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2021-07-14 Meeting Minutes Pt 3d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) of the site in relation to the Work for which this BID is submitted. e. BIDDER has correlated the information known to BIDDEN, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, Studies and data with the Contract Documents, f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and conveyunderstanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUESTE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation, BIDDER has not directly or indirectly induced or solicited' any other BIDDER to submit a false of sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to completethe Work, in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts` are to be shown in both :words and figures, and in case of disercpancy, the:atuount in words shall govern, b. BIDDER acknowledges that the quantities are not guaranteed and final payment^ will be based on the actual quantities determined as provided in the Contract tjPIM1TTfYYPtlLC '' c; I d. BIDDER acknowledges that, at OWNER's option and/or at QWNER's requests any of the quantities may deleted, reduced, or increased based', upon the respective unit Prices. 06300-2 M04ndohl N4: t -?[a" a Md WproY@msnts BASE BID T. _ ID— -------- M_--i]N- ------ITEM---._ .--------------- --- - — �. BID li1D DiiSCRIPTIOF WITIt ITEM QTX. UNIT PRIG WRITTEN 1N WORDS AMOUNT 1. I LS Furnishing Mobilization and Insurance as per plans and Specifications for a lump sum price of 1'✓.L lt4ii T4t,.t aid%. 2, 3. 4. and t7h Gents, LS Tarnishing equipment, materials and labor for the installation of the CD13G temporary and a permanent acknowledgement sign as per page 02845-1 of the ` specifications for a lump sum price of �1"Jbl''%IP77i Dollars and O Gents. LS One (1) Centerpiece Flay Structure meeting the following requirements:, age group 5-12, ADA inclusive, minimum capacity of 80, approximate use zone of 45' x 45' and be made of materials and stainless -steel fasteners suitable for coastal cnvironruents, including labor, equipment and materials for a complete installation as per plans and DAX Ilu jr6v.m TNnrt A,+an _ .2, 000 - ram Dollars and < b}t Gents. s 1-7i + flil6.6ep' LS Four (4) total bench seat with back rest/ support includ-tng. labor, equipment and materials for complete installation as per plans and specifications for a lump sum price of Dollars ands l to Cents: _q radi c 00300-3; fiat ndm No t—Plapg�d tmpmyep,,t, BID BID DESCRIPTION OF'ITEM WITH ITEM QTY, UNIT PRICE WRITTEN IN WORDS AMOUNT 51 1 LS Four (4) total park trash receptacle including labor, equipment and materials complete in place as per plans and specifications for a lump sum price of Dollars and ova Cents. a_ t'3, 5cit� "e 6. 1 LS Earthwork required to ensure stable base below playground zone including, stripping top ,layer organic material subgrade preparation and excavation or imported fill to meet required slopes and elevations as necessary to ensure ADA. compliancy including labor, equipment and materials, far a complete installation as per plans and specifications for a lump sum price of Dollars and, NO Cents. $ Ib 7. 1 LS AD.7s minimum and ADA inclusive playground surfacing, facing for ADA inclusive. centerpiece a total of 7,600 SF of both ADA k inclusive surfacing, including labor,' -rial for a complete installation as per ons for a lump sum price of Yi 'TLv�e.r,V 1,4A)J,' nil:: Dollars and AA-2 Cents, $l (JGfi_0a, 00300.4 Mdcndnm No. I- Ptaygraund imprnvemenrfi.. BID 1310 DESCRIPTION OF ITEM WITH ITEM QTY. UNIT rRICE WRITTEN IN IYORDS AMOUNT 8. 1 LS Four (4) inch thick steel reinforced with perimeter grade beams as required, 4,000 psi concrete pedestrian walkway approximately 2,300 SF including labor, equipment and materials for a complete installation as per the plans and specifications for a lump sum price of ,-/LTJ,' Dollars and IVO Cents. CX-)Q. ' 4: 1 L5 Furnishing labor for the installation of approximately 2,400 SF of Flortam species sodding around the perimeter sidewalk filled areas; that are disturbed as per plans and specifications, for a lump sum price of tc't7C' •%dw�.rartl� it�?,tC F%wvvt3� Dollars and Ate: Cents:' S}, i-d-hh.....1�r�+++!-I-+1-i-ti I AWARD OF CONTRACT SIiA LL BE BASED ON T.RiE "BASE BID" WITH CONSIDERATION OF'IIIIE OWN'WS OPTIONS �--ram'--rz"-"I i ram'..... . 1 i : H-+1 1-I--4 ........... -E-:-+++ 00300-5 MdwKWm No, 1-Plovgmund Lmpmapnar , OWNER'S OPTIONS BID BID ITF51 QTV. UNIT DESCRIPTION OF ITEM WITH PRICE WRITTEN IN WORDS AMOUNT 01. 1 LS Three (3) Bay Powder Coated Steel Swing Set with Swings designed with future shade intended. Two (2) being Standard Belt Seats, two (2) being Bucket Seats, one (1) ADA compliant Swing and One ADA compliant wheel chair accessible swing which shall include ADA inclusive surfacing materials required and a deduction for the standard ADA surfacing not required due to the increase in ADA inclusive surfacing for the wheel chair swine section including labor, equipment and materials for a complete installation as per plans and speeifications for a lump sum price of ii}-NC Tmoi ccl"i :Dollars and Aicz, Cents.. 02. 1 LS' One (1) ADA Compliant Zip Line between 5' to 100' in length including labor, equipment and materials for a complete installation as pot plans and specifications `for`a lump- serum price of �-kf•,-M JI& fGuzxt G Dollars and Ab Gents. $ z :, - 03. 1LS One (1) ADA CoMPE'ant powder coated steel monkey bar f: horizontal ladder play equipment suitable for wheel' chair accessibility including labor, equipment and materials for a, complete installation as per plans and specifications For a lump sum price of it ' �lll 24 10n I: ,F+ AakUjM Dollars and AA) Gents. 0030M Addkrs4uM IJo. l �I'laygrowul 1pnprkvtmmngt: DID DID DESCRIPTION OF ITENT WITH ITEM QTV. UNIT PRICE WRITTEN IN WORDS AMOUNT 04. 1 LS One (1) standard height powder coated steel monkey bar play equipment including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum price of Dollars and L10 Cents. 05. 1 LS One (1) ADA Compliant wheel chair accessible merry--go- round which: shall include ADA inclusive surfacing materials required and a deduction for the standard ADA surfacing not required due to the increase in ADA inclusive surfacing for the merry-go-round including labor, equipment Arid materials for a complete installation as per plans and specifications for a lump sum price of ,.l�'i.3�"i' r N ZtA*a.FaR3i`i Dollars and Alo Cents. $ 0 66. 1 Lam" One (1) Motion Spring Rider`for Ages 2 to 5 {theme to be determiners) including labor, equipment and materials for a, complete installation as per plans and specifications for a lump sum price of "�k' �11ft&lEti "7��+e� �.fn1�`rt• ISallars and t*t Cents. S`' , 00. 07♦ 1 LS One'(1) Motion Spring bider for Ages 1 to 2 (theme to be determined) including labor, equipment and materials fora complete instaliation'as per plans and specifications for a lump sum price of Dollars and Cents, $ 00300-7 Addendum No- 3—Playgr4iLnd Improvemenld'' RID BID DESCRIPTION OF ITEM WITH ITEM QTY, UNIT PRICE WRITTEN ITV WORDS AlY101UNT 0& 1 LS There (3) total Rubber Mushrooms including Tabor, equipment and materials for a complete installation as per plans and specifications for a lump sun price of No B b 061:> SET S ;g�cLw3fT%-Tio Pc' P.riO Dollars and Cents. 09 l LS One (1) in -ground mounted drum/bongo kit for musical play including labor, equipment and materials for a complete installation as per plans and specifications for a: lupp sum price of lakx i� Sa L"i LQ l na: a PA" > t (6iM- lor, ECAc.N and Cents. $ 010. 1 LS One (1) climb and play wall/tunnel including labor, equipment and materials for a complete installation as per plans and specifications for a lump sum.. price of j 11�. TH&uxiwY Dollars. and 011, 1 LS Sun Shade Canopy for Three Bay Swing Set in Base Bid including labor, equipment and materials for a complete installation for a lump sum price of No eta �* I LrOTEMATE6ruAFy r=TcP cap 13a,f Si rcri ,�Gi r and Gents. 00300-8 Addoudmn No. t—Mayaround IrnpjWoh)eMk BID BID DESCRIPTION OF ITEM WITH ITEM QTY, UNIT PRICE WRITTEN IN WORDS 012. 1 LS Sun Shade Canopy for One Bay Tire Sluing Set in Base Bid including labor, equipment and materials for a complete installation for a lump stem price of 'im'i u) 7-lipa�-5WIL 013. 1 014. 1 015`. 1 o16' 1 and N9 Gents LS Triangle Sail Shade Canopy (40'x4o'x40') Structure including labor, equipment and materials for a complete installation for a lump sum price of ' �i"1( : iii�lc 'ITMIi(}LLrF51171� Dollars and NO Gents. LS Hopscotch play atthe ,proposed sidewalk including labor, equipment and materialsfor a complete installation for a lump sum price of AID axb Dollars and Gents. LS LS Themed Steppers (5 EA) Play including labor, equipment and materials for a complete installation for a lump sum Price of Dollars and Gents per cubic yard'. AMOUNT $ 9400 lv $2;PJR J y0. S. 00300-J ABdandur No I— Playground Lnprammcnts:_ s i +++— F-FF-F-I1-1 1-+-H-H-1-t-i-k-I-I i-#-I,-r,-r.. r-rm-'r...J H-}�-I-++4 1 -1 ........ b. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14,07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are attached to and made a. condition of this BID: DOCUMENT NO. 00411- RQ{ UIRED BID SUHIMITTAL INSTRUCTIONS 8. Communications about this Bib shall be directed to BIDDER's address indicated below. SUBMITTED this r dayof JttNE 2021. Name: I?77,VD i I,tc Title: tlt n Attesting Signature Name: Legal PirmNlame: 1in'rrnl '1:rJc Business Address: i??, pnx Oo% ARRj &NiailAddress (optional): r j leskracnaiyy,±. State of Incorpetration, i f applicoble c c State Contractor Liderise No.:li�+ END OF DOCUMENT 00300-10 Addendum Na I-t'layg@una )ntpYoventovfss KNOWAL6 MEN BY THESE PRESENTS, that we Lester Contracting, Inc. PO Box 986, Port Lavaca Tx 77979 as'rincipal,tlereinaftercalledthe Principal, and Contfilent`ulCasualtyCompany- 151 N. Frarildin St., Chicago, IL 60606 a corporation duty organized tinder the laws of the State of Illinois as Surety,. hereinafter called the Surety; are held and firmly bound unto.. Calhoun County: 211 South Alan Street 3rd Floor, Suite 301, Port Lavaca, Tx 77979 as Obligee; hereinafter called the Obligee, in the sum of 5% Greatest Amount Bid Dollars (t, 5% GAB l; for the. payment of which sum well and truly to be made, the said Pnneipal andthe said Surety, bind ourselves, oortle rs, executors, administrators, successors and assigns. jointly and severally, firmly by these presents. WHEREAS, the Principal has sritpmitteda bid for lltfrastructure at Little Chocolate BAYOU. ParlL-PIaVLrouxlti Irtt3rpYemertis Signed and sealed this 229th ::. day of `--.Tun¢ - ti nes's) 1 ' (Witness) Kim15rr1yF7ores iArittsess Lester Contracting, Inc. (Principal) (Seal) Hy; r� °tTlle) T nrenre tTagiiai}ue GcneeaLMattager Canrilletttai Castlai Campy (Suretyl (Sealy. ay, Kristie Rodriguez ' one}Relcirti4 In Fact The language in thigdomment conlormsmoctly to the language used in AlA©ocumenl A310-:9id Bond February 1970 Edition, .. ...... ... ..... Pt1Yi`ER Or ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-IFACT Know All I%len icy These Presents, That Contirreald Casually Camp ay, an I I]ineis insurance company, National Vim Ins,jirnca C'.omp.my cr Hanford, an ill inn is insurance ewnirany.. and ANnerican Casualty Company of Reading, l''eonsylvanin. a Pennsylvania inSuraltae cMPally (herein called "the GNA Cempt mien '), are duly organized and a •isling insmmnee companies having their principal offices in the City of Chkago. and stato of Illinois, and drab they do by virine of thesignamres and scats herein affixed ltcreky make, constitute and aopotnC - Gary Grissotn, Randy Reynolds, Laurie J Barnes, Ronda Brown, Denise 1?ugon, James Russell, Ann Rodriguez, Kristie Rodriguez,Sllanna Wagner, Coy Sunderman.Individually of Austli; TX, their true and fill! power Mid autltr>riiy hereby r,¢nferreti to sign, sell and execute for and on flmrr behalf bonds, undertakings annd other obliwafory instruments of similar filature - In Unlimited Amounts - and to bind ilium thereby as fully and to the same extent as If such instrumenis wetc signed by a duly authorized officer of their insurancetompanies: and all the actS of said Anarney, pursuant to die authority herebygiven is hereby ratified and confirmed. 'Phis Power of Atuumv is made and execued pursuant to and by nu lionly (if the By -Law and Resolutions, printed on the reverse Hereof, dqly- adapted, as indicated, by the Boards ol'Direnfors offle insurance companies: In Witness Whereof, the GNA Uompanichave caused theso piesanis to basigoad by their V lee i'iesident and their'eorpomts-scals to be hereto. affixed oil this 22nd day of June. 2021, �eti�"� tit era ` rs,oa Continental Casualty Company National Fire Insurance Company of Hanford ' c°rsonera .abp'r"safe . Amerieart Calhy, Company of Re•ding, Penns}1wita it. SOUTH Monw- /�{y e 'ta. w.nm.++• .. ti : n MyConlmissionExpiresMareh2,2026 M.Bud / Notary.Public CERTIFICATE P'of id'FG853-Q4012' I t over'nger ifyou want.tavnr4 bond authenticity. lie AHthorizing.Uy-Laws and Resolutions AHQPTLC BY ITT BOARD OF DIRECTORS OP CONI INL1,11 Al..CASUALI Y COMPANY: This Power of Attorney is rieda and exeaoiml pursuant in and by aadhor ty of ilia lahowhig resolmipa duly addplid by dl:c Heard of Directors oftlie Calupafyat a mecting held on May 12, 1995: 'RF..SOLVU); 111a1. any guilder w Group Vice. President play nalhmize an iniTiccr In sign specific dacamants, ngreemerns arid insbluneriLs cn behalf of d,e Compnny provided that the name of sucn acdmried user and it d:soription rif the document, aprasments or instruments due such oiFcer may sign will be provided in w riling, by the Senior or Group Vice PreSfdnit to IBeSecromy, ofthe Conlptory prior In such execution becoming Ispecdve." Tnir; Power of Attorney is signed by Pau: T. Badll 1. Vice President, ivho bus been n thonzen mirs.imn to the above iesoluitop to execute power of attorneys on Lehalf afContinental Casuallyulimpally: fbis Power of Attorney is signed and scale() by facsimile under&id 13Y the aulhorihy al' die failowiug Resolution adopicil by llj Rapid of fhncemra orfat coutpray by uni n milts written, consent dated the 25" Jay of April, 2011 " Wilcruas, the bylaws of toe C:hopany or specific resolution ofille Hoard o'Divetorz [tag onthorixed Narrows ofhecre Cibe':4btlia;rixed f75sers'}[a uxavute varairs pcticics. bonds, undertakings and otter flIlAgnitory inerrumonts bfbke narnre;acid Whereas, train time tv time, fheafgrenure ofthc Aulhavied Uffiegrt, in addition to beingyror idud. is original,, bard copy formal, tinny baprovuled via f isiadle or odainybe, in an dectronleformat(collectively, "Rlcchcnie 9ignefures"): Now thururorcbe it rtsolvail: drat the chuil[olnc Signature of any Autiorind Offiac shall be valid nodbindingon Lie Company: " ADDI TEE BY THr BOARD] OF l)DIi•:CTORS OF3,1ATI }NALFIRG.. INSLIRrACL: COtMOANY O1; HAWYFD a This power of Attorney is nmde sand executed pursuma to unit by authority of Ilia follalrinz P"xohihon duly adiallcd by the Baard oP17:ieafor8 of the Company by unanimous suihcn cimsuntnated May. 14, 100 "RESOLVED: That :any Snmiur. or Creep Vice president niay uudmnw an oHirer to IL114;Pcuific doetimcnis, agreemenu and vlstnantaw an behalf of ibe Con pany proetded that file name of such autliorized officer mid a description nflhc documents, agreements of lrsliumeants tall suer ofTleitrmop stein will: be Tilly MWisr of A4orncy is 5iyned by Pml T BntRal, Vice (resident, wile tins Levi aW wa[4,ed prirment 1ti1hC move reiohnnoa touxeantC pows~w ofaltarrxyr on b lialfofNEdualal fire lnsurancee:cmpany of;iartlord.... . !ins Paver of Altomey lsslamred and seliecd by fictinii is under and by ;lie allillOrity Rf the Riliawiog Rassibgian adopted by the Bnmd, orDireclors ofilm Coulpmty uy'- untlniniallsir�ni[v'i'itk}nsarhfdated the 25"!dnyaFAVAI, 2012;,- "Whcilas, thehylawo,ofIlW Cmslpany U. spea0a mridubon if [lie orDireatous hla alatriu rkd Vsdo:r.ofit m(Ere"Anusirlsd OfGecrA�yho eaaaate variant relicies, bonds,uadcraair;i and ufhcr obligatory inshurne'r t oflihe nature; and "Phis POsear OfAtinhtry, is made andBsecided tuitional tc and by milloi=ly, tafthe fallowing reaplinloidthy stlop{Cd by the Hozrdtf Direttata a€the Company:be uniallwaki v iihan cousentdided May 10, 1993: - "RFSPLVJiQ 'flat any Senior or Group'V* President may mithodze an officer m sign specific ducunlaIII& nyrnemanls and iidtmmrtfts an behplfgf the Company ptdvllild loot ilia nmna of such nbblorita d ofticcf and a deseription oFilhe dacmncri agreanmds uz instromaats,ilrpf 3dci officer 'map sigan SYdIb. provided in vvAlirlg byllicScaiodor Group Vice Prsidcatta llieScareutry artlic Coi piny Prior to scoh aau Alf," ,fiar:uming+iffaaisys." Tbfa rilveer of Attorney i5 signed by PiwI f, HntAid, Men Psesidcrit, Who Inurlonan add lucroled (1[ir$tkail hi Ile; n1fnYGib$nlilifaYi to ex Dole poworof taille,ts an 6ahnlf{ifraniruicnn Cnsaalw Company of Raadutg,. Canns_rlvaaia. 'flus rower of AgGrnuy isgigned And sealaul by diabolic under and by the datllanYy of fee following Resolution adopted by llie Boardro6bactdts birdie campany bby nngnimous{vziiteu aotisentxfared ➢rt25" ii4yof Awd,2012; - sBWllcrgis. thin loylwai of did flmupmry.or specific otso liti on of the%use of Nreavoji l n;:mtficarna variaas otligeis (the "Au0hu'rized Othc rs^)io execute "t-lous poliaies..bonds: mticnakfngs and ahh:x a6liRtieA;}' inanlmenls of like nuotriv and - - LFSTCON.n1 nnnaAsr CERTIFICATE OF LiABILITY INSURANCE OATBVAMaDMTYf _. _ -1211712420. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS. UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE. DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES` BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI�AUTHORIZfD' REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the tenificate hoidar Is an ADDITIONAL INSURED, the pollay(ies) must have ADDITIONAL INSURED provisions or bo on ivniad, If SUBROOATiON IS WAIVED, subject to the Corms and conditionsol the policy, certain policies may requirean endorsement. Astatemenlon this certificate does not confer ri his to the aortilicate holder mite. ofsdch endomemen s . PRODUCER Texas Associates Insurom 1124) Ca of TX Hwy: South skin PHONE Fix w. S12327-8337 SAWN§Ea:�612328-7676 --- Austin, Tx 79746 a1 Ra A.t31TC0Natlo al insurance om n 20109 INSURED ;BITC0 General lnsu a Ga ■ ran • 20096 INSURER G:TexasMutual Insurance Company22845 Lester Contracting,.inc. P.O. Box 986 Port Lavaca, TX 77979 INSURER D: _. INSURER a INSURERF::.. __--.----- ..ter. rrrro Iru en:. REVISIONNUMBER' 1111O is TO GERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPOI.ICY PERIOD INOICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VUHICHTHIS. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED .BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS„: EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWNMAYHAVE BEEN REDUCED BY.PAID CLAIMS. F INSGRARGE a iUa PGLICYt1UUBFR. POIJCYEFF' MOL1CYEXP Uwi3 GENEaALL1AULM :EACH MWARtr{Ce 1AOE X OCCUR GLP37O09A9 12f31{2a2a12t31f2a21lte Poll lm 8,011 VMNSR; HJURY QUIT APj�PtI S�PeR:' �... G 1 LAADREGATE S Q,Da0,ODO L_l i B ... AU1OINEWIL€L1A04.171.'. CGh1LNNEGiiNGLEfIh11T `q ir0a9,DaD X ANYAVa p?.Vi9E60NLY' AP37aD989 17131/2020 '12r3112D21 rry es - a GI t9 Y Pere � E �OgJLED: X OS ONLY x vo vep OPE n _ 5 EACH a 5 $ X UMme"L1Ae ,..x OCCUR - sxcLsavLlAs CLAIMS -MADE OUP2817T39 : 1=1=2D.:12131f202'1 Ia:a +§ RETENDONe 10, O '. G RRKNEapsgGG�rI �p�SA ANDEMPLOYERs`LIAaITUTY x _ ANYPA ROORIPAR EWENECUL'YE AM A, MEXCL ED? L NIA 8FDa91298772 12f3f12a2D 12131Ma21 E3, EhSti ACCIOERT ,.l Oaa aaa. ! nI3EASE_@AE PIDY S 1.aDa.oap. ,J L.,_J M yy§LdRraiEe urWm _ A UESCRIPTt OF T eater LoaeetliRenMd ... .. CLP370D9it9 1213iCt44121S17RDT EL.IR Fi{6E.PIXxrY LIMT Per Mehl r. E iraaD,9aa 380000 OE6GRIPnOH GFOPERAnOn3iLOGAYlON6/vEN1CLE6 tACORD te1,AAtl116naIReM§riu SeMavle,mry Ee Ott§tluea Rcrcip§ae3 Wrpol' GUAL7nGudes blanket Addl lasumd.GLlimulS Pdmarymon Conhihutory, C,LtALiINC inalvdos Wankot aivaroi$ubroptiifon::3aDNOC apples (n8caplla days for nonpaymentj,Alf, provfelons apply whan required by Ylrinan tontnect, BHOUW ANY OF FOR INFORMATION PURPOSES.; THE EXPIRATION ACCORDANce YB AUnfOlin■a REPRESS D 26 (2D1SIC31 CID 198 The ACORD name and logo are registered fneriis of 'fHEATE DERSOE:,S NOTICE I aE CANCDELIV BEFORE DATE THELEDF', NOTICE yY1LL aE DELIVERED IN , TH THE FOLiCYPR0Vf810NS, NWIVE 11-2015 At:ORD CORPORATION. All rights reserved Arnan B12112021 SAKgov i Search An official website of the United States government Here's haw you know Search z vt >c.sl ccs Saved Searches e.g. 3605N020Q02, aspha Select Domain All Domains + Filter By Keywords Federal Organizations inter Code or Name Status II Active Inactive Resets sartby Showing i - i of i results Relevance Lester Contracting Inc Active DUNS Unique entity If) IfltpSrllsam.gav/searo}�i7fndeK=all&page.=SBsott=-retavarace&afm9'o5Bctatus9'w�'C3°id56isoaclfva�K;5CS=1�ve�sfm°hSBkeyvrords°Ja5fl°65Ei0%SC1%56key...; 1f2- 612112021 SAM-gov j Svrch 026959510 =SAM UniqueEntitylD VSFTEM85M881 CAGE Code IJMS4 PhysicatAddress 3677 Hwy 35 S, Port Lavaca, TX 7T979 USA Entity Registration Expiration Date May. 12, 2022 Purpose of Registration AflAwards Results ,perpoge < I of 1 > 25 =z— Feedback Our Website Our Partners Policies CustomerService This is a U.S. General Services Administration General Services Administration Federal Governmenicomputer system that is "FOR OFFICIAL USE ONLY."This system is subject to monitoring. Individuals found performing unauthorized activities are subject to disciplinary action including criminal prosecution. STATE OF TEXAS D AFFIDAVIT COUNTY OF CALHOUN {} BEFORE ME, the undersigned authority; on this day personally appeared _r,otd ftr7094zrt known to me to be the person whose name is subscribed to the following, who, upon oath says: 1 am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder In the matter of the bids to which this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not bid thereon. I affirm that -I am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, not intends to give at, any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount,trip,. favor, or service to a public servant in connection with the submitted bid, The contents of this Bid as to prices, terms or Conditions of, said Sid have not been communicated by the undersigned nor by any employee or agent to any other person engaged+in this type of business prior to the official opening of this Bid - Name -of Bidder (Company) -Trnz Fr,ruatxrtjfMt ice,&. Address po &,t okI J&eAOV f t :DE 77176 Phone Number (tl i)5 i» sin t�E FaxNumber /Q1 552- 9r)rJG' Emall Address,f} SWORN TO AND SUBSCRIBEDBEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are -true and correct, this 2.,(. day -of t 20 Z 1 . f,,+ 0IASNIE SCALES Ir 1' -Notary ID tA164088 MY Corm ilsion sxptra3 $re Octaber IVZ(in {'`� Notary Public in and for l..,&At� btkyt County, Texas CERTIFICATE OF EVTEIzr:STED PARTITS, FOILM 1295 Form 1295 must be Filled out online. The copy included is a Sample Copy Only. #I): Contractor's Name, City; State and Country #t2): Calhoun County, Texas 43): Infrastructure at Little Chocolate Bayou County Park —Playground Improvements TX GLO ContraotNo. 