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2016-12-08
Regular 2016 Term THE STATE OF TEXAS § COUNTY OF CALHOUN § Held December 8, 2016 BE IT REMEMBERED, that on this 8th day of December, A.D., 2016 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 County Judge Roger C. Galvan Commissioner, Precinct #1 Vern Lyssy Commissioner, Precinct #2 Kenneth W. Finster Commissioner, Precinct #4 Desiree Garza 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 Lyssy led the Pledge to the Texas Flag. Page 1 of 32 Hear Report From Memorial Medical Center. Jason Anglin spoke for Memorial Medical Center. He shared with the court that October was the slowest month they've had in about a year. He said October and November are generally slow months for them. On the positive side, outpatient has been up in December. Mr. Anglin advised Dr. Andres resigned her position and they are looking into bringing John Self in. Jason Anglin also spoke on other highlights for the hospital which are included in the Memorial Medical Center report attached to the minutes. Page 2 of 32 Memorial Medical Center - Port Lavaca, Texas CEO Report November 21, 2016 Financial Results: In October we had a Net Loss of $209,746 decreasing our Income for the year to $2,029,239. Waiver 1115 updates October is reporting month for our five Waiver 1115 projects. Physician Recruiting We have a follow-up call with an OBGYN candidate this week. We received a 90-day notice from Dr. Andrus. Her practice was building and she was doing well. Unfortunately, her spouse did not end up liking Port Lavaca and they are relocating to another area of the State. I have on the agenda to approve a Physician Recruitment agreement with John G Self Partners Inc. Nursing Home Program updates: Not much change here. Next fall is still a target date for the new QIPP program. Efforts are still being made to revive the Nursing Home MPAP program for 2017. Memorial Medical Clinic: Dr. Rojas office is now in Memorial Medical Clinic. Jerry continues to work with the state in having our Medicaid Rates reviewed and updated. This will lead to higher payment rates for Medicaid in our RHC and we will receive retroactive payment. This may be a long process. Radiologist transition Currently working on the I.T. interfaces for the transition. Chapel Dedication in Memory of D.J Williams- We held the dedication on November 22na Information on Board Items: Proposed Financial Assistance Policies- We have been working to update our financial assistance policies. A goal is to be able to classify more as charity care vs bad debt. Proposed Discount Policies- We also have been working on updating our discount policies. We have on the agenda for Insurance Renewals for: 1. Healthcare Professional and General Liability Renewal 2. Regulatory / Billing Errors and Omissions Insurance Renewal 3. Director & Officers Liability Insurance Renewal 4. Workers Compensation Insurance Renewal As of writing this report we are waiting on the renewal proposals. We anticipate having those at the board meeting. Proposed physician recruitment agreement with John G Self Associates — Please find the attached recruitment agreement to replace Dr. Andrus at Memorial Medical Clinic. Proposed Compliance Plan — We have been working to update our compliance plan. Presentation on MMC Productivity System — We will give an update of where our staffing is in comparison to industry benchmarks. Strategic Planning Discussion —As we think strategical about the future I would like to have a Discussion of MMC's current Strengths, Weaknesses, Opportunities and Threats. I'll start the discussion with a presentation. Closed Session — I have a closed session posted for Legal. R pectfully, Jason Angl n, CEO Memorial Medical Center Memorial Medical Center Financial Report For the Month of: October 2016 Overview: Low patient volumes pushed patient revenues down to their lowest point since November 2015, ending at $5,538,682. After discounts and adjustments the hospital recorded Net Revenue of $3,926,336. Though expenses were down some we ended the month with a Net Loss of $209,746 compared to a budget of $226,191 and a loss of $179,331 in October 2015.For the year, our total Net Profit including the nursing home MPAP is $2,029,239 against a loss of $336,217 at this point last year. We had actually budgeted for a profit of $2,029,239 for the year, but when we did the budget we had every expectation that MPAP would continue until the new program started so, taking that out we are $48,147 lower in profit than we budgeted. Operating expenses for the month of October (excluding the nursing homes) were $2,133,414 compared to a budget of $2,237,799 and for the year we have spent $21,970,893 against a 10 month budget of $22,377,992. Salaries & Wages are a little more than $300,000 under budget and all other expenses are running lower than expected except for Employees Benefits. Our expenses here are driven by actual claims so there is not as much control over these as we can exercise over other spending types. Memorial Medical Clinic's volume continues strong in spite of losing Ms. Dobbins with a total of 1,931 visits. Both Nurse Practitioners and Dr. Truong saw increased volume. The Surgery Clinic also saw a decline in volume with a total of 70 visits in October. Statistics: Inpatient volume fell to the lowest since November 2015 with 74 admissions and 286 patient days. Observation patients were lower than September, at 39, but were equal to August. There were 6 babies born in the hospital, which is about 3 less than our average has been this year. Emergency Room visits also were lower than any month since November 2015 The low inpatient volume resulted in reduced volume in the ancillary departments as well, as all departments showed decreases in volumes. Balance Sheet Highlights: ASSETS Bank Accounts Cash and Investment balances have grown to a total of $6,058,172, with $1,884,144 in Operating cash and an additional $1,845,373 in the Private Waiver account for future IGTs when they are needed. We know there will be a large DSRIP funding in January along with some UC and perhaps DSH fundings as well. In mid -November, the hospital made its second payment on the County loans as scheduled. All accounts' Days Cash on Hand was 61.46 at the end of October, with 34.64 days of spending in the bank if we exclude the Private Waiver account. Since there will be very little funding of the Community Benefit unless something changes, this account could well be used for funding Nursing Home MPAP/QIPP when the program is approved. Accounts Receivable Hospital Accounts Receivable fell to $10.46 million in October, helped by good collections and the lower than usual charges. Hospital agings improved for Medicare, Medicaid, and Blue Cross and the Blue Cross accounts actually attained our goal of having over 90% of the balance less than three months old. Clinic receivables also decreased by $124,000 due to increased collections and cleanup activities. As of Tuesday November 22, the hospital and clinic was at 54 Days Revenue in Accounts Receivable, which is about 6 days higher than our target. Accounts Receivable — Other The balance in Other A/R is $3,434,844. This will begin to grow slightly as we accrue for UC/DSH in the coming months. Accounts Receivable Nursing Home There is a balance of $4,626,796 in accounts receivable on the five nursing home books. Accounts Receivable Est. 3rd Party Payer Settlements We continue to show a payable to the program at this time so the balance in this account is zero. LIABILITIES Accounts PaVable Accounts payable decreased slightly, to $746,381. 1 think this will continue to decrease as our new person becomes more comfortable in her role. Due to Cantex The balance due to Cantex is high due to their higher than usual Accounts Receivable balance, and $1,828,555 in the Nursing Home bank accounts. Accrued Expenses We carried accrued payroll and benefits payable to hospital employees totaling $1,396,352, which is higher than usual. With Thanksgiving, Christmas, and New Year's coming up soon, this should get used up. Accrued Intergovernmental Transfers IGT liability increased to $567,173 on the expectation of funding some UC/DSH, but we have ceased to add dollars for the Community Benefit program. Accrued Payable — Est. 3rd Party Payer We currently show a payable to the Medicare program of $123,072. One of the few benefits of our low volume last month is that we owe less back to the federal government. Notes Payable The hospital's note payable to Calhoun County decreased to $2,905,069due to us recording our first payment. The second payment has already been made so the balance will drop again for November. Leases Payable The hospital has $653,407 in longterm debt of which $40,809 is due over the next 12 months. Current Ratio The ratio between our current assets and current liabilities is 1.69 compared to a 2.3 benchmark. Other Projects We continue to work with Patrick E. Carroll and Associates to identify and implement non -salary cost saving ideas, with about $150,000 identified so far. Also, I have spent a lot of time working with the rest of the Senior Team on new ideas to help offset the loss of the community benefit programs. One personnel note — Marissa Sutherland, our HIM director, passed her RHIT exam in November and will graduate with her degree on November 29. vmi n N N .ai V O n b mM am„.-itiom a o m ry o ry m 0 Ol V t0 T N tO O 'i N E W N O ONl ti n VI m N N a ei VI N OI rl rl N rl m Q m w � `o a E � m c m m.ni � rv.O1 .+ry T u W m p — Nco s Y m a a O o a o o a n Z Z o r RM 0 N N wf r w w `a a � = m .^ :Ml- w V m � Q 3 = M m V C � O c Q6 �a rrr � _ O Q V V d .Ni i y Z `a N v 0 —1— w N w l+l m m m 3 'W n M t0 tD t0 to t0 N h Vl c � O U m ON '� iN M m O ci n 1f1 N m Ol � v n rl N N O n� lD O rvl u O O O O O M N N N N t O O O O O M N N N N p O O O O O n l0 lD t0 tO t0 ri c-I c-I ri rl M ci �-1 �-1 ri v 0 m M n n t0 m m m m m on m w w O o m w O C m O -1 O N M n N m II O o mmmmoominry m t0 m O m O n O N w O d' V m m n m W �l c M O f•'1 tm m w w .ti V v N O N M M w w M lD C X W C a m tO m N c-I Ill IfI w O w ri m of cd .-i o pCj io Q -C v N N m d' m m U in p O w V CY) t0 ao N u L G �-1 N O rl N O c0 N m t6 V} W O M O m m N M n n n ul C M h Ol lm tm h O r-I' N Ol 0 0— N o7j v1 t0 V tm h N a 0 Ol N M O N n O] tD t0 c w ri .ti v rci of of � m o .ti p M N It) N m M N N 4l1 m 3 O m Q m tm 01 d' N c-1 1� .i ri N N N N N ivl toll OOi Omi Omi ti tN VI N rl i-i N m V 1� ? N m O U1 ry vl N N tD O vl m m M m m al°j � tm m n .-i vi vi v v to �i w � v m to w ti m v In N o m a w .+ w m m e m dN m to m w M N In v m v In m m In �o In ri � m t0 M m e-1 m to o m n °Ml ti v m m �m-1 M rl N vl n m O m to to l0 tD t» t0 N of m ti ti � N v N N N N N N N N Oi O1 l0 lO .y ti m m vl n w m w M m w W O m N n � v a1 ' OJ m m m d cf N n w w m m [O I-� N' m N �-1 Ill m N tD n t0 O m n n INn m � a m m 0 0 m � m N N m m w In n w io N ri a of v M ei V1 v } u> U y uv. Q:5 7! Q m O Z O F m n o n ti m o ci ri � n mlm ti n my m lm N d m N W N .mi m NJM � v3i v�i F -2- 0 Medical/Surgical/IN MObs[etms oSwing9ed -3- Memorial Medical Center Operating Statistics 12-Month Trends Outpatient Statistical Trends ' 2,126 2082 2,102 21015 2,016 2121 2,029 1,8]] 1,8]4 2,000 __. 1,720 _ _ _- 1,526 1,000 666 _ _ _ _686 691 ----938-""- 802 --___821-]18_. _]48-...__]26-'---743 _._ 684 500 465 476 456 502 485 573 532 525 516 564 518 530 0 Nov-15 Dec-15 Jan-16 Feb-16 Mar-ls Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16, �Outpatlent Visits �Emargen[y Room Visits y.=Spe<laity Clinic Visits Total Surgery & Endoscopy 200 p .. 9]____. 110_ __-8]-__ 95 105 ___. 111 -._96 ____.98__. .108. _._..___...__-132 1s1 _ �. 92 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 M-16 Aug-16 Sep-16 Oct-16 Radiology Procedures 2,000 1,000 1,543--1.593 _ 1,451-1�604""--1,636"'14]0----1,b]3--1,650'- 1,516 1,338 1,381 1155 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jol-16 Aug16 Sep-16 Oct-16 Total Laboratory Procedures 40,000 ___- -- __ - _._ -__ _. .__._— __- __-- ___- 120,000 ----------29]25-_32,514-___32,612__.-29,218--31,6]5.__.31,471-,._29,601-- 26,450 32,002___32,504-._28,929 22,]49 '. 0 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Physical Therapy Procedures- 4,90D 2,000 0 --1,505._-__1739,___1,803-__ 1,558_..__1,592-___3,535_. --1726 _,_1.89, 1805-2,052 1,861 ___-1,36J-- '', Nov-15 Dec-15 Jan-16 Feb16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 SeP16 OQ-16 -4- m m o N m m to � w o N n a m .-� m m m m IY N .-� 0 0 m rn n m o v 0 •-a O o In m to .y o m t0 m o r to a n m a w N of o m r m Ill m m a O N o a m m m vl n ry N c; N ei ei m 1' Vl 'i W tU m r a n a .-i m In r m m O' O' ,y' N <YI N m N a a M IO Ill V1 N m N m t0 �-I O Ql V O N m r m O N N N V1 n N l0 l0 r l0 O M N r m a O n m W m a V N M M n N W N m N a �-I N N n N V V N ci N m ei m w m tO O •-1 N N N m n N O r r m O �-1 'i O t0 ei m OJ N a n ID n n Ill Ip n N m O m �-1 M O N V ei N N N a O O N m V O �-1 'I n vl rl Vl r [i N N 'i IO 'R vl rl ei M m �-1 m �-i tO m N V M O1 V m m rl' N r m a n �-1 N l0 m m n O� tO a �-I N O] O ei DJ m r m N Il) m lO a ei O lO n N m O m O N r m V m m 'i N M V N IO Ill O N r V1 N '-I m a n VI Ol n N N n t0 OJ tO N �-I lO m tll m a O m If1 O1 I Ol O `i N m m N m n Ill O n rl '1 N M a� N n n a m O m N n a m 10 W l`p D] I m a N N m m N rl Qt O r V1 r O �-1 O M O lO m ^'I of o o -m m o �1 `-1 N Qi N ti rl O V N N N �-1 V1 N m r m m 41 N Ol [} rn N OJ VI W O N M IO N lD VI r Ill tO VI m N O 1� O N a m m If1 W OJ O m n N Ill N m O N N OI n a rl rl O Vl Vl m N m N n N m Ol a �-1 n N O Y1 N n a m O V m a m N �-1 N l0 VI n n N Ol It) m m m m a �-I n 01 O m lO a Ol N w m M Cl n O r V1 a O OW WN 1 m Nm I m rNnOm 1 r1 •-1 N N N •4 rl •-1 � if) 4 m N tO O O M O m p� m tO O O a N m V m VI m M m m M V W 0' 10 M a rl M r m n N m m n N �-1 N t0 ei N a "1 n m 'i O vl O ul m 'i •-1 N Ol N �-1 '1 rl O V' H M N n m a O N M r N l0 m t� N Vl 1t) n a O 'i 'i N m r m c1 M O W O O a N N m V1 OJ n N O m O ei M m r1 N m a CO Ol r Ol O] r 'i n Ol m V m m N M [i l0 n �i �-i N V1 m M N IQ m a n •i rl N N m .-I rl aY � vl � n Vl Ul O1 l0 N r m VI O m N M M N Vl a N m a a a N W N m m lO lO �-i O IO N OJ r m n O l0 r IO m M O 19 V rl W m `i m O m ci 'i ci N N rl "1 e: N V N m M m a a m a vl W tY m n n n '-I l0 n Il) m ry O a N IO a N N ei 'i W O rn a n r1 0 o to .y n to m m vi a "I a' o o .ti m m �4 N m m to a n rl •4 N IY ry ry m ci o ry 'i ry �-1 m m .-I m `i � If1 T N M O 'i r N O m N N n r O IO l0 O O �-I O m O O m m a m N Ol �-1 O Ot ei m m N l0 n O N Ill ei rl rl' N rl si rl e-1 N M ONI� a N N m n O O M •4 l0 N n l0 t0 ll1 n m ei O O N Vl O m m O Ill N V1 n O W N Vl In M ei r VI W N tD V m V lO m ID IO N l0 l0 m a m Ifl lO a n O ci �-I n 41 Ip m m l0 'i �-1 ci O m Ill N O W O m IO m m n O lO n O ei m m ry N W m T u� U Q «•S N E i I'l N U c v m L° T � wrE wwE oO w�o Eo Eo :5 O O z O z > > Ci m vl w w in ¢ a a o a -5- Memorial Medical Center YTD YTD YTD 10/31/2016 Statistical Comparison 10/31/14 10/31/1S 10/31/16 OVER (UNDER) %OF (10 months) (10 months) (10 months) 10/31/2015 CHANGE Total Admissions 1,104 917 969 52 5.7% ERAdmissions 776 779 615 (164) -21.1% Total Patient Days 4,319 3,821 3,800 (21) -0.5% AVERAGE DAILY CENSUS Medical/Surgical/ICU 11.06 9.73 10.02 0.47 4.7% Obstetrics 1.00 0.83 0.75 (0.17) -18.0% Swing Bed 2.10 1.97 1.69 (0.47) -22.3% Total AVG Daily Census 14.16 12.53 12.46 (0.17) -1.3% Total AVG LOS - Acute Care 3.55 3.81 3.66 (0.08) -2.2% Observation - Patients 407 410 476 66 16.1% Newborns -births 100 103 90 (13) -12.6% MMClinicVisits 7,428 9,632 18,562 8,930 92.7% Surgical Clinic Visits 532 460 927 467 101.5% Outpatient Visits 20,160 18,545 20,590 2,045 11.0% Emergency Room Visits 8,598 8,407 7,403 (1,004) -11.9% Specialty Clinic Visits 4,326 4,721 5,181 460 9.7% Total Surgery & Endoscopy 980 997 1,075 78 7.8% Total Laboratory Procedures 274,497 275,515 310,256 34,741 12.6% Radiology Procedures 7,987 8,009 7,109 (900) -11.2% RadiologyOP- Clinic 0 0 1,243 1,243 #DIV/01 Bone Density 123 125 136 11 8.8% Nuclear Medicine 200 156 191 35 22.4% Ultrasound 1,914 2,063 1,951 (112) -5.4% Ultrasound -Clinic 0 0 450 450 #DIV/01 CT Scans 2,400 2,240 2,570 330 14.7% MRI 983 945 1,138 193 20.4% Mamograms 830 685 829 144 21.0% Total Radiology Procedures 14,437 14,223 15,617 1,394 9.8% Respiratory Therapy Procedures 9,237 9,498 7,755 (1,743) -18.4% Stress Test 96 60 70 10 16.7% EKG Exams 3,015 3,158 3,144 (14) -0.4% EEG Exams 10 20 0 (20) -100.0% Sleep Studies 91 61 141 80 131.1% Total Respiratory 12,403 12,797 11,110 (1,687) -13.2% Physical Therapy Total 21,077 16,467 17,190 723 4.4% Occupational Therapy Total 0 423 2,187 1,764 417.0% Speech Therapy Total 0 85 573 488 574.1% Pharmacy Total 92,829 124,047 119,953 (4,094) -3.3% Dietary Total 106,229 113,470 47,075 (66,395) -58.5% Pounds of Linen 211,254 201,761 125,333 (76,429) -37.9% -6- moN'mOno a"'e »m��xmmmm TNN r ohm mN a ti°"°mon0o m'o »»no �N�Nm 4 x x O o E v3¢Z 16 v'„ a o 16 _7 _ Memorial Medical Center Payer Mix Payer Mix Memorial Medical Center As of October 31, 2016 E E 3 m ¢ m E o L. U o v v n O Z � N Medicare —Medicaid ' C: —Blue Cross-' Commercial Private Other a m O O N n n m [t b O] N o ,y rl rl o ro ri ro a .I .y n momo.-i � mMm 0 000n nln mm moln n lmll :a .=goo n�o m wva N N V n O V N N r N a r O N �^ wm omul a i� rob N O M O b M O O M N M olrIF ri Lr o .=lmry m n mrm '^ .Ni rai nuoi lmn mam v o brie O ei I.mi vmi�moo my elan m romp ^'' mn non mNo m m e O N m VI N O N ,1py oo�Mi mole mIq 6 a mm a � vb vio o1 le ry m1p .i av m N N N N 111 M W ✓m1 ON N N b W b c rP rci ti ri m y of v N� r eMi O M O N M VI O N N r O M �N-Iry nleon o mmm m In vlM abo a n mMb `moo n`io m ommumi onm M N VN'mmo n .aim m ry :ice `� V VI 0 a N N N rl M' MI n N r O VI m N m b N O aO N o Iril �-i O VI O m b O T b n M a O W m Mmvminon tilea m "INN l'+ aN mN Mm aMm c .i b ri a o .-i ro ro m In b vo vMon eo.M-I-� v � ono N O S V M m r N O m N O V1 W CO d' N N al N N On) m O O m n I N W N m N Q „ N V n N N Ifl Ol V M o Ill a N b m N b ,I^y oor000 a m "' tilmn amo Vci N ei C E V C C V. « c ¢` Q t4 U Nw ,-U z a m w Q 16 'v w x¢ r ci ¢¢ m m In m mom n.n+ � n o m o'e tV N .bi v Irnrnm m n m ti m n `{ 1p O o In N d ldil ei N N ♦i ei m m r n m r a a m ti N V N N Imll m 'i d' IITI V �i ul m m ON � T N M ID M m uNl Vl rbi � n V N m n m N IdU N C' O C I n O � Vl 1/O„1 n ~ N ti I \ N m b a-1 M Ill e01 V1 Ill •i m N m O �� O� T b � d T rl N V IO N b N N M y V O b n YO) Ill O n ei M N rl N Vl m N Vl rtl �-I IN -In m ao 1pm .=I I1On ti �m� vl tiri v omi �ma N Ne n m cl � d r o m Io ri In .+ v d c ui m dm In � .+mdm Iom m .-1 b N .in Nomm Inmmme in N Imov� IO N fi N I � � m' 1 h n m M N N m N b V O N �a-I y ei m m IyMIII O d b ryry N M b b b Imll �n-I vml o Ol n M O V N N d' N N m 1� NN Oml Ill rl m 'i Ill L 0 N N Oi M rl ri d' „ g 'i r4 O' rl N N b m C N W I N N V n C fn-I nm1 IMII r1 rl rl M N'rl ti N n ti ti m M DJ b O m N m N O m m m V N b n O O O N y N P p-1 N r Imll M II V �-1 m m Id ti I N c m m m r d a m n n n d m ,1py mn vbi,o me amnm o.=1 m o mmI°10 °' mm tilNll O1ro Ino3o .-io m N not ri vmin momm .-Immm a om Io m b' m m M nInm \ rl N O T h W ^� �m vtiti m `VI' .i `Ory n v oN omo 9 IMp n n I� n Vn V N V N O Ilml V 'ml adi N N �-I N N Im*1 b ti IN m ti N o m b �-1 m .-+m mmrm In or n d .i mn nom 111 Inn lance IQ Ili ano •o on -{o n n v N"l mo llminna C W � V C N O F y T N c L c w .. v v _ Memorial Medical Center Income Statement by Operating Unit For the Month Ended October 31, 2016 Revenue Current Period Year to Date Nursing Nursing Hospital Clinics Homes Combined Hospital Clinics Homes Combined 873,288 - - 873,288 Inpatient Revenues 13,077,066 - - 13,077,066 2,337,238 564,254 - 2,901,493 Outpatient Revenues 26,035,652 5,153,369 - 31,189,021 1,763,901 - - 1,763,901 ER Revenues 17,889,512 - - 17,889,512 - - 3,386,974 3,386,974 Resident Revenues - - 34,906,491 34,806,491 4,974,428 564,254 3,386,974 8,925,656 Total Patient Revenue 57,002,230 5,153,369 34,806,491 96,962,090 3,080,183 284,665 - 3,364,848 88,762 - - 88,762 58,583 - - 58,583 (79,992) 79,992 - - (278,324) - - (278,324) 692,467 - - 692,467 3,561,680 364,657 - 3,926,337 1,412,748-199,597 3,386,974 4,999,320 34,023 35,840 - 69,863 1,446,771 235,437 3,386,974 5,069,182 Hospital Current Period Nursing Clinics Homes Combined 766,214 99,574 - 865,788 224,752 33,193 - 257,945 206,760 173,920 - 380,680 258,589 14,953 - 273,541 218,879 17,751 - 236,630 3,567 - - 3,567 26,563 - - 26,563 83,369 5,331 - 38,700 - - 3,386,974 3,386,974 1,788,692 344,722 3,386,974 5,520,388 59,164 19,622 - 79,786 1,847,856 364,344 3,386,974 5,599,174 (401,085) (128,907) - (529,992) 105 - - 105 (2,590) - - (2,590) 100 - - 100 (98,735) - - (98,735) 247,446 173,920 - 421,366 146,326 173,920 - 320,246 (254,759) 45,013 (209,746) Revenue Deductions Contractuais Charity Indigent Care Overhead DSH Bad Debt Total Revenue Deductions Net Patient Revenue Other Operating Revenue 33,649,453 1,471,460 - 35,120,913 1,181,753 - - - 1,181,753 441,089 - - 441,089 (207,291) 207,291 - - (2,409,344) - - (2,409,344) 6,549,176 - - 6,549,176 39,204,836 1,678,751 - 40,883,587 17,797,393 3,474,618 34,806,491 56,078,502 342,854 187,910 - 530,764 Total Operating Revenue 18,140,248 3,662,528 34,806,491 56,609,267 Operating Expenses Salaries & Wages Employee Benefits & PR Taxes Professional Fees Purchased Services Supplles Insurance Utilities Other Expenses Nursing Home Fee Total Operating Expenses Depreciation Year to Date Nursing Hospital Clinics Homes Combined 7,637,524 1,015,693 - 8,653,217 2,447,993 318,196 - 2,766,189 1,935,040 1,657,273 - 3,592,313 2,712,222 365,929 - 3,078,151 2,475,532 150,165 - 2,625,697 56,342 - - 56,342 425,968 - - 425,968 728,233 44,784 - 773,016 - - 34,806,491 34,806,491 18,418,854 3,552,039 34,806,491 56,777,384 695,148 196,222 - 891,369 Total Expenses 19,114,002 3,748,260 34,806,491 57,668,753 Net Operating Income / (Loss) Non Operating income / (Exp) Investment Income Interest Expense Contributions and Grants IGT Expense Service Contribution by SOSEf Nursing Home MPAP Total Non -Operating Revenue Total Net Income / (Loss) (973,754) (85,732) - (1,059,486) 1,219 - - 1,219 (30,560) - - (30,560) 600 - 600 (1,477,517) (1,038,347) - (2,515,864) 2,217,134 1,657,273 - 3,874,406 - - 1,758,924 1,758,924 710,876 618,926 1,758,924 3,088,726 (262,879) 533,194 1,758,924 2,029,239 -11- Memorial Medical Center Capital Acquisitions For the Month Ended October 31, 2016 Month Description Building Equipment Total 01/16 IF Electronic Lab Interface -ELR - 4,475 4,475 January 2016- Computer Purchases - 6,317 6,317 WebPTSoftware - 7,S24 7,524 Hotter Recorders (4) - 6,299 6,299 Clinic-CIP- Various Equipment - 18,401 18,401 Sub Total January 43,015 43,015 02/16 February 2016- Computer Purchases - 1,271 1,271 Clinic- CIP- Various Equipment 11,042 133,730 144,771 Sub Total February 11,042 135,001 146,042 03/16 Samsung Lease -X-Ray Room - 206,040 206,040 Evident - Lab interface - 4,554 4,554 Exebridge Intranet Project -CIP - 1,500 1,500 Clinic - CIP -K&T Pay App 277,983 - 277,983 Clinic - CIP -ACl/Boland 18,S35 - 18,535 Clinic-CIP- Various Equipment - 24,079 24,079 Sub Total March 296,518 236,173 532,691 04/16 Clinic - CIP -ACl/Boland 2,770 - 2,770 Clinic-CIP- Various Equipment - 5,363 5,363 Deposit on Voice Recognition Interface - 3,000 3,000 April 2016- Computer Purchases - 4,044 4,044 EMDS Software License - Dr. Andrus - 8,790 8,790 Sub Total April 2,770 21,197 23,967 05/16 Clinic - CIP -K&T Pay App 154,794 - 154,794 Cardin Rehab Equipment - 10,529 10,529 PACS Interface - Downpayment - 500 Soo Sub Total May 154,794 11,029 165,823 06/16 June 2016- Computer Purchases - 4,043 4,043 Sub Total June 4,043 4,043 07/16 Surgial Eye Microscope - 31,500 31,500 CR-E Class Control Station for Radiology - 9,750 9,750 Sub Total July 41,250 41,250 08/16 August 2016-Computer Purchases - 5,109 5,109 CIP- Air Conditioning Unit for Lab - 4,965 4,965 Sub Total August 10,074 19,074 09/16 Defibrillator-Lifepak 20e - 7,406 7,406 Network5witches - 6,679 6,679 September 2016- Computer Purchases - 11,382 11,392 PACS Storage - Downpayment - 5,058 5,058 Sub Total September 30,52S 30,525 10/16 October 2016- Computer Purchases - 3,430 3,430 PACS Storage -Backup Tapes - 1,54S 1,545 EM US License -50%of Invoice - 4,425 4,425 Fence and Ramps at Clinic 7,550 - 7,550 Concrete Improvements 11,050 - 11,050 HVAC Fan Coil - 8,700 8,700 Bailer - 8,250 8,250 Sub Total October 18,600 26,350 44,950 Total $ 483,723 $ 558,656 $ 1,042,379 -12- Physician Revenue Trend Memorial Medical Center As of October 2016 October 2016 2016 YTD PRIOR YEAR TD Memorial Medical Center Clinic 011005 William Crowley $ 523,800 $ 5,039,503 $ 5,553,225 019000 Ric Arroyo -Diaz $ 340,148 $ 4,183,947 $ - 009293 Serina Danielson $ 101,132 $ 2,065,427 $ 2,336,280 000966 Thao Truong $ 209,175 $ 1,412,368 $ 451,559 041743 Angela Dobbins $ 11,667 $ 951,883 $ 515,358 005966 Carol Andrus $ 125,564 $ 530,886 $ - 058001 CourtThurlkill $ 39,793 $ 423,754 $ 39,833 002099 Traci Shefcik $ 48,035 $ 632,218 $ 40,943 009294 John Durst $ 81,778 $ 85,801 $ - 009292 Charles Fillingane $ - $ - $ 243,396 $ 1,481,092 $ 15,325,787 $ 9,180,595 28% 25% 17% Memorial Medical Surgical Clinic 022000 Peter Rojas $ 198,334 $ 2,639,515 $ 735,899 $ 198,334 $ 2,639,515 $ 735,899 4% 4% 1% Hospitalist 130006 Hospitalist $ 495,807 $ 6,946,051 $ 2,252,918 $ 495,807 $ 6,946,051 $ 2,252,918 9% 11% 4% Port Lavaca Clinic 013000 Don Paul Bunnell $ 23,275 $ 328,383 $ 3,206,542 050001 John Wright $ 224,351 $ 3,734,164 $ 3,878,930 019000 Ric Arroyo -Diaz $ - $ - $ 2,640,487 013001 Leigh Anne Falcon $ 205,995 $ 2,277,273 $ 2,125,193 008800 N i rtas Kwi Timu $ 233,551 $ 1,912,095 $ 1,962,908 001500 Jewel Lincoln $ 191,348 $ 2,301,219 $ 1,377,518 320001 Shanna Odonnell $ 32,141 $ 385,536 $ 349,289 012000 Jeannine Griffin $ 23,429 $ 196,847 $ 348,466 700003 Bludua/Bunnell $ - $ 53,964 $ - 320000 John Lee $ - $ - $ 35,860 $ 934,089 $ 11,189,481 $ 15,925,193 17% 18% 29% Specialty Clinic 022000 Peter Rojas $ - $ $ 849,215 012100 Donald Breech $ 122,953 $ 779,243 $ 751,995 000404 Ayo Ad $ 76,298 $ 826,716 $ 821,298 070002 Richard Steinberg $ 19,935 $ 184,382 $ 144,186 525225 Azhar Malik MD $ 5,106 $ 70,488 $ 70,533 900000 Dakshesh Parikh $ 3,131 $ 59,422 $ - 057006 A Qadri $ - $ - $ 48,956 $ 227,423 $ 1,920,251 $ 2,686,182 4% 3% 5% -13- Physician Revenue Trend Memorial Medical Center As of October 2016 October 2016 2016 YTD PRIOR YEAR TD Coastal Medical Clinic 011000 Tim McFarland $ 77,838 $ 805,588 $ 446,448 000806 William McFarland $ 29,930 $ 248,874 $ 194,366 $ 107,768 $ 1,054,462 $ 640,814 2% 2% 1% Independent 006000 M S Lin $ 5,414 $ 1,553,397 $ 1,410,264 004000 G A Williams $ - $ 20,257 $ 93,071 310001 Michelle Cummins $ 39,531 $ 569,488 $ 739,660 330000 Nhi Le MD $ 2,706 $ 29,785 $ 79,516 004002 Laura Deming $ - $ - $ - $ 47,651 $ 2,172,927 $ 2,322,511 1% 3% 4% Other Medical Staff 065002 George Boozalis $ 18,731 $ 233,612 $ 127,637 075000 Laborator Ramos $ - $ - $ 604 $ 18,731 $ 233,612 $ 128,241 0% 0% 0% Total E/R Physicians $ 1,411,250 $ 15,976,412 $ 16,156,329 $ 1,411,250 $ 15,976,412 $ 16,156,329 26% 26% 29% Other Ordering Physicians Other Ordering Physicians 004004 Neese/Twin Foun 000359 EarnestAlsop 000080 Marcus Caughron 807077 Nilesh Patel 800003 Bryan Kestler 900327 Dharmendr Verma 000077 Scott Stein 900116 Sabbagh Mohamme 012102 Jerr Followwill 142001 Greg Cowart Totals $ 375,050 $ 3,730,190 $ 3,394,058 $ - $ 169,391 $ 390,575 $ $ - $ 22,656 $ $ 33,768 $ - $ 27,850 $ 593,898 $ 803,216 $ 1,777 $ 45,056 $ 11,272 $ 6,390 $ 92,393 $ 122,828 $ 1,091 $ 49,672 $ $ 6,746 $ 47,420 $ 31,052 $ - $ 25,595 $ 69,031 $ - $ - $ 109,203 $ 418,903 $ 4,787,384 $ 4,953,891 8% 8% 9% $ 5,341,048 $ 62,245,881 $ 54,982,575 Memorial Medical Center Hospital Accounts Receivable quality Indicators Accounts Receivable by Payer S P B Medlta�e Metlloltl ABlue boss YCommeNal ®Pm'ale Pay Medicare Aging <60 Days '', ''.. Blue Cross <90 Days IW.036 MY' 91% 91Y< 89% 90% B6X 06n BJ% 98!6 BEYa'.. ]W.O:'o 8J% 9lF 9 89a 85% 83%" Bt% 93 0]qy n% 85% 81% .M6 '.. Mlpib ]O.OK ]0.01'e if 30.O:i ,. 30.oi i0vX 30.0% � 300%30,M ti h5 1 ti TO 1 1, T5 .16 ti C�. �� >6 � P%y SQ o. .. o �� O� ��ti >C.'>' \h0 PCh� leQ v E°a>o �zb � l o Medicaid Aging< 90 Days, Commercial< 90 Days S.,A "I 89% es% ) q, 78% J>M 76% Jb% 73X 74% 7cM)003� SO P)6 9 3005 l00% 5 § ,Yti 1 h S6 ` 1 'iz ti0 16 .zfa .z6 b —15— Memorial Medical Center Clinic Accounts Receivable Quality Indicators Accounts Receivable by Payer fioboca '. 6W,Om aw,D6o ' aD,o6DAllow s.o-lb onafi wo.a6 Deca6 N1etl11— Medicaltl QBlue — Medicare < 60 Days Blue Cross< 90 Days ]aoor. _. 3W.ln wux; lna% cam: sa.o% sDm: Iv" 90M6 300M _ _.. — _. _ - _. _. A= .. x00X xDOi IOme 1D. O.DX 00'.6 LP16 Octdb Nov-]6 Dec36 SeP]6 Oct-36 Novl6 Oec-]6 Medicaid <90 Days Commercial <90 Days 663% F% 60.OX 63 .e�.r. &1 ]DO'A )00% W O% 60Pe 41� 40.m'v SO. 3Im0% 2,W - x0.0:o 0.0]e O.OPi Sep16 IXFI6 Nov-]6 Dec-]6 SeP]6 0CN6 Nov-]6 Dec16 -16- RUN DATE:11/17/16 MEMORIAL ME➢ICAL CENTER TIME:15:08 CHECK REGISTER 10/01/16 TURN 10/31/16 BANK--CHECK------------------------------------------ CODE NU14BER DATE 94OUNT PAYEE A/P 000827 10/04/16 883.47 MCKESSON A/P 000828 10/04/16 1,007.54 MCKESSON A/P 000829 10/04/16 9,579.22 MCKESSON A/P 030830 10/10/16 1,338.59 MCKESSON A/P 000931 10/10/16 427.11 MCKESSON A/P 000932 10/10/16 526.91 MCKESSON A/P 000833 10/17/16 1,225,30 MCKESSON A/P 000834 10/17/16 198.60 MCKESSON A/P 000835 10/17/16 1,401,77 MCKESSON A/P 000836 10/24/16 152.03 MCKESSON A/P 000837 10/24/16 693.19 MCKESSON A/P f 000838 10/24/16 605.20 MCKESSON A/P f 167956 10/19/16 189,02CR JOHNSTONE SUPPLY A/P 168168 10/04/16 600,00 SMART SHERRI KAY A/P 168169 10/07/16 1,978,68 US FOOD SERVICE A/P 169170 10/07/16 213.79 DOHS CENTRAL LAB MC2004 A/P 168171 10/07/16 305.19 MERCEDES MEDICAL A/P 169172 10/07/16 271.80 PHARMEDIUM SERVICES LLC A/P 168173 10/07/16 780.00 SPECTRUM TECHNOLOGIES A/P 168174 10/07/16 2,001.34 PRINCIPAL LIFE A/P 168175 10/07/16 390.44 DEWITT POTH & SON A/P 168176 10/07/16 26.61 PRECISION DYNA14ICS CORP (PDC) A/P 168177 10/07/16 .00 VOIDED A/P 168178 10/07/16 15,783.73 MORRIS & DICKSON CO, LLC A/P 168179 10/07/16 98.28 PLATINUM CODE A/P 168180 10/07/16 29,525.00 WOUND CARE SPECIALISTS A/P 168181 10/07/16 45,001.00 BKD, LLP A/P 168182 10/07/16 268.92 RAUSHANAH MONDAY A/P 168183 10/07/16 919.19 CAREFUSION 2200, INC A/P 168184 10/07/16 390.00 SIGN AD, LTD. A/P 168165 10/07/16 2,140.00 LIFESOURCE E➢UCATIONAL SRV LIE A/P 169186 10/07/16 2,188.26 STRYKER SUSTAINABILITY A/P 160187 10/07/16 792,643.11 PRIVATE WAIVER CLEARING ACCT A/P 168188 10/07/16 98,791,47 MMC EMPLOYEE BENEFIT PLAN A/P 168189 10/07/16 9,564.11 HRALTHSTREAM, INC. A/P 168190 10/07/16 416.00 WALLER,LANSDEN, DORTCH & DAVIS A/P 168191 10/07/16 250,00 CAL14OUN SPORTS ME➢ICINE A/P 168192 10/07/16 1,300.00 REED, CLAYMON, MEEKER & HARGET A/P 168193 10/07/16 2,646.78 COMBINED INSURANCE CO A/P 169194 10/07/16 1,146.40 BIRCH COMMUNICATIONS A/P 168195 10/07/16 877,50 PABLO GARZA A/P 168196 10/07/16 851.75 STRATUS VIDEO INTERPRETING A/P 168197 10/07/16 249.00 COLA RESOURCES, INC. A/P 168198 10/07/16 8,233.19 PAETEC A/P 160199 10/07/16 31,974.11 TXU ENERGY A/P 16B200 10/07/16 57.08 FRONTIER A/P 168201 10/07/16 263.35 IRON MOUNTAIN A/P 168202 10/07/16 126,573.19 TEXAS BLOC A/P 168203 10/07/16 31,148.06 JACKSON & COKER LOCUM THEBES, A/P 168204 10/07/16 9,019.75 AMN HEALTHCARE ALLIED, INC. PAGE 1 GLCKREG -77- RUN DATE:11/17/16 MENIORIAL MEDICAL CENTER PAGE 2 TIME:15:08 CHECK REGISTER GLCKREG 10/01/16 THRU 10/31/16 BANK --CHECK------------------------------------___ CODE NUMBER DATE AMOUNT PAYEE ---------------------------- A/P 160205 10/07/16 443,00 GREAT BASIN SCIENTIFIC, INC A/P 169206 10/07/16 4,990.00 3WON, LLC A/P 168207 10/07/16 7,989,60 REMI CORPORATION A/P 168208 10/07/16 9,000.00 PECA A/P 168209 10/07/16 2,505.00 MEDW,AB,INC A/P 168210 10/07/16 298.32 JANIE BACERRA A/P 168211 10/07/16 15.53 GULF COAST HARDWARE / ACE A/P 168212 10/07/16 85.71 AIRGAS USA, LLC - CENTRAL DIV A/P 168213 10/07/16 995.27 CARDINAL HEALTH 414,11C A/P 168214 10/07/16 73,00 ANNOUNCEMENTS PLUS TOO AGAIN A/P 169215 10/07/16 260.00 BARD PERIPHERAL VASCULAR A/P 168216 10/07/16 633,15 BAXTER HEALTHCARE A/P 168217 10/07/16 6,166.94 BECKMAN COULTER INC A/P 168219 10/07/16 239.00 BENTLEY & SMART A/P 168219 10/07/16 116.41 CALHOUN COUNTY A/P 168220 10/07/16 202.50 CERTIFIED LABORATORIES A/P 168221 10/07/16 69.25 CONMBD CORPORATION A/P 168222 10/07/16 6,783.44 CDW GOVERNMENT, INC. A/P 169223 10/07/16 33,588.91 EVIDENT A/P 168224 10/07/16 425.97 C R BARD, INC A/P 168225 10/07/16 98.30 DOWNTOWN CLEANERS A/P 168226 10/07/16 185.60 DLE PAPER & PACKAGING A/P 168227 10/07/16 47.47 CENTERPOINT ENERGY A/P 168228 10/07/16 7.74 FEDERAL EXPRESS CORP. A/P 168229 10/07/16 4,944,66 FISHER HEALTHCARE A/P 168230 10/07/16 12S,00 GULF COAST DELIVERY A/P 168231 10/07/16 314.98 HOSPIRA WORLDWIDE, INC A/P 168232 10/07/16 45.64 INDEPENDENCE MEDICAL A/P 168233 10/07/16 1,571.67 WERFEN USA LLC A/P 168234 10/07/16 1,859.19 J & J HEALTH CARE SYSTEMS, INC A/P 168235 10/07/16 294.98 JOHNSTONE SUPPLY A/P 168236 10/07/16 138.40 MARTIN PRINTING CO A/P 162237 10/07/16 3,629,09 MCKESSON MEDICAL SURGICAL INC A/P 168238 10/07/16 5.77 MEDLINE INDUSTRIES INC A/P 168239 10/07/16 192.87 MMC AUXILIARY GIFT SHOP A/P 168240 10/07/16 447.84 MERRY X-RAY/SOURCECNE HEALTHCA A/P 168241 10/07/16 179.84 ON -SITE TESTING SPECIALISTS A/P 168242 10/07/16 1,760.20 ORTHO CLINICAL DIAGNOSTICS A/P 168243 10/07/16 .00 VOIDED A/P 168244 10/07/16 6,040.10 0WENS & MINOR A/P 168245 10/07/16 37.50 R & D BATTERIES INC A/P 168246 10/07/16 324.00 SHIP SHUTTLE TAXI SERVICE A/P 168247 10/07/16 1,797.64 SMITH & NEPHEW A/P 168240 10/07/16 456.11 STRYKER SALES CORP A/P 168249 10/07/16 5,534.95 TEXAS ASSOCIATION OF COUNTIES A/P 168250 10/07/16 4,731.00 TEXAS MUTUAL INSURANCE CO A/P 168251 10/07/16 81.54 UNIFIRST HOLDINGS A/P 168252 10/07/16 615.77 UNIFORM ADVANTAGE A/P 168253 10/07/16 2,622,74 UNIFIRST HOLDINGS INC A/P 169254 10/07/16 239.63 GRAINGER A/P 168255 10/07/16 200.00 CURRY BRIAN I" RUN DATH;11/17/16 MEMORIAL 14EDICAL CENTER PAGE 3 TIMRE 15:08 CHECK REGISTER GLCKREG 10/01/16 TURD 10/31/16 BANK --CHECK---------------------------------' CODE NUMBER DATE AMOUNT PAYEE A/P 168256 10/07/16 164.41 MUELLER MARK R A/P 168257 10/12/16 2,626.59 PHILIPS HEALTHCARE A/P 168258 10/12/16 305.24 EREE USA INC SURGICAL SYSTEMS A/P 168259 10/12/16 9,436.91 US F00D SERVICE A/P 168260 10/12/16 383.41 149RCEDES MEDICAL A/P 168261 10/12/16 465,43 SPECTRUM TECHNOLOGIES A/P 168262 10/12/16 2,719.19 CENTURION MEDICAL PRODUCTS A/P 168263 10/12/16 859.27 ➢EWITT BOTH & SON A/P 168264 10/12/16 148.62 PRECISION DYNAMICS CORP (PDC) A/P 168265 10/12/16 .00 VOIDED A/P 168266 10/12/16 22,366.04 MORRIS & DICKSON CO, LLC A/P 168267 10/12/16 151.68 PLATINUM CODE A/P 168268 10/12/16 175,00 ROGBRS HOME MEDICAL A/P 168269 10/12/16 1,500.57 LUMINANT ENERGY COMPANY LLC A/P 168270 10/12/16 1,275.00 SIGN A➢, LTD. A/P 168271 10/12/16 1,560,00 LIFESOURCE EDUCATIONAL SRV LLC A/P 168272 10/12/16 495.00 OSCAR TORRES A/P 1682U 10/12/16 540,971.14 PRIVATE WAIVER CLEARING ACCT A/P 168274 10/12/16 90.00 TEXAS PRESCRIPTION PROGRAM A/P 166275 1C/12/16 44,978.12 LAIC EMPLOYEE BENEFIT PLAN A/P 168276 10/12/16 30,430.73 ALLIED BENEFIT SYSTEMS A/P 169277 10/12/16 3,477.27 NOVA BIOMEDICAL A/P 168278 10/12/16 305.50 GENESIS DIAGNOSTICS A/P 168279 10/12/16 2,693.28 WAGEWORKS A/P 168280 10/12/16 9,012.65 RICOH USA, INC A/P 168281 10/12/16 35.00 MEMORIAL MEDICAL CLINIC A/P 168282 10/12/16 1,382.50 M G TRUST A/P 169263 10/12/16 583.99 BERRI HART A/P 168284 10/12/16 75.00 FIRST CLEARING A/P 168285 10/12/16 139.68 THE BRATTON FIRM A/P 168286 10/12/16 18,938.27 STUDER GROUP, LLC A/P 168287 10/12/16 6,678.76 EXEBRIDGE A/P 168288 10/12/16 14,49 MISTY RECTOR A/P 168289 10/12/16 11,257.48 GARDNER & WHITE, INC. A/P 168290 10/12/16 16.68 JACK80N & COKER LOCUM SERENE, A/P 168291 10/12/16 299,00 JOBS THERAPY A/P 169292 10/12/16 121.00 GENERAL HOSPITAL SUPPLY A/P 168293 10/12/16 99,59 TROEMNER, LLC A/P 168294 10/12/16 310.00 AVENO NETWORKS A/P 168295 10/12/16 261.41 GULF COAST HARDWARE / ACE A/P 168296 10/12/16 50.75 AIRGAS USA, LLC - CENTRAL DIV A/P 168297 10/12/16 687.56 ALPHA TEC SYSTE14S INC A/P 168299 10/12/16 344,62 BARD PERIPHERAL VASCULAR A/P 269299 10/12/16 514.09 BAXTER HEALTHCARE A/P 168300 10/12/16 1,400,00 CABLE ONE A/P 168301 10/12/16 25.00 CAL COM FEDERAL CREDIT UNION A/P 168302 10/12/16 680.00 CAD SOLUTIONS, INC A/P 168303 10/12/16 476,699,73 CALHOUN COUNTY A/P 168304 10/12/16 62.50 COASTAL OFFICE SOLUTONS A/P 168305 10/12/16 313.00 GI SUPPLY A/P 168306 10/12/16 56239 CRAMMING L BETE CO INC -19- RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER PAGE 4 TIME:15;08 CHECK REGISTER GLCKREG 10/01/16 THRU 10/31/16 BANK --CHECK---------------________----------------________--_ CO➢E NUMBER DATE AP40UNT PAYEE ------------------------------------------------------------ _ _ A/P 168307 10/12/16 547.12 CONNED CORPORATION A/P 168308 10/12/16 31.59 COW GOVERNMENT, INC. A/P 168309 10/12/16 166.37 C R BARD, INC A/P 168310 10/12/16 1,407,99 FISHER HEALTHCARE A/P 168311 10/12/16 530.00 FORT BEND SERVICES, INC A/P 168312 10/12/16 557.51 GULF COAST PAPER COMPANY A/P 168313 10/12/16 32.54 H E BUTT GROCERY A/P 168314 10/12/16 305.08 INDEPENDENCE MEDICAL A/P 169315 10/12/16 618.00 WERFEN USA LLC A/P 168316 10/12/16 2,968.39 J & J HEALTH CARE SYSTEMS, INC A/P 168317 10/12/16 104.40 M.C. JOHNSON COMPANY INC A/P 168318 10/12/16 1,285.79 SHIRLEY KARNEI A/P 168319 10/12/16 109.59 LOWE'S HOME CENTERS INC A/P 168320 10/12/16 6,441.53 MCKESSON MEDICAL SURGICAL INC A/P 168321 10/12/16 110.79 MEDLINE INDUSTRIES INC A/P 168322 10/12/16 157.98 MERRY X-RAY/SOURCEONE HEALTHCA A/P 168323 10/12/16 91.87 NEC VOLUNTEERS A/P 168324 10/12/16 601.32 MEDIVATORS A/P 168325 10/12/16 3,000.00 NUTRITION OPTIONS A/P 169326 10/12/16 123,48 OFFICE DEPOT A/P 168327 10/12/16 866,57 CRIED CLINICAL DIAGNOSTICS A/P 168328 10/12/16 372.24 CITRUS & MINOR A/P 168329 10/12/16 151.40 R & DBATTERIES INC A/P 168330 10/12/16 249.10 CULLIGAN OF VICTORIA A/P 168331 10/12/16 1,465.58 SIEMENS MEDICAL SOLUTIONS INC A/P 168332 10/12/16 72.89 SMILE 14AKERS A/P 168333 10/12/16 5,431.48 SO TEK BLOOD & TISSUE CENTER A/P 168334 10/12/16 361.31 STRYKER SALES CORP A/P 168335 10/12/16 79.00 HAMMIT? BETHANY A/P 166336 10/12/16 294.69 TLC STAFFING A/P 169337 10/12/16 137.90 TEXAS WIRED MUSIC INC A/P 169338 10/12/16 112.63 TG A/P 168339 10/12/16 3,000.00 TRINITY PHYSICS CONSULTING LLC A/P 168340 10/12/16 2,701.12 TORCH A/P 168341 10/12/16 81.54 UNIFIRST HOLDINGS A/P 168342 10/12/16 720.05 UNIFORM ADVANTAGE A/P 168343 10/12/16 3,251.97 UNIFIRST HOLDINGS INC A/P 168344 10/12/16 58.86 THE VICTORIA ADVOCATE A/P 168345 10/12/16 5,073.75 CARMEN C. ZAPATA-ARROYO A/P 168346 10/12/16 72.20 BARBARA ADAMS A/P 168347 10/12/16 1,403.30 PRS A/P 168348 10/12/16 4,013.23 GOLDEN RULE INS CO. A/P 168349 10/12/16 95.00 HUMANA HEALTH CARE PLAN A/P 168350 10/12/16 50.00 IBG/GENERIC A/P 168351 10/18/16 600.00 ST DAVIDS HEALTHCARE A/P 168352 10/20/16 165.00 PORT LAVACA CHAMBER