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2021-03-03 Meeting MinutesCommissioners' Court - March 03, 2021 CAL H OUN COUNTY COMMISSIONERS'COURT T REGULAR TERM 2021 P1 MARCH 3, 2021 BE IT REMEMBERED THAT ON MARCH 3, 2021, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING 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 Joel Behrens 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 4. Genera/Discussion ofPubiic Matters and Pub/ic Participation. Commissioner Lyssy announce the passing of Dora Garcia former Elections Administrator. Page 1 of 8 Commissioners' Court — March 03, 2021 S. Hear report from Memorial Medical Center. Jason Anglin, CEO of Memorial Medical Center, presented the report. 6. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 6) To evaluate the current option/homestead exemption rate and make any needed changes, (RM) Jesse Hubbell, Tax Appraisal District, explained the exemption rate. Motion made to continue w/current homestead rate. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 7) To appoint LaDonna Thigpen as Civil Rights Officer in accordance with TxCDBG funding through Texas General Land Office Grants, (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Richard Meyer, County Judge SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese S. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 8) To appoint LaDonna Thigpen as Section 2 Coordinator in accordance with TxCDBG funding through Texas General Land Office Grants, (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 8 Commissioners' Court — March 03, 2021 9. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 9) To implement the attached steps to promote the use of Section 3 residents and businesses forfederally-fundedgrantprojects, (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 10) To rescind the award forA/tosid 30 Day Briquets andAltosidXR Residual Briquets that were previously awarded on November 25, 2020 to ES OPCO USA LLC dba Veseris. See the attached email from Keith L, Haas, BCE, Public Health Specialist for Veseris. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 11) To award the bid to the next vendor that met specifications for Altosid 30 Day Briquets andA/tosidXR Extended Residual Briquets that were previously awarded on November 25, 2020, Seepage 2 of the attached Bid Tabulation. Clark Mosquito Control was awarded. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 8 Commissioners' Court — March 03, 2021 12. Public Hearing concerning a Petition to Vacate Lots i through 5, Block 96 and a portion of Alamo Beach Boulevard according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z, Page 13 of the Plat records of Calhoun County, Texas. (DH) Commenced: 10:32 a.m. Delia Lebrecht and Alisa Jarvis presented questions and concerns to the Commissioners. Adjourned: 10:44 a.m. 13. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 13) To vacate Lots 1 through 5, Block 96 and a portion ofAlamo Beach Boulevard according to the established map or plat ofAlamo Beach Subdivision recorded in Volume Z, Page 13 of the Plat Records of Calhoun County, Texas. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 14) To approve the Final Plat ofAlamo Beach Subdivision, Block 96, Resubdivision No. 1. (DH) Terry Ruddick of Urban Engineering presented the plat. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 8 Commissioners' Court — March 03, 2021 15. Public Hearing concerning a Petition to Vacate a portion of Lots 7-12, Block 40, and all of Block B of the revision of the map of Olivia as recorded in Vol. M, Page 532 of the deed records of Calhoun County, Texas. (]B) Commenced: 10:46 a.m. Adjourned: 10:49 a.m. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 16) To Vacate a portion of Lots?--12, Block40, and all ofBlock B of the revision of the map of Olivia as recorded in Vol. M, Page 532 of the deed records of Calhoun County, Texas. (1B) Terry Ruddick presented final plat of Keller's Landing. RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 17. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 17) To authorize Commissioner Reese to apply for a grant with the M.G, and Lilly A.lohnson Foundation for the Emergency Medical Services Helipad for Seadrift, Texas. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5 of 8 Commissioners' Court— March 03, 2021 18. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 18) To authorize payment of$500 to Smartt Grants for writing and submitting a grant to the M. G, and Lily A. Johnson Foundation for the Emergency Medical Services Helipad for Seadrift, Texas, (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 19. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 19) To approve a Lease Agreement with First National Bank for the location site for an Emergency Medical Services Helipad in Seadrift, Texas and authorize Judge Meyer to sign all documentation. (GR) $0/unlimited lease. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 20. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 20) To approve the specifications/scope of services for the Request for Qualifications, RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the CAM Cycle 25 Grant, GLO Contract No. 21-060-013-C673 for Boggy Bayou Nature Parklmprovements, Phase 1 and authorize the County Auditor to advertise for these services. RFQ 2021.04 will be due by 2.,00 p.m, on Tuesday, March 30, 2021. (GR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 8 Commissioners' Court— March 03, 2021 21. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 21) To appoint the following committee to rate RFQ 2021.04 that will be received Tuesday, March 30, 2021 forProfessiona/Engineering, Architectural, and Surveying Services for the CMP Cycle 25 Grant, GLO Contract No. 21-060-013-C673 for Boggy Bayou Nature Parklinprovements, Phase 1. (GR) a. Gary Reese, Commissioner, Pct 4 b. Richard H. Meyer, County judge c. Cindy Mueller, County Auditor d. Peggy Hall, Assistant Auditor RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 22. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 22) On an insurance proceeds check received from VFIS in the amount of$2,408,19 for an EMSAmbulance Accident of February 1, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 23. CONSIDER AND TAKE NECESSARY ACTION (AGENDA ITEM NO. 23) On the second insurance proceeds check received from VFIS in the amount of $3,139.46 for the Port Lavaca Volunteer Fire Truck for repairs from the December 8, 2020 tire blow-out. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 8 Commissioners' Court — March 03, 2021 24. Consider and take necessary action on any necessary budget adjustments. 2020 and 2021 RESULT: MOVER: SECONDER: AYES: APPROVED [UNANIMOUS] Gary Reese, Commissioner Pct 4 Joel Behrens, Commissioner Pct 3 Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 25. Approval of bills and payroll. MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Payroll RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 11:00 a.m. Page 8 of 8 II Agenda Items Properly Numbered Contracts Completed and Signed All 1295's Flagged for Acceptance (number of 1295's ) `All Documents for Clerk Signature Flagged On this 54k) day of / 2021 a complete and accurate packet for u of�`/ 2021 Commissioners Court Regular Session was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Calhoun rn..niw 7..d..e/w..: a__a COMMISSIONERSCOURTCHECKLIST/FORMS AGENDA I NOTICE OF MEETING-3/3/2021. 11L�_.Sql 0 OCK ik M Richard Ha Meyer FEB 16 2021 County judge COUN LE ' MCA?6-' N'000 d?YjDf�(tid gall, Commissioner, Precinct 1 BY: g er yssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, March 3, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: I. Call meeting to order. 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. 5. Hear report from Memorial Medical Center. 6. Consider and take necessary action to evaluate the current optional homestead exemption rate and make any needed changes. (RM) 7. Consider and take necessary action to appoint LaDonna Thigpen as Civil Rights Officer in accordance with TxCDBG funding through Texas General Land Office Grants. (RM) s. Consider and take necessary action to appoint LaDonna Thigpen as Section 2 Coordinator in accordance with TxCDBG funding through Texas General Land Office Grants. (RM) 9. Consider and take necessary action to implement the attached steps to promote the use of Section 3 residents and businesses for federally -funded grant projects. (RM) Page 1 of 3 NOTICE OF MEETING — 3/3/2021 10. Consider and take necessary action to rescind the award for Altosid 30 Day Briquets and Altosid XR Residual Briquets that were previously awarded on November 25, 2020 to ES OPCO USA LLC dba Veseris. See the attached email from Keith L. Haas, BCE, Public Health Specialist for Veseris. (RM) 11. Consider and take necessary action to award the bid to the next vendor that met specifications for Altosid 30 Day Briquets and Altosid XR Extended Residual Briquets that were previously awarded on November 25, 2020. See page 2 of the attached Bid Tabulation. (RM) 12. Public Hearing concerning a Petition to Vacate Lots 1 through 5, Block 96 and a portion of Alamo Beach Boulevard according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z, Page 13 of the Plat Records of Calhoun County, Texas. (DH) 13. Consider and take necessary action to Vacate Lots 1 through 5, Block 96 and a portion of Alamo Beach Boulevard according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z, Page 13 of the Plat Records of Calhoun County, Texas. (DH) 14. Consider and take necessary action to approve the Final Plat of Alamo Beach Subdivision, Block 96, Resubdivision No. 1. (DH) 15. Public Hearing concerning a Petition to Vacate a portion of Lots 7 — 12, Block 40, and all of Block B of the revision of the map of Olivia as recorded in Volume M, Page 532 of the deed records of Calhoun County, Texas. (JB) 16. Consider and take necessary action to Vacate a portion of Lots 7 — 12, Block 40, and all of Block B of the revision of the map of Olivia as recorded in Volume M, Page 532 of the deed records of Calhoun County, Texas. (JB) 17. Consider and take necessary action to authorize Commissioner Reese to apply for a grant with the M. G. and Lilly A. Johnson Foundation for the Emergency Medical Services Helipad for Seadrift, Texas. (GR) 18. Consider and take necessary action to authorize payment of $500 to Smartt Grants for writing and submitting a grant to the M. G. and Lilly A. Johnson Foundation for the Emergency Medical Services Helipad for Seadrift, Texas. (GR) 19. Consider and take necessary action to approve a Lease Agreement with First National Bank for the location site for an Emergency Medical Services Helipad in Seadrift, Texas and authorize Judge Meyer to sign all documentation. (GR) 20. Consider and take necessary action to approve the specifications/scope of services for the Request for Qualifications, RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the CMP Cycle 25 Grant, GLO Contract No. 21-060-013-C673 for Boggy Bayou Nature Park Improvements, Phase 1 and authorize the County Auditor to advertise for these services. RFQ 2021.04 will be due by 2:00 p.m. on Tuesday, March 30, 2021. (GR) Page 2 of 3 NOTICE OF MEETING — 3/3/2021 21. Consider and take necessary action to appoint the following committee to rate RFQ 2021.04 that will be received on Tuesday, March 30, 2021 for Professional Engineering, Architectural, and Surveying Services for the CMP Cycle 25 Grant, GLO Contract No. 21- 060-013-C673 for Boggy Bayou Nature Park Improvements, Phase 1. (GR) a. Gary Reese, Commissioner, Precinct 4 b. Richard H. Meyer, County Judge c. Cindy Mueller, County Auditor d. Peggy Hall, Assistant Auditor 22. Consider and take necessary action on an insurance proceeds check received from VFIS in the amount of $2,408.19 for an EMS Ambulance Accident of February 1, 2021. (RM) 23. Consider and take necessary action on the second insurance proceeds check received from VFIS in the amount of $3,139.46 for the Port Lavaca Volunteer Fire Truck for repairs from the December 8, 2020 tire blow-out. (RM) 24. Consider and take necessary action on any necessary budget adjustments. (RM) 25. Approval of bills and payroll. (RM) / / 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.org under "Commissioners' Court Agenda' for any official court postings. Page 3 of 3 PUBLIC HEARING-3/3/2021 AT"8 . 54 O CLOCK f-� �n FEB 2 6 2021 Richard H. Meyer ANNA 8801IAf County judge e COUN ERK F0 tNT T"X S BY: 130 ➢l, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF PUBLIC HEARING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, March 3, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse, 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Courtwill hold a public hearing in the Commissioners' Courtroom, 211 S. Ann Street, in Port Lavaca, Texas, at 10:00 a.m. concerning a Petition to Vacate a portion of Lots 7 —12, Block 40, and all of Block B of the revision of the map of Olivia as recorded in Volume M, page 532 of the deed records of Calhoun County, TX. The public shall have the right to be present and participate in such hearing. Mchard 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.org under "Commissioners' Court Agenda" for any official court postings. Page 1 of 1 PUBLIC HEARING — 3/3/2021 AT !, 5 i LiL 5 �CLocK.__ _4__M FEB 2 6 2021 Richard Ho Meyer r Ua �NN AL' IJ ! COUN Y. TEXAS County judge Em David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, March 3, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse, 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Court will hold a public hearing in the Commissioners' Courtroom, 211 S. Ann Street, in Port Lavaca, Texas, at 10:00 a.m. concerning a Petition to Vacate Lots 1 through 5, Block 96 and a portion of Alamo Beach Boulevard according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z. Page 13 of the Plat Records of Calhoun County,Texas. The public shall have the right to be present and participate in such hearing. chard Meyer, County u e 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.org under "Commissioners' Court Agenda' for any official court postings. Page 1 of 1 I WORKSHOP — 2/10/2021 LED FEB 2 6 2021 Richard H. Meyer CO f CLEANN FfF100 �AnIUN'fY; TEXAS BY: 0 County judge ON�F David Hall, Commissioner, Precinct I Vern ]Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas will meet on Thursday, March 4, 2021 at 1:30 p.m. in the Courtroom A on the second floor of the County Courthouse at 211 S. Ann Street, Port ]Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: To compare and prepare resources for future emergencies. Richard Meyer, Courtytypudge Calhoun County, Te 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.org under "Commissioners' Court Agenda' for any official court postings. Page 1 of 1 #5 #6 CALHOUN COUNTY APPRAISAL DISTRICT : ,�-j APP Board of Directors 426 West Main Street * P.O. Box 49 O� R9f William Swope, Chairman Port Lavaca, Texas 77979 O William Hauer, Vice Chairman Appraisal:. (361) 552-8808 Z E X r Jessie Rodriguez, Secretary Collections: (361) 552-4560 T A O Vern Lyssy, Board Member Fax: (361)552-4787 O� S .may Kevin Hill, Board Member. - Website: www.calhotincad.org �6� y7t Chief Appraiser Jesse W. Hubbell. February 8, 2021 To: All Governing Bodies of the Taxing Units with the Calhoun County Appraisal District RE: Optional Homestead Exemption Agenda Item Please add the above item to your agenda for action at your next board, council or commissioners' court meeting. This should be an annual agenda item. I have enclosed a listing of the homestead exemptions currently granted for all taxing units in Calhoun County. Please review your exemptions and notify the ap rp aisal district no later than March 31,'2021, if any changes are to be made for the 2021 tax year. Notification may be submitted by email to: jhubbell c ,calhouncad.org or tammy@calhounead.org. calhounead.org. All taxing units currently granting the optional 20% homestead exemption may reduce the percentage of the "exemption, but cannot increase the percentage. A taxing unit that has not granted an optional percentage homestead exemption may do so, but only up to 20%. The optional 65 and over and disabled exemption may be increased or decreased. Taxing units cannot change any veteran exemption. Should you have any questions or concerns please contact Tammy Blakeman or me. Respectfully; Jesse W. Hubbell Chief Appraiser rim W R F� V Z `{ r A' O O t S F• O O S C O O WON'O ST ''J 0<IM xSSA"t�i{ N O pnOj` �i ir{ vi r/1 n <it �P � fnrc 'S: .zl tPi.rr;{ f ` 3 O i i O Q$ t o"'Yt co, E},y o S q';Mi o o O c O o O 0 'dam "cgc. � �C'£? XT it: f, fG � Q1"S O 00 O �� p "}7 p O O O �!"i O #E{ r#wek 00 -? "h,ry 0 ?g, p O O C O O O O O O O O O Q d' V O O O p 0 i tF i.XSty 4;}q 1 'D �p 1 O O AIR I U F y N NO o c `�%`kAN -+�k c D, o 0 0 o N ry O 0. C b»`. ram'(. r:. O � � FiYm y 3 k i k� j 11410x n if�f y F nfv yy; i O O O O O O C O O � 'k+t 'm P S C aP C C (11" P x(k„,. O vl O O O O 3F'kAtY L1 W y'kLYtA k V Q F Q-F�J e' T P, n nl N N 1� F.-Y "4'S.{ g Ol .� cNT O M V 1� P L c +.� Nr r P" c z < -] } xl Jt C } z } }� Z O FQ vs,•r k*,''�il'a Z �.: z Z z z z z z zKnT x`' ; ' "i, ' zi o E s i 3k L o 0 ,?# is o Ov z 3 '.` e: 4 All Zu 4Y a 't si?r of = O,, G 2 y G o OU ' k O b u x # C C C Q R h C U Q G c O O a o r-k m �E 3� `^ v m o U m U m Q t'}.a ''Y U a U K=yrF U 3 aJ O ,it coU CALHOUN COUNTY APPRAISAL DISTRICT � APb Board of Directors 426 West Main Street * P.O. Box 49 O� 9� William Swope, Chairman '.Port Lavaca, Tezas:77979 O y : William Bauer, Vice Chairman Appraisals a, Texas as 77 7 V E X C Jessie Rodriguez, Secretary Collections:: (361) 552-4560 T Vern Lyssy, Board Member Fax: (361) 552-4787 O ' S Y Kevin Hill, Board Member. Website: www.calhouncad.org y�bJ y7ti� Chief Appraiser Jesse W. Hubbell . February 11, 2021 To: All Taxing Unit Governing Bodies within the Calhoun County Appraisal District From: Jesse Hubbell, Chief Appraiser RE: Availability of the 2021 certified appraisal roll As the Calhoun County, Appraisal District serves as the assessor -collector for your entity through an inter -local agreement, the certified appraisal/tax roll is maintained at our office located at 426 W. Main in Port Lavaca. If you wish to receive a copy of the 2021 appraisal roll after certification in July it can be made available to you in electronic format upon request. Should you wish to receive it in a different format please let us know. The 2021 certified roll will be available after July 25, 2021 Respectfully, 1! u tt(,/ ,�� ? U Jesse W. Hubbell Chief Appraiser L&OJ Calhoun County Section 3 Policy In accordance with Section 3 of the U.S. Housing and Urban Development (HUD) Act, Calhoun County agrees to implement the following steps, which, to the greatest extent feasible, will provide job training, employment and contracting opportunities for low- and very low-income persons residing in the community in which HUD funds are spent and to businesses that provide economic opportunities for these persons. A. Introduce and pass a resolution adopting this plan as a policy to strive to attain goals for compliance to Section 3 regulations by increasing opportunities for employment and contracting for Section 3 residents and businesses. B. Assign duties related to implementation of this plan to the Calhoun County Civil Rights Officer. C. Notify Section 3 residents and business concerns of potential new employment and contracting opportunities as they are triggered by HUD Community Development Block Grant (CDBG) awards through the use of public hearings and related advertisements; public notices; bidding advertisements and bid documents; solicitations and contracts; notification to local business organizations; local advertising media, including public signage; project area committees and citizen advisory boards; local HUD offices; regional planning agencies; and all other appropriate referral sources. D. Maintain a list of those businesses that have identified themselves as Section 3 businesses for utilization in CDBG funded procurements, notify those businesses of pending contractual opportunities, and make this list available for general county procurement needs. E. Maintain a list of those persons who have identified themselves as Section 3 residents and contact those persons when hiring/training opportunities are available through grant awards or contractors. F. Require that all prime contractors and subcontractors with contracts over $100,000 commit to this plan as part of their contract work. The County will monitor the contractors' performance with respect to meeting Section 3 requirements and require that they submit requested reports to the appropriate agency. G. Submit reports as required by a funding agency regarding contracting with Section 3 businesses and/or employment as they occur; and submit reports within federal fiscal year requirements that identify and quantify Section 3 businesses and employees. H. Maintain records, including copies of correspondence, memoranda, etc., which document all actions taken to comply with Section 3 regulations. As officers and representatives of Calhoun County, we the undersigned have read and fully agree to this plan and become a party to the full implementation of the plan. Approved this 17th day of February 2021. f Richard N, Meyer, C ty Judge Calhoun County Commissioner, Pct. 1 0" '-� Vern Lys y Calhoun County Commissioner, Pct. 2 f � Joel MJ Behrens Gary Rees Calhoun County Commissioner, Pct. 3 Calhoun Cou ty Commissioner, Pct. 4 Attest: Anna Goodman, County Clerk i MM#10 #10 Agenda Item for Commissioners Court — Wednesday, March 3, 2021 Consider and take necessary action to rescind the award for Altosid 30 Day Briquets and Altosid XR Extended Residual Briquets that were previously awarded November 25, 2020 to ES OPCO USA LLC dba Veseris. See attached email from Keith L Haas, BCE, Public Health Specialist for Veseris. Peaav Hall From: keith.haas@Veseris.com (Keith Haas) < keith.haas@Veseris.com > Sent: Saturday, February 13, 2021 1:26 PM To: peggy hall Subject: [WARNING -Remote attachments, verify sender] Bid 2021.02 Peggy, During the bid announcement period for bid #2021.02, Central Life Sciences announced 2021 pricing and because of travel and normal work flow I failed to recognized their 2021 announcement until after the bid package submittal. Since agency pricing is the same for Central Life Science agents, please award the following products to an agent that submitted the Central Life Sciences pricing for 2021. Products: 1. Methoprene Briquets XR 2. Methoprene Briquets 30 Day I apologize for the situation, and have asked Central Life Sciences to announce future year pricing before October of each year whereas this type of situation does not repeat. Keith L. Haas, BCE Public Health Specialist l Veseris M:713-203-0436 oestweb.com I veseris.com VESERIS 1 #11 Agenda Item for Commissioners Court — Wednesday, March % 2021 Consider and take necessary action to award the bid to the next vendor that met specifications for Altosid 30 Day Briquets and Altosid XR Extended Residual Briquets that were previously awarded November 25, 2020. See page 2 of the attached Bid Tabulation. • The next vendor that met specifications (See page 2 of the attached Bid Tabulation): Clarke Mosquito Control Products, Inc. ° Altosid 30 Day Briquets $480.00/per Case ° Altosid XR Extended Residual Briquets—Altosid XR Briquets $759.00/per Case fA U Z U W a J Q 0 3 Q d 0 N N L N a,e, CmC L d Zyy' z C � Z W m C.m m 3 Z a Q r a a N n J C Q Z ! 