20-065-064-CI82 On #4 and 45, complete only the one that applies toy9 r C47�tpMIX #4: Fill in the correct information OR #5: Mark an X in the Box #6)t 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" He sure that all of 96 is completed and signed; Do not leave out any information. The form does net need to be notarized. It is an Unsworn Declaration. CERTIFICATE OF INTERESTED PARTIES FORM 1295 i.of+ Complete Nos I.4 and 6 it there are interested pSnies. OFFICE USE ONLY. Complete Nos: 1. 2, 3, S. and 6 if there we no interested parties. CERTIFICATION OF FILING Certificate Numben 1 Name of business. entity riling form, and the city, state and country of the business entity's place otbusiness. 2021-7691s1 Lester Contracting, Inc. Port Lavaca, TX United States pate riled. 06/2112021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County, Texas Date Ackhowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a . description of the services, goads, or other property to be provided under the contract. TY GLO NO.20-065-064-C182 INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK - PLAYGROUND IMPROVEMENTS TX GLO CONTRACT NO. 20-065-064-C382 A Name of Interested Party Nature of interest City, State, country (place of business) [check applicable) :Controlling .intermediary' Laster; Jr., Ken Pon Lavaca, TX United States X. 5 Check only if there is NO Interested Party. ©. A UNSWDRN DECLARATION My name is aEe aFEidhis My addrt:SS is � ., � V1`A .. ,... city.... '{state) ... (wuntry) I doidam udder penalty of pa}}lury, that the foregoing is true and correct, Exaeutadin 1��Y5CiV County,Siatenf ,an#ie�.l#ldayof �v-� -20al . _ ("In) (year)CL Lur,-y ' Sigwtira of"thoritad agentotcontracting business entity '. (Declarant}; Forms provided by Texas Edties Commission w&w.ethics.state.tx.us Version V1.1cerolgila Calhoun County, Texas POLICY OF COMPLTANCC SE C`110N 2252.908 TEAS GOYU1 RNMENT CODE Approved by Commissioners Court January 28,2016 Amended by Commissioners Court January 31,2018 AACKQ-R-QLND Section 2252.908 was added to the Govenimerit Code by the 8411 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 IntereWd 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 corpturation (whether for -profit or non-profit). The term "contract"includes; amendment, extension or renewat of an existing contract. The law does not apply to a contract between the County and another governmental entity or state alAncy. 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. entered into or amended on or after bratary 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) it contract with an electric utilityas defined by Section 31,002 of the Utilities Code, or 3) a contract with a gas utilit: y as dallied by Section 121.001 of the lAffifies Code - Notarization of Form, E295 has been Toplaccd by an intswom statement -under penalty of p6dury by an authorized representative tifthe business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal form1295.1urn. 'A business entity will generate Form 1295 online. Calho on County will acknowledge online the, receipt of Form 1295 after a contract Is executed. Within Moen business days, Form 1295 will, be available for public viewing on the CominissionN website. Calhoun Counity'Convulasloners Court will not consider for tiotioiWAny contract or bid with a business entity unless it 1 1 a 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 inter titan A qnJ0daysaar�0mnrmssiouees ODurtapproves a contract -at at awards a, bid with a non exempt business entity, the, County Clark will rile acknowledgement of receipt of the Form 1295 with the Mica Commission. Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned cortices, 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 offlceror employee of Congress, or an employee of a Memberof 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 modificatipn of any Federal contract, grant, loan, or cooperative agreement. (b) it any funds other then 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-Igbbying, certification be Included in the award documents for all subawards at ail tiers (Including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipierats shall certify and disclose accordingly. The Contractor, 3mmv. Qi �,2nc x� L 1;ar.._, cortices 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 at seq., apply to this certification and disclosure, If any. ` Date Disclosure of Lobbying Activities I£Not Applicable, contactor must mark NA and sign and date Approved byOMB 0348-0046a Disclosure of Lobbying Activities Complete lhis foam to disclose Lobbying activides pursuant to 31 U;S.C.1352 6Searoverse for public burden disclosure) 1. Type of Federal Action; 2. $tutusofFedcrolAction: s, ReportTypei it. contrast a. bidlallcrlapplieotiun Ortitiaifing b, grant b, initial award _ b. material change j e. cooperative agreement C. post -award d,loan For material change only; Ilk e. loan guarantee Kk Yoar_ rinnrter f loan insurance Dato0flast repmt 4. Name red Address ofReporting Entity: S. ifRopartingEntityinNo.4isSubawardee,Enter .,— Prima Subawardee Name sed Address of prime: Tier ,if Known; '. Congressional DistrictIf known: Congressional INstrict, if known. 6. Federal a Da rtmcnt/A ena : p.. g y 7. Federal pro gramPlatne/Description: 011-, T) J CPDA Number, lrappltcable: S: Federal Actian Number,lfkno".- 9. Award Ana ot. irknoivi VVN s 10. a. Name and Address of Lobbying Registrant b: Individuals Performing,Services(Inelydtngaddress y' fy'indfviduaJ, lust aamn Jirutr+ame. MIf;' dwarertlfMos No. JOO) flaarnahie, frif nam,4 Alf:'. 11. Information, requested through this form fir authorized by title 31 II.S.C.section 1352. This Sigaatura;. - Name: ilLKrtf disclosure of lobbying activities is a material mpresentattoa foactupon wldchreliancewasplaced print lJ3ti by the tier nbove:when this transaction was made or entered into. This disclosure Is required pursuant to 31 Title: An utirrt�t- US.C.1352. This information will be reported to the Oongress scmi-annually and will be available for publie / Tglephopa No.., fad S 7 Sn4 Date: b 71 hl.i Inspection. Any person wbo-thlla to file the required disclosure stall be subjeottoa civil penally of out lose " than $10,000 and not mom 64u S10U,004 for encit such failure. Federal Ilse Only - Authorized for Local: Reproduction standard Form -1.LL {Raw 7-97) INSTRUCTiONS FOR COMPLETION OF SF•LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awarded or prime Federal recipient, at-lbe initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant Willie 31 U.S.C, section 1351 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 aollon. Complete all Items that apply for both the initial filing and material change report Refer to the implementing guidance published by the Once of Management and Budget for additional Information. I. Identify the type of covered Federici 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. identifytheappropilateclasslflcatjonoflhtsrepDrt. If this Is a follow -tip report caused bya material change to the information previously reported, enter the year anti quarter In which the change occurred. Enter the date: of the fast previous IV submitted (apart by this reporting entity for this covered Federal action. 6, ifthe organization riling the report In Remo checks "Sub awardee,`:thon 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 retaking the award or loan commitment, include at least one organlzattonai level below agertoV'name, If known. For iiem"Je, Department of Transportation, United States Coast Guard. 7, Enter the Federal program name or description for She covered Federal action (Item 1). if lorown, eater the fug Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agraamente, loans, and loan commitments. S. Enter the most appropriate Federal identifying number available for the Federal action lderffffi id in ftem 1 (og., Request far proposal (RFP) number; fmltatlans for Bid (IFS) number; grant ar, nouncement number; this ed=proflrtes, o.g„ "RFpaDE=60--00i:' 0. For a covered Federal action where there has been an award or loan commitment by the Faderal'F enter the Federal.'emourit of the awardlfoan commitment for the prime entity identified In Item 4 or 5;; (b) Enter the full names of the ihdlvidual(s) performing services,and Include -full address if different from 10(a). Enter Last Name, FirstNama, and Middle Initial (MI). 11, the certifying official shall sign and date the form, printhlstner name, this. and telephone number.. Aacordir is fire Paparwark Reduagcn Aef as emended, no perms are requited W raepond to a collection of intarmagon enless g dlsplayS a vallddMB naahal Number. Tkte.valicCMB control numher for toils intarma9tog aoilect[on lst3tvl8 No. a9Atk gaga. public!epic(tong burden far thisaalleatlan at informanan Is abNmated to average t4 mtnutas;par respanxsi including time for revlawlrg lnstnmilans searGdng ex(sftig !Tate sources, gatherbg and maintaidin the'data ns�dad, and cam eltrg and revIe rlgthe,caltealI noIInlormatlon. Sandcommenisregarding tliaherdons$timeaoranyOthersapeataftlilsr liactlohof infarmaltan,1nduding suggasgons tar reduaing tnla'tsunien, to the QEiloa of Mami slhenC and tsudg0, PaparworkReductio t.: pro lit (03AM0 Sj, was mkin, DC 20503 Appreved by OMS 0348 0046 d. Have notwithin a tht a-yeat period preccdirig this application I proposal had iGulV l jxs. ^ anian !i ILt7f. Name and Title of Authorized Agent iStun ofAutftorized Agent' 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 deparhnent 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 withttbtaining, 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; a governmental entity paragraph (1) (b) of one or more public I am unable to cerkffy to the above statements. My explanation is attached.- Date DEBARMENT & SUSPENSION Executive Order 12549--Debartnent and Suspension Sou rec. The provisions of Executive Order 12549 of Feb. 18, 1986,appear at 51 FR 6370, 3 CPR, 1986 Comp., p.189, unless otherwise rioted. By the authority vested in ore 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 2. (a) To the extent permitted by law and subject to the limitations in Section 1(e), Executive departments and agencies shall participate in a system for debartncat and suspension from programs and activities involving Federal financial and oonfinaneial 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 prugtams and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment, See, 2, To the extent permitted by law, Executive departments and agei eies shall: (a) Follow government wide criteria and government-widd ridnimum due process procedures when they act to debar or suspcnd:participants 'in Wected; programs. (b) Send to the agency designated pursuant to Section S identifying information concerning de barred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Etteoutive Orders, This information shall be included in the list to bemairitained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any £xocutive department or agency has debarred, suspended, on otherwise excludrld (to the extent specified in the exclusion agreement) that party from participation in an affected program, An agency may grant an oxeaptionpormitting a debarred suspended, orexeludedparty to participate its aparticular transaction upon &written determinadan by the agency head or authorized designee stating tine reasons) for deviating frorn this Presidential policy. See. 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 ofManagernent 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 governrnent-wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See„ 6. The Director of the Office of Management and Budget is authorized to issiro guidelines to Executive departments and agencies that govern whichprograms and activities are covered bythisOrder, prescribe: government -wide criteria and government -wide minimum due process procedures, and set fordo other reh sted-details for the, offective administration of the guidelines, See.I The Directorofilia OfFico'of Management and Budget shall report to the President within three, years of the date ofthis Order on Federal agency compliance with the Order, including the number of exceptions made under Sect7on2(e), and shall make recommendations as are appropriate furtherto curb. fraud, wnste and abuse. Implementation in this $ Programs Additional ):references' C dU C.VA.Part h: EPA Regulations on Debarment and Suspension, Conflict of Interest Questionnaire Form CIQ Every contractor doing business with the County or seeking to do business rvitb the County must complete Box l and sign and date in Box 7. Whether or not a conflict exists determines the other information to include to include on the farm. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO for vendor doing business with local governmental entity This questionnaire reflects changes mada to the law by H.B. 23, 1141h Leg., Hegular Session. orFTcE LISEONLY This questionnaire. Is being Bled in accordance with. Chapler 176, Local Government Code, by a vendor who Date BwolVbd has a business relationship as defined by &Orion l76.0g7(ta) with a local govommental entity and the vendor meets requirements under Section 176,006(e). By law this questionnairo must be filed wllh the records adminishalor of the local gcvemmenlal enfily not later Than. the 7Gr business day altar the dale the vendor becomes aware at fads that require the statement to be filed See Section 176.006(wl), Local Government Coda. A vendor commila an offense it the vendor knowingly Violates Section 176.006, Local Government Code. An offense under Nis section I& a misdemeanor. t Name of vendor who has a business relationship with local governmental entity. 217 Checkitils box If you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire wdh the appropriate tiling authority not later than the 71h business day after the date on which t7 (� you became aware that the originally filed questionnaire was Incomplete or inaocurele.), S Name of local government offfooraboutwhom the information Is being disclosed.: tY�Yt biome of Oflicer a nescribe each employment or other buslhes8 relationship with the local government officer, or a family member at the officer, as described by Section 176,003(m)(2)(A), Also describe any family relationship with the local government officer. Complete subparts A and B for each ompioyfnentor, businoss relationship described, Attach additional pages to this Falra. C44 as necesaary A. Is the local government officer or a fan, Ily member of the officerreceiving or likely to recaiVe takable income; other than investment income. from the vendDrt Yes' FlNoy B. Is the vendor receiving or likely to receive taxable Income, other than Investrnenl Income, from or at Lhe direction of the local government officer or a family member of the offloor AND the taxable income is net received from the local governmental entity? Yes No s Ceeorlbeeachemployment Orbusfnesseflatiopshipthatthavendornamed, lnSectionimalntakswlthacrrporstlanor othar business entity, with respow ie which fho igoel government officer serves as an officer or director, or holds-an awriershipinterestofOne porsemtormore. " 6 ❑Chack this boX If the vendor has given the local:govemmeht officer or a family memberof the off car ane or more grits as described in 156cflan 176.003(a)(2)(B), excluding gifts described In Section 176.003(a-t). tF T Signature afndoe doing business wAh the govornmenlal anoly ; al► � pomlprovldsdby7exasEihiesCommission www.athks,sttte.tx.us:. - pevlsad-nMoj2o75. CONFLICT OF INTEREST QUESTIONNAIRE For vendor doling business with local governmental entity A complete copy of Chapter 176 of the Local Government Code may be found at http:/Avww,statutes.legiu.slale_tx.vs/ DocsnG/Mm/LG.176.1itm. For easyreference, below are some of the sections cited onthis form. Local Government Code 6176,001(1-a): "Business relationship" means a connection between Iwo 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 transaotton conducted at a price and subject to terms available to the public, or (C) a purchase orlease of goods or services from aperson that is chartered by astate or federal agency and that is subject to regular examination by, and reporting to, that agency. local Government Code S 176003(a)(2)(A) and t131 (a) A local government officer shelf file a conflicts disclosure statemenlwith respect to a vendor it: (P) the vendor; Mding the date that the officer becomes aware that (i) a contraot between the local governmental entily andwendorhas been executed; or (if) the local governmental entity is considering entering into a contract with the vendor, oiflearbacomasawarethatr , (I) a contract between the local governmental entity and vendor has been executed; or (11) the localgovernmental entity is consldering e'ntaring into a contract with the vendor, Local Government Code fi'176.006fsi and (a-1) (a) A vendor shall file a completed conflict Of interest questionnaire If the vendor has a business relationship with a local governmental entity and: () has an employment or other business relationship with a local government officer of that local governmental entity, ore, family member of the officer, described by8ection 176,0b3(a)(2)(A); (2) has given a local government officer of that Local govemmental entity, or a family momber of the officer, one ormore gihswiUithe aggregafevaluespecified by Section' I76.003(a)(2)(B), Otluding any gift described by $action176.f)03(a-1); or (3) has a family relationship with a local government officer ofthat loctilgovernmenvi entity. (a-1) The completed_ conflict of Interest questionnaire must be filed with tho`appmpriateroeordsadtrinistrator not laterthan the sertenth business day after the later of (1) the date that the vendor: (A) begins discussions or negotiations to enter Into # contract with the Ideal governmental entity; or (B) submits to the local goverhmental entity an sppliCation, response to aregtlestfor proposals at bids, correspondence, or another vatting related to a potential contract with the local governmental entity; or (2) the date file vendor becomes aware: (A) of aft amployment or other business relationship with a local government officer, or a familymember ofthe efffcer descrtbedby8ubsaCffen (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) Of a family falatlonship with a local gpvetnmentofficer, n provided by Texas Eihlve Commisslsxa ivww.aEhias.sfate.ix.us Revlsad :11MQMO16 HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 I, A„, „I Ak k'< . the undersigned representative of Representatlue crtJt T CNNe - (hereafter referred to as Company) berg 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,.. 2. ,rfp�2l��.�Zj Data RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252,001 et seq., as amended, Calhoun .County requests Residence Certification. §2252,001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below; Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident, (4) "Resldent bidder" refersto 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. Ef I certifythat - is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (City and State) ,. a I-certifvthat /J-7Cd 6N4Ac=Y—')Ais a "Resident Bidder" of Texas as: - ,tC�mvarn Nam�j.... defined in Government Code §2252.001, Signature of Aut rlted Agent Rat /) r"Berx ,14 Al—= Jetyl 0 Printed Name and Title of Authorized Agent Date W-9 Request for Taxpayer Give Form tothe Fmn tRrr. f3ctahBr zOta} Identification Number and Certification requester, On not Depadmand Bi the Treasury send to the IRS. Intemel Ravtnet Seruxt ►Go to www.lrsgovlFormM for instructions and the latest information. t Name{as 3rown on year income Tnx mluro}, Name is ragUBeacntles fine; dons teaveth.0 One blank. Lester Contracting, inc... 2 Business name./dlsregardad entity name; 9 didamn; from above +n m 3f;Wk appmp'iale bax for federal tax class1knation of the parsonwhnaa name is orders on finer Check only one of The a Exemptions toddles apply only to fotltwirigseven a bnxAs. s @ conatn entRiW see a S 1rAlVid:lilrmla peprictoro. ❑'' GCorpasalm D 8Corpomtwn ❑ Pnomrship ❑ Vbnyestais lnsirontiCna frogs sic cn page . c single membuTLLG Exempt payee mod§ (if §nyi too[,] timidtt llahilftY company, Enterihe tax nay.,p{setlon{C�Ccnrponitnan.$_S condemner, P=Parme ehlpj►. a Mote; Check the appropriate box In the line above forthe tax clans€ncollon of the single•mombor owner, ponot.Check Exemption iron FATCA rapompp ; a LLC If the LLC is tiaaslhtd as a sI re-mamber LLC Ilan is dlsre-ardad tram own er ner onto= me ow LL nor of the C is anolher LLC that is natdisregardd irean thecwnafurir.S. federallax purBCeas 01herwl5e,asingls•member LW lhal cocepf any} -- s %disregarded from the owner should check the appropriate box for the taxclassmcakon of its owner. ❑ other Ism Instructions)► W,+ idrm�sawumnua:esi m.m.c+e us , rq 5Address [nUmtior,West, and net, asvltgnot) Soo irrghurflans naquss[efs arms and oddress(aptfonalj m we PO Box 986 _: CALHOUN COUNTY 8 Gty, slats, end 2lP wee 702 S ANN ST., PO PT LAVACA, Tx 77979- Pon LaVAd,_TX 77979 __. _ _d361-553-4610 FAX-.361d53.4614 7 List eFWintarmbeK,$)tleratohtionaq Taxpayer Identification Nurnber (TIN) tmer your l IN in trite oppropnare aox the TIN provided must match ere name giver -ern line 1. toaveld I about secureynomaer. r backup withholding. Foriet ir, rrdisrais is gGeemlly your social security ctions number(SSN). Howlluir'ora _ , rGsidofr[ aran, solo proprietor, or disregarded entity, she the instructions for PGA 1, Inter. For outer entities, it to your Empidyer idant8icallon number (EIN), Ifyau do not have ek number, see Now to gates 77N" Woe. or Note.it dnoaccauntis-in mare than ongname. sea:the tnsfruetfons for lino 1. MOW What Nameand EmptavartdeMiltaeuon numttar Number To Give the RequeshvIlbr guidelines on whose number to enter. r 7 4 �) 1 8 T B 1,.. 