Loading...
2021-10-6 CC Meeting MinutesI NOTICE OF MEETING — 10/6/2021 Richard ]H . Meyer County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, October 6, 2021 at 10:00 a.m. in the Commissioners'Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA q : 31 "FILED The The subject matter of such meeting is as follows: AT� o�c bu L"� , 1. Call meeting to order. 12M 10:00AW1 , 2. Invocation. 1) R 3. Pledges of Allegiance. eIP- /VL OCTi 12021 $ R�� C�J ' 4. General Discussion of Public Matters and Public Participation. ,10 : 01 a Brandon ' Tup l 5. Approve the minutes of the September 29, 2021 meeting. 6. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for VL'/D N the period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three'- one year periods if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2.00:00 PM Tuesday, November 9, 2021. (RM) pe9gq discussed adCl1h9fcha.n9e, pacKei- 7. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid D�/VL Number 2022.02 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) pRq q' - Nc) Gharres ex "V clues Z fDr W+ 8. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials and Asphalts, Oils and Ur/B Emulsions, Bid Number 2022.03 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) Pegcjg- No Unc�nges except clo+es C,fvrmai' Page 1 of 2 NOTICE OF MEETING—10/6/2021 9. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Inmate Food Services, for the Calhoun County Adult Detention Center, Bid Number 2022.04 for the period beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly if agreeable with both the successful bidder and Calhoun County.and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) PeqS� cL66ed changeS(i¢ excel is chanyec� bid wi l -Nor 43'✓ ACCEPTED) 10. Consider and take necessary action to approve a First Responder Affiliation Agreement V VD the Calhoun County EMS and the Point Comfort Volunteer Fire Department. (RM) Dustin JentKins -pcvFP wants FRo status 11. Consider and take necessary action to approve a First Responder Affiliation Agreement ��VL between the Calhoun County EMS and the Six Mile Volunteer Fire Department. (RM) DUSJ n JenKins 12. Consider and take necessary action to approve the FY2022 Texas Indigent Defense Commission Formula Grant Request for Application resolution and authorize the County Judge to apply online. (RM) ' 13. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as National 4-11 Week in Calhoun County. (RM) qli 9 row 14. Consider and take necessary action to approve a resolution declaring October 3 — 9, �� 2021 as Texas Extension Education Association Week in Calhoun County. (RM) YB Martha WA `ru]�A 15. Accept report from the following County Office: i. County Treasurer - July 2021 UL/4 16. Consider and take necessary action on any necessary budget adjustments. (RM) 6-12/J3 17. Approval of bills and payroll. (RM) MMc Gaup v L- Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx,ore under "Commissioners' Court Agenda" for any official court postings. )O�,. 10-'35 A Page 2 of 2 I NOTICE OF MEETING-10/6/2021 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 (Vary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, October 6, 2021 at 10:00 a.m. in the Commissioners'Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port ]Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: A, 3� oC OCK-� M 1. Call meeting to order. OCT 0 1pp2021 2. InVOCatlon. �Y 'LE NNA LH UH TEXA P 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. 5. Approve the minutes of the September 29, 2021 meeting. 6. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one year periods if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) 7. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2022.02 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) 8. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions, Bid Number 2022.03 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) Page 1 of 2 I NOTICE OF MEETING—10/6/2021 9. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Inmate Food Services, for the Calhoun County Adult Detention Center, Bid Number 2022.04 for the period beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) 10. Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Point Comfort Volunteer Fire Department. (RM) 11. Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Six Mile Volunteer Fire Department. (RM) 12. Consider and take necessary action to approve the FY2022 Texas Indigent Defense Commission Formula Grant Request for Application resolution and authorize the County Judge to apply online. (RM) 13. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as National 4-H Week in Calhoun County. (RM) 14. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as Texas Extension Education Association Week in Calhoun County. (RM) 15. Accept report from the following County Office: i. County Treasurer — July 2021 16. Consider and take necessary action on any necessary budget adjustments. (RM) 17. Approval of bills and payroll. (RM) ichard Meyer, County J d Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible tot he general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.org under "Commissioners' Court Agenda' for any official court postings. Page 2 of 2 reffj�ml�l %I/All Agenda Items Properly Numbered ontracts Completed and Signed it 1295's Flagged for Acceptance (number of 1295's ) All Documents for Clerk Signature Flagged On this � day of. 6d;�7- ) 2021 a complete and accurate packet for (0*j of 2021 Commissioners Court Regular Session Day Month was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Q,44i Zl// Ca oun County Judge/Assistant COMMISSIONERSCOURTCHECKLIST/FORMS Richard H. Meyer Coll nity jIl dge David Hall, Commissioner, Precinct I Vern ]Lyssy, Commissioner, Precinct 2 (Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, "Texas dvill meet on Wednesday, October 6, 2021 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: `f Call meeting to order. Invocation. 43. Pledges of Allegiance. OCT 01 2021 a wW oi TEXAS ort 4 General Discussion of Public Matters and Public Participation. 5 Approve the minutes of the September 29, 2021 meeting. G Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one year periods if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) tr. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2022.02 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) ti -- Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions, Bid Number 2022.03 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) Page I of 2 NOIIC1 (A Nil LIIN(I—i0/t7/102I 49 Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Inmate Food Services, for the Calhoun County Adult Detention Center, Bid Number 2022.04 for the period beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) fil-�Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Point Comfort Volunteer Fire Department. � (RM) il. Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Six Mile Volunteer Fire Department. (RM) Y1. Consider and take necessary action to approve the FY2022 Texas Indigent Defense Commission Formula Grant Request for Application resolution and authorize the County Judge to apply online. (RM) 13 Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as National 4-H Week in Calhoun County. (RM) 4. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as Texas Extension Education Association Week in Calhoun County. (RM) q.5 Accept report from the following County Office: `l County Treasurer — July 2021 r/ 16. Consider and take necessary action on any necessary budget adjustments. (RM) T7.-Approval of bills and payroll. (RM) Richard Meyer, County Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse,211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.org under "Commissioners' Court Agenda" for any official court postings. Page 2 of 2 AGENDA #5 NOTICE OF MEETING — 10/6/2021 Richard Fl. Meyer County judge David ]Hall, Commissioner, Precinct I Vern ]Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Com missioners' Court of Calhoun County, Texas will meet on Wednesday, October 6, 2021 at I0:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port ]Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting called to order at 9:59 a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag — Gary Reese Texas Flag — David Hall 4. General Discussion of Public Matters and Public Participation. Brandon Gilbrenth, resident of Tap Road spoke on a matter of the public abusing the road. Commissioner David Hall has been in contact and is aware of all matters. 10:01-10:04 5. Approve the minutes of the September 29, 2021 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Gary Reese, Commissioner, Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 1 of 13 Richard ]H . Meyer County judge David Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Clary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, September 29, 2021, at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port ]Lavaca, Calhoun County, Texas. Attached are the true and correct minutes of the above referenced meeting. r Richard Meyer, County u e Calhoun County, Texas Anna Goodman, County Clerk Page 1 of 1 COMMISSIONERS' COURT-9/29/2021 Richard H. Meyer County judge David ]Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Karla Perez, Deputy Clerk CALH[OUN COUNTY COMMISSIONERS'COURT REGULAR TERM 2021 § SEPTEMBER 29, 2021 BE IT REMEMBERED THAT ON SEPTEMBER 29, 2021, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting called to order at 10:00 a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag — Gary Reese Texas Flag — Vern Lyssy 4. General Discussion of Public Matters and Public Participation. 5. Hear report from Memorial Medical Center. Rosh anda Thomas with MMC gave monthly report. 6. Approve the minutes of the September 15, 2021 and September 22, 2021 meetings. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: David Hall, Commissioner, Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 1 of 3 COMMISSIONERS' COURT-9/29/2021 7. Consider and take necessary action on the transition and compensation for Precinct 1 Justice of the Peace, Judge Hope Kurtz, as Judge Pro Tern to complete the unexpired term of retiring Precinct 2 Justice of the Peace Judge Calvin Anderle, beginning October 1, 2021. (RM) Hope Kurtz presented Calvin Anderle plaque for 16 years of service. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to approve the final plat of the J.M. Turner Subdivision (part of the Lot 4 and Lot 5, Block 3 Resubdivision No. 1, FM 2760, Pon`. Lavaca, Texas). (DH) Jake Helfner with Elite Engineering spoke on this. RESULT: APPROVED[UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to approve proposal #21-054 from Gonzales Contracting, Inc. to complete the work on Six Mile Pier Project using GOMESA funds. Scott Mason with G&W Engineering spoke on this. RESULT: APPROVED[UNANIMOUS] MOVER: David Hall Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to approve the final plat of the Casarez Subdivision (a replat of part of Outlot 2 in Outblock 24 of the Port 0/Connor Townsite). (GR) PASS 11. Consider and take necessary action on the scope of the recommended engineering study for Green Lake] both the Master Plan and Phase 1. (GR) PASS Page 2 of 3 COMMISSIONERS' COURT-9/29/2021 12. Accept reports from the following County Offices: i. County Auditor — August 2021 ii. County Extension Offices — August 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action on any necessary budge adjustments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Approval of bills and payroll. (RM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1. SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Payroll RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 10:28 a.m. Page 3 of 3 #6 NOTICE OF MEETING— 10/6/2021 6. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one year periods if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: David Hall, Commissioner, Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 13 September 29, 2021 To: Judge Meyer From: The office of the County Auditor Peggy Hall, Assistant Auditor Please place the following item on the Commissioners Court Agenda for October 6, 2021: • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one year periods if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. Agenda Item #6 Commissioners Court — Wednesday, October 6, 2021 Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Delivered Fuel, Bid Number 2022.01 for the period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one year periods if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. CHANGES FROM PREVIOUS SPECIFICATIONS AND INVITATION TO BID PACKET: ADDED: With an option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County CHANGED: Updated the dates for the new bid period and use same format as other bid packets. CHANGED: 1. Information on MMC Generators From: One fuel tank above ground and one fuel tank underground To: Both generators are above ground 1— 3,000 gallon fuel tank 1— 2,000 gallon fuel tank 2. Accounts Payable contact From: Melissa McKissack To: Ellen Heiman CHANGED: 1. Invitation to Bid Form From: Mark -UP To: Plus or Minus per Gallon 2. Texas Environmental Fee Clarified to say "Fee Per Delivery" The Fee, if charged, is per delivery: Less than 2,500 Gallons — Fee is $1.70 per delivery 2,500 Gallons but less than 5,000 Gallons — Fee is $3.45 per delivery I have changed the heading on the Invitation to Bid Form to: Texas Environmental Fee Per Delivery (See Texas Petroleum Products Delivery Fee Schedule for 5,000 Gallons or more) CALHOUN COUNTY, TEXAS INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL Bid Number: 2022.01 Bid Term: January 1, 2022 thru December 31, 2022 With an option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County SEALED BIDS WILL BE RECEIVED UNTIL 2:00:00 Tuesday, November 9, 2021 AT THE OFFICE OF Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 31 Floor, Suite 301 Port Lavaca, Texas 77979 PUBLIC BID OPENING will be conducted at 2:00 PM, Tuesday, November 9, 2021 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas 77979. At this time, each bidder's name will be read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all bidders that submitted a bid and will also be posted on the County's website (www.calhouncotx.org) under Bid Notices and Results, Results 2022 as soon as time permits. CONTENTS • Invitation To Bid • Return Instructions • General Conditions • Specifications for Annual Supply Contract for Delivered Fuel • Estimated Quantity Information • Contact and Billing Information and Location of Fuel Tanks and Generator Fuel Tanks • Required Information/Forms o Invitation to Bid Form (Page 1— 7) o Method or Source Document used for Mark-up throughout the bid period o Affidavit o Bidder and Order Information Form o Certificate of Interested Parties Form 1295 — Must return when submitting your bid o Certificate of Liability Insurance — Return a copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the bidder who is awarded the bid must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. o Conflict of Interest Questionnaire Form CIQ — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. o Certification Regarding Debarment & Suspension and Other Responsibility Matters o Certification Regarding Lobbying o Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date o House Bill 89 Verification o Residence Certification o W-9 OTHER INFORMATION INCLUDED WITH THE INVITATION TO BID PACKET • Current Awarded Bid Tabulation for Delivered Fuel - January 1, 2021 thru December 31, 2021 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas, will receive SEALED BIDS for Delivered Fuel as needed by the Road and Bridge Precincts, other Calhoun County Departments, and the Calhoun County Hospital and Clinic (Memorial Medical Center & Memorial Medical Clinic) for fuel tanks and/or generator fuel tanks. BID NUMBER: 2022.01, ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL Bids are for a one (1) year period beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County. The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. SEALED BIDS ARE DUE: Date: Tuesday, November 9, 2021 Time: BEFORE 2:00:00 PM Location: County Judge's Office Calhoun County Courthouse 211 South Ann Street 3'd Floor, Suite 301 Port Lavaca, Texas 77979 At this time, all bids will be publicly opened and each bidder's name read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. All bids (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9x12 or larger envelope and CLEAREY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.01 ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL Calhoun County does not accept faxed or emailed bids. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the time the bids received will be opened. Bids received after the deadline will be returned unopened. Bids shall include all requirements of the Invitation to Bid Packet for Bid Number 2022.01, Annual Supply Contract for Delivered Fuel. SEALED BIDS MAY BE HAND DELIVERED OR MAILED TO: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 3rd Floor, Suite 301 Port Lavaca, TX 77979 Page 1 of 2 Calhoun County reserves the right to waive any formality or irregularity, accept or reject any and/or all bids, to accept the bid deemed most advantageous to and in the best interest of Calhoun County. The award of a bid shall be made to the responsible bidder whose bid is determined to be the most beneficial to Calhoun County, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid Packet. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit bids. Cindy Mueller County Auditor Calhoun County, Texas Page 2 of 2 RETURN INSTRUCTIONS For Submitting a Bid for ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Bid Number: 2022-04 Bid Period: January 1, 2022 thru December 31, 2022 With the option to renew yearly (one year terms) if agreeable with both the successful bidder and Calhoun County Return the following BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 Check List for submitting your Bid: Return One (1) Original and 3 Copies Be sure all necessary forms are included and or completed, signed and dated Invitation to Bid Form, page 1-17 (plus attachments, if applicable) Affidavit Bidder Information Form Certificate of Interested Parties, Form 1295 Form 1295 must be completed online —Copy that is included is Sample Copy Only Do Not Fill Out Sample Copy. Form 1295 must be completed online. #1: Bidder's Name, City, State and Country #2: Calhoun County, Texas #3: Bid Number: 2022-04; Annual Supply Contract for Inmate Food Services, January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to your company #4: Fill in the correct information OR #5: Mark an X in the Box #6: Fill in the correct information and print When you print you should see a Certificate Number and Date Filed in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. Certificate of Liability Insurance Please return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you currently carry at least the minimum required coverage. Once bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured Conflict of Interest Questionnaire, Form CIQ Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. Certification Regarding Debarment & Suspension and Other Responsibility Matters Certification Regarding Lobbying Disclosure of Lobbying Activities —If Not Applicable, bidder must mark NA and sign and date House Bill 89 Verification Residence Certification W-9 Do Not Fold any of the above information. Bid must be returned in a SEALED 9 x 12 or larger envelope clearly marked: SEALED BID NUMBER 2022.04 ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES If you send your bid by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.04 ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Submit Sealed Bid to: Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 3rd Floor, Suite 301 Port Lavaca, TX 77979 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFC, and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ, and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFQ, and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ, and/or Contract is due. The Bid, RFP, RFQ, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ, and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ and/or Contract in collusion with any other bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ, and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ, and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidder's/vendor's Bid, RFP, RFQ and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Page 1 of 13 Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ, and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ, and/or Contract will specify the date and time due. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ and/or Contract is received and the time the Bid, RFP, RFQ and/or Contract will be opened. A late deliverywith an early postmark or delivery of the Bid, RFP, RFQ and/or Contract to the wrong office will not suffice. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ, and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ, and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ, or Contract. If the Bid, RFP, RFQ and/or Contract is sent by UPS, Fed Ex or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ, or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ, and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ, and/or Contract was submitted to. A Bid, RFP, RFQ, and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ, and/or Contract price. Bids, Page 2 of 13 RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum. Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendor's performance under this Bid, RFP, RFQ, and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes. Tax exempt forms will be furnished upon request to the Calhoun County Auditor's Office. Page 3 of 13 Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be ail inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act', commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ, and/or Contract on the basis of lowest and/or best Bid, RFP, RFC, and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the solejudge in determining which Bid, RFP, RFC, and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ, and/or Contract based on lowest and/or best Bid, RFP, RFQ, and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ, and/or Contract' means a bid or offer providing the best value considering associated direct Page 4 of 13 and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFC, and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFC, and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ, and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFC, and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFQ, and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet Page 5 of 13 specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFC, and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination• Calhoun County reserves the right to terminate the Bid, RFP, RFQ, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFC, and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFCl and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFC, and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFC, and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties— Form 1295 Section 2252.908 was added to the Government Code by the 841h Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85' Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 6 of 13 Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf_ info_form1295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract' includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFQ, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFQ, and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only' located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Bid, RFP, RFQ and/or Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than thirty (30) days after Calhoun County Commissioners Court approves a contract, or awards a Bid, RFP, and/or RFQ with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Page 7 of 13 Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFC, and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFC, and/or Contract submission and the time of execution of the Bid, RFP, RFQ and/or Contract. A print out of the search results, including principals, if any, from the System for Award Management (www.SAM.gov) that includes the record date must be included with the bidder's/vendor's Bid, RFP, RFC, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFC, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFC, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Page 8 of 13 Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFC, Contract, order, and/or service. In the event a Bid, RFP, RFQ Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFQ and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFC, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFC, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and Page 9 of 13 be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Majeure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFC, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFQ and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFQ and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFQ and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFQ, and/or Contract shall be governed bythe Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFQ and/or Contract. Otherwise, Texas state and federal law shall apply. Page 10 of 13 Prohibition against Personal Interest in Bids, RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFQ, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ, and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ, and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFQ, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ, and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ, and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. General Liability ($100,000/$300,000 or greater) Workers' Compensation (at Statutory Limits) Employer's Liability ($1,000,000 or greater) Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) Professional Liability Insurance (if applicable) Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of Page 11 of 13 the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFQ, and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ, and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFQ, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: Name, mailing address and business phone number of the protesting party; Appropriate identification of the Bid, RFP, RFQ and/or Contract being protested; A precise statement of the reasons for the protest; and Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. Page 12 of 13 If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFQ, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or byjudicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Cindy Mueller Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: cindy.mueller@calhouncotx.org To request a Bid, RFP, and/or RFQ packet from Calhoun County, or information on how to obtain a packet, please contact: Peggy Hall Assistant Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: peggy.hall@calhouncotx.org Bids, RFPs, and/or RFQs may also be viewed on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results. Page 13 of 13 SPECIFICATIONS FOR ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL BID NUMBER 2022.01 BY ORDER OF the Commissioners Court of Calhoun County, Texas, sealed bids will be received for the Annual Supply Contract for Delivered Fuel as needed by the Road and Bridge Precincts, other Calhoun County Departments, and the Calhoun County Hospital and Clinic (Memorial Medical Center & Memorial Medical Clinic), (all hereinafter called Calhoun County) for fuel tanks and/or generator fuel to n ks. See Contact and Billing Information and Location of Fuel Tanks and Generator Fuel Tanks for complete information for each Calhoun County delivery location. INVITATION TO BID PACKET The complete Invitation to Bid Packet may be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. The complete Invitation to Bid Packet must be used in preparing the bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.01 ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL If the SEALED BID is sent by UPS, FedEx, or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.01 ANNUAL SUPPLY CONTRACT FOR DELIVERED FUEL SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 A late delivery with an early postmark will not suffice. Page 1 of 8 Calhoun County is not responsible for the delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid due date and time. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the bid is received and the time the bid will be opened. No bids will be accepted after the due date and time has been reached. Calhoun County accepts no financial responsibility for any cost incurred by the bidder in the course of responding to these specifications. Faxed or emailed bids shall not be accepted. BID TERM The bid shall be in effect for a period of one (1) year beginning January 1, 2022 and ending December 31, 2022 with an option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County. BID INFORMATION/REQUIREMENTS To submit a valid bid, read the entire Invitation to Bid Packet for all required information that must be included and all required forms (see page 7) that must be returned and/or filled out, signed and dated and returned. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a bid. If you will not be submitting a bid, we would appreciate your indicating on your "NO BID" response any requirements of this bid request which may have influenced your decision to "NO BID." Calhoun County is not responsible for errors if the Bid Forms are handwritten. It is recommended that all information submitted by the vendor on the Bid Forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. All bidders shall provide the Brand Name for each type of fuel to be used throughout the bid period in the space provided on the Invitation to Bid Forms. Unleaded Gasoline must be free from water and suspended matter and octane of 87 and octane of 93 non -Ethanol. Diesel Fuel must be free from water and suspended matter. The bidder who is awarded the bid shall supply Calhoun County with a 1,000-gallon skid fuel tank and pump with meter at no additional charges. The movable skid fuel tank should be double wall or a single wall tank and secondary containment that satisfies TCEQ requirements. Delivery (free of delivery charges by the awarded bidder) of the empty skid fuel tank will be to the Calhoun County Recycle Center, 900 Landfill Road, Port Lavaca. The skid fuel tank, when needed, will be moved by Page 2 of 8 Calhoun County to close proximity of the Calhoun County Courthouse, 211 S. Ann St., Port Lavaca and fuel will be delivered to this location. The bid will be plus or minus the fixed differential in excess of the lowest available branded daily rack prices posted for Regular Unleaded 87 Octane, Regular Unleaded 93 Octane, Diesel Low Sulfur (Clear - Undyed), Off Road Low Sulfur Dyed Diesel. All bidders are required to bid a plus or minus per gallon for each fuel type and location. Unless noted under Other Fees the plus or minus per gallon shall include any and all delivery charges and other fees that will be billed in addition to the Lowest Rack Price and Texas State Excise Tax that is listed. THE PLUS OR MINUS PER GALLON WILL REMAIN CONSTANT THROUGHOUT THE TERM OF THE CONTRACT. All bidders shall provide with their bid a copy of the method or source document used for plus or minus per gallon throughout the bid period. The bid shall be for the lowest available branded daily rack prices. Calhoun County is aware that the Rack Price may vary throughout the term of the contract. Bidders shall note on the bid sheet the method or source that will be used throughout the term of the contract to determine the lowest Rack Price and shall provide a sample copy of any documentation available with their bid. In addition, the bidder shall supply documentation of corresponding lowest rack price with each invoice. Awarded bidder will be required to furnish acceptable evidence to substantiate the rack price charge with each billing and bill of lading from pickup location. Calhoun County is EXEMPT from all Federal Excise Taxes and Sales Tax (county, city and state sales tax). Calhoun County is subject to Texas State Excise Tax on gasoline and clear diesel. The bidder must state on the Invitation to Bid Form all Other Fees that are not included in the plus or minus per gallon. Only Other Fees listed on the Invitation to bid form or separate page that is signed and dated by an authorized representative and returned by the bidder with their bid and awarded as such to the successful bidder will be allowed to be included on the invoice when the awarded bidder submits the invoice for payment. If bidder does not list any Other Fees, then the invoice shall only include the Lowest Rack Price plus or minus per gallon bid amount and Texas State Excise Tax when applicable. Bid price shall include all transportation costs to the designated delivery locations. Bidder must list on the Invitation to Bid Form any delivery charges or fees for after hours, weekends and/or holidays. If these charges or fees are not listed, no other delivery charges or fees can be included on the invoice. All charges must be included in the plus or minus per gallon or clearly stated on Bid Form. Additional charges listed separately, if any, will increase the amount of the bid. Page 3 of 8 Any exceptions and/or variations from the specifications in this bid document must be indicated on the bid form or on a separate attachment to the bid and labeled as such. Exceptions taken and/or variations made to the specifications and listed on the bidder's bid or separate attachment may void the bid. The request for a bid on delivered fuel does not guarantee that Calhoun County will purchase this product during the bid period. Calhoun County does not guarantee to purchase any minimum or maximum quantities. Fuel will only be ordered as needed. Calhoun County has the right to reject, at any time, any fuel that is undesirable. Calhoun County legally accepts delivery of fuel after it is unloaded and approved by Commissioners and or an employee of other Calhoun County Departments. Loaded weight of truck, trailer and fuel cannot exceed legal state and county weight limits on road and bridges that approach designated delivery sites. Bidder shall check with Precinct Commissioner for such limits. All fuel ordered will be delivered to the delivery site designated and within 24 hours from time of order. In the event a contracted bidder is unable to deliver the fuel ordered within 24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the said fuel from the bidder which submitted the next lowest bid that met bid specifications and/or requirements and can deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or other charges when cancelling an order. Awarded bidder shall be required to notify Calhoun County in the event of unforeseen delay arising in the delivery of an order. In the event an order will not arrive at the Calhoun County delivery location at the designated time, Calhoun County shall have the right to cancel and/or refuse acceptance of the order. Calhoun County shall not be assessed any penalties, fees and/or other costs due to this cancellation and/or refusal. If awarded bidder cannot supply a product, a written statement from the bidder indicating the reason, must be sent to the County department and Calhoun County reserves the right to spot purchase the product. Calhoun County and/or the awarded bidder have the right to cancel the delivery of fuel at any time due to weather and/or road conditions. No penalties, fees and/or other charges will be billed to Calhoun County if the delivery of fuel is cancelled by Calhoun County and/or the awarded bidder due to weather and/or road conditions. Calhoun County reserves the right to refuse any order delivered for not being in compliance with the specifications, general conditions and/or the "Hazardous Communications Act", commonly known as the "Texas Right to Know Act". No penalties, fees and/or other charges will be billed to Calhoun County in the event an order is refused due to non-compliance of the specifications, general conditions and/or State and Federal Regulations. The bidder, at the bidder's cost, shall immediately remove the fuel from the Calhoun County location that are deemed unsatisfactory, and are not in compliance with the specifications, general conditions Page 4 of 8 and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other charges shall be billed to Calhoun County for the removal of the fuel from the Calhoun County location. Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified by State and Federal Regulations. Calhoun County reserves the right to conduct random sampling of pre -qualified products for testing and to perform random audits of test reports. Calhoun County representatives may sample products from the manufacturing plant, terminal, shipping container and any other source they deem necessary to insure reliability of the products. If testing will be performed through a third party, the bidder will be required to allow the third -party access to the facilities in order to acquire samples for testing. Regardless of results of any product(s) test required by Calhoun County, all costs incurred for such tests shall be paid for by the bidder. The award of a bid will be voided if specifications, general conditions and/or instructions within this Invitation to Bid Packet are not followed. The bid would then be awarded to the bidder which submitted the next lowest bid that met specifications and all requirements of the Invitation to Bid Packet. Invoices shall not include other charges, including freight, handling charges or special delivery charges, when invoiced unless these charges were noted on the bid form or separate attachment and awarded as such. Invoices to Calhoun County must be billed to Calhoun County with reference to the Commissioner and Precinct or other Calhoun County Department that is being invoiced. (See Contact and Billing Information and Location of Fuel Tanks and Generator Fuel Tanks) Invoices must list separately the Texas State Excise Tax and/or Other Fees if any Other Fees were awarded. Invoices must not include any Federal Excise Taxes or Sales Tax (county, city or state sales tax). Each invoice must include the delivery ticket that was signed by a Calhoun County employee at the time of delivery. Each invoice must include a copy of the source document used to calculate the base price of the fuel purchased, with such base price highlighted or clearly marked. The successful bidder shall use the same source document throughout the term of the awarded bid (example: weekly OPIS Price Index; rack pricing from the same company, etc.). It is understood that Calhoun County Commissioners Court reserves the right to accept or reject any and/or all bids for any/or all fuel and/or services covered in this bid request and to waive informalities or defects in bids or to accept such bids as it shall deem most advantageous and to be in the best interest of Calhoun County. Calhoun County will evaluate and award bid based on lowest and best bid meeting specifications and all requirements of the Invitation to Bid Packet. "Lowest and best" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, other fees, Page 5 of 8 maintenance, reliability, life cycle, warranties and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options bid as it deems to be in the best interest of Calhoun County. Although the cost of fuel to be provided is an essential part of the bid, Calhoun County is not obligated to award a bid (contract) on the sole basis of cost but will award to the bidder considered to be the best value to the County. The bid award shall be based on, but not necessarily limited to, the following factors: ■ Plus or Minus per gallon ■ Other Fees, if any, not included in plus or minus per gallon ■ Special needs and requirements of Calhoun County ■ Delivery • Compliance in returning and/or including all required forms • Results of testing samples (if required by Calhoun County) • Calhoun County's experience with products bid ■ Bidder's past performance record with Calhoun County If bids are awarded, award information will be emailed and/or mailed to all bidders that submitted a bid regardless if the bidder was awarded a bid or not. Calhoun County Commissioners Court and the County Auditor's office work diligently to get this information to the bidders as soon as possible. To obtain results, or if you have any questions, please contact Peggy Hall, Calhoun County Assistant Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4610, peggy.hall@calhouncotx.org. As time permits, bid awards will be posted on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results, Results 2022. Once bids are awarded by Calhoun County Commissioners Court, this bid packet in its entirety will be the working contract between Calhoun County and the successful bidder for the period designated. Calhoun County or the bidder may cancel this bid (contract) at any time for any reason, provided a written notice is given. Should there be a change in ownership or management, the bid (contract) shall be cancelled unless a mutual agreement is reached with the new owner or manager to continue the bid (contract) with its present provisions and prices. Bidder understands that Calhoun County is a government entity subject to Texas State and Federal Public Information Statutes. Bidder hereby waives any obligation to the release to the public of any documents submitted in accordance with the bid. No person has the authority to verbally alter these specifications or any information within the Invitation to Bid Packet. Any changes will be made in writing (Addendum approved by Calhoun County Commissioners Court) and mailed and/or emailed to each bidder that received a bid packet. All disputes or protests will be held in Calhoun County, Texas. Page 6 of 8 INSURANCE REQUIREMENTS The awarded bidder must furnish, at their own expense, certificates of insurance or other acceptable evidence from a reputable insurance company or companies acceptable to Calhoun County, licensed to write insurance in the State of Texas showing the contractor and/or bidder is covered by insurance within the minimum limits of liability listed in the General Conditions that are included in this Invitation to Bid Packet. REQUIRED INFORMATION/FORMS TO BE RETURNED WITH INVITIATION TO BID ■ Invitation to Bid Form (page 1-7) ■ Method or Source Document that will be used throughout the bid period ■ Affidavit ■ Bidder and Order Information Form • Certificate of Interested Parties, Form 1295 — Must return when submitting your bid ■ Certificate of Current Liability Insurance — Return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you carry at least the minimum required coverage. Once the bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured. • Conflict of Interest Questionnaire, Form CIQ — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. ■ Certificate Regarding Debarment & Suspension and Other Responsibility Matters ■ Certification Regarding Lobbying ■ Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date • House Bill 89 Verification ■ Residence Certification ■ W-9 RENEWAL The awarded bid (contract) shall be for a period of one (1) year with an option for renewal for an additional three — one (1) year periods, if agreeable with both the successful bidder and Calhoun County. Intentionally Left Blank Page 7 of 8 ADDITIONAL INFORMATION All fuel tanks and/or generator fuel tanks currently being used by Calhoun County are owned by Calhoun County. All fuel tanks and generator fuel tanks are above ground. Calhoun County is not currently an OPTS subscriber. Average size of delivery for the Calhoun County Precincts: Precinct 1: About 1000-1500 gallons each of unleaded & diesel Precinct 2: About 800-900 gallons of unleaded & 2000-3000 gallons diesel Precinct 3: About 700-800 gallons unleaded & 300-400 gallons diesel Precinct 4-P: About 500 gallons unleaded & 400-500 gallons diesel Precinct 4-S: 104 E Dallas —About 1200-1500 gallons unleaded & 900-1000 diesel; 448 Harbor Road — About 800-1000 gallons diesel Do Calhoun County Precincts typically order both products at one time? Precinct 1: Yes Precinct 2: No (due to the extra 3,000-gallon tank for diesel) Precinct 3: Yes Precinct 4-P: Sometimes (try our best, but not always possible) Precinct 4-S: Sometimes (try our best, but not always possible) How often are orders placed? Precinct 1: About 4 times a year depending on work being done Precinct 2: About every 6 weeks for unleaded and every 3rd order for diesel (about 4 times a year) Precinct 3: About 5 times a year Precinct 4-P: About every 2 to 3 months for unleaded and diesel Precinct 4-S: 104 E Dallas — About every month for unleaded and quarterly for diesel; 448 Harbor Road — About every 2 months for diesel Generators: As needed depending on necessity of use of generator All Calhoun County Precincts and other Calhoun County Departments order at a different time including 4-P (Port O'Connor) and 4-S (Seadrift). All Calhoun County Precincts and other Calhoun County Departments handle their own fuel orders; therefore, invoices are billed to each separately. (See Contact and Billing Information and Location of Fuel Tanks and Generator Fuel Tanks) Page 8 of 8 Calhoun County, Texas ESTIMATED QUANTITY INFORMATION The quantities listed below are merely estimates of annual usage - not actual order amounts. During the period of the Delivered Fuel Contract, Calhoun County will buy only the actual quantity required, and it will neither be obligated to the purchase of nor limited to the quantities listed below. Fuel will only be ordered as needed and amounts will vary by need. Tank Size Estimated Yearly Department (Gallons) Type of Fuel Quantity (Gallons) Precinct 1 2,000 Gasoline, Unleaded, 87 Octane 6,000 305 Henry Barber Way 500 Gasoline, Unleaded, 93 Octane, Non -Ethanol 500-1,000 Port Lavaca 2,600 Diesel, Low Sulfur, Clear Diesel (On Road) 8,500 Precinct 2 1,000 Gasonline, Unleaded, 87 Octane 6,000 1,000 Diesel, Low Sulfur, Clear Diesel (On Road) 8,500 5812 FM 1090, Port Lavaca 3,000 Diesel, Low Sulfur, Clear Diesel (On Road) Precinct 3 24627 State Hwy 172 1,000 Gasoline, Unleaded, 87 Octane 4,000 Port Lavaca 500 Gasonline, Unleaded, 93 Octane, Non -Ethanol 500-1,000 (Precinct 3 is in Olivia) 1,000 Diesel, Low Sulfur, Clear Diesel (On Road) 8,000 Precinct 4 - Port O'Connor 93 Trevor Street (Off of Hwy 185) 500 Gasoline, Unleaded, 87 Octane 4,000 Port O'Connor 500 Diesel, Low Sulfur, Clear Diesel (On Road) 3,000 Precinct 4 - Seadrift 3,000 Gasoline, Unleaded, 87 Octane 9,000 104 E Dallas 500 Gasoline, Unleaded, 93 Octane, Non -Ethanol 500-1,000 Seadrift 3,000 Diesel, Low Sulfur, Clear Diesel (On Road) 6,000 Precinct 4 - Seadrift 448 Harbor Road, Seadrift 1,000 Diesel, Low Sulfur, Clear Diesel (On Road) 4,000 ** Skid Fuel Tank Within close proximity to the Calhoun County Courthouse for Fuel Delivery **1,000 Diesel, Low Sulfur, Clear Diesel (On Road) NA **Skid Fuel Tank: 1,000 gallon Skid Fuel Tank with Pump and Meter to be provided by successful bidder at no charge. The skid fuel tank should be double wall or a single wall tank and secondary containment that satisfies TCEQ requirements (See Specifications) Page 1 of 2 Estimated Quantity Information -- Continued All Generators are: Above Ground Fuel Tanks Tank Size Estimated Yearly Department (Gallons) Type of Fuel Quantity (Gallons) Generator - Calhoun County Courthouse 211SAnn St, Port Lavaca 785 Diesel for Generator, Low Sulfur, Red Diesel 0 - 785 Generator - Calhoun County Adult Detention Center (JAIL) 302 W Live Oak, Port Lavaca 706 Diesel for Generator, Low Sulfur, Red Diesel 0 - 706 Generator - EMS Central Station (Emergency Management Services) 705 Henry Barber Way Port Lavaca 250 Diesel for Generator, Low Sulfur, Red Diesel 0-250 Generator - EMS South Station (Emergency Management Services) 6084 State Hwy 185 E Seadrift 250 Diesel for Generator, Low Sulfur, Red Diesel 0-250 Generator - Memorial Medical Center 2,000 Diesel for Generator, Low Sulfur, Red Diesel 0 - 2,000 (Hospital) 815 N Virginia St Port Lavaca 3,000 Diesel for Generator, Low Sulfur, Red Diesel 0-3,000 Generator - Memorial Medical Clinic 1016 N Virginia St Port Lavaca 500 Diesel for Generator, Low Sulfur, Red Diesel 0 - 500 Page 2 of 2 CALHOUN COUNTY, TEXAS .d•7►�ti�_[ _ ��I�[�ILI �liubiire1L AND LOCATION OF FUEL TANKS AND GENERATOR FUEL TANKS Calhoun County Precinct 1 Commissioner David Hall 305 Henry Barber Way (by the County Fairgrounds) Port Lavaca, TX 77979 Office Manager: Angela Torres Office: 361-552-9242 Fax: 361-553-8734 Location of Fuel Tanks: 305 Henry Barber Way, Port Lavaca, TX Calhoun County Precinct 2 Commissioner Vern Lyssy 5812 FM 1090 (Six Mile) Port Lavaca, TX 77979 Office Manager: Lesa Jurek Office: 361-552-9656 Fax: 361-553-6664 Location of Fuel Tanks: 5812 FM 1090, Port Lavaca, TX Calhoun County Precinct 3 Commissioner Joel Behrens 24627 State Hwy 172 (Olivia) Port Lavaca, TX 77979 Office Manager: Lynette Adame Office: 361-893-5346 Fax: 361-893-5309 Location of Fuel Tanks: 24627 State Highway 172, Olivia TX Calhoun County Precinct 4 Precinct 4-P (Port O'Connor) Commissioner Gary Reese Trevor St off of Hwy 185 Port O'Connor, TX 77982 Office Manager: April Townsend Use same numbers as Seadrift (4-S) Location of Fuel Tanks — Pct 4-P Barn #3: 93 Trevor Street off of Highway 185, Port O'Connor, TX Page 1 of 3 CONTACTAND BILLING INFORMATION AND LOCATION OF FUEL TANKS AND GENERATOR FUEL TANKS, Continued Calhoun County Precinct 4 Precinct 4-S (Seadrift) Commissioner Gary Reese 104 E Dallas St PO Box 177 Seadrift, TX 77983 Office Manager: April Townsend Office: 361-785-3141 Fax: 361-785-5602 Location of Fuel Tanks — Pct 4-S Barn #1 Location of Fuel Tanks — Pct 4-S Barn #2 104 E Dallas, Seadrift TX 448 Harbor Road, Seadrift TX Skid Fuel Tank: Calhoun County Attn: Commissioner David Hall 305 Henry Barber Way Port Lavaca, TX 77979 Office: 361-552-9242 Fax: 361-553-8734 Storage Location when not in use: Calhoun County Recycle Center, 900 Landfill Rd, Port Lavaca TX Location for Fuel Delivery: Within close proximity to the Calhoun County Courthouse, 211 S Ann St, Port Lavaca TX Calhoun County Courthouse - Generator Calhoun County Maintenance Attn: Everett Wood, Maintenance Supervisor 2115 Ann St Port Lavaca, TX 77979 Contact Person: Everett Wood, Maintenance Supervisor Office: 361-553-4499 Fax: 361-553-4497 Location of Generator: 211 S Ann St, Port Lavaca, TX Calhoun County Adult Detention Center (Jail) - Generator Calhoun County Maintenance Attn: Everett Wood, Maintenance Supervisor 2115 Ann St Port Lavaca, TX 77979 Contact Person: Everett Wood, Maintenance Supervisor Office: 361-553-4499 Fax: 361-553-4497 Location of Generator: 302 W Live Oak, Port Lavaca, TX (Corner of Live Oak and San Antonio St) Page 2 of 3 CONTACTAND BILLING INFORMATION AND LOCATION OF FUEL TANKS AND GENERATOR FUEL TANKS, Continued EMS Central Station (Emergency Management Services) - Generator Calhoun County EMS Central Station Attn: Accounts Payable 705 Henry Barber Way Port Lavaca, TX 77979 Office: 361-552-1140 Fax: 361-552-6552 Location of Generator: 705 Henry Barber Way, Port Lavaca, TX EMS South Station (Emergency Management Services) - Generator Calhoun County EMS South Station Attn: Accounts Payable 705 Henry Barber Way Port Lavaca, TX 77979 Office: 361-552-1140 Fax: 361-552-6552 Location of Generator: 6084 State Hwy 185 East, Seadrift, TX Memorial Medical Center (Hospital) — Generators (2 Generators) Memorial Medical Center Attn: Accounts Payable 815 N Virginia St Port Lavaca, TX 77979 Accounts Payable: Ellen Heiman — Office: 361-552-0256; Fax: 361-551-4504 Order Contact: Bethann Diggs, Plant Services Dept. Asst. — Office: 361-552-0392; Fax: 361-552-0312 Location of Hospital Generators: 815 N Virginia St, Port Lavaca, TX Memorial Medical Clinic - Generator Memorial Medical Clinic c/o Memorial Medical Center Attn: Accounts Payable 815 N Virginia St Port Lavaca, TX 77979 Accounts Payable: Ellen Heiman — Office: 361-552-0256; Fax: 361-551-4504 Order Contact: Bethann Diggs, Plant Services Dept. Asst. — Office: 361-552-0392; Fax: 361-552-0312 Location of Clinic Generator: 1016 N Virginia St, Port Lavaca, TX Page 3 of 3 REQUIRED INFORMATION/FORMS INFORMATION/FORMS REQUIRED TO BE RETURNED WITH BIDDER'S BID Bidder must return one (1) original of the following information/forms with their Bid: • Invitation to Bid Form (Page 1— 7) • Method or Source Document used for Mark-up throughout the bid period • Affidavit • Bidder and Order Information Form • Certificate of Interested Parties Form 1295 — Must include when submitting your bid • Certificate of Liability Insurance — Return a copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the bidder who is awarded the bid must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • Conflict of Interest Questionnaire Form CIO— Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Debarment & Suspension and Other Responsibility Matters • Certification Regarding Lobbying • Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date • House Bill 89 Verification • Residence Certification • W-9 INVITATION TO BID FORM • Return the Invitation to Bid Form (page 1— 