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U l Lam) /1 AT D S:JCiOs,K_ ...,tom Y FEB 2 6 2021 Richard ]H . Meyer i°PrCounty judgeco t�pN Y ExrsBYLL A U� David Hall, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4- NOTICE OF PUBLIC HEARING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, March 3, 2021 at 10:00 a.m. in the Commissioners'Courtroom in the County Courthouse, 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Court will hold a public hearing in the Commissioners' Courtroom, 211 S. Ann Street, in Port Lavaca, Texas, at 10:00 a.m. concerning a Petition to Vacate Lots 1 through 5, Block 95 and a portion. of Alamo Beach Boulevard according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z. Page 13 of the Plat Records of Calhoun County,Texas. The public shall have the right to be present and participate in such hearing.. J, chard 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 Noticeshall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at wwvi.calhou ncotx.c under "Commissioners' Court Agenda` for any official court postings. Page 1 of I #13 All Land Surveying+Aerial Imaging Slnce1831 February 22, 2021 David Hall Calhoun County Commissioner Precinct #1 305 Henry Barber Way Port Lavaca, TX 77979 RE: Alamo Beach Subdivision, Blk 96, Resubdivision No. 1 (our job E24071) Dear Commissioner Hail, Please consider this letter as my request to have the following items placed on the March 3, 2021 Commissioner's Court agenda: Public Hearing concerning Petition to Vacate Lots 1 through 5, Block 96 and a portion of Alamo Beach Blvd. according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z, Page 13 of the Plat Records of Calhoun County, Texas. Consider and take necessary action to Vacate Lots 1 through 5, Block 96 and a portion of Alamo Beach Blvd. according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z, Page 13 of the Plat Records of Calhoun County, Texas. Consider and take necessary action to approve the Final Plat of Alamo Beach Subdivision, Blk. 96, Resubdivision No. 1 If I can provide additional information please do not hesitate to contact me. Sin rely, �{ Te iry T. Rdick, R.P.L.S. C.E.O. Victoria San Antonio Cuero 2004 N. Commerce Victoria, TX77901 12661 Silicon Drive San Antonio, TX78249 104 E. French Street Cuero, TX77954 - i.VCrl�F1GiLi�''IFtlr.C�ia� 361-578-9837 210-267-8654 381-277-9081 Firm M: 10021100 Firm #: 10193843 Firm #: 10021101 PETITION TO VACATE Lots 1 through 5, Block 96 and a portion of Alamo Beach Blvd. Alamo Beach Subdivision THE STATE OF TEXAS} THE COUNTY OF CALHOUN) KNOW ALL MEN BY THESE PRESENTS: That the undersigned being the designated agent of the owners of the property described as Lots 1 through 5, Block 96 and a portion of Alamo Beach Blvd. according to the established map or plat of Alamo Beach Subdivision recorded in Volume Z, Page 13 of the Plat Records of Calhoun County, Texas, do hereby petition the Calhoun County Commissioner's Court to Vacate said Lots 1 through 5, Block 96 and a portion of Alamo Beach Blvd., in accordance with Sections 206 and 207 of the Subdivision Regulations and Recreational Vehicle Park Regulations Adopted by Calhoun County Commissioner's Court on November 29, 2004 and amended on December 13, 2007. The property is proposed to be re -platted in accordance with a plat submitted to the Calhoun County Commissioner's Court. The petition will be considered by the Calhoun County Commissioner's Court on March 3, 2021 at 10:00 am. Urban Surveying, In 2004 N. Commerce Victoria, TX 77901 361-578-9837 (E24071) #14 1.271 ACRES THE STATE OF TEKAS) THE COUNTY OF CALHOUN) BEING a 1.272 acre tract of land situated in the Jose Felix De La Fuentes Survey, Abstract No. 13, Calhoun County, Texas out of the Seadrift Townsite according to the established map or plat thereof as recorded in Volume 2, Page 4 of the Plat Records, Calhoun County, Texas being comprised of a portion of the remainder of a called 2.864 acre tract of land described by Warranty Deed dated July 25, 1988 conveyed from W.H. Bauer, Jr., at al to the Seaport Bank of Seadrift as recorded in Volume 21, Page 6S9 of the Official Records, Calhoun County, Texas and a called 0.29 acre tract of land described by Special Warranty Deed dated June 30, 1976 conveyed from Mobil Oil Corporation to W.H. Bauer, Jr., at al as recorded in Volume 298, Page 710 of the Deed Records, Calhoun County, Texas, said 1.271 acre tract being more particularly described by metes andbounds as follows: BEGINNING at a found 5/8" steel rebar marking the intersection of the northeast line of Railroad Avenue (a 60-foot Right -of -Way) with the westerly line of Main Street (an 80-Foot Right -of -Way) being the south corner of the aforesaid 2.864 acre tract and being the wrest most corner of a called 11.40 acre tract of land described by Instrument to the City of Seadrift as recorded in Volume 20, Page 148 of the Official Records, Calhoun County, Texas for the south corner of the herein described tract; THENCE, North 34'12'05" West (North 33'33'00" West), along the northeast right-of-way line of said Railroad Avenue, with the southwest line of said 2.864 acre tract, at a distance of 298.57 feet passing the south corner of the aforesaid 0.29 acre tract and continuing for a total distance of 398.57 feet to a set 5/8" steel rater with yellow plastic cap stamped "URBAN SURVEYING, INC." marking the west corner of said 0.29 acre tract and being along the common line of Said Railroad Avenue and said 2.864 acre tract for the west corner of the herein described tract; THENCE, North 55'4755" East (North 56'27'00" East), departing the northeast right-of-way line of said Railroad Avenue, with the northwest line of said 0.29 acre tract, at a distance of 125.00 feet passing the north corner of sold 0.29 acre tract and continuing across said 2.864 acre tact a total distance of 200.19 feet to a set 5/8" steel rebar with yellow plastic cap stamped "URBAN SURVEYING, INC." along the northeast line of said 2.864 acre tract and being the southwest line of that certain tract of land described by Instrument to Thomas Gurley as recorded In Volume 327, Page 583 of the Official Public Records, Calhoun County, Texas for a point of curvature to the left and the north corner of the herein described tract; THENCE, along the common line between said 2.864 acre tract and the aforesaid Gurley Tract, with a curve turning to the left having a radius of 1382.40 feet, an arc length of 138.46 feet, and a delta angle of 05'44'19", with a chord bearing of South 37'56'29" East, and a chord length of 138.40 feet to a set 5/8" steel rebar with yellow plastic cap stamped "URBAN SURVEYING, INC' along the westerly right-of-way line of said Main Street marking the east corner of said 2.864 acre tract and being the south corner of said Gurley Tract for the east corner of the herein described tract; THENCE, South 04°34'20" West (South 05°33'25" West), along the westerly right-of-way line of said Main Street, with the easterly line of said 2.864 acre tract, a distance of 334.09 feet to the POINT OF BEGINNING, CONTAINING within these metes and bounds a 1.271 acre tract of land, more or less. Basis of bearing is based on the Texas State Plane Coordinate System (NAD 83), South Central Zone (4204). This survey was adjusted using a combined scale factor of 1.000D1170537413 (GEOID32A). The foregoing legal description and accompanying survey plat were prepared from an actual survey made on the ground under my supervision in January, 2021 and are true and correct to the best of my knowledge and belief. OF• F} �P: ataTeA'':il+ HICHAEL K. WILlL1LLS Urban Surveying, Inc = o • 6616d By: Michael K. Williams t4o6castt4'v?Q.- Registered Professional Land Surveyor '9i ••.. y� Texas No. 6616 S- 523893.01 zp2 r� ep X C 1 U > w w WYCO rI Y rV¢i N W~aV �oo'a x z zzS7� Sao o m 1^ pyU C ri?a <�O r O �`W K• Zy00 a �a —, O •Y v Cc ~ UZ 00 1 ' r _ n iy {i o 0 55 w � ¢ pn 2 �¢� a W w r �z <w wW � V wrw N zN2Y ti Z 6.QC j U VZp p <<01- p;yN f V y 2yV N F�WW 'Z <-�O Src�� w-.am C WNO >30 yV' OC U NWW2 #15 FiLEU �r Sy 01C1.8C u EES 2 6 2021 Richard H. Meyer BYOS�WEEDAP County judge a i, Commissioner, Precinct 1 Vern L,yssy, Commissioner, Precinct 2 ,Joel Behrens, Commissioner, Precinct 3 Cary Reese, Commissioner, Precinct 4- NOTICE OF PUBLIC HEARING The Commissioners' Court of Calhoun County, Texas will. meet on Wednesday, March 3, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse,. 211 S. Ann Street, Suite 101, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Court will hold a public hearing in the Commissioners' Courtroom, 211 S. Ann Street, in Port: Lavaca, Texas, at 10:00 a.m. concerning a Petition to Vacate a portion of Lots 7 —12, Block 40, and all of Block B of the revision of the map of Olivia as recorded in Volume M, page 532 of the deed records of Calhoun County, TX. The public shall have the right to be present and participate in such hearing. 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 countys website at w vw.ca l houncotx.ora, under "Commissioners' Court Agenda" for any official court postings.. Page I of I. Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309 Email: icel.behrens(Dwalhouncotx.om 9 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 Commissioner's Court Agenda for March 3, 2021. • Please Consider and Take Necessary Action on Public hearing concerning petition to vacate a portion of Lots 7-12, Block 40, and all of Block B of the revision of the map of Olivia as recorded in Volume M, page 532 of the deed records of Calhoun County, TX. Sincerely, 401 rv\- Joel Behrens Commissioner Pet. 3 #16 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 —Office (361) 893-5346 —Fax (361) 893-5309 Email: ioel.behrens4calhouncotx.orx (9 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 Commissioner's Court Agenda for March 3, 2021. • Please Consider and Take Necessary Action to vacate a portion of Lots 7-12, Block 40, and all of Block B of the revision of the map of Olivia as recorded in Volume M, page 532 of the deed records of Calhoun County, TX. Sincerely, q04� VN,-, 13 Joel Behrens Commissioner Pct. 3 M M 51 Land Surveya¢¢�+$ev¢a9 @auaaS9¢a� Slnnle9l PETITION TO VACATE A portion of Lots 7-12, Block 40, and all of Block "B" of the Revision of Map of Olivia, Calhoun County, T exas THE STATE OF TEXAS} THE COUNT! OF CALHOUN) KNOW ALL MEN BY THESE PRESENTS: That the undersigned being the designated agent of the owners of the property described as a portion of Lots 7 — 12, Block 40, all of Block B, of the Revision of Map of Olivia according to plat recorded in Volume "M", Page 532 of the Deed Records of Calhoun County, Texas do hereby petition the Calhoun County Commissioner's Court to Vacate said tracts of land, in accordance with Sections 206 and 207 of the Subdivision Regulations and Recreational Vehicle Park Regulations Adopted by Calhoun County Commissioner's Court on November 29, 2004 and amended on December 13, 2007. The property is proposed to be re -platted in accordance with a plat submitted to the Calhoun County Commissioner's Court. The petition will be considered by the Calhoun County Commissioner's Court on March 3, 2021 at 10:00 am. r Jr. Tern{T, Ruddick/uR.P.L.S Urban Surveying Ina _ 2004 N. Commerce Victoria, TX 77901 361-578-9837 (S22614.01 Bethany) Victoria San Antonio Cuero 2004 N. Commerce 12661 Silicon Drive 104 E. French Street Victoria, TX 77907 San Antonio, TX 78249 Cuem,TX 77954 urbansu$'i9yiniCy^,^L,S$m 361-578-9837 210-267-8654 361-277-9061 Firm#: 10021100 Firm4: 10193843 Firm#: 10021101 #17 Gary D. Reese County Commissioner County of Calhoun Precinct 4 February 22, 2021 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 March 3, 2021. • Consider and take necessary action to authorize Commissioner Reese to apply for a grant with the M. G. and Lilly A. Johnson Foundation for the Emergency Medical Service Heli Pad for Seadrift, Texas. Sincerely, —)Q,� Gary D. Reese GDR/at P.O. Boa 177 — Seadrift, Texas 77983 — email: earw ees o calltouncotx.org — (361) 785-3141 —Fax (361) 785-5601 E 0 Gary D. Reese County Commissioner County of Calhoun Precinct 4 February 22, 2021 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 March 3, 2021. • Consider and take necessary action to authorize payment of $500 to Smartt Grants for writing and submitting a grant with the M.G. and Lilly A. Johnson Foundation for the Emergency Medical Service Heli Pad for Seadrift, Texas. Sincerely, Gary D. Reese GDR/at P.O. Box 177 — Seadrift, Texas 77983 — email: eary.reeseRcalhouncomore — (361) 785-3141 — Fax (361) 785-5602 #19 Gary D. Reese County Commissioner County of Calhoun Precinct 4 February 22, 2021 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 March 3, 2021. • Consider and take necessary action on Lease Agreement with First Nation Bank for location site for an Emergency Medical Service Heli Pad in Seadrift, Texas and authorize Judge Meyer to sign all documentation. Sincerely,, Gary D. Reese GDR/at P.O. Box 177 — Seadrift, Texas 77983 — email: eary reesena.calhouncom.ora — (361) 785-3141 — Fax (361) 785-5602 Lease Basic Information Date: 2021 Landlord: First National Bank, a Texas corporation Landlord's Address: Tenant: First National Bank Port Lavaca, TX 77979 Calhoun County, a unit of Texas government Tenant's Address: Calhoun County, Texas c/o Gary Reese, Commissioner Precinct #4 of Calhoun County P.O. Box 177 Seadrift, TX 77983 Premises: 1.271 acre tract of land situated in the Jose Felix De La Fuentes Survey, Abstract No. 13, Calhoun County, Texas out of the Seadrift Townsite according to the established map or plat there of as recorded in Volume 2, Page 4 of the Plat Records, Calhoun County, Texas being comprised of a portion of the remainder of a called 2.864 acres tract of land described by Warranty Deed dated July 25, 1988 conveyed from W.H. Bauer, Jr. et al to the Seaport Bank of Seadrift as recorded in Volume 21, Page 659 of the Official Records, Calhoun County, Texas and a called 0.29 acre tract of land described by Special Warranty Deed dated June 30, 1976 conveyed from Mobil Oil Corporation to W.H. Bauer, Jr. et al as recorded in Volume 298, Page 710 of the Deed Records, Calhoun County, Texas, said 1.271 acres tract of land being more particularly described by metes and bounds on Exhibit "A" and depicted on Exhibit `B" attached hereto and incorporated for all purposes. Term (months): 5 years (60 months) Commencement Date: March 2021 Termination Date: December 31, 2026. Base Rent (monthly): $0.00 Renewal Option: This lease may be renewed by Tenant for additional 3-year terms upon Commissioners' Court approval. This clause expressly grants extension of this lease between Tenant and Landlord for multiple 3-year terms. Tenant's Pro Rata Share: Zero percent (0%) Security Deposit: $0.00 Permitted Use: Construction and use of the premises as an emergency medical helicopter landing pad. Tenant's Insurance: Statutory amounts as required by law. Tenant shall provide Landlord proof of said insurance coverage when requested by Landlord. Landlord's Insurance: N/A Tenant's Rebuilding Obligations: If the Premises are damaged by fire or other elements, Tenant will be responsible for repairing or rebuilding the following leasehold improvements: The emergency medical helicopter landing pad. A. Definitions A.1. "Agent" means agents, contractors, employees, licensees, and, to the extent under the control of the principal, invitees. A.2. 'Essential Services" means utility connections reasonably necessary for occupancy of the Premises for the Permitted Use. A.3. "Injury" means (1) harm to or impairment or loss of property or its use, (2) harm to or death of a person, or (3) "personal and advertising injury" as defined in the form of liability insurance Tenant is required to maintain. A.4. "Lienholder" means the holder of a deed of trust covering the Premises. A.S. 