3 8 19 Ma CorkiNcat:ion lJndar penalEias orparjory,lcedify that: 1. The number shown on this form is my canal taxpayer identification number for I am waiting for a number to be issued to rmfi; and , 2, t am notsubjeatto backup withholding becausin (a) fare exampt irornbackup withholding, or (b) Ihaw.nat boon nohped by rho letomat fdavonr,4 :.. ServToe, (IRS) that am subject to backup withholding as,a result of a fahum to report all Interest or clMdends, or (a) the IRS has rotpied me11hat f orn no longersubjeet to Ironton v{ithboldingt and 3.1 am a':U.S. cpizen ":other U.S. parson (defined bestow); and 4, The FATCA cade(s) entered on this; farm (if any) indicating that I am exempt from FATCA reporting is correct. Composite" instructions, You must croaaout itam2 above it you have been notphatc! by the IRS that you are currently sua)ect to backup wiltfidlding because' you have falled to repart all Wariest and divldendsanyour tax return;:For real estate transactions, hem 2delta fiat apply -For mortgags interest paid, acgriisithm or abandonment of secured property, cancellation of.det4,. comntrotk ed; to on Individual re.hementasmngemem (lulu and generGGy, gaymertts other than Interest andArvldands, you we not required to sign the oerthrostion but you must pmvtde.your corracG11N:Seothe kistrucdio7sforlood It, iatec. Sign 6lgnansa ot Here u.s.pGreoaffc (',,.J�,W �3SL''+"•`J._,: Pate, �ri �Z11 General irl5trueticIns • Form 14f99-D{V (dividends, in eluding those ,trGm sioda; tor nodual funds) Section rkfarences are to Ilia Internal Revonua Code unless otherwise „Form 10s i-MIME (various types of iklconao, prizes'.awarda, or grass noted. prpceads) Future developments:. For tide falked information about developments . Fogg 1099,9 (stock a' mutual fundsa(es and tsartala atifGC related tb Form W-D and its Instruction o. such .as legislation enacted Ir msactions bytuokent) after they were published, go to wwWJrr"oV1F0rmW9. Farm 10g9-S tproceeds from: real esiateir`dnsactinh&j. Purpose of Form - • Perm 1099-K (merchant card and third party netwmOransea8ons):.. An Individual or entity (Form W g requester) who Iss-required to file an .. Farm 100 (home mortgage lnferast), 109&E (student Icar lntemad} information return whir `the IRS must obtaln your carreaAte payei. 1098-T (ruttier) identification number CTIN) which may be yoursocial security nur°iber .;Form 1099-C(canceled all (SSN), individual taxpayer fdan0ildaNdn number hTIN), adoption .Form 10g9,-A (acquisition ar atrandonmant ptseaured propiirry) taxpayer ldentlpaa,Han rxtmbaT (AMM, or employer Identification number (EIN), to Yopart do an rtltormatipn Tehnrtt the tabountpafd to you, orother Use Fenn W 9 only if you are a U.S. person (inalud(hg a resident amount reportable bhan information rsmm, Examples of Marinello alleN, to provide your = et(TIM returns inptode, but are not limited toithololicWthg. ttyou do not retum From l•1+-.,9 to the requesterw/tha 7)*, you mrpht • Fotm it;ss-IFIT [interest eafitad or palEij, be sufilecttabo kup withAWdind. SeaN7tet batdtttp'vrlttltiotding, later, . cot:No. 1023i% _. FoanWA.';(Fil 1e10181 ASSURANCES - CONSTRUCTION PROGRAMS oMe kumter. 4040.0009 Publio reporting burden for this collection of information is estimated to average 15 minutes par 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 FMoct {0348-0042), Washington, OC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE Certain of these assurances may not be applicable to your projector program. if you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may raquire applicants to certify to additional assurances. If such is the case, you Will be notified. As the duly authorized representative of the applicant:, I certify that the applicant: 1, Has the legal authority to apply for Federal assistance, 8, and the Institutional, managerial and financial capability (including funds sufficient to pay the non -Federal share management and completion of project described in this application. 2.Will givathe-awardingagency, the: Comptroller Gene ` of the United States and, if appropriate, the State, the rtghtto examine all records, books, papers, or documents related to the assistance and Will establi. a proper accounting system to accordance wfft7 generally accepted accounting standards or agency directives. 3. Will notdtapose of, modify the use of, orchange the d' Will comply with the requiratnents of the assistance . approval of construction plans and specifications. a 7;, Pr®vlaus ti iltcp Usable 9. 10. Atigibrized far bodal Reproducflon' Slandatill Form 424o (Rev. 7,97), - Nesedbed by 0Msii,+C moor A702 11. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real ProperlyAcquisilion Policies Act of 1970 (P.l. 91-646) whichprovide forfeit and equitable treatment of persons displaced or whose property Is acquired as a result of Federal and federally -assisted programs. These requirements apply to all interests in real. property acquired for project purposes regardless of Federal participation in purchases, f2. Will comply with the provisions of the Hatch Act (S U,S.C. §§1501-1308 and 7324.732B) which limit the political sotivit)es of employees whose principal employment activities are funded In whole or in part with Federal funds. 13. Will comply, as applicable, with the provisions of the Davis Bacon Act (40 M.C. §§276a to 276a-7), the Copeland Act (40 U S,G. §276c and 18 U.S,C, §674), and the Contract Work Hours and Safety Standards Act (40 US,C, §§327- 333)'regarding labor standards for fedemllyassisted' constnlclion subagreaments, ' 14. is, DYING taFFtCtAI ) Federal actions to State (Clean At* implementation Plans under Section 176(c) of the Glean Air Act of 1955. as amended (42 U,S.C.. §§7401 of seq,); (g) protection of underground sources of drinking water under the ;cafe Drinking Water Act of 1974, as amended (P.L 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L.93-205). 16. Will comply with the Wild and Scenic Rivers Act of 19M (16 U.S.C....§§1271 at seq.) related to proteciog components or potential components of the national wild and scenic rivers system. 17. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 196% as amended (16 U.S.C. §470), ED 11593 (identification and protection of historic properties), and the Archaeological and Historic' Preservation Act of 1974 (15 U.S:C. §§469a-1 at seq), 18. Will cause lobe performed the required financial and compliance audits in accordance with the Single Audit' Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non -Profit Organizations," 19. Will comply with all applicable requirements of all other; Federal laves, executive orders, regulations; and policies governing this program. 20, TITLE DATE SUBMITTEfO,... J . V SF-424r7 tRey, 7-97) Backe GrrnW:sutvaripiepr �— � Warp !lira dxamenrina aDPca,.!e. Mce Texas General Land Office Community Development Block Grant (CDBG) Disaster Reoovery Program "''" Contractor Certification of Efforts to Fully Comply with Employment and Traln ng Provislons of Secttatl 3 Economic Opportunities for Lott/ and very Loin'-lncomePersons THE BIDDER REPRESENTS AND CERTIFIES AS PART OF ITS BIDIOFFERTHAT IT: E Ise -Section 3 Business Concern. ASection 3 Business Conce n means a business concanr. i, That isSt°/dormom owned &j Section 3Residenl(s);cr 2.. Whose palmorrant, full -into employees include persons, at least 300/ of whom are currently section 3 Residents, ar 3. Thatprovidesw4denceofacomarhmanitosubconbactina)cessol`26%orthe doltarvalue(if ell sybconkacislobe awarded to $action 3Business Conoems; that meal die qualifications set forth in paragraphs i or 2 herein, . Is NOT a Section 3 Business Concern, but who has and will canikiue tb seek compliance with section 3 by certifying hie fallowing eitorls to. be undertaken. EFfORTSTOAWARDSUBCONTTHACrORTO6ECjQN CONCERNS ' (CheckAM that apply) ' EI By contacting businesserssIstaince agencies, mukUlly contractors associations and community organizations to Inform Ifiern at the contracting opportunities and requesting tboa assistance in iderblying Section 3 businesses which may solicit hills for a portion of the work By adverlisIng contracting opporlunitias by; posting helices, which, prowde general infwrnaSon aboof the work to be contracted and More for. obtain addllionai informaGam, In lhocommon areas of the applicable developmengs) owned and managed by the Housing Autlrarhy„ By pfavtdjN Witten notice to OlVknown &eolion 3 Business cancerns nrtt of eon opporthas, Thls notice should be in suNcient time ks allow the Seegon 3 Basinons Concemsta respond to bid invitations ❑- By following up with section Business Concerns that have espressed interest in the contracting opportualties.. Ej By cobrdlnar ngmeetings at which section 3 Business Concerns couldbe informed of spebllle elements of the work tiri"which subcontract :., bids are being sought:. By conducting workshops on cantrachngproceduresand pecirieconbacBngopportunitiesinalimelymannersathataectionBBusiness. ' Concerns partake advantage otbontrachn; opportaniglas! BgadulcingSeaAan3Business Cancsrnsis10whae6,seekassstancefaovercomabarderssYrchasth biltytoobtain bond ng,linesof orediL financing, or insaranco andaiding section 3 Businesses in qualifying for such tiontling, Mancang, odors ca, etc...., ❑` Where appropriate, by brgaking out contract work into econom[cal ty feasible untts to facigiato perticipation by &action 3 businesses. By developing and using a list of eligible fthan 3 Business concerns Byactivafysupporting arid undertaking jamlventures with ;s io-n3Businessas. tFFORT&.f62MVIDETRALNIN(iANOENIpLO ENi7OSEC lO 3RE61DENTS [] Byanteringfntaa'frstsourte'',hiingagraemnlswiihorgdnizatfonsrapr8sanfng5ecdati3Resdants. By estoblishing'h'aining programs, which are consistent MIN the requirements of fie Daparhneni ofLakor, sp�5caky fat section 3 Residents in ttie building tmdps Q ByadvarlieingamptgymentandeainingpositionstodwellingunitsoccupiedbyCalagcryI and2reddarts. Byconta6Vng residept couneiis,and ether mddcnt organization In the affected housing development to requestass stance in noilfytng residenikoftfutVeto ingand em mymenippsidbnstaba.egad. '- Q ey arranging intsrviawa and conducting ihtary ews on thelob sita. ® 8y undertaking such c 1hroadjDII- raining elnorts as maybe necessary to ensure the continued employment of Section 3 R%Idenls' Prat/ csJyiaredforemploymentapp«tirniCuak E BypiatfinglobvacandaskWoritfn= s asprrittlmyloralWorktorcosofu&ansCenlee: Contractor NamelSmsin."s Nat iN Ljslt-� 6atnerisrrk6 a t'. AutharizedRepTos+niativaNamg: �lNnr) �i�ic�R�s 6igriaWra: =-.� r Date, /i/xf/XPZ1 DOCUMENT NO.00415 CONTRACTOR'S CORPORATE RESOLUTION I hereby certify that it was RESOLVFD by a quorum of the directors of meeting on the 14." day of `T'iav �Ak 20 2_ta i that be, and hereby is, authorized to execute all documents necessary for the transaction of business in the f, State of Texas on behalf of the said CUP kttt + 13 A :iiA C. and (Raao of Corporation) I That the above resolution was unanimously, ratified by the Board of Directors at said meeting and that the resolution has not been rescinded or amended Ltd is!now in full force and effect; and in authentication of the adoption of this resolution, I subscribe my name this day of jMT , 20 '�Zj Secretary Ifyou are not corporation, please check the box and sip below F—I, Company Name- SignedBy' PrintNameNitle END OF DOcumcN1' 00415-1 DOCUMENT NO.00416 4 NON-COLLUSIONAFFIDAVIT rmAVIT State of :Ff--x'As ) Countyof Cat.-iar�aral i,4+�i tla+tv5 being first duly sworn, deposes and says that: i. He is p��:> tt rzn taz of �L 1tY trnvrnwr nft- L . the BIDDER that has submitted the attached Bid; 2. He is fully infoimed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid;, 4. Neither the said BIDDER nor any of its officers, partners, owners, agents,. representatives, employees or parties in interes4 including this affiant, has in any way, or profit or cost element of the Bid price or the Bid price of any, other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOIUN C0UNTY (OWNER) or any person interested in the pxoposed Contract; and S. The price or, prices quoted in the attached :Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including Subscribed and sworn to me this' lvty,comrnissonexpires 7 tkn END OF DOC VMl5NT 0(Itltb'l Notary public =NLD64 1222 DOCUMENT NO.00417 TRENCH SAFETY SYSTENJS INDEMNITY AGREEMENT OWNER: CONTRACTOR: ENGINEER: PROJECT: Calhoun County (company name) G & W Engineers, like., Port Lavaca, Calhoun County, Texas INFRASTRUCTURE AT LITTLE, CHOCOLATE BAYOU COUNTY PARK - PLAYGItOVKI) IMPROVEl4IENTS CALHOUN COUNTY, TEXAS TEXAS GENERAL LANDOFFICE CONTRACT NO.20-065-05d-C182 AND CALHOUN COUNTY 2020' CDBG-DR CONTRACT WORK ORDER NO. E-1. entered into a contract with OWNER for the construction of the Project fined the Project on behalf of OWNER, but has, not designed. any trench said CONTRACTOR, as pant of its consideration to OWNER for the contract for tiie construction of the Project, agrees oat It will be solely responsible for compliat'ice with its trench safety plans and with all applicable standards of federal, state and/or local laws relating; to trench safety; CONTRACTOR further agrees to hold harmless, Indemnify, and defend OWNER and ENGINEER, and all officers, agents and employees of either OWNER or ENGINEER, from and against any and all claims, demands or causes of action of any nature, character or description In oouacctloa with the presence, or in any way arising out of, the use or construction of trenches or EXECUTER, this day of 2{) OWNER` �COntraClOi"S weal) By: Officer's Name: Richard II. Meyer Title of Officer, Calhoun County Jude; ENGINEER BY; Engineer's Name.- Scott P. Masan. P.E Title of Ful nmr: Sr, Project Bug! END 0FDOCU1VIE NT t}tlAl7-1 DOCUMENT NO.00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional Information it desires. Date: GJz.I ,b7-02.1_ Bidder (Legal Name of Firm), ice, rt'P(oAsm, rau.. ;T' ! Date Organized: lff5711 Name of Owner(s): L&N UsmP- a - Address: Bate Incorporated: Ic-j i Federal tD Number �� Itp7to:35f Number of Years in contracting business udder present name List all other names under which your business has operated In the last 10 years: Work Presently Under Contract: Contract Amount $ Completion Date s Type of work performed by your company.': ~ ilFr r r �f pn ir, ii jdrrixrrP_" Tr _ tuyca, pvtniv auaV,aaummwy va umaana•u„ a Dupa,ays 01 me cause and resolution) Have you ever defaulter! on a contract? 0 Yes Q (If yes, please attach summary of details on a separate sheet.) f explanation of Has your organization had any disbarments or suspensions that have been imposed in the Nt'five year's or that was still in effect during the five year period or is still in effect? n Yes o (if yes, list and explain; > such list must include disbarments and suspensions of officers; principals, partners, members, and empioyees of your organization.)` List the projects most recently completed by your firm (Include project of similar importance): Project Amount $ MoNr Completed. ( iarr- u Arm( C�l Major equipment available fcr this contract: Ce}711Urtl® :qulrements? vy'.. 0 Nn C04204 Are you a Section 3 business? (sea below) o Yes JNo Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipient's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low income persons. Bank References Address: Contact Name: City & State: Vkf mrcx)a. 7x Zip: 77 Phone Number (bi } 5n rprstP Credit available: $ 1, I13ob aoo Has the firm or predecessor firm been involved in a bankruptcy or reorganization? a Yes too (if yes, please attach summary of details on a separate sheet,) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder overthe last five (5) years with amount of claim and brief description. List on a sheet attached hereto • all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years -and brief explanation of claimand outcome. Attach resume(s)for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project; Oi...,...t Printed Name and Title: Zqnlay W{+AW-6 :. Subscribed and sworn before me this Zl day of art 20 t Notary Public is 5lgnature: DIANNE SCALES -r.� I\f ''FOP Notary ID�47�S4 84. Itfit 114't - Li 7hy CommiWbn 9)(00O3 Printed Name: �c l c S:- coma=r a, , fexx Commission Expires:.lb 3 t -z-2- The penalty for making false statements is prescribed In the U. S. Criminal Code, 18' U.S.C. 1001' END`OP DOCUMENT` A04204 Total Staff Employed by Firm Managers — Es Superintendents — 3 Foreman —10 Opera tors --25 Pipe Layers —20 Labors -20 Office Staff — 8 o O E E E N E 4 € ry V 'e. O Y E N M 6 T m m . o a l' rk L W d `v m 1 �27 a Q u ro J OC O 2z 2 d c . t It .0 15 o M of aQ IQ m is Z'. Lul WLIJ gr O 4 AU CidGg C C. LN O ej n�Y m�eo 4» s, r u a L a o E` o£i Cat 330 Excavator Cat 329L Excavator Cat 325D Excavators (2) Cat 324L Excavator Cat 320CL Excavator Cat M6 Excavator Cat314 Excavator Cat308 Excavator Cat301 Excavator Cat D6N dozer (2) Cat 140M Motorgradere Cat 140H Motdrgrader P.O. Box 986 . Port Lavaca RACTMNc,- • 77979 • (361) 552-3024 - FAX (261) OWNED EQUIPMENT HEAVY EQUIPME14T TRUCKS Cat42OF BackhoetLoaders (2) Cat430 Backhoe/Loader Cat 924F 2 - G.Y. Loaders (2) Cat 926 Loader Cat950 Loader Cat 725 Articulating Dump Truck Cat Compact Track,Loaders,(6) Smooth & Sheepioot Compactors Tractor & Shredder or Offset Disc Rental Equipment as Needed Haul Truck with 50 Ton Lowboy One Ton Truck with Gooseneck.Traller 14 C.Y, Tandem axle Dump Trucks (9) 2,000 Galloh Water Truck 20 C;Y End or Belly Dumps (4) 3,000 Gallon Water Trucks(6) MISCELLANEOUS EQUIPMENT Pickups Electric & Pneumatic Tools: Crew Trucks: loot Sheds orJoh Shacks Air Compressors w)zn.Hoses . Chain haws Centrifugal Pumps:Wth Hoses Concrete Breakers Timber'Dragline and Crane Mats Compactors Generators Noted We Isasa'or rent.equipment as needed to supplement Our owned equlpmenk. D6,yhacumWiulLcl D6eu.mmvtWwd List i . 040M 4:59-PM. DOCUMENT NO.00430 CONTRACTOROS LOCAL OPt0JRTVNffY PLAN Lz3rrx agrees to implement the following specific affirmative action steps directed at increasing the utilization of lower income residents and businesses within CALFIOIIN COUNTY, hereinafter called OWNER, A. To ascertain from OWNEWs CDBG-DR program official the exact boundaries of the project area and where advantageous, seek the assistance of local officials in preparing and implementing the affirmative action plain. 13, To attempt to recruit from OWNER the necessary number of lower income residents through local advertising media, signs placed at the proposed site for the project, and community organizations and public or private institutions operating within and servicing the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (01C), Urban League, Concentrated Employment Program, v:..«.,�+....:., btu«--#T—rre n,.,«r...,..,e.,a Q—:,., - C. To maintain a list of all lower income residents who have applied either on their own: or on -referral from any source, and to employ such persons, if otherwise eligible and if a vacancy exists., A To require all subcontracts to have an affirmative ative action plan including utilization goals and the specific steps planned to accomplish those goals, E. To insure that subcontracts (greater than $10,600) which are typically lot on a negotiated rather than a lid basis it areas other than the covered project area are also let on'a F. G. To formally contact unions, subcontractors; and trade associations to secure their' cooperation in this effort. To insure that all appropriate project area business concerns are notified of pending suite contractual opportunities, eta„ which L To appoint or recruit an executive official of the company or agency as Equal Opportunity officer to coordinate the implementation of this plan,` J. To maintain records concerning the amount and number of contracts, subcontracts, and, purchases which contribute to objectives. 06430-1 K. To maintain records of all projected work force needs for all phases of the project by occupation, trade, skill level, and number of positions and to update these projections based on the extent to which hiring meets these Local Opportunity objectives. As officers and representatives of /_r'Mz we, the undersigned, have read and fully agree to this Plan, and become a party to the full implementation of the program and its provisions. C ?�/ /'t 1� SiBnatore _ -; printed Name ri.S'rtr'� t bate Title IErm Or, DO UMENT 00430-2 DOCUMENT NO.. 00440 CONTRACTOR'S SUBCONTRACTIWORY(FORCE BREAKDOWN .0I PROPOSED CONTRACTS BREAKDOWN S4}' 6. i i,�i s - - rCRntrnata "`�G,iVujnbe`r,'Bf „3 ,CCohipa¢ts, ' `v3(imdteil`PCgta1IF.+filhr�lmooht� ;;^' Tiusi`ness ..,.� SfGe'hs1 , :.::�: PaYr�uu� GausF- 5uu'i' v � _ mL<tar=_ k_ a �m� x .tr n•; �_. +.,. yx, o- m .. �:Y _ .r�vt...,a+. W3_.: MFT#3tr'2 £:.i�.'r,o_ .�"_.5 aI .r1 Y.�jfiY ..t'r Y{ :—r..x+�l .02 ESTIMA.TED PROJFCr WORKFORCE BREAKDOWN wY�rk ' sssl a do sss...s i'.`3 s a.«Fii n � 8t S.7''t G� . ,ta't t n, .ahlted..:s 7'" ti�Sr�rc u {liigd.t,.s= ..._ r,�ni!651�F asiribnf&. `aiGdY+oni4ons..r+�'��nrxeof �v. n. t?•.:r.. ..s * aS'Met. >n. � 'e u-:� JA to .[T ,-. � :fV�4 � .r".�� JL,; t ia..4 t fit. atr END OI, DOCUMENT M40-1 Instructions far Proposed Contracts Breakdown and Estimated Project Workforce Breakdown Proposed Contracts Breakdown for Section 3s' Tyae of Contracts Ast all construction, materials; or other types ofsuboontraots (for example: electrical, plumbing; concrete, boring, etc.) ND of Contracts —Amount of contracts under this category ANAR&jmate Totat DsIWrAmuunt—Total amountofeach contract Estimated Percentage of Cemract to Local Business —What percentage of each type of contract will be awarded too. Section 3 Business Concern (see below for definition)? For example: will you h4v any local employees or subcontractors? Estimated S Amount to Local Business - Flow many dollars will be spent locally Poi• each type of contract? For example: will you hire any local employees or subcontractors? Estimated Project Workforce Breakdown gr r4 k ClasslArations —Classification of project employees as defined on \'Naga Rate Total Estimated Pnait€Ona =List the number employees for each work olassiftcailon will you aced on tuls project Number ofPositicns Curtentlu Filled -List the number of estimated positions you currently lsavo filled b) Businesses whose perrt mmir, fully Section-3 residents, orwithin three cj Businesses thatprovide evideneeo; of all subcontracts to be awarded to d) Businesses located within the Gran ned by -Section 3 residents, nnnitmenttosubcontraetin excess oft. lenses that meet the qualifications descl picd6 jnrlsd€ction that identifies therm o opportunities for low- and very low in ant of whom arc cuoently irin were Section 3 residonist ercent of the dollar amount ni Abo've; or ves as Section 3 Business me persons. DOCUMENT NO.00450 C0NTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiting Federal Contractorto adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights: ,NAME AND ADDRESS OF BIDDER (include ZIP Code) Fa tGq t'x CERTIFICATION BY BIDDER Bidderhas participatt Ina previous contractor subcontract subject to Civil Rights Laws and Regulations.% ti7 Yes ❑ No The undersigned hereby Gertifiesthat The Provision of Lassa! irsintnq mulayment, and Business Opuartunitles clause (Section 3 provision) is included Iti the Contract, A written Section S plan (Local Clpporlunily Plan) was prepared and submitted as part oflhe bid 1proceedloas'(if bid equals or exceads $1007 000). P the ggUal 9pilnity clause is included In the Contract (if bid equals or exceeds $10,000). �/The Section 503 clause is,included in the contract Have you ever been or are you being considereddf rsanction due to violation of Executive Order 1124s, as amended? 