7) • Complete all information • If Not Applicable or No Charge, mark NA • On page 1 state: 1. Bidder's Name and Address 2. Method or Source that will be used throughout the bid period (bottom of page 1) • Be sure to complete and sign the bottom of page 7 CALHOUN COUNTY, TEXAS INVITATION TO BID FORM Annual Supply Contract for Delivered Fuel Bid Number: 2022.01 January 1, 2022 thru December 31, 2022 With an option for renewal for an additional three- one (1) year periods, if aggreeable with both the successful bidder and Calhoun County BIDDER'S NAME AND ADDRESS: • Please type or print in ink. If handwritten, must be legible. • White out is not acceptable. • This is a bid form only and does not represent an order for a purchase by Calhoun County. • Acceptance of the successful bid shall obligate the bidder to provide up to the amount bid at the bid terms and conditions stated herein. Acceptance of the successful bid shall only obligate Calhoun County to purchase some of the items from that bidder. Calhoun County reserves the right to require any successful bidder to enter a separate written contract containing the terms herein and other reasonable conditions. The Invitation to Bid packet, in its entirety, will be the binding contract between Calhoun County and the successful bidder. • SEE SPECIFICATIONS FOR DELIVERED FUEL AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS • Estimated quantities are not guaranteed for the year. Amounts will vary by need. • ALL Transportation Costs and Other Fees must be included in the bid plus or minus or clearly stated on the bid • Delivery in 24 hours from receipt of order. • Calhoun County is Exempt from all Federal Excise Taxes and Sales Tax (county, city and state sales tax). • Calhoun County is Not Exempt from: Texas State Excise Tax on Gasoline and Clear Diesel • ALL OTHER FEES NOT INCLUDED IN PLUS OR MINUS PER GALLON MUST BE LISTED AND CLEARLY STATED ON THE INVITATION TO BID FORM. If extra space is needed to list Other Fees, attach a separate page stating the fee and amount of the fee. This separate page must be signed and dated by an authorized respresentative. Make note of this separate page under the Other Fees column. Only Fees listed on the bid returned by the bidder and awarded as such to the successful bidder will be allowed to be included on the invoice when the awarded bidder submits the invoice for payment. List Method or Source that will be used throughout the bid period and provide a copy: Page 1 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN PLUS OR MINUS PER GALLON If No Charge OR Not Applicable, Mark NA Texas List Any Other Environmental Fees) AND Fee Per Delivery Amount of Plus or Texas OSLTF- (See Texas Petroleum Minus Per State LUST Federal Oil Products bellueryFee Fee(s) Schedule for 5,000 Gallons U: After Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or mere) Service Fee Less than 2,500 Precinct 1 Gasoline Gallons the Fee is Unleaded $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 305 Henry Barber Way grand Name: Less than 5,000 Port Lavaca TX 77979 Gallons the Fee is $ Gasoline Less than 2,500 Unleaded Gallons the Fee is $ 93 Octane $ $0.20 2,500 Gallons but Non -Ethanol Less than 5,000 Brand Name: Gallons the Fee is Diesel Less than 2,500 Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Gasoline Less than 2,500 Precinct 2 Gallons the Fee is Unleaded $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 5812 FM 1090 Brand Name: Less than 5,000 Port Lavaca TX 77979 Gallons the Fee is Less than 2,500 Diesel Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is $ Page 2 of 7 Invitation to Bid Form -Annual Supply Contract for Delivered Fuel --Continued OTHER FEES NOT INCLUDED IN PLUS OR MINUS PER GALLON If No Charge OR Not Applicable, Mark NA Texas List Any Other Environmental Feels) AND Plus or Texas OSLTF- Fee Per Delivery (see Texas Petroleum Amount of Minus Per State LUST Federal Oil Products DellveryFee Fee(s) Schedule for 5,000 Gallons IN: After Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee ormore) Service Fee Precinct Gasoline Less than 2,500 Gallons the Fee is Fuel Tank(s) Location: Unleaded $ 24627 State Hwy 172 87 Octane $ $0.20 2,500 Gallons but Port Lavaca TX 77979 Brand Name: Less than 5,000 (Precinct 3 is in Olivia) Gallons the Fee is $ Gasoline Less than 2,500 Unleaded Gallons the Fee is 93 Octane $ $0.20 $ 2,500 Gallons but Non -Ethanol Less than 5,000 Brand Name: Gallons the Fee is Diesel Less than 2,500 Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Precinct 4 Gasoline Less than 2,500 Gallons the Fee is (Port O'Connor) Unleaded $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 93 Trevor Street Brand Name: Less than 5,000 (Off of Hwy 185) Gallons the Fee is Port O'Connor TX 77982 $ Diesel Less than 2,500 Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Page 3 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN PLUS OR MINUS PER GALLON If No Charge OR Not Applicable, Mark NA Texas List Any Other Environmental Fee(s) AND Fee Per Delivery Amount of Plus or Texas OSLTF - (See Texas Petroleum Minus Per State LUST Federal Oil Produces DeliaeryFee Feels) Schedule for 5,000 Gallons Ex: Aker Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or more) Service Fee Less than 2,500 Precinct 4 Gasoline Gallons the Fee is (Seadrift) Unleaded $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 104 E Dallas Brand Name: Less than 5,000 Seadrift TX 77983 Gallons the Fee is Gasoline Less than 2,500 Unleaded Gallons the Fee is $ 93 Octane $ $0.20 2,500 Gallons but Non -Ethanol Less than 5,000 Brand Name: Gallons the Fee is Less than 2,500 Diesel Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is $ Precinct Gasoline Less than 2,500 Gallons the Fee is (Seadrift) Unleaded $ Fuel Tank(s) Location: 87 Octane $ $0.20 2,500 Gallons but 448 Harbor Road Brand Name: Less than 5,000 Seadrift TX 77983 Gallons the Fee is Less than 2,500 Diesel Gallons the Fee is Low Sulfur $ (Clear Diesel) $ $0.20 2,500 Gallons but Brand Name: Less than 5,000 Gallons the Fee is Page 4 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN PLUS OR MINUS PER GALLON If No Charge OR Not Applicable, Mark NA Texas List Any Other Environmental Feels) AND Plus or Texas OSLTF- Fee Per Delivery (See Texas Petroleum Amount of Minus Per State LUST Federal Oil Products Delivery Fee Fee(s) Schedule for 5,000 Gallons Ex: After Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or more) Service Fee Skid Fuel Tank Skid Location for Fuel Diesel Less than 2,500 Gallons the Fee is Delivery: Low Sulfur $ Within Close Proximity (Clear Diesel) $ $0.20 2,500 Gallons but to the Calhoun County grand Name: Less than 5,000 Courthouse Gallons the Fee is 211 S Ann Street $ Port Lavaca TX 77979 Generator - CalhounCounty Diesel Less n 2,500 Gallon the Gallons the Fee is Courthouse Low Sulfur $ Generator Fuel Tank (Red Diesel) $ NA 2,500 Gallons but Location for Fuel Brand Name: Less than 5,000 Delivery: Gallons the Fee is 211 S Ann Street $ Port Lavaca TX 77979 Generator - Calhoun County Less than 2,500 Adult Detention Diesel Gallons the Fee is Low Sulfur $ Center (JAIL) (Red Diesel) $ NA 2,500 Gallons but Generator Fuel Tank grand Name: Less than 5,000 Location for Fuel Gallons the Fee is Delivery: $ 302 W Live Oak Port Lavaca TX 77979 Page 5 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN PLUS OR MINUS PER GALLON If No Charge OR Not Applicable, Mark NA Texas List Any Other Environmental Fee(s) AND Plus or Texas OSLTF- Fee Per Delivery (See Texas Petroleum Amount of Minus Per State LUST Federal Oil Products Delivery Fee Feels) Schedule for S,OOD Gallons Ex: After Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or more) Service Fee Generator - EMS Central Station Less than 2,500 (Emergency Diesel Gallons the Fee is Low Sulfur $ Management (Red Diesel) $ NA 2,500 Gallons but Services) Brand Name: Less than5,000 Generator Fuel Tank Gallons the Fee is Location for Fuel $ Delivery: 705 Henry Barber Way Port Lavaca TX 77979 Generator - EMS South Station Less than 2,500 (Emergency Diesel Gallons the Fee is Low Sulfur $ Management (Red Diesel) $ NA 2,500 Gallons but Services) Brand Name: Less than5,000 Generator Fuel Tank Gallons the Fee is Location for Fuel $ Delivery: 6084 State Hwy 185 E Seadrift TX 77983 Page 6 of 7 Invitation to Bid Form - Annual Supply Contract for Delivered Fuel -- Continued OTHER FEES NOT INCLUDED IN PLUS OR MINUS PER GALLON If No Charge OR Not Applicable, Mark NA Texas List Any Other Environmental Fee(s) AND Plus or Texas OSLTF- Fee Per Delivery (See Texas Petroleum Amount of Minus Per State LUST Federal Oil Products Delivery Fee Fee(s) Schedule for S,000 Gallons Ex: After Hours Call Out Department Fuel Type Gallon Excise Tax FEE Spill Fee or more) Service Fee Generators - Memorial Less than 2,500 Medical Center Diesel Gallons the Fee is Low Sulfur $ (Hospital) $ NA 2,500 Gallons but (Red Diesel) Generators Fuel Tank Brand Name: Less than 5,000 Location for Fuel Gallons the Fee is Delivery: $ 815 N Virginia Street Port Lavaca TX 77979 Generator - Memorial Diesel Less than 2,500 Gallons the Fee is Medical Clinic Low sulfur $ Generator Fuel Tank (Red Diesel) $ NA 2,500 Gallons but Location for Fuel Brand Name: Less than 5,000 Delivery: Gallons the Fee is 1016 N Virginia Street $ Port Lavaca TX 77979 The undersigned affirms that they are duly authorized to execute this bid and that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder, that the contents of this bid as to prices, terms or conditions of said bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment gift, loan, gratuity, special discount, trip, favor, or service to any official, employee, or agent of Calhoun County in connection with this bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands and has followed all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date: Authorized Signature & Title: Printed Name & Title of Authorized Signature: Phone Number: REMARKS: Email: Page 7 of 7 (FOR PLUS OR MINUS PER GALLON) • Return a copy of the Method or Source Document that will be used for the Plus or Minus per Gallon throughout the bid period AFFIDAVIT • Complete and return this form with your bid STATE OF {} AFFIDAVIT COUNTY OF {} The undersigned certifies that the bid price contained in this bid has been carefully checked and is submitted as correct and final and if bid is accepted, agrees to pay for said lease upon the conditions contained in the Agricultural Lease, Specifications and General Conditions. BEFORE ME, the undersigned authority, on this day personally appeared known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bid 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 leases bid on, or to influence any person to bid or not to bid thereon. I affirm that I am duly authorized to execute this bid, that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder. I further affirm that the bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid. The contents of this bid as to price, terms or conditions of said bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business or to any official, employee or agent of Calhoun County prior to the official opening of this Bid. Affiant Printed Name and Title of Affiant Name of Bidder (Company) Address Phone Number Fax Number Email Address SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 20 Notary Public, State of Stamp/Seal My Commission Expires BIDDER AND ORDER INFORMATION FORM • Complete and return this form with your bid BIDDER AND ORDER INFORMATION Please Type If handwritten, must be in ink and legible Bidder's Name: Address: Remittance Address: Telephone: Fax: Email: Email(s) to send Bid Information: Signature of Authorized Representative: _ Printed name of Authorized Rep: ORDER - CONTACT INFORMATION Order Contact Name & Title: Order Contact Telephone: Order Contact Fax: Order Contact Email: CERTIFICATE OF INTERESTED PARTIES, FORM 1295 • Form 1295 must be filled out online, printed, #6 completed including signature and returned with bidder's bid. The copy included is a Sample Copy Only. • Return completed Form 1295 with your bid #1 Vendor's Name, City, State and Country #2 Calhoun County, Texas #3 Bid Number 2022.01 Delivered Fuel, January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, sign and print When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. The form does not need to be notarized. It is an Unsworn Declaration. CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos, 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� /. t Name of business entity filing form, and the city, state and country of the business entity's place of business. ` 1. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. ♦ 3 Provide the identification number used by the governmental entity or state agency to tyy k o identify the contract, and provide a description of the services, goods, or other property to be provided ue contract. 4 City, State, Country :Nature of Interest (check applicable) Name of Interested Party (place of business) ♦ Controlling Intermediary IL 5 ❑Check only if there' I terested Party. 6 UNSWORN DIECLt� N My name is +�`` and my date of birth is My addre� -� (street) (city) (state) (zip code) (country) under penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission v .ethics.state.tx.us Revised 12122/2017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84' Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 851h Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal his://www.ethics.state.tx.us/whatsnew/elf info form1295.1itm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. COPY OF CURRENT CERTIFICATE OF LIABILITY INSURANCE • Return a copy of your current Certificate of Liability Insurance with your bid. This copy of your current insurance will provide proof that you carry at least the minimum required coverage. At this time, this copy does not require listing Calhoun County as an additional insured. • Once an award is made, the awarded bidder must provide Calhoun County a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • See General Conditions and Specifications for complete insurance requirements CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ • Complete and return this form with your bid Every vendor doing business with the County or seeking to do business with the County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.00111-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. jJ Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? F7Yes F� No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes E-1 No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.0010-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code 4176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code 4176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS • Complete and return this form with your bid CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING LOBBYING • Complete and return this form with your bid Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 at seq., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official Date DISCLOSURE OF LOBBYING ACTIVITIES • Complete and return this form with your bid • If Not Applicable, bidder must mark NA and sign and date Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a, initial filing _ b. grant _ b. initial award _ b. material change c. cooperative agreement c. post -award d. loan For material change only: e.loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter _ Prime _ Subawardee Name and Address of Prime: Tier , if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ifapplicable: S. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address iJ' (if individual, last name, first name, MI): different from No. I0a) (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the 1 st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportafion, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No, 0348- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0346-0046), Washington, DC 20503 Approved by OMB 0348-0046 HOUSE BILL 89 VERIFICATION • Complete and return this form with your bid HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 the undersigned representative of Representative (hereafter referred to as Company) being an Company or Business Name adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel; and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in on Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for -profit sole proprietorship, organization, association, corporation, partnership, Joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. Signature of Representative Print Name & Title Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount. RESIDENCE CERTIFICATION • Complete and return this form with your bid RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ I certify that is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) ❑ I certify that (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION • Complete and return this form with your bid W-9 Request for Taxpayer Give Form to the Form (Rev. Octaher2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. irdemel Revenue Samoa ► Go to wwwJ gcv1FmmW9 for instructions and the latest information. t Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business narre/disregarded entity name, if different from above m3 Check appropriate box for federal tax classification of the person whose name Is entered on Tina 1. Check only one of the 4 Exemptions (codes apply only to m following seven boxes. certain entities, not individuals; sea a p ❑ Individualreole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ TrusVeslate instructions on page 3): 0 single -member LLC Exempt payee code Of any) ❑ Umited liability company. Fitter the tax classification (C=G corporation, 8=3 corporation, P=Partnership) ► a Note. Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting V LLC if the LLC Is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that code (if my) a g is disregarded from the owner should amok the appropriate box for the tax classification of its owner. 8 ❑ Other (a" Instructions) ► 44ns.. ma�amm.numenaawe uwusJ cs 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) CALHOUN COUNTY m 202 S ANN ST, PORT LAVACA TX 77979 s City, state, and ZIP code 361-553.4610 FAX:361.553-4614 7 Ust account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this Is generally your social security number (Sant• However, fora resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other FM - m - entities, it Is your employer identification number (EIM• If you do not have a number, see How to get a TIN, later. or Note: if the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer Identification number Number To Give the Requester for guidelines on whose number to enter. j—n IMF Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer identification number (or I am waking for a number to be Issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt tram backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA codes) entered on this form Of any) Indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out kern 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you ere not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part II, later. Sign I signature of Here US.peraan► Date► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to wwwirs.gov/FormW9. Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), Individual taxpayer Identification number QTIN), adoption taxpayer identification number (ATIM, or employer identification number (EIM, to report on an Information return the amount paid to you, or other amount reportable on an Information return. Examples of information returns Include, but are not limited to, the following. • Form 1099-INT (Interest earned or paid) • Farm 1099-DIV (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (vadous types of Income, prizes, awards, or gross proceeds) • Form 1099-5 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-5 (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest),1098-E (student loan Interest), 1098-T (tuition) • Farm 1099-C (canceled debt) • Farm 1099-A (acquisition or abandonment of secured properly) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231x Form W-9 (Rev. 10-2018) CURRENT AWARDED BID TABULATION FOR THE CURRENT BID PERIOD January 1, 2021 thru December 31, 2021 O " z o w F 0 S w F O A� w G1 m O m v d O c— °- w G m F A X O 2 C 9 O O O O O T m D Q n 9 '� .0 O O O O O X �y9 Z. •aPi di. m 0 0 0 0 8 e a m y F O y w w w m rA R N O O 1 1 8- e o e o 10 � s� z. A 1 a K N N S N T N'N N T N N N s N N N o�$o.G. .ego. o.� g'cp O �' e e � N w w a o =� 2 8 -� o p m 0. 92zG o �S m P �.. m o �S � o P o ZS Ol�3y nd ' m s i O z 2 IV ti D D D D D z i lM1 VL tM1 'V� ih D 9 A L+ 0 0 0 0 p X O z 9 3nt vn 0 vn 0 �n 0 �n 0 0 ,y % y m C 3• C p 0 0 o a o T T In Z O T ti T D D D D D m 1^ a n •1 Q O O O N N C V r O O O a 40 w O a w 40 w = r O y O P; m 0 O D �• D Q O O .+ 1n N O O .n N o rl 3 0 0 0 0 0 0 0 0 o 0 z -ao a N A ' O 8"— 8"— 8"8"— •"•' In g Z T u � •. b C 3 d Oa 2 T Oo 2 T Oo S d Oo 2 d Oo S N T q° p c p° Q O O O O� O i n 11 O O O a O O j N j N j N N j N T R in N J J N J J N J J N J J N J VI 6 i N �+ 2 O ri O m z y J O F w w f m o o r m a o y^ n= — _ m n m m a m m r m Z e YR O N O N O G! O i/Y O N �1 y^ D m A. 3 V 0 0 o o o m m Q< Z w m N m n e m 8 S 8 n O� �A m 1. N. y m OLI 6N,.0 �.b °idppN Ll���6A 6cdC O. poO�pLp�S iO pNp p�p od � �p�. � � m R� m m O Z Z: z 2 Z "Z A iA N N N i? D y A r m 'L.. n N 0 N 0 N 0 N 0 N 0 y X 0 0 N N N D X 0 0 0 0 o n Y Z Z Z Z Z D D D D i Y p 0 O m a w A w w 0 O z S= yNi S N Y yNi N Fv N {Ny S N N yNj S N N r yNj S N r m 0 6 0 y N Z p D m Z Ll o o o c 41 °s u F C 3 = ''O n O N S o SF S N S o Z m m i.+ i°.+ 5 i°.+ N o a N o N u n° in C F` u �� 3 y o m (') 9 N Spp w >w Tpo Spy N N 2 2 2 2 ° 2 ui Ll d Ll ^' m a oNo o 0 oNo s w& N a d w 9 6 6 .�• .i• m H o N a O m o o N �o, m 0� w O m o r E m w a= w — c A � O O y �° =• V O O O D�D 6 o o oPi m .• r .� f. ' N y v P m y o y •O O O ON O in9 m N 0 Z W N N b l0~O q d T m C A w A w w m cg 1. _O P W n Z V^ N N N» N N N T N N S N T N N VL M N N N T N ~ Gi p]gO� O]Op B.� Li O]�}Oin p 0.7.0.0.� m� 1.N O A. K+`�G1N� oLINP yONOyO Kio LlNy NoLI NOGI�� RS yC O. pp 8 pp " N 4! 00 p YO '"J O Y p0 O Yp W O b 00 W 00 � O? 00 p 00 ] a QS O `n C Z W •. N am_ p N p N N O° N. ] R O z z 2 z z m D D D D D m A i 2 0 3 � aR F, rr Tx 0 0 3 3 0 0 o Z A C to O p 0 to O O to y X �i -� 5• C N N N N N X N D N 0 0 0 0 0 o m�� ° O n Y z z z z z ¢ Y p p N m r a 0 0 0 0 a n 0 + o 0 0 0 0 0 A W A W W �• N _O O D D ii 2 Z I_ToI_ z = N o= ° ° �oI o o= ° ° oI_� ° ° _ �oI_ ° z d m a'Zm oci am oci° oo. 00. a o p? 3 0? 3 3 0= 3 p 3 3 p° N O ° ° N N ^' N ''^ °" z .m. n o P S m li >; _ y N s u i ? w i w w T w in N ao x ao x x ti @. O W INn In N J W H �1 N N N W N N 9 N A o oa g c A= o s 6 S r u o C 3 cn 3 v m o o m � 0 o C n 2 N N N O'a F C Z w v `D D C SC m m C w N �O r' J 00 n' O N G .IOIVV S z 1O1JJ 1NJ �Oa 1y1JJ W O? W W O O? N O N E N d� _ o R32 =„ d 3 y T:Q m z \ \ m = D D D. N z N w nR'^ FmA N 3 3 N Z A C a 0 6 v z z> m D D o E N O m m ° O n Y 0 o o O D m y A N C_ o O O m Z 3 Z m Ne,iN^ rN% wgn'Yi- wT^'rN m< o -c o - o cz 3 S °�' y c•e C 0 0 3 M = w 2 d w 2 N a w 2 N N a° o ry o 0 a o p m vmi N H _ a N � N J � W O 8 m m cz=3 s�zdN a9 .n 4 � � � -I � f• 4 � ° -1 01 p 0 3 0 n � % z A Q A A A s F O n F o n F O m " m Z C 9 9 Z Z Z Z a n a xx V D D O O O 0 m y $m D G O N Z VI O P dp Gp b Ll � a ' d '^ A 6 P C O ppoo b00 �N ryp dOp.NN pp S bOO�N p WOpO—�N _ OLH c OR OI � m w A T O O O O O A C � 9 C D D D D N y y N O O ^ ti 6 0 0 0 0 0 o 0 C a 3 O O O O O O O O m y ry� m Y O N A G ! O r A A A A N ' O D H• D (i _O o o - � - = o - o m O p•'o C N c o o T w 2 T pp 2 d Oo 2 T NOTICE OF MEETING— 10/6/2021 7. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2022.02 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Vern Lyssy, Commissioner, Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 13 September 29, 2021 To: Judge Meyer From: The office of the County Auditor Peggy Hall, Assistant Auditor Please place the following item on the Commissioners Court Agenda for October 6, 2021: • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2022.02 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. Agenda Item #7 Commissioners Court — Wednesday, October 6, 2021 Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2022.02 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. CHANGES FROM PREVIOUS SPECIFICATIONS AND INVITATION TO BID PACKET: No changes to Specifications or the Invitation to Bid Form. Only changes were to update the dates for the new bid period and to use same format as other bid packets. CALHOUN COUNTY, TEXAS INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Bid Number: 2022.02 Bid Term: January 1, 2022 thru December 31, 2022 SEALED BIDS WILL BE RECEIVED UNTIL 2:00:00 Tuesday, November 9, 2021 AT THE OFFICE OF Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 PUBLIC BID OPENING will be conducted at 2:00 PM, Tuesday, November 9, 2021 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 3`d Floor, Suite 301, Port Lavaca, Texas 77979. At this time, each bidder's name will be read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all bidders that submitted a bid and will also be posted on the County's website (www.calhouncotx.org) under Bid Notices and Results, Results 2022 as soon as time permits. CONTENTS • Invitation To Bid • Return Instructions • General Conditions • Specifications for Annual Supply Contract for Insecticides for Mosquito Control • Contact and Billing Information for Calhoun County Precincts • Required Information/Forms o Invitation to Bid Form o Material Information and Safety Data Sheets for each Insecticide o Affidavit o Bidder and Order Information Form o Certificate of Interested Parties Form 1295 — Must return when submitting your bid o Certificate of Liability Insurance — Return a copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the bidder who is awarded the bid must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. o Conflict of Interest Questionnaire Form CIQ — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. o Certification Regarding Debarment & Suspension and Other Responsibility Matters o Certification Regarding Lobbying o Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date o House Bill 89 Verification o Residence Certification o W-9 OTHER INFORMATION INCLUDED WITH THE INVITATION TO BID PACKET • Current Awarded Bid Tabulation for the Annual Supply Contract for Insecticides for Mosquito Control —January 1, 2021 thru December 31, 2021 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas, will receive SEALED BIDS for Insecticides for Mosquito Control as needed by the Road and Bridge Precincts BID NUMBER: 2022.02, ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Bids are for a one (1) year period beginning January 1, 2022 and ending December 31, 2022. The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. SEALED BIDS ARE DUE: Date: Tuesday, November 9, 2021 Time: BEFORE 2:00:00 PM Location: County Judge's Office Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 At this time, all bids will be publicly opened and each bidder's name read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. All bids (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9x12 or larger envelope and CLEAREY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.02 ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Calhoun County does not accept faxed or emailed bids. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the time the bids received will be opened. Bids received after the deadline will be returned unopened. Bids shall include all requirements of the Invitation to Bid Packet for Bid Number 2022.02, Annual Supply Contract for Insecticides for Mosquito Control. SEALED BIDS MAY BE HAND DELIVERED OR MAILED TO: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, TX 77979 Page 1 of 2 Calhoun County reserves the right to waive any formality or irregularity, accept or reject any and/or all bids, to accept the bid deemed most advantageous to and in the best interest of Calhoun County. The award of a bid shall be made to the responsible bidder whose bid is determined to be the most beneficial to Calhoun County, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid Packet. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit bids. Cindy Mueller County Auditor Calhoun County, Texas Page 2 of 2 RETURN INSTRUCTIONS For Submitting a Bid for ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Bid Number: 2022-02 Bid Period: January 1, 2022 thru December 31, 2022 Return the following BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 Check List for submitting your Bid: Return One (1) Original Be sure all necessary forms are included and or completed, signed and dated Invitation to Bid Form (page 1-5) Material Information and Safety Data Sheets for each Insecticide Affidavit Bidder and Order Information Form Certificate of Interested Parties, Form 1295 Form 1295 must be completed online —Copy that is included is Sample Copy Only Do Not Fill Out Sample Copy. Form 1295 must be completed online. #1: Bidder's Name, City, State and Country #2: Calhoun County, Texas #3: Bid Number: 2022-02; Annual Supply Contract for Insecticides for Mosquito Control, January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to your company #4: Fill in the correct information OR #5: Mark an X in the Box #6: Fill in the correct information and print When you print you should see a Certificate Number and Dote Filed in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. Certificate of Liability Insurance Please return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you currently carry at least the minimum required coverage. Once bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured Conflict of Interest Questionnaire, Form CIQ Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box land sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. Certification Regarding Debarment & Suspension and Other Responsibility Matters Certification Regarding Lobbying Disclosure of Lobbying Activities —If Not Applicable, bidder must mark NA and sign and date House Bill 89 Verification Residence Certification W-9 Do Not Fold any of the above information. Bid must be returned in a SEALED 9 x 12 or larger envelope clearly marked: SEALED BID NUMBER 2022.02 ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL If you send your bid by UPS, FeclEx or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.02 ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Submit Sealed Bid to: Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 3rdFloor, Suite 301 Port Lavaca, TX 77979 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFQ, and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ, and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ, and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFQ, and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ, and/or Contract is due. The Bid, RFP, RFQ, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ, and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ, and/or Contract in collusion with anyother bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ, and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Page 1 of 13 Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ, and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ, and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ, and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ, and/or Contract will specify the date and time due. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ, and/or Contract is received and the time the Bid, RFP, RFQ, and/or Contract will be opened. A late delivery with an early postmark or delivery of the Bid, RFP, RFQ, and/or Contract to the wrong office will not suffice. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ, and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ, and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ, and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ, or Contract. If the Bid, RFP, RFQ, and/or Contract is sent by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ, or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ, and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ, and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ, and/or Contract was submitted to. A Bid, RFP, RFQ, and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ, and/or Contract price. Bids, Page 2 of 13 RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ, and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum. Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendor's performance under this Bid, RFP, RFQ, and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes. Tax exempt forms will be furnished upon request to the Calhoun County Auditor's Office. Page 3 of 13 Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will because to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ and/or Contract on the basis of lowest and/or best Bid, RFP, RFC, and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the solejudge in determining which Bid, RFP, RFC, and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ, and/or Contract based on lowest and/or best Bid, RFP, RFQ and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ and/or Contract" means a bid or offer providing the best value considering associated direct Page 4 of 13 and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ, and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ, and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFQ and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet Page 5 of 13 specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFC, and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFQ, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFQ, and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFQ, and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFC, and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 84th Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 6 of 13 Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf_ info_form1295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFC, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFQ and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Bid, RFP, RFQ and/or Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than thirty (30) days after Calhoun County Commissioners Court approves a contract, or awards a Bid, RFP, and/or RFQ with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Page 7 of 13 Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFC, and/or Contract submission and the time of execution of the Bid, RFP, RFC, and/or Contract. A print out of the search results, including principals, if any, from the System for Award Management (www.SAM.gov) that includes the record date must be included with the bidder's/vendor's Bid, RFP, RFC, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFQ and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Page 8 of 13 Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFC, Contract, order, and/or service. In the event a Bid, RFP, RFQ Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrantsthat products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the eventthe bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFC, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFC, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFC, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and Page 9 of 13 be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Maieure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFC, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFC, and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFC, and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFC, and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFC, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFC, and/or Contract. Otherwise, Texas state and federal law shall apply. Page 10 of 13 Prohibition against Personal Interest in Bids, RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFQ, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ, and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ, and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFO, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFC, and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ, and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. General Liability ($100,000/$300,000 or greater) Workers' Compensation (at Statutory Limits) Employer's Liability ($1,000,000 or greater) Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) Professional Liability Insurance (if applicable) Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of Page 11 of 13 the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFQ and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ, and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFQ, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: Name, mailing address and business phone number of the protesting party; Appropriate identification of the Bid, RFP, RFQ and/or Contract being protested; A precise statement of the reasons for the protest; and Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. Page 12 of 13 If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFC, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or byjudicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Cindy Mueller Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: cindy.mueller@calhouncotx.org To request a Bid, RFP, and/or RFQ packet from Calhoun County, or information on how to obtain a packet, please contact: Peggy Hall Assistant Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: peggy.hall@calhouncotx.org Bids, RFPs, and/or RFQs may also be viewed on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results. Page 13 of 13 SPECIFICATIONS FOR ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL BID NUMBER 2022.02 BY ORDER of the Commissioners Court of Calhoun County, Texas, sealed bids will be received for Insecticides for Mosquito Control as needed by the Road and Bridge Precincts. See Contact and Billing Information for Calhoun County Precincts for complete information and location on each of the Road and Bridge Precincts. INVITATION TO BID PACKET The complete Invitation to Bid Packet may be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. The complete Invitation to Bid Packet must be used in preparing the bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.02 ANNUAL SUPPLY CONTRACT FOR INSECTIDICES FOR MOSQUITO CONTROL If the SEALED BID is sent by UPS, Fed Ex, or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.02 ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 A late delivery with an early postmark will not suffice Calhoun County is not responsible for the delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery, it is recommended Page 1 of 6 that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid due date and time. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the bid is received and the time the bid will be opened. NO BIDS will be accepted after the due date and time has been reached. Calhoun County accepts no financial responsibility for any cost incurred by the bidder in the course of responding to these specifications. Faxed or emailed bids shall not be accepted. BID TERM The bid shall be in effect for a period of one (1) year beginning January 1, 2022 and ending December 31, 2022. BID INFORMATION/REQUIREMENTS To submit a valid bid, read the entire Invitation to Bid Packet for all required information that must be included and all required forms (see page 6) that must be returned and/or filled out, signed and dated and returned. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a bid. If you will not be submitting a bid, we would appreciate you indicating on your "NO BID" response any requirements of this bid request which may have influenced your decision to "NO BID". Calhoun County is not responsible for errors if the bid forms are handwritten. It is recommended that all information submitted by the bidder on the bid forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. LIST OF INSECTICIDES FOR MOSQUTIO CONTROL • Mineral Oil — BVA Mosquito Larvicide Oil — MC30 or Equivalent ■ Malathion ■ Malathion EW ■ 30-30 ULV ■ 31-66 ULV • 31-67 ULV ■ 4-4 ULV ■ 4-8 ULV ■ Altosid 30 Day Briquets or Equivalent ■ Altosid XR Extended Residual Briquets or Equivalent ■ DeltaGard or Equivalent • FourStar Sustained Release 45/90/180 Day Microbial Briquets or Equivalent Page 2 of 6 Bidder may bid on any or all Insecticides for Mosquito Control. Insecticides for Mosquito Control shall be ordered in quantities as determined by each Calhoun County Commissioner. Calhoun County is EXEMPT from all Sales Tax (county, city and state sales tax) and all Federal Excise Taxes, if applicable. One (1) copy of the Material Information and Safety Data Sheet(s) listing the active ingredients and safety instructions for each insecticide the bidder is submitting a bid on MUST be returned with the bidder's bid. Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified by State and/or Federal Regulations. Bid price shall include all transportation costs to the designated Calhoun County Precinct. All charges, including freight, handling charges or special delivery fees must be included in bid price or clearly stated on bid form. Additional charge listed separately, if any, will increase the amount of the bid. Only other fees or charges listed on the Invitation to Bid form or separate page that is signed and dated by an authorized representative and returned by the bidder with their bid and awarded as such to the successful bidder will be allowed to be included on the invoice when the awarded bidder submits the invoice for payment. Any exceptions and or variations from the specifications in this bid document must be indicated on the bid form or on a separate attachment to the bid and labeled as such. Exceptions taken and/or variations made to the specifications and listed on the bidder's bid or separate attachment may void the bid. The request for a bid on an insecticide does not guarantee that Calhoun County will purchase this insecticide during the bid period. Calhoun County does not guarantee to purchase any minimum or maximum quantities. The insecticides will only be ordered as needed. When required, all insecticides ordered will be delivered to the Calhoun County Precinct within 24 hours from time of order. In the event the awarded bidder is unable to deliver the product(s) ordered within 24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the said insecticide(s) from the bidder which submitted the next lowest bid that met specifications and can deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or other charges when cancelling an order. Bidder shall be required to notify Calhoun County in the event of unforeseen delay arising in the delivery of an order. In the event an order will not arrive at the Calhoun County Precinct at the designated time, Calhoun County shall have the right to refuse acceptance of the order and Calhoun County shall not be accessed any penalties, fees and/or other costs due to this refusal. Page 3 of 6 Calhoun County or the bidder have the right to cancel the delivery of a product(s) at any time due to weather and/or road conditions. No penalties, fees and/or other charges will be billed to Calhoun County if the delivery of a product(s) is cancelled by Calhoun County or the bidder due to weather and/or road conditions. The County reserves the right to refuse any order delivered for not being in compliance with the specifications, general conditions and/or the "Hazardous Communications Act", commonly known as the "Texas Right to Know Act". The bidder, at the bidder's cost, shall immediately remove the product(s) from the Calhoun County Precinct that are deemed unsatisfactory, and are not in compliance with the specifications, general conditions and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other charges will be billed to Calhoun County for the removal of the product(s) from the Calhoun County Precinct. Calhoun County reserves the right to conduct random sampling of pre -qualified products for testing and to perform random audits of test reports. Calhoun County representatives may sample products from the manufacturing plant, terminal, shipping container and any other source they deem necessary to insure reliability of the products. If testing will be performed through a third party, the bidder will be required to allow the third party access to the facilities in order to acquire samples for testing. Regardless of results of any product(s) test required by Calhoun County, all costs incurred for such tests shall be paid for by the bidder. The award, of a bid will be voided if specifications, general conditions and/or instructions within this Invitation to Bid Packet are not followed. The bid would then be awarded to the bidder which submitted the next lowest bid that met specifications and all requirements of the Invitation to Bid Packet. All Calhoun County Precincts handle their own orders and order at different times; therefore invoices shall be billed to each Calhoun County Precinct separately. Invoices shall not include other charges, including freight, handling charges or special delivery charges, when invoiced unless these charges were noted on the bid form or separate attachment and awarded as such. All invoices must be billed to Calhoun County to the attention of the Calhoun County Commissioner and Precinct ordering the insecticides(s). (See Contact and Billing Information for Calhoun County Precincts) Insecticide description per bid specifications, awarded bid price per unit, or other charge, if any other charge was included in the award, must appear on all invoices in order to be considered for payment. Invoices shall be free from sales tax (county, city or state sales tax) and federal excise taxes, if applicable. Invoices shall include a copy of the delivery ticket and/or packing slip that shows confirmation of delivery. Page 4 of 6 It is understood that Calhoun County Commissioners Court reserves the right to accept or reject any and/or all bids for any/or all insecticides and/or services covered in this bid request and to waive informalities or defects in bids, or to accept such bids as it shall deem to be most advantageous and in the best interest of Calhoun County. Calhoun County will evaluate and award bid based on lowest and best bid meeting specifications and all requirements of the Invitation to Bid Packet. "Lowest and best" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options bid as it deems to be in the best interest of Calhoun County. Although the cost of insecticides(s) to be provided is an essential part of the bid, Calhoun County is not obligated to award a bid (contract) on the sole basis of cost but will award to the bidder considered to be the best value to the Calhoun County. The bid award shall be based on, but not necessarily limited to, the following factors: ■ Unit price ■ Extended price (that includes other charges, if any) ■ Special needs and requirements of Calhoun County ■ Delivery ■ Compliance in returning and/or including all required forms ■ Results of testing samples (if required by Calhoun County) • Calhoun County's experience with products bid • Bidder's past performance record with Calhoun County If bids are awarded, award information will be emailed and/or mailed to all bidders that submitted a bid regardless if the bidder was awarded a bid or not. Calhoun County Commissioners' Court and the County Auditor's office work diligently to get this information to the bidders as soon as possible. To obtain results, or if you have any questions, please contact Peggy Hall, Calhoun County Assistant Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4610, peggy.hall@calhouncotx.org. As time permits, bid awards will be posted on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results, Results 2022. Once bids are awarded by Calhoun County Commissioners Court, this bid packet in its entirety will be the working contract between Calhoun County and the successful bidder for the period designated. Calhoun County or the bidder may cancel this contract at any time for any reason, provided a written notice is given. Should there be a change in ownership or management, the bid (contract) shall be cancelled unless a mutual agreement is reached with the new owner or manager to continue the bid (contract) with its present provisions and prices. Page 5 of 6 Bidder understands that Calhoun County is a government entity subject to Texas State and Federal public information statutes. Bidder hereby waives any obligation to the release to the public of any documents submitted in accordance with the bid. No person has the authority to verbally alter these specifications or any information within the Invitation to Bid Packet. Any changes will be made in writing (Addendum approved by Calhoun County Commissioners Court) and mailed and or emailed to each bidder that received a bid packet. All disputes or protests will be held in Calhoun County, Texas. INSURANCE REQUIREMENTS The awarded bidder must furnish, at their own expense, certificates of insurance or other acceptable evidence from a reputable insurance company or companies acceptable to Calhoun County, licensed to write insurance in the State of Texas showing the contractor (bidder) is covered by insurance within the minimum limits of liability listed in the General Conditions that are included in this Invitation to Bid Packet. REQUIRED INFORMATION/FORMS TO BE RETURNED WITH INVITIATION TO BID • Invitation to Bid Form (page 1-5) ■ Material Information and Safety Data Sheets for each Insecticide ■ Affidavit • Bidder and Order Information Form ■ Certificate of Interested Parties, Form 1295 — Must return when submitting your bid • Certificate of Current Liability Insurance — Return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you carry at least the minimum required coverage. Once the bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured. • Conflict of Interest Questionnaire, Form CIQ — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. ■ Certificate Regarding Debarment & Suspension and Other Responsibility Matters ■ Certification Regarding Lobbying ■ Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date • House Bill 89 Verification • Residence Certification ■ W-9 Page 6 of 6 CALHOUN COUNTY, TEXAS CONTACT AND BILLING INFORMATION FOR CALHOUN COUNTY PRECINCTS Calhoun County Precinct 1 Commissioner David Hall 305 Henry Barber Way (by the County Fairgrounds) Port Lavaca, TX 77979 Office Manager: Angela Torres Office: 361-552-9242 Fax: 361-553-8734 Calhoun County Precinct 2 Commissioner Vern Lyssy 5812 FM 1090 (Six Mile) Port Lavaca, TX 77979 Office Manager: Lesa Jurek Office: 361-552-9656 Fax: 361-553-6664 Calhoun County Precinct 3 Commissioner Joel Behrens 24627 State Hwy 172 (Olivia) Port Lavaca, TX 77979 Office Manager: Lynette Adame Office: 361-893-5346 Fax: 361-893-5309 Calhoun County Precinct 4 Precinct 4-P (Port O'Connor) Commissioner Gary Reese Trevor St off of Hwy 185 Port O'Connor, TX 77982 Office Manager: April Townsend Use same numbers as Seadrift (4-S) Calhoun County Precinct 4 Precinct 4-S (Seadrift) Commissioner Gary Reese 104 E Dallas St PO Box 177 Seadrift, TX 77983 Office Manager: April Townsend Office: 361-785-3141 Fax: 361-785-5602 REQUIRED INFORMATION/FORMS INFORMATION/FORMS REQUIRED TO BE RETURNED WITH BIDDER'S BID Bidder must return the following information/forms with their Bid: • Invitation to Bid Form (page 1-5) • Material Information and Safety Data Sheets for each Insecticide • Affidavit • Bidder and Order Information Form • Certificate of Interested Parties Form 1295 — Must include when submitting your bid • Certificate of Liability Insurance — Copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the awarded bidder must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • Conflict of Interest Questionnaire Form CIQ— Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Debarment & Suspension and Other Responsibility Matters • Certification Regarding Lobbying • Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date • House Bill 89 Verification • Residence Certification Wit&'] INVITATION TO BID FORM • Return the Invitation to Bid Form (page 1— 5) • Complete all information • Be sure to complete and sign the bottom of page 5 CALHOUN COUNTY, TEXAS INVITATION TO BID FORM ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Bid Number: 2022.02 January 1, 2022 thru December 31, 2022 Bidders's Name & Address • Please Type or Print. If handwritten, must be in ink and legible. White out is not acceptable. • This is a bid form only and does not represent an order for a purchase by Calhoun County. • Acceptance of the successful bid shall obligate the bidder to provide up to the amount bid at the bid terms and conditions stated herein. Calhoun County reserves the right to require the successful bidder to enter a separate written contract containing the terms herein and other reasonable conditions. The Invitation to Bid Packet, in its entirety, will be the binding contract between Calhoun County and the successful vendor. SEE SPECIFICATIONS AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS Mineral Oil - BVA Mosquito Larvicide Oil - MC30 OR Equivalent 5 Gallon Pail $ 50 Gallon Drum $ 55 Gallon Drum $ 275 Gallon Tote $ /per 5 Gallon Pail /per 50 Gallon Drum /per 55 Gallon Drum /per 275 Gallon Tote , List Name of Mineral Oil Page 1 of 5 Invitation To Bid Form -Annual Supply Contract for Insecticides for Mosquito Control --CONTINUED Malathion F List Insecticide Name Active Ingredients: Malathion 96.5%; Other 3.5% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 5 Gallon Pail $ /per 5 Gallon Pail 55 Gallon Drum $ /per 55 Gallon Drum 260 Gallon Tote $ /per 260 Gallon Tote Malathion EW � List Insecticide Name Active Ingredients: Malathion 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Drum $ /per 30 Gallon Drum 30-30 ULV � List Insecticide Name Active Ingredients: Permethrin 30%; Piperonyl Butoxide 30°% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 5 Gallon Pail $ /per 5 Gallon Pail 30 Gallon Drum $ /per 30 Gallon Drum 55 Gallon Drum $ /per 55 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote Page 2 of 5 Invitation To Bid Form - Annual Supply Contract for Insecticides for Mosquito Control -- CONTINUED 31-66 ULV List Insecticide Name Active Ingredients: Permethrin 31.28%; Piperonyl Butoxide 66%; 4 x 1 Gallon $ /per Case (Case = 4x1 Gal Jugs) 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Drum $ /per 30 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote 31-67 ULV List Insecticide Name Active Ingredients: Permethrin 31.15%; Piperonyl Butoxide 66.85% 4 x 1 Gallon $ /per Case (Case = 41 Gal Jugs) 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Drum $ /per 30 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote 4-4 ULV F List Insecticide Name Active Ingredients: Permethrin 4.0%; Piperonyl Butoxide 4.0% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Tote $ /per 30 Gallon Tote 55 Gallon Drum $ /per 55 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote Page 3 of 5 Invitation To Bid Form -Annual Supply Contract for Insecticides for Mosquito Control -- CONTINUED 4.8 ULV List Insecticide Name Active Ingredients: Permethrin 3.98%; Piperonyl Sutoxide 8.48% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Tote $ /per 30 Gallon Tote 55 Gallon Drum $ /per 55 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote Altosid 30 Day Briquets OR Equivalent List Insecticide Name Active Ingredients: (S) Methoprene 8.62% 400 Per Case $ /per case Altosid XR Extended Residual Briquets OR Equivalent List Insecticide Name Active Ingredients: (S) Methoprene 2.1°% 220 Per Case $ /percase DeltaGard OR Equivalent List Insecticide Name Active Ingredients: Deltamethrin 2% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Drum $ /per 30 Gallon Drum 250 Gallon Tote $ /per 250 Gallon Tote Page 4 of 5 Invitation To Bid Form - Annual Supply Contract far Insecticides for Mosquito Control -- CONTINUED FourStar Sustained Release 45/90/180 Day Microbial Briquets R Equivalent List Insecticide Name Live Ingredients: Bacillus sphaericus 6%; Bacillus thuringiensis subspecies israelensis 1°% 45 Day ----- 200 Per Case $ /per case 90 Day ----- 200 Per Case $ /per case 180 Day-----200 Per Case $ /per case The undersigned affirms that they are duly authorized to execute this bid and that this company, corporation firm, partnership or individual has not prepared this bid in collusion with any other bidder, that the contents of this bid as to prices, terms or conditions of said bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with this bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands and has followed all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date: Authorized Signature & Title: Printed Name & Title of Authorized Signature: Phone Number: Email: Exceptions and/or Variations from Specifications and/or additional Notes: Page 5 of 5 MATERIAL INFORMATION AND SAFETY DATA SHEETS • Return one (1) copy of the Material Information and Safety Data Sheets for each insecticide you are submitting a bid on. AFFIDAVIT • Complete and return this form with your bid STATE OF {} AFFIDAVIT COUNTY OF {} The undersigned certifies that the bid price contained in this bid has been carefully checked and is submitted as correct and final and if bid is accepted, agrees to pay for said lease upon the conditions contained in the Agricultural Lease, Specifications and General Conditions. BEFORE ME, the undersigned authority, on this day personally appeared known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bid 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 leases bid on, or to influence any person to bid or not to bid thereon. I affirm that I am duly authorized to execute this bid, that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder. I further affirm that the bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid. The contents of this bid as to price, terms or conditions of said bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business or to any official, employee or agent of Calhoun County prior to the official opening of this Bid. Affiant Printed Name and Title of Affiant Name of Bidder (Company) Address Phone Number Fax Number Email Address SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 120. Notary Public, State of Stamp/Seal My Commission Expires BIDDER AND ORDER INFORMATION FORM • Complete and return this form with your bid BIDDER AND ORDER INFORMATION Please Type If handwritten, must be in ink and legible Bidder's Name: Address: Remittance Address: Telephone: Fax: Email: Email(s) to send Bid Information Signature of Authorized Representative: _ Printed name of Authorized Rep: ORDER - CONTACT INFORMATION Order Contact Name & Title: Order Contact Telephone: Order Contact Fax: Order Contact Email: CERTIFICATE OF INTERESTED PARTIES, FORM 1295 • Form 1295 must be filled out online, printed, #6 completed including signature and returned with bidder's bid. The copy included is a Sample Copy Only. Return completed Form 1295 with your bid #1 Bidder's Name, City, State and Country #2 Calhoun County, Texas #3 Bid Number 2022.02 Annual Supply Contract for Insecticides for Mosquito Control January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, sign and print When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. The form does not need to be notarized. It is an Unsworn Declaration. CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. ♦ 3 Provide the identification number used by the governmental entity or state agency to.;tt�7/�Y�k' o identify the contract, and provide a description of the services, goods, or other property to be provided a contract. 