'Rent" means Base Rent plus any other amounts of money payable by Tenant to Landlord. Clauses and Covenants B. Tenant's Obligations BL Tenant agrees to - B.I.a. Lease the Premises for the entire Term beginning on the Commencement Date and ending on the Termination Date. Tenant shall maintain the premises in neat manner consistent with the permitted use of the property as an emergency medical helipad. B.I.b. Accept the Premises in their present condition "AS IS," the Premises being currently suitable for the Permitted Use. B.1.c. Obey (a) all laws relating to Tenant's use, maintenance of the condition, and occupancy of the Premises and Tenant's use of any common areas and (b) any requirements imposed by utility companies serving or insurance companies covering the Premises. B.1. d. Pay monthly, in advance, without demand, on the first day of the month, the Base Rent to Landlord at Landlord's Address. R I.e. Pay a late charge of 5 percent of any Rent not received by Landlord by the tenth day after it is due. B. If Obtain and pay for all utility services used by Tenant and not provided by Landlord. B.1.g. Pay Tenant's Pro Rata Share of any utility services provided by Landlord. B. I. h. Allow Landlord to enter the Premises to perform Landlord's obligations, inspect the Premises, and show the Premises to prospective purchasers or tenants. B.1. i. Repair, replace, and maintain any part of the Premises that Landlord is not obligated to repair, replace, or maintain, normal wear excepted. B.1 j. Submit in writing to Landlord any request for repairs, replacement, and maintenance that are the obligations of Landlord. B. I.k. Allow Landlord to file a financing statement perfecting the security interest created by this lease. B.I.I. Vacate the Premises on the last day of the Term. B.I.m. INDEMNIFY, DEFEND, AND HOLD LANDLORD AND LIENHOLDER, AND THEIR RESPECTIVE AGENTS, HARMLESS FROM ANY INJURY (AND ANY RESULTING OR RELATED CLAIM, ACTION, LOSS, LIABILITY, OR REASONABLE EXPENSE, INCLUDING ATTORNEY'S FEES AND OTHER FEES AND COURT AND OTHER COSTS) OCCURRING IN ANY PORTION OF THE PREMISES IF CAUSED IN WHOLE OR IN PART BY THE ACTS OR OMISSIONS OF TENANT OR ITS AGENTS, INCLUDING IN WHOLE OR IN PART BY THE NEGLIGENT ACTS OR OMISSIONS OF TENANT OR ITS AGENTS. THE INDEMNITY CONTAINED IN THIS PARAGRAPH (i) IS INDEPENDENT OF TENANT'S INSURANCE, (ii) WILL NOT BE LIMITED BY COMPARATIVE NEGLIGENCE STATUTES OR DAMAGES PAID UNDER THE WORKERS' COMPENSATION ACT OR SIMILAR EMPLOYEE BENEFIT ACTS, (M) WILL SURVIVE THE END OF THE TERM, AND (iv) WILL APPLY EVEN IF AN INJURY IS CAUSED IN PART BY THE ORDINARY NEGLIGENCE OR STRICT LIABILITY OF LANDLORD BUT WILL NOT APPLY TO THE EXTENT AN INJURY IS CAUSED IN WHOLE OR IN PART BY THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF LANDLORD, LIENHOLDER, OR THEIR RESPECTIVE AGENTS. B2. Tenant agrees not to - B.2.a. Use the Premises for any purpose other than the Permitted Use. B.2.b. Create a nuisance. B.2. c. Permit any waste. B.2.d. Use the Premises in any way that would increase insurance premiums or void insurance on the Premises. B.2.e. Change Landlord's lock system. B.2.f. Alter the Premises. B.2.g. Allow alien to be placed on the Premises. B.2.h. Assign this lease or sublease any portion of the Premises without Landlord's written consent. C. Landlord's Obligations C.I. Landlord agrees to - C. La. Lease to Tenant the Premises for the entire Tenn beginning on the Commencement Date and ending on the Termination Date. C. L b. Obey all laws relating to Landlord's operation of the Premises. C.1. c. Provide the Essential Services. Cl.d. Repair, replace, and maintain the (a) roof, (b) foundation, and (c) structural soundness of the exterior walls, excluding windows and doors. C.1. e. Return the Security Deposit to Tenant, less itemized deductions, if any, on or before the N/A day after the date Tenant surrenders the Premises. C2. Landlord agrees not to - C2.a. Interfere with Tenant's possession of the Premises as long as Tenant is not in default. C.2. b. Unreasonably withhold consent to a proposed assignment or sublease. D. General Provisions Landlord and Tenant agree to the following: D.1. Alterations. Any physical additions or improvements to the Premises made by Tenant will become the property of Landlord. Landlord may require that Tenant, at the end of the Term and at Tenant's expense, remove any physical additions and improvements, repair any alterations, and restore the Premises to the condition existing at the Commencement Date, normal wear excepted. D.2. Abatement. Tenant's covenant to pay Rent and Landlord's covenants are independent. Except as otherwise provided, Tenant may not abate Rent for any reason. D.3. Insurance. Tenant must and Landlord may maintain the respective insurance coverages described hereinabove. D.4. Release of Claims/Subrogation. LANDLORD AND TENANT RELEASE EACH OTHER AND LIENHOLDER, AND THEIR RESPECTIVE AGENTS, FROM ALL CLAIMS OR LIABILITIES FOR DAMAGE TO THE PREMISES, DAMAGE TO OR LOSS OF PERSONAL PROPERTY WITHIN THE PREMISES, AND LOSS OF BUSINESS OR REVENUES THAT ARE INSURED BY THE RELEASING PARTY'S PROPERTY INSURANCE OR THAT WOULD HAVE BEEN INSURED BY THE REQUIRED INSURANCE IF THE PARTY FAILS TO MAINTAIN THE PROPERTY COVERAGES REQUIRED BY THIS LEASE. THE PARTY INCURRING THE DAMAGE OR LOSS WILL BE RESPONSIBLE FOR ANY DEDUCTIBLE OR SELF -INSURED RETENTION UNDER ITS PROPERTY INSURANCE. LANDLORD AND TENANT WILL NOTIFY THE ISSUING PROPERTY INSURANCE COMPANIES OF THE RELEASE SET FORTH IN THIS PARAGRAPH AND WILL HAVE THE PROPERTY INSURANCE POLICIES ENDORSED, IF NECESSARY, TO PREVENT INVALIDATION OF COVERAGE. THIS RELEASE WILL NOT APPLY IF IT INVALIDATES THE PROPERTY INSURANCE COVERAGE OF THE RELEASING PARTY. THE RELEASE IN THIS PARAGRAPH WILL APPLY EVEN IF THE DAMAGE OR LOSS IS CAUSED IN WHOLE OR IN PART BY THE ORDINARY NEGLIGENCE OR STRICT LIABILITY OF THE RELEASED PARTY OR ITS AGENTS BUT WILL NOT APPLY TO THE EXTENT THE DAMAGE OR LOSS IS CAUSED IN WHOLE OR IN PART BY THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF THE RELEASED PARTY OR ITS AGENTS. D.5. Casualty/Total or Partial Destruction D.5. a. If the Premises are damaged by casualty and can be restored within ninety days, Landlord will, at its expense, restore the roof, foundation, and structural soundness of the exterior walls of the Premises and any leasehold improvements within the Premises that are not within Tenant's Rebuilding Obligations to substantially the same condition that existed before the casualty and Tenant will, at its expense, be responsible for replacing any of its damaged furniture, fixtures, and personal property and performing Tenant's Rebuilding Obligations. If Landlord fails to complete the portion of the restoration for which Landlord is responsible within ninety days from the date of written notification by Tenant to Landlord of the casualty, Tenant may terminate this lease by written notice to Landlord before Landlord completes Landlord's restoration obligations. D.5.b. If Landlord cannot complete the portion of the restoration for which Landlord is responsible within ninety days, Landlord has an option to restore the Premises. If Landlord chooses not to restore, this lease will terminate. If Landlord chooses to restore, Landlord will notify Tenant in writing of the estimated time to restore and give Tenant an option to terminate this lease by notifying Landlord in writing within ten days from receipt of Landlord's estimate. If Tenant does not notify Landlord timely of Tenant's election to terminate this lease, the lease will continue and Landlord will restore the Premises as provided in D.5.a. above. D.5.c. To the extent the Premises are untenantable after the casualty, the Rent will be adjusted as may be fair and reasonable. DA Condemnation/Substantial or Partial Taking D. 6. a. If the Premises cannot be used for the purposes contemplated by this lease because of condemnation or purchase in lieu of condemnation, this lease will terminate. D.6. b. If there is a condemnation or purchase in lieu of condemnation and this lease is not terminated, Landlord will, at Landlord's expense, restore the Premises, and the Rent payable during the unexpired portion of the Term will be adjusted as may be fair and reasonable. D.6.c. Tenant will have no claim to the condemnation award or proceeds in lieu of condemnation. D.7. Uniform Commercial Code. Tenant grants Landlord a security interest in Tenant's personal property now or subsequently located on the Premises. This lease is a security agreement under the Uniform Commercial Code. Landlord may file financing statements or continuation statements to perfect or continue the perfection of the security interest. D.B. Default by Landlord/Events. Defaults by Landlord are failing to comply with any provision of this lease within thirty days after written notice and failing to provide Essential Services to Tenant within ten days after written notice. D.9. Default by Landlord/Tenant's Remedies. Tenant's remedies for Landlord's default are to sue for damages and, if Landlord does not provide an Essential Service for thirty days after default, terminate this lease. D.10. Default by Tenant/Events. Defaults by Tenant are (a) failing to pay Rent timely, (b) abandoning the Premises or vacating a substantial portion of the Premises, and (c) failing to comply within ten days after written notice with any provision of this lease other than the defaults set forth in (a) and (b). D.11. Default by Tenant/Landlord's Remedies. Landlord's remedies for Tenant's default are to (a) enter and take possession of the Premises and sue for Rent as it accrues; (b) enter and take possession of the Premises, after which Landlord may relet the Premises on behalf of Tenant and receive the Rent directly by reason of the reletting, and Tenant agrees to reimburse Landlord for any expenditures made in order to relet; (c) enter the Premises and perform Tenant's obligations; and (d) terminate this lease by written notice and sue for damages. Landlord may enter and take possession of the Premises by self-help, by picking or changing locks if necessary, and may lock out Tenant or any other person who may be occupying the Premises, until the default is cured, without being liable for damages. D.12. Default/Waiver. All waivers must be in writing and signed by the waiving party. Landlord's failure to enforce any provisions of this Lease or its acceptance of late installments of Rent will not be a waiver and will not estop Landlord from enforcing that provision or any other provision of this Lease in the future. D.13. Mitigation. Landlord has mitigated the loss of rent if Landlord, within thirty days after Tenant's loss of possession, (a) places a "For Lease" sign at the Premises, (b) places the Premises on Landlord's inventory of properties for lease, (c) makes Landlord's inventory available to area brokers on a monthly basis, (d) advertises the Premises for lease in a suitable trade journal in the county in which the Premises are located, and (e) shows the Premises to prospective tenants who request to see it. D.14. Security Deposit. If Tenant defaults, Landlord may use the Security Deposit to pay arrears of Rent, to repair any damage or injury, or to pay any expense or liability incurred by Landlord as a result of the default. D.15. Holdover. If Tenant does not vacate the Premises following termination of this lease, Tenant will become a tenant at will and must vacate the Premises on receipt of notice from Landlord. No holding over by Tenant, whether with or without the consent of Landlord, will extend the Term. D.16. Alternative Dispute Resolution. Landlord and Tenant agree to mediate in good faith before filing a suit for damages. D.17. Attorneys Fees. If either party retains an attorney to enforce this lease, the party prevailing in litigation is entitled to recover reasonable attorney's fees and other fees and court and other costs. D.18. Venue. Exclusive venue is in the county in which the Premises are located. D.19. Entire Agreement. This lease, its exhibits, addenda and riders, are the entire agreement of the parties concerning the lease of the Premises by Landlord to Tenant. There are no representations, warranties, agreements, or promises pertaining to the Premises or the lease of the Premises by Landlord to Tenant, and Tenant is not relying on any statements or representations of any agent of Landlord, that are not in this lease and any exhibits, addenda, and riders. D.20. Amendment of Lease. This lease maybe amended only by an instrument in writing signed by Landlord and Tenant. D.21. Limitation of Warranties. THERE ARE NO IMPLIED WARRANTIES OF MERCHANTABILITY, OF FITNESS FOR A PARTICULAR PURPOSE, OR OF ANY OTHER KIND ARISING OUT OF THIS LEASE, AND THERE ARE NO WARRANTIES THAT EXTEND BEYOND THOSE EXPRESSLY STATED IN THIS LEASE. D. 22. Notices. Any notice required or permitted under this lease must be in writing. Any notice required by this lease will be deerned to be given (whether received or not) the earlier of receipt or three business days after being deposited with the United States Postal Service, postage prepaid, certified mail, return receipt requested, and addressed to the intended recipient at the address shown in this lease. Notice may also be given by regular mail, personal delivery, courier delivery, or e-mail and will be effective when received. Any address for notice may be changed by written notice given as provided herein. D.23. Aanclonecl Property. Landlord may retain, destroy, or dispose of any property left on the Premises at the end of the Term. D. 24. Early Terrninalion. Landlord may terminate this Lease before the hereinabove- stated termination date of December 31, 2026 with three months' prior written notice to Tenant at P.O. Box 177, Seadrift, Texas 77983 that Landlord wishes to terminate this Lease agreement. t r Executed in Duplicate originals this the 1 day of ,`"Z J�'r V"ti `j , 2021. First National Bank, a Texas corporation, William Bauer, Rwsidant I vk a unit of Texas government H. Meyer, STATE OF TEXAS COUNTY OF CALHOUN This hereinabove instrument was acknowledged before me, the undersigned authority on rpia rr , I /, P-D>1 ) by William Bauer, President of First National Bank in the capabilities stated. f,;pr0''R',, CAROLYNWHITEHEAD 4@ My Notary ID N 3241520 Explrea Juna 17, 2021 STATE OF TEXAS COUNTY OF CALHOUN &"'i' W� Notary Publ This hereinabove instrument was acknowledged before me, the undersigned authority on �A�rl/ 3, 262 1 , by Richard H. Meyer, County Judge for Calhoun County, Texas in the capabilities stated. MAE BELLE CASSEL ;,; •: My Notary ID # 132012524 ..�g< pia play 14, 2023 �L� �L _.wj�� FNB W. H. BAUER, JR. CHAIRMAN FIRST NATIONAL BANK IN PORT LAVACA POST OFFICE D12ANs"ER 7 PORT LAVACr1., TEti.35 r 7979 February 11, 2021 Calhoun County, Texas c/o Gary Reese, Commissioner Precinct #4 of Calhoun County P.O. Box 177 Seadrift, Texas 77983 Dear Commissioner: Please find enclosed the Lease Agreement for property in Seadrift that the county is going to put a Helicopter pad on. Sincerely, W.H. Bauer Chairman W H B/cw TELEPI-IO\T 361.-332-6726 # zo Gary D. Reese County Commissioner County of Calhoun Precinct 4 February 24, 2021 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 March 3, 2021. Consider and take necessary action to approve the specifications/scope of services for the Request for Qualifications, RFQ 2021.04 for Professional Engineering, Architectural, and Surveying Services for the CMP Cycle 25 Grant, GLO Contract No. 21-060-013-C673 for Boggy Bayou Nature Park Improvements, Phase 1 and authorize the County Auditor to advertise for these services. RFQ 2021.04 will be due by 2:00 PM, Tuesday, March 30, 2021. Sincerely, (� Gary D. Reese GDR/at P.O. Box 177 — Seadrift, Texas 77983 — email: ery.reeseOcalhouncom.ore — (361) 785-3141 — Fax (361) 785-5602 CALHOUN COUNTY, TEXAS REQUEST FOR QUALIFICATIONS RFQ 2021.04 For PROFESSIONAL ENGINEERING, ARCHITECTURAL, AND SURVEYING SERVICES FOR CMP CYCLE 25 GRANT, GLO CONTRACT NO.21-060-013-C673 BOGGY BAYOU NATURE PARK IMPROVEMENTS, PHASE 1 CONTENTS • Request for Qualifications, RFQ 2021.04 (Page 1 thru 2) • Specifications/Scope of Services for Professional Engineering, Architectural, and Surveying Services For CMP Cycle 25 Grant, GLO Contract No. 21-060-013-C673 for Boggy Bayou Nature Park Improvements, Phase 1 (Page 1 thru 6) • General Conditions (Page 1 thru 13) THE BELOW INFORMATION/FORMS MUST BE RETURNED WITH RESPONDENT'S RFQ If a question or form is not applicable, mark the question or form with "NA" and return with your RFQ • Affidavit • Certificate of Interested Parties, Form 1295 — Must complete and include when submitting your RFQ • Conflict of Interest Questionnaire, Form CIQ— Every vendor doing business with the County or seeking to do business with the County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Lobbying • Disclosure of Lobbying Activities • System for Award Management — Consultant/Firm, and its Principals, may not be debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM). Include verification that the company as well as the company's principles are not listed (are not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date and verification that the Company, Corporation, Firm, or Partnership as well as their principles are not listed (are not debarred) through the System for Award Management. • Certification Regarding Debarment & Suspension and Other Responsibility Matters Form • Copy of Current Certificate of Insurance that includes Professional Liability • House Bill 89 Verification • Residence Certification • W-9 OTHER INFORMATION INCLUDED WITH THE RFQ • Required Contract Provisions • Engineering, Architectural, and Surveying Rating Sheet (How the RFQ will berated) REQUEST FOR QUALIFICATIONS RFQ 2021.04 FOR PROFESSIONAL ENGINEERING, ARCHITECTURAL, AND SURVEYING SERVICES FOR CMP CYCLE 25 GRANT, GLO CONTRACT NO.21-060-013-C673 BOGGY BAYOU NATURE PARK IMPROVEMENTS, PHASE 1 March 3, 2021 BY ORDER OF the Commissioners Court of Calhoun County Texas, sealed Request for Qualifications (RFQs) will be received for Professional Engineering, Architectural, and Surveying Services. These services are being solicited to assist Calhoun County in support of the Boggy Bayou Nature Park Improvements, Phase 1. The County is seeking a professional firm(s) to provide engineering, comprehensive design, review, analysis, planning, surveys, studies, and other ancillary services necessary to implement projects under terms and conditions established by this RFQ and Calhoun County. Respondent(s) chosen by the County for Boggy Bayou Nature Park Improvements projects must have Professional Engineers, registered in the State of Texas, on staff and must have demonstrated experience in performing coastal engineering projects, including obtaining permits from the U.S. Army Corps of Engineers — Galveston District, for coastal engineering projects. Respondent(s) must demonstrate a coastal presence or substantial history of coastal work and services within the Texas Coastal Management Zone and the ability to perform the services listed within this RFQ. Multiple contracts may be awarded as a result of this solicitation. The County will, in its sole discretion, determine the number of contracts awarded, and may decide not to award any contracts. The RFQ can be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results), or by contacting Peggy Hall, Assistant Auditor at 361-553-4610 or peggy.hall@calhouncotx.org. SEALED RFQs ARE DUE on or before 2:00 PM, TUESDAY, MARCH 30, 2021. At this time, all RFQs will be publicly opened and acknowledged. The RFQs will be considered for award on Wednesday, April 7, 2021 during Commissioners Court. The complete submittal, consisting of one (1) unbound original and three (3) bound copies, of the statement of qualifications for the proposed services and all required information and forms must be delivered in a sealed 9 x 12 envelope or larger clearly marked on the outside of the envelope: RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the Boggy Bayou Nature Park Improvements, Phase 1. Calhoun County does not accept faxed or emailed RFQs. It is the responsibility of the submitting entity to ensure that the RFQ is received in a timely manner. RFQs received after the deadline will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting entity. Page 1 of 2 SEALED RFQs (One Unbound Original and 3 Bound Copies) may be hand delivered or mailed to: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 S. Ann St., Ste. 301 Port Lavaca, TX 77979 NOTE: The outside of the sealed 9 x 12 or larger envelope must be clearly marked: RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the Boggy Bayou Nature Park Improvements, Phase 1 If you are sending your RFQ by FedEx, UPS, or other delivery service, the outside of this envelope must also be clearly marked: RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the Boggy Bayou Nature Park Improvements, Phase 1 Calhoun County reserves the right to reject any or all RFQs and to waive informalities in the request for qualifications Calhoun County reserves the right to negotiate with any and all individuals or firms submitting RFQs, per the Texas Professional Services Procurement Act and the Uniform Grant and Contract Management Standards, to accept the RFQ deemed most advantageous to Calhoun County and to be the sole judge in determining which RFQ will be most advantageous to Calhoun County. Any award is contingent upon the successful negotiation of final contract terms, approval of contract by the County's Attorney and the approval and award by Calhoun County Commissioners Court. The County of Calhoun, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit RFQs. Sincerely, Peggy Haff Peggy Hall Assistant County Auditor 361-553-4601 peggy.hall@calhouncotx.org Page 2 of 2 SPECIFICATIONS/SCOPE OF SERVICES FOR THE REQUEST FOR QUALIFICATIONS RFQ 2021.04 FOR PROFESSIONAL ENGINEERING, ARCHITECTURAL, AND SURVEYING SERVICES FOR CMP CYCLE 25 GRANT, GLO CONTRACT NO.21-060-013-C673 BOGGY BAYOU NATURE PARK IMPROVEMENTS, PHASE I GENERAL DESCRIPTION Calhoun County is soliciting this Request for Qualifications (RFQ) for professional Engineering, Architectural, and Surveying Services in support of the Boggy Bayou Nature Park Improvements, Phase I. The County is seeking a professional firm(s) to provide engineering, comprehensive design, review, analysis, planning, surveys, studies, and other ancillary services necessary to implement projects under terms and conditions established by this RFQ and Calhoun County. Respondent(s) chosen by the County for Boggy Bayou Nature Park Improvement projects must have Professional Engineers, registered in the State of Texas, on staff and must have demonstrated experience in performing coastal engineering projects, including obtaining permits from the U.S. Army Corps of Engineers — Galveston District, for coastal engineering projects. Respondent(s) must demonstrate a coastal presence or substantial history of coastal work and services within the Texas Coastal Management Zone and the ability to perform the services listed within this RFQ. SCOPE OF SERVICES The County is seeking engineering services necessary to implement projects, surveys and studies at Boggy Bayou Nature Park. Park projects may include activities such as shoreline restoration, marshland restoration, restoration and/or creation of bird islands, and construction of recreational outdoor infrastructure. The County may require one or more of the following areas of expertise for the successful implementation of park projects. The capability of Respondent(s) to provide expertise in more than one (or all) of the services identified below will be considered favorably in the County's ranking and selection process. Respondent(s) may subcontract for such services; however, existing relationships are preferred. All subcontracting relationships for services shall be clearly documented. No priority is implied by the order of the following services requested by the County: • Development of protection and restoration methods for shorelines, bird islands, coastal marshes and wetlands; • Design of shore protection projects and coastal structures; Page 1 of 6 • Design of outdoor recreational infrastructure such as piers, boat ramps, pavilions, and habitat observation facilities; • Economic analysis of public and/or private recreational and environmental benefits and cost allocation strategies; • Development