13 Yes 9 No JVAtuit AND TITLE OF SIGNER (Please type) pry r�7aNrocra. SIGNATURE DATE e 60450-1, SECTION 604 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The k59L1Z retiyrL�<arx7irar, does not discriminate on the basis of disability status in the admission or access to, or treatment or employment In, Its federally assisted programs or activities. (Name) ,IZ57T2, &NrL..!r-Trw- 2156. (Address) PC) qu, filar--, 1A14 4 -5( City State Zip Telephone Number (`36i ) 5.62 - 1�1 Voice (141 ) z? 40411 TDD e5Afni ✓ fr rn)r of has been designated to <coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban, Developments (HUD) regulations implementing Section 804 (24 CFR Part 8. dated June,2,' 1988), v.0� uernn r rer>=rvr Ur nvuoUwa nrvu vnUMN ucv"WrIVIGry r. COMMUNITY DEVELOPMENT BLOCK GRANT PR©GRAM. CONTRACTOR'S CERTIFICATION CONCERNING LABOR STANDARDS AND PREVAILING WAGE REQUIREMENTS 1. The undersigned, having executed a contract with-LAwii,+unt cas 031�i for the construction of the above -identified project, acknowledges that: (a) The Labor Standards provisions are included In His aforesaid contract, (h) Correction of any Infractions of the aforesaid conditions including infractions by any subcontractors and any tower Per sutirnntractors, is Contractor's -responsibility: 2. Carlifies that.' _ (a) Neither Contractor nor any firm, partnership orassociahon InMrlileh It has substantial lideresils designated as on Ineligible contractor by the Compeller General of the United States pursuant to Section SX(b) of the Regulations of the Secretary of Labors Part 5 (29 CPR. Part 5) orpursuant to Section 3(a) of the Drnil$ t3acon AA, as amended (b) 'No part of the alcrementionedcontract has been or will be subcontractor! to any subcontractor Ifsuch subcontractor or any firm, corporation„ partnership or association In which such auboontractor has a substantial Ioterestis dasignatedes on ineligible contractor pursuant to any of the aforementioned regulatory or stattitory provisions. Date /9/^ f u-zt (Contractor) fly G&WENGINEERS, 205 W. Live Oak - Port Lavaca, TX 77979 - p; (361)5524609 • f; TEIPE Firm Registration No. F04188 June 9, 2i121 SUBJECT; LETTER OF CLARIFICATION AND BID ADDENDUM NO.1 REFERENCE; INVITATIONTOBID INFRASTRUCTURE AT LITTLE: CHOCOLATE BAYOU COUNTY PARK FOR CALHOUN COUNTY, TEXAS —TEXAS GENERAL LAND OFFICE CONTRACT NO, 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1 AND INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE' CONTRRCT"NO, 20.055-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1 TO: All, Prospective Respondents This Leiter of Clarification is Issued for the following reason: I. To extend the Invitation to Bid Due Date/Bid Opening from Before 2iOMIJ PM, Thursday; June 17, 2021 to before 2100500 PIN, Thursday, June 24, 2021, The location remains the same; County Judge's Office, Calhoun County Courthouse, 211 South Ann Street; 3rd Floor, Suite 301, Port Lavaca, Texas, 2. To provide Clarlficatmos and information contained in the Sid Addendum No.1. When Issued, Letter(s) of Clarification and any Addenda shall automatically become a part of -the It them into their bids. Should, you have questions or need further clarification regarding this solicitation, please contact ma at 361-552-4508 or smason@gwengineers.com. Please include this Cetterin'your Bid as Acknowledgment of Receipt. Sincerely, G 8, W_Engincers, Inc. Z' S Ott P, t6I689tA, P-i«, Engineering ConsultingPlanning: _ Sur% ADDENDUM NO.1 10 the CONTRACT DOCUMENTS FOR INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS FOR CALHOUN COUNTY, TX WEST AUSTIN STREET PORT LAVACA, TEXAS TEXAS GENERAL LAND OFFICE' CONTRACT NO.20-065-064-CI8 And CALHOUN, COUNTY 2020 CDBG-pR CONTRACT WORK ORDER NO. E-1 JUNE 08, 2021 fmteers Prepared by: G&W Engineers, Inca 205West Live Oak Port Lavaca, Texas 77979 (36f552-4509 a & W engjaeens, Inc. _ Texas Registered Engineeeing Finn M4198 Pigf ect No. 5310.011 e. Page ! q Dare: Clarifications to the original Contract Documents, Contract Drawings and/or Specifications have been deemed necessary, and in certain cases, revisions to the original Contract Documents, Contract Drawings and/or Specifications are required. If discrepancies and/or inconsistencies exist between these specified revisions and the original Contract Documents, Contract Drawings and/or Specifications, said Addendum No. 1 shall govern. CLARIFICATIONS; 1. Forms required with proposal as part of the bid package will be acceptable with signature using electronic signature. 2. Bids Opening will be rescheduled for June 24, 2021 at the same time and locution specified. This extension is to allow forbidders to take into consideration the modifications of the bid package and its requirements. 3. Allbidd6-swi116exe uiredits:5tlli'ittit.a: italtimie-dro neilavout-nrnicture>aridanvnther Mu for thr factorfo 4, This bid the Gout the best superset concerni 5. A CAB 6. 7. be et the requirements for the exu incorporated into the Ci s rights i allows Wed aid, have Stainless Steel hardwareand s. ild the bidder present a,themed 's Options should match the theme of PPW¢3 P1l, Anu&nyMNO. t.laune08.20E1t: l�rxmrkvarsai rrnh ril%Lf rrP?9xR�wwry Pnrtt'MumMdlmne�..�s�u. l'ntlwnp Ceemq rhAJrrn.utly CONTRACT DOCUMENTS; SECTION 00300—PROPOSAL RI I4IOVIKEntire Section REPLACE with: "Revised" Section Attached to Addendum • Modified Previous & Current Bid Item No.3. • Deleted Previous Bid Item No. 4,5,7,10.11, & 13. • Renumbered Bid Items. • Modified Previous Bid Item No. 4 "Earth....". • Combined and Modified Previous Items 10 & I I to Include ALL Surfacing Required into One (1)'Bid Item. • Modified Previous Bid Item No: b & R. • Modified Prcvious Bid Item No. 14. CONTRACT DRAWINGS - REMOVE: Sheet C3.2 This sheet has been removed entirely. REMOVE: Sheets Cl &'CIA REPLACE with: "Revised" Sheets C l & C3.1 with Rev B, signed for 06/09/2021 iaage 7 af3'.. A4r}F.Nnt1M No,] chiaelMazr}: lrfja&nrenmemlil,fe cJu. xGAi9nu�hi�aed�PA�va+axulmtum�rFewn CWAexve C4ixx}r�3i/11i1/ie1 A& 2021 Play Equipment Warranty landseap structures, You have our word. All the warrantees commence on date of Marufacturers involos. Should any failure to conform to the above express warranties appear within the a policablowarranty period. Manufacturer shall, upon being notified io train p•omptly after discovery of the defect and within the applicable warranty panod, correct such nonconformity either by repairing any defactive part or parts. or by meking available a replacement part within 60 days of written notification, Manufacturer shall deliver the repaired or r€piacement part or parts to the site free of cnarge,:but vAl not be responsible for Providing labor or the cost of labor for the rarnaral of the defective part or parts, the installation of any replacement part or parts or for disposal costs of my part or. parts. Replacement parts will be warranted for the balance of the original warranty:.. THIS WARRANTY lS EXCLUSIVE AND IN LIEU OF ALL OTHER WARRANTIES, WHETHER EXPRESSED OR IM.°LIED, INCLUDING OUR NOT LIMITED TO ANY WAMANTY OF MERCHANTABILITY OR OF FITNESS FOR :A PARTICULAR PURPOSE. The remedies Itereby provided shall be the exclusive_ and sole remedies of the purchaser, Manufacturer shall not be liable for arty direct, indiract.,. spaclal. incidental of consequential damages. Manufacturer ntdtharassumes nor authorizes any employee, rapresereaGVe or any other person to assume for Manufacturermy other Iabhaty,in connection with the sale or use of sloe structures sold, and thereereno are erected In confortnarce with Larich instructions and maintained accardingto not than Manufacturer or Manufacturer's deSgnees fri my respect which, in the judgement of Manufoohirer, all", the condition or operation of - the stnteturea- To make a. claim, send your wdsten statement of balm, plotig with the original jab number or: invoice number to,.' Landscape 3tructuros Inc. 6017th Street South, Oelmo. Minnesota, ::5632$$605 .' Signed: �f-r.... ,wldam Data:-,`OtN1i202i�. Terms of Sate PRICING! Landscape Structureslist prices do not Include delivery and handling charges. Prices are subject to change without notice. TERMS: To tax -supported Institutions and those witn established credlG net 30 days from the date of the invoice. 15%-par month thereafter; freight charges are prepaid and applied to the IImroice. - TARES: Landscape Structures' list prices do not include applicable taxes, If any,. or a als. For a Ilst of factory -cubed installers in trea, please contact your Landscape Structures ound consultant; RETURN POLIM As an indication of our commitment. toour customers, Landscape Structures will accept returns of new structures and/or new equipment purchased within 60 days of the original Invoice data. Advance notincaCion is necessary to ensure proper. credit Partsnot includedin this return policy are custom parts (including PlayShaperO posts) as well. as used or damaged parts. A 20% restock fee plus all return freight charges will apply to all product returns:. NOTE All parts are subject to inspection upon return:. Parts returned: damaged may not receive a full craclit: For this reason, It is important that all lWorried parts. are properly packaged to prevent damage while- in transit. Please .contact your Landscape Structures playground consultant for the shipping address. PRODUCT CHANGES: Because of our commitment to se^ety, innovation, and value, via reserve the right to change specifications at anytime. PLEASE CONTACT US AT,. _ Landscape Structures Inc. M1111t ?Tiff. 6017th St. South �; �;i NuWrY Pub 60.17th Street. South - Delano, MN SE328.8605 • 881438.6574 763.972,5200 - Fax 763,972.3185 • playlsk corn` #262901 W021 Lartlscope Structures Inc Printed in the USA All rights reservad. #765.2125: S i landscape structures - To_ Whom It May Concern Subject. CPSIA 2608 Date: 11120/2020 J On August 1A,2008 the Presidentsignedthe Consumeri'roduct5afetylmprovementAct of2008 (CPSIA) into law. This law has several requirements including limits on the amount of lead in paints, coatings and other materialsused on children's precincts. The CPSIA also set limits of'certain heavy metals and phthalates to be used in certain toys and child care articles. All children's products manufactured and distributed through Landscape Structures meet the requirements of the CPS7A. order, lead is paints and coating is limited to 90 ppm. The CPSLA law also regulates that all dldren shall have a lead content of less than 100 ppm, All of Landscape Structures - ve been tested by an accredited third party laboratory to meet these limns. Landscape ifioatc of. conformance with each shipment stating that our coatings and materials on, and shipped -as eat None of the products manufactured or sold by Landscape Structures Inc, contain asbestos or cbromated-copper arsenate{CCA}, Sineerely,: �`'��° Ngtery. iublk f xttrinasota My Coaftatssfian Fxpirey Jan 3t, 2024 N Y N rg a umh y �IL ƒ, D (D 0 %\j\ oa£r�r- &7/& << /\ ƒ\ .(D ƒ _ /a77y } ± {®«od }} b ;ig y _ U C O N N L o Q ao CL y j O 0O p 00 O r U O CO)h E o(D u � L L O~ N Q Ulu N �9 U y O U 0 0 0 O t m ,0. O Cam. � E a 2 -_. - g� 5 r z .;t s ,� v - _ _ #14 Calhoun County, Texas DEPARTMENTAL INVENTORY TRANSFER REQUEST FORM Requested By: Inventory Serial Number Description No. Transfer From/To Department 1 �(tt1 #15 *Treasurer Receipt Numbers: F2021SUN005, 014,022,037.044 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/1/2021 COURT NAME: DISTRICT CLERK MONTH OF REPORT: JUNE YEAR OF REPORT: 2021 ACCOUNT NUMBER ACCOUNT NAME DEBIT CREDIT 1000-00144190 SHERIFF'S SERVICE FEES $2,689.66 1000-001-44140 JURY FEES $40.00 1000-001-44045 RESTITUTION FEE $0.00 1000-00144020 DISTRICT ATTORNEY FEES $0.00 1000-001-49010 REBATES -PREVIOUS EXPENSE $6.50 1000-00149030 REBATES-ATTORNEY'S FEES $1,820.99 1000-00144058 DISTRICT CLERK ELECTRONIC FILING FEES $0.00 1000-00144322 TIME PAYMENT REIMBURSEMENT FEES $28.36 1000-001-43049 STATE REIMB- TITLE IV-D COURT COSTS $0.00 DISTRICT CLERK FEES CERTIFIED COPIES $102.00 CRIMINAL COURT $107.85 CIVIL COURT $2,802.21 STENOGRAPHER $210.00 CIV FEES DIFF $0.00 1000-001-44050 DISTRICT CLERK FEES $3,222.06 1000-999-20771 FAMILY VIOLENCE FINE $0.00 1000-999-10010 CASH - AVAILABLE $7,807.57 2706-001-44055 FAMILY PROTECTION FEE $75.00 2706-999-10010 CASH - AVAILABLE $75.00 2740-00145055 FINES - DISTRICT COURT $865.91 2740-999-10010 CASH - AVAILABLE $865.91 2620-00144055 APPELLATE JUDICIAL SYSTEM $70.00 2620-999-10010 CASH - AVAILABLE $70.00 2670-00144065 COURTHOUSE SECURITY $140.31 2670-999-10010 CASH - AVAILABLE $140.31 2673-00144055 CRT RECS PRESERVATION FUND- CO $240.00 2673-999-10010 CASH - AVAILABLE $240.00 2739-00144055 RECORD MGMT/PRSV FUND - COUNTY $133.95 2739-999-10010 CASH - AVAILABLE $133.95 2737-00144055 RECORD MGMT/PRSV FUND -DIST CLRK $203.79 2737-999-10010 CASH - AVAILABLE $203.79 2731-00144055 LAW LIBRARY $490.00 2731-999-10010 CASH - AVAILABLE $490.00 2663-00144050 CO & DIST CRT TECHNOLOGY FUND $10.08 2663-999-10010 CASH - AVAILABL $10.08 7040-999-20740 BREATH ALCOHOL TESTING - STATE $0.00 7040-999-10010 CASH - AVAILABLE $0.00 2667-00144055 CO CHILD ABUSE PREVENTION FUND $0.45 2667-999-10010 CASH - AVAILABLE $0.45 7502-999-20740 JUDICIAL & COURT PERSONNEL TRAINING FUND -STATE $100.00 7502-999-10010 CASH-AVAILABE $100.00 7383-999-20610 DNA TESTING FEE - County $3.27 7383-999-20740 DNA TESTING FEE - STATE $29.47 7383-999-10010 CASH - AVAILABLE $32.74 7405-999-20610 EMS TRAUMA FUND - COUNTY $2.40 7405-999-20740 EMS TRAUMA FUND - STATE $21.60 7405-999-10010 CASH - AVAILABLE $24.00 7070-999-20610 CONSOL. COURT COSTS - COUNTY $39.94 7070-999-2b740 CONSOL. COURT COSTS - STATE $359.47 7076-999-10010 CASH - AVAILABLE $399.41 7072-999-20610 STATE CONSOL. COURT COSTS- COUNTY $37.16 7072-999-20740 STATE CONSOL. COURT COSTS- STATE $334.48 7072-999-10010 CASH- AVAILABLE $371.64 2698-001-44030-010 DRUG CRT FROG FEE - COUNTY (PROGRAM) $46.25 2698-999-10010-010 CASH -AVAILABLE $46.25 7390-999-20610-999 DRUG COURT FROG FEE - COUNTY (SVC FEE) $9.25 7390-999-20740-999 DRUG COURT FROG FEE - STATE $36.99 7390-999-10010-999 CASH -AVAILABLE $46.24 7865-999-20610-999 CRIM - SUPP OF IND LEGAL SVCS - COUNTY $0.53 7865-999-20740-999 CRIM - SUPP OF IND LEGAL SVCS - STATE $4.81 7865-999-10010-999 CASH -AVAILABLE $5.34 7950-999-20610 TIME PAYMENT - COUNTY $45.71 7950-999-20740 TIME PAYMENT - STATE $45.70 7950-999-10010 CASH - AVAILABLE $91.41 7505-999-20610 JUDICIAL SUPPORT-CRIM - COUNTY $2.51 7505-999-20740 JUDICIAL SUPPORT-CRIM - STATE $14.19 7505-999-10010 CASH -AVAILABLE $16.70 7505-999-20740-010 JUDICIAL SALARIES -CIVIL - STATE(42) $1,008.00 7505-999-10010-010 CASH AVAILABLE $1,008.00 2740-001-45050 BOND FORFEITURES $0.00 2740-999-10010 CASH - AVAILABLE $0.00 2729-001-44034 PRE-TRIAL DIVERSION FUND $0.00 2729-999-10010 CASH - AVAILABLE $0.00 7857-999-20610 JURY REIMBURSEMENT FUND- COUNTY $2.67 7857-999-20740 JURY REIMBURSEMENT FUND- STATE $24.07 7857-999-10010 CASH -AVAILABLE $26.74 7860-999-20610 STATE TRAFFIC FINE- COUNTY $0.00 7860-999-20740 STATE TRAFFIC FINE -STATE $0.00 7860-999-10010 CASH - AVAILABLE $0.00 7403-999-22888 DIST CRT - ELECTRONIC FILING FEE - CIVIL $680.00 7403-999-22991 DIST CRT - ELECTRONIC FILING FEE - CRIMINAL $12.61 CASH - AVAILABLE $692.61 1-44050 DISTRICT CLERK FEES $80.36 9-10010 CASH - AVAILABLE $80.36 1-44055 RECORD MGMT/PRSV FUND - COUNTY $50.23 9-10010 CASH - AVAILABLE $50.23 1-44050 COUNTY JURY FUND $2.01 9-10010 CASH - AVAILABLE $2.01 1-44055 COURTHOUSE SECURITY $20.09 9-10010 CASH - AVAILABLE $20.09 1-44050 CO & DIST CRT TECHNOLOGY FUND $8.04 9-10010 CASH - AVAILABLE $8.04 1-44050 COUNTY SPECIALTY COURT FUND $50.23 9-10010 CASH - AVAILABLE $50.23 7855-999-20784-010 7855-999-20657-010 7855-999-20792-010 7855-999-20658-010 7855-999-20740-010 7855-999-20610-010 DIST CRT - DIVORCE & FAMILY LAW - STATE DIST CRT - DIVORCE & FAMILY LAW - COUNTY DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - STATE DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - COUNTY DIST CRT - OTHER CIVIL PROCEEDINGS - STATE DIST CRT - OTHER CIVIL PROCEEDINGS - COUNTY $342.00 $6.00 $340.50 $9.50 $759.01 $39.95 7855-99940790-010 7855-999-10010-010 Revised 01/31/20 DUE TO STATE - NONDISCLOSURE FEE $0.00 CASH - AVAILABLE $1.496.96 TOTAL (Distrib Req to Oper Acct) $14,817.00 $14,606.05 DUE TO OTHERS (Distrib Req(s) attached) ATTORNEY GENERAL (RESTITUTION) 0.00 OUT -OF -COUNTY SERVICE FEES 1,265.00 REFUND OF OVERPAYMENTS 129.50 DUE TO OTHERS 0.00 TOTAL DUE TO OTHERS $1,394.50 REPORT TOTAL - ALL FUNDS 16,000.55 PLUS AMT OF RETURNED CKS 0.00 LESS: TOTAL TREASURER'S RECEIPTS (16,000.55) OVER / (SHORT) $0.00 DISTRICT COURT JUNE STATE COURT COSTS REPORT 2021 JUNE SECTION I: REPORT FOR OFFENSES COMMITTED COLLECTED COUNTY STATE 01/1/20 - Present 7„ , „ 37.16 334.48 01/01/04-12/31/19 $399.20 39.92 359.28 09/01/01-12/31103 0.02 0.19 09/01/99 - 08/31 /01 - - 09/01/97 - 08/31 /99 r " 09/01/95 - 08/31 /97 DNA TESTING FEES 32.74 3.27 29.47 EMS TRAUMA FUND 24.00 2.40 21.60 JUV. PROB. DIVERSION FEES JURY REIMBURSEMENT FEE $26.74 2.67 24.07 INDIGENT DEFENSE FUND $5.34 0.53 $4.81 STATE TRAFFIC FEES $0.00 - $0.00 DRUG CRT PROG FEE $92.49 $55.50 36.99 SECTION II: AS APPLICABLE STATE POLICE OFFICER FEES FAILURE TO APPEAR/PAY FEES - - JUD. FUND-CONST. CO. CRT. JUD. FUND -STATUTORY CO. CRT. MOTOR CARRIER WEIGHT VIOLATIONS TIME PAYMENT FEE $91.41 45.71 45,70 DRIVING RECORD FEE JUDICIAL SUPPORT FEES $16.70 2.51 14.19 ELECTRONIC FILING FEE -CR $12.61 $12.61 TOTAL STATE COURT COSTS $1,073.06 $ 189.70 $ 883.38 CIVIL FEES REPORT JUNE COLLECTED COUNTY STATE BIRTH CERTIFICATE FEES MARRIAGE LICENSE FEES DECL. OF INFORMAL MARRIAGE ELECTRONIC FILING FEE - CV $680.00 $680.00 NONDISCLOSURE FEES 0. $0.00 $0.00 JUROR DONATIONS JUSTICE CRT. INDIG FILLING FEES STAT PROB CRT INDIG FILING FEES STAT PROB CRT JUDIC FILING FEES STAT CNTY CRT INDIG FILING FEES STAT CNTY CRT JUDIC FILING FEES STAT CNTY CRT -JUDICIAL SUPPORT CONTT CNTY CRT INDIG FILING FEES CNST CNTY CRT JUDIC FILING FEES DIST CRT DIV & FAMILY LAW $348.00 6.00 342.00 DIST CRT OTHER THAN DIV/FAM LAW_. 19 $350.00 9.50 340.50 DIST CRT OTHER CIVIL FILINGS __._. 40I $798.96 39.95 759.01 FAMILY PROTECTION FEE JUDICIAL SUPPORT FEE 24 ';. $1,008.00 $1,008.00 JUDICIAL & COURT PERSONNEL TRANING FEE.. `- 40 $100.00 - $100.00 TOTAL CIVIL FEES REPORT $ 3,284.96 $ 55.45 $ 3,229.51 TOTAL BOTH REPORTS $ 4,358.04 $ 245.15 $ 4,112.89 CALHOUN COUNTY 201 West Austin PAYEE Name: Calhoun County Oper. Acct. Address: City: State: Zip: Phone: DISTRIBUTION REQUEST DR# 420 A 44379 PAYOR Official: Anna Kabela Title: District Clerk ACCOUNT NUMBER - DESCRIPTION AMOUNT 7340-999-20759.999 District Clerk Monthly Collections - Distribution $14,606.05 JUNE 2021 V# 967 TOTAL 14,606.05 r -7- /4_ Signature of Official Date ENTER COURT. NAME: JUSTICE OF PEACE NO.1 ENTER MONTH OF REPORT- - JUNE ENTER YEAR OF REPORT - 2021 - - - CODE AMOUNT CASH BONDS 0.00 REVISED 01/29/20 - ADMINISTRATION FEE -ADMF 40.00 - BREATH ALCOHOL TESTING - BAT 0.00 - - - CONSOLIDATED COURT COSTS -CCC 136.20 STATE CONSOLIDATED COURT COST-2020 4,149.38 - '. LOCAL CONSOLIDATED COURT, COST- 935.88 COURTHOUSE SECURITY -CHS 13.63 CJP 0.00 - CIVIL JUSTICE DATA REPOSITORY FEE -CJDR 0.11 CORRECTIONAL MANAGEMENT INSTITUTE -CMI 0.00 - '. CR 0.00 CHILD SAFETY -CS 0.00 -CHILD SEATBELT FEE '-CSBF 0.00 CRIME VICTIMS COMPENSATION -CVC 0.00 - DPSC/FAILURE TO APPEAR -OMNI-DPSC 23.24 - '' ADMINISTRATION FEE FTA/FTP (aka OMNI). 2020 106.45 - .ELECTRONIC FILING FEE- EEF 0.00 - -. - FUGITIVE APPREHENSION - FA 0.00 GENERAL. REVENUE -GR 0.00 CRIM -IND LEGAL .SVCS- SUPPORT -IDF 6.81 JUVENILE CRIME &- DELINQUENCY -JCD 0.00 JUVENILE CASE MANAGER FUND -JCMF 20.00 JUSTICE COURT PERSONNEL TRAINING -JCPT 0.00 JUROR SERVICE FEE -JSF 13.63 LOCAL ARREST FEES - LAF 267.47 LEMI 0.00 LEDA 0.00 - LEOC 0.00 .PARKS& WILDLIFE ARREST FEES -PWAF 0.00 - : STATE ARREST FEES -SAF 83.83 '.SCHOOLCROSSINGICHILD SAFETY FEE -SCF 0.00 SUBTITLE C-SUBC 30.00 - STATE TRAFFIC FINES -EST 9.1.19-STF 1,932.37 TABC ARREST FEES -TAF 0.00 TECHNOLOGY FUND -TF 13.63 TRAFFIC -TFC 3.00 LOCAL TRAFFIC FINE. 2020 116.06 - TIME PAYMENT -TIME 72.39 TIME PAYMENT REIMBURSEMENT FEE-2020 218.69 TRUANCY EREVENTION/DIVERSION FUND :-TPDF 2.00 - LOCAL& STATE WARRANT FEES-. WRNT 587.29 COLLECTION SERVICE FEE-MVBA-. CSRV 1,560.57 DEFENSIVE DRIVING .COURSE -CDC 9.90 DEFERRED FEE - .OFF 1,030.71 DRIVING EXAM FEE- PROV DL 0.00 'FILING FEE -FFEE 330.00 FILING FEE SMALL CLAIMS -FFSC 0.00 JURY FEE -JF 0.00 - COPIES/CERTIFED COPIES -CC 2.00 INDIGENT FEE -- CIFF or INDF 66.00 JUDGE PAY RAISE FEE -JPAY 17.99 - - 'SERVICE .FEE -SFEE 225.00 -. OUT -OF -COUNTY SERVICE FEE 0.00 ELECTRONIC FILING FEE -EEF CV 110.00 EXPUNGEMENTFEE-:EXPG 0.00 - EXPIRED .RENEWAL -EXPR 0.00 ABSTRACT OF JUDGEMENT -AOJ 0.00 - ALL WRITS -WOP/WOE 150.00 ..CPS FTA FINE -DPSF 1,740.00 LOCAL FINES -FINE 6,563.86 -. -LICENSE &WEIGHT'FEES -LWF 0.00 - PARKS &.WILDLIFE FINES:-PWF. 764.00 SEATBELT/UNRESTRAINED CHILD FINE -SEAT 0.00 -JUDICIAL &.COURT PERSONNEL TRAINING-JCPT 0.00 OVERPAYMENT (OVER $10)-OVER 0.00 • OVERPAYMENT S10 AND LESS) -OVER 0.00 - . RESTITUTION -.REST 0.00 PARKS & WILDLIFE -WATER SAFETY FINES-WSF 600.00 -. MARINE SAFETY PARKS & WILDLIFE-MSO 0.00 TOTAL ACTUAL MONEY RECEIVED - 21,942.07 TYPE: AMOUNT TOTAL WARRANT FEES 587.29 - - - ENTER LOCAL WARRANT FEES 330.84 RECORD ON TOTAL PAGE OF HILL COUNTRY SOFTWARE MO. REPORT - - STATE WARRANT FEES $256.65 RECORD ON TOTAL PAGE OF HILL COUNTRY SOFTWARE MO. REPORT DUE TO OTHERS: AMOUNT. - - DUE TOCCISD-50% of Fine OD JV caa28 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT DUE TO DA RESTITUTION FUND 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT REFUND OF OVERPAYMENTS- - 0.00 PLEASE INCLUDE O.R, REQUESTING DISBURSEMENT OUT -OF -COUNTY SERVICE FEE-' 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT CASH BONDS' 0.00 PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT (IF REQUIRED) '.TOTAL DUE TO OTHERS.-. 0.00. TREASURERS RECEIPTS FOR MONTH, -AMOUNT CASH, CHECKS, M.O.s&CREDIT CARDS L 21,942.07 Calculate from ACTUAL Treasurer's Receipts TOTAL TREAS. RECEIPTS 21942:07 _- MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/1/2021 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: JUNE YEAR OF REPORT: 2021 ACCOUNT NUMBER ACCOUNT NAME AMOUNT CR 1000-001-45011 FINES 8,508.46 CR 1000-001-44190 SHERIFF'S FEES 870.49 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 9.90 CHILD SAFETY 0.00 TRAFFIC 119.06 ADMINISTRATIVE FEES 1,177.16 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44361 TOTAL ADMINISTRATIVE FEES 1,306.12 CR 1000-001-44010 CONSTABLE FEES -SERVICE 375.00 CR 1000-001-44061 JP FILING FEES 330.00 CR 1000-001-44090 COPIES / CERTIFIED COPIES 2.00 CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 218.69 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 1,560.57 TOTAL FINES, ADMIN. FEES & DUE TO STATE $13,171.33 CR 2670-001-44061 COURTHOUSE SECURITY FUND $337.78 CR 2720-001-44061 JUSTICE COURT SECURITY FUND $3.41 CR 2719-001-44061 JUSTICE COURT TECHNOLOGY FUND $281.02 CR 2699-001-44061 JUVENILE CASE MANAGER FUND $20.00 CR 2730-001-44061 LOCAL TRUANCY PREVENTION & DIVERSION FUND $334.24 CR 2669-001-44061 COUNTY JURY FUND $6.68 STATE ARREST FEES DPS FEES 68.10 P&W FEES 0.