OF COMMERC A/P 168353 10/20/16 207.04 LANSON PRODUCTS A/P 168354 10/20/16 1,979.35 US FOOD SERVICE A/P 168355 10/20/16 258.62 MERCEDES MEDICAL A/P 168356 10/20/16 466.90 PHARMEDIUM SERVICES LLC A/P 168357 10/20/16 8,333.33 HITACHI MEDICAL SYSTEMS -20- RUN DATE;11/17/16 MEMORIAL MEDICAL CENTER TIME;15;08 CHECK REGISTER 10/01/16 THRU 10/31/16 BANK --CHECK ------------------------------------------ CODE NUMBER DATE A14OUNT PAYEE A/P 168358 10/20/16 823.84 CENTURION MEDICAL PRODUCTS A/P 168359 10/20/16 1,405.08 DENITT BOTH & SON A/P 168360 10/20/16 276.44 PRECISION DYNAMICS CORP (PDC) A/P 168361 10/20/16 .00 VOIDED A/P 168362 10/20/16 4,639.48 MORRIS & DICKSON CO, LLC A/P 168363 10/20/16 1,315.00 AMERICAN PROFICIENCY INSTITUTE A/P 168364 10/20/16 2,202.00 BK➢, LIP A/P 168365 10/20/16 8,495.37 GLAXOSNITHKLINE PHARMACUETICAL A/P 168366 10/20/16 119.27 CAREFUSION 2200, INC A/P 168367 10/20/16 520.00 LIFESOURCE EDUCATIONAL SRV LLC A/P 169368 10/20/16 1,783.60 THBRACOM, LLC A/P 168369 10/20/16 451.50 PARAGARD DIRECT A/P 169370 10/20/16 1,879.00 BBALTHSTREAM, INC. A/P 168371 10/20/16 1,114.61 NOVA BIOME➢ICAL A/P 168372 10/20/16 225.42 GENESIS DIAGNOSTICS A/P 168373 10/20/16 1,333,33 SIEMENS FINANCIAL SERVICES A/P 168374 10/20/16 6,145.37 BANK OF THE 419ST A/P 168375 10/20/16 2,351.15 REVCYCLE+, INC. A/P 168376 10/20/16 559.00 SHIFTHOUND A/P 168377 10/20/16 600,00 CALHOUN CO INDIGENT ACCT A/P 168378 10/20/16 1,052.75 TRIZETTO PROVIDER SOLUTIONS A/P 168379 10/20/16 5,415.63 FUSION MEDICAL STAFFING, LLC A/P 169380 10/20/16 1,650.00 GULF COAST REGIONAL A/P 168381 10/20/16 166,50 COURIER THURLKILL A/P 168382 10/20/16 31.32 MISTY RECTOR A/P 168383 10/20/16 5,955.29 MEDICAL DATA SYSTEMS, INC. A/P 168384 10/20/16 500.00 LAW COMPANIES A/P 168385 10/20/16 756.12 FLDR DESIGNS LLC A/P 168386 10/20/16 23,943.03 JACKSON & COKER LOCUM TENENS, A/P 168307 10/20/16 2,938.25 ANN HEALTHCARE ALLIED, INC. A/P 168388 10/20/16 225.92 GULF COAST HAR➢WARE / ACE A/P 168389 10/20/16 2,809.56 AIRGAS USA, LLC - CENTRAL DIV A/P 168390 10/20/16 954.00 ALCON LABORATORIES, INC. A/P 168391 10/20/16 809.51 CARDINAL HEALTH 414,LLC A/P 168392 10/20/16 29.09 AQUA BEVERAGE COMPANY A/P 168393 10/20/16 20.23 AUTO PARTS & MACHINE CO, A/P 168394 10/20/16 1,018,43 BAXTER HEALTHCARE CORP A/P 160395 10/20/16 2,450.00 BECIU4AN COULTER INC A/P 168396 10/20/16 237,95 BEEKLBY MEDICAL A/P 168397 10/20/16 1,904.88 CUB GOVERNMENT, INC. A/P 168399 10/20/16 79.95 DLB PAPER & PACKAGING A/P 169399 10/20/16 47.40 FASTENAL COMPANY A/P 169400 10/20/16 133.00 FEDERAL EXPRESS CORP. A/P 168401 10/20/16 357.50 FFF ENTERPRISES A/P 168402 10/20/16 3,774.93 FISHER HEALTHCARE A/P 168403 10/20/16 111.72 GETINGE USA A/P 168404 10/20/16 83.95 GREENHOUSE FLORAL DESIGNERS A/P 168405 10/20/16 626.40 GULF COAST PAPER COMPANY A/P 168406 10/20/16 393.39 H E BUTT GROCERY A/P 169407 10/20/16 149,12 INDEPENDENCE MEDICAL A/P 169408 10/20/16 126,00 J & J HEALTH CARE SYSTEMS, INC PAGE 5 GLCKREG -21- RUN DATB:11/17/16 MEMORIAL MEDICAL CENTER PAGE 6 TIME;15:08 CHECK REGISTER GLCKREG 10/01/16 TURD 10/31/16 BANK --CHECK--------------___-_----------____ _--- CODE NUMBER DATE A40MT PAYEE A/P 168409 10/20/16 5.40 LANGUAGE LINE SERVICES A/P 168410 10/20/16 446.14 MCKESSON MEDICAL SURGICAL INC A/P 168411 10/20/16 111.29 MEDLINE INDUSTRIES INC A/P 168412 10/20/16 1,033.44 BAYER HEALTHCARE A/P 168413 10/20/16 82.66 MELSTAN, INC. A/P 169414 10/20/16 1,821,47 MERRY X-RAY/SOURCEONE HEALTHCA A/P 168415 10/20/16 1,132,10 NATIONAL BUSINESS FURNITURE A/P 168416 10/20/16 1,782.00 ORTHO CLINICAL DIAGNOSTICS A/P 169417 10/20/16 .00 VOIDED A/P 168418 10/20/16 9,556.41 OWENS & MINOR A/P 168419 10/20/16 55.00 PALACIOS BEACON A/P 168420 10/20/16 213.13 PITNEY BODES INC A/P 168421 10/20/16 27.54 POWER ELECTRIC A/P 168422 10/20/16 375.00 RADIOLOGY UNLIMITED, PA A/P 168423 10/20/16 1,672.50 SANOFI PASTEUR INC A/P 168424 10/20/16 14.49 SHERWIN WILLIAMS A/P 168425 10/20/16 297.00 TEXAS DEPARTMENT OF PUBLIC SAS A/P 168426 10/20/16 137.90 TEXAS WIRED MUSIC INC A/P 168427 10/20/16 4,555.00 T-SYSTEM, INC A/P 168428 10/20/16 557.12 TRI-ANIM HEALTH SERVICES INC A/P 168429 10/20/16 81.54 UNIFIRST HOLDINGS A/P 168430 10/20/16 466.11 UNIFORM ADVANTAGE A/P 168431 10/20/16 4,234.75 UNIFIRST HOLDINGS INC A/P 168432 10/20/16 35.97 UNITED AD LABEL CO INC A/P 168433 10/20/16 1,000.00 US POSTAL SERVICE A/P 168434 10/20/16 24.80 THE VICTORIA ADVOCATE A/P 168435 10/20/16 710.00 VICTORIA RADIOWORKS, LTD A/P 168436 10/20/16 1,112.40 WRIGHT JENNIFER A/P 168437 10/20/16 27,480.13 THE BROADMOOR AT CREEK A/P 168438 10/20/16 8,623.47 SOLERA WEST HOUSTON A/P 168439 10/27/16 336.00 DENS CENTRAL LAB MC2004 A/P 168440 10/27/16 8,333,33 HITACHI MEDICAL SYSTEMS A/P 168441 10/27/16 496.83 WHOLESALE ELECTRIC SUPPLY A/P 168442 10/27/16 36.90 HEALTH CARE LOGISTICS INC A/P 168443 10/27/16 1,693.24 CENTURION MEDICAL PRODUCTS A/P 168444 10/27/16 792.10 DEWITT POTH & SON A/P 160445 10/27/16 276.44 PRECISION DYNAMICS CORP (P➢C) A/P 168446 10/27/16 827.01 GE HEALTHCARE IITS USA CORP A/P 168447 10/27/16 .00 VOIDED A/P 168448 10/27/16 10,970.44 MORRIS & DICKSON CO, LLC A/P 168449 10/27/16 503.87 PLATINUM CODE A/P 168450 10/27/16 19,375,00 WOUN➢ CARE SPECIALISTS A/P 168451 10/27/16 214.92 RAUSHANAH MONDAY A/P 168452 10/27/16 1,050.56 COVIDIEN A/P 168453 10/27/16 93.19 GLOBAL EOUIPMENT CO. INC. A/P 168454 10/27/16 495.00 FASTHEALTH CORPORATION A/P 168455 10/27/16 5,561.20 CLINICAL PATHOLOGY A/P 168456 10/27/16 1,347.50 MINDRAY BE USA, INC. A/P 168457 10/27/16 1,409.25 HEALTHSTREAM, INC, A/P 168458 10/27/16 2,693,28 WAGBWORKS A/P 168459 10/27/16 60,48 ROSHANDA GRAY -22- RUN ➢ATE:11/17/16 MEMORIAL MEDICAL CENTER TIME:15;08 CHECK REGISTER 10/01/16 THRU 10/31/16 BANK --CHECK-----------_-------------_______------. CO➢E NUMBER ➢ATE AMOUNT PAYEE A/P 168460 10/27/16 1,400.00 ACUTE CARE INC A/P 168461 10/27/16 1,978.75 TRUVEN HEALTH ANALYTICS INC A/P 169462 10/27/16 180.00 MEMORIAL MEDICAL CLINIC A/P 168463 10/27/16 1,382.50 M G TRUST A/P 168464 10/27/16 7,692.67 CSI LEASING INC A/P 168465 10/27/16 423,17 DERRI HART A/P 169466 10/27/16 4,050.00 RECONDO A/P 168467 10/27/16 75,00 FIRST CLEARING A/P 169468 10/27/16 1,220.60 BIRCH COMMUNICATIONS A/P 168469 10/27/16 119.00 TRIZETTO PROVIDER SOLUTIONS A/P 168470 10/27/16 727.50 PABLO GARZA A/P 168471 10/27/16 3,183.00 FUSION MEDICAL STAFFING, LLC A/P 168472 10/27/16 1,341,14 THE US CONSULTING GROUP A/P 168473 10/27/16 595.00 YOURMEMBERSHIP A/P 168474 10/27/16 2,916.54 MEDICAL DATA SYSTEMS, INC. A/P 168475 10/27/16 68.50 NORTH COAST MEDICAL INC A/P 169476 10/27/16 252.90 IRON MOUNTAIN A/P 168477 10/27/16 1,075.76 JACKSON & COKER LOCUM TENENS, A/P 168478 10/27/16 443,00 GREAT BASIN SCIENTIFIC, INC A/P 168479 10/27/16 489.95 MEDIA PRINT SOLUTIONS A/P 16848E 10/27/16 161.87 GULF COAST HARDWARE / ACE A/P 168481 10/27/16 760.18 AIRGAS USA, LLC - CENTRAL ➢IV A/P 168482 10/27/16 6,396.40 AFLAC A/P 168483 10/27/16 153,20 ANNOUNCEMENTS PLUS TOO AGAIN A/P 168484 10/27/16 25.98 AUTO PARTS & MACHINE CO. A/P 169485 10/27/16 3,663.09 BAXTER HEALTHCARE CORP A/P 168486 10/27/16 7,681.07 BECKHAM COULTER INC A/P 168487 10/27/16 38.26 BIODEX MEDICAL SYSTEMS INC A/P 168468 10/27/16 196.82 BOUND TREE MEDICAL, LLC A/P 168489 10/27/16 932.54 CABLE ONE A/P 163490 10/27/16 25.00 CAL COM FEDERAL CREDIT UNION A/P 168491 10/27/16 155.8E OLE PAPER & PACKAGING A/P 168492 10/27/16 33,64 FASTENAL COMPANY A/P 168493 10/27/16 30.98 FEDERAL EXPRESS CORP. A/P 169494 10/27/16 35.94 GALLS,LLC A/P 168495 10/27/16 120.73 GRAPHIC CONTROLS LLC A/P 168496 10/27/16 596.41 HILL -ROM COMPANY, INC A/P 168497 10/27/16 11.25 HOSPIRA WORLDWIDE, INC A/P 169498 10/27/16 19.25 INDEPENDENCE MEDICAL A/P 168499 10/27/16 3,140.46 WERFEN USA LLC A/P 168500 10/27/16 326,36 J & J HEALTH CARE SYSTEMS, INC A/P 168501 10/27/16 636.76 JOHNSTONE SUPPLY A/P 168502 10/27/16 1,243.11 SHIRLEY KARNEI A/P 168503 10/27/16 42.00 MY SURGICAL INC A/P 168504 10/27/16 26.5E LABCORP OF AMERICA HOL➢INGS A/P 169505 10/27/16 146.71 MARKETLAB, INC A/P 168506 10/27/16 3,341.73 MCKESSON MEDICAL SURGICAL INC A/P 168507 10/27/16 55.15 MEDLINE INDUSTRIES INC A/P 168508 10/27/16 516.72 HAYER HEALTHCARE A/P 168509 10/27/16 1,380.00 MERRITT, HAWKINS & ASSOCIATES A/P 168510 10/27/16 179.84 ON -SITE TESTING SPECIALISTS PAGE 7 GLCKREG -23- RUN ➢ATE:11/17/16 TIME:15:08 BANK --CHECK ---------- CODE NUMBER DATE --------------------- A/P 168511 10/27/16 A/P 160S12 10/27/16 A/P 168513 10/27/16 A/P 168514 10/27/16 A/P 168515 10/27/16 A/P 168516 10/27/16 ,1/P 168517 10/27/16 A/P 168518 10/27/16 A/P 168519 10/27/16 A/P 168520 10/27/16 A/P 168521 10/27/16 A/P 168522 10/27/16 A/P 168523 10/27/16 A/P 168524 10/27/16 A/P 169525 10/27/16 A/P 168526 10/27/16 A/P 168527 10/27/16 A/P 168528 10/27/16 A/P 168529 10/27/16 A/P 168530 10/27/16 A/P 168531 10/27/16 A/P 168532 10/27/16 A/P 168533 10/27/16 A/P 168534 10/27/16 A/P 168535 10/27/16 A/P 168536 10/27/16 A/P 169537 10/27/16 A/P 168538 10/27/16 A/P 168539 10/27/16 A/P 166540 10/27/16 A/P 168541 10/27/16 A/P 169542 10/27/16 A/P 168543 10/27/16 A/P 168544 10/27/16 A/P 168545 10/27/16 A/P 169546 10/27/16 A/P 160547 10/27/16 A/P 169548 10/27/16 A/P 168549 10/27/16 A/P 168550 10/27/16 A/P 168551 10/27/16 A/P 169552 10/27/16 A/P 168553 10/27/16 A/P 168554 10/27/16 A/P 169555 10/27/16 A/P 168556 10/27/16 A/P 168557 10/27/16 A/P 168558 10/27/16 A/P 16BS59 10/27/16 A/P 169560 10/27/16 A/P 168561 10/27/16 MEMORIAL MEDICAL CENTER CHECK REGISTER 10/01/16 THRU 10/31/16 ----------------------- AMOUNT PAYEE .00 VOIDED .00 VOIDED 2,860.69 OWENS & MINOR - 10,150.00 PREMIER SLEEP DISORDERS CENTER 125,26 POLY14EDCO INC. 992.25 PORT LAVACA HAVE 378.02 POSITIVE PRO140TIONS 15.17 R & D BATTERIES INC 364.70 CULLIGAN OF VICTORIA 41.25 RED DANK 784.79 EVOQUA WATER TECHNOLOGIES LLC 584.20 SERVICE SUPPLY OF VICTORIA INC 597.34 SMITHS MEDICAL AND INC 250.81 SMITH & NEPHEW 9,504.91 SO TEX BLOOD & TISSUE CENTER 361,31 STRYKER SALES CORP .00 VOIDED 9,872.83 SYSCO FOOD SERVICES OF 2,064.63 STERICYCLE, INC 9,000,00 TOSHIBA AMERICA MEDICAL SYST. 732.00 THYSSENKRUPP ELEVATOR CORP 112,63 TG 91.54 UNIFIRST HOL➢INGS 135.85 UNIFORM ADVANTAGE 2,389.42 UNIFIRST HOLDINGS INC 1,261.48 WATERMARK GRAPHICS INC 36.83 CARLO VICTORIA 37.46 DEBAULT ALEXANDERIA 1,232,14 HUMAN MARGIE 520.42 LEITA 14ARIA 34.47 51ONTEMAYOR YESENIA 188.80 PATEL RUPAKKUMAR 37.63 ONDREAS SANDRA 100,00 DAGGS BONNIE K 35.86 LUONG DIEM N 1,443.00 FRICKE MICHAEL 1,147.28 HERNANDEZ FELIPE 36.32 BOR➢OSKY CLY➢E 136.08 GRESHAM GLYNDA 479.60 VANCE BLAND 10.78 LONA MARIA B 16.25 CONTRERAS DOW MIKE 2,638.00 SENSABAUGH SAM 301.47 LIU I --AN CHI 35,96 ESTRELLO GLORIA 461.12 REED JESSAMY 517.17 WHITE DAGB 37.21 MCGEE SHANA 37.46 TENNISON LINDA KAY 37.76 BELL DANA 703.72 RAY JACLYN PAGE 8 GLCKREG -24- RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER TIME:15:08 CHECK REGISTER 10/01/16 TURD 10/31/16 BANK --CHECK-----------------------------------------` CODE NUMBER DATE AMOUNT PAYEE A/P 169562 10/27/16 A/P 168563 10/27/16 A/P 168564 10/27/16 A/P 16BS65 10/27/16 A/P 168566 10/27/16 A/P 168567 10/27/16 A/P 169568 10/27/16 TOTALS: 35.66 REED SESSAMY 1,995.23 GBALAZEH MELHISSA PAOL 1,058.16 LUMLEY JAMBS ALEXANDER 35.08 BROWNING REMEDIOS C 1,866.80 MCFARLIN ANNETTE 217.14 JOHNSTONE BARBARA 1,708,91 MEZA OVIDIO 2,952,264,78 PAGE 9 GLCKREG -25- RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER TIME:15:08 CHECK REGISTER 10/01/16 THRU 10/31/16 BANK--CHECK------------------------------------------ CODE NUMBER DATE AMOUNT PAYBE ICP 011879 10/31/16 71.93 ICP 011879 10/31/16 1,187.81 ICP 011980 10/31/16 728.68 ICP 011881 10/31/16 220.19 ICP 011882 10/31/16 1,074.00 ICP 011883 10/31/16 87,950.96 ICP 011984 10/31/16 973.33 ICP 011885 10/31/16 655.53 ICU 011886 10/31/16 185,02 ICP 011887 10/31/16 187.52 TOTALS: 93,234.97 MICHELLE M. CUMMINS, M.D. PORT LAVACA CLINIC ASSOC, PA RADIOLOGY UNLIMITED PA REGIONAL EMPLOYEE ASSISTANCE MEMORIAL MEDICAL CENTER MEMORIAL MEDICAL CENTER MEDINPACT HEALTHCARE SYS, INC. ADU SPORTS MEDICINE CLINIC VICTORIA PROFESSIONAL MEDICAL AMERICAN HOMEPATIENT PAGE 10 GLCKREG -26- RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER PAGE 11 TIME:15:08 CHECK REGISTER GLCKREG 10/01/16 THRU 10/31/16 BANK--CHECK---------------------------------------------------- CODE NUMBER DATE MOUNT PAYEE ------------------------------------------------------------- NHA 000011 10/28/16 307,489.47 MEMORIAL MEDICAL CENTER TOTALS: 307,499.47 -27- RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER PAGE 12 TIME;15:00 CHECK REGISTER GLCKREG 10/01/16 TRRU 10/31/16 BANK--CBBCK__--------------------- _____------- CODE NUMBER DATE AMOUNT PAYEE ----------------------------------------------------------------------------------------------- EBB 000010 10/20/16 7,321.87 MEMORIAL MEDICAL CENTER TOTALS: 7,321.87 sm RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER TIME:15:08 CHECK REGISTER 10/01/16 THRD 10/31/16 BANK --CHECK-----_____________________________-----__------_ CODE NUMBER DATE AMOUNT PAYEE --------------------------------------------------------------- NBC 000007 10/29/16 29,610.02 MEMORIAL MEDICAL CENTER TOTALS: 29,610.02 PAGE 13 GLCKREG -29- RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER PAGE 14 TIME:15:08 CHECK REGISTER GLCKRBG 10/01/16 THRU 10/31/16 BANK--CRECK ---------------------------------------------------- CODE NUMBER DATE AMOUNT PAYEE NHF 000007 10/29/16 95,306.74 MEMORIAL MEDICAL CENTER TOTALS: 95,306.74 �� RUN DATE:11/17/16 TIME:15:08 BANK--CHECK------- CODENUMBER DATE NHS 000007 10/28/16 TOTALS: MEMORIAL MEDICAL CENTER CHECK REGISTER 10/01/16 THRU 10/31/16 ----------------------------------------- AMOUNT PAYEE ----------------------------------------- 89,579.84 MEMORIAL MEDICAL CENTER 89,579.84 PAGE 15 GLCKREG -31- RUN DATE:11/17/16 MEMORIAL MEDICAL CENTER PAGE 16 TIME:15:08 CHECK REGISTER GLCKREG 10/01/16 THRU 10/31/16 BANK--CHECK------ CODEHEMMER DATE PR- + 000000 10/06/16 PR- 061818 10/06/16 PR- 061819 10/06/16 PR- 061820 10/06/16 PR- 061821 10/20/16 PR- 061822 10/20/16 PR- * 061823 10/20/16 PR- 999999 10/06/16 TOTALS: AI4OUNT 12.86 57.17 1,711.64 732.03 356.43 1,376.33 278.76 534,210.90 538,736.12 PAYEE PAY-P.09/16/16 09/29/16 PAY-P.09/16/16 09/29/16 PAY-P.09/16/16 09/29/16 PAY-P.09/16/16 09/29/16 PAY-P,09/30/16 10/13/16 PAY-P.09/30/16 10/13/16 PAY-P.09/30/16 10/13/16 -32- RUN DATE: 11/21/16 TIME: 14:53 PRTitle REGISTERED NURSE DEPARTMENTAL ASSIST ASST PURCHASE BUYER PURCHASING SUPERVISR IP/EH/RM NURSE REGISTERED NURSE FOOD SERVICE STAFF ES AIDE REGISTERED NURSE MANAGER-SURGERY-OPC PAYROLL CLERK REGISTERED NURSE LICENSED VOCATIONAL LICENSED VOCATIONAL REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE DIRECTOR OF INPT SVC REGISTERED NURSE LICENSED VOCATIONAL ADMINIST ASSISTANT REGISTERED NURSE REGISTERED NURSE PRE -ADMISSION NURSE REGISTERED NURSE LICENSED VOCATIONAL RADIOLOGICAL TECH REFERRAL SPECIALIST MEDICAL LAB TECH LAB DIRECTOR LAB ASSISTANT 14EDICAL LAB TECH MEDICAL TECHNOLOGIST REGISTERED NURSE PT TECH II REGISTERED NURSE TRANSCRIPTIONIST-RIC REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CLINICAL IT SPCLST MEDICAL LAB TECH REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CNO-DIRECTOR OF QA REGISTERED NURSE REGISTERED NURSE LICENSED VOCATIONAL PRACT ADMINISTRATOR REGISTERED NURSE NURSE PRACTIONER LICENSED VOCATIONAL CERTIFIED NURSE AIDE MEMORIAL MEDICAL CENTER DEFAULT FORMAT FROM DBO19 ac��6 PRDeptName PRTotGross EMERGENCY ROOM MAINTENANCE CENTRAL SUPPLY CENTRAL SUPPLY INFECTION PREVENTION MED/SURG DIETARY ENVIRON16ENTAL SERVICES SURGERY SURGERY ACCOUNTING MED/SURG OBSTETRICS MED/SURG ICU OBSTETRICS EMERGENCY ROOM MED/SURG OBSTETRICS MED/SURG ADMINISTRATION EMERGENCY ROOM ICU SURGERY SURGICAL CLINIC SURGERY DIAGNOSTIC IMAGING MEMORIAL MEDICAL CLINIC LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY EMERGENCY ROOM PHYSICAL THERAPY MED/SURG HEALTH INFORMATION MANAGEMENT OBSTETRICS OBSTETRICS OBSTETRICS ADMINISTRATION -CLINICAL SERVIC LABORATORY OBSTETRICS OBSTETRICS OBSTETRICS QUALITY ASSURANCE SURGERY - MED/SURG MED/SURG MEMORIAL MEDICAL CLINIC ICU MEMORIAL MEDICAL CLINIC MED/SURG MED/SURG 5130.30 2496.00 2324.43 4571.56 5790.23 2221.50 1601.30 2091.35 1278.75 6600.20 3638.53 5483.68 3174.13 3573.21 1287.13 2709.37 5449.40 5948.20 5073.24 2464.54 3522.80 1279.32 4611.19 3721.86 5562.35 3940.85 5254.61 2379.62 1100.25 4969.00 3879.17 4401.44 4275.74 4338.38 2018.52 1458.00 2312.64 5213.10 4294.56 4975.44 4754.88 1502.63 566.75 2183.44 4595.09 7208.20 5426,41 3842.67 804.50 7332.20 1323.76 7538.40 421.25 171.50 PAGE 1 -33- RUN DATE: 11/21/16 MEMORIAL MEDICAL CENTER PAGE 2 TIME: 14:53 DEFAULT FORMAT FROM DBO19 PRTitle SUPERVISOR LVN/RPhT CASE MANAGER/UR/DP REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CERTIFIED NURSE AIDE REGISTERED NURSE CERTIFIED NURSE AIDE LICENSED VOCATIONAL REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CERTIFIED NURSE AIDE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CERTIFIED NURSE AIDE LICENSED VOCATIONAL LICENSED VOCATIONAL REGISTERED NURSE LICENSED VOCATIONAL REGISTERED NURSE LICENSED VOCATIONAL REGISTERED NURSE LICENSED VOCATIONAL CERTIFIED NURSE AIDE CERTIFIED NURSE AIDE NURSE SUPERVISOR CERTIFIED NURSE AIDE FAM NURSE PRACTIONER REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE RN -OR SCRUB NURSE REGISTERED NURSE 0 R TECH REGISTERED NURSE RN-PERIOPERATIVE OR TECHNICIAN CENTRAL SUPPLY TECH REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE EMERGENCY DIRECTOR REGISTERED NURSE REGISTERED NURSE PRDeptName PHARMACY UTILIZATION REVIEW MED/SURG MED/SURG MED/SURG OBSTETRICS NEWBURG MED/SURG MED/SURG MED/SURG MED/SURG MED/SURG ICU MED/SURG MED/SURG MED/SURG NEWBURG ICU MED/SURG NEWBURG MED/SURG MED/SURG MED/SURG MEMORIAL MEDICAL CLINIC MED/SURG MED/SURG EMERGENCY ROOM MEMORIAL MEDICAL CLINIC MED/SURG MED/SURG MEMORIAL MEDICAL CLINIC MED/SURG MEMORIAL MEDICAL CLINIC EMERGENCY ROOM ICU ICU ICU ICU ICU ICU ICU SURGERY SURGERY SURGERY SURGERY SURGERY SURGERY CENTRAL SUPPLY EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM PRTotGross 3180.72 4346.34 4255.39 5125.50 5566.60 5006.61 1349.78 3702.25 1550.48 2005.90 1864.50 5269.05 4117.22 1635.50 3959.35 1772.60 5510.09 4712.09 6098.40 164.00 2203.94 221.38 3510.80 1477.26 5292.42 2474.48 4350.58 1245.25 1636.04 2181.52 2818.98 1598.38 7538.40 4462.08 5026.50 428.25 4226.25 3885.96 2021.98 1337.19 4509.25 4709.23 5789.48 2912.89 5856,94 5963.14 1708.37 1785.19 2571.88 7467.54 1248.82 1614.00 6084,60 4779.25 4053.60 -34- RUN DATE: 11/21/16 MEMORIAL MEDICAL CENTER PAGE 3 TIME: 14:53 DEFAULT FORMAT FROM DBO19 PRTitle REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CLINIC COORDINATOR GENERAL SUPERVISOR TECHNICAL SUPERVISOR MEDICAL LAB TECH REGISTERED NURSE MEDICAL LAB TECH TECHNICAL SUPERVISOR LABORATORY ASSISTANT MEDICAL TECHNOLOGIST LAB ASSISTANT LABORATORY ASSISTANT LABORATORY ASSISTANT LAB ASSISTANT MEDICAL TECHNOLOGIST LAB ASSIST/SECRETARY MEDICAL LAB TECH MEDICAL LAB TECH CERTIFIED NURSE AIDE REGISTERED NURSE REGISTERED NURSE RADIOLOGICAL TECH RADIOLOGY SUPERVISOR RADIOLOGY TECH RADIOLOGICAL TECH RADIOLOGICAL TECH RADIOLOGICAL TECH RADIOLOGICAL TECH RADIOLOGICAL TECH NUCLEAR MED TECH RADIOLOGICAL TECH RADIOLOGICAL TECH RADIOLOGICAL TECH LVN-CHG-CHART AUDITR REGIST PHARMACY TECH REG PHARMACY TECH RECEPTIONIST MEDICAL ASSISTANT LICENSED VOCATIONAL RECEPTIONIST INSURANCE CLERK RECEPTIONIST RECEPTIONIST OPERATOR LICENSED VOCATIONAL INSURANCE CLERK RECEPTIONIST OUT PT COORDINATOR MEDICAL ASSISTANT PHYSICIAN ASSISTANT MEDICAL ASSISTANT RECEPTIONIST PRDeptName EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM SPECIALTY CLINIC LABORATORY LABORATORY LABORATORY MED/SURG LABORATORY NEC CLINIC - LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY LABORATORY MED/SURG MED/SURG EMERGENCY ROOM DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING 1414C CLINIC - DIAGNOSTIC IMAGIN DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC_ IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING PHARMACY PHARMACY PHARMACY MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MFA40RIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC PATIENT FINANCIAL SERVICES MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC PRTotGross 1772.50 4649.32 4988.76 4745.52 4233.81 4146.13 1753.89 4575.43 3689.79 3837.02 2635.82 1049.25 2541.15 2070.50 501.63 1421.13 348.75 2349.62 3323.85 4211.81 425.44 474.00 6348.15 4931.22 2052.78 6335.78 5906.06 445.50 1326.99 5418.75 4224.74 1914,20 6330.00 3064.36 1653.75 3687.67 2842.74 2969.95 2819.28 2201.52 1584.41 3513.38 1898.46 1896.23 311.32 1836.38 1682.58 2051.43 2212.46 1964.97 1773.28 2715.76 10399.85 2061.85 1454.62 -35- RUN DATE: 11/21/16 MEMORIAL MEDICAL CENTER PAGE 4 TIME: 14:53 DEFAULT FORMAT FROM DBO19 PRTitle MEDICAL ASSISTANT MEDICAL ASSISTANT PT ASSISTANT PT ASSISTANT OCCUPATION THERAPIST TEAM LEAD PTA REGISTERED NURSE PT TECH 1 PT ASSISTANT DIRECTOR PT TECH DISCHARGE ANALYST HIM SPECIALIST HIM SPECIALIST MEDICAL ASSISTANT REGISTERED NURSE FOOD SERVICE STAFF RECEPTIONIST -PBX FOOD SERVICE STAFF DIRECTOR OF DIETARY FOOD SERVICE STAFF FOOD SERVICE STAFF FOOD SERVICE STAFF FOOD SERVICE STAFF GROUNDSKEEPER-PAINTR SECURITY OFFIER BIO-MED TECHNICIAN BIO-MED TECHNICIAN PLANT UPS SPECIALIST DIRECTOR SECURITY SUPERVISOR ES AIDE ES AIDE FLOOR TECHNICIAN ES AIDE ES AIDE ES AIDE ES AIDE LICENSED VOCAT NURSE ES AIDE REGISTRATION CLERK ES AIDE ES AIDE FLOOR TECHNICIAN ES AIDE ES AIDE OR AIDE SECURITY OFFICER PLANT UPS SPECIALIST REGISTERED NURSE OUTPATIENT THERAPIST FIN CNSLR-COORDINATR SELF PAY CLERK OFFICE MANAGER REGISTRATION CLERK PRDeptName MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY OBSTETRICS PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY HEALTH INFORMATION MANAGEMENT HEALTH INFORMATION MANAGEMENT HEALTH INFORMATION MANAGEMENT MEMORIAL MEDICAL CLINIC ICU DIETARY MEMORIAL MEDICAL CLINIC DIETARY DIETARY DIETARY DIETARY DIETARY DIETARY MAINTENANCE SECURITY BID MEDICAL ENGINEERING BIO MEDICAL ENGINEERING MAINTENANCE MAINTENANCE SECURITY ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES MED/SURG ENVIRONMENTAL SERVICES PPS - REGISTRATION ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES SURGERY SECURITY MAINTENANCE ICU BEHAVIORAL HEALTH INDIGENT CARE PROGRAM PATIENT FINANCIAL SERVICES MEMORIAL MEDICAL CLINIC PATIENT FINANCIAL SERVICES PRTotGross 2952.25 1726.18 4001.55 4148.34 6395.73 5022.50 5477.20 89.95 3685.50 8600.10 2159.38 1699.69 1789.12 1420.44 2505.04 1332.88 2599.72 1724.85 2146.23 4072.91 1974.41 2369.03 1480.07 1124.55 2142.40 1258.95 487.50 4428.21 2238.94 5820.20 2168.80 1366.88 1842.78 1818.88 2283.02 1483.20 1514.43 1725.15 2116.83 1799.41 2031.20 638.89 1907.46 1815.54 1950.26 1185.74 1785.08 1836.00 3417.00 1141.50 4015.00 2835.55 1908.80 2449.10 1626.99 -36- RUN DATE: 11/21/16 1EMORIAL MEDICAL CENTER PAGE 5 TIME: 14:53 DEFAULT FORMAT FROM DB019 PRTitle REGISTRATION CLERK CASHIER -SWITCHBOARD INSUR COORDINATOR BILLING CLERK RECEPTIONIST TEAM LEADER REGISTRATION CLERK PFS DIRECTOR REGISTERED NURSE OFFICE COORDINATOR REGISTRATION CLERK SECURITY OFFICER FINANCIAL COUNSELOR REGISTRATION CLERK DIRECTOR OF HIM MEDICAID COORDINATOR REGISTRATION CLERK MEDICARE COORDINATOR TRAUMA COORDINATOR DIRECTOR REGISTRATION CLERK REGISTRATION CLERK I.T. DIRECTOR IT SYSTEM ANALYST REGISTERE➢ NURSE PAYROLL AP ASSISTANT CONTROLLER ACCOUNTANT ASSIST ADMINISTRATOR C.F.O. C.E.O. ADMIN ASST TO AA-CNO SPECIAL PROJECTS MGR Grand totals Total lines = 252 PRDeptName PATIENT FINANCIAL SERVICES PATIENT FINANCIAL SERVICES PATIENT FINANCIAL SERVICES PATIENT FINANCIAL SERVICES MEMORIAL MEDICAL CLINIC PATIENT FINANCIAL SERVICES PFS - REGISTRATION PATIENT FINANCIAL SERVICES EMERGENCY ROOM PHYSICAL THERAPY ITS - REGISTRATION SECURITY INDIGENT CARE PROGRA14 PFS - REGISTRATION HEALTH INFORMATION MANAGEMENT PATIENT FINANCIAL SERVICES PFS - REGISTRATION PATIENT FINANCIAL SERVICES EMERGENCY ROOM DIAGNOSTIC IMAGING PFS REGISTRATION PFS - REGISTRATION INFORMATION TECHNOLOGY INFORMATION TECHNOLOGY EMERGENCY ROOM ACCOUNTING ACCOUNTING ACCOUNTING ADMINISTRATION ADMINISTRATION ADMINISTRATION ADMINISTRATION -CLINICAL SERVIC ADMINISTRATION PRTotGross 1995.76 1714.25 1873.70 2088.90 2395.12 2588.60 2322.04 3762.20 1117.01 2010.45 762.01 1829.54 2334.24 2261.75 3091.40 2388.50 347.18 2186.50 4548.45 5137.26 1101.02 1430.66 5658.56 4592.25 3196.29 2383.13 4621.00 1612.08 9137.00 10794.22 17657.68 2225.18 2991.45 795539.99 -37- ©IFis Source Totals Report Issued 11/16/16 Calhoun Indigent Health Care Batch Dates 11/01/2016 through 11/01/2016 For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 14,975.93 2,368.21 01-2 Physician Services -Anesthesia 1,794.00 401.81 02 Prescription Drugs 673.52 537.52 08 Rural Health Clinics 6,430.00 5,648.27 14 Mmc - Hospital Outpatient 104,595.56 34,708.19 15 Mmc - Er Bills 16,415.33 5,402.06 Expenditures 145,319.49 49,501,21 Reimb/Adjustments -435.15 -435.15 Grand Total 144,884.34 49,066.06 EXPENSES +1074.00 COPAYS - <610.00> TTOAL 49,530.06 a" Calhoun County Indigent Care Patient Caseload Approved Denied Removed Active Pending January 4 5 3 58 6 February 7 2 8 57 7 March 2 3 5 51 9 April 5 2 14 46 8 May 4 3 3 47 3 June 6 2 6 55 2 July 13 2 4 66 3 August 5 1 5 66 5 September 13 0 6 73 2 October 5 0 11 66 3 November December YTD 64 20 65 585 48 Monthly Avg December 2015 Active 6 2 7 59 5 57 -39- Award bids for Fuel to be delivered for the period December 16, 2016 through January 15, 2017. (MP) Commissioner Lyssy made the motion to award Diebel Oil for fuel. Diesel at $2.18 and unleaded at $2.11. Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 3 of 32 AGENDA ITEM THURSDAY, December 8, 2016 Consider and take necessary action to award bid for Bulk fuel to be Delivered for the period beginning December 16, 2016 and ending January 15, 2017. J`' 0 W of W J W 0 Y J D m J W D LL LW r aE c m w d y :° m m w ° � C J W O K .L a m W0 -o cE 00 N �+ a :° w m m w ° � G ❑ N Z j y W O IL Y Ii e e m � m W W y y 0 CALHOUN COUNTY, TEXAS BID SHEET- FUEL -BULK DELIVERED INVITATION TO BID BIDDER DIEBEL OIL CO INC SAM BIEBEL PO BOX 71 PORT LAVACA TX 77070 BID ITEM FUEL -BULK DELIVERED PERIOD FRUM. DECEMBER 16, 2016 PERIOD TO: JANUARY 16, 2017 YOU ARE INVITED TO SUBMIT A DID ON THE ABOVE ITEM TO: MICHAEL]PFEIFER, CALHOUNCOUNTYJUDGE, 211 SANNST, JRD FLOOR, ROOMJ01, PORTIAVACA TX77979 BIDS SHOULD BE SUBMITTED IN A SEALED ENVELOPE PLAINLY MARKED: SEALED BID- [FUEL-BULKD8LIV£RED j BIDS ARE DUE AT THE JUDGE'S OFFICE ON OR BEFORE: 10,00AM, THURSDAY, DECEMBER 1, 2016 BIDS WILL BE AWARDED AT THE COMMISSIONERS' COURT MEETING ON: THURSDAY, DECEMBER 8, 2016 THE CLOCK IN THE COUNTY JUDGE'S OFFICE IS THE OFFICIAL CLOCK THAT WILL BE USED IN DETERMINING THE TIME THAT A DID IS RECEIVED AND THE TIME THAT BIDS WILL BE OPENED. BIDS RECEIVED AFTER THE OPENING TIME WILL BE RETURNED UNOPENED TO BIDDER. THE COMMISSIONERS' COURT RESERVES THE RIGHT TO WAIVE TECHNICALITIES, REJECT ANY OR ALL BIDS, TO ACCEPT THE BID DEEMED MOST ADVANTAGEOUS TO CALHOUN COUNTY AND TO BE THE SOLE JUDGE IN DETERMINING WHICH BIDS WILL BE MOST ADVANTAGEOUS TO THE COUNTY. THE COUNTY OF CALHOUN, TEXAS IS AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER. THE COUNTY DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, SEX, RELIGION, AGE OR HANDICAPPED STATUS IN BID ITEMY FUEL -BULK DELIVERED DEPARTMENT.• VARIOUS DELIVERY FOB COUNTY FUEL TANKS DESTINATION VARIOUS sPEcocAnoms: DIESEL FUEL >>DELIVERY must be made within 24 hours after receiving order from the County Department in the quantity ordered. if vendor cannot deliver within 24 hours or refuses to deliver, the County Department will order from the next lowest bidder. >>PRICE Per Gallon MUST INCLUDE all fees and charges including all Taxes/Fees the County is not exempt from (for example: $0.20 State Excise Tax, State Delivery/Environmental Fees, Federal Oil Spill Recovery Fees and Federal LUST Tax) >>FREE FROM WATER AND SUSPENDED MATTER UNIT UNIT PRICE GALLON 2 I B -_ ---_______--..______________.__._ sPEcncAwNs: REGULAR UNLEADED GASOLINE >>DELIVERY must be made within 24 hours after receiving order from the County Department in the quantity ordered. If vendor cannot deliver within 24 hours or refuses to deliver, the County Department will order from the next lowest bidder. >>PRICE Per Gallon MUST INCLUDE all fees and charges including all Taxes/Fees the County is not exempt from (for example: $0.20 State Excise Tax, State Delivery/Environmental Fees, Federal Oil Spill Recovery Fees and Federal LUST Tax) >>FREE FROM WATER AND SUSPENDED MATTER AND A MINIMUM OCTANE OF 87 (AVERAGE METHOD) UNIT UNIT PRICE GALLON 2 , I I DATEOFBUt AUTHORMSICNATIIIE AND TULE: PRINT NAME � i0 n, TELEPHONE NUMBER: PLEASE UST ANY EXCEPTIONS TO THE ABOVE SPECIFICATIONS: Consider and Take Necessary Action to award bid for Prescription Drugs for the Calhoun County Indigent Program for the period beginning January 1, 2017 and ending December 31, 2017 with the option to renew yearly if notification of renewal is accepted by Commissioners' Court. (MP) Commissioner Galvan made the motion to award bid for prescription drugs to Medicine Man Pharmacy and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 4 of 32 Agenda Item for Commissioners' Court —Thursday, December 8, 2016 Consider and take necessary action to award bid for Prescription Drugs for the Calhoun County Indigent Program for the period beginning January 1, 2017 and ending December 31, 2017 with the option to renew yearly if notification of renewal is accepted by Commissioners Court. k- �+1 U r O� N co N U N r 0 N cc 7 C m E L F- C i 0 I *N' 3 N U U) C E Q U 0) E - 2>, IZ ca 0 0 °' Q w m 3 c U)e m m c o 0 o m co :3 c 0a. 4� 01 d U. 0 Q 0) d O O U co i 19 m c a a o m m a Q QC Z d 'N co ((5 O C Z 0) N N 0) N E o d L q) o m (i 0) + m ca (°� mam N 0 000 (cam i N> � 0 0(0 Zo `-�O �0 `'�0 N(,N ro 'a II 0 y w Na m 5� wa o61vo; �p a) C� 5 m a w N d° U Nco U C3 _ m y 0 N h m >+ 0 U 07 co II o N = w .L � O O� CI C O ( o (DZ Z a w O w p0- ((0'r>—+U 0') CL p� c L tr_ NQ Of ° Oa' C) yQ �o o I1 0 a o c �wZ -a o (DN m o 0 a ? m c° o •L (D V 00 r hL LL O h y,. r- 01 c 0) O O C U)w�N oi ' (D a O Iai O CDh t) N L W co � m o coN N v O. 4) 0) Q Q. U)'O .N ca m O p O ~Qy 3 N 61) O N_ II c` LO v +� OHO *O' t0 � G CL 00 N C S3. (D o > N O O N N- � :_� N EL 3 U a ¢ a a ¢ awm¢ V (D co co m c m (Ti (0 U) �L l6 N LO saw E (i = IL CALHOUN COUNTY, TEXAS -INVITATION TO BID FORM PRESCRIPTION DRUGS Calhoun County Indigent Program JANUARY 1, 2017 Thru DECEMBER 31, 2017 With the Option to Renew Yearly if notification of renewal is accepted by Calhoun County Commissioners' Court ► Do Not Fold Bid Form ► Please Type * Calhoun County Indigent Program tgy' NET COST to be computed in accordance with the Department of State Health Services, County Indigent Health Care Program Handbook, Payment Standard for Prescription Drugs. (Section Four, Page 10, from the DSHS Handbook attached — Handbook may be updated at various times during the year) Fill in appropriate blanks Net Cost: Generic--) AWP Minus 50% LESS Additional Discount �o - 7� Minimum Amount ����1l Additional Discount Total Discount Percentage off of AWP (Minimum is 50%) Dispensing Fee—PLUS�d. W/o Plus Dispensing Fee, if any ($3.00 maximum) Net Cost: / Name Brand--) AWP Minus 15% LESS Additional Discount �% - �C�• s o� Minimum Amount g ��11 Additional Discount Total Discount Percentage off of AWP (Minimum Is 15%) Dispensing Fee- PLUS ac• 6 Plus Dispensing Fee, if any ($3.00 maximum) The undersigned affirms that they are duly authorized to execute this bid form, 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 otherperson engaged in this type of business prior to the official opening of this bid. The undersigned affirms that they have read the entire Invitation to Bid Package and fully understands and has followed all specifications and general conditions. Date of Bid: J 1 - 1 % - 16 Company: M e_CfZ1,6. ; Authorized Signature Print Name & Title of Telephone Number: (_ 6W `SSA--�,A'X7 Fax Number: (3 (,1) 8cl,K - 6K3 Email: Contact Person: & Title Contact Information: ksb1) SS 0 List any exceptions to the given bid specifications OR Outside Billing Company (Processor/Partner), if any, that process payu:euts CERTIFICATE OF INTERESTED PARTIES FORM 1295 left Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2016-137996 Medicine Man Pharmacy Port Lavaca, TX United States Date Filed: 11/17/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2017 Calhoun County Indigent 2017 Calhoun County Indigent Program Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling I Intermediary Medicine Man Pharmacy Port Lavaca, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Mauritz Rogers Natxry Public. r _ Statc efTcxxs a� Expires: 09/03/2079 Signature of authori gent of contracting business entity AFFIX NOTARY STAMP/SEAL ABOVE T�/1 --t Sworn to and subscribed before me, by the said J e �� ' `-� ��5 , this the I day of 10 11 , 20_1JJ__, to certify which, witness my hand and seal of office. Stgnat, il!5r ministering oath Printed name of officer adhiinistering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us version V1.o.z// CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos, 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2016-137996 Date Filed: 11/17/2016 Date Acknowledged: 12/29/2016 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Medicine Man Pharmacy Port Lavaca, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2017 Calhoun County Indigent 2017 Calhoun County Indigent Program 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Medicine Man Pharmacy Port Lavaca, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said , this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us version v1.0.27r CALHOUN I COUNTY, TEXAS -INVITATION TO BID FORM PRESCRIPTION DRUGS Calhoun County Indigent Program JANUARY 1, 2017 Thru DECEMBER 31, 2017 With the Option to Renew Yearly if notification of renewal is accepted by Calhoun County Commissioners' Court ► Do Not Fold Bid Form ► Please Type • Calhoun County Indigent Program r1V NET COST to be computed in accordance with the Department of State Health Services, County Indigent Health Care Program Handbook, Payment Standard for Prescription Drugs. (Section Four, Page 10, from the DSHS Handbook attached — Handbook may be updated at various times during the year) Fill in appropriate blanks Net Cost: G , f Generic--) AWP Minus 5o% LESS Additional Discount__ _ (� 6 g�� L e ve Minimum Amount Additional iscount Totals Discount Percentage off of AWP (Minimum is 50%) Dispensing Fee- PLUS � •g9 (s.00 -U li spe.rtse Qce -I- . $9 QAmi r% ' Q-) Plus Dispensing Fee, if any ($3.00 maximum) Net Cost: Name Brand--) AWP Minus 15% LESS Additional Discount Minimum Amount v' Additional Discount Total Discount Percentage off of AWP (Minimum is 15%) Dispensing Fee- PLUS - o C 2,'OD (7 is pence Fee1 • Sq G\din Plus Dispensing Fee, If any ($3.00 maximum) p The undersigned affirms that they are duly authorized to execute this bid form, 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. The undersigned affirms that they have read the entire Invitation to Bid Package and fully understands and has followed all specifications and general conditions. Date of Bid: ! t"' CS-1 l0 Company: Authorized Print Name& Title ofAuthorized �SiggnnaturrejEla ME4ch AcyA ' "^ ou,` ,+��j'' 'Q '- /k"— Telephone Number: �'�O1_ `� ` •�� Fax Number: 2-' � ` 3 " ^ Aoq 3l Email: �e►1chaect.elv0.@ h��•eum Contact Person: Contact List any exceptions to the given bid McAlmPA,c_+ WTI a x, spun 4- A01AR'l (613 I mend�aca •elves-@ i,�b. eor� OR Outside Billing Copipany (Processor/Partner), If any, that process payments CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of1 Complete Nos, 1- 4 and 6 if there are Interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2016.136946 HEB Rxtra Advantage San Antonio, TX United States Date Filed: 11/15/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhound County Indigent Program Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 1295 Prescription medication administration Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling I Intermediary Menchaca, Elva San Antonio, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 9EF�9ii _ I swear, or affirm, under penalty of perjury, that the above disclosure is We and correct. ""`° TINA PRINCE MyDbruary ion Expires �! February 15, 2019 Grta,cr9 Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP I SEAL ABOVEfy Sworn to and subscribed before me, by the said t_Iy Q P— V-1 �6l Lt C, this the �� 4�/ day of "t 2g--HOL_, to certify which, witness my hand and seal of office. if C� Si nature of officer administering oath Printed name of officer administering oath Tifle of officer administering Path Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 Consider and Take Necessary Action to award bid for Calhoun County EMS Station, Calhoun County Precinct 4, Seadrift, Texas. (MP) Commissioner Lyssy made the motion to award K & T Construction a contract based on their base bid and Commissioner Galvan seconded that motion. Commissoner Finster recued himself. Commissioners Galvan, Lyssy and Judge Pfeifer all voted in favor. Page 5 of 32 Agenda Item for Commissioners' Court —Thursday, December 8, 2016 Consider and take necessary action to award bid for Calhoun County EMS Station, Calhoun County Precinct 4, Seadrift, Texas. G&WENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)552-4509 • f: (361)552-4987 Tx Firm Registration No. F-4188 December 2, 2016 Honorable Michael J. Pfeifer Calhoun County Judge 211 S. Ann Street, Suite 301 Port Lavaca, Texas 77979 Re: Calhoun County EMS Station, Precinct 4, Seadrift, Texas RECOMMENDATION FOR AWARD On Wednesday, November 30, 2016, sealed bids for the above referenced project were received and publicly opened in the Judge's office at the Courthouse. A Bid Opening Table and Itemized Bid Tabulation Sheet is attached, comparing the six (6) bids received. There were no mathematical errors found in the extensions and/or sums calculated in the bids. Although the Invitation to Bid stated that bids were to be submitted in triplicate, there is no such requirement cited in either the Instructions to Bidders or on the Bid Form, so our recommendation is to waive the requirement for 3 copies of the bid. With this consideration, and after a close examination of the bid bonds and other documents submitted with the bids, it was determined that three (3) valid and complete bids were received: • A&A Constructors, Inc. with a base bid of $603,000.00 • BLS Construction, Inc. with a base bid of $629,200.00 • K&T Construction Co., Inc. with a base bid of $579,000.00 The other bids were disqualified as follows: o Amason Air, Inc. — No calendar days were bid and the Bid bond was for $20,000.00 which is less than the required 5% of the greatest amount bid (GAB) of $624,086.00 o Don Krueger Construction — No calendar days were bid o Rexco, Inc. — the Bid Bond was for $8,500.00 which is less than the required 5% GAB of $683,588.35 The apparent LOW BIDDER therefore is K&T Construction Co., Inc. with a base bid of $579,000. We recently worked with K&T Construction Co., Inc. on the construction of the Memorial Medical Center Medical Clinic on Virginia Street in Port Lavaca and found them to be a very capable and conscientious contractor. MMC CEO Jason Anglin commented to me that the hospital was "pleased with the quality of work they did." He said that they were "a little slow with construction", but they "also had a lot of rain delays." He added however that "K&T Construction Co., Inc would be at the top of the list to use" for any future project. With all these things taken into consideration, and assuming the Commissioners are satisfied with the two -course asphalt surface treatment specified for the road and parking area in the base bid, we therefore recommend that the Calhoun County Commissioner's Court award a construction contract for the above referenced project to I T Construction Co., Inc. in the amount of $579,000.00, being the total Base Bid. ennaP "Weaver, P.E.eer G&W Engineers, Inc. xc: Peggy Hall; file 9045.014 art:2 Engineering Consulting Planning Surveying W W LQL 1� Z Z W a O o W Y N y N N N ao i } } > } > Q iQ w O O w 00 } z z w } } w } U z Q o O O n O m Q o ((9 0 0 Q o N in � o 0 o E9 N m N v N N N v Q O W W W W W W } } } } } } m N Q p n W z W z z} o Z W N z W o 0 W a O> m O> M N Q z (9 z 9 U n z O Z a m o O 0 0 0 0 O aiv !7 O m o O 0 0 O 0 N o o v Q O �•�j 16 N M N L6 M W Z m fA y� Ny Fy 0 J O - r U z H E 0 0 0 0 0 0 m m o 0 0 0 o u O .o l� O m 0 0 Mo' 0 0 0 o 0 N Mo' w O M M OJ N N O W 'u N- fA to N- >Z > J O � V m d N O O O O O p Z m O a M M O O E c o rn u o N m Fa j C (A fA (9 f9 fA m O O O O O A W O O N O O h W (O 4i N f9 [O fR (O f9 N FA (O UY O U � c � � U c � U O ~ i C C C O Z � i N N °6 ro -j 0 °� E axi Q Q m 0 Y Ir 0 m a W W_ N Z 0 Q J Q 1- Q m N N_ E W t w w w w w w w 8 8 8 8 26 m G m n 6Y N < F 2` ro Y w w w w O aU N w t2n 2 zo 00 0 w w w w w w I V N w w 19 w w w I 0 0 o a q $ o �d a w w w m N n 8 � u ¢�2 Es ` g E `x e - �na so sm as �3 z8 �� E �- 0 Y E E Eo 0 -� �� w Eo w c y u E E 3a rn__ y W o and C' Sc ovrc c c'au °c O1S o m- EEuc' 'N2 Ea m E IL y li .