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2022-02-09 Final Packet
r(a 1 12 I I I(fWOW (1, 1I�1� _✓AII Agenda Items Properly Numbered Contracts Completed and Signed AIt/Fn All 1295's Flagged for Acceptance (number of 1295s ) All Documents for Clerk Signature Flagged On thisday of 2022 a complete and accurate packet for 14 of 2022 Commissioners Court Regular Session Day Month was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Calhoun County Judge/Assistant COMMISSIONERSCOURTCHECKLIST/FORMS AGENDA ' N0TICF OF MEET 1NG 2/9/2022 Richard ]H . Meyer County judge David ]Full, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 (nary Reese, Commissioner, Precinct 4 1£addne Smith, Deputy Clerk NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, February 9, 2022 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. The public may participate in the meeting through the following video conference link or toll free number: PC with camera and microphone capabilities —flittps://txcourts.zoom.us/i/2130882273 AGENDA The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting was called to order at 10:00 a.m. 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. Happy Birthday Cindy! Page 1 of 4 NOTICE OE MEETING 2/9/2022 5. Approve the minutes of the January 26th, 2022 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER:- Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 6. Discuss with ADAPCO concerns regarding the bid specifications for the Mosquito Control Annual Supply Contract. (RHM) Cathy Russell with ADAPCO explained concerns with Vender packets. NO ACTION TAKEN. 7. Consider and take necessary action to approve the Agreement between Calhoun County and Inmate Calling Solutions, LLC dba ICSolutions for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearly for one year terms upon Commissioners Court approval and authorize the County Judge to sign the agreement and any necessary forms. Form 1295 was submitted when the bid was awarded on October 27, 2021. (RHM) Sheriff Bobby Vickery explained agreement. RESULT: APPROVED [UNANIMOUS], MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Enter Continuing Education hours for County Clerk, Anna Goodman, into the official record. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 9. Consider and take necessary action to accept the 2021 Racial Profiling report that was submitted to the State to be in compliance with TCOLE requirements. (RHM) RESULT: APPROVED [UNANIMOUS]; MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER:; David Hall,,; Commissioner Pct-1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 2 of 4 NOTICF OF MEETING - 2/9/2022 10. Consider and take necessary action to authorize the CCEMS Director to sign a Field Internship Affiliation Agreement between CCEMS and the School of EMS. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 11. Consider and take necessary action to authorize the EMS Director to sign a Credit Application with Crossroads Tire Service. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: GaryReese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to approve the Infrastructure Development Plat for the Santos Mag Beach RV Park. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Mever, Commissioner Hall, Lvssv, Behrens, Reese 13. Consider and take necessary action to declare the equipment on the attached list from MMC as Waste. (RHM) RESULT: APPROVED [UNANIMOUS]' MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action to extend Interlocal Agreements with the following agencies and authorize the County Judge to sign the purchase orders. (RHM) (1) Calhoun County Senior Citizen's Association, Inc. $35,000.00 (2) The Harbor Children's Alliance & Victim Center $28,500.00 (3) Calhoun County Crime Stoppers $ 1,000.00 (4) Calhoun County Soil and Water Conservation District No. 345 $ 7,750.00 (5) Gulf Bend Center $26,000.00 TABLE Page 3 of 4 I NO-iICF OF MEF.. FING 2/9/2022 15. Accept Monthly Reports from the following County Offices: i. Floodplain Administration — January 2022 ii. Sheriff's Office — January 2022 RESULT: ' APPROVED [UNANIMOUS]' MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: < Joel Behrens, Commissioner Oct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. Consider and take necessary action on any necessary budget adjustments. (RHM) 2021: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge; Meyer, Commissioner Hall, Lyssy, Behrens, Reese 2022: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: "Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 17. Approval of bills and payroll. (RHM) MMC RESULT: APPROVED [UNANIMOUS]' MOVER: David Hall,Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 2021 Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct'2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 2022 Bills RESULT: APPROVED [UNANIMOUS], MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 4 of 4 I�IOI It E_ U1 Ml l I INO 2/'1/2012 Richard H. Meyeir County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 (Joel ]Behrens, Commissioner, Precinct 3 Cary Reese, Commissioner, Precinct 4 NOTICE OF MEETING ING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, February 9, 2022 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. The public may participate in the meeting through the following video conference lints or toll free number: PC with camera and microphone capabilities — hops://txcourts.zoom.us/j/2130882273 AGENDA The subject matter of such meeting is as follows: l �:ry�LCCK FILED �M ,--'Call meeting to order. FEB 0 3 2022 '2/A7 "b'C. Invocation. ANNA .coMY,TPYaoouAN COS !, S BY• Y./Pledges of Allegiance. General Discussion of Public Matters and Public Participation. Approve the minutes of the January 26t", 2022 meeting. b. Discuss with ADAPCO concerns regarding the bid specifications for the Mosquito Control ,/ Annual Supply Contract. (RHM) 7. Consider and take necessary action to approve the Agreement between Calhoun County and Inmate Calling Solutions, LLC dba ICSolutions for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearly for one year terms upon Commissioners Court approval and authorize the County Judge to sign the agreement and any necessary forms. Form 1295 was submitted when the bid was awarded on October 27, 2021. (RHM) Page 1 of 2 f=1JTlt OF Ivll f 1 N(j /'.�/�021 r/ 8. Enter Continuing Education hours for County Clerk, Anna Goodman, into the official ,/record. (RHM) ' Consider and take necessary action to accept the 2021 Racial Profiling report that was submitted to the State to be in compliance with TCOLE requirements. (RHM) `f0. Consider and take necessary action to authorize the CCEMS Director to sign a Field I�nt nship Affiliation Agreement between CCEMS and the School of EMS. (RHM) I1. Consider and take necessary action to authorize the EMS Director to sign a Credit Application with Crossroads Tire Service. (RHM) Y2. Consider and take necessary action to approve the Infrastructure Development Plat for the Santos Mag Beach RV Park. (DH) 73. Consider and take necessary action to declare the equipment on the attached list from MMC as Waste. (RHM) �-e Ali F-,)- N¢Ki- WA ,#-X, rAlg4. Consider and take necessary action to extend Interlocal Agreements with the following agencies and authorize the County Judge to sign the purchase orders. (RHM) (1) Calhoun County Senior Citizen's Association, Inc. $35,000.00 (2) The Harbor Children's Alliance & Victim Center $28,500.00 Pcw° (3) Calhoun County Crime Stoppers $ 1,000.00 Pa°� po.4_(4) Calhoun County Soil and Water Conservation District No. 345 $ 7,750.00 (5) Gulf Bend Center $26,000.00 15. Accept Monthly Reports from the following County Offices: 1:.�Floodplain Administration — January 2022 ll. Sheriff's Office — January 2022 ii6. Consider and take necessary action on any necessary budget adjustments. (RHM) 17. Approval of bills and payroll. (RHM) Richard H. Meyer, Calhoun County, 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 #5 NOTICE OF MEETING — 2/9/2022 5. Approve the minutes of the January 261h, 2022 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 14 Mae Belle Cassel From: Kaddie.Smith@calhouncotx.org (Kaddie Smith) <Kaddie.Smith@calhouncotx.org> Sent: Friday, January 28, 2022 9:55 AM To: MaeBelle.Cassel@caIhouncotx.org; Richard.Meyer@calhouncotx.org; david.hall@calhouncotx.org; Angie Torres; Lesa.Jurek@calhouncotx.org; Joel Behrens; Lynette.Adame@calhouncotx.org; Gary Reese; april.townsend@calhouncotx.org; peggy.hall@calhouncotx.org; cindy@texasfile.com; ladonna.thigpen@calhouncotx.org Subject: Jan 26, 2022 Meeting Minutes needing approval Attachments: D00012822.pdf Happy Friday! Please see attached meeting minutes needing approval for 1-26-22 Thanks! Kaddie Smith Deputy Clerk Commissioners' Court Calhoun Countv Clerk's Office 211 S Ann Street. Ste 102 Port Lavaca, Texas 77979 Phone:361.553.4417 Fax:361.553.4420 The information contained in this transmission may be strictly confidential. If you are not the intended recipient of this message, you are notified that you may not disclose, print, copy or disseminate this information. If you have received this transmission in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail may be a violation of criminal law. Calhoun County Texas Calhoun County Texas Richard H. Meyer County fudge David Hall, Commissioner, Precinct i Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, January 26, 2022, at 10:00 a.m. in the Commmussnoners' 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 chard H. Meyer, Co Judge Calhoun County, Texas Anna Goodman, County Clerk Deputy Clerk Page 1 of 1 NOTICE OF MEETING — 1/26/2022 Richard 1-1. Meyer County Judge David Hall, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Kaddie Smith, Deputy Clerk NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, January 26, 2022 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: 1. Call meeting to order, Meeting was called to order 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. N/A 5. Hear report from Memorial Medical Center. Roshanda Thomas gave the report. Page 1 of 4 NOTICE OF MEETING— 1/26/2022 6. Public Hearing regarding the abandonment and closure of right-of-way of a 0.884-acre portion of an undeveloped county road situated in Precinct #3 in Calhoun County, Texas. (RHM) Regular meeting was closed at 10:19. Donald Anderson spoke on matter. Regular meeting was opened at 10:32. 7. Consider and take necessary action to abandon and close a 0.884-acre portion of an undeveloped county road situated in Precinct # 3 in Calhoun County, Texas. (JB) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to accept proceeds in the amount of $531.40 for Texas Port Recycling for scrap metal and place funds in Precinct 3 Road & Bridge account 560-53510. (JB) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to authorize Commissioner Behrens to contract with Smartt Grant Services for oversight services for the Olivia Haterius Park Project and service cost in amount of $500.00 per calendar quarter, for total of $2,000.00 per year. (JB) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action on approval of Geigle's Utilities for Inspections agreement for public restroom septic system located at 865 N Ocean Drive and authorize Commissioner Hall to sign 1-year contract. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judqe Mever, Commissioner Hall, Lvssv, Behrens, Reese Page 2 of 4 NOTICE OF MEETING— 1/26/2022 11. Consider and take necessary action to declare the attached list of equipment from MMC as waste. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to declare the attached list of equipment from MMC as surplus. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to accept the Continuing Education Transcript from the Tax Assessor -Collector. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Accept Monthly Reports from the following County Offices: i. Tax Assessor/Collector — December 2021 RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judqe Mever, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action on any necessary budget adjustments. (RHM) 2021: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 2022: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 4 NOTICE OF MEETING — 1/26/2022 16. Approval of bills and payroll. (RHM) M MC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 2021 Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 2022 Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER- Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Adjourned: 10:41 a.m. Page 4 of 4 #6 NOTICE OF MEETING — 2/9/2022 6. Discuss with ADAPCO concerns regarding the bid specifications for the Mosquito Control Annual Supply Contract. (RHM) Cathy Russell with ADAPCO explained concerns with Vender packets. NO ACTION TAKEN. Page 3 of 14 s •00 •• azelis 000 January 25, 2022 Mr. Richard H. Meyer County Judge Calhoun County Courthouse 211 S. Ann St. 3rd Floor, Suite 301 Port Lavaca, TX 77979 til Oft ADAPCO' Preserving Public Health Email: Maebette.cassei@cathountcotx.org peggy.hall@calhouncotx.org cindy.muetter@cathouncotx.org Subject: Inquiry - Bid#2022.02 Insecticides for Mosquito Control Dear Judge Meyer, We are in receipt of Ms. Peggy Hall's letter explaining ADAPCO did not meet the bid specifications for the Mosquito Control Annual Supply Contract. First off, I would like to say that it is not ADAPCO's normal procedure, position, or desire to contest bids awarded by our valued customers. Upon seeing the results of this bid, however, we would like to ask for a reevaluation of the bid and the document in question that disqualified our entire bid. To clarify, the Disclosure of Lobbying Activities Form 0348-0046 was marked "ADAPCO, LLC - None" at the top of the form, but the form was not signed, though your specifications do say to sign. As we reviewed the form again, it goes against normal business practices to require a signature within a form that is not applicable. If the signature requirement was placed it a different area, such as above or below the questions on the form, the signature would make more sense. As a suggestion for future bids is it possible to have a separate signature line on the very top or very bottom of the form that designates a signature for Not Applicable? Please see the attached mock-up of the Disclosure for Lobbying Activities as a suggestion only. 2. We are the sole provider/distributor of a few of the products pack sizes on this bid that the end users prefer. Is there any possibility that the County Precincts could purchase off of a sole source letter? Example: Fyfanon ULV in 55 gallon drums and 260 gallon totes; please see sole source letter attached. 3. Is it possible to re-evaluate ADAPCO's bid due to the language in the bid that reads: Calhoun County reserves the right to waive any technicalities 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. Innovation through formulation ADAPCO 100 Colonial Center Parkway, Ste 170 Lake Mary, FL 32746 T 800 367 0659 azelis.com/us I myadapcoxom We do appreciate the enormous time and energy put forth by Calhoun County Purchasing in handling and administering these types of bids and contracts. We would appreciate the reevaluation of ADAPCO's bid submittal for this year's bid. We have been dedicated to serving the constituents of Calhoun County for over 30 years. We feel we have aligned our company to offer the highest level of service and support for your Mosquito Control Districts, as well as at the fairest prices. It might be well worth asking the Precinct end users if they agree. Please do not hesitate to contact us with any questions you have for the outcome of your decision on this action. We thank you for the opportunity to do business once again and we look forward to our continued partnership for many years to come. Should you have any questions or immediate needs, please contact Kathy Russell our Contract Manager or me at (407) 328-6519. Regards, Jason Trumbetta VP and General Manager Bid Related: Kathy Russell Contract Manager bids@mvadpaco.com Attachments: Mock-up of Disclosure of Lobbyist Activity Form ADAPCO/FMC Sole Source Letter for Fyfanon ULV ADAPCO T 800 367 0659 550 Aero Ln Sanford, FL 32771 azelis.com7us I nnyadapco.conn Approved by OMB ADAPCO, LLC - None 0348-0046 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 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 Formaterial 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, ffapplicable: S. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address iij (if individual, last name, first name, Ml): diffcrentfirnm Mo. 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: bythe 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) If Not Applicable, please check here and sign below. Vendor Name: Signature: Print Name: Title: Telephone: Date: aD FyfanoInsectln Date: January 1, 2022 To whom it may concern: fMC An Agricultural Sciences Company 2929 Walnut Street Philadelphia, PA 19104 This letter affirms that FMC Corporation is the sole manufacturer of the trademarked products Fyfanon® ULV Mosquito Insecticide and Fyfanon® EW Insecticide for the calendar year 2022. Fyfanon products are sold by FMC Authorized distributors only. ADAPCO, an Azelis company, Van Diest Supply Company and Veseris are Authorized distributors for the respective products in the defined territories below: Fyfanon® ULV MosquitoInsecticide (2.5-gal) United States and its territories AK, AL, AR, AZ, CT, DC, DE, FL, Fyfanon® ULV Mosquito Insecticide GA, HI, ID, IL, IN, KY, LA, MA, MD, (55-gal drums and,260-gal totes); ME, MI, MN, MS, NC, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX; UT, VA, VT, WA, WI, & WV �! a �� ? 005 all �. � - - ER � 4 � � �t.�tes �It Fyfanon® ULV Mosquito Insecticide (2.5-gal) United States and its territories Fyfanon® ULV Mosquito Insecticide CO, IA, KS, MO, MT, NE,'SD, ND, &- (55-gal drums and 260-gal totes) WY Fyfanon® ULV Mosquito Insecticide (2.5-gal, Bulk delivery) United States and its territories Fyfanon® ULV Mosquito Insecticide FL (55-gal drums and 260-gal totes) _ Please note that due to the sustained impact of the global pandemic, many of our input costs, including technical, raw materials, packaging and logistical costs have increased. As stated in in a previous letter, market letter price was increased by 5.0% on most Fyfanon ULV vector control products effective July 1, 2021. Furthermore, due to continued tightness in supply and pressure on costs, pricing will increase 5.0% on January 1, 2022. We wish you and your team continued success and safety throughout the 2022 season. Sincerely, Wendell Codner Wendell Codner Director, FMC Global Specialty Solutions — Consumer and Environmental Solutions Email: Wendel Lcodnerafmc.com ® FMC and Fyfanon are trademarks of FMC or an affiliate. 02021 FMC Corporation. All rights reserved. TO: Commissioners Court FROM: Auditor's Office RE: Commissioners Court, February 9, 2022 AGENDA ITEM #6 Attached please find copies of the Disclosure of Lobbying Activities Form that shows that ADAPCO failed to sign the form for the 2022 Bid Period but for the 2021 Bid Period ADAPCO marked the form "NA" and signed the form: 1. Disclosure of Lobbying Activities Form for 2022 Bid Period Marked at the top of the form - "ADAPCO, LLC — None" Was not signed as instructed in the Bid Specifications and Instructions 2. Disclosure of Lobbying Activities Form for 2021 Bid Period Marked "NA" and Signed as instructed in the Bid Specifications and Instructions For 2022 Bid Period 2 Bidders did not meet specifications forth following reasons.• 1. ADAPCD— Did not sign the Disclosure of Lobbying Activities Form 2. TARGET— Did not sign their Bid For 2021 Bid Period 1 Bidder did not meet specifications for the following reasons: 1. Target— Did not sign their Bid and Affidavit was not notarized For 2019 Bid Period 1 Bidder did not meet specifications for the following reason• 1. Univar— Form 1295 was not returned For 2018 Bid Period 2 Bidders did not meet specifications for the following reasons: 1. Clarke— Did not sign their Bid 2. Univar— Did not return a completed form 1295 For 2017 Bid Period 1 Bidder did not meet specifications for the following reason: 1. Clarke — Bid was received late (received a day after the due date of bids) For 2016 Bid Period —All Bidders met specifications Recommendation for future bids: When future Bid Specifications are brought before Commissioners Court for approval the following forms will be removed from the Bid Specifications: 1. Certification Regarding Debarment & Suspension and Other Responsibility Matters 2. Disclosure of Lobbying Activities 3. Residence Certification BUJ ADAPCO, LLC INSECTICIDES FOR MOSQUITO CONTROL ANNUAL SUPPLY CONTRACT t" BID NUMBER 2022.02 Beginning January 1, 2022 and Ending Delp bey' 31, 2022 4 r 'CAN �3. Approved by OMB ADAPCO, LLC - None 0348.0046 Disclosure of Lobbying Activities Complete this fort to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for nuhlic burden dkelmi,m) 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 lest 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 (if individual, last name, first name, Ml): dierentfmmNo. I0a) (last name, first name, M1): 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 510,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) RETURN INSTRUCTIONS Naf GO 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 syf a all necessaryforms 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 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 land sign znd date in Box 7. Whether or not a conflict exists determines the other information to include on the form. �ertification Regarding Debarment & Suspension and Other Responsibility Matters 't V Certification Regarding Lobbying f irr S Disclosure of Lobbying Activities — If Not Applicabi , bidder mu mark NA and sign and date House Bill 89 Verification t/ Residence Certification —TW-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, FedEx 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., 31d Floor, Suite 301 Port Lavaca, TX 77979 ADAPCO, LLC INSECTICIDES FOR MOSQUITO CONTROL ANNUAL SUPPLY CONTRACT BID NUMBER 2021.02 Beginning January 1, 2021 and Ending December 31, 2021 Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse foruublic burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: N/A a. contract a. bidlefler/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: Con ressional District, if ]mown: 6. Federal Department/Agency: 7. Federal Program Name(Description: CFDA Number, if applicable: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. individuals Performing Services (including address if (if individual, last name, first name, Ml): diiferentfrom 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: On TrUmt)etta by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: VP and Secretary U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: (407) 328-6519 Date.. 11/04/2020 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) RETURN INSTRUCTIONS For /�j Co LL (' Submitting a Bid for '� `" ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Bid Period: January 1, 2021 thru December 31, 2021 Bid Number: 2021-02 Return the following by 2:00 PM, TUESDAY, NOVEMBER 10, 2020 Check List for submitting vour Sid: Be lure all necessaryforms 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 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: Vendors Name, City, State and Country #2: Calhoun County, Texas #3: Bid Number: 2021-02; Insecticides for Mosquito Control, January 1, 2021 thru December 31, 2021 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 cut any information. This form does not need to be notarized. It is now an Unsworn Declaration. Form 1295 must be signed 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 Vendor and Order Information Form 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 2021.02 — Insecticides for Mosquito Control If you send your bid by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: Sealed Bid 2021.02 — Insecticides for Mosquito Control Submit Sealed Bid to: Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 RETURN INSTRUCTIONS Aclaf �0 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 sy e all necessaryforms 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 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. ::VCertification Regarding Debarment & Suspension and Other Responsibility Matters Certification Regarding Lobbying Disclosure of Lobbying Activities —If Not Applicabl , bidder mu 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, FedEx 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., 3`d Floor, Suite 301 Port Lavaca, TX 77979 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 land 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 SPe 5 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 INFORMATION/FORMS REQUIRED �; :I► 7jj) 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 CERTIM —rh:5 Poop 's in troy-,4- D-� 4-he -Urn') DISCLOSURE OF LOBBYING ACTIVITIES ® Complete and return this form with your bid ® If Not Applicable, bidder must 'ark NA and sign and date NOTICE OF MEETING — 2/9/2022 Consider and take necessary action to approve the Agreement between Calhoun County and Inmate Calling Solutions, LLC dba ICSolutions for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearly for one year terms upon Commissioners Court approval and authorize the County Judge to sign the agreement and any necessary forms. Form 1295 was submitted when the bid was awarded on October 27, 2021. (RHM) Sheriff Bobby Vickery explained agreement. 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 14 January 26, 2022 To: Judge Meyer From: The office of the County Auditor For the Calhoun County Adult Detention Center Please place the following item on the Commissioners Court Agenda for February 2, 2022: Consider and take necessary action to approve the Agreement between Calhoun County and Inmate Calling Solutions, LLC dba ICSolutions for Inmate Telephone Services and Inmate Banking Software, Commissary Service and Fiduciary Management Services for the Calhoun County Adult Detention Center for the two year period beginning February 15, 2022 and ending February 14, 2024 with the option to renew yearly for one year terms upon Commissioners Court approval and authorized the County Judge to sign the agreement and any necessary forms. Form 1295 was submitted when the bid was awarded on October 27, 2021. Inmate Telephone Services, Resident Banking Software, Commissary Services and Fiduciary Management Services Agreement This Inmate Telephone Services Agreement ("Agreement") is made by and between Inmate Calling Solutions, LLC, d/b/a ICSolutions ("ICS"), having its principal place of business at 2200 Danbury Street, San Antonio, TX 78217, and Calhoun County, Texas by and through the Calhoun County Adult Detention Center, a correctional institution in the State of Texas (the "County") having its principal address as set forth on Exhibit A, attached hereto. NOW, THEREFORE, intending to be bound, the parties agree as follows: 1. Term of Contract: This Agreement shall be effective on February 15, 2022 and shall remain in force and effect for an initial term of two (2) years. This Agreement shall renew for additional terms of one (1) year upon Commissioners Court approval, each upon the same terms and conditions as set forth herein. Either party may terminate this Agreement with sixty (60) day's prior written notice for any reason. Either party has immediate termination rights for cause based on an adverse economic change, beyond such party's reasonable control, that materially affects such party's rights or obligations hereunder. Upon termination of this Agreement, County shall immediately cease the use of any Equipment provided hereunder. 2. Service & Equipment: This Agreement applies to the provision of a) inmate telephone services by ICS; and b) commissary services by ICS through its affiliate, Keefe Commissary Network, Inc. ("KCN"); such services having been established under the Prior Agreement and using Equipment either centrally located or within space provided by the County at each of the "Service Locations" listed on Exhibit A, attached hereto. The term `Equipment" is defined herein as telephone sets, computer systems, software and related items, all as more fully described on Exhibit 13, attached hereto. All Equipment shall be installed by properly trained personnel and in a good, workmanlike manner. Any Equipment of ICS installed upon the premises owned, leased or otherwise under the supervision of County, shall remain in all respects the property of ICS. ICS reserves the right to remove or relocate any Equipment that is subjected to recurring vandalism or insufficient usage. ICS shall not exercise such right of removal or relocation unreasonably and, in any case with at least thirty (30) days prior notice to County. Upon removal of Equipment by ICS, ICS shall restore the premise to its original condition, ordinary wear and tear excepted. 