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 68.10 CR 7070-999-20610 CCC-GENERAL FUND 13.62 CR 7070-999-20740 CCC-STATE 122.58 DR 7070-999-10010 136.20 CR 7072-999-20610 STATE CCC- GENERAL FUND 414.94 CR 7072-999-20740 STATE CCC- STATE 3,734.42 DR 7072-999-10010 4,149.36 CR 7860-999-20610 STF/SUBC-GENERAL FUND 1.50 CR 7860-999-20740 STF/SUBC-STATE 28.50 DR 7860-999-10010 30.00 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 77.29 CR 7860-999-20740 STF- EST 9/1/2019- STATE 1,855.08 DR 7860-999-10010 1,932.37 CR 7950-999-20610 TP-GENERAL FUND 36.20 CR 7950-999-20740 TP-STATE 36.19 DR 7950-999-10010 72.39 Page 1 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/1/2021 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: JUNE YEAR OF REPORT: 2021 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 3.30 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 62.70 DR 7480-999-10010 66.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 0.68 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 6.13 DR 7865-999-10010 6.81 CR 7970-999-20610 TUFTA-GENERAL FUND 7.75 CR 7970-999-20740 TL/FTA-STATE 15.49 DR 7970-999-10010 23.24 CR 7505-999-20610 JPAY- GENERAL FUND 1.80 CR 7505-999-20740 JPAY-STATE 16.19 DR 7505-999-10010 17.99 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 1.36 CR 7857-999-20740 JURY REIMB. FUND- STATE 12.27 DR 7857-999-10010 13.63 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.01 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.10 DR 7856-999-10010 0.11 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND- STATE 0.00 DR 7502-999-10010 0.00 7998-999-20740 TRUANCY PREVENT/DIV FUND - STATE 1.00 7998-999-20701 JUVENILE CASE MANAGER FUND 1.00 DR 7998-999-10010 2.00 7403-999-22889 ELECTRONIC FILING FEE - CV STATE 110.00 DR 7403-999-22889 110.00 TOTAL (Distrib Req to OperAcct) $20,782.67 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT; 0.00 OUT -OF -COUNTY SERVICE FI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 649.40 WATER SAFETY FINES 510.00 TOTAL DUE TO OTHERS $1,159.40 TOTAL COLLECTED -ALL FUNDS $21,942.07 LESS: TOTAL TREASUER'S RECEIPTS $21,942.07 REVISED 01/29/20 OVER/(SHORT) $0.00 Page 2 of 2 DISTRIBUTION )COUNTY CALHOUN REQUEST - 201 West Austin DR# 450 A 44379 PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: Hope Kurtz Address: Title: Justice of the Peace, Pct. 1 City: State: Zip: Phone: - - ACCOUNT NUMBER _ DESCRIPTION - - - AMOUNT 7541-999-20759-999 JP1Monthly Collections- Distribution $20,782.67 JUNE 2021 V# 967 TOTAL 20,782.67 t of Official Date ENTER MONTH OF REPORT ENTER YEAR OF REPORT IJUNE - 2021 CODE AMOUNT REVISED 03/04/16 CASH BONDS 0.00 ADMINISTRATION FEE -ADMF 90.00 .BREATH ALCOHOL TESTING - BAT 0.00 CONSOLIDATED COURT. COSTS -CCC 525.71 STATE CONSOLIDATED COURT COST-2020 3,636.43 LOCAL CONSOLIDATED COURT .COST-2020 786.80 COURTHOUSE SECURITY -CHS 52.58 CJP 0.00 _ CIVIL JUSTICE DATA REPOSITORY FEE -CJDR 0.93 CORRECTIONAL MANAGEMENT INSTITUTE -CMI 0.00 CR 0.00 CHILD SAFETY -CS 0.00 CHILD SEATBELT FEE -CSBF 0.00 CRIME VICTIMS COMPENSATION -CVC 0.00 DPSC/FAILURE TO APPEAR -OMNI-DPSC 129.65 ADMINISTRATION FEE FTA/FTP (aka OMNI} 2020 38.27 ELECTRONIC FILING FEE 40.00 FUGITIVE APPREHENSION - FA 0.00 GENERAL REVENUE -GR 0.00 CRIM- IND LEGAL SVCS SUPPORT -IDF 26.28 JUVENILE CRIME & DELINQUENCY -JCD 0.00 JUVENILE CASE MANAGER FUND -JCMF 58.05 JUSTICE COURT PERSONNEL TRAINING -JCPT 0.00 JUSTICE COURT SECURITY FUND -JCSF 0.00 -JUROR SERVICE FEE -JSF 52.58 LOCAL ARREST FEE$ - LAP 206.64 LEMI 0.00 LEDA 0.00 LEOC 0.00 OCL 0.00 PARKS& WILDLIFE ARREST FEES -PWAF 6.22 STATE ARREST FEES - SAF 120.38 SCHOOLCROSSING/CHILD SAFETY FEE -SCF 0.00 SUBTITLE C -SUBIC 8.71 STATE TRAFFIC FINE -EST 9AA9-STF 1,953.47 TABC ARREST FEES - TAF 0.00 TECHNOLOGY FUND -TF 52.58 TRAFFIC -TFC 3.88 LOCAL TRAFFIC FINE-2020 114.47 TIME PAYMENT -TIME 98.27 TIME PAYMENT REIMBURSEMENT FEE -2020 223.26 TRUANCY PREVENT/DIVERSION FUND -TPDF 26.03 LOCAL & STATEWARRANT FEES - WRNT 615.58 COLLECTION SERVICE FEE-MVSA-CSRV 1,120.95 DEFENSIVE DRIVING COURSE-DDC 69.30 DEFERRED FEE -DFF 1,520.42 DRIVING EXAM FEE- PROV DL 0.00 - FILING FEE -FFEE 241.00 FILING FEE SMALL CLAIMS- FFSC 0.00 COPIES/CERTIFED COPIES - CC 1.00 INDIGENT FEE -CIFF or INDF 24.00 JUDGE PAY RAISE FEE -JPAY 78.86 SERVICE FEE -SFEE 0.00 OUT -OF -COUNTY SERVICE FEE 0.00 EXPUNGEMENT FEE -EXEC 0.00 EXPIRED RENEWAL -EXPR 0.00 ABSTRACT OF JUDGEMENT -AOJ 5.00 ALL WRITS-WOP/WOE 0.00 DIPS ETA FINE -DPSF 875.95 LOCAL FINES - FINE 6,179.70 LICENSE & WEIGHT FEES -LWF 0.00 PARKS & WILDLIFE FINES -PWF 104.00 SEATBELT/UNRESTRAINED CHILD FINE- SEAT 0.00 V- JUDICIAL& COURT PERSONNEL TRAINING FUND- JCPT 0.DO OVERPAYMENT ($10 & OVER) - OVER 0.00 OVERPAYMENT (LESS THAN $10) - OVER O.OD RESTITUTION - REST 0.00 PARKS & WILDLIFE -WATER SAFETY FINES-WSF 0.00 WCR O.OD TOTAL ACTUAL MONEY RECEIVED $18,088.95 ENTER LOCAL WARRANT FEES 275,56 RECORD ONTOTAL PAGEOF HILL COUNTRY SOFTWARE MO. REPORT STATE WARRANT FEES $340.02 RECORD ON TOTAL PAGE OF HILL COUNTRY SOFTWARE MO. REPORT OTHERS: AMOUNT CCISD - 60%Of Fine on JV Cases PLEASE INCLUDE D.R. REQUESTNG DISBURSEMENT DA RESTITUTION FUND 0.00 PLFABE INCLUDE D.R. REQUESTING DISBURSEMENT OF OVERPAYMENTS 0.00 PUEMEINCLUDE D.R. REQUESTING DISBURSEMENT COUNTY SERVICE FEE 0.00 PTFABE INCLUDE D.R. REQUESTING DISBURSEMENT )NDS 0.00 PIFASEINCLUDE D.R. REQUESTING DISBURSEMENT (IF REQUIRED) TOTAL DUE TO OTHERS $0.00 from ACTUAL Treasurers Receipts MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/1/2021 COURT NAME: JUSTICE OF PEACE NO. 2 MONTH OF REPORT: JUNE YEAR OF REPORT: 2021 ACCOUNT NUMBER ACCOUNTNAME AMOUNT CR 1000-001-45012 FINES 7,071.25 CR 1000-001-44190 SHERIFF'S FEES 855.50 ADMINISTRATIVE FEES., DEFENSIVE DRIVING 69.30 CHILD SAFETY 0.00 TRAFFIC 118.35 ADMINISTRATIVE FEES 1,648.69 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44362 TOTAL ADMINISTRATIVE FEES 1,836.34 CR 1000-001-44010 CONSTABLE FEES -SERVICE 0.00 CR 1000-001-44062 JP FILING FEES 246.00 CR 1000-001-44090 COPIES / CERTIFIED COPIES 1.00 CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 223.26 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 1,120.95 TOTAL FINES, ADMIN. FEES & DUE TO STATE $11,354.30 CR 2670-001-44062 COURTHOUSE SECURITY FUND $314.82 CR 2720-001-44062 JUSTICE COURT SECURITY FUND $13.15 CR 2719-001-44062 JUSTICE COURT TECHNOLOGY FUND $277.38 CR 2699-001-44062 JUVENILE CASE MANAGER FUND $58.05 CR 2730-001-44062 LOCAL TRUANCY PREVENTION & DIVERSION FUND $281.00 CR 2669-001-44062 COUNTY JURY FUND $5.62 STATE ARREST FEES DPS FEES 92.08 P&W FEES 1.24 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 93.32 CR 7070-999-20610 CCC-GENERAL FUND 52.57 CR 7070-999-20740 CCC-STATE 473.14 DR 7070-999-10010 525.71 CR 7072-999-20610 STATE CCC- GENERAL FUND 363.64 CR 7072-999-20740 STATE CCC- STATE 3.272.79 3,636.43 CR 7860-999-20610 STF/SUBC-GENERAL FUND 0.44 CR 7860-999-20740 STF/SUBC-STATE 827 DR 7860-999-10010 8.71 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 78.14 CR 7860-999-20740 STF- EST 9/1/2019- STATE 1,875.33 DR 7860-999-10010 1,953.47 CR 7950-999-20610 TP-GENERAL FUND 49.14 CR 7950-999-20740 TP-STATE 49.13 DR 7950-999-10010 98.27 Page 1 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/1/2021 COURT NAME: JUSTICE OF PEACE NO. 2 MONTH OF REPORT: JUNE YEAR OF REPORT: 2021 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 1.20 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 22.80 DR 7480-999-10010 24.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 2.63 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 23.65 DR 7865-999-10010 26.28 CR 7970-999-20610 TUFTA-GENERAL FUND 43.22 CR 7970-999-20740 TUFTA-STATE 86.43 DR 7970-999-10010 129.65 CR 7505-999-20610 JPAY-GENERALFUND 7.89 CR 7505-999-20740 JPAY-STATE 70.97 DR 7505-999-10010 78.66 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 5.26 CR 7857-999-20740 JURY REIMB. FUND- STATE 47.32 DR 7857-999-10010 52.58 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.09 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.84 DR 7856-999-10010 0.93 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND -STATE 0.00 DR 7502-999-10010 0.00 7998-999-20701 JUVENILE CASE MANAGER FUND 13.02 CR 7998-999-20740 TRUANCY PREV/DIV FUND - STATE 13.02 DR 7998-999-10010 26.03 CR 7403-999-22889 ELECTRONIC FILING FEE - STATE 40.00 DR 7403-999-10010 40.00 TOTAL (Distrib Req to OperAcct) $18,998.55 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT; 0.00 OUT -OF -COUNTY SERVICE FI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 88.40 WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $88.40 TOTAL COLLECTED -ALL FUNDS $19,086.95 LESS: TOTAL TREASUER'S RECEIPTS $19,086.95 REVISED 03/04/16 OVER/(SHORT) $0.00 Page 2 of 2 CALHOUN DISTRIBUTION COUNTY REQUEST 201 West Austin DR# 460 A 44379 PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: cabin Anderle Address: Title: Justice of the Peace, Pct. 2 City: State: Zip: Phone: ACCOUNT NUMBER - DESCRIPTION AMOUNT 7542-999-20759.999 JP2 Monthly Collections - Distribution $18,998.55 JUNE 2021 V# 967 TOTALI 18,998.55 P Signature of Official Date ENTER COURT NAME: ENTER MONTH OF REPORT ENTER YEAR OF REPORT CI CASH BONI ADMINISTRATION FEE - AD BREATH ALCOHOL TESTING - E CONSOLIDATED COURT COSTS -C STATE CONSOLIDATED COURT COST-21 LOCAL CONSOLIDATED COURT COST- 21 COURTHOUSE SECURITY -C ( CIVIL JUST DATA REPOS FEE - CJDR/N CORRECTIONAL MANAGEMENT INSTITUTE -( CHILD SAFETY - CHILD SEATBELT FEE - CE CRIME VICTIMS COMPENSATION - C DPSC/FAILURE TO. APPEAR - OMNI - DP ADMINISTRATION PEE FTA/FTP (eke OMNI)-21 ELECTRONIC FILING F FUGITIVE APPREHENSION - GENERALREVENUE- CRIM - IND LEGAL SVCS SUPPORT - JUVENILE CRIME & DELINQUENCY -J JUVENILE CASE MANAGER FUND - JC JUSTICE COURT PERSONNEL TRAINING - JC JUROR SERVICE FEE LOCAL ARREST FEES-L PARKS & WILDLIFE ARREST FEES - PN STATE ARREST FEES -E SCHOOL CROSSING/CHILD SAFETY FEE - E SUBTITLE - SU STATE TRAFFIC FINES- EST 9.1.19-. E TABC.ARREST FEES -1 TECHNOLOGY FUND - TRAFFIC - T LOCAL TRAFFIC FINE- 21 TIME PAYMENT -TI TIME PAYMENT REIMBURSEMENT FEE- 21 TRUANCY PREWDIVERSION FU LOCAL & STATE WARRANT FEES- WR COLLECTION SERVICE FEE-MVBA-CS DEFENSIVE DRIVING COURSE - D DEFERRED FEE -C DRIVINGEXAm FEE- PROV FILING FEE- FFEE & C% FILING FEE SMALL CLAIMS- FF COPIES/CERTIFED COPIES - INDIGENT FEE - CIFF or IN JUDGE PAY RAISE FEE -JP SERVICE FEE - SF ALL WRITS - WOP /' DES ETA FINE - I LOCAL FINES - LICENSE & WEIGHT FEES - PARKS & WILDLIFE FINES - SEATBELT/UNRESTRAINED CHILD FINE-1 :V-JUDICIAL & COURT PERSONNEL TRAINING-. - OVERPAYMENT ($10 & OVER) - C ' OVERPAYMENT (LESS :THAN $10)-C RESTITUTION. I PARKS & WILDLIFE -WATER SAFETY FINES - TOTAL ACTUAL MONEY RECE TYPE: TOTAL WARRANT FEES ENTER LOCAL WARRANT I STATE WARRANT I DUE TO OTHERS: DUE TO CCISD - 50 % of Fine on JV cases DUE TO DA RESTITUTION FUND REFUND OF OVERPAYMENTS OUT -OF -COUNTY SERVICE FEE CASH BONDS TOTAL DUE TO OTF REVISED 01/30/20 10.00 530.03 1,438.91 324.91 53.00 0.73 210.00 50.00 40.00 26.50 40.00 53.02 97.30 85.00 267.52 949.56 53.00 24.75 60.98 100.00 18.13 12.50 350.00 1,636.50 20.00 86.00 125.00 - 30.00 79.50 ' 10.00 670.00 3,711.66 45.00 25.00 AMOUNT 000 IPLEASE INCLUDE D.R. REQUESTING DISBURSEMENT 000 IPLBSE INCLUDE D.R. REQUESTING DISBURSEMENT 000 1PLESSEINCLUDE D.R. REQUESTING DISBURSEMENT 000 PLEASEINCLUDE DAREQUESTINGDISBURSEMENT 000 PLEASEINCLUDE DAREQUESTING DISBURSEMENT (IF REQUIRED) 9PT e from ACTUAL Treasunn'S Receipts MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/1/2021 COURT NAME: JUSTICE OF PEACE NO.3 MONTH OF REPORT: JUNE YEAR OF REPORT: 2021 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 2.65 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 23.85 DR 7865-999-10010 26.50 CR 7970-999-20610 TL/FTA-GENERAL FUND 70.00 CR 7970-999-20740 TL/FTA-STATE 140.00 DR 7970-999-10010 210.00 CR 7505-999-20610 JPAY-GENERALFUND 7.95 CR 7505-999-20740 JPAY - STATE 71.55 DR 7505-999-10010 79.50 CR 7857-999-20610 JURY REIMB. FUND-GEN. FUND 5.30 CR 7857-999-20740 JURY REIMB. FUND -STATE 47.72 150 DR 7857-999-10010 53.02 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS.- GEN FUND 0.07 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS.- STATE 0.66 DR 7856-999-10010 0.73 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND -STATE 25.00 DR 7502-999-10010 25.00 7998-999-20701 JUVENILE CASE MANAGER FUND 6.25 CR 7998-999-20740 TRUANCY PREVENT/DIVERSION FUND- STATE 6.25 DR 7998-999-10010 12.50 CR 7403-999-22889 ELECTRONIC FILING FEE 40.00 DR 7403-999-10010 40.00 TOTAL (Distrib Req to OperAcct) $11,196.25 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY 0.00 DA - RESTITUTION 0.00 REFUND OF OVERP 0.00 OUT -OF -COUNTY SI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE 38.25 WATER SAFETY FIN 0.00 TOTAL DUE TO OTHERS $38.25 TOTAL COLLECTED -ALL FUNDS $11,234.50 LESS: TOTAL TREASUER'S RECEIPTS $11,234.50 REVISED 01/30/20 OVER/(SHORT) $0.00 Page 2 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 7/l/2021 COURT NAME: JUSTICE OF PEACE NO. 3 MONTH OF REPORT: JUNE YEAR OF REPORT: 2021 ACCOUNTNUMBER ACCOUNTNAME AMOUNT CR 1000-001-45013 FINES 4,388.41 CR 1000-001-44190 SHERIFF'S FEES 475.30 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 20.00 CHILD SAFETY 0.00 TRAFFIC 85.73 ADMINISTRATIVE FEE 146.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44363 TOTAL ADMINISTRATIVE FEES 251.73 CR 1000-001-44010 CONSTABLE FEES -SERVICE 10.00 CR 1000-001-44063 JP FILING FEES 125.00 CR 1000-001-44090 COPIES / CERTIFIED COPIES 0.00 CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 18.13 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 1,636.50 TOTAL FINES, ADMIN. FEES & DUE TO STATE $6,905.07 CR 2670-001-44063 COURTHOUSE SECURITY FUND $153.47 CR 2720-001-44063 JUSTICE COURT SECURITY FUND $13.25 CR 2719-001-44063 JUSTICE COURT TECHNOLOGY FUND $145.83 CR 2699-001-44063 JUVENILE CASE MANAGER FUND $40.00 CR 2730-001-44063 LOCAL TRUANCY & PREVENTION DIVERSION FUN $116.04 CR 2669-001-44063 COUNTYJURYFUND $2.32 STATEARRESTFEES DPS FEES 57.00 P&W FEES 0.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 57.00 CR 7070-999-20610 CCC-GENERAL FUND 53.00 CR 7070-999-20740 CCC-STATE 477.03 DR 7070-999-10010 530.03 CR 7072-999-20610 STATE CCC- GENERAL FUND 143.89 CR 7072-999-20740 STATE CCC- STATE 1,295.02 1,438.91 CR 7860-999-20610 STF/SUBC-GENERAL FUND 13.38 CR 7860-999-20740 STF/SUBC-STATE 254.14 DR 7860-999-10010 267.52 CR 7860-999-20610 STF- EST 9/1/19- GENERAL FUND 37.98 CR 7860-999-20740 STF- EST 9/1/19- STATE 911.58 949.56 CR 7950-999-20610 TP-GENERAL FUND 50.00 CR 7950-999-20740 TP-STATE 50.00 DR 7950-999-10010 100.00 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 1.50 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 28.50 DR 7480-999 001 30.00 Page 1 of 2 #16 i0 iM ;N :O :LzL :r :z iW i� id iW G Z J g Z Z q ti Lf Lrx m v � V N w N N = iA w O w 0 O Ln W O O O O = N CC W w O � Yf off wo O O - OC W N w a p �q - J �q O 0 C N N N =0 C6� a aW in _Zw w w Ti = Z 0 0 0 0 = W o 0 0 0 0 =F r _L km N 0 0 0 O 0 W Ow Ow Ow N Ow W w w w w W O O = W O O v H w z ° a °z ZZ� - zzz� Z Z Z N H z000 z z 2 U h e rn rn¢ O =W V rn rn rn V a2 m = U o a ee 0 =z 5 0 =0 z W W =W O >ow =Z Y^1 C aCL awo w< W O =H gg w =W �L)W e W > O i N N =d Z z a 00 = Q =0 =N =0 = z =z =W =Q =d =W =G 9 19 W J V F N IG W IZ z W ;g i� :W T a 99 z z e Is O W O W el W 01 0 H Y w w J U u N G C CD O O N LZaO �� ia�B C $ d o o g44g1 fS5 Ess w ur N =_a coo o -W W �y fA fR 19 19 = C W W M M =� Q L UJ W WM f9 EA M f9 = � W Vi =W o OF ci W aa�e z z 2 cFOi _ N e�6e CD(DLn F zzw =0 F 2W fa O =z a =W Z w _U W W p w o =111 O Z era p `zz _Z O a a 'F qN Z $ W c c _� F cc M Z W Z �L Z Z oo _o l Q M 4 N a k d z z § � L § 2 2 .4 z § $ ) 2 2 �§§7( B§k�� al \� \� B§ § z z z 0 00 o. zzz ■,,,� �mmm al co 0 z z LLI � L § C ■e B■§ ■e= al a�sa / §� §; al / (g )a .z ■� k§ )� )L )§ § z m O V Q I F F 1 0 m T G wl O O w Z LL LLI 0 g Z 2 =q _F O� OR t1 ip =Z , _W = od =W W =Q =0 V 2Z z =a =0 ° =i W -W O a z =Z O =Z a W =W � w W W w oomoo 2 C C i e w c o c o N WI M � e 0000 �y w E9 Vi EA H3 i �rrrrr Z Z Z Z Z 9 9 9 � 9 (D (7 (9 (7 0 00000 z z z z z e m m m m m m rn rn m rn m o a. z (n of w w a w r D� e�6a OWNS > w w a as �aotomW .6 z om M¢ U r > 0 2 2 a o Q Lm W z w N d 0� U) w a 0 z U W a w z ao 0 z 0 0 w b 0 b O fy # 17 T MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---July 14, 2021 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDS TOTAL NURSING HOME UPL EXPENSES TOTAL INTER -GOVERNMENT TRANSFERS $ 343,129.22 $ 29,109.67 $ 419,774.83 _� $ 28,646;09 L"� GRAND TOTAL DISBURSEMENTS APPROVED July, 14,2021 $ 820i659.71 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---July 14, 2021 PAYABLES AND PAYROLL 7/9/2021 Weekly Payables 318,920.80 7/9/2021 3M Company -software 15,704.57 7/912021 Patient Refunds 123,00 7112/2021 McKesson-340B Prescription Expense 5,704.18 7/12/2021 Amedsource Bergen-340B Prescription Expense 995.45 Prosperity Electronic Bank Payments 7/6/2021 Credit Card & Lease Fees. 727.01 716-719121 Pay Plus -Patient Claims Processing Fee 340,01 7/912021 ExpertPay- child support 614.20 TOTAL PAYABLES,, PAYROLL AND,ELECTRONIC BANK PAYMENTS $ 343,129,22 TRANSFER BETWEEN FUNDS TO NURSING HOMES 7/9/2021 MMC Operating to Ashford- correction of NH insurance payment deposited into MMC operating in error 1,665.50 7/9/2021 MMC Operating to The Crescent-eorreolton of NH insurance payment deposited Into MMC Operating in error 556.50 7/9/2021 MMC Operating to Golden Creek Healthcare -correction of NH insurance payment deposited into MMC Operating in error 4,259.13 7/9/2021 MMC Operating to Gulf Pointe Plaza -correction of NH insurance payment and QIPP deposited into MMC Operating 7.848.89 7/9/2021 MMC Operating to Tuscany Village -correction of NH insurance payment deposited into MMC Operating in error 1.558.69 7/9/2021 MMC Operating to Bethany Senior Living- correction of NH insurance payment deposited into MMC Operating in error 11,390.56 MEDICARE ADVANCE PAYMENT RECOUP 7/12/2021 Ashford to MMC Operating -correction of Ashford medicare recoup taken from MMC Operating 277.01 7/1212021 Ashford to Bethany -correction of Ashford medicare recoup taken from Bethany 28.04 7/12/2021 Broadmoor to Bethany -correction of Broadmoor medicar recoup taken from Bethany 28.04 711212021 Crescent to Bethany -correction of Crecent medicare recoup taken from Bethany 28.04 7/12/2021 Solera to Bethany -correction of Solera medicare recoup taken from Bethany 28.04 7112/2021 Tuscany to Bethany -correction of Tuscany medicare recoup taken from Bethany 28.04 7/12/2021 Golden Creek to Bethany -correction of Golden Creek medicare recoup taken from Bethany 28.04 7112/2021 Broadmoor to MMC Operating -correction of Broadmoor medicare recoup taken from MMC Operating 277.01 7/1212021 Tuscany Village to MMC Operating -correction of Tuscany Village medicare recoup taken from MMC Operating 277.01 7/12/2021 Golden Creek to MMC Operating -correction of Golden Creek medicare recoup taken from MMC Operating 277,01 7/12/2021 Solera to MMC Operating -correction of Solera medicare recoup taken from MMC Operating 277.01 711212021 Crescent to MMC Operating -correction of Crescent medicare recoup taken from MMC Operating 277.01 TOTAL TRANSFERS BETWEEN FUNDS $ 29,109.47 NURSING HOME UPL EXPENSES 7/12/2021 Nursing Home UPL-Cantex Transfer 81,002.66 7/12/2021 Nursing Home UPL-Nexion Transfer 11,106.85 7/12/2021 Nursing Home UPL-HMG Transfer 16,926.77 7/1212021 Nursing Home UPL-Tuscany Transfer 64,021.18 7/12/2021 Nursing Home UPL-HSL Transfer 246,717.37 TOTAL NURSING HOME UPL EXPENSES $ 419,774.83 r INTER -GOVERNMENT TRANSFERS 7l12/2021 IGT UHRIP PGY4 to be paid on August 06, 2021 28,646.09 TOTAL 1M Ei-GOVER,NNILNT TRANSFERS $ 28,646.09 GRAND TOTAL DISBURSEMENTS APPROVED.July 14, 2021 $ 820,669.71 7/8/2021 tmp_cw5repor(2432581820764640235.html MEMORIAL MEDICAL CENTER 07/08/2021 0 AP Open Invoice List 1622 ap_open_invoice.templale Due Dates Through: 07/28/2021 Vendor# Vendor Name Class Pay Code 11283 ACE HARDWARE 15521 r% Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 154929 ✓/ 06/30/2021 06/15/2021 07/10/2021 23.99 0.00 0.00 23.99 ter. SUPPLIES 154932 ✓ 06/30/2021 06/15/2021 07/10/2021 115.96 0.00 0.00 115.96 SUPPLIES 155077 �06/3012021 06/21/2021 07/1 EV2021 13.47 0.00 0.00 13.47✓ SUPPLIES 155063 4, 06/30/2021 06/21/2021 07/16/2021 47.98 0.00 0.00 47.98 SUPPLIES 155090 ✓% 06/30/2021 06/22/2021 07/17/2021 13.99 0,00 0.00 13.99 SUPPLIES 155292 06/30/2021 06/28/2021 07/23/2021 32.95 0.00 0.00 32.95 SUPPLIES 165327 f 06/30/2021 06/29/2021 07/24/2021 35.75 0.00 0.00 35.75 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11283 ACE HARDWARE V 284.09 0.00 0.00 284.09 Vendor# Vendor Name Class Pay Code 13180 ADVANCED STERILIZATION PROD 11Z Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8020057531 ,p6/30/2021 08/31/2090 07/07/2021 864.00 0.00 0.00 864.00 i SUPPLIES 8020265705r06/30/2021 03/19/2021 04/19/2021 3,000.00 0.00 0.00 3,000.00 4,�t SUBSCRIPTION 8020319321 Q6930/2021 06/24/2021 07/07/2021 864.00 0.00 0.00 i 864.00 b% SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Nat 13180 ADVANCED STERIL 4,728.00 0.00 0.00 4,728.00 Vendor# Vendor Name Class Pay Code A1705 ALIMED INC. Y% M Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net SPSVO3609106/3012021 06/21/2021 07/06/2021 119.89 0.00 0,00 119.80 %11 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net A1705 ALIMED INC. 119.89 0.00 0.00 119.89 Vendor# Vendor Name 4 Class Pay Code 10419 AMBU INC - Invoice# Coglmene Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 221107209 P0613012021 06/21/2021 07/08/2021 67,00 0.00 0.00 87.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10419 AMBU INC 87.00 0.00 0.00 87.00 Vendor# Vendor Name Class Pay Code 11632 AMERICAN CONSTRUCTION Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1623 ,,. ' 06/30/2021 06/29/2021 06/29/2021 800,00 0.00 0.00 800.00 4'- FREON CHILLERS / 1626 r/ 06/30/2021 06/30/2021 06/30/2021 4,945.00 0.00 0.00 4,945.00 .= FREON 30 PD CYLINDER Vendor Totals; Number Name Gross Discount No -Pay Net 11632 AMERICAN CONSTI 5,745.00 0.00 0.00 5,745.00 Vendor# Vendor Name Class Pay Code B1150 BAXTER HEALTHCARE W Invoice# C,cJ^men[ Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 70980296 �./06/23/2021 06/05/2021 06/30/2021 40.69 0,00 0.00 40.69 file:/I/C:lUsers/mmckisseck/cpsltmemmed.cpsinet.cam/u88l50/data_5/Imp_ cw5report2432581820764640235.html 1/16 1718/2021 imp_ cw5report2432581820764640235.html SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 81150 BAXTER HEALTHC/ 40.69 0.00 0.00 40.69 Vendor# Vendor Name Class Pay Code 91210 BECKMAN COULTER, INC. ,i M Invoice# CPmmenl Tran DI Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 7277--- 1 06/30/2021 08/17/2020 09/16/2020 6,554.90 0.00 0,00 6,554,90 ,t!' SUPPLIES 1085 661 e/06/30/2021 08/17/2020 09/17/2020 1,062.14 0.00 0.00 1,062.14 SUPPLIES 108598872 46/30/2021 08/27/2020 09/26/P020 741.52 0.00 0.00 741.52 .