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2020-09-23 CC PACKETers court —September 23,2020 COMMISSIONERS' COURT REGULAR 2020 TERM SEPTEMBER 23, 2020 BE IT REMEMBERED THAT ON SEPTEMBER 23, 2020, THERE WAS BEGUN AND HOLDEN A REGULAR TERM OF COMMISSIONERS' COURT. 1. CALL TO ORDER This meeting was called to order at 10:00 A.M by Judge Richard Meyer. 2. ROLL CALL THE FOLLOWING MEMBERS WERE PRESENT: Richard Meyer David Hall Vern Lyssy Clyde Syma Gary Reese Anna Goodman Catherine Sullivan County Judge Commissioner, Precinct #1 Commissioner, Precinct #2 Commissioner, Precinct #3 Commissioner, Precinct #4 County Clerk Deputy County Clerk 3. INVOCATION & PLEDGE OF ALLEGIANCE (AGENDA ITEM NO. 2 & 3 Invocation — Commissioner David Hall ) Pledge to US Flag & Texas Flag — Commissioner Gary Reese/Vern Lyssy Page 1 of 7 (2rs court - September 23, 2020 4, General Discussion of Public matters and Public Participation. 5. Hear a presentation from Wendy Cabrera regarding the United Way, Pass 6. CONSIDER AND TAKE NECESSARY ACTION To accept the donation of a pergola constructed as a BOY y Scouts Eagle Scout Project completed by Cade Query in the total amount of $3,792.36. Cade Query addressed the court as well as Luis DeLaGarza (Cub Scout Leader) RESULT. APPROVED MOVER: David Hall, CommissioMOPct I SECONDER: Vern L ss y AYES; Judge Meyer, Commis onerr Hall L ss Y Y, Syma, Reese 7• (AGENDA ITEM NO. 6) Approve the minutes of the September 9, 2020 meeting. RESULT: APPROVED MOVER: Vern L ss [UNANIMOUS] SECONDER: Gary Reese Comm ss oner Pct 4 AYES: Judge Meyer, Commissioner Hall L ss Y y, Syma, Reese Page 2 of 7 "" lu I lu I s I-ourt—September 23, 2020 8. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 7) On a Tax Abatement Agreement between Calhoun County, Texas and Formosa Plastics Corporation, Texas. (RM Motion made to table item until the 10/14/20 Regular Meeting. RESULT. APPROVED MOVER: David Hall, Commissioners Pctt]1 SECONDER. AYES: earl' Reese, Commissioner Pct 4 Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese 9. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 8) To abandon a portion of a public road located in Alamo Beach Townsite, Calhoun County, Texas. (DH) Anne Marie Ode fey addressed the court. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, , L Yss Y, Syma, Reese 10. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 9) On the attached Surplus/Salvage Form utilizing listed items to be used as trade in. (DH) RESULT: APPROVED MOVER: David Hall, SECONDER: CommisNoMOpS7ct 1 Vern L ss AYES: Judge Meyer, Commsss onerr Hall L ss Y y, Syma, Reese Page 3 of 7 11. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 10) On an agreement for donation of labor, equipment, or materials and liability waiver for Brendan Road in Calhoun County by Philip Gonzales in the amount of $7,000 and authorize the County Judge to sign. (DH) RESULT. APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese 12. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 11) To award the bids for the 2020 Calhoun County Boating Access Improvements (Magnolia Beach Boat Ramp Improvements and Six Mile Park Boat Ramp Improvements) and authorize the County Judge to sign all contracts and necessary documents. (DH) Scott Mason (G&W Engineering) will prepare 2 separate contracts. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese 13. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 13) To pre -approve expenditures by Incumbent County or Precinct Officer(s) under Calhoun County's Policy of Compliance with LGC 130.908. (RM) Crossroads Tire $10,000 Estimate on service repairs on Unit #308 2012 Dump Truck International 4300 7.6 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese Page 4 of 7 14. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 14) To authorize the Calhoun County Sheriff's Office to enter into an agree- ment with an MOU with AFT (Alcohol, Tobacco, Firearms) to reimburse overtime of up to $2,000.00 annually for ATF approved cases. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese 15. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 15) On the preliminary plat for Smalley RV Park. (VL) Mark & Enrica Smalley presented the preliminary plat. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese 16. Enter 2020 Annual Road Reports into Official Records and authorize the County Judge to send reports and letter to the 2020 Grand Jury. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese Page 5 of 7 17. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 17) To approve the attached Waste Declaration forms from Memorial Medical Center and authorize the disposal of listed items. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese 18. Accept report from the following County Office: 1. County Clerk — August 2020 2. Justice of the Peace, Precinct 3 — August 2020 RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese 19. Consider and take necessary action on any necessary budget adjustments. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese Page 6 of 7 20. Approval of bills and payroll. MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese Indigent RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese Adjourned: _10:26 a.m._ Page 7 of 7 All Agenda Items Properly Numbered -k5 �Aa • p, 4",TV tea. k _ Contracts Completed and Signed 4:7-r-��-Ec� �� — All 1295's Flagged for Acceptance -fir. l I (number of 1295's ✓All Documents for Clerk Signature Flagged met `� °" `"" 4-1 On this 1441 day of 0-t-�4✓ 2020 a complete and accurate packs for e,� Day 2020 Commissioners Court Regular Session Day Md nth was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Calhoun County Judge/Assistant At :3 I FILED OCT 0 12020 COMMISSIONERSCOURTCHECKLIST FORMS BY: A A i;ot'Cirygiq CPU TY CLER , CALu,SUN COUNTY TEXAS R-PUry AGENDA OCLO CK J-UCK6 M SEP 18 2020 Richard gee Meyer ANNA GOODMAN COU TY ERK, CAL OUN COUNTY, TEXAS®unty judge BY DEPU avid Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Clyde Syma, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Com missioners' Court of Calhoun County, Texas will meet on Wednesday, September 23, 2020 at 10:00 a.m. in the Connmissioners' Courtroonn in the County Courthouse at 211 S. Ann Street, Smite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: 1. Call meeting to order. 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. 5. Hear a presentation from Wendy Cabrera regarding the United Way. 6. Approve the minutes of the September 9, 2020 meeting. 7. Consider and take necessary action on a Tax Abatement Agreement between Calhoun County, Texas and Formosa Plastics Corporation, Texas. (RM) 8. Consider and take necessary action to abandon a portion of a public road located in Alamo Beach Townsite, Calhoun County, Texas. (DH) 9. Consider and take necessary action on the attached Surplus/Salvage Form utilizing listed items to be used as trade in. (DH) 10. Consider and take necessary action on an agreement for donation of labor, equipment, or materials and liability waiver for Brendan Road in Calhoun County by Philip Gonzales in the amount of $7,000 and authorize the County Judge to sign. (DH) Page 1 of 2 I IN I KUL UL IVILL I INCH — `J/L3/LULU 11. Consider and take necessary action to award the bids for the 2020 Calhoun County Boating Access Improvements (Magnolia Beach Boat Ramp Improvements and Six Mile Park Boat Ramp Improvements) and authorize the County Judge to sign all contracts and necessary documents. (DH) 12. Consider and take necessary action to accept the donation of a pergola constructed as a Boy Scouts Eagle Scout Project completed by Cade Query in the total amount of $4,305.83. (DH) 13. Consider and take necessary action to pre -approve expenditures by incumbent County or Precinct Officer(s) under Calhoun County's Policy of Compliance with LGC 130.908. (RM) Crossroads Tire $10,000 Estimate on service repairs on Unit #308 2012 Dump Truck International 4300 7.6 14. Consider and take necessary action to authorize the Calhoun County Sheriff's Office to enter into an agreement with an MOU with AFT (Alcohol, Tobacco, Firearms) to reimburse overtime of up to $2,000.00 annually for ATF approved cases. (RM) 15. Consider and take necessary action on the preliminary plat for Smalley RV Park. (VL) 16. Enter 2020 Annual Road Reports into Official Records and authorize the County Judge to send reports and letter to the 2020 Grand Jury. (RM) 17. Consider and take necessary to approve the attached Waste Declaration forms from Memorial Medical Center and authorize the disposal of listed items. (RM) 18. Accept report from the following County Office: i. County Clerk — August 2020 ii. Justice of the Peace, Precinct 3 — August 2020 19. Consider and take necessary action on any necessary budget adjustments. (RM) 20. Approval of bills and payroll. (RM) --i Richard Meyer, County) Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.or¢ under "Commissioners' Court Agenda' for any official court postings. Page 2 of 2 #5 Ere Richard H. Meyer County judge David Hall, Commissioner, Precinct I Vern ]Lyssy, Commissioner, Precinct 2 Clyde Symsa, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas stet on Wednesday, September 9, 2020, at 10:00 a.m. in the Commissioners' Courtrooms in the County Courthouse at 211 S. Ann Street, Suite 104, Port ]Lavaca, Calhoun County, Texas. Attached are the true and correct minutes of the above referenced meeting. Richard Meyer, Co n Judge Calhoun County, as Anna Goodman, County Clerk Page 1 of i Commissioners' Court —September 09, 2020 A 1 1111;�• - 11:: ; i LE I REGULAR 2020 TERM § SEPTEMBER 09, 2020 BE IT REMEMBERED THAT ON SEPTEMBER 09, 2020, THERE WAS BEGUN AND HOLDEN A REGULAR TERM OF COMMISSIONERS' COURT. 1. CALL TO ORDER This meeting was called to order at 10:00 A.M by Judge Richard Meyer. 2. ROLL CALL THE FOLLOWING MEMBERS WERE PRESENT: Richard Meyer County Judge David Hall Commissioner, Precinct #1 - Absent Vern Lyssy Commissioner, Precinct #2 Clyde Syma Commissioner, Precinct #3 Gary Reese Commissioner, Precinct #4 Anna Goodman County Clerk Catherine Sullivan Deputy County Clerk 3. INVOCATION & PLEDGE OF ALLEGIANCE (AGENDA ITEM NO.2 & 3) Invocation — Commissioner Clyde Syma Pledge to US Flag & Texas Flag — Commissioner Gary Reese/Vern Lyssy Page 1 of 10 Commissioners' Court —September 09, 2020 4. General Discussion of Public matters and Public Participation. N/A S. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO.5) To authorize Ron Langford of Veteran Services to apply for a grant from Texas Veterans Commission for transportation funds for county veterans to travel to scheduled medical appointments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 6. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 6) To authorize Greg Baker, TAMU Extension Agent, to apply for a County Feral Hog Grant. 7. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 7) To change the November 11, 2020 regular session meeting to November 9, 2020 in observance of Veteran's Day. (RM) Motion made to move to November 10, 2020 to accommodate Treasurer's Office reporting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese Page 2 of 10 Commissioners' Court -September 09, 2020 8. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 8) To update the county Return to work Test. (RM) Pol�owin_a - p051tive C_ O_Vip 19 Erin Clevenger of MMC Medical spoke on this matter. No action taken. 9. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM N0.9) On an Order from the District Judges setting salaries of the County Auditor Assistants for fiscal year 2021 and approving the number the Auditor's office for fiscal year 2021. (RM) of assistants for RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 10. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO.10) To approve an Order Prohibiting Outdoor Burning. (RM) 11. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO, 11 To waive participation in the Deferral of Withholding, Deposit, and Payment Of certain payroll taxes in response to COVID-19. (RM) Motion made to waive part RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER. Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese Page 3 of 1 o Commissioners' Court —September 09, 2020 12. CONSIER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 12) To award the bid for the lease of the Langdon Tract, 60 acres farming that is solely for planting, raising and harvesting row crops and for no other purpose and authorize the ' or dry land and any necessaryThe County Judge n sign the lease agreement end August 31, 203 with the Option �neillNbegm November 1, 2020 and terms upon Commissioners' Court a or multiple three PProval. (RM) (3) Year Kyle Malaer was awarded the lease. RESULT: APPROVED[UNANIMOUS] MOVER: Vern L ss SECONDER: AYES: Clyde Sym , Commllssfoner Pct 3 Judge Meyer, COmmissloner L ss Y Y, Syma, Reese 13. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM N0.13) To award the bid for the lease of the Event Center Premises,194.16 acres, for dry land farming that is solely for planting, raisin crops and for no other purpose and authorize the CountyJudge to sign the lease agreement and any necessary9, and harvesting row 1, 2020 and end August 31, 2023 ithothe opt on to renew will r multiple three (3) y�,r � begin October terms upon Commissioners' Court approval, (RM) Cody Malaer awarded pending increasing insurance to limits of 100/300/100. County required RESULT: MOVER. APPROVED (UNANIMOUS] SECONDER: Vern L ss Y Y, Commissioner Pct 2 Gary Reese, AYES: Commissioner Pct 4 Judge Meyer, Commissioner Hall, Lyssy, Syma, Reese Page 4 of 1 o Commissioners' Court —September 09, 2020 14. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO.14) To accept payment in the amount of $39,673.52 from the City of Seadrift for road work and place said funds in Precinct 4 Road & Bridge account S70-53510 — Road & Bridge Supplies. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Vern Lyssy, Commissioner Pct2 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 15. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 15) To authorize Commissioner Reese to apply for a Texas Parks & Wildlife Local Parks Non -Urban Recreation Grant for the Bill Sanders Memorial Park at Swan Point and sign all documentation. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 16. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 16) To authorize Commissioner Reese to contract with Smartt Grant Services to write the Texas Parks & Wildlife Local Parks Non -Urban Recreation Grant for the Bill Sanders Memorial Park at Swan Point. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese Page 5 of 10 Commissioners' Court —September 09, 2020 17. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO.17) To approve the Preliminary Plat of Live Oak Bayou, Lot 1R. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 18. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 18) To approve the Final Plat of Live Oak Bayou, Lot 1R. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 19. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 19) To authorize Commissioner Vern Lyssy to apply for and act on behalf of Calhoun County Airport and sign the Texas Department of Transportation CARES Act Airport Grant Agreement. (VL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese Page 6 of 10 commissioners' Court —September 09,2020 20. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 20) To place proceeds from GovPlanet Auction in the amount of $12,665.00 into the 2020 Capital Outlay — Precinct 2 account (1000-550-70850). (VL) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 21. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 21) To accept a General Warranty Deed in reference to gifting to Calhoun County Lot Eight (8), Block One Hundred Forty Eight (148), Unit No. Two (2) of Bayside Beach a Subdivision according to the plat thereof recorded in the Map and Plat Records of Calhoun County, Texas valued at approximately $100.00. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 22. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 22) On the Victoria Electric Cooperative Electric Service Data Form in regards to electrical service for Magnolia Beach Fire Building CDBG-DR project, and authorize Commissioner Hall to sign. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese Page 7 of 10 Commissioners' Court —September 09, 2020 23. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 23) To accept a donation to the Calhoun County Sheriff's Office from Law Enforcement Magnets in the amount of $700.00 to be deposited Into the Motivation Account— 2697-679. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 24. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 24) To accept a donation to the Calhoun County Sheriff's office from Jesse Cortez, Jr. in the amount of $25.00 to be deposited into the LE Supplies account — 760-53430. (RM) Must be placed in the donations fund per Auditor. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 25. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 25) To accept a donation of $5,000 to the Calhoun County Museum in memory of Curtis M. Foester, Jr. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese Page 8 of 10 Commissioners' Court —September 09, 2020 26. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 26) To pre -approve expenditures by incumbent County or Precinct Officer(s) under Calhoun County's Policy of Compliance with LGC 130.908. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vem Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 27. Accept reports from the following County Offices: 1. Flood Plain Administration — August 2020 2. Justice of the Peace, Pct 1— Aug. 2020; Pct 2 — Aug. 2020; Pct 4 — Aug. 2020; Pct 5 — Aug. 2020 3. Sheriff's Office —August 2020 RESULT: APPROVED [UNANIMOUS] MOVER: Vem Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese 28. Consider and take necessary action on any necessary budget adjustments. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese Page 9 of 10 commissioners' Court —September 09,2020 29, Approval of bills and payroll. MMC RESULT: APPROVED[UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Clyde Syma, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Lyssy, Syma, Reese County RESULT: MOVER: SECONDER: AYES: APPROVED [UNANIMOUS] Gary Reese, Commissioner Pct 4 Clyde Syma, Commissioner Pct 3 Judge Meyer, Commissioner Lyssy, Syma, Reese Adjourned: 10.35 a.m. Page 10 of 10 #7 STATE OF TEXAS § COUNTY OF CALHOUN § KNOW ALL MEN BY THESE PRESENTS: § NOTICE OF INTENT TO ABANDON A PORTION OF PUBLIC ROAD IN ALAMO BEACH, CALHOUN COUNTY, TEXAS Attached is a petition to abandon a portion of a public road located in Alamo Beach, Calhoun County, Texas, which application is intended to be filed with the Calhoun County Commissioner's Court and heard by the Commissioner's Court upon expiration of twenty days after August A, 2020, being the date that this Notice of Intent is posted at the following locations: on the portion of the public r1pad to be abandoned, at the Indianola Fishing Center, and the Courthouse door in CalhoA Coputy, Texas, Ann ie Ode A rn for Hemnau and Fay Ramdass P, ox 9 Port Lavaca, Texas 77979 (361) 552-2971 STATE OF TEXAS § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF CALHOUN 6 APPLICATION AND PETITION TO ABANDON A PORTION OF A PUBLIC ROAD TO THE HONORABLE COMMISSIONER'S COURT OF CALHOUN COUNTY: NOW COMES, Hemnauth and Fay Ramdass, being the owners of Lots Three (3), Twelve (12) and Thirteen (13), Block Four (4), Alamo Beach Townsite, Calhoun County, Texas, according to the plat of said subdivision or record in Volume Z, Page 13, Plat Records of Calhoun County, Texas, hereby petitions Commissioner's Court to abandon the following portion of a certain designated public road in said county pursuant to Texas Transportation Code Section 251.051, to -wit: BEING a 0.046 acre tract of land situated in Calhoun County, Texas being a portion of a 20-foot Ally out of Block 4 in the Alamo Beach Townsite, according to the established map or plat thereof as recorded in Volume V, Page 01, of the Deed Records, Calhoun County, Texas and Volume Z, Page 13, of the Plat Records, Calhoun County, Texas, said 0.646 acre tract of land being more fully described by metes and bounds on Exhibit "A" attached hereto. In support hereof, the undersigned party, Hemnauth and Fay Ramdass, being the owners of Lots Three (3), Twelve (12) and Thirteen (13), Block Four (4), Alamo Beach Townsite, Calhoun County, Texas, according to the plat of said subdivision or record in Volume Z, Page 13, Plat Records of Calhoun County, Texas, will show the Court that: a. There are no other property owners in said precinct whose property rights will be affected by the abandonment of the above described portion of said road; b. The county has never opened or maintained said portion of said road; c. Texas Transportation Code Section 251.051 and Section 251.052 provide that a county may alter an existing roadway; and d. There are no adjoining landowners. WHEREFORE, the. undersigned party( Hemnauth and Fay Ramdass, being the owners of Lots Three (3), Twelve (12) and Thirteen (13), Block Four (4), Alamo Beach Townsite, Calhoun County, Texas, according to the plat of said subdivision or record in Volume Z, Page 13, Plat Records of Calhoun County, Texas, pray that after proper notice of this petition to abandon the following portion of a certain roadway in said county pursuant to Texas Transportation Code Section 251.051 & Section 251.052 has been posted at the Courthouse door of Calhoun County, Texas and at other places in the vicinity of the affected route and on the site of the portion ofthe road to be abandoned as required by law, that this Honorable Commissioner's Court enter an order abandoning that portion of the road described above, to the Applicants pursuant to Texas Transportation Code Section 251.051 & Section 251.052. WITNESS OUR HANDS, this � day of August, 2020. H naut6 Ramd ss Fay Ram s STATE OF TEXAS § COUNTY OF ^ t� § This instrument was sworn to and acknowledged before me on this the 2L day of August, 2020, by Hemnauth Ramdass and Fay Ramdass. EM RIkSe of Teems-2420213�6 Notary Public, State of T�ca, THE STATE OF TEXAS) 0.046 ACRES 11 COUNTY OF CALHOUNj BEING a 0.046 acre tract of land situated in Calhoun Coun In the Alamo Beach TownsRe, according to the established the Deed tY. Texas being a portion of a 20-fool Ally out of Block 4 the D acre tract of land County, Texas and volumemet or Plat thereof as recorded Volume V, nd being more fully described b Z, Page d3 u the Plat Records, Calhoun Coun Page , s of BEGINNING Y metes and bounds as follows; N, Texas, said line of a 20. at a found S/8" steel rebar with yellow plastic cap �, foot Alley marking a common corner betty p stamped URBAN SURVEYING, northeast corner of the herein describe tract; between Lots 3 & 4 RVamo B INC," along the Block q, of said Alamo Beach g north THENCE, South D2' ' �� h TownsRe for the 4710 East, over and across said U foot Alley, a distance of 20.00 (20,00) feet to a sound 5/8" steel rebar with yellow plastic cap stamped TURBAN SURVEYING, INC" & 12, Block 4 of said Alamo Beach Townsite, for the southeast corner of the hereto described tract; marking a common corner between Lots li THENCE, South 87'12'SO" West along the south line of said 20•fot Alley, Block 4 of said Alamo Beach TownsRe, a distance of 100.00 (100.00) feet to a found north Plastic cap stamped "URBAN SURVEYING, INC.- with the north lines of Lots 12 & 13, / steel rebar with yellow THENCE, North 02'g7'10n yyest over and across said 20-foot Alley, a distance of 20.00 feet to a found 5 8" steel rebar with yellow plastic cap stamped "URBAN SURVEYING, INC." Block 4 of Bald Alamo Beach Townsite, for the northwest corner of the herein described tract, marking a common corner between Lots 2 & 3, THENCE, North 87°12'5O" East, along the north line of said 20-foot Alley, distance of 100A0 feet to the POINT OF BEGINNING, CONTAINING whhin these metes and bounds a id Lot acre tract of land, more or less, t'✓Rh the south Ilne of said Lot 3, a 0. Basis of bearing is based on the Texas State Plane Coordinate System (NAD 83), South Central Zone (g2pq), The foregoing legal description and accompanying ground under my supervision in 03 17 survey plat were and belief, / /2017 and SO/18/2019 a prepared from an actual survey and are true and correct to the best of my knowledge ade le the Y knowledge Urban Surve In OB/11/2020 BY; Michael K, g' Inc. Registered Professional Land Surveyor Texas No. 6616 522028.01 EXHIBIT nAn EXHIBIT SITI BEING A 0.045 ACRE TRACT OF LAND SITUATED IN CALHOUN COUNTY, C TEXAS, BEING A PORTION OF A 20•FOOT ALLEY OUT OF BLOCK 4 IN THE ALAMO BEACH TOWNSI E, ACCORDING TO THE ESTABLISHED MAP OR PLAT THEREOF AS RECORDED IN VOLUME V, PAGE 01. OF THE DEED RECORDS, CALHOUN COUNTY, TEXAS AND VOLUME Z, PAGE'13, OF THE PLAT RECORDS, CALHOUN COUNTY, TEXAS. RiR WITH LOT 2 cAw cv / LOT S 6160)000 4Sf00M rAo0:OlB0a tl00000a Vr IF= 02r \ � a®00ae0000r CUM aS60700BS 4�U0WPWr 71Bffie NOT W SCALE 0 e®BABm 36 Sam "mallmold WEST ALAMO STREET (CARRIGAN STREET) w D z5:� 3 a L4. z S N � O: o � V VICINITY MAP OPAL : LOT 1 LOT 2 LOT. 3 LOT 4 LOT 5 LOT 6 2000 Sq. Feet 0.046 Acrid �VSRI POINT OF MR WOH W BEGINNING IS GP L4 MISS CAR 20' ALLEY ! N BT 12'SO' E 130.0 LAP Ufl CAP Usl C B L 0•0 K 4 LOT LOT LOT LOT I LOT LOT LOT 16 1S 14 13 12 11 10 RR MTH Fbg WIM MOR M 0 N S BP125O' W 160.0w 5 BTI2150' W N IG0.00, BOWIE STREET (W. KRUSE STREET) 0 100 200 GRAPHICSCALEIN FEET SIGNED: LEGEND Th...ma.rd mw'w NOTE, hr MmEH IM EmxYiO. THE PROPERTY OESCRWEU HEREON MAY OR MAY NOT BE IN SSRO aEf WO.4TEPLRlBAR WRN VBP GP COWUANCE WRIT CITY, COOM OR STATE SUBTRYSION FER a POMNO N-STRELREW ORDINANCES, PLATED LOTLINE WE SURVEY WAS COMPUnTO MOM IRE 91N OF AN ABSIRACf Di TIRE iXER¢ MAY BE FASFMFNI9, OR ORIDI MAl1EP5, NOT SNOWN. LOT 7 LOT B LOT 9 N W 2'50. E MCNORGTE�SYSaA1 (NM 53),HSOUTH COMAE 11DAS ZONE (4204), THE ABOVE PLAT WAS PREPARED FROM AN ACTUAL SURVEY MADE ON THE GROUND UNDER MY SUPERVISION IN 117/2 017 AND 1011812019 AND IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDOE AND BELIEF. ACCORDING TO THE FLOOD INSURANCE RATE MAP (FIRM) FOR CALHOUN COUNTY, TEXAS, COMMUNITY PANEL NUMBER 48067C 0205 E. MAP REVISED OCTOBER 15, 2014, THE SUBJECT PROPERTY IS LOCATED IN ZONE X WHICH IS NOT SPECIAL FLOOD HAZARD AREA. Dust Land SUrveying +Aedal Imaging IXTam4 RAa iieilin ooei 1IRMii.11.1 roNIO,RXM N10I4RJSN RRM410/10810 DRAWN BY: EBD JOB N0: S22028.01 I :qlp C v� ID' &LEY d � � do m s f JEFFERSON AVENUE 1]D' RgHI-DF-NAY) G Y� 4 'a9 ]D' KICY 6 5 0 9 a JACKSON AVENUE (DMMWN STREET) {\A t VACATE AND ABANDON A PORTION OF PUBLIC ROAD IN ALAMO BEACH, CALHOUN COUNTY, TEXAS A Motion was made by f-'pmrpissioner DW-T> Rbuc and secnnded h., Commissioner IF,P-M `, SSY to Vacate and Abandon a portion of a public road in Alamo Beach, Calhoun County, Texas as shown on the following Order with exhibits attached. Uu, ; voted in favor of the motion. ORDER DECLARING CLOSURE OF A PORTION OF PUBLIC ROAD IN ALAMO BEACH, CALHOUN COUNTY, TEXAS WHEREAS, on the 30' day of September, 2020, the Commissioner's Court of Calhoun County, Texas considered the request of Hemnauth and Fay Ramdass, being property owners in Precinct 1 of Calhoun County, Texas, to abandon and vacate the following portion of a public road in Alamo Beach, Calhoun County, Texas more fully hereinafter described and as shown on the Exhibit "A" which is attached to this order and incorporated by reference. WHEREAS, Texas Transportation Code §251.051 vest in the Commissioner's Court the authority to abandon and vacate a portion of the road; and WHEREAS, the Commissioners have not previously classified the subject road as either a first class or second class road; and WHEREAS, the Commissioner's actions to abandon or vacate the road have not been enjoined or sought to be enjoined by any party; and WHEREAS, proper notice of the petition to abandon and vacate the road has been posted at the Courthouse door of Calhoun County, Texas and at other places in the vicinity of the affected route, being at the Indianola Fishing Center and on the property at 1 the portion of the road to be abandoned and vacated, for at least twenty (20) days before the date the application was made to the Court; and WHEREAS, the Commissioners have voted unanimously to abandon and vacate the portion of the road described on the attached Exhibit "A"; and WHEREAS, all requirements of Texas Transportation Code §251,051 and §251.052 have been complied with in declaring said road to be abandoned and vacated. NOW, THEREFORE, ON MOTION DULY MADE �` `wBY``Commissioner I and SECONDED by Commissioner V&N L i /, and upon said Motion having been approved by the Commissioner's Court in a properly posted public meeting; IT IS ORDERED AND DECREED, that Calhoun County does hereby CLOSE, ABANDON and VACATE that portion of road described on the attached Exhibit "A". IT IS FURTHER ORDERED AND DECREED that on the date this Order is signed, title to the portion of road closed by this Order is vested in Hemnauth and Fay Ramdass, pursuant to Texas Transportation Code §251.058(b). IT IS FURTHER ORDERED AND DECREED that a copy of this Order is to be filed in the Official Records of Calhoun County, Texas and a duly filed copy of the Order shall serve as the official instrument of conveyance of the closed portion of the road, Alamo Beach, Calhoun County, Texas from CALHOUN COUNTY to the respective owners of the abutting property as set forth hereinabove, pursuant to Texas Transportation Code §251.058(b). 2 SIGNED this 23' day of September, 2020. COUNTY, TEXAS CALHOUN COUNTY ATTESTED TO BY: ANNA GOODMAN CALHOUN COUNTY CLERK #9 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax (361)553-8734 Please place the following item on the Commissioners' Court Agenda for Sept 23rd, 2020. • Consider and take necessary action on attached surplus salvage form utilizing listed items be used as trade in. Si David E, Hall DEH/apt Calhoun County, Texas SURPLUS/SALVAGE DECLARATION REQUEST FORM Department Name: RB1-540 Requested By: Commissioner David Hall Inventory Reason for Surplus/Salvage Number Description Serial No. Declaration 21-0268 John Deere 310K Backhoe 1T0310KXLCE222717 No longer needed/for trade 21-0281 Hydraulic Thumb Attached to backhoe # io David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax (361)553-8734 Please place the following item on the Commissioners' Court Agenda for September 23rd, 2020. Consider and take necessary action on agreement for donation of labor, equipment, or materials and liability waiver for Bredan in Calhoun County by Philip Gonzales in the amount of $7000.00 and allow County Judge to sign Sincerely, DEH/apt IN THE COMMISSIONERS COURT OF CALHOUN COUNTY, TEXAS AGREEMENT FOR DONATION OF LABOR, EQUIPMENT, OR MATERIALS FOR ROADS IN CALHOUN COUNTY, TEXAS And RELEASE OF LIABILITY I ^ J ^ BE IT REMEMBERED, that on the vJ day of _Y" 2020, came on to be considered the donation of Money, Land, Labor, Equipmeni or I Road Building Materials to Calhoun County, Texas, by Phillip Gonzales, die owner thereof, hereinafter referred to as the Donor. After careful consideration, the Commissioners Corot of Calhoun County, Texas, has determined that the donation, described as follows: Shaping, aumacting, rolling, hauling of material is suitable to aid road building or maintenance and that the application of said donation to the benefit of county roads would improve the all-weather capabilities of said roads, and thereby serve a public benefit. BE IT THEREFORE ORDERED, ADJUDGED and DECREED, that the donated item has it reasonable cash market value of $7,000.00. (Donations valued at more than $500.00 will be reported by Calhoun County to the IRS on form 8282. Donors should report such donations on IRS form 1040, Schedule A, or IRS Form 8283.) In return for the donation of labor, equipment and materials by the Donor named above, Calhoun County, Texas, acting by and through its Commissioners Court and its officers and employees, has determined that such improvements, conditioned upon supervision and approval of die Commissioners Court, shall be performed by the Donor, who is possessed of sufficient equipment and experience in die sae and proper operation of said equipment to conduct repairs and to perform maintenance upon that portion of County Road Bredan located upon die property of the Donor real property. Donor shall be permitted to enter upon said County Road, after notification of the Commissioners responsible for the maintenance of roads in the jurisdiction containing the identified County Road, and after consultation and agreement upon the rnetlhods and procedures to be used, the County Commissioner has inspected the road, and has determined that. the suggested repairs and maintenance is needed, and that the Donor is able to perform fire work. In this regard, due donation of labor, equipment and necessary material shall constitute satisfactory consideration sufficient to support a donation pursuant to §251.003, and §2.51.019 of the Texas Transportation Code, V.A.C.S. To this end, the County also releases the. Donor of liability arising from the performance of repairs and maintenance upon the identified County road, and Calhoun County grants a limited right of ingress, egress and access upon and across said County Road necessary to permit the work described in this agreement. Calhoun County and its officers and employees shall exercise reasonable care in the administration of this agreement. Executed this2M.day of Se-V 'Cf2020. APPROVED BY DONOR: Donor Acceptec y. r Calhoun County Judge V.T.C.A., Transportation Code § 251.019 § 251.oi9. Donations Effective: September 1, 2013 Currentness (a) A commissioners court may accept donations of Sabor, money, or otherpropert to aid in the building or maintaining of roads, culverts, or bridges in the county. (b) A county operating under the county road department system on September 1, 2013, may use the authority granted under this section without holding a new election under Section 252.301. county that accepts Office of the Attorney General State of Texas *1 Opinion No. JC-0073 July 6, 1999 Re: Whether a commissioner's court may accept a donation conditioned upon spending the money to improve a particular county road ( RQ 1171) The Honorable Rob Hofmann Mason County Attorney County Courthouse P.O. Box 157 Mason, Texas 76856 Dear Mr. Hofmann: You ask whether the Commissioners Court of Mason County may accept, under section 252.214 of the Transportation Code, a donation of $50,000 with the condition that the money be used to improve and pave a road in the county specified by the donor. We conclude that the commissioners court may accept a donation for road building subject to reasonable conditions. It is a matter for the exercise of good faith discretion by the commissioner's court to determine whether the condition attached to a particular donation is reasonable. You state that a person owning property in Mason County contacted the county road superintendent offering to donate $50,000 to the county under the condition that the money be used to improve and pave a specific road within the Mason County Road System. Brief from the Honorable Rob Hofmann, Mason County Attorney, to Honorable Dan Morales, Attorney General (July 27, 1998) (on file with Opinion Committee) [hereinafter "Hofmann Brief"]. Neither the commissioners court nor the road superintendent has the paving. of this specified road as a priority or even an option in the current road plan. You also state that $50,000 would not pave the entire unpaved portion of the road, nor would it fund the maintenance of the road in the future, but the potential donor has stated that future donations for additional paving and/or maintenance may be forthcoming. Id. Section 252.214 of the Transportation Code applies to. counties that have adopted the county road superintendent system set out in Transportation Code, chapter 252, subchapter C. See Tex. Transp. Code Ann. § 252.203 (Vernon 1999) (commissioners court may adopt thissubchapter by appointing a road superintendent for the county or one superintendent in each precinct). We assume that Mason County has adopted this road system so that section 252.214 applies to it. See also id. § § 252.103, .109 (commissioners court or road commissioners of county under road commissioner system may accept donations of money, labor, or other property to aid in building or maintaining roads). Section 252.214 states that "[a] commissioners court may accept donations of labor, money, or other property to aid in building or maintaining roads in the county." Id. § 252..214. You believe that this section does not authorize the county to accept money for a specific road, but only for "roads in the county" in general. You also state that the statute specifies that money may be accepted to "aid in building . roads," not to be the sole source of money for a particular county road. Finally, you point out that it is possible to use a donation of money, unlike a donation of land, anywhere in the county. Hofmann Brief, supra, at 3. *2 Section 252.214 of the Transportation Code does not expressly state that conditions may be attached to donations of money, but this provision may be, and we think should be, construed more broadly than you suggest. While the commissioner's court has only that authority specifically conferred by the constitution and statutes, where a right is conferred upon it, the court has implied authority to exercise broad discretion to accomplish the purposes intended. Canales v. Laughlin, 214 S.W.2d 451, 453 (Tex. 1948); Anderson v. Wood, 152 S.W.2d 1084, 1085 (Tex. 1941). Thus, section 252.214 is to be construed as giving the commissioners court broad discretion to carry out the purpose of road building and road maintenance, including discretion to accept donations of money subject to reasonable conditions, when this would help implement the county's road -building and maintenance duties. The interpretation of section 252.214 is consistent with judicial decisions about the commissioners court's acceptance of donations of money to be used for improvements in a particular location. In Behan v. Ghio, 12 S.W. 996 (Tex. 1889), the court referred favorably to the county's acceptance of donations conditioned on the voters' decision to locate the county seat in particular place. Behan, 12 S.W. at 997. Contributions to individual voters to secure their votes for a specific site were found to be bribes in Roby v. Carter, 25 S.W. 725 (Tex. Civ. App. 1894, no writ), but the court determined that "the donation of aid in the way of land or money to a state, county, or public body, for the purpose of inducing the location of public buildings or of a county seat at a particular place, is not considered a bribe to the individual voters." Roby, 25 S.W. at 727. The decision in Board of Permanent Road Commissioners v. Johnson, 231 S.W. 859 (Tex. Civ. App.