3. Alteration and Attachments: County shall not make alterations or place any attachments to Equipment and Equipment shall not be moved, removed, rendered inoperable or unusable, or made inaccessible to inmates or users by County without the express written permission of ICS. 4. Training: ICS shall provide on -site training plus internet-based training at no cost to County. Additional training may be provided upon County's request based on availability of ICS. 5. Call Rates: ICS shall provide calling services to retail consumers at the rates and charges set forth on Exhibit C, attached hereto. ICS may permit certain consumers to be billed on a collect basis and reserves the right to establish thresholds for the level of any collect call credit to be allowed for such billed consumers. Rates and charges may be subject to change based on an order or rule of a regulatory authority having applicable jurisdiction. Page I of 12 6. Commissions to County: ICS will install, operate and maintain Equipment at no charge to County. ICS will pay County the commission amounts set forth on Exhibit D, attached hereto (collectively the "Commissions"), in consideration of the County granting ICS exclusive rights for the installation and operation of Equipment servicing the Service Locations. No Commissions shall be paid to County on amounts relating to taxes, regulatory surcharges such as universal service fund, or other fees and charges not applicable to the billed calls, except as expressly provided on Exhibit D. ICS will pay Commissions to County on a monthly basis on or before the first business day occurring forty five (45) days following the end of the month in which such Commissions are earned or accrued. Such Commissions shall be sent to the address designated by County or wired to an account designated in writing by County for such purpose. Each Commission payment to County shall be final and binding unless ICS receives written objection from County within ninety (90) days of County's receipt of such payment. The parties agree that all financial consideration for services hereunder is predicated on the rates and charges applicable at the time of execution and is, therefore, subject to adjustment based on any changes that may be required by any law, rule, tariff, order or policy (any of which, a "Regulatory Change") of, or governed by, a regulatory body having jurisdiction over the public communications contemplated herein. In the event that a Regulatory Change affects such rates and charges, the parties agree to enter into good faith negotiations to amend this Agreement in a manner that provides sufficient consideration to ICS for ongoing services, as well as complies with the Regulatory Change. If the parties cannot reach an agreement as to the amendment necessary within thirty (30) days of public notice of the Regulatory Change, then either party may terminate this Agreement with an additional sixty (60) days' prior written notice. County shall: a. Advise ICS of any Services Location or related premise that has been closed. b. Throughout the term of this Agreement, including any renewal terms, use ICS as its exclusive provider for all matters relating to inmate telecommunication services. c. Reasonably protect the Equipment against willful abuse and promptly report any damage, service failure or hazardous conditions to ICS. d. Provide necessary power and power source, at no cost to ICS, and an operating environment with reasonable cooling consistent with general office use. e. Provide suitable space and accessibility for inmates' use of telephone services. f. Permit ICS to display reasonable signs furnished by ICS and not affix or allow to be affixed any other signs, equipment or information to the Equipment. g. Permit reasonable access by ICS to County's Service Locations as reasonably necessary for ICS to install, support and maintain the Equipment. Jr. Be responsible for designating any required destination numbers as `do not record' to ensure privacy for, among other things, attorney client privilege calls, using system features designed for such purpose. Page 2 of 12 i. Comply with all federal, state and local statutes, rules, regulations, ordinances or codes governing or applicable to the telephone services offered by ICS. 8. Law and Venue: The domestic law of the State of Texas shall govern the construction, interpretation and performance of this Agreement and all transactions hereunder. All disputes hereunder shall be resolved exclusively in state or federal jurisdictions located in Calhoun County of Texas. 9. Notices: Any notice or demand required hereunder shall be given or made by mail, postage prepaid, addressed to the respective party at the address first set forth or referenced above unless otherwise communicated in writing. 10. Entire Agreement: The Agreement Documents consists of (1) This Agreement and all Attachments to the Agreement, (2) The Invitation to Bid Form, (3) Any attachments, if any, to the submitted Invitation to Bid Form, (4) Bid Specifications, (5) Calhoun County, Texas — General Conditions, and (6) ICS's Bid, in its entirety, and constitutes the entire Agreement between the parties and may not be modified or amended other than by a written instrument executed by both parties and approved by Calhoun County Commissioners Court. Any orders placed by County hereunder shall be incorporated herein by mutual consent of the parties and shall supplement but not supersede the provisions of this Agreement. The County represents and warrants that it has the legal authority to make decisions concerning the provisions of space for telephones placed by ICS at the Service Locations covered by this Agreement and that ICS may rely thereon. This Agreement supersedes any prior written or oral understanding between the parties. 11. Risk of Loss: ICS shall relieve County of all risk of loss or damage to Equipment during the periods of transportation and installation of the Equipment. However, County shall be responsible for any loss or damage to Equipment located on the premise caused by fault or negligence of County, its employees or others under County's supervision. 12. Default: In the event either party shall be in breach or default of any terms, conditions, or covenants of this Agreement and such breach or default shall continue for a period of thirty (30) days after the giving of written notice thereof by the other party, then, in addition to all other rights and remedies at law or in equity or otherwise, including recovering of attorney fees and court cost, the non -breaching party shall have the right to cancel this Agreement without charge or liability. The waiver of any default hereunder by either party shall not constitute, or be construed as, a waiver of any subsequent default. 13. Assignment: This Agreement may not be transferred or assigned, in whole or in part, by ICS to any parent, successor, subsidiary, or affiliate of ICS without prior written consent from Calhoun County Commissioners Court. ICS may not sub -contract any portion of its duties hereunder provided without prior written consent from Calhoun County Commissioners Court, however if approved by Calhoun County Commissioners Court, ICS shall remain at all times responsible for such sub -contracted duties. 14. Relationship: The parties hereto are independent contractors and this Agreement shall not be construed as a contract of agency or employment. Each party shall be solely responsible for compliance with all laws, rules and regulations and payment of all wages, unemployment, social security and any taxes applicable to such party's employees. Each party represents and warrants that: (a) it is duly organized, validly existing and in good standing under the laws of the jurisdiction Page 3 of 12 of its formation; (b) the execution, delivery and performance of this Agreement has been duly authorized by all necessary corporate actions; and (c) its performance hereunder shall be in compliance with applicable state and federal legal and regulatory requirements. 15. Indemnification: Each party shall indemnify, defend and hold harmless the other party from and against any and all claims, losses, injuries, or demands asserted by third parties (collectively "Claims") arising from the material breach, negligent acts or misconduct of such indemnifying party, its agents or employees, in the performance of any of its obligations hereunder. Except for the foregoing express indemnification, each party shall bear its own liability and costs of defense for any third -party claims. 16. Force Majeure: Either party may suspend all or part of its obligations hereunder and such party shall not otherwise be held responsible for any damages, delays or performance failures caused by acts of God, events of nature, civil disobedience, acts of government, military action, acts of terrorism, epidemics or similar events beyond the reasonable control of such party. 17. Severability: If any of the provisions of this Agreement shall be deemed invalid or unenforceable under the laws of the applicable jurisdiction, such invalidity or unenforceability shall not invalidate or render unenforceable the entire Agreement, but rather the entire Agreement shall be construed as if not containing the particular invalid or unenforceable provision or provisions, and the rights and obligations of ICS and County shall be construed and enforced accordingly. 18. Special ADA: ICS will install Equipment in accordance with the Americans with Disabilities Act and any related federal, state and local regulations in effect at the time of installation. ICS shall make any alterations to the Equipment as necessary for its correct operation and/or compliance with applicable laws at no cost to County. 19. Limitation of Liability: IN NO EVENT WILL EITHER PARTY BE LIABLE TO THE OTHER PARTY FOR ANY LOSS OF PROFITS, LOSS OF USE, LOSS OF GOODWILL, CONSEQUENTIAL, SPECIAL OR PUNITIVE DAMAGES REGARDLESS OF THE FORM OF ANY CLAIM, WHETHER IN CONTRACT OR IN TORT OR WHETHER FROM BREACH OF THIS AGREEMENT, IRRESPECTIVE OF WHETHER SUCH PARTY HAS BEEN ADVISED OR SHOULD BE AWARE OF THE POSSIBILITY OF SUCH DAMAGES. 20. Warranty: Subject to County's compliance with its obligations hereunder, Equipment shall be free from defects in workmanship and material, shall conform to ICS' published specifications in effect on the date of delivery or as otherwise proposed to County in writing, and shall not infringe any patent or trademark. This warranty shall continue while Equipment is in operation at each Service Location. County shall provide ICS with prompt written notification as to the specifics of any nonconformity or defect and ICS shall have a commercially reasonable timeframe to investigate such nonconformity or defect. As County's sole and exclusive remedy, ICS shall, at ICS' sole option and expense, either: (a) correct any nonconformities or defects which sub- stantially impair the functionality of the Equipment in accordance with the aforesaid specifications; (b) use reasonable efforts to provide a work -around for any reproducible nonconformities or defects which substantially impair the functionality of the Equipment in accordance with the aforesaid specifications; (c) replace such nonconforming or defective Equipment; or (d) promptly refund any amounts paid to ICS by County with respect to such nonconforming or defective Equipment upon ICS receipt of such nonconforming or defective Equipment. ICS does not warrant that the operation of the Equipment shall be uninterrupted or Page 4 of 12 error -free. No warranty is made with respect to the use of Equipment on or in connection with equipment or software not provided by ICS. Equipment may contain recycled, refurbished or remanufactured parts which are equivalent to new parts. ICS makes no warranties or representations that it will solve any problems or produce any specific results. EXCEPT AS EXPRESSLY PROVIDED HEREIN, THERE ARE NO OTHER EXPRESS OR IMPLIED WARRANTIES AND ICS HEREBY DISCLAIMS ANY OTHER WARRANTIES INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTIES OF MER- CHANTABILITY AND FITNESS FOR ANY PARTICULAR PURPOSE. THE FOREGOING SHALL BE THE SOLE AND EXCLUSIVE REMEDY WITH RESPECT TO NONCONFORMING OR DEFECTIVE EQUIPMENT AND SERVICES. NOTHING CONTAINED HEREIN SHALL OBLIGATE ICS TO ENHANCE OR MODIFY THE SERVICES OR EQUIPMENT BEYOND THE SUBSTANTIAL FUNCTIONALITY INTIALLY ACCEPTED BY FACILITY, WHICH ACCEPTANCE SHALL BE DEEMED TO HAVE OCURRED UPON THE GENERATION OF CALL REVENUE. 21. No Hire/No Solicit: During the term of this Agreement, and for a period of six (6) months thereafter, neither party shall solicit or hire the other party's employees, agents or representatives engaged by such party to perform work relating to this Agreement, without the express written consent of the other party. 22. Confidentiality: During the term of this Agreement, each party may disclose to the other certain proprietary information including, without limitation, trade secrets, know how, software, source code, techniques, future product plans, marketing plans, inventions, discoveries, improvements, financial data, business strategies and the terms of this Agreement (collectively, "Confidential Information") of a character identified by the disclosing party as confidential and that should reasonably have been understood by recipient, because of legends or markings, the circumstances of disclosure or the nature of the information itself, to be proprietary and confidential to the disclosing party. Each party and each of its employees or consultants to whom disclosure is made shall hold all Confidential Information in confidence, and shall not disclose such information to any third party or apply it to uses other than in connection with the performance of this Agreement. Each party shall use the same degree of care that it utilizes to protect its own information of a similar nature, but in any event not less than reasonable duty of care, to prevent the unauthorized use or disclosure of any Confidential Information. A recipient may not alter, decompile, disassemble, reverse engineer, or otherwise modify any Confidential Information received hereunder and the mingling of the Confidential Information with information of the recipient shall not affect the confidential nature or ownership of the same as provided hereunder. The obligations of this paragraph shall survive termination of this Agreement for a period of three (3) years. This Agreement shall impose no obligation of confidentiality upon a recipient with respect to any portion of the Confidential Information received hereunder which is: (a) now or hereafter, through no unauthorized act or failure to act on recipient's part, becomes generally known or available; (b) lawfully known to the recipient without an obligation of confidentiality at the time recipient receives the same from the disclosing party, as evidenced by written records; (c) hereafter lawfully furnished to the recipient by a third party without restriction on disclosure; or (d) independently developed by the recipient without use of the disclosing party's Confidential Information. Nothing in this Agreement shall prevent the receiving party from disclosing Confidential Information to the extent the receiving party is legally compelled to do so by any governmental or judicial agency having jurisdiction. Page 5 of 12 All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of information. ICS waives any obligation to the release to the public of any documents submitted in accordance with the Bid and Agreement. The entire submitted Bid and this Agreement and all attachments are considered public record. 23. License to Use Software: With respect to the Equipment provided under this Agreement, ICS hereby grants to County a nontransferable, nonexclusive license to install, store, load, execute, operate, utilize and display (collectively, "Use") the runtime versions of the software used in the performance of this Agreement including, where applicable to the purposes hereunder, such Use on computers owned by County. Such license is specific to the County and Service Location(s) for which the ICS Services are provided and may not be transferred other than through an authorized assignment of this Agreement. Upon the termination hereof, this license and all rights of County to Use the software will expire and terminate. County will not transform, decompile, reverse engineer, disassemble or in any way modify any of the software or otherwise determine or attempt to determine source code from executable code of any elements of the software. 24. Third Party Software: Third -party software licenses may be contained in certain software included with equipment and may therefore require a click -through acceptance by any users. Such software licenses are incorporated herein by reference and can be made available upon request. 25. Taxes: a. ICS shall pay any applicable taxes or fees accrued from Inmate calls to the appropriate entity, including the State of Texas (See submitted bid, Section 5 — Page 105 410 and Section 10 — Page 36). b. ICS shall pay all taxes. ICS remits all taxes on behalf of the County. (see submitted bid, Section 5 —Page 113 #22). c. Inmates shall be charged a cost that includes applicable tax on product prices and taxes shall be paid by ICS to the appropriate entity, including the State of Texas (See submitted bid, Section 10 — Page 37). d. ICS shall pay any applicable taxes or fees accrued from Commissary items to the appropriate entity, including the State of Texas (See submitted bid, Section 10 — Page 37). 26. Insurance. At all times during the Term of this Agreement, ICS shall maintain in effect the following types and amounts of insurance: a. General Liability Insurance: $1,000,000 per occurrence; $1,000,000 personal injury; $2,000,000 general aggregate; $2,000,000 products/completed operations. b. Commercial Automobile Liability: $1,000,000 Combined Single Limit. c. Workers' Compensation: ICS shall comply with all workers' compensation requirements for the jurisdictions in which employees/representatives perform applicable duties. ICS shall provide Calhoun County with certificates evidencing the above coverage amounts and the certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Page 6 of 12 IN WITNESS WHEREOF, the parties hereto have executed this Agreement by their duly authorized representatives on the dates set forth below, and represent and warrant that they have full authority to execute this Agreement on behalf of their respective parties: Inmate Calling Solutions, LLC d/b/a ICSolutions (Signature) Mike Kennedy (Printed Name) Vice President Sales & Marketing (Title) 2/2/2022 (Date) Calhoun County, Texas by and through the Calh n L�ounty Adult Detention Center (Signature) Richard H. Meyer (Printed Name) County Judge (Title) Z4'qIZZ (Date) Page 7 of 12 Exhibit A — County Addresses Principal Business Address (used for all notices hereunder): Calhoun County Attn: Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 Tel: 361-553-4600 Copy of all notices also sent to: Calhoun County Adult Detention Center Attn: Rachel Martinez, Jail Administrator 302 West Live Oak St. Port Lavaca, TX 77979 Calhoun County Sheriff Attn: Bobbie Vickery 211 S. Ann St., Suite 105 Port Lavaca, TX 77979 Calhoun County Auditor 202 S. Ann St., Suite B Port Lavaca, TX 77979 Facilities & Service Locations: Facility Name Service Locations Calhoun County Adult Detention Center 302 West Live Oak St., Port Lavaca, TX 77979 Equipment to be shipped to: Calhoun County Adult Detention Center 302 West Live Oak St., Port Lavaca, TX 77979 Commissions to be paid to: Calhoun County Attn: Rachel Martinez, Jail Administrator 302 West Live Oak St., Port Lavaca, TX 77979 Page 8 of 12 Exhibit B — Equipment & Services THE ENFORCER® Inmate Calling Platform, centralized in ICS' Atlanta data center and backed up at its headquarters in San Antonio, TX, along with: • Continued & uninterrupted access to all historical call detail records & call recordings • Continued & uninterrupted access to all historical investigative results & case notes • 14 stainless steel inmate telephones • 3 cart phones • 10 visitation phones, wired to THE ENFORCER® for monitoring & recording • 1 booking phone • 1 TDD/TTY and/or VRS device for hearing impaired inmates • 1 master control / monitoring workstation with printer • Online storage of all call recordings and call data for the entire contract duration • Long-term recording storage of visitation sessions • Unlimited ENFORCER® user licenses • JMS and KCN commissary / banking interfaces to enable: o DIRECTLINK TRusTTM Debit Calling o Automated inmate ID/PINS o Electronic commissary ordering • Inmate voicemail messaging • 24 x 7 x 365 live, U.S.-based service for Facility staff & called parties • Local technicians to provide onsite maintenance & support • Initial and ongoing training for all Facility users • All-inclusive warranty, support, and repair/replace maintenance package o Backup supply of inmate phones (3) maintained onsite to expedite phone repairs o Optional repair stipend when County staff wish to perform onsite phone replacement THE ENFORCER® Investigative & Voice Biometrics Suite • THE WORD DETECTORTM keyword search toolset • THE ANALYZERTM link analysis / data mining tools • THE VERIFIERTM pre -call inmate voice verification o Features automatic voice enrollment • THE IMPOSTERTM in -call continuous voice biometrics THE ENFORCER® IVR Suite • THE INFORMERTM PREA module • THE COMMUNICATORTM paperless inmate communications portal • THE ATTENDANTm automated information line THE BR[OGETM 8 Video Visitation -Enabled Inmate Tablets • Tablets with 8" screens (1 tablet for every 2 inmates) • Wireless charging carts to make charging easy, reduce breakage, and minimize wiring • Inmate Calling app — enables secure inmate calling through ICS' ENFORCER® platform; standard usage rates and security controls apply • Wall -mounted tablet cradles to support video visitation o Remote visitation, with bandwidth provided by ICS o Visits may be scheduled or on demand Page 9 of 12 • Inmate email messaging • Educational content, including free, unlimited access to the EdovoTm educational platform • Religious materials • Job search • Law library research • Entertainment content • Grievance reporting + appointment request • Access to scanned postal mail (when deployed) • Optional video messaging • Turnkey installation including all hardware, software, & charging stations CasemakerTM Law Library • Accessible via THE BRIDGE 8 Tablets • Simple and complex searching of Federal and State case law, statutes, and administrative law • Updated daily by experienced legal editors Optional Mail Scanning • Offsite and/or onsite scanning of non -legal postal mail (Offsite affects Commissions on Tablet usage — See Exhibit D) • Delivered to inmates via THE BRIDGE 8 inmate tablets Page 10 of 12 Exhibit C — Rates & Charges The following rates apply to calls from all Service Locations: ........._. Prepaid, Debit, QwikcallTM & Direct Bill Calling Rates Call Type Per Minute Per Minute Charae Local $0.21 Intrastate/IntraLATA $0.21 Intrastate/InterLATA $0.21 Interstate $0.21 International (Debit only) $0.24 NOTES: Domestic interstate rates apply for calls to U.S. territories including American Samoa, Guam, Northern Mariana Islands, Puerto Rico and U.S. Virgin Islands. All non-U.S. destinations are rated as international. International rate will be reduced to comply with the latest FCC regulations (See submitted bid, Section 11—Page 2). Call rates shown do not include local, county, state and federal taxes, regulatory fees and billing fees. Call rates do include an FCC authorized commission recovery of $0.02per minute. Billing Fees (non-commissionable): Payment Processing Fee (Live Agent) ......................... $5.95 Payment Processing Fee (IVR, Internet) ..................... $3.00 Direct Billing Statement Fee ..................................... $0.00 Other Service Fees (commissionable, see Exhibit D): Inmate voicemail (per inbound message) ..................... $1.00 Email/Text Messaging (per message/photo).................. $0.25 Tablet Entertainment Streaming (per minute) ............... $0.05 Remote Video Visitation via Tablets (per minute).......... $0.25 Video Messaging (per inbound message) ..................... $0.35 (All other fees free or waived) Page 11 of 12 Exhibit D — Commissions ICS shall pay to County a Commission of 85% of the gross call revenue for all call types generated from County's Service Locations. ICS shall also pay to County a Commission of 50% of any service fees collected with respect to Inmate Voicemail and 25% of any service fees collected with respect to Tablet usage. In the event that County deploys the optional off -site mail scanning, then the commission on Tablet usage shall exclude email/text message service fees. The foregoing Commissions shall be subject to a monthly minimum guarantee of $6,700.00. ICS shall cause KCN to pay to County a Commission of 36% of the revenue collected from commissary sales. The foregoing Commission shall be subject to a monthly minimum guarantee of $2,300.00. ICS shall also pay to County, promptly upon full execution hereof, a one-time Commission bonus of $25,000.00. Note: Commissions shall be made payable and sent to the address so designated on Exhibit A to this Agreement. Page 12 of 12 0 NOTICE OF MEETING — 2/9/2022 8. Enter Continuing Education hours for County Clerk, Anna Goodman, into the official record. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 5 of 14 i o U v E 4-0 a O o O U v O ` E l n 4-J C o V o C6 U v U 4— L Q O U 76 U Conference Detail for Anna Goodman For certificate 2021 CE Hours Certificate- PH 21 ce Welcome, Opening - Stacey Kemp, CDCAT President, Collin County Clerk Media Relations' -Leslie Rhode, Communications Consultant 02/02/2021 9:00 AM 9 15 AM 016 Escheating Funds - Sheri Woodfm, Court Consultant, OCA 02/02/2021 02/0212021 91$,AM '10:;15 AM 10:30 AM 12:00 PM 1:00 1.30 Adobe Tool's: Tips and Tricks - Isabel Garciai Founder and Owner, Double,Citck 02/02/202, Trainers i e-File - Tracy Hopper, Harris County Assistant Director for IT CJIS/NICS Reporting - Craig Lopez, CJIS Auditor III, IO2%02l2021 02/02/2021 2:25 PM 3 25 PM 1 00 TXDPS 3;3SPM '4:50f�M Total for 2021 Virtual CDCAT Winter Conference: 6:00 Tonal Updates on the 2021 Legislative Session - Craig Hopper and Hon. Guy Herman 03/12/2021 8:45 AM - 9:45 AM 1:00 Heirship Proceedings & Small Estate Affidavits - Clint Alexander ' 03/12/2021 9:55.AM -1170 qM 15T5 Attorneys Fees in Probate Court- Hon. Guy Hermon, Travis County Probate 03/12/2021 11:15 AM -12:00 PM 0:45 Court No. 1 Total for Texas College of Probate Judges Regional Workshop: 3:00 Cybarsecurity in the Real World What's Your Bounce Factor? Learn to Thrive in Uncertain Times 04/08/2021 &00 AM 10 30!,AM 1 30 Business Meeting 04/08/2021 04Id8j2021 . 10:30 AM -11:30 AM 1:00 11,00 RM -,12 0MM Total for CDCAT Region VIII Spring Meeting: 3:00 Rules of the Road + Tabs Opaning a Safety Deposit Box Citations Subsequent Filings & Commission to. Take Depositions Foreign Wills Bey6i[!8e6`5ion Professor Gerry Beyer Rules of the Road Guardianships + Tabs Te1WpdI`6ry Guardianships Subsequent Filings AnnuatReporta; Annual Accounts & Letters Transfers In and Out Registryof the Court Reports Wllsrb'r Safekeeping Appeals Legislative Introduction of Retired Clerks, Regional Directors, Past Presidents;, Ratiress,;` Spopsors , Business Meeting Keynote:CourthoUse Security -Active Shooter Part 1 Keynote, Courthouse Security -Active Shooter Part 2 Breakout County: Recording and Indexing; Breakout County: DBA/UCC/Commissioners Court -Standing Up for Yourself Legislative Discussion Total for 2021 TAC Probate Academy: 14:30 Printed 01/13/2022 10:11:10 Conference Detail for Anna Goodman For certificate 2021 CE Hours Certificate- PH 21 Roundtable Discussions: CoUnty/Disttict/Combo Public Records Posting Requirements: Physical & Virtual 'Open Records and Redactions Closjng & Adjourn 06/ b/2021 10 45 AM =i Total for CDCAT 126th Annual Conference: 15:00 Total credits for period: 41:30 Panted 01/13/2022 10:11:18 #9 NOTICE OF MEETING — 2/9/2022 9. Consider and take necessary action to accept the 2021 Racial Profiling report that was submitted to the State to be in compliance with TCOLE requirements. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 6 of 14 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: RICHARD MEYER, COUNTY JUDGE SUBJECT: 2021 Racial Profiling Report DATE: FEBRUARY 9, 2022 Please place the following items) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR FEBRUARY 9 ,2022 Consider and take necessary action to accept the 2021 Racial Profiling report that was submitted to the State to be in compliance with TCOLE requirements. Sincerely, Bob a Vickery Calhoun County Sheriff Racial Profiling Report I Full Agency Name: CALHOUN CO. SHERIFF'S OFFICE Reporting Date: O1/27/2022 TCOLE Agency Number: 057100 Chief Administrator: BOBBIE J. VICKERY Agency Contact Information: Phone: (361) 553-4646 Email: Bobbie.Vickery@calhoimcotx.org Mailing Address: 211 S. ANN ST. PORT LAVACA, TX 77979-4297 This Agency filed a full report CALHOUN CO. SHERIFF'S OFFICE has adopted a detailed written policy on racial profiling. Our policy: 1) clearly defines acts constituting racial profiling; 2) strictly prohibits peace officers employed by the CALHOUN CO. SHERIFF'S OFFICE from engaging in racial profiling; 3) implements a process by which an individual may file a complaint with the CALHOUN CO. SHERIFF'S OFFICE if the individual believes that a peace officer employed by the CALHOUN CO, SHERIFF'S OFFICE has engaged in racial profiling with respect to the individual; 4) provides public education relating to the agency's complaint process; 5) requires appropriate corrective action to be taken against a peace officer employed by the CALHOUN CO. SHERIFF'S OFFICE who, after an investigation, is shown to have engaged in racial profiling in violation of the CALHOUN CO. SHERIFF'S OFFICE policy; 6) requires collection of information relating to motor vehicle stops in which a warning or citation is issued and to arrests made as a result of those stops, including information relating to: a. the race or ethnicity of the individual detained; b. whether a search was conducted and, if so, whether the individual detained consented to the search; c. whether the peace officer knew the race or ethnicity of the individual detained before detaining that individual; d. whether the peace officer used physical force that resulted in bodily injury during the stop; e. the location of the stop; f. the reason for the stop. 7) requires the chief administrator of the agency, regardless of whether the administrator is elected, employed, or appointed, to submit an annual report of the information collected under Subdivision (6) to: a, the Commission on Law Enforcement; and b. the governing body of each county or municipality served by the agency, if the agency is an agency of a county, municipality, or other political subdivision of the state. The CALHOUN CO. SHERIFF'S OFFICE has satisfied the statutory data audit requirements as prescribed in Article 1 of 9 2.133(c), Code of Criminal Procedure during the reporting period. Executed by: Johnny Krause Chief Deputy Date: 01/27/2022 2 of Motor Vehicle Racial Profiling Information Total stops: 7578 Street address or approximate location of the stop City street 528 US highway 742 County road 1820 State highway 4486 Private property or other 2 Was race or ethnicity known prior to stop? Yes 321 No 7257 Race / Ethnicity Alaska Native / American Indian 17 Asian / Pacific Islander 115 Black 325 White 3689 Hispanic / Latino 3432 Gender Female 1802 Alaska Native / American Indian 3 Asian I Pacific Islander 23 Black 65 White 1017 —_ --Hispanic -/ Latino— --- ---.__.----694 Male 5776 Alaska Native I American Indian 14 Asian / Pacific Islander 92 Black 260 White 2672 Hispanic / Latino 2738 Reason for stop? Violation of law 227 Alaska Native / American Indian 0 Asian / Pacific Islander 4 Black 10 White 109 3 of Hispanic / Latino 104 Preexisting knowledge 77 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 2 White 46 Hispanic / Latino 29 Moving traffic violation 6398 Alaska Native / American Indian 16 Asian / Pacific Islander 102 Black 273 White 3086 Hispanic / Latino 2921 Vehicle traffic violation 876 Alaska Native / American Indian 1 Asian / Pacific Islander 9 Black 40 White 448 Hispanic / Latino 378 Was a search conducted? Yes 245 Alaska Native / American Indian 0 Asian / Pacific Islander 2 Black 16 White 116 -..... ........ ..:---- No 7333 Alaska Native / American Indian 17 Asian / Pacific Islander 113 Black 309 White 3573 Hispanic / Latino 3320 Reason for Search? Consent 64 Alaska Native / American Indian 0 Asian / Pacific Islander 1 Black 4 White 28 4of9 Hispanic / Latino 31 Contraband 34 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 0 White 14 Hispanic / Latino 20 Probable 124 Alaska Native / American Indian 0 Asian / Pacific Islander 1 Black 11 White 59 Hispanic / Latino 53 Inventory 20 Alaska Native I American Indian 0 Asian / Pacific Islander 0 Black 1 White 13 Hispanic / Latino 6 Incident to arrest 3 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 0 White 2 Hispanic / Latina 1 Was Contraband discovered? Alaska Native / American Indian 0 Asian / Pacific Islander 1 Black 7 White 59 Hispanic / Latino 59 No 119 Alaska Native / American Indian 0 Asian / Pacific Islander 1 Black 9 White 57 Hispanic / Latino 52 --- Dird t -e finding result tn -7arT'est? (total should equal previous column) Yes 0 No 0 Yes 0 No 1 Yes 0 No 7 Yes 10 No 49 Yes 14 No 45 5 Of Description of contraband Drugs 99 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 8 White 49 Hispanic / Latino 42 Weapons 7 Alaska Native I American Indian 0 Asian I Pacific Islander 0 Black 1 White 4 Hispanic / Latino 2 Currency 1 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 0 White 1 Hispanic / Latino 0 Alcohol 47 Alaska Native / American Indian 0 Asian / Pacific Islander 1 Black 1 White 20 Hispanic / Latino 25 Stolen property 0 Alaska Native / American Indian 0 Asian I Pacific Islander 0 Black 0 White 0 Hispanic / Latino 0 Other 21 Alaska Native / American Indian 0 Asian I Pacific Islander 1 Black 1 White 9 Hispanic / Latino 10 Result of the stop Verbal warning 598 6of9 Alaska Native / American Indian 2 Asian / Pacific Islander 9 Black 18 White 416 Hispanic / Latino 153 Written warning 5095 Alaska Native / American Indian 9 Asian / Pacific Islander 75 Black 228 White 2529 Hispanic / Latino 2254 Citation 1737 Alaska Native / American Indian 5 Asian / Pacific Islander 30 Black 73 White 684 Hispanic / Latino 945 Written warning and arrest 122 Alaska Native / American Indian 0 Asian / Pacific Islander 1 Black 5 White 45 Hispanic / Latino 71 Citation and arrest 22 Alaska Native / American Indian 1 Asian I Pacific Islander 0 Black 1 White 11 Hispanic / Latino 9 Arrest 4 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 0 White 4 Hispanic / Latino 0 Arrest based on Violation of Penal Code 40 Alaska Native I American Indian 0 Asian I Pacific Islander 0 7 of Black 3 White 22 Hispanic / Latino 15 Violation of Traffic Law 42 Alaska Native / American Indian 1 Asian / Pacific Islander 0 Black 1 White 16 Hispanic / Latino 24 Violation of City Ordinance 0 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 0 White 0 Hispanic / Latino 0 Outstanding Warrant 66 Alaska Native / American Indian 0 Asian / Pacific Islander 1 Black 2 White 22 Hispanic / Latino 41 Was physical force resulting in bodily injury used during stop? Yes 3 Alaska Native / American Indian 0 Asian / Pacific Islander 0 Black 0 White Hispanic / Latino Resulting in Bodily Injury To: Suspect Officer Both No Alaska Native / American Indian Asian / Pacific Islander Black White Hispanic / Latino 2 1 2 0 7576 17 115 325 3688 3430 8of9 Number of complaints of racial profiling Total 0 Resulted in disciplinary action 0 Did not result in disciplinary action 0 Comparative Analysis Use TCOLE's auto generated analysis Use Department's submitted analysis Optional Narrative NIA Submitted electronically to the I The Texas Commission on Law Enforcement Racial Profiling Analysis Report CALHOUN CO. SHERIFF'S OFFICE 01. Total Traffic Stops: 7578 02. Location of Stop: a. City Street 528 6.97% b. US Highway 742 9.79% c. County Road 1820 24.02% — ---------- d. State Highway 4486 --59.20% e. Private Property or Other 2 0.03% 03. Was Race known prior to Stop: a. NO 7257 95.76% b. YES 321 4.24% 04. Race or Ethnicity: a. Alaska/ Native American/ Indian 17 0.22% b. Asian/ Pacific Islander 115 1.52% c. Black 325 4,29% d. White 3689 48.68% e. Hispanic/ Latino 3432 45.29% 05. Gender:-----. --- --- a. Female 1802 23.78% i. Alaska/ Native American/ Indian 3 0.04% ii. Asian/ Pacific Islander 23 0.30% iii. Black 65 0.86% iv. White 1017 13.42% v. Hispanic/ Latino 694 9.16% b. Male 5776 76.22% i. Alaska/ Native American/ Indian ............ . 14 0.18% ii, Asian/ Pacific Islander 92 1.21% iii. Black 260 3.43% iv. White 2672 35.26% v. Hispanic/ Latino 2738 36.13% 06. Reason for Stop: a. Violation of Law 227 3.00% 1. Alaska/ Native American/ Indian 0 0.00% ii. Asian/ Pacific Islander 4 1.76% 1/27/2022 1 of 7 Racial Profiling Analysis Report ill. Black 10 v. Hispanic/ Latino 29 37.66% c. Moving Traffic Violation 6398 84,43% I. Alaska/ Native American/ Indian 16 0,25% ii. Asian/ Pacific Islander 102 1.59% iii. Black ., a. 273 _ 4.27/0 iv. White 3086 48.23% v. Hispanic/ Latino 2921 45.65% d. Vehicle Traffic Violation 876 11.56% i. Alaska/ Native American/ Indian 1 0.11% H. Asian/ Pacific Islander 9 1.03% iii. Black _._...—._ ..-........ .— ..... 40 4.57% iv. White 448 51.14% v. Hispanic/ Latino 378 43.15% 07. Was a Search Conducted: 08. Reason for Search: _.Searcch:h: -. a. Consent 7333---------96:77%---------... 17 0.23% 113 1.54% 309 4.21 % 3573 ---....----- 48.72%—.._...... .............. - ... 3320 45.27% 245 3.23% 0 0.00% 2 0.82% _45.31%....-.- ._. 1-11_...,-... 64 0.84% 1/27/2022 2 of 7 Racial Profiling Analysis Report I. Alaska/ Native American/ Indian 0 0.00% ii. Asian/ Pacific Islander 1 1.56% iii. Black 4 6.25% iv White 28 43.75% v. Hispanic/ Latino 31 48.44% b. Contraband in Plain View 34 0,45% I. Alaska/Netive American/ Indian 0 0.00% ii. Asian/ Pacific Islander 0 0.00% -.-iii. Black 0 iv- White 14 41.18% v. Hispanic/ Latino 20 58.82% c. Probable Cause 124 1.64% ii. Alaska/ Native American/ Indian - n...-..._........�.vo.._,,..,__- W._ .z._,-..-.._.3,.,,..�.,.,.�._....�... -_ -.-,_ 0 0.00% .._..__-.. i. Asian/ Pacific Islander - - ,1.�.._-._.e,w...0 .._— ..__._ _. .81 % iii. Black 11 a .87% iv. White 59 47.58% v. Hispanic/ Latino 53 42.74% d.Inventory 20 0.26% I. Alaska/ Native American/ Indian 0 0,00% ii. Asian/ Pacific Islander 0 0.00% iii. Black 1 5.00% iv. White 13 65.00% v. Hispanic/ Latino 6 30.00% e. Incident to Arrest ....._..,._.... - 3 0.04% I. Alaska/ Native Amencan/Indian 0 0.00% ii. Asian/ Pacific Islander 0 iii. Black 0 0.00% iv. White 2 66.67% v. Hispanic/ Latino 1 33.33% 126 1.66% 0 0 00% 0 0 ................. 1 7 5,56% 1/27/2022 3 of 7 Racial Profiling Analysis Report Finding resulted in arrest - YES 0 Finding resulted in arrest - NO 7 iv. White 59 46.83% Finding resulted in arrest - YES 10 Finding resulted in arrest - NO 49 v. Hispanic/ Finding resulted in arrest - YES Finding resulted in arrest - NO 45 b. NO 119 1.57% I. Alaska/ Native American/ Indian 0 1. Asian/ Pacific Islander --.1... --0.84% iii. Black . .. . ........ . 9 7.56% iv. White 57 47.90% v. Hispanic/ Latino 52 43.70% 10. Description of Contraband a. Drugs 99 1.31% 1. Alaska/ Native American/ Indian 0 0.00% ii. Asian/ Pacific Islander 0 0.00% 11i. Black 8 8,08% v. White 49 49A9% v. Hispanic/ Latino 42 42.42% b. Currency 1 0.01% i. Alaska/ Native American/ Indian 0 0.00% ii. Asian/ Pacific Islander 0 0.00% —iii—.131—ack- ....... . ..... -------- — --------- ------- -0--- , 0:00%- . ..... ........... . iv. White --- — ------- 1 — 100,00% -------- v. Hispanic/ Latino 0 0.00% .......... c. Weapons -- -- --------- 7 0.09% I. Alaska/ Native American/ Indian 0 0.00% ji. Asian/ Pacific Islander 0 0.00% Ill. Black 1 14.29% ... iv. White .. . 4 ...... . ....... 57.14% v. Hispanic/ Latino .... ------ 2 28.57% d. Alcohol 47 0.62% i. Alaska/ Native American/ Indian . . ............ . ...... ...... . - . . .. ...... — .... ... ...... 0 0.00% ii. Asian/ Pacific Islander 1 2.13% iii. Black 1 ------------ 2,13% iv. White 20 42.55% 1/27/2022 4 of 7 Racial Profiling Analysis Report v. Hispanic/ Latino e. Stolen Property i. Alaska/ Native American/ Indian ii. Asian/ Pacific Islander .--. -1— 1.-,-----,--,--- iii. Black iv. White v. Hispanic/ Latino f. Other i. Alaska/ Native American/ Indian i. Asian/ Pacific Islander iii. Black iv. White v. Hispanic/ Latino v. HisDanic/ Latino 25 53.19% 0 0.00% 0 0 0 0 0 LL 21 0.28% 0 0.00% 1 4.76% 1 4.76% 9 42.86% 10 47.62% 598 7.89% 2 0.33% 9 1.51% 18 3,01% 153 25.59% 5095 67.23% 9 0.18% 75 228 4.47% . .......... ----Z529-- ......... .. ---49:6-40/c� 2254 44.24% 1737 22.92% 5 0.29% 30 1.73% 73 4.20% 684 39.38% 945 54.40% 122 1,61% 0 0.00% 1 0.82% 5 4.10% -- — - --------- 45 . ... ...... .. ..... .... 36.89% -.— ........ 71 58.20% 1/27/2022 5 of 7 Racial Profiling Analysis Report e. Citation and Arrest i. Alaska/ Native American/ Indian lii. Asian/ Pacific Islander FViii. Black____.m....�..-w..._�d.__._..,... ..._..ck -...., — _ _....... iv. White v. Hispanic/ Latino ..f. Arrest........___._ ..............__ m-. _w._.s.m.m.. i. Alaska/ Native American/ Indian ii. Asian/ Pacific Islander iii. Black iv. White v. Hispanic/Latino 12. Arrest Based On: a. Violation of Penal Code µ _ �i. Alaska/ Native American/ Indian ii. Asian/ Pacific Islander iii. Black—__.-,-_..__.._..r_,......,....H. iv. White 22 0.29% 1 _0 4.55% 0.00% 1. _._.4,555% 11 ~— u 50.00% 9 40.91% 4,..__m...__. 0.05% 0 T 0.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 40 0,53% 3 7.50% 22 55.00% 15 37.50% 42 0.55% 0 0.00% 1 2,38% 24 57-14% 0 0.00% 0 0 ---......... --........... ..... — 0 0 .......... 0 _.-..... 66 0 87% ...._r 0 0.00% 1 1.52% _... _......... ......_..,.._............_._._...._--____........_...__.... _.._.._ _.._ .. _.. 22 33,33% 41 62.12% 1/27/2022 6 of 7 Racial Profiling Analysis Report 13. Was Physical Force Used: a. NO 7575 99.96% i. Alaska/ Native American/ Indian 17 0,22% ii. Asian/ Pacific Islander 115 1.52% iii. Black----- 325 .4.29% iv. White 3688 48.69% v. Hispanic/ Latino 3430 45.28% b. YES 3 0.04% i. Alaska/ Native American/ Indian 0 0.00% ii. Asian/ Pacific Islander 0____. 0.00.% iii. Black-___., . ...... . .. 0 0.00% iv. White 1 33.33% v. Hispanic/ Latino 2 66.67% b 1. YES: Physical Force Resulting in Bodily Injury to Suspect 1 33.33% b 2. YES: Physical Force Resulting in Bodily Injury to Officer 2 66.67% b 3. YES: Physical Force Resulting in Bodily Injury to Both 0 0.00% 14. Total Number of Racial Profiling Complaints Received: REPORT DATE COMPILED 01/27/2022 A I 1/27/2022 7 of 7 #10 NOTICE OF MEETING — 2/9/2022 10. Consider and take necessary action to authorize the CCEMS Director to sign a Field Internship Affiliation Agreement between CCEMS and the School of EMS. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 7 of 14 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Tuesday, February 1, 2022 11:14 AM To: Mae Belle Cassel Cc: Lori McDowell Subject: Fwd: RE: RE: [EX] Clinical Internship Attachments: School of EMS Affiliation Agreement_CCEMS_2022.docx.pdf Mae Belle, I hope you are having a great day! Please find attached a Field Internship Affiliation Agreement between CCEMS and the School of EMS to be placed on the next Commissioners Court agenda for approval to sign. 1295 to follow. Thanks, Dustin From: "VGLAMAY@schoolofems.org (Vicky LaMay)" <VGLAMAY@schoolofems.org> To: Dustin Jenkins <Dustin.Jenkins@calhouncotx.org>, Lori McDowell <Lori.McDowell@calhouncotx.org> Date: Mon, 31 Jan 2022 20:02:50 +0000 Subject: RE: RE: [EX] Clinical Internship CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Hello, I have attached the document with the School's signatures. Please let me know if this will work. Thank you, Vicky LaMay Director of Clinical Services School of EMS 115 Jordan Plaza Blvd, Suite 200 Tyler, Texas 75704 Main: 888-390-5081 1 Cell: 903-399-1463 valamay(cbschoolofems.org I https://schoolofems.org 4 Eta SCHOOL OF moos EMS From: Dustin Jenkins<Dustin.Jenkins@calhouncotx.org> Sent: Thursday, January 27, 2022 12:26 PM To: Lori McDowell <Lori.McDowelI@calhouncotx.org> Cc: Vicky LaMay <VGLAMAY@schoolofems.org> Subject: Fwd: RE: [EX] Clinical Internship Lori, Before we can send this to Commissioners Court, it will require signatures from the signatory parties with "The School of EMS". I have filled out the information needed in the Affiliation Agreement attached to this email. If they could sign anc send us a scanned copy, I will then forward to Commissioners Court for approval to sign. Thanks, J. Dustin Jenkins, DMin, MBA, MTh, LP Director of EMS Calhoun County, TX From: "Lori.McDowell@calhouncotx.org (Lori McDowell)" <Lori.McDowell @caIhouncotx.org> To: "Dustin Jenkins" <Dustin.Jenkins(.acalhouncotx.org> Date: Wed, 19 Jan 2022 15:02:03 -0600 Subject: Fwd: RE: [EX] Clinical Internship Lori McDowell, BS, LP, EMS Coordinator, CADS Assistant EMS Director Calhoun County EMS 705 Henry Barber Way Port Lavaca, TX 77979 (361)552-1140 lori. mcdowellOcalhou ncotx.org CONFIDENTIALITY NOTICE: The contents of this email message and any attachments are intended solely for the addressee(s) and may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message or their agent, or if this message has been addressed to you in error, please immediately alert the sender by reply email and then delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited. From: "VGLAMAYCalschoolofems.org (Vicky LaMay)" <VGLAMAYcaschoolofems.org> To: Lori McDowell<Lori.McDowellClacalhouncobcorg> Date: Wed, 19 ]an 2022 18:59:29 +0000 Subject: RE: [EX] Clinical Internship CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you Hello Lori, I appreciate you reaching out to help Joe with his ride -outs. Attached you will find our Standard Affiliation Agreement, which we can deploy via DocuSign if the verbiage is approved or we can review and sign your site specific paperwork. I have also attached our Letter of Accreditation. You can find our Institutional Catalogue and Clinical Handbook at the following website. htti)s://schoolofems.org/catalog htti)s://www.schoolofems.org/clinicals/ Please let me know if you will need any additional information. Vicky LaMay Director of Clinical Services School of EMS 115 Jordan Plaza Blvd, Suite 200 Tyler, Texas 75704 Main: 888-390-5081 1 Cell: 903-399-1463 vglamayCalschoolofems.org I https://schoolofems.orci 4 I KHOOL OF r°° EMS From: Lori McDowell <Lori. McDowellCalcalhouncotx.org> Sent: Wednesday, January 19, 2022 9:29 AM To: Vicky LaMay <VGLAMAY(cbschoolofems.org> Subject: [EX] Clinical Internship CAUTION: this email originated from outside of the organization. Do not click links or open attachments unless you recognrze_the sender and know the content is safe. Hi Vicky, We have Joe Robert Perez that is interested in doing his paramedic with you guys, so we definitely would like to set up a clinical internship agreement with your company. How do we proceed? Thanks, Lori McDowell, BS, LP, EMS Coordinator, CADS Assistant EMS Director Calhoun County EMS 705 Henry Barber Way Port Lavaca, TX 77979 (361) 552-1140 loci.mcdowell(&calhouncotx.org CONFIDENTIALITY NOTICE: The contents of this email message and any attachments are intended solely for the addressee(s) and may contain confidential and/or privileged information and may be legally protected from disclosure. If you are not the intended recipient of this message or their agent, or if this message has been addressed to you in error, please immediately alert the sender by reply email and then delete this message and any attachments. If you are not the intended recipient, you are hereby notified that any use, dissemination, copying, or storage of this message or its attachments is strictly prohibited. Calhoun County Texas Calhoun County Texas J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX d usti n.jenki ns@cal houncotx.org (361) 571-0014 Calhoun County Texas J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org (361)571-0014 Calhoun County Texas DocuSign Envelope ID: 78858058-1348451 C-9F132-4360CM571392 4) SCHOOL OF SUN EMS CLINICAL AFFILIATION AGREEMENT Calhoun County EMS And School of EMS This agreement made and entered into this (Date) 1/31/2022 1 114yWd between (Clinical Site) Calhoun County EMS (hereinafter referred to as the "clinical site") and the School of EMS (hereinafter referred to as "School of EMS") and will continue until the agreement is terminated by either party. I. PURPOSE The clinical site shall provide the School of EMS students with practical experience in EMS -based patient care activities through the clinical site's owned entities and the School of EMS shall provide the student with academic experience. II. RESPONSIBILITIES OF THE CLINICAL SITE The clinical site shall: A. Provide cooperation to ensure students of the School of EMS receive an effective clinical experience. B. Provide a suitable clinical experience situation as prescribed by the curriculum provided by the School of EMS and outlined by the National Highway Traffic Safety Administration. C. Assist with clinical teaching and supervision of agreed upon number of students of the School of EMS. D. Ensure the standards of patient care established by the clinical site remain in control of the employees. E. Reserve the right to determine the manner in which the clinical site's owned equipment and supplies shall be used and operated. F. Provide a contact person for the School of EMS at the clinical site so as to facilitate interaction between the training program and our system. III. RESPONSIBILITIES OF THE SCHOOL OF EMS The School of EMS shall: A. Ensure that students who use the clinical site's facilities will abide by the clinical site's policies. B. Ensure students of the School of EMS will have professional liability insurance in the appropriate amount prior to beginning clinical experience with the clinical site. C. Ensure each student has been provided infection control training as outlined by the Department of Transportation knowledge objectives for EMS courses. D. Ensure each student has been provided HIPAA training in accordance with the Federal and State guidelines. E. Ensure each student has been cleared through a background check to include the federal inclusion/exclusion list. F. Ensure each student has passed a 10-panel drug screen. G. Ensure that documentation has been established by the School of EMS on how students are determined to be proficient in both basic and advanced skills which are expected to be utilized in the clinical internship setting. H. Provides each student a Competency Check List so that the student may present this to the clinical site's facility they are assigned to during all internship assignments. I. Consider promptly any complaint made by the clinical site against a student in accordance with the School of EMS standards and procedures of disciplinary action. J. Shall provide preceptor training to relevant clinical site staff at the clinical location(s) or via online services. IV. HOLD HARMLESS The School of EMS agrees and is bound to hold the clinical site whole and harmless against any and all claims for damages, costs and expenses to persons or property that may arise out of or be occasioned by this contract or any activities or from any act or omission of any teacher or student involved in the School of EMS. DocuSign Envelope ID: 78858058-134B-451C-gFD2-43BOC9A57D92 ftp SCHOOL OF DODO MEMO EMS CLINICAL AFFILIATION AGREEMENT Calhoun County EMS And School of EMS This agreement made and entered into this (Date) 1/31/2022 1 13:39 r4r4M between (Clinical Site) Calhoun County EMS (hereinafter referred to as the "clinical site") and the School of EMS (hereinafter referred to as "School of EMS") and will continue until the agreement is terminated by either party. I. PURPOSE The clinical site shall provide the School of EMS students with practical experience in EMS -based patient care activities through the clinical site's owned entities and the School of EMS shall provide the student with academic experience. It. RESPONSIBILITIES OF THE CLINICAL SITE The clinical site shall: A. Provide cooperation to ensure students of the School of EMS receive an effective clinical experience. B. Provide a suitable clinical experience situation as prescribed by the curriculum provided by the School of EMS and outlined by the National Highway Traffic Safety Administration. C. Assist with clinical teaching and supervision of agreed upon number of students of the School of EMS. D. Ensure the standards of patient care established by the clinical site remain in control of the employees. E. Reserve the right to determine the manner in which the clinical site's owned equipment and supplies shall be used and operated. F. Provide a contact person for the School of EMS at the clinical site so as to facilitate interaction between the training program and our system. III. RESPONSIBILITIES OF THE SCHOOL OF EMS The School of EMS shall: A. Ensure that students who use the clinical site's facilities will abide by the clinical site's policies. B. Ensure students of the School of EMS will have professional liability insurance in the appropriate amount prior to beginning clinical experience with the clinical site. C. Ensure each student has been provided infection control training as outlined by the Department of Transportation knowledge objectives for EMS courses. D. Ensure each student has been provided HIPAA training in accordance with the Federal and State guidelines. E. Ensure each student has been cleared through a background check to include the federal inclusion/exclusion list. F. Ensure each student has passed a 10-panel drug screen. G. Ensure that documentation has been established by the School of EMS on how students are determined to be proficient in both basic and advanced skills which are expected to be utilized in the clinical internship setting. H. Provides each student a Competency Check List so that the student may present this to the clinical site's facility they are assigned to during all internship assignments. I. Consider promptly any complaint made by the clinical site against a student in accordance with the School of EMS standards and procedures of disciplinary action. J. Shall provide preceptor training to relevant clinical site staff at the clinical location(s) or via online services. IV. HOLD HARMLESS The School of EMS agrees and is bound to hold the clinical site whole and harmless against any and all claims for damages, costs and expenses to persons or property that may arise out of or be occasioned by this contract or any activities or from any act or omission of any teacher or student involved in the School of EMS. DocuSign Envelope ID: 78858058-134B-451 C-9FD2-43BOC9A57D92 SCHOOL OF E4 4 EMS NEON V. RESPONSIBILITIES OF THE CLINICAL SITE AND THE SCHOOL OF EMS The clinical site and the School of EMS shall: A. Agree upon the number of students to be placed at the clinical site for clinical rotations. B. Revise and modify this contract in writing if both parties agree to the revision or modification. VI. TERMINATION This contract may be terminated by either party upon one hundred eighty (180) days written notice to the other party by registered mail, return receipt requested. The termination shall not take effect until students who are enrolled at the time such notice is given have completed the courses in which they are enrolled. VII. DISCRIMINATION The clinical site and the School of EMS shall not lawfully discriminate in their respective performance of this contract. Vill. CONTACT PERSONS The contact person and authorized designee of the School of EMS for the purposes of this agreement is: Name: Vicky LaMay Title: Director of Clinical Services Email: clinicals(ccDschoolofems.orc Address: 115 Jordan Plaza Blvd. Tyler, Texas 75704 Phone Number: (903) 399-1463 The contact person and authorized designee of the Clinical Site for the purposes of this agreement is: Name: Lori McDowell Title: Assistant Director/Training Coordinator Email: lori.mcdowell@calhouncotx.org Address: 705 Henry Barber Way, Port Lavaca, TX 77979 Phone Number: (361) 552-1140 EXECUTED on 1/31/2022 1 13:31 CSthe clinical site and the School of EMS have executed this agreement by and through one of its duty authorized officers, thereby binding themselves, their successors and assignees and representatives for the faithful and full performance of the terms and provisions of this contract. Calhoun County EMS Signatur Name: Lori McDowell Title: Assistant Director/Training Coordinator Signature: Name: . Dusti nkins School of EMS Signature: U" Name: Vicky LaMay Title: Director of Clinical Services Signature: it f-biwal Name: TC Howard Title: Director of EMS Title: Chief Operating Officer DocuSlgn Envelope ID: 78858058-134B-451C-9FD2-43BOC9A57D92 4400 SCHOOL OF oaoo EMS NEON V. RESPONSIBILITIES OF THE CLINICAL SITE AND THE SCHOOL OF EMS The clinical site and the School of EMS shall: A. Agree upon the number of students to be placed at the clinical site for clinical rotations. B. Revise and modify this contract in writing if both parties agree to the revision or modification. VI. TERMINATION This contract may be terminated by either party upon one hundred eighty (180) days written notice to the other party by registered mail, return receipt requested. The termination shall not take effect until students who are enrolled at the time such notice is given have completed the courses in which they are enrolled. VII. DISCRIMINATION The clinical site and the School of EMS shall not lawfully discriminate in their respective performance of this contract. VIII. CONTACT PERSONS The contact person and authorized designee of the School of EMS for the purposes of this agreement is: Name: Vicky LaMay Title: Director of Clinical Services Email: clinicals(dschoolofems.orc Address: 115 Jordan Plaza Blvd. Tyler, Texas 75704 Phone Number: (903) 399-1463 The contact person and authorized designee of the Clinical Site for the purposes of this agreement is: Name: Lori McDowell Title: Assistant Director/Training Coordinator Email: lori.mcdowell@calhouncotx.org Address: 705 Henry Barber Way, Port Lavaca, TX 77979 Phone Number: (361) 552-1140 EXECUTED on 1/31/2022 1 13:31 CSFhe clinical site and the School of EMS have executed this agreement by and through one of its duty authorized officers, thereby binding themselves, their successors and assignees and representatives for the faithful and full performance of the terms and provisions of this contract. Calhoun County EMS Signature: Name: Lori McDowell Title: Assistant Director/Training Coordinator Signature: Name: J. Dustin Jenkins School of EMS Signature: Name: Vicky LaMay Title: Director of Clinical Services Signature: T, NWA4 Name: TC Howard Title: Director of EMS Title: Chief Operating Officer CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-845685 The EMS Training School, LLC, dba School of EMS Tyler, TX United States Date Filed: 02/01/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. Affiliation Agreement Ambulance Ride -Outs for EMS Students 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is Vicky Lamay and my date of birth is My address is - - - - - - Tyler TX 75704 Smith (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Smi th County, State of Texas on the 1st day of February 20 22 (month) (year) IJI.CK.w r�G.�a.u. Signature of authoriz d agent of co tracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc #11 NOTICE OF MEETING — 2/9/2022 11. Consider and take necessary action to authorize the EMS Director to sign a Credit Application with Crossroads Tire Service. (RHM) 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 14 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Wednesday, February 2, 2022 2:34 PM To: Mae Belle Cassel Subject: Fwd: W-9, 1295 FORM Attachments: CALHOUN CO W9-1295 FORMS.pdf, Application for Credit -Crossroads Tire Service - Laurent.pdf Mae Belle, Please add to the next Commissioners Court agenda for authorization to sign a Credit Application with Crossroads Tire Service. The Application, 1295 form, and W9 are attached. Thanks, Dustin From: "Donna.Hall@calhouncotx.org (Donna Hall)" <Donna. Hall@ca lhouncobcorg > To: "Dustin Jenkins"<Dustin.Jenkins@calhouncotx.org> Date: Wed, 02 Feb 2022 14:09:59 -0600 Subject: Fwd: W-9, 1295 FORM Dustin, Here is the 1295 Form, W9 and Credit Application for Crossroads Tire Service. Donna From: "vicki@crossroadtire.com (Vicki Rodriquez)" <vicki@crossroadtire.com> To: "donna.hall@calhouncobcorg" <donna.hall@calhouncotx.org> Date: Wed, 2 Feb 2022 13:54:31 -0600 Subject: W-9, 1295 FORM CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Good afternoon, Please find our W-9 and 1295 form attached. Let me know if you need anything else. Sincerely, Vicki Rodriquez Admin, Assistant Crossroads Tire Service, LLC 361-894-8705 Donna Hall Admin Asst Calhoun Co EMS Calhoun County Texas J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org (361) 571-0014 Calhoun County Texas 2905 N. Laurent VICTORIA, TEXAS 77901 (361)894-8705 Company Name Calhoun Co EMS Applicants Name Dustin Jenkins Mailing Address 705 Henry Barber Way Port Lavaca, Texas 77979 Shipping Address 705 Hen! ry Barber Way Port Lavaca, Texas 77979 Phone Number 361-552-1140 Fax Number 361-552-6552 Type of Business Emergency Medical Services Years in Business Circle One: Proprietorship Partnership / Corporantioon Other Government Federal I.D. N or Social Security p / 7 — v a� `Y ot3 ame Accou Number Officers Name Telephone 05a K C�f1 fl t 1-55 Yl G Name City, State Telephone Fax Gulf Coast Paver Victoria Bound Tree Medical LLC Dublin OH - 800-257-5713 Stryker Meducal Portage, MI 866-511-2618 Have you ever filed bankruptcy or had legal collection action taken against you? Yes or No Read Carefully Before Signing: I/We certify the foregoing Information has been supplied truthfully, accurately and voluntarily and therefore authorize crossroads Tire Service to investigate my/our credit worthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means, Including direct contact with past and present creditors. I/We understand that payment terms are NET 30 and I/we agree to make payment promptly in accordance with terms. It is fully understood by the applicant and each maker, surety or endorser hereon this application that each jointly and severally waives grace, demand, presentment, notice, protect and consents that time of payment may or not be extended without notice. The credit applicant herein indicated fully agrees to pay all Interest or finance charges (not to exceed 9.9%annually) as stipulated on the Invoice. It is specifically agreed and stipulated that if this matter consisting of unpaid charges supported by invoice and accrued interest charges is placed in the hands of an attorney or any other parry for collection, or collected through suit, probate or bankruptcy proceedings we joint and severally agree to pay any and all reasonable fees, attorneys fees and all costs as may be awarded in addition to the principle and interest due at the time of collection of payment or said principle and interest In full. t-\.S 2— /_Z0ZZ Printed Name 46ttiorized Signature Title Date 2905 N. Laurent VICTORIA, TEXAS 77901 (361) 894-8705 r Company Name Calhoun Co EMS Applicants Name Dustin Jenkins Mailing Address 705 Henry Rarber Way Port Lavaca, Texas 77979 Shipping Address 705 Henry Barber Way Port Lavaca, Texas 77979 Phone Number 361-552-1140 Fax Number 361-552-6552 Type of Business Emergency Medical Services Years in Business Circle One: Proprietorship Partnership Corporation Other Government Federal I.D. # or Social Security p "/ `7 —60Q /Q,�3 ame I I Accou Number Officers Name I Telephone P Name City, State Telephone Fax Gulf Coast Pager Victoria. Bound Tree Medical. Dublin OH - - 800-257-5713 Stryker Medecal Porta e, MI 866-511-2618 Have you ever filed bankruptcy or had legal collection action taken against you? Yes or No Read Carefully Before Signing: I/We certify the foregoing Information has been supplied truthfully, accurately and voluntarily and therefore authorize Crossroads Tire Service to investigate my/our Creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means, including direct contact with past and present creditors. I/We understand that payment terms are NET 30 and I/we agree to make payment promptly in accordance with terms. It is fully understood by the applicant and each maker, surety or endorser here on this application that each jointly and severally waives grace, demand, presentment, notice, protect and consents that time of payment may or not be extended without notice. The credit applicant herein indicated fully agrees to pay all interest or finance charges (not to exceed 9.9%annually) as stipulated on the Invoice. It is specifically agreed and stipulated that if this matter consisting of unpaid charges supported by Invoice and accrued interest charges is placed in the hands of an attorney or any other party for collection, or collected through suit, probate or bankruptcy proceedings we joint and severally agree to pay any and all reasonable fees, attorneys fees and all costs as may be awarded In addition to the principle and Interest due at the time of collection of payment or said principle and Interest In full. Printed Name Authorized Signature Title Date CERTIFICATE OF: INTERESTED PARTIES FORM 1295 loft Complete Nos. t - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-846235 Crossroads Tire and Automotive Service Tire Pros Victoria, TX United States Date Filed: 02/02/2022 2 Name of governmental entity or state agency that is a party tot the contract for which the form is being filed. Other Date Acknowledged: g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. vicki@crossroadtire.com Automotive and tire repairs and services, Tire sales 4 Name of Interested Part Y City, State, Country lace of business Y, Y (p ) Nature of interest check applicable) ( PP ) Controlling Intermediary RODRIQUEZ, ADRIAN Victoria, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION p_ + My name is &,bah �Clfi Ll.2,Z and my dateof birth is_ My address is—L-t--L=-�P--t--- (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. -y— 11 Executed in Y 1���1 a County, State of I �y�0.