECIFICATIONS AND AUTHORIZE THE COUNTY AUDITOR TO ADVERTISE FOR BIDS
FOR ASPHALTS, OILS AND EMULSIONS FOR THE PERIOD BEGINNING JANUARY 1, 2013 AND
ENDING JUNE 30, 2013. BIDS WILL BE DUE ON THURSDAY, DECEMBER 6, 2012 AND CONSIDERED
FOR AWARD ON THRUSDAY, DECEMBER 13,2012:
Peggy Ha II:
Nothing has changed. It Is the same as last year.
A Motion to approve the specifications and authorized the County Auditor to advertise for bids was made by
Commissioner Fritsch and seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
SPECIFICATIONS FOR
ASPHALTS, OILS AND EMULSIONS
1. The County of Calhoun is requesting sealed bids for Asphalts, Oils and Emulsions as needed
by the following Road and Bridge Precincts:
Precinct #1, Fairgrounds Area or Jobsites
Precinct #2, Six Mile Area or Jobsites
Precinct #3, Olivia Area or Jobsites
Precinct #4-P, Port O'Counor Area or Jobsites
Precinct #4-S, Seadrift Area or Jobsites
2. The bid shall be in effect for a period of Six (6) Months Beginning January 1, 2013 and
ending June 30,2013.
3. Materials shall meet or exceed TDOT Specifications for construction of highways, roads and
bridges. Materials shall conform to the Texas Highway Department Item #300 entitled
"Asphalt, Oils and Emulsions." (Also see Invitation to Bid form.)
The Bid Items are:
'Primer Oil
Must Meet All TXDOT Specifications
.Item 300, Asphalts, Oils and Emulsions: [AC-5]
Must Meet All TXDOT Specifications
.Item 300, Asphalts, Oils and Emulsions:(RC250)
Must Meet All TXDOT Specifications
.Item 300, Type CRS-2, Emulsified Asphalt (Cationic Rapid Setting)
Must Meet All TXDOT Specifications
.Item 300, Type CRS-2P, Emulsified Asphalt (Cationic Rapid Setting)
Must Meet All TXDOT Specifications
Calhoun County reserves the right to conduct random sampling of pre-qualified materials
for testing and to perform random audits oftest reports. County representatives may sample
material from the manufacturing plan, terminal, shipping container and any other source
they deem necessary to insure reliability of the products.
4. Delivery shall be FOB Destination to Jobsite.
All charges (including freight) must be included in bid price.
No other charges may be added to the bid price when invoiced unless noted as an exception
on the bid form.
5. NO PERSON has the authority to verbally alter these specifications. Any changes to
Specifications will be made in writing (Addendum approved by Commissioners' Court) and
sent to each person having a bid package.
Page 1 -
6. If any further information is needed concerning specifications, contact
Commissioner Roger Galvan, Precinct 1, 361-552-9242
Commissioner Vern Lyssy, Precinct 2,361-552-9656
Commissioner Neil Fritsch, Precinct 3, 361-893-5346
Commissioner Kenneth Finster, Precinct 4, 361-785-3141
7. To request a bid package, please contact:
Calhoun County Auditor's Office
Calhoun County Courthouse Annex II
Attn: Peggy Hall
202 S. Ann St., Ste B
Port Lavaca TX 77979
Phone: (361) 553-4610
Fax: (361) 553-4614
Emai1: peggy.hal1@ca1houncotx.org
Page 2
CINDY MUELLER
COUNTY AUDITOR, CALHOUN COUNTY
COUNTY COURTHOUSE ANNEX II - 202 S. ANN ST.
PORT LA V ACA, TEXAS 77979
(361) 553-4610
MEMORANDUM
TO: mDGE PFEIFER & SUSAN RILEY
COUNTY JUDGE'S OFFICE
FROM: AUDITORS OFFICE - PEGGY HALL
DATE: October 19, 2012
RE: AGENDA ITEM - OCTOBER 25, 2012
AGENDA ITEM
THURSDA Y, OCTOBER 25, 2012
~ Consider and take necessary action to approve specifications and authorize the
County Auditor to advertise for bids for Insecticides for the period beginning
January 1,2013 and ending June 30, 2013. Bids will be due Thursday, December 6,
2012 and considered for award on Thursday, December 13, 2012. (CM)
APPROVE SPECIFICATIONS AND AUTHORIZE THE COUNTY AUDITOR TO ADVERTISE FOR BIDS
FOR INSECTICIDES FOR THE PERIOD BEGINNING JANUARY 1, 2013 AND ENDING JUNE 30, 2013.
BIDS WILL BE DUE ON THURSDAY, DECEMBER 6,2012 AND CONSIDERED FOR AWARD ON
THURSDAY, DECEMBER 13, 2012:
Peggy Ha II:
Only change as requested by Commissioner Fritsch to add on Mineral 011 to include a bid on a 275 gallon tote.
Commissioner Fritsch:
In the past, the quote was per gallon and there was no price difference whether you bought a gallon or 275
gallons. Maybe by buying by volume might get a tax break and do not have to dispose of the drums.
A Motion to approve the specifications and authorize the County Auditor to advertise for bids was made by
Commissioner Fritsch and seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
SPECIFICATIONS FOR
INSECTICIDES FOR MOSQUITO CONTROL
1. The County of Calhoun is requesting sealed bids for Insecticides for Mosquito Control as needed
by the following Road and Bridge Precincts:
Precinct #1, Fairgrounds Area or lobsites
Precinct #2, Six Mile Area or lobsites
Precinct #3, Olivia Area or 10bsites
Precinct #4-P, Port O'Connor Area or lobsites
Precinct #4-S, Seadrift Area or 10bsites
2. The bid shall be in effect for a period of Six (6) Months Beginning January 1, 2013 and
Ending June 30, 2013.
3. Bid Items:
· Mineral Oil
. Malathion
· 30-30 ULV
. ANY ADDITIONAL INSECTICIDES YOU WISH TO BID ON
Please list additional insecticides, if any, your company would like to submit a
bid on and their prices on the Invitation To Bid Form. The Product Data Sheet
listing the active ingredients must be included.
Calhoun County reserves the right to conduct random sampling of pre-qualified materials for
testing and to perform random audits oftest reports. County representatives may sample
material from the manufacturing plan, terminal, shipping container and any other source they
deem necessary to insure reliability of the products.
4. Delivery shall be FOB Destination to 10bsite. All charges mllst be included in bid price.
No other charges may be added to the bid price when invoiced unless noted as an
exception on the bid form.
5. NO PERSON has the authority to verbally alter these specifications. Any changes to
Specifications will be made in writing (Addendum approved by Commissioners' Court) and
sent to each person having a bid package.
6. If any further information is needed concerning specifications, contact
Commissioner Roger Galvan, Precinct 1, 361-552-9242
Commissioner Vern Lyssy, Precinct 2,361-552-9656
Commissioner Neil Fritsch, Precinct 3, 361-893-5346
Commissioner Kenneth Finster, Precinct 4,361-785-3141
7. To request a bid package, please contact:
Calhoun County Auditor's Office
Calhoun County Courthouse Annex II
Attn: Peggy Hall
202 S. Ann St., Ste B
Port Lavaca TX 77979
Phone: (361) 553-4610
Fax: (361) 553-4614
Email: peggy.hall(@calhouncotx.org
CALHOUN COUNTY, TEXAS -Invitation To Bid Form
INSECTICIDES FOR MOSQUITO CONTROL
All Calhoun County Precincts
JANUARY 1, 2013 thru JUNE 30, 2013
~ Return this Form and 5 copies of the Product Data Sheet( s) for each
Insecticide you are Ustin2: below: Print or Type - All information must be legible
PRODUCT DATA
BID ITEM UNIT UNIT PRICE SHEET INCLUDED
MINERAL OIL Yes No
MINERAL OIL 275 Gal Tote Yes No
MALATHION Yes No
30-30 UL V Yes No
Yes No
Yes No
Yes No
Yes No
You may.list additional insecticides you wish to bid on that are not listed above.
If additional space is needed to list insecticides, you may copy this form as needed. If copies are made, eaclt page must be signed.
All charf!es must be included in bid price.
No other charees may be added to the bid price when invoiced unless noted as an
exception on the bid form.
.... See Specifications for Insecticides for Mosquito Control and General Conditions of bidding
The undersigned affirms that they are 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, and that the contents oj this bid as to prices, terms, or conditions
of said bid have not been communicated by the undersigned nor by ony employee or agent to any other person engaged in this type of
business prior to the official opening oj this bid.
NAME OF COMPANY:
ADDRESS:
Authorized Signature & Title:
Priut Name & Title:
Date of Bid:
Telephone Number:
EmaU:
List auy exceptions to the given bid specifications:
Fax Number:
Page 1 of 1
CINDY MUELLER
COUNTY AUDITOR, CALHOUN COUNTY
CALHOUN COUNTY COURTHOUSE ANNEX II - 202 S ANN ST
PORT LA V ACA, TEXAS 77979
(361) 553-4610
MEMORANDUM
TO: nmGE PFEIFER & SUSAN RILEY
COUNTY JUDGE'S OFFICE
FROM: AUDITORS OFFICE - PEGGY HALL
DATE: October 19,2012
RE: AGENDA ITEM - OCTOBER 25, 2012
AGENDA ITEM
THURSDAY, OCTOBER 25, 2012
~ Consider and take necessary action to approve specifications and authorize the
County Auditor to advertise for bids for Road Materials for the period beginning
January 1,2013 and ending June 30,2013. Bids will be due Thursday, December 6,
2012 and considered for award on Thursday, December 13, 2012. (eM)
APPROVE SPECIFICATIONS AND AUTHORIZE THE COUNTY AUDITOR TO ADVERTISE FOR BIDS
FOR ROAD MATERIALS FOR THE PERIOD BEGINNING JANUARY 1, 2013 AND ENDING JUNE 30,
2013. BIDS WILL BE DUE ON THURSDAY, DECEMBER 6,2012 AND CONSIDERED FOR AWARD ON
THURSDAY, DECEMBER 13, 2012:
Peggy Hall:
Question: The past two (2) times that this has been bid out, the vender has substituted Item No. 350 (Type D
Hot-Mix Cold Laid Asphaltic Concrete Pavement) for Item No. 334 (Micro Surfacing). Should it be Item No. 334
and not Item No. 3507
Commissioner Fritsch and Commissioner Lyssy:
Have ordered Item No. 334 and was happy with it.
A Motion to approve the specifications (including the substitution of Item No. 334) and authorize the County
Auditor to advertise for bids was made by Commissioner Fritsch and seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
SPECIFICATIONS FOR
ROAD MATERIALS
1. The County of Calhoun is requesting sealed bids for Road Materials as needed by
the following Road and Bridge Precincts:
Precinct #1, Fairgrounds Area or Jobsites
Precinct #2, Six Mile Area or Jobsites
Precinct #3, Olivia Area or Jobsites
Precinct #4-P, Port O'Connor Area or Jobsites
Precinct #4-S, Seadrift Area or Jobsites
2. The bid shall be in effect for a period of Six (6) Months Beginning January 1, 2013 and
Ending June 30, 2013.
3. Materials shall meet or exceed TDOT Specifications for construction of highways, roads and
bridges. Calhoun County Specifications for Road Materials, Specifications on the Invitation To Bid
Form and General Conditions of Bidding must also be met/followed.
The Bid Items are:
.Item 334 Micro Surfacing
Item 350, Type D Hot-Mix Cold Laid Asphaltic Concrete Pavement has been
replaced by Item 334
.Item 330, Limestone Rock Asphalt
.Item 332, Limestone Rock Asphalt
.Item 330, Type D (Pre-Mix Limestone)
.Item 304, Type PE (Topping Rock), Grade 4
.Item 302, Type PE (Topping Rock), Grade 3
.Item 249, Type B (Flexible Processed Base), Grade 3:(Min PI 6)
.Item 249, Type A Limestone, Grade 3 [1 y" Inch]
'Type PB (Topping Rod,), Grade 4
'Limestone-3/4 Inch to Dust
'Fly AshlBottom Ash (Petcol,e Fly Ash;Circulating Fluidized Bed(CFB)Combustion Ash)-
Hydrated (Product Code - OPF42F)
Product Ingredients: Components: Calcium Sulfate 40-60%, CAS Number 7778-18-9,
GHS Classification-Not Hazardous According to GHS criteria; Calcium Oxide 30-50%,
CAS Number 1305-78-8, GHS Classification-Corrosive IE H3314; Carbon 5%, CAS
Number 7440-44-0, GHS Classification-Not Hazardous According to GHS criteria;
Silicon Dioxide <5%, CAS Number 14808-60-7, GHS Classification-Carc. lA, STOT-
RE2; H350, H373; Magnesium Oxide <4%, CAS Number 1309-48-4, GHS
Classification-Not Hazardous According to GHS criteria.
Calhoun County reserves the right to conduct random sampling of pre-qualified
materials for testing and to perform random audits oftest reports. County
representatives may sample material from the manufacturing plant, terminal, shipping
container and any other source they deem necessary to insure reliability of the product.
~ Bid Items continued on page 2
Page I
-Fly Ash
CalhOlill County reserves the right to conduct random sampling of pre-qualified
materials for testing and to perform random audits oftest reports. County
representatives may sample material from the manufacturing plant, terminal,
shipping container and any other source they deem necessary to insure reliability
of the product.
-Bottom Ash
Calhoun County reserves the right to conduct random sampling of pre-qualified
materials for testing and to perform random audits oftest reports. County
representatives may sample material from the manufacturing plant, terminal,
shipping container and any other source they deem necessary to insure reliability
of the product.
-Top Wash
Calhoun County reserves the right to conduct random sampling of pre-qualified
materials for testing and to perform random audits of test reports. County
representatives may sample material from the manufacturing plant, terminal,
shipping container and any other SOlUTe they deem necessary to insure reliability
of the product.
-Topping
Calhoun County reserves the right to conduct random sampling of pre-qualified
materials for testing and to perform random audits of test reports. County
representatives may sample material from the manufacturing plant, terminal,
shipping container and any other source they deem necessary to insure reliability
of the product.
4. Delivery shall be FOB Destination to Jobsite. All clUll'ueS must bc includcd in bid pricc.
No othcr chargcs may be added to the bid pricc when invoiccd unless noted as an excclltion
on the bid form.
5. Regarding all bid items: Calhoun County reserves the right to conduct random sampling of
pre-qualified materials for testing and to perform random audits of test reports. County
representatives may sample material from the manufacturing plant, terminal, shipping container
and any other source they deem necessary to insure reliability of the product(s).
6. NO PERSON has the authority to verbally alter these specifications. Any changes to
specifications will be made in writing (Addendum approved by Commissioners' Court) and
sent to each person having a bid package.
7. If any further information is needed concerning specifications, contact
Commissioner Roger Galvan, Precinct 1, 361-552-9242
Commissioner Vern Lyssy, Precinct 2,361-552-9656
Commissioner Neil Fritsch, Precinct 3, 361-893-5346
Commissioner Ke1l1leth Finster, Precinct 4,361-785-3141
Page 2
8. To request a bid package, please contact:
Calhoun County Auditor's Office
Calhoun County Courthouse Annex II
Attn: Peggy Hall
202 S Ann St, Ste B
PortLavaca T)( 77979
Phone: (361) 553-4610
Fax: (361) 553-4614
Email: peggy.hall@calhowlCotx.org
Page 3
AGREEMENT FOR AMBULANCE SERVICES BETWEEN PORT LAVACA NURSING AND
REHABILITATION CENTER AND CALHOUN COUNTY EMERGENCY SERVICES:
Henry Barber:
Same agreement that we have had with them before. They have been deiaylng the signing of the contract and
it has finally been signed by the new administrator. They wiil be coming back at the last part of November or
the first part of December with another contract for next year.
A Motion to approve the agreement for ambuiance services was made by Commissioner Lyssy and seconded by
Commissioner Fritsch.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
Final 2012
AGREEMENT FOR AMBULANCE SERVICES
BETWEEN
PORT LA V ACA NURSING AND REHABILITATION CENTER
AND
CALHOUN COUNTY EMERGENCY MEDICAL SERVICES
THIS AGREEMENT, made and entered into by and between the following PORT LA V ACA NURSING AND
REHABILITATION CENTER (hereinafter referred to as "FACILITY") and CALHOUN COUNTY EMERGENCY MEDICAL
SERVICES. (hereinafter referred to as "PROVIDER"), provides as follows:
WHEREAS, FACILITY desires to maximize efficiency and service levels for medical transportation and has conducted an analysis of
its medical transportation needs. Through this analysis, FACILITY has determined that such needs will best be met through a
preferred coordinated medical transportation system agreement with the PROVIDER; and
WHEREAS, PROVIDER is in the business of providing medical and ambulance transpOltation and advanced life support professional
services; and
WHEREAS, FACILITY and PROVIDER recognize that the ground ambulance transportation needs of F ACILlTY will be evolving
and therefore, it is not possible to define all of the terms of the specific services required by FACILITY, which may be provided by
the PROVIDER. The parties desire at this time to define the transportation services to be provided by PROVIDER and to establish
mechanisms under which PROVIDER may provide future services to FACILITY related to ambulance transpOltation services,
including services to be developed through prioritization of pre-planned, scheduled, emergent and non-emergent ambulance calls
initiated by FACILITY. The parties intend that ifthe future services outliued in this AGREEMENT are expanded, the parties will
execute addenda, further defming the services to be provided; and
WHEREAS, FACILITY and PROVIDER desire to enter into a long-term, agreement under which FACILITY and PROVIDER will
jointly develop and PROVIDER will operate and/or coordinate a turn-key coordinated medical u'ansportation system to serve all of
FACILITY'S ambulance transportation needs utilizing existing reimbursement sources which maximizes the benefits ofa coordinated
network; and
NOW, THEREFORE, FACILITY and PROVIDER do hereby agree as follows:
1. SERVICES AND RESPONSIBILITIES OF PROVIDER
FACILITY has selected PROVIDER as its "preferred provider of medical transportation" services within the primaty
service area as defined by Section VIII below, through an analysis ofthe quality of ground ambulance transpOltation services
that PROVIDER provides. Accordingly, during the term of this AGREEMENT and extensions hereto, PROVIDER agrees
as follows:
A. Services Provided
PROVIDER agrees to provide appropriate ambulance transpOltation and related services to FACILITY in
accordance with the terms of this AGREEMENT and all addenda hereto. Requests by FACILITY for services
which originate and lor terminate outside the boundaries of the primary service area as defined in Section VIII
beiow may by referred by provider to another licensed ground or air ambulance provider after appropriate
coordination with and approved by Facility.
(In this circumstance, PROVIDER will not be liable to the alternative ambulance provider for the payment of any
charges, fees or professional service charges rendered in association with such transpOlt.)
Fin,d 03i:'.CJ!200(, FINAL MMC AGI([C:MFNT I'(JR I\MBlILANCL SFRVICES 12..doG '
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B. Emergency and Non Emergency lines
Provider agrees to provide and maintain a telephone number for FACILITY to access PROVIDER for all
FACILITY ambulance transportation requests covered by this AGREEMENT. This number is intended as a public
number. PROVIDER will provide sufficient telephone lines and communication technicians to assure prompt
answering of all incoming calls fi'om FACILITY. PROVIDER'S telecommunication personnel will coordinate the
required transportation services.
PROVIDER will provide a listing of emergency numbers, non-emergency numbers and pager numbers that can be
utilized to contact the PROVIDER 24 hours per day seven days a week.
C. Inter-facility Ambulance Transportation Services
Provider will provide inter-facility ambulance transportation services and such other ambulance ground
transportation services at the request ofthe FACILITY. Inter-facility ambulance transportation services shall be
defmed as ground ambulance transports originating at FACILITY and other facilities as FACILITY and
PROVIDER may mutually agree upon in writing. Inter-facility transportation services ordered by FACILITY shall
be ordered through the Emergency and Non Emergency lines described in the preceding paragraph. Compensation
rates for each facility shall be listed in ADDENDUM A below.
D. Applicable Standards
PROVIDER agrees in the performance of the services, to be bound by, and comply with, (i) by the bylaws, policies,
rules and regulations ofF ACILITY and the medical staff of the FACILITY facilities, as each may be amended fi'om
time to time (provided that such amendments do not materially increase PROVIDER's obligation hereunder or
materially affect the fmancial or economic interests hereunder of PROVIDER), and (iI) the standards, rules and
regulations of the United States Department of Health and Human Services (hereinafter refen'ed to as "HHS"), the
Texas Department of Health, the Joint Commission on the Accreditation of Healthcare Organizations (hereinafter
referred to as "JCAHO"), Medicare, Medicaid, and any other federal, state or local govemmental agency or third-
party payor, exercising authority with respect to, accrediting or providing reimbursement for FACILITY.
E. Etiquette
PROVIDER, through its employees, shall treat all FACILITY staff and employees with proper respect, courtesy and
professionalism. PROVIDER's employee's conduct shall at all times be appropriate and conductive to effective
patient care and consistent with prevailing norms recognized and accepted throughout the community.
F. Licensure
PROVIDER covenants, represents and warrants to FACILITY that: (i) it and its employees are, as appropriate, duly
licensed, cettified, registered and in good standing under the laws ofthe State of Texas and the county(s) outlined in
Section VIII below to provide the services under this AGREEMENT, and agrees that they shall retain such
licensure, celtification, registration and good standing status during the term ofthis AGREEMENT; (ii) each
ambulance vehicle shall be registered and licensed according to state and localmles, regulations and laws; and (iii)
each ambulance vehicle shall be staffed with celtified and/or licensed personnel in accordance with state and local
rules and regulations.
G. Experience and Training
PROVIDER represents and warrants to FACILITY that its employees are professionally trained in emergency
medical technician practice and will, during the term of this AGREEMENT, take all actions necessary to maintain
such training.
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H. Training
Provider agrees to conduct an in-house training program for field employees that significantly supplements the
training that they received in their EMT training courses that meets or exceeds TDH standards.
I. Vehide Maintenance
PROVIDER agrees that its fleet will be well maintained and response ready to provide services under this
AGREEMENT.
J. Access to Records
Provider shall maintain a medical record, known as a "Patient Care Report," for each patient receiving services
under this AGREEMENT. Said medical record shall be in such form and containing such information as required
by the laws, ruled and reguiations of the State of Texas and JCAHO.
K. Good Faith
PROVIDER agrees to act in good faith at all time in perfonning its obligations and implementing the provisions of
this AGREEMENT, including negotiating alternate reimbursement practices and the telms of any addenda.
L. Services Excluded
Transports of a distance greater than 150 miles
II. RESPONSIBILITIES OF FACILITY
During the term of this Agreement and extensions hereto, FACILITY agrees as follows:
A. Promotion of AGREEMENT
F AClL TY will conduct an internal and promotional campaign to educate its medical staff members, employees and
others making arrangements for ambulance transportation about the general tenns ofthis AGREEMENT, including
periodic updates and reminder notices. Specifically, FACILITY will use its best effOlis to ensure that employees
who requests ambulance transportation services are informed of and utilize the Emergency and Non Emergency
lines and have been made aware ofthe preferred nature ofthis AGREEMENT.
B. Promotion to Medical Staff Members
FACILITY and FACILITIES medical staff members, including physicians providing services under managed care
arrangements, are accountable under Federal COBRA regulations for the selection of an appropriate medical
transpOliation provider. FACILITY shall communicate in a reasonable manner the general terms of this
AGREEMENT to said medical staff members.
C. Access to records
FACILITY shall provide necessaty records and information about patients to PROVIDER to facilitate the provision
of appropriate services and data collection. This information shall include the provision of a face sheet if available
and substantially complete at the time of PROVIDER'S services hereunder, on each patient transported at the time
the transport is initiated. When face sheets are not available or are not substantially complete at such time,
FACILITY shall designate a liaison who will be responsible for obtaining and forwarding face sheets for the
PROVIDER upon request.
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Final 2012
The parties herein mutually agree that in the event that FACILITY'S billing procedures and/or files will allow
PROVIDERS access to the patient database in such manner that is acceptable to both the FACILITY and
PROVIDER.
D. Good Faith
FACILITY agrees to act in good faith at all times in performing its obligations and implementing the provisions of
this AGREEMENT, including negotiating alternate reimbursement practices and the terms of any addenda.
E. Patient Tracking
FACILITY agrees to provide reasonable assistance to PROVIDER in the completion of PROVIDER'S authorization
or utilization forms, as appropriate, and to provide access to face sheets in accordance with Section II(D) above.
III. INSURANCE
PROVIDER shall, at no cost to or expense to FACILITY, carry a policy or policies of professional liability insurance,
comprehensive general insurance, and medical malpractice insurance issued by an insurance carrier.
IV. COMPENSATION
A. Except as provided for in this AGREEMENT, neither F ACILlTY nor PROVIDER shall charge the other for
services provider pursuant to this AGREEMENT, without mutual assent.
B. The rate schedule in ADDENDUM A herein shall represent PROVIDER'S full compensation for services provided
under this AGREEMENT. Such charges must, at all times, comply with applicable laws, mles and regulations.
V. TERMINATION OR AMENDMENT AS THE RESULT OF GOVERNMENTAL REGULATIONS
FACILITY and PROVIDER shall each have the right to terminate or unilaterally amend this AGREEMENT, without
liability, in order to comply with any order issued by any federal or state department, agency or commission, or any provision
oflaw or of the JCAHO or other accreditation organization which invalidates or is inconsistent with the terms ofthis
AGREEMENT or which would cause one ofthe pmties to be in violation oflaw. In the event FACILITY or PROVIDER is
required to amend this AGREEMENT pursuant to this Section and the amendment is unacceptable to the other pmty, such
pmty may choose to terminate this AGREEMENT immediately without liability.
VI. Term
A. Term and Termination
Subject to each party's right oftermination as set forth in the preceding paragraph and below, this AGREEMENT
shall be for a term of one year commencing at midnight on 01/01/2012 and terminating at
midnight on 12/31/2012 (hereinafter referred to as "INITIAL TERM").
I. FACILITY or PROVIDER may mutually agree to terminate this AGREEMENT in writing, with or without
cause upon 30 days written notice; or
2. Except as provided for elsewhere in this AGREEMENT, with cause by either party upon default by the
other party of any material term, covenant or condition of this AGREEMENT, where such default
continues for a period of (30) days after the defaulting party receives written notice thereof from the other
party specifYing the existence of default: or
3 Immediately if PROVIDER fails to maintain licensure as required in Section I, Paragraph G (ii) or (iii)
herein, or fails to maintain insurance as required in Section III herein.
Final 03120/2006 FINAL IvIIv1C ACiRFEIVlI'NT F'OR AIVlI\lJI.iINCE SERVICES 12.doc
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B. Re-negotiation
During the sixty (60) day period of prior to the end of the INITIAL TERM or any RENEWAL TERM, this
AGREEMENT shall be subject to the review by the parties. During this 60-day period, the parties agree to use their
best efforts to meet together at mutually agreeable times to review and if appropriate to re-negotiate the telws of this
AGREEMENT. If the parties agree to modifY this AGREEMENT, such modifications shall be in writing and
executed in accordance with Section XVII here of.
VII. FORCE MAJEURE
Provider shall be excused from performance under this AGREEMENT iffor any period PROVIDER is prevented from
perfOlwing any obligations pursuant hereto, in whole or in part, as a result of au Act of God, war, civil disturbance,
catastrophe, court order, labor dispute or cause beyond its reasonable control, including shOltages or fluctuations in electrical
power, heat, light, air conditioning or fuel shortages, and such non-perfOlwance shall not be a ground for termination or
default.
PROVIDER will use its reasonable effOlts under such circumstance to ensure that alternate services be made available should
any of these conditions arise. In the event PROVIDER cannot obtain altemate services, F ACILlTY may exercise its right to
contract temporarily with another service until PROVIDER is once again able to meet the needs ofFACILlTY.
VIII. AREAS OF SERVICE
PROVIDER will provide the services described herein to FACILITY anywhere within Calhoun and adjacent surrounding
Counties and any other areas within the State of Texas up to 50 miles, as mutually agreed upon by both parties hereto.
Transport from the FACILITY greater than 50 miles shall be agreed upon by both parties at the time of service.
IX. INDEPENDENT CONTRACTOR
The relationship between the parties shall at all times be that of an independent contractors. No provision of this
AGREEMENT is intended to, or shall be construed to, render one party an agent, employee, servant, or partner ofthe other.
N either party shall represent to any third party or entity that is authorized to enter into any contract for or on behalf of the
other party. Neither party shall execute any contract for or on the behalf of the other, nor attempt to bind the other to any
obligation, without the other party's written consent. FACILITY and PROVIDER shall not combine their business
operations in any way, but instead shall maintain their operations as separate and distinct entities.
PROVIDER'S employees shall not have any claim under this AGREEMENT or otherwise FACILITY for vacation pay, sick
leave, retirement benefits, Social Security, worker's compensations, disability or unemployment insurance benefits of any
kind. PROVIDER'S employees shall not be entitled to any rights or privileges established for employees ofF ACILlTY, such
as vacation, sick leave, paid holidays, or severance pay upon telwination of this AGREEMENT.
FACILITY shall neither have nor exercise any control or direction over the method by which PROVIDER performs its work
or functions; the sole interest and responsibility ofF ACILITY is to assure that their services contemplated by this
AGREEMENT will be performed in accordance with the terms hereof.
X. SUCCESSORS AND ASSIGNS
F ACILlTY and PROVIDER shall have the right to assign this AGREEMENT and to delegate all rights, duties and
obligations hereunder, whether in whole or part, to any parent, affiliate, successor or subsidiary organization or company of
FACILITY or PROVIDER only with consent of other party, which consent shall not be unreasonably withheld. Subject to
the foregoing, this AGREEMENT shall be binding upon the parties hereto and their successors and assigns.
Final 03/20/2006 FINAL iYIlV1C ACiREEIVlENT FOR AivlIJULANCE': SERVICES 12.<10<:
Final 20 12
XI. PREFERRED STATUS
FACILITY and PROVIDER agree and acknowledge that in order for PROVIDER to PROVIDE the most timely, efficient
and responsive inter-facility ambulance transportation services, and for PROVIDER and FACILITY to provide the safest and
most efficient care, that the inter-facility ambulance transpOltation services under this AGREEMENT shall be on the
preferred basis as set forth here in. Except as set for herein, the inter-facility ambulance transportation services provided by
PROVIDER hereunder are provided on a preferred basis and FACILITY agrees not to contract with any other companies,
organizations or agencies for such services during the term of this AGREEMENT. This preferred status shall not apply if
this patient, the patient's guardian, third patty payor, or the attending physician requests another ambulance service.
XII. FIRST RIGHT OF REFUSAL
In the event FACILITY desires to evaluate or implement developing a system for critical care ground u'ansportation services,
wheelchair transportation service, or other programs relating to ambulance ground transpOltation services, then FACILITY
shaIl give PROVIDER written notice of such desire. FoIlowing such notice, FACILITY and PROVIDER agree to negotiate
for a period of 30 days, on a preferred basis, for PROVIDER to perfOlm such services for FACILITY and its patients.
XIII. NOTICES
Any notice required to be given pursuant to the terms and provisions hereof shall be in writing and shaIl be sent certified or
registered mail or by hand delivery to the parties at the addresses set forth below or to such address which a party may
designate by notice.
PROVIDER:
Calhoun County
Emergency Medical Services
705 County Road 101
POIt Lavaca, Texas 77979
FACILITY:
Port Lavaca Nursing and Rehabilitation Center
524 Village Road
Port Lavaca, Texas 77979
Either party may change its address to which notices are sent by a notice similarly sent.
XIV. SEVERABILITY
In the event that any part, telm of provision of this AGREEMENT is, by any arbitrator or court of competent j urisdiction,
held to be iIlegal, unconscionable, in conflict with any law of state where enforcement of this AGREEMENT is sought, or
any public policy thereof, the validity of the remaining portion or provisions shall be construed and enforced as ifthe
AGREEMENT did not contain the particular part, term or provision to be invalid.
XV. CONTROLLING LAW
The interpretation and enforcement of this AGREEMENT shaIl be consistent with the laws of the State of Texas. In addition,
the parties agree that if any legal action is commenced for enforcement of any term of provision of, or arising under or related
to, this AGREEMENT, said action shall be preferably commenced on the state or federal courts located within the State of
Texas, and the parties consent to the jurisdiction and venue of such courts.
XVI. MODIFICATION
This AGREEMENT constitutes the entire understanding of the parties hereto and no changes, amendments, or alterations
shall be effective unless signed by both parties. That is, any increase or decrease in services must be mutually agreed upon in
writing.
Fillal03/201200(, FINAL. MMC' ;\CmEI,iVIENT I"OR ;\iVIlJlIL;\NCE SERVICES 12.doc
Final 2012
XVII. HOLD HARMLESS CLAUSE
Each party to this AGREEMENT shall defend, hold harmiess and indemnifY the other party and its commissioners,
managers, affiliates, shareholders, directors, trustees, officers, employees, and agents against all claims demands, suits
judgments, expenses and costs of any and all kinds arising as a result of damages or injuries caused through the performance
or failure of performance of this AGREEMENT by said party.
XVIII. COMPLETE AGREEMENT
This AGREEMENT contains the complete AGREEMENT concerning the subject matter of this AGREEMENT between the
parties and shall as of the effective date hereof, supersede all agreements between the parties pertaining to the same subject
matter.
The parties stipulate that neither ofthem has made any representation with respect to the subject matter of this
AGREEMENT, except as set forth herein. The parties further acknowledge that any statement or representation that may
have heretofore been made by either party to the other is of no effect, and that neither of them has relied thereon on
connection with its dealings with the other.
XIX. EXECUTION OF ADDITIONAL INSTRUMENTS
Each party shall at any time, and from time to time, at the other's request execute, acknowledge and deliver any reasonable
instruction, instlUment or acknowledgment that may be necessary or proper to cany out the provision s and intent of this
AGREEMENT.
XX. WAIVER AND SURVIVAL
The failure of either party to insist upon strict compliance by the other with respect to any of the terms and conditions of this
AGREEMENT shall not be construed as a waiver, nor shall such course of action deprive such party ofthe right thereafter to
require strict adherence to the terms and provisions of this AGREEMENT.
XXI. NON-DISCLOSURE
FACILITY and PROVIDER agree to treat the pricing contained within this AGREEMENT as CONFIDENTIAL
INFORMATION and as PROVIDER'S CONFIDENTIAL INFORMATION pursuant to the provisions of Section XXIII.
XXII. CONFIDENTIALITY
PROVIDER acknowledges that in connection with entering into this AGREEMENT and the services provided by
PROVIDER pursuant to it, it will be acquiring and making use of confidential information and trade secrets (hereinafter
referred to as the "CONFIDENTIAL INFORMATION") of FACILITY, which include, but are not limited to, management
repOlts, marketing studies, marketing plans, financial statements, intemal memoranda, repOlts, patient lists and other material
or records of confidential information. PROVIDER agrees that it will not, after the date hereof, and for so long as any such
CONFIDENTIAL INFORMATION may remain confidentiai, secret or otherwise wholly or partially, use such information
except in connection with the performance of the duties pursuant to this AGREEMENT.
PROVIDER will not use or divulge the CONFIDENTIAL INFORMATION to any third party, unless: (i) FACILITY
consents in writing to such use or divulgence; (iI) PROVIDER is under legal obligation to disclose such CONFIDENTIAL
INFORMATION; or (iii) such CONFIDENTIAL INFORMATION becomes available to the public by a reason other than a
PROVIDER'S breach of this Section.
PROVIDER acknowledges that a breach of this section would result in irreparable damage to FACILITY, and, without
limiting other remedies which may exist for a breach of this Section, PROVIDER agrees that this Section hereof may be
enforced by temporary restraining order, tempormy injunction, or following a trial on the merits. PROVIDER hereby waives
the claim or defense that an adequate remedy at law for such a breach exists. The covenants contained in this Section shall
survive any termination of this AGREEMENT for two years.
FinaI03!20/200C, FINAL MMC AGREFivlLNT FOR AMBlJl.ANCE SERVICI'/S 12.cloc
Final 2012
F ACILlTY acknowledges that in connection with entering into this AGREEMENT and the services provided by PROVIDER
pursuant to it, it will be acquiring and making use of confidential infOlmation and trade secrets (hereinafter referred to as the
"PROVIDER'S CONFIDENTIAL INFORMATION") which include, but are not limited to, management reports, marketing
studies, marketing plans, [mancial statements, internal memoranda, reports, patient lists and other material or records of
confidential information. FACILITY agrees that it will not, after the date hereof, and for so long as any such PROVIDER'S
CONFIDENTIAL INFORMATION may remain confidential, secret or otherwise wholly or partially, use such information
except in connection with the perfOlmance ofthe duties pursuant to this AGREEMENT.
FACILITY will not use or divulge the PROVIDER'S CONFIDENTIAL INFORMATION to any third party, unless: (i)
PROVIDER consents in writing to such use or divulgence; (i1) F ACILlTY is under legal obligation to disclose such
PROVIDER'S CONFIDENTIAL INFORMATION; or (iii) such PROVIDER'S CONFIDENTIAL INFORMATION
becomes available to the public by a reason other than a PROVIDER'S breach of this Section.
FACILITY acknowledges that a breach of this section would result in irreparable damage to PROVIDER, and, without
limiting other remedies which rnay exist for a breach of this Section, FACILITY agrees that this Section hereof may be
enforced by temporary restraining order, temporary injunction, or following a trial on the merits. F ACILlTY hereby waives
the claim or defense that an adequate remedy at law for such a breach exists. The covenants contained in this Section shall
survive any termination of this AGREEMENT for two years.
XXIII. NO INFLUENCE ON REFERRALS
It is not the iutent of either the FACILITY or PROVIDER ofthis AGREEMENT that any remuneration, benefit or privilege
provided for under this AGREEMENT shall influence or in any way be based on the referral or recommended referral by
either party or patients to the other party or its affiliated providers, if any, or the purchasing, leasing, or ordering of any
services other that specific services described in this AGREEMENT. Any payments specified in this AGREEMENT are
consistent with what the parties reasonably believe to be fair market value for the services provided.
XXIV. THIRD PARTY BENEFICIARY
The parties to this AGREEMENT do not intend to confer any benefits hereunder n any person or other legal entity other that
the paIties hereto, including without limitation any patients of PROVIDER or FACILITY, and no third-party beneficiary
rights are intended to be created hereby.
XXV. NAME OR TRADEMARK
Nothing contained herein shall confer upon either party hereto a license to use, or ownership of (i) the name ofthe other party
hereto or any name under which a party operates, or (ii) any trade name, service mark or trademark owned by such party.
XXVI. THIRD PARTY PAYOR CONTRACTS
PROVIDER will cooperate with FACILITY with respect to all programs established between FACILITY and health
maintenance organizations, exclusive provider organizations and other managed care programs.
XXVII, NOTICE OF LITIGATION
PROVIDER and FACILITY shall promptly notifY the other in the event that any paIty leams of any threatened or actual
litigation in which it is a party defendant in a case which involves serviced provided under this AGREEMENT. Within five
(5) calendar days after being served with a summons, complaint or other pleading which has been filed in any federal or state
court or with any administrative or regulatory agency or after receiving notice of threatened litigation, the party so served or
notified shall deliver copies of such document(s) to the other party.
XXVIII. HEADINGS AND CAPTIONS
The headings and captions used in this AGREEMENT are for the convenience of reference only, and to not for a part ofthis
AGREEMENT.
FillaI0.1120/2()O(, I"INAL MiYlC MiRl'.F:iYIFNT FOR AiYIBlILANCF SI':rWICFS l2.do<:
Final 2012
XIX. BINDING EFFECT
The parties agree that this AGREEMENT shaH not be binding upon either patty unless and until it is executed by an
authorized representative of each party. FACILITY and PROVIDER represent that their representative signatory, whose
signature appears below, has been and is, as ofthe date first written above, duly authorized by aH necessary, appropriate and
applicable corporate legal action to execute this agreement.
XXIX. AGREEMENT READ AND UNDERSTOOD
The patties hereto have read and understand this entire instrument and acknowledge that they both have had competent legal
counsel available to them in their review and execution of said AGREEMENT.
IN WITNESS WHEREOF, the patties hereto have executed this AGREEMENT Effective
01/0112012.
FACILltJ. ..
BY:~9~
Title: A-vl,^, l,v I Hx../A-rilL
PROVIDER
By: Yl!lA/J.,,~ c)PrL.
Title: ~ ~l"f' 'b[ 9<-j Lf
Date: jOjJ-t;-/1..--
Date:
Fillal03/.20!201J(, FINAL IYIIYIC AGREE';!I;1ENT FOR AiV!lJlJl.ANCE SERVICES 12.do<:
Final 2012
ADDENDUM A
COMPENSATON SCHEDULE AND BILLING PRACTICES
1. A. Provider will bill its customary rates pursuant to this AGREEMENT.
B. Where patients have third party coverage, including Medicare, Medicaid, and private insurance, PROVIDER
will bill said insurance and accept as payments in full the amounts allowed by said third party coverage. In such
cases, patients will only be billed for:
(a) their co-insurance and deductible as determined by their third party coverage or where mandated by
federal or local government: and
(b) any services which said third party insurer determines are not covered by the terms ofthe patient's
policy.
C. Where patients have no third pmiy coverage, PROVIDER will bill the patients directly. In the event the patient
refuses to pay for provider service, the FACILITY will be responsible for payment.
D. FACILITY will only be responsible for ambulance services which:
(a) are pre-approved and authorized by FACILITY (a request for ambulance transport by a facility
employee, will be considered as pre-approved and authorized by the FACILITY)
(b) where FACILITY is legally responsible
(c) where transport is requested by the FACILITY because patient has no other means oftransportation or
payment.
(d) where the FACILITY request transpOlt due to the FACILITY transport unit being out of service.
(e) where the patient is being discharged from the hospital and is returning to the FACILITY.
II. For Ground Transports that are the legal responsibility of the FACILITY, the FACILITY will pay:
Transports within the Calhoun and SUlTounding Counties from one (1) through one hundred fifty
miles:
CUlTent Rate Contract Rate II Contract Rate 12
BLS Non-emergency Base Rate: 399.00
239.00
251.00
Mileage per Loaded Mile: 12.10
7.80
8.19
This payment schedule will be all inclusive of supplies and equipment and accepted as payment in full for any and
all transports that are the legal responsibility of the FACILITY or third party. Payment shall be received as defined
in section IV. It is understood that these patients shall meet the existing Medicare guidelines for medical necessity
for ambulance transportation and have the CeJtification of Medical Necessity completed for Provider. It is also
understood, that for all non-emergency ambulance services where Medicaid is the primary payor, a Prior
Authorization number will be obtained by the FACILITY.
Ill. PROVIDER guarantees that the above contracted rates shall be effective for the duration this AGREEMENT.
Thereafter, the rates shall be evaluated upon renewal of said AGREEMENT.
IV. PROVIDER shall submit invoices to FACILITY on a per call basis for the services provided under the
AGREEMENT.
FinaI03i2()!i()()(, FINAL MMe' AGRU'ivIHNT 1"01( AlvllHII,ANCIe SleRVICI;S 12.doc
INTERLOCAL AGREEMENT FOR FIRE SERVICES BETWEEN CITY OF PORT LAVACA AND CALHOUN
COUNTY AND AUTHORIZE COUNTY JUDGE TO SIGN:
Judge Pfeifer;
For $178,500: We won't pay this until January 1 in the new budget year and they are aware of that.
A Motion to approve the agreement for fire services was made by Commissioner Finster and seconded by
Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
INTERLOCAL AGREEMENT FOR FIRE SERVICES
BY AND BETWEEN THE CITY OF PORT LA V ACA AND CALHOUN COUNTY
STATE OF TEXAS 9
9
COUNTY OF CALHOUN 9
THIS INTERLOCAL AGREEMENT, approved by each party at a duly called
meeting of each entity as shown below, by and between the CITY of PORT LA V ACA,
Texas, a home lUle city located in Calhoun County, by and through their duly authorized
City Manager or Mayor, (hereinafter "CITY") and the COUNTY OF CALHOUN,
through its duly authorized County Judge, (hereinafter "COUNTY") such governments
acting herein under the authority and pursuant to the terms of the Texas Government
Code, Section 791.001 et seq., known as the "Interlocal Cooperation Act.
WHEREAS, the COUNTY desires to provide for fire protection and emergency
services for life and property of its residents that live outside the jurisdiction of the CITY;
and,
WHEREAS, the CITY owns certain trucks and other equipment designed for and
capable of being used in the protection of persons and property from and in the
suppression and the fighting of fires and has assigned individuals trained in the use of
such equipment; and,
WHEREAS, the CITY has authority to enter into contracts providing for the use of
fire ttucks and other fire protection and fire-fighting equipment for citizens outside of its
jurisdiction; and
WHEREAS, in exchange for the fire services to be provided by CITY hereunder,
the COUNTY shall provide funds with an annual adjustment each year using the
Municipal Cost Index ("MCI") as measured from June 1 st of each year to the prior June
1st of each year. If there is a decrease in the MCI, there shall be no adjustment for that
year; and,
NOW, THEREFORE, for and in consideration of the mutual benefits to be derived
by each ofthe patties hereto, said parties agree and covenant as follows:
1
Section 1: SERVICES AND CONDITIONS
The CITY shall provide to the COUNTY fire suppression services and to dispatch
equipment and/or personnel in accordance with and subject to the terms and conditions
hereinafter set forth. It is specifically agreed that:
1.1 The CITY agrees to furnish emergency fire suppression services upon a
request for assistance from the 911 dispatcher or county volunteer fire depmiments within
the County.
1.2 The CITY'S Public Safety Director or his designee shall be the sole judge
of the type and amount of equipment and manpower dispatched in response to a request
for assistance.
1.3 Any request for aid hereafter shall include a statement of the amount and
type of equipment and number of personnel requested, and shall specify the location to
which the equipment and personnel are to be dispatched.
1.4 The CITY shall report to the officer in charge of the requesting pmiy at the
location to which the equipment and/or personnel is dispatched and there, to render the
assistance required.
1.5 The CITY shall be released by the requesting pmiy when such services of
the CITY are no longer required or when the CITY must respond to another emergency.
The authorized official of the CITY, may detelmine in the official's own discretion that
the health, safety and welfare of the CITY'S personnel may be endangered by any order
of the requesting party, and may withdraw all of CITY'S personnel from the scene.
1.6 Although the CITY shall endeavor to respond to all requests for assistance,
nothing herein is to be interpreted as imposing any duty or obligation upon the CITY to
respond to any fire emergency. The provision of fire protection service to each paliy's
own area of responsibility shall always remain the primary function of that pmiy.
1.7 In the event the CITY cannot or is unable to respond to a request for
assistance, the CITY'S authorized official shall immediately notify the party requesting
such assistance.
1.8 The CITY'S Director of Public Safety, in accordance with the terms of this
agreement, shall consult with COUNTY as necessary with respect to the implementation
of additional policies and procedures for improving the provision of fire protection
services in response to requests for assistance.
2
1.9 The CITY shall maintain insurance coverage on each of its motor vehicles
and personnel.
Section 2: INDEMNITY CLAIMS
2.1 All claims for worker compensation benefits arising out of this agreement
shall be the sole responsibility of the party who is the employer of the employee filing
such claim.
2.2 At no time shall the employees of a responding party be considered to be
borrowed servants or on loan to the requesting party under this agreement.
Section 3: TERM and PAYMENT
3.1 This agreement shall remain in effect through December 31, 2013, provided
that it shall automatically be renewed for a one year period unless any party hereto shall
give the other pmty written notice on or before ninety (90) days prior to the renewal date,
at which time this agreement shall tenuinate at the end of the ninety (90) day period.
3.2 COUNTY shall pay CITY the sum of $178,500.00 on or before March 31,
2013 for the provision of fire services by the CITY for the COUNTY budget year
Janum')' 1, 2013 to December 31, 2013. On or before July 1, 2013, the CITY shall
calculate the annual adjustment for the 2014 budget year using the change in the
Municipal Cost Index ("MCI") as measured from June 1,2012 to June 1, 2013 and said
percentage change shall be multiplied by $178,500.00. The COUNTY shall be notified
of the new amount as soon as practicable after the calculation is determined. If there is a
decrease in the MCI, there shall be no adjustment for that year. A like calculation shall
be made by the CITY and provided to the COUNTY for budgeting purposes as soon as
practicable after the June 1st index is published each year. The percentage increase, if
any, shall be multiplied by the then rate in effect under this Agreement. Following the
calculation, said amount shall be the amount charged under this Agreement for the
subsequent year.
Section 4: GENERAL TERMS
4.1 The pmiies hereto may telminate this Agreement without recourse or
liability, upon ninety (90) days written notice of their intent to tenuinate to the other
party.
4.2 This agreement shall supersede any previous agreements. It may only be
amended in writing and signed by all palties.
3
Approved at a duly called meeting of the City of Port Lavaca on the 15 day
of October, 2012.
(,~
ATIEST:,
p
/y . (I '[ T
.V\~U~Arl-.\. .
MANDY GRANT!
CITY SECRETAruYJ
\,/
Approved at a duly called meeting of the Commissioner's Court of Calhoun
County on the ~ day of () ck'cl2r ,2012
ATIEST:
Anita Fricke, Calhoun County Clerk
By: ~ t&~
Deputy C rk
4
INTERLOCAL AGREEMENT FOR ANIMAL CONTROL SERVICES BETWEEN CITY OF PORT LAVACA
AND CALHOUN COUNTY AND AUTHORIZE COUNTY JUDGE TO SIGN:
Judge Pfeifer:
Same agreement, same price: $65,000.
A Motion to approve the agreement for animal control services was made by Commissioner Finster and
seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
INTERLOCAL AGREEMENT FOR ANIMAL CONTROL SERVICES
STATE OF TEXAS S
S
COUNTY OF CALHOUN S
THIS Interlocal Agreement, entered into to be effective on the 1st day of January,
2013, by and between the CITY of PORT LA V ACA, Texas, a Texas Home Rule City, of
Calhoun County (hereinafter "CITY"), by and through its duly authorized City Manager
or Mayor, and by and between the COUNTY OF CALHOUN, through its duly authorized
County Judge, (hereinafter "COUNTY"), such governments acting herein under the
authority and pursuant to the terms of the Texas Government Code, Section 791.001 et
seq., known as the "Interlocal Cooperation Act."
WHEREAS, the COUNTY to secure for unincorporated areas of the County the
benefits of Animal Control; and,
WHEREAS, the CITY being in possession of equipment, trained personnel and
licensed facilities for the use in small animal control; and
WHEREAS, CITY has authority to enter into contracts providing for small animal
control services for citizens outside its jurisdictional limits; and
WHEREAS, COUNTY is desirous of obtaining said animal control services to
protect the health and safety of residents in the unincorporated areas of County; and
WHEREAS, for the small animal control services rendered hereunder, the
COUNTY shall pay to CITY the amount of ($65,000) for the below described small
animal control services in the unincorporated areas of Calhoun County; and,
1
NOW, THEREFORE, for and in consideration of the mutual benefit to be derived
by each of the parties hereto, said parties agree and covenant as follows:
1. SERVICES AND CONDITIONS
1.1 The CITY will provide personnel, equipment and facilities for the control,
impoundment and euthanasia of animals according to the laws of the State of Texas.
1.2 The CITY shall maintain its equipment and facilities in accordance with all laws
applicable to such and shall train its Animal Control Officer(s) as required by law, all of
which are at CITY expense.
1.3 The CITY shall respond to calls from County residents and the Calhoun County
Sheriffs Office for detainment, impoundment and euthanasia of small animals.
1.4 The CITY shall maintain applicable insurance coverage on each of its motor
vehicles and personnel.
1.5 It is the intent of the patties that this Agreement covers small animals such as dogs,
cats, etc. Lmge animals, like livestock, at'e not covered by this Agreement.