-Dallas 1921, no writ) addresses the location of a county road and thus is especially relevant to the question before us. When a county board of road commissioners decided to locate a road over a route that qualified for state and federal funding, rejecting its initial choice of the Jacobia route that would serve more people, the court found no abuse of discretion. Johnson, 231 S.W. at 860. There was no evidence of bad faith on the board's part in rejecting the Jacobia route. Id. Both routes had certain merits, and the evidence showed that the board carefully and patiently considered the entire situation, weighing the advantages of the Jacobia route against the loss to the county road system that the loss of federal and state aid would entail. Id. "Not even the semblance of corruption or disregard of duty is discoverable in the record." Id. In this matter, the exercise of discretion meant "a consideration and weighing of whatever entered as afactor to contribute to or detract from the general welfare of the county from the standpoint of a permanent road system for the entire county." Id. On the facts of this case, "a proper exercise of discretion permitted, if it did not require, consideration of the $106,000 of proffered aid." Id. *3 We conclude that a commissioners court, in a good faith exercise of discretion, has authority under section 252.214 to accept a donation of money subject to the condition that it be used to improve a particular road in the county road system. The availability of donated money for improving aroad is one factor, but certainly not the only factor, for the court to consider in deciding whether or not to improve a particular county road. Tex. Transp. Code Ann. 9 251.003 (Vernon 1999). The county roads are public roads, built and maintained for the use of the public. See Robbins v. Limestone County, 268 S.W. 915, 919 (Tex. 1925). The county is to exercise its power to provide for the improvement of the public roads for the general good of the public, and not in the interest of any particular individual or entity. Grayson County v. Harrell, 202 S.W. 160, 163 (Tex. Civ. App.-Amarillo 1918 writ ref'd) (dicta). A commissioner's court may not accept a condition that is inconsistent with other law, such as provisions of the road law applicable to the county. Nor may the commissioners court delegate its decision -making authority to others. Id.; see also Clear Lake Citv Water Auth. v. Clear Lake Utils. Co.. 549 S.W.2d 385. 391 (Tex. 1977). In deciding whether or not to improve a particular county road, the commissioners court should evaluate all factors in terms of their contribution to the county road system as a whole. See generally Tex. Att'y Gen. LO-98-087, at 6. A court will reverse a commissioner's court's decision to improve a particular county road only if the court "has acted arbitrarily, capriciously, collusively, fraudulently, or otherwise in abuse of its discretion." Hooten v. Enriquez, 863 S.W.2d 522, 528 (Tex.. App.-El Paso 1993, no writ). You have mentioned various factors indicating that the county's acceptance of the donation to pave the county road in question would not benefit the Mason County road system. It is for the commissioners to evaluate these and all other relevant matters and to decide, in the exercise of good faith discretion, whether to pave the road and to accept the donation to be used for that purpose. If it makes this determination, the court may agree to accept the donation with the specified condition, the agreement subject to being overturned only for an abuse of discretion. of course, the commissioners court may not agree to any condition contrary to relevant statutes or constitutional provisions. Summary A commissioners court has authority under section 252.214 of the Transportation Code to accept a donation for improving a specific county road subject to reasonable conditions. It is a matter for the exercise of good faith discretion by the commissioner's court, subject to judicial review for abuse of discretion, to determine whether the condition attached to a particular donation is reasonable. Yours very truly, John Cornyn Attorney General of Texas Andy Taylor First Assistant Attorney General •4 Clark Kent Ervin Deputy Attorney General - General Counsel Elizabeth Robinson. Chair Opinion Committee Prepared by Susan L. Garrison Assistant Attorney General Tex. Atty. Gen. Op. JC-0073, 1999 WL 499819 (Tex.A.G.) #�1 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax(361)553-8734 Please place the following item on the Commissioners' Court Agenda for September 23rd, 2020. Consider and take necessary action to award the bids for the 2020 Calhoun County Boating Access Improvements (Magnolia Beach Boat Ramp Improvements and Six Mile Park Boat Ramp Improvements) and authorize the County Judge to sign the contracts and all DEH/apt f G&WENGINEERS, INC. 206 W, Live Oak • Port Lavaca, TX 77979 p: (361)562-4509 f: (361)552-4987 TBPE Firm Registration No. F04188 September 15, 2020 Honorable: Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 31d Floor, Suite301 Port Lavaca, TX 77979 RE: LETTER OF RECOMMENDATION 2020 Calhoun County Boating Access Improvements Magnolia Beach Boat Ramp Improvements and Six Mile Park Boat Ramp Improvements Dear Honorable Judge & County Commissioners, Bids for construction of the above referenced project(s) were received at the County Judge's office until 2:00 p.m., Tuesday, September 8,.2020, at which time said Bids were publicly opened and read aloud. The enclosed Bid Opening Table and Bid Itemized Table indicate there were a total of five (5) Bidders with only -three (3) submitting Bids. After 4horoughly reviewing the bids, it would be most advantageous to the County to make two separate awards. We recommend awarding Derrick Construction Company Inc. for Base Bid A,- -Magnolia Beach Boat Ramp Improvements plus Owner's Option A-OI''fort a total of $167,100. 0 01 and awarding'SJS Industrial, LLC. for` Base Bid B - Six Mile Park Boat Ramp Improvements plus .0wner's Options B.01 and B.02 for a total of $293 775,00, We have worked with both Derrick Construction Company, Inc. and with SJS Industrial, LLC and: they both have proven to be a qualified -and capable of doing the required work for these projects. Construction Contract packages will be prepared and 'delivered iuunediately to the contractors upon the award of the contracts. Please call me cr (361) 552-4509 if you have any questions. Sincerely, Q 8e WEngineers Inc. Soo P. Mason, P.E. Enclosures: Bid Opening Table & Bidrltemi'zed Table cc; file 9115.026a1& 9347.017 l Engineering Consulting' + ' Planning Surveying „i d m O o W m Y P rJl n v' C PS 0, a rc O. Y �i I O Q' tl 0 m 0 N a ry{ m m m m N N 41 VI N h N. 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N. � a c n K x a a: 43 0p a� a x �3p a; 10O w o b m 0 s uc •+. P O 73e C x %i C 1 r z � 0 m A o c N a z O N N: O O N p O O O O O O O m N Z N O W O n 0 n a o - y o a w rn o o a o v N m o c 0 0 O O O O O O O O O O O O O O O 0 O o O a O o O 0 O 0. O o O o. O o O 0 O 0 O 0 O 0 y o 0 o o 0 a 0 o 0 0 0 0 o 0 o 0 b 0 o 0 b 0 o 0 b 0 L N N O Y O N N N O O N P O O O O N O O. O O O O N O O O O O O O 0 O O O 0 O 0 m E N m 0 v D cu C r O Z ■ ƒ )#§ - } k } � ) 00 < \ Derrick Construction Company, Inc , hereinafter called "BIDDER", (Legal Finn Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER'. 1. Terms used in this BID 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 famish 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 terns and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Imitation 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.: N/A 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 5. 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. 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. 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. BASE BID A: MAGNOLIA BEACH BOAT RAMP MPROVEMENTS BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT Al 1 LS Furnishing Mobilization and Insurance as per plans and specifications for a lump sum price as per plans and specifications for a lump sum price of _Eiahteen Thousand and Zero Cents. A2. 1 LS Furnishing materials, equipment and labor for the construction and removal of a temporary coffer dam to include dewatering to allow for the installation of two concrete ramps including the removal and reinstallation of a section of the existing wooden pier as per plans and specifications for a lump sum price of Forty -Two Thousand and . Zero Cents. A3. 1 LS Furnishing equipment and labor for the demolition and disposal of the existing concrete ramp as per plans and specifications for a lump sum price of Five Thousand Seven Hundred Zero A4. 1 LS Furnishing materials, equipment and labor for the installation of two reinforced concrete ramps (15' x 605 as per plans and specifications for a lump sum price of Thirty -One Thousand Two Hundred Dollars and Zero Cents. 00300-3 $ 42,000.00 $ 5.700.00 BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT A5. 1 LS Furnishing equipment and labor for the removal by either mechanical or hydraulic means of approximately 1,200 CY of silt materials to the dewatering site and Gcotube® (if hydraulically dredged) also including phasing and sampling of material and containment structures (temporary barriers) and decant structures as required for USAGE & TCEQ compliance and reconstruction of damaged areas and paved areas as per plans and specifications for a lump sum price Of Thirty Thousand and Zero Cents. $30,000.00 A6. 1 LS Furnishing materials, equipment and labor for the installation of 270 SY of cement stabilized sand and general regrading of area and additional cement stabilized sand in front of the new boat ramps and removal of vegetation and trees as required to facilitate work and access to the ramps as per plans and specifications for a lump sum price of Twelve Thousand and Zero Cents. ' $ 12,000.00 TOTAL BASE BID A AMOUNT, for Magnolia Beach Boat Ramp Improvements, being Items Al thru A6 above is: One Hundred Thirty -Eight Thousand Nine Hundred DOLLARS Zero CENTS. $ 138,900.00 CALANDAR DAYS 120 OWNER'S OPTION— MAGNOLIA BEACH BOAT RAMP IMPROVEMENTS BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT A-01 1 LS Furnishing equipment and labor for the movement of the— dewatered dredged materials (1,200 CY) including allowance for phasing of the material to be moved from the dewatering site to a County site within 10 miles of project as per plans and specifications for a lump sum price of Twenty -Eight Thousand Two Hundred Dollars and Zero Cents. $ 28.200.00 ADDITIONAL CALANDAR DAYS 30 BASE BID B: SIX MILE PARK BOAT RAMP 1WROVEMENTS BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT BI 1 LS Furnishing Mobilization and Insurance as per plans and specifications for a lump sum price as per plans and specifications for a lump sum price of Eighteen Thousand M and LS Furnishing materials, equipment and labor for the construction and removal of a temporary coffer dam to include dewatering to allow for the installation of one reinforced concrete ramp as per plans and specifications for a lump sum price of Forty Three Thousand One Hundred and 00300-5 BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRYMNIN WORDS AMOUNT B3. 1 LS Furnishing equipment and labor for the demolition and disposal of the existing concrete ramp and approximately 275 LF of existing concrete cap as per plans and specifications for a lump sum price of Seven Thousand Nine Hundred Eiahty Dollars and Zero Cents. $ 7,980.00 B4. 1 LS Furnishing materials, equipment and labor for the installation of one reinforced concrete ramp (15' x 60D as per plans and specifications for a lump sum price of Seventeen Thousand Nine Hundred Forty Dollars and 7ero Cents. $ 17,940.00 B5 1 LS Furnishing materials, equipment and labor for the removal by either mechanical or hydraulic means of approximately 1,600 Total CY split into Dredge Area 1 and Dredge Area 2 of silt materials to the dewatering site and Geotube® (if hydraulically dredged) also including phasing and sampling of material and containment structures (temporary barriers) and decant structures as required for USACE & TCEQ compliance and reconstruction of damaged areas and paved areas as per plans and specifications for a lump sum price Of Ninety -One Thousand One Hundmd Twenty Dollars and 7ero Cents. $ 91,120.00 B6. 1 LS Furnishing materials, equipment and labor for the construction of approximately 275 LF of reinforced concrete bulkhead cap as per plans and specifications for a lump sum price of Fifty -Four Thousand Dollars and Zero Cents. $ 54,000.00 00300-6 BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT B7. 1 LS Furnishing materials, equipment and labor for the installation of approximately 26 concrete cap drains as per plans and specifications for a lump sum price of Seventeen Thousand Five Hundred and B8. 1 LS Furnishing materials, equipment and labor for the installation of approximately 100 SY of concrete stabilized sand as per plans and specifications for a lump sum price of Five Thousand Two Hundred Dollars and Zero Cents. B9 1 LS Furnishing materials, equipment and labor for the repair of approximately 150 LF of the existing timber breakwater as per plans and specifications for a lump sum price of Nine Thousand Six Hundred Fifty and B10. 1 LS Furnishing materials, equipment and labor for the installation of approximately 19 timber pilings and approximately 120 LF of 4"%6" timber waler as per plans and specifications for a lump sum price of Twenty -Eight Thousand Four Hundred Fifty -Two and Zero Cents. Bll. 1 LS Furnishing materials, equipment and labor for the installation of approximately 125 LF of Duramax 100 Series DB-115 Dock Bumper or approved equal as per plans and specifications for a lump sum price of Twelve Thousand Two Hundred Twenty Dollars and Zero Cents. 00300-7 $ 17,500.00 � 11 $ 28,452.00 $12,220.00 B12. 1 LS Furnishing materials, equipment and labor for the installation of 0.5 CY of concrete stop gap, as per plans and specifications for a lump sum price of Three Thousand Two Hundred Fifty Dollars and Zero Cents. $ 3,250.00 TOTAL BASE BID B AMOUNT, for Six We Park Boat Ramp Improvements, being Items B1 thru B12 above, is: Three Hundred Eight Thousand Four Hundred Twelve DOLLARS CENTS $ 308,412.00 CALANDAR DAYS 120 OWNER'S OPTIONS — SIX MILE BOAT RAMP IMPROVEMENTS BID BID DESCRIPTION OF ITEM WITH ITEM QTY• UNIT PRICE WRITTEN IN WORDS AMOUNT B-01 I LS Furnishing equipment and labor for the movement of the dewatered dredged materials (approximately 1,600 CY) including allowance for phasing of the materials from the dewatering site to a County site within 6 miles of project as per plans and specifications for a lump sum price of Thirty -Seven Thousand Six Hundred and Zero Cents. $ 37,6(M 00 ADDITIONAL CALANDAR DAYS 30 B-02 1 LS Furnishing equipment and labor for the installation of approximately 275 LF of 4' wide reinforced concrete sidewalk as per plans and specifications for a lump sum price of Twelve Thousand Dollars and Zero Cents. $ 12,000.00 ADDITIONAL CALANDAR DAYS 30 00300-8 TOTAL COST to complete the 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS SHOULD BIDDER ELECT TO BID ON BOTH PROJECTS being TOTAL BASE BID A + TOTAL BASE BID B above is. Four Hundred Forty -Seven Thousand Three Hundred TweiveDOLLARS Zero CENTS. $447 312.00 The 5% BID BOND is based on the GREATEST AMOUNT BID, being either BASE BID A and/or BASE BID B or the SUM OF BASE BID A+BASE BID B Commissioners' Court reserves the right to award these bids on the basis of lowest and/or best bid, to waive any formality or irregularity, to make awards to more than one bidder, to accept and/or reject any or all bids, and to be the sole judge in determining ning which bid will be most advantageous to CALHOUN COUNTY. 7r1 t t 6_ BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are attached to and made a condition of this BID: DOCUMENT NO.00135 - 8. Communications about this BID shall be directed to BIDDEWs address indicated below. SUBMIT TFD this 08 day of September , 2020. Authorized Signature: L, 4 W Name: Rose Johnson Title: President Attesting Signature: �� pQ Name: Delle Shedden Title: Contracos Administrator Legal Firm Name: Derrick Construction Company Inc Business Address: 250 S. Cove Harbor, Rockport, TX 78382 Phone Number: 361-729-2423 Facsimile Number: 361-729-1218 E-Mail Address (optional): delle@derrickconstruction.net State ofincorporation, if applicable: Taxac State Contractor License No.: END OF DOCUMENT 00300-10 AWre KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, DERRICK CONSTRUCTION CO., INC. as PRINCIPAL, and THE CINCINNATI CASUALTY COMPANY , as SURETY are held and firmly bound unto (CALHOUN COUNTY. TEXASI hereinafter called the "Local Public Agency", in the penal SUM Of FIVE PERCENT GREATEST AMOUNT BID Dollars, ($ 5%G.A.B. ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated SEPTEMBER STH, 2020 , for: 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS — Magnolia Beach Boat Ramp Improvements and Six Mite Park Boat Ramp Improvements. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within sixty (60) days after the said opening, and shall within the period specified therefor, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between the amount specified In said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, If the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above parties have executed this instrument this sTH day of SEPTEMBER, 2020 , the name and corporate seal of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. Attest: Attest: Countersigned By (SEAL) DERRICK CONSTRUCTION CO., INC. (SEAL) Affix Corporate Seal By: Affix Corporate Seal DOCUMENT NO.00415 CONTRACTOR'S CORPORATE RESOLUTION I hereby certify flint it was RESOLVED by a quorum ofthe directors of Derrick Construction Company, Inc (Name of C04wation) meeting on the 1st day of September , 2020 , that' Rose Johnson President be, (Name of Prinow Cri te) and hereby is, authorized to execute all documents necessary for the transaction of business in the State of Tem on behalf the said Derrick ConstructionCompany Inr•111� 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 day of September ,20_20 . 00415-1 tr� ,-,A CINCINNATI INSURANCE COMPANIES SURETY BOND SEAL ADDENDUM The CINCINNATI CASUALTY COMPANY Due to logistical issues associated with the use of traditional seals during the COVID-19 pandemic, The Cincinnati Casualty Company ("Cincinnati") has authorized its Attomeys-in-Fact to affix Cincinnati's corporate seal to any bond executed on behalf of Cincinnati by any such Attorney -in -Fact by attaching this Addendum to said bond. To the extent this Addendum is attached to a bond that is executed on behalf of Cincinnati by its Attorney -in -Fact, Cincinnati hereby agrees that the seal below shall be deemed affixed to said bond to the same extent as if its raised corporate seal was physically affixed to the face of the bond. Dated this 24th day of March, 2020. The Cincinnati Casualty Company . ``roan CdsG h ; CINCINNATI, �� p o: OHIO a3 By --- Stephen A. Ventre, Senior Vice President THE CINCINNATI INSURANCE COMPANY THE CINCINNATI CASUALTY COMPANY Fairfield, Ohio POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That THE CINCINNATI INSURANCE COMPANY and THE CINCINNATI CASUALTY COMPANY, corporations organized under the laws of the State of Ohio, and having their principal offices in the City of Fairfield, Ohio (herein collectively called the "Companies"), do hereby constitute and appoint William Blanchard; Tracy Miller, Katie Rogers; James R. Reid; William Mitchell Jennings; Aaron Endris; Mary Ellen Moore; Tricia Balolong; Payton Blanchard; Lindsay Senior Gingras and/or Jessica Turner Of Fort Worth, Texas their true and legal Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and deliver on behalf of the Companies as Surety, any and all bonds, policies, undertakings or other like instruments, as follows: Any such obligations in the United States, up to Fifty Million and Noll00 Dollars ($50,000 000.001. This appointment is made under and by authority of the following resolutions adopted by the Boards of Directors of The Cincinnati Insurance Company and The Cincinnati Casualty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the President or any Vice President be hereby authorized, and empowered to appoint Attorneys -in -Fad of the Company to execute any and all bonds, policies, undertakings, or other like instruments an behalf of the Corporation, and may authorize any officer or any such Attorney -in -Fact to affix the corporate seal; and may with or without cause modify or revoke any such appointment or authority. Any such writings so executed by such Attorneys -in -Fad shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. RESOLVED, that the signature of the President or a Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary and the Seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company. IN WITNESS WHEREOF, the Companies have caused these presents to be sealed with their corporate seals, duly attested by their President or a Vice President this 19th day of December, 2018. CORPORATE $diva PORAiF a THE CINCINNATI INSURANCE COMPANY °dS E A L = ` 5 A L ' THE CINCINNATI CASUALTY COMPANY oxi0 Pxio STATE OF OHIO )SS: COUNTY OF BUTLER ) Vice President On this 19th day of December, 2018 before me came the above -named President or Vice President of The Cincinnati Insurance Com- pany and The Cincinnati Casualty Company, to me personally known to be the officer described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of said Companies and the corporate seals and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporations. �PAIAC ,{�o �'2° �\\!Ili•?� jr*= Keith Co* Attorney at Law ' `A,slq'•••... Notary Public — State of Ohio (My commission has no expiration date. .•';_� +,tE ..... F 0 o Section 147.03 O.R.C. I, the undersigned Secretary orAssistant Secretary of The Cincinnati Insurance Company and The Cincinnati Casualty Company, hereby certify that the above is the Original Power ofAttomey issued by said Companies, and do hereby further certify that the said Power of Attorney is still in full force and effect. _ Given under my hand and seal of said Companies at Fairfield, Ohio, this 8TH day of SEPTEMBER 2020 ®RPORAI'E�a (RRIRRAIFEAAL° " a r - Ohio Secretary BN-1457 (12/18) A �� CERTIFICATE OF LIABILITY INSURANCE DA serzo2lo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA71ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the Certificate holder is an ADDITIONAL INSURED, the policy(bes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Higginbotham Insurance Agency, Inc. PO Box 870INC.No:361.844.0101 W. Renee Terrell PHONE 36t-561�237 FAX Corpus Christi TX 78403-0870 AOD� ; rterrell hi g inbotham.net INSURER(3)AFFORD01000VERAGE NNCC INSU RERA: Stan Indemnity B Liability Co. 38318 MURED DERRCO"I Derrick PO Box 1o048 Construction Co., Inc, Sen a: Texas Mutual Insurance Company 22945 muREec: The Continental Insurance Company 35289 muaERD: State Automobile Mutual ins Co. 25135 Rockport TX 783814046 013URERE: RSURERF: COVERAGES CERTIFICATE NUMBER: 790292870 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR TYPE OF INSURANCE S a POLiCYNUYeER POLICYEFF POLICYEW LIMRB C X 1COMMERCULLGENERALLJABILINY CLNMS�E rx-1 OCCUR 12131/2019 12/31/2020 EACHOCCURRENCE $1.000,000 m smsma $50,000 MEDEXP(Anygp�) $5,000 OWL PERSONAL S ADV INJURY 51.000,D00 AGGREGATE UNrt APPLIES PER: POLICY�jEEcr ElLOC OTHER GENERALAGGREGATE $2,000.000 PRODUCTS-COMP/OPAGG $1.000.000 $ D AYTOMO&IELWBILIfY ANYAUTO (hWEO LY SCHEDULED AUTOS ONAUTOS HIRED NON-OVMm AUTOS ONLY X AUTOS ONLY 12131/2079 12/31/2020 LDNEDR a9T NGLEL $1,000,000 X X BODILY INJURY(PxpeN ) S BODILY INJURY (Per acWamd) $ Perms GC $ $ A X UMBIRELLALUIa EXCESS LUIS X OCCUR CIA%1S-MN)E 12/31/2019 12/31/2020 EACHOCCUNREHCE $10,000,000 AGmREGATE $10.000.000 can I X IRETENnON $ B BR MRCmPeumrom PLOYER LUBxm, YIN AHYPfIOPWETORRAR1HEwE>V=CMNE OFRCWMBUBERIXCWOEdt O (Umd"Nrie1) Nyyeess,,d ON under DESCRIPnON OFOPERKnONSb NIA ® 72/37/2079 71/31/2020 X A-N� EL.EACHACCIDENT $1,000,000 EL DISEASE-FAFAmLD 51,000,000 EL. DISEASE -POLICY LIMH $1,00%000 C 12131f2019 12`3112020 Pal and S1,000,0m $1.000,000 OESCRPTION OF OPERATIDN3l LOCgiION3l YENICLES (ACORD 19/, AtltlNRxel Ren,aMSehedub, may M BtlaclRd HRnore apace N rtpWmtl) See Attached... Calhoun County` 211 S. Ann St., 3rd Floor, Suite 301 Port Lavaca TX 77979 ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ce The ACORD name and logo are registered marks of ACORD reserved. AGENCY CUSTOMER ID: _ LOC C fa ADDITIONAL REMARKS SCHEDULE Page 1 Of 2 AGENCY Higginbotham Insurance Agency, Inc. NAMED INSURED Derrick Construction Co., Inc. PO Box 1046 Rockport TX 78381-1046 POLICY NUMBER cmutim NAIC CODE EFFECTIVE DALE AUU111VNAL KCMAKAS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Marine General Liability pokry includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the insured antl certificate holder that requires R. (Manuscript Form). Marine General Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the insured and certificate holder that required such status. (Manuscript Form). Marine General Liability pollq includes a primary & noncontributory provision only when there is a written contract between the insured and certificate holder ch that requires suprovsion. (Manuscript Form), Marine General Liability policy includes In Remand Action Over Indemnity Buyback - Manuscript form and Pollution Limitation Endorsement (Sudden & Accidental Basis) - Pollution guy Back - Manuscript form. Auto policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the insured and certificate holder that requires it. (Texas Business Auto Policy Plus Endorsement -Form SA 30 0206108). Auto policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holler only when there is a written contract between the insured and certificate holler that required such status. (Texas Business Auto Policy Plus Endorsement- Form SA 30 02 06108). Auto policy includes a provision that provides Primary Auto Liability Coverage for any liability assumed under an insured contract. (Business Auto Coverage — Form CA0001 03106). - Marine Excess Liability ("Bumbershooty policy includes a blanket automatic waiver of subrogation and blanket automatic additional insured endorsement that provides this feature Only when there is a written contract between the insured and certificate holderthat requires it. (Additional Insured / Waiver of Subrogation /Notice of Cancellation - Standard "Bumbershoor Wording). Marine Excess Liability ("Bumbershoor) policy follows form of the underlying Commercial Marine Liability. Auto Liability, Employers Liability, Vessel Pollution and Protection & Indemnity policies- Bumbershoot Liabilities. Wotkers' Compensation policy includes a blanket automatic waiver of subroga8on endorsement that provides this feature only when there is a written contract between the insured and car holder that requires it. (Texas Waiver of Our Right to Recover from Others - Form WC 42 03 04B). Wodkers' Compensation po includes Longshore and Harbor Workers' Compensation ActCovemge Endorsement (Form TM-LHW-2001) and Outer Continental Shelf Lands Acltoverage Endorsement (Form TM-OCS-2001). Protection & Indemnity policy covers master &crew members. (Protection & Indemnity ClausesSP 23). Protection & Indemnity policy includes Jones Act, Death on the High Seas, In -Rem and Transportation, Wages, Maintenance & Cure. (Protection & Indemnity Clauses-SP23). Protection & Indemnity policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the insured and certificate holler that requires it. (Protection & Indemnity ClausesSP 23). Protection & Indemnity policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the insured and certificate holder that required such status. (Protection & Indemnity ClausesSP 23). Protection & Indemnity policy Includes Collision Liability -Tower's Liability. Hull & Machinery. Company -Continental Insurance Company Coverage $3,882,429 Scheduled Vessels, PoficyN H0877477, Policy Period 12131119-20 Marine Vessel Pollution: Company -State National Ins Co / Star Indemnity & Liability Co/ Berkshire Hathaway Specialty Ins Co nce, Coverage $5,000,000 Per OccurrePoficyN ill Policy Period 12/31/19.20 Rigger's Liability: XL Speclally Insurance Company Coverage: $ 000 Any One Project Limit, Policy XUMONS2119MA19A, Policy Period 12131/19-20 The Workers Compensation policy includes an endorsement providing that 30 days of notice of cancellation will he fumished to the certificate holder except 10 days notice of nonpayment of premium. (Texas Notice of Material Change Endorsement- Forth WC 42 06 01). The Marine General Liabll ppoolIiIccyy indutles an endorsement providing that 30 days of notice of cancellation will be fumlahed to the certificate holder except 10 days notice of nonpaymeMofpremium. (Manuscript Farm). The Auto Liability policy includes an endorsement providing that 30 days of notice of cancellation will be furnished to the certificate holder except 10 days notice of nonpayment of premium. (Notice of Cancellation -Scheduled Parties- Form S1102006/10). ACORD 101 (2008101) 02008 ACORD CORPORATION. All darts msarved The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC 9: ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 w��'� NAMED elaegEp Higginbotham Insurance Agency, Inm Derrick Construction Co., Inc. PO Box 1046 Polio Nuaem Rockport TX 78381-1046 CAfnaEa NAIL CODE rFFECENEDATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE The Marine Excess Liability ("Bumbershoot") policy includes an endorsement providing that 30 days of notice of cancellation will be furnished to the cedficate holder except 10 days notice of nonpayment of premium. (Manuscript Form). 'Certificate Holder Amended to Read: Calhoun County, Calhoun County's Employees and Owners Engineers. ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. The ACURO name and logo are registered marks of ACORD DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT All questions must be answered and the data given must be dear and comprehensive. This statement must be notarized. if necessary, questions may be answered od separate attached streets. The Bidder may submit any additional Information he desires. Name of Bidder. Derrick Construction Company, Inc Data Organized 1950 Address: 250 cove Harbor South _ Data Incorporated: 1990 Rockport, Texas 78382 Number of Years in contracting business under current name: 30 Are yqu a Section 3 business? (see belovr) o Yes A No Section 3 &nlrrew Conosmi : a) auslneases that are 51 percents more Owned by Sec9on 3 midents; b) 6usheesoewfiew pemtenerd, ItI Mro oroloyses Indude perernw, of bast So Permit of whom are ounenty aedion 3 residerd9, or Ww" flues yam of the date of Ibd empioyrned with the 0m were Sacdlar 3 rsatdards; p a IM '«bm*sdMexomd28perm9ofMadoWa muntdamaubo6ntredstobamxdedtD 0 � MA d) audneases boated wilhin the Grara Redptornra)urMdldion that Identity limanilm as rAdlon 3 anahess Conoems boom& theyJimide ecdromk opporbsAm for bw. and vm low Income Pomona, CONTRACTS ON HAND: Contract Dollar Amount Completion Date City of Fulton, TX- Fulton Fishing Pier Rebuild $1 495 500.00 December 2020 University of TX: MSI 0 Port Aransas Research Pier Rebuild $1,599,087.00 September 2020 Hancock & Sheridan: Benson Shoreline Stabilization & Bulkheads $1 226 640.00 October 2020 Type of work performed by your company: Marine Construction Have you ever failed to complete any wort awarded to you? No Have you ever defaulted cn a contray. No List the projects most recently completed by your firm Onclude project of similar hnportaned): Project I DollarAmount Molyrtomplew VCND: Port _of Victoria Maintenance Dredge $247 220.00 March 2020 JE Services: Cofferdam Installation $45 624.00 March 2020 Lazarus Energy' Dock Dredge $55 575.00 January 2020 Major equipment available for this contract Excavator, Dozer, Crane Barge, Maintainer Attach resume(s) for the principal member(s) of your organization. Including the offloars as well as the proposed superintendent for One project. Creditavailabie: $ ® Bank reference: The undefsigrted hsrebyputho" and requests any person, firm, or corporation to furnish any Information requested by The l I) Olin .D is In verification of the recitals comprising this Statement of Bidder's Quailfk:allons. Executed IhI inn y gp septembeC 20 20 by: President re) (Title) END OF DOCUMENT 00420-1 Form W-9 Request for Taxpayer Give Fmra to the ftw. oacar8er�l,t khmbru=Uo' n Number and Certification Donut sadro tlm Rts. k9wwdnrees:r rlmrw(�Meam anyatrermnretmtrea.rd DwFh c Cerusmlcdm Cenipany, h= ri Ohamsnsrnaftnegwdadaftnah*. tdMa- toniMnee a � cahedraQprepriMaeaafor mdaMtax drc ® ❑ kart&. fmleprWWwr ❑ CCwPwWar 0 Slbrpa Ste ❑ Pat—HO ❑ TmMhSWB ❑ UTAWUb , 9.6naramtue on«kCaepm&WLSdcmp-NMP-PWMwg I s I o ❑ Omerpeetrmmrdba,► Ad3imsksmiba. atnM, m,derr.arsaerref RsnaeesMtldras 2W Cwe Afarbor south wy,abAamZlPoode m Rockport M6 78362 kith aecetra rwmiha(y hero kPaera¢ T 1 n HUMber Enter yatvTIN In the qVGPIMB boy The TM PwAded muetmatchtheaaneglMontre•Nana'6ne SadM,-,-,Nbnwnbw � toaaoWbadmpwteardkg.Fcr6hi*SPKtdebyoureadsecurtyramtw@SS .Homwo,kra rid men6 sohpoprtelo, or dWregmded arty, ass the Part l knmrWon on pop 3 For;;Wr rM -m -j 1 amiss, t h yohverrgrbfwrkhrhtl&dim mmher�J. d yw tmrot have amrt� seeFka•taava AIV an page 3. 