4 City, State, Country ature of Interest (check applicable) Name of Interested Party il. (place of business) _♦ ♦ J ConVollin g Intermediary 5 Check only if the I terested Party. ❑ 5 UNSWORN DE(C♦�L1Q N My name is +�`` , and my date of birth is My addre4� , �-�`J' (street) (city) (state) (zip code) (country) dcl'Onder penalty of perjury that the foregoing is true and correct. Executed in County, State of on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) F- ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission w .ethics.state.tx.us Revised 12/22/2017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84' Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 851' Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state.tx.us/whatsnew/elf info form1295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. COPY OF CURRENT CERTIFICATE OF LIABILITY INSURANCE • Return a copy of your current Certificate of Liability Insurance with your bid. This copy of your current insurance will provide proof that you carry at least the minimum required coverage. At this time, this copy does not require listing Calhoun County as an additional insured. • Once an award is made, the awarded bidder must provide Calhoun County a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • See General Conditions and Specifications for complete insurance requirements CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ • Complete and return this form with your bid • Every vendor doing business with the County or seeking to do business with the County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. jJ Name of vendor who has a business relationship with local governmental entity. 2 ❑ Check this box if you completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) IJ Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes F7No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes E7No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.0010-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code S 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code G 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx. us Revised 11/30/2015 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS • Complete and return this form with your bid CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a—d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING LOBBYING • Complete and return this form with your bid Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official Date DISCLOSURE OF LOBBYING ACTIVITIES • Complete and return this form with your bid • If Not Applicable, bidder must mark NA and sign and date Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for oublic burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a, initial filing _ b. grant _ b. initial award _ b. material change c. cooperative agreement c. post -award d. loan For material change only: e. loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter _ Prime _ Subawardee Name and Address of Prime: Tier_, if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ifapplicable: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individua1,, last name, fitst name, MI): differentfrom No. 10a) (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the tat tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g.,'RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 HOUSE BILL 89 VERIFICATION • Complete and return this form with your bid HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 the undersigned representative of Representative (hereafter referred to as Company) being an Company or Business Name adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel; and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means o for -profit sole proprietorship, organization, association, corporation, partnership, Joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. Signature of Representative Print Name & Title Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount. RESIDENCE CERTIFICATION • Complete and return this form with your bid RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ I certify that is a "Nonresident Bidder" of Texas (Company Name( as defined in Government Code §2252.001 and our principal place of business is (City and State) ❑ 1 certify that (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION • Complete and return this form with your bid Request for Taxpayer Give Form to the Fenn V�o (Rev. October 2018) Identification Number and Certification requester. Do not Departmm1 of tha Treasury send to the IRS. Imemal Revenue Service ► Go to www.lrs govyFormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business namaldisregarded entity name, if different from above m 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to 0 following seven boxes. certain entitles, not individuals; see �. c ❑ Individuallsole proprietor or ❑ C Corporation 118 Corporation ❑ Partnership ❑ TrosUestete Instructions on page 3): single -member LLC Exempt payee code Of any) o Umhed liability company. Enter the tax classification C C corporation, S=S ❑ p y. (= rpo corporation, P=Partnership) ► p Note: Check the appropriate box in the line above forthe tax claasifiostion of the single -member owner. Donotcheck Exemption from FATCA reporting LLC 0 the LLC Is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that code Of any) is disregarded from the owner should check the appropriate box for the tax classification of its owner. Y. ❑ Other(" insuucgom)► woase+roeawu,o-,rm,mmeawmme me us,� N 6 Address (number, street, and apt or suite no.) See instructions. Requester's name end address (opaonali m CALHOUN COUNTY 202 S ANN ST, PORT LAVACA TX 77979 6 City, state, and ZIP code 361.553.4610 FAX: 361-553.4614 7 Ust account numbs*) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number ) backup withholding. For Individuals, this Is generally your security number (Sant• However, fora resident alien, sole proprietor, or disregarded entity, see thea Instructions for Part I, later. For other entities, it Is your employer identification number (EIM. If you do not have a number, see How to get a TIN, later, or Note: If the account Is in more than one name, see the Instructions for line 1. Also sae What Name end I Employer identification number Number To Give the Requesterfor guidelines on whose number to enter, n-1 F-T--F-T-7r Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that 1 am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and S. I am a U.S. citizen or other U.S, person (defined below); and 4. The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out hem 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For rest estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part 11, later. Of General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Form W-9 and Its instructions, such as legislation enacted after they were published, go to www.bs.gov1FormW9. Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number MN) which may be your social security number (SSN), Individual taxpayer Identification number (ITIN), adoption taxpayer Identification number (ATIM, or employer identification number (EIN), to report on an Information return the amount paid to you, or other amount reportable on an Information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Dais► • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. parson (including a resident alien), to provide your correct TIN. If you do not retum Fomh W-9 to the requester with a 7IN, you might be subject to backup withholding. Sea What Is backup withholding, later. Cat. No. 10231X Fakm W-S (Rev.10-2016) CURRENT AWARDED BID TABULATION FOR THE CURRENT BID PERIOD January 1, 2021 thru December 31, 2021 i * � m m m Obi • O m n o 3�oD 3 a s 3no.�. 3 o N m' 'o 'o O C z a a. A O gg N 0 N Q N n o n o o m .. a .. N N N N N W w N N w N N ut N C V O _ V w O O Ol O to V ut O z n n n n n a n n "' n n N y w d m m — w a— w n w_ a w — W - n > O O > > O O O 3 > > > O 3 0°° C G 9 m 3 rbo rbo m 3 3 =�• m 3 m m 3 m, m m 3 3 D n n aw' Z Z Z Z O OO O p 2 O 2NO,3N 0 O A G O 9 W oa W oa W n W n 40 W n �p W a N x m m p� f, bo 3 A A b N. W oa 3 c N �n 0 N l0 a vbi O t� O of A 2 D O A m w V ry OF z z z z :� !"' Z w o -» 3 Z Z Z Z Z Z z Z Z z O O m o m O W O W J b N bo o N C :^. » O W O m O W O W O O O m O m o o m C p C ORE E E Em y o m 0 Z o 0 00 z o O � 'x>'RaR Rn a aRMSER a ka 3 6 3 �. D aS aR aR q Ay R $R �R_ - a O25 ' y Z z TO O o 0 o a a a - O n n A O D 3 i w m a i 3 o i a -�' a i _ C= 0, D n n 3 nq 'o m o.T C3 n 3 = $O ONi N A Z O N�+ O Z O aYWWzZ O E _ yu 10 O O O q N W 10 m N 3 O O 2 N 0 0 0 x m o g o 6 �^ _ ^ o: 3 o c o N b o 0 0 _ a N< m A D a 3" m m w a oW d< n m r Q N O N r m n (z'� N W R N X m j Z A 0 LA rD- W�ti � n a;WdO o tW+ �, -ri N O N r C V D 9 C lO/1 C � N A N m l < p A O O m C y �.Z W : 3 d a m A N y ryryryry b N O C N N N N W X X % % A % O N vl WO N N to O N N O N C Z o a N p y m o o m= m w d m= i a= a a >> - N m - O - O O - O - - - - O O O n n n O O O n C N N N O N A,N m a D � n v am D vn a nn w V .Or z 2 z O z O Z O Z O W P N pt 9 � Y O W v y w w p W O p O 0 in ao o c a a s o: a N a vAi x m' '^ 1O A a p; '3 w r pzp � J N a D � 0 a - _ n =an =ng z z z M. u a 0 0 0 o p pP - x o s p 0 0 0 0 �+ o o -» 3 0 0 0 0 C IDW 00 00 0 0 m„ W W W W 0 C p 0 0 3 Z 00 Z A 0 r _ _ _ =0_ _ C 3 a `_, 3 3 a. 3 a. 3 a. 3 d A aRa _ n R R 3a3=3= Dz �: _0. �O 80gag9 p ca 8c '6 ° n _ m x <o - 0 0 0 p - x - .. i z 3 z z z z m 6 O Ll y w A O 6 m %? n n n W^ X W W W W O 0- D m D 2 ' 9 z O z O Z O VVi O i X V p O O O O to T O m m m N m N A W O m m m w V O W N O fc In O O W O m ma 2 a a g ¢ +W a' 0 w a s a a y� p x j O O O" - m m °mJ ry o a 0 0 n q d o o m 'S Q A D N Pt R S A N r A V J N N � a §, ■, 2§ ; ;§ a =f\Rig m o -K k) )§d0 ( R0 e§ ° §§ § iz »��{( \§� §10 LP - a - a k) �K §0 z z z UIR - -0 -_, § §| 0 (\(^\ 0 NOTICE OF MEETING—10/6/2021 8. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions, Bid Number 2022.03 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner, Pct 4 SECONDER: Joel Behrens, Commissioner, Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 13 September 29, 2021 To: Judge Meyer From: The office of the County Auditor Peggy Hall, Assistant Auditor Please place the following item on the Commissioners Court Agenda for October 6, 2021: • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions, Bid Number 2022.03 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. Agenda Item #8 Commissioners Court— Wednesday, October 6, 2021 Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions, Bid Number 2022.03 for the period beginning January 1, 2022 and ending December 31, 2022 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. CHANGES FROM PREVIOUS SPECIFICATIONS AND INVITATION TO BID PACKET: No changes to Specifications or the Invitation to Bid Form. Only changes were to update the dates for the new bid period and to use same format as other bid packets. CALHOUN COUNTY, TEXAS INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS .JI1 ASPHALTS, OILS AND EMULSIONS Bid Number: 2022.03 Bid Term: January 1, 2022 thru December 31, 2022 SEALED BIDS WILL BE RECEIVED UNTIL 2:00:00 Tuesday, November 9, 2021 AT THE OFFICE OF Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3111 Floor, Suite 301 Port Lavaca, Texas 77979 PUBLIC BID OPENING will be conducted at 2:00 PM, Tuesday, November 9, 2021 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 3`d Floor, Suite 301, Port Lavaca, Texas 77979. At this time, each bidder's name will be read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all bidders that submitted a bid and will also be posted on the County's website (www.calhouncotx.org) under Bid Notices and Results, Results 2022 as soon as time permits. CONTENTS ' Invitation To Bid ' Return Instructions • General Conditions ' Specifications for Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions ' Contact, Billing and Location Information for Calhoun County Precincts ' Required Information/Forms o Invitation to Bid Form o Affidavit o Bidder and Order Information Form o Certificate of Interested Parties Form 1295 — Must return when submitting your bid o Certificate of Liability Insurance — Return a copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the awarded bidder must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. o Conflict of Interest Questionnaire Form CIQ— Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. o Certification Regarding Debarment & Suspension and Other Responsibility Matters o Certification Regarding Lobbying o Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date o House Bill 89 Verification o Residence Certification o W-9 OTHER INFORMATION INCLUDED WITH THE INVITATION TO BID PACKET • Current Awarded Bid Tabulation for the Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions for the period January 1, 2021 thru December 31, 2021 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas, will receive SEALED BIDS for Road Materials and Asphalts, Oils and Emulsions as needed by the Road and Bridge Precincts. BID NUMBER: 2022.03, ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS Bids are for a one (1) year period beginning January 1, 2022 and ending December 31, 2022. The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. SEALED BIDS ARE DUE: Date: Tuesday, November 9, 2021 Time: BEFORE 2:00:00 PM Location: County Judge's Office Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 At this time, all bids will be publicly opened and each bidder's name read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. All bids (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9x12 or larger envelope and CLEAREY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.03 ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS Calhoun County does not accept faxed or emailed bids. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the time the bids received will be opened. Bids received after the deadline will be returned unopened. Bids shall include all requirements of the Invitation to Bid Packet for Bid Number 2022.03, Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions. SEALED BIDS MAY BE HAND DELIVERED OR MAILED TO: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, TX 77979 Page 1 of 2 Calhoun County reserves the right to waive any formality or irregularity, accept or reject any and/or all bids, to accept the bid deemed most advantageous to and in the best interest of Calhoun County. The award of a bid shall be made to the responsible bidder whose bid is determined to be the most beneficial to Calhoun County, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid Packet. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit bids. Cindy Mueller County Auditor Calhoun County, Texas Page 2 of 2 RETURN INSTRUCTIONS For Submitting a Bid for ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS Bid Number: 2022-03 Bid Period: January 1, 2022 thru December 31, 2022 Return the following BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 Check List for submitting your Bid: Return One (1) Original Be sure all necessary forms are included and or completed, signed and dated Invitation to Bid Form (page 1-8) Affidavit Bidder and Order Information Form Certificate of Interested Parties, Form 1295 Form 1295 must be completed online —Copy that is included is Sample Copy Only Do Not Fill Out Sample Copy. Form 1295 must be completed online. #1: Bidders Name, City, State and Country #2: Calhoun County, Texas #3: Bid Number: 2022-03; Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions, January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to your company #4: Fill in the correct information OR #5: Mark an X in the Box #6: Fill in the correct information and print When you print you should see a Certificate Number and Date Filed in the upper right hand box that is marked "Office Use Only". Be sure that all of #5 is completed and signed. Do not leave out any information. Certificate of Liability Insurance Please return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you currently carry at least the minimum required coverage. Once bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured Conflict of Interest Questionnaire, Form CIO Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. Certification Regarding Debarment & Suspension and Other Responsibility Matters Certification Regarding Lobbying Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date House Bill 89 Verification Residence Certification W-9 Do Not Fold any of the above information. Bid must be returned in a SEALED 9 x 12 or larger envelope clearly marked: SEALED BID NUMBER 2022.03 — ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS If you send your bid by UPS, FeclEx or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.03 — ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS Submit Sealed Bid to: Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., P Floor, Suite 301 Port Lavaca, TX 77979 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFC, and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFC, and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ, and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFC, and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ and/or Contract is due. The Bid, RFP, RFQ, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ, and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ, and/or Contract in collusion with anyother bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFC, and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ, and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidder's/vendor's Bid, RFP, RFQ and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Page 1 of 13 Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ, and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ, and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ, and/or Contract will specify the date and time due. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ, and/or Contract is received and the time the Bid, RFP, RFQ, and/or Contract will be opened. A late delivery with an early postmark or delivery of the Bid, RFP, RFQ, and/or Contract to the wrong office will not suffice. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ, and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ, and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. If the Bid, RFP, RFQ and/or Contract is sent by UPS, FeclEx or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ, and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ, and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ and/or Contract price. Bids, Page 2 of 13 RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ, and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ, and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum. Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ, and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendor's performance under this Bid, RFP, RFQ and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes. Tax exempt forms will be furnished upon request to the Calhoun County Auditor's Office. Page 3 of 13 Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act', commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will because to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ, and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the sole judge in determining which Bid, RFP, RFQ and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ and/or Contract based on lowest and/or best Bid, RFP, RFQ, and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ, and/or Contract' means a bid or offer providing the best value considering associated direct Page 4 of 13 and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ, and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ, and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFQ, and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet Page 5 of 13 specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFQ, and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination• Calhoun County reserves the right to terminate the Bid, RFP, RFQ, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFQ and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFQ, and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ, and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFQ, and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 84th Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 6 of 13 Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf_info_forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFC, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFC, and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Bid, RFP, RFQ and/or Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than thirty (30) days after Calhoun County Commissioners Court approves a contract, or awards a Bid, RFP, and/or RFQ with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Page 7 of 13 Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFQ, and/or Contract submission and the time of execution of the Bid, RFP, RFQ and/or Contract. A print out of the search results, including principals, if any, from the System for Award Management (www.SAM.gov) that includes the record date must be included with the bidder's/vendor's Bid, RFP, RFQ and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFC, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Page 8 of 13 Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ, Contract, order, and/or service. In the event a Bid, RFP, RFC, Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFC, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFC, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFQ, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and Page 9 of 13 be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Majeure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFC, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFC, and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFQ and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFC, and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFQ, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFQ, and/or Contract. Otherwise, Texas state and federal law shall apply. Page 10 of 13 Prohibition against Personal Interest in Bids, RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFC, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFC, and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFC, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ, and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. General Liability ($100,000/$300,000 or greater) Workers' Compensation (at Statutory Limits) Employer's Liability ($1,000,000 or greater) Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) Professional Liability Insurance (if applicable) Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of Page 11 of 13 the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFQ, and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ, and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFQ, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: Name, mailing address and business phone number of the protesting party; Appropriate identification of the Bid, RFP, RFQ, and/or Contract being protested; A precise statement of the reasons for the protest; and Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. Page 12 of 13 If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFQ, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or byjudicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Cindy Mueller Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: cindy.mueller@calhouncotx.org To request a Bid, RFP, and/or RFQ packet from Calhoun County, or information on how to obtain a packet, please contact: Peggy Hall Assistant Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: peggy.hall@calhouncotx.org Bids, RFPs, and/or RFQs may also be viewed on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results. Page 13 of 13 SPECIFICATIONS FOR ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OIL AND EMULSIONS BID NUMBER: 2022.03 BY ORDER of the Commissioners Court of Calhoun County, Texas, sealed bids will be received for Road Materials and Asphalts, Oils and Emulsions as needed by the Road and Bridge Precincts. See Contact, Billing and Location Information for Calhoun County Precincts for complete information and location on each Calhoun County Road and Bridge Precinct. INVITATION TO BID PACKET The complete Invitation to Bid Packet may be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. The complete Invitation to Bid Packet must be used in preparing the bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3'd Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.03 ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS If the SEALED BID is sent by UPS, Fed Ex, or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.03 ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3'd Floor, Suite 301 Port Lavaca, Texas 77979 A late delivery with an early postmark will not suffice. Page 1 of 8 Calhoun County is not responsible for the delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid due date and time. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the bid is received and the time the bid will be opened. No bids will be accepted after the due date and time has been reached. Calhoun County accepts no financial responsibility for any cost incurred by the bidder in the course of responding to these specifications. Faxed or emailed bids shall not be accepted. BID TERM The bid shall be in effect for a period of one (1) year beginning January 1, 2022 and ending December 31, 2022. BID INFORMATION/REQUIREMENTS To submit a valid bid, read the entire Invitation to Bid Packet for all required information that must be included and all required forms (see page 8) that must be returned and/or filled out, signed and dated and returned. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a bid. If you will not be submitting a bid, we would appreciate you indicating on your "NO BID" response any requirements of this bid request which may have influenced your decision to "NO BID". Calhoun County is not responsible for errors if the bid forms are handwritten. It is recommended that all information submitted by the vendor on the bid forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. Intentionally Left Blank Page 2 of 8 Materials shall meet or exceed "Texas Department of Transportation Current Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges" and/or Calhoun County requirements. ROAD MATERIALS Bid Item #1: Limestone-3/4 Inch to Dust Bid Item #2: Item 247, Type A Limestone, Grade 2 [1 % Inch] Bid Item #3: Item 247, Type A Limestone, Grade 3 [1 % Inch] Bid Item #4: Item 275, Cement 275-2.1, Hydraulic Cement Type 1, Bulk (Pneumatic Tankers, Spreader Bar Needed) 275-2.1, Hydraulic Cement Type 1, 47 lb. Bag (on Pallets) Bid Item #5 Item 302, Type PB, Grade 3 (Pre -Coated Rock) Bid Item #6 Item 302, Type PB, Grade 4 (Pre- Coated Rock) Bid Item #7 Item 302, Type PE, Grade 3 (Pre -Coated Rock), *Material Source out of Bid Item #8 Item 302, Type PE, Grade 4 (Pre -Coated Rock), *Material Source out of Bid Item #9 Item 302, Type E, Grade 5, Ice Rock (Non Coated Limestone Only) Bid Item #10 Item 330, Type D (Pre -Mix Limestone) Bid Item #11 Item 330 D, Pothole Repair, Limestone Rock Asphalt (LRA) The material will be used to construct a base course, a surface course, a level -up course, pothole repair, or any combination of these courses of the types and grade using a cold -mixed material consisting of native limestone rock asphalt (LRA) aggregate, fluxing material, water. LRA Mixture -Furnish LRA according to DMS-9210, "Limestone Rock Asphalt (LRA)", Item 330 D per the Surface Aggregate Classification plans as set forth by TXDOT Standard Specifications for Construction and Maintenance of Highways, Streets, and Bridges 2014. No material will be accepted that has been blended and stored on the producer's pad for more than 24 hours prior to loading and shipment. Bid Item #12 Item 334, Type D, Hot Mix Cold Laid Asphalt Concrete Pavement Material must meet or exceed Item 334, 4.1.2 JMF Table #5 Laboratory Mixture Design Properties found in the Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges. Bid Item #13 Item 432 Riprap, Section 2.3 Stone Riprap, 12" Limestone ASPHALTS, OILS & EMULSIONS Item 300, Asphalts, Oils and Emulsions Bid Item #14 Primer Oil Bid Item #15 RC-250 —Temperature must be no lower than 140' Bid Item #16 CRS-2 —Temperature must be no lower than 150' and no higher than 180' Bidder may bid any or all material(s) for any location. Bidder must be able to furnish bid items under terms of these specifications and general conditions if bidder is awarded a bid. Page 3 of 8 Calhoun County is EXEMPT from all Sales Tax (county, city and state sales tax) and all Federal Excise Taxes, if applicable. Pump and hoses, if applicable, are to be furnished by the vendor at no extra charge or shall be included in the bid. Demurrage charges, if applicable, stated separately from the bid price of the material will increase the amount of the bid price for the material. Materials bid must be broken down into price per unit and delivery price. A fuel adjustment will be allowed on the delivery price only as fluctuations in diesel prices occur as listed on http://www.eia.gov/petroleum/gasdiesel, using the Gulf Coast Region. The baseline price will be the price on this site on November 8, 2021 rounded to the nearest one -hundredth and thereafter the index will be adjusted and documented on Monday of each week after bids are accepted. The allowable fuel adjustment will be calculated by subtracting the baseline price from the posted price (for the Monday immediately prior to the delivery date of the material), and if the difference is less than 5 cents no adjustment will be allowed; 5 cents to 9 cents a 1% adjustment to the delivery price per unit; 10 cents to 14 cents a 2% adjustment to the delivery price per unit; 15 to 19 cents a 3% adjustment to the delivery price per unit; 20 to 24 cents a 4% adjustment to the delivery price per unit and so on. A 1% adiustment will be made on the delivery price for every 5 cent increase or decrease from the baseline price. Bidder must include a copy of the document from the EIA.GOV website that was used to determine delivery price when invoicing Calhoun County and the calculations on the increase or decrease in the delivery price. Bidder will be required to deliver to all jobsites in Calhoun County as directed by the Commissioner of applicable Calhoun County Precinct. Jobsite can be road, field location or stockpile at designated Calhoun County locations. Miles from pit to stockpile and/orjobsite will be shortest legal route. Bid price shall include all transportation costs and/or delivery fees to the designated Calhoun County Precinct stockpile or jobsites. Materials shall be ordered in quantities as determined by each Calhoun County Commissioner. Calhoun County Precincts will put out needed signs and barricades for traffic control. Calhoun County Precincts will accept the number of trucks necessary to do a job on a most cost efficient basis, which could require various numbers of trucks. Any Vendor traveling on Calhoun County roads will not exceed its legal gross weight. Page 4 of 8 Each load shall be weighed on a certified public scale. Truck and trailer shall be weighed empty at least once on each job run, or when a change is made due to changing truck, trailer, or other. Cost of weighing shall be paid by the hauler. Driver shall get a material company ticket from pit or location when loading. A copy of the scale weight ticket, material company ticket and company delivery ticket shall be given to the Calhoun County employee at the jobsite when load is inspected and dumped. Calhoun County Precincts will supervise the dumping of loads and a Calhoun County employee will sign the delivery ticket. The Calhoun County Precinct must receive a copy of the signed delivery ticket. Calhoun County shall have the right to pull sample loaded truck(s) to a certified scale of Calhoun County's choice for loaded weight, unload truck(s) and take empty weight on same scale to verify weights. Calhoun County shall pay for the weighing. Calhoun County legally accepts the materials after it is unloaded and approved by the Calhoun County Commissioner of said precinct. Any exceptions and or variations from the specifications in this bid document must be indicated on the bid form or on a separate attachment to the bid and labeled as such. Exceptions taken and/or variations made to the specifications and listed on the vendor's bid or separate attachment may void the bid. The request for a bid on a material does not guarantee that Calhoun County will purchase this material during the bid period. Calhoun County does not guarantee to purchase any minimum or maximum quantities. The materials will only be ordered as needed. When required, all materials ordered will be delivered to the Calhoun County Precinct within 24 hours from time of order. In the event the vendor is unable to deliver the materials(s) ordered within 24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest bid that met specifications and can deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or other charges when cancelling an order. Bidder shall be required to notify Calhoun County in the event of unforeseen delay arising in the delivery of an order. In the event an order will not arrive at the Calhoun County Precinct at the designated time, Calhoun County shall have the right to cancel the order or refuse acceptance of the order. Calhoun County shall not be accessed any penalties, fees and/or other costs due to this cancellation or refusal. Calhoun County or the bidder have the right to cancel the delivery of a material(s) at any time due to weather, road conditions and/or machinery breakdown. No penalties, fees and/or other charges will be billed to Calhoun County if the delivery of a material(s) is cancelled by Calhoun County or the vendor due to weather, road conditions and/or machinery breakdown. The County reserves the right to refuse any order delivered for not being in compliance with the specifications, general conditions and/or the "Hazardous Communications Act", commonly known as the "Texas Right to Know Act". Page 5 of 8 The bidder, at the bidder's cost, shall immediately remove the material(s) from the Calhoun County Precinct that are deemed unsatisfactory, and are not in compliance with the specifications, general conditions and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other charges will be billed to Calhoun County for the removal of the material(s) from the Calhoun County Precinct. Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified by State and/or Federal Regulations. Calhoun County reserves the right to conduct random sampling of pre -qualified materials for testing and to perform random audits of test reports. Calhoun County representatives may sample materials from the manufacturing plant, terminal, shipping container and any other source they deem necessary to insure reliability of the materials. If testing will be performed through a third party, the vendor will be required to allow the third party access to the facilities in order to acquire samples for testing. Regardless of results of any material(s) test required by Calhoun County, all costs incurred for such tests shall be paid for by the vendor. Specifications are not being met if materials are not delivered at the required temperatures. The award of a bid will be voided if specifications, general conditions and/or instructions within this Invitation to Bid Packet are not followed. The bid would then be awarded to the vendor which submitted the next lowest bid that met specifications and all requirements of the Invitation to Bid Packet. All Calhoun County Precincts handle their own orders; therefore invoices shall be billed to each Calhoun County Precinct separately. All invoices must be billed to Calhoun County to the attention of the Calhoun County Commissioner and Precinct ordering the material(s). Bid item number and material description, as stated on the bid form, awarded material bid price per unit and delivery price must appear on all invoices in order to be considered for payment. No other charges, including pump, hoses, special fees or after hour delivery fees, may be added to the awarded bid price per unit and delivery price when invoiced unless these charges were noted on the bid form or separate attachment and awarded as such. Invoices shall be free from sales tax (county, city or state sales tax) and federal excise taxes, if applicable. Invoices shall include a copy of the document from the EIA.GOV website that was used to calculate the increase or decrease in the delivery charge. Invoices shall show the calculation on how the increase or decrease in delivery price was reached. Invoices shall include a copy of the delivery ticket that shows confirmation of delivery. Page 6 of 8 It is understood that Calhoun County Commissioners Court reserves the right to accept or reject any and/or all bids for any/or all materials and/or services covered in this bid request and to waive informalities or defects in bids, or to accept such bids as it shall deem to be most advantageous and in the best interest of Calhoun County. Calhoun County Commissioners have the right to reject at any time any material that is undesirable for either road or jobsite location. Calhoun County will evaluate and award bid based on lowest and best bid meeting specifications and all requirements of the Invitation to Bid Packet. "Lowest and best" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options bid as it deems to be in the best interest of Calhoun County. Although the cost of materials(s) to be provided is an essential part of the bid, Calhoun County is not obligated to award a bid (contract) on the sole basis of cost but will award to the vendor considered to be the best value to the Calhoun County. The bid award shall be based on, but not necessarily limited to, the following factors: • Unit price ■ Extended price (and other charges, if any) • Special needs and requirements of Calhoun County • Delivery ■ Compliance in returning and/or including all required forms ■ Results of testing samples (if required by Calhoun County) ■ Calhoun County's experience with materials bid ■ Bidder's past performance record with Calhoun County If bids are awarded, award information will be emailed and/or mailed to all vendors that submitted a bid regardless if the vendor was awarded a bid or not. Calhoun County Commissioners Court and the County Auditor's office work diligently to get this information to the vendors as soon as possible. To obtain results, or if you have any questions, please contact Peggy Hall, Calhoun County Assistant Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4610, peggy.hall@calhouncotx.org. As time permits, bid awards will be posted on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results, Results 2022. Once bids are awarded by Calhoun County Commissioners Court, this bid packet in its entirety will be the working contract between Calhoun County and the successful bidder for the period designated. Calhoun County or the vendor may cancel this contract at any time for any reason, provided a written notice is given. Should there be a change in ownership or management, the bid (contract) shall be cancelled unless a mutual agreement is reached with the new owner or manager to continue the bid (contract) with its present provisions and prices. Page 7 of 8 Bidder understands that Calhoun County is a government entity subject to Texas State and Federal public information statutes. Bidder hereby waives any obligation to the release to the public of any documents submitted in accordance with the bid. No person has the authority to verbally alter these specifications or any information within the Invitation to Bid packet. Any changes will be made in writing (Addendum approved by Calhoun County Commissioners Court) and mailed and or emailed to each vendor that received a bid packet. All disputes or protests will be held in Calhoun County, Texas. INSURANCE REQUIREMENTS The awarded bidder must furnish, at their own expense, certificates of insurance or other acceptable evidence from a reputable insurance company or companies acceptable to Calhoun County, licensed to write insurance in the State of Texas showing the contractor (bidder) is covered by insurance within the minimum limits of liability listed in the General Conditions that are included in this Invitation to Bid Packet: REQUIRED INFORMATION/FORMS TO BE RETURNED WITH INVITIATION TO BID • Invitation to Bid Form (page 1-8) ■ Affidavit ■ Bidder and Order Information Form ■ Certificate of Interested Parties, Form 1295 — Must return when submitting your bid • Certificate of Current Liability Insurance — Return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you carry at least the minimum required coverage. Once the bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured. ■ Conflict of Interest Questionnaire, Form CIQ — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. ■ Certificate Regarding Debarment & Suspension and Other Responsibility Matters ■ Certification Regarding Lobbying • Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA, and sign and date ■ House Bill 89 Verification ■ Residence Certification • W-9 Page 8 of 8 CONTACT, BILLING AND LOCATION INFORMATION FOR CALHOUN COUNTY PRECINCTS Calhoun County Precinct 1 Commissioner David Hall 305 Henry Barber Way (by the County Fairgrounds) Port Lavaca, TX 77979 Office Manager: Angela Torres Office: 361-552-9242 Fax: 361-553-8734 Location Stockpile: 305 Henry Barber Way, Port Lavaca, TX Calhoun County Precinct 2 Commissioner Vern Lyssy 5812 FM 1090 (Six Mile) Port Lavaca, TX 77979 Office Manager: Lesa Jurek Office: 361-552-9656 Fax: 361-553-6664 Location of Stockpile: 5812 FM 1090, Port Lavaca, TX Calhoun County Precinct 3 Commissioner Joel Behrens 24627 State Hwy 172 (Olivia) Port Lavaca, TX 77979 Office Manager: Lynette Adame Office: 361-893-5346 Fax: 361-893-5309 Location of Stockpile: 24627 State Highway 172, Olivia TX Calhoun County Precinct 4 Precinct 4-P (Port O'Connor) Commissioner Gary Reese Trevor St off of Hwy 185 Port O'Connor, TX 77982 Office Manager: April Townsend Use same numbers as Seadrift (4-S) Location of Stockpile — Pct 4-P Barn #3: 93 Trevor Street off of Highway 185, Port O'Connor, TX Calhoun County Precinct 4 Precinct 4-S (Seadrift) Commissioner Gary Reese 104 E Dallas St PO Box 177 Seadrift, TX 77983 Office Manager: April Townsend Office: 361-785-3141 Fax: 361-785-5602 Location of Stockpile — Pct 4-S Barn #2: 448 Harbor Road, Seadrift TX REQUIRED INFORMATION/FORMS INFORMATION/FORMS REQUIRED TO BE RETURNED WITH BIDDER'S BID Bidder must return the following information/forms with their Bid: • Invitation to Bid Form (page 1-8) • Affidavit • Bidder and Order Information Form • Certificate of Interested Parties Form 1295 — Must include when submitting your bid • Certificate of Liability Insurance — Copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the awarded bidder must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • Conflict of Interest Questionnaire Form CIQ — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Debarment & Suspension and Other Responsibility Matters • Certification Regarding Lobbying • Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date • House Bill 89 Verification • Residence Certification W_9 INVITATION TO BID FORM • Return the Invitation to Bid Form (page 1— 8) • Materials bid must be broken down into price per unit and delivery price per unit. Do not list just total price • Be sure to complete and sign page 8 CALHOUN COUNTY, TEXAS INVITATION TO BID FORM ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS Bid Number: 2022.03 January 1, 2022 thru December 31, 2022 Bidder's Name & Address • Please Type. If handwritten, must be in ink and legible. White out is not acceptable. -The Invitation to Bid Packet, in its entirety, will be the binding contract between Calhoun County and the successful vendor. • SEE SPECIFICATIONS AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS • MATERIALS BID MUST BE BROKEN DOWN INTO PRICE PER UNIT AND DELIVERY PRICE PER UNIT ROAD MATERIALS Bid Item #1: Limestone-3/4 Inch To Dust Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION UNIT MATERIAL DELIVERY TOTAL LOAD/ORDER I Precinct 1 I Ton I I I I I I Precinct 2 I Ton I I I Precinct 3 I Ton I I Precinct 4-P I Tan I I t 1 I Precinct 4-S i Ton Remarks: Bid Item #2: Item 247, Type A Limestone, Grade 2, [1 3/4 Inch] Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I I I Precinct 1 1 Ton I I I I I Precinct 2 Ton I I I I I Precinct 3 I Ton I I I I I Precinct 4-P ; Ton I I I I Precinct 4-S ; Ton Remarks: Page 1 of 8 Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions --CONTINUED Bid Item #3: Item 247, Type A Limestone, Grade 3 [13/4 Inch] Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I I Precinct 1 I Ton I I I Precinct Ton Precinct I Ton I I I I I I Precinct 4-P I Ton I I I I Precinct 4-S I Ton I I I I rks: Item #4: Item 275, Cement 275-2.1, Hydraulic Cement Type 1, Bulk (Pneumatic Tankers, Spreader Bar Needed) 275-2.1, Hydraulic Cement Type 1, 47 lb Bag (Cost per Pallet) List # of 47 lb Bags on a Pallet Price per unit / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I Precinct 1 1 Ton I I ; ' of 47 lb I I ; I I I Bags on Pallet I I I I I Precinct 2 I Ton I I I I of 47 lb iI I I I I Bags on Pallet Precinct 3 1 Ton I I I I ' of 47 lb — I I I Bags on Pallet I I I I Precinct 4-P I Ton I I I _of471b Bags on Pallet Precinct 4-S Ton of 47 lb Bags on Pallet Page 2 of 8 Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions --CONTINUED Bid Item #S: Item 302, Type PB, Grade 3 (Pre -Coated Rock) Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I Precinct 1 Ton I I I i I Precinct 2 I Ton I I I I I I I I I I Precinct 3 I Ton i I I I I I I Precinct 4-P ; Ton I ' I I I Precinct 4-S ; Ton I Remarks: Bid Item #6: Item 302, Type PB, Grade 4 (Pre -Coated Rock) Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I Precinct 1 ' Ton ' I Precinct 2 I Ton I I I I I I Precinct 3 I Ton I I Precinct 4-P I Ton I I I I I I I I Precinct 4-S ; Ton ; I I Remarks: Item 302, Type PE, Grade 3 (Pre -Coated Rock) Bid Item #7: *Material Source out of Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I I I Precinct 1 Ton I ' Precinct 2 1 Ton I I 1 I I I Precinct ; Ton I I Precinct4-P I Ton i i i' I I I I Precinct 4-S ; Ton Remarks: Page 3 of 8 Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions --CONTINUED Item 302, Type PE, Grade 4 (Pre -Coated Rock) Bid Item #8: *Material Source out of Price per ton / delivery price to County Stockpile and/or Jobsite LOCATION Unit MATERIAL DELIVERY TOTAL Precinct 1 I Ton I I Precinct 2 I Ton I I Precinct 3 Ton I I I I Precinct4-P I Ton I I I Precinct 4-S I Ton I Remarks: MINIMUM LOAD/ORDER Bid Item #9: Item 302, Type E, Grade 5, Ice Rock (Non -Coated Limestone Only) Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDE Precinct 1 Ton Precinct 2 I Ton Precinct 3 I Ton Precinct 4-P Ton Precinct 4-S 1 Ton arks Item #10: Item 330, Type D (Pre -Mix Limestone) Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDE I Precinct 1 I Ton I I I I Precinct 2 I Ton I I Precinct 3 ' Ton ' I Precinct4-P; Ton I Precinct4-S Ton I marks: Page 4 of 8 Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions --CONTINUED Bid Item #11: Item 330 D, Pothole Repair, Limestone Rock Asphalt (LRA) See Bid Item #15, Page 4, for more information on this material. Price per unit / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I Precinct 1 I Ton I I I I i Yard3 I SO lb Bag I I I I I I Precinct 2 ' Ton ' i I I I 1 I Yard3 I I I , ' 50lb Bag I ' I Precinct 3 I Ton I I I I I I I Yard3 I I I I i I I I I I SO lb Bag I I I I I I I Precinct4-P I Ton I I I I I I I Yard' i i I I I I 50lb Bag I I I Precinct4-S I Ton I I I I I Yard' i I iI I I I I I 50lb Bag I Remarks: Bid Item #12: Item 334, Type D Hot Mix Cold Laid Asphalt Concrete Pavement Material must meet or exceed Item 334, 4.1.2 JMF Table #5 Laboratory Mixture Design Properties found in the Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges. Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER Precinct 1 ; Ton I I I I Precinct 2 ; Ton I Precinct 3 Ton I I I I I I Precinct 4-P ; Ton I I I I I I I I Precinct4-S ; Ton I I I I Remarks: Page 5 of 8 Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions --CONTINUED Item #13: Item 432, Riprap, Section 2.3 Stone Riprap, 12" Limestone Price per ton / delivery price to County Stockpile and/or Jobsite LOCATION Unit MATERIAL DELIVERY TOTAL Precinct 1 Ton I I I I I I Precinct 2 1 I I Ton 1 I I I I ; Precinct 3 1 Ton I Precinct 4-P ; Ton I I Precinct 4-S I I Ton , 300, Asphalts, Oils and Emulsions Item #14: Primer Oil Price per gallon / delivery price to County' LOCATION I Unit I MATERIAL Precinct 1 I Gallon Precinct 2 i Gallon Precinct 3 1 Gallon Precinct 4-P I Gallon Precinct 4-S I Gallon rks: e and/or Jobsite DELIVERY I TOTAL MINIMUM LOAD/ORDER DEMURRAGE Per Hour After Free Hours Per Hour After Free Hours _ Per Hour After Free Hours Per Hour After Free Hours _ Per Hour After Free Hours Page 6 of 8 Invitation To Bid Form -Annual Supply Contractfor Road Materials and Asphalts, Oils and Emulsions --CONTINUED Item #15: RC-250 Temperature must be no lower than 140a Price per gallon / delivery price to County Stockpile and/or Jobsite LOCATION I Unit I MATERIAL I DELIVERY 1 I Gallon Precinct 2 : Gallon Precinct 3 . Gallon Precinct4-P 1 Gallon 4-5 i Gallon Remarks: Item #16: CRS-2 TOTAL I DEMURRAGE I$ Per Hour After Free Hours I$ Per Hour After I Free Hours '$ Per Hour After Free Hours ;$ Per Hour After i _Free Hours i �$ Per Hour After Free Hours Temperature must be no lower than 1501 and no higher than 1800 Price per gallon / delivery price to County Stockpile and/or Jobsite LOCATION Unit MATERIAL DELIVERY TOTAL DEMURRAGE I I I ;$ Per Hour After Precinct 1 1 Gallon I I I I Free Hours , i$ Per Hour After Precinct 2 1 Gallon I I I Free Hours I I i I I I I I$ Per Hour After Precinct 3 I Gallon I I I Free Hours I I I ;$ Per Hour After Precinct4-P I Gallon I I I i Free Hours I I I I i Per Hour After Precinct 4-5 I Gallon I I I I Free Hours (Remarks: Be sure to complete next page (page 8) Page 7 of 8 Invitation To Bid Form -Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions --CONTINUED The undersigned affirms that they are duly authorized to execute this bid and that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder, that the contents of this bid as to prices, terms or conditions of said bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with this bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands and has followed all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date: Authorized Signature & Title: Type Name & Title of Authorized Signature: Phone Number: Email: Exceptions and or Variations from Specifications and/or additional Notes: Page 8 of 8 AFFIDAVIT • Complete and return this form with your bid STATE OF 0 AFFIDAVIT COUNTY OF 0 The undersigned certifies that the bid price contained in this bid has been carefully checked and is submitted as correct and final and if bid is accepted, agrees to pay for said lease upon the conditions contained in the Agricultural Lease, Specifications and General Conditions. BEFORE ME, the undersigned authority, on this day personally appeared known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bid 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 leases bid on, or to influence any person to bid or not to bid thereon. I affirm that I am duly authorized to execute this bid, that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder. I further affirm that the bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid. The contents of this bid as to price, terms or conditions of said bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business or to any official, employee or agent of Calhoun County prior to the official opening of this Bid. Affiant Printed Name and Title of Affiant Name of Bidder (Company) Address Phone Number Fax Number Email Address SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 120 Notary Public, State of Stamp/Seal My Commission Expires BIDDER AND ORDER INFORMATION FORM • Complete and return this form with your bid BIDDER AND ORDER INFORMATION Please Type If handwritten, must be in ink and legible Bidder's Name: Address: Remittance Address Telephone: Fax: Email: Email(s) to send Bid Information: Signature of Authorized Representative: _ Printed name of Authorized Rep: ORDER - CONTACT INFORMATION Order Contact Name & Title: Order Contact Telephone: Order Contact Fax: Order Contact Email: CERTIFICATE OF INTERESTED PARTIES, FORM 1295 • Form 1295 must be filled out online, printed, #6 completed including signature and returned with bidder's bid. The copy included is a Sample Copy Only. • Return completed Form 1295 with your bid #1 Bidder's Name, City, State and Country #2 Calhoun County, Texas #3 Bid Number 2022.03 Annual Supply Contract for Road Materials and Asphalts, Oils and Emulsions January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, sign and print When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. The form does not need to be notarized. It is an Unsworn Declaration. CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. ♦ 3 Provide the identification number used by the governmental entity or state agency to It k o identify the contract, and provide a description of the services, goods, or other property to be provided uIlI contract. a City, State, Country ature of Interest (check applicable) Name of Interested Party (place of business) ♦ Controlling Intermediary if 5 ❑Check only if there' I terested Party. s UNSWORN DE(C♦,lfQ N My name is +�`` , and my date of birth is My addret�� , (street) (city) (state) (zip code) (country) ,Ldnder penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission v ..ethics.state.tx.us Revised 1212212017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84't' Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 851 Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state.tx.us/whatsnew/elf info forml295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. COPY OF CURRENT CERTIFICATE OF LIABILITY INSURANCE • Return a copy of your current Certificate of Liability Insurance with your bid. This copy of your current insurance will provide proof that you carry at least the minimum required coverage. At this time, this copy does not require listing Calhoun County as an additional insured. • Once an award is made, the awarded bidder must provide Calhoun County a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • See General Conditions and Specifications for complete insurance requirements CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ • Complete and return this form with your bid Every vendor doing business with the County or seeking to do business with the County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. 1J Name of vendor who has a business relationship with local governmental entity. 2 ❑ Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? EJ Yes E7No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes E� No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 8 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.001 (1 -a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code S 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code S 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS • Complete and return this form with your bid CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a —d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING LOBBYING • Complete and return this form with your bid Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 at seq., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official DISCLOSURE OF LOBBYING ACTIVITIES • Complete and return this form with your bid • If Not Applicable, bidder must mark NA and sign and date Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial Sling _ b. grant _ b. initial award _ b. material change c. cooperative agreement c. post -award d. loan For material change only: c. loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter _ Prime _ Subawardee Name and Address of Prime: Tier , if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ifapplicabie: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individua1,, last name, first nave, MI): diferentftom No. IOa) (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or Ivan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 HOUSE BILL 89 VERIFICATION • Complete and return this form with your bid HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 the undersigned representative of Representative (hereafter referred to as Company) being an Company or Business Name adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel; and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company' means o far -profit sole proprietorship, organization, association, corporation, partnership, Joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. Signature of Representative Print Name & Title Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount. RESIDENCE CERTIFICATION • Complete and return this form with your bid RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ 1 certify that is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) ❑ I certify that (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION • Complete and return this form with your bid W-9 Request for Taxpayer Give Form to the Farm (Rev. Odober2018) Identification Number and Certification I requester. Do not Depamnem of the Treasury send to the IRS. Iraemd Revenue Service ► Go to www.irs gov/FonnVA for Instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Buslnws name/dimagarded entity name, if different from above m S Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to m following seven boxes. certain entities, not individuals; a" a p ❑ Individuallsole proprietor or ❑ C Corporation 118 Corporation ❑ Partnership ❑ Tmst(estate instructions on page 3): single -member LLC Exempt payea code Qf any) 3 � Umaed liability company. frier the tax classification C-C co ❑ P Y• (_ rporation, S=5 corporation, P=Partnership) ► p Note. Check the appropriate box in the line above forthe tax classification ofthe single -member owner. Donotcheck Exemption from FATCA reporting C — LLC if the LLC Is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that code (if any) 0. is disregarded from the owner should check the appropriate box for the tax classification of its owner. Y. ❑ Other (am instructions)► wre.,ro..vwm rarma•uwroa.usd y S Address (numInstructions., street, and apt. or suite no.) Sea Instructions. Requester's name and address (optional) y CALHOUN COUNTY 202 S ANN ST, PORT LAVACA TX 77979 s City, state, and ZIP code 361-553-4610 FAX:361-553-4614 7 Uat account numbeKa) here (optionap Tax a fir Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this Is generally your social security number (Sant. However, fora resident alien, sole proprietor, or disregarded entity, see the Instructions for Part 1, later. For other - m - entities, it is your employer identification number (EIM• if you do not have a number, see How to get a TIN, later, or Note: If the account Is in more than one name, see the instructions for line 1. Also see What Name and I Employer Identification number Number To Give the Requesterfor guidelines on whose number to enter. F-T-1 F—F—r—F7— Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and 2.1 am not subject to backup withholding because; (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding m a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your coned TIN. See the Instructions for Part 11, later. sign I signature of Here U.S. person► Data► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Form W-9 and Its Instruction, such as legislation enacted after they were published, go to www.lis govIFormW9. Purpose of Form An individual or entity (Forth W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN), Individual taxpayer identification number (ITIN), adoption taxpayer Identification number (ATIM, or employer Identification number (EIM, to report on an Information return the amount paid to you, or other amount reportable on an information return. Examples of information returns Include, but are not limited to, the following. • Form 1099-INT (Interest earned or paid) • Form 1099-DIV (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds) • Form 1099-8 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuition) • Farm 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Forth W-9 only If you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat No. 102SIX Form W-9 (Rev.10-2018) CURRENT AWARDED BID TABULATION FOR THE CURRENT BID PERIOD January 1, 2021 thru December 31, 2021 CALHOUN COUNTY, TEXAS AWARDED Bids are Highlighted in Yellow BID TABULATION -- AWARD ROAD MATERIALS AND ASPHALTS, OILS AND EMULSIONS ANNUAL SUPPLY CONTRACT, BID NUMBER: 2021.03 For the Period Beginning January 1, 2021 and Ending December 31, 2021 BASELINE PRICE (November 9. 2020) FOR FUEL ADJUSTMENT ON DELIVERY PRICE: $2.132 ROAD MATERIALS Tie Bids: The winning bid is determined per Texas Local Government Code 262.027(b). Award determined by drawing in Commissioners Court on 11/25/20. Bid Item #1: Limestone-3/4 Inch to Dust LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $6.00 $21.50 $27.50 24 tons X Quality Hot Mix, Inc. 'NOTE' ALL DELIVERIES ARE IN END DUMP TRAILERS. BELLY DUMP TRAILERS CAN BE REQUESTED & PROVIDED IF AVAILABLE. Precinct 2 Ton $6.00 $21.50 $27.50 24 tons X Precinct Ton 1 $6.00 1 $21.50 1 $27.50 1 24 tons X Precinct 4-P Ton $6.00 $21.50 $27.50 24 tons X Precinct 4-S Ton $6.00 $21.50 $27.50 24 tons X Precinct Ton $5.50 $24.00 $29.50 Belly 25tons K-C Lease Service, Inc. dba Matagorda Construction & Materials Precinct 2 Ton $5.50 $24.00 $29.50 Belly 25 tons Precinct 3 Ton $5.50 $24.00 $29.50 Belly 25 tons Precinct 4-P Ton $5.50 $24.50 $30.00 Belly 25 tons Precinct 4-5 Ton $5.50 $24.00 $29.50 Belly 25 tons Precinct 1 Ton $6.00 $24.00 $30.00 24 MiclTex Materials, LLC (Bid has error on Precinct 4-5) Precinct 2 Ton $6.00 $24.00 $30.00 24 Precinct 3 Ton $6.00 $24.00 $30.00 24 Precinct 4-P Ton $6.00 $26.00 $32.00 24 Precinct4-S Ton $6.00 $6.00 (Bidhas$6.00) $30.00 (Bid has $30) 24 Precinct 1 Ton $4.97 $26.48 $31.45 N/A Johnnie R. Gresham Operating, Inc. Precinct 2 Ton $4.97 $26.48 $31.45 N/A Precinct 3 Ton $4.97 $26.48 $31.45 N/A Precinct 4-P Ton $4.97 $26.48 $31.45 N/A Precinct 4-S Ton $4.97 $26.48 $31.45 N/A Page 1 of 10 Bid Item #2: ITEM 247, TYPE A LIMESTONE, GRADE 2 [1 3/4 INCH] LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $6.00 $21.50 $27.50 24 tons X Quality Hot Mix, Inc. 'NOTE' ALL DELIVERIES ARE IN END DUMP TRAILERS. BELLY DUMP TRAILERS CAN BE REQUESTED & PROVIDED IF AVAILABLE. Precinct 2 Ton $6.00 $21.50 $27.50 24 tons X Precinct Ton $6.00 $21.50 $27.50 24 tons X Precinct 4-P Ton $6.00 $21.50 $27.50 24 tons X Precinct 4-S Ton $6.00 $21.50 $27.50 24 tons X Precinct 1 Ton $5.00 $24.00 $29.00 Belly 25 tons K-C Lease Service, Inc. dba Matagorda Construction &Materials Precinct 2 Ton $5.00 $24.00 $29.00 Belly 25 tons Precinct Ton $5.00 $24.00 $29.00 Belly 25tons Precinct4-P Ton $5.00 $24.50 $29.50 Belly 25tons Precinct 4-S Ton 1 $5.00 $24.00 $29.00 Belly 25 tons Precinct 1 Ton $6.00 $24.00 $30.00 24 MidTex Materials, LLC Precinct 2 Ton $6.00 $24.00 $30.00 24 Precinct 3 Ton $6.00 $24.00 $30.00 24 Precinct 4-P Ton $6.00 $26.00 $32.00 24 Precinct 4-S Ton 1 $6.00 $24.00 $30.00 24 Precinct 1 Ton $4.47 $26.48 $30.95 N/A Johnnie R. Gresham Operating, Inc. Precinct 2 Ton $4.47 $26.48 $30.95 N/A Precinct 3 Ton $4.47 $26.48 $30.95 N/A Precinct 4-P Ton $4.47 $26.48 $30.95 N/A Precinct 4-S Ton $4.47 $26.48 1 $30.95 N/A Precinct 1 Ton $23.50 $14.00 $37.50 24 tons Martin Marietta Materials, Inc. 'VIA GREGORY RAIL YARD' 'Page 8of Bid, under Exceptions and/or Variations from Specifications and/or additional notes: SEE ATTACHED LETTER REGARDING MATERIAL TESTING -NO LETTER WAS ATTACHED/INCLUDED WITH THEIR BID Precinct 2 Ton $23.50 $14.25 $37.75 24 tons Precinct Ton $23.50 $15.96 $39.46 24 tons Precinct 4-P Ton $23.50 $15.96 $39.46 24 tons Precinct4-S Ton $23.50 $13.80 $37.30 1 24 tons Precinct 1 Ton $22.50 $19.00 $41.50 22 tons Vulcan Materials Company dba Vulcan Construction Materials, LLC Precinct 2 Ton $22.50 $20.00 $42.50 22 tons Precinct 3 Ton $22.50 $21.50 $44.00 22 tons Precinct4-P Ton $22.50 $21.50 $44.00 22 tons Precinct 4-S Ton $22.50 $19.00 $41.50 22 tons Page 2 of 10 Bid Item #3: ITEM 247, TYPE A LIMESTONE, GRADE 3 [13/4 INCH] LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $6.00 $21.50 $27.50 24 tons X Quality Hot Mix, Inc. `NOTE* ALL DELIVERIES ARE IN END DUMP TRAILERS. BELLY DUMP TRAILERS CAN BE REQUESTED & PROVIDED IF AVAILABLE. Precinct 2 Ton $6.00 $21.50 $27.50 24 tons X Precinct Ton $6.00 $21.50 $27.50 24 tons X Precinct 4-P Ton $6.00 $21.50 $27.50 24 tons X Precinct 4-S Ton $6.00 $21.50 $27.50 24 tons X Precinct 1 Ton $6.00 $24.00 $30.00 24 MidTex Materials, LLC Precinct 2 Ton $6.00 $24.00 $30.00 24 Precinct 3 Ton $6.00 $24.00 $30.00 24 Precinct 4-P Ton $6.00 $26.00 $32.00 24 Precinct 4-S Ton $6.00 $24.00 $30.00 24 Precinct 1 Ton $4.47 $26.48 $30.95 N/A Johnnie R. Gresham Operating, Inc. Precinct 2 Ton $4.47 $26.48 $30.95 N/A Precinct 3 Ton $4.47 $26.48 $30.95 N/A Precinct 4-P Ton $4.47 $26.48 $30.95 N/A Precinct 4-S Ton $4.47 $26.48 $30.95 N/A Precinct 1 Ton $22.50 $19.00 $41.50 22 tons Vulcan Materials Company dba Vulcan Constructions Materials, LLC Precinct 2 Ton $22.50 $20.00 $42.50 22 tons Precinct 3 Ton $22.50 $21.50 $44.00 22 tons Precinct 4-P Ton $22.50 $21.50 $44.00 22 tons Precinct 4-S I Ton 1 $22.50 $19.00 $41.50 22 tons Bid Item #4: ITEM 275, CEMENT 275-2.1, Hydraulic Cement Type 1, Bulk (Pneumatic Tankers, Spreader Bar Needed) 275.2-1, Hydraulic Cement Type 1, 47 lb Bag (Cost per Pallet) List # of 471b Bags on a Pallet LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM BIDDER LOAD/ORDER AND REMARKS, IF ANY Precinct 1, 2, 3, Ton 4-P & 4-S NO BIDS RECEIVED _ of 47 Lb Bags on Pallet Page 3 of 10 NOTE: Award for Bid Item #5 and Bid Item #6 was determined by drawing in Commissioners Court on 11/25/20 -- per Local Government Code 262.027(b) Bid Item #5: Item 302, Type PB, Grade 3 (Pre -Coated Rock) LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $23.39 $38.61 $62.00 24 tons X Martin Marietta Materials, Inc. *VIA BLACK SPUR QUARRY* * Page 8 of Bid, under Exceptions and/or Variations from Specifications and/or additional notes: SEE ATTACHED LETTER REGARDING MATERIAL TESTING - NO LETTER WAS ATTACHED/INCLUDED WITH THEIR BID Precinct 2 Ton $23.70 $38.30 $62.00 24 tons X Precinct Ton $21.18 $40.82 1$62.00 24 tons X Precinct4-P Ton $20.71 $41.29 $62.00 24 ton: X Precinct 4-S Ton $23.07 $38.93 $62.00 24 tons X Precinct 1 Ton $53.00 $9.00 $62.00 24 tons Quality Hot Mix, Inc. "NOTE* ALL DELIVERIES ARE IN END DUMP TRAILERS. BELLY DUMP TRAILERS CAN BE REQUESTED & PROVIDED IF AVAILABLE. Precinct 2 Ton $53.00 $9.00 $62.00 24 tons Precinct 3 Ton $53.00 $9.00 $62.00 24 tons Precinct 4-P Ton $53.00 $9.00 $62.00 24 tons Precinct 4-S Ton $53.00 $9.00 $62.00 24 tons Bid Item #6: Item 302, Type PB, Grade 4 (Pre -Coated Rock) LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $53.00 $9.00 $62.00 24 tons X Quality Hot Mix, Inc. *NOTE* ALL DELIVERIES ARE IN END DUMP TRAILERS. BELLY DUMP TRAILERS CAN BE REQUESTED & PROVIDED IF AVAILABLE. Precinct 2 Ton $53.00 $9.00 $62.00 24 tons X Precinct Ton $53.00 $9.00 $62.00 24 tons X Precinct 4-P Ton $53.00 $9.00 $62.00 24 tons X Precinct 4-S Ton $53.00 $9.00 $62.00 24 tons X Precinct 1 Ton $23.39 $38.61 $62.00 24 tons Martin Marietta Materials, Inc. *VIA BLACK SPUR QUARRY* * Page 8 of Bid, under Exceptions and/or Variations from Specifications and/or additional notes: SEE ATTACHED LETTER REGARDING MATERIAL TESTING - NO LETTER WAS ATTACHED/INCLUDED WITH THEIR BID Precinct Ton $23.70 $38.30 $62.00 24 tons Precinct Ton $21.18 $40.82 $62.00 24 tons Precinct4-P Ton $20.71 $41.29 $62.00 24 tons Precinct4-S Ton $23.07 $38.93 $62.00 24 tons Page 4 of 10 Bid Item #7: Item 302, Type PE, Grade 3 (Pre -Coated Rock) *Material Source out of LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM AWARD BIDDER LOAD/ORDER AND REMARKS, IF ANY Precinct 1 Ton $22.50 $37.98 $60.48 24 tons X Vulcan Materials Company Precinct 2 Ton $22.50 $38.75 $61.25 24 tons X dba Vulcan Construction Materials, LLC Precinct 3 Ton $22.50 $40.30 1 $62.80 24 tons X Precinct 4-P Ton $22.$0 $38.75 $61.2$ 24 tons X * MATERIAL SOURCE OUT OF DABNEY(UVALDE)* Precinct 4-S Ton $22.50 $38.75 $61.25 24 tons X Martin Marietta Precinct 1 Ton $27.91 $38.61 $66.52 24 tons Materials, Inc. Precinct Ton $29.18 $38.30 $67.48 24 tons * MATERIAL SOURCE OUT OF UVALDE* *VIA BLACK SPUR QUARRY* Precinct 3 Ton $28.40 $40.82 $69.22 24 tons *Page 8 of Bid, under Exceptions and/or Variations from Specifications and/or additional notes: SEE ATTACHED LETTER Precinct 4-P I Ton 1 $27.93 1 $41.29 1 $69.22 1 24 tons REGARDING MATERIAL TESTING - NO LETTER WAS ATTACHED/INCLUDED WITH Precinct 4-5 I Ton $27.59 $38.93 $66.52 24tons THEIR BID Bid Item #8: Item 302, Type PE, Grade 4 (Pre -Coated Rock) *Material Source out of LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM AWARD BIDDER LOAD/ORDER AND REMARKS, IF ANY Precinct 1 Ton $23.50 $37.98 $61.48 24 tons X Vulcan Materials Company Precinct 2 Ton $23.50 $38.75 $62.25 24 tons X dba Vulcan Construction Materials, LLC Precinct 3 Ton $23.50 $40.30 $63.80 24 tons X Precinct 4-P Ton $23.50 $38.75 $62.25 24tons X *MATERIAL SOURCE OUT OF DABNEY(UVALDE)* Precinct 4-S Ton $23.50 $38.75 $62.25 24 tons X Precinct 1 Ton $27.91 $38.61 $66.52 24 tons Martin Marietta Materials, Inc. Precinct Ton $29.18 $38.30 $67.48 24 tons * MATERIAL SOURCE OUT OF UVALDE* *Page 8 of Bid, under Exceptions and/or Precinct Ton $28.40 $40.82 $69.22 24 tons Variations from Specifications and/or additonal notes: SEE ATTACHED LETTER Precinct4-P Ton $27.93 $41.29 $69.22 24 tons REGARDING MATERIAL TESTING - NO LETTER WAS ATTACHED/INCLUDED WITH Precinct 4-S Ton $27.59 $38.93 $66.52 24 tOns THEIR BID Page 5 of 10 Bid Item #9: Item 302, Type E, Grade 5, Ice Rock (Non -Coated Limestone Only) LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $15.50 $24.00 $39.50 Belly 25 tons X K-C Lease Service, Inc. dba Matagorda Construction and Materials Precinct 2 Ton $15.50 $24.00 $39.50 Belly 25tons X Precinct 3 Ton $15.50 $24.00 $39.50 Belly 25 tons X Precinct 4-P Ton $15.50 $24.50 $40.00 Belly 25 tons X Precinct 4-S Ton $15.50 $24.00 $39.50 Belly25tons X Precinct 1 Ton $26.50 $23.50 $50.00 24tons Quality Hot Mix, Inc. *NOTE* ALL DELIVERIESARE IN END DUMP TRAILERS. BELLY DUMP TRAILERES CAN BE REQUESTED & PROVIDED IF AVAILABLE. Precinct 2 Ton $26.50 $23.50 $50.00 24tons Precinct Ton $26.50 $23.50 $50.00 24tons Precinct 4-P Ton $26.50 $23.50 $50.00 24tons Precinct 4-S I Ton 1 $26.50 1 $23.50 1 $50.00 1 24tons Bid Item #10: ITEM 330, TYPE D (PRE -MIX LIMESTONE) LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $10.50 $26.48 $36.98 N/A X Johnnie R. Gresham Operating, Inc. Precinct 2 Ton $10.50 $26.48 $36.98 N/A X Precinct 3 Ton $10.50 $26.48 $36.98 N/A X Precinct 4-P Ton $10.50 $26.48 $36.98 N/A X Precinct 4-S Ton $10.50 $26.48 $36.98 N/A X Precinct 1 Ton $40.50 $37.98 $78.48 24tons Vulcan Materials Company dba Vulcan Construction Materials, LLC LIMESTONE ROCK ASPHALT* Precinct Ton $40.50 $38.75 $79.25 24tons Precinct 3 Ton $40.50 $40.30 $80.80 24tons Precinct4-P Ton $40.50 $38.75 $79.25 24tons Precinct 4-S Ton 1 $40.50 $38.75 $79.25 24tons Precinct 1 Ton $46.00 $38.61 $84.61 24tons Martin Marietta Materials, Inc. *VIA BLACK SPUR QUARRY *Page 8 of Bid, under Exceptions and/or Variations from specifications and/or additional notes: SEE ATTACHED LETTER REGARDING MATERIALTESTING - NO LETTER WAS ATTACHED/INCLUDED WITH THEIR BID Precinct 2 Ton $46.00 $38.30 $84.30 24 tons Precinct Ton $46.00 $40.82 $86.82 24tons Precinct4-P Ton $46.00 $41.29 $87.29 24tons Precinct4-S I Ton 1 $46.00 1 $38.93 1 $84.93 24tons Page 6 of 10 Bid Item #11: ITEM 330 D, POTHOLE REPAIR, LIMESTONE ROCK ASPHALT (LRA) LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM AWARD BIDDER LOAD/ORDER AND REMARKS, IF ANY Precinct 1 Ton $46.50 $37.98 $84.48 24tons x Yard No Bid 50lbBag No Bid Precinct 2 Ton $46.50 $38.75 $85.25 24tons x Yard No Bid 50lbBag No Bid Vulcan Materials Company Precinct 3 Ton $46s0. $40.30 $86.80 24 tons x dba Yard No Bid Vulcan Construction Materials, LLC * D PLUS MIX* 50 lb Bag No Bid Precinct 4-P Ton $46.50 $38.75 $85.25 24tons x Yard No Bid 50 lb Bag No Bid Precinct 4-S Ton $46.50 $38.75 $85.25 24tons x Yard No Bid 50lbBag No Bid Ton $58.77 $39.18 $97.95 24Tons Yard $65.23 $43.49 $108.72 22 Cu Yds x Precinct 1 50 lb Bag $12.00 - $12.00 62 Bags= x 1 Pallet Ton $57.32 $38.22 $95.54 24Tons Yard3 $67.64 $45.10 $112.74 22 Cu Yds x Precinct 2 SOIb Bag $12.00 - $12.00 62 Bags= x 1 Pallet Ton $64.75 $43.17 $107.92 24Tons Yard $76.41 $50.94 $127.35 22 Cu Yds x Precinct 3 Blades Group, LLC 50 lb Bag $12.00 - $12.00 62 Bags = x 1 Pallet Ton $64.24 $42.82 $107.06 24 Tons Yard $75.80 $50.53 $126.33 22 Cu Yds x Precinct 4-P 50 lb Bag $12.00 - $12.00 62 Bags = x 1 Pallet Ton $62.28 $41.52 $103.80 24Tons Precinct 4-S Yard3 $73.49 $48.99 $122.48 22 Cu Yds x 50 lb Bag $12.00 - $12.00 62 Bags = x 1 Pallet Page 7 of 10 Bid Item #12: ITEM 334, TYPE D, HOT MIX COLD LAID ASPHALT CONCRETE PAVEMENT LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $75.00 $9.00 $84.00 25 tons X Quality Hot Mix, Inc. *NOTE* ALL DELIVERIES ARE IN END DUMP TRAILERS. BELLY DUMP TRAILERS CAN BE REQUESTED & PROVIDED IF AVAILABLE. Precinct 2 Ton $75.00 $9.00 $84.00 25tons X Precinct3 Ton $75.DD $9.00 $84.00 25tons X Precinct 4-P Ton $75.00 $9.00 $84.00 25 tons X Precinct 4-S Ton $75.00 $9.00 $134.00 25tons X Precinct 1 Ton $85.00 $30.59 $115.59 25 TONS DELIVERED Waller County Asphalt, Inc. * BID IS FOR HIGH PERFORMANCE ASPPM GRADE IV Precinct 2 Ton $85.00 $31.51 $116.51 25 TONS Precinct 3 Ton $85.00 $27.83 $112.83 25 TONS Precinct 4-P Ton $85.00 $35.19 $120.19 25 TONS Precinct 4-S Ton $85.00 $34.96 $119.96 25 TONS Bid Item #13: ITEM 432, Riprap, Section 2.3 Stone Riprap, 12" Limestone LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $17.33 $34.13 $51.46 N/A X Johnnie R. Gresham Operating, Inc. Precinct 1 Ton $17.33 $34.13 $51.46 N/A X Precinct 3 Ton $17.33 $34.13 1 $51.46 N/A X Precinct 4-P Ton $17.33 $34.13 $51.46 N/A X Precinct 4-S Ton $17.33 $34.13 $51.46 N/A X Precinct 1 Ton $26.00 $50.00 $76.00 24 MidTex Materials, LLC Precinct 2 Ton $26.00 $50.00 $76.00 24 Precinct 3 Ton $26.00 $50.00 $76.00 24 Precinct 4-P Ton $26.00 $52.00 $78.00 24 Precinct 4-S Ton $26.00 $50.00 $76.00 24 Precinct 1 Ton $40.00 $45.00 $85.00 22 tons Vulcan Materials Company dba Vulcan Construction Materials, LLC Precinct 2 Ton $40.00 $45.00 $85.00 22 tons Precinct 3 Ton $40.00 $50.00 $90.00 22 tons Precinct 4-P Ton $40.00 $47.00 $87.00 22 tons Precinct 4-S Ton $40.00 $45.00 $85.00 22 tons Page 8 of 10 ASPHALTS, OILS AND EMULSIONS Item 300, Asphalts, Oils and Emulsions Bid Item #14: Primer Oil LOCATION Unit MATERIAL DELIVERY TOTAL DEMURRAGE AWARD BIDDER AND REMARKS, IF ANY $80.00 Per Hour Precinct 1 Gallon $2.00 $0.20 $2.20 After 2 Free Hours x $80.00. Per Hour Precinct 2 Gallon $2.00 $0.20 $2.20 After 2 Free Hours x Cleveland Asphalt Products, Inc. $80.00 Per Hour PRICE BASED ON MINIMUM. FULL LOAD Precinct 3 Gallon $2.00 $0.20 $2.20 After 2 Free Hours x OF 5000 GALLONS, FOR SMALLER QUANTITIES PLEASE CALL 800-334-0177. DILUTED MATERIAL CANNOT BE $80.00 Per Hour RETURNED FOR CREDIT. Precinct 4-P gallon $2.00 $0.20 $2.20 After 2 Free Hours x $80.00 Per Hour Precinct 4-S Gallon $2.00 $0.20 $2.20 After 2 Free Hours x $70.00 Per Hour Precinct 1 Gallon $2.65 $0.19 $2.84 After 2 Free Hours $70.00 Per Hour Precinct 2 Gallon $2.65 $0.19 $2.84 After 2 Free Hours Martin Products Sales, LLC dba $70.00 Per Hour Precinct 3 Gallon $2.65 $0.17 $2.82 After 2 Free Hours Martin Asphalt Company * MC-30' $70.00 Per Hour ' 5,000 GAL MINIMUM Precinct 4-P Gallon $2.65 $0.21 $2.86 After 2 Free Hours $70.00 Per Hour Precinct 4-S Gallon $2.65 $0.21 $2.86 After 2 Free Hours Page 9 of 10 Bid Item #15: RC-250 LOCATION Unit MATERIAL DELIVERY TOTAL DEMURRAGE AWARD BIDDER AND REMARKS, IF ANY $70.00 Per Hour Precinct 1 Gallon $2.55 $0.19 2.74 After 2 Free Hours x $70.00 Per Hour Precinct 2 Gallon $2.55 $0.19 2.74 After 2 Free Hours x Martin Products Sales, LLC $70.00 Per Hour dba Precinct 3 Gallon $2.55 $0.17 2.72 After 2 Free Hours x Martin Asphalt Company * 5000 GALLON MINIMUM $70.00 Per Hour Precinct 4-P Gallon $2.55 $0.21 2.76 After 2 Free Hours x $70.00 Per Hour Precinct 4-S Gallon $2.55 $0.21 2.76 After 2 Free Hours x $80.00 Per Hour Precinct 1 Gallon $2.75 $0.20 2.95 After 2 Free Hours Cleveland Asphalt $80.00 Per Hour Precinct Gallon $2.75 $0.20 2.95 After 2 Free Hours Products, Inc. * PRICE BASED ON MINIMUM FULL LOAD $80.00 Per Hour Precinct 3 Gallon $2.75 $0.20 2.95 After 2 Free Hours OF 5000 GALLONS, FOR SMALLER QUANTITIES PLEASE CALL 800-334-0177, $80.00 Per Hour Precinct 4-P I Gallon 1 $2.75 1 $0.20 1 2.95 lAfter 2 Free Hours DILUTED MATERIAL CANNOT BE RETURNED FOR CREDIT. $80.00 Per Hour Precinct 4-S I Gallon $2.75 $0.20 2.95 After 2 Free Hours Bid Item #16: CRS-2 LOCATION Unit MATERIAL DELIVERY TOTAL DEMURRAGE AWARD BIDDER AND REMARKS, IF ANY $80.00 Per Hour Precinct 1 Gallon $2.75 $0.20 $1.95 After 2 Free Hours x Cleveland Asphalt $80.00 Per Hour Precinct 2 Gallon $1.75 $0.20 $1.95 After 2 Free Hours x Products, Inc. $80.00 Per Hour * PRICE BASED ON MINIMUM FULL LOAD Precinct 3 Gallon $1.75 $0.20 $1.95 After 2 Free Hours x OF 5000 GALLONS, FOR SMALLER QUANTITIES PLEASE CALL 800-334-0177. $80.00 Per Hour DILUTED MATERIAL CANNOT BE Precinct 4-P Gallon $1.75 $0.20 $1.95 After 2 Free Hours x RETURNED FOR CREDIT. $80.00 Per Hour Precinct 4-S Gallon $1.75 $0.20 $1.95 After 2 Free Hours x $70.00 Per Hour Precinct 1 Gallon $1.85 $0.19 $2.04 After Free Hours $70.00 Per Hour Precinct 2 Gallon $1.85 $0.19 $2.04 After 2 Free Hours Martin Products Sales, LLC dba $70.00 Per Hour Precinct 3 Gallon $1.85 $0.17 $2.02 After 2 Free Hours Martin Asphalt Company * 5000 GALLON MINIMUM $70.00 Per Hour Precinct 4-P I Gallon 1 $1.85 1 $0.21 1 $2.06 lAfter 2 Free Hours $70.00 Per Hour Precinct 4-S Gallon $1.85 1 $0.21 1 $2.06 After 2 Free Hours Page 10 of 10 #9 NOTICE OF MEETING—10/6/2021 9. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Inmate Food Services, for the Calhoun County Adult Detention Center, Bid Number 2022.04 for the period beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: Gary Reese, Commissioner, Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5 of 13 September 29, 2021 To: Judge Meyer From: The office of the County Auditor Peggy Hall, Assistant Auditor Please place the following item on the Commissioners Court Agenda for October 6, 2021: • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Inmate Food Services, for the Calhoun County Adult Detention Center, Bid Number 2022.04 for the period beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. Agenda Item #9 Commissioners Court— Wednesday, October 6, 2021 Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Inmate Food Services, for the Calhoun County Adult Detention Center, Bid Number 2022.04 for the period beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly if agreeable with both the successful bidder and Calhoun County and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Tuesday, November 9, 2021. CHANGES FROM PREVIOUS SPECIFICATIONS AND INVITATION TO BID PACKET: Updated the dates for the new bid period and use the same format as other bid packets. Chanaes: 1. Specifications a) Added: Information that is included in the contract for the current 2021 Contract Year b) Added the wording: The bidder may request the Invitation to Bid Form be sent to them in the Excel Format. If the bidder requests the Invitation to Bid Form be sent to them in the Excel Format, the bidder understands that the form and/or format shall not be changed in any way. The bidder shall not delete and/or add items to the Invitation to Bid Form. The bidder understands that by changing the form and/or format in any way shall disqualify their bid. The Excel Format may be requested only as a means to enter the required information. Requests for the Excel Format of the Invitation to Bid Form must be sent to Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or calling 361-553-4610. Bidder must request the Excel Format. The Excel Format will not be sent with the Invitation to Bid Packet. It must be requested from the County Auditor's office, Peggy Hall, Assistant Auditor. 2. No contract is being sent with the Invitation to Bid Packet for. a) The Contract, if needed, will be completed after the bid has been awarded b) The contract will then be brought back to Commissioners Court for Court approval 3. Due to the contract not being sent with the Invitation to Bid Packet, the Invitation to Bid Form was changed to include: a) Food and Non -Food Items not listed on this Invitation to Bid Form shall be provided at: Cost Plus % Basis b) Other equipment, services or products used in the Detention Facility's Kitchen will be offered at: Free of Charge, a Discounted Price, or Cost Plus % Basis c) Attachment(s) to Invitation to Bid Form: Yes No CALHOUN COUNTY, TEXAS CALHOUN COUNTYADULT DETENTION CENTER INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Bid Number: 2022.04 Bid Term: January 1, 2022 thru December 31, 2022 With the option to renew yearly (one year terms) if agreeable with both the successful bidder and Calhoun County SEALED BIDS WILL BE RECEIVED UNTIL 2:00:00 Tuesday, November 9, 2021 AT THE OFFICE OF Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 31d Floor, Suite 301 Port Lavaca, Texas 77979 PUBLIC BID OPENING will be conducted at 2:00 PM, Tuesday, November 9, 2021 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, P Floor, Suite 301, Port Lavaca, Texas 77979. At this time, each bidder's name will be read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all bidders that submitted a bid and will also be posted on the County's website (www.calhouncotx.org) under Bid Notices and Results, Results 2022 as soon as time permits. CONTENTS Invitation To Bid • Return Instructions • General Conditions • Specifications for Annual Supply Contract for Inmate Food Services • Required Information/Forms o Invitation to Bid Form, page 1-17 (plus attachments, if applicable) o Affidavit o Bidder Information Form o Certificate of Interested Parties Form 1295 — Must return when submitting your bid o Certificate of Liability Insurance — Return a copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the bidder who is awarded the bid must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. o Conflict of Interest Questionnaire Form CIO — Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. o Certification Regarding Debarment & Suspension and Other Responsibility Matters o Certification Regarding Lobbying o Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date o House Bill 89 Verification o Residence Certification o W-9 OTHER INFORMATION INCLUDED WITH THE INVITATION TO BID PACKET • Current Awarded Contract, Contract Renewal and Grocery Pricing List for the Annual Supply Contract for Inmate Food Services —January 1, 2021 thru December 31, 2021 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive SEALED BIDS for furnishing food and non-food items to the Calhoun County Adult Detention Center. Bid Number 2022.04, Annual Supply Contract for Inmate Food Services Bids are for a one (1) year period beginning January 1, 2022 and ending December 31, 2022, with the option to renew yearly (one year terms) if agreeable with both the successful bidder and Calhoun County. Each yearly renewal must be approved by Commissioners Court prior to the end date of the contract. The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022), or by contacting Peggy Hall, Assistant Auditor, peggy.hall@calhouncotx.org or 361-553-4610. The complete Invitation to Bid Packet must be used in preparing the bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. Bids shall include all requirements of the Invitation to Bid Packet for Bid Number 2022.04, Annual Supply Contract for Inmate Food Services. SEALED BIDS ARE DUE: Date: Tuesday, November 9, 2021 Time: BEFORE 2:00:00 PM Location: County Judge's Office Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 At this time, all bids will be publicly opened and each bidder's name read aloud. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street V Floor, Suite 301 Port Lavaca, TX 77979 ALL BIDS (one original and three copies) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2022.04 ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Page 1 of 2 If the SEALED BID is sent by Ups, FedEx, or other delivery service, the outside of this envelope must be clearly marked: BID NUMBER 2022.04 ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Calhoun County does not accept faxed or emailed bids. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the time the bids received will be opened. Bids received after the deadline will be returned unopened. Commissioners Court reserves the right to waive technicalities, reject any or all bids, to accept the bid deemed most advantageous to and in the best interest of Calhoun County. The award of the Bid and Contract shall be made to the responsible bidder, whose bid is determined to be the most beneficial to Calhoun County and the Calhoun County Adult Detention Center, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid Packet. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit bids. Cindy Mueller County Auditor Calhoun County, Texas Page 2 of 2 RETURN INSTRUCTIONS For Submitting a Bid for ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Bid Number: 2022-04 Bid Period: January 1, 2022 thru December 31, 2022 With the option to renew yearly (one year terms) if agreeable with both the successful bidder and Calhoun County Return the following BEFORE 2.00.00 PM TUESDAY NOVEMBER 9 2021 Check List for submitting your Bid • Return One (1) Original and 3 Copies Be sure all necessary forms are included and or completed, signed and dated Invitation to Bid Form, page 1-17 (plus attachments, if applicable) Affidavit Bidder Information Form Certificate of Interested Parties, Form 1295 Form 1295 must be completed online — Copy that is included is Sample Copy Only Do Not Fill Out Sample Copy. Form 1295 must be completed online. #1: Bidders Name, City, State and Country #2: Calhoun County, Texas #3: Bid Number: 2022-04; Annual Supply Contract for Inmate Food Services, January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to your caravanv #4: Fill in the correct information OR #5: Mark an X in the Box #6: Fill in the correct information and print When you print you should see a Certificate Number and Date Filed in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. Certificate of Liability Insurance Please return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you currently carry at least the minimum required coverage. Once bids are awarded, the bidder that is awarded a bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured Conflict of Interest Questionnaire, Form CIQ Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. Certification Regarding Debarment & Suspension and Other Responsibility Matters Certification Regarding Lobbying Disclosure of Lobbying Activities —If Not Applicable, bidder must mark NA and sign and date House Bill 89 Verification Residence Certification W-9 Do Not Fold any of the above information. Bid must be returned in a SEALED 9 x 12 or larger envelope clearly marked: SEALED BID NUMBER 2022.04 ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES If you send your bid by UPS, FeclEx or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2022.04 ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Submit Sealed Bid to: Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 3rd Floor, Suite 301 Port Lavaca, TX 77979 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFQ and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ, and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFQ and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ and/or Contract is due. The Bid, RFP, RFQ and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ and/or Contract in collusion with any other bidder/vendor or anyofficial or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidder's/vendor's Bid, RFP, RFQ and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Page 1 of 13 Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3'd Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ and/or Contract will specify the date and time due. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ and/or Contract is received and the time the Bid, RFP, RFQ and/or Contract will be opened. A late delivery with an early postmark or delivery of the Bid, RFP, RFQ and/or Contract to the wrong office will not suffice. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. If the Bid, RFP, RFQ and/or Contract is sent by UPS, Fed Ex or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ and/or Contract price. Bids, Page 2 of 13 RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ, and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum. Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ, and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendor's performance under this Bid, RFP, RFQ, and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes. Tax exempt forms will be furnished upon request to the Calhoun County Auditor's Office. Page 3 of 13 Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act', commonly known as the "Texas Right To Know Act', a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the solejudge in determining which Bid, RFP, RFQ, and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ, and/or Contract based on lowest and/or best Bid, RFP, RFQ and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ, and/or Contract' means a bid or offer providing the best value considering associated direct Page 4 of 13 and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ, and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ, and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid RFP RFQ and/or Contract If the Bid, RFP, RFQ and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Obligation of the Bid RFP RFQ and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet Page 5 of 13 specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFQ and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFQ and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFQ, and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFQ, and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFQ and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 84th Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 6 of 13 Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the. Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf—info—forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity' includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract' includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFC, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFC, and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Bid, RFP, RFQ and/or Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than thirty (30) days after Calhoun County Commissioners Court approves a contract, or awards a Bid, RFP, and/or RFQ with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Page 7 of 13 Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ, and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFQ, and/or Contract submission and the time of execution of the Bid, RFP, RFQ, and/or Contract. A print out of the search results, including principals, if any, from the System for Award Management (www.SAM.gov) that includes the record date must be included with the bidder's/vendor's Bid, RFP, RFQ and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFQ, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Page 8 of 13 Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ, Contract, order, and/or service. In the event a Bid, RFP, RFQ, Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFQ, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFC, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFQ, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and Page 9 of 13 be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Majeure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFC, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFQ and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFQ and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFQ and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFC, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFC, and/or Contract. Otherwise, Texas state and federal law shall apply. Page 10 of 13 Prohibition against Personal Interest in Bids RFPs RFQs and/or Contracts• No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFQ, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ, and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ, and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFC, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ, and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ, and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ, and/or Contract. General Liability ($100,000/$300,000 or greater) Workers' Compensation (at Statutory Limits) Employer's Liability ($1,000,000 or greater) Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) Professional Liability Insurance (if applicable) Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance(Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of orfailure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of Page 11 of 13 the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFQ, and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFQ, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: Name, mailing address and business phone number of the protesting party; Appropriate identification of the Bid, RFP, RFQ, and/or Contract being protested; A precise statement of the reasons for the protest; and Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. Page 12 of 13 If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFC, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or byjudicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Cindy Mueller Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: cindy.mueller@calhouncotx.org To request a Bid, RFP, and/or RFQ packet from Calhoun County, or information on how to obtain a packet, please contact: Peggy Hall Assistant Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: peggy.hall@calhouncotx.org Bids, RFPs, and/or RFQs may also be viewed on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results. Page 13 of 13 BID SPECIFICATIONS ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES BID NUMBER 2022.04 Commissioners Court of Calhoun County, Texas is requesting SEALED BIDS for the Annual Supply Contract for Inmate Food Services at the Calhoun County Adult Detention Center, located at 302 West Live Oak Street in Port Lavaca, Texas. The Calhoun County Adult Detention Center is hereinafter called "DETENTION FACILITY". INVITATION TO BID PACKET The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Bid Notices and Results, Bid Notices 2022) or by contacting Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or 361-553-4610. The complete Invitation to Bid Packet must be used in preparing the bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of incomplete sets of the Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, TUESDAY, NOVEMBER 9, 2021 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3'd Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original and three copies) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: BID NUMBER 2022.04, ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES If the SEALED BID is sent by Ups, FedEx, or other delivery service, the outside of this envelope must be clearly marked: BID NUMBER 2022.04 ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES. SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979. A late delivery with an early postmark will not suffice. Calhoun County does not accept faxed or emailed bids. Any bid received after the due date and time will not be opened. Page 1 of 11 Calhoun County is not responsible for the delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid due date and time. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the bid is received and the time the bids will be opened. No bids will be accepted after the due time and date has been reached. Calhoun County accepts no financial responsibility for any cost incurred by and BIDDER in the course of responding to these specifications BID TERM The bid shall be in effect for a period of one (1) year beginning January 1, 2022 and ending December 31, 2022 with the option to renew yearly (one year terms) if agreeable with both the successful bidder and Calhoun County. Each yearly renewal must be approved by Commissioners Court prior to the end date of the contract. BID INFORMATION / REQUIREMENTS To submit a valid bid, read the entire Invitation to Bid Packet for all required information that must be included and all required forms (see page 5) that must be returned and/or filled out, signed and dated and returned with your bid. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a bid. If you will not be submitting a bid, we would appreciate you indicating on your "No Bid" response any requirements of this bid request which may have influenced your decision to "No Bid". Calhoun County is not responsible for errors if the Bid Forms are handwritten. It is recommended that all information submitted by the vendor on the Bid Forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. The bidder may request the Invitation to Bid Form be emailed to them in the Excel Format. If the bidder requests the Invitation to Bid Form be sent to them in the Excel Format, the bidder understands that the form and/or format shall not be changed in anv way. The bidder shall not delete and/or add items to the Invitation to Bid Form. The bidder understands that by changing the form and/or format in any way shall disqualify their bid. The Excel Format may be requested only as a means to enter the required information. Requests for the Excel Format of the Invitation to Bid Form must be sent to Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or by calling 361-553-4610. Bidder must request the Excel Format. The Excel Format will not be sent with the Invitation to Bid Packet. It must be requested from the County Auditor's office, Peggy Hall, Assistant Auditor. Intentionally Left Blank Page 2 of 11 • All charges, fees, and/or delivery/transportation fees must be included in the bid price. No other charges, fees, and/or delivery/transportation fees may be added unless noted as an exception on the Invitation to Bid Form. Exceptions may void the bid. • All bid prices shall be firm for the entire bid period • Once awarded, if an item(s) is substituted, the item(s) shall be equal or lower in price. The price of the substituted item(s) shall not be more than the awarded bid price for that item(s). The price of the substituted item(s) may be lower than the awarded bid price. • Bids submitted in any other Invitation to Bid Form format shall not be considered. Any alterations to the Invitation to Bid Form shall disqualify the bid. • Bids submitted must be legible. • Deliveries will be made at specific times (at least twice a week) and in sufficient quantities to ensure that there will be sufficient food on hand at the DETENTION FACILITY to make and provide all meals. • Deliveries shall be made between Monday and Friday between the hours of 7:00 AM to 10:00 AM and 1:00 PM to 4:00 PM in order not to disrupt the DETENTION FACILITY kitchen in preparing meals. • Should an ordered item(s) not arrive as ordered, wrong item(s) is delivered, or item(s) is delivered damaged, the successful bidder will deliver the correct or substitute item(s) within 24 hours from the date the missing or damaged item(s) was supposed to be delivered. No extra charges and fees shall be allowed to be billed to correct the error or damaged items(s). • Should the successful bidder not be able to supply an item(s) to the DETENTION FACILITY, the DETENTION FACILITY may purchase the item(s) from another source without being in conflict with the contract. • Liquid items shall be delivered in plastic crates to prevent damages when stacked. • A sales representative from the provider shall contact the Jail Administrator, Assistant Jail Administrator, their appointed representative, or kitchen officer at least monthly, in person, to discuss any issues or new products offered. New products shall be offered to the DETENTION FACILITY at the lowest possible cost plus percentage basis as stated on the Invitation to Bid Form and successful bidder shall provide information to the DETENTION FACILITY on the calculation of this cost. • All food and non-food items on the Invitation to Bid Form are speculative products and should not be considered as firm products to be purchased during the term of the agreement. • Bidder shall provide products that are needed for inmates with high blood pressure, diabetes or for religious reasons. Page 3 of 11 • If bidder cannot supply a food or non-food item, mark "NA" on the Invitation to Bid Form in the price column next to that item. If a bidder marks a food or non-food item "NA", the DETENTION FACILITY may purchase this food or non-food item from another source without being in conflict with the bid or contract. • If bidder wishes to suggest alternate, comparable or less costly products, please do so on a separate page marked as an attachment and if applicable, noting the appropriate page and line number on your suggestion with pack size and price. • Products and services available from the successful bidder but not listed on the Invitation to Bid Form shall be available free of charge, at a discounted price, or Cost plus the percentage basis stated on the Invitation to Bid Form on such products and services used in the DETENTION FACILITY kitchen, such as dispensers for coffee, chemicals, etc. • Food and Non -Food items not listed on the Invitation to Bid Form shall be provided at Cost plus the Percentage basis stated on the Invitation to Bid Form and successful bidder shall provide information to the DETENTION FACILITY on the calculation of this cost. The Calhoun County Auditor's Office and the Detention Facility may audit the Cost plus Percentage basis at any time and the successful bidder shall provide the documentation necessary for this audit at no additional charge. • Order processing shall be made available by in person, phone, fax and/or website. • All bids received will be considered final, no changes accepted. • Bidders are prohibited from offering, giving, selling, supplying, or conveying in anyway or form, products for personal use to any official, employee or agent of Calhoun County. Samples may be provided to the DETENTION FACILITY for use within the DETENTION FACILITY for evaluation purposes. • Bidder agrees to notify the Sheriff or Jail Administrator of any solicitations from any official, employee or agent of Calhoun County for services not officially associated with the DETENTION FACILITY operations. • Once the Invitation to Bid Packet is approved by Calhoun Count's Commissioners Court and Commissioners Court has authorized the Calhoun County Auditor's Offices to advertise for bids, no questions may be answered unless in the form of an addendum that is approved by Commissioners Court. All addendums are released by the County Auditor's Office. Intentionally Left Blank Page 4 of 11 REQUIRED INFORMATION/FORMS TO BE RETURNED WITH THE INVITATION TO BID • Invitation to Bid Form, page 1-17 (plus attachments, if applicable) • Affidavit • Bidder Information Form • Certificate of Interested Parties, Form 1295 — Must return when submitting your bid • Proof of Liability Insurance — Return a copy of your current Certificate of Liability Insurance with your bid. This will provide proof that you carry at least the minimum required coverage. Once the bids are awarded, the bidder that is awarded the bid must provide a Certificate of Liability Insurance that reflects that Calhoun County (certificate holder) is an additional insured on general liability subject to the conditions of the additional insured. • Conflict of Interest Questionnaire, Form CIQ— Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Debarment & Suspension and Other Responsibility Matters • Certification Regarding Lobbying • Disclosure of Lobbying Activities - If Not Applicable, bidder must mark NA, sign and date • House Bill 89 Verification • Residence Certification • W-9 GENERAL INFORMATION Addenda No oral statement from any person shall modify or otherwise change or affect the terms, conditions or specifications stated in the bid. Any interpretations, corrections or changes to this bid will be made by addenda and approved by Commissioners Court. Once the addendum is approved by Commissioners Court, the Calhoun County Auditor's Office will send the addendum to each bidder that received an Invitation to Bid Packet and posted on the County's website, www.calhouncotx.org, under Bid Notices and Results, Bid Notices 2022. No addendum can be sent out until Commissioners Court has approved the addendum. Assignment The successful bidder shall not sell, assign, transfer or convey any Contract resulting from this bid, in whole or in part, without the prior written consent of the Calhoun County Commissioners Court. Audit Bidder shall permit the DETENTION FACILITY, their representative and/or the County Auditor's office to read, review, audit, and copy all records pertaining to this bid at no additional charge. Page 5 of 11 The DETENTION FACILITY, their representative and/or the County's Auditor's office may audit the Cost plus Percentage basis at any time and the successful bidder shall provide the documentation necessary for this audit at no additional charge. Award of Bid Calhoun County reserves the right to reject any or all bids, including without limitation the rights to reject any or all nonconforming, nonresponsive, unbalance or conditional bids and to reject the bid of any bidder if the County believes that it would not be in the best interest of the DETENTION FACILITY to make an award to that bidder, whether because the bid is not responsive or the bidder is unqualified or of doubtful financial ability or fails to meet any other pertinent standard or criteria established by Calhoun County. Calhoun County reserves the right to waive all informalities not involving price, time or changes in the bid, waive technicalities, and to negotiate contract terms with the successful bidder. Calhoun County Commissioners Court shall be the sole judge in determining which bid shall be the most advantageous to Calhoun County. Calhoun County may conduct such investigations as Calhoun County deems necessary to assist in the evaluation of any BID and to establish the responsibility, qualifications and financial ability of bidder. Bid Form The Invitation to Bid Form is included in the Invitation to Bid Packet. All blanks on the Invitation to Bid Form shall be completed by printing in ink or by typewriter. Bids by corporations shall be executed in the corporate name by the president or a vice-president (or other corporate officer accompanied by evidence of authority to sign). The corporate address and state of incorporation shall be shown below the signature. Bids by partnerships shall be executed in the partnership name and signed by a partner, whose title shall appear under the signature and the official address of the partnership shall be shown below the signature. All names shall be typed or printed in ink below the signature. The Addendum, if any, shall be acknowledged on the Invitation to Bid Form. Evidence of authority to conduct business as an out-of-state corporation in Texas shall be provided. State license number, if any, shall also be shown. Bidders / Bids All bidders and the bid each bidder submits shall comply with all Federal, State, County and local laws governing or covering this type of service. Page 6 of 11 Certificate of Interested Parties (Form 1295) Calhoun County Commissioners Court WILL NOT consider for action any bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. Certificate of Liability Insurance A copy of proof that the bidder has Liability Insurance shall be submitted with the bidder's bid. Once the bid is awarded and before commencing work, the successful bidder shall be required, at their own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the minimum required insurance coverage as stated in the Calhoun County General Conditions. If successful bidder at any time neglects, refuses to provide, or cancels the insurance required, Calhoun County shall have the right to terminate the bid and Contract or pursue any remedy available by law. Insurance coverage requirements in the bid and contract will in no way be construed as limiting the scope of indemnification. Conflict of Interest No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in this bid except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the bid voidable bythe Calhoun County Commissioners Court. Contract This request for bid and submitted documents, when properly accepted by Calhoun County, shall constitute a Contract equally binding between the successful bidder and Calhoun County. No different or additional terms will become a part of this bid and contract with the exception of an Addendum or Amendment approved by Calhoun County Commissioners Court. Disclosures of Fees and/or Charges No other fees, taxes and/or charges shall be billed to the DETENTION FACILITY unless noted as an exception to this bid. If exceptions are made to this bid, they shall be listed at the end as an attachment. Exceptions may void the bid. Equal Employment Opportunity Bidder shall ensure that no discrimination will occur against employees and applicants for employment because of their ethnic background, gender, age, religious practice, familial status, disability, or limited English language proficiency. Page 7 of 11 General Conditions The Calhoun County's General Conditions (Calhoun County, Texas — General Conditions) are a part of the Bid Specifications. Governing Law The bid shall be governed and construed according to the laws of the State of Texas. For any disputes, Calhoun County, Texas shall be the County of venue for any suit involving any dispute that may arise under this bid and contract. The bid and contract is performable in Calhoun County, Texas. Minimum Standards for Responsible Prospective Bidders A prospective bidder shall affirmatively demonstrate their responsibility. A prospective bidder shall meet the following requirements: • Have adequate financial resources, or the ability to obtain such resources as required • Be able to comply with the required or proposed delivery schedule • Have a satisfactory record of performance • Have a satisfactory record of integrity and ethics • Be otherwise qualified and eligible to receive the award Calhoun County may request representation and other information sufficient to determine bidder's ability to meet these requirements listed above. Notices Any notice required to be given under the provisions of this BID shall be in writing and shall be delivered in person or sent by registered or certified mail, return receipt requested to the parties at the following addresses: DETENTION FACILITY: BIDDER: Calhoun County Attn: Calhoun County Judge Richard H. Meyer 211 South Ann Street, Suite 301 Port Lavaca, Texas 77979 Telephone: 361-553-4600 Fax: 361-553-4444 With a copy of any notices to each of the three (3) below addresses: 1. Calhoun County Adult Detention Center Attn: Rachel Martinez, Jail Administrator 302 West Live Oak Street Port Lavaca, Texas 77979 Page 8 of 11 2. Calhoun County Sheriff Attn: Bobbie Vickery 211 South Ann Street, Suite 105 Port Lavaca, Texas 77979 3. Calhoun County Auditor 202 South Ann Street, Suite B Port Lavaca, Texas 77979 Either party may designate a different address by giving the other party written notice. Performance of Bid / Contract Calhoun County reserves the right to enforce the performance of this bid and contract in any manner prescribed by law or deemed to be in the best interest of the County and the Inmates in the DETENTION FACILITY in the event of breach or default of award. Public Information Act All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or by judicial decision, or information for which an exception to disclosure has not been sought. Bidder waives any obligations to the release to the public of any documents submitted in accordance with the bid. Sales Tax Calhoun County is by statute exempt from State, City and County Sales Tax and Federal Excise Taxes on items provided for use by Calhoun County; therefore the bid shall not include these taxes. Signing of Contract Once the award of the bid is approved by Commissioners Court, the Calhoun County Auditor's Office shall issue a Notice of Award and the required number of unsigned counterparts of the Contract to the successful bidder for proper signatures. Within ten days thereafter the successful bidder shall sign and deliver the required number of counterparts of the Contract to Calhoun County. Submittal of Confidential Material Any material that is to be considered as confidential in nature shall be clearly marked as such by the BIDDER and will be treated as confidential by Calhoun County as allowed by the Local Government Code. SUCCESSFUL BIDDER Successful bidder shall defend, indemnify and hold Calhoun County and all its officers, agents and employees harmless from all suits, actions or other claims of any character, name and description brought forth for or on account of injuries or damages received or sustained by any person, persons, or property on account of any direct or indirectly negligent act or fault of the successful bidder or of Page 9 of 11 any agent, employee, subcontractor or supplier in the execution of, or performance under, any Contract which may result from the award of the bid. Successful bidder shall pay any judgement with cost which may be obtained against Calhoun County growing out of such injury or damages. Successful bidder shall procure and maintain, with respect to the subject matter of this bid and Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation and employer's liability insurance with adequate limits to cover bidder's liability as may arise directly or indirectly from work performed under terms of this bid and Contract. Certification of such coverage shall name Calhoun County as an additional insured and be provided to the County upon request. Term and Termination The term of the bid shall be for a one (1) year period beginning on January 1, 2022 and ending on December 31, 2021 and continue in full force and effect for the one (1) year period unless terminated in accordance with the terms of this bid. Before the end of the initial bid and contract term, the bid and contract has the option to renew yearly (one year terms) if agreeable with both the successful bidder and Calhoun County. Each yearly renewal must be approved by Commissioners Court prior to the end date of the contract. The bid and contract may be terminated by either party at any time for any reason upon giving sixty (60) days written notice to the other party of such termination. The successful bidder shall state therein the reasons for such cancellation. Prior written notice shall be delivered in person or sent by registered or certified mail, return receipt requested, proper postage paid and properly addressed to: 1) Calhoun County Adult Detention Center, Attn: Rachel Martinez, Jail Administrator, 302 West Live Oak Street, Port Lavaca, Texas 77979; 2) Calhoun County Sheriff, Attn: Bobbie Vickery, 211 South Ann Street, Suite 105, Port Lavaca, Texas 77979; 3) Calhoun County Judge, Attn: Richard H. Meyer, Calhoun County Courthouse, 211 South Ann Street, Suite 301, Port Lavaca, Texas 77979; and 4) Calhoun County Auditor, 202 South Ann Street, Suite B, Port Lavaca, Texas 77979. Either party has immediate termination rights for cause. Venue The bid will be governed and construed according to the laws of the State of Texas. All disputes shall be held in Calhoun County, Texas. This bid is performable in Calhoun County, Texas. Intentionally Left Blank Page 10 of 11 IT IS UNDERSTOOD THAT the Commissioners Court of Calhoun County, Texas reserves the right to waive any formality or irregularity, accept or reject any and/or all bids, to accept the bid deemed most advantageous to and in the best interest of Calhoun County. The award of the bid shall be made to the responsible bidder, whose bid is determined to be the most beneficial to Calhoun County and Calhoun County Inmates, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid. BIDS SHALL include the Invitation to Bid Form, attachments, if applicable, and all Required Forms. Any interlineations, alterations, or erasures made before receiving time shall be initialed by the signer of the bid, guaranteeing authenticity. The Invitation to Bid Form and all Required Forms shall be manually signed in ink by a person having the authority to bind the bidder in a Contract and placed in a SEALED envelope. The outside of the SEALED envelope shall clearly be marked with the bid number and name. LATE BIDS will be considered void and unacceptable. Calhoun County is not responsible for delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery or other delivery service, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid due date and time. The cell phone in the County Judge's office or cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the bid is received and the time the bids will be opened. BIDS will be received and publicly acknowledged at the location, date and time stated in these specifications. Bidders, their representatives and interested persons may be present at the bid opening. Bids will be reviewed bythe DETENTION FACILITY and once completed, their recommendation will be presented to Commissioners Court for the award. After the award, the awarded information will be available on the County's website (www.calhouncotx.org, under Bid Notices and Results, Results 2022) or by contacting Peggy Hall in the Auditor's office at 361-553-4610 or peggy.hall@calhouncotx.org. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit bids. Page 11 of 11 REQUIRED INFORMATION/FORMS INFORMATION/FORMS REQUIRED TO BE RETURNED WITH BIDDER'S BID Bidder must return the following information/forms with their Bid: • Invitation to Bid Form, page 1-17 (plus attachments, if applicable) • Affidavit • Bidder Information Form • Certificate of Interested Parties Form 1295 —Must include when submitting your bid • Certificate of Liability Insurance — Copy of your current coverage — This will provide proof that you carry at least the minimum required coverage — Once an award is made, the awarded bidder must provide a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • Conflict of Interest Questionnaire Form CIQ— Every bidder doing business with Calhoun County or seeking to do business with Calhoun County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. • Certification Regarding Debarment & Suspension and Other Responsibility Matters • Certification Regarding Lobbying • Disclosure of Lobbying Activities — If Not Applicable, bidder must mark NA and sign and date • House Bill 89 Verification • Residence Certification 0 W-9 INVITATION TO BID FORM • Return the Invitation to Bid Form, page 1-17 (plus attachments, if applicable) • Be sure to complete and sign the page 17 Calhoun County, Texas Calhoun County Adult Detention Center INVITATION TO BID FORM ANNUAL SUPPLY CONTRACT FOR INMATE FOOD SERVICES Bid Number 2022.04 January 1, 2022 thru December 31, 2022 With the option to renew yearly (one yearterms) if agreeable with both the successful bidder and Calhoun County. Bidder's Name and Address • PLEASE TYPE. IF HANDWRITTEN, MUST BE IN INK AND LEGIBLE. • WHITE OUT IS NOT ACCEPTABLE • ITEM OR ITEMS NOT BIDDING: MARK "NA" UNDER COST OR LEAVE BLANK • ADDING ITEMS: LIST ON A SEPARATE PAGE AND NOTE AS AN ATTACHMENT TO THE INVITATION TO BID FORM • SEE SPECIFICATIONS AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS • BE SURE TO COMPLETE, SIGN AND DATE THE LAST PAGE OF THE INVITATION TO BID FORM PLEASE NOTE: The bidder may request the Invitation to Bid Form be emailed to them in the Excel Format. If the bidder requests the Invitation to Bid Form be sent to them in the Excel Format, the bidder understands that the form and/or format shall not be changed in any way. The bidder shall not delete and/or add items to the Invitation to Bid Form. THE BIDDER UNDERSTANDS THAT BY CHANGING THE FORM AND/OR FORMAT OF THE INVITATION TO BID FORM IN ANY WAY SHALL DISQUALIFY THEIR BID. The Excel Format may be requested only as a means to enter the required information. Requests for the Excel Format of the Invitation to Bid Form must be sent to Peggy Hall, Assistant Auditor, at peggy.hall@calhouncotx.org or by calling 361-553-4610. Page 1 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Pack/Size Item # Pack / Size if different Brand Description Cost ESTIMATE on from Listed How Often Used: 1 / 40 lb Apples Sliced Solid Pack Fresh weekly 24 / 2 oz Apple Slice Red weekly 6/#10 Apple Sauce Unsweet weekly 6/#10 Apple Sauce Sweet weekly 1 1300 ct Bacon Precooked Thin weekly 1 130 lb Bacon Slab Sliced Raw weekly 12 16 ct Bagel Plain Sliced 2.3 oz weekly 6 / 5 lb Baking Powder quarterly 24 / 1 lb Baking Soda quarterly 1 / 40 lb Bananas green tip weekly 2 / 7 lb Base - Beef Granular quarterly 2 / 9 lb Base - Chicken Flavor Paste quarterly 1 / 5 oz Basil Ground quarterly 1 / 5 oz Basil Leaf quarterly 1 / 1 lb Bay Leaves quarterly 6/#10 Bean Baked Oven Prepared weekly 6/#10 Bean Chili Homestyle weekly 6/#10 Bean Chili Chuck Wagon Max weekly 1 / 20 lb Bean Cut Green Bean - Frozen weekly 6 / #10 Bean Cut Green Bean - Canned weekly 1 / 20 lb Bean Green Regular Cut weekly 6 / #10 Bean Kidney Dark Red quarterly 1 120 lb Bean Baby Lima Bean - Dry quarterly 1 120 lb Bean Navy Pea Dry quarterly 6/#10 Bean Pinto Fancy weekly 1 / 50 lb Bean Pinto Triple Clean Dried weekly 6 / #10 Bean Pork and Beans Fancy weekly 6 / #10 Bean Ranch Style Fancy weeny Page 2 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item # Pack / Size Pack/Size if different from Listed Brand Description Cost ESTIMATE on How Often used: 6 /#10 Bean Refried Weekly 6 / #10 Bean Vegetarian Baked Beans Weekly 4 / 5lb tub Beef BBQ Beef Chopped with Sauce Weekly 5 / catch Beef - Brisket Boneless 120 No Roll quarterly 2 17 lb avg Beef - Roast Top Round Cooked Quarterly 8 / 10 lb avg Beef Ground Fine 73/27 Weekly 4014 oz Beef - Patty 4/1 with Tvp weekly 40 / 4 oz Beef - Patty Breaded weekly 90 13 oz Beef - Patty Flame Broiled Quarterly 102 12.5 oz Beef Patty Charbroiled pre-cooked Quarterly 3 124 lb avg Beef Shoulder Clod Quarterly 4014 oz Beef Steak Fritter Natural 4/1 Raw Weekly 215 Ib Beef Stew Meat Weekly 160 / 1 oz Beef Steak Finger Breaded Cooked 1 oz Weekly 2418 oz Biscuits Buttermilk 10 ct Monthly 96 / 1.55 oz Biscuits Dinner Rolls Thaw & Serve weekly 216 12.2 oz Biscuits Dough Southern Style weekly 8 / 24 oz Bread Sandwich Wheat Loaf weekly 8 124 oz Bread Sandwich White Loaf weekly 6 / 12 doz Bread Tortillas Corn weekly 18 / 24ct Bread Tortillas Flour Weekly 1211 lb Bologna Turkey Club Weekly 1 / 20 lb Broccoli Cuts Weekly 12 149 oz Broth Chicken Quarterly 2 / 20 at Bun Hamburger Wheat Weekly 618 ct Bun Hamburger Wheat weekly 2 120 ct Bun Hamburger White Weekly 6 18 ct Bun Hamburger White Weekly 6 112 ct Bun Hot Dog Weekly 72 / 4 oz Burrito Beef & Bean Weekly 64 14 oz Burrito Beef & Bean Red Chili Weekly Page 3 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Pack/Size Item # Pack / Size if different Brand Description Cost ESTIMATE on from Listed How Often Used: 1 / 50 lb Cabbage Green Monthly 6 / 5 lb Cake Mix Chocolate Monthly 6 / 5 lb Cake Mix Devils Food Monthly 615 lb Cake Mix White Monthly 6 / 5 lb Cake Mix Yellow Monthly 1 / 12 ct Cantaloupe Fresh weekly 1 / 50 lb sack Carrots Jumbo weekly 12 / 2 lb Carrots Diced weekly 6 / #10 Carrots Sliced Canned weekly 1 / 20 lb Carrots Smooth Sliced weekly 6 / #10 Carrots Sliced Medium weekly 1 120 lb Cauliflower LOF Monthly 1 140 lb Celery Fresh weekly 4 / 26 oz Cereal Bulk Corn Flakes weekly 12 / 28 oz Cereal Cream of Wheat weekly 12 / 28 oz Cereal Farina Enriched weekly 4 / 45 oz Cereal Bulk Frosted Flakes weekly 4 146 oz Cereal Bulk Fruit Dyno Bites weekly 4139 oz Cereal Bulk Honey Nut Cheerios weekly 1 / 50 lb Cereal Oats Rolled #5 weekly 6 / 36 oz Cereal Bulk Raisin Bran weekly 4 / 35 oz Cereal Rice Tootie Fruitie Weekly 6 15 lb Cheese American Melt Loaf Monthly 6 / 5 lb Cheese Product American 120 Slices weekly 4 / 5 lb Cheese American 184 Slices weekly 4 / 5 lb Cheese Chedder Shredded Imitation quarterly 2 / 5 lb Cheese Chedder Jack Shredded weekly 2 / 5 lb Cheese Cheddar & Mont. Jack Shreeded weekly 2 / 5 lb Cheese Cottage Cheese Sm Curd 4% weekly Page 4 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Pack/Size Item # Pack / Size if different Brand Description Cost ESTIMATE on from Listed How often Used: 10 / 3 lb Cheese Cream Cheese Loaf Grade A Monthly 6 / 5 lb Cheese Melting Loaf Yellow Monthly 4 15 lb Cheese Mozzarella Reg Shredded monthly 2 / 5 lb Cheese Pimento Cheese Spread Monthly 6129 oz Cheese Powdered Cheese Mix Weekly 6 15 lb Cheese Queso Melt Weekly 4 / 10 lb Chicken Boneless Skinless Chicken Thighs - Plain Weekly 1 110 lb Chicken Boneless Skinless Chicken Thighs - Flavored Weekly 6013.1 oz Chicken Breast Patty Breaded Weekly 160 / 3 oz Chicken Patty Breaded Cooked Weekly 2 / 5 lb Chicken Breaded Chicken Fritter Weekly 107 / 1.5 oz Chicken Breakfast Patty Quarterly 2 / 5 lb Chicken Diced All White Cooked Weekly 52 / 3 oz Chicken Breast Fillet Fajita monthly 1 / 10 lb Chicken Fajitas Sliced Chicken Raw weekly 2 / 5lb Chicken Fajita Strip Cooked Monthly 2 15 lb Chicken Fajita Meat Lacocina Monthly 1 / 10 lb Chicken Fajita Thigh Meat Frozen Monthly 4 / 10 lb Chicken Leg Meat Bonless Weekly 1 / 20 lb Chicken Nuggets Raw Monthly 4 110 lb Chicken Thigh Meat Raw Frozen Monthly 4 14 lb Chili Frozen - With Beans Weekly 6 / 5lb Chili Frozen - Without Beans Weekly 6 / #10 Chili Canned - With Beans Weekly 6 / #10 Chili Canned - Without Beans Weekly 6 / #10 Chili Hot Dog Sauce w/meat Monthly 6 / 1 Ib Chip Frito Corn Bulk Weekly 10 / 16 oz Chip Potato Kettle Weekly Page 5 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item# Pack If Size Pack / Size if different from Listed Brand Description Cost Estimate on How Often used: 6116 oz Chip Potato Regular Bulk weekly 8 / 16 oz Chip Potato Ridged Ruffled weekly 6 12 lb Chip Tortilla Yellow Round weekly 3 / 50 ct Chip Variety weekly 1 / 5 lb Cinnamon Ground Monthly 1 / 10 lb Coconut Sweetened Coconut Monthly 12 / 2 lb Coffee Traditional Weekly 12 / 2 lb Coffee Can weekly 42 11.25 oz Coffee Todays Gourmet w/Filter weekly 4 / 5 lb ct Coleslaw Mix Shredded weekly 1 / 10 lb Cookie Chocolate Chip Weekly 1 / 10 lb Cookie Oatmeal Homestyle weekly 1 110 lb Cookie Sugar Homestyle weekly 1 / 51b Cookie Vanilla Wafers Weekly 320 / 1 oz Cookie Dough Chocolate Chip Weekly 320 / 1 oz Cookie Dough Oatmeal Raisin weekly 320 / 1 oz Cookie Dough Sugar Weekly 6 / #10 Corn Cream Style Monthly 1 / 20 lb Corn Cut Weekly 6 / 2 lb Corn Corn Nuggets Sweet Battered weekly 6 / #10 Corn Whole Kernel Fancy Canned Weekly 240 / .67 oz Corn Dogs No Sticks weekly 240 / .67 oz Corn Dogs Turkey Mini - No Sticks weekly 6 / 5lb Cornbread Mix Homestyle weekly 6 / 3.5 lb Cornbread Stuffing Mix Monthly 1 / 25 lb Cornmeal quarterly 200 12 pk Crackers Graham Honey Mid - Individually Wrapped Monthly 12 116 oz Crackers Saltine - Bulk Weekly 500 / 2 pk Crackers Saltine - Individually Wrapped Monthly 300 / 2 pk Crackers Cafe Club Monthly 24 / 12 oz Creamer Non Dairy Canister Weekly 1 / 4.5 lb Cumin Ground Quarterly Page 6 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item # Pack / Size Pack/Size if different from Listed Brand Description Cost Estimate on How often Used: 4/1 gal Dressing Coleslaw quarterly 200 / 12 gm Dressing PC Italian Packets Monthly 4 11 gal Dressing Lt Italian Dressing Gallon Monthly 4 11 gal Dressing Ranch Buttermilk Gallon quarterly 200 / 12 gm Dressing PC Ranch Buttermilk weekly 18 13.2 oz Dressing Ranch Mix weekly 60 11.5 oz Dressing PC Thousand Island Monthly 4 / 1 gal Dressing Honey Mustard Monthly 12 124 oz Drink Mix Fruit Grape Powdered weekly 12 / 24 oz Drink Mix Strawberry Powdered weekly 12 / 24 oz Drink Mix Fruit Punch Powdered weekly 12124 oz Drink Mix Pink Lemondade Powdered weekly 12 / 24 oz Drink Mix Peach Powdered weekly 12 11.8 oz Drink Mix Sugar Free Fruit Punch Powdered weekly 12 / 2.2 oz Drink Mix Sugar Free Pink Lemonade Powdered weekly 15 12 lb Egg Mix Scrambled w/2% Milk weekly 1 120 lb Eggs Whole Liquid w/citric weekly 2 120 lb Egg Whole Liquid w/citric weekly 200 / 1 oz Egg Scrambled Patty Round weekly 1 110 lb Egg Hard Cooked Peeled weekly 1 / 200 at Egg Fresh Shell Jumbo USDA weekly 90 / 1.75 oz Enchilada Cheese IQF weekly 1 /pt Extract Vanilla Imitation quarterly 1 / 15 lb Fillet Swai Fillet 5-7 oz weekly 1 / 10 lb Fish Strip 1.5 oz Breaded weekly 4 110 lb Fish Pollock Fillet 4-6 oz weekly 1 / 10 lb Fish Pollock Rect Breaded Wg weekly 1150lb Flour All Purpose Monthly 80 12 oz Franks All Meat 8/1 Monthly 2 15 lb Franks Turkey Monthly 6 / 5 lb French Fries RC 3/8 IN weekly 6 / #10 Fruit Cocktail X Lt Syrup weekly 6 / #10 Fruit Mix Lt Syrup weekly Page 7 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item # Pack / Size Pack/Size if different from Listed Brand Description Cost ESTIMATE on Howaften Used: 1 / 7 lb Garlic Granulated Monthly 24 / 3.14 oz Gelatin Cup Monthly 12 / 24 oz Gelatin Mix Mixed Assorted Citrus Monthly 12 / 24 oz Gelatin Mix Lime Monthly 12 / 24 oz Gelatin Red Variation Monthly 1 / 35 Ib Grapefruit Ruby Choice 40 weekly 6 / 13 oz Gravy Mix Brown Country Style Monthly 6 114 oz Gravy Mix Chicken Monthly 6 / 24 oz Gravy Mix Peppered Monthly 6 / 11.3 oz Gravy Mix Pork Roast Monthly 6 111.3 oz Gravy Mix Turkey Roasted Monthly 6 / 3 lb Greens Mustard Greens weekly 2 / 10-12 lb Ham Buffet Style weekly 6 / 5 Ib Ham Chopped quarterly 4 / 3 lb Ham Pre -Sliced Quarterly 2 / 13 Ib Ham Shaving Cooked 4 x 6 Deli weekly 2 / 10-12 lb Ham Shaving Smoked Boneless Quarterly 4 / 3 lb Ham Sliced Smoked Quarterly 2 / 20 at Hamburger Buns weekly 120 / 2.2 oz Hashbrowns Golden Patty weekly 6 / 3 Ib Hashbrowns Redi Shred weekly 6 / 3 lb Hashbrowns Lqf Shredded weekly 1 / 30 lb Honey Dew Melon US #1 8 ct weekly 6 / 12 ct Hot Dog Buns weekly 2 / 5 lb Hushpuppies Regular Round weekly 4 / 5 lb Hushpuppies Homestyle weekly 1 / 12 lb Icing Chocolate Quarterly 1 / 12 lb Icing Vanilla Quarterly 200 / .5 oz Jelly PC Assorted Cup Monthly 200 / .5 oz Jelly PC Grape Cup weekly 70 / 4 oz Juice Apple 100% Carton Carton weekly 70 / 4 oz Juice Orange 100% Carton weekly Page 8 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Pack / Size Item# Pack If Size if different Brand Description Cost ESTIMATE on from Listed Now often Used: 1000 19 gr Ketchup Individual Packets Weekly 6 / #10 Ketchup Standard Weekly 1 / case Lettuce Iceberg Weekly 4 / 5 lb Lettuce Shred 1/4 Inch Weekly 900 / 5 gr Margarine PC Cup Spread Monthly 432 / 14 gr Margarine pcks 30 / 1 Ib Margarine Solids Pure Vag Monthly 12 116 oz Marshmallows Jet Puffed Quarterly 4 / 1 gal Mayonnaise Heavy Duty Gallon Monthly 200 / 12 gm Mayonnaise PC Weekly 1 / 30 lb Melons Honey Dew US #1 8 ct Weekly 2 / 5 lb Meatballs Beef & Chicken weekly 320 / .5 oz Meatballs Flame Broiled Weekly 76 / 3.15 oz Meatloaf Patty Deluxe Weekly 24 114 oz Milk Condensed Sweetened Monthly 24 / 12 oz Milk Evaporated Monthly 1 / 25 lb Milk Powdered Skimmed NF Monthly Milk Powdered Homo Vitamin D Monthly 4 11 gal Milk 2% Reduced Fat 1 Gallon Weekly 4 11 gal Milk Homo Vitamin D 1 gallon weekly 25 / 1/2 pt Milk 1% Reduced Fat 1/2 pint cartons weekly 25 / 1/2 pt Milk 2% Reduced Fat 1/2 pint cartons weekly 25 / 1/2 pt Milk Homo Vitamin D 1/2 pint cartons weekly 4 / 1 gal Mustard Prepared Gallon Quarterly 500 15.5 gr Mustard PC Pouch weekly Page 9 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Pack/Size Item# Pack/Size if different Brand Description Cost ESTIMATE on from Listed How often Used: 6 11 gal Oil Butter Flavored Monthly 6 / 1 gal Oil Pan & Grill Trans Fat Free Monthly 6 / 17 oz Oil Pan Spray Monthly 1 / 35 lb Oil Shortening Clear Fry Monthly 1 / 20 lb Okra Cut 1/2 inch Grade A weekly 1 / 20 lb Okra Cut Heavily Breaded weekly 6 / 2 lb Okra Cut Breaded Southern Style weekly 1 / 3 lb Onion Dried Flakes Chopped Monthly 4 / 5 lb Onion Sliced Monthly 1 / 50 lb Onion Yellow Jumbo Sack Monthly 1 / 35 lb Oranges Fresh weekly 1 / 35 lb Orange Choice weekly 6 / #10 Oranges Mandarin Oranges Broken Lt weekly 1 / 12 oz Oregano Ground quarterly 144 / 1.2 oz Pancake Original - Frozen weekly 1 / 10 oz Parsley Flakes quarterly 2 / 5lb Pasta Egg Noodle Wide 1/2 Inch Monthly 2 / 10 lb Pasta Elbow Macaroni Monthly 12 / 16 oz Pasta Lasagna Ribbed Monthly 2 / 10 lb Pasta Spaghetti Thin 10 Inch Monthly 6 / #10 Peaches Sliced Extr Lt Syrup weekly 6 / #10 Peaches Diced Extra Lt Syrup weekly 6 / 5 Ito Peanut Butter Creamy weekly 200 / 0.75 oz Peanut Butter Pc weekly 6 / #10 Pears Sliced Light Syrup weekly 6 / #10 Peas Blackeyed weekly 1 / 20 Ito Peas Peas & Diced Carrots Frozen weekly 1 /20lb Peas Green weekly Page 10 of 17 Invitation to Sid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item# Pack/Size Pack/Size if different from Listed Brand Description Cost ESTIMATE on How Often used: 6 / #10 Peas Sweet Mixed weekly 1118 oz Pepper Black Gourd Fine Pure Monthly 12 / 27 oz Peppers Chili Diced Green Monthly 1/1 1/9 Bulk Pepper Bell Green Chopper Monthly 6/#10 Pepper Jalapeno Nacho Sliced quarterly 1 / 7 lb Pepper Lemon Seasoning Quarterly 4 11 gal Pickles Dill Relish Monthly 1 15 gal Pickles Dill Sliced Hamburger Monthly 6 / 43 oz Pie Pumpkin 10 Inch PreBaked - Quarterly 6 181 oz Pineapple Chunks in Extra Lt Syrup weekly 6 / #10 Pineapple Sliced in Juice weekly 6 / #10 Pineapple Tidbits in Juice weekly 128 / 3.31 oz Pizza Breakfast Turkey Sausage Monthly 96 / 4.48 oz Pizza Pepperoni Whole Grain Monthly 36 18 oz Popcorn Kit All In One Monthly 6 / 6-8 lb Pork Loins Boneless Monthly 40 / 3.75 oz Pork Patty Breaded Cooked Monthly 52 13.1 oz Pork Patty Rib Shape Cooked Monthly 46 13.5 oz Pork Rib Patty Monthly 80 13 oz Pork Rib Patty w/BBQ Sauce Monthly 6 12.5 lb Potato Hashbrown Red! Shred weekly 6 / #10 Potato Instant with milk weekly 1 150 lb Potato Idaho #2 weekly 1 / 50 lb Potato Red #2 weekly 1 / 50 lb Potato Russet 10 oz US #2 weekly Potato Russet 80 ct IDA weekly 6/#10 Potato Sweet Cut Fancy weekly 8 15 lb Potato Tater Bites Seasoned weekly 6 15 lb Potato Tater Tots weekly 6/#10 Potato White Diced weekly 6 / #10 Pudding Banana weekly 6 / #10 Pudding Chocolate weekly 24 13.625 oz Pudding Chocolate Sugar Free weekly 6/#10 Pudding Lemon weekly 6 / #10 Pudding Tapioca weekly 6 / #10 Pudding Vanilla weekly 6 / #10 Pudding Vanilla Sugar Free weekly Page 11 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Pack/Size Item # Pack / Size if different Brand Description Cost ESTIMATE on from Listed How Often Used: 24/6/1 oz Raisins Individual Packs weekly 24 / 15 oz Raisins Golden Seedless weekly 6 / #10 Ravioli Beef RTU weekly 1 150 lb Rice Long Grain weekly 1 150 lb Rice Long Grain Parboiled 4% Broken weekly 4 / 1 gal Relish Dill Premium Monthly 4 / 5 lb Salad Mix Lettuce in Bag weekly 1 / 30 Ib Salad Potato Homestyle Monthly 384 /.5 oz Salami All Meat Sliced weekly 1 / 25 lb Salt Iodized Table quarterly 4 / 1 gal Sauce BBC Monthly 6 / #10 Sauce Cheese weekly 6 / #10 Sauce Cheese Nacho weekly 24 / 14 oz Sauce Cranberry Jellied quarterly 4 / 1 Gal Sauce Enchilada Mild RTU weekly 6/#10 Sauce Enchilada Mild RTU weekly 4/#10 Sauce Manwich Sloppy Joe weekly 4 11 Gal Sauce Picante Mild Gallon Monthly 6 / #10 Sauce Pizza weekly 4 / 1 gal Sauce Soy Sauce Gallon Monthly 6 / #10 Sauce Spaghetti RTU weekly 200 / 9 gr Sauce PC Taco weekly 50019 gr Sauce PC Taco weekly 200 / 7/16 oz Sauce Tarter Creamy Packets weekly 6/#10 Sauce Tomato Fancy weekly 4 / 1 gal Sauce Worcestershire quarterly 2 / 5 lb Sausage Beef Breakfast Chorizo weekly 107 11.5 oz Sausage Chicken Patty Cooked weekly Page 12 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item If Pack / Size Pack/Size if different from Listed Brand Description Cost ESTIMATE on How Often Used: 128 / 1.25 oz Sausage Turkey Cooked weekly 2 / 5 Ito Sausage Chorizo Pork Raw weekly 2 / 5 lb Sausage Ground Bulk Raw Mild weekly 200 / .8 oz Sausage Link Natural .8 oz Cooked weekly 92 / 1 oz Sausage Link Mild 1 oz Cooked weekly 2 / 5lb Sausage Pork Topping Cooked weekly 1 110 lb Sausage Smoked Rope Cooked weekly 154 11.25 oz Sausage Patty Cooked weekly 12 / 17 oz Seasoning Creole quarterly 1 / 8 to Seasoning Creole Original quarterly 1 124 oz Seasoning Mexican Rub Mix quarterly 1 123 oz Seasoning Montreal quarterly 114.5 lb Seasoning Salt Traditional Monthly 6 / 15 oz Seasoning Sloppy Joe Mix weekly 1 / 24 oz Seasoning Taco Quarterly 1 / 35 lb Shortening Clear Fry Liquid Monthly 12 / 50 oz Soup Chicken Noodle Monthly 12 150 oz Soup Cream of Chicken Monthly 12 150 oz Soup Cream of Mushroom Monthly 12 / 50 oz Soup Cream of Potato Monthly 12 / 50 oz Soup - Tomato Monthly 12 / 50 oz Soup - Vegetable Monthly 4 15 lb Sour Cream Cultured Monthly 6 / #10 Spinach Chopped Fancy weekly Vol Fill Squash Zucchini Mad 18-25 weekly 24 / 1 Ito Starch Corn quarterly 6 / 3.5 lb Stuffing Mix Cornbread weekly 12/2 lb Sugar Brown light in Bag Monthly 1 / 50 lb Sugar Pure Cane Extra Fine weekly 1 150 lb Sugar Pure Cane Granulated weekly 12/2 Ito Sugar Powdered White quarterly 100 / 1 oz Syrup PC Pouch -Cup weekly 100 / 1 oz Syrup PC Pouch -Cup Sugar Free 1 oz Monthly Page 13 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Pack/Size Item# Pack/Size if different Brand Description Cost ESTIMATE on from Listed How often Used: 96 11 oz Tea Bags 1 oz weekly 96 11 oz Tea Iced Filter Pouch 1 Gal weekly 1 125 lb Tomatoe Bulk Cafe weekly 6/#10 Tomatoe Diced in Juice weekly 12 128 oz Tomatoe Diced With Green Chilis Monthly 1 125 lb Tomato Roma #2 weekly 6 / #10 Topping Chocolate Fudge Monthly 12/1 lb Topping Whip Mix Add Water quarterly 6166.5 oz Tuna Chunk Light in Water Monthly 12 / 1 lb Turkey Breast Lunchmeat Combo weekly 218-9 lb Turkey Breast Oven Roasted Monthly 2 / 9.9.5 lb c Turkey Breast Smoked Skinless Monthly 4 / 10 lb Turkey Ground Tubes 80/20 weekly 2 / 7-8 lb Turkey Ham Buffet Deluxe weekly 5 15 lb Turkey Medallion Roasted Monthly 215 lb Turkey Ham - Diced Cured weekly 128 11.25 oz Turkey Sausage Patty Cooked weekly 61 #10 Vegetables - Mixed Fancy weekly 1 120 lb Vegetables - Blend Peas & Carrots weekly 6/#10 Vegetables For Stew Fancy Chunky Monthly 12/2 lb Vegetables - Blend Stir Fry Monthly 1120 lb Vegetables - Mixed 5 Way weekly 12 / 12 ct weekly rYams-Cut id 6/#10 Monthly 20/1 Ib nt ReI Label quarterly Page 14 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item # Pack / Size Pack / Size if different from Listed Brand Description Cost ESTIMATE on How often Used: NON FOOD ITEMS: 10 1100 ct Apron, Plastic Full Length Med Wt 24x42 Quarterly 1 1100 ct Apron, Plastic White Disposable Quarterly 1 1500 ct Bag Ice 10 lb Draw String 1 / 2000 ct Bag Sandwich w/Flip Top Quarterly 1 1500 ct Bag Sandwich Reclosable 6.5x6 Quarterly 1 / 500 ct Bag Zip Seal Quart Quarterly 1 / 200 ct Bag Freezer Reclosable 1 Gallon Quarterly 1 / 250 ct Bag Reclosable Zip 1 Gallon Quarterly 1 1100 ct Bag Freezer Reclosable Zip 2 Gallon Quarterly 1 1500 ct Bag - White Paper Bag 128 / 2 oz Cleaner Floor Degreaser Quarterly 64 12 oz Coffee Filter Packs monthly 2 / 100 ct Container Foam Hngd 3-c White Quarterly 40 / 25 ct Cup, Foam 12 oz Monthly 40 125 ct Cup, Foam 16 oz Monthly 10 1100 ct Cup Lids for 12 oz Monthly 10 1100 ct Cup Lids 12L Trans Slotted monthly 10 1100 ct Cup Lids for 16 oz monthly 10 1100 ct Cup Lidis for 16L Trans Slotted Monthly 2 / 1 gal Detergent Paramount Heavy Duty weekly 1 / 5 gal Detergent Speed Clean weekly 1 / 5 gal Detergent Dishwasher weekly Page 15 of 17 Invitation to Bid Form -Annual Supply Contract for Inmate Food Services --CONTINUED Item # Pack / Size Pack/Size if different from Listed Brand Description Cost ESTIMATE on How often Used: 11 roll Film 18 x 1000 Clear Wrap Monthly 1 / roll Foil 18 By 1000 1 / roll Foil 24 x 500 #633 EX H Monthly 4 110 ct Grill Cleaning Pad weekly 10 / 100 ct Gloves Clear Plastic Large weekly 10 1100 ct Gloves Vinyl Powder Free Large weekly 10 / 100 ct Gloves Vinyl Powder Free Marge weekly 1 / 144 ct Hairnet Dark Brown Light Weight weekly 1 / roll Label 100% Dissolvable weekly 1 / 250 ct Label 2 x 3 Dissolvable Use By weekly 1 / 1000 ct Liner Pan Lift Off Grease Monthly 1 / 250 ct Meal Kit (K F S Napkin) MW W quarterly 1 ea Mitt - Oven Mitt Black 17 1 / roll Plastic Wrap Monthly 1 / 5 gal Rinse Aid Fast Dry weekly 6 / 1 qt Sanitizer Redi San Rtu weekly 4 / 500 ct Straws 7.75 Jumbo Clear Wrap Monthly BE SURE TO COMPLETE, SIGN AND DATE THE NEXT PAGE Page 16 of 17 Invitation to Bid Form - Annual Supply Contract far Inmate Food Services --CONTINUED Food and Non -Food Items not listed on this Invitation to Bid Form shall be provided at: Cost Plus % Basis Other equipment, services or products used in the DETENTION FACILITY'S Kitchen will be offered at: Free of Charge, a Discounted Price, or Cost Plus % Basis Example: Dispensers for coffee, chemicals and other products Bidder understands that Calhoun County or their representative may audit the Cost Plus Percentage Basis at any time and the documentation necessary for this audit will be provided at no additional charge to Calhoun County. Attachment(s) to Invitation to Bid Form: YES NO The undersigned affirms that they are duly authorized to execute this bid and that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder, that the contents of this bid as to prices, terms or conditions of said bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with this bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands and has followed all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date Authorized Signature & Title: Type Name & Title of Authorized Signature: Phone Number: Email: Exceptions and/or Variations from Specifications and/or Additional Notes: Page 17 of 17 AFFIDAVIT • Complete and return this form with your bid STATE OF {} AFFIDAVIT COUNTY OF {} The undersigned certifies that the bid price contained in this bid has been carefully checked and is submitted as correct and final and if bid is accepted, agrees to pay for said lease upon the conditions contained in the Agricultural Lease, Specifications and General Conditions. BEFORE ME, the undersigned authority, on this day personally appeared known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bid 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 leases bid on, or to influence any person to bid or not to bid thereon. I affirm that I am duly authorized to execute this bid, that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder. I further affirm that the bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid. The contents of this bid as to price, terms or conditions of said bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business or to any official, employee or agent of Calhoun County prior to the official opening of this Bid. Affiant Printed Name and Title of Affiant Name of Bidder (Company) Address Phone Number Fax Number Email Address SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of , zD Notary Public, State of Stamp/Seal My Commission Expires BIDDER INFORMATION FORM • Complete and return this form with your bid BIDDER INFORMATION Please Type. If handwritten, must be in ink and legible Bidder's Name: Address: Remittance Address: Telephone: Fax: Email: Signature of Authorized Representative: Printed name of Authorized Rep: ORDER - CONTACT INFORMATION Order Contact Name & Title: Order Contact Telephone: _ Order Contact Fax: Order Contact Email: INVOICES - CONTACT INFORMATION INFORMATION FOR INVOICE CONCERNS AND/OR CORRECTIONS Address all Invoice Inquiries to: Contact Name & Title: Contact Telephone: Contact Fax: Contact Email: CERTIFICATE OF INTERESTED PARTIES, FORM 1295 • Form 1295 must be filled out online, printed, #6 completed including signature and returned with bidder's bid. The copy included is a Sample Copy Only. • Return completed Form 1295 with your bid #1 Bidder's Name, City, State and Country #2 Calhoun County, Texas #3 Bid Number2022.04 Annual Supply Contract for Inmate Food Services January 1, 2022 thru December 31, 2022 On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, sign and print When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". Be sure that all of #6 is completed and signed. Do not leave out any information. The form does not need to be notarized. It is an Unsworn Declaration. CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. ♦ 3 Provide the identification number used by the governmental entity or state agency to tyyyik 3 identify the contract, and provide a description of the services, goods, or other property to be provided ue contract. 4 City, State, Country ature of Interest (check applicable) Name of Interested Party (place of business) C J Controlling Intermediary X Ilk 64 5 ❑Check only if there' I terestedParty. 6 UNSWORN DEC=Lt@ N My name is �`` , and my date of birth is My addre� (street) (city) (state) (zip code) (country) under penalty of perjury that the foregoing is true and correct. E ecuted in County, State of on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission w .ethics.state.tx.us Revised 1212212017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84' Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 851 Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state.tx.us/whatsnew/elf info forml295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. COPY OF CURRENT CERTIFICATE OF LIABILITY INSURANCE • Return a copy of your current Certificate of Liability Insurance with your bid. This copy of your current insurance will provide proof that you carry at least the minimum required coverage. At this time, this copy does not require listing Calhoun County as an additional insured. • Once an award is made, the awarded bidder must provide Calhoun County a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. • See General Conditions and Specifications for complete insurance requirements CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ • Complete and return this form with your bid • Every vendor doing business with the County or seeking to do business with the County must complete Box 1 and sign and date in Box 7. Whether or not a conflict exists determines the other information to include on the form. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. t Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 31 Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes FIND B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes E-1 No 6 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code 4 176.0010 -a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code S 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code 6176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS • Complete and return this form with your bid CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. Name and Title of Authorized Agent Signature of Authorized I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING LOBBYING • Complete and return this form with your bid Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 at seq., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official Date DISCLOSURE OF LOBBYING ACTIVITIES • Complete and return this form with your bid If Not Applicable, bidder must mark NA and sign and date Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial filing b. grant _ b. initial award _ b. material change c. cooperative agreement c. post -award d. loan For material change only: e.loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Prime _ Subawardee Name and Address of Prime: Tier_, if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ifapplicable: S. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (ifindividual, last name, first name, MI): diferenifi»m No. IOa) (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report, Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the let tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0346- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 HOUSE BILL 89 VERIFICATION • Complete and return this form with your bid HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 the undersigned representative of Representative (hereafter referred to as Company) being an Company or Business Name adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel; and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for -profit sole proprietorship, organization, association, corporation, partnership, Joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. Signature of Representative Print Name & Title Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount. RESIDENCE CERTIFICATION • Complete and return this form with your bid 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. ❑ I certify that (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) ❑ 1 certify that is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION • Complete and return this form with your bid WMe Request for Taxpayer Give Form to Form (Rev. October 2018) Identification Number and Certification the requester. Do not Im Reven�euaService a ► Go to warmilm.govfFontriW9 for instructions and the latest information. send to the IRS. t Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business nameldisregarded entity name, If different from above m S Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to 1) following seven boxes. certain entities, not indidduais; a" n li ❑ Individuallsole proprietor or ElC Corporation ❑ S Corporation ElPartnership ❑ TrnsVeslate Instructions on page 3): osingfe-member LLC Exempt payee code Of any) ❑ Umited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)► S 2 Note: Chwkthe appropriate box in the line above forthe tax classification of the single -member owner. Oo not check Exemption from FATCA reporting $ D LLC it the LLC Is classified es a aingle-member LLC that is disregarded tram the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that code (deny) a IS is disregarded from the owner should check the appropriate box for the tax classification of its owner. X ❑ Other (am Instructions) ► Wo•ce.romauwm6,umeeamw�meus� q 5 Address (number, street, and apt. or suite no.) See instructions. Requester's time and address (optionsoj CALHOUN COUNTY e 202 S ANN ST, PORT LAVACA TX 77979 6 City, stele, and ZIP cede 361.553-4610 FAX: 361-553-4614 7 Ust account numbers) here (optional) Tax aver Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the time given on line 1 to avoid I Social security number _ backup withholding. For Individuals,this Is generally your social security number (SS". However, fora resident alien, sole proprietor,,or or disregarded regarded entity, see the instructions for Part I, later. For other eMNes, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer Identification number Number To Give the Requester for guidelines on whose number to enter. nF-1 F_T_­T__T__r Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2.1 am not subject to backup withholding because; (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this forth Of any) Indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out Item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provlde your correct TIN. See the Instructions for Part 11, later. Here General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Forth W-9 and Its instructions, such as legislation enacted after they were published, go to www.IrsgovyFormW9. Purpose of Form An Individual or entity (Forn W-9 requester) who Is required to file an Information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN), Individual taxpayer identification number (ITIN), adoption taxpayer identification number (4TIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Forth 1099-INT Qnterest earned or paid) Date ► • Forth 1099-DIV (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan Interest), 1098-T (tuftion) • Forth 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Forth W-9 only if you are a U.S. person Qncluding a resident Wien), to provide your correct TIN. If you do not return Foon W-9 to the requester with a TIN, you might be subject to backup withholding. Sea What is backup withholding, later. Cat. No. 10231x Form W-9 (Rev. 10-2018) CURRENT INFORMATION RENEWAL, CONTRACT CURRENT GROCERY PRICING LIST January 1, 2021 thru December 31, 2021 RENEWAL OPTION FOR THE CONTRACT FOR FOOD SERVICES FOR THE CALHOUN COUNTY ADULT DETENTION CENTER THE STATE OF TEXAS COUNTY OF CALHOUN WHEREAS, Calhoun County, Texas acting through their Adult Detention Center hereinafter called the "JAIL" and Ben E. Keith Company hereinafter called "PROVIDER" did enter into a contract dated December 19, 2018 for the CONTRACT year beginning January 1, 2019 and ending December 31, 2019 and renewed on November 13, 2019 for the year beginning January 1, 2020 and ending December 31, 2020 as described in said contract and renewal. In the CONTRACT, the JAIL did grant unto PROVIDER the option to renew yearly upon Commissioners Court approval prior to the end date of the preceding contract and both the JAIL and PROVIDER agree to said renewal. THEREFORE, the CONTRACT term shall be extended for an additional year, the additional year running from January 1, 2021 and continuing through December 31, 2021. JAIL and PROVIDER agree that during the Additional Year, the contract will continue as written. EXECUTEDthisthe %' dayof _ac-0/,7 ey 2020. JAIL: CA OU COUNTY,TEXAS I Richard H. Meyer, Calho County Judge By: Deputy PROVIDER: -e� Emily Lyn , District Sales Manager Ben E. Keith Company COUNTY CLERK g,asa S`�e000scwvice o�siaieuioae„ Calhoun County Adult Detention Center 302 West Live Oak Street Port Lavaca, TX 77979 Customer #318222 10/9/2020 Ben E. Keith would like to offer a one-year renewal, January 1, 2021, thru December 31, 2021, on the current Contract for Food Services and Grocery Pricing List with the Calhoun County Adult Detention Center. This renewal is in compliance with the contract awarded December 19, 2018 for the current year January 1, 2020 thru December 31, 2020. Thank you for your business and your consideration. Sincerely, Emily Lynch District Sales Manager 361-205-4070 eslynch@benekeith.com CONTRACT FOR FOOD SERVICES CALHOUN COUNTY ADULT DETENTION CENTER STATE OF TEXAS COUNTY OF CALHOUN This agreement is by and between 3Eiy E. eel iY Name of Company hereinafter called "Provider' and Calhoun County acting through their Adult Detention Center hereinafter called the "Jail" and is to provide for the furnishing of food and food stuffs to the Jail. The effective date of this agreement is January 1, 2019 and is for a period of one year from that date. This agreement will end on December 31, 2019. This agreement has the option to renew yearly upon Commissioners' Court approval. Each additional year renewal must be approved by Commissioners' Court prior to the end date of the preceeding contract. The food and non-food items to be provided are set out in the attached Grocery Pricing List and said prices will be honored for the one year period. Any items ordered not on the attached Food Bid Pricing List shall be provided at Cost Plus /Z % basis. The Jail may audit the Cost Plus % basis at any time and the Provider will provide the Jail with documentation necessary for this audit at no additional charge. The Jail agrees to pay for said food, non-food items or goods upon presentation of an invoice and verification that said food, non-food items or goods have been delivered and received. Provider will use its best efforts to provide quality products and good and healthy food but makes no warranties express of implied about their fitness for use. Page 1 of 3 Provider will provide products that are needed for inmates with high blood pressure, diabetics or for religious reasons. Provider will offer other equipment, services or products used in kitchen at free of charge, discounted price, or Cost Plus 1?