^ SUPPLIES // 108600980 d66/30/2021 08/28/2020 09/27/2020 $72.23 0.00 0.00 372.23 ,f SUPPLIES 108601536 "6130/2021 08128/2020 09/27/2020 735.84 0.00 0.00 736.84 SUPPLIES 108607753.06/30/2021 09/01/2020 10/01/2020 734.84 0.00 0.00 734.84 yam' SUPPLIES 106611461 v06/30/2021 09/02/2020 10/02/2020 14.66 0100 0.00 14.66 SUPPLIES 4r' 108609357 06/30/2021 09/02/2020 10/02/2020 4,497.48 0.00 0.00 4,497.48 SUPPLIES � 108610720.46/30/2021 09/02/2020 10102120PO 960.20 0.00 0.00 980.20 SUPPLIES 108608956 •06/30/2021 09/02/2020 10/02/2020 5,261.68 0.00 0.00 5,261.68 SUPPLIES 108609752 0B/30/2021 09/02/2020 10/02/2020 1,594.26 0.00 0.00 1,594.26 •f ,,�� SUPPLIES 108630991 v06/30/2021 09/15/2020 10/15/2020 1,288.45 0.00 0.00 1,288.45 SUPPLIES 67,4244-10- 06/30/2021 12/07/20PO 01/06/2021 94AS 0.00 0.00 94.18 Io%'1Sb1W11 SUPPLIES 1089933191N6/30/2021 04/02/2021 05/02/2021 467.40 0.00 0.00 467.40 SUPPLIES 5440139 ,/06/30/2021 04/30/2021 05/30/2021 3,507.27 0.00 0.00 3.507.27 �✓ SUPPLIES 7293834 ✓J06130/2021 05/04/2021 06/03/2021 7,248.11 0.00 0.00 7.248.11 / SUPPLIES 109138052 W30/2021 06/21/2021 07/21/2021 1,367.91 0.00 0.00 1,367.91 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 61210 BECKMAN COULTE 36,524.07 0.00 0.00 36,524.07 Ventlor# Vendor Name Class Pay Code 12740 BUILDING KID STEPS V/' Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net MAY2021 06/30/2021 05/31/2021 06/30/2021 1,039.00 0.00 0.00 11039.00 LI SPEECH THERAPY SERVICES MAY2021A 06/30/2021 05/31/2021 06/30/2021 50.00 0.00 0.00 50,00 SPEECH THERAPY SERVICES MAY2021B 06/30/2021 05/3112021 06/30/2021 1,200.00 0.00 0.00 1,200.00 SPEECH THERAPY SERVICES JUNE2021B 06/30/2021 06/30/2021 07/08/2021 1,052.00 0.00 0.00 1,052.00 SPEECH THERAPY SERVICES JUNE2021A 06/30/2021 06/30/2021 07/08/2021 1,013.00 0.00 0.00 1,013.00 SPEECH THERAPY SERVICES JUNE2021 06/30/2021 06/30/2021 07/08/2021 876.00 0.00 0.00 876.00 SPEECH THERAPY SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 12740 BUILDING KID STIFF 5,230.00 0.00 0.00 5,230.00 Vendor# Vendor Name Class Pay Code 11224 CABLES AND SENSORS r ^ file:/IIC:/Users/mmokissacklopst/memmed.opsinet.comIuBB150/data_5/tmp_ew5report2432581820764640235.html 2116 n1 r 7/8/2021 tmp_cw5report2432581820764640235.html Invoice# Comment Tram Dt Inv Dt Due DI Check DI Pay Gross Discount No -Pay Net 111901 � 06/30/2021 05/13/2021 06/12/2021 134.00 0.00 0.00 134.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11224 CABLES AND SENS 134.00 0.00 0.00 134.00 Vendor# Vendor Name Class Pay Code C1048 CALHOUN COUNTY ..- W Invoice# Comment Tran Of Inv Of Due 0t Check Dt Pay Gross Discount No -Pay Net 063021 FUEI06/3012021 06/30/2021 07/14/2021 94.20 0.00 0.00 94.20 FUEL u Vendor Totals: Number Name Gross Discount No -Pay Net C1048 CALHOUN COUNTY 94.20 0.00 0.00 94.20 Vendor# Vendor Name Class Pay Code 11088 QAf#TEX-1qEAL-TFI-CAPte0E:NTERS Invoice# Comment Tran Dt Inv Dt Due Of Check Dt Pay gross Discount No -Pay Net 062421 00/3012021 06/24/2021 07/22/2021 3,342!03 0.00 0.00 3,3 03 TRANSFER Vendor Totals: Number Name Gross Discount No -Pay 11088 CANTEX HEALTH C 3,342.03 0.00 0.00 __N,�eert 3,342,03 Vendor# Vendor Name Class Pay Cade C1325 CARDINAL HEALTH 414, INC. �� W Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 8002565444 r0613012021 O6/1212021 07/07/2021 161.68 0.00 0.00 161.88 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C1325 CARDINALHEALTH 161.68 0,00 0.00 161.68 Vendor# Vendor Name Class Pay Code 13992 CARIANT HEALTH PARTNERS Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 125911 / O6/30/2021 06/23/2021 06/23/2021 980.00 0.00 0.00 980.00 MED BURG STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net 13992 CARIANT HEALTH F 980.00 0.00 0.00 980.00 Vendor# Vendor Name Class Pay Code 13028 CAVALLO ENERGY TEXAS LLC ✓/f 1,ylluvL,q,f Wilt r� Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 2117300153:06/30/2021 06/21/2021 07/23/2021 5.29 0.00 0:00 8.29 y' GAS 2117300153:06/3012021 06/21/2021 07/23/2021 16.68 0.00 0.00 I 18'eB GAS 11 Vendor Totals: Number Name ,t Gross Discount No -Pay Net 13028 CAVALLO ENERGY 24,W 9-Cl 0.00 0.00 S.;Cj 24!87 Vendor# Vendor Name Class Pay Code C1992 COW GOVERNMENT, INC. y'r M Invoice# Comment Tran DI Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net D124288 /06/22/2021 05/13/2021 07/23/2021 307.15 0.00 0.00 307,15 V� SUPPLIES F704173 v' 0613012021 06/16/2021 07/16/2021 1,553.95 0.00 0.00 1,553.95 �,/ SCANNER/ MS OFFICE Vendor Totals: Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMEN 1,861.10 0.00 0.00 1,861.10 Vendor# Vendor Name Class Pay Code 12768 CHEMAQUA v7 Involce# Cu Comment Tran Dt Inv Dt Da Ot Check Dr Pay Gross Discount No -Pay Net J 7397856 v' 0&30/2021 06/10/2021 06/20/2021 500.00 0.00 0.00 500.00 WATER TREATMENT Vendor Totals: Number Name Gross Discount No -Pay Net 12768 CHEMAQUA 500.00 0.00 0.00 500.00 Vendor# Vendor Name Class Pay Code 13000 CLEARFLY v� Involce# Comment Tran Dt Inv Ot Due DI Check DI Pay Gross Discount No -Pay Net file �///C:/Users/mmckissacWcpsllmemmed.cpsinel.comlu88150/dala_5/tmp_ ew5report2432581820764640235.html 3116 7/8/2021 anp_cw5report2432581820764640235.htm1 INV360418 v67/01/2021 07/01/2021 07/15/2021 1,112.50 0.00 0.00 1,112,50 PHONES L Vendor Totals: Number Name Gross Discount No -Pay Net 13000 CLEARFLY 1,112.50 0.00 0.00 1,112,60 Vendor# Vendor Name Class Pay Code C2157 COOPER SURGICAL INC a!� M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 5821831 ,-'006/30/2021 04/23/2021 04/23/2021 66.44 0.00 0.00 66,44 V,,r SUPPLIES 5869461 06/30/2021 06/09/2021 07/23/2021 66,44 0.00 0.00 66.44 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C2157 COOPER SURGICA` 132.88 0.00 0.00 13288 Vendor# Vendor Name Class Pay Code 10646 COVIDIEN ✓ Invoice# Compent Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 5863617819,P6/30/2021 05/28/2021 06/07/2021 1,435.32 0.00 0.00 1,435.32 980 VENTILATOR 5863619319,p6/30/2021 05/28/2021 06/07/2021 805.25 0.00 0.00 805.25 980 VENTILATOR ' 5863619323.060/2021 05/28/2021 06/07/2021 180.25 0100 0.00 180.26 980 VENTILATOR 5863627916,P86012021 06/01/2021 06/11/2021 309.00 0.00 0.00 309.00 ✓` // 960 VENTILATOR 5863628656 06/30/2021 06/01/2021 06/11/2021 67.783.00 0100 0.00 67,783.00 980 VENTILATOR- POdi4i11-11 "W(Z 551.0`Id-.00]'IW 3645U v/ 1•c0 5863667013 P6/30/2021 06/07/2021 06/17/2021 1,180.94 0.00 0.00 1,180.94 v� ELCETOCARETERY MACHINE Vendor Totals: Number Name Gross Discount No -Pay Net 10646 COVIDIEN 71,693.76 0.00 0.00 71,693.76 Vendor# Vendor Name Class Pay Code 12612 f DASHBOARD MID y -' Invoice# Cement Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 11329 /07/0112021 07/01/2021 07/01/2021 550,00 0.00 0.00 550.00 PROCESSING AND SUPPORT FEE Vendor Totals: Number Name Gross Discount No -Pay Net 12612 DASHBOARD MD 550.00 0.00 0.00 550.00 Vendor# Vendor Name Class Pay Code 10368 DEWIT POTH & SON V Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 6468700 �r06130/2021 06/15/2021 07/10/2021 480.76 0.00 0.00 480.76 ff SUPPLIES 6470540 .%06/801P021 06116/2021 07/11/2021 60.19 0.00 0.00 60.19 SUPPLIES W, 6470541 /06/30/9021 06117/2021 07/12/2021 34.36 0.00 0.00 34,$6 - SUPPLIES 6468811 ,,/06/3012021 06/17/2021 07/12/2021 55.32 0.00 0.00 55.32 SUPPLIES 6471570 -'06/30/2021 06/17/2021 07112/2021 194,92 0.00 0.00 194.92 SUPPLIES 6471571 ./ 06/30/202l 06/18/2021 07/13/2021 72.36 0.00 0,0D 72.36 SUPPLIES 6477010 y,. 06/30/2021 06IM2021 07117/2021 24.97 0.00 0.00 24.97 ,J"' SUPPLIES 6476720 v' 06/30/2021 06/22/2021 07/17/2021 48.44 0.00 0.00 48.4411 SUPPLIES 6476750 >,/ 06/80/2021 06/22/2021 07/17/2021 375.00 0.00 0.00 375.00 ' SUPPLIES 6477400 0;' 06/30/2021 06/23/2021 07/18/2021 407.39 0.00 0.00 407,39 SUPPLIES 6478350 ,/'06/3012021 06/24/2021 07/19/2021 194.85 0.00 0,00 194,85 v file:///C:/Userslmmckissacklcpsi/memmed.cpsinet,comtu88l 501data_5/imp_av5report2432581820764640235,html 4116 7/8/2021 tmp_cw5report2432581820764640235.html SUPPLIES 6478950 V'06/30/2021 06/24/2021 07/19/2021 36.48 0.00 0.00 36.48 SUPPLIES a 6483390 /06/$0/2021 06/28/2021 07/23/2021 82.26 0.00 0.00 82.26 SUPPLIES 6483100 r! 06/30/2021 06/28/2021 07/23/2021 31.72 0.00 0.00 31.72 ✓' SUPPLIES 6483110 -/06130/2021 06/2812021 07/23/2021 190.40 0.00 0.00 190.40 y,.! SUPPLIES 6483090 '06/30/2021 06/29/2021 0712412021 95,06 0.00 0.00 95.061,,,'" �/ SUPPLIES 6483350 06/2912021 07/24/2021 281.38 0.00 0.00 281.38 V/06/30/2021 SUPPLIES 6483351 �/ 06/30/2021 06/29/2021 07/24/2021 3.27 0.00 0.00 3.27 y/ � SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SC 2,669,13 0.00 0.00 2,669.13 Vendor# Vendor Name Class Pay Code 10026 DONN STRINGO i v Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 051621 06/30/2021 05/16/2021 05/16/2021 23.72 0.00 0.00 23.72 REIMBURSE SUPPIES Vendor Totals: Number Name Gross Discount No -Pay Net 10026 DONN STRINGO 23,72 0.00 0.00 23.72 Vendor# Vendor Name Class Pay Code D1710 DOWNTOWN CLEANERS ,1 W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 060121 06/30/2021 06/01/2021 06/11/2021 784.60 0100 0.00 784.60 LAUNDRY Vendor Totals: Number Name Gross Discount No -Pay Net D1710 DOWNTOWN CLEAT 784.60 0.00 0.00 784.60 Vendor# Vendor Name Class Pay Code S0501 EVOQUA WATER TECHNOLOGIES Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Nat 904967188•,/07/08/2021 06/30/2021 07/25/2021 556.50 0.00 0.00 556.50 SUPPLIES "f! Vendor Totals: Number Name Gross Discount No -Pay Net S0501 EVOQUA WATER TI 556.50 0.00 0.00 556.50 Vendor# Vendor Name Class Pay Code 10788 FIRETROL PROTECTION SYSTEM: Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 100725560 ✓06/30/2021 06/23/2021 07/03/2021 435,00 0100 0.00 435.00 BATTERY FOR ALARM SYSTEM Vendor Totals; Number Name Gross Discount No -Pay Net 10788 FIRETROL PROTEC 436.00 0.00 0.00 435.00 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 9285955 i,/ 06/23/2021 06/08/2021 07/03/2021 61.07 0.00 0.00 61.07 SUPPLIES 9285954 06/23/2021 06/08/2021 07/03/2021 61.07 OAO 0.00 61.07 SUPPLIES 0319901 �/06/30/2021 06/21/2021 07/16/2021 74.80 0.00 0.00 74,80,,' SUPPLIES 0466839 �% 06/30/2021 06/22/2021 07/17/2021 99.49 0.00 0.00 99.49 .� SUPPLIES 0605088 "'06/3012021 08/23/2021 07/18/2021 127.50 0.00 0.00 127.50 SUPPLIES 0800979 /6/30/2021 06/24/2021 07/19/2021 1,277.36 0.00 0.00 1,277.36 SUPPLIES 1326624 ,/ 06/30/2021 06/25/2021 07/20/2021 13.05 0,00 0.00 13.05 file:///C:iUserslmmckissacWcpsi/memmed.cpsinal.comIU881501data_5/tmp_cw5repart2432581820764640235.html 5116 r"1 i 7/8/2021 tmp_cw5report2432581820764640235. html SUPPLIES 1326527 ✓!06/30/2021 06/25/2021 07/20/2021 516.93 0.00 0.00 516.93 SUPPLIES f,, Vendor Totals: Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCA 2,231.27 0.00 0.00 2,231.27 Vendor# Vendor Name Class Pay Code 11183 FRONTIER y f Invoice# Comment Tran of Inv Dt Due Dt Check Dt Pay Grass Discount NO -Pay Net 061921 06/30/2021 06/19/2021 07/13/2021 65.40 0,00 0.00 65.40 PHONE 062321 06/30/2021 06/23/2021 07/19/2021 9.09 0.00 0.00 9.09 �- PHONE Vendor Totals: Number Name Gross Discount No -Pay Net 11183 FRONTIER 74.49 0.00 0.00 74.49 v Vendor# Vendor Name Class Pay Code 12638 FUSION CLOUD SERVICES, LLC f Invoice# Co!pment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 28207237 r/66/30/2021 06/16/2021 07/16/2021 1,084.56 0.00 0.00 1,084.56 PHONE Vendor Totals: Number Name Gross Discount No -Pay Net 12636 FUSION CLOUD SE 1,084,56 0.00 0.00 1,084.56 Vendor# Vendor Name Class Pay Code W1300 GRAINGER Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9915, 08881 V /08/2021 05/27/2021 06/21/2021 454.50 0.00 0.00 454.50 SUPPLIES Vendor Totals: Number Name Gross Discount No•Pay Net W1300 GRAINGER 454.50 0.00 0.00 454.50 Vendor# Vendor Name Class Pay Code G0401 i GULF COAST DELIVERY ,.' Invoice# Comment Tran Ot Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net - 063021 06/30/2021 00/30/2021 07/28/2021 50.00 0.00 0.00 50.00 Z DELIVERY SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net G0401 GULF COAST DEW 50.00 0.00 0.00 50,00 Vendor# Vendor Name Class Pay Code G1210 GULF COAST PAPER COMPANY M' Invoice# Comment Tran DI Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 2.063749 /66/3012021 06/22/2021 07/22/2021 541.30 0.00 0.00 541.30 Lr "' SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPE 541.30 0.00 0,00 541.30 Vender# Vendor Name /, Class Pay Code 11095 GULF COAST SCIENTIFIC V Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 74458 06/90/2021 06/11/2021 07/08/2021 296.47 0.00 0.00 296.47 ✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11095 GULF COAST SCIEI 296.47 0.00 0.00 296.47 Vendor# Vendor Name Class Pay Code 10334 HEALTH CARE LOGISTICS INC /J Invoice# Com ant Tran DI Inv D7 Due Dt Check Dt Pay Gross Discount No -Pay Net 308051302 /30/2021 013/17/2021 07/12/2021 134.75 0.00 0.00 134.75 ✓-' SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10334 HEALTH CARE LOG 134.75 0.00 0.00 134.75 Vendor# Vendor Name Class Pay Code 12716 HITACHI HEALTHCARE -r, Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net PJIN01744400130/2021 06/15/2021 07/25/2021 7,908.33 0.00 0.00 7,908.33 SMA FEE y f file:/AC:/Users/mmckissack/cpsllmemmed.cpsinet.com/u88150/data_5/tmp_cw5report2432581820754640235.html 6116 7/8/2021 imp_cw5report2432581820764640235.htm1 Vendor Totals: Number Name Gross Discount No -Pay Not 12716 HITACHI HEALTHC/ 7,908,33 0.00 0.00 7,906.33 Vendor# Vendor Name Class Pay Code 10442 INTERSTATE ALL BATTERY CENTI Invoice# Comment Tran Dt Inv Ot Due Ot Check Dt Pay Gross Discount No -Pay Net 1901101023(05/30/2021 06/21/2021 07/21/2021 73.48 0.00 0.00 73.48 ✓' Div BATTERIES 1901103020:06/30/2021 06/21/2021 07/21/2021 265.89 0,00 0.00 265.89 5q, RADIO BATTERY Vendor Totals: Number Name Gross Discount No -Pay Net 10442 INTERSTATE ALL B 339.37 0.00 0.00 339.37 Vendor# Vendor Name Class Pay Code 11576 JOHNGSELF+PARTNERS, INC Invoice# Cp mment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 003739 06/30/2021 06/28/2021 06/28/2021 2,592.39 0.00 0.00 2,592,39 ADVERTISING FOR CFO Vendor Totals: Number Name Gross Discount No -Pay Net 11576 JOHNGSELF+PAR 2,592.39 0.00 0.00 2,592.39 Vendor# Vendor Name Class Pay Code 13956 KOETTER FIR PROTECTION ,'' Invoice# omment /06/3012021 Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 32929 06/29/2021 06/29/2021 1,760.00 0.00 0.00 1,760.004,,.-` HOOD SUPPRESSION LABOR Vendor Totals: Number Name Gross Discount No -Pay Net 13956 KOETTER FIR PRO- 1,760,00 0.00 0.00 1,760.00 Vendor# Vendor Name Class Pay Code 11275 KYLE DANIEL ./ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 070121A 07/01/2021 07/01/2021 07/01/2021 tt n'I STW1-c, 279.20 0.00 0.00 279.20 L,", TRAVEL FOR TRAMA ED (1f t LS ^ 1r i 3e l w h,,&LL.. Vendor Totals: Number Name Gross Discount No -Pay Net 11275 KYLE DANIEL 279.20 0.00 0.00 279.20 Vendor# Vendor Name class Pay Code 10972 M G TRUST Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 070621 07/07/2021 07/06/2021 07/06/2021 790.86 0= 0.00 790.86 ✓ ` PAYROLLDED Vendor Totals: Number Name Gross Discount No -Pay Net 10972 M G TRUST 790.86 0.00 0.00 790.86 Vendor# Vendor Name Class Pay Code M1511 MARKETLAB, INC y` w Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INOIS69325 r06/23/2021 05/26/2021 06/02/2021 109.07 0.00 0.00 109.07 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M1511 MARKETLAB, INC 109.07 0.00 0.00 109.07 Vendor# Vendor Name Class Pay Code M2178 MCKESSON MEDICAL SURGICAL I V,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 18268825 i 06/,30/2021 06/22/2021 07/07/2021 420.79 0.00 0.00 420.79 SUPPLIES e' Vendor Totals: Number Name Grass Discount No -Pay Net M2178 MCKESSON MEDIC 420.79 0.00 0100 420.79 Vendor# Vendor Name Class Pay Code 11203 MEDI-DOSE, INC rr' Invoice# Comment Tran Dt Inv Dt Due Ol Check Dt Pay Gross Discount No -Pay Net 0811167 ✓ 06/30/2021 05/28/2021 06/28/2021 206.25 0.00 0.00 206.25 p•`- SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11203 MEDI-DOSE, INC 206.25 0.00 0.00 206.25 Vendor# Vendor Name Class Pay Code file:IUC:/UserslmmckissacWcpsilmemmed.cpsinet.com/u88150/data_5/imp_cw5report2432581820764640235.htm1 7116 7/8/2021 tmp_cw5report2432581820764640235.html M2470 MEDLINE INDUSTRIES INC M Invoicelt Compent Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1954678034,0612312021 08/09/2021 07/04/2021 36.08 0.00 0.00 36.08 SUPPLIES 1955047177,06/23/2021 06/11/2021 07/06/2021 339.08 0.00 0.00 339.08 4f SUPPLIES 1955490316 g6/23/2021 06/16/2021 07/11/2021 8.68 0.00 0.00 6.68 SUPPLIES 1954678066 98130/2021 06/09/2021 07/04/2021 266,05 0.00 0.00 266.05 SUPPLIES 1954678053 9660/2021 06/09/2021 07/04/2021 7,599.80 0.00 0.00 7,599.80 a` SUPPLIES 19546780589660/2021 05/09/2021 07/04/2021 1,440.49 0.00 0.00 1,440.49 ,..� SUPPLIES 1954678064 06/30/2021 06/09/2021 07/04/2021 82.89 0.00 0.00 82.89 SUPPLIES 1954678050 06/30/2021 06/00/2021 07/04/2021 4,910.86 0.00 0.00 4,910,66 ,r SUPPLIES � 1954678038 06/30/2021 06/09/2021 07/04/2021 41.24 0.00 0.00 41.24 SUPPLIES 1954678041 0§/30/2021 06/09/2021 07/04/2021 44.29 0.00 0.00 44.29 SUPPLIES ��i 1954678D56 {16/30/2021 06/09/2021 07/04/2021 128,97 0.00 0.00 128.97 SUPPLIES ��. 1954678039 Q6730/2021 06/09/2021 07/04/2021 32.18 0.00 0.00 32,18. SUPPLIES 1955224971 0(030/2021 06/14/2021 07/09/2021 779.50 OM 0.00 779.50 SUPPLIES 1955248476 0P60/2021 06/15/2021 07/10/2021 284.07 0.00 D.00 284.07 i SUPPLIES 1955248490 06/30/2021 06/15/2021 07/10/2021 48.79 0.00 0.00 48.79 f SUPPLIES 1055245489 r0/30/2021 06/15/2021 07/10/2021 78.95 0.00 0.00 78.95 SUPPLIES 1955291336 9660/2021 06/15/2021 07/10/2021 392.83 0.00 0.00 392.83 SUPPLIES 1955248484.06/30/2021 06/1512021 07/10/2021 3,903.38 0.00 0.00 3,903.38 ` V� SUPPLIES 1955248492,96//30/2021 06/15/2021 07/10/2021 116.42 0.00 0.00 116.42 SUPPLIES 1965248482 96/30/2021 06/15/2021 07/10/2021 48.06 0.00 0.00 48,08 SUPPLIES 1955248473 WkMO21 06/1512021 07/10/2021 56.18 0.00 0100 56.18 ✓ SUPPLIES 1955248485 ,D613019021 06/15/9021 07/10/2021 19.71 0.00 0.00 19.71 ur - , SUPPLIES f 1955291337 2JA/2021 06/15/2021 07/10/2021 178.89 0.00 0.00 178.89 L•', SUPPLIES 199955245&06/30/2021 06/15/2021 07/10/2021 197.14 0.00 0.00 197.14 y/ 1455 24�%O SUPPLIES 1955248477 98/50/2021 06/15/2021 07/10/2021 112.63 0.00 0.00 112.63 SUPPLIES 1955248483 96/30/2021 06/15/2021 07/10/2021 197.14 0.00 0100 197,14 // SUPPLIES 1955248481 96/30/2021 06/15/2021 07/10/2021 127.30 0.00 0.00 127.30 f% SUPPLIES 1955248487,06/30/2021 06/151P021 07/10/2021 48.79 0= 0.00 48.79 SUPPLIES 1955248475 ,90/30/2021 06/15/2021 07/10/2021 30.97 0.00 0.00 30.97 SUPPLIES 1955490321 SW 2021 06/16/2021 07/11/2021 8.93 0.00 0.00 8.93 file:///C:/Userslmmckissack/cpsllmemmed.cpsinet.comlu86150/data_5/tmp_cw5report2432581620764640235.html 8116 r � 7/8/2021 tmp_cw5report2432581820764640235.htm1 SUPPLIES 1955490329 0 /30/2021 06/16/2021 07/11/2021 1,249.01 0.00 0.00 1.249.01 ✓ SUPPLIES //. 1955490339 06/30/2021 06/10/2021 0711 M021 167.50 0.00 0.00 167.50 ✓f. ✓✓ SUPPLIES 1955490320 26J,30/2021 06/16/2021 07/11/2021 53.74 0.00 0.00 53.74 t•,Z SUPPLIES 1955490318 V; 4/2021 06/16/2021 07/11/2021 93.30 0.00 0.00 93.30 SUPPLIES 1955490322 OY30/2021 06/16/2021 07/11/2021 4.75 0.00 0.00 4.75 SUPPLIES rrr 1955490335 06/30/2021 06/16/2021 07/11/2021 4,409.84 0.00 0.00 4,409.80. SUPPLIES 1955490338 0.6/30/2021 O6/16/2021 07/11/2021 83.75 0.00 0.00 83.75 SUPPLIES 1955490319 y&/2021 06/16/2021 07/11/2021 84.31 0.00 0.00 84.31 4•`• SUPPLIES 1955781052 330/2021 06/18/2021 07/13/2021 421.53 0.00 0.00 421,53 „sr� '"' SUPPLIES 1954678036 P/68/2021 06/09/2021 07/04/2021 84.31 0.00 0.00 84.31 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTR 28,210.33 0.00 0.00 28,210.33 Vendor# Vendor Name Class Pay Cade 10963 MEMORIAL MEDICAL CLINIC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 070621 07/07/2021 07/06/2021 07/08/2021 237.71 0.00 0.00 237.71 V,(' PAYROLL DIED Vendor Totals: Number Name Gross Discount No -Pay Net 10963 MEMORIAL MEDICF 237.71 0.00 0.00 237.71 Vendor# Vendor Name Class Pay Cade M2621 MMC AUXILIARY GIFT SHOP Invoice# Comment Tran Dt Inv Dt Due Dt ��Nl Check Dt Pay Gross Discount No -Pay Net 070121 07/01/2021 07/01/2021 07/Ot/2021 121.77 0.00 0.00 121,77 PAYROLL DED Lam' Vendor Totals: Number Name Gross Discount No -Pay Net M2621 MMC AUXILIARY GI 121.77 0.00 0.00 121.77 Vendor# Vendor Name Pay Code /Class 10536 MORRIS & DICKSON CO, LLC uJ Invoice# Cpmmant Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 7053294 4 f O6/3012021 06/29/2021 07/09/2021 140.62 0.00 0.00 140.62 y� INVENTORY 7053295 ✓ 06/30/2021 00/29/2021 07/09/2021 106.61 0.00 0.00 106.61 INVENTORY 7053293 ,/ 06/30/2021 06/29/2021 07/09/2021 9.59 0-00 0.00 9.59 „l INVENTORY 7052015 ✓'06/30/2021 06/29/2021 07/09/2021 33.20 0.00 0.00 33.20 / INVENTORY 7050534 .X0613012021 06/29/2021 07/0912021 28.36 0.00 0,00 28.36 INVENTORY 7050535 ✓ 05/30/2021 06/29/2021 07/09/2021 28.32 0.00 0.00 28.32 INVENTORY 7053296✓ 06/30/2021 06/2912021 07/09/2021 1,433.40 0.00 0.00 1,433.40 INVENTORY 7053297 ,% 06/30/2021 06/29/2021 07/09/2021 293.24 0.00 0.00 293.24 a•-^' INVENTORY 3929 ✓' 06/30/2021 06/30/2021 07/10/2021 .5.00 0.00 0.00 -5.00 f' / INVENTORY 7058396 ✓ 06/30/2021 06/30/2021 07/10/2021 205.87 0.00 0.00 205.87 INVENTORY 4321 �/ - 06/30/2021 06/30/2021 07/10/2021 .0.15 0.00 0.00 -0.15 ✓''� Ole:///C:IUserslmmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/Imp,_cw5repor124 32561820764640235.html 9116 7/8/2021 tmp_cw5report2432581820764640235.html / CREDIT 7055552 V 06/30/2021 06/30/2021 07/10/2021 1.15 0.00 0.00 1.15 L % INVENTORY 7058397 ✓08130/2021 06/30/2021 07/10/2021 567.75 0.00 0.00 567.75 fir. INVENTORY 7055556 ,,6613012021 06/30/2021 07/10/2021 2.13 0.00 0.00 2.13 ✓'` INVENTORY 4320 � � 08/30/2021 06/30/2021 07/10/2021 -4.99 0.00 0.00 -4.99 CREDIT 7055553 y/06/30/2021 06/30/2021 07/10/2021 51.63 0.00 0.00 51.63 INVENTORY I 7058398 06/30/2021 07/10/2021 812.46 0.00 0.00 812.45 �/06130/2021 k�F INVENTORY 7055554 +A6/30/2021 06/30/2021 07/10/2021 7.29 0.00 O,OD 7.29 INVENTORY 4089 J 06/301202, 06/30/2021 07/10/2021 -5.00 0.00 0.00 -5.00 CREDIT 4090 �% 06/30/2021 06/30/2021 07/10/2021 -5.00 0.00 0.00 -5.00 CREDIT 7057790 ✓O613012021 06/30/2021 0711=021 3$.47 0.00 0.00 33.47 INVENTORY 7055551 ✓06/3012021 06/30/2021 07/10/2021 80.34 0.00 0.00 80.34 INVENTORY Vendor Totals: Number Name Gross Discount No -Pay Net 10536 MORRIS 8 DICKSOI 3,815.28 0.00 0.00 3,815.2E Vendor# Vendor Name Class Pay Code M2659 MXR IMAGING, INC M �� Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 8800774318„06/30/2021 06/18/2021 07/18/2021 977.62 0.00 0.00 977S2 SUPPLIES 880077471O 012021 06/21/2021 07/21/2021 222.47 0.00 0.00 222.47 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2659 MXR IMAGING, INC 1,200.09 0.00 0.00 1,200.09 Vendor# Vendor Name Class, Pay Code 13548 NACOGDOCHES TRANSCRIPTION Invoice# Comment Tran Dt Inv Ot Due Ot Check Dt Pay Gress Discount No -Pay Net 7400 uJ 06/30/2021 06/30/2021 08/30/2021 225.68 0.00 0.00 225.68 TRANSCRIPTION Vendor Totals: Number Name Grass Discount No -Pay Net 13548 NACOGDOCHES TF 225.68 0.00 0.00 225.68 Vendor# Vendor Name Class Pay Code 12796 NEW DISTRIBUTING Invoice# Co�p�mL ent Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 160792106 U6V30l2021 06/15/2021 06/15/2021 384.22 0,00 0.00 384.22 VVV FUEL r Vendor Totals: Number Name Gross Discount No -Pay Net 12796 NEW DISTRIBUTINC 384.22 0.00 0.00 384.22 Vendor# Vendor Name Class Pay Code 00920 OFFICE DEPOT v� Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 1748775410tt6/30/2021 05/24/2021 07/08/2021 376.18 0.00 0.00 376.18 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 00920 OFFICE DEPOT 376,18 0.00 0.00 376.18 Vendor# Vendor Name Class Pay Code 01600 OLYMPUS AMERICA INC t./ M Invoicep Co5nment Tran Ot Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 31107789 v06/30/2021 06/17/2021 07/12/2021 193.11 0.00 0.00 193.11 SUPPLIES 31128226 06/30/2021 06/22/2021 07/17/2021 361.86 0.00 0.00 361.86 t1 filea!lC:(Users/mmckissack/cpst/memmed.cpsinet.com/u88150ldata_5/imp_cw5repon24325B1820784840235.fitm1 10116 7/8/2021 tmp_cw5report2432581620764640235.htm1 SUPPLIES 31128225 ✓{16/3012021 06/22/2021 07/17/2021 226.95 0.00 0.00 226.95 SUPPLIES v Vendor Totals: Number Name Grass Discount No -Pay Net 01500 OLYMPUS AMERIC 781.92 0.00 0.00 781.92. Vendor# Vendor Name Class Pay Code 10152 PARTSSOURCE, LLC Invoice# CoSllment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 03835377 A15/30/2021 04/30/2021 05/30/2021 306.95 0.00 0.00 306.05 POWER SUPPLY 03822088 v68/30/2021 05/10/2021 06/10/2021 445.67 0.00 0.00 445.67,.' SUPPLIES 03861293 J613012021 05/21/2021 06/20/2021 366,16 0.00 0.00 366.15 ✓`� SUPPLIES 03859174 1)18/30/2021 OW21/2021 06/20/2021 15.32 0.00 0.00 15.32 SUPPLIES 03859690 06/30/2021 05/21/2021 00/20/2021 49.88 0.00 0.00 49.68 SUPPLIES V,' 03862569 96/30/2021 05/21/2021 06/20/2021 840.11 0.00 0.00 840.11 CENTERFUGE REPAIR v` 03859745 /06/30/2021 06/21/2021 06/20/2021 77.47 0.00 0.00 77.47 SUPPLIES 03860089 05/21/2021 06/20/2021 86.48 0.00 0.00 85.4E E. ✓}06/30/2021 SUPPLIES A ,,// 03p861755 06/30/2021 05/21/2021 06/20/2021 487.67 0.00 0.00 487.67 ,..E // SUPPLIES 03808307 06/30/2021 06/10/2021 07/10/2021 73.79 0.00 0.00 73.79 ' SUPPLIES 03869406 � 66/30/2021 06/10/2021 07/10/2021 241.51 0.00 0.00 241.51 V SUPPLIES 03892968 06h4/2021 07/14/2021 200.65 0.00 0.00 200.65 V/ '(G/30/2021 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10152 PARTSSOURCE, LL 3,190.65 0.00 0.00 3,190.65 Vendor# Vendor Name Class Pay Code 12544 PATRICK OCHOA,-/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 070121 07/01/2021 07/01/2021 07/01/2021 520.00 0.00 0.00 520,00 HOSPITAL LAWN 070121A 07/01/2021 07/01/2021 07/01/2021 380.00. 