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For federeitax purposes, you am aeddaed a U.S. pmsm ff you are: • An ihdhddual wh a b all-& Is crU.S. maWardmar, • A pabWSW owpamar. cmggM. oraswdmmaaebd or orgwdasdinth UmbodStdosorurAwUnkw ofthetkned States. •An estma (Darer drmaloeigr ems, or -Adornm6ctent(as dehredhltre secYatSDt.77M n. Speeidndmfwpabuaslapa antcaiAtdabodem busbeastotattnked StatesemgerwrmyregdradrepayavANwk rg lac m ayfaggrl prtrhmY ekes dkecarre korrr arJh bhnkhes. Further. m oatehrcam wherea Form W-9 has not been received. a perkxnWphngLimdmpeen*andap~ba pmson, adpoyarewMdwk"Wx Thwdoe,tyoumeaU.S.p moth tlon p lim mapab*rsbptorKkicBgaerodeorbh dnmbea*tkulad Saab, powide Form YV-9to thavatimal tossuMmyourLM atahnad evdd w ith otdig myayshme of p rtrisift irwoma. CM. ere. tozaix Farr*""wr.12-mH) Derrick Construction Company, Inc. (DCCI) is located in Rockport, Texas. DCCI is HUB certified and Woman Owned (Certificate # 1742569812700). We are bonded and fully insured for all Land and Marine Construction. Derrick Construction began its legacy in the marine business in 1959 under the name Fulton Boat Yard. The company's name changed to Derrick Construction Company, Inc. and was incorporated under the laws of Texas in 1990. With many years in Marine Industry, Derrick Construction Company, Inc. has become extremely diversified in this field. DCCI is capable and willing to work in all regions along the Texas Gulf Coast, including all bays, canals and estuaries located in those regions. DCCI has successfully completed many debris removal, derelict vessel removal and disposal projects, and underwater pipeline installation and removal projects over the last 25 years. DCCI employs 30+ highly skilled and trained personnel, all of which live in close proximity to DCCI's office in Rockport, Texas. Of these employees, approximately 30 employees can be assigned to any location along the Texas Gulf Coast. The following is a list of our Board of Directors: President Rose Johnson Vice President Roy Johnson Treasurer Derrick Johnson Secretary Shane Johnson Derrick Construction Company's Corporate Office is located at 250 Cove Harbor South, Rockport, TX 78382. DCCI's mailing address is PO Box 1046, Rockport, TX 78381. We do also have the capabilities & equipment to set up mobile offices & quarters on location when and where needed. Derrick Johnson is the Director of Operations and Point of Contact for DCCI and is located at the Corporate Office in Rockport, Texas. If for any reason he is unable to be reached, you may call the office and speak to Roy Johnson (Vice President). Office Number: (361)729-2423 Email: derrickrderrickconstruction.net 91812020 Search Results I System for Award Management I View ussistaillec for SATY1.9ov Della Shedden t.og Ou. A ALERT'. SEA wixie.&ityis experiencing a. ouvage. For questions shout small business size status, mers should return later or contart SEA dfta*(www.sbagov). A ALERM SAILgir, will be zlwm for scheduled mainteranst Saturday, 09/12/2020 from 8:oo AM to i:oo PM. Search Results Current. Search Terms: Derrick Consbriaction Company, lum- TOLIT lecords:i Result Page: I Sort bN Relemce Your search for Derrick Construction Company, Inc.* returned the following results... antity DerrkConstrucoon Company. c. IStatus: Adse a DUNS: C&GECode:. IU3V4 H.AcUw,E.dmu,n?: No DODAAC- EKphation Date: ost/iol"au Debt liuldeettoOffset?: No PurpossofItegianathim ARAwards ResUlt Page: i f)aLlAccess ACMISHIffit', GSA.gov/IAE chevl: Staltz'� pnvjcc 1101 : IeN GSA.go, About USA.,iov HUIP i"V4 Save PDFFExpoitResufts F Print Carder [)yDescending , Fs-mPI)F FB—wMResufts F —Print https:/Isam.gov/SAM/pagesJpublidsearchRemrdsfwamhResults.jsf ill Company Resume: Derrick Johnson Name: Derrick Johnson Contact Information: Phone: 361-729-2423 E-mail: derrickna derrickconstroction.net Education, Certification, Business Management and Marketing Degree —North Wood And Licenses: University, Cedar Hill, Texas HAZWOPER Certification Transportation Workers Identification Credentials Holder OQ Certified Employment: Derrick Construction Company (1994 — Present) Director of Operations Skills/Service: Estimator Project and Safety Manager Mobilization and Demobilization Manager Site Coordinator Experience: Derrick has over 25 years of experience working and supervising various types of projects throughout the Texas Gulf Coast. Mr. Johnson has had direct oversight on the following projects: 2002 — assisted in removal of abandoned cabins and debris from Upper Laguna Madre to Aransas Bay for Coastal Conservation Association; 2004 to 2005 — excavated and constructed the harbor and boat lifts at the Flour Bluff Marina, Flour Bluff, TX; 2008 — provided land based support for major oil companies for drilling and work -over projects. 2010 — Dredged over 5000 foot of material out of the Aransas Pass Harbor and also the reconstruction of the San Patricio Navigation's Marina; 2014 — Major Repair Work at the Citgo Dock #6, Completed a Drilling Site Pad for Endeavor Natural Resources, and Removed over 4000 pilings for the Texas General Land Office in Galveston Bay, Texas; 2016 — Reconstructed the Rockport, Texas Beach Boat Ramp for the Aransas County Navigation District and removed a 10" pipeline for Cheniere Energy; 2017-2018 — Assisted several agencies in the Hurricane Harvey Disaster cleanup efforts. 2018 — Removed approximately 3000 tons of tires in Gatesville, Texas for the Texas General Land Office; Repaired several docks and breakwater walls due to Hurricane Harvey; decommissioned several pipelines in the local bays of Aransas County for the oil and gas companies. Company Resume: Roy Johnson Name: Roy Johnson Contact Phone: 361-729-2423 Information: E-mail: moose llab.derrickconstruction.net Education, Certification, Transportation Workers Identification Credential Holder And Licenses: Oil Spill & Response Certification Natural Disaster Certification OQ Certification Employment: Derrick Construction Company (1967 — Present) Vice President / Owner Skills/Service: Owner / Operator Estimator Risk Manager Facility and Project Manager Mobilization and Demobilization Manager Experience: Mr. Roy Johnson has been in the Marine Construction field for over 45 years. He has worked with the Texas General Land Office, Railroad Commission, Coastal Conservation Association and Army Corps of Engineers on all types of projects along the Texas Gulf Coast. Mr. Johnson has had direct oversight on the following major projects: 1970 - raised a sunken drilling rig from the ICW at Aransas Pass Bridge and salvaged 150 to 175 boats and barges sunk during Hurricane Celia; 1970 — 1982 Contract Gauging for the following companies: Cities Services, LADD Petroleum, Patrick Petroleum, Genesis, Vintage Petroleum, Corpus Christi Oil and Gas, along with other independent oil and gas producing companies; 1982 — 1990 Assisted in the oil and gas business by laying pipeline, building and hooking up platforms, pipeline lease work; 2001 to 2003 — removed additional 200 tons of debris for CCA and TX GLO along the shoreline from Corpus Christi to Brownsville; 2005 — participated in cleanup efforts in Venice, Louisiana after Hurricane Katrina; 2007 — removed a sunken barge from Rio Hondo, Arroyo Colorado River for TX GLO; 2010 — Assisted in an Oil Spill cleanup in Aransas Bay; 2017-2018 — Assisted several agencies in the Hurricane Harvey Disaster cleanup efforts; oversaw the decommissioning of several pipelines in the Aransas County area for the oil & gas companies. DCCI offers a variety of services including but not limited to: Pile Driving and Removal Platform Fabrication and Installation Tug and Barge Leasing Well Guard Fabrication and Installation Maintaining Rig Locations Wellhead Hookups Pipeline Burial and Removal Plug & Abandonment of Wells Various Disaster Relief Efforts Mechanical & Hydraulic Dredging Vessel Salvage & Disposal Construction of Marinas and Docks Bulkhead Construction Sandblasting and Painting All Derrick Construction Company, Inc (DCCI) equipment is Coast Guard approved and DCCI owned. Our equipment is capable of mobilization into water as shallow as 2 % feet to the gulf waters. DCCI has executed many regulated contracts with the Texas General Land Office, Victoria Navigation District, Aransas County Navigation District, Texas Parks and Wildlife, Texas Railroad Commission and other surrounding Navigation Districts. DCCI has removed small and large platforms, all sizes of vessels, submarines, barges, vast amounts of pipelines, derelict pilings and structures. DCCI has strategically sunk barges for artificial reefs, built extensive bulkheads and marinas as well as emergency oil spill cleanup and P & A of wells. DCCI has been utilized as a general contractor for all scopes of marine clean up and construction, as well as properly disposing of hazardous debris. Whether considering the utilization of our large capacity cranes to lift sunken vessels, our experience in demolition and removal of buildings, vessels, platforms, pipelines and various infrastructure remains after previous disasters, DCCI has the experience, capability and equipment needed to complete all aspects of the marine debris removal and disposal as well as all oil field related projects. DCCI has worked for many oil and gas companies such as EOG, Cinco Resources, Cheniere Energy, Southcross, Sabco, White Marlin, Vintage Petroleum, Lamar Oil and Gas, Magnum Engineering, Neumin Production, BNP, Petro Hunt, Matagorda Resources, Copano Resources, Kinder Morgan and Gold King among others. Over the last 50 years, DCCI's main specialties have been pipeline installation, maintenance, and removal, bulkhead/boat ramp repair or replacement, vessel and debris removal and disposal, and mechanical/ hydraulic dredge work. DCCI is an environmentally conscious company that has not had any environmentally detrimental spills during operations. From the plugging jobs for the Texas Railroad Commission to the various projects we have completed for our oil and gas production clients, DCCI is extremely cautious when it comes to the environmental aspects of each project. Each project depicts its own unique environmental challenges and DCCI is well -versed in providing the proper equipment and procedures for each individual circumstance. DCCI has vast experience in marine derelict structure removal and cleanup as well as land clean up and is equipped to handle any level of cleanup along the Texas Gulf Coast. With our fleet of marine vessels to gather and transport debris to a designated sort/lay down facility on land and our land based equipment to sort and transport all debris to the appropriate disposal sites and/or recyclable material sites, DCCI is experienced, equipped and prepared to facilitate any removal & cleanup projects. STATE OF TEXAS 0 AFFIDAVIT COUNTY OF CALHOUN {} BEFORE ME, the undersigned authority, on this day personally appeared Rose Johnson known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not to bid thereon. I affirm that 1 am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant In connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this Bid. /7 Afflaht -f Rose Johnson - President Printed Name and Title of Afflant Name of Bidder (Company) Derrick Construction Company,Inc Address PO Box 1046, Rockport, TX 78381 Phone Number 361-729-2423 Fax Number 361-729-1218 Email Address delie0derrickconstruction.net SWORN TO AND SUBSCRIBED BEFORE ME by the above Afffiant, who, on oath, states that the facts contained in the above are true and correct, this day of 2020 :*D:PH1LA0ELPH1A BREANNE SHEDDEN. .hLonr Jtary ID A131481367 Commission ExpiresNota Public in and for Aransas Coun Texas March 8, 2022 Notary County, ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040.OW9 Public reporting burden for this collection of information Is estimated to average 15 minutes per response, Including time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of intonation. Send comments regarding the burden. estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE' Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the ' Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. if such Is the rase, you will be notified. As the drily authorized representative of the applicant:. I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, B. Will comply with the Intergovernmental Petsonnai Act and the institutional, managerial and financial capability of 1970 (42 U.S.C. §§4728-4763) relating to prescribed (including funds sufficient to pay the non -Federal share standards of medt systems for programs funded of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in management and completion of project described in Appendix A of OPM's Standards for a Merit System of this application. Personnel Administration (5 C.F.R. 900, Subpart F). 2. Will give the awarding agency, the Comptroller General 9. Wig comply with the Lead -Based Paint Poisoning of the United States and, if appropriate, the State, Prevention Act (42 U.S.C. §§4801 at seq.) which the right to examine all records, books, papers, or prohibits the use of lead -based paint in construction or documents related to the assistance; and wig establish rehabilitation of residence structures. a proper accounting system in accordance with generally accepted accounting standards or agency 10. Will comply with all Federal statutes relating to non - directives. discrimination. These include but are not limited to: (a) Title V1 of the Civil Rights Act of 1964 (P.L. 88.362) 3. Will not dispose of, modify the use of, or change the which prohibits discrimination on the basis of race, terms of the real property tilts or other interest In the color or national origin; (b) Title D( of the Education site and families without permission and instructions Amendments of 1972, as amended (20 U.S.C. §§1681 from the awarding agency. Will record the Federal 1683, and 1685-1686), which prohibits discrimination awarding agency directives and will include a covenant on the basis of sex; (c) Section 504 of the in the title of real property acquired in whole or in part Rehabilitation Act of 1973, as amended (29) U.S.C. with Federal assistance funds to assure non- §794), which prohibits discrimination on the basis of discrimination during the useful life of Ore project. handicaps; (d) the Age Discrimination Act of 1975, as 4. Wig comply with the requirements of the assistance amended (42 U.S.C. §§6101-6107), which.prohdMts awarding agency with regard to the drafting, review and discrimination on the basis of age; (e) the Drug Abuse approval of casstruc6os plans and specifications- Office and Treatment Act of 1972 (P.L. 92-255), as amended relating to nondiscrimination on the basis of S. Will provide and maintain competent and adequate drug abuse; (1) the Comprehensive Alcohol Abuse and engineering supervision at the construction site to Alcoholism Prevention, Treatment and Rehabilitation ensure that the complete work conforms with the Act of 1970 (P.L. 91-616), as amended, relating to approved plans and specifications and will fumish nondiscrimination on the basis of alcohol abuse or progressive reports and such other information as may be alcoholism: (g) §§523 and 527 of the Public Health required by the assistance awarding agency or State. Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 as 3), as amended, relating to confidentiality of alcohol 6- Will Initials and complete the work within the applicable and drug abuse patient records; (h) Title Vill of the time from after receipt of approval of the awarding agency. Civil Rights Act of 1968 (42 U.S.C. §§3601 at seq.), as 7. Will establish safeguards to prohbit employees from amended, relating to none iscrinrcnatioh in the sale, rental or financing of housing; (1) any other using theirpositions for a purpose that constitutes or atl provisions in the specific statue(s) presents the appearance of personal or organizational pli under which under for Federal assistance is being conflict of interest, or personal gain. and ) the requirements made; and Q) me requirements of any other nondiscrimination slatue(s) which may apply to the application - Previous EdNon Usable Authorized for Local Reproduction Standard Form 424D tRev. 7-97) Proscribed by OMB Circular AA02 11. Will comply, or has already compiled, with the requirements of Titres 11 and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and faderallyassisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 12. Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activides are funded in whole or In part with Federal funds. 13. Wig comply, as applicable, with the provisions of the Davis - Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 16 U.S.C. §674), and the Contract Work Hours aM Safety Standards Act (40 U.S.C. §§327- 333) regarding labor standards for federally-assleted construction suhagreements. 14. Will comply with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients In a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 15. Will mq* with environmental standards which may be prescnbed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91- 190) and Executive Order (ED) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990: (d) evaluation of good hazards in ttoodphafns In accordance with EO 11988; (a) assurance of project consistency with the approved Stale management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 at seq.); (1) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 at seq.); (g) protection of underground sources of drinking water under the Safe Drinking WaterAct of 1974. as amended (P.L 93-523}; and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L 93.205). 16. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 at seq.) related to protecting components or potential components of the national wild and scenic rivers system. 17. Will assist the awarding agency in assuring compliance with Section 105 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a-1 at seq). 18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments. and Nan -Profit Organizatfmns." 19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. 20. W W comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000. as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub -recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is In effect (2) Procuring a commercial sex act during the period of time that the award Is in effect or (3) Using forced labor in the performance of the award or subawards under the award. S510N OF AUUi ZE C . FYINGOFFICIAL, TITLE President APPLICA T ORGANIZAT N _ DATE SUBMITTED Derrick Construction Company, Inc�� 20 SF424D (Rev. 7-97) Back CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84m Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the Date Received vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. 1J Name of vendor who has a business relationship with local governmental entity. Derrick Construction Company, Inc 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. N/A Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2XA). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? FlYes FKI No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Ves I No 5 Describeeach employment or business relationship that the vendor named InSection I maintainswith acorporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 2020 Calhoun County Boating Access Improvement Contract 6 Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 09/08/2020 naw of ve r doi with the governmental entity Date Fomt provided by Texas Ethics Commission www.ethics.stale.ix.us Revised 11/30/2015 PCCA Project No. 18.033U CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the hest of his / her knowledge and beliet, that its principals: a. Are not presently debased, suspended, proposed for debarment, declared ineligible, orvoluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (I)(a—d) of this certification. Rose Johnson - President bq- g' to Name and Title of Authorized Agent Date q#i o6zed Agent 1 am unable to certify to the above statements. My explanation is attached. Corpoationa Section P.O.Box 13697 Austin, Texas 78711-3697 �I,T E OF Y Office of the Secretary of State Packing Slip DERRICK CONSTRUCTION COMPANY, INC. PO BOX 1046 Rockport, TX 78391 Batch Number: Client ID: Batch Date: 10-18-2007 Return Method: Mail Phone No: 361-729-2423 - Phil Wilson Secretary of State October 22, 2007 Page 1 of 1 Document Number Document Detail Page Filing Number/Name Count Fee hange of Registered DERRICK CONSTRUCTION 0 $15.00 Agent/Office COMPANY, INC. Total Document Fees $15.00 Payment Type Payment Status Payment Reference Amount Check Received 09783 $15.00 Total Payments Received $15.00 Total Amount Charged to Client Account $0.00 Total Amount Credited to Client Account $0.00 Note: This is not a bill. Please do not send any payments until the monthly statement is received. Any amount credited to Client Account may be refunded upon request. Refunds (if applicable) will be processed within 10 business days. Acknowledgement of Filing Document(s) (if present) is attached. User ID: MACONKEL Come visit us on the Internet @ h11p:1Avevw.sos.state.=tal Phonc:(512)463-5555 FAX (512) 463-5709 Dial: 7-1-1 for Relay Services Corporations Section ,�P'Cfi CF P.O.Box 13697 c� R Austin, Texas 78711-3697 Office of the Secretary of State October 22, 2007 DERRICK CONSTRUCTION COMPANY, INC. PO BOX 1046 Rockport, TX 78381 USA RE: DERRICK CONSTRUCTION COMPANY, INC. File Number: Phil Wilson Secretary of State It has been our pleasure to file the change of registered agent or registered office, or both for the referenced entity. This letter may be used as evidence of the filing and payment of the filing fee. If we may be of further service at any time, please let us know. Sincerely, Corporations Section Statutory Filings Division (512)463-5555 Enclosure Come visit us on the internet at http://www.sos.state.tx.usl Phone: (512) 463-5555 Fax: (512) 463-5709 Dial: 7-1-1 for Relay Services Prepared by: Mary Ann ConkeI TID: 10087 Document: 190038850002 Corporations Section O�ACg DST P.02ox13697 Austin, Texas 787I1-3697 s t~ Office of the Secretary of State CERTIFICATE OF FILING OF DERRICK CONSTRUCTION COMPANY, INC. File Number: Phil Wilson Secretary of State The undersigned, as Secretary of State of Texas, hereby certifies that the statement of change of registered agentloffice for the above named entity has been received in this office and has been found to conform to law. ACCORDINGLY the undersigned, as Secretary of State, and by virtue of the authority vested in the Secretary bylaw hereby issues this Certificate ofFiling. Dated: 10/18/2007 Effective: 10/18/2007 Phil Wilson Secretary of State Come visit us on the Warner at hlep:lhvww.sos.state.tx, us! Phone: (512) 463-5555 Fax: (512) 463-5709 Dial: 7-1-1 for Relay Services Prepared by: Mary Ann Conkel TM: 10013 Document:190D38850002 Form 401 This space reserved for office use. (Revised 01106) ScaTr nFr Return in duplicate to: \i FILED rt ti Secretary of Skate 1n the Offleo of the P.O. Box I3697 - Secretary of State of Texas Austin, TX 78711-3697 OCT 18 �0� 512 463-5555 Statement of Change of FAX: 512/463-5709 Registered Office/Agent Corporations Sedon Filing Fee: See instructions The entity name is: _DERRICK CONSTRUCTION COMPANY, INC. The file number issued to the entity by the secretary of state is: The registered agent and registered office of the entity as currently shown on the records of the secretary of state are: Witham N Johnson P.O. BOX 3046 Rockport, TX 78382 or the filing entity as follows: Registered Agent Change (Complete either A or B, but not both. Also complete C if the address has changed.) ❑ A. The new registered agent is an organization (cannot be entity named above) by the name of: [✓� B. The new registered agent is an individual resident of the state whose name is: Rov M. Johnson Registered Office Change ❑ C. The business address of the registered agent and the registered office address is changed to: TX Street rm (We P.O. Bar) iry Stara --Sp Code The street address of the registered office as stated in this instrument is the same as the registered agent's business address. The charge specified in this statement has been authorized by the cmity in 11he manner required by the BOC or in the manner required by the law governing the filing entity, as applicable. Exeeution The undersigned signs this document subject to the penalties imposed by law for the submission of a materially false or fraudulent instrument. Date: t (4 t5 d7 ZX2----mot—4 Signature and title of authorized person (see instructions) 6/22/2020 Franchise Search Results ILi l�.n 'fir �Aly6, �lii �tg"Fyy.. N Franchise Tax Account Status As of: 06/22/2020 09:29:36 This page is valid for most business transactions but is not sufficient for filings with the Secretary of State DERRICK CONSTRUCTION COMPANY, INC. Texas Taxpayer Number Mailing Address PO BOX 1046 ROCKPORT, TX 78381-1046 B Right to Transact Business in ACTIVE Texas State of Formation TX Effective SOS Registration Date 0311511990 Texas SOS File Number Registered Agent Name ROY M JOHNSON Registered Office Street Address P.O. BOX 1046 ROCKPORT, TX 78382 hops:llmycpa.cpa.state.tx.ustwo/waSearchB" 1/1 CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft 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. 2020-664828 Derrick Construction Company, Inc Rockport, TX United States Date Filed: 0g/05/2020 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County, Texas Date Acknowledged: 10/26/2020 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. 2020 Calhoun CTY Boat Access General Contractor 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 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct, Executed in County, State of , on the _day of , 20_ (month) (year) Signature of authorized agent of contracting business entity (Declarant) corms provlDett Dy I exas Ethics Commission www.ethics.state.tx.us Version V1.1.3a6aaf7d CERTIFICATE OF INTERESTED PARTIES FORM 1295 loll Complete Nos. 1- 4 and 6 it there are interested parties. OFFICE USE ONLY Complete Nos. L 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. 2020-664828 Derrick Construction Company, Inc Rockport, TX United States Date Filed: 2 Name of govemmemal entry or state agency that is a parry to the contract for which the form is 09l05/2020 being filed. Calhoun County, Texas 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 contracL 2020 Calhoun CTY Boat Access General Contractor 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Irdermetlfary 5 Check only if there is NO Interested Party. ❑X 6 UNSWORN DECLARATION �n n My name is f\ kl 2Y� �® i7 h11 f and my date of birth is My address is (cilY (state) lap code) (muntry) t declare under penaltyof perjury that the foregoing is true and correct. Executed in f,v►sa s County. State of. �, on the day of y�, 20-2_0. (month) (Y-r) PHILADELPNIA BRFANN...... SNE.OEN Notary ID R'131481387 My Commission Expires Marsh 8'2022 ignature o agent of contracting business entity a.e. (Declarant) (D Forms orovided by Texas Ethics Commission www.ethir-q ntate.tx_us Varsinn VI 1 3a9aaf7d HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 I, Rose Johnson the undersigned representative of Representative Derrick Construction Company . Inc (hereafter referred to as Company) being an Company or Business Name adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel-, and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Code: 1. "0oycott Israel" means refusing to deal with, terminating business acthrities with, orotherwise taking any action that Is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israet or with a person or entity doing business in Israel or In an Israeli -controlled territory, but does not include an action madefor ordinary business purposes; and 2. Company"means a for-profitsole proprietorship, organization, association, corporation, partnership. Joint venture, limited partnership, limited Habi7lty partnership, or any limited liability company, induding a whogyowned subsidiary, m*rrty-owned subsidiary, parent company or ti iilote of those entities or business associations that exist to make a profit tgnatu of Repre Rose Johnson - President Print Name fl Title 09/08/2020 Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of Texas ) County of Aransas ) Rose Johnson being fast duly sworn, deposes and says that: i. He is President of Derrick Construction Company, 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 for 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 S. 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 ages, representatives, owners, employees, or parties in interest, including this affiant (Signed rt�int Title Subscribed and sworn tome this day of �W 'tr 20ZL. By: . Y expires M(� yog �t 2 (� ZZ N tary Public M commission a fires END OF DOCUMENT SO, pHMDELPHIABREANNESHEDDEN Notary ID N1314813a7 2022 My commission Expires March B, 00416-1 RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Govemment Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.0D1(3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ■ i certify that is a "Nonresident Bidder" of Texas (Carapany Name) as defined in Government Code §2252.001 and our principal place of business is (ogand State) ■ I certify that Derrick Construction Company, Inc is a "Resident Bidder" of Texas as (Cmnp vName) defined in Government Code §2252.001. 4sign ture of Au t gent Rose Johnson - President Printed Name and Title of Authorized Agent 09/08/2020 Date � BED J--nd U 5L IC(( L IfT l , hereinafter called "BIDDER", (Legal Firm Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". Terms used in this BID 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 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: 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 famishing 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. Tliis 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 OWNERs 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 A: MAGNOLIA BEACH BOAT RAMP MPROVEMENTS ----- ---------------------------------------------------------------------------------------------------------- BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT Al 1 LS Furnishing Mobilization and Insurance as per plans and specifications for a lump sum price as per plans and specifications for a lump sum price of O ( Dollars and n Cents. A2. 1 LS Furnishing materials, equipment and labor for the construction and removal of a temporary coffer dam to include dewatering to allow for the installation of two concrete ramps including the removal and reinstallation of a section of the existing wooden pier as per plans and specifications for a lump sum price of 'lflC3&11t6L Dollars and Cents. A3. 1 LS Furnishing equipment and labor for the demolition and disposal of the existing concrete ramp as per plans and specifications for a lump sum price of r and i 111 A4. 1 LS Furnishing materials, equipment and labor for the installation of two reinforced concrete ramps (15' x 60) as per plans and specifications for a lump sum price of Dollars r and I 00300-3 BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT --------------------------------------------------------------------------------------------------------------------------- A5. 1 LS Furnishing equipment and labor for the removal by either mechanical or hydraulic means of approximately 1,200 CY of silt materials to the dewatering site and Geotube® (if hydraulically dredged) also including phasing and sampling of material and containment structures (temporary barriers) and decant structures as required for USACE & TCEQ compliance and reconstruction of damaged areas and paved areas as per plans and specifications for a lump_ su-m! price of Dollars and Cents. ! p A6. 1 LS Furnishing materials, equipment and labor for the installation of 270 SY of cement stabilized sand and general regrading of area and additional cement stabilized sand in front of the new boat ramps and removal of vegetation and trees as required to facilitate work and access to the ramps as per plans and specifications for a lump sump 'c of yUl v2 / AUCAOUOL M Ov Ip Dollars and E-" Cents. $ TOTAL BASE BID A AMOUNT, for Magnolia Beach Boat Ramp Improvements, being Items Al thru A6 above is: 96k�_ DOLLARS CENTS. CALANDAR DAYS $ %23TS�Ct`l.- +-1-++ 1 1 1! 1 1-++;-+++++ i 1 1 i1-1- +++++1-1 1 1 1.-1 11 TT+++++-f--I-++++++ 00300-4 OWNER'S OPTION —MAGNOLIA BEACH BOAT RAMP IMPROVEMENTS --------------------------------------------------------------------------------------------------------------------- BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT A-01 1 LS Furnishing equipment and labor for the movement of the dewatered dredged materials (1,200 CY) including allowance for phasing of the material to be moved from the dewatering site to a County site within 10 miles of project as per p, ns and specifications for a lump sum price of k ,max l c vu Dollars and ! ICJ w Cents. $15 00. ADDITIONAL CALANDAR DAYS % !III ++++++++++++++++++++++++++++++++++++++1111111++++++++++++++mot; ++++III ! ............. H 1 ++++ 1 1 1 H -1 ! H-1 +++++-14 ++-FF+++++++.... !-III ! ! -! ' +++++ BASE BID B: SIX MILE PARK BOAT RAMP IMPROVEMENTS --------------------------------------------------------------------------------------------------------------- BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT B1 1 LS Furnishing Mobilization and Insurance as per plans and specifications for a lump sum price as per plans and specifications for a lump sum price of Dollars and Cents. $ b O d b . B2. 1 LS Furnishing materials, equipment and labor for the construction and removal of a temporary coffer dam to include dewatering to allow for the installation of one reinforced concrete ramp as per plans and specifications for a lump sum price of Dollars 1 �.;I i boa — and 00300-5 BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT ------------------------------------------------------------------------------------------------------------------------------ B3. 1 LS Furnishing equipment and labor for the demolition and disposal of the existing concrete ramp and approximately 275 LF of existing concrete cap as per plans and specifications for a lurpp sum price 0 OYJ— ku -1 )ili l_ Dollars (� and At%417 Cents. $ ?315CC 134. 1 LS Furnishing materials, equipment and labor for the installation of one reinforced concrete ramp (15' x 60') as per plans and specifications for a lump sum price of k _ Dollars and gzLo _Cents. $ 1 q) R)0. B5 1 LS Furnishing materials, equipment and labor for the removal by either mechanical or hydraulic means of approximately 1,600 Total CY split into Dredge Area 1 and Dredge Area 2 of silt materials to the dewatering site and Geotube® (if hydraulically dredged) also including phasing and sampling of material and containment structures (temporary barriers) and decant structures as required for USACE & TCEQ compliance and reconstruction of damaged areas and paved areas as per plans and specifications for a lump sum price of Dollars and Cents. $ t7 . 136. 1 LS Furnishing materials, equipment and labor for the construction of approximately 275 LF of reinforced concrete bulkhead cap as per plans and specifications for a lumps m,price of Dollars and blO Cents. $ lil (y2,5. 