2. INDEMNITY CLAIMS
2.1 All claims for workers compensation benefits arising out of this agreement shall be
the sole responsibility of the party who is the general employer of the employee filing
such claim.
2.2 At no time shall the employees of a responding patty be considered to be bon-owed
servants or on loan to the requesting patty under this agreement.
2
3. TERM and TERMINATION
3.1 This Agreement shall be for one (1) year beginning January 1, 2013. This
agreement shall automatically be renewed for a one year period unless any party hereto
shall give the other party written notice on or before October 1 st of each year.
3.2 Notwithstanding any notice to te1roinate, all rights, duties, and responsibilities of the
parties are unaffected for the remainder of the tetro.
4. ENTIRE AGREEMENT
This agreement shall take the place of and supersede any previous agreements; it
shall only be amended in writing and signed by all parties.
Approved at a duly called meeting of the City of Port Lavaca on the 15 day of
October, 2012.
f~
,MAYOR
ATTEST:
'"~ c' ~--It--
. .. V ~O--v~ ... /eel-y,V
MANDY GRANT IJ.
ClTY SECRETARY:
3
Approved at a duly called meeting of the Commissioner's Court of Calhoun
County on the ;;$""" day of oc4--ohe..r
,2012
V\IlA vLvJ ~ f/if-l-
MICHAEL J. <EIF R, COUNTY JUDGE
ATTEST:
Anita Fricke, Calhoun County Clerk
BY:~~
Deputy erk
4
CHANGE THE SECOND COMMISSIONERS' COURT MEETING DATE IN NOVEMBER TO NOVEMBER
19TH DUE TO THE THANKSGIVING HOLIDAY:
A Motion to change the Commissioners' Court meeting date to November 19 was made by Commissioner Finster
and seconded by Commissioner Fritsch.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
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GLO CONTRACT NO. 12-617-000-7021- ClAP AWARD IN THE AMOUNT OF $2,101,271.00 AND
AUTHORIZE ALL APPROPRIATE SIGNATURES:
Judge Pfeifer:
This is the Federal part of the grant for Green Lake Acquisition. We still have another $1,000,000+ coming from
our part of the State [funds].
A Motion to approve the GLO contract was made by Commissioner Galvan and seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
I
Texas General Land Office
Legal Services Division - MC 158
PO BOX 12873 / Austin, TX 78711-2873
512.475.2225 - judy,coover@glo.texas.gov
TRANSMITTAL OF DOCUMENTS - OCTOBER 16, 2012
i!"?EGf;iVi:-fJ
The Honorable Michael Pfeifer
Calhoun County Judge
211 S. Ann Street, Suite 301
Port Lavaca, TX 77979
'I ()
. ()
I)
RE: GLO CONTRACT No. 12-617-000-7021-CIAP AWARD
Dear Judge Pfeifer:
Enclosed concerning the GLO document referenced above is one full original document
plus the execution page(s) from the GLO's original. Please have the documents signed where
indicated by the official authorized to bind the County, and return onlv the six (6) sie:natnre
~, directly to my attention, in the enclosed envelope. I will promptly return fully-executed
signature page(s) to rejoin with your original document.
Please do not hesitate to contact me if you have any questions. I can be reached at (512)
475-2225 or by email at iudv.coover@glo.texas.gov.
Ju )\ Coover, Contract Manager
Custodian, External Funds
GLO Legal Services Division
enclosures
TEXAS GENERAL LAND OFFICE
LEGAL SERVICES DIVISION - MC 158
1700 N. CONGRESS AVENUE 78701/ PO BOX 12873/ AUSTIN, TX 78711-2873
Texas General Land Office
Legal Services Division - MC 158
PO BOX 12873 / Austin, TX 78711-2873
512.475.2225 - judy,coover@glo.texas.gov
TRANSMITTAL OF DOCUMENTS - OCTOBER 31,2012
The Honorable Michael Pfeifer
Calhoun County Judge
211 S. Ann Street, Suite 301
Port Lavaca, TX 77979
RE: GLO CONTRACT No, 12-617-000-7021- ClAP AWARD
Dear Judge Pfeifer:
Enclosed concerning the GLO document referenced above is one full set of signature
pages to rejoin with your original document.
Please do not hesitate to contact me if you have any questions. I can be reached at (512)
475-2225 or by email at iudv.coover@,glo.texas.gov.
Ju y, Coover, Contract Manager
Custodian, External Funds
GLO Legal Services Division
enclosures
TEXAS GENERAL LAND OFFICE
LEGAL SERVICES DIVISION - MC t58
1700 N. CONGRESS AVENUE 78701 / PO BOX 12873/ AUSTIN, TX 78711-2873
,r "
,
SIGNATURE PAGE FOR GLO CONTRACT No. U-617-000-7021
Larry L. Laine, Ie Clerk/
Deputy Land Commissioner
(0 (L4llt.-
Date of execution:
~~;~AL f!~;y
AGC
GC
CALHOUN COUNTY
~(Av-JJ 9- f}fJ--
By: Michael J. Pfeifer
Title: Calhoun County Judge
Date of execution: 10-25-12
ATTACHMENTS TO THIS CONTRACT:
ATTACHMENT A:
ATTACHMENTB:
ATTACHMENT C:
ATTACHMENTD:
ATTACHMENT E:
ATTACHMENT F:
ATTACHMENT G:
Work Plan and Project Budget
ClAP Supplemental Telms and Conditions
USFWS Financial Assistance Award Agreement with the GLO for
USFWS Award No. Fl2AF00873
Federal Assurances Construction (SF-424D) or Non-
Construction (SF-424B), as applicable
Standard FOlm-5l2, Certifications Regarding Lobbying; and
Standard Form LLL, Disclosure of Lobbying Activities
General Affirmations
Sample Additional Required Forms:! Monthly Progress Report;
ClAP Invoice Form; Budget Amendment Request FOlm; HUB
Expense Reporting Form; Audit Reporting Form
ATTACHMENTS FOLLOW
I Additional required forms may be revised from time to time, and should be downloaded at
http://www.glo .texas. govlwhat -we-do/caring- for-the-coastlgrants- funding/ciap/grantee-requirements.html before
each usage.
, ,
, ,
, ,
, ,
Attachment D (Page 2 of 2)
11, Will comply, or has already compiled, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally-assisted
programs, These requirements apply to all interests In reai
property acquired for project purposes regardless of
Federal participation in purchases.
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
551501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded In whole or In part with Federal funds.
13. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U,S.C. 55276a to 276a-7), the Copeland Act
(40 U.S.C. 5276c and 18 U.S.C. 5874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. 53327-
333) regarding labor standards for federally-assisted
construction sub agreements.
14. Will comply with !load Insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P .l. 93-234) which requires recipients In a special !load
hazard area to participate in the program and to purchase
flood Insurance If the total cost of insurable construction
and acquisition is $10,000 or more.
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) Institution of
environmental quality control measures under the
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
(V\Jl()~/l-JY
APPLICANT ORGANIZATION
Calhoun County
National Environmental Policy Act of 1969 (P.l. 91-
190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738: (c)
protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in !loodplains In accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
developed under the Coastal Zone Management Act of
1972 (16 U.S.C. 351451 et seq.): (f) conformity of
Federal actions to State (Clean Air) Implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. 337401 et seq.): (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P.l. 93-523); and, (h) protection of
endangered species under the Endangered Species Act
of 1973, as amended (P.L. 93-205).
16, Will comply with the Wild and Scenic Rivers Act of
1968 (16 U,S.C. 331271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
17. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U,S.C. 3470), EO 11593
(Identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U,S.C. %469a-1 et seq.).
18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, local Governments, and Non-Profit
Organizations."
19. Will comply with ali applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
TiTLE
Calhoun County Judge
DATE SUBMITTED
10-25-12
THIS PAGE MUST BE EXECUTED BY SUBRECIPIENT
SF-424D (Rev. 7-97) Back
FORM CQ'~1,f
IReV12-04)
Attaclunent E
Page 1 of 3
U,s. oePARtMwoF'COMMaRCc
CERTIFICATION REGARDING LOBB\'1NG
LOWER Tll!:R COVERED TRANSACTIONS
Applicants should review the Instrucllons for certification Included In the regul~tlons b~fore completing this form, Signa!ure
on Ihls form provides for compliance wllh certification requirements under 15 CFR Part 28, 'New ReWlctlons on LObbying:
LOBBYING
As required by Section 1352, Title 31 of the U.S. Code, and
i1T1jlie~tedai 1SCFR Part 28, for parsons.entering Into a gran~
coopef!llJVe llQreement or contract over $100,000 or a loan or loan
9\laf1!l1~pver$150,000 as defined at 15 CFR PaIt 28, Sections
28.105 and 28,110, the applicantcertffies ll1at to ll1e best of his or her
knowledge and bE>lief, that
(1) No Federal appropriated funds have bean paid or will bE> paid,
by or on b!>haW Of !he undersigned, 10 any person for i1f1uene1ng or
attempting to influence an officer or employ.... of any egency, a
Member of Congress In conncection with the awarding of any
Federal C<lntraGt, the making of any Federal grant, !he making of
any Pe<j~ralloen, the entering into of any cooperative llQreement,
and the extension, continuation, renewal, amendment, or
medification of any Federal contract, grant, loan, or cooperative
llQreemenl
(2) It any funds other than Federal appropriated funds have been
paid ClrViiJibil,i?Wd to any person for Influencing or attempting to
Infi~enqe'lln o!flpar or employ"" of any Il\lency, a Member of
CoJ'Ig[~,anqllicef or employee of Congtes$, or an employee of a
m6ll1bilt\9~S9Pgll!S!!ln connection with this Federal contraGt, gran~
i<r,l!1,qr~tivall9reeman~ the undersigned shall complete and
SUbilJiJ~M! FpIffiliL, 'Disclosure Form 10 Report Lobbying."
In a<;Cdrdan<;a wilh Ils Instructions.
(3) Thayn1a~lg~edshall require that the language of this
cerllfi""tipn'b<li'nFi(Jd!l9 In the award documents for all subawards at
all tl~tll'~nCl@It1lls~\,(;~lOtracts. subgrants, and contracts under
granill,l\J!Ins,Md !X)OpilraUve llIJreamenls) and that all subrecipients
shall certify and disclose aa:onJlngly,
This C\ltlIficaJion Is a material representation of fact upon which
reI~Wes~whenlhl&lransedJoo W8Ii made Of entered into.
SUbmt,,~iO,n Of thte certlficaUon is a prareqytsija for making or
ent8llnQ into 1l1!$ trsrlSl;lC\iOn ~ bYSectlQhI352, UIIe 31, U.S.
Code. My pel1QO wh(>faJIs to file !he ~~Ollr!lftcation shell be
subject to a plvll penalty of not le.e than $10,000 and not mora
than $100,000 fOr eeoh euch failure oecurrlng on or before
October 23, 1996, and of nolles. than $11,000 and not mora
lhan $110,000 for each such failure occurring aner October 23,
1996,
Statement for Loan Guaranteus and Loan Insurance
The undersigned .tates, to the best of his or her knowledge
and belief, that:
In any funds have be'en paid or will be paId to any person for
influencing or attempting to Influence a ^ ee
of any agency, a Member of Congress,a. e
of Congress, or an employae of a Ma 'In
connectiOn with this commitment providing for ad
Slates to Insure or guerantee a loan, the undersigned shall
complete and submit standard Fom-LLL, "Dlsdosure Fom
10 Report Lobbying," in accordance with IIll Instrucllons.
Submission of this statement Is a prerequisite for making or
enteong Into this transaollon Imposed by seotlon 1352, tille
31, U.S. Code. Any parson who fells to flle tha required ~t~l....
ment shall be subject to a civil penalty of not less than $1d,OOO
and not more than $100,000 for eech such failure occurring
on or be/ore October 23, 1996, end of not les. than $11,00,0
end not more than $110,000 for each such failure occurring
after October 23, 1996.
As the ~1I1)'allthorlzed tflllresentatlva of the applicant, I hereby certify that tha applleant wI/I compl)' with the
above appl/cable certification.
NAME OF APPLICANT
Calhoun County
PRINTED NAME AND TITLE OF AUTHORtZED REPRESENTATIVE
Michael J, Pfeifer, Calhoun County Judge
SIGNATURE /
AWARD NUMBER ANO/OR PROJECT NAME
F12AF00873
DATE
10-25-12
SUBRECIPIENT GRANT AGREEMENT
GLO CONTRACT No. 12-617-000-7021
COASTAL IMPACT ASSISTANCE PROGRAM
USFWS FINANCIAL ASSISTANCE AWARD NUMBER F12AF00873
This Subrecipient Grant Agreement (the "Contract") is entered into by and between the
GENERAL LAND OFFICE (the "GLO" or "Recipient"), a State agency, and CALHOUN COUNTY
("Subrecipient") to provide financial assistance using funds received under U.S. Fish and
Wildlife Service ("USFWS") Financial Assistance Award Number F12AF00873 for the project
entitled "Green Lake Acquisition."
ARTICLE 1- GENERAL PROVISIONS
1.01 PURPOSE
The purpose of this Contract is to set forth the terms and conditions of a Subgrant from the
GLO to the Subrecipient under the Coastal Impact Assistance Program ("ClAP").
1,02 CONTRACT DOCUMENTS
The GLO and Subrecipient hereby agree that this document and the following
Attachments, which are incorporated in their entirety for all purposes, either physically or
by reference, shall govern this Contract:
ATTACHMENT A: Work Plan and Project Budget
ATTACHMENT B:
ATTACHMENT C:
ATTACHMENT D:
ATTACHMENT E:
ATTACHMENT F:
ATTACHMENT G:
ClAP Supplemental Terms and Conditions
USFWS Financial Assistance Award Agreement to the GLO for
Award No. F12AF00873
Federal Assurances, as applicable - Construction (SF-424D) or
Non-Construction (SF-424B)
Certification Regarding Lobbying Lower Tier Covered
Transactions (CD-5l2); and Disclosure of Lobbying Activities
Form (SF-LLL)
General Affirmations
Sample Additional Required Forms: Monthly Progress Report;
ClAP Invoice Form; Budget Amendment Request Form; HUB
Expense Reporting Form; Audit Reporting Form
GLO Contract No. 12-617-000-7021
Page 1 ofl8
1.03 DEFINITIONS
"Act" means Section 384 of the Energy Policy Act of 2005, Public Law 109-58, 109th
Congress, 119 Stat. 739 (August 8, 2005) (amending the Outer Continental Shelf Lands
Act, Title 43, United States Code, Section 1356a).
"Administrative and Audit Regulations" means the regulations included in Title 43, Code
of Federal Regulations, Part 12.
"Budget" means the budget for the Project funded by the Contract, a copy of which is
included in Attachment A,
"ClAP" means the Coastal Impact Assistance Program.
"ClAP Supplemental Terms and Conditions" means the agreed terms and conditions
applicable to this Contract and attached hereto as Attachment B.
"CMP Rules" means the rules set forth in Chapters 501 through 505 of Title 31 of the
Texas Administrative Code for the Texas Coastal Management Program, authorized by
statute in Chapter 33, Subchapter F, of the Texas Natural Resources Code.
"Coastal Impact Assistance Program" means the federal grant program for certain coastal
states, as authorized by the Act and managed by the U.S. Fish and Wildlife Service, a
bureau of the U.S. Department of the Interior. The State of Texas uses the GLO as
administrative support for the ClAP program.
"Compliant Format" means the format for electronically stored information that complies
with the standards set forth in Section 2.4 of Attachment B.
"Deliverable(s)" means the work product(s) required to be submitted to the GLO as set
forth in the Work Plan.
"Equipment" means tangible personal property having a useful life of more than one (I)
year and an acquisition cost of Five Thousand Dollars ($5,000.00) or more per unit.
"Event of Default" means the occurrence of any of the events set forth in Section 8.01
herein.
"Federal Assurances" means Standard Form 424B (Rev. 7-97), as prescribed by OMB
Circular A-102 (non-construction projects); or Standard Form 424D (Rev. 7-97), as
prescribed by OMB Circular A-I02 (construction projects), in Attachment D, attached
hereto and incorporated herein for all purposes.
"Federal Certifications" means U.S. Department of Commerce Form CD-512 (Rev 12-
04), "Certification Regarding Lobbying Lower Tier Covered Transactions," in
Attachment E, attached hereto and incorporated herein for all purposes.
"Final Report" means a written report that must be received by the GLO upon completion
of the Work Plan, as set forth in Section 4.02 herein.
"Financial Assistance Award" means the financial award made to the GLO by the
USFWS under the ClAP, providing funding for the Project under this Contract; may be
used interchangeably with "Grant."
GLO Contract No. 12-617-000-7021
Page 2 of18
"Financial Assistance A ward Agreement" means the formal grant agreement between the
GLO and USFWS; USFWS Financial Assistance Award Number F12AF00873, for the
period ending April 30, 2013, making funding available to the State of Texas under the
ClAP for the Project. A copy of the Agreement is attached hereto as Attachment C.
"GAAP" means "generally accepted accounting principles" as applicable.
"GASB" means accounting principals as defined by the Governmental Accounting
Standards Board.
"General Affirmations" means the affirmations in Attachment F, attached hereto and
incorporated herein for all purposes, to which Subrecipient certifies by the signing of this
Contract.
"Grant" means the financial award made to the GLO by the USFWS under the ClAP,
providing funding for the Project under this Contract; may be used interchangeably with
"Financial Assistance Award."
"Grant Administrator" means the GLO staff member assigned to monitor the Project, as
may be designated from time to time by the GLO.
"Grant Administration Form" means one of the several forms required to be submitted
under this Contract, copies of which are included in Attachment G.
"HUB" means Historically Underutilized Business as defined by Chapter 2161 of the
Texas Government Code.
"Monthlv Reports" means written progress reports that must be received by the GLO as
set forth in Section 4.02 herein.
"Plans" means the engineering specifications, construction plans, and/or architectural
plans for the construction of improvements approved by the GLO for the Project, if any.
"Project" means the Green Lake Acquisition project which this Subgrant will fund, as
defined in Attachment A hereto.
"Public Information Act" means Chapter 552 of the Texas Government Code.
"Recipient" means the GLO, which is the ClAP recipient under the Financial Assistance
Award to which this Contract relates.
"Subgrant" means pass-through funds received through the Financial Assistance Award
under the ClAP and approved for use by the Subrecipient in accordance with the terms of
this Contract.
"Subrecipient" means the entity to which the Subgrant is made, which is the same entity
as the "subrecipient" and the "sub grantee" as referred to in the Financial Assistance
Award Agreement and in Title 43, Code of Federal Regulations, Part 12.
"Supplement" means the ClAP Supplemental Terms and Conditions document attached
hereto as Attachment B.
"USFWS" means the U. S. Fish and Wildlife Service, a bureau ofthe U.S. Department of
the Interior.
"Work Plan" means the statement of work and special conditions, if any, contained in
Attachment A.
GLO Contract No. 12-617-000-7021
Page 3 ofI8
1.04 INTERPRETIVE PROVISIONS
(a) The meanings of defined terms are equally applicable to the singular and plural
forms of the defined terms;
(b) The words "hereof," "herein," "hereunder," and similar words refer to this
Contract as a whole and not to any particular provision, section, attachment, work
order, or schedule of this Contract unless otherwise specified;
(c) The term "including" is not limiting, and means "including without limitation"
and, unless otherwise expressly provided in this Contract,
(i) references to contracts (including this Contract) and other contractual
instruments shall be deemed to include all subsequent amendments and
other modifications thereto, but only to the extent that such amendments
and other modifications are not prohibited by the terms of this Contract,
and
(ii) references to any statute or regulation m'e to be constmed as including all
statutory and regulatory provisions consolidating, amending, replacing,
supplementing, or interpreting the statute or regulation;
(d) The captions and headings of this Contract are for convenience of reference only
and shall not affect the interpretation of this Contract;
(e) All attachments within this Contract, including those incorporated by reference,
and any amendments, are considered part of the terms of this Contract;
(1) This Contract may use several different limitations, regulations, or policies to
regulate the same or similar matters. All such limitations, regulations, and
policies are cumulative and each shall be performed in accordance with its terms;
(g) Unless otherwise expressly provided, reference to any action of the GLO or by the
GLO by way of consent, approval, or waiver shall be deemed modified by the
phrase "in its/their sole discretion."
Notwithstanding the preceding sentence, any approval, consent, or waiver
required by, or requested of, the GLO shall not be unreasonably withheld or
delayed;
(h) All due dates and/or deadlines referenced in this Contract that occur on a weekend
or holiday shall be considered as if occurring on the next business day;
(i) All time periods in this Contract shall commence on the day after the date on
which the applicable event occurred, report is submitted, or request is received;
and
CD Time is of the essence in this Contract.
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GLO Contract No. 12-617-000-7021
Page 4 of 18
ARTICLE 2 - FINANCIAL ASSISTANCE AWARD AND SCOPE OF PROJECT
2.01 FINANCIAL ASSISTANCE AWARD
Subrecipient submitted an application for Subgrant funds under Texas' ClAP. USFWS
has made the Financial Assistance Award to Recipient based on Subrecipient's
application.
Subject to the terms and conditions of this Contract, the GLO agrees to make a Subgrant
to Subrecipient in an amount not to exceed Two MILLION ONE HUNDRED ONE
THOUSAND Two HUNDRED SEVENTY-ONE DOLLARS ($2,101,271.00), payable in
installments as reimbursement of allowable expenses incurred by Subrecipient, to be used
in strict conformance with the Budget in Attachment A hereto, and the Financial
Assistance A ward Agreement in Attachment C.
rt is expressly understood and agreed by Subrecipient that the GLO shall have the right to
recapture, and to be reimbursed for, any payments made by the GLO under this Contract
that Subrecipient has not used in strict accordance with the terms and conditions of this
Contract and the Financial Assistance Award Agreement. THIS RECAPTURE PROVISION
SHALL SURVIVE THE TERMINATION OR EXPIRATION OF THE CONTRACT.
The GLO is not liable to Subrecipient for any costs incurred by Subrecipient before the
effective date of this Contract, or after its termination. However; the GLO, in its sole
discretion, may reimburse Subrecipient for allowable program costs incurred prior to the
effective date of this Contract.
2.02 INCORPORATION OF FINANCIAL ASSISTANCE AWARD TERMS
The Financial Assistance Award Agreement authorizes the use of the Subgrant by
Subrecipient for the Project in accordance with the terms of the Financial Assistance
Award Agreement and applicable state and federal law.
Recipient and Subrecipient understand and agree that any and all terms and provisions of
the Financial Assistance A ward Agreement that apply to the Recipient by operation of
this Contract are also applicable to Subrecipient.
2,03 PROJECT AND WORK PLAN
The Project shall be performed in accordance with the Work Plan in Attachment A; the
Supplemental Terms and Conditions in Attachment B; the description in the Financial
Assistance Award Agreement in Attachment C; the assurances and certifications in
Attachments D and Ej and the General Affirmations in Attachment F.
The Work Plan or the scope of the Project may be amended by the Grant Administrator
upon submission of a written request and detailed justification by Subrecipient, in the
manner prescribed in Supplement Article 1, Grant Administration, in Attachment B.
Modifications may require the approval of the USFWS, which may cause significant
delays. ANY COSTS INCURRED WHILE WAITING FOR APPROVAL OF THE REQUESTED
CHANGES ARE THE RESPONSIBILITY OF SUBRECIPIENT. THE GRANT ADMINISTRATOR
WILL INFORM SUBRECIPIENT IF THE REQUEST IS APPROVED.
GLO Contract No. 12-617-000-7021
Page 5 oflB
2,04 REAL ESTATE IMPROVEMENTS AND LAND ACQUISITION REQUIREMENTS
If applicable, Subrecipient should ensure compliance with Supplement Alticle 4, Special
Conditions Applicable to Real Estate. Improvements and Land Acquisitions, in
Attachment B.
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GLO Contract No. 12-617-000-7021
Page 6 oflB
Article 3 - TERM
3.01 DURATION AND EXTENSION OF TERM
This Contract shall be effective as of the date executed by the last party, and shall
terminate upon completion of the Project, or on March 30, 2013, whichever occurs first.
Upon receipt of a written request and acceptable justification from Subrecipient to the
Grant Administrator and approval from the USFWS, the Grant Administrator may extend
this' Contract for a period not to exceed twelve (12) months. ANY REQUEST FOR
EXTENSION MUST BE RECEIVED BY THE GRANT ADMINISTRATOR AT LEAST SIXTY (60)
DAYS BEFORE THE ORIGINAL TERMINATION DATE OF THIS CONTRACT.
3.02 EARLY TERMINATION
The GLO may terminate this Contract by giving written notice specifYing a termination
date at least thirty (30) days subsequent to the date of the notice. Upon receipt of such
notice, Subrecipient shall cease work, undertake to terminate any relevant subcontracts,
and incur no further expense related to this Contract. Such early termination shall be
subject to the equitable settlement of the respective interests of the patties, accrued up to
the date of termination.
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GLO Contract No. 12-617-000-7021
rage 7 ofl8
ARTICLE 4 - GRANT ADMINISTRATION
4,01 SUBMISSIONS
Except for legal notices that must be sent by specific instrucIions under Section 9.07
below, any written report, form, or request required to be submitted to the Grant
Administrator under this Contract shall be sent in Compliant Format via email to the
following email address:
ciapreceiptslalglo. texas. gOV
4.02 REPORTS
Subrecipient shall submit Monthly and Final Reports, as required in the Work Plan, in
Compliant Format to the Grant Administrator at the time and in the manner prescribed in
Supplement Article I, Grant Administration, in Attachment B.
4.03 DELIVERABLES
Subrecipient shall submit each of the Deliverables, as required in the Work Plan, in
Compliant Format to the Grant Administrator at the time and in the manner prescribed in
Supplement Article 1, Grant Administration, in Attachment B.
The GLD may require Subrecipient to conform any data presentation or products funded
under this Contract to reflect GLD comments.
Deliverable due dates may be amended by the Grant Administrator upon submission of a
written request and detailed justification by Subrecipient, and written approval by the
Grant Administrator. Such exchanges may be made by regular mail, electronic mail, or
facsimile transmission. Modifications may require the approval of the USFWS, which
may cause significant delays. THE GRANT ADMINISTRATOR WILL INFORM
SUB RECIPIENT IF THE REQUEST IS APPROVED.
4,04 REIMBURSEMENT REQUESTS
Subrecipient shall submit requests for reimbursement for costs allowed under this Contract
at the time and in the manner prescribed in Supplement Article 1, Grant Administration, in
Attachment B.
REQUESTS FOR REIMBURSEMENT UNDER THIS CONTRACT MUST BE RECEIVED BY THE
GLO NOT LATER THAN SIXTY (60) DAYS FROM THE DATE SUBRECIPIENT INCURS THE
EXPENSE. FAILURE BY SUBRECIPIENT TO COMPLY IN A TIMELY MANNER WITH THIS
REQUIREMENT MAY, AT THE GLO's SOLE DISCRETION, RESULT IN DENIAL OF THE
REQUEST FOR REIMBURSEMENT.
Failure by Subrecipient to submit a Deliverable in a timely manner may, at the GLD's
sole discretion, result in withholding of a percentage of the reimbursement request until
Subrecipient submits said Deliverable.
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GLO Contract No. 12-617-000-7021
Page 8 of 18
4.05 BUDGET VARIANCE
Subrecipient may request pelmission to reallocate funding among budget categories by
submitting a written request and detailed justification to the Grant Administrator in the
manner prescribed in Supplement Article I, Grant Administration, in Attachment B.
A Budget reallocation shall be effective upon receipt of the Grant Administrator's approval.
A FINAL, ACTUAL BUDGET SHALL BE SUBMITTED BY SUBRECIPIENT NO LATER THAN
SIXTY (60) DAYS FOLLOWING THE EXPIRATION OR TERMINATION OF THIS CONTRACT,
4.06 ADDITIONAL GRANT COMPLIANCE REQUIREMENTS
Subrecipient shall comply with additional provisions relating to Grant Administration
required by state and federal law in Supplement Article I, Grant Administration in
Attachment B,
Subrecipient understands and agrees to the terms included in the Supplement that require
assurances, affirmation, actions, and activities to fulfill state and federal legal
requirements. These requirements include, but are not limited to, GLO electronically
stored information standards, acknowledgement of source of funds, special conditions for
real estate improvements and land acquisitions, federal assurances, coastal management
consistency declaration, and historically underutilized business plans. The information
included in the Supplement is current as of the date of the execution of the Contract, but
it is the sole responsibility of the Subrecipient to ensure that it complies with the
applicable legal requirements at any given time.
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GLO Contract No. 12-617-000-7021
Page 9 of 18
ARTICLE 5 - FEDERAL FUNDING I STATE FUNDING I
RECAPTURE OF FUNDS I OVERPAYMENT
5.01 FEDERAL FUNDING
(a) Funding for this Contract is appropriated under Section 384 of the Energy Policy
Act of 2005, Public Law 109-58, I09th Congress, 119 Stat. 739 (August 8, 2005)
(amending the Outer Conlinental Shelf Lands Act, Title 43, United States Code,
Section l356a), and made available through a Financial Assistance Award
managed by the U.S. Fish and Wildlife Service, a bureau of the U.S. Department
of the Interior. The fulfillment of this Contract is based on those funds being
made available to the GLO as the lead administrative state agency. All
expenditures under this Contract must be made in accordance with this Contract,
the rules and regulations promulgated under the ClAP Program, and any other
applicable laws. FUliher, Subrecipient acknowledges that all funds are subject to
recapture and repayment for non-compliance.
(b) All participants in the ClAP grant program must have a data universal
numbering system (DUNS) number, as well as a Commercial And
Government Entity (CAGE) Code.
(c) The DUNS number and CAGE Code must be reported to the GLO for use in
various grant reporting documents, and may be obtained by visiting the
System for Award Management web site at:
sam.gov
Assistance with this web site may be obtained by calling 866-606-8220,
5,02 STATE FUNDING
(a) This Contract shall not be construed as creating any debt on behalf of the State of
Texas and/or the GLO in violation of Atiicle III, Section 49, of the Texas
Constitution. In compliance with Article VIII, Section 6 of the Texas Constitution, it
is understood that all obligations of the GLO hereunder are subject to the availability
of state funds. If such funds are not appropriated or become unavailable, this
Contract may be terminated. In that event, the patiies shall be discharged from
further obligations, subject to the equitable settlement of their respective interests,
accrued up to the date of termination.
(b) Furthe1more, any claim by Subrecipient for damages under this Contract may not
exceed the amount of funds appropriated for payment, but not yet paid to
Subrecipient, under the annual budget in effect at the time of the breach. Nothing
in this provision shall be construed as a waiver of sovereign immunity.
5.03 RECAPTURE OF FUNDS
Subrecipient shall conduct, in a satisfactory manner as determined by the GLO, the
Project as set f01ih in the Contract. The discretionary right of the GLO to terminate for
GLO Contract No. 12-617-000-7021
Page 10 oftS
convenience under SECTION 3,02 notwithstanding, it is expressly understood and agreed
by Subrecipient that the GLO shall have the right to terminate the Contract and to
recapture, and be reimbursed for any payments made by the GLO (i) that exceed the
maximum allowable rates; (ii) that are not allowed under applicable laws, mles, and
regulations; or (iii) that are otherwise inconsistent with this Contract, including any
unapproved expenditures.
5,04 OVERPAYMENT
Subrecipient understands and agrees that it shall be liable to the GLO for any costs
disallowed pursuant to financial and/or compliance audit(s) of funds received under this
Contract. Subrecipient further understands and agrees that reimbursement of such
disallowed costs shall be paid by Subrecipient from funds which were not provided or
otherwise made available to Subrecipient under this Contract.
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GLO Contract No. 12-617-000-7021
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ARTICLE 6 - INTELLECTUAL PROPERTY
6,01 OWNERSHIP AND USE
(a) The parties to this Contract expressly agree that all right, title, and interest in, and to, all
reports, drafts of reports, or other material, data, drawings, computer programs and
codes associated with this Contract, and/or any copyright or other intellectual property
rights, and any material or information developed and/or required to be delivered under
this Contract shall be jointly owned by the parties with each party having the right to
use, reproduce, or publish any or all of such information and other materials without
the necessity of obtaining permission from the other palty and without expense or
charge.
(b) The USFWS is granted a royalty free, non-exclusive, and ilTevocable license to
reproduce, publish, or otherwise use, and to authorize others to use, for U.S.
Government purposes, all reports, drafts of reports, or other material, data, drawings,
computer programs, and codes associated with this Contract, and/or any copyright or
other intellectual propelty rights, and any material or infOlmation developed and/or
required to be delivered under this Contract.
6.02 NON ENDORSEMENT BY STATE AND THE UNITED STATES
Subrecipient shall not publicize or otherwise circulate promotional material (such as
advertisements, sales brochures, press releases, speeches, still and motion pictures,
alticles, manuscripts, or other publications) that states or implies State of Texas or U.S.
Government, or government employee, endorsement of a product, service, or position that
the Subrecipient represents. No release of information relating to this Financial
Assistance Award may state or imply that the State of Texas or the U.S. Government
approves of Subrecipient's work products, or considers Subrecipient's work product to be
superior to other products or services.
6.03 ApPROVAL OF PUBLICATION AND SPECIFIC DISCLAIMER REQUIRED
Prior to publication, Subrecipient must submit to the Grant Administrator, for USFWS
approval, any public information releases conceming this Financial Assistance Award that
refer to the Department of the Interior or any bureau or employee. The specific text, layout
photographs, and so fOlth, of the proposed release must be submitted with the request for
approval. The specific aclmowledgements and funding statements that must be included in
certain publications funded by the Subrecipient al'e set fOlth in Article 3 of Attachment B.
6.04 SURVIVAL
THE PROVISIONS OF THIS ARTICLE 6 SHALL SURVIVE THE TERMINATION OR
EXPIRATION OF THIS CONTRACT.
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GLO Contract No. 12-617-000-7021
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ARTICLE 7 - RECORDS, AUDIT, RETENTION,
AND PUBLIC INFORMATION
7.01 BOOKS AND RECORDS
Subrecipient shall keep and maintain under GAAP or GASB, as applicable, full, true, and
complete records necessary to fully disclose to the GLO, the Texas State Auditor's Office,
the United States Government, and/or their authorized representatives, sufficient
information to determine compliance with the terms and conditions of this Contract and all
state and federal rules, regulations, and statutes.
7.02 INSPECTION AND AUDIT
Subrecipient agrees that all relevant records related to this Contract or any work product
produced, including those of its subcontractors, shall be subject at any reasonable time to
inspection, examination, review, audit, and copying at any location where such records may
be found, with or without notice by the Texas State Auditor's Office, the GLO, its
contracted examiners, or the Texas Attomey General's Office. In addition, the USFWS, the
Comptroller General, the General Accounting Office, the Office of Inspector General, or
any of their authorized representatives of the U.S Government shall also have this right of
inspection. ALL SUBCONTRACTS SHALL REFLECT THE REQUIREMENTS OF THIS SECTION.
7.03 PERIOD OF RETENTION
Subrecipient shall retain all records relevant to this Contract for a minimum of five (5)
years. The period of retention begins at the date of final payment of reimbmsable expenses
by the GLO, or from the date of termination of the Contract, whichever is later. The period
of retention shall be extended for a period reasonably necessmy to complete an audit and/or
to complete any administrative proceeding or litigation that may ensue.
7.04 PUBLIC INFORMATION
Pursuant to the Public Information Act ("PIA"), records received from Subrecipient may be
open to public inspection and copying. The GLO will have the duty to disclose such
records, unless a particular record is made confidential by law or exempted from the PIA.
Subrecipient may clearly label any individual records as a "trade secret;" however,
Subrecipient acknowledges it is solely responsible for defending any such claim in
accordance with the PIA. The failure to so label any record shall constitute a complete
waiver of any and all claims for damages caused by release of the records. If a request for a
labeled record is received by the GLO, the GLO will notify Subrecipient of the request in
accordance with the PIA.
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GLO Contract No. 12-617-000-7021
Page 13 of 18
ARTICLE 8 - EVENTS OF DEFAULT AND REMEDIES
8,01 EVENTS OF DEFAULT
Each of the following events shall constitute an Event of Default under this Contract: (I)
Subrecipient's failure to comply with any term, covenant, or provision contained in this
Contract; (Ii) Subrecipient makes a general assignment for the benefit of creditors or takes
any similar action for the protection or benefit of creditors; or (Iii) if at any time,
Subrecipient makes any representation or warranty that is incorrect in any material respect
to the Work Plan, any request for payment submitted to the GLO, or any report submitted
to the GLO related to the Contract.
8,02 REMEDIES; No WAIVER
Upon the occurrence of any such Event of Default, the GLO shall be entitled to avail itself
of any equitable or legal remedy. A right or remedy confelTed by this Contract upon either
party is not intended to be exclusive of any other right or remedy, and each and every right
and remedy shall be cumulative and in addition to any other right or remedy given under
this Contract, or hereafter legally existing, upon the occurrence of an Event of Default. The
failure of the GLO either to insist at any time upon the strict observance or performance of
any of the provisions of this Contract, or the GLO's failure to exercise any right or remedy
as provided in this Contract, shall not impair any such right or remedy or be construed as a
waiver or relinquishment thereof with respect to subsequent Events of Default.
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GLO Contract No. 12-617-000-7021
Page 14 of 18
ARTICLE 9 - MISCELLANEOUS PROVISIONS
9.01 CONTRACT AMENDMENT
Unless otherwise provided herein, any amendment to this Contract must be made by
formal Contract amendment, executed by both parties and approved by the USFWS, to
the extent required by the Financial Assistance A ward Agreement.
9.02 LEGAL OBLIGATIONS
Subrecipient shall procure and maintain for the duration of this Contract any state, county,
city, or federal license, authorization, insurance, waiver, permit, qualification, or
cerlification required by statute, ordinance, law, or regulation to be held by Subrecipient
to provide the goods or services required by this Contract. Subrecipient will be
responsible for payment of all taxes, assessments, fees, premiums, permits, and licenses
required by law. Subrecipient agrees to be responsible for payment of any such
govemment obligations not paid by its subcontractors during performance of this
Contract. Subrecipient shall not commence work on the Project until it has obtained the
requisite licenses and/or permits, if applicable. COPIES OF SUCH LICENSES AND PERMITS
SHALL BE INCLUDED AS A PART OF THE MONTHLY REpORT FOR THE PERIOD DURING
WHICH THEY ARE OBTAINED.
9.03 INDEMNITY
As GOVERNMENTAL ENTITIES AND REQUIRED UNDER THE CONSTITUTION AND LAWS OF
THE STATE OF TEXAS, EACH PARTY UNDERSTANDS THAT THEY ARE LIABLE FOR ANY
PERSONAL INJURIES, PROPERTY DAMAGE, OR DEATH RESULTING FROM THE ACTS OR
OMISSIONS OF SUCH PARTY. IN THE EVENT THAT THE GLO IS NAMED AS A PARTY
DEFENDANT IN ANY LITIGATION ARISING OUT OF ALLEGATIONS OF PERSONAL INJURY,
DEATH, OR PROPERTY DAMAGE RESULTING FROM THE ACTS OR OMISSIONS OF
SUBRECIPIENT, AND FOR WHICH THE GLO IS LIABLE, IF AT ALL, ONLY THROUGH THE
VICARIOUS LIABILITY OF SUBRECIPIENT, THEN, IN SUCH EVENT, SUBRECIPIENT AGREES
THAT IT WILL PAY, ON BEHALF OF THE GLO, ALL COSTS AND EXPENSES OF LITIGATION
(INCLUDING ANY COURT COSTS, REASONABLE ATTORNEYS' FEES, FEES OF ATTORNEYS
APPROVED BY THE OFFICE OF THE TEXAS ATTORNEY GENERAL) AS WELL AS ALL
AMOUNTS PAID IN SETTLEMENT OF ANY CLAIM, ACTION, OR SUIT, INCLUDING
JUDGMENT OR VERDICT, ARISING OUT OF OR IN CONNECTION WITH THIS CONTRACT. IN
THE EVENT THAT SUBRECIPIENT IS NAMED AS A PARTY DEFENDANT IN ANY LITIGATION
SEEKING ANY DAMAGES FOR ANY PROPERTY DAMAGE, PERSONAL INJURY, OR DEATH
RESULTING OUT OF THE GLO's ACTIONS OR OMISSIONS, AND SUBRECIPIENT'S SOLE
LIABILITY, IF ANY, IS ONLY VICARIOUSLY THROUGH THE GLO, THEN, IN SUCH EVENT,
THE GLO AGREES TO PAY ANY AND ALL CLAIMS, DEMANDS, OR LOSSES, INCLUDING
EXPENSES OF LITIGATION (INCLUDING REASONABLE ATTORNEYS' FEES AND COURT
COSTS) INCURRED BY SUBRECIPIENT, INCLUDING ANY VERDICTS OR JUDGMENTS OR
AMOUNTS PAID IN SETTLEMENT OF ANY CLAIM ARISING OUT OF, OR IN CONNECTION
WITH THIS CONTRACT. ANY ATTORNEYS RETAINED BY SUBRECIPIENT TO REPRESENT
ANY INTEREST OF THE GLO MUST BE APPROVED BY THE GLO AND BY THE OFFICE OF
THE TEXAS ATTORNEY GENERAL. ANY ATTORNEYS RETAINED BY THE GLO TO
REPRESENT THE INTEREST OF SUBRECIPIENT MUST BE APPROVED BY SUBRECIPIENT.
GLO Contract No. 12-617-000-7021
Page IS of 18
9.04 ASSIGNMENT AND SUBCONTRACTS
(a) Subrecipient shall not assign, transfer, or delegate any rights, obligations, or duties
under this Contract not encompassed within the Work Plan without the prior
written consent of the GLO. Notwithstanding this provision, it is mutually
understood and agreed that Subrecipient may subcontract with others for some or
all of the services or work to be performed. In no event may Subrecipient delegate
or transfer its responsibility for use of the funds under this Contract.
(b) Subrecipient is responsible for upholding the integrity of the procurement process
and must comply with the organizational conflicts of interest and/or
noncompetitive procurement practices as required by Title 43, Code of Federal
Regulations, Part 12, and the Financial Assistance Award Agreement, in
connection with any subcontract under this Contract.
(c) In any approved subcontracts, Subrecipient shall legally bind any such
subcontractors to perform, and make such subcontractors subject to, all the duties,
requirements, and obligations of Subrecipient specified herein. Nothing in this
Contract shall be construed to relieve Subrecipient of the responsibility for
ensuring that that the goods delivered and/or the services rendered by Subrecipient
and/or any of its subcontractors comply with all the terms and provisions of this
Contract. A copy of each subcontract shall be submitted to the GLO within
ten (10) business days after execution,
(d) The GLO and the USFWS shall have the right to initiate communications with
any subcontractor, and may request access to any books, documents, papers, and
records of a subcontractor which are directly pertinent to this Financial Assistance
Award. Such communications may be required to conduct audits and
examinations and gather additional information as provided in Section 7.02 and
the Administrative and Audit Regulations.
9.05 RELATIONSHIP OF THE PARTIES
Subrecipient is associated with the GLO only for the purposes and to the extent specified
in this Contract and, in respect to Subrecipient's performance pursuant to this Contract,
Subrecipient shall have the sole right to supervise, manage, operate, control, and direct
performance of the details incident to its duties under this Contract. Nothing contained in
this Contract shall be deemed or construed to create a partnership or joint venture, to
create relationships of an employer-employee or principal-agent, or to otherwise create
for the GLO any liability whatsoever with respect to the indebtedness, liabilities, and
obligations of Subrecipient or any other party.
9.06 COMPLIANCE WITH OTHER LAWS
In the performance of this Contract, Subrecipient shall comply with all applicable federal,
state, and local laws, ordinances, and regulations. Subrecipient shall make itself familiar
with and at all times shall observe and comply with all federal, state, and local laws,
ordinances, and regulations that in any manner affect performance under this Contract.
GLO Contract No. 12-617-000-7021
Page 16 ofIB
9.07 NOTICES
Any notices required under this Contract shall be deemed delivered when deposited either
in the United States mail, postage paid, certified, retum receipt requested; or with a
common carrier, overnight, signature required, to the appropriate address below:
GLO
Texas General Land Office
1700 N. Congress Avenue, Mail Code 158
Austin, TX 78701
Attention: Legal Services Division
WITH A COpy TO:
Texas General Land Office
1700 N. Congress Avenue, Room 330
Austin, TX 78701
Attention: ClAP Grant Administrator
Subrecipient
Calhoun County
211 S. Ann Street, Suite 301
Port Lavaca, TX 77979
Attention: The Honorable Michael Pfeifer, County Judge
Notice given in any other manner shall be deemed effective only if and when received by
the party to be notified. Either party may change its address for nolice by written notice to
the other party as herein provided.
9.08 GOVERNING LAW AND VENUE
This Contract and the rights and obligations of the parties hereto shall be governed by,
and construed according to, the laws of the State of Texas, exclusive of conflicts of law
provisions. Venue of any suit brought under this Contract shall be in a court of
competent jurisdiction in Travis County, Texas. Subrecipient irrevocably waives any
objection, including any objection to personal jurisdiction or the laying of venue or based
on the grounds of forum non conveniens, which it may now or hereafter have to the
bringing of any action or proceeding in such jurisdiction in respect of this Contract or any
document related hereto. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS A
WAIVER OF SOVEREIGN IMMUNITY BY THE GLO.
9.09 SEVERABILITY
If any provision contained in this Contract is held to be unenforceable by a court of law or
equity, this Contract shall be construed as if such provision did not exist and the non-
enforceability of such provision shall not be held to render any other provision or
provisions of this Contract unenforceable.
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Page 17 of 18
9.10 DISPUTE RESOLUTION
If a contract dispute arises that cannot be resolved to the satisfaction of the parties, either
patty may notify the other party in writing of the dispute. If the parties at'e unable to
satisfactorily resolve the dispute within fourteen (14) days of the written notification, the
parties must use the dispute resolution process provided for in Chapter 2260 of the Texas
Government Code to attempt to resolve the dispute. This provision shall not apply to any
matter with respect to which either party may make a decision within its respective sole
discretion.
9.11 ENTIRE CONTRACT AND MODIFICATIONS
This Contract atld its integrated attachments constitute the entire agreement of the parties
and at'e intended as a complete and exclusive statement of the promises, representations,
negotiations, discussions, and other agreements that may have been made in connection
with the subject matter hereof. Any additional or conflicting telms in such attachment(s)
shall be harmonized with this Contract to the extent possible. Unless such integrated
attachment specifically displays a mutual intent to amend a particular palt of this Contract,
general conflicts in language shall be construed consistently with the terms of this Contract.
9,12 PROPER AUTHORITY
Each party hereto represents and walTants that the person executing this Contract on its
behalf has full power and authority to enter into this Contract. Subrecipient acknowledges
that this Contract is effective for the period of time specified in the Contract. Any work
performed by Subrecipient after the Contract terminates is performed at the sole risk of
Subrecipient.
9.13 COUNTERPARTS
This Contract may be executed in any number of counterpatts, each of which shall be an
original, and all such counterparts shall together constitute but one and the same Contract.
9.14 SUBGRANT OFFER SUBJECT TO CANCELLATION
IF SUBRECIPIENT DOES NOT RETURN THE ORIGINAL SIGNED CONTRACT TO THE GLO
WITHIN THIRTY (30) DAYS OF TRANSMITTAL OF THE CONTRACT TO SUBRECIPIENT,
SUBGRANT FUNDING FOR THE PROJECT MAY BE SUBJECT TO CANCELLATION,
SIGNATURE PAGE FOLLOWS
GLO Contract No. 12-617-000-7021
Page 18 of 18
SIGNATURE PAGE FOR GLO CONTRACT No. 13-617-000-7021
GENERAL LAND OFFICE
CALHOUN COUNTY
l'Y\A I /l~ rr '* j---
By: Michael J. Pfeifer
Title: Calhoun County Judge
Larry L. Laine, Chief Clerk!
Deputy Land Commissioner
Date of execution:
Date of execution: 10-25-12
GC
ATTACHMENTS TO THIS CONTRACT:
ATTACHMENT A:
ATTACHMENT B:
ATTACHMENT C:
ATTACHMENT D:
ATTACHMENTE:
ATTACHMENTF:
ATTACHMENT G:
Work Plan and Project Budget
ClAP Supplemental Tenns and Conditions
USFWS Financial Assistance A ward Agreement with the GLO for
USFWS Award No. Fl2AF00873
Federal Assurances Construction (SF-424D) or Non-
Construction (SF-424B), as applicable
Standard Fonn-512, Certifications Regarding Lobbying; and
Standard Fonn LLL, Disclosure of Lobbying Activities
General Affirmations
Sample Additional Required Forms:! Monthly Progress Report;
ClAP Invoice Fonn; Budget Amendment Request Fonn; HUB
Expense Reporting Form; Audit Reporting Form
ATTACHMENTS FOLLOW
I Additional required forms may be revised from lime to time, and should be downloaded at
hllo://www.glo.texas.gov/what-we-do/caring-for-the-coast/grants-funding/ciao/grantee-requirements.htmlbefore
each usage.
Attachment A
GLO Contract No. 13-617-000-7021
Page 1 of 1
WORK PLAN AND BUDGET
Green Lake Acquisition
Project Summarv:
Calhoun County is seeking $2,101,271 in 2009 State ClAP funds to purchase Green Lake, a
6,434.49 acre tract of land lying entirely in Calhoun County. Approximately 5,420 acres of the
tract is an open water lake, about 864 acres is ephemerally inundaled lowlands and about 150
acres is wooded uplands/coastal prairie. In addi'tion to these state ClAP funds, Calhoun County
is allocating the entirety of its county ClAP funds for FY09 and FYIO and a reallocation of
$125,000 from FY2007 county funds toward this projecl, for a total county contribution of
$1,398,729. An appraisal is under review by the GLO appraisal group to ensure compliance with
the Uniform Appraisal Standards for Federal Land Acquisitions. The survey was reviewed and
approved by GLO survey group.
Statement of Work:
Task I: Execute the sub-recipient agreement with Calhoun County (October 2012)
Task 2: Purchase the tract (January 2013)
Task 3: Develop and implement a management plan (March 2013)
Task 4: Install sign and prepare final report (March 2013)
Deliverables:
, Executed deed 10 days after receipt of filed copy
Settlement document 10 days after execution
Photograph of signage March 15,2013
Management Plan March 15,2013
Final Report March 30, 2013
BUDGET:
Salaries/wages $0.00
-_.- $0.00
Fringe
=- -$0.00
Travel
Supplies $0.00
E'. $0.00
qUlpment
Contractual $0--:00
--- $0.00
Construction
.-
Land Acquisition $2,101,271.00
- -$.00
Other
Total $2,101,271.00
Attachment B
Page lofll
ClAP SUPPLEMENTAL TERMS AND CONDITIONS
ARTICLE 1- GRANT ADMINISTRATION
1.1 GENERAL REQUESTS
Subrecipient may submit requests provided for in the Contract, in writing, by
regular mail, electronic mail or facsimile transmission, in Compliant Format.
Requests must cite the nature of the request, the section of the Contract that
authorizes the request, and a detailed justification for the request. A request is
granted only upon receipt by Sub recipient of written approval from the
Grant Administrator.
1.2 GRANT ADMINISTRATION FORMS
(a) Recurring forms that must be submitted to the GLO Grant Administrator
can be downloaded at the following web address:
http://www . glo. texas. gov/what - we-do/caring - for-the-coast/ grants-
funding/ ciap/ grantee-requirem ents .html
A copy of the current version of each recurring form required is included
in Attachment G, for convenience. However, these forms are updated
from time to time and Subrecipient should periodically check the website
for updated forms. Subrecipient is responsible for using the proper forms.
(b) Subrecipient must submit certain additional fonns required by the Contract
or the Financial Assistance Award Agreement to show that Subrecipient has
complied with required state and federal laws applicable to the Financial
Assistance Award Agreement. The forms and celtifications described below
are found in Attachments D and E.