0.00 0.00 380,00 LAWN 070121E 07/01/2021 07/01/2021 07/01/2021 200.00 0.00 0.00 200.00 LAWN Vendor Totals: Number Name Gross Discount No -Pay Not 12544 PATRICK OCHOA 11100.00 0.00 0.00 1,100.00 Vendor# Vendor Name Class Pay Code 14016 PER RY MECHANICAL SYSTEM 41 Invoice# Con)ment Tran Ot Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 210382BD ✓06130/2021 05/11/2021 06/11/2021 2,293.00 0.00 0.00 2,293.00 .. 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IP t/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1873520210476/30/2021 04/3012021 05/30/2021 350.00 0.00 0.00 350.00 LZ LAB SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 11087 PROMETHEUS LAB 350.00 0.00 0.00 350.00 Vendor# Vendor Name Class Pay Cade 13936 PROTOUCH STAFFING Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 030737 /06180/2021 06/26/2021 07/20/2021 2,737.50 0.00 0.00 2.737.50 ✓" ICU STAFFING 030805 „i 7/07/2021 07/0412021 07/04/2021 5,250.00 0.00 0.00 5,250.00 ICU STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net 13936 PROTOUCH STAFF 7,987.50 0.00 0.00 7,987.50 Ventlor# Vendor Name Class Pay Code 10896 QIAGEN INC Invoice# Coff��ment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 997893705 f06/30/2021 06/22/2021 07/22/2021 352,69 0.00 0.00 352.69 SUPPLIES Vendor Totals: Number Name Grass Discount No -Pay Net 10896 QIAGEN INC 352.69 0.00 0.00 352.69 Vendor# Vendor Name Class Pay Code 13460 RELIANT, DEPT 0954 ✓'- Invoice# Comment Tran Ot Inv DI Due Dt Check Dt Pay Grass Discount No -Pay Net 1120129011ip6/30/2021 O6/21/2021 07/21/2021 25.447.06 0.00 0.00 25,447.06 V - 11 ELECTRICITY Vendor Totals: Number Name Gross Discount No -Pay Net 13460 RELIANT, DEPT 095 25.447.06 0.00 0.00 25,447.06 Vendor# Vendor Name Class Pay Code 13940 RN NETWORK '/ v' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 3930163RI % 06/2912021 06/28/2021 07/28/2021 2,831.00 0.00 0,00 2,831_00 NURSE STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net 13940 RN NETWORK 2.831.00 0.00 0.00 2,831.00 Ventlor# Vendor Name Class Pay Code S0900 SAM'S CLUB DIRECT ,i� W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 002878 06/30/2021 05/23/2021 07/08/2021 44.84 0.00 0.00 44.84 SUPPLIES 003243 06/30/2021 05/2512021 07/08/2021 92.13 0.00 0.00 92.13 f SUPPLIES 006659 06/30/2021 06/06/2021 07/08/2021 77.90 0.00 0.00 77.90 ,/- file:///C:/Users/mmokissacWcpslimemmed.cpsinet.com/u88150/data_51tmp pw5repoft2432581820764640235.htmi 12116 718r2021 tmp_cw5repart2432581820764640235.html SUPPLIES 007963 06/30/2021 06/08/2021 07/08/2021 65.58 SUPPLIES L210620 06/30/2021 06/19/2021 07/08/2021 11.13 FINANCE CHARGE 008426 06/30/2021 06/19/2021 07/08/2021 52.68 SUPPLIES Vendor Totals: Number Name Gross Discount S0900 SAM'S CLUB DIREC 344.26 0.00 Vendor# Vendor Name Class 51405 SERVICE SUPPLY OF VICTORIA IN W �/ ' Invoice# Comment Tran Dt Inv Dt Due Dt Checem Pay Gross 701101714 v 6/30/2021 06/18/2021 07/18/P021 407.68 FREON CYLINDERS 701102330 96/30/2021 06/24/2021 07/24/2021 137.25 t/ SUPPLIES Vendor Totals: Number Name Gross Discount S1405 SERVICE SUPPLY C 544.83 0,00 Vendor# Vendor Name Class S1800 SHERWIN WILLIAMS �-� W 0.00 0.00 65.58 0.00 0.00 11.13 ,,,•'� 4 0.00 0.00 52,68 No -Pay Net 0.00 344.26 Pay Code Discount No -Pay Net 0.00 0.00 407.58 �..� 0.00 0.00 137.25 W�'' No -Pay Net 0.00 544.83 Pay Code Invoice# /Gommenl Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay 92536 ,/ 06/30/2021 06/23/2021 07/08/2021 32.21 0.00 0.00 SUPPLIES Vendor Totals: Number Name Gross Discount 51800 SHERWIN WILLIAM! 32.21 0.00 Vendor# Vendor Name Class $2001 SIEMENS MEDICAL SOLUTIONS IN M Invoice# Comment Tran Dt Inv Dt Clue Dt r Check Dt Pay Gross 116069396 �03012021 06/17/2021 07/12/2021 2,193.83 MAMMO Vendor Totals: Number Name Gross Discount S2001 SIEMENS MEDICAL 2,193.83 0.00 Vendor# Vendor Name Class 10699 SIGN AD, LTD. Invoice# C6mment Tran Dt Inv Dt Due Dt Check DI Pay Gross 262548 r 06/30/2021 06/01/2021 06/11/2021 400.00 AD Vendor Totals: Number Name Gross Discount 10699 SIGN AD, LTD. 400.00 0.00 Vendor# Vendor Name Class 52270 SMILEMAKERS / M Net f 32.21 No -Pay Net 0.00 32.21 Pay Code Discount No -Pay Net 0.00 0.00 2,193.83 No -Pay Net 0.00 2,193.83 Pay Code Discount No -Pay Not 0.00 0.00 400.00 No -Pay Net 0.00 400.00 Pay Code Invoice# Comment Tran Dt Inv Dt � Due Ot Check Dt Pay Gross Discount No -Pay Net 8983152 /06/30/2021 06/23/2021 07/18/2021 188.94 0.00 0.00 188.94 SUPPLIES/STICKERS Vendor Totals: Number Name Gross Discount No -Pay Net S2270 SMILE MAKERS 188,94 0.00 0,00 188.94 Vendor# Vendor Name Class Pay Code 11296 SOUTH TEXAS BLOOD & TISSUE C Invoice# Corr ment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net CM4862 �0613012021 06/30/2021 07125/2021 -1,896.00 0.00 0.00 -1,896.00 v CREDIT MEMO BLOOD BANK 1 f IQ9015600 ,06/30/2021 06/30/2021 07/25/2021 3.798.00 0.00 0.00 3,798,00 BLOOD Vendor Totals: Number Name Gross Discount No -Pay Net 11296 SOUTH TEXAS BLO 1,902.00 0.00 0.00 1.902.00 Vendor# Vendor Name Class Pay Code C1010 SPARKLIGHT ��% W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 062021 06/30/2021 06/20/2021 07/04/2021 98.54 0.00 0.00 98.54 4/ CABLE Vendor Totals: Number Name Gross Discount No -Pay Net file:///C:/Users/mmckissack/cpsilmemmed.cpsinet.com/u88150/data_5ltmp_cw5report2432581820764640235.html 13116 7/8/2021 tmp_cw5report2432581620764640235. html C1010 SPARKLIGHT 98.54 0.00 0.00 9B.54 Vendor# Vendor Name Class Pay Cade S2833 STRYKER ENDOSCOPY / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 10538372E W¢ 0/2021 06/17/2021 07/08/2021 1,602.81 0100 0.00 1,602.81 �r SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net S2833 STRYKER ENDOSC 1,602.81 0.00 0.00 11602.61 Vendor# Vendor Name Class Pay Code 10735 STRYKER SUSTAINABILITY " Invoice# Comment Tran Dt Inv Dt Due Of Check Dt Pay Gross Discount No -Pay Net 4112310 ✓- 02/23/2021 02/08/2021 07/22/2021 -8.50 0.00 0.00 -8.50 {� CREDIT 4210366 ✓ 06/30/2021 06/21/2021 07/21/2021 2,615.14 0.00 0.00 2,615.14 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10735 STRYKER SUSTAIN 2,606.64 0.00 0.00 2,606.64 Vendor# Vendor Name Class Pay Code 12440 SUN LIFE ASSURANCE COMPANY Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 062321 06/30/2091 06/23/2021 06/23/2021 4,821.35 0,00 0.00 4,821.35 INSURANCE Vendor Totals: Number Name Gross Discount No -Pay Net 12440 SUN LIFE ASSURAP 4,821,35 0.00 0.00 4.821.35 Vendor# Vendor Name Class Pay Cede T2539 T-SYSTEM, INC J" W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 46432 v 06/30/2021 06/27/2021 07/27/2021 431.42 0.00 0,00 431.42 L ,' ER SOFTWARE Vendor Totals: Number Name Gross Discount No -Pay Net T2539 T-SYSTEM, INC 431.42 0.00 0.00 431.42 Vendor# Vendor Name . Class Pay code 13880 TEXAS SELECT STAFFING V Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0017611510,06/30/2021 06/30/2021 06/30/2021 3,187.50 0.00 0.00 3,187.50 V -711-11`J ICU NURSE Vendor Totals: Number Name Gross Discount No -Pay Net 13880 TEXAS SELECT STr 3,197.50 0.00 0.00 3,187.50 Vendome Vendor Name Class Pay Code 10756 TEXAS SELECT STAFFING, LLC ,,.'i Uped t.rNr{�xci Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay G as Discount No -Pay Not DEPOSIT.JE 07/08/2021 07/08/2021 07/08/2021 6,00;Q 0.00 0.00 6.00000 DEPOSIT FOR TRAVEL RN Vendor Totals: Number Name Gross Discount No -Pay ,IVat 10758 TEXAS SELECT STr 6.006.00 0,00 0.00 o Vdf 00 Vendor# Vendor Name Class Pay Code 11908 TMS SOUTH ✓� Invoice# Comment Tran Dt .Inv Dt Due Dt Check Dt Pay Gross Discount INV15872A6/30/2021 05/07/2021 06/06/2021 206.05 0.00 SUPPLIES INV16036 �/66/30/2021 05/10/2021 06/09/2021 140.82 0.00 SUPPLIES INV15947 96/30/2021 051IM021 06/09/2021 239.53 0.00 t�' SUPPLIES INV19427 /66/30/2021 06/17/2021 07/17/2021 198.56 0.00 SUPPLIES No -Pay Net. 0.00 206.05 0.00 0.00 0.00 Vendor Totals: Number Name Gross Discount No -Pay 11908 TMS SOUTH 784.96 0.00 0.00 Vendor# Vendor Name Class Pay Code T3334 TRINITY PHYSICS CONSULTING U W w/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay file:I/IC:iUsers/mmckissocklcpsi/memmed.opsinet.com/u881 50/data-S/imp__pw5report2432581820764640235.htmI 239.53 198.56 Net 784.96 Net 14116 7/812021 tmp_aw5report2432581820764840235.himl 9651@8- r 06/30/2021 06/16/2021 07/16/2021 1.600.00 0.00 0.00 1,600.00 D3-61A Vendor Totals: Number Name Gross Discount No -Pay Net T3334 TRINITY PHYSICS C 1,600.00 0.00 0.00 1,800.00 Vendor# Vendor Name Class Pay Cade U1054 UNIFIRST HOLDINGS ,�' W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8400367580 Q6/30/2021 06/17/2021 07/12/2021 100.06 0.00 0.00 100.06 LAUNDRY 8400367526 V30/2021 06/17/2021 07/12/2021 170.61 0.00 0.00 170.51 .% LAUNDRY 8400368238 00/30/2021 OW412021 07/19/2021 121.55 0.00 0.00 121.55 ✓� LAUNDRY 8400868290 qe30/2021 06/24/2021 07/19/2021 69.43 0.00 0.00 69.43 „^'r LAUNDRY 8400368240 i06%W/2021 06/24/2021 07/19/2021 170.07 0.00 0.00 170.07 Yf' LAUNDRY 8400368241 06/30/2021 06/24/2021 07/19/2021 194.90 0.00 0.00 194.90 j LAUNDRY 8400368259 0$/30/2021 08/24/2021 07119/2021 84,83 0.00 0.00 84.83 ems' LAUNDRY 8400368239bg6/3012021 06/24/2021 07119/2021 176.36 0.00 0.00 176,36 LAUNDRY 8400368236 Q6/30/2021 06/24/2021 07/19/2021 41.07 0.00 0.00 41.07 r; LAUNDRY 8400368272 �P60/2021 06/24/2021 07/19/2021 1,664,99 0.00 0.00 1,664.90 LAUNDRY 8400368541 ,g6//30/2021 06/2812021 07/23/2021 1,806.23 0,00 0.00 1,806,23 LAUNDRY 8400368619 Q§160/2021 06/28/2021 07/23/2021 45.16 0,00 0.00 45.16 LAUNDRY 8400368516 89/30/2021 06/28/2021 07/23/2021 45.15 0.00 0= 46.15 LAUNDRY Vendor Totals: Number Name Gross Discount No -Pay Net U1054 UNIFIRST HOLDING v'' 4,690.31 0.00 0.00 4,69031 Vendor# Vendor Name Class Pay Code 12400 UPDOXLLC Invoice# Comment Tran Dt Inv Dt Due Or Check Dt Pay Gross Discount No -Pay Net INV002633%M6/3012021 06/30/2021 013/30/2021 800.00 0.00 0100 8001001A,,:'"� FAXING Vendor Totals: Number Name Gross Discount No -Pay Net 12400 UPDOX LLC 800.00 0.00 0.00 800.00 Vendor# Vendor Name Class Pay Code U2000 USPOSTALSERVICE /'r, Invoice# Comment Trap Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Not 062921 06/30/2021 06/29/2021 06/29/2021 2,200.00 0.00 0.00 2,200.00 POSTAGE Vendor Totals: Number Name Grass Discount No -Pay Net U2000 US POSTAL SERVIC 2,200.00 0100 0100 2200.00 Vendor# Vendor Name Class Pay Code V1056 VICTORIA AIR CONDITIONING LTD W ✓' Invoice# Comment Tran Dt Inv Dt Due Or Check Or Pay Gross Discount No -Pay Net 185257 09/14/2020 09/14/2020 1.890.49 0.00 0.00 1,890.49 1/06/30/2021 MOTOR 18575806/30/2021 09/14/2020 09/14/2020 422.00 0.00 0.00 422.00 / AHU REPAIR Vendor Totals: Number Name Gross Discount No -Pay Net V1066 VICTORIA AIR CON 2,312.49 0.00 0.00 2,312.49 Vendor# Vendor Name Class Pay Code V1058 VICTORIA ANESTHESIOLOGY W Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net fie://IC:/Users/mmcRissack/cpsilmemmed.cpsinet.com/u86150/data_5/imp_cwSreport2432581820764840235.html 15116 7/8/2021 tmp_cw5report2432581820764640235.himl 063021 06/30/2021 06/30/2021 06/30/2021 42,187.17 0.00 0.00 42,187.17 ANESTHESIA Vendor Totals: Number Name Gross Discount No -Pay Net V1058 VICTORIA ANESTHI ✓ 42.187.17 0.00 0.00 42,187.17 Vendor# Vendor Name Class Pay Code 10793 WAGEWORKS, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 070621 07/07/2021 07/06/2021 07/06/2021 3,532.48 0.00 0.00 3,532.48 PAYROLL DED Vendor Totals: Number Name Gross Discount No -Pay Net 10793 WAGEWORKS, INC. 3,532.48 0.00 0.00 3.532.46 Vendor# Vendor Name Class Pay Code j W1005 WALMART COMMUNITY ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 02873 0613012021 05/20/2021 07/14/2021 -2.76 0.00 0.00 -2.76 CREDIT 552642 06/30/2021 06/02/2021 07/14/2021 81.20 0.00 0.00 81.20 SUPPLIES 507991 06/30/2021 06/07/2021 07/14/2021 70.84 0.00 0.00 70.84 SUPPLIES 061921 O6/3O/2021 06/19/2021 07/14/2021 6.44 0.00 0.00 6.44 FINANCE CHARGE Vendor Totals: Number Name Gross Discount No -Pay Net W 1005 WALMART COMMU 155.72 0.00 0.00 155.72 Grand Totals: Gross Discount No -Pay Net 328,279.41 0.00 0.00 328,279,41 t313°+R-09> Py ovy,C-iuv-,�, 4)vgg> L-4t000•00? ,rift IS 2021 � ,1WAS �3jSM20-00 file:lllC:/Users/mmekisseck/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5report2432581820764640235.html 16116 7/9/2021 tmp-_„4w5report1533074026953668116.htm1 MEMORIAL MEDICAL CENTER 07/09/2021 0 AP Open Invoice List 14:43 ap_open_Invoice.template Dates Through: Vendor# Vendor Name Class Pay Code T2900 3M COMPANY t/ M Invoice# Co/�mment Tran Dt Inv Dt Due Dt Cheek Dt Pay Gross Discount No -Pay Net SC87045 ✓06/3012021 O6/0112021 06/26/2021 15,704.57 0.00 0.00 16,704.57 SOFTWARE Vendor Totals: Number Name Gross Discount No -Pay Net T2900 3M COMPANY 15,704.57 0.00 0.00 15,704.67 IiGpGri 3U1fliYm'�: Grand Totals: Gross Discount No -Pay Net 15,704.57 0.00 OAO 15,704.57 AMMOV am JUL 19 M1 . LAWWWA to file:!lIC:IUserslmmckissacklcpsi/memmed.cpsinet.com/u68150aldata_5/tmp_cw5repor11533074026953666115.html 1/1 RUN DATE: 07/09/21 TIME: 16:22 PATIENT NUMBER PAYEE NAME ..................................... ------------------------------------- ARID=0001 TOTAL ---------- ------------------------- TOTAL ..um'�tw � �, UVAti MEMORIAL MEDICAL CENTER EDIT LIST FOR PATIENT REFUNDS ARID=0001 PAY PAT DATE A14OUNT CODE TYPE DESCRIPTION ------------------------------------------------------ 070721 123.00 ,/2 REFUND FOR ------------------------------------------------------ 123.00 ------------------------------------------------------ i23.00 PAGE 1 APCDEDIT GL NUM � / 0 k( � & z § 0 m; CC ® �} LU z� | 0 ) E19 !j2 ■ , v k %| § to � £ 2 §( Ul U) | iE 2 �■ � � 7 § � ƒ G § § ) k !§! on in 0 } k ) ( No -e §: 41 (| IS ! | �} 0 7 �k )E to ! ■ 2 ! § . ! ! . fto � § - f . ! k ° � | IS 7 ) ! 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K¢m¢O¢O¢0WOx22x a a U 4 a a U a 0 0 0 0 U U U Hsaw U Y$ w w ❑no 0000 U U U U U U U U U U U U U 0 U U co en (Azzzzzzzzzzzzzzz Jason Anglin From: Luba Kubinski <luba@ahcv.com> Sent: Friday, July 9, 2021 6:51 PM To: Steve.King@dchstx.org; Eric.Hamon@dchstx.org; ksnook@postacutecorporate.com; HBernal@pamrehab.com; Steve.Takacs@surgerypartners.com; Julie.Wittwer@surgerypartners.mm; Nicosia Chris; angelajones@emesthealth.com; MichaelPierce@emesthealth.com; Mike_Healey@chs.net eric_graves@chs.net; michael tea@chs.net; Harrison, Jaclynn J.; czafereo@cmcvtx.org; pstrauss@cmcvtx.org; Duane.Woods@cmcvtx.org; David Lee; Jason Anglin; Susan Parker; jmoehler@ rcmhospital.org' Cc. David Elliot; Robin Daniel Subject: Nueces - UHRIP PGY4 Additional IGT Notification Attachments: 20210707 DRAFT Nueces SDA PGY4 Additional IGT Allocation.xlsx; TeHNet User Guide.pdf, UHRIP Year Additional IGT by SDA.xlsx [WARNING -Remote attachments, VERIFY SENDER] CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Dear All, Based on HHSC's notification email below, the PGY4 Additional IGT submission deadline is Thursday, August 5th, and the Nueces SDA will need to submit $1,657,687.49 in IGT expense. To ensure 100% funding of the SDA prior to HHSC's deadline, we are requesting confirmation of the amounts and funding sources within the attached Allocation Summary by the deadlines listed below. PRIVATE HOSPITALS: Please review the requested IGT amounts for your facility and provide any comments or questions no later than Friday, July 16, 2021. If we do not hear from your organization, we will assume your organization is in agreement with the requested IGT. PUBLIC HOSPITALS: Please provide a copy of the TexNet sent to HHSC by EOD Thursday, July 29th to those copied on this email. If you expect the amount will be different than the amount noted within the attached Allocation Summary, please let us know as soon as possible. Please let me and those copied on this email know if you have any questions going forward. Best regards, Luba Kubinski Financial Analyst AHCV - Adelanto HealthCare Ventures L.L.C. 401 W. 15th Street, Suite 840 Austin, TX 78701 Direct: 512-508-9545 hftos://ahcv.com! From: HHSC PFD UHRIP Payments cPFD UHRIP PavmentsAiihhs.reras.Povn Sent: Wednesday, July 7, 20219:31 AM Subject: UHRIP Year 4 Additional IGT Notification UHRIP Providers, This additional call for IGT is based on the enhanced FMAP rate. Caseload has increased at a greater rate than initially projected at the beginning of the fiscal year which has increased UHRIP payments. Due to this increase in caseload, we need additional IGT for the remainder of Program Year 4. UHRIP providers will receive commensurate increases in the payments received from MCOs. HHSC is providing notification that the IGT for the remainder of 2021 UHRIP must be entered into TexNet no later than close of business Thursday August 5, 2021 with a settlement date of August 6, 2021. These funds will need to be placed in the "UHRIP" Bucket. The amount that needs to be entered into TexNet are calculated by SDA in cells 84-1316 of the attached "UHRIP Year 4 Additional IGT by SDA" workbook. If the TexNet is entered online, please provide a screen shot or PDF of the confirmation/trace sheet and reference which SDA the funds should be allocated towards in the body of the email. If the TexNet is entered over the phone, please provide the confirmation number. Please send an email with this information to PFD UHRIP Payments@hhs.texas.eov Please email any questions to PFD UHRIP Pavments@hhs.texas.eov. Thank you, HHSC Provider Finance Payments (Formerly Rate Analysis) Texas Health and Human Services Commission Attention: Provider Finance Department North Austin Complex 4601 Guadalupe St Austin, TX 78751 Mail Code H-400 P.O. Box 149030 Austin, Texas 78714-9030 lim �';, TEXAS t: Health and Hurnan Ne- Services [WARNING -Remote attachments, VERIFY SENDER] CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. UHRIP Providers, This additional call for IGT is based on the enhanced FMAP rate. Caseload has increased at a greater rate than initially projected at the beginning of the fiscal year which has increased UHRIP payments. Due to this increase in caseload, we need additional IGT for the remainder of Program Year 4. UHRIP providers will receive commensurate increases in the payments received from MCOs. HHSC is providing notification that the IGT for the remainder of 2021 UHRIP must be entered into TexNet no later than close of business Thursday August 5, 2021 with a settlement date of August 6, 2021. These funds will need to be placed in the "UHRIP" Bucket. The amount that needs to be entered into TexNet are calculated by SDA in cells 84-B16 of the attached "UHRIP Year 4 Additional IGT by SDA" workbook. If the TexNet is entered online, please provide a screen shot or PDF of the confirmation/trace sheet and reference which SDA the funds should be allocated towards in the body of the email. If the TexNet is entered over the phone, please provide the confirmation number. Please send an email with this information to PFD UHRIP Pavments2hhs.texas.eov Please email any questions to PFD UHRIP Pavmentsfths.texas.gov. Thank you, HHSC Provider Finance Payments (Formerly Rate Analysis) Texas Health and Human Services Commission Attention: Provider Finance Department North Austin Complex 4601 Guadalupe St Austin, TX 78751 Mail Code H-400 P.O. Box 149030 Austin, Texas 78714-9030 q'H JTEXAS I; Health and Human cC- 5ervices 7/812021 tmp_cw5report3951764514057563315.htm1 07/08/2021 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 16:27 ap open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11816 ASHFORD GARDENS Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 062921A 06/30/2021 0612912021--II10,7/29/2021 1.480.000� 0.00 1,480.00 y TRANSFER NN jYkSq MiU_ V atrNk�/t lGc�-i4i 1 wL, �.,_ "0.00 o�0 (Ay-'r�/ 062921E 06/30/2021 06/29/2021 07/29/2021 185.50 b.00 D O.00 185.50 TRANSFER ik It Vendor Totals: Number Name Gross Discount No -Pay Net lisle ASHFORD GARDEN 1,665.50 0.00 0.00 1,665,50 Grand Totals: Gross Discount No -Pay Net 1.665.50 0.00 0.00 1,665.50 A& / 9 2l21 a<►1 00MY4" °xns 81edUC:/Users/mmckissack/cpsi/memmed.cpsinet.com/u8sl50/data_5/1mp_cw5report3951764514057563315.html 1/1 718/2021 tmp_cw5report753512410337742932.html 07/08/2021 MEMORIAL MEDICAL CENTER 0 1628 AP Open Invoice List ap_open_Invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11824 THE CRESCENT Invoice# Comment Tran Or Inv Ot Due DI Check Dt Pay Grass Discount No -Pay Net 062921A 06/30/2021 06/29/2021 07/29/2021 556.50 0.0011-- 0.00 556.50 TRANSFER NH init,,wuj.t,L VDk4 Agojmi" I"MWIuC. ()rKA, Vendor Totals: Number Name Gross Discount N Pay Net 11824 THE CRESCENT 556.50 0.00 0.00 556.50 �=,r.pori. ymwr,;tt-; Grand Totals: Grass Discount No -Pay Net 556.50 0.00 0.00 556.50 f UK JUL 19 2121 �Yrii'Lal3ir iWIS 1 file:ll/C:/Userslmmckissack/cpsilmemmed.cpsinet.com/u88150/data_5/tmp_ew5report753512410337742932.html 111 7/8/2021 tmp_cw5report1471391172709984083.html MEMORIAL MEDICAL CENTER 07/08/2021 0 AP Open Invoice List 16:27 ep_open_invoice.templale Dates Through: Vendor# Vendor Name Class Pay Code 11836 GOLDENCREEK HEALTHCARE J Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 062921C 06130/2021 D612912021'/07/29/2021 6L36.00 0.00 0.00 636.0 0 TRANSFER rvq WOKY- pgwt{ &1rgyill� 1 )OV Jilikkr llnt,�. 