00300-6 BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT ----------- -------------------------------------- —------------------------------------- ---------------------------- B7. 1 LS Furnishing materials, equipment and labor for the installation of approximately 26 concrete cap drains as per plans and specifications for a lump sum price of Dollars and Cents. $ I DOCK. B8. 1 LS Furnishing materials, equipment and labor for the installation of approximately 100 SY of concrete stabilized sand as pe ans and spe i icatiom for lump sum price of C, Dollars and !" 7V UJ Cents. B9 1 LS Furnishing materials, equipment and labor for the repair of approximately 150 LF of the existing timber breakwater as per plans. and specificp�t'`o; nsf,Bor a lump um price of ./1/�l IIn"MJi f- '"�`,—,n.I �1 LO�IiLC Dollars and i P' `�K MTV Cents. $ 9 MO B 10. 1 LS Furnishing materials, equipment and labor for the installation of approximately 19 timber pilings and approximately 120 LF of 4"X6" timber waler as per plans and spe 'fications f r a lump sum price of v ) ��,, K�"�� v >44ADollars and l'X��hJ Cents. $ 10,�JrJ B11. 1 LS Furnishing materials, equipment and labor for the installation of approximately 125 LF of Duramax 100 Series DB-115 Dock Bumper or approved equal as per plans specific 'ons fora lump um price of Dollars and 44 Cents. $ _ 00300-7 B12. 1 LS Furnishing materials, equipment and labor for the installation of 0.5 CY of concrete stop gap, as per plans and specifications for a lump sum price of Vl P A pxz. Dollars and / SIA12 Cents. $ I OD . — TOTAL BASE BID B AMOUNT, for Six Mile Park Boat Ramp Improvements, being Items B I thru B 12 above, is: CENTS. $ 2 7 o� CALANDAR DAYS l 2115 OWNER'S OPTIONS — SIX MILE BOAT RAMP IMPROVEMENTS ----------------------------------------------------------------------------------------------------------------- BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT B-01 1 LS Furnishing equipment and labor for the movement of the dewatered dredged materials (approximately 1,600 CY) including allowance for phasing of the materials from the dewatering site to a County site within 6 miles of project as per plans and specifications for a lump sum price of S(Jlf A lk�r� j(�VL(J� Dollars and Cents. ADDITIONAL CALANDAR DAYS LS Furnishing equipment and labor for the installation of approximately 275 LF of 4' wide reinforced concrete sidewalk as per plans and specifications for a lump sum price oo Dollars I and U Cents. $ L 5 d0. ADDITIONAL CALANDAR DAYS 00300-8 ++++++-H-+++-I-++++++++++++++++++++-I-+++++++++++++-r+ ! ! ! ! + -+++ !++-!III ... +i-F+++++ ++++-FF++i-i-i+++++-i i i i i i rT-i-F++++++++++++++++ ! i! i i i! +++++ i i!! ++++++++-FH-++++++ TOTAL COST to complete the 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS SHOULD BIDDER ELECT TO BID ON BOTH PROJECTS being TOTAL BASE BID A + TOTAL BASE BID B above is: CENTS. +++++++++++++r-rrrr... i ++++++++++++++++,- 1 1 1 1-,-T+++++++++++++Trr1 ! 1 1 1!1-+++++ The 5% BID BOND is based on the GREATEST AMOUNT BID, being either BASE BID A and/or BASE BID B or the SUM OF BASE BID A + BASE BID B Commissioners' Court reserves the right to award these bids on the basis of lowest and/or best bid, to waive any formality or irregularity, to make awards to more than one bidder, to accept and/or reject any or all bids, and to be the sole judge in determining which bid will be most advantageous to CALHOUN COUNTY. +4+++++1 ..+++i+ ++++++.i'iI I I! +.++ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions 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: DOCUMENT NO. 00135 - REQUIRED BID SUBMITTAL INSTRUCTIONS 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this day of iYL , 2020. Authorized Signature: 11^ Name: NV �/ 11 V1 cSt7 Y1 Title: OW n�� Attesting Signature: lu� -4� F-'blo Name: V118V5 �Er n Legal Firm Name: 53-5 Jind u-sk i�J ; Business Address: ��2 0.�d L�i'j11� ° X %3UL Phone Number:/I� Facsimile Number: cJ� Ir ��5 R4S E-Mail Address (optional): y ULU-3 i) ;51 �Xpyh State of Incorporation, if applicable: State Contractor License No.: END OF DOCUMENT 00300-10 DOCUMENT NO.00411 REQUIRED BID SUBMITTAL INSTRUCTIONS FOR: 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS - Magnolia Beach Boat Ramp Improvements and Six Mile Park Boat Ramp Improvements Return the following by 2:00 p.m., Tuesday, September 8, 2020 One Unbound Original of the ENTIRE Bid (00300), with all required forms included and or filled out, signed and dated must be returned by the time and date due. Check List for submitting your Bid: Be sure all necessary forms are included and or completed, signed and dated ✓ Submit one unbound original Bid Form (00300) Submit Bid Bond (00410). A Bid Bond in the amount of 5% of the greatest amount bid, issued by an acceptable surety. A certified check or bank draft payable to CALHOUN COUNTY or negotiable U.S. Government Bonds (as par value) may be submitted in lieu of the Bid Bond. ✓ Certificate of Liability Insurance - Please provide a copy of your Certificate of Liability Insurance (proof of required coverage).—' * Once bids are awarded, the bidder(s) that are awarded bid(s) must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) and on ALL POLICIES name CALHOUN COUNTY as an additional insured for all insurance requirements, by policy endorsement, along with CALHOUN COUNTY's Employees and OWNER'S Engineer as ADDITIONAL INSURED and must provide coverage to the maximum extent permitted by law. The additional insured endorsements shall be on the ISO CG2010 11185 form or CG 2010 (10/93) in combination with CG 2037 of CG 2033, or suitable form equivalent. Reference Document No. 00705 - Calhoun County General Conditions and Document No. 0820 Insurance Requirements Be sure to complete the following. If a question or form is not applicable, mark the question or form with "N/A" ✓� Affidavit V Certificate of Interested Parties, Form 1295 ✓ Certification Regarding Debarment & Suspension and Other Responsibility Matters Conflict of Interest Questionaire, Form CIQ J House Bill 89 Verification Residence Certification W-9 00411-1 NIL Document No. 00415 — Contractor's Corporate Resolution Document No. 00416 - Noncollusion Affidavit ✓ Document No. 00420 — Bidder Qualification Statement Assurances — Construction Programs System for Award Management - CONTRACTOR must not be debarred or suspended from the Excluded Parties List System (EPLS) in the System for Award Management (SAW and must have an active registration with the System for Award Management (www.SAM.gov). Include verification that your company is registered and that the company's principal is not listed (is not debarred) through the System for Award Management (www.SAM.eov). Enclose a print out of the search results that includes the record date. Do Not Fold any of the above information. Bids must be returned in a 9 x 12 or larger envelope clearly marked: SEALED BID — 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS Submit Sealed Bid to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 00411-2 HARLANDCLARKE" 180P864-1659 F7ry fmOD i`F[ 09 m-TTm T" ii €P, E2 € v 9 m � 4 9 O� Zn m pd8 � nmipoC H 02MfmO µ gzom 3 N d^p' mma �imDn CFF �zmG m �com q� 951 Bidder must Insert a copy of Certificate of Liability Insurance showing proof of coverage required under this Bid Package. ** Once bids are awarded, the bidder(s) that are awarded bid(s) must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) and on ALL POLICIES name CALHOUN COUNTY as an additional insured for all insurance requirements, by policy endorsement, along with CALHOUN COUNTY's Employees and OWNER'S Engineer as ADDITIONAL INSURED and must provide coverage to the maximum extent permitted by law. The additional insured endorsements shall be on the ISO CG2010 11185 form or CG 2010 (10/93) in combination with CG 2037 of CG 2033, or suitable form equivalent. Reference Document No. 00705 - Calhoun County General Conditions and Document No. 0820 Insurance Requirements 7 SJ51N-1 .acoao° CERTIFICATE OF LIABILITY INSURANCE np in °A 9/0812'20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED, the pollcy(Ies) must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies. may require an endorsement A statement on this certificatedog not 0 nfer,riahtstothecGrOficatehollder in Ileu of such endorsements . PRODUCER 361-884-2776 Carlisle insurance 500 N Water Suite 900 Corpus Chriati, TX 78401-0234 Select Business Unit WIPCT JenniferGregor 361-884.2775 361.684.3470 ��xo Etl: NA. M.-jennifairgecarlisleins.cm INSURIERIS1 AITOROINQNAICs •AMGUARD Insurance Com an 42390 RED i LyLgCy .Texas Mutual Insurance Co 22945 pn9�ust�rianlg R 1 sic 1'X 7838[ .GreatAmerfcan Ins Company INSURER F: F TUJIMMO THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUfUECT TO ALL THE TERMS, EXCLUSIONS AND CONDMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INWi TYPEOFINSURANCE fNIUCYNUMBER POLICY EFF POLICI'EXP ,I COMMERCIAL GENERAL UAWUW CIAIMSI I)E ❑ OCCUR EACH OCMSeCURRENCE DAMAGE TO RENTED MED EXP act $ PERSONAL &ACV INJURY 5 GENL AGGREGATE LIMMAPPUES PER: POLICY O jF& 1:1LOC GENERALAGGREOATE PRODUCTS-COMP/OPAGG a A AUTOeowLEum,ufY X ANYAEEUUpTO CCHH�� RW�pTEOpSONLY X ANU�rNIIO.00SWWUN�r1EED AUTOS ONLY X AUTOS ONLQ own 02/17/2020 02117/2021 COMSWEDSWOLEUMD f,00D,Doo BOD YWJURV Pet arson ILYINMRY eractlWnl OPER MADE UMBRELLA IMB EXCESSLWB OCCUR CLAIMS -MADE EACHOCCUR ENCE $ A CEO RETENTION s B ANDI�PLf@lNl 91UTY ApNFY PROaPRM�IELMTSOERg/PARTNE I IMs�nr�hrYR Inle EXCLUR CUDVE Y N e deeclbe undw D OR RA NIA 0=512020 02MV2021 X I PERMM OTN- EL.EACHACCIDENT 1 1,0,000 L. DISEAS -EA EMPLOYE � 1 �D,D POLICY LIMIT 3 1,000.000 r Equipment Floater 05122f2020 06@2/2021 1 EgWpmem LeaseRent 289,380 600,000 DESCRIPnONOFOPERATRXIS/LOCATNNIS/VEHICLES(MORO IW, AddRIMMI Rw rks SMsdule, RMYI:I D hld 11 m epp Mrw Wd ) Sample Certificate SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROWICNs. ACORD 26 (2016103) 0IND-2015 ACORD CORPORATION. All rights reserved. I w AL:Lm) dame and logo are registered marks of ACORD CERTIFICATE OF INTERESTED PARTIES, FORM 1295 Form 1295 must be filled out online. The copy included is a Sample Copy Only. #1): Contractor's Name, City, State and Country #2): Calhoun County, Texas #3): 2020 Calhoun County Boating Access Improvements On #4 and #5, complete only the one that applies to your company #4: Fill in the correct information OR #5: Mark an X in the Box #6): Fill in the correct information and print When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. The form does not need to be notarized. It is an Unswom Declaration. CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 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. 2D2D-664717 1 Name of business entity filing form, and the city, state and country of the business entity's piece of business. SJS Industrial, LLC ROCKPORT, TX United States Date Filed: D9/04l2D20 2 Name of governmental entity or state agency that Is a party to the contract for which the forms being filed. Calhoun County, Texas - Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract 2020 2020 Calhoun County Boating Access improvements. 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Johnson, Shawn Rockport, TX United States X 5 Check only If there is NO Interested Party. ❑ 6 UNSWORN DECLARATION c'hMy name is Oand m date of birth is My address is ( coon ry 1 declare under penalty yof perjury thattheforegoing is true and correct �tt� � ice, ,� �, ty� �t � Executed in �N IS/ WJ-VVJ/ County, State of y w�, on the l day of , 20 % U ( nth) (Year) Signature uthodzed agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www-ethics.state.tv_us Vocainn Vt f.Raaa:nd 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: 2020-664717 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. SJS Industrial, LLC ROCKPORT, TX United States Date Filed: 09/04/2020 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County, Texas Date Acknowledged: 10/26/2020 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. 2020 2020 Calhoun County Boating Access Improvements. 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Johnson, Shawn Rockport, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the _day of , 20_ (month) (year) Signature of authorized agent of contracting business entity (Declarant) Porms provided by Texas Ethics commission www.ethics.state.tx.us Version V1.1.3a6aaf7d CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. t Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. 3 Provide the identification number used by the governmental entity or state agency to tfffiii��k )Identify the contract, and provide a description of the services, goods, or other property to be provided t^e contract. 4 City, State, Country ature of Interest (check applicable) Name of Interested Party (place of business) ♦ Cj Controllin 9 Intermediary NN 5 ❑Check only if there' I terested Parry. B UNSWORN DE(C♦,L1Q N My name is +�`` , and my date of birth is My addre�� , _�`- (street) (city) (state) (zip code) (country) under penalty of pertury that the foregoing is true and correct. 6cecuted In County, State of , on the day of , 2g_ (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY .. ....... ..I:- --- I-- 0-4-A NM9M01 7 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84" Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state witlsin 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85`h Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defused by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.etbies.state.tx.us/whatsnew/elf info forml295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. STATE OF TEXAS {} AFFIDAVIT COUNTY OF CALHOUN {} r BEFORE ME, the undersigned authority, on this day personally appeared :5 hct Wj j Johnson known to me to be the person whose name is subscribed to the following, who, upon o h says: s: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not to bid thereon. I affirm that I am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other persoo engaged in this type of business prior to the official opening of this Bid. o,--, '-'/ Name of Bidder (I Address Phone Number Fax Number Affiant _ I Printed Name and Title of Affiant / i 1 0 , it �_ Email Address NJ MU'a(0)`.]IhII-Y-- rhM SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this. day of 20-2—.L_. , VENUS W. FORBESV A) Notary Public, State of Taxesc [G&, V Y 12 Comm. Expires 08-23.2024• Notary ID 4798068 Notary Public in and for County, Texas CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. thaw q 5-)knsonn,-^ Name and Title of Authorized f gent Signature,qKuthoriAd Agent I am unable to certify to the above statements. My explanation is attached. DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 19, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have govermnent-wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent pennitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a patty to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception pennitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. See. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe govertment-wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. See. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. JJ Name of vendor who has a business relationship with local governmental entity. 'SJ7S �g6 y LLG 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 71h business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information Is being disclosed. - Name of Officer - 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? ElYes Eg'Ao B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? F]Yes 5 'No 6 Describe each employment or business relationship that thevendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts ❑ as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor do g business with the governmental entity Date CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at hftp://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code G 176.001(1-a); "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code S 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government off icerora family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (1) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (1) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code & 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of afamily relationship with a local government officer. c--T _-...41-11.. 1--- thi,c ern . N .e Rnuisad 11/30/2n15 HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 I, 5� , � II__ I t�Whn�0r the undersigned representative of Representative n8 usLc oj) LIC (hereafter referred to as Company) being an Company or Business Name adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel; and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Code: 1. "Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for -profit sole proprietorship, organization, association, corporation, partnership, Joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. S gnature of Repre ative Sbawn t 6160 r\ Print Name & Title ncl I n4-120 zn Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount. RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252,001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252,001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. li I certify that is a "Nonresident Bidder' of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) ■ 1 certify that J -ITS J n-1C�(1� a "Resident Bidder' of Texas as (Company Name) defined in Government Code §2252.001. i Signature of AuthorizedAgent JcJhnson 10imar Printed Name and Ti le of Authorized Agent -Oil 10 4- I z.b 20 Date Form W'9 Request for Taxpayer Give form to the Identification Number and Certification requester. Do not Intpnal1 nt Dapadmctabe the thn Treasury send to the IRS. Internal Revenue servkre n Name (as shown on your income tax return) m SJS INDUSTRIAL, LLC nBusiness name, if different from above c 0 aCheck appropriate box: ❑ Individual/Sols proprietor ❑ Corporation ❑ Partnership ' © Limited liability company. Ester the tax classification (0=disregarded entry, _ C-co rporalion, P=parinarship) ► Fxempt ❑ `o _$ .... ❑Other (see insiructiom)► payee ,C a Address (number, street, and apt. or suite no.) Requester's name and address (options! a ¢ 121 PALO BLANCO DR CALHOUN COUNTY Ciry, state, and ZIP code 202 S ANN ST. PORT LAVACA, X 77979 re ROCKPORT, TX 78382 3615534610 FAX: 361.553.4614 List account numbers) here (optional) R i Taxpayer identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on Line 1 to avoid social seourily number backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part 1 Instructions on page S. For other entitles, it is your employer identification number (EIN). If you do not have a number, see Now to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. IMMMMMM Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer Identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a)1 am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that 1 am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For reel estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4. Sign I signature of Here U.S. xenon ► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, Income paid to you, real estate transactions, mortgage Interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA, Use Form W-9 only if you are a U.S. person (Including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving Is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form If it is substantially similar to this Form W-9, Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An Individual who is a U.S. citizen or U.S, resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that Is a partner in a partnership conducting a trade or business In the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership Income. The person who gives Form W-9 to the partnership for purposes of establishing Its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: • The U.S: owner of a disregarded entity and not the entity, Cat. No. 10231X Form W-9 (Rev. 10-290 DOCUMENT NO.00415 CONTRACTOR'S CORPORATE RESOLUTION I hereby certify that it was RESOLVED by a quorum of the directors of meeting on the that (Name of Corporation) day of ,20— , 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 (Name of Corporation) , and 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 day of , 20_ Secretary END OF DOCUMENT 00415-1 a DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of a..1 Iexo) County of A0 F ' )0'5 ) c)Y a W h o being first duly swom, deposes and says that: 1. He is 15 ha vvn -jo n 5 q n of d I'S lG i ush 1 1 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, this affiant. Subscribed and sworn tome this day of 20-M. 1 A (r r,, ,, _ , By: Q✓ LA4. ) 0 n , Notary Public My commission expires !�k— END OF DOCUMENT `:Oy...i�' VENUS W. FOBBES �.p..p.... ¢g, :at =YsNotary Public, State of Texas y % "� Comm. Expires 06-23-2024 11010 Notary 10 419BO59 00416-1 DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he desires. 1 , Name of Bidder: S 5t 1 rtclt f5i rta l ) a _ Date Organized: Address: 121c a Date Incorporated: c o _:5 3 Number of Years in contracting business under current name: _7 Are yqu a Section 3 business? (see below) ❑ Yes "o Section 3 Business Concerns.' a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract In excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipient's Jurisdiction that Identify themselves as Section 3 Business Concerns because they provide economic opportunities for low. and very low income persons. CONTRACTS ON HAND: Contracts DollarAmount Completion Date Type of work performed by your company: Have you ever failed to complete any work awarded Have you ever defaulted on a contract? List the projects most recently completed by your firm (include project of similar importance): �tcre(e INOrIL. Project DollarAmount MoNr Completed Sam T Gal (e ,) 2AZ) t1 LAAr, c�. c+ n2_o - i-ed5 �� `� C f`letJ coa3ht c;, )h I01 5r D nn o l 2t7 2D this cont Ct: Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. U I Credit available: � _Bank reference: The un rs geed herebtt authori as and requests any person, firm, or corporation to furnish any Information requested by they f10lAY\ 41UY1 in verification of the recite ��"YP ��ry VFCR Bidder's Qualifications. �.�.. �e ENUS W. BES Notery Public, State of Texas �i,/^t. B Comm. Expires 06-23-2024 Executed this da 202 „�a¢,. . Notary ID 4198059 by: Signature} (Title) END OF DOCUMENT ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040-0009 vamrzvae Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Certain of these assurances may not be applicable to your projector program. If you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant:, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, 8. Will comply with the Intergovernmental Personnel Act and the institutional, managerial and financial capability of 1970 (42 U.S.C. §§4728-4763) relating to prescribed (including funds sufficient to pay the non -Federal share standards of merit systems for programs funded of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in management and completion of project described in Appendix A of OPM's Standards for a Merit System of this application. Personnel Administration (5 C.F.R. 900, Subpart F). 2. Will give the awarding agency, the Comptroller General 9. Will comply with the Lead -Based Paint Poisoning of the United States and, if appropriate, the Slate, Prevention Act (42 U.S.C. §§4801 at seq.) which the right to examine all records, books, papers, or prohibits the use of lead -based paint in construction or documents related to the assistance; and will establish rehabilitation of residence structures. a proper accounting system in accordance with generally accepted accounting standards or agency 10. Will comply with all Federal statutes relating to non - directives. discrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) 3. Will not dispose of, modify the use of, or change the which prohibits discrimination on the basis of race, terms of the real property title or other interest in the color or national origin; (b) Title IX of the Education site and facilities without permission and instructions Amendments of 1972, as amended (20 U.S.C. §§1681 from the awarding agency. Will record the Federal 1683, and 1685-1686), which prohibits discrimination awarding agency directives and will include a covenant on the basis of sex; (c) Section 504 of the in the title of real property acquired in whole or in part Rehabilitation Act of 1973, as amended (29) U.S.C. with Federal assistance funds to assure non- §794), which prohibits discrimination on the basis of discrimination during the useful life of the project, handicaps; (d) the Age Discrimination Act of 1975, as 4. Will comply with the requirements of the assistance amended (42 U.S.C. §§6101-6107), which.prohibits discrimination on the basis of age; (a) the Drug Abuse awarding agency with regard to the drafting, review and Office and Treatment Act of 1972 (P.L. 92-255), as approval of construction plans and specifications. amended relating to nondiscrimination on the basis of 5. Will provide and maintain competent and adequate drug abuse; (f) the Comprehensive Alcohol Abuse and engineering supervision at the construction site to Alcoholism Prevention, Treatment and Rehabilitation ensure that the complete work conforms with the Act of 1970 (P.L. 91-616), as amended, relating to approved plans and specifications and will furnish nondiscrimination on the basis of alcohol abuse or progressive reports and such other information as may be alcoholism; (g) §§523 and 527 of the Public Health required by the assistance awarding agency or State. Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol 6. Will initiate and complete the work within the applicable and drug abuse patient records; (h) Title VIII of the time frame after receipt of approval of the awarding agency. Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination In the sale, 7. Will establish safeguards to prohibit employees from rental or financing of housing; (I) any other using their positions for a purpose that constitutes or nondiscrimination provisions in the specific statues) presents the appearance of personal or organizational under which application for Federal assistance is being conflict of interest, or personal gain. made; and 0) the requirements of any other nondiscrimination statue(s) which may apply to the application. Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7-97) Prescribed by OMB Circular A-102 11. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and federally -assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 12. Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 13. Will comply, as applicable, with the provisions of the Davis - Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327- 333) regarding labor standards for federally -assisted construction subagreements. 14. Will comply with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance If the total cost of insurable construction and acquisition is $10,000 or more. 15. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91- 190) and Executive Order (ED) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (a) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to State (Clean Air) implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 at seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205). 16. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 at seq.) related to protecting components or potential components of the national wild and scenic rivers system. 17. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a-1 et seq). 18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non -Profit Organizations." 19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. 20. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub -recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award. SIGNATURE OF AUT RI D CERI I OFFICIAL TITLE APPLICANT ORGANIZATI DATE SU MITTED S 5 ' LLC I o D+ ZOZO JY-4[4u tttev. r-ar) Caox Insert System for Award Management (SAM) Record Search for company and company principal(s). BM SAM SYSTEM FOR AWARD MAWFAMW Shawn Jol !J] ALERT: SBA connectivity is experiencing an outage. For questions about small business size status, users should return later or contact SEA directly(, ® ALERT: SAM.gov will be down for scheduled maintenance Saturday, 09/12/2020 from 8:0o AM to 1:0o PM. Entity Dashboard r Entity Ovendew . Entit3LM9i9ration r Core Data Assertions r Reps 8r CeTts r POCs r Reports Sjs Industrial, LLC 2io4 Marshall Ln DUNS: GE Code: 889S1 Aransas Pass, TY, 78336-61 _ Status: Active UNTIED STATES Expiration Date: 05/11/2021 Purpose of Registration: All Awards Entity Overview ............. r Service Contract Report ) BioPreferred Report r Exclusions r Active Exclusions . Inactive Exclusions : Exeluded Family Members R2N'i+D Sih'ltCfi: ,.:.: IBM-P-20200824-1154 WWW3 .. _............ Entity Registration Summary Name: Sjs Industrial, LLC Business Type: Business or organization Lest Updated By: Shawn Johnson Registration Status: Active Activation Date: 05/11/2020 Expiration Date: o5/ti/2osu Exclusion summary Alive Exclusion Records? No Search Records Disclaimei Data Access Accessibib Check Status Privacy Pc About Help C I c' BID J Lr lei �� "'S �Gl� S�(1 tL j/a�} ( , hereinafter called "BIDDER", (Legal Firm Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". 1. Terms used in this BID 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 Daysafter 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. 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. 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 A: MAGNOLIA BEACH BOAT RAMP MpROVEMENTS BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS ----------------- AMOUNT Al 1 LS Furnishing Mobilization and Insurance as per plans and �— specifications for a lump sum price as per plans and specifications for a turn sum price of MLp-U4 Ct f'lrouSa Dollars 0�_ and �C Cents. $ 1Q 6 r A2. 1 LS ' Furnishing materials, equipment and labor for the construction and removal of a temporary coffer dam to include dewatering to allow for the installation of two concrete ramps including the removal and reinstallation of a section of the existing wooden pier as per plans and specifications for a lump sum price of and �rr Dollars lvg Cents` $ tX A3. 1 LS Furnishing equipment and labor for the demolition and disposal of the existing concrete ramp as per plans and specifications for a lump sum price of Ii 12 , 1 and Cents. A4. 1 LS Furnishing materials, equipment and labor for the installation of two reinforced concrete ramps (15' x 605 as Per plans and specifications for a lump anTrice of .UP Vl 'Q.191n1 —_ _I I-l. J �i R �k " Dollars 1 and _ O Cents. $ d 00300-3 -------------------- ------------------ BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT A5. 1 LS Furnishing equipment and labor for the removal by either — mechanical or hydraulic means of approximately 1,200 CY Of silt materials to the dewatering site and Geotube® (if hydraulically dredged) also including phasing and sampling of material and containment structures (temporary barriers) and .decant structures as required for USACE & TCEQ compliance and reconstruction of damaged areas and paved areas as per plans and specifications for a lump sum price of �{ r Dollars and /v6 Cents. A6. 1 LS Furnishing materials, equipment and labor for the installation of 270 Sy Of cement stabilized sand and general regrading of area and additional cement stabilized sand in front of the new boat ramps and removal of vegetation and trees as required to facilitate work and access to the ramps as per plans and specifications for a lump su�? price of C 12U-P V1 e3LtSC, P Dollars and C40 Cents. $ II TOTAL BASE BID A AMOUNT, for Magnolia Beach Boat Ramp Improvements, being Items Al thm A6 bove is: W u n L A l _1 +61A Sa �i (r' DOLLARS a � CENTS. $ Q (� CALANDAR DAYS_ 00300-4 OWNER'S OPTION —MAGNOLIA BEACH BOAT RAMP IMPROVEMENTS — DE------SCRB'1'IONOF---N--------- BID BID ITEMWITA--- _--------- ---- --------- — ------- ��_. ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT A-Ol 1 LS Furnishing equipment and labor for the movement of the dewatered dredged materials (1,200 CY) including allowance for phasing of the material to be moved from the dewatering site to a County site within 10 miles of project as per plans and specifications for a ump sum price of Dollars and oa Cents. $ ADDITIONAL CALANDAR DAYS -F+-F-F.+f-Fi-II--F-F�-:rr+.i-F'+'H-++4-F-F++++-H-++++i-i--F++i� BASE BID B: SIX MILE PARK BOAT RAMP IMPROVEMENTS BID BID DESCRIPTION OFITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS lE LS Furnishing Mobilization and Insurance as per plans and specifications for a lump sum price as per plans and specifi 'ons for a lump sum pri a of Dollars and 0 Cents. LS Furnishing materials, equipment and labor for the construction and removal of a temporary coffer dam to include dewatering to allow for the installation of one reinforced concrete ramp as per plans and specifications for a lump sum ace 1of lX �� nr1� Cq r Dollars and N Z? Cents. 00300-5 AMOUNT a Q� $ oac, — QO $ S6 Gov - TH---------_--- B DID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT B3. 1 LS Furnishing equipment and labor for the demolition and disposal of the existing concrete ramp and approximately 275 LF of existing concrete cap as per plans and specifications for a lump sum price of Dollars and Cents. Qo B4. 1 LS Furnishing materials, equipment and labor for the installation of one reinforced concrete ramp (15' x 60D as per plans add specifications for a lump su price of (a2r1A1 ��uQ ilwuSa �rr Dollars and Ind Cents. �— B5 1 LS Furnishing materials, equipment and labor for the removal by either mechanical or hydraulic means of approximately 1,600 Total CY split into Dredge Area 1 and Dredge Area 2 of silt materials to the dewatering site and Geotube® (if hydraulically dredged) also including phasing and sampling of material and containment structures (temporary barriers) and decant structures as required for USACE & TCEQ compliance and reconstruction of damaged areas and paved areas as per plans and specifications for a lump sum price Of U�nQ �ntuv��-�lniYi-�) �-2veti� 1 U1°LIAA Dollars 1� and _ 06 Cents. B6. I LS Furnishing materials, equipment and labor for the T construction of approximately 275 LF of reinforced concrete bulkhead cap as per plans and specifications for a lump sum price of Dollars and Cents. AO $ ��' 00300-6 BID BID DESCRIPTION OF ITEM WITH ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT B7, 1 LS Furnishing materials, equipment and labor for the installation Of approximately 26 concrete cap drains as per plans and sFecifications; fora 1wnD sum price of Dollars ev •'' and I 0 Cents. $ &W , i B9. I LS Furnishing materials, equipment and labor for the installation of approximately 100 SY of concrete stabilized sand as per plans and specificati ns for a lump sum price of Dollars and. G Cents. ov $ D Ot7ZJ, B9 1 LS Furnishing materials, equipment and labor for the repair of approximately 150 LF of the existing timber breakwater as per plans and specifications for a 1 p sum price of Dollars and �l5 Cents. $ laid. B10. 1 LS Furnishing materials, equipment and labor for the e installation of approximately 19 timber pilings and approximately 120 LF of 4"X6" timber wafer as per plans and specifications for a lump sum $rice of Dollars r and NG Cents. a $ d 66z6,'� B11. 1 LS Furnishing materials, equipment and labor for the installation of approximately 125 LF of Duramax 100 Series DB-115 Dock Bumper or approved equal as per plans and specifications:for a lump s1pm price of Dollars and Cents. ©� 00300-7 B12. 