(i) Either the federal Assurances for Construction Programs (Standard
Form 424D) or Assurances for Non-Construction Programs
(Standard Form 424B), as applicable to the Project, is found in
Attachment D and must be executed by Subrecipient.
(ii) Certification Regarding Lobbying Lower Tier Covered Transactions
(Standard Form CD-512) is found at Page 1 of Attachment E, and
must be executed by Subrecipient.
(iii) Disclosure of Lobbying Activities Form (Standard Form-LLL) is
found at Page 2 of Attachment E and must be submitted by the
Subrecipient if required by Section 5.5 of the Supplemental Terms
and Conditions, relating to Lobbying Disclosnre.
ClAP Supplemental Terms and Conditions
Attachment B
Page 2 of II
1.3 REPORTS
Subrecipient shall submit Monthly Progress Reports and the Final Report to the
Grant Administrator.
Monthly Progress Reports are due on or before the 10th day of each month during
the term of the Contract, commencing December 10,2012. No Monthly Report is
required for the month in which a Final Report is to be submitted.
A Final RepOlt must be received by the GLO within ten (10) days of completion of
the Project or termination of the Contract, whichever is earlier. Notwithstanding
the preceding, upon written request by Subrecipient and written approval by the
GLO, this Deliverable due date may be extended. The request and approval may
be exchanged by regular mail, electronic mail, or facsimile transmission.
1.4 DELIVERABLES
Subrecipient shall submit electronically each of the Deliverables set forth in the
Work Plan in Attachment A, in Compliant Format and in the time and manner
prescribed therein, to the Grant Administrator.
1.5 REIMBURSEMENT REQUESTS
Each request for reimbursement shall be on the approved ClAP Invoice Form, and
provide such other information as the GLO may request. With each
reimbursement request, Subrecipient shall include copies of all actual receipts,
cancelled checks, and/or such other documentation that, in the judgment of the
GLO, allows for full substantiation of the costs incurred, and which displays the
full GLO Contract Number, as well as Catalog of Federal Domestic Assistance
("CFDA") No. 15.668. Any request for reimbursement that does uot include
this information will be rejected and returned to Subrecipient, which may
result in a significant delay in payment of the invoice.
Reimbursement requests may be submitted monthly to the Grant Administrator on
or before the 10th day of each calendar month.
1.6 BUDGET VARIANCE
Upon written request and justification by Subrecipient to the Grant Administrator,
reallocation among budget categories may be allowed. Subrecipient must use the
GLO Budget Amendment Form. This form may be downloaded at:
http://www . glo. texas. gov /what - we-do/caring - for- the-coast/ grants-
funding/ ciap/ grantee-requirements .html
Such reallocations may not increase or decrease the amount of the grant or total
Budget; and shall be effective only after approval by the GLO. Any request for a
variance that changes the total budget amount or the Project scope or outcome
may be allowed only through the formal, written Contract amendment process. A
ClAP Supplemental Terms and Conditions
Attachment B
Page 3 of 11
FINAL, ACTUAL BUDGET, TO BE A TT ACHED TO THE CONTRACT AS A TT ACHMENT
A-I, SHALL BE SUBSTITUTED FOR THE EXISTING BUDGET IN ATTACHMENT A,
AND SHOULD BE SUBMITTED BY SUBRECIPIENT NO LATER THAN SIXTY (60) DAYS
FROM THE EXPIRATION OR TERMINATION DATE OF THE CONTRACT,
1. 7 RETAIN AGE - ApPLICABLE TO ALL PROJECTS
To ensure full performance, the GLO may retain an amount equal to thirty-three
percent (33%) of Subrecipient's grant amount until Subrecipient's delivery, and
GLO's approval, of all Deliverables required herein. The GLO shall make a final
disbursement only upon receipt of documentation sufficient to determine that
Subrecipient has completed the Project in accordance with the Work Plan, and
that all requirements of the Contract and the relevant provisions of the Financial
Assistance A ward have been fulfilled by Subrecipient.
1.8 PURCHASES
Subrecipient shall not purchase any equipment and/or computer software not
included as a reimbursable item shown on the Budget in Attachment A. Title
and possession of any Equipment will remain the property of Subrecipient unless
and until transferred to the GLO, upon written request by the GLO. Subrecipient
shall furnish, with its final request for reimbursement, a list of all Equipment
purchased with Grant funds under the Contract, including the name of the
manufacturer, the model number, and serial number. The disposition of any
Equipment shall follow the Administrative and Audit Regulations.
1.9 AUDIT COMPLIANCE
The GLO, as a pass-through entity, has the responsibility to ensure that
Subrecipients expending FIVE HUNDRED THOUSAND DOLLARS ($500,000.00) or
more in federal awards during each of Subrecipient's fiscal years of funding have
met audit requirements in accordance with U.S. Office of Management and
Budget Circular A-133. Subrecipient shall complete and return the Audit
Reporting Form to the Grant Administrator no later than September 1st of each year
until the Contract is telminated. .
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ClAP Supplemental Terms and Conditions
Attachment B
Page 4 of Il
Article 2 - GLO ELECTRONICALLY STORED INFORMATION STANDARDS
2.1 GEOGRAPHIC INFORMATION SYSTEMS
Data, databases, and products associated with electronic Geographic Information
Systems ("GIS") that have been collected, manipulated, or purchased with
Subgrant funds will be subject to all applicable terms of the Texas Geographic
Information Standards of the Texas Geographic Information Council and Rule
201.6 - Geographic Information Standards, Texas Administrative Code Title 1,
Pmi 10, Section 201.6. The Geographic Information Standards Rule is available
on the World Wide Web at: www.dir.state.tx.us/tgic/pubs/pubs.htm or by writing
to Department of Information Resources at P.O. Box 13564, Austin, Texas
78711, email tgichelp@dir.state.tx.us, telephone (512) 305-9076.
2.2 TRANSFER OF DATA
Any GIS data to be transferred or exchanged that is collected, manipulated, or
purchased with funds fi'om the Contract must be documented as specified in the
Federal Geographic Data Committee document Content Standard for Digital
Geospatial Metadata, version 2 (FGDC-STD-001-1998) or later. The federal
metadata standard is available on the World Wide Web at:
www.fgdc.gov/metadata/csdgm. Metadata must be submitted in HTML, XML, or
ASCII text formats.
2.3 FORMAT
Although the GLO has adopted Environmental Systems Research Institute, Inc.
software products as in-house GIS software, the GLO does not endorse these, or
any other, products. However, any electronic spatial data collected, manipulated,
or purchased with Subgrant funds shall be transferred in a mutually-acceptable
GIS format, along with any corresponding metadata referred in the Contract.
Nonspatial data deliverables (text, database, spreadsheet, images) must be
delivered in MS Office, dBase (.dbf), ASCII, or standm'd image (JPEG, TIFF,
GIF, etc.) formats. Acceptable media for delivery include CD-ROM, DVD, USB
flash drive, floppy disk, Zip disk, and external hard drives.
Subrecipient is expected to comply with these guidelines. If Subrecipient cannot
comply with these guidelines then Subrecipient must provide a written
justification detailing why an exception is warranted.
2.4 COMPLIANT FORMAT FOR GRANT ADMINISTRATION
Subrecipients should submit written reports, requests in Word format; invoices
and sUPPOliing documentation in pdf fOlmat; and photographs in .jpg format and
form, unless otherwise agreed by the Grant Administrator.
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ClAP Supplemental Terms and Conditions
Attachment B
Page 5 of 11
Article 3 - ACKNOWLEDGEMENT OF SOURCE OF ClAP FUNDS;
SIGNAGE, PHOTO DOCUMENT A TION, PUBLICATIONS, AND WEBSITES
3,1 ACKNOWLEDGEMENT OF SOURCE OF ClAP FUNDS
Subrecipient shall aclmowledge the source of funding for the Project as set forth
in the Financial Assistance Award Agreement. When the use of the USFWS logo
is required, it may be found at the following location:
hUp:llwsfrprograms.fws.gov/subpages/grantprograms/CIAP ICIAP .htm
Subrecipient is required to inform the public that the Project is being funded, in
whole or in part, by Grant funds under the Coastal Impact Assistance Program.
Acknowledgement of the source of funds may take many forms (e.g., signage or
written acknowledgement in a project publication or Web site).
Subrecipient agrees to fulfill applicable obligations of the Recipient set forth in
the Financial Assistance Award Agreement.
3.2 ClAP ACKNOWLEDGEMENT
If Subrecipient or its employee( s) use funds under the Contract to publish reports
and other materials completed in whole or in part as a result of the Contract, the
author shall ensure that the paper or Web site bears the following statement as
well as the USFWS logo on the front cover or title page of such document and
other materials:
"THIS **PUBLlCATlON!WEB SITE** IS FUNDED ("IN PART," IF
APPROPRIATE) WITH QUALIFIED OUTER CONTINENTAL SHELF OIL AND
GAS REVENUES BY THE COASTAL IMPACT ASSISTANCE PROGRAM, U.S.
FISH AND WILDLIFE SERVICE, U.S. DEPARTMENT OF THE INTERIOR."
The USFWS logo should be located on the lower right corner of the
acknowledgement.
3.3 ClAP FUNDING STATEMENT
If Subgrantee or its employee(s) use funds under this Contract to publish a paper
based, in whole or in part, on the work funded by the Contract, the author shall
ensure that the paper bears the following statement as well as the USFWS logo on
the fi'ont cover or title page of the paper:
"THIS PAPER IS FUNDED ("IN PART," IF APPROPRIATE) BY A
FINANCIAL ASSISTANCE AWARD FROM THE U.S DEPARTMENT OF
THE INTERIOR, U.S, FISH AND WILDLIFE SERVICE, COASTAL
IMPACT ASSISTANCE PROGRAM. THE VIEWS EXPRESSED HEREIN
ARE THOSE OF THE AUTHOR(S) AND DO NOT NECESSARILY REFLECT
THE VIEWS OF THE U.S. FISH AND WILDLIFE SERVICE."
ClAP Supplemental Terms and Conditions
Attachment B
Page 6 of 11
If Subrecipient or its employee(s) use Grant funds under the Contract to produce
signage as part of a presentation related to this Project, Subrecipient shall ensure
that the signage bears the following statement, as well as the USFWS and GLO
logos on all signs:
"THIS PROJECT IS FUNDED ("IN PART," IF APPROPRIATE) BY A
FINANCIAL ASSISTANCE AWARD FROM THE V,S, DEPARTMENT OF
THE INTERIOR, U.S. FISH AND WILDLIFE SERVICE, COASTAL
IMPACT ASSISTANCE PROGRAM."
3.4 ClAP PUBLICATION
All information submitted for publication or other public releases of information
regarding this Project shall carry the following disclaimer:
"THE VIEWS AND CONCLUSIONS CONTAINED IN THIS DOCUMENT ARE THOSE
OF THE AUTHORS AND SHOULD NOT BE INTERPRETED AS REPRESENTING
THE OPINIONS OR POLICIES OF THE U.S, GOVERNMENT OR THE STATE OF
TEXAS. MENTION OF TRADE NAMES OR COMMERCIAL PRODUCTS DOES
NOT CONSTITUTE THEIR ENDORSEMENT BY THE U.S, GOVERNMENT OR
THE STATE OF TEXAS".
When issuing statements, press releases, requests for proposals, bid solicitations,
and other documents describing projects or programs funded in whole or in part
with Grant funds, Subrecipient shall clearly state (i) the percentage of the total
costs of the proj ect or program which will be financed with federal money; (ii) the
dollar amount of federal funds for the project or program; and (iii) the percentage
and dollar amount of the total costs of the project or program that will be financed
by nongovernmental sources. ALL DOCUMENTS AND MATERIALS MUST CONTAIN
THE USFWS LOGO ON THE FRONT OR TITLE PAGE.
3.5 SURVIVAL
THE PROVISIONS OF THIS ARTICLE 3 SHALL SURVIVE THE TERMINATION OR
EXPIRATION OF THE CONTRACT.
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ClAP Supplemental Terms and Conditions
Attachment B
Page 7 of II
Article 4 - SPECIAL CONDITIONS APPLICABLE TO REAL EST ATE
IMPROVEMENTS AND LAND ACQUISITIONS
4.1 USE AND DISPOSITION OF PROPERTY
Any property improved or acquired under the Contract shall be governed by the
requirements of Title 43, Code of Federal Regulations, Part 12.
Any real property improved or acquired with funds from the Subgrant must be
used and disposed of in accordance with the provisions ofthe Financial Assistance
A ward Agreement.
4.2 FEDERAL REQUIREMENTS FOR LAND ACQUISITION
For all land acquisitions, Subrecipients must comply with the Financial Assistance
A ward Agreement.
4.3 IMPROVEMENTS
If funds under the Contract are used to improve real property, Subrecipient must
file a memorandum of agreement in the county records where the property is
located notitying third parties as follows:
"THIS PROPERTY WAS IMPROVED (IN WHOLE OR IN PART) WITH
FUNDS PROVIDED BY THE U.S. DEPARTMENT OF THE INTERIOR,
FISH AND WILDLIFE SERVICE, PURSUANT TO FINANCIAL
ASSISTANCE AWARD NUMBER F12AF00873 (UNDER GLO
CONTRACT NUMBER 12-617-000-7021) FROM THE COASTAL
IMPACT ASSISTANCE GRANT PROGRAM, AND WILL BE MANAGED
FOR THE PURPOSE OF THIS GRANT, IN ACCORDANCE WITH
APPLICABLE FEDERAL AND STATE LAW. PROPERTY MAY NOT BE
DISPOSED OF IN ANY MANNER, OR USED FOR PURPOSES
INCONSISTENT WITH THE PROGRAM FOR WHICH IT WAS
ACQUIRED, WITHOUT THE PRIOR APPROVAL OF THE DIRECTOR,
U.S. FISH AND WILDLIFE SERVICE - WASHINGTON, D.C."
Prior to any construction undertaken under the Contract, Subrecipient shall deliver
to the GLO one (1) copy of Plans to be used for the Project. Any construction to
be undertaken with funding from the Contract shall be completed in compliance
with final Plans approved by the GLO.
UPON COMPLETION OF CONSTRUCTION, SUBRECIPIENT SHALL SUBMIT A FINAL
"AS BUILT" DESIGN IF REQUIRED BY THE LOCAL BUILDING CODE OR LOCAL
BUILDING OFFICIAL, AND SHALL INCLUDE PHOTOGRAPHS OF THE
CONSTRUCTION IN THE FINAL REpORT.
Subrecipient may not remove any improvements constructed with funds provided
under the Contract, unless the USFWS is compensated in accordance with the
Administrative and Audit Regulations.
CIAP Supplemental Terms and Conditions
Attachment B
Page 8 of 11
4.4 SURVEYS REQUIRED
(a) Inland Survey, In the event that land is to be acquired with funds under the
Contract, any parcel of land that (1) does not abut any waters and (2) is
acquired by lot and block may be surveyed by a "registered professional land
surveyor" or "RPLS" as that term is defined in Chapter 1071 of the Texas
Occupations Code. The survey must meet the requirements of a Category
lA, Land Title Survey, as defined in the Manual of Practice for Land
Surveying in Texas, published by the Texas Society of Professional
Surveyors. Any survey conducted by an RPLS under this Section must be
accompanied by copies of each recorded subdivision plat that includes any
portion of the area to be acquired, and appropriate deeds and other
documents referenced on the survey plat.
(b) Survey of Land Abuttiug Water. Any parcel of land to be acquired with
funds under the Contract other than land described in Sectiou 4.4(a), above,
must be surveyed by a "licensed state land surveyor" 01' "LSLS" as that tenn
is defined in Chapter 1071 of the Texas Occupations Code.
(c) Coastal Boundary Survey. In the event that a coastal boundmy survey is
required for the Project, Subrecipient must conduct the coastal boundary
survey for the Project site in accordance with Section 33.136 of the Texas
Natural Resources Code. For surveys of tracts on 01' adjacent to Gulf
beaches, maps, surveys, and/or profiles shall not delineate 01' map
vegetation, the line of vegetation, 01' the landward boundary of the public
beach. Such maps, surveys, and/or profiles shall also not include any
mention of the location of the line of vegetation 01' the boundary of the
public beach. For any work funded in whole 01' part by funds under the
Contract, vegetation, the line of vegetation, and/or the landward boundmy
of the public beach can only be mapped, delineated, 01' described with
specific written authorization from the GLO. The coastal boundary
survey, as well as surveys of land as described in Section 4.4(b), above,
must contain the following statement:
"THIS SURVEY DOES NOT, NOR IS IT INTENDED TO BE USED
TO, IDENTIFY, DELINEATE, OR FIX THE LINE OF
VEGETATION OR THE LANDWARD BOUNDARY OF THE
PUBLIC BEACH,"
(d) REQUIRED DEED LANGUAGE AND RESTRICTIONS. If funds under the
Contract m'e used to acquire real property, the acquisition deed must
contain the following language:
"THIS PROPERTY WAS ACQUIRED (IN WHOLE OR IN PART)
WITH FUNDS PROVIDED BY THE V.S, DEPARTMENT OF THE
INTERIOR, FISH AND WILDLIFE SERVICE, PURSUANT TO
FINANCIAL ASSISTANCE AWARD NUMBER F12AF00873
(UNDER GLO CONTRACT NUMBER 12-617-000-7021),
ClAP Supplemental Terms and Conditions
Attachment B
Page 9 of 11
FROM THE COASTAL IMPACT ASSISTANCE GRANT
PROGRAM, AND WILL BE MANAGED FOR THE PURPOSE OF
THIS GRANT, IN ACCORDANCE WITH APPLICABLE
FEDERAL AND STATE LAW, PROPERTY MAY NOT BE
DISPOSED OF IN ANY MANNER, OR USED FOR PURPOSES
INCONSISTENT WITH THE PROGRAM FOR WHICH IT WAS
ACQUIRED, WITHOUT THE PRIOR APPROVAL OF THE
DIRECTOR, V.S, FISH AND WILDLIFE SERVICE -
WASHINGTON, D.C."
If Grant funds under the Contract are used to improve public or private
real property, Subrecipient must file in the real property records of the
county where the property is located, a memorandum of restriction,
conservation servitudes or easements affecting the real property, in a form
acceptable to the GLO, that will protect the land and its natural resources
and preserve the public use and benefit of the land.
4.5 ApPRAISALS
All appraisals pelformed in connection with the acquisition of land and/or
easement under this section shall be completed in accordance with the
Uniform Appraisal Standards for Federal Land Acquisitions. These
standards can be found at: http://www.justice.gov/enrd/Iand-ackl
4.6 GLO ApPROVAL OF REAL ESTATE DOCUMENTS
The survey, appraisal, and the memorandum of restrictions, conservation
servitudes, easement, or deed must be approved by the GLO. A recorded
copy of the memorandum of restrictions, conservation servitudes,
easement, or deed must be submitted to the Grant Administer.
The GLO will not "hold" an easement or accept a third-party right of
enforcement.
4. 7 SURVIVAL
THE PROVISIONS OF THIS ARTICLE 4 SHALL SURVIVE THE TERMINATION OR
EXPIRATION OF THE CONTRACT.
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ClAP Supplemental Terms and Conditions
Attachment B
Page 10 of 11
ARTICLE 5 - MISCELLANEOUS TERMS AND CONDITIONS
5,1 FEDERAL REGULATORY REQUIREMENTS
Subrecipient canies the responsibility to be aware of and comply with the federal regulatory
requirements for federal financial assistance awards included in the Code of Federal
Regulations and listed in Section F of the Financial Assistance Award Agreement, as
applicable.
5,2 COMPLIANCE WITH TEXAS COASTAL MANAGEMENT PROGRAM (CMP)
If the Project is located within a coastal management zone established by Chapter 33 of the
Texas Natural Resources Code, Subrecipient shall complete the requirements of the
Contract in compliance with the CMP Rules, and shall ensure that the performance of all
subcontractors is in compliance therewith.
5.3 FEDERAL ASSURANCES
Subrecipient shall execute the Assurances-Construction/Non-Construction Programs Form,
attached to the Contract as Attachment D, and submit it with the signed Contract, assuring
that it will comply with all federal statutes listed thereon and, when applicable, shall obtain
and retum completed assurance of compliance forms from its subcontractors.
5.4 FEDERAL LOBBYING CERTIFICATION
Subrecipient shall certify, by executing Standard Form CD-512, included as Page I of
Attachment E, that no federal funds have been or will be paid to any person for
influencing or atlempting to influence the award to Subrecipient contemplated under this
Contract.
5.5 LOBBYING DISCLOSURE
If at any time any non-federal funds have been paid for such purposes, Subrecipient shall
complete and submit the Disclosure of Lobbying Activities Form (Standard Form-LLL),
atlached hereto and incorporated herein for all purposes as Page 2 of Attachment E.
5.6 HISTORICALLY UNDERUTlLIZED BUSINESSES
(a) In accordance with State law, it is the GLO's policy to assist HUBs whenever
possible, to participate in providing goods and services to the GLO. The GLO
encourages Subrecipient to adhere to this same philosophy in selecting
subcontractors to assist in fulfilling Subrecipient's performance under the
Contract. In addition to other infOlmation required by the Contract, Subrecipient
will provide the Purchasing Department of the GLO with pertinent details of any
participation by a HUB in fulfilling Subrecipient's performance under the
Contract.
(b) The GLO encourages Subrecipients to partner with cel1ified HUBs that participate
in the Comptroller's Mentor Protege Program. For more information on the
program, and how it can assist your firm in meeting good faith eff011 goals please
visit:
ClAP Supplemental Terms and Conditions
Attachment B '
Page 11 of 11
www.window.state.tx.us/procurement/prog/hub/mentorprotege.
(c) Subrecipient shall, not later than the dates listed on Attachment G of the
Contract, complete and return the HUB expense report included in Attachment
G.
5,7 Buy AMERICAN ACT REQUIREMENTS
Subrecipient shall take notice of the Buy American Act Requirements set forth in Section
F of the Financial Assistance Award Agreement.
5,8 SEAT BELT POLICIES AND PROGRAMS
Subrecipient is encouraged to adopt and enforce on-the-job seat belt use policies and
programs as described in the Financial Assistance A ward Agreement.
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ClAP Supplemental Terms and Conditions
Attachment C
Contract No. 12-617-000-7021
Page 1 of 5
United States Department of the Interior
~u.. .v.:Y.LIJunt
~i<....
FISH AND WILDLIFE SERVICE
Washington, D.C. 20240
In Raply RefarTa:
WSFRlCIAP/F12AF00873
Mr. Larry L Laine
OepuWLand c;prrunl$sioMr
General L:and Office
17QQ N.CongrassAVf3.
Austin, Texas 18101.1495
SUQject: Notice of f:lnanelal Asslstanc.eAward..... Green Lake Acquisition
RECEIVED JUL 052012
Dear Mr. Laine:,
This letter constitutes U,S. Fish and Wildlife Service (USFWS) approval of your gralit
F12AF0087S Green Lake Acquisition, In the amoLlnt of $2,101.271.00. This Ooastal
Impact Assistance Grant will be used by the St1:lte of Texas to acquire apptox,lmately
se7a acreS of the entire 6434.29 acre Green Lake land parcel, The rest of the land will
be pl.lroliased with OIAP funds by Calhoun Oounty. Once purchased. this land will be
protected in perpetuity. This grant is effective July 2, ~012 for the grant period from
May 1, 2012 through April 30. 21m.
The grant has been approved through Catalog of Federal Domestic Assistance (0 FDA)
number 15.668. the Coastal Impact Assistance Program (ClAP), This grant is .
administered through the Wildlife and Sport Fish Restoration Program. ClAP Branch.
Terl'l)s of AcceDta{lce:
Acceptance of a Federal award from the Department of the Interior (001) carries with it
the re~onsibility to be aware of and to comply with the terms and conditions of the
award per (hltpll/www.doi.govloam!TarmsandConditions;htmlt Acceptance is defined
as stal1lng work, drawing down funds, or acqeptlng the aWard via electronic means.
Awards are based on the application submitted to and approved by the USFWS.
Awards are subject to the terms and conditions lncorp()rated either directly or by
reference In thafolIowing:
. Program legIslation. regulation. and provisions.
. Oode of Feqeral Regulations (CFR) Requirements. including but hot limited to:
o 2 CFR Part 25, Central Oontractor Registration and Data Universal
Numbering System
Attachment C
Contract No. 12-617-000-7021
Page 2 of 5
o 2 CFR Part 25, Central Contractor Registration and Data Universal
Numbering System
o 2 CFR Part 170, Reporting Sub awards and Executive Compensation
o 2 CFR Part 1400, Govemment-wide Debarment and Suspension
(Nonprocurement)
o 2 CFR Part 175, Trafficking Victims Protectlon Act of 2000
o 43 CFA 12(A), Administrative and Audit Requirements and Cost PrincIples
for AssIstance Programs
o 2 CFR Part 1401, Govemment-wide Requirements for a Drug-Free
Workplace
o 43 CFR 18, New Restrictions on Lobbying
o 305 OM 3, integrity of Scientific and Scholarly Activities :
. Assurances-Non-Construction Programs (SF-424B) and/or Assurances-
Construction Programs (SF-4240), as applicable
. State and local laws and regulations.
This grant Is not subject to the requirements of 43 CFR 12. 70(c)(1 )(Ii). Grant funds may
be transferred between pro]ects/actlvlties/budget categories without prior approval from
this agency.
Grantees must comply with the Federal Funding Accountability and Transparency Act
(FFATA). Additional Information can be found at
htto:/lwww.dQi.oov/oamllinanclalassistance/awarcWndex.html.
PaYment Reauests:
Payments are processed through the U.S. Department of the Treasury's Automated
Standard Application for Payments (ASAP). For information on ASAP, visit the
SelVice's website at: http://WWW.fws.govllbms/asapJndex.html. If you have any
questions about the reimbursement process and payments, please direct them to:
asapenrollment@fws.gov.
Reportina Reaulrements:
Grantee must comply with the Interim Guidance for FinanCial Status and Performance
reporting dated May 15, 2009, found at:
htto:/lwsfrorograms.fws.gov/subDaaesltoolkltflies/intgdrpt.oclf . Financial and
performance reports are required under this award, as follows:
Re ort
Financial & performance
re Its
Re ort Period
05/01/2012 - 04/30/2013
Re rt Due Date
7/30/2013
FInancial Reports: Annual interim SF-425, Federal Financial Reports are required, A
final SF-425, Federal Financial Report is required within 90 calendar days of the end
date of the grant. This form is on the web at:
http://wsfroroarams,fws.aov/subpaaes/toolkitflleS/Sf425FFR,odf,
. ,
Attachment C
Contract No. 12-617-000-7021
Page 3 of 6
Performance Reports: An annual interim and a final performance report are required
under this award. For guidance on financial and performance reporting requirements
please refer to: htto://wsfrproarams.fws.gov/suboaaes/toolkitfiles/intgdrot.odf .
Performance reports must contain: 1) a comparison of actual accomplishments with the
goals and objectives of the grant as detailed In the approved scope of work; 2) a
description of any significant deviations, including why established goals, objectives,
and deadlines were not met, if appropriate; and 3) any other pertinent Information
relevant to the grant.
Grant Condltlon~:
Cost accounting is required at the grant level.
SHPO
landscape altering activities may be subject to State HIstoric Preservation Office
review, applicable tribal/native consultation, and National Historic Preservation Act
compliance requirements,
Acaulsltlon of real Drooertv:
1. The grantee must obtain the permission of the USFWS to modify the use of, change
the terms of, encumber, or convey title to, the Interest in the real property acquired
under this grant. The grantee will protect the Federal interest by ensuring the title
includes a covenant as described below or a Notice of Property Restriction as
described below that is recorded separate from the title but with ref6(ence to it. The
covenant or Notice of Property Restriction must:
a. Identify the interest in real property to which the Notice of Property Restriction
applies and where the title to this interest Is recorded;
b. Identify the name and address of the grantee and other authorized entity (if
any) that hokls title to the Interest In real property;
c, Identify the grant by name(Green Lake Acquisition) and Identifying number
(F12AFOO873); .
d, State the purpose of the acquisition: To protect and conserve environmentally
sensitive land, Including wetlands,
e. State that the grantee and any other authorized tltle holder will not conveyor
encumber the Interest In real property, in whole or In part, without consent of
the USFWS and will manage the Interest in real property for the project's
authorized purpose unless USFWS authorizes otherwise; and
1. State that the Notice of Property Restriction rlXls with the Interest in real
property and none of the items In the covenant or Notice of Property
Restriction may be changed and none will cease to be applicable unless
USFWS provides written authorization, which the grantee, subgrantee, or
other authorized titleholder must also record with reference to the title to the
real property Interest. Suggested language for the title is:
Attachment C
Contract No. 12-617-000-7021
Page 4 of 5
''This properly was acquired (In whole or in part) with funds provided by the U. S.
Department of Interior, Fish and Wildlife SeNlee, pursuant to grant number
F12AF00873, GrMn Lake Acquisition, from the Coastellmpaut Assistance Grant
Program, and w/ll be, managed for the purpose of this grant, In accordance with
applicable Federal and State law. Prqperty may not be disposed of In any
mimner, or used for purposes Inconsistent with the Program for which It was
acquired, WithOut the prior approval of the Director, V,S, FIsh and Wildlife Service
- Washington"
2. Theappraif!al and review appraisal documents must be submitted to the W8FR
Program for review and approval before Federal funds can be used to purchase the
land,
if you have qUestions on this award, specified conditions or reporting requirements,
please contact the ClAP Grants Management Specialist Identified beiow.
JheqlAPiGl'ai)ts MMag~l'l'll)tlt The Point 01 CtintElctfot tills aWard Is:
SPecialist
1ortl1l$ llwardl$:
Peter 1'/. Barlow LarryLLaine "
Coa$UJ.IJrnpl1.crA~slstanc~Pr'o!;lr'am DepUty'lan4pgrnnj'SSiOrW
U.S. Flsh and Wildlife Service GeneraILand()ff)c~
. .. .....,... .....
Oi!tpa.rtroent of tl't~ Interipr 1700 N.. 0on!;lre$sAvEW.le
4'lOfN.F;:lIffaxDrlve, W$fFl4020 Austin, Texas 787'914495
Arlitigto(l. \lA2~203 Phonl:l:q12,93~-t927'
F'hom'l:.7(j3~25a..3604 Larv:lainera?qlo.texas.gov
F~:703-258,3S49 P1re9t pr()ie~tquE!stipri$to:
Peter barlowra?fIJ\!s.aov
f()l' T~cilll')lqal~uQstl()tls Regardlngthl!l Ms. MelisS~)\. porter
@rants "e~m L~!lder
Grant/Please Contact: Phone: 512..475..1393
TprriC.e.1ht\i1 Melissa.oorter@alo,fexas.dOv
State Liaison; CiAP
F'honEl:512'4~~-!31PP
Thoml'lS r Calnan@tWs.nov
. ,
Attachment C
Contract No. 12-617-000-7021
Page 5 of 5
Please submit correspondence, amendment requests, financial and pertormance
reports and general Inquiries to FW9_WSFR_CIAP@fws.gov. We appreciate this
opportunity to work with you as the Implementation of this approved State ClAP Plan
project continues.
Cc:
Tom Calnan
ClAP State Liaison, Texas
penny Bartnicki, Branch Chief
Coastal Impact Assistance Program
Attachment D OMS Approval No. 0348-0042
ASSURANCES. CONSTRUCTION PROGRAMS Page 1 of 2
Public reporting burden for this coilection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the coilection of
information. Send comments regarding the burden estimate or any other aspect of this coilection of information, inciuding suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be appiicable to your project or program. if you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legai authority to apply for Federal assistance, 8. Wiil comply with the Intergovernmental Personnel Act
and the institutionai, managerial and financial capability of 1970 (42 U.S.C. S94728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards for merit systems for programs funded
of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of the project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration (5 C.F.R. 900, Subpart F).
2. Wiil give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine ail records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with
generaily accepted accounting standards or agency
directives.
3. Wiil not dispose of, modify the use of, or change the
terms of the real property title, or other interest in the
site and facilities without permission and instructions
from the awarding agency. Wiil record the Federal
interest in the title of real property in accordance with
awarding agency directives and will include a covenant
in the title of real property aquired in whole or in part
with Federal assistance funds to assure non-
discrimination during the useful life of the project.
4. Wiil comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.
5. Wiil provide and maintain competent and adequate
engineering supervision at the construction site to
ensure that the complete work conforms with the
approved plans and specifications and will furnish
progress reports and such other information as may be
required by the assistance awarding agency or State.
6. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
7. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
9. Will comply with the Lead-Based Paint poisoning
Prevention Act (42 U.S.C. S94801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
10. Will comply with ail Federal statutes reiating to non-
discrimination. These inciude but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race,
color or nationai origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. 9s1681-
1683, and 1685-1686), which prohibits discrimination
on the basis of sex: (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C.
s794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. %6101-6107), which prohibits
discrimination on the basis of age: (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to nondiscrimination on the basis of
drug abuse: (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) S9523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 9s290 dd-3 and 290 ee-
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. S93601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing: (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made: and, G) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 4240 (Rev. 7-97)
Prescribed by OMS Circular A-102
~l,):",BJ.:itH,l(ji1!,',t\*i1.0_~,;;';,;.:ai;;""'.'';'1."",-.,i''44:c,;.j/;;fi~:;;;:iidd,td'::;;'Ci>},;!i:.t'~'S;"':::i.:"h:;i2i~!4i;,,\S\i:.;'-0-;~~:i-;~&",t;:,~'f.c'f,,\i!;i~.i,\;tj;};d]k"/."~':1.Vilb>"-'.:,.;>;!ci',~""'i;c;t..-ji'}<:,;;'~;.'.!;ii,","';:"'I";,$;Y"..W"'',;_';'''''''''''''''*~>'''''''''''''',_"'=-i,'c......,<>->=-~"v
11. Will comply, or has already complied, with the
requirements of Tilles II and III of the Uniform Relocation
Assislance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equllable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally-assisted
programs. These requirements apply to all Interests in reai
property acquired for project purposes regardless of
Federal participation in purchases.
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
ss1501-1508 and 7324-7328) which limit the political
activlUes of employees whose principal employment
activities are funded in whole or in part with Federal funds.
13. Will compiy, as applicabie, wilh the provisions of the Davis-
Bacon Act (40 U.S.C. ss276a to 276a-7), the Copeland Act
(40 U.S.C. s276c and 18 U.S.C. (874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. SS327-
333) regarding labor standards for federally-assisted
construction subagreements.
14. Will comply with flood Insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P.L. 93-234) which requires recipients In a special flood
hazard area to participate In the program and to purchase
flood insurance If the total cost of insurable construction
and acquisition Is $10,000 or more.
15. Will comply with environmental standards which may he
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
rVvluk b-J!
APPLICANT ORGANiZATION
Calhoun County
Attachment D (Page 2 of 2)
National Environmentel Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514: (b) notification
of violating facilities pursuant to EO 11738: (c)
protection of wetiands pursuant to EO 11990: (d)
evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
deveioped under the Coastal Zone Management Act of
1972 (16 U.S.C. SS1451 et seq.): (f) conformity of
Federal actions to State (Clean Air) Implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. ss7401 et seq.): (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P.L. 93-523); and, (h) protection of
endangered species under the Endangered Species Act
of 1973, as amended (P.L. 93-205).
16. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. SS1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
17. Will assist the awarding agency in assuring compliance
with Section 106 of the Nationai Historic Preservation
Act of 1966, as amended (16 U.S.C. (470), EO 11593
(Identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 V.S.C. ss469a-1 et seq.).
18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMS Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations,"
19. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
TITLE
Calhoun County Judge
DATE SUBMITTED
10-25-12
THIS PAGE MUST BE EXECUTED BY SUBRECIPIENT
SF-424D (Rev. 7-97) Back
,;;'.~j,'0S_;ji:~;H;}A'i:i{'1(;i~ii,\F"i:\!i';:-~;:~Aif:,'."-'iJii~.'j":<i.-!",,",i?i;:'i;-',-f..;;~:',<f,idjj;;'i:Y;,;::-!);)ii~di-~,f",)";,'~;;;i_,,,,:i~;,;,!,[,'}!i;.to'B<..'i~':;,';2ik'7~,;i:l"'r,:t;\',~:"'{!.,-'i.l;"",,,':,,;f:'.':i':;'c4!~!.!i,,JiJ;:'';':d<~'"'i";4>:i;;!~ih';'A~'?!i:I!',,&j!,,;r,+>~;0~w)ili0<,i8.if;,!i;'''h,'I~';~d,,,~_~YJ:>h,-'>a~..>j''i.''iSf.-;;j,,,,.
'O~M CQ41,t
(REV 11-04)
Attaclunent E
Page 1 of 3
u.$.o~CllCOMMERcI
CERTIFICATION REGARDING LOBBYING
LOWER TIER COVERED TRANSACfIONS
Applicants should review the Instruelions for certification included In the ragulallons before complellng this (onn. Slqna!ure
on Ihls tonn provides for compile nee wllh certlficaUon requlramenls under 15 CFR Part 28, 'New ReetrlcUone on lobbying:
LOBBYlNG
As requlrs<l by Secllon 1352, TiUe 31 of tha U.S. Code, and
i'T~leiJJ~iltljjfet15' CFR Part 28, for persons .entering Into a gran~
~llil~t or contract over $100,000 or a loan or loan
9\l8IilI1Ul!IoVlll' $150,000 as donned al15 CFR Part 28, Sections
26.100 imd 28,110, lhe appiicant cerlffies that to the bast of his or her
knowle<J!ja and belief, that
(1) No Feaenil appropriated funds have been paid or wIi be paid,
by or on Iieh8If of the undllrsigl>ed, to any peI8OI\ lOr ilIluendng or
aUamptlii(j to Influence art ofllcer or employee of any agancy, a
MambGt of Can1jTe88 In conncaction with the aW81dlng of any
Fea8lll (lQ1\lra<;I, 1M maklrQ of any Federal gtanl. 1M making of
MY f'Bij~Ioan, 1M entering into of any cooperativil agraement,
and th. ext,nslort. continuation, ranewal, amendment, or
modiftoalk>n of MY Federal contract, gran~ loan. or cooperative
agreement
(2) If lllIY furr<4 other Ihen Feaeral "I'I""Ptialed tI.i1ds have been
paId.~\yi~,1Je ~ 10 MY P8f8OO for Inft~ or attempting to
Inft~'Il~.lUl ol!liler or llITIPloyee of any lIgel'lC'l. a MGmber of
~~,lili'ot$iet or employee of Congress, or 811 8/1llIOyee of a
n\tjQt~9t~1rT dliinedIon with 1Ns l'8delaI oontract, gran~
1oaO.9~~IMlilgn.em8l1l. 1M undal9lgil8d shall complete and
subl'M;~ FQfir\'UL. 'Disclosure Fonn to Report Lobbying."
in aQOOrcl8~ with lis Instrudions.
(3) , Tlle u~er.IQnll<l shall require that the language of this
~1\lI1"q~ Ir1the awerd documents for all subawards at
all tJiil1!.'(fndj1i:tI~. aYli9ontracts. subgrants, and contracts under
gral1llii~.isllI ~ agreements) and that allsubreciplents
shaij CilIjlty and dlsdoall accordingly.
This <*\IfiCQlfon III a materiall'$p_Uon of fad upon which
reJ~,_Pl!c*Iwl\Bri lhiofniroeecfJ()n lNoI8(Tllldeor entered Into.
Sublnfoslon of \1\'" .ertlftcatloo ts a p"""8Il~Isl\8 for meklng or
anteMg InID \Ills trl!tJIlQClIOn irfl105ad 'r1/ ~13&2. bile 31, U.S.
Code.A/lypeRQllwhaiiillllofl1&1IMl~~!'li!Uftcetlon shell ba
subJect to a oIv,U p....alty of nol Ieoo than $1C1.~ and not mora
than $'1<)0,0'0'0' for each such failure ooourtlng on or berore
Oelob.r 23, 1996, and of notlesa Ihan $11,0'00 and not more
than $110',0'00' tar ..ch such f.llure occurring after Octobar 23,
1996.
Statement for Loan Guaranteea and LOBn In.urana.
The undonllgned .tales, to tha be.t of his or her knowiedge
and belief, that:
In any fundshave baan paid orwtll bepaillto arly ~~on,for
intiuenclng or att.mpUng to InftU~~~.l!O~fIl~~,9r~mBlo~a.
of any agency. aMembal'oIConQr,~"i!i}{JiIl~f!l!'~ro~@Y,lj.
of Congress, or an employaa oh, ~~I1l~C)f\Ci'l~(,,"ln
connection with thle commltrtlenl provldroqJortlj~Unlled
state. to Insure or guer.ntse . loal1, Iftil unq,,",lgl1.ltsb~1
complete and sUbml1 standard FootMJ.,L, "ofa<llt)iU"",FQnn
10 Report Lobbying," In sccordanos with Its IrlsltUctlons.
Submission of this statemantls a prare~ul8itll for JT)qk1/ll1,or
entering Into !hili transectlon lmposs<l bYS,l!Olion t~!I. ~Ue
31, U.S. Code. AnYpilf8Onwhohlllatoftl~ih'r!l<lW~\M,\!l.l.lI-
mant shall be subl~tqa eMl panalty ofno\I"ll:lI1llT] iW'09l>
and not more than $100.000 lor ..ch .uch ja"u"~!\fil9
on or before Oelab<!r 23. 1996, and of nolla.. \halI $11.0'00
end nol more than $110',0'0'0' for each auch failure occurring
after October 23, 1996.
As Ihe (MV a\lthllrlz!ld representative of the applicant. I hereby certify that the applicant will comply with the
above applicable certification.
AWAAD NUMBER ANOIOR PROJl!CT NM1E
NAME OF APPliCANT
Calhoun County
PRiNTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Michael J, Pfeifer, Calhoun County Judge
SiGNATURE
F12AF00873
DATE
10-25-12
Attachment E
Page 2 of 3
1. Type of Feeleral Action:
o a. contract
b. grant
c. cooperative agreement
d.loan
e. 19~~~\I<lrantee
f.JQan)l!~aYrance
4. Name liridAddreiJs of Reporting Entity:
o Prime 0 Subawardee
Tier , If known:
DISCLOSURIa OF LOBBYING ACTIVITIIaS
Complete this form to di$c1qae lobbying activities pursua~t(O)31 U.S.C. 1352
SeeJeversafor yblic burden disclosure.
2. StlltulIofl"adaral Action::!. Report Type:
Oa. bid/offer/application 0 a. !nlUa! flling
b. Initlal award b. material changa
c. post-award For MaterIal Ohange Only:
year quarter
date of last report
Approved by OMB
0348-0048
5. If RepQrthigE:!l\tJty In No.4 18 a SubaWard.e, E:!nter NarnG
and Addres8 of Prime:
Con resalonel District, if known: 4c
6. Fedoral Department/Agency:
Con I'tlSSIOnlll Dllltrlct, If known:
7. Federal Program Name/Oescrlpllon:
CFDA Number, Ifapp/ioable:
10. a. NIlI1l,~rid)A<idress of LobbyIng Registrant
(If IndivIdual, last name, first name, MI):
9. Award Amount, If known :
$
b. Inell1llelu.lIe F'erfom111lS ServIces (Including address If
dIfferent from No. 1 Oa)
(last name, first name, MI):
8. Federal Action Number, if known:
~~,lblB fonn II luthoriZed by title 31 U.S.c. ~
,,(,~lctivit\l\eII"'materlfllrafll""Mtallono(rflc:(
byV\& Uw above \YMn 1hI1 trf;llJ~ WN made
I$' ffKlUlred p.nvanl It) 31 U.S.C. 1352-. Th!1
pObllclfllfloedloo,"'ly~V<hofd.loftkoUlIt
,~ectlll' r;MIpoIIlltyoll'lQl,lln \hen $10,QOOlllld
kirHmlUGtlfdl,l~.
Signature:
Print Name:
Tille:
Telepnqne flfO.:
Date:
Attaclunent E
Page 3 of 3
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This dlsclosur. form .hsU b. oompl.lecj by th. ",porllng .nllty, wh.ll1.r subew.rd.. or prtm. Fed...1 ",clpl.nt, al 1h.1QlUaUon or .....Ipt of . cov.red F.p....1
action, or. mllflllilllolllmg.lo . pr.vJou.~Ung, pUl1!u.nl fo 00. Sf U.S.C. ..otlon t35~. Tho nUns 0' . 'oml"lo required for 6I\c:h "aloin..lor 119re.m.iJtlo m.k.
paym.nllo sny lobbying .nOly for InRu.no4lg or att.mpUnglo Influence .n of!1cor or .mploy..of .ny .g.noy, 8 M.mber of Congf1'S8, an of!1cer or .mploya.of
Congress, or Clhemployeeof'aM~berof Congms In connectlonwl!h a covered Federafactfon, Compfefe:all'ltems that~plyfCir:bOUlthe Irtffialfillrtg and:niaterlal
change report Refar to the ImpJemenUng guIdance published by the Office of Managemenl and Budget for addJUonallntdrmBUon.
1. IdentIty the type of covered Federal acllon for whIch lobbying activity Is end/or has been a9cored to Influence the outcome of a covered l=ederal action.
2. ldenllfythe status of the covered Federal action.
3. Idei'lUry the appropnlJteolasslficatlon of this report. If this Is 8 followup report caused by B material chang&to the lnfCltn'l"Uon pr&v1oUify'~PQ~~ienter
the year and quarter In whIch lhe change occurred. Enter lhe date of Ihe lasl previously submllft:ld reporf'by this repoH1iig enUly (or this GOveredF&deral
action.
4. Enter {he fufl name, address, cIty, State and zIp code of lhe reporting Bntlty.lnchJde CongreasiclOalpl$trlci, It known. Checktt\8 approprla{ecfasslftca,Von
of the reportIng entIty that designates If It Is, or expects to be, a pOmBQI' Bubawsl'd reolplent IdaoU1ylhetlerof thea'\.It>a:W$'de8.e,g~, the firil fluba:wtlrdee
of the prime Is the 1st Uer, Subawards Include but are not Umlted to sUbconlracl6, subgrants and contract awarosunder gmnts.
5. If the organlzatlontillng the report In Item 4 checks 'Subawardee,.then enter the full name, address, clly, State and zip coda of ths prima Federal
recipient. Include CongressIonal DIstrict, If known.
6. Enterthe name of the Federal agency makIng the award or loan commitment. Include at least one organlzatlonallevel balow agency name. If known. For
example, Department ofTransportatlon, United States Coast Guard.
7. Enter the Federal program name or descripUon (or the covered Federal8GUon (!lam 1). If known, enter the full Catalog of Federal Domestic Aaslstance
(CFDA) number for granls, cooperative agreements, loans, end loan commitments.
6. Enter the most epproprlateFttdefalldenUfylng number aveUablefQr the FW6ral acUen identlfledlndtel!' 1 (e.g., RequesUor Propo"8EIt(RfPl,number;
Invitation for Bid (IFB) number; gmnt announcement number; the contract, grant. Or loan award number; the appllcaUonlprOpclsal'control number
assigned by the Fooeralagency). Include prefixes, e.g., .RFP~DE.90-o01.. .
9. For 8 covered Federal acUon where there has been an award or loan commitment by the Federal agenoy, enter the Federal amoufllof lheawardlloan
commitment for the prime enUty Identified In Item 4 or 5.
10. (a) Enlerthe full nem., addr..., olty, Stal. and zip code ofl!1alobbylng reg~lT.nt undertha lobbying Disclooure Act of 1995.nSll/l8d by !h. ..porllng
entity klenlllied In item 4 10 lnnuence the covered Federal action.
(b) Enter the fullllam6S or Ihe indlviduaf{s) perfonnlng services, and Include full address If different from 10 (a). Enter Last Name. First Name. and
Mlddleln;ti.1 (MI).
11. The cerfltylng offiolal ~all sign and date the fonn, prim hls/her name, title, and leIGph<mE) number.
Accordlng.lQIh.,Pep6lfWQJkR~JJ,ction Act, 4i5 ltfAend~~.nC),MfJPnS, are requlNd_k> fQ8P9~~i9,:,,~J~n:Qf InfOm1f1tlQnpI}J,~'~J~,
Number. Th. v.lld OMS control number for Il1Is information ooneo1lon Is OMS No, 0341l-O().48, Publlo reportlng burdon
esumatlildW,~~~~g~ 1?TI,,~t~.~rfQsp(mae. Irtolud'n~l U'TI~J?rnWf6w(!1g InlitNc~na,'~~q:.~~f~UJlg dafa'QjJ~,I,:~~
n.eded, end aompleUng end reviewing the aolleCtion of Information, Send aommenla tegerdln\tthe burden satlma\ll OIlny
Inlonnation, Including auggeaUonslor reduclng Ihls burdan, to !ha Ol1k:8 01 Managemenlsnd Budget, Paperworl< Reduotlon Pro/eel (
OC 20503.
Attachment F
Page 1 of2
GENERAL AFFIRMATIONS
Provider agrees without exception to the following affirmations:
1. The Provider has not given, offered to give, nor intends to give at anytime
hereafter any economic opportunity, future employment, gift, loan, gratuity,
special discount, trip, favor, or service to a public servant in connection with this
Contract.
2. Pursuant to Title 10, Section 2155.004 of the Texas Government Code, the
Provider has not received compensation from the GLO for preparing any patt of
this Contract.
3. Under Section 231.006, Family Code, the vendor or applicant certifies that the
individual or business entity named in this contract, bid, or application is not
ineligible to receive the specified grant, loan, or payment and acknowledges that
this contract may be terminated and payment may be withheld if this cettification
is inaccurate. Any Provider subject to this section must include names and Social
Security numbers of each person with at least twenty-five percent (25%)
ownership in the business entity named in this Contract. This information must
be provided prior to execution of any offer.
4. Provider certifies that the individual or business entity named in this Contract: i)
has not been subjected to suspension, debarment, or similar ineligibility to receive
the specified contract as determined by any federal, state, or local governmental
entity; H) is in compliance with the State of Texas statutes and rules relating to
procurement; and Hi) is not listed on the federal government's terrorism watch list
as described in executive order 13224. Entities ineligible for federal procurement
are listed at http://www.epls.gov. Provider acknowledges that this contract may
be terminated and payment withheld if this cettification is inaccurate.
5. Provider agrees that any payments due under this Contract will be applied towards
any debt, including, but not limited to, delinquent taxes and child SUPPOlt that is
owed to the State of Texas.
6. Provider certifies that they are in compliance with Texas Government Code, Title
6, Subtitle B, Section 669.003, relating to contracting with the executive head of a
state agency. If this section applies, Provider will cornplete the following
information in order for the bid to be evaluated:
Name of Former Executive:
Name of State Agency:
Date of Separation from State Agency:
Position with Provider:
Date of Employment with Provider:
7. Provider agrees to comply with Texas Government Code, Title 10, Subtitle D,
Section 2155.4441, relating to the purchase of products produced in the State of
Texas under service contracts.
Attachment F
Page 2 of2
8. Provider understands that acceptance of funds under this Contract acts as
acceptance of the authority of the State Auditor's Office, or any successor agency,
to conduct an audit or investigation in connection with those funds. Provider
further agrees to cooperate fully with the State Auditor's Office, or its successor,
in conducting the audit or investigation, including providing all records requested.
Provider will ensure that this clause is included in any subcontract it awards.
9. Provider certifies that if it employs any former employee of the GLO, such
employee will perform no work in connection with this Contract during the
twelve (12) month period immediately following the employee's last date of
employment at the GLO.