� u Il E IL IL y 2 IL (V �- IL E s mF N N < m n m m _ `ffi i'h sty �33 bhSA'rVt w C�',(n�' hereinaftercalled'BIDDER% (Legal Firm Name) is submitting this Proposal for Furnishing and Performing the Work specified herein as CALHOUN COUNTY EMS STATION, CALHOUN COUNTY PRECINCT 4, SEADRIFT, TEXAS This PROPOSAL is Submitted to CALHOUN COUNTY, hereinafter called "OWNER". 1. Terms used in this PROPOSAL are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform. all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents, 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Calendar Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: Ol Date Received: b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in.relation to the Work for which this BID is submitted. C. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents. are generally sufficient to indicate and convey understanding of all terns and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation, BIDDER has not.directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not. solicited or induced any person, fern or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER, 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities. determined as provided in the Contract Documents. c. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices, d. 'BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance -with paragraph 11.03.B of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Base Bid BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS -------------------------------------------------------- ----------------------------------- l. 1 LS For mobilization and insurance costs associated with the project in accordance with the specifications for a lump sum price of 2. 3. and Cents. 1 LS Furnishing material, labor and equipment for the construction of the EMS building that includes but not limited to structural fill, foundation, 6 foot wide concrete aprons, building structure, overhead doors, exterior doors and windows, all as per plans and specifications for a lump sum price of 71 "�101 ' Dollars and Cents. 1 LS Furnishing material, labor and equipment for the construction of the interior rooms of the EMS facility that includes but not limited to plumbing, plumbing fixtures water heater, air conditioning, and kitchen appliances, all as per plans and specifications for a lump sum price of BID AMOUNT $ 3io, boo $1304006 00300-3 I BID BID DESCRIPTION O1+ ITEM WITH UNIT ITEM QTV. UNIT PRICE WRITTEN IN WORDS BID AMOUNT 4. 1 LS Furnishing material, labor and equipment for the installation of the electrical components on the interior of the EMS facility and power line to the sewage treatment plant, all as per plans and specifications for a lump sum price of j DI and cents. 5. 1 LS Furnishing material, Iabor and equipment for the installation of the generator with transfer switch, all as per plans and specifications for a lump sum price of �IJR� Dollars and j cents.'• s u erEr a - a 6. 1 LS For obtaining permits, furnishing and installation of an on -site sewage treatment system to serve five employees (300 GPD) with sprinlder system disposal area and sewer lines to the building. Reference On -Site Sewage Facility Design attached at the end of the Specifications, The system shall be complete and ready to operate as per plans and specifications for a lump sum price of Dollars and Cents. $ 2? 0 491 0 00300-4 BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT IS Furnishing materials, labor and equipment for the construction of the 2 course asphaltic treatment with 10" crushed limestone base driveway and parking lot (approx. 15,650 SF) and 2" cold laid asphalt with 8" crushed limestone between S.H. 185 and property ROW (approx. 1,280 SF), as per plans and specifications for a lump sum price of `�t.aS.�vA�a.rD� Dollars MIM Cents. $101, aao 8. 1 LS Furnishing material, labor and equipment for the site grading including drainage ditches and seeding of exposed areas, end treatments for existing (18") culvert at S.H. 185 and end treatments for on -site 12"culvert, as per plans and specifications for a lump sum price of Dollars and Cents. �~'Ib 00 9. 1 IS Furnishing materials, labor and equipment for implementation, enforcement, and maintenance of TPDES requirements for duration of project (S WPPP) for a lump sum price of r rs AJoo +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 00300-5 ADDENDUM NO. 1(November 17. 2016) Calhoun County EMS Station, Calhoun County Prtu lnot 4. Seadrift, TX (MeNo. 9045.014) OWNER'S OPTION'S BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT ---------------------------------------------------------------- --------------------------------------- ------------------------ 01. 1 LS Cost for furnishing material, labor and equipment for the installation of 2" hot mix asphalt and 8" crushed limestone driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7, as per plans and specifications for a lump sum price of OD And Cents. $18,-10a 02. 1 IS Cost for furnishing material, labor and equipment for the installation of a concrete driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7 above, as per plans and specification for a lump surorice of Dollars and Cents. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions within 1_Z,,6 Calendar Days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are attached to and made a condition of this BID: a. Required Bid Security in the form of FO. np J&oNiJ b. Document No. 00412 — Certificate of Interested Parties (Form 1295) C. A tabulation of Subcontractors, Suppliers and other persons and organizations required to be identified in the BID. • d. Document No. 00415 - CONTRACTOR's Corporate Resolution. e. Document No. 00416 - Noncollusion Affidavit f. Document No. 00420 - Bidders Qualification Statement. 00300-6 ADDENDUM NO.1 !November 17.2016) CAA n County ENIS Station. CaNnun Counry Pmcinct 4• SC Yc.9 (He No. 9N5.014) 3. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this 30 day of N o��rn �� 2016. Authorizdd Signature: Name: T r-KNA tpez-c Title: TiC�E/ISVRR Attestb Name: Legal Firm Name: �� v ��y�5 � "(11Gi1 Co, I nc Business Address: �1��t�•�bh�b�k'xu+� UI(YVC1����1�0� Phone Number: 361 511O 17M Facsimile Number: 3(o l b] (0 125D E-Mail Address: 5W5 ki C,64-oA C256. 1u,DA - he'd" State of Incorporation, if applicable: Igob State Contractor License No.: 7` - Z0 SD Z 4 q - S END OF DOCUMENT 00300-7 J� BID DUE Texas PENAL SUM FORM 13OND BOND NUMBER: Bid Bond DATE (Not later than Bid due date): November 30, 2010 PENAL SUM: .Five Per Cent of the Greatest Amount Bid — $ 5% G.A.B. (Words) (Figures) IN WITNESS WHEREOF, Surety and Bidder, intending to be legally bound hereby, subject to the terms Printed on the reverse side hereof, do each cause this Bid Bond to be duly executed on Its behalf by Its authorized officer, agent, or representative, BIDDER SURETY K & T Construction Company, Inc. (Seal) North American Specialty Insurance Company ($eat} Bidder's Name and Corpo to Seal Surety's Name and Car orate Seat �?S�'SEG Signature and Title Signature an IUa Rita G. Gulizo, Attorney -in -Fact (Attach PowerofAttornsy) Attest ABest��� gV'� Signature and Title signature and "Ilia Cynthia S. Vaughn, fitness Note: (1) Above addresses are to be used forgiving required notice, (2) Any singular reference to Bidder, Surety, -OWNER or other party shall be confide +ed' plural where applicable. ' r i EJCAG NO. 1910-28-C (1996 Edition) 00410.1 1 1. Bidder and Surely, jointly and severally, bind themselves, their heirs, executors, administrators, successor's and assigns to pay to OWNER upon default of Bidder the penal sum sot forth on the face of this Bond. 2. Default of Bidder shall occur upon the failure of Bidder to dolivor within the timeroquired by the Bidding Documents (or say extension thereof agrocd to in writing by OWNER) the excouted Agreement required by ilia Bidding Documents and any porformanoo and payment Bonds required by the Bidding Documents. 3. This obligation shall be null and void If., 3.1, OWNER maple Bidder's Bid and Bidder delivers within the tbne required by the Bidding Documents (or any extension thereof agreed to In writing by OWNER) the oxecuted Agreement required by the Bidding Documents and say performance and payment Bonds required by the Bidding Documents, or 3.2. AB Bids are rejected by OWNER, or 3.3. OWNER falls to issue a Notice of Award to Bidder widda the time specified in the Bidding Documents (or any extension thereof agreed to in writing• by Bidder and, If applicable, consented to by Surely when required by paragraph 5 hereop. 4. Paymont under this Bond will be duo and payable upon default by Bidder and within 30 calendar days after receipt by Bidder and Surely of written notice of default from OWNER; which notice will be given wlth reasonable promptness, Identifying this Bond and the Project and Including a statement of the amount duo. 5. Surety waives notice of and any and till defenses based on or arlsbtg out of any time extension to issue Notice of Award agreed to In writing by OWNER and Bidder, provided that the total time for issuing Notice of Award including oxiensfons shall not In the aggregate exceed 120 days froin Bid due date without Surety's written consent. 6. No suit or action Owl be commenced under this Bond prior to 30 calendar days skor the notice of default required In paragraph 4 above is received by Hfddor end Surety. and in no case later than one year after Bid due date. 7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located In the state in which the Project Is located. PENAL SUM FORM 8. Notices required bereunder spell be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notfoea,nrny be sent by personal delivery, commercial courier or by United States Registered or Certified M4 return receipt requested, postage pre -paid, ad shall be deemed to be effective upon reeolpt by the party oonamed, 9. Surely shall cause to be attached to this Bond a current and effective Power or Attorney evidencing the authority of the officer, agent or representative who executed this Eoud on bebalfof Surety to oxeoute, seat and deliver much Bond and bind the Surety thereby. 10. This Bond is intended to conform to all applicable slatutoryroquireme-M. Any applicable requfrementof any applicable statute that has been omitted from this Bond shall be deemed to be Included herein as if.set forth at length. If any provision of this Bond conflicts with'any applicable statute, then die provision of sold otatate shall govern and the remainder bf this Bond that Is not in conffiot therewith shall continue in flail force and effect. il, The term "Bid" as used herein includes a Bid, offer or proposal as applicable. '97Ci7C NO.1910-28-C (1996 Editfon) 00410.2 J Y. NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg, Illinois, each does hereby make, constitute and appoint: RITA G. GULIZO and SUSAN D. ZAPALOWSKI JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION ($50,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 90' of May, 2012: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." \ Vmmuuwmuy \ \QQ•i)t car?9 •Ctj\� �Tad!Q��y,a v� , _ AARpb..... SG 9El SEAL 169 SEmrenP.And.m,SenimVicePres(denlofWuhl.gimI.tc..fi.Il.a..mCompavy -7SFAL -ZA 1073 otSOq` & senior NaeNaidmi.Mmlh Ameriran Smdaltylnevnvice Compnoy act If„' "Y n ��. //G bdN+lyyd\\pp&'rtb� h/i/l/llii11111t\\\\ E e//� .rJ`•"�;••••�t<a Michael A.Ito,SeTVer�rt�i�l f�ry7eieog777��/Tan )ntemanov u�uraotZomPanY mry &Senior Vice Preaidmt ofNoah Ameriran Spedilty Insumna Campeny IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington Intemational Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this 27th day of August 2015 North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook ss: On this 27th day of August , 2015 • before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of Washington Intemational Insurance Company and Senior Vice President of North American Specialty Insurance Company and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly swom, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIALSEAL M KENNY / NOTARY PUBLIC, STATE OF IWNOIS M. Kenny, Notary Public , MY COMMISSION EXPIRES 12/04/2017 I, Jeffrey Goldberg: .the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington Intemational Insurance Company, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 30th day of November , 20 16 —�� JeffreyG Idber& Pu Praidema Assistant Beads d Wazhinglan Inlemadon al huumn ca Company & NoM American Sp edalry Nmmnce Company North American Specialty Insurance Company Washington International Insurance Company TEXAS CLAIMS INFORMATION IMPORTANT NOTICE ADVISO IMPORTANTE In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jim Carpenter, Vice President — Claims at 1-800-338.0753 You may call Washington International Insurance Company and/or ' North American Specialty Insurance Company's toll -free number for information or to make a complaint at: 1-800-338.0753 You may also write to Washington International Insurance Company and/or North American Specialty Insurance Company at the following address: 475 N. Martingale Road Suite 850 Schaumburg, IL 60173 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1.800-252-3439 You may write the Texas Department of Insurance: P.O. Box 149104 Austin, TX 78714.9104 Fax: (512)490.1007 Web: htto://`www.tdi.state.tx.us Email: ConsumerProtection@tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the Washington International Insurance Company and/or North American Specialty Insurance Company. If the dispute is not resolved, you may contact the Texas Department oflnsurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. Puede comunicarse con Jim Carpenter, Vice President —Claims, al 1.800-338-0753 Usted puede Ilamr at numero de telefono gratis de Washington International Insurance Company and/or North American Specialty Insurance Company's para informacion o para someter una queja al: 1-800.338.0753 Listed tambien puede escribir a Washington International Insurance Company and/or North American Specialty Insurance Company al: 475 N. Martingale Road Suite 850 Schaumburg, IL 60173 Puede escribir al Departmento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quelas al: 1-800.252-3439 Puede escribir al Departmento de Seguros de Texas: P.O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: hlto:/Avww.tdi.state.tx.us Email: ConsumerProtection@td"tate.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Washington International Insurance Company and/or North American Specialty Insurance Company primero. Si no se resuelve la disputa, puede entonces comunicarse con el Departmento de Seguros de Texas. UNA ESTE AVISO A SU POLIZA Este aviso es solo para proposito de infromacion y no se converte en parte o condicion del documento adjunto. CERTIFICATE OF INTERESTED PARTIES FORM 1.295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos.1, 2, 3, 5, and 6 if there are no Interested parries. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place • of business. 2016-141156 K & T Construction Co., Inc. Victoria, TX United States Date Filed: 11/30/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being'filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2016 EMS Station Nature of interest 4 Name of Interested Party city, State, Country (Place of business) (check applicable) Controlling Intermediary Tomanek, Larry Victoria, TX United States X Strnadel, Scott El Campo, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. o� "10 Jeri E Gart "���j`�.��fy+ My Commiseca•Exr:• Y V�e 09/2412076 `"�"'•`�'^�1d�'�"' Signature of aut onzed agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE ,,fit- (�f,,,� �,tl Sworn to and subscribed before me, by the said n U (l S f f IGrdtt , this the ^ ` I I.," 5 D day of ICI �VMW'r, 26 to certify which, witness my hand and seal of office. t�,& j6ri Ic &af TA offi?e ig ature of officer administer) oath - Printed name of officer administering oath Title of officer adrri' istering oath Forms provided by Texas Ethics Commission www.etNcs.state.tx.us Verswn V1.0.411 CERTIFICATE OF INTERESTED PARTIES FORM 3.295 1of1 Complete Nos. 1-4 and 6 if there are interested parties. Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2016-141156 Date Filed: 11/30/2016 Date Acknowledged: 12/29/2016 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. K & T Construction Co., Inc. Victoria, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County 3 Provide the identification number used by the governmental entity or state agency to track or identify description of the services, goods, or other property to be provided under the contract. 2016 EMS Station the contract, and provide a 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Tomanek, Larry Victoria, TX United States X Strnadel, Scott El Campo, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of , 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 "OC i�'.1' ISO. 00415 tthat certify C® 0 � So L TIO atit Was RESOLVED by a quorum c F SU y the dtrectorsof IIleetin (Name of g on the J� corporation) day of %, DY'm b1 that S(Q �'L zo l (o (Name ofPrincipal) V l Ci�t T C and hereby is' authorized to execu State of te all doc (Title) be Texas on bmnettfs necess ehalf ofthe said Ky ary for the transaction of business in the df�n(NameofcMess ab That the rporation) and ove resolufio n Was o tznanimouslyradfied b that the resolution •has bythe Board not been resc d or ofDrreCtors at said mee authentica ittde amended tzon of the ad and is fuig and option of this reso now In fan force and e °f ffect; and in lution,1subscribemYna�e this �^►I 0 �- day Secretary MD O-P DOCUMENT 00415-1 State of_�Tw — County of V j cb'VY a ) U�&n r.e bein g first 1u1Y sworn de ores and says that 1. He is �� I Tirea� of �,V� 1 l �� , the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affrant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract, and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) 'Sff I ZV?GtS. t Title Subscribed and sworn to me this �D day of i`rbVMCltX 20 1(.o ` Ll Notary ublic My commission expires END OF DOCUMENT 00416-1 ='�Y�� Jeri E Garza � jy++ My Commission Enpiwt s�o �}e 09/24/20SB 1.< DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT -Bidder shall answer all questions, and answers shall be clear and comprehensive. This form shall be notarized upon completion. As necessary, BIDDER may use separate attached sheets to answer questions, and may submit additional information, if desired. BIDDER's Name: �4'� ConS c soh (0,1 V1 C . Organization Date: 1 q (o Address: g67J N Sohn ����(�/ Incorporation Date: Iggl Type of Work Performed. G ti-oJ (:t1Wwd-f 6 n Ever Failb Complete Awarded Work? Y or Ever Default on Any Contract? Y or g Attach a LIST OF PROJECTS, similar in size and scope to the work covered by this proposal, which BIDDER has MOST RECENTLY COMPLETED. Amount of Date owner Contract Contract Award Tyne of Work Completed and phone no. Attach a LIST OF PROJECTS BIDDER is now ENGAGED IN COMPLETING. Amount. of Percent Owner Contract Contract Award Type of Work Complete and phone no. Attach a LIST OF EQUIPMENT THAT WILL BE AVAILABLE FOR THIS PROJECT including type, model, owned or leased. Attach a RESUME FOR EACH OFFICER OF THE COMPANY AND THE PROPOSED SUPERINTENDENT for this Project. ALSO, indicate the number of Foremen, Equipment Operators, Laborers, etc. that will be available for this project. Credit Available: $ 11000)00 0 Bank Reference/Contact: 301 5-7Zi 2?4J00 The undersigned hereby authorizes any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY, in relation to the verification of the statements comprising this BIDDER's Qualification St a ent. Signe Executed and sworn to before me, the � undersigned authority, on this 30day r Name & Title: of t� OVP.PYIbw 201(, Jeri E Garza My CommlWon Expires END OF DOCUMENT 00420-1 PROPOSAL A & A Constructors, Incorporated , hereinafter called "BIDDER", (Legal Firm Name) is submitting this Proposal for Furnishing and Performing the Work specified herein as CALHOUN COUNTY EMS STATION, CALHOUN COUNTY PRECINCT 4, SEADRIFT, TEXAS This PROPOSAL is Submitted to CALHOUN COUNTY, hereinafter called "OWNER". 1. Terms used in this PROPOSAL are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Calendar Days after the date of OWNER's Notice of Award, 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: one (1) Date Received: 11-122/16 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and Punishing and performing the Work. 00300-1 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. C. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g, This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER aclarowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. 'BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Base Bid BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS 1. I LS For mobilization and insurance costs associated with the project in accordance with the specifications for a lump sum price of T bU n. % Dollars and 1 l/v Cents. 2. 1 LS Furnishing material, labor and equipment for the construction of the EMS building that includes but not limited to structural fill, foundation, 6 foot wide concrete aprons, building structure, overhead doors, exterior doors and windows, all as per plans and specifications for a lump sum price of On,2 h "-c Pia— 4w, o 6 _APB s8 Md 11 ne 6-Uv t'YdVQ d Dollars and //Vaa) Cents. 3. 1 LS Furnishing material, labor and equipment for the construction of the interior rooms of the EMS facility that includes but not limited to plumbing, plumbing fixtures water heater, air conditioning, and kitchen appliances, all as per plans and spec//ifncations Tor a lump sum price of %i �'j2b)OS���J'�f✓G�i/C {! t rt Vick Dollars andCents. MT)MYTTI]MR $'N 'Zbo. o0 00300-3 BID BID DESCRIPTION OF ITEM WITH (UNIT ITEM QTY, UNIT PRICE WRITTEN IN WORDS 4, 1 LS Furnishing material, labor and equipment for the installation of the electrical components on the interior of the EMS facility and power line to the sewage treatment plant, all as per plans and specifications for a lump sum price of G 1.1 :5 -//nine �4buA�� o€t� haGa . (- o Dollars and /V6 Cents. 1 LS Furnishing material, labor and equipment for the installation of the generator with transfer switch, all as per plans and specifications for a lump sum price of Twenly - se e'o —A ores I AIG�Q'd'�,� and 11 /'d Cents. 1 LS For obtaining permits, furnishing and installation of an on -site sewage treatment system to serve five employees (300 GPD) with spinlder system disposal area and sewer lines to the building. Reference On -Site Sewage Facility Design attached at the end of the Specifications. The system shall be complete and ready to operate as per plans and specifications for a lump sum price of f L—I e V8 7 �d2 h f/un&-P1i( Dollars and �� Cents. BID AMOUNT 00300-4 BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT --------------------------------------------------------------------------------------------------------------------------------- 7. 1 LS Furnishing materials, labor and equipment for the construction of the 2 course asphaltic treatment with 10" crushed limestone base driveway and parking lot (approx. 15,650 SF) and 2" cold laid asphalt with 8" crushed limestone between S.H. 185 and property ROW (approx. 1,280 SF), as per plans and specifications for a lump sum price of O 4[3y_5,a 1c1j `J (i� i1 Z%Y1C! riP Dollars and A,6 Cents. $ Y1 f� 60® 8. 1 LS Furnishing material, labor and equipment for the site grading including drainage ditches and seeding of exposed areas, end treatments for existing (18") culvert at S.H. 185 and end treatments for on -site 12" culvert, as per plans and specifications for a lump -sum price of / IN f.at fu ' �r tfGJ 'T "� DLt 5 ch/at� and Jub Cents. $ 25.,300 9. 1 LS Furnishing materials, labor and equipment for implementation, enforcement, and maintenance of TPDES requirements for duration of project (SWPPP) for a 1 mp sum price of 01/L �hoLcs'�gmd &--114-1 0 t I&til Ci y-2e and NO Cents. $ F ?'9 o z Total Base Bid, being Items 1 thru 9 above, is: $ to032a w +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 00300-5 ADDENDUM NO. 1(November 17, 2016) Calhom County EMS Station, Calhoun County Precinct 4, ScadrM, TX (Pile No. 9045.014) OWNER'S OPTION'S BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT 01. 1 LS Cost for furnishing material, labor and equipment for the installation of 2" hot mix asphalt and 8" crushed limestone driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7, as per plans and specifications for a lump sum price of ng J and s Cents. $ - 4a 00� 02. 1 LS Cost for famishing material, labor and equipment for the installation of a concrete driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7 above, as per plans and specifications for a/lump sum price of 1fi and V4"> Cents. $ +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions within 180 Calendar Days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. 7. The following documents are attached to and made a condition of this BID: a. Required Bid Security in the form of 5% Bid Bond b. Document No. 00412 — Certificate of Interested Parties (Form 1295) C. A tabulation of Subcontractors, Suppliers and other persons and organizations required to be identified in the BID. d. Document No. 00415 - CONTRACTOR's Corporate Resolution. C. Document No. 00416 - Noncollusion Affidavit f. Document No. 00420 - Bidders Qualification Statement. 00300-6 ADDENDUM NO. 1(November 17, 2016) CeNow County EMS Station, Calhoun County Prednal4, Scedrifl, i (F& No. 9045.014) 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this 30th day of November 2016. Title: President Attesting Signature! Name: Matt Alv Title: Secretary/Treasurer v Legal Firm Name: A 6 A Constructors, Incorporated Business Address: 4401 North Main Street; victoria, TX 77904 Phone Number: (361) 575-7070 Facsimile Number: (361) 575-7685 E-Mail Address: balvarez@aaconstructors.com State of Incorporation, if applicable: State Contractor License No.: N/A END OF DOCUMENT 00300-7 9 'Imp, a /1 i 3 °I l Bid Dond CONTRACTOW SURETY: (Yana, legal sfafns and aeldreav) (Value, legal Swim and])rinolpal ])face A & A Constructors, Inc. ofbusiness) AiiilYlbNa AND l7rl.li'fIDN11: PO Box 465 FCCI Insurance Company The author of ]his document has Victoria, TX 77902 6300 University Parkway added information needed for Ile OWNGR; Sarasota, Florida 34240 comptellan. The author cony also havo.rovised the text of the od0lnal Oafire, legal nut addnrsa• g ) AIA shoo and form. An Add/dons and County of Calhoun Deletions Report that notes added 211, S. Ann St., Port Lavaca, TX 77979 Informallon as vroll as rovislons to 1110 standard form text Is available from BOND AMOUNT; $ five percent (5%) of bid amount the author and should be rWevred,A vortical line In ilia loft margin of this PROJECT: documont Indicates whore Ilia author (Nacre, location or ar(dressi and Profecl mmnGe; ({•Nay) has added necessary informatlon • Calhoun County EMS Station and whole the author has added to or Calhoun County Precinct 4 -deleted from Iho orldinol AIA text. Seadrift, TX Tills document lion Impartial Wall The Contractor and Sure are bound to the Owner in tide nnnount set forth above, for the Surety consegnencos; Consultation vrtm an attorney Is encouraged with respect pfiyndcat of}vlilch the Contractor arld Surety bind Ihmnselves, their heirs, executors, to Its completion or modification. adliblIstators, successors mid assigns, jofutly and severally, as provided lierein. The conditions of this Bond are such that If line Owner accepts the bid of the Conlrnclor wlthbn Anyshirolar reference to Contractor, the time speci0ed fit the bid documents, or within such limeperiod as may be agreed to by surety, ovxcr or other party shalt be line Owner and Conlrnclor, find the Contractor ofther (1) enders Into a contract with Iho considered plural where applicable, Owner in accordance Willi the terms of such bid, all([ gives such bond or bands as may be specified In Iho bidding or Cortract I)ocrnlents, Willi it surely admitted in lhojurisdic(ion of file T9•ojeet find olbcrwlso nccepinble to the owner,for the lalthfill perlormm7ce ofsuch Con(ract find for the prompt payment orlabor mid material furnished in (be prosecution thereof, or (2) pays to ttte Owner tine difference, not to exceed (he mount of this Bond, betwelia theaniount specified ill said bld and such larger amount for which the Owner may in good faith contract Willi another party to perform the work covered by said bid, (hen lids obligation shalf be null and void, otherwise to ronudi in fil(I force find ofiec6'nco Surety hereby walves ally notice Oran agreement between ibe Owner mid Contractor to extent rile lime in which the Owner nmy accept the bid. Waiver ofoo(ice by the Surety shot( not apply to any extension exceeding sixty (60) days fn file aggregate beyond file (line for ficceptmnee of bills specirred in (be bid documents, and the Owner and Contractor shall obletil the Sure(y's consent for fin extension beyond sixty (60) days, if this Bond is issued fit connection with n subcontractor's bid (o fi Contractor, the term Contractor in this Bond shnll be deened to be Subcontractor and file teem Owner shall be declined to be Contractor. Wien this Bond has been furnished to comply with a statutory or other legal requirement in the location of (lie Project, any provision in this Boil couf3tctbtg with swill statutory or fegat requirement shall be deemed deleted herefrom and provisions conforining to such statutory or.ether legal requirement shall be decided Incorporated herefr, When so fintol lied, [lie intent Is (hill (his Bond slmll beconstrued as a statutory bon(( fill(( not as a conmion law bond, hill. --._.--,-....,... - ---• - f It may.rooalod saver Copyanht Law malinaillollond Trowill be¢,nnmthodtodle rhaxmuonorOnohlbutionorler AlA noo.hic, dol,nradwas proll duced may.rooelk In eovorn ¢lull and crintnoi ponalllaa, and will ro prosoonded to Iho aiaeximnm axlonbposalblounder Ili¢ tear. Tills docan7onlwos produced l AlAsofNmre atm:48;44 on 04/2e12013•under Ordor No.08289A66TM1_t wdAoh expires on 07/0612013, and is notforresolo. Uoor Notos: (101022s070) 30t November, 2016 Signed and Sentett (I1I5 4any o£ sty, (!f9 hess) M tf. A varez (fYllnesa) Wt. A & A Constructors, Inc. Bob Alvarez; FCCI Insurance Company (SarcrV) \ Pao ase, Attorney -in -Fact or officers and its corporate Seal to be hereunto affixed, this day SEAL �: uuui nwa cay., nic rew Gov ment Affairs and Corporate t s<oa�o" ' FCCI lnsurance,Comp�ny 5 ohnson'who Is personally known fo me and vJho executed the - CERTIFICATE OF INTERESTED PARTIES 1295 FORM 1of1 Complete Nos. 1- 4 and 61f there are Interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number; 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2016-138753 A & A Constructors, Incorporated Victoria, TX United States Date Filed; 11/18/2016 2 Name of governmental entity or state agency that Is a party to the contract forwhlch the form is being filed. Calhoun County EMS Station; Precinct 4 Date Acknowledged: 3 Provide the Identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 9045.014 New Construction - EMS Station Nature of interest 4 Name of Interested Party City, State, Count ry (place of business)(check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT Bob Alvarez I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. erP ' LESLIE SWANNER e' ° % Notary Public, State of Texas A� ' My Commission Expires %' January 08,2018 ' Signs[ rerof authorized agent of c ra tslness entity AFFIX NOTARY STAMP/SEAL ABOVE Sworn to and subscribed before me, by the said Bob Alvarez this the 30th day of November 20 16 , to certify which, witness my hand and seal of office. Leslie Swanner Bookkeeper Signature of officer administering oath Printed name of officer administering oath Tide of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us version V 1.O.zr i l t Jt1-1_ Z - \ �' 1 1'' CONTRACTOR'S CORPORATE RESOLUTION I hereby certify that it was RESOLVED by a quorum of the directors of A & A Constructors, Incorporated (Name of Corporation) meeting on the 30th day of november , 20_16 , that Bob Alvarez President (Name of Principal) (Title) be, and hereby. is, authorized to execute all documents necessary for the transaction of business in the State of Texas on behalf of the said A & A Constructors, Incorporated ,and (Name of Corporation) That the above resolution was unanimously ratified by the Board of Directors at said meeting and that the resolution has not been rescinded or amended and is now in full force and effect; and in authentication of the adoption of this resolution, I subscribe my name this 30th day of November ,20 16 END OF DOCUMENT 00415-1 DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of Texas County of victoria Bob Alvarez , being first duly sworn, deposes and says that: 1. He is President Of A h A Constructors, Inc. , the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) Jlowwx�,? a t lvar z• slc4 "r. Title Subscribed and sworn to me this 3o day of November 2016 By: Notary Public My commission expires 01-08-18 Leslie swanner END OF DOCUMENT LESLIE SWpNNER `�oT,PTP44�o_ Notary Public, State of Texas ,i, •� My Commission Expires ;; 'i;6 January 08, 2018 00416-1 DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT Bidder shall answer all questions, and answers shall be clear and comprehensive. This form shall be notarized upon completion. As necessary, BIDDER may use separate attached sheets to answer questions, and may submit additional information, if desired. BIDDEWs Name: A & A Constructors, Inc. Organization Date: August, 2004 Address: 4401 North Main Street Victoria, Tx 77904 Type of Work Performed: Ever Fail to Complete Awarded Work? Y or N Ever Default on Any Contract? Y or N Incorporation Date: August 16, 2004 ATTACH THE FOLLOWING INFORMATION: Attach a LIST OF PROJECTS, similar in size and scope to the work covered by this proposal, which BIDDER has MOST RECENTLY COMPLETED. Amount of Date Owner Contract Contract Award Type of Work Completed and phone no. * * * Attached * * * Attach a LIST OF PROJECTS BIDDER is now ENGAGED IN COMPLETING. Amount of Percent Owner Contract Contract Award Tvrie of Work Complete and hone no. * * * Attached * * * Attach a LIST OF EQUIPMENT THAT WILL BE AVAILABLE FOR THIS PROJECT including type, model, owned or leased. JLG Scissor Lift; Caterpiller Backhoe/Loader; Case 1450 Front End Loader; Case 480 Loader/Box Blade; RCH Skytract Forklift Attach a RESUME FOR EACH OFFICER OF THE COMPANY AND THE PROPOSED SUPERINTENDENT for this Project. ALSO, indicate the number of Foremen, Equipment Operators, Laborers, etc. that will be available for this project. Credit Available: $ Bank Reference/Contaet:Prosperity Bank Mr. Herschel VanSickle (361) 574-1670 The undersigned hereby authorizes any person, firm, or corporation to furnish any information requested by CAWOUN COUNTY, in relation to the verification of the statements comprising jli M ER's Qualification Statement. Signed: & Title.. Froob Alvarez; LESLIE SWANNER • P B�� Notary Public, State of Texas t o My Commission Expires +euiiEt° JanuOry 08, 2018 •onu,o� Executed and sworn to before me, the undersigned authority, on this 3o day of November 2016 . Notary Public in and for Victoria County; State of Texas END OF DOCUMENT 00420-1 PROPOSAL BLS Construction, Inc. hereinafter called "BIDDER", (Legal Firm Name) is submitting this Proposal for Furnishing and Performing the Work specified herein as CALHOUN COUNTY EMS STATION, CALHOUN COUNTY PRECINCT 4, SEADRIFT, TEXAS This PROPOSAL is Submitted to CALHOUN COUNTY, hereinafter called "OWNER". 1. Terms used in this PROPOSAL are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. ( 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Calendar Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: 1 Date Received: 11/22/16 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site. conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. C. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g, This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER'S option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. "BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11,03.11 of the General Conditions. C. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Base Bid BID BID DESCRIPTION Or ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS 1. 1 LS For mobilization and insurance costs associated with the project in accordance with the specifications for a lump sum price of/ `5 Y a .-t i v� / ���-4,'AI / Dollars and -AlO Cents. 2. 1 LS Furnishing material, labor and equipment for the construction of the EMS building that includes but not limited to structural fill, foundation, 6 foot wide concrete aprons, building structure, overhead doors, exterior doors and windows, all .as per plans and specifications jfor a/lump sum price of b.JFk�jc✓r�/d��A/0yrwow Zs tiiJ Dollars and Cents. 3. 