� on the �d ay of 20 (year) Signature of authorized agent of c tracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us version v1.1.191Dbcac Form W'9 Request for Taxpayer Give Form to the Identification Number and Certification requester. Do not (Rev. October 20181 Dapanment of the Treasury send to the IRS. Intemai Revenue Service ► Go to wwwdrs,goviFormiW9 for instructions and the latest Information. 1 Name (as shown on your income tax return). Name is requires on this line: do not leave t is brie blank, L_ 2 Business name/disregarded entity name, it different from above N 3 Check appropriate box for federal tax classification of me person whose name is entered on line i. Check only one of the 4 Exemptions (codes aPPiy only to Nfollowing seven boxes. Certain entities. not individuals: see C. instructions on page 3). p ❑ Individuaysoie proprietor or ❑ C Corporation El Corporator ❑ Pannersmp ❑ Truavestate e NC if single -member LLC 14S._ Exempt payee code (if any) 4"p [Z Limited liability company. Enter the tax classification (C=C corporation. S=S corporation. P=Partnership)► p 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 C C LLC i1 the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code Id any) 'C 6 another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise a single -member LLC inaI is disregarded from the owner should check the appropriate box for the tax daSsi6cation of its owner. op ❑ Other jsee instructions) 1, N S AtldY055 (0embef. Street. and apt. Or suite no.) See instructions. RequaslV s name and address (optionab 6 City, state. and ZIP code 7 List account number(s) h re (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 backup withhoding. For individuals, this is generally your social security number (SSN). However, for a resident alien. sole proprietor, or disregarded entity, see the instructions for Part I. later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN. later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. ...x ........... or MEMO 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. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) 1 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 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 correct TIN. See the instructions for Part 11, later. sign Signature of li ( � % Date► Here U.S. person 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.irs,gov1F0rmW9. 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 (ITIN), adoption taxpayer Identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but 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-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. 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. Cal. No, 10231x Form W-9 (Rev. 10.20131 #12 NOTICE OF MEETING — 2/9/2022 12. Consider and take necessary action to approve the Infrastructure Development Plat for the Santos Mag Beach RV Park. (DH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct l SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Mever, Commissioner Hall, Lvssv, Behrens, Reese Page 9 of 14 Mae Belle Cassel From: david.hall@calhouncotx.org (David Hall) <david.hall@calhouncotx.org> Sent: Thursday, February 3, 2022 2:06 PM To: MaeBelle.Cassel@calhouncotx.org Subject: FW: Santos Mag Beach RV - Infrastructure Development Plat Attachments: 8730.002 - Santos RV Mag Beach RV - IDP - For Approval 012722.pdf; approved 3-31-21 Antonio Santos (RV Park) FM 2760 - Calhoun Signed.pdf; Septic Permit pt 1.pdf; Septic Permit pt 2.pdf; WOTUS Report - Santos Property_Optimized.pdf; partOjpg From: smason@gwengineers.com (Scott Mason) [mailto:smason@gwengineers.com] Sent: Thursday, February 3, 2022 10:46 AM To:'David Hall' <david.hall@calhouncotx.org> Cc: angela.torres@calhouncotx.org; marlaj@gwengineers.com Subject: Santos Mag Beach RV - Infrastructure Development Plat CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. David, We finally have everything in line to bring the IDP for Mr. Santos to court. Please see the attached. Could we request an agenda item for court next week to consider approving the Infrastructure Development Plat for court 02/09/2022. Respectfully Submitted, Scott P. Mason, P.E. Lead Project Engineer G&W Engineers, Inc. 205 W. Live Oak Port Lavaca, Texas 77979 P: (361) 552-4509 F: (361) 552-4987 smasonCagwengineers.com Calhoun County Texas W I W W 1 2 C' IW LL I.L W I � ° v a I ©O My L-----------------------= v yJFIF � z �a T-15" a A zo z aow �¢ �zU F �Q o C �mZ U F w W wVI W R; oH�z� UUZOF z�°Qz O �6W xvzWQ aFwza o�oo�a, w OFF P.M A- U w o m a�wzo RI um, 06WF� W a�d�d U 6 q X z W N¢OWF P �5 o a> a w °o°wwoFa w�U°a a E xoaw. to 0. G1 C zvxW0m a�xwa �wxx> F z8 zc 0 °2gQQ oc PERMIT NUMBER: TxDOT ENTER PERMIT NUMBER HERE OPS4 ROADWAY REQUESTOR I LATITUOF, LONGITUDE HWY NAME FM 2760 25.552554,45.545771 FOR TxDOTS USE NAME Antonio Santos CONTROL 1 2714 SECTION 1 03 MAILING ADDRES§ 404 Margie Tewme Road CRY, 6TATE, ZIP Pod Lavaca, Texas 77979 PHONE NUMBER 36171199255 Ym.OM POSfr10MNO SYSTEM COORDINATES ATIMEASECDON OF DRNEWAYCENTERUNE WITHARUMNOROADWAY Is this parcel in current litigation with the State of Texas? ❑ YES ® NO The Texas Department of Transportation, hereinafter called the State, hereby authorizes AntonloSantos hereinafter called the Pernlltse, to ® construct 1 ❑ reconstruct a commercial —RV Park (residential, convenience store, retail mail, farm, air) access driveway an the highway right of way abutting highway number 276o in Calhoun County, located 965 fit south of La Lucina St, Magnolia Beach cur mm�xvut sires s aeraro This permit is subject to the Access Driveway Policy described an page 2 and the following: 1. The undersigned hereby agrees to comply with the terms and conditions set forth in this permit for construction and maintenance of an access driveway on the state highway right of way. 2. The Pennies represents that the design of the facilities, as shown In the attached sketch, is In accordance with the Roadway Design Manual, Hydraulic Design Manual and the access management standards net forth in the Access Management Manual (except as otherwise permitted by an approved variance). 3. Construction of the driveway shall be in accordance with the attached design sketch, and is subject to inspection and approval by the State. 4. Maintenance of facilities Constructed hereunder shall be the responsibility of the Permihee, and the State reserves the right to require any changes, maintenance or repairs as may be necessary to provide protection of life or property on or adjacent to the highway. Changes in design will be made only with prior written approval of the State. S. The Permillee shall hold harmless the Slate and its duly appointed agents and employees against any action for personal injury or property damage related to the driveway permitted hereunder. 6. Except for regulatory and guide signs at county made and city streets, the Permittes shall not erect any sign on orexlending over any portion of the highway right of way, The Permiles shall ensure that any vehicle service fixtures such as fuel pumps, vendor stands, or tanks shall be located at least 12 feel from the right of way line to ensure that any vehicle services from these fixtures will be off the highway right of way. 7. The State reserves the right to require a new access driveway permit in the event of (1) a material change in land use, driveway traffic volume or vehicle types using the driveway, or (III) reconstruction or other modification of the highway facility by the State. 8. The State may revoke this permit upon violation of any provision of this permit by the Permittee. S. This permit will become null and void if the above -referenced driveway facilities are not constructed within six (6) months from the Issuance date of this permit 10. The Permttee will contact the State's representative Jon Adame telephone, (361 ) 552-6131 , at least twenty-four (24) hours prior to beginning the work authorized by this permit 11. The requesting Permillee will be provided instructions on the appeal process if this permit request Is denied by the State. The undersigned hereby agrees to comply with the terms and conditions set forth in this permit for construction and maintenance of an access driveway on the higpway, right of way. Date: �&( Signed-(�fflaLUaaJL we4ixc Access Driveway Policy Title 43 Texas Administrative Code (Transportation), Chapter 11 (Design), Subchapter C (Access Connections To Stale Highways) and the 'Access Management Manuar establish policy for the granting of access and the design, materials, and construction of driveways connecting to state highways. All driveway facilities must follow this policy. To the extent there is any conflict between this permit and the policy, the policy shall control. If a proposed driveway does not comply with the access management standards, the owner may seek a variance to a requirement contained in the access management standards by conlecling the local TXDOT office. TxDOT Driveway Permit Request Contact For a local contact for your TXDOT Driveway Permit Request or variance request, visit: J(p'/lwunutxdot.00vfinside-b dol/dlstdd.html. You can dick on the section of the map closest to your location to find the local TxDOT office. You can also dick on the drop down box below the map to And the district for your county. Other Conditions In addition to Items 1 thru 11 on page 1 of this permit, the facility shall also be in accordance with the attached sketch and subject to the following additional conditions stated below. Variance Documentation Justification For a Variance request, please indicate which of the below are applicable, as required by TAC 611.52(e): a significant negative Impact to the owners real property or Its use will likely result from the denial of its request for the variance. Including the loss of reasonable access to the property or undue hardship on a business located on the property. an unusual condition affecting the property exists that was not caused by the properly owner and jusfifiss the request for the variance. For the conditions selected above, provide written Justification below. (Attach additional sheets, if needed) For TXDOT use below. For Variance denials, please indicate which of the below conditions, as provided In TAC §11.52(e), were delennined © adversely affect the safely, design, construction, mobility, efficient operation, or maintenance of the highway; or likely Impair the ability of the stale or the department to receive funds for highway construction or maintenance from the federal government. Attachments; Sketch of Installation All Variance Documentation Commercial and Industrial DrivewayAccess Request Form Date: 4yr' I (D ili)fZil District: YOAKUM-13 1 Codnty: CALHOUN Highway: P M 271,X Umfts: 1324,Wf-eY VW-6�1, (j1v\a M0.5(" (:ta,� UACt1 1. Purpose of Request: Explain the need for access driveway Mr. Santos will be opening an RV park. He does not currently have a driveway to the property on either side of the creek that runs through the property. 2. Proposed use of the property: Operations, facilities, frequency of access use, types and sizes of vehicles for each Individual year of the next three year period The RV park will have 14 stands with water, sewer and electrical hookups. The only amenity on the property will be a cabana. Vehicle types will be passenger vehicles/trucks, with and without RVs, and motorhomes—approximately 84 vehicle trips per day at max capacity (6 trips per stand.) There will be an occasional garbage truck to service the dumpster. Mr. Santos may expand the park in the future but it would be on the other side of the creek and have a separate entrance which is proposed to be a public (county) road in a platted public easement. 3. Background: Dated chronologyofpreviouscorrespondence, meetings, ordiscusslonsabout driveway access, Identiflcationofpropertyzoning or approved platting If applicable March 29,2021 Mr. Santos met with Jon Adame, Maintenance Supervisor, at the site. March 30, 2021 Mr. Santos met with G&W Engineers (Marla Jasek and Scott Mason) to discuss handling driveway design submission and RV park layout. March 31, 2021 Mrs. Jasek submits Form 1058 to Jon Adame. 4. Participant(s) in the request process: Including as applicable city, county, developers, consultants, legal counsel, etc. County 911 has assigned an address for the property. Mr. Santos has coordinated with the TxDOT maintenance supervisor. G&W has been employed for driveway submission and layout of the RV park. Construction of the RV park will require coordination with the Calhoun County Floodplain Manager. S. Highway layout showing the requested access site and upstream/downstream roadway system and other associated access: Attachvictnitymap(surroundingarea),projectlocatlonmap (adjacenthlghway/rompsandlocalstreets),locatlonof access breaks (in relationship to property boundaries) Map attached. rxaOrae/2013 Page 1.2 Commercial and Industrial Driveway Access Request Form AOT,number/wldthaflanes/shoulders postedspeed,bddgestructures,utllltyoverheadand 6. Existingroadwaycharacteristics: underground(locatlon/relocation), geometrlcs atproposed access(S/ght distance, grades, verdcal/horizontal curves), pavement (structure, width, andmaterlal) FM 2760 is a 2 lane roadway with 12 ft lanes and 5 ft shoulders. The AADT in 2019 was 929 vehicles per day. The posted speed in this section is 55 mph. No utilities will need to be relocated forthis installation. The roadway grade is fairly flat at this location and there is a long horizontal curve. Pavement structure is unknown. 7. Proposed driveway: Proposed rodll, throat width and length, entry/exit width The proposed driveway will have radii of 20 ft. The throat width is 24 ft and approximately 55 ft long (distance from edge of pavement to ROW line.) Total entry/exit width at the edge of pavement will be 64 ft (24' width plus 2-20' radii.) TworOo/2013 Page 2.2 ACCESS DRIVEWAY PERMIT REQUEST DATE:Wig [ j, j_ Property Owner: Mailing Address: COUNTY: CALHOUN Phon6ee`aNu�mber.36% 552-4509 Mall: m QJ ugInCP(SI DrivewayType: Private & Permenant Commercial ❑ Temporary ❑ X , Driveway Width Requested:`( FEET HIGHWAY: 17 lk rZ-7too 7ZG-79 IF FOR COMMERCIAL USE Company name: Business Type: R N� Phone Number: JOi- IOIG-�tZSs Email: -- Expected Vehicle Usage/DAY: Car/pickup, Truck --[— Other Comments: 14 t-V 15 iS W 4+1 no malwc a ay-i4i ""Safety End Treatments (6:1 slopes) are required on ALL driveways; pipe runners may also be required when needed" TXDOT VSYMP WIDTH OF DRIVE ,�JV I rNR 1— DISTANCE FROM EDGE PIPESIZE .ICJ "- -.7 POWs AADT LENGTH OFPIPE jQ&Z& NTROL/SECTION o%%/ 03 SIGHT DISTANCE .stfl� W! & [i GPS Coordinates "?9. 1 Lw/, sy-1-7 j/ Other Comments: DetMd- fzr Proposed RV Park Driveway for 355 Margie Tewmey Road (FM 2760) Property owner has had wetland areas delineated. Wetland boundary is shown approximately in red. Property Is located In the Floodplain--Zone AE. All drainage on the property currently drains away from the FM 2760 ROW. The drainage on the property will not be changed for development of the RV Park. No additional water will be brought to the State ROW, x ; � i _1.., ° '� II as ✓ yT T_.; 7 i r v I^ �b. Y I. .I '- 4 I 4 9, FM 2760 —Antonio Santos Extra Information on Drainage i� FM _S tl loe- WL4 s Et- he F X i Sa - t 'I"�f l , �. Cca " C FOIL , KVeCA�YlirO 4 f! CK-1 �a hC� tlYc ��var-lj�'_ �"vwyP � 11 dYl'1�Q� Mjasek 05/04/21 "^ () W , J �/1 Y lbr�roav� yvo �p•� ynC�'V iG — f FM 2760 —Antonio Santos Extra Information on Drainage RtadUJ(3 %1, �cvar,oJol( WiJl ll -.7) k t2 e'-6a:- d Mjasek 05/04/21 1�0p 0 � pl" base -b N)GL{-C h T�Yive..Wo„Uy �e��`t�r f a- TYPICAL 6:1 SLOPE (8:1 PREFERRED) DEPTH OF DITTCH SAFETY END TREATMENT DRIVEWAY CROSS SECTION (WITH PIPE CULVERT) LENGTH OF PIPE REQUIRED r RIVEWAY WIDTH DRIVEWAY DRAINAGE PIPE STABILIZED ALL WEATHER,SURFACE MATERIAL FILL ITCH 6 /- F LOW 1 / LINE SAFETY END TREATMENT The sloped ends shall be installed the same day as the driveway pipe. YOAKUM DISTRICT DRIVEWAY DETAIL TYPICAL ACCESS DRI W/EXPANSION JOINT Cararete Alprop Note) Refer to Bridge Division Stonagrds for Dotal IN --F IM LIM ToMal 1 ONE PIPE INSTALLATION WITH DIAMETER LESS THAN JO" co note Rtoew tr'Me PfM FIM LIM TMgI 1 ONE PIPE INSTALLATION WITH OIAAETER 30" OR GREATER Coetrote Rlorw w CrOOA PIMTome 7WD PIPE INSTALLATION M LIM C.te Natol Refer Stondc all 1. L1. 1M T�lI SINGLE BON CULVERT INSTALLATION LESS THAN 3O' WIDI ZC. t�F.em 'Q Tyo,-, trpq Flret C o IM nwYril +/FIM LIM 1 9Yttall p9lple P11 Npep' TeftMll SINGLE BOX CULVERT INSTALLATIO Ml' AND GREATER IN WIDTH BULTIPLE BOX CULVERT INSTAL6ATI2N TYPICAL SAFETY END TREATMENTS TYPICAL. SAFETY END TRI FOR DRIVEWAY CULVERTS FOR DRIVEWAY CULVI 53a E U rs AE ee aov ,ye n�o w6 Y BEN vtii�v5 c Working Point (at intersection of nominal I.D.) ,�Trimeea Edge ofPipe �O6 4 NOTE: All Cross Pipes, calculations, and dimensions are based on the pipe culverts mitered as shown in this detail. Alternate styles of mitered ends will require that appropriate adjustments be made to the values presented on this standard, SIDE ELEVATION OF TYPICAL PIPE CULVERT MITER (Showing Corrugated Metal Pipe Culvert.) (Details at Concrete Pipe Culvert ore similar.) ISOMETRIC VIEW OF TYPICAL INSTALLATION Cross Pipe Length 2" Q2 (See Table),_ Q1 (See Table) 2" Cross Pipe Cross Pipe over over Insitle Outsitle 15/1e" D i a Barrel Barrel Through Hole (Typ) PIPE W/ BOLTED ANCHOR e6 Anchor Bar x 1._4.. (Ty P) 4.. 30 Typ TYP Bend first Cross Pipe Anchor Bars as necessary to maintain 2" clear cover to Toewall edge of concrete Riprap PIPE W/ ANCHOR BARS 3" TYD 4., yp i Cross Pipe r l�< 3° TYD N x6 Anchor Bar x 1'-4° (Typ) SECTION C-C CROSS PIPE DETAILS Limits of Riprap (to be included with S.E.T. for payment) Working Point — 2•.0.. TL Cross Pipe (flush with top of Riprap) Trimmed Edge of Pipe Culvert Q Cross Pipe Anchor Bolt/ n a Top 0 0. Pipe L 3 � a 6.. Ei fi P I 3 C Limits of Riprap 1, (to be included with S.E.T. for payment) S P �Ii 3 %2" Dia Cross Pipe (DO N 8" 4'` Plow i A Line 12° See DETAIL "A" SIDE ELEVATION OF CAST -IN -PLACE CONCRETE (Showing Concrete Pipe Culvert.) (Details at Corrugated Metal Pipe Culvert ore similar.) SHOW 1 NI CULVI 4" 2 0� Anchor Toewall— Pipe 0 (C. M.P Concre co O•L0.L o> co'. oa] 3++ 00 zo- FW «L oa PCP C E awn° d �w0 -a aow c + w�- wxa oxd %1- L Id- + LN >U au 0 v�o Ld� ia0 Pn« wao ROAD WORK CW20-1D AHEAC 48" % 48" IFlags- See note 1) Channelizing Devices (See note 2)AL Chonnelizing devices may be Witted if the worK area is a minimum of 30' from the nearest traveled way.— Shadow Vehicle with TMA and high intensity rotating, flashing, oscillating or strobe lights. (See notes 4 & 5)— Channelizing Devices (See note 2)Ak I I I I L I L d d I I c TCP (1-10) v 0 0 x x ROAD WORK CW20-1D 48" % 48" (Flags - See notes 1 & 7) WORK SPACE NEAR SHOULDER Conventional Roads END ROAD ROADWORK WORK D20-2 AHEAD 2/48(Se x 24" (See note 2)� I CW20-1D 48" % 48" (Flags - See note 1) w L Channelizing Devices (See note 2)A L o O m p N L , E o' _v +cN N L �/ ^ 0 0 a•a+ L W V V t Ewnc O N aw X I d m 0>. d X odoN •-ON" C I 0 N ��.1 10, fiery Min.'•.•• fl d �Iti". o ':11• N + 0 L Shadow Vehicle :l.f• 3 with TMA and high Intensity rotating, o C flashing, m oscillating or strobe lights. (See notes 4 & 5) I I m I I m L o 0 w O w END E ROAD WORK o 0 L 48" X 24" E (See note 2Ak 0 0 L0 oa Channelizing Devices (See note 2)A WORK aCW20-ID TCP (1 -1 b) (FI aos48" See notes I WORK SPACE ON SHOULDER Conventional Roads VICTORIA COUNTY PUBLIC HEALTH DEPARTMENT OSSF PERMIT 2805 N. Navarro NO. Victoria, Texas 77901 (361)578-6281 Fax (361) 579-6348 v t.?ot..} '3j 1. Authorization to Construct an On -Site Sewage Facility (OSSF) '1 Application Log Number L. - z) Receipt Number 14 76 County OSSF Owner Ay� /n / Ia OSSF Location 1515cdr;alr This serves to notify all persons that an on -site sewage facility application, related technical data, and the appropriate fee have been received by the Victoria County Public Health Department (VCPHD) from the property owner or owner's representative. The application has been reviewed for technical and administrative consideration against the standards set forth by the Texas Commission on Environmental Quality (TCEQ). Approval is hereby granted for the construction as shown on the submitted plans. Any modifications to submitted plans require approval by VCPIID prior to installation. You or your installer must contact VCPHD five working days prior to the day of final inspection. This Authorization to Construct is valid for one year from the date of issue. If a final inspection has not been performed within one year of issue, a new application and fee will be required. Date Approved I'417/21 Designated Representative 1/�, -,, r,,.-, OS-j _S� ......................................................................................... Notice of Installation Inspection This serves to notify all persons that this on -site sewage facility has been inspected by VCPHD and meets the standards set forth by the Texas Commission on Environmental Quality EXCEPT: OSSF Owner will make electrical connections Paperwork Needed: Other Approval to Operate the OSSF will not be granted until the above items have been completed and approved by VCPHD. Operation of the OSSF before being issued Approval to Operate is a Class C Misdemeanor with fines up to $200. TCEQ can impose additional administrative penalties. Inspection Date Designated Representative OS- ......................................................................................... NOTICE OF APPROVAL TO OPERATE ON -SITE SEWAGE FACILITY This serves to notify all persons that the on -site sewage facility at the above location has satisfied design, construction, and installation requirements of the TCEQ. This VCPHD On -Site Sewage Facility Permit is issued for the operation of the above -identified OSSF. ANY MODIFICATIONS TO THE STRUCTURE (i.e. increase in bedrooms or square footage, etc.), OSSF SYSTEM COMPONENTS, OR CHANGES OF OWNERSHIP MAY REQUIRE ANEW PERMIT. The owner must notify VCPHD at (361) 578-6281 of the aforementioned changes. -Designated Representative License No. Date WHITE -HEALTH DEPARTMENT / YELLOW -FACILITY OPERATOR / PINK - INSTALLER / GOLD -AUTHORIZATION TO CONSTRUCT OSSF 06/30/15 LONE STAR SEPTIC SERVICE Installation - Maintenance - Repairs PO Box 4522- Victoria, TX 77903-4522 (361)782-2421 Jim Walpole - Lic # 0007059 - Clay Walpole - Lic #0024927 - MP#0000530 ANTONIO SANCHEZ 355 MARGEY TEWMEY PORT LAVACA, TX 77979 12/20/2021 12/20/2021 600 GPD AEROBIC SEPTIC TANK; RISERS; SPRAYERS; PIPING & MATERIALS; ELECTRICAL WIRINGAT TANK; SAND; EQUIPMENT & LABOR; DELIVERY. ALL SALES TAX INCLUDED SEPTIC DESIGN & PERMITS & FILINd 0 - &-,-1 - a -I IT IS AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL & COMPLETE PAYMENT IS MADE, AND IF SETTLEMENT IS NOT MADE AS AGREED, THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL THEREOF. TERMS; DUE ON RECEIPT PARTS WARRANTY All parts as recorded ere warranted as per manufacturer specifications. LABOR GUARANTY The labor charge as recorded here relative to the equipment serviced as noted, is guaranteed for a period of 30 days. We do not, of course, guaranty other parts than those we supply. Repairs later that become necessary due to other defective parts, will be charged separately. Invoice No. DUE AT INSTALL 0194611 7,000.001 7,000.00 500.001 500.00 Subtotal 1 $7,500.00 Total 1 $7,500.00 Down Payment 1-$1,500.00 Balance Due 1 $6,000.00 New ❑ Replacement ❑Alteration Property Owner Mailing Address: Telephone Numb OSSF Site Addre; Legal Description VICTORIA COUNTY PUBLIC HEALTH DEPARTMENT ENVIRONMENTAL SERVICES Application for On -Site Sewage Facility Construction (Middle) (Section/Tract) (Block) (Lot) VCPHD USE ONLY County Application Date Receipt No Application Log No. Subdivision: Acres Water Source: 21 Private Water Well ❑ Public: Water Savings Devices .0 Yes ❑ No Water Treatment System: ❑ Yes ❑ No Single Family Residence: No. Bedrooms: Square Footage: Other: 1 A V $ CommerciaVlnstitution/Multi-Family: No. Employees/Occupants/Units: cD'ays/wk Occupied: I. Treatment Unit: Daily Wastewater Usage Rate: LIy O gallons/day (gpd) A. Septic Tank Size: gal. #Tanks/Compartinents: Pump Tank Size: gal. 1"Tank/com arhnent V,Rglume: gal. B. Aerobic Model: /V v w A7.M— gpd Manufacturer: _NC [r' C. Other: H. Disposal System: Drain field Area: -7 o -7 1 % sq ft Trench Depth: inches A. Gravity ❑ 4" with gravel ft Trench width ft Gravel depth ft ❑ 8" gravel less ft ❑ 10" gravel less ft ❑ Evapotranspiration Bed ❑ Multipipe -pipe bundle It ❑ Leaching Chamber ft or panels B. Other ❑_Low Pressure Dosed It Trench width It Gravel depth inches Surface Irrigation 1V9�g ft ❑ Drip Irrigation ft ❑ Mound ❑ Other Site Evaluator: James W. Soderholtz Cert/License No. 29758 Telephone: 361-655.7818 Designer: James W. Soderholtz R.S./P.E. No. 3799 Telephone: 361-655-7818 Installer. Clayton Walpole Registration No. OS0024927 Telephone: 361-782-2421 ***************VICTORIA COUNTY ONLY: $100 REINSPECTION FEE MAY BE REQUIRED**************** I certify that the above statements are true and correct to the but of my knowledge: Authorization is hereby given to the authorized agent to enter upon the above described property for the purpose of lot evaluation and inspection of the on -site sewage facility and that a permit to operate the facility will be granted following successful inspection of the installed system which indicates that the system was installed in compliance with 30 TAC $ 285, On -Site Sewage Facility Rules. rv_ Si attire of Owner/Authorized Agent LAT: 28.552678 //_ Ll - 2 / Date LONG:-96.545617 Revised 22/31/14 INITIAL AEROBIC MAINTENANCE POLICY Our company LONE STAR SEPTIC SERVICE will maintain the aerobic septic system located at 355 MARGIE TEWMEY RD, PORT LAVACA, TX 77979, Permit # for the period of two (2) years beginning and ending This contract will provide for all required inspections, testing and routine service of your aerobic treatment system. The policy will include the following: 1. Three service inspections a year (at least one every 4 months), for a total of six inspections over the two (2) year period. Service inspections will include all applicable component parts to ensure proper function of it. Any component found not functioning correctly will be repaired or replaced. 2. An effluent quality inspection consisting of visual check for color, turbidity, scum overflow and examination for odors. A test for chlorine residual and PH will be taken and reported as necessary. 3. Any additional visits, inspections or sample collections required by specific Municipalities, Water/River authorities, County Agencies, COMMISSION, or any other authorized regulatory agency in your jurisdiction will be covered by this policy. If any improper operation is observed, which cannot be corrected at the time of the service visit, you will be notified immediately in writing of the conditions and estimated date of correction. Maintaining the chlorine tablets correctly is the homeowner (customer) responsibility. The chlorine tube must contain chlorine at all times. If the service representative finds improper or no chlorine at the time of the routine service call, the representative will p9te on inspection form to add chlorine. Installer's initials t Homeowner's initials ? The Homeowners Manuel must be strictly followed or warranties are subject to invalidation. Pumping of sludge build-up, for reasons other than due to warranted mechanical failure, are not covered by this policy and will result in additional charges. Additional services, replacement of out -of -warranty parts and other services offered by installer/representative can be done with written notice for an additional charge. IMPORTANT: This warranty/service agreement does not cover the cost of service call, labor, or materials which are required due to "misuse or abuse" of system; failure to maintain electrical power to the system; sewage flows exceeding the hydraulic/organic design capabilities; disposal of non -biodegradable materials, chemicals, solvents, grease, oil, paint, etc.; or any usage contrary to the requirements listed in the owner's manual or as advised by authorized service representative. Charges for parts and additional services can be obtained by contacting your service representative. If a problem occurs, we will respond within 24 hours from the time of call. Jim Walpole is certified to do sewer and maintenance on all aerobic septic systems. HOMEOWNER SERVICE PROVIDER Name: ANTONIO SANTOS Name: Lone Star Septic Service Address: 355 MARGIE TEWMEY RD Address: 1283 Jentry Rd, City: PORT LAVACA, TX City: Inez, TX Zip code: 77979 Zip code: 77968 Phone: Phone: 361-782-2421 (� # OO67059 Signature o meowner/ thorized Agent �f. Signa a of Service Provider License # LONE STAR SEPTIC SERVICE MAINTENANCE INSTRUCTIONS AND WARRANTY All septic systems require some maintenance. The following are suggested for your system to insure the best possible performance and longest life. Maintenance and Management Practices: 1. An OSSF should not be treated as if it were a normal city sewer system. 