10. The Provider shall not discriminate against any employee or applicant for
employment because of race, disability, color, religion, sex, age, or national
origin. The Provider shall take affirmative action to ensure that applicants are
employed and that employees are treated without regard to their race, color, sex,
religion, age, disability, or national origin. Such action shall include, but is not be
limited to, the following: employment, upgrading, demotion, or transfer;
recruitment or ['ecruitment advertising; layoff or termination; rates of payor other
forms of compensatioh; and selection for training, including apprenticeship. The
Provider agrees to post notices, which set f0l1h the provisions of this non-
discrimination at1icle, in conspicuous places available to employees or applicants
for employment. The Provider shall include the above provisions in all
subcontracts pel1aining to the work.
II. Provider understands that the GLO does not tolerate any type of fraud. The
agency's policy is to promote consistent, legal, and ethical organizational
behavior by assigning responsibilities and providing guidelines to enforce
controls. Any violations of law, agency policies, or standards of ethical conduct
will be investigated, and appropriate actions will be taken. Providers are expected
to report any possible fraudulent or dishonest acts, waste, or abuse affecting any
transaction with the GLO to the GLO's Internal Audit Director at 512.463.5338 or
traccy. hall((O,gl o. state. tx. us
NOTE: Information, documentation, aud other material in connection with this
Contract may be subject to public disclosure pursuant to the "Public
Iuformation Act," Chapter 552 of the Texas Government Code.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
Attachment G
Page] of6
MONTHLY PROGRESS REPORT
Reporting Period
Date
Project Title
GLO Contract #
Snb-grantee
Project Manger
Email Address
Telephone #
Task 1: (Name of task as identified in sub-grantee agreement)
1. Description of the status of the task (started, finished, percentage completed)
2. Description of task accomplishments during this reporting period
3. Identification of any problems or obstacles encountered (e.g., delays), remedial action taken,
and a revised schedule, if appropriate. If the task is ahead of schedule, explain why.
4. Description of task activities that should occur during the next month
(Repeat for each task)
Deliverable(s) submitted with this progress report:
Attachment G
Page 2 of6
INVOICE FOR ClAP EXPENDITURES
Invoice #: Federal ill #:
GLO Contract #:
Project Title:
Subgrantee:
Address:
City, State Zip:
Contact Name:
Phone:
Budget Category ClAP Budget Expenditures Previously Amount
This Invoice Invoiced Remaining
Salaries/wages $0.00 $0.00 $0.00 $0.00
Fringe $0.00 $0.00 $0.00 $0.00
Travel $0.00 $0.00 $0.00 $0.00
Supplies $0.00 $0.00 $0.00 $0.00
Equipment $0.00 $0.00 $0.00 $0.00
Contractual $0.00 $0.00 $0.00 $0.00
Construction $0.00 $0.00 $0.00 $0.00
Land Acquisition $0.00 $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00 $0.00
Subtotal $0.00 $0.00 $0.00 $0.00
Indirect Costs $0.00 $0.00 $0.00 $0.00
Total $0.00 $0.00 $0.00 $0.00
Attach receipts/cancelled checks for all expenditures.
Submitted by:
Email Address:
Date:
For GLO Use Only:
Req# Invoice Amount $
Service Date
Req#
Invoice Amount $
Invoice approved by Contracts Specialist
Invoice reviewed by Project Manager
Date
Date
Invoice approved for reimbursement:
Grant Manager
Date
Attachment G
Page3 of 6
BUDGET AMENDMENT REQUEST
GLO Contract #:
Project Title:
Subgrantee:
Address:
City, State Zip:
Contact Name:
Phone:
Email Address:
Budget Category
Current ClAP Budget
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
S alaries/wages
Fringe
Travel
Supplies
Equipment
Contractual
Construction
Land Acquisition
Other
Subtotal
Indirect Costs
Total
Submitted by
Requested Changes
Revised Budget
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Date
Note: A written justifcation must be submitted with tltis request.
If approved, the revised budget will replace all previous budgets and will become part of your permanent GLO legal file.
For GLO Use Only:
Request approved by Contracts Specialist
Request reviewed by Project Manager
Budget amendment approved:
Grant Manager
Date
Date
Date
Attachment G
Page 4 of6
HISTORICALLY UNDERUTILIZED BUSINESSES
EXPENSE REPORT
Date submitted:
RepOlting Period (ie. mm/yr - mm/yr):
Project:
Subgrantee:
GLO Contract #:
Reporting Period: September 1 through February 28
or
March 1 through August 31
Due March 7
Due September 7
In accordance with state law, it is the General Land Office's (GLO) policy to assist Historically
Underutilized Businesses (HUBs), whether minority or women-owned, whenever possible in
providing goods and services to the GLO. The GLO encourages you to adhere to this same
policy when selecting subcontractors to assist your organization in fulfilling its contractual
obligations with the GLO.
In that regard, please provide us with the estimated amount of project funds your organization
paid to HUB vendors during the above reporting periods. Submit this form electronicallv to the
OLO bv March 7 and September 7 of each vear.
PROJECT AMOUNT PAID: VENDOR NAME:
TYPE OF HUB VENDOR:
American Women (WO)
Hispanic Americans (HI)
Black Americans (BL)
Asian Pacific Americans (AS)
Native Americans (NA)
Other
I am not sure if the following vendor is a HUB:
Vendor's name
Amount paid: $
_ No project funds were paid to a HUB vendor during the stated time period.
Please em ail this page to the Grant Administrator at the following e-mail address:
CIAPreceipts(al,glo.state.tx.us. If you have questions, please contact Ms. Debby French (512)
463-5309.
Audit Reporting Form
Subgrantees receiving (granted/awarded) federal funds, through the General Land Office (GLO), are subject to the requirements of the
Single Audit Act of 1996, Office of Management and Budget (OMB) Circular No. A-133, (httn://www.omb.gov/grants). Subgrantees
expending (spending/reimbursed) federal funds totaling $500,000 or more in a fiscal year are required to conduct an audit in accordance
with the Single Audit Act.
Attachment G
Page 5 of6
Please complete this questionnaire and send by facsimile to 512-475-0680 aUn: Coastal Impact Assistance Program or mail to:
General Land Office
Attn: Coastal Impact Assistance Program
Coastal Resources Division
P.O. Box 12873
Austin, Texas 78711-2873
Section 1: Entitv Information
Name of Entity (Subgrantee)
Project Title and GLO Contract Number
(additional grants may be listed on a separate page)
through
What is your entity's fiscal year?
Month I Year
Month/Year
Section 2: Single Audit Requirement
For your most recently completed fiscal year (Fiscal Year 20_:), account for all federal funds (awards/grants) expended
(spent/reimbursed) regardless of the source. (Provide your most recently completed fiscal year above)
What was the total amount of federal funds (awards/grants) expended (spent/reimbursed)? $
D If less than $500,000 in total federal funds (awards/grants) were expended: Your entity is exempt from further audit
requirements for the repOlting period. COInolete Sections 4 and 5 (Federal Awards Information and Signature Sections),
D If $500,000 or more in total federal funds (awards/grants) were expended: Complete all remaining sections.
Section 3: Audit Information
. Date of last completed audit:
Period Covered by Audit:
through
Date Month / Year Month I Year
. Audit Findings: D No Findings (it is not necessary to submit ~ copy of your audit report package)
D Findings (provide a copy of your audit reporting package if findings were related to funds issued through the GLO.
If findings were umelated to OLD issued funds submit the schedule of findings and questioned costs.)
Period covered by next scheduled audit:
through
. Next scheduled audit:
Month/Year
Month I Year
Month / Year
Section 4: Federal Awards Information
For the fiscal year provided, account for all federal funds (awards/grants) received (granted/awarded) regardless of the source.
For Fiscal Year 20_: (fiscal year must match fiscal year provided in section 2)
What was the total amount of federal funds (awards/grants) received(granted/awarded)? $
(For the fiscal year listed, use the following table to list the Federal funds (awards/grants) your entity received)*
Name of federal award(s) granted Period of Award Amount CFDA Number
(month/vr month/vI')
-
-
-
-
-
-
Section 5: Signature Section
Signature of Preparer
Date
Printed Name of Pre parer and
Title
Preoarer's Contact Information:
Email:
Phone:(
ext.
Attachment G
Page 6 of6
Instruction Sheet for the Audit Reporting Form
The purpose ofthe Audit Reporting (AR) Form is to assist the General Land Office (GLO) in complying with federal
guidelines for pass through entities issuing federal funds. The AR Form also assists entities receiving federal funds, in
meeting their audit reporting requirement. Federal guidelines for pass through agencies issuing federal awards and the
subgrantee of those funds are set forth in the Single Audit Act of 1996, Office of Management and Budget (OMB) Circular
No. A-133. The OMB's website, httn://www.omb.gov/grants, has information regarding requirements ofthe Single Audit
Act.
Review the following instructions for assistance in completing the Audit Reporting Form.
Section 1: Entity Information.
Name of En tit v - The HName of Entity" should match the name on the grant contract.
Proiect Title and GLO Contract Number - Provide the "Project Title and GLO Contract Number" for your entity's grant.
The project title must match the title of the project found in "Attachment A" of the grant contract. A separate sheet
listing additional project titles and contract numbers may be attached if necessary.
Eutitv's Fiscal Year - Provide the period covered by your entity's fiscal year. (i.e. Jan. '06 through Dec. '06)
Section 2: Single Audit Requirement.
Following the text "For Fiscal Year 20_", insert your entity's fiscal year end for the reporting period (the most recently
complete fiscal year). For the fiscal year listed, provide the total amount offederal funds (awards/grants) expended
(spent/reimbursed). Account for all federal funds expended, regardless of the source.
Choose one ofthe following options:
I. Mark the first box, if your entity has expended less than $500,000 in total federal funds. Your entity is exempt from
further audit requirements for the reporting period, but must complete Sections 4 and 5.
2. Mark the second box, if your entity has expended $500,000 or more in total federal funds. Your entity is not exempt
from further audit requirements and must complete all remaining sections of the form.
Section 3: Audit Information.
Date of Last Completed Audit - Indicate the date of your entity's last completed audit.
Period Covered bv Audit - Provide the period covered by your entity's last completed audit. This period should
correspond to the audit indicated on the previous line.
Audit Findinl!s - Choose one of the following options:
1. Mark the box before "No findings" if your entity's last completed audit disclosed no findings. If there were no
findings, it is not necessary to provide a copy of your audit reporting package.
2. Mark the box before "Findings" if your entity's last completed audit disclosed findings. If there were findings related
to GLO issued funds, submit a copy of the audit reporting package. If the findings were unrelated to GLO issued
funds, submit a copy of the schedule of findings and questioned costs.
. Next Audit Scheduled for - Provide the month and year of your entity's next scheduled audit.
. Period Covered bv Next Audit - Indicate the period to be covered by your entity's next scheduled audit.
Section 4: Federal Awards Information.
Following the text "For Fiscal Year 20_", insert your entity's fiscal year end for the current reporting period (should
match the fiscal year provided in Section 2). For the fiscal year listed, provide the total amount offederal funds
(awards/grants) your entity has received (granted/awarded). Account for all federal funds received, regardless ofthe
source. It is Dossible for the amount of federal funds received/awarded to disagree with the amount expended/spent.
Federal Grants Table - For the fiscal year listed, use the table to provide: 1) the grants/awards that comprise the total amount
offederal funds your entity received; 2) the period of awards (i.e. May '06 - May '08): 3) amount of awards; and, 4) the
Catalog of Federal Domestic Assistance (CFDA) numbers for each award. If the CFDA number is unknown, you may contact
the issuing agency. If additional space is needed, attach a separate sheet listing the abovementioned federal grant information,
Section 5: Signature Section.
Signature of Prenarer - The person who prepared the AR form must sign and date the form.
Printed Name ofPrenarer - Print the name and title of the person who prepared the AR Fonn.
Prenarer's Contact Information - Provide an email address and phone number for the preparer.
For additional assistance contact Melissa Porter, ClAP Team Leader, at 512-475-1319 or by email at Melissa.P01iel'({V,glo.texas.f!ov.
\a-..
Criminal District Attorney
Calhoun County, Texas
I~:
~~
Half Moon Reef Lighlhouse
RANDY R. CRIDER
Investigator
DAN W. HEARD
Criminal District Attorney
SHANNON E. SALYER
Assistant Criminal District Attorney
ALICIA FLORES
Victim Assistance Coordinator
DAIN WffiTWORTH
Assistant Criminal District Allomey
JAMES D. HENDERSON
Assistant Criminal District Attorney
October 10, 2012
Ms. Susan Riley
Calhoun County Judge's Office
RE: Item for Commissioners Court Agenda
Dear Susan:
I am requesting that the following item be placed on the Commissioners Court agenda on
October 25,2012.
2012 Chapter 59 Asset Forfeiture Report by Attorney Representing the State
Thank you for your assistance.
yours,
AN W. HEARD,
Criminal District Attorney
for Calhoun County, Texas
DWH:jam
L
P.O. Box 1001 . 211 South Ann Street . Port Lavaca, Texas 77979 . (361) 553-4422 . Fax (361) 553-4421
2012 CHAPTER 59 ASSET FORFEITURE REPORT BY ATTORNEY REPRESENTING THE STATE:
Judge Pfeifer:
This is from the District Attorney. It is his financial report.
A Motion to approve the report was made by Commissioner Finster and seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
FY 2012 Chapter 59 Asset Forfeiture Report
by Attorney Representing the State
Agency Name:
Calhoun County Criminal
Attorney's Office
District Report;ngP,riod: 09-01-11
(example: 911/11- 08/31/12)
to 08-31-12
Name of Attorney
Representing the
State (Printed):
Dan W. Heard
Agency Mailing
Address;
P.O. Box 1001
Port Lavaca TX 77979
Phone Number:
(361) 553-4422
Calhoun
dan,heard@calhouncotx.org
This should be a pennanent agency email address
County:
Email Address:
NOTE: PLEASE ROUND ALL DOLLAR AMOUNTS TO THE NEAREST WHOLE DOLLAR
t. SEIZED FUNDS (Funds that have been seized, but not yet been awarded to your agency by the judicial system)
A) Beginning Balance:
Instructions: Include total amount of seized funds on band (in your agency's possession) at the
beginning of the reporting period including interest. Include funds that may have been forfeited but
have ~ot been transferred to your agency's forfeiture account. Do not include funds tbat are in an
account held by anotber agency, e.g. a police department's account. $ 2 t 180
B) Ending Balance:
Instructions: Include total amount of seized funds on hand (in your agency's possession) at the end
ofrepomng period including interest, Do not include funds that are in an account held by another
agency, e.g, a law enforcement account. $' 7, t 656
11. FORFEITED FUNDS (Funds awarded to your agency by the Judicial system)
A)
Beginning Balance:
Instructions: Include total amount of forfeited funds tbat have been forfeited to your agency and
are on band (in your agency's account or in your agency's possession) at the beginning of the
reporting 'period including interest. Do not include funds that have been forfeited but have not yet
been received by your agency.
$
2,180
B)
Ending Balance:
Instructions: Total amount offoueited funds that have been forfeited to your agency and are on
hand (in your agency's account or in your agency's possession) at the end of the reporting period
including interest. Do not include funds that have been forfeited but have not yet been received by
your agency.
7,656
$'
III. SEIZURES DURING REPORTING PERIOD
A)
Amount Seized By Employees of Your Agency:
Instructions: Include only those seizures which occurred during the reporting period and where the
seizure affidavit required by Article 59.03 is sworn to by a peace officer employed by your agency. $
o
FonnDHtc04/03/12
PHgcl
B) Forfeiture Petitions Filed For All Agencies You Represent
Instructions: Enter the total amount of seized funds forwbich forfeiture petitions were filed during
the reporting period. (This should be a currency amount, for example $1,000). $ 264,253
C) Property:
Instructions: List the number of items seized for the following categories:
Please Note: tbese MOTOR VEHICLES REAL PROPERTY COMPUTERS FIREARMS (Include OTHER
should be a number, not (Include cars, (Count each parcel Include computer only firearms seized (Include
a currency amount. For motorcycles, tractor seized as one item) and attached system for forfeiture under description)
example: 4 pending, 3 trailers, etc.) cpmponeots, such as Chpt. 59. Do not
seized, 12 new printers and monitors include weapons
petitions,etc.... as one item) disposed of under
Chpt.lB)
Seized by your agency 0 0 0 0 0
during reporting period:
New petitions filed for
all agencies during 2 0 0 0 0
reporting period:
Forfeited to your
agency during reporting 2 0 0 0 0
period:
IV. FORFEITED FUNDS RECEIVED DURING REPORTING PERIOD
Amount Forfeited to and Received by ReportingAgency (Including Interest) DuringReportingPeriod:
Instructions: Do not include amounts forfeited but not yet received by your agency; interest refers to
the amount eamed prior to forfeiture and distributed as part of the judgment of forfeiture. $ 5,457
V. LACK OF LOCAL AGREEMENT:
Amount deposited to State Treasury to the Credit oftbe General Revenue Fund Due to Lack of Local 0
Agreement (Art. 59.06 (a)): $
VI. FORFEITED PROPERTY RECEIVED FROM ANOTHER AGENCY
Instructions: Enter the total number of items transferred to your agency where tbe forfeiture judgment
. awarded ownership of the property to anotber agency prior to the transfer.
A)
B)
C)
D)
E)
Motor Vebicles (tbe number of vehicles, not a currency amount):
o
o
o
o
o
Real Property (the number of separate parcels of property, not a currency amount):
Computers (the number of computers, not a currency amount):
Firearms (the number of firearms, not a currency amount):
Other (the number of items, not a currency amount):
VII. FORFEITED PROPERTY TRANSFERRED OR LOANED TO ANOTHER AGENCY
Instructions: Enter the total number of items transferred or loaned from your agency where the forfeiture
judgment awarded ownersbip of the property to your agency prior to the transfer.
A)
Motor Vehicles (the number of vehicles, not a currency amount):
o
founDate04/03fl2
Page 2
Real Property (the number of separate parcels of property, not a currency amount:
o
Il)
C)
D)
E)
Computers (the number of computers, not a currency amount):
o
o
o
Firearms ( the number of firearms, not a currency amount):
Other (the number of items, not a currency amount):
VIII.
EXPENDITURES
Instructions: This category is for Chapter 59 expenditures SOLELY for law
enforcement purposes or for the official purpose of your office - not for
expenditures made pursuant to your general budget. List the total amount
expended for eacb of the following categories. If proceeds are expended for a
category not listed, state the amount and nature oftbe expenditure under the Other
category.
A) SALARIES
1. Increase of Salary, Expense, or Allowance for Employees (Salary Supplements): $ 0
2, Salary Budgeted Solely From Forfeited Funds: $ 0
3, Number of Employees Paid Using Forfeiture Funds; 0
TOTAL SALARIES PAID OUT OF CHAPTER 59 FUNDS: $ 0
III OVERTIME
1. For Employees Budgeted by Governing Body: $ 0
2, For Employees Budgeted Solely out of Forfeiture Funds: $ 0
3, Number of Employees Paid Using Forfeiture Funds: 0
TOTAL OVERTIME PAID OUT OF CHAPTER 59 FUNDS: $ 0
C) EQUIPMENT
1. Vehicles: $ 0
2, Computers: $ 0
3, Firearms, Vests, Personal Equipment $ 0
4, Furniture: $ 0
5, Software: $ 0
6, Maintenance Costs: $ 0
7, Uniforms: $ 0
8, K9 Related Costs: $ 0
9, Other (provide Detail on Additional Sheet): $ 0
TOTAL EQUIPMENT PURCHASED WITH CHAPTER 59 FUNDS: $0
Fonn Date 04/03/J2
roge3
D) SUPPLIES
l. Office Supplies: $ 0
2, Cellular Air Time: $ 0
3, Internet: $ 0
4, Other (Provide Detail on Additional Sheet) : $ 0
TOTAL SUPPLIES PURCHASED WITH CHAPTER 59 FUNDS: $ 0
E) TRAVEL
t, In State Trayel
a) Transportation: . $ 0
b) Meals & LJdging: $ 0
c) Mileage: $ 0
d) Incidental Expenses (Any other travel expense not included on a, b, or c above): $ 0
Total In State Travel $ 0
2, Out of State Travel
a) Tra.nsportation: $ 0
b) Meals & LJdging: $ 0
c) Mileage: $ 0
d) Incidental Expenses (Any other travel expense Dotinc1uded on a, b, or c above): $ 0
Total Out of State Travel $ 0
TOTAL TRAVEL PAID OUT OF CHAPTER 59 FUNDS: $ 0
F) TRAINING
1. Fees (Conferences, Seminars): $ 0
2, Materials (Books, CDs, Videos, etc.): $ 0
3, ,Other (Provide Detail on Additional Sheet): $ 0
TOTAL TRAINING PAID OUT OF CHAPTER 59 FUNDS $ 0
Gl INVESTIGATIVE COSTS
1. Infonnant Costs: $ 0
2, Buy Money: $ 0
3, Lab Expenses: $ 0
4, Other (provide Detail on Additional Sheet) : $ 0
FonnDote04/031l2 Page>!
TOTAL INVESTIGATIVE COSTS PAID OUT OF CHAPTER 59 FUNDS: $ 0
H) TOTAL PREVENTION/TREATMENT PROGRAMS/FINANCIAL
ASSISTANCE
1. Total Preventionffreatment Programs (pursuant to 59.06 (h), (1), 0): $ 0
2, Total Financial Assistance (pursuant to Articles 59.06 (n) and (0)): $ 0
TOTAL PREVENTION/TREATMENT PROGRAMS/FINANCIAL
ASSISTANCE (pursuant to Articles 59.06 (h), (I), (j), (n), (0)): $ 0
I) FACILITY COSTS
1. Building Purchase: $ 0
2, Lease Payments: $ 0
3, Remodeling: $ 0
4, Maintenance Costs: $ 0
5, Utilities: $ 0
6, Other (Provide Detail on Additional Sheet): $ 0
TOTAL FACILITY COSTS PAID OUT OF CHAPTER 59 FUNDS: $ 0
J) MISCELLANEOUS FEES
1. Court Costs: $ 0
2, Filing Fees: $ 0
, 0
3, Insurance: $
4, Witness Fees: $ 0
5, Audit Costs and Fees: $ 0
6, Other (provide Detail on Additional Sheet): $ 0
TOT ~ MISCELLANEOUS FEES PAID OUT OF CHAPTER 59 FUNDS: $ 0
K) PAID TO OR SHARED WITH COOPERATING AGENCY: $ 0
L) TOTAL OTHER PAID OUT OF CHAPTER 59 FUNDS (provide detailed
descriptions on additional sheet(s) and attach to this report): $ 0
M) TOTAL EXPENDITURES: S 0
Fonn Dole 04/03/12
PageS
BOTH THE COMMISSIONERS COURT AND ATTORNEY REPRESENTING THE STATE
CERTIFICATIONS MUST BE COMPLETED
NOTE: ART. 59.06(g)(1) requires the Commissioners Court to perform the audit.
CERTIFICA TION
I swear or affirm that the Commissioners Court has conducted the audit required by Article 59.06 ofthe Code of Criminal
Procedure, unless after due inquiry, it ha~ been determined that no accounts, funds or other property pursuant to Chapter
59 of the Code of Criminal Procedure are being held or have been transacted in the relevant fiscal year by the agency
for which this report is being completed, and that upon diligent inspection of all relevant documents and supporting
materials, I believe that this asset forfeiture report is true and correct and contains all of the required information.
COUNTY JUDGE (Printed Name):
Michael J. Pfeifer
f'fur~~v
Calhoun
SIGNATURE:
COUNTY:
DATE:
10-25-12
CERTIFICA TION
I swear or affirm, under penalty of perjury, that 1 have accounted for the seizure, forfeiture, receipt. and specific
expenditure of all proceeds and property subject to Chapter 59 of the Code of Criminal Procedure, and that upon diligent
inspection of all relevant documents and supp.orting materials, 1 believe that this asset forfeiture report is true and correct
and contains all information required under Article 59.06 of the Code of Criminal Procedure. I further swear or affirm
that all expenditures reported herein were lawful and proper, and were made in accordance with Texas law.
ATTORNEY REPRESENTING THE
STATE (Elected Official) (Printed
Name):
Dan W. Heard
SIGNATURE:
DATE:
10-25-12
RETURN COMPLETED FORM TO:
Office of the Attorney General
Criminal Prosecutions Division
P,O, Box 12548
An,tin, TX 78711-2548
Attn: Kent Richardson
(512)936-1348
WE CANNOT.ACCEPT FAXED OR EMAILED COPIES. PLEASE MAIL
THE SIGNED, ORIGINAL DOCUMENT TO OUR OFFICE AT THE
ADDRESS ABOVE.
Fonn Dale 04/01112
l'oge6
HEALTHY COUNTY 2012 RESULTS & EMPLOYER REWARDS APPLICATION AND AUTHORIZE
APPROPRIATE SIGNATURES:
Susan Riley:
Employees earned $3,37S for their participation in the Wellness Program and taking the Health Risk Assessment.
With those funds we have purchased three (3) automatic scales, will be setting up Lunch & Learn Program, and
purchase some rewards for the Maintain-No-Gain Program.
We were number one in the State for employee participation. Almost half of the employees participated in the
Sonic Boom Challenge.
A Motion to approve the application and authorize appropriate signatures was made by Commissioner Lyssy and
seconded by Commissioner Finster.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
The mission of Healthy County, the Texas Association of Counties Health
and Employee Benefits Pool (TAC HEBP) wellness program, is to optimize
the health and well-being of its members.
What is the Healthy County Employer
Rewards program?
A successful wcllness program requires effort and support
at the local level. The E.mploycr Rewards program honors
participating counties for their eflorlS and success in
helping employees enroll and complete various Healthy
County programs. The Texas Association of Counties
Health and Employee Benefits Pool (TAC HEBP) grants
counties funds that are comparable to the amount their
employees earn in BluePoints incentive prizes through
program participation to use for future health and wellness
initiatives in their county.
Who is eligible to receive
employer rewards?
Employers are eligible to receive a reward when they:
. Are a member of the TAC HEBP Pool (ASO groups
are not included);
. Designate a wellness coordinator and wellness
sponsor; and
. Participate in wellness training hosted by Texas
Association of Counties.
How do counties earn employer rewards?
By participating in Healthy County, employees were
eligible to receive 10,000 BluePoint'\ for completing the
Health A'5essment (HA) during the 1st quarter 01'2012
and another 7,500 BluePoints reward for completing Sonic
Boom's 8-week challenge in May 2012. Counties receive
their award based on the participation of their employees
in these Healthy County activities. For example, if your
employees earned a total of $750 in incentives, TAC HEBP
writes a check to your county for the matching amount
of $750,
Why is TAC HEBP doing this?
The intent is to provide counties with resources to build
positive, healthy and safe connty cnvironmenL'\ and to
encourage county employees to engage in heallhier behaviors.
The elected officials and employees of Texas counties
represent one of our state's most valuable assets - public
servants to all Texas citizens. When elected officials and county
employees are healthy, they are better able to provide quality
service, manage stress appropriately, experience fewer lost
workdays and model healthy behaviors for their families and
the community. Healthy employees save county taxpayers
money due to lower health care costs and lower workers'
compensation costs as well as reducing rates of absenteeism.
TAC HEBP's ultimate goals are to reduce health care costs
and make better use of tax payers' dollars while also improving
the quality of your employee', health,
How can counties use the Healthy Connty
employer rewards?
The rewards MUST be:
. Health related;
. Inclusive of all employees, preferably accessible across
the lifespan;
. Promote ongoing attention to health initiatives that
provide lasting benefit:
- Initiatives must be evidence-based; and
- Initiatives must pass the "Straight Face" test: Can
you look a taxpayer in the eye and say this was
good use of health care funds?
TAC HEBP recommends wellness rewards are used:
. To provide healthy evidence-based worksite and
safety programs. Such trainings arm individuals with
new knowledge about their own health and safety.
Examples include: flu, pneumonia and adult
vaccinations, biometric screening for cholesterol,
triglycerides, blood glucose and blood pressure,
learning lunches or various educational
programs (like those provided by Agrilife
Extem'iion Agents) and ergonomic training.
. To support an individual who is responsible for
coordinating county health initiatives~ building
infrastructure and promoting employee wellness.
Health initiatives are more effective when an
individual assigned to this responsibility is provided
with time and resources necessary to meet identified
objectives.
Examples include: allowing time and financial
compensation for the Health County wellness
coordinators to roll out programs and organize
wellness initiatives.
. To prepare and implement safety, health and
wellness policies. To guarantee a healthy worksite
culture, it is necessary to create policies that
reinforce healthy lifestyle efforto;.
Examples include: smoke free policies, c1ean-
air maintenance plan and allO\-\'ing a tlextime
schedule to encourage exercise during lunch.
Create a media library for employees to check-out
educational DVDs on various health and safety
topics such as stress management, the risks of
obesity, balancing work and home life, co-worker
dynamics, the importance of physical exercise, ete.
. To improve environmental conditions. By identifying
and improving the county's physical environment,
employee's health and productivity afe increased.
Examples include: installing hands~frce fixtures
(faucets, flushers, soap and paper towel
dispensers) in restrooms and kitchens to prevent
spread of infections, purchasing a kiosk computer
to provide Internet access for those without a
work or home computer, conducting a worksite
wellncss audit, developing walking routes and
trails near the worksite, installing bike racks
or creating a storage area for them, installing
slip-resistant flooring and guardrails, providing
adequate shower and changing facilities, setting-
up motivational signs and adding rubber treading
to stairs or carpet to encourage stair c1imhing at
the worksite.
. To provide ongoing stress management trainings.
Ongoing stress management trainings provide
individuals with strategies for identifying and
reducing-negative effects of specific stressors while
restoring personal equilibrium.
Examples include: putting treadmills in hallways
to relieve stress, purchasing working treadmills
stations or exercise DVDs.
.. To improve the nutritional value of food products
available to elected officials and county employees.
Healthier food choices during the work day equal
healthier adults.
Examples include: creating a "healthy foods"
only mandate during meetings, purchasing (or
subsidizing) healthy snack machine with items
such as fat-free milk, fruits, low--calorie snacks and
caffeine-free beverages and hosting a Farmer's
Market during peak growing seasons.
.. To encourage participation and sustain employee
engagement in health and wellness activities. The
purchase of incentives arc permitted with the
following conditions:
- Incentives or promotional items purchased must
not exceed 20 percent of a county's total eligible
employer rewards amount.
- Items must be related to wellness,
Examples include: fitness and exercise
equipment, hand sanitizers, exercise baUs to
sit on, ete.
Various laws apply to incentives. When requesting the
use of Employer Rewards to purchase incentives, your
application must be approved by the county attorney
or legal representative.
- To comply with Penal Code 36,08, funds
cannot be used for cash prizes which include
gift cards or an item in excess of $50 per
employee.
- If incentives are based on employees reaching
a certain target (Le certain amount of weight
loss, defined blood pressure value, etc,) then
the county must follow the rules defined in
the Patient Protection and Affordable Care
Act regarding discrimination,
TillS APPLICATION MUST BE SIGNED
BY THE COUNTY ATTORNEY OR LEGAL
REPRESENTATIVE WHEN USING INCENTIVES,
Healthy County employer rewards should
NOT be used for the following:
. Staff room improvements;
Gl Personal trainers;
. Massages;
. Gym memberships;
. Water coolers;
. Health fair promotional items; and
. Staff gatherings.
For a list of vendors that can use your Employer Rewards to
help you coordinate various wellness activities, go to:
www.county.org/vendorlisl.html
Healthy County Employer Rewards Application Instmctions
Please mall the below application (0 the Texas Ao;sodation of Counties c/o Jennifer Rchme at P.O. Box 2UH, Austin,
Texas 787U8. Please utlow three weeks for processing.
Application:
Name of County: Calhoun County
Name ofWellness Coordinator: Ms. Susan Riley
Whose attention do we send the check? Susan Riley
Phone #: 361-553-4600 Email address:
Mailing Address: 211 S. Ann St. Suite 301
Port Lavaca TX //~/~
susan.riley@calhouncotx.org
# of employees that completed HA: 60
# of employees that completed Sonic Boom (weeks 1-8) 91
Total employer rewards available: $3,775
Had all employees participated (estimated county employees x $50): $9,250
Please circle all that a Iy: Within the past year the county held the followin wellness activities:
Flu shots or adult vaccinations Health fair Bio-metric screenings xercise classes
Agrilife Extension class
r:~ded Healthy County Web~
--~~~
Attended BCBSTX Employer Webinars
Lunch and Learns Other:
None
Request for Healthy County Employer Rewards:
How will you spend this year's matching funds? (If you need more room, please attach separate sheet):
Incentives for various Wellness events
3 Sonic Boom Scales
DVD Player for Exercise Program - After Work Exercise Program in Lobby
Fitness Dvds
Lunch and Learn Supplies - To Begin Lunch and Learn Program with
Extension Program as soon as possible
Note: If requesting the use of a portion of Employer Rewards to purchase incentives, please have the county
attorney or legal representative sign below after reviewing the wellness statutes document provided separately
in the packet.
w,_.s"'".~s.""". ~
Wellness Coordinator Signatu~e . .~
County Attorney or Legal
~
Representative Sig~<llure(6nly if requesting funds for incentives}
Date:
Date:
Date:
10-31-12
10-31-12
10-31-12
2013 INDIGENT DEFENSE REQUEST FOR APPLICATIONS (RFA) FORMULA GRANT PROGRAM IN
THE AMOUNT OF $12,000 AND AUTHORIZED COUNTY JUDGE'S OFFICE TO SUBMIT
RESOLUTION/INTERNET SUBMISSION FORM:
The Texas Legislature has available funds through the Texas Indigent Defense Commission for an indigent
defense formula grant. At this time, the FY2013 Grant packet was sent to the constitutional county judges with
a summary of revisions to the Texas Administrative Code Chapter 173.
Judge Pfeifer:
This is to offset indigent defense. We are eligible to receive $12,000. We apply for it every year and normally
get it.
A Motion to approve the 2013 Indigent Defense request and authorize Judge's office to submit form was made
by Commissioner Lyssy and seconded by Commissioner Fritsch.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor,
rJTl DC
The Honorable Michael Pfeifer
Calhoun County Judge
211 S, Ann St, 3rd Floor,
POIt Lavaca, Texas 77979
October 12, 2012RECEI \lED
OCT ~ 8 2Cj:~
TEXAS INDIGENT DEFENSE COMMISSION
Chair;
The HonorabJe Sharon Keller
Presiding Judge. Court of CrimInal Appeals
Vice Chair:
The Honorable Olen Underwood
ExOfflcloMembers:
Honorable Sharon Keller
Honorable Wallace B.Jefferson
Honorable Roberto Alonzo
Honorable Pete Gallego
Honorable laura Weiser
Honorable Jeff Wentworth
Honorable John Whitmire
Members Appointed by Governor:
Honorable Jon Burrows
Mr, Knox Fitzpatrick
Mr. Anthony Odiorne
Honorable Sherry Radack
Honorable Olen Underwood
Honorable Laura Weiser
Honorable B. Glen Whitley
Executive Director:
James D. Bethke
Mike Pfeifer
Calhoun County Judg3
2013 Indigent Defense Request For Applications (RFA) - Formula Grant Program
Dear Judge Pfeifer:
The Texas Indigent Defense Commission (Commission) is pleased to announce the availability
of funds by the Texas Legislature to improve indigent defense services in Texas, Calhoun
County is eligible for an indigent defense formula grant. The formula is under review by the
Commission this fiscal year in an effort to ensure faimess and stability for all counties. This
packet provides information on what is needed to obtain these funds, This FY2013 Formula
Grant packet is sent to all 254 constitutional county judges, A courtesy letter will be sent to all
local administrative district and statutory judges and county financial officers informing them
of the availability of grant funds,
The local administrative judges and Chairs of Juvenile Boards have already submitted their
biennial indigent defense plans, Judges may amend their plans in the on-line system
(https:lltidc,tamu,edu ) at any time, Staff will continue to work with counties to ensure that all
of the statutory and Commission required elements are included in each plan if judges make
amendments,
The Commission recently re-adopted Texas Administrative Code Chapter 173 with small
changes in order to implement the grant authority established by the Texas Legislature, These
administrative rules and the attached RF A are available at: www.txcourts,gov/tidc , The rules
and the RF A establish the guidelines for the administration of grant funds and application
submission process for FY2013, A summary of the revisions is included in this mailing,
Please call Bryan Wilson, at the Commission office, toll free in Texas at (866) 499-0656, if
you have any questions about the application process.
Sincerely,
Sharon Keller
Chair, Texas Indigent Defense Commission
Presiding Judge, Coutt of Criminal Appeals
Enclosed: Swnmary of Revisions of Grant Rules, FOl1nu]a Grant RFA
Texas Indigent Defense Commission
209 West 14th Street, Suite 202 Price Daniel, Sr. Building' Austin, Texas 78701
www,txcourts,gov/tidc' Phone: 512,936,6994 . Fax: 512-463-5724
.'
2~~~!1~ s~~~J~~~ri!?~~er~.~~d~g~~n~~~~16~~,
Austin, Texas 78701, Fax: 512-463-5724
www.txcourts.gov/tidc
FY2013 Formula Grant Program
Requests for Applications (RF A)
October 12,2012
Total Grant Amount Budgeted for Statewide Use Available:
FY2013. $12,000,000
Type of Grant
Formula - The Commission distributes funds to counties through a fonnula, Counties must meet minimum
spending requirements to qualify,
Eligibility:
Only Texas counties may apply. See further eligibility below,
Grant Applications Due:
All applications must be submitted on-line. Applications must be completed and submitted by December 3, 2012.
See submission requirements below for waiver requests and other deadlines,
Method of Application:
On-line submission can be accessed at htto:lltidc,tamu,edu, All county judges have been assigned a unique user
name and password, See contact infonnation below for access to the system,
Time Period for Funding:
October I, 2012 through September 30, 2013
Commissioners Court Resolution Required:
This application is submitted on-line but requires a commissioners' court resolution/internet submission fonn be
adopted and scanned and e-mailed or uploaded on the application page of the website, or it may be faxed. The
resolution is generated by the on-line system and must be printed out from the on-line application page,
Payments:
Funds will be distributed in four (4) disbursements for this fiscal year for most counties,
Steps in Submitting a Grant Application
1) Log onto http://tidc.tamu,edu (Follow on-line page instructions),
2) Verify that the online screen shows the appropriate grant officials and judicial officials.
3) Verify on-line that Commission records indicate whether submitted county-wide plans are in
compliance and meet the grant eligibility requirements, Contact Commission staff to discuss
compliance issues.
4) Complete by scanning and e-mailing the Resolution / Internet Submission Fonn along with any
required plan documents,
Texas Indigent Defense Commission
Authorization to Fund, Applicable Authority and Rules
Texas Government Code Sec. 79.037. TECHNICAL SUPPORT; GRANTS.
(a) The commission shall:
( I) provide technical support to:
(A) assist counties in improving their indigent defense systems; and
(B) promote compliance by counties with the requirements of state law relating to indigent defense;
(2) to assist counties in providing indigent defense services in the county, distribute in the form of grants any
funds appropriated for the purposes of this section; and
(3) monitor each county that receives a grant and enforce compliance by the county with the conditions of the
grant, including enforcement by:
(A) withdrawing grant funds; or
(B) requiring reimbursement of grant funds by the county,
(b) The commission shall distribute funds as required by Subsection (a)(2) based on a county's compliance with
standards adopted by the board and the county's demonstrated commitment to compliance with the requirements of state
law relating to indigent defense,
(c) The board shall adopt policies to ensure that funds under Subsection (a)(2) are allocated and distributed to counties
in a fair manner.
(d) A county may not reduce the amount of funds provided for indigent defense services in the county because of funds
provided by the commission under this section.
Texas Administrative Code Chapter 173 (Newly revised)
Uniform Grant Management Standards (UGMS)
Formula Grant Program
A. Introduction
Fonnula Grants are provided to Texas Counties by the Texas Indigent Defense Commission (Commission) to help meet
the Commission's statutory mandates and to promote Texas counties' compliance with standards adopted by the
Commission,
Fonnula grants provide money to counties for increased indigent defense costs based on a fonnula set by the Commission,
Qualifying counties are eligible for funds detennined by the formula only to the extent their spending exceeds the
amounts in their baseline year. Other grant distribution formulas may be considered in the future as more data becomes
available, Counties must meet minimum spending requirements to receive credit for spending the funds,
The grant period for this application is October 1, 2012 through September 30, 2013. Expenses must be
incurred and/or obligated during this time.
B. Eligibility
Only counties are eligible to apply for funds,
C. Direct Disbursement Pool
Counties with low incidence of crime and low indigent defense expenses may also choose not to submit the
application, They will be eligible to receive funding under the Commission Direct Disbursement policy and
procedures, If a county has had to refund fonnula grant money to the Commission or has not received grant funds
in the previous year, please consider not applying for the formula grant and the county will be eligible for the
Direct Disbursement Pool. This Commission policy is intended to reduce application procedures for counties that
have both low incidences of crime and low indigent defense costs, The policy governing reimbursement of
eligible expenses under this policy vary depending on whether a county spent any of the fonnula grant funds in
the preceding year.
2 of 6 pages
FY20l3 Formula Grant RFA
Due: December 3, 2012
.' Texas Indigent Defense Commission
A county that has not spent any formula grant funds in the preceding year and does not apply for a formula grant
in the current fiscal year may submit receipts for direct disbursements. If the county incurs indigent defense costs
above its baseline year amount (or adjusted baseline), it is eligible to receive up to twice the amount of the initial
allocation of funds for the county under the formula grant program as established by the Commission prior to
issuing the Request for Applications, In addition, the county is also eligible to receive the unspent balance of the
initial allocation of formula grant funds from the previous fiscal year as established by the Commission prior to
issuing the Request for Appl ications,
A county that spent a portion of the formula grant funds in the preceding year and does not apply for a fonnula
grant in the current fiscal year may submit receipts for direct disbursements. If it experiences indigent defense
costs above its baseline year amount, such a county is eligible to receive up to the amount of the initial allocation
of funds for the county under formula grant program as established by the Commission prior to issuing the
Request for Applications,
The Indigent Defense Commission will budget up to two-thirds of the funds allocated to counties that do not
apply for formula grant funds to the direct disbursement pool. Funds will be disbursed from the pool based on a
county's compliance with the current year grant eligibility requirements and written documentation that the
county has actually expended its baseline year amount in addition to the amount requested. All payments
considered for reimbursement are subject to availability of funds,
Applications with expense infonnation for direct disbursement must be submitted on or before August 15,2013,
The time period for calculating the direct disbursement will be September I, 2012 through August 15,2013. A
county that applied for fonnula grant in FY2012 (between October I, 2010 and September 31,2012) may not
include expenses incurred in September 2012 in their direct disbursement submission, However, this change in
time period for direct disbursement calculation will not affect the time period for the statutory Indigent Defense
Expenditure Report,
D. Notification of Availability
This FY 13 Formula Grant - Request for Applications (RF A) is sent to all 254 Texas Constitutional County Judges. A
courtesy notice is mailed to all local administrative district judges, local administrative statutory county judges, chairman
of juvenile board and each county auditor (or treasurer), The notice infonns other county stakeholders to seek a copy of
the grant RFA from the constitutional county judge or to go to the Commission website www,txcourts,l!ov/tidc to
download a copy, The Commission staff uses the cODtact information reported by counties in our web based system.
Please make sure that all contact information is accurate, Counties are required to maintain correct contact information on
the Commission 'grants and reporting' website (httv://tidc,tamu,edu). The notice of grant availability is also published in
the Texas Register.
E. Application
The Commission is committed to reducing paperwork burdens for Texas counties, Therefore, the grant application process
will be electronic,
The application steps are:
1) Review the baseline (FYO I) - The baseline is the amount counties must spend in indigent defense before they
qualify as having spent the grant. Counties that have received or applied for grants in previous years have already
established a baseline with the Commission, To meet the requirements under Texas Government Code
979,037(d), the Commission has adopted as an expenditure baseline based on each county's FYOI indigent
defense expenditures, Attorney fees, investigator expenses, expert witness expenses, and other litigation expenses
paid by the county on behalf of indigent criminal defendants / juvenile respondents are allowable expenses, This
infonnation remains static unless a county requests an alternative baseline, as described below,
a. The baseline amount is used for comparison to determine grant qualification for each year,
b, To qualify for grant funds each year, the county must spend an amount at least equivalent to the FYOI
baseline,
3 of 6 pages
FY2013 Fonnula Grant RFA
Due: December 3, 2012
'fexas Indigent Defense Commission
2) All applications must be submitted online using the User ID and Password. Contact the Commission Grant
Administrator for instructions to obtain a waiver to the on-line application,
3) If a person other than the recipient of this letter needs to obtain a user name and password for the online
application system, contact The Texas A&M University Public Policy Research Institute (PPRI) - [PPRI manages
the collection, storage and retrieval of data for the Commission]. County officials contact PPRI through e-mail
(dbrennan@ppri,tamu,edu), (MMclntire@oorLtamu,edu), fax (888-351-3485) or by regular mail:
Darby Brennan or Megan McIntire, PPRI
314 H. C. Dulie Bell Building,TAMU, Mailstop 4476
College Station, Texas 77843-4476
PPRI will not provide user names and passwords over the phone, Individuals using personal e-mail accounts may
be asked to provide additional infonnation,
a) Go to the PPRI Commission website at httos:lltidc,tamu,edu
b) Enter the User ill and Password or contact PPRI.
4) Apply on-line
a. Sign in - The authorized official or designee logs in to the website using a unique username and password and
selects "FY20l3" in the upper left then select "Apply for Formula Grant". A designee may actually perfonn the
tasks if allowed by the authorized officiaL
b. Review the eligibility requirements - Each year the Commission adopts specific measures as eligibility
requirements for the Formula Grant funds, These measures are intended to encourage each county's compliance
with statutory requirements or policy and standards adopted by the Commission. The grant application screen
will reveal the compliance checklist maintained by the Commission's special counseL Counties that have blank
check boxes in any category will not be able to receive funds until they meet all grant program eligibility
requirements, They should complete the on-line application then contact the Commission for iustructions
to resolve plan compliance issues.
c. Verify that the County's stored information is correct - The authorized official reviews the data the
Commission has stored for the county's grant positions, (Note: Please remember to update the county contact
information during the grant year as changes in officials or contact infonnation occurs,)
d. Identify the individuals in the following grant positions as required in Texas Administrative Code Rule 173,301.
Make changes as needed,
i. Authorized official - This person must be authorized to apply for, accept, decline, modify, or cancel the
grant for the applicant county, A county judge or a designee authorized by the governing body in its
resolution may serve as the authorized official
ii. Fiscal Officer - This person must be the county auditor or county treasurer if the county does not have a
county auditor.
iii. Program Director - This person must be the officer or employee responsible for program operation or
monitoring or implementation of the indigent defense plan and who will serve as the point-of-contact
regarding the program's day-to-day operations. (By rule this person cannot be the financial officer).
Use the "Change" Button - When the person listed is no longer authorized to perform the duties with the
Commission previously authorized by the county. It is also used to change contact infonnation for any grant
officiaL This situation usually arises when county officials turnover as a result of elections, retirements, or some
other removal from office,
e. Select the "Submit" button, The page will become a confinnation page at that point. Select the Resolution link
to create your county's completed resolution,
f. Print I download resolution - The system will allow the user to download a resolution in an MS Word document
or provide an opportunity to print the document based on the selections above,
g. Receive confirmation - The system will provide a confinnation page to the grant officials confirming that the
application has been completed and infonning them that the resolution must be adopted by the commissioner's
court and then faxed to the Commission, PLEASE PRINT THE CONFIRMATION PAGE.
4 of 6 pages
FY20l3 Formula Grant RFA
Due: December 3, 2012
.' . Texas Indigent Defense Commission
5) Please scan and upload on the application page of the website the resolution adopted by commissioners' court on
or before December 3, 2012. Alternatively. you may email the resolution to the Grants Administrator
(bryan, wilson@txcourts,gov) or fax it to him at 512-463-5724,
F. Review
Prior to the Commission meeting set to award the Fonnula Grants, the Grant Administrator will review the application for
completeness and notify counties via e-mail, fax, or mail whether any additions or corrections need to be made,
G. Denial of Grant
Counties not completing the grant application process or those not meeting minimum eligibility requirements will be
notified by mail within 30 days following the Commission award meeting,
H. Use of Funds
Funds must be used to improve indigent defense systems, Attorneys fees, investigator expenses, expert witness expenses,
and other direct litigation costs that a county spends on behalf of a criminal defendant or juvenile respondent in a criminal
matter that has been detennined by a court of competent jurisdiction to be indigent are allowable expenses, All funds must
be spent in compliance with the following: Texas Administrative Code, Title 1 Administration, Part 8 Texas Judicial
Council, Chapter 173 Indigent Defense Grants; and Texas Uniform Grant Management Standards.
The Indigent Defense Commission website maintains links to electronic copies of these documents, Grant applicants!
recipients may contact the Commission staff in writing for paper copies if no electronic means are available to secure the
documents,
I. Statement of Grant Award
Statements of Grant Awards will be prepared exactly as authorized by the Commission, These may include special
conditions, The e-mail with the attached Statements of Grant Award will be directed to the official designated in the
resolution adopted by the commissioners' court, The Countv will have thirtv davs to notifv the grant administrator of
errors or cancelation after receiot of the award.
J. Special Conditions
The Commission may detennine special conditions or authorize staff to apply the conditions on criteria set by the
Commission (TAC 173.201), The Commission may develop special conditions that relate to expenditures, compliance
with statutory requirements or standards adopted by the Commission,
K. Required Reports
All counties are statutorily required (Texas Government Code Sec, 79,036 (e)) to submit an Indigent Defense Expenditure
Report each year on November I in the fonn and manner prescribed by the Commission, In accordance with T AC
~ 173,109 the reporting will be through the internet.
The Local Administrative District Judges, the Local Statutory County Court Judges (or County Judge as applicable) and
the Chairman of the Juvenile Board for each county must submit a copy of all fonnal and informal rules and fonns that
describe the procedures used in the county to provide indigent defendants with counsel in accordance with the Code of
Criminal Procedure (Countywide Plans) to the Commission as required in Government Code ~79,036, The Countywide
Plans must be submitted by November I" of each odd numbered year in the form and manner prescribed by the
Commission,
L. Payments
Counties must have met all eligibility, spending, and grant condition requirements before receiving payments, Payments
will be made quarterly for most counties, Some counties may have a special conditions related to meeting minimum
spending requirements, These counties will receive funds only after a supplemental expenditure report establishes that
they have spent the predetennined minimum amount stated in the special condition,
5 of 6 pages
FY2013 Formula Grant RFA
Due: December 3, 2012
'Texas Indigent Defense Commission
No payment shall be made from grant funds to a county until all special conditions have been met unless the special
condition adopted by the Commission provides an alternative payment schedule or instructions for payment. Commission
staff shall maintain documentation through electronic/paper files or correspondence to the county stating how the special
condition was met.
,
M. Maintain Official Contact Information
All counties must maintain the grant and plan officials contact information on counties' home page set up at
http://tidc,tamu,edu , Counties must advise the Commission of changes in the authorized official, program director,
financial officer, local administrative district judge, local statutory county judge, chairman of the juvenile board and
county judge by updating this website contact information. This infonnation will be used to provide notices for grant or
plan submission information, The Commission staff will use e-mail whenever possible to notify counties of required
reports and funding opportunities.