1 LS Furnishing material, labor and equipment for the construction of the interior rooms of the EMS facility that includes but not limited to plumbing, plumbing fixtures water heater, air conditioning, and kitchen appliances, all as per plans and specifications for a ip�p F O 12A"t, Ui2ld''�ft !vi and -i1- Cents. BID AMOUNT $r y7D,0" 00300-3 BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS 4. 1 LS Furnishing material, labor and equipment for the installation of the electrical components on the interior of the EMS facility and power line to the sewage treatment plant, all as per plans and specifications for a lump sum price of E 3 and --V — Cents. 1 LS Furnishing material, Iabor and equipment for the installation of the generator with transfer switch, all as per plans and specifications for a lump sum price of Dollars and Cents 1 LS For obtaining permits, furnishing and installation of an on -site sewage treatment system to serve five employees (300 GPD) with sprinlder system disposal area and sewer lines to the building. Reference On -Site Sewage Facility Design attached at the end of the Specifications. The system shall be complete and ready to operate as per plans and specifications for a lump sum price of c;AP del and - --V `- 11 lly"I OA 11►Y Y $ . $ 3f BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT ------------------------------------------------------------------------------------------- ------------------ 7. 1 LS Furnishing materials, labor and equipment for the construction of the 2 course asphaltic treatment with 10" crushed limestone base driveway and parking lot (approx. 15,650 SF) and 2" cold laid asphalt with 8" crushed limestone between S.H. 185 and property ROW (approx. 1,280 SF), as per plans and specifications for a 1 p sum price of L"ei ✓ e and Cents. 8. 1 LS Furnishing material, labor and equipment for the site grading including drainage ditches and seeding of exposed areas, end treatments for existing (18") culvert at S.H. 185 and end treatments for on -site 12" culvert, as per plans and specifications for a lump sum price/pf ,�'�Pn7rl,�j ✓ � Tf� t3'tr�d c n/� Dollars eg and 12) — Cents. $o25,T10G)�` 9. 1 LS Furnishing materials, labor and equipment for implementation, enforcement, and maintenance of TPDES requirements for duration of project (SWPPP) for a lump sum price of _fIL r idraVsan.1 - - 3 and Cents. $rX Total Base Bid, being (Items 1 thhru 9 above, is: y// _SJ Y AtliLN/'P.✓J7WeN�A VIA IV tlloV.54 rZ- el tU LV3141J Cents +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ADDENDUM NO.1 (November 17, 2016) Calhoun CountyEMS Station, Calluun Countyli lnct 4, Seadrift, TX (Fda No. 9045,014) OWNER'S OPTION'S BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY: UNIT PRICE WRITTEN IN WORDS -------------------------------------------------------------------------------------------------------- 01. 1 LS Cost for furnishing material, labor and equipment for the installation -of 2" hot mix asphalt and 8" crushed limestone driveway and parking lot (approx. 16,930 -SF) in lieu of Bid Item No. 7, as per plans and specifications for a lump sum price of A J A r e e -M, Dollars and - Cents. 02. 1 LS Cost for furnishing material, labor and equipment for the installation of a concrete driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7 above, as per pl/ann s and specifications for a lump sum price of and c MILIuT__ 11IN 1 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions within Calendar Days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. 7. The following documents are attached to and made a condition of this BID: a. Required Bid Security in the form of Bid Bond b. Document No. 00412 — Certificate of Interested Parties (Form 1295) C. A tabulation of Subcontractors, Suppliers and other persons and organizations required to be identified in the BID. d. Document No. 00415 - CONTRACTOR's Corporate Resolution. e. Document No. 00416 - Noncollusion Affidavit f. Document No. 00420 - Bidders Qualification Statement. 00300-6 ADDENDUM NO. 1(November 17, 2016) Cahoun County6MS Station, Calhoun County Precinct 4,Snddft, T (Ml NuAM5.014) s= 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this 30th day of Nove er 2016. Authorized Signature: Name- William Kev Title: President Attesting Signature: U VLUU 1- Name: Doynnna Olday Title: Offira Rlannnar Legal Firm Name: BLS Construction, Inc. Business Address: 207 Fahrenthold St El Campo, Texas 77437 Phone Number: 979-543-2696 Facsimile Number: 979-543-5006 E-Mail Address; william.key@bisconstruction.net State of Incorporation, if applicable: Texas State Contractor License No.: END OF DOCUMENT 00300-7 207 FAHRENTHOLD STREET EL CAMPO, TX 77437 P: 979-543-2696 F: 979-543-5006 Clarifications to Calhoun County EMS Owner to pay for TXDOT permit. No concrete pad is figured for septic tanks as listed on page C2 and thus detail 2 on C3. Lockers are to be furnished and installed by owner. Light poles, lights for light poles, concrete footings, conduit to light poles and wire to light poles are to be provided by VEC. Windstorm inspections are to be provided by G and W and paid by owner. ADA review is to be provided by architect and paid by owner. Testing is to be paid by owner. In asphalt spec section it lists to be tested but the general conditions and supplementary conditions have owner paying for all testing. Security system is to be provided and installed by owner. Sprinkler system and fire alarm are not included. Diesel in generator is to be provided by owner. Signage and installation is by owner. Minority and female participation cannot be achieved. We have performed a good faith effort in requesting bids and solicitations from these companies and unions as per TXDOT requirements. No epoxy coating included for rebar. We have figured to scrape grass at the building pad and proof roll of existing sub grade. Then install roughly 1' of select fill in 6" lifts compacted to 9S% capacity. This includes a 5' overbuilding of the building pad. Pavement areas: In the base bid we have figured to scrape the ground and remove existing soils to achieve proper depth then proof roll to install 10" crushed limestone for the area of two course and scrape and remove existing soils to proper depth then proof roll to install 8" crushed limestone for 2" asphalt. No lime stabilization is included. The specifications list lime stabilization but we spoke with the engineer and agreed lime stabilization, especially in sand is not proper. Termite treatment to be provided by owner. The County is to move pile of limestone currently onsite. We have included Cat 5 cabling per the drawings but all other communications and installation is by owner. The metal building roof slope is figured as a 1/12 roof pitch. THE AMERICAN INSTITUTE OF ARCHITECTS AIA DocumentA310 Bid Bond KNOW ALL MEN BY THESE PRESENTS, that we BLS Construction, Inc. Bond No.: 293326 207 Fahrenthold St., El Campo, TX 77437 as Principal, hereinafter call the Principal, and Merchants Bonding Company (Mutual) P.O. Box 14498, Des Moines, Iowa 50306-3498 a corporation duly organized under the laws of the State of Iowa as Surety, hereinafter called the Surety, are held and firmly bound unto Calhoun County 211 S Ann St Port Lavaca TX 77979 as Obligee, hereinafter called the Obligee, in the sum of Five Percent of Bid Amount Dollars ($ 5 % ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Calhoun County EMS Station NOW THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 30th day of November 2016 XXX BLS (Principal) (Seal) (Witness) William y (rifle) President — t Mordamrtr9griding Company Mutual is ty) (Seal) Kristie Rodriguez (Witne s - ---- James Russell Attorney -in -Fact AIA DOCUMENT A310 • BID BOND •AIA@ • FEBRUARY 1970 ED. *THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 N.Y. AVE., N.W., WASHINGTON D.C. 20006 ' MERCHANTS Bond #: 293326 BONDING COMPANY, POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, James Russell their true and lawful Attorney(s)-In-Fact, to make, execute, seal and deliver on behalf of the Companies, as Surety, bonds, undertakings and other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the amount of: Five Hundred Thousand ($500,000.00) Dollars This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 24, 2011. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attorney -In -Fact Includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of Its obligations under its bond. In connection with obligations In favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 15th day of August , 2015 niMrr, MERCHANTS BONDING COMPANY (MUTUAL) ,,�Pet•a� '�^.- •�O�1OPPp9q p92•• MERCHANTS NATIONAL BONDING, INC. �. 2CC.3 � n � • a• 1933 STATE OF IOWA"v'+ar,anu`"` •••••••'' COUNTY OF Dallas ss. President On this 15th day of August 2015 , before me appeared Larry Taylor, to me personally known, who being by me sworn did say that he is President of the MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. SCR' rs WENDY WOODY y Commission Number 75465 4 z I&' ° ° ° " My Commission Expires June 20. 2017 Notary PubL , County, Iowa (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of the MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 30th day of November , 2016 . .,nNpr,/ty ••� . r-'s .Z• d: 3: 24C3 1933 Secretary POA 0014 (6/15) CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entityfiling form, and the city, state and country of the business entity's place of business. 2016-140586 BLS Construction, Inc. El Campo, TX United States Date Filed: 1112912016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 9045.014 New construction of 50' x 80' building for EMS Station 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear, or affirm, under penalty f perjury, th 4he above disclosure is true and correct. ar"on., DEVONNA OLDAG asp• 40 ;Notary Public, State of Texas 'C : f V ° = Comm. Expires 06-18-2020 %,�6a•+�}dam Notary ID 124023689 Signa r of uthorized agent of contracting business entity nn,ma AFFIX NOTARY STAMP / SEAL ABOVE \l� I I i �t p Sworn 3o�and subscribed before me, by the said M V i 14 � t,l.{/i� e __ this the 20 to certify which, witness my hand and seal of office. 2 /�rf,,• day of—Almecmw, NV)�tigo(�w INty6ylj pu.bliL Signature of officer administering oath Printed name of o icer administering oa Title of officer ad inistering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 I hereby certify that it was RESOLVED by a quorum of the directors of BLS Construction, Inc. (Name of Corporation) meeting on the 29th day of November 2016 that William Key President be, (Name of Principal) (Title) and hereby is, authorized to execute all documents necessary for the transaction of business in the State of Texas on behalf of the said BLS Construction, Inc. and (Name of Corporation) That the above resolution was unanimously ratified bythe Board of Directors at said meeting and that the resolution has not been rescinded or amended and is now in full force and effect, and in authentication of the adoption of this resolution, I subscribe my name this 29th day of November 2016 Devorma • �iltl 1 41 / l ii END OF DOCUMENT 00415-1 ;.l State of Texas ) County of Wharton ) William Key , being first duly sworn, deposes and says that: 1. He is President of BLS Construction, Inc. the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the j3IDDER or any of its agents, representatives, owners, employees, or parties ' ter {, including this affiant. (Signed) President Title Subscribed and sworn tome this 30th day of November j�, 2016n By: J JWL lyl Notary Public My commission expires June 18, 2020 END OF DOCUMENT DEVONNA OLDAG �oENotary Public, State of Texas Comm. Expires 06-18-2020 Notary ID 129023689 nuuN 00416-1 .......:.::.. i? Please see attached AIA Document A305-1986. DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT Bidder shall answer all questions, and answers shall be clear and comprehensive. This form shall be notarized upon completion. As necessary, BIDDER may use separate attached sheets to answer questions, and may submit additional information, if desired. BIDDER'sName: BLS Construction, Inc. Address:207 Fahrenthoid St, El Campo, Texas 77437 Type of Work Performed: Ever Fail to Complete Awarded Work? Y or® Ever Default on Any Contract? Y or Organization Date: October 1982 Incorporation Date: October 1982 ATTACH THE FOLLOWING INFORMATION: Attach a LIST OF PROJECTS, similar in size and scope to the work covered by this proposal, which BIDDER has MOST RECENTLY COMPLETED. Amount of Date Owner Contract Contract Award Tyne of Work Comnleted and phone no. Attach a LIST OF PROJECTS BIDDER is now ENGAGED IN COMPLETING. Amount of Percent Owner Contract Conh-act Award Type of Work Complete and phone no. Attach a LIST OF EQUIPMENT THAT WILL BE AVAILABLE FOR THIS PROJECT including type, model, owned or leased. Attach a RESUME FOR EACH OFFICER OF THE COMPANY AND THE PROPOSED SUPERINTENDENT for this Project. ALSO, indicate the number of Foremen, Equipment Operators, Laborers, etc. that will be available for this project. Credit Available: $ Bank Reference/Contact: The undersigned hereby author' s any person, fret, or corporation to famish any information requested by CALHO�UNTY, in relation to the verification of thestatements statements comprising this Blip* Qualification Statement. Signed: livo Executed and sworn to before me, the undersigned authority, on this 30th day Name & Title: William Key, President of November 2016 .. Notary Public in and for BLS Construction, Inc. END OF DOCUMENT DEVONNA OLDAG c:°�' e!o%Notary Public, State of Texas 00420-1 v,::r Comm: Expires 06-18-2020 Notary ID 129023689 PROPOSAL , hereinafter called "BIDDER", is submitting this Proposal for Furnishing and Performing the Work specified herein as CALHOUN COUNTY EMS STATION, CALHOUN COUNTY PRECINCT 4, SEADRIFT, TEXAS This PROPOSAL is Submitted to CALHOUN COUNTY, hereinafter called "OWNER". 1. Terms used in this PROPOSAL are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Calendar Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the. Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: Date Received: b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. e. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. £ BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govem. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. "BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to f i nish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Base Bid BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS 1 2. 0 1 LS For mobilization and insurance costs associated with the project in accordance with the specifications for a lump sum gripe of. —41 AL m 1 LS Furnishing material, labor and equipment for the construction of the EMS building that includes but not limited to structural fill, foundation, 6 foot wide concrete aprons, building structure, overhead doors, exterior doors and windows, all as per plans and specificatio s for/'a 1 p sum p ice of e� 1 LS Furnishing material, labor and equipment for the construction of the interior rooms of the EMS facility that includes but not limited to plumbing, plumbing fixtures water heater, air conditioning, and kitchen appliances, all as per plans and r--e ons%ralum}�s}�mprice of Dollars and Cents. BID AMOUNT $ �5 aJD.'06 00300-3 BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT --------------------------------------------------------------------------------------------------------------------------------- 4. 1 LS Furnishing material, labor and equipment for the installation of the electrical components on the interior of the EMS facility and power line to the sewage treatment plant, all as per plans and specifications for a lump sum price of Dollars and O Cents. $ 5. 1 LS Furnishing material, labor and equipment for the installation of the generator with transfer switch, all as per plansandspecifications for a lump sum price of Dollars and Cents. -4 6. 1 LS For obtaining permits, furnishing and installation of an on -site sewage treatment system to serve five employees (300 GPD) with sprinkler system disposal area and sewer lines to the . building. Reference On -Site Sewage Facility Design attached at the end of the Specifications. The system shall be complete and ready to operate as per plans and sp fications for a lump sum price f Dollars and Cents. $ �Z v ' d 0 00300-4 ---------------------------------------------------------------------------------------------------------------------•----------- BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT 7. 1 LS Furnishing materials, labor and equipment for the construction of the 2 course asphaltic treatment with 10" crushed limestone base driveway and parking lot (approx. 15,650 SF) and 2" cold laid asphalt with 8" crushed limestone between S.H. 185 and property ROW (approx. 1,280 SF), as per plans and specificatio s for a lump sum price of and `0 Cents. $ �m �� ��� do 8. 1 LS Furnishing material, labor and equipment for the site grading including drainage ditches and seeding of exposed areas, end treatments for existing (18") culvert at S.H. 185 and end treatments for on -site 12" culvert, as per plans and specifications for a lump sum price of l/ ✓P irk m- 2 Dollars / and Cents, 9. 1 LS Furnishing materials, labor and equipment for implementation, enforcement, and maintenance of TPDES requirements for duration of project (SWPPP) foorr%a lump sumJpr1ce oflcr 'I — and Cents. $" -a�� Total Base Bid, being Items 1 thru 9 above, is: $ % OeiC ++++++++++++++++++++++t+++++++++++++++++++++t+++++++++++++++++t+++++r++++++++++++ 00300-5 ADDENDUM NO. 1(November 17, 2016) Ca toun Quntyrim Station, ca oun countyPadnct 4, S."iT (Mk No. 9045.U)9) OWNER'S OPTION'S BED BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS -------------------------------------------------------------------------------------------------------- 01. 1 LS Cost for furnishing material, labor and equipment for the installation of 2" hot mix asphalt and 8" crushed limestone driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7, as per plans and specificatio s for a lump sum price o/f p,a AU-..,f-. �t ZZ Dollars and Cents. 02. 1 LS Cost for finnishing material, labor and equipment for the installation of a concrete driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7 above, as per planand s ecifi atiolls for a lump sum price of X< < Dollars and Cents. BID AMOUNT $ $ r01 000•a-4 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are attached to and made a condition of this BID: a. Required Bid Security in the form of ,9/ C /-�° b. Document No. 00412 — Certificate of Interested Parties (Form 1295) C. A tabulation of Subcontractors, Suppliers and other persons and organizations required to be identified in the BID. d. Document No. 00415 - CONTRACTOR's Corporate Resolution. e. Document No. 00416 - Noncollusion Affidavit f. Document No. 00420 - Bidders Qualification Statement. 00300-6 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this -FC? day of 4&,Y 9r!/ 2016. Authorized Signature: .&-j Attestb Name: Title: i/ Legal Firm Name: Business Address: Phone Number: rTZ S� Facsimile Number: E-Mail Address Of State of Incorporation, if applicable: State Contractor License No.: END OF DOCUMENT 00300-7 PENAL SUM FOR BIDDER (Name and Addressl: SiWNER (Name andAddressi BOND BOND RiW& ER: 0113016 DATE 11/3012016 PENAtStffsi; TWE V Thousand $20,000 . MAW&) ( gares) IN WITNESS WHEREOF, Surety and Bidder, intendingto baiegaliy bound hereby, subjeotto the terms printed onthe.revars'e.side hereot; do each cause this Bid'Bondto be duly execllted on its behel(by its authorized officer, agent, or representative, BIDDER SURM The OWo a asuait7y 3nsuxance aaso� Air, Inca inn 02 ._ a] 3iddes me ang rporate .S. F Sraws Nafiiaand Cae�larate Sea€ BTt Si -Mature and 7155 StI saiure ej,0 TiVe _; w r` Atfe_w •:� 'ss 3it1E3`GCT.?=1E' Signature and Tffe S€gnatitYe anc2 s ilia Note: (t) Above addresses are Wbe used for giving.required notice. (R) Any.eingular reference -to Bidder, Suraty,-OWNER orother party shall be considered 1 plural where applicable. E7Gi�.0 N0.19 t'6 28-G (1:416 Edttien) 00410-i 5527704 This -Power of Attorney limits the acts of those named herein, and They have no authority to bind the Company except in the manner and to the extentherein stated. Certificate No. American Fire and Casualty Company Liberty Mutual Insurance Company The OhioCasualtyinsbrahceCompany Peerless Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESEPRESENTS: ThatArdedcan .FoapPasuaity Company.and The Ohio Casualty Insurance Company are cOrporations duly organized underlhe laws of the State of Ohio, that Liberty Mutual Insurance Company is a corporation duX.organaed:Onder the lays of the Slate of Massachusetts; Thal Peerless Insurance Company Is. a corporation duly organized underlhe laws ofthe $late of Navy Hampshire, and West'Arik,cen fr'sufance Company is a:o$-0iafioh duly,organized under the laws of the.State of Indiana (herein cellectiaely called the'Companies°), pursuanttoand hyaulUodty,'hereineef%rth; dgesherebyname, constilutesnd�@ppnjnk MICHAEL'N.;ReneEflG; SNSAN'Ct1A1N;TpYLER OWEN .. .. and deliv'eCforand antis brthaif es surety and as iisacf . and deeindividuallyttihemhem.ihandn. named; rf:Weadlawful :attorneyiraomake,execN'e,sPal,acknovA�ge rns naliofthedVol. slateofeach'ndetaings,en0pursuanceoese pesents and shall d anyandam be as tiindingdpon lfieCorripames as ifYliey�haye;b'een:duly signed_hy,lryepresidentaod:attes[ed-byaheseuetarj'of the Companies in ihelr ow,n,properpersops: rdte-seals9fNeGbm anieS.havefiee_nafiixedtherelothis . _- Y INWITNES.SWHEREOF,'this:PAwergJtifldmeyhasbeensubs8dbedbyanauthdinedofficerorofficialoTlheCompSniesandUe, rpo,., ,__, ,-:_ p; :_. ,. _. ;.:,;. zlsr dayof, AU9ust 2012 - Amencan 5re and Casualty Cbmpany, ' �",0*F/pF,\`'U '•Cc s Ar"e"/cqy _ The Ohio Casualtyinsurance Company' (/e 'e•.tibettyMutuallnsuranceComfamy _ /.¢ .da2nft.. a. ,: r. 'cpa°,-?2• ni. :. BeerlessjiisuranceCDmpany.':':.._ s� / .- aVJesFATnencaninspCace:Comp'any G,4 bxg- •9H. ro ter- '- c�' ' i T:'.. �f6Ce G0'' - _ _ _ _ . 21, . .� : ....•.. ,... r... -. -.. - -. _ . _ 'sistant Secretary . _ Bregory-Vif:Davenpar4As ' _ - , - �OUNTYdF.KINGi;:S ri;.:3rcreMrv.nM1Ameiiran Fire and Noraed'so;tpdo; execule:lie foreyoingYlhslrunlehF(prlhe�urposes iheram contaTned.:by'slgning onbehalfnEthecoip'oralid`ns'by;hiniseBas:duly,;alNipriied:otficer •_._ '. WffNESS:.WkiEREOF tiave'hereunto subscnbedmypamis and affixed'mynotanaTsealaYSeagleSWashlrlglaa on the day andyearflrst abovevi[dlen -- - WS ey Y(D•Riley_;JJota Pubba zutw, auupnoummm..o ,..,..,:....... r9 ^?v—?-r:'C`:: ]qv'_. .. ..- _ ... _ - .- podisionsafOfsaticlemaybetYpked.afanytlme'bgthe.BoaN,iheC.hai mag`hGPresiden[orbylhe officer or ofTce sgmdtiP9 suCh:povle nP:auNon y:'., ' me sd0fecito such amnap0asa3vie atananun.vLmypw1.-..- ,,�).r ";••,�,�••*'re;•, 1.w:'� -...:_ -_. - seal,`acknoiv)edge aiid'defi0er.assifmty aRyznd,all':uodertakings4tiogds,:lecognrzancps_.and:othersurety-datgagdns:;Stich:a Omeys-Imizcfsdtiject to tiie:llinitations sgEtodh lnUreir' u�-t respective.powersofatigr0ey,shalrhavefullpoevertobindthe:Companyby.theii..sfgnalure.andexbWbonofarrysuchmsUumenisandtoattach.Uierelbthe seal:dFiheCompany. When so }o�, execdtedsuch lnstruimmsshioubeas'binding'asifstgnadby the:pmslde0t.anti altes)eQ by ihesecrelary.. 'flcafe,of�0esi nation-ThePiesideat ofrihe Company; acUhg:puisganftg ihe�Bylatvs.otUid'Compsny,. autiorizes Gragdiy W. OavmporL AssistanLSscretary to.appoini such Cerb. g aftomey-(o-fectas may eoecessary fo act onttehalt of fhe.Company.to:make exeWd=,seal, acMioi�iledge and delrverassurety'any and all undone (tings, bonds; recognnances and Omer sorely dbiinafions. Authorization -By Unanimous consentof the.Colgpanys Board of Directors, fia.Company consenti{hat facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of my power of attorney issued by the Company in connection wilhsuietybbpds, shall be valld and biding upon the Company tviti the same force and effect as though manually affixed. - I, David M, Carey, the undersigned,'Assislant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Lberty'Muluai.insumnce Company, West American hisurance.Company and Peerless Insumnce'Company do hereby Gently that the original power,,( attorney of whichihe foregoing is a full, We and correct copy of the Powerof Attorney executed by said'Companles, is Info]] force and effecl and has not been revoked: 2 a' rq IN TESTIMONY INHEREOF. I have heammoeef ny hand and affixed the seals of said Companies this l0 dayof 0V ' , 20 j k . nufar"It- FDA-AFOC, W,��<Y .rtspR�n,\stri.un rss �sURfi/e,, C Sj FIFE; 0 2 r z :Fcoearp ttcav :12 cr 9p4� b ra 1y€ By: _ � Cavid M. Carey.Assistant Secretary E WIG. OGIG, PIG & WAIG tM5_i2973 041012 KNOW ALL MEN BY THESE PRESENTS, that we AMASON AIR. INC.._ as principal, hereinafter called the 'Principal;' and THE OHIO CASUALTY INSURANCE COMPANY, as surety, hereinafter called the "Surety," are held and firmly bound unto CALHOUN COUNTY as obligee, hereinafter called the Obligee, in the sum of Five Percent ( 5%) of the Amount Bid by Principal for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the principal has submitted a bid for EMS Station. NOW, THEREFORE, if the contract be timely awarded to the Principal and the Principal shall within such time as specified in the bid, enter into a contract in writing or, in the event of the failure of the Principal to enter into such Contract, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. PROVIDED, HOWEVER, neither Principal nor Surety shall be bound hereunderunless Obligee prior to execution of the final contract shall furnish evidence of financing in a manner and form acceptable to Principal and Surety that financing has been firmly committed to cover the entire cost of the project. SIGNED, sealed and dated this 301h day of November 20 16. The Ohio Casualty Insurancceee Company Michael N. Rudberg, Attorney -in I f qt Austin Electric Company bid bond Rev 1.1.06 LIBERTY QUICKACCESS INDEMNITY AGREEMENT Indemnftor represents that all statements made in the Application are true and made without reservation to Induce Surety to extend surety credit an Its behalf in reliance upon the Agreement; confirms that 4 has a material and beneficial interest in the provision of each Bond requested including Bonds requested in other Applications or as otherwise permitted; and hereby agrees with Surely as follows: 1. Definitions applicable to the Indemnity Agreement: Agreement: This Indemnity Agreement and any other agreement between Indemnitor and Surety executed for Surety's benefit, Bonds: Any and all bonds or other cibiigatons, renewals, extensions, replacements and substitutions thereof, issued prior to or after the execution of this Agreement, and issued for or at the request of Indemnitor. Indemnifier: Each and all of the undersigned, their current and future subsidiaries and affiliates, and any person or business entity added by written amendment (to which amendment Indemnitors hereby agree may be executed solely by that new Indemnitor), joint and severally, whether acting alone or in joint venture with others, and, as to all of them, their successors, assigns, and heirs. Where used in the Agreement the term applies to Indemnftors individually and collectively. Loser Claims, losses, liability. damages of any type (including punitive). costs, fees, expenses, suits, orders, judgments, or adjudications whatsoever, and interest thereupon from the date upon which Surety incurs a Loss or posts reserves in amicipaken of Loss, which Surety may Incur in any manner relating to the extension of surety credit, including the enforcement of the Agreement, Surety: Ohio Casualty Insurance Company and any other member of the Liberty Mutual Group for which Liberty Mutual Surety underwrites surety bonds, severally not jointly; their respective successors and assigns; any co-suaty, reinsurer, or surety that Issues a Bond at the request of Surety. 2. Premiums: To pay premiums when due, and to deliver evidence satisfactory to Surety, of the release of all liability; 3. Indemnity: To exonerate, Indemnify and hard harmless Surety from and against all and all Loss; 4. Place in Funds: To place Surety in funds immediately upon demand In the amount Surety deems necessary to protect itself from any Loss or potential Loss, Surety having the right to use all or pad of the funds in payment, settlement, at reimbursement to itself of any Loss; 6. Assignment: (1) SwIse; Indemnftor assigns and pledges to Surety as security, a lien and security interest in Its Interest, title, and rights in and growing out of the following: (a) any bonded contract, any agreement related to a bonded contract including any labor or supply subcontract and any bond in support thereof, and any action, claim or demand which Indemnifier may acquire against any party to these contracts or otherwise related to a bonded contract; (b) all machinery, supplies, equipment, plant tools and materials which are or may be on the site of the bonded contract, including materials purchased, being constructed, In storage, or in transit; (c) to the extent Surety determines necessary to fulfill or complete bonded obligations: licenses, patents, copyrights, trade secrets, limited partnership and general partnership interests; (d) any funds that am due or may become due on a bonded canimct or other contact including retention and recovery from claims. (II) Exercise of his b Sure : The assignment is effective upon the date of this Indemnity Agreement, but the Surety may exercise its rights only if Indemnitor: @ breaches a bonded contract. Bond, or the Agreement (11) is declared in default by a Bond obligee or a payment bond claim Is made; (iiq makes an assignment for the benefit of creditors; an application for the appointment of a trustee or receiver is made; or files an appltwffon under the Bankruptcy Code or similar laws of any state; (iv) Is subject to any pmweding which deprives 8 of the use of the materials referred to in (b), above; (v) is debarred or otherwise declared ineligible for public work; and (v0 if an individual, an Indemnitors death, disappearance, Incompetence, Insolvency, conviction of a felony or Imprisonment 6. Security Agreement: This Agreement shall constitute a Security Agreement to the Surety and a Financing Statement, both In accordance with the Uniform Commercial Code of every jurisdiction In which such Code Is in effect, but the filing or recording of the Agreement shall be solely at Surety's option, and the failure to file shall not release or impair any Indemnitors obligations under the Agreement or otherwise, nor shall it be in any manner in derogation of any of the Surety's rights. 7. Power of Attorney.- Indemnitor Irrevocably appoints Surety as Attorney-infad with the full right and authority, but not the obligation, to exercise the rights of Indemnitor assigned to Surety above, and to execute on behalf of and sign Indemnitors name a any document deemed necessary by Surety to give full effect to the purposes of the Agreement. Indemnftor hereby ratifies all acts taken by Surety as attorney -In fact, acknowledges that this power of attorney is a power coupled with an Interest, and agrees to hold harmless Surety from any claims, damages, loss or expense incurred by Its use. 8. Surety's Rights: (a) LL.: Surety has the right at its sole discretion to pay or setae any Loss and the mom voucher of payment signed by Surety shall be prima facia evidence of Indemnitors liability; (b) 5A-W. Surety may bring separate lawsuits to recover under the Agreement, and doing so or recovering by way of judgment upon a cause of action shall not prejudice or bar the bringing of suits upon other causes of action, whenever they may arise; (c).0juaLAgreemenis:Any rights Surety may have or acquire against Indemnftor under the Agreement are in addition to and not in lieu of any tights afforded Surety under any other agreement related to surety credit; and, if Surety executes any Bond with a cosurety or reinsures all or part of a Bond, all the terms of the Agreement shall apply and operate for this benefit of the co -surety, and reinsurer, as (heir interests may appear; (d) ecljge or Cancel Bonds: Surety shall have the right to decline or cancel a Bond at any time, free of claim for loss or damage by Indemnitor, and Surety shall be under no obligation to disclose its reasons therefore, the provisions of any law to the contrary being hereby waived; (a) Non -waiver the exercise, delay or failure by Surety to exercise any right, remedy or power whatsoever shall not preclude any subsequent exercise or waiver of these or any other rights, remedies by the Surety. 9. This Application may be executed In multiple counterparts, each being deemed an original but all of which constitute one and the same agreement. 10. This Document: Ifthe execution of this Agreement shall be defective for any reason, such defect or invalidity shall not affect the validity of the Agreement as to any other Indemnftor, if any provision is held invalid, the remaining provisions shall retain their full force and effect. A facsimile, photocopy, or electronic reproduction shall be considered an original and shall be admissible In a court of law to the same extent as an original. 14. Termination: Indemnitor may terminate its indemnity obligations under this Indemnity Agreement for future bonds upon twenty (20) days written notice to Surely, sent by registered or certified mail, to 9450 Seward Road Fairfield, OH 45014, Attn: Bond Depart, f QuickAccess. Such -notice shall not modify or discharge Indemnitors obligations for Bonds authorized, executed, or committed to by Surety prior to the discharge date (including renewals, extensions, madffiwtions and substitutions), or for final Bonds issued for bid bonds Issued prior to the discharge date. 12. Effective Date: This document shall be effective on the date it is executed by one or more Indemnitors. This Indemnity Agreement is dated: Novem1=29th , 2016 By signing below, each Individual signing on behalf of a business entity represents and warrants that he or she is duly authorized by the business entity to bind it to this indemnity Agreement: NOTE: Persons authorized to sign on behalf of each business entity: Sole Proprietor - Owner, Partnership - Managing Partner, Limited Partnership - General Partner. C or S Corporation. - President; Limited Liability Company - Managing Member t¢d_omnitrzrlBsisine�u$); Company Name: Amason Atgfnc p^�Authorized Signature: G Printed Nomey .fa on Amason (j�� Signature:^ � 1 Printed Name: aysan �.s IgdemrtCoLlletLviduab.- Signature: Printed Name: IntlemnifaL(ILrdividua();, Signature: Printed Name: �+.� �, �s LRSIe nito (S�g1iga.)i Signature: y..� i9 �*..�r` Printed Name: Nicole Am:rson 11L�mbiC9L(SPo s ' Signature: Printed Name; 108e]g i or gQusg)i Signature: Primed Name: LMS 10011 092011 Page 4 of CERTIFICATE OF INTERESTED PARTIES FORm 1295 -tell Complete Nos. l - 4 and 6 if them are interested parties. OFFICE USE ONLY Complete Nes.1, 2, 3, 5, and 6 if there are no interested parties CER7IFlCATION OF FILING Certificate Number_ 1 Name of business emityfiling form, and thecity, state and country of the business entity'splace of business. ZO1f-140829 Amason Air Inc. Port Lavaca, TX United States Oats Fled: 2 Name of governmental entity or state agency that isaparty tothe contract for wfwhthe form is "12912016 being filed. Calhoun County Date Acinow[edged' g Provide the identification number used by the governmental entity or slate agency to back or identify the contract, and provide description of the services, goods, or other property to be provided under the contract 9045.014 Provide and construct metal building with interior finish_ Nature of interest 4 Name of Interested Party City, State, County (place of bvsme s) (check appficable) Controlling I bntenawa ry 5 Check only ifthere is NO Interested Party. ❑ X 6 AFFIDAVIT iswear, or affirm, under malty of pe M. that the above disdusure is true and correct VICtO L WHITAKER �=` MY COMMISSION EXPIRES f/ "r�;vk�� P' h(6fch i6, 2017 e ofauthORZ agemilfCantraCtifig business eecfity AFFIX NOTARY STAMP !SEAL ABOVE Swo n and subscribed before me, by the said �!' 1t�/S17 h YCV-'c�GSC3F� tluslhe C dayaf s�iv""k 20, to cer* which, wihnP.ss my hand and seal df office_ Signam officer aduffnisteri g oath Prided name of officer admudsavmg oath TnBe of officer - ' oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us version v1.u.[t i DOCUMENT NO.00415 I hereby certify that it was RESOLVED by a quorum of the directors of A (Name of Corporation) meeting on the -� day of _.� 0 d Pay r\ j �y , 20A > that-� r Y S o t, 1 �C--c G i. (Name of Principal) — � f P C �� `~ be, (Title) and hereby is, authorized to execute all documents necessary for the transaction of business in the State of Texas on behalf of the saids b t A- and (Name (Name of Corporation) That the above resolution was unanimously ratified by the Board of Directors at said meeting and that the resolution has not been rescinded or amended and is now in full force and effect, and in authentication of the adoption of this resolution, I subscribe my name this — sz1_ daY of_IlV o Je�rx--\ L P,, - , 20J( Seer END OF DOCUMENT 00415-1 DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of of County of being first duly sworn, deposes and says that: 1 • He is, t s '� w17+ of _ L N\ c�-Sa n A i the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all Pertinent circumstances respecting such Bid; 3• Such Bid is genuine and is not a collusive or sham Bid; 4• Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER; or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDE this affiant. R this any of its agents, representatives, owners, employees, or parties in interest, including Sub 'y �Ysc�i S M day March i6, 2017 My commission expires (Signed) Title C END OF DOCUMENT 00416-1 DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT Bidder shall answer all questions, and answers shall be clear and comprehensive. This form shall be notarized upon completion. As necessary, BIDDER may use separate attached sheets to answer questions, and may submit additional information, if desired. BIDDER's Name; Address: lV// Sl�l? 77 Type of Work Performed: W /lvf¢ C Ever Fail to Complete Awarded Work? Y or (NJ Ever Default on Any Contract? Y or N ATTACH THE FOLLOWING INFORMATION Organization Date: 9 — t — a--e) i 3 Incorporation Date: CC —'S--a e> 13 Attach a LIST OF PROJECTS, similar in size and scope to the work covered by this proposal, which BIDDER has MOST RECENTLY COMPLETED. Amount of Date Owner Contract Contract Award Type of Work Completed and phone no Attach a LIST OF PROJECTS BIDDER is now ENGAGED IN COMPLETING. Amount of Percent Owner Contract Contract Award Tvpe of Work Complete and phone no Attach a LIST OF EQUIPMENT THAT WILL BE AVAILABLE FOR THIS PROJECT including type, model, owned or leased. Attach a RESUME FOR EACH OFFICER OF THE COMPANY AND THE PROPOSED SUPERINTENDENT for this Project. ALSO, indicate the number of Foremen, Equipment Operators, Laborers, etc, that will be available for this project. Credit Available: $ Pf; n o v Bank Reference/Contact: The undersigned hereby authorizes any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY, in relation to the verification of the statements comprising this BIDDER's, Qualification Statement. Signed: Name Executed and sworn to before me, the and rsigned authority, on this day sor ram. Rf%�Y�%P,, SelWa L WHITAKER `=MYOOMMISSION EXPIRES otary Public in and for `` Maroh 16, 2617 CO l kOtt P\ END OF DOCUMENT 00420-1 PROPOSAL DON KRUEGER CONSTRUCTION CO. hereinafter called "BIDDER', (Legal Firm Name) is submitting this Proposal for Furnishing and Performing the Work specified herein as CALHOUN COUNTY EMS" STATION, CALHOUN COUNTY PRECINCT 4, SEADRIFT, TEXAS This PROPOSAL is Submitted to CALHOUN COUNTY, hereinafter called "OWNER". 