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2015-07-23
Regular 2015 Term THE STATE OF TEXAS § COUNTY OF CALHOUN § Held July 23, 2015 BE IT REMEMBERED, that on this 23rd day of July, A.D., 2015 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 following members of the Court, to -wit: Michael J. Pfeifer Roger C. Galvan Vern Lyssy Neil Fritsch Kenneth W. Finster Anna Goodman Josie Sampson County Judge Commissioner, Precinct #1 Commissioner, Precinct #2 Commissioner, Precinct #3 Commissioner, Precinct #4 County Clerk Deputy County Clerk Thereupon the following proceedings were had: Commissioner Gavan gave the Invocation. Commissioner Finster led the Pledge to the US Flag and Commissioner Fritsch led the Pledge to the Texas Flag. APPROVE MINUTES OF JUNE 11, 2015 AND JUNE 25, 2015 MEETINGS: Commissioner Lyssy made a motion to approve Minutes of June 11, 2015 and June 25, 2015 meetings. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Regular 2015 Term THE STATE OF TEXAS § COUNTY OF CALHOUN § Held June 11, 2015 BE IT REMEMBERED, that on this 11th day of June, A.D., 2015 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 following members of the Court, to -wit: Michael J. Pfeifer Roger C. Galvan Vern Lyssy Neil Fritsch Kenneth W. Finster Anna Goodman Farleigh Sutton County Judge Commissioner, Precinct #1 Commissioner, Precinct #2 Commissioner, Precinct #3 Commissioner, Precinct #4 County Clerk Deputy County Clerk Thereupon the following proceedings were had: Commissioner Galvan gave the Invocation. Commissioner Finster led the Pledge to the US Flag and Commissioner Fritsch led the Pledge to the Texas Flag. Regular 2015 Term THE STATE OF TEXAS § COUNTY OF CALHOUN § Held June 25, 2015 BE IT REMEMBERED, that on this 25 day of June, A.D., 2015 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 following members of the Court, to -wit: Michael J. Pfeifer Roger C. Galvan Vern Lyssy Neil Fritsch Kenneth W. Finster Anna Goodman Josie Sampson County Judge Commissioner, Precinct #1 Commissioner, Precinct #2 Commissioner, Precinct #3 Commissioner, Precinct #4 County Clerk Deputy County Clerk Thereupon the following proceedings were had: Commissioner Galvan gave the Invocation. Commissioner Finster led the Pledge to the US Flag and Commissioner Fritsch led the Pledge to the Texas Flag. NOTIFICATION FROM ADAPCO INC. REGARDING AWARDED BID FOR ALTOSID 30 DAY BRIQUETS. ADAPCO INC. CANNOT HONOR THEIR BID DUE TO THEIR TYPO ON THEIR BID AMOUNT: Commissioner Lyssy made a motion to not accept the bid for Altosid 30 day Briquets from Adapco Inc. as Adapco Inc cannot honor their quote due to a typographical error on their part. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Commissioner Lyssy made a motion to rescind the prior motion. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Commissioner Lyssy made a motion to not accept the bid for 30 day Briquets from Adapco Inc and to award the bid to Target Specialty Products. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. CINDY MUELLER COUNTY AUDITOR, CALHOUN COUNTY COUNTY COURTHOUSE ANNEX H - 202 S. ANN ST. PORT LAVACA, TEXAS 77979 (361) 553-4610 FE MEMORANDUM TO: JUDGE PFEIFER & SUSAN RILEY COUNTY JUDGE'S OFFICE FROM: AUDITORS OFFICE - PEGGY HALL DATE: July 14, 2015 RE: AGENDA ITEM — July 23, 2015 ► Consider and take necessary action on notification from ADAPCO Inc. regarding awarded bid for Altosid 30 Day Briquets. ADAPCO Inc. cannot honor their bid due to their typo on their bid amount. (CM) Peggy Hall From: Kathy Russell <KRussell@e-adapco.com> Sent: Thursday, July 02, 2015 7:36 AM To: Peggy Hall Subject: RE: Calhoun County, Texas: Insecticides for Mosquito Control Bid Tabulations July 1, 2015 thru December 31, 2015 Attachments: 2015 Altosid Agency Agree (End -user Pricing).pdf; Calhoun County, Texas: Insecticides for Mosquito Control Bid Tabulation... (3.57 MB) Good morning Peggy, Thank you for the bid results, from this I see that I have made a typo for one of the Altosid items that ADAPCO bid. We are on an Agency Agreement with the Manufacturer Central for Altosid items and all Vendors must supply Altosid pricing at the same price. Is it possible for you to use this email as official notification that the line item for Altosid 30 Day Briquets should be $440.00/case and NOT $420.00/case as I entered in error. I have attached the Manufacturer (Central Life) end user pricing as proof of the pricing. My sincere apologies Please let me know if there is anything else you need from me. Kathy Kathy Russell ADAPCO, Inc. Contract Manager 550 Aero Ln, Sanford, FL 32771-6342 800-367-0659 Direct: 407-328-6519 Fax: 866-330-9888 Bids@MVADAPCO.com Krussell@MVADAPCO.com www.MVADAPCO.com " 4 1 \QAP .\ iQ From: Peggy Hall [mailto:pegov hall calhouncotx oro] Sent: Wednesday, July 01, 2015 7:19 PM To: Bids Adapco; Elizabeth Leibee Subject: Calhoun County, Texas: Insecticides for Mosquito Control Bid Tabulations July 1, 2015 thru December 31, 2015 Please see attached. This information will also be mailed to you. If you have any questions, please call me. Peggy 9faff Assistant Auditor Calhoun County Courthouse Annex II 202 S Ann St, Ste B Port Lavaca TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Wellmark International d.b.a. EXHIBIT B WELLMARK INTERNATIONAL AGENCY AGREEMENT SALES PRICE: TERRITORY 2015 ALTOSIDO (End Use) Agency Agreement Price List Effective January 1, 2015 PRODUCT # S �ONFILLET PRODUCTCT DESCRIPTION RIPTION xi I LLLL GURATION C G� PRICE 100508842 XR Briquets 220/cs 48 cases $ 697.40 100508845 XR Briquets NY Label 220/cs 48 cases $ 697.40 100508843 Ingot XR Briquet 220/cs 48 cases $ 697.40 100508846 Ingot XR Briquet NY Label 220/CS -in 8 100508841 g t XR Briquet (SliEm— R) 220/cs 8cases $ 697.40 3706OF 30 Day Briquets 400/cs 162 cases $ 440.00 37230E SR-20 2x2.5 gallon/cs 33 cases $ 4,460.00 37240E A.L.L. SR-5 4x1 gallon/cs 27 cases $ 1,001.60 37730D Pellets 2122 Ib./cs 36 cases $ 1,124.20 38540 WSP Pellets 7.0 gram pouch (50 X 16)cs 40 cases $ 648.00 37330 XR-G (40 lb. Bag) 50 bags $ 333.20 38880 XR-G 1,000 lb. Bag) 1 bag $ 8,330.00 100518214 SBG II (40 lb bag) 50 bags $120.00 100518222 SBG II (1,000 lb bag) 1 bag $3,000.00 U.S. Price List: WELLMARK INTERNATIONAL RESERVES THE RIGHT TO CHANGE ABOVE PRICES AT ANY TIME WITHOUT NOTICE. Territory: The United States of America — 50 States. Terms: Agent billings to end -use customers -- Net 30 days (Agent invoice terms on all sales to purchasers unless all suppliers are required to offer specific alternate terms). Invoice Commentary: ALL AGENT INVOICING TO PURCHASERS MUST INCLUDE THE FOLLOWING STATEMENT; `Altosid2enivex sold herein is under Agency Agreement and is for the Account of Wellmark. Agent is authorized to invoice and collect under the terms of Agency contract. Only upon written direction from Wellmark or Agent are the amounts due under this invoice payable to Wellmark'. 1501 E. Woodfield Road, Suite 200 West 847.330.5300 Rev. 3/22/05 Schaumburg, IL 60173 Pja'PCZ) CALHOUN COUNTY, TEXAS — Invitation To Bid Form INSECTICIDES FOR MOSQUITO CONTROL All Calhoun County Precincts JULY 1, 2015 thru DECENMER 31, 2015 ► Return this Form and 5 conies of the Material Safety Data Sheets listing the active ingredients & safety instructions for each Insecticide you are listing below: PLEASE TYPE — All information must be TYPED MATERIAL SAFETY BID ITEM UMT UMT PRICE DATA SHEETS INCLUDED PERMANONE RTU 4-8 PERMANONE RTU 4-8 DELTAGARD ALTOSID 30 DAY ALTOSID XR BRIQUETS FOURSTAR 45 DAY BRIQUETS FOURSTAR 90 DAY BRIQUETS 2x2.5 GL CASE $34.75/GAL 30 GL TOTE $33.04/GAL 2x2.5 GL CASE $165.33/GAL 400/CASE $420.00/CASE 220/CASE $697.40/CASE 200/CASE $243.65/CASE 200/CASE $406.09/CASE Ye ✓ No Les No Yes ✓ No Yes ✓ No ,,/No Yes ✓ No Yes No FOURSTAR 180 DAY BRIQUETS 200/CASE $636.94/CASE 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 ma& each page must be signed. All charrees must be included in bid price. w See Specifications for Insecticides for Mosquito Control and General Conditions of bidding The undersigned q*ms 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 of this bid as to prices, terms, or conditions ofsaid bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this bid. NAME OF COMPANY: ADAPCO, INC. t0 I.N. SANFORD�FL 32771 Authorized Signature & Title: Type Name & Title: JASON Telephone Number: 800-367-0659 Email: BIDS@MYADAPCO.COM List any exceptions to the given bid specifications: of Bid: 06/01/2015 Fax Number: 866-330-9888 Additional Page if needed Cv m 2-('b Y a i 3 a n` `m�oc Z u n b n b �a 3" W ui c � � f J N Zi u J OW m P Z__Lu- OV U O 0 C c � C W CO C G LL C W N r U } J G' y Z 01 C f. + C Z c O c 0 m � V o D 3 0 a 0 0 U coii N 6 > � b 7 4 I q ^^JJfifi 1 J J b a U � + J F � � & R N S ib 61 El S al 6 6.. a � e ff & z 'S: a s C g %r F: a q 0 3 9@ a3 e 3? n S o a NOTIFICATION FROM TARGET SPECIALTY PRODUCTS ON THE BID AWARDS FOR INSECTICIDES FOR MOSQUITO CONTROL: PASS CINDY MUELLER COUNTY AUDITOR, CALHOUN COUNTY COUNTY COURTHOUSE ANNEX II - 202 S. ANN ST. PORT LAVACA, TEXAS 77979 (361) 553-4610 MEMORANDUM TO: JUDGE PFEIFER & SUSAN RILEY COUNTY JUDGE'S OFFICE FROM: AUDITORS OFFICE - PEGGY HALL DATE: July 14, 2015 RE: AGENDA ITEM — July 23, 2015 AGENDAITEM rF ► Consider and take necessary action on notification from Target Specialty Products on the bid awards for Insecticides for Mosquito Control. (CM) Peggy Hall From: Mike Nichols <mike.nichols@target-specialty.com> Sent: Thursday, July 02, 2015 7:29 AM To: Peggy Hall Subject: Re: Calhoun County, Texas: Insecticides for Mosquito Control Bid Tabulations July 1, 2015 thru December 31, 2015 Peggy, Regarding the bid tabulation you sent yesterday for mosquito control products, I have a concern on one item. On bid item number 4, 30-30 ULV, we (Target Specialty Products) bid Evoluer 30-30 at $57.00 per gallon. The container size was not stated on the bid as it was on other items, which in this case was meant to imply all available container sizes were the same price (2.5/5, 30, 55, 250/275). That being the case, we would not have won all container sizes, but should have been given the award on both 2.5 / 5 gallon conatiners and 30 gallon containers. This is uniform with how we have bid this item in the past on your bid, and we have even been occasionally awarded the product and provided these smaller containers when bidding a flat per gallon price. I noticed that you had this questioned on the bid award, and I wished someone had called for clarification. respectfully request that the award be revised on the 2.5, 5, and 30 gallon container sizes for 30-30 ULV to show Target as the awarded vendor. I know this seems small in the grand scheme of things, but I would appreciate you consideration of this. If you have any questions about this, you can reach me all day today and most of next week on my cell phone listed below. Thanks for your consideration. k'Ffiko- Nlc otw Vector Business Manager Senior Sales Representative Target Specialty Products 5042 Service Center Drive San Antonio, TX 78218 Office: 800 925 3922 Cell: 713 249 2075 Fax: 210 662 8686 Email: mike. nichols(cbtarget-specialty.com 0 ,^nv�.� t7Eget-s7eci�3iL_ccryr This e-mail together with any attachments is intended only for the recipient(s) named above. It may contain confidential and/orpnvileged information and express views or opinions that are those of the sender and not necessarily of the sender's organization. The disclosure, reproduction, distribution or other dissemination or use of this %, rq e -f- CALHOUN COUNTY, TEXAS - Invitation To Bid Form INSECTICIDES FOR MOSQUITO CONTROL All Calhoun County Precincts JULY 1,.2015 thru DiECEMER 31, 2015 OP- Return this Form and 5 copies of the Material Safety Data Sheets listing the active ingredients & safety instructions for each Insecticide T®II are liSting beloWd PLEASE TYPE -All Information must heTYPXD BID ITEM UNIT MATERIAL SAFETY UNIT PRICE DATA SHEETS INCLUDED / \ f)IVIINERAL OIL L / �/ - j� 4T 2�/�tt) (.3a�� n a7 / o� Yes --)'IN. `` CS►�f-f j `��NIINERAL OIL / 275 Gal Tote ?s £ � � _ a% ;�iQ i Yes No 3�ATHION/f AlIf iV10 41A Yes / �30-30 iJLV // `?`�' !2J'), ✓ ZI 0 K o�. S / Lj //e/1 /�ft•�� (4j 2efiiyC E'I o 1.3c tiI /.fir, y tyh ! / �o / {i -% es) I, No 2t o,, tl& 'Ey f V dt+ <) `f J` "t o �J y /Jl ol/ yes � No 2e'a v'e1i £5 yt7�J / Lit!�7It 7�r S.SI �t(. es 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. Ifcopies are angLIG eddh page must be sinned exception on the bid form. Exceptions may void the bid. w See -Specifications for Inswetteldes for Mosquito Control and General Conditions of biddifag The undersigned affirms that they areduly.aGthoriaed to execute this contract, that.this company, corporation, firm, partnership, or individugl has not prepared this bid in collusion with any other bidder, and that the contents of this Was to prices, terms, or conditions oflaid bid hove not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the ofcial opening of this, bid / NAME OF COMPANY: ctrt •�(f �' 'c:jcs�pl ,1�T rG{c3 n ADDRESS: f/� .�(?r f/i G@ Ga A.1- r, SCII'� .^ 1eA V . a Authorized Signature & Title: � tl, 4e Type Name & Title:/Ll,fIR///c6V�l0,hot/�I ate of Bid, Telephonel4umbbri(oop®�?,�)5---,;�iad 0/0) 66j-,SU VFaxNumber: (aLL" As do Emaii: fi/!,`kii. %ir(iPich Q� -6at:; ee,!y/�'�'eiCi�l�i List any exceptions to. the given bid specifications: J -large-f- CALHOUN COUNTY, TEXAS - Invitation To Bid Form INSECTICIDES FOR MOSQUITO CONTROL All Calhoun County Precincts JULY 1, 2015 thru DECEMBE'R.31, 2015 Return this Form and 5 copies of The Material Safety Dlta Sheets lis Ia t � ��ttv apt ��atne�t & saff y kstrueflons for each Insecticide ®dI gre Ming Diu'���aPLEASE TYPE — All iuformatton must be TYPED BID ITEM g"I i9) U,MT{ % t--^ i /roji UT INaI jPRICE MATERIAL SAFETY DATA SHEETS INCLUDED es ✓ No es / No ces,/ No. esV, No �IJ �rytlglr f - l 6) S .° / or- 3hj) 12, �- e ✓ 'No t / J No ut� a7r (xL ) �" 26` ii, � � %- ��S /f ✓ No /�� l Y1V+Gt1 i�{i /5 �U/� � es � No 4n� ch if 711 j ipr 3 u TM, ���fi a "' �O!! � 12 4 17i_-1 Yes '� No You may list additional insecticides you wish to bid ou that are not listed above. If additional space is needed to list insecticides, you may copy this form as needed. If copies are made, each page must be si ned. All charges most be included in bid price. No other charges may be added. to the bid price when invoiced unless noted as an exceution on the bid form. ifteentions may void the bid. w See Specifications for Insecticides for Mosquito Control and General Conditions of bidding The undersigned gQ?rms that they are duty authorized to execute this contract, that this company, corporation, firm, parmership, -or individual has notprepared this bid in collusion with any other bidder, and that the contents of this bid as to prices, terms, or conditions ofsaid bid have not been comm indicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the grwlal opening of this bid NAME OF Authorized Signature & Title: Type Name & Title. r�J��' ClrYrt 101f �k, {\ y/Jij�!t}fSflr!`"r°i��✓kateofBid: ! 6" /a/jof5 TelephonaNumper: 300)9. :.39ciJ01v J� fU�1as.Number: QZ0 ) i, 6)- l✓y Email: '1-,?,ve1-S`,t1()e1z1k _ 611M List any exceptions to -the given bill AdditionalPageif needed CPU Pwa6b4 'la rgg e CALHOUN COUNTY, TEXAS — Invitation To Bid Form INSECTICIDES FOR MOSQUITO. CONTROL All Calhoun County Precincts JULY 1, 2015 thru DECEMBER.319 2015 Return thiq Form and 5 coDie Mete at Sariny ITDato Sheets tin t-Ie active iIaa.redients & safety instructions for each Insecticide '12gArtliaggg belowt PLEASE TYPE, - All inbrmztloa must lea TWED KATEW" SAFETY BID ITEM ^� Imo! UMT UNIT PRICE DATA SHEETS INCLUDED 7, , ll L i i1ll rl lil (.o4't,, � 73 6%) Ct��_� /Q!1 VI Yes ✓ No l PTt _a C -a� % ft �%I f1n f ,� fin. � el< Ye . ✓ No /°I� Ll iW 6S!'i 1444 600- �l �%€Jc C Ctle /O0 %. Q-0 C es ✓ No. oif /7r{; L' �'ll✓� C�%G /.d ./%Q�)!f (.�i;/;2i�3j-/d��-` ��` Ole, ✓ No o 1AXelyl* (,/,y i ,"No Gfip �Bfi5C ((/S�'d,I/I Z'�J%� W/a —"v//Oej . s /No ,)i) A//aw A141E 6 Aoj "ca`? `?!�JC�r j' ✓No You may list additional insecticides you wish to hit} on that at a not listed above. If additional space is needed to list insecticides, you may copy this form as needed. liwaw are trade. each ogee must besigned. All Chartres usust be included in bid ofice. w See Spoelfications for Insectisldes for Mosquito Control and General conditions of bidding The undersigned affirms that they are duly authorhed to execute this contract, that.this company, corporation, firm, partnership, or tndfvidualhas not prepared this bid to collusion with any other bidder, and that the contents, of this bid as to prices, terms, or conditions of said bid have not been communicated by the undersigned nor by any employee or agent to any otherperson engaged in this type of business prior to the official opening of this bid , NAME OF v; Authorized Signature & Title: Type Name & Title:///���f/''f1CF / Vi G!AA �ed //-YJL l+7t'yy�lf�i aPpte of Aid: // (i7 .3 --j/ 015- Telephoue Numbbri lit03 ��3 `3 % ��l/i7, 4 &� � l aa.I�ipgaber:_ `obi c, icV`i �- `9-�td' Email: Iy//Kr, /1l dirlytJ List any exceptions to4he giftn bid Additional P e if needed acge CALHOUN COUNTY, T15XAS — Invitation To Bid Form INSECTICIDES FOR MOSQUITO CONTROL All Calhoun County Precincts JULY 112015 thru DECEMBER31, 2015 Return this Form and 5 cowes of ghe Material Safety Data Sheets Usting the for each 1-pseeticide on are US949 bel2wa PL7EAaE TWE-All Information mustbeTY-TED MATERIAL SAFETY BID ITEM UNIT UNIT PRICE DATA SHEETS INCLUDED Ct%tE L % iilr Yes No L., L (� X /cl//j /XS Jib !'J%Yil f �>rC��JJ �a� try Xo2/S y 4/' CIISE'�S Cci� 7/�n�j es / No rd di, .S(dN�li%1(T G�✓i`3Jr:c�Gl (LfGC/�C?Jt� jGCdJ cqsc/ 6sCj < " ewe es No A.) SL�aryl lgryleAd l � g / t% C�/ �c� �0 , t� d/e es ✓ No //�`06 f c� J � ��' LSIYYf t:i °LC dr 15 4%) &//in 6'1� @s No 36) V.� l ' S L1L✓ lol-5 Qr 3•C ryr7%) 6Ct//r,Ci SY C� 6-` 1 Y0. 1 No ` 3I� Ile C .i � S- ULV ('SS- &IV) 6�0 01 $e� �- t */ �4� e✓s No �aJyilii t' iG1C� ilJt�irladl{l i6t-!K)a1 Yes No You may Iist additional insecticides you wish to bill on that are not listed above. If additional space is needed to list insecticides, you may copy thus form as needed. Ironies are made, each ranee must bestened. Adl e4arl es must be included in bid price. w See Specifications for Insecticides for Mosquito Control and General Conditions of bidding The undersigned atflrms that they are duty authorized to execute this contract, that this company, corporation, firm, parmershtp, or individual has notprepared this bid in collusion with any other bidder, and that the contents of this bid as to prices, terms,, or conditions of said bid hope hot been communicated Sy the undersigned nor by any employee or agent to any other persoh engaged in this type of business prior to the gfftctal opening of this bid NAME OF COMPANY:, Authorized Signature & Title: y �l�c r ��y/ / �J Jij�W/t�fgr i l il} ){�/(:!a✓J Type Name &TitleAr lle N.'t CA /I e / tfir%)t �l tib of (Did: t{� —,399// O Gt%S Telephone Number: P`'JyJS�3 '�' l`Zfd�6�,A4 �Fai.I+iuinber.0/0 &/6 tr4' Emdil: /�9ilit`--r,irvrvta �' rt�r�t; List Any exceptions to the givep bid speci8c."atlOiYs: L Cis Additional uge if needed/ { c ma3 VI o m Z , W ,My <<sa' in. W m W 0w r o c v� o c �w C c o � o o r H uj J 0 U m G' N C x Z C H - Z o m cigo o m a a i Q L V m LL. Q � t� 4$ 'a h !�V W U R" gol O J N a 7 Qj - j. tin rvu RdR S U >NE It a L @ e° tkk §.. 0 g3 pz 6 s 0 �o(5 S>6�� yp O e 6 0 0 0 0 0 0 a 0 0 q y J y y j J J y y. ry .a( z z 2 z z z z $'. gs gl d b d: � Gl f E i f F F f� �: i H �Ti m m +tea \—C;: CONTRACT WITH CABLE ONE FOR FIBER OPTIC INTERNET ACCESS FOR CALHOUN COUNTY COURTHOUSE AND AUTHORIZE COUNTY JUDGE TO SIGN: Commissioner Finster made a motion to approve the contract with Cable One for Fiber Optic Internet Access for Calhoun County Courthouse and authorize County Judge to sign. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Susan Riley From: Tami Maldonado <tamimaldonado@yahoo.com> Sent: Monday, July 06, 2015 3:17 PM To: Susan Riley Subject: Fw: Cable One fiber quote Attachments: Calhoun County Courthouse-Contract.pdf Susan please add this to the next court agenda. If you have any questions please let me know. I have a printed copy for you already. Thanks, Tami On Monday, July 6, 2015 3:04 PM, "Kavanagh, Danny" <Daniel.Kavanagh@cableone.biz> wrote: It was kicked back again From: Kavanagh, Danny Sent: Monday, July 06, 2015 4:03 PM To:'tami.maldonado@calhouncotx.org' Subject: Cable One fiber quote Tami, Attached is the contract for the fiber optic internet for the Calhoun County Courthouse. Once you get it signed if you could forward the signed copy back to me I will get the installation process started. Thank you for choosing Cable One as your fiber optic internet provider. Thanks, Danny Kavanagh Business Account Executive II Biloxi -Gulfport -Pascagoula and Texas Coast Cable One 786 Dr. Martin L. King Blvd. Biloxi, Ms. 39530 Cell: 228-348-2405 Fax: l -228-436-1060 danny.kavanaqh@cableone.biz GABLUCWE WIRE YOUR BUSINESS FOR EUCCM' BUSINESS 1 //g g_�51woo OFFICE: BILOXI ADDRESS: CABLE ONE -BUSINESS SALES 786 DR MARTIN LUTHER KING BLVD BILOXI, MS 39530 COMPANY NAME: Calhoun County ADDRESS: 211 Ann St. ClUGINAL SCANNED BUSINESS SER Monday, July 06, 2015 ACCOUNT EXECUTIVE: Danny Kavanagh TELEPHONE: (228) 348-2405 FAX: (228) 436-1032 EMAIL: danny.ksvanagh@cableone.biz AUTHORIZED CONTACT: Tam! Maldonado TELEPHONE: 361-553-95 66 EMAIL: tami.maldonado@calhouncotx.org 100 Mbps ADDITIONAL IP ADDRESSES PRICE PER IP SERVICE MRC 0 $ 5.00 $ ADVANCED ROUTING (BOP) NRC SERVICE MRC No $ - $ - TOTAL BUILD MRC NRC SERVICE MRC $ - $ - $ 1,353.28 SfECIgL,CODIT10,NS,' Customer acknowledges that Cable One will incur significant construction costs processing this service order. Customer agrees to reimburse Cable One for all of Its construction costs if Customer terminates service before the end of the contract term. The customer has agreed to pay a portion of the charges, totaling $19,842.74. If Customer cancels the contract before the construction has been completed and service initiated, . Customer will reimburse Cable One for its construction costs, which are estimated at $19,842.74, Incurred up to the dale of cancellation. THE SERVICE CHARGES TOTAL $1,353.28 PER MONTH. THESE FEES AND CHARGES ARE SUBJECT TO ADDITIONAL APPLICABLE LOCAL, STATE AND FEDERAL TAXES AND SERVICE FEES AS REQUIRED OR AUTHORIZED BY LAW. By signing below, I acknowledge that I have read, understand, and agree to be bound by and comply with the above service information and charges, and the attached terms and conditions and service -specific agreements. I warrant that I am the Customer or have the authority to represent and bind the Customer. IF I provide an email address, a copy of this document and the relevant service -specific agreements will be emailed to me for my records. I understand that I have the right to receive paper copies of this and any other agreements applicable to the Service(s) I have ordered by calling my local Cable One office, and 1 consent to the use of electronic documents and signature, CUSTOMER SIGNATURE jp (J(j�v. " �J 0 CUSTOMER AUTHORIZED SIGNATURE �_/, tt,f) ' 1 Michael J. Pfeifer PRINTED NAME DATE July 23, 2015 CABLE ONE SIGNATURE CABLE ONE AUTHORIZED SIGNATURE PRINTED NAME 1 l i I" v 9b W r & - DATE CABLEoNE- Z=-M=NNW B U S I M E S S CABLE ONE COMMERCIAL SERVICE AGREEMENT This Commercial Service Agreement ("Agreement) is made this July 06, 2015 by and between Cable ONE, Inc, ("Cable ONE") located at 210 East Eart Drive, Phoenix, AZ 85012 and Calhoun County ("Subscriber'), located at 211 Ann SL,Port Lavaca, Tx. 77979. THE PARTIES AGREE AS FOLLOWS: SECTION 1: DATA SERVICES During the term of this Agreement, Cable ONE shall provide fiber optic Direct Internet Acces service ("Data Service') to the locations set forth in Business Services Agreement and fully described therein. SECTION 2: FEES In consideration of the equipment and services provided to Subscriber for the Term of the Agreement and as described below, Subscriber shall pay the following fees and charges to Cable ONE in the manner set forth herein. These fees and charges are subject to additional applicable local, slate and federal taxes and service fees as required or authorized by law. Recurring monthly charges shall be payable in advance of each month of service during the term hereof. Monthly charges will commence on the date specified under the Section 3: TERM. Installation and construction charges are due 20 days after execution of this Agreement. Any payment not made when due will be subject to a late charge of the highest rate allowed by law on the unpaid Invoice. SECTION 3: TERM This Agreement shall remain in effect for a term of 36 months commencing on the date that Cable ONE completes the Installation of the Data Service and shall be automatically renewed on a month to month basis unless written notice of intent not to renew is provided by either party no later than 30 For the sake of clarity, this section is only addressing terminations effective at the end of a term. Notice must be given to the other party at the address shown herein (or such other address as Is subsequently provided in writing). The monthly charge may increase in any renewal term by the lesser of 4% or change in the CPI with 30 days advance written notice to the Subscriber. SECTION 4: ENGINEERING REVIEW Activation of Data Service is subject to Cable ONE's engineering review for distribution availability by existing cable plant as well as review of other external factors and may require additional fees. In the event Cable ONE determines that Data Service is not available to the Premises of Subscriber, this Agreement shall be void, and Subscriber shall be entitled to a refund of all prepaid charges in accordance with Cable ONE's refund policies. SECTION 5: INSTALLATION & MAINTENANCE OF CABLE ONE EQUIPMENT Subscriber hereby grants to Cable ONE (subject to any necessary governmental or third party approvals) the right to Install all necessary equipment for receiving Data Service. Subscriber, at no cost to Cable ONE, shall secure throughout the tern of Service any easements, leased or other agreements necessary to allow Cable ONE to use existing pathways Into and in each Building. Cable ONE -owned equipment provided to Subscriber hereunder shall be maintained by Cable ONE in good operating condition. Such maintenance obligation is contingent upon Subscriber ....ua,:....r..r.r.. nnrc:....,:.....0................r...........a.,......,r..,....�...... r. .,......�......, c......,., r,.. r..u..Wort,....,..;.,,,,.,.,,,,... ,.r.m.,n....,. ,.,. ....r r..ar. umrywg a.dme vrvc, u, d every umuuei, wnc,uepon m ,a ucaeoaa,y, ex1epum i.aoro v,vo a man neuauce uengmm,m de ae, wuu herein, Subscriber shall indemnify Cable ONE and hold It harmless from and against any and all losses, claims and expenses relating to the equipment provided hereunder to Subscriber, Including without limitation, losses caused by accident, fire, theft or misuse of equipment. Subscriber shall provide Cable ONE with reasonable access to the Premises during normal hours for purposes of performing required maintenance. Cable ONE shall retain ownership of all equipment provided hereunder, including all data transmission equipment, drop and fiber optic material required to provide Service to the business. Subscriber shall not, directly or Indirectly, sell, mortgage, pledge, or otherwise dispose or encumber any Cable ONE -owned equipment provided to Subscriber, nor shall it change the location of, tamper with, damage, mishandle or alter In any manner such equipment. Subscriber also shall not relocate Cable ONE -owned equipment within its Premises. In additlon, If Subscriber decides to move Premises, Subscriber shall notify Cable ONE of Its move. Cable ONE will relocate the Cable ONE -owned equipment for Subscriber within Subscriber's Premises or, in accordance with Section 4, to another Premises; Subscriber acknowledges that It may incur additional charges for such relocation. Subscriber shall, upon the expiration or earlier termination of this Agreement, promptly return to Cable ONE all of such equipment in good condition (or pay the full replacement value therefore). If services are no longer provided to the Subscribers Premises, Subscriber shall provide Cable ONE with reasonable access to such Premises for purpose of removing any Cable ONE -owned equipment. Cable ONE shall have no obligation to Install, operate or maintain subscriber provided facllitles or equipment. SECTION 6: USE OP DATA SERVICE AND EQUIPMENT Subscriber's use of the Data Service and equipment is subject to adherence to Cable ONE's acceptable use policywhere applicable. Subscriber shall not use the Data Service or equipment to directly or Indirectly: (a) (b) invade another person's privacy, unlawfully use, possess, post, transmit or disseminate obscene, profane or pornographic material; post, transmit, distribute or disseminate content that is unlawful, threatening, abusive, libelous, slanderous, defamatory, materially false, Inaccurate or misleading or otherwise offensive or objectionable; unlawfully promote or incite hatred; or post, transmit or disseminate objectionable information, including, without limitation, any information constituting or encouraging conduct that would constitute a criminal offense, give rise to civil liability, or otherwise violate any municipal, provincial, federal or international law, order, rule, regulation for policy or any network accessed using the Service; access any computer, software, data, or any confidential, copyright protected or patent protected material of any other person or entity, without the knowledge and consent of such person or entity, nor use any tools designed to facilitate such access; (c) collect a listing or directory of Cable ONE subscribers, or if any such directory Is made available, use, copy or provide to any person or entity (whether or not for a fee) such directory or any portion thereof; (d) upload, post, publish, deface, modify, transmit, reproduce, or distribute In anyway, information, software or other material obtained through Cable ONE that is protected by copyright, or other proprietary right, or related derivative works, without obtaining permission of the copyright owner or right holder; or otherwiseviolate the rights of any person or entity, Including the misuse, misappropriation or other violation of any intellectual property of any person or entity; (a) alter, modify or tamper with the equipment or any feature of the Data Service, Including, without limitation, attempt to disassemble, decomplle, create derivative works of, reverse engineer, modify, sublicense, distribute or use the equipment for any purpose other than as expressly permitted; restrict, inhibit or otherwise interfere with the ability of any other person to use or enjoy the Data Service or the Internet generally or create an unusually large burden on Cable ONE's network, including, without limitation: posting or transmitting any Information or software that contains a virus, lock, key, bomb, worm, Trojan horse or other harmful or debilitating feature, distributing mass or unsolicited messages, chain letters, surveys, advertising, promotional materials or commercial solicitations (i.e., spam) or mass chat room or bulletin board posts, or otherwise generating levels of traffic sufficient to impede others' ability to send or retrieve information; (9) Interfere with computer networking, cable or telecommunications services to or from any Internet user, host or network, Including but not limited to denial of service attacks, overloading aservice, Improper seizure and abuse of operator privileges ("hacking") or attempting to "crash" a host; or (h) falsely assume the Identity of any other Individual or entity, including, without limitation an employee or agent of Cable ONE, for any purpose, Including, without limitation, accessing or attempting to access any account for which Subscriber is not an authorized user. (1) resell or share any portion of this Data Service to a third party. In addition to our termination rights set out elsewhere In this Agreement and otherwise available at law, Cable ONE may suspend service or terminate this Agreement if Subscriber engages in one or more of the above prohibited activifies. Additionally, Cable ONE reserves the right to charge Subscriber for any direct or Indirect costs incurred by Cable ONE or Its affiliates in connection with Subscribers breach of any provision of this Agreement, Including costs incurred to enforce Subscribers compliance with it. SECTION 7: CONTENT ACCESSED AND PURCHASES MADE THROUGH CABLE ONE Subscriber acknowledges and agrees that there is some content accessible through the Data Service and the Internet that may be offensive, or that may not be in compliance with applicable law. For example, it is possible to obtain access to content that is pornographic, obscene, or otherwise inappropriate or offensive, particularly for children. Cable ONE does not assume any responsibility for or exercise any control over the content accessible through the Data Service. Subscriber accesses and uses all content obtained through the Data Service at Subscribers own risk, and Cable ONE will not be liable for any claims, losses, actions, damages, suits or proceedings arising out of or otherwise relating to Subscriber's access to or use of such content. In addition, Cable ONE shall not be responsible for any of Subscriber's purchases or charges on the Internet. SECTION 8: COPYRIGHT MATERIALS Subscriber shall hold Cable ONE harmless for any Improper use of copyrighted materials accessed through Cable ONE's Data Service, Cable ONE bears no responsibility for, and Subscriber agrees to assume all risks regarding, the alteration, falsification, misrepresentation, reproduction, or distribution of copyrighted materials without the proper permission of the copyright owner. If Cable ONE receives notice under the Digital Millennium Copyright Act, 17 U.S.C. § 512, that Subscriber has allegedly Infringed the intellectual property rights of a third party, Cable ONE retains the right to take down or disable access to the allegedly infringing matedal. It is Cable ONE's policy, in appropriate circumstances, to terminate the accounts of subscribers who repeatedly Infringe the Intellectual property rights of third parties. Cable ONE also will take such other action as appropriate under the circumstances to preserve our rights. SECTION 9: SUBSCRIBER'S RESPONSIBILTY FOR SECURITY Cable ONE uses resources that are shared with many other subscribers. Moreover, Cable ONE provides access to the Internet, a public network, which is used by millions of other users. Information (personal and otherwise) transmitted over such public network necessarily maybe subject to Interception, eavesdropping or misappropriation by unauthorized parties. Subscriber shall be solely responsible for taking the necessary precautions to protect itself and its equipment, files and data against any risks inherent in the use of this shared resource. Cable ONE will not be liable for any claims, losses, actions, damages, suits or proceedings resulting from, arising out of or otherwise relating to Subscriber's failure to take appropriate security measures. SECTION 10: RIGHT TO MONITOR AND DISCLOSE CONTENT Cable ONE has no obligation to monitor content provided through the Data Service. However, Subscriber agrees that Cable ONE has the right to monitor content electronically from time to time and to disclose any information as necessary to: (a) conform to the edicts of the law or comply with legal process served on Cable ONE, (b) protect and defend the rights or property of Cable ONE, its Data Service or the users of the Data Service, whether or not required to do so by law, or (c) protect the personal safety of users of Cable ONE's Data Service or the public. We reserve the right to either refuse to post or to remove any Information or materials, in whole or in part, that we decide are unacceptable, undesirable, or in violation of this Agreement. SECTION 11: SUBSCRIBER PASSWORDS Subscriber is responsible for all use of Subscribers account(s) and for maintaining the confidentiality of passwords. Subscriber shall immediately notify Cable ONE about: (1) any loss or theft of Subscribers password, or (it) any unauthorized use of Subscriber's password or of the Service. If any unauthorized person obtains access to the Service as a result of any act or omission by Subscriber, Subscriber shall use best efforts to ascertain the source and manner of the unauthorized acquisition. Subscriber shall additionally cooperate and assist in any investigation relating to any such unauthorized access. SECTION 12: SUBSCRIBER PRIVACY Cable ONE is committed to protecting the privacy of Subscribers personal information. Cable ONE's privacy policy regarding the collection, use and disclosure of personal Information is posted on Cable ONE's webslie (vnvw.cableone.net). Subscriber acknowledges that he or she has read and accepted the terms and conditions of such statement. SECTION 13: ASSIGNMENT Subscriber shall not assign its rights of delegate Its duties under this Agreement without the priorwrilien consent of Cable ONE, which consent shall not be reasonably withheld. Any assignment of this Agreement by Subscriber without Cable ONE's wripen consent shall be vold and shall, at the Cable ONE's option, constitute a breach hereof by Subscriber. In the event Subscriber is a business entity and ceases to do business at the Premises, Subscriber shall return to Cable ONE all Cable ONE -owned equipment Installed at the Premises; such cessation shall not; however, reduce Subscriber's payment obligations hereunder unless Cable ONE otherwise agrees In writing. This Agreement shall be fully assignable by Cable ONE. Subject to the foregoing, this Agreement shall be binding upon and shall insure to benefit of the parties and their respective successors, representatives and assigns. SECTION 14: TERMINATION BY CABLE ONE If Subscriber fails to perform any of its obligations hereunder, does not cure such breach within thirty (30) days after written notice thereof from Cable ONE, or if Subscriber becomes insolvent or bankrupt, Cable ONE, in addition to all other rights it may have under law or its Agreement, shall have the right(]) to declare all amounts 10 be paid by Subscriber during the remaining term hereof immediately due and payable, (II) to cease providing services to Subscriber, and CM) immediately to enter the Premises and take possession of all Cable ONE -owned equipment without liability to Subscriber therefore and without relieving Subscriber of its obligations under this Agreement. Subscriber shall reimburse Cable ONE for all costs and expenses, including reasonable attorneys fees and court costs, incurred In connection with Cable ONE's exercise of its rights under this Agreement. Cable ONE may, in its sole discretion, Immediately terminate this Agreement in the event that it is unable to provide Service due to any law, rule, regulation, Force Majeure event, or judgment of any court or government agency. In the event Cable ONE is declared to be a common carrier by a law, rule, regulation, orjudgment of any court or government agency, Cable ONE may terminate this Agreement. SECTION 15: TERMINATION BY SUBSCRIBER If Cable One fails to perform any of its obligations hereunder, does not cure such breach within thirty (30) days after written notice thereof from Subscriber, or if Cable One becomes Insolvent or bankrupt, Subscriber, in addition to all other rights it may have under law or its Agreement, shall have the right to terminate this Agreement without penalty and will only be responsible for any fees it incurs prior to cessation of service. If Subscriber exercises Its termination right, Cable One shall remove all Cable One -owned equipment without cost or fee to Subscriber. Should Subscriber engage in early termination of the Agreement but without the justification of a Cable One breach, Subscriber will be required to pay an early termination penalty consisting of 60% of the monthly fees for the remaining period or the term. SECTION 16: DATA SERVICE AND EQUIPMENT (a) EXCEPT AS PROVIDED IN SECTION 15(b), CABLE ONE'S DATA SERVICE AND EQUIPMENT ARE PROVIDED WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND WITH RESPECT TO THE DELIVERY OR PERFORMANCE OF THE EQUIPMENT, ANY SERVICE, CABLE ONE'S NETWORK, OR ANY WORK PERFORMED UNDER THIS AGREEMENT INCLUDING ANY AND ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE OR USE OR ARISING FROM A COURSE OF DEALING, USAGE OR TRADE, AND ALL SUCH WARRANTIES ARE HEREBY EXPRESSLY EXCLUDED. FOR ADDITIONAL CLARIFICATION, CABLE ONE DOES NOT WARRANT THAT SUBSCRIBER'S USE OF THE DATA SERVICE WILL BE UNINTERRUPTED OR ERROR -FREE, BUG -FREE OR VIRUS -FREE, IN ADDITION, CABLE ONE DOES NOT WARRANT THAT ANY DATA OR FILES SENT BY OR TO SUBSCRIBER WILL BE TRANSMITTED IN A SECURE OR UNCORRUPTED FORM OR WITHIN A REASONABLE PERIOD OF TIME. IN THE EVENT THAT SUBSCRIBER'S BUSINESS REQUIRES CONTINUOUS AND UNINTERRUPTED SERVICE, SUBSCRIBER MAY WISH TO OBTAIN A SECONDARY SERVICE FROM AN ALTERNATE PROVIDER. (b) EXCLUDING EVENTS BEYOND CABLE ONE'S CONTROL, CABLE ONE REPRESENTS THAT IT WILL MAINTAIN 99.99 % SERVICE AVAILABILITY, THE AVAILABILITY OF SERVICE IS MEASURED BY SERVICE DOWNTIME ("SERVICE DOWNTIME"OR"DOWNTIME"). SERVICE DOWNTIME SHALL MEAN TIME WHEN SUBSCRIBER IS NOT ABLE TO TRANSMIT AND RECEIVE DATA THROUGH SUBSCRIBER'S ACTIVE CABLE ONE PORT(S). SERVICE DOWNTIME BEGINS WHEN SUBSCRIBER REPORTS THE DOWNTIME TO CABLE ONE AND A TROUBLE TICKET IS OPENED. SERVICE DOWNTIME ENDS WHEN SUBSCRIBER'S SERVICE HAS BEEN RESTORED AND THE TROUBLE TICKET HAS BEEN CLOSED BY CABLE ONE. CABLE ONE WILL ALLOW A PRO -RATED CREDIT AGAINST FUTURE PAYMENT FOR SERVICE DOWNTIME AS SET FORTH BELOW, EXCEPT AS SPECIFIED IN "EXCEPTIONS TO CREDIT ALLOWANCES". LENGTH OF SERVICE INTERRUPTION PERIOD TO BE CREDITED LESS THAN 1 HOUR NONE 1 HOUR UP TO.AND INQLUDING,4 HOURS 1/2 DAY 4 HOURS UP TO AND INCLUDING 8 HOURS 1 DAY 8'HOURS UP TO:AND INCLUDING 12 HOURS. .. _ 2:DAYS. . . 12 HOURS UP TO AND INCLUDING 24 HOURS 4 DAYS 24AOURS.UP,TO�AN6IN6L615I1,1648 HOURS,' .. .. .... 7:DAYS THE TOTAL NUMBER OF CREDIT ALLOWANCES PER MONTH SHALL NEVER EXCEED THE MONTHLY CHARGE FOR THE AFFECTED SERVICE. SERVICE DOWNTIME CANNOT BE AGGREGATED FOR THE PURPOSES OF DETERMINING THE CREDIT ALLOWANCE. EXCEPTIONS TO CREDIT ALLOWANCES SERVICE DOWNTIME SHALL NOT QUALIFY FOR THE REMEDIES OUTLINED ABOVE IF SUCH DOWNTIME IS A RESULT OF: (1) FORCE MAJEURE EVENTS, (2) ACTS OF GOD, (3) SCHEDULED MAINTENANCE EVENTS, (4) THE ACTIONS OR OMMISSIONS OF SUBSCRIBER OR PERSONS ACTING ON BEHALF OF SUBSCRIBER, INCLUDING EMPLOYEES, AGENTS AND CONTRACTORS (6) THE FAILURE OF HARDWARE, EQUIPMENT, CIRCUITS, APPLICATIONS OR SYSTEMS NOT OWNED OR CONTROLLED BY CABLE ONE, (6) CABLE ONE'S INABILITY TO CONTACT SUBSCRIBER OR CABLE ONE'S LACK OF ACCESS TO SUBSCRIBER'S PREMISE AS A RESULT OF SUBSCRIBER'S LIMITED AVAILABILITY, (7) CABLE ONE'S TERMINATION OF SERVICE FOR CAUSE INCLUDING MATERIAL BREACH AND SUBSCRIBERS USE OF SERVICE IN UNLAWFUL MANNER OR IN VIOLATION OF CABLE ONE'S ACCEPTABLE USE POLICY, SECTION 17: LIMITATION OF LIABILITY UNLESS OTHERWISE SPECIFIED IN THIS AGREEMENT, CABLE ONE SHALL NOT BE LIABLE TO SUBSCRIBER FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES, INCLUDING BUT NOT LIMITED TO, DAMAGES FOR LOSS OF PROFITS, GOODWILL, USE, DATA OR OTHER INTANGIBLE LOSSES (EVEN IF CABLE ONE HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES), RESULTING DIRECTLY OR INDIRECTLY FROM: (A) THE USE OR THE INABILITYTO USE THE DATA SERVICE; (B) UNAUTHORIZED ACCESS TO OR ALTERATION OF SUBSCRIBER'S TRANSMISSIONS OR DATA; (C) STATEMENTS OR CONDUCT OF ANY THIRD PARTY ON THE DATA SERVICE; OR (D) ANY OTHER MATTER RELATING TO CABLE ONE'S DATA SERVICE OR EQUIPMENT. THIS SECTION SHALL SURVIVE ANY TERMINATION OF THIS AGREEMENT. SECTION 18: INDEMNIFICATION Subscriber shall indemnify, defend, and hold Cable ONE, its subsidiaries, members, affiliates, officers, directors, employees, and agents harmless from any claim, demand, liability, expense, or damage, including costs and reasonable atiorneys' fees, asserted by any third party relating to or arising out of Subscriber's use of or conduct on the Cable ONE Data Service, Cable ONE will notify Subscriber within a reasonable period of time about any claim for which Cable ONE seeks Indemnification and will afford Subscriber the opportunity to participate In the defense of such claim, provided that Subscribers participation will not be conducted in a manner prejudicial to Cable ONE's interests, as reasonably determined by Cable ONE. This Section shall surNve termination of this Agreement. - SECTION 19: NONDISCLOSURE (a) Unless prior written consent is obtained from a Party hereto, the other Party will keep in strictest confidence all information Identified by the first Party as confidential, or which, from the circumstances, in good faith and in good conscience, should be treated as confidential; provided that (a) the owner thereof has taken reasonable measures to keep such information secret; and (b) the Information derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable through proper means by the public. Such Information Includes but Is not limited to all forms and types of financial, business, scientific, technical, economic, or engineering information, including patterns, plans, compilations, program devices, formulas, designs, prototypes, methods, techniques, processes, procedures programs, or codes, whether tangible or intangible, and whether or not stored, compiled, or memorialized physically, electronically, graphically, photographically, or in writing. A Party shall be excused from these nondisclosure provisions if the information has been, or is subsequently, made public by the disclosing Party, Is independently developed by the other Party, if the disclosing party gives its express, prior written consent to the public disclosure of the Information, or if the disclosure is required by any law or governmental or quasi -government role or regulation. (b) Each Party agrees that violation of this section 18 would result in irreparable injury and the Injured Party shall be entitled to seek equitable relief, including injunctive relief and specific performance in the event of any breach hereof. SECTION 20: MISCELLANEOUS ia) This Agreement is govemed by the laws of the State of Arizona. Subscriber hereby consents to the exclusive jurisdiction and venue of courts in Maricopa County, AZ in all disputes arising out of or relating to this Agreement and/or use of the Data Service and/or Cable ONE -owned equipment. (b) This Agreement constitutes the entire Agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, conversations, representations, promises of warranties (express or Implied) whether verbal or written. No modification of this Agreement shall be valid unless made in writing and signed by both parties. (c) The waiver of a breach of any provision of this Agreement shall not be construed as waiver of any subsequent breach of the same or a different provision of this Agreement. (d) If any clause or provision of this Agreement is held to be illegal, invalid or unenforceable under present or future laws effective during the term hereof, then, and in the event, It is the intention of the parties hereto that the remainder of this Agreement shall not be affected thereby. As indicated by the signatures below, both parties agree to and accept the terms of this Agreement as of the day and year slated above. CUSTOMER SIGNATURE CUSTOMER AUTHORIZED SIGNATURE CABLE ONE SIG CABLE ONE PRINTED NAME Michael J. Pfeifer DATE July 23, 2015 PRINTED NAME 1 V� k`' &VV—e r DATE b !