2. The excessive use of in -sink garbage grinders and grease discarding should be avoided. In -sink grinders can cause a rapid buildup of sludge or scum resulting in a requirement for frequent cleaning and possible failure. 3. Do not use the toilet to dispose of cleaning tissues, cigarette butts, or other trash. This disposal practice will waste water and also impose an undesired solids load on the treatment system. 4. Septic tanks shall be cleaned before sludge accumulates to a point where it approaches the bottom of the outlet device. If sludge or scum accumulates to this point, solids will leave the tank with the liquid and cause possible clogging of the perforations in the drain field line resulting in sewage surfacing or backing up into the house through the plumbing fixtures. 5. Since it is not practical for the average homeowner to inspect his tank and determine the need for cleaning, a regular schedule of cleaning the tank at two -to -three year intervals should be established. Commercial cleaners are equipped to readily perform the cleaning operation. Owners of septic tank systems shall engage only persons registered with the COMMISSION to transport the septic tank cleanings. 6. Do not build driveways, storage buildings, or other structures over the treatment works or the drain field. 7. Chemical additives or the so-called enzymes are not necessary for the operation of a septic tank. Some of these additives may even be harmful to the tank's operation. 8. Soaps, detergents, bleaches, drain cleaners, and other household cleaning materials will very seldom affect the operation of the system. However, moderation should be exercised in the use of such materials. 9. It is not advisable to allow water softener back flush to enter any portion of the OSSF. 10. The liquid from the OSSF is still heavily laden with bacteria. The surfacing of this liquid constitutes a hazard to the health of those that might come into contact with it. Water Conservation Practices: 1. Showers usually use less water than baths. Install water saving showerheads that use less than 2 '/z gallons per minute and saves both water and energy. 2. If you take a tub bath, reduce the level of water in the tub from the level to which you customarily fill it. 3. Leaky faucets and faulty commode fill -up mechanisms should be repaired as quickly as possible. 4. Check commodes for leaks that may not be apparent. Add a few drops of food coloring to the tank. Do not flush. If the color appears in the bowl within a few minutes, the toilet fill or ball cock valve needs to be adjusted to prevent water from overflowing the standpipe, or the flapper at the bottom of the tank needs to be replaced. 5. Reduce the amount of water used for flushing a 3.5 gallon or larger commode by installing one of the following: a new toilet; a toilet dam; or filling and capping one -quart plastic bottles with water (usually one is all that will fit in a smaller toilet tank) and lowering them into the tank of the existing 3.5 gallon or larger toilet. Do not use bricks since they may crumble and cause damage to the fixture. 6. Try to run the dishwasher with a full load whenever possible. 7. Avoid running the water continuously from brushing teeth, washing hands, rinsing kitchen utensils or for cleaning vegetables. 8. Use faucet aerators that restrict flow, to no more than 2.2 gallons per minute to reduce water consumption. CALHOUN COUNTY PERMIT & INSPECTION DEPARTMENT NOTICE TO OWNER/OPERATOR OF AN AEROBIC TRATMENT UNIT UTILIZING SURFACE APPLICATION Chapter 285.7 of the Texas Natural Resource Conservation Commission regulations require a maintenance contract for an on -site sewage facility utilizing an aerobic treatment unit and surface application as a disposal method. A copy of the signed maintenance contract between the property owner and the approved maintenance company shall be provided to the permitting authority (CALHOUN County). The initial maintenance contract must be valid for a minimum of two years. After the initial two-year contract, on -going maintenance is required. The owner of each surface application system shall continuously maintain a signed written contract with a valid maintenance company and shall submit a copy of the contract to the permitting authority at least 30 days prior to expiration of the previous contract. If the property owner or Maintenance Company desires to discontinue the provision of the maintenance contract, the maintenance company shall notify, in writing, the permitting authority at least 30 days prior to the date service will cease. If a maintenance company discontinues business, the property owner shall within 30 days of the termination date, contract with another approved Maintenance Company and provide the permitting authority with a copy of the newly signed maintenance contract. I understand that as the property owner of an OSSF system consisting of an aerobic treatment unit and surface application, I am required to have in force an on -going maintenance contract for the life of my system. Should I fail to have a contract in place, I am aware I am in violation of the Order Adopting Rules of CALHOUN County, Texas for On -Site Sewage Facilities, Health and Safety Code 341.014, 366,0515 and the Texas Administrative Code, 30 TAC 285.7. Failure to have a current maintenance contract in effect will cause the permit issued for said system to be considered void. 4�kl 11- t(,2 Prop Owner/Authorized Agent Date ��-K.2V Wi es Date Permit # Name: R s1 J o m v Address: $'," .Y' nln qe71 7-eu.1mey R•r% Matl4cei. A. Wastewater Load: The OSSF will serve RV Trailer @ 40 Gpd, with water devices. Wastewater load is gallons per day. B. Topography: Slope = Less than 2% C. Treatment Svstem: Pro Flo ATU inor equivalent 400 Gallon Th Tank 800 Gallon Aerobic Unit 771 Gallon Pump Tank Chlorinator: This system will be equipped with a liquid or tablet chlorinator. C. Irrigation Area: Q / RI = Total Square Feet of Irrigation Area jjg ' .048 Y,� Total Square Feet of Required Irrigation Area E. Nozzle: l ..— 3 Spray Head #: Type: K-Rain or equivalent Number:. GPM: 3.1 Psi:40 e Radius- 3 Spray Area: Total Square Feet of Application Area I - ff Gov\ I F. Pump Requirements: Use V schedule 40 purple pipe for sprinkler system. Total gallons per minute equal 12.4 Use.a % horsepower pump capable a pumping 12.4 gallons per minute. G. Time of Discharge: Pump to discharge between midnight and four A.M. H. Vegetation: As soon as construction will allow, the surface application area shall be covered with grasses. Plants intended for human consumption shall not be grown within disposal area. All vegetation grown inside the disposal area shall be properly maintained to prevent sprinkler head interferences. The homeowner is responsible for providing and maintaining the vegetation in the disposal area. Notes and Additional Specification Requirements: If discrepancies exist between the design and actual size conditions the installer shall notify the designer and the local permitting to county and state rules/polices, unless specifically noted on this design and approved ;by the local permitting authority. Additional Notes: 1) Water Softener must not drain into aerobic treatment chamber. 2) No surface improvements such as buildings, sidewalks, driveways, patios, etc. shall be constructed on the disposal area. 3) Grease, cigarettes butts, personal hygiene products, and other trash shall be disposed of in the garbage. 4) It is the Installer's responsibility to review the design criteria prior to construction. 5) The site shall be finish graded for positive drainage, and or adequate drainage structures shall be constructed if needed prior to system installation. 6) Any warranties of the products installed are those made by the manufacturer. The permit holder assumes full responsibility of the system following final inspection approval by the licensing authority. Victoria County Public Health Department Environmental Services OR -Site Sewage Facility SoU and Site,9 U nation Date Performed:, 44 — of s') New Installation Replacement Alteration Property Owner's information Name_&LnTbii i c) SG vt 1 a.57 Address �W_ City i, r l a v ac o State jy( Zip Code r797 9 Phone Fax Property Description Plat Date Sec Lot Block` Subdivision Street/Road Address Comity Unincorporated Area? Y or N City Zip Code Property Size Acreage Survey Abstract Additional Information Certified Site b valuator/rE uformation Name Tames G 406—r_ Company S w iJBS rl Address OQ }yi mi city State Zip Code ,1%3—Pitone Fax TCEQ Registration Number. 7� Installer information Company Address City State Zip Code Phone_ _ Fax TCEQ Registration Number TOPOGRAPHY Slope Vegetation Site Reference Soil Survey Book • ]Drainage ❑ Flat (under 2%) ❑ GrassBrush ❑ Poor ❑ Seasonal water table O'SHght (under 4%) ❑ Lightly Bdequate ❑ Water table (upper water shed) evident ❑ Severe (over 5e/n) Wooded Depth: ❑ Gullies/erosion ❑ Heavily ❑ Good ❑ Presence of adj9cent ponds, streams, water Wooded impoundments Comments/Observations: Private ( Public For on -site water well: g? ATRR SUPPLY Name of public water supplier Is water well less than 100 feet from drainfield? ^'Ifyes, attach documentation, i.e. well log or driller affidavit, that well is pressure cemented or grouted to required depth. Neighboring wells within 100 feet of property line? *If neighboring wells e)dst they must be shown on the design. Water saving devices Yes No '-Yes No i '-Yes � No) ❑ Water softener ❑ Reverse osmosis system ❑ Other: Victoria Comty Public Health Department Environmental Services OSSF Applicationpadet Page 10 of35 Revised 02(08f2016 SOIL iEVALUA TIION Requirements; ® At least two soil evaluations must be performed on the site, at opposite ends of the proposed disposal area. Locations of soil boring or dug pits must be shown on the drawing, ® For subsurface disposal, soil evaluations must be performed to a depth of at least two feet below the proposed trench depth. For surface disposal, the surface horizon must be evaluated. ® Please describe each soil horizon and identify any restrictive features in the space provided below. Draw lines at the appropriate depth. Proposed Trench Depth (Will be 1 S" to 36" unless designed by P.E. or R.S.) Soil Bo Number Depth Textural Soil Texture Gravel Analysis Drainage (Mottles/Water Restrictive (Feet) Class And Color For Class II and lII Table) indicate color of Horizon Mottling 0 1 G (a Y z 3 4 5 6 Soil Boring:Number Depth Textural Soil Texture Gravel Analysis Drainage (Mottlea(Water Restrictive (Feet) Class And Color For Class II and III Table) indicate color of Horizon mottling o 1 � G,� y 2 3 4 5 6 I cr=e"7 thi sport are based on my field observations and are accurate to the best of my ability. a q-7SY S- 11� --1% S" ature of Certified Site Il aluatorM & License # Date Victoria County Puhlie Health DepaitmentHnvironmental Services Page I l of3s OSSF Application Packet Revised 02/08/2016 SOEL EVALUATION Requirements: ® At least two soil evaluations must be performed on the site, at opposite ends of the proposed disposal area. Locations of soil boring or dug pits must be shown on the drawing, ® For subsurface disposal, soil evaluations must be performed to a depth of'at least two feet below the proposed trench depth. For surface disposal, the surface horizon must be evaluated. ® Please describe each soil horizon and identify any restrictive features in the spaee provided below. Draw lines at the appropriate depth. Proposed Trench Depth (Will be 18" to 36" unless designed by P.E. or R.S.) Soil BoringNumber Depth Textural Soil Texture Gravel Analysis Drainage (Mottles/Water Restrictive (Feet) Class And Color For Class 11 and M Table) indicate color of Horizon mottling 0 2 3 4 5 6 Soil BoringNumher Depth Textural Soil Texture Gravel Analysis Drainage (Mottles(Water Restrictive (Feet) Class And Color Fot Class U and III Table) indicate color of Horizon mottling o 1 �. 2 _ 3 4 5 6 Ice ' that the f gs f Yhi eport are based on my field observations and are accurate to the best of my ability. r 7A 9-75Y-" 5-- � -- Q . S' atom of Certified Site B aluator/PE & License # Date Victoria County Public Health Depalmentfinv'iroamental services Page 11 or35 033F Application Packet Revised O2/0g12016 THE COUNTY OF CALHOUN STATE OF TEXAS 2021-05038 OSSF Total Pages: 2 milI1Nprr�il��+ I l�f�dlK'Kd�'lL f��l'dl�tYrl�GrlYlti+�11III AFFIDAVIT According to Texas Commission on Environmental Quality Rules for On -Site Sewage Facilities (OSSFs), this document is filed in the Deed Records of CALHOUN County, Texas. I The Texas Health and Safety Code, Chapter 366 authorized the Texas Commission on Environmental Quality (TCEQ) to regulate on -site sewage facilities (OSSFs). Additionally, the Texas Water Code (TWC), Sec 5.012 and Sec 5.013, gives the TCEQ primary responsibility for implementing the laws of the State of Texas relating to water and adopting rules necessary to carry out its powers and duties under the TWC. The TCEQ under the authority of the TWC and the Texas Health and Safety Code, requires owners to provide notice to the public that certain types of OSSFs are located on specific pieces of property. To achieve this notice, the TCEQ requires a deed recording. Additionally, the owner must provide proof of the recording to the OSSF permitting authority. This recorded affidavit is not a representation or warranty by the TCEQ of the suitability of this OSSF, nor does it constitute any guarantee by the TCEQ that the appropriate OSSF was installed. II An OSSF requiring a maintenance contract, according to 30 Texas Administrative Code Sec 285.91(12) will be Installed on the property described as: TILKE & CROCKERAST ADD -M MB. BLOCK 1l2 OF 30, ACRES 4,546 & TILKE & CROCKER-1ST ADD AB/M& BLOCK 33, ACRES 8,468, The property is owned by ANTONIO SANTOS. This OSSF shall be covered by a continuous service policy for the first two years. After the initial two-year service policy, the owner of an aerobic treatment system for a single-family residence shall either obtain a maintenance contract within 30 days or maintain the system personally (when the permitting authority allows). As per Sec. 285.7(d)(4)(B) An owner may not maintain an OSSF under the provisions of this section for commercial, speculative residential, or multifamily property. If applicable, applicant agrees that, in the event of sale of property, the properties above will be sold together as one. If the properties are to be sold separately, the existing on -site sewage facility which shares both properties must be dismantled, Permits for the alteration of the on -site sewage facility may be required. Planning materials for existing, permitted, on -site sewage facilities are available with the authorized agent, which at the time of this signing is the Victoria County Public Health Department located at 2805 N. Navarro, Victoria, Texas 77901, Upon sale or transfer of the above -described property, the permit for the OSSF shall be transferred to the buyer or new owner. A copy of the planning materials for the OSSF can be obtained from Victoria County Public Health Department, IN WITNESS, WHEREOF (s)he has hereto set his/her hand, SIGNATURE: PRINTED NAME: 4e I hereby certify that RXl Vp%j n , known to me to be the afiiant In the foregoing affidavit, personally appeared before me thGday and having been by me duly sworn deposes and says that the facts set forth in the above affidavit are true and correct. WITNESS MY HAND AND OFFICEAL SEAL THIS THE " DAY Op t ►OY.PiIYf1NX 12021. Return copy to: �= Lone Star Septic Service ary Publiq Slate of 1283 Jentry Rd. Notary's Printed Name: Inez, TX 77968 My Commission Expire ALI WALPOIE '=•i •z My Notary ID # 132487851 Expires May 20, 2024 FILED AND RECORDED OFFICIAL PUBLIC RECORDS 2021-05038 OSSF Fee; $2S.00 22/06/2021 10:34 AM ksmith 0p) Anna Goodman County Clerk Calhoun County, Texas 2021-06038 12/06/2021 10:34:48 AM Page 2 of 2 Calhoun County Floodplain Administration 211 South Ann Street, Suite 301 Port Lavaca, TX 77979-4249 Phone: 361-553-4455/Fax: 361-553-4444 e-mail: ladonna.thigpen@calhouncotx.org November 1, 2021 Lone Star Septic Service 1261 Gentry Road Inez, TX 77968 Re: Antonio Santos, 355 Margie Tewmey, Port Lavaca, TX Property ID #38933 and 39050 Dear Ms. Walpole, This letter is a Floodzone determination only for the installation of a septic system at the above referenced property. The actual septic permits are issued through the Victoria City -County Health Dept. for Calhoun County. This information can't be used for any other purpose, such as obtaining insurance or as permission to build. Development permits are issued from the Floodplain office located in the Calhoun County Courthouse at 211 S. Ann St., Suite 301, Port Lavaca, TX. The property located at 355 Margie Tewmey, in the unincorporated area of Calhoun County, is located in Flood Zone AE (el 10) Community #480097 Panel #48057CO225E. This property has wetlands and development can only be done in the designated area. Sincerely, LaDonna Thigpen, CFM Preliminary WOTUS Delineation Santos Property Port Lavaca, Calhoun County, Texas August 10, 2021 Terracon Project No. 90217343 Prepared for: Antonio Santos Port Lavaca, Texas Prepared by: Terracon Consultants, Inc. San Antonio, Texas August 10, 2021 Antonio Santos 355 Margie Tewmey Port Lavaca, TX 77979 Re: Waters of the U.S. Delineation Santos Property Port Lavaca, Calhoun County, Texas Terracon Project No. 90217343 Dear Mr. Santos: Irerracon Terracon Consultants, Inc. (Terracon) is pleased to submit the enclosed Preliminary Waters of the United States (WOTUS) Delineation report addressing Section 404 of the Clean Water Act compliance requirements as they may affect the proposed RV park project in Port Lavaca, Calhoun County, Texas. Based on Site conditions at the time of reconnaissance, it is Terracon's opinion that there are jurisdictional features present within the Site; however, the U.S. Army Corps of Engineers (USACE) is the official agency to make the final determination of the location, type, and extent of jurisdictional WOTUS. Should the proposed project change, please contact Terracon to discuss if formal coordination would be required. We appreciate the opportunity to be of service to you on this project. For more detailed information on all of Terracon's services please visit our website at www.terracon.com. If there are any questions regarding this report or if we may be of further assistance, please do not hesitate to contact Jennifer T. Peters at (210) 218-7010 or by e-mail at Jennifer. peters@terracon.com. Sincerely, Terracon Consultants, Inc. Jennifer Trombley Peters Senior Project Manager Environmental Planning Attachments Terracon Consultants, Inc. 6911 Blanco Road, San Antonio, Texas 78216 P [210] 641-2112 F [210] 641-2124 terracon.com Texas Professional Engineers No. 3272 TABLE OF CONTENTS EXECUTIVESUMMARY......................................................................................... Opinion........................................................................................................ 1.0 INTRODUCTION......................................................................................... 2.0 PRELIMINARY DATA GATHERING AND ANALYSIS ............................. 2.1 Topographic Map........................................................................... 2.2 National Wetlands Inventory Map .................................................. 2.3 Soil Survey..................................................................................... 2.4 FEMA Flood Insurance Rate Map .................................................. 2.5 Aerial Photographs......................................................................... 2.6 Wetland Hydrologic Index.............................................................. 3.0 FIELD METHODS....................................................................................... 3.1 Wetland Field Methods.................................................................. 3.1.1 Vegetative Community...................................................... 3.2 Hydric Soils.................................................................................... 3.2.1 Wetland Hydrology............................................................ 3.3 Non -Wetland WOTUS Field Methods ............................................ 4.0 FIELD OBSERVATIONS............................................................................ 4.1 Vegetative Community ................................................................... 4.2 Stream and Open Features........................................................... 4.3 Wetlands........................................................................................ 5.0 PRINCIPAL FINDINGS OF THE INVESTIGATION ................................... APPENDICES APPENDIXA EXHIBITS Exhibit 1: Vicinity Map Exhibit 2: Site Map Exhibit 3: USGS Topographic Map Exhibit 4: National Wetland Inventory Map Exhibit 5: Soils Map Exhibit 6: Flood Insurance Rate Map Exhibit 7: EMST Exhibit 8: WOTUS Map APPENDIX B PHOTO LOG APPENDIX C DATA FORMS APPENDIX D COMMON ACRONYMS Page No. .................. I 1 ................. 2 ................. 2 ................. 2 ................. 2 ................. 3 ................. 4 ................. 4 ................. 5 ................. 5 ................. 5 ................. 6 ................. 7 ................. 7 ................. 8 ................. 8 ................. 9 ................. 9 ...............10 Preliminary WOTUS Delineation 1rerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 EXECUTIVE SUMMARY Terracon Consultants, Inc. (Terracon) conducted a delineation of waters of the United States (WOTUS) for the undeveloped Site of approximately 12-acre tract of land located approximately 3,375 feet southwest of Magnolia Beach in Port Lavaca, Calhoun County, Texas. Terracon's qualified wetland scientists Christopher Amy and Jennifer Peters conducted a site visit on July 2nd, 2021 in order to assess the presence of potentially jurisdictional WOTUS within the Site. The Site was reviewed for potential WOTUS using the routine determination methodology published in the 1987 Corps of Engineers Wetland Delineation Manual (Technical Report Y-87-1, online edition) as amended by the Atlantic and Gulf Coastal Plain Regional Supplement manual. The Site was also reviewed for potential WOTUS, including wetlands, following the current guidance from the U.S. Environmental Protection Agency and the U.S. Army Corps of Engineers (USACE). Opinion Terracon's opinion is that there is a potential jurisdictional feature within the Site. The wetland feature receives water from off -site to the northwest and a stormwater conveyance system from the southwest, surface runoff from Margie Tewmey Road, overland flows and is connected to Old Town Lake prior to discharging into the Lavaca Bay. Therefore, consistent with the rule and guidance, the features listed above within the Site should be considered WOTUS and subject to USACE jurisdiction under Section 10 of the Rivers and Harbors Act and Section 404 of the CWA. However, the USACE is the official agency to make the final determination of the location, type, and extent of jurisdictional WOTUS. Terracon's opinion of jurisdictional waters is summarized as follows: ■ Wetland This opinion is part of an executive summary and incomplete without the remainder of the Preliminary WOTUS Delineation report. Responsive ■ Resourceful ■ Reliable Preliminary WOTUS Delineation lrerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 1.0 INTRODUCTION Terracon Consultants, Inc. (Terracon) conducted a delineation of waters of the United States (WOTUS) for the Site undeveloped Site of approximately 12-acre tract of land located approximately 3,375 feet southwest of Magnolia Beach in Port Lavaca, Calhoun County, Texas, Calhoun County, Texas (Site), as shown on Exhibits 1— 2.3 in Appendix A. Terracon conducted the preliminary WOTUS delineation in order to assess the jurisdiction of WOTUS on the Site. The following Exhibits are included in Appendix A: ■ Vicinity Map (Exhibit 1) ■ Site Map (Exhibits 2)) ■ USGS Topographic Map (Exhibit 3) ■ National Wetlands Inventory Map (Exhibit 4) ■ Soils Map (Exhibit 5) ■ Floodplain Map (Exhibit 6) ■ EMST(Exhibit 7) ■ WOTUS Map (Exhibit 8) Terracon's qualified wetland scientists conducted a Site visit on July 2nd, 2021 in order to assess the presence of potentially jurisdictional WOTUS within the Site. The Site was reviewed for potential WOTUS using the routine determination methodology published in the 1987 Corps of Engineers Wetland Delineation Manual (Technical Report Y-87-1, online edition) as amended by the Atlantic and Gulf Coastal Plain Regional Supplement manual. The Site was also reviewed for potential WOTUS, including wetlands, following the current guidance form the U.S. Environmental Protection Agency (EPA) and the USAGE. Geographically referenced features were collected using a Trimble Geo7X Global Positioning System (GPS) handheld receiver, capable of sub -foot accuracy, to record the locations of data collected and the boundaries of potentially jurisdictional WOTUS on the Site, as applicable. If the proposed Site layout would impact all or a portion of jurisdictional WOTUS on the Site, then the proposed project may require coordination for a Section 10 of the Rivers and Harbor Act and/or Section 404 of the Clean Water Act permit from the USACE. The observations and opinions contained in this report are based on guidance, regulations, and data available at the time of preparation as well as Site conditions encountered at the time of the site reconnaissance. Guidance, regulations, data furnished by others, and site conditions are dynamic and subject to changes beyond the control of Terracon. A future evaluation may yield differing results. Responsive ■ Resourceful ■ Reliable Preliminary WOTUS Delineation l rerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 This Preliminary WOTUS Delineation report is prepared for the exclusive use and reliance of Antonio Santos. Use or reliance by any other party except a governmental entity having jurisdiction over the Site is prohibited without the written authorization of Antonio Santos and Terracon. Reliance on the Preliminary WOTUS Delineation by the client and all authorized parties will be subject to the terms, conditions and limitations stated in the proposal, Preliminary WOTUS Delineation report, and the Agreement for Services. 2.0 PRELIMINARY DATA GATHERING AND ANALYSIS Prior to performing the site visit, several sources of mapping and other relevant background data were reviewed to assist with identifying aquatic features with the Site. Each source of data is described below. 2.1 Topographic Map The United States Department of the Interior Geologic Survey (USGS) 7.5-Minute Topographic Map of the Site was reviewed to identify drainages or suspect WOTUS within the Site. A portion of the Calhoun County, Texas quadrangle can be seen on Exhibit 3 in Appendix A. The USGS map does exhibit a blueline to the north and east of the Site. The presence of a blueline may indicate a potential WOTUS occurring but must be field verified to report present site conditions. 2.2 National Wetlands Inventory Map The National Wetlands Inventory (NWI) Map of the Site was reviewed to identify suspect wetland areas. The map for the Site was published by the U.S. Department of the Interior's Fish and Wildlife Service (USFWS) and depicts suspect wetland areas based on stereoscopic analysis of high -altitude aerial photographs. Two wetland features were mapped within the site: PEM1J Palustrine (P), Emergent (EM), Persistent (1), Intermittently flooded (J); and PEM1/SS3A Palustrine (P), Emergent (EM), Persistent (1), Scrub -shrub (SS), Broad-leaved evergreen (3), temporarily flooded (A). The NWI Map is found on Exhibits 4 in Appendix A. 2.3 Soil Survey According to the NRCS online Soil Data Mart and the 1978 Soil Survey of Calhoun County, Texas, the project lies within two general soil types and one Land Resource Area and Region as listed in Table 1 & 2. Table 3 lists the general soil types listed on the Site. Based on finding from the soil sampling conducted during the field survey, it appears this classification accurately describes existing conditions. The soils map exhibits the general soil types and locations and is found on Exhibit 5 in Appendix A. Responsive ■ Resourceful ■ Reliable 2 Preliminary WOTUS Delineation Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 Table 1. Soil Type lrerracon General Soil Type Textureand Drainage General Location Percent of Site Deep, nearly level to Livia Series gently sloping, non- Low Coastal Uplands 81.8% calcareous and saline loamy soils Matagorda Series Deep, nearly level, non- Low Coastal Uplands 7.5% calcareous loamy soils Placebo Series Deep, nearly level, non- Floodplains along Streams 10.8% calcareous clayey soils Table 2. Major Land Resource Area Land Resource Region ` ,fie- �. AWN, G..'`t x' sTid' ..a y SM1^•^-ai F Sf' b; FYwa.+i ®' % i •-J4 �$,r�Jl qa� „t, c i .. + n� f-i -{� yST 5c°iti`� i 4...a+�"ru.eu. 1�gf.CFR(yei4 i y. M; Y"NN dix.w+�.i t o_' °� SSWdnu. .w r 1%Juuex.1-1 "il)yMS 'J k i[ N °Y et",'�14 '7 y, .�^x i.usti�'ct r..�`i"�`iis.n ^�.&;�;fSGulf Coast Prairies Atlantic and Gulf Coast Lowland Forest and Crop Region Table 3. Mapping Units Livia silt loam, 0 to 1 percent slopes, rarely 0.0-0.06"/hr Somewhat poorly drained No flooded (Lo) Livia clay loam, 0 t.. 1 0.0-0.06"/hr Poorly drained Yes percent slopes eroded 0.0-0.06"/hr Poorly drained Yes (Lx) Matagorda very fine sandy loam, occasionally 0.0-0.06"/hr Somewhat poorly drained No flooded (Ma) Placebo clay, 0 to 1 percent slopes, frequently 0.0-0.06"/hr Very poorly drained Yes flooded, occasionally ponded (Pc) 2.4 FEMA Flood Insurance Rate Map Terracon downloaded and reviewed Federal Emergency Management Agency (FEMA) Flood Insurance Rate Map (FIRM). According to the FIRM map, the entire Site does fall within the 100- year floodplain; the mapped areas within the Site is located in Zone AE, which is defined as areas that are inundated by the 1-percent-annual-chance flood event. A FEMA Map is included as Exhibit 6 in Appendix A. Responsive ■ Resourceful ■ Reliable 3 Preliminary WOTUS Delineation lrerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 2.5 Aerial Photographs Terracon reviewed aerial photographs to review suspect WOTUS, including wetland areas that may be present on the Site. Aerial photograph from 2016 (Exhibit 2, Appendix A) was analyzed to determine land use and historic changes to the Site. The Site consists of undeveloped land and aquatic features. From the north, northwest portion of the Site to the southeast, there appears to be large area of dense vegetation immediately adjacent to a defined surface water feature and adjacent ponded areas. The northeastern and southern portions of the Site appear to have less vegetation than the portion previously described. The Site is bordered by a road to the east, and undeveloped land to the north, west, and south. A development is located to the southwest of the site that includes a building surrounded by an anthropogenic canal. 