—% basis if available. These products include dispensers for coffee, chemicals and other products used in kitchen. Provider will include all charges in the bid price. No other charges may be added unless noted as an exception. All bid prices must be good for the entire bid period. Once awarded, if an item(s) is substituted, the item(s) must be of equal or lower in price. The substituted item cannot go over the bid price for that item. Deliveries will be made at specific times (at least twice a week) and in sufficient quantities to ensure that there will be sufficient food on hand at the jail to make and provide all meals. Deliveries will be made between Monday and Friday between the hours of 7:00 AM to 10:00 AM and 1:00 PM to 4 PM in order not to disrupt the jail kitchen in preparing meals. Should an ordered item(s) not arrive as ordered, wrong item(s) is delivered, or item(s) is delivered damaged, Provider will deliver the correct or substitute item(s) within 24 hours from the date the missing or damaged item(s) was supposed to be delivered. No extra charges will be allowed to be billed to correct the error or damaged item(s). Liquid items will be delivered in plastic crates to prevent damages when stacked. A sales representative from the Provider shall contact the Jail Administrator or Jail Kitchen Officer at least monthly, in person, to discuss any issues or new products offered. Page 2 of 3 All products on the bid list are speculative products and should not be considered as firm products to be purchased during the term of the agreement. Order processing will be made available by fax and / or website. By acceptance of this agreement Provider agrees to notify the Jail Administrator or Sheriff of any solicitations from employees of Calhoun County for services not officially associated with jail operations. Provider is prohibited from offering, giving, selling, supplying, or conveying in any way or form, products for personal use to employees of Calhoun County. Samples may be provided to the Jail for use within the facility for evaluation purposes. All disputes or protests will be held in Calhoun County, Texas. z--- SIGNED AND ACCEPTED this the jW day of XCEMSUL 2018. PRnvlr)FR• Za# )ku_AwsreNF pie. Mailing Address VICTORIA. Tx 77904 City, State, Zip Code I CALHOUN COUNTY, TEXAS CALHOUN COUNTY ADULT DETENTION CENTER 211 S Ann St, 3`d Floor, Ste 301 Michael J Pre er, C hotCounty Judge Port Lavaca, TX 77979 Page 3 of 3 Calhoun County, Texas Calhoun County Adult Detention Center (Jail) Grocery Pricing List January 1, 2019 thru December 31, 2019 Vendor Name: Ben E. Keith Foods Pack/Size is taken from current vendor invoices - - Pack/Size and Description may vary by Vendor Item # Pack / Size Brand Description Price ESTIMATE on How often Used: 301171 1 140lb Flavpac Apples Sliced Solid Pack Fresh $49.99 Weekly 9848 24 / 2 oz Sun Rich Apple Slice Red $14.48 Weekly 125049 6/#10 Ellingtn Apple Sauce Unsweet $25.88 Weekly 125048 6/#10 Ellingtn jApple Sauce Sweet $27.18 Weekly 530582 1/300ct Smithfield Bacon Precooked Thin $39.69 Weekly 101756 1130 Lb Coverwgn Bacon Slab Sliced Raw $58.99 Weekly 398921 1216ct Lenders Bagel Plain Sliced 2.3 oz $18.38 Weekly 696005 6/5 Lb Clabgirl Baking Powder $54.18 Quarterly 696130 24/1 Lb Hosptlty Baking Soda $17.97 Quarterly 018004 40 Lb Packer Bananas green tip $25.79 Weekly 811196 2/7 Lb Kth/Home Base - Beef Granular $34.07 Quarterly 124194 2/9 Lb Kth/Home Base - Chicken Flavor Paste $38.78 Quarterly 774010 1/50z Mcormick Basil Ground $5.97 Quarterly 774010 115 Oz Mcormick Basil Leaf $5.97 Quarterly 774911 1/1 Lb Txcustom Bay Leaves $11.48 Quarterly 650061 6/#10 Aliens Beans Baked Oven Prepared $36.88 Weekly 123884 6/#10 Ellingtn Beans Chili Homestyle $64.09 Weekly 334355 1120 Lb Mrkn/Fc Beans Cut Green Bean - Frozen $18.87 Weekly 125054 6#t10 Ellingtn Beans Cut Green Bean - Canned $26.08 weekly 334355 1/20 Lb Mrkn/Fc Beans Green Regular Cut $18.87 Weekly 650051 6/#10 Bush Beans Kidney Dark Red $25.97 Quarterly 122432 1/20 Lb Ellingtn Beans Baby Lima Bean - Dry $22.37 Quarterly 122437 1/20 Lb Ellingtn Beans Navy Pea Dry $14.07 Quarterly 652031 1150 Lb Gransabr Beans Pinto Bean Triple Clean Dried $24.89 weekly 111698 61#10 Lakeside Beans Pork and Beans Fancy $29.58 Weekly 650085 61#10 Ranchsty Beans Ranch Style Fancy $37.17 Weekly 782002 6M10 Aliens Beans Refried $31.19 Weekly 117441 6/#10 Bush Beans Vegetarian Baked Beans $38.57 weekly 546263 4/5 Lb Tu Eddy Beef BBQ Beef Chopped with Sauce $84.09 Weekly Page 1 of 12 Item # Pack / Size Brand Description Price Now often Used: 500245 5/Catch Ibp Beef - Brisket Boneless 120 No Roll $3.19 Quarterly 501004 2/7#Avg Tyson Beef- Roast Top Round Cooked $5.07 Quarterly 506080 8/10 Lb Packer Beef Ground Fine 73/27 $1.98 weekly 506104 4014 Oz Holten Beef - Patty 4/1 with Tvp $19.79 weekly 508121 4014 Oz Apf Red Beef- Patty Breaded $37.27 weekly 509345 90/3 Oz Tndrbrl Beef- Patty Flame Broiled $78.18 Quarterly 509155 102/2.5 Oz Tndrbrl Beef Patty Charbroiled pre-cooked $77.18 Quarterly 504750 3/24 Lb Cargill Beef Shoulder Clod $2.59 Quarterly 508121 40/4 Oz Apf Red Beef Steak Fritter Natural4/1 Raw $37.27 weekly 111031 2/5 Lb Amerfood Beef Stew Meat $32.27 weekly 510225 16011 Oz Beko Beef Steak Finger Breaded Cooked 1 oz $38.68 weekly 695004 24/8 Oz Merico Biscuits Buttermilk 10 ct $13.78 Monthly 398435 96/1.55 Oz Rotelias Biscuits Dinner Roils Thaw & Serve $25.69 weekly 140607 216/2.2 oz Ellingtn Biscuits Dough Southern Style $35.97 weekly 290073 8124 oz Frsh/Kth Bread Sandwich Wheat Loaf $16.07 weekly 290020 8/24 Oz Frsh/Kth Bread Sandwich White Loaf $14.07 weekly 106047 6112 Doz Gransabr Bread Tortillas Com $21.98 weekly -106048 18/24 Ct Gransabr Bread Tortillas Flour $29.99 Weekly 492954 12/1 Lb Butterbl Bologna Turkey Club $31.28 Weekly 335208 1/20 Lb Mrkn/Fc Broccoli Cuts $19.88 Weekly 808022 12/49 Oz Vanee Broth Chicken $30.09 Quarterly 101916 2/20ct MrsBaird Bun Hamburger $9.97 weekly 290220 6/12ct Frsh/Kth Bun Hot Dog $13.77 Weekly 385014 72/4 Oz 4hombres Burrito Beef & Bean $23.37 weekly 385147 6414 Oz Elmontry Burrito Beef & Bean Red Chili $25.27 Weekly 92015 1/60 Lb S Packer Cabbage Green Cabbage $18.87 Monthly 691402 615 Lb Contmill Cake Mix Chocolate $30.69 Monthly 691401 615 Lb Contmill Cake Mix White $27.39 Monthly 691400 6/5 Lb Contmill ICake Mix Yellow $27.39 Monthly 117566 1/12 Ct Mrkn/Fc Cantaloupe Fresh $33.47 weekly 98005 1/50 Lb S Mrkn/Fc Carrots Jumbo $30.69 weekly 336335 12/2Lb Mrkn/Fc Carrots Diced $17.88 weekly 113583 6/#10 Lakeside Carrots Sliced Canned $27.07 weekly 336150 1120 Lb Mrkn/Fc Carrots Smooth Sliced $20.09 Weekly 113583 61#10 Lakeside lCarrots Sliced Medium $27.07 Weekly 337112 1/20 Lb Mrkn/Fc Cauliflower LQF $22.59 Monthly 102012 1140 Lb Mrkn/Fc Celery Fresh $32.77 weekly 799224 12/28 Oz Quaker Cereal Cream of Wheat $26.17 weekly Page 2 of 12 Item # Pack / Size Brand Description price ESTIMATE on Now often Used: 799231 1150 Lb Lacrosse Cereal Oats Rolled #5 $28.78 weekly 799100 4/26 oz Kelloggs Cereal Bulk Com Flakes $24.97 weekly 799116 4/45 oz MOM Cereal Bulk Frosted Flakes $31.67 Weekly 799114 6/36 Oz MOM Cereal Bulk Raisin Bran $35.27 weekly 799120 4146 oz MOM Cereal Bulk Fruit Dyno Bites $33.59 weekly 799276 4/39 Oz Genmills Cereal Bulk Honey Nut Cheerios $49.48 Weekly 799103 4/35 oz MOM Cereal Rice Tootie Fruitie $29.18 weekly 761010 6/5 Lb Gldhrvst Cheese American Melt Loaf $69.87 Monthly 121802 4/5 Lb Schreibr Cheese American 184 Slices $43.87 Weekly 121801 4/5 Lb Schreibr Cheese Chedder Shredded Imitation $35.18 Quarterly 740078 2/5 Lb Gldhrvst Cheese Chedder Jack Shredded $23.79 weekly 740078 215 Lb Gldhrvst Cheese Chedder & Mont. Jack Shreeded $23.79 weekly 121671 215 Lb Frsh/Kth Cheese Cottage Cheese Sm Curd 4% $17.57 Weekly 742002 1013 Lb Gldhrvst Cheese Cream Cheese Loaf Grade A $70.07 Monthly 761010 6/5 Lb Gldhrvst Cheese Melting Loaf Yellow $69.87 Monthly 747050 415 Lb Cortona Cheese Mozzarella Reg Shredded $49.98 Monthly 759001 2/5 Lb Gldhrvst Cheese Pimento Cheese Spread $38.38 Monthly 121922 6/29 Oz Gldhrvst Cheese Powdered Cheese Mix $45.38 Weekly 762137 6/51b Landolake Cheese Queso Melt $82.98 Weekly 487156 4/10 Lb Packer Chicken Boneless Skinless Chicken Thighs - Plain $37 27 Weekly 487080 1110 Lb Supreme Chicken Boneless Skinless Chicken Thighs - Flavored $32.57 Weekly 497701 60/3.1 Oz Advance Chicken Breast Patty Breaded $27.57 weekly 114922 215 Lb Tyson Chicken Breaded Chicken Fritter $27.27 Weekly 122494 107/1.6 oz Jones Chicken Breakfast Patty $32.09 Quarterly 131445 2/5 Lb Waynefrm Chicken Diced All While Cooked $35.07 Weekly 487431 52/3 oz Smrtsrve Chicken Breast Fillet Fajita $44.07 Monthly 487105 1110 Lb Supreme Chicken Fajitas Sliced Chicken Raw $32.57 Weekly 488404 2/5 Lb Plathvst Chicken Fajita Strip Cooked $41.29 Monthly 102197 2/5 Lb Gransabr Chicken Faille Meat Lacocina $3.27 Monthly 487080 1/10 Lb Supreme Chicken Fajita Thigh Meat Frozen $32.57 Monthly 487856 4/10 Lb Packer Chicken Leg Meat Bonless $38.68 weekly 126814 1/20 Lb Dixie Chicken Nuggets Raw $13.68 Monthly 487156 4110 Lb Packer Chicken Thigh Meat Raw Frozen $37.27 Monthly 101470 4/4 Lb Campbell Chili Frozen - With Beans $55.77 weekly 546709 6/5 Lb Chilibwl Chili Frozen - Without Beans $64.67 weekly 123884 61#10 Ellingtn Chili Canned - With Beans $64.09 Weekly 123883 6/#10 I Ellingtn IChili Canned - Without Beans $82.08 weekly Page 3 of 12 ESTIMATE on Item # Pack / Size Brand Description Price Now often Used: 123885 61#10 Ellingtn Chili Hot Dog Sauce w/meat $52.87 Monthly 699399 811 Lb Fritolay Chips Frito Com Bulk $15.59 Weekly 699514 6/16 Oz Lays Chips Potato Regular Bulk $14.77 Weekly 699048 6/2 Lb Mission Chip Tortilla Yellow Round $20.78 weekly 101559 3/50ct Fritolay Chip Variety $41.59 weekly 774022 115 Lb Spicecls lCinnamon Ground $24.18 Monthly 692113 1110 Lb Snowflak Coconut Sweetened Coconut $28.38 Monthly 121718 12121b S&D Coffee Traditional 5 lb. $129.99 Weekly 121718 12/21b S&D Coffee Traditional 10 lb. $129.99 Weekly 121718 12/21b S&D Coffee Can Weekly 640555 42/1.25 Oz S&D Coffee Todays Gourmet w/Filter $22.87 weekly 92071 4/5 Lb Ct Mrkn/Rss Coleslaw Mix Shredded $16.27 weekly 772015 1110 Lb Nabisco Cookie Chocolate Chip $22.18 Weekly 772021 1110 Lb Nabisco Cookie Oatmeal Homestyle $19.57 Weekly 772023 1110 Lb Nabisco Cookie Sugar Homestyle $19.57 Weekly 772010 1/5 Lb Keebler Cookie Vanilla Wafers $14.18 Weekly 432441 32011 Oz Valuzone Cookie Dough Chocolate Chip $42.28 weekly 432442 320/1 Oz Valuzone ICookie Dough Oatmeal Raisin $47.99 Weekly 432443 320/1 oz Valuzone Cookie Dough Sugar $39.69 weekly 650172 6/#10 Allen Com Cream Style $33.59 Monthly 338602 1/20 Lb Mrkn/Fc Com Cut $17.38 Weekly 338836 6/2 Lb Gldncrsp Com Com Nuggets Sweet Battered $28.38 weekly 125734 61#10 Ellingtn Com Whole Kernel Fancy Canned $30.28 Weekly 124523 240/.67 Oz Ellingtn Com Dogs No Sticks $31.68 weekly 124523 2401.67 Oz Ellingtn Com Dogs Turkey Mini - No Sticks $31.68 weekly 691056 615 Lb Pioneer Combread Mix Homestyle $31.49 weekly 117439 613.5 Lb Ellingtn Combread Stuffing Mix $55.98 Monthly 119165 1/25 Lb Ellingtn Commeai $9.67 quarterly 772080 200/2 Ct Nabisco Crackers Graham Haney Mid - Individually Wrapped $22 47 Monthly 771314 12/16 Oz Nabisco Crackers Saltine - Bulk $34.09 Weekly 771332 500/2 Pk Lance Crackers Saltine - Individually Wrapped $12.57 Monthly 771303 30012 Ct Sunshine Crackers Cafe Club $21.57 Monthly 639071 24/12 Oz N Joy Creamer Non Dairy Canister $38.17 Weekly 774055 1/4.5 Lb Spicecls Cumin Ground $22.07 quarterly 119441 4/1 Gal Ellingtn Dressing Coleslaw $38.37 quarterly 674077 200/12 Gm Ppi Dressing PC Italian Packets $14.68 Monthly Page 4 of 12 Estimate on Item # Pack / Size Brand Description Price How Often Used: 119440 4/1 Gal Ellingtn Dressing Lt Italian Dressing Gallon $24.58 Monthly 119442 4/1 Gal Ellingtn Dressing Ranch Buttermilk Gallon $40.99 quarterly 674146 200/12 Gm Ppi Dressing PC Ranch Buttermilk $15.39 Weekly 122557 18/3.2 oz Ellingtn Dressing Ranch Mix $25.59 Weekly 674135 60/1.5 oz Classicg Dressing PC Thousand Island $13.98 Monthly 662056 4/1 Gal Kens Dressing Honey Mustard $45.47 Monthly 122648 12/24 oz Ellingtn Drink Mix Fruit Grape Powdered $30.58 Weekly 122645 12/24 oz Ellingtn Drink Mix Strawberry Powdered $30.58 weekly 122642 12124 Oz Ellingtn Drink Mix Fruit Punch Powdered $30.58 weekly 122647 12124 Oz Ellingtn Drink Mix Pink Lemondade Powdered $30.58 Weekly 122644 12124 oz Ellingtn Drink Mix Peach Powdered $30.58 Weekly 630281 12/1.8 Oz Crystigt Drink Mix Sugar Free Fruit Punch Powdered $44.67 Weekly 630280 12/2.2oz Crystigt Drink Mix Sugar Free Lemonade Powdered $44.67 weekly 393383 1/20 Lb Papettis Eggs Whole Liquid w/civic $30.67 weekly 393759 200/1 oz Papettis Eggs Scrambled Patty Round $31.38 weekly 138229 1110 Lb Papettis Eggs Hard Cooked Peeled $20.57 Weekly 142359 V200 ct Ellingtn lEggs Fresh Shell Jumbo USDA $31.89 weekly 777035 1/Pt Mcormick Extract Vanilla Imitation $4.19 quarterly 451162 1/15 Lb Packer Fillet Swai Fillet 5-7 oz $54.29 Weekly 455779 1110 Lb Seastar Fish Strip 1.5 oz Breaded $34.98 Weekly 451711 4110 Lb Packer Fish Pollock Fillet 4-6 oz $70.07 Weekly 146484 1/10 Lb Highline Fish Pollock Rect Breaded Wg $37.67 Weekly 688090 1150 Lb Goldmedl Flour All Purpose $13.97 Monthly 536111 80/2 Oz Farmland Franks All Meat 8/1 $19.69 Monthly 492029 2/5 Lb eutterbl Franks Turkey $16.48 Monthly 353053 6/5 Lb Lmb Wstn French Fries RC 3/81N $23.18 weekly 125647 61#10 Kth/Valy Fruit Cocktail X Lt Syrup $42.48 weekly 125646 6/#10 Kth/Valy Fruit Mix Lt Syrup $41.97 Weekly 774865 W Lb Txcustom Garlic Granulated $49.77 Monthly 767052 24/3.14oz Jello Gelatin Cup $9.89 122655 12/24 Oz Ellingtn Gelatin Mix Mixed Assorted Citrus $32.57 Monthly 767043 12124 oz Royal Fd Gelatin Mix Lime $26.79 Monthly 122654 12124 Oz Ellingtn Gelatin Red Variation $32.57 Monthly 27120 1/35 Lb Packer Grapefruit Ruby Choice 40 $26.47 Weekly 797058 6113 Oz Morrison Gravy Mix Brown Country Style $20.97 Monthly Page 5 of 12 Item # Pack / Size Brand Description Price ESTIMATE an How often used: 797060 6/14 Oz Pioneer Gravy Mix Chicken $22.27 Monthly 797246 6/24 Oz Morrison Gravy Mix Peppered $16.07 Monthly 797237 6/11.3 Oz Pioneer Gravy Mix Pork Roast $25.78 Monthly 797240 6/11.3 Oz I Pioneer IGravy Mix Turkey Roasted $21.07 Monthly 12362 6/3 Lb Packer Greens Mustard Greens $19.47 Weekly 131635 2/10-12#C Briarstr Ham Buffet Style $1.77 weekly 538695 615 Lb Farmland Ham Chopped $68.57 quarterly 538037 4/3 Lb Farmland Ham Pre -Sliced $42.18 Quarterly 131640 2113 Lb Briarstr Ham Shaving Cooked 4 x 6 Deli $51.89 weekly 130709 2/10-12 L Briarstr Ham Shaving Smoked Boneless $1.78 Quarterly 538037 4/3 Lb Farmland Ham Sliced Smoked $42.18 quarterly 101916 2/20 Ct Mrsbaird Hamburger Buns $9.97 Weekly 361069 120/2.2 Oz Ore Ida Hashbrowns Golden Patty $26.47 Weekly 361065 6/3 Lb Lamb Sup Hashbrowns Redi Shred $25.79 Weekly 361065 613 Lb Lamb Sup IHashbrowns Lqf Shredded $25.79 Weekly 37009 1/30 Lb Packer Honey Dew Melon US #1 8 ct $20.58 weekly 290220 6112 Ct Frsh/Kth Hot Dog Buns $13.77 Weekly 123003 216 Lb Ellingtn Hushpuppies Regular Round $15.98 Weekly 405128 4/5 Lb Hagys Hushpuppies Homestyle $30.87 weekly 766108 1/12 Lb Richs Icing Chocolate $27.57 Quarterly 766107 1112 Lb Richs Icing Vanilla $21.47 quarterly Jelly Assorted Monthly 677017 2001.5 Oz Keith Jelly PC Assorted Cup $11.07 Monthly 677034 200/.5 Oz Keith Jelly PC Grape Cup $10.08 1 weekly 318011 70/4 Oz Ard Frm Juice Apple 100% Carton Carton $11.89 weekly 318011 7014 Oz Ard Frm Juice Apple 100% Carton Carton $11.89 Weekly 318034 7014 Oz Ard Firm Juice Orange 100% Carton $15.48 Weekly 318034 70/4 Oz Ard Firm Juice Orange 100"/o Carton $15.48 Weekly 674024 1000/9 Gr Red Gold Ketchup Individual Packets $19.47 weekly 122416 6/#10 Kth/Home Ketchup Standard $24.07 Weekly 123001 1/Cs Packer Lettuce Iceberg $62.99 weekly 129726 900/5 Gram Gldhrvst Margarine PC Cup Spread $21.09 Monthly 129726 900/5 gram Gldhrvst Margarine pcks $21.09 Page 6 of 12 Item # Pack / Size Brand Description Price ESTIMATE on How Often Used: 119460 30/1 Lb Ellingtn Margarine Solids Pure Veg $22.87 Monthly 800711 12/16 Oz Kraft Marshmallows Jet Puffed $19.77 quarterly 662037 4/1 Gal Kth/Home Mayonnaise Heavy Duty Gallon $27.47 Monthly 674060 200/12 Gm Keith Mayonnaise PC $17.77 Weekly 37009 1/30 Lb Packer Melons Honey Dew US #1 8 ct $20.58 1 weekly 104374 215 Lb Bonici Meatballs Beef & Chicken $29.38 weekly 522410 320/.5 Oz Advance Meatballs Flame Broiled $42.98 weekly 509618 7613.15 Oz Smartpic Meatloaf Patty Deluxe $73.79 weekly 798022 24/14 Oz Magnolia Milk Condensed Sweetened $44.18 Monthly 798001 24/12 Oz Velvet Milk Evaporated $22.09 Monthly 798059 1/25 Lb Ramsen Milk Powdered Skimmed NF $55.67 Monthly N/A Milk Powdered Homo Vitamin D Monthly 114982 4/1 Gal Dairypur Milk 2% Reduced Fat 1 Gallon $17.98 Weekly 114981 4/1 Gal Dairypur Milk Homo Vitamin D 1 gallon $19.37 Weekly 284410 251/2 pint Oakfarms Milk 1% Reduced Fat 1/2 pint cartons $8.68 weekly 119825 251/2 pint Dairypur Milk 2% Reduced Fat 1/2 pint cartons $8.87 weekly 119826 25 1/2 pint Dairypur Milk Homo Vitamin D 112 pint cartons $9.18 weekly 124165 4/1 Gal Kth/Valy Mustard Prepared Gallon $11.77 Quarterly 674050 500/5.5 Gm Keith Mustard PC Pouch $12.39 weekly 119462 611 Gal Ellingtn Oil Butter Flavored $52.07 Monthly 119462 6/1 Gal Ellingtn Oil Pan & Grill Trans Fat Free $52.07 Monthly 698007 6/17 Oz Pam Oil Pan Spray $19.18 Monthly 779123 1135 Lb Kth/Home Oil Shortening Clear Fry $20.78 Monthly 342131 1/20 Lb Pictswt Okra Cut 112 inch Grade A $14.67 weekly 325205 1/EO Lb I Beko Okra Cut Heavily Breaded $16.48 weekly 124370 612 Lb Ellingtn Okra Cut Breaded Southern Style $12.38 weekly 775002 1/3 Lb Mcormick Onion Dried Flakes Chopped $13.08 Monthly 146298 4/5 Lb Buds Onion Sliced $27.09 155012 1150 Lb Mrkn/Fc Onion Yellow Jumbo Sack $15.09 Monthly 31069 1135 Lb Mrkn/Fc Oranges Fresh $29.39 Weekly 31069 1135 Lb Mrkn/Fc Orange Choice $29.39 134942 6/#10 Ewimport Oranges Mandarin Oranges Broken Lt $39.29 Weekly 774929 1/12 Oz Txcustom Oregano Ground $9.69 Quarterly 401352 144/1.2 Oz Mbtrwrth Pancake Original - Frozen $17.59 Weekly 774727 1/10 Oz Mcormick Parsley Flakes $13.29 Quarterly 700033 2/5 Lb Gorton Pasta Egg Noodle Wide 1/2 Inch $14.18 Monthly Paee 7 of 12 Item # Pack / Size Brand Description Price ESTIMATE on How often Used: 700020 2110 Lb Cortona Pasta Elbow Macaroni $19.47 Monthly 700267 12/16 Oz Cortona Pasta Lasagna Ribbed $15.58 Monthly 700087 2/10 Lb Cortona Pasta Spaghetti Thin 10 Inch $19.47 Monthly 125643 6/#10 Kth/Valy Peaches Sliced Extr Lt Syrup $40.27 weekly 125648 6/#10 Kth/Valy Peaches Diced Extra Lt Syrup $40.27 weekly 124180 6/5 Lb I Ellingtn Peanut Butter Creamy $58.88 weekly 1 677052 200/.75 oz I Smuckers I Peanut Butter Pc $41.17 Weekly 125733 6l#10 Kth/Valy Pears Sliced Light Syrup $39.08 Weekly 113580 6/#10 Lakeside Peas Blackeyed $28.48 weekly 349712 1/20 Lb Mrkn/Fc Peas Peas & Diced Carrots Frozen $18.39 Weekly 343555 1/20 Lb Mrkn/Fc Peas Green $19.87 Weekly 125740 6Hf10 Kth/valy Peas Sweet Mixed $34.18 weekly 774160 1/18 Oz Mcormick Pepper Black Gound Fine Pure $15.19 Monthly 685214 12/27 Oz Rosarita Peppers Chili Diced Green $48.19 Monthly 165010 1/1 1/9 B Mrkn/Esn Pepper Bell Green Chopper $38.59 Monthly 110417 6/#10 Gransabr Pepper Jalapeno Nacho Sliced $24.27 Quarterly 774829 1/7 Lb Txcustom Pepper Lemon Seasoning $23.58 Quarterly 687006 411 Gal Caj Chef Pickles Dill Relish $26.79 Monthly 123278 1/5 Gal Kth/Home Pickles Dill Sliced Hamburger $21.27 Monthly 430075 6/43 Oz Chef P Pie Pumpkin 10 Inch PreBaked $36.87 Quarterly 600379 6/81 Oz Dole Pineapple Chunks in Extra Lt Syrup $31.88 Weekly 600390 61#10 Dole Pineapple Sliced in Juice $42.67 weekly 134845 61#10 Ewimport Pineapple Tidbits in Juice $26.27 weekly 384029 12813.31 Oz Tonys Pizza Breakfast Turkey Sausage $52.68 Monthly 384420 96/4A8oz Tony's Pizza Pepperoni (homestyle pizza) $53.89 653001 36/8oz Fancyfrm Popcorn Kit All In One $24.99 119917 6/6-8 Lb Farmland Pork Loins Boneless $1.87 Monthly 544240 40/3.75 Oz Advance Pork Patty Breaded Cooked $23.49 Monthly 532010 46/3.5oz Advance Port Patty Rib $37.48 Monthly 650337 6/2.5 Lb Goldngrl Potato Hashbrown Redi Shred $43.37 Weekly 650361 6/#10 Trurecip Potato Instant with milk $51.27 Weekly 170017 1/501-bCt Packer Potato Idaho#2 $16.29 Weekly 169190 1/50 Lb Packer Potato Red #2 $15.59 Weekly 170017 1/501-b Ct Packer Potato Russet 10 oz. US #2 $16.29 Weekly 360811 6/5 Lb Ore Ida jPotato Tater Tots $41.47 Weekly 650314 6/10# Allen Potato White Diced $25.47 weekly 765086 6/#10 Can Myhmtwn Pudding Banana $27.48 Weekly 765085 6/#10 Can Myhmtwn Pudding Chocolate $27.18 Weekly Page 8 of 12 Item # Pack / Size Brand Description Price �ilmAlton How Often Used: 765037 24/3.625 O Jello Pudding Chocolate Sugar Free $11.39 weekly 123292 6/#10 Eliingtn Pudding Lemon $32.97 Weekly 123293 6/#10 Ellingtn Pudding Tapioca $35.39 weekly 765084 6/#10 Can Myhmtwn Pudding Vanilla $27.18 Weekly 765036 6/#10 Luckylf Pudding Vanilla Sugar Free $40.77 Weekly 800042 24/6/1 Oz Vlypride Raisins Individual Packs $33.47 Weekly 800058 24115 Oz Sunmaid Raisins Golden Seedless $53.47 Weekly 786201 6/10# Chefboy Ravioli Beef RTU $38.99 Weekly 654044 1/50 Lb Producer Rice Long Grain $18.08 Weekly 654060 1/50 Lb Comet Ri Rice Long Grain Parboiled 4% Broken $19.48 Weekly 687006 4/1 Gal Caj Chef Relish Dill Premium $26.79 Monthly 127018 4/5 Lb Ba Mrkn/Rss Salad Mix Lettuce in Bag $28.99 Weekly 768025 1/30 Lb Resers Salad Potato Homestyle $45.38 Monthly 547118 384/.5oz Farmland Salami All Meat Sliced $32.99 Weekly 676026 1/25 Lb Morton Salt Iodized Table $6.59 quarterly 660017 4/1 Gal Lil Pig Sauce BBQ $17.27 Monthly 660505 6410 Mipueblo Sauce Cheese $37.59 Weekly 660583 6/10# Mipueblo Sauce Cheese Nacho $37.57 weekly 600065 24/14 Oz Oceanspr Sauce Cranberry Jellied $37.48 1quarterly 123271 4/1 Gal Ellingtn Sauce Enchilado Mild RTU $32.69 Weekly 123270 4/1 Gal Ellingtn Sauce Picante Mild Gallon $40.09 Monthly 125659 6/10# Ellington Sauce Pizza $24.89 Weekly 124163 411 Gal Ellingtn Sauce Soy Sauce Gallon $19.97 Monthly 660606 6115oz Mcormick Sauce Mix Sloppy Joe Seasoning $27.48 Weekly 125660 61#10 Ellingtn Sauce Spaghetti RTU $26.57 1 weekly '674097 50019 Gm Keith Sauce PC Taco $25.49 Weekly 674812 200/7/16 Oz Kraft Sauce Tarter Creamy Packets $15.38 Weekly 125658 6/#10 Ellingtn Sauce Tomato Fancy $20.37 Weekly 660298 411 Gal Caj Chef Sauce Worcestershire $17.78 Quarterly 541205 2151b Alamo Sausage Beef Breakfast Chorizo $21.59 weekly 122494 107/1.5oz Jones Sausage Chicken Breakast $31.98 Weekly 492773 128/1.25 Oz J Dean Sausage Turkey Breakfast $27.67 weekly 541029 215 Lb Laxson Sausage Chorizo Pork Raw $21.07 weekly 539067 2/5 Lb Tenn Prd Sausage Ground Bulk Raw Mild $21.98 Weekly 541092 200/.8 Oz Natchoic Sausage link Natural .8 oz Cooked $30.17 Weekly 541587 192/1 Oz Beko Sausage Link Mild 1 oz Cooked $27.17 Weekly Page 9 of 12 Item # Pack / Size Brand Description Price ESTIMATE on Hoxi Own Used: 549125 2/51b Pizzano Sausage Pork Topping Cooked $20.99 Weekly 541170 1/10 Lb 5 Maid Sausage Smoked Rope Cooked $27.59 weekly 540057 154/1.25oz Kth/Vally Sausage Patty Cooked $27.98 Weekly 774458 12/17oz Chachere Seasoning Creole $30.98 115570 81b Chachere Seasoning Creole Original $12.57 Quarterly 660714 1/24 Oz Mcormick Seasoning Mexican Rub Mix $10.29 Quarterly 774450 23oz Mcormick Seasoning Montreal $9.89 Quarterly 774396 1/4.5 Lb Mcormick Seasoning Salt Traditional $13.97 Monthly 660714 1124 Oz Mcormick Seasoning Taco $10.29 Quarterly 779123 1/35 Lb Kth/Home Shortening Clear Fry Liquid $20.78 Monthly 808040 12/50 Oz Campbell Soup Chicken Noodle $46.57 Monthly 808030 12/50 Oz Campbell Soup Cream of Chicken $51.27 Monthly 808060 12/50 Oz Campbell Soup Cream of Mushroom $50.89 Monthly 808083 12150 Oz Campbell Soup Cream of Potato $51.59 Monthly 808090 12150Oz Campbell Soup -Tomato $35.29 Monthly 808100 12150 Oz Campbell Soup - Vegetable $51.18 Monthly 669027 4/5 Lb Daisy Sour Cream Cultured $25.47 Monthly 650395 6/#10 Popeye Spinach Chopped Fancy $28.37 weekly 200098 Vol Fill Packer Squash Zucchini Med 18-25 $24.99 weekly 697100 24/1 Lb Argo Starch Com $19.19 Quarterly 117439 6/3.5 Lb Ellingtn Stuffing Mix Combread $55.98 weekly 780009 1212 Lb Imperial Sugar Brown light in Bag $25.69 Monthly 133884 1/501-b Cargill Sugar Pure Cane Granulated $25.59 Weekly 781005 12/2 Lb Imperial Sugar Powdered White $25.69 Quarterly 677005 100/1 Oz Ppi Syrup PC Pouch $10.38 Weekly 793036 10011 Oz Smuckers Syrup PC Pouch Sugar Free 1 oz $15.17 Monthly 640209 96/1 Oz Ceylon ITea Bags 1 oz $23.57 Weekly 640209 9611 Oz Ceylon Tea Iced Filter Pouch 1 Gal $23.57 weekly 211111 1/251-b Ct Packer Tomatoes Bulk Cafe $29.47 weekly 125654 6/#10 Ellingtn Tomatoes Diced in Juice $20.87 Weekly 6505467 12/28oz Red Gold Tomatoes Diced With Green Chills $20.98 Monthly 791075 6/10# Jubilee Topping Chocolate Fudge $69.95 122650 1211 Lb Ellingtn Topping Whip Mix Add Water $33.78 Quarterly 134852 6/68.5 Oz Ewimport Tuna Chunk Light in Water $63.37 Monthly 492954 12/1 Lb Butterbl Turkey Breast Lunchmeat Combo $31.28 weekly 492131 2/8-91b Festive Turkey Breast Oven Roasted $2.19 Monthly 492291 2/9-9.5#C Carolina Turkey Breast Smoked Skinless $2.98 Monthly Page 30 of 12 Item # Pack / Size Brand Description Price ESTIMATE on How often Used: 100167 4/10 Lb Carolina Turkey Ground Tubes 80/20 $31.39 weekly 492682 277-81b Carolina Turkey Ham Buffet Deluxe $1.55 weekly 492309 5/5 Lb Carolina Turkey Medallion Roasted $84.38 Monthly 492681 2/5 Lb Carolina Turkey Ham - Diced Cured $20.97 Weekly 492773 12811.25 Oz J Dean Turkey Sausage Patty Cooked $27.67 139312 6/#10 Lakeside Vegetables - Mixed Fancy $35.89 Weekly 349712 1/20 Lb Mrkn/Fc Vegetables - Blend Peas & Carrots $18.39 weekly 650250 61#10 Kth/Excl Vegetables For Stew Fancy Chunky $28.69 Monthly 349198 12/2 Lb Mrkn/Fc lVegetables - Blend Stir Fry $38.19 Monthly 349136 1/20 Lb Mrkn/Fc Vegetables - Mixed 5 Way $19.38 Weekly 127425 12/12 Ct Eggo Waffles $18.57 Weekly 650380 6X10 Princela Yams - Cut $35.89 Monthly 697001 20/1 Lb Saf Yeast Saf Instant Red Label $52.89 Quarterly NON FOOD ITEMS: 883595 10/100 Ct Disco Apron, Plastic Full Length Mad Wt 24x42 $83.97 Quarterly 883615 1/100 Ct Essntial Apron, Plastic White Disposable $21.78 Quarterly 875027 1/2000 Ct Essntial Bag Sandwich w/Flip Top $24.47 Quarterly 875403 1/500 ct Reynolds Bag Sandwich Reclosable 6.5x6 $19.39 Quarterly 129706 1/500 Ct Essntial Bag Zip Seal Quart $32.98 Quarterly 875321 11200 Ct Reynolds Bag Freezer Reclosable 1 Gallon $26.09 Quarterly 875406 1/250 Ct Reynolds Bag Reclosable Zip 1 Gallon $26.07 Quarterly 875322 1/100 Ct Reynolds Bag Freezer Reclosable Zip 2 Gallon $26.47 Quarterly 114852 11500 Ct Duro Bag - White Paper Bag $22.98 885225 128/2 Oz Ssdc Cleaner Floor Degreaser $39.57 Quarterly 640405 64/2 Oz Elgtncof Coffee Filter Packs $52.87 Monthly 872203 2/100 Ct Dart Container Foam Hngd 3-c White $19.67 Quarterly 860041 40/25 Ct Dart Cup, Foam 12 oz $30.78 Monthly 860060 40/25 Ct Essntial Cup, Foam 16 oz $44.39 Monthly 860045 10/100 Ct Dart Cup Lids for 12 oz $18.69 Monthly 860045 10/100 Ct I Dart Cup Lids 12L Trans Slotted $18.69 Monthly Page 11 of 12 Item# Pack/Size Brand Description Price ESTIMATE on How Often Used: 860055 10/100 Ct Dart Cup Lids for 16 oz $19.18 Monthly 860055 10/100 Ct Dart Cup Lidis for 16L Trans Slotted $19.18 Monthly 887097 2/1 Gal Ssdc Detergent Paramount Heavy Duty $72.87 1 weekly 887056 1/5 Gal Essntial Detergent Speed Clean $94.57 Weekly 887056 1/5 Gal Essntial Detergent Dishwasher $94.57 weekly 877019 1 Roll Reynolds Film 18 x 1000 Clear Wrap $23.68 Monthly 876063 1 Roll Hfa Foil 18 By 1000 $69.57 876111 1 Roil Reynolds Foil 24 x 500 #633 Fit H $131.69 Monthly 888048 4/10 Ct Scotchbr Grill Cleaning Pad $65.99 883757 10/100 Ct Valugard Gloves Vinyl Powder Free Large $28.48 Weekly 883790 10/100 Ct Amercare Gloves Vinyl Powder Free Aarge $25.28 Weekly 883708 1/144 Ct Disco Haimet Dark Brown Light Weight $16.47 Weekly 878231 11250 Ct Daymark Label 2 x 3 Dissolvable Use By $14.17 Weekly 875476 1/1000 Ct Dixie Liner Pan Lift Off Grease $47.89 Monthly 871356 1/250 Ct Primesrc Meal Kit (K F S Napkin) MW W $18.37 quarterly 918944 1 Each Sanjamar Mitt- Oven Mitt Black 17 $15.98 877017 1/Roll Durable Plastic Wrap $15.29 Monthly 887078 1/5 Gal Essntial Rinse Aid Fast Dry $122.57 weekly 885915 6/1 Qt Ssdc Sanitizer Redi San Rtu $23.69 Weekly 873802 4/500 Ct Essntial Straws 7.75 Jumbo Clear Wrap $12.57 Monthly Page 12 of 12 Extra Page to add items that the Jail may consider Descripflon III■�� �� #10 NOTICE OF MEETING— 10/6/2021 10. Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Point Comfort Volunteer Fire Department. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: David Hall, Commissioner, Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 13 Calhoun County Emergency Medical Services First Responder Affiliation Agreement (FRO) The purpose of this document is to provide verification of support for First Responder Organizations within Calhoun County as required by TEXAS DEPARTMENT OF STATE HEALTH SERVICES rule 157.14 (c) (1) (2) (Requirements for First Responder Organization Registration.). Continuum of standards of care shall be the responsibility of the FRO and the EMS provider. The FRO personnel shall be held to the same standards of professional ethics, behavior and demeanor as EMS provider personnel. FRO personnel shall be held to the same standards of patient care as the EMS provider personnel. (c) (1) The FRO shall have an agreement with all licensed providers and their medical directors ivho rmainely a anspo, I paFrents .stahilized by the FRO's persmmel. The agreement .shall he approved by the responsible person for ate first responder, the service director and the medical director gfthe licensed EMSprmader. This agreement addresses the following criteria that shall be followed by the FRO and/or submitted by the FRO to the EMS provider. The FRO / provider agreement. 1 understand that, as FRO l will: • Submit and update a list of certified medical personnel that respond. • Require as a minimum for patient care that anyone rendering care hold a current ECA or greater Certificate or License (Exception: Responder CPR, a Current Healthcare provider card) Upon recertification the FRO personnel must maintain a minimum of 70 overall score on the TEXAS DEPARTMENT OF STATE HEALTH SERVICES exam. Copies of shall be submitted to the EMS provider. Submit evidence that TEXAS DEPARTMENT OF STATE HEALTH SERVICES certified/licensed responders are participating in the on-line continuing education program and are current with TEXAS DEPARTMENT OF STATE HEALTH SERVICES continuing education requirements. (minimum hours in 2 year period) Continuing education records shall be submitted to EMS provider once per month. Adopt and utilize the county wide BLS protocols provided by Calhoun County EMS and the medical director. Medical equipment must be approved by the EMS provider (Standardize within county) • A schedule shall be provided to the EMS provider that specifies the number of certified/licensed personnel available to respond. The FRO shall provide the EMS provider the schedule once a month. • The FRO shall be responsible for Quality Improvement (QI) of the medical records. The EMS provider will QI the reports upon receipt. • The FRO and the EMS provider will develop a process for assessment of care provided by the FRO personnel (Criteria based on: On scene observation, Continuing Education and QI of run reports. • FRO personnel shall run emergency when responding in a designated Emergency Response Vehicle Only. • On scene chain of command: The highest certified FRO personnel shall be in command of patient care until arrival of EMS provider personnel. Command shall be relinquished at that time to the EMS provider. The FRO personnel shall continue to assist as needed. • The FRO personnel shall not cancel the EMS provider except under the following conditions: I . The patient has been evaluated by an ECA or greater and the patient does not wish to be treated or transported. 2. The patient has left the scene. 3. False Alarm Note: On scene deaths are not an exception. The EMS provider shall continue response and assess the scene/patient. • The FRO personnel may accompany the patient during transport upon request or approval of the EMS provider. • Patient confidentiality shall be observed at all times. Discussion of patient care delivered shall be restricted to those certified/licensed individuals on scene or to administrative personnel of the FRO or EMS provider. No patient information shall be provided to the news media or others making a request without permission of the EMS provider administration. (Health and Safety Code, Chapter 773, Subchapter D, 773.091-773.096) The FRO shall develop departmental polices that address the criteria above and submit cries to the EMS nrovider. include: Responsibilities of the FRO. Daring the registration period the FRO's responsibilities shall I. Assuring ongoing compliance with the terms of the provider agreement 2. Assuring that all personnel, when on -scene , are prominently identified by name, certification level and organization 3. Monitoring and taking appropriate action regarding the quality of patient care provided by FRO personnel 4. Monitoring personnel compliance with medical protocols 5. Maintaining confidentiality of patient information according to the Health and Safety Code, Chapter 773, Subchapter D,773.091-773.096 6. Carrying proof of first responder registration in all vehicles belonging to the FRO 7. Maintaining compliance with all applicable laws and regulations 8. Monitoring and enforcing general safety policies including at least personal protective equipment, immunizations and communicable disease exposure and emergency vehicle operation 9. Notify Texas Department of State Health Services within five (5) days if: The FRO ceases to exist or merges with another FRO There is a change in the: I. Official business address and /or phone number 2. Level of service 3. Declared service area 4. Physical location of the first responder organization 5. Physical location of patient report file storage 6. Administrator 7. Email address 8. EMS Providers associated with the FRO 10. Notify Texas Department of State Health Services within one (1) business day if: • There is a change in the: I. Medical Director The FRO / provider agreement. I understand that, as EMS provider I will: • Provide off line Medical Direction • BLS protocols • Provide continuing education through established continuing education programs currently in place. • Assist FRO with resolving medical issues that may arise • Provide medical supplies to the FRO at provider cost. Any supplies that the provider bills for will be at no charge. • Assist FRO personnel with certification issues and interact with TEXAS DEPARTMENT OF STATE HEALTH SERVICES personnel to answer any questions. Act as a liaison between the FRO and the Medical Director • Act as liaison between the FRO and the hospital • Act as liaison between the Sheriffs Department on Medical Dispatch issues. Allow active participation by the FRO personnel in the treatment of the patient. • Respect the FRO's ability and role played in the Healthcare system. Calhoun County EMS agrees to assume the responsibility of the EMS provider for the following First Responder organizations. First Responder Point Comfort V FD Provider Calhoun County EMS October 1, 2021 - December 31, 2023 & , � Paul Bunnell, MD, Medical Director �Dustm ins, in., Thl , MBA, LP Director of EMS Calhoun County EMS Point Comfort VFD Adriana Whitwell, Volunteer EMT -Advanced Administrator of Record #11 NOTICE OF MEETING— 10/6/2021 11. Consider and take necessary action to approve a First Responder Affiliation Agreement between the Calhoun County EMS and the Six Mile Volunteer Fire Department. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Vern Lyssy, Commissioner, Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 13 Calhoun County Emergency Medical Services First Responder Affiliation Agreement (FRO) The purpose of this document is to provide verification of support for First Responder Organizations within Calhoun County as required by TEXAS DEPARTMENT OF STATE HEALTH SERVICES rule 157.14 (c) (1) (2) (Requirements for First Responder Oreanizetion Registration.). Continuum of standards of care shall be the responsibility of the FRO and the EMS provider. The FRO personnel shall be held to the same standards of professional ethics, behavior and demeanor as EMS provider personnel. FRO personnel shall be held to the same standards of patient care as the EMS provider personnel. (c). (1) The FRO shall have an agreernew with alllicensed providers and then -medical directors who routlmly transport patients smhilized by the FRO's personnel. The agreement .shrill he approved by the responsihle persogfor the,Jirsi responder% the service director and the medical director of the licensed F.hfS provider. This agreement addresses the following criteria that shall be followed by the FRO and/or submitted by the FRO to the EMS provider. The FRO / provider agreement. I understand that, as FRO I will: • Submit and update a list of certified medical personnel that respond. • Require as a minimum for patient care that anyone rendering care hold a current ECA or greater Certificate or License (Exception: Responder CPR, a Current Healthcare provider card) Upon recertification the FRO personnel must maintain a minimum of 70 overall score on the TEXAS DEPARTMENT OF STATE HEALTH SERVICES exam. Copies of shall be submitted to the EMS provider. • Submit evidence that TEXAS DEPARTMENT OF STATE HEALTH SERVICES certified/licensed responders are participating in the on-line continuing education program and are current with TEXAS DEPARTMENT OF STATE HEALTH SERVICES continuing education requirements. (minimum hours in 2 year period) Continuing education records shall be submitted to EMS provider once per month. • Adopt and utilize the county wide BLS protocols provided by Calhoun County EMS and the medical director. • Medical equipment must be approved by the EMS provider (Standardize within county) • A schedule shall be provided to the EMS provider that specifies the number of certified/licensed personnel available to respond. The FRO shall provide the EMS provider the schedule once a month. • The FRO shall be responsible for Quality Improvement (QI) of the medical records. The EMS provider will QI the reports upon receipt. • The FRO and the EMS provider will develop a process for assessment of care provided by the FRO personnel (Criteria based on: On scene observation, Continuing Education and QI of run reports. • PRO personnel shall run emergency when responding in a designated Emergency Response Vehicle Only. • On scene chain of command: The highest certified FRO personnel shall be in command of patient care until arrival of EMS provider personnel Command shall be relinquished at that time to the EMS provider. The FRO personnel shall continue to assist as needed. • The FRO personnel shall not cancel the EMS provider except under the following conditions: 1. The patient has been evaluated by an ECA or greater and the patient does not wish to be heated or transported. 2. The patient has left the scene. 3. False Alarm Note: On scene deaths are not an exception. The EMS provider shall continue response and assess the scene/patient. • The FRO personnel may accompany the patient during transport upon request or approval of the EMS provider. • Patient confidentiality shall be observed at all times. Discussion of patient care delivered shall be restricted to those certified/licensed individuals on scene or to administrative personnel of the FRO or EMS provider. No patient information shall be provided to the news media or others making a request without permission of the EMS provider administration. (Flealth and Safety Code, Chapter 773, Subchapter D, 773.091-773,096) The FRO shall develop departmental polices that address the criteria above and submit copies to the CMS nrovider. include: Responsibilities of the FRO. During the registration period the FRO's responsibilities shall I. Assuring ongoing compliance with the terms of the provider agreement 2. Assuring that all personnel, when on -scene , are prominently identified by name, certification level and organization 3. Monitoring and taking appropriate action regarding the quality of patient care provided by FRO personnel 4. Monitoring personnel compliance with medical protocols 5. Maintaining confidentiality of patient information according to the hlealth and Safety Code, Chapter 773, Subchapter D, 773.091-773.096 6. Carrying proof of first responder registration in all vehicles belonging to the FRO 7. Maintaining compliance with all applicable laws and regulations 8. Monitoring and enforcing general safety policies including at least personal protective equipment, immunizations and communicable disease exposure and emergency vehicle operation 9. Notify Texas Department of State Health Services within five (5) days if: 'File FRO ceases to exist or merges with another FRO There is a change in the: 1. Official business address and /or phone number 2. Level of service 3. Declared service area 4. Physical location of the first responder organization 5. Physical location of patient report file storage 6. Administrator 7. Email address 8. EMS Providers associated with the FRO 10. Notify Texas Department of State Health Services within one (1) business day if: • There is a change in the: 1. Medical Director The FRO / provider agreement. 1 understand that, as EMS provider 1 will: • Provide off line Medical Direction • BLS protocols • Provide continuing education through established continuing education programs currently in place. • Assist FRO with resolving medical issues that may arise • Provide medical supplies to the FRO at provider cost. Any supplies that the provider bills for will be at no charge. • Assist FRO personnel with certification issues and interact with TEXAS DEPARTMENT OF STATE HEALTH SERVICES personnel to answer any questions. Act as a liaison between the FRO and the Medical Director • Act as liaison between the FRO and the hospital • Act as liaison between the Sheriff s Department on Medical Dispatch issues. • Allow active participation by the FRO personnel in the treatment of the patient. • Respect the FRO's ability and role played in the Healthcare system. Calhoun County EMS agrees to assume the responsibility of the EMS provider for the following First Responder organizations. First Responder Six Mile VFD Provider Calhoun County EMS October 1, 2021 — December 31, 2023 Paul Bunnell, MD. Medical Director Dustin t tins, D.Mii ., ThM, MBA, LP Director of EMS Calhoun County EMS Six Mile VF v John Day, LP Administrator of Record #12 NOTICE OF MEETING— 10/6/2021 12. Consider and take necessary action to approve the FY2022 Texas Indigent Defense Commission Formula Grant Request for Application resolution and authorize the County Judge to apply online. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner, Pct 4 SECONDER: Joel Behrens, Commissioner, Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 13 2022 Calhoun County Resolution Indigent Defense Grant Program WHEREAS, under the provisions of the Texas Government Code Section 79.037 and Texas Administrative Code Chapter 173, counties are eligible to receive grants from the Texas Indigent Defense Commission to provide improvements in indigent defense services in the county; and WHEREAS, this grant program will assist the county in the implementation and the improvement of the indigent criminal defense services in this county; and WHEREAS, Calhoun County Commissioners Court has agreed that in the event of loss or misuse of the funds, Calhoun County Commissioners assures that the funds will be returned in full to the Texas Indigent Defense Commission. NOW THEREFORE, BE IT RESOLVED and ordered that the County Judge of this county is designated as the Authorized Official to apply for, accept, decline, modify, or cancel the grant application for the Indigent Defense Formula Grant Program and all other necessary documents to accept said grant; and BE IT FURTHER RESOLVED that the County Auditor is designated as the Financial Officer for this grant. Adopted this Oh day of October, 2021. County Judge Attest: l Qa By: Deputy County Cler MTIDC TEXAS INDIGENT DEFENSE COMMISSION September 20, 2021 CHAIR: The Honorable Richard H Meyer The Honorable Sharon Keller Calhoun County Judge Presiding Judge Court of Criminal Appeals 211 S. Ann Street Suite 301 Port Lavaca, TX 77979 EX OFFICE) MEMBERS: Honorable Sharon Keller Honorable Nathan Hecht Re: FY2022 Formula Grant Request for Applications Honorable John Whitmire Honorable Brandon Creighton Honorable Nicole Collier Dear Judge Meyer: Honorable Reggie Smith HonorableSherryVwianRaae Honorable Vivian Torress The Texas Indigent Defense Commission announces the FY2022 Formula Grant Request for g q Applications (RFA). Applications are due Monday, November 15, 2021. The attached packet MEMBERS APPOINTER BY GOVERNOR: Mr. Alex Benin provides information on what is needed for counties to obtain Formula Grant funds. There are two Honorable Richard Evans simple steps to apply for your formula grant: Mr. Gonzalo Rios Honorable Missy Medary Honorable Valerie Covey 1. Commissioners Court should adopt the attached FY2022 TIDC Formula Grant Resolution. ExccunvE DIRECTOR: 2. Upload the signed resolution on TIDC's grants and reporting website, httos://tidc.tamu.edu, Geoffrey Burkhart confirm contact information for county officials, and click the "submit" button Step by step instructions are included in the Request for Applications. To be eligible, the local administrative judges and chairs of Juvenile Boards should have submitted their biennial indigent defense plans by November 1, 2021 through our on-line system. TIDC staff will continue to work with counties to ensure that all of the statutory and required elements are included in each plan if judges make amendments. Also, county financial officers must submit their Indigent Defense Expense Report by November 1, 2021. The reporting manual for county financial officers is available at httv://www.tidc.texas.gov/oversieht/submit-data-and-reports/. Both of these requirements are required by Texas Government Code §79.036. The Commission adopted Texas Administrative Code Chapter 173 in order to implement the grant authority established by the Texas Legislature. These administrative rules and the attached RFA are available at: www.tidc.texas.gov. Please contact Edwin Colfax, Director of Grant Funding at ecolfax@tidc.texas.gov or 512-936-6994, if you have any questions about the Formula Grant Program or the application process. Sincerely, Sharon Keller Chair, Texas Indigent Defense Commission Presiding Judge, Court of Criminal Appeals Enclosed: FY2022 Formula Grant RFA FY2022 Formula Grant Resolution Texas Indigent Defense Commission 209 West 141h Street, Room 202 • Austin, Texas 78701 512.936.6994 www.tidc.texas.gov ErrIDC TEXAS INDIGENT DEFENSE COMMISSION 209 West 141" Street, Suite 202 Price Daniel, Sr. Building, Austin, Texas 78701 512-936-6994 www.tidc.texas.gov FY2022 Formula Grant Program Request for Applications (RFA) Issued September 2021 Formula Grant Program Overview The Texas Indigent Defense Commission (Commission) provides financial and technical support to counties to develop and maintain quality, cost-effective indigent defense systems that meet the needs of local communities and the requirements of the Constitution and state law. Formula Grants are awarded to eligible Texas counties to help counties meet constitutional and statutory requirements for indigent defense and to promote compliance with standards adopted by the Commission. Annlication Due Date Formula grant applications for Fiscal Year 2022 must be submitted on-line by Monday, November 15, 2021. The grant period is October 1, 2021 through September 30, 2022. Total FY 2022 Formula Grant Amount Budgeted: $20.5 million Eligibility for Formula Grants Only Texas counties may apply. Counties must meet the following requirements: 1) Indigent Defense Expenditure Report — All counties are statutorily required (Texas Government Code Sec. 79.036 (e)) to submit an Indigent Defense Expenditure Report each year on November 1 in the form and manner prescribed by the Commission. Counties that do not complete the Indigent Defense Expense Report on or before November 1, 2021 may have payments temporarily suspended by Commission staff until the report is submitted and reconciled by staff. 2) Indigent Defense Plan Requirements — The Local Administrative District Judges, the Local Statutory County Court Judges (or County Judge as applicable) and the Chairman of the Juvenile Board for each county must submit a copy of all formal and informal rules and forms that describe the procedures used in the county to provide indigent defendants with counsel in accordance with the Code of Criminal Procedure (Countywide Plans) to the Commission as required in Government Code §79.036. The Countywide Plans submitted must be in compliance with applicable statutes and rules and must meet the minimum requirements for each plan section as outlined in the Biennial Indigent Defense Countywide Plan Instructions. Plans were due November 1, 2020. Formula grant payments during the year may be withheld until plans are submitted or meet the minimum requirements for each plan section set by Commission. FY2022 Formula Grant RFA 1 of 5 Application Steps a. Go to the TIDC Grants and Reporting website (hosted by PPRI) at https://tidc.tamu.edu. b. Sign in and enter the User ID and Password or contact PPRI (Follow on-line page instructions). c. Select "FY2022" and your county in the upper left part of the screen. d. Select "Apply for Formula Grant" from the column on the left side of the screen. e. Review the eligibility requirements. The screen will display the County's compliance status regarding indigent defense plans. Counties that have outstanding requirements will not be able to receive funds until they meet all grant program eligibility requirements. If indigent defense plans are not marked "Complete" counties should still submit the application and then contact the Commission for instructions to resolve plan compliance issues. f. Identify the individuals in the following grant positions as required in Texas Administrative Code Rule 173.301. i. Authorized official - This person must be authorized to apply for, accept, decline, modify, or cancel the grant for the applicant county. A county judge or a designee authorized by the governing body in its resolution may serve as the authorized official ii. Fiscal Officer - This person must be the county auditor or county treasurer if the county does not have a county auditor. Use the "Change" button make changes as needed to officials or contact information. g. Click the "Submit" button at the bottom of the screen. You should be taken to a confirmation page at that point. h. Maintain confirmation — When the system provides a confirmation page to the grant officials confirming that the application has been completed and informing them that the resolution must be adopted by the commissioner's court and then faxed to the Commission. PLEASE PRINT THE CONFIRMATION PAGE. i. Select the "Resolution" link in the confirmation page to create your county's resolution form. j. Print or download resolution. The system will allow the user to download a resolution as a Microsoft Word document or provide an opportunity to print the document. Please use the resolution printed from the website. The resolution must be adopted by the commissioners court. k. Please scan the resolution adopted by commissioners court and then upload it in the application page of the website on or before the DUE DATE Monday, November 15, 2021. Alternatively, you may email the resolution to Heather Caspers (hcaspers ,ppri.tamu.edu) or fax it to 888-351-3485. Contact Edwin Colfax, Grants Administrator, ecolfax@tidc.texas.gov or 512-463-2508 for questions. Notice of Funding • Statement of Grant Award — Statements of Grant Awards will be prepared as authorized by the Commission. These may include special conditions. The e-mail with the attached Statements of Grant Award will be directed to the official designated in the resolution adopted by the commissioners' court. The County will have thirty days to notify the grant administrator of errors or cancelation after receipt of the award. • Special Conditions The Commission may determine special conditions or authorize staff to apply the conditions on criteria set by the Commission (TAC 173.201). The Commission may develop special conditions that relate to expenditures, compliance with statutory requirements or standards adopted by the Commission. • Denial of Grant — Counties not completing the grant application process or those not meeting minimum eligibility requirements will be notified by mail within 30 days following the Commission award meeting. FY2022 Formula Grant RFA 3 of 5 Authorization to Fund Applicable Authority and Rules Texas Government Code Sec. 79.037. TECHNICAL SUPPORT; GRANTS. (a) The commission shall: (1) provide technical support to: (A) assist counties in improving their indigent defense systems; and (B) promote compliance by counties with the requirements of state law relating to indigent defense; (2) to assist counties in providing indigent defense services in the county, distribute in the form of grants any funds appropriated for the purposes of this section; and (3) monitor each county that receives a grant and enforce compliance by the county with the conditions of the grant, including enforcement by: (A) withdrawing grant funds; or (B) requiring reimbursement of grant funds by the county. (b) The commission shall distribute funds as required by Subsection (a)(2) based on a county's compliance with standards adopted by the board and the county's demonstrated commitment to compliance with the requirements of state law relating to indigent defense. (c) The board shall adopt policies to ensure that funds under Subsection (a)(2) are allocated and distributed to counties in a fair manner. (d) A county may not reduce the amount of funds provided for indigent defense services in the county because of funds provided by the commission under this section. Texas Administrative Code Chapter 173 Uniform Grant Management Standards (UGMS) FY2022 Formula Grant RFA 5 of 5 #13 NOTICE OF MEETING—10/6/2021 13. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as National 4-H Week in Calhoun County. (RM) 4H Teacher Emily DeForest introduced students. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner, Pct 1 SECONDER: Vern Lyssy, Commissioner, Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 13 Proclamation WHEREAS, The , �ftof� is prou to honor the 4-H Y uth Development Program of the Texas A&M AgriLife Extension Servic for 114 years of providing ex erience-based education to youngsters throughout the Lone State State; and WHEREAS, This admirable program, which seeks to provide a learning experience for the whole child, including head, heart, hands, and health, helps young Texans to acquire knowledge, develop life skills, and form attitudes to enable them to become self -directed, productive, and contributing members of our society; and WHEREAS, Its more than SS0,000 urban, suburban, and rural youth participants, ranging in age from eight to nineteen, hail from diverse ethnic and socioeconomic backgrounds and truly represent a cross- section of the state; and WHEREAS, The program undoubtedly could not have achieved the success that it has today were it not for the service of its more than 22,000 volunteers, who have given generously of their time, talents, energies, and resources to the youth of Texas; and WHEREAS, Throughout its proud history, the 4-H program has developed positive role models for countless Texans and through its innovative and inspiring programs, continues to build character and to instill the values that have made our state strong and great; n w, therefore,,be it i RESOLVED, the �pyrv� r� � It eby designated October -9, 2021 as National 4-H Week in Texas and commend the 4- outh Development Program of the Texas A&M AgriLife Extension Service and the many men nomen who have made the program a success. missioner Precinct 1 Commissioner Precinct 3 County .. , G110 Commissioner Precinct 2 ommissioner Precin #14 NOTICE OF MEETING— 10/6/2021 14. Consider and take necessary action to approve a resolution declaring October 3 — 9, 2021 as Texas Extension Education Association Week in Calhoun County. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner, Pct 4 SECONDER: Joel Behrens, Commissioner, Pct. 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 10 of 13 TEXAS EXTENSION EDUCATION ASSOCIATION (TEEA) WEEK PROCLAMATION At a regular meeting of the Commis ers' Co of Cal oun County, Texas held on the 6th day o cto er, on a mot' n by and seconded by v�the following Pf mation was adopted: COMMISSIONERS' COURT § OF § CALHOUN COUNTY, TEXAS § WHEREAS, the Texas Extension Education Association of Calhoun County believes strong families are basic to the wellbeing of Texas; and WHEREAS, they have education programs that address critical needs impacting Texas families and communities; and WHEREAS, they see education as a lifelong learning process; and WHEREAS, they believe volunteers and opportunities for volunteer development are important; and WHEREAS, they develop leadership that offers opportunities for personal growth and development; and WHEREAS, cultural and ethnic diversity in programs and membership is present; and WHEREAS, global awareness is recognized; and WHEREAS, the Texas Extension Education Association cooperates with Texas A & M AgriLife Extension Service to attain mutual goals; and WHEREAS, October 3 — 9, 2021 is Texas Extension Education Association Week in Texas, NOW, THEREFORE, BE IT RESOLVED AND APPROVED, by the Commissioners' Court of Calhoun County, Texas, to hereby proclaim the week of October 3 — 9, 2021 as TEXAS EXTENSION EDUCATION ASSOCIATION WEEK IN CALHOUN COUNTY, TEXAS. ADOPTED, ORDERED, AND ENTERED OF RECORD in the minutes of the Commissioners' Court of Calhoun County, Texas, this 6th day of October 2021. r Richard H. Meyer, County Judge David Calhoun County Commissioner, Pct. 1 M Joel M. Behrens Calhoun County Commissioner, Pct. 3 Attest: Anna Goodman, County Clerk By: Deputy Clerk -L Vern Lyssy Calhoun County Commissioner, Pct. 2 Gary Reese Calhoun County Commissioner, Pct. 4 #15 NOTICE OF MEETING— 10/6/2021 15. Accept report from the following County Office: I. County Treasurer — July 2021 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner, Pct 2 SECONDER: David Hall, Commissioner, Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 11 of 13 CALHOUN COUNTY, TEXAS COUNTY TREASURER'S REPORT MONTH OF: JULY2021 BEGINNING ENDING FUND FUNDBAIANCE RECEIPTS DISBURSEMENTS FUNDBAIANCE OPERATING FUNDS: GENERAL $ 30,460,997.41 $ 2,142.020.68 $ 3.306.430.24 $ 29,296,587.85 AIRPORT MAINTENANCE $ 71,680.13 136.99 2,176.34 69,640.78 APPELLATE JUDICIAL SYSTEM 850.56 145.44 996.00 COASTAL PROTECTION FUND $ 2,327.423.42 1,201.21 37,804.80 2,290,819.93 COUNTY AND DIST COURT TECH FUND $ 7,584.80 133.77 - 7,718.57 COUNTY CHILD ABUSE PREVENTION FUND S 693.28 0.81 - 694.09 COUNTY CHILD WELFARE BOARD FUND $ 6,448.92 15133 - 6,600.15 COUNTY JURY FUND $ 332.43 46.04 - 378.47 COURTHOUSE SECURITY $ 286.823.35 2.216.40 - 299,039.75 COURT INITIATED GUARDIANSHIP FUND 5 12,363.19 6638 - 12,429.57 DIST CLK RECORD PRESERVATION FUND $ 38,154.32 409.69 - 38,564.01 COURT REPORTERS SERVICE FUND $ 336.31 78.77 - 415.08 CO CLK RECORDS ARCHIVE FUND $ 294,132.93 5,721.81 - 299,95474 COUNTY SPECIALTY COURT FUND $ 2.662.06 575.59 - 3,237.65 DONATIONS $ 103,353,27 1,904.30 367.14 104.890.43 DRUGIDWI COURT PROGRAM FUND -LOCAL $ 25564.91 62.67 - 25.627.58 JUVENILE CASE MANAGER FUND $ 18.642.20 282.60 594.90 18,329.90 FAMILY PROTECTION FUND $ 13,832.96 112.14 - 13,945.10 JUVENILE DELINQUENCY PREVENTION FUND $ 9.184.97 4.74 9,18971 GRANTS $ 796.269.45 19,392.61 84,588.69 731,073.38 JUSTICE COURTTECHNOLOGY S 90.938.69 912.26 295.16 91,555.79 JUSTICE COURT BUILDING SECURITY FUND $ 6,507.45 43.01 - 6,550.46 LATERAL ROAD PRECINCT#I S 4,355.43 2.25 - 4,357.69 LATERAL ROAD PRECINCT#2 $ 4,355A3 2.25 - 4.357.69 LATERAL ROAD PRECINCT#3 $ 4.355AI 2.25 - 4,357.66 LATERAL ROAD PRECINCT#4 $ 4,355.43 2.25 - 4,357.68 JUROR DONATIONS. HUMANE SOCIETY $ 3,631.91 156.00 - 3,787.91 PRETRIAL SERVICES. FUND S 84,236.98 43AS - 94,280.46 LOCALTRUANCY PREVENTION/DIVERSION FUND $ 10,169.79 888.73 - I1,058.52 LAW LIBRARY S 214,163.90 1,125.53 2,298.30 212,991.13 LAW ENFOFFICERS STD. EDUC.(LEOSE) $ 28,212.47 14.56 (969,87) 29,196.90 PGC COMMUNITY CENTER $ 16,912.06 3.108.73 3,720.05 16,300.74 RECORDS MANAGEMENT -DISTRICT CLERK $ 8.625.26 208.24 - 8,933.50 RECORDS MANAGEMENT -COUNTY CLERK S 203,370.37 5.699.30 - 209,059.67 RECORDS MGMT & PRESERVATION $ 35.573.60 971.59 - 36,545.19 ROAD &BRIDGE GENERAL $ 1,569,408.72 30,604.09 - 11599.012.81 6MILE PIERBOAT RAMP INSUIUMAINT $ 35.420.96 18.28 - 35.439.24 CAPITAL PROD- BOGGY BAYOU NATURE PARK S 182.839.00 19,944.80 - 202,683.80 CAPITAL PROJ AMERICAN RESCUE PLAN ACT $ - 2,067,666.50 - 2,067,666.50 CAPITAL PROD - CDBG DR INFRASTRUCTURE $ 49,002.60 - 32,295.24 16.707.36 CAPITAL PROJ CHOCOLATE BAYOU BOAT RAMP $ 176,250.01 - 200.00 176,050.01 CAPITAL PROD- ELECTION MACHINES $ 0.21 - - 0.21 CAPITAL PROJ-RB INFRASTRUCTURE $ 9,714.41 - 9,714.41 CAPITAL PRO) ENERGY TRZ#1 $ 221,799.00 9,021.00 9,020.15 221,799.85 CAPITAL PRO) AIRPORT RUNWAY IMPROVEMENTS $ 14,972.13 - - 14,972.13 CAPITAL PRO) MAGNOLIA BEACH EROSION CONT S 175,000.00 - - 175.000.(10 CAPITAL PROI EVENT CENTER $ 125.927.09 - - 125.927.09 CAPITAL PROJ FIRE TRUCKS & SAFETY EQUIP $ 6,448.68 - - 6,448.68 CAPITAL PROD -GREEN LAKE PARK S 7,160.74 - - 7.160.74 CAPITAL PROD HATERIUS PARKBOAT RAMP $ 20.242.36 - 20,242.36 CAPITAL PROD PORT ALTO PUBLIC BEAC14 $ 223.132.59 - 221,647.80 1.484.78 CAPITAL PROJ HURRICANE HARVEY FE•MA $ 54.914.68 - - 54,914.68 CAPITAL PROI IMPROVEMENTS PROJECTS $ 344,369.10 - - 344,369.10 CAPITAL PROI HOSPITAL IMPROVEMENTS $ 2.944,602.66 - - 2,944,602.66 CAPITAL PROJ -MMC LOANS S 1500,000.00 3,500,000.00 ARREST FEES $ 1,031.93 262.58 900.67 393.84 BAIL BOND FEES (HE 1940) S 2,115.00 690.00 2,775.00 30.00 CONSOLIDATED COURT COSTS (NEW) S 5,488.88 2,135.92 7,594.79 30.01 CONSOLIDATED COURT COSTS 2020 $ 26,364.49 14,929.46 41,293.95 - DNA TESTING FUND $ 349.80 32.74 132.54 250.00 DRUG COURT PROGRAM FUND -STATE $ 205.81 49.46 ?54.96 0,31 $ 44892.85 7 4. 33D89.23 $ 3753420.84 45.472524.18 SUBTOTALS 0... 1 ni i COUNTY TREASURER'S REPORT MONTH OF; JULY 2021 BEGINNING ENDING FUND FUNDBAL4NCE RECEIPTS DISBURSEMENTS FUND BALANCE OPERATING FUNDS -BALANCE FORWARD S 44,892,955.79 S 4,333,089.23 S 3,753,420.84 $ 45,472,524.18 ELECTION SERVICES CONTRACT' 96,163.78 39.09 - 0,202.86 ELECTRONIC FILING FEE FUND 3.248.83 1,39729 4,640.12 0.00 EMS TRAUMA FUND 1,431.79 1,279.71 2,584.93 126.57 FINES AND COURT COSTS HOLDING FUND 7,947.31 7.847.31 INDIGENT CIVIL LEGAL SERVICE 576.3D 30D.00 852.00 24.30 JUDICIAL FUND(ST. COURT COSTS) 110.64 26.06 136.70 0.00 JUDICIAL& COURT PERSONNEL TRAINING FUND 339.81 225.00 750.32 14.49 JUDICIAL SALARIES FUND 4.160.42 1.896.52 6,056.92 0.02 JUROR DONATION -TX CRIME VICTIMS FUND 360.00 16.00 8.00 368.00 JUVENILE PROBATION RESTITUTION 62.57 - 62.57 LIBRARY GIFT AND MEMORIAL 39,9D2.60 120.59 - 40,023.19 MISCELLANEOUS CLEARING 11,941.70 187.42 2,220.98 9,80B.14 REFUNDABLE DEPOSITS 2,W0.00 - 2,000.00 STATE CIVIL FEE FUND 5,398.10 2,535.26 7,960.36 (27.00) CIVIL JUSTICE DATA REPOSITORY FUND 6.23 2.46 8.69 0.00 JURY REIMBURSEMENT FEE 463.06 189.40 652.46 0.00 SUBTITLE C FUND 12,242.55 6,234.16 18.462.94 13,77 SUPP OFCRIM INDIGENT DEFENSE 231.37 86.75 319.12 0.00 TIME PAYMENTS 1,467.98 583.21 2.051.14 0.05 TRAFFIC LAW FAILURE TO APPEAR 1,900.71 614.15 2,514.86 0.00 UNCLAIMED PROPERTY 12,602.82 0.53 12,603.35 TRUANCY PREVENTION AND DIVERSION FUND 292.23 60.20 247.33 105.10 BOOTCAMPIDAEP 147.43 147.43 JUVENILE PROBATION 284.474.00 32.887.81 56.235.95 261.125.86 5 45,380,328.02 $ 4,381,764.93 S 3,859,122.66 S 45.902.970.19 SUBTOTALS TAXES IN ESCROW 0.00 0.00 0.00 S 45 80 28,02 S 4381764.83 S 3.859.122.66 4.5,902,970.19 TOTAL OPERATING FUNDS OTHER FUNDS D A FORFEITED PROPERTY FUND 13.809.18 5.14 525.00 13.289.32 SHERIFF NARCOTIC FORFEITURES 24,973.72 SAS 525.85 24,457.35 CERT OF OB-CRTHSE REF SERIES 2010 505,610.03 2,41BA6 - 508,028.49 CERT OF OB-CRTTIOUSE I&S SERIES 2012 691,165.78 3,176.17 694.341.95 CAL. CO. FEES & FINES 145.58.72 202.201.23 221.816.52 125 643.43 9 MEMORIAL MEDICAL CENTER OPERATING 2,418,188.82 6,017,595A5 4,370329.45 5 4,09,054.82 MONEY MARKET 1,107,607.10 517.39 - S 1,108,124.49 INDIGENT HEALTHCARE 4.950.92 10,830.66 10,760.65 5.020.33 PRIVATE WAIVER CLEARING FUND 431.14 0.16 - 431.30 CLINIC CONSTRUCTION SERIFS 2014 535.51 0.20 - 535.71 NH ASHFORD 77.734.89 463,626.57 385,302.20 156.059.25 NHBROADMOOR 44.476.63 402,819.68 349,81231 97,484,OD NH CRESCENT 8,248.80 265,264.75 205,370.92 68,142.63 NHFORTBEND 7472.68 111,031.98 73,497.06 45.207.60 NEI SOLERA 13.647.07 368,406.28 273,605.90 108,447.45 NH GOLDEN CREEK 35,420.41 344.060.25 226.898.50 152,582.16 NEI SOLERA DACA O.OD - - ODD NHASHFORDOACA OLD - - 0.00 NH BROADMOOR DACA 0.00 0.00 NH GULF POINTE-PRIVATE PAY 79.091.96 222,872.39 241,663.02 6030I.33 NH GULF POINT PLAZA MEDICARE MEDICAID 26,187.99 186,777.07 173.229.03 39:736.03 NH BEIHANY SENIOR LIVING 101,486.12 942,079.14 820,153.58 123,411.68 NHTUSCANYLIVING 180728.67 337482.81 363.437.69 154773.79 TOTAL MEMORIAL MEDICAL CENTER FUNDS S 4106 08.W $ 9,573364.78 S 7.494.460.31 $ 195313.07 DRAINAGE DISTRICTS NO.6 44,425.97 16.98 - $ 44,442.95 NO.8 138,014.78 52.15 3,565.00 134,501.93 NO. 10-MAINTENANCE 201.645.54 93.28 - 201.738.92 NO. 11 MAINTENANCE/OPERATING 160,640.62 1.773.27 35,825.69 126.588.21 NO. 11-RESERVE 225.403.58 86.15 225.489.73 TOTAL DRAINAGE DISTRICT FUNDS S 770130.49 S 2.021.83 S 39.390.68 $ 732761.64 CALHOUN COUNTY WCID 01 OPERATING ACCOUNT $ 363,979.18 68.65 21,271.99 S 342,775.84 PAYROLLTAX S 1.984.85 0.00 166.28 S 1.818.57 $ 365,964.03 68.65 21 38.27 S 344594.41 TOTAL WCID FUNDS CALHOUN COUNTY PORT AUTHORITY MAINTENANCE AND OPERATING $ 4909451 S 133.86 S $ 49228.37 CALHOUN COUNTY FROST BANK $ 2,035.87 $ S 5.00 S 2030.87 $ 5d93 .50 9575589.I2 $ 7555.294.36 7313928.36 TOTAL MMC, DR DIST., NAV. DIST, WCID &FROST $ .92,054,778.95 $ 14,165.164.43 $ 11,637,284.29 $ $4,687,659.09 TOTALALLFUNDS COUNTY TREASURER'S REPORT I MONTH OF: JULY 2021 BANEBECONCILIATION LESS: CERTOF DEPI FUND OUTSTNOGDER1 PLUS: CHECKS BANE FUND BALANCE OTHERITEMS OUTSTANDING BALANCE OPERATING + $ 45,902,970.19 4,999,999.06 433,369.87 $ 41,336,341.00 OTHER D A FORFE1T13D PROPERTY FUND 13,289.32 - - 13,289.32 SHERIFF NARCOTIC FORFEITURES 24,457.35 - - 24,457.35 CERT OF OB-CRTHSE REF SERIES 2010 508,029.49 - - 508,028.49 CERT OF OB-CRTHOUSE I&S SERIES 2012 694,341.95 - - 694,341.95 CAL, 00 FEES & FINES 125,643.43 16,331.93 15,767.66 15,079.16 MEMORIAL MEDICAL CENTER OPERATING $ 4,065,054.82 - 1,297,954.07 5,363,009.89 MONEY MARKET i,108,124A9 1,108,124.49 INDIGENT HEALTHCARE 5,020.83 10,698.2A 11,112.24 5,434.93 PRIVATE WAIVER CLEARING FUND 431.30 - - 431.30 CLINIC CONSTRUCTION SERIES 2014 535.71 - - 535.71 NH ASHFORD 156.059.25 - - 156,059.25 NHBROADMOOR 97,484.00 - - 97,484.OD NH CRESCENT 68.142.63 - - 69,142.63 NH FORT BEND 45,207.60 - 45,207.60 N➢SOLERA 108,447.45 - - 109.447.45 NH GOLDEN CREEK 152,582.16 - - 152,582,16 NH SOLERA DACA 0.00 - - OLD NH ASHFORD DACA OLD - - 0.00 NH BROADMOOR DACA 0.00 - - 0.00 NH GULF POINT PRIVATE PAY 60,301.33 - - 60,301.33 NH GULF POINTE PLAZA MEDICARE MEDICAID 39,736.03 - - 39,736.03 NH BETHANY SENIORLIVING 123,411.68 - - 123,411.68 NH TUSCANY VILLAGE 154.773.79 - - 154,773.79 DRAINAGE DISTRICT. - NO. 6 44.442.95 - - 44,442.95 NO.8 134.501.93 - - 134.501.93 NO. lO MAINTENANCE 201,738.82 - - 203.738.82 NO. 11 MAINTFNANCUOPERA'DNG 126,58811 - - 126.588,21 NO. 11 RESERVE 225,489.73 - - 225,499.73 CALHOUN COUNTY WCID81 ++++ OPERATINGACCOUNT 342,775.84 - - 342,775.84 PAYROLLTAX 1.818.57 - - 1,818,57 CALHOUN COUNTY PORT AUTHORITY *+++ MAINTENANCEIOPERATING 49,228.37 - - 49,228.37 CALHOUN COUNTY.... FROSTBANK 2,030.87 - 2,030.87 TOTALS Is 54582659.09 I S 5027029.23 I7A9 203.84 1 S 53313833.70 *•* PROSPERITY BANK CDs --OPERATING FUND $5,224;857.49 **+* THE DEPOSITORY FOR CALHOUN COUNTY WCID IS INTERNATIONAL BANK OF COMMERCE - PORT LAVACA **** THE DEPOSITORY FOR CALHOUN CO. NAVIGATION DISTRICT IS FIRST NATIONAL BANK- PORT LAVACA **•* THE DEPOSITORY FOR CALHOUN COUNTY FROST IS FROST BANK - AUSTIN, TEXAS THE DEPOSITORY FOR ALL OTHER COUNTY FUNDS IS PROSPERITY E PORT LAVACA Court costs and fees collected and reported may not be current an" -to -date a to on -comp!' cc by er county offices. hereby certify that the current balances are correct to all monies hat ha bee ece A by t Count Tr/a�surer as of the dal of this report. 4 i l) i ill L7 7 f tIM / L /] H-7-- Pnur 3 of 3 #16 NOTICE OF MEETING—10/6/2021 16. Consider and take necessary action on any necessary budget adjustments. (RM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner, Pct. 4 SECONDER: Joel Behrens, Commissioner, Pct. 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 12 of 13 .I J a 0 0 F- K 0 O V c r� =0 =W w c W O wU z �' N Z = =F Q O x w Q) = z�, 11�1 z C/) W Z a a =� =F W =d Z zrnN W �i fN•) rMi 0 Q C fp (D w =0 CO O z =W 0 fnrnrnrn rn rn rn rn f9 f9 f9 � i e ofw W N f9 f9 E9 fA E9 N f9 O O o o f WVJ E9 f9 (9 f9 f ee i g z z z z z z 0 0 0 0 0 Z Z Z Z Z rnrnrnfnrn rn rn rn rn rn rn rn rn rn rn m U) Z w O 7 U a w a O rn m IS ~ O Z J Qw OQ>Q W K co zz U2 w Z of 2 w O w z a g7�aa �ou�ofoo M M M fMD � C N�fo co r J a 0 0 u F U z U z a w J m co co z 0 U i0 i� ;N :z : r :z ;CCW G :L !W `o =0 =N =0 =_z =Z =W = d =W = 0 Z LL J Z g Iq Z LL y F z D 0 tl a NNN m � M � EM9 � O O v � � � pmp = O OCp Wy fA N N N � ux7 0 0 0 0 0 0 0 - f» e - W L9� V3 fA fR Yi fR C M 19 z z z z z Z Z Z Z Z Q Q Q Q Q 00000 z z z z z z � rn rn rn rn rn rn rn rn rn rn m�mmm e z Z O 0 Q 0 Z_ �y W 2 O K W Z)W F O � $' oUw2 a Q o > 0 W W LL Z F- Z dog c7 W M - J z LU V U Z S 0LLI o 0 o w w v N r m M t�0 0 N 0 Z F" Z W d W 0 2 � Q � O O � N WCI� N N O O N e 4� V N N V N N peZ fA My fA � fA LV v 0 0 0 0 0 e 0 0 0 0 0 W � b3 f9 H3 V3 E9 zzzzzz z z z Z QQ QQ K K K x K K 0 U' C7 U' (D U' 000000 zzzzzz Io O w o w o M v w o w w w n r r N H M O N N N N H «n w 0 0 w w ■ ■-§\}/} � 3 �■�� ■ §§©\_ o ) �■ - - ) k = � /� Ez 2 �§ §sass■ B § )§ IL k§ § § � k 0 ■ § ■ - ° k k&2&&� LU t »&!!§ oo=o■ 2222% ■ ■ § - K §&±I* \� § % z \@LU ■ /q q LLI $ §LLI ■ § .LU 3 j\ _ B rLU Ez Lij \)k\- Az _® § S§§� % )� § % 022) \ )L §§ )§ % § $ MB§®¥- Ing ■ �8coo - �000 a §� I � I --- - ■ Br/ �\j L§ ■/: §QE :a :z :§ :JL :§ LU ;o :z .� :z :§ '2 k k « BB" k LLI / ƒ B � :a :z .� :§ :4- :§ :■ :o ;z ;z ;o E § § § mom m § §. B§"-- - § �§§ ) Bak B■ )8 \Z low ■ =Z )§ .p. �« _ ■ jLLI ) § ■§ �- ) ) § § pa B (z § §w � ( kL . z �L § § (o S )v z |U 2 jk w _ » o § \� k § / \w � ; ■ )§ % LU B G 0 z z W F IL W 0 F z 7 0 a y J F 0 V 2 U w K a w w a LL 0 w U U) O Ch z z W F W 0 = F _Z =W L , -W F __ t1 =W 7 =d W v _=0 o a _W W z =v_ Q =y G =_7 =i W =W O =a z =_Z W z W lu 0 2 °W � a Eno 000 0 =T W C Q EA bi t9 � 0 e ' = z 0 0 0 0 =W LU V W fA fA W 19 � C W W Cp's0 = a �1 J ~ ~ = _' Q o Z m ZZ� UA 2 a = W OOZ U = . I z ZZg W = Se W a _ J p = W W ui 0 _ a 0° a =W H J -_Z z a a - W F Q LU w W uzQQi b LL J =G o � __ W z CW p G p Z N Q =L z C m con m - W y2j W Z LL J uj Z LU c) ui Z Z LL BO =_a =o = Z =F _Z -W =g __�w _ L EW =G Z ZK W K m Z O U W 00 z z oV yWj 9rnrn o LL O m = d W a �- W � m 'Q Z 6NZ ;z 12 F- o a F` W a Q 0 d 0 $ 00 zUA W V 0 0 WI fA fA C 3 a Lp C? w F- FL Q a Z W z� a a Q o ��1 ` m W w T w J 0 0 z U w a w C7 p K m z z a c 0 w Z QJ W W 0 g 73 Z m o ro n 0 0 0 0 0 o c N W O O fA H3 H3 O e r n n = CCCC w o 0 m N � M 4] C = = ` 6 0 0 0 0 0 = W o 0 0 0 0 0 W � E9 Vi fA 19 19 =C W W fA fR fA fR fR fA W - m m CO =_d =W 0 0 0 0 0 0 0 0 0 0 0 fJi fA N H V1 = � W � fA EA fA fA Uj fA o o - 4 fj z - Z Z Z U ` z z z z z z (D(DCD W =W o (D(D(D(D00 y 0000 Z 0 V 000000 �� Z z Z z z Z �i Z CCe fn V rnrnrn¢ _ =m LL 5 ; mommom y r� a °a =Z 3 & .a a =0 F wF-W� W -_� W ''''�¢0w > N Z_ Q a a U z Z j W A N .� W ui U) w Z iQaa 2Q aN. Z i(Daaaiviog 4� 0 a} =Z y 0 g�wgw� 0 w N N 0 Z a �w =_� a mzUWSJ W a- =Z W aszo�Ja Z �UZ =W : poW av� =� WW 00 W W �m?u QZ i M O Ed Z 0 0 0 N O O W M M -W W W M M M M M O 12 a a W I 1 m Z Q 1 0 y 0 F z 1 z m z w 1 V ~ r a 6 ao Z Z 0 0 00 • � F z z z z r Z 1 C e k rn rn � o a z 1 � i O W W O > 0 O y � U • Z N wLU i W� E F z =Z ox W � p 2 G z o o M NO LLI W # 17 NOTICE OF MEETING— 10/6/2021 17. Approval of bills and payroll. (RM) f uTW 0 RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER, Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned 10:34 a.m. Page 13 of 13 October 6, 2021 2021 APPROVAL LIST - 2021 BUDGET COMMISSIONERS COURT MEETING OF BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 14 FICA MEDICARE FWH NATIONWIDE RETIREMENT SOLUTIONS OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT 10/06/21 $117,775.18 P/R $ 54,978.68 P/R $ 12,857.98 P/R $ 37,938.80 P/R $ 4,892.50 P/R $ 1,516.15 TOTAL VENDOR DISBURSEMENTS: $ 229,959.29 TOTAL AMOUNT FOR APPROVAL: $ 229,959.29 &-' I Dale Requenee _. 10/f/3011 rover ME01WE RemhdnsegJvl4aM F08 PequaileE EY IgIUM bUPCUNBU51NK5YiflCf MNNAGFN Reque mn tlmd Igol �Lelli.VrY lrvuu[oy Xmmrybtlfanepelnllm °r^iemmmmrrewupmmtplbwprm P eMne P 'HJmINxnFUtle olimkaantl amoueloF MrmCerrs 36LSSIMW mlhgm RemlPr rrai rtgY Olpnetor[oun1V enER<rN(YMlgMla tq: [Nr�• (N GIM1ow .61, BghwVSenm hvi, ejtln �" OCT 0 4 A r.rowww'"No Request for Transfer of Funds Tanner N: Oeu xequestetl 9/b/E@l NOABWOM]985 Pan/ NmAii RequeeW by Un-H.,g Req... Wr e.l Lmyper 18�Ne.J :v�IIYrIIF [om Nequ.al11 p.ne number 03-M8012 WSMet Or Caunty Mamullal Medal Cenuy iaiillw GMen Creek Mrerv'�ISNV11IXau.�um nanlnn:IDmmo on pdtlenl Hanle / )ateW4xbe F 9/W203f vr,,,e". b eak Nu I Cb a�IVfbetl� Nna in Ma 5(2,42501) E176052760 CVflAP0.4'[O)98585 5 2pE8.00 o[es iusnny V:lpgu T(Ii0.L 512.<ESAa 5 2A25.04 lletl aul6 Memoaul Metllul Cen¢nce 92]IDild hy: MaVra Mill:necebeh: 1[': Li ¢1I,..v IucunYV: ageI, en Creec 3A SOiJmMerwo-rs:franile/:tl1111-To tl: =A—t� nwa5aon eK OCT 0 2021 I 3 Memorial Medical Center Nursing Home UPI Weakly CaxtexTransEer ProsPeritVAccount9 loJa/zou ereraVr uenuna eeSNnM[ xvmb.. a.I. _.._ OFF 469.41128' iy AOI Penury ..in Gwam In167,930.92 >,)B4J9 a' ]3,913 fig J ro4av'a eapnnln[ AmaYnl en Ba innalenN la MVrainr MYrce Hama BS,M3.91 / 69,896.11 Bank Balance 85.013-0I ✓ Yanan[e L.v.m eaanR Ioo.ac IULY NTGSR / "j,G , ]),aj✓/ W ORTNtli SFPIHTGFSr 31.09✓/ AdkY tSoianRRtanaln Amt N,Mllt ✓' 24.439.02 16,999a1 0aM B41mR 2gM902 Y/ Varian¢ tawlin9Elnnµ 1M.D0 MEDICARE REPAYMFMOUFT00E3 V 3,"7.10✓/- MEDIGEM REREPAYMDUETOT NY ;SaLtSw MEDICARE REPAYMEM DUE TO MIACUNIC 443.42// MEDICARE AEPAYMEW DUE YO 60NEN GEEE / Z,425.0 If IUlY1NTEREST s1.13✓ "'PIFFAEST I'm SEPINEERW ass Aalwt &IarneRranElerAmt IE999.21 V Uf103,35}SB�T.i55Aa ai 57.885.99 �' SO,BIiJ$ Bani OalanR VarianR 5).tE5.99 v leaYlln Ea6nR MEDIGPEPEPAYMEMDU[T06ETNAN 1MA0 1,µ3.]D J/ MIUIGRIPEPATMEMOUTTOTUSGNV 19E1.3E/ MEDIGREPFPAYMFMDY[tOMMO1ryl[ µ)AEI MEUIGRE MPAYMEMUUTTO p01OEN0tE[K 2IM.✓ NEYIWMUT 10,sal/ AUGIMREST 9.26� SEPINRREST SLID AdiYrt Oalarxe(TramlerAmt so. ..193.06 /�5.078.64 .14.180.]] ✓/ ]Z,275 14 12A10.20 BanY Balance 11,335.14 VariarRe leave ln0alanSn I0000 MEDICARE REPAYMW DUE TO MM RINK low / IUlYNGIRM B.TZV// AUUINIERFST 6ASy SEPM actor ass � � f atljun BaUneeRMmlvrAmt Ey%p,30 fiU3ef�_a�Wwl O,u;`Q'P.ji 379,327.16 `/3)9,103J9\ 111,590.81 lll714.19 104,670.47 BsAB.,.nm 111,734.18�/ Varbn[v Mava In Llan[e U"Go MEDICAREREPATMEWOUET0MMU411Y 1,4R3,to/ GIN MTUIGPE PEPAYMEW UUETONSGNY E.581.36 t MFDIL1xFPEPAYMEXTpUFTOMM0IMG µ3A2✓/ MEOIGRE REPEM AYMDUET000WINOSEEK 3Az,." f/ OCT 2�21 inn`�S"z'LI r ImVINRRES] M." / AUG IMEREST 16 Us Vf (f SEPIMEREST 2PAI V �nui Adiu.8A.n4ejNnIf.IAmt '"AMA] 30rAETMNSFERs 2 IM74 ADproved. 1{aY---A.�E6EA�. Norc palalMonrnaforufSLW Y+IIaa 1, IaiPEAnE11M10±0 „• D� xorr2 mmxrwnrmm�Eaq Em'mre e). ..........vYnl. �1l 10(4(2021 IAHNWeIIIY irrnrllta\NMYPeiranaiEl]vmmWVO}1\Otlnbrr\HNIIPINanrler iYmmlrylnallaYe I:1NH W,Nm, mlm\ww W.w..0 WNmh.H ,NJgUUobeltlAAU, ov„MA.. Os»a11An IOOr».N. r.fe1 "`' 's� 4/1]/1P11 Y NLCPMM.WI 11.m MIW M`w3i119Im }, 9/11/5021 VN No. AM LN.0=XT Mm16u wool aIllim?INALTHHUMANSVC HCCUIMPMT I116JOHIU 52 91111m: AmenMmp7RSCN[CUIM1MTll6JQQW lJUw 9/l9/im1 w:nE WisSN6ORp N FAj"CAR[C[M[NlnU VHCCOMMOMWII HIXWMPMf 166m%3390 1I19/302L 1R0 9/lAMIN VMCCPMMVMIIY pl MCCUMAH, 1lANl39lmti 9/t9PQO WCC.MMVNm.MCcAAUIMIWww.119lmm 9/111bRi NUNN SCHUMN HCCUIMPMl 67542342MIN VIM/M22.ANOWJµo"hur., 9/lq/Nll YMIedHnOM1µrtMCCUIMVMTi46m3111 I14214 10/1/m011 10W 419 ml64 OJ",UHCCO.MUNI"#LNICUIMPM»[M341l9Mf lo/vo1 MM"PLMMpMT»6m3A. Vp[1[56 ./V;xpMM.=1IMCnAMpMILW%I.moom A W dRR/1,1 XX g 1J;1031 1 CX 1»8 /ll/181C[{]9 9/])/]OS3 ffp0 9/])/1C21 NOVON SOWfION NCC4IMPMT 6>%5)Ilmml» 9/EI120II XOVRR4 f01UIlOH NCCUIMaMi6]835)IlOM11]1 9/29/39I1 WIN OU]CAN ix NUITNC.fa000NRM Al 4/S9/MSl UXCCOMMUNISY BI NCEWMPML MBm32=133 9/29/2m1 adIdW3P3VTIPX xCCUIM4MT6)[3»A)Y{U 183 9/3wtau NdAN1e'Mmgak _ 11]p%o»YMetllluhhnnllCCUIM9M]]AfmtA11111]BA - 10/112e21 efux Hoj.olSP/Utml cin) t .111202CXn6 IWV2 02MA1 WOprlt S,SM.. S.Saw 1WU10i1 xpefWOx»»IR Mxt PMNTmM]mm000A39l11 / tM5A0 I6]]M,]f ]3,919.89 ✓�, MMCNI WIOM mpP/... rnnNx.Wl nnMe..l Wn/tempt N5110AH,2 OPON op, 61,9n OPNTI Nx PPMmx 512.9) 1,370310 M 3d 1/»/Jml CNI55 011 Cf156 :/27/ 9/1J/M21 91W]0 9/U/ID» NIMOMMYMry19NCCUIMIMTJNINAH, NFNTNCPM CCMCFRtet AAR APtiNMIC 9/b/3011 N[p SyWhmenM NCNIMpMTA6mHllRg6i 1/3Wiwl MRNM.CA1AAU. 1B 3U wom 9/30/1011 Yn1IMne.NNnn N[CUIMIMT JICCOJy1 J1gB0 ."N'T 111.1m 1243M "I"6 10/4102C[I59 HJVJ.1 iep/1a21 cxt» l0 mul ANNR6UNoxFil»6 MNSYMHTmG'M. mMUJ,A1 m/1110.. UROOMMUNNYPOICMIMPMT]AUMMINAM 9/t)/Sml CIMU6 W11/t0z1 C6»5l CN115, 9/»/2021 CN362 9/»N011 .1180 9/»/lgl) YMR(ONfMIXC.1ff Nf[ulMfMi..6m3Ul IN)% m" ml Ameryrvup IXBf NCMIMPMI»bI518»e lllllm 9/37/201 YHc comMJWH,'t.cc A NNMl mau1k 9Ma Wilh011 NOW)N SOIUTNIHNCCUIMiM18161IPf1AWl» IIIIIW21 HUMAN INS co HmuNmpmr MIMl W0170, 9/1]/t021 URPSUppNMenll"a,HNUM,,.AlI 1241" 9/ Hol A"'...` USC XCCUIMPMT 3111141101 JIM 9/lNloll NOUOAI.....ONRXWM NIT11611af2.111 9/28/2ml IIUMA.... CO IrtMIMIM11108611]hOp58)611 91"11 AAAP SW`M meM. NOCWMPMTlNWNI1l2ARA 9/l9pOl1 UAMOUTCANTIXNTAITff Dft 1IN%%11, f/29/lWl PmeNev.PIXSNCCUIMOMT3I,,m .0112m0 MONO] PoIleONaIIMm NCCUMANT)C6m1611 IJUANIf 11NN - 9lW20?l INMIM 1CUT10NNIXU1MPMf8)NIO1 6,7p1,61 gJ0161 L121.» t1.4. SOIm.95 l0}m.9J 101.36113 6.J66.06 6J4f.m 3'Imm 6,91193 ].H551 L199.51 5,656.31 9/l1/1ut CNICI W2111OEI &HA, 9/»R011 g163 9/]1/ipll YNCCOMMUHIp II XCCUIMPMTl16mM119IQW 9]»A031 NOWUN SOLUTION NECWMPMT I'll. INUMM 1/]0/1013 WINOU3Y NH SOLUTION Miloltn 2WP1]L 9121/1031 WIN W34N]fYNfYMCaPi C[HifM 61 91299P31 YNC[OMMYNIIY II HC[41MPMT]I(m%II91mb 9/SP/tpf) NNlkaiR5PlYhr .,._ ..:: 11MR:: YnIIMNnNhorcNLCU1MMAT]A6mlNllif361 UUJJH) CN165 1014]WI CNI66 UVWm. 1.109 m/4]Ptl CMM 10/4202lUNCCOMMURMFINCCWMIMT716mH113IfOA O,If15f If91.3] 10/W@S NOVI]NfOIUTMNNCCu1MPMf611f2911CM.I. 3,411 SS 1%1/.ei. XNMAN4 [NAOOB IICMIMpM3mANNKMl1l6 g13013 ./ 3A3LIf M11 yPp/fumpi MMCPoN110.V NPMfanµ f mn f 7Sip0 inmrenln NpP/Gm 1 ypv/Cwnpl WPM Qppp NX PORTION 1.310,11 MMCK)"OM OIGp/[amµ Iti01(].nJp Wpp/COmµ NPp/Cvmpi ypp/Camp] Rupu pI11T NNPON]IOX 19363 195.61 IO.i51.61 - 30,)52.61 b.lOb,Gl 6.116.61 I15.31 1]SJl 131.003A1 C,%9A8 1,96f.16 8.1S5F0 - 8,353.60 ' s,f%.es s.fb.65 41131 ILOS ].360A3 ll,li] la 7.31o.m ).law 3,3m.m 10.953.58 lJJgsAs0 iFsl.l} 0.01A2 J u9.3%.13 M,i6].SO ✓ 140s1.N MMcm.nmm 01Pp/4mN IllylWp RiNyLJy g531/Camp{ W9P/Cu... WPI(femP3 MUM, OPP71 NNPORIWN 51393 66.3i ,,I'll U],31L95 S,ISl.I9 f.19].I9 - ),2f1.91 1151.91 - ISim Ma 1fV.m 6,96 C95 - 3.M3.32 1,199.59 ],015.19 - A.Me 9A I6,II931 f.tl3flJ1 f318.06 216§:. Adt606 - 1.316m II.53 law ],Ll6m 28.W NO.m 38].61 Lmzv 1,39im 51.31 L198m 36mf.µ fLlm.)3 all 11.130.» mNNUAnON Tne.le r.W1 Inntl.nln pWP/Gm11 p19P/Gem OIPPIOUW1 OIPN �' 51193 '11 TIXN PaxnpN ff6J6 m6.iJ l.lbws ip)031 6.911.OB )91 T9» ].42 7311.66 - ]59.)7 - 9,I.Sjl 7.51266 Gam 9445.39 114"M 620.m S19.3) 3FSI.W ' 7.9mA5 36J32.6p ' 1669m ],TM05 30,444.59 1.611,50 32L25 . a;4z. uaas .Al2.m 11A1 I,613m 2..]»Ay 2.61L06 u\nn w.nly n.A•i.w\un6 o.wAloae wwnn<wglox4lk306wWn un6u..loaHN.n.L mm lobsL..H. 9130/SAL HUMAMI NCC"IMPMT 663.6) pR• AVI INIS3ML06)3P5 9/30/xMl XUMANA [HAOiSBx:CUIMPMTlW663yNA0i9te ' 6636) IL MIUIMIS 1i5N 1t 1619M.11 10/U3AL IOJV 496L99 3M3S1 ' C.166 C61i66 1119951 - ' IaVxau [kf163 MVi➢21 6,Mi. 10/111QZIMI UnOUHe 1161A)6a MUMMFL KWIMT74PMT7 t0/1/3011 UNCCOMMuprypI MCMIMPMi)WN]9tt 91[vA 3.4 0.00 3AN.N C3A1619Mi6)6llAASMWttb l0/V)NI H039TMINSCO 36).e1 1q.13 KC 10(]/1N1 X0MANAIX9CO HCCIAIMPMi39N6I63IXAp91b916 l), 690.<6 / 33,990.a6 13.A•6al 1] .0 1T9,16).n ILL990Af TOALp 196.639.A) 390.L6.19 10/4/2021 Quick View Select Quick View Accounts Account Number/Name Account Type IF Search All DDA Account Number Current Balance Treasury Center Select Group Grou s Atld Group Data reported as of Oct a 202- Available Balance Collected Balance Prior Day Salanc MEMORIAL MEDICAL CENTER / NH ASHFORD 585,023.81 ✓ $114,785.47 $85.023.81 $81.563.2 •4403 MEMORIAL MEDICAL CENTER/NH g2q,059,82 $48,464.26 $24,059.82 533,751 c BROADMOOR *4411 MEMORIAL MEDICAL CENTER / NH CRESCENT $57,885,99 ✓ $67,755.63 $57,885,99 $58,375.2 *4446 MEMORIAL MEDICAL CENTER / NH FORT BEND $12,275.14 $24.376.09 $12.275.14 $18.259.E •4438 MEMORIAL MEDICAL l CENTER/SOLERAAT $111,734.16 / $128,419.34 $111,734.18 $98,434,5 WEST HOUSTON nttps:/Iprosperilyolbanking,com/onlineMessenger Memorial Medical Center Nursing Home UPL Weekly Nexlon Transfer Prosperity Accounts 10/4/2021 Prewaaa Aaoupt Bry1nnl0g Pending Tedey't Beginning Ampunl to ae4ansferndw Nuning No L�`xom xumbv Balanee iranafervout TnnSlerin a nak Balanw xoma ^ Bank BaOnee ]0.]S346 Yananu Lee¢e In Balann 100.00 SupaOar AUG/ADSOIPp MEDICAXEREPAYMENTOUETOaETHANY 31,42690.,/ 1,447.10J MEDIWEREPAYMENTOUETDY%UQ Y 2,5$1.36✓. MEDICARE REPAYMENT DUE TO CANIC 447.41,/ IUIYiNTEREST 26,48r1 " AUGINTEAEST 10.27 SEPINTERESE 17.23 Atlfun {apnreRranalarnmt 3 IN 70 ¢� Nate: Onlyb M,ttno)eur$5.000W0 be 4.ntfenedro Me nuainp Acme. NO, Z. Fneb o¢munrgPta bme babace¢f5100 fhA[MMGdep4fifedfo ppm ¢aeon!. App ed: L M'V — SawnAn{iln, CEO 1 10/4/2021 ANVO M dw OCT 6 4 2021 00111111111W a� 'ANU Weekl]Tranlfp\NH U4l TI.W11 W—m,%2(l1\0RPen\NH UllT-0.,Smmary 10.¢.11.aln CN13a 539,9) 127=1 11 C9 166.36 9127//2)/20f0)DIM [N316 LS]03p 9121/2Y31 WIRLOIt 9/1IA I OUTN6INN ATU01069SMU 59,437.07 nw CD511 9p9/]0L 166R%A.r,tBYSO1MIi HlBN3556)693)9 9/]1d3013 P66W10MFIRST 9/10/103315Y1/IMMS9IMT BX[O111Mi 436A6555619I79 16/1I162] CX12) 6,961,95 CN126 ],I65 S1 1010021 10/]/]O11 CN139 I,IH31 10/3/2033 O 101I1146 l01I Gnuni Mlmplrie L[0.36A1663333W101I5610 MMCp0R190N ypo/mnyaat NN tnmHrJn NPP/Gmvl WH/[aHf gmp)cemvl aIm 41"ll , RION 3'.0 .1.2 1T.Rl 83050 11.1.5.61 33.01613 LA11.3) SyY39 ] 0]YM V1R It3l B]0.16 ".M., (138.]6) �111.011 11.8M9] ].16933 2Y)na.>2 10.116.]1 tl.l]13) S}H.66 1136 )tl ( � 10N/2021 Quick View Select Quick View Accounts Account Number! Name Account Type v Search All LDOA Account Number Current Balance https:0 Treasury Center Select Group Groups Add Group Data reported as of Oct 4 202' AVallabla Ralanm r•�.ne.�.,a e..�..___ . MEMORIAL MEDICAL / NH GOLDEN CREEK $70.253.46,$75.753.46 $70,253.46 $15,548.3 HEALTHCARE 1/1 Memorial Medical Center NurSing Hume UPL Weekly HMG Transfer Prosperity Ru0unts 10/4/2021 M Wn9 xuaNHam. 93.2IH,Bl Irmo, R[[owt B.{mlry NUItln6NOT1 XumWr MIg4_ Q�COI�RR{04:�I�1�[1�2h1?k�f�.cu:+ 9i.311.M Reu .Nr nlenrv6uldve Nftlo NINe:cehlsl=nmeh-l. tall ll0$10 M.1 em[mnmPRmme. NINe l: £a[M1 e[[awlllafa Dafe Wlontta($1MMOI MMCtlePunte✓[Oapen ):IJIN W[µlyTnp11m1/IN VPt irintlar Summlry\SW I\Ottabu\fIN Vy{Trantlnyumnury I01]lyu v.namy GmeunlMbe TnMvnOIP Byl.nl.ei dlnb WNnm lnAllJl Vallan[e [YreN &lan[e lrygp ECHOCIAIMPA MERUTON0U) yII.N1.91 SUPERIOR000019P p•yly,yyy IUVINTEREST 11.01,/ LV41XI WT sEPINRNE 1 9L✓ U.17 RGu[I & a—flnngr[Aml 1.114,17 Nnounl to Be Rvulmatlyo ToeaY[BegnnlM BINIItl Nwlfe Nene - Is.0y0.f1 erns BaXe¢ a,Bsy.H var:ma lea.[ In Balm. 100.00 m1Nlxrmsn Is.w "� WOINTEREK b.S SFRIXIIRFST l,S! Pdlwt0lYme(eanafertmt _ .5.l1106 / Mull R INFERS ano ay.d� IawnlryUry tE0 30(0/303t OCT 0 h 2021 9/2>/I031 HNBFWOHQUIMPMT )a6W34114gO0p0245911 " .. " Tnn4En.0U1 9/2I/l0)1 HNB ECHO NCMIMPME ]<Wp36116600MN591) 9/3]/2031 HNB-ECHOMCMW PMT)I6W3411 MOOW24591> 9/!9/1031 IINB • FCNO M[CWMPMf i46W3[I11400W])9696 9/1R/iW i XNB ECHO ngUlMpMi )g6pD39114100002)1896 9iK/3031 NNfi.ECHO MCC4IMPMI ]460W1119100CB2)4696 9/29/3011 WIRF OU$HMGSFRMLFS.IIC 9/29/2021 NNB ECHO HCCWMPMT)4µ63111 MM WIOµSS 2d454B 9/39/2021 HNB ECHO HCCUIHPMi )1600391{44pW0206153 9/30/3021 HNB. ECHO HCWIMPMT]46003411440W0610 I t 9130/02/ "NO. ECHO HCCUIMPMf]460D311144BO 610 9/30/2021 HNB-ECHO HCCWMPMT]46W}411440WO610 9/30fNR HHB.E[XO NCCWMPMTT<60W41]IIWW2M,,3934610 9/30/2021 HIM 'ECHO H0%MMPM1464Ru411490W0234610 9/30{ID21 NNB.ECNOXCg NUlIT7460D3d11 µOXM2MlI0 9/30/2021 NNB.ICNONCCUIMPMT746W313144=0234610 9A0/2021 HNB.ECHO HCCWMPMT]46003411440DW2µ610 9/3D/201 NNB FCNO HCOWMPMT )46W}41111W09)34610 IOIII 121 CRUM ' 10/1/2021 HNB- ECHO HCCUIMPMT)46W3411 MOOOpM1O46 L.3351 20/1/1621 HNB. ECHO wc="PMT 74MOUll MW Wpµµ6 10/117021:Gmena M3pa6eme" 3BIBJ463311COmlll , 9/3Tf2021 WPSTDMCCOMRHZlMPMT222256385331000 A 9/27/2021 NOR101MMNCCUIMpMT6756924200WIM1214 9/29/2021 WIRE OUT HMO SERVICES, uC 9/29/2021 INMTOEOC CONTI HCCUIMPM1222U M9T 21000 9030120E A6dvd to Atv9unt I0h/2021 OVOmO " ]0/IRO21 NORIDIANl3AHCCWMPMT613692420W01223699 MMC PORTION Tv30Avr.Ml OIPP/GmAF yPP/Com ] yIPP/C p3 OIPP4 omp46 I NH 1,33937 OPPII PORTION 2.327.74 I.33"Al JMAS 2.327.71 4,30304 76440 1.461.49 1.303.04 9973 IA63A3 99.73 5881 L604.18 µ6) 2,5125.99 553,05 RX1.14 $4,10 15.68 62.13 2146 1,289.93 321.22 Seal 2, 04,19 34.61' L91599 56395 3,273,14 SI.IO 15,69 62]3 2146 1.281.93 3)1.2] 23.52 614RO a"]8,93T39 {614.39 R•)µ.0�5 691}1.tl /ll,33290 3p01.99 23.69 Ill w29 N29 2AME 23.53 11MORS 20.561,60 M,33L9D 3,2OAM MMCPORTION Tmntt Ou CVIFICpmp1& NH Tr1^n4SO pIPP/Gmpl OIPP/Camp2 Q< / W U OII TI PORTION 6.99 6,360.39 15.99 941122.61 6,380.39 MAD 4.59 WZSo 32.514 95 44B 5.681]4 32,518.95 9,681.24 90.122b3 IS,S39,µ 45,93B.µ _ fOL90F.fi6 Pe,)Q 43 >33i 90 3Rq 69 33! 91 R016 10/412021 Quick View Select Quick View Accounts Account Number / Name Account Type IF Account Number Treasury Center Select Group Groups Add Group of Oct C441 MMC -NH GULF POINTE / PLAZA- $45.660.51 ✓ $45,660.51 $45,660.51 MEDICARE/MEDICAID .$7.460.2 5I$ MIMIC -NH GULF POINTE G3nA n,/ �ai ,...,. ..._ _- 1/1 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity Amounts 101412021 vaalnv. pmmm to He •aeunt @MMnlni vmdit Tremlertetlty Nv[IRN Nnmbr yhne Tnml tOn SlAk1f@!N CWClund pa Yeia'aNin' B.Onn Xunl N Tpjpp(fQ�pidYF}"F3il��•`X'Nk.;E4 n9,a>52n /86,3TS.ZG�86,19E BI ✓ 6,39ZA6 Ah36339 &n9@a4nn .6,39381 y/ Non: PilybWvntn ofvvn$S,CNr➢)blVwfmM)Othlnvmnghvme Nottl: Ev[hutwun[bv3v Een Eufunavf$IMM,vtMMCdVmrttdngmvccpinl. Variance Leiv<In Wlince l[OM MOYNA011 ) SIe.W I/ MWIWIREPAVMENTOYETOSEmoo, I,H>.lC� omW REEAYMpMTOOETOMMWNIC MFMUWIE REPAYMENT OYETO COMlM@EER 3,136-09,� Yfua@Wm/MntivAml eE,3916 / A to t l@)a/ZCll lasvn4y4n mO OCT 0 4 2021 MMCPORTION Tensler-Out Tmiss3er-In QIPP/Compl QIPP/Comp4 QIPP/Cpmp2 QIPP/ComP3 At.... QIPPT NN PORTION 512.92 3,524.95 2,819.21 • 1,020.00 2.819.21 74,125.06 - 1,020.00 510,00 510.00 56,819.92 ' - 11.27 50.818.92 0,961.95 - 11.22 1.199.51 - " 9/27/2021 CK1056 9/27/2021 CK3052 9/12/2021 Deposit 9/28/2021 MOIINAHEALTI-1W MOIINAACH OINS988 420=13 9/29IM21 WIRE OUTLINBAR ENTERPRISES, LLC 9/29/20Z1 NOMAS SOLUTION HCCLAIMPMT676201 4200MIJU, 9/30/2021 Added to Amount 10/1/2021 CK1O58 10/3/2021 CK109 to/l/Z@1 Deposit IO/1/2021 Deposit 11,382.08 .14.141.33 31,381.D8 B6,32584 ./ 86,192.81 ld 141.39 102000 SI000 8568281 10/4/2021 Quick View Treasury Center Select Quick View Accounts Account Number/Name Select Group Groups Adtl Group Account Type as of Oct •3407 IC -NH TUSCANY $86.292.01 VILLAGE✓ $116.728.78 $86.292.81 $68,930.E https://prosperity.olbanking,com/onlineMessenger 1/1 Memorial Medical Center Nursing Nome UPI Weekly NSUransfer Prosperity Accounts 10/4/2021 a,ov NulYn N �ki11V'diaN[.. Mwe: Orly bv!v m ofine, SSOw MN be,vn[fao flolba nw,InO hame. M e11o[h vaowiba[obalebalaoCeofSSW that MMCdeaMrte4 to aMa 1;1XX WnihiumlmµH WlTnn4n5umm,ryli@lWdeM[yn[ Vtt TmtlnSumn[ry 30d33.du lmlln6 Pmavnl to ae M[dlbrt Tna16„edio IR.U..li Bans 6ientl u3a:a33 M,mn[a Ieneln Menm low ARVINTFAW lm✓� AUGa sW —INTEREST 11.9a✓ Mr., &19n[[/f[[n[le[}ml 1{3OSISU �/ v[eVld 1 wndnalN(FO 10/{/lBil OCT 0 h 2021 ailyrr.l��i.oic ML �`..�. ...... .. r RON. 4 , -. 9/27/2021 C81006 9/27/2021 Deposit 9/27/2021 Deposit 9/27/2021 Deposit 0/97/2021 O."Ift 912B/2021 Deposit 9/2W2022 WIRE OUT BETHPHY SENIOR HYING, LTD 9/29/2021 Deposit 9L30/202YMdM tp AaoYna:. 913D/2021 Deposit 10/1/2021 Deposit 10/l/2021 Deposit 10/1/2021 Deposit 10/1/2021 Deposit 10/1/2022 HOSPICE OP SOUTH Prytpen6 N 5113122650020MB MMC PORTION COPP/Campo Transfer4u[ Trans/enln OIPP/C4mpl gtpP/Cpmp2 OmP(ComP3 &lapse OIPPTI NHPORTION 1,229 99 5.04000 2.564.BS 649 20 64,294.45 1.606.43 25)]3H.91 80.24 i21i98. 149.W $4.517.79 24,279.77 5,580.00 656.00 2.273.47 3,040.011 ;sum 949.20 64,294.45 1,50643 8024 21.98 149.00 34,837.79 24,2)9.)) S,Se0.00 65G.00 2,273.47 i 298,964.9p J 142.033.18 ✓/4203318 1 or4/2o21 Quick View Treasury Center Select Quick View Accounts Select Group Account Number/Name Groups Account Typo Add Group Account Number Current Balance A�.u.t,t. ast..,,.e •5506 MMC -NH BETHANY $142,228.22 ✓ $142.228.22 5142,228,22 $74,601.1 SENIOR LIVING https:/lprosperity.olbanking,00m/onlineMessenger r 1/1 3 ------------- ---- — Memorial Medical Center Operating 10/04/2021 — ----- ...... _j 4w A/ P Cliec-11 OCT 04 2021 GWftWAVWmgft L 1Rer.uj-,i -hc< is Dep, ---- ------ AKAOLINT $26.45 21000011 .......... .... . ..... July- Septmeber interest t X P L", I i'ff! C', t" - Mayra Martinez p A --------- --- RF MEMORIAL MEDICAL CENTER 10/4/21 A.r;10JNT $31,426.90 SUPERIOR AUG QIPP & ADJ2 MAYRA MARTINEZ AMMKYM SK OCT 0 4 2021 10255040 MEMORIAL MEDICAL CENTER 10/4/21 ANAOUNT $18,947.29 FXPJ_41,140,iO,N: SUPERIOR AUG QIPP --- ------- MAYRA MARTINEZ I Fm ikclm, USE. `)[,lr, AM09yom 4w OCT 0 4 2021 1 !L—j , J, I to ves),i�z (WINWAIIIIIIIIIII011ft SALCM 66111111AW, NUN N(jT%;12Fp,: 10255040 I I . 1\411.-� UK`) A, L MEMORIAL MEDICAL CENTER quec10/4/21 f $510.00 I 1--fiR.40-1. UH ONIN 4K OCT 0 A ID24 10255040 NIRVIORW- IvIODICAL CAD�JFFFR Memorial Medical Center Operating 10/4/21 SK Ir-1-prest Casir [],iA/P Ched� OCT 0 A 2021 FPic,,JN-f $77.70 21000011 July -September Interest f XP�-AIWAT;C-!N: Mayra Martinez . I I ---------- - ----- - - ---- Pvlf. IV( R it AL' k/l E C' E I:N� F Memorial Medical Center Operating 10/4/21 iovaoymD OCT 04 2021 'MailCheckwVemior 00111111W 1111111111111145 L lF-i Rettlt "'MOUNT $59,69 21000011 July- September Interest 1 1'rl' fi. Mara Martinez Hr F"IFf, R e. I I . F. A y Memorial Medical Center Operating 10/4/21 FOP, .C(J. UH OND 4w jilnpic, OCT 0 4 2021 tomi I c! "C' I is IgAtuaft @Wong MWAS jRerilrnCh--ci�w!,je��i -4,10UNT $41.32 G/1 21000011 - — - -------------- ---- - July- September Interest -ANfAT;f-',',j, I -- - ------ - - ----- Mayra Martinez 'I If7F Memorial Medical Center Operating omc 10/4/21 ON OCT 04 2021 L7A/p Checi; 0441MW ANA"PM I GAJAK*W 04160M, IIIW if _1 .f,i90jiqT $25.97 21000011 -- --------- July- September Interest — j! Mayra Martinez v -J ---------- -- - - ----- ---- ---- ------ ------ CA Memorial Medical Center Operating 10/4/21 1 FOR AL' I. 0,_ M,HN 'Olipiloocym) w OCT 04 2021 SAIAWAV 001111fW. 7=UZ $62.79 21000011 July -September Interest A v --------- -- Memorial Medical Center Operating 10/4/21 PUR ACCT. U S E Of,' OCT 04 2021 L7A"P Ctler iz 1 RALW*W 60111WIffit, IMUS R .... . .. ..... 0 J N $53.98 21000011 I L (A: N L rJ Memorial Medical Center Operating 10/4/21 A AVONKFOO OCT Ch 2021 i i JNI:il hoci, to "JFindol REUI DLpI $68,22 21000011 July. September Interest j X -i! jw,kMayra Martinez G" F.-, 1.4 , Memorial Medical Center Operating 10/4/21 11':�Oii� I I lir��nrest;:sr. OCT 0A?U'tt ,,,I,,nC)ONT $117,02 ;r . I'IaPgc;cf;, 21000011 July- September Interest Jib"r Mayra Martinez MEMORIAL 11EDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---October 06 2021 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDS TOTAL NURSING HOME UP.L.EXPENSES'' TOTAL INTER -GOVERNMENT TRANSFERS $ 3881033,41 $ 83,88127 '"� $ .6231-85228' MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---October 06 2021 PAYABLES AND PAYROLL 9/29/2021 Weekly Payables 225,337.08 '1014/2021 McKesson-3408 Prescription Expense 0,404.61 101412021 Amerlsource Bergen-340B Prescription Expense 779.52 Prosperity Electronic Bank Payments 10/1/2021 Credit Card & Lease Fees 271.38 10116/2021 TCDRS September Retirement 150,882.46 9/27-10/l/21 Pay Plus -Patient Claims Processing Fee 518,06 9127/2021 CK 3103-Deposit item return 226.10 10/112021 ExpertPay-child support 614,20 TOTAL PAYABLES; PAYROLL AND ELECTRQNIC BANK PAYMENTS $368,033.4I TRANSFER BETWEEN FUNDS TO NURSING HOMES 9I30/2021 MMC Operating to Tuscany Village -correction of MMC medicare recoup taken from Tuscany 5,691.04 9/30/2021 MMC Operating to Bethany -correction of NH insurance payment deposited into MMC Operating in error and medicare recoup 48,593.06 MEDICARE ADVANCE PAYMENT RECOUP 10/412021 Broadmoor to MMC Operating -correction of Broadmoor medicare recoup taken from MMC Operating 447.42 10/4/2021 Broadmoor to Bethany -correction of Broadmoor medical recoup taken from Bethany 10/4/2021 Broadmoor to Golden Creek -correction of Broadmoor medical recoup taken 1,447.10 from Golden Creek 2,425.04 10/4/2021 Broadmoor to Tuscany Village -correction of Broadmoor medical recoup taken from Tuscany Village 2,581.36 10/4/2021 Crescent to MMC Operating -correction of Crescent Medicare recoup taken from MMC Operating 44742 10/412021 Crescent to Tuscany Village -correction of Crecent medicare recoup taken from Tuscany Village 2.681,36 10/4/2021 Crescent to Bethany -correction of Crecent medicare recoup taken from Bethany 10/412021 Crescent to Golden Creek -correction of Crescent medicare recoup taken 1,447.10 from Golden Creek 2,426.04 10/4/2021 Fort Bend to MMC Operating -correction of Fort Bend medicare recoup taken from MMC Operating 78.97 10/4/2021 Solera to MMC Operating -correction of Solera medicare recoup taken from MMC Operating 447.42 10/4/2021 Solera to Golden Creek -correction of Solera medicare recoup taken from Golden Creek 2,425.04 101412021 Solera to Bethany -correction of Solera medicare recoup taken from Bethany 101412D21 Solera to Tuscany Village -correction of Soleramedicare recoup taken from 1,447.10 Tuscany V81age 2,581.36 1014/2021 Golden Creek to MMC Operating -correction of Golden Creek recoup taken from MMC Operating 447.42 10/4/2021 Golden Creek to Tuscany Village -correction of Golden Creek medicare recoup taken from Tuscany Village 2,581.36 10/4/2021 Golden Creek to Bethany -correction of Golden Creek medicare recoup taken from Bethany 1,447.10 10/4/2021 Tuscany to MMC Operating -correction of Tuscany medicare recoup taken from MMC Operating 10/4/2021 Tuscany to Bethany -correction of Tuscany medicare recoup taken from 447.42 Bethany 101412021 Tuscany to Golden Creek -correction of Tuscany medicare recoup taken 1,447.10 from Golden Creek TOTALTRANSFERS BETWEEN FUNDS 2,425.04 $ 83 867.27; NURSING HOME UPL EXPENSES 1014/2021 Nursing Home UPL-Cantex Transfer 10/4/2021 Nursing Home UPL-Nexion Transfer 10/412021 Nursing Home UPL-HMG Transfer 10/4/2021 Nursing Home UPL-Tuscany Transfer 10/4/2021 Nursing Home UPL-HSL Transfer QIPP CHECKS TO MMC 10/4/2021 Golden Creek 10/4/2021 Gulf Pointe 10/4/2021 Tuscany TRANSFER BETWEEN FUNDS TO MMC OPERATING 10/4/2021 Ashford -Interest Earned 10/4/2021 Broadmoor-Interest Earned 10/4/2021 Crescent -Interest Earned 10/412021 Fort Bend -Interest Earned 10/4/2021 Solera-Interest Earned 10/4/2021 Golden Creek -Interest Earned 10/4/2021 Gulf Pointe MWInterest Earned 10/4/2021 Gulf Pointe PP -Interest Earned 10/4/2021 Bethany -Interest Earned TOTAL: NUR81140 HOME UPk EXPENSES TOTAL INTER-QQVERNMENTTRANSFERS 269,429.74 34.196.70 45,534.08 81,363.25 142,011.20 31,426.90 18.947.29 510,00 77.70 59.69 41.32 25.97 62.79 53.98 26.45 08.22 117.02 $ 623,96228 t 9/30/21,,, 3;1A PM. _.- - tmp cw5report1602693052412549895.html Oy/90/9P211 U .l r i MEMORIAL t.lr..l MEDICAL CENTER 15:i2 AP Open Invoice List 0 Due Dates Through: 1011312021 ap_open_invotce.template V;ndo # Vendor Name Class Pay Code R1200 ADT COMMERCIAL Invoice# Cc ment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 141760188. 09/30/2021 09/06/2021 10/01/2021 49.18 0.00 0.00 49.18 ./ FIRE MONITORING Vendor Totals: Number Name Gross Discount No -Pay Net R1200 AOTCOMMERCIAL 49.18 0.00 0,00 49.18 Vendor# Vendor Name Class Pay Code 13180 ADVANCED STERILIZATION PROD ✓� Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 8020336789 09/29/2021 08/30/2021 OW29/2021 7,500.00 0.00 0.00 7,500.00 SERVICE CONT 8/30/21-8129/22 Vendor Totals: Number Name Gross Discount No -Pay Net 13180 ADVANCED STERIL 71500.00 0.00 0.00 7,500.00 Vendor# Vendor Name Class Pay Cade A1680 AIRGAS USA, LLC - CENTRAL DIV M r,� Invoice# Com%dent Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 9117448500 439/30/2021 09/07/2021 10/02/2021 238.24 0.00 0.00 238.24 OXYGEN Vendor Totals: Number Name Gross Discount No -Pay Net. A1680 AIRGAS USA, LLC - 238.24 0.00 0.00 238.24 Ventlor# Vendor Name Class Pay Code A1705 ALIMED INC. ,;' M Invoice# Comment Tran Dt Inv 01 Due Ot Check Dt Pay Gross Discount No -Pay. Net PRSVO366OWa/29/2021 09/13/2021 09/28/2021 81 106.02 0.00 0.00 106.02 SUPPLIES RPSV03648509/30/2021 08/23/2021 09/30/202, 123.29 0.00 0.00 123.29 15 SUPPLIES s+� Vendor Totals: Number Name Gross Discount No -Pay Net A1706 ALIMED INC. 229,31 0.00 0.00 229.31 Vendor# Vendor Name Class Pay Code 10958 ALLYSON SWOPE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net. 092921 09/30/2021 09/29/2021 09/29/2021 1.611.00 0.00 0.00 1,611.00 CONTRACT EMPOLYEE Vendor Totals: Number Name Gross Discount. No -Pay Net 10958 ALLYSON SWOPE 1,611.00 0.00 0.00 1,611,00 Vendor# Vendor Name Class Pay Code A0400 AUREUS RADIOLOGY LLC y% Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 2315806 / 09/21/2021 09/13/2021 10/13/2021 2,242.50 0.00 0.00 2,242.50 ✓" LAB STAFFING 2315532V� 09/21/2021 09/13/2o21 10/13/2021 2,160.75 0.00 0.00 2.160.75 4f: LA13 STAFFING 2315959 ,t�0021/2021 09/13/2021 10/13/2021 1,507.50 0.00 0.00 1.507.50 LAB STAFFING Vendor Totals: Number Name Gross Discount No -Pay Net A0400 AUREUS RADIOLOr 5,910.75 0.00 0.00 5,910.75 Vendor# Vendor Name r Class Pay Code B0436 BARD ACCESS Invoice# Comment Tran Dt Inv Dt Due Ot 46449784 09/15/2091 Check Dt Pay Gross Discount No -Pay Net r%09/29/2021 09/09/2021 150.00 0.00 0.00 150.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net B0436 BARD ACCESS 150.00 0.00 0.00 150.00 Vendor# Vendor Name Class Pay Code B1150 BAXTER HEALTHCARE ✓` W filed//C:/Users/mmcklssackfcpsl/memmed.cpsinetcom/u88150/data_5/imp_cw5report1602693052412549895.html 1/11 9/30121, 3:13 PM r r tmp_cw5reportl 602693052412549895.html Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 71463299./69/29/2021 07/21/2021 08,15/202, 234.86 0.00 0.00 SUPPLIES 234.86 71473796 �; 09/29/2021 07/21/2021 08/15/2021 LEASE 2.367.50 0.00 OAO 2,367,50 Vendor Totals: Number Name Gross Discount No -Pay Net 81150 BARTER HEALTHC! 2,602.36 0.00 0.00 Vendor# Vendor Name Class 2,602.36 81220 BECKMAN COULTER INC M Pay Code i,.�` Invoice# Comment Tran Dt Inv Dt Due Dt 5446370 Check Ot Pay Gross Discount No -Pay Net c/09/21/2021 09113/202, 10/08/2021 6,016.58 0.00 0.00 5,016.58 MAINT CONTRACT LEASE 109301699 V09/21/2021 09/16/2021 10/11/2021 SUPPLIES 139.34 0.00 0.00 139.34 10930175 09/21/2021 09/16/2021 10/11/2021 43.58 0.00 0.00 43.56 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Not 81220 BECKMAN COULTE 5,199.48 0.00 0.00 Vendor# Ventlor Name Class 5,199.48 B1680 . BOUND TREE MEDICAL, LLC -P M / � r¢1udrL Pay Code Cs;-i-lir, Invoice# Comment Tran Ot Inv DI Due Ot jkr Check Dt Pay Gross Discount No -Pay Net 84207223 y/09/29/2021 09/14/2021 101131202, SUPPLIES 343.63 0.00 040 343.63 v''y 64728368 09/29/2021 09/17/2021 10/01/2021 132.617 SUPPLIES 0.00 0.00 132�67 Vendor Totals: Number Name Gross Discount No Pay Net Vendor# 81680 BOUNDTREEMEDI ��// 476,80 346.43 0.00 0.00 g7g,V3g5,t, Vendor Name Class B7800 BRIGGS HEALTHCARE yi'� M Pay Code Invoice# Cpmment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net B386590 v 09/29/2021 09/10/2021 10/10/2021 205.20 SUPPLIES 0.00 0.00 205,20 13366521 -/09/29/2021 09/10/2021 10/10/2027 1,197.60 0A0 SUPPLIES 0.00 1,797.60. Vendor Totals: Number Name Gross Discount No -Pay Not B1800 BRIGGS HEALTHCF 1,402.80 0.00 0.00 Vendor# Vendor Name Class 1,402.80 14120 CALHOUN COUNTY EMS ri' Pay Cade Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 21090001 /69/3wo2i 09/m/2021 10/01/2021 F TRANSPORT PATIENT 860.00 0.00 0.00 880.00✓' Vendor Totals: Number Name Gross Discount Net 14120 CALHOUN COUNTY 880.00 0.00 Vendor# Vendor Name Class 0.00 0.00 860.OD .00 C7325 CARDINAL HEALTH 414, INC, ii W Pay Code Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 8002640199*09/30/2021 09/11/2021 10/06/2021 SUPPLIES 165.06 0.00 0.00 185.06 Vendor Totals: Number Name Gross Discount No -Pay C1325 CARDINAL HEALTH 185,06 0.00 Net Vendor# Vendor Name Class 0.00 185.06 C1992 CDW GOVERNMENT, INC. „� M Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt. Check Dt Pay Gross Discount No -Pay Net J843054 V 09/29/2021 08/25/2021 09/24/2021 SUPPLIES 70.09 0.00 0.00 70.09 Vendor Totals: Number Name Gross Discount No -Pay CDW GOVERNMEN 70.09 0.00 Net Vendo01992 r11 Vendor Name Class 0.00 70.09 12768 CHEMAQUA ./ Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 7504502 ✓ 09/30/2021 09/10/2021 09/20/2021 518.75 0.00 file:///C:/Users/mmckissack/cpsi/memmed,cpsinat: com/u88l5Otdata_5/tmp_pw5reportl6O2693052412549895.html 0.00 518.75 tr'_ 2111 9130121, 3:13 PM t , tmp_cw5repod1602893052412549895.html WATER TREATMENT Vendor Totals: Number Name Gross Discount No -Pay Net 12768 CHEMAQUA 618.75 0.00 0.00 518.75 Vendor# Vendor Name Class Pay Code Cl166 COASTAL OFFICE SOLUTONS �% W Invoice# Comment Tran Dt Inv Dt Due Dt Check. Dt Pay Gross Discount No -Pay Net W0487771/29/2021 08/13/2021 08/23/2021 210.60 0.00 0.00 210.60 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net C1166 COASTAL OFFICE; 210.60 0.00 0.00 210.60 Vendor# Vendor Name Class Pay Code W080 CORROHEALTH, INC. Invoice# Comment Tom Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 48848 V' 09/29/2021 09/03/2021 10/03/2021 31062.10 0,00 0.00 3,062.10 CODING SERVICES Vendor Totals: Number Name Gross Discount No -Pay Net 14080 CORROHEALTH, IN 3,062.10 0.00 0.00 3,062.10 Vendor# Vendor Name Class Pay Code 10006 CUSTOM MEDICAL SPECIALTIES V' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 285127 09/30/2021 08/31/2091 09/01/2021 282.42 0.00 0.00 282.42 4,rf SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10006 CUSTOM MEDICAL 282.42 0.00 0.00 282.42 Vendor# Vendor Name Class Pay Code C1443 CYGNUS MEDICAL LLC Y M Invoice# comment Tran Dt Inv Dt Due Ot Check Dt Pay Grass Discount No -Pay Net 353570 .,/ 09/30/2021 08/31/2021 09/30/2021 419.00 0.00 0.00 419.00 / SUPPLIES V Vendor Totals: Number Name Gross Discount No -Pay Net C1443 CYGNUS MEDICAL 419.00 0.00 0.00 419.00 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON .r Invoice# Comment. Tran Dt Inv Dt Erue Dt Check Dt Pay Gross Discount No -Pay Net 6560080 ,A6/20/2021 09113/20PI 10/08/2021 398.71 0.00 090 398.71 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10358 DEWITT POTH & SC 398.71 0.00 0.00 398.71 Vendor# Vendor Name Class Pay Code 12988 DIESEL FUEL MAINTENANCE, INC Inv01ce# Comment Tran Dt Inv Dt Due Dt */ Check Dt Pay Gross Discount No -Pay Net 699, / 09/29/2021 06/08/2021 06/08/2021 375.00 0.00 0.00 375.00 V'A CLINIC DIESEL/CLEAN Vendor Totals: Number Name Gross Discount No -Pay Net 12988 DIESEL FUEL MAIN' 375.00 0.00 0.00 375.00. Vendor# Vendor Name Class Pay Code 11046 J E-MDS, INC y/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 465532 09/29/2021 09/17/2021 09/17/2021 9,275.00 0.00 0.00 9,275,001�/ HOSTING SUBSCRIPTION QTRLY Vendor Totals: Number Name Gross Discount No -Pay Net 11046 E-MDS, INC 9.276.00 0.00 0.00 9.275.00 Vendor# Vendor Name Class Pay Code 11284 EMERGENCY STAFFING SOLUTIO Invoice# JComment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 40603 ✓ 09/30/2021 09/30/2021 10/101202, 40,062.50 0.00 0.00 40,062,50 PRO FEES E/R L if-idt-Wmµl Vendor Totals: Number Name Gross Discount No -Pay Net 11284 EMERGENCY STAF 40,062.50 0.00 0.00 40,062.50 Vendor# Vendor Name / Class Pay Code 02510 EVIDENT /! M file:U/C:/Users/mmcldssaeldcpsi/memmed.cpsinat.com/u88150/data_5/tmp cw5report1602693052412549895.html 3/11 9130/21, 3:13 PM t e tmp cw5report1602693052412549895,html Invoice# Comment Tran Dt Inv Dt Due.Dt Check Dt Pay T210909137109/30/2021 09/09/2021 10/04/2021 Gross Discount No -Pay Net Q1 20,124.17 0.00 0.00 20,124.17 .