/)—"'( /2-01G SUPPORT INFORMATION: Please provide the contact Information for at least two people for Cable ONE to incorporate in to the support contact list in the event of a technical outage. These contacts will also be contacted at the time of any notifications of a planned maintenance scheduling. Ku I LJ: u.C., orLufHL UUIVIIVILIV I J UK CONTACT INFORMATION Tami Maldonado PRIMARY CONTACT NAME: PRIMARY CONTACT EMAIL: tami.maldonado@calhouncotx.org 361-553-4609 PRIMARY CONTACT PHONE: SECONDARY CONTACT NAME: Ron Reger SECONDARY CONTACT EMAIL: ron.reger@calhouncotx.org SECONDARY CONTACT PHONE: 351-553-4606 BILLING CONTACT NAME: Susan BILLING CONTACT EMAIL: susan.riley@calhouncotx.org BILLING CONTACT PHONE: 361-553-4600 CONTRACT WITH ADT SECURITY SYSTEM FOR JP#3 AND AUTHORIZE COUNTY JUDGE TO SIGN: Tanya Dimak JP #3 stated she has enough funds for installation and the monthly fee. Commissioner Lyssy made a motion to approve the contract with ADT Security System for JP #3 and authorize County Judge to sign. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Susan Riley From: Tanya Dimak <tanya.dimak@calhouncotz.org> Sent: Tuesday, July 14, 2015 9:55 AM To: 'Susan Riley' Subject: Agenda - July 23rd meeting Susan — Can you please put me on the agenda for the July 23th Commissioners Court meeting. I am presenting the ADT Security Contract. I will have to make copies and bring them to you. The contract is so light I am having to darken it on the printer. I tried scanning it up you can't read it. How many copies do you need? Thanks, Tanya Q Diimak ,justice of the Teace, Tct. 3 P O Box sat Point comfort, V 77978 361-987-2661 361-987-2798 fa ( W Tanya D. Dimak Justice of the Peace, Pct. 3, Calhoun County, Texas P O Box 542, Point Comfort, TX 77978 361-987-a66r 9 361-987-z798fax Judge Pfeiffer Commissioner Galvan Commissioner Lyssy Commissioner Fritsch Commissioner Finster RE: ADT Security System Contract Good Morning Gentlemen: Attached is the contract for the ADT Security System for the new JP3 office building. When the sales rep sent me the original quote, which I had presented in court, he forgot to put on it the surveillance cameras. When he noticed this he talked to his supervisors and was allowed to give us $769.0o in discounts for the misunderstanding. I have checked with Peggy Hall in the auditor's office and I have enough in the Courthouse Security Fund to cover the installation expenses of $965.57. My monthly monitoring fee will be $107.79 and I have enough in my budget to cover that each month. Should you allow me to accept this contract, they will remove all of the taxes since we are tax exempt, so our prices should be a little lower without taxes. What we will be receiving for this price is the following: • Security Contact on all doors and windows • Battery Backup • Cellular Back up if our phone lines are cut • Initial Hardwiring system into the building • Motion detector • Security Control Panel • Inside and outside Camera's with DVR recording • Pulse Gateway - allows us to connect into the camera's and see what is happening while away from the office I wanted to thank you for taking the time to review this contract and ask that you please allow me to accept the contract for the security of our office. Respectfully, Tanya Dimak Justice of the Peace, Pct. 3 Calhoun County, TX Docul Envelope ID: 326D2C3F-759D4447-80FE-CB5AF440DAC6 0 Order Details E54000E01 Pulse Di,rannts 5-400.110 Package Totals $323.00 S51.99 Video [A-ADT4HS2-500j- 4 Chanel DVR package $350.00 $18.25 Accessories 4 [A-CB7D36PI] - Color Bullet Comem: 3.6mm $388.00 $29.32 Dixmnnls 1369.00 Package Tell $569.00 S47.57 Taxes* Installation Taxes $73.57 Monitoring Taxes $4.61 QSP Texas $3.62 Order Total $965.57 $107.79 'The tax amounts shown are only estimates; the final amount will be calculated and detailed on your bill 7 of 7 (03115) DocuSign Envelope ID: 1A5CDD90-4796-4A7D-A86D-34E2C2263064 0 SMALL BUSINESS CONTRACT E54000EOI ANT LLC dba ADTSecurity Servicc3("ADT") Business Name Justice Of The Peace PcHt3 OfficeAddress 's ("Customer" or or"me''cr snif) Premises' Address 112 Jones City Point Comfort State TX Zip 77978 Responsible Tanya Dimak Party Name -- W W W.MyyADT.coln pax Exempt Tex Expire Data 800.ADT'.ASAP® p (800.238.2727) Protected Premises' (361) 987-2661 Phone (Required) IF FAMILIARIZATION PERIOD ISREJECPED INITIAL HERE (see Paragraph B3 million Terms and Conditions for explanation) RhiAH, tanva.dimak@calhouncotx or Communications Authorization: I authorize ADT to provide me with information and aPdutes about the security system and new ADT and tbird,mly pmduct. aad services to the contact information provided by me.I may unsubwriba or optout by emndiag donotcontact©edtcom or by calling 888.DNC4ADT (888.362.4238). ]ratio[ hero IN have provided or do provide AU'1'with a phone number, including but not limited to a cell phone number a number that l later convert to a cell phone number, or any number that subsequently provide for billing and other nor -solicitation purposes, Iagree that AD'f may contact me at this' these remit I also agree to receive calls and messages such as pre-recorded messages and calls and massages from automated dialing systems at the numbers) provided. Ownership of System and Equipment-. __(brtomer-Owned X AD'f-0wned i acknowledge and agree to each of the folimvin er (A) this Contract consists of six (6) pages. Before signing this Contract, I have read, undesstmul and agree to each and every term of this Contract, including but not limited to Paragraphs C and E of the important terms and conditions. (B) The leftist term of this Contract is three (3) years. (C) No alarm system can provide complete protection or guarantee prevention of loss or injury. Fires, floods, burglaries, robberies, medical problems and other incidents are unpredictable vad cannot always be detected or prevmrtsd by an mere system. Human error Is always possible, and the response time of police, are antl medical emergency ascomal is outside the central of ADT. ADT may not receive a farm signals If communications or power is Interrupted for any consort. (D) ADT recommends that I manually test the alarm system monthly and any time 1 change telephone service, by calling 800.ADT.ASAP. (E) This Contract requires Mal approval by an ADT authorized menage, before ADT may provide any equipment ar.ervira, and if approval Is denied, then this contract will be terminated, and AD'PS mvIy cogitation will be to ,ratify me of,a eh bandannas and refund any amounts I paid in advance. ADTRepsesertahve Scott Witte Rep. License No. Rep. ID 48008 (If Required) No. Cmtomeer''sss A,prm'al: Original SignnmRespired re Rered X A I VI. I j,R 1 of 7 s)20lS ADT LLC dba ADT SecurityServices. All rights reserved.(03115) DocuSiBn Envelope ID: 325D2C3F-758D-4447-$DFE-CB5AF440DAC8 6 SMALL BUSINESS CONTRACT E54000EOI ADT LLC dba ADT Security Services("ADT") Business Name Justice Of The PoliceOffice Address' ("Customer" or "I" m "me" or "my") Premises' 1 I I Jones St Precinct 43 Address j city Point Comfort State TX Zip 71978 i Responsible Tanya Dimak Party Name www.MyADT.com 800.ADVASAP® Tax Exempt No, Tax Expire Date (800.DS.2727) Protected Premisrs 361 987 2661 Phone(Required) IF FAMILIARIZATION PERIOD IS REJECTED INITIAL I-IL'RF. (see Paragraph B3 ofthe Terms and conditions for explanation) I MAIL tanya dimalc0calhounco x or¢ i Communications Authorization: I authorize ADT to provide me with information and updates about the security system and new A➢T and third -party, products and services to the contact information provided by me.1 may unsubseribo or opt out by emailing dmoteontact(sgadtcom or by calling 9HgDNC4ADT (88936Z,1238), hu".d hero If have provided or do provide ADT with a phone number, including but not limited to a cell phone number,a number that I later convert to a cell phone number, t or any number that I subsequently provide for billing and ether non-solimuaion purposes, I agree that ADT may cament me at this/ these number(s). ) also agree to receive calls and messages such se; pre-reendod messages and calls and messages from automatist dialing systems at rho numbers) provided. Ownership of System and Equipment: —Customer-Owned ADT-Owned 1 acknowledge and agree to tacit of the following: (A) this Contract consists of six (6) pages. Before signing this Contract, I have rend, underrmad and agree to each and every term of this Contract, including but not limited to Paragraphs C and E of tiro important terms and conditions. (8) The Initial term of Homes., proorcme nnu umennememe are m,prememme man cannot asters no maestro or prevenwm or on warm eysmm. numan error is always poulble, and the response time of police, this and medical emergency pers inn t is outside the control of ADT. ADT may not receive alarm signals iforomunlcalions or power is interrupted for any reason.(D) ADT recommends that I manually lest the alarm system monthly and any time l change '. telephone service, by calling 800.ADT.ASAP.(E) This Contract requires final approval by an ADT authorized manager before ADT may provide any ". equipment or services, and if approval is denied, then this contract will be terminated, and ADT's only obligation will be to madly me of such termination and refund any amounts I paid in advance. ADT Representative Soon WIftC Rep. License No. Rep. ID (If Required) No. 48008 C'usti a s "s Appnnul: Original 5imm'u, r Regnhid NOTES I of 7 02015 ADT LLC dba ADT Security Services. All rights reserved.(03115) DocuSlgn Envelope ID: 325D2C3F-759D.4447-8DFE-CB5AF440DAC6 0 SMALL BUSINESS CONTRACT and Notification Services MomMy Service Charge On site Services Guard Response: _ Interior_ Exterior Other Pulse Parallel Protecting OpeNCiose Login Supervised Scheduled 0,im/Close ADT Entry Solutions Other Services Quality Service Plan (QSP) TfQunlity Service Plan (QSP) for Access is Declined Customer ..at Initial here Preventative M to arl fi P Y E54000EOI Total Monthly Service Charge Monthly Service Charge $ 44.99 $99.56 Initial Fee ADT to obtain Electrical Permit WANIM Municipal Electrical Permit Customer to obtain and pay for initiallannunl municipal come use permit. Failure to obtain unit P-Ade ADT with the municipal alone use permit mgietmtion number cauld result in no municipal fircipolice impose to an alone from We por iscs and/or a fine. Admin Fee Other Police Permit $43.65 installation Price $892.00 Taxable Amount(Leave blank ifADT-Owned) eve ve am naac use. an s Pe ear _ 1_2_3_4_6_12 ablNon-Taxe Amount (Leave blank if ADT-Owned) Training ConnectiontAcfivafion Fee Direct Connection Services Sales Tax on Installation' $73.57 Total Installation charge $965.57 Monthly Recurring Municipal Fee (Subject to change based on local law) Trip Charge Received _ Customer to obtain and pay for municipal alarm use permit Deposit Received: 100%deposit required <$500 Minimum 50%deposit required $500+ *The tax shown above for Taxable Amount and Sales Tax on Installation is only Raton Due $965.57 an mo estimate; the final aunt will be calculated and detailed on your bill. 2 of 7 02015 ADT LLC dice ADT Security Services. All rights reserved. (03115) DocuSi9n Envelope ID: 325D2C3F-759D.4447-8DFE-CB5AF440DAC6 E54000E01 IMPOH•FAMI" 1'IlAi AND CONDITIONS A. RQUIPMEN'1. 1. r,"I'toam. The y,ob'.nen Ifal "ce"... eu't,011.d to page two (-') of fit, (-owmce u,I,l ,, Iil,mnuFs pnmhuze Orden, whmh a., a, glwd suhscgaenRy by ADT Uncloding ndAilim,. repl;menaana and r.,flectoi Ifiml, me lu4enod a, a1lb, lively a, the T(limpnwnL" 2.Sht,,Io,. All Leaimn,otarzk.x,tgttdny,shipping will"sli,pbedIOlt AD'v na Its",Pphct:. Iutilitius. Culotte, ill pugall""it...... dnJinµ,n.nrancc. n,r b:mdfinq and nnm;ponif, the uni"i fen, iron, and a, .;uch LlsiMies and'Lift; forany y,:n>on fncy, Ihun AD I a or (m rvhi,h er<nl I'teu, of I"ll ,le,li, ulna be Pm"uml w an AD I Pletmn M11holldlne Anhoemtuml of AD 1 Y ,Itnn, ill Ia''Iaowncnl of the Lyn, Pmmn n,,I 1,, <11u1" "1 Cnumoll, puo:oiIM Ill 'I:n'Innty lose., u Quality Semcu PI;n ("QSP"1. 3. Uwner'sl,ip of LquiP,nent. It "Ruavnur Owned" "ood"It •dun I`Jec one 111 ui lhu CuiJruat, the CgalPn,cnl will loan.... Ne ,I l' orCmtoo" upon Puynmul ,I[ till I'fill lfstallutil ('It.", nuhalAi on Page nFo 124 Otbyrvd,u. ILO@ym'mvnlwilt mo,.h,... o, dADLa, mJicaledoo let, nfy Il). Alf] lovmmnve.,% o"os, nodalI Custion,,ob.fJuo in.ahilk of in Pan, oit Atl'-o+ vJ dy osill e.m, appliunmz.aabiocl,,woingrtnhlc out edannuteehtn lo,luiatcd Vital flu' Lyorpo'w, I wuotnatton,Itile, ('autuml,'ohow obhgatin io•rJs t,,ydavndesly pe,llonolCo,omm's"'lloixen olio xodl,emovuL and the ,emuval or abidenut of ao,holatelials'hull not be Laid Incr,u.bwm It to,.. of lha,ipid.4'AD"f ,cahoot any uLn,Sa's ILa( brave been;menwd ..,,eery ba naAoud hereumkr. Atli' sh:dl hive I, linbilly for Inn illy to warm nnrasa,n, mold. Rolgi. will ,I dry rot or It.., Jena. 4. AuRmrit,. Csl .a.... ianls that it; (a)Fit rviveavAd,u Cgoipmmo, zpmiiiwl in Ihi,(.'ommIfrn...v.,u;eand fill Ga IF, b""ftk-.olly doill IN, fit oaf, ,it .... ...... i, to which Ihu Equ,lfnm,t I, I'll lo..... filed ar h., tn•an ......,l, nolboriaed by the new, of lh,.ploPety to engage AD1 It, luny n111 it, ,Ismuntian III Ilov prcnnsas; Intd KI will romPly witi.1; Iuwa,ttnlas nnA reguinum,s punutninR al ,be t i of it,.! IlgnipmenOnervtaes. 5, Cmtuuter Ac,litnnce Cmtnnau achnnwladgcethat (ill ADT Mee euPlainrJ the Od) on", o1 p11 pn pvlent and nemyc„rvailable. iooL M) additional pmleatinn over andabove than mnvutell halm is neaihtnle flan A, I: ho.. V,,,, 1, emoyi ofolItis nmottcled for only theFImPtncnt ondlor servile(%)itelnizell ,n this CIm mill. b.C'ommnnieatlm, I'ncilitle,,(,I) Alin notion.ADI,nay n,uka rarycSlt lbr,nluununon,avIll e al I'lo,new in nnvos'c.I oo he Or"f(',ulaot"n„J lalepbonettoi,siny, wnelcn...me,Vr otherentil, pinvnling (xn lnt"'ab Rawil...et... Vmeu tin bunami.xioo oLognalu(tile "Cotmuun,euhon Adhorizluleli') o`dA Ihi., Cnewao,('i,; I,,aplic, thols,mhuiupinnm uompuny'witel"emnei. ur mho. ... tys Lillis is It ... it,( In thenanly extent ADP, Iibday is lituitell ,oPaoli E Ifdn,CgnNeL(it) DIIp6,1 (bmtn it'll, IIafb iwl(lnnu0fmfl,.r.amatm c000lecl IuA)%Cnailnmr Mooitoon.('ormr'("CMC"). Cnfo nail pnvido: yabon tifough i.lo" I..leek,.odcpLouc I'll",,v:of" be ley..ited it, o,coo, the AUTolun v,,mfolI ulPuenuo p,. Mile the wrvlyc.Sol I ........ mill"wdi bu ekeukallyits, berme may flla,hd"Folle rat('uvmny,cgtiollot,and will Ire loeuwdwhtun)I) full of IF. AD'f Illo V omn.I P;u,el. AD'T,vill'n.vid, .nub c,,,I,u titou:n ('odanei . ¢qoe., uod........ le) AD'I"S ItF,('EII"1' OF ALARM !iICNA1.S, t:LE('I'ItfIN/C DATA. VOICE DATA OR IMA(:F.S(COLLLCTIVFLY',"ALARM1I SIGNALS.. PROdi'OIR FVUIPMI?NT OR SVS'FENI INS'1'A I.LP:U IN CUH'FUMFR'S IIIZIiMISRS IS DEPENDRN'I' UPON Pit01'EIt'I I(ANSM1II!SSION UP SUCII ,\I ARM RIGNALS, ,AU'1"S C'M(.' G\NN01' MlCTI VR ALARM SIGNALS WHEN CUP I EI.EPHONE SE.R V ICE Oil OTHER I RANSMISSION NOTE IS NOIOPERA FiNG OR HAS BEEN C'11'1. INI 1,12FERED WITH QUALITY. CUS'I'Oh1E li ENDERS I ANDS I IIA'I 01 HER 1`01 EN"I'JAL CAUSES 01 SUCH A FAILURE OVER CEKFAIN'FELEPHON2: SEE% It FS I INCIAMING RI I'1 NOT FULL 1121)'1'O.SONII: "I V'PIiS OF PS,, ,ADSL, Y01It VIC:1'1'A, 1'IIONT, IN*I FUNIA PROFOC OL. BASED PHONE OR O'LBER IN I LANE I IN'I LRI ACP:=F1'ItE Sgl(VICL Olt RADIO SERVIC'L, INCLUDING. C'E.LIAI AR OR PRI VAT I: RADIO, I•.FC,OR CUS'FOMER'F OWN PROPIt11Cl'Altl' TEI,ECOMMUNIC.1'fION NE'C WOltk, INI IC\Nk-I' OI21P-PlI X, OR O'f11ER P1tOPRII?TAILY l'ELECOMMUNICATION NETWORK, Olt OTHER T IURD-PAltT Y EQI RPMEN'I OR VOICFAM FA TRANSMISSION NETWORKS Olt SYSTEMS OWNED, MAINTAINED Olt SERVICED BY CUSTOMER OR THIRD PARR IESI l"NON-'I'RADI' I'IONAL'I MLEPHONE SERVIC Fit IN( LODE BUT ARE NO f Ii I'ED'1'0: (1) LOSS OF NORMAL ELECTRIC POWI.'IS'f(1'I'HC MONI'IOIIED Pltt.Vl15FIS (THI') IIA'FI'E111' IIA(:I(-I IP POfi AD'1"S ALARM PANEI. DOI'.R NUT POWER CUS I ONIER'S ( OMNDINICATION RACU JI IES OR I ELEPIIONE 1GIV, ICL); AND (2) F1 FCFRONICS FALURES SU ''O AS A MODEM MALFUNCTION. CUSTOMER LINDEIISTANDS "r11A'f ADT W ILI. UNIX REVIEW THE INITIAL C'OMPATURI.IT'VOF TILE ALARM SYSTEM WITH CUSTOMER-S NON-TRADITIONAL TLI.I(1.00NI? 5E:RVICL AI"FIf E'1'14IF (If IN'I I'IAI.INS I'AI.I.A'IYON AND T'1IA'f CHANGES IN *1'HE'I'KLF.PHONE SEEI V 1C'.1 :9 DATA FORMAT AE FER ADVS INITIAL REVIEW OP COMPATIBILITY COULD MAKE THE TGLEI'HONI: SER VICE UNAHLE'1'O'PRANSMI'f ,\LARNI SIGNAI 1 TO AD'1':S C'M('JP ADl' DETERMINES IN Il'S SOIL DISCII I, MON I'IIAI' I ' IS CONIPA'I HILL, AL I WILL PCIR IR i' CUS FOVIER 10 USE I'I s NON-1 HALF I IONAL'I ELEPRONE SERVICE AS TLE, PRIMARY METHOD OF TItANRMI'L lING ALARM SIGNALS, ALLIIOUGH CUS I ONIER IINDE RS'CANDS I ON I ADI' RECOMMENDS 'HIAT CUS'I (INTER ALSO USLAN ADDI'I IONAI. IIAC'K-UP NIL' IHOD OF CONin111NICAPION'10 C'ONNECI CUS'I(INTEWS ALARM SYSI LIVID AD CS CMC REGARDLESS OF'I IIL 1' V P6 Oil I ELLPHONL SLIAVIC L USED. CUS'I ONTE R ALSO UNDERS LANDS I UAL ' 16 AD'1 ULTEIiMINES IN I I S SOLE HIMME PION THAT CUSTOMER'S NON-IAADIl ZONAL 1'LLLPHONE SERVICE IS Olt LAI ER BECOMES NON-CONIS\'1'IHl.li, Olt IF BY RII!ANS OTHER "I R AN A'1'RAlll I IONAL'1'Ir.LLPHONI: LINE, ANTI (U,S I ONI612 UNDL(16'1 ANDS "I HA'I 11' IY SOLP]A' tMSPOM,IIfI.h: FOR ASSURING THAT IT USES TRAUITIONAI. T'FJ,RI'1)UNia. SP,RV'ICE POR dM' SUCII MONCfORINk AND 1'HA V I'I' CONIPI JES WI III NATIONAL FIRE ALARM1I S'CANDARDS AND LOCAL FIRE COM',N. CUS'I'ONIER A. SO UND1,16 LANDS THA T W CUS I'ONIFAVS ALARM SYSTEM HAS A LINT: CUT FEAl URC. I MAY NOI' DE ABLE TO DE-FIXCTill THE NON-FRADIIIONAL TELEPHONF. SFRVICPI LINE IS CUT Olt INI ERRUVrED, AND THAT AD'F.MAV NOTRE ADLF I O DOWNLOAD SYSTEM CHANGES OR PROVIDE, CFRTAIN AUXILIARY MONITORING SERVICES l DROUGtl A NON-FRADI I'IDEAL Y ELEPHONE LINE, Olt SERVICE. CUS FOMER ACIINOWLEDGLS FDA] ANY DECISION'10 USE NON=1'JUMCIONAL"1 LLEILIONE SEAMCE AS'I'HL ML IHOD FOR i RANSND1'i'ING ALAIIM SIGNALS IS 6ASE1) ON C115'fOMI•:R'S OW N INDEPI NDEN'l IMSINKSS JUDGMFN'I AND 'I'l1A )' ANVSUCII DLC'IAION N MADU W I I IIUU'I Ah'1' \SSIS I'Ae CE, Ih'1'OLt'EMENH INPII'I', RECONIMENDA I ION OR ENDORSL IEN'C ON l'lik PART' OF ADT, It. SERVICES. AM .µlee, to pluvide the acnrcev indkalal on Pogo nvo (2). which nary o rode anv ilf the billowing ("Svn toes"1: I. fnstalL Dou S,vvice , As:tpphcuble. AD'I vfi,ca to iu,odl Um [ynipmmol, "'died oo p:ge ooc (1), 1n a'mli.uziomd mrnneg l..... P ynafified pcuuouel; indodtali ail'lT.Itcu told llac'u.,u,y latllll In i,t.lull Iffy hgtri)onyfl l„ a.eo izo," W not Ibis (:raw.... mrd any appbeuhic o;.n.fnevne, s,eyllolsboo,. ACT ' at ill no, be ,e, o 1, bk I'll, JUV tut.'ill lLcdoLcetV nFSyIVtau,i.ynuA is o-:n%..noble conned L.,htllobon<'hwpCl%i ally ixanlan ACID rlia,uing,the n,mallanou will, it. o,rn per,ol et. II ILI :nil rsusoo mstulluunn mull be pcd'onned by ontxid. coommbv,, la"ntkiion I ton", nary be,ab", Il ...•wit I ..Mont. ugmea n,,nnply with and emote that Cmnnav's prep..... cuoglly wnh nil upplicnMe I.nvv, cedes ,, tole, al ill IL„e, dnrifg ILe ,—,if lee:: C'on,twi, Gaston,.. Fill... agncx Ibut ,he A,nn %plan lolls not bttn designed,p1,f,ol d or inxtulled Pnnirml toanv law.Conkorrely Iba, twY be ll,luubla,o lit. ..... nuns, indodinR hntnm limliwlmsnYrude pmvisiuna nt'tha Naliorfd Eire Prorcvtlon A... o vuw, 2. Sillmd lteeeiving nml No(Mra(ho Strait,. Signal Re'e...... and f:milie:mnn Service shall be Po,,,Fd by ADT if IN, Colon,rl indnJez .charge forService. If n ah,nf "goal re3i"ea:n ADT. CM(', A D'T shall endeavor to nmifY Ihe:g,pmpo;ne P,,11, to Plm Deponmem and ilia Jcsiglwed rcpre.en.ntirr nf('nsmnmr. If.. burglarMmin.....id ar meslxlnil,e.,2,F al All C NW. ADI;.. u. odeds"'ll nnI,sildymor toeewaCi Ca.tofm(x'I.... "•a by Meph..ne tor, In the cane efu hu fLo alarm "'tol only, by I wu W nv Vuitm 11'soc11 non0euog scrviav Las L.A..'I'd by I Tlsulit erl to fluty That the"lout %fill fuse. I odiog m mnlucl ('twenty, pnanplly,, gf"bot tl the name It (Ile fespon.a leeelvM upon seat eurdnd,ADI'shidl endeaenr to notill flole"proPnlle R,Itce DaDmnnool or Fin, D"snwent. (ofomm agreed that AD 1 stall have nil toilidrynntalfinµ III ait, IauWit, Vase ... mnnntamon nr... nn161"moo. If asu,,, of, s,onoi nrIan.hle tvgnal mFomr.. VI ADT.v CIVIC, ADT sbwl end,:. na,laitylbedes,gu'drep.esua:,uvcof(V,.un..— 3.FfnilieriafR...Periu od. If('aI"o,IL,uol,)toted a 5-duy"Fnmilmu.a'e lien IriurP,,i,iluvnoy Imlulimiof tin(' uiloo",wn opervli b:e�nue It Till "whinu a1 the ulnnll.yell, f'Spmn"1.',ail..hide. Los Iawihalt"dittl Period steel..... aPmes lift fn the event any %iµ.cd loctaJa.g in al:lml sqi of any anwm mgolcu a, ADTYC'MC. ADT limn onL ,e.pk-nJ ,n may %,yllah, eod'000, to I lily the aoth i't e,, eadeat o. Ill nn.i ly Co,lon,r or ('tntou,ci a dc.tgunled .clnnnnwiec k-r , idwilkc:l, talon maioa with,,ild I,a any 11fife, n$llh,u ill I'll dray o,:m:mtu:1 JoIllgcncs el eel. J. Alain 1'crifintlLnl Srrvke. Ifnla,',n vcnlicunnt umvi¢ i, hill. fiaftsbcd, it i, m ol"11, I 1","nd and aa3,eed fill, tgoipnnn is hying imtalled loo, Ju ill .main lecnliml.v in illy...ante<. will r..plim lheecuvullfn of8ve ssmsin,. dm"yt u, or.. ",hold ,, I'llton nl'u.inav,dann a,»oq .1.1 wntinuotl, alunf fleto fmmI a abslile wns'."in order loranalarm signal t,heo'ansn.i0ed. I u,,Iu,let aloill.uvula fidU "ol"il IDty III, it" "Petal ,n toranv andail bypua orssvncIt ebo, provided for discolmecml6 III reu,nnealmg Ile, hlnrnsooudift, umUnr Ilil inR Flp,ipnadnto(.abbe ..... ..... lu,iS(,"lore.reprexnu, batanv Venh tobepnnaOzl by AD'f hm'etmdur hY ruOnA or vihmton delednr systems has the minunum enn,l,Ra(ion cha,anm9sties prcnenhed Iry Undownteni Lahuratories. Ina. Cuzbnner u.ma<[o lost nny uhruwic, miennvuea, cafaeiWnuo urotherdeauome Ldnip,neuI nc.p...a"o"It a,v.Yhnn the SYsinil for nlo,ell i imE, aceordng Ie procedures maverthed by AD f. mid to nottly At)'I' promptly It such Lyaipmmn, I'll, m m%pond w d" Ii 5. l9nrrnnly Service, ]fit lv....... V,b n,vpl.s"('lu'too,Owned"any{ranufthe ky,mn,,owludinelhcairing, inamlled undo. till,('onlmr, dy P.eco'. m be defic(ive in Steer o, ,orkmml,h,p wuhio newly (90) day, Ill 'thc dale ill conPll l of ow"lla,inn rv,If Vi ou ,m,ed o, r ,pL¢cd o, AD'@ opbof,mib a nets or limamo.mlly opeolnepun. Lobo mid mwcnalmIto"dto rpun',,',plaaumeh Jda'live cuugnvuuls will he by, of tar, for It panod olatuety Mn day, following dw aomplcnou of the original iu%Iullnlion. I It,, Warmly don not apply to the "I otulilimis Not Covent by Mfirronty " IIfust bulk-. lots "Cofdllmlls"1 out If Ciaofoe,aall, AUI' fill mrncr mnettile W:eumly It I..hnnf..."loo by ADI',mpm,alna,isaonloodfoal oue of fuse Ln.ldowl, III, kJ In On innpernb,lily .nppmeft ourperai`ih{yul'tlw SY•(en.,nvl.argu1.11Ill mull. lh. l'.. a.,acy 1.11 ill ADM1..... m:n.+e whether ar I Lea.alto-willb, m'olk,on J., Sys'li.,,. Should it fully be ii ontloil, mpm uh, y".,loJou... .,nz of lbwil y C ofdil nivn:o l Lanud. e I..feh wO afkal ALL',tlm-:q+l.iiceblo on n9ube, eel ti !ill, svn wilt by to ianad by ADT during A)'I nnoaal n... 'till, no ,18(111 A,M..n9:10 P.Mto"tMondug,hray.b Fn'd;,y,,-cep. Fnlltt,ye Condiliom Neeole. I: Aed 1Vmm�lly(u)DulnagrnI eamracrvivc,imr nsuLingfromll Acnb,all,.dtoat.LBhnn,gs,rlku,,ii,ac Iololhmrm,ism, art,ofPllr, fly 1)r;. C...(I mnpertnl!or.N.%a, xJI It -tone. rcp,in or AdUlol.Ilne no, Anne by by or Ono p.nn.n unnes,;n.;u.hmrnm..1, i ko•,—ood l-oi;loe,iby ADT;(h) Cm,y' n,lrcuprrv`pm,too per n(o) I'aha,r A,Ilu"I'll aceev::n..le.I.—Iideo u..ne.0 a.n.,LP.l��u,1. i,uprope"rldli ta„andante Si,,.uinCdiRe.i nat,,U)I)phliugdeA,,i to er nGb'i', nnblednem inlanuPnonoit IfIlwdII o thy uwtl;w.via o, o ..(Nun Tuulidonul'FdepLby(Sctvicm h•nd(11) lirtlliladul, by C I s dCl, to l l(r,LLll all pralt'tlnl ate lyYlt ll pli"JI. lnl Itnl lull e(I le, ("A".d'Illw ln, ,,u lF:ln1 Syalellt ell'JIIpC;; I(11nt'$IUI by ('lull, 1114'I':,ind (td anv fuitne ray RI"Omer m keep Gusunnl•1's Prcmiacs m anmpliam'e wilt oily aPpimnhlr .Odle u'gul1linns w law... 3of7 Ton nn"and CDndilious continue DDacmnapmlying sheets. (03/I5) DocuSlgn Envelope ID: 325D2C3F-759D-4447-BDFE-CB5AF440DAC6 E54000E01 I RlportRnt Ter nis Old condBlRlrs (Ggtintic(l) ' TIIE FOREGOING WARRANT V IN IN LIRA OF ALL 01'IIFR WA RHANTTEN, FXPIHiSS Olt INIPLIED, INCLUDING BU r NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERC'HANTARHd'I'Y OR FI'rNLSS FOR A FAIL I ICULAH PURPO54:. CUS I' ONILItt4lJXCL(1SI V E 11LAILI DY WO'14 it"PRUT TO ANY AND ALL LOSSIiS (Ill DAMAGES RESU LTTNG PROM ANY CAE)SF. W IIAI SOUVER, I.YCLU DI NG AU'I IN NLGLIGCNCP., SHALLBE ItCPAIR OR REPLACEMENI AS SPLC'IFILD ABOVE. AI) ISI IALI. IN NO EVIiN F RL LIABLE FOR ANY C'ONSCQURTS'I'I A L OR INCIDENTAL.I)AMAGtrg OFAN V NA 1'RIt L, INC'LUDING IY'l l i10❑'I' I ],NH IA I ION, DAMAGES FOR PERSONAL INJURY Oil DAMAGES TO PROPERLY, AND HOWEVER OCCASIONED. WTRl'FIIE t ALLECI!U AS REIR)LIVIC FRONT BREACH OF WARR AN'EY Olt CO ST RACT BVAD'I' OR NEGLIGENCE OF ADT Olt O'I'HilliNV15L+. 6 Ma II me5 /Qu d,)Sarriee Plano QSP) II( t hmI i iM-ml .l1 v Ilea r .I"oefl,nn,ADTt,.tpon UI :I',l II vl Irry 1 P Irl -.I I .d l 1 II II -tl 1 r 111 I I l au rline., yu lw r ulr l' I II C ( ,, ..... h... f , I'I. I T Il , t Ic '.:try by hole nCe:h nrr p I.e_ 1 ( ), 1 n 0 sv:I } u' by III -nrl fADf ball hcbhe Atli I_uol (ut nrino,Rv) Ill neb Inv Ileum, ar ool IALI.(,rn,nu, ,-,Iu.r, chew „a.en.Cfll , puti,l Illka IIII1AM." 1:3 Pmellt' ,ally ,t,lc,dtbmlll,rur I'-,ll lion :..11ll'1 gin:nh SYqu,sl:dl or prrfvnnlJmn 11 Yi'onmrlw Log tit v,d A:RtiF M. ,IJU P.M Munhy Ih'nulh Iridav, ce,epl holidays " LCCIUSIONS MU will n if,, tll vu I,e 0bI kd'ell n'i vl 'r-INo". (1) troll, too, f).e, D,. nI.(I)enm lot moral delit,11, 0)FROM (1'1' id,R 11DIlMI,y)1.)Llquy»rt nnul lu:no th, Condil 1, Not Co„aI IY'nnlyl laed , lua,olh B. till 41IS) ol"Ponvi h3-111311. eofnvl a nrcoml I I nwnmaks. Ito" i :noA tnd alwhat, A[W.-oblig.ttloo retitle.II.I„'oll Iv . I11 of ti :H II m Lq,,gr Iee I under them a Sr I kentwU.,d I.nADI nil,Nobll,,aodmntN n - I.'PWu.,I-n 1rth r, f yl it I Uo t III not nvralled by ALI If t IC quo for bolorc do li t III W rw lv AUI wII I- I M't S GI,- IY'R -:I n�,l, s)ar,m and n, Hoelty oldie syI rt Err t f l ll III' Plell ortalo,raa11'IAll tirno 000lrii INSPLCIIONSAUl vlllr TI dI 1 r,fluy 'n fll 1ys1 non ly vl ill 1 tli Cal r'nl Ili h l«hrI -IIL 1 U ...... dioin, ADP. n Iwolhor, Ill ,o,ofk:00AAV.to4.10lI.M.bhWrydo.... ld'Ary,cvccpt bnLdly'n,l snlg,amFVl LI1SION3"e LIollL llrm(rapld lbnnly 7,e myule,. hrvenllP.ntnr Re,pnnxe Service. If lovnclyalnr Re,pnuer bruit, o I, gcu:g 11: oo"d nn 1" des ('ommn, dlc srlvmr Pmr:ded d,,dl be a oelfing to the level u�lrnr:l us Ibllowa: I ellI Fov, fill Inv, l,t .UI q I'b.'I-Imt 'i'lloofr Cosillowl Irtr ADI I, Ididoo to orrilylg Ill, Pon D"'nnv a, i I.I1 Nc In ill e ..... no (ostt kiL Cd 111 enf,n Ill 1. „I , -t li,l to p.. lid r C'.I. , the p f,V vill rAe me'U.u, Ito ,E . .... I. Ill P I it lisp by vehicle. At l Iu,itnoff f,>an rtivu'n uy men, AD] will itorls,(nanudr dcslgnukd nv...I ofIll, o" It>Ill IIa lnteupauo I. LeNel H 1 no In v,l, 1 n; llPoo "t-i l of a ht nil 1 11' 1'uldono, ... . ...... i. AD I' I I l n, ,, ,.. lyr.y 1h, f t— U I I ,I 'b II " la. 'I I, I I., will til t, SII I' vem"tirt and own error Col 11"P10 with keys t t,:lb ,lovidedby(,xrn II A ., III, - I I use'o'lloo,H 10 - l l 11lark, tile AD1 r,e,,i,00ao, willl " , du, " 'Il the I II n -I o'color, , ry .. mole"'ifdee l„ 1101dild ifIl,.I ,bL, ,irmll O,bawi-, s ot,ol,,- Iftl I Tn f, Hat 1 Ilk ollooforit. Tor ro. I Idohno-li"'lion, ( ll,lork,, zooffil...II' i. ADL lo,arm,lbrt"lot ro,l'" ,Io....... whirl, m d'p' I:.andwhold I ,l l -. dt,( rot n, or i 11 will A, n+e 1 wuort v,,md in, wl (aeon itellooldyADI orsoLlaowBAITER. lost '1 one 11,.rosuynrlce of .,.It an't.a. 'If('..miner rcquenv Iha,,be AID dry... rr m,,run.un.IlIhrDao'e;pcndit,(,,onee,:nnu'al.:url ADn'agrees tocomply. ('ostoloer will be ef:nq,ed Ill AO'P. ,Ireo rorrenr dale firr sorb zr,, ",, S. hurvoon DefeoRun nr Wid,brooll" Repnrlin, S. ke. If tor,(otlmtn provide, it), In I DBedion St.. I, t"Nvnmpnom's ll,"Nng SeMn., rho service will I'll prnvidrd in ocaoNnuve will the I"oo, of a "'none hider, which look he atud,cd hcreln.tnd medc I purl I.1 0,, Connu,T. F. Parellel Pmlcelieo.ty If low Contmrl Pn:vidcn for Pmalld Pmteetion Selr¢u,, glen+nnnr .reknuwledges thaw 11"alvun deo r. will whole, C oelomer lit, mnuunai oh AIM, Selfee l volt,) ill unfrtldvill CONNLCI 24Wors-1 C<I lmini,,t I'1 IfONNL(124) to u.anpon alr- ,lit RIIn Cualwnul's prtt,lr,, eel,I, ton", ' Uht,yiar 111- unnoneucoln, oewolk.ll000pe, tol'.,Hula propiclary,vdnln' teoh,ulogy developed by Ccllemr,ry LIC',n1it, affifiowd ,I ol,e,l ('eller Illy rod I. 'ell, (11 n,euy Senor vh hutilim�..nuun nlber PrnPliUry 41ulal' technology d t I P Ily Isell'olth w I," Inc(Ltd lP.on,b , CONNI-(1 + Iwils, WilorinmA' t'lil'III ¢ file Ahmnlenice PRIVidero, tintrellrgmith<dluler NII Too I-vl wmtg "'mrsh, lot son, If,, n ICo.,lo nIf lrrri,,, ("Asoo,fott.i(dhl.l........IION' LCT 24,( ellenstrv. Bcllaondlaul tile A. I 1 C01ola, ( - II t 110 II d ,elf ,pl v. ClotCloo.loor or MI vl 1,, doll( , I' roolroireli rJolioo,foltu will the Al S I 1 1 I tlt ,III ofu ( Too,`Icl•,nld tl ., till tYS I) '.tapsoidoll (lie ttll tivll , luxullhou wrokoty I 1pct,r111, li II Wool I l fl Tty. f,X(F.T' I' AN 1,16111 V1 'ED BY LAW. LOT I11I'I%OF'I]IF CCILLME I BY PROVIDERS FOR ANV . LOSS OR DAVIAC ARISING OUT (B NI V II AICES, OMISSIONS, INTERRUPT 10N5. DELAYS, ERRORS OR DEFECI b IN THE CCLLCNtF,1 BY SERVICE. Olt TRANSMISSION OF'1'HE CL:LLRMPI'(tY.S F.RV ICP, (In FOR LOS.SRS Olt DAMAC.I?S ARISING OUC OF THE PAILOBE OF TIIE, CELLE.ML'FRVPROVIDERS10 MAINTAIN PROPERSTANDARDS OF AIAINTFNANC'FAND OPER.CI'TON IIIALL N OT L:%Cr,ED TII E G R EA I E R OFT ED, AMOUNT' PAID RV I fit, CUSTOMER FOR THE CELLFMEFRI, SCIf \'ICE, OR T250.011. NONE OF THE CCLI.FEAR IBY PROVIDERS SI ALL HALF. ANY 1 AARILI'1'1' FOR ANY MIST'AtO:" OMISSION, WE C!RIIUPTION Oft DRFP.CT' THAT DOES NOT LAST' FOR A'f LEAST 24 HOURS. NONE OI' 1'IIE CIA,LLNIC'I It, PROVIDERSSHALL THE LIABLE FOR ANY NINE ANT, OMISSION, IN I KRRUP PION OR DEFECT IN TIIE CLLLCML I'Rf SERVIC I, CAUSIA) TIN' E D L NEGLIGENCE Olt W ILPUL ACF OF THE DP:ALF.It. CUti'1'OMER. PAItT'IF:S 011i Elt'fIIAN Twill CF.l EI BY PROV'IUERS OR WIIEN CA URLI) BY ACTS OF GOD, F. BE. NAIL RIOT S, GOVER N NI LN'I Ali I HOR fro ES, DEFAUUf OF Sll PPLIF:It Olt OTHIiR (`RUSES RL:YOND'I-HE CON'1'ItOL I'ME CLLLEIHI; l'RY PROVIDERS, INC'LUDINU NVI I HOT I' LIMITATION DEFECT INORFAILURE,OFF:QUIPMEN'I'PROVIDED BV IHEDEALER Oil ANYPARTYOL HER'I MAN THE( ELLEDIA BY PROVIDERS. NONE: Oil THE CEL.LENIFA RY PROVIDERS SUALL HAVE ANN' LIABILITY FOR INCIDCN-CAL OR ('ONSEQUENTIAL DANIACES RESULTING PROM ANY ❑6PAIIIA Olt BREA(IT OF DUTYBY'I'HCC I'LEYETRYPROVIDER.Ill-CF,LLFvEFARVSERVICE IS PIR)VIDI!DWI'I'HOUTWARRANTY OF ANV KIND, WHRf1IFlt FXPIUiSS Olt IMPLIED, INN LUDING ANl' WARRANT Y OF MER('CAN 'I'ARIIA IV AND ANY WARRANT Y 'THAI* THE CCLCENIETIO' SERVNT IS FIT FOR ANY PALL' R OLM2 PORPOSE. ANY PRODUCTS MANUFA( DIRl'ID BY( ELLEMEA BY PROYIDTDIFT SIN NCI'TU'fllSANT.LOWINGANSTTI'.DOR RIPLICIO'OF.NTO)I ARL' fLLOWIERSI1rIE RATE :SARM.WARRANTED AGNNS'f UFFECIB IN MATERIALS AND N'ORI{AIANBRIP FOR A PISIt I(lU OF ONTO) I YR.AIL 1'OLLONi'INC'IRE RATE OF PURCINSE. UFC CCLLF,ONERl' PROVIDERS' OPTION, ANY l WODUCE1P LIVEN I' \IF FIFFE(T V IN VIAT "PO REI'AIIUNC OR RCPLN('INC VVL'f)1 I OTRINDITION FU ECTIVAR rs, A'f IL$OPTION,ANY HERE PRODUCE TURNED IHBC ARM SERF:C APROVIDER OR \VO)O(MANSRIP IV SLI NOR MALUSG.Dh:FEC'f IVC LLLYELIMUCIS SHOULDLRS STALLIO)VE TH h.ALIGAI N IC'E PROVIDER IINLRIYFOBTAN{4AtV IF I SEIODMC Olt REPLACEDOltI'fHECELLCMLTPAIPItO It SLISSHALLNAN NAOBLIGATION UNDERE R ELVANI ELLRANIVIPRO PROVIDER. Altli ALTERED Olt IMI'ItOPE12LY RP:PAIRFU (Ili 9EftV ICED 114 ANY Pe\Iffy O'1'HLIt'fHIAN TI IE RELfNSIry f CE1.LEh1Ul'I[Y PRUYIDEit. F:XQiFT AS SF:I' PDlt1'H IIEIILIN.'111W CF.LLI:MLi'r1tY PIiOVIULILS d121; PRU V IUING'fI11lR I'RODUCIS NVI'r1lO(l1' WARRANTY OF ANY KINIL EXI-11FSS Olt IM1'LIRD, INCLUDING ANY WARRAN Il' OP AILRC'HAN'I ARILI'I Y .AND ANY WARRANT I 1 HA I "I'MR PROI)UC' I S ARE, Ill'1" FOR ANY PAKFICULAR PURPOSE. ,U.ADTn,lecl Dols a re'SID 11 i t Ill ( u,lon r li'At) IIItOr&m vll.Ilt (Lh maill, ,th,i,r lnr lady, I 11. hneraclum VidolAudfo AlrnnVt ffooCion. Il Pnh.l I YC ;tn AD 111 vnlr(N, or"llodo, - g f 1,-I L donntl'1 fk. ,oldy blow," lbuurers t,ill lu Ibc pl t I( ill, I. Ill li l N) 1101 3o IIIIA1111.111d Ill,l.alif, I 1 dl ,w„I bauYU till, rllobsfrretsd ode,I,, doo ("ADI'loo,.oriv, Vvko M S11-' �, UI All r It I I I IL I: In Ct I n Y f i t-,AD'ftwlt coder.,or 1, fJloo,.l) Ej,or—llpi oE.r Hold Up Atont,iol.11Irtn kpx4n• prom,,. AD l v'fl rvnM.tvu' K. I, ryC, alpropt kilt Ind LnolellneU.Sen.ya,Il repon Rte sigmd rinder'AT) Ps sltn:a rro,wi by and notniaou I p oto"'I u<a "Hold Up" emuvl Ir.:eired Irnm thin loe:nion: lb) Opor aipt of n Rurgis Alaro aignvl frunl Cusmmeripremise, sad erwbl"ho,"m.a vid... ,uuVar two pFamv,oeho 000.r hmi.... .nn I11'AFIT ino,solt•It, inlon dnemunex, hunts on IhavideounoVur au ll unnnnl t n th.. DlA atelotala,If, fly I, t L jo,,I r ( . I ., AOT offered ufylb-yj uPr a1,low ol twneo'l i"nr,y and u•P Ill.'I,oll... d ADI ,,,oaln, I' t 'lr till'.( 1 r u U ril l -Ina)'„. I fivollhal lm Ill t-lull their endeavor to notify file pemoill on C t n, r:En )ton yC nl k, Lim, (ill Num rtimd.ao, iN l-, kfng,Ir AL)L "Pr n.c sh'fl le tinumd to. rtAD1. sole lisen1int codeavoling In tneke the SIR".,, blatoolnl es Ilfvth,ordi_ (tit, lhi,i.d ,n011- .lee Yor, n ,.e LEl l buoo,, pnryr: .tthis l YID." 12Ps,o,d ADIroll donorto ob,ir In ll mew". orosemodnmw,vd 11 If,, pn+pd' '.rim on ill reee,olALIArlll ends ul: ill lY,oledi"Oelion. to trout, Rl. ll oprial I'v 1 lecher, rl, f 161111011e DegI"Ilist lu toalhnptt ➢t,'t (ll.Slom, nlil'. Iueononl(u,IOtl Ufr, hnretgeew f nllall List by telepll:m frwo-W:ry voke to aonhnn IWI till Motor I. It"' tame. It All r halo (I, rower, Crolomul et, eonnunu nn Cmromeh Cmalgatcy (L�ll(L„4n' It AUII dart. 't , I 1 -It, l nDl lull I w Im"Ulf, file illyi )tier low uoinunun agencvaud th") L kayo to roll, tire pew, olC ...nr'fill ryvy( for, illf It tile 1 pol pas+ i. i IAIO'.I III If II'r Ilrtk frtor T e'Inr II v 1 ally rl Iu: oulsl I,:L 'I I ,t, y( , L , AtliY I. I 1 "1 'l,is I 11 It I V dr. 'I,t III II. t Ili t1'1 V rIll'i age rl .IA b will I C , I I I AD fd 't I.IllInflell andAD h II f', oo bboodityl Iy II'Iein ll le ,yd Rugrrt condoned t., 141R.1de1.1y mdu nowhelflo r.utroy li r or, rill n,i.,nr...... pmtain +I whlhu all zollmor Is oenu,norral C. I C 61 null PAVAIENTN. I. h:Illef IChlo (ulloolI I v ADT,he Total . 'III 11 g_ ImldI'll IIaV(Ill (O.l To, (,rolr,el, Plr try 1pl'blo sieulls:is x piconditioe rooetostoonot tire E 1 I 1 Y' I f l l r FI loollel000 11, AL'1 (bll 'I \ th (ti A.0 me llcd ln.ldlvf I Thu Rpb I Irr clu(nu mlto-a ullJ in. nllln cni In.ial, Ill. I1.u'tm- ,dCl tl ,4 loll punt, to ,foil i TAUT. It Inv i. ,, tin UI't f:II Inns In xynlnu ( IIb CL 1 Im rSyt n nJh ,air„ IhYCost I.,op,rnlar cool rvill iretomu,'flhntdo"o,"nl«IyuoIII, awnf", door,I of.. l; utred ouinl Ilp,I,r:,Ilo,Uncnl ofmrniuIls, cup tempoens. 4 of 7 Trams and C'onditioun cominuc nu occoillpmryiilg shrews (03/15) " DocuSIgn Envelope ID: 32502C3F-759D.4447-6DFE-CB5AF440DAC6 E64000EOI Important Tennis and Condition., (continue)) 2 T<rm till([Pny(n lid Fnr lbel I xth v 1. I ll. ( , (t l - r r pal I ' .d i ri hl k.hi (s (thin( Lr lei i-r n (1)flhCold Ir i I. pl li II i i r I. rl Ilrxl I till (f)y i.'UI inl I I n 1 AS n.IADI h' hill.- i U t Iur'llll 41)y Ir ViniJmNI n II l Ihr+C un t Ih I (III m111,111h fir nil d¢ .iS v uu I Ir11;Cm ( Alt r the loud ltnn, thi, L ml [:hill n"null,f n rIII b.r.,,Ile,.l iiN Ily111 PIyV -1rn wl ill b,oJAWLI.'I 'ifl Imx .uVdva w0minn• uilhh i lu i tiUll IIi II b f r ninninadind,. a Cv.l nimI ,,It AD ,N00 i 1dI4S if(i 'h Ix lopry•Iny aunlu n+when dur vale. till lllu ADI IdJ Ira thvbin l ( I InI LIII ( rI f 1 1 LiffI kk'I natt y(ia li,vnn1. nil II llu tllelil I71' 11 -fIII ll i I ( nlly idl bb i1111 vly ryl l I Ift, :Tel na Ii LiamAddi[I. Illy,(.lnr I Iiri 0 t ih tl1r. u: bun II rI rn A07 I Ih ( t Id nL 1. 1. 11 II IItI' rat if ii t PInin,11( ldilbi l inn (f,t.b., ifkl"in ilit.I Iv Iiil ^ rib p l S 'ni i If i11III I.I.. (in Aninnalti.ry (I n(Oen (,tblad fin II, 1 .... .. I bint IfII ( I Lt IIIl i nn t 'tilil 1'I' (.LIII I n b i monnallLit bInl I, motr Penally. AD f l ll li.lveth. nghd I Allnn IS fl Lr(:Iihr 111 Adi (III ( i p y. I itbv y - III IJviIil non t r.61Irn � rPa I1, fl.1I IP .abn, t. nl .. 11 1'e'¢Ilr lib (1!u6 ..... na i ca L nl I......,lt h a Lv,IN, LItrl:n+o to r(,nrnd hnFe+r.lfn, Ill, rnpJ lad Ft ningIWnr S S" I., Wi l under lh\(.ruvn. 11 3, Fees'Intl Permile. it AU'I' In lennind to obtain tiny Ion([ penny of hhnse to cnublc iI b1 in..411 Ill, Lgniln- nl a( C'mhnnds sde, (Yt+rnlner will teimbnna• ADT Rn :my ranukd f.=cs nrehu.ges. 4 Cnnc II LLl n.I iADI ) na lIIIc Inn I I inin" ' '' 1, I ILL All I I M( ht dvIf IbYt 'I rl aI rADI I, tInr lih 1."brl y I f 'N ll ti' II dI i InIfin If I bl I( l . All III CM( -II M r If 'I Il DIi,, nl .a rl (1U(n.I nr roll (IIr ADI r n 1f -( i ,,I I,, II 'a na rtoldl I'a 1 c Fit" SYrcnnm uncxd lnJo il'c 1Vu ty Ma.I t S a. QSI (in( II L'th" i i II d unI i imal Ii ail th,AD11: h.n n11 nl Ifl I W our niluuLl l (V. ADP, f In II 1 1-.I11(SVII .null ll I i 1 n1I I III i 'II 11aft" 'n.-(IIi I LI tendu uaau u,hi f Sc, v Y'inI t l .f .11 Un I't '.a sou Vi. d, "A"'! III ... Nlhaldyl A]11 It I ... I ILI ( it II I, nn,dLnnn,,it aun n v Vcn'"Y'a+nt:d1 l y 1 IDf IIIAUf r' u I i I ii I ......... .....:alert du bite I IIPI ✓ II' I S 611t "'t '.Rlliftl ntd I I,IY Ctn 'ADT nIry Ili.( i i aI u ( tlbi ( :! It i fit Ill lra'tl nv 1 bl ru nnl rihi< RI I" 'in,n nl I fl sC nv d I lulnra dluUnn rxputw+i m MIv,ndal Ia,11",0uyn nC Iimmla, Mwl, l:ah Dow, i11 ,, lh. (Iland mmvi ngma dl (ail.rw.. nn oay.v .Ind nu ley+h.esl. D. CIIS'POh1Ek RNSI'ONSIt11Lil'IF.S. Crninnua xymw to pnwin, and be tildiRlnvd Ili the polnvinl;: ( Sit I p 'nil III n d nand It I Itl n Cunomc'anvil P'oa d, ei 11 c and a-f i' c : y bit I VI lyny In'di va lagn,'Lowe, io Ili, Fgnbl all I I II vq AUI I F i is FI lh m t I k11. ( I NI I I I I II tI y II 111 n (( I ill 1 '1 '.1 II 1 I 111 it II' A. Ii. II .I'rl IGI 1 'i I'...... tl ),I II 6 IIv FII G I Il a 11 nl I A At)I h l IF I ......I I ) -) I I S Il , I Sn II ID IY OI II II I II II 1,-tI u b t Illitn I Ii� III i. AUi ll tl.........LI i i - i \DI "11 II Iil I i Yf II 111}a ( I L (III Y II' Y I III ; I I ,ilLvtl 1 1 `lib : 1 Iflh II t 1DLanl III i Pure IIi1 A Ivllll'p t ril Iri yl 1 uYaPpin, ll wmm�(y... Qy at, L U( I i 'n:'. 1 1 II nuF. l i 1 [' il' I 1 'd III,ll 11 11 I. I SP(ItllgnG tlR(11aiI 1. IF,tI limn IEI'I n iM avid( IliI: I11a-rnr+Ilfnur nul rl ondt r tl l loin p .Pe dal . nb nsndhl .aava. Unl mrulleillcIll0I& slate eq 1purenll vnll¢u:b n.ADlf I PII bl I 1 .I � y 1AW l`111 ellhlL tR.f n I'(.Ii sillpalll'Inpl 11 i' Jall f i i i Prf- IeI f'ny f m 11 Idlnllb I'PI f I ( h➢mnki rimy' I 11)\ I' M1 t NIt I'rC - l I,,,, III,, 'f'lillii ., III 'Ink" wlh ul It CtSI I i t'l nu't II v71 wihm lio nl pen Ca I. ieids [III IViP0n1%IWJILy IllM nA und filiN Vul,plyun,Il alilll'tll I. I Llugnnent Soft a 1. Av fia I Id Mill the II nisi i <( a'Ib 1In, S uia 1. ll Ipei ryli ADl anA/..'ADT +1I P11 (.1 ii-I d r:ult Ol An( Inv 'Ir xIo''f (aliuueriny at lU d al+ the aoA ten'.. .if, to rylh. it'd lbldlll ¢.......Na ruupy ,,It r mi i "fill' In Om tl inwl ,, pinnl lied IILL fl Ist, I II-L niii ni 1 h'I pr b \'ptl SRvl L.ensc AS lrv( find 1111, il Ay 1 mbly' nAT) I IIl It IIII:I rvi rtI Ify an nih r- I Vne,hLV ud. Il-1' nnI,s 1'- 50'nrhpmdSan hro[Lgmin iL II(LI al f'uiADI in kill, 1111 II) gninf,i ADTk and ily find +Intill. Ixluipmrn and all llvnwd> IIi I(i)vdl ,ail Ia. it Ll II IFIn, nnji,, I '.li .III. 101111111ild Clnil in; (it) inali, ,,a11 I n it, an' -h ti on Ilt."Inin,la it I', In, t"10,111illn infiLl IhIn b.V At I 111 I -I, III, I.RnjLb nhxunl untll ill anon LIA,I]I al VU n,ktidf Le kn Mt losx of lialt of, In, Fin,, nt,nr vhile n run Ca.a,n up,mimonr "Int.I,and(IUvnl in 11It, F:Pnpmanlpnlprny-..dull ooze or pannil:my 5qu i"it b(v:nore pnrnnnrnlly nlbl` ttI an, rent pu.peny nk ILL frh ini fi .:bill II 1 I IL:--Iil.......dd/ n Lind ADI'In-.i II term ,I, IVILLulpf .. lyl'0 '0. d l 11lr it 1, lll.(tlo ill, f bl i'I ftIli, Oh i)hwe Lin I I ca il l ff xPh (IIr I It I I I I fI1 IUt r p CI': i v di :Inn If d tang ilnrapnn in CU.innnr Ill tIn AU, C M(minv In, hid, nnhnr flbIt 'V, Itt a' II I ( i A dlF:i' ilia vll 11, into,it lFrz e.. in kiltind nl:m tinnIly nindlylhur in Ini, i I Y i itly 11011L Iti.11.11 I'lli - . lin, I1 by binblen+.Inl idnIl itl pr d c(mnunlliia (rlmaf+h9lniITY d' h: IV, ItnIll na a indxl I. din1All )1 III I I.idol ny,m i dj l .1'bII d a t. r t anyDid in, 1 -by I Iyll «,aeph ,de,,r 'uulin}in n II ulkl)14 IndlIdIng bill , hnnn,,dt nisa+of:.kon An i Ji!iuy. Jill ItL, lupl Ina nI it alali f\pi vn1. IN ADDITION, CUs DILL It SHALT. INDLbNIPY AND SAVI. HARMLESS, AND Al I S OwN CUJI AND LNYLNSt DLFEND Atli FROM AND At iAVIN I' ANY AND ALI DAMA, f SI.IABII.I I Y AND ('OS 15 OR HYPEIISE OF ANY AND LVERY KIND (iRC VINU nU'1'Of OR Ill' Ill ASUN OF ANY VIDE,) OR AUDfn Ili;( I ':I ORDINOS 'AKLN ty d(R it VIDRO/A(f❑IO FQIJIPMIrNT OR In IN ANY REASON OUT OP'fHE I(IILEA.V*, Rb PRODUCTION, I'IRCULA ,'ION. VOInAll Al ION Olt P.MPLOYMENI' OI: ANY Sit( I I VIDEO/ AUDIO RECORDINGS nx' ANvnNn.err I v.:III II. ............................. . AO,mny.ranxnlit.reuon 1, n1uiY, pnrvidu and Tenn,,, uni, [,J dutynn.iin.uged via it,, In1arnel h1 the dnur.;o inblI).:nub Wing bn. nnf bini"Ll u I If" Pin nIJ1111OnrCnstolner i Prcmivi. and i b) A 1) 1 ammo. (I it duct aY. 1. rin vr.v t'I. I ..I Ln.: n if f n vi,nl ri V,In .l-11(.u, d. I: Iv S•anIit, Ri kIll) (ituc . Lhy;;x ni. I I Ie,ixvi mi IJ b pee AD'I of n I11'nn 111 Suitt Ity I21+A'.l and "Si;;ms)'9. Ina WIN." In, nut Iinnlnd ,I It........ "alin, that u I pc:ina"'My di"da, Ilnd;diiv all>u<Ir Sign, at and upon ongll.... Iof eR time... id ADf lmenmm,c Video Mnnifauny. Semce. uc. +Ln11 oat export ut ..•.expo. t, dncmly Imdn\•nly, uuy. (n) pnWucl,, navira Pnr I bit iwun at pn"d node. dn, Canna br nay avnntry ini mild, the Ifunnd Slaw, (;, urel avilhuul Iin1 oMnnnng:n.y liran:ca `Lomb n. Pcanhs JIM nnry ter mglnmd mN Ey)nn Adnun.nrmR,n Act mId Rvn:dni nm, end sh,.11 i.mn.rymac in :.It eepoa rliipp..I :n it, oavn "I" nse. defl:nd. ind"I'Ll fv and sale. Ilararl ,, AI) f liam and agnu..r all'h Id olher depnsa• nnlq, aaansud:ly.invl ur iu0:;ed by ,\OP m a renal ofnn:dlcpniv .mu.ned in IhL penigmph hall .un ive It, ".mmub:,n n. e"Imnion..I en, Comma. ,V>'I'GIh1RGES CU:i I<Ipt Pat AIiP.:YUI INSURANCE PREMIUMS. SUCH CHARGES ARE BASED EM AND EIIUIPMEN I AD, PROVIDES AND AItE UNREIA'I'EIN I O'i'HN VALUE 01; CUSTOMER )C'A I ED IN CU." O.NVER S PRUMISLI, Oft ANY RISK 06 LOSS ON fUJ I ONILIf :S VREn119ES. RNl'DO NOT C'.wsE AND<'t1YN0'F LLIMINn'fN (tr!'l len", Ir.a 1'. 11-...rr.:....... m...... ILL FF:C'I' OR AVERT SUCH F.VENI:S Olt 1'HE CUNSE LIE 'ti.,. I•.,,,• •„-..,.„���������"a olr.ol Orc n.ijOu•alFNI' NUPPLIE.DWILL 'I'HA'1' (:USd'OMEIi!S PERSON ON PROPER'IV, OR'FH P: I'EIts6N OIt PROP( R.I. (1f dfD'HER.h. MAY113E SIIRJIi('1' TO INDOLSIRI dh 211`OR LOSS H: 1D(IH AN I?ArEN'I' O(TllltU. TT{N,}LLO('A'f1UN OP Sll(:H RISK REMAINS 5Y1'Lli Cits I o1llilt, NOT' A)1'I'. IN.SU' RANCV,11: ,ANY. COV ERINO SUCH RISK SHALT. kF.ORTANED Ily CUS'FUNH:II. ADI' gLIA41. I1AVF. NO i 4ARIhITY I'DIt 6055, DAM1tAGb:Oit IN.IIIRY DUE DIRECTLY OR INDIRECTLY 1'0 RA-Inq'I:S. Oft T'IIR CONS Q,,NCRF'fll,RLFUO61, WfOCII'1lli? ti}'STRM171111 $6.12VICIiS nRR INTENDED TO UGTECF Olt AVRRq•. CUST(1N1NI2 SHALT. IAOR 1?NCI.USI \'RI.V TO I'FS INSURER AND NO'F'I()AD'I"1'O PAV CU51'ONICI( IN T)III EVENT Ol' ANY SUCH LOSS. DAMAGE OR INAURV, CIN FONIER RILINASlis AND V, AIVFS FOR 1'1'SEI SELFAND I1'S RAI AI.1, SUBROG1T,ON' AND OTHER RIGIJIN IORECOVER ROMADT MUSINGASA RESUL' F I'0iPAf1N(;AN}('LAINIOILLOSS,D:YMAOI•.Olt I,NJURV'OFCUHTONIEROR ANOTHPAH-URRON. 5 of 7 Tenn. lilt(] Cmrditlo is emidtive uD nmunipanying shoclt. (03/I $) DocuSign Envelope ID: 325D2C3F-759D.4447-8DFE-CR5AF440DAC6 E54000EOI Drlpm'tant'Porrns vnd Co I'd it iml, (continued) 3, IF NITWIT LISI ANDING IIIX PROVISIONS Oil THIS PARAGRAPH F., ADT IS FOUND LIABLE. FOP,LOSS', DAMAGE (114 INJ DRY UNDER ,AN{' LFA: A], H1EORY OVE 10 A FA LUUE OT T1IR l IlRVICLS, NI:SI'R. LI OR LOU I TIMES F IN ANT' RP.SPItc r, ITS IA A BIT ITV SDAIA. RE LIMIT ED 10A SUM EQUAL 1010%, OF IHE ANNUALSER\9CE C91ARCL OR SLOSS, WTI 102,,, Ifi GItE6fEfL AS AGRP:1!U UPON DAMAGES AND NOI ASA PP:NALIA, ASCUYI'Ud1EAVSSTAXLt�:MEDY. I'1115 WIt,L UF:'I'IIE SO.1 RERMGREDECOUSE I'1 Ift M) C PCDAMGNU EX I'IIEAILLY DI199CUL I T D OETERMINE'I'l1E AC'I'UA L DAAIAG44, IPANY, WH 1Cft MAY ItESIIL'1' FROM AUl'S FAILURE Tl1 AN OfIRM ANY UP 119 OULIGAI'IONS ONIIEIt "f1115 C'OKI'IkAI'E. IF CU9"1'OMER REQUES I'S, AD'E MAY ASSUME GREAT Lit LIAUILI'EY BY Alf ACHING A RIDLk'1 O HUS CONI'RAC"IMATING I RL EX I'EN 1 OF AD'I N ADDITIONAL LL1811,IT1' AND l"t14: ADDI I'IONAL C'11ARGI;S CUS'1'OMUR WILL PAY FOR AU PS ASSUMPI ION OP SUCH GREAT Ell LIARILl IV. 110WEVEILSUCH ADDI'l JONAL CHARGL'SARE NOT INSURANCL PREMIUMS, AND ADl' IS NOT AN INSURER EVEN IF IT EN IERS INTO SIA 11 A iliDER. 