2.6 Wetland Hydrologic Index Terracon downloaded and reviewed local climate data to identify current Site hydrologic conditions. Data from the NRCS Agriculture Applied Climate Information System (AgACIS) was downloaded and reviewed using the Direct Antecedent Rainfall Evaluation Method (DAREM). The DAREM provides an index of climatic conditions, as they pertain to wetland hydrology, for the time period in which field data was collected. Rainfall data was obtained from the Point Comfort, TX weather station; the nearest weather station to the study area with the range of historic data available necessary to calculate the DAREM. Table 4 and Table 5 summarize the DAREM index data for the Site at the time of the site investigation in July 2021. According to the DAREM, the Site was experiencing wetter than normal hydrologic conditions at the time of the site investigation, and field observations should be evaluated with those conditions in mind. Table 4: Project Area Wetland Hydrologic Condition for August 2021 Prior Month Month WETS Percentile (in) Measured Rainfall' Condition2 Weight3 Score 30'h lOrh 1st June 2.65 6.31 11.83* 3 3 9 2nd May 1.81 5.25 10.96 3 2 6 3rd April 1.11 3.27 16.01 3 1 3 Total: 18 'Measured rainfall recorded at Point Comfort, Texas weather station 2Condition: 1 = monthly rainfall totals less than the 30-year Extreme Rainfall Distribution 30t^ percentile, 2 = monthly rainfall totals between the 30t^ and 70t^ percentile for the 30-year Extreme Rainfall Distribution, 3 = monthly rainfalls totals greater than the 70r^ percentile for the 30-year Extreme Rainfall Distribution 3Monlhly weights equal 3 for the prior month, 2 for the second prior month, and 1 for the third prior month. *Missing data in month/under estimate Responsive ■ Resourceful ■ Reliable 4 Preliminary WOTUS Delineation l Terracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 Table 5: DAREM Score Summary DAREM Score (Observed Score) 6 7 8 9 10 11 12 13 14 15 16 17 18 DAREM Wetland Hydrologic Wetter than Drier than normal Normal Condition normal 3.0 FIELD METHODS Terracon wetland scientists conducted a reconnaissance of the Site to characterize existing conditions and identify the presence/absence of potentially jurisdictional WOTUS. Terracon used post -processed data from a Trimble Geo 7X handheld GPS unit (model number 88161) to geographically reference features such as wetland boundaries, OHWM, and the soil station points collected during the field survey. Geographic Information System (GIS) software was used to analyze collected features, calculate areas, and generate figures provided in Appendix A. The Site was reviewed for potentially jurisdictional WOTUS (including wetlands) using the routine determination methodology published in the 1987 Corps of Engineers Wetland Delineation Manual (Technical Report Y-87-1, online edition) as amended by the Atlantic and Gulf Coastal Plain Regional Supplement manual. The Site was also reviewed for potential WOTUS, including wetlands, following the current guidance from the U.S. Environmental Protection Agency and the USACE. Guidance as presented in the USACE Jurisdictional Determination Form Instructional Guidebook was also used. The boundaries of potential wetlands, if present, would have been placed at the point where one or more of the field indicators of wetlands were no longer observed. If present, the boundaries of streams and other open water bodies were determined using the OHWM as described in the current guidance. 3.1 Wetland Field Methods Wetlands generally have three essential characteristics: hydrophytic (water -loving) vegetation, hydric soils, and wetland hydrology. During the Site reconnaissance, Terracon personnel traversed the Site and recorded observations with attention paid to suspect areas if they were identified on NWI maps and aerial photographs prior to the site visit. Vegetation and hydrology observations were performed randomly throughout the Site where access was permitted, and soils were evaluated to determine if wetland characteristics were present. Data regarding the three essential characteristics was gathered within observed suspect wetland areas to further delineate boundaries. 3.1.1 Vegetative Community Suspect areas were visually observed to determine the species, when possible, and absolute percentage of ground cover for five strata of plant community types. Herbs were generally observed within a five-foot radius, shrubs/saplings within a fifteen -foot radius, and trees and vines Responsive ■ Resourceful ■ Reliable 5 Preliminary WOTUS Delineation 1rerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 within a thirty-foot radius of the observation location. Areas representing different vegetative communities were identified throughout the Site and a plant community assessment was performed in each vegetative community. For each species of vegetation observed, wetland indicator status was evaluated. The indicator status was determined using the USACE National Wetlands Plant List (NWPL) version 3.3. The NWPL can be found at http://wetland Plants. usace.army.mil. Indicator categories for vegetation are listed below: ■ Obligate Wetland (OBL) — occur almost always (estimated probability greater than 99%) under natural conditions in wetlands. ■ Facultative Wetland (FACW) — usually occur in wetlands (estimated probability 67-99%) but occasionally found in non -wetlands. ■ Facultative (FAC) — equally likely to occur in wetlands or non -wetlands (estimated probability 34-66%). ■ Obligate Upland (UPL) — rarely occur in wetlands, but occur almost always (estimated probability greater than 99%) under natural conditions in non - wetlands. The percent cover of each stratum was determined and dominance was evaluated. Dominant species were the most abundant species that accounted for more than 20 percent of the absolute percent coverage of the stratum. The number of dominant species with an indicator status of OBL, FACW, and/or FAC was compared to the total number of dominant species across all strata. Typically, when more than 50 percent of the dominant species had an indicator status of OBL, FACW, and/or FAC, hydrophytic vegetation was present. If the percentage of dominant species with an indicator status of OBL, FACW, and/or FAC was less than 50 percent, prevalence index and morphological adaptations may have been evaluated to confirm if hydrophytic vegetation was present or absent. 3.2 Hydric Soils After Terracon evaluated wetland vegetation, subsurface soil samples were collected. The samples were collected to a depth of approximately 16 inches below ground surface (or until rock was encountered) and were visually compared to Munsell Soil Color Charts which aided in the evaluation of hydric soil characteristics. The soil samples were further examined for hydric soil indicators including, but not limited to, histosol, thick dark surface, sandy gleyed matrix, sandy redox, loamy gleyed matrix, redox dark surface, and/or redox depressions. If these or other hydric soil indicators were observed in the subsurface soil sample, the observation location was considered to have hydric soil. Responsive ■ Resourceful ■ Reliable 6 Preliminary WOTUS Delineation 1 Terracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 3.2.1 Wetland Hydrology Visual indicators of wetland hydrology were evaluated. Examples of primary wetland hydrology indicators include, but are not limited to surface water, high water table, soil saturation, water marks, sediment deposits, drift deposits, iron deposits, inundation visible on aerial imagery, sparsely vegetated concave surface, and water -stained leaves. If at least one primary or two secondary indicators were observed, the observation location was considered to have wetland hydrology. 3.3 Non -Wetland WOTUS Field Methods Terracon recorded observations of non -wetland Site features that may be considered a jurisdictional WOTUS. If a potential jurisdictional WOTUS was identified, observations regarding its characteristics were recorded. Potentially jurisdictional non -wetland WOTUS were generally evaluated based on the following characteristics: ■ Flow regime o Perennial — flowing water year-round during a typical year o Intermittent — flowing water during certain times of the year (groundwater supports streamflow) o Ephemeral — flowing water for a short duration during and after a precipitation event (groundwater is not a source for streamflow) ■ OHWM — The limit line established by fluctuation of a water surface ■ Bank shape Undercut — banks overhang the channel Steep — bank slope greater than 30 degrees Gradual — bank slope equal to or less than 30 degrees ■ Aquatic Habitat o Pool — deep portion of stream where water flows slower Riffle — shallow portion of stream with swift flow over rock or coarse substrate producing turbulence on the surface o Run — section of stream with little or no turbulence on the surface 3.3.1 Tidal Areas The USACE defines tidal waters as "the landward limits of jurisdiction in tidal waters extend to the high tide line or when adjacent non -tidal waters of the U.S. are present, to the limits of the non -tidal waters." Section 10 jurisdiction in these areas extends to the mean high-water line. A precise determination of the mean high-water line is accomplished by survey with reference to available tidal datum averaged over a period of approximately 19 years. A method to estimate the high-water line location without survey is accomplished by observing a line created by physical Responsive ■ Resourceful ■ Reliable 7 Preliminary WOTUS Delineation 1 rerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 characteristics such as debris accumulation, lines of vegetation, or changes in vegetation types along the coastal shore. High and low tide can also be estimated by collecting georeferenced locations of the tide line during high and low tide events. For purposes of this scope of work, Terracon delineated the approximate high and low tide lines using data from National Oceanic and Atmospheric Administration (NOAA) Tides and Currents website (https://tidesandcurrents.noaa.gov/). The website uses data collected from tidal stations located throughout the U.S. The Seadrift, Texas location (tidal station number 8773037) was used to estimate the approximate high and low tides times for the August 21 & 22, 2019 site visit. Terracon used a Trimble Geo 7X handheld GPS unit (model number 88161) capable of sub -foot accuracy to geographically reference the high and low tide lines at the estimated times given by NOAA. Please note this data is not survey data from a Licensed State Land Surveyor (LSLS), as survey was not included in the scope of service for this work. 4.0 FIELD OBSERVATIONS 4.1 Vegetative Community Vegetative communities are classified by the Texas Parks and Wildlife Department Ecological Mapping System of Texas (EMST). The vegetative communities identified by Texas Parks and Wildlife Department are further described below. Species observed during the site visit included: saltmarsh mallow (Kosteletzyka virginica), sea ox-eye daisy (Borrichia frutescens), common sunflower (Helianthus annuus), marshhay cordgrass (Spartina patens), smooth cordgrass (Spartina alterniflora), saltmarsh club -rush (Schoenoplectus maritimus), sea purslane (Sesuvium maritimum), cow pea (Vigna luteola), seaside heliotrope (Heliotropium curassavicum), salt cedar (Tamarix gallica), hackberry (Celtic leevigata), Bermudagrass (Cynodon dactylon), and giant reed (Arundo donax). A EMST Map is included as Exhibit 7 in Appendix A. 1. Coastal: Salt and Brackish High Tidal Shrub Wetland These sites may be dominated by species such as, Iva frutescens (shrubby sumpweed) or Baccharis halimifolia (eastern baccharis). 2. Gulf Coast: Salty Prairie Occurrences of the system lacking significant shrub cover. 3. Gulf Coast: Salty Prairie Shrubland Occurrences of the system where shrubs, such as those listed above, have dominated the site. 4. Native Invasive: Baccharis Shrubland This type is mapped on salty or sandy soils and Baccharis spp. (baccharis), Prosopis glandulosa (honey mesquite), Tamarix spp. (salt cedars), and Iva frutescens (shrubby sumpweed) are the Responsive ■ Resourceful ■ Reliable 8 Preliminary WOTUS Delineation 1rerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 most common dominants. Other shrubs may include Triadica sebifera (Chinese tallow), Borrichia frutescens (sea ox-eye daisy), Rosa bracteata (Macartney rose), Forestiera acuminata (swamp privet), and Zanthoxylum fagara (colima), and grasses may include Spartina spartinae (Gulf cordgrass), Distichlis spicata (saltgrass), Cynodon dactylon (bermudagrass), and Sporobolus indicus (rat-tail smutgrass). 5. Non -Native Invasive: Chinese Tallow Forest, Woodland, or shrubland More or less dense stands of Triadica sebifera (Chinese tallow) characterize this type, which is generally mapped over prairie soils, but a diversity of mainly invasive deciduous shrublands and sparse woodlands are circumscribed. Other component species may include Prosopis glandulosa (honey mesquite), Acacia farnesiana (huisache), Baccharis spp. (baccharis), Rosa bracteata (Macartney rose), Ulmus crassifolia (cedar elm), Quercus nigra (water oak), Ligustrum sinense (Chinese privet), and Ilex vomitoria (yaupon). Sparse tree cover with Celtis laevigata (sugar hackberry), Quercus nigra (water oak), Quercus phellos (willow oak), Quercus fusiformis (plateau live oak), Quercus virginiana (coastal live oak), Pinus taeda (loblolly pine), and Liquidambar styraciflua (sweetgum) may be present. 4.2 Stream and Open Features During the field reconnaissance, Terracon observed that site conditions were not consistent with those observed on background information. An ordinary high water mark (OHWM) was not observed within the vegetated area located within the center of the property, from the northwest to the southeast. 4.3 Wetlands During the Site visit, Terracon personnel traversed the study area and observed three wetland features that did exhibit vegetation, soil, and hydrology indicators typically indicative of being classified as a wetland. Site descriptions can be seen on the USACE Wetland Determination Data forms (Appendix C) for the nine data points that were taken during the site reconnaissance. Data points 2, 5, and 7 describe the indicators of the wetlands observed. The remaining data points did not exhibit the three essential characteristics for a wetland. The sample locations can be seen on Exhibit 8, in Appendix A. Table 6 summarizes the wetland feature observed during the site visit. Table 6: Wetland Features Welland Feature Acres Type Wetland -5.16 Emergent Wetland Responsive ■ Resourceful ■ Reliable 9 Preliminary WOTUS Delineation l rerracon Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 5.0 PRINCIPAL FINDINGS OF THE INVESTIGATION According to the Federal Register (33CFR §328.3(a)), WOTUS may include intrastate rivers and streams, including impoundments and other waters. Since the 2006 Supreme Court decision (Rapanos v. U.S., 547 S. Ct. 715) the USACE and EPA have continued to assert jurisdiction over traditionally navigable waters (TNW) and non -navigable tributaries of TNW where the tributaries are relatively permanent waters (i.e. streams with perennial or intermittent flow). Current USACE guidelines require a significant nexus evaluation for: (1) waterbodies and tributaries that are not relatively permanent waters (i.e. ephemeral), including adjacent wetlands if present; and, (2) wetlands adjacent to, but not directly abutting, a traditionally navigable or relatively permanent water. A significant nexus exists if the aquatic features in question has more than a speculative or insubstantial effect on the chemical, physical, or biological integrity of a traditionally navigable water. Establishment of a significant nexus is necessary to establish jurisdiction as a WOTUS. The wetland feature that is present on the Site is considered a Emergent Wetland and is therefore considered to be WOTUS and subject to USACE jurisdiction under Section 404 of the Clean Water Act (CWA). This function demonstrates more than a speculative or insubstantial effect on the chemical, physical, or biological integrity of a TNW. Therefore, consistent with the rule and guidance, the features listed above within the Site should be considered WOTUS and subject to USACE jurisdiction under Section 404 of the CWA. As noted in 33CFR § 328.3 the USACE generally does not consider the following types of features to be WOTUS: 1. Non -tidal drainage and irrigation ditches excavated on dry land; 2. Artificially irrigated areas which would revert to upland if the irrigation ceased; 3. Artificial lakes or ponds created by excavating and/or diking dry land to collect and retain water and which are used exclusively for such purposes as stock watering, irrigation, settling basins, or rice growing, 4. Artificial reflecting or swimming pools or other small ornamental bodies of water created by excavating and/or diking dry land to retain water for primarily aesthetic reasons; 5. Waterfilled depressions created in dry land incidental to construction activity and pits excavated in dry land for the purpose of obtaining fill, sand, or gravel unless and until the construction or excavation operation and the resulting body of water meets the definition of waters of the United States. Responsive ■ Resourceful ■ Reliable 10 Preliminary WOTUS Delineation Santos Property ■ Calhoun County, Texas August 10, 2021 ■ Terracon Project: 90217343 1 rerracon Features described in the categories described above were not observed within the Site. Table 7 below lists the WOTUS features, regulation section, approximate linear feet, and approximate acreage of the features observed within the Site. Table 7: WOTUS Features Within Project Areas - ° Approx. Lerigth, (linear' Appr�ox. Acreage Feature Regulation,USAGE Classification feetYWithin"Site_ ' Within Site Wetland Section 404 Emergent Wetland 785 5.16 Responsive ■ Resourceful ■ Reliable 11 APPENDIX A EXHIBITS roject Mngr: JTP Riuly2021 1f�rr�Can VicinityMapExhibit yawn By: AA Santos Property hecketl By: CA Con Ent ineel5., Scientists Margie Tewmey Rd pprovetl By: JTP 6911 Blanco Roaan Anlano. TX ]6216 Port Lavaca, Calhoun County, Texas PH 210 647-2112 Fax 2R1 641-2124 roject Mngr. JTP ro7No. 02173 3 Site Mapm rewn By: AA �le: erracon 1 in = 150 ft Santos Property hocked By: CA BPE Firm F 3272 Consulting Engii,eBrs & Scientists Margie Tewmey Rd pproved By: JTP ale: 6911 Blanco Road San Antonio, TX 76216 Port Lavaca, Calhoun County, Texas July 2021 PH 210 641-2112 Fax 210 641-2124 reject wgr: J,j,P Ej 3 Topographic MapExhibit 1#1 1 erracon Santos Property Comultln.- En meen & Scientists2 a s Margie Tewmey Rd3 6911 Blanco Road SanMtonio.TX]8216 Port Lavaca, Calhoun County, Texas PH 210 641-2112 Fex 210 841-2124 r0i tMngr. rolect No. JTP 90217343 Natinal Wetland InventoryMapExhibit town By: AA tale: 11'erracon 1 in = 150 ft Santos Property hacked By: BPE Firm No. Consulting En ineem ft Scieph6(ti cA F-3272 7 B Margie Tewmey Rd 4 pproved By: JTP atejlll 2021 6911 Blanco Road San Antonio, TX 78216 Port Lavaca, Calhoun County, Texas Y PH 210 641-2112 Fax 210 641-2124 g' lN aocm Soils Maprl raven By: � tale: 1 in = 150 ft lrerracon Santos Property Necked By: cq BPE Finn F- F-3272 Consulting En IneeN & Scientists � B Margie Tewmey Rd pprovetl By: ate: July 2021 6911 Blanco Raad San Antonio, TX 78216 Port Lavaca, Calhoun County, Texas JTP PH 216 641-2112 Fax 210 641-2124 roject Mn9r: raject No. J7P Flood lain Ma Exhibit rewn By: AA caie: Irerracon 1 in = No. ft Santos Property hecketl By: BP Finn No. Consulting En iiiee.N & Scientists cn F-3272 � s Margie Tewmey Rd 6 plumed By: DTP ate: 2021 6911 Blanco Road San Antonio, TX 78216 Port Lavaca, Calhoun County, Texas Y PH 210 641-2112 Fax 210 641-2124 inject Wq'.. JTP roject No. 90217343 l�err�con Vegetation MapExhibit 2wn By: � tn 150 ft Santos Property hacked By: CA F 3272 Consulting Engineen i,& ScientISR Margie Tewmey Rd4pproved By: JTP 2021 8911 Blanco Road SanAntanio. TX 78216 Port Lavaca, Calhoun County, Texas PH 210 641-2112 Fez 210 641-2124 roject Mngr: roject No. JTP 2 7343 Potential) Jurisdictional Areas MapExhibit raven By: *July2021 �rr�con Santos Property Consultin En inee.t & SCIRni16t5 Margie Tewmey Rd$fiancooaannono. Port Lavaca, Calhoun County, TexasPH 210 64i-2112 Fez 210 641-2124 APPENDIX B PHOTO LOG ■ j; � \ ■ y.. . v .,. . .� . . . . . 11 �r u 4 l 1 � I j� I D APPENDIX C DATA FORMS WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region Project/Site: Santos City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 Applicant/Owner: Santos State: TX Sampling Point: DP01 Investigator's): C. Amy, J. Peters Section, Township, Range: Magnolia Beach Landform (hillslope, terrace, etc.): Flat Local relief (concave, convex, none): none Subregion (LRR or MLRA): LRR T 150A Let: 28.553011 Long:-96.545908 Soil Map Unit Name: Livia silt loam (Lo) NWI classification: Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation , Soil , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Slope (%): 1 Datum: NAD 83 Yes X No Are Vegetation , Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X within a Wetland? Yes No X Wetland Hydrology Present? Yes No X Remarks: Upland slope to south east area HYDROLOGY Wetland Hydrology Indicators: Secondary Indicators (minimum of two required) ❑ Surface Soil Cracks (136) ❑ Sparsely Vegetated Concave Surface (B8) Primary Indicators (minimum of one is required: check all that apply) ❑ Surface Water (Al) ❑ Aquatic Fauna (1313) High Water Table (A2) Mad Deposits (1315) (LRR U) ❑ Drainage Patterns (B10) I❑ LJ Saturation (A3) 10 Hydrogen Sulfide Odor (C1) Moss Trim Lines (B16) El Water Marks (B1) 1I—Jf Oxidized Rhizospheres along Living Roots (C3) I❑-I1 yDry-Season Water Table (C2) ❑ Sediment Deposits (B2) 1u�f LJ Presence of Reduced Iron (C4) ❑ Crayfish Burrows (C8) Drift Deposits (B3) ❑_ Recent Iron Reduction in Tilled Soils (C6) Saturation Visible on Aerial Imagery (C9) r❑l---II Algal Mat or Crust (64) ❑ Thin Muck Surface (C7) ❑ Geomorphic Position (D2) Iy-1I Ly Iron Deposits (65) El Other (Explain in Remarks) ❑ Shallow Aquitard (D3) Inundation Visible on Aerial Imagery (B7) ❑ FAC-Neutral Test (D5) Water -Stained Leaves (B9) ❑ Sphagnum moss (138) (LRR T, U) Field Observations: Surface Water Present? Yes No X Depth (inches): Water Table Present? Yes _ No X Depth (inches): Saturation Present? Yes _ No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A Remarks: No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal. Plain Region - Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' 1 None Absolute Dominant Indicator ) % Cover Species? Status Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 0.0 (A/B) 2. 3. 4. 5. 6. 7 Prevalence Index worksheet: Total % Cover of: Multiply by: OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 8 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3. 4. 5. Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation 2 - Dominance Test is >50% ❑ 3 - Prevalence Index is 53.0' ❑ Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7. 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1. Axonopus affinis 80 y UPL 2. Setaria parviflora 5 N FACW Definitions of Four Vegetation Strata: Tree -Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub -Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 ft (1 m) tall. Herb -All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine -All woody vines greater than 3.28 ft in height. 3. Panicum capillare 5 N FAC q. Rhynchosia americans 10 N NL 5 6. 7, 8. 9. 10. 11. 12. Woody Vine Stratum (Plot size: 1 None 100 = Total Cover 50% of total cover: 47.5 20% of total cover: 19 5' ) Hydrophytic Vegetation Present? Yes No x 2. 3. 4. 5. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix (inches) Color (moist) % Redox Features Color (moist) % Type' Loc Texture Remarks 0-5' 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. 'Location: PL=Pore Linin , M=Matrix. Hydric ❑ 0 0 L] ❑ 0 0 ❑ ❑ L] Soil Indicators: (Applicable to all LRRs, Histosol (At) Histic Epipedon (A2) Black Histic (A3) Hydrogen Sulfide (A4) Stratified Layers (A5) _E] Organic Bodies (A6) (LRR P, T, U) 5 cm Mucky Mineral (A7) (LRR P, T, U) +II Muck Presence (AS) (LRR U) JJ 1 cm Muck (A9) (LRR P, T) Depleted Below Dark Surface (At 1) unless otherwise noted.) Polyvalue Below Surface (S8) (LRR S, T, U) 0 Thin Dark Surface (S9) (LRR S, T, U) Loamy Mucky Mineral (F1) (LRR O) Loamy Gleyed Matrix (F2) Depleted Matrix (F3) ❑ Redox Dark Surface (F6) Depleted Dark Surface (F7) Redox Depressions (F8) ❑ Marl (F10) (LRR U) ❑ Depleted Ochric (F11) (MLRA 151) Indicators for Problematic Hydric Soils': ❑ 1 cm Muck (A9) (LRR O) 2 cm Muck (A10) (LRR S) Reduced Vertic (F18) (outside MLRA 150A,B) -❑ Piedmont Floodplain Soils (F19) (LRR P, S, T) U Anomalous Bright Loamy Soils (F20) (MLRA 153B) ❑ Red Parent Material (TF2) ' Very Shallow Dark Surface (TF12) j Other (Explain in Remarks) [] [] Thick Dark Surface (Al2) Coast Prairie Redox (A16) (MLRA 150A) ❑ Iron -Manganese Masses (F12) (LRR O, P, T) 3Indicators of hydrophytic vegetation and Umbric Surface (F13) (LRR P, T. U) wetland hydrology must be present, L] L] L] L] Sandy Mucky Mineral (S1) (LRR O, S) Sandy Gleyed Matrix (S4) Sandy Redox (S5) Stripped Matrix (S6) Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. ❑ Reduced Vertic (F18) (MLRA 150A, 150B) ❑ Piedmont Floodplain Soils (F19) (MLRA 149A) ❑ Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D) L] Dark Surface (S7) (LRR P, S, T, U) Restrictive Layer (if observed): Type: None Depth (inches): NIA Hydric Soil Present? Yes No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region Project/Site: Santos City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 Applicant/Owner: Santos State: TX Sampling Point: DP01 Investigator(s): C. Amy, J. Peters Section, Township, Range: Magnolia Beach Landform (hillslope, terrace, etc.): Flat Local relief (concave, convex, none): none Slope (%): 1 Subregion (LRR or MLRA): LRR T 150A Let: 28.553011 Long:-96.545908 Datum: NAD 83 Soil Map Unit Name: Livia silt loam (Lo) NWI classification: Are climatic / hydrologic conditions on the site typical for this time of year? Yes X Are Vegetation Soil or Hydrology significantly disturbed? Are Vegetation _, Soil , or Hydrology naturally problematic? No (If no, explain in Remarks.) Are "Normal Circumstances" present? Yes X No (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transects, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X within a Wetland? Yes No X Wetland Hydrology Present? Yes No X Remarks: Upland slope to south east area HYDROLOGY LJ Surface Water (Al) Q High Water Table (A2) ❑ Saturation (A3) ❑_ Water Marks (131) ❑ Sediment Deposits (132) I❑ Drift Deposits (63) Uy Algal Mat or Crust (84) Q Iron Deposits (135) ✓V Inundation Visible on Aerial Imagery (137) EJ Water -Stained Leaves (139) Aquatic Fauna (B13) Marl Deposits (1315) (LRR U) Hydrogen Sulfide Odor (Cl) Oxidized Rhizospheres along Living Roots (C3) Presence of Reduced Iron (C4) Recent Iron Reduction in Tilled Soils (C6) Thin Muck Surface (C7) Other (Explain in Remarks) ❑ Surface Soil Cracks (136) ❑ Sparsely Vegetated Concave Surface (138) ❑ Drainage Patterns (B10) ❑ Moss Trim Lines (1316) n Dry -Season Water Table (C2) ❑ Crayfish Burrows (C8) I�I-II Saturation Visible on Aerial Imagery (C9) L1 Geomorphic Position (D2) ,❑ Shallow Aquitard(D3) ❑I ---II FAC-Neutral Test (D5) 11 Sphagnum moss (138) (LRR T, U) Surface Water Present? Yes No X Depth (inches): Water Table Present? Yes _ No X Depth (inches): Saturation Present? Yes _ No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' 1 None Absolute Dominant Indicator ) % Cover Species? Status Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAG: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 0.0 (A/B) 2. 3. 4. 5. 6. 7 Prevalence Index worksheet: Total %Cover of: Multiply by: 8 OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3 4. 5. Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation 2 - Dominance Test is >50% El 3 - Prevalence Index is 53.0' C1 Q Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7. 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1. Axonopus affinis 80 Y UPL 2. Setaria parviflora 5 N FACW Definitions of Four vegetation Strata: Tree- Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub - Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 ft (1 m) tall. Herb -All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine -AII woody vines greater than 3.28 ft in height. 3. Panicum capillare 5 N FAC Rh nchosia americans 10 N NL 4. Y 5 6. 7, 8. 9. 10. 11. 12. Woody Vine Stratum (Plot size: 1. None 100 = Total Cover 50% of total cover: 47.5 20% of total cover: 19 5' ) Hydrophytic Vegetation Present? Yes _ No x 2. 3. 4. 5. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type' Lac Texture Remarks 0-5" 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. 'Location: PL=Pare Lining, M=Matrix. Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.) Indicators for Problematic Hydric Soils': 0 Histosol (Al) .[� Polyvalue Below Surface (S8) (LRR S, T, U) ❑ 1 cm Muck (A9) (LRR O) -❑ Histic Epipedon (A2) Thin Dark Surface (S9) (LRR S, T, U) 2 cm Muck (At 0) (LRR S) El Black Histic (A3) Loamy Mucky Mineral (F1) (LRR O) Reduced Vertic (F18) (outside MLRA 150A,B) ,[] Hydrogen Sulfide (A4) Loamy Gleyed Matrix (F2) Piedmont Floodplain Soils (F19) (LRR P, S, T) 0 Stratified Layers (A5) ✓ Depleted Matrix (F3) Anomalous Bright Loamy Soils (F20) .