N. Compliance with Monitoring Reports
A county must respond within the required time, take corrective action for findings of non-compliance, and satisfactorily
address all recommendations in a Commission fiscal or policy monitoring report, Failure to comply with any of these
requirements could result in the Commission imposing a remedy under TAC 173,307 or Texas Government Code
~79,037 ,
O. Countywide Plan Requirements
The Countywide Plans submitted must be in compliance with applicable statutes and rules and must meet the minimum
requirements for each plan section as outlined in the Biennial Indigent Defense Countywide Plan Instructions,
P. OCA Reporting
The applicants' county and district clerks must be in compliance with reporting requirements promulgated by the Texas
Judicial Council as of August 31, 2012, The district clerks and county clerks must submit their monthly court activity
reports to OCA electronically not later than September 2012, unless OCA grants a temporary waiver for good cause,
a. Impact of Multi-year Discretionary Grant
Counties that receive multi-year discretionary grants from the Commission are encouraged to continue to apply for the
Formula Grant. Formula Grant payments will be made as scheduled. The county will submit its annual Indigent Defense
Expenditure Report on or before November I of each year, If the impact of the Multi-year funded program results in
overall reduction of the county's indigent defense expenses below the baseline amount, then all or a portion of the formula
grant may need to be returned to the Commission as directed by the Commission,
R. Impact of Multi-year Discretionary Regional or Sustainability Grants
Counties that receive multi-year regional or sustainability discretionary grants from the Commission are encouraged to
continue to apply for the Formula Grant. Formula Grant payments will be made as scheduled, Such counties may use
their formula grant payments to maintain the discretionary grant program, The county will submit its annual Indigent
Defense Expenditure Report on or before November I of each year,
6 of 6 pages
FY20 13 Formula Grant RFA
Due: December 3, 2012
Summary of Revisions to Grant Administration Rules
adopted to be effective September 13,2012
Substantive Changes:
1. Remove requirement that counties accept Formula Grants by returning a signed
Statement of Grant A ward
Rationale- Streamline the process and reduce unneeded paperwork.
2. Require grantees to develop and submit a monitoring plan when using grant funds
to contract for substantial services
Rationale- Although currently a requirement of the discretionary grant RF A, staff
has found grantees are not monitoring their contracts.
3. Process for grantee to request to appear before Commission prior to imposing a
remedy on the grantee, such as withholding grant funds
Rationale- The need for a process was raised by county associations.
4. Conversion of "other funds" categories of funding to "grants"
Rationale- Due to change in statute that now provides for the Commission to
distribute funds only in the fonn of grants.
5. Establishes timelines and process details for the fiscal monitoring program.
Rationale- The changes will align fiscal monitoring program with procedures
established previously in the policy monitoring rules
Non-Substantive Changes:
I. Name change from Task Force on Indigent Defense to Texas Indigent Defense
Commission
2. Change statutory references based on HB 1754 amendments
2013 Calhoun County Resolution
Indigent Defense Grant Program
WHEREAS, under the provisions of the Fair Defense Act, 77th Regular Session, counties are
eligible to receive grants from the Texas Indigent Defense Commission to provide improvements
in indigent defense services in the county; and
WHEREAS, this grant program will assist the county in the implementation of the provisions of
the Fair Defense Act and the improvement of the indigent criminal defense services in this
county; and
WHEREAS, Calhoun County Commissioners Court has agreed that in the event of loss or
misuse of the funds, Calhoun County Commissioners assures that the funds will be returned in
full to the Texas Indigent Defense Commission,
NOW THEREFORE, BE IT RESOLVED and ordered that the County Judge of this county is
designated as the Authorized Official to apply for, accept, decline, modify, or cancel the grant
application for the Indigent Defense Formula Grant Program and all other necessary documents
to accept said grant; and
BE IT FURTHER RESOLVED that the County Judge is designated as the Program Director and
contact person for this grant and the County Auditor is designated as the Financial Officer for
this grant.
Adopted this 25th day of October, 2012.
r~4IJIIJ ~~~_.
I ,
M~ ael Peifer
County Judge
Attest: Anita Fricke
County Clerk
~~~~
By: Suzana Eckermann, Deputy Clerk
Susan Riley
From:
Sent:
To:
Subject:
. Attachments:
Kenny Finster [kenny.finster@calhouncotx,org]
Thursday, October 18, 2012 1:26 PM
Susan Riley
Fwd: Urban Engineering Work Order for Seadrift Pier
Urban proposaI101812,pdf; ATT00268,htm; Work Orderdocx; ATT00271,htm
Susan, please take necessary action to execute this at the next Commissioner's Court.
Thank you for crafting the proper agenda item,
(this is not sent by my iPhone"5" but by my "Big Mac")
Kenny Finster
Calhoun County Pct.4
361-785-3141
kenny, finster@calhouncotx,org
Begin forwarded message:
From: Kathy Smartt <smarttqrants@sbcqlobal.net>
Subject: Urban Engineering Work Order for Seadrift Pier
Date: October 18, 2012 9:54:13 AM CDT
To: Kenny Finster <kenny,finster@calhouncotx,orq>
Cc: Susan Riley <sljsan,riley@calhouncotx,orq>
Commissioner,
Attached is Urban Engineering's proposal and work order for the engineering work to be done for the Seadrift
Pier. If you approve both documents, please have Susan put the matter on next week's court agenda. If you want
any changes made to the work order, please let me know as soon as possible,
Thanks,
Kathy
1
PROPOSAL FROM URBAN ENGINEERING FOR PROFESSIONAL AND SURVEYING SERVICES FOR
SEADRIFT PIER:
Urban Engineering responsibilities will include:
1) perform a topographic survey though a subcontract with Urban Surveying, Inc
2) prepare the preliminary design
3) prepare the final design
4) oversee the bidding process
S) perform project administration
6) prepare and submit permit modifications if required
Due Dates:
1) Topographic Survey and Coordinate Specific Design Requests: 01/02/13
2) Complete Construction Plans, Bidding Documents Advertising: 03/01/13
3) Bidding:
04/01/13
4) Project Administration:
As project progresses
Fees:
Combined Total:
$39,600.00
Commissioner Finster:
This is the starting of the engineering work on the pier project with grant funds that were awarded.
Judge Pfeifer:
Awarded $680,000+ to build the pier. The City of Seadrlft City Council started the project, mayor left/moved,
new mayor. City Councilman was working on it and retired/moved out of town, she had the permit and the
County continued working with the State on it and was awarded the grant. Once the pier is completed, the
County will do an MOU to the City of Seadrift,
Commissioner Finster:
Hoping to coordinate the dedication of the construction with the Centennial on December 1".
A Motion to approve the proposal from Urban Engineering for professional and surveying for Seadrift Pier was
made by Commissioner Finster and seconded by Commissioner Fritsch.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
e n
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October 18, 2012
Honorable Michael J, pfeifer, County Judge
Calhoun County Courthouse
2]]S,AnnSt.
Third Floor, Ste, 30]
Port Lavaca, TX 77979
RE: Calhoun County - Seadl'ift Pier
Worl{ Ol'del' No, OS-S107-486-W01
Seadl'ift, Texas
Dear Judge Pfeifer:
Thank you lor selecting Urban Engineering to perfonn professional engineering and surveying services
for the above referenced pr()ject. The dedicated and experienced professionals at Urban Engineering will
strive to provide you with excellent service, reliability and satisfaction, The scope of work, tasks with
due dates and fee summary are detailed below,
SCOPE OF WORK
Urban Engineering's responsibilities will include: 1) perform a topographic survey through a subcontract
with Urban Surveying, Ine" 2) prepare the preliminary design, 3) prepare the final design, 4) oversee the
bidding process, 5) perform project administration, and 6) prepare and submit permit modifications, If
required.
TASKS
Task 1: Delivemhle(s)/Milestone(s) - due on 01' before
I , Topographic Survey
2, Coordinate Specific Design Requests
3, Submit Permit Modifications
Due: 01/02/13
Due: 0]/02/13
Due: If required
Task 2: Delivel'3ble(s)/Milestone(s) -. dne on 01' before
I, Complete Construction Plans
2, Bidding Documents
Due: 03/0 I /13
Due: 03/01/13
Task 3: Delivcrnhle(s)/Milestone(s) - dne on 01' before
], Advertising
2, Bidding
Due: 03/01/1 3
Due: 04/01/13
Task 4: Delivcl'ablc(s)/Milestone(s) - due on or before
1, Project Administration
Due: As project progresses
(361) 578-9836 ' h.lX (361) 576-98;6 ' 2004 N. Commerce' Vletoria, Texas 77901
TI{[Yfi F. !611 www.urbanvictoria.com
FEE SUMMARY
The fee for services associated with this project will be a tixed base fee of $39,600, The breakdown of
the engineering and surveying services tee is as follows:
Topographic Survey
Preliminary Design
Final Design
Bidding
Project Administration
Governmental & Agency Fees, Prints, Postage &
Adve.tising Fees
$ 1,600,00 (fixed tee)
$ 7,000,00 (fixed tee)
$15,750,00 (fixed fee)
$ 3,500,00 (fixed fee)
$ 8,750,00 (fixed fee)
$ 3,000,00 (fixed fee)
Total
$32,{>QOJ2Q
Urban Engineering fully complies with all applicable engineering practice requirements of federal, state
and local statutes, codes, regulations and ordinances.
Once again, thank you for considering Urban Engineering to fulfill your project needs, If I can provide
additional information, please do not hesitate to contact me at (361) 578-9836 or by email at
tschmidt(cvurbanvictoria,com, I look forward to further discussing this project with you in the ve,y near
future.
Sincerely,
1-k1hZ44~;;L/;;zt;
Thomas A. Schmidt, P,E,
Urban Engineering
TAS/dmf
Amendments to Work Order: Material changes to this Work Order may be made only by
agreement of the pmties, in writing,
In witness whereof, all parties executed this Work Order, to be eflective as of the date signed by
the last party,
CALHOUN COUNTY
-Jj^wk1!tJ!:I~"~---.
Michael J, Pfeifer
Calhoun County Judge
Date of execution: _j!J.:::.;;v:;.::.L "Z- _._
President / _
Date of execution: I oj'2k?~
Page 4 01'9
'~'C__~_-"'.""'.'='__"'_^",-=".~,,",
Susan Riley
From:
Sent:
To:
Cc:
Subject:
Attachments:
Kathy Smartt [smarttgrants@sbcglobal.net]
Thursday, October 18, 2012 8:54 AM
Kenny Finster
Susan Riley
Urban Engineering Work Order for Seadrift Pier
Urban proposaI101812,pdf; ATT00098,htm; Work Order,docx; ATT00101,htm
Commissioner,
Attached is Urban Engineering's proposal and work order for the engineering work to be done for the Seadrift
Pier. If you approve both documents, please have Susan put the matter on next week's court agenda, If you want
any changes made to the work order, please let me know as soon as possible.
Thanks,
Kathy
1
WORK ORDER NO. OS-S107-WOl WITH URBAN ENGINEERING IN AN AMOUNT NOT TO EXCEED
$39,600:
A Motion to approve Work Order No. 05-5107-WOl was made by Commissioner Finster and seconded by
Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
WORK ORDER No. 05-5107-486-WOl
UNDER PROFESSIONAL SERVICES PROVIDER CONTRACT
Pursuant to the Professional Services Provider Contract (Contract) between Calhoun County
(County) and Urban Engineering (Provider), Provider is authorized to perform the services
described below, subject to the Scope of Services, Tasks, Budget, Deliverables, and any other
conditions of this Work Order (Work Order) for the Coastal Impact Assistance Program federal
grant entitled "Seadrift Pier."
SCOPE OF SERVICES
Provider will support the County's efforts to construct a wooden pier off the San Antonio Bay
shoreline in Seadrift, Texas by providing the associated engineering tasks listed below,
TASKS
TASK 1: Conduct site assessment and preliminary engineering.
Provider will conduct a topographic survey required for construction plans and develop a
conceptual site plan for the constlUction of the pier and entrance ramp area. A preliminary
engineering drawing and cost estimate will be prepared and discussed with the County, The
existing D,S, Army Corps of Engineers (Corps) permit will be revised, if needed,
Deliverables - due on or before 01/02/13
1. Topographic survey consisting of AutoCad drawing that includes points and descriptors,
one (I) foot contours showing all features surveyed and ASCII file containing all
surveyed points (Northing, Easting, Elevation, Descriptor),
a, One (I) hard copy and one (I) digital copy on CD
2, Preliminary engineering drawing and cost estimate,
a, One (I) hard copy and one (1) digital copy on CD
3, Corps Notification Letter/Revised Permit, if needed
a, One (1) digital copy on CD
Page 1 of9
TASK 2: Conduct final design and prepare construction documents.
The construction design shall correspond to the available budget. Technical specification,
construction level drawings and cost estimates will be developed for construction, Drawings will
consist of a project site plan and detail sheets, A 100% completion level set construction
docwnents consisting of contract documents, final engineering drawings and technical
specifications, a construction cost estimate, and construction schedule will be developed in
accordance with the County's procurement process for solicitation of a coastal construction
contractor.
Deliverables - due on or before 03/01/13
1, 100% completion level set construction docwnents consisting of contract documents, final
engineering drawings and technical specifications, a construction cost estimate, and
construction schedule,
a, Three (3) hard copies and two (2) digital copies on CD
TASK 3: Conduct a competitive solicitation for a construction contractor.
The County will follow its procurement process and 43 CRF 12,76 in the solicitation of
competitive sealed construction proposals, The County, in coordination with Provider, will
evaluate the submitted proposals to deteImine an award of construction contract. Following
execution ofthe contract, a Notice to Proceed will be issued to the contractor.
Milestones
1. Advertising - completed by 03/01/13
2, Bidding - completed by 04/01/13
TASK 4: Provide construction administration.
The construction contractor will build the pier and entrance ramp to the specifications of the final
design. Provider will oversee the construction process and coordinating efforts, Provider will
process the monthly pay estimates, submit to the County for payment, and make at least one site
visit per week to inspect the construction project.
BUDGET
The total compensation due to Provider for services provided or performed pursuant to this Work
Order will not exceed Thirty-nine Thousand Six Hundred Dollars ($39,600.00).
Compensation will be based on actual costs incurred,
MONTHLY PROGRESS REPORTS
Provider must submit progress reports electronically on or before the first day of each calendar
month during the term of this Work Order, commencing December 1, 2012. All Progress
Reports should be prepared in Microsoft Word@ and follow the format of the Progress Report
Page 2 of9
Form. attached hereto as Attachment A. All reports should be emailed to the County Project
Manager, as identified herein below,
REQUESTS FOR REIMBURSEMENT
Provider shall submit monthly invoices electronically to the County Project Manager and follow
the format of the Requestfor Reimbursement Form, attached hereto as Attachment B, Requests for
payment must be suppmted by documentation as required under the Contract, such as invoices,
receipts, cancelled checks, statements, stubs, tickets, time sheets, and any other which, in the
judgment of the County, provides full substantiation of reimbursable costs incurred, The County
is not liable to Provider for any costs incUlTed by Provider before the effective date of this Work
Order or after termination of this Work Order.
Requests for Reimbursement under this Work Order must be received by the County
Project Manager not later than sixty (60) days from the date Provider incurs the expense.
Notwithstanding the preceding, requests for reimbursement for expenses incurred by any
subcontractor must be received by the County Project Manager not later than thirty (30)
days from the date Provider receives that invoice from a subcontractor. Failure by
Provider to comply in a timely manller with these two requirements may, at the County's
sole discretion, result in denial of the request for reimbursement.
ACKNOWLEDGEMENT QF FEDERAL FUNDS
All reports and other materials completed as a result of this Work Order must bear the following
statement and the Department of the Interior and County logos on the front cover or title page of
such document and other materials:
"This report was funded with qualified outer continental shelf oil and gas revenues by the
Coastal Impact Assistance Program, Fish and Wildlife Service, U.S. Department of the
Interior."
MISCELLANEOUS
County Project Manager Point of Contact:
Kathy Smartt
SmarttGrants
1-512-800-4740
smarttgrants@sbcglobal,net
Termination or Interruption of Work: The County reserves the right to halt or defer all or any
portion of the work included in the Scope of Services of this Work Order any time during the
performance period, If such an event occurs, the parties agree that the schedule and budget may
require renegotiation,
Page 3 of9
Amendments to Work Order: Material changes to this Work Order may be made only by
agreement ofthe parties, in writing,
In witness whereof, all parties executed this Work Order, to be effective as of the date signed by
the last party,
CALHOUN COUNTY
URBAN ENGINEERING
_Y'M, A\vuP4 PI)
Michael J, Pfeifer
Calhoun County Judge
Date of execution: 1/)-,] c: - J L.-
,
Thomas A. Schmidt
President
Date of execution:
Page 4 of9
ATTACHMENT A
PROGRESS REPORT FORM
Page 5 of9
PROGRESS REPORT
Seadrift Pier
Urban Engineering
Date:
Work Order: 05-5107-486-WOl
Point of Contact:
Phone:
Email Address:
Task 1: Conduct site assessment and preliminary engineering.
Percentage of completion:
Activity completed during this reporting period:
Problems or obstacles encountered during this reporting period:
Plans for the next reporting period:
Deliverables submitted during this reporting period:
Task 2: Conduct final design and prepare construction documents.
Percentage of completion:
Activity completed during this reporting period:
Problems or obstacles encountered during this reporting period:
Plans for the next reporting period:
Deliverables submitted during this reporting period:
TASK 3: Conduct a competitive solicitation for a construction contractor.
Percentage of completion:
Activity completed during this repOIting period:
Problems or obstacles encountered during this reporting period:
Plans for the next reporting period:
Deliverables submitted during this reporting period:
Page 6 of9
TASK 4: Provide construction administration.
Percentage of completion:
Activity completed during this reporting period:
Problems or obstacles encountered during this reporting period:
Plans for the next reporting period:
Deliverables submitted during this reporting period:
Page 7 of9
ATTACHMENT B
REQUEST FOR REIMBURSEMENT FORM
Page 8 0[9
REQUEST FOR REIMBURSEMENT
Date:
Federal ID No,:
Work Order: 05-5107-486-WOl
Billing Period:
Urban Engineering
Seadrift Pier
Invoice No,
Invoice Point of Contact:
Phone:
Email Address:
Submitted by:
Signature:
Printed Name:
Amount Requested: $
Supporting documentation is attached,
Page 9 of9
AUTHORIZE THE SHERIFF TO PURCHASE WITH THE MOTIVATION FUND VARIOUS INEXPENSIVE
ITEMS TO BE AWARDED AT THE ANNUAL BANQUET IN RECOGNITION OF EMPLOYEE SERVICE:
A Motion to authorize the Sheriff to purchase items to be awarded at the annual banquet in recognition of
employee service was made by Commissioner Lyssy and seconded by Commissioner Fritsch,
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor,
NOTICE OF PUBLIC HEARING
NOTICE IS HEREBY GIVEN that Calhoun County Commissioners'
Court will hold a public hearing in the Commissioners' Courtroom, 211 S, Ann Street, in
Port Lavaca, Texas, at 10:00 a,m, on October 25, 2012 on the matter of amending the
2012 Calhoun County Budgets,
The public shall have the right to be present and participate in such hearing,
Michael J, Pfeifer
Calhoun County Judge
PUBLIC HEARING ON THE MATTER OF AMENDING THE 2012 CALHOUN COUNTY BUDGETS:
The Public Hearing began at 10: 14 A.M.
Cindy Mueller: Read from Amendment Approval List
Amendments to the 2012 budget ending line total fund balance increases/decreases Grand Total: ($462,659)
General Fund: Total Amount: ($462,658)
o Commissioners Court Amendment Number 3184: ($459,795)
o Commissioners Court Amendment Number 3185: ($2)
o County Court-at-Law Amendment Number 3194: ($19,600)
o Debt Service Amendment Number 3193: ($1)
o District Clerk Amendment Number 3191: $0
o Emergency Management Amendment Number: $0
o Sheriff Amendment Number 3183: ($2)
o Transfers Amendment Number 3188: $16,142
o Transfers Amendment Number 3189: $600
Lateral Road Fund Precinct #1: Total Amount: $0
o No Department Amendment Number 3190: ($9)
o Revenue Amendment Number 3190: $9
Lateral Road Fund Precinct #2: Total Amount: $0
o No Department Amendment Number 3190: ($9)
o Revenue Amendment Number 3190: $9
Lateral Road Fund Precinct #3: Total Amount: $0
o No Department Amendment Number 3190: ($9)
o Revenue Amendment Number 3190: $9
Lateral Road Fund Precinct #4: Total Amount: $0
o No Department Amendment Number 3190: ($9)
o Revenue Amendment Number 3190: $9
Cap, Proj, - ClAP Coastal Improvements: Total Amount: $0
o No Department Amendment Number 3186: $0
o No Department Amendment Number 3187: $0
o Revenue Amendment Number 3146: $0
Cap Proj - Annex Renovation: ($1)
o No Department Amendment Number 3188: ($1)
Cap Proj - Olivia/Port Alto Ambuiance: $0
No Department Amendment Number 3189: $0
No comments from the public.
The Public Hearing ended at 10:20 A,M.
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AMEND THE 2012 CALHOUN COUNTY BUDGETS:
A Motion to approve the amendments to the 2012 Calhoun County Budget was made by Commissioner Galvan
and seconded by Commissioner Lyssy.
Commissioner Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
COUNTY REPORTS:
The following monthly reports were presented:
1) County Clerk: September 2012
2) Justices of Peace:
i. Justice of the Peace #5: September 2012
3) Calhoun County Extension Service: September 2012
A Motion to approve the county reports was made by Judge Pfeifer and seconded by Commissioner Lyssy,
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
ANITA FRICKE - COI::INi1i1I!l~hERK
MONTHLY REPORT RECAPITULATION
OFFICE FUND - SEPTEMBER<2012
CIVIL FUNDS
County Fees
County Clerk's Fees
Recording
Probate
Civil
Total County Clerk's Fees
Judge's Fees
Probate
Civil
Total Judge's Fees
Probate Fees (Education Fees)
Sheriffs Fees
Jury Fees
Law Library Fees
Beer Licenses
Appellate Fund (TGC)
Court Reporter Fees
Civil Indigent Fees
Record Management Fees (County Clerk)
Record Management Fees (County)
Security Fees (County)
Bond Forfeitures
Subtotal County Fees
$13,447,60
280,00
200,00
$13,927,80
28,00
0,00
28,00
35,00
325,00
44,00
420,00
0,00
60,00
180,00
160,00
2,130,00
80,00
80,00
0,00
$17,469,60
State Fees
Judicial Funds (CV$,OO + PR$,OOl
Marriage License Fees
Birth Certificate Fees
Total State Fees
SUBTOTAL
Overpmt of Filing Fees to be Refunded by Co, Clk,
TOTAL CiVIL FUNDS COLLECTED
984,00
372,50
77,40
1 ,433,90
$18,903,50
$18,903,50
0,00
$18,903,50
CRIMINAL FUNDS
Total Criminal Court Costs & Fines & Pre-Trial Diversion
TOTAL FUNDS RECEIVED (As per ACS Report)
Bank Interest Earned
$8,545,50
$27,449.00
TOTAL FUNDS RECEIVED
Less Refunds for Overpayment of Filing Fees
ADJUSTED FUNDS RECEIVED $0,00
Plus Re-Deposit of NSF Checks (Not recorded in ACS)
Less NSF Checks (Not recorded In ACS)
Co, Clerk Check
AMOUNT DUE COUNTY TREASURER I $27,449,00 I
DISBURSEMENTS
CK#
CASH ON HAND OFFICE FUND
Beginning Book Balance
Funds Received
Disbursements
Plus Redeposit of NSF Checks
Less NSF Checks
Ending Book Balance
CASH ON HAND, TRUST FUND
Beginning Book Balance
Funds Received
Disbursements
Ending Book Balance
ANITA FRICKE - COUNTY CLERK
MONTHLY REPORT RECAPITULATION (con't)
OFFICE FUND - SEPTEMBER 2012
Pavable To
Descriotion
TOTAL DISBURSEMENTS
BANK RECONCILIATION OFFICE FUND
Ending Bank Balance
Outstanding Deposits....
Outstanding Checks""
Plus Other Items"
Less Other Items'"
Reconciled Bank Balance
$22,494,63
8,074,31
(8,074,31)
$22,494,63
BANK RECONCILIATION TRUST FUND
Ending Bank Balance
Outstanding Deposits**
Outstanding Checks""
Reconciled Bank Balance
**See Attached
~~aU-~kj
SUBMITTED BY: Anita Fricke, County Clerk
Amount
$0,00
$0,00
$0,00
$0,00
$22,494,63
$22,494,63
10/10/2012 13:49 351-983-2451
CALHOUN CO PCT 5
PAGE 01
Calhoun County Justice Court, Pct 5
Judge Nancy Pomykal
508 West Main
POBox 454
Port O'Connor, Texas 77982
Phone (361) 983.2351 Fax (361) 983-2461
10-10-2012
FACSIMILE TRANSMITTAL
To: THE HON. MI~I; f'F'E.lFER AND COMMISSI.QbJERS COURT
Fax: 361.55a.4~
PAGES TO FOLLOW 8
INCLUDING THIS COVER SHEET
From: JUDGE NANCY POMYKAI..
Su..bject: MONTHLY REPORT OF COLLECTIONS FOR THE MONTH OF
SEPTEMBER 2012
Comments: Faxlnp the report of collections of September. 2012. Please
give me a call If you have any qY~IJiQDi.
Thank you,
~ p, o~'-(
The Information contained in the facsimile message is confidential, Intended only for the use of the
Individual or entity named, If the reader of this message Is not the Intended recipient, or the
employee or agent responsible to deliver said message to the Intended recipient, you are hereby
notified that any dissemination, distribution, copying or the taking of any action In reliance on the
contents of this communication is strictly prohibited. If you have received this communication In
error, please immediately notify us by telephone and return the original message to us at the above
address via the U. S. Postal Service,
10/10/2012 13:49
361-983-2461
CALHOUN CO PCT 5
PAGE 02
10/09/2012
Money Di.tribution Report
JUDGE NANCY POMYKAL . SEPTEMBER 2012 REPORT
Page 2
~------~-.~-~---------~--------------~-~~-------------~~----------~-------------~._-~---------------~------------~-~-------------~
Receipt C~Y&e/Defehdant I Code Amount I Code Amount I Code Amount I Code Amount I co<le Amount I Code Amount Total
I I I I I I
0374555 12-09-028~-c 09-27-2012 I JSF 4.00 I cee 40,00 I eMS 3,00 I LAF 5,00 I TF 4.00 I JCSF 1.00 315,00
DEADMOND, BRIAN D JR, I JPAY ~.OO I IDF 2.00 I FINE 250.00 I I I
Jail Credit I I I I I I
10/10/2012 13:49
CALHOUN CO PCT 5
361-983-2461
PAGE 03
10/09/2012 Monay Diatrib~tion Report P6g~ 3
JUDGE NANCY POMYKAL . SEPTEMBER 2012 REPORT
_.__~________~w____~_~________~_~__~___________~~___~_-----------~~_____~_____________~_w~____~_________________.w_________________
The following tot.l. r.pr...nt - c..h ond Ch.ek. CoLl.oted
Type Code De,cription COl,lnt R~tained Disburs.d Money-Total,
The following totQle repr~&~nt - Cash and Check& collected
COST CCC CONSOLIDATED COURT COSTS 10 36.00 324.00 360.00
COST CHS COURTHOUSE SECURITY 10 27,00 0.00 27,00
COST lDF INbIGENT DEFENSE FUND 9 1.60 14,40 16,00
COST JCSF JUSTICE COURT SECURITY FUND 10 9.00 0.00 9.00
COST JPAY JUDGE PAY RAISE FE' 10 5.20 46.80 52,00
COST JSF JUROR SERVICE FUND 10 3.60 32,40 36,00
COST LAF SHERIFF'S FEE 6 25.00 0.00 25.00
COST MVF MOVING VIOLATION FEE 6 0,06 0.54 0,60
COST PWAF TEXAS PARKS & WILDLIFE 2 8,00 2.00 10,00
COST SAF DPS 2 B.OO 2,00 10,00
COST TF TECHNOLOGY FUND 10 36.00 0.00 36.00
COST TFC TPC 6 18,00 0.00 18.00
FEES CSRV COLLECTION SERVICES FEE 1 48.30 0,00 4B,30
FEES DFf DEFERRED FEE 3 260.10 0.00 260.70
FEES DSC DRIVER SAFETY COURSE 01/200B 2 19,BO 0.00 19.80
FEES EXRF EXPIRATION RENEWAL FEE 2 20.00 0.00 20,00
FEES FILl FILING FEE 1 25.00 0,00 2~.00
FEES IFEE INDIGENT FEE 1 0.30 5.70 6.00
FEES MEF MINOR EXPUNGMENT PEE 1 30.00 0.00 30.00
FEES sUBC sUB TITLE C 6 9.00 171.00 180.00
FINE FINE FINE 4 201,90 0.00 201.90
FINE WSF WATER SAFETY FINE 2 60,00 340.00 400.00
Mon~y Tote ~~ 16 852,46 938,84 1,791.30
rho following total. '.p,...nt - Trono1o.. CoLl..t.d
COST CCC CONSOLIDATED COURT COSTS 0 0.00 0.00 0.00
COST CHS COU~THOUSE SECU~ITY 0 0,00 0.00 0.00
COST lPF INDIGENT DEFENSE FUND 0 0,00 0.00 0.00
COST JCSF JUSTICE COURT SECURITY FUND 0 0.00 0.00 0.00
COST JPAY JUDGE PAY RAISE FEE 0 0,00 0,00 0.00
COST JSF JUROR SERVICE FU~b 0 0.00 0,00 0,00
COST LAF sHERIFF'S FEE 0 0.00 0.00 0.00
COST MVF MOVING VIOLATION FEE 0 0.00 0.00 0.00
COST PWAF T.XAS PARKS & WILDLIFE 0 0.00 0.00 0.00
COST SAF DPS 0 0.00 0.00 0.00
COST TF rECHNOLOGY FUNb 0 0.00 0.00 0.00
COST TFC TFC 0 0.00 0.00 0.00
FEES CSRV COLLECTION SERVICES FEE 0 0.00 0.00 0.00
FEES OFF PEFERRED FEE 0 0.00 0.00 0.00
FEES DSC DRIVER SAFETY COURSE 01/2006 0 0.00 0.00 0.00
FEES EXRF EXPIRATION ReNEWAL FEE 0 0.00 0.00 0.00
FEE$ FILl FlUNG FEE 0 0.00 0.00 0.00
FEES IFEE INPIGENT FEE 0 0,00 0.00 0.00
FEES MEF MINOR EXPUNGMENT FEE 0 0.00 0.00 0.00
FoES oUSt SUS TITLE C 0 0,00 0.00 0.00
10/10/2012 13:49
351-983-2461
CALHOUN CO PCT 5
PAGE 04
10/0~/2012 MOney Distripytion Report poge 4
JUDGE NANCY PONVKAL . SEPTEMBER 2012 REPORT
_~_______~ww~_w____________~~~___w_~_____________~~~__ww__________________~_____W_H_____________~-~______~________________._~ft___U__
The following toUls represent. T""ootor. Collected
Typ. Code Description Count Ret.ined Disbursed Money- Totols
FINE FINE FINE 0 0,00 0,00 0,00
FINE WSF WATER SAFETY FINE 0 0.00 0,00 0.00
Transfer Totals 0 0,00 0.00 0,00
The following totals rep~~$ent - JaiL Credit and community Servioe
COST C" CONSOLIDATED COURT COSTS 3 12.00 108.00 120.00
COST CHS COURTHOUSE SECURITY 3 ~.OO 0.00 ?OO
COST IDF INDIGENT DEFENSE FuND 3 0,60 5,40 6.00
COST JCSF JUSTICE COURT SECURITY FUND 3 3.00 0.00 3.00
COST JPAY JUDGE PAY RAIsE FEE 3 1,80 16.20 18.00
COST JSF JUROR SERVICE FUND 3 1.20 10,80 12,00
COST LAF SHERIFF'S FEE 3 15,00 0,00 15.00
COST MVF MOVIN. VIOLATION pEE 0 0.00 0.00 0.00
COST PWAF TEXAs PARKs & WILDLIFE 0 0,00 0.00 0.00
COST SAF OPS 0 0,00 0,00 0,00
COST TF TECHNOLOGV FuND 3 12,OQ 0,00 12.00
COST TFC 1FC 0 0.00 0.00 0.00
FEES CSRV COLLECTtON SERVICES FEE 0 0.00 0,00 0,00
FEES OFF DEFERRED FEE 0 0,00 0,00 0.00
FEES DSC DRIVER SAFETV COURSE 01/2008 0 0,00 0,00 0,00
PEES eXRF eXPIRATION RENEWAL FEE 0 0,00 0.00 0.00
FEES FILl FILING FEE 0 0.00 0.00 0.00
FEES IFEE INDIGENT FEE 0 0.00 0.00 0,00
FEE$ MEF MINOR EXPUNGNENT FEE 0 0,00 0,00 0,00
PHS SUBC SUB TITLE C 0 0,00 0,00 0.00
FINE FINE fiNE 3 615.00 0.00 615.00
FINE W8F WATER SAFETV FINE 0 0,00 0.00 0,00
Credit Totols 3 669,60 140.40 810,00
The 'foLtowit'lg totals represent - Credit Card Payments
COST CCC CONSOLIOATE~ COURT COSTS 0 0,00 0.00 0.00
COST CHS COURTHOUSE SECURITY 0 0,00 0.00 0,00
COST IDF INDIGENT DEFENSE FUND 0 0,00 0.00 0,00
COST JCSF JUSTIce COURT SECURITY FUND 0 0,00 0.00 0,00
COST JPAV JUDGE PAY RAISE FEE 0 0,00 0,00 0,00
COST JSF JUROR SERVICE FUND 0 0,00 0.00 0.00
COST LAF SHERIFF'S FEE 0 0.00 0,00 0.00
COST MVP MOVING VIOLATION FE~ 0 0,00 0.00 0.00
COST PWAF TEXAS PARKS & WILDLIFE 0 0,00 0.00 0.00
COST SAF DfS 0 0.00 0.00 0,00
COST 1F TeCHNOLOGV fUND 0 0.00 0.00 0.00
COST He TFC 0 0,00 0,00 0,00
FEES CSRY COLLECTION SERVICES FEE 0 0,00 0,00 0,00
FEES OFF DEFERRED FEE 0 0,00 0,00 0.00
FEES DSC DRIVER SAFETY COURSE 01/~OOB 0 0.00 0.00 0.00
10/10/2012 13:49
361-983-2461
CALHOUN CO PCT 5
PAGE 05
10/09/2012 Money Distribution Report Page 5
JUDGE NANCY POMYKA~ - SEPTeMBER 2012 REPORT
_____.~________________~~~~w_____~~~______________________~~~____~__N_~_~____________________________~----~___~w_____a_____________
The folLowing totals r~~r&5ent - Credit Cerd Payment$
Type coda De&ct'iption Count Retained D; obu...d Money-Totals
FEES EXRF eXPIRATION RENEWAL FEE 0 0.00 0,00 0.00
FEES FILl HLING FEE 0 0,00 0.00 0.00
FeES IFEf INDIGENT FEE 0 0,00 0,00 0.00
FEES MEF MINOR EXPUNGMENT FEE 0 0.00 0.00 0.00
FeEs SUBC SUB TITLE C 0 0.00 0.00 0.00
FINE FINe FINE 0 0.00 0.00 0.00
FINE WSF WATER SAFETY FINE 0 0.00 0.00 0,00
Credit Tot/ilL$ 0 0,00 0,00 0.00
The following tot&ls rep~e&el'1t - Comb1ned Honey and Credit.
COST CCC CONSOLIDATED tOURT COSTS 13 48,00 432,00 480.00
COST CHS tOURTHOUSE SECURITY 13 36.00 0,00 36.00
COST IDF INDIGENT DeFENSE FUND 12 2.20 19,80 22.00
COST JCSF JUSTICE COURT SECURITY FUND 13 12.00 0,00 12.00
COST JPAV JUDGE PAY RAISE FEE 13 7.00 63,00 70,00
COST JSP JUROR SERVICE FUND 13 4.80 43.20 48.00
COST LAP SHERIFF'S FEE 9 40,00 0,00 40.00
COST MVF NOVING VIOLATION FEE 6 0,06 0.54 0.60
COST PWAF TEXAS PARKS & WILDLIFE 2 B.OO 2.00 10.00
COST SAF DPS 2 8,00 2.00 10,00
COST TF TECHNOLOGY FUND 13 48.00 0,00 48,00
COST TFC TFC 6 1B.00 0,00 16.00
FEES CSRV COLLECTION SERVICES FEE 1 46.30 0.00 48.30
FEES DFF DEFERRED FEE 3 260.70 0.00 2~0.70
FEES DSC DRIVER SAFETY COURSE 01/2008 2 19.60 0,00 19.80
FEES EXRF EXPIRATION RENEWAL FEE 2 ZO.OO 0.00 20,00
FEES Fill F ILlNG FEE 1 25.00 0.00 25.00
FEES IFE!; INDIG!;NT FEE 1 0.30 5,70 6.00
FEES MEF NINO~ .XPuNGM.MT FEE 1 30,00 0,00 30.00
FEES SuBC SUB TITLE t 6 9,00 171,00 1BO,00
FlNE FINE FINE 7 816.90 0,00 816.90
FINE WSF WATER SAFETY FINE 2 60.00 340.00 400.00
Report TotA l:s 19 1,522.06 1,079.24 2,601 .30
10/10/2012 13:49
351-983-2451
CALHOUN CO peT 5
PAGE 05
10/09/2012 Money Distribution Report Page 6
JUOGE NANcY POMYKAL . SEPTEMBER 2012 REPORT
___"~_~~W_~__~~.________________________________~__~~"w______~___WW___~"__._______________________________________________________
bAn PAYMENT-TYPE FINES COURT-COSTS FEES BONDS RESTITUTION OTHER TOTAL
00-00-0000 C.sh & Checks collected 0,00 0,00 0,00 0,00 0,00 0.00 0.00
J~it Credit' & Comm service 0.00 0,00 0,00 0,00 0,00 0,00 0,00
Cr~dit Cards & Trana1er$ 0,00 0,00 0,00 0.00 0,00 0,00 0,00
Total of alL Co~~ect;O"i 0,00 0,00 0.00 0.00 0,00 0.00 0,00
09-01-1991 cash & Chec~9 CoLLeoted 0.00 0.00 0,00 0,00 0.00 0,00 0,00
Jail Credits & Comm s~rvice 0,00 0.00 0.00 0.00 0,00 0,00 0,00
credit Card. & Tren.ter. 0,00 0.00 0.00 0.00 0,00 0,00 0,00
Total of all ColleGtions 0,00 0.00 0.00 0.00 0.00 0.00 0,00
09-0H99~ C..h & Checks Collected 0.00 0,00 0.00 0.00 0,00 0.00 0,00
Joil credits & COmm S~rvice 0,00 0.00 0,00 0,00 0,00 0,00 0,00
Credit Carde ~ Transfers 0,00 0.00 0,00 0,00 0.00 0.00 0,00
Tot.l of .ll Collections 0,00 0.00 0.00 0.00 0,00 0,00 0.00
0~-01-1995 C.sh & checks collected 0.00 0.00 0,00 0.00 0.00 0,00 0.00
Jeil Credit8 & Comm Service 0,00 0.00 0.00 0.00 0.00 0.00 0,00
Credit Cards & Trans1er$ 0,00 0.00 0.00 0.00 0,00 0,00 0,00
Total of all Collections 0.00 0.00 0.00 0.00 0.00 0.00 0,00
09-01-1997 cash & Checks collected 0.00 0.00 0.00 0.00 0.00 0,00 0.00
J~il Cre~it$ & (omm Service 0.00 0.00 0.00 0.00 0,00 0.00 0.00
crtdit Cards & Trans1er$ 0.00 0.00 0,00 0.00 0,00 0,00 0.00
Total of all Collections 0,00 0.00 0.00 0.00 0.00 0.00 0.00
09-01-1999 cash & Cheoks colleeted 0.00 0.00 0.00 0,00 0,00 0,00 0.00
Jail credits & Comm service 0.00 0,00 0,00 0.00 0.00 0,00 0,00
Credit Cards & Transfors 0.00 0,00 0,00 0,00 0.00 0.00 0,00
Total of all collection. 0,00 0,00 0,00 0,00 0.00 0,00 0,00
09-01-2001 cash & Cheoks collected 0.00 0.00 0.00 0.00 0.00 0,00 0.00
Ja,l Credits & Carom Service 0,00 0.00 0,00 0.00 0,00 0.00 0,00
Cr~dit C~rd~ & Transfers 0,00 0,00 0.00 0.00 0.00 0.00 0,00
Tot~l of ~ll collections 0.00 0.00 0,00 0,00 0.00 0,00 0.00
09-01-2003 cash & Checks Collected 0,00 0.00 0,00 0.00 0.00 0.00 0.00
J.il Credit. & Comm Service 0.00 0.00 0.00 0.00 0,00 0,00 0.00
Credit Cards & T~!n&f~r& 0.00 0.00 0,00 0,00 0.00 0.00 0,00
Totlill of a~~ Collections 0,00 0.00 0,00 0.00 0,00 0.00 0.00
01-01-2004 C.sh & Che.ks Colle.ted 601,90 599.60 58~,80 0.00 0,00 0.00 1,79UO
Jail Credits & Carom s~rvice 615.00 195,00 0,00 0,00 0,00 0,00 610.00
credit ~erds & Tran,fer~ 0.00 0.00 0.00 0.00 0,00 0,00 0.00
Total 01 all Collections 1,216.90 7~4,60 569,60 0.00 0,00 0.00 2,601.30
TOTALS Cash & Cheeks colle.ted 601.90 599.60 589,80 0.00 0,00 0,00 1,791.30
Jail Credits & Comm Service 615.00 195,00 0.00 0.00 0,00 0,00 810,00
C~tdit Cards & 1rQnsfers 0.00 0.00 0.00 0.00 0.00 0,00 0.00
Tot~~ of a~~ CoLlections 1,216,90 7~4,60 569.60 0.00 0,00 0,00 2,601.30
10/10/2012 13:49
361-983-2461
10/09/2012
CALHOUN CO PCT 5
Money Di.tribution Report
JUDGE NANCY POMYKAL " SEPTEMBER 2012 REPORT
DATE
PAYMENT-TYPE
State 01 Tex~a Quarterly Reporting TotBls
Deeor;ptic;m
State Comptrolle~ COst and F~ea Report
Sftction I. R~po~t for Offen$e$ committed
01-01-04 Forward
09-01-01 - 12-31-03
08-31-99 - 08-31-01
09-01-97 - 08-30-99
09-01-91 - 08-31-97
8all 80nd f..
DNA Testing Fee - conviatioh$
DNA T&&ting Fee ~ Comm Supvn
nNA Te$ting Fee - Juvenile
EMS Trou.a FUnd (EMS)
Juvenile Probation Diver$;Qn Fee~
J~ry Reimbursement Fee
Indigent Oefense F~nd
Moving Violation f...
State Traffic F1n~
soction II' A. Appli..bl.
Peace Officer Fees
F.ilur. to App.ar/pay F...
Judicial Fund - CQn$t County Court
Judicial Fund - Statutory county Court
Motor Corri.r Weight Violation.
Time Payment Fees
Driving Record Fee
JUdicial suppo~t Fee
Repc~t sub Total
State Comptroller Civil Fee$ Roport
Cf' Birth Cortificat. F...
CF: MarriQ9~ ~icenae Fees
CF: Declaration of Informal M~rr1~ge
cP: No~disQLosure Fees
CF: Juror Don'tions
CF: Justice Court Indig Filing Fee$
CF: Stat Prob Court Indi~ Filing Fee&
CF: Stat prob Court JudiQ fi~ing Fees
CF, St.t Cnty Court Indig Filing F...
CF: stat cnty Court Judie Fi~ing Fees
CF, Cn.t Cnty Court Indig Filing F...
CF: Cnat cnty Court Judio fiLing Fees
CF: Diat Court bivorQe & F.mily law
CF: Di&t Court Other Divoro6jFamily Law
CF~ D1~t court Indig Legal S~rvice&
CF: JudiQlal support Fee
~eport Sub Total
totel Due For Th1~ period
FINES COURT-COSTS
FEES
Count
Coll..tad
10
o
o
o
o
o
o
o
o
o
o
10
9
6
6
360.00
0,00
0,00
0,00
0,00
0.00
0,00
0,00
0,00
0,00
0,00
36,00
16.00
0,60
180.00
4
o
o
o
o
o
o
10
SS
20.00
0.00
0.00
0,00
0.00
0.00
0.00
52.00
664,60
o
o
o
o
o
1
o
o
o
o
o
o
o
o
o
o
1
0,00
0.00
0.00
0.00
0.00
6,00
0,00
0.00
0.00
0.00
0.00
0.00
0.00
0,00
0.00
0.00
6.00
;6
670,60
BONDS RESTITUTION
Rota 1 nod
~6.00
0.00
0.00
0.00
0.00
0,00
0.00
0.00
0.00
0,00
0,00
3,60
1,60
0.06
9.00
16.00
0.00
0.00
0.00
0.00
0.00
0.00
5.20
71.46
0.00
0,00
0.00
0.00
0.00
O.~O
0.00
0.00
0.00
0,00
0.00
0.00
0.00
0.00
0.00
0.00
O.~O
71.76
Di $bursed
324.00
0,00
0.00
0.00
0.00
0,00
0.00
0,00
0.00
0,00
0,00
~2,40
14,40
0,54
171,00
4,00
0,00
0,00
0.00
0.00
0,00
0.00
46,80
593,14
0.00
0,00
0,00
0,00
0,00
5.70
0,00
0.00
0,00
0.00
0,00
0,00
0.00
0.00
0.00
0,00
S.70
598,84
PAGE 07
Page
7
OTHER
TOTAl.
10/10/2012 13:49
361-983-2461
CALHOUN CO PCT 5
PAGE 08
10/09/.on Monoy ~i.'ribYt1on Report Page 1
JUOG~ MAMCY POMYKAl . S~PTEMeER 2012 REPORT
--_~__~__~~__.~_~~__~wW~w~M~w~_~W_~W__M~_W"~.~W~._~_~.__~~~~~__w.__~_w_______~_____________ -----~---------------------------------
Receipt Cause/Defendant I Code Amount I Cod. Amount I Code Amount I Code AMount Code AmoUt'1t I cod. AmOYnt I To,ol
I I I I I
0374537 12-06-0270 09-04-2012 I JSF 4.00 I TFC 3,00 I CCC 40.00 CMS 3.00 LAr 5.00 TF 4.00 I 165.00
CENTENO, MARCOS ANTONIO I JCSF 1.00 I JPAY 6.00 I 10F 2.00 MVF 0.10 OFF 66,90 suec 30.00 I
, C..h I I t I
0374.36 12-0S-0<71 09-04-2012 I JsF 4.00 I 1FC 3,00 I CCC 40.00 CMS 3.00 LAF 5.00 TF 4.00 I 165.00
CENTENO, MARCOS ANTONIO I JCSF 1.00 I JPAY 6.00 I IOF 2.00 MVF 0.10 DFF 66.90 SUBC 30.00 I
C..h I I I I
0374539 12-06-0250 09-04-2012 I J$F 4.00 I CCC 40,00 I CHS 3.00 LAF 5,00 TF 4.00 JCSF 1.00 I 165,00
CARAREZ, FRANK I JPAY 6.00 I IOF 2,00 I FtNE 100.00 I
CQmm Se-rvi Qe I I I I
0374540 12-09-0279 09-10-2012 I JSF 3.06 I CCC 30.77 I CHS 2,31 lAF 3,85 TF 3.08 JCSF 0.77 I 50,00
CHAVEZ, JOEL I JPAY 4,62 IDF 1.54 I I
cash I I I
0374541 12-05-0196 09-11-2012 , rlM~ 50.00 I I 50,00
eALAOE~, CARMELA VALLEJO I I I
Money Order I , I I
0374542 09-07-0294 09-11-2012 I MEF 30.00 I I I 30,00
ROBINSON, RYAN ALLEN I I I I
Money Orde.r I I I I I
0374543 12-07-0220 09-11-2012 I JSf 4.00 eec 40,00 I CHS 3.00 I PWAF 5.00 TF 4.00 I JCSF 1.00 I 365.00
GARtIA, OANIEL RODRIQUEZ I JPAY 6,00 tPF 2.00 I ~SF 300.00 I I I
c..hi.r'. Check I I I I
0374544 12-09-0283-JC 09-12-2012 I IFEE 6,00 FILl 25,00 I I I 31,00
OETAR HOSPITAL NORTH I I I I
company Check I I I I
0374545 12-06-0274 09-13-<012 I JSF 4,00 TFC 3.00 I CCC 40,00 I CHS 3.00 SAF '.00 TF 4.00 I 165.00
PUA~TE NUNEZ, JOSE ALBERTO I ,CSP 1.00 JPAY 6,00 I IOF 2.00 I MVF 0,10 FINE 66.90 SUBe 30.00 I
Honey O,.der I I I I
0374546 06 -12-0292 0~-17-2012 , JSF 4.00 CCC 40.00 I CHS 3,00 I PWAP ;,00 TF 4,00 JCSF 1.00 I 209,30
HARTL, DENNiS JAM~S I WSF 100.00 CSRV 48.30 I JPAY 4,00 I I
Company Ch~ck. I I I I
0374547 12-09-0279 09-17-2012 I JSF 0.94 CCC 9.23 I CHS 0.69 I LAP 1.1~ TF 0,92 JCSF 0.23 I 50,00
CHAVEZ, JOEL I JPAY 1.38 IDF 0.46 I FINE 35.00 I I I
C..h I I I I I
0374548 12-09-0276 09-20-2012 I ,SF 4.00 I 1FC 3.00 I ecc 40.00 I CHS 3.00 I LAP 5,00 TF 4,00 I 108,00
GALLEGOS, sHANNON WESAR I JCSF 1.00 I JPAY 6.00 I IOF 2.00 I MVF 0.10 DSC 9.90 sUBC 30,00 I
Honey Ord~r I I I I I
0374549 12-06-0275 09-24-2012 I JSF 4.00 I TFC 3.00 I cee 40.00 I CMS 3.00 SAF 5,00 TF 4.00 I 225.00
HUTCHINS, ERNEST LAVER_NE I JCSF 1.00 I ,PAY 6,00 I lOP 2.00 I MVF 0.10 PfF 126,90 suec 30.00 I
Per$ona L Check. I I I I I
0374550 12-06-0265 09-25-2012 I JSF 4.00 I TFC 3,00 I CCC 40.00 I CHS 3.00 LAF 5,00 Tf 4.00 I 106.00
~UGH, BR~TT TYLER I JCSF 1,00 I JPAY 6.00 I IDF 2.00 I MVr 0.10 DSC 9.90 suec 30.00 I
cosh I I I I I
0374.51 12-0~-0279 09-26-2012 I PINE 50.00 I I I I 50,00
CHAVEZ, JOEL I , I I I
Cash I I I I I
0374~S2 12-09-0286 09-26-2012 I EXRF 10.00 I I I I 10.00
BROWN, JAM~s MICHAEL JR I I I I I
C..h I I I I I
0374553 12-0~-0280 09-27-2012 I E~RF 10,00 I I I I 10.00
KALINA, CHRtSTOPHER MICHAEL I I I I I
Per,Qnal cheek I I I I I
0374554 12-~-02S7 09-27-2012 I JSP 4.00 I eec 40.00 I tHS 3.00 I LAF 5.00 TF 4,00 I JCSF 1,00 I 330,00
CAIN, JOSHuA SCOTT I JPAY 6,00 I IDF 2.00 I FINE 265.00 I I I
Jtlli l Credit I I I I I I
TEXAS A&M
Rlt,I
EXTENSION
Calhoun County Commissioners Report
September, 2012
Selected major activities for the month of September 2012
9/4 - Armyworm test site seiection began,
9/5 - 9/6 - Extension Faii Faculty Conference,
9/20 - Cattlemen's committee meeting,
9/27 - Applied insecticide test on Donald Wehmeyer's Jiggs Bermuda pasture,
Direct Contacts - 30
Office - 4 Phone - 10
Site -16
Mileage
County Truck - 380,3
Personal Vehicle - In County - 197,6
Personal Vehicle - Out of County - 48,5
Total 626.4
Major events for next month - September 2012
10/9 - Our Lady Of the Gulf School Ag Days field trip
10/12 - Pasture Pest Management Program
10/16 -10/20 - Calhoun County Fair
10/24 -10/25 - South Texas Farm & Ranch Show
Ryan Damborsky
Name
Calhoun
Cou nty
CEA - Agriculture & Natural Resources
Title
October, 2012
Date
TEXASA&M
i
EXTENSION
CALHOUN COUNTY COMMISSIONERS REPORT
SEPTEMBER, 2012
Miles traveled 275,14
Selected maior activities since last report- September 2012
September 5&6: Attended D-11 Program planning in Corpus Christi. Where we discussed and adopted are
plans for the 2013 year.