4.'THE PROVISIONS OF PHIS PARAGRAPH E SHALL APPLY NU MAI I Ell HOW THE LOSS, DAMAGE OR INJURY OR OTHER CONSEQUENCE OCCURS, EVEN IF DUE 1'0 ADT'S PERFORMANCE Olt NONPERFORMANCE OP ITS OULIGA I IONS UNDER EHiS CON'1'RAC I' OR FROM NEGLIGENCE iAC'fl\'li Oft 0I'111•-ItNAISEh SLITT( I' IIAUILI'I \', VIOLA "PION OF ANY APPLICAELO, CONSUMER ['110-1'ItC1 10N LAW Olt %NV OTHER ALLEGED PAIAX ON THE PART OP AUT, ITS AGENTS OR FAIPLOYEL.S', Ill ANY OTHER PERSON, INCLUDING CUS IT MER!S SURROGATING INSURER. MALLS ANY CLAIM OR PILES .SNI' LAWSIll T AGAINM ADT IN AN'V WAl' It EL.AI'fNCI'U TOE: SlikNl'I:S, SYSTEM Oil EQDIPMEN'r TRAP ART, FlUrSURIT{Cri'S pF lLOTS C(1NTRA(T, THEN CU6fOMEII SDALT. INDEMNIFY ANT) HOLD An r HARMLESS FROM ANY AND ALL SU(II CLAIMS AND LAW90rfS, INCLUDING I DE PAYMENT OF AL1. ')ANT AGE$. EXPENSES, COSTS AND ATTORNEYS' FEES. 5, NO SUTf OR ACTION SHALL RL OROUGIII" AGAINST AO 1 1)k 1'I S AGIiMI"S. F:MYLOI'F.EN, tiU1sSIDL\IkIE&.1VRIL1,\'I'IiS UIi I'AIt F:N'LS (UpTH DIRE("I' AND INDIREC I) MORE I IL\N ONE O) VEAR AFI HR I'DG INCIDENT"F A'1' RESIT ILD IN TDE LUSK, IN.IURY OI2 DAYIAGL OUCURRED,OR'Oil SIIOk'I'L3I❑URA"LION 1-13011'IT'Ell IIN'DI{It APPLIC'AULL LAW IFSUCII PEfOOD ISGRIvA"1'LR IFIAN(11NE(OYEAR. h.l LIE PROVISIONS 01 FIRS PARAGRAPH L SIIA LI. APPLI' I'll AND UIiNEIT I AD] AND 1'IF AGENT'S, F:MI'LU\'EF:S, CON I'RACI ORS, SIIDSIDIAIt MISS,.\PFILIA'rE6,P,11t1:N'Iti flJO'fH D[lil!f'I' AND INDIRFA f)AND AFPINEI'YMARKIIJ'HRS. IP'1'"Ill ("ONI'RACI' PROVIDLSFOR INDIRECT CONNED ION'T O A MUNICIPAL POLICE Olt FIRE, DE.PAR'I'MCN'I' Olt (Ffl9ttlt OItCANIZATiON,'T HEN'T HA'I DEPAR'I'1MFINI' OR Ol'HER ORGANIZA`HON MAY ALSO INVOKE 'I'H P.I'ROVISIONS OF'ITHS PARAGRAPH F. AGAINST ANY( FAINTS ID 111, 10 ANY FAILURE OF SUCH DEPART MEN'r OR ORGANILAIION. F.VIDE,OEQRIPMEN'f.('asmr I., will pwviduuJalnutc Alt, inutiou mS,k, loperaUnnal coOuomfur tha,,oper•grectlnm oftl1A dasvd aimuil ldmiviwin umvcrn l"ll will 1 Mil 11r IIt) A(pit .... :I.Ply whw.«grit1 r11 IUI ...1 I r..Il. G. DIREC I CONNECTION MONITORING. II th N R 11: le lit, adi......... l the Mn. cif 1 Pl,iite Firs Dap mv.nt r'Iny ot1 enla ny, it ,II1111Y I.. I 1 t- it I 6 t t 1 TI w fn Dvp+vn.en I l y ndlh.athc i of. ll ml it I;d 110Fit,D-..... _r 1m;w, lu .1 Ithl.P..(. ,IAD 1.1,1611,ADl.,aa.tw,ny vials'b 1'ry liv lh( mavlar ill vhlth anch siµln.L.as numinrtit till (I)e leaPnlne, if: m. tI..nch.ienals. IT. I IALARDOUS MA I LRI\LS. In Ill x 11 It Nit II n nI t C' a S, 1 xt fC l t'. 6 I l ,Ihc nvd u 1 0( Luvl -1.1a. .v I' I III 1,I I '1 a1. 1'll i 1 I t f . It lul 6.I mu(n n1 -Mal. P IY 61rmlvl hill A LCI ), li rm II lydemolb 1 r mII 6rxIC A ,a h¢¢1 lu rtlIfanv III ul:w sr1 1. .. nUe k,ir. AUI ill tl' r lt' ii l tli,11 serviLe lite Lyt111 tut h t lnl Ilmil U.t ani"h 11.1 AI t 11III."llI (,III, m 1l l (I,f r hallI Iffy 11 1 1I1 IIAT) 1 1 it i' t ,1 }, it l y l L: i 111 IwIt, ll ) n i AUI illy II I : 1' l t 1 I i 1"'1ul I.1 1 i 1 A,uw [I,l lh,l 1 i )' ,all v,u.pply h Uri IlI 'IOt 11 rl t,I I (Inn ,.rF I IYVUI LO L1IS ADl , , li ullvl I l." rst lLda nuts Lglfl 1 I Mi r.- I :11 1.1 ,hewu'm uv.s Lo Im ' I 1tl 1 f II - 1 ti( f r11 ,l ikel.It,0oo(L nN,I(I"d y(. .0 F.ymui h.. inn nl ,(ADT.:lndwdi m,l SC I. .....- dm �phply.v.0 ap (ra,Iorl 11111l.. t tlmulim"I'd Sir\eel tlnit," .1. ASSIGNd14:NI'; P:NFURCEAIti LI'f Y. 'Phi, Cuulnst it nw :i...gnebic by, t"It w, eveoln ISnn... .inen cenxvrl nr ADT n,,, bcinp,Iht.d ed. ADI'shall ha,, the nghl 1n ncs.gn thi.a C'anuaa or v. w6aoml:u I any of ill ubligal¢.1n 1md, I l :ic GNnall wnhrm nmiuc w QI[InlnI ,. ICmy of ILe pmvihinlr.lalIII, Comma shill[ he delIIIIIi ed v. be imnlid or:nwt,rarca:lble, the nnn:nning Prnvisinll+.hull '.sill in Till[ luI,l m'd 01'ea. L. SYSTEM 801-1 {AHI HE, (WORK CONNECTIONS A y. lmt..... .. fill. nh Arc laidMill 1111 S,IlitV, 11 I1,JIiwllwym AD':mA/ 1ADI+I1P11iu Illli hen. lo' Ib1 mpl1.Cut II a t.. A b. ( :amvh levy nn.(1)d1d Ih R.ws r I"cwl tovnylhnd Drte. (it Id Ilcow, 1 1 - 'Cl,, lit r:nv iIt.fIl R,t'Il... 'li 1 Aa..11w,nx win Cyailnnsm uthil-R ,11,0 dca „nml S"Iun vilhwIS,:h 11 i..wor. ADT nloy:nsc:::rdJihuml : 01c Nenvatk and lho I qu.Placm. This Comma rrnxntutes the until 17. Casunnu ugrccs that 11ny ro-pn 's nunpuicl'uanenls ('ry rworV:"). ADT.mIi I'unlisL m.Ill mwil the 19 w the Now ... A seuiug. snpplicll by I'Imwinrer. h1emlWhoa shall 1mt In L'i tllr zc110., o111-1wwi or SiNIleuwma o1'Ow NCtwu(t or Na,,,wk unacot n1 lhr Nowo, k of il'mry additional Eynllaunul6 ,chaired to wnl AD I, In axreobng this Cnntuit, Cas.n.twi w lint relying on any iuduamnentonm'ryt tY,"j"V"ur Inlplitd, ,,it in.:lwled ill ,riling in y us w imad wnlnan aIS'nOan ar qu;dILendnn, eeoqu:n spvohndly y wcnmiacnl nr nddnional umis:nuI canlitn with', wunY Purrhn+r oiler r ther douume.W nlbnnned [IVCustu, lw,. - M. ELECI RC NIC NIL,DIA; PERSONAL INFORAL\IION. AD I' nary xean, anupe ur wilhenrz3e,,nnven thls ConNmt Inln mh ulucuunic fomu0 of any nnnln•. A iy aIi,C 1 l I 1 ni f man. IEally µirlesuo[]Ic I'Iinul lu 1y and'dT It,, (' n'lldinl, lit"atilt Ih n'11 nfim Itial'olial)"ll l"'PSeer 1tl 111n th [( I I i 11 ADi n 1 lilt IC ll thwilYALI 1) lid fry I vhhn 1 tl0 mt urn[[( Inel ecinselit,1 At)'I. IC 1 I A f I flh.Id ( 1h U t I.1 II(l[tlh It11 ( fnnllhim, .ut"ll, l bolo:unnR ( 1 winlyl 1 IhslWlilg 1 tl'PI.. 4l.il h 1 'wil,lh,I all l...ML11,, w, wall Ifni 1 l Id, obta,,wdAcCwi.nl i I Ili, IhhdPat l .h: Idli 1 u1 ('.InIII I,w11nADlToil. II I ( r A ad `r l n[ < Sltllilwl's al,itmlt AlIft AU tandmpi,wid,d l III, n LA D y ofli,,'16 'I (' .I -it I( 1 l l l l 1 I it At) f QlQ, djI,,lw,,l lixtl I ( :I rl mlll.i, "I.0 flIal 11, I1 '1 llylr'l r[ ADl i rl 'Ihh1. .F i I'III ill nar' 1 va, u. wild (11n111 1,,my:Pphulhlrnlln,-ly b.vin.Prylit l On1u0cson I fravtiu. 1 d 11 1 l ": 1 1 Y.ICIIII' 1. 1 r\ II' p.F ill. N. IicFNSC INFgi<MAfIUN M1F..( 11Ttu b'in.11 Try b"IfilItId Ili lit, All FM In rSu I H 1.1 1 wc� 1.. 715-V thn Rd., 'fiva'f ILln uy3( 11 (T3t) ( :tw¢ AI(a/I+tl SS?0I k (11.tNo SN 009A AR LI MIA I, Ra•Lt 1rd by Nka 1.5. fhi. of I'rir: 0.•invesligubnN di S iryAC IIISIIcPaI PI. D Llul Roll,. l[7209 I50q(10 x(Ite;AL (UC 19591'GAAI UZUS einn nR. ,Y 1 rm1 Y-- ITnaed 1 Jr Swill Iby lh Dlr IS Ivily 3.h. f;,u nS 0 D11..fL NE54 rAVU405 nn n1,9;111(4 )14441 ELL I" 43 IF 12401792LL; DC LCS9U /12 PL P:I II0UI 12I 6A LVA ilt 1 1115.Ln. 0$S/ .0>(]'1, .0t4]l, LVIJ40st 7t n11414v; IO(I t)21T,IU ELL Sc G4i, It ❑r1001 P)2. LA P 103V. PI WU.19o41, IVb54. I1 ¢55: MA nLC: MI tGi11y01i!t9, iUO_'11F d ISZ Pia Nnuh Dr tilt Lh Mint. MI 4a5(H; YIN ISo$0251; NC ]535PI. 7501 P_', 7t(ZPIll 7NtP'1. 75(SI195bM1P') AIAnn SvslnnxLun iny, Ud 4901(;;nw nA, `Iw.-OU R,Iiµ1y L17e1(III, 748 S320:NM i/tSih; NY 007710p NJ FICui d(:nnnwwr lA IPv 34PAQW40500, 34BA00179000791 Biowriiiig 12I-Pnnvulk, NI PNIS9: N1'1200050 It,Li.ea d by N)6 Dept al ll414 Off 50-18 001 S, SIT-25-0d23, 5024(KX L SII ,11-t1014. 50 46-011UN. SIFSA-Om15- 50.7W IIIDb, SlbxuA)(IU>, S3�E9-1126:OE 1995; pit 1965101 PA Pvnnsylvvata 14unle I nptovc„u0('ontr 1 RF1PtwIV II IAOaD7971U 5-xt TNA(( 1aNl I<h) I(n UII Il )2. I(N i('W,-Ib•.S I")"'I;C HI]94A-HIT Huller Itd Ste MUDS A n 1 'I'k 7S t 'f m.1'ri t S n � R a: h(R \. 1. F I A. T ]x]5211 r Zha65 ); \'A i 17135 i i�]J4tl. I I-ZJ51. IIIL11759N i7AIO,1I1115,11h351.I S44]2AC+1477_¢(lay.it(oru...6ml L..cla.o.1f.M.WAADILLLnSIU(1.1I&2d NtlocA PNwytliW, Ho.Melh 1VA' KO I� WI?❑h9A3r D'V 0In7hA. MS 1501 CIS f I s2015 AOf LLC dbu AUT Lcenrity Snvin`s. All rights mselvnl. 6of7 ((13/IS) REQUEST BY COMMISSIONER PRECINCT #1 FOR AUTHORIZATION TO ENTER INTO A CONTRACT WITH AT&T FOR CELL PHONE FOR OFFICE MANAGER AND FOREMAN AND TO AUTHORIZE COMMISSIONER GALVAN TO SIGN CONTRACT: Commissioner Galvan made a motion to authorize contract for Precinct #1 with AT&T for cell phone for Office Manager and Foreman and authorize Commissioner Precinct #1 to sign. Commissioner Fritsch seconded the motion Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor Calhoun County Conunissioner Precinct #1 211 S. Ann Port Lavaca, TX 77979 (361) 552-9242 July 16, 2015 Honorable Michael Pfeifer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Pfeifer: Please place the following Item on the next Commissioner's Court Agenda, Fax(361).553-8734 Pager (361) 579-7915 Mobile (361) 935-3552 Consider and take necessary action to authorize Precinct 1 to enter into a cell phone contract with AT&T for the office manager and foreman, and to authorize Commissioner Ro Ga van to sign the contract. Sincerely,` County Commis' ner f 1 Roger C. d`alvan RCG/apt to b'oRt MorvimlaU. (IIIiIfINIIIpTi'.YII.Y AT&T Wire Agreement Foreman's Phone: $99.00 for New Rugby 4 with 2yr Contract $40.00 Upgrade Office Manager's Phone: $ .991 phone 5C with 2yr contract $40.00 Activation Fee $40.00 Monthly Charge Old Monthly Charges about: $80.00 New Monthly Charges about $100.00 APPOINT BOARD MEMBER TO CALHOUN COUNTY LIBRARY BOARD: Commissioner Galvan made a motion to appoint Magda Wyatt to the Calhoun County Library Board. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Susan Riley From: Noemi Cruz <ncruz@cclibrary.org> Sent: Wednesday, July 15, 2015 9:47 AM To: 'Susan Riley' Subject: Agenda Item Hi Susan, Please add to agenda for next Commissioners' Court meeting. - Approval of new board member -Thanks Noemi Cruz, Library Director Calhoun County Public Library 200 W.Mahan Port Lavaca, TX 77979 Phone 361.552.7250 ext. 23 Fax 361.552.4926 Email ncruz@cclibrary.org Web www.cclibrary.org Calhoun County Library Board Port Lavaca, Texas July 15, 2015 Judge Michael Pfeifer: The Calhoun County Library Board presents Magda Wyatt for approval by the Commissioner's Court for appointment to this Board. Magda is replacing Virginia Lichac. We would greatly appreciate you including this on the agenda of your next meeting. Sincerely, Ryan Smiga, President TAKE ACTION ON GENERAL WARRANTY DEED, PROPERTY IS BLOCK 11, LOTS 2 & 3, BAYSIDE BEACH ADDITION, CALHOUN COUNTY, TEXAS. AUTHORIZE COUNTY JUDGE TO EXECUTE WARRANTY DEED AND SEND LETTER OF APPRECIATION TO ROBERT D. PRUESSNER. Commissioner Galvan made a motion to approve General Warranty Deed for Block 11, Lots 2 & 3, Bayside Beach Addition, Calhoun County, Texas and authorize County Judge to execute Warranty Deed and send letter of appreciation to Robert D. Pruessner. Commissioner Lyssy seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor Robert D. Pruessner 201 McDermott St., Apt 108 Deer Park, Texas 77058 281 930- 7879 2 July 2015 Dear Mr. Salyer, I greatly appreciate you going beyond your normal duties to help me give a sliver of a lot to Calhoun County to simplify the settling of my estate for my kids. I suspect that Mr Heard also had to support your doing this so I owe him a Thanks also. Mr Hubbell's support of course was critical by requesting the legal help from the District Attorneys office. I have in the past tried several ways to achieve this result but always ended up in a dead end situation. This will also be a small reduction in work load for the Calhoun County tax system which resulted in costly employee time and paper work expenses for a two dollar annual "income". Thanks for your considerate help, Bob Pruessner r. Bob Pruessner General Warranty Deed Date: July Z 2015 Grantor: Robert D. Pruessner Grantor's Mailing Address: Robert D.Pruessner 201 McDermott, Apt. 108 Deer Park, Texas 77536 Grantee: Calhoun County, a Texas corporation Grantee's Mailing Address: Calhoun County 211 S. Ann Port Lavaca, Texas 77979 Consideration: Cash and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged. Property (including any improvements): Block 11, Lots 2 & 3 Bayside Beach Addition, a subdivision in Calhoun County, Texas Reservations from Conveyance: None Exceptions to Conveyance and Warranty: None Grantor, for the Consideration and subject to the Reservations from Conveyance and the Exceptions to Conveyance and Warranty, grants, sells, and conveys to Grantee the Property, together with all and singular the rights and appurtenances thereto in any way belonging, to have and to hold it to Grantee and Grantee's heirs, successors, and assigns forever. Grantor binds Grantor and Grantor's heirs and successors to wanfant and forever defend all and singular the Property to Grantee and Grantee's heirs, successors, and assigns against every person whomsoever lawfully claiming or to claim the same or any part thereof, except as to the Reservations from Conveyance and the Exceptions to Conveyance and Warranty. Hp i-n UM —JH :an �H �n mr, �v r_ 4ca �r .�a H 40 470 am 0 40 70 uv P 0) w a v GRANTEE IS TAKING THE PROPERTY IN AN ARMS -LENGTH AGREEMENT BETWEEN THE PARTIES. THE CONSIDERATION WAS BARGAINED ON THE BASIS OF AN "AS IS, WHERE IS" TRANSACTION AND REFLECTS THE AGREEMENT OF THE PARTIES THAT THERE ARE NO REPRESENTATIONS OR EXPRESS OR IMPLIED WARRANTIES. GRANTEE HAS NOT RELIED ON ANY INFORMATION OTHER THAN GRANTEE'S INSPECTION. GRANTEE RELEASES GRANTOR FROM LIABILITY FOR ENVIRONMENTAL PROBLEMS AFFECTING THE PROPERTY, INCLUDING LIABILITY (1) UNDER THE COMPREHENSIVE ENVIRONMENTAL RESPONSE, COMPENSATION, AND LIABILITY ACT (CERCLA), THE RESOURCE CONSERVATION AND RECOVERY ACT (RCRA), THE TEXAS SOLID WASTE DISPOSAL ACT, AND THE TEXAS WATER CODE; OR (2) ARISING AS THE RESULT OF THEORIES OF PRODUCT LIABILITY AND STRICT LIABILITY, OR UNDER NEW LAWS OR CHANGES TO EXISTING LAWS ENACTED AFTER THE EFFECTIVE DATE OF THE PURCHASE CONTRACT THAT WOULD OTHERWISE IMPOSE ON GRANTORS IN THIS TYPE OF TRANSACTION NEW LIABILITIES FOR ENVIRONMENTAL PROBLEMS AFFECTING THE PROPERTY. When the context requires, singular nouns and pronouns include the plural. Robert D. Pruessner Calhoun County, a division of Texas government, i e fei r, my Judge STATE OF TEXAS COUNTY OF HARRIS This instrument was acknowledged before me on i o7 20 r , 2015, by Robert D. Pruessner. y f MARQO RIEVES Notary P blic, to of T as + { MY COMMISSION EXPIRES My _ commission expires: AS, March25,2018 3 STATE OF TEXAS F�H'IbIll xaff WV1 This instrument was acknowledged before me on z.2015, by Mike Pfeifer, as the County Judge of Calhoun County, a uniGFTe c s government, on behalf of said county. eQ.wt Notary Public, State of Tex My commission expires: PREPARED IN THE OFFICE OF: Shannon E. Salyer Assistant District Attorney P.O. Box 1001 Port Lavaca, Texas 77979 Tel: (361) 553-4422 Fax: (361) 553-4421 AFTER RECORDING RETURN TO: Shannon E. Salyer Assistant District Attorney P.O. Box 1001 Port Lavaca, Texas 77979 Tel: (361) 553-4422 Fax: (361) 553-4421 July 29 2015 8:36 AN This Document has been received by this Office for Recording into the Official Public Records. Re do hereby spear that we do nut discriminate due to Race, Creed, Color, Sex or National Origin. Filed for Record in: Calhoun County Honorable Anna Goodman County Clerk �Deputy Instr.: 144140 Stamps: 4 Page(s) COMMISSIONERS'COURT CAAL>E3OUN COUNTY, TEXAS 211 S. ANN STREET, SUITE 301 PJRT iAVACA TEXAS 361-663-4600 July 29, 2015 Robert D. Pruessner 201 McDernlott St., Apt. 108 Deer Park TX 77058 Re: Block 11, Lots 2 & 3, Bayside Beach Addition Dear Mr. Pruessner, On behalf of Calhoun County Commissioners' Court, I would like to express our appreciation for the gift to Calhoun County of the Uvo lots at Bayside Reach. Having these two lots titled to the County will greatly simplify things for all concerned. The Court accepted the General Warranty Deed on July 23, 2015. I have enclosed a copy for your records. Again, the Court extends its appreciation to you. Sincerely, � 4 r Michael J. Pfeifer Calhoun County Judge MJP/sr E'nc(s) R/SRPTY.Oy1\ DEPARTMENT OF STATE HEALTH SERVICES CONTRACT 2016-000020-00 IN THE AMOUNT OF $60,082.00 AND AUTHORIZE APPROPRIATE ELECTRONIC SIGNATORY PERSONNEL: Commissioner Galvan made a motion to authorize Department of State Health Services Contract 2016-00020-00 in the amount of $60,082.00 and authorize County Judge to sign. Commissioner Lyssy seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. DEPARTMENT OF STATE HEALTH SERVICES CONTRACT 2016-000020-00 This Contract is entered into by and between the Department of State Health Services (DSHS or the Department), an agency of the State of Texas, and Calhoun County Health Department (Contractor), a Governmental, (collectively, the Parties) entity. 1. Purpose of the Contract: DSHS agrees to purchase, and Contractor agrees to provide, services or goods to the eligible populations. 2. Total Amount: The total amount of this Contract is $60,082.00. 3. Funding Obligation: This Contract is contingent upon the continued availability of funding. If funds become unavailable through lack of appropriations, budget cuts, transfer of funds between programs or health and human services agencies, amendment to the Appropriations Act, health and human services agency consolidation, or any other disruptions of current appropriated funding for this Contract, DSHS may restrict, reduce, or terminate funding under this Contract. 4. Term of the Contract: This Contract begins on 09/01/2015 and ends on 08/31/2017. DSHS has the option, in its sole discretion, to renew the Contract. DSHS is not responsible for payment under this Contract before both parties have signed the Contract or before the start date of the Contract, whichever is later. 5. Authority: As applicable, DSHS enters into this Contract under the authority of Texas Health and Safety Code Chapter 12 or 1001 or Texas Government Code Chapters 531, 771, 791 or 2155. 6. Program Name: RLSS/LPHS RLSS/Local Public Health System-PnP Page 1 of 12 7. Statement of Work: A. CONTRACTOR will improve or strengthen local public health infrastructure within the State of Texas by: 1. Developing objective(s) to address a public health issue; 2. Utilizing resources provided through this Program Attachment to conduct activities and services that provide or support the delivery of essential public health services; 3. Assessing, monitoring, and evaluating the essential public health activities and services provided through this Program Attachment; and 4. Developing strategies to improve the delivery of essential public health service(s) to identified service area. B. These tasks shall be performed in accordance with Department of State Health Services (DSHS) Division for Regional and Local Health Services Interlocal Application. The assessment and/or evaluation activities must include measurable standards. Acceptable standards include the National Public Health Performance Standards approved by the Centers for Disease Control and Prevention Healthy People 2020 (Healthy People) related goals and objectives, and DSHS Programmatic grant guidance and performance standards relative to the contractors identified scope of work, as well as any federal, state or local law or regulation governing the delivery of essential public health services. Other evaluation methods utilizing standards not listed in this Program Attachment must be pre -approved by DSHS. C. CONTRACTOR will comply with all applicable federal and state laws, rules, regulations and standards including, but not limited to, the following: 1. Chapter 23-11 of the Healthy People 2020; 2. Section 121.002 of Texas Health & Safety Code; 3. Section 403.1055 of Texas Government Code. D. CONTRACTOR will not use funds from the Permanent Fund for Children and Public Health for lobbying expenses under the Texas Government Code Section 403.1067. E. CONTRACTOR will comply with all applicable regulations, standards, and guidelines in effect on the beginning date of this Program Attachment. F. DSHS will inform CONTRACTOR in writing of any changes to applicable federal and state laws, rules, regulations, standards and guidelines. CONTRACTOR shall comply with the amended law, rule, regulation, standard or guideline except that CONTRACTOR shall inform DSHS Program in writing if it shall not continue performance under this Program Attachment within 30 days of receipt of an amended standard(s) or guideline(s). DSHS may terminate the Program Attachment immediately or within a reasonable period of time as determined by DSHS. G. DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. DSHS will monitor CONTRACTOR's expenditures on a quarterly basis. If expenditures are below that projected in CONTRACTOR's total contract amount, CONTRACTOR's budget may be subject to a decrease for the remainder of the contract term. Vacant positions existing after 90 days may result in a decrease in funds. H. Contractor agrees to read DSHS Contractor Financial Procedures Manual (CFPM) and work with DSHS staff regarding the management of funds received under this Contract. http://www.dshs.state.tx.us/contracts/cfpm.shtm. Page 2 of 12 PERFORMANCE MEASURES A. CONTRACTOR will complete the Performance Measures as stated in the CONTRACTOR'S FYI Local Public Health Service (LPHS) Service Delivery Plan, and as agreed upon by DSHS, hereby attached as Exhibit A. B. CONTRACTOR will provide activities and services required under this Program Attachment in the Service Area designated in the most recent version of Section 8,"Service Area" of this contract. See Programmatic Reporting Requirement section for required reports. BILLING INSTRUCTIONS: CONTRACTOR will request payment using the State of Texas Purchase Voucher (Form B-13) on a monthly basis with acceptable supporting documentation for reimbursement of the required services/deliverables. Vouchers and supporting documentation should be mailed or submitted by fax or electronic mail to the addresses/number listed below. Claims Processing Unit, MC1940 Department of State Health Services 1100 West 49th Street PO Box 149347 Austin, TX 78714-9347 The fax number for submitting State of Texas Purchase Voucher (Form B-13) to the Claims Processing Unit is (512) 776-7442. The email address is invoices@dshs.state.tx.us. -- Page 3 of 12 8. Service Area Calhoun County Page 4 of 12 This section intentionally left blank. Page 5 of 12 10. Procurement method: Non -Competitive I me ragency/I me riocal GST-2012-Solicitation-00025 RLHS GOLIVE LPHS PROPOSAL 11. Renewals: Number of Renewals Remaining: 0 Date Renewals Expire: 08/31/2017 12. Payment Method: Cost Reimbursement 13. Source of Funds: 93.991, 93.991, STATE 14. DUNS Number: rF 3BIOkB3Y21! Page 6 of 12 15. Programmatic Reporting Requirements: Report Name Frequency Period Begin Period End Due Date Project Service Quarterly 09/01/2015 11/30/2015 12/31/2015 Delivery Plan Project Service Quarterly 12/01/2015 02/29/2016 03/31/2016 Delivery Plan Project Service Quarterly 03/01/2016 05/31/2016 06/30/2016 Delivery Plan Project Service Quarterly 06/01/2016 08/31/2016 09/30/2016 Delivery Plan Project Service Quarterly 09/01/2016 11/30/2016 12/31/2016 Delivery Plan Project Service Quarterly 12/01/2016 02/28/2017 03/31/2017 Delivery Plan Project Service Quarterly 03/01/2017 05/31/2017 06/30/2017 Delivery Plan Project Service Quarterly 06/01/2017 08/31/2017 10/15/2017 Delivery Plan Financial Status Quarterly 09/01/2015 11/30/2015 12/31/2015 Report (FSR) Financial Status Quarterly 12/01/2015 02/29/2016 03/31/2016 Report (FSR) Financial Status Quarterly 03/01/2016 05/31/2016 06/30/2016 Report (FSR) Financial Status Quarterly 06/01/2016 08/31/2016 09/30/2016 Report (FSR) Financial Status Quarterly 09/01/2016 11/30/2016 12/31/2016 Report (FSR) Financial Status Quarterly 12/01/2016 02/28/2017 03/31/2017 Report (FSR) Financial Status Quarterly 03/01/2017 05/31/2017 06/30/2017 Report (FSR) Financial- Status Quarterly 06/01/2017 08/31/2017 10/15/2017 Report (FSR) Submission Instructions: Contractor shall submit Project Service Delivery Plan (Exhibit A) report on a quarterly basis, as noted on the Exhibit A, to the contract manager by the end of the month following the end of each quarter. Submit to: LocaIPHTeam@dshs.state.tx.us ; Fax #: 512/776-7391. Contractor shall.submit quarterly FSRs to Fiscal -Claims Processing Unit by the last business day of the month following the end of each quarter. Contractor shall submit the final FSR no later than 45 calendar days following the end of the applicable term. Submit to: invoices@dshs.state.tx.us ; Fax #: 512/776-7442. Page 7 of 12 16. Special Provisions General Provision, ARTICLE XIV, General Terms, Section 14.12, Amendment is revised to include the following: Contractor must submit all amendment and revision requests in writing to the Division Contract Management Unit at least ninety (90) days prior to the end of the term of this Program Attachment. General Provisions, ARTICLE II COMPLIANCE AND REPORTING, Section 2.05 Reporting, are revised to include the following paragraph: CONTRACTOR shall submit quarterly and final performance reports that describe progress toward achieving the objectives contained in approved Contractor's Service Delivery Plan and any written revisions. Contractor shall submit the performance reports by the end of the month following the end of each quarter, in a format to be provided by DSHS. Failure to submit a required report of additional requested information by the due date specified in the Program Attachment (s) or upon request constitutes breach of contract, may result in delay payment, and may adversely affect evaluation of Contractor's future contracting opportunities with the department. Programmatic Reporting Submission Requirements: Reports and Report signature page should be sent electronically to: LocalPHTeam@dshs.state.tx.us, or the signature page can sent by facsimile to 512-776-7391. A copy of the report should be sent to the respective DSHS Health Service Region, Attention: Deputy Regional Director. See Programmatic Reporting Requirements. section for required reports. General Provisions, ARTICLE XXI Program Operations, Section 21.06 Responsibilities and Restrictions Concerning Governing Board, Officers and Employees, is not applicable to this program Attachment. General Provisions, ARTICLE XXII Program Equipment and Supplies, Section 22.01 Equipment, is revised to include the following: For the purpose of this Program Attachment, equipment is not approved as part of the base budget for RLSS/LPHS. The funds are for direct services. Although, at mid -year of the contract term, if funds are identified as not being used, the funds may be used to purchase equipment in the 3rd quarter of the contract or program attachment term. Contractor must submit proposal to redirect funds with justification as to how the equipment helps achieve the goals, objectives, and deliverables outlined in Exhibit A (Project Service Delivery Plan). The proposal must be submitted to the contract manager assigned to the program attachment. Page 8 of 12 17. Documents Forming Contract. The Contract consists of the following: a. Contract (this document) 2016-000020-00 b. General Provisions Subrecipient General Provisions c. Attachments Budget d. Declarations Certification Regarding Lobbying, Fiscal Federal Funding Accountability and Transparency Act (FFATA) Certification e. Exhibits Exhibit A Any changes made to the Contract, whether by edit or attachment, do not form part of the Contract unless expressly agreed to in writing by DSHS and Contractor and incorporated herein. 18. Conflicting Terms. In the event of conflicting terms among the documents forming this Contract, the order of control is first the Contract, then the General Provisions, then the Solicitation Document, if any, and then Contractor's response to the Solicitation Document, if any. 19. Payee. The Parties agree that the following payee is entitled to receive payment for services rendered by Contractor or goods received under this Contract: Name: Calhoun County Treasurer Vendor Identification Number: 17460019239 20. Entire Agreement. The Parties acknowledge that this Contract is the entire agreement of the Parties and that there are no agreements or understandings, written or oral, between them with respect to the subject matter of this Contract, other than as set forth in this Contract. I certify that I am authorized to sign this document and I have read and agree to all parts of the contract, Department of State Health Services By: Signature of Authorized Official Date Name and Title 1100 West 49th Street Address Austin, TX 78756-4204 City, State, Zip Telephone Number E-mail Address Calhoun County Health Department By: Signature of Authorized Official Date Name and Title Address City, State, Zip Telephone Number E-mail Address Page 9 of 12 Organization Name: Contract Number: Budget Categories Budget Summary Calhoun County Health Department 2016-000020-00 Program ID: RLSS/LPHS Budget Categories DSHS Funds Requested Cash Match In Kind Match Contributions Category Total Personnel $60,082.00 $0.00 $0.00 $60,082.00 Fringe Benefits $0.00 $0.00 $0.00 $0.00 Travel $0.00 $0.00 $0.00 $0.00 Equipment $0.00 $0.00 $0.00 $0.00 Supplies $0.00 $0.00 $0.00 $0.00 Contractual $0.00 $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 $0.00 Total Direct Costs $60,082.00 $0.00 $0.00 $60,082.00 Indirect Costs $0.00 $0.00 $0.00 $0.00 Totals $60,082.00 $0.00 $0.00 $60,082.00 Page 10 of 12 RLHS FY16 Local Hlth Svcs Renewal Organization: Calhoun County Health Department Exhibit: Exhibit A Organization Name: Calhoun County Health Department Contract Number: 2016-000020-00 Program ID: Contract Term: 9/1/2015 - 8/31/2017 Program Name: Exhibit Title: Exhibit A RLHS-2016-RLSS/LPHS-00011 RLSS/LPHS RLSS/Local Public Health System-PnP FY 2016/17 Request for Local Public Health Services Funds Project Service Delivery Plan Texas Department of State Health Services Local Health Department: Calhoun County Health Department Contract Term: September 1, 2015 through August 31, 2017 Indicate in this plan how requested Local Public Health Services (LPHS) contract funds will be used to address a public health issue through essential public health services. The plan should include a brief description of the public health issue(s) or public health program to be addressed by LPHS funded staff, and measurable objective(s) and activities for addressing the issue. List only public health issues/programs, objectives and activities conducted and supported by LPHS funded staff. List at least one objective and subsequent required information for each public health issue or public health program that will be addressed with these contract funds. The plan must also describe a clear method for evaluating the services that will be provided, including identification of a specific evaluation standard, as well as recommendations or plans for improving essential public health services delivery based on the results of the evaluation. Complete the table below for each public health issue or public health program addressed by LPHS funded staff. (Make additional copies of the table as needed) Public Health Issue: Briefly describe the public health issue to be addressed. Number issues if more than one issue will be addressed. 1. Adult and Childhood Immunization activities for Calhoun County. 2. Tuberculosis Control activities for Calhoun County. Essential Public Health Service(s): List the EPHS(s) that will be provided or supported with LPHS Contract funds 1. Enforce laws and rules that protect the public health and ensure safety in accordance with those laws and rules (EPHS #6). 2. Diagnose and investigate community health problems and community health hazards (EPHS #2). Objective(s): List at least one measurable objective to be achieved with resources funded through this contract. Number all objectives to match issue being addressed. Ex: 1.1, 1.2, 2.1, 2.2, etc.) 1. Maintain high immunization rates in all adults and children of Calhoun County. 2. Maintain comprehensive Tuberculosis investigation and treatment for all classifications of patients in Calhoun County. Performance Measure: List the performance measure that will be used to determine if the objective has been met. List a performance measure for each objective listed above. 1. Increase childhood immunizations in 0 — 35 month olds by 4-6%. 2. Provide 100% Directly Observed Therapy (DOT) to all adult Tuberculosis cases, and perform 100% of contact investigations of Tuberculosis cases. Activities List the activities conducted to meet the proposed objective. Use numbering system to designate match between issues/programs and objectives. 1.1. Order and correctly store DSHS TVFC vaccines and private vaccine supplies to maintain a 07/16/2015 Page 1 of 2 RLHS FY16 Local Hlth Svcs Renewal Organization: Calhoun County Health Department RLHS-2016-RLSS/LPHS-00011 Exhibit: Exhibit comprehensive immunization program. 1.2. Conduct immunization clinics outside of Calhoun County Health Department to various local public health partners in Calhoun County. 2.1. Maintain simple procedures for DOT administration at Calhoun County Health Department, in patient's homes, and with other community health partners, i.e., hospitals, school nurses, etc. 1.2 Conduct contact investigations on Tuberculosis case patients. Evaluation and Improvement Plan List the standard and describe how it is used to evaluate the activities conducted. This can be a local, state or federal guideline. 1.1. CDC, ACIP, and DSHS Immunization Guidelines are to be utilized in the proper ordering, handling and administration of immunizations. 2.1. DSHS Tuberculosis Control Guidelines, which are continually updated, will be utilized for all activities of the Tuberculosis Control Program, specifically in ordering the correct medications and in utilizing DOT guidelines. Deliverable Describe the tangible evidence that the activity was completed. 1.1. DSHS vaccine inventory and ordering reports are to be reported at least quarterly. 1.2. Reports of immunization clinics outside of Calhoun County Health Department will be reported at least quarterly. 2.1. Reports of DOT activity are to be reported at least quarterly, including the forms sent to DSHS concerning this activity. 2.2. Reports on contact investigations are to be performed at least quarterly. 07/16/2015 Page 2 of 2 Exhibit A Organization Name: Calhoun County Health Department Contract Number: 2016-000020-00 Program ID: RLSS/LPHS Contract Term: 09/01/2015 - 08/31/2017 Program Name: RLSS/Local Public Health System -Pi FY 2016/17 Request for Local Public Health Services Funds Project Service Delivery Plan Texas Department of State Health Services Local Health Department: Calhoun County Health Department Contract Term: September 1, 2015 through August 31, 2017 Indicate in this plan how requested Local Public Health Services (LPHS) contract funds will be used to address a public health issue through essential public health services. The plan should include a brief description of the public health issue(s) or public health program to be addressed by LPHS funded staff, and measurable objective(s) and activities for addressing the issue. List only public health issues/programs, objectives and activities conducted and supported by LPHS funded staff. List at least one objective and subsequent required information for each public health issue or public health program that will be addressed with these contract funds. The plan must also describe a clear method for evaluating the services that will be provided, including identification of a specific evaluation standard, as well as recommendations or plans for improving essential public health services delivery based on the results of the evaluation. Complete the table below for each public health issue or public health program addressed by LPHS funded staff. (Make additional copies of the table as needed) Public Health Issue: Briefly describe the public health issue to be addressed. Number issues if more than one issue will be addressed. 1. Adult and Childhood Immunization activities for Calhoun County. 2. Tuberculosis Control activities for Calhoun County. Essential Public Health Service(s): List the EPHS(s) that will be provided or supported with LPHS Contract funds 1. Enforce laws and rules that protect the public health and ensure safety in accordance with those laws and rules (EPHS #6). 2, Diagnose and investigate community health problems and community health hazards (EPHS #2). Objective(s): List at least one measurable objective to be achieved with resources funded through this contract. Number all objectives to match issue being addressed. Ex: 1.1, 1.2, 2.1, 2.2, etc.) 1. Maintain high immunization rates in all adults and children of Calhoun County. 2. Maintain comprehensive Tuberculosis investigation and treatment for all classifications of patients in Calhoun County. Performance Measure: List the performance measure that will be used to determine if the objective has been met. List a performance measure for each objective listed above. 1. Increase childhood immunizations in 0 — 35 month olds by 4-6%. 2. Provide 100% Directly Observed Therapy (DOT) to all adult Tuberculosis cases, and perform 100% of contact investigations of Tuberculosis cases. Activities List the activities conducted to meet the proposed objective. Use numbering system to designate match between issues/programs and objectives. Page 11 of 12 1.1. Order and correctly store DSHS TVFC vaccines and private vaccine supplies to maintain a comprehensive immunization program. 1.2. Conduct immunization clinics outside of Calhoun County Health Department to various local public health partners in Calhoun County. 2.1. Maintain simple procedures for DOT administration at Calhoun County Health Department, in patient's homes, and with other community health partners, i.e., hospitals, school nurses, etc. 1.2 Conduct contact investigations on Tuberculosis case patients. Evaluation and Improvement Plan List the standard and describe how it is used to evaluate the activities conducted. This can be a local, state or federal guideline. 1.1. CDC, ACIP, and DSHS Immunization Guidelines are to be utilized in the proper ordering, handling and administration of immunizations. 2.1. DSHS Tuberculosis Control Guidelines, which are continually updated, will be utilized for all activities of the Tuberculosis Control Program, specifically in ordering the correct medications and in utilizing DOT guidelines. Deliverable Describe the tangible evidence that the activity was completed. 1.1. DSHS vaccine inventory and ordering reports are to be reported at least quarterly. 1.2. Reports of immunization clinics outside of Calhoun County Health Department will be reported at least quarterly. 2.1. Reports of DOT activity are to be reported at least quarterly, including the forms sent to DSHS concerning this activity. 2.2. Reports on contact investigations are to be performed at least quarterly. Page 12 of 12 InlelliOmws TXDSHS - Document Page *�a A Department of State Health Services ' � CFvk Gp4vl Finn Document Information: R HS- O1U-R / PH -00011 Parent Information: R H - 01 -R SS/ PH -000Og 1 Details You are here: > Renewal Menu > Forms Organization Name: Calhoun County Health Department Contract Number: 2016-000020-00 For contracts greater than $100,000, this attachment is applicable and must be signed as part of the contract agreement. CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief that: (1) No federal appropriated funds have been paid orwill be paid, by oron behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) if any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit, an officer or employee of congress, or an employee of a member of congress in connection with this Standard Form-11, "Disclosure Form to Report Lobbying; in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less that $10,000 and not more than $100,000 for each such failure. © Applicable © Nan -Applicable Signature of Authorized Individual Date: https:llegrants,dshs.texas.gov/ObjeetPage2.aspx7omWD-101988&pgoID-20166[7/16/20l5 3:18:38 PN9 InteliiGrants 1'XDSHS -Document Page Navigation Links ..._.... ... .. .___....._ ......---- - - - istatus Page Name Note Created B y Last Modified By Certification Regard"nq Lobby na i r Fi�lFed�l�q Accountability and Transpacem Act (EFATA) LI Cuttification Sianalure Paae t zenerel Pfov s ons Contract Print Exh bit Wilczynski, Jonah - RLHS 6/25/2015 2:23:47 PM Top of the Page Powered by IntelliGrants Tm © Copyright 20 00-2015 Agate Software, Inc. https://egrants.dshs.texas.gov/ObjectPage2.aspx7onmlD=101988&pgeID-20166[71162O15 3:18:38 PM] InteltiGrants TXDSHS - Document Page i *�5 TEXAS Department of State Health Services Heck 1.0 - :.�-ara:�e+��ya�:E�.nnyrn Parent Information: RLHS-2015-RLSS/LPHS-00009 Details You are here: > Renewal Menu > FormsMenu The certifications enumerated below represent material facts upon which DSHS relies when repoding information to the federal government required under federal law. If the Department later determines that the Contractor knowingly rendered an erroneous certification, DSHS may pursue all available remedies in accordance with Texas and U.S. law. Signor further agrees that it will provide immediate written notice to DSHS If at any time Signor learns that any of the certifications provided for below were erroneous when submitted or have since become erroneous by reason of changed circumstances. If the Signor cannot certify all of the statements contained in this section, Signor must provide written notice to DSHS detailing which of the below statements It cannot certify and why. Organization Name Calhoun County Health Department Address 117 W Ash St City Port Lavaca State Texas Payee Name Calhoun County Treasurer Address County Auditor Treasuer 202 S Ann St Ste B _ City Port Lavaca State TX Vendor Identification No. 17460019239 Payee DUNS No.* 087309324 Zip Code (9 digit) 77979-2912 Zip Code (9 digit) 77979-4204 MailCode 004 1. Did your organization have a gross income, from all sources, of mete. than $300,000 in your previous tax year? ©Yes 0No ; Identify contact persons for FFATA Correspondence.' FFATA Contact Person #1 Name` Email' Telephone` FFATA Contact Person #2 Name' Email' Telephone' 0 a https:llcgmnts.dshs.texas.gov/ObjectPago2.aspx7pgelD=20160&omnPwent_omnlD=101978&omnID=101982[7/1612015 2:48:20 PM Intelli(Mmts TXDSHS - Document Page 0 As the authorized representative of the Organization, I hereby certify that the statements made by me in this certification form are true, complete and correct to the best of my knowledge. E-Signature Date Navigation Links Certification Regafding Lobbvina i Fiscal Federal Fundino Accountability and Transparency Act (FFATAI Certification LJ Signature Page General Provisions > Contract Print Exhibit Wilczynski, Jonah - RLHS I 6/25/2015 2:23:47 PM i ' Too of the Page Powered by IntelliGrantsn" © Copyright 2000-2015 Agate Software, Inc. https://egmnts.dshs.texas.gov/ObjeotPage2.aspx?pgeID20160&omnParent omnlD=101978&omnID=101982[7/16/20152:48:20PM] IntetliGrants TXDSHS - Document Page ® � i LX l Department of State !-Health Services ME Document Information: FRI H - 016-R ! PHS-00011 Parent Information: R H - 01 -R SS/LPHS-00009 .Details You are here: > Renewal Menu > Forms Menu SIGNATURE PAGE Contract Number Program ID -Program Name - Contract Amount Contract Term - Contractor Signature Q 1 certify that I am authorized to sign this document, and any attachments or addendums thereto, and I have read and agree to all parts of the contract. Signed By: Date Signed: DSHS Signature _ ❑—' I certify that I am authorized to sign this document, and any attachments or addendums thereto, and I have read and agree to all parts of the contract. Signed By: Date Signed: Navigation Links Wilczynski, Jonah -RLHS 6/25/2015 2:23:47 PM https://egmnts.dshs.texas.gov/ObicetPagc2.aspx7omnID-101987&pgeID=20165[71162015 3:16:31 PM] Fiscal Year 2016 Department of State Health Services Contract General Provisions ARTICLEI CONTRACT COMPONENTS.......::..............................................................................................................4 SECTION1.01 CONTRACT COMPONENTS.................................................................................................................................4 SECTION1.02 ORDER OFPRECEDENCE...................................................................................................................................4 t ARTICLE COMPLIANCE AND REPORTING.......................................................n....................................................4 SECTION2.01 COMPLIANCE....................................................................................................................................................4 SECTION2.02 PRECEDENCE OF CONTRACT TERMS................................................................................................................4 SECTION 2.03 EFFECT OF LEGISLATIVE CHANGES..................................................................................................................4 SECTION 2.04 COMPLIANCE WITH REQUIREMENTS OF SOLICITATION DOCUMENT................................................................4 SECTION2.05 REPORTING.......................................................................................................................................................4 SECTION 2.06 APPLICABLE CONTRACTS LAW AND VENUE FORDISPUTES....................... .:................................................... 4 SECTIONZ.07 STATUTES AND STANDARDS OF GENERALAPPLICABILITY...............................................................................4 SECTION2.08 APPLICABILITY OF GENERAL PROVISIONS TO INTERAGENCY AND INTERLOCAL CONTRACTS ........................6 SEcTION2.09 CIVILRIGHTSPOLICY AND COMPLAINTS ......................... :............................................................................... 7 SECTION 2.10 LICENSES, CERTIFICATIONS, PERMITS, REGISTRATIONS AND APPROVALS......................................................7 SECTION2.11 FUNDING OBLIGATION......................................................................................................................................7 SECTION2.12 WHISTLEBLOL9ERACT PROTECTION...............................................................................................................7 ARTICLE HI SECTION3.01 EDUCATION TO PERSONS IN RESIDENTIAL FACILITIES.....................................................................................7 SECTION 3.02 DISASTER SERVICES..........................................................................................................................................8 SECTION 3.03 CONSENT TO MEDICAL CARE OF A MINOR............. .......................................................................................... 8 SECTmN3.04 TELEMEDICINE/TELEPSYcmATRY MEDICAL SERVICES..................................................................................8 SECTION3.05 SERVICES AND INFORMATION FOR PERSONS WITH LIMITED ENGLISH PROFICIENCY......................................9 ARTICLEIV FUNDING........................................................................................................................................................9 SECTION4.01 DEBT TO STATE AND CORPORATE STATUS.......................................................................................................9 SECTION 4.02 APPLICATION OF PAYMENT DUE.......................................................................................................................9 ARTICLE V PAYMENT METHODS AND RESTRICTIONS..........................................................................................9 , SECTION5.01 PAYMENTMETHODS. ........................................................................................................................................ 