[] Organic Bodies (A6) (LRR P, T, U) Redox Dark Surface (F6) (MLRA 153B) ❑ 5 cm Mucky Mineral (A7) (LRR P, T, U) Muck Presence U) Depleted Dark Surface (F7) Redox Depressions Red Parent Material (TF2) -E] Very Shallow Dark Surface (TF12) �] (AS) (LRR 1 cm Muck (A9) (LRR P, T) (F8) Marl (F10) (LRR U) U Other (Explain in Remarks) L] Depleted Below Dark Surface (At 1) Depleted Ochric (F11) (MLRA 151) ❑ Thick Dark Surface (At 2) Iron -Manganese Masses (F12) (LRR O, P. T) 3Indicators of hydrophytic vegetation and 0 Coast Prairie Redox (At 6) (MLRA 150A) Umbric Surface (F13) (LRR P, T, U) wetland hydrology must be present, L] Sandy Mucky Mineral (S1) (LRR 0, S) jj Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. Sandy Gleyed Matrix (S4) n F1 Reduced Vertic (F18) (MLRA 150A, 150B) Sandy Redox (S5) Piedmont Floodplain Soils (F19) (MLRA 149A) Stripped Matrix (S6) Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D) Dark Surface (S7) (LRR P, S, T, U) Restrictive Layer (if observed): Type: None Depth (inches): NIA Hydric Soil Present? Yes No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM —Atlantic and Gulf Coastal Plain Region Project/Site: Santos Applicant/Owner: Santos Investigator(s): C. Amy, J. Peters Landform (hillslope, terrace, etc.): Flat Subregion (LRR or MLRA): LRR T 150A Soil Map Unit Name: Livia silt loam (Lc City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 State: TX Sampling Point: DP01 Section, Township, Range: Magnolia Beach Local relief (concave, convex, none): none Let: 28.553011 Long:-96.545908 NWI classification: Slope (%): 1 Datum: NAD 83 Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation _, Soil , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No Are Vegetation , Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X within a Wetland? Yes No X Wetland Hydrology Present? Yes No X Remarks: Upland slope to south east area HYDROLOGY LJ Surface Water (Al) Q High Water Table (A2) ❑ Saturation (A3) ❑ Water Marks (B1) ❑ Sediment Deposits (B2) . ❑ Drift Deposits (B3) . 12 Algal Mat or Crust (134) u Iron Deposits (135) Inundation Visible on Aerial Imagery (137) Water -Stained Leaves (B9) Aquatic Fauna (1313) Marl Deposits (B15) (LRR U) Hydrogen Sulfide Odor (Cl) Oxidized Rhizospheres along Living Roots (C3) Presence of Reduced Iron (C4) Recent Iron Reduction in Tilled Soils (C6) Thin Muck Surface (C7) Other (Explain in Remarks) ❑ Surface Soil Cracks (B6) ❑ Sparsely Vegetated Concave Surface (138) ❑ Drainage Patterns (1310) ❑ Moss Trim Lines (B16) ❑ Dry -Season Water Table (C2) ❑ Crayfish Burrows (C8) ❑ Saturation Visible on Aerial Imagery (C9) Geomorphic Position (D2) Shallow Aquitard(D3) FAC-Neutral Test (D5) Sphagnum moss (D8) (LRR T, U) Surface Water Present? Yes _ No X Depth (inches): Water Table Present? Yes No X Depth (inches): Saturation Present? Yes No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' ) 1. None Absolute Dominant Indicator % Cover Species? Status Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 0.0 (A/B) 2. 3. 4. 5. 6. 7. Prevalence Index worksheet: Total % Cover of: Multiply by: 8. OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3. 4' 5' Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation �-I M 2 - Dominance Test is >50% 1�_-tI 3 - Prevalence Index is 53.0' 11 Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7' 8' 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1, Axonopus affinis 80 Y UPL 2. Setaria parviflora 5 N FACW Definitions of Four Vegetation Strata: Tree- Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub- Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 ft (1 m) tall. Herb -All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 It tall. Woody vine - All woody vines greater than 3.28 ft in height. 3. Panicum capillare 5 N FAC q. Rhynohosia Americana 10 N NL 5 6. 7, 8. 9. 10. 11. 12. 100 = Total Cover 50% of total cover: 47.5 20% of total cover: 19 Woody Vine Stratum (Plot size: 5' ) 1• None 2. 3. 4. 5• Hydrophytic 0 = Total Cover Vegetation 50% of total cover: 0 20% of total cover: 0 Present? Yes No x No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description:. (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type' Loc Texture Remarks 0-5" 10 YR 312 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. 'Location: PL=Pore Lining, M=Matrix. Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.) Indicators for Problematic Hydric Soils': �] J—I IL�J 0 0 Histosol (At) Histic Epipedon (A2) ,[] Black Histic (A3) Hydrogen Sulfide (A4) Stratified Layers (A5) Polyvalue Below Surface (S8) (LRR S, T, U) ❑ 1 cm Muck (A9) (LRR O) Thin Dark Surface (S9) (LRR S, T, U) 2 cm Muck (At 0) (LRR S) j] Loamy Mucky Mineral (F1) (LRR O) Reduced Vertic (F18) (outside MLRA 150A,B) [] Loamy Gleyed Matrix (F2) Piedmont Floodplain Soils (F19) (LRR P, S, T) L] Depleted Matrix (F3) U Anomalous Bright Loamy Soils (F20) ❑ Organic Bodies (A6) (LRR P, T, U) ,❑ 5 cm Mucky Mineral (A7) (LRR P, T, U) ,❑ Muck Presence (A8) (LRR U) ,❑ 1 cm Muck (A9) (LRR P, T) ,❑ Redox Dark Surface (F6) Depleted Dark Surface (F7) Redox Depressions (F8) Marl (F10) (LRR U) (MLRA 1536) ❑ Red Parent Material (TF2) -TT❑11 Very Shallow Dark Surface (TF12) LJ Other (Explain in Remarks) Depleted Below Dark Surface (At 1) ❑ Depleted Ochric (F11) (MLRA 151) [� ❑ ,❑ Thick Dark Surface (Al2) Coast Prairie Redox (At 6) (MLRA 150A) Sandy Mucky Mineral (S1) (LRR O, S) ,❑ Sandy Gleyed Matrix (S4) Sandy Redox (S5) Stripped Matrix (S6) Dark Surface (S7) (LRR P, S, T, U) ❑ Iron -Manganese Masses (F12) (LRR O, P, T) 'Indicators of hydrophytic vegetation and ❑ Umbdc Surface (F13) (LRR P, T, U) wetland hydrology must be present, Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. Reduced Vertic (F18) (MLRA 150A, 150B) Piedmont Floodplain Soils (1719) (MLRA 149A) Anomalous Bright Loamy Soils (1720) (MLRA 149A, 153C, 153D) Restrictive Layer (if observed): Type: None Depth (inches): NIA Hydric Soil Present? Yes No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM —Atlantic and Gulf Coastal Plain Region Project/Site: Santos Applicant/Owner: Santos Investigator(s): C. Amy, J. Peters City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 State: TX Sampling Point: DP01 Section, Township, Range: Magnolia Beach Landform (hillslope, terrace, etc.): Flat Local relief (concave, convex, none): none Slope (%): 1 Subregion (LRR or MLRA): LRR T 150A Let: 28.553011 Long:-96.545908 Datum: NAD 83 Soil Map Unit Name: Livia silt loam (Lo) NWI classification: Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation _, Soil , or Hydrology significantly disturbed? Are "Normal Circumstances' present? Yes X No Are Vegetation _, Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X within a Wetland? Yes No X Wetland Hydrology Present? Yes No X Remarks: Upland slope to south east area HYDROLOGY Wetland Hydrology Indicators: Secondary Indicators (minimum of two required) ❑ Surface Soil Cracks (136) ❑ Sparsely Vegetated Concave Surface (B8) Primary Indicators (minimum of one is required: check all that apply) Surface Water (Al) El Aquatic Fauna (B13) t❑ LJ High Water Table (A2) ❑ Marl Deposits (1315) (LRR U) ❑ Drainage Patterns (B10) ❑ Saturation (A3) Hydrogen Sulfide Odor (C1) Moss Trim Lines (1316) Water Marks (Ell) 1❑f 1"f Oxidized Rhizospheres along Living Roots (C3) n❑ r•'I Dry -Season Water Table (C2) tern❑II Sediment Deposits (132) Presence of Reduced Iron (C4) ❑ Crayfish Burrows (C8) _ Drift Deposits (B3) 1L�Jf LJ Recent Iron Reduction in Tilled Soils (C6) ❑ Saturation Visible on Aerial Imagery (C9) Algal Mat or Crust (134) ❑ Thin Muck Surface (C7) ❑ Geomorphic Position (D2) n❑ LL Iron Deposits (135) ❑ Other (Explain in Remarks) ❑ Shallow Aquitard (D3) a Inundation Visible on Aerial Imagery (137) FAC-Neutral Test (D5) a Water -Stained Leaves (Bg) n❑ r'I Sphagnum moss (138) (LRR T, U) Field Observations: Surface Water Present? Yes No X Depth (inches): Water Table Present? Yes No X Depth (inches): Saturation Present? Yes _ No X Depth (inches): Wetland Hydrology Present? Yes X No _ includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A Remarks: No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' 1. None Absolute Uommant moicator ) % Cover Species? Status Uommance lest worksneet: Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAG: 0.0 (A/B) 2. 3. 4. 5. 6. 7. Prevalence Index worksheet: Total % Cover of: Multiply by: 8 OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3. 4. 5. Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation ❑ 2 - Dominance Test is >50% ❑ 3 - Prevalence Index is 53.0' Q Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7. 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1. Axonopus affinis 80 y UPL 2. Setaria parviflora 5 N FACW Definitions of Four Vegetation Strata: Tree -Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub- Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 It (1 m) tall. Herb -All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine -AII woody vines greater than 3.28 ft in height. 3, Panicum capillare 5 N FAC 4. Rhynchosia americana 10 N NL 5 6. 7, 8. 8. 10, 11. 12. Woody Vine Stratum (Plot size: 1. None 100 = Total Cover 50% of total cover: 47.5 20% of total cover: 19 5' ) Hydrophytic Vegetation Present? Yes _ No x 2. 3. 4. 5. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type' Loc Texture Remarks 0-5" 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining, M=Matrix. Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.) Indicators for Problematic Hydric Soils': ❑ ❑ L] ,❑ D Histosol (Al) Histic Epipedon (A2) ,[� Black Histic (A3) ,[] Hydrogen Sulfide (A4) Stratified Layers (A5) ,[] Organic Bodies (A6) (LRR P, T, U) ,❑ 5 cm Mucky Mineral (A7) (LRR P, T, U) ,❑ Muck Presence (AS) (LRR U) 1 cm Muck (A9) (LRR P, T) ,❑ [] Polyvalue Below Surface (S8) (LRR S, T, U) ❑ 1 cm Muck (A9) (LRR O) Thin Dark Surface (S9) (LRR S, T, U) -0 2 cm Muck (A10) (LRR S) Loamy Mucky Mineral (F1) (LRR O) -❑ Reduced Vertic (F18) (outside MLRA 150A,B) [] Loamy Gleyed Matrix (F2) ID Piedmont Floodplain Soils (F19) (LRR P, S, T) Depleted Matrix (F3) Anomalous Bright Loamy Soils (F20) Redox Dark Surface (F6) (MLRA 153B) Depleted Dark Surface (F7) ❑ Red Parent Material (TF2) Redox Depressions (F8) .❑ Very Shallow Dark Surface (TF12) Marl (Flo) (LRR U) Other (Explain in Remarks) L] Depleted Below Dark Surface (At 1) F1 Depleted Ochric (F11) (MLRA 151) D 0 D L] Thick Dark Surface (Al2) ,❑ Coast Prairie Redox (Al 6) (MLRA 150A) Sandy Mucky Mineral (Si) (LRR O, S) Sandy Gleyed Matrix (S4) Iron -Manganese Masses (F12) (LRR O, P, T) 3Indicators of hydrophytic vegetation and Umbric Surface (F13) (LRR P, T, U) wetland hydrology must be present, Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. Reduced Vertic (F18) (MLRA 150A, 1508) D Sandy Redox (S5) Stripped Matrix (S6) Dark Surface (S7) (LRR P, S, T, U) Piedmont Floodplain Soils (1`19) (MLRA 149A) Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D) Restrictive Layer (if observed): Type: None Depth (inches): NIA Hydric Soil Present? Yes No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM —Atlantic and Gulf Coastal Plain Region Project/Site: Santos Applicant/Owner: Santos Investigator(s): C. Amy, J. Peters Landform (hillslops, terrace, etc.): Flat Subregion (LRR or MLRA): LRR T 150A Soil Map Unit Name: Livia silt loam (Lc City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 State: TX Sampling Point: DP01 Section, Township, Range: Magnolia Beach Local relief (concave, convex, none): none Let: 28.553011 Long:-96.545908 NWI classification: Slope (%): 1 Datum: NAD 83 Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation _, Soil or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No Are Vegetation , Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X within a Wetland? Yes No X Wetland Hydrology Present? Yes No X Remarks: Upland slope to south east area HYDROLOGY Wetland Hydrology Indicators: Secondary Indicators (minimum of two required) ❑ Surface Soil Cracks (86) ❑ Sparsely Vegetated Concave Surface (138) Primary Indicators (minimum of one is required: check all that apply) ❑ Surface Water (At) ❑ Aquatic Fauna (B13) ❑ High Water Table (A2) Marl Deposits (B15) (LRR U) ❑ Drainage Patterns (1310) ❑ Saturation (A3) 1❑7 Hydrogen Sulfide Odor (Cl) Moss Trim Lines (B16) Q Water Marks (131) 1u—f Oxidized Rhizospheres along Living Roots (C3) n❑ Lt Dry -Season Water Table (C2) ❑ Sediment Deposits (82) fug Presence of Reduced Iron (C4) Crayfish Burrows (C8) Drift Deposits (B3) 1L—Jf Recent Iron Reduction in Tilled Soils (C6) I❑ -I Satumtion Visible on Aerial Imagery (C9) 10 rl Algal Mat or Crust (134) ��uff LJ Thin Muck Surface (C7)II Iy-1I Geomorphic Position (D2) ❑ Iron Deposits (135) ❑ Other (Explain in Remarks) ❑ Shallow Aquitard (D3) Inundation Visible on Aerial Imagery (B7) ❑ FAC-Neutral Test (D5) Water -Stained Leaves (B9) Sphagnum moss (D8) (LRR T, U) Field Observations: Surface Water Present? Yes No X Depth (inches): Water Table Present? Yes _ No X Depth (inches): Saturation Present? Yes _ No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A Remarks: No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' 1. None Absolute Dominant Indicator ) % Cover Species? Status Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 0.0 (AIB) 2. 3. 4. 5. 6. 7 Prevalence Index worksheet: Total % Cover of: Multiply bv: 8. OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 0 = Total Cover 50% of total cover 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3 4. 5. Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation nII--II 2 - Dominance Test is >50% n u�-IL 3 - Prevalence Index is 53.0' I__ Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7. 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1. Axonopus affinis 80 Y UPL 2. Setaria parviflora 5 N FACW Definitions of Four Vegetation Strata: i Tree Woody plants, excluding vines, 3 in. (7.6 cm) or more n diameter at breast height (DBH), regardless of height. Sapling/Shrub- Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 It (1 m) tall. Herb - All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine - All woody vines greater than 3.28 ft in height. 3. Panicum capillare 5 N FAC 4. Rhynchosia americana 10 IN NL 5 6. 7. 8. 9. 10. 11. 12. Woody Vine Stratum (Plot size: 1. None 100 = Total Cover 50% of total cover: 47.5 20% of total cover: 19 5' ) Hydrophytic Vegetation x Present? Yes No - 2. 3. 4. 5' 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type,Loc Texture Remarks 0-5" 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining, M=Matrix. Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.) Indicators for Problematic Hydric Soils': 0 Histosol (Al) _[] Polyvalue Below Surface (88) (LRR S, T, U) ❑ 1 cm Muck (A9) (LRR O) ,[] Histic Epipedon (A2) Thin Dark Surface (89) (LRR S, T, U) 2 cm Muck (Al 0) (LRR S) -❑ ,[] Black Histic (A3) H Loamy Mucky Mineral (F1) (LRR O) Reduced Vertic (F18) (outside MLRA 150A,B) [] Hydrogen Sulfide (A4) j] Loamy Gleyed Matrix (F2) _E1 Piedmont Floodplain Soils (F19) (LRR P, S, T) 0 Stratified Layers (A5) Depleted Matrix (F3) Anomalous Bright Loamy Soils (1720) L] Organic Bodies (A6) (LRR P, T, U) � Redox Dark Surface (F6) (MLRA 153B) D 5 cm Mucky Mineral (A7) (LRR P, T, U) _E] Depleted Dark Surface (F7) ❑ Red Parent Material (TF2) Muck Presence (A8) (LRR U) Redox Depressions (F8) Very Shallow Dark Surface (TF12) L] 1 cm Muck (A9) (LRR P, T) ❑ Marl (F10) (LRR U) -E�ll :1 Other (Explain in Remarks) ,[] Depleted Below Dark Surface (At 1) ❑ Depleted Ochric (F11) (MLRA 151) [] Thick Dark Surface (Al2) ❑ Iron -Manganese Masses (F12) (LRR O, P, T) 'Indicators of hydrophytic vegetation and ,[] Coast Prairie Redox (A16) (MLRA 150A) Umbric Surface (F13) (LRR P, T, U) wetland hydrology must be present, ,[] Sandy Mucky Mineral (S1) (LRR O, S) Lj Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. 0�'( Sandy Gleyed Matrix (S4) ❑ Reduced Vertic (F18) (MLRA 150A, 150B) HJlSandy Redox (S5) ❑ Piedmont Floodplain Soils (F19) (MLRA 149A) Stripped Matrix (S6) Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D) Dark Surface (S7) (LRR P, S, T, U) Restrictive Layer (if observed): Type: None Depth (inches): N/A Hydric Soil Present? Yes No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region Project/Site: Santos City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 Applicant/Owner: Santos State: TX Sampling Point: DP01 Investigator(s): C. Amy, J. Peters Section, Township, Range: Magnolia Beach Landform (hillslope, terrace, etc.): Flat Local relief (concave, convex, none): none Slope (%): 1 Subregion (LRR or MLRA): LRR T 150A Let: 28.553011 Long:-96.545908 Datum: NAD 83 Soil Map unit Name: Livia silt loam (Lo) NWI classification: Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation , Soil , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No Are Vegetation , Soil or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X Wetland Hydrology Present? Yes No X within a Wetland? Yes No X Remarks: Upland slope to south east area HYDROLOGY Surface Water (At) High Water Table (A2) Saturation (A3) Water Marks (131) Sediment Deposits (132) Drift Deposits (B3) Algal Mat or Crust (134) Iron Deposits (B5) Inundation Visible on Aerial Imagery (B7) Water -Stained Leaves (139) Aquatic Fauna (1313) Marl Deposits (B15) (LRR U) Hydrogen Sulfide Odor (Cl) Oxidized Rhizospheres along Living Roots (C3) Presence of Reduced Iron (C4) Recent Iron Reduction in Tilled Soils (C6) Thin Muck Surface (C7) Other (Explain in Remarks) Surface Soil Cracks (B6) ❑ Sparsely Vegetated Concave Surface (B8) ❑ Drainage Patterns (B10) ❑ Moss Trim Lines (1316) n Dry -Season Water Table (C2) ❑ Crayfish Burrows (C8) ❑ Saturation Visible on Aerial Imagery (C9) ❑ Geomorphic Position (D2) Shallow Aquitard(D3) FAC-Neutral Test (D5) Sphagnum moss (D8) (LRR T, U) Surface Water Present? Yes No X Depth (inches): Water Table Present? Yes _ No X Depth (inches): Saturation Present? Yes No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A Remarks: No hydrological indicators are present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' ) 1. None ADSOIme UOmman[ moicaror % Cover Species? Status uommance Ies worKsneer: Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 0.0 (A/B) 2. 3. 4. 5. 6. 7 Prevalence Index worksheet: Total % Cover of: Multiply by: 8 OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3. 4. 5. Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation ❑ 2 - Dominance Test is >50% Q 3 - Prevalence Index is 53.0' Q Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7. 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1. Axonopus affinls 80 Y UPL 2. Setaria parviflora 5 N FACW Definitions of Four Vegetation Strata: Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub- Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 ft (1 m) tall. Herb - All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine - All woody vines greater than 3.28 ft in height. 3. Panicum capillare 5 N FAC q. Rhynchosia americans 10 N NL 5 6. 7, 8. 9. 10. 11. 12. 100 = Total Cover 50% of total cover: 47.5 20% of total cover: 19 Woody Vine Stratum (Plot size: 5' ) 1. None 2. 3. 4. 5. Hydrophytic 0 = Total Cover Vegetation 50% of total cover: 0 20% of total cover: 0 Present? Yes No x- No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type' Loc Texture Remarks 0-5" 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. 'Location: PL=Pore Lining, M=Matrix. Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.) Indicators for Problematic Hydric Soils': [� Histosol (At) ❑ Polyvalue Below Surface (S8) (LRR S, T, U) ❑ 1 cm Muck (A9) (LRR O) ,[] Histic Epipedon (A2) Thin Dark Surface (S9) (LRR S, T, U) 2 cm Muck (A10) (LRR S) _❑ �] Black Histic (A3) Loamy Mucky Mineral IN) (LRR O) Reduced Vertic (F18) (outside MLRA 150A,B) 0 Hydrogen Sulfide (A4) [] Loamy Gleyed Matrix (F2) Piedmont Floodplain Soils (F19) (LRR P, S, T) 0 Stratified Layers (A5) Depleted Matrix (F3) Anomalous Bright Loamy Soils (F20) [] Organic Bodies (A6) (LRR P, T, U) H Redox Dark Surface (F6) (MLRA 153B) L] 5 cm Mucky Mineral (A7) (LRR P, T, U) ❑ Depleted Dark Surface (F7) ❑ Red Parent Material (TF2) n Muck Presence (AB) (LRR U) f] Redox Depressions (F8) -E] Very Shallow Dark Surface (TF12) ❑ 1 cm Muck (A9) (LRR P, T) n Marl (F10) (LRR U) 1:1 Other (Explain in Remarks) L] Depleted Below Dark Surface (Al 1) n Depleted Ochric (F11) (MLRA 151) Thick Dark Surface (Al2) DIron-Manganese Masses (F12) (LRR 0, P, T) 3Indicators of hydrophytic vegetation and Coast Prairie Redox (Al6) (MLRA 150A) n Umbric Surface (F13) (LRR P, T, U) wetland hydrology must be present, Sandy Mucky Mineral (S1) (LRR O, S) 1._ I Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. [] Sandy Gleyed Matrix (S4) Reduced Vertic (F18) (MLRA 150A, 1506) L] Sandy Redox (S5) Piedmont Floodplain Soils (F19) (MLRA 149A) Stripped Matrix (S6) Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D) L] Dark Surface (S7) (LRR P, S, T, U) Restrictive Layer (if observed): Type: None Depth (inches): NIA Hydric Soil Present? Yes No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region Project/Site: Santos City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 Applicant/Owner: Santos State: TX Sampling Point: DP01 Investigator(s): C. Amy, J. Peters Section, Township, Range: Magnolia Beach Landform (hillslope, terrace, etc.): Flat Local relief (concave, convex, none): none Slope (%): 1 Subregion (LRR or MLRA): LRR T 150A Let: 28.553011 Long;-96.545908 Datum: NAD 83 Soil Map Unit Name: Livia Silt loam (Lo) NWI classification: Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation _, Soil , or Hydrology significantly disturbed? Are "Normal Circumstances' present? Yes X No Are Vegetation , Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X within a Wetland? Yes No X Wetland Hydrology Present? Yes No X Remarks: Upland slope to south east area HYDROLOGY Wetland Hydrology Indicators: Secondary Indicators (minimum of two required) ❑ Surface Soil Cracks (B6) ElSparsely Vegetated Concave Surface (138) Primary Indicators (minimum of one is required: check all that apply) Surface Water (A1) ❑l Aquatic Fauna (B13) I❑f LJ High Water Table (A2) Marl Deposits (1315) (LRR U) ❑ Drainage Patterns (B10) ❑ Saturation (A3) 10 Hydrogen Sulfide Odor (Cl) ❑ Moss Trim Lines (1316) ❑ Water Marks (B1) 1u—f Oxidized Rhizospheres along Living Roots (C3) Q Dry -Season Water Table (C2) El Sediment Sediment Deposits (B2) 1u�f u Presence of Reduced Iron (C4) ❑ Crayfish Burrows (CB) Drift Deposits (63) ❑_ Recent Iron Reduction in Tilled Soils (C6) ❑ Saturation Visible on Aerial Imagery (C9) ILJII L'1 Algal Mat or Crust (B4) ❑ Thin Muck Surface (C7) ❑ Geomorphic Position (D2) ❑ Iron Deposits (B5) ❑ Other (Explain in Remarks) ❑ Shallow Aquitard (D3) Inundation Visible on Aerial Imagery (B7) ❑ FAC-Neutral Test (D5) Water -Stained Leaves (B9) ❑ Sphagnum moss (D8) (LRR T, U) Field Observations: Surface Water Present? Yes _ No X Depth (inches): Water Table Present? Yes _ No X Depth (inches): Saturation Present? Yes No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A Remarks: No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' ) None Absolute Dominant Indicator °/n Cover Species? Status Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 0.0 (A/B) 2. 3. 4. 5. 6. 7 Prevalence Index worksheet: Total % Cover of: Multiply by: 8 OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3. 4. 5. Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation f11❑f���2 - Dominance Test is >50% 11 3 - Prevalence Index is 53.0' Q Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7. 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1. Axonopus affinis 80 Y UPL 2. Setaria parviflora 5 N FACW Definitions of Four Vegetation Strata: Tree - Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub- Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 ft (1 m) tall. Herb -All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine - All woody vines greater than 3.28 ft in height. 3. Panicum capillare 5 N FAC q. Rhynchosia americans 10 N NL 5 6. 7, 8' 9. 10. 11. 12. 50% of total cover: 47.5 Woody Vine Stratum (Plot size: 5' ) 1. None 100 = Total Cover 20% of total cover: 19 Hydrophytic Vegetation Present? Yes No x 2. 3. 4. 5. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Remarks: (If observed, list morphological adaptations below). No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix (inches) Color (moist) % Redox Features Color (moist) % Type' Loc Texture Remarks 0-5" 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. 2Location: PL=Pore Lining, M=Matrix. Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.) Indicators for Problematic Hydric Soils': ❑ 0 0 0 Histosol (A1) Histic Epipedon (A2) Black Histic (A3) Hydrogen Sulfide (A4) Stratified Layers (A5) Polyvalue Below Surface (S8) (LRR S, T, U) ❑ 1 cm Muck (A9) (LRR O) Thin Dark Surface (S9) (LRR S, T, U) -0 2 cm Muck (A10) (LRR S) Loamy Mucky Mineral (F1) (LRR O) ❑ Reduced Vertic (F18) (outside MLRA 150A,B) [] Loamy Gleyed Matrix (F2) -❑ Piedmont Floodplain Soils (F19) (LRR P, S, T) ✓ Depleted Matrix (F3) 0 Anomalous Bright Loamy Soils (F20) ,[] ❑ L] Organic Bodies (AS) (LRR P, T, U) 5 cm Mucky Mineral (A7) (LRR P, T, U) Muck Presence (AS) (LRR U) 1 cm Muck (A9) (LRR P, T) Redox Dark Surface (F6) L] Depleted Dark Surface (F7) ❑ Redox Depressions (F8) Marl (F10) (LRR U) (MLRA 153B) ❑ Red Parent Material (TF2) ID Very Shallow Dark Surface (TF12) E] Other (Explain in Remarks) Depleted Below Dark Surface (At 1) Depleted Ochric (F11) (MLRA 151) L] [] D L] Thick Dark Surface (Al2) Coast Prairie Redox (A16) (MLRA 150A) Sandy Mucky Mineral (S1) (LRR O, S) Sandy Gleyed Matrix (S4) D Iron -Manganese Masses (F12) (LRR O, P, T) 'Indicators of hydrophytic vegetation and n Umbric Surface (F13) (LRR P, T, U) wetland hydrology must be present, L Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. f] Reduced Vertic (F18) (MLRA 150A, 150B) n D ,❑ Sandy Redox (85) Stripped Matrix (S6) _E1 Dark Surface (S7) (LRR P, S, T, U) � Piedmont Floodplain Soils (F19) (MLRA 149A) Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D) Restrictive Layer (if observed): Type: None Depth (inches): NIA Hydric Soil Present? Yes No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region Project/Site: Santos Applicant/Owner, Santos Investigator(s): C. Amy, J. Peters Landform (hillslope, terrace, etc.): Flat Subregion (LRR or MLRA): LRR T 150A Soil Map Unit Name: Livia silt loam (Lc City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 State: TX Sampling Point: DP01 Section, Township, Range: Magnolia Beach Local relief (concave, convex, none): none Slope (%): 1 Lat: 28.553011 Long:-96.545908 Datum: NAD 83 NW] classification: Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation _, Soil , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No Are Vegetation _, Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc. Hydrophytic Vegetation Present? Yes Hydric Soil Present? Yes Wetland Hydrology Present? Yes Remarks: Upland slope to south east area HYDROLOGY �❑f Surface Water (Al) LI High Water Table (A2) ❑ Saturation (A3) ❑ Water Marks (B1) ❑ Sediment Deposits (132) ❑ Drift Deposits (B3) ❑ Algal Mat or Crust (134) ❑ Iron Deposits (B5) Inundation Visible on Aerial Imagery (137) Water -Stained Leaves (139) No X Is the Sampled Area No X No X within a Wetland? Aquatic Fauna (1313) Marl Deposits (1315) (LRR U) Hydrogen Sulfide Odor (Cl) Oxidized Rhizospheres along Living Roots (C3) Presence of Reduced Iron (C4) Recent Iron Reduction in Tilled Soils (C6) Thin Muck Surface (C7) Other (Explain in Remarks) Yes No X ❑ Surface Soil Cracks (B6) ❑ Sparsely Vegetated Concave Surface (138) ❑ Drainage Patterns (1310) ❑ Moss Trim Lines (B16) ❑ Dry -Season Water Table (C2) ❑ Crayfish Burrows (C8) ❑ Saturation Visible on Aerial Imagery (C9) ❑ Geomorphic Position (132) ❑ Shallow Aquitard (D3) FAC-Neutral Test (D5) ❑ Sphagnum moss (D8) (LRR T, U) Surface Water Present? Yes No X Depth (inches): Water Table Present? Yes _ No X Depth (inches): Saturation Present? Yes No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Sampling Point: DP01 Tree Stratum (Plot size: 30' 1. None Absolute Dominant Indicator ) % Cover Species? Status Dominance Test worksheet: Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are DEL, FACW, or FAC: 0.0 (A/B) 2. 3. 4. 5. 6. 7 Prevalence Index worksheet: Total % Cover of: Multiply by: OBL species x 1 = FACW species 5 x 2 = 10 FAC species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2 3 4. 5' Hydrophytic Vegetation Indicators: 1 -Rapid Test for Hydrophytic Vegetation IE�lI 2 - Dominance Test is >50% 1n_L 3 - Prevalence Index is 53.0' Lt Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. 6. 7 8. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 Herb Stratum (Plot size: 5' ) 1. Axonopus affinis 80 Y UPL 2. Setaria parviflora 5 N FACW Definitions of Four Vegetation Strata: Tree -Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub - Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 ft (1 m) tall. Herb - All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine -All woody vines greater than 3.28 It in height. 3, Panicum capillare 5 N FAC q. RhynChosia americans 10 N NL 5 6. 7, 8. 9. 10. 11. 12. Woody Vine Stratum (Plot size: 1. None 100 = Total Cover 50% of total cover: 47.5 20% of total cover: 19 5' ) Hydrophytic Vegetation Present? Yes No x 2. 3. 4. 5. 0 = Total Cover 50% of total cover: 0 20% of total cover: 0 No hydrophytic vegetation observed at data point. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type, Loc Texture Remarks 0-5" 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. Location: PL=Pore Lining, M=Matrix. Hydric Soil Indicators: (Applicable to all LRRs, unless otherwise noted.) Indicators for Problematic Hydric Soils': ,[] Histosol (At) .[] Polyvalue Below Surface (S8) (LRR S, T, U) ❑ 1 cm Muck (A9) (LRR O) 0 Histic Epipedon (A2) .[] Thin Dark Surface (S9) (LRR S, T, U) � 2 cm Muck (At 0) (LRR S) ,[] Black Histic (A3) .