of construction plans and specifications, bid documents, and bid analysis; • Regulatory issues and permitting management and oversight; • Construction management and oversight; • Geotechnical and geophysical investigations necessary for the design of coastal engineering construction projects; • Monitoring and data collection; • Marsh and wetland monitoring; • Study of flora, fauna, and habitats of coastal marshes, uplands and bayou environments; • Study of hydraulics of river channels, bays, and inlets; • Management planning and sediment source identification and quantification; • Storm hazard analysis, failure analysis, probability, and certainty; • Study of long-term response to coastal hazards, such as hurricanes, severe rain events and river overflow; • Independent engineering review of all above -mentioned services. PROJECT SCHEDULE(S) It is anticipated multiple individual projects will be of varying duration, scope and complexity. Specific project schedule(s) will be coordinated between the County and the successful respondent(s). DESCRIPTION OF SERVICES AND SPECIAL CONDITIONS All work requested of Respondent(s) described in the Scope of Services will be issued by specific written work authorization from Calhoun County. Such authorization will be in the form of a "Work Order" and include a particular scope of services, a schedule, a list of deliverables, and such other information or special conditions as may be necessary for the work requested. One or more work orders may be issued under a contract during the contract term. Page 2 of 6 CONTRACT AND TERM Services provided under any contract resulting from this RFQ will be required on an irregular and as needed basis throughout the contract period. The County reserves the right to increase this amount if additional funds become available. Any contract resulting from this RFQ shall be effective from the date the contract is awarded not to exceed four (4) calendar years from that date forward. The County, at its own discretion, may extend any contract(s) awarded pursuant to this RFQ for up to four (4) additional years, subject to terms and conditions mutually agreeable to both parties. Any award is contingent upon the successful negotiation of final contract terms, approval of contract by the County's Attorney and the approval and award by Calhoun County Commissioners Court. Selected/successful Respondent(s) will be compensated under a work order, if any, based on a negotiated fee. NO GUARANTEE OF VOLUME OR USAGE Calhoun County makes no guarantee of volume or usage under any work order or contract resulting from this RFQ. WRITTEN WORK AUTHORIZATION During the term of any contract awarded under this RFQ, the County may request Respondent(s) to perform certain tasks as listed in the Scope of Services, subject to a specific work order. All work orders shall be in writing, signed by both parties, and shall include a scope of services, a list of tasks to be performed by Respondent, a time schedule, a list of deliverables and such other information or special conditions as may be necessary for the work requested. SCORING CRITERIA RFQ responses shall be consistently evaluated and ranked in accordance with the following criteria: CRITERIA MAXIMUM POINTS Experience 60 Work Performance 25 Capacity to Perform 15 Total 100 See the attached copy of the Engineer, Architect, and Surveyor Rating Sheet for more detailed information on the criteria. For this RFQ, Respondent's qualifications will be evaluated and the most qualified Respondent will be selected, subject to negotiation of fair and reasonable compensation. Calhoun County reserves the right to reject any or all RFQs, and to waive informalities in the request for qualifications. Page 3 of 6 Calhoun County reserves the right to negotiate with any and all individuals or firms submitting RFQs, per the Texas Professional Services Procurement Act and the Uniform Grant and Contract Management Standards, to accept the RFQ deemed most advantageous to Calhoun County and to be the sole judge in determining which RFQ will be most advantageous to Calhoun County. EVALUATION CRITERIA In conformance with state law, RFQ Responses shall be evaluated in accordance with Chapters 2155-2157 of the Texas Government Code. MINIMUM QUALIFICATIONS Respondents must meet the minimum qualifications listed below. Furthermore, RFQ responses that appear unrealistic in terms ortechnical capability, commitment, that show a lack of technical competence, or that indicate a failure to comprehend the risk and complexity of a potential contract may be rejected. Respondents must have been in business for a minimum of three (3) years or the principals shall have had ownership/management experience in a previous company that provided coastal engineering, comprehensive design, review, planning, analysis, surveys, studies and other services. • Respondents must have demonstrated experience in providing engineering services in coastal areas in the categories requested in the Scope of Services. Respondents must employ at least one (1) engineer registered as a Professional Engineer (P.E.) in the state of Texas as a full-time permanent employee of the respective company. REQUIRED RESPONDENT INFORMATION Respondent must provide satisfactory evidence of its abilityto manage and coordinate the types of activities described in the Scope of Services and to produce the specified products or services on time. RESPONDENT MUST PROVIDE THE FOLLOWING INFORMATION FORMATTED IN THE RESPONSE AS FOLLOWS: Company Narrative: (1) The year the company was founded, background and history (and parent company, if applicable) and, if incorporated, the state in which the company is incorporated and the date of incorporation. If the company is an out-of-state Respondent, a Certificate of Authority to do business in Texas from the Secretary of State must be provided as an Appendix. (2) The company ownership structure (corporation, partnership, LLC, or sole proprietor). Page 4 of 6 (3) Location of company headquarters and location of the primary office(s) that will service any contract resulting from this RFQ, in addition to listing of offices intended to support the contract with city, state, telephone number, email contact address, and total number of personnel at each of these offices. b. Staffing Profile: Name, address, telephone number, and email address of the Respondent's point of contact for a possible contract resulting from this RFQ. Respondent should provide brief resumes for key staff to be responsible for the performance of any contract resulting from this RFQ. The staff profile(s) should describe personnel by discipline and should identify the Texas Profession Engineer(s) who will sign/seal engineering work products. c. Respondent Justification: Complete information regarding how the Respondent is qualified to provide the services described in the Scope of Services, focusing on the company's key strengths and advantage to Calhoun County select the Respondent. d. Major Sub -consultant Information Respondent must identify any sub -consultants with whom the Respondent intends to utilize in performing work under any contract or work order resulting from this RFQ. Respondent must indicate whether or not Respondent holds any financial interest in any sub -consultant activities. e. Litigation History: Respondent must include a complete disclosure of any alleged or significant contractual failures. In addition, Respondent must disclose any civil or criminal litigation or investigation pending over the last three (3) years that involves Respondent or in which Respondent has been judged guilty or liable. Failure to comply with the terms of this provision may disqualify and Respondent. If none, Respondent must state this in their response. ADDITIONAL INFORMATION/FORMS REQUIRED TO BE RETURNED WITH RESPONDENT'S RFQ Respondent must return the following information and forms with their RFQ: If a question or form is not applicable, mark the question or form with "NA" • Affidavit • Certificate of Interested Parties, Form 1295 — Must include when submitting your RFQ • Conflict of Interest Questionnaire, Form CIQ— Every vendor doing business with the County or seeking to do business with the county must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Lobbying • Disclosure of Lobbying Activities Page 5 of 6 System for Award Management — Consultant/Firm, and its Principals, may not be debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM). Include verification that the company as well as the company's principles are not listed (are not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date and verification that the Company, Corporation, Firm, or Partnership as well as their principles are not listed (are not debarred) through the System for Award Management. • Certification Regarding Debarment & Suspension and Other Responsibility Matters Form • Copy of Current Certificate of Insurance that includes Professional Liability • House Bill 89 Verification • Residence Certification • W9 DEADLINE FOR SUBMISSION OF RFQs: The submission, consisting of one (1) unbound original and three (3) bound copies, of the Request for Qualifications (RFQ) must be received in the County Judge's office no later than 2:00 PM, Tuesday, March 30, 2021. Calhoun County does not accept faxed or emailed RFQs. It is the responsibility of the submitting entity to ensure that the RFQ is received in a timely manner. RFQs received after the deadline will not be considered for award, regardless of whether or not the delay was outside the control of the submitting entity. SUBMIT THE SEALED RFQ (1 Unbound Original and 3 Bound Copies) to the following address: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 S. Ann St., Ste. 301 Port Lavaca, TX 77979 The RFQ must be delivered in a sealed 9 x 12 larger envelope clearly marked on the outside of the envelope: RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the Boggy Bayou Nature Park Improvements, Phase 1 If you are sending your RFQ by Fed Ex, UPS, or other delivery service, the outside of the UPS/Fed Ex/Other Delivery Service envelope must be clearly marked: RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the Boggy Bayou Nature Park Improvements, Phase 1 Page 6 of 6 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFQ, and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFC, and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ, and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFC, and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ, and/or Contract is due. The Bid, RFP, RFC, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFC, and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ, and/or Contract in collusion with any other bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ, and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ, and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ, and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Page 1 of 13 Submission of Bid, RFP, RFQ, and/or Contract: On or before the due date and time, the bidder/vendor must return the original and required number of copies of their completed Bid, RFP, RFQ, and/or Contract and any additional required information/forms to the Calhoun County Judge's Office, 211 S. Ann St., 3rd Floor, Suite 301, Port Lavaca, Texas. The clock in the Calhoun County Judge's office is the official clock that will be used in determining the time the Bid, RFP, RFQ, and/or Contract is received and the time the Bid, RFP, RFQ and/or Contract will be opened. A late delivery with an early postmark will not suffice. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a sealed 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the sealed envelope must be clearly marked: SEALED BID (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. If the Bid, RFP, RFQ, and/or Contract is sent by UPS, Fed Ex or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ, and/or Contract price. Bids, RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ and/or Contract. Page 2 of 13 Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum. indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ, and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFC, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendor's performance under this Bid, RFP, RFQ, and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes. Tax exempt forms will be furnished upon request to the Calhoun County Auditor's Office. Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Page 3 of 13 Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and abilityto meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the sole judge in determining which Bid, RFP, RFQ, and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ, and/or Contract based on lowest and/or best Bid, RFP, RFQ, and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ and/or Contract" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Page 4 of 13 Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFC' and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ, and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFC' and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFC' and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFC' and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Page 5 of 13 Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFQ and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFC, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFC, and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFQ, and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFQ and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 84th Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Page 6 of 13 Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf_info_forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFQ, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFC, and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Bid, RFP, RFQ and/or Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than thirty (30) days after Calhoun County Commissioners Court approves a contract, or awards a Bid, RFP, and/or RFQwith a business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ, and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFQ, and/or Contract submission and the time of execution of the Bid, RFP, RFQ and/or Contract. Page 7 of 13 A print out of the search results, including principals, if any, from the System for Award Management (www.SAM.gov) that includes the record date must be included with the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFQ, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ, Contract, order, and/or service. In the event a Bid, RFP, RFQ, Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Page 8 of 13 Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the eventthe bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFC, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFQ, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFQ, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the rightto cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur Page 9 of 13 any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Majeure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFC, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFC, and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFQ, and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFQ and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFQ, and/or Contract shall be governed bythe Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFC, and/or Contract. Otherwise, Texas state and federal law shall apply. Prohibition against Personal Interest in Bids, RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFC, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ, and/or Contract involved voidable by the Calhoun County Commissioners Court. Page 10 of 13 Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFQ and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ, and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ, and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. General Liability ($100,000/$300,000 or greater) Workers' Compensation (at Statutory Limits) Employer's Liability ($1,000,000 or greater) Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) Professional Liability Insurance (if applicable) Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of orfailure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFQ and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ, and/or Contract or pursue any remedy available by law. Page 11 of 13 The insurance coverage requirements in the Bid, RFP, RFQ and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: Name, mailing address and business phone number of the protesting party; Appropriate identification of the Bid, RFP, RFQ, and/or Contract being protested; A precise statement of the reasons for the protest; and Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun.County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFQ, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or byjudicial decision, or information for which an exception to disclosure has not been sought. Page 12 of 13 CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Cindy Mueller Calhoun County Auditor Calhoun County Courthouse Annex If 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: cindy.mueller@calhouncotx.org To request a Bid, RFP, and/or RFP packet from Calhoun County, or information on how to obtain a packet, please contact: Peggy Hall Assistant Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: peggy.hall@calhouncotx.org Bids, RFPs, and/or RFQs may also be viewed on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results. Page 13 of 13 ADDITIONAL INFORMATION/FORMS REQUIRED TO BE RETURNED WITH RESPONDENT'S RFQ Respondent must return the following additional information/forms with their RFQ: If a question or form is not applicable, mark the question or form with "NA" • Affidavit • Certificate of Interested Parties, Form 1295 Must include when submitting your RFQ • Conflict of Interest Questionnaire, Form CIQ Every vendor doing business with the County or seeking to do business with the County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Lobbying • Disclosure of Lobbying Activities • System for Award Management — Consultant/Firm, and its Principals, may not be debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM). Include verification that the company as well as the company's principles are not listed (are not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date and verification that the Company, Corporation, Firm, or Partnership as well as the Company's, Corporation's, Firm's or Partnership's principles are not listed (are not debarred) through the System for Award Management. • Certification Regarding Debarment & Suspension and Other Responsibility Matters Form • Copy of Current Certificate of Insurance that includes Professional Liability • House Bill 89 Verification • Residence Certification • W-9 STATE OF TEXAS {} AFFIDAVIT COUNTY OF CALHOUN {} BEFORE ME, the undersigned authority, on this day personally appeared known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Company, Corporation, Firm, or Partnership in the matter of the Request for Qualifications to which this affidavit is attached, and I have full knowledge of the relations of the Company, Corporation, Firm, or Partnership with others in this same line of business, and the Company, Corporation, Firm, or Partnership is not a member of any trust, pool or combination of to control the services in this Request for Qualifications, or to influence any person to submit a Request for Qualifications or not to submit a Request for Qualifications thereon. I affirm that I am duly authorized to execute this Request for Qualifications, that this Company, Corporation, Firm, or Partnership has not prepared this RFQ in collusion with any other Company, Corporation, Firm, Partnership or Individual. I further affirm that the Company, Corporation, Firm, or Partnership 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 or to any official, employee, or agent of Calhoun County in connection with the submitted Request for Qualifications. Affiant Printed Name and Title of Affiant Company Address Phone Number Fax Number Email Address SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 20_ Notary Public in and for County, Texas CERTIFICATE OF INTERESTED PARTIES, FORM 1295 Form 1295 must be filled out online, printed, #6 completed including signature and returned with respondent's RFQ. The copy included is a Sample Copy Only. #1 Respondent's Name, City, State and County #2 Calhoun County, Texas #3 RFQ 2021.04 Professional Engineering, Architectural, and Surveying Services for the Boggy Bayou Nature Park Improvements, Phase 1 On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #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 Unsworn Declaration. CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. ` 1. 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 tJ k o identify the contract, and provide a description of the services, goods, or other property to be providedJia contract. •/uq 4 City, State, Country ature of Interest (check applicable) Name of Interested Party (place of business)67 ♦ Controlling Intermediary 5 Check only if there' 1 terested Party. El 6 UNSWORN DECSI!