9 SECTION 5.02 INVOICEBILLING SUBMISSION . ........................................................................................................................ 9 SECTION 5.03 FINAL INVOICEBH.LING SUBMISSION...................:..................................................................................I..... 10 SECTION5.04 THERDPARTYPAYORB.................................................................................................................................... 10 ARTICLE VI TERMS AND CONDITIONS OF PAYMENT............................................................................................ 10 SECTION6.01 PROMPT PAYMENT.......................................................................................................................................... 10 SECTION 6.02 PAYMENT BY DEPARTMENT............................................................................................................................ 10 SECTION6.03. WITHHOLDING PAYMENTS............................................................................................................................. 11 ARTICLEVH CONFIDENTIALITY.............................................................................................................................................. it SECTION 7.01 MAINTENANCE OF CONFIDENTIALITY............................................................................................................ 11 SECTION 7.02 DEPARTMENT ACCESS TO PHI AND OTHER CONFIDENTIAL INFORMATION .................................................. IS SECTION7.03 EXCHANGE OF CLIENT -IDENTIFYING INFORMATION . ......................... ........................................................... 11 SECTION7.04 SECURITY OF PATIENT OR CLIENT RECORDS................................................................................................. 11 SECTION 7.05 HIV/AIDS MODEL WORKPLACE GUIDELINES.............................................................................................. 12 ARTICLE VIII PUBLICINFORMATIONACT.................................................................................................................. 12 General Provisions (September 1, 2016) 5ECTION8.01 TEXAS PUBLIC INFORMATION ACT................................................................................................................. 12 ARTICLE IX SECTION9.01 ARTICLE X SECTION 10.01 SECTION 10.02 SECTION 10.03 RE CORDS RETENTION RETENTION. ACCESS, INSPECTION AND AUDIT OF RECORDS 12 12 ACCESSAND INSPECTION................................................................................................................................ 13 STATEAUDITOR'S OFFICE.............................................................................................................................. 13 RESPONDINGTO DEFICIENCIES....................................................................................................................... 13 ARTICLE XI REPORTINGREQUIREMENTS............................................................................................................... 13 SECTION11.01 CHILD ABUSE REPORTING REQUIREMENT........................................................................................... I......... 13 SECTION11.02 SIGNIFICANT INCIDENTS................................................................................................................................. 14 SECTION11.03 LITIGATION... ............................................................................. :.................................................................... 14 SECTION 11.04 CONTRACT ORLICENSE ACTION AGAINST THE CONTRACTOR...................................................................... 14 SECTION11.05 INSOLVENCY ............................ :........................................................................ :............................................... 14 SECTION 11.06 PERFORMANCE MALFEASANCE.....................................................................6............................................... 14 SECTION 11.07 CRIMINAL ACTIVITY AND DISCIPLINARY ACTION.......................y................................................................. 15 SECTION11.08 RETALIATION PROHIBITED.............................................................................:..........................................A... IS SECTION11.09 DOCUMENTATION..................................................................................................................................I........ 15 ARTICLE XII ASSURANCES AND CERTIFICATIONS..................................................................................................is SECTION12.01 CERTIFICATION............................................................................................................................................... 15 SECTION12.02 CHILD SUPPORT DELINQUENCIES................................................................................................................... 16 SECTION12.03 AUTHORIZATION............................................................................................................................................. 16 SECTION 12.04 GIFTS AND BENEFITS PROHIBITED.................................................;................................................................ 16 SECTION 12.05 INELIGIBILITY TO RECEIVE TIM CONTRACT.................................................................................................. 16 SECTION12.06 ANTITRUST...................................................................................................................................................... 17 ARTICLE XIII GENERAL BUSINESS OPERATIONS OF CONTRACTOR................................................................... 17 SECTION13.01 PROGRAM SITE............................................................................................................................................... 17 SECTION 13.02 HISTORICALLY UNDERUTILIZED BUSINESSES (RUBS) ................................................................................... 17 SECTION13.03 BUY TEXAS...................................................................................................................................................... 17 SECTION13.04 STATUS OF SUBCONTRACTORS........................................................................................................................ 17 SECTION13.05 INDEPENDENT CONTRACTOR..........................................................................................................................1$ SECTION13.06 TAXLIABUdTY................................................................................................................................................ 18 SECTION 13.07 NOTICE OF ORGANIZATIONAL CHANGE.............................:..........................:................................................18 SECTION13.08 No ENDORSEMENT.......................................................................................................................................... 18 SECTION13.09 &VERIFY SYSTEM.......................................................................................................................................... 18 ARTICLEXIVGENERALTERMS ...................................................................................................................................... 18 SECTION14.01 ASSIGNMENT................................................................................................................................................... 18 SECTION14.02 LOBBYING................................................................................................................................... .................... 19 SECTION14.03 CONFLICT OFINTEREST.................................................................................................................................. 19 SECTION 14.04 TRANSACTIONS BETWEEN RELATED PARTIES................................................................................................ 20 SECTION14.05 INTELLECTUAL PROPERTY.............................................................................................................................20 SECTION14.06 OTHER INTANGIBLE PROPERTY...................................................................................................................... 21 SECTION14.07 SEVERAEHdTY AND AMBIGUITY..................................................................................................................... 21 SECTION14.08 LEGALNOTICE................................................................................................................................................21 SECTION14.09 SUCCESSORS....................................................................................................................................................21 SECTION14.10 SURVIVABILITY OF TERMS.............................................................................................................................. 21 SECTION14.11 CUSTOMER SERVICE INFORMATION............................................................................................................... 21 General Provisions (September 1, 2016) 5ECTION14.12 AMENDMENT................................................................................................................................................... 21 SECTION14.13 CONTRACTOR'SNOTmCATION OF CHANGE OF CONTACTPERSON ORBEY PERSONNEL ............................. 21 SECTION14.14 UNILATERAL AMENDMENT............................................................................................................................. 21 SECTION14.15 INTERIM EXTENSION AMENDMENT.............................:................................................................................... 22 SECTION14.16 IMMUNITYNOT WAIVED.................................................................................................................................22 SECTION 14.17 HOLD HARMLESS AND INDEMNIFICATION...................................................................................................... 22 SECTION14.18 WAIVER........................................................................................................................................................... 22 SECTION 14.19 ELECTRONIC AND INFORMATION RESOURCES ACCESSIBILITY AND SECURITY STANDARDS .......................... 22 SECTION14.20 FORCE MAJEURE............................................................................................................................................ 24 SECTION 14.21 COOPERATION AND COMMUNICATION................................................................................................... ........ 24 SECTION14.22 INSURANCE......................................................................................................................................................24 ARTICLE XV BREACH OF CONTRACT AND REMEDIES FOR NON-COMPLIANCE ........................................... 25 SECTION 15AI ACTIONS CONSTITUTING BREACH OF CONTRACT.......................................................................................... 25 SECTION15.02 GENERAL REMEDIES AND SANCTIONS............................................................................................................. 25 SECTION 15.03 NOTICE OF REMEDIES OR SANCTIONS . ........................................................................................................... 26 SECTION15.04 EMERGENCYACTION............................................................................................................................:......... 26 ARTICLEXVI CLAIMS AGAINST THE DEPARTMENT -NOTICE OF DISPUTE....................................................... 27 SECTION16.01 BREACH OF CONTRACT CLAIM ...................................................................:...................................................27 SECTION16.02 NOTICE..............................................................................................................:............................................. 27 SECTION16.03 PERFORMANCE NOT SUSPENDED . .............................................. ).................................................................... 27 ARTICLEXVII TERMINATION AND TEMPORARY SUSPENSION.............................................................................. 27 SECTION 17.01 EXPIRATION OF CONTRACT ORPROGRAM ATTACHMENTS............................................................................ 27 SECTION 17.02 EFFECT OF TERMINATION OR EXPIRATION....................................................................................................27 SECTION 17.03 TERMINATION ORTEMPORARY SUSPENSION WITHOUT CAUSE..................................................................... 27 SECTION17.04 IMMEDIATE TERMINATION............................................................................................................................. 28 SECTION 17.05 TERMINATION FOR CAUSE.............................................................................................................................. 28 SECTION 17.06 NOTICE OF TERMINATION..................................................>.:.......................................................................... 28 ARTICLE XVIII VOID, SUSPENDED AND TERMINATED CONTRACTS..................................................................... 28 SECTION18.01 VOID CONTRACTS........................................................................................................................................... 28 SECTION 18.02 EFFECT OF VOID, SUSPENDED, OR INVOLUNTARILY TERMINATED CONTRACT ............................................. 28 SECTION 18.03 APPEALS RIGHTS FOR DSHS FUNDED BLOCK GRANTS ........ :........................................................................ 28 ARTICLEXIX CLOSEOUT ................................................ ............................................. .................................. :.................. 28 SECTION 19.01 CESSATION OF SERVICES AT CLOSEOUT......................................................................................................... 28 SECTION19.02 ADMINISTRATIVE OFFSET............................................................................................................................... 29 SECTION19.03 DEADLINE FOR CLOSEOUT.............................................................................................................................. 29 SECTION19.04 PAYMENT OF REFUNDS...................................................................................................................................29 SECTION 19.05 DISALLOWANCES AND ADJUSTMENTS............................................................................................................. 29 General Provisions (September 1, 2016) ARTICLE I CONTRACT COMPONENTS Section 1.01 Contract Components. As used in herein, the "Contract" consists of the following documents: a. The Contract, including any applicable Program Attachment(s); The Department of State Health Services Fiscal Year 2016 General Provisions (General Provisions) and if applicable, the ; c. The solicitation document, if applicable; and d. The response, proposal or application submitted by Contractor in response to the solicitation document, if applicable. Section 1.02 Order of Precedence. To the extent that there is any conflict between the terms of any contract component document, the conflict shall be resolved in the above order of priority in Section 1.01. ARTICLE H COMPLIANCE AND REPORTING Section 2.01 Compliance. Contractor shall comply and require its subcontractor(s) to comply with the requirements of these general provisions and all other applicable state and federal statutes, regulations, rules and executive orders, as such statutes, regulations, rules and executive orders including as such statutes, regulations, rules and executive orders may be amended. Section 2.02 Precedence of Contract Terms. To the extent this Contract imposes a higher standard or additional requirements beyond those required by applicable statutes, regulations, rules or executive orders, the terms of this Contract shall take precedence and control. Section 2.03 Effect of Legislative Changes. Contractor agrees that upon notification from Department of State Health Services (DSHS or Department) Contractor shall comply with any changes to the term of the contract include in its contracts that are a result of legislation during the term of this Contract. Section 2.04 Compliance with Requirements of Solicitation Document. If applicable :and except as specified in these General Provisions or the Contract's terms, the Contractor shall comply with the requirements, eligibility conditions, assurances, certifications and program requirements of the Solicitation Document for the duration of this Contract or any subsequent renewals. The Parties agree that the Department has relied upon Contractor's response to the Solicitation Document. The Parties agree that any misrepresentation contained in Contractor's response to the Solicitation Document constitutes a breach of this Contract and may result in termination. Section 2.05 Reporting. Contractor shall submit reports in accordance with the reporting requirements established by the Department and provided for in the. Contract and in these General Provisions. Except as otherwise provided for in this Contract or General Provisions, the Contractor shall submit reports to the assigned contract manager. Contractor shall also provide any other information requested by the Department in the format required by DSHS. Failure to submit any required report or additional requested information by the due date specified in the contract or upon request may constitute a breach of contract,result in delayed payment and/or the imposition of sanctions and remedies. And failure to comply with a reporting requirement may adversely affect evaluation of Contractor's ability to contract in the future with the Department. Section 2.06 Applicable Contracts Law and Venue for Disputes. Except as provided for in Article XV, all issues related to this contract, including formation, performance and interpretation that may arise in any dispute between the Parties, shall be governed by and construed in accordance with the laws of the State of Texas and venue shall be in Travis County, Texas. Section 2.07 Statutes and Standards of General Applicability. Contractor is responsible for reviewing and complying with all applicable statutes, rules, regulations, executive orders and policies. To the extent applicable General Provisions (September 1, 2016) to Contractor, Contractor shall comply with the following: a. Statutes, rules, regulations, and DSHS policy (and any of their subsequent amendments) that collectively prohibit discrimination, exclusion from or limitation of participation in programs, benefits or activities or denial of any aid, care, service or other benefit on the basis of race, color, national origin, limited English proficiency, sex, sexual orientation (where applicable), disabilities, age, substance abuse, political belief or religion: 1. Title VI of the Civil Rights Act of 1964, 42 USC §§ 2000d et seq.; 2. Title IX of the Education Amendments of 1972, 20 USC §§ 1681-1683, and 1685-1686; 3: Section 504 of the Rehabilitation Act of 1973, 29 USC § 794(a); 4. Americans with Disabilities Act of 1990, 42 USC §§ 12101 et seq.; 5. Age Discrimination Act of 1975, 42 USC §§ 6101-6107; 6. Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970, 42 USC § 290dd (b)(1); 7) 45 CFR Parts 80, 84, 86 and 91; 7. U.S. Department of Labor, Equal Employment Opportunity E.O. 11246; 8. Tex. Labor Code Chapter 21; 9. Food Stamp Act of 1977 (7 USC §§ 2011 of seq.); 10. Executive Order 13279, 45 CFR Part 87 or 7 CFR Part 16 regarding equal treatment and opportunity for religious organizations; 11. Drug Abuse Office and Treatment Act of 1972, 21 USC §§ 1101 of seq., relating to drug abuse; 12. Public Health Service Act of 1912, §§ 523 and 527, 42 USC § 290dd-2, and 42 CFR pt. 2, relating to confidentiality of alcohol and drug abuse patient records; . 13. Title VIIi of the Civil Rights Act of 1968, 42 USC §§ 3601 et seq., relating to nondiscrimination in housing; and 14. DSHS Policy AA-5018, Non-discrimination Policy for DSHS Programs; b. Immigration Reform and Control Act of 1986, 8 USC § 1324a, and Immigration Act of 1990, 8 USC 1101 of seq., as amended by Public Law113-4 (March 7, 2013), regarding employment verification; and Illegal Immigration Reform and Immigrant Responsibility Act of 1996; c. Pro -Children Act of 1994, 20 USC §§ 6081-6084, and the Pro -Children Act of 2001, 20 USC § 7183, regarding the non-use of all tobacco products; d. National Research Service Award Act of 1971, 42 USC §§ 289a-1 et seq., and 6601 (P.L. 93-348 and P.L. 103-43), regarding human subjects involved in research; e. Hatch Political Activity Act, 5 USC §§ 1501-1508 and 7324-26, which limits the political activity of employees whose employment is funded with federal funds; f. Fair Labor Standards Act, 29 USC §§ 201 of seq., and the Intergovernmental Personnel Act of 1970, 42 USC §§ 4701 of seq., as applicable, concerning minimum wage and maximum hours; ' g. Texas Government Code Chapter 469 pertaining to eliminating architectural barriers for persons with disabilities; h. Texas Workers' Compensation Act, Texas Labor Code Chapters 401-406, and 28 Texas Administrative Code (TAC) pt. 2, regarding compensation for employees' injuries; i. The Clinical Laboratory Improvement Amendments of 1988,42 USC § 263a, regarding the regulation and certification of clinical laboratories; j. The Occupational Safety and Health Administration Regulations on Blood Borne Pathogens, 29 CFR § 1910.1030, or Title 25 Tex. Admin Code Chapter 96 regarding safety standards for handling blood borne pathogens; k. Laboratory Animal Welfare Act of 1966, 7 USC §§ 2131 et seq., pertaining to the treatment of laboratory animals, 1. Environmental standards pursuant to the following: 1. Institution of environmental quality control measures under the National Environmental Policy Act of 1969, 42 USC §§ 4321-4347 and Executive Order 11514 (35 Fed. Reg. 4247), "Protection and Enhancement of Environmental Quality;" General Provisions (September 1, 2016) 2. Notification of violating facilities pursuant to Executive Order 11738 (40 CFR Part 32), "Providing for Administration of the Clean Air Act and the Federal Water Pollution Control Act with respect to Federal Contracts, Chants, or Loans;" 3. Protection of wetlands pursuant to Executive Order 11990, 42 Fed. Reg. 26961; 4. Evaluation of flood hazards in floodplains in accordance with Executive Order 11988, 42 Fed. Reg. 26951 and, if applicable, flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234); 5. Assurance of project consistency with the approved State Management program developed under the Coastal Zone Management Act of 1972, 16 USC §§ 1451 et seq.; 6. Federal Water Pollution Control Act, 33 USC §§ 1251 et seq.; 7. Protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, 42 USC §§ 300f-300j; 8. Protection of endangered species under the Endangered Species Act of 1973, 16 USC §§ 1531 et seq.; 9. Conformity of federal actions to state clean air implementation plans under the Clean Air Act of 1955, 42 USC §§ 7401 et seq.; 10. Wild and Scenic Rivers Act of 1968, 16 USC §§ 1271 et seq., related to protecting certain river systems; and in. Lead -Based Paint Poisoning Prevention Act, 42 USC §§ 4821 et seq., prohibiting the use of lead -based paint in residential construction or rehabilitation; n. Intergovernmental Personnel Act of 1970, 42 USC §§ 4278-4763, regarding personnel merit systems for programs specified in Appendix A of the federal Office of Program Management's Standards for a Merit System of Personnel Administration, 5 CFR Partl200 et seq; o. Titles 11 and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of, 42 USC §§4601 or seq (PL 91-646), relating to fair treatment of persons displaced or whose property is acquired as a result of Federal or federally -assisted programs; p. Davis -Bacon Act, 40 USC §§ 3141-3148; q. Copeland Act, 40 USC §§ 276c and 18 USC § 874; r. Contract Work Hours and Safety Standards Act, 40 USC § 3702 et seq., regarding labor standards for federally -assisted construction subagreements; s. National Historic Preservation Act of 1966, § 106, 16 USC § 470; Executive Order 11593; and the Archaeological and Historic Preservation Act of 1974 (16 USC §§ 469a-1 et seq.) regarding historic property to the extent necessary to assist DSHS in complying with the Acts; t. Trafficking Victims Protection Act of 2000, Section 106(g) (22 USC § 7104); u. Executive Order 13513 (Oct. 1, 2009), Federal Leadership on Reducing Text Messaging While Driving, October 1, 2009, if required by a federal funding source of this Contract; v. Whistleblower Protection Enhancement Act (5 U.S.C. 2302(b)(8)) and Texas Whistleblower Act (Tex. Gov. Code Chapter 554); and w. Requirements of any other applicable state and federal statutes, executive orders, regulations, rules and policies. Section 2.08 Applicability of General Provisions to Interagency and Interlocal Contracts. a. The following sections or portions of sections of these General Provisions shall not apply to Interagency Cooperation Contracts (Texas Government Code 771) or Interlocal Cooperation Contracts (Texas Government Code Chapter 791): 1. Hold Harmless and Indemnification, Section 12.18; 2. Independent Contractor, Section 11.05; 3. Historically Underutilized Businesses (HUBS), Section 11.02 (Contractor, however, shall comply with HUB requirements of other statutes and rules specifically applicable to that entity; 4. Debt to State and Corporate Status, Section 3.01; General Provisions (September 1, 2016) 5. Application of Payment Due, Section 3.02; and 6. Article XIV, Claims against the Department. b. The following additional provisions shall apply to Interlocal Cooperation Contracts: 1. Payments made by DSHS to Contractor shall be from current revenues available to DSHS; and 2. Each Party represents that it has been authorized to enter into this Contract. Section 2.09 Civil Rights Policy and Complaints. Upon request, Contactor shall provide the Health and Human Services Commission (HHSC) Civil Rights Office with copies of all Contractor's civil rights policies and procedures. Contractor shall notify HHSC's Office of Civil Rights of any civil rights complaints received relating to performance under this Contract no more than ten calendar days after Contractor's receipt of the claim. Notice must be directed to: Civil Rights Office Health and Human Services Commission 701 W. 51" Street, Mail Code W206 Austin, Texas 78751 (888) 388-6332 or 512-438-4313 TTY Toll -free (877) 432-7232 HHSCivifRightsOffice@hhsc.state.tx.us Section 2.10 Licenses, Certifications, Permits, Registrations and Approvals. Contractor shall obtain and maintain all applicable licenses, certifications, permits, registrations and approvals to conduct its business and to perform the services under this Contract. Failure to obtain or any revocation, surrender, expiration, non -renewal, inactivation or suspension of any such license, certification, permit, registration or approval constitutes grounds for termination of this Contract or other remedies the Department deems appropriate. Contractor shall ensure that all its employees, staff and volunteers obtain and maintain in active status all licenses, certifications, permits, registrations and approvals required to perform their duties under this Contract and shall prohibit any person who does not hold a current, active required license, certification, permit, registration or approval from performing services under this Contract. Section 2.11 Funding Obligation. This Contract is contingent upon the availability of funding. If funds become unavailable through lack of appropriations, budget cuts, transfer of funds between programs or health and human services agencies, amendment of the Appropriations Act, health and human services agency consolidation, or any other disruptions of current appropriated funding for this Contract, DSHS may restrict, reduce or terminate funding under this Contract. Notice of any restriction or reduction shall include instructions and detailed information on how DSHS shall fund the services and/or goods to be procured with the restricted or reduced funds. Section 2.12 Whistleblower Act Protection. This Contract is required to include the Whistleblower Protection Acts (See Section 2.07(v)) protections to grantees, their subgrantees and subcontractors, and contractor must inform their employees of whistleblowers' rights and remedies. The requirement is in effect for all grants, contracts, subgrants, and subcontractors issued beginning July 1, 2013 through January 1, 2017. ARTICLE III SERVICES Section 3.01 Education to Persons in Residential Facilities. If applicable, Contractor shall ensure that all persons, who are housed in Department -licensed and/or -funded residential facilities and are 22 years of age or younger, have access to educational services as required by Texas Education Code § 29.012. General Provisions (September 1, 2016) Contractor shall notify the local education agency or local early intervention program as prescribed by this Section not later than the third calendar day after the date a person who is 22 years of age or younger is placed in Contractor's residential facility. Section 3.02 Disaster Services. In the event of a local, state, or federal emergency, including natural, man- made, criminal, terrorist, and/or bioterrorism events, declared as a state disaster by the Governor, or a federal disaster by the appropriate federal official, Contractor may be called upon to assist DSHS in providing services, as appropriate, in the following areas: a. Cormnunity evacuation; b. Health and medical assistance; c. Assessment of health and medical needs; d. Health surveillance; e. Medical care personnel; f. Health and medical equipment and supplies; g. Patient evacuation, h. In -hospital care and hospital facility status; i. Food, drug and medical device safety; j. Worker health and safety; k. Mental health and substance abuse; 1. Public health information; in. Vector control and veterinary services; and n. Victim identification and mortuary services. Contractor shall carry out disaster services in the manner most responsive to the needs of the emergency, in the most cost-effective, and least intrusive manner to Contractor's primary services. Section 3.63 Consent to Medical Care of a Minor. If Contractor provides medical, dental, psychological or surgical treatment to a minor under this Contract, either directly or through contracts with subcontractors, Contractor shall not provide treatment of a minor unless informed consent to treatment is obtained pursuant to Texas Family Code Chapter 32 relating to consent to treatment of a child by a non -parent or the child or other state law. If requirements of federal law relating to consent directly conflict with this Chapter, then federal law supersedes state law. Section 3.04 Telemedicine/Telepsychiatry Medical Services. If applicable, the Contractor shall ensure that if Contractor or its subcontractor uses telemedicine/telepsychiatry that the services are implemented in accordance with written procedures and using a protocol approved by Contractor's medical director and using equipment that complies with the equipment standards as required by the Department. Procedures for providing_telemedicine service must include the following requirements: a. Clinical oversight by Contractor's medical director or designated physician responsible for medical leadership; b. Contraindication considerations for telemedicine use; c. Qualified staff members to ensure the, safety of the individual being served by telemedicine at the remote site; d. Safeguards to ensure confidentiality and privacy in accordance with state and federal laws; e. Use by credentialed licensed providers providing clinical care within the scope of their licenses; f. Demonstrated competency in the operations of the system by all staff members who are involved in the operation of the system and provision of the Services prior to initiating the protocol, g. Priority in scheduling the system for clinical care of individuals; h. Quality oversight and monitoring of satisfaction of the individuals served; and General Provisions (September 1, 2016) i. Management of information and documentation for telemedicine services that ensures timely access to accurate information between the two sites. Telemedicine Medical Services does not include chemical dependency treatment services provided by electronic means under 25 TAC Rule § 448.911. Section 3.05 Services and Information for Persons with Limited English Proficiency. a. Contractor shall take reasonable steps to provide services and information both orally and in writing, in appropriate languages other than English, to ensure that persons with limited English proficiency are effectively informed and can have meaningful access to programs, benefits and activities. b. Contractor shall identify and document on the client records the primary language/dialect of a client who has limited English proficiency and the need for translation or interpretation services and shall not require a client to provide or pay for the services of a translator or interpreter. c. Contractor shall make every effort to avoid use of any persons under the age of 18 or any family member or. friend of the client as an interpreter for essential communications with a client with limited English proficiency unless the client has requested that person and using the person would not compromise the effectiveness of services or violate the client's confidentiality and the client is advised that a free interpreter is available. ARTICLE IV FUNDING Section 4.01 Debt to State and Corporate Status. a. Pursuant to Texas Government Code § 403.055, the Department shall not approve and Texas Comptroller of Public Accounts shall not issue payment to Contractor if Contractor is indebted to the State for any reason, including a tax delinquency. b. Contractor, if a corporation, certifies by execution of this Contract that it is current and shall remain current in its payment of franchise taxes to the State of Texas or that it is exempt from payment of franchise taxes under Texas law (Texas Tax Code §§ 171.001 et seq.). As a corporation, this Contractor further certifies that it is and shall remain in good standing with the Secretary of State's office. c. A false statement regarding franchise tax or corporate status is a material breach of this Contract. If franchise tax payments become delinquent during the Contract term, all or part of the payments under this Contract may be withheld until Contractor's delinquent franchise tax is paid in full. Section 4.02 Application of Payment Due. Contractor agrees that any payments due under this Contract shall be applied towards any debt of Contractor, including but not limited to delinquent taxes and child support that is owed to the State of Texas. ARTICLE V PAYMENT METHODS AND RESTRICTIONS Section 5.01 Payment Methods. Except as otherwise provided by the provisions of this Contract, the payment method is based on a unit rate (fixed price or a specified) or fee for service (delivery of a specified unit of service) as stated in the Contract. Section 5.02 InvoiceBilling Submission. General Provisions (September 1, 2016) a. Contractor shall bill the Department in accordance with the Contract in the form and format prescribed by DSHS. If applicable, the Contractor must submit of all required documentation, reports, forms and/or deliverables in order to receive payment from the Department. b. Unless otherwise specified in the Contractor permitted under the Third Party Payers (See Section 5.04 below), Contractor shall submit requests for payment monthly by the last business day of the month following the end of the month covered by the bill. c. Contractor shall maintain all documentation that substantiates billing submissions and make the documentation available to DSHS upon request. Section 5.03 Final Invoice/Billing Submission. Unless otherwise provided by the Department, Contractor shall submit a reimbursement or payment request as a final close-out bill not later than 45 calendar days following the end of the term of the Contract. Section 5.04 Third Party Payers. Except as provided in this Contract, Contractor shall screen all clients and may not bill the Department for services eligible for reimbursement fiom third party payors, who are any person or entity who has the legal responsibility for paying for all or part of the services provided, including commercial health or liability insurance carriers, Medicaid, or other federal, state, local and private funding sources. As applicable, the Contractor shall: a. Enroll as a provider in Children's Health Insurance Program and Medicaid if providing approved services authorized under this Contract that may be covered by those programs and bill those programs for the covered services; b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs; c. Allow clients that are otherwise eligible for Department services, but cannot pay a deductible required by a third party payer, to receive services up to the amount of the deductible and to bill the Department for the deductible; d. Not bill the Department for any services eligible for third party reimbursement until all appeals to third parry payers have been exhausted; e. Maintain appropriate documentation from the third party payer reflecting attempts to obtain reimbursement; f. Bill all third party payers for services provided under this Contract before submitting any request for reimbursement to Department; and g. Provide third party billing functions at no cost to the client. ARTICLE VI TERMS AND CONDITIONS OF PAYMENT Section 6.01 Prompt Payment. Upon receipt of a timely, undisputed invoice pursuant to this Contract, Department shall pay Contractor. Payments are contingent upon a signed Contract and shall not exceed the total amount of authorized funds under this Contract. Contractor is entitled to payment only if the service, work, and/or product has been authorized by the Department and performed or provided pursuant to this Contract. If these conditions are met, Department shall make payment in accordance with the Texas Prompt Payment Act (Texas Government Code Chapter 2251). Contractor acknowledges and agrees that it shall comply with the provisions in the Texas Prompt Payment Act regarding its prompt payment of its financial obligations to its subcontractors. Section 6.02 Payment by Department. Payment of invoices by the Department shall not constitute acceptance or approval of Contractor's performance nor,foreclose the right of the Department and HHSC to recover excessive or illegal payments. All invoices and Contractor's performance are subject to review and audit by the Department. General Provisions (September 1, 2016) 10 Section 6.03 Withholding Payments. Department may withhold all or part of any payments to Contractor to offset overpayments that Contractor has not refunded to Department. Department may take repayment from funds due to the Contractor for services performed or goods delivered in amounts necessary to fulfill Contractor's repayment obligations. ARTICLE VII CONFIDENTIALITY Section 7.01 Maintenance of Confidentiality. Contractor must maintain the privacy and confidentiality of information and records received during or related to the performance of this Contract, including patient and client records that contain protected health information (PHI) and any other information that discloses confidential personal information or identifies any client served by DSHS in accordance with any applicable federal and state taw, rules and regulations, including but not limited to: a. 7 Code of Federal Regulations (CFR) Part 246; 42 CFR Part 2, 45 CFR Parts 160 and 164 (Health Insurance Portability and Accountability Act [HIPAA]); b. Texas Health and Safety Code Chapters 12, 47, 81, 82, 85, 88, 92,161, 181, 241, 245, 251, 534, 576, 577, 596, 611 and 773; c. Texas Occupations Code, Chapters 56 and 159; and d. Any other applicable federal -and state laws, rules or regulations. The HHS Data Use Agreement (Version 8.3) at http://www.hhse.state.tx.us/about hhscBusOpp/data-use- aareement.pdf is incorporated as part of the Contract and describes Contractor's rights and obligations with respect to the Confidential Information and the limited purposes, for which the Contractor may create, receive, maintain, use, disclose or have access to Confidential Information. For the purpose of this Contract, the: ❑ Contractor does not access Confidential Information and does not have to comply with HHS Data Use Agreement (Version 8.3); or ❑ Contractor accesses Confidential Information as defined in and agrees to comply with the HHS Data Use Agreement (Version 8.3). Section 7.02 Department Access to PHI and Other Confidential Information. Contractor shall cooperate with Department to allow Department to request, collect and receive PHI and other confidential information under this Contract, without the consent of the individual to whom the PHI relates, for funding, payment and administration of the grant program and for purposes permitted under applicable state and federal confidentiality and privacy laws. Section 7.03 Exchange of Client -Identifying Information. Except as prohibited by other law, Contractor and DSHS shall exchange PHI without the consent of clients in accordance with 45 CFR § 164.504(e)(3)(i)(B), Texas Health and Safety Code § 533.009 and 25 TAC Chapter 414, Subchapter A or any other applicable federal or state laws, rules or regulations. Contractor shall disclose information described in Texas Health and Safety Code § 614.017(a)(2) relating to special needs offenders, to an agency described in Texas Health and Safety Code § 614.017(c) upon request of that agency, unless Contractor documents that the information is not allowed to be disclosed under 45 CFR Part 164 or other applicable law. Section 7.04 Security of Patient or Client Records. Contractor shall ensure that patient and client records are managed in compliance with state and federal law relating to security and retention of medical or mental health and substance abuse patient and client records. Department may require Contractor to transfer original or copies of patient and client records to Department, without the consent or authorization of the patient or client, upon termination of this Contract or a Contract to 'General Provisions (September 1, 2016) 11 this Contract, as applicable, or if the care and treatment of the individual patient or client is transferred to another entity. Prior to providing services funded under this Contract to a patient or client, Contractor shall attempt to obtain consent from the patient or client to transfer copies of patient or client records to another entity funded by DSHS upon termination of this Contract or a Contract to this Contract, as applicable or if care or treatment is transferred to another DSHS-funded contractor. Section 7.05 HIV/AIDS Model Workplace Guidelines. If providing direct client care, services, or programs, Contractor shall implement Department's policies based on the HN/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), AIDS Model Workplace Guidelines for Businesses, State Agencies and State Contractors Policy No. 090.021. Contractor shall also educate employees and clients concerning HIV and its related conditions, including AIDS, in accordance with the Texas. Health & Safety Code §§ 85.112-114. A link to the Model Workplace Guidelines can be found at: http://www.dshs.state.tx.us/hivstd/policy/policies.shtm . ARTICLE VIII PUBLIC INFORMATION ACT Section 8.01 Texas Public Information Act. The Contractor understands that DSHS shall comply with the Texas Public Information Act (Texas Government Code Chapter 552). If the Contractor is not a state agency, institution of higher education or other governmental entity, then the Contractor is required to make any information created or exchanged with the state pursuant to a contract, which is not otherwise excepted from disclosure under the Texas Public Information Act, available in a format that is accessible by the public at no additional charge to the state. ARTICLE IX RECORDS RETENTION Section 9.01 Retention. a. Contractor shall retain and preserve records in accordance with applicable state and federal statutes, rules and regulations. At a minimum, Contractor shall maintain all records, including but not limited to financial that are generated or collected by Contractor under the provisions of this Contract for a period of four years after the termination of this Contract. b. If the federal retention period for services are funded through Medicaid is more than four years, then the Contractor will retain the records for longer period of time. c. Contractor shall retain all records pertaining to this Contract that are the subject of litigation or an audit until the litigation has ended or all questions pertaining to the audit are resolved. d. Contractor shall retain medical records in accordance with 22 TAC §165.1(b) or other applicable statutes, rules and regulations governing medical information. e. Contractor shall include this provision concerning records retention in any subcontract it awards. f Contractor ceases business operations, it shall ensure that records relating to this Contract are securely stored and are accessible by the Department upon Department's request for at least four years from the date Contractor ceases business or from the date this Contract terminates, whichever is sooner. g. Contractor shall provide, and update as necessary, the name and address of the party responsible for storage of records to the contract manager assigned to this Contract. ARTICLE X ACCESS, INSPECTION AND AUDIT OF RECORDS General Provisions (September 1, 2016) 12 Section 10.01 Access and Inspection. In addition to any right of access arising by operation of law, Contractor and any of Contractor's affiliate or subsidiary organizations or subcontractors shall permit the Department or any of its duly authorized representatives, as well as duly authorized federal, state or local authorities, including the Comptroller