1. Terms used in this PROPOSAL, are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Calendar Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: 1 Date Received: 11/22/16 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work, C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. e. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g, This BID is GE NUM and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID, BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER, 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. 'BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Base Bid BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS --------------------------------------------------------------------------------------------------------------------------------- BID AMOUNT i, l LS For mobilization and insurance costs associated with the project in accordance with the specifications for as lump ssuumt price of � JV-'V .IbCWS � Dollars and Cents. $ L d 2. 1 LS Furnishing material, labor and equipment for the construction of the EMS building that includes but not limited to structural fill, foundation, 6 foot wide concrete aprons, building structure, overhead doors, exterior doors and windows, all as per plans and specifications for a lump sum price of Two �UNb12En�t�EZtkDLTlSt�kn: �DLIR U f.3bfL�CJ TiU� t A `Dollars Cents, and 3. 1 LS Furnishing material, labor and equipment for the construction of the interior rooms of the EMS facility that includes but not limited to plumbing, plumbing fixtures water heater, air conditioning, and ldtchen appliances, all as per plans and specifications for a lumps rice of h P . e��ti — i��ins and Cents. $ / u'? 00300-3 DID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS 9 5 9 I LS Furnishing material, labor and equipment for the installation of the electrical components on the interior of the EMS facility and power line to the sewage treatment plant, all as per plans and specifications for a lump sum price of ^Jr_—Vr,-0-r% ' i'1it "MoL35-&,Atri 5fayra" 0-uliDemp ei! NWT`( BID AMOUNT Dollars and Cents. 1 LS Furnishing material, labor and equipment for the installation of the generator with transfer switch, all as per plans and specifications for a lump sum price of�V�l�►1't`� cJ�ifi �►d �1#a4S�.Fr� FiyE 01.IaDeep Pii r-T r �5t�-A Dollars and Cents. 1 LS For obtaining permits, furnishing and installation of an on -site sewage treatment system to serve five employees (300 GPD) with sprinlder system disposal area and sewer lines to the building. Reference On -Site Sewage Facility Design attached at the end of the Specifications. The system shall be complete and ready to operate as per plans and specifications for a lump sum price of Dollars and Cents. $ V91015c, 00300-4 BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT 7. 1 I.S Furnishing materials, labor and equipment for the construction of the 2 course asphaltic treatment with 10" crushed limestone base driveway and parking lot (approx. 45,650 SF) and 2" cold laid asphalt with 8" crushed limestone between S.H. 185 and property ROW (approx. 1,280 SF), as per plans and specifications for a lump sum price of a oy, 464arzo njii txr-r oas sSA.4o e)tsE_: VIUMlaeJED E 16l- -r--( 4tr.1 r= Dollars and Cents. $ 1211 1 g 1 8. 1 I.S Furnishing material, labor and equipment for the site grading including drainage ditches and seeding of exposed areas, end treatments for existing (18") culvert at S.H. 185 and end treatments for on -site 12" culvert, as per plans and specifications for a lump sum price of s Y.Tges I -n-toLw_-,y►D t=1ve 11u ltoizoo Smv r=t�TY '1'"eig and Cents. $ i (e+ S7 3 9. 1 LS Furnishing materials, labor and equipment for implementation, enforcement, and maintenance of TPDES requirements for duration of project (SWPPP) for a lump sum price of I� I KI IIAW;5)N D V� 40a09F_0 0113 T7' `Ti and Cents. $ 911513 Total Base Bid, being Items 1 thru 9 above, is: $I Ea606 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 00300-5 ADDrNDOM NO.1 (November M 2016) Calhoun Cwmy6MS MO... Calhoun C.MyP.,IW4, S.1d1M.TX R. N.. MOW OWNER'S OPTION'S BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS ...............•-------•--------•----•------------------------•---------------- -•---------------------. 01. 1 LS Cost for furnishing material, labor and equipment for the installation of 2" hot mix asphalt and 8" crushed limestone driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7, as per plans and specifications for a lump sum rice of 412C2yt� > S&&Jc> and Cents. 02. 1 LS Cost for furnishing material, labor and equipment for the installation of a concrete driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7 above, as per plans and specifications Afor a lump sum price of bp ` WtyY TO-c w5kw IZ FiUf- N-i,ZMINLED and BID AMOUNT $ +3b)5o0 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions within Calendar Days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement, The following documents are attached to and made a condition of this BID: a. Required Bid Security in the form of BID BOND ATTACHED b. Document No. 00412 — Certificate of Interested Parties (Form 1295) C. A tabulation of Subcontractors, Suppliers and other persons and organizations required to be identified in the BID. d. Document No. 00415 - CONTRACTOR's Corporate Resolution. e. Document No, 00416 - Noncollusion Affidavit f. Document No. 00420 - Bidders Qualification Statement. 00300-6 ADDENDUM NO. 1(November 17, 2016) Calhoun Cavmywsswi., Qihoun County Prtdna 4. $Wnft.T (Pik No. M5A(4) 8. Communications about this BID shall be directed to BIDDEWs address indicated below. SUBMITTED this 30TH day of NOVEMBER Authorized Signature: Name: Kevin R. Krueger Title: President Attesting Name: Title: Secretary/Treasurer , 2016. Legal Firm Name: Don Krueger Construction Co. Business Address: 205 Profit Dr., Victoria, TX 77901 Phone Number: 361-573-5291 Facsimile Number: 361-573-0162 E-Mail Address ; kkrueger@donkruegerconstruction.com State of Incorporation, if applicable: (Texas State Contractor License No.: 011 A END OF DOCUMENT Xl 1 0 } Cd a cd cc! Y cd Y cs 4 cd cd Pi +O-' v ' 2 N 0 Cd U cd °A C� w � °o o U F�oy M U ti cN+! N O UO U - 4 W U rl U P�-io cis W W i7 ... ..... ......:... ,::.0 t .,,..... .... .J ,... r a, > ..., .. .':.t... ..� ,:\1\•i�. ... .$1i•... a,. .:� .. .... ..-.�t`,:.1: e... ,.va. ..a .....:.f�... .is:f.....v. .::>: ii:i�'0. v4': .°l .',. PENAL SUM FORM 13DDUEPATE: November30,2016 PROJRCT (Brief Description haoludllrq Loaafi n); Calhoun Countv EMS Staiion. Calhoun Countv Precint 4 pONb BOND NUMBER: ( DATE (Not later than Bid due da'Al: November 30.201E _ _ _ 5% PENAL SUM' Five Percent of the Greatest Amount Bid by Prfnctpal Words) (Figures) IN WITNESS WHERBOF, Surety and Bidder, Intending to be legally bound hereby, Subject to the terms printed on the reverse side hereof, do oath cause this Bid Bond to be duly executed on its behalf by Its authorized officer, agent, or aspresenfative. BIDDER Don Krueger Construction Cc (Seal) 91 cider's Name nd Corpoo''rrafe Seat / Signatu and Tlile SURETY Travelers Casualty & Surety Sure Na o anti Co or' Attest.` VGua w✓ AML S !Ire end Tllls Signature (Attach N of America Douglas Vrazel, Attorney -in -fact Tide Lyneli Scherer, ASCR Note; (1) Above addresses are to be used forgiving required notice. 1 (2) Any singular reference to Bidder, Surety; OWNER or other party shall be considered plural Where apptivabie. EJCDCNO.19t0-28-C (1996 Edition) 00410.1 3`arc iimj GCsiibcCamj 4 aw4 csira€ x of Am&,m , for m%maa-m tiE tD Tmke ac-uuc-piala l 'Biers ism hiar_liai�s tsm tgp_q Toter, Roft _nw PL+TY� l9iti: YD{: L,�CD fMCt e� T �upr_Pi�75YFi P1rz�to O{7ia + 1C �L*f 'nfltinn C;Yr DDnymmi -, wwaa itoltaor expl2afsau Terse tta€frsa�rrs: PA, BDY 1491 GA, A-usiia, TX. Ml 44104 M2512=3ul ALITACH TIRS NOUCHE TO r YOUR BUM, This nDtm is fae iafor=rjDj only Wl io=s Mt beco a a amdiffon Df the attek ed dw m eivt and 15Inwato myviy Milan �253-'J7 [, Gwvci�� i~ody av3 rir� 53 �'!� k�rc�.a-iy vim- wF_e RED POWER OFATTORNEY • fRAVELERSJ Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company `. St. Paul Guardian Insurance Company Attorney -In Fact No. 230506 Certificate No. O O 6 O 7 2! O 5 IfNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Bobby Jacob, Douglas Vrazel, Lynell Scherer, Jim R. Poe, Dana Mickey, Raul Barberena Jr., and Leslie Anders of the City of Victoria , State of Texas , their has and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this day of June , 2016 - - Farmington Casualty Company . Fidelity and Guaranty, Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insmance Company St. Paul Guardian Insmance Company 10th St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company FBV tt N �Ns f IX8 � SY gryQ 'f ;Y.,ny o d'POh€ o .FP10e�4' WCOrtteR47te� a i FX`! � �( ,rlcnPORATp`a'"= p 9m Seanq�m tvez o 1977 g - _ i :fi —_ ?a: ttaororm, less °O$ 1951 a e. " �VySEAL o".' i a S88L'a° ca+N. Z ewce� a L4':O< 1S l� ,f I "•r � . xt�� fi ,ISNMN�jr � ••'•d'� �+ . xP�D ��I ANL State of Connecticut City of Hartford as. 1 By: , Robert L. Raney, Senior Vice President On this the 10th day of June 2016 , before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G,YFT In Witness Whereof, I hereunto se[ my hand and official seal T+w My Commission expires the 30th day of June, 2021. P i0f10�\G� Made C. Teneault, Notary Public 58440-5-16 Printed in U.S.A. 1. Bidder and Surety, jointly and severalty, bind themselves, their heirs, executors, administrators, successors and assigns to pay to OWNER upon default of Bidder the penal sum set forth on the face of this Bond. 2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding Documents (or any extension thereof agreed to In writing by OWNER) the executed Agreement required by the Bidding Documents and any performance and payment Bonds required by the Bidding Documents. 3. This obligation shall be null and void if, 3.1. OWNER accepts Bidder's Bid and Bidder delivers within the time required by the Bidding Documents (or any extenslon thereof agreed to in writing by OWNER) the executed Agreement required by the Bidding Documents and any performance and payment Bonds required by the Bidding Documents, or 3.2. Alt Bids are rejected by OWNER, or 3.3. OWNER falls to issue a Notice of Award to Bidder within the lime specified In the Bidding Documents (or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by paragraph 5 hereof). 4. Payment under this Bond will be due and payable upon default by Bidder and within 30 calendar days after recelpt by Bidder and Siuety of written notice of default from OWNER, which notice will be given with reasonable promptness. Identifying this Bond and the Project and including a statement of the amount due. 5. Surety waives notice of and slimy and all defenses based on or arising out of any time extension to issue Notice of Award agreed to in writing by OWNER tool Bidder, provided that the total time for issuing Notice of Award including extensions shall not in the aggregate exceed 120 days from Bid due date without Surety's written consent. 6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of default required In paragraph 4 above is received by Bidder and Surety and in no case later than one year after Bid due date. 7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction Located in the state in which the Project is located. PENAL SUM FORM 8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier or by United States Registered or Certified Mail, return receipt requested, postage prepaid, and shall be deemed to be effective upon receipt by the party concerned. 9. Surety shall cause to be attached to this Bond a rmYent and effective Power or Attorney evidencing the authority of the officer, agent or representative who executed this Bond on behalf of Surety to execute, seal and deliver such Bond and bind the Surety thereby. 10. This Bond is intended to conform to all applicable statutory requiroments. Any applicable requirement of any applicable statute that has boon omitted from this Bond shall be deemed to be included herein as if, set forth at length. If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shall govern and the remainder bf this Bond that is not in conflict therewith shall continue in full force and effect. 11, The term "Bid" as used herein includes a Bid, offer or proposal as applicable. E7CDCN--O. 1 110-28-C (1996 Edition) 00410.2 CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. - 2016-140330 Don Krueger Construction Co. Victoria, TX United States Date Filed: 11/28/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form Is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 9045.014 General Contracting Services 4 Name of Interested Party City, State, Country (place of business) Nature of Interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. +�pv""rGe NORMA CHACON 7�0^ o� Notary Public / State of Texas C/h• ��€ ID if 129726750 t"';°F Comm. Expires 02-25.20t8 Signature of authorized gent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the _ day of n DV , 20_1_(e_� to cenify which, witness my hand and seal of office. NUM Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission - www.ethics.state.tx.us Version V1.0.277 DOCUMENT NO. 00415 CONTRACTOR'S CORPORATE RESOLUTION I hereby certify that it was RESOLVED by a quorum of the directors of Don Krueger Construction Co., 205 Profit Dr., Victoria, TX 77901 (Name of Corporation) meeting on the 1 st day of June ,20 16 , that Kevin R. Krueger President (Name of Principal) (Title) be, and hereby is, authorized to execute all documents necessary for the transaction of business in the State of Texas on behalf of the said Don Krueger Construction Co. and (Name of Corporation) That the above resolution was unanimously ratified by the Board of Directors at said meeting and that the resolution has not been rescinded or amended and is now in fall force and effect; and in authentication of the adoption of this resolution, I subscribe my name this 30th day of November , 20 16 v Secret y Don Kr ger Cons Co., 205 Profit Dr., Victoria, TX 77901 Incorporated in the State of Texas LEND Or DOCUMENT 00415-1 DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of Texas County of Victoria ) Kevin R. Krueger , being first duly sworn, deposes and says that: He is President of Don Krueger Construction Co. the BIDDER that has submitted the attached Bid, 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including this affiant, y (Signed) ! (.� �• `�_ President Subscribed and sworn tome. this 30th day of November My commission expires 02-25-2018 I;ND OE DOCUMENT 00416-1 16 Notary Pubtic State of Texas ID H 129726750 comm. Expires 02-254018 DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT Bidder shall answer all questions, and answers shall be clear and comprehensive. This form shall be notarized upon completion. As necessary, BIDDER may use separate attached sheets to answer questions, and may submit additional information, if desired. BIDDER's Name: DON KRUEGER CONSTRUCTION CO. Organization Date: June 1962 Address: 205 PROFIT DR. Incorporation Date: March 26, 1965 VICTORIA, TX 77901 Type of Work Performed: GENERAL CONTRACTOR Ever Fail to Complete Awarded 'Work? Y or N Ever Default on Any Contract? Y or N ATTACH THE FOLLOWING INFORMATION: Attach a LIST OF PROJECTS, similar in size and scope to the work covered by this proposal, which BIDDER has MOST RECENTLY COMPLETED. Amount of Date Owner Contract Contract Award Tyne of Work Completed _ and phone no _ SEE ATTACHED LIST Attach a LIST OF PROJECTS BIDDER is now ENGAGED IN COMPLETING. Amount of Percent Owner Contract Contract Award Type of Work Complete and phone no. SEE ATTACHED LIST a^ Attach a LIST OF EQUIPMENT THAT WILL BE AVAILABLE FOR THIS PROJECT including type, model, owned or leased. SEE ATTACHED LIST Attach a RESUME FOR EACH OFFICER OF THE COMPANY AND THE PROPOSED SUPERINTENDENT for this Project. ALSO, indicate the number of Foremen, Equipment Operators, Laborers, etc. that will be available for this project. SEE ATTACHED CreditAvailable;$OCO,= Bank Reference/Contact: Mark Nolen, Frost Bank 361-844-1158 The undersigned hereby authorizes any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY, in relation to the verification of the statements comprising this BID/ DER's Qualificatio tatement. Signed: G ' l Executed and sworn to before me, the undersigned auth 'ty, on this 30th day Name & Title: Kevin R. Krueger, President November 20 16, Not c m anaFft N (votary Pub is ' state of Texas qy� ID k 129726750 Comm. LXP11= END OF DOCUMENT 00420-1 YY�/X i}Y PROPOSAL 'Le_X(a C6a5 lu- V V) '�l2 BSI �ViC hereinafter called "BIDDER', (Legal Firm Name) is submitting this Proposal for Furnishing and Performing the Work specified herein as CALHOUN COUNTY EMS STATION, CALHOUN COUNTY PRECINCT 4, SEADRIFT, TEXAS This PROPOSAL is Submitted to CALHOUN COUNTY, hereinafter called "OWNER'. 1. Terms used in this PROPOSAL are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDEN accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Calendar Days after the date of OWNERS Notice of Award. 4. In submitting this BID, BIDDER represents, as, more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: Date Received: — T --- T-� b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws mid Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. P. BIDDER has correlated the information known to BIDDER, information and observations obtainedfrom visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g, This BID is GENUM and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount -in words shall govern. b. BIDDER acknowledges thaf the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. " d. 'BIDDER acknowledges that.Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. C. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Base Bid BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS 1, 1 LS For mobilization and insurance costs associated with the project in accordance with the specifications for a lump sum price of n10 ] n Nnw, sa d "yt� i BID AMOUNT and Ze Y'-0 Cents. $ a�� 2. 1 LS Furnishing material, labor and equipment for the construction of the EMS building that includes but not limited to structural fill, foundation, 6 foot wide concrete aprons, building structure, overhead doors, . exterior doors and windows, all as per plans and specifications for a lump sum price of Two 11.L cdn- d LcJe _e Bp t91 A I- n u s r `j Do ,- ht d lre Ol .�1 ✓�lv Dollars and lNtft%_ -Rue Cents. $ 228� �33. 3S 3. 1 LS Furnishing material, labor and equipment for the construction of the interior rooms of the EMS facility that includes but not limited to plumbing, plumbing fixtures water heater, air conditioning, and kitchen appliances, all as per plans and specifications for a lump sum price of ONO K A j" �l lrU7 4-hcu.sCk,1J +r to k4- y.C, Dollars and 70 ra Cents. $ 3 y�S lO S o� 00300-3 - - --------------------_----------------------------------------------- BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS 9 S. U 1 LS Furnishing material, labor and equipment for the installation of the electrical components on the interior of the EMS facility and power line to the sewage treatment plant, all as per plans and specifications for a lump sum price of pu Dollars and Z 't,C-) Cents. 1 LS Furnishing material, labor and equipment for the installation of the generator with transfer switch, all as per plans and specifications for a lump sum price of 7—uje n i no, - k4w SOA C� - -M q T �clue-1 -eAr 42 �.O Dollars and Cents. 1 LS For obtaining permits, furnishing and installation of an on -site sewage treatment system to serve five employees (300 GPD) with sprinlder system disposal area and sewer lines to the building. Reference On -Site Sewage Facility Design attached at the end of the Specifications. The system shall be complete and ,ready to operate as per plans and specifications for a lump sum price of IxgH* Amajo 1"3%(4 and Z-66E) Cents. BID AMOUNT $ %F, /00• $_/0,'jf'2.1 00300-4 BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS BID AMOUNT 7. 1 LS Furnishing materials, labor and equipment for the construction of the 2 course asphaltic treatment with 10" crushed limestone base driveway and parking lot (approx. 15,650 SF) and 2" cold laid asphalt with 8" crushed limestone between S.H. 185 and property ROW (approx. 1,280 SF), as per plans and specifications for a lump sum price of d Dollars and T,c ✓C Cents. 8. 1 LS Furnishing material, labor and equipment for the site grading including drainage ditches and seeding of exposed areas, end treatments for existing (18") culvert at S.H. 185 and end treatments for on -site 12" culvert, as per plans and specifications for a lump sum price of / and ZC -0 `Cents. $ 3 0-( % 20. ®o 9. 1 LS Furnishing materials, labor and equipment for implementation, enforcement, and maintenance of TPDES requirements for duration of project (SWPPP) for a lump sum price of op and Ze 60 Cents. Total Base Bid, being Items 1 thru 9 above, is: �itf14� A(/ Cents $ +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 00300-5 ADDENDUM NO. 1(November 17, 2016) C.Jhu.Ca..ty EMS Statioq C.1..lCounty&da4, San ,T (14k No. 9045.014) OWNER'S OPTION'S BID BID DESCRIPTION OF ITEM WITH UNIT ITEM QTY. UNIT PRICE WRITTEN IN WORDS --------------------------------------------------------------- ------------------------------- 01. 1 LS Cost for furnishing material, labor and equipment for the installation of 2" hot mix asphalt and 8" crushed limestone driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7, as per plans and specifications for allu-mp 'sum price of Df�P rnU (\el /`�' -)t Sctn�A -pk Je, Dollars and ZC ✓ o Cents. 02. 1 LS Cost for furnishing material, labor and equipment for the installation of a concrete driveway and parking lot (approx. 16,930 SF) in lieu of Bid Item No. 7 above, as per plans and specifications for a lump sum price of —t Vl,t�( Scvn l 'fOu.ri VL4e Ar-�Ih'ml �o%Lcx Dollars - and Z.e (/D Cents. BID AMOUNT $ . 00-s(' $)3Z /z/D,cn +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions within 2L/ O Calendar Days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. 7. The following documents are attached to and made a condition of this BID: a. Required Bid Security in the form of .r (n. 8j awd fyam . b. Document No. 00412 — Certificate of Interested Parties (Form 1295) C. A tabulation of Subcontractors, Suppliers and other persons and organizations required to be identified in the BID. d.. Document No. 00415 - CONTRACTOR's Corporate Resolution. e. Document No. 00416 - Noncollusion Affidavit f: Document No. 00420 - Bidders Qualification Statement. 00300-6 ADDENDUM NO. 1(November 17, 2016) CelAoun County EMS Station, Canon County Pmcinct 4, Seadrift, T (File N.3NS.014) 8. Communications about this BID shall be directed to BIDDERs address indicated below. SUBMITTED this -- day of 0 ` d f "� �r� 2016. Title: vNr - Attesting Signature: Name:�.�nSS ICc� ' 1✓" J o Legal Firm Name: �2kCa �Io���t�G�lti >�fv�CeS�. c, Business Address: lob M,�d<? TY • 2 ?T _�__� � /h � I Phone Number: Facsimile Number: E-Mail Address : JewhlSa (-eX(UiHC rCo✓� State of Incorporation, if applicable:?cQ S State Contractor License No.: END OF DOCUMENT 00300-7 ._...... a �.....,.:i:. ;:... PENAL. SUM FORM IM BID D PROD am - BOND NUMBER: DATE (Not later then Bid due data): PINAL BIIM.• E %I. ixJo may t i vF N� n, Da F� oeARs.� SpD e a, ONords) (Figures) IN Wf7NESS INEdEREOF, SuretyandBiddet, fntend�g t0 bo.legaHy iiognd hereby, sctb}eoCto.th+g tentts printed on the r6Versd side Ihereof; do each cause this Bid Bond to be duly executed:on its:behalt by its authorized officer, agent, or repre€en ative. BIDDER �E� a'irrQnt��a� r7�rro � sP�2 r104 Xnc,(Seal) Bidder's: Name and Co rate: Seal SIdoature and Title/ Signature and"fills SURETY Surety's trlarcis and Corpdrale Seal slansturai and TiHe�r.raRT1�r-rrvfHe. / Q f ch PawarofAlto") Attest Signature and We Note'. (1). Above addressesareto,heusedforgivingrequirednolice. 1 {2) Any.slrigularrefererrcafoBklder;Surety,-OWNER'orotherparty shall be Considered ! pluraluihere applicable. EICDCM.1910-28>CZ1996Edition) 00410-1 POWFR OF ATTOMNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presegfs, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance compmy,'and American casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having theirprincipal offices in the City of Chicago, and Stateof Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Luann Bognar, Scott C ICakaeck, Individually of Richmdsun, TX, their true and lawful Attomey(s)-in-Fact with.full•power and authority hereby conferred to sign, seat and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind them thereby as fully and to the same extent as if such instruments weresignedby a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is herebyratifiedand -confirmed. This Power of Attomey is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reversehereoty duly adopted, as indicated, by the Boards of Directors of the insurance companies., In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this Sth day of Lune, 2015. Continental Casualty National Mid Insurer a,�oanR% x AmericanCas tyC 7ULYM71. P�.:t T Rniflnt State of South Dakota, County of Minnehaba, ss: - On this Sth day of June, 2015, before me personally came Paull. Bruflat to me known, who, being byme duly swum, did depose and say: tbathe resides in the City of Sioux. Falls, State of South Dakota; that he -is a VicePreslddgt of Coptmental Casualty Ccmpang.an Illinois insurance company, National Fire insurance Company of Hartford, anIllinois insurance company; and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed.the above instrument that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so. affixed.pursuant to authority given by the Boards of Directors of said insurance companies and that -he signed his name thereto pursuant to like authority, and .acknowledges _some to be the act and deed of said insurance companies. e�waneww�aawu�w.r.,.wam+� = S. EICH ; p� nownrtatmtc sount aAtaoia iaaaaaraaarr�w+++++nan+ My Commission Expires February 12, 2021 1, D. Bull, Assistant,Secretary of Continental Casualty C Illinois insurance company, andAmedgan Casualty Compaq vnwe of Attorney herein above set forth is still in force, and S. Fie otary[�— CERTIFICATE insurance companiesthis_ 30'a dayof 'NaVEMOEQ< <P�'oMSUgCp tN511R,q A �a„nroe �U SEAL T < 197E 1997 � HAa'tF� o - npany;, Nationni:Fire insurance Company of Hartford, an nsylyama insurance company:do hereby certify that the A Resolution of the Board of Druectors of theinsurance subscribed my nameand affixed the seal of the said Usually Company Insuawage:C'ompany of Hartford Secretary Form F6853-4/2012 Authorizing By -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power ofAttomey is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company at a -meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Companyprovided that -the name of such authorized officerand a description of the documents, agreements or instruments that such officer may sign will be provided iowriting by the Sehioror Group Vice President to the Secretary of the Company ptor to such execution becoming effective." This Power of Attorney is 'signed by Paul T. gnitlat Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of Continental Casualty Company. This. Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by fire Board of Directors of the Company by unanimous written consent dated the 25o'day ofApril, 20I2: ' "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officem'j to execute various policies, bonds, undertakings and other obligatory instmments of like nature; and. Whereas, from dime to time, the signatum of the Authorized Officels, in addition to.being_provided in original, haul copy format may be.pmvided via facsimile or othemise in ad electronic format {wtlectively,"Electronic Signatures'); Now therefore be it resolved: that the Electronic Signature of any Authorized Officersball be valid and binding on the Company" ADOPTED By THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD: This power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unardmouswritten wnsent dated May 10, 1995: "RESOLVED: That any Senior or Group. Vice President may authorize an officer to sign specific documents, agreements and instruments onbehalf of the -Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided iu writing.by the Senior bugmup VicePresident to the Secretary of the Company prior to such execution becoming effecfive," This Power of Attorney is signed by Paul T. Bmfla, Vice President, who has beenauthorized pursuant to the above.resolution to execute power of attorneys oubebalfofNational fire insurance Company of Hartford This Power of Attorney is signed and sealed by "facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25" day ofApril, 2012: "whereas, the bylaws of the:Compa4 or specific remIngon of the Board of Direcmks has authorized various pfficem (the "Authorized Officers".) to execute various policies, bonds, undertakings and other obligatoryinstruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being Provided in original, bard copy format may be provided via facsimile or otherwise inan: electronic format (correctively, `:_mlectronic signatureft Now therefore be it resolved: that the Electronic:Signature ofany Authorized Officer shall be valid and binding on the -Company." .ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attomeyis made and executed pursuant to and by authority of the following resolution duty adopted by the Board of Directors of the Company by unanimous written consent dated May 10,1095: '*RESOLVED: That any Senioror Group VicePresidentmay authorize an officer to sign specific documents, agreements and rash maents on behalf of the Companypmvided that thouture of such authorized officer and a description of the domments, agreements or instruments that such officer may sign -wilt bepmiided in writing the Senior or Group Vice.President to the Secretary of the Company priorto such execution "becoming effective." This Power of Attorney is signed by Paul T Brbflag Vice President who has been authorized pursuant to the above msoludon to execute power of. allomeys onbhhalf ofAmericad Casualty -Company of Reading Pennsylvania. This Power of Attorney is signed and seated by facsimile under: and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consentdated the 2P day of April, 2d12: "Whereas, the bylaws ofthe.Compauy or spec resolution of the guard of Directors had authorized various officers (the "Authorized'Officers') to execute va"tious policies, bonds, undeiteldugs andu&r obirgotoryinstruments of likke nature; and Whereas, from timb.to fine, the signature of the Authorized Officers, in addition to being Pmyided in origina), hard copy format; may be provided via facsimile or otherwise in as electronic format (collectively, "Electronie7Signatttres );"Now thereforebe it resolved: that the Electronic Signature of any Authorized Officer shallbe valid and binding on the Company." 1. Bidder and Sbreey, Judy and severally, bind themselves, their hefts, oxeoatora, adtnitileftitiors, suecessom and assigns to pay to OWNER upon defaoit of Bidder the penal sum set forth on line face of this Bond. 2. Default of Bluer shall occur upna the failure of Bidder to deliver within the time requited by the Bidding Documents (or any eatwslon thereof agreed to in writing by OWNER) the executed Agrecmeat Melted by the Bidding Documents and guy petfozouutao and paymcut Bonda mg lwd by tine Bidding Docmnems, 3. This obligattion. shalt be wil and void if: 3.1. OWNER aWVM Bidder`s Hid and Bidder delivets witbhtthe tmc engulfed by dte Bidding Documents (or any extension theseofagreed to in wrft}pg by OWNER} the executed Agiieementferittiradby the'Bldding DocuuMAIS and any performance and PaYmeot Bouts required by ibe Bidding Documents, or 3.2. All Bids are rejected by 6WiNBR, or 3.3. OWNHR faits to issue a Notice of Award to Bidder whbia tic time specified is the Bidding DwAune nts (or any extension ttrereof agtoed to in writing by Bidder sod. if applicable, onceanted to by surety when required by Paragraph 5 bereop. d, payment Bader this Bond will be due and paynlile open defauk by Bidder and wltdn 3fl ealemdardays after receipt by Bidder andSkety of Vented notice of default frem OWNER, which notes will be given untie reasonable pmmptaese, idcntfying rids Bond and the project and ioeladmg a statement of the amount duo. 5. Surety "waives notice of and BUY shed all "on based on or ariaifig out of >aw time exteusioa to issue Notice of Award agreed to is writing by OWNER and Bidder: provided that the total tines fca Issuing Notice of Award including egteltaiona attedl not it the aggregate exceed 12o days front Bid due date without S[trety's written cMom. 6. No suitor action atoll be commenced under this Bond prier to 3o calendar days Am the notice of unfair& regahad'b8paragrapb 4 above de retwlved by Bidder int surety and eta no ceao. heist thenone.year after old due date. i, Any salt of action under this Bond sbas be commenced only in a route of competent jurlsdiwon taratetlin the state in wbdeli the Prajxt is toeated. PENAL SUM FORM 6. Notices rcqul ed hereunder shall be in writing and "at io Bidder no Surety at Their respective addresses shown on the face of Ills Bond. Such natices.may be sent by personal deLkety, comahta'clai courier ar by United States Rogtstered or Certified F/tail, return to to effeealve won reeaipt by the Party concerned, 9. Surety shall cease m be attadted to this Bond a current and effeetwe Power or AttoMy evidencing the authority of tw officer, agent or representative who executed ibis Bond oa behalf of Surety m Omwte, seal and deliver sueh,Bond and bind the Surety thereby. 16. 1I» s Bond is iateadedto conformto aft applicable statutory requirements. Any applicable requirement of any applicable statute that boa beep amdtted front this BONI abuit be deemed to be included herein as if set forth at length, If any provisroa of4sia Bond conHieta With eoy applicable staiuto; then rite pravdsioa of said Mae abseil govern suet the remainder bf this Bel ttat is not in coofIlict therewlth shall c006m9e in foil force and effect, 11. ''Fine term'Bid" aB sued herein includes a B'sl, offer or proposal as applicable. �rc�� uo. i9io-2s-c (1396 Ediflon> 0041ti,2 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2016-141131 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Rexco Construction Services, Inc. Port Lavaca, TX United States Date Filed: 11/30/1016 Date Acknowledged: 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract, Calhoun County EMS Station General Contractor Nature of interest 4 Name of Interested Party City,State, Count ry (place of business)(check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. DEBRAFLORES My Commission -Expires sign re of authorized agent of contracting business entity February 24. 2018 A IX m �hSTAMP/SEAL ABOVE r! nq h (�) Sworn to and subscribed before me, by the said lb) IJ C' (/1�1r�� this the �U day of 20 i% to certify which, witness my hand and seal of office. r.�c�/YT� i UV �'O�i /VGr�iYUY _�N►,IC.�,� Signa a of officer administering oath Printed name of officer administering oath Title of officer adr�jnistering oath Forms provided by Texas Ethics Commission www.etnlcs.state.tx.us veibiuir v1.0.41 i I hereby certify that it was RESOLVED by a quorum of the directors of (Name ofI Corporation) (, meeting on the )-LI day of ? Gvi �^� "1 , 20 r , that MiClei I i106M55 U1P: be, ame of Principal) (Title) and hereby is, authorized to execute all documents /necessary for the transaction of business in the State of Texas on behalf of the said �eK�C� l �v1Sf tic' i 1��1 �nl V� (�$ rt �, and (Name of Corporation) That the above resolution was unanimously ratified by the Board of Directors at said meeting and that the resolution has not been rescinded or amended and is now in full force and effect; and in authen.tticpat�ion of the adoption of this resolution, I subscribe my name this day of A We -A , 201 � . Secretary END OF DOCUMENT 00415-1 NON -COLLUSION AFFIDAVIT State of ex County of _ o' I )e n n I S -; �I �eCol'n ` being first duly sworn, deposes and says that: 1. He is ,Secnt (I `fr of K2)clo (o�ST tug I i h the BIDDER that has submitted therattached. Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is.genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including this of lant. (Signed) �itle Subscribed and sworn to me this day of € 'A •rr 20%P . By: g6tv �"a No Public My commission expires END OF DOCUMENT °' OEBRA FLORES My Commission Expires February 24, 2018 00416-1 ��EECs,E�y DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT Bidder shall answer all questions, and answers shall be clear and comprehensive. This form shall be notarized upon completion. As necessary, BIDDER may use separate attached sheets to answer questions, and may submit additional information, if desired. BIDDER's Name:p j wb r,64-1>6 cf-ULV,\ �1V��� P�c� • Organization Date: D� � Address: -163b i"l �j-J D ./ ��Nl L` Aer Y` i� ` i Incorporation Date: 5Cxj i Type of Work Performed: Ever Fail to Complete Awarded Work? Y or N Ever Default on Any Contract? Y or ATTACH THE FOLLOWING INFORMATION: Attach a LIST OF PROJECTS, similar in size and scope to the work covered by this proposal, which BIDDER has MOST RECENTLY COMPLETED. Amount of Date Owner Contract Contract Award Type of Work Completed and phone no. Attach a LIST OF PROJECTS BIDDER is now ENGAGED IN COMPLETING. Amount of Percent Owner Contract Contract Award Type of Work Complete and phone no. Attach a LIST OF EQUIPMENT THAT WILL BE AVAILABLE FOR THIS PROJECT including type, model, owned or leased. Attach a RESUME FOR EACH OFFICER OF THE COMPANY AND THE PROPOSED SUPERINTENDENT for this Project. ALSO, indicate the numb of orepi u, E�1 pment Operators, Laborers, etc. that will be available for this project. ` v�cw� �e '� ' 0*%,e/,, �1l Credit Available: $ Bank Reference/Contact: S The undersigned hereby authorizes any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY, in relation to the verification of the statements comprising this BIDDER's Qualification Statement. Signed:.b�:� '�— Executed and sworn to before me, the unde igned a thorityI on this day Name & Title: IS Kcx i �e 1��� of 7�f 20 Notary/I blic in and form DEBmi CommFLOission ES My Commission Expires February 24,2018 'O "�""z E OF DOCUMENT 00420-1 Consider and Take Necessary Action on plat request of Eddie Powers for Country Club RV Park. (KF) PASS. Page 6 of 32 Susan Riley From: Kenny Finster <kenny.fnster@pct4.org> Sent: Monday, December 05, 2016 8:30 AM To: Susan Riley Subject: Eddie Powers Country Club RV Park Attachments: EddiePowersCountryClubRVpark.pdf DATNA: To approve plat request of Eddie Powers for Country Club RV Park. Thank you. Your friend, Kenny Finster / i0 1133H5 YN +'ON 'NO '07i A3Aans aNVI "`"eu:uiixi mI oou•y u,.ii'mi °1 sz1 xY,'m �uex.YtlLlYtl0flY1. x. 1.' aYOAI9 •4biiNf ONB .09 - .I +37VJ$ 60t0/i/ +'ON 8Oi aavoNV1S .i c.: 1 A 1 ., 51190101 +31VO bH8 :AB NNtlHO V M Sd p NP QNO � YQG$O,F ` u Ea ' ONW N •.V_ g-Ji p • .