@ N My name is �`` and my date of birth is My addreNo -�`J' (street) (city) (state) (zip code) (country) �Ld under penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20. (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission v=v.ethics.state.tx.us Revised 12122/2017 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 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal hUs://www.ethics.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. 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, 84th Leg., Regular Session. OFFICE USE ONLY 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. 1J Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 2J Name of local government officer about whom the Information is being disclosed. Name of Officer 4j 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? F7Yes E-1 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? FlYes F-1 No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑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 doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 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 http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code 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 officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (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: (i) 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 S 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying;' in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official Date Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial filing _ b. grant _ b. initial award _ b. material change e. cooperative agreement c. post -award I, d. loan For material change only:'. e.loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter _ Prime _ Subawardee Name and Address of Prime: Tier_, if Known: '. Congressional District, if known: Congressional District, if known: II' 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ifapplicable: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if' (if individual, last name, f art name, MI): different from No. 10a) (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name. - by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the 1 at tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0346- 0046. Public reporting burden for this collection of information is estimated to average 10 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 (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 Provide the printout of the System for Award Management (SAM) Record Search for company and company principal(s) • Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm, or Partnership as well as the Company's, Corporation's, Firm's or Partnership's principles are not listed (are not debarred) through the System for Award Management 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. Name and Title of Authorized Agent Signature of Authorized Agent 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 Comp., p. 199, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. 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 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. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. 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. Provide a Copy of Current Certificate of Insurance that includes Professional Liability • Provide a copy of the Company's, Corporation's, Firm's or Partnership's current Certificate of Insurance that includes proof of Professional Liability Insurance HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 the undersigned representative of Representative (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. Signature of Representative Print Name & Title Date State law requires certification from a Companyfor 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 (City and State) ❑ 1 certify that (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as War Request for Taxpayer Give Form to the (Form Rev. Oc tober2019) Identification Number and Certification I requester. Do not Deportment of the Treasury send to the IRS. Iraemal Revenue service ► Go to wwty bs gov/Formals for instructions and the latest information, 1 Name (as shown on your income tax return). Name is required an this line; do not leave this line blank. 2 Business name/disregarded entity name, B different from above m 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see a c ❑ Individuaysole proprietor or ❑ C Corporation ❑ 5 Corporation ❑ Partnership ❑ 7mstlestate Instructions on page 3): or single -member LLC Exempt payee code Of any) e ❑ Unified liability company. Enter the tax classification (C.0 corporation, S=S corporation, P=Partnership) ► p Nate: Check the appropriate box in the line above for the tax clessficetion oFthe single -member owner. Do not check Exemption from FATCA reporting _ — LLC if the LLC Is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is another LLC that is not disregarded from the owner for U.S. federal tax purpoeas. Otherwise, a single -member LLC that code Of any) a 0 is disregarded from the owner should check the appropriate box for the tax classification of Its owner. Q ❑ Other (aft Instructions) ► Wwaerro.«wnu,wnarnwwmrrao. usl N5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) CALHOUN COUNTY y 202 S ANN ST, PORT LAVACA TX 77979 6 City, state, and ZIP code 361.553-4610 FAX: 361-553.4614 7 Uat axoum numbeds) here (optional) Tax a err Identification Number (TIN) Enter your TIN in the appropriate box, The TIN provided must match the name given on line 1 to avoid I Social security number backup withholding. For Individuals,this Is generally your social security number ISSN. However, fora resident alien, sole proprietorr,,or or disregarded entity, see the instructions for Part I, later. For other FM - m - entitles, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer Identification number Number To Give the Requester for guidelines on whose number to enter. F-7--1 (—fir 1. The number shown on this form Is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA codes) entered on this forth Of any) Indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out Item 2 above If you have been noted by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part 11, later. ct9n signature of Here I U.S. person► Daft ► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Forth W-9 and Its instructions, such as legislation enacted after they were published, go to www.i s.gov1FormW9. Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (BSN), Individual taxpayer identification number (ITIN), adoption taxpayer Identification number (ATIN), or employer Identification number (EIN), to report on an Information return the amount paid to you, or other amount reportable on an Information return. Examples of information returns Include, but she not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-Div (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds) • Forth 1099-5 (stock or mutual fund sales and certain other transactions by brokers) • Forth 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third parry network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 109E-T (tuitlon) • Forth 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U.S. person (Including a resident allen), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Required Contract Provisions REQUIRED CONTRACT PROVISIONS 2 CFR 200.326 Contract provisions. The non -Federal entity's contracts must contain the applicable provisions described in Appendix II to Part 200—Contract Provisions for non -Federal Entity Contracts Under Federal Awards. The non -Federal entity's contracts must contain the applicable provisions described in Appendix II to Part 200—Contract Provisions for non - Federal Entity Contracts Under Federal Awards. All Contracts THRESHOLD PROVISION CITATION Contracts for more than the simplified acquisition threshold currently set at >$150,000 $150,000, which is the inflation adjusted amount determined by the Civilian 2 CFR 200 (Simplified Agency Acquisition Council and the Defense Acquisition Regulations Council APPENDIX II Acquisition (Councils) as authorized by 41 U.S.C. 1908, must address administrative, (A) Threshold) contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate. All contracts in excess of $10,000 must address termination for cause and for 2 CFR 200 >$10,000 convenience by the non -Federal entity including the manner by which it will be APPENDIX II effected and the basis for settlement. B Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of "funding agreement" under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or 2 CFR 200 None performance of experimental,developmental, or research work under that"funding APPENDIX II(F) agreement," the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government - wide exclusions in the System for Award Management (SAM), in accordance with 2 CFR 200 None the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR APPENDIX II part 1986 Comp., p.189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment (H) and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority otherthan Executive Order 12549. Records of non -Federal entities. The U.S. Department of Housing and Urban Development (HUD), Inspectors General, the Comptroller General of the United States, the Texas General Land Office (GLO), and the pass -through entity, or any of their authorized representatives, must have the right of access to any None documents, papers, or other records of the non -Federal entity which are pertinent 2 CFR 200.336 to the Federal award, in order to make audits, examinations, excerpts, and transcripts. The right also includes timely and reasonable access to the non - Federal entity's personnel for the purpose of interview and discussion related to such documents. Financial records, supporting documents, statistical records, and all other non - Federal entity records pertinent to a Federal award must be retained for a period of three years from the date of submission of the final expenditure report or, for Federal awards that are renewed quarterly or annually, from the date of the None submission of the quarterly or annual financial report, respectively, as reported to 2 CFR 200.333 the Federal awarding agency or pass -through entity in the case of a subrecipient. Federal awarding agencies and pass -through entities must not impose any other record retention requirements upon non -Federal entities. The only exceptions are the following: (a) If any litigation, claim, or audit is started before the expiration of the 3-year period, the records must be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken. (b) When the non -Federal entity is notified in writing by the Federal awarding agency, cognizant agency for audit, oversight agency for audit, cognizant agency for indirect costs, or pass -through entity to extend the retention period. (c) Records for real property and equipment acquired with Federal funds must be retained for 3 years after final disposition. (d) When records are transferred to or maintained by the Federal awarding agency or pass -through entity, the 3-year retention requirement is not applicable to the non -Federal entity. (e) Records for program income transactions after the period of performance. In some cases recipients must report program income after the period of performance. Where there is such a requirement, the retention period for the records pertaining to the earning of the program income starts from the end of the non -Federal entity's fiscal year In which the program income is earned. (f) Indirect cost rate proposals and cost allocations plans. This paragraph applies to the following types of documents and their supporting records: indirect cost rate computations or proposals, cost allocation plans, and any similar accounting computations of the rate at which a particular group of costs is chargeable (such as computer usage chargeback rates or composite fringe benefit rates). (1) If submitted for negotiation. If the proposal, plan, or other computation is required to be submitted to the Federal Government (orto the pass -through entity) to form the basis for negotiation of the rate, then the 3-year retention period for its supporting records starts from the date of such submission. (2) If not submitted for negotiation. If the proposal, plan, or other computation is not required to be submitted to the Federal Government (or to the pass -through entity) for negotiation purposes, then the 3-year retention period for the proposal, plan, or computation and its supporting records starts from the end of the fiscal year (or other accounting period) covered by the proposal, plan, or other computation. Contracting with small and minority businesses, women's business enterprises, and labor surplus area firms. (a) The non -Federal entity must take all necessary affirmative steps to assure that minority businesses, women's business enterprises, and labor surplus area firms are used when possible. (b) Affirmative steps must include: None (1) Placing qualified small and minority businesses and women's business 2 CFR 200.321 enterprises on solicitation lists; (2) Assuring that small and minority businesses, and women's business enterprises are solicited whenever they are potential sources; (3) Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses, and women's business enterprises; (4) Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's business enterprises; (5) Using the services and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce; and (6) Requiring the prime contractor, if subcontracts are to be let, to take the affirmative steps listed in paragraphs 1 through 5 of this section. Verification No Boycott Israel. As required by Chapter 2270, Government Code, CONTRACTOR hereby verifies that it does not boycott Israel and will not boycott Israel through the term of this Agreement. For purposes of this verification, "boycott Israel" Texas None means refusing to deal with, terminating business activities with, or otherwise taking Government any action that is intended to penalize, inflict economic harm on, or limit commercial Code 2270.002 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. Foreign Terrorist Organizations. Pursuant to Chapter 2252, Texas Government Code, [Company) represents and certifies that, at the time of execution of this Agreement neither [Company], nor any wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of the same (i) engages in business with Iran, Sudan, or Texas None any foreign terrorist organization as described in Chapters 806 or 807 of the Texas Government Government Code, or Subchapter F of Chapter 2252 of the Texas Government Code, Code 2252.152 or (11) is a company listed by the Texas Comptroller of Public Accounts under Sections 806.051, 807.051, or 2252.153 of the Texas Government Code. The term "foreign terrorist organization" in this paragraph has the meaning assigned to such term in Section 2252.151 of the Texas Government Code. Option Contract Language for contracts The contract award is contingent upon the receipt of CDBG-DR funds. If no such Optional awarded prior to funds are awarded, the contract shall terminate. Grant Award EO Clause for Construction Contracts > $10K including administration & engineering contracts associated with construction contracts Equal Employment Opportunity. Except as otherwise provided under4l CFR Part 60, all contracts that meet the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, 41 CFR §60- >$10,000 "Equal Employment Opportunity" (30 FIR 12319, 12935, 3 CFR Part, 1964-1965 1.4(b) and Comp., p. 339), as amended by Executive Order 11375, "Amending Executive 2 CFR 200 Order 11246 Relating to Equal Employment Opportunity," and implementing APPENDIX II (C) regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor." 41 CFR 60-1.4 Equal opportunity clause. (b) Federally assisted construction contracts. (1) Except as otherwise provided, each administering agency shall require the inclusion of the following language as a condition of any grant, contract, loan, insurance, or guarantee involving federally assisted construction which is not exempt from the requirements of the equal opportunity clause: The applicant hereby agrees that it will incorporate or cause to be incorporated into any contract for construction work, or modification thereof, as defined in the regulations of the Secretary of Labor at 41 CFR Chapter 60, which is paid for in whole or in part with funds obtained from the Federal Government or borrowed on the credit of the Federal Government pursuant to a grant, contract, loan, insurance, or guarantee, or undertaken pursuant to any Federal program involving such grant, contract, loan, insurance, or guarantee, the following equal opportunity clause: During the performance of this contract, the contractor agrees as follows: (1) The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender Identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. (2) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. (3) The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. (4) The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. (5) The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. (6) The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (7) In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be canceled, terminated, or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts orfederally assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be Imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. (8) The contractor will include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, that in the event a contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the contractor may request the United States to enter into such litigation to protect the interests of the United States. The applicant further agrees that it will be bound by the above equal opportunity clause with respect to its own employment practices when it participates in federally assisted construction work: Provided, that if the applicant so participating is a State or local government, the above equal opportunity clause is not applicable to any agency, instrumentality or subdivision of such government which does not participate in work on or under the contract. The applicant agrees that it will assist and cooperate actively with the administering agency and the Secretary of Labor in obtaining the compliance of _contractors and subcontractors with the equal opportunity clause and the rules, regulations, and relevant orders of the Secretary of Labor, that it will furnish the administering agency and the Secretary of Labor such information as they may require for the supervision of such compliance, and that it will otherwise assist the administering agency in the discharge of the agency's primary responsibility for securing compliance. The applicant further agrees that it will refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965, with a contractor debarred from, or who has not demonstrated eligibility for, Government contracts and federally assisted construction contracts pursuant to the Executive Order and will carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by the administering agency or the Secretary of Labor pursuant to Part ll, Subpart D of the Executive Order. In addition, the applicant agrees that if it falls or refuses to comply with these undertakings, the administering agency may take any or all of the following actions: Cancel, terminate, or suspend in whole or in part this grant (contract, loan, insurance, guarantee); refrain from extending any further assistance to the applicant under the program with respect to which the failure or refund occurred until satisfactory assurance of future compliance has been received from such applicant; and refer the case to the Department of Justice for appropriate legal proceedings. (c) Subcontracts. Each nonexempt prime contractor or subcontractor shall include the equal opportunity clause in each of its nonexempt subcontracts. (d) Inclusion of the equal opportunity clause by reference. The equal opportunity clause may be included by reference in all Government contracts and subcontracts, including Government bills of lading, transportation requests, contracts for deposit of Government funds, and contracts for issuing and paying U.S. savings bonds and notes, and such other contracts and subcontracts as the Director of OFCCP may designate. (a) Incorporation by operation of the order. By operation of the order, the equal opportunity clause shall be considered to be a part of every contract and subcontract required by the order and the regulations in this part to include such a clause whether or not it is physically incorporated in such contracts and whether or not the contract between the agency and the contractor is written. (f) Adaptation of language. Such necessary changes in language may be made in the equal opportunity clause as shall be appropriate to identify properly the parties and their undertakings. THRESHOLD PROVISION CITATION Compliance with the Davis -Bacon Act (40 U.S.C. 3141 at seq.) as supplemented by Department of Labor regulations (29 CFR part 5) and with the Copeland 'Anti-Kickback"Act (18 U.S.C. 874; 40 U.S.C. 3145) as supplemented in Department of Labor regulations (29 CFR part 3): Davis -Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non -Federal entities must include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing >$2,000 wages specified in a wage determination made by the Secretary of Labor. In 2 CFR 200 addition, contractors must be required to pay wages not less than once a week. APPENDIX II (D) The non -Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non -Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic >$100,000 and laborer on the basis of a standard work week of 40 hours. Work in excess of 2 CFR 200 the standard work week is permissible provided that the worker is compensated APPENDIX II (E) at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. Clean Air Act (42 U.S.C. 7401-7671 q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended —Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non -Federal >$150,000 award to agree to comply with all applicable standards, orders or regulations 2 CFR 200 issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal APPENDIX II (G) Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid 2 CFR 200 for an award exceeding $100,000 must file the required certification. Each tier APPENDIX II (I) >$100,000 certifies to the tier above that it will not and has not used Federal appropriated and funds to pay any person or organization for influencing or attempting to influence 24 CFR an officer or employee of any agency, a member of Congress, officer or 570.303 employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier uD to the non -Federal award. contracts the Section 3 clause): to as A. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701 u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD -assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR part 136, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training >$100,000 positions, the qualifications for each; and the name and location of the person(s) 24 CFR §135.38 taking applications for each of the positions; and the anticipated date the work shall begin. D. The contractor agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR part 135. E. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR part 135. F. Noncompliance with HUD's regulations in 24 CFR part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. G. With respect to work performed in connection with Section 3 covered Indian housing assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (1) preference and opportunities for training and employment shall be given to Indians, and (it) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of Section 3 and section 7(b) agree to comply with Section 3 to the maximum extent feasible, but not In derogation of compliance with section 7(b). A non -Federal entity that is a state agency or agency of a political subdivision of a state and its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the 2 CFR 200 item exceeds $10,000 or the value of the quantity acquired during the preceding APPENDIX II (J) fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. 78 FR 78608, Dec. 26, 2013, as amended at 79 FR 75885, Dec. 19, 2014 Mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued In compliance with the 42 U.S.C. 6201 Energy Policy and Conservation Act. Engineering, Architectural, and Surveying Rating Sheet How RFQ will be rated Engineer/Architect/Surveyor Rating Sheet RFQ 2021.04 Boggy Bayou Nature Park Improvements, Phase 1 CMP Cycle 25 Grant, GLO Contract No. 21-060-013-C673 Name of Respondent Date of Rating Evaluator's Name Experience -- Rate the respondent for experience in the following areas: Comments Factor Max. Pis. Score 1. Has previously designed shoreline and park infrastructure type of projects 20 2. Has worked on similar construction projects 15 3. Has worked on projects that were located in this general region. Note: Location for A/E (Architect/Engineer) may be a selection criterion provided its application leaves an appropriate number of qualified firms, given the nature and size of the project, to compete for the contract. 2 CFR 200.319(b) 10 4. Extent of experience in proiect construction manaqement 15 Subtotal, Experience - EnterBelow 60 Work Performance Factor Max. Pts. Score 1. Past projects completed on schedule 10 2. Manages projects within budgetary constraints 5 3. Work references 10 Subtotal, Performance - Enter Below 25 NOTE: Information necessary to assess the respondent on these criteria may be gathered from past experience with the respondent and/or by contacting past/current clients. Capacity to Perform Factor Max. Pts. Score 1. Staff Level / Experience of Staff 5 2. Adequacy of Resources 5 3. Professional liability insurance is in force 5 Subtotal, Capacity to Perform-EnterBelow 15 TOTAL SCORE FROM EACH ABOVE CATEGORY Factor Max. Pts. Score ❑ Experience 60 ❑ Work Performance 25 ❑ Capacity to Perform 15 TOTAL SCORE 100 #21 Gary D. Reese County Commissioner County of Calhoun Precinct 4 February 24, 2021 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 March 3, 2021. • Consider and take necessary action to appoint a committee to rate RFQ 2021.04 that will be received on Tuesday, March 30, 2021 for Professional Engineering, Architectural, and Surveying Services for the CMP Cycle 25 Grant, GLO Contract No. 21-060-013-C673 for Boggy Bayou Nature Park Improvements, Phase 1. o Committee Members: Gary Reese, Commissioner Pct 4 Richard H Meyer, County Judge Cindy Mueller, County Auditor Peggy Hall, Assistant Auditor. j`Sincerely, /V'?p`,_ Gary D. Reese GDR/at P.O. Box 177 — Seadrift, Texas 77983 — email: 2arv.reeseAcalhouncotx.ore — (361) 785-3141 — Fax (361) 785-5602 # Zz Mae Belle Cassel From: candice villarreal <candice.villarreal@calhouncotx.org> Sent: Wednesday, February 24, 2021 12:09 PM To: maebelle.cassel@calhouncotx.org; Richard H. Meyer; David Hall; vern lyssy; Gary Reese; joel.behrens@calhouncotx.org; cindy mueller Subject: Agenda Item - VFIS Insurance Proceeds for EMS Ambulance Attachments: VFIS Claim Ck 021221.pdf; PL VFD VFIS Claim Letter.rtf MaeBelle, Please add the following agenda item for Commissioners Court on March 3, 2021. • Consider and take necessary action an insurance proceeds check received from VFIS in the amount of $2,408.19 for an EMS Ambulance Accident on February 1, 2021. Thank you, Candice Viffarreaf 19AssistantAuditor Caniioun County Auditors Office 202 S. Ann Street, Suite B Tort Lavaca, ZY77979 (Phone (361)SS3-4612 Calhoun County Texas 11100000094 4 Se,; VFIS Claims Managementlift �� F ' 183 Leader Heights Road I P.O. Box 5126 I York, PA 17405 7.17.741.0911 1 800.233,1957 1 f: 7177477051 1 CA License #2D89880 and #OD89880 S@ A DOA=n nl elatfnllm Inmi.m:n Vrcwp February 24, 2021 Dustin Jenkins Calhoun County 202 S Ann Street, Suite B Port Lavaca, TX 77979 Emailed to: dustin.jenkins ci;calhouncotx.ore RE: Insured: Calhoun County Policy Number: VFNUCM0002360-01 Claim Number: TXCM21020064 Date of Loss: 02/01/2021 Description: 2019 Ford Amb Als / VIN: 1FDBW2XM6KKB26717 Dear Mr. Jenkins: VFIS Claims Management, Inc. is handling this matter on behalf of National Union and its Affiliated Companies. Enclosed you will find a check, in the amount of $2,408.19. This represents the repair costs shown on the enclosed appraisal prepared by Port Lavaca Auto, less the $1,000.00 deductible. If your repair facility cannot complete the work for the amount of the appraisal and/or additional damage is discovered and you wish to present a supplemental claim, you or your representative must contact me prior to authorizing additional repairs or repair costs. Upon notification, it may be necessary for us to inspect the damage. When your vehicle is taken to the shop for repair, please request that the shop help preserve your rights under the insurance policy by advising you immediately if they are unable to complete the repairs as quoted. For your convenience, an extra copy of this letter is enclosed and may be given to your repairer. We are happy to have been of service. Please feel free to contact me if you have any questions at the toll free number above. Sincerely, 0-1 L-4--e - Vang Her Sr. Claims Representative Extension: 8059 Email: claims2glatfelters.com c: VFIS of TX # 23 Mae Belle Cassel From: candice villarreal <candice.villarreal@calhouncotx.org> Sent: Wednesday, February 24, 2021 12:09 PM To: maebelle.cassel@calhouncotx.org; Richard H. Meyer; David Hall; vern lyssy; Gary Reese; joel.behrens@calhouncotx.org; cindy mueller Subject: Agenda Item - VFIS Insurance Proceeds for PLFD Fire Truck - 2nd Truck Attachments: VFIS Claim Ck 020821.pdf, Supplemental PL VFD VFIS Claim Letter.pdf MaeBelle, Please add the following agenda item for Commissioners Court on March 3, 2021. Consider and take necessary action on the second insurance proceeds check received from VFIS in the amount of $3,139.46 for the Port Lavaca Volunteer Fire Truck for repairs from the December 8, 2020 tire blow-out. If this looks familiar to anyone, I had to ask MaeBelle to disregard the previous email request from earlier this week — There are two VFIS checks for two separate items. Candice Viffarreaf 1" Assistant Auditor Calhoun County Auditors Office 202 S. Ann Street, Suite B (Port Lavaca, V 77979 Thone (361)553-4612 Calhoun County Texas 1110000009 264'IN, VFIS Claims Management'1'1► F ' t83 L�acler Heights Road P.O. Box 5126 I York, PA 17405 717741.0911 1 800.233.1957 1 f:717.747.70a1 1 CALicense.?2D89880and,&OD89880 � S. k Di ..... ul C101,lfr.,, Im;urmm i3mxip February 8, 2021 Chief Joe Reyes Calhoun County 1501 W Austin Street Port Lavaca, TX 77979 RE: Insured: Calhoun County Policy Number: VFNUCM0002360-00 Claim Number: TXCM20120414 Date of Loss: 12/08/2020 Description: 2000 Intl Pumper / VIN: 1HTSDADR4YH225307 Dear Chief Reyes: VFIS Claims Management, Inc. is handling this matter on behalf of National Union and its Affiliated Companies. Payment was issued to Calhoun County in the amount of $3,139.46. This represents the supplemental repair costs shown on the enclosed appraisal prepared by Palladin Claims Service. If your repair facility cannot complete the work for the amount of this appraisal and/or additional damage is discovered and you wish to present a supplemental claim, you or your representative must contact Appraiser Brett Robbins at 936-443-1442 prior to authorizing additional repairs or repair costs. If you are unable to reach the Appraiser, please contact me at the toll -free number shown above. Please request that the shop help preserve your rights under the insurance policy by advising you immediately if they are unable to complete the repairs as quoted on the original appraisal. We are happy to have been of service. Please feel free to contact me if you have any questions at the toll -free number above. Sincerely, �i6V Timothy Donohue Auto Claims Specialist Extension: 7608 Email: claims@glatfelters.com c: VFIS of Texas ibtlabin Ciaimo 6erbice, 3ne. ESTIMATE OF DAMAGES 172UCI,-/TRACTOR/TRAD ER/HEAFI' EOUIPMEN] Company: Policy Nwu6er: Clahn Number: PCS FlleNumber: Date; Glatfelter Claims Management, Inc. Not Given TXCIV120120414 2974 12/15/2020 Insured: Claimant: Address: Phone: Calhoun County N/A 800 N. Hwy. 35 Poll Lavaca, TX 77979 361-676-0210 Year: Date of Mfg: Make: Model: Style: VLN / Serial Number: 2000 07/99 Anternati 4900 Pum er IIITSDADR4YII225307 Date of Loss: State: / License: Mileage: Condition: Date of Inspection: 12/08/2020 Tx / 122 2016 73,167 Average 12/14/2020 Location of Ins ection: Insured Location I Adjuster: Brett Robbins I Adjuster License: 1394433 REP LACE RE- PAIR DETAILS OF REPAIRS AND/OR REPLACENIENTS LABOR 14OURS Price Sublet --$UPPJ4EMCNT- x Front Bumper (Price Difference) -0- 532.47 x Front Bumper Bracket (Price Diflerence) -0- 136.03 x Headlam R/S (Price Difference) -0-1 52.30 x Headlamp Adjusting Screw & Nut R/S Additional Part 0.5 26.66 x Headlamp Bezel R/S (Price Difference) -0- 10.00 x Turn Signal R/S (Price Difference) -0- 16.54 x Fender Splash Shield R/S (Price Difference) -0- 110.24 x Fender Extension R/S (Price Difference) -0- 111.35 x Front NN beel Simulator R/S (Additional Part) ml.5 793.52 x Scribe Front Wheel WS & Report (Additional Labor) I111.0 ---0--- x Front Wheel IIub Cover, Gasket, & Splash Shield (Additional Part) mt.5 43.83 x Repack Wheel Hub (Additional Labor) m2.0 ---0--- x Scene Light & Bracket R/S (Additional Part) 1.0 151.52 x Repair Scene Light Wiring (Additional Labor) 2.0 25.00 TOTALS 9.5 2,009.46 Undersignedfirm agrees to complete and Guarantee repairs for: S 3,139.46 Of the amount above the owner is to pay: Depreciation: S 0.00 Deductible: Conipam•Net: S 3,139.46 Appraiser: Brett Robbins Date: 02/0512021. Adjuster/Appraiser License: 1394433 Firiu Name: French Ellison By: James Gonzalez Date: 02/05/2021 Body Labor: 3.0 IIRS @ $ 95,01) $ 285.00 Mech Labor: 6.5 IIRS Lal S 130.00 $ 845.00 Parts Cost: $ 2,009.46 Less Discount: 0% $ 0.00 Equal Net Parts Cost: $ 2,009.46 Sublet Items: $ 0.00 Tax: 8.25 % On: TA%EXLMPT S 0.00 Towing: $ 0.00 Grand Total: $ 3,139.46 "NO SUPPLEMENT WITH OUT PRIOR APPROVAL" A-51- IZAT FOFORREPAIRS MI7iST 8E:%SECVR0 FRQlt%I O"WNEI Page l of l PDR/ 11-1.01 /RE V.. 12-05-01 # 24 r� k ) m )a =z §� ■z =§ M )JL _ )§ k § K g 5 ;z .§ ;■ ;« ;z , z a t � 2 �§aaa2$ � §§aaa2$ � §§aaa2$ § zzz(2- »»»C)»2 0 0 0 0 0 0 222222 ■,,,,mm §moms$@ ■,2,_wo, §\!)))d / � ei Z W z � _ W W v a z F 3 H Z e O W o Z W F Q LU C Z 19 {y (G W I NO m 64 z z 9 9 z z w i U Q z w I co w� of w gC wN �i f9� 8Cp.1i. C a Q O o e m Z z z z C z2 zz M Q Z m m I O mm a Z w a o C 0 K W U U ¢-W EL ? b H o D J N K Q w J U f Q LL W 2 O W g s _ o 4 n w O m a k k k i ui § z i LU , m 2 2 uj q § B g 2 2 � 0 z a 2 z k o z L §: . t � � 2 & 0 � 19 t Z � § ■ :0 & 2 ■ \\a I§§ e � \ §§\�§ §§--- - §§a2■ _ § zz \\ mom 0 10 ■�! §d z § ' ) ' § , .q ■ 0 R iz LouS § �LU « « �z B : © _ LU $ § § ) § ■ )Lu c § § §� % B 16 ƒ 0 LU \ ii k # 25 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---March 03, 2021 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $: 903,363;69 TOTAL TRANSFERS BETWEEN FUNDS $ TOTAL NURSING HOME UPL EXPENSES $ 1 728,199A-7 TOTAL INTER -GOVERNMENT TRANSFERS $ GRAND TOTAL DISBURSEMENTS APPROVED March 03 , 2021 $ 2,631,663.1& f MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---March 03,2021 PAYABLES AND PAYROLL 2/25/2021 Weekly Payables 2/25/2021 Patient Refunds 3/1/2021 McKesson-340B Prescription Expense 3/1/2021 Payroll Liabilities -Payroll Taxes 3/1/2021 Payroll Prosperity Electronic Bank Payments 2122-2/26121 Pay Plus -Patient Claims Processing Fee TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDSi NURSING HOME UPL EXPENSES 3/1/2021 Nursing Home UPL-Cantex Transfer 3/1/2021 Nursing Home UPL-Nexion Transfer 3/1/2021 Nursing Home UPL-HMG Transfer 3/1/2021 Nursing Home UPL-Tuscany Transfer 3/1/2021 Nursing Home UPL-HSL Transfer QIPP/INTEREST/RECOUP CHECKS TO MMC 3/1/2021 Ashford 3/1/2021 Broadmoor 3/1/2021 Crescent 3/1/2021 Fort Bend 3/1/2021 Solera 3/1/2021 Golden Creek 3/1/2021 Gulf Pointe 3/1/2021 Tuscany TOTAL NURSING HOME UPL EXPENSES'. TOTAL INTER -GOVERNMENT TRANSFERS 515,634.45 1,384.59 3,582.37 92,103.16 289,486.86 1,172.26 $ 903,363.69 990,828.47 47,370.63 160,660.57 170,830.68 123,987.67 58,070.30 24,034.38 19,320.86 23.523.53 22,762.97 40,569.03 23,985.99 22,254.39 $ 1728,199.47 GRANDTOTAL DISBURSEMENTS APPROVED March 03, 2021 $ 2,.631,563.16: r 2/25Gs'021 tmp_cw5report5432210460738182140.htm1 1 11 .1-1-_-r• MEMORIAL MEDICAL CENTER 13:08 "('r t AP Open Invoice List Y`/,+,,� �7{ "^ ap_open_invoice.template <� T0GDue Dates Through: 03/18/2021 eClass Vendo1123 ,�LSsiSefrtlie=ZIJp, Pay Code 3WONr LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2467 ✓ 02/24/2021 02/01/2021 03/01/2021 597.00 0.00 0.00 597.00 ..•' CREDENTIALING Vendor Totals: Number Name Gross Discount No -Pay Net 11237 3WON, LLC 597.00 0.00 0.00 597.00 Vendor# Vendor Name class Pay Code At 680 AIRGAS USA, LLC - CENTRAL DIV M r Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9109318795�02/23/2021 01/25/2021 02/19/2021 230.57 0.00 0.00 230.57v-' OXYGEN 9109438960.02/23/2021 01/29/2021 02/23/2021 2,849.07 0.00 0.00 2,849.07 1/ OXYGEN 9977228292�02/23/2021 01/31/2021 02/25/2021 41.63 0.00 0.00 41.63 f OXYGEN 9977228291.42/23/2021 01/31/2021 02/25/2021 669.88 0.00 0.00 669.88 OXYGEN 9977228290,02123/2021 01/31/2021 02/25/2021 495.91 0.00 0.00 495.91 f // OXYGEN / 9109502750�A2/23/2021 01/31/2021 02/25/2021 2,248.76 0.00 0.00 2,248,76 ✓ OXYGEN 9109720511 r02/23/2021 02/05/2021 03/02/2021 545.08 0.00 0.00 546.08 OXYGEN Vendor Totals: Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC - 7,080.90 0.00 0.00 7.080.90 Vendor# Vendor Name Class Pay Code A1705 ALIMED INC. v� M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net RPSV03513-,02/23/2021 01/29/2021 02/13/2021 60.34 0.00 0.00 60.34�� 15y SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net A1705 ALIMED INC. 60.34 0.00 0.00 60.34 Vendor# Vendor Name Class Pay Code B1220 BECKMAN COULTER INC ✓ M Invoice# Co ment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1088829452124/2021 02/03/2021 02/28/2021 833.60 0.00 0.00 833.60 ,f SUPPLIES / 5436158 v/02/24/2021 02/05/2021 03/02/2021 6,249.42 0.00 0.00 6,249.42 ✓ MAINT CONTRACT LEASE 5436450 V/ 02/24/2021 02/13/2021 03/10/2021 5.016.58 0.00 0.00 5,016.58 // MAINT CONTRACT/LEASE 108902377 v02/24/2021 02/15/2021 03/12/2021 11288,45 0.00 0.00 1,288.45 v� MAINT CONTRACT LEASE Vendor Totals: Number Name Gross Discount No -Pay Net B1220 BECKMAN COULTE 13.388.05 0.00 0.00 13,388.05 Vendor# Vendor Name Class Pay Code 12600 BIOFIRE DIAGNOSTICS LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1280090361/02124/2021 12/22/2020 01/22/2021 20,562.51 0.00 0.00 20,562.51 j SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 12600 BIOFIRE DIAGNOSI 20,562.51 0.00 0.00 20,562.51 Vendor# Vendor Name / Class Pay Code 13740 BLEH HTOO " Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 021221 c2/24/2021 02/12/2021 02/12/2021 100.00 0.00 0.00 100.00 file:///C:/Users/mmekissacWcpsi/memmed.cpsinet.wm/u88150/data_5/tmp_cw5report5432210460738182140.html 1/11 r 2/25/2021 tmp_cw5report5432210460738182140.html Vendor Totals: Number Name Gross Discount No -Pay Net 13740 BLEH HTOO 100.00 0.00 0.00 100.00 Vendor# Vendor Name Class Pay Code 12324 BLUE CROSS BLUE SHIELD v/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 021521 02/24/2021 02/15/2021 03/01/2021 202,119.82 0.00 0.00 / 202,119.82 r/ INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 12324 BLUE CROSS BLUE 202,119.82 0.00 0.00 202,119.82 Vendor# Vendor Name Class Pay Code C1325 CARDINAL HEALTH 414, INC. W V/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8002440065 aW24/2021 01/23/2021 02/17/2021 147.76 0.00 0.00 147.76 � SUPPLIES 8002445756 O'24/2021 01/31/2021 02/25/2021 320.74 0.00 0.00 320.74 j SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C1325 CARDINAL HEALTH 468.50 0.00 0.00 468.50 Vendor# Vendor Name Class Pay Code 13760 CIGNA Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 3969406 02/24/2021 02/16/2021 02/16/2021 216.30 0.00 0.00 216.30 ./ Vendor Totals: Number Name Gross Discount No -Pay Net 13760 CIGNA 216.30 0.00 0.00 216.30 Vendor# Vendor Name Class Pay Code C2157 COOPER SURGICAL INC M Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 5714986 �// 02/18/2021 01/05/2021 01/04/2021 338.91 0.00 0.00 338.91 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C2157 COOPER SURGICA 338.91 0.00 0.00 338.91 Vendor# Vendor Name / Class Pay Code 11366 CYRACOM LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1274747./01/31/2021 01/31/2021 03/17/2021 267.11 0.00 0.00 267.11 j INTERPERTATION SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 11368 CYRACOM LLC 267.11 0.00 0.00 267.11 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 6334980 �/02/24/2021 02/04/2021 03/01/2021 120.74 0.00 0.00 120.74 SUPPLIES 6334981 1/02/24/2021 02/08/2021 03/05/2021 51.57 0.00 0.00 51.57v/ SUPPLIES 6339810✓02/24/2021 02/09/2021 03/06/2021 36.18 0.00 0.00 36.181/ SUPPLIES 6339240./ 02/24/2021 02/11/2021 03/08/2021 30.65 0.00 0.00 30.65 ✓ / SUPPLIES / 6342620 �02/24/2021 02/11/2021 03/08/2021 151.50 0.00 0.00 151.50 i� SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SC 390.64 0.00 0.00 390.64 Vendor# Vendor Name Class Pay Code 11011 DIAMOND HEALTHCARE CORP Invoice# Comnnent Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net IN20054384,A2/23/2021 02/01/2021 02/26/2021 19,166.67 0.00 0.00 19,166.67,,-' CPR IN20054383 ,02/23/2021 02/01/2021 02/26/2021 31,144,58 0.00 0.00 31,144.58 ✓/ file:MC:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5432210460738182140.html 2111 r 2/25/2,b21 tmp_cw5report5432210460738182140.html BEV HEALTH Vendor Totals: Number Name Gross Discount No -Pay Net 11011 DIAMOND HEALTH( 50,311.25 0.00 0.00 50,311.25 Vendor# Vendor Name Class Pay Code 11201 DOROTHY LONGORIA „/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 022321E 02/24/2021 02/23/2021 02/23/2021 23.90 0.00 0.00 23.90 ✓ ICE 022321A 02/24/2021 02/23/2021 02/23/2021 7.51 0.00 0.00 7.51� ICE 022321 02/24/2021 02/23/2021 02/23/2021 10.36 0.00 0.00 10.36 REIMBURSE ITEMS PURCHASED Vendor Totals: Number