General of the United States, the Office of the Inspector General at HHSC (OIG) and the State Auditor's Office (SAO) or any of their successor agencies, unrestricted access to and the right to examine any site where business is conducted or client services are performed, and all records, which includes but is not limited to financial, client and patient records, books, papers or documents related to this Contract. If deemed necessary by the Department or the OIG, for the purpose of investigation or hearing, Contractor shall produce original documents related to this Contract. The Department and HHSC shall have the right to audit billings both before and after payment, and all documentation that substantiates the billings. Contractor shall include this provision concerning the right of access to, and examination of, sites and information related to this Contract in any subcontract it awards. Section 10.02 State Auditor's Office. Contractor shall, upon request, make all records, books, papers, documents, or recordings related to this Contract available for inspection, audit, or reproduction during normal business hours to any authorized representative of the SAO. Contractor understands that the acceptance of funds under this Contract acts as acceptance of the authority of the SAO, or any successor agency, to conduct an audit or investigation in connection with those funds. Contractor shall cooperate fully with the SAO or its successor in the conduct of the audit or investigation, including providing all records requested, and providing access to any information the SAO considers relevant to the investigation or audit. The SAO's authority to audit funds shall apply to Contract funds disbursed by Contractor to its subcontractors, and Contractor shall include this provision concerning the SAO's authority to audit and the requirement to cooperate, in any subcontract Contractor awards. Section 10.03 Responding to Deficiencies. Any deficiencies identified by DSHS or HHSC upon examination of Contractor's records or during an inspection of Contractor's site shall be conveyed in writing to Contractor. Contractor shall submit, by the date prescribed by DSHS, a resolution to the deficiency identified in a site inspection, program review or management or financial audit to the satisfaction of DSHS or, if directed by DSHS, a corrective action plan to document and resolve the deficiency. A DSHS or HHSC determination of either an inadequate or inappropriate resolution of the findings may result in contract remedies or sanctions under the Breach of Contract and Remedies for Non -Compliance (See Article XV). ARTICLE XI REPORTING REQUIREAVIENTS Section 11.01 Child Abuse Reporting Requirement. This section applies to mental health and substance abuse contractors and contractors for the following public health programs: a. Human Immunodeficiency Virus/Sexually Transmitted Diseases (HIV/STD); b. Family Planning (Titles V, X and XX); c. Primary Health Care; d. Maternal and Child Health, and e. Women, Infants and Children (WIC) Nutrition Services. All Contractors shall comply with child abuse reporting guidelines and requirements in Texas Family Code Chapter 261 relating to investigations of reports of child abuse and neglect. Contractor shall develop, implement and enforce a written policy that includes at a minimum the Department's Child Abuse Screening, Documenting, and Reporting Policy for Contractors/Providers and train all staff on reporting requirements. General Provisions (September 1, 2016) 13 Contractor shall use the DSHS Child Abuse Reporting Form located at www.dshs.state.tx.us/childabusereporting as required by the Department. Contractor shall retain reporting documentation on site and make it available for inspection by DSHS. This section is in addition to and does not supersede any other legal obligation of the Contractor to report child abuse. Section 11.02 Significant Incidents. In addition to notifying the appropriate authorities, Contractor shall repot to the contract manager assigned to the Contract significant incidents involving substantial disruption o Contractor's program operation or affecting or potentially affecting the health, safety or welfare of Departmen funded clients or participants within 72 hours of discovery. Section 11.03 Litigation. Contractor shall notify the contract manager assigned to this Contract of litigation related to or affecting this Contract and to which Contractor is a party within seven calendar days of becoming aware of such a proceeding This includes, but is not limited to an action, suit or proceeding before any court or governmental body, which includes but is not limited to environmental and civil rights matters, professional liability and employee litigation. Notification must include the names of the parties, nature of the litigation and remedy sought, including amount of damages, if any. Section 11.04 Contractor License Action Against the Contractor. Contractor shall notify the contract manager assigned to the contract if Contractor has had any contract suspended or terminated for cause by any local, state or federal department or agency or nonprofit entity within three working days of the suspension or termination. Such notification must include the: a. Reason for such action; b. Name and contact information of the local, state or federal department or agency or entity; c. Date of the contract; d. Date of suspension or termination; and e. Contract or case reference number. If Contractor has surrendered its license or has had its license suspended or revoked by any local, state or federal department or agency or non-profit entity, it shall disclose this information within three working days of the surrender, suspension or revocation to the contract manager assigned to the Contract by submitting a one - page description that includes the: a. Reason for such action; b. Name and contact information of the local, state or federal department or agency or entity; c. Date of the license action; and -d. License or case reference number. Section 11.05 Insolvency. Contractor shall notify in writing the contract manager assigned to the Contract of Contractor's insolvency, incapacity or outstanding unpaid obligations to the Internal Revenue Service (IRS) or Texas Workforce Commission (TWC) within three working days of the date of determination that Contractor is insolvent or incapacitated or the date Contractor discovered an unpaid obligation to the IRS or TWC. The Contractor shall also notify in writing the contract manager assigned of its plan to seek bankruptcy protection within three working days of such action by Contractor. Section 11.06 Performance Malfeasance. Contractor shall report to the contract manager assigned to the Contract any knowledge of debarment, suspected fraud or unlawful activity related to performance under this Contract. Contractor shall make such report no later than three working days from the date that Contractor has General Provisions (September 1, 2016) 14 knowledge or reason to believe such activity has taken place. Additionally, if this Contract is federally funded by the Department of Health and Human Services (HITS), Contractor shall report any credible evidence that a principal, employee, subcontractor or agent of Contactor, or any other person, has submitted a false claim under the False Claims Act (31 U.S.C. §§3729-3733) or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds. Contractor shall make this report to the SAO at http://sao.fi•aud.state.tx.us, and to the ENS Office of Inspector General at hftp://www.oig.hhs�ov/fraud/hotline/ no later than three working days from the date that Contractor has knowledge or reason to believe such activity has taken place. Section 11.07 . Criminal Activity and Disciplinary Action. a. Contactor affirms that Contact nor any no person who has an ownership or controlling interest in the organization or who is an agent or managing employee of the organization has been placed on community supervision, received deferred adjudication, is presently indicted for or has been convicted of a criminal offense related to any financial matter, federal or state program or felony sex crime. b. Contactor shall report in writing the contact manager assigned to the Contact, no later than three working days from the date that Contactor has knowledge or reason to believe such activity has taken place, if it has reason to believe Contactor, or a person with ownership or controlling interest in the organization or who is an agent or managing employee of the organization, an employee or volunteer of Contractor, or a subcontractor providing services under this Contract has engaged in any activity that: 1. Would constitute a criminal offense equal to or greater than a Class A misdemeanor; 2. Reasonably would constitute grounds for disciplinary action by a state or federal regulatory authority, c. Has been placed on community supervision, received deferred adjudication, or been indicted for or convicted of a criminal offense relating to involvement in any financial matter, federal or state program or felony sex crime. Contactor shall not permit any person who engaged, or was alleged to have engaged, in any activity subject to reporting under this section to perform direct client services or have direct contact with clients, unless otherwise directed in writing by DSHS. Section 11.08 Retaliation Prohibited. Contactor shall not retaliate against any person who reports a violation of, or cooperates with an investigation regarding, any applicable law, rule, regulation or standard to the Department, another state agency, or any federal, state or local law enforcement official. Section11.09 Documentation. Contactor shall maintain appropriate documentation of all notices and reporting to DSHS as required under these General Provisions or this Contact. ARTICLE XII ASSURANCES AND CERTIFICATIONS Section 12.01 Certification. Contactor certifies by execution of this Contact to the following and will include such in all of its subcontracts: a. It is not disqualified under 2 CFR § 376.935 or ineligible for participation in federal or state assistance programs; b. Neither it, nor its principals, are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal or state department or agency in accordance with 2 CFR Parts 376 and 180 (parts A -I), 45 CFR Part 76 (or comparable federal regulations); General Provisions (September 1, 2016) Is c. It has not knowingly failed to pay a single substantial debt or a number of outstanding debts to a federal or state agency; d. It is not subject to an outstanding judgment in a suit against Contractor for collection of the balance of a debt; e. It is in good standing with all state and/or federal agencies that have a contracting or regulatory relationship with Contractor; f. That no person who has an ownership or controlling interest in Contractor or who is an agent or managing employee of Contractor has been convicted of a criminal offense related to involvement in any program established under Medicare, Medicaid, or a federal block grant; g. Neither it, nor its principals have within the three year period preceding this Contract, has been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a private or public (federal, state or local) transaction or contract under a private or public transaction, violation of federal or state antitrust statutes (including those proscribing price-fixing between competitors, allocation of customers between competitors and bid -rigging), or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements or false claims, tax evasion, obstruction of justice, receiving stolen property or any other offense indicating a lack of business integrity or business honesty that seriously and directly affects the present responsibility of Contactor or its principals; h. Neither it, nor its principals is presently indicted or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with the commission of any of the offenses in subsection (g) above;and i. Neither it, nor its principals within a three year period preceding this Contract has had one or more public transaction (federal, state or local) terminated for cause or default. Where Contractor is unable to certify to any of the statements in this Article, Contactor shall submit an explanation to the contract manager assigned to the Contract. Also, if Contractor's status with respect to the items certified in this Article changes during the term of this Contract, Contractor shall immediately notify the contract manager assigned to the Contract. Section 12.02 Child Support Delinquencies. As required by Texas Family Code § 231.006, a child support obligor who is more than 30 calendar days delinquent in paying child support and a business entity in which the obligor is a sole proprietor, partner, shareholder or owner with an ownership interest of at least 25% is not eligible to receive payments from state funds under a contract to provide property materials, or services or receive a state - funded grant or loan. If applicable, Contractor shall maintain its eligibility to receive payments under this Contract, certifies that it is not ineligible to receive the payments specified in this Contract and acknowledges that this Contract may be terminated and payment may be withheld if this certification is inaccurate. Section 12.03 Authorization. Contractor certifies that it possesses legal authority to contract for the services described in this Contract and if applicable, a resolution, motion or similar action has been duly adopted or passed as an official act of Contractor's governing body, authorizing the binding of the organization under this Contract including all understandings and assurances contained in this Contract, and directing and authorizing the person identified as the authorized representative of Contactor to act in connection with this Contract and to provide such additional information as may be required. Section 12.04 Gifts and Benefits Prohibited. Contractor certifies that it has not given, offered to give, nor intends to give at any time hereafter, any economic opportunity, present or future employment, gift, loan, gratuity, special discount, trip, favor, service or anything of monetary value to a DSHS or HHSC official or employee in connection with this Contract. Section 12.05 Ineligibility to Receive the Contract. General Provisions (September 1, 2016) 16 a. Pursuant to Texas Government Code § 2155.004 and federal law, Contractor is ineligible to enter into this Contract with the Department if this Contract includes financial participation by a person who received compensation from DSHS to participate in developing, drafting or preparing the specifications, requirements, statement of work or Solicitation Document on which this Contract is based. Contractor certifies that neither Contractor nor its employees nor anyone acting for Contractor has received compensation from DSHS for participation in the developing, drafting or preparation of specifications, requirements or statements of work for this Contract or in the Solicitation Document associated with this Contract. b. Pursuant to Texas Government Code §§ 2155.006 and 2261.053, Contractor is ineligible to enter into this Contract, if Contractor or any person who would have financial participation in this Contract has been convicted of violating federal law or been assessed a federal civil or administrative penalty, in connection with a contract awarded by the federal government for relief, recovery or reconstruction efforts as a result of Hurricanes Rita or Katrina or any other disaster occurring after September 24, 2005. c. Contractor certifies that the individual or business entity named in this Contract is not ineligible to receive the specified Contract under Texas Government Code §§ 2155.004, 2155.006 or 2261.053 and acknowledges that this Contract may be terminated and payment withheld if these certifications are inaccurate. Section 12.06 Antitrust. Pursuant to 15 USC Sec. 1, et seq., and Texas Business & Commerce Code § 15.01, et seq. Contractor certifies that neither Contractor nor anyone acting for Contractor has violated the antitrust laws of this state or federal antitrust laws nor communicated directly or indirectly regarding a bid made to any competitor or any other person engaged in Contractor's line of business for the purpose of substantially lessening competition in such line of business. ARTICLE XHI GENERAL BUSINESS OPERATIONS OF CONTRACTOR Section 13.01 Program Site. Contractor shall provide services only in locations that are in compliance with all applicable local, state and federal zoning, building, health, fire and safety standards. Section 13.02 Historically Underutilized Businesses (RUBs). If Contractor was not required to submit a HUB subcontracting plan and if subcontracting is permitted under this Contract, Contractor is encouraged to make a good faith effort to consider subcontracting with HUBS in accordance with Texas Government Code Chapter 2161 and 34 TAC § 20.14 et seq. Contractors may obtain a list of HUBs at http://www.window.state.Mus/procurement/ rroog/hub. If Contractor has filed a HUB subcontracting plan, the plan is incorporated by reference in this Contact. If Contractor desires to make a change in the plan, Contractor must obtain prior approval of the revised plan from the Department's HUB Coordinator before proposed changes shall be effective under this Contract. Contractor shall make a good faith effort to subcontract with HUBS during the performance of this Contract and shall report HUB subcontract activity to the Department's HUB Coordinator by the 15`s day of each month for the prior month's activity, if there was any such activity in accordance with 34 TAC § 20.16(c). Section 13.03 Buy Texas. Contractor shall purchase products and materials produced in Texas when the products and materials are available at a price and time comparable to products and materials produced outside of Texas as required by Texas Government Code § 2155.4441. Section 13.04 Status of Subcontractors. Contractor shall require that all subcontractors certify that they i General Provisions (September 1, 2016) 17 are/have: a. In good standing with all state and federal funding and regulatory agencies; b. Not currently debarred, suspended or otherwise excluded from participation in federal grant programs; c. Not delinquent on any repayment agreements; d. Not had a required license or certification revoked; e. Not ineligible under the following sections of these General Provisions: Ineligibility to Receive the Contract (Assurances and Certifications Article) or the Conflict of Interest or Transactions Between Related Parties sections (General Terms Article); and f. Not had a contract terminated by the Department. Contractors shall further require that subcontractors certify that they have not voluntarily surrendered within the past three years any license issued by the Department. Section 13.05 Independent Contractor. Contractor is an independent contractor. Contractor shall direct and be responsible for the performance of its employees, subcontractors, joint venture participants or agents. Contractor is not an agent or employee of the Department or the State of Texas for any purpose whatsoever. For purposes of this Contract, Contractor acknowledges that its employees, subcontractors, joint venture participants or agents shall not be eligible for unemployment compensation from the Department or the State of Texas. Section 13.06 Tax Liability. Contractor shall comply with all state and federal tax laws and is solely responsible for filing all required state and federal tax forms and making all tax payments. If the Department discovers that Contractor has a liability or has failed to remain current on a delinquent liability to the IRS, this Contract shall be subject to remedies and sanctions under this Contract, including immediate termination at the Department's, discretion. If the Contract is terminated under this section, the Department shall not enter into a contract with Contractor for three years from the date of termination. Section 13.07 Notice of Organizational Change. Contractor shall submit written notice to the contract manager assigned to the Contract within 10 business days of any change to Contractor's name, contact information, key personnel, organizational structure, such as merger, acquisition or change in form of business, legal standing or authority to do business in Texas. A change in Contractor's name and certain changes in organizational structure require an amendment to this Contract in accordance with the amendment provisions in Article XIII. Section 13.08 No Endorsement. Other than stating the fact that Contractor has a contract with DSHS, Contractor and its subcontractors are prohibited from publicizing the contractual relationship between Contractor and DSHS and from using the Department's name, logo or website link in any manner that is intended or that could be perceived as an endorsement or sponsorship by DSHS or the State of Texas of Contractor's organization, program, services or product, without the express written consent of DSHS. Section 13.09 E-Verify System. By entering into this Contract, the Contractor certifies and ensures that it utilizes and will continue to utilize, for the term of this Contract, the U.S. Department of Homeland Security's E- Verify system to determine the eligibility of: a. All persons employed to perform duties within Texas, during the term of the Contract; and b. All persons (including subcontractors) assigned by the Contractor to perform work pursuant to the Contract, within the United States of America. ARTICLE XIV GENERAL TERMS Section 14.01 Assignment. Contractor shall not transfer, assign, or sell its interest, in whole or in part, in this General Provisions (September 1, 2016) 18 Contract without the prior written consent of the Department. Section 14.02 Lobbying. a. Contractor shall comply with Texas Government Code § 556.0055, which prohibits contractors who receive state funds from using those funds to pay lobbying expenses. Further, Contractor shall not use funds paid under this Contract, either d{'rectly or indirectly, to support the enactment, repeal, modification, or adoption of any law, rdgulation or policy at any level of government, or to pay the salary or expenses of any person related to any activity designed to influence legislation, regulation, policy or appropriations pending before Congress or the state legislature, or for influencing or attempting to influence an officer or employee of any federal or state agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any contract or the extension, continuation, renewal, amendment, or modification of any contract (31 USC § 1352). b. If at any time this Contract exceeds $100,000 of federal funds, Contractor shall file with the contract manager assigned to the Contract a declaration containing the name of any registrant under the Lobbying Disclosure Act of 1995 who has made lobbying contacts on behalf of Contractor in connection with this Contract, a certification that none of the funds provided by Department have been or shall be used for payment to lobbyists, and disclosure of the names of any and all registered lobbyists with whom Contractor has an agreement. c. Contractor shall file the declaration, certification, and disclosure: 1. At the time of application for this Contract; 2. Upon execution of this Contract unless Contractor previously filed a declaration, certification, or disclosure form in connection with the award; and 3. At the end of each calendar quarter in which any event occurs that materially affects the accuracy of the information contained in any declaration, certification, or disclosure previously filed. Contractor shall require any person who requests or receives a subcontract to file the same declaration, certification, and disclosure with the contract manager assigned to the Contract. Contractor shall include this provision in any subcontracts. Section 14.03 Conflict of Interest. Contractor represents to the Department that it and its subcontractors, if any, do not have, nor shall Contractor or its subcontractors knowingly acquire or retain any financial or other interest that would conflict in any manner with the performance of their obligations under this Contract. Potential conflicts of interest include, but are not limited to, an existing or potential business or personal relationship between Contractor (or subcontractor), its principal (or a member of the principal's immediate family) or any affiliate or subcontractor and Department or HHSC, their commissioners, officers or employees, or any other entity or person involved in any way in any project that is the subject of this Contract. Contractor shall establish safeguards to prohibit employees and subcontractors and their employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain. If, at any time during the term of this Contract, Contractor or any of its subcontractors has a conflict of interest or potential conflict of interest, Contractor shall disclose the actual or potential conflict of interest to the contract manager assigned to the Contract within 10 days of when Contractor becomes aware of the existence of the actual or potential conflict of interest. Contractor shall require each of its subcontractors to report to Contractor any conflict of interest or potential conflict of interest the subcontractor has or may have within 10 days of when the subcontractor becomes aware of the actual or potential conflict of interest. General Provisions (September 1, 2016) 19 Section 14.04 Transactions Between- Related Parties. Contractor shall identify and report to DSHS any transaction between Contractor and a related party that is part of the work that the Department is purchasing under this Contract before entering into the transaction or immediately upon discovery. A related parry is a person or entity related to Contractor by blood or marriage, common ownership or any association that permits either to significantly influence or direct the actions or policies of the .other. Contractor, for purposes of reporting transactions between related parties, includes the entity contracting with the Department under this Contract as well as the chief executive officer, chief financial officer and program director of Contractor. Contractor shall submit to the contract manager assigned to the Contract the name, address and telephone number of the related party, how the party is related to Contractor and the work the related party shall perform under this Contract. Contractor shall comply with Texas Govermnent Code Chapter 573. Contractor shall maintain records and supply any additional information requested by the Department, regarding a transaction between related parties, needed to enable the Department to determine the appropriateness of the transaction pursuant to applicable state or federal law, regulations or circulars, which may include 45 CFR § 74.42. Section 14.05 Intellectual Property. a. Texas Health and Safety Code §12.020 authorizes DSHS to protect intellectual property developed as a result of this Contract. "Intellectual property" is created property that may be protected under copyright, patent, or trademark%service mark law. b. For purposes of this Contract, intellectual property prepared for DSHS use, or a work specially ordered or commissioned through a contract for DSHS use is a "work made for hire." DSHS owns works made for hire unless it agrees otherwise by contract. To the extent that title and interest to any such work may not, by operation of law, vest in DSHS, or such work may not be considered a work made for hire, Contractor irrevocably assigns the rights, title and interest therein to DSHS. c. DSHS has the right to obtain and hold in its name any and all patents, copyrights, registrations or other such protections as may be appropriate to the subject matter, and any extensions and renewals thereof. Contractor shall give DSHS and the State of Texas, as well as any person designated by DSHS and the State of Texas, all assistance required to perfect the rights defined herein without charge or expense beyond those amounts payable to Contractor for goods provided or services rendered under this Contract. If federal funds are used to finance activities supported by this Contract that result in the production of intellectual property, the federal awarding agency reserves a royalty -free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use, for federal government purposes: 1. Copyright in any intellectual property developed under this Contract including any subcontract; and 2. Any rights of copyright to which a Contractor purchases ownership with contract funds. d. Any rights of copyright, service or trademarks or patents to which a grantee, subgrantee or a Contractor purchases ownership with contract funds General Provisions (September 1, 2016) 20 e. If the results of the contract performance are subject to copyright law, Contractor cannot publish those results without prior review and approval of DSHS. Contractor shall submit requests for review and approval to the contract manager assigned to the Contract. Section 14.06 Other Intangible Property. At the conclusion of the contractual relationship between Department and Contractor, for any reason, Department shall have the sole ownership rights and interest in all non-copyrightable intangible property that was developed, produced or obtained by Contractor as a specific requirement under this Contract or under any grant that funds this Contract, such as domain names, L )RLs or software licenses with a value of $500 or more. Contractor shall cooperate with Department and perform all actions necessary to transfer ownership of such property to the Department or its designee, or otherwise affirm Department's ownership rights and interest in such property. This provision shall survive the termination or expiration of this Contract. Section 14.07 Severability and Ambiguity. If any provision of this Contract is construed to be illegal or invalid, the illegal or invalid provision shall be deemed stricken and deleted to the same extent and effect as if never incorporated, but all other provisions shall continue. The Parties represent and agree that the language contained in this Contract is to be construed as jointly drafted, proposed and accepted. Section 14.08 Legal Notice. Except as otherwise provided in this Contract or General Provisions, any notice required or permitted to be given by the provisions of this Contract or General Provisions shall be deemed to have been received by a Party on the third business day after the date on which it was mailed to the Party at the address specified by the Party. to the other Party in writing or, if sent by certified mail, on the date of receipt. Section 14.09 Successors. This Contract shall be binding upon the Parties and their successors and assignees, except as expressly provided in this Contract. Section 14.10 Survivability of Terms. Termination or expiration of this Contract or a Contract for any reason shall not release either party from any liabilities or obligations in this Contract that the parties have expressly agreed shall survive any such termination or expiration or remain to be performed, including but not limited to maintaining confidentiality of information and records retention. Section 14.11 Customer Service Information. If requested, Contractor shall supply such information as required by the Department to comply with the provisions of Texas Government Code Chapter 2114 regarding Customer Service surveys. Section 14.12 Amendment. All amendments to this Contract must be in writing and agreed to by both Parties. If a Contractor requests an amendment, it must be submitted in writing and include a justification for the request, to the contract manager assigned to the Contract. Section 14.13 Contractor's Notification of Change of Contact Person or Ivey Personnel. Within ten calendar days shall notify in writing the contact manager assigned to the Contract of any change enumerated in the Contractor's Contact Personnel or Key Personnel, if included in their response to a solicitation document. Section 14.14 Unilateral Amendment. The Department reserves the right to amend this Contract through execution of a unilateral amendment signed by the contract manager for this Contract and provided to the Contractor with ten days notice prior to execution of the amendment under the following circumstances to: a. Correct an obvious clerical error in this Contract; b. Incorporate new or revised federal or state laws, regulations, rules or policies; and General Provisions (September 1, 2016) 21 c. Change the name of the Contractor in order to reflect the Contractor's name as recorded by the Texas Secretary of State. Section 14.15 Interim Extension Amendment. a. Prior to or on the expiration date of this Contract, the Parties agree that this Contract can be extended as provided under this Section. b. DSHS/HHSC shall provide written notice of interim extension amendment to the Contractor under one of the following circumstances: 1. Continue provision of services in response to a disaster declared by the governor; or 2. To ensure that services are provided to clients without interruption. c. DSHS will provide written notice of the interim extension amendment that specifies the reason for it and period of time for the extension. d. Contractor will provide and invoice for services in the same manner that is stated in the Contract. e. An interim extension under Section (a)(1) above shall extend the term of the contract not longer than 30 days after governor's disaster declaration is declared unless the Parties agree to a shorter period of time. f. An interim extension under Section (a)(2) above shall be a one-time extension for a period of time determined by HHS/DSHS. Section 14.16 Immunity Not Waived. THE PARTIES EXPRESSLY AGREE THAT NO PROVISION OF THIS CONTRACT IS IN ANY WAY INTENDED TO CONSTITUTE A WAIVER BY DEPARTMENT OR THE STATE OF TEXAS OF ANY IMMUNITIES FROM SUIT OR FROWLIABILITY THAT DEPARTMENT OR THE STATE OF TEXAS MAY HAVE BY OPERATION OF LAW. Section 14.17 Hold Harmless and Indemnification. Contractor, as an independent contractor, agrees to hold Department, the State of Texas, individual state employees and officers, and the federal government harmless and to indemnify them from any and all liability, suits, claims, losses, damages and judgments, and to pay all costs, fees, and damages to the extent that such costs, fees, and damages arise from performance or nonperformance of Contractor, its employees, subcontractors, joint venture participants or agents under this Contract. Section 14.18 Waiver. Acceptance by either Party of partial performance or failure to complain of any action, non -action or default under this Contract shall not constitute a waiver of either party's rights under this Contract. Section 14.19 Electronic and Information Resources Accessibility and Security Standards. a. Applicability. The following Electronic and Information Resources (EIR) requirements apply to the Contract because the Contractor performs services that include EIR that DSHS employees are required or permitted to access or members of the public are required or permitted to access. This Section does not apply to incidental uses of EIR in the performance of the Agreement, unless the Parties agree that the EIR will become property of the State of Texas or will be used by HHSC's clients or recipients after completion of the Agreement. General Provisions (September 1, 2016) 22 Nothing in this section is intended to prescribe the use of particular designs or technologies or to prevent the use of alternative technologies, provided they result in substantially equivalent or greater access to and use of a Product. b. Definitions. For purposes of this Section: "Accessibility Standards" means accessibility standards and specifications for Texas agency and institution of higher education websites and EIR set forth in 1 TAC Chapter 206 and/or Chapter 213. "Electronic and Information Resources" means information resources, including information resources technologies, and any equipment or interconnected system of equipment that is used in the creation, conversion, duplication, or delivery of data or information. The term includes telephones and other telecommunications products, information kiosks, transaction machines, Internet websites, multimedia resources, and office equipment, including copy machines and fax machines. "Electronic and Information Resources Accessibility Standards" means the accessibility standards for electronic and information resources contained in I Tex.Admin. Code Chapter 213. "Product" means information resources technology that is, or is related to, EIR. "Web Site Accessibility Standards/ Specifications" means standards contained in Volume 1 Tex. Admin. Code Chapter 206(c) Accessibility Requirements. Under Tex. Gov't Code Chapter 2054, Subchapter M, and implementing rules of the Texas Department of Information Resources, DSHS must procure Products and services that comply with the Accessibility Standards when those Products are available in the commercial marketplace or when those Products are developed in response to a procurement solicitation. Accordingly, Contractor must provide electronic and information resources and associated Product documentation and technical support that comply with the Accessibility Standards. c. Evaluation, Testing, and Monitoring. 1. DSHS may review, test, evaluate and monitor Contractor's Products and services, as well as associated documentation and technical support for compliance with the Accessibility Standards. Review, testing, evaluation and monitoring may be conducted before and after the award of a contract. Testing and monitoring may include user acceptance testing. Neither the review, testing (including acceptance testing), evaluation or monitoring of any Product or service, nor the absence of review, testing, evaluation or monitoring, will result in a waiver of the State's right to contest the Contractor's assertion of compliance with the Accessibility Standards. 2. Contractor agrees to cooperate fully and provide DSHS and its representatives timely access to Products, records, and other items and information needed to conduct such review, evaluation, testing, and monitoring. d. Representations and Warranties. 1. Contractor represents and warrants that: i. As of the Effective Date of the Contract, the Products and associated documentation and technical support comply with the Accessibility Standards as they exist at the time of entering the Agreement, unless and to the extent the Parties otherwise expressly agree in writing; and General Provisions (September 1, 2016) 23 ii. If the Products will be in the custody of the state or an DSHS' client or recipient after the Contract expiration or termination, the Products will continue to comply with Accessibility Standards after the expiration or termination of the Contract Term, unless DSHS or its clients or recipients, as applicable, use the Products in a manner that renders it noncompliant. 2. In the event Contractor becomes aware, or is notified that the Product or service and associated documentation and technical support do not comply with the Accessibility Standards, Contractor represents and warrants that it will, in a timely manner and at no cost to DSHS, perform all necessary steps to satisfy the Accessibility Standards, including remediation, replacement, and upgrading of the Product or service, or providing a suitable substitute. 3. Contractor acknowledges and agrees that these representations and warranties are essential inducements on which DSHS relies in awarding this Contract. 4. Contractor's representations and warranties under this subsection will survive the termination or expiration of the Contract and will remain in full force and effect throughout the useful life of the Product. e. Remedies. 1. _ Under Tex. Gov't Code § 2054.465, neither the Contractor nor any other person has cause of action against DSHS for a claim of a failure to comply with Tex. Gov't Code Chapter 2054, Subchapter M, and rules of the Department of Information Resources. 