1 LS Furnishing materials, equipment and labor for the installation of 0.5 CY of concrete stop gap, as per plans and specifications for a lump sum price f 1 Dollars and [Vo oG Cents. TOTAL BASE BID B AMOUNT, for Six Mile Park Boat Ramp Improvements, being ItemsB 1 thru `B 12 above, fis: ttrep Z DOLLARS CENTS. CALANDAR DAYS $ 39 &'J. (1-6) Ln 11 1 ++++++++ 1 1 1 1 ++H-}+err-i ++++-H++4-++4 ... .1 1 FrT++++++++++ OWNER'S OPTIONS — SIX MILE BOAT RAMP IMPROVEMENTS _-------_--_-- --_— BID BID DESCRIPTION OF ITEM WITH -- —� �— --- - -- -- - — ITEM QTY. UNIT PRICE WRITTEN IN WORDS AMOUNT B-01 I LS Furnishing equipment and labor for the movement of the dewatered dredged materials (approximately 1,600 Cy) including allowance for phasing of the materials from the dewatering site to a County site within 6 miles of project as per plans and specifications for a I p sum price of Vl� and _ ( 0 Cents. ADDITIONAL CALANDAR DAYS k B-02 1 LS Furnishing equipment and labor for the installation of approximately 275 LF of 4' wide reinforced concrete sidewalk as per plans and specifications for a lump sum price of _ t Dollars 60 and fJ b Cents. $ 2 066, ADDITIONAL CALANDAR DAYS k 00300-8 +++++-H4+-H-++++++++++-1-+++-FL-�++r+i-r-F-1--F-F+++-F++-F++++rrT-r+++f-1 +++++++++-I-+++++++-H--H444-r+++++++i-I-}+++++}F.}+++t+'rT--r............. TOTAL COST to complete the 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS SHOULD BIDDER ELECT TO BID ON BOTH PROJECTS being TOTAL BASE BID A + TOTAL BASE BID B above is: OLLARS CENTS. ++++.-;..4+T++t++++++++1++ +++++��T II 11++++1+++ The 5% BID BOND is based on the GREATEST AMOUNT BID, being either BASE BID A and/or BASE BID B or the SUM OF BASE BID A + BASE BID B Commissioners' Court reserves the right to award these bids on the basis of lowest and/or best bid, to waive any formality or irregularity, to make awards to more than one bidder, to accept and/or reject any or all bids, and to be the sole judge in determining which bid will be most advantageous to CALHOUN COUNTY. +-F1 0 1 H-F-'T}}+}.. +++++; �T+rTr+++i+F+F! i 9 00300-9 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions 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: DOCUMENT No. 00135 - REOUD2ED BID SUBMITTAL INSTRUCTIONS 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this a day of_ J ept(',, 4r- 2020. Authorized Signature: �v✓� n I S; Attesting Name: (- (T L f(Lq d`+--I Title: L f-A' Legal Firm Name: n ( -� JCS CeVjjjriaC nM (�2 7 Business Address: P Q. (� ( �q G(eUe[o %x �D 3i Q Phone Number: Facsimile Number: 41- S-i z- 9�q E-Mail Address (optional): Ss Con 4V,,4 L&t State of Incorporation, if applicable: State Contractor License No.: END OF DOCUMENT 00300-10 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Shirley & Sons Construction Co., Inc. as PRINCIPAL, and Harco National Insurance Company , as SURETY are held and firmly bound unto (CAL.HOUN COUNTY, TEXASI hereinafter called the "Local. Public Agency*. In the penal sum of Five Percent of the Greatest Amount Bid Dollars, ($ 5% G.A.B. ), lawful money of the United States, for Me payment of whkfih sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, sucoossors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated September 8, 2020 , fer: 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS — Magnolia Beach Boat Ramp Improvements and Six Mule Park Boat Ramp Improvements. NOW, THEREFORE, the Principal shot not withdraw said Bid within the period specified therein after the opening of the same, or, If no period be specified, within sbdy (60) days after the said opening, and shall within the period specified therefor, or If no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter Into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter Into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between Me amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, t the latter be in excess of the former, then the above obligation shall be void and of no effect otherwise to remain In full force and virtue. IN WITNESS THEREOF, the above parties have executed this Instrument this 8th day of September, 2020 . the name and corporate seat of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body - (SEAL) Shirley & Sons Construction Co., Inc. Attest 4* By:(SEA L) . S ey, II, President Affix Corporate Seal Haab National Insurance Company . Attest By: 44vL J N. Berry, Attoimen-Fact Affix Corporate ' ' ` . Seal Attest By: Countersigned BY Attomey-in-Fact, State of Taxes CERTIFICATE AS TO CORPORATE PRINCIPAL 1, G.D. Shirley , oartify that I am the Secretary of the Corporation named as Principal in the bid bond; that Ronald R. Shirley, II , who signed the sold bond on behalf of the Principal was then President of said corporation; that I know his/her signature, and his/her signature thereto Is genuine; and that said bond was duly signed, sealed, and attested to, on behalf of sold corporation by authority of its governing body. Corporate Seal Title: Secretary Power -of -attorney for person signing for Surety Company must be attached to bond. POWER OF ATTORNEY Bond# NIA HARCO NATIONAL INSURANCE COMPANY INTERNATIONAL FIDELITY INSURANCE COMPANY Member companies of IAT Insurance Group, Headquartered: 702 Oberlin Road, Raleigh, North Carolina 27605 KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and appoint JAMES N. BERRY Houston, TX their true and lawful attomey(s)4n-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had been duty executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney Is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018. "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attomeys-in-Facl or agents with power and authority as defined or limited In their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments ofjoint-control custodians, agents for acceptance of process, and Attomeys-in-fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY have each executed and attested these presents on this 31st day of December, 2018 ......... co aSTATE OF NEW JERSEY STATE OF ILLINOIS ?Otr''NOCounty of Essex / County of Cooktoe• Kenneth Chapman •`•,?r *;T"" Executive Vice President, Hama National insurance Company •••• and International Fidelity Insurance Company On this 31 st day of December, 2018 , before me came the individual who executed the preceding instrument, to me personalty known, and, being by me duty swom, said he Is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duty affixed by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written. jam. Q. Shirelle A. Outlay a Notary Public of New Jersey My Commission Expires April 4, 2023 CERTIFICATION 1, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companiesas set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are wrred transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and Is now in full force and effect. ' • t -. IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, September 08, 2020 A02198 Irene Matins, Assistant Secretary IMPORTANT NOTICE To obtain information or make a complaint: You may contact your Harco National Insurance Company at: 1-800-333-4167 You may also write to: Harco National Insurance Company c/o IFIC Surety Group at: Ann: Claims Department One Newark Center, 201' Floor Newark, NJ 07102 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: www.tdi.texas.gov E-mail: ConsumerProtectionnn,tdi.texas.2ov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent or the company first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR BOND: This notice is for information only and does not become a part or condition of the attached document. AVISOIMPORTANTE Para obtener informaci6n o para presentar una queja: Usted puede comunicarse con so Hareo National Insurance Company al: 1-SM333-4167 Usted tambien puede escribir a Harco National Insurance Company do IFIC Surety Group at: Attn: Claims Department One Newark Center, 206 Floor Newark, NJ 07102 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companies, coberturas, derechos o quejas al: 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 490-1007 Web: www.tdi.texos.2ov E-mail: ConsumerProtectionCa)tdi.texas.eov DISPUTAS SOME PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a on reclamo, debe comunicarse con el agente o la compania primero. Si no se resuelve In disputa, puede entonces comunicarse con el deparamento (TD4 UNA ESTE AVISO A SU FIANZA DE GARANTIA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. AC br CERTIFICATE OF LIABILITY INSURANCE DATE(MMIGO/YYYY) D9/Daz9zo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. N SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not Confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 06NTeCT Jim Berry, CPCU, CIC, ARM BERRY INSURANCE AGENCY P. 0. BOX 130625 HOUSTON, TX 77219-0625 _ PHONE (713) 266-5041 F^xNe: (713) 797fi778 EE RIL 1beny0411@gmail.com INSUREPAS) AFFORDING COVERAGE NAICC INSURERA: Argonaut Insurance Company 19801 INSURED INSURER B: American Fire and Casualty Company 21113 SHIRLEY & SONS CONSTRUCTION CO., INC. DISURERC: Star -Stone National insurance Company 25496 P.O. BOX 429 INSURERD: Texas Mutual Insurance Company 22945 CLEVELAND, TX 77328-0429 INSURER E: Evanston Insurance Company 35378 INSURER F: COVERAGES CERTIFICATE NUMBER: RIVIRION NUMRLR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE L SUBR POLICY NUMBER P YEFF PO OCYEXP UNITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIALGENERALUABILRY CIAIMS-MADE OCCUR PREMGET EBENIED ce S 100,000 MEO EXP( one person) S 5,000 A Y Y 11111sm 05/25/2020 05/25/2021 PERSONAL& ADV INJURY $ 1,000,000 GENERALAGGREGATE S 2,000,000 GEMLAGGREGATEUMR APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 PoucY X PRO- LOc $ AUTOMOBILELIABILI X Y ANYAUTO COMBINED SINGLE UMIT Ee amldent 1000,0()0 BODILYINJURY(P ;Ierson) S B X ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS X ANIOROSWNEO Y Y 04130/2020 04130/2021 BODILY INJURY (Per acdden) $ PoOPEERrY DAMAGE $ $ C X UMBRELLA LIAB EXCE 8m=" X OCCUR CLMMSMADE Y Y 05/25/2020 05/2512021 EACH OCCURRENCE S 5.000,000 AGGREGATE $ 5,000,000 DEC RETENTIONS $ WORKERSCOMPENSATION X I WC STAT% OTH- D AND EMPLOYEW ILIABIL TY ANY PROPRIETOMPARTNEMEXECUOVE YIN OFFICERIMEMBEREXCLUDEDT (Mandatory in NH) Ifyee, deeddbe under DESCRIPTION OF OPERATIONS babe NIA Y - 10/21/2019 10/21/2020 EL EACH PCCIDEm $ 1,000,000 ELDISEASE-EABuPLOYO S 1,000,000 EL DISEASE -POLICY LIMIT $ 1,000,OOD CONTRACTORS POLLUTION E LIABILITY Y Y 05125/2020 05/25/2021 Each Pollution Condition Limit: $2,000.000 DESCMI NOFOPERATIONS/WO MONSIYENICLES (ALW ORD101,Addit lRmm Sc ub,Bmaresllaaa la nqulnd) Ref: Calhoun County Busing Access Improvements - Magnolia Beach Boat Ramp Improvements & SIX Mlle Boat Ramp Improvements Certificate Holder is included as Additional Insured for both ongoing and completed operations with primary & noncontributory wording and Waiver of Subrogation on a blanket basis as required by written agreement. CALHOUN COUNTY 211 S. ANN ST., THIRD FLOOR, SUITE 301 PORT LAVACA, TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. M.-M 0 The ACORD name and logo are registered marks of ACORD CERTIFICATE AS TO CORPORATE PRINCIPAL ce@rtify� that I am the Secretary of the Corporation named as n Principal in the bid bond; that �I (.G� W �f J [t, /trawho signed the said bond on behalf of the Principal was then Y i S v) i _ of said corporation; that I know his/her signature, and his/her signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, on behalf of said corporation by authority of its governing body, Corporate Seal Title: 5CY-9 1 Power-of-attomey for person signing for Surety Company must be attached to bond. DOCUMENT NO.00411 REQUIRED BID SUBMITTAL INSTRUCTIONS FOR: 2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS - Magnolia Beach Boat Ramp Improvements and Six Mile Park Boat Ramp Improvements One Unbound Original of the ENTIRE Bid (00300), with all required fors included and or filled out, signed and dated must be returned by the time and date due. Check List for submitting your Bid: Be sure all necessary forms are included and or completed, signed and dated Submit one unbound original Bid Form (00300) Submit Bid Bond (00410). A Bid Bond in the amount of 5% of the greatest amount bid, issued by an acceptable surety. A certified check or bank draft payable to CALBOUN COUNTY or J/negotiable U.S. Government Bonds (as par value) may be submitted in lieu of the Bid Bond. Certificate of Liability Insurance - Please provide a copy of your Certificate of Liability Insurance (proof of required coverage). * Once bids are awarded, the bidder(s) that are awarded bid(s) must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) and on ALL POLICIES name CALHOUN COUNTY as an additional insured for all insurance requirements, by policy endorsement, along with CALHOUN COUNTY's Employees and OWNER's Engineer as ADDITIONAL INSURED and must provide coverage to the maximum extent permitted by law. The additional insured endorsements shall be on the ISO CG201011185 form or CG 2010 (10/93) in combination with CG 2037 of CO 2033, or suitable form equivalent. Reference Document No. 00705 - Calhoun County General Conditions and Document No. 0820 Insurance Requirements Be sure to complete the following. If a qua ion or form is not applicable, mark the question or form with "N/A" Affidavit ertificate of Interested Parties, Form 1295 Certification Regarding Debarment & Suspension and Other Responsibility Matters Conflict of Interest Questionaire, Form CIQ � House Bill 89 Verification 4'W",9 idence Certification 00411-1 No. 00415 — Contractor's Corporate Resolution No. 00416 - Noncollusion Affidavit ✓/ document No. 00420 — Bidder Qualification Statement ssurances — Construction Programs System for Award Management - CONTRACTOR must not be debarred or suspended from the Excluded Parties List System (EPLS) in the System for Award Management (SAM) and must have an active registration with the System for Award Management (www.SAM.gov), Include verification that your company is registered and that the company's principal is not listed (is not debarred) through the System for Award Management CM=--SAM.Qovl. I nclose a print out of the search results that includes the record date, Do Not Fold any of the above information. Bids must be returned in a 9 x 12 or larger envelope clearly marked: SEALED BID —2020 CALHOUN COUNTY BOATING ACCESS IMPROVEMENTS Submit Sealed Bid to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 00411-2 Bidder must Insert a copy of Certificate of Liability Insurance showing proof of coverage required under this Bid Package. ** Once bids are awarded, the bidder(s) that are awarded bid(s) must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) and on ALL POLICIES name CALHOUN COUNTY as an additional insured for all insurance requirements, by policy endorsement, along with CALHOUN COUNTY's Employees and OWNER's Engineer as ADDITIONAL INSURED and must provide coverage to the maximum extent permitted by law. The additional insured endorsements shall be on the ISO CG2010 11185 form or CG 2010 (10/93) in combination with CG 2037 of CG 2033, or suitable form equivalent. Reference Document No. 00705 - Calhoun County General Conditions and Document No. 0820 Insurance Requirements STATE OF TEXAS {} AFFIDAVIT COUNTY OF CALHOUN {} BEFORE ME, the undersigned authority, on this day personally appeared &" RIJ S k i i 4 � r— known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit Is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not to bid thereon. I affirm that I am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant In connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this Bid. G Affiant C�,�l,<'�1 &S Printed Name and Title of fflant Name of Bidder Address Phone Number Fax Number Email Address 1 Iz.- -7y he i� SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this V_ day of Se p iP 1L1eC , yD ZG t yPjm., tAURACLPUBLIC NOTARY PUBLIC • 10# 10931284 State of Texas comm.6=. e4-17-2021 Notary Public in and for LI g razxI County, Texas LED CERTIFICATE OF INTERESTPARTIES FORM 1295 iofl Complete NOS. 1- 4 and 6 it there are Interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. Name of business entity filing form, and the city, state and a of business. shidey & sons construction co.,inc. CLEVELAND, TX United States being filed. Calhoun County business OFFICE USE ONLY CERTIFICATION OF FILING Fled: Acknowledged: 3 movtae ms tvenvocavon number used by the governmental amity 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. 9317.047 & 9115.026A 2020 Calhoun County Boating Access Improvements 4 I Nature of interest Name of Interested Party City. State, Country (place of business) (chock applicable) Cheek only If there Is No Interested party. ❑ X l Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84" Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity? includes a sole Proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency Is the objective of the law. Senate Bill 255 adopted by the 85°' Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.00I of the Utilities Code. Notarization of Form 1295 has been replaced by an unswom statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal htms://www.ethics state.tx us/wbatsnew/elf info forml2951tm, A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COWLAINCE Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belie% that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or bad a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1)-(a— d) of this certification. f Name and Title of Authorized Agent Signs eofA thorizedAgent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370,3 CFR, 1986 Camp., P. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section I(c), Executive departments and agencies shall participate hi a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. See. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow govemment-wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section S. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. S. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list, coordinate with tite lead agency responsible for govemment-wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32,S10, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R Part 32, there are a wide range of other sanctions that can tender a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. r ICONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 841h Leg., Regular Session. OFFICEISEONLY This quesficnnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Cale Recelved has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be tiled with the records administrator of the local governmental entity not later than the 71h business day after the date the vendor becomes aware of facts that require the statement to be flied. See Section 176.006(a-1), Local Government Code. A vendor commits an offense ff the vendor knowingly violates Section 178.006, Local Government Code. An offense under this section is a misdemeanor. Name of vendor who has a business relationship with local governmental ent(ty. S�r� I �-s� Co 2 ElCheck this box if you are 0114 an update to a previously filed questionnaire. (rho law requires that you file anupdated completed questionnaire with the appropriate Citing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was Incomplete or inaccurate.) Name of local government officer about whom the Information Is being disclosed. � Name of Officer Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B foreach employment or business relationship described. Attach additional pages to this Form CIO as necessary. A, is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes ED No S. Is the vendor receiving or likely to receive taxable Income, other than investment income, from or at the direction of the local government officer or a family m mber of the officer AND the taxable Income is not received from the local governmental entity? FlYes E!fNo Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership Interest of one percent or more. f— ❑ Check this box If the vendor has given the local government officer or a family member of the officer one or more gilts as described in Section 176.003(a)(2)(8), excluding gifts described In Section 176.003(a•1). r Sign pure of vendor dori buamoss with the govemmental enhly l Data Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11i30M016 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomptete copy of Chapter 176 of the Local Government Code maybe found at htip://www.statutes.legis.state.tx.us/ DOGS/LG/htm/LCa176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code 6176.0010-0): "Business relationship"means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods orservices from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Loa] Government Code 4176,003(a)(2)(A) and (B)• (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer ora family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (1) a contract between the local governmental entity and vendor has been executed; or (11) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officeror a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the 'officer becomes aware that: (1) a contract between the local governmental entity and vendor has been executed; or (it) the local governmental entity is considering entering Into a contract with the vendor. Local Government Code a 176.006(a) and (a•1) (a) Avendor shall file a completed conflict of Interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter Into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. r•orm provx1e0 by 10115 F=MIW COrnmiesbn www.ethics.stats.tx.us Revised 11/a012015 HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 1. �6 11 S�1r Y _ the undersigned representative of i RepresentativeC S►� \ klj SEQ-) (bh CO. Z nC , (hereafter referred to as Company) being an Company or ksinessName adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel; and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Lode. I. Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that Is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person arentity doing business in Israel or In an Isroelf-controlled territory, but does not include on action mode for ordinary business purposes; and 2. Company" means a for -profit sole proprietorship, organization, association, corporation, partnership, Joint venture, limited partnership, limited Iloblgty partnership, orany Ilmited liability company, Including a wholly owned subsidiary, majooty-owned subsidlary, parent company or affiliate of those entities or business associations that exist to make a profit. Signature of Representative A,—J s ,c4,i Print Name & Title am I—w— 7o Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount. RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. ■ 1 certify that (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has Its principal place of business in this state. Is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (Ulyand5tam) ■ i certify that _SL,,f lei �P�S (�, Uv\ is a "Resident Bidder" of Texas as Company Name) defined in Government Code §2252.001. Signature of Authorized Agent PNnted Namvve and Title of Authonzeci Agent —0—�6 Date Form W -9 I i UT MW Request for Taxpayer owe Form to me Identification Number and Certification requester. Do not ►0otowww.ftmce/FonnxmmrIn. on....•axeI..-rr..._. I sod to the IRS. t (m enyadrGworna taxmtm). taquked antis Ana, danstlMw Wehbecenk 1if, 2 6u—aemdtlleregaNed MMY mme,IfCMarem from above t k� G> E� oSJ a duck eppmpdme rwfedemlr®camrAratbn of me IOAawma svnIn Dozes, paean whoeenemehenlemd on dl•1. CfbMraMYone of the wdkl (not o ❑ IndNlduayeo7 www 0`G m muon ❑ aGovemuse ❑ Partnership ❑ Thast/estwe carldn Ir4Mdyonlylo dnawa roam not see NeWatlmwenPe➢s➢$ t� drlgkr-memhur LLO Lo 001114am00codeftiwM1, �j ❑ LhftdllabNhowvww 6nbrahs fax CIWRowlon Poo Cows wI, W3 cmPueuan. P.Patteddhwo) $ NOW. Chwk4a epppogldda Dwtt the Jim above trthetxoleeeHkatlalM➢uafn➢y.nsober ownv, Do not shaft LLCHthe LLOtdaadfletl GaetabnxvnbwLLCuralladDm➢ercled from am mmaruMeas Hie owner of the LLoie t]ernpHonfromFATCAmpatln➢ mother LLo that best d➢emgerded from the owner for U.B. U.a. ledamlhe xpuposat owiea,seNyemember LLolh Ie dbmgudedfmm the vesu rsluuld rhuRthe eppmpHtle bar fwthe hetdewltcdlan alus owdhw. e0reny) 0uar(eee1m6uotione)► 14ri wwwwsraa! e Aedfe69(mxnMOr ~,and apt. waft nQ3eolmWmbna Hequsater'e rows endaddrpa(apHma4 (ape IO „Jd fJ LA G CALHOUN COUNTY a uW, etwa eon ZIP ° L 202 S ANN ST, PORT LAVACA TX 77979 v`�lq a 4S 361-353.4610 FAX: 361-553.4614 7 Itt edrount nuMhada) hem (odlsneD • _MustT..e��..�_.J��.,e__a. • i .u. _ cnwr Yaur d im m aha apProPnata nmr, TaeTIH ProNded must match the namo gNwh on line 1 to avdd backup mien, lift. For lnd a d • the le gwwdY your social security number OM. However, for a resident ata entitles, k in Yaw employer lde on numbers((EIM ll you do rat have ta number. to other TIN, later. Notez Iftthe account is In more than one nuns, see the Instrudlone tor the 1. Alm see Whatl4 me and A4rmber7b GAS ea RequesterforgUkfelfnes on whom mrmberto hurter. Underpenalues 1. The numbere 2.1 am rat etlbb far a number to be 3.1 am a U.S, dOxen crotherU,G. parson (deffned below); and 4. The FATCA cod*) entered on this form Of any) Indicating that I am exempt from FATCA vacation is correct. uenerai mstruotions Form 10994MV (dividends, Including those from stooks orMuWW necd. don referees; am to the Internal Revenue Cods unless othensiss Kinds)- Form adoustypes of Income, plans, Imarda, orsu asums Furors dwratepmonte. Forthe latest Informadon about dovelopments related toFsrm W-0 and Its Inabuatloru, such ea Marten enacted sggg-MW .Form 109g-8 (stock ormutuelfimd mW end cedsln other afterthe/were puhl(ehed, got* www.6sgov/FonnWB. hwtedtcna by txock Purpose of Form •Form 10W-g(pmoewb from real estate tmnsedorha) • Form 10W-K(merehantcard and third party tmt➢alltgeidBCtlom) An individual oreniky (Form W-0 requesks) who Is required to Me an Information return Willi the MS must obtain your consul taxpayer • Form 1098 Owme mortgage Imersey, 10911-E (student Jaen hderssq, loga-TOu" Identification number(IM which may be your amW security number MON), Individual humayerldentlgcatlon number OON), adoption • Form 109" (canceled debq taxpayer Idwhtlgcadon rmmber(ATI14 cremployer Identification number •Form 1011s-A(d W181tlon orabandonment of secured pmpmty) MIN), to report on an Information return the amount peld to you, of mbar Use Form W-9 only ryou are a U.S. jo mon Ondadh8 areddwn amount reportable ananlnformelbnrotum.l0mmpksoflnfomulbn RION,toprovldeYaw cormetTIN. realms Include, but are not Iknhad to, the following. HYoudo Mot mk=Form W-9 to gre rsgda9fWWlth a71N, youmlgbt • Form 1099-INT Ontameteemed orpW4 b9 W*dtto bw*W Wubbold/tg, See What Is backup withholding, later. Got. Na toPmix F&MW-9ow. 1O- MG) DOCUMENT NO.00415 CONTRACTOR'S CORPORATE RESOLUTION certify that it was RESOLVED by a quorum of the directors of I (Name of Corporation) meeting on the -.. V— day of IS::Ppig vim. l -2 that /.(M9 �� J`� If LP'-j A i d 1161 be, (Name ofPrincipal) (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 S� i r Sif W+;61 (U, .-t IC -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 ry day of j2 v` � Q r a 20 0 icre END OF DOCUMENT 00415-1 DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of County of U�d- j ) eI GLi� O .5�1 tT�. being first duly sworn, deposes and says that: L 1, He is oy QS l A of . � 1^ 4 4- q3 C&i 4i0) 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) . �( Title Subscribed and sworn to me this p day of Se p,�, ,y4 r 2070 . By:_, e. My commission expires q' in' 2821 Notary Public END OF DOCUMENT MM EONARD PUBLIC31264Teas 04-it-2021 00416-1 DOCUMENT NO. 00420 BIDDER QUALIFICATION STATEMENT All questions must be answered and the data given must be Gear and comprehensive. This statement must be notarized. If necessary, questions may be answered orf separate attached sheets. The Bidder may submit any additional information he desires. Name of Bidder: Nan i rle�l �S Cz,4uc ;&, Date organized: Address. PO, 66A r A Date Incorporated y-l'r ) 4 Number of Years in contracting business undercurrent name: 4_ Are yqu a Section 3 business? (see below) ❑ Yes d No Sec6en 3 Business Concerns: a) Businesses that are 61 percent Of more owned by section 3 residents; - b) Businesses whose pemrarlem, full-time employees include poisons, at least 3D percent of whom are currently Section 3 residents, or within three years of the dote of Piet employment whh the firm were Section 3 residents; n) Businesses that provide evidence of a contmMrent to subcontract In excess of 26 percent of the dollar amount of all subcontracts to be awarded to businesses that meet Ne qualifications deaadbed above; or d) Businesses located within the Gram Redplant's Jurisdiction that Idennry themselves as Section 3 Business Concerns because they provide economic opportunities for low. and very tow income persons. CONTRACTS ON HAND: Contracts Dollar Amount Comoletion Date Le /pe of work performed by your company: &.vat 1 4W� r ua Cc✓ 5 h� �� Have you ever felled to complete any work awarded to you? Have you ever defaulted on a contract? List the projects most recently completed by your firm (Include project of simllar Importance): - Project DollarAmount MOW Completed Willa:) ir�rktWP .6P 3 3, c3 842� willox3 Rrx EWnnrrP rti<tip Z 7 ZSFI Sl&.1C )ha,l Ir:7_Q equipment available for this contract: Attach resume(s) for the principal member(s) of your organization, Including the officers its well as the proposed superintendent for the project, Credit available; Bank reference: T The undersigns hereby authorizes and requests any person, firm, or corporation to fumish any Information requested by the (tile in veriflestlon of the recitals com�gA RkAr "NARD Bidders Qualifications. 4 sr.,. I AunA C LEONARD 'Xecuted this day of ZU '* ID# f0631264 �n& 20 •:!i� &i �9'A Camtate ofTexas vi Yee, Ignature) (Title) Wvazv co,TX END OF DOCUMENT 00420-1 ASSURANCES -CONSTRUCTION PROGRAMS OMB Number. 4040-OW9 Public reporting burden for this collection of information Is estimated to average 15 minutes per response, Including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20603. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE' Certain of these assurances may not be applicable to your projector program. it you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. if such Is the case, you will be notified. As the duty authorized representative of the applicant:, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non -Federal share of project costs) to ensure proper planning, management and completion of project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, the right to examine all records, books, papers, or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will not dispose of, modify the use of, or change the terms of the real property title or other interest In the site and facilities without permission and instructions from the awarding agency. Will record the Federal awarding agency directives and will include a covenant in the title of real property acquired In whole or in part with Federal assistance funds to assure non- discrimination during the useful life of the project. 4. Will comply with the requirements of the assistance awarding agency with regard to the dmting, review and approval of construction plans and specifications. 5. Will provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications and will furnish progressive reports and such other information as may be required by the assistance awarding agency or Slate. 6. WIII inifiete and complete the work within the applicable time frame after receipt of approval of the awarding agency. 7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of Interest, or personal gain. 8. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728.4763) relating to prescribed standards of merit systems for programs funded under one of the 19 statutes or regulations specified In Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). S. Will comply Win the Lead -Based Pain( Poisoning Prevention Act (42 U.S.C. §§4801 at seq.)which prohibits the use of lead -based paint In construction or rehabilitation of residence structures. 10. Will comply with all Federal statutes relating to non- discrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88352) which prohibits discrimination on the basis of race, color or national origin; (b) 7109 IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681 1683, and 1685-1686), which prohibits discrimination on the basis of sex, (c) Section 504 of the Rehabilitation Act of 1973, as amended (29) U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which.prohibits discrimination on the basis of age; (a) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616). as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd3 and 290 as 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 at seq.), as amended, relating to nondiscrimination In the sale, rental or financing of housing; (I) any other nondiscrimination provisions In the specific statue(s) under which application for Federal assistance is being made; and Q) the requirements of any other nondiscrimination statue(s) which may apply to the application. -'Previous Edition Usable Authorized for Local Reproduction Standard Form 424D(Rev. 7.97) Preahslbed by OMB Circular A-102 ' 11. Will comply, or has already complied, with the Federal actions to Stele (Clean Air) Implementation r requirements of Titles It and III of the Uniform Relocation Plans under Section 176(c) of the Clean Ak Act of Assistance and Real Property Acquisition Policies Act of 1955, as amended (42 U.S.C. §§7401 at seq.); (9) 1970 (P.L. 91.646) which provide for fair and equitable protection of underground sources of drinking water treatment of persons displaced or whose property Is under the Safe Drinking Water Act of 1974, as acquired as a result of Federal and federally -assisted amended (P.L. 93-523); and, (h) protection of programs. These requirements apply to all Interests in real endangered species under the Endangered Species property acquired for project purposes regardless of Act of 1973, as amended (P.L. 93-205). Federal participation In purchases. 12. WIII comply with the provisions of the Hatch Act (5 U.S.C. 16. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 at seq.) related to protecting §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment components or potential components of the national activities are funded in whole or In part with Federal funds. wild and scenic rivers system. 13. WIII comply, as applicable, with the provisions of the Davis- 17. WIII assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Act of 1966, as amended (16 U.S.C. §470), EO 11593 Work Hours and Safety Standards Act (40 U.S.C. §§327- (Identl6catlon and protection of historic properties), and the Archaeological and Historic Preservation Act of 333) regarding labor standards for federally -assisted 1974 (16 U.S.C. §§469a-1 at seq), construction subagreemenls. . 14. Will comply with flood Insurance purchase requirements of 18. WIII cause to be performed the required financial and compliance audits in accordance with the Single Audit Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood Act Amendments of 1996 and OMB Circular No. A-133. "Audits hazard area to participate In the program and to purchase of States, Local Governments, and Non -Profit Organizations.' flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 19. Will comply with all applicable requirements of all other 15. Will comply with environmental standards which may be Federal laws, executive orders, regulations, and policies governing this program. prescribed pursuant to the following: (a) Institution of environmental quality control measures under the National 20. WIII comply with the requirements of Section 106(g) of Environmental Policy Act of 1969 (P.L. 91- the Trafficking Victims Protection Act (TVPA) of 2000, as 190) and Executive Order (ED)11514; (b) notification amended (22 U.S.C. 7104) which prohibits grant award of violating facilities pursuant to EO 11738; (c) recipients or a sub -recipient from (1) Engaging in severe protection of watiands pursuant to ED 119W: (d) fors of trafficking in persons during the period of lime evaluation of flood hazards In floodplaina In accordance that the award is In effect (2) Procuring a commercial with EO 11988; (a) assurance of project consistency sex act during the period of time that the award Is In with the approved Stale management program effect or (3) Using forced labor in the performance of the developed under the Coastal Zone Management Act of award or subawards under the award. 