Name Gross Discount No -Pay Net 11201 DOROTHY LONGOF 41.77 0.00 0.00 41.77 Vendor# Vendor Name Class Pay Code 10175 DSHS CENTRAL LAB MC2004 „/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net CN0426012002/2312021 02/02/2021 02/27/2021 605.80 0.00 0.00 605.80 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10175 DSHS CENTRAL LA 605,80 0.00 0.00 605.80 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 981541 02/23/2021 01/26/2021 02/20/2021 474.96 0.00 0.00 474.96 SUPPLIES A210203137Jy02/23/2021 02/03/2021 02/28/2021 17.333.00 0.00 0.00 17,333.00 SUPPORT Vendor Totals: Number Name Gross Discount No -Pay Net C2510 EVIDENT 17,807.96 0.00 0.00 17,807.96 Vendor# Vendor Name Class Pay Code F1050 FASTENALCOMPANY M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net TXPOT2333f02/23/2021 02/01/2021 03/03/2021 3.30 0.00 0.00 3.30 ✓ V4 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net F1060 FASTENAL COMPAI 3.30 0.00 0.00 3.30 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9910286 /02/24/2021 01/18/2021 02/12/2021 719.15 0.00 0.00 719.15 SUPPLIES 0219909./02/24/2021 01/19/2021 02/13/2021 250.57 0.00 0.00 250.57r,Z SUPPLIES 0219910 ✓02/24/2021 01/19/2021 02/13/2021 1,353.07 0.00 0.00 1,353.07 SUPPLIES 1210535 ✓02/24/2021 01/22/2021 02/16/2021 732.01 0.00 0.00 732.01 SUPPLIES 1210534✓ 02/24/2021 01/22/2021 02/16/2021 270.88 0.00 0.00 270.88 SUPPLIES 1756614,.E 02/24/2021 01/26/2021 02/20/2021 28,145.50 0.00 0.00 28,145.50 SUPPLIES 1756622,/ 02/24/2021 01/26/2021 02/20/2021 4,711.38, 0.00 0.00 4,711.34/ / SUPPLIES 2092564 ✓ 02/24/2021 01/29/2021 02/23/2021 191.44 0.00 0.00 191.44 SUPPLIES / 2170473 ,/ 02t24/2021 02/01/2021 02/26/2021 9,960.51 0.00 0.00 9,960.51 ,/ SUPPLIES 2317168 ✓02/24/2021 02/04/2021 03/01/2021 109.36 0.00 0.00 109.36 r/ SUPPLIES 2386803 ✓02/24/2021 02/04/2021 03/01/2021 201.34 0.00 0.00 201.34 file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88l50/data_5/tmp_cw5report5432210460738182140.html 3111 r 2/25/2b21 tmp_cw5report5432210460738182140.html SUPPLIES 2386806r,/ 02/24/2021 02/04/2021 03/01/2021 162.22 0.00 0.00 162.22 / SUPPLIES 2317167 ✓ 02/24/2021 02/04/2021 03/01/2021 491.95 0.00 0.00 491.95 +/ SUPPLIES 2499744 ✓02/24/2021 02/05/2021 03/02/2021 184.75 0.00 0.00 184.75 SUPPLIES 2009113 ✓02/25/2021 01/28/2021 02/22/2021 94.28 0.00 0.00 94.28 SUPPLIES / 2092562 /02J25/2021 01/29/2021 02/23/2021 ✓✓✓ 75.92 0.00 0.00 75,92 SUPPLIES 2170468/ 02/25/2021 02/01/2021 02/26/2021 4,995.04 0.00 0.00 4,995.04 SUPPLEIS � 2241024 r/02/25/2021 02/02/2021 02/27/2021 9,360.00 0.00 0.00 9,360.00 SUPPLIES / 2241026 02/25/2021 02/02/2021 02/27/2021 ✓ 15.04 0.00 0.00 15.04 SUPPLIES 2317166/02125/2021 02/03/2021 02/28/2021 8.83 0.00 0.00 8.83 SUPPLIES ✓ / 2317165 02/25/2021 02/04/2021 03/01/2021 ✓ 7,687.79 0.00 0.00 7,687.79 g t. jgjyj SUPPLIES 41440 02/25/2021 02/05/2021 03/02/2021 18,720.00 0.00 0.00 18,720.00✓- SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCA 88,441.03 0.00 0.00 88,441.03 Vendor# Vendor Name Class Pay Code 11183 FRONTIER Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 020221 02/23/2021 02/02/2021 02/26/2021 1,176.84 0.00 0.00 1,176.84 PHONES Vendor Totals: Number Name Gross Discount No -Pay Net 11183 FRONTIER ✓ 1,176.84 0.00 0.00 1,176.84 Vendor# Vendor Name Class Pay Code 12404 GE PRECISION HEALTHCARE, LLC ,,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 6001767784.A2/23/2021 02/01/2021 03/01/2021 572.33 0.00 0.00 572.33 MAINT CONTRACT Vendor Totals: Number Name Gross Discount No -Pay Net 12404 GE PRECISION HEF 572.33 0.00 0.00 572.33 Vendor# Vendor Name Class Pay Code w1300 GRAINGER M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9788747849 �Q2 23/2021 01/28/2021 02/22/2021 302.40 0.00 0.00 302.40 SUPPLIES 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Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2002386 ✓02/19/2021 02/10/2021 03/12/2021 727.01 0.00 0.00 727.01 ✓ SUPPLIES 2000774 V/02/24/2021 02/08/2021 03/10/2021 87.80 0.00 0.00 87.80 SUPPLIES 1982290 /62/25/2021 12/29/2020 01/28/2021 116.40 0.00 0.00 116.40 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPE 931.21 0.00 0.00 931.21 Vendor# Vendor Name Class Pay Code 12380 HEALTH SOLUTIONS DIETETICS Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 013021 02/25/2021 01/30/2021 01/30/2021 3,000.00 0.00 0.00 3,000.00 % DIETICIAN Vendor Totals: Number Name Gross Discount No -Pay Net 12380 HEALTH SOLUTION 3,000.00 0.00 0.00 3.000.00 Vendor# Vendor Name Class Pay Code 11552 HEALTHCARE FINANCIAL SERVICI Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 100424790 624/2021 02/01/2021 03/01/2021 7,447.86 0.00 0.00 7,447.86 LEASE 100424791 Oi/24/2021 02/01/2021 03/01/2021 1,797.44 0.00 0.00 1,797.44 LEASE 100424789�02/24/2021 02/01/2021 03/01/2021 7,154.17 0.00 0.00 7,154.17 � LEASE 100424788 O�P/24/2021 02/01/2021 03/01/2021 4,919.41 0.00 0.00 4,919.41 LEASE Vendor Totals: Number Name Gross Discount No -Pay Net 11552 HEALTHCARE FINA 21,318.88 0.00 0.00 21,318.88 Vendor# Vendor Name Class Pay Code 12932 INTRADO / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INV002325 , IY2/4/2021 01/31/2021 02/28/2021 576.20 0.00 0.00 576.20 / HOUSE CALLS Vendor Totals: Number Name Gross Discount No -Pay Net 12932 INTRADO 576.20 0.00 0.00 576.20 Vendor# Vendor Name Class Pay Code 13768 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 020521 02/25/2021 02/05/2021 02/05/2021 460.74 0.00 0.00 460.74� PATIENT REFUND Vendor Totals: Number Name Gross Discount No -Pay Net 13768 460.74 0.00 0.00 460.74 Vendor# Vendor Name Class Pay Code L1640 LOWE'S HOME CENTERS INC W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 09305 02/25/2021 01/14/2021 02/28/2021 24.61 0.00 0.00 24.61 t/ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net L1640 LOWE'S HOME CEN 24.61 0.00 0.00 24,61 Vendor# Vendor Name Class Pay Code 13764 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 021221 02/25/2021 02/12/2021 02/12/2021 147.10 0.00 0.00 147.10 PATIENT REFUND Vendor Totals: Number Name Gross Discount No -Pay Net 13764 147.10 0.00 0.00 147.10 Vendor# Vendor Name Class Pay Code M2178 MCKESSON MEDICAL SURGICAL I Invoice# Comment Tran Dt Inv Dt Due Dt CFt-eck Dt Pay Gross Discount No -Pay Net file:///C:/Users/mmckissack/cpsi/memmed.cpsinet.com/uBB150/data_5/tmp_ew5reporL5432210460738182140.html 5/11 r 2/25/2b21 tmp_cw5report5432210460738182140.html 20440664,�02/23/2021 01/27/2021 02/11/2021 252.36 0.00 0.00 252.36 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2178 MCKESSON MEDIC 252,36 0.00 0.00 252.36 Vendor# Vendor Name Class Pay Code 11203 MEDI-DOSE, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0798055 /02/23/2021 02/05/2021 03/05/2021 108.45 0.00 0.00 108.45 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11203 MEDI-DOSE, INC 108.45 0.00 0.00 108.45 Vendor# Vendor Name Class Pay Code 10613 MEDIMPACT HEALTHCARE SYS, It A/P �� Invoice# Comment Tran Dt Inv Dt Due Dt ChecltDt Pay Gross Discount No -Pay Net 022421 02/24/2021 02/24/2021 02/24/2021 83.96 0.00 0.00 83.96 INDIGENT INVOICE r� 022421A 02/24/2021 02/24/2021 02/24/2021 32.08 0.00 0.00 32.08 INIGENT CARE Vendor Totals: Number Name Gross Discount No -Pay Net 10613 MEDIMPACT HEAL1 116.04 0.00 0.00 116.04 Vendor# Vendor Name Class Pay Code / M2470 MEDLINE INDUSTRIES INC �/ M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1939575477V*25/2021 01/27/2021 02/21/2021 83.96 0.00 0.00 83.96 SUPPLIES 19395754739Z25/2021 01/27/2021 02/21/2021 37.17 0.00 0.00 37.17 ✓ SUPPLIES � 1939575472 Q2/25/2021 01/27/2021 02/21/2021 251.52 0.00 0.00 251.52 SUPPLIES 1939575475 92/25/2021 01/27/2021 02/21/2021 69.67 0.00 0.00 69.67 � SUPPLIES 1939575474tQ2125/2021 01/27/2021 02/21/2021 50.92 0.00 0.00 50.92 � SUPPLIES 1939575476 Q2%25/2021 01/27/2021 02/21/2021 173.96 0.00 0.00 173.96 SUPPLIES 1939674798 0 512021 01/28/2021 02/22/2021 70.66 0.00 0.00 70.66 ' SUPPLIES 1939674799,M25/2021 01/28/2021 02/22/2021 45.55 0.00 0.00 45.55,% SUPPLIES 1939674796 Q2(25/2021 01/28/2021 02/22/2021 85.00 0.00 0.00 85.00 SUPPLIES 1939674794„02/25/2021 01/28/2021 02/22/2021 241.48 0.00 0.00 241.48✓ SUPPLIES 1940291222.02/2512021 02/02/2021 02/27/2021 107.05 0.00 0.00 107.05 .i SUPPLEIS 1940291220 02/25/2021 02/02/2021 02/27/2021 142.38 0.00 0.00 142.38 J SUPPLIES 1940291218 �PJ25/2021 02/02/2021 02/27/2021 17.48 0.00 0.00 17.48 SUPPLIES 1940291219 02/25/2021 02/02/2021 02/27/2021 50.84 0.00 0.00 50.84✓ SUPPLEIS 1940291225 P2�5/2021 02/02/2021 02/27/2021 4,302.76 0.00 0.00 4,302.76 SUPPLIES t� 1940291221 02/25/2021 02/02/2021 02/27/2021 130.80 0.00 0.00 130.80 � SUPPLEIS 1940291215 021 5/2021 02/02/2021 02/27/2021 215.28 0.00 0.00 215.28 SUPPLIES 1940291213 25/2021 02/02/2021 02/27/2021 89.47 0.00 0.00 89.47,,,- SUPPLIES 1940291217 0912512021 02/02/2021 02/27/2021 40.22 0.00 0.00 40.22�' SUPPLIES file:WC:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5432210460738182140.html 6/11 2/25/2b21 tmp_cw5report5432210460738182140.html � 1940291216 02/02/2021 02/27/2021 69.83 0.00 0.00 69.83✓ ,�P25/2021 SUPPLIES 1940561906 YY25/2021 02/04/2021 03/01/2021 95.95 0.00 0.00 95.95 / SUPPLIES 1940561907 0 25/2021 02/04/2021 03/01/2021 149.35 0.00 0.00 149.35_-- SUPPLIES 1940561905 eW25/2021 02/04/2021 03/01/2021 222.49 0.00 0.00 222.49 /,. SUPPLIES t/ Vendor Totals: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTR 6,743.79 0.00 0.00 6,743.79 Vendor# Vendor Name Class Pay Code" 13752 ^ "'- Invoice# Comment Tran Dt Inv ur DGe Dt Check Dt Pay Gross Discount No -Pay Net 021221 02/24/2021 02/12/2021 02/12/2021 171.99 0.00 0.00 171.99 / PATIENT REFUND V Vendor Totals: Number Name Gross Discount No -Pay Net 13752 171.99 0.00 0.00 171.99 Vendor# Vendor Name Class Pay Code M2621 MMC AUXILIARY GIFT SHOP / w Invoice# Comment Tran Dt Inv Dt Due Dt ,/ Check Dt Pay Gross Discount No -Pay Net 021121 02/24/2021 021112021 02/11/2021 361.49 0.00 0.00 361.49 ✓ PAYROLL DED Vendor Totals: Number Name Gross Discount No -Pay Net M2621 MMC AUXILIARY GI 361.49 0.00 0.00 361.49 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 6585465 ✓62/23/2021 02/10/2021 02/20/2021 580.91 0.00 0.00 580.91 / ✓ / INVENTORY 8932 ,/ 02/23/2021 02/11/2021 02/21/2021 -20.00 0.00 0.00 -20.00 ✓ CREDIT 6590402 ✓02/23/2021 02/11/2021 02/21/2021 161.38 0.00 0.00 161.38 / INVENTORY 6589463 ✓ 02/23/2021 02/11/2021 02/21/2021 53.06 0.00 0.00 53.06 INVENTORY 6590404 Z02123/2021 02/11/2021 02/21/2021 457.41 0.00 0.00 457.41 ✓ INVENTORY 6590403 ✓02/23/2021 02/11/2021 02/21/2021 295.67 0.00 0.00 295.67 INVENTORY 6595562/02/23/2021 02/13/2021 02/23/2021 1,400.05 0.00 0.00 1,400.05 �✓ INVENTORY 6595561r/ 02/23/2021 02/13/2021 02/23/2021 1,370.14 0.00 0.00 1.370.14 � INVENTORY 6595560 ✓02/23/2021 02/13/2021 02/23/2021 39.19 0.00 0.00 39.19 / INVENTORY 6601695✓ 02/23/2021 02/16/2021 02/26/2021 384.78 0.00 0.00 384.78 INVENTORY 6601697 2/23/2021 02/16/2021 02/26/2021 66.20 0.00 0.00 66.20 INVENTORY 6601696 02/23/2021 02/16/2021 02/26/2021 153.62 0.00 0.00 153.82 INVENTORY 6604099 02/23/2021 02/17/2021 02/27/2021 16.35 0.00 0.00 16.35 INVENTORY 6603885 02/23/2021 02/17/2021 02/27/2021 70.83 0.00 0.00 70.83 INVENTORY 6603884 02/23/2021 02/17/2021 02/27/2021 36.40 0.00 0.00 36.40 INVENTORY 6604100 ✓ 02/23/2021 02/17/2021 02/27/2021 440.24 0.00 0.00 440.24� / INVENTORY 6605870 1/ 02/23/2021 02/19/2021 03/01/2021 34.65 0.00 0.00 34.65 INVENTORY file:NC:/Users/mmckissack/cpsi/memmed.cpsinet.com/u8B150/data_5ltmp_cw5report5432210460738182140.html 7111 r 2/25/2021 tmp_cw5report5432210460738182140.html 6609445 02/23/2021 02/19/2021 03/01/2021 1,149.77 0.00 0.00 1,149.77 INVENTORY 6605867 02/23/2021 02/19/2021 03/01/2021 39.49 0,00 0.00 39.49 - INVENTORY 6609447 ✓02/23/2021 02/19/2021 03/01/2021 0.95 0.00 0.00 0.95 INVENTORY 6609446 /2/23/2021 02/19/2021 03/01/2021 67.16 0.00 0.00 67.16 INVENTORY 6605868 02/19/2021 03/01/2021 ✓02/23/2021 2,818.19 0.00 0.00 2,818.19 INVENTORY 6609444✓02/23/2021 02/19/2021 03/01/2021 10.61 0.00 0.00 10.6v INVENTORY 6605869 ✓02/23/2021 02/19/2021 03/01/2021 878.30 0.00 0.00 878.30/ INVENTORY 6605865 , '02123/2021 02/19/2021 03/01/2021 174.70 0.00 0.00 174.70 INVENTORY 6605866 ✓02/23/2021 02/19/2021 03/01/2021 140.34 0.00 0.00 140.34✓ INVENTORY 6613961✓02/23/2021 02/21/2021 03/03/2021 866.78 0.00 0.00 866.78 INVENTORY 6613960 ✓02123/2021 02/21/2021 03/03/2021 851.58 0.00 0.00 851.58 INVENTORY / 6579951 ,/ 02/24/2021 02/09/2021 02/19/2021 222.50 0.00 0.00 222.50 INVENTORY 6581032 /02/24/2021 02/09/2021 02/19/2021 1.995.43 0.00 0.00 1,995.43 ✓ INVENTORY 6581031 02/09/2021 02/19/2021 426.64 0.00 0.00 426.64 V//02/24/2021 INVENTORY 6681033 ✓02/24/2021 02/09/2021 02/19/2021 268.29 0.00 0.00 268.29✓ / INVENTORY 6578000 �/ 02/24/2021 02/09/2021 02/19/2021 357.44 0.00 0.00 357.44 11� INVENTORY 6578002 /02/24/2021 02/09/2021 02/19/2021 107.12 0.00 0.00 107.12 f� SUPPLIES 6579802 /02124/2021 02/09/2021 02/19/2021 4,342.50 0.00 0.00 4,342.50 INVENTORY Vendor Totals: Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSOI 20,258.67 0.00 0.00 20,258.67 Vendor# Vendor Name Class Pay Code 13548 NACOGDOCHES TRANSCRIPTION Invoice# omment Tran Dt Inv Dt Due Dt �0212312021 Check Dt Pay Gross Discount No -Pay Net 7297 02/11/2021 02/11/2021 507.92 0.00 0.00 507.92 TRANSCRIPTION Vendor Totals: Number Name Gross Discount No -Pay Net 13548 NACOGDOCHES TF 507.92 0.00 0.00 507.92 Vendor# Vendor Name Class Pay Code 12388 NATIONAL FARM LIFE INSURANCE Invoice# C mment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 336249602/24/2021 02/23/2021 03/01/2021 3,903.25 0.00 0.00 3,903.25 VI INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 12388 NATIONAL FARM LI 3,903.26 0.00 0.00 3,903.25 Vendor# Vendor Name Class Pay Cade 13744 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 021221 02/24/2021 02/12/2021 02/12/2021 125.00 0.00 0.00 125.00 PATIENT REFUND Vendor Totals: Number Name . Gross Discount No -Pay Net 13744 125.00 0.00 0.00 125.00 Vendor# Vendor Name Class Pay Code P0706 PALACIOS BEACON w file:///C:/Users/mmokissackJcpsi/memmed.cpsinet.com/u88150/data 5/tmp_cw5report5432210460738182140.html 8/11 ` 2/25/2b21 tmp_cw5report5432210460738182140.html Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 33057830✓02/23/2021 01/25/2021 02/24/2021 187.50 0.00 0.00 187.50 r/ AD Vendor Totals: Number Name Gross Discount No -Pay Net P0706 PALACIOS BEACON ✓ 187.50 0.00 0.00 187.50 Vendor# Vendor Name Class Pay Code 11155 PARA / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 7317 / 02/25/2021 12/01/2020 12/31/2020 ✓ 950.00 0.00 0.00 950.00 PRICE TRANSPRANCEY QRTLY Vendor Totals: Number Name Gross Discount No -Pay Net 11155 PARA 950.00 0.00 0.00 950.00 Vendor# Vendor Name Class Pay Code S0905 PERFORMANCE HEALTH M Invoice# Co ment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net IN93441136�722/2312021 02/06/2021 03/03/2021 93.66 0.00 0.00 93.66 -/ 40220050 Vendor Totals: Number Name Gross Discount No -Pay Net 50905 PERFORMANCE HE 93.66 0.00 0.00 93.66 Vendor# Vendor Name Class Pay Code P2100 PORT LAVACA WAVE W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 013121 02/23/2021 01/31/2021 02/25/2021 356.00 0.00 0.00 356.00 NEWSAD Vendor Totals: Number Name Gross Discount No -Pay Net P2100 PORT LAVACA WA\ 356.00 0.00 0.00 356.00 Vendor# Vendor Name Class Pay Code 12480 PRO ENERGY PARTNERS LP Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 21010600,/02/24/2021 01/31/2021 02/15/2021 4,289.00 0.00 0.00 4,289.00 ' ✓ GAS Vendor Totals: Number Name Gross Discount No -Pay Net 12480 PRO ENERGY PAR- 4,289,00 0.00 0.00 4,289.00 Vendor# Vendor Name Class Pay Code 10987 REVCYCLE+, INC. / Invoice# Comment Tran Dt Inv Dt✓ Due Dt Check Dt Pay Gross Discount No -Pay Net 43049 02/23/2021 02/05/2021 03/02/2021 1,979.45 0.00 0.00 1,979.45 CODING SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 10987 REVCYCLE+, INC. 1,979.45 0.00 0.00 1,979.45 Vendor# Vendor Name Class Pay Code 10645 REVISTA de VICTORIA,/ Invoice# Comment Tran Dt Inv Di Due Dt Check Dt Pay Gross Discount No -Pay Net 01202115 02/23/2021 01/26/2021 01/26/2021 262.50 0.00 0.00 262.50� AD Vendor Totals: Number Name Gross Discount No -Pay Net 10645 REVISTA de VICTOI 262.50 0.00 0.00 262.50 Vendor# Vendor Name Class Pay Code 11764 ROBERT RODRIQUEZ Invoice# Comment Tran Dt Inv Dt ue Dt Check Dt Pay Gross Discount No -Pay Net 022421 02/24/2021 02/24/2021 02/24/2021 8.95 0.00 0.00 8.95 ICE Vendor Totals: Number Name Gross Discount No -Pay Net 11764 ROBERT RODRIOU 8.95 0.00 0.00 8.95 Vendor# Vendor Name Class Pay Code G0425 ROBERTS, ODEFEY, WITTE & WAL W ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 76 / 02/23/2021 02/03/2021 02/13/2021 572.00 0.00 0.00 572.00 V LEGAL 178 02/23/2021 02/03/2021 02/13/2021 8,313.25 0.00 0.00 8,313.25 LEGAL file:l//C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report5432210460738182140.html 9111 ' 2/25/2'021 tmp_cw5report5432210460738182140.him] 102 02/23/2021 02/03/2021 02/13/2021 360.00 0.00 0.00 360.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G0425 ROBERTS, ODEFEY 9,245.25 0.00 0.00 9,245.25 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 022321 02/24/2021 02/23/2021 03/10/2021 8,923.36 0.00 0.00 8,923.36 ✓ INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 12476 SUN LIFE FINANCIP 8,923.36 0.00 0.00 8,923,36 Vendor# Vendor Name Pay Code T2204 ,C^Ila/ss TEXAS MUTUAL INSURANCE CO V Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1002481878 02/24/2021 02/25/2021 02/27/2021 4,511.00 0.00 0.00 4,511.00 WORKERS COMP Vendor Totals: Number Name Gross Discount No -Pay Net T2204 TEXAS MUTUAL IN,' 4,511.00 0.00 0.00 4,511.00 Vendor# Vendor Name Class Pay Code 10732 THERACOM, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2203164313(02125/2021 11/30/2020 02/28/2021 1,995.10 0.00 0.00 1,995.10 INVENTORY Vendor Totals: Number Name Gross Discount No -Pay Net 10732 THERACOM, LLC 1,995.10 0.00 0.00 1,995.10 Vendor# Vendor Name Class Pay Code 13748 Invoice# Comment Tran Dt Inv Dt " Due Dt Check Dt Pay Gross Discount No -Pay Net 021221 02/24/2021 02/12/2021 02/12/2021 104.93 0.00 0.00 104.93 PATIENT REFUND Vendor Totals: Number Name Gross Discount No -Pay Net 13748 104.93 0.00 0.00 104.93 Vendor# Vendor Name Class Pay Code U1054 UNIFIRST HOLDINGS ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8400354660 Oc%2412021 02/01/2021 02/26/2021 1,765.19 0.00 0.00 1,765.19 LAUNDRY 8400354635,p/24/2021 02/01/2021 02/26/2021 45.15 0.00 0.00 45.15 LAUNDRY 8400354636 fl2/24/2021 02/01/2021 02/26/2021 61.90 0.00 0.00 61.90 LAUNDRY 8400355038 OQA 021 02/04/2021 03/01/2021 1,333.52 0.00 0.00 1,333.52 LAUNDRY 8400355008,02/24/2021 02/04/2021 03/01/2021 144.52 0.00 0.00 144.52 LAUNDRY 8400355009 �4/2021 02/04/2021 03/01/2021 186.38 0.00 0.00 186.38 / ✓ LAUNDRY 8400355026 02(24/2021 02/04/2021 03/01/2021 80,90 0.00 0.00 80.90 LAUNDRY 8400355006 02/24/2021 02/04/2021 03/01/2021 121.55 0.00 0.00 121.55 ✓ / V LAUNDRY 8400355004 02f24/2021 02/04/2021 03/01/2021 23.41 0.00 0.00 23.41 LAUNDRY 8400356289 02(24/2021 02/18/2021 03/15/2021 120.58 0.00 0.00 120.58 j LAUNDRY (/ Vendor Totals: Number Name Gross Discount No -Pay Net U1054 UNIFIRST HOLDING 3,883.10 0.00 0.00 3.883.10 Vendor# Vendor Name / Class Pay Code U2000 US POSTAL SERVICE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 021921 02/24/2021 02/19/2021 02/19/2021 2,200.00 0.00 0.00 2,200.00 file:///C:/Users/mmckissack/cpsitmemmed.cpsinet.comiu88150/data_5llmp_cw5report5432210460738182140.html 10111 ' 2I2512b21 tmp_cw5report5432210460738182140.html POSTAGE Vendor Totals: Number Name Gross Discount No -Pay Net U2000 US POSTAL SERVK 2,200.00 0.00 0.00 2,200.00 R(,pnri Sununar:� Grand Totals: Gross Discount No -Pay Net 515,634.45 0.00 0.00 515,634.45 FES 2 5 2021 file:MC:IUserslmmckissacktcpsitmemmed.cpsinet.comlu8B150/data_51tmp_cw5report5432210460738182140.htm1 11111 Y Y _ 11 � RON DATE: 02/25/21 _, I MEMORIAL MEDICAL CENTER TIME; 13:03 EDIT LIST FOR PATIENT REFUNDS ARID=0001 PATIENT <'[3d7+ rn Y t '_7.ki 7 YYr_w`t77 PAY PAT 04BER ----------------------------------------------------------------------- PAYEE NAME DATE AMOUNT CODE TYPE DESCRIPTION 022521 220.34 2 REFUND FOR /. 022521 30.04 ✓ 3 REFUND FOR 022521 49.25 ✓ 2 REFUND FOR 022521 651.38 ,/ 2 REFUND FOR 022521 35.281/ 2 REFUND FOR 022521 022521 100.00 ✓ 2 REFUND FOR 50.00 2 REFUND FOR 022521 88.97,/ 2 REFUND FOR 022521 159.43 ✓ 5 REFUND FOR ' 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N ee N N Vf p 17 OO N N O M 1O M N N N M M n O M N W m N m Yf O� m M ry V7 tp n O ry 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o c 0 0 0 0 0 0 0 0 o 0 0 o a o$ o 0 o s o 0 0 0 0 0 o c c o o c c o c o 0 0 o c d o d o 0 0 0 o c o c a o o c hO Nm Nm CO1 tCfl Mn P On mO NP ^ NN NO NNNM[pmN0MMN OiOi NN 0 0 N ' t2. tG tv C O n 0 m n n aY VpVp N N m m m .- m m n n N N N O N O O .- A r 0 r n 0 N m N N ep M V) O O V) n n m �' M V t0 Q m. m mmmmmmmmmm �imm�immmm �im �immmm U aCi d 0 0 uNi O O O 0 T d OO< VV p Y M n m m �p �p M O O n 0 0 0 N lON 'mV' m M n n n 0 0 0 0 N N N W 7 Q$$$ n n n rM. p a o n o O v v a o n n n n O M M M M O Ini (n') S M P'l M t+nl m pp p} p yyy �yy O. z M M M M M M M M M M M M M M ti non M M M M 17 M n N N N N N N N N N N N N N N N N N N N N N N N N N N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N N N N N N N N N N N N N N N N N N y�d„md�m6666666666 a+m O O o 0 0 0 0 0 0 0 0 0 0 0 0 d�d6 mm 9mNN N N N N N N N N NN 0 Q OmOiA OmOuS 0 0 0 0 0 0 0 0 0 0 0 0 c d N N N N N N N N N N N N N N N N N N N N N N N N N N E o 0 0 0 0 0 0 0 p o 0 o a o 0 0 0 0 0 0 0 0 0 0 0 0 O N N N N N N N N N N NN NNN N N N V1 YS N fb ri OQ N N t� N N N N N ry ry N N N N N N N N N N O O O O O p O 0 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 0 0 0 cmi I��e�•gim nuninmm�: m N O N W a o 0 0 0 0 0 o p O O O c O O O O c O c G W C c 7 O E CN N O CN G cfl U N � O N m J f0 V M M C � 00 °' a 0 0 0 0 0 CD d a E m z c a E �m 2 {BYi°3P3°! Q H E E= E 5 5 5== 5 E Z W v O � and mmm�imm$oop�p$'�.