-V.. O W O4FP^` �iLL o a or'n ca " ".N PON = s4 33 / .00*091 M .61.b l.Cs s a�J .16'ROtldA i; � x 6 F�b m—� lz �tl8 1 i ggQ1F�8 is .. 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RV 5pACC5 Z' 6reX /00• C4c-P &a-rrN I'"o'4 6'X/2 Co,vcn �'f.Esas �z) z4'w ins ��Raw��s CcoNceEr-E) (Z) IS' Wlb-E- Gass �es�rs Z, SA�e�TtiAcT �uSEp � zs gc�FS� sr47:e- APIVAVv' .56PTIC- SYS7" I 1 I I Consider and Take Necessary Action to pass 2017 Salary Order setting maximum salaries, making various appropriations, setting vacation policy and sick leave policy, setting policy on payment of hospitalization insurance premium, setting holiday schedule and setting miscellaneous policy matters. (MP) Commissioner Galvan made the motion to pass 2017 Salary Order and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 7 of 32 From: Cindy Mueller <cindy.mueller@calhouncotx.org> Sent: Monday, November 28, 2016 9:31 AM To: 'Susan Riley' Cc: Mary Orta; Farleigh Sutton; Josie Sampson; Kenny Finster; mike pfeifer; veil Fritsch; roger galvan; vern lyssy Subject: Agenda Item Request -Annual Salary Order Attachments: SALARY ORDER-2017.pdf Please place the following item on the agenda for December 8, 2016: CATNA to pass 2017 Order setting maximum salaries, making various appropriations, setting vacation policy and sick leave policy, setting policy on payment of hospitalization insurance premium, setting holiday schedule and setting other miscellaneous policy matters. Cindy Mueller Calhoun County Auditor 202 S. Ann, Suite 8 Port Lavaca, TX 77979 Phone 361.553.4610, Fax 361.553.4614 2011 ORDER PASSING MAKIMUM SALARIES, MAKING MOUNLYAPPROPRIATIONS, AND PASSING NOLIDAY SONEDULE WHEREUPON, on motion by Commissioner Galvan, seconded by Commissioner Lyssy, and unanimously carried, on the 8th day of December, 2016, the Court ordered the following Order be adopted and entered: The various officials, supervisors, and permanent employees will be compensated for the Calendar Year 2017 not to exceed the following amounts: SEE SALARY SCHEDULE ATTACHED (Salary Schedule contains salaries for the Juvenile Probation Department. This department is administered by the Juvenile Board and is not included in the County's Budget or Financial Statements; however, the State Statutes indicate that these are employees of the County. These salaries are included for informational purposes only.) All County employees shall be paid on a bi-weekly basis (annual salary divided by the number of bi-weekly pay periods in the year). Each of the officials named herein shall fix the compensation of the employee(s) authorized for his department within the maximum amounts authorized by this Order. Each of said officials will complete and deliver the payroll forms to the County Treasurer to indicate the pertinent information for all employees covered by the Fair Labor Standards Act who were employed during the pay period; he will also see that the necessary exemption certificates and other information are furnished to the County Treasurer so that proper deductions may be made and records compiled for Federal Withholding Tax, Social Security Tax, Group Insurance, and Retirement Plan. EMERGENCY MEDICAL SERVICE SEE SALARY SCHEDULE ATTACHED In addition, employees are paid an overtime rate of one and one-half times the above rates. An employee on call is paid an hourly rate of $1.00. Amounts shown in the attached Salary Schedule are for budgeting purposes only. PART-TIME OR TEMPORARY HELP The various officials/supervisors will be allowed to employ extra help at the following maximum hourly rates ➢ Building Department Labor $ 7.25 ➢ Clerical Help in County Offices $ 725 ➢ Road and Bridge Precinct Labor $ 7.25 ➢ Waste Management Department Labor $ 725 ➢ Mechanics $ 9.00 ➢ Skilled Help $ 15.00 ➢ JP Court Clerks -Part -Time $ 13.00 ➢ Librarians -Part -Time $ 12.78 ➢ Bailiffs $ 12.50 ➢ Heavy Equipment Operators $ 12.00 ➢ Veterans Service Officer -Part -Time $ 12.60 ➢ License Differentials (per certification and if applicable): ➢ Pesticide[Herbicide $ 0.12 ➢ EMT Intermediate Certification $ 0.14 ➢ Vector $ 0.58 ➢ CDL $ 0.17 ➢ CDL-X (Hazmat endorsement) $ 0.26 ➢ K-9 $ 0.58 ➢ Paramedic License $ 0.58 ➢ Pesticide/Herbicideplus Vector $ 0,69 Payments may be made up to the amount authorized in each department budget, approved by the Commissioners Court in the 2017 Budget. The officials/supervisors affected by this Order will not obligate the County for the payment of any compensation in excess of the extra help allowance Page No. 1 2017 ORDER PASSING MANIMUM SALARIES, MAKING MONTHLY APPROPRIATIONS, AND PASSING HOLIDAY SCHEDULE without prior authorization of Commissioners Court. These employees will be considered part-time or temporary employees of the County and will be subject to Federal Withholding Tax and Social Security Tax deductions. APPROPRIATIONS FOR CELL PHONE ALLOWANCE County Commissioners will be paid a bi-weekly set allowance as follows: Commissioner, Precinct No. 1 Commissioner, Precinct No. 2 Commissioner, Precinct No. 3 Commissioner, Precinct No. 4 $69.23 Bi-Weekly $69.23 Bi-Weekly $69.23 Bi-Weekly $69.23 Bi-Weekly APPROPRIATIONS FOR TRAVEL ALLOWANCE Officers, agents or employees of the County will be reimbursed for actual traveling expenses while out of the County on official County business or in attendance at conferences relating to County government up to the amount authorized in the 2017 budget for this purpose in accordance with the County's purchasing manual. Reimbursement will be requested on the travel form available in the office of the County Treasurer and will be filed, with supporting documentation, in the County Treasurer's Office within one month after the trip has been made. Certain personnel will be reimbursed for actual traveling expenses in the County in amounts not to exceed the appropriations authorized in the 2017 budget. Mileage reimbursement for the use of personal automobiles, which have been authorized, will be computed at the current rate set by the Internal Revenue Service for tax purposes with the following exceptions which will be paid a bi-weekly set allowance as follows: County Judge Constables Justices of Peace Nuisance Enforcement Officer $296.15 Bi-Weekly $296.15 Bi-Weekly $238.46 Bi-Weekly $296.15 Bi-Weekly APPROPRIATIONS FOR CALHOUN COUNTYAPPRAISAL DISTRICT Payable in quarterly installments from the General Fund to the Calhoun County Tax Appraisal District: Appraisal Services Collection Services HOLIDAY SCIIEDULE The Court set the following holiday schedule for the calendar year 2017: Good Friday Memorial Day Independence Day Labor Day Veterans' Day Thanksgiving Day Christmas Day New Year's Eve New Year's Day $55.751.25 Quarterly $18,093.25 Quarterly Friday, April 14 Monday, May 29 Tuesday, July 4 Monday, September 4 Friday, November 10 Thursday, November 23 & Friday, November 24 Monday, December 25 & Tuesday, December 26 Friday, December 29 Monday, January 1, 2018 However, it was agreed that if any of the above holidays should fall on a non -working day, the employees should be allowed to observe the nearest working day preceding or following the holiday, as shown above. Page No. 2 20110RDER PASSING MAl11MUM SALARIES, MAKING MOMLYAPPROPRIATIONS, AND PASSING NOLIDAY SONEDULE POLICIES PERTAINING TO SICK LEAVE, JOB RELATED ACCIDENTS, AND VACATION WILL BE FOLLOWED AS PER EMPLOYEE POLICY AND PROCEDURES MANUAL. 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V3 V3 Ui 6q � Ui � p50 U 00000 F o a 0 0 o 0 o 0 0 0 0 0 0 0 w w W W W A M M � �n rn rn rn rn rn rn h � h z w G b M N (s9 Pass Order Setting Day of Week, Location and Alternate Location of Regular Term for Commissioners' Court for Calendar Year 2017. (MP) Commissioner Lyssy made the motion with the change of CR 101 to Henry Barber Way to pass the order setting day of the week, location and alternate location of regular term for commissioners' court calendar year 2017 and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 8 of 32 ORDER SETTING DAY OF WEEK, LOCATION AND ALTERNATE LOCATION OF REGULAR TERM FOR COMMISSIONERS' COURT FOR 2017 CALENDAR YEAR Motion by Commissioner Lyssy, seconded by Commissioner Galvan, and carried, that the following order be entered: At a regular term of the Commissioners' Court in and for Calhoun County, Texas, held in the regular meeting of said Court in the County Courthouse in Port Lavaca, Texas, on the 8th day of December, 2016, with County Judge Michael J. Pfeifer presiding, and Commissioners Roger Galvan, Vern Lyssy, and Kenneth Finster present, there having come on for hearing the matter of determining the day of week and location of the regular term of Calhoun County Commissioners' Court for the calendar and fiscal year, 2017, it was ordered that the regular term should be the second and fourth Thursday of each month. The location of such meetings will be the Commissioners' Courtroom located in the County Courthouse, Suite 104, 211 S. Ann Street, Port Lavaca, Calhoun County, Texas, The first alternate location of such meetings will be the Bauer Exhibit Building, Henry Barber Way, Port Lavaca, Calhoun County, Texas. IT IS SO ORDERED this 8th day of December, 2016. COMMISSIONERS' COURT OF CALHOUN COUNTY, TEXAS By: icbael J. PfeyTWCAnt§ Judge ATTEST:�'a 's Anna Goodman, County Cle By: Deputy Cory Cl�k n° Consider and Take Necessary Action to ratify Interlocal Agreement for the Assessing and Collection of Taxes with the Calhoun County Appraisal District. (MP) Commissioner Galvan made the motion to ratify Interlocal Agreement for the Assessing and Collection of Taxes with the Calhoun County Appraisal District and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 9 of 32 Agreement for the Assessment and Collection Functions of the County of Calhoun To Be Performed by the Calhoun County Appraisal District This agreement made and entered into on this the 10 day of December, 2015 , by and between the County of Calhoun (hereinafter referred to as "COUNTY") and the Calhoun County Appraisal District (hereinafter referred to as "DISTRICT") as duly authorized by the governing body of each party to the contract, Purpose and Authority The parties to this agreement wish to enter into an agreement whereby the assessment and collection of property taxes for the COUNTY will be performed by the DISTRICT; The parties enter into this agreement in order to eliminate duplication of services for the assessment and collection of taxes and to promote governmental efficiency; and The parties enter into this agreement pursuant to the authority granted by section 6.23 and 6.24 of the Property Tax Code and Art. 4413 (32c) V.A.T.S., otherwise known at the Inter -local Cooperation Act. In consideration of the premises and of the terms, provisions, and mutual promises herein contained, it is mutually agreed as follows: Lenyth of Contract Period This contract shall be effective January 1, 2016, through December 31, 2018, and shall continue in full force and effect from year to year until such time as either party hereto, by written notice to the other, may terminate the same at the end of the contract year, such termination to be effective only if provided to the other party on or before September 1 of the year in which the party intends for the contract to terminate. The consolidated office conducting the assessment and collection functions, including, but not limited to receipts, statements and correspondence, shall be referred to as the Calhoun County Appraisal District. Assessment Services to be Performed The DISTRICT shall perform, through a Texas Department of Licensing and Regulations registered or certified assessor, all the functions of assessment of ad valorem property taxes for the COUNTY as provided under the Property Tax Code and the Texas Comptroller of Public Accounts, Property Tax Division rules, including the calculation and publication of the effective tax rate of the COUNTY according to section 26.04 and the guidelines established by the Texas Comptroller of Public Accounts, Property Tax Division. In the event that the COUNTY proposes to adopt a tax rate exceeding the limits of section 26.05(c) and necessitating further publication of hearings per section 26.06, the costs will be a direct expense to the COUNTY. However, if the COUNTY fails to adopt its tax rate by September 30th, or if the COUNTY'S adopted tax rate is rolled back, the costs for additional publications and notices will be the responsibility of the COUNTY and any additional assessing costs incurred by the DISTRICT for late and separate tax bill processing or issuance of corrected bills associated therewith shall be strictly accounted for by the DISTRICT and shall be payable by the COUNTY submission of that accounting by the DISTRICT. Page 1 of 5 Should the COUNTY offer discounts to its taxpayers under section 31.05(b) or 31.05(c), or both, the DISTRICT agrees that if a consolidated billing system is utilized by the DISTRICT that, upon request or attempted remittance by a taxpayer of taxes imposed by the COUNTY, the DISTRICT will generate a separate billing for that account so that such remittance by taxpayer will not constitute a partial payment under section 31.07. Collection Services to be Performed The DISTRICT shall perform through a Texas Department of Licensing and Regulations registered or certified collector, all the functions of collection of ad valorem property taxes for the COUNTY as provided under the Property Tax Code and the Texas Comptroller of Public Accounts, Property Tax Division rules, including required reports to the COUNTY, notices to taxpayers including the 33.07 collection cost penalty notice and issuance of refunds under section 31.11. COUNTY agrees to transfer authority for performance of the taxing unit's approval function for any request exceeding $2,500.00, issuance of tax certificates, and auditor function under section 31.11 to be performed by the DISTRICT's Chief Appraiser. The DISTRICT shall provide at least 7 days written notice to the COUNTY of all refunds in excess of $2,500.00 prior to the DISTRICT issuing the refund. The DISTRICT further agrees to administer and collect special inventory tax as defined in 23.121, et seq„ of the tax code in the same manner as it performs all other collection activities for the COUNTY. The COUNTY agrees to deliver or make available to the DISTRICT all delinquent and other tax records necessary for the performance of the DISTRICT'S duties under this contract. At any time the COUNTY may have access to these records, and will be provided with a complete set of records in electronic format or disc if and when COUNTY may wish to terminate this contract agreement. Furthermore, DISTRICT agrees to protect against loss of records by providing for duplicate record storage at periodic intervals, at least weekly, and agrees to make accessible in electronic format, disc or printout, the delinquent records to any delinquent tax attorney operating in behalf of the COUNTY. In addition, the DISTRICT'S collector will be bonded in the amount of $100,000.00, payable to the governing body of the COUNTY. The DISTRICT shall also provide for an independent audit of its collection operation annually to be contracted by the DISTRICT with final reports from auditing firm to the COUNTY. Paxment of Services In consideration for the functions of assessing and collecting services to be performed as specifically provided in this contract and according to the Property Tax Code and the Texas Department of Licensing and Regulation rules, and as included in Exhibit A of this contract, the COUNTY agrees to pay to the DISTRICT its pro rata share of the actual costs incurred by the DISTRICT for the assessing and collection functions based on an audit of actual costs incurred. The accounting period of such costs shall be from January 1 through December 31 of each year. M •W The COUNTY transfers to the DISTRICT the right to contract with a delinquent tax attorney of its choice under section 6.30 and 6.24(b) to enforce the collection of delinquent taxes for the COUNTY. The attorney's compensation under the contract shall not exceed that set forth in section 6.20 of the amount of taxes, penalty and interest collected. The COUNTY further agrees that such fee as specified herein as attorney's fees will be paid by the COUNTY from the delinquent taxes, penalties and interest collected for the COUNTY by said private legal counsel. Page 2 of 5 The DISTRICT shall make available the delinquent tax records to the specified attorney by July I of each year the contract remains in effect and each year the attorney is contracted to perform these functions, The DISTRICT further agrees that these records will be provided to the attorney contracted within the form of duplicate computer tapes or disks. Other Provisions and Definitions The DISTRICT shall not be liable to the COUNTY on account of any failure to collect taxes nor shall the collector be liable unless the failure to collect taxes is a result of malfeasance. All expenses incurred by the DISTRICT for the assessment and collection of taxes shall be clearly kept on the books and records of the DISTRICT. The COUNTY or its designated representative is authorized to examine the records to be kept by the DISTRICT at such reasonable intervals as the COUNTY deems fit. Such books and records will be kept in the offices of the DISTRICT. In the event a contract dispute arises between the parties herein named to the contract, a mutually agreed upon third party will be named to act as independent arbitrator whose compensation will be paid in equal parts by both parties to the contract, whose decision regarding the dispute will be a binding decision on both parties to the contract. For the purposes of this agreement, the term "assessment" shall include the following: 1) Submission to the COUNTY'S governing body the appraised, assessed and taxable value of new properties and of all discovered, taxable properties in the unit; 2) Calculation and publication of the effective tax rate calculation; 3) Application of the unit's adopted tax rate to the values on the appraisal roll; 4) Submission of the appraisal roll to the governing body for approval and creation of the COUNTY'S tax roll, proration of taxes, maintenance of the integrity of the tax roll through correction of clerical error in the tax roll; and 5) and all other assessment duties mandated under the Property Tax Code. The term "collection" for purposes of this agreement shall include the collection of tax liabilities, issuance of refunds, monthly, annual and other collection reports as provided by this contract, required notices to taxpayers including the collection cost penalty notice section 33.07, Property Tax Code, deposits to the COUNTY'S designated depository at intervals as specified herein, issuance of tax certificates and all other collection functions mandated by the Property Tax Code. For the purposes of assessment and collection, the County is defined to include the jurisdictions that the County is presently assessing and collection for as follows: Calhoun County Calhoun County Navigation District (now known as Water Control and Improvement District #1 Drainage District No. 6 Drainage District No. 8 Drainage District No. 10 Drainage District No. I I Page 3 of 5 Exhibit "A" Basis of Annual Charge for Tax Assessment and Collection I, Expenses of the tax collection office of the DISTRICT used to determine the annual charges to the COUNTY for assessment of property and the collection of taxes thereof are: Peroll All salaries and other payroll expenses are charged to the DISTRICT'S tax collection, including, but not limited to insurance, payroll taxes, workmen's compensation and health insurance. Purchased and Contracted Services All expenses incurred by the DISTRICT'S tax collection office for services rendered by firms, individuals, or professionals which are independent of the DISTRICT such as maintenance contracts, publications, legal fees, upkeep of grounds and buildings, utilities, rentals, and all other purchased and contracted services not mentioned above. This excludes fees of the delinquent tax attorney. Supplies and Materials All expenditures for supplies and materials necessary for the operation and maintenance of furniture, data processing equipment, janitorial, buildings and grounds, books, office supplies, printings, and all other material and supplies not mentioned above. Other Operating Expenses Expenditures necessary for the operation of the tax office such as travel, subsistence, insurance, bonding expense, fees and dues, and other miscellaneous expenses not mentioned above. Capital Outlay All expenditures for furniture, and equipment necessary in the operation of the tax office. II. The following factors and formula will be used in determining the total yearly cost to the COUNTY for assessment and collection: a. Total current tax levy in all of Calhoun County by all jurisdictions. b. Current tax levy of the COUNTY. c. Sum of the costs and expenditures delineated in section I of this Exhibit. Formula: (B / A) x C = COUNTY'S cost Page 4 of 5 Annroval of County of Calhoun I, Mike Pfeiffer, do hereby approve the consolidation of the functions of assessment and collection as set forth in this contract and authorized by section 6.24(b) Property Tax Code and Art. 4413(32c) V,A,T,S. otherwise known as the Interlocal Cooperation Act, Aikefe' e C unty Judge County of C lhoun Executed in Port Lavaca, Texas on the date and year first written above. Bill Swope ` / Chairman, Board of Directors Calhoun County Appraisal District Page 5 of 5 Consider and Take Necessary Action on request to open credit accounts with Jimmy Sanders, Inc. for Road and Bridge Precincts 1, 2, 3, & 4. (VL) Commissioner Lyssy made the motion to open credit accounts with Jimmy Sanders Inc. and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 10 of 32 Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 November 21, 2016 Honorable Michael Pfeifer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Pfeifer: (361) 552-9656 Fax (361) 553-6664 Please place the following item on the Commissioners' Court Agenda for December 8, 2016 Discuss and take necessary action to open credit accounts with Jimmy Sanders, Inc. for Road & Bridge Pct. 1, Pct. 2, Pct. 3 & Pct. 4. Sincerely, Vern Lyssy `�� VL/Ij Date: Wholcralet❑ Retanto Restricted VnAPPiicatora: Sales Laotian: Sales Representative: Amount of Requested Credit:i ("Credit Limit"). Floandal Statements Submitted? Vas/Na The tam °CredRm°1 mans the reRowing sleeted andty(les) and Includes such entity's suggestion and eu@m (if Ire box is checked, "Creditor" meant Pinnacle Operating Corporation god Its Subsidiaries): p68FaNM �►rCe PROUIOENCE �'ANDEFM The term "Customer" means the ctutomor(s) described below, whether one or more. The term "Guera tor" mono the guarantor(s) described below, whethar e...r mare. CUSTOMER INFORMATION Legal Business Name ofCalomer: 0 Phone: W6,1—S-gz DBA. if any: Foxg 3k ! ""G StroetAddmtst 5'$ Z CII . 2 s i Country: aa/6,aua SSN or EIN: lq Dun and Bradstreet Number. N PereattAmllated Com o a Ira Sable); A(IA Fug Name,Addrest and Phan? Number: E•mallAddrust �, ') Webelim Busing" Form: )lndividualowoer ( (LLCf nership I ]Corporation Date of Incorporation: St.morloco omdam Data Business Started(Post tbwmen: Dam Hudneu Slnrietl P ions Ownersl Contact Person: L¢SPt_ Pboam 1- 2-^ Fax: _ 9Ios6 TRADE REFERENCE ' 1 Namn IDate Established: .2)PIamal _ �— eta ta611shed Acel, ar et4 , Contact: Credit Lira: o Ic41t Credit Line: Addems: Address: CI( /Stal CI /Statew Phone Fax: Phone.- Fast E-mail Addrsas: "all Addres» BANK REFERENCE IPiwea I.A.ds. nrodnedn. 6.4.. If —A i Nume: ale mbllshed• 2 Name: Date Eetabllshed: Accl. a: Amt.; Lasn Ofeeer: ILase St Lou O e: a AddromAddress: Citylstate4zhu Cit/Statim : Illegal Fax: Phone: xl en ddrosa Addre s; GUARANTnfieFl C sualor' Nerve: amnmr'sN_— dmr •ZD Cn /lime P Z7 7 Cl ismmrL 1 Canm4t: onto • Phone ]Phone. SSN or TIN: ISSNarEiNt Please Include IateNal andlatIpa"Nal fraaarial sialemeafs (boll, Inmate slalesneat and halmreeslreenJ. IN WITNESS WHEREOF Customer and Guarantor have "muted this Credit Application Agreement under seat ae of the day and year But above written, and by signing under Sod eatb Customer and Guarantor agrees to the terns of this Credit Application Agreement UNSIGNED OR INCOMPLETE CRED/TAPPLICATIONAGREEMENTS )FILL NOT DE PROC&SSED. CUSTOSfER(S): CUSTO51ER(S): Principal Owner/ Ofcar(Pdnulype) Principal Owned Offlor(print+iype) Principal Ownea Omter(Sigmmrc) T)do; Principal Owners OSieer(Signanua) Tibet GUARANTOR(S): Ouomme (Prin t ype) Ouummor (PrinVi)ryq) Guarantor(Slgnamro) Ouommor(Signaeure) OUARANTOR(S): I \Mare+el e.ig; I 7N, ClodNARlhmmAr m.., DhN•Apemmma) 6$A-k W by Cmoa. ad Voodoos (aDvaivdn'ikbo") et m PEP= a Qom w douwq mvmm mad0 tadR.d6 C7a dbap D*M bwaby p mbxbw cmdhw m and o amd bpmw of me I OMMU mid DWet Dowd he ft Ataammasd dbwwM a b meaty m monk QrUM m aady m Ufom,dm 006111131 In m Apaeme,t d er aaw, We «.Aww&km W mwww MVOWA* of Dowers, m VAN" Mb b d vwmb Mdm um to mommdt lofatmRD, and pONwrm Oedtw admeb odor idMdalo led .mi es dam my end in HOMWO.OwWaP Rea do sa6mierd poAdo o m m ama breredodm MUM AND PAYdd&fPTERMS1 Pavdr modrml, Omwm,rspee, to pW* PRY to OmOrd* dfChoRmemmaimmPdmbdmrofde, Clem LW mDue mD dMaSW brek Oi ap,m der aR PgmmU mkmW dmmomtr min due In madaD WA me lam Wind In SMN W hamb. 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Wiener aroo a domed asav kW wb.mrcw ern ra RRMWIRk UpmtMmomeamofravmofddYdr,ComrmW,u W opdmap Aw"10 DaaCaller MY 06W@ pOWWK bWdarmb,DdAgmodmmda u bR 6 agaiy, a aMNro, do a W am a main ado aabWfyt O) drr,.W ed w mere wmlpdoos sower. Immemay8erdpulaH. W mReR.v d W ra ram godly mrD. W tlrr.q,, me5 ad(D)mfmmGsdmbaomfgiunmi Mha.gitMalamrprwbae Phkdk A",Y'awkwNAfobbw CU87OMRR(R)'RuarL,e 6o OUARAMMOrsRUT AM CMdit WII"llm AW WMP1I Pop O""'„'• 01-924 1 ', V (Rev.9-1513) Texas Agricultural Sales and Use Tax Exemption Certificate Commercial agricultural producers must use this form to claim exemption from Texas sales and use tax when buying, leasing or renting qualifying agricultural items they will use exclusively in the production of agricultural products for sale. You cannot use this form to claim exemption from motor vehicle tax when buying motor vehicles, including trailers. To claim motor vehicle tax exemption, you must give a properly completed Texas Motor Vehicle Tax Exemption Certificate for Agricultural and Timber Operations (Form 14-319) to the vehicle's seller or dealer. You must also claim the exemption on the Application for Texas Title (Form 130-U) when titling or registering the vehicle with the local County Tax Assessor -Collector. This form is not required when purchasing the following types of agricultural items: • horses, mules and work animals commonly used in agricultural production; • animal life, the products of which ordinarily constitute food for human consumption, such as cows, goats, sheep, chickens, turkeys and pigs; feed for farm and ranch animals, including oats, corn, chicken scratch and hay, and • seeds and annual plants, the products of which are commonly recognized as food for humans or animals (such as corn, oats and soybeans) or are usually only raised to be sold in the regular course of business (such as cotton seed). All other purchases of agricultural items require this properly completed form to claim a sales tax exemption. See the back of this form for examples of exempt and taxable items. Name of retailer Jimmy Sanders, Inc. Address (Street and number, P.O. Box or route number) P.O. Box 350 City, State, ZIP code El Campo, TX. 774377 Proper use of this certificate Purchasers - You can only use this certificate for items you purchase for exclusive use in an exempt manner. You should be familiar with qualifying items. Any non-agricultural or personal use disqualifies the purchase from exemption. See the back of this form for examples of exempt and taxable items. Retailers -You can accept this certificate in good faith at the time of sale if it is propertly completed with an agftimber number and expiration date. You can also accept it as a blanket certificate covering all sales made during the time this certificate is valid on qualifying items that can reasonably be used to produce agriculture products for sale. Name of purchaser mho Cow 2-tO Address (Street and number, P.O. Box or route number) .BIZ City, St1ja,,ZIP code , — �- TW 77!?-F Phone Area code and number) 3`�i _! 5, ; z-9 Agmmber number Name of person to whom number is registered, if different than purchaser This exemption certificate expires on Dec. 31, 2 0 sign here fense to issue an exemption certificate to the seller for taxable items that I know will be used in a exemptions found in Tax Code Section 151.316. The offense may range from a Class C misdemeanor Purchaser's name (print or type) I Date This certificate should be given to the retailer. Do not send the completed certificate to the Comptroller of Public Accounts. Form 01-924 (Back)(Rev.9-1513) Always Exempt These items are always exempt and do not require an exemption certificate or an ag/timber number. • Horses, mules and work animals commonly used in agricultural • Feed such as oats, hay, chicken scratch, wild bird seed and deer production; corn for livestock and wild game (pet food is not exempt); and • Animal life, the products of which ordinarily constitute food for human • Seeds and annual plants, the products of which are commonly consumption, such as cattle, goats, sheep, chickens, turkeys and recognized as food for humans or animals, such as corn, oats and hogs; soybeans or for fiber, such as cotton seed. Exempt Here are examples of items that are exempt from sales tax when used exclusively on a farm or ranch to produce agricultural products for sale and pur- chased by a person with a current ag/timber number. Air tanks Augers Bale transportation equipment Baler twine Baler wrap Balers Binders Branding irons Brush hogs Bulk milk coolers Bulk milk tanks Calf weaners and feeders Cattle currying and oiling machines Cattle feeders Chain saws used for clearing fence lines or pruning orchards Choppers Combines Conveyors Corn pickers Corral panels Cotton pickers, strippers Crawlers — tractors Crushers Cultipackers Discs Drags Dryers Dusters Egg handling equipment Ensilage cutters Farm machinery and repair or replacement parts Farm tractors Farm wagons Farrowing houses (portable and crates) Feed carts Feed grinders Feeders Fertilizer Fertilizer distributors Floats for water troughs Foggers Forage boxes Forage harvesters Fruit graters Fruit harvesters Grain binders Grain bins Grain drills Grain handling equipment Greases, lubricants and oils for qualifying farm machinery and equipment Harrows Head gates Hoists Husking machines Hydraulic fluid Hydro -coolers Implements of husbandry Incubators Irrigation equipment Manure handling equipment Manure spreaders Milking equipment Mowers (hay and rotary blade) Pesticides Pickers Planters Poultry feeders Poultry house equipment Pruning equipment Rollbar equipment Rollers Root vegetable harvesters *As of Sept. 1, 2015, telecommunications services used to navigate farm machinery and equipment are exempt. Rotary hoes Salt stands Seed cleaners Shellers Silo unloaders Soilmovers used to grade farmland Sorters Sowers Sprayers Spreaders Squeeze chutes Stalls Stanchions Subsoilers Telecommunications services used to navigate farm machinery and equipment* Threshing machines Tillers Tires for exempt equipment Troughs, feed and water Vacuum coolers Vegetable graders Vegetable washers Vegetable waxers Taxable These items DO NOT qualify for sales and use tax exemption for agricultural production. • Automotive parts, such as tires, for vehicles licensed for highway • Materials used to construct roads or buildings used for shelter, use, even if the vehicle has farm plates housing, storage or work space (examples include general storage • Clothing, including work clothing, safety apparel and shoes barns, sheds or shelters) • Computers and computer software used for any purposes other than • Motor vehicles and trailers* agricultural production • Pet food • Furniture, home furnishings and housewares • Taxable services such as nonresidential real property repairs or • Golf carts, dirt bikes, dune buggies and go-carts remodeling, security services, and waste removal • Guns, ammunition, traps and similar items * See wvvw.comptroller.texas.gov/taxinfo/agriculture. Tax Help: www.comptrollertexas.gov/taxhelp • Window on State Government: www.comptroller.texas.gov Tax Assistance: 1-800-252-5555 Sign up to receive email updates on the Comptroller topics of your choice at www.comptroller.texas.gov/subscribe. 0: 1 ,at sea : tft�.atva) Texas Agricultural Sales and Use Tax Exemption Certificate Commercial agricultural producers must use tills form to claim exemption from Texas sales and use tax when buyinr , teasing orronifng qualifying agricultural items they will use exclusively in the production of agricultural products for sale. ! You cannot use this Ifum to claim exemption from T motor vehicle tax when buying motor vehicles, including trailers, claim motor vehicle tax exemption, you must give a properly completed Texas Motor Vehicle Tax Exemption Certificate forAgticr ttuml and Timber Operations (Form 14-319) to the vehicle's selieror dealer. You must also claim the exemption on the Application for((TTexes Tille (Fenn 130-11) when titling or registoting the vehicle with the focal County Tax Assessor-Coiloctor. j This form Is not required when purchasing the followingtypes of agricultural items: • horses, mutes and work animals commonly used In agricultural production; • animal life, the products of which ordinarily constitute food for human consumption, such as cows, lit ats, Sheep, chickens, turkeys and pigs; • feed for farm and ranch animals, including oats, corn, chicken scratch and hay; and • seeds and annual plants, the products of which are commonly recognized as food for humans or anti nals (such as corn, oats and soybeans) or are usually only raised to be sold in the regular course of best ss (such as cotton seed). ,r All other purchases of agricultural items require this properly completed form to claim a sales tax exemption, See the kock of this form for examples of exempt and taxable Items. Name of retailer Jimmy Sanders, Inc, Address(SNeetand number, PO. Box arroure number) P.Q. Box 350 City, State, ZIP code _T El Campo, TX, 774377 i Purchasers - You can only use this certificate for items you purchase for exclusive use in an exempt anner. You should be familiar with qualifying items. Any non-agricultural or personal use disqualifies the purchase from exemption. See the back of this form for examples of exempt and taxable items. Retailers - You can accept this certificate in good faith at the time of sale if it is propertly completed wi h an agltimber number and expiration date, You can also accept it as a blanket certificate covering all sales made during the time this certificate is valid on qualifying items that can reasonably be used to produce agriculture products for 4ale, Name or purchaser Calhoun County Road & Bridge Pct. 4 Address (Street and number, P.O. Boxer roala numbers P.O. Box 177 City, State, ZIP coda Seadrift, TX 77983 Phone (Area code and number, 361-552-9656 Aftnimber number Name of person to whom number is reeistered, it different than purchaser This exemption certificate expires on Dec. 31, 2 , 0 , j I understand that i am required tokeep records to verity eligibility for the exemption(s) claimed and that I will be requi ad to pay sales or use tax on purchases that do not qualify for the exemption(s), in addition to any applicable interest and penalties. I understand that It is a criminal offense to issue an exemption certificate to the seller for taxable items that I kney Will be used In a mannerthat does notclualify forthe exemptions found in Tax Code Section 151.316. The offense may'range from a Cla fs'Cmisdemeanor to a felony of the second degree., Purchasers signature sign Purchasefs name (ref if ortylsm Date heref This certificate should be given to the retailer. Do not send the completed certificato to the Comptroller of Pahl {c Accounts. j1 i Dates wbohmbr❑ Rmu:[] Rntrlebd Dn APPUMM sales inea)Iaer Sala wrmwgl+'m— Ameost of Ragoemd CrWl: S (`CrcdR UjWrY. Pleandel auteaewD Sub The term ocndltar" mmAe Me rob** Wetted aadwu) and wewdn tuth mt)ly%aaeuten ad utku Of m bmt Plaaade Opuaan cam"fioe ow lu wbddlmlyd)t 0 Adflur D e ° FRQVIllENCE Tha lerm'"Untdmet` tnaana tlrcasta®m{IY deaadya�S ucwm;wb�har uam armen. TAe term "Cudrenw.e wbrebax ooewtacn. (`I Ifi'T'nfuC4 IUCnDaA ATInN t�uDoslmaName arfur)armr: Calhoun Count Y Puy 361-785-314 D&A.Ranya a oun Count oa n e c . re Strva Aft= P 0 BOX j 77 clt :Seadrift stun: TX t 77 "N.arim 74-6001923. DuaudBnrhlntetN -ter PmnVAtndated ce W t b4: NIA M?bnt;Addrea and Pbove Nnmbe: E-"Addrata a ril ct4.or Webdw Bat)atu.Torar: ! Ylediddue)Ouaer ! 14LGtParlaanbbo. YCarpmmdoa. Daie afi0[arPWadaa: 8.6 at rNwar Dab Dedatu Shntl el•Manet Uate BuYnYBtCnOdlour Owavot conga panam A rll Townsend Phaan361.785.3141 Ival 361-785-5602 TDAna.Drnenvsrnn 1 I tLam Ilk* b)baed> AM:dt tbetnstl CrWR bar Was an ,..b.. b P Put E.maD g-rn®gAddrms SAt;K_RFFER£c,PiCE rznAna WTnarm nem a CalhounCounty 't dd 202SAnnSt.Addmst Port Lavaca TX 77979 i Cind Mueller - County pb"ll 361-5534610 them ssi mnN: MarelNt Mwe todede Isle" endlauyeanend,�aaxrldr(atrm n(iwh Inomm awwwno>}aMmrrrkemy. IN WITNESS WHEREOF, CaNamar..and Ot tw have,,,uted thh.CrMtAppikson Agrewent maderaeal uofd Am Abma wrlam, Mel by algalag under $W cub Cuatww end Gmmmar egtwa to the tarma of thh i r#o App" ONMGNSO OR INCOMPLM CMflAPPLICA770SAGREEMVM OF7U M7.08P&OCBSSM ctffmd ")t Nlti0.11gDf$k PdndPdovx OR4xr(PrineT ) Pdaggtal OnmrFOPkvft3ria4TYM) i+dua)pal O�ean+`OtAMTISigm+mnl. Pe�:iPal OaralDPo>+aC ) GUARAMPO")1 GmnaorePriaVTYp,) Cmroaurtiiam wo) Otaw,wi "Type) Onu wa skm ) n+u.A,waat6m tix.