1972 (16 U.S.C. §§1451 at seq.); (f) conformity of $ICNATU E OF AUT RIZED CERTIFYING OFFICIAL. TI7 E � APPLICANT ORGANIZATION DATE SUBMITTED S L;k Sys cltIS4461+i61 �. 1 c 1 I- 20 i qpd do tn. 7-1171 R.A Q a _ W � o sow o � A � m 1�1 0 1 y O � o E O +❑ V� m O Q N � wp N �Vl •M y A N O N c g H w° N 0 m d 7 O q F 'O 'fic N N d � b p � o o o ii u N C � M U J � O � F v, Ga :r< W P, a cu 0 V Q � a m a c N Ct f c E m m m` Q `c" E ... N #12 r " David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax(361)553-8734 Please place the following item on the Commissioners' Court Agenda for September 23rd, 2020. Consider and take necessary action to accept donation of Pergola constructed as a Bo Scouts Eagle Scout Project completed by Cade Query in the total amount of $4 3 Sinraraly_ #,3 :4 l2. 3(0 >? 1. ` 1, LOWE'S HOME CENTERS, LLC 8602 MONTH NAVARRO ST. 11 VICTORIA, 1'X 77904 (361) 573-7700 R_R't' — SALE — W.F.$N: 80282Ct11 Our>v °011434 64-I6-20 875076 PWRPRO ONE EXT I -LB 00 X 28.41 3 0 9.47 45997 12-01 UNIU SAT ESPRESSO B. t1.96 2 0 5.98 ,49Aifi 6-6 POST ANCHOR TL (-1527 157.92 4 0 39.48 1289434 9-a2 LOC PL. PREMIUM MAX 9.48 . 580256 OAK 5/16-IN X 5-I/8-IN EX 12.64 a 0 1.58 153404 OII 3XBIN Timm DRILL B 9.18 "E98 1'2�IN %STED SIRP MTN1E 32 0 1.13 489109 2-6-12 TC TREATED 02 PRIM 151,52 16 0 9.47 465130 6-6-8 TREATED 02 ARADE TI 87.06 4 0 21.77 59077 1/2-ill X 2-IN 2 HX LAO SC 9.12 16 0 0.57 • SUBPOTAL: 5t3.47 _ TAX: 42.36 INUOICE 45267 TOTAL: 555.83 VISA: 555.83 NYLOWF.'S CARO NUMBER: 481000517375174 VISAAXXXXXXXXRXX9036 ANOUNT:555.63 AUTHCOA18696 CHIP REFID:020245372426 04/18/20 11:00:01 CUSTOMER CODE: Goy scouts APL: Visa Credit TUR: 0000008000 'Ti,u. `HCUUiIU(IUCJ IIIL NI: LOU STORE: 0282 TERMINAL: 45 04/18/20 11:04:27 ua UFIGEFBS PURCHASED, a'? EXCLUDES FEES, SENUICES AND SPECIAL ITEMS jORDER THANK YOU FOR SHOPPING LOWE'S. .SEE REVERSE SIDE FOR RETURN POCKY. STORE MANAGER: BRAYDEN 0. ROBERi50N LORE'S PRICE MATCH 6UABABTEE FOR MORE DETAILS, VISIT LONES.CONIPRICEMATCH p'4yT#M###Rt###Mk#M#aA##4NF#Al#K:k#MM##MiM$##k#+###M#gdkA # SHARE YOUR FEEOBACKI - ENTER FOR A CHANCE TO BE ONE OF FIVE $500 NIINIERS ORABN MONTHLY! # iENTRE EN EL SORTED MENSUAL x PARA SER ONO BE LOS CIRO NARROWS BE $5001 r # ENTER BY C.OMPLETIN, A SNORT SURVEY x NITHIN ONE KEEN AT: m.IOaes.c!n/surueY Y 0 U R 10 8 452616 028251 099276 # # # NO PURCHASE NECESSARY lu ENTER OR MIH. Lr 7kA'*� �fonlrsriar 5. Inc BILL TO: AY- .VOC P.O. BOX25POINTCOMFORT, TX77978 (361) 551-4042 OF= -(361) 552-2095 FAX jessicap@conmetaYnc.com DONATION INVOICE #Donation-042020 DATE: 06/26/2020 Boy Scouts of America Troop #361: Cade Query & Calhoun County ATTN: Donation SHIPPED VIA PROJECT NO. CONTRACT NO. TERMS Con -Metal Contractors NET 10 QUANTITY DESCRIPTION OF WORK UNIT PRICE TOTAL 10 x 10 Pergola Foundation Labor and Material $3,750.00 $ 3,750.00 Con -Metal Contractors, Inc. Donation $(3,750.00) Total Due This Invoice $0.00 Make all checks payable to: Con -Metal Contractors, Inc. THANK YOU FOR YOUR BUSINESS!!! David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann , (361)552-9242 Port Lavaca, TX 77979 �� FaN Fax (361)553-8734 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, Please place the following item on the Commissioners' Court Agenda for September 23rd, 2020. Consider and take necessary action to accept donation of Pergola constructed as a Boy Scouts Eagle Scout Project completed by Cade Query in the total amount of $43 Sincerely, Q vid Hall DEH apt I I LOUE'S HOME CENTERS, LLC 0602 NORTH NAVARRO ST. -yk r VICTORIA, I77904 (361) 573.7100 lN�''X - SALE - �� OJ SHLE.'SM: 502821.0I liydl„u ,.,,,�"::• ?A2YSR3M1 ItW-IF-'±0 875075 PORPBO ONE EST 1-1.8 08 X 3 0 9.47 28.41 45997 12-01 UNIU SAT ESPRESSO B 11.96 2 0 5.96 ,49n7fi 6.6 POST ANCHOR 1Z (-1527 157.92 4 0 39.48 1289434 9-02 LOC PL PREMIUM MAX 9.48 . 580256 OAK 5/16-1N X 5-1/8-I0 EX 12.64 8 9 1.50 153484 NN 310IN TY1AN111N DRILL B 9.18 -°9b ' ---- 12-iN TWi,1E0 S14 MTBI2 -....-_— .a.I 32 0 1.13 489109 2-6-12 TC TREATED 02 PATH 151.52 16 0 9.47 465130 6-6-6 TREATED 02 ANNE TI 4 0 21.7.7 , 07.08 59017 1/2-IN X 2-IN 2 HX LAD SC 16 0 D.57 9.12 " , • SUBPO7A�.: 513.47 � � l7 1 TAX: 42.3i INUUIL'E 45267 TOTAL: 555,855.83 ' VISA: 555.03 HYLONF.'S CARD NUMBER: 481000511375174 UISA:XXXXXXXXXXXX9036 ABUUNi:555.83 AUTNCD:018696 CHIP REFIO:020245372426 04/18/20 11:00:07 CUSTOMER CODE: bay scouts API' Ill Cr Alt TVA0060008000- - so e . r . _... �,ir:'rcuunUuuuaiin• IN Will STORE: 0282 TERMHOL: 45 04/IB/20 11:04:L/ a OF ITEMS PURCHASED: a'? EXCLUOCS FEES, SERUICES AIR SPECIAL ORDER ITEMS THANK YOU FOR SHOPPINB LORE'S. SEE REVERSE SIDE FOR RETURN POLIO. STORE RANABER: BRAYDEN 0. ROBER,SOH LORE'S PRICE HATCH GUARANTEE FOR HOBE DETAILS, VISIT LORES.CON/PRICEHATCH +S*n#s#k##kk#ak#kxr#4'a4#kr#k*#k*kkYvk#ark##k##rr#rk*kkrk # SNARE YOUR FEEDBAC91 * ENTER FOR A CHANCE TO BE. r ONE OF FIVE $500 RINNERS BRAU'H NORTIN.Y! !ENTEE EN EL SORTED MENSUAL + k PARA SER ONO BE LOS CINCO BAHAOURES BE 8500! r # # ENTER BY C.ONPLETIN. A SNORT SURVEY * ViT FIA ORE BEEN AT: m1noes.cas/sum # Y 0 U R I 0 0 452616 028251 099276 r # r k NO PURCHASE NECESSARY It ENTER OR VIM. ..-. ..-..-._..... .,.—.,... — a,,. r. rn eu. .. #13 PRE -APPROVAL LIST COMMISSIONER CLYDE SYMA SEPT. 23, 2020 CROSSROADS TIRE $ 10,000 ESTIMATE ON SERVICE REPAIRS ON UNIT # 308 2012 DUMP TRUCK I NTL. 4300 7.6 Crossroads Tire Service, LLC. 9406 US Hwy 59 North Victoria, TX 77905 - 361-827-7694 9/14/2020 8:36:43 AM Repair Order #7905 Pagel CALHOUN COUNTY PRECINT #3 Phone: KLYDE 361-893-5346 24627 TX-172 PORT LAVACA TX, 77979 Service Writer : 0010 Vehicle : 2012International Durastar 4300 7.6 L 466 CID L6International Ma:atforce DT VIN : IHTMMAAMXCH436201 Tag/State :1346014/TX Fleet #/Driver:: 308 / Created : 9/4/2020 10:38:38 AM Odometer In : 1 Odometer Out : 1 ON Code/Tech* Deurintion Condition Unit am MECHANICAL SERVICE CALL $210.00 Note: SERVICE DATE: 8/27/2020 REF WORK ORDER: 27676 CLOCK IN/ CLOCK OUT: 8:00AM/5:00PM LABOR FOR SERVICE REQUESTED $630.00 Note: SERVICE DATE: 8/27/2020 JOB DESCRIPTION & CORRECTIONS: FOUND IPR VALVE MALFUNCTIONING. PICKED UP VALVE IN VICTORIA. REPLACED VALVE AND CLEARED CODES. STARTED TRUCK FOUND ICP SENSOR PRESSURE FALLING DOWN WHEN HOT. REPLACED ICP SENSOR PICK PART UP IN TOWN. FOUND OIL PRESSURE STILL FALLING. REPLACED OIL PUMP CUSTOMER PAID FOR OIL PUMP. TO LOCATION $120.00 Note: SERVICE DATE: 8/27/2020 LOCATION: 24627 TX172, PORT LAVACA,TX 2 FUEL SURCHARGE $12.50 $25.00 Note: SERVICE DATE: 8/27/2020 1 SENSOR-ICP PRESSURE SENSOR New $357.78 $357.78 Note: SERVICE DATE: 8/27/2020 1 VALVE-IPR KIT New $444.06 $444.06 Note: SERVICE DATE: 8/27/2020 2 PARTS RUN $17.99 $35.98 Note: SERVICE DATE: 8/27/2020 MECHANICAL SERVICE CALL $210.00 Note: SERVICE DATE: 8/3112020 REF WORK ORDER: 27703 CLOCK IN/ CLOCK OUr: 12:00PM/3:30PM LABOR FOR SERVICE REQUESTED $315.00 Note: SERVICE DATE: 8/31/2020 JOB DESCRIPTION & CORRECTIONS: 08/31/2020-TRUCK WONT STAY RUNNING HARD START -CHECKED CAM AND CRANK SENSORS CAM TESTED HIGH, CRANK WAS DIRTYON END PIECES OF METAL ON MAGNET -ORDERED NEW ONES TO LOCATION $120.00 Note: SERVICE DATE: 8/31/2020 LOCATION: 24627 TX 172 PORT LAVACA TX 77979 2 FUEL SURCHARGE $12.50 $25.00 Note: SERVICE DATE: 8/31/2020 6 SEAL -INJECTOR KIT New $40.60 $243.60 Note: SERVICE DATE: 8/31/2020 1 SEAL -HP OIL RAIL New $189.70 $189.70 Note: SERVICE DATE: 8/31/2020 LABOR FOR SERVICE REQUESTED $210.00 Note: SERVICE DATE: 9/01/2020 JOB DESCRIPTION & CORRECTIONS: 09/01/2020- WENT BACK WITH NEW PARTS STARTED TRUCK TOOK FOR TEST DRIVE IT SHUT DOWN REMOVED TURBO HOSE. IT WAS FULL OF OIL, NEED TO TOW BACK TO 59 SHOP 1 SENSOR -CRANK POSITION SENSOR New $211.28 $211.28 Note: SERVICE DATE: 9/01/2020 1 SENSOR-CAMSHAFT/CRANKSHAFT New $205.32 $205.32 Note: SERVICE DATE: 9/01/2020 Crossroads Tire Service, LLC. 14k 9406 US Hwy 59 North Victoria, TX 77905 361-827-7694 9/14/2020 8:36:43 AM Repair Order #7905 Pagel CALHOUN COUNTY PRECINT #3 Vehicle: 2012International Durastar 4300 7.6 L 466 QtV Code/Tech- Description Condition Unit Price aim 1 TOWING SERVICES $615.38 $615.38 Note: SERVICE DATE: 9/01/2020 DIAGNOSE AND SCAN COMMERCIAL VEHICLE $149.99 Note: SERVICE DATE: 9/01/2020 LABOR FOR SERVICE REQUESTED $262.50 Note: SERVICE DATE: 9/08/2020 JOB DESCRIPTION & CORRECTIONS: REMOVE AND REPLACE INJECTOR #3 LABOR FOR SERVICE REQUESTED $493.50 Note: SERVICE DATE: 9/08/2020 JOB DESCRIPTION & CORRECTIONS: MECHANIC REMOVED THE DOG HOUSE TO REMOVED THE VALVE COVER. REMOVED THE OIL MANIFOLD AND ALL THE INJECTORS AND RESEALED THE INJECTORS AND MANIFOLD. MECHANIC PUT BACK TOGETHER, PRIMED, STARTED UP AND RUNNING. MECHANIC PRESSURED TESTED AND FOUND INJECTOR NUMBER 3 WAS BYPASSING OIL TO IT. REMOVED AND SWAPPED INJECTOR NUMBER.3 AND RETESTED AND THE BAD INJECTOR FOLLOWED. 2 MANUAL REGEN $199.00 $398.00 Note: SERVICE DATE: 9/08/2020 REASON. FOR REGEN-HAS SHUT DOWN LIGHT FOR REGEN. 6 INJECTOR, I334, 466 REMAN New $584.94 $3,509.64 Note: SERVICE DATE: 9/08/2020 6 INJECTOR -CORE New $187.50 $1,125.00 Note: SERVICE DATE: 9/08/2020 .6 INJECTOR -CORE New $187.50 ($1,125.00) Note: SERVICE DATE: 9/08/2020 Labor............................................................ $2,720.99 Parts............................................................ $5,161.38 Sublet/Misc............................................................. $615.38 ShopSupplies............................................................ $38.54 Charges ........................................ I................... $483.98 Repair Total $9,020.27 Technician Code Certification # 055 046 Approvals Date &Time Total Amount Authorized By Method Employee I hereby authorize the repair work herein set forth to be done along Wth the necessary material and agree that you are not responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft or any other cause beyond your control. I hereby grant you and/or your employees permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of testing and/or Inspection. An express garagekeeper's lien is hereby acknowledged on above vehicle to secure the amount or repairs thereto. All Vehicles left over48 hrs. after repairs are completed WILL INCUR A $25.00 PER DAY STORAGE FEE. Customer Signature #14 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET FORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: RICHARD MEYER, COUNTY JUDGE SUBJECT: TransUnion Agreement DATE: September 23, 2020 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR September 23, 2020 Consider and take necessary action to allow the Calhoun County Sheriffs Office to enter into an agreement with an MOU with ATF (Alcohol Tobacco Firearms) to reimburse overtime of up to $2000.00 annually for ATF approved cases. Sincerely, Bobbie Vickery Calhoun County Sheriff 899-A L000/L000d 906-1 899b-£99-0£ JJI83HS 00 NnOHIGO -WOad 80:60 OZ,-9L-60 US. Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives Joint Law Enforcement Operations Request for State and Local Overtime Funding The Joint Law 'Enforcement Operations (JLEO) State and Local Overtime (SLOT) program reimburses State, County, and Local Law Enforcement agencies for overtime (OT) expenses incurred by sworn law enforcement officers assisting in open ATF investigations. In order for the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) to generate a Memorandum of Agreement (MOA), the below form, and the ATF UFMS Vendor Form must be completed and emailed to ATF's JLEO Program office at SLOT64atf, sov. 2020 Calhoun County Sheriffs Office Section I — Memorandum of Agreement Cl New ❑ Renewal Section H — Agency Information Bobbie Vickery I Shertff 211 S Ann Port Lavaca I TX 1 77979 1 361-553.4646 Calhoun County ❑ Municipality t County ❑ State ❑ Temtory 0 Tribal ❑ Other Section III — Agency Reimbursement Information The agency must have an active registration in the System for Awards Management (www.sam.govl in order to do business with the Federal Government. The information recorded in SAM by the agency must match the ATF UFMS Vendor Form and the information recorded below. I3. Agency Contact First and Cast Name(Reference Payment): 14. Email Address: Rhonda Kokena Rhonda.kokena@calhouncotx.org 15. Taxpayer Identification 16. Duns &Bradstreet (DUNS) 17. Cage Code 18. National Crime Information Center's (NCIC Number (TIN): Number: (Optional). Originating Agency Identifier (ORI): 74-6001923 087309324 TX0290000 Section IV — ATF Information 19. Field Division: 20. Special Agent in Charge First and Last Name: Houston Fredrick Milanowski 21. Field Office: 22. Resident Agent in Charge or Group Supervisor First and Last Name: Corpus Christi Richard Miller 23. Street Address (Field Office): 802 N. Camncahua Suite 1670 24. City: 25. State: 26. Zip Code: 27. Telephone Number: Corpus Christi TX 78401 (361)887-2400 n.ab iz r v2 Revised A012019 899-J L000/Z000d 906-1 899b-899- M 33183HS 00 NIIOHIVO -WOa3 80:60 OZ,- 9L-60 Section V — ATF Investigative Emphasis and Justification 28. ATF Task Force Name: ATF Task Force 29. Number of SLOT Recipients Assigned to the ATF Task Force: 30. Requested Funding Amount: 1 1 $ 2,000.00 Equitable Sharing Agreements, or 32. Description of the Work of the Task Force or Investigation: JUO Yam v2 Revised Apri12018 899-3 L000/£000d 906-1 899t-£99-L9£ 331a3HS 00 NnOHIVO -WOa3 60:60 OZ,-96-60 Instructions for Completing the Request for SLOT Funding Form Section 1: Memorandum of Agreement 1-2 Enter the fiscal year for the MOA to be generated. Select if this is a new request or a renewal. If the agency has had a previous MOA with ATE, then renewal shall be selected. Section H. Local, County or State Agency Information 3-12 Enter the official name of the State, county or local law enforcement agency requesting to receive JLEO fonds through the Department of Justice (DOJ) Asset Forfeiture Funds (AM - Enter the Agency heads name as shown on his/her signature block. Enter the Agency head official title (i.e. Police Chief, Sheriff, etc.). Enter the street address, city, state, and zip code whore the agency is located. Enter the Agency's point of contact phone number. Provide the name of the county or counties served by the agency. Select the jurisdiction type from one of the following options: "Municipality" represents a recognized and designated city, town, township, village, etc. "County" may represent one county or more than one county in partnership. "State" represents a state law enforcement agency, a state -directed activity. "Territory" represents Puerto Rico, Guam, U.S. Virgin Islands, and the Northern Mariana Islands. "Tribal" represents an American Indian/Alaska Native law enforcement entity. Section III: Agency Reimbursement Information 13-18 Enter the name of the person from the agency and their email address of who will reference payments. This person will be the liaison for ATF should there be any issues with reimbursement. Enter the agency's Taxpayer Identification Number (TIN). The TIN is a nine digit number. Enter the Duns & Bradstreet (DUNS) number. The agency can request a DUNS number for free from D&B if they do not have one. Enter the Commercial and Government Entity (CAGE) code (this is optional). The CAGE code is a five character ID number. Enter the National Crime Information Center's Originating Agency Identifier (ORI). The ORI contains nine alphanumeric characters. Section IV: ATF Information 19-27 This section is to be filled out by ATF personnel. Enter the field division the agency will be assigned to. Enter the Special Agent in Charge (SAC) name as shown on his/her signature block. Enter the field office the agency will be assigned to. Enter the Resident Agent in Charge (RAC) or the Group Supervisor (GS). Enter the street address, city, state, and zip code where the field office is located. Enter the field office telephone number. Section V: ATF Investigative Emphasis and Justification 28-32 This section is to be filled out by ATF personnel. Enter the ATF Task Force Name (no abbreviations). Enter the number of SLOT recipients that is anticipated to be assigned to the ATF Task Force. A SLOT recipient must be a sworn law enforcement officer who has the authority to enforce law, make arrest, and carry firearms within their agency's jurisdiction. ATF Task Force Officers, ATF Special Deputy's, and sworn law enforcement officers are eligible to participate. .Enter an estimated amount of SLOT funding the field division could potentially be requesting. Enter a brief or detailed description for 31 and 32. JLFA FQM V2 Revised Ayrt12018 899-d L000/b000d 906-1 899b-699- M Jd181HS 00 Nf WV0 -WNA 60:60 N, 91-60 Unified Financial Management System (UFMS) UFMS Instructions for completing UFMS VendA Request Form LJ New ❑ Update ❑ Deactivate Inau uctions on cornPir6ka tttis form are on the second nsrse. Met& audined in "RF.D^ are eeonimd_ 2. Is the vendor required to 1 13. If not, what is the register in CCR (Y/N)?* Y FAR exemption tie. EmploYee,Faaipn vendor,ek): °Iftheve dar it requiwis"psto to ccx#owelme them &" bejom eompletinglhitform. CCR Registration wrrep0ons aanbefound in FAR 4.IJg1.7Noannmption a dwr the CCR infotmallon It whd Ifdte hlformddaa mmmly livedat CCR.gov win UFMS is h?aweat then tho votdertMuldbecrntwtedto be updotedihor CCR hrfomtadon, If the vendor is not required to register, ulease Comulete all fields on this reauest. 4. Date of Request: (MMJYYJDD) 8125/20 S. Requesting Component: Bureau of Alcohol, Tobacco, Firearm 6. Component Contact: c- not be the some u du vendor David Taylor 7. Ofiice Phone No.: (361)533-3819 8. Purpose of Request State and local Overtime 9. UFMS Security Org: ATF 10. Vendor Type: State and Local (SLG) 11. Component- Specific Justification: State and Local Overtime Vendor 12. Payment Type: CCD 13. Prompt Pay Type: Standard (STD) ,. ...,. �......,... .......... ..,' .._ ., ....,.............,...,..... .. . . . .:... :. ..; . is 14. Vendor Name: County of Calhoun 15. DUNS Number+4: 087309324 16. EIMSSN/TIN 74-6001923 17. Street Address: 31 S Ann 18. City, State, Zip Code: Port Lavaca, TX 77979 19. Country: United States 20. E-mail Address: Rhonda.kokena@calhouneotx.org 21. Vendor Phone No.: (ineludieg Brea code) 361-553-4619 22. Fax Number: (including was Bode 361-553.4614 23. Contact Name: nFx Kokena, Rhonda 24. NCIC Code- TX-0290000 25. Federal Vendor Agency Locator Code (ALC): a 26. Bank Name: Prosperity Bank 27. Street Address: 1107 North Hwy 35 28. City, State, Zip Code: Port Lavaca, TX 77979 29. Country: United States 30. Bank Phone No.: 361-552-7411 31. ABA Number: 32. Account Number: 33. Account Type: Corporate Checking ACH Format: All vendors will be setup with CTX and CCD ACH peymni format PRWACFACTSTATEMEN7:- nefoilowing igfbmadon lopmvidedto oomplyullb MoPrAveyAetof1.074(P.G0-57.0). Alhnfarmodon wDeamdon thnfarm is requlredundn the poWsionofil U.SC 3322and 3) CPR 210. this infw dfia.willbe owedby the7reotvry beparrmrntto oontmitpayment data. by alwamic means v wndor'fia vial insiindion. Fedwe to provide the Yequaled it formoaan.0 &layw pMnt the recaipl ofpalm nts lhmagh the Aabmoied Clmwi"g Hausa Pajwm? hparcm. J,4 l UnG - Vendor Request Forst February 2076 899-3 L000/9000d 906-1 899b-£99-L9£ ddIa3HS 00 NnOHIVO -WOad 60:60 OZ,-9L-60 UFMS Instructions for completing UFMS Vendor Request Form Please type or print legible all required information The following are the steps for completing the UFMS Vendor Request Form. Box 1: This is a required field. Place a check in the box corresponding to the type of request required. Options are: • Box New - select if vendor is not in UFMS • Box Update - select if a Non-CCR vendor needs to be modified or CCR information has been updated by the vendor. • Box Deactivate - select if a non-CCR vendor is to be deactivated Box 2: Is the vendor required to register in CCR? (See note on form) Box 3: If not, what is the FAR Exemption? Select exemption from drop down. 79 Box 4: This is a required field. Identify date request submitted Box S: This is a required field. Using the drop down arrow, identify Component submitting vendor request. Box 6: This is a required field. Identify individual to be contacted in the event there is a question about request. Box 7: This is a required field. Identify phone number of individual in Box 6. Box 8: Description / Purpose of the vendor request Box 9: UFMS Security Organization for vendor - Select Defaultorg for Commercial, Federal, Foreign Government and State/Local Government (when applicable). For all other Vendor Types, Select Component (Justification required for Component -specific) Box 10: Using the drop -down arrow, identify Vendor Type from UFMS table listing: • Commercial (COM) - Select for commercial vendors • Confidential (CNF) - Select for confidential payees • Employee (EMP) - Select for employee payees • Federal (FED) - Select for Federal vendors other than DOJ • Foreign Government (FOR) - Select for foreign government vendors • Inna-Departmental (DOJ) - Select for DOJ vendors • Non -Agency Personal (NAP) - Select for Task Force Officers • Non -Vendor (NON)- Select for third -party payments, return of funds payments, etc. • State and Local (SLG}Select for State & Local Government vendors (Local Police Departments, Local Jails, etc.) Box 11: Justification requited if other than DEFAULTORG SecOrg is entered Box 12: Enter Default Payment type for this vendor_ (CCD will be used as the standard unless otherwise Specified) • CCD- Cash Concentration or Disbursement- Select for Corporate accounts • Check- Select if vendor is requesting to be paid by check • CTX- Corporate Trade Exchange (only select if requested by the vendor) • PPD- Prearranged Payment or Deposit- Select for Personal accounts Box 13: Enter Prompt Payment type for this vendor. • Standard (STD)- Select for Commercial vendors • Construction (CON)- Select for Construction vendors • Dairy Productions (DAM Y)- Select for Dairy vendors • Employee (EMP)- Select for employee payees • Fruits and Vegetables (DFV)- Select for Fruits and Vegetables vendors • Meats (MEA) - Select for Meat vendors • Non -Prompt Pay Act (NONPPA)- Select for third -party payments, return of funds payments, and State/ Locals • Travel (TRV) - Select for Task Force Officers and other invitational travelers • Utilities(UTL) - Select for Utility type vendors 899-d L000/9000d 906-1 899b-£99-19£ ddIdIHS 00 NnOHIVO -WOdJ 60:60 OZ, 96-60 UFMS Instructions for completing UFMS Vendor Request Form Please type or print legible all required information the name of the vendor to be added to the vendor table. Box 1S: Duns number (required for Commercial vendors and all other vendor types where applicable) Box 16: This is a required field. Identify TIN/SSN of Vendor Box 17-18: These are required fields. Provide address information for vendor Box 19: Assumed US — provide if foreign Box 20: Must be included if vendors want to receive disbursed payment email notifications Box 21-23: Provide information relative to entitv identified in box 8. Box 24:National Crmie Information Center (NCIC) code. Reguu Box 25: Enter in the Federal Government Agency Location Code tl� - •d � uS. t Box 26: Identify Bairldng Institution receiving funds. Box 27-28: These are required fields. Provide address information for Identified Bank Box 29: Assumed iJS — provide if foreign Box 30: Provide phone number at bank should the need arise. Box 31: This is a required field. ABA Routing number of identified Bank* Box 32: This is a required field. Account number to receive funds at Bank.* Box 33: Identify Account Type — choose either Personal/Corporate Checking or Savings *NOTE BankAouting and Account Numbers refer to ACUpayments only and not Wire Transfers Which have separate rowing numbers. Wire Transfer payments cannot be disbursed using UFMS Please SUBMIT this form via e-mail to the mailbox as instxttcted by your component UFMS help -desk. i 899-3 L000/LOOOd 906-1 899b-£99-69£ JJld3HS 00 NAOHIVO -WOa3 OL:60 OZ,- 51-60 #15 A Vern L_yss Calhoun County Commissioner, Precinct #2 5812 FM 1090 Fort Lavaca, TX 77979 September 17, 2020 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: 9 (361) 552-9656 Fax (361) 553-6664 Please place the following item on the next Commissioners' Court Agenda • Consider and take action on preliminary plat for Smalley RV Park SnLyssy V VL/Ij PK "We < TO 00 < LOP) > m Ln X _0 DMCL^n m =1-40 (A x rn�ro Z 3: m so z in m ro '0. I I I f\cI I,",^ 0 T� RF O� 6'o F4; m A O O) O EU A O D{ s o N z m N D y m m < c � z 3 y _. .-- MN!AV 1Y EIEC1gIC 60'%700' FUTURE BUILOINO/OLUSHOUSE I I i. �i 1^WMMVO 0IPM � � /ram, I Vh RF 10% 4>. I; aa pq qq qL( p9( �Y9 pL{p Epp °A� ONE , Ila' Mpggq Z DD, gg ggp ygp�p[4 3 a � k 0 mm '1 tg 9 tD Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 POG �OJi September 17, 2020 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: (361) 552-9656 Fax (361) 553-6664 Please place the following item on the next Commissioners' Court Agenda • Consider and take action on preliminary plat for Smalley RV Park Sincere , Vern Lyssy VL/lj a.00.. PORTLAVACA .11% ' SITE SHEET INDEX COVER SHEET C 1.0 SITE PLAN C 2.0 UTILITY PLAN C 3.0 GRADING/DRAINAGE PLAN C4.0 DETAILS C 5.0 PRELIMINARY SITE PLANS FOR SMALLEY RV PARK HWY 87 PORT LAVACA, TEXAS 77979 05 oP VQ li QQ RO J� J� Q PRGPG6Fn reNDGwG TREATMENT UNITS RGUMSELFERCELNE SPRAY SPRAY AREA ONSTEINWERSYSTEM AREA 64,000 SQ. FT. 04,000 SQ. FT. GUI 1.GE m SSUMF\SI6FRELIMIwwYANDMI COxlRptiGE USE IIpDEVELwIxG FILLING MR THE RV FARR EGG.IR EFARxwrENDIBEEE _ DMIGNED.SUCHA,GGUST@a aiE�P1�aM NNassM SFxpv ` OMERMD ENGINEER RIC DO ARSE OVRING IHE CONaiRVttOXPRIgXG POIPOCEa& HN i�D IHFSasarlFAsiie OURS MORTO o. TIESS.DTORaNH1ENaURE.A-LREOVIESS KFULREMEINNPNOPRORTOBEGIRNIxawORF ISµ_l CC6µklYSYBIFMS.IFMPLI HE,SN REIN EwRNOsxpanorIX9axFulHaVErvcOOE CONCERSUCTON Brµ�e Opa E GINXIXGEON...NEWNMCTOR. IOR.N SN"T.POExIVEFULSIN l NSIWLaEIXP4E0µg04a W iWO ROf➢WaY XOTRY RµOGRMGCFNEANMTLNFENOTCEI. ON�FYERGENEERIWO �NPGFOCCXEETYp�E6ai P1LiIMEa. ROaIXYaM a FRIOa TOREOYIREOGE NMY 711Ea. IABSSHOURS RHE MUCHINGPLµ. ME.lEGGFLYIFp016EpEPµCYWFOUNOIN REOVIREV I6NW µOIMPIE FGT 6I PPPVH IF Ia.TNECLUME OR EREEFOxELEFOa01RHIRREAND 20,&LLOX Ex6IONSPAEm FPCEOFCVRSUNLES5 EWSE _ 6 xa MLm Pnn .1MIlTPe RG.FUFw NRG alc FORcooPn xnnxawRx xaccaaoulcawnxnAreaxo FORM NU LOAGEGFFSVEMENTNSruuTGNWI NO Fm Lniau Ral�wre. FORB FHEIGxSARE W THE DGE OF MYEMENT. TORS FN6RXO FPCIOFHEnEE. CNGPHOSIIEWAIe VXg1OWXai 1 .NN GUAP. GMNNERµDFNMNCM,T46EP4N6 a Np Ag16XAxE'OI6NRBEOBFNCKKMK9 WGERENALLEE PERFORMED VNOERTIE WwRNOwOFFENOMCXRECi FORFENCXGMAIERWSµO CgngIOFFEi10E E SUPEENSOXOFAREG SNRSORp LS. G. FFW MVA REIDYLGUURMERERIX6P FP llUMEGMON0GFfRE REPR=DMANGMO SUNNECIOXT)µ`SERNGGBPAWATEReYe1El OWNERIS ENGNE MMEVIpTF1YOFA SONFIC DT CREM EAE FORVYORMHWORRUCTONE EVP1.G.O EC09 90FEACXOPTONFORRSGGFSEWUE 1 R FIEVATIONS6ROMNw AO-SHREOLPNEMPRWM9IE IS T IEEONTUCSORISNESFONGIGLEMFa CHARGES CONTSRSURCR AUASE07HUR CEORREINF SYSIFM6.SERNCE X:L .VIORISINTENOEDT HHEEIEVA UNNMCHFASRXO A680ENTEOW ,U'UR"" ORPERNORENTRELOCAl..OF GROUND. FO RPOLEGMRTIISPRWEU. 7. a`NGALFFHORm O xr'NE SYSTEM. *NEENOFaNVORCPEPµCY 6 xa MLRR F. RESPONSIBLEFORSAIDIGRTRSSRUCT GRAREN PW ELEGI KNPL111CLO EVATUN. PIANoa PULL THROUGH SPACE DIMENSIONS BACK IN SPACE DIMENSIONSPRI PRmNMFROvuFROMENGNEERIEcttawEO. N.ETTERIRUGRMAmE.GFVIE 44t s TH—GREFs.1a%,S% IOBNO. E2GC01 DATE OST"IO DESIGNER INN SHEET Dx0 N3unXG,Es _ 'I� ZPVCPEAE 8 6 CON6XLUClE00c�/ � 1V Pa Wi 1HW EECCX 2 � V 6 J�J c`onsmu�E'noiew nXuiieiuvvcEEBiwni�Enuxessliwp�� !(-` IN6iNLFOIHACCOgpµCE WIiX LOCPLC00E6. ,f„/��w//. UM WDE� THE GBNDPER CCOMPN3VPXOMF➢FVXSFO E3NL� @ iOq ER BCOLB.EUtM1 W COY EVILLEFOR pP L LIW AC MtMNl1G¶ooN6 WHENEVER XLL p 3�9 IBEH36PVCPHO6NPLLBEIN6iAllEO PEfl U/FPC.E CiF➢O 9C8 Qp Imm61RVCiTON6.P Il MMH6� EIESIEC INPCCORONI E _ B PUELIC..B 1C11 �n B,E -9cc5 RLINE�^ COXC3aUTMOnµ0X6 AwE rWAEROfHGEW11MlI11E3q Pzvil Mpplpq OFi ElF1U INI9TPRIY E. - FOWA�iEREEWFAC1iG63NN0iGUIRBMfLEU0L6NMlEAECiTMP6LEC.1. VEL lb o N I cw.vEL \ a4XG w I _ WATER WELL f' EW,'erR 6 LIaE'. i. (IFUBEC SEE ` R Y BE GRRVEL x U o ss YwArEau '- \\ \ I a BumPeru3wUSkE,, \ 1' \\ I. _____ _z6v-rsEwEauxE_ GRAMSI 'a �S I i GRAVEL PRMSEO MNCELINE SPRAY AREA 64,000 SQ. FT. - TREATMENT UNITS ON SITE SEWER SYSTEM �a SPRAY AREA 64,000 SQ. FT. unUW PE06 N BE BUILT Foa EACH RV EPME aXOMM'M OTENON. a OCdRO Ox 1XE.. BE\YFASERNCE MRux _ .W EREEgm EWILL RUNITw 4.1, MDMON Mc N SEWER UNE3 RUNNING VNDMx Cav PEL9TPLWHERETEPMS.SEY EEWCEFORGtlS6 EWILL GO NGIGFOFAPxrwIEN1UP➢PaoMIAMiELv t•rvARIFb VTNI EEp ,OFa•6EEERUHEWI' AG CHM� NW RMaNS MC.YTHI3 PLE, ELYIPOF�PAWAETlld NCEL EM' ACCNNECTON 0. E�EGMVW ELECFRICLLeERWC BEBBB�"PVEW 6EPPAATEPRrvA�I SMI0. DINGSWU.EK EE810E N. AVTOMAiICN1YTWJ18MIi RFi➢INGS WILLEECON6IOEREO. GRAVEL W C P � G L�I C � e W 7 W= 3� wEsm saaao\��®to. I — t2 2s T ,N 21.1 UQ�r4� e Iz - C Jg Ile a� .ZO.Y O U / OR4INAGE9WAlE __ 2/1 _ _ _ _ _ _ w-* l A F l / cfi CN L / gXN \ / ti 49 U� oP ®N ^�,� rm„R v s� l Qe \ \�9 6 .v -- 2 — —SS�NAi.E SWRE --- - \ Pww6EortxcEiwE FMM9E04FXfiFLXE '\ ONSITESEWMWB7EM \ 2E6 . zr.o 1. 6ox6nncmRsx+umaxraxvwmvEORnI�wGEoxuL MVFMEMAHU 6IUEWPINMFA6. OS R D JN6EO NUiIFY P.1NGE6AXEFUUXG6EMEE1 GNLE66NGWN XEAEGNANGFiEw GMOE6. <. GPPoiNG6XUWNI6 FORM0.99G1U01XOPURPoSE6Ip WfryEY KIEWLLRESNEOI EDXX¢9NADMWEI MSSPTIEENE eTIE WILL6EFlNEGNPGEUIOPLLOW NRVNAGETGM66 BETWEEN nE6roTxECNaxxEu 6FE6nEEruoFGRGMIxnGE z6.6 '.258s m RNNAGE 9WALE n...�_ Z � QN � J( 0. amr Z 3U W = � o UL a JOB NO. -.1 GATE DSI 0 DESIGNER JNN ENEEf 04.1 ,. CGNIMCIEMB,NPLLMNXINN,O,RMCOP1JXn,EGNNL b� e.W�6�o�NNMFAB. COXfIU�NemNLLLNOIiFY �F➢YX iNO PEPM'CIEBMEFOCX08EMEEH FlE1oGpnOE& RIBTXGPHO PPOPO,ED..NT. OTBEttIEEX 10B 3. BADESSHO W ASBVMBOLPEPP£BENTAPPOPOSED ® EEB GFNfYDIe EB. BXEA6IIXBGR90E NOTFY OFTOEIXBDBXBTO PTIEMKETERETNEERD,R1MEMOiS DDw°HlNOHi1 E s EMEE ER08 ENT7OMNHBDM'Di¢R'"PE,E oRuruDE GwvEnM awiDa�eac�rEaT BnnowuMEnmo Tc=E9MiXOiE6 IHRXEITY=I.BXNW PFAKOISCNPRGEDwYFAP�=I6.W CF9 OPN,OMIXUIE6 B. 1.6,ACRE9 IIO<E BCMViGEFOPBOIHDWJ,NGEPPFA9 OF T¢BPEME iowmouETOTXEPuxortmEFFIBIFXr DEMvn6EnT PBCPo,Eo OBOM6. TXE.IOORIMINDMONSUCRE OO SEcEmE B cwEa'n,EP1OixFiu6Penho�acov"EaioBoumE�v�w�ET6mE xwLlx 4B'i BLOB DRAINAGE AREA B 1.56 ACRES DRAINING TO HWY 87 PROPOSEO mrEx,m.�i 6Ai Pwxe uBE, RUXCFFCOFFFlCIENF=C.II FEANGISCX+AGE(IW YFM�=]BSBCF6 ID- OMINGIES B:I.,,KPE9 IWHOfPCCFFFICIFM=OM DRAINAGE AREAA 10.14 ACRES DRAIP TO GIN ROAD iI I Z `( 75.98 ACRES y�0 ��5 I O I f� FUTURE DEVELOPMENT O II�Iu ��1i� TRAPEZOIDAL CHANNEL WITH 6' BOTTOM WIDTH, 3:1 SIDE I I TRAPEZOIDAL CHANNEL WITH 4' BOTTOM WIDTH, 3:1 SIDE SLOPES, I'MIN DEPTH I FUTURE DEVELOPMENT TRAPEZOIDAL CHANNEL WITH 6' BOTTOM WIDTH, 3:1 SIDE SLOPES, 1.6' MIN DEPTH FL-17.30 GIN ROAD DITCH _ - RAI DNGE DITCH TO GIN ROAD - - - - JOB NO, e[Ouur DATE B..0 DESIGNER JNH SHEET O4D SCE OF r,{®.d�l i*: '•*tl ................... .... 7CLAYTON T. MAYFIELDo B................. ,j W .q�3567 It do'G/SfE.... r �� f �1 a4A le 4, 500 Gal Lit Tank 1,500 Gat Septic Tank SYSTEM I 19,713 SF TOTAL SPRAYAREA SMALLEY RV PARK 4236 US Hunt 87 Port lavaca, Texas 77979 Ysidro Benavides Survey Abstract 38 Portion of Tract 17 Westerlund Subdivision 76.041 Acres - Floodzone X Scale: 1" =100' SYSTEM 3 25,485 SF TOTAL SPRAYAREA al Septic Tank 500 Gal L;R Tank __________ SYSTEM 2 25,485 SF TOTAL SPRAY AREA 2 Zone Alternating Valve 2,000 Gal Pump Tank 1,500GPDATU 2,000 Gal Dosing Tank Sleeve Pipe Under Road -2,000 Gal Dosing Tank 1,500 GPD ATU 2,000 Gal Pump Tank 2 Zone Alternating Valve #16 RICHARD H. MEYER Calhoun County Judge 211 S. Ann Street, Suite 301 - Port Lavaca, Texas 77979 (361) 553-4600 - Fax (361) 553-4444 - Email: richard.meyer@calhouncotx.org September 23, 2020 TO: 2020 Grand Jury RE: Annual Road Report GRAND JURY FOREMAN Attached is the Annual Road Report from each precinct as required by Section 251.005 of the Texas Transportation Code. These reports have been filed in the Official Record of the September 23, 2020 Commissioners' Court meeting. RICHARD H. MEYER Calhoun County Judge RHM/mbc www.calbouncotx.org Riebard H. Meyer coull-ty jild re David Hall, Commissioner, Prccincl I Vern Lyssy, Commissioner, Prccincl 2 Clyde Syma, COmmiN.%iollCr, Prccincl 3 Gary 12ecse, Commissioner, Precinet it ANNUAL, ROAD REPORT County of Calhoun Precinct No. 1 1. Condition of each road, culvert and bridge in the precinct: N 2. Amount of money necessary for maintenance of the precinct roads during the next fiscal year: 3. Number of traffic control devices in the precinct defaced or torn down: Z�::) 4. Any new road that should be opened in the precinct: 5. Any bridges, culverts or other improvements necessary to place the precinct roads in good condition, and the probable cost of the improvements: _��'3_37_5..gc&—. Submitted by the undersigned on the day 2020, Commission , Precinct 1 Subscrib and sw rn to, before me, the undersigned authority, this Day of 12026 MAEBELLECAML Notary Public MY NehrY Ink 182012624 -- — -� ExpMaaMay 14,2029 My commission expires: -44-tZ3 � f. Richard H. Meyer County judge David Hall, Commissioner, Precinct & Vern Lyssy, Commissioner, Precinct 2 Clyde Synma, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 County of Calhoun Precinct No. 2 1. Condition of each road, culvert and bridge in the precinct: 2. Amount of money necessary for A me ainc��the precinct roads during the next fiscal year: `�, 3. Number of traffic control devices in the precinct defaced or torn down: 4. Any new road that should be opened in the precinct: /9-ye�;Pv e, E Any bridges, culverts or other improvements necessary to place the precinct roads in good condition, and the probable cost of the improvements: Submitted by the undersigned on the day of , 2020. Commissioner, Precinct 2 Subscry' ed and sworn to, before me, the undersigned authority, this 5kL Day of �24 MAE BELLE C SE1 •` My Notary ID81=12M Notary Public Exphs May 14,2= My commission expires: 5 Z3 Richard H..Meyer County judge David ball, Commissioner, Precinct l Vern Y,yssy, !Commissioner, Precinct 2 Clyde Syrna, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 County of Calhoun Precinct No. 3 1. Condition of each road, culvert and bridge in the precinct: Fair- repairing and repaving some county roads required Several culverts need replacing 2. Amount of money n the next fiscal year: for maintenance of the precinct roads during ,754.00 3. Number of traffic control devices in the precinct defaced or torn down: 10 4. Any new road that should be opened in the precinct: None S. Any bridges, culverts or other improvements necessary to place the precinct roads in good condition, and the probable cost of the. improvements: Re -paving and seal coating several county roads and replacing few culverts $ 89,754.00 Submitted by the undersigned on the S day of 2020. commissioner, rrecinct 3 Subscrib and swgrn to,before me, the undersigned authority, this 3y Day of vYY a _ M BELLECA"FL Notary Public "f YNatary101132012524 ''?;o�,$'• SOMS May 14, 2023 My commission expires: Richard H. Meyer County judge David Hall, 'Commissioner, Precinct I Vern I,yssy, Commissioner, Precinct 2 Clyde Syma, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 11101ar1k1j"Aia��z� County of Calhoun Precinct No. 4 1. Condition of each road, culvert and bridge in the precinct: Roams bridges, and culverts are in good condition. 