2. In the event of a breach of Contractor's representations and warranties, Contractor will be liable for direct, consequential, indirect, special, or liquidated damages and any other remedies to which DSHS may be emitted under this Contract and other applicable law. This remedy is cumulative of any other remedies to which DSHS may be entitled under this Contract and other applicable taw. Section 14.20 Force Majeure. Neither Party shall be -liable for any failure or delay in performing all or some of its obligations, as applicable, under this Contract if such failure or delay is due to any cause beyond the reasonable control of such Party, including, but not limited to, extraordinarily severe weather, strikes, natural disasters, fire, civil disturbance, epidemic, war, court order or acts of God. The existence of any such cause of delay or failure shall extend the period of performance in the exercise of reasonable diligence until after the cause of the delay or failure no longer exists and, if applicable, for any reasonable period of time thereafter required to resume performance. A Patty, within a period of time reasonable under the circumstances, must inform the other party as soon as practicable. This Party must also submit written notice with proof of receipt of the existence of a force majeure event or otherwise waive the right as a defense to non-performance. Section 14.21 Cooperation and Communication. Contractor shall cooperate with Department staff and as applicable, other DSHS contractors and shall promptly comply with requests from DSHS for information or responses to DSHS inquiries concerning Contractor's duties or responsibilities under this Contract. Section 14.22 Insurance. Contractor shall acquire and maintain for the duration of this Contract, insurance and with financially sound and reputable insurers licensed by the Texas Department of Insurance, in the type and amount customarily carried within the Contractor's industry or profession. Contractor must submit evidence of insurance as required under this Contract, including if requested a schedule of coverage or "underwriter's schedules" establishing to the satisfaction of DSHS the nature and extent of coverage granted by each such policy upon request by DSHS. In the event that any policy is determined to be deficient to comply with the terms of this Contract, Contractor shall General Provisions (September 1, 2016) 24 secure such additional policies or coverage as DSHS may reasonably request or that are required by law or regulation. ARTICLE XV BREACH OF CONTRACT AND REMEDIES FOR NON-COMPLIANCE Section I5.01 Actions Constituting Breach of Contract. Actions or inactions that constitute breach of contract include, but are not limited to, the following: a. Failure to properly provide the services and/or goods purchased under this Contract; b. Failure to comply with any provision of this Contract including failure to comply with all applicable statutes, rules or regulations; c. Failure to pay refunds or penalties owed to the Department; d. Failure to comply with a repayment agreement with Department or agreed order issued by the Department; e. Discovery of a material misrepresentation in any aspect of Contractor's application or response to the Solicitation Document; f. Any misrepresentation in the assurances and certifications in Contractor's application or. response to the Solicitation Document or in this Contract; or g. Contractor is on or is added to the Excluded Parties List System (EPLS). Section 15.02 General Remedies and Sanctions. The remedies and sanctions in this section are available to the Department against Contractor and any entity that subcontracts with Contractor for provision of services or goods. Additionally, HHSC OIG may investigate, audit and impose or recommend imposition of remedies or sanctions to Department for any breach of this Contract. The Department may impose one or more remedies or sanctions for each item of noncompliance and shall determine remedies or sanctions on a case -by -case basis if Contractor breaches this Contract by failing to comply with one or more of the terms of this Contract, including but not limited to compliance with applicable statutes, rules or regulations, the Department may take one or more of the following actions: a. Terminate this Contract by one of means provided in Article XVII. If applicable, notify Contractor of the opportunity to request a hearing on the termination pursuant to Texas Government Code Chapter 2105 regarding administration of Block Grants; b. Suspend all or part of this Contract by notifying that the Contractor that DSHS is temporarily discontinue performance of all or a part of the Contract as provided for in Article XVII; as of the effective date of the suspension pending DSHS's determination to terminate, amend the Contract or permit the Contractor to resume performance. Contractor shall not bill DSHS for services performed during suspension, unless expressly authorized by the notice of suspension, c. Use as a basis to deny additional or enter into future contracts with Contractor; d. Temporarily withhold cash payments to Contractor for proper charges or pending resolution of issues of noncompliance with conditions of this Contract or indebtedness to the United States or to the State of Texas; q. Permanently withhold cash payments by retaining funds billed by Contractor; f. Request that Contractor be removed from the Centralized Master Bidders List (CMBL) or any other state bid list, and barred from participating in future contracting opportunities with the State of Texas; g. Declare this Contract void upon the Department's determination that this Contract was obtained fraudulently or was illegal or invalid from this Contract's inception and demand repayment of any funds under this Contract; General Provisions (September 1, 2016) 001 h. Delay execution of a new contract or renewal with Contractor while other imposed or proposed sanctions are pending resolution, i. Demand repayment from Contractor when it has been verified that Contractor has been overpaid for reasons such as payments are not supported by proper documentation or failure to comply with Contract terms; j. Pursue a claim for damages as a result of breach of contract, k. Require Contractor to prohibit any employee or volunteer of Contractor from performing under this Contract or having direct contact with DSHS-funded clients or participant, if the employee or volunteer has been indicted or convicted of the misuse of state or federal funds, fraud or illegal acts that are in contraindication to continued obligations under this Contract, as reasonably determined by DSHS; 1. Withhold any payment to Contractor to satisfy any recoupment imposed by DSHS and take repayment from funds available under this Contract in amounts necessary to fulfill Contractor's payment or repayment obligations; in. Reduce the Contract term; n. Recoup improper payments when Contractor has been overpaid for reasons such as payments are not supported by proper documentation, improper billing or failure to comply with Contract terms; and o. Impose any other remedies, sanctions or penalties permitted by federal or state statute, law, regulation or rule. Section 15.03 Notice of Remedies or Sanctions. a. Department shall formally notify Contractor in writing when a remedy or sanction is imposed, stating the nature of the remedies and sanction, the reasons for imposing them, the corrective actions, if any, that must be taken before the actions shall be removed and the time allowed for completing the corrective actions, and the method, if any, of requesting reconsideration of the remedies or sanctions imposed. . b. Other than'in the case of repayment or recoupment, Contractor is required to file, within 15 calendar days of receipt of notice, a written response to Department acknowledging receipt of such notice. c. If requested by the Department, the written response must state how Contractor shall correct the noncompliance by agreeing to a corrective action plan or demonstrate in writing that the findings on which the remedies or sanctions are based are either invalid or do not warrant the remedies or sanctions. If Department determines that a remedy or sanction is warranted, unless the remedy or sanction is subject to review under a federal or state statute, regulation, rule, or guideline, Department's decision is final. Department shall provide written notice to Contractor of Department's final decision. d. If required by the Department, Contractor shall submit a corrective action plan for DSHS approval and take corrective action as stated in the plan approved by DSHS. If DSHS determines that repayment is warranted, DSHS shall issue a demand letter to Contractor for repayment. If full repayment is not received within the time limit stated in the demand letter, and if recoupment is available, DSHS shall recoup the amount due to DSHS from funds otherwise due to Contractor under this Contract. Section 15.04 Emergency Action. In an emergency, Department may immediately terminate or suspend all or part of this Contract, temporarily or permanently withhold cash payments, deny future contract awards, or delay contract execution by delivering written notice to Contractor, by any verifiable method, stating the reason for the emergency action. An "emergency" is defined as Contractor is noncompliant and the noncompliance has a direct adverse effect on the public or client health, welfare or safety. The direct adverse effect may be programmatic and may include failing to provide services; providing inadequate services; or providing unnecessary services. General Provisions (September 1, 2016) 26 Whether Contractor's conduct or noncompliance is an emergency will be determined by Department on a case - by -case basis and will be based upon the nature of the noncompliance or conduct. ARTICLE XVI CLAIMS AGAINST THE DEPARTMENT -NOTICE OF DISPUTE Section 16.01 Breach of Contract Claim. The process for a breach of contract claim against the DSHS provided for in Texas Government Code Chapter 2260 and implemented in the rules at 25 TAC § §4.11-4.24 or as amended by DSHS, shall be used by DSHS and Contractor to attempt to resolve any breach of contract claim against DSHS. Section 16.02 Notice. Contractor's claims for breach of this Contract that the Parties cannot resolve in the ordinary course of business must be submitted to the negotiation process provided in Chapter 2260 and 25 TAC or as amended. To initiate the process, Contractor shall submit written notice, as required by Subchapter B, to DSHS Office of General Counsel. The notice must specifically state that the provisions of Chapter 2260 are being invoked and comply with all the requirements in this Chapter and TAC. A copy of the notice must also be given to all other representatives of DSHS and Contractor. Section 16.03 Performance Not Suspended. Neither the occurrence of an event nor the pendency of a notice of claim filed by the Contractor constitutes grounds for the suspension in whole or part of performance by Contractor. ARTICLE XVII TERMINATION. AND TEMPORARY SUSPENSION Section 17.01 Expiration of Contract or Program Attachments. a. Except as provided in the Survivability of Terms section of the General Terms Article, Contractor's service obligations stated in each Contract or Program Attachment shall end upon the expiration date of that Contract or Program Attachment unless extended or renewed by written amendment. b. Prior to completion of the term of all Contracts or Program Attachments, all or a part of this Contract may be terminated with or without cause under this Article and in the Contract. c. A Program Attachment's term cannot extend past the Contract term in its associated Contract. Section 17.02 Effect of Termination or Expiration. a. Upon termination of this Contractor Program Attachment, as applicable, Contractor shall cooperate with DSHS to the fullest extent possible to ensure the orderly and safe transfer of responsibilities under this Contract or Program Attachment, as applicable to DSHS or another entity designated by DSHS. b. Upon termination of all or part of this Contract, Department and Contractor shall be discharged from any further obligation created under the applicable terms of this Contract or Program Attachment, as applicable, except for the equitable settlement of the respective accrued interests or obligations ilrcurred prior to termination and for Contractor's duty to cooperate with DSHS and, except as provided in the Survivability of Terms section of the General Terms Article. c. Termination does not, however, constitute a waiver of any remedies for breach of this Contract. Section 17.03 Termination or Temporary Suspension Without Cause. General Provisions (September 1, 2016) 27 a. Either Parry may terminate this Contractor Program Attachment, as applicable with at least 30 calendar days prior written notice to the nonterminating Parry. b. If Contractor seeks to terminate a Contract that involves residential client services, Contractor shall give the Department at least 90 calendar days prior written notice and shall submit a transition plan to ensure client services are not disrupted. c. The Parties can agree to terminate by mutual agreement. DSHS may temporarily suspend or terminate this Contract or Program Attachment, as applicable if funds become unavailable through lack of appropriations, budget cuts, transfer of funds between programs or HHSC agencies, amendments to the Appropriations Act, health and human services consolidations or any other disruption of current appropriated funding for this Contactor Program Attachment. Contactor shall be notified in writing of any termination or temporary suspension and of any cessation of temporary suspension. Upon notification of temporary suspension, Contactor will discontinue performance under the Contact as of the effective date of the suspension for the duration of the suspension. Section 17.04 Immediate Termination. Department may immediately terminate this Contact or Program Attachment, as applicable, when, in the sole determination of Department, termination is in the best interest of the State of Texas. Section 17.05 Termination For Cause. Department may terminate this Contact, in whole or inpart, for breach of contact by providing 10 calendar days written notice to Contactor. Section 17.06 Notice of Termination. Either Party may deliver written notice of intent to terminate by any verifiable method. Notice of termination is effective when it is received by the non -terminating party. ARTICLE XVIII VOID, SUSPENDED AND TERMINATED CONTRACTS Section 18.01 Void Contracts. Department may void this Contract upon determination that the award was obtained fraudulently or was otherwise illegal or invalid from its inception. Section 18.02 Effect of Void, Suspended, or Involuntarily Terminated Contract. A Contactor who has been a party to a contact with DSHS that has been found to be void, is suspended or is terminated for cause is not eligible for any renewal or increase of funding for an existing contract or new contacts or renewals until in the case of suspension or termination the Department has determined that Contactor has satisfactorily resolved the issues underlying the suspension or termination. Additionally, if this Contract is found to be void any amount paid to the Contactor is subject to recoupment by DSHS Section 18.03 Appeals Rights for DSHS Funded Block Grants. Pursuant to Texas Government Code § 2105.302, after receiving notice from the Department of termination of a contract with DSHS funded by block grant funds, Contactor may request an administrative hearing under Texas Government Code Chapter 2001. ARTICLE XIX CLOSEOUT Section 19.01 Cessation of Services at Closeout. Upon expiration or termination of this Contract or Program Attachment, as applicable, Contractor shall stop providing services or the delivery of goods under this Contract and if necessary, shall cooperate with DSHS to the fullest extent possible to ensure the orderly and safe transfer of responsibilities under this Contract to DSHS or another entity designated by DSHS. General Provisions (September 1, 2016) 28 Contractor shall not bill DSHS for services performed or goods delivered after termination or expiration of Contract or Program Attachment. Upon termination or expiration of this Contract or Program Attachment, Contractor shall immediately initiate Closeout activities described in this Article. Section 19.02 Administrative Offset. The Department has the right to administratively offset amounts owed by Contractor against any invoice submitted for payment. Section 19.03 Deadline for Closeout. Contractor shall submit all performance, and other Closeout reports required under this Contract within 45 calendar days after the Contract or Program Attachment, if applicable, has terminated. Section 19.04 Payment of Refunds. Any funds paid to Contractor in excess ofthe amount to which Contractor is finally determined to be entitled under the terms of this Contract constitute a debt to the Department and shall result in a refund due, which Contractor shall pay within the time period established by the Department. Section 19.05 Disallowances and Adjustments. The Closeout of this Contract or Program Attachment does not affect the Department's right to recover funds on the basis of a later audit or other review or Contractor's obligation to return any funds due as a result of later refunds, corrections or other transactions. General Provisions (September 1, 2016) 29 2016 FEDERAL, GRANT SUBRECIPIENT ADDITIONAL PROVISIONS ARTICLE XXI PROGRAM OPERATIONS........................................................................................................31 Section 21.01 Client Financial Eligibility . ................................. .................... :.................................................. 31 Section 21.02 Contracts with Subrecipient and Vendor Subcontractors.....................................................31 Section 21.03 Incorporation of Terms in Subrecipient Subcontracts...........................................................31 Section 21.04 Quality Management . ................................................................................................................ 32 Section 21.05 Contractor's Notification of Change to Certain Contract Provisions...................................32 Section 21.06 Responsibilities and Restrictions Concerning Governing Body, Officers and Employees. .32 ARTICLE XXII PROGRAM EQUIPMENT AND SUPPLIES .................... Section22.01 Equipment . ........... ............................ ................................................................................... .:..... 33 Section22.02 Equipment List...........................................................................................................................33 Section22.03 Supplies.......................................................................................................................................34 Section 22.04 Property Inventory and Protection of Assets...........................................................................34 Section 22.05 Assets as Collateral Prohibited . ..... :................ :......................................................................... 34 ARTICLE XXIII PROGRAM FUNDS AND PAYMENTS.......................................................................:.........34 Section23.01 Use of Funds...............................................................................................................................34 Section 23.02 Use for Match Prohibited..........................................................................................................34 Section23.03 Program Income.........................................................................................................................35 Section23.04 Nonsupplanting............................................................. ....... ...................................................... 35 Section23.05 Payment Methods.......................................................................................................................35 Section 23.06 Financial Status Reports(FSRs)...............................................................................................35 Section 23.07 Working Capital Advance.........................................................................................................35 Section 23.08 Condition Precedent to Requesting Payment.......................................................................... 36 Section 23.09 Management and Control Systems...........................................................................................36 Section 23.10 Effect of Grant Close Out................................................. :................................................... ..... 36 ARTICLE XXIV ALLOWABLE COSTS AND AUDIT REQUIREMENTS....................................................36 Section 24.01 Allowable Costs..........................................................................................................................36 Section24.02 Property Acquisitions................................................................................................................37 Section 24.03 Cost Allocation Plan...................................................................................................................38 Section 24.04 Overtime Compensation............................................................................................................38 Section 24.05 Independent Single or Program -Specific Audit . ................................................... ................... 38 Section 24.06 Submission of Audit...................................................................................................................39 ARTICLE XXV INSURANCE AND BONDS ................. ..................... :................................................ :............... 39 Section 25.01 Insurance .............................................. Section 25.02 Fidelity Bond ........................................ Section 25.03 Liability Coverage ................................ ...................................................................... 3 9 ............................. ..:................................. ..... 40 ARTICLE XXVI TERMINATION, BANKRUPTCY AND CLOSEOUT Section 26.01 Final Budget.............................................................................................. Section26.02 Bankruptcy................................................................................................. Section 26.03 Title to Property......................................................................................... Section 26.04 Disposition of Property.............................................................................. Section 26.05 Closeout of Equipment.............................................................................. ........40 ........40 ............................ 40 ............................ 40 ............................ 41 ............................ 41 ........................... 41 ARTICLE XXVII NON-EXCLUSIVE LIST OF APPLICABLE LAWS...........................................................41 ARTICLE XX DSHS GENERAL PROVISIONS In addition to the terms and conditions in the Department of State Health Services (DSHS or Department) FY 2016 General Provisions (General Provisions), Contractor agrees to comply with these 2016 Federal Grant Subrecipient Additional Provisions. ARTICLE XXi PROGRAM OPERATIONS Section 21.01 Client Financial Eligibility. Where applicable, Contractor shall use financial eligibility criteria, financial assessment procedures and standards developed by the Department to determine client eligibility. Section 21.02 Contracts with Subrecipient and Vendor Subcontractors. a. Contractor may enter into contracts with Subrecipient subcontractors unless restricted or otherwise prohibited in the Contract or Program Attachment(s). b. Prior to entering into a Subrecipient agreement equaling or exceeding $100,000, Contactor shall obtain written approval from DSHS. c. Contractor shall establish written policies and procedures for competitive procurement and monitoring of subcontracts and shall produce a subcontracting monitoring plan. d. Contractor shall monitor subrecipient subcontractors for both financial and programmatic performance and shall maintain pertinent records that must be available for inspection by DSHS. e. Contractor shall ensure that subcontractors are fully aware of the requirements placed upon them by state/federal statutes, rules, and regulations and by the provisions of this Contract. f. Contacts with all subcontractors, whether vendor or subrecipient, must be in writing and include the following: 1. Name and address of all parties and the subcontractor's Vendor Identification Number (VIM or Employee Identification Number (EIN); 2. Detailed description of the services to be provided; 3. Measurable method and rate of payment and total not -to -exceed amount of the contract; 4. Clearly defined and executable termination clause; and 5. Beginning and ending dates that coincide with the dates of the Contract. g. Contractor is responsible to DSHS for the performance of any subcontractor. h. Contactor shall not contract with a subcontractor, at any tier, that is debarred, suspended, or excluded from or ineligible for participation in federal assistance programs or if the subcontractor would be ineligible under the Sections 12.05, 14.03 and 14.04 of the General Provisions. Section 21.03 Incorporation of Terms in Subrecipient Subcontracts. a. Contractor shall include in all its contracts with subrecipient subcontractors and solicitations for subrecipient subcontracts, without modification (except as required to make applicable to the subcontractor): 1. Assurances and Certifications in Article 12 of the General Provisions; 2. Sections 14.03 and 14.04 of the General Provisions; and Subrecipient General Provisions (September 1, 2016) 31 3. A provision granting to DSHS, SAO, OIG, and the Comptroller General of the United States, and any of their representatives, the right of access to inspect the work and the premises on which any work is performed, and the right to audit the subcontractor in accordance with Article X of the General Provisions; b. Each subrecipient subcontract contract must also include a copy of these General Provisions and a copy of the Statement of Work and any other provisions in the Program Aitachment(s) applicable to the subcontract. c. Contractor shall ensure that all written agreements with subrecipient subcontractors incorporate the terms of this Contract so that all terms, conditions, provisions, requirements, duties and liabilities under this Contract applicable to the services provided or activities conducted by a subcontractor are passed down to that subcontractor. d. No provision of this Contract creates privity of contract between DSHS and any subcontractor of Contractor. e. If a subcontractor is unable to certify (or status changes during contract term) to any of the statements in Section 14.03 and 14.04 or any of the certifications stated in Article X of the General Provisions, Contractor shall submit an explanation to the contract manager assigned to the Contract. Section 21.04 Quality Management. Contractor shall comply with quality management requirements as directed by the Department. Section 21.05 Contractor's Notification of Change to Certain Contract Provisions. The following changes may be made to this Contract without a written amendment or the Department's prior approval: a. Cumulative budget transfers that do not exceed 25% among direct cost categories, other than the equipment category, of less than $100,000, provided that the total budget amount is unchanged (This subsection does not apply to contracts funded by funding sources that have different percentage requirements); and b. Change in Contractor's share of the budget concerning non-DSHS funding other than program income and match, regardless of the amount of the change, provided that in changing the budget, Contractor is not supplanting DSHS funds. Contractor within ten calendar days shall notify in writing the contract manager assigned to the Program Attachment of any change enumerated in this section, but the contract will not be amended. Section 21.06 Responsibilities and Restrictions Concerning Governing Body, Officers and , Employees. a. Contractor and its governing body shall bear full responsibility for the integrity of the fiscal and programmatic management of the organization. This provision applies to all organizations, including Section 501(c) (3) organizations as defined in the Internal Revenue Service Code as not - for -profit organizations. b. Each member of Contractor's governing body shall be accountable for all funds and materials received from Department. The responsibility of Contractor's governing body shall also include accountability for compliance with Department Rules, policies, procedures, and applicable federal and state laws and regulations; and correction of fiscal and program deficiencies identified through Subrecipient General Provisions (September 1, 2016) 32 self -evaluation and Department's monitoring processes. Contractor's governing body shall ensure separation of powers, duties, and functions of governing body members, and staff. c. No member of Contractor's governing body, or officer or employee of Contractor shall vote for, confirm or act to influence the employment, compensation or change in status of any person related within the second degree of affinity or the third degree of consanguinity (as defined in Texas Government Code Chapter 573) to the member of the governing body or the officer or any employee authorized to employ or supervise such person. This prohibition does not prohibit the continued employment of a person who has been continuously employed for a period of two years prior to the election, appointment or employment of the officer, employee, or governing body member related to such person in the prohibited degree. These restrictions also apply to the governing body, officers and employees of Contractor's subcontractors. Section 21.07 Direct Operation. At the Department's discretion, the Department may temporarily assume operations of a Contractor's program or programs funded under this Contract when the continued operation of the program by Contractor puts at risk the health or safety of clients and/or participants served by Contractor. ARTICLE X�M PROGRAM EQUIPMENT AND SUPPLIES Section 22.01 Equipment. Equipment means tangible personal property having a useful lifetime of more than one year and a per -unit acquisition cost that exceeds the lesser of the capitalization level established by the of $5,000 or more. Contractors shall inventory all equipment, and report the inventory on the Contractors Property Inventory Form. Contractor shall initiate the purchase of all equipment approved in writing by DSHS, in the first quarter of the Contract or Program Attachment term, as applicable. Failure to timely initiate the purchase of equipment may result in the loss of availability of funds for the purchase of equipment. Requests to purchase previously approved equipment after the first quarter in the Program Attachment must be submitted to the contract manager assigned to this Contract. Section 22.02 Equipment List. a. All items of equipment to be purchased with funds under this Contract must be itemized in Contractor's equipment list as finally approved by the Department in the executed Contract. The equipment list must include: 1. Description of the property; 2. Serial number or other identification number; 3. Source of funding for the property (including the Federal Assistance Identification Number); 4. Who holds title, 5. Acquisition date and cost of the property; 6. Percentage of Federal participation in the project costs for the Federal award under which the property was acquired, 7. Location use and condition of the property; and 8. Any ultimate disposition data including the date of disposal and sale price of property. Any changes to the approved equipment list in the executed Contract must be approved in writing by Department prior to the purchase of equipment. b. Contractor shall submit to the contract manager assigned to this Contact, a written description including complete product specifications and need justification prior to purchasing any item of Subrecipient General Provisions (September 1, 2016) 33. unapproved equipment. If approved, Department will acknowledge its approval by means of a written amendment. Section 22.03 Supplies. a. Supplies are defined as consumable items necessary to carry out the services under this Contract including medical supplies, drugs, janitorial supplies, office supplies, patient educational supplies, software, and any items of tangible personal property other than those defined as equipment above. b. Tangible personal property includes controlled assets, including firearms, regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more, but less than $5,000, which includes desktop and laptop computers (including notebooks, tablets and similar devices), non -portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment are also considered Supplies. c. Prior approval by DSHS of the purchase of Controlled Assets is not required, but such purchases must be reported on the Contractors Property Inventory Form as detailed under Section 14.23. Section 22.04 Property Inventory and Protection of Assets. Contractor shall maintain an inventory of equipment, supplies defined as controlled assets, and property described in the Section 14.06 of the General Provisions and submit an annual cumulative report of the equipment and other property on Contractor's Property Inventory Report to the Department's Contract Oversight and Support Section, Mail Code 1326, P.O. Box 149347, Austin, Texas 78714-9347, no later than October 151" of each year. The report is located on the DSHS website at: http://www.dshs.state.tx.us/contracts/f`orms.shtm. J Contractor shall maintain, repair, and protect assets under this Contract to assure their full availability and usefulness. If Contractor is indemnified, reimbursed, or otherwise compensated for any loss of, destruction of, or damage to the assets provided or obtained under this Contract, Contractor shall use the proceeds to repair or replace those assets. Section 22.05 Assets as Collateral Prohibited. Contractors on a cost reimbursement payment method shall not encumber equipment purchased with Department funds without prior written approval from the Department. ARTICLE XXHI PROGRAM FUNDS AND PAYMENTS Section 23.01 Use of Funds. Contractor shall expend Department funds only for the provision of approved services and for reasonable and allowable expenses directly related to those services. Section 23.02 Use for Match Prohibited. Contractor shall not use funds provided through this Contract for matching purposes in securing other funding unless directed or approved by the Department in writing. Subrecipient General Provisions (September 1, 2016) 34 Section 23.03 Program Income. a. Gross income directly generated from Department funds through a projector activity performed under a Contract and/or earned only as a result of this Contract during its term is considered program income. b. Unless otherwise required under the terms of the grant funding this Contract, Contractor shall use the addition alternative, as provided in Subsection 25(g)(2) of the Uniform Grant Management Standards, for the, use of program income to further the program objectives of the state or federal statute that provided the authority of this Contract or its Program Attachment, and Contractor shall spend the program income on the same Project Attachment or Statement of Work project under which it was generated. c. Contractor shall identify and reportthis income in accordance with Article IX of these General Provisions and the provisions in the Contract or its Program Attachment(s). d. Contractor shall expend program income during the Program Attachment term and may not carry forward to any succeeding term. Contractor shall refund program income not expended in the term in which it is earned to DSHS. e. DSHS may base future funding levels, in part, upon Contractor's proficiency in identifying, billing, collecting, and reporting program income, and in using it for the purposes and under the conditions specified in this Contract. Section 23.04 Nonsupplanting. Contractor shall not use funds from this Contract to replace or substitute existing funding from other sources that also supports the activities that are the subject of this Contract but rather shall use funds from this Contract to supplement existing state or local funds currently available for a particular activity. Contractor shall make a good faith effort to maintain its current level of support. Contractor may be required to submit documentation substantiating that a reduction in state or local funding, if any, resulted for reasons other than receipt or expected receipt of funding under this Contract. Section 23.05 Payment Methods. Section 5.01 of the General Provisions is replaced with the following: Except as otherwise provided by the provisions of this Contract or its Program Attacbment(s), the payment method for it will be cost reimbursement. This payment method is based on an approved budget in this Contract or its Program Attachment(s) and acceptable submission of a request for reimbursement. Section 23.06 Financial Status Reports (FSRs). Except as otherwise provided in these General Provisions or in the terms of Contracts, if a contract has a categorical budget, Contractor shall submit quarterly FSRs to Accounts Payable by the last business day of the month following the end of each quarter of the Contract term for Department review and financial assessment. Contractor shall submit the final FSR no later than 45 calendar days following the end of the Contract term. Section 23.07 Working Capital Advance. If necessary, if allowed by law, and if permitted at DSHS sole discretion, Contractor's requests for an advance of funds shall be limited to the minimum amount needed for effective accomplishment of the Project under this Contract, and shall be timed as closely as possible to actual cash requirements. Contractor Subrecipient General Provisions (September 1, 2016) 35 shall establish procedures to minimize the time elapsing between the transfer of funds from DSHS to Contractor, and shall ensure that such funds are disbursed as soon as administratively possible. Section 23.08 Condition Precedent to Requesting Payment. Contractor shall disburse program income, rebates, refunds, contract settlements, audit recoveries, and interest earned on such funds before requesting cash payments including any advance payments from Department. Section 23.09 Management and Control Systems. a. Contractor shall maintain an appropriate contract administration system to ensure that all terms, conditions, and specifications are met during the term of the contract through the completion of the closeout procedures. b. Contractor shall develop, implement, and maintain financial management and control systems . that meet or exceed the requirements of UGMS. Those requirements and procedures include, at a minimum, the following: 1. Financial planning, including the development of budgets that adequately reflect all functions and resources necessary to carry out authorized activities and the adequate determination of costs; 2. Financial management systems that include accurate accounting records that are accessible and identify the source and application of funds provided under each Program Attachment of this Contract, and original source documentation substantiating that costs are specifically and solely allocable to a Contract and its Program Attachment and are traceable from the transaction to the general ledger; 3. Effective internal and budgetary controls; 4. Comparison of actual costs to budget, determination of reasonableness, allowableness, and allocability of costs; S. Timely and appropriate audits and resolution of any findings; 6. Billing and collection policies; and 7. Mechanism capable of billing and making reasonable efforts to collect from clients and third parties. Section 23.10 Effect of Grant Close Out. Contractor must submit all requests for reimbursement prior to the date of the closure of the grant. DSHS may reject any request for reimbursement submitted after closure of the grant. ARTICLE XXIV ALLOWABLE COSTS AND AUDIT REQUIREMENTS Section 24.01 Allowable Costs. a. Except as provided by section 23.06, DSHS will reimburse Contractor for services satisfactorily . performed, and sufficiently documented for allowable costs. b. Contractor must have incurred a cost prior to claiming reimbursement and within the applicable term to be eligible for reimbursement under this Contract._ c. DSHS will determine whether costs submitted by Contractor are allowable and eligible for reimbursement. Subrecipient General Provisions (September 1, 2016) 36 d. If DSHS has paid funds to Contractor for unallowable or ineligible costs, DSHS will notify Contractor in writing, and Contractor shall retain the funds to DSHS within 30 calendar days of the, date of this written notice. e. DSHS may withhold all or part of any payments to Contractor to offset reimbursement for any unallowable or ineligible expenditures that Contractor has not refunded to DSHS, or if financial status report(s) are not submitted by the due date(s). DSHS may take repayment (recoup) from funds available under this Contract in amounts necessary to fulfill Contractor's repayment obligations. Applicable Cost principles, Audit requirements and Administrative Re uirements Applicable Entity Applicable Cost Audit Requirements Administrative Principles Requirements State, Local and Tribal OMB Circular A-87 OMB Circular UGMS, OMB Circular Governments (2 CFR, Part 225) A-133 and UGMS A-102, and applicable Federal awarding agency common rule Educational Institutions OMB Circular A-21 OMB Circular OMB Circular A-110 (2 (2 CFR, Part 220) A-133 CFR, Part 215) and applicable Federal awarding agency common rule; and UGMS, as applicable Non -Profit OMB Circular OMB Circular UGMS; OMB Circular Organizations A-122 (2 CFR, Part A-133 and UGMS A-110 (2 CFR, Part 230) 215) and applicable Federal awarding agency common rule For -profit Organization 48 CFR Part 31, OMB Circular A- UGMS and applicable other than a hospital and Contract Cost 133 and UGMS Federal awarding an organization named Principles agency common rule in OMB Circular A-122 Procedures, or (2 CFR Part, 230) as not uniform cost subject to that circular. accounting standards that comply with cost principles acceptable to the federal or state awarding -agency A chart of applicable Federal awarding agency common rules -is located through a weblink on the DSHS website at http://www.dshs.state.tx.us/contracts/links.shtm. OMB Circulars will be applied with the modifications prescribed by UGMS with effect given to whichever provision imposes the more stringent requirement in the event of a conflict. The Contract will specify appropriate grant guidance. Section 24.02 Property Acquisitions. Department funds must not be used to purchase buildings or real property. Any costs related to the initial acquisition of the buildings or real property are not allowable. Subrecipient General Provisions (September 1, 2016) 37 Section 24.03 Cost Allocation Plan. a. Contractor shall implement and follow the applicable Cost Allocation Plan. b. Contractor shall submit a Cost Allocation Plan on the format provided by DSHS to the Department's Contract Oversight and Support Section, at Mail Code 1326, P.O. Box 149347, Austin, Texas 78714-9347, or by email to mailto:coscW@dshs.state.tx.us no later than the 601s calendar day after the effective date of the Contract, except when a Contractor has a current Cost Allocation Plan on file with the Department. If Contractor's plan is the same as the plan previously submitted to DSHS, by signing this Contract, Contractor certifies that its current Cast Allocation Plan for the current year is the same as the plan previously submitted. c. If the Cost Allocation Plan changes during the Contract term, Contractor shall submit anew Cost Allocation Plan to the Contract Oversight and Support Section within 30 calendar days after the effective date of the change. Section 24.04 Overtime Compensation. Except as provided in this section, Contractor shall be responsible for any obligations of premium overtime pay due employees. Premium overtime pay is defined as any compensation paid to an individual in addition to the employee's normal rate of pay for hours worked in excess of normal working hours. Funds provided under this Contract may be used to pay the premium portion of overtime only under the following conditions: a. With the prior written approval of DSHS; b. Temporarily, in the case of an emergency or an occasional operational bottleneck; c. When employees are performing indirect functions, such as administration, maintenance, or accounting; d. In performance of tests, laboratory procedures, or similar operations that are continuous in nature and cannot reasonably be interrupted or otherwise completed; or e. When lower overall cost to DSHS will result. Section 24.05 Independent Single or Program -Specific Audit. a. If Contractor within Contractor's fiscal year expends a total amount of at least $750,000 in federal funds awarded, Contractor shall have a single audit or program -specific audit in accordance with the 2 CFR § 200.501. The $750,000 federal threshold amount includes federal funds passed through by way of state agency awards. b. If Contractor within Contractor's fiscal year expends a total amount of at least $500,000 in state funds awarded, Contractor must have a single audit or program -specific audit in accordance with UGMS, State of Texas Single Audit Circular. c. For -profit Contractors whose expenditures meet or exceed the federal and/or state expenditure thresholds stated above shall follow the guidelines in 2 CFR § 200.501 or UGMS, as applicable, for their program -specific audits. d. The HHSC Office of Inspector General (OIG) will notify Contractor to complete the Single Audit Status Registration Form. e. If Contractor fails to complete the Single Audit Status Form within 30 calendar days after notification by OIG to do so, Contractor shall be subject to DSHS sanctions and remedies for non- compliance with this Contract. Subrecipient General Provisions (September 1, 2016) 38 f. The audit must be conducted by an independent certified public accountant and in accordance with applicable OMB Circulars, Government Auditing Standards, and UGMS, which is accessible through a web link on the DSHS website at bgp://www.dshs.state.tx.us/contracts/links.shtin. g. Contractor shall procure audit services in compliance with this section, state procurement procedures, as well as with the provisions of UGMS. Contractor, unless Contractor is a state governmental entity, shall competitively re -procure independent single audit services at least every six years. Section 24.06 Submission of Audit. Within thirty 30 calendar days of receipt of the audit reports required by the Independent Single or Program - Specific Audit section, Contractor shall submit one copy to the Department's Contract Oversight and Support Section, and one copy to the OIG, at the following addresses: Department of State Health Services Contract Oversight and Support, Mail Code 1326 P.O. Box 149347 Austin, Texas 78714-9347 Health and Human Services Commission Office of Inspector General Compliance/Audit, Mail Code 1326 P.O. Box 85200 Austin, Texas 78708-5200 Electronic submission to DSHS should be addressed as follows: COSContractAdministration@dshs.state.tx.us Electronic submission to HHSC should be addressed as follows: Oueenah.Teamah@hhsc.state. bLus If Contractor fails to submit the audit report as required by the Independent Single or Program -Specific Audit section within thirty 30 calendar days of receipt by Contractor of an audit report, Contractor shall be subject to DSHS sanctions and remedies for non-compliance with this Contract. ARTICLE XXV INSURANCE AND BONDS Section 25.01 Insurance. In addition to the hisurance provision in Section 14.24 of the General Provisions, Contractor shall maintain insurance or other means of repairing or replacing assets purchased with Department funds. Contractor shall repair or replace with comparable equipment any such equipment not covered by insurance that is lost, stolen, damaged or destroyed. If any insured equipment purchased with DSHS funds is lost, stolen, damaged or destroyed, Contractor shall notify the contract manager assigned to this Contract within 5 business days of learning of the loss, to obtain instructions whether to submit and pursue an insurance claim. Contractor shall use any insurance proceeds to repair the equipment or replace the equipment with comparable equipment or remit the insurance proceeds to DSHS. Subrecipient General Provisions (September 1, 2016) 39 Section 25.02 Fidelity Bond. a. For the benefit of DSHS, Contractor is required to cant' a fidelity bond or insurance coverage equal to the amount of funding provided under this Contract up to $100,000 that covers each employee of Contractor handling funds under this Contract, including person(s) authorizing payment of such funds. b. The fidelity bond or insurance must provide for indemnification of losses occasioned by any fraudulent or dishonest act or acts committed by any of Contractor's employees, either individually or in concert with others, and/or failure of Contractor or any of its employees to perform faithfully his/her duties or to account properly for all monies and property received by virtue of his/her position or employment. The bond or insurance acquired under this section must include coverage for third party property. c. Contractor shall notify, and obtain prior approval from, the DSHS Contract Oversight and Support Section before settling a claim on the fidelity bond or insurance. Section 25.03 Liability Coverage. For the benefit of DSHS, Contractor shall at all times maintain liability insurance coverage, referred to in Tex. Gov. Code § 2261.102, as "director and officer liability coverage" or similar coverage for all persons in management or governing positions within Contractor's organization or with management or governing authority over Contractor's organization (collectively "responsible persons"). This section applies to entities that -are organized as non-profit corporations under the Texas Non -Profit Corporation Act; for -profit corporations organized under the Texas Business Corporations Act; and any other legal entity. Contractor shall maintain copies of liability policies on site for inspection by DSHS and shall submit copies of policies to DSHS upon request. Contractor shall maintain liability insurance coverage in an amount not less than the total value of this Contract and that is sufficient to protect the interests of Department in the event an actionable act or omission by a responsible person damages Department's interests. Contractor shall notify, and obtain prior approval from, the DSHS Contract Oversight and Support Section before settling a claim on the insurance. ARTICLE XXVI TERMINATION, BANKRUPTCY AND CLOSEOUT Section 26.01 Final Budget Contractor shall submit an actual Budget to DSHS no later than sixty (60) days after the contract termination date or at the conclusion of all contract activities, whichever occurs fist. The Budget shall be in a format prescribed by DSHS and shall be accompanied by a report of all activities performed under this Contract. Section 26.02 Bankruptcy. In the event of bankruptcy, Contractor shall sever Department property, equipment, and supplies in possession of Contractor from the bankruptcy, and title must revert to Department. If directed by DSHS, Contractor shall return all such property, equipment and supplies to DSHS. Contractor shall ensure that its subcontracts, if any, contain a specific provision requiring that in the event the subcontractor's bankruptcy, the subcontractor must sever Department property, equipment, and supplies in possession of the subcontractor from the bankruptcy, and title must revert to Department, who may require that the property, equipment and supplies be returned to DSHS. Subrecipient General Provisions (September 1, 2016) 40 Section 26.03 Title to Property. At the expiration or termination of this Contact for any reason, title to any remaining equipment and supplies purchased with funds under this Contract reverts to Department. Title may be transferred to any other party designated by Department. The Department may, at its option and to the extent allowed by law, transfer the reversionary interest to such property to -Contractor. Section 26.04 Disposition of Property. a. Contractor shall follow the procedures in the American Hospital Association's (AHA) "Estimated Useful Lives of Depreciable Hospital Assets" in disposing, at any time during or after the Contract term, of equipment purchased with the Department funds, except when federal or state statutory requirements supersede or when the equipment requires licensure or registration by the state, or when the acquisition price of the equipment is equal to or greater than $5,000. b. All other equipment not listed in the ABA reference (other than equipment that requires licensure or registration or that has an acquisition cost equal to or greater than $5,000) will be controlled by the requirements of UGMS. c. If, prior to the end of the useful life, any item of equipment is no longer needed to perform services under this Contract, or becomes inoperable, or if the equipment requires licensure or registration or had an acquisition price equal to or greater than $5,000, Contractor shall request disposition approval and instructions in writing from the contract manager assigned to this Contract. d. After an item reaches the end of its useful life, Contractor shall ensure that disposition of any equipment is in accordance with Generally Accepted Accounting Principles, and any applicable 'federal guidance. Section 26.05 Closeout of Equipment. At the end of the term of a Contract that has no additional renewals or that will not be renewed (Closeout), or when a Contract is otherwise terminated, Contractor shall submit to the contract manager assigned to this, an inventory of equipment purchased with Department funds and request disposition instructions for such equipment. All equipment purchased with Department funds must be secured by Contractor at the time of Closeout, or termination of this Contract, and must be disposed of according to the Department's disposition instructions, which may include return of the equipment to DSHS or transfer of possession to another DSHS contractor, at Contractor's expense. ARTICLE XXVII NON-EXCLUSIVE LIST OF APPLICABLE LAWS Where applicable, federal statutes and regulations, including federal grant requirements applicable to funding sources, will apply to this Contract. Contractor agrees to comply with applicable laws, executive orders, regulations and policies, as well as Office of Management and Budget (OMB) Circulars (as codified in Title 2 of the Code of Federal Regulations), the Uniform Grant and Contract Management Act of 1981 (UGMA), Tex. Gov. Code Chapter 783, and Uniform Grant Management Standards (UGMS), as revised by federal circulars and incorporated in UGMS by the Comptroller of Public Accounts, Texas Procurement and Support Services Division. UGMA and UGMS can be located through web links on the DSHS website at http://www.dshs.state.tx.us/confracts/links.shtm. Subrecipient General Provisions (September 1, 2016) 41 Contractor also shall comply with all applicable federal and state assurances contained in Section 14 of the Uniform Grant Management Standards. If applicable, Contractor shall comply with the Federal awarding agency's Common Rule, and the U.S. Health and Human Services Grants Policy Statement, both of which may be located through web links on the DSHS website at http://www.dshs.state.tx.us/contracts/links.shtm. For contracts funded by block grants, Contractor shall comply with Tex. Gov. Code Chapter 2105. Subrecipient General Provisions (September 1, 2016) 42 2015-2016 INSURANCE PLAN FOR MEDICAL & DENTAL INSURANCE THROUGH THE TEXAS ASSOCIATION OF COUNTIES WITH A RENEWAL DATE OF OCTOBER 1, 2015: Commissioner Finster made a motion to approve Option 1 rates for the 2015-2016 insurance plan for medical and dental insurance through the Texas Association of Counties with a renewal date of October 1, 2015. Commissioner Lyssy seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Kenneth W. Finster County Commissioner County of Calhoun Precinct 4 July 8, 2015 Honorable Michael Pfeifer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Pfeifer: Please place the following item on the Commissioners' Court Agenda July 23, 2015. • Discuss and take necessary to accept and approve the 2015-2016 Insurance Plan for medical & dental insurance through the Texas Association of Counties with a renewal date of October 1, 2015. Sincerely, Kenneth W. Finster KWF/at P.O. Box 177 — Seadrift, Texas 77983 —email: kfinster@calhouncotx.org— (361) 785-3141 — Pax (361) 785-5602 TEXAS ASSOCIATION 0J' COUNTIES .HEALTH AND Eb1PLOYiLr BENEFITS POOL 2015 - 2016 Amended Renewal Notice and Benefit Confirmation Group: 32810 -Calhoun County . Anniversary Date: 10/01/2015 Return to TAC by: 08/03/2016 . [ taoo. Please initial and complete each section confirming your group's benefits and fill out the contribution schedule according to your group's funding levels. Fax to 1512-481-8481 or email to LaurenH@County.Org. For any plan or funding changes other than those listed below, please contact Lauren Henry at 1-800456-5974. Medical: Plan I I00-G $30 OV/Spec, $120 ER, $900 Ded, 80%, $3600 OOP RX Plan: Option4B-G $10130145, $100 Ded Max Your payroll deductions for medical benefits are: Pre Tax New Rates New Amount New Amount New Amount Current Effective Employer Employee Retiree Pays Tier Rates 1011/2016 Pays Pays (if applicable) Employee Only $669.30 $700.06 Employee + Child $931.14 $972.90 Employee + Child(ren) $1,270.00 $1,325.98 Employee + Spouse $1,485.80 $1,550.84 e+Family $1,993.02 $2,079.34 T 'Initial to accept Medical Plan and New Rates. Dental: Plan II 100% Prevent., $50 Ded, 80% Basic, 50% Major Your % rate increase is: 5.24% Your payroll deductions for dental benefits are: Pre Tax New Rates Current Effective Tier Rates 10M12015 Employee Only $23.48 $24.70 Employee + Child(ren) $47.00 $49.46 Employ + Spouse $51.70 $54.40 Empl e + Family $75.18 $79.12 'Initial to accept Dental Plan and New Rates. New Amount New Amount New Amount Employer Employee Retiree Pays Pays Pays (if applicable) $ 9.1.9A $ 3.4-9 $ $ 9D-c0t0 $ a8.90 $ $ Aa. - $ 33. 