�.d Psa.� Consider and Take Necessary Action on renewal of Texas Pollution Discharge Elimination System (5 years Jan -December 2017-2022) for the Calhoun County Airport and authorize County Judge to sign. (VL) Commissioner Lyssy made the motion on renewal of Texas Pollution Discharge Ellimination System and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 11 of 32 Vern Lyssy 13 Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 November 22, 2016 Honorable Michael Pfeifer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Pfeifer: (361) 552-9656 Fax (361) 553-6664 Please place the following item on the Commissioners' Court Agenda for December 8, 2016 Discuss and take necessary action to renew Texas Pollution Discharge Elimination System (5 years Jan -Dec 2017-2022) for the Calhoun County Airport. S incer rly, 4___1 Vern Lyssy VL/Ij EXHIBIT A SERVICE ORDER Locations: Calhoun County Airport Texas Pollution Discharge Elimination System (TPDES) TPDES General Industrial Storm Water Permit • Prepare Site Map of facility according to the permit • Prepare Notice of Intent for the Permit. (Permit Fee to be paid by the client) • Prepare Storm Water Pollution Prevention Plan (SWPPP) per TPDES Permit requirements • Assist with implementation of Pollution Prevention Plan Cost per facility for TPDES renewal: ............................................................................................................ $3,875.00 Annual Storm Water Pollution Prevention Training • Records generated for your files • Video and interactive slide presentation • Reviews and handouts provided • Meeting State and Federal Regulations Cost per on-line sessiot Quarterly Inspections .................... $650.00 • Conduct inspections to document implementation of plan Costper inspection: .......................................... ............................................................................................... $450.00 Annual Review of Plan • Update plan to take into consideration major changes to operation Cost per year:........... Sampling Services • Storm water sample analysis (*Samples to be • Provide sampling kit collected onsite by trainedfacility representative. • Provide FEDEX or similar pick-up service AARC will not be responsible far obtaining water • Sample analysis report and review samples.) Discharge Monitoring Report (DMR) to EPA Cost annually per outfall for Texas Effluent Limitations (TEL) sampling: ...................................................... $485.00* Arsenic, Barium, Cadmium, Chromium, Copper, Lead Manganese, Meremy, Nickel, Selenhan, Silver, and Zinc. *This mnount will be invoiced on the specific date on Exhibit B regardless if and when monitoring occurs at the site. The associated discharge monitoring reports (DMRs) will be prepared and submitted regardless ofwhether or not monitoringhas occurred The DMR preparation and submittal costs are included in the amount invoiced to you Also, a $25 additional charge will be incurred if a sample kit that has previously been supplied, but not used forAARC sanples, needs to be replaced. ***The terms of this agreement are found in the Master Service Agreementwhich has been previously signed*** Calhoun County AARC Environmental, Inc. By: M 4?JkJ By: Name:Michael f - r Date 12-08-16 Name: Fidel R. Rul, III Title: County Judge Title: Environmental Counsel M Two Riverway, Suite 1780, Houston, TX 77056 (713) 974-2272 // FAX: (713) 339-2272 CERTIFICATE OF INTERESTED PARTIES FORM 1295 Intl Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no Interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2016-142119 AARC Environmental, Inc. Houston, TX United States Date Filed: 12/02/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Airport Date Acknowledged: g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. NA Environmental Consulting Services 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary- 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. [G�gyx2010. .:.nature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE 1/ �^i Sworn to and subscribed before me, by the said F.� �in (�of c ( a.l (-\an( , this the 20 1 , to certify which, witness my hand and seal of office. + day of 101ikC! `U Signature of officer admmlsterlfig oath Printed name of officer administering oath Title of o r administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us version V1,0.277 CERTIFICATE OF INTERESTED PARTIES FORM 3.295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2016-142119 Date Filed: 1210212016 Date Acknowledged: 12/29/2016 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. AARC Environmental, Inc. Houston, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Airport 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. NA Environmental Consulting Services 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said , this the day of , 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 EXHIBIT B PAYMENT STRUCTURE Locations: Calhoun County TPDES General Industrial Storm Water Permit Due Herewith (First'/ Permit Cost).............................................................. Due Upon Delivery (Second %: Permit Cost) .................................................. Annual Storm Water Pollution Prevention Training Due per session upon completion of Storm Water Training for 2017-2022................... Quarterly Inspections Due upon completion of 1" quarter inspection (Jan -Mar. 2017-2022) .. Due upon completion of 2"a quarter inspection (April -June 2017-2022) Due upon completion of 4`h quarter inspection (Oct -Dec 2017-2022) . Annual Review of Plan .......................... $1,937.50 .......................... $1, 93 7.50 .................... $650.00 .............. $450.00 .............. $450.00 .............. $450.00 Due upon completion of Annual Review (July -September 2017-2027)...........................................................$450.00 Sampling Services Texas Effluent Limitation Due per outfall on January 15, 2017-2022 for TEL Sampling ...... ................................................................... $485.00 ***The terms of this agreement are found in the Master Service Agreementwhich has been previously signed*** Calhoun Count AARC Environmental, Inc. By. e ue er Date — 8-16 N 0 k y . Name: Fidel R. Rul, III Title:County d Title: Environmental Counsel AW Two Riverway, Suite 1780, Houston, TX 77056 (713) 974-2272 H FAX: (713) 339-2272 Consider and Take Necessary Action to declare Phase One of DRS Grant No. DRS010020 (Ocean Drive) as complete and authorize County Judge to sign 7- 7 Certificate of Construction Completion — Force Account. (RG) Commissioner Galvan made the motion to declare Phase One of DRS Grant No. DRS010020 (Ocean Drive) as complete and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 12 of 32 ROGER C. GALVAN ) 2118, Ann Port Lavaca, `1'X 77979 (361) 552-9242 November29, 2016 Calhoun County Commissioner• ftecznct #1 51pTt 6Y Tf Honorable Michael Pfeifer Calhoun County Judge 211 S. Ann Port Lavaca, TX77979 RE: AGENDA ITEM Dear Judge Pfeifer: Fax (361) 553-8734 Pager (361) 579-7915 Mobile (361) 93.5-3552 Please place the following item on the Commissioner's Court Agenda for December 8, 2016. • Discuss and take the necessary action to submit the Certificate of Construction Completion Phase 1 for Ocean Drive. Texas General Land Office - Disaster Recovery Non -Housing 7-7 Certificate of Construction Completion - Force Account (Submit One for Each Prime Construction Project) Grantee: Calhoun County GLO-DR Contract No; P00166 A-4 DRS Grant No.: DR5010020 PART 1 . CERTIFICATION OF CONSTRUCTION COMPLETION day This is to certify that a final inspection of the project described below was conducted on the M of May , in the year 2016 Summary of Construction Work Completed Activity Code Project Name (from performance Statement) Description (What is yotractivityl! 4uantity -Metric 4 - Street Improvements Ocean Drive Reconstruction Civil Reconstruction 1 # of Projects This is to further certify that the work has been completed in accordance plans and specifications thereto with the following exceptions: Certified By: _,,.._7 Engineer's Signature: Name; Title: Firm: Ben L, Galvan Professional Engineer CivilCorp, LLC M Mgr's Name: Roger( Mgr's Title: County City/County of: Magnolia Beach/Calhoun Elected Official's Signature: official's Name: Title: City/County of: �V` Mike Pfeifer Countyludge Magnolia Beach/Calhoun PART 2 - CERTIFICATION OF EXPENSES Amount of GLO-DR funds expended on this construction: $93,405.00 Amount of Local/Oth expended: $9,719.96 Certified By, (note, ocal project Local Project Mgr's Signature: nature: representative must sign before elected official): Manager's Name:' Roger Galvan \- I Title: County Commissioner Pct. i City/County of: Magnolia6each/Calhoun Elected Official's Signature: Official's Name: Mike Pfeifer Title: County Judge City/county of: Magnolia Beach/Calhoun Revised Form Effective 1/7/13 Page 1 of 1 Consider and Take Necessary Action to correct the duplicate entry in the fixed asset database: Asset #24-0102. Hog Bayou Boat Ramp. (KF) Commissioner Finster made the motion to correct the duplicate entry in the fixed asset database: Asset #24-0102 and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 13 of 32 From: kenny.finster@pct4.org Sent: Friday, December 02, 2016 8:03 AM To: Susan Riley Subject: Agenda item Importance: High Susan, can you please change the wording on the agenda item about the duplicate entry in the Fixed Asset Item inventory? DATNA: To correct the duplicate entry in the fixed asset database. Asset # 24-0102, Hog Bayou Boat Ramp. Thank you, Kenny Finster 3617855602 CALHOUN COUNTY PCT4 15`.52:45 11-30-2016 2 /7 n PLACE: DATE BIDS AND PROPOSALS - BOG BAYOU BOAT RAMP, PMOINCT NO. 4 Motion by Commissioner Maddux, seconded by Commissioner Mikula, and carried, that the following bid of Sylva Construction Company, being the only bid received, be accepted in the amount of $21,158.00 for construction of the Hog Bayou - Hwy. 35 Boat Ramp and that the County Judge be authorized to enter into a contract with Sylva Construction Co. Port Lavaca, Texas ,?^!3 - 8i PROPOSAL PROPOSAL OF A CORPORATION ORGANIZED AND EXISTING UNDER THE LAWS OF THE STATE OF TEXAS: OR.A PARTNERSHIP CONSISTING OF 70: Calhoun County Judge Calhoun County Courthouse 211 S. Ann Street Port Lavaca, Texas 77979 GENTLEMEN: The undersigned hereby proposes to furnish all labor, materials, tools, and necessary equipment, and to perform the work required for the construction of TEXAS PARKS & WILDLIFE DEPARTMENT HOG BAYOU BOAT RAMP FACILITY for the ' County of Calhoun, Texas at the locations set out by the plans and specifications, and in strict accordance with the contract documents for the following prices to -wit: 421 3617855602 CALHOUN COUNTY PCT4 15:52:53 11-30-2016 317 DID ITEM 1. 2. 3. 4. S. 6. 7. QUANTITY & UNIT DESCRIPTION & PRICE IN WORDS FIGURE TOTAL PRICES AMOUNT 1 EA Concrete Ramp and Apron, Lump , Sum of Ff✓t A-&.4,0/I °N h.,,/.el d6f:r/4 s ral Dollars 97,'00 aa 1 - 0 - Cents 250 CY Compacted Embankment at Turnaround, Complete the the Sum of /w. yl. Zo sere,. Doll ors / y3% IV37. —o Cents 683 SY Scarify and Compact Existing Roadway Shoulder Material, Camplgto the Sum of &i ,f %1°ASded &404 h��'.dpSrvnd Ooilars /j,07p0 �a 1707, - 0— Cents 776 SY 69 Compacted Subgrade, Complete the Sum of AV4 bras°a ve"V4 2%� 0 Dollars ao 1 4 w.0 . U - Cents 776 SY 6" Compacted Base, Complete of the Sum //a !"W Z°4 oa �O rh4°aNI A'fW '4d r4Aa� Dollars a .36 el. - o - Cents 1459 SY Prime Coat, Complete the Sum of jfe u�{w� �� Dollars $75oa k75.°� -O- Cents 1459 SY Asphalt surfacing, Complete the Sum of Foy. Ih� sn ✓d .vD .,✓./-ed 1Lv. Dollars �7�11 �0 - o - Cents Page 2 422 3617855602 CALHOUN COUNTY PCT4 15:53:04 11-30-2016 4/7 FIGURE TOTAL DID ITEM QUANTITY & UNIT DESCRIPTION & PRICE IN WORDS PRICES AMOUNT 9. 58 EA 6" Treated Posts, Complete the Sum of Ode hacrd df fit+. ao uJ hudd„fy: { Dollars 3 5 0, J?90- 4 - / Cents 9. Trim Trees, Lump Sum of �N,t �! r✓r/rt d ao do 1_,alDollars IDS. f1(S _0 Cents do TOTAL AMOUNT DID FOR THIS PROJECT (Items 1 through 9) $ 2.1 XSK'• 493 3617855602 CALHOUN COUNTY PCT4 15:53:13 11-30-2016 5/7 The undersigned hereby declares that he has visited the site and has ' carefully examined the plans, specifications and contract documents relating to the work covered by his bid -or bids, that he agrees to do the work, and that no representations made by Shearer Engineering, Inc. are in any sense a warranty, but are mere estimates for the guidance of the Contractor. Upon receipt of notice of the acceptance of the bid, we will execute th[ formal contract attached within ten days. The bid security attached. without endorsement, in the sum of re f/.ram r �w /;jc�u .?Py[N non%9� td- �r/iN�/� B�✓f_r�� 7 is to bcFome the property atne County o Calhoun, alhoun, in the event tne contract is not executed with the time set forth, as liquidated damages for the delay and additional work caused thereby. Number of Signed Sets of oc Duments: The Contract and all bonds will be prepared. in not less than four 4 counterpart (original signed) sets. Time off Completion: The undersigned agrees to complete the work within * 1 5" working days from the date designated by the Notice to Proceed.. The undersigned further declares that he will provide'all necessary tools and apparatus, do all the work and furnish all materials and do everything required to carry out the above mentioned work covered by this ' proposal in strict accordance with the contract documents, and the requirements pertaining thereto for the sum or sums set forth above. Respectfully submitted, * Indicate number of working days in blank provided. Page 4 &24 3617855602 CALHOUN COUNTY PCT4 15:53:26 11-30-2016 6/7 3617855602 CALHOUN COUNTY PCT4 15:54:02 11-30-2016 717 Consider and Take Necessary Action to accept TAC insurance settlement in the amount of $63,921.03 for Tropical Storm Bill piers and bulkhead repair. (MP) Commissioner Galvan made the motion to accept TAC insurance settlement in the amount of $63, 921.03 and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 14 of 32 From: Cindy Mueller <cindy.mueller@calhouncotx.org> Sent: Monday, November 21, 2016 10:47 AM To: 'Susan Riley' Cc: Donald K. Gray, ARM; Kenny Finster; mike pfeifer; neii fritsch; roger galvan; vern lyssy Subject: Agenda Item Request Please place the following item on the agenda for December 8, 2016: a CATNA to accept TAC insurance settlement in amount of $63,921.03 for Tropical Storm Bill piers and bulkhead repair. Below is TAC's claim analysis. Final engineering invoice has not been received but is reimbursable. Cindy Mueller Calhoun County Auditor 202 S. Ann, Suite B Port Lavaca, TX 77979 Phone 361.553.4610 Fax 361,553,4614 Estimated Estimated Amount ID Description ACV outstanding ACV Claimed. Paid to Date NA Port Alto 81WX0 0.00 8,000.00 8,ow,04 8,000.00 403 Six Male Plot 709.67. 0X0 709,67. 7099.67 709.67 NA Flamingo St. 9ulkhead IPct 3 N Port Alto) 27,00t1.00. 0.00 27;000.00 27,000.0D.. 27,000.0(1 399 tourtosy-ClockatViagaolia Beach 064t Remp 62,000.00 0.0 37,200X0 62,000.00 62,000.00 NA Dispo#at of TWO phhs and tsvnsaurn-V docks 3olwoloo 0100 0,00 30,000,00: 30,000.00' NA. Nla6rt43td ach Bulkhead jderno and rewn) 109,308.83 0.00 65,585.30 109,308.81 101,3018,33 400 CrabWng0rddge-at MABrooksBea cbs. 48,000.00 0.00 28,800.00 48,000,00 48,000.00 401 ,odtanals Fishing P;W.: 218,500,00 0,00 131,100,00 218,500.W. 218,500.00 NA UBM. 001e, 0.00 0.00 Moo 0,00. 0.00 404 214c Stet Fcxhkng pfor 324,200,00 0A0 194,520.00 374,200.00 324,200.00 39$ Courtesy DmkatAls oBeach a Ramp 42,100,00 -- - 0.00 25,260.00 42,10U0 42,100.00 Totals 8b9,818 50 0.00 518;174.97 869,818.50 869,818.50 10 nestription Engineering Fees Aepa"trs, by sinriey and Estimated Estimated Amount ACv outstanding ACV Claimed 45,000.00 ( d.37.1 ('r'.,1 43,626.00 41,626.00 41,626.00 Paid to Date Totals 914,81850 3,37CN) 559,800.97 911,444,50 53i,444,50 Less Deductible g517.ca:c.c) f5.t},Gouxll Net 861,444,50 %2,444:60.- 1 Precinct 1 Tropical Storm Bill Damages and Insurance Recovery Engineering $ 41,626.00 Shirley & Sons 871,420.00 Total expended to date 913,046.00 Policy deductible named storm (50,000.00) TAC's adjustments * (37,311.17) Insurance recovery to date $825,734.83 *Adjustments to repair bid (upgrades not existing before storm) 1) 350 LF bulkhead sidewalk not replaced 11,508.00 2) 168 additional LF vinyl bulkhead (47,199.17) 3) 12 light poles (1,620.00) 11/21/2016, 11:46 AM Auditor recap Pct 1 damage claim Consider and Take Necessary Action to change the date of the first meeting in February, 2017 from February gth to February 13th due to a conflict. (MP) Commissioner Lyssy made the motion to change the date of the first meeting in February, 2017 from February gth to February 13th and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 15 of 32 February 2017 Monday Tuesday Wednesday Thursday Eriday Saturday Sunday 30 31 I i �1 2 3 14 1 1 5 i I 6 17 8 19 10 11 112 (AGENDA ' ITEMS DUE 13 14 15 116 17 �18 19 COURT AGENDA i ITEMS DUE i I i25 26 20 21 22 23 24 COURT 27 28 1 12 i 3 4 5 6 17 8 �9 10 i11 12 i I j ! i I otes: T-. Consider and Take Necessary Action to enter into the Official Court records the 24t" Judicial Community Supervision and Correction Department Financial Statement for Fiscal year 2016. (MP) Commissioner Galvan made the motion to enter into the Official Court records the 24th Judicial Community Supervision and Correction Department Financial Statement for Fiscal year 2016 and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 16 of 32 9 tit CALHOUN COUNTY a DEWITT COUNTY GOLIAD COUNTY 24`aJUDICIAL DISTRICT COMMUNITY SUPERVISION AND CORRECTIONS DEPARTMENT 205 North Bridge Street, Suite 201 P. O. Box 165 Victoria, Texas 77902 (361)575-0201 TO: Commissioner's Court FROM: Greg Cummings Director SUBJECT: Financial Statement for Fiscal Year 2016 EACKSONCOUNTY REFUGE) COUNTY VICTORIA COUNTY Date: November 28, 2016 As per Local Government Code 140.004, attached please find the 24th Judicial District Community Supervision and Corrections Department's Financial Statement for Fiscal Year ending August 31, 2016. Also as per TDCJ-Community Justice Assistance Division Financial Management Manual, the CSCD is providing copies of the last quarterly reports for all budgets for the period ending August 31, 2016. The above reports are for information only and no action is required from the Commissioners' Court. GC:ams 24TH JUDICIAL DISTRICT COMMUNITY SUPERVISION AND CORRECTIONS DEPARTMENT BASIC SUPERVISION PROGRAM FINANCIAL REPORT FOR FISCAL YEAR 2016 FISCAL OFFICER Stephanie Thurman CIHEF COUNTY Victoria FISCAL YEAR ENDING August 31, 2016 a. Basic Supervision Prograin beginning on 9/1/15...... ........................................ -- ..... -............. $ 858,476.41 b. Prior Period Adjustment ..................... -................................................................. ........................................ $ 75.00 c. Prior Year Refunds...................................................................-........................................................... $ (1,093.68) d.InterfundTransfer (Specify):..CCP,,DP.-MentalHealth„SeX_Offena,,Sub. b.... $ (84,637.81) e. Adjusted Fund Balance................................................................................................................................... $ 772,819.92 REVENUES: f. State Aid - Basic Supervision Program............................................................................................ $ 969,053.00 g. State Aid - Supplemental Funding ................................................... ................ ......... ............................. $ 71,572.08 h. Probation Fees ............. ...... ............................................ ......... .................................................... I........................ $ 1,799,505.33 i. Payments by Program Participants..................................._.................................................................... $ 175,299.40 j. Interest Income..................................................................................................................................................... $ 5,347.75 k. Other Revenue....................................................................................................................................................... $ 35,217.26 I. Total Revenue (e+f+g+h+i-i7)................................................................................................................. $ 3,054,994.82 m. Total Pands Available(d+k).....................................................................................................:......I......... $ 3,827,814.74 EXPENDITURES: n. Salaries/Fringe Benefits........................................................ o. TraveI/Furnished Transportation ••• p. Contract Services for Offenders .................................... q. Professional Fees....................................................................... r. Supplies and Operating Expenditures ........................ s. Facilities, Utilities, and Equipment ............................ t. Total Expenditures (m+n+o+p+g+r) ....................... u. Basic Supervision Program Balance on 8/31/16 $ 2,730,841.08 $ 50,061.45 $ 15,181.69 $ 71,113.34 $ 92,219.71 $ 51,157.81 $ 3,010,575.08 $ 817,239.66 11/21/2016 3LULUya 11/21/2016 DATE SIGNATURE OF FISCAL OFFICER DATE Quarterly Financial Report - Print Page TEXAS DEPARTMENT OF CRIMINAL JUSTICE COMMUNITY JUSTICE ASSISTANCE, DIVISION Financial Report For information or assistance, contact Fiscal Management at (512) 305-9200 VERSION: 1 Program N: 900 Program Title: Basic Supervision Chief County (CSCD): Victoria Fiscal Year: 2016 Quarter: 4 Quarter Fnding Date: 08/31/2016 Funding Source: BS Status: Finalized A. Program Fund Balance ...... ........................ $ 1 —664,285.46 .. ......................................................... ........... ...................._.._....................................................... B. Prior Period Adjustment: _.............._................................................................. $ 0.00 C. Prior Year Refunds (Basic Supervision Only): ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, .........................__..................,..........,....,................................._......................._.............................._. $ 0.00 D. Interfund Transfer: [I] Basic Supervision: ................................................................................__.............._.........................................................._......_..........................................._....._..._. $ 441767.32 (Basic Supervision Transfer notes) to OCP = $21398.56 to DP-MH = $4754.20 to DTP = $12421.36 to DP -Sex Offender = $5593.20 [21 Community Corrections: $ 0.00 ..................................... ......... ......................... ...... .................................... _...._.................................-....._..........._.............. E. ADJUSTED FUND BALANCE (A+B+c+))): $ F 960,118.08 REVENUES F. State Aid: ........................................ (state Aid notes) $24822 (Dedicated Salary) + $224390 (State Aid) _ $249212 249,212.00 G. SAFPF Payments (Basic Supervision only): $ 36.026.24 .........................._............................_.._..........._...—..............._......................._....._.._...._..........._........................._ H. Communtiy Supervision Fees Collected (Basic Supervision only): $ 371,121.35 .................................._....._............ .............................__................_................... ............................_...._....... I. Payments by Program Participants: $ 45,829.80 ................................_.....................................................................................................,,..,.,...................................................... . iraymems oy rMp=n rwuc,yanrs auws; Transfer fees = $5338 DA Fees = $91.42 Assessment Fees = $16669.80 DOEP = $7020 DWI = $2710 Payments by Prog. Part. _ $4950 J. Interest Income (Basic Supervision only): ...........................................__..................................................................,........._...................................................................................................... K. Other Revenue: --..............................................................._....._......................................................._........_...._......_...._.................._..... (Other Revenue nottess) $ 1,426.79 $ 8,163.98 Page I of 2 http://cjadweb.tdoj.state.tx.us/EXT4/Protected/pages_print/print_all.aspx 11/28/2016 Quarterly Financial Report - Print Page Unpay. Rest. Fee = $40.55 Transaction Fees = $7387.61 DHS — $735,82 L. TOTAL REVENUE (P+c+ii+i+a+iq: $ 711,780.16 ............................................................................................................................................................................................................................... M. TOTAL FUNDS AVAILABLE (E+L)c $ r 1,671,898.24 Page 2 of 2 EXPENDITURES $ 781,163.27 N. Salaries/Fringe Benefits: ._._............ .................................__._.................................._..................................................._......................................................... O. Travel/Furnished Transportation: $ 187267.86 ..... ................... .........................._..................... ..............................._....._..........................................._..._._.................. P. Contract Services for Offenders: $ 6,155.60 ..............-.............._................._................_.........._..............................................._._........_...................................._......._........ Q. Professional Fees: ........... ........................_............ .. $ 806.00 ............... ._........................................_......................... .............. ............ ......._......_....................._....._.........._ R. Supplies & Operating. Expenditures: .........................:.................................................................................................................. $ 35,289.27 ...F............................................................... S. Facilities: $ 0.00 �� T, Utilities: $ 12,314.21 ........................................._......................................................_................._._............._.................._........_................................................._.._.... U. Equipment: ............................. $ 662.37 V. TOTAL EXPENDITURES (N+o+P+Q+R+S+T+U): $ 854,658.5& ....-.b...._"o'...............................................................-................................,..........._................................................. W. Smb Total (M-v): $ 817239.66 X. Refund to CJAD (Enter as negative number, CCP, DP and TAIP only): .................................... ......................................................._.......................... .... $ 0.00 ................................. ........... .................... ..... ............ ...................... Y. CARRY OVER TOTAL (w+x): ................................_...._.._..__......................._..... ................................. ..................... ....:....................................... ............ ..............._....._......__... $ 817, 339.66 Is this a revision? €-7 Yes ONo If yes, Date Revised: Signature of Fiscal Officer Date 43na4refctor Date Fiscal Officer (please print) Director (please http://cjadweb.tdcj.state.tx.us/EXT4/Protected/pages_print/print_all.aspx 11/28/2016 Quarterly Financial Report - Print Page TEXAS DEPARTMENT OF CRIMINAL JUSTICE COMMUNITY JUSTICE ASSISTANCE DIVISION Financial Report For information or assistance, contact Fiscal Management at (512) 305-9200 VERSION: I Program 4: 3 Program Title: Special Services Chief County (CSCD): Fiscal Year: 2016 Quarter: 4 Quarter Ending Date: Funding Source: CCP Status: Finalized Victoria 08/31/2016 A. Program Fund Balance $ 0.00 _......................................................................._................................................................................................................................e.......,_. B. Prior Period Adjustment: $ o.0o ... ............................._. C. Prior Year Refunds (Basic Supervision Only): $ 0.00 .............................._..........._........_..........................................................................................................................._............................................... D. Interfund Transfer: [1] Basic Supervision: ...... ........................._.........._.................... ..................... ..................... ................... ...... ................... ............. ........ ........ .............._......._........ (Basic Supervision Transfer notes) from Basic [2] Community Corrections: .. .................... ............... .._..._.... ............. .................. ......... ........ .......... ........... ................................... ....... _................................. _........ E. ADJUSTED FUND BALANCE (A+B+c+))): REVENUES F. State Aid: $ F 21,398.66 $ 0.00 $.F 21,398.56 $ 93,766.00 G. SA . ..................................... .......... _........_............ _.................._..........._..........._...................................... H. Communtiy ... ............._.................................................................................................................................... I. Payments by Program Participants?....__.............._...__.._._.._.............._...._.._. _................................................................... _......._.................... $ 0.00 J. Interest Income (Basic Supervision only): $ 0.00 .................._..._............._._........_....._........_.................._.................._........_..........._._...................................._...................................._........_........ K. O-- ................................_...._................................................_........_............................................._......................._.................._.....,.._........ L. TOTAL REVENUE(r+c.+ii+t+,r+x)......_ $ 93,766.00 ....._......._..................................... .......... . .................._........._..........._.................... ......... M. TOTAL FUNDS AVAILABLE(E+L):............................................................................................ _....... ....... ...... ........, $ 115.164.56 EXPENDITURES Page 1 of 2 http://ejadweb.tdcj.state.tx.usBXT4/Protected/pages_print/print_all.aspx 11/28/2016 Quarterly Financial Report - Print Page Page 2 of 2 Is this a revision? 0 Yes [ 'No If yes, Date Revised: FLi 1 1 j��l �' • Signature of Fiscal Officer Date apa�;P ► Inur�rna�n Fiscal Officer (please print) http://cjadweb.tdcj.state.tx.us/EXT4/Protected/pages_print/print_all.aspx 11/28/2016 Quarterly Financial Report - Print Page TEXAS DEPARTMENT OF CRIMINAL JUSTICE ® COMMUNITY JUSTICE ASSISTANCF, DIVISION Financial Report For information or assistance, contact Fiscal Management at (512) 305-9200 VERSION: I Program 11: 7 Program Title: Fiscal Year: 2016 Quarter: Funding Source: DP Status: Specialized Sex Offender Caseload Chief County (CSCD): Finalized Quarter Ending Date: Page 1 of 2 Victoria 08/31/2016 A. Program Fund Balance $ 0.00 .................................................................................................................................................. B. Prior Period Adjustment: .......... .._........ .........._ .......................................................,,........... .........o.......... ..nt.......... .._................... d.._ju...... not......)....... r Per..i A (Priod Astmees Previous FY Reimbursements from defendants for polygraphs C. Prior Year Refunds (Basic supervision Only): ._........................................ 1............. ......_..................... ................-............................ $ 0.00 .............. ........................................................................ D. Interfund Transfer: [1] Basic Supervision: ....................... ..... .......... ....._........................ .......... ..._....._.............. ........ ....._....._..._........... .... $ 5, 993 2-0 .............................__.......................................... (Bpsic Supervision Transfu notes) from Basic [2] Community Corrections: ............_.........._........._....._................................................_........_.........................._................_...._........................................................... $ 0.00 E. ADJUSTED FUND BALANCE (A+B+C+D): _. $1 5,608.20 REVENUES F. State Aid: ........................ $ 10,265.00 G. SAFPF Payments (Buie Supervision only): . ............... ...................................................... $ O.DO .................................._........................._..................................................._.............._.......... H. Communtiy Supervision Fees Collected (Basic Supervision only): $ 0.00 .................._.................................._...................._........__......,.....................................,..................................... I. Payments by Program Participants: $ 0.00 ........._.............._..............................................._....................................................................._...._................................................................_...__. J. Interest Income (Basic Supervision only): $ 0.00 ........................................................._................................................_........................ _........................................_........................................._. K. Other Revenue: L. TOTAL, REVENUE (r+c+x+l+a+rc): $ 10,265.00 .................................._.................._........_............................_................... M. TOTAL FUNDS AVAILABLE (E+r.): ................ $ 16,873.20 EXPENDITURES N. Salaries/Fringe Benefits: $ 15,873.20 ......................._..............._............................._.........._..............................._....................................................................................... O. Travel/Furnished Transportation: $ 0.00 ..................................................._........_.._p............._............................_........ P, Contract Services for Offenders: $ 0.00 http://cjadweb.tdoi.state.tx.us/EXT4/Protected/pages_print/print_all.aspx 11/28/2016 Quarterly Financial Report - Print Page Page 2 of 2 Q. Professional Fees: $ 0.00 ...... ........................ .................... ...... ... ........................................ ........._....... R. Supplies & Operating. Expenditures.:......................................................................................................... ...................... $ 0.00 S. Facilities: $ 0.00 .................................,........................................................................................_..........._. ............................................................... T. Utilities: $ o.00 ............ ....................... .............. ..................................... ..................... .... ........ ............. ............ .... _.......... ...._............... U. Equipment: ................ ..................................... ..................... $ o.ao ...................................................................................._..._..._.................._........_. ....................... TOTAL EXPENDITURES (N+o+P+Q+R+s+T+u): .......... ........................ _............ $ 16 3.20 7V. .........._................_.............._........................._................................. ...... ......... ._............. W. Sub Total (m>-v): $ 0.00 ...... .................................. ............................. ............................. ........................................ ..................._..........._....... _..........._...._........ _........_.. X. Refund to CJAD (Enter as negative number,CCP, DP and TAIP only): $ 0.00 ....................._.........................__............._...._................................. .._......................._............................................................................... ............ Y. CARRY OVER TOTAL (w+x): _........................................................................................................................................ .. $ o.ao Is this a revision? lC'`i Yes *NO If yes, Date Revised: Signature of Fiscal Officer Date !a2 V11U �VM L � Fiscal Officer (please print) J Director (please p ' t) .1L �J-`! Date http://ciadwe.b.tdci.state.tx.us/EXT4/Protected/pages_print/print_all.aspx 11/28/2016 Quarterly Financial Report - Print Page Page 1 of 2 TEXAS DEPARTMENT OF CRIMINAL JUSTICE ® COMMUNITY JUSTICE ASSISTANCE DIVISION Financial Report For information or assistance, contact Fiscal Management at (512) 305-9200 VERSION: 1 Program #: 10 Program Title: Fiscal Year: 2016 Quarter: Funding Source: DP Status: Substance Abuse Specialized Caseload Chief County (CSCD): Finalized Quarter Ending Date: E. A13J UNIEL NU1NU 13ALA1N UE(A+B+C+D): ..................................................... .................................................... _............._..._........ ..._......_.................. ...... .................................................__. REVENUES F. State Aid: L. TOTAL REVENUE (r+G+ll+l+a+x): M. TOTAL FUNDS AVAILABLE(E+L):................................................................ ..........................................................................................................................1........... ......... EXPENDITURES N. Salaries/Fringe Benefits: ... ....................._............................................................................................................................................. _........ ........... .............. _..................... O. Travel/Furnished Transportation: _..................................................................... ..........._...................................... .................. .......... _........... _... ..... P. Contract Services for Offenders: Professional Fees: R. Supplies & Operating Expenditures: ....................................................................................................................... Victoria 08/31/2016 $ 12,421.36 $ 48,962.00 $ 48,962.00 $ F 61.383.36 $ F 31.533.04 0.00 $ 29,697.78 $ 0.00 http://cjadweb.tdcj.state.tx.us/FXT4/Protected/pages_print/print_all.aspx 11/28/2016 Quarterly Financial Report - Print Page Page 2 of 2 S. Facilities: T. Utilities: Is this a revision? El Ye4No A I av-uaw '/ Signature of Fiscal Officer $ 0.00 $ 152.57 $ 61,383.36 If yes, Date Revised: h-PAt'a Date na irector Date Fiscal Officer (please print) irector (please print http://cjadweb.tdcj.state.t c.us/EXTA/Protected/pages_pdnVprint_all.aspx 11/28/2016. Quarterly Financial Report - Print Page Page I of 2 TEXAS DEPARTMENT OF CRIMINAL JUSTICE COMMUNITY JUSTICE ASSISTANCE DIVISION Financial Report For information or assistance, contact Fiscal Management at (512) 305-9200 VERSION: I Program H: 14 Program Title: Mental Health Initiative Specialized Chief County (CSCD): Caseload Fiscal Year: 2016 Quarter: 4 Quarter Ending Date: Funding Source: DP Status: Finalized Victoria 08/31/20I6 A. Program Fund Balance $ 0.00 ....... ........................................................................................-......... B. Prior Period Adjustment: $ 400 ..................................................................................................................................................................................................... ................... C. Prior Year Refunds (Basic Supervision ............ ....... ......._............ _...... ---- ........................... .......... ..... .... _... . D.Interfund Transfer: $ 0.00 [1] Basic Supervision: $ 4,754.20 . ......................................................................................................._..................................................................-.........._.- ........_..............._..... (Basic Sopervision Transfer notes) from Basic [2] Community Corrections: ......................._. $ 0.00 ...___......_._.................................................. _............_. E. ADJUSTED FUND BALANCE (A+B+c+D): $ 47754.20 REVENUES F. State Aid: $ 11.1 99.00 G. SAFPF Payments (Basle supervision only): ...._..._. ................................................................................................................................................__................. ........... H. Communtiy Supervision Fees Collected (Basic supervision only): ............... . ..... ..._...................................... $ 0.00 ........................................................................................................................ ....-...................... .--.- I. Payments by Program Participants: _......._......................................._._........___......_..................................................__._............................................................._.._..........._. $ 0.00 J. Interest Income (Basic Supervision only): $ 0.00 ............ ...................._............ ........._............................ ..............................._................................ ..........................._._.................... K. Other Revenue: ................................................................................................................................................................................... $ 0.00 L. TOTAL REVENUE (r+c.+n+1+x+1): $ 11,119.00 .........................._..._................... ................................................,...,.................. ........................... ............................................. M. TOTAL FUNDS AVAILABLE(B+L):._.._....._..._....._......_..._........._..-...............I.................... $ 15,873.20 EXPENDITURES http://cjactweb.tdcj.state.tx.us/EXT4/Protected/pages_print/pTint_all.aspx 11/28/2016 Quarterly Financial Report - Print Page Page 2 of 2 Is this a revision? M Yes �No If yes, Date Revised: �i SPAA><h.A� Signature of Fiscal Officer Date S e o irector Date I) rvmo Fiscal Officer (please print) Director (please pr t) http://cjadweb.idej.state.tx.us/EXT4/Protected/pages_print/plinLall.aspx 11/28/2016 Quarterly Financial Report - Print Page Page 1 of 2 TEXAS DEPARTMENT OF CRIMINAL JUSTICE COMMUNITY JUSTICE ASSISTANCE DIVISION Financial Report For information or assistance, contact Fiscal Management at (512) 305-9200 VERSION: 1 Program #: 4 Program'ritle: Screening, Assessment & Referral Services Chief County (CSCD): Fiscal Year: 2016 Quarter: Funding Source: TAJP Status: Finalized Quarter Ending Dale: A, Program Fund Balance $ 38,902.00 ...............-....._.. ..._........... B. Prior Period Adjustment: $ 1 0.00 C. Prior Year Refunds (Basic Supervision only): $ 0.00 ............................................................................................................................._....._._.............................. D. Interfund Transfer: [1] Basic Supervision: $ D.00 ..... _. _............................................................................. ...... [2] Community Corrections: $ 0.00 ....._......_._........................ ..................-............. _...............__.-___........................................._...............,......... E. ADJUSTED FUND BALANCE (A+B+C+D): $ 38,902.00 .......__..............._.............................. ......... .............................. _._....... ............ _._............... _............. REVENUES F. State Aid: $ 50,000.00 G. SAFPF Payments (Basic Supervision only): $ .... ........................................................................._..............._..........................................._............................ 14. Communtiy Supervision Fees Collected (Basic supervision $ 0.00 only) :................................. I. Payments by.Program...Pa..rt....icipauts:............................. .... ........................ .................... $ 0.00 J. Interest Income (Basic Supervision only): ...................... .......... ................................ ..._.............. _....... ....... _...... $ 0.00 ... ..... ......... _........ K. Other Revenue: $ 0.00 Victoria 08/31/2016 http://cjadweb,tdcj.state,tx.us/EXT4/Protected/pages_print/print_aIl.aspx 11/28/2016 Quarterly Financial Report - Print Page Page 2 of 2 T. Utilities: U. Equipment: __..................._........................_..._._........._ ..__..._...__................_...._.........._........_........_.._............... V. TOTAL EXPENDITURES (N+o+P+Q+R+S+T+v): ..... ....... ............................ ........... ............... ....................... ............_.... ........................ _....................._........... ................._.. W. Sub Total (mI-v): ......_...................................................................................................._...................-_................................_......._.. X, Refund to CJAD (inter as negative number, CCP, DP and TAIP $ 0.O0 $ 85,934.75 $ 2967.25 $ 0.00 ...................._.... ...... ......................_....... ....... ...... ...... ...... ................................_.............._...._..__........ Y. CARRY OVER TOTAL (w+x): $ 2,967.25 _....._..........._...._..__...................._._...-............................................._.................................._............................_. Is this a revision? V1 Yes LF No If yes, Date Revised: Signature of Fiscal Officer Date afore of Dire c Date Fiscal Officer (please print) Director (please p�•' t) http://cjadweb.tdcj.state.tx.us/EXT4/Protected/pages_print/prinf all.aspx 11/28/2016 Accept reports of the following County Offices: Calhoun Tax'Assessor/Collector- OCT 2016 County Treasurer County Sheriff District Clerk County Clerk- NOV 2016 Justices of Peace 5- NOV 2016 County Auditor Floodplain Administration Extension Service Adult Detention Center SHP Medical Judge Pfiefer made the motion to approve reports from the above highlighted offices and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. 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Page 12-01-16;11:09AM;From:Calhoun County JP5 To:5534444 ;3619832461 # 3/ 7 Money Distribution Report NOVEMBER cA HODN COUNTY JP5 Type Cods, DGflQXiPti*e, Count Retained Disbursed Moncy-Totals The following totals, repkeotnt - Cash and Checks Collected COST CCC CONSOLIDATED COURT COSTS 7 26.00 234.02 290.02 COST OHS COURTHOUSE SECURITY 1 19.50 0.00 19.50 COST DPSC UPS FAILURE TO APPEAR /OMNI PEES 1 9.90 20.10 30.00 COST IDF INDIGENT DEFENSE FUND 7 1.20 11.70 13.00 COST JCSF JUSTICE COURT SECURITY FUND 7 6.50 0.00 6.50 COST SPAY JUDGE PAY RAISE FEE 7 3.90 35.10 39.00 COST JSF JUROR SERVICE FUND 7 2.60 23.42 26.02 COST LAP SHERIFF'S FEE 5 25.00 0.00 25.00 COST MVF MOVING VIOLATION FEE 4 0.03 0.32 0.39 COST PWAF TEXAS PARKS 4 WILDLIFE 1 4.00 1.00 5.00 COST SAP DPS 1 2.00 0.50 2.50 COST SUBC SUB TITLE C 4 105.01 0.00 105,01 COST TF TECHNOLOGY FUND 7 26.00 0.00 26.00 COST TFC TFC 4 10.50 0.00 10.50 COST TIME TIME PAYMENT VDE 1 12.50 12.90 25.00 COST TPDF TRUANCY PREVENTION A DIVERSION FUND 6 0.00 11.00 11.00 COST WRNT WARRANT FEE 1 50.00 0.00 50.00 FEES CSRV COLLECTION SERVICES FEE 1 115.50 0.00 115.50 FEES DUO DRIVER SAFETY COURSE - 2013 1 9.90 0.00 9.90 FEES DFF DEFERRED FEE 1 40.00 0.00 40.00 FEES EFF ELECTRONIC PILING FEE 3 0.00 30.00 30.00 FEES FILI FILING FEE 3 75.00 O.DO 75.00 FEES IPBE INDIGENT FEE 3 0.90 17.10 18.00 FEES SEES SERVICE FEE 2 150.00 0.00 150.00 FINE FINE PINE 4 502.70 0.00 582.70 FINE WSP WATER SAFETY FINE 1 4.20 23.00 20.00 Money Totals 10 1,282.94 420, S6 1,703.50 The following totala represent - Transfers Collocted COST CCC CONSOLIDATED COURT COSTS 0 0.00 0.00 0.00 COST CHS COURTHOUSE SECURITY 0 0.00 0.00 0.00 COST DPSC DPS FAILURE TO APPEAR /OMNI FEES 0 0.00 0.00 0.00 COST IDF INDIGENT DEFENSE FUND 0 0.00 0.00 0.00 COST JCSF JUSTICE COURT SECURITY FUND 0 0.00 0.00 0.00 COST JPAY JUDGE PAY RAISE FEE 0 0.00 0.00 0.00 COST JSF JUROR SERVICE FUND 0 0.00 0.00 0.00 COST LAP SHERIFF'S FEE 0 0.00 0.00 0.00 COST MVF MOVING VIOLATION FEE 0 0.00 0.00 0.00 COST PWAF TEXAS PARKS G WILDLIFE 0 0.00 0.00 0.00 COST SAP DES 0 0.00 0.00 0.00 COST SUBC SUB TITLE C 0 0.00 0.00 0.00 COST TF TECHNOLOGY FUND 0 0.00 0.00 0.00 COST TFC TFC 0 0.00 0.00 0.00 COST TIME TIME PAYMENT FEE 0 0.00 0.00 0.00 COST TPDF TRUANCY PREVENTION s DIVL•IRSION FUND 0 0.00 0.00 0.00 COST WRNT WARRANT FEE 0 0.00 0,00 0.00 FEES CSRV COLLECTION SERVICES PEE 0 0.00 0.00 0.00 FEES DDC DRIVER SAFETY COURSE - 2013 0 0.00 0.00 0.00 FEES DFF DEFERRED FEE 0 0.00 0.00 0.00 FEES EFF ELECTRONIC FILING FEE 0 0.00 0.00 0.00 FEES FILI FILING FEE 0 6.00 0.00 0.00 FEES IFF.E INDIGENT FEE 0 0.00 0.00 0.00 FEES $FEE SERVICE FEE 0 0.00 0.00 0.00 PINE PINE FINE 0 0.00 0.00 0.00 FINE WSF WATER SAFETY FINE 0 0.00 0.00 0.00 Trensfar Total" 0 0.00 0.00 0.00 The following totals represent - Jail Credit and Community Sckvi0c COST CCC CONSOLIDATED COURT COSTS 0 0.00 0.00 0.00 COST CHS COURTNOUSE SECURITY 0 0.00 0.00 0.00 COST DPSC DPS FAILURE TO APPEAR /OMNI FEES 0 0.00 0.00 0.00 COST IDF INDIGENT DEFENSE FUND 0 0.00 0.00 0.00 COST JCSF JUSTICE COURT SECURITY FUND 0 0.00 0.00 0.00 COST JPAY JUDGE PAY RAISE PEE 0 0.00 0.00 0.00 Page 2 12-01-16;11:09AM;From:Calhoun County JP5 To:5534444 ;3619832461 # 4/ 7 money Didtributien Report NOVEMBER CALHOUN COUNTY JP5 Type Code Denoription Count Retained Disbursed Money -Totals COST JSP 7VROR SERVICE FUND 0 0.00 0.00 0.00 COST LAP SHERIPF'S FEE 0 0.00 0.00 0100 COST MVP MOVING VIOLATION FEE 0 0.00 0.00 0,00 ' COST PWAF TEXAS PARKS & WILDLIFE 0 0.00 0.00 0.00 COST SAP DPS 0 0.00 0.00 0.00 COST SUUC SUI3 TITLE C 0 0.00 0.00 0.90 COST IF TECHNOLOGY FUND 0 0.00 0.00 0.00 COST TFC TFC 0 0.00 0.00 0.00 COST TIME TIME PAYMENT FEE 0 0.00 0.00 0.00 COST TPDF TRUANCY PREVENTION A DIVERSION FUND 0 0.00 0.00 0.00 COST WRNT WARRANT FEE 0 0.00 0.00 0.00 FEES CSRV COLLECTION SERVICES FEE 0 0.00 0.00 0.00 FEES DDC DRIVER SAFETY COURSE - 2913 0 0.00 0.00 0.00 FEES OFF DEFERRED PEE 0 0.00 0.00 0.00 FEES EFF ELECTRONIC FILING PER 0 0.00 0.00 0100 FEES FILI FILING FEE 0 0.00 0.00 0.00 FEES IFEE INDIGENT FEE 0 0100 0.00 0.00 FEES SFEE SERVICE FEE 0 0.00 0.00 0.00 FINE FINE FINE 0 0100 0.00 O,DO FINE NAP WATER SAFETY FINE 0 0100 0.00 0100 Credit Totals 0 0,00 0.00 0.00 The following totalu YopXopCAt - Credit Card Payments COST CCC CONSOLIDATED COURT COSTS 2 0.00 72,00 00.00 COST CHS COURTHOUSE SECURITY 2 6.00 0.00 6.00 COST DPSC DPS FAILURE TO APPEAR IOMNI FEES 0 0.00 0.00 0.00 COST IDP INDIGENT DEFENSE FUND 2 0.40 3.60 4.00 COST JCSF JUSTICE COURT SECURITY FUND 2 2,00 0.00 2.00 COST JPAY JUDGE PAY RAISE PGE 2 1,20 10.80 12.00 COST JSF 1OROE. SERVICE FUND 2 0.80 7.20 8.00 COST LAP SHERIFF'S PEE 2 10.00 0100 10.00 COST MVF MOVING VIOLATION FEE 2 0.02 0.19 0.20 COST PWAF TEXAS PARKS A WILDLIFE 0 0.00 0.00 0.00 COST SAP DPS 0 0.00 0.00 0.00 COST SUEC SUE TITLE C 2 60.00 0100 60.00 COST IF TECHNOLOGY FUND 2 8.00 0.00 8.00 COST TFC TPC 2 6.00 0.00 6.00 COST TIME TIME PAYMENT FEE 0 O.00 0.00 0.00 COST TPDF TRUANCY PREVENTION & DIVERSION FUND 2 0.00 4.00 4.00 COST WANT WARRANT FEE 0 0.00 0.00 0100 FEES CSRV COLLECTION SERVICES FEE 0 0.00 0.00 0.00 FEES DDC DRIVER SAFETY COURSE - 2013 1 9.90 0.00, 9190 FEES DFF DEFERRED FEE 0 0.00 0.00 0.00 FEES EFF ELECTRONIC FILING FEE 0 0.00 0.00 0,00 FEES FILI FILING FEE 0 0.00 0.00 0100 FEES SFEE INDIGENT FEE 0 0.00 0.00 0.00 FEES SFEE SERVICE FEE 0 0.00 0.00 0100 FINE FINE FINE 1 149.90 0.00 149.90 FINE WSF WATER SAFETY FINE 0 0.00 0100 0.00 Credit Totals 2 292.22 97.79 360.00 The following tOC410 represent - Combined Money and credits COST CCC CONSOLIDATED COURT COSTS 9 34.00 306.02 340.02 COST CHS COURTHOUSE SECURITY 9 25.50 0.00 25.50 COST DPSC DPS FAILURE TO APPEAR /OMNI FEES 1 9.90 20.10 50,00 COST IDF INDIGENT DEFENSE FUND 9 1,70 15.30 17.00 COST JCSF JUSTICE COURT SECURITY FUND 9 0.50 0.00 0.50 COST JPAY JUDGE PAY RAISE FEE 9 5,10 45.90 51.00 COST JSF JUROR SERVICE FUND 9 3.40 30.62. 34.02 COST LAP SHERIFF'S FAA 7 35.00 0.00 35.00 COST MVP MOVING VIOLATION FEE 6 0.05 0.50 0,55 COST PWAF TEXAS PARKS & WILDLIFE 1 4.00 1.00 5.00 COST SAP DPS 1 2.00 0.50 2.50 COST SUOC SUB TITLE C 6 165.01 0.00 1G5,01 COST TF TECHNOLOGY FUND 9 34.00 0.00 34.00 COST TFC TFC 6 16.50 0.00 16,50 COST TIME TIME PAYMENT FEE 1 12.50 12.50 20,00 12-01-2016 Page 12-01-16;11:09AM;From:Calhoun County JP5 To:5534444 ;3619832461 # 5/ 7 money Distribution Report NOVENEER CALHOUN COUNTY .729 Type Cpdo DOFtriptien Count Retained Dioburaed monoy-Totnla COST TPDF TRUANCY PREVENTION 4 DIVERSION FUND 0 0.00 15,00 15.00 COST WRNT WARRANT FEE 1 $0.00 0.00 90.00 FEES CSRV COLLECTION SERVICES FEE 1 115,50 0.00 115,50 FEES DOC DRIVER SAFETY COURSE - 2013 2 10.80 0,00 10.80 FEES DFF DEFERRED FEE I 40.00 0.00 40.00 FEES EFF ELECTRONIC FILING FEE 3 0.00 30.00 30.00 FEES FILL FILINO FEE 3 79.00 0.00 75.00 FEES IFEE INDIGENT FEE 3 0.90 17,10 10.00 FEES SFEE SERVICE FEE 2 150.00 0.00 150.00 FINE FINE FINE 5 732.60 0.00 732.60 FINE WSF WATER SAFETY FINE 1 4.20 23.00 20.00 Report Totale 12 1'545.16 518.34 2,062,50 12-01-2016 Page 4 12-01-16;11:09AM;From:Calhoun County JP5 To:5534444 ;3619832461 # 6/ 7 NOney Distribution Report NOVEMBER CALHOUN COUNTY JP5 Date Paymant lyre Fines Court Cents Fees Eendn Rootitution Ott= Total 00-00-0000 Cash & Checks Collected 0,00 0.00 0.00 0.00 0.00 0.00 0.00 Jail Credits & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Tranotero 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total Of all Collections 0.00 0.00 0.00 0.00 0.00 0.00 0.00 09-01-1591 Caeh & Checks Collocced 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Jail Credits, & Comm service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total of all Collections 0.00 0.00 0100 0.00 0.00 0.00 0.00 09-01-1993 Cash & Checks Collected 0.00 0.00 0.00 0.00 0.00 0100 0.00 Jail Credits & Comm service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers, 0.00 0.00 0.00 0.00 6.00 0.00 0.00 Total of all Collections 0.00 0.00 0.00 0.00 0.00 0.00 0.00 09-01.1999 Cash & Checks Collected 1. 0.00 0.00 0.00 0100 0.00 0.00 0.00 Jail Crodics & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total of all Collections U.00 0.00 0.00 0.00 0.00 0.00 0.00 09-01-1597 Cash & Checks Collected 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Jail Credits & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers 0.00 0.00 0.00 0100 0.00 0.00 0.00 Total of all Collections 0.00 0.00 0.00 0.00 0.00 0.00 0.00 09.01-1999 Cash & Checks Collected 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Jail Credits & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Tranafers 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total of all Collections 0.00 0.00 0,00 0.00 0.00 0.00 0.00 09.01.2001 Cash & Checks Collected 0.00 0.00 0.00 0.00 O.DO 0.00 0.00 Jail Credits & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers 0.00 0,00 0.00 0.00 0.00 0.00 0.00 Total Of all Collections 0.00 0.00 0.00 0.00 0.00 0,00 0.00 09-01-2003 Cash & Checks Collected 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Jail Crodice & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total of all Collections 0.00 0.00 0.00 0.00 0.00 0.00 0.00 01-01-2004 Cash & Checks Collected 610.70 654.40 438.40 0.00 0.00 MO 11703.50 Jail Credits & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers 149.90 200.20 9.90 0.00 0100 0.00 360.00 Total of all Collections 760.60 054160 448.30 0.00 0.00 0.00 2,063.60 TOTALS Cash & Checks Collected 610,70 654.40 430.40 0.00 0.00 0.00 1,703.50 Jail Credits & Comm Service 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Credit Cards & Transfers 149.90 200.20 9.90 0.00 0.00 0.00 360.00 Total of all Collections 760.60 954.60 440.30 0.00 0.00 0.00 2,063.50 12-01-2016 ppgo 12-01-16;11:09AM;From:Calhoun County JP5 To:5534444 ;3619832461 # 7/ 7 Money Distribution Royorc NOVSMBBR CALHOUN COUNTY JP5 Deooription Count Collected Retained Disbursed State of Texas Quarterly Reporting Totalo State Comptroller Cost and Fees Report Section 1: Report for Of£ensos Committed 01.01-04 Forward SS 505.03 105.03 0.00 09-01-01 - 12-31-03 a 0.00 0.00 0.00 08-31-99 - 08-11-01 0 0.00 0.00 0.00 09-OZ-97 - 08-30-99 0 0.00 0.00 0.00 09-01-91 - 00-31.97 0 0.00 0.00 O,Oa Bail Bond Fee 0 0.00 0.00 0.00 DNA Tosting Fee - Convictions 0 0.00 0.00 0.00 DNA Testing Pea - Comm Supvn 0 0.90 0.00 0,00 DNA Testing Foe - Juvenile 0 0.00 0.00 0.00 EMS Trauma Fund (EMS) 0 0.00 0.06 0.00 Juvenile Probation Diversion Fees 0 0.00 0.00 0.00 Jury Reimbursement Fee 9 34.02 3.40 30.62 Indigent Defenoo Fund 9 17.00 1.70 15.30 Moving Violation Fees 6 0.55 0.05 0.50 State TYaffio Fine 0 0.00 0.00 0.00 Section 11: As Applicable Peace Officer Fees 2 7.50 6.00 1.50 Failure to Appear/Pay Fees 1 30.00 9.90 20.10 Judicial Fund - Coast County Court 0 0.00 0.00 0.00 Judicial Fund - Statutory County Court 0 0.00 0.00 0.00 Motor Carrier weight Violations 0 0.06 0.00 0.00 Time Payment Foss 1 25.00 12,50 12,50 Driving Record Poo 0 0'00 0.00 0.00 Judicial Support Fee 9 51.00 6.10 45.90 Truancy Prevention and Diversion Fund 0 0.00 0.00 0.00 Report Sub Total 52 670,10 543.68 126.42 State Comptroller Civil Fees Report CF, Birth Certifioate Fees 0 0,00 0.00 0.00 CF: Marriage License Fees 0 0.00 0.00 0.00 CF: Declaration of Informal Marriage 0 0.00 0.00 0.00 CP: Nondiacloauro Fees 0 0.00 0.00 0.00 CF; Juror Donations 0 0.00 0.00 0.00 CF: Justice Court Indig Filing Fees 3 18.00 0.90 17,10 CF; Stat Prob Court Indig Filing Fees 0 0.00 0.00 0.00 Cr: Stet Prob Court Judie Filing Fees 0 0.00 0.00 0.00 Cr: Stat Cnty Court Indig Filing Fees 0 0.00 0.00 0.00 CP; Stat Cnty Court Judio Filing Fees 0 0.00 0.00 0.00 CF, Cnat Cnty Court Indig Filing Peas 0 0.00 0.a0 0.00 CF: Cnst Cnty Court Judic Piling Foam 0 0.00 0.00 0.00 CF: Dist Court Divorce & Family Law 0 0.00 0.00 0.00 CF: Dist Court Other Divoroo/Family Law - 0 0.00 0.00 CF: Dist Court Indig Legal Sorvicos 0 0.00 0.00 0.00 0.00 Cr, Judicial Support Fee 0 0.00 0.00 0.00 Report Sub Total 3 10.00 0.90 17.10 Total Due For This Period 55 488,10 544,58 143.52 THE STATE OF TNXAS Before me, the undorbigned authority, this day County 0£ Calhoun County personally appeared Nanoy Pomykal, Juot4CO of the Peace, Precinct Ne 5, Calhoun County, Texas, who being duly sworn, deposes and says that the abov an{ foregoing report is true and correct. witness my hand this -j � day Of A.D. Ju tics o he Peace, Pro inat No Inoue ounCy, Texas Calhoun County Flo odplain Administration 211 South Ann Street, Suite 301 Port Lavaca, TX 77979-4249 Phone: 361-553-4455/Fax: 361-553-4444 e-mail: ladonna.thigpen@calhouncotx.org November 2016 Development Permits New Homes-0 Renovations/Add On-0 Mobile Homes-0 Boat Barns/Storage Buildings/Garages-0 Commercial Buildings-0 Total Fees Collected: $0.00 No construction permits issued for November 2016 Consider and take necessary action to accept cash donation in the amount of $227.00 from unknown donor to the Calhoun County Historical Commission. Commissioner Lyssy made the motion to accept cash donation for $277.00 from unknown donor to the Calhoun County Historical Commission and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 19 of 32 o Susan Riley From: Rhonda Kokena <rhonda.kokena@calhounwtx.org> Sent: Tuesday, November 29, 2016 4:28 PM To: Susan Riley Subject: DONATION ITEM Please put on the next agenda: O0 To be accepted cash donation to the Historical Commission, donator unknown. 1 Thanks. Also, we can put the newly elected officials info on the first agenda of the year for credit cards. RHONDA S. KOKENA Cot"4y Treasurer CaU-w Cowwty Aix II 202 S. Ah St, Sv-4v A Poi+1_avaea, Tray 77979 (361)553-4619 off" (361)553-4614 fax Consider and Take Necessary Action to accept donation to the Magnolia Beach Volunteer Fire Department in the amount of $500 from the Dobbins Foundation. (RG) Commissioner Galvan made the motion to accept donation to the Magnolia Beach Volunteer Fire Department for $500 from the Dobbins Foundation and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 19 of 32 N THE DOBBINS FOUNDATION 7527 East Severn Place Denver, Colorado 80230 303-343-3176 Cris and Elvira B. Dobbins, Founders in 1962 Christopher Dobbins, Past President TRUSTEES Michael Anthony Dobbins, President Christopher Andrew Dobbins, Vice President & Treasurer Julia Elizabeth Dobbins, Secretary Margaret Powell Dobbins Andrea Katherine Badot George Clement Dobbins Jeb Anthony Dobbins November 28, 2015 Calhoun County Commissioners Court 211 South Ann Street, Suite 301 Port Lavaca, TX 77979 Subject: Donation in Support of Magnolia Beach Volunteer Fire Department Dear Commissioners: We are happy to forward you this check from our foundation in the amount of $500.00 made out to the Calhoun County Commissioners Court, earmarked for the purpose of supplementing support for the work of the Magnolia Beach Volunteer Fire Department, which does excellent work in safeguarding our beach communities. We look for the use of these funds to be used at the discretion of the Department. Thanks for your ongoing support of the Department, and we look forward to continuing to support its work in the future. Please send copies of your acknowledgment to us at the address below and to Julia Dobbins at the above address. 01 ;ejgy and Mike Dobbins 0 Peachtree Street, #4-i Atlanta, GA 30308 404 723 8698 mike.dobbins@coa.gatech.edu c. Julia Dobbins Tom Andrews 144%4146161;-o' 1� Consider and take necessary action to accept donations to Calhoun County. N/A Page 20 of 32 Consider and Take Necessary Action to rescind the action taken on agenda item number 16 by Commissioners' Court on November 22"d to declare certain items of property in Precinct #3 as waste and remove from inventory. (NF) Commissioner Lyssy made the motion to declare certain items of property in Precinct #3 as waste and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 21 of 32 From: neil fritsch <neil.fritsch@calhouncotx.org> Sent: Thursday, December 01, 2016 3:46 PM To: Mike Pfeifer; susan riley Cc: candice villarreal; Janie Delgado; Cindy Mueller Subject: Agenda Item 12/08/2016 Judge, Please place the following item on the Commissioner Court agenda for December 08, 2016. " CTNA to rescind the Precinct 3 Waste Disposal agenda Item from previous Commissioner Court meeting on November 22, 2016. " Thank you.. Any questions, please ask. Neil E. Fritsch Commissioner Calhoun County, Precinct 3 24627 State Highway 172 Port Lavaca, Texas 77979 (361) 893-5346- Office (361) 893-5309- Fax neil.fritsch@calhouncotx.org Sent from my iPhone 1 Susan Riley From: Candice Villarreal<candice.villarreal@calhouncotx.org> Sent: Thursday, December 01, 201611:04 AM To: michael. Pfeifer; susan.riley@calhouncotx.org Cc: rleil.fritsch@calhouncotx.org Subject: Rescinding of Agenda Item 16 from Comm Crt 11/22/16 Attachments: Waste Declaration Request Form.pdf Attached is the Waste Declaration Request for agenda item 16 from Commissioners Court on November 22"d and wording for the agenda item to be rescinded. « Consider and take necessary action to rescind the action taken on agenda item number 16 by Commissioners Court on November 22nd to declare certain items of property in Precinct 3 as waste and remove from inventory. Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: Requested By: oo-�tlli Inventory Number Description Serial No. Reason for Waste Declaration 23_� %iL 611 eyyrr C2` or / w� 5 fe u� �sq.b 6 x eras lO 6K IjvLlri r ° "' /g bX Fl.r+ebie G c��`�S rr r a3-oala a - 7 C ror:�te ,1to$ � ct -' Consider and Take Necessary Action to declare certain items of property in the Adult Detention Center as Waste and authorize disposal of same. (See List) (MP) Commissioner Lyssy made the motion to declare certain items of property in the Adult Detention Center as Waste and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 22 of 32 Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: Calhoun County Adult Detention Center Requested By: Tristum Mitchell Il Inventory Number Descriation Serial No. Reason for Waste Declaration Pelco ICS-D0150A 04244-026-3851 Broken/Replaced Pelco ICS-DO150A 04244-026-3851 Broken/Replaced Pelco ICS-DOI50A 04244-026-3851 Broken/Replaced Inmate Uniform B/W Top 18 Total Damaged/Unusable Inmate Uniform B/W Bot 33 Total Damaged/Unusable Inmate Uniform G/W Top 46 Total Damaged/Unusable Inmate Uniform G/W Bot 46 Total Damaged/Unusable Inmate Uniform R/W Top 33 Total Damaged/Unusable Inmate Uniform R/W Bot 24 Total Damaged/Unusable Inmate Uniform Yel Top 35 Total Damaged/Unusable Inmate Uniform Yel Bot 34 Total Damaged/Unusable 1 R/W Inmate Jumper Damaged/Unifsable 5-1a-ola'2 Dell Vos4ro a,b a"aok iJ A lbroKew /Ao41- worKt Consider and Take Necessary Action to declare certain items of property in the Adult Detention Center as Surplus/Salvage and remove from Inventory. (See List) (MP) Commissioner Galvan made the motion to declare certain items of property in the Adult Detention Center as Surplus/Salvage and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 23 of 32 Calhoun County, Texas SURPLUS/SALVAGE DECLARATION REQUEST FORM Department Name: Calhoun County Requested By: Tristum Mitchell Inventory Number Description Serial No. Aention Center Reason for Surplus/Salvage Declaration 512-0108 Camera Set (2) with 30 User Licenses N/A Only 1 Camera in possession when new admin took office and not working, User licenses are for Golden Eagle 512-0104 Intel Based Dual Core P4 System D955 N/A Not In Possession when New Administration took office 512-0102 Intel Based Dual Core P4 System D955 N/A Not In Possession when New Administration took office 512-0103 Intel Based Dual Core P4 System D955 N/A Not In Possession when New Administration took office 512-0105 Intel Based Dual Core P4 System D955 N/A Not In Possession when New Administration took office 512-0118 Computer - Intel D946GZL Intel Pentium D4 N/A Not In Possession when New Administration took office 512-0120 Medical Computer System Intel D945MB Intel P4 N/A Not In Possession when New Administration took office 512-0115 Intel D101MB Intel P4 531+ Processor N/A Not In Possession when New Administration took office 512-0122 Dell Vostro 1310 Notebook N/A Not In Possession when New Administration took office 512-0138 Topseller X200 Tablet N/A Not In Possession when New Administration took office 512-0117 TM20 Ethernet Barcode Reader Time Clock N/A Not In Possession when New Administration took office 512-0137 DD4TC16 Pelco Spectra IV 16X Color Dome Drive N/A Replaced Consider and Take Necessary Action to declare certain items of property in the Narcotics Department as Surplus Salvage and remove from Inventory. (See List) (MP) Judge Pfiefer made the motion to declare certain items of property in the Narcotics Department as Surplus/Salvage and Commissioner Lyssy seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 24 of 32 M 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: REMOVE ITEMS FROM PROPERTY LIST DATE: DECEMBER 8, 2016 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR SEPTEMBER 22, 2016 To acknowledge the & remove items from property list of the Calhoun County Narcotics Department. The following items have not been in our inventory since Sheriff Aleman took office. See attached list Sincerely, George Aleman Calhoun County Sheriff IMM 0 � � � � 66d � LAJ Go* Go* � 661 X � . 0 IL § \ @� ■ ` � � & � _ ow § \ 0\ k ( ) ,: & j !a/ }� § ) ) \ § { \ \ / � � Consider and take necessary action on the matter of declaring certain items of County property as surplus/salvage. N/A Page 25 of 32 Consider and take necessary action on matter of transferring certain items of County property from one County department to another County Department. (See List) N/A Page 26 of 32 Approval of payroll. Commissioner Lyssy made the motion to approve November payroll and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 27 of 32 t 1l CALHOUN COUNTY PAYROLL 2016 MONTH/OCTOBER Payroll through 10-07-2016 $ 251,376.75 Payroll through 10-31-2016 $ 257,812.45 APPROVED TOTAL PAYROLL $ 5099189.20 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 !tWhx above is true and correct to the best of my knowledge November 30, 2016. N::m RHO14DA S. KOKENA, DEC u ii 2016 CALHOUN COUNTY TREASURER ACCEPTED AND APPROVED THIS THE DAY OF �a)O C , 2016 IN THE CALHOUN COUNTY COMMISSIONERS' COURT, PORT LAVACA, TEXAS 77979. CALHOUN COUNTY PAYROLL 2016 MONTH/NOVEMBER Payroll through 11-04-2016 $ 254,280.57 Payroll through 11-30-2016 $ 271,887.50 APPROVED TOTAL PAYROLL $ 526.168.07 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 tha & bove is true and correct to the best of my knowledge November 30, 2016. r RHONDA S. KOKENA, CALHOUN COUNTY TREASURER D� C u b 2016 k-,ALH0Ui\i GOUi T'y ACCEPTED AND APPROVED THIS THE _ DAY OF 2016 IN THE CALHOUN COUNTY OMMISSIONERS' COURT, PORT LAVACA, TEXAS 77979. Consider and take action on any necessary budget adjustments. Commissioner Lyssy made the motion to approve necessary budget adjustments and Commissioner Galvan seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. 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Page 29 of 32 Susan Riley 31 From: Tristum Mitchell<tristum.mitchell@calhouncotx.org> Sent: Monday, November 28, 2016 12:41 PM To: susan riley Cc: michelle velasquez Subject: Approval through Comm Court Attachments: 3 3rd Eyes_Vt.pdf, Calhoun Co SO ST101.docx; Calhoun County Jail Pelco PTZ Controller Price Revised 2.pdf Susan, I'm attaching 3 quotes that we would like to have placed on the next commissioners court agenda for approval. If you have any questions please feel free to contact me. Tristum Mitchell Assistant Jail Administrator Tristum.Mitchel I(c caIhouncotx.arg Calhoun County Adult Detention Center 302 W. Live Oak St. Port Lavaca, Tx 77979 0 : (361) 553-4482 F : (361) 553-4480 CONFIDENTIALITY NOTICE: The information contained in this transmission may be strictly confidential. If you are ® = _ �® ®® VCS SECURITY SYSTEMS 302 Kerh Blvd. Victoria, TX, 77904 (361) 575-1528 Fax (361) 570-1298 _corn darV1.stirnsonP_vcscompaaies Name: email: Address: City/State/Zip: Telephone: Proposal for Calhoun County Jail 302 W. Live Oak Port Lavaca, TX 77979 361-553-4481 Michelle Velasquez Date: CAMERA SYSTEM PROPOSAL Valid 30 Days 11/23/2016 ITEM QTY. MODEL AND DESCRIPTION UNIT PRICE EXTENDED PRICE 1 3 Pelco CM9760-KBD-IJS White Keyboard $1,611.42 $4,834.27 2 4 WBOX 22" LED Monitor W/ HDMI, BNC, & $216.00 $864.00 3 VGA inputs 4 5 6 7 8 9 10 11 12 13 14 15 EQUIPMENT TOTAL: INSTALLATION: SUB -TOTAL: $5,698.27 $0.00 $5,698.27 System Installation: This price is for equipment ONLY. EXEMPT TAX: GRAND TOTAL: $5,698.27 Special 1 time pricing. Terms: Balance due upon completion Prepared by: Date: Daryl Stimson 11 /23/2016 Accepted by: VCS Security Systems (Customer Signature) (Date) Pricing is VCS Security Systems confidential and proprietary. 23020 Mlles Road Bedford Heights, OH 44218 Phone: 216-780-1413 Fax:216-663-9289 Email: info@stuntronics.com Sales Person: R. Salev Quote DATE 11/23/2016 CUSTOMER: SHIP TO: Calhoun County Sheriff's Office Attn: Tristum Mitchell 361-553-4482 Part # Item / Service ST101 Band -it System Includes: 1 Stun Pack w/ Rechargable Battery, 1 Transmitter & Pouch, Battery Charger, 2 Keys, 3 Carriers, 2 Year Warranty (electronics only) Thank you for choosing StunTronicsl Unit Price Quantity Total $995.00 1 $995.( Sub Total $995.( Shiping $20.( Tax Total www.stuntronics.com IVOL COX Wolfcom Enterprises 5910 W. Sunset Blvd. Hollywood, CA 90028 Phone: 323-962-1061 Fax: 323-962-1068 Bill To Name Calhoun County Adult Detention Center Bill To 302 West Live Oak St. Port Lavaca, Texas 77979 United States WOLFCOM 3rd Eye Camera Approved by: Signature: Date Quote Number 00000859 Prepared By Robert Harris Created Date 1112212016 Expiration Date 12/612016 Ship To Name Calhoun County Adult Detention Center $475.00 Subtotal Discount Tax Shipping and Handling Grand Total $475.0011 3.00 $1,425.00 0.00% $0.00 $29.00 $1,454.00 $1,425.00 12/8/2016 Sheritt: Pre -approval Listing Commissioner's Court Meeting Date i Y Vendor Description Amount SOUTHERN SOFTWARE INC RIMS ANNUAL RENEWAL FEE $ 5,203.00 SOUTHERN SOFTWARE INC CAD SOFTWARE RENEWAL FEE $ 7,545.00 CODEX CORP EXTENDED LIFE BATTERIES $ 10,615.00 SOUTHERN SOFTWARE INC RENEWAL SUPPORT FEE $ 5,880.00 CORNERTONE SERVICE & SUPPLY REPAIR FOR VIOLENT CELL $ 5,372.40 VCS SECURITY SYSTEMS INC NEW JAILER RADIOS & BATTERIES $ 3,447.25 WOLFCOM ENTERPRISES BODY CAM $ 1,454.00 VCS SECURITY SYSTEMS INC CAMERA CONTROLLERS & MONITORS $ 5,698.27 SUN TRONICS LLC STUN PACK WITH BATTERY $ 1,015.00 TASER INTERNATIONAL TASER BATTERY PACKS $ 951.42 Total $ 47,181.34 December 8th, 2016 2016 APPROVAL LIST - 2016 BUDGET COMMISSIONERS COURT MEETING OF 12/08/16 Commissioner Roger Galvan Road & Bridge #1 CLEVELAND ASPHALT PRODUCTS ASPHALT EMULSION & CUTBACK $ 13,274.69 DIEBEL OIL CO INC 504 GAL OF GAS & 709 GAL DIESEL $ 2,587.79 G&W PROFESSIONAL SERVICES FOR 10/03-10/30 $ 1,350.00 I Subtotal: $ 17,212.48 Commissioner Neil Fritsch`, Road & Bridge #3 DIEBEL OIL CO INC 290 GAL UNLEADED FUEL & 400 GAL DIESEL $ 1,400.00 QUALITY HOT MIX INC 26.92 TONS HOT MIX COLD $ 2,261.28 ISubtotal: $ 3,661.28 Sheriff George Aleman Jail & Sheriff's Department BEN E KEITH FOODS INMATE GROCERIES & KITCHEN LABELS $ 6,309.75 CODEX CORP RENEWAL FEE $ 3,854.00 HILL COUNTRY DAIRIES MILK $ 670.14 QUILL CORP MISC OFFICE SUPPLIES $ 817.26 JIMMY RAMIREZ ELECTRICAL WORK FOR FIRE STATION $ 4,094.00 FIRESTONE OF PORT LAVACA OIL CHANGES & NEW TIRES $ 3,188.58 SINGLETERRY BRUCE A OIL CHANGES & REPLACE BRAKES $ 1,238.76 SOUTHERN HEALTH PARTNERS DEC BASE PAY FOR INMATE MEDICAL $ 10,350.75 WOLFCOM ENTERPRISES EMS ANNUAL SERVICE MAINTENANCE $ 720.00 Subtotal: $ 31,243.24 Total Vendor Disbursements: $ 52,117.00 j December 8th, 2016 2016 APPROVAL, LIST - 2016 BUDGET CCiMMISSI®IOERS COURT MEETING ®I. 12/08/16 Commissioner Roger Galvan Road & Bridge #1 CLEVELAND ASPHALT PRODUCTS ASPHALT EMULSION & CUTBACK $ 13,274.69 DIEBEL OIL CO INC 504 GAL OF GAS & 709 GAL DIESEL $ 2,587.79 G&W PROFESSIONAL SERVICES FOR 10/03-10/30 $ 1,350.00 JIMMY RAMIREZ FOR ELECTRICAL WORK AT MAG BEACH VFD $ 4,094.00 Subtotal: $ 21,306.48� Commissioner Neil Fritsch Road & Bridge #3 j DIEBEL OIL CO INC 290 GAL UNLEADED FUEL & 400 GAL DIESEL $ 1,400.00 QUALITY HOT MIX INC 26.92 TONS HOT MIX COLD $ 2,261.28 Subtotal: $ 3,661.28 Sheriff George Aleman Jail & Sheriff's Department BEN E KEITH FOODS INMATE GROCERIES & KITCHEN LABELS $ 6,309.75 CODEX CORP RENEWAL FEE $ 3,854.00 HILL COUNTRY DAIRIES MILK $ 670.14 QUILL CORP MISC OFFICE SUPPLIES $ 817.26 SOUTHERN HEALTH PARTNERS DEC PAY FOR INMATE MEDICAL $ 10,350.75 SINGLETERRY BRUCE A OIL CHANGES & REPLACE BRAKES $ 1,238.76 FIRESTONE OF PORT LAVACA OIL CHANGES & NEW TIRES $ 3,188.58 WOLFCOM ENTERPRISES EMS ANNUALSERVICE MAINTENEANCE $ 720.00 Subtotal: $ 27,149.24 Total Vendor Disbursements: $ 52,117.00'' Approval of bills. Commissioner Lyssy made the motion to pay bills dated 12/8/2016 and Commissioner Finster seconded that motion. Commissioner Lyssy made the motion to pay Commissioner Galvan Road & Bridge #1 and Commissioner Finster seconded that motion. Commissioner Lyssy made the motion to pay Commissioner Fritsch Road & Bridge #3 and Commissioner Finster seconded that motion. Commissioner Lyssy made the motion to pay Sheriff George Aleman Jail & Sheriffs Department and Commissioner Finster seconded that motion. Commissioners Galvan, Lyssy, Finster and Judge Pfeifer all voted in favor. Page 30 of 32 December 8, 2016 2016 APPROVAL LIST- 2016 BUDGET COURT MERTING OF 12/08/16 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 94 FICA P/R $ MEDICARE P/R $ FWH P/R $ NATIONWIDE RETIREMENT SOLUTIONS P/R $ OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT P/R $ AT&T MOBILITY A/P $ CALHOUN COUNTY NAVIGATION DISTRICT A/P $ CENTERPOINT ENERGY A/P $ CITY OF PORT LAVACA AT $ CSI A/P $ FRONTIER COMMUNICATIONS A/P $ MCI MEGA PREFERRED A/P $ PORT O'CONNER IMPROVEMENT A/P $ REPUBLIC SERVICES #847 A/P $ VICTORIA ELECTRIC CO-OP A/P $ WASTE MANAGEMENT A/P $ WCID#I A/P $ 95 $243,677.88 42,377.78 10,087.12 36,062.91 2,737.98 1,401.24 1,646.78 329.06 75.15 470.12 2,876.00 757.16 259.85 377.98 68.20 89.96 1,072.56 11.47 TOTAL VENDOR DISBURSEMENTS: $ 344,379.20 TOTAL TRANSFERS BETWEEN FUNDS: $ - TOTAL AMOUNT FOR APPROVAL: $ 344,379.20 P is 0 0 O b C7 ' N a. 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OF OE. 00F 000 po z ° ° ° U w 4� 0 z F z z z z z z z a a w a w a w w w w w F A A A Ca Q n n n Ll 0. a z 0z z oz zo zo zo zo z° A ( ) 43 \) \ \ ) \ \ 2 / ! 2 2 § 6: (\ }\ ©a } / ( \ j \ \ \ a Q ! 2 2 2 0 0 0 v U a N V O M N V O M P q F U O 0 a o N y P W U � OH m U q 0 ,4 vq . ryry F 9P w b 0 U ri p N O O ryu F F W a � c7 q a ci N P O Q � F F F p!^ A \ Q Q °z Q zz A d U o rn O N O O � N N A Q F rl Vw] Q O b N [-! � r � •-• a a> i4 b b a d� L� d¢ cS � cS� QHo QHu Qw� U�D �u uwo H V a V V v�aw U� V V F Uda V O b � C i b U o b 0 0 a Fl vMi a\ � � z H � �a"wx o a V7 OU ¢ W x 04PA o z� cagyl O o O C V U F CP . N OO � b r] d C �l C7 O b b b b b b b b O � z V Q w w x � as Ewa o aQ�a a � � q � H F A A Q Q Q Q Q Q Q N v O O O O O O O O O n Q z z z z z z z z z a Q Consider and take necessary action on single source, emergency and public welfare purchases and bills. N/A Page 31 of 32 Public discussion of County matters. Judge Pfiefer reminded everyone of the swearing in. Meeting Adjourned at 10:39 AM Page 32 of 32