2. Amount of money necessary for maintenance of the precinct roads during the next fiscal year: $2,030,241 3. Number of traffic control devices in the precinct defaced or torn down: 25 4. Any new road that should be opened in the precinct: NONE 5. Any bridges, culverts or other improvements necessary to place the precinct roads in good condition, and the probable cost of the improvements: Guadalupe River Road Bridge is 25% complete by TxDot Submitted by the undersigned on the day of 2020. Commissioner, Precinct 4 Subscribe, and sworn to, before me, the undersigned authority, this �v Day of (,()a2za4 dr, o P�APRIL TOWNSEND �• otar Public ?r°�' +roc Notary Public, State of Texas is Comm. Expires 05-15-2021 Notary ID 126901398 My commission expires: _��— #17 Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: Memorial Medical Cent Storage Units - September 2020 Requested By: Jason Anglin, CEO Inventory Number Description Serial No. Reason for Waste Declaration 3 Pink Office Chairs No Longer Used/Broken 1 Gray Office Chair No Longer Used/Broken 1 Black Office Chair No Longer UsedlBroken 18 Digital Wall Clocks No Longer Used/Broken 2 Wooden Filing Cabinets No Longer Used/Broken 2 Wooden Chair No Longer Used/Broken 1 Wooden Side Table No Longer Used/Broken 1 Cooler from Kitchen No Longer UsedlBroken 3 Large Room Pictures No Longer Used/Broken 1 Gray Lateral File Cabinet No Longer Used/Broken Drawer Slides 1 Large Brown File Cabinet No Longer Used/Broken Drawer Slides 1 Gray Large File Cabinet No Longer UsedlBroken Drawer Slides 1 Treadmill No Longer Used/Broken 1 Total G m No Longer UsedlBroken don't make parts any more 1 TV No Longer Used/Broken 3 Green Boxes Old Generator Parts No Longer UsedlBroken 1 Covid BOX No Longer Used/Broken 1 Tolle No Lon er UsedlBroken 1 Sink No Longer Used/Broken Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: Memorial Medical Ce ter Storage Units - September 2020 page 2 Requested By: Jason Anglin. CEO 4�^ Inventory Number Description Serial No. Reason for Waste Declaration 1 WIFI Extender No Longer UsedlBroken Parts No Longer Avail. 1 Wheelchair Black Wheels No Longer UsedlBroken 1 Wheelchair Gray Wheels No Longer Used/Broken 1 Red Chair No Longer UsedlBroken 1 Phlebotomy Chair No Longer Used/Broken 2 Plaid Chairs No Longer Used/Broken 2 Equipment Carts No Longer Used/Broken Parts No Longer Avail. 1 Exercise Bike No Longer UsedlBroken 3 Oil Heaters No Longer UsedlBroken 1 Pump No Longer Used/Broken Parts No Longer Avail. Box of Shelving Parts No Longer Used/Broken Book Shelf No Longer UsedlBroken Shelving #18 CALHOUN COUNTY CLERK MONTHLY REPORT, RECAPITUATION �,Alkiil$YB36'a� DISTRICT ATTORNEY FEES 100044020 $� 619.78 $ 619.78 REERUCENSE IM42010 $ 5.00 S 500 COUNTY CLERK FEES E696440311 $ 507,70 $ 1,379.74 $ 12.497.60 S 410.00 3 14,795.04 APPEAL FROM JP COURTS t00044030 $ - $ - COUNTY COURT ATLAW AIJURY FEE 100044140 $ ' JURY FEE IM44140 $ $ - $ ' ELECTRONIC DUNG FEES FOR E FILINGS 1000440513 $ - $ $ - $ - $ - JUMICSEDUCATION FEE 100044160 $ - $ - $ $ 35.00 $ 35,00 JUDGE'S ORDER/SIGNATURE 1000-44180 $ 6.00 $ - $ - $ 7000 S 7600 SHERIFF'S FEES 1W 4190 $ 225.00 $ 1,077.70 $ - S 25D00 $ 1,55270 VISUAL RECORDER FEE 100044250 $ 189Y3 $ 18973 TIME PAYMENTFEE-COUNTY "NEW 2020'• IM44332 $ 38.79 $ 38.79 COURT REFPORTER FEE 100044270 $ 90.00 S - $ - $ 10500 $ 19500 RESTTUTION DUE TO OTHERS 1000490ID $ ' ATTORNEYFEFS COURTAPPOINTED 100049030 $ 63.00 $ 63.00 APPELLATE FUND(TGC) FEE 262044030 $ 40.00 $ 35.00 S 75.00 TECHNOLOGYFUND 266344030 $ 137B4 $ 137.94 COURTHOUSE SECURITY FEE 267044030 $ 40.00 IS 21985 $ 434.00 $ 4D.00 $ 733.85 COURT INITIATED GUARDIANSHIP FEE 267244030 $ 140.00 $ 14000 COURT RECORD PRESERVATION FUND 267344030 $ 7DOO $ - $ 70,00 $ 140.00 COURT RIFINITERSERWCE FUND'•NEWS020'• 2674M 30 $ 49.85 $ 49.86 RECORDS ARCHIVE FEE Z67544030 $ 4.120.00 $ 4,120.00 COUNTYSPECMLTYCOURT ••NE3112010•• 26764MO $ 332.41 $ 332.41 COUNINJURYFUNO'•NEW2020^ 2679.440." $ 15.62 $ 16,62 DRUG& ALCOHOL COURT PROGRAM 269844030 005 $ 188.64 $ 18864 JUVENILE CASE MANAGER FUND 269944033 $ - $ - FAMILY PROTECTION FUND 270644030 $ 45NO $ 45.00 JUVENILE CRIME DELINQUENCY FUND 2715 FARGO $0.00 $ - PRE-TRIALDIVERSON AGREEMENT 272944034 $ - $ UAWLIBARVFEE 273144030 6 210.00 $ 24500 S 455.00 RECORDS MANAGEMENT PEE COUNTYCLfRKK 2738-04380 $ 44.69 $ 4.150.00 $ 4,194,69 RECORDS MANGEMENT FEE - COUNTY 273944010 $ 40.00 $ 817.71 $ 40.00 IS 897.71 FINES - COUNTY COURT 274045040 $ 11,68881 $ 11,668.81 BOND FORFEITURE 27M 45050 S 53.00 $ 53.00 STATE POLICE OFFICER FEB - STATE (BPS)(20%) 702020740 $ 12.15 $ 12.15 CONSOLIDATED COURT COSTS COUNTY 7070-20610 $ 91,04 $ 9104 CONSOLIDATED COURT COSTS STATE 707020740 $ 819.35 $ 019.35 CONSWRIATEDCOURTCOS75-COUNTY '•NEW2020•• =-20610 $ 324.27 $ 324.27 COMMIOATEOCOURTCOSTS-STATE •'NEWZOM'• 707E-2ONO $ 2,018.42 S Z,B15.42 JUDICIAL AND COURT PERSONNEL TRAINING -ST (IDO%) 7502-20740 $ 25.00 $ - $ 35.00 S 60.00 DRUG& ALCOHOL COURT PROGRAM -COUNTY 73N 20610 $ 37.73 $ 37.73 DRUG A ALCOHOL COURT PROGRAM - STATE 739020740 $ 150.91 $ 150.91 STATE ELECTRONIC FIUNG FEE, CIVIL M03-22887 $ 21000 $ - $ 210.00 $ 420.00 STATE ELECTRONIC FILING FEE CRIMINAL 7401-22990 $ 8933 $ 8933 EMS TRAUMA -COUNTY (3D%) 7405-20610 $ 182220 $ 1,022.20 FMSTRAUMA STATEI9086) 740520740 $ 11368 $ 11358 CIVIL INDIGENT FEE COUNTY 74M20610 $ 4,00 S 3.50 $ 7.50 CIVIL INDIGENT FEE STATE 74"20740 $ 76.00 $ 66.50 $ 142.59 JUDICIAL FUND COURT COSTS 7495-20740 $ 268.10 $ 268.10 JUDICIAL SALARY FUND COUNTY11036) 7505-20610 $ 658 $ 0.58 IUOICIALSALARYFUNO STATE(90G) 750520740 $ 5920 $ 59.20 JUDICIAL SALARY FUND (CIVIL &PRORATE) STATE 750520740005 1 $ 252.00 $ 294.00 $ 546,00 MATFIC LOCAL (ADMINISTRATIVE FEES) 7538-228&UI00044359 $ Ulm $ 1355 COURT COST APPEAL OF TRAFFIC REG UP APPEAL) 7538-22US $ - BIRTH - STATE 785520790 S 104 40 $ 104.40 INFORMAL MARRIAGES STATE 785520782 $ - $ JUDICIAL FEE 785520796 $ 24000 $ - $ 260,00 $ 520DO FORMALMARRIAGES STATE 7855-20788 $ 18000 $ 180.00 NONOISCL05URE FEE - STATE 7855-10790 $ - $ - 5 - $ - TCLEOSECOURT COST -COUNTY flQ) 765620610 $ 0.12 $ U12 TCLEOSECOURTCOST STATEEO%1 785520740 $ 106 $ 1 06 JURY REIMRUMEMENT FEE COUNTY(( M 7857.20610 $ 3.38 $ 3.38 JURY REIMBURSEMENT FEE -STATE (9DM) 7857-20740 $ 30.40 $ 30.40 STATETRAFFICHNE-COUNTY(5%) 7860,Z0610 $ 466 $ 4.56 STATE TRAOFlC FINE STATE(95%) 796020740 $ 88.6E $ 86,61 STATE TRAFFIC FINE. COUNTY(4%J 91112019 7860.20610 $ 2.00 $ 2.00 STA TE TRAFFIC FINE -STATE(%%)91112019 7860.20740 $ 48.00 $ 48,00 INDIGENT DEFENSE FEE CRIMINAL COUNTY(105Q 786520610 $ 2,42 $ 2.42 INDIGENT DEFENSE FEE -CRIMINAL -STATE (90%) 7865-20740 $ 21,78 $ 2178 TIME PAYMENT - COUNTY (50%) 79" 206 10 $ 41,54 $ 41.54 TIMEPAVMENT-STATE(50%J 795026740 S 41.54 $ 41.54 BAIL JUMPING AND FAILURE TO APPEAR - COUNTY 7970-20610 $ FALL JUMPING AND FAILURE TO APPEAR - STATE 7970-20740 $ - DUEPORTIAVACAPD 999099991 $ 58.73 $ 58.73 DUE SEADRIFT PD 99969999E IS - $ - OUETOPOINTCOMFORTPD 999099993 $ - $ - DUETOTEKASPARKS&WILOUPE 939699994 $ 3,827.20 $ 3,827.20 DUE TO TEXAS PARKS& WILDLIFE WATER SAFETY 939099995 $ - DUETOTABC S99099996 $ - DUE TOATTORNEY ADLITEMS 9B90-99997 $ DUE TO OPERATING SF CHARGES/DUE TO OTHERS 7120.20759 $ $ 30.00 $ 43680 $ 1000.00 1E 694.00 $ 2,133.70 $ 28,97700 $ 21,055.00 $ 3,329.00 S 53,468.70 TOTAL FUNDS COLLECTED $ 53,488.70 - FUNDS HELD IN ESCROW: $ - AMOUNT DUE TO TREASURER (2DR'S): TOTAL RECEEPTB AMOUNT DUE TO OTHERS (LESS SF-S): $ 4,47993 HEPOR75 Nrtr. 1 Of enrrm:o CALHOUN COUNTY CLERK BEGINNING SOCK BALANCE FUND RECEIVED DISBURSEMENTS ENDING ENDING BANK BALANCE OUTSTANDING DEPOSITS" OUTSTANDING CHECKS" .7 87' $ 1.000.00 1 -BALANCE OF CASH BONDS" $ 86.758.]0 6 ' "OTHER REGISTRY UENIS" "IBC CASH BOND CHECKS" 8/31/202O $ 86,895,16 'TOTAL REGISTRY FUNDS- IF $ IS IF CERTIFICATES OF I POSITS HELD IN TRUST PROSPERITY BAN 1044a V2412018 S 1,081.15 $ 1.681.15 10441 12412018 $ 10,232.07 $ 10,232.07 10*12 V242(lffl $ 1,271.39 $ 1.271.39 10443_ I125f2018 $ 1,271.39 IF 1,271.39 10444 11252018 $ 9,601.19 $ 9,601,19 Ims 1/252018 $ 9,601.19 $ 9.601.19 ID416 112512018 $ 9,601.19 IF 9,601.19 10449 WWI) 18 $ 20,198.28 $ 50,77 $ 20,249,05 104" 31212018 $ 3.579.19 $ 3,579.19 10455 31212/118 $ 3,579.19 $ 3.579.19 10 i i486a(2612020 $ 5,911,20 $ 5,911.20 t� I TOTALS: $ 70,816.23 $ 6,961.97 IF 76,778.20 tN I tK G V UK I NHMC JUS I IUC UY YCXGC NU. J ENTER MONTH OF REPORT AUGUST ENTER YEAR OF REPORT 2020 `. CODE AMOUNT CASH BONDS REVISED 01130120. ADMINISTRATIONFEE -ADMF BREATH ALCOHOL TESTING - BAT CONSOLIDATED COURT. COSTS -CCC 280.99 STATE CONSOLIDATED COURT COST-2020 694.92 LOCAL CONSOLIDATED COURT COSI 2020 156.92 COURTHOUSE. SECURITY-. CHS 27.60 :CJP CIVIL JUST DATA REPOSFEE -CJDR/MVF 0.50 - - CORRECTIONAL MANAGEMENT INSTITUTE -CMI CR -CHILD SAFETY -.CS CHILD SEATBELTFEE -CSBF CRIME VICTIMS COMPENSATION -CVC DPSC/FAILURE TO APPEAR -OMNI-DPSC 5.19 ADMINISTRATION FEE FTAIFTP (aka OMNI)-2020 ELECTRONIC FILING FEE 20.00 - - FUGITIVE APPREHENSION - FA GENERAL REVENUE -GR CRIM- IND LEGAL SVCS SUPPORT -OF 13.80 JUVENILE;CRIME .&: DELINQUENCY -JCD JUVENILE CASE MANAGER FUND -JCMF 20.00 JUSTICE COURT PERSONNEL TRAINING -JCPT 10.00 '. JUROR SERVICE FEE -JSF 27.61 LOCAL ARREST FEES - LAF 48.54 LEMI LEDA LEOC OCL PARKS& WILDLIFE ARREST FEES -PWAF 8.73 STATE ARREST FEES- SAF 33.25 SCHOOL CROSSING/CHILD: SAFETY FEE - SCF SUBTITLE C'-SUBC 49.54 STATE TRAFFIC FINES. EST 9,1.19-STF 465.47 TABC ARREST FEES-TAF' TECHNOLOGY FUND -TF 27.60 TRAFFIC -.TFC 4.95 LOCAL TRAFFIC FINE- 2020 27.92 TIME PAYMENT -TIME 25.87 TIME PAYMENT REIMBURSEMENT FEE-. 2020 3.13 TRUANCY PREV/DIVERSION FUND 11.52. LOCAL& STATE WARRANT FEES :-WRNT 108.64 COLLECTION SERVICE' FEE-MVBA-CSRV 235.50 DEFENSIVE DRIVING COURSE- DDC 20.00 DEFERRED FEE - OFF 408.00 DRIVING EXAM FEE- PROV DL FILING FEE =FFEE&CUFF 50.00 FILING FEE SMALL CLAIMS -:FFSC COPIES/CERTIFEO COPIES - CC INDIGENT FEE -CIFF oriNDF 12.00 JUDGE PAY RAISE FEE - JPAY 41.40 SERVICE FEE -.SFEE OUT -OF -COUNTY SERVICE' FEE EXPUNGEMENTFEE-EXPG EXPIRED RENEWAL -EXPR ABSTRACT OF.JUDGEMENT -AOJ ALL WRITS WOP / WOE :CPS FTAFINE - DPSF LOCAL FINES - FINE 2,416.91 LICENSE &:WEIGHT FEES - LWF PARKS & WILDLIFE FINES -PWF 249.00 SEATBELT/UNRESTRAINED CHILD TINE -SEAT V-JUDICIAL& COURT PERSONNEL TRAINING-JCPT :. - OVERPAYMENT ($10&OVER) -OVER OVERPAYMENT (LESS THAN $10) - OVER RESTITUTION -.REST PARKS & WILDLIFE -WATER SAFETY FINES,WSF WCR TOTAL ACTUAL MONEY RECEIVED $S,SOb.fiO TYPE: AMOUNT TOTAL WARRANT FEES 108.64 ENTER LOCAL WARRANT FEES 58.64 RECOBOON TOTAL RAGEOF HIRCOUNTRY SOFTWARE MO. REFoRT STATE WARRANT. FEES $50.00. RECORD ON TOTAL PAGE OF RILL COUNTRY SOFTWARE MO. REPORT DUE TO OTHERS: AMOUNT DUE TO CCISD-50% of Floe OR JV cases - 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT DUE' TO DA RESTITUTION FUND 0:00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT REFUND OFOVERPAYMENTS - 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT OUT -OF -COUNTY SERVICE FEE 0.00 PLEASE INCLUDE DR. REQUESTING DISBURSEMENT CASH BONDS 0.00 PLEASE INCLUDE O.R. REQUESTING DISBURSEMENT (IF REQUIRED) TOTAL DUE TO OTHERS $0.00 TREASURERS RECEIPTS FOR MONTH AMOUNT CASH, CHECKS, M.O.s&CREOITCARDS $5,505.50. Calculate from ACTUAL Treasurers Receipts TOTAL TREAS. RECEIPTS $5505.50 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 9/1/2020 COURT NAME: JUSTICE OF PEACE NO.3 MONTH OF REPORT: AUGUST YEAR OF REPORT: 2020 ACCOUNTNUMBER ACCOUNTNAME AMOUNT CR 1000-001-45013 FINES 2,454.26 CR 1000-001-44190 SHERIFF'S FEES 180.76 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 20.00 CHILD SAFETY 0.00 TRAFFIC 32.87 ADMINISTRATIVE FEE 408.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44363 TOTAL ADMINISTRATIVE FEES 460.87 CR 1000-001-44010 CONSTABLE FEES -SERVICE 0.00 CR 1000-001-44063 JP FILING FEES 50.00 CR 1000-001-44090 COPIES/CERTIFIED COPIES 0.00 CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 3.13 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 235.50 TOTAL FINES, ADMIN. FEES & DUE TO STATE $3,384.52 CR 2670-001-44063 COURTHOUSE SECURITY FUND $75.62 CR 2720-001-44063 JUSTICE COURT SECURITY FUND $6.90 CR 2719-001-44063 JUSTICE COURT TECHNOLOGY FUND $72.43 CR 2699-001-44063 JUVENILE CASE MANAGER FUND $20.00 CR 2730-001-44063 LOCAL TRUANCY & PREVENTION DIVERSION FUN $56.04 CR 2669-001-44063 COUNTY JURY FUND $1.12 STATEARRESTFEES DPS FEES 16.65 P&W FEES 1.75 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 18.40 CR 7070-999-20610 CCC-GENERAL FUND 29.10 CR 7070-999-20740 CCC-STATE 261.89 DR 7070-999-10010 290.99 CR 7072-999-20610 STATE CCC- GENERAL FUND 69.49 CR 7072-999-20740 STATE CCC- STATE 625.43 694.92 CR 7860-999-20610 STF/SUBC-GENERAL FUND 2.48 CR 7860-999-20740 STF/SUBC-STATE 47.06 DR 7860-999-10010 49.54 CR 7860-999-20610 STF- EST 9/1/19- GENERAL FUND 18.62 CR 7860-999-20740 STF- EST 9/1/19- STATE 446.85 465.47 CR 7950-999-20610 TP-GENERAL FUND 12.94 CR 7950-999-20740 TP-STATE 12.93 DR 7950-999-10010 25.87 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.60 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 11.40 DR 7480-999-10010 12.00 Page 1 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 9/1/2020 COURT NAME: JUSTICE OF PEACE NO. 3 MONTH OF REPORT: AUGUST YEAR OF REPORT: 2020 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 1.38 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 12.42 DR 7865-999-10010 13.80 CR 7970-999-20610 TUFTA-GENERAL FUND 1.73 CR 7970-999-20740 TUFTA-STATE 3.46 DR 7970-999-10010 5.79 CR 7505-999-20610 JPAY- GENERAL FUND 4.14 CR 7505-999-20740 JPAY-STATE 37.26 DR 7505-999-10010 41.40 CR 7857-999-20610 JURY REIMB. FUND-GEN. FUND 2.76 CR 7857-999-20740 JURY REIMB. FUND -STATE 24.85 150 DR 7857-999-10010 27.61 CR 7856-999-20610 CIVILJUSTICEDATA REPOS: GEN FUND 0.05 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.45 DR 7856-999-10010 0.50 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND -STATE 0.00 DR 7502-999-10010 0.00 7998-999-20701 JUVENILE CASE MANAGER FUND 5.76 CR 7998-999-20740 TRUANCY PREVENT/DIVERSION FUND- STATE 5.76 DR 7998-999-10010 11.52 CR 7403-999-22889 ELECTRONIC FILING FEE 20.00 DR 7403-999-10010 20.00 TOTAL (Distrib Req to OperAcct) $5,293.85 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY 0.00 DA - RESTITUTION 0.00 REFUND OF OVERP 0.00 OUT -OF -COUNTY SI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE 211.65 WATER SAFETY FIN _ 0.00 TOTAL DUE TO OTHERS $211.65 TOTAL COLLECTED -ALL FUNDS $5,505.50 LESS: TOTAL TREASUER'S RECEIPTS $6,605.50 REVISED 01/30/20 OVER/(SHORT) $0.00 � J Page 2 of 2 #19 \§ § I " § § § k §§ ■ / Fn - ) § ) § m § ■ k m 0 § ® % m �! ®� ■, §| k : z; 3( m m; _ _ c z: m) °■ § j c § � § § � � � @ : o . § ■ \ z § § § @ B 2) §se !e° �) § z■ o § o ; �a - 9 £ , ƒ \§ � m m: »: ■: m: z: z: ■; q: o: E. § ) L Id - ■ � � ■ z I z 0 k U k a § k W O W .11 al 0 S N A N 0 0 z 0 MR O: ma a€ 70: m Z: Z. V: 03 c v n m m A a 2 0 # 20 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---- September 23 2020 INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES Cardiovascular Associates of Victoria Clinical Pathology Labs Richard Arroyo -Diaz HEB Pharmacy (Medimpact) Pharmacy Reimbursement MMCenter (In•paaent $0.00/ out -patient $5,055.131 ER $0) Memorial Medical Clinic Singleton Associates, PA Victoria Anesthesiology Assoc SUBTOTAL Memorial Medical Center (Indigent Healthcare Payroll and Expenses) Co -pays adjustments for August 2020 Reimbursement from Medicaid by:CT 33.27 122.98 55.60 130.88 5,065.13 200.00 118.42 160.48 5,886.76 4,166.67 Subtotal 10,053.43 (60.00) 0.00 COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT I I UNIT TOTAL NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY PRICE PRICE 1000-800-98722-999 Transfer to vav bills for Indigent Health Care $10,003.43 approved b Commissioners Court On 09/23/2020 1000-001-46010 August 31, 2020 interest ( 2.02) R 10,001.41 COUNTY A TOR a THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE RFAOVAL Y OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY THIS OBLIGATION. Q z . Z a O "'� 0] U I CERTIFY ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME Q IN GOOD C I ON AND REQUEST THE COUNTY TREASURER TO PAY THE AHO LIGATION. O-� S a BY: 9/23/2020 "'"" DEPARTMENT HEAD DATE ©iHS Issued 09/02/20 Source Description Source Totals Report Calhoun Indigent Health Care Batch Dates 09/01/2020 through 09/01/2020 For Source Group Indigent Health Care For Vendor: All Vendors Amount Billed Amount Paid 01 Physician Services 2,427,55 330.27 01-2 Physician Services -Anesthesia 546.00 160.48 02 Prescription Drugs 130.88 130.88 08 Rural Health Clinics 200.00 200.00 14 Mmc - Hospital Outpatient 15,774.02 5,065.13 Expenditures 19,155.66 5,963.97 Reimb/Adjustments -77.21 -77.21 Grand Total 19,078.46 6,886.76 EXPENSES 4,166.67 10,053.43 COPAYS <50.00> TOTAL 10,003.43 APPROVED ON 5EP I S BY CALHOUN COUNTY AUDITOR OHS Source Totals Report Issued 09/02/20 Calhoun Indigent Health Care Batch Dates 02/01/2020 through 09/01/2020 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 18,455.28 2,795.44 01-2 Physician Services -Anesthesia 3,666.00 1,045.51 02 Prescription Drugs 1,350.80 1,350.80 08 Rural Health Clinics 7,287.00 6,301.27 13 Mmc-Inpatient Hospital 47,647.45 22,870.77 14 Mmc - Hospital Outpatient 80,791.06 26,077.73 15 Mmc - Er Bills 7,163.00 2,292.16 Expenditures 167,010.00 63,383.09 Reimb/Adjustments-649.41 -649.41 Grand Total 166,360.59 62,733.68 EXPENSES 33,333.34 96,067.02 COPAYS <910.00> TOTAL 96,167.02 MEDICAL- �� CENTER Bill To: Calhoun County 815 N. Virginia St. Port Lavaca, Texas 77979 (361) 552-6713 Date: 9/8/2020 Invoice # 347 For: Aug-20 D$SGRIPjION AMOUNT . Funds to cover Indigent program operating expenses. Jason AnV—ZU-L CEO Total $ APPROVED ON 4,166.67 4,166.67 SEE ? 1 2020 BY U CAL -NOUN COUNTY AUDrrm P A MEMORIAL MEDICAL CENTER CHECK REQUEST Calhoun County Indigent Account Date Requested: 09/8/2020 "''• APPRAVW Y 2.020 E 0OVN.VYAtWfr0..R nALHOUN COUNTY, TEAS FOR ACCT. USE ONLY 1-1imprest Cash FIA/P Check Mail Check to Vendor Return Check to Dept AMOUNT 50.00 G/L NUMBER: 50240000 To transfer indigent co -pays from the operating account to the indigent bank EXPLANATION: .,r ...t REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: RUN DATE: 09/02/20 MEMORIAL MEDICAL CENTER PAGE 94 TIME: 08:51 RECEIPTS FROM 00/01/20 TO 08/31/20 RCERBP G/L RECEIPT PAY CASE RECEIPT DISC COLL GL CUR NUMBER DATE MRIDBR TYPE PAYER AMOUNT ANOUNR MEMBER MR DATE INIT CODE ACCOURT 50240.000 08/03/20 559416 CA 10.00 10.00 00/00/00 CAS 2 50240,000 00/11/20 560168 CA 10.00 10.00 00/00/00 PLB 2 50240.000 00/14/20 560570 CA 10.00 10.00 00/00/00 PLB 2 50240.000 08/25/20 561317 CA 10.00 10.00 00/00/00 HE 2 50240.000 08/31/20 561779 CA 10.00 10.00 00/00/00 PLB 2 **TOTAL** 50240.000 COUNTY INDIGENT COPAYS 50.00 y Calhoun County Indigent Care Patient Caseload 2020 Approved Denied Removed Active Pending January 0 2 1 17 2 February 0 1 2 15 2 March 0 0 1 15 1 April 1 0 6 10 2 May 1 2 0 11 1 June 0 0 0 11 0 July 0 0 0 11 1 August 1 0 1 10 1 September October November December YTD Monthly Avg 0 1 1 13 1 December 2019 Active 18 Number of Charity patients 178 Number of Charity patients below 100% FPL 93 Calhoun County Pharmacy Assistance Patient Caseload 2019 Approved Refills Removed Active Value January 0 2 0 114 $1,498.00 February 3 6 0 110 $12,514.00 March 3 3 1 112 $10,108.00 April 1 6 0 111 $26,370.00 May 1 3 0 112 $9,424.00 June 2 6 0 114 $38,390.00 July 1 5 0 115 $28,973.00 August 2 3 1 116 $15,553.00 September October November December YTD PATIENT SAVINGS Monthly Avg 2 4 0 113 $17,853.75 0 December 2019 Active 112 WSJ v � PROSPERITY BANK? Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13387 STATEMENT SUMMARY Public Fund Contractual Ckg w Int Account No 08/01/2020 Beginning Balance $5,486.% 3 Deposits/Other Credits + $6,590.31 4 Checks/Other Debits - $6,600.46 08/31/2020 Ending Balance 31 Days in Statement Period $5,476.81 Total Enclosures 6 8/31/2020 Page 1 of 2 Date Description Amount ,� 08/04/2020 Deposit $6,518.29 J"A.e 1„�� 08/20/2020 Deposit $70.00 CPS 08/31/2020 Accr Earning Pymt Added to Account $2.02 yt Check Number Date Amount Check Number Date Amount SS 12383 08.03 $4,166.67 12385 08.04 $2,280.02 12384 08.03 $99.51 12386 08-06 $54.26 Date Balance 08.01 $5,486.96 08-03 $1,220.78 Interest Paid This Period Interest Paid YTD MEMBER FDIC Date Balance 08.04 $5,459.05 08.06 $5,404.79 Below is an itemization of the $2.02 $19.96 Sarnings paid this period. " Annual Percentage Yield Earned Days in Earnings Period Earnings Balance Date Balance 08-20 $5,474.79 08-31 $5,476.81 0.45 % 31 $5,305.72 NYSE Symbol 'PB" Yt`�I MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---September 23, 2020 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES ;TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 667,849.12 'TOTAL TRANSFERS BETWEEN FUNDS $ 57,461.48 TOTAL NURSING HOME UPL EXPENSES $ 1,021,187.71 TOTAL INTER -GOVERNMENT TRANSFERS $ GRAND TOTAL DISBURSEMENTS APPROVED September 23, 2020 $ 1,646,498.37 1/ MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---September 23, 2020 PAYABLES AND PAYROLL 9/18/2020 Weekly Payables 9/18/2020 Patient Refunds 9/22/2020 McKesson-340B Prescription Expense 9/22/2020 Amerisource Bergen-340B Prescription Expense Prosperity Electronic Bank Payments 9/20/2020 Sales Tax for August 2020 9/14-9/18/2020 Pay_Plus-Patient Claims Processing Fee TOTAL PAYABLES, PAYROLL ANDELECTRONIC BANK PAYMENTS TRANSFER BETWEEN FUNDS -NURSING HOMES 9/1812020 MMC Operating to Golden Creek Healthcare -correction of NH insurance payment deposited into MMC Operating 9/18/2020 MMC Operating to Gulf Pointe Plaza -correction of NH insurance payment deposited into MMC Operating 9/18/2020 MMC Operating to Tuscany Village -correction of NH insurance payment deposited into MMC Operating 9/18/2020 MMC Operating to Bethany Senior Living -correction of NH insurance payment deposited into MMC Operating TOTAL TRANSFERS BETWEEN FUNDS NURSING HOME UPL EXPENSES 9/22/2020 Nursing Home UPL-Cantex Transfer 9/22/2020 Nursing Home UPL-Nexion Transfer 9/22/2020 Nursing Home UPL-HMG Transfer 9/22/2020 Nursing Home UPL-Tuscany Transfer 9/22/2020 Nursing Home UPL-HSL Transfer CREDIT CARD & LEASE FEES 9/15/2020 Tuscany -Enhanced Analysis 558,157.98 29,39 7,838.11 345.59 1,391.14 86.91 $ 667,849.12 63.19 23,544.67 26,409.62 7,444.00 _ $ 67,461.48' 697,187.03 14,684.75 89,212.92 308,838.42 11,224.59 TOTAL NURSING HOME UPL EXPENSES $ 1,021,187.71 TOTAL INTER -GOVERNMENT TRANSFERS $ GRAND TOTAL DISBURSEMENTS APPROVED, September 23, 2020 $ 1,646,498.31 ell7PG020 1 tmp_cw5report5463498191708328600.html i�•) In J(�J `I' MEMORIAL MEDICAL CENTER 09/17/2020, J J i If r1 /' j?`� 0 -• , .t., AP Open Invoice List 10:38 ap_open_invoice.template \," i±Ya 9 Due Dates Through: 09/30/2020 tir1_,1 8 i AVO Vendor# Vendor Name Class Pay Code 112a3atadot¢et ACE HARDWARE 15521 C0104lt Ar„ Invoice# omml tw r?ran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net /-� 147628,/ 09/11/2020 09/02/2020 09/27/2020 25.98 0.00 0.00 25.98 j SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11283 ACE HARDWARE 1! 25.98 0.00 0.00 25.98 Vendor# Vendor Name ` Class Pay Code 10950 ACUTE CARE INC . Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 25123 ✓ 09/08/2020 09/20/2020 09/30/2020 1,400.00 0.00 0.00 1,400.00 / RFID FEE ✓ Vendor Totals: Number Name Gross Discount No -Pay Net 10950 ACUTE CARE INC 1,400.00 0.00 0.00 1,400.00 Vendor# Vendor Name / Class Pay Code 10958 ALLYSON SWOPE ,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 091520 09/14/2020 09/15/2020 09/15/2020 611 2,322.00 0.00 0.00 2,322.00 / CONTRACT EMPLOYEE(to - to I'W) t/ Vendor Totals: Number Name Gross Discount No -Pay Net 10958 ALLYSON SWOPE 2,322.00 0.00 0.00 2,322.00 Vendor# Vendor Name Class Pay Code 13472 AMERICAN COLLEGE PF PHYSICU, / Invoice# Comment Tran Dt Inv Dt Due Dt heck Dt Pay Gross Discount No -Pay Net 017776 09/16/2020 09/04/2020 09/04/2020 245.00 0.00 0.00 245.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 13472 AMERICAN COLLEC 245.00 0.00 0.00 245.00 Vendor# Vendor Name Class Pay Code 11376 APPLETON MEDICAL SERVICES IN Invoice# omment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 409980 09/16/2020 04/30/2020 09/16/2020 821.95 0.00 0.00 821.95 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11376 APPLETON MEDICP 821.95 0.00 0.00 821.95 Vendor# Vendor Name Class Pay Code A2218 AQUA BEVERAGE COMPANY Z'M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 989554 V"�08/31/2020 08/31/2020 09/25/2020 29.96 0.00 0.00 29.96 WATER Vendor Totals: Number Name Gross Discount No -Pay Net A2218 AQUA BEVERAGE ( 29.96 0.00 0.00 29.96 Vendor# Vendor Name Class Pay Code B1150 BAXTER HEALTHCARE ✓ W Invoice# Cgmment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 12112102 09/16/2020 08/29/2020 09/23/2020 13.32 0.00 0.00 13.32 LATE FEE Vendor Totals: Number Name Gross Discount No -Pay Net B1150 BAXTER HEALTHC/ 13.32 0.00 0.00 13.32 Ventlor# Vendor Name / Class Pay Code 12600 BIOFIRE DIAGNOSTICS LLC ✓ Invoice# Cement Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 1280065926�09/11/2020 09/01/2020 09/11/2020 9,463.47 0.00 0.00 9,463.47 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 12600 BIOFIRE DIAGNOSI 9,463.47 0.00 0.00 9,463.47 Vendor# Vendor Name Class Pay Code file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150a/data_5/tmp_cw5report5463498191708328600.html 1/15 6'/17120203 imp_cw5report5463498191708328600.html B1800 BRIGGS HEALTHCARE .// M Invoice# Cc mant Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net B307089 09I14/2020 08/10/2020 09/09/2020 125.73 0.00 0.00 125.73 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net B1800 BRIGGS HEALTHCF 125.73 0.00 0.00 125.73 Vendor# Vendor Name Class Pay Code 12740 BUILDING KID STEPS Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net AUGUST 20:09/16/2020 09/15/2020 09/15/2020 1,261.00 0.00 0.00 1,261.00✓ SPEECH THERPAY AUGUST20209/16/2020 09/15/2020 09/15/2020 1,000.00 0.00 0.00 1,000.00 ✓� SPEECH THERAPY AUGUST20209/16/2020 09/15/2020 09/15/2020 463.00 0.00 0.00 463.00 ASPEECH THERAPY Vendor Totals: Number Name Gross Discount No -Pay Net 12740 BUILDING KID STEF 2,724.00 0.00 0.00 2,724.00 Vendor# Vendor Name / Class Pay Code 11224 CABLES AND SENSORS✓ Invoice# . Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 98248 1/ 09/16/2020 08/31/2020 154.00 0.00 0.00 154.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11224 CABLES AND SENS 154,00 0.00 0.00 154.00 Vendor# Vendor Name Class Pay Code C1992 CDW GOVERNMENT, INC. '// M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net ZVX3566✓08/31/2020 08/25/2020 09/24/2020 2,454.49 0.00 0.00 2,454.49 CART BATTERY Vendor Totals: Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMEN- 2,454.49 0.00 0.00 2,454.49 Vendor# Vendor Name Blass Pay Code L1629 CHRISTINA ZAPATA-ARROYO ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net AUGUST20209/14/2020 09/14/2020 09/14/2020 261.25 0.00 0.00 261.25 SPEECH THERAPY Vendor Totals: Number Name Gross Discount No -Pay Net L1629 CHRISTINAZAPATF 261.25 0.00 0.00 261.25 Vendor# Vendor Name / Class Pay Code C1730 CITY OF PORT LAVACA ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 080520 09/14/2020 08/05/202G 08/05/2020 42.28 0.00 0.00 42.28 �✓ 12-1260-02 UTILITIES 080520A 09/14/2020 08/05/2020 08/05/2020 5,805.07 0.00 0.00 5,805.07 v✓ 12-1320.00 UTILITIES 090720A 09/16/2020 09/07/2020 09/07/2020 42.28 0.00 0.00 42.28 , V 12-1260-02 090720 09/16/2020 09/07/2020 09/07/2020 6,112.06 0.00 0.00 6,112.06 12-1320-00 Vendor Totals: Number Name Gross Discount No -Pay Net C1730 CITY OF PORT LAV, 12,001.69 0.00 0.00 12,001.69 Vendor# Vendor Name Class Pay Code 10212 CLINICAL PATHOLOGY LABS //ICP Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2020080 09/15/2020 08/31/2020 09/30/2020 70,897.03 0.00 0.00 70,897.03 1/ LAB SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 10212 CLINICAL PATHOLC 70,897.03 0.00 0.00 70,897.03 Vendor# Vendor Name Class Pay Code 13336 COCA COLA SOUTHWEST BEVER, Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net file:///C:/Users/mmekissack/cpsi/memmed.cpsinet.com/u88150a/data_5/tmp_cw5repor[5463498191708328600.htmi 2/15 5/17/2020 ) tmp_cw5report5463498191708328600.html 7991204487 09/14/2020 07/01/2020 07/31/2020 339.98 0,00 0.00 339.98 ✓ SODA FOR LUBY'S Vendor Totals: Number Name Gross Discount No -Pay Net 13336 COCA COLA SOUTF 339.98 0.00 0.00 339.98 Vendor# Vendor Name Class Pay Code C1970 CONMED CORPORATION ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 331795 ✓ 09/11/2020 08/26/2020 09/26/2020 87.50 0.00 0.00 87.50,/ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C1970 CONMED CORPOR, 87.50 0.00 0.00 87.50 Vendor# Vendor Name Class Pay Code C2157 COOPER SURGICAL INC j M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 5586398 ./ 09/11/2020 08/21/2020 09/11/2020 2,050.38 0.00 0.00 2,050.38 SUPPLIES 5587172�/ 09/11/2020 08/24/2020 09/11/2020 330.89 0.00 0.00 330.89 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C2157 COOPER SURGICAI 2,381.27 0.00 0.00 2,381.27 Vendor# Vendor Name Class Pay Code 13476 CROSSOVER SYMMETRY ,/ Invoice# C mment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 6041410 (9/16/2020 09/08/2020 09/08/2020 192.00 0.00 0.00 192.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 13476 CROSSOVER SYMA 192.00 0.00 0.00 192.00 Vendor# Vendor Name Class Pay Code 10006 CUSTOM MEDICAL SPECIALTIES Invoice# Cpinment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 271524 �/ 09/16/2020 09/02/2020 09/16/2020 326.25 0.00 0.00 326.25 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10006 CUSTOM MEDICAL 326.25 0.00 0.00 326.25 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON t/ Invoice# .Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 617377009 /11/2020 08/31/2020 09/25/2020 264.37 0.00 0.00 284.37 SUPPLIES 6175440 1/09/1112020 09/01/2020 09/26/2020 232.07 0.00 0.00 232.07 f SUPPLIES 6175750 /09/11/2020 09/02/2020 09/27/2020 225.00 0.00 0.00 225.00 Y / / SUPPLIES 6180340 ✓ 09/11/2020 09/04/2020 09/29/2020 78.53 0.00 0.00 78.53 ✓ SUPPLIES 6180320 �/609/11/2020 09/04/2020 09/29/2020 96.35 0.00 0.00 96.35 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SC 896.32 0.00 0.00 896.32 Vendor# Vendor Name Class Pay Code 11011 DIAMOND HEALTHCARE CORP Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net IN20054030 06/31/2020 08/31/2020 09/25/2020 19,166.67 0.00 0.00 19,166.67 � CPR IN20054029 W 31/2020 08/31/2020 09/25/2020 31,144.58 0.00 0.00 31,144.58,,," BEV HEALTH Vendor Totals: Number Name Gross Discount No -Pay Net 11011 DIAMOND HEALTH( 60,311.26 0.00 0.00 50,311.25 Vendor# Vendor Name Class Pay Code 10789 DISCOVERY MEDICAL NETWORK Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net file:///C:/Users/mmekissack/cpsi/memmed.cpsinet.com/u88l50a/data_5/tmp_cw5report5463498191708328600.html 3116 4/17/20205 tmp_cw5report5463498191708328600.html MMC091520,09% 6/2020 09/15/2020 09/15/2020 140,204.87 0.00 0.00 140,204.87 PROFEES (0h-gljSi'>a) Vendor Totals: Number Name Gross Discount No -Pay Net 10789 DISCOVERY MEDIC 140,204.87 0.00 0.00 140,204.87 Vendor# Vendor Name / Class Pay Code 11291 DOWELL PEST CONTROL Invoice# 13omment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 18472 08/31/2020 08/31/2020 09/25/2020 260.00 0.00 0.00 260.00 ✓ / PEST CONTROLL 18470 ✓ 08/31/2020 08/31/2020 09/25/2020 160.00 0.00 0.00 160.00 ✓ PEST CONTROL 18297 ✓08/31/2020 08/31/2020 09/25/2020 105.00 0.00 0.00 105.00 PEST CONTROL ✓ Vendor Totals: Number Name Gross Discount No -Pay Net 11291 DOWELL PEST COP 525.00 0.00 0.00 525.00 Vendor# Vendor Name Class Pay Code 11046 E-MDS, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 394088✓ 09/14/2020 09/14/2020 09/14/2020 9,275.00 0.00 0.00 9,275.00 HOSTING SUBSCRIPTION QTRLY Vendor Totals: Number Name Gross Discount No -Pay Net 11046 E-MDS, INC 9,275.00 0.00 0.00 9,275.00 Vendor# Vendor Name Class Pay Code 11284 EMERGENCY STAFFING SOLUTIO % Invoice# Comment Tran Dt Inv Dt Due Dt 15heck Dt Pay Gross Discount No -Pay Not 39538 ✓09/14/2020 09/15/2020 09/25/2020 40,062.50 0.00 0.00 40,062.50 ER STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net 11284 EMERGENCY STAF 40,062.50 0.00 0.00 40,062.50 Vendor# Vendor Name Class Pay Code C2510 EVIDENT ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net A200903137B)9/16/2020 09/03/2020 09/28/2020 20,074.00 0.00 0.00 20,074.00 SUPPORT/MONTHLY SUB T20090813709/16/2020 09/08/2020 09/08/2020 10,022.16 CONSULTINGBUSINESS SERVICE Vendor Totals: Number Name Gross Discount C2510 EVIDENT 30,096.16 0.00 Vendor# Vendor Name Class 50501 EVOQUA WATER TECHNOLOGIES / 0.00 0.00 10,022.16 ✓ No -Pay Net 0.00 30,096.16 Pay Code Invoice# Co mant Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount 904521848 79/11/2020 07/07/2020 08/01/2020 1,376.70 0.00 SUPPLIES Vendor Totals: Number Name Gross Discount S0501 EVOQUA WATER TI 1.376.70 0.00 Ventlor# Vendor Name Class F1100 FEDERAL EXPRESS CORP. v/ W Invoice# Cont ant Tran Dt Inv Dt Due Dt Check Dt Pay Gross 707994281 .99/11/2020 07/30/2020 08/24/2020 54.58 SHIPPING 710614309 /11/2020 08/27/2020 09/21/2020 145.57 SHIPPING Vendor Totals: Number Name Gross Discount F1100 FEDERAL EXPRES; 200.15 0.00 Vendor# Vendor Name Class F1400 FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 6762110 08/31/2020 08/31/2020 09/25/2020 51.38 SUPPLIES 6367917 9/15/2020 08/20/2020 09/14/2020 431.55 SUPPLIES file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150aldata_5/tmp_cw5report5463498191708328600.htmi No -Pay Net 0.00 1,376.70 No -Pay Net 0.00 1,376.70 Pay Code Discount No -Pay Net 0.00 0.00 54.58 0.00 0.00 145.67 No -Pay Net 0.00 200.15 Pay Code Discount No -Pay Net 0.00 0.00 51.38 0.00 0.00 431.55✓ 4115 6/17/2020 1 tmp_cw5report5463498191708328600.html 6455048 �/09/15/2020 08/21/2020 09/15/2020 33.66 0.00 0.00 33,66✓ /- SUPPLIES 6659911 ✓ 09/15/2020 08/25/2020 09/19/2020 39.12 0.00 0.00 39.12 ✓ SUPPLIES / 4931836,/ 09/16/2020 08/10/2020 09/04/2020 134.71 0.00 0.00 134.71 ✓ SUPPLIES / 4931837 V/ 09/16/2020 08/10/2020 09/04/2020 666.21 0.00 0.00 666.21 / SUPPLIES 5071744 109/16/2020 08/11/2020 09/05/2020 187.34 0.00 0.00 187.34 / SUPPLIES 5225820,/ 09/16/2020 08/12/2020 09/06/2020 - 1,102.68 0.00 0.00 1,102.68 SUPPLIES 5225807 ✓09/16/2020 08/12/2020 09/06/2020 913.10 0.00 0.00 913.10 SUPPLIES 6367916 /09/1612020 08/20/2020 09/14/2020 290.52 0.00 0.00 290.52 SUPPLIES 6659916 /09/16/2020 08/25/2020 09/19/2020 6.10 0.00 0.00 6.10 SUPPLIES 6762109 ✓ 09/16/2020 08/26/2020 09/20/2020 1,190.11 0.00 0.00 1,190.11 SUPPLIES F/ 687024409/16/2020 08/27/2020 09/21/2020 604.87 0.00 0.00 604.87 � SUPPLIES 7142819 ✓09/16/2020 09/01/2020 09/26/2020 1,327.17 0.00 0.00 1,327.17� SUPPLIES 7372190✓09/16/2020 09/03/2020 09/28/2020 3,818.82 0.00 0.00 3,818.82 SUPPLIES ��. 