� Vendor Totals: Number Name 02610 EVIDENT Gross Discount No -Pay Net Vendor# ; Vendor Name 20 12417 0.00 0.00 20,124.17 S0501 EVOQUA WATER TECHNOLOGIES Class Pay Code Invoice# Comport Tran Dt Inv Dt Due Dt 905069045 k19/29/2021 Check Dt Pay Gross Discount 09/17/2021 10/12/2021 No -Pay Net SUPPLIES 1.421.96 0.00 0.00 1,421.96 Vendor Totals: Number Name S0501 EVOOUA WATER TI Gross Discount No -Pay Net Vendor# ,,,% Vendor Name 1.421.9g 0100 0.00 1,421.86 10689 FASTHEALTH CORPORATION Class Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 09521 MMC `�09/30/2021 09/01/2021 09/16/2021 Gross Discount No -Pay .Net WESSITE 995.00 0.00 0.00 995.00 �J / 09A21MMQ/69/30/2021 09/01/2o21 09/16/2021 WESSITE 1,490,00 0.00 0.00 1,490.00 Vendor Totals: Number Name 10689 FASTHEALTH COR1 2,465.00 Gross Discount Net Ventlor# Vendor Name Class 0.00 0.00 0.00 2,465.00 F1400 - FISHER HEALTHCARE (vt Pay Code Invoice# Comment Tran Dt Inv Dt DGe//Dt 1280326 „09/29/2021 09J07/2021 10/02/2027 Check Or Pay Gross Discount No -Pay SUPPLIES 4.35 0.00 0.00 1567628 ,ZO912912021 09/09,202, 10/04,202, SUPPLIES 353.22 1567631 09/29/2021 09/09/2021 10/04/2021 - SUPPLIES 653.01 1290328 ✓i 09/30/2021 09/07,202, 10/02/2021 SUPPLIES 1,100.82 1290331 09/30/2021 09/07/2021 10/02/2027 SUPPLIES 1,678.69 1667636 4,/�09/30/2021 09/09/2021 10/04/2o21 SUPPLIES 1,926.68 1692739 ,i'09/30/2021 09/10/2021 10/05/2021 SUPPLIES 1,114.36 Vendor Totals: Number Name F1400 FISHER HEALTHCA Gross Discount Vendor# Vendor Name 6;771.13 0,00 11183 FRONTIER Class Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 091921 09/30/2021 09/19/20P1 10/13/2021 Gross PHONES ACCT 2101881480091211 85:40 Vendor Totals: Number Name 11183 FRONTIER Gross Discount Vendor# Vendor Name 65.40 0.00 W1300 Class GRAINGER * f. M Invoice# Cc ment Tran Dt Inv Dt Due Dt Check Dt Pay 905262692Y 09/29/2021 09/14/202, 10/09/2021 Gross SUPPLIES 154.00 9053807690 0�9/29/2021 09/15/2027 10/10/2021 c SUPPLIES 55.80 9053807682 q/29/2021 09/15/2021 10/10/2021 SUPPLIES 67.37 9054655759 09/29/2021 09/15/2021 10/10/202, SUPPLIES 67.37 Vendor Totals: Number Name Gross Net 4.35 j 0.00 0.00 353.22 w� 0.00 0.00 653.01 ✓ 0.00 0.00 1,100.82 0.00 0.00 11618.69 0.00 0.00 1,926.68 0.00 0.00 1.114.36 ' No -Pay Net. 0.00 6,771,13 Pay Code Discount No -Pay Net 0.00 0.00 65.40 No -Pay Net 0.00 65,40 Pay Code Discount No -Pay Net 0.00 0.00 154.00 0.00 0.00 $5.80 0.00 0.00 67,37 0.00 0.00 67.37,-,- W1300 GRAINGER 0.00 Discount No -Pay Vendor# 344.54 0.00 Vendor Name Class Pay Code 81e:l/!C:/Usersfmmckissack/cpsilmemmed.cpsinet.com/u88150/data_5/tmp_cw5repart1602693052412549895.html Net 344.54 9/30121, 3:13 PM t e imp_cw5repodiG02693052412549895.html 11984 GUERBET, LLC ✓Z Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay 18524052 �/69130/2021 05/04/2021 08/13/2021 760.00 0.00 0.00 SUPPLIES Vendor Totals: Number Name Gross Discount 11984 GUERBET, LLC 700.00 0.00 Vendor# Vendor Name Cass G7210 GULF COAST PAPER COMPANY ✓M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 2098832 % 6/20IP021 09/07/2021 10/07/2021 172.24 SUPPLIES 2098837 ,/09/20/2021 09/07/2021 10/07/202, 883.43 /�+ SUPPLIES 2099130 V U9/20/2021 09/07/2021 10/07/P021 71.88 SUPPLIES P099124 16912012021 09/07/2021 10/07/202t 30.97 SUPPLIES Vendor Totals: Number Name Gross Discount G1210 GULF COAST PAPE 11158.52 0.00 Vendor# Vendor Name Class 12380 HEALTH SOLUTIONS DIETETICS .1 Invoice# Comment Tran Dt Inv Dt Due Dt �/ Check Dt Pay Gross 092921 09129120PI 09/29/2021 09/29/2021 3,000:00 DIETICIAN Vendor Totals: Number Name Net 700,00 No -Pay Net 0.00 700.00 Pay Code Discount No -Pay Net 0.00 0.00 172.24 0.00 0.00 883.43 0.00 0.00 71.8E 0.00 0.00 30.97 !� b No -Pay Net 0.00 11158.52 Pay Code Discount No -Pay Net 0.00 0.00 3,00D.00 a` - Gross Discount No -Pa 12380 HEALTH SOLUTION 3,000.00 0.00 y Net Vendor# Vendor Name 0.00 3,000.00 Class Pay Code 11552 HEALTHCARE FINANCIAL SERVICI Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -pay Not 100508587 V0 129/2021 08/27/2021 10/01/2021 4,610.52 0.00 0.00 4,610.52 ✓' PHONES/STERLIZER/GEM PREM 4 Vendor Totals: Number Name Gross Discount No -Pay Net 11552 HEALTHCARE FINA 4,610,62 0.00 Vantlor# Vendor Name 0.00 4,610.52 H1399 Class HILL-RO Pay Code M COMPANY, INC ,/ M Invoice# Comment Tran Dt Inv Dt Due Dt 2597672 1/09/29/2021 Check Dt Pay Gross Discount No -Pay Net 08/31/2021 09/30/2021 312.54 0.00 0.00 312.54 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay H1399 HILL -ROM COMPAN 312.54 0.00 Net Vendor# Vendor Name, Class 0.00 3t2.54 12932 f INTRADO ✓ Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt INV0023773fl09/30/2021 Check Dt Pay Gross Discount No -Pay Net 08131 /2021 09/30/2021 h HOUSE CALLS 886.21 0.00 0.00 886.21 br'' Vendor Totals: Number Name Gross Discount No -Pay 12932 INTRADO 886.21 0.00 Net Ventlor# Vendor Name Class 0.00 886.21 J0150 J & J HEALTH CARE SYSTEMS, IN( Pay Cade Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 926477191 b'09/29/2021 09/09l2021 10/09/2021 SUPPLIES 84.00 0.00 0.00 84;00 Vendor Totals: Number Name Gross Discount No -Pay Net JG150 J & J HEALTH CARE 84.00 0.00 Vendor# Vendor Name Class 0.00 Pay Code 84.00 L1005 LAERDAL MEDICAL CORPORATIO,V Invoice# Comment Tran Dt Inv Dt Due Dt 2021/20000409/29/2021 Check Dt Pay Gross Discount No -Pay Net 09/21/2021 10/02/2021 ri 07Jy SUPPLIES 100.00 0.00 0.00 ,. 100.001'' Vendor Totals: Number Name Gross Discount No -Pay 1.1005 LAEROAL MEDICAL 100.00 Q00 Net file:///C.'/Users/mmekiss8cktcpsi/Memmed.cpsinet.com/uaB150/data 5/tmp_cw5reportl6O2693052412549895.html 0.00 100.00 5111 9130/21, 3:13 PM lmp cw5report1602693052412549895,html Vendor# Vendor Name Class 12244 LOLA RODRIGUEZ Pay Cade yam' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 092521 09/29/2021 09/25/2021 09/25/2021 Gross Discount No -Pay Not REIMBURSE ITEMS PURCHASED 24.90 0,00 0.00 24.90�,/ Vendor Totals: Number Name 12244 LOLA RODRIGUFZ Gross Discount No -Pay Net Vendor# Vendor Name 24.90 % Class 0.00 0.00 24.90 10972 M G TRUST Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay 092721 09/29/2021 09/27/2021 09127/2021 Gross Discount No -Pay Net PAYROLL DED 790.86 0.00 0.00 790.86 Vendor Totals: Number Name 10972 M G TRUST Grass Discount No -Pay Net 790.86 Vendor# Vendor Name 0.00 0.00 790.86 M2827 Class MEDIVATORS �.. Pay Code M Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay 91027727 ✓ 09/30/2021 08/25/2021 08/25/2027 Gross Discount No -Pay Net SUPPLIES 100.29 0.00 0.00 100.29 Vendor Totals: Number Name M2827 MEDIVATORS Gross Discount No -Pay Net 100 29 Vendor# Vendor Name 0.00 0.00 100.29 M2470 Class MEDLINE INDUSTRIES INC M Pay Code ,f Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 1965205371,.09/2012021 09/04/2021 09/29/2027 Gross Discount No -Pay Net SUPPLIES 5,449.64 0.00 0.00 5,449.64 19662242371Q9 8/2021 09/14/2020 10/09/2020 / SUPPLIES 847.57 0.00 0.00 847.57 1963301176L89/28/2021 08/20/2021 09/14/2021 f„! SUPPLIES 191.31 0.00 0.00 191.31✓� 1963622227 09/28/2021 08/24/2021 09/18/2021 SUPPLIES 7,00 0.00 0.00 7.00 1963022216,09//28/2021 08/24/2021 09/18/2021 SUPPLIES 100,98 0.00 0.00 100.98 1963622218 ,0912812021 08/24/2021 09/18/2021 SUPPLIES 335.88 0.00 0.00 335.88 „✓ 1963622226 06912812021 08/24/2021 09/18/2021 SUPPLIES 226,56 0.00 0.00 226.56t,,-' 1963622238,04/28/2021 08/24/202, 09/18/2021 ,,, SUPPLIES 97.56 0.00 0,00 97.56 ✓ 1963622217a09/28/2021 08/24/2021 09/18/2021 SUPPLIES 32,30 0.00 0.00 32.30 ✓'� 1963622219 Q^9/28/2021 08/24/2021 09/18/2021 SUPPLIES 85.61 0.00 0.00 85.61 1964480737 Q96/2021 08/31/2021 09/25/2021 SUPPLIES 1,588.47 0.00 0.00 1,588,47 1965293945 Q9/28/2021 09/06/2021 10/01/2021 /• .SUPPLIES 39.77 0.00 0.00 39.77 1965293946 09/28/2021 0910B/2021 10/01/2021 U' � SUPPLIES 144.30 0.00 0.00 144.30 �,-' 1965331852 03728/2021 09/07/2021 10/02/2021 SUPPLIES 525.41 0.00 0.00 525.41 1965331854 F09, 28/2021 09/07/202 7 10/02/2027 70.02 .02 OA0 0.00 70.02 1965636471 Q,9/26/2021 09/09/2021 10/04/2027 SUPPLIES 255.70 0.00 0.00 255.70 1965636472`q�/28/2021 09/09/2021 10/04/2021 ��j SUPPLIES 90.94 0100 0100 90.94�' � 1965636473 ,o /28/2021 09/09/2021 10/04/2021 - SUPPLIES 129.75 0.00 0.00 129.75 1985636478 /28/2021 09/09/2021 10/04/202, file://!C;/Users/mmckissacWcpsilmemmed.cpsinekcam/u86150/data_5ltmp 40.84 0.00 0.00 40.84 cw5report1602693052412549895.html 6/11 9/30/21, 3:13 PM 1 R imp_ cwSrepod1602693052412549895.html SUPPLIES 1965636475 09(28/2021 09/09/2021 10/04/2021 ✓� 516.19 0.00 0.00 516.19 SUPPLIES 1965636476 09/28/2021 09/09/2021 10/04/2021 103.06 0.00 0.00 103.06 SUPPLIES 1965723078 09/2812021 09/10/2021 10/05/2021 31.03 0.00 0.00 31.03 SUPPLIES 1966325526 09/28/2021 09/15/2021 10/10/2021 6,229.36 0.00 0.00 6,229.36 SUPPLIES 1906325611 ?9/28/2021 09/15/2021 10/10/2021 2,557.13 0.00 0.00 2,557,13 4 SUPPLIES 1962480979 09/29/2021 08/13/2021 09/07/2021 -55.00 0.00 0.00 -65,00 ✓` I CREDIT INVOICE 1955490335 1962480981 09/29/2021 08/13/2021 09/07/2021 -89.22 0.00 0.00 -89.22 CREDIT INVOICE 1962480981 1702587837,09/29/2021 08/21/2021 09/15/2021 116.42 0.00 0.00 116.42�i INTEREST 196348832490/30/2021 08/13/2021 09/07/2021 14,156.65 0.00 0.00 14,156.65 SUPPLIES ` �•- 1963488323 09/30/2021 08/21/2021 09/15/2021 16,044.20 0.00 0.00 16,044,20 SUPPLIES // 09 1963813528 20/2021 08/25/2021 09/19/2021 2,914.50 0.00 0.00 2,914.50 SUPPLIES L^'' Vendor Totals: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTR 52,783.93 0.00 0.00 52,783.93 Vendor# Vendor Name Class Pay Code 10963 MEMORIAL MEDICAL CLINIC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt. Pay Gross Discount No -Pay Net 092721 09/29/2021 09/27/2021 09/27/9021 150.00 0.00 0.00 150.00 ✓" PAYROLL DED Vendor Totals: Number Name Gross Discount No -Pay 10963 MEMORIALMEDICP 150.00 0.00 0.00 Vendor# Vendor Name Class Pay Code M2621 MMC AUXILIARY GIFT SHOP e,/ W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay 092321 09/29/2021 09/23/2021 09/23/2021 258.02 0.00 0.00 PAYROLL DED Vendor Totals: Number Name Gross Discoun M2621 MMC AUXILIARY GI 258.02 0.00 Vendor# Vendor Name Class 10680 MMC EMPLOYEES ACTIVITIES TE) Invaice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 092721 09/30/2021 09/27/2021 09/27/2021 920,00 REMIBURSE SANOCRAB PRIDE St Vendor Totals: Number Name Gross Discount 10680 MMC EMPLOYEES, 920.00 0.00 Vendor# Vendor Name Class M2659 MXR IMAGING, INC V/ M Invoice# Com�ant Tran Dt Inv Dt Due Dt Check Dt Pay Gross 8800807971 09/29/2021 09/13/2021 10/13/2021 182.78 SUPPLIES Vendor Totals: Number Name Gross Discount M2659 MXR IMAGING, INC 182.78 0.00 Vendor# Vendor Name Class, 13546 NACOGDOCHES TRANSCRIPTION ,�./ Net 150.00 Net 258.02 vim} No -Pay Net 0.00 258.02 Pay Code Discount No -Pay Net 0.00 0.00 920.00 No -Pay Net 0.00 920.00 Pay Code Discount No -Pay Net 0.00 0.00 182.78� - No -Pay Net 0.00 182.78 Pay Code Invoice# ,..Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 7480 09/29/2021 09/22/2021 09/22/2021 517.72 0,00 0.00 517.72 TRANSCRIPTION t 0j 2-- W j3 J-.Z1) 7492 `� 09/29/2021 09/28/2021 09/28/2021 262.36 0.00 0.00 262.36 TRANSCRIPTION ( P1 14- 011 Y-1) 11 Vendor Totals: Number Name Gross Discount No -Pay Net file:/!/C:/Users/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/lmp_cw5reportl602693052412549895.html 7/11 9/30121, 3:13 PM tmp_cw5reportl 602693052412549895.html i 13548 NACOGDOCHES TF 780.08 0.00 0.00 780.08 Vendor# Vendor Name Class Pay Code 11472 OCCUPRO LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 22593 p4i29/2021 08/07/2021 09/06/2021 487.47 0.00 0.00 487.47 PROVIDER/MONTHLY SUPPORT Vendor Totals: Number Name Gross Discount No -Pay Net 11472 OCCUPRO LLC 487.47 0.00 0.00 487.47 Vendor# Vendor Name Class Pay Code 01500 OLYMPUS AMERICA INC �� M Invoice# Comment Tran Dt Inv Ot Due Dt Check Ot Pay Gross Discount No -Pay Not 31428804 08/24/2021 09/30/2021 197.92 0.00 0.00 197.92 1/09/30/2021 SUPPLIES v� Vendor Totals: Number Name Gross Discount No -Pay Net 01500 OLYMPUS AMERIC, 197.92 0.00 0.00 197.92 Vendor# Vendor Name Class Pay Code 11069 PABLO GARZA Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 092821 09/29/2021 09/28/2021 09/28/2021 2,543.13 0.00 0.00 2,543.13 CONTRACT EMPLOYEE (7ijIR Vendor Totals: Number Name Gross Discount No -Pay Net 11069 PABLO GARZA 2,543.13 0.00 0.00 2,543.13 Vendor# Vendor Name Class Pay Code 10152 PARTSSOURCE, LLC �Z Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 04015839 " 9/29/2021 09/13/2021 516.80 0.00 0.00 516.80 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10152 PARTSSOURCE, ILL 516.80 0.00 0.00 516.80 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 90121A 1/ 09/30/2021 09/01/2021 09/01/2021 380.00 0.00 0.00 380.00 ✓� CLINIC LAWN 090121 /b9/30/2021 09/01/2021 09/01/2021 520.00 0.00 0.00 520.00 r: 1" HOSPITAL LAWN 090121E 0/30/2021 09/01/2021 09/01/2021 200.00 0.00 0.00 200.00 t,''' REHAB LAWN Vendor Totals: Number Name Gross Discount No -Pay Net 12544 PATRICK OCHOA 1,100.00 0.00 0.00 1,100.00 Vendor# Vendor Name , Class Pay Code 13988 PAYCHEX, ADVANCE FSO Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 006728 09/30/2021 09/29/2021 3,900.00 0.00 0.00 3.900.00 MED SUR STAFFING Vendor Totals., Number Name Gross Discount No -Pay Net 13988 PAYCHEX, ADVANC 3,900.00 0.00 0.00 3,900.00 Vendor# Vendor NameClass Pay Code P2100 PORT LAVACA WAVE �-' W Invcice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 083121 09/30/2021 08/31/2021 09/25/2021 1,206.00 0.00 0.00 1,206.00 AD Vendor Totals: Number Name Gross Discount No -Pay Net P2100 PORT LAVACA WA\ 1,206.00 0.00 0.00 1,206.00 Vendor# Vendor Name Class Pay Cade 10645 REVISTA de VICTORIA �l Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount NO -Pay Net '073021- 09/30/2021 07/30/2021 07/30/2021 262.50 0.00 0.00 262.50 M o -LVWzA L✓ AD _083121- 09/30/2021 08/31/9021 08/31/2021 262.50 0.00 0.00 262.50_,-- D Z 1�L-1- AD file:/UC:IUserslmmckissacklcpsi/memmed.cpsinet.com/u88150/data_5/imp_cw5reportl602693052412549895.html 8111 9130/21, 3:13 PM r Ventlor# 11296 tmp_cw5repvrN 602693052412549895.html Vendor Totals: Number Name Gross Discount 10645 REVISTA de VICTOf 525.00 0.00 Vendor Name Class SOUTH TEXAS BLOOD & TISSUE Cuf Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 107017273 8961/2021 09/15/2.021 10/10/2021 BLOOD CM5411 �I09/21/2021 09/15/2021 10/10/2021 CREDIT Vendor Totals: Number Name Gross 112 6 No -Pay Net 0.00 525,00 Pay Cade Gross Discount No -Pay Net 7,077.00 0.00 0.00 7,077.00 V/ -3,749.00 0.00 0.00 -3.749.00 ""Z Discount 9 SOUTH TEXAS BLO 3,328.00 0.00 Vendonf Vendor Name Class C1010 SPARKLIGHT ✓ W - pVQl W-S F.Q.• jf\G1t�rl.ul Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 092021 09/30/2021 09/20/2021 09/20/2021 1Ula,`17 205'I� CABLE ACCT 128686862 Vendor Totals: Number Name {Goss 01010 SPARKLIGHT 205.51`d ��tf Vendor# Vendor Name class'r 12288 SPBS CLINICAL EQUIPMENT SRVC Invoice# Comment Tran Dt Inv Dt Due Dt -1 Check Dt Pay FCHRGO12409/29/2021 09/15/2021 09/15/2021 11J FINANCECHARGE Vendor Totals; Number Name Gross 12288 SPBS CLINICAL EQ ✓� 3.48 Vendor# Vendor Name Class 14112 STEPHEN HUEY f Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 092621 09/29/2021 09/26/2021 09/26/2021 CFO CANIDATE TRAVE REIMBURE Vendor Totals: Number Name Gross 14112 STEPHEN HUEY 87/74 Wjj.qj, Vendor# Vendor Name Class 13528 STRYKER FLEX FINANCIAL Invoice# Corpment. Tran Dt Inv Dt Due Dta. Check Dt Pay 219549 e09/29/2021 08/10/2021 10/01/2021 RFA MACHINE Vendor Totals: Number Name Gross 13528 STRYKER FLEX FIN 1,294.26 Vendor# Vendor Name Class T2204 TEXAS MUTUAL INSURANCE CO Wei` Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay 1003055882 V130/20PI 09/15/2021 10/07/2021 WORKERS COMP Vendor ToWs: Number Name Gross T2204 TEXAS MUTUAL IN: 4,411.00 Vendor# VendorName Class 13880 TEXAS SELECT STAFFING Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay 00181845107 0�9/{30/2021 09/29/2021 09/29/2021 '1 011v ICU MED SUR STAFFING Vendor Totals; Number Name Gross 13880 TEXAS SELECT ST/ 9,045.70 Vendor# Vendor Name ,-Class 12444 THE UPS STORE VICTORIA Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay 083021 09/30/2021 08/30/2021 OW30/2021 FOAMBOARD - Vendor Totals: Number Name Gross 12444- THE UPS STORE VI 36.00 Vendor# Vendor Name riae� No -Pay Net 0.00 3.328.00 Pay Code Discount No -Pay 0,00 0.00 Discount No -Pay 0.00 0.00 Pay Code Gross Discount No -Pay 3.48 0.00 0.00 Discount No -Pay 0.00 0.00 Pay Code Gross Discount No -Pay 874 tj).V4 0.00 0.00 Discount No -Pay 0.00 0.00 Pay Code Net 205.51 i0(0 Net 205.0 1 W, Net 3.48 Net 3.48 Net 873/4 Net 871'74 871-k Gross Discount No -Pay Net 1,294.26 0.00 0.00 1,294:26 Discount No -Pay Net 0.00 0.00 1,294.26 Pay Code Gross Discount No -Pay Net 4,411.00 0.00 0.00 4,411.00 Discount No -Pay Not 0.00 0.00 4,411.00 Pay Code Gross Discount No -Pay Net 9,045.70 0.00 0.00 9,045.70ew.,, Discount No -Pay Net 0.00 0.00 9,045.70 Pay Code Gross Discount No -Pay Net 36.00 0.00 0.00 36.00 VF Discount No -Pay Net 0.00 0.00 36.00 Pay Code file:tliC:/Users/mmckissacklcPsi/memmed.cpsinetcom/u88150/data_5/Imp_PwBrepon1602693052412549895.htmi 9111 9/30/21' 3:13 PM tmp^ewSrepartl602693052412549895,htmI r U1054 UNIFIRST HOLDINGS,/ W Involce# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8400376390yk9/2021 09/13/2021 10/08/2021 1,421,25 0.00 0.00 1,421.26 LAUNDRY 8400376367,09%29/2021 09/13/2021 10/08/2021 47.47 0.00 0.00 LAUNDRY 47.47 j 8400376366,9949/2021 09/13/2021 10/08/2021 45A5 0.00 0.00 LAUNDRY 45J5 8400376841 %29/2021 09/16/2021 10/11/2021 ..09 1,779.63 0.00 0.00 7,779.63 V i LAUNDRY 8400376813,09%P9/2021 09/16/2021 10/11/2021 194.23 0.00 0.00 194.23 ✓' LAUNDRY 8400376810 �09/2021 09/16/2021 10/11/2021 286.81 0.00 0.00 286,81 LAUNDRY Vendor Totals: Number Name Gross Discount No -Pay Net U1054 UNIFIRSTHOLDINC 3,774.54 0.00 0.00 3,774.54 Vendor# Vendor Name Class Pay Code U2000 US POSTAL SERVICE -" Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 092021 09/29/2021 09/20/2021 09/20/2021 2,200.00 0.00 0.00 2,200.00 POSTAGE Vendor Totals: Number Name Gross Discount No -Pay Net U2000 US POSTAL SERVIC 2,200.00 0.00 0.00 21200.00 Vendor# Vendor Name Class Pay Code V0552 / VERATHONINC ✓' Invoice# Comr�rent Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 8035717E 09/29/2021 09/17/2021 10/12/2021 42.19 0.00 0.00 42.19 • SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net V0552 VERATHON INC 42.19 0.00 0.00 42.19 Vendor# Vendor Name Class Pay Code 13808 VITA PERSONA LLC .�� Invoice# Comment Tran Dt Inv Dt Due Ot VP20212342Q9k9/2021 Check Dt Pay Gross Discount No -Pay Net 09/14/2021 09/29/2021 1,439.20 0.00 0.00 1,439.20 ' SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Not 13808 VITA PERSONA LLC 1,439.20 0.00 0.00 1,439.20 Vendow Vendor Name Class Pay Code 10793 WAGEWORKS, INC. .-- Invoice# Comment Tran Dt Inv Ot Due Dt Check Ot Pay Grass Discount No -Pay Not. 092721 09/29/2021 09/27/2021 09/27/2021 3,382.29 0.00 D.00 3.382.29�j PAYROLLDED Vendor Totals: Number Name Gross Discount No -Pay Net 10793 WAGEWORKS, INC. 3,382.29 0.00 0.00 3,382.29 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC ✓f Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 911104036202121/2021 09/16/2021 10/11/2021 1,571.67 0.00 0.00 1,571.67,V'� SUPPLIES 9111031262 QS&/2021 08/25/2021 09/19/2021 2,470.31 0.00 0.00 2,470.31 SUPPLIES 9111039912 V/ 9/2021 09/15/2091 10/10/2021 1,241.42 0.00 0.00 1,241.42 SUPPLIES 9t1104119906/29/2021 09/16/2021 10/11/2021 306.84 0.00 0.00 306.84 ✓` SUPPLIES 9111037232 Q9/30/2021 09/09/2021 10/04/2021 144.30 0.00 0.00 144.30 SUPPLIES lam` Vendor Totals: Number Name Gross Discount No -Pay Net 11110 WERFEN USA LLC 5,734.64 0.00 0.00 5,734.54 Vendor# Vendor Name Class Pay Code 11400 WEST COAST MEDICAL RESOURC fiieJ/IC:lUsers/mmckissack/cpsi/memmed.cpslnet.comlu88150/data 5/tmp_c report1602693052412549895.html 10/11 9/30/21, 3:13 PM tmp_cw5report1602693052412549895.html Invoice# Co meet Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INV07501 09/15/2021 09/07/2021 09/15/2021 138.00 0.00 0.00 138.00 SUPPLIES Vendor Totals: Number Name /i Gross Discount No -Pay Net 11400 WESTCOASTMEDI w 138.00 0.00 0.00 Vendor# Vendor Name Class 138.00 Y1000 / YOUNG PLUMBING CO ,/ W Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net OB3401 ,06/2912021 09/15/2021 09/15/2021 21.90 0.00 0.00 SUPPLIES 21.90 / Vendor Totals: Number Name L Gross Discount No -Pay Y1000 YOUNG PLUMBING 21.90 0.00 0.00 Ref)art SIun lao, Grand Totals: Gross Discount 225,570.17 0.00 13 bi - e:0'ii I — ioo-�; — 871 S<, trv000 411101 $f!P 2 9 2021 OMENWAGOMM Net 21.90 No -Pay Net 0.00 225,570.17 - p� H tAvYwiiw. <au5.�1� to. el < 813.14 �2tis,331. o� file://IC:lUsers/mmckissack/cpsi/memmed.cpsinet.com/u88150/data_5/tmp_cw5reportl602693052412549895.html 11lit MSKESSONSTATEMENT As at: 10/01/2021 Paso; 002 To ensure proper craOR to Your w,nn•+g xaoa actdalt, tlelach and Mum this uC: 6115 stub With Your remh once, MEMORIAL MEDICAL CENTER As of: 10/01/2021 Page: 002 AP AMT DUE REMITTED VIA ACH DEST Territory: Mall to: Comp: 600o 815 N VIRGINIA STREET Statement for informalkm only AMT DUE REMITTED VIA ACH DEBIT PORT LAVACA T% 77979 Customer. 632536 Statement for Information only Date: 10/02/2021 cull: 632536 PLEASE CHECK ANY Date: 10/02/2021 ITEMS NOT PAID (s) Niletional Dust Accaum ��9y36 —' '--- ---.. — )at:, )ate Date NumbeReceivaM Number Relorerma Cash DeacrlPtion Discount Amount P `ems", t F (9.) F NRae¢Ibveable +P column Iegeml: P = Past Due Item, F = Red. Due Item. blank = Current Duo Item TAI_ Nmbrlel Acd 832536 MEMORIAL MEDICAL uB4TER Subt.bus: 9.596.56 USD 9aure Due: 0.00 'aal Due: It Paltl By 1010512021, 0.00 Pay, Thla Amount 0,404.61 USD am Payment 2,451.97 If Paid After 10/05/2021, IB/07/2017 Pay this Amount; 9,596.56 USD Q•L US "uN � 6 4 ' 5, 1•2>Z tse 6•i/ 29-11 .wu t ma wt OCT 0 4 2021 OAU O�p�o For AR Inquirics please contact 800-867-0333 One If Paid On Time: USD Disc lost it paid tale: 9,404.61 191.95 Due If Paid late: USD 9,596.56 MSKESSON STATEMENT As of: 10/0112021 Page: 001 co,npmv: e000 To emsem proper awk to your account, detach aM 1Hum this DC: 8115 stub with your rmnktanou HEM MEMORIAL 0 MEDICAL MED PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CBJTFA Melt to 10/01/2021 Page: 001 Territory: 400 VICKY KAUSEK Stalemenl to' information only Camp: 8000 815 N VIRGINIA ST Customer: 190813 PORT ANT DUE REMITTED VIA ACH DEBIT Statemenl for intonation only LAVACA T% ]79]9 Date: 10/02/2021 _ Cum; 190813 PLEASE CHECK ANY --- _fi3xca __------'_-- -- Riling Due etlenal Account tale FWcaNabl� _ — Dale: 101OW2021 ITEMS NOT PAID (a) Date Number omere Referenre Oesmiptlon Discount Amount P Amount F '—' Mt) nt F Aterms) Jupomer Number H® PN 0 4 Mm MS - _----------- Number In 05MG2 -9/29/2021 10/05/2021 T29694]819 72 9 819 2017036264 1151nvaice 0.60 30.03 —_—_ 'F column kWW: P = Pest Due Item, F = Future Oae Ilem, Wank = Current Due Item 29.43�/ r'-- ]29694]B19 LJ 'OTAL Cupomer Number 190813 H® PHCY 04341M@M MED PNS 9ubigel& 30.03 LED 'uture Due: 0.00 'ap Due: If Paid By 1010512021, 0.00 Due 11 Paid On Time: Pay This Amount: LED 2y 43 29.43 LSD ad Pa 1M 6,]B].]6 Disc lop it bold late: P W After 10105/2027, 19/2]1202If 1 0.80 Pay Ods Amount 30.03 USD Due It Paid Late: LED 30.03 l�07iR off OCT O 5 2021 For AR Inquiries please contact 800-867-0333 MWESSON STATEMENT As of: lotolYd021 compeer: $ono DC: B115 CVS PHCY 7006/MWORIA MS MEMORIAL MEDICAL CENTER AMT DUE REMITTED VIA ACH DEBIT Territory: 400 VICKY KAUSEI( Statement for information only 815 N VIRGINIA Customer: 262262 PORT LAVACA TX 77979 Date: 10/02/2021 Vlling Due mt. Date ,,,NaWpational Account Mp6 -- - - Number Reference Description Cash Disocrunt ;uetamer Number 282252 CVS PNCY ]OOWMEMORIq PHS -913012021 10/05/2021 7297212775 1376285 IISlevalco 0.13 T neurone ("and: P = Pass Due Item, F = Future Due Item, blank = Current Due Item VFAL• Customer Number 262252 CVS PHCY 7008/MEMOPoA PHS SUGOtals: 6.70 USU 'Mure Due: 0.00 'aal Due: - If Paid By 10/05/2021, 0.00 Pay This Amount: .at Payment 8,787.76 If Paid After tOmS/2021, 19/27/2021 Pay this Amount: OCT 0 � 2021 Page: 001 To Meme proper credit to your amd at, detach and Mum this stub with your (61111NenCa As of: 10/01/2021 Page: 001 Mall to: Comp: 6000 ANT DUE R0,HTTED VIA ACH DEBIT Statement for infpnnalion only CUM: 262252 PLEASE CHECK ANY Date: 10/0212021 IrINS NOT PAID (r) Amount P (armed F Amount P Receivable (.t) F Number 6.70 6.57,/ 7297212775 �J Due If Paid On Time: US0 6.5]� 6.57 USD Oowtse lost II past late: 0A3 Due If Paid We. 6.70 USD USE) 6.70 For AR Inquiries please contact 800-867-0333 MSKESSONSTATEMENT As at; 10/01/2021 Page: 001 To Owner proper cretlh to your coo,vam: asae DC: 911s aeeount, tletxh antl return this atlm wNh your remMena HM MY FC 490/1412v1 MC FHS AMT DUE FWITTED VIA ACH DEBIT Terrho VICKY AL MEDICAL CENTER Statement for inlormetion only 1Y: 400 815 N KALISIX Y 815 N VIflGINIA ST Customer. 464450 As of: 10/01/2021 Page: 001 Mail to: Comp: 8000 onlH DEBIT Sta Statement for Information only Y PORT LAVACA TX 77979 Data: 10/02/2021 Cost: 464450 PURSE CHECK ANY _... _ Dale: 10/02/2021 ITEMS NOT PAID (r) AllI_.ng t4n tonal Account �8 - - late Due NumberReCOIvUlE" fate Oet¢ Number onsc ,.... Refenenae Description Oixount _____.___ Amount P (gores) F ._... Amount P Number e (net) F Number 41 lustomet Number 464450 H® RAY FC 490/MEM MC PHS - - _ — --'-- - 19/30/2021 10/05/2021 7297218257 5SK549664 1151nvoice 78.15 19/30/2021 10/OS/2021 7297218258 55x649670 1151nvoice 1.04 19/30/2021 10105R021 7297219842 55x649641 1151nvoice 5.9] 907.62 298.3.0 689.47 ✓ 7297218257 3 ,/ 729721825E 292..33 ✓ ]29]219842 1F calumn Islam: P = Past Due Item, F _ Future Due Item, blank = Conant Due Item _.— __-'_._...._._ ___ 'OTAL: Customer Number 464960 H® PHY FC 490IMQa MC PHS Subtotalm 1,258.03 USD `inure Due: 0.00 It Poitl 6y to/o5/2021, last Due: 0.00 Pay This Amount: 1.232.87 USD Due II PoM Dn Time: USD 1,'232.37-1 Dix lest if paid late: ad Poymam 6p87.76 It After 10/05/2021, 19/27/2021 Poy this this Amount: 1,258.03 USD 25.16 Due 11 Poltl late: USD 1,258.03 q�'i ` +a OC1T V2021 OGNOMAMOS" 4AUNW0400* 1i0 For AR Inquiries please contact 800-867-0333 MWESSON STATEMENT As of: 10/01/2021 comiuny: enoo DC: 8115 CVS PHCY 7475/MEM Me WE ANT DUE REMITTED VIA ACH D®1T Territory: 400 MEMORIAL MEDICAL CENTER Statement for information only VICKY KALISER Customer. 835438 815 N VIRGINIA ST Dete: 10/02/2021 PORT LAVACA TX 7797E filling Due Rereivabl�Nans1 Account e late Date — Number Ralererwe _ Descripllan :umamer Number 835438 CVS PNCY 7475/MEA Me PHS 19/30/2021 10/05/2021 7297396778 1376761 1151nvoice rF column lamentl: P = Pam Due Item, F = Future Due Item, blank = Current Due Item 'OTAL' Customer Number 83449E CVS PNCY 74]6/MBA MC PNS Subtatalm *inure Due: 0.00 If Paid By 10/05/2021. ram Due: OAO Pay This Amount: am Payment 6,787.76 If Paid After 10/0512021, �9/27/2021 Pay this AmeunC OCT 0 4 2021 > MASNOM .,... Page: 001 To ensure PMPm eretlfl to your aceaunt, tlelaah and Mum this mob with your remMance As of: 10101/2021 Page: 001 Mall to: Comp: 8000 AMT DUE REMITTED VIA ACH DEBIT Statement for information only Cum: 835438 PLEASE CHECK ANY Date: 10/02/2021 ITEMS NOT PAID (w) Cash Amount P Marcum (gross) F Amount P (net) F Receivable Number _— 5.40 269.90 264.50 ✓ 7297396778 269.90 USD Due If Paid On Time: ft LED 264.50..�Ij 264.50 USD of. had it Rid late: tlTt' 5.40 Due If Paid late: 269.90 USO USD 269.90 For AR Inquiries please contact 800-867-0333 Pd1=RGJDVIY STATEMENT As of: 10/0112021 Page: 001 To ensure Proper c uda to year account, detach and return this r nam: sao4 stub with your remRtano¢ OC: 8195 As of: 10/01/2021 Page: 001 WALMART 5315/MEMRL Me P-IS AMT DUE REMITTED VIA ACH DEBIT Tepil 99 Mail to: Comp: 8000 MEMORIAL MEDICAL CENTER Statement (or information only AMT DUE REMITTED VIA ACH DEBIT A/P Customer: 945479 Statement for information only 81S N VIRGINIA ST Date: 10/02/2021 PORT LAVACA TX ]]979 Cues: 945479 PLEASE CHECK ANY Date: 1010212021 ITEMS NOT PAID (r) ational Account WW36 older Cash ailing Duo NumbRecther )ate Date Number Rsl¢rence Deadpllon Discount (g.) F (gross) F Amount P Number (net) F Numhar :lutamer Number 846479 WALMART S315/MEMRL Me PHIS 19/27/2021 10/05/2021 7296494105 MHO9242021 1961nvoice 13.38 669.06 655.68 ✓ 7296494105 O W Column legend: P = Past Due Item, F = Pmure Due Item, blank = Curren Ma Item OTAIL CUAomer Number 945419 WglMpifr 6316/MEMNL MC PHS Subtotals: 669.06 Use inure Due: 0.00 Due It Paid On Time: N Paid By 10105/2021, USD 656.66 1/ -ad Due: 0.00 Pay Title Amourd: 655.68 USD Dlac lost it paw late: 3.38 ast Payment 9.207.30 It Pald After 10/05/2021, Due If Peld late: 1911312021 Pay this Amount: 669.06 USD USD 669.06 A1PD� Oi OCT 0 4 2021 OR .AIMO .�t•..6k$ For AR Inquiries please contact 800-867-0333 lMSKESSON .. s000 WALMART 1098/MEN MED WS MEMORIAL MEDICAL CENTER VICKY KALISEK 815 N VIRGINIA ST PORT LAVACA T% 77979 STATEMENT AMT DUE REMITTED VIA ACH DEBIT Statement for inlormalion only As of: 10/01/2021 OC: 8115 Tomitary: 480. CWomer: 256342 Oat.: 10/02/2021 P .__.. 918 4atl.nal pccwnt Rbnc efi 6 )stag Oate a oar Refem Disc Oesci lion Olscount :uat0mef Number 256342 19/27/2021 10/05(2021 19/27/2021 10105/2021 19/27/2021 10/05/2021 19/27/2021 10/05/2021 19/27/2021 10/05/2021 19/27/2021 10/05/2021 -9/2712021 10/05/2021 1912M021 10/05/2021 19,28/2021 10105t2021 19/29/2021 10/05/2021 19/29/2021 10105/2021 19/29/2021 10/05/2021 029/2021 10/05/2021 -912912021 1010SY2021 19/30/2021 10/05/2021 19/30/2021 IOIDS)2021 19/30/2021 10/05/2021 19/30/2021 10/05/2021 19/30/2021 ING512021 0/01/2021 10/06/2021 WO 1/2021 10/05/2021 0/Ol /2021 10/05/2021 0/01/2021 10/05/2021 WALMART 1098/MEM MED 7290370425 7296370426 7296370429 7296370430 7296370431 7296370432 7296570340 7296678030 7295836568 7296978159 7296970160 7296978161 7297116049 7297118051 7297225977 7297225979 7297225981 7297225984 7297400326 7297486581 7297486582 7297630315 7297630316 PHIS Page: 001 To ensure proper croon to your account, detach and Mum this stub with your mmhtmee Aa of: 10/01/2021 Page: 001 Mail to: Comp: 8000 AMT DUE REMITTED VIA ACH DEBIT Statement for Inlormation only Chet: 256342 PLEASE CHOCK ANY Data: 10/0212021 ITEMS NOT PAID (,) Amount P Amount P Rac.ivable (gross) _F _._ (oat) F Number - 16060105 11 Sinvace 7.69 384.51 376,82 ✓ 7296370425 16060105 1151nvoice 0.01 0.32 0.31 ./ 7296370426 16DB2879 II51nvd.. 10.53 526.28 515.75� 7296370429 16103270 1151nvolce 24.23 1.211.51 1.187.28 "� 7296370430 16103270 1151nvolc. 0.01 0.32 0.31✓ 7296370431 16163590 1151nvoice 5.09 254.74 249.65� 7296370432 0924210717 1951nvolce D.02 0.95 0.93 ✓ 7296570340 16218683 1151nvoice 5.10 254.82 249.72✓ 7296678030 0927210943 1151nvoice 3.96 197.88 193.92 ✓ 7296836568 1626021D 1151nvoice 5.10 255.14 250.04✓ 7296976159 15260210 1151nvoic. 0.01 0.63 0.62 ✓ 16298039 1151nvaice 5.09 254.74 249, 7296978160 0928210848 1951nvoic. 1.27 63.26 5✓ 61:SV 7296978161 0028210931 1151nv0ica 28.67 1,433.53 1.404,06 ✓ 7297118049 9297118a51 16322250 1151nvoice 0101 0.32 0.31 / 7297225977 16322250 1151nva1ce 0.01 0.33 0.32 ,/ 7297225979 16360646 1151nvolce 16.98 848.78 831.80 7297226981 16360646 1151mi.mo 0.15 7.35 7.20 ✓ 7297225984 0929211027 IISinvolce 10.23 511.52 501.29 ✓ 7297400326 16384497 1151 .wo 18.08 933.88 915.20 ✓ 7297486581 16384497 1151nvolc. 0.03 1.56 1.55 ✓ 7297486582 0930210913 1951nvoice 4.00 200.05 196.05 7297630315 0930210733 1151nvaic. 0.41 20AD 19.99 ! 7297630316 For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT WEMORIAL ' 1093/M8T1 M PHS MEMORIAL MEDICAL CBJTER AMT DUE REMITTED VIA ACH DEBIT VICKY KALISIX Statement for inlarmalion only 815 N VIRGINIA ST PORT IAVACA TX 77979 An of: 10/0112021 DC: 8115 T-"OW: 400 CUAcmer: 256342 Date: 10/02/2021 uilln late ne9 Due �tr44Alonal Account " eabl6' �6 `—'- tsunn Date Number Relererce omdptfn h: column *Ipm: P = pug Due Item, F = Future Due Item, blank = Current One Item "OTAU Customer Number 256342 WALMART 1098/MFM Mf3) PHS Subtmele: more Due: 0.00 aA Due: 0.00 If Para By 1010512021, Pay This Amoure: eA Payment 19/27/2021 6,767.76 If Pold After 10106/2021, Any this AmcueU I� OCT 0 + 2021 Cash Discount 7,362.84 USD Rage: 002 To Moore Proper credit to your eccourd, Much ane return lhle Aub with your remMance As.of: 10/01/2021 POW.00z Man to.CmeP: 8000 AMT DUE REMITTED VIA ACH DEBIT Slalemenl for iniounallon anly Cue: 256342 PLEASE CHECK ANY Date: 10/02/2021 ITEMS NOT PAID (v) Amount P AmWOt P .--_....—..- (9roesl F Aeeeleabie Des H Paid Dn Thee 7,216.56 USD USD 7.215.56 ✓ Disc Ion If paitl late: 47.28 7.362.84 USD Due It Pall Tate: USD 7,362.84 For AR Inquiries please contact 800-867-0333 Amer sourceBer em g STATEMENT Statement Number: 61728616 Date: 10-01-2021 1 of 7 AMERISOURCEBERGEN DRUG CORP WALGREENS a12494 340B 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER 1001352841037028186 SUGAR LAND TX 77478.6101 1302 N VIRGINIA ST PORT LAVACA TX 77979-2509 DEA: RA0289276 Sal -Fri Due in 7 days 866-451-9655 AMERISOURCEBERGEN P.O. Box 905223 CHARLOTTE INC 282905223 Nat Yel Due: 0.00 Current: 779.62 Past Due: 0.00 Total Due: 779.52 Account ACtlVlty Account Balance : ]]9.52 Document Due Reference Date Purchase Order Document Original Last Receipt Amount Received Balance Date Number Number Type Amount 09-2]-2021 10-08.2021 3066834769 162947 Invaice 114.03 09-27-2024 10-08-2021 3068834890 162948 Invoice 0.09 0.00 114.p3✓ 09-27-2021 10-08-2021 3066839697 162949 Invoice 0.00 0.09✓. 09-28-2021 10-08.2021 3060988321 163003 Invoice 399a7 0.00 399.67� 09-29-2021 10-08 2021 3069267551 163022 Invoice 169.15 0.00 169.15 09-30-2021 1p-08-2021 3069287551 163072 Invoke 49.67 0.00 49.57 10-01-2021 10-p8-2021 30fi9394999 16302] Invoice 09.57 000 495] ✓' 1.01 0.00 1.01 ./ Current 1.15 Days 16-30 Days 31.60 Days 61 90 Days 91 120 Days Over 120 Days 779.52I 0.001 0.00I 0,001 0.001 000 000 Thank You for Your Payment Date Amount 10-01-2021 (75760) rr.. Ar"M)V D CVA J IJCJ �c� ON OCT U 4 2Uz1 D111itNWANUIM OAVMWW3r9041e,MMS Reminders Due Date Amount IGOO-2021 779.52 Total Due: E797521 MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT --- September 27, 2021-October 3, 2021 Date Bank Description 10/1/2021 TRANSFIRST LLC VMC SETTLE 41399801332385 611 30/1/2021 STATE COMPTRLR TEXNET 03681118/109302100002 10/1/2021 PAY PLUS ACHTRAN5452579291101000696411653 30/1/2021 IRS USATAXPYMT 220167462022147 6103602000195 10/1/2021 IRS USATAXPYMT 220167430348617 6103601000191 10/1/2021 EXPERTPAY EXPERTPAY 7460034119100001632849E 10/1/2021 AMERISOURCE BERG PAYMENTS 0100007768 2100002 30/1/2021 MEMORIAL MEDICAL PAYROLL 746003411113122650 9/30/2021 PAY PWSACHTRANS452579291 1010006955ZI620 9/29/2021 PAY PLUS ACHTRANS 452579291101000694467066 9/28/2021 PAY PLUS ACHTRANS 452579291101000693485464 9/28/2021 MCKESSON DRUG AUTO ACH ACH04745530910000128 9/27/2021 PAY PLUS ACHTRANS 45257929110100069ZS29168 9/27/2021 CK 3103 - Deposit Item Return Jason Anglin, CEO Memorial Medical Center PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT -- ESTIMATED ACHS Date Description 10/15/2021 ACH Payment TEXAS COUNTY DRS RECEIVABLE 0419 21000024329 Jason Anglin, CEO Memorial Medical Center CP.. MMCNotes Amount -Credit Card Processing Fee 271.38 DY10 Final UC Payment 310462,69 - Credit Card Processing Fee ,"jgl - Payroll Taxes 9530637�}'' -Payroll Taxes 687,06�` -Child Support Payment -Payroll Ending '-' " - 3408 Drug Program Expense 757.6 - Payroll 302518.89jj'' - Credit Card Processing Fee 399 !qt Credit Card Processing Fee - Credit Card Processing Fee1"'gs:;r - 340B Drug Program Expense 5gjje c - Credit Card Processing Fee 42�,.r Return Check n}y 758,170.11 October 4, 2021 Ofliw,� Rl3- ll l Cc - 6 1 L . 6" 955•Ilull = `O.1. 11 jU, MMCNotes Amount (, 8'7 , - Retirement Funding ,150,88214E' October 4, 2021 3S0,882.46 ti 0 �I' ! i c 621) t6 I,6 z 9.,4 1 , 6, U•Uu , 36icme n i 10//5l a -I Date/Time 10-01-2021 / 10:33 AM Submitted By Pay Date 09-30.2021 Employee Deposits $65,969.87 Employer Contributions $84,912.59 Group Term Life Premiums $0.00 Total $150,882.46 Comments Payroll File September 2021 Retirement Upload.xlsx 9/30421 ?2.49 FM - _ tmp_ow5report9186849168778161962.html iy'i;-P pp 09/80/20210 MEMORIAL MEDICAL CENTER AP Open Invoice List 0 - Vendor# -. Oates Through: ap_open_invoica.template Vendor Name Class 12792 BETHANY SENIOR LIVING Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 092121 09/29/2021 09/21/2021 10/14/2021 Discount No -Pay Net 092321A ��,II``,, r� TRANSFER/go2l i VV)wl d6FQq(+j wh 12,443.04 0.00 0.00 %/�wv_ 12,448.04�,/� 0/14/20P,tt 09/29/2021 09/23/2021 tOh4/2021 t�J"- p CYO-+. TRANSFER It 1,218.59 0 0.00 1,218.59 092321 09/29/2021 09/23/2021 10/14/2021 1 TRANSFER r1 21,002.53 0.00 0.00 21,002.53 092721 09/29/2021 09/27/2021 10/14/2021 1 t MEDICARE REPAYMENT 13,923.90 0,00 0.00 13,923.90 Vendor Totals: Number Name Gross Gross 72792 SENIOR 1 48,593.06 Discount No -Pay Net 0.00 0.00 48,593.06 Grand Totals: Gross Discount 48,593.06 No -Pay Net 0.00 0.00 48,593.06 Avabowm 4w SEP 3 0 2021 sAMBM seum gnus 9/30(21 ,225 PM tmp cw5repon2704985968754053950.html 09/30%2'I)�1J I) �j-`�j J, MEMORIAL ORIAL MEDICAL CENTER AP Open Invoice List 0 Dates Through:ap_open_Involce.tempiate Vendor# `DJ 13004 Vendor Name i Class Pay Code TUSCANY VILLAGE ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 092721 09/29/2021 09/27/2021 10/14/2021 5,691.04 0.00 0.00 5.691.04 MEDICARE REPAYMENT Vendor Totals: Number Name Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 5,601.04 0.00 0.00 5,691.04 Grand Totals: Gross Discount No -Pay 5,691.04 0.00 0.00 Net 5,691.04 4w SEP 3 0 2021 Request for Transfer of Funds Tmm/Y k OYe RequeYad Payer Requested by xaquesmfsemaR Requmnys pbone number maNleearruunly Facmly HNem Name RE OIREO Ingtemvlx OIREO Tweo)pavmem qe F ''" -°— payment erF u b sl�eutidsasnut nerm ,m Lq]Q 119y{uypj7 E1R(fR NIA N/A 9 23 031 EFT EkTFA936E3 NOAR00 30.90 .9 RROROMOOR Ai CREEMIOE N/A AT NA 912�023AWT EFT 2.618.69 3,618.69 ETTM9499 026169 N..M2.69 324.63 eROAOMOM AT CREMIDE N/A N/A 91MIPM EFT ),467.66 EF) NOAROWRNfi9 193.93 OROAOMOORA)CREEy310f N/A N/A 9/pd/2@1 EFT A63.08 IMM EFT41W35) N..Mb7age, RMAOMOCIR Ai CREE8510E N/A N/A 1 Cii $ 1.295.08 EFTfi102@9 NOARMT]6Bfi9 .1.0 Rl6f RROAOMOOR AT CREERSIOE N/A N/A 9/33/$O31 w1po CFI $ 12I.I6 6FT6302598 NOAPOD'A34dfi9 60B OROAOMOOR AT CFffB{IM TOTAL 1, 9iCO.98 1 1 447.42 tO be filledarrtb Memarlel MelGnl COmlF: OaeRtte 9a0 33 Approved by: ryra MaNlne[ Pate AT —fec 10 6 203 imm H01 OROAOMOOR A, BUOF TO FiCou, MM Cbrue Annabel: We, PmumMlmmr4m Y: Ogle ollexuye.: FmmytllN To Ammunural l: AMMMrJVM OCT 6 4 1U21 GOINWANUMOM OAXIAWM Request for Transfer of Funds rranee[•: WH.R[quesbd ]p/1/ M Pay[[ MEMCARE Requa¢db,. TATUM GORGON- BUSINESS OFFICE MANAGER Roque[ small Ia. e: M:nLYeln ny Muuv�[nn: Reyues!olS Phgne numbs 361-551-0500 olAri[E o[Cuunry [agwun FatlrM BMbanySmmrlielnE F Of WWOSEMEe (REWIRED N IP n 9/E)/p]! ryceo!Paw:wnl E PavmeR jbMl[ um MalR NYmbe[ Bq ry4M_Cgl[E rush Fl [r una3k L^Y�LgI MSea. Mes SM cn N/AN/A E. 609919R ._ NOARCLgpEW69 LM7.10 THE 9RWOMORECREEKSIbE.AUMI"Hl AWANCLPMT lY be Filkd oul6 MemotlalMMi[al Cencec Pe!e Ra4W:: 1p pE Fmm orl mnlEen MrMa E RE'l Pmm FMIIHy: X BROAOMO L[ESIGCA NILLARY AOVAH CE PMT To fa[flILY: gcl anyimia bw:y WpeNN innOe[0[1e e1: Oa[q al Nan3kn Nam ia[iliry: Amo [t[ Amoune AWMAKYnM OCT 0 � 2021 +•tom @a+r Request for Transfer of Funds uamw R oam ReyYaae 9/21/IDz, Pager MAI. MARp 2069 RepYeAeOby: Glnni Noppe! Re9Yeib(e Prm9 Cx41p!LrlaNerinnIlewh[om RePueSlcfs pxane num6m 9p33)z-89I1 Olsl:ktorinunly Memo�iM Mfd:[al Cemn Geil, Wd-Cmek [[In'me• Wnn [pylf�ai�:9 nrtx�✓_a[uin Pepen[Name RR plRf0 Rm N4rv4a uM6 m '"° r UmT RR hamene h t e A[NanneetlN.un MRfeE m.e.unr�nm (RypygaemYpt M10 9/zLxpzz s z,azs.pal CvpngpOpQoow s 2.9E5,p9 nw emadmwrC,e6, TOTAL _ $IEA35.p9 5 E.45.W _ ._ ,e ee n4e wt b M emarbl MedW Cemer: eh Ile[e p 31 Eoz APpmuetl xY% Mry:a Marllnet pate Of Namfer'. 10e6%Ep1L fromiaeiliry: Ixepro.E Cm 'Crt' Teea I; G w mek. Amevnt z.9ES W... wte m Lmmre�ml Fmmia[1111y; To fatlliry MmunL OCT 0 12021 Request for Transfer of Funds lraMkrh. palegequaWd 1.36.2E Rryer MCMANE .1o.W b, M01E1A...S fl[pu[Mfs[mail gr v.nr o.mtmtpTspM1one number ]l3-]]093pp Wn.otmomm, flpASpAlq .al, TV3CANYVIII E vmen[ f]� IS l S.lel.E:: FR6IpA53) Wp/NpngOWp)6g69 ;lgtfs 6rwtlmopr MIRMWRWN&�. fOTPt 3,SBL3G1 5,391.36 Te be Nledaut Memoeipl M¢CiHILen31 Oala g p)1 0.pprpepOhy: MPY maMmrlXer: pill a WI Tmmiluw, gUW NV r TeaumL it/KANY,VItIP Amount 2,1tll.36. a:uler[aeat From znar[r. Tohdi:i111y: ]nry; Ammna err OCT a h 2011 Request for Transfer of Funds panaled: Da@pequegetl payer ReyumeEbY: R'ueylels email Requefbl'S pl:°ne number Dlfttln°rfnunry FeGllry mW EDR pmiebnre Adrlceeo: [r a w� nmrpm mna 9nr °nlw arpy rl MNa�rEC IREO pMelServke UIPEp pa °! n IVce°Fpar°'e Ilpq— ra}pYAi Mlm vrMe4uler Hp] luntlal. er EVypNRam:: 4i r n]n.93tIRECRESENT N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 9/22/3@1 9/Z2/3O21 9/23@@1 9/21/3@1 9/27/2021 9/21/3021 EFT EFT FFI EFT ER ER ]GM69 3,222.90 3233,90 MI.GG295M 5 1,37"5 $ ]3].]5 EFT609]533r EF)6O3] a9 cVlog�"61w0% aF =2]S9 EMM529 EFifi1p2596 NMPOCu M5] NIMR0 1955] WWN 19557 NOAPOWOl955] NOAR0W0055] NpAP01pO1955] 15ML 153.91T —22 26I'ME GL61 4W T DIE TOTAL 9.000.98 4042 etl pN[ by MlnmNl MCEInI Bela r: 9 ... StlbPeY: ' MMaMysO:Mm[iNM FFrQMFwlJiW.ER3NT 3 TDFl: AmUn; 1a)g2 oWNNTwIre Ua¢PE: newmmren TFetlli[y: T. A --I: -I: OCT 0 h 2021 Request for Transfer of Funds Wte Pequested 9.28.21 payer Mf01CnNF Repum@Ebi: MCXELPRENAMS Pepu<alofs<m<II _cri �1�3".L[�ir_ry flepu<itofs plrone numbs, )13-iM-53W Oblli[IOI CounW 9Pp M. ia[Iliry iU5[pNY VIWGE [tlwaneerNmm[nrvr6 vn yalLrez@mm[nm Pot en[Name (IS4Q� EO Wb!olYrvke NIREO RMe Ol pavme iweol Wvmem rm=[y/Ej�f- PivmeM C11e[YNumhpr tl<Im Number pNueeetle0.0 (yggEl,Jy Funtly(<j bYONp.[[ f( ipe��< qy A3B.$1 IET 5 S.SBSM EFT61NS37 WO/CVOr1RO 30SSI 5 },55156 C—ent iOiFL x.591,14 i$91.36 ro memorl<IMetlWlCmler. ftcetliutb Appmweve xz pppmweey:� MNufln NneuOCIIiW . zoemn FNm Fi[IIiLY CflE5CFN1. ii .., }IY VIW 2.5 4=' 'i,50E oel.nrtam<el: ip ..., <mo OCT D 4 2021 Request for Transfer of Funds ranee,%: OaM.,ue,t a 10/1/1@l payer MfOKARE Requenea bY: TATUM GGROOM - BUSINESS OffICE MRORGER Requefmheeeell g�tlpnpBe ry,_myJ...... Requealor5 pw,e ..her 3ll-R ST SBD DBIMaKouary Calhom FAR ay selbany 5eniw VNe, H1m a0,MH an areTiymenl ar maupmenL pkiH p,Ovb<FpO el m[ryib WOn carte m: mm� ema+mmpngpl+,.,[,r,.e , net u9nm nLraao f E L[_M IHm,- 1 pa E VIREp reUMED pafe al Ps }<ce el FeunHnl Ue E pawnent (T<[X Numhv Ira Nu RMmnMN-Enter 1L •11C1kgALIE1 Ho F shown an N/A N/A 9/i3R0E1 EFT FFT4099199 "DAROCV]1955] 1.e47.10 MRE ECSENT-AMIUM YAOVANCEPMT _ TOTAL I.a<].10 TO Ee mlea out hymemaaal mealol tenter. e Re[e ahY 11 Dewnn Nwnine[ aH <Itnnrlor: IG]31$E l Rom RY AOVAN EPMT T<Fa[IpK RtlnamSeeio[ur1:6 Rmeunr: .: 1.«I.I RMwn +rate, oa,e q: Dete Fwat Pecolkv. r: Frvm h[tllly: Tp ixlllly: Amo ~i OCT 6 4 2021 Gomm a+ao,an a&nwm WON 7R!N Request for Transfer of Funds rmnnn. n: OehfleyuwlM 9/}}/2021 PMaegtm[k pmt Nwitm U"GOG0J19557 gemlNanttgdvke entlfOB Gry...dby: C.,.,. oppw MmmgltM1YeneplM MpegprymenlwneNpmen4plemprwlJn WOMaewpeMtlllm Remail REpuq." "tory pMne (rrn nrrWNera X •1aYwtNime,NmolStnkeeM/uneuniMgymenlM1m Remlttlnw MlYemuitNRged numbw 9R}3}}RaIE a eema RYmRtln teM1que a aM MA. W: at" , odlavam RI[Oitlw[ounry MlmeriNMedrei Center Elm ea n 90h, Gddun4eek P rlmane IIIR pile olYrvke REG IPa Reee(Wvment pm�[RY J•n, n ¢ Humhea NI L94L KfN�41t1 ko.Ypype{ypyrrrl{ nl 9/EvIon $IE,Q5.04l NUgp0Wg19557 5 0,O35.W lbe(meen! TOTgI $ i<}S.MI 5 }A}S of Tobe RfEAoutby MwremaI.dkalR.G,. HWE App.dby: oym MaRlnet R:le nrtanare� } 9 } iromfwgity: epeirnl Ta OGnl 6a aenaoeY gmpun[ ,d pp, ReRuu,HmwltrRne Pt: pale nElaana(!,: Tmm Potlllry: gmium: INK A ., �P Request for Transfer of Funds Tln,le: p: Oeh.I.I d payer PequeeW by: Nquefeoh Nmll P<9ueemnpnon< camber olretl0l Br County ratlllry E n x PF PFO FM m•-ml PE NxFO pa eol Iime nrWmW >,.mew rM1own an Nu Ax W::.,ele. mre. hWWbfpM,1, �e]B.9] N/A N/A a 11/]0!1 Efi 1,999A3 FFi6051]93 NpAPCWOl9556 fOPi BfNI]HGLIMGXF TOTAL I,B99Rt ]B.9] To he filletl W11ry MemorldlMetllGl C0P1lr: )ep tt 9 3 9 ApprovOJ hYAhyra Mm ne, Oah of xin[IBr: 1416/EU :I imm iullily: fOPi PENP 11FAl]XGflF T_u illly; MM C4ne ,aq:lnetl u.ml.. pnu]: ofih 9rlmnery �N Fmmh[IIIM: Ta nNiry: 4meunt Request for Transfer of Funds namrm a: data RegnertM wyer Repunleq by: paXnalwrF em.x RaXwswrF pnpna nnmbe. OI M[I Of dunly fa[ility F1Lym:mmm[nm ar w(dmm nr il.w Ptl4na Nd n:e RE Oaw OIRn[e 0 pa pa type al PaameN w E wmwm ber Ualm Nu Prlbn nrrlM.Fmee Iunar l.la hMr Y1 wyLllp a[wu l)9.63 IfagE N/A N/A 9/l E/2O31 EFT I,657.9O FT6 EFT6 [ MIUM191]O SOUMW[STUOUSTON N/A NM 9/3]/EOL EIT 3,619.69 EFT6O9)499 749E OIXl]O 5OIFMWESTNOUSMN N/A N/A 9/33/3@1 EFT 3.]3190 ER6p99OE1 UDAA FHMRO 161IO n3.61 353.91 5OlEMWFSTXOUSTON N/P N/A 9/E4/ffi1 ER 96).66 ERUM�g CUMpmiallo SUFEM W05T 11OU51ON N/A N/A 9127I ER S 3127.15 EFT61O36)9 61.64 61.09 SO[ERP WEST IIOUSTON N/A N/A 21 9/3>/2031 EFT $ 13)JS FFl61@S9b MAXM:OI911U NOAXCCOO1W1O fiAB S01fRA W[Si IIOUSTON IOTAI 9.4W.96 14].43 TOWr1lled o"by Memerkl Medlnl[emen iw NPw a 93 ]0)1 Approaed by: -- ---- baze 111W. vr: SOv . fa[IIIW: L RA WEST XOUSTON To fa[Illly: MM [Inl[ Anwunt H]AE pw of irYne R: Mceol vd.naler: Flopm Fa<iIR6qw [IIW: unl 021 Request for Transfer of Funds Tfdnslef b: Oate Pegeedntl 9/37/ID21 CYpggppMaRVR Fayer Novllas Re ucsted by GVIna ft, xaqueat,scmeR rnongT, xr on•t�un_[om flequnnCf pM1ane number 5R33RBPl) Pnm[t or County Memorial Metlinl Cem<r as ., VOMen[,.. nnem xanr R R pme alsm F VI O t Tw.arpa.men[ G CM1e[Y NY Oal pp6m neNe6 Wa[L_a LeL yq TfU1 [Sav_nl (tIq(5F wYme"t [F 9/I3]WIL $ R.J 35M rypPP0Wb191]R $ IA ]S Ua Sole [a Wnt MYuslYn TOTAL ]T befiliad wt by Memmlal Mebbl Centee Oa[e flenlve : p EIR 3] Appl.dby; MaVta MdOinm pa4 Mtnn[/m WOWS from Po[Ilily: 5 n T.faaJhV: G Jm Amount xa.IA25M mbnvea u.aa[.an..z: bale alvanner F/em Fa[11iLy: TO Fa[lllty; unl: OCT 0 4 2021 Request for Transfer of Funds igNm, 0: oale Rayveme 101I12on Poyrr MfOKAPE Rllueeletl by: TAEUM GOROON'RUSINf55OFFICE MANAIW Re4ueyWlsemail U;n_ nIS4r:1:�._u. nr lo_ Pe9uexlPIYPIIene numLe, a51.551.:1[m 0hlYine, county [alAPu EafIN1Y 9n1:arvY5enio: LlWnG patkntNeme N O OAN elYnce R O:e al Payment ivpael Pavme �= pm y e kN I hee BEWRS544SA:tN81. F_vnMMwwnJxl,v H _ N/A N/A 9RBk021 EET EFTMOI98a CVUANB000181]0 1.997.t0 $o1e:i WM1 Hombn-AUXIIIPPYPOVPNCE PMT io be NleEPu16 Memorbl Medltal[entes: att Pe¢XS 1 1 E011 APP:e+aJ W: MaYea Manure OavmL Innxle r: IDI LI LC31 T. C111tlllly: exa Wes111alRlnn-PUXI YAOVPNCEY T. 1: &1 anySevrcOng Amount: Oale Fmm Faallily:.011;Ee:;nae m Ho11Ny: mun rrammnRequest for Transfer of Funds : 6eie nepuertea 9.2e.y vaye. m[61uxE RepueileJby: xaCNEINRENWS MpuenPlwnull {iaby rn�n vab�= cZe.ri£1 flepueiloryOxPne number ]33.]]O.SIM LbthtPrCmnty BMEBNIP EveHI WxPX, V11.6E r%OD"m qw OCT 0 4 2021 OOMPKAIWNKM 8.V..E Request for Transfer of Funds Tramhr p: 0amaepuesea Payee Pepueatea by: Plqu-weKemall numbeb([Pllen! numbed OIyN[lor Enunty Will, rtv NJpkvena FllO htlkm aallnxanweryaymmt011emu0meW pleJxplMEeEOaMMIylNelaM RCmRdMKAGYIgb: LElcrrnecr( mm[ nn n wi WkName N MhnyS[wlae [4 menl LYee Mpevnxnt EFT E ASBY9LR Pa1'm$nL CM[FNumbee tlal Numb¢ AMwmeeM.[nur ly9e[MwFuntlFfrl. {gLON_K a42y Not aMwn Rn NM N/A 9122IM21 EFT EFT6MR]] ]fl99 COWER CREEK N/A N/A 9]22/M21 EFT 21618.90 2,626.69 EH609H9e UDKKQEp11195E0 121.63 COWER N/A 9]2UM21 EFT 3,233.66 EFT6090033 ..DVOR9X0 NWARD)Dl19M0 15192 CM MEEK 601DEN CREEK NfA N/A WA 9/2AR022 EFT Efi].66 3 NOAHDECQ 90 GOI.M N/A fR $ 1,293.9R FKQW EE)6102629 CVDAKIXCu19W 622d26K.. 6LW MEEK CREEK N/A MA N/A W2)/M21 9/Z]/MEl fFi 5 IH.]5 EFi6102598 NOAflIXPo195C0 600 WLOM GOLOFN CHEEK TOTAL 9A0D.90 ia],A2 TY be Dlh6 Rul IRK Mlmurial Medkal Cenun 9 3 2621 Apprpva6 by: Mayan Malbn[a Oafe RltmW.': a0 21 R.E. FaNlty: —.CREEK ]R fades: m PepxYe!]rrvM1eWusE: Oat. FPRm HxRHW..tlIi1Y ANONYM) TRPa[pltY Rurrt OK OCT 6 i 2021 Request for Transfer of Funds iran3ler p: 0U Ml..Ied 9.28,21 Payer MEVICANE pique Sled by MCH EL ApfNAiA3 pique mn emal --a:@ ..... pequal'n Pnone -ber 10-74 93Gd .WltvC my kMto.. Fa Illy TUSCANy VIIIAOE Gfygrq¢r�mnM a me[R`mm mnrlli_JL Patknl Xarm (pEOYIpEp1 Nit 9f4M[e L VIREO OeN of Payment Tvoe of Pannenl (Cfy(k[jQf. Pa JTS: LC Qmek Xumhe! tlalm Xumke[ A[tl^^nMW6nY! ry4[I.lu LLMUp vuo Llp(pL $PymyA 9.1k.33 EFT $ l l6 EFTSINS37 WOXVGAPi)lil1 aP 5 Sn6e L36 Gdden Creek TOTAL 3.5111.14 3,583.36 Tote filled6ut by Memodar Medkalh ter: Oale Rau 9 3 wMD.W INby: MAYpA hNpPHf2 Nlmmrer: eamndllry: anon cm TO FHlllty: LV%ANY VXLI4E Amount 3.SB1.36 uwrnat..W:tN. n: Oale ollnMlel: Flomifift : is facllilY unl: 4w OCT 0 4 2021 Request for Transfer of Funds Date Requested 10/42021 Payer MEOIWE Requeated hy: iNDMGORWN DWINFSS WAKE MANAGER Requealo 6a.11 m, LM1elM1anv liv:n xequeslofa phone number aculll n. outdtt,e caunq camnun fadia, pHM1any Smlot Wlnn ..rev. ee ®mnm�ap.,o ptorYe[OealTapallahAn Patlenl Nar:p ul Rpip nlLrvlu LQI(IRJ Ga I Trceel Pamm yvmeM o9, ecM bee Ctal x A[IFx:neNed-Fnma E{gSgF In^aaLlasnanhh FOMUAa[rw M x/A X/A 9/2}pEl EFT FfTbM919B (VpAPLWp195W Idd].]D G0L0EN (RE. B PENAX-ADaa.RY Af1VANCE PML idiAL I,IJ),1p To W filled out ba, Mem rill Medical Center. w pRen ve: io :pL W.ovedbK MaVaa MaXlnpa wte ollMnthn 1 6 O l Pmm PaNky, LOEX FREFK&R ApRILPRYAWANCE A frilily: anYdpn:or Llvin( A lw l:dq l:10' Papaw render W:ep): Data uutvm en fmmfaafiry: Atmouns OCT o 4 2o21 Request for Transfer of Funds hamlet N: OaM RepueOetl PsyC, Raque[letl by: MqueAaYvemail aeryevvoVvpM1oi:e WI,IRo, Eounty ixlllry rtlUSSaa�. Ip[31f wearsemN. aE uMEO O. pt t rveemw.m. IWLL4ER [_IeMet tlaMxunNei aaNm meee4Mo, rv.e[a e.rme Nl eyaue.:.m tl]a Nme[ x/A x/A 9/22/Mll EfT 2.65].96 fffW7mhet E11.]12E NGAPOW]J]9B3 90 TU$S YVIL A E N/A NA 9(2]/M EE] 2,61869 ffiM9034 LVfIA1w 124.63 N14WY VILIAGE N/A N/A 9/)3/E021 EFT 3,233.9. EfT6099033 19a1 EVOAaOWM)905 113.9E NYVILIAGf N/A N/A 91,712121 EFT 4nm EFTGI6O09 WOANOOWO)935 WN TUSGNYVIIIAGF N/A N/A 9B)2011 S IM.W E"GID25E9 WOAPOMM5 61.)b 61W F WA N/A 9/2] 20L EHEff FFL S lE],]5 ffT61@59B W0rtp00'q. 0]9P5 GOB IWA.WI iViFANY VIIIAGF TOTAL 9,W0.9B 41)A2 Ta be NlletlouthYMemprblMeEleal tenlee Oate Ren a 93 1021 AppFmMlrl MaY[a Marline OaM of lMmle,: 3p 202 immEa[NiM VIWWF TO ..Om FaeaiN AmoYm: MM iM1441.41' tl: Oat olMmhr.nik. immfatlllry: TOFa[Illly: Amaum: � OCT 0 h 2021 2 I§ \ \\\ \\§ \\\ ) /)9 25§ !■§ j\ \ ( 0 2 / )e� )\_ \ , t#/ ()/ §&® § § \\� \ <\ \\ \\ °\ ; ;; } _ } I / } ! ) ! § � \ 2 ) \)_ \( \k /\ )§/ )§ )§ \\ c c o 0 0 I v K Fm- Q r a vQW¢i m 0 a O V tl Z N ry U m 3 w � ❑ f r0 �ep ❑ V m a U_ p U Q P� O P W� P Q� � a � � O m❑ Q0Q� W 600 ¢F t¢ci. aX ❑O < o0F 0a oa crWi. c�N F¢ e o CL d U E P N O O � m r m r P � � b 0 F ❑ O .7 N 0 O C d >on P N m q � ••• N O Vf V m Q N X a ❑ F OV Y O °d z O z WN ¢ ¢ Z Q Q o a U "0 7 U v aww >" >c°� m U I h N N N V N m O a e o o n n o m n 0 a p a a K O U �x 0> 0�Q 0 >a'❑ W zy, Z U F v0 �O 0 00 cW7 'C N A vmi F �' o F 0 N 9 Fv 0 v F o ry itl 16 [^ F U F ccU�� FO H E F F F � FF FF= FO C a z z �a 6�a �a� aaa� a ❑ o_ u o 0� 0 0 0 u 0 o 0 u 00 00 00 00 00 00 0 o0u on 7 I ! 7 I! { }§ ) \\ )\ \ { ! );�/ )7a § \o k ° ®' f y )A 5 k\ ) \ ) } I )) ■ z ; \ / k ) ( ) ( § ) ) 0 \ \ \ } k/ ; !r kz \§ �( ;/ &! �!! 7 )} %a! owe )k)) 'No §\w wrm ) § � ( §)Ow ) (\ k f \ /) n ( z )) ) \\ w / \ � ) a ao �o i c co - P eo o a n n oo ry r r h w1 N N a x x W N U `° V oU L' m w' O a z Z 3 j Uz a V eo OO E'" 000 KCS « a:7 a; QN,' `aU y a rn my P� Pa P� P> h> OQY 00 a, of f w iw Xa {-„WjU X O XOO m W.� w< W Q w W Q w W W� wU WC7 W �0.' W Ooo w'�O C N P P h O O O O P O = O }F x W ,U.7 z ZU d W e a V' P to v� O p N V Vl YJ Vl Nf O V1 t1 O P b � b b trt e� of ? V V Vf b O N rt of o z w a w cai � w a z Q Z W CZ 5w jW Q�W >W x w OU E 0.OU V C7 ,mac F U y O W O Zw h w V O O x ww w w `a a.m u.am )�2 0 (w( §`( - ) 2w( 8w) ( /} 2 , ] t#2 ()) !( §k § )\ \\ \\� \ k\ (/ \ ! ) \ ( ( k I 7 \ \ ) a� §) (\ ) \ §\( § ) (§ _ ) ) ) ) \\} \ } \ $ $ $ $ $ m @ @ E E §/§\]k§/\/ ) \ §m mz m \ §N § / §§ /\ D ° a U 0 N m F b O F E F =a U �Z 0 O 0 d y > 0 x j Q F > j Y > w Z a Q u < w y o m e ? z 6 @ e 'pyen rI U v V O U U a u w° W b b N b b M b b P P P s F W 0 U a c m o F a O O N m a o N _ N d - N W v¢ m Y X Y Ll wF' m000 UN ° uFa 000 m tl a O V N N N N O F> N_ Y y W O O O ^O N b N C. P M CK C K K K fb W `o Z <0 am s �F �o z z `d H> m F m a 0 m¢ m p in m S U p W r Q Q K N N M M � N 6 a o voi voi voi n w P 0 o M M M N N rn n m e v a a �u ur O O O O O F W O I1W a; m ¢ >> rw,N Wd�q94 04 ;'�¢�j Zp 7 ¢Y¢ ° aW�CC Y �W O h S m U U m r¢A a a � N U U U y Zm ti �rrX am o j� m� o N � Q O R F ^ F N a a N x N a U U U a F > > a z 0 O a ° a w wor p LU UU U W Z o+ W lit C 0 v v U N n0 Hz Nz Nz W `u W QtXY QfYp WQ � QC o'+FU oF0 of d' N CL N �F UFO UFO UFZ w o o 00 0 12 F O �3u O Q u3U Co¢ U3v X m WC Z X w w0U N b O F y Ey h o v 0 V 0 0 0 G K z 3 a U m y J � d > Q a a a n C K } > °a o 0 0 Q U Q 14 a •La U U O O `v m v v W N f. y O Q y � Q U o z W C zz r O x U > Q Q `z e- O�cWi cC. i m� mull rnvPNim w � Q m � wocai z3 xMmL'� KmU O b v1 C N N O N M ad h r ? N h a rn ro < N .] O g o z Q Q a aU a O oz W7W �yy z .WI Ua U.a] 4'a .l6 WU a vi vmi e e e Q mO ° < U W a O Zm m 0 rn P O m o � - m F o F vi a F V 5 U FyQ= pz W G. O 7 Q vl � W C7 W zm O n OO 1� b m N 0 0 v U P VI N O W Vf P T P N P R V� O W N V N P N fV V O N w V y � } 6 ❑ U w¢ W P G U 6, w F O w ❑ ¢ j0 ¢ w ❑C O� a. wh x w a ❑ F e m � am � H C oF.}.1 ❑a O y2' O N. b T T P O L P P P q P G N N N¢ N N N.7. N�y N❑ .] m E tG N a'F m d' cCF R'U< rCa C Ua cC C Nti C c' N b T S r W � Q M N Vl N Oi b N U U Q `Z- Q Vj �.. �❑ b �O � Q e� v� N b O m m M � y F Z a o o z a d a °^ w w w E E' O a a °' °' U w zoz Vo z Q U ci U U ce G w U O O � F c, 0 � z< z< z¢ CC m o Z`o 3� �� �O� a0c W ❑� � V OE V � v❑a �w wj mj -� � w a� 3 a ° 11 w5 V m � N V N P P P h V1 UT �l V1 VI VM1 V1 V1 b b b V1 VI Vf VMi N r � 9 O y a o U N e o h h 6 ❑ F $ E h F N UWU{� WUw� WU�7 �U�yy Z❑Z a qzC ❑za' ❑Z4' ❑y K o� o� oa od oa ❑ Cm ctm a:m cCm cCm 0 § in,\ � \ \ § ) \ §\)a §$;\)/;) )k \ \( ( \ \ \ \ \\e e e ®§ »®2 2 ')!o@ume< ; 02 / ( ® \ §))§/§/k(( ~ )§ \ (§\ ( ! \ \ \\) \ ;\ ) \ \ CR W a W F q � oa c" -_ z! ( (/ a am00 ( e)§ - ) \)§ ( ; k k � \ \ J( # § , ± 2 2 \ k B2e B!e !e!#k 15 es ) ) \ \ ! n ) 3 ) § § ( m ] 0 0 0 �I P r W VI V R vl m H1 u ❑ m O 0. N O y W N V rn N m W NO =F ❑ c Q U m ❑ 6 �C C E a N ¢ U F. N ❑ Sz ° > �n o0 h v 0 U a n � F y � E W O� O z F {y pp> ] P U P P v ❑ c a F a tzi] W emu.. F O � o A zz °z 0 ea§ (/ _ } )\) )\\ \( \ § )(} (\\ )!® K \ b d \( ( ! ) [ k I ) } \ 3 ± \ k 2 ) ƒ ]