- VJ > a>z N h N ^ d N tpp 10 Pp tOD .- n m m n N m m m m o .- W m m T m m N O P y N N p m M n n m M m N n N m N n C Z M M M M M M M M M M M M M N N N N N N N N N N N N N L ?•�• O O O O O O O O D O 0 0 0 N N N N N N N N N N N N N O Q � 7 6 N N N N N N N N N N N N N C d N N N N N N N N N N N N N 0 C O = d 0 0 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N N N N N N N O O O Q Q ss N N 6 N N N N N N 7 N •' M N � E �onM tri C1 C R o 0 0 0 •C Q N N N N G d O m d � N 0 0 0 0 0 0 NO < 00 y �« ga �3 o UT a Vf v o f o $ <o <c w Z Y, Q^ N N <03 yd Q't U O N O O O m � N O ` N �y N o � dE ay o ci c W Z Z IUD W h � m Q h [Qi N III Fx a W < Y> o o o > m zg {ii �j amrE o �<mS U d E z' 6LL EW 6LL a m N N th�l O Ln m y m N m N di • N N O N N C N � � � O U a U f Q C o o 0 o r a? O O N N M N N n u a s` Z �h � E " i O xa 5 ya m ry mX r- r F CV .p J z .<l h � N cll N �M cV O N p 6� Q e &§ \ i s 2 2| . (| q < 0 / W • � - G | 7 Z - W \) W 2! � � §k £ � $\ f® ® 7777\ ; wl !_/z, \ $§;2b % � $ m / ! d $ )§& a $ : ! 9 \: )! §/ ! e � k » § ( ■ ® , , P �{ » | & kL U Uo O' a WO z m g G' t jz Fy Qg p N O N r- P N T N ¢ � N 6LL Cyl 1C N CO N N py O— yq 4Z ¢N UO a� dLL O i aV N N Q I U NO M O N N P N r UO N 0 R O € U o dr Lyy d O ®e �L J r U y 6 > a cc 5 O Y Z 2 ¢ 2a U N 3f>mg N m m m m O m N m ^ .- mm cl ImU t7 - M m N m q �- O O N N O m m m m N Of m d m m m N m ^ .- Q P O O N N O O M m m N U U U U U U U U U U C C C C C G C C C C O UE n Y N m m n^ n^ N m m ry m o P n m m m n n P n N M m m c e m m m� M n rn m a P d Q Q IN P d d Q N E tll L n r n m O m m N N N jm m m N M d d n w o o coi n a Q P Q Q d N N N N N E N N N N N N N N N N ai F N N N N N N N N N N n n n n n n n n n n a a O _ _ d o 0 0 0 0 0 0 0 0 0 N N N N N N N N N N y yl N N N N N N N N N N N 0 0 0 0 0 0 0 0 0 0 c� ro In n m m m n m M g`rooO000000o v N N N N N N N N N N C � o 0 0 0 0 0 0 0 0 o E N N N N N N N N N N IL n L; S � N 5 i i V r i i m d o m VI m N ~ d a tR b m y 01 O n O .0 O = 0 o m O O N O O n N I - EN mT O a N N / - G \ } / k\ \� 0 } kuui | f� � f n � El \ \ � ] ! 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I. ! 2 § I ) I© ` -mi \ � � ! § 2 12 I� � I•� i 00 0 I� | _ . | � kV� | q �$f) )/ � Z �\ !| j! \ , %| � �§ £m z �§ � ( f/ :\ )k§; � )0/}� ! §k!b Cjj FP � q )) 3« I �E k ! � ) � k ;, - §§ f � I| ) E § E ; 2 i$ ! � � | k\\ k�a � E / § !§! !] TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) F7"ENTER 9-DIGITTAXP4YER IDENTIFICATION NUMBER" "ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" F"IF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGIT TAX FILING YEAR" El "ENTER 2-DIGIT TAX FILING ENDING MONTH" 15T QTR - 03 (MARCH) - Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) - July, Aug, Sept 4TH QTR - 12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" "6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER #p## ENTER: 0 0 $ 92,103.16 1 $ 48,240.60 $ 11,282.26 $ 32,580.30 CHECK $ CALLED IN BY: CALLED IN DATE: CALLED IN TIME: G:1Flnance SharelAP-Payroll FileslPayroll Taxe8120211#5 R1 MMC TAX DEPOSIT WORKSHEET 2.2521.xls 31112021 Run Date: 03/01/21 MEMORIAL MEDICAL CENTER Page 116 Time: 09:51 Payroll Register ( Bi-Weekly I P2REG Pay Period 02/12/21 - 02/25/21 Run# 1 Final Summary .-- P a y C o d e S u m m a r y-------------------------------- -- --------- D e d u c t i o n s S u m m a r v -------------- PayCd Description Mrs JOTISHIWEIHOICBI Grass I Cade Amount '--------------------------------------------------------------------------•----...---------------------------------------------' 1 REGULAR PAY-S1 9425.50 N N 11 169579.59 A/R 650.89 A/R2 25.00 A/RE 1 REGULAR PAY-S1 1767.50 N N N N 77782.61 ADVAIIC AWARDS BOOTS 1 REGULAR PAY-81 253.15 Y N N 6498.66 CAPE H CAFE-1 CAFE-2 2 REGULAR PAY-S2 2230.50 N N 11 51577.78 CAFE-3 CAFE-4 CAPE-5 2 REGULAR PAY-82 150.50 Y 11 N 5071.90 CAFE-C CAFE-D 1784.88 CAFE-F 3 REGULAR PAY-S3 1403.75 N N N 36879.42 CAFE-3 21578.40 CAFE -I CAFE-L 3 REGULAR PAY-S3 133.00 Y N N 5269.98 CAPE-P CANCER CHILD 544.62 C CALL PAY 2436.50 N 1 N 11 4873.00 CLINIC 185.00 C0MBIN 434.57 CREDUN E EXTRA WAGES N 1 N N N 1324.00 DO ADV DENTAL DEP-IF I INSERVICE 8.00 N 1 N N 231.60 DIS-LF PAT FATCSH R E%TENDED-ILLNESS-BANK 194.00 N 1 11 N 3732.38 FEDTAX 32580.30 FICA-M 5641.13 FICA-0 24120.30 M MEAL REIMBURSEMENT N N N N 270.00 FIRSTC FLEX S 3916.32 FIR FE P PAID-TIMR-OFF 215.42 N N N N 3810.50 FORT D FUTA GIFT S 260.22 P PAID -TIME -OFF 2183.26 N 1 N 11 45773.61 GRANT GRP-I11 GIL X CALL PAY 2 160.00 N I N 11 320.00 HOSP-I ID TFT LEAF Z CALL PAY 3 96.00 N 1 N 11 288.00 LEGAL 280.32 NASA 906.00 MEALS 196.62 p PAID TIME OFF - PROBATION 218.00 N 1 N N 3560.34 METVIS 921.99 RISC NIM C PHONE & DATA N N 11 N 965.00 MMCSHR NATFML 1955.51 OTHER v COVID-FFCRA 72.00 11 1 N 11 2826.00 PHI PRIG•• PR FIN RELAY REPAY SAME SCRUBS SIGNON ST-TX STONDF 790.86 STONE STONE2 STUOEN SUNACC 781.60 SUNILL 668.44 SUNIND 613,12 SUNLIF 774.81 SUNSTD 1175.65 SUNVIS SURCHG 760.00 TSA-1 TSA-2 TSA-C TSA-P TSA-R 29445.93 TUTI0N UNIFOR 273.03 UW/HOS '-------------------- Grand Totals: 19947.68------- ( Gross: 420654.37 Deductions: 131167.51 Net: 289406,86 Checks Connt:- Fr 203 PT 8 Other 46 Female 225 Male 30 Credit OverAmt 8 ZeroNet Iern Total: 2>5 I\V,1N1ili1'-Y111 _ ----------------------------------------------------------------------------------------------------------------- ........ �tl�Quie- U3•U5•u r ON O N a N ,��• GV N h u) VV !� N N r A d N O N N N C � W � Z 4L U Z J Z i CO ~ 0 a v J H Q 0 If Z W C a O z LL W N Q f u O G J W Q 03 - N k ry N C N t� O t0 R o0 1- C M 1 W 0 M N r z y N W 1f01 � N n� u O N W m O�1 O .m-i U 0.omma'mmma 0- o o N o 0 o Z eo ow a m o 0 0 0 0 0 o J \ m m x m m m N N V vl V1 V^1 Z o m u�viO�in urvig G a v H o a a z z a z z z Z a x x x x x z a a Quuu z a a a J J J Vl J J J O m a a Y a a a w iy T T U T T y OC N 0 0 0 0 0 0 0 N N N N N N N N Y ry ry m M e/ � t0 tp C N N N N N N N N i �zw; C !� C 3 O Q v1 O T 21 a d c v O u U L m � a O c o E a 2 n Memorial Medical Center Nursing Home UPL Weekly Centex Transfer Prosperity Accounts 3/1/2021 P[.Naw TC - irwnt e[9lnnlry ATx / Itednnln nnwunrm6a Tnn[lem4tonunlri[ ry Ikm n+a,- BalaM. LanslarGt Tnnllmn Yanam w 9mne xmmr '�3M41d@9 2)3,961.38 39:,]O9IJ 321,33934 - 210.595A5 / iS2,261.i6 Bank Baian[e 210,595A5 ✓ Varun[c tear.In D.N. ME INN 56.0N30 CUFF 1,143 t/ .�• larnur lntmA 16.IS� Rb W...A 91d ldjus[Balan[MnnaerAmt / 16;E6].Y6 / ''''..ii�� ;etyyge{ IP p ':_ a 30],33S91�EW.]044a✓ ItYA63.94 , I18.59341 94,30.65 Bank BnY.. II8,586.41 ✓ vnbn;e - leavem6Yan[4 loom QPP"3mE 24.034.33 ✓ ]enlmxml 34,47.// ieblMrtM 35ffi Mpu ealanmRnn9lerPmt win."✓ 'di"(v+ynyp ✓1$'''n� / 102:59134 ✓1%,43969 ✓252.5UAi / / VV✓ 164,73319 / I4$,236.6I 6ank BaOn<e 3W.J33.19/ YaNnce - lepp lME 10 0tPP 13A ME 16 IR320A6 ✓ MNINTFPEST "A0 F.b W.,eft 4536 Mju9t BabnaRnnter?mt 145R36.0 J q'',F 54,53]A3 V, 54,418,47,/ 103.499.7a / 103,601,66 / 79,939.17 Y ✓ &nt9alantt Variance 103,60].6fi 1.O,w. 1W,W QN1,LWS 3E 11S13S3 'En M]ERST 36.96✓ Febinbrm 26m Mµst Sa1ante(r1an0erAm4 7%939.17 f 1�14 L-g93uc�11� 166,930.97 /194.735.77 ,/ ia1,953]3 S42.W4.92 y/ eankealax. 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IMH31w1110T91nf Vl6/IOII XUMANf INf CONCRMMPMI lyN6IHWOHbi9 ]/lMml Pa6aUbAaaa+m .TXS Hi.>aJ) mo4u uJM.0 LH6.[i Ywa 9 mw Yo)aw tHJYAt MMcrwmX[I mn/wxP6 JJ2v.9aJ Tmaxr,In apt/mmpl apnGmpi mn/rpwt upl. mnn xxroglwll J5.]I415 12.166 J1 1,910.11 � J,9M.13 I,SIOm J.SIOm . I,SNY ISH.Y IJYAf ?6S49f . f169t 506.91 s,zwm s,1wm 31.'Jbi 59 . 10,3)J.A [.l9lA] 1,01S.A }Has. N.A 6J99.IB I,1wib t?oom HAxim l9.ibSm M33>W LwFJi I.Ml.la lEO.w IS,AidI 9A6J.H 1]5.9a091 film 9]Lm - iMI,S... IO.IYY J.6pbH 1,6mIS 55.93 55.91 tOT.K1.Y YIAY]I 11.tt001 LIY.03 LHt.K ISAY SA9t411 Y.6I9JG NMGPoAIwN mn/umpi r^x.r•,m hvvluln mPP/PnmpJ mPP/PomP1 mn/GmW JYPu tlnn XNPogIION ]L�W.i1 11,1m - 60f AI A Ia.11 - 96,Y9,0 96,SlAH n.mY 411t91 9}13.R Y0.15 ;OPLtS Y.R RNf.iq LUSJ5 . 6AAI.9s Y,11495 Mwm 49wm 15,11E9i 9.Y4]X ;G6m 9,IM1G U. ILAL39 S.>95.6p t6U36J1 6.650.m 0.6%.m . Lue:H P1v1 61. . gS 41.11 i5.Sm16 , i14699J9 BLYI.J1 i9.0YY LH1Jt 9JfOJ9 169JJ Y.iMlb ]Y.lwJ6 a NAI[iOPIIM an/mmM mjtif[� lranaXr.ln MP/Carol mIP(Gmpi mn/fwn3 iYpw SyIPn M1NPoAiION Il.bf.G . I9,916.Y MIJIM 10916.99 - :OSA6 69S.f6 LI.SI],Ll SS.SOL)] 9Ansl 4MLl, S... ".. Imm q,. ;6H:H WIllH ]J}SIAO LHs.Y [A. 1S0.5U MS" 1.411. 905.1E SOSA2 4S9]S1 f.S31.Y l;lLl if I1}.1S. Sbm 6 PASS., }bS . L.]ffn I.. 'Al. YW W..Y Ad65.V 4 MMCPox1lq an/ q fnmlSL'.Q'1 )nmlarAv mn/T.xwl OIPr/Gm9x mn/Cplgx wW onn xx POxnpN - 1fx9m 1,fMM 14x9f.Of x3f9AAi • LYom ;HOW iW W xWm s}fi.)s S]H.lf A.n191 9.61a 11 4149m I,NLtf ;11L25 6L%t )Af3.H UYEi Um W Lemm . i19,bH.i) MAf1AA )oldo ]Gm S,OSOW SWOm I1.411.f0 ll.51x12 I.M.ISVA M.IfAA.If ;2f1.M l6EiJ1 I.6E6M A9flm , ?ISIM M. 11S64x9.W BAl9.IS MY ]f4134T/ /H1191.H I i>.)H.tt L9x9J5 iltial )xf.il ly]Q93 sY WLn _>mAfO;Y LfY,)ASAS M... U.Yin 4AWAS U.S. UX] L394WSm 3r12021 Treasury Center aemcn DOA D'T., ":poN.0 -a vt rldr 1. Account Number Prior Day Blanco Current Balance Available Balance Collected Balance '4351 MEMORIAL MEDICAL. 3210.59545 $2.12,236.90 5210,595.45 551.1'19393 ^FNTFR 1 NH ASHFORD :'•403 MEMORIAL MEDiCAt i5'n 5941 511a,536 .1 Sltfi vfiF, i: $2fi9.9.".f.�?5 CENTERINH DROADMOCR '4411 MEMORIAL MEDICAL $I1 :.733.19 S'.70.53d.76 S164.733.!9 5308.329.5e CE14TFR • ICH CRESCENT '4446 MEMORIAL MEDICAL S103,607.56 5:03.607.65 $103,607.66 $106,6Cti ::'S CENTER r NH FORT BEND •4s3 MEMORIAL MEDICAL CENTER 1 SOLERA AT Sa12.0>•:57 5545.575.0<" S542,QP-I92 5672.771.7E WEST HOUSTON nee:. P;uT� ce-.erne4 ,:,: (i3ne.2Li.", t nl t h1(p5.1/pr0ipp^ly. Dlp,inkind.CORIIonli,^.v SlesSene¢! 1!1 Memorial Medical Center Nursing Home UPL Weekly Nexion Transfer Prosperity Accounts 3/1/2021 Premep, Ncmunt 8eeinnmg Penalnp Today', 9eemmne Mwunt to 0e imnAerrm to nuntn( NurW Nome Numher 6elanx Tnmfer-0ut , iramfio la pe o9ft Bolan Nome Gg .An 331,690.81✓ 398,304.M I53,738.81 - - BB,140.9) / 47,370.63 Bank Bahnce 88,144.97 Ndmoe - leave In B4NM4 moo QIPP 1.2.31 W39 40,569.03,/ IANINrEBEST 773 - FESIATEaEST 78M I AJiufl Balance?rardw Amt 47JS0.63 Note:Onybokr¢es o)over3i0A1 xMbe tnn>JenMW Me nunfn0 heme. Nvte2:Eachv¢ounthv,abutbobncey$L80 thaf MMCdepo,ltedtopptn..ro f, Aopmved; AlY'I� fatonmalm,CE0 3/1/1021 MAR 01 2021 R1G 4 I;\flx weexr Toot/m\xn uelin,nler Summary\Tot]\/Harsh\nNUPLTansln5ummary3g41.df[ s I.I.I S/ll(]NpC S X1ETlFMEN33[MKEit05333!]994a69]a9 I/llllCli NOVI1.035p1Y1WNxCCUIM0M36>0J'vNEMM[H . E/143M1 M 61HOM E114)CUT I5Y3/IINSII[Si 9KO5RA1i5CI[863510E69119 - Itl</]MI UU1145XI{VIIOx M[CUIM)MI616dll4SMYJI30 E/Il/IOI1Cenlm<Men<9<m<fCOr3I08W633ILpEvY51915 I/I51[Wt Gpaxl W511013 x0YnI5 .AAAN x2HmveR SIL49l91ItTAIT MI/39I1 xENIXxV IARTUH OIAT pM13NcArIc [l91]I $/16/EM1 WiPL VY1 M[FMIIXINMAi GO<9LHCP[[A Il0.pp4,10 Mmvonnox T''''�''�� app)LplpHu NN . •. �.. aPp/Canpt aPP/Umpi aPp)Nmpl pp< 4VpT MRIION 19,930<9 IB,91901 C,354W 5,5:545 69,519.9i Si.9t63] 6�NA66 S0).9l 11IY.10 lI]B.b l),Sy90 - 4,154M - S,S4S i9 .W.I9 W}tl 09 5,91057 144 l 0. NJ 04 - ]9].95 2/)6/E9I1 HFAIiN xuM4N SVCHCCW AIiN.it]ILD]H1t3Yli l 5)$BI 1)ldl )90.%4.66 /353.)G.OEI 11.590.30 LIMA ILMN Ma 4D.Sm0 IHUIIA. 3!1;2021 Treasury Came, Account Type DDA D.A"rCpcnuC as ur Mo, " ZU-1 1 1 Account Number Current Balance Available Balance Collected Balance Prior Day Balance NH GOLDEN CREEK 144 H 1 onus,vno en HEALTHCARE hl[Ps Hprus,,,,j!y. 0 Memorial Medical Center Nursing Home UPL Weekly HMG Transfer ProsperityAccounts 3/1/2021 .nwuv Nmewtla Ne ewvunt OaµnNi PaMiry namremN[v Nut[ M e nvrM✓ 0a4nn linJenWt ii[u[lanln LYaeleYaJ [Iv M1 TNa a InNn Ba4rca NON Nam ✓ BanY Babnu b,KId9✓� nar VaMnce w..emmwn Iww avvi,A],bva. nprs.Bs 1NIIN)EBiSf 6.M Hb Mtmtt LSs adlu[ u4nw/fnn[la[ aml I10.9 V.0]I / WaWvua Pmpnl tv0e A[[wrl PandM3 Tn[uFrtNtu NWna Noma B.I. 41uw iran[IerM TnMar.ln OavN Oe iela 1Ba i Waiva M New �,� JM�i�, `=�, Oa,aN.30 / 00j4V3 IW.691.00 160,00S.Si /100r660.5] 1� Oank GNna t60.095.5]3/ VaNanm leaven BaYn[e IWlO NeIY. M.fY6vlvnU+afoHl Sf,0.V MI h M1M[f[rrH1011revYnnp POnl. I(OtP ]: FarF Oe(OW[f.0(000flbelPl(!O/$]w MOtMMC6lPorlIW bep[nvacant. IR emike5T ]1a0 10jou'r i Nb .1.0shau,junow M0 / ]f0.F0.5]✓ TOTunts,snUd Isaw.) NWwN'. ]awn Pn0Nq Q0v 3/UE03] O:Wxw[aNrt..rtm\Nxuvs(nm�eswemarvVOIIWaNM01uN Lam�nsam+urvarx•.e. 212 DI lJI 2/2420E1 NIRAANAUTA OISB I3CCtA1MPMi 6I49ffid3W001i39 3/3d/3031 h34 iB,B61.]] 7/26/2021 Cameo Wme l mmu SERVICES, 3886m633110030mtO12 x(x6/z021 AUN4,M01 tics impmr LL{ ASJ16 38 2/28/2021 AF3NAA501lICC41MPM113192103319p 51C000]3431 x/xa/z9n Aaaaam Ao<wm kyg3.3rv� 4 E1�1-?.yYiZ§=. �bR �tr✓�z e RB4 T5758 �nS 1 is i'+�ti^u1 2/24/2021 NOAIOMN 13A RCC1AIMPM3 SISB9241WN1261m0 112512021 NON01AN13A NCCINMPME 63589N200WIWI995 2/25/2021 Cep011t 2225/2031 NO810YN13A NCLLVMPM3625892 42O0W11m1m 2/26/3021 WIRE OW HMO SEANCES, NC 2/iB12021 mdtl IOPR[un[ mmcpo9noN areI.. N11 Tnnsfenin aPPlC4mpl aPP/Comp2 aeP/Cwnp3 lepw pIPVN Po5TION 6,118.36 5,218.36 E9,2tolm ILfi9L60 11ISM 2.279.L1 }m 88 2319Ae.99 5,29,139 1.250,00 3.750.W 25.55 38.85 Sm,5M.69 C 6.P]39 4,691.60 L12H2O LSM,M MASS USES." 1L79130 MMCYCHMON T an let aPP/CamPaL NN ]lei93 qPP/Cgnpi aPP/Canp2 aPP/Camp3 4vpte aPPil Po4,7WN i 1,21393 111357.63 1,351.63 3,351.63 33,tl63,33,MS.22 - ]022 ,665.13 - ]Q66511 m.3al.]3 32M 32,21? ILIM1.7Z 160.692.H6 160.693Jfi 323.91A37 197,430.15 m.691.m SlIm 0 7379.10 113.11, zlm5 93 973"As 3112021 Treasury Center Account Tym Seari:h tll DDA Data repone as of bar 1. 20k1 1 Account Number Current Balance Available Balance Collected Balance Prior Day Balance 'SG1i tdMC NH GULF POINTE PLAZA - Ste':'.905.5,: 5180,805.52 5160,805.51 S249,11n.95 I.IEDICAREdAEDICAID SA, i MMC-NH GULF POINTE $I j.80529 $13,809.19 513.809.29 S977a712 PLAZA- PRIVATE PAY wec:dr... .;,c arnrralnd nn �,a11%2. 11 al+: htlpcv/pmsperily. ollinnk;ng.comionl Inekio ssenger i V1 Memorial Medical Center Nursing Home UP1 Weekly Tuscany Transfer Prosperity Accounts 3/1/2021 NUN Npn ft—ul Artounl 64ixdnr Ne4nre 7nnJervW r sss.ebe.gT Nu:r:we rvSs,pJOW/brnenr/mNu:henunmgbwne. Nwr3:179d, uuIhw.b.v Dalmuol $LMMot MMC drpnnrdm.xnomunt. ..unt b e. BankBMnu 593.1a5.0 J 4' IeawlnBihna Io6M / glgq;l.),lagl. 33.151.31 ✓ ldiwte.LnuttoMbrarn no ub.0 barwed: l.+mMtlln.Qe � 3/Uf0i1 + ppftv.w l MAR 0 1 2021 MMC PORTION gIPP/Cpmp4 TT40if!]-0YL TTan]flrvin I QIPP/COmpi QIPP/COmp2 gipP/Camp3 &lapfe QIPPT NHPORTION 5,122.21 - SAll.21 55,706.13 - 1111,061.91 k Imdmrxnl0].inmrtil _I a ¢ 7r rl° it 41 i i ih-4 2/23/202i Molina HC of Td HCCIAIMPMT PNIZ757178944200 2/24/2021 cN 5 2/25/2021 Refund 9 months Enhanced An4N4u 2125/2DZ1 Deposit 2/25/2021 AMERIGROUP CORPO &PAYMENT EESZ13786011/0DO 2/25/2021 NOVITAS SOLUTION HCCLAIMPW 676201420ON173 2/26/2021 WIRE OUT UNBAR ENTERPRISES, LLC 2/26/2022 KS PIANAOMINISTHCCLAIMPW 179111900020323 - 13,955.00 - 13,95500 2/28/2021 Added mAccount ]2.12 7212 365,]68.09 3,085.0] 17,342.% 2,897.18 6,745.58 180.90 22,254.39 170,830.68 330.00 - 330.00 27,488.97 - 27,488.97 27,267.22 17,342.56 2.897.18 6,745.58 180.90 22,254,39 4,912.83 118.949.55 - 118,949.55 3M2021 Treasury Center Accou^1 Type 1 f ®1® repogcn .'d of Les 1. 20?' i '3407 M10C-PiH TUSC ANY 5183.18507 5206,7W 91 5103.185.07 $289 VILLAGE .2 19.E5 n11,^,5-prGsparily.OlOa^. i,ing C✓m:onhnehlessenger Memorial Medial [enter Nursing Home UPL Weekly HSLTranSfer Prosperity Amounts 3/1/2021 nnHnYs smwnsfne. Auwm 9etlnMq ven0lq inMrrtNte My�UN�ny{�Nymm:�ye�� Nunb.. Biluun iiunlerAul i TnmNNn �rnnreX M TWB .N Mnln MNm NUNn Xamn ydN1Hf 1AN/,� „`� , � ]13.116A) )]3.lET.SI / 333,3E656 ✓ 11{.215.5] /123Aa).b) ✓ BanS BaLnn 124]15.Sy/ L[Irenin 0il{n2 LWW MHIHRREfi O.Y i<blmrnn bA] atll'^tBWnn/tnmlerimt li)A2L6] �� Natt:p.!vbo/onns n/✓nr SS.eo]eiNbrrmnr/mrmro!eenwfMahrme, run: Nott 1: FaMoncu(M1orn6meW!rnnry$IW Hat MM1ICdePorHMfo �oc[wnl. ImnPyM QO � 3/1/E031 MAR 01202, i:WN WnYN1nnJ.n\NI:YRinnJnSumm.h\1wllNrnM1WN VilinnJerfummW ld�ll.�h� MMCPORTION OIPP/Comp4 Trens2eT-0pt n ewe OIPP/Camel QIPP/c0mp2 CIPP/Comp3 &Upse QUIPTI NH PORTION 9,942.9E - 3,942.92 231200.29 - 23,200.29 - 11,379.62 - 11,370.62 - 6,465.4E 6,46SA7 - 2641 - 264,341.64 - 19,6S9.24 - 19,659.24 722,167.51 - - x a5: 2/22/2021 Deposit 2/2312021 HEALTH HUMAN SVC HCCtAIMPMT 1746COd4L13016 2 2/24/2021 Deposit 2/14/2021 Deposit 2/25IN21 Depose 2 ZS/2021 NOVITAS SOLUTION HCCLAIMPMT STUBS 4200DO173 2/26/2021 WIRE OUT SETHANY SENIOR LIVING, LTD 2/26/2022 Deposit 2,135A0 - 2,135.40 2/26/2021 HOSPICE OF 60 T2 VENDORS NF 91000015528S33 - 21062.S3 - 2,062.51 2/28/2021 Added so RceOVnt BOA) GI 722,16).51t 333A66.96 ✓ 333.266S6 312021 Treasury Center t iam mme NH. aF rHANY S12-1.215 52 S135.479 52 $124,215,62 S842 ;G4 6.5 SFNICR LIVING naps v1prosparIly.016,1n 4Ing.cOmiOnlinehiSs sengor iii P A Y. F E MEMORIAL MEDICAL CENTER CHECK REQUEST MMC Operating D3tF Requested! 3/1/21 WR 0 1 2021 FOR ACCT. USE ONLY 0 Imprest cash DA/P Check DMail Check to Vendor 1j, Return ChezJto Depl Amouiwr 58,070.30 GIL NUMBER: 10255040 -XPLAINAT'ON" Molina and Amerigroup QIPP 1,2,3 and Lapse adj for 2021— h Adft"( -------- - --- .S FEF? By: Caitlin Clevenger A(jTHfjRl*,.1.FD BY: MEMORIAL I\AEDICAL CENTER C..HECK REQUEST P MMC Operating Datf� R-que-sted: 3/1/21 A APPROVAD E MAR fl 1 2021 FOR ACCT. USE ONLY LlImprest cash []A/P Check F] Mail Check to Vendor CJ Re.cm n Ch(�ck w Depi AMOUNT 24,034.38 G/LNUMBER: 10255040 LXPIA,iATIONI: Molina and Amerigroup QIPP 1,2,3 and Lapse adj for Jan 2021- f1xoadrftoov, M-C UF 71 1 ) P"i Caitlin Clevenger M,,. 7 - ----- ------ P A - - --------- ...... MEMORIAL MEDICAL CENTER 'I.-f-IECV REQUEST Date Requested: 3/1/21 APf'A0V= FOR ACCT. USE WILY []lrnprest Cash E MAR 01 2021 F]A/P Check E—Plail Check to Vendor 1-11leturn Ch(zck Lo DPPI AMOUNT 19,320.86 C-11-NUMBER: 10255040 EXPLANATiON Molina and Amerigroup QIPP 1,2,3 and Lapse adj for Jan 2021 MMC Operating i E010ul ;7,Hj WCaitlin Clevenger P MIVIC Operating ----------------- IVIEN/10RIAL MEDICAL CENTER CHECK REQUEST DafF Requested: 3/1/21 E MAR 01 2021 Tar _45 FOR ACCT. USE ONLY r—I Imprest Cash []A/P Check ElMail Check to Vendor FiRecurn Check to Depi AMIOUNT 23,523.53 G/L NUMBER: 10255040 EXPLANATION: Molina and Amerigroup QJPP 1,2,3 and Lapse adj for Jan 2021 9wdl— I R4-Oijr'�TFI , B, Caitlin Clevenger AUTHOf WED B"': -------- . ....... ------- k�E&4^RI, 1 A L K8E--D!7A, NT�� (-��rrK��(lH��T °^~~�,`^-`^`,�~. � N1MCVpemhnQ U«��q*��d� 3�/1 � � A@OUNT 22,762.97 ��A0R��8�1 ,".. v / ^.^. D ~V-^`~ Retum cl, - ��=^" -__''_----'-_------- 10255040 Molina and Ame,iQruup[QPP1.Z.3and Lapse adj for JanIVIl _��v\�w�' ! x�8.!�- "T''S9, Caitlin Clevenger L---_'---_-------_-- '�--' P MMC Operating A I'VIClViyC)RIALIME iICALCENTER HIECK REQUEST i7a?n t&=quest�ati: 3/1/21 FOR ACCT. USE DAY ufmpYe.=.tCash I j—jA/P CneCv i [Ifl$311 :-f)2CIC i0 VFt7UOr jtictUri"! Ciliiia: iO Dept F,f✓iQUf4 40,569.03 G/L P1UiviSFf2: 10255040 EXPL=`iN'A1'fUNi: Superior QIPP 1,2,3 and Lapse adj for Jan 2021 — 9OI ACYI LYee IL Caitlin Clevenger LU-fH^.MZFDBY: p MMCOpemng A K�rK�0��^ K8~0[`di F�N`^�Q �`.°,.`,.`,"`�',.�~.��,`��,.^�'` (`A��`KA��U��- .�.^.`',�.��`+`-°` D��r��qyc�'�d� 3/1/21 ------- ~-- POP. ACCT. USE ONLY ' || [1«/rCtsck � ---------------^^~-^----^-'--- MAR Ay28/) Flk4uil[heckioVendn/ E -.-_-.---_-----�-_-----_ --- | �7Kebon�ka�k�o�cpc !LJ ' | | AAAOU,.,qT 2l,98S�99 G/L0y�08��1VZ55V4U ,--.-- ---�-----.--'-------. ---..-.--'—.---.-'.----- .-.K�LAN&T!ON Superior OUPP1,l'3and Lapse adjfor Ian ZU2l- �4-1&^, hUOevenger ��a��n�_�� -----''--'--'^'-----`-~----^^---''--- 1\11 E M 0 R i A L '1101 E D I (,"A L CENTER , ""'K FU: " 1 j, - MIVIC Operating ppit R,,!mjcsud: 3/1/21 MAR 01 uz-i FOR, AC—T. UH ONILY Ellinprest Cntsh FIA/P Chec,: UM12-Al Chtick to Ve:;Jor F1 RetUrr: Cha-.k io iD�pi AW. I /( HUM., 10255040 OUNIT 22,254.39 C ,ER: XPLANAPOAmerigroup QIPP 1,2,3 and Lapse adj for Jan 2021 — N: ---------- --- - - - ------------ -- Caitlin Clevenger ---- — - ---- ----- ---- March 3, 2021 2021 APPROVAL LIST - 2021 BUDGET COMMISSIONERS COURT MEETING OF 03/03/21 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 24 $265,874.52 FICA P/R $ 690.78 MEDICARE P/R $ 161.54 FWH P/R $ 717.28 AFLAC P/R $ 2,726.09 PRINCIPAL FINANCIAL GROUP P/R $ 1,473.49 TEXAS COUNTY & DISTRICT RETIREMENT SYSTEM P/R $ 162,839.47 AT&T MOBILITY A/P $ 111.35 CITY OF POINT COMFORT A/P $ 88.98 JACKSON ELECTRIC COOP, INC. A/P $ 760.47 LA WARD TELEPHONE EXC. INC. A/P $ 342.33 REPUBLIC SERVICES #847 A/P $ 537.00 VICTORIA ELECTRIC CO-OP A/P $ 1,147.51 TOTAL VENDOR DISBURSEMENTS: $ 437,470.81 PAYROLL FOR 3/5/21 P/R $ 364,626.40 TOTAL PAYROLL AMOUNT: $ 364626.40 TOTAL AMOUNT FOR APPROVAL: $ 802 097.21 m m m m y y yni e P o o ti O O O J O 0, G r O �n< moo a a O z N b P R W N P O O� O �D O O O xr amA3 amA3 m m 3m W O O N b O 2n 2C 3C) nS nS nm n z1 O �Oy O � A � 0 0 0 e m b O � O - N U N O O> CrCy ZQ Xs rCOn A s O J ro ° n N N On m 'o HAI o' n y n r o o yy < m o b � A a a°Co ��yyyAff 2 0 0 zv w Y z z m OA OA ;p � 'O a a W b W b 00 C n o i7 o � 9 N A n O O y o � c cnn ro { M m m o. 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