September 10: Attended TEEA Meeting where we had 9 attended, The meeting discussed the upcoming trip
to Beaumont. I also mentioned to start of the Pecan sale, Also attended a meeting with Signey with Wesley
Nurses to talk about teaming up to do presentations, Later that evening had the clothing and textile 4-h project
meeting where we had 23 kids attend,
September 11: Did a presentation for the Wesley Nurses coalition meeting, Where I discussed all the various
types of programs that I can help and offer support with,
September 14: Had meeting with Sea breeze Apartments meet with the staff to do presentations for their
clientele, Planning first presentation in November,
September 18; Had a food and nutrition project meeting at the Bauer Exhibit hall where the kids made Sloppy
Joe Casserole, We had 12 kids attend,
September 22: Helped with a food and nutrition workshop in Jackson county talking about my plate and the
benefit along with the vitamins that we receive through eating my plate,
September 24: Had a Baking and Decorating cake class all day in the Bauer where the kids learned how to
make and decorate a cake from scratch, We had 22 kids attend this event.
Direct Contacts:
Phone: 85 E-mail/Letters:15
Office:13 Site:5
Website: Volunteers: 0
o
Maior events for next month October 2012
Porl O'Connor Intercoastal 4-H Meeting
TEEA Meeting
Food and Nutrition Meeting ( Porl O'Conner Location)
Fair Events
Travel(Personal Vehicle)
In County Mileage:
Wal-Marl (3): 13,02
9/4,9/17,9/21
United Methodist(1 )4,84
HEB: (1)6,14
Sea Breeze Aparlments(1)2,00
Out of County Mileage:
Corpus Christi:180,58
Jackson County:68,56
Tina Trevino f~ f;i~Wp
Name
Calhoun
County
Countv Extension Aaent-Familv and Consumer Science
Title
October 2012
Date (Month-Year)
Texas A&M AgriLife Extension Services' College Station, Texas
TEXAS A&M
I
EXTENSION
Calhoun County Extension Office
September 2012 Report to Commissioner's Court
September 3 - Intercoastal 4-H Meeting
Charles attended the 4-H Club Meeting to update families on the changes of the 4-H program in
the upcoming year. He also discussed some of the programs we will see in the near future. to help
diversify the program and incorporate more people,
September 4 - All Around 4-H Club Meeting
Charles attended the 4-H Club Meeting to update families on the changes of the 4-H program in
the upcoming year, He also discussed some of the programs we will see in the near future to help
diversify the program and incorporate more people.
September 5 - Greenlake/Long Mott 4-H Club Meeting
Charles attended the 4-H Club Meeting to update families on the changes of the 4-H program in
the upcoming year. He also discussed some of the programs we will see in the near future to help
diversify the program and incorporate more people.
September 8 - Colorado County Livestock Judging Contest
Charles traveled with the Livestock Judging Team to Columbus, TX to participate in the
Colorado County Livestock Judging Contest. The Junior Team was 3rd overall with two
individuals placing in the top ten individually,
September 9 - Six Mile Sanddollar 4-H Meeting
Charles attended the 4-H Club Meeting to update families on the changes of the 4-H program in
the upcoming year, He also discussed some of the programs we will see in the near future to help
diversify the program and incorporate more people,
September 9 - Olivia 4-H Club Meeting
Charles attended the 4-H Club Meeting to update families on the changes of the 4-H program in
the upcoming year, He also discussed some of the programs we will see in the near future to help
diversify the program and incorporate more people.
September 9 - Town and Country 4-H Club Meeting
Charles attended the 4-H Club Meeting to update families on the changes of the 4-H program in
the upcoming year, He also discussed some of the programs we will see in the near future to help
diversify the program and incorporate more people,
September 10 - Clothing and Textiles Meeting
The Clothing and Textiles meeting met to create pillow pets to take home for decoration or give
to a friend, The event was well attended with over 20 kids participating,
September 11 - Mariner 4-H Club Meeting
Charles attended the 4-H Club Meeting to update families on the changes ofthe 4-H program in
the upcoming year, He also discussed some ofthe programs we will see in the near future to help
diversify the program and incorporate more people,
September 11 - CCF Rabbit Validation
Charles helped facilitate the Rabbit Validation for the Calhoun County Fair. Over 35 pens were
tattooed and validated for the Calhoun County Fair.
September 13 - Port O'Connor Open House
Charles traveled with the Ambassadors to attend the Open House of the Port O'Connor
Elementary, The Ambassadors talked to families about 4-H, all ofthe programs we have to offer,
as well as trying to recruit new members,
September 15 - Fair Workday and Progress Show
Charles helped facilitate for the Fair Workday and progress show. Over 120 youth showed up to
help put together the barn and show ring for the upcoming Calhoun County Junior Livestock
Show. A progress show was'held soon after where students had the opportunity to hone their
showmanship skills,
September 16 - Rabbit Clinic 1
Charles helped facilitate the Calhoun County Fair Rabbit Clinic, Over 20 youth attended the
clinic conducted by rabbit breeder Ross James, The clinic covered rules, nutrition, facilities and
selection of pens,
September 18 - Rabbit Clinic 2
Charles helped facilitate the Calhoun County Fair Rabbit Clinic, Over 20 youth attended the
clinic conducted by rabbit breeder Ross James, The clinic covered rules, nutrition, facilities and
selection of pens,
September 19 - Seadrift ElementalY Open House
Charles and the Ambassadors traveled to Seadrift Elementary to talk to families about 4-H and
recruit new members, More than 75 individuals were notified of all of the opportunities that 4-H
has to offer.
September 22 - Washington County Livestock Judging
Charles traveled with the Livestock Judging Team to Brenham where they competed in the
Washington County Livestock Judging Contest. 3 Individuals were in the top ten individually in
their respective age divisions, The Intermediate team was loth overall and the Senior team was
6th overall.
September 24 - Council and PALA Meeting
The monthly meeting of the Calhoun County 4-H Council and Adult Leader Association was
held to discuss budgets, community service opportunities, as well as the theme for the year. The
theme for this year is "Calhoun County 4-H, where nobody sits the
bench",
September 25 -NationaI4-H PI'oc/amation
The Ambassadors met with County Judge Mike Pfeifer to sign the
proclamation for National4-H Week.
September 25 - Shooting Sports Meeting
Charles and Ryan met with the Shooting Sports leaders to develop plans for the upcoming year.
We determined what our goal for any funds raised were, in addition recruitment and promotion
plans were discussed,
September 26 - Livestock Judging Seminar
Charles traveled to Edna to help teach Livestock Evaluation for interested youth in Jackson
County, Six youth attended the session and expressed their interest for more sessions in the
future,
Upcomina Events
October 1-5 - State Fair of Texas
October 6 - Fort Bend County Livestock Judging Contest
October 13 - Jackson County Livestock Judging Contest
October 8-13 - National 4-H Week
October 13 - One Day 4-H
October 16-20 - Calhoun County Fair
October 29 - Council and PALA Meeting
Travel
In County
Project Visits - 159 mi
Errands and Other - 241 mi
Out of County
9/5 - Program Planning Conference - Corpus Christi - 191 mi
9/6 - Program Planning Conference - Corpus Christi -191 mi
9/8 - Livestock Judging Contest - Columbus - 266 mi
9/16 - Meeting - Victoria - 96 mi
9/26 - Livestock Judging Program - Edna - 71 mi
Personal Vehicle
N/A
Total Miles Driven 1,215 miles
Contacts
Site - 220
Telephone - 89
Email - 200
721 Total Contacts
Cj~- ~
Charles Seely
CEA 4-H and Youth Development
Calhoun County
Mail - 212
ADM 2,6
Reprint - 2,81
0-843
EXTENSION ACTIVITY REPORT TO COUNTY COMMISSIONERS COURT
Miles traveled 473.3
Selected maior activities since last report
September 5-6: District II AgriLife Meeting in Corpus Christi - Cummins attended the Fall Faculty
Meeting with the other agents to focus on programming for next year and heal' administrative updates.
September 6: Offshore fishing regulation meeting - NOAA Fisheries, Texas Parks and Wildlife
Department, and Texas Sea Grant hosted this meeting for the recreational and for-hire anglers that fish in
federal waters, Some of the federal regulations are much different than the state regulations and can be
enforced by State Game Wardens, While the meeting was highly promoted, the attendance was low.
September 8: Point Comfort Fish-o-ree - Cummins set up the saltwater aquarium
in Point ComfOlt for the 34th annual Boy Scout Fish-o-ree, During the three hour
event, 18 species were collected from the weigh masters to showcase the diversity
of Lavaca Bay and teach about the local marine life, 65 youth enjoyed this year's
fishing event.
September II: Mariner 4-H club meeting - The new 4-H year is starting and the new club at Our Lady of
the Gulf Catholic School is entering its second year, The club is focused around science topics but not
limited to them, The first meeting had the installation of new officers and a presentation by Charles Seely
about many of the opportunities available to the club members,
September 22: Adopt-a-Beach fall cleanup - The annual clean up at Magnolia
Beach was a success with 133 volunteers participating, Thank you to Waste
Management for donating the dumpsters and the Marine Advisory Committee
for sponsoring lunch.
September 24-26: Sea Grant Professional Development Conference in Port
Aransas - Cummins joined the other Coastal & Marine Resource Agents, Sea
Grant Specialists, Director, Extension Leader, and others for a series of meetings necessary to help align the
Texas strategic plan for 2013-2017 with the National Sea Grant plan issued from Washington,
Direct Contacts:
Office: IS
E-mail/Letters: 763
Newsletters: 861
Website: 0
Volunteers: 64
Site: 76
Phone: 71
Maior events for next month - October 2012
October 2: Seagreen's 7'h annual Neighbor's Night Out
October 9: Mariner 4-H meeting
October 15-20: Calhoun County Fair
October 16-18: Gulf States Marine Fisheries Commission Meeting
October 20: 75th Anniversary of the Aransas National Wildlife Refuge
Rhonda Cummins
Name
Calhoun
County
CEA - CMR
Title
September 2012
Date (Month-Year)
Texas A&M AgriLife Extension' The Texas A&M University System. College Station, Texas
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*
PRE-APPROVE EXPENDITURES BY INCUMBENT COUNTY OR PRECINCT OFFICER(S) UNDER
COUNTY'S POLICY OF COMPLIANCE WITH LGC 130.908:
Estimated expenditures were presented by Calhoun County Adult Detention Center and Calhoun County Sheriff's
Office and after reading and verifying same a Motion was made by Commissioner Finster and seconded by
Commissioner Lyssy to pre-approve the expenditures,
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor,
Calhoun County Adult Detention Center
Bills to be approved on
October 25, 2012
Vendor Description Amount
Hill Country Dairies Groceries 688,75
Aliied Waste Jail Utiiities 630,24
Port Lavaca Family Dentistry Inmate Medical 1045,00
Golden Eagle Law Enforcement Systems Software 2500,00
Ben Keith Co Groceries 6847.49
Ben Keith Co Mise Supplies 49,22
Calhoun County Health Department Physicals 60,00
Gulf Coast Paper Inmate Suppiies 380,73
Gulf Coast Paper Jail Maintenance 337.40
Gulf Coast Paper Mise Supplies 344,85
Moore Medical Infirmary Supplies 500,00
Hall Wireless Capital Outlay 100,00
Ricoh Copier Rentals 335,00
ICS Jail Supplies Ine, Inmate Suppiies 700,00
FedEx Postage 185,28
Quill Office Supplies 335,66
Quill Mise Suppiies 34,74
Skyline Equipment Jail Maintenance 753,71
SDG Systems Mise Service 800,00
Dewitt Poth & Sons Office Suppiies 250,00
Dewitt Poth & Sons Mise Suppiies 250,00
Codex Mise Service 1556,36
Codex Mise Suppiies 295,85
Bob Barker Inmate Supplies 1100,00
Matera Paper Company Ine, Inmate Suppiies 661,14
Calhoun County Adult Detention Center
Bills to be approved on
October 25, 2012
Matera Paper Company Inc, Mlsc Supplies
Gulf Coast Hardware Mlsc Supplies
David B. Hensley Physicals
Golden Crescent Communications Misc Service
Pitney Bowes Postage
Total
638,86
100,00
300,00
50,00
130,50
21960,78
Calhoun County Sheriffs Office
Biils to be approved on
October 25, 2012
Vendor Description Amount
Cintas Mise Supplies 71,00
Nextei Sprint Telephone Services 2124,95
Golden Eagle Law Enforcement ~ Software 2500,00
Coastai Medicai Clinic Physicals 200,00
Keep-U-Neat Cleaners Uniforms 124,00
G,T, Distributors Uniforms 1237,26
G,T, Distributors Law Enforcement Supplies 100,00
CDW-G Capital Outlay 107,26
Aqua Beverage Company Mise Supplies 100,00
Detar HealthCare System Emergency Medicai Service 1251,96
CDWG Capital Outlay 125,00
Cintas Mise Supplies 106,50
Pitney Bowes Postage 130,50
Exxon Fuel 10000.00
Sheil Fuel 10000,00
Totai 28178.43
BILLS:
Claims for Memorial Medical Center Operating Fund totaling $1,388,410.70 and for Indigent Healthcare totaling
$49,318,26 for a total amount of $1,437,728,96 were presented by Memorial Medical Center and after reading
and verifying same a Motion was made by Commissioner Fritsch and seconded by Commissioner Lyssy to
approve the bills and that all said claims are approved for payment,
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
Claims totaling $1,186,037.65 were presented by the Calhoun County Treasure's Office and after reading and
verifying same a motion was made by Commissioner Fritsch and seconded by Commissioner Lyssy to approve
the bills and that all said claims are approved for payment.
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
Claims totaling $22,461.46 were presented by the Calhoun County Sheriff's Office and after reading and
verifying same a motion was made by Commissioner Fritsch and seconded by Commissioner Lyssy to approve
the bills and that all said claims are approved for payment.
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor,
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR mn October 25. 2012
MEMORIAL MEDICAL CENTER OPERATING FUND
MEMORIAL MEDICAL CENTER WEEKLY CHECKS
Date Approved bv County Auditor (See attached lists)
9/13/2012 Weekly Payables
9/13/2012 Patient Refunds
9/20/2012 Weekly Payables
9/20/2012 Weekly Payables
9/27/2012 Weekly Payables
9/27/2012 Patient Refunds
10/4/2012 Weekly Payables
Total Payables and Patient Refunds
$ 236,973,34
2,968.40
192,005,82
58,198,00
161,674,82
2,289,14
145,843,59
$ 799,953.11
MEMORIAL MEDICAL CENTER PAYROLL
Date of Pavroll Run & Date Liabilitv Called In (See attached lists)
9/11/2012 Net Payroll
9/18/2012 Payroll Liabilities
9/25/2012 Net Payroll
9/26/2012 Net Payroll
10/2/2012 Payroll Liabilities
Total Net Payroll and Payroll liabilities
216,583,18
71,925,56
225,617.46
548,75
73,782,64
$ 588,457.59
GRAND TOTAL OPERATING FUND
$ 1.388,410.70
APPROVED INDIGENT HEALTHCARE FUND EXPENSES
$ 49,318.26
IGRAND TOTAL BiLLS APPROVED 10/25/2012
$ 1,437.728.961
APPROVED
OCT 2 5 2012
CALHOUN COUNTY
COMMISSIONERS COURT
MEMORIAL MEDICAL CENTER
COMMISSIONERS COURT APPROVAL LIST FOR .... October 25.2012
INDIGENT HEAL THCARE FUND:
INDIGENT EXPENSES
Coastal Medical Clinic
Raymond p, Dickey 0,0,
HEB Pharmacy
Laboratory Corporation of America
Memorial Medical Center (In-patient $12,501.30 Out-patient $13,776,62 ER $13,416.48)
Memorial Womens' Center
Port Lavaca Clinic
Radiology Unlimited PA
1,285,63
85,00
605,50
24,11
39,694.40
54.41
1,413,53
372.35
SUBTOTAL
43,534.93
Memorial Medical Center (Indigent Healthcare Payroll and Expenses)
5,783,33
TOTAL APPROVED INDIGENT HEAL THCARE FUND EXPENSES
49,318.26
**$400.00 in Co.Pays were collected by Memorial Medical Center in September
@IHS
Source Totals Report
Issued 10/11/2012
Source Description
Calhoun Indigent Health Care
09-01-2012 through 09-30-2012
For Vendor: All Vendors
Amount Billed
Amount Paid
01 Physician Services
02 Prescription Drugs
05 Lab/x-ray
08 Rural Health Clinics
13 Mmc - Inpatient Hospital
14 Mmc - Hospital Outpatient
15 Mmc - Er Bills
5,218,00
605,50
80.00
2,826,31
17,859.00
31,180.00
30,492.00
Expenditures
Reimb/Adjustments
88,285.24
-24.43
Grand Total
88,260.81
1,250.43
605,50
24.11
1,960.49
12,501.30
13,776.62
13,416.48
43,559.36
-24.43
43,534.93
Fiscal Year 382,336.47
APPROVED
BY
OCT 1 B 2012
CALHOUN COUNTY
AUDITOR
Payroll/Expenses 5,783.33
-
'1'\M'VW-(v'~Uvt~
Calhoun County Indigent Coordinator
800 10222012 01 CALHOUN COUNTY, TEXAS
DATE:
10/22/2012
CC Indigent Health Care
VENDOR # 852
ACCOUNT
NUMBER DESCRIPTION OF GOODS OR SERVICES
1000-800-98722-999 Transfer to pay bills for Indi ent
approved b Commissioners Court on
for a total of $49,318.26
1000-001-46010
COUNTY AUDITOR
APPROVAL ONLY
APPROVED
BY
OCT 2 2 2012
CALHOUN COUNTY
AUDITOR
UNIT
PRIC
QUANTITY
Health Care
10/25/2012
Se tember Interest$O.OO
THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE
OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY
THIS OBLIGATION,
DEPARTMENT HEAD DATE
I CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME
IN GOOD CONDITION AND REQUEST THE COUNTY TREASURER TO PAY
THE ABOVE OBLIGATION,
10/22/12
DATE
BY:
DEP
TOTAL
PRICE
$49,318.26
$0.00
$49,318,26
2011 Calhoun Indigent Care Patient Case load
Approved Denied Removed Active Pending
Jan 7 22 10 152
Feb 9 13 17 156
Mar 32 33 26 153
Apr 8 19 28 164
May 6 19 16 149
Jun 25 21 23 146
Jul 1 19 5 140
Aug 1 13 39 108 2
Sept 2 43 32 79 11
Oct 8 15 27 62 16
Nov 7 8 21 47 15
Dee 1 24 27 30 14
YTD 107 249 271 1386 58
12 Mo Avg 9 21 23 116 5
2012 Calhoun Indigent Care Patient Caseload
Approved Denied Removed Active Pending
Jan 4 10 2 37 9
Feb 1 17 2 36 11
Mar 4 16 3 38 20
Apr 1 15 3 39 21
May 3 11 3 40 17
Jun 10 12 5 46 15
Jul 6 15 5 48 22
Aug 10 21 1 59 20
Sept 5 17 4 59 19
Oct
Nov
Dee
YTD 44 134 28 402 154
Monthly Avg 5 15 3 45 17
RUN DATE: 10/04/12
TIME: 1l:26
MEMORIAL M8DICAL CEllTER
RECEIPTS FRDl4 09/01/12 TO 09/30/12
PAGE 97
RCMREP
50240,00009/04/12 10,00 10.00 AIK 2
50240,00009/04/12 10,00 10,00 AIK 2
50240,00009/04/12 10,00 10,00 AIK 2
50240,00009/04/12 10,00 10,00 AIK 2
50240,00009/05/12 10,00 10,00 AIK 2
50240,00009/07/12 10,00 10,00 AIK 2
50240,00009/10/12 10,00 10,00 AYK 2
50240,000 09/10/12 10,00 10,00 AYK 2
50240,000 09/11/12 10,00 10,00 AYK 2
50240,00009/12/12 10,00 10,00 KRR 2
50240,00009/12/12 10,00 10,00 AYK 2
50240,00009/12/12 10,00 10,00 AIK 2
50240,00009/13/12 10,00 10,00 KRR 2
50240,00009/13/12 10,00 10,00 KRR 2
50240,00009/13/12 10,00 10,00 AIK 2
50240,000 09/13/12 10,00- 10,00- AYK 2
50240,000 09/13/12 10,00 10,00 AIK 2
50240,00009/14/12 10,00 10,00 AIK 2
50240,00009/17/12 10,00 10,00 IllH 2
50240,00009/17/12 10,00 10,00 AIK 2
50240,00009/18/12 10,00 10,00 AIK 2
50240,00009/19/12 10,00 10,00 AYK 2
50240,00009/19/12 10,00 10,00 AIK 2
50240,00009/20/12 10,00 10,00 JHB 2
50240,00009/20/12 10,00 10,00 AIK 2
50240,00009/20/12 10,00 10,00 AYK 2
50240,00009/21/12 10,00 10,00 AYK 2
50240,00009/21/12 10,00 10,00 AYK 2
50240,000 09/21/12 10,00 10,00 AYK 2
50240,00009/24/12 10.00 10,00 IllH 2
50240,00009/24/12 10,00 10,00 AIK 2
RlJN DATE: 10/04/12
THIS: 11:26
MEMORIAL HEDICAL C8lITER
RECEIPTS FROM 09/01/12 TO 09/30/12
G/L
NUMBER
CASH
AMOIRII
RECEIPT PAY
DATE NUMSER TYPE PAYSR
50240,000 09/25/12
50240,000 09/25/12
50240,00009/26/12
50240,00009/26/12
50240,00009/26/12
50240,00009/27/12
50240,00009/27/12
50240,00009/27/12
50240,000 09/26/12
50240,00009/2S/12
50240,00009/26/12
10,00
10,00
10,00
10,00
10.00
10,00
10,00
10,00
10,00
10,00
10,00
'*wrAL" 5024UOO COUNTY IlIDJ08lIT roPAYS
PAGE 96
RCMREP
RECEIPT
AMOUNT NUMBES NAME
10,00
10,00
10,00
10,00
10,00
10,00
10,00
10,00
10,00
10,00
10,00
400,00
DISC roLL GL CASH
'DATE INIT CODE ACCOUNT
IllH 2
AYK 2
AYK 2
KRR 2
AYK 2
AYK 2
KRR 2
AYK 2
IllH 2
IlRF 2
AYK 2
MEMORIAL MEDICAL CENTER
Port Lavaca, Texas
MANUAL JOURNAL ENTRIES
MONTH OF
SEPTEMBER, 2012
Page_of_
Debit Credit
Acct# JE# Descriotion Check # Amount Amount
10255000 Indigent Healthcare 5,783,33
40450074 Reimbursement - Caihoun Ctv 4,427,99
40015074 Benefits - FICA 216.49
40025074 Benefits - FUT A -
40040074 Benefits - Retirement 241,68
60320000 Benefits - Insurance 797,04
40220074 Suppiies - General -
40225074 Supplies - Office 100,13
40230074 Forms -
40610074 Continuing Education -
40510074 Outside Services -
40215074 Freight -
40600074 Miscellaneous -
,~v
BY
, Ul; I i IJ ZUll
CALHOUN COUNT\'
AUDllul1 ..
TOTALS 5,783,33 5,783,33
J
.j
/
j
EXPLANATION FOR ENTRY
REVERSING:
YES
NO
JE#
RUN DATE: 09/12/12
TUIE: 15.39
MEI,IORIAL I1EDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 09/25/12
PAGE. 1
APOPEN
VEND#.NAME...".....,..,...,...,...,.CLS.INVOICE#".......TRN DT.INV DT.DUE DT.CK DT..PC....,..GROSS..,..DISC...,..NO-PAY.......,NET
A1715 ALCO SALES & SERVICE CO
SUPPLIES HOUSEKEEPING [o! 2468693-IN 091012 090412 092412 39.74 .00 39.14'/
TOTALS...."........."".........."",..... . 39.74 .00 39.74
A1645 ALCON LABORATORIES INC
LENS KITS l~ 13964725 082712 082112 092012 1564,50 .00 1564.50 ,/
TOTALS.,..,........,..............,.,....,.., : 1564.50 .00 1564,50
A1360 AMERISOURCEBERGEN DRUG COR 932.63/
PIlAlUlACEUTICALS w 704681308 090412 090412 092512 932.63 .00
PIlAlUlACEUTICALS 704765220 091112 090612 092512 24.26 .00 24. 26 ./
TOTALS..",.....,.."...."...,....".,..,.., : 956.89 .00 956,89
A0777 ANDERSON CONSULTATION SERV
COLLECTIONS PFS W 1033 082412 082012 091912 2702.39 .00 2702,39 ,/
TOTALS...,.,.,....,.......,........,........, : 2702.39 ,00 2702,39
BI075 BAXTER HEALTHCARE CORP
SUPPLIES CS INV II 38143739 083112 082312 092212 288,53 .00 288,53 ./
PHAIU~CEUTICALS 38111141 090512 082012 091912 305.54 ,00 305,54./
TOTALS.,..,.................,..............., : 594.07 ,00 594,07
B1220 BECKllAN COULTER INC
SUPPLIES LAB II 103059113 083112 082112 092012 139,42 ,00 139.42 ./
SUPPLIES LAB 103060525 083112 082112 092012 87.60 ,00 87.60'/
TOTALS...,.........,..,.,.,................., : 227.02 ,00 227,02
B1655 BOSTON SCIENTIFIC CORPORAT 454.00/
SUPPLIES SURGERY II 933654213 082712 082012 091912 454.00 .00
TOTALS.....,.,..,..............,............, : 454.00 .00 454.00
Cl030 CAL COli FEDERAL CREDIT UNI 25.00/
EMPLOYEE DEDUCTIOM W 18246 091112 091112 091112 25.00 .00
TOTALS...............".........,............ : 25.00 ,00 25.00
C1203 CALHOUN COOOY I1ASTE HGI~T
I1ASTE PICKUP 326891 083112 090412 090412 10.00 ,00 10,00/
TOTALS.".......,:...".....,.,..........,.,. . 10.00 ,00 10,00
C1390 CENTRAL DRUGS 514.50/
PHARllACEUTICALS 11 JUNE 2012 091112 063012 071512 514.50 .00
TOTALS..".............."........,.....,.." . 514.50 .00 514.50
10350 CElITURION llEDICAL PRODUCTS
SUPPLIES VARIOUS 919091123 082412 082012 091912 231. 72 .00 231. 72 ./
SUPPLIES CS INV 91092214 082912 082112 092012 59.79 .00 59.79./
SUPPLIES CS INV 91095152 083112 082412 092312 467.50 .00 467.50/
TOTALS......,..,.....,................ ,.,....: 759.01 .00 759.01
C1410 CERTIFIED LABORATORIES
SUPPLIES DIETARY II 827553 091012 082112 083112 394. 78 .00 394.78 ,/
RUN DATE: 09/12/12
TUIE: 15:39
lmMORIAL MEDICAL CENTER
AP OPEM IMVOICE LIST THRU DUE DATE OF 09/25/12
PAGE: 2
APOPEN
VENDff.MAME.........,........".......CLS.IMVOICEff.........TAN DT.IMV DT.DUE DT,CK DT..PC..."..GROSS....,DISC......NO-PAY"......NET
TOTALS.."........,...,.....,.........,..,.., : 391. 78 .00 394,78
10720 CHRIS RAMIREZ, JR,
CONTINUING ED ICU 12043 082912 082312 092212 150.00 .00 150.00 ./
TOTALS....."...............,................ : 150.00 .00 150.00
C2510 CPSI
STATEMENT PROCESSING II 746075 091012 082312 082312 33.60 .00 33.60/
EBOS 746710 091012 082412 082412 331.34 .00 331.34./
TOTALS.".................................... : 364.94 ,00 364.94
10284 CYTO THEml L.P. 199.54/
SUPPLIES LAB 283155 083112 082312 092212 199.54 .00
TOTALS.........,..,................,........, : 199.54 .00 199.54
10562 DENISE CHANEY 556.06 .-/
TRAVEL EXPENSES PHAIU1ACY 24102 083112 083112 083112 556.06 ,00
TOTALS............,........................,. : 556.06 .00 556,06
10368 DE;ITTT POTH & SON
OFFICE SUPPLIES PFS 342699-0 Q91012 090512 091512 18.00 .00 18,00/
OFFICE SUPPLIES AlP 339253-0 091112 080112 081512 12,58 .00 12.58'/
TOTALS...................,....,.."...,...., ,: 30.58 .00 30.58
D1530 DIEBEL OIL CO INC 351.22/
FUEL W AUGUST 2012 091212 083112 091012 351.22 .00
TOTALS....,.,..,.....................,....... : 351.22 .00 351,22
F1300 FIRESTONE OF PORT LAVACA
REPAIR TRANSPORTATION \'l 0011553 082112 082112 092012 122.05 .00 122.05./
TOTALS.,.,.....,..,..."...,..............,.. : 122.05 .00 122.05
F1400 FISHER HEALTHCARE
SUPPLIES LAB 11 1064778 082912 082112 092012 1192.12 .00 1192,12/
SUPPLIES LAB 13474779 082912 082112 092012 72.09 ,00 72,09/
SUPPLIES LAB 1564858 082912 082312 092212 915,59 .00 915,59/
SUPPLIES CREDIT LAB 1702315 083112 082412 092312 -95,48 .00 -95.48./
TOTALS......,.................,..",.,..,.,.. : 2084.32 .00 2084.32
10642 GLAXOSMITHKLlNE PHARMACUET
PHARMACEUTICALS 30698700 082412 081312 092512 1868.41 .00 1868.41'/
PJIAlU1ACEUTICALS 30700601 082412 081312 092512 1188.21 .00 1188.21-:/
PHARMACEUTICALS 30705625 082412 081512 092512 1462.23 .00 1462.23
PHARMACEUTICALS 30722620 083112 082212 092212 1782.31 .00 1782.31/
TOTALS.........,..,.."..................... .1 6301.16 .00 6301.16
l'l1300 GRAINGER )
SUPPLIES PLANT OPS M 9906545042 082412 082012 091912 36.01 .00 36.01/
DEPT REPAIR DIETARY 9911215052 083112 082412 092312 53.47 .00 53.47
TOTALS.,..,.................................. : 89.48 .00 89.48
A1292 GULF COAST HARDWARE I ACE
SUPPLIES BIOIIED W 069522 083112 061412 071312 128.97 .00 128.97/
RUN DATE: 09/12/12
TIloIE: 15.39
MEMORIAL MEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 09/25/12
PAGE: 3
APOPEN
VEND#.NAlIE.............."...........CLS.INVOICE#...,..,..TRN DT,INV DT,DUE DT.CK DT,.PC".,...GROSS"."DISC",...NO-PAY.."....NET
DEPT REPAIR PFS 070786 083112 082012 091912 1. 79 .00 1.79 /
SUPPLIES PLANT OPS 070845 083112 082212 092112 14,99 .00 14.99./
DEPT REPAIR WOMEN CLINIC 070872 083112 082312 092212 25.97 .00 25.97./
TOTALS......"."........"..,............,., : 171. 72 .00 171.72
H0030 H E BUTT GROCERY
SUPPLIES DIETARY I! 302516 083112 080212 090112 247.68 ,00 247.68,./'
SUPPLIES DIETARY 304424 083112 080312 090212 49.98 ,00 49.98/
SUPPLIES DIETARY 313207 083112 080912 090812 27.31 ,00 27.31 /
SUPPLIES DIETARY 313464 083112 080912 090812 205.16 .00 205,16/
SUPPLIES DIETARY 315288 083112 081012 090912 11.81 .00 11.84./
SALES TAX CREDIT 320232 083112 081312 091212 -.66 .00 -,66/
SALES TAX CREDIT 320235 083112 081312 091212 -.81 .00 -.81./
SUPPLIES DIETARY 320216 083112 081312 091212 6.96 .00 6.96./
SUPPLIES DIETARY 323081 083112 081512 091412 161.71 .00 161. 71/
SUPPLIES DIETARY 326037 083112 081712 091612 15.48 .00 15.48"'/
SUPPLIES DIETARY 332283 083112 082112 092012 14.69 .00 14.69 ..-/
SUPPLIES DIETARY 335111 083112 082312 092212 209.99 .00 209.99 ..--/
TOTALS.........,............ I................: 949.33 .00 949.33
HII00 HAYES ELECTRIC SERVICE
SUPPLIES PLANT OPS W A2120822-09 082912 082212 092112 13.50 .00 13.50 ./
TOTALS... ,.......: ............,.,............1 13.50 .00 13,50
10334 HEALTH CARE LOGISTICS INC ..J
SUPPLIES MED SURG 4535663 082712 082012 091912 15.08 ,00 15.08
TOTALS............,.......................... . 15.08 .00 15.08
10298 HITACHI llEDICAL SYSTEIIS 9166.67 ./
SRV CONTRACT 9/25-10/24 PJIN0042237 082412 081512 092512 9166.67 .00
TOTALS,.......................,........".... . 9166.67 .00 9166.67
10415 INDEPENDENCE MEDICAL 23.91"/
SUPPLIES CS INV 27086099 082912 082212 092112 23.91 .00
TOTALS..."..........,.............",......, : 23,91 .00 23.91
J0150 J & J HEALTH CARE SYSTEMS, 190,46 /
SUPPLIES ER 908467398 083112 082312 092212 190.46 .00
SUPPLIES SURGERY CREDIT 500664683 091012 090612 091512 -95.03 ,00 -95.03-::/
SUPPLIES SURGERY 908439257 991012 082012 091912 216.53 ,00 216,53
TOTALS......,...........,............,....... : 311.96 .00 311.96
C2698 JACKSON CROSS
DEPT REPAIR PLANT OPS 24081 082712 082512 092412 900.00 ,00 900.00/
TOTALS.....................,................ .: 900.00 .00 900.00
10771 leA BANK CORPORATION ,/
DOlffl PAYlIENT 24106 091212 091112 091112 4096.00 .00 4096.00
TOTALS.........., ,...........................: 4096.00 .00 4096.00
J1350 M.C. JOHNSON COMPANY INC /
SUPPLIES CS INV I! 00237959 082912 082112 092012 102.74 ,00 102.74
RUN DA~E, 09/12/12
~IME: 15.39
llEMORIAL MEDICAL CENTER
AP OPEM IMVOICE LIS~ THRU DUE DATE OF 09/25/12
PAGE' 4
APOPEM
VEND#.NAlIE.."............,....,., ,. ,CLS.IMVOICE#........ .TRN DT.IMV D'I.DUE D'I.CK DT..PC...... ,GROSS.... .DISC.... ..NO-PAY,...... .NE~
TO'l'ALS. to.. II........ ,..0..... ...............: 102.74 .00 102.74
M1500 MARKS PLUMBING PARTS
DEPT REPAIR ER M 1146191 082412 082012 091912 135.58 ,00 135.58/
SUPPLIES PLANT OPS 1146677 083112 082112 092012 47.84 .00 47,84/
SUPPLIES PLANT OPS 1147145 883112 082312 092212 46.20 .00 46.20-
TOTALS......,..,.............. .............', I 229.62 .00 229.62
M2590 MERCURY MEDICAL
SUPPLIES CS IMV M 554862 082912 082212 092112 181.46 .00 181.46 -
TOTALS................,..........,........... . 181.46 .00 181.46
H2659 MERRY X-RAY- SAN ANTONIO
SUPPLIES CT SCAN H 476928 082712 082312 092212 358.66 .00 358.66 ----
TOTALS...................................... .1 358.66 .00 358.66
10441 IIMC EHPLOYEE BENEFI~S
WEEKLY CLAIHS 18245 091012 090712 090712 1631. 02 .00 1631. 02 ,/
WEEKLY CLAIMS 18250 091212 091212 091212 13356.19 .00 13356,19 ....-
~OTALS............,.............,............ . 14987.21 .00 14987,21
10536 HORRIS & DICKSON CO, LLC
PHARMACEUTICALS 3765924 091012 090412 092512 7629.35 .00 7629.35/
PHARMACEUTICALS 3765925 091012 090412 092512 2854.84 .00 2854.8P'
PHARMACEUTICALS 3770279 091012 090512 092512 3741.97 .00 3741.97/
PHARMACEU~ICALS 3770281 091012 090512 092512 4824.36 .00 4824.36'"
PHARMACEU~ICALS 3775355 091012 090612 092512 3657.64 .00 3657.64/
PHARl4ACEUTICALS 3776233 091012 090612 092512 18.94 .00 18.94
SHIPPING CHARGES 0060 091112 090612 092512 1800.00 .00 1000.00'/
PHARMACEUTICAL CREDIT 0273 091112 091012 092512 -3.01 .00 -3.01,/
PHARMACEUTICAL 3785538 091112 091012 092512 7.05 .00 7.05/
PHARMACEUTICAL 3785539 091112 091012 092512 3379.27 .00 3379.27/
PHARMACEUTICAL CREDIT Cl440075 091112 091012 092512 -22.94 .00 -22.94/
PHARl4ACEUTICAL CREDIT CH40076 091112 091012 092512 -255.35 .00 -255.35 ,/
TOTALS. ......................... .............1 26832 .12 .00 26832.12
A2252 NADINE GARNER ./
TRAVEL EXPENSES W 24104 091012 090712 090712 32.19 .00 32.19
lJ.'01'AL8........................,.............. : 32.19 ,00 32,19
10709 ONESTAFF HEDICAL, LLC 2088.00 /
CONTRAC~ NURSE 6060 082712 082212 092112 2088.00 .00
TOTALS....................................... : 2088.00 .00 2088,00
01660 ORIENTAL TRADING CO INC 79.50/
SUPPLIES PACU M 652611587-01 082912 082212 092112 79.50 .00
F",,( Peel', "(>.+:"",-\-5 ~OTALS................... .............,.,...,: 79.50 .00 79.50
OH425 OWENS & MINOR 97.42 /
SUPPLIES VARIOUS 1977298 082412 082112 092012 97.42 .00
SUPPLIES ER 1977317 082412 082112 092012 214.42 .00 214.42 ./
RUN DATE: 09/12/12
TIllE: 15:39
MEMORIAL MEDICAL CENTER
AP OPEM INVOICE LIST THRU DUE DATE OF 09/25/12
PAGE: 5
APOPEN
VEND#.NAlm".........."",...."....CLS.INVOICE#.........TRN DT.INV DT.DUE DT.CK DT..PC,....,.GROSS.,.,.DISC......NO-PAY........NET
SUPPLIES SURGERY 1977322 OS2412 082112 092012 95,54 ,00 95.54;/
SUPPLIES CS INV 1977353 082412 082112 092012 36.33 .00 36.33
SUPPLIES VARIOUS 1977537 082412 082112 092012 487.51 .00 4S7.51 .....-
SUPPLIES VARIOUS 1977934 082712 082212 092112 20S6.66 .00 2086.66/
SUPPLIES DIETARY 1978437 082712 092312 092212 3.45 .00 3.45/
SUPPLIES CS INV 1978477 082712 082312 092212 4.16 .00 4.16/
SUPPLIES CS INV 1978532 082712 082312 092212 4.16 .00 4.16_
SUPPLIES VARIOUS 1978799 OS2712 082312 092212 1714.85 .00 1714,S5/
SUPPLIES SURGERY 1978770 083112 082312 092212 1109.73 .00 1109,73 /
SUPPLIES VARIOUS 1975432 091012 081612 091512 138.S8 .00 138,S8 .....-
TOTALS.....,................................. : 5993.11 .00 5993.11
PII00 PC CONNECTION SALES CORP 572.49 ./
SUPPLIES IT M 493551S7 091112 081412 091412 572.49 .00
TOTALS....................................... : 572.49 .00 572.49
10032 PHILIPS HEALTHCARE
SUPPLIES PACU 924692590 082912 082212 092112 79.S0 .00 79,SO ...-->
TOTALS.............. I.... to............ ......: 79.S0 .00 79,80
P1600 PHYSIO CONTROL CORPORATION /'
SUPPLIES CS INV M 113017809 083112 062712 072612 88.S0 .00 SUO
TOTALS,."........,.........,..........",.,. : 88.S0 ,00 S8,80
P2200 POimR ELECTRIC
DEPT REPAIR PLAlIT OPS W 160202 082912 082112 092012 16.35 ,00 16.35/
TOTALS........",.,..................,....... : 16.35 ,00 16.35
P2370 PROGRESSIVE DYNAlIICS 11EDIC 66,26 /
SUPPLIES SURGERY M 129607 OS2912 082212 092112 66,26 .00
TOTALS...................,.,.,............... : 66,26 .00 66,26
R1268 RADIOLOGY UNLIMITED, PA 1510.00/
READING FEES W 24107 091212 062812 072812 1510.00 .00
TOTALS".,...................,......,........ : 1510.00 .00 1510.00
10520 RICOH USA, INC. 7984.40:/
COPIER RENTAL II 87335555 091112 071112 080512 7984.40 .00
COPIER RENTAL 87506592 091112 091012 090512 4870.00 .00 4870.00
TOTALS..............",.......,.......,....,. : 12854.40 .00 12854.40
10602 SERVICE ORGANIZATION 69127.70 )
JULY 2012 COLLECTIONS 24103 083112 083112 083112 69127.70 .00
TOTALS.......".......,...................... : 69127.70 .00 69127.70
S1405 SERVICE SUPPLY OF VICTORIA 4.47 '/
SUPPLIES PLAlIT OPS W 700632669 091112 090612 090312 4.47 .00
SUPPLIES PLAlIT OPS 700632994 091112 080612 090512 41.20 .00 41. 20
TOTALS....................................... : 45.67 .00 45,67
S1800 SHERWIN WILLIAlIS
DEPT REPAIR RADIOLOGY II 0485-3 082912 082012 091912 20.89 .00 20.89/
RUN DATE: 09/12/12
TIME: 15:39
IIEMORIAL I1EDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 09125/12
PAGE: 6
APOPEN
VEND#.NAlIE........,..".",.........,CLS,INVOICE#,......,.TRN DT.INV DT.DUE DT.CK DT..PC,..,...GROSS,....DISC,.,...NO-PAY..,..."NET
DEPT REPAIR PFS
DEPT REPAIR PFS
DEPT REPAIR PFS
DEPT REPAIR ADMIN
D0350 SIE!1ENS HEALTHCARE DIAGNOS
SUPPLIES I INV LAB M
10699 SIGN AD, LTD.
ADVERTISING SEPT
S2270 S1IILE 11AKERS
SUPPLIES LAB
S2830 STRYKER SALES CORP
SUPPLIES SURGERY
S2950 BYSCO FOOD SERVICES OF HOU
SUPPLIES DIETARY II
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
10239 T&R MECHANICAL
ANNUAL INSPECTION
T0500 TEAll REHAB
INTERIM BILLING
10758 TEXAS SELECT STAFFING, LLC
CONTRACT NURSE
CONTRACT NURSE
T2303 TG
E!IPLOYEE DEDUCTION
S2679 THE ST JOHN COIIPANIES, INC
SUPPLIES CS INV N
T0801 TLC STAFFING
CONTRACT NURSE
0487-9 082912 082012 091912
0070-3 083112 081012 090912
0577-7 083112 082212 092112
0698-1 083112 082512 092412
TOTALS,.,.....,...................,..,....... :
971330474 083112 082312 092212
TOTALS.",...,.,.:",...,..,....,....,....... :
158218 091012 090112 091012
TOTALS,..............,..........,............ :
10I
6602235
091112 080812 090712
TOTALS. t.... to...............................1
M
208487A 082912 082112 092012
TOTALS....."........................,...... .:
205252738 083112 052512 061512
206142684 083112 061412 070412
208090859 983112 080912 090712
208160538 083112 081612 090512
208230808 083112 082312 091212
208301026 083112 083012 091912
TOTALS......,...........................,.... :
B12-0321
082412 082012 091912
TOTALS............,.....................,.... :
il 24105 091112 091012 091012
TOTALS,...........,.....,.,.............,.... :
0002468-51-079-1 091112 080212 080212
0002512-51-079 091112 081612 081612
TOTALS...."......,....."...........,....... :
if 18249 091112 091112 091112
TOTALS,.................... .........,........,
07947662 083112 082412 092312
TOTALS.....................,................. :
il 10521
082712 082112 092012
33.03
25.55
36.44
38.62
154.53
6329.85
6329.85
350.00
350.00
71.89
71.89
325.00
325.00
35,00
154.66
649.47
701. 70
963.95
1085.03
3589.81
6290.00
6290.00
12643.59
12643.59
2025.65
1995.40
4021.05
130.19
130.49
410.00
410,00
2216.54
.00 33,03/
.00 25,55/
.00 36.44-
.00 38.62-
.00 154.53
.00 6329.85 ./
.00 6329,85
.00 350.00 /"
.00 350.00
,00 71. 89 ./
,00 71.89
.00 325,00/
.00 325.00
,00 35.00/
.00 154.66/
,00 649.47/
,00 701. 70 .-/
,00 963.95/
.00 1085.03/
,00 3589,81
.00 6290.00 /
,00 6290.00
.00 12643.59 ../
,00 12643.59
,00 ./
2025.65/
,00 1995,40
.00 4021.05
,00 130,49/
.00 130,49
.00 410.00/
.00 410.00
.00 2216.54/
RUN DATE: 09/12/12
TIME' 15,39
MEMORIAL MEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 09/25/12
PAGE, 7
APOPEN
VEND#.~,m..........,."...........,.CLS.INVOlCE#.,....,..TAN DT.INV DT.DUE DT,CK DT..PC.......GROSS.....DISC...,..NO-PAY........NET
T3130 TRI-ANIM HEALTH SERVICES I
SUPPLIES PACU M
SUPPLIES CARDIO
U1054 UNIFIRST HOLDINGS
LAUNDRY MAINTENANCE
LAUNDRY MAINTENANCE
U1064 UNIFIRST HOLDINGS INC
LAUNDRY HOUSEKEEPING
LAUNDRY PLAZA
LAUNDRY DIETARY
LAUNDRY OB
LAUNDRY HOUSEKEEPING
LAUNDRY HOSPITAL LINEN
LAUNDRY HOSPITAL LINEN
10172 US FOOD SERVICE
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
SUPPLIES DIETARY
V0552 VERATHON INC
SUPPLIES MEDSURG
TOTALS....................................... :
60809696 082712 082212 092112
60723337 091112 053112 063012
TOTALS..........................,............ :
W 8150581247 982112 082112 092012
8150580472 091012 081412 091312
TOTALS.,..,.............,...........,..,..... :
8400131212 082112 082112 092012
8400131213 082112 082112 092012
8400131214 082112 082112 092012
8400131215 082112 082112 092012
8400131216 082112 082112 092012
8400131264 082112 082112 092012
8400131445 082912 082412 092312
TOTALS....................................... ,
4877668
5001481
5079203
5102347
5124320
5154718
5154721
5254440
5254442
5377884
5356744
083112 021812 031712
083112 080912 083112
083112 081412 090312
083112 081412 091312
083112 081612 081412
083112 081712 090612
083112 081712 090612
083112 082312 091412
083112 082312 091312
083112 083012 091912
091012 082812 091712
TOTALS...................................... II
379672 082912 082312 092212
TOTALS...............................,....... ,
V0555 VERIZON SOUTHWEST
TELEPHONE 08/28 - 09/27 M 5520220082812 091012 082812 092212
10472 VISA
MISCELLANEOUS
10767 VNC SIGNS, INC
SUPPLIES PLANT OPS
TOTALS............. II ....... It to..........,..1
JULY2012 091212 081812 091912
TOTALS....................,.....,.........,.. ,
65662 083112 082412 092312
TOTALS....................................... :
10394 IjILLIAM E HElKAMP, TRUSTEE
EMPLOYEE DEDUCTION 18247
091112 091112 091112
2216.54
30.78
235.66
266.44
32.54
32.54
65.08
182.19
157.18
174.86
86.70
189.92
731. 68
697.36
2219.89
108.50
3562.34
141.30
60.42
3527.90
98.21
61.49
2963.41
275.89
3985.12
140.64
14925.22
34.16
34,16
106.28
106.28
11493.00
11493.00
1050.00
1050.00
400.00
.00 2216.54
.00 30.78 ..--
.00 235.66 ./
.00 266.44
.00 32.54..-
.00 32.54 ...-
.00 65.08
.00 182,19/
.00 157.18 ....--
,00 174,86 ...--
.00 86.70 ....--
,00 189.92 ,/
.00 731.68/
.00 697.36/
.00 2219.89
.00 108.50 ,-/
.00 3562.34....-
.00 141.30 ./
.00 60.42...-'
.00 3527.90/
.00 98.21---
.00 61.49./
.00 2963.41..--'
.00 275.89.-'
.00 3985.12 ...-
.00 140.64 ./'
.00 14925.22
.00 34.16 --
.00 34.16
.00 106.28 ---
.00 106,28
t,.1 '\3.a.
.00 11493.00
.00 11493.00
../
.00 1050.00
.00 1050.00
.00 400.00 ...---'
RUN DATE. 09/12/12
TIME. 15.39
MEMORIAL MEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 09125/12
PAGE. 8
APOPEN
VEND#.NAME.......................... .CLS.INVOICE#..,..,. ..TRN DT.INV DT.DUE DT.CK DT..PC..... ..GROSS.... .DISC..... .NO-PAY....... .NET
TOTALS....................................... :
10429 WILLIAlI E HEITKAMP, TRUSTE
EMPLOYEE DEDUCTION 18248 091112 091112 091112
TOTALS.."........,...............,.......... .
GRAND TOTALS..................................
C I<S :It ) 4, Cj 1 :J-I
-/,0
.:Ii NHqL{
VOIDS
-dt-/i190 ;L
:iJ/Lj9973
AIPIPROVEIJi
Sl:,F 1 ::I 20\2
<<:;OUI\l1'Y t~I.IDI"fOi'l
400.00
400.00
.00
495.00
495.00
495.00 ,,-
495.00
.00
.00
236973.32
<. JVm.(>D';
1- II/H3.D'Z.
236973.32 .00 i
Cor,...c.-I-\ cr>"'-
p~. 7 _
A3f.,/173.3t.(
VVlJr).J.~
Michael J. Pfeifer
CalhoL!J} County Judge
Date:-1.-::::.11~ 1<-=
RUN DATE. 09/12/12
TIME: 15.29
MEMORIAL MEDICAL CENTER
EDIT LIST FOR PATIENT REFUNDS ARID=OOOI
PAGE .