9(0 $ $ lq,gf $ �R- 6tn $ 32810 - Calhoun County, 2015-2016 Renewal Notice and Benefit Confirmation TrXAs ASSOCIATION 0J' COUNTIES HEALTH AND EMPLOYEE BLNErl'rS POOL 2015 - 2016 Amended Renewal Notice and Benefit Confirmation Group: 32810 - Calhoun County Anniversary Date: 10/01/2015 Return to TAC by: 08/03/2015 y e Iti-I --,q&o6 Please initial and complete each section confirming your group's benefits and fill out the contribution schedule according to your group's funding levels. Fax to 1-512-481-8481 or email to LaurenH@County.Org. For any plan or funding changes other than those listed below, please contact Lauren Henry at 1.800-456-5974. Medical: Plan 1100-G $30 OV/Spec, $120 ER, $900 Ded, 80%, $3600 OOP RX Plan: Option4B-G $10130145, $100 Ded Max Your payroll deductions for medical benefits are: Pre Tax New Rates Current Effective Tier Rates 10/1/2015 Employee Only $669:30 $700.06 Employee + Child $931.14 $972.90 Employee +Child(ren) $1,270.00 $1,325.98 Employee + Spouse $1,485.80 $1,550.84 Empl yee+Family $1,993.02 $2,079.34 Initial to accept Medical Plan and New Rates. New Amount New Amount New Amount Employer Employee Retiree Pays Pays Pays (if applicable) $ 11$ ?&I.L4 $ $in14.a7$ 30�7L$ $ td 15.a $ 335.5 $ Dental: Plan II 100% Prevent., $50 Ded, 80% Basic, 50% Major Your % rate increase is: 5.24% Your payroll deductions for dental benefits are: Pre Tax New Rates Current Effective Tier Rates 10/1/2016 Employee Only $23.48 $24.70 Employee +Child(ren) $47.00 $49.46 Employee + Spouse $51.70 $54A0 e + Family I $75.18 $79.12 IEmpI - Initial to accept Dental Plan and New Rates. New Amount New Amount New Amount Employer Employee Retiree Pays Pays y Pays (if applicable) $ o21. Zi $ 3-4 $ -- $ o•to$ a,?. So $ -° $ ao. $ 33• V4P $ — $ t • a $ 54. 1(v $ 32810 - Calhoun County, 2015-2016 Renewal Notice and Benefit Confirmation LIFE - BASIC Basic Life Products: Coverage Volume per Employee: $10,000 (Rates are per thousand) Amount Amount New Rates Employer Employeel Current Effective Pays Retiree Pays Rates 10/112016 (if applicable) Basic Term Life $0.202 $0.202 100% 0% Basic D&D $0.030 $0.030 100% 0% Initial to accept New Basic Life Rates. WAITING PERIOD Waiting period applies to all benefits. Employees 60 days - 1st of the month following date of hire but first of the month Initial to confirm. 32810 - Calhoun County, 2015-2016 Renewal Notice and Benefit Confirmation Elected Officials 60 days - 1st of the month following date of hire but first of the month COBRA ADMINISTRATION Please indicate how your group manages COBRA administration: ❑ County/Group processes COBRA on OASYS *County/Group is responsible for fulfilling COBRA notification process and requirements. ❑ BCBS COBRA Department processes COBRA *BCBS COBRA Department administers via COBRA contract with the County/Group - Initial to confirm COBRA Administration. PLAN INFORMATION Broker or Consultant Information Please confirm your broker or consultant's name, if applicable: John Debler/GSM Insurance Agency Name: n JLUO /- J Agency Address:?, • 0 • goyl k (of N bar and Street City I `State '�Ziipj_ �,,y Broker Representative or Consultant's Name: 'j-o Mgr 1 r,JC�i.1 k Contact Phone Number: Cant t mail Address:, tC1tX3 �J'f'fttel5l.>-6'7r'S,COt1"r Initial to confirm Broker or Consultant information • Please update broker or consultant's information. • Broker commissions are included in rates listed on page 1. • Retirees pay the same premium as active employees regardless of age for medical and dental. • Rates based upon current benefits and enrollment. A substantial change in enrollment (10% over 30 days or 30% over 90 days) may result in a change in rates. • Form must be received by 08/03/2015 in order to avoid additional administrative fees. • Signature on the following page is required to confirm and accept your group's renewal. 32810 - Calhoun County, 2015-2016 Renewal Notice and Benefit Confirmation TAC HEBP Member Contact Designation Calhoun County QVITRACTIRG AITAORITV As specified in the Interlocal Participation Agreement, each Member Group hereby designates and appoints, as indicated in the space provided below, a Contracting Authority of department head rank or above and agrees that TAG HEBP shall NOT be required to contact or provide notices to ANY OTHER person. Further, any notice to, or agreement by, a Member Group's Contracting Authority, with respect to service or claims hereunder, shall be binding on the Member. Each Member Group reserves the right to change its Contracting Authority from time to time by giving written notice to TAG HEBP. Please list changes and/or corrections below. Name/Title Honorable Rhonda S. Kokena, CIO/Treasurer Address 202 South Ann Street, Suite A Port Lavaca, TX 77979-4210 Phone 361-553-4619 Fax 361-553-4614 Email rhonda.kokena@calhouncotx.org CONTACTBILLING Responsible for receiving all invoices relating to HEBP products and services. Please list changes and/or corrections below. Name/Title Honorable Rhonda S. Kokena, CIO/Treasurer ,% Address 202 South Ann Street, Suite A Port Lavaca, TX 77979 Phone 361-553-4619 Fax 361-553.4614 Email rhonda.kokena@calhouncotx.org HIPAA Secured Fax CONTACTPRIMARY HEBP's main contact for daily matters pertaining to the health benefits. Please list changes and/or corrections below. NamelTitle Honorable Rhonda S. Kokena, CIO/Treasurer y Address 202 South Ann Street, Suite A Port Lavaca, TX 77979 Phone 361-553-4619 Fax 361-553-4614 Email rhonda.kokena@calhoupcotx.org ' ay 01 W bblb Date: Signature of Cogunty J�u}d(tg�e o �(o t c/ting Authority Nt l G iU C� 1• C S �1't r 1 C7 1 01� �— Please PRINT Name and Title The Texas Association of Counties would like to thank you for your membership in the only all county -owned and county directed Health and Employee Benefits Pool in Texas. 32810 - Calhoun County, 2015-2016 Renewal Notice and Benefit Confirmation AGREEMENT WITH FORESTER BENEFITS FOR THE FOLLOWING SUPPLEMENTAL INSURANCE PRODUCTS: • Short Term Disability • Long Term Disability • Group Term Life & AD&D • Universal Life w/Long Term Care • Critical Illness and Accidental SAID PRODUCTS WILL BE AVAILABLE TO FULL-TIME, PART-TIME, AND TEMP EMPLOYEES WHO WORK 20 HOURS OR MORE A WEEK BEGINNING OCTOBER 1, 2015: Commissioner Finster made a motion to approve agreement with Forester benefits for the following supplemental insurance products: Short Term Disability, Long Term Disability, Group Term Life & AD&D, Universal Life w/ Long Term Care and Critical Illness and Accidental. Products will be available to full-time, part- time, and temp employees who work 20 hours or more a week beginning October 1, 2015. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Kenneth W. Finster County Commissioner County of Calhoun Precinct 4 July 8, 2015 Honorable Michael Pfeifer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Pfeifer: Please place the following item on the Commissioners' Court Agenda July 23, 2015. Discuss and take necessary to accept and approve Calhoun County to enter into an agreement with Forester Benefits for the following supplemental insurance products: o Short Term Disability o Long Term Disability o Group Term Life & AD&D o Universal Life w/LongTermCare o Critical Illness and Accidental Said products will be available to fulltime, part-time, and temp employees that work 20 hours or more a week beginning October 1, 2015. Sincerely, Kenneth W. Finster KWF/at P.O. Box 177 — Seadrift, Texas 77983 — email: kfinster@calhouncotx.org — (361) 785-3141 — Fax (361) 785-5602 wr f N 1 .. May 11, 2015 Presented by: Forester Benefits Management Trustmark Sales Team Alex Williams — Senior Regional Sales Director, Southeast Region Ryan Paddack — Senior Account Executive Heather Dawson — Senior Sales Implementation Manager This is an underwriting offer summary only and riot intended to be distributed to a potential purchaser. Limitations, exclusions, rideis, rails and product availability may vary by state. Check for availability in your slate at htits:((,trnk-webapp.trus:maikins yomlap�slVolun"nr; nefi!s/Pr rfl ssOnlV/StateMafnx cfn� . Refer to th& policyoi ceniftafe io-i more Information. Please contact your fegional sales dlrentor listed on thee front rover 4vlth ariy questinins. © 2014 Trustmark Page 1 History of Trustmark Trustmark began in 1913 when four enterprising railroad employees decided that "passing the hat" no longer adequately provided financial security for an injured or disabled coworker. They formed a fraternal association, known as the Brotherhood of All Railway Employees, offering voluntary insurance benefits and quick claim payment. The small fraternal association grew quickly. Ten years after its founding, it became a mutual insurance company, managed for the benefit of its policyholders. In 1994, the company was renamed Trustmark, in 2001 it acquired National Worksite Advantage, a leading consolidated billing TPA, in 2010, it acquired Health Fitness Corporation and in 2011, acquired Focused Health Solutions (FHS). The company is rated A - (Excellent) by A.M. Best. Since that pioneering, one -desk beginning, Trustmark has been a company uniquely linked with the people it serves. Experience the Trustmark Difference With more than 100 years in the voluntary market, we are committed to provide efficient product and service delivery. You receive the attention of experienced worksite professionals committed to serving your needs and the needs of your employees. Key Trustmark Strengths o Pioneer in offering Universal Life with a long-term care benefit that is one of the most extensive in the industry o First voluntary carrier to enter the Critical Illness market o Currently ranked No. 1 in U.S. sales for Universal Life o Offer billing that battles some of the best in the industry with the flexibility to handle specific requirements of payroll -deducted products, as well as create custom interfaces for consolidated billing Smooth Implementation To ensure an efficient, educational experience for you and your employees, we provide a dedicated implementation manager as your single point of contact. Your implementation manager actively coordinates and oversees each step of the process: o Onsite enrollment team training, specific to your group's enrollment o Setting up the call with your payroll team to start off billing on the right track o Secure, electronic enrollment system built to your plan's specifications Experience the Service Difference We provide exceptional front -to -back product and service delivery. Our systems were designed to handle the unique requirements of payroll -deducted products and offer: o Deduction starts and stops to match the timing and format of your payroll system o Billing and reconciliation dates based on your payroll calendar o Internet capability for. billing and remitting premiums as well as inquiry ability o Experienced, caring claim representatives to walk employees through the claim process This is an underwriting oiler summary only and not intended to be distributed to a potential purchaser. limitations, exclusions, riders, rates and product availability may vary by state. Check for availability in your state at htbs:(ltmk-wekaun,trusrnyarkinsyomlap�P:ol,untai��Benefts/ProducersOn!ylStatenAatrix.efm . Refer to the policy or certificate former(., Information. Please contact your regional sales director listed on the front cover with any questions, v 2014 Trustmark Page 2 Universal Life Trustmark's fully portable Universal Life solutions address differing employee needs for permanent life insurance and peace of mind for a lifetime, and are available for employees, their spouses and children. Employees do not have to have coverage themselves to purchase life insurance for their family members. These options include the industry's most comprehensive Living Benefits package. Plan Features Guaranteed Universal Life Offers the flexibility of universal life with the lifetime guarantees of whol It features guaranteed level premiums, death benefit and cash value. P employees can adjust death benefits and cash values without buying a second policy. Accelerated Death Benefit Accelerates 75% of death benefit when life expectancy is 24 months or less. Long Term Care — Built -In • Long -Term Care (LTC) — Death benefit accelerates 4% per month up to 25 months when receiving assisted living, home healthcare, adult day care or skilled nursing home care. Payments proportionately reduce the death benefit. Subject to a 90-day waiting period and pre-existing condition limitation of 6/6, meaning benefits are not payable for a loss due to a pre-existing condition that starts during the first six months after the effective date of this rider. Death Benefit Restoration — Built -In • Death Benefit Restoration — Fully restores the death benefit reduced by LTC. Selection(s) Benefit Examples • LTC pays $4,000 per month for 25 months $100,000 LTC Benefits • Benefit Restoration restores the death benefit $100,000 Death Benefit • Extension of LTC extends living benefits an additional 25 months $100,000 Extension Benefits • Living benefit package can double the value of this policy $200,000 Total Benefit Eligibility Guaranteed Universal Life • Employees, actively at work Ages 18 to 80 Full-time (30+ hours per week), employed at least 30 days Part-time, (20 to 29 hours per week), employed at least 90 days • Spouses Ages 18 to 70 • Children — Under the age of 24, including natural, step children or legally adopted or under legal guardianship (full-time student/dependent 18 to 23)'- • Grandchildren - Under the age of 19* :'Only eligible for the standard Universal Life Insurance plan. This is an underwriting offer summary only and not intended to be distributed to a potential purchase. Limitations, exclusions, riders, rates and product availability may vary by state. Check for availability in your state at httpslttmk-weba.t�tmarkins�cemlappslVoluntaryBenefitslProducersOily/State�,atljx.cfnl . Refer to the policy or certificate for more information. Please contact your regional sales director listed on the front cover with any questions. © 2014 Trustmark Page 3 Additional Benefits Accidental Death Benefit - Employee Option im Doubles the death benefit available at time of claim in the event of death by accidental means prior to the insured's 75th birthday. May not exceed base coverage. Rates Weekly Rates Trustmark Guaranteed Universal Life Hcceieraiea ueacn tsenern Tor crnicai care, Haamonai i erm i.ne insurance ae Non -Smoker Rates -Weekly Money Purchase $3.00 $6.00 $8.00 $10.00 $12.00 Issue Age Insurance ':Insurance < ,... Insurance ,. Insurance Insurance Amount - Amount = Amount ' Amount. Amount 35 10,157 23,578 32,525 41,473 50,420 45 5,761 13,418 18,522 23,626 28,730 55 NIA* 7,092 9,790 12,488 15,186 Accelerated Death Benefit for Critical Care, Additional Term Life Insurance Be Smoker Rates - Weekly Money Purchase $3.00 $6.00 $8.00 $10.00 $12.00 Issue Age Insurance Insurance Insurance (Insurance ,.. Insurance Amount Amount Amount Amount ; Amount 35 6,798 15,782 21,771 27,760 33,749 45 N/A * 9,020 12,451 15,882 19,313 55 N/A * N/A * 6,425 8,196 9,967 Accelerated Death Benefit for Critical Care, Additional Term Life Insurance Be Non -Smoker Rates - Defined Benefit $25,000 $50,000 $75,000 $100,000 $150,000 Issue Age Weekly Weekly Weekly Weekly Weekly .Premium :'Premium .Premium Premium l Premium 35 6.32 11.91 17.50 23.09 34.26 45 10.54 20.34 30.14 39,93 59.52 55 19.28 37.81 56.35 74.88 111.94 Accelerated Death Benefit for Critical Care, Additional Term Life Insurance E Smoker Rates - Defined Benefit $25,000 $60,000 $75,000 $100,000 $150,000 Issue Age Weekly : Weekly 1 Weekly Weekly i Weekly :Premium -.Premium .Premium '' Premium Premium 35 9.08 17.43 25.78 34.13 50,83 45 15.32 29.89 44.46 59.04 88.18 55 28.99 57.22 85.46 113.70 170.17 *Minimum $5,000 benefit requires premium greater than $3 per week nefit !nefit nefit This Is an underwriting offer summary only and not Intended to be distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state, Check for availability in your state at n s://tmk-webapp.trustmarkins.coin/appsidoluntary8enefits/ProdticersOq,ly(StateMatrix.cfm . Refer to the policy or cerilflcate for more information. Please contact your regional sales director listed on the front cover with any questions. © 2014 Trustmark Page 4 Guaranteed Universal Life Underwriting Guaranteed Issue Underwriting The Employee Guaranteed Issue (GI) offer is the lesser of the face amount purchased by $10 per week or $200,000. The AIDS and treated in past six -months modified guarantee issue (MGI) health questions must be completed for consideration even though they will not be used for underwriting the face benefit. Enrollment Conditions 1) The benefits communication/enrollment firm has access to at least 70% of the eligible employees during a face-to-face, one-on-one enrollment meeting/a combined core benefit/voluntary enrollment conducted via a call center and assisted by the benefits communication/enrollment firm. (Eligible employees are required to meet/talk with an enroller to learn about the offer. The employee may then choose to elect of waive coverage). 2) Waiver cards are required and may be obtained through one of the following methods: o Electronic option through our enrollment system o Paper waiver cards, Election Not to Participate form o Trustmark-approved method of tracking employees seen; must receive prior approval from case underwriting. 3) No more than two Trustmark products should be enrolled. The total number of products being offered at the case (both Trustmark and non-Trustmark) must be communicated to the case underwriter. 4) Minimum employee application requirement for UL is 20 employee applications. Enrollment conditions will be verified when the case is sold. Trustmark offers the waived participation GI underwriting offer with the expectation that when these conditions are met the employee participation will exceed 20%. If the requirements outlined in the proposal are met and final employee participation is less than 20%, however, all employees ages 18 to 64 who apply for coverage will be issued at least the GI amount. Modified Guaranteed Issue ** The Employee Modified Guaranteed Issue (MGI) offer is the lesser of the face amount purchased by $12 per week or $200,000. MGI underwriting is also used for the dependent spouse and child amounts and EZ Value options shown on page 4. Two health questions, asking about AIDS and a six-month history of treatment in a medical facility, must be answered. If the answer is "yes," the simplified issue (SI) questions must be answered. Requires at least 20 employee applications. Employee Modified Guarantee Issue underwriting is required when Guarantee Issue is not being offered or for benefits over the Guarantee Issue limit. • Spouse: Greater of amount purchased by $3 per week or $5,000, • Children: Amount of coverage purchased by $3.03 through $4.32 per week, based on riders selected. This is an underwriting offer summary only and not intended to be distributed to a potentlaI purchaser. Limitations, exclusions, riders, rates and product availability may Mary by state. Check for availability in your state at hiVs tmk-weba p.trustmarkins_ccin(zips/Velunor Benefits/ProciucersOnly/StateMatrix.ofm . Refer to the policy or certificate for more information. Please contact your regional sales director listed on the front cover with any questions. © 2014 Trustmark Page 5 Simplified Issue Underwriting Employee and Spouse Simplified Issue (SI) is a maximum face amountlof $300,000. Employee and spouse age 65+ and all grandchildren policies use SI underwriting. Simplified Issue is also used for amounts in excess of the GI or MGI amounts or when there is a yes answer to the MGI questions. SI requires that the proposed insured provide height and weight plus answers to three additional questions: • Details of any major health impairments (within the last five years) • Any history of drug or alcohol treatment • Specify the reason for seeing a medical practitioner in the past 12 months (other than for a routine physical) **questions vary slightly in some states. `Rollback' Underwriting When an application is qualified for a GI amount, but excess coverage is applied for, the excess will be underwritten using an accept or decline basis. If we decline the excess, we will issue the available maximum amount based on the GI rules. We follow the same practice when there is an application in excess of available MGI limits and SI underwriting is used. Trustmark's application includes an area that permits the applicant to accept these alternate coverages in advance. This eliminates the need for separate amendments to be signed at a later date. Underwriting for Employee Riders Underwriting of Employer -Level (Built -In) Riders Built-in riders are underwritten on the same basis as the base coverage. Cost for these riders will be included in the premium for the underwriting limits established for this case. Underwriting of Employee -Optional Riders —Accidental Death Benefit Rider These optional riders are underwritten on the same basis as the base coverage. Cost for these riders is not included in the premium for the case underwriting limits. Underwriting for Riders for Dependents Riders are underwritten on the same basis as the base coverage. Cost for these riders will be included in the premium for the underwriting limits established for this case. This is an underwriting offer summary only and not Intended to be distributed to a potential purchaser. Limitations, exclusions, ricers, rates and product availability may vary by state. Check for availability in your state at hjtcrs_!ltmk=we,baptofir.stmarklns.corn(aposlVoiuntarygerefitslProducersOniylStateMatrix.cfm . Refer to the policy or certificate for more nformation. Pieria contact your regional sales director listed on the front cover with any questions. U 2014 Trustmark Page 6 l * • Trustmark's Accident insurance helps pay for unexpected healthcare expen! accidents that occur every day — from the soccer field to the ski slope and the highway in-between. Accident insurance provides benefits due to covered accidents for initial care, injuries and follow-up care. Benefits are paid directly to the employee, in addition to any other coverage they have. Plan Features • Guaranteed issue — No medical questions. Requires at least 20 applicati • Level premiums — Rates do not increase with age • No limitations for pre-existing conditions • Guaranteed renewable — Coverage remains in force for life, as long as p are paid • Portable coverage — Employees can continue coverage if they leave or retire • Plan designs based on highest recorded utilization, so employees get the most comprehensive coverage when they need it most. Eligibility Employees — Ages 18 to 80, actively working full-time (30+ hours per week) and employed at least 30 days or part-time (20+ hours per week) and employed at least 90 days Spouses — Ages 18 to 80, who are not disabled • Children — Under the age of 26, who are unmarried and dependent Benefits for Non -Occupational Coverage, Plan 4 Accidental Death Benefit Rider Employee $25,000 Spouse $10,000 Children $5,000 Accidental Death Benefit Rider Common Carrier Employee $50,000 Spouse $20,000 Ambulance Third-degree 35 or more sq. in $10,000 Third-degree 9 to 34 sq. in. $1,500 Second-degree for 36% or more of body$750 rstrophic Accident Benefit Employee $100,000 Spouse $50,000 Dislocations Open reduction Up to $4,000 Closed reduction - Up to $2,000 Doctor's Office Visit $100 This is an underwriting otter summary only and not intended to be, distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for availability in your state at httes;(ltml<_w„e�p tr;ustmarkins.comtaUpsNoluntar Benefits(Producers6,nly(StatePAatrix cfm . Refer to the policy or certificate for more information. Please contact your regional sales director listed or the front cover with anv questions. © 2014 Trustmark Page 7 Emergency Dental Benefit Extraction $50 Room Treatment Open reduction Up to $7,500 Closed reduction Up to $3,750 Chins ':. 25% of closed amount Hospital Admission Hospital Confinement ICU Iner day uD to 15 Loss of finger, toe, hand, foot or sight of an eye Loss of both hands, feet, sight of both eyes or any combination of two or more losses $15,000 Loss of one hand, foot or sight of one eye i $7,500 Loss of two or more fingers, toes or any combination of two or more losses $1,500 Loss of one finger or one toe $750 Prosthetic Device or Artificial Limb More than one $1 25% of burn benefit abdominal, thoracic I $1,250 atory $125 Repair of more than one i $1,200 Repair of one ! $800 Exnloratory without repair ! $200 IN Most benefits are paid once per person per covered accident unless otherwise noted. Weekly Rates (assumes deductions of 52 times per year Employee Employee and Spouse Employee and Children Family Rate $2.67 1 $3.80 $5.50 1 $6.63 Additional Benefits Accidental Death Benefit - Built -In Provides a lump -sum benefit for an accidental death that occurs within 90 days of a covered accident: o Pays $25,000 for the insured, $10,000 for the spouse and $5,000 for a child. o The benefit doubles if the accidental death is due to a common carrier. Catastrophic Accident Benefit - Built -In Helps families during the transitional period following a catastrophic loss: o Provides a lump -sum benefit for catastrophic loss after fulfilling a 90-day elimination period o Pays $100,000 for the insured, $50,000 for the spouse and $50,000 for a child. o A catastrophic loss is the loss of use of sight, hearing, speech, arms or legs. This is an underwriting offer summary only and not intended to he distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for availability in your state at hh _/Itink_webapp 4rustmar`rins.comlapns(VoluntaryBenefiislProducersO,n StateMatrix.cfm . Refer to the policy or ceriificate for more monnation. Please contact your regional sales director (!step on the front cover with any questions, 0 2014 T rustmark Page 8 Definitions Covered Accident An accident causing injury, which: Occurs after the effective date; Occurs while the certificate is in force; and Is not excluded by name or specific description in the certificate. Elimination Period The period of time after the date of a covered accident for which catastrophic accident benefits are not payable. Injury or Injuries An accidental bodily injury that resulted from a covered accident. It does not include sickness, disease or bodily infirmity. Overuses syndromes, typically due to repetitive or recurrent activities, such as osteoarthritis, carpal tunnel syndrome or tendonitis, are considered to be a sickness and not an injury. Maximum Benefit Period The longest period of time for which hospital benefits will be paid. Non -occupational Injury An injury that did not result from a person's work or occupation; applicable to non -occupational coverage only. This is an undeivvriting offer summary only and not Intended to be distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for availability in your state at hits s lfml<_webggL); trustmarkins,coralantsIVoluntalDenefitsiProdugersOnly S�ateMatJx_cfm . Refer to the policy or certifleate for more information. Please contact your regional sales director listed on the front cover with any questions. © 2014 T rustmark Page 9 Trustmark's Critical Illness with Cancer insurance offers a lump -sum benefit payment upon first diagnosis of a covered critical illness including: 100% Benefit Invasive cancer Stroke Heart attack Major organ transplant Renal failure Paralysis of two or more limbs Blindness ALS (Lou Gehrig's disease) 26% Benefit Carcinoma in situ Coronary artery bypass surgery Stand-alone versions of Critical Illness and Cancer are available. Plan Features • Unique underwriting — Guaranteed issue, modified guaranteed issue or simplified issue • No benefit reduction • Level premiums — Rates do not increase with age • Guaranteed renewable — Coverage remains in force to age 100, as long as premiums are paid • Waiting period — 30-day waiting period waived if coverage begins more than 30 days after enrollment • Portable coverage — Employees can continue coverage if they leave or retire • Best Doctors® — Access to the right medical information and expertise Eligibility Employees — Ages 18 to 70, actively working full-time (30+ hours per week) and employed at least 30 days or part-time (20 to 29 hours per week) and employed at least 90 days Spouses — Ages 18 to 70 Children Under the age of 26, who are unmarried natural, adopted or step children and dependent grandchildren. Weekly Rates Employee $5,000 to $100,000 Spouse 50% of employee benefit, $2,500 to $50,000 Child(ren) 10% of employee benefit, $500 to $10,000 This is as undemriting offer su nrnary only and not intended to bedistributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for avallablKy in your state at tps_lAnik. weba,.trustmarkins.com(annslVoluntzBenefitslProducersOnlV(StateiNatt .cfm . Refer to the pol;cy or ce ifieate for more information. Please contact your regional sales director listed on the front cover with any questions. 9014 Trustnark Page 10 Riders Suhsnnuent Cnnditinn Hnalth Scnanninn- 1.95n Non' -Tobacco Rates, Trustmark Critical Illness wl Cancer Insurance Plan Insurance Amount - $20,000 Employee Employee and Spouse Employee and Children Employee, Spouse, and Children Issue Weekly Premium Weekly Premium Weekly Premium Weekly Premium Age 35 4.76 7.36 5.11 7.71 45 8.92 14.10 9.27 14.45 55 15.72 25.35 16.11 25.74 Riders Suhseeuent Condition Health Screening- $50 Tobacco Rates Trustmark Critical Illness w/ Cancer Insurance Plan Insurance Amount - $20,000 Employee Employee and Spouse Employee and Children Employee, Spouse, and Children Issue Age Weekly Premium Weekly Premium Weekly Premium Weekly Premium 35 6.85 10.82 7.20 11.17 45 15.53 25.07 15.90 25.44 55 31.21 51.34 31.62 51.75 Riders Trustmark Critical Illness Only Insurance Plan Insurance Amount - $20,000 Employee Employee and Spouse Employee and Children Employee, Spouse, and Children Issue Weekly Premium Weekly Premium Weekly Premium Weekly Premium Age 35 N/A 3.96 N/A 4.12 45 5.02 7.40 5.17 7.55 55 8.60 13.04 8.80 13.24 Riders Subsequent Condition Health Screening: $50 ,. �.... - Tobacco Rates Trustmark Critical Illness Only Insurance Plan Insurance Amount - $20,000 Employee Employee and Spouse Employee and Children Employee, Spouse, and Children Issue Weekly Premium Weekly Premium Weekly Premium Weekly Premium Age 35 3.46 5.03 3.61 5.18 45 7.68 11.72 7.83 11.87 55 15.49 24.35 15.68 24.54 This Is an underwriting offer summary only and not intended to be distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for availability In your state at https:M-nk-webapp,frastmarkins.coinlamps/VoluhtaivBenefits/ProdueersOn!V/Stat.MaVix.cfm . Refer to the policy or certificate for more information. Please contact your regional sales director listed on the front cover with any questions. Oc 2014 Trustrnark Page 11 Optional Benefits Subsequent Benefit: Built -In This rider provides a cash payment for each of the covered conditions in the event the covered person is diagnosed with multiple different covered conditions or illnesses. • Each subsequent diagnosed condition is paid at 100% of the original benefit with a 90 day separation period. Plus, 25% of the total benefit will be paid once each for carcinoma in situ and coronary artery bypass surgery. Health Screening Benefit: Built -In This benefit provides $50 for a screening test, every calendar year for each insured with no coordination of coverage. Eligible tests include: — Low -dose mammography — Pap smear for women overage 18 — Flexible sigmoidoscopy — Hemocult stool specimen — Colonoscopy — Prostate -specific antigen (PSA) test for prostate cancer — Stress test on a bicycle or treadmill — Fasting blood glucose test — Blood test for triglycerides — Bone marrow testing The premium is the same for all issue ages: — Serum cholesterol test to determine HDL and LDL levels — Breast ultrasound — CA 15-3 (blood test for breast cancer) — CA 125 (blood test for ovarian cancer) — CEA (blood test for colon cancer) — Chest x-ray — Serum protein electrophoresis (blood test for myeloma) — Themograph Pre -Existing Conditions Pre -Existing Limitation In most states, no benefit will be paid for any condition caused by or resulting from a pre-existing condition, which begins in the first 12 months after the covered person's coverage date. Guaranteed Issue Underwriti Non -Takeover o Employees only The greater of $3 per week or $10,000 o Spouses ( $5,000 o Children 1 $1,000 • Requires 20% of the eligible employees to participate. Based on 220 eligible, 44 applications are required to meet the guaranteed issue participation. Guarantee issue does not mean guaranteed benefit. If a person was previously diagnosed with a covered condition or illness prior to the plan effective date, no benefit will be paid for a subsequent diagnosis of the same covered condition or illness after the plan effective date. This is an underwriting alter summary only and not Intended to be distributed to a potential purchaser. Limitations, exclusions, rides, rates and produce availability may vary by state. Check for availability in your state at hps:(Ittnk-rvebaapd ustmark ns_corn/a2�slVoluntarvBenefits(ProducersOnlylStateNla,,dx.cfm . Refer to the policy or certificate for more information. Please contact your regional sales director listed on the font cover with any questions. O 2014 Trustmark Page 12 Modified Guarantee Issue (MGI) Underwriting: Employee, Spouse and Children Underwriting for amounts up to $50,000 is based on responses to three simple questions. Requires at least 20 applications. Simplified Issue (SI) Underwriting: Employee Only For amounts of $50,001 to $100,000: o Three additional questions are required. o No medical exams or other requirements are needed. o The maximum benefit amount is equal to two times pay. Questions may vary by state. There is a $50,000 maximum benefit in Louisiana and Maryland. Modular Underwriting If coverage for other critical illness is declined, we will issue coverage for cancer, provided the insurability provisions for cancer are met. If coverage amounts in excess of $50,000 are applied for and coverage for such amount is declined due to a response to the additional underwriting questions, we will issue the $50,000 if the proposed insured qualifies. If an applicant does not qualify for MGI or Sl, the GI amount will be issued. Definitions Pre -Existing Condition A sickness or injury for which medical care, diagnosis or advice was received or recommended, or the existence of symptoms, which would have caused an ordinarily prudent person to seek medical care, treatment, diagnosis or advice during the 12 months immediately prior to the coverage effective date. This is an underwriting offer summary only and not intended to be distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for availability in your state at hips:1/tmk-webapp rystmarkins.comlappsNoluntz BenefhslProduoersonly/StateMafux.cfm . Refer to the policy or certificate for more ne mation. Please contact your regional sales director listed on the treat cover vvith any questions. © 2014 Trustmark Page 13 State Specific Information Universal Life • Ages: Children: UT underage 26rWA— Universal Life policies not available to children/grandchildren • Benefits: NC —Minimum policy benefit $10,000 • Riders: o Long Term Care: Not available in HI, OR, UT, VT. Built-in only FL, MA o Death Benefit Restoration: Not available in HI, NY, OR, UT, VT o Extension of Benefits: Not available in CO, CT, FL, HI, MA, MN, NC, NY, OR, TX, UT, VT, WA o Combo Restoration/Extension of Benefits: Not available in CO, CT, FL, HI, MN, NC, NY, OR, TX, UT, VT, WA o Accident Death Benefit: Not available in OR o Accelerated Death Benefit: Not available in OR o Child Term Rider: UT - available to age 25 o EZ Value: Not available in NH, NY o Loss of Work/Strike Rider: Not available in CA, FL, MN, MO, MT, NH, NY, TN, VT, WA Accident • Ages o Employees & Spouses: 18-64 CA, NY o Children: NE under age 30; IN, WA even if married • Product Availability/State requirements: o FL: Plan 1: 24-Hour Coverage Only— must include accidental death and catastrophic benefits; o KY, NC, SD only 24-Hour Coverage available; o Plan 1, 2 or 3 not available in HI, KY, OH o Plans 4, 5 or 6 not available in: FL, MN, NH, NY, WA o Plan 6 not available in CA, CO, LA, o CT: Air & Ambulance benefit must be paid at state level; Hospital Confinement $200 per day/Hospital ICU $400 per day up to 30 days for accidental ingestion or consumption of a controlled drug; Outpatient Care $500 per calendar year for accidental ingestion or consumption of a controlled drug o NM: TMJ $25 benefit o NY: Plans 2, 3, 8 & 9 limited to: $165 Hospital Confinement; $330 Hospital ICU; Plans 7, 8 & 9: only available in NY o FL, MN, NH, NY: Enhanced schedule of benefits o VT: Loss of two or more fingers, toes or any combination of two or more losses $5,000; Loss of one finger or one toe $2,500 • Riders: o Accidental Death Benefit/Common Carrier: Not available in MN o Catastrophic Benefit: Not available in MN; UT no waiting period o Health Screening Rider: Available only with plans 4, 5 or 6; not available in CO, CT, FL, MN, NH, NY, WA. Available in CA, LA with plans 4 & 5 o Loss of Work/Strike Rider: Not available in FL, MO, MT, NH, NY, TN, VA, VT, WA o Wellness Benefit: Available only with plans 1, 2 or 3; Not available in CT, HI, KS, MN, NH, NY; FL, WA No family visit maximum; ID, UT, WA No waiting period; FL $50 wellness rider built-in This Is an underwriting offer summary only and not intended to be distributed to a potential purchaser. Limitations, exclusions, riders, rates and product avallabillty may vary by state. Check, for amailability in your state at saltink-webag c�trustma��kirs.coilagoslVolanUryLenefits/ProducersOnlylStabdAetrix.cfm . Refer to the policy or ce dficate for more information. Please contact your regional sales director listed on the front cover with any questions. 0 2014 Trustmark Page 14 Critical Illness • Ages: o Employees & Spouses: 18-64: CA, NY o Children: NE under age 30 o Grandchildren: MN, WI under age 18 • Benefit Maximums: GA: $30,000 Cancer Only plan; $50,000 in LA, MD • Benefit Minimums: WA: $25,000 • Riders: o Best Doctors: Not available in CT; GA (Cancer Only plans) o EZ Value: Not available in CT, NH, NY, UT, GA -Cancer Only plans o Double Benefit: Not available in CT, NH, SD o Subsequent Benefit Riders: Not available in MN, NH, WA o GA — No recurrence for Renal Failure; Blindness; Paralysis or ALS o Loss of Work: Not available in CT, FL, MO, MT, NH, NY, TN, VA, VT, WA o Occupational HIV: Not available in GA, NH, NY, SD, VT o Waiver of Premium: Not available in GA, NY Pre -Existing Condition Limitation: Not applicable in AZ, CA, DC, GA, HI, IL, KY, MA, MI, NJ, PA, SC, VA; Period limitation/definition varies in ID, IN, ME, MT, NY, OR, UT State specific regulations: o AR — cannot issue coverage to anyone under any Title XIX Plan (Medicaid or similar plans) o CA, MA, NY, VT — Every applicant must have Major Medical or Hospital & Medical coverage before applying for this coverage. o CT — 0 day separation period for subsequent benefit riders This is an underwriting offer summary only and not intended to be distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for avallabillty in your state at http_silimk=wgba_Lp,frustmac ins,ecml gpsNoltmtaryBenefitslProducersOnl / fatetAgiri Xh . Refer to the policy or certificate for more information. Please contact your regional sales director listed on the front cover M, th any questions. 