062921A 06/30/2021 06/29/9021 07/29/2021 3,307.16 0.ddo 00 3,307.16 TRANSFER tt 11 0629216 06/30/2021 06/29/2021 07/29/2021 315.97 0.00 0.00 315.97 TRANSFER it 11 Vendor Totals: Number Name Gross Discount No -Pay Net 11836 GOLDENCREEK HE 4.259.13 0.00 0.00 4,259.13 Grand Totals: Gross Discount No -Pay Net 4,259.13 0.00 0.00 4,259.13 ItfIll 9K JUL 19 2921 AMIl as • 60triav, TEAS file:l//C:/Userslmmcklssacklepsi/memmed.epsinet.com/u881501date_51tmp_cw5reportl471391172709984083.html 1/1 7/8/2021 Imp _cw5reportl 972377307291467555.html 07/0812021 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 1626 ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 12696 GULF POINTE PLAZA Invoicog Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 062821 06/30/2021 0612812021`/ 07/29/2021 3,953.89 0.00 0.00 3,953,89 TRANSFER Iy" 1"SUVAm- Pt� Kl �I(�7gc u K4V TAWLL, LpG{h� 062921 06/30/2021 06/29/2021 07/29/2021 �J 1,680.00 0.00 0.00 1.680.00 TRANSFER V it 062921A 06/30/2021 06/29/2021 07/29/2021 2,215.00 0.00 0.00 2,216.00 TRANSFER ll 1t Vendor Totals: Number Name Gross Discount No -Pay Net 12696 GULF POINTE PLA2 7,848.89 0.00 0.00 7,848.89 Grand Totals: Gross Discount No -Pay Net 7,848.89 0.00 0.00 7,848.89 �f A& / 9 2121 .1''� aoaruRsr, TV" file:///C:lUserslmmckissacktcpsllmemmed.cpsinet.com/u88l5O/data_5/tmp_cw5reportl 972377397291467555.html ill 7/8/2021 tmp_cw5reportl 511150528928563262.html 07/08/2021 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 16:25 ap_open_involce.template Dates Through: Vendor# Vendor Name Class Pay Code 13004 TUSCANY VILLAGE J Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 062821 06/30/2021 06/26/2021 07/29/2021 900.69 0.00 0.00 900.69 TRANSFER tjjj fnswkn(c VIVWV (Aq)OUtA IKIu WIL 062921 06/30/2021 06/29/2021 07/29/2021 658.00 0.00 0.00 658.00 ✓ TRANSFER Vendor Totals: Number Name Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 1,558.69 0.00 0.00 1,558.69 F;ce�cr7. 53:.;au:...rV Grand Totals: Gross Discount No -Pay Net 1,558.69 0.00 0.00 1,558.69 QR4 JUL 19 2121 s nx W#TM r, wz4s file:MC:/Users/mmckissacklopsilmemmed.cpsinet.com/u88150/data 6/tmp_ew5report1511150528928563262.html 111 7/8/2021 tm p_cw5report1297453383731307711. him[ 07/08/2021 MEMORIAL MEDICAL CENTER 0 16:23 AP Open Invoice List ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 062821 06/30/2021 06/28/2021 07/29/2021 11,390.56 0.00 0.00 11,390.66 TRANSFER NO P1.Alyk tc p41p1,a 51-}La{ jjt'h VV1Mj, Vendor Totals: Number Name U Gross Discount No -Pay Net 12792 BETHANY SENIOR 1 11,390.56 0.00 0.00 11,390.56 P.cr. nri •:m ,..0 • Grand Totals: Gross Discount No -Pay Net 11,390.56 0.00 0.00 11,390.56 Atlfult►� 9!P JUL 89 20 "ISMAs111+s7119 File://lC:AJsers/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5reportl297453383731307711.html 1/1 \ \ !� {� {))� (kr! !| } !!� ! !!!!! |ƒ!Au �| \•` / � |!! �| . 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(|{) ! ] { $!k !{ � i� ) i) � \)§~ )� )) !y !� )! ;� �! ` q ))\� !~ �� loll �i Memorial Medical Center Nursing Home UPL Weekly CanteR Transfer Prosperity Accounts 7/12/2021 Pre.Ieua ree,y. arwm eeDnnma mN Penmm a¢mme4 Ame,mle eem.J<.<u, xnnlm xunln rmme Ymk<r exn<. lnmx,.ln9SS,I, p4hTDi�l fa6)E6p0'.". ). b644181 W-121 )15,9A]I I15.8]1 !1 1i,054 i] 11,4SSd! 11.550.42 Bank B>bnce 11.9S5.47 Variance Laeva in 8.1-1. 100.00 MEONARIMPYMlOW UTOOB]xAW 2804/ MEOICAREREPYMYOWEOTOMMCYNIC ]7)O1 � Rqul Mlnle(mellon br A(M1Io(l6alen(: Altlia(tlllwlN [me {enterlW Co IDMa.[on CAox Bang ABA tI10aD614 A((eunleddb}3<}5} BbiBmOD1' 2/6844403 1S4,86101,/151j6103 "32,61673 ✓ 216914411 A6.69345 /16.59345 1/25,93661 rylvBt�,_ �, xi.TL 2I6844446 26]0).A2 T/ )6.602A2 � II9.)9 b0ltt k154N0131uD_:. 216844438 T0,11208 ✓)D012M r/II,B14,05 Carve, mmM1 Cme Cen en llr(t[ /PMNPan U.ole Mnkr A. I23Cf0514 Ae<eunrr93}66H}I NOK'9nIY Mlaneea o)over f3.Rtl W,tl0e1,4Mlr, X9ur mmeaoom6rramverlwn9/Haor NLYINTERESE AUG INTEREST SEP INTEREST Aeryrt OaUnm/rnnde. aml 34350.43 - 32.7M73 Bank 8[14n(a 32,71673 ✓ VUlan.. Leave In 8a1mtt IMOD / MEDICARE REPYMT OWED TO BETNANY MW (! MEDICARE REPYMT OWED TO MMOUNIC 2)).D1 V! IULYINTERES( AUG INTEREST IEPINTERESt 1 Aeivn B.t.I,0 .tak, Aml 32311.6e 26.035,51 Bank 60ame 36,036.61 V,I,Nnm Uavb )n8alan[e I0000 MEUICARERXPYMTOWEDTOBETNANY 28.M� MEDICARE REPYMT OWED IOMMUINIC 2>].DI IULYINTEREST AUGINTEREST SEPINTEREST Anus Belan..pramkr Am[ 25.631.S6 / ✓ 22,n / Bank Balance 229.79 V Vanana Leave In B41M[e IDGDO MED I CARE EXPIRES OW EO TO BEMANY MEDICAAE REPYMT OWED TO MMCUNIC IULYINTEREST AUG INTEREST SEP INTEREST AJ,.0 Ba -celTramfcrAm IRS." " 11,914,05 / Bank Bala... 11.914.05 vaean(e 4ave In Bala.. IMN MEDICARE REPYMTOWED TO 6EYNANY 28.04 f MEDICARE REPYMT OWED TO MAIMNIC 227,01 32,311.58 25.632.56 11,509.00 a t'RRI!EI�� iJ ' 4 3ULYINEREBi AUG INTERESTSEPIJUL i Z jLi ] i I li Aelm[BaenraR amN er AmL t1,509.00 iOTALiMNSPFRf PpplOve@ r` C r tale. Mann CED 7/12/2021 I: VIM Weekly(ranJarl\NNDPliramin Summary\I021\Iuly1X11UM rranJrr SYmmary),It.lS.JY 1 IN. w.IIYF. NHVM,l.., log a wenm I, 'IV.) Bant O—Ic 0r..IL IN.).ln I LOW Paa.t MMCPORIION _V'rJ)�u9f cl� 4 6 PI. 4 'd 70/2021 WIRT HEALTH T ASHMANS 0 HEALTHCARECENTER 02341 71812WI HEgIM HUMAN SVC NCCIPIMPMi l)46003g 13005 E )/9/ID31 CA 113R 7/Bho)1 CR 1137 7/01202, CNIl39 7111 II Oepmil 7/8/2021 UNC COMMUNITY PI HCCIAIMPM3 )aCM3411910000 )28/3D21 UHLTH HUMAN PC HCMIMPMT 174WO141=52 3/9/3D31 HEALTH HUMAN ]VC NCCIAIM9Mt 3)4C003g113W53 MM kF Lw 7/6/Wt MRP OUT TCARTER HCCWMPRE Yd6003d111}4304 ]H/2021 WINE OUTUN306NU]iNURECSW341III 1/8/2021 UinklODaRhnre HCCtAIMPF1i 3d6W3111124384 7/8/2021 Cheh100 ]/8/2011 Check99 Y/8/2021 Ched101 7/612021 0epin 7/0/2021 UHCCO MUN Pt HOCMPMT246W3M1114334 910 71912M1 UN HEALTH HUMAN S P1 HCCIAIMPMY 74SIMMOIL113DUR 2 )/9/2021 NFpl1H HUMAN SVC HC<IAIRIPMT ]Yd W03JI13 W4 3 41 7/6/2021 MANAGHEALTH HUMANTP 11 LAWS HCCSAHMMOWOOOBOOW3]6801 ]/b/2021 WIRE OUT HUMAN SVC HEALTH CARE CENI60034113W81 l(l/2621 WIREOUTCAMEHCCLAMPMHECFNO341111 ]p/1021 N013e4H SOLUT NCCCAAMPl906003g342MWI )/]/2021 NOVITA650LUT'9N XCCIAIMPM16T632343W00155 /82021 Chmk13 5 712021 Che3 7/812031 Chp1,16 )/8/021 ok 7/e/Z031 UHCCOMMUNITY PL MCCIFIM1IPMT 146003411910000 S NMI �rl. E" 717IM21 WIRE OUCCANTEB HEALTH CARE CENTERS(11 718120210.431 7/8/2021 ChMkl30 7MZ021 Checkl32 E/9tAQl URCCOMMUNIHIPLHCCIAIMPME 146003411910000 ,.t4 7/6/2021 NOVIWERE OUT CANTI0NHAWCARECEMPMT fiERS III 000180 117IM21 WIRCOUTUNINPLHCCTH ARECENTER5111 11UN21 UNHkI134 NItt PL NCCLpIMPMT ]46C63d11910W0 7/8/2021 Chnk1131 ]]8/2021 Chec11,1133 1/8/2021 Ch.cAlD.P., 35 ]/8/2021 De0P0t ]/812021 UH HEALTH HUMAN HCCUUMPMT 1746W t1 3007 2 ]/B/2031 HFA1TX NUMFN SYC N(CIp1MPM11]46C0341L300]2 TOTALS W Camp 1180f�808P3 / Tn lit /nnln NPP/Compl OIPY/Comps QIPP/CpmMp3 blea @]]T NX PDRnON I IS,Oi4,YSy _ 2Y6.18� 3.52<60 - - 3.5E4.GB ISO.21 am.60.91 . - 3,62302 - - 3,6234E 3162362 1,11223 1,112.2E - I.112.Z3 I,46691 - IA46.94 116,611.11 1]ASS,q J ILBSS.gi MMCPOBTON OIPP/CQn,4 Tmm� TONNI,,lp OIPP/Comet OIPP/Cemp2QIPP/CPmpS A.M. IVPPT NHPOBn ON - HOW 153.00).)51/ - 60D00 / 770.00 216.16 ),)4D00 216.58 J V - 360.53 f 14"V0A0 14.70D.00 9.VD.00 - 4,17000 6)D23 530.A SS6.SD - SS5.SO 154,761A1 32,616.73 326Ifi. 33 MMCPOp310N Trpetltt-0ut TIA-0-11n OIPP1Cpmp1 CUPO/CpmPZ CUPP/Cpmp3 QIPP/Cemp3 CHIP n NH POMION .ON Now - / 1.22A 6 1R23.46 g5R]3.15y 3.12D. 0 1.120.90 ✓ 13.318OB - 13,318 tl8 26.16 81.1 ✓/ 360.51 / . 8605D9 R - 3165.07 0.593145 if.936.61 Isms." MINCED... q PP/Ump LALMyy3 43D3let10 OIPP/C9m01 DIPP/Cempi OlW/Com03 1laDM W9PT NN PoRTON 23,911.2E _ 276.18 49.5050 36051 129.)9 129-)9 36.6D2.42 129.19 IL II9.79 MMCPONNON Iran � J^rlenln 0PV/C4mpt CIIPP/COmpa GIPP/Canp3 01PP/[pmpl gIPPn NNPORTON Am'. ].)020 69,247.56 51,63 - Slog ZMA8 123.6E 360.53 - 4,997.04 A997,04 1,759.44 1,159,44 2,303.10 - 2.30310 20.012.00 IL314TS I� 21,1114.11S 423.145.68 82,232.15 - 8233L65 7112/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number / Name Groups Adrf Grouu Account Type v Snarrr, All ODA Data reported as of Jul 12. 202 Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $3,846,949.48 $3,963,843.92 $3,846,949.48 $4,198,128.0 CAL CO INDIGENT $14,697.82 514,697.82 514,697.82 55,444.7 HEALTHCARE "4454 MEMORIAL MEDICAL 1 NH GOLDEN CREEK 511,511.90 $21,265.58 $11.511.90 $9.297.2 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES 5535.51 5535.51 $.535.51 5535.E 2014 '4357 MEMORIAL MEDICAL 52,298,720.58 52,372,240.51 52,298,720.58 S2,675.090.E CENTER -OPERATING .4373 MEMORIAL MEDICAL CENTER - PRIVATE $431-14 5431.14 5431.14 $431.1 WAIVER CLEARING '4381 MEMORIAL MEDICAL 511.955.47✓ 517,275.81 $11.955.47 $10.488.1 CENTER / NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $32,716.73 543,918.16 532,716.73 $32,160.a BROADMOOR '4411 MEMORIAL MEDICAL 526.036.61 ✓ $26.036-61 S26,036.61 526,036.E CENTER/NH CRESCENT *4446 MEMORIAL MEDICAL $229.79 $6,020.22 5229.79 $100.0 CENTER / NH FORT BEND '4438 MEMORIAL MEDICAI. CENTER / SDLERA AT 511.914.05 ✓ 513,331.15 $11,914.05 511,914.c WEST HOUSTON '2998 MMC-MONEY MARKET 51, 107,607.10 51,107,607.10 51,107,607.10 51,107,607A FUND '5506 MMC -NH BETHANY 5246.817.37 5246,817.37 $246.8'17.37 5246,194.E SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- $2.322.41 S12,072.87 $2,322,41 $2,322.4 bIEDICAREIMEDICAID '5433 MMC -NH GULF POINTE 517,026.77 517.161.84 517,026.77 PLAZA - PRIVATE PAY $9.181.E '3407 MMC -NH TUSCANY VILLAGE $64.426.23 S64.426.23 $64,426.23 561,323.E https:/Iprosperity.olbanking.com/onlineMessenger 1/1 Memorial Medical Center Nursing Home UPI Weekly Nexion Transfer Prosperity Accounts 7/12/2021 Plevlau5 AftPunt Be81^^I^6 P<ntlI11Q TYdayi BeQlnn , AMQUPt to Be TrdNfecr dto NUailne NYNn XPme Number Balanae Tmnalt,0to Tnnsfenln Oh .,its Belanaa Nome Get; re@k 76,323.21 76,22311 11,411.90 ./ 11,513.90 11�106.B5 Bank Baanao 11.511.90 varanre No2.: anrybamnca:a{ave. $saavwatae d to the coin, name. Nate3: Each account has bwe he fence d/$1W that AIMCdeOosited to aot0 aec ahL v JUL 12 2021 Lesvein Balm.. 200.00 MEDICARE REPYMT OWED TO BETHANY 23Ae✓ MEDICARE REPYMT OIY<D TO MMWNIC 27T.01 IULYINTEREV AUG INTEREST SEP INTEREST Adjust Bolanou'Wrifel Amt 11.106$5 APalaye d: •Y�a"al !axon MQlin,aO 1n 7/i2/1011 t\NH W-M,Trunale..WH UPI Lnntlm5ummaT\2021VUIY\NX UPI Tpnafet Summvy 112.21.Yu ]/)/3031 WI0.(Oui N[YIONxG11 NA16C10(N GEEx ]/l/]011 i3K/]P6NSII0.5L eXCO51LMt9J 169i35991691)9 ]/]/3931 II3A 1i1111111MNSVL IILCWIMPM1l1J6Y]]J I13011] 1ryRon <nea91 ]/e/mlt <nm o 1/1/]011 CM191 1/e/1o31 uo9m 1/6/2621 ISH/NNNSf69<O S RN] 560596919 /221 IY/ NSpmr SMi 4345SS97691 79 7/4/2021 ISbnPFMTDOi1MiSlM4]69lI9 7//3011 6oL9fNCRIEKNEALtMI0.YP IOM91M1]J S mMCFOAPON 41PP/<vmy.6t NH I(IOLt(94I Sltt!SiiCN wM..PI NPP/[6mpZ UIPP/Lvm01 GIiPN POWIM ]S,a6131 / - 949.39 - SO21 a,1n xe ,162fn In n/ 051/ - 1.591.66 - 1.591.66 901.00 901.W 4611.W ].a 31.W 1 IMM - 1.136 191.67 111.61 76,221.21 uAu90 ILa190 „ r 7112/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/Name Groups ACID Group Accounl Type v LDDA Data reported as of Jul 12 202' Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $3,846,949.48 $3.963,843.92 $3,846,949.48 $4,198,128.0 '4551 CAL CO INDIGENT S14.697.82 S14,697,82 S14,697.82 $5.444.7 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK S11,511 AD j S21,265,58 $11,511,90 $9,297.' HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $535.51 S535.51 S535.51 S535.E 2014 '4357 MEMORIAL (MEDICAL S2.298,720.58 S2.372,240.51 S2,296,720.58 $2,675,090.E CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $431,14 5431.14 $431.14 $431.1 WAIVER CLEARING '4381 MEMORIAL MEDICAL S11,955.47 $17.275.81 S11,955.47 S10,488.E CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTERINH S32.716.73 S43.918.16 $32,716.73 $32,160.2 BROADMOOR '4411 MEMORIAL MEDICAL S26.036.61 $26.036,61 S26,036.61 526,036.E CENTER INH CRESCENT '4446 MEMORIAL MEDICAL S229.79 S6,026.22 $229.79 $100.0 CENTER/NH FORT BEND '4438 MEMORIAL CENTER I SOLERA AT S11,914.06 $13,331.15 $11.914.05 S11,914.0 WEST HOUSTON '2998 MMC-MONEY MARKET S1,10Z607.10 S1.107,607.10 S1,107,607,10 $1.107,607.1 FUND '5506 MMC NH BETHANY S246,B17.37 S246.817.37 S246.817.37 S246,194.E SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- S2,322.41 S12,072,87 S2,322.41 S2,322.4 MEDICAREIMEDICAID -54n MMC-NH GUI,F POINTE S17,026.77 $17,161-84 $17,026,77 59.181.E PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY S64A26.23 S64R26.23 $64.426.23 $61,323.E VILLAGE r https:/iprosperity,olbankipg.com/onlineMBssenger 1/i Memorial Medical [enter Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 7/12/2021 m n.a dad, acn.m [aYnm�o vlending,TramN—neaea Nnninexame Xnmer, dnan[e mmle..am xannenn nanebna w aN rada ,ae mnmBnan[e x 16, Nome WR9p1n1 �iq-/Fq}F 9iY 9J,)60 )L 91,56U.)6 15,9}6 )) I).On," 16,9E6.» Bank Balan[e ]E9}b.11� Van tnaveN B]IaMe IN" IULYINTIR ST nu61NTENEST SEPINTEREST Adluat Bah nnRnmla.1 16,9}6D 911, 11 gmeunSra Be n[Beelnnin[ vmAnO Xm Nn.� .— rnnrlemealo unNnllnBe— /rnmrn am .inn,lenln d flared Oe xb Tntla ',Be umn eapnn Nurdn Nnma t4I(Y-aS+:!F.EbS N[dtbre/N dl Td "" J),»naJ nx9)nl :xx: al nal -E3tFCE-..?j0-fvLHAfw mnaaabna x.sPau.al� vmunu EnuxnolMarmotlm lx GUHPanIe Mo[a: xo[conrybolonaa a/Doers;oeow,neenam/enedminenmxe Name Abt<}'feehottevnl Aof o eo,[ balor[eof$1091M[MMC deparnNivapMa[evvn(. juL 12 2021 *,W= ,.In m 6114nn 1000 JULYZERUT AI. Teign SEPINRAEST / Adlutl BNanuReanLlee Am, EBEFAI ✓ TOTALigpNSFFfli yIEEEAS.. ia,ga4.77 APProved !� Ia,dn M[IIn,[FO x(l3/x021 6 el'HPrdn'P.�'jN° •ciWePnbw _ 716/2021"ND ECHOIICCLAIMPMT 74=3411 A40000290923 7/6/2021 HHB ECHO HCCOIIAPM114100111144 OO290973 7/6/2021 MAN - ECHO HCCUMMPMT 74600341L 44000290971 717/2021 WIRE OUT HMG SEM ES. LLC 2p/3011 PNC-ECHO HCCIMMPhIT 74000MI 142MD120800797 7/2/2021 HNO ECHO HCCMIMPMT 746003411442ND739165 7J8R021 CNetkIo00 2/8/2021 HNO ECHO HCCUUNIPMT)4600241144000D270846 7JU2021 HNB. ECHO H[CMIMPMi 74600341144MO270246 2/8/1021 HNB- ECHO HM"IMPMT 14600341144WW270046 7/9/2021 HNB- ECHO HCCIAIMWAT 7460034LI 44MOD294696 1/0/2021 HNB � ECHO HCCLUMPMT 346034I144MM294688 i p a 1P t { t 7/6/2023 W PSdD[FIC CONTR HCCIAIAIPAII 2231132907 21000 T/T/2021 WIRE OUT HMG]ERVICES, CLC )/)/2021 HEALTH HUMAN SVC IICCLAIMPMT 114GW34113013 2 7/8/2021 ChnUXi MMC PORTION OIPP/[ample NR Tmmier•OPI Tran[feM. CIPP/CemPl WPP/COM2 CIPP/CemP3 Lap. Opp TT PORTION 3,179.11 3,17911 111.93 119.03 / 93.50 9350 9g62530 ✓ 399.45 - 399.a5 / 309 i8 10926 3506 �/ 2.22232 - 2,222.92 - 1,83014 1830_l4 1,11333 1,123.23 7.74.35 ),)41.35 MAE - 10,36 91660A6 16.926.33 1692632 MMC PORTION TBPP/Cump6 PH Tranrlex0ur Tandenln I C9PP/CRmPI WPP/COMP2 OIPP/COmP3 up. OIPPn i PORTION "o 83 100.82 47.11100 ✓ / 1,821Sa 8201.✓ 1,82154 4),293.01 3.13i.41 1,111.41 14L$S3.77 MUM).M - 19,119.11 7/12/2021 Quick View Select Quick View Accounts Account Number! Name Account Type v Treasury Center Select Group Groups Add Gmuu Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $3,846,949.48 $3,963,843.92 $3,846,949.48 $4,198,128.0 '4551 CAL CO INDIGENT HEALTHCARE $14.697.82 $14.697.82 $14,697.82 55.444.7 '4454 N MEMORIAL MEDICAL / NW GOLDEN CREEK 511,511.90 $21.265.58 $11,511.90 59.297.E HEALTHCARE '4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES 5535.51 5535.51 5535.51 5535.E 2014 '4a57 MEMORIAL MEDICAL CENTER -OPERATING $2.298,720.58 52,372,240.51 $2,298,720.58 S2.675,090.0 AM MEMORIAL MEDICAL CENTER - PRIVATE $431,14 5431.14 5431.14 5431.1 WAIVER CLEARING '4381 MEMORIAL MEDICAL CENTER/NH ASHFORD 511.955.47 517275.81 511,955.47 $10,488.E '4403 MEMORIAL MEDICAL CENTER/NH $32,716.73 $43,918.16 532.716.73 $32J60.5 BROADMOOR '4411 MEMORIAL MEDICAL CENTER/NH CRESCENT $26.036.61 $26.036.61 526.036.61 526.036.E '444E MEMORIAL MEDICAL CENTER/NH FORT BEND $229.79 56.026.22 5229.79 $100.0 '4438 MEMORIAL MEDICAL CENTER SO / SOLERA AT S11.914.05 513.331.15 511,914.05 511 914 C WEST HOUSTON '2998 MMC-MONEYMARKET FUND 51,107,607.10 $1.107.607.10 $1.107.607.10 $1,107,607.1 15—M MMC-NH BETHANY SENIOR LIVING 5246.817.37 5246.817.37 5246,817.37 5246,194.E '5441 MMC -NH GULF POINTE PLAZA- 52.322.41 512,072.87 52,322,41 52.3224 MEDICAREIMEDICAID .5433 MMC-NH GULF POINTE PLAZA - PRIVATE PAY $17,026.77 $17,161.84 S17,D26.77 59,181.E '3407 MMC -NH TUSCANY VILLAGE 564,426.23 564,426 23 $64,426,23 $61 323 https://prosperity.olbanking.comlonlineMessenger t 1!1 Memorial Medical Center Nursing Home VPL Weekly HSLTransfer Prosperity Accounts 7/12/2021 PnWam PWI, ameuntm Be A,wun3 avtl^nlni mWlert. u.robrt.aee I wA. Ir nOurs Iw,a3U) van mawmaalanw ImPP npmTFPs ) AUG lxTFRFST SFP M)FPFST Pdlm1Balann/rnnderAm3 3<16.]I0.37 Nere: nnrl W.—of ovwSF,WO AG Ee'—fnrcd3o the nunmg b.,.. avp.uPd: Nvee 3: CAINGwum hw a be:ebol—/$IW 04.1 Mcd.1.1. w meno[[uunl. U.—Arslin,coD r 111UZ0]3 JUL 12 2121 GONWASONM fAl 11n4 weAM NAUWAwmPI pwdee 1—GA.M.IPVw uel7—deesvmmag vl).tl..w 7/6/2021 Deposit 7/6/2021 HEALTH HUMAN SVC HCCIAIMPMT 17460034113016 2 7/7/2021 WIRE OUT BEFHANY SENIOR LIVING, LTO 2/7/2021 NOVITAS SOLUTION HCCLAIMPMT 676481420000255 7/7/1021 HEALTH HUMAN SVC HCCLAIMPMT 17460034113016 2 7/8/2021 Che61005 7/8/2021 Deposit 2/8/2031 Deposit 7/8/2021 HEALTH HUMAN SVC HCCLAHVI 17460034113016 2 7/9/2021 HOSPICE OF SO TX VENDORS NF 91000012246899 MMCPORTION OIPP/COmp9 Trans/er-Out Transfer -In OIPP(Lpmpt OIPP/Comp2 OIPP)Cpmp3 &lapse OIPPN NH PORTION 37.511.57 - 37,511.S2 - 1,444A0 1.444,10 / 212,115.78 - ✓ - 159.89 - 259.89 - 61961.50 - 210.34 / - 6.9fi1.50 1.933.26 - 1.933.26 194,441.79 - 194,441P9 3.042.56 - 3.042.56 62210 - 622.70 2111526.12 246217.37 246 21T 3T r a r r 711212021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number l Name Groups Hdd Grnup Accoum Type v [DDA Data reported as of Jul 12. 202 Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $3,846,949.48 $3,963,843.92 $3,846,949.48 $4,198,128.0 '4551 CAL CO INDIGENT S14.69T82 514,697.82 $14.697.82 $5,444i HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK S11,511.90 $21,265.58 $11,511.90 S9.297.2 HEALTHCARE •4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $535.51 S535.51 S535.51 S535.° 2014 '4357 MEMORIAL MEDICAL 52,298,720,58 S2,372,240.51 S2,298,720.58 S2.675,090.E CENTER -OPERATING am MEMORIAL MEDICAL CENTER - PRIVATE $431,14 S431.14 $431.14 $431.1 WAIVER CLEARING '4381 MEMORIAL MEDICAL S11,955.47 S17.275.81 $11,955.47 $10.488.E CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTERINH S32.716.73 $43.918.16 $32,716.73 $32,160.i BROADMOOR '4411 MEMORIAL MEDICAL $26.036.61 $26.036.61 $26,036.61 526,036.E CENTER! NH CRESCENT '4446 MEMORIAL MEDICAL S229.79 $6.026.22 $229.79 5100.0 CENTERINH FORT BEND '4438 MEMORIAL MEDICAL CENTER ISOLERA AT S11,914.05 513,331.15 911.914.05 S11,914.E WEST HOUSTON '2998 MMC-MONEY MARKET S1.107.607.10 $1.107,607.10 S1,107,607.10 S1,107,607.1 FUND '5506 MMC -NH BETHANY $246.817.37 S246.817.37 S246,817.37 S246.194.E SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- S2,322,41 $12.072.87 $2,322.41 $2,322A MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE S17,02677 S17.161.84 S17.026.77 59.181.E PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY S64.426.23 $64,426,23 S64,426.23 $61.323.E VILLAGE v t https:Uprosperity.olbanking.comlonlineMessongar V1 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity Accounts 7/12/2021 sub.,. Paso.. Nov:oEaharcun I boa bus 6wnmrb.m ualMIC nwfrnab.mr. Net. ]: Fo[M1 onoum boa bm a holon[e.($I00 Mo. MMC dcNnv6 to oyen a.oun.. P.alne Won.. 6.nklialan.. Voss... ..ve in Lhnu MEDIWE aEPYMTOWEDTO DMANV MEOICAAE a6PYMtmoo TO MMcl uac "I... 0.1.nm(T.mfar Aml ovons 1. e. 10000 / :sae ✓ :n.b6 )non A.Elln ClO �, )h]tlo]] JUL 12 2921 �OR n , 4 Ti0r 7/7/2021 WIRE OUT UNBAR ENTERPRISES, Lit 7/8/2021 Chack1025 7/8/2021 Ch44kl026 7/8/2021 Depasif 7t8/202l NOVITA55OWTION HCCIAIMPMT 6762UI 42MOD178 7/9/2021 Mohna HC of TM HCCLAIMPMT PN 12757178944200 MMCPORTION QIPP/ComP4 Transfer -Out an do I glpp(EOmpl QIPP/Comp2 QIPP/CPmp3 &lapse QIPP JlNH PORTION 2D5,294.04 ✓ - - 276.18 ✓ 360.51 49.884,68 - 49,884.68 11.338.87 - 11,338,87 3,102.68 - 3,302.68 205,930.73 54,325.23 - 64,326.23 7/12/2021 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/Name Groups Add Gruup Account Type v IDDA Data reported as of Jul 12, 202 Account Number Current Balance Available Balance Collected Balance Prior Day Balane Number of Accounts: 15 $3.846,949.48 $3,963,843.92 $3.846,949.48 $4,198,128.0 '4551 CAL CO INDIGENT $14.697.82 $14,697,82 514.697.82 $5.444.-1 HEALTHCARE '4454 MEMORIAL MEDICAL I NH GOLDEN CREEK 511,511.90 $21,265.58 511,511.90 59,297.4 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES 5535.51 5535.51 $535.51 $535.E 2014 -4357 MEMORIAL MEDICAL 52,298,720.58 52,372,240,51 $2,298,720.58 52,675,090.E CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $431.14 $431A4 5431.14 5431.1 WAIVER CLEARING '4381 MEMORIAL MEDICAL 511,955.47 $1Z275.81 511,955.47 510,488.E CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH 532.716.73 543,918.16 $32.716.73 $32,160.F BROADMOOR '4411 MEMORIAL MEDICAL $26.036.61 $26.036.61 $26,036.61 $26,036,C CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $229.79 58,026.22 $229.79 5100.0 CENTER NH FORT BEND '4438 MEMORIAL MEDICAL CENTER I SOLERA AT $11.914.05 513,331.15 511,914.05 511,914.0 WEST HOUSTON '2998 MMC-MONEY MARKET $1,107.607.10 $1,107.607.10 $1,107,607.10 $1,107.607.1 FUND 'S506 MMC -NH BETHANY 5246.817.37 5246,817.37 5246,817.37 5246.1941 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA- 52,322.41 $12.072.87 $2.322.41 $2.322.4 MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE $17,026.77 $17,161.84 $17,026,77 59.181 C PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY 564.426.23 $64.426.23 $64,426.23 561.323.E VILLAGE r hllps:l/prosperity.olbanking.comlonlineMessengar N1 July 14, 2021 2021 APPROVAL LIST - 2021 BUDGET COMMISSIONERS COURT MEETING OF 07/14/21 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 19 $190,525.47 FICA P/R $ 52,222.84 MEDICARE P/R $ 12,213.48 FWH P/R $ 34,341.20 NATIONWIDE RETIREMENT SOLUTIONS P/R $ 4,870.00 OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT P/R $ 1,516.15 TEXAS ASSOCIATION OF COUNTIES - UNEMPLOYMENT FUND P/R $ 6,519.78 AT&T MOBILITY A/P $ 1,838.93 CITY OF POINT COMFORT A/P $ 64.80 FRONTIER COMMUNICATIONS A/P $ 55.46 SPARKLIGHT A/P $ 82.69 TISD, INC A/P $ 344.95 VOYAGER A/P $ 16,452.57 VERIZON WIRELESS A/P $ 75.98 TOTAL VENDOR DISBURSEMENTS: $ 321124.30 TOTAL AMOUNT FOR APPROVAL: $321,124.30 ): J U U U O N 0 0 N 0 N 0 o� � -0-0y � n ° o og on My n0 � Q Q W N W 0 o a o K Sti N D U O u 0 �o 0 S Y Y > A C a � r 0 co � o. 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