APCDEDIT
PATIENT
NOMBER
PAYEE NAlIE
ARID=OOOl TOTAL
DATE
PAY PAT
AMOUNT CODE TYPE DESCRIPTION
GL N11M
091112
20.00/
-~~-~-------------------------------------------------------------------------------------------------------------------------------
TOTAL
091112
43.00/
CI(-S-I< 1'4 Ii qq S
-t'D
.Ii !!ft)ool!f
"*C.R:IJ:/YO,135 vc:de..d.. ev,d Rel.5s....ed w\+h %;$ ck.frI4'1'7'1&'
( ~(Hr2.I>\?:)
091112
16.96.1
082212 62.00 -+
091212 518.40 ,/
091212 1156.00/
091212 287.90/
091212 50.00 V
091212 714.14 ./'
091212 100.00.1
2968.40
2968.40
APPROVED
SEP 1 3 2012
COUNTY ,i\lI!JlTOR
fJIM]tJ}~--
Michael ,_I. Pfeifer
c;a!lloL~J ?o~r~y Judge
U[\(Le_LfI'l--I-1.../-
RUN D~TE: 09/19/12
TII1E: 12:56
MEMORI~L MEDIC~L CENTER
~P OPEM INVOICE LIST THRU DUE D~TE OF 10/02/12
P~GE: 1
~POPEN
VEND~.NAl4E"............,...........,CLS.INVOICE~...."...TRN OT,INV OT.DUE DT,CK DT..PC....,..GROSS,..,.DISC,.,.,.NO.P~Y"...,.,NET
A1350 ACTION LUlffiER ./'
SUPPLIES PLANT OPS W 27856 091012 082712 092612 240.00 .00 240,00
TOT~LS........."..,.........,..."..,.,..... : 240.00 ,00 240,00
~1680 ~IRG~S'SOUTHWEST 166o.s8 ./
IIEDICAL GAS II 9008271010 091112 083112 093012 1660.88 .00
TOTALS.""....,........................,... .1 1660.88 .00 1660.88
A1645 ALC91l LABORATORIES INC 318.00/
LENSES II 14009147 083112 082812 092712 318.00 ,00
LENSES 14010552 083112 082812 092712 636.00 ,00 636.00/
TOTALS...,....",.,.................",...... : 954.00 ,00 954,00
A1360 Al4ERISOURCEBERGEN DRUG COR 161.36/
PHARllACEUTICALS 1'1 704551070 083112 082912 092812 161. 36 ,00
PHARllACEUTICALS 704873415 091412 091012 092512 210.80 ,00 210.80;/
PH~RJolACEUTICALS 704873416 091412 091012 092512 62.91 .00 62.91
TOTALS....,..,.,............................. : 435.07 .00 435.07
10738 AMS SALES CORPORATION 1617.00/
SUPPLIES SURGERY 12055636 083112 082812 092712 1617.00 .00
TOTALS....,.....................,......,.... .. 1617.00 .00 1617.00
A2050 Al!TEC
SUPPLIES NUC MED M 45583 083112 082912 092812 117.50 .00 117.50/
TO'lALS.....................,......"......... : 117.50 ,00 117.50
A2218 AQUA BEVERAGE COl4PANY 18.26/
SUPPLIES LAB II 420250 091412 083112 092512 18.26 .00
TOTALS,...,.................................. : 18.26 .00 18.26
10759 ASHLEY TORRES 13.32/
TRAVEL EXPENSE LAB 24111 091412 091212 091212 13.32 ,00
TO'lALS,..."...".............,....."".... ,: 13.32 .00 13.32
10719 AUSTIN IlEDICAL PRACTICE 2037.80/
OUTSIDE SRV WOllEN CLINIC 4683 091412 090512 092012 2037.80 .00
TOTALS..........,.......,............,.,.",. : 2037.80 .00 2037.80
Bl075 BAXTER HEALTHCARE CORP 279.31/
PHARMACEUTICALS II 38143884 091712 082312 092212 279.31 .00
TOTALS..............,......,.."..,.......... : 279.31 ,00 279.31
B1220 BEC~'mN COULTER INC 5382.13/
LEASE/llAINTENANCE LAB II 5276706 091412 083112 093012 5382.13 .00
TO'lALS..........,....".,.............,.,." .1 53B2.13 .00 5382,13
B1655 BOSTON SCIENTIFIC CORPORAT
SUPPLIES SURGERY II 933726151 083112 082712 092612 454.00 .00 454,00 /
TOTALS..,.;...................,...,....,..... : 454.00 .00 454,00
Cl033 CAD SOLUTIONS, INC
CAD CASES 201676 091812 083112 093012 536.00 ,00 536,00/
RUN DATE: 09/19/12
TIME: 12:56
~IEMORIAL NEDICAL CENTER .
AP OPEN IMVOICE LIST THRU DUE DATE OF 10/02/12
PAGE: 2
APOPEN
VEND#,NM1E.......,.,.................CLS.IMVOICE#...,."..TRN DT,IMV DT.DUE DT.CK DT..PC..."..GROSS.....DISC"""NO-PAY..."...NET
TOTALS".............."."."............... : 536.00 .00 536.00
A1825 CARDINAL HEALTH
SUPPLIES NDC NED N 08108134 091812 082412 082412 453.10 .00 453.10 ,/
SUPPLIES NDC NED 08108152 091812 083112 083112 190.46 .00 190,46 ,/
SUPPLIES NDC NED 08108166 091812 090712 090712 333.66 .00 333,66/
TOTALS............".. ,. ".."......"....".: 977.22 .00 977 ,22
C1390 CENTRAL DRUGS
PHARHACEUTICALS II AUGUST 091412 083112 091512 385.00 .00 385.00 ,/
TOTALS"........,.... ". "..,.",.".,..,....: 385.00 .00 385.00
10350 CENTUEION ~IEDICAL PRODUCTS 262,50 ~
SUPPLIES CS IMV 91098423 083112 082912 092812 262.50 .00
FORNS ER 91099447 083112 083012 092912 380.00 .00 380,00
TOTALS........................."..."....... : 642.50 .00 642,50
10105 CHRIS KOVAREK
TRAVEL EXPENSES SOC WORK 24116 091712 091712 091712 669.62 .00 669.62/
TOTALS...."..,.,........"."......"....... : 669.62 .00 669.62
C2297 COVER ONE 148.50 ./
OFFICE SUPPLIES ADMIN II 7735 091012 082712 092712 148.50 .00
TOTALS....................,....".,..,....", : 148.50 .00 148,50
C2510 CPSI
STATEIlENT PROCESSING 14 747665 091412 083012 083012 63.00 .00 63,00/
EBOS 748325 091412 083112 083112 159.62 .00 159.62 ::/
STATEMENT PROCESSING 749215 091412 090612 090612 71.40 .00 71.40
HARDWARE/SOFTWARE/TECH A1209061378 091712 090612 090612 14981.00 .00 14981.00/
TOTALS." "."...........".""....."......: 15275.02 .00 15275.02
10006 CUSTOII MEDICAL SPECIALTIES 555.26 ./
SUPPLIES CT SCAN 142909 090512 OS2912 092812 555.26 .00
TOTALS.....................,.".."...,..".. : 555.26 .00 555.26
10509 DME 2529.00 ./
ACCOUNTING FEES 24101 083112 083112 093012 2529.00 .00
TOTALS................... ,. ....,.... ,.,.,....: 2529.00 .00 2529.00
S2896 DANETTE BETHANY 153,74/
FLEX SPEND REIIIBURSE~IENT II 24114 091412 091312 091312 153,74 .00
TOTALS.............".....,."..."".....". : 153.74 .00 153.74
10368 DEI1ITT POTH & SON 64,74 /
OFFICE SUPPLIES ADIIIN 342893-0 091412 091012 091512 64.74 .00
OFFICE SUPPLIES CS INV 343161-0 091412 091012 091512 250.66 .00 250.66 ./
OFFICE SUPPLIES DIETARY 343176-0 091412 091012 091512 116.76 .00 116.76 ./
TOTALS.......,...........................,.,. : 432,16 .00 432.16
D1752 DLE PAPER & PACKAGING 155.80 )
FORIIS CS IMV II 6746 082912 082712 092612 155.80 .00
RUN DATE. 09/19/12
TIl1E. 12.56
l1EIIORIAL IlEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/02/12
PAGE. 3
APOPEN
VEND#.NAllE..............".,..,......CLS.INVOICE#.........TRN DT.INV DT.DUE DT.CK DT..PC,.,.,.,GROSS"..,DISC....,.NO-PAY..".,..NET
FORMS CS INV 6753 083112 082912 092812 179.75 .00 179.75 .-/
TOTALS......,....:.",..,.............,...., .. 335.55 .00 335.55
El070 EDWARDS PLUlffiING INC ./
STORAGE TANK REPLACEl'lENT 11 52156-1 091812 082212 092112 17014.00 .00 17014.00
TOTALS,..",......,......................... .. 17014.00 .00 17014.00
10701 FAGAN ANSVlERING SERVICE AN /
OUTISIDE SRV WOllEN CLINIC 74554 091412 090712 090712 76.73 .00 76,73
TOTALS,.....,..... ,............,.............. 76.73 .00 76,73
10689 FASTHEALTH CORPORATION
NONTHLY SEPTEMBER 09Al2MMC 091712 090112 093012 495.00 .00 495.00 ./
TOTALS.........................,............ .. 495,00 ,00 495.00
F1400 FISHER HEALTHCARE 1024.79 J
SUPPLIES LAB M 1821682 083112 082712 092612 1024.79 .00
SUPPLIES LAB 1934769 083112 082812 092712 1997.44 .00 ./
1997.44/
SUPPLIES LAB 1934770 083112 082812 092712 69.82 .00 69.82
SUPPLIES LAB 1934772 083112 082812 092712 1698.11 .00 1698.11 ~
SUPPLIES BLOOD BANK 2026274 083112 082912 092812 929.44 .00 929.44
SUPPLIES LAB 2224637 091412 083112 093012 621.34 .00 621.34,...1
SUPPLIES LAB 2224638 091412 083112 093012 127.97 .00 127.97 -;:f
SUPPLIES LAB 2329593 091412 090412 100212 40.00 .00 40.00
TOTALS....,."....,..,..,...,............... .. 6508.91 .00 6508,91
F1653 FORT BEND SERVICES, INC 495.00/
CONTRACT SEPTEMBER 0176853-IN 091012 090412 093012 495.00 ,00
TOTALS....................................", . 495.00 ,00 495.00
G0100 GE HEALTHCARE 3504,39/
SRV CONTRACT SEPT il 5466601 091812 090312 100212 3504,39 ,00
TOTALS,....,......,.....,................... .J 3504,39 .00 3504,39
G1870 GOLDEN CRESCENT COl~4UNICAT 55.00/
SUPPLIES PLANT OPS M 32782 091412 082912 092812 55,00 .00
TOTALS.......... 0'....... ....................: 55,00 .00 55,00
G0401 GULF COAST DELIVERY 275,00/
OUTSIDE SRV AUGUST2012 091912 083112 093012 275.00 .00
TOTALS.........".........,................. .. 275.00 .00 275,00
A1292 GULF COAST HARDWARE / ACE
SUPPLIES PLANT OPS II 070987 083112 083012 092912 16.97 ,00 16.97/ /
SUPPLIES BIOHED 070989 083112 083012 092912 28.48 .00 28,48
TOTALS....................,."............... : 45.45 .00 45,45
G1210 GULF COAST PAPER COMPANY 29.00Y
SUPPLIES HOUSEKEEPING 11 444205 083112 082812 092712 29.00 .00
SUPPLIES HOUSEKEEPING 444207 083112 082812 092712 87,48 .00 87.48
TOTALS...................................... .1 116,48 .00 116.48
H0030 H E BUTT GROCERY 229.29 J
DIETARY SUPPLIES M 344977 091412 083012 092912 229,29 .00
RUN DATE: 09/19/12
TIME, 12:56
ImMORIAL IlEDlCAL CENTER
AP OPEM INVOICE LIST THRU DUE DATE OF 10/02/12
PAGE' 4
APOPEM
VEMD#.N~IE..,......,..,..,...,.......CLS.INVOICE#.......,.TRM DT.INV DT.DUE DT,CK DT,.PC..,....GROSS,..,.DISC,.,...NO-PAY.,.....,NET
TOTALS.....,...............,..............,.. : 229.29 ,00 229.29
H1399 HILL-R0I1 COMPANY, INC ,/
RENTAL BED IlED SURG J.I 7841843 091012 083112 093012 990,00 .00 990,00
TOTALS......,.,.......",.,.,........,.,..,. .: 990,00 .00 990,00
10415 IMDEPEMDENCE MEDICAL 50,29/
SUPPLIES CS INV 27105501 091012 082712 092612 50,29 ,00
TOTALS...........................,.,......... : 50.29 ,00 50,29
10950 INFOLAB INC 872.90 .-/
SUPPLIES BLOOD BANK M 3157846 083112 082812 092712 872.90 .00
SUPPLIES LAB 3157847 083112 082812 092712 917.95 .00 917.95/
SUPPLIES LAB 3158078 091412 082912 092812 34,73 .00 34,73 .-/'
TOTALS.......................,......,...,.... : 1825,58 .00 1825,58
10671 INNOVATIVE K-RAY SERVICES 458.33/
SRV CONTRACT IIONTHLY 2012CL0515-5-6 091812 090112 093012 458.33 ,00
TOTALS........,.....,......,.........,....,.. , 458.33 ,00 458.33
J0150 J . J HEALTH CARE SYSTENS, 931.80/
SUPPLIES VARIOUS 908486115 083112 082712 092612 931.80 .00
TOTALS.....,.......,...................,.... .: 931,80 ,00 931.80
10285 JAlmS A DANIEL 750,00 ,/
OCTOBER RENT 24120 091712 091512 091512 750,00 .00
TOTALS.................,...,................. : 750.00 .00 750.00
10341 JENISE SVETLIK 999.00/
FLEX SPEMD REIJ.lBURSEMENT 24113 091412 091312 091312 999.00 .00
TOTALS.,.........,.......................... .: 999.00 .00 999.00
K1231 KONlCA IUNOLTA MEDICAL lMA 510.00/
SRV CONTRACT AUG 18916 091812 083012 092912 510.00 .00
TOTALS..,...............................,..,. : 510.00 .00 510,00
L0700 LABCORP OF M1ERlCA HOLDING 13,80/
OUTSIDE SRV LAB N 38775606 091412 090112 093012 13,80 ,00
TOTALS."...,.,..;....,....,....,....,....... : 13,80 ,00 13,80
L1288 LANGUAGE LINE SERVICES 153.76/
INTERPRETATION 1'1 3003305 083112 083112 093012 153.76 .00
TOTALS,....,................,.,.,.,........,. : 153.76 .00 153,76
N1500 IlARKS PLUlIBING PARTS 215.88)
SUPPLIES PLANT OPS II 1149374 083112 083112 093012 215.88 ,00
TOTALS.....,..,..,........................", : 215,88 ,00 215.88
112449 !1EDISAFE ~IERlCA LLC 2194,50 )
SRV CONTRACT - SONIC 12 II II 30659 091012 083012 092912 2194.50 .00
TOTALS.............,....,.....,.,.,..,....... : 2194.50 .00 2194,50
112485 IIEDRAn INC )
SUPPLIES CT SCAN II 139304879 090512 082912 092812 537.31 .00 537.31
RUN DATE: 09/19/12
TUIE: 12:56
MEMORIAL MEDICAL CENTER
AP OPEM INVOICE LIST THRU DUE DATE OF 10/02/12
PAGE: 5
APOPE~
VEND~.MAME..,..,...........,..."....CLS.INVOICE~.,.......TRN DT.INV DT.DUE DT.CK DT,.PC.......GROSS...,.DISC".,.,MO-PAY"..,..;NET
l!2659 !IERRY X-RAY- SAN ANTONIO
SUPPLIES VARIOUS M
l!2650 METLIFE
I~SURANCE W
10441 !IMC EMPLOYEE BENEFITS
IIEEKLY CLAms
WEEKLY CLAINS
10536 MORRIS & DICKSOM CO, LLC
PHAlU1ACEUTICALS
PHAlU1ACEUTICALS
PHAllMACEUTICALS
PHAlU'lACEUTICALS
PHAlU1ACEUTICALB
PHAllMACEUTICALS
PHAlU1ACEUTICAL CREDIT
PllAll!lACEUTICALS
PHAllMACEUTICALS
PHAllMACEUTICALS
PHAllMACEUTICALS
PHAllMACEUTICALS
PHAllMACEUTICALS
10008 OMNI-PORT LAVACA 07, L.P.
OCTOBER RENT
OM425 OIIENS & MIMOR
SUPPLIES CS INV
SUPPLIES OUTPATIENT
SUPPLIES CS INV
SUPPLIES VARIOUS
SUPPLIES VARIOUS
SUPPLIES SURGERY
SUPPLIES PACU
SUPPLIES SURGERY
SUPPLIES CS INV
SUPPLIES SURGERY
SUPPLIES VARIOUS
TOTALS........."...........".............., :
477391 983112 083012 092912
TOTALS.,...........,...,..................... :
18252 091412 091112 090112
TOTALS.",................................... :
18251 091412 091312 091312
18255 091912 091812 091812
TOTALS.,.,."""."...,............."..,.,. :
3790450 091412 091112 092512
3795098 091412 091212 092512
3795099 091412 091212 092512
3804091 091712 091412 092512
3804092 091712 091412 092512
3804203 091712 091412 092512
CM41648 091712 091412 092512
3521570 091812 062012 071012
3521571 091812 062012 071012
3545034 091812 062712 071012
3613939 091812 071912 081812
3699621 091812 081412 082512
CM42094 091812 091712 092512
TOTALS....................................... :
24119 091712 091512 091512
TOTALS"..,..,..,...............,....".,.... :
1980496 083112 082812 092712
1980502 083112 082812 092712
1980580 083112 082812 092712
1980620 083112 082812 092712
1980788 083112 082812 092712
1980797 083112 082812 092712
1981029 083112 082912 092812
1981126 083112 082912 092812
1981128 083112 082912 092812
1981165 083112 082912 092812
1981666 083112 082912 092812
TOTALS."............,...,."....,..,....,.,. :
l!1245 PANACEA HEALTHCARE SOLUTIO
SUBSCRIPTION LAB 166032
083112 073112 093012
537.31
554,40
554,40
258.52
258.52
7878,56
8927,79
16806.35
362,20
423.37
1505.67
54,52
687,51
113,41
-537,01
2119,70
706.57
3155.76
283.42
2826.26
-87.28
11614.10
10320.70
10320.70
120.00
52,95
637.94
190.18
2003.78
322.92
11.12
72.10
15,98
33,75
848.96
4309.68
197.00
.00 537,31
.00 554,40 /
.00 554,40
.00 258,52/
.00 258,52
.00 7878,56/
.00 8927.79 /
.00 16806.35
.00 362.20 /
.00 423.37 -;:;
.00 1505.67
.00 54.52~
.00 687.51
.00 113.41/
.00 -537.01/
.00 2119.70/
.00 706.57/
.00 3155.76/'
.00 283.42/
.00 2826.26:::/
.00 -87.28
.00 11614.10
.00 10320.70/'
.00 10320.70
.00 120.00/
.00 52.95 ~
.00 637,94/
.00 190.18~
.00 2003.78 ~
.00 322.92 /'
.00 11.12
.00 72.10 .../
.00 15,98./
.00 33.75/
.00 848,96 /
.00 4309,68
.00 197.00 /
RUN DATE: 09/19/12
TUIE: 12:56
MEMORIAL MEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/02/12
PAGE: 6
APOPEN
VEND#.NAME.......................... .CLS.INVOICE#........ .TRll DT.INV DT.DUE DT.CX DT. .PC...... .GROSS.... .DISC..... .NO-PAY....... .NET
TOTALS....................................... : 197.00 .00 197.00
00450 PATRICIA OWEN
FLEX SPEND REllolBURSE"ENT l'I 24114 091412 091312 091312 198.36 .00 198.36 ...--
TOTALS....................................... : 198.36 .00 198.36
P1100 PC CONNECTION SALES CORP
SUPPLIES PFS M 49270653 091412 071912 081812 543.24 .00 543.24 ----
TOTALS....................................... : 543.24 .00 543.24
10032 PHILIPS HEALTHCARE 679.00/
INSTRUNENT REPAIR ER 924715757 083112 082812 092712 679.00 .00
TOTALS....................................... : 679.00 .00 679.00
P2100 PORT lJIVACA l'IAVE 700.50/
ADVERTISING l'I AUGUST2012 091012 083112 093012 700.50 .00
TOTALS....................................... : 700.50 .00 700.50
P2200 POl'lER ELECTRIC /
DEPT REPAIR ICU ~I 160276 083112 082712 092612 7.58 .00 7.58 /
DEPT REPAIR RADIOLOGY 160283 083112 082712 092612 32.74 .00 32.74
DEPT REPAIR RADIOLOGY 160284 083112 082712 092612 10.37 .00 10.37'/
TOTALS................... to....... '" to" to..: 50.69 .00 50.69
10629 QUEST DIAGNOSTICS 35.40/
OUTSIDE SRV LAB 9145036193 091412 082812 092712 35.40 .00
TOTALS....................................... : 35.40 .00 35.40
Rl045 R & 0 BATTERIES INC
SUPPLIES CARDIO M 997043 083112 082812 092712 37.50 .00 37.50 .--
TOTALS...................... I.'.'............: 37.50 .00 37.50
R1268 RADIOLOGY UNLI"ITED, PA
READING FEES l'I 24112 091412 090812 090812 465.00 .00 465.00/
TOTALS....................................... : 465.00 .00 465.00
Rl321 RECEIVABLE IlANAGEblENT, INC
COLLECTIONS \'1 080112T0083112 091212 083112 093012 1616.55 .00 1616.55 ~
TOTALS....................................... : 1616.55 .00 1616.55
10543 ROGERS HOllE MEDICAL
RENTAL 7/20 - 7/31 37446 083112 082812 092712 275.00 .00 275.00 ./
TOTALS....................................... : 275.00 .00 275.00
S1800 SHER~aN ~aLLIAlIS 18.14/
SDPPLIES PlJINT OPS l'I 0862-3 091412 082912 092812 18.14 .00
DEPT REPAIR PFS 0956-3 091412 083112 093012 65.71 .00 65.71 ,/
TOTALS....................................... : 83.85 .00 83.85
S2001 SIEOOENS OOEDICAL SOLUTIONS
SRV CONTRACT 8/18-9/17 M 95727031 091812 081812 091812 941.58 .00 941. 58 /
RUN DATE: 09/19/12
TIOOE: 12:56
MEOOORIAL MEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/02/12
PAGE: 7
APOPEN
VEND#.NroIE...........................CLS.INVOICE#.........TRll DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
SRV CONTRACT 8/30-9/28
S3960 STERICYCLE, INC
IIEDICAL WASTE PICKUP AUG
C2299 SUDDENLINK OOEDIA
ADS 7/30 - 8m
OUTSIDE SRV 6/25-7/29
10333 SDNTRUST EQUIPllENT FINANCE
LEASE PAYflENT
S2951 SYSCO FOOD SERVICES OF
SUPPLIES DIETARY
SUPPLIES DIETARY
T2539 T-SYSTEM, INC.
OUTSIDE SRV ER
T0420 TELEFLEX IIEDICAL
SUPPLIES SURGERY
112336 TERESA HILLER
INSURANCE REFUND
95730736 091812 083012 093012
TOTALS...................................... .:
4003627917 091412 083112 093012
TOTALS....................................... :
INV-491962 091012 082812 092712
INV-475860 091412 073112 083012
TOTALS....................................... :
1467968 091812 090612 090612
TOTALS....................................... :
H 209060835 091012 090612 092612
209130762 091412 091312 100112
TOTALS....................................... :
W 205EV23014 083112 083112 093012
TOTALS....................................... :
91515475 090512 082712 092612
TOTALS....................................... :
18254 091712 091612 091612
TOTALS....................................... :
T1880 TEXAS DEPARTMENT OF LICENS
BOILER CERTIFICATE AlP 24109 091412 091112 091112
TOTALS....................................... :
T1900 TEXAS ELECTRICAL SUPPLY
SDPPLIES PlJINT OPS M
T2230 TEXAS WIRED IIDSIC INC
lIDZAK W
IlliZAK
S2679 THE ST JOHN COIIPANIES, INC
SUPPLIES CS INV II
OFFICE SUPPLIES PHAR!lACY
Vl050 THE VICTORIA ADVOCATE
ADVERTISING AUG
26886 083112 082712 092612
TOTALS....................................... :
A688242 091412 090112 090112
A688243 091412 090112 090112
TOTALS....................................... :
07949837 090512 082812 092712
0795190 091012 083012 092912
TOTALS....................................... :
W AUG2012
091012 083112 093012
697.58 .00 697.58 /'
1639.16 .00 1639.16
589.56 .00 589.56 /
589.56 .00 589.56
120.00 .00 120.00/
1440.00 .00 1440.00 ,/
1560.00 .00 1560.00
22688.57 .00 22688.57/
22688.57 .00 22688.57
927.40 .00 927.40/
883.77 .00 883.77 ./
1811.17 .00 1811.17
4107.00 .00 4107.0V
4107.00 .00 4107.00
155.11 .00 155.11/
155.11 .00 155.11
600.00 .00 600.00/
600.00 .00 600.00
140.00 .00 140.00/
140.00 .00 140.00
312.90 .00 312.90/
312.90 .00 312.90
59.95 .00 59.95.....
73.95 .00 73.95/
133.90 .00 133.90
22.95 .00 22.95/
73.79 .00 73.79 ./
96.74 .00 96.74
916.00 .00 916.00 /
RUN DATE: 09/19/12
TUIE: 12,56
HEIIORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/02/12
PAGE: 8
APOPEN
VEND#.NA}IE...........................CLS.INVOICE#.........TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
llEEKLY SUBSCRIPTION 906632 091812 072112 082012 12.40 .00 12.10/
llEEKLY SUBSCRIPTION 915732 091812 081112 091012 12.40 .00 12.10/
/
IIEEKLY SUBSCRIPTION 920425 091812 082512 092412 12.40 .00 12.40/
l'IEEKLY SUBSCRIPTION 922491 091812 090112 093012 12.40 .00 12.40
TOTALS...................................... .: 965.60 .00 965.60
10192 THIE 4118.00 ./
INSURANCE INSTALUIENT 24121 091712 091512 091512 4118.00 .00
TOTALS....................................... : 4118.00 .00 4118.00
T080l TLC STAFFING
CONTRACT HORSE II 10525 083112 082812 092712 189.05 .00 189.05 /
TOTALS....................................... : 189.05 .00 189.05
Tl724 TOSHIBA A}IERICA IIEDICAL SY
SRV CONTRACT 9/20-10/19 10021023 091812 082112 092012 9874.50 .00 9871.50/'
OUTSIDE SRV RAD 40013185 091812 082312 092212 1537.50 .00 1537.50 /
TOTALS....................................... : 11412.00 .00 11412.00
Ul054 UNIFIRST HOLDINGS
LAUNDRY OOAINTENANCE W 8150582035 082912 082812 092712 32.54 .00 32.54/
TOTALS....................................... : 32.54 .00 32.54
Ul064 UNIFIRET HOLDINGS INC 348.59/
LAUNDRY OR 8400131446 082912 082812 092712 3'8.59 .00
LAUNDRY HOSPITAL LINEN 8400131598 082912 082812 092712 924.59 .00 924.59/
LAUNDRY HOUSEKEEPING 8400131599 082912 082812 092712 182.19 .00 182.19/
LAUNDRY PLAZA 8400131600 082912 082812 092712 164.83 .00 164.83/'
LAUNDRY DIETARY 8400131601 082912 082812 092712 173.07 .00 173.07/
LAUNDRY OB 8400131602 082912 082812 092712 86.70 .00 86.70/
LAUNDRY HOUSEKEEPING 8400131603 082912 082812 092712 96.92 .00 96.92/
LAUNDRY HOSPITAL LINEN 8400131829 083112 083112 093012 622.99 .00 622.99/
LAUNDRY OR 8400131830 083112 083112 093012 318.59 .00 348.59/
TOTALS....................................... : 29'8.47 .00 2948.47
Ul056 UNIFORlI ADVANTAGE
EHPLOYEE DEDUCTION W 45666 091012 083012 092912 197.90 .00 197.90 /
TOTALS....................................... : 197.90 .00 197.90
U0414 !!NUN LIFE INS CO OF AOOERIC
PREHIUM 1011 - 10/31 18253 091412 091112 100112 4370.91 .00 4370.91/
TOTALS....................................... : 4370.91 .00 4370.91
10172 US FOOD SERVICE
SUPPLIES DIETARY 5499411 091012 090612 092612 172.90 .00 172.90/
SUPPLIES DIETARY 5499413 091012 090612 092612 3593.50 .00 3593.50/
SUPPLIES DIETARY 5630249 091412 091312 100112 3578.23 .00 3578.23 /
SUPPLIES DIETARY 5630250 091412 091312 100112 30.68 .00 30.68 /
TOTALS....................................... : 7375.31 .00 7375.31
U2000 US POSTAL SERVICE 1000.00 I
POSTAGE 24118 091712 091512 091512 1000.00 .00
RUN DATE: 09/19/12
TillE: 12:56
MEMORIAL MEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/02/12
PAGE: 9
APOPEN
VEND#.NAHE...........................CLS.INVOICE#.........TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
V0555 VERIZON SOUTHWEST
TELEPHONEE M
TELEPHONE
TELEPHONES
TELEPHONE
TELEPHONES
V1471 VICTORIA RADIOWORKS, LTD
RADIO AD 8/310NE DAY 1'l
TOTALS....................................... :
5523521090112 091112 090112 092612
5512513090712 091712 090712 100212
5526713090712 091712 090712 100212
5528103090712 091712 090712 100212
5537803090712 091712 090712 100212
TOTALS....................................... :
120B0335 091012 083112 093012
TOTALS....................................... :
1'l1363 WOLTERS KLUWER HEALTH, INC
CONTINUING ED PHARHACY N 24000 070312 061612 100112
TOTALS....................................... :
GRAND TOTALS.................................:
CAs. Ii 1>'0005
-ro
-d /5'009&
V D ~d
-
Jf IS oD~1
1~~PR<<J\JE\o)
StY 2 a 2012
(rOUN'rll t,m~11Qfii
_4 _
1000.00 .00
42.23 .00
202.30 .00
1274.85 .00
48.22 .00
303.97 .00
1871.57 .00
60.00 .00
60.00 .00
590.18 .00
590.18 .00
192005.82 .00
Michael J. Pfeifer
Calhoun County Judge
Date: tj'J# 7,/ )Y--
1000.00
42.23 ,./'
202.30 ---/
1274.85 ,/
48.22 ;-
303.97
1871.57
60.00/
60.00
590.18/
590.18
192005.82
RUN DATE:09/20/12
TIHE:08,36
MEMORIAL HEDICAL CENTER
EDIT LIST FOR BATCH 556 1051
CRT#556
TRANSACTION SEQUENCE
PAGE 1
GLEDIT
ACCOUNT A.H.A.
SEQ. NUHBER NUlIBER
TRANS
DATE JOURNAL
AOOOUNT SUB-LED REFERENCE IIEHO
G.L. ACCOUNT DESCRIPTION
-~----------------------------------------------------------------------------------------------------------------------------------
1 10000000 09/20/12 CD 56,218.00CR T2062 A/PC150097 TEXAS MEDICAID . HEALTH OPERATING -CASH
20000000 09/20/12 CD CD 56,218.00 T2062 A/PC150097 TEXAS MEDICAID . HEALTH ACCOUNTS PAYABLE -AlP
2 10000000 09/20/12 CD 1,980.00CR T3067 A/PC150098 TRAILBLAZER HEALTH ENTE OPERATING -CASH
20000000 09/20/12 CD @ 1,980.00 T3067 A/PC150098 TRAILBLAZER HEALTH ENTE ACCOUNTS PAYABLE -AlP
60000000 10258 600390
- - - - - - - - - -R E C A P- - - - - - - - - -
JOURNAL YRNO COUNT DEBIT
CD 1209 4 58,198.00
TOTAL 4 58,198.00
CREDIT
58,19B.00
58,19B.00
ACCOUNT TOTAL RECAP ON NEXT PAGE
CD
Te (\ -\-a..+~\lQ..
fer:od
~e J: Ca..: J 5 e-\.-\- \ et"'l\e-Io1.+ -CD r + ~e..
eA"ld: "5 1':4/aI/1I C K.,j,I16oDC/ 7
0-[e..i\..-1-a.l-:\Ie. se--\.-I-lem€.J'L+ ~o(' ~ : Sea. \ per :ad
e.ncl:n~ 1'2./31/11 QI-<'=* 15'OD9S
APPROVED
~I:Y 2 0 2U12
ICOUiII'fif AUDITOR
/JLuLJ!} ~
Michael J. Pfeifer e
Calhoun county .~g
Dale:_ tj~7-J
RUN DATE, 09/26/12
TIME: 11:12
HEMORlAL IIEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/09/12
PAGE: 1
APOPEN
VEND#.N~IE......................... ..CLS.INVOICE#........ .TRN DT.INV DT.DUE DT.CK DT. .PC...... .GROSS.... .DISC..... .NO-PAY....... .NET
A1790 AFLAC /
FEES 9/1 - 9/30 W 497836ER 092412 091712 100112 130.00 .00 130.00
TOTALS...................................... ,I 130.00 .00 130.00
A1690 AIRGAS-SOUTffiIEST /
HEDICAL GAS H 9904075071 092012 083112 093012 379.35 .00 379.55
TOTALS....................................... : 379.35 .00 379.35
10533 ALERE NORTH _RICA INC 313.57/
EUPPLIES LAB 9001391226 092512 091012 100912 313.57 .00
TOTALS....................................... : 313.57 .00 313.57
A1746 ALPHA TEC SYSTEI'IE INC
SUPPLIES LAB I! INV-00001969 091712 090512 100412 233 .29 .00 O\L~""'"
TOTALS....................................... : 233.29. .00 233. 8
10775 ANDRUS, HOOD. WAGSTAFF, P 43.78 /
DUPLICATE PAYMENT 24122 092012 091912 091812 43.78 .00
TOTALS...................................... .: 43.79 .00 43.78
B2001 ANGIE BURGIN
TRAVEL ER -1'1\.\ \eA~e. 24125 092012 091812 091812 251.21 .00 ;n.\.::2..l ~
lfO'l'ALS....................................... : 251.21 .00 251.2
A0910 AORll
HEMBERSHIP RENEWAL W 241100 091412 090612 100612 125.00 .00 125.00 ,./
TOTALS....................................... : 125.00 .00 125.00
A2260 ARROW INTERNATIONAL INC
SUPPLIES CS INV II 4210906 091412 090512 100512 970.83 .00 870.83 ,/
TOTALS....................................... : 970.83 .00 870.83
A2345 AT&T HOBILITY 5.32/
TELEPHONE Z09192012 092412 091112 100612 5.32 .00
TOTALS...................................... II 5.32 .00 5.32
Bl075 BAXTER HEALTHCARE CORP 2767.00/
LEASE IV PlmlPS H 39243289 091412 090512 100412 2767.00 .00
LEASE SOFTl'IARE 39243908 091412 090512 100412 190.50 .00 190.50j'
SUPPLIES CS INV 39256118 091712 090712 100612 456.15 .00 456.15
TOTALS. II... to.. 11."....... II.... to... II....: 3413.65 .00 3413.65
B1220 BECKIlAN COULTER INC 333.00 ~
SUPPLIES LAB H 103081834 091412 090412 100312 333.00 .00
SUPPLIES LAB 103082242 091412 090512 100412 10691.20 .00 10691.20/
SUPPLIES LAB 103092243 091412 090512 100412 6609.57 .00 6609.57/
SUPPLIEE LAB 103093699 091412 090512 100412 7049.99 .00 7049.99
TOTALS....................................... : 24683.76 .00 24693.76
B1835 BUCKEYE CLEANING CENTER 1095.80/
EUPPLIES HOUEEKEEPING II 692410 091412 090712 100612 1095.80 .00
RUN DATE, 09/26/12
TI[.IE, 11:12
HEHORIAL IIEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/09/12
PAGE: 2
APOPEN
VEND#.NAlIE...........................CLS.INVOICE#......... TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
TOTALS....................................... , 1095.80 .00 1095.80
B0437 C R BARD INC 253.50 )
SUPPLIES CS INV II 43605589 091012 090512 100412 253.50 .00
TOTALS....................................... : 253.50 .00 253.50
Cl010 CABLE ONE 286.50 v'"
CABLE 1I 091612-101512 092012 091612 092512 286.50 .00
TOTALS....................................... , 286.50 .00 286.50
Cl030 CAL COM FEDERAL CREDIT UNI
EIIPLOYEE DEDUCTION 1I 18259 092512 092512 092512 25.00 .00 25.00.....-
TOTALS....................................... : 25.00 .00 25.00
10650 CAREFUSION 2200, INC 31.3)
SUPPLIES SURGERY 9103761735 091712 091012 100912 31.34 .00
TOTALS....................................... : 31.34 .00 31.34
C1219 CAROLINA LIQUID CHEMISTRIE 215.14 /
EUPPLIES LAB 0104511-IN 091412 090412 100312 215.14 .00
TOTALS...........:........................... : 215.14 .00 215.14
10350 CENTURION HEDICAL PRODUCTS
SUPPLIES CS INV 91102721 091012 090512 100412 997.75 .00 997.75 ,./
TOTALS....................................... , 997.75 .00 997.75
10661 CENTURYLINK ../
TELEPHONE 1228188073 091012 090312 100312 265.98 .00 265.98
TOTALS....................................... , 265.98 .00 265.98
10105 CHRIS KOVAREK 286.94/
FLEX SPEND REIllBURSE"ENT 24130 092512 092412 092412 286.94 .00
TOTALS....................................... : 286.94 .00 286.94
C1730 CITY OF PORT LAVACA
lIATERISE~IER II 080812-090712 092412 090712 100512 7317.35 .00 7317.35 V"
WATER 080812T0090712 092412 090712 100512 898.60 .00 898.60 ./
TOTALS....................................... : 8215.95 .00 8215.95
C0399 CORPUS CHRISTI PROSTHETICS 45.00/
SUPPLIES SURGERY 28706CS 091412 090612 100512 45.00 .00
TOTALS....................................... : 45.00 .00 45.00
C2510 CPSI 10212.0E-:!
PRIVATE PAY II 749799 092512 091112 091112 10242.08 .00
EBOS 750531 092512 091212 091212 411.10 .00 411.10
STATEIlENT ~ROCESSING 750910 092512 091312 091312 36.00 .00 36.00~
STATE"ENT PROCESEING 751935 092512 092012 092012 33.60 .00 33.60
TOTALS....................................... : 10722.78 .00 10722.78
S2896 DANETTE BETHANY 217.00/
TRAVEL I'IED SURG W 24126 092412 092412 092412 217.00 .00
RUN DATE: 09/26/12
Tll!E: 11:12
MEIIORIAL MEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/09/12
PAGE: 3
APOPEN
VEND#.NAME...........................CLS.INVOICE#.........TRN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
TRAVEL liED SURG 24133 092512 091312 091312 102.40 .00 102.40 /
TOTALS...............................-........ : 319.40 .00 319.40
01153 DARLING INTERNATIONAL IflC.
GREASE PICK UP 500:2237690 092512 091812 091812 35.00 .00 35.00 r-
TOTALS...................................... .1 35.00 .00 35.00
10175 DEBS CENTRAL I.AB MC2004
OUTSIDE SRV LAB JUNE/JULY 091712 090412 100312 392.00 .00 392.00 --
TOTALS............... ........................: 392.00 .00 392.00
10772 DXE MEDICAL, INC.
Llfep...K 10 'j::>e.\!'.\>. 64636 091712 090512 100412 6140.00 .00 6140.00./
~,,( E. fl.. TOTALS...................................... .1 6140.00 .00 6140.00
10558 EOOPLOYEE ACTIVITIES TEAM
EMPLOYEE DEDUCTION 24128 092412 092412 092412 95.00 .00 95.00 ~
TOTALE....................................... : 95.00 .00 95.00
Fl050 FASTENAL COHPANY
SUPPLIES PLANT OPS N TXPOT112224 091712 090512 100512 120.50 .00 120.50 0/
TOTALE...........:........................... : 120.50 .00 120.50
F1300 FIRESTONE OF PORT LAVACA
DEPT REPAIR MAINTENANCE II 0011787 091412 091012 100912 56.90 .00 56.90""
REPAIR IlAINTENANCE 0011796 091412 091012 100912 347.10 .00 347.10--"
TOTALS....................................... , 404.00 .00 404.00
F1400 FISHER HEALTHCARE
SUPPLIES LAB l! 2329595 091412 090412 100312 1024.87 .00 1024.87 :/
SUPPLIES LAB 2471603 091412 090512 100412 66.97 .00 66.97
SUPPLIES LAB 2471604 091412 090512 100412 132.31 .00 132.31/
SUPPLIES LAB 2643513 091412 090612 100512 299.90 .00 299.90/
TOTALS...................................... .J 1524.05 .00 1524.05
G0100 GE HEALTHCARE 447.91/
SRV CONTRACT SEPT W 5466617 091812 090312 100312 447.91 .00
TOTALS....................................... : 447.91 .00 447.91
G0120 GE HEDICAL SYSTEOOS, INFO T .171.00 /
SRV CONTRACT OB 10/1 - 10 7378785 091412 090812 100812 171. 00 .00
TOTALS....................................... : 171.00 .00 171.00
,
Gl001 GETINGE USA
SUPPLIES SURGERY 7779256 092112 090412 100312 107.78 .00 107.78/"
TOTALS....................................... : 107.78 .00 107.78
10642 GLAXOSIIITHKLINE PHARNACUET 1188.21/
PIlARlIACEUTICALS 30748908 092012 091012 100912 1188.21 .00
TOTALS....................................... : 1188.21 .00 1188.21
A1292 GULF COAST HARDWARE I ACE 14.99 )
SUPPLIES PLANT OPE W 071077 091112 090512 100412 14.99 .00
RUN DATE: 09/26/12
. TIME: 11:12
OOEHORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/09/12
PAGE: 4
APOPEN
VEND#.NAME.......................... .CLE.INVOICE#........ .TRll DT.INV DT.DUE DT.CK DT. .PC...... .GROSS.... .DISC.... ..NO-PAy....... .NET
SUPPLIES PLANT OPS 071086 091112 090612 100512 12.76 .00 12.76 /'
TOTALS....................................... : 27.75 .00 27.75
G1210 GULF COAST PAPER COHPAMY
SUPPLIES ROUSEKEEPING !l 447026 091012 090412 100312 62.80 .00 62.80 .....
SUPPLIES HOUSEKEEPING 447027 091712 090412 100312 153.93 .00 153.93 ~
TOTALS....................................... : 216.73 .00 216.73
H0032 H + H SYSTEfl, INC.
SUPPLIES PHAR!lACY 4154 091112 090412 100312 52.50 .00 52.50../
TOTALS..................................,.... ; 52.50 .00 52.50
H0030 H E BUTT GROCERY
SUPPLIEE DIETARY I! 356319 091412 090612 100512 248.12 .00 248.12 -----
TOTALS.... ....................... ............: 248.12 .00 248.12
10415 INDEPENDENCE llEDICAL
SUPPLIES CS INV 27155724 091412 090512 100412 49.74 .00 49.74 /
TOTALS....................................... , 49.74 .00 49.74
10950 INFOLAB INC
SUPPLIES LABIBLOOD BANK !l 3160236 092512 090412 100312 1771.73 .00 1774.73 .......-
SUPPLIEE LAB 3161186 092512 090512 100412 210.23 .00 210.23 v'
SUPPLIES LAB 3163784 092512 091212 100912 472.31 .00 472. 31 V'
TOTALS...................................... .1 2457.27 .00 2457.27
11100 INSTRUl!ENTATION LABORATORY
SUPPLIES LAB !l 910110280B 091712 090512 100412 190.48 .00 190.48/'
TOTALS....................................... : 190.48 .00 190.48
J0150 J & J HEALTH CARE SYSTEI!S, 628.66'/
SUPPLIES ER 908539632 091012 090512 100412 628.66 .00
TOTALS....................................... , 628.66 .00 628.66
111500 IlARKE PLUl!BING PARTS 18.30/.
SUPPLIES PlJINT OPS !l 1151265 091412 090712 100612 18.30 .00
TOTALS...................................,... : 18.30 .00 18.30
10749 IICKESSON AUTOllATION INC. 885.23 /
i......J...\ U,f.......S 3467423 091712 090712 100612 885.23 .00
TOTALS...........:............... ............: 885.23 .00 885.23
N3656 HERIDIAN BIOSCIENCE 2694.94/
SUPPLIES LAB 739419 091412 090512 100512 2691.94 .00
TOTALS....................................... : 2694. 94 .00 2694.94
112659 IIERRY X-RAY- SAN ANTONIO
SUPPLIES RADIOLOGY H 477566 091012 090712 100612 106.42 .00 106.42 /
TOTALE....................................... : 106.42 .00 106.42
01781 HIETY PASSMORE /
FLEX SPEND REIHBURSEMENT Ii 24129 092512 092412 092412 216.78 .00 216.78
RUN DATE: 09/26/12
TIME: 11:12
IIEMORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/09/12
PAGE: 5
APOPEN
VEND~.NroIIE...........................CLE.INVOICE~.........TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
TOTALS....................................... : 216.78 .00 216.78
N2621 Ml!C AUXILIARY GIFT SHOP 267.51/
E~IPLOYEE PURCHASES \'1 24127 092412 092412 092412 267.51 .00
TOTALS....................................... : 267.51 .00 267.51
10441 Ml!C E'IPLOYEE BENEFITS
~IEEKLY CI.AIOOS 18257 092112 092112 092112 4689.83 .00 4689.83 ~
~lEEKLY CI.AIOOS 18252 092512 092512 092512 19669.86 .00 19669.86
TOTALS...................................... .: 24359.69 .00 21359.69
10601 NOBLE Al~ERICAS ENERGY 30523.24 ,..../
ENERGY 122650002559473 092412 092112 093012 30523.24 .00
TOTALS................... ....................: 30523.24 .00 30523.24
10352 NUANCE COI~R1HICATIONE, INC 2684.00/
SRV CONTRACT 9/8/12-9/7/1 30057417 092112 061012 071912 2681.00 .00
TOTALS....................................... , 2681.00 .00 2684.00
10709 ONESTAFF MEDICAL, LLC 208E.00 ./
COHTRACT NURSE 5889 092512 071912 081812 2088.00 .00
TOTALS....................................... : 2088.00 .00 2088.00
000425 O~lENS & OOINOR 75.72/
SUPPLIES PT 1983249 091012 090412 100312 75.72 .00
SUPPLIES VARIOUS 1983544 091012 090412 100312 1810.93 .00 1810.93 j
SUPPLIES CARDIO 1984440 091012 090612 100512 11.12 .00 11.12
SUPPLIES CS INV 1984456 091012 090612 100512 33.88 .00 33.88.j
SUPPLIES SURGERY 1984922 091012 090612 100512 149.16 .00 149.16/
SUPPLIES CS INV 1984954 091012 090612 100512 537.61 .00 537.61/
SUPPLIES VARIOUS 1985481 091712 090712 100612 1972. 35 .00 1972.35
TOTALS....................................... : 4590.77 .00 1590.77
01531 PATRICIA DIEBEL /
TRAVEL EXPENSES ~I 24132 092512 091312 091312 144.86 .00 141.86
TOTALS....................................... : 144.86 .00 144.86
Pl100 PC CONNECTION SALES CORP 327.73/
SUPPLIES IT 1,1 49438293 091412 090612 100512 327.73 .00
SUPPLIES AD!oIIN 19443441 091712 090712 100612 788.38 .00 788.38/
SUPPLIES LAB 19448261 991712 091012 100912 191.91 .00 191.91 /
TOTALS....................................... : 1308.02 .00 1308.02
10541 PLATINill! CODE 133.28 ./
SUPPLIES LAB 147373 091412 090412 100312 133.28. .00
TOTALS...................................... .: 133.28 .00 133.28
P2200 P01~R ELECTRIC 13.98/
SUPPLIES PlJINT OPS \'I 160384 090512 090412 100312 13.98 .00
SUPPLIES PLANT OPS 160410 091112 090612 100512 39.97 .00 39.97/
TOTALS....................................... : 53.95 .00 53.95
10326 PRINCIPAL LIFE 1728.23 /
LIFE INSURANCE 18256 092112 091712 100112 1728.23 .00
RUN DATE: 09/26/12
TI!IE: 11,12
llElolORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/09/12
PAGE, 6
APOPEN
VEND#.NAHE.......................... .CLS.INVOICE#........ .TRll DT.INV DT.DUE DT.CJ( DT..PC...... .GROSS... ..DISC..... .NO-PAY....... .NET
TOTALS....................................... : 1728.23 .00 1728.23
P2370 PROGRESSIVE DYNAHICS llEDIC ,/
SUPPLIES SURGERY H 129652 091412 090512 100412 175.01 .00 175.01
TOTALS....................................... : 175.01 .00 175.01
Rl030 R G & ASSOCIATES INC 213.20'/
SLAT DELIVERY I! 204982 091112 090712 100612 213.20 .00
TOTALS....................................... : 213.20 .00 213.20
R1200 RED HANK
Il0NTHLY CONTRACT PlJINT OP 7020390985 091412 090612 100512' 27.56 .00 27.56./
TOTALS....................................... , 27.56 .00 27.56
10645 REVISTA de VICTORIA 375.00/
ADVERTISING SEPT AD 09201232 091412 091012 100912 375.00 .00
TOTALS....................................... : 375.00 .00 375.00
10520 RICOH USA, INC. 5269.23/
COPIER RENTAL I! 87672556 091112 091012 100512 5269.23 .00
TOTALS.............. .........................: 5269.23 .00 5269.23
S1200 SEARS 142.00.J
DEPT REPAIR [IAINTENANCE II 40504794 992012 080912 093012 142.00 .00
SUPPLIES HAINTENANCE T538291 092012 082212 093012 19.30 .00 19.30'/
DEPT REPAIR IlAIHTEHANCE T538302 092012 082212 093012 25.15 .00 25.15./
SRV CONTRACT PRESSURE ~lAS T715607 092012 082812 093012 89.23 .00 89.23.......