7372186 �/09/16/9020 09/03/2020 09/28/2020 63.30 0.00 0.00 63.30 SUPPLIES 7487756 ,/09/16/2020 09/04/2020 09/29/2020 63.30 0.00 0.00 63.30 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCA 10,923.94 0.00 0.00 10,923.94 Vendor# Vendor Name Class Pay Code 12948 GREAT AMERICAN FINANCIAL SV( Invoice# C mment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2775343009/15/2020 09/07/2020 09/30/2020 10,028.68 0,00 0.00 10.028.68 J ✓ COPIER PRINTER LEASE Vendor Totals: Number Name Gross Discount No -Pay Net 12948 GREATAMERICAN 10,028.68 0.00 0.00 10,028.68 Vendor# Vendor Name Class Pay Code G1210 GULF COAST PAPER COMPANY wM/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 1915132 ✓ 08/31/2020 08/25/2020 09/24/2020 584.84 0.00 0.00 584.84 / SUPPLIES 1914874 ,/ 08/31/2020 08/25/2020 09/24/2020 102.56 0.00 0.00 / 102.55 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPE 687.39 0.00 0.00 687.39 Vendor# Vendor Name Class Pay Code 10334 HEALTH CARE LOGISTICS INC ,/ Invoice# Cc ment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 307677385 00,/14/2020 08/10/2020 09/04/2020 91.20 0.00 0.00 91.20 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10334 HEALTH CARE LOG 91.20 0.00 0.00 91.20 Vendor# Vendor Name Class Pay Code 10804 HEALTHCARE CODING & CONSUL Invoice#'Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 10017 09/15/2020 08/31/2020 09/30/2020 544.00 0.00 0.00 544.00 CODING SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net file:///C:/Users/mmckisseck/cpsitmemmed.cpsinet.com/u88l50a/data 5/tmp_cw5report5463498191708328600.html 5115 4/1712020t tmp_cw5report5463498191708328600.html 10804 HEALTHCARE COD 544.00 0.00 0.00 544.00 Vendor# Vendor Name Class Pay Code H0031 HEB CREDIT RECEIVABLES DEPT: Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 464651 ✓08/31/2020 08/02/2020 09/25/2020 24.79 0.00 0.00 24.79 SUPPLIES 832560 ✓08/31/2020 08/03/2020 09/26/2020 55.02 0,00 0.00 55.02 tj / SUPPLIES 630650 ,/ 08/31/2020 08/05/2020 09/25/2020 19.76 0.00 0.00 19.76,, SUPPLIES 631285 /68/3112020 08/07/2020 09/25/2020 ✓ 9.17 0.00 0.00 9A7 ✓' SUPPLIES 677793 08/31/2020 08/08/2020 09/25/2020 69.51 0.00 0.00 69.51 SUPPLIES 938857 08/31/2020 08/09/2020 09/25/2020 17.08 0.00 0.00 17.08✓ /• SUPPLIES 569432 J 08/31/2020 08/10/2020 09/25/2020 24.34 0.00 0.00 24.34 SUPPLIES 646055 ✓ 08/31/2020 08/11/2020 09/25/2020 43.92 0.00 0.00 43.92 ✓; / SUPPLIES 839635 �/ 08/31/2020 08/15/2020 09/25/2020 12.28 0.00 0.00 12.28 v/ SUPPLIES 843181 08/31/2020 08/16/2020 09/25/2020 30.93 0.00 0.00 30.93✓ / SUPPLEIS 843166 ✓ 08/31/2020 08/16/2020 09/25/2020 -6.40 0.00 0.00 -6.401/` CREDIT 577478 /08/31/2020 08/17/2020 09/25/2020 64.05 0.00 0.00 64.05 SUPPLIES 827406 /08/31/2020 08/20/2020 09/25/2020 31.81 0.00 0.00 31.81 SUPPLIES 850281 ✓08/31/2020 08/23/2020 09/25/2020 36.72 0.00 0.00 36.72 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net H0031 HEB CREDIT RECEI 432.98 0.00 0.00 432.98 Vendor# Vendor Name Class , Pay Code 10922 HUNTER PHARMACY SERVICES ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 4033 ✓ 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Discount No -Pay Net 090820 09/14/2020 09/08/2020 09/08/2020 300.00 0.00 0.00 300.00 file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150a/data_5/tmp_cw5repori5463498191708328600.html 6/15 6/17/2020' tmp_cw5report5463498191708328600.html PATIENT REFUND Vendor Totals: Number Name Gross Discount No -Pay Net 13464 300.00 0.00 0.00 300.00 Vendor# Vendor Name Class Pay Code J0150 J & J HEALTH CARE SYSTEMS, IN( Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 922997727 a6/11/2020 08/05/2020 09/04/2020 22.34 0.00 0.00 22.34 SUPPLIES 923002721 ,A9/11/2020 08/06/2020 09/05/2020 765.36 0.00 0.00 765.36 SUPPLIES 923015351 ✓09/11/2020 08/07/2020 09/06/2020 40.29 0.00 0.00 40.29 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net J0150 J & J HEALTH CARE 827.99 0.00 0.00 827.99 Vendor# Vendor Name Class Pay Code 10834 JACKSON & CARTER, PLLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2727 / 09/14/2020 09/05/2020 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180.36 � SUPPLIES 1921845866,p9/16/2020 08/25/2020 09/19/2020 83.75 0.00 0.00 83.75 SUPPLIES 1921845867 qp/4/2020 08/25/2020 09/19/2020 93.78 0.00 0.00 93.78 � SUPPLIES 1921984323 99/16/2020 08/26/2020 09/20/2020 13.18 0.00 0.00 13.18 � SUPPLIES 1921984318 Q9116/2020 08/26/2020 09/20/2020 1,295.09 0.00 0.00 1,295.09 SUPPLIES 1921984317 0 /16/2020 08/26/2020 09/20/2020 46.64 0.00 0.00 46.64 SUPPLIES / 1921984321 09/'I6/2020 08/26/2020 09/20/2020 601.32 0.00 0.00 601.32 j ✓ SUPPLIES / 1921984319 O>9/16/2020 08/26/2020 09/20/2020 3,232.53 0.00 0.00 3,232.53 SUPPLIES 192265289609/16/2020 09/01/2020 09/26/2020 82.23 0.00 0.00 82.23 SUPPLIES 16/2020 / 1922653701 Dg 09/01/2020 09/26/2020 46.80 0.00 0.00 46.80 SUPPLIES / 1922662898 9916/2020 09/01/2020 09/26/2020 2,343.03 0.00 0.00 2,343.03 ✓ SUPPLIES / 1922653713Y/16/2020 09/01/2020 09/26/2020 211.07 0.00 0.00 211.07 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTR 20,908.14 0.00 0.00 20,908.14 Vendor# Vendor Name Class Pay Code 10963 MEMORIAL MEDICAL CLINIC / Invoice# Comment Tran Dt Inv Dt Due Dt ✓ Check Dt Pay Gross Discount No -Pay Net 091120 09/14/2020 09/11/2020 09/11/2020 120.00 0.00 0.00 120.00 PAYROLLDED Vendor Totals: Number Name Gross Discount No -Pay Net 10963 MEMORIALMEDICR 120.00 0.00 0.00 120.00 Vendor# Vendor Name Class Pay Code M2659 MERRY X-RAY/SOURCEONE HEAL M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8800648802 W/11/2020 08/03/2020 09/02/2020 181.80 0.00 0.00 181.80 / SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2659 MERRY X-RAY/SOU 181.80 0.00 0.00 181.80 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 6012724 Z09/11/2020 09/10/2012 09/20/9012 15.68 0.00 0.00 15.68 INVENTORY 1865 / 09/11/2020 08/31/2020 09/10/2020 -456.21 0.00 0.00 -456.21 ✓ CREDIT 1734 ✓ 09/11/2020 08/31/2020 09/10/2020 -7.36 0.00 0.00 -7.36 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�/09/115/2020 08/20/2020 08/20/2020 262.50 0.00 0.00 262.50 AD Vendor Totals: Number Name Gross Discount No -Pay Net 10645 REVISTA de VICTOf 262.50 0.00 0.00 262.50 Vendor# Vendor Name Class Pay Code 11252 RX WASTE SYSTEMS LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2710 ✓ 08/31/2020 09/01/2020 09/26/2020 235.00 0.00 0.00 235.00 DISPOSAL SERVICE Vendor Totals: Number Name Gross Discount No -Pay Net 11252 FIX WASTE SYSTEM 235.00 0.00 0.00 235.00 - Vendor# Vendor Name Class Pay Code S1800 SHERWIN WILLIAMS W Invoice# Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net �omment 50500 09/11/2020 09/02/2020 09/17/2020 153.77 0.00 0.00 153.77 SUPPLIES 51276 ✓ 09/11/2020 09/03/2020 09/18/2020 57.37 0.00 0.00 57.37 ✓ SUPPLIES 53843 ✓ 09/11/2020 09/09/2020 09/24/2020 114.73 0.00 0.00 114.73 t/ SUPPLIES / 53835 09/16/2020 09/09/2020 09/24/2020 197.16 0.00 0.00 197.15 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net S1800 SHERWIN WILLIAM! 523.02 0.00 0.00 523.02 Vendor# Vendor Name / Class Pay Code K0536 SHIRLEY KARNEI ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 091720 09/17/2020 09/17/2020 09/17/2020 171.49 0.00 0.00 171.49 CONTRACT EMPLOYEE Vendor Totals: Number Name Gross Discount No -Pay Net K0536 SHIRLEY KARNEI 171.49 0.00 0.00 171.49 Vendor# Vendor Name Class Pay Code 11296 SOUTH TEXAS BLOOD & TISSUE C Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net CM2846 ✓08/31/2020 08/31/2020 09/25/2020 -1,185.00 0.00 0.00 -1,186.00 CREDIT 107008414 Y/31/2020 08/31/2020 09/25/2020 5,762.00 0.00 0.00 5,762.00 BLOOD Vendor Totals: Number Name Gross Discount No -Pay Net 11296 SOUTH TEXAS BLO 4,577.00 0.00 0.00 4,577.00 Vendor# Vendor Name / Class Pay Code 52830 STRYKER SALES CORR/ M Invoice# Com gent Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 3105962M 0.9714/2020 08/06/2020 09/06/2020 110.00 0.00 0.00 110.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net S2830 STRYKER SALES C ✓ 110.00 0.00 0.00 110.00 Vendor# Vendor Name Class Pay Code 12476 SUN LIFE FINANCIAL Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net file:///C:/Users/mmckissack/cpsitmemmed.cpsinet.com/u88150a/data_5/tmp_cw5report5463498191708328600.html 12115 4/17/2020 r tmp_cw5report5463498191708328600.html 082520 09/16/2020 08/25/2020 09/10/2020 10,572.57 0.00 0.00 10,572.57✓ INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 12476 SUN LIFE FINANCIP 10,572.57 0.00 0.00 10,572.57 Vendor# Vendor Name Class Pay Code 13168 SWINGING ON A STAR, INC Invoice# omment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 37249 �/' 09/14/2020 05/19/2020 06/18/2020 104.50 0.00 0.00 104.50 SUPPLIES 37697 �/19/14/2020 07/20/2020 08/19/2020 104.50 0.00 0.00 104.50 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 13168 SWINGING ON A S7 209.00 0.00 0.00 209.00 Vendor# Vendor Name Class Pay Code T2539 T-SYSTEM, INC W ,// Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 38299 / 08/31/2020 08/27/2020 09/26/2020 ✓ 431.42 0.00 0.00 431.42 / / ERX LICENSE v 38295 08/31/2020 08/31/2020 09/30/2020 5,699.00 0.00 0.00 5,699.00 TRACKING/STAT/CLOUD HOSTIN( 38184 ✓08/31/2020 08/31/2020 09/30/2020 1,144.00 0.00 0.00 1,144.00 ✓ CLOUD HOSTING Vendor Totals: Number Name Gross Discount No -Pay Net T2539 T-SYSTEM, INC 7,274.42 0.00 0.00 7,274.42 Vendor# Vendor Name C�ss Pay Code T2204 TEXAS MUTUAL INSURANCE CO N Invoice# Comant Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1002701652�(119/16/2020 09/08/2020 09/30/2020 4,025.00 0.00 0.00 4,025.00 WORKERS COMP Vendor Totals: Number Name Gross Discount No -Pay Net T2204 TEXAS MUTUAL IN: 4,025.00 0.00 0.00 4,025.00 Vendor# Vendor Name Class Pay Code 11100 THE US CONSULTING GROUP Invoice# Comment Tran Dt Inv Dt Due Dt ✓ Check Dt Pay Gross Discount No -Pay Net 340379999,/09/14/2020 09/10/2020 09/20/2020 315.04 0.00 0.00 / 315.04 TRASH SERVICE 340380000 09/ 4/2020 09/10/2020 09/20/2020 248.47 0.00 . 0.00 / 248.47 1/ TRASH SERVICE 340380001 09/'i 4/2020 09/10/2020 09/20/2020 ,, ✓ 1,353.87 0.00 0.00 1,353.87 TRASH SERVICE Vendor Totals: Number Name Gross Discount No -Pay Net 11100 THE US CONSULTIr 1,917.38 0.00 0.00 1,917.38 Vendor# Vendor Name / Class Pay Code T0801 TLC STAFFING V/ W Invoice# Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net /Comment 26464 ✓ 09/16/2020 09/08/2020 09/08/2020 1,285.70 0.00 0.00 1,285.70 STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net T0801 TLC STAFFING 1,285.70 0.00 0.00 1,285.70 Vendor# Vendor Name Class Pay Code U1054 / UNIFIRSTHOLDINGS ✓ W Invoice# Comrr dnt Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8400341089 0 5/2020 08/31/2020 09/25/2020 45.15 0.00 0.00 f 45.15J LAUNDRY 840034111U615/2020 OW3112020 09/25/2020 1.347.08 0.00 0.00 1,347.08-/ LAUNDRY 8400341090 99/15/2020 08/31/2020 09/25/2020 291.99 0.00 0.00 291.99 LAUNDRY � 8400341452 29/15/2020 09/03/2020 09/28/2020 131.55 0.00 0.00 131.55 LAUNDRY 8400341494 89/15/2020 09/03/2020 09/28/2020 130.11 0.00 0.00 130.11 file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.comtu88150a/data_5/tmp_cw5repart5463498191708328600.html 13115 9/17/2020 ' tmp_cw5report5463498191708328600.html � LAUNDRY 0.00 / 1,219.53 8400341474o9/15/2020 09/03/2020 09/28/2020 1,219.53 0.00 LAUNDRY 8400341454 /15/2020 09/03/2020 09/28/2020 162.24 0.00 0.00 162.24 LAUNDRY 8400341450 15/2020 09/03/2020 09/28/2020 23.75 0.00 0.00 23.75✓ LAUNDRY 8400341455 0 15/2020 09/03/2020 09/28/2020 173.83 0.00 0.00 173.83 LAUNDRY 8400341466 pA5/2020 09/03/2020 09/28/2020 81.67 0.00 0.00 81.67 LAUNDRY � 8400341453 09/15/2020 09/03/2020 09/28/2020 146.77 0.00 0.00 146.77 ✓ LAUNDRY Vendor Totals: Number Name Gross Discount No -Pay Net U1054 UNIFIRSTHOLDINC 3,753.67 0.00 0.00 3,753.67 Vendor# Vendor Name Class Pay Code U1056 UNIFORM ADVANTAGE W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 11553274 09/11/2020 08/31/2020 09/15/2020 201.88 0.00 0.00 201.88✓ UNIFORM MIST BEST 11654625 _A11112020 09/01/2020 09/16/2020 143.91 0.00 0.00 143.91 � UNIFORM AMBER HOLT 11587626 V09/16/2020 09/08/2020 09/23/2020 31.99 0.00 0.00 31.99 UNIFORM DORTHY REND... 11,987626 �9/16/2020 09/09/2020 09/24/2020 208.71 0.00 0.00 208.71 UNIFORM ERIN WISDOM 11,989836 , A/16/2020 09/10/2020 09/25/2020 63.98 0.00 0.00 63.98 ✓ UNIFORM MARIA LONGORIA Vendor Totals: Number Name Gross Discount No -Pay Net U1056 UNIFORM ADVANT/ 650.47 0.00 0.00 650.47 Vendor# Vendor Name Class Pay Code V1056 VICTORIA AIR CONDITIONING LTD W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 185073 J 09/16/2020 09/02/2020 0910PJ2020 170.00 0.00 0.00 170.00 BLOWER MOTOR Vendor Totals: Number Name Gross Discount No -Pay Net V1056 VICTORIA AIR CON 170.00 0.00 0.00 170.00 Vendor# Vendor Name Class Pay Code 10793 WAGEWORKS, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 091120 09/14/2020 09/11/2020 09/11/2020 4,295.95 0.00 0.00 4,295.95 PAYROLL DED Vendor Totals: Number Name Grass Discount No -Pay Net 10793 WAGEWORKS, INC. 4,295.95 0.00 0.00 4,295.95 Vendor# Vendor Name Class Pay Code / 11110 WERFEN USA LLC/ Invoice# Com en t Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9110867941 0 Y0912020 08/31/2020 09/26/2020 1,206.53 0.00 0.00 1,206.53, SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11110 WERFEN USA LLC 1,206.53 0.00 0.00 1,206.53 Vendor# Vendor Name Class Pay Code 11400 WEST COAST MEDICAL RESOURC Invoice# Com ant Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INV061257 09/04/2020 09/16/2020 895.00 0.00 0.00 895.00 ,99/16/2020 v/ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11400 WEST COAST MEDI 895.00 0.00 0.00 895.00 Vendor# Vendor Name Class Pay Code 10556 WOUND CARE SPECIALISTS/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150a/data_5/imp_cw5report5463498191708328600.html 14/15 b/17/2020' o tmp_cw5report5463498191708328600.html WCS0000396/14/2020 09/01/2020 09/30/2020 8,725.00 WOUND CARE Vendor Totals: Number Name Gross Discount 10556 WOUND CARE SPE 8,725.00 0.00 . e[.i on Summary Grand Totals: Gross Discount No -Pay 558,157.98 0.00 0.00 APPROVrJ) Oki SEP 18 lair:! COUNTY AUDITOR C.ALI30iN COUNTY,1 t X,q : 0.00 No -Pay 0.00 0.00 8,725.00 Net 558,157.98 Net 8,725.00 ile:///C:IUsers/mmckissacklcpsilmemmed.cpsinet.com/u88150aldata_5/tmp_cw5report5463498191708328600.htm1 15/15 to T(IME: 0Sy:0 PATIENT "N!MBBA ='. :C;PAYEEjtUG1E` 1402608 01 ARID=0001 TOTAL ________________________________ TOTAL AFFI=OVI;D ON SEP 11? 1U1+, COIINTY AUDIT01i. .CAMOUN COIINTY, TB: A`' MEMORIAL MEDICAL CENTER EDIT LIST FOR PATIENT REFUNDS ARID=0001 PAY PAT DATE AMOUNT CODE TYPE DESCRIPTION 091120 29.39 3 REFUND FOR --------------- •... -'----•-•--------------- 29.39 v ---------------------------------- _________ 29.39 PAGE 1 APCDEDIT GL MUM §§ m ®o LLJ § li | §§ . ° k )2 � � k ! . � 2k O Ul { /»\2 � ! �cow 00 (� <0 2| < §§ - _! � § q Z - W §) %) . W r2 � 2! �E cn §; IE z |§ (2 0 a! A (LLI \\§)\ w §§Q! f =,;;§ $ . � § / ( . ! . i § 0 §t B� ! � ! B 2 § §© J ) z |( o Q OOW .�^.. 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Print this oaae for your records. Reference Number: Date and Time of Fl11ng: 09/17/2020 01:58:55 PM Taxpayer ID: Taxpayer Name: MEMORIAL MEDICAL CENTER Taxpayer Address: 015 N VIRGINIA ST PORT LAVACA , TX 77979 - 3025 Entered by:: Email Addreax: Telephone No. ---- IF Address :redits Taken ve you taking credit to reduce taxes due on this Credit' is return. N .1censed Customs Broker Exported Sales )Id you refund sales tax for this filing period on Items exported outside the United States based on a Texas Licensed Refund Sale, customs Broker Export Certification? Tax M Lee Total Texas Taxable Taxable Subject to State Tax State Tax Subject to Local Tax Local Tax # Sales Sales Purchases (Rate.062S) Due Local Tax Rate Due 10004 16,947 16,947 0 16,947 1,059.19 16,947 .02000 338.94 'otal Tax Due 1,398.13 Total Tax Due: = 1,398.13 Timely Filing Discount: - 6.99 Balance Due: = 1,391.14 Pending Payments: - 0.00 Total Amount Due and Payable: = 1,391.14 (State amount due is 1,053.89) (Local amount due is 337.25) Payment Summary State Amount: 9 337,25 Local Amount: 337,25 Amount to Pay: $1,391.14 Electronic Check: $1,391.14 Payment Reference Number: Trace Number: Type of Bank Ac---... Accountholder Name: Bank Routing Number Bank Account Number: -- Payment Effective Date Page 1 of 1 Print Return to Menu File for Anolher Taxpayer texas.cov Texas Records and Information Locator (TRAIL) State Link POINC Texas Homeland Security ! Texas Veterans. Portal Glenn Hegar, Texas Comptroller tlWt • contact U• Privacy and Security Policy Accessibility Policy Link Policy Public Information Act Compact with Texans https://mycpa.cpa.state.tx.us/salestaxweb/GotoSuccess.do 9/17/2020 6/17/2020 ' tmp_cw5report669039409770999106. html MEMORIAL MEDICAL CENTER 09/17/2020 0 AP Open Invoice List 09:07 ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11836 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 090820 09/15/2020 09/08/2020 10/01/2020 63.19 0.00 0.00 63.19L,,' TRANSFER A QjMuIAtK(L Pl Igtj da(/dh,kA l t j% Vkk4(-- 11�1t/y Vendor Totals: Number Name Gross Discount o No -Pay Net 11836 GOLDENCREEK HE 63.19 0.00 0.00 63.19 Grand Totals: Gross Discount No -Pay Net 63.19 0.00 0.00 63.19 APPROVED ON SEP 18 2020 COUNTY AUDITOR CALHOUN COUNTY, TP%4S file:///C:/Users[mmckissacktcpsi/memmed.cpsinet.com/u88150aldata 5/tmp_cw5report669039409770999106.html 1/1 §117/2020tmp_cw5report9073659134372142365.htmI MEMORIAL MEDICAL CENTER 0 09/17/2020 09:05 ' ' r AP Open Invoice List + ��1tj Dates Through: ap_open_invoice.template Vendor#„ Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 090820 09/15/2020 09/08/2020 10/01/2020 7,444.00 0.00 0.00 7,444.00 TRANSFER NN jMUMkLtk_ pvntt do f Q4jAL L iKb htUkL.. Olpt Vendor Totals: Number Name Gross Discount N(jPay Net 12792 BETHANY SENIOR 1 7,444.00 0.00 0.00 7.444.00 IaP�R Sunvnarj Grand Totals: Gross Discount No -Pay Net 7,444.00 0.00 0.00 7,444.00 APPROVED ON SEP 18 2020 Car up�� OLTNTY,TL file:///C:IUsers/mmckissock/cpsilmemmed.cpsinet.com/u88150a/data_5/lmp_cw5reporl9073659134372142365.html 1/1 4/17/2020 ' tmp_cw5report8717463693076393168.html MEMORIAL MEDICAL CENTER 09/17/2020 0 �p 09:05 ?>*;',l j iljl.� AP Open Invoice List ap_open_invoice.template Dates Through: Vendor# `;-:r!?stiy rlall�i#a1i Vendor Name Class Pay Code el�. 1'289fi GULF POINTE PLAZA" Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 090120 09/11/2020 09/01/2020 10/01/2020 16,812.95 0.00 0.00 16,812.95,/ TRANSFER nIN' ins�uu�t(A. puj.4 J�Pam6�.c�h''d( 090220 09/15/2020 09/02/2020 6,578.72 0.0 0.00 6,578.72 u''i{0/01/202 l TRANSFER NN kiltva(t pu/ 1 L4,p�GY1- 1 v1 kv� 9VL' Ore' 090420 09/15/2020 09/04/2020` 153q.0�0 0.00 0.0�,,� 153.00 r10/01/2020 L TRANSFER N/t AUyj K4. �1yJMl 4fij4lct "`�'11� ! / i6 IY KL, jou%, �( Vendor Totals: Number Name Gross Discount iii((N•JJJt'''0-Pay Net 12696 GULF POINTE PLA2 23,544.67 0.00 0.00 23,544.67 cpo;ISL lnin�y Grand Totals: Gross Discount No -Pay Net 23,544.67 0.00 0.00 23,544.67 APPROVED ON SEF 18 2020 COUNTY AUOTTOR 'XWOUN COUNTY, TE*L" file:///C:/Users/mmckissack/cpsilmemmed.cpsinet.com/u88150a/data_5/tmp_cw5report8717463693076393168.html 1/1 6/17/2020 tmp_cw5report343535930783638298. html ��pp �„ .� �ot811 / I MEMORIAL MEDICAL CENTER 0 7t �!L'i� - b9.66 AP Open Invoice List II�� 11 r# �ti Dates Through: ap_open_invoice.template Veit f i ,/t Vendor Name Class Pay Code 13004 ',dS'1a3i452.:i1lln4tOice#Comment TUSCANY VILLAGE Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 090120 09/11/2020 09/01/20201I 10/01/2020 14,816.87 0..00' 0.00 14,816.87✓ nnyy�� }- N L TRANSFER W141hSu4u_ vow (�G�v"tA� 'M.f• J, Kw_L. LIVL �„I �/ 090320 09/15/2020 09/03/2020 10/01/2020 6,104.60 0. 0 0.00 6,104.601/ TRANSFER fJ�iYtS giiiCt,P�Wt dgyijhcd-',�i� kv kf_ OpM 090420 09/15/2020 09/04/2020 10/01/2020 5,175.35 00 0.00 5,175.35 TRANSFER WR jkij(VkK(L V�Kt dM(14Ck. - tKN W-W14-bV W-'r-y O 091120 09/15/2020 09/11/2020 10/01/2020 4 II' 312.80 0.00 0.00 312.80 ✓ TRANSFER NN JNU L LMy_ MWUt dtpoji 4tk VLh kKL W� Vendor Totals: Number Name Gross Discount No Net 13004 TUSCANY VILLAGE 26,409.62 0.00 0.00 26,409.62 r: eporl5ummar„ Grand Totals: Gross Discount No -Pay Net 26,409.62 0.00 0.00 26,409.62 pygBAVED ON SEP 18 20N COUNTY AUDYtpll ChLAOUN COUNTY, TE1tA9 file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.comtu88l5Oaldata_5/tmp_cw5report343535930783638298.html 1/1 Memorial Medical Center Nursing Home UPL Weekly Cantez Transfer Prosperity Accounts 9/22/2020 PrMOYt TO.". Abbate DHFnI, AM Pekinese, Amount toIfTranefmad to Wrong NUNIn Home bon. r mlm0ut Tnnlbrin Pene4 Douglas 844nee He. 33,]08.a 33503.as 201,526.23 - 204,73I.36 % 204.526.23 Bank Balane! 204,731.36 ✓ Visions loos In eabnn 100.00 Pendln,aPPr11ld - AOubaaf06,rmorlanurA4A11omGembe, VIAa - Ashford MeaNACare Center Ltd Co aPP1,23AND4 - IPMomosCAaseBank lulYlntmert 62.43✓ _ "Print .... t 43.70 Septembntnterett / Adjust WanRR.nsfer Arms 204,526.13 63,022.59p/ 67.843.57 M 198,634.56 193,813.58 j 198r634.56 k B Bana4n. 19a,813.58 ✓ Vlrianfe IeosO in Bi4nn 100.00 OPP 1,2,3,4&Issue - Pending aPPciting, - Y2ADl ]ulTlntoeH 39.10, AuOlrtlnterert 39.9E Septmmberintered Adjust BPlan./TramferAmt 198.634.5E 33.204.81✓ 33,036.60 ✓ 67,950.35 t/ 68,118.56 67.950.35 Bank 8a4n. 68,118.56 i✓ Van.m. It.. In Balm. ID0.00 QIPP IX3,4&Los. - Pendin,appe0ed - aFpY2A0l J.1"iterekt 34.02✓ Au,.ltntenrt 3d.19 Septtmberintlrert Adjust ealan.7rRnumAme 67,950sei r/ 13,06.56 10,755.10 8/ 45,711.03 ✓ 48,023.54 / 47,891.12 Bank Btlmce 48.022.54" Venoms. - loot In B414e. 1D0.00 Plndlls,aPPebed - CUPPY2AMPYMT aPP1294 ]ulvinterest 35.1E ✓ August Interest 16M septemberintereH Adjun Balmn/rri Amt 47.89112 f / ✓ 78.357.60 76.184.77 t ".a. a 6&7PSA6 Y 78,184.77 Bank Babe. 78,357.60 Vann. molt"".. IDD.DD APPROVED Pendng(p ed - ON aPP YI AM Routine humor,/ CIrurm150rmm Wmrxommn/fbrr Centre Health Core Cenlnt$1, 11C -' 1i OPP 1234 ;�� !/k LOLt1 2 u IJ 0 ! [_ l) L fp MmpareOmu Bank lYlYlnhR. 34.5E j "lust Interest 38.27 ✓ Seplembertntereat COUNTY AUDITOR b 7 '• q % U - c;p7,ROUN COUNTY, TEXAS L _1 `' ( '• a � � "jurt&lan./TRnsfnAmt 78,184.77 / ✓ LF _ ( / TOTALTMNsiFAS 597.1".03 Man: Dnbbmamer o7we, ss,tmmnbeuvmleaeeromem j 9 `/ 1 1 Li La J Approved: Mom 7: CaNamount4m a base bounce 4SIMUat MMC dp_ la.n M,Il0 ai), 9/22/2020 FANH Weekly Tnmurt\NHUPI Tramkr Summery\1o20uePtembet\HH UIITramur 5umman,9-22-20,du OIPP/CmnN Tani l.,. },ana3ae.In WM/CAMP, DIM/(GmP2 WIP/Cadamp, Blapw DMP31 HIMMINON 0 53115.12 53.1,3.1E D 92107 9,t101D O ]MSIA] 10.%4,43 SIN.H 0 0 39790.18 19.190.18 0 INUOIS 13,61061 0 .100443 13,ON.A }6A134 0 0 INA 16 0 VUIGG },611.01 0 0 H2821 E601, 3,It811 26017% )I30P.61,/ A&S16.P1 3DP,S16.39 madc"nON TtaImLul � yg"'In ww/Comes T•QIPP/hmPl NM/fmnpl DIPP/Ibmpl !Hry NPPD NNPoRIION 5&91.8] 417O.M &IIOM J1.9I1.10 14.111.30 9$Oli 5$SIlD 5}5930 I.OW.M 1.MO.M 169,056% f1.M33) b L6M.% b I946H56 MMCPopNON /f1P)la_r'J Trana)Mn N01/fanPl MN/CmmP] NPI/CPmPi 1MPIP MIITI MNIOIIIION 2.36]A2 2313A1 350M ISOM 6.013.05 6,023.K 5,60556 5.4038 19.966.8! 19.9M81 B.IM.1( 6,IM.H l5]6951 I6.M).M O,M0.M 6.136M 827.14 en.H LAH.Np 0.916M 17 WIS MMCP.m. Nw/w N T nra ale -0y) TeanalxAn qIN/CmePl 0111/(anp2 OI%/Cann W9M MMT "PORTION 9,E55.90 I6,171.61 16p11,61 17.359.98 1].159.99 1. 6,SIOM / &510% 14I95.% CA)ym 45.71. MMt"AlloX MPP/(em94 Tani sfM.DM TuItMJn OIPP/CANE W"/C"2 MPP/Canty 4," WnTI Nx G.H. 1,601.5E 116M52 4%7.61 4.0761 %6M.15 S,6MAS 7A17.60 7.3170 W.11 IY.]1 .2.801.91 PALM 9.00a11 9.M.la 59,051] - 9.1.21 FAMM WeM/nann-ktain3 Dn SUAl WOn0I,enUO2U\WvUmI,,\NH SAM Mwlo ad 9.14.20mm 9.]a)mw NwI MMCPoRNOM 9/15/2020 NnerV,olp WC HMWMPMT 3112281414 III0S)TRM• t•ll!]28iU(•i)326032J1\ 9/IS/E010 VNCMMMUNIUPLNCMIMPMT14M34I191Rtl N-1.202.11113M20.1912MISI'4 X01\ 9/15/2020 MAIN HUMAN SVC HCCWMPMT 11160EH113NS 2 TRN•1.09165s91326411IN. 11NMISV 9/I6/2030 WIRFOUSAINFORDNGI7NGIC3NT RLTO 911612020 UXCCORIMUNMPIMCCWMPMT1960W61191=MN'l'2U 311I11CO216'1912MI6t•CWREX01\ 9110102U HEALTH HUMAN SW WCI4RVMi 3H6W14113C621RN'1.03F%U411IN161R9•UKLLOls6' 9/P/2010 VNCCOMMUNT'PIxttWMPM1 M600361I9ICAtl fR11'Itl0]%9t6111%H6'HIIMM41•WA• 1b011 9/1812WO UNCCK CO 1110ZG20 UHC COMMUNM IL NCCIMMPMTUM341191C0[OIRX•1']OIONIiH6W}R)•1911%t161.OKO18XOl{ 9/11/E030 UNC COMMUNIV PI NCCWMPMT IM%16119IKOOlRN•{'I%OAl)I]oWL45.1913C08161.0%OIG01\ 9Ul 020 UMC SfUNID l OAI MPM 67SA)l U191D]O]TRH•,90EpA1l-l2aAOv1913CW161•¢WRX01\ 9/il/]D]D XOVrtA55OLHTIDM N[[LAIM9Mi6151)l1)DYY14R111M•1•IM69RtM9•J2ns>9va9)•nm'uatt 9/16R030 WIM ONI CAME% NGl1N mi amm. 111 9/16/]O30 UK CanmW19 PI KCVIMPMT74MJ41191WM MN•l'2MMl31001303'1912W6361•M UX01\ 9/11A010 OMCCOMMURM It MCCWMPM3116MIC1291IXN1RN't•IO]MJ615MM96.1912M916PMMIFX01\ 9/1MMO CR67 9/IMMO VMCCOMMUN3IY It MCCWMPM31UM141191MW 1AN'1'lMWll]II6M196']91]MI)61'000OHMIk 9121CM0 MAMGMDNER]ll MNSPMIQMLIXm(WXI9141NS$5U 9/]WMO NOWMWL MNNCCWMPMi616IS742 T107UN-I-IM]MIIJ'1205E%I3]•O%YN01t\ 1114/2020 HU%IWA INS CO NCCWMPMT3901N 61KOZ)SME 1M1'I'MIE9M6ZIJIt3]'I39126H13\ 9/142010 HUMANA CN6 MSS MCCWMPMT)9p8616JMM1%1 TRH• I.0I6140I0167IEM•IISIOUIM\ 9/I5/ZMO INS SOD CUSMIM390814 H1191MWM-1-1MOMI316101EM•1911GA73\'MM1F%01\ 9/IS/]MO HUMANAIN5[OSE,HCC MFWI "420))IIH TRN•I•MlE9MbN59i]5.1391Z6H]!\ 9/6/]MO NUMMMCMOISBNCCWMPMTS% 42IX 12N%N•I.OlI 1016]9836.16110111U\ 9/iWMO IXJMAW CM.906S NC(WMPMil90W QMMI)M1PM'I•M16WIM636]H46110I1IM\ 9WO20 WIR60UTGXTFANGLMCMFlFX3611S111 911 W010 UHCCOMMUNMILKC MPMI]IIM 1191M nN'1.1MM1310JMM0.19l2Mlll'MMTS%l\ W1]/JMO UNCCOMMUNMPLHUMMPMT)16MH1191=0. N•1•IMM161Z1%%1.1911M6161-M XOI\ 9/IT/EMO UNCCOMMUNISYPI NUWMPMT]I6M11191CQtl1RN•ItlMM16155M191.191EMI6l'MMR%0l\ 9/IWMO CA Is 9/2WOI0 CIGNI4X6MCCWMPMT IN9860115910000111191191PN'1'E0ANl)MMM)4'159103I071\ 9/IS/]020 NWTN HUMAN 5VCMC(GIMPM311(6MHI1)M 11RX•1'M%SS6B1]!Ob]15M•Il(6M01%` 9/IWEOlOIINC COMMUNITY 9L NCLWMPMi)6M1(11910M1AN'1'1O3M31HSMQ•1913M161'MMIENM\ 1/17/1020 NGIINNMURMPk CCWMPM]I16MH11I1 1nN.1.002MIGl 9%IR'191Z III56` 9/Il/IMO UNC(OMMVNIIY Pl HCCGIMIMLli6MH1191MW lAN'l']OEMIbl6(Na1)•191]M361'MMI3X01\ 9/IMMO CR% 9/IMMo IINL (OMMVNID 9L NCMIMpMI)(M!]II91ttW iXM'1`]O]MI)1}3MI69'1913M9361'MZ1F}DI\ 9/14/2020 HUMANA INS CO HCCWMPMT)%MS II000CS119)2@N•1•Mll9M]CA151.1391161g1\ 9/14/ZOE0 MUMMMCNPOISBHCMIMPMTl90%242MM1%IDN•1.916M01016]4D9•I61IOp03\ 9/15/2020 Amalyroop TIOC HCCGIMPMT 311228745IU0M TRN•1•113Z10M1S•1RI60113D 9/5/2020 UNCCOMMUNIDPLHCMIMIMT)4M3411 9IMNiIIX•1•EOlMlE10Wt110']9L3M16t'%MlFgl\ 9/IS/2010 NVMMM INS CO HMUIMPW 3901631100005RM67RX•1•MI19TQU4B343L•I191361473{ 9115/2020 XUM4 INSCOXQUIMFMTJM6303yp 74%I3M)•1•Mt39M24592]4•1391361411\ 9/15/3020 HUMIMCMDISBHCCUIMPMT39 211MM12%TRN•1.Ol4 10109N7•16IIO1310\ 9/16/I0H) WME OUT GNM HGLM GIE CENNN IX 1/16/202G DNCWMMUNMPLNCCWMPMi]46MN319IDY%l]TIN•1•]01Ml315LMM0•1911MISS-C )LX01\ 91102WO UIICCOMMVNMPIXCCWMPMT)46%141191M0]6N•L4MMl31MM316.191ZWN61- M XDI\ 9/17/1M0A Npwp TXSC HCCLVMPMT 31125273%IIIODD X•1'llllSll3%'NS1M1M1\ 9/1]ZI030 UMCCOMMUHN'IIL HCCINMPMi]KMNI191M]1PN'I']MM16155M1D1'I911M161•MMIIX01\ 9I181IN0 CR 109 9/IMNO IMMAMCM OIfB NCCWMPMiI90%]UOMOIN)1RM'1.OHMOIN69131I•IM101lieJ\ 9639 9159 9120010 391.M )3]I111) f N,MS.M T,tM]9 .J ]I.I6UI 311AM.40 SN.O%.% 595M699 5.226M 5111600 H.151.11 1].I5I.31 b,56L]9 6$61A9 9222020 Treasury Center Quick View Select Quick View Accounts Select Group Account Number! Name Groups Add Group Amount Type 'A 81 MEMORIAL MEDICAL 5204,731.36 $208.638.62 $204.731_36 S17528615 CENTER; NH ASHFORD '4403 MEMORIAL MEDICAL 5198,813.56 $198894. 113 5198.813.58 $48676.62 CENTER/NH BROADMOOR '4411 MEMORIAL MEDICAL 568.118.56 S'' 00,221 78 568.118.56 567 291 42 CENTER I NH CRESCENT '4446 MEMORIAL MEDICAL $48.022.54 S48.022.54 $48,022.54 $48022.54 CENTER I NH FORT BEND '4436 MEMORIAL MEDICAL CENTER I SOLERA AT $78.357.60 $79.117.60 578.357.60 574,786.60 WEST HOUSTON https'ilDrosperity.olbanking.com/oiilinehiessenger •�nrate Ppgc {,helm' r 1:7 C Memorial Medical Center Nursing Home UPL Weekly Negion Transfer Prosperity Accounts 9/22/2020 Prrvlom �[� m Account Nunln ti. Number E4.986.09 / 24,813.07 ,/ 14,684.75 Routina Information for(olden Creak - Assign Health of (olden Creek Wells Form, Bank, N.A. Note: Only bolanns afaver S5,000 will be transferred to the Awning home. Nan 2: Each account has a bane balance of SIM that MMC IHP0aNd m open account. Pending Decals, Today. anginal, Amount to Be TI.mfeoed to Nursing Be.... He.. 14,857.77 / 14,684.75 Bank Otl.... 10.857.77E variance leave In Orion,. 100.00 QIPP 1230 QIPP YS AOI PYMT SUPERIOR 1.1, Into ... t 37.57 ✓� August lnt.... t 35A5 September Interest Adjust Balancu/Tnmet Arms A.600A5 Approved, JA1/` laton Anglin, CEO 9/22/2020 APPROVED ON SEP 2 2 2020 COUNTY AUDTTOR CALHOUN COUNTY, TEXAS P:\NH WeeNy Lamfors NN UPI innate, Summary\2020\SsptembepNN UPL 7nmfe16ammary 9Q2d0.11u mmc YORPON aPP/Lo-npLaL HN Tjynelei-0yfi Tran+Mr.In pIPP/Coop} aPP/Lmmp] aPP/fpnpl apu aPPT PUflTON 9/IA/}OEORMLTHHUWNiBK. SI].01 11116 9/IVEa HMM]Sa]LN]LH1691)91a9PNH'MF947115.07LP]GHGl IS6'Al1E0 M.O.T AI.I.N f.dl]]6 IAI1.16 a IMC lPM]I]lMfall]011)iPll'1`Ol]9A])111]NI]]94A'1]A60.1116` 9/I"Z WIRUU)HGIONNGl1114i GO10[IILP[[N }i,P1I.a 9p]g020 ] 9.291.59 ACHSE 9/Pg0E0 nCN 1fIIlW[HHfPNC[a1051EH19 %U169)Wa 3.712. ),]aE.60 � 1pa2.40 / }Atll.a 14W.]S Ia.W.)S W2'2020 Quick View Treasury Center Select Quick View Accounts Select Group Account Number ; Name Groups nua croup Account Type '44 4 MEMORIAL MEDICAL 1 $14,857.77 $14.857,77 $14.857 77 S14,857.77 NH GOLDEN CREEK HEALTHCARE Tune gcnormen o".Er23 'qr a: naps.:Iprosoerny.olhanking.ComionlineMessonger m Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 9/22/2020 Pntllu3 emmml we! M[wnr Resin.., M1namp rnmren.dN NUN. Name Nombn YYn[! Trmo,,-0on Trmrbnln 4r MmJ of h TeG! rOe Innln OYn[e .—I Nome 21.173.61 21.060.9] 3),3fi,N 3>AS)01 / 3).3C1.30 IMnicu n[e ])ASIBy I. — In I.— n BNan[e IN. Pl[Wnl N.r Y Nnne Non:0n1Y0lIlnor.)o.er$$,6m.+tlpen.v/enad l9Mlnunn9Fame. NINr): F![F e[[mnrF!) apvm bvlanay$Im�M1m M1IM[dew3erd�o.pen lttaun�. .lPP 12M Pe"np01PP d:o MMC wry merin aM MYwvnmm 9.m sepump..lm.nn / / rWlun Olbnn/Tnn@rGm) T.HL1. a/ lPM vindx�E rrMnlundmmem 9anY 0!1!n1r Yvon. 31.03]P9 12.02109 ...n Inur" IN.m 01; U.03 01Pai WeE INylnwna! 19 •uNnlntenat 11.65 J MpNmberinNreae ntliurtaelennRnmre.Ynr s1.871.1e T014i 51FERs 8.111.91 AD-ed. 1lwn M[pR<[0 9/IIR020 APPROVED ON SEP 2 2 2020 COUNTY AUDITOR. CALSOUN COUNTY. TIEYAS r:Wx w.l rnmlmWxuR uwuersvmmervl)o)g3epxmMlxx on umnnsvmm.rvat).)onu MMC PORTION OIPPASNIMs Na 0Pn43u-Out Pan Prdn CUPP/C MPI OIPP/CNAP2 OIPP/CmAP3 um OIPPN PORTION 9/14/20A) HUMANACNA DISK MCCUIMPMt 624982410W01951 TRN'l-0148601016)490T1611013183\ 30.121.25 30,121,25 9/15/2020 HUMANA INS CO HCMIMPMT 62498283WWS)S218 TRN' 1'0I29005249USI' 13912Elvl\ 3.67IAO 3,67140 9116/2020 WIRE OUT HMG SERVICES, IIC . 21,060,93 - 9/16/2020 MUMAMA INS CO HCCIAIMPMT 62493283W805248,15 TRN' 1'0012S00S2S0S920'I39NfiUT3\ 2,4W.64 - $40764 9/23/2020 AETNA AWI HCCUIMPMT 19210927W SIOON19521TRN-142026ROW299311'1066033492\ 1,140.65 - 11140.85 31.00.93 37341.24 3734Lt4 PANIC PORTION GIPP/CMAP44 NN T41NI6r-OUI Tren4T4Nln OIPP/Camel gIPPIONAP2 CRITICS 3 4pu DIPPL PORTION 9/14/2020 HEALTH HUMAN SVC HCCIAIMPMT 17460G341130131 TAN-1-0569497819I2092IN-174MI 13,172.33 13.17233 9/15/2D20 NORIOMN OA HCMIMPMT 6758924200001013382 TRN'1'ER69309i9'14501)3185'WO03( 31,379.24 31,379.24 9/16/2020 WIRE OUT HMG SERVICES, LUC 41.250,17 91I6/2020 HEALTH HUMAN SVC HUWMF41T 174M34113013 2IRN-1b0966561922092390']]460001 2.780,84 2,)Np_IN 9/17/2020 HEAl3H HUMAN SVC HCCIAIMPMT 174E9034113013 2 TRN-1'0559)6681922092190tl]46ml 4,53937 4.53937 43,350.17 SIA)1.]3 SLB]LT 62,311.10 89A3L92 89AIL93 I 9122,2020 Quick View Treasury Center Select Quick View Accounts Select Group Account Number I Name Groups An[I Creep Accounl Type '5441 MMC -NM GULF POINTS 552.023. eg / PLAZA , t/ $52.023.89 S57 023.83 557.073 89 •sass MMC -NH GULF POINTE $37 453 52 S37 453B2 S37 453 a2 Sir, 3 ?7 PLAZA,PRIVATEPAY Pugs 9vnernoa on u714-?:i.'o a:'� nups:llprosperity.plbanking.com'onllneMessenger v, Memorlsl Medical Center Nursing Home UPL WeekiY To.., Transfer PropPerlty Accounts 9/22/2010 Imlw. 4naw55s4 a,51Mn5 lr,n,FmO» '- .Mw» Lr,nrl,rf.Y, it M1rY PnRrF.e 0.M' fM, 'r4 mN Wan X�re MpnF µ 666.N 11,59i4 11.1459 � � � II.IIi,Y ll,t1i.59 11.!»Yv m.cenar. n.Yn.o axon. mm r»u.atire Suet 44cr.n1.a55Vv5a1 MNcponFe Wln5ryryin N ...n Sn •uPrn Flx»r 5.% / Lp»mArFrnFS 4HYIrJwRnntln4M IL5459 au4 ema,•» vnwr,ea...nae»rszow q ru+Y mev+rn..neu»eLzvr alAmrnn nurc arm�nauep+sra+r Swn MSun.aa "PROVM, ON SEP 2 2 2020 COUNTY AUDITOR CALHOUN COUNTY, TEXAS Transfer -Out 9/15/202D Enlimed Analysis Ch 40A0 9/16/2020 WIRE OUT LINEAR ENTERPRISES, U.0 14.558.84 9/17/2020 DEPOSIT - 9/18/2020 MPBna HCofUHCCIAIMPMTPN12T5T198944200TRN•1•EPT - 9/18/2020 Molina HCof TRHCCIAIMPMTPN12259198944200TRNfl•EPf - MMC PORTION QIPP/Cemp4 Transfer -In I QIPP/[ompi QIPP/[omp2 QIPP/[omp8 8lapu gIPPT NH PORTION 1,886.64 2,662.90 6,71SAS 1,886.64 2.662.90 6.715.05 14,598.84 11,264.59 J 11.264.59 97222020 Treasury Center Quick View Select Quick View Accounts Select Group Account Number / Name Groups 1 Aau GrmiV Account Type 407 MIMIC -NH TUSCANY 511.332 45 S11,332.45 S11.33245 S11,33245 VILLAGE nerve mo-nn�n9:[7:na .r nitps dprosperlly.otbanhing.comionbno6lessenger Memorial Medical Center Nursing Home UPL Weekly HSLTransfer Prosperity Accounts 9/22/2020 %.taro Am...,roll. q<nnN e.p.m, v.name n.nt.n.a 1. nuNn xw. a—x. eaue. Insfo,11 r..nn..I" 2211—C 0. r.e .G. Irmo ubr. xuNn xom. $1.60647 61.Q]<5 / 300,015At 309,WR 1 AOa.8m.4z V &n40lnn<. 109.001.41 ✓ V..I.nn LNve In stunt. tos. PIFP 1,2too Iul9lnra.n C. •uxualnl.ml N.Oa j S.rinl.nit V galntt a.uN.nnundnnn..amr _ lalsls.gx None. OnN6prpn<eta/pw.S5,IXtl Wait lmnurena to thenunin9 pane. Appremint: \ Nor.l: 1o[M1o[munr M1molorflNonnolSl W Uwr MnICO.PnRN10 openo[<aunC loo.M311n,Ceo V. 912VZ020 APPROVED ON SEP 2 2 2020 COUNTYAUDITOR CAIROUN OOUNTY, TEXAO iVm w.Nhnu✓m\rm un nm@svmm.hVo30Umlmh.\xn Wurm✓n 3umm.ry sl3.lo.x. r n t 9/14/2020 Deposit 9/16/2020 WIRE OUT BETHANY SENIOR LIVING, tTO 9/16/2020 Deposit 9/17/2020 Deposit 9/18/2020 Deposit 9/21/2020 NOVITAS SOLUTION HCCIAIMPMT 676,1814200013107 Ts MMC PORTION QIPP/COmpq Transfer-0ut Transfer -In I OIPP/Cpmp1 OIPP/Cpmp2 QIPP/[omp3 8tapse QIPP TI NH PORTION 12.022.18 - 12.022.18 81,437.48 - - - 450.18 3,016.06 22,876.59 271,473.41 450.18 3.016.06 21.876.59 271,473.41 81,43778 308,838.42 ✓ 308,838.42 9/2D2020 Quick View Treasury Center Select Owck View Accounts Select Group Account Nllmbor / Name Groups ACo Group Account Type Data remnee as of Sop 2:'. 1i L16 :- 'S5f16 MMC-NH BETHANY 5309.00741 5312.94976 S30900741 537.534.00 SENIOR WING eWale. n i'npu umwrala.l ou (IJ ` :'if?i Vu .e •. hips llprospertty.olbanking.comtonlineM@ssenger I„ September 23, 2020 2020 APPROVAL LIST - 2020 BUDGET COMMISSIONERS COURT MEETING OF 09/23/20 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE $210,576.17 FICA P/R $ 53,382.18 MEDICARE P/R $ 12,484.50 FWH P/R $ 37,297.46 NATIONWIDE RETIREMENT SOLUTIONS P/R $ 4,407.00 OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT P/R $ 1,523.07 AT&T MOBILITY A/P $ 201.87 BEN E KEITH FOODS Jail- Groceries AT $ 4,535.42 CENTERPOINT ENERGY A/P $ 2,277.02 CPL RETAIL ENERGY AT $ 20.89 FRONTIER COMMUNICATIONS AT $ 2,408.40 GULF COAST PAPER Bldg Maint- Misc Supplies AT $ 2,570.51 TOTAL VENDOR DISBURSEMENTS: $ 331,684.49 TOTAL PAYROLL AMOUNT: $ - CALHOUN COUNTY INDGENT HEALTH CARE A/P $ 10,001.41 CALCO GENERAL FUND TRANSFER FUNDS TO OPERATING (BILLS & PAYROLL) A/P $ 1,500,000.00 ✓ TOTAL INVESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: $ 1,510,001.41 TOTAL AMOUNT FOR APPROVAL: $ 1,841,685.90 0 y0 y0 y0 0 0 j-C K K Hy Hy m 0 0 t0- y�Z-ri 0 m y K w O O O O O O O O VWi W W r N N N N N N N N O N A O O O O O O O O O O O tNn 0 R6 H m �O O y rm rp rp o D rm rm rm 5 C O m a W ONe a T P T a N Oa Ge P ry� Ord O S Y Y Y oOW zo N N N N N N N N A ^ O O S3 b � 8x pia oA m_P ON om Gino 7a ncm Ca yz Da ^t On 0 H H 3H mH JH 4oH ;vH CoH �oH az y� J8 a a a ha rha a Khaha m�,� ns� oS h� yb boy �o� pegc �> � a �o �o �o 'io no �o O a wSao y'-• Pq 1p m P N W N W P W N N W OPp U w o q p •O O J N IJ iA •O J �p p �p y O IJ O I O •O C O O I A n O y�o �Om� E y 5 n om � on m n m m m 0 8 g o 0 y A P m O O O A m n K M t^O ,tA v N z z o o A A N N � O� P to b b O b O J O CO b pa b q O A a N q p w [4 N U O to W In p� N tNn a W y O p w W b � b w W � •NI N �tio yNv_ �o go �o no my Ho no �o �o AVi �AN �� ay oa N N Ona a ay ya �K.H KH nH 'Z 'H H y 8(^• nna nny ym �p x�a yoo na Ca a^ m°° A� Nw xw O m� �Tr1m rCKn> a �o m>a >> zCo nr- � �o yC a o zN a a yy-7 � m N O O b O N pL� O A Vpi N N M J VNi O U O b A P 12 O O O ri 0 0 o av_ o ^ C r r O O r� �yC mad mwC cn n p S m p Ott y { O O O O O O O O O O O O yi O yNj O y O J tOA J U J N J n U r W O O O O O O O O O O S O Qy R P F i m p O O O A b n y Z w z y z y Z 5 x 5 ti vm, m y N y An W Ge W A A A P N P N P N Ca Oi � I G N N N O N N N N p a S ZS N N N N N N � A tOn J A b O CQNl yIy1 o� JJd on Ho n WAj] 0 py bpto0iO-�7gdi t hAn W6 a n n p ZTcy'a'j Fay y—w0 a`yf G 7CAo N Ady � a. � ,O W 1p b `D O b .. s I�bJ �Oy 9y vy 'rC r'y 'Cv-4 �-� rH An o OC Q 7t9�iCC, w W N �O O N N 41 N N Y N O VPi V O �O N J IJ O W b b C b Ll IP O O O O N N P O W Oi b O J W W O A c O O O O O O W P N pp� J J J J P U O O J J VJi t~A A O � [On O �On r�Jr J g L�rpl W N [n cymx "�[`%S03 °°S OS o3 F73 m3 m3 'N°S -1y A N m�oH ��n roN roy y pN pN pN ypy a� zy nj �� y >� cn O "mA N Rp b Opg m Oe N b N W A N A U J J N U P A W W W W U W J O A O O Oa O J O W J O �p F IR zgC � C 8 L� 0H Hm S S n y 2 Ocf0� y O ny m z o z z o u H P c o P P 4 0 P V N w J O O a 3 ° 9 n 7H O O C %o� a COC w m qP J P P P W N W N W N W N O O N O n r P P N A O W O O O O O O p D ,Cp0 10 10 m o z off v 0 z J m b m P P N P P P Wes` O W J d 'S! 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