20.14 Trustmark Page 15 Proposal Offer This proposal of insurance is dated May 11, 2015. The values illustrated in this proposal are subject to change at any time prior to enrollment of employees. The underwriting offer is valid if accepted within 90 days, subject to any required documents. Coverage cannot be cancelled as long as premiums are paid. Individual employee premiums are level. That means premiums are based on the age of the employee at time of policy issue. Policy premiums do not increase due to employees getting older. Families can keep the same benefit and premium levels even if employees leave their employer or retire. Premiums may only be changed if filed with the state and approved by the department of insurance. A written notice of adjustment will be sent at least 30 days prior to the effective date of any approved increase. The benefits and premiums quoted in this proposal, the final enrollment plan, as well as the solicitation materials which may be developed, are subject to final approval by Trustmark, based upon receipt and acceptance of all signed documents. The benefits, premiums, solicitation materials and marketing are also subject to state insurance department rules and regulations. Trustmark reserves the right to modify this proposal to conform to such rules and regulations. Non-standard marketing materials are subject to Trustmark compliance approval and may result in additional costs not included in this proposal. Experience the Trustmark Difference Thank you for taking the time to consider Trustmark. We are committed to provide efficient product and service delivery. You receive the attention of experienced worksite professionals committed to serving your needs and the needs of your employees. Please feel free to contact us with any questions you may have. We look forward to serving you and your employees. This is an underwriting offer summary only and not intended to be distributed to a potential purchaser. Urniiations, exclusions, riders, rates and product availability rnay vary by state. Check for availability in your state at hltpsaltink-webaPP frustmarklns.cgm/ap s/g Vcf 1( innfal VBbenefifs/ProducersOnlyl5tateN atrlx.ofm . Refer to the policy or certificate for more nformation. Please contact your regional sales director listed on the front cover with any questions. © 2014 Teustmark Page 16 Volnntalry Benefit .Solutions A . rmshnark Company PERSONAL, FLEXIBLE. TRUSTED. Employer's Application for Insurance Program This is an agreement to establish an employee payroll deduction program between the undersigned employer ("you/your") and Trustmark Insurance Company and/or Trustmark Life Insurance Company of New York (`Trustmark"). You agree that the payroll deductions will consist of 100% employee funds. Each of your eligible employees is entitled to apply for the insurance coverage(s) you have selected which are issued by Trustmark on a payroll deduction basis. Employee eligibility and coverage specifications are outlined in the Underwriting Offer for this program. You agree to provide Trustmark representatives with reasonable access to eligible employees on your business premises during regular working hours for the purposes of explaining the plan(s) and enrolling employees. You agree to honor and administer on a timely basis the written payroll deduction request of each participant. All deductions will be remitted to Trustmark in accordance with a billing schedule to be determined. You will maintain adequate records to ensure that the deductions can be reconciled to the employee, and will notify Trustmark monthly of any change in employee status. Employer: CALHOUN COUNTY Employer Tax ID No: 74-6001923 211 S. ANN STREET, PORT LAVACA, TEXAS 77979 This agreement is to remain in effect for a minimum of 12 months from the effective date of coverage for your employees. After that, either you or Trustmark may terminate this program with 60 days prior written notice to the other party. Following termination, your obligation to collect and remit premium ceases, and payments must be made directly to Trustmark by any insured employees who elect to continue coverage. Each eligible employee has the right at any time to either (1) elect not to participate in this plan; or (2) if participating, elect to cancel. In the event an insured employee ceases to be employed by you, (s)he has the right to continue insurance subject to the provisions of the policy(ies). The insurance coverage(s) you have selected for the purpose of insuring your eligible employees may be provided under Group Policies issued to an insurance trust to which you hereby make application to participate (if applicable), and you agree subject to acceptance to become a participating employer in said trust (if applicable). Accepted and Approved for Employer: Accepted and Approved: By: MICHAEL J. PFEIFER TRUSTMARK (Printed name) By: (Signature) Title: COUNTY JUDGE Date: JULY23,2015 Title: Date: This is an underwriting offer summary only and not intended to be, distributed to a potential purchaser. Limitations, exclusions, riders, rates and product availability may vary by state. Check for availability in your state at Mp :�fmk_wc. a,p trustmarkins.cowla s/VoluntartBenefts/Piod1L rsCnfy�Sta di atrlx.cfm . Refer to the policy or certificate for more information. Please contact your regional sales director listed on the front cover with any questions. © 20'IA Trustmi k Page 17 SOSTON 120 Royal[ Cant APPLICATION FOR GROUP MT_7TIJAT Canton, MAA02002021 1av,- CRITICAL ILLNESS INSURANCE CALHOUN COUNTY by Employer/Union Name of : 202 S. ANN STREET, SUITE A, PORT LAVACA, TEXAS 77979 Home Office Location (City & State) for a Plan of Group Critical Illness Insurance, and representations are made as follows: Class of Employees/Members eligible for coverage: o Number of regular full-time employees/members: 207 O Other: 12 / PART-TIME OR TEMPORARY (APPROXIMATE) A full-time employee/member is defined as one who works [twenty (20)] hours or more per week. An employee/member must be Actively at Work on the date he/she applies for insurance, and on the date his/her Insurance is to become effective. An employee/member must have completed months of continuous service before being eligible. 2. The minimum number of enrolled employees/members necessary to keep the Group Policy in force is: 3. Effective Date — The requested effective date of the Group Master Policy is: 4.Optional Features: 5. Will this Group Critical Illness Policy replace any existing group critical illness policy? o Yes o No 6. General Agreement: The applicant agrees to transmit the total premiums under the group policy to the Insurer named below at its home office when due. No agent or other person except an officer can make or change any contract or agreement on behalf of the Insurer named below. Refer to the attached list for the appropriate State Fraud Warning. Signature of Employer/Union Representative Title Date Underwritten by: SOSTON 7V1[i J'l'i JAi (.rrr., iNsu(zn,vcr.. 1891 WS-CI Master Application 7/12 Page 1 of 3 228-076 7/12 LAFRAUD WARNING NOTICES PLEASE READ THE FRAUD WARNING NOTICE FOR YOUR STATE [ALASKA: A person who knowingly and with intent to injure, defraud or deceive an insurance company files a claim containing false, incomplete, or misleading information may be prosecuted under state law. ARIZONA: For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. ARKANSAS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. CALIFORNIA: For your protection California law requires the following to appear on this form: Any person who know- ingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. COLORADO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies. DELAWARE: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete or misleading infor- mation is guilty of a felony. DISTRICT OF COLUMBIA: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. IDAHO: Any person who knowingly, and with intent to defraud or deceive any insurance company, files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony. ]INDIANA: A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete, or misleading information commits a felony. KENTUCKY. Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. LOUISIANA: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or know- ingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. MAINE: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. MARYLAND: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. MINNESOTA: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. NEW HAMPSHIRE: Any person who, with a purpose to injure, defraud, or deceive any insurance company, files a statement of claim containing any false, incomplete, or mis- leading information is subject to prosecution and punishment for insurance fraud, as provided in RSA 638:20. NEW JERSEY. Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Page 2 of 3 see other side FRAUD WARNING NOTICES... coitt. PLEASE READ THE FRAUD WARNING NOTICE FOR YOUR STATE NEW MEXICO: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES. OHIO: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. OKLAHOMA: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. OREGON: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud. PENNSYLVANIA: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. PUERTO RICO: Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall incur a felony and, upon conviction, shall be sanctioned for each violation with the penalty of a fine of not less than five thousand dollars ($5,000) and not more than ten thousand dollars ($10,000), or a fixed term of imprisonment for three (3) years, or both penalties. Should aggravating circumstances are present, the penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are present, it may be reduced to a minimum of two (2) years. RHODE ISLAND: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. TENNESSEE: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. TEXAS: Any person who knowingly presents a false or fraud- ulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. VIRGINIA: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. WASHINGTON: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits. WEST VIRGINIA: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. ALL OTHER STATES: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.] Page 3 of 3 13(S'.3TG)N Mi J'I"CTAL x.rs-n xNac irannc-v l`FfMx'ANI� EMPLOYER'S AGREEMENT To: Boston Mutual Life Insurance Company Worksite Administration 120 Royall Street Canton, MA 02021 CALHOUN COUNTY will withhold premiums for Boston Mutual voluntary insurance product(s) sold to its employee We agree that each employee will be allowed to attend a scheduled group meeting and/or meet individually with an insurance sales representative on company time and premises. We agree until further notice to honor payroll deduction requests made by the employees for coverage they may apply for. Deductions will be made systematically and prior to the date due. We agree to promptly forward, within 10 days, the amount deducted upon receipt of your monthly statement. Payment will include accurate reporting of deductions taken for each employee and will enable Boston Mutual to apply policy payments accurately. We understand and agree that we are acting on behalf of our employees and that if such payments are not received by you, within the grace period allowed by the insurance policy coverage will terminate. We assume no responsibility for payment except for payroll deductions previously made and we have the right to discontinue this agreement at any time after 90 days written notice to Boston Mutual. We will promptly notify you upon termination of any participant. It is our understanding that any employee may elect to withdraw from the program and discontinue payroll deductions. Date: 07/23/2015 Name: MICHAEL J. PFEIFER Title: COUNTY JUDGE Address: 211 S. ANN STREET PORT LAVACA, TEXAS 77979 Authorized Signature: Employers Agreement 7/2012 Reliance Standard Life Insurance Company PRELIMINARY APPLICATION FOR GROUP INSURANCE 1. Prospective Policyholder: CALHOUN COUNTY (Exact Legal Name) 2. Federal Employer Identification Number: 74-6001923 3. Complete address: 211 S. ANN STREET PORT LAVACA TEXAS CALHOUN COUNTY 77979 Executive Correspondent RHONDA S. KOKENA Title COUNTY TREASURER Phone 361-553-4619 Routine Correspondent RHONDAS.KOKENA Title COUNTY TREASURER Phone 361-553-4619 Mailing Address (If different) 202 S. ANN STREET, SUITE A. PORT LAVACA TEXAS 77979 4. Nature of business: (If Association: purpose, when formed) LOCAL GOVERNMENT 5. The prospective policyholder is a r-1 corporation, r-1 partnership, _0 proprietorship, r-1 union, gassociation, O other (specify) GOVERNMENT 6. INDICATE AFFILIATES OR SUBSIDIARIES TO BE COVERED, IF ANY: (Include divisions only if all are not to be included) Name and Location Nature of Relationship Nature of Business No. of Employees by Coverage Life AD&D WI LTD VAR STOP LOSS Other 7. POLICY TO BE ISSUED IN THE STATE OF : TExgd 8. Requested Effective Date: 10-01-2015 (If other than state of Applicant's main office, explain in REMARKS) (Month) (Day) (Year) 9. COVERAGES APPLIED FOR: OLife, DAD&D, 0 WI, OLTD,[aVAR, ❑STOP LOSS, ❑Other 10. Is any group insurance now in force or currently being applied for on the Proposed Insureds?dyes _[:]_no If yes, (A) Indicate in Remarks: name of carrier; type of coverage; effective date; brief benefit description; eligibility; etc. (B) Provide prior experience, including premiums and incurred claims(or paid claims and claim reserves at start and end of period.) 11. Is it proposed to terminate or change any existing group insurance coverage? I—1 es Mno If yes, indicate in REMARKS: name of carrier; type of coverage, and date of termination, or date and type of change. 12. Are all Proposed Insureds actively at work? jayes ono If not, please list the following for employees not actively at work: NAME DATE OF BIRTH LAST DAY WORKED FACE AMOUNT REASON FOR ABSENCE REMARKS: This Preliminary Application is subject to the acceptance and approval in writing by Reliance Standard Life Insurance Company at the Administrative Offices in Philadelphia, Pennsylvania; and nothing contained herein shall be binding upon said Company until this Preliminary Application is so approved. $_ has been paid herewith. It will be applied toward the first premium due on the policy or policies if any be issued. Such issuance is subject to the: terms; conditions; limitations; and exceptions of the policy or policies if any be issued. Name of Agent or Broker of Record (print or type) Share Print or type name of Broker's firm, if applicable by (authorized signature) Dated at (title or position with Applicant) Group by Agency Office (authorized signature) (Title) LRS-8209-1088 ACCEPT REPORTS OF THE FOLLOWING COUNTY OFFICES: Judge Pfeifer made a motion to accept reports of the following County Offices: • Calhoun Tax Assessor/Collector — May 2015 • County Treasurer — May 2015 (Revised) • County Clerk — May 2015 • Calhoun County Library - 2014 Meeting Room Annual Usage Report • Calhoun County Library — Seadrift Branch — 2014 Meeting Room Annual Usage Report Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. o D D o v M Cl) a o o o yv 3 n n m `< 0 a SU� g m w N o Q< a) am m m m w o Dr0 mmD N, m D mmv0. 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O (D O X N N N N n 0 m m D z n X 1 y m O z N N n ` M. r N z O a N N z U/ m g PD" N N n C > 00 n 0 O r 0 r O r rm m m z F D D, 1 m z O -I z N N to to tH to to to to to to to to fA to to to to ffl w N O co W A C4 (O .a N (A � a) V A ? <N O V P V in O V 0c0 W V V 40 to Vi vi to to to ro to w to 0i Vi to to to w f0 s N N N 00 co w y1 W N N cn M N V 00+ V A V s 4 O V V 0000 W V V CALHOUN COUNTY, TEXAS COUNTY TREASURER'S REPORT -REVISED MONTHOF: MAY 2015 BEGINNING ENDING FUND FUND BALANCE RECEIPTS DISBURSEMENTS FUND BALANCE OPERATING FUNDS: GENERAL $ 28.317,910.22 $ 1.094,315.03 $ 2,216,475.51 $ 27,195,749.74 AIRPORT MAINTENANCE 25,943.01 6,741.99 965.54 31,719.46 APPELLATE JUDICIAL SYSTEM 603.16 133.17 - 736.33 COASTAL PROTECTION FUND 39,118.00 7.27 - 39,125.27 COUNTY AND DIST COURT TECH FUND 2,675.22 73.53 - 2,748.75 COUNTY CHILD ABUSE PREVENTION FUND 300.35 8.75 - 309.10 COUNTY CHILD WELFARE BOARD FUND 1.768.08 12.33 - 1,780.41 COURTHOUSE SECURITY 237,382.04 1,246.03 764.00 237,864.07 COURT INITIATED GUARDIANSHIP FUND 3,407.35 60.63 - 3.467.98 DIST CLK RECORD PRESERVATION FUND 10,228.48 225.11 - 10,453.59 CO CLK RECORDS ARCHIVE FUND 70,790.74 4,618.16 75,408.90 DONATIONS 78,590.77 40,978.19 41,410.62 78,159.34 DRUGIDWI COURT PROGRAM FUND -LOCAL 9,574.01 148.40 - 9,722.41 JUVENILE CASE MANAGER FUND 9,195.09 22.33 - 9,217.42 FAMILY PROTECTION FUND 6,445.54 91.20 - 6,536.74 JUVENILE DELINQUENCY PREVENTION FUND 8,586.19 1.60 - 9,587.79 GRANTS 539,844.02 3,614.66 2,507.08 540,951.60 JUSTICE COURT TECHNOLOGY 63,031.42 794.31 734.97 63,090.76 JUSTICE COURT BUBAING SECURITY FUND 9.646.78 195.70 - 9,842.48 LATERAL ROAD PRECINCT#1 4,324.76 0,80 - 4,325.56 LATERAL ROAD PRECINCT#2 4,324.76 0.80 - 4,325.56 LATERAL ROAD PRECINCT#3 4,324.76 0.80 - 4,325.56 LATERAL ROAD PRECINCT#4 4.324.77 0.80 - 4,325.57 PRETRIAI-SERVICES FUND 65,587.48 410.0 - 65,997.57 LAW LIBRARY 193,317.94 897.31 717.95 193,497,30 LAW ENF OFFICERS STD. EDUC.(LEOSE) 22,192.03 4.12 - 22,196.15 POC COMMUNITY CENTER 67,924.32 3,712.63 2,862.11 68,774.84 RECORDS MANAGEMENT-DISTRICTCLERK 5,346.46 151.94 - 5,49SAO RECORDS MANAGEMENT -COUNTY CLERK 112,017.51 54.34 412.25 111,659.60 RECORDS MGMT&PRESERVATION 190,632.03 5,386.53 - 196,018.56 ROAD&BRIDGE GENERAL 1,395,934.47 44.316.64 - 1,440,251.11 SHERIFF FORFEITED PROPERTY 1,281.61 0.24 - 1,281.85 6MILE PIER/BOAT RAMP INSUR/MAiNT 54,390.00 10.11 1.791.94 52,608.17 CAPITAL PROT-RB INFRASTRUCTURE 1,072,599.35 - 86,213B4 986,386.31 CAPITAL PROD- COUNTY ENERGY TRZ#1 354,745.05 - - 354,745.05 CAPITAL PROD -SWAN POINT PARK 5,096.40 - 94.50 5,001.90 CAPITAL PROT- AIRPORT RUNWAY IMPROV 78,472,13 - - 78,472.13 CAPITAL PROT-COUNTY ROAD 101 150,000.00 - - 150,000.00 CAPITAL PROD -EMS SUBSTATION 347,399.23 - - 347,399.23 CAPITAL PROT-EMER COMM SYS 30,848,06 - - 30,848.06 CAPITAL PROD - GREEN LAKE PARK 30,428.92 - 4,043.54 26,385.38 CAPITAL PRO]- HATE•RIUS PARKBOAT RAMP 21.064.00 - - 21,064.00 CAPITAL PROT -PORT ALTO PUBL BEACH -STORM REP 6,484.78 - - 6.484.78 CAPITAL PROT- IMPROVEMENT PROJECTS 394,465.62 - 20,250.00 374,215.62 CAPITAL PRO]- PORT O'CONNOR LIBRARY 1.167.00 - - 1,167.00 CAPITAL PROD-MMC CLINIC ACQUISITION LOAN - - CAPITAL PROT- NURSING HOME UPL PROGRAM LOAt 2,000,000.00 - - 2,000,000.00 CAPITAL PROT-MMC BUSINESS IMPROVEMENT LOAD 1.500.000.00 - L500.000.00 ARREST FEES 393.81 415.32 - 809.13 BAIL BOND FEES (HE 1940) - 1,380.00 - 1,380.00 CONSOLIDATED COURT COSTS (NEW) 30.00 9.576.00 - 9,606.00 DNA TESTING FUND 250.00 26.92 - 276.92 DRUG COURT PROGRAM FUND -STATE. 0.28 t46.62 146.90 SUBTOTALS 37554409.00 1219780,40 2379243.05 $ 36394945.35 Page I of 3 COUNTY TREASURER'S REPORT MONTH OF: MAY2015 BEGINNING ENDING FUND FUND BALANCE RECEIPTS DISBURSEMENTS FUNDBAIANCE OPERATING FUNDS -BALANCE FORWARD $ 37,554,408.00 $ L219,780.40 $ 2,379,243.05 $ 36,394,945.35 ELECTION SERVICES CONTRACT 66,912.07 12.44 - 66,924.51 ELECTRONIC FILING FEE FUND 0.00 831,27 - 831.27 EMS TRAUMA FUND 126.57 297.00 - 423.57 FINES AND COURT COSTS HOLDING FUND INDIGENT CIVIL LEGAL SERVICE 7,847.31 24,00 - 164.00 - - 7,847.31 188.00 IDICIAL FUND (ST. COURT COSTS) JUDICIAL SALARIES FUND JUROR DONATION -TX CRIME VICTIMS FUND 0.00 0.00 210.00 201.15 2,634.41 86.00 - - - 201.15 2,634.41 296.00 JUVENILE PROBATION RESTITUTION LIBRARY GIFT AND MEMORIAL 2,191.00 52,367.04 - 9.73 - - 2,191.00 52,376.77 MISCELLANEOUS CLEARING 14,378.10 73,425.78 19,259.52 68,544.36 REFUNDABLE DEPOSITS 2.000.00 - 2,000.00 STATE CIVIL FEE FUND 0.00 2,196.39 - 2,196.39 CIVIL JUSTICE DATA REPOSITORY FUND 0.00 14.46 - 14.46 JURY REIMBURSEMENT FEE SUBTITLECFUND SUPP OF CRIM INDIGENT DEFENSE 0.00 7.77 0.00 849.32 3,811.92 428.27 - - - 849.32 3,819.69 428.27 TIME PAYMENTS 0.00 1.338.13 - 1.338.13 TRAFFIC LAW FAILURE TO APPEAR 0.00 575.03 - 575.03 UNCLAIMED PROPERTY 5,907.95 1.10 - 5,909.05 TRUANCY PREVENTION AND DIVERSION FUND 25.19 354.52 - 379.71 BOOT CAMPDJAEP 147.43 - - 147.43 JUVENREPROBATION 237898.14 18660.22 51955.58 204602.78 SUBTOTALS $ 37,944,450.57 $ 1,325,671.54 $ 2,450.458.15 $ 36,819,663.96 'TAXES IN ESCROW 0.00 0.00 0.00 37 944 450.57 1325 671.54 2 450 458.15 36 819 663.96 TOTAL OPERATING FUNDS OTHERFUNDS D A FORFEITED PROPERTY FUND 32.254,03 - - 32,254.03 SHERIFF NARCOTIC FORFEITURES 11,140.28 - 150.50 10,989.78 CERT OF OB-CRTHSE REF SERIES 2010 477,129.36 2,713.40 - 479,842.76 CERT OF OB-CRTHOUSE I&S SERIES 2012 641,674.43 3,545.28 - 645,219.71 OCEAN DRIVE IMPROVEMENTS 1.00 - - 1.00 CAL. CO. FEES & FINES OTHER CO. FUNDS! 117 242.11 97 7TOTAL 108 089,97 96 874.31 1 ,ZT LIT 021.77 IF MEMORIAL MEDICAL CENTER OPERATING 2,099,028.67 2,717,832.95 2,288,808.70 $ 2,528,052.92 INDIGENT HEALTHCARE 2,249.38 36,888.92 36,948.41 2,189.89 REFUND IMPREST ACCOUNT 5,061.64 - - 5,061.64 PRIVATE WAIVER CLEARING FUND 325,069.79 - - 325,069.79 CLINIC CONSTRUCTION SERIES 2014 1,628.046.29 - - 1.629,046.29 NH ASFORD 21,320.28 848.341.40 582,101.39 287,560.29 NH BROADMOOR 100)o 88,6M96 38,590.25 50,120.71 NO CRESCENT 100.00 102,504.91 50.602.74 52,002.17 NH FORT BEND 3,013.49 147,980.43 102,431.94 48,561.98 NH SOLERA 100.00 224 693.04 157 914.60 66 868,44 TOTAL MEMORIAL MEDICAL CENTER FUNDS 4,084,089.54 $ 4166 842,61 3,257,399.03 $ 4,993,534.12 DRAINAGE DISTRICTS NO.6 24.295.56 $ - $ 85.72 $ 24,209.84 NO. R 141,224.58 610.37 16,084.51 125,750.44 NO. 10-MAINTENANCE 139,439.42 - 3,933.13 135,506.29 NO. II-MAJNTENANC&OPERATING 270,101,92 1,415.48 1,611.09 269,906.31 NO. I I -RESERVE 154909.90 154909.90 TOTAL DRAINAGE DISTRICT FUNDS 729971.38 2025.55 21714.45 710282,78 CALHOUN COUNTY W CID 81 OPERATING ACCOUNT $ 477 127.93 11.50 11 196.71 S 465 942.72 CALHOUN COUNTY PORT AUTHORITY MAINTENANCE AND OPERATING $ 241 550.37 $ 3,625.15 $ 7,298.48 237 877.04 CALHOUN COUNTY FROST BANK $ 6258.87 $ 491.1 5767.87 $ - $ TOTAL MMC, DR. DIST., NAV. DIST, WCID & FROST 5,538,998.09 4,172,505.11 3,Z98.098.67 6 413 404.53 $ 44,752,890.27 $ 5,602,157.10 $ 5,856,797.29 $ 44,498,250AR TOTAL ALL FUNDS Page 2 of 3 COUNTY TREASURER'S REPORT I MONTHOF: MAY2015 BANK RECONCILIATION LESS: CERTOFDEP/ FUND OUTSTNDGDEPI PLUS: CHECKS BANK FUND BALANCE OTHERITEMS OUTSTANDING BALANCE OPERATING* $ 36,819,663.96 5 35,667,298.45 $ 452,222.34 $ 1,604,587.85 OTHER D A FORFEITED PROPERTY FUND 32,254.03 - - 32,254.03 SHERIFF NARCOTIC FORFEITURES 10,989.78 - 150.50 11,140.28 CERT OF OB-CRTESE REF SERIES 2010 479,842.76 1,086.03 - 478,756.73 CERT OF OB-CRTHOUSE I&S SERIES 2012 645,219.71 1,372.03 - 643,847.68 OCEAN DRIVE IMPROVEMENTS- CAP PROD 1.00 1.00 CAL, CO FEES & F1NFS 96,874.31 25,718.63 107.289.86 178,445.54 MEMORIAL MEDICAL CENTER OPERATING t 2,528,052.92 500,250.60 692.247.78 2,720,050.10 INDIGENT HEALTHCARE 2,189.89 36,538.92 37,138.42 2,799.39 REFUND IMPREST ACCOUNT 5,061.64 - - 5,061.64 PRIVATE WAIVER CLEARING FUND 325,069.79 - - 325,069.79 CLINIC CONSTRUCTION SERIES 2014 1,628,046.29 - - 1,628,046.29 NH ASHFORD 287,560.29 - -. 287,560.29 NHBROADMOOR 50,120.71 - - 50,120.71 NH CRESCENT 52,002.17 - - 52,002,17 NH FORT BEND 48,561.98 - - 48,561.98 NH SOLERA 66,868.44 - - 66,868.44 DRAINAGE DISTRICT: NO.6 24,209.84 - 85.72 24,295.56 NO.8 125,750.44 - - 125,750.44 NO. 10 MAINTENANCE 135,506.29 - - 135,506.29 NO, 11 MAINTENANCIVOPERATING 269.906.31 417.81 - 269,488.50 NO, 11 RESERVE 154,909.90 - - 154,909.90 CALHOUN COUNTY WCID HI OPERATING ACCOUNT 465,942.72 - - 465,942.72 CALHOUN COUNTY PORT AUTHORITY MAINTENANCE/OPERATING**** 237,877.04 - - 237,977.04 CALHOUN COUNTY FROSTBANK 5,767.87 - - 5,767.87 TOTALS Is 44,498,250.08 6 232 682 47 1.289.134.62 554 02 23 CDs OPERATING FUND $35;500,000.00 -< $ CD's - MMC OPERATING FUND - $500,000.00 "*** THE DEPOSITORY FOR CALHOUN CO. NAVIGATION DISTRICT IS FIRST NATIONAL BANK -PORT LAVACA THE DEPOSITORY FOR ALL OTHER COUNTY FUNDS IS INTERNATIONAL BANK OF COMMERCE - PORT LAVACA **** THE DEPSOSITORY FOR CALHOUN COUNTY FROST IS FROST BANK - AUMN, TEXAS Court costs and fees collected and reported may not be current an up=to-da e due to non-compliance by other county offices. I hereby certify e tify that the current balances are correct to all movie that, Eve bin req�eived by Sjie Cptylty Treasurer as othe date of this report. �� / v(\ s e . . n j MMIcSri.. S.KOKBNA COUNTY TREASURER Page 3 of 3 CALHOUN COUNTY CLERIC MONTHLY REPORT RECAPITUATION NTY CLERK FEES 1000-44030 $ 912.85 $ 494.75 $ 9,857.60 $ 316.00 $ 11.681.10 :TRONIC FILING FEES FOR&FILINGS 1000-44058 $ 28.00 $ - $ - $ 10.00 $ 38.00 3E'S EDUCATION FEE 1000-44160 $ 9.76 $ 30.00 $ 39.76 3E'S ORDER/SIGNATURE 1000-44180 $ 6,00 $ 28.00 $ 34.00 LIFF'S FEES 1000.44190 $ 566.25 $ 220.08 $ - $ 225.00 $ 1,011.33 AL RECORDER FEE 100044250 $ 61.73 $ 61.73 RT REFPORTER FEE 1000-44270 $ 89.26 $ 90,00 $ 179.25 ALATE FUND (TGC) FEE 2620-44030 $ 30.00 $ 30.00 $ 60.00 iNOLOGYFUND 2663.44030 $ 44.48 $ 44.48 RTHOUSE SECURITY FEE 2670.44030 $ 39.76 $ 33.34 $ 384.00 $ 30.00 $ 487.09 ITT INITIATED CUARDIANSHfP FEE 2672-44030 $ 120.00 $ 120.00 )RDS ARCHIVE FEE 2675.44030 $ 3,695,00 $ 3,695.00 G& ALCOHOL COURT PROGRAM 2698.44030-005 $ 165.32 $ 105.32 LIBARY FEE 2731-44030 $ 102.20 $ 210.00 $ 372.20 )RDSMANAGEMENT FEE - CO CLK 2738-44380 $ 27.80 $ 27.80 )RDS MANGEMENT 2739-10899,44030 $ 69.75 $ 250.16 $ 3,725.00 $ 60.00 $ 4,104.91 D FORFEITURE 2740 001-45050 $ 600.00 $ 600.00 5-COUNTY COURT 2740-45040 $ 2,349.60 $ 2,349.60 E POLICE OFFICER FEES 7020.20740 $ 2.30 $ 2.30 SOLIDATED COURTCOSTS- COUNTY 7070-20610 $ 92,29 $ 92.29 SOLIDATED COURT COSTS - STATE 7070-20740 $ 834A3 $ 834.43 3& ALCOHOL COURT PROGRAM -COUNTY 7390-20610-999 $ 33.06 $ 33.06 3& ALCOHOL COURT PROGRAM - STATE 7390-20740-999 $ 132.27 $ 132.27 E ELECTRONIC FILING FEE 7403-999-22887 $ 80.00 $ 120.00 $ 200.00 E ELECTRONIC FILING FEE CR 7403-999-22990 $ 48.13 $ 48.13 TRAUMA 7405-999-20740 $ 296.93 $ 298.93 INDIGENTFEE -COUNTY 7480-20610 $ 3.00 $ 3.00 $ 6.00 INDIGENT FEE STATE 7480-20740 $ 67.00 $ 57.00 $ 114,00 'IAL FUND COURT COSTS 7495-20740 $ 166.78 $ 166.78 :IAL SALARY FUND -COUNTY 7505-20610 $ 6.66 $ 6.06 ;IAL SALARY FUND - STATE 7505-20740 $ 60.05 $ 60.05 :IAL SALARY FUND 7505-20740-005 $ 108.00 $ - $. 252.00 $ 420.00 FIC LOCAL 7538-22884 $ 6.12 $ 6.12 i - STATE 7855-20780 $ 90,00 $ 00.00 RMAL MARRIAGES -STATE 7855-20782 $ 12.50 $ 12.50 ;IAL FEE 7855-20786 $ 18220 $ 240.00 $ 422.20 IAL MARRIAGES - STATE 7855-20788 $ 480,00 $ 480.00 )SE COURT COST 7856-999-20740 $ 0.54 $ 0.54 REIMBURSEMENT FEE -COUNTY 7857-20610 $ 4.46 $ 4.46 REIMBURSEMENT FEE -STATE 7857-20740 $ 40.02 $ 40.02 2 TRAFFIC FINE -COUNTY 7860-20610 $ 3.06 $ 3.06 °TRAFFIC FINE - STATE 7860-20740 $ 58.14 $ 58.14 ;ENT DEFENSE FEE - COUNTY 7865-20610 $ 2,24 $ 2.24 TENT DEFENSE FEE -STATE 7865-20740 $ 19.99 $ 19.99 PAYMENT -COUNTY 7950-20610 $ 138.98 $ 138.98 PAYMENT -STATE 7950-20740 $ 138.98 $ 138.08 'ORT LAVACA PD 9990-99991 $ 66.76 $ 05.76. TOTAL FUNDS COLLECTED $ 29,145.40 FUNDS HELD IN ESCROW: $ (64.00) AMOUNT DUE TO TREASURER: TOTAL FUNDS COLLECTED; U:ISREPORTSIWNTHLYRREASURER REPORT12015.053115.7REASURER REPORTS IOF2 CALHOUN COUNTY CLERK MONTHLY REPORT RECAPITUATION MAY201S CASH ON HAND, TRUST FUND BEGINNING 800K BALANCE 4/30/2015 $ 47,376.51 FUND RECEIVED $ 38,658.20 DISBURSEMENTS $ (40,868.20) ENDING BOOK BALANCE 5/31/2015 $ 45,076.51 BANK RECONCILIATION TRUST FUND ENDING BANK BALANCE 4130/2015 $ 45,531.51 OUTSTANDING DEPOSITS' $ - OUTSTANDING CHECKS" $ (465.00) RECONCILED BANK BALANCE 5/31/2015 $ 45,076.51 "see attached CERTIFICATES OF DEPOSITS HELD IN TRUST- INC BANK CD'S +: Date Issued Balance Purchases Withdrawals Balance 4130/2015 05131115 74926 $ 1,846.63 $ 1,846.53 49466. $15,042.10 $ 19,642A0 50782 1115/2015 $ 9,378.58 $ 9,378.58 60790 1/16/2015 $ 9378.58 $ 9,378.68 50804 1/15/2015 $ 9,378.58 $ 9,378.58 50863 2/2/2015 $ 3,600.00 $ 3;500.00 60871 212/2016 $ 3,600.00 $ 3,600,00 51134 5128/2015 $ $ 38,568.20 1 $ $ 38,658.20 TOTALS: $ 50,624.37 $ - $ $ 95,182.57 Submitted by: Anna M Goodman, County Clerk UAREPORTSINOMHLYUREASURER REPORMW5.053116.TREASURER REPORTS 2 OF 2 Calhoun County Public Library System (361) 552-7323 200 W Mahan Port Lavaca, Texas 77979 To: Commissioners' Court From: Noemi Cruz Subject: Meeting Room Annual Usage Report 2014 Date Organization 2-Jan Port Lavaca Thursday Book Club 7-Jan Take Shape For Life 8-Jan Library - Storytime 9-Jan Veterans Group 9-Jan Library Board 14-Jan Calhoun County Historical Commission 15-Jan Library - Storytime 22-Jan Library - Storytime 23-Jan Veterans Group 23-Jan Library - Family Movie Night 29-Jan Library - Storytime 4-Feb Take Shape For Life 5-Feb Library - Storytime 6-Feb Veterans Group 11-Feb Calhoun County Historical Commission 12-Feb Library - Storytime 19-Feb Library - Storytime 20-Feb Veterans Group 26-Feb Library - Storytime 27-Feb Library - Family Movie Night 4-Mar Elections 4-Mar Take Shape For Life 5-Mar Library - Storytime 6-Mar Port Lavaca Thursday Book Club 6-Mar Library Board 6-Mar Veterans Group 11-Mar Calhoun County Historical Commission 12-Mar Library - Storytime 13-Mar Library - Harlan Bryant Book Signing 14-Mar HeadStart 18-Mar Calhoun County Historical Commission 19-Mar Library - Storytime 20-Mar Veterans Group 20-Mar Program - Anti-Bulleying Awareness 21-Mar HeadStart 26-Mar Library - Storytime 27-Mar Library - Family Movie Night 1-Apr Take Shape For Life 2-Apr Library - Storytime 3-Apr Veterans Group 8-Apr Calhoun County Historical Commission 9-Apr Library - Storytime 16-Apr to 26-Apr Friends of Calhoun County Library - Book Sale 16-Apr Library - Storytime 23-Apr Library - Storytime 30-Apr Library - Storytime 6-May Take Shape For Life 7-May Library - Storytime 8-May Port Lavaca Thursday Book Club 8-May Library Board 13-May Calhoun County Historical Commission 14-May Library - Storytime 15-May Veterans Group 17-May to 23-May Friends of Calhoun County Library - Scholastic Book Fair 21-May Library - Storytime 29-May Library - Family Movie Night 29-May Veterans Group 3-Jun HJM 3-Jun Take Shape For Life 7-Jun Library - Summer Reading Program Kickoff 10-Jun Calhoun County Historical Commission 11-Jun Library - Storytime 12-Jun Library - Storytime 12-Jun Veterans Group 13-Jun Library - Friday Flicks 18-Jun Library - Storytime 19-Jun Library - Storytime 19-Jun Main Street Theatre 20-Jun Library - Friday Flicks 25-Jun Library - Storytime 26-Jun Library - Storytime 26-Jun Veterans Group 27-Jun Library - Friday Flicks 1-Jul Take Shape For Life 2-Jul Library - Storytime 3-Jul Library Board 3-Jul Port Lavaca Thursday Book Club 9-Jul Library - Storytime 11-Jul Library - Friday Flicks 16-Jul Library - Storytime 18-Jul Library - Friday Flicks 23-Jul Library Storytime 25-Jul Library - Friday Flicks 5-Aug Take Shape For Life 5-Aug Program - Wells Fargo 6-Aug Library - Storytime 12-Aug Calhoun County Historical Commission 13-Aug Library - Storytime 13-Aug Calhoun County Historical Commission 20-Aug Library - Storytime 27-Aug Library - Storytime 2-Sep Take Shape For Life 3-Sep Library - Storytime 4-Sep Port Lavaca Thursday Book Club 4-Sep Library Board 4-Sep Veterans Group 9-Sep Calhoun County Historical Commission 10-Sep Library - Storytime 17-Sep Library - Storytime 24-Sep Library - Storytime 25-Sep Library - Family Movie Night 1-Oct Library - Storytime 2-Oct Veterans Group 7-Oct Take Shape For Life 8-Oct Library - Storytime 14-Oct Calhoun County Historical Commission 15-Oct Library - Storytime 16-Oct to 25-Oct Friends of Calhoun County Library - Book Sale 29-Oct Library - Storytime 30-Oct Library - Halloween Party/ Movie Night 30-Oct Veterans Group 4-Nov Elections 4-Nov Take Shape For Life 5-Nov Library - Storytime 6-Nov Veterans Group 6-Nov Port Lavaca Thursday Book Club 6-Nov Library Board 11-Nov Calhoun County Historical Commission 12-Nov Library - Storytime 19-Nov Library - Storytime 20-Nov Library - Movie Day 26-Nov Library - Storytime 2-Dec Girl Scouts 2-Dec Take Shape For Life 3-Dec Library - Storytime 4-Dec Veterans Group 5-Dec to 13-Dec Friends of Calhoun County Library - Scholastic Book Fair 17-Dec Library - Storytime 18-Dec Veterans Group 20-Dec The Dance Company Calhoun County Public Library System (361)552-7323 200 W. Mahan Port Lavaca, Texas 77979 To: Commissioners' Court From: Noemi Cruz Subject: Meeting Room Annual Usage Report 2014 - Seadrift Branch Library Date Organization 7-Jan Mary Kay Belter - Walking Aerobics 8-Jan Friends of the Seadrift Library 9-Jan Mary Kay Belter - Walking Aerobics 14-Jan Mary Kay Belter - Walking Aerobics 16-Jan Bay Book Club 16-Jan Mary Kay Belter - Walking Aerobics 18-Jan Private - Lauren Banda 21-Jan Mary Kay Belter - Walking Aerobics 23-Jan Mary Kay Belter - Walking Aerobics 23-Jan Private - Monica Henson 28-Jan Mary Kay Belter - Walking Aerobics 30-Jan Mary Kay Belter - Walking Aerobics 4-Feb Mary Kay Belter - Walking Aerobics 6-Feb Mary Kay Belter - Walking Aerobics 8-Feb Texas Master Naturalist - MidCoast Chapter 11-Feb Mary Kay Belter - Walking Aerobics 13-Feb Mary Kay Belter - Walking Aerobics 18-Feb Mary Kay Belter - Walking Aerobics 20-Feb Mary Kay Belter - Walking Aerobics 20-Feb Bay Book Club 25-Feb Mary Kay Belter - Walking Aerobics 27-Feb Mary Kay Belter - Walking Aerobics 4-Mar Mary Kay Belter - Walking Aerobics 6-Mar Friends of the Seadrift Library 6-Mar Mary Kay Belter - Walking Aerobics 11-Mar Mary Kay Belter- Walking Aerobics 13-Mar Mary Kay Belter - Walking Aerobics 15-Mar Private - Anna Avalos 18-Mar Mary Kay Belter - Walking Aerobics 20-Mar Mary Kay Belter - Walking Aerobics 20-Mar Bay Book Club 22-Mar Private - Sheree Henderson 25-Mar Mary Kay Belter - Walking Aerobics 27-Mar Mary Kay Belter - Walking Aerobics 1-Apr Mary Kay Belter - Walking Aerobics 3-Apr Mary Kay Belter - Walking Aerobics 8-Apr Mary Kay Belter - Walking Aerobics 10-Apr Mary Kay Belter - Walking Aerobics 12-Apr Private - Yolanda Aguilar 15-Apr Mary Kay Belter - Walking Aerobics 17-Apr Mary Kay Belter - Walking Aerobics 17-Apr Bay Book Club 22-Apr Mary Kay Belter - Walking Aerobics 24-Apr Mary Kay Belter - Walking Aerobics 29-Apr Mary Kay Belter - Walking Aerobics 1-May Mary Kay Belter - Walking Aerobics 6-May Mary Kay Belter - Walking Aerobics 8-May Mary Kay Belter - Walking Aerobics 13-May Mary Kay Belter - Walking Aerobics 15-May Bay Book Club 15-May Mary Kay Belter - Walking Aerobics 20-May Mary Kay Belter - Walking Aerobics 22-May Mary Kay Belter - Walking Aerobics 27-May Mary Kay Belter - Walking Aerobics 29-May Mary Kay Belter - Walking Aerobics 31-May Private - Kristine Pendergrass 3-Jun Mary Kay Belter - Walking Aerobics 5-Jun Mary Kay Belter - Walking Aerobics 5-Jun Friends of the Seadrift Library 10-Jun Mary Kay Belter- Walking Aerobics 12-Jun Mary Kay Belter - Walking Aerobics 17-Jun Mary Kay Belter - Walking Aerobics 19-Jun Mary Kay Belter - Walking Aerobics 19-Jun Bay Book Club 24-Jun Mary Kay Belter - Walking Aerobics 26-Jun Mary Kay Belter - Walking Aerobics 1-Jul Mary Kay Belter - Walking Aerobics 3-Jul Mary Kay Belter - Walking Aerobics 8-Jul Mary Kay Belter - Walking Aerobics 10-Jul Mary Kay Belter - Walking Aerobics 13-Jul Private - Tina Renald 15-Jul Mary Kay Belter - Walking Aerobics 17-Jul Mary Kay Belter - Walking Aerobics 17-Jul Bay Book Club 22-Jul Mary Kay Belter - Walking Aerobics 24-Jul Mary Kay Belter - Walking Aerobics 29-Jul Mary Kay Belter - Walking Aerobics 2-Aug Private - Evelyn Williams 5-Aug Mary Kay Belter - Walking Aerobics 7-Aug Mary Kay Belter - Walking Aerobics 9-Aug Private - Evelyn Eure 12-Aug Mary Kay Belter - Walking Aerobics 14-Aug Mary Kay Belter - Walking Aerobics 19-Aug Mary Kay Belter - Walking Aerobics 21-Aug Mary Kay Belter - Walking Aerobics 21-Aug Bay Book Club 26-Aug Mary Kay Belter - Walking Aerobics 28-Aug Mary Kay Belter - Walking Aerobics 30-Aug Private - Rebecca Rodriguez 2-Sep Mary Kay Belter - Walking Aerobics 4-Sep Mary Kay Belter - Walking Aerobics 4-Sep Friends of the Seadrift Library 6-Sep Private - Alice Stalcup 9-Sep Mary Kay Belter - Walking Aerobics 11-Sep Mary Kay Belter - Walking Aerobics 14-Sep Private - Summer Wooldridge 16-Sep Mary Kay Belter - Walking Aerobics 18-Sep Bay Book Club 18-Sep Mary Kay Belter - Walking Aerobics 20-Sep Private - Meghan Moncrief 23-Sep Mary Kay Belter - Walking Aerobics 25-Sep Mary Kay Belter - Walking Aerobics 27-Sep Private - Evelyn Eure 30-Sep Mary Kay Belter - Walking Aerobics 2-Oct Mary Kay Belter - Walking Aerobics 7-Oct Mary Kay Belter - Walking Aerobics 9-Oct Mary Kay Belter - Walking Aerobics 11-Oct Texas Master Naturalist - MidCoast Chapter 14-Oct Mary Kay Belter - Walking Aerobics 14-Oct Private - Sharon Jackson 16-Oct Mary Kay Belter - Walking Aerobics 16-Oct Bay Book Club 18-Oct Private - Crystal Cossey 19-Oct Private - Julie Banda 21-Oct Mary Kay Belter- Walking Aerobics 23-Oct Mary Kay Belter - Walking Aerobics 28-Oct Mary Kay Belter - Walking Aerobics 30-Oct Mary Kay Belter - Walking Aerobics 4-Nov Mary Kay Belter - Walking Aerobics 6-Nov Mary Kay Belter - Walking Aerobics 8-Nov Private - Rhonda Lamphier 13-Nov Mary Kay Belter - Walking Aerobics 15-Nov Private - Meghan Moncrief 18-Nov Mary Kay Belter - Walking Aerobics 20-Nov Bay Book Club 20-Nov Mary Kay Belter - Walking Aerobics 20-Nov Private - Melina Padierna 25-Nov Mary Kay Belter - Walking Aerobics 2-Dec Mary Kay Belter - Walking Aerobics 4-Dec Friends of the Seadrift Library 4-Dec Mary Kay Belter - Walking Aerobics 9-Dec Mary Kay Belter - Walking Aerobics 11-Dec Mary Kay Belter - Walking Aerobics 16-Dec Mary Kay Belter - Walking Aerobics 18-Dec Mary Kay Belter - Walking Aerobics APPROVAL OF PAYROLL Commissioner Fritsch made a motion to approve the following June 2015 payrolls: • June 5, 2015 $ 244,242.78 • June 30, 2015 242 387.56 TOTAL $ 486,630.34 Commissioner Lyssy seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. CALHOUN COUNTY PAYROLL 2015 MONTH / JUNE Payroll throu91L 06-05-2015 $ 244,242.78 Payroll through 06-30-2015 $ 242,387.56 APPROVED TOTAL PAYROLL $ 486,630.34 The items listed above have been pre -approved by all Department Heads and I certify that funds were available to pay the obligations. I certify that the above is true and correct to the best of my luiowledge July 20, 2015. i APPROVED S S. KOKENA, CALHOUN COUNTY TREASURER JUL2 3 2015 CALHOUN COUNTY COMMISSIONERS COURT 2 ACCEPTED AND APPROVED THIS THE a� 3 DAY OF 7, 2015 IN THE CALHOUN COUNTY COMMISSIONERS' COURT, PORT LAVACA, TEXAS 77979. let» dl]y/e12J_I4 11-3 Commissioner Fritsch made a motion to pay Memorial Medical Center bills in the amount of $1,999,963.73, Inter -Government Transfers for June 2015 in the amount of $381,094.64, Nursing Home UPL Expenses of $1,605,619.23, Nursing Home Inter -Government Transfer for June 2015 in the amount of $809,742.13, Indigent Healthcare Fund Expenses in the amount of $32,797.13 for a Grand Total of $4,829,216.86. Commissioner Lyssy seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Commissioner Fritsch made a motion to approve County bills in the amount of $1,675,082.61, Transfer of Funds for Indigent Health Care in the amount of $32,797,13, for a total amount of $1,707,879.74. Commissioner Lyssy seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ----- July 23, 2015 PAYABLES AND PAYROLL 6/1/2015 McKesson Drugs 3,771.32 6/2/2015 Weekly Payables 385,300.40 6/2/2015 Patient Refunds 6,958.05 6/2/2015 Payroll 244,535.39 6/4/2015 Returned Check 48.80 6/8/2015 McKesson Drugs 1,882.42 6/9/2015 Payroll Taxes 89,631.08 6/10/2015 Weekly Payables 322.50 6/10/2015 Weekly Payables 279,340.26 6/10/2015 Patient Refunds 14,617,22 6/12/2015 Weekly Payables 702.00 6/15/2015 McKesson Drugs 1,756.69 6/15/2015 TCDRS 105,332.45 6/16/2015 Payroll 237,590.43 6/17/2015 Weekly Payables 46,688.06 6/17/2015 Credit Card Invoice 1,472.54 6/22/2015 McKesson Drugs 1,776.57 6/23/2015 Weekly Payables 357,607.39 6/23/2015 Patient Refunds 13,579.42 6/23/2015 Payroll Taxes 89,651.84 6/29/2015 McKesson Drugs 1,584.92 6/30/2015 Weekly Payables 108,497.22 6/30/2015 Patient Refunds 162.06 6/30/2015 Monthly Electronic Transfers for Payroll Expenses(not ind above) 721.62 6/30/2015 Monthly Electronic Transfers for Operating Expenses 6,433.08 Total Payables and Payroll $ 1,999,963.73 SUBTOTAL MEMORIAL MEDICAL. CENTER; DISBURSEMENTS $ 1999,963.73L1 MMC INTER -GOVERNMENT TRANSFERS June 2016 $ 381,094.64;'; NURSING HOME UPL EXPENSES $ 1,605,619.23,; NURSING HOME INTER -GOVERNMENT TRANSFER FOR June 2016 $ 809,742.13; INDIGENT HEALTHCARE; FUND EXPENSES $ 32,797.13 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---- July 23, 2015 INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES B.A.T.E.S. Place, Inc 582.50 Clinical Pathology Labs 115.04 Michelle M. Cummins MD 967.03 HEB Pharmacy 1,631.27 Memorial Medical Center (Phys Fees $1,413.12, IP $14,383.43/ OP $3,794.34/ ER $3,130.72: 22,721.61 Port Lavaca Clinic Assoc 670.33 Radiology Unlimited PA 280.69 Regional Employee Assistance 221.53 Victoria Eye Center 126.44 Victoria Professional Medical 244.34 179.36 (300.00) Victoria Surgical Associates Less: Co -Pays collected in June 2015 SUBTOTAL 27,440.14 Memorial Medical Center (indigent Healthcare Payroll and Expenses) 5,356.99 July 23, 2015 2015 APPROVAL LIST - 2015 BUDGET 38 COMMISSIONERS COURT MEETING OF 07/23/15 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 37 $ 168,951.99 FICA P/R $ 41,287.50 MEDICARE P/R $ 9,656.06 FWH P/R $ 32,845.27 AFLAC P/R $ 5,476.44 COMBINED INSURANCE C/O PEOPLES UNITED BANK P/R $ 2,892.92 NATIONWIDE RETIREMENT SOLUTIONS P/R $ 2,780.48 OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT P/R $ 1,332.97 PRINCIPAL FINANCIAL GROUP P/R $ 3,752.21 TEXAS COUNTY & DISTRICT RETIREMENT SYSTEM P/R $ 126,969,84 TMPA P/R $ 336.00 UNITED WAY OF CALHOUN COUNTY P/R $ 1,018.31 WILLIAM E. HEITKAMP, TRUSTEE P/R $ 695.34 ATCO INTERNATIONAL A/P $ 170.00 AT&T MOBILITY A/P $ 51.28 BANK OF TEXAS A/P $ 1,048,775.00 BAREFOOT CONSTRUCTION & REMODEL A/P $ 5,323.00 BEN E ICEITH FOODS A/P $ 5,016.20 BOSART LOCK AND KEY A/P $ 181.95 CABLE ONE A/P $ 1,050.06 CARDMEMBER SERVICE - COUNTY A/P $ 3,744.39 CENTERPOINT ENERGY A/P $ 1,266.52 CITY OF SEADRIFT A/P $ 89.03 CONSTELLATION NEW ENERGY A/P $ 26,603.95 CPL RETAIL ENERGY A/P $ 87.64 GRAY & COMPANY, LLC A/P $ 1,712.85 GREEN DIAMOND DISTRIBUTORS A/P $ 174.22 GULF COAST PAPER A/P $ 741.36 GULF COAST HARDWARE A/P $ 166.25 JERRY HUGGANS A/P $ 125.00 MEMORIAL MEDICAL CENTER A/P $ 125,733.92 OSCAR GOTTSCHALT AT $ 39,600.00 POC MUD DISTRICT A/P $ 576.26 POWER ELECTRIC A/P $ 3.99 REPUBLIC SERVICES #847 A/P $ 1,422.35 SOCIAL SECURITY ADMIN A/P $ 163.20 SPRINT A/P $ 182.96 TANYA DIMAK A/P $ 1,438.97 TEXAS WAVENET WIRELESS A/P $ 136.28 TISD, INC A/P $ 619.92 VOYAGER A/P $ 11,930.73 TOTAL VENDOR DISBURSEMENTS: $ 1,675,082.61 CALHOUN COUNTY INDIGENT HEALTH CARE A/P $ 32,797.13 TOTAL TRANSFERS BETWEEN FUNDS: $ 32,797.13 TOTAL AMOUNT FOR APPROVAL: $ 1,707,879.74 DONATIONS TO CALHOUN COUNTY: N/A RECEIVE INTO CALHOUN COUNTY SHERIFF'S DEPARTMENT INVENTORY A 1999 AUDI, VIN WAUBB28D2XA206850 (SEIZED VEHICLE), DECLARE IT AS SURPLUS, AND AUTHORIZE IT TO BE AUCTIONED AT A LATER DATE: Commissioner Lyssy made a motion to receive into Calhoun County Sheriff's Department inventory a 1999 Audi, VIN WAUBB28D2XA206850 (Seized Vehicle), declare it as surplus, and authorize it to be auctioned at a later date. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: MIKE PFEIFER, COUNTY JUDGE SUBJECT: SEIZED VEHICLE DATE: JULY 23, 2015 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR July 23, 2015 • Consider and take necessary action on a 1999 Audi, VIN# WAUBB28D2XA206850 that is a seized vehicle & as of June 8, 2015 became property of Calhoun County Sheriff's Office. It is to be auctioned at a later date. Sincerely, George Aleman Calhoun County Sheriff TRANSFER A 2001 CHRYSLER TOWN AND COUNTRY VAN VIN32C4P44371R423767 FROM CALHOUN COUNTY SHERIFF'S DEPARTMENT TO THE MAINTENANCE DEPARTMENT: Commissioner Lyssy made a motion to transfer a 2001 Chrysler Town and Country Van VIN32C41344371R423767 from Calhoun County Sheriff's Department to the Maintenance Department. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: MIKE PFEIFER, COUNTY JUDGE SUBJECT: TRANSFER VEHICLE DATE: JULY 23, 2015 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR July 23, 2015 • Consider and take necessary action on a 2001 Town and Country Chrysler Van, VIN# 32C4GP44371 R423767 that is property of the Sheriff s Office and transfer to Calhoun County Maintenance Dept. Si rely, 0 z1�. George Aleman Calhoun County Sheriff TRANSFER A 2009 DODGE RAM VAN, VIN1D3HB18P89S7S0285 FROM THE CALHOUN COUNTY MAINTENANCE DEPARTMENT TO THE SHERIFF'S DEPARTMENT: Commissioner Lyssy made a motion to transfer a 2009 Dodge Ram Van, VINID3HB18P89S7S0285 from the Calhoun County Maintenance Department to the Sheriff's Department. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Calhoun County, Texas DEPARTMENTAL INVENTORY TRANSFER REQUEST FORM Requested By: EVERETT WOOD MATTER OF TRANSFERRING CERTAIN ITEMS OF COUNTY PROPERTY FROM ONE COUNTY DEPARTMENT TO ANOTHER COUNTY DEPARTMENT: N/A DECLARE A 22" MURRAY PUSH MOWER AT THE EMS DEPARTMENT AS SURPLUS/SALVAGE AND ALLOW FOR TRADE IN ON NEW 22" MURRAY PUSH MOWER. TRADE-IN VALUE $10.00: Commissioner Lyssy made a motion to declare a 22" Murray Push Mower at the EMS Department as Surplus/Salvage and allow for trade in on new 22" Murray Push Mower. (Trade in value $10.00) Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Consider and take necessary action to declare 22 inch Murray Push Mower at the EMS Department as surplus salvage and allow for trade in on new 22 inch Murray Push Mower. Trade in Value $10.00. (HB) Calhoun County, Texas SURPLUS/SALVAGE DECLARATION REQUEST FORM Department Name: EMS Requested By: Henry Barber Inventory Reason for Surplus/Salvage Number Description Serial No. Declaration NA 22 inch Murray Push NA No longer usable — approx. 15 years old Mower DECLARE CERTAIN ITEMS IN THE OFFICE OF ROAD AND BRIDGE PRECINCT #1 AS WASTE AND REMOVE FROM INVENTORY: Commissioner Galvan made a motion to declare certain items in the office of Road and Bridge Precinct #1 as Waste and remove from Inventory. Commissioner Fritsch seconded the motion. Commissioners Galvan, Lyssy, Fritsch, Finster and Judge Pfeifer all voted in favor. Calhoun County Conunissionel• Precinct #1 211 S. Ann Port Lavaca, TX 77979 (361)552-9242 July 6, 2015 Honorable Michael Pfeifer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Pfeifer: Please place the following item on the next Commissioner's Court Agenda. County Fax (361) 553-8734 Pager (361) 579-7915 Mobile (361) 935-3552 Consider and take necessary action to declare the following items WASTE and remove from Precinct 1 Road & Bridge inventory: 1. Canon CFX-1-3500 IF Sit UEF15815 2. IBM Wheel Writer 30 Series II Sit 143060011RB762 ,a Roger C. Galvan RCGfapt 1, Sall, Mom,menr Md1mala, TeAro Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: 540 — PCT 1 ROAD & BRIDGE Requested By: ANGELA P TORRES Inventory Number Description Serial No. Reason for Waste Declaration 005 CANON CFX-L35001F 1JEF15M OIISOLIiTI? TI'sCLINOL,OGY LASER Mi.JLTI FUNCTION SYSTI3M 004 II3MWHEELWRITER IM762 OBSOLETEI'ECFINOLOGY 30 SERIES Il DECLARE CERTAIN ITEMS OF COUNTY PROPERTY AS SURPLUS/SALVAGE: N/A BUDGET ADJUSTMENTS: Commissioner Fritsch made a motion to approve budget adjustments. Commissioner Finster seconded the motion. 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Chief Appraiser Jesse Hubbell presented the 2015 Certified Values for Calhoun County. MEETING ADJOURNED AT 10:31 A.M.