SALES TAX CREDIT FROll JUL AUG-CREDIT 092612 092612 092612 -3.04 .00 -3.04 .--
TOTALS...................................... .1 272.64 .00 272.61
S2400 SO TEX BLOOD & TIESUE CENT
SUPPLIES BLOOD BANK CREDI H 20124010 091412 090412 100312 -1666.00 .00 -1666.00"-
SUPPLIES BLOOD BANK 20124077 091412 090412 100312 6265.00 .00 6265.00/
TOTALS....................................... : 4599.00 .00 4599.00
S2694 STANFORD VACUUH EERVICE
GREASE TRAP PUNP OUT [! 649983 091012 080912 090812 320.00 .00 320.00 ----
TOTALS....................................... : 320.00 .00 320.00
10618 TEroI HEALTH HEDICAL CALL C 1765.41/
CALL CENTER BA12443 092512 083112 083112 1765.41 .00
TOTALS....................................... : 1765.41 .00 1765.41
T2303 TG
EI!PLOYEE DEDUCTION W 18258 092512 092512 092512 131.27 .00 131.27./'
TOTALS....................................... , 131.27 .00 131.27
Vl050 THE VICTORIA ADVOCATE 12.40'/
~IEEKLY SUBSCRIPTION II 925320 091812 090812 100712 12.40 .00
TOTALS....................................... : 12.40 .00 12.40
T0801 TLC STAFFING
CONTRACT NURSE 1'/ 10574 091112 090512 100512 509.92 .00 509.92 ./
RUN DATE: 09/26/12
TIl4E, 11:12
HEMORIAL llEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/09/12
PAGE: 7
APOPEN
VENDU.NroIIE...........................CLS.INVOICE#.........TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......HO-PAY........NET
TOTALS....................................... , 509.92 .00 509.92
T3334 TRINITY PHYSICE CONSULTING 3350.00/
OUTSIDE ERV RADIOLOGY 11 03-1981 092112 090112 100112 3350.00 .00
TOTALS....................................... : 3350.00 .00 3350.00
U2035 U S DIARY
SUPPLIES AOIlIN 11 3285972 091712 090712 100612 67.49 .00 67.49 /
TOTALS....................................... : 67.49 .00 67.49
Ul054 UNIFIRST HOLDINGS
LAUNDRY HAINTENANCE Iq 8150582805 090512 090412 100312 32.54 .00 32.54/
TOTALS....................................... : 32.54 .00 32.54
Ul064 UNIFIRST HOLDINGS INC
LAUNDRY HOSPITAL LINEN 8400131953 090512 090412 100312 685.57 .00 685.57""'-
LAUNDRY HOUSEKEEPING 8400131954 090512 090412 100312 182.19 .00 182.19/
LAUNDRY PLAZA 8400131955 090512 090412 100312 152.50 .00 152.50""'-
LAUNDRY DIETARY 8400131956 090512 090412 100312 174.86 .00 174.86./
LAUNDRY OB 8400131957 090512 090412 100312 86.70 .00 86.70/
LAUNDRY HOUSEKEEPING 8400131958 090512 090112 100312 111.22 .00 141. 22 /
lJIUNDRY HOSPITAL LINEN 8400132186 091012 090712 100612 776.40 .00 776.40 /
lJIUNDRY OR 8400132187 091012 090712 100612 348.59 .00 348.59 /'
TOTALS....................................... : 2548.03 .00 2548.03
Ul056 UNIFORll ADVANTAGE
EMPLOYEE PURCHASE W 4483197 092112 073112 093012 411.83 .00 411.83-/
EHPLOYEE PURCHASE 1530203 092112 073112 083012 14.99 .00 14.99
EHPLOYEE PURCHASE 4587914 092112 090712 100612 151.93 .00 151. 93../
TOTALE....................................... , 578.75 .00 578.75
U1250 UNIVERSAL HOSPITAL SERVICE 112.00/
RENTAL EQUIPHENT I-l 02937483 091012 090612 100512 112.00 .00
TOTALS...................................... .: 112.00 .00 112.00
U1350 UPS FREIGHT
FREIGHT 11 0000778941372 092112 091512 092612 311.84 .00 311.84 .....-
FREIGHT 20977968 092112 091412 091412 132.50 .00 132.50 ../
TOTALS....................................... : 444.34 .00 444.34
K1751 VICKY KALISEK
FLEX SPEND REIMBURSEMENT W 24131 092512 092412 092412 420.00 .00 420.00/
TOTALS...........;........................... : 420.00 .00 420.00
10325 l'/HOLESALE ELECTRIC SUPPLY
DEPT REPAIR SURGERY 79-2947479 092112 090412 100312 75.28 .00 75.28/
TOTALS....................................... : 75.28 .00 75.28
10394 WILLIAlI E HEIKAOOP, TRUSTEE
EMPLOYEE DEDUCTION 18260 092512 092512 092512 400.00 .00 400.00/
TOTALS....................................... : 400.00 .00 400.00
10429 l'IILLIRN E HEITKAlIP, TRUSTE 495.00/
EHPLOYEE DEDUCTIOH 18261 092512 092512 092512 495.00 .00
TOTALS....................................... , 495.00 .00 495.00
GRAND TOTALS.................................:
ttSll- /'>O{(t.-{
+0
j 150 ''1$'"
fY'AvlJ. ~ P-/J
. Michael J. Pfeifer
Calhoun County Judge
Date: tIJ' ).'h1...-'
AIPPiFUJ'\!tEJDJ
!:it.!' 2 7 2012
COUNTY !\iJDlTOR
161704.82 .00
~d\~
?'O \
---
161704.82
[ (/151.21')
+.;<),1,;;((
llo!) {p ltJ-. 55 '2--
HEOOORIAL HEDICAL CENTER PAGE f
EDIT LIST FOR PATIENT REFUNDS ARID=OOOl APCDEDIT
PAY PAT
DATE AMOUNT CODE TYPE DESCRIPTION GL NUN
092612 925.60
092612 384.00/
092612 602.28)
071712 47.20 I
092612 237.41 /
092612 48.19 /
092612 32.741
092612 11.72 /
RUN DATE: 09/26/12
TIHE: 11:32
PATIENT
NUHBER
PAYEE HAIlE
~-_._-------------------------------------------------------------------------------------------------~-----------------------------
ARID=OOOl TOTAL
2289.14
------------------------------------------------------------------------------------------------------------------------------------
TOTAL
2289.14
()~j:j} IfD/9tp
-rD
jl: 150),W
PM~ F)-If.!
Michael J. pfeifer
Calhou9, County Judge
oate:.J1_::.kt~:LJ/
&i\~1PROVEr))
2 7
RUN DATE, 10/03/12
TIllE' 12:11
IIEMORIAL I!EDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/16/12
PAGE: 1
APOPEN
VEND#.NAflE...........................CLS.INVOICE#.........~RN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
A1360 MIERISOURCEBERGEN DRUG COR /
PHARflACEUTICALS W 705422044 093012 092612 101012 117.30 .00 117.30
PHARflACEUTICALS 705422045 093012 092612 101012 13.14 .00 13.14 /
PHARflACEUTICALE 705425578 093012 092612 101012 48.88 .00 V-
48.88 .I
Pl1ARlIACEUTICALS 705477637 093012 092712 101012 783.97 .00 783.97
TOTALS... ....... to.. ..... to... ....,.. 11......t 963.29 .00 963.29
A2150 ANNOUNCEI.IENTS PLUS TOO AGA
SUPPLIES OB 11 02416 093012 090612 100512 52.00 .00 52.00 ./
TOTALS...................................... .1 52.00 .00 52.00
A2345 A~&T I!OBILITY
TELEPHONE ZX09262012 093012 092612 101312 522.65 .00 3'7,;{,(Pg ~
TOTALS....................................... : 522.65 .00
A2600 AUTO PARTS << HACHINE CO.
SUPPLIES PlJINT OPS W 654786 093012 091712 101612 17.88 .00 47.88 )
TOTALS....................................... , 47.88 .00 47.88
Bl075 BAXTER HEALTHCARE CORP 315.63 ,,/
SUPPLIEE CS INV l! 38302197 092112 091412 101312 315.63 .00
SUPPLIEE CS INV 38304550 092112 091412 101312 567.47 .00 567.47 /
TOTALS...................................... .1 883.10 .00 883.10
B1220 BEClIIlAN COULTER INC
SUPPLIES LAB l! 103090769 092512 091012 101112 255.93 .00 255.93 /
SUPPLIES LAB 103090860 092512 091012 101012 367.09 .00 367.09 ,,/
SUPPLIEE LAB 103095347 092512 090912 101012 407.72 .00 407.72'/
LEASE/!lAINTENANCE LAB 5277588 092512 091212 101212 3140.19 .00 3440.19 ./
LEASE/llAINTENANCE LAB 5277589 092512 091212 101212 3933.48 .00 3933.48/
TO~ALS....................................... , 8404.41 .00 8104.41
10599 BKD, LLP 11821.00/
AUDITING FEES BK00106130 093012 092812 092812 11821. 00 .00
TOTALS...................................... .1 11821. 00 .00 11821.00
B1655 BOSTON SCIENTIFIC CORPORAT
SUPPLIES SURGERY I! 933908805 091712 091212 101112 207.52 .00 207.52 ,/
TOTALS....................................... : 207.52 .00 207.52
B0437 C R BARD INC 238.00/
SUPPLIES SURGERY l! 61011667 091812 091212 101112 238.00 .00
TOTALS.............. .........................: 238.00 .00 238.00
10350 CENTURION HEDICAL PRODUCTS 539.96 j
SUPPLIES CS INV 91107736 091712 091212 101112 539.96 .00
SUPPLIES CS INV 91110225 092012 091412 101312 662.50 .00 662.50/,
SUPPLIES CS INV 91110742 092112 091712 101612 331.59 .00 331.59
TOTALS....................................... : 1534.05 .00 1534.05
C1478 CHANNING L BETE CO INC
SUPPLIES EDUCATION l! 52547846 092112 091412 101312 349.03 .00 349.03 ./
RUN DATE: 10/03/12
TII!E, 12:44
IIEHORIAL 1.IEDICAL CENTER
AP OPEN IHVOICE LIST THRU DUE DATE OF 10/16/12 .
PAGE' 2
APOPEN
VEND#.NrolE...........................CLS.INVOICE#.........TRN DT.INV DT.DUE DT.CK DT..PC.......GROES.....DISC......NO-PAY........NET
TOTALS....................................... : 349.03 .00 349.03
H2900 CHERYL HITCHEW 115.83 .../
TRAVEL PFS W 24147 093012 092712 092712 415.83 .00
TOTALS....................................... : 415.83 .00 415.83
C1970 CONflED CORPORATION 643.93 /
SUPPLIES SURGERY N 407318 092112 091712 101612 643.93 .00
TOTALS...................................... .: 643.93 .00 643.93
C0399 CORPUS CHRIETI PROSTHETICS 95.00/
SUPPLIES SURGERY 24117 091712 091212 101112 95.00 .00
TOTALS...................................... .: 95.00 .00 95.00
10556 CPP WOUND CARE ~28,LLC
WOUND CARE AUGUST2012 092412 092712 101012 19050.00 .00 19050.oiV
TOTALS....................................... : 19050.00 .00 19050.00
C2510 CPSI
ELECTRONIC PAYSTUB !I 752061 093012 092112 092112 148.05 .00 148.05/
EBOS 752588 093012 092112 092112 265.98 .00 265.98'/
STATEMENT PROCESSING 753479 093012 092712 092712 62.40 .00 62.40/
TOTALS....................................... : 476.43 .00 476.43
10368 DEWITT POTH & SON
SUPPLIES VARIOUS 312668-0 091712 090512 101512 279.56 .00 279.56 ,/
OFFICE SUPPLIES 343347-0 091712 091212 101512 8.61 .00 8.61'/
OFFICE SUPPLIES ACCT 343348-0 091712 091212 101512 12.58 .00 12.58/
OFFICE SUPPLIES VARIOUS 343451-0 091712 091212 101512 156.31 .00 156.31/
OFFICE SUPPLIES "ED EURG 313614-0 091712 091312 101512 18.00 .00 18.00 ,,/
OFFICE SUPPLIES VARIOUS 343857-0 092112 091712 101512 259.94 .00 259.94"::;
OFFICE SUPPLIES CE INV 314280-0 092112 091912 101512 195.83 .00 195.83
OFFICE SUPPLIES INDIGENT 345165-0 093012 092612 101512 98.85 .00 98.85-::1
OFFICE SUPPLIES PT 345167 -0 093012 092612 101512 85.16 .00 85.16
OFFICE SUPPLIES VARIOUS 345305-0 093012 092612 101512 296.87 .00 296.87 ;;
OFFICE SUPPLIES CARDIO 345340-0 093012 092612 101512 74.22 .00 74.22
OFFICE SUPPLIES WOHENS CL 345375-0 093012 092712 101512 269.86 .00 269.86.....
OFFICE SUPPLIES ER 345574-0 093012 092812 101512 5.49 .00 5.49'l
OFFICE SUPPLIES HR 345613-0 093012 092812 101512 27.00 .00 27.00'/
OFFICE SUPPLIES FORMS 73750 093012 092412 101512 13.33 .00 13.33 ,,/
TOTALS...................................... .: 1801. 61 .00 1801.61
D1608 DIVEREIFIED 8USlNESE SYSTE 362.85 .../
SUPPLIES CS IHV M 22842 091112 091112 101012 362.85 .00
TOTALS....................................... , 362.85 .00 362.85
01752 DLE PAPER & PACKAGING /
FORBS CS INV \q 6771 092112 091712 101612 179.75 .00 179.75
TOTALS...................................... .: 179.75 .00 179.75
D1710 DOl'lNTOliN CLEANERS /
OUTSIDE SRV WOHENS CLINIC W ~lC-AUGUST 092512 091312 101212 52.00 .00 52.00
RUN DATE: 10/03/12
TI!IE: 12:41
"E"ORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/16/12
PAGE: 3
APOPEN
VEND#.NAlIE...........................CLS.INVOICE#.........TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
TOTALS...................................... .: 52.00 .00 52.00
F1400 FISHER HEALTHCARE
SUPPLIES LAB II 3025252 092512 091112 101012 95.48 .00 95.48 -'
SUPPLIES LAB 3025259 092512 091112 101012 95.48 .00 95.48 ,/
SUPPLIES LAB 3025260 092512 091112 101012 67.36 .00 67.367
SUPPLIES LAB 3095833 092512 091212 101112 765.09 .00 765.09
SUPPLIEE LAB 3168231 092512 091312 101212 672.48 .00 672.48 ......-
SUPPLIES LAB CREDIT 3245829 092512 091412 101312 -672.48 .00 -672.48/
SUPPLIES LAB 3335376 092512 091712 101612 16.20 .00 16.20 ......-
SUPPLIES LAB 3449990 992512 091812 101512 29.16 .00 29.16/
TOTALS....................................... : 1098.77 .00 1098.77
W1300 GRAINGER
SUPPLIES plJINT OPS II 9923460191 091712 091012 101012 182.52 .00 182.52 /
TOTALS....................................... , 182.52 .00 182.52
G0401 GULF COAST DELIVERY /
OUTSIDE SERIVCE AUGUST 093012 093012 093012 100.00 .00 100.00
TOTALS....................................... , 100.00 .00 100.00
A1292 GULF COAST HARD~'ARE I ACE J
SUPPLIES BIOllED W 071292 092112 091712 101612 3.78 .00 3.78
TOTALE....................................... :. 3.78 .00 3.78
G1210 GULF COAST PAPER COHPANY
SUPPLIES HOUSEKEEPING II 451403 091712 091112 101012 188.52 .00 188.52 /
TOTALS....................................... , 188.52 .00 188.52
H0030 H E BUTT GROCERY
SUPPLIES DIETARY H 365105 091412 091112 101012 43.54 .00 43.54~
SUPPLIES DIETARY 368665 092012 091312 101212 303.99 .00 303.99
TOTALS....................................... : 347 .53 .00 347.53
Hll00 HAYES ELECTRIC SERVICE /
DEPT REPAIR DIETARY 1'1 A2120620-04 093012 061512 071412 626.03 .00 626.03 /
DEPT REPAIR A2120625-02 093012 062512 072412 714.09 .00 711.09
DEPT REPAIR OOEDSURG A2120810-09 093012 090612 090512 652.11 .00 652.11 ,./
TOTALS...................................... .: 1992.23 .00 1992.23
H3400 HUBERT COllPANY 258.54 /
SUPPLIES DIETARY H 951732 091712 091112 101012 258.54 .00
TOTALE...................................... .: 258.54 .00 258.51
10950 INFOLAB INC
SUPPLIES BLOOD BANK H 3163285 092512 091112 101012 320.02 .00 320.02 /
SUPPLIES LAB 3165667 092512 091712 101612 965.68 .00 965.68 ./
TOTALE....................................... : 1285.70 .00 1285.70
11100 INSTRUlIENTATION LABORATORY 2060.54/
SUPPLIES LAB 1I 9101107792 092512 091112 101012 2060.54 .00
RUN DATE: 10/03/12
TIllE, 12:44
!IEMORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/16/12
PAGE, I
APOPEN
VEND#.NroIE........... ................CLS.INVOICE#. ........TRN DT.INV DT.DUE DT.CK DT..PC.......GROSS... ..DISC..... .HO-PAy........NET
TOTALS....................................... : 2060.54 .00 2060.54
11263 IVANS
COLLECTIONS AUGUST II 12D0128237 092512 091312 101212 203.88 .00 203.88 ..........
TOTALS....................................... , 203.88 .00 203.88
J1201 JACK L. !lARCUS, INC 203.86 /
E~IPLOYEE PURCHASE 71997 091812 091412 101312 203.86 .00
TOTALS........................,............. .: 203.86 .00 203.86
J1300 JECKER FLOOR & GLASS
SUPPLISS PI.ANT OPS II 67536 092112 091212 101112 19.50 .00 19.50 .....--
TOTALS....................................... , 19.50 .00 19.50
J1400 JOHNSON & JOHNSON
SUPPLIES SURGERY 908617862 092412 091712 101612 501.00 .00 501.00 .......
TOTALS....................................... , 501.00 .00 501.00
L0700 lJIBCORP OF AOOERICA HOLDING
OUTSIDE SRV LAB II 38620311 093012 090112 100112 98.00 .00 98.00 ..--
TOTALS....................................... : 98.00 .00 98.00
R1452 llARISSA SUTHERLAND
FLEX SPEND REllIBURSE!IENT 11 24149 093012 100212 100212 131. 00 .00 131.00,./'
TOTALS....................................... : 131.00 .00 131. 00
M1500 lWU(S PLlmlBlNG PARTS 100.68 /
SUPPLIES PI.ANT OPS II 1152812 092112 091312 101212 100.68 .00
TOTALS....................................... : 100.68 .00 100.68
N2659 HERRY X-RAY- SAN ANTONIO 2042.56 /
EUPPLIES VARIOUS M 477731 091712 091312 101212 2042.56 .00
TOTALS....................................... , 2042.56 .00 2042.56
112685 lIICROTEK HEDICAL INC
SUPPLIES CE INV !l 2941031 092112 091712 101612 223.66 .00 223.66 /
TOTALS....................................... : 223.66 .00 223.66
10663 MIRELES TECHNOLOGIES, INC /
INSTRlmlEHT REPAIR10533 5650 092512 091212 101112 520.00 .00 520.00
TOTALS....................................... : 520.00 .00 520.00
10441 t~IC EMPLOYEE BENEFITS
l'IEEKLY ClJIII!S 18261 093012 092812 092812 4028.69 .00 4028.69 ,./
TOTALS....................................... : 4028.69 .00 4028.69
10536 HORRIS & DICKSON CO, LLC -70.98/
PHAroIACEUTICAL CREDIT 1291 091812 091712 101012 -70.98 .00
PHARIlACEUTICALS 3810254 091812 091712 101012 256.65 .00 256.65:;
PHAR!lACEUTICALS 3810255 091812 091712 101012 536.04 .00 536.04 :/
PHARIlACEUTICALS 3813407 092012 091812 101012 298.29 .00 298.29
RUN DATE: 10/03/12
THIEl 12:44
HEMORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/16/12
PAGE: 5
APOPEN
VEHD#.Nro!E.......................... .CLS.INVOICE#........ . TEN DT.INV DT.DUE DT.CK DT. .PC...... . GROSE. ... .DISC..... . NO-PAY. ...... .IIET
PHAR!lACEUTICALS 3817518 092012091912 101012 1133.81 .00 1133.81/
PHARIlACEUTICALS 3819239 092012 091912 101012 54.81 .00 54.81 ,/
PHAR!lACEUTICALS 3819240 092012 091912 101012 2747.84 .00 ,/
2747.84./
PHAlUIACEUTICALS 3819720 092012 091912 101012 12.02 .00 12.02
PHAlUIACEUTICAL CREDIT CI!42547 092012 091812 101012 -10.01 .00 -10.01 "...
PHAlUIACEUTICALS CREDIT CI!43076 092012 091912 101012 -37.16 .00 -37.16 ,,/
PHAlUIACEUTICAL CREDIT 2162 092412 092012 101012 -380.46 .00 -380.16 ./
PHAR!lACEUTICALS 3823856 092412 092012 101012 4770.18 .00 4770.18 ./
PHAlUIACEUTICALS 3823857 092412 092012 101012 3177.84 .00 3177.84/
PHAR!lACEUTICALS 3823858 092412 092012 101012 92.17 .00 92.17/
PHARIlACEUTICAL CREDIT C>l43667 092412 092012 101012 -54.54 .00 -51.54 ,/
PHAR!lACEUTlCALS 3833118 993012 092412 101012 15.53 .00 15.53/
PHAR!lACEUTICALS 3833419 093012 092412 101012 876.58 .00 876.58 ,./
PHAR!lACEUTICALS 3833420 093012 092412 101012 1369.95 .00 1369.95 ,./
PHAR!lACEUTICALS 3837791 093012 092512 101012 7.48 .00 7.48/
PHAR!IACEUTICALS 3837792 093012 092512 101012 585.51 .00 585.61......
PHAR!IACEUTICALS 3841216 093012 092612 101012 5705.20 .00 5705.20/
PHAlUIACEUTICALS 3841570 093012 092612 101012 226.81 .00 226.81/
PHAR!lACEUTICALS 3841571 093012 092612 101012 19.54 .00 19.54,/
PHAR!lACEUTICALS 3842844 093012 092612 101012 357.34 .00 357.34'/
PHAR!lACEUTICALS 3842845 093012 092612 101012 820.55 .00 820.55 ,/
PHAR!lACEUTICALS 3847659 093012 092712 101012 38.71 .00 38.71"/
PHAR!lACEUTICALS 3847660 093012 092712 101012 940.14 .00 940.14~
PHAR!lACEUTICALS 3848112 093012 092712 101012 160.01 .00 150.01
SHIPPING SC9512 093012 092512 101012 23.95 .00 23.95/
TOTALS....................................... : 23673.90 .00 23673.90
A2252 NADINE GARNER 39.68/
TRAVEL EXPENSES IIlF CONTR W 24148 093012 100112 100112 39.58 .00
TOTALS....................................... : 39.68 .00 39.68
N1225 NUTRITION OPTIONS
DIETICIAN 11 SEPT2012 093012 093012 101512 3000.00 .00 3000.00/
TOTALS....................................... : 3000.00 .00 3000.00
OH425 OlIENS & 11INOR
SUPPLIES SURGERY 1986537 091712 091112 101012 107.21 .00 107.2V
SUPPLIES VARIOUS 1986945 091712 091112 101012 4119.20 .00 4119.20,/
SUPPLIEE CS INV 1987035 091712 091112 101012 570.52 .00 57o.s2 /
SUPPLIES ANESTHESIA 1987189 091712 091212 101112 9.09 .00 9.09/
SUPPLIES VARIOUS 1987975 091712 091312 101212 265.97 .00 265.97/
SUPPLIES CS INV 1988124 091712 091312 101212 25.01 .00 26.01/
SUPPLIES VARIOUS 1988842 092012 091412 101312 2037.47 .00 2037.47 ~
SUPPLIES SURGERY 1988143 093012 091312 101212 145.85 .00 145.85
TOTALS....................................... , 7281.32 .00 7281.32
P1800 PITNEY BOI~S INC 207.00/
QTLY 10/16 - 1/15 W 661717 092512 091612 101612 207.00 .00
TOTALS....................................... : 207.00 .00 207.00
P1876 POLYI!EDCO INC. I
SUPPLIES LAB N 1009713 092512 091312 101212 608.70 .00 608.70
RUN DATE: 10/03/12
TIllE: 12:44
11EI!ORIAL IIEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/16/12
PAGE, 6
APOPEN
VEND#.NAl!E...........................CLS.INVOICE#......... TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
TOTALS....................................... , 608.70 .00 608.70
R1200 RED HAlIK 725.00 ./
QRTLY 9/1 - 11/30 7020390984 093012 090612 100512 725.00 .00
TOTALS....................................... : 725.00 .00 725.00
10528 RICK HART 1008.00 ,/
FLEX SPEND REI~lBURSEMENT 24150 093012 100212 100212 1008.00 .00
TOTALS....................................... : 1008.00 .00 1008.00
10664 SAGENT PHARNACEUTICALS, IN 1128.00 /'
PHAR!lACEUTICALS 257310 100112 091312 101312 1128.00 .00
TOTALS...........,........................... : 1128.00 .00 1128.00
S1800 SHERWIN ~aLLIAl~S
DEPT REPAIR RADIOLOGY 11 1327-6 092412 091112 101012 18.44 .00 18.44/
DEPT REPAIR OUT PATIEHT 1455-5 092412 091312 101212 41.37 .00 11.37......
SUPPLIES PlJIN TOPS 1491-0 092412 091412 101312 36.28 .00 36.28/
TOTALS....................................... : 96.09 .00 96.09
S1850 SHIP SHUTTLE TAXI SERVICE
OUTSIDE SRV ER 11 24151 093012 091212 101212 22.00 .00 22.00 /
TOTALS..................................... ..: 22.00 .00 22.00
10699 SIGN AD, LTD. 350.00/
OCT BILLING 159118 093012 100112 101012 350.00 .00
TOTALS....................................... : 350.00 .00 350.00
S2651 SPS MEDICAL 22.50/
SUPPLIES SURGERY 285622 100112 091112 101012 22.50 .00
TOTALS...........;........................... , 22.50 .00 22.50
82694 STANFORD VACum! SERVICE 320.00 ./
GREASE TRAP PUlIPED II 221134 092012 091112 101012 320.00 .00
TOTALS....................................... : 320.00 .00 320.00
83940 8TERIS CORPORATION 71.79 -:::
INSTRUlIEHT REPAIR SURGERY H 4396246 092112 091212 101112 71.79 .00
INSTRUlIENT REPAIR SURGERY 4401052 092412 091712 101612 217.13 .00 217.13
TOTALS........ ...............................: 288.92 .00 288.92
S2951 SYSCO FOOD SERVICES OF /
SUPPLIES DIETARY M 209200779 092512 092012 101012 960.99 .00 960.99 /
SUPPLIES DIETARY 209270801 100112 092712 101612 966.76 .00 966.76
TOTALS..................................... ..: 1927.75 .00 1927.75
T1450 TAC UNEIIPLOYlIENT FUND 7730.21/
UNEOOPLOYloIENT FUND 11 18262 100112 092812 092812 7730.21 .00
TOTALS........... ~...........................: 7730.21 .00 7730.21
T0500 TEAll REHAB 15000.00/
INTER!!! BILLING 11 24152 100112 100112 100112 15000.00 .00
RUN DATE, 10/03/12
TIME: 12:14
IIE!!ORIAL MEDIcAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/16/12
PAGE: 7
APOPEN
VEND#.NroIE...........................CLS.IHVOICE#.........TEN DT.INV DT.DUE DT.CK DT..PC.......GROSS.....DISC......NO-PAY........NET
TOTALS...................................... .: 15000.00 .00 15000.00
T1900 TEXAS ELECTRICAL SUPPLY
SUPPLIES PI.ANT OPS II 26929 100112 091712 100112 246.75 .00 246.75 ........
SUPPLIES PLANT OPS 26930 100112 091712 100112 238.80 .00 238.80~
SUPPLIES PI.ANT OPS 26939 100112 091912 100112 20.85 .00 20.85
TOTALS...................................... .: 506.40 .00 506.40
T2204 TEXAS IlUTUAL INSURANCE CO ./
INSURANCE \'1 18263 093012 093012 101512 6180.00 .00 6180.00
TOTALS....................................... : 6480.00 .00 6180.00
T0801 TLC STAFFIMG /
CONTRACT NURSE \'1 10588 092412 091112 101112 523.75 .00 523.75
TOTALS...................................... .: 523.75 .00 523.75
Ul054 UNIFIRST HOLDINGS 32.54 /
LAUNDRY llAINTENAHCE II 8150583558 091112 091112 101012 32.54 .00
TOTALS....................................... : 32.54 .00 32.54
Ul064UNIFIRST HOLDINGS INC 732.31-2
LAUNDRY HOSPITAL LINEN 8400132309 091112 091112 101012 732.31 .00
LAUNDRY HOUSEKEEPING 8400132310 091112 091112 101012 182.19 .00 182.19 Y
LAUNDRY PLAZA 8100132311 091112 091112 101012 157.55 .00 157.55
LAUNDRY DIETARY 8400132312 091112 091112 101012 174.86 .00 174.86}
LAUNDRY OB 8100132313 091112 091112 101012 86.70 .00 86.70 "/
LAUNDRY HOUSEKEEPIHG 8400132314 091112 091112 101012 90.22 .00 90.22
LAUNDRY HOSPITAL LINEN 8100132536 092012 091412 101312 683.28 .00 683.28 /
LAUNDRY SURGERY 8400132537 092012 091412 101312 348.59 .00 348.59/
TOTALS....................................... : 2455.70 .00 2455.70
Ul056 UNIFORN ADVANTAGE 390.74~
EIIPLOYEE PURCHASE il 4592525 092112 091112 101012 390.71 .00
EIIPLOYEE PURCHASE 4598535 093012 091412 101312 12.99 .00 12.99
TOTALS....................................... , 403.73 .00 403.73
10172 US FOOD SERVICE 4069.51 ~
SUPPLIES DIETARY 5755729 092512 092012 101012 4069.51 .00
SUPPLIES DIETARY 5777916 093012 092012 101012 78.17 .00 78.17
SUPPLIES DIETARY 5S84875 100112 092712 101612 3641. 00 .00 3641.00/
TOTALS....................................... , 7788.68 .00 7788.68
V0555 VERIZON SOUT~~ST 111.28../
TELEPHONE H 5522646091612 092412 091612 101112 111.28 .00
TELEPHONE 5525926091612 092412 091612 101112 62.56 .00 62.56/
TELEPHONES 197-7697091912 093012 091912 101412 53.38 .00 53.38 /
TELEPHONE 5521567091912 093012 091912 101112 43.43 .00 43.43 /
TOTALS...................................... .: 270.65 .00 270.65
VOS59 VERIZON I<aRELESS 161.70/
BROADBAND CARD 6787149632 092412 091612 101112 161. 70 .00
RUN DATE: 10/03/12
TIHE: 12:44
HEIIORIAL HEDICAL CENTER
AP OPEN INVOICE LIST THRU DUE DATE OF 10/16/12
PAGE: 8
APOPEN
VEND#.NAME...........................CLE.INVOICEn.........TEN DT.INV DT.DUE DT.CK DT..PC.......GROEE.....DISC......NO-PAY........NET
TOTALS..................... ...................:
V1471 VICTORIA RADIOWORKS, LTD
ADVERTISING 9/7 - 9/28 1'1 12090320 093012 093012 101512
TOTALS...................................... .:
1'11005 WALlW\T COHlroHITY
VARIOUS MISC PURCHASES 1'1 AUGUST2012 092112 091012 101212
TOTALS...... ,........ ........................:
GRAND TOTALS.................................:
~KSJ;\ /)"0 wy
+--0
q!<-/SD:275
v 0 /05
----
8;50 z-~
JJ- (502/0
p}p(
~ c' /) 1--
IO/J
AiPPROVEI:>>
lll! 0 1j 2012
COUNT'\! I"UIJI10fOfi
161. 70 .00 161.70
140.00 .00 140.00 /
140.00 .00 140.00
110.05 .00 110.05)'
110.05 .00 110.05
145993.56 .00 145993.56
Correcf:i)r) { !fZZ.(P~)
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Run Date: 09/11/1?- MEMORIAL JlED1CAL CElIlER Page 63
Time: 13:15 Payroll Register I ai-Weekly J P2RBQ
pay Period 06/24/12 - 09/06/12 Run! 1
Final Summary
*-- Pay Cod e Sum mar y _n___u_~___n________d_n.._______~___tn D e due t ion s Sum m a I y __n______u_*
"PayCd Description II" ImlslIl'ml"olcBI Gross IDJde Amount I
t_____.__.______________~________________._______h__~_____.w_.___n__u____i_._______._~________._____.___._____~__________.____i
1 RRGurJlR PAY-Sl 7104.00 N N N 127596.27 AIR 610.00 AilARDS 1lOOI'S
1 REGULAR PA'f-Sl 1092.25 11 N N N 35992.15 .Cl\FE-C 679.96 Cl\l'E-P 644.05Cl\FH
1 REGULlIR PAY-Sl 224.00 N N Y 5577.62 Cl\FB'N 7775.66 Cl\FlH' 266,~6 CI\lH-L 110.14
1 REGIJLl\R PAY-S1 70.50 Y II N 2065.59 Cl\FB'P 392.05 CANCBR 12.58 CLINIC 50.00
2 REQIJLl\R PAY-S2 2235.50 N N N 46204.15 CREDUN 25,JlQ.",DIlNTAL 520.60 OEP-LF 200.58
2 REGIJLl\R PA~-S2 1.50 11 N N N 52,31 Fll~!'i'ICl\-M 4292.21 FICII.-O 12432.52
2 RllG\lLAA PAY-S2 159.50 fl " ~ 4994.02 FLBKS1547.74 FORT D FOTA
2, REGULlIR PAY-S2 48.00 Y N N 1656.73 GUT S 262.79GRlIN! GRP-rN 129.25
3 REGULAR PAY-S3 1l80.50 N N N 32572.93 G'fL HOSP-I 4230.00 rom
3 REGULAR PAY-S3 123.25 N 11 Y 4316.50 LIlA' MISC 40,00 arll" 1970.37
3 REGULAR PAY-S3 104.00 Y 11 N 440U5 PHI PR FIN 390.69 R8PAY
8 SICK BOhllS 35.00 N N N N 591.12 SHX S'11lDIlN 130.49 TSA-l
C CALL PAY 634.00 N N N N 1256.00 TSA.2 TSA-C TSH
C CALL PAY 1822.75 II N N 3545.50 TSA-> 21556.59 'IUTION UW/HOS
B EX'lRA WAGllS N N N II 636.90
B EXTRA WAGBS II 1 II N II 1155.00
F FUll8RA1 LIlAVE 24,On II 1 II ll' 353.04
I nlSBRVICR 13.25 II 1 II II 372.21
K EX'lBNDBD- ILrnESs-BlllX 16.no II 11 II II 266.40
K EXTENDED~ ILLNESS -BANK 322.00 N 1 JI N 5213.18
, PAID-1IME-OFF 214.11 II N N N 5570,90
, PAID-TIllE.OFF 1310.!5 II 1 N II 22185,39
X CALL PAY 2 139.00 N 1 11 N 211,00
y YMCA/CURVES N N II II 60,00
Z CALL PAY 3 120.00 II N N 160,On
p 'AID 1Il1B OFF . 'RORATION 20.00 N N N 190,64
*_n~~~~n_____~~__'_ Grand Totals: 17215.56 ---~~~~ ( Gross: 307950.65 Deductions: 91361.51 Net: 216533.161
I Checks Count: - FT 162 'I 16 Other 29 Female 179 Male 26 Credit OverAmt 17 Zerollet Terra Total: 2071
*._._.~.__________._~__..__._____~.___~.._________.._.__.~_....__~__...~_.___..~__.__..___~..._____.~.~_....__.__________~_____~J
FED TAX 32,555.64/ ':-l t~
/ j i.~ "
FICA 0 30,785.38 l.:
8,584.54/ :.-IU j
FICAM i 1-...-0
,
TOTALS 71,925.56
Tax Payment Report Worksheet
EFTP5 Voice Response 51 (Photocopy this worksheet forfuture use.)
~ You dial:
EFTPS responds:
You enter:
1-800-555-3453
"Welcome to the Electronic Federal Tax Payment System"
"If you are calling from a Touch Tone phone, press 1."
1 (For Touch Tone phone)
"~;l'-1 EFTPS prompts: "Enter your 9-digit Taxpayer Identification Number'
You enter: IIJIJlJ []2J[Q]@] mWm m
(9-dlgit Employer Identification Number)
1l';';'~;11 EFTPS promts:
You enter:
"Enter your 4-digit PIN"
.--...,.~
digit Personal Identification Numb
,,~<11 EFTPS prompts:
You enter:
i-";,;~ EFTPS prompts:
You enter:
EFTPS responds:
Lists the Main Menu Selections
Press 1 (to initiate a tax pryment)
"Enterthe Tax Type numberfollowed by the pound (# sign:'
rn@] [Z]r-tD 0 (3-t06digittaxtypenumberfrom
the IRS Tax Form-Ta6le1iiAppendlx A)
"You entered Tax Type{Tax Description (Based on the selection in step #5)
You enter:
~,),i~l EFTPS prompts: "EnterTax Payment Type"
'~Uj EFTPS prompts:
You enter:
I~<<(\~ EFTPS prompts:
You enter:
fJ;l[% EFTPS prompts:
I.ffi EFTPS responds:
You enter:
1 digit number Tax Payment Type
(Tax Payment Type specific to Tax Form Code In Appendix D)
"Enter the 4-digit Tax Filing Period starting with the year ollowed by !'lonth'"
IJJ f/,h1 []] ~ (Valid 4-digit Tax Period based on IRS Tax Form
Table iii1P'Pendix A)
"Enter the payment Amount followed by thepound (#) sign."
(You must enter cents even If you are reporting a whole dollar amount.)
$DO,OrnITJ,GJOO[5].I3JEI
(Your payment amount cannot exceed $99,999,999.99)
Enter the 2-digit Verification Code."
o D Verification Code*
'(See Appendix E for Verification Code Calculation)
"Enter the 6-diglt tax payment sel1:lement date by month, day, year."
(Note, the next business date you enter must be at least one business day
in the future). ~
{JlJ1KJ G:IIKJOJ EEl '
(6-digit tax payment settlement day in MMDDYV format) (Continue)
~J;--
5S~qo-O;rD
to.ttt( (.fA,. ,
qll~IIQ
Run Date: 09/25/12
Time: 11:20
Final summary
MEMORIAL M80ICAL CENTER
Payroll Register ( Ei-Weekly J
Pay Period 09/07/12 - 09/20/12 Runl1
Page E3
P2REG
*_~ Pay Cod e Sum mar y u_~_u~__nnn"__d______________._____tu D e due t i 011 S Sum mar y _u___ndU_r
I PayCd oescription Hrs 10TIsHlwBIHOlcBI Gross I Code lII10unt I
*________________________u________________________________________________*____________________________________________n____ui
1
1
1
2
2
3
3
B
C
C
E
E
F
I
I
K
K
P
P
X
X
Z
REGUlAR PAY-S1
REGULAR PAY-S1
REGULAR PAY-S1
REGUlAR PAY -S2
REGUlAR PAY-S2
REGUlAR PAY-S3
REGUlAR PAY-S3
SICK BONUS
CALL PAY
CALL PAY
EXTRA WAGES
EXTRA HAGES
FUNBRAL LEAVE
INSERVICE
INSBRVICE
EXTENDED- ILLNESS-BANK
EXTBNOED- ILLNESS-BANK
PAID-TIME-OFF
PAID-TmB-OFF
CALL PAY 2
CALL PAY 2
CAL1 PAY 3
7B93.75 N N N
928.25 N N N N
132.25 Y N N
2!98.00 N N N
93.75 Y N N
1552.00 N II N
113.00 Y N N
71.92 N N N
12.00 N N N N
2141.00 N 1 N N
N N N II
N 1 N N N
21.00 N 1 N N
141.75 N 1 N N
.25 Y 1 N N
10!.OO N N N N
140.00 N 1 N N
28.00 N N N N
115\.85 N N N
32:00 N N N N
120.00 N N N
82.00 N N N
115263.83
2986!.O9
!743.37
52119.97
3047.58
36834.75
5032.37
1569.11
2!.OO
5080.00
210.10
1405.00
766.32
5293.31
12.53
1878.32
1882.52
280.80
22639.00
6!.00
2!0.00
246.00
A/R
CAFE-C
CAFB-H
CAFE-P
CREDUN
FEOTAX
FLEX S
GIFT S
GTL
LEAF
PHI
ST-TX
TSA-2
TSA-R
672.50 AWARDS
679.96 CAFE-D
7685.00 CAFE-I
392 . 0 5 CANCER
25.00 DENTAL
J3337.65 FICA-H
1521.2! FORT D
75.18 GRANT
HOSP-I
I.usC
PR PIN
STUOBN
TSA-C
22223.98 TOTION
800TS
835.50 CAFE-F
288.06 CAFE-L
12.68 CLINIC
536.800EP-1F
4447.32 FICA-O
POTA
GRP-IN
4392.22 lD TF!
55.00 OTHER
390.89 REPAY
131.27 TSA-1
TSA-P
UN/HOS
110.14
200.68
12674.9!
129.26
1791.89
*~_____~_uu_.u____ Grand Totals: 11566.11 ___".n (Gross: 318521,27 Deductions: 92909.81 Net: 225611.46 J
I Checks Count;- FT 160 PT 16 Other 3S Female 179 Male 32 Credit OverAmt 19 ZeroNet Term Total: 211 I
i....______.._______._______._____._._____________________..._____..___________________...______u_________________"------------*
Run Date: 09/26/12
Time: 08:51
Department 090
MEMORIAL m:nrCAL CENTER
Payroll Register ( Bi-Weekly )
Pay Period 09/07/12 . 09/"/12 Run! 2
Dept, Sequence
Page
P2REG
to. E III P 1 0 Y e e ____.t.. Tim e uun...uuud.___.n__n_nnnnn.n__i__ 0 e due t ion S ._____nn___n.n__n___!
INum/lype/Name/pay/E<enptlpayCd Dept Hrs IOTlsalllRIHolcBI Rate Gross I Code PJlt()unt I
tH...___________________.i_____________._.__________._._________________________..__________.__.........__....____________________!
00482 IT HrlV: 19.6900 B 090 36.00 N
N N N 19.6900
108.81 FEDIAX 10.12 FlCJ\-H 10.2B FrCA.O 29.11
TSH !9.62
Fed-Ex, S-OO St-Ex, -00
L.___unn___.u___n_____.t Total: 36.00 ___n.n.n__m j Gross:
108.8!
Deductions: 160.09
Net:
518.751
Department Summary
*-~ Pay Cod e Sum mar y H_n._n___....u..m_._.____._.__u___~__ 0 e due t ion s Sum mar Y _.U.____H..'
I PayCd Description Hrs IOTISHIHEIHolcBI Gross I Code _nt I
i.__.___________""________............_____._________________._________n__*_._.._............._..._.______________________...._1
B 36.00 N N N N 708,61 AIR AWARDS BOOIS
CAFE-C CAFE-D CAFE-F
CAFE.H CAFE-I CAFH
CAFE-P CAIICER CLIIIIC
CREDIDf DBIITAL DBF-LV
FEDTAX 70,12 FICA-N 1D,2B FICA-O 29,77
FL8X S FORT 0 FUIA
GIFT S GRANT GENN
OIL HOSN rom
LEAF MISC OTHER
PHr PR FIll REPAY
ST-TI STUDBN TSA-l
TSA-2 TSA'C TSA-!
TSH !9,62 TUTION W/HOS
*...uu_.___n_ Department Totals: 36.00 -----.. (Gross: 708,64 Deductions: 160,09 Net: 54l!...75)
I Checks Count:. FT 1 PT Other Female 1 Male Credit OverAmt ZeroNet Term Total: 11
* _______~__ _~n____ _u _ ___ ____...... .... _ .._. _ _ _ u _ _ n _ n_ n____ ___.__u......... __.. n. _n u un. n_n. _n _._.._ __.. .._" .__.. ..i
.----------
......
---...
Tax Payment Report Worksheet
EFTPS Voice Response S, (Photocopy this worksheet for future use.)
lB1ill You dial:
EFTPS responds:
You enter:
1-800-555-3453
"Welcome to the Electronic Federal Tax Payment System"
"If you are calling from a Touch Tone phone, press 1."
1 (For Touch Tone phone)
"Enter your 9-digit Taxpayer identification Number"
It1:lI EFTPS prompts:
You enter:
!IJ1J[]QL][Q]@JQJrnmm
(9-digit Employer Identification Number)
You enter:
"Enter your 4-dig\t PIN"
~l""'""'"
~~
EFTPS promts:
J digit Personal Identification Numb
II'>!","' EFTPSprompts:
--~
You enter:
Lists the Main Menu Selections
ltJg, EFTPS prompts:
You enter:
Press 1 (to initiate a tax pryment)
EFTPS responds:
"Enter the Tax Type number-followed by the pound (ff) sign."
w@]wOOD (3-t06digittaxtypenumberfrom
the IRS Tax Form-Table in Appendix A)
"You entered Tax Type/Tax Description (Based on the selection in stel" ff5)
~ EFTPS prompts:
You enter:
"Enter Tax Payment Type"
1 digit number Tax Payment Type
(Tax Payment Type specific to Tax Form Code in Appendix D)
~ EFTPS prompts:
You enter:
"Enter the 4-digit Tax Fili~g Period starting with the year followed by month'"
wI:];] m ~ (Valid 4-digit Tax Period based on IRS Tax Form
Table in Appendix Al
1m EFTPS prompts:
You enter:
"Enter the payment Amountfollowed by the pound (ff) sign."
(You must enter cents even if you are reporting a whole dollar amount.)
$DO,Ornm.ITIlIJIIlCIiJITtl
(Your payment amount cannot exceed $99,999,999.99)
~ EFTPS prompts:
g EFTPS responds:
Enter the 2-digit Verification Code."
00 Verification Code*
*(See Appendix E for- Verification Co~e Calculation)
You enter:
~w '( 'fs;.IJ''\
1A~~*'
Jj J,-41 ,) [Q HI!
"Enter the 6"digit tax payment seUlement date by month, day, year."
(Note, the next business date you enter must be at least one business day
in the future).
CO[[J DlJ[2][[] m-
(6-digit tax payment settlement day in MMDDYY format) (Continue)
e ltlli-t JiN..
lqrliif vA
October 25, 2012 2012 APPRO V AL LIST 30
COMMISSIONERS COURT MEETING OF 10/2512012
BALANCE BROUGHT FORWARD FROM PAGE 29 $ 610,967.93
FICA PIR $ 58,856.93
MEDICARE P/R $ 16,519.52
FWH P/R $ 55,928.63
AFLAC PIR $ 4,789.10
NATIONWIDE RETIREMENT SOLUTIONS PIR $ 3,174.48
OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT P/R $ 903.70
PRINCIPAL FINANCIAL GROUP PIR $ 3,496.28
TEXAS COUNTY & DISTRICT RETIREMENT SYSTEM P/R $ 106,026.09
ALLIED WASTE SERVICES AlP $ 29.06
AT&T MOBILITY AlP $ 330.28
CABLE ONE AlP $ 712.97
CAHOUN COUNTY GENERAL FUND AlP $ 172,053.39
CC INDIGENT HEALTH CARE AlP $ 49,318.26
CENTERPOINT ENERGY AlP $ 3,064.07
CITY OF PORT LA V ACA AlP $ 2,417.30
CPL RETAIL ENERGY AlP $ 87.10
CREDIT CARD CENTER AlP $ 7,931.83
EXXON AlP $ 4,245.17
MAGNOLIA BEACH VOLUNTEER FIRE DEPARTMENT AlP $ 2,267.00
RELIANT ENERGY SOLUTIONS AlP $ 2,466.42
RICOH USA, INC. AlP $ 579.51
SHELL FLEET PLUS AlP $ 1,957.78
STATE COMPTROLLER AlP $ 69,203.82
TRAVIS COUNTY MEDICAL EXAMINER AlP $ 2,600.00
VERIZ0N SOUTHWEST AlP $ 5,674.23
WAL-MART AP $ 436.80
TOTAL AMOUNT FOR APPROVAL $ 1,186,037.65
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October 25, 2012
2012 APPROVAL LIST
COMMISSIONERS COURT MEETING OF 10/25/2012
DEPT. OF CALHOUN COUNTY SHERIFF B B BROWNING
(SHERIFF/JAIL)
BALANCE BROUGHT FORWARD FROM PAGE 3
ALLIED WASTE SERVICES #847
EXXON/MOBIL
SHELL FLEET PLUS
AlP
AlP
A/P
TOTAL AMOUNT FOR APPROVAL
4
$
12,621.28
$
$
$
280.24
6,615.35
2,944.59
$
22,461.46
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Vern Lyssy
Calhoun County Commissioner, Precinct #2
October 10,2012
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(361) 552-9656
Fax (361) 553-6664
5812 FM 1090
Port Lavaca, TX 77979
The Honorable Mike Pfeifer
Calhoun County Judge
201 S. Ann Street
Port Lavaca, Texas 77979
Re: Agenda Item for Next Commissioners' Court Meeting
Dear Judge,
Please place the following matter on the agenda for the next regularly-scheduled meeting:
"Consider and take necessary action to transfer from Road and Bridge Precinct
Two to the Six Mile Volunteer Fire Department, a Curriculum Package (#543-
0036), and remove it from the Road and Bridge Precinct Two asset inventory
list."
Thank you in advance for your attention to this matter.
Sincerely,
viJ~
'\
VL/rm
TRANSFER FROM ROAD AND BRIDGE PRECINCT #2 TO the SIX MILE VOLUNTEER FIRE
DEPARTMENT A CURRICULUM PACKAGE (ASSET #543-0036) AND REMOVE FROM ROAD AND
BRIDGE PRECINCT #2 INVENTORY LIST:
Commissioner Lyssy:
Item was entered on the Precinct #2 Asset list by accident. It should have been on the inventory for Six Mile
Volunteer Fire Department.
A Motion to transfer Asset #543-0036 was made by Commissioner Finster and seconded by Commissioner Lyssy.
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
DECLARE CERTAIN ITEMS OF COUNTY PROPERTY IN THE FOLLOWING OFFICES AS
SURPLUS/SALVAGE AND REMOVE FROM INVENTORY:
Items for surplus/salvage by department:
1) Code Enforcement:
Description
Reason for Salvaqe
HP Color LaserJet Ink Cartridges
Black, Magenta, otow, Yellow
does not fit any printer in County
2) Highway Patrol:
Description
Serial Number
Reason for Salvaqe
HP PSC ZllO All in One
Printer/Scanner/Copier
MY243812MI
upgraded by the State
3) Road and Bridge Precinct #2:
Description
Inventory Number
Dell Optiplex GX260T
computer & monitor
#22-0229
A Motion to declare items as salvage and remove from inventory was made by Commissioner Finster and
seconded by Commissioner Fritsch.
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
Calhoun County, Texas
SURPLUS/SALVAGE DECLARATION REQUEST FORM
Department Name: Cod ~ t;;1IJ+of'ce fY1~
Requested By: Bru- c ~ t)leu; n.J5
Inventory
Number
Description
Serial No.
Reason for Surplus/Salvage
Declaration
Calhoun County, Texas
SURPLUS/SALVAGE DECLARATION REQUEST FORM
/
Department Name:
Requested By:
Reason for Surplus/Salvage
Declaration
Vern Lyssy
Calhoun County Commissioner, Precinct #2
5812 FM 1090
Port Lavaca, TX 77979
(361) 552-9656
Fax (361) 553-6664
October 10,2012
The Honorable Mike Pfeifer
Calhoun County Judge
201 S. Ann Street
Port Lavaca, Texas 77979
Re: Agenda Item for Next Commissioners' Court Meeting
Dear Judge,
Please place the following matter on the agenda for the next regularly-scheduled meeting:
"Consider and take necessary action to declare a Dell Optiplex GX260T computer
and monitor (#22-0229) as scrap and remove it from the Road and Bridge
Precinct Two asset inventory list."
Thank you in advance for your attention to this matter.
Sincerely,
VemLyssy
VLlrm
DECLARING CERTAIN ITEMS OF COUNTY PROPERTY AS SUPLUS/SALVAGE:
Description Serial Number Reason for Salvaqe
18 oz Weedeater 01090N501408-4 does not work
DVD Therm AlC 21234947 does not work
. DVD Therm AIC 43632683 does not work
. DVD Therm AIC 50432532 does not work
Garmin GPSmap16Z 96648732 screen broken; cannot be replaced
Garmin GPSmap16Z 96648731 screen broken; cannot be replaced
. Garmin GPSmap16Z 96648730 screen broken; cannot be replaced
RTS 1500 Portable 687%GWE637 lost or misplaced
A Motion to declare items as salvage was made by Commissioner Finster and seconded by Commissioner Lyssy.
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
10/22/2012 10:13
3515534800
CALHOUN COUNTY EMS
PAGE 01
Calhoun County, Texas
WASTE DECLARATION REQUEST FORM
Department Name:
Requested By:
BUDGET ADJUSTMENTS:
A Motion to approve the budget adjustments was made by Commissioner Finster and seconded by
Commissioner Fritsch.
Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor.
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PUBLIC DISCUSSION:
Peggy Dio:
Fleet Gas Cards are in and wiil be handed out later.
Susan Riley:
Renew contact list for Federal Surplus. Need representatives for each department if commissioners do not want
to go to San Antonio to pick up. Right now it is just Judge Pfeifer and the Commissioners on the pick-up list.
Need names of anyone else that should be authorized.
Judge Pfeifer and Commissioners:
Congratulated Mrs. Dworaczyk.
Court was adjourned at 10:27 A.M.