�] Loamy Mucky Mineral (F1) (LRR O) Reduced Vertic (F18) (outside MLRA 150A,B) ,[] Hydrogen Sulfide (A4) 0 Loamy Gleyed Matrix (F2) Piedmont Floodplain Soils (F19) (LRR P, S, T) 0 Stratified Layers (A5) Depleted Matrix (F3) Anomalous Bright Loamy Soils (F20) ,[] Organic Bodies (AS) (LRR P, T, U) �] Redox Dark Surface (F6) (MLRA 153B) ❑ ,[] 5 cm Mucky Mineral (A7) (LRR P, T, U) Depleted Dark Surface (F7) Red Parent Material (TF2) -El ❑ Muck Presence (A8) (LRR U) ❑ Redox Depressions (F8) Very Very Shallow Dark Surface (TF12) ,❑ 1 cm Muck (A9) (LRR P, T) r] Marl (F10) (LRR U) LJ Other (Explain in Remarks) L] Depleted Below Dark Surface (A11) L] Depleted Ochric (F11) (MLRA 151) L] Thick Dark Surface (Al2) Iron -Manganese Masses (F12) (LRR O, P, T) 3Indicators of hydrophytic vegetation and Coast Prairie Redox (At 6) (MLRA 150A) Umbric Surface (F13) (LRR P, T, U) wetland hydrology must be present, L] Sandy Mucky Mineral (S1) (LRR O, S) �n Delta Ochric (F17) (MLRA 151) unless disturbed or problematic. D Sandy Gleyed Matrix (S4) r'I Reduced Vertic (F18) (MLRA 150A, 150B) ,❑ Sandy Redox (S5) Piedmont Floodplain Soils (F19) (MLRA 149A) D Stripped Matrix (S6) Anomalous Bright Loamy Soils (1720) (MLRA 149A, 153C, 153D) Dark Surface (S7) (LRR P, S, T, U) - Restrictive Layer (if observed): Type: None Depth (inches): N/A Hydric Soil Present? Yes _ No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 WETLAND DETERMINATION DATA FORM — Atlantic and Gulf Coastal Plain Region Project/Site: Santos Applicant/Owner: Santos Investigator(s): C. Amy, J. Peters Landform (hillslope, terrace, etc.): Flat Subregion (LRR or MLRA): LRR T 150A Soil Map Unit Name: Livia silt loam (Lc City/County: Magnolia Beach / Calhoun Sampling Date: 8/20/2021 State: TX Sampling Point: DP01 Section, Township, Range: Magnolia Beach Local relief (concave, convex, none): none Let: 28.553011 Long:-96.545908 NWI classification: Slope (%): 1 Datum: NAD 83 Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.) Are Vegetation Soil , or Hydrology significantly disturbed? Are "Normal Circumstances" present? Yes X No Are Vegetation Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.) SUMMARY OF FINDINGS — Attach site map showing sampling point locations, transacts, important features, etc. Hydrophytic Vegetation Present? Yes No X Is the Sampled Area Hydric Soil Present? Yes No X within a Wetland? Yes No X Wetland Hydrology Present? Yes No X Remarks: Upland slope to south east area HYDROLOGY Wetland Hydrology Surface Water (At) . High Water Table (A2) Saturation (A3) Water Marks (B 1) Sediment Deposits (B2) Drift Deposits (93) Algal Mat or Crust (134) Iron Deposits (135) Inundation Visible on Aerial Imagery (137) Water -Stained Leaves (139) Aquatic Fauna (B13) Marl Deposits (B15) (LRR U) Hydrogen Sulfide Odor (Cl) Oxidized Rhizospheres along Living Roots (C3) Presence of Reduced Iron (C4) Recent Iron Reduction in Tilled Soils (C6) Thin Muck Surface (C7) Other (Explain in Remarks) ❑ Surface Soil Cracks (B6) ❑ Sparsely Vegetated Concave Surface (138) ❑ Drainage Patterns (B10) ❑ Moss Trim Lines (B16) ❑ Dry -Season Water Table (C2) ❑ Crayfish Burrows (C8) ❑ Saturation Visible on Aerial Imagery (C9) ❑ Geomorphic Position (D2) Shallow Aquitard (D3) FAC-Neutral Test (D5) ❑ Sphagnum moss (D8) (LRR T, U) Surface Water Present? Yes _ No X Depth (inches): Water Table Present? Yes No X Depth (inches): Saturation Present? Yes _ No X Depth (inches): Wetland Hydrology Present? Yes X No includes capillary fringe) Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available: N/A No hydrological indicators are present. US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 VEGETATION (Four Strata) - Use scientific names of plants. Tree Stratum (Plot size: 30' ) 1. None 2. 3. 4. 5. 6. 7. 8. 50% of total cover: 0 Sapling/Shrub Stratum (Plot size: 15' ) 1. None 2. 3. 4. 5. 6. 7. 8. 50% of total cover: 0 Herb Stratum (Plot size: 5' Sampling Point: DP01 % Cover Species? Status Number of Dominant Species That Are OBL, FACW, or FAC: 0 (A) Total Number of Dominant Species Across All Strata: 1 (B) Percent of Dominant Species That Are OBL, FACW, or FAC: 0.0 (A/B) Total % Cover of: Multiply by: OBL species x 1 = FACW species 5 x 2 = 10 FAG species 5 x 3 = 15 FACU species x 4 = UPL species 80 x 5 = 400 Column Totals: 95 (A) 425 (B) Prevalence Index = B/A = 4.4 0 = Total Cover 20% of total cover: 0 0 = Total Cover 20% of total cover: 0 1. Axonopus affinis 80 Y UPL 2, Setaria parviflora 5 N FACW 3. Panicum capillare 5 N FAC 4. Rhynchosia amencana 10 N NL 5. 6. 7. 8. 9. 10. 11. 12. 50% of total cover: 47.5 Woody Vine Stratum (Plot size: 5' ) 1. None 2. 3. 4. 5. 50% of total cover: 0 100 = Total Cover 20% of total cover: 19 ❑ 1 - Rapid Test for Hydrophytic Vegetation ❑� 2 - Dominance Test is >50% i1 3 - Prevalence Index is 53.0' Problematic Hydrophytic Vegetation' (Explain) 'Indicators of hydric soil and wetland hydrology must be present, unless disturbed or problematic. Tree -Woody plants, excluding vines, 3 in. (7.6 cm) or more in diameter at breast height (DBH), regardless of height. Sapling/Shrub - Woody plants, excluding vines, less than 3 in. DBH and greater than 3.28 ft (1 m) tall. Herb - All herbaceous (non -woody) plants, regardless of size, and woody plants less than 3.28 ft tall. Woody vine - All woody vines greater than 3.28 ft in height. Hydrophytic 0 = Total Cover Vegetation 20% of total cover: 0 Present? No hydrophytic vegetation observed at data point. Yes No x US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region - Version 2.0 SOIL Sampling Point: DP01 Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.) Depth Matrix Redox Features (inches) Color (moist) % Color (moist) % Type, Loc Texture Remarks 0-5" 10 YR 3/2 100 sandy loam 6-16" 10 YR 4/2 100 sandy loam 'Type: C=Concentration, D=De letion, RM=Reduced Matrix, MS=Masked Sand Grains. Location: PL=Pare Lining, M=Matrix. Hydric .❑ 0 ,[] ,[] 0 Soil Indicators: (Applicable to all LRRs, Histosol (At) Histic Epipedon (A2) ,[] Black Histic (A3) Hydrogen Sulfide (A4) Stratified Layers (A5) unless otherwise noted.) Polyvalue Below Surface (138) (LRR S, T, U) Thin Dark Surface (S9) (LRR S, T, U) [] Loamy Mucky Mineral (F1) (LRR O) [] Loamy Gleyed Matrix (F2) ✓ Depleted Matrix (173) Indicators for Problematic Hydric Soils': ❑ 1 cm Muck (A9) (LRR O) .❑ 2 cm Muck (At 0) (LRR S) Reduced Vertic (F18) (outside MLRA 150A,B) Piedmont Floodplain Soils (F19) (LRR P, S, T) Anomalous Bright Loamy Soils (1720) ,[] ❑ n Organic Bodies (A6) (LRR P, T, U) 5 cm Mucky Mineral (A7) (LRR P, T, U) Muck Presence (AS) (LRR U) 1 cm Muck (A9) (LRR P, T) Redox Dark Surface (F6) ❑ Depleted Dark Surface (F7) ❑ Redox Depressions (F8) Marl (F10) (LRR U) (MLRA 153B) ❑ Red Parent Material (TF2) -0 Very Shallow Dark Surface (TF12) D Other (Explain in Remarks) ,F1 Depleted Below Dark Surface (A11) ❑ Depleted Ochric (F11) (MLRA 151) ❑ 0 Thick Dark Surface (Al2) Coast Prairie Redox (A16) (MLRA 150A) [] Iron -Manganese Masses (F12) (LRR O, P, T) 3Indicators of hydrophytic vegetation and Umbric Surface (F13) (LRR P, T, U) wetland hydrology must be present, ,[] [� HSandy El Sandy Mucky Mineral (S1) (LRR O, S) Sandy Gleyed Matrix (S4) Redox (S5) Stripped Matrix (S6) Dark Surface (S7) (LRR P, S, T, U) Delta Ochric (1717) (MLRA 151) unless disturbed or problematic. ❑ Reduced Vertic (F18) (MLRA 150A, 150B) ❑n Piedmont Floodplain Soils (F19) (MLRA 149A) I --I Anomalous Bright Loamy Soils (F20) (MLRA 149A, 153C, 153D) Restrictive Layer (if observed): Type: None Depth (inches): NIA Hydric Soil Present? Yes _ No X Remarks: No hydric soils present US Army Corps of Engineers Atlantic and Gulf Coastal Plain Region — Version 2.0 APPENDIX D COMMON ACRONYMS COMMON ACRONYMS CLOMR Conditional Letter of Map Revision CWA Clean Water Act DFIRM Digital Flood Insurance Rate Map EPA Environmental Protection Agency FEMA Federal Emergency Management Agency FIRM Flood Insurance Rate Map GIS Geographic Information System GPS Global Positioning System IH Interstate Highway LiDAR Light Detection and Ranging NAIP National Agricultural Imagery Program NRCS Natural Resources Conservation Service NRPW Non -Relatively Permanent Water NWI National Wetland Inventory OHWM Ordinary High Water Mark PJD Preliminary Jurisdictional Determination RHA Rivers and Harbors Act RGL Regional Guidance Letter RPW Relatively Permanent Water TNRIS Texas Natural Resource Information System TPWD Texas Parks and Wildlife Department TNW Traditionally Navigable Water U.S. United States USACE U.S. Army Corps of Engineers USDA U.S. Department of Agriculture USFWS U.S. Fish and Wildlife Service USGS U.S. Geologic Survey WOTUS Waters of the U.S. �� � \2 � � \: � ©:d° <.� � : � \� � � #13 NOTICE OF MEETING — 2/9/2022 13. Consider and take necessary action to declare the equipment on the attached list from MMC as Waste. (RHM) 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 14 Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: Memorial Medical Center Storage Units -February 2022 page i Requested By: Roshanda Thomas, Interim C Inventory Number Description Serial No. Reason for Waste Declaration Y Black Office Chairs No Longer Used/Broken 5 Gray Chairs No Longer Used/Backed 5 Medication Gains No Langer Make Parts I Broken 1 IT Desk No Longer UsetllBroken Vahoua campuler components End of life no longer compatible / Broken .'. Fhng ('abxiel No Loop, UsetllBroken #14 NOTICE OF MEETING — 2/9/2022 14. Consider and take necessary action to extend Interlocal Agreements with the following agencies and authorize the County Judge to sign the purchase orders. (RHM) (1) Calhoun County Senior Citizen's Association, Inc. $35,000.00 (2) The Harbor Children's Alliance & Victim Center $28,500.00 (3) Calhoun County Crime Stoppers $ 1,000.00 (4) Calhoun County Soil and Water Conservation District No. 345 $ 7,750.00 (5) Gulf Bend Center $26,000.00 TABLE Page 11 of 14 #15 NOTICE OF MEETING — 2/9/2022 15. Accept Monthly Reports from the following County Offices: i. Floodplain Administration — January 2022 ii. Sheriffs Office — January 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 12 of 14 Calhoun CountyFloodplain Administration 211 South Ann Street, Suite 301 Port Lavaca, TX 77979-4249 Phone: 361-553-4455/Fax: 361-553-4444 e-mail: karen.rinasz@calhouncotx.org January 2022 Development Permits New Homes — 7 Renovations/Additions —1 Mobile Homes —1 Boat Barns/Storage Buildings/Garages -1 Commercial Buildings/RV Site -1 Tower Addition - 0 Total Fees Collected: $660 SHERIFF'S OFFICE MONTHLY REPORT JAN. 2022 BAIL BOND FEE $ 255.00 CIVIL FEE $ 501.40 JP#1 $ 815.30 JP#2 $ - JP#3 $ JP#4 $ JP#5 $ PL MUN. $ COUNTY COURT $ SEADRIFT MUN. $ PC MUN. $ - OTHER $ 11.00 PROPERTY SALES $ - DISTRICT $ CASH BOND $ TOTAL: $ 1,582.70 v #16 NOTICE OF MEETING — 2/9/2022 16. Consider and take necessary action on any necessary budget adjustments. (RHM) 2021: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 2022: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 13 of 14 p= JOWO U 3 p= rnrn� 3 p= C N N A W W ii1 = N OJ O A y m 111 = W0 O) m Z m- z �= 0 0 0 0 0 z z Z �= o a z z m m -0K e m m X= a � = O > X Fn z � _ (n ai z `i A _ 3=_ �oZC) -1 _ 3= n� : 3= m Z= ��Z�Z m 4 Z= mcmi m= z y Z A H m,= Z O y �= m Z= �m�o� O z= 0Y' O z= m a=_ DZ<cma Z a= Z a= O_ y n y K i (n O ee 111-_ O c� 1 F. r 111E A O 111E r m 3 m n= _ C O T m fA = m_ - �= Cl) 3 tN= m r- p m= "' a a= z T z- z= oo=_ n=_ o z '� r= �= $ 0 0 m m In !"= c 0 m O fOA a= y n m m m m m z m y �_ z 13f1=_ z _a m Z= _ ao z z z z z 1 e�, m° z m z z -1 ip .4= p m 600000 O {22� �7= C) 600 co Q mo a= m ZDDDDD O C1A �= Z ZDD 2 a trN= z Z-ZizZz zP+ m Z Z-z�a� 'yi CZI= ram= 1 'N° m N= Z '9 C m= m m Ci O O a z = O O M= D n (A = --I ' m n O a fA EA EA EA EA 4A EA T "' M EA EA fA T ^' p- O 0 0 0 0 0 0 p= O O O O p= a a= T a€ 3 = EA EA EA EA EA EA T 3 = m0 = O o O O O O m_ O coo m=_ z= z=_ z= z = iA fA EA Ci p z = fA EA EA z = O c_ �W w W c= z WE 001 T O �0 00 0 T= N N N O - = t00 fOD A A (D fAO EAT = N N EAN rT+� __ 6 9 B 2 EA EA EAN W iy W N N �i W = W - - N N O A Flo- m a a za m= min m m= ��� 3 G= z m= oA� z 1 .0= ;M� z Z m= e 3 a= co as Q a o0v 3 a- Z �= D O Z .� �= m 00 Z .� 3=_ _ -1 3= -0 z -1 3= m __ < a mE A ZQ mE m Z=_ m D m ZE m ZE y �° 3 n y �E m z N -1_ Z= z z Z= m C Z= esa Z a= m Z b a= o' Z a= MrR Ce"a b m= Z co m a m o= mmT ,� m= AZT m m- o �__ 10 KE 0 3= 0=_ z- m 70E 2 � a= Z : H_ m Z � mZE ae A �1 z �1 ID e Z O (�= m 3 e Z ;a m mzze z m= t�A Q m= Z DOO (AA �_ n DOO U! 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Approval of bills and payroll. (RHM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 2021 Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens 2022 Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens Page 14 of 14 February 9, 2022 2022 APPROVAL LIST - 2022 BUDGET COURT MEETING OF 02/09/22 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 17 $370,271.90 NATIONWIDE RETIREMENT SOLUTIONS P/R $ 4,855.00 OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT P/& $ 1,002.46 TEXAS COUNTY & DISTRICT RETIREMENT SYSTEM P/R $ 188,985.10 CALHOUN COUNTY NAVIGATION DIST. JANUARY 2022 TAX COLLECTIONS A/P $ 1,014.87 WCID NO.1 JANUARY 2022 TAX COLLECTIONS A/P $ 235,742.77 VOYAGER A/P $ 16,146.30 TOTAL VENDOR DISBURSEMENTS: $ 818,018.40 CALHOUN COUNTY OPERATING ACCOUNT - TRNSFR FROM MONEY MKT TO OPERATING ACCT FOR PAYROLL & AP $ 1,200,000.00 TOTAL AMOUNT FOR APPROVAL: $ 2,018,018.40 - February 9, 2022 2022 APPROVAL LIST - 2021 BUDGET COMMISSIONERS COURT MEETING OF 02/09/22 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 4 $47,115.85 TOTAL VENDOR DISBURSEMENTS: $ 47,115.85. TOTAL AMOUNT FOR APPROVAL: $ 47,115.85 February 9, 2022 2022 APPROVAL LIST - 2022 BUDGET COMMISSIONERS COURT MEETING OF 02/09/22 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 17 $370,271.90 NATIONWIDE RETIREMENT SOLUTIONS P/R $ 4,855.00 OFFICE OF THE ATTORNEY GENERAL - CHILD SUPPORT P/R $ 1,002.46 TEXAS COUNTY & DISTRICT RETIREMENT SYSTEM P/R $ 188,985.10 CALHOUN COUNTY NAVIGATION DIST. JANUARY 2022 TAX COLLECTIONS AT $ 1,014.87 WCID NO.1 JANUARY 2022 TAX COLLECTIONS A/P $ 235,742.77 VOYAGER A/P $ 16,146.30 TOTAL VENDOR DISBURSEMENTS: $ 818,018.40 ✓ TOTAL INVESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: $ CALHOUN COUNTY OPERATING ACCOUNT - TRNSFR FROM MONEY MKT TO OPERATING ACCT FOR PAYROLL & AP $ 1,200,000.00 TOTAL AMOUNT FOR APPROVAL: $ 2,018,018.40 ✓ I February 9, 2022 2022 APPROVAL LIST - 2021 BUDGET COURT MEETING OF 02/09/22 BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 4 $47,115.85 TOTAL VENDOR DISBURSEMENTS: $ 47,115.85 1/ TOTAL AMOUNT FOR APPROVAL: $ 47,115.85 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---February 09, 2022 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL P4YABLES,;PAYROLL:AND ELECTRONIC BANK PAYMENTS; $ .666;120,OZ1 / TOTAL TRANSRERSBETWEENTUNDS $ 380;661.07, TOTAL NURSING 1p UPL RXPGNSGS; $ 720,0�$.S6( / TOTALINTER-GOURRNM NTTRANSFERS $ GRANp TOTAL,DISBURSEMENTS APPROVED. Fdbsua. 09,,2022 $ 1,Z58,694.39' MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR---February 09, 2022 PAYABLES AND PAYROLL 2/312022 Weekly Payables 477,930.27 2/7/2022 SAM 9upporl-support renewal fee 799.99 27712022: Patient Refunds 270,00 2/V2022 McKesson-3406 Prescription Expense 11,468.44 21712022 Amerisource Bergen-340B Prescription Expense 1,033.25 Prosperity Electronic Bank Payments 2/3/2022 Credit Card & Lease Fees 559.90 2115/2022 TCDRS January Retirement 163,191.16 1131.213122 Pay Plus -Patient Claims Processing Fee 227.71 2/4/2022 ExperfPay- child support 614.20 21212022 Authnet Gateway Billing 3rd Party Paycr Fee 25.10 tOTALP,%IYAgLES,lPAVItCiLLAND BI EC1RI?NIE QANK PAYMENT- � '638,t20a02; TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 2/3/2022 MMC Operating to Ashford -correction. of NH QIPP payment deposited into 6,255.68 MMC Operating 213/2022 MMC Operating to Solera-correction of NH insurancea and QIPP payment 10,085.44 deposited into MMC Operating in error 2/312022 MMC Operating to Fort bend -correction on NH QIPP payment deposited into 2,531.20 MMC Operating 2/3/2022 MMC Operating to Broadmoor-correctlon of NH insurance payment 3.397,82 deposited into MMC Operating 2/312022 MMC Operating to Crescent -correction of NH QIPP payment deposited into 2,079.20 MMC. Operating in error 2/312022 MMC Operating to Golden Creek -correction of NH insurance and QIPP 36,607.33 payment deposited into MMC Operating in error 2/3/2022 MMC Operating. to Gulf Pointe Plaza -correction of NH insurance and QIPP 56,528.30 payment deposited into MMC Operating 213I2022 MMC Operating to Tuscany Village-oorrectionof NH insurance and QIPP 86,481.16 payment deposited intoMMC Operating 2/312022 MMCOperatingto$ethany-correction of NH insurance and medicare recoup 147,353,40 payment deposited into MMC Operating in error MEDICARE ADVANCE PAYMENT RECOUP 2/7/2022 Broadmoor to MMC Operating -correction of Broadmoor medicare recoup 10,747,18 taken from MMC Operating 2/T12022 Crescent to MMC Operating -correction of Crescent medicare recoup taken 10.747.18 from MMC Operating 2/7/2022 Solera to MMC Operating -correction of Solera medicare recoup taken from 10,747,18. MMC Operating TOTAL TR,A0s 90. 09`"' A FUI]pS+ � ',983,TiBAc�7? NURSING HOME UP], EXPENSES 2/7/2022 Nursing. Home UPL-Canlex Transfer 96,215.52 217/2022 Nursing Home UPL-Nexion Transfer 68,287.14 2/7/2022 Nursing. Home UPL-HMG Transfer 83,106.35 2/7/2022 Nursing Home UPL Tuscany Transfer 33,933.40. 2/7/2022 Nursing HomeUPL-HSL Transfer 279,580,33 QIPP CHECKS TO MMC 2/7/2022 Ashford 65,215.44 2/7/2022 Broadmoor 22,864,47 2/7/2022 Crescent 18,211.48 217/2022 Fort Bend 22,395.05 217/2022 Solera 21,641.97 2/7/2022 Tuscany 29.562.15 TO�IAI• FIU�i91�I1 `+'HOME UPL EXPENSES $ 7,E4 U I3 30: TOj'AJ INTO GPi ERNMENT TRANSP QEtANO'?QTALDISBUR,SEMENTSAPPROVED,Iet>rtia Ofr2ti23 $. 7`7$9;68tk39.1 Page 1 of 18 iORR ON � D "ff2u42 MEMORIAL MEDICAL CENTER z022 0 AP Open Invoice List Orb 54 Due Dates Through: 02/23/2022 ap_open_invoioe.template rn���urvtpS CAt1Y�t�d1aF9�wrw.* Class Pay Code 11283 ACE HARDWARE15521 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 160967 01/31/20 01103/20 01128/20. 26.99 0.00 0.00 26.99 SUPPLIES 161001 v/ 01/31/20 01/04/20 01/29/20. 7.79 0.00 0.00 7.79v/ SUPPLIES 161204 ✓ 01/31/20 01/11/20 02/05/20 28.79 0.00 0.00 28.79 ✓ SUPPLIES 161254� 01131/20 01/12/20 02106120, 12.99 0.00 0.00 12.99 SUPPLIES 161351 r/ 01/31/20 01114/20 02108/20, &59 0.00 0.00 8.59 ✓� SUPPLIES 161390 ✓ 01/31/20 01/17/20 02111120 13.99 0.00 0.00 13.99 ✓ SUPPLIES / 161597 V 01131/20 01/24/20 02/18/20 31.99 0.00 0.00 31.99 SUPPLIES 161592✓ 01131/20. 01/24/2002/18120. 119.99 0.00 0.00 119.99 SUPPLIES 161593 V/ 01/31/20 01/24/20 02/18/20. -20.00 0.00 0.00 -20.00 CREDIT / 161617 ✓ 01/31120 01/25/20 02119/20 99.98 0.00 0.00 99.98 ✓ SUPPLIES 161704 ✓/ 01131/20; 0112712002/21/20 8.98 0.00 0.00 8.98 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11283 ACE HARDWARE 15521. 340.08 0.00 0.00 340:08 Vendor# Vendor Name Class Pay Code 13180 ADVANCED STERILIZATION PRODUCT Invoiceit Comment Tram Dt Inv Or Due Dt Check Pay Gross Discount No -Pay Net 020122. 02/02/2002/02/2002102/20 1,00;4 0.00 0.00 1,00/00 CONTRACT Vendor Totals Number Name Gross Discount No -Pay Net 13160 ADVANCED STERILIZATION PRODUCT 1,000.� 0.00 0.00 (/ 11000:00 Vendor# Vendor Name Class Pay Code A1680 .AIRGAS USA, LLC-CENTRAL DIV y/ M Invoice# C9mment Tran Pt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9121645116 V 01/31/20.01/17/20 02/11/20 3.403.12 0.00 0.00 3,403.12 ✓ OfQEN 9121847274%/ 01/31/2001/20/2002/14/20 239:81 0.00 0.00 239.61 OXYGEN Vendor Totals Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC-CENTRAL.DIV 3.642.73 0.00 0.00 3,642.73 Vendonik Vendor Name / Class Pay Code A1705 ALIMED INC- ✓ M Invoice# /Comment Tran Dt Inv Dt Due Dt Check D'Pay Gross Discount No -Pay Net / 03737306/ 01/31/2001/1812002/02/20. 135.02 0.00 0.00 135.02 y' SUPPLIES file:///C:/Users/eheimwVcpsi/rnermned.cDsinet.com/u98547a/data 5/tmn cw5reoort58664... 2/3/2022 Page 2 of 18 Vendor Totals NumberNameGross Discount No -Pay Net A1705 ALIMED INC. 135.02 0.00 0.00 135.02 Vendor# Vendor Name /, Class Pay Code ✓ 10958 ALLYSON SWOPE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 013122 01131/20.01/3112001/31/20 2,097.00 TRANSCRIPTION SERVICES Vendor Total: Number Name Gross 10958 ALLYSON SWOPE 2,097,00 Vendor# Vendor Name Class Pay Code 14028 AMAZON CAPITAL SERVICES / Invoice# Comment Tran Dt. Inv Dt Due Dt Check D Pay Gross 012522 01/31120 01/25120 01/25/20 29.07 SUPPLIES Vendor Totals Number Name Gross 14028 AMAZON CAPITAL SERVICES 29.07 Vendor# Vendor Name Class Pay Cade 10410 AMBUINC f Invoice# Comment Tran Dt Inv Dt Due Dt. Check D, Pay Gross / 222048946d 01/31120. 01/27/2002/01/20. 174.00 SUPPLIES Vendor Totals Number Name Gross 10419 AMBU INC 174.00 Vendor# Vendor Name Class Pay Code / A1360 AMERISOURCEBERGEN DRUG CORP' ✓ W Invoice# Fomment Tran Ot Inv Dt Due Di Check D,PayGross 803319394 t/ 01/31/20 01/15/20 01/21/20 302.30 INVENTORY 3081312057 1/ 01/31/20. 01/25/2001/31/20 26,000.00 IINVENOTRY 3081443231V 01/31/20 01/27/20 02/02120 93.35 INVENTORY Vendor Total: Number Name Gross A1360. AMERISOURCEBERGEN DRUG CORP 26,395.66 Vendor# Vendor Name Class Pay Code A0400 AUREUS RADIOLOGY LLC Invoice# Comment Tran Dt Inv Dt .Due Dt Check D� Pay Gross 2452799✓ 01131/20 01/24120 02/23/20 2,931.25 TRAVEL LAB STAFFING (11-1- t 16{1i 664 2452951 V1 01/31/2001/2412002123/20. 2,730.25 TRAVEL LAB STAFFING (1110-^ 11131'17,)%WWWN 2452904V/ 01/31/20,01/24/2002/23/20 2,760.00 TRAVEL LAB STAFFING (11-1-TL),S* unit•k VendorTotals Number Name Gross A0400 AUREUs RADIOLOGY LLC 8,421.50 Vendor# Vendor Name Class Pay Code B1150 BAXTER HEALTHCARE ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check Pay Gross 73642725 01/31/20. 01/20/20 o2/14/20 676,63 SUPPLIES Vendor Total- Number Name Gross Discount No -Pay Net 0.00 0.00 2,097.00 f Discount No -Pay Nei 0.00 0.00 2,097.00 Discount No -Pay Net 0.00 0.00 29.07 Discount No -Pay Net 0.00 0.00 29.07 Discount No -.Pay Not 0.00 0.00 174.00 V/ Discount No -Pay Net 0.00 0.00 174.00 Discount No -Pay Net 0.00 0.00 302.30 ✓ 0.00 0.00 26,000.00 ✓ 0.00 0,00 93.35 ✓' Discount No -Pay Net 0.00 0.00 26,395.65 Discount No -Pay Net 0.00 0.00 2.931.95 V/ 0.00 0.00 2,730.25 V/ 0.00 0.00 2,7%00 Discount No -Pay Net 0.00 0.00 8,421.50 Discount No -Pay 0.00 0.00 Discount No -Pay Net 676.63 Net file:///C`:/Users/eheiman/cl)si/menmed.ci)sinet.com/u4R547a/data S/tm„ ewSrannrtSRFFd �n/�n�� B1150 BAXTER HEALTHCARE 676.63 0.00 Vendor# Vendor Name / Class ✓ Pay Code B1220. BECKMAN COULTER INC M Invoice# Qcmment Tran Dt Inv Dt Due or Check D Pay Gross Discount 109635596 V 01/26/2001/24/20 02/18(20 151.20 0.00 SUPPLIES 109635731/ 01/25/20. 01/24/2002118/20 1,363.99 0.00 rS.UPPLIES 109590684✓ 01/31/20.01/07/2002/01/20 139.34 0.00 SUPPLIES 0 10965609 01/31/2001/2712002/21/20 80.47 0.00 SUPPLIES 109650379v/ 01/31/20.01/27/2002121120 321.88 SUPPLIES Vendor Totals Number Name Gross B1220 BECKMAN COULTER INC 2,056.88 Vendor# Vendor Name/ Class Pay Code W599 BKO, LLP ✓ Invoice# Co ment Tran Dt Inv Dt Due Dt Check or Pay Gross SK01516145v01/31120 01/28120 02122120. 6,864.00 LEGALFEES Vendor Totals Number Name Grosse 10599 SKID, LLP 6,864.00 Vendor# Vendor Name Class Pay Code / C1048 CALHOUN COUNTY ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check Pay Gross 012422FUEL 01/31/20. 01/24/2001/24/20 101.78 FUEL Vendor Totals Number Name Gross C1048 CALHOUN COUNTY 101.78 Vendor# Vendor Name Class Pay Code C1325 CARDINAL HEALTH 414,.INC: ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 8002744690 1./ 01/3V2001/15/2002/09/20 167A6 SUPPLIES Vendor Total. Number Name Gross C1325 CARDINAL HEALTH 414, INC. 167.46 Vendor# Vendor Name Class Pay Code 13028 CAVALLO ENERGY TEXAS LLC V/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 16673166 01/31/2001/19/2002/22/20 1.254,00 ELECTRICITY 16673167 01/31/2001/19/2002/22/20 637.13 ELECTRICITY 16673168 01/31/2001/19/2002/22/20 16.34 ELECTRICITY Vendor Totals Number Name Gross, 13028 CAVALLO ENERGY TEXAS LLC 1,907.47 Vendor# Vendor Name Class Pay Code / C1992 COW GOVERNMENT, INC. ✓ M Invoice# Comment Tran Ot Inv Dt Due Dt Check D' Pay Gross 0.00 Discount 0.09 Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 Page 3 of 18 0.00 676.63 No -Pay Net 0.00 151.20 ✓ 0.00 1,363.90 V 0.00 139.34 ✓ 0.00 80.47 ✓/ 0.00 321.88 ✓ No -Pay Net 0.00 2,056.88 No -Pay Net 0,00 / 6,864.00 ✓ No -.Pay Net 0.00 6,864.00 No -Pay Not 0.00 101.78 ✓/ No -Pay Net 0.00 101.78 No -Pay Net 0.00 167.46 ✓ No -Pay Net 0.00 167A6 Discount No -Pay Net 0.00 0.00 ,+ 1,254.00 v^ 0.00 0.00 637.13 0.00 0.00 16.34 ✓ Discount No -Pay Net 0.00 0.00 1,907.47 Discount No -Pay Net file:/UC:/Users/eheiman/cnsi/memmed.ensinet.com/u9R547n/data Sh n, cw5rrnnrtiA6A4 0lSht109 Page 4 of 18 0979706 01/25/20 01118/20 02/17/20, 4,535.68' SUPPLIES [Ilia lkIVWL1d00" 110 60#11A hvM"US Vendor Totals Number Name Gross. C1992 COW GOVERNMENT, INC. 4,535.68 Vendor# Vendor Name Class Pay Code 12768 CHEMAQUA Invoice# Comment Tran Ot Inv Ot Due Dt Check D. Pay Gross / 76413971! 01/31120 01110/20 01/20/20 518.75' WATER TREATMENT Vendor TotaleNumber Name Gross 12768 CHEMAQUA 518.75 Vendor# Vendor Name .Class Pay Code 10105 CHRIS KOVAREK Invoice# Comment Tran Dt Inv Dt Due Dt Check O Pay Gross 59 01/31/20 01131/20 02102/20, 280.00 PURCHASE SERVICES L I (14- 131 Z2� Vendor TotaleNumber Name Gross 10105 CHRIS KOVAREK 280,00 Vendor# Vendor Name Class Pay Code. C1166 COASTAL OFFICE SOLUTONSY/ W .Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross OEOT193641 ✓/ 01131/20'01/07/2001117/20 3,669.20' SUPPLIES CPOEQT1 939111 v1 01/3112001/1912001/29/20. -8.02 CREDIT OEQT194351 y//01/31120 01/28/20 02/07/20 96.50 SUPPLIES Vendor Totals Number Name Gross C1166 COASTAL OFFICE SOLUTONS 3,757,66 Vendor# Vendor Name Class Pay Code / 11029 COASTAL REFRIGERATION V Invoice# / Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross 5114802 �/ 01/31/20 01/25/20 02/01/20 539.85 REPAIR SERVICES 5114482,/ 01/31120. 01/25/2002101/20. 923.32 /REPAIR SERVICES 5114424J 01/31/20. 01/2512002/01/20 617.75 REPAIR SERVICES 5114483/ 01/31120 01/25/20 02101120 323.45 REPAIR SERVICES Vendor Total; Number Name Gross 11029 COASTAL REFRIGERATION 2,404.37 Vendor# Vendor Name Class Pay Code 14804 COFFEE BARREL, LLC ✓ 0.00 0.00 4.535,68 Discount No -Pay Net 0.00 0.00 4,535.68 Discount No -Pay Net 0.00 0.00 518,75 ✓f Discount No -Pay Nei 0.00 0.00 518.75' Discount No -Pay Net 0.00 0.00 / 280:00 Mf Discount No -Pay 0,00 0.00 Discount NO -Pay 0.00 0.00 0.00 0.00 0.00 0.00 Discount No -Pay 0.00 0.00 Discount No -Pay 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Discount No -Pay 0.00 0.00 Invoiceo Comment Tran Dt Inv Ot Due Dt Check D• Pay Gross Discount FES2022 01131/200113112001/31/20 66,875.00 0.00 INTERIM PRACTICE ADMINIST (-1-1 I - 4I 31 z2-) }TGWU = Iq ax.00 Vendor Totals Number Name 5411&1y•00 IV KO Gross Discount 14304 COFFEE: BARREL, LLC 66,875.00 0.00 Vendor#Vendor Name Class Pay Code 11030 COMBINED INSURANCE L�/ Net 280.00 Net 3,669.20 ✓ -8.02 ✓/ 96.50 ✓ Net 3,757.68 Net // 539.85 %" 923.32 ✓ 617.75 323.45 Net 2,404.37 No -Pay Net 0.00 66,075.00 No -Pay Net 0,00 66,875.00 file:///C:/Users/cheiman/cnsi/memmed.cDsinet.com/u9R5472/data 5/tmn nwirennrtSRAAd ?/a/?n" Page, 5 of 18 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net JAN2022 01131/20 01/31/20 02/01/20, 657.70 0.00 0.00 657.70 PAYROLLDEDUCT Vendor Totals Number Name Gross Discount No -Pay Net 11030 COMBINED INSURANCE 657.70. O.OD 0.00 657.70 Vendor# Vendor Name Class Pay Code C1970 CONMED CORPORATION M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gloss f Discount No -Pay Net 780599 �/ 01/31/2001/31/2001/31120 87.50 0.00 0.00 87.50 SUPPLIES Vendor Totals Number Name Gross. Discount No -Pay Net C1970 CONMED CORPORATION 87.50 0.00 0.00 B7.50 Vendor# Vendor Name Class Pay Code 10006 CUSTOM MEDICAL SPECIALTIES ✓ Invoice# / Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 290314 101/31/20. 01/24/20 02O1120 349.01 0.00 0.00 j 349.01 v" SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10006 CUSTOM MEDICAL SPECIALTIES 349.01 0.00 0,00 349.01 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON Invoice# Comment Tran Dt Inv Dt DueDt Check D-Pay Gross Discount No -Pay Net 6693290✓ 01/28/20.011/18/2002/18120 301.44 0.00 0.00 301.44✓ SUPPLIES 66921421/ 01/31/2001/24/2002/16/20 34.64 0.00 0.00 34.64 ✓ / SUPPLIES 670260✓ 01131/2001125/2002119/20. 69,30 0.00 0.00 69.30 f SUPPLIES 6612191 ✓ 01/31/20 01/26/20 02/20/20 41.20 0.00 0.00 41.20 ✓ / SUPPLIES 6703890v 01/31/20 01/26/20 02120/20 474.63 0.00 0.00 / 474.63 ✓ SUPPLIES 6704760 0113112001127/2002/21/20 185.60 0.00 0.00 185.60 SUPPLIES' Vendor Totals Number Name Gross Discount No -Pay Net 10868 DEWITT POTH & SON 1,106.81 0.00 0.00 1,106.81 Vendor# Vendor Name Class Pay Code 10789 DISCOVERY MEDICAL NETWORK INC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check -D Pay Gross Discount No -Pay Net MMC013122 01/31/2001/31/2001/31/20 124,365,33 0.00 0.00 124,365.33 PHYSICIAN SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 10789 DISCOVERY MEDICAL NETWORK. INC 124,365.33 0.00 0.00 124,365.33 Vendor# Vendor Name Class Pay Code W1167 ELITECH GROUP INC (WESCOR) W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 771453 ✓ 01/28/20 01/12120 01/10/2o 108.66 0.00 0.00 108.66i/ SUPPLIES. VendorTotais Number Name Gross Discount No -Pay Net W1167 ELITECH GROUP INC (WESCOR) 108.66 0.00 0.00 108.66 Vendor# Vendor Name Class Pay Code file:///C:/Users/eheiman/ct3si/memmed.cDsinet.com/u98547a/data 5/tmn ew5renort5R664__. 2/3/2[122 Page 6 of 18 C2510 EVIDENT ✓ M Invoice# comment Tran Dt Inv Dt Due Or Check D Pay Gross Discount No -Pay Net T2201071378✓ 01/31/2001/07/2002/O1/20. 19,760.52 0.00 0.00 19,760.52 994397 J 01/31/2001/18/20.02/12/20 90.00 0.00 0.00 90.00 FORMS Vendor Totals Number Name Gross Discount No -Pay Net. C2510 EVIDENT 19,850.52 0.00 0.00 19,850.52 Vendor# Vendor Name Class Pay Code S0501 EVOQUA WATER TECHNOLOGIES LLC ✓ Invoice# ,/Comment Tran Dt Inv Dt Due Dt Check D• Pay Gross Discount No -Pay Net 905226704✓ 01131/20. 01/26/20 OPJ20/20 752.93 0.00 0.00 752.93 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net S0501 EVOQUA WATER TECHNOLOGIES LLC 762.93 0.00 0.00 752.93 Vendor# Vendor Name 11 Class Pay Code 10003 FILTER TECHNOLOGY CO; INC ✓ Invoice# Comment Tran Dt InV Dt Due Dt Check D, Pay Gross. Discount No -Pay Net 111823 / 01/31/20,00/1 W2009/17/20, 212.80 0.00 0.00 212,80 „If SUPPLIES Vendor Totals Number Name Grass Discount No -Pay Net 10003 FILTER TECHNOLOGY CO,. INC 212.80 0.00 0.00. 212.80 Vendor# Vendor Name Class Pay Code 14092 FIRST CONNECT CENTER LLC d/ Invoice#Comment Tran Dt. Inv Dt Due Dt Check D, Pay Gross Discount No•Pay Net 3767 ✓/ 01/21/20. 01/20/2002/19/20 4,500,00 0.00 0.00 4,500:00 TRAVEL NURSE STAFFING Lt'lt-t�13`2Zi BOrr�tlAn� v/ ,/ ✓ 3768 01/21/20.01/20/20 02/19/20, 4,437.50. 0.00 0.00 4,437.50 ✓ TRAVEL NURSE STAFFING LIt14-1IWI72-� Rurnhbm 3019 01/31/20.10/15/2011/14/20 4,687.00 0.00 0.00 4,687.00 ✓I TRAVEL NURSE STAFFING tj0jq--t0jILj'l') I> riAlvL 3749 ✓ 01/31/2001/2012002/19/20 3,513.85 0.00 0.00 / 3,513.85 1/ TRAVEL NURSE STAFFING L1j4-0gjza,)Vt,LL Vendor Totals Number Name Gross Discount No•Pay Net 14092 FIRST CONNECT CENTER LLC 17,138.35 0.00 0.00 17,138.35 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Pay Grosse Discount No -Pay Net 865PP87 ✓/ 01/25/20 01/24/20 02/18/20 516.74 0.00 0.00 516.74 SUPPLIES / 6422094 v' 01/28/20.12/03/20. 02/18/20 365.81 0.00 0.00 365,81 ✓� SUPPLIES 8127383/ 01/28/20.01/12I2002/18/20 1,31652 0.00 0.00 1,316.52 ✓'� _SUPPLIES 8322852� 01131/20, 01117/2002/11/20 52.78' 0.00 0:00 ,r 52.78 ✓ SUPPLIES / 8322051✓ 01/31/20: 01/17/2002/11/20: 43.67 0.00 0.00 43.67 SUPPLIES 8322856 ✓ 01/31/20.01/17/2002/11/20 192.04 0.00 0.00 192.04 ✓ SUPPLIES 8322853 f� 01/31/2001/17/2002/11/20 154.44 '0,00 0.00 154.44 file:///C:/Users/eheiman/eDsi/memmed.cnsinet.com/nM547n/tints Vtmn cwSrP mt;RAAA Page 7 of 18 / SUPPLIES 8764251 ✓ 01/31/20. 01/26/2002/20/20 41.44 0.00 0.00 41.44 ✓ SUPPLIES 8821608✓ 01/31120.01/27/2002/21/20 238.49 0.00 0.00 238.49 /SUPPLIES 8877723 ✓ 01/31/20 01/28120 02/22/20. 645.21 0.00 0.00 / 645.21�,/ SUPPLIES Vendor Total.Number Name Grass Discount No -Pay Net F1400 FISHER HEALTHCARE 3,567.14 0.00 0.00 3,667.14 Vendor# Vendor Name Class Pay Code 11183 FRONTIER Invoice# Comment Tran Dt Inv Dt DueDtCheck D Pay Gross Discount No -Pay Net 011922 01/31/20,01/1912002/14/20 65.40 0.00 0.00 65.40 TELEPHONE JAN2022 01131/2001/2312002/16/20, 14.00 0.00 0.00 14.00 u/ TELEPHONE Vendor Total, Number Name Gross Discount No -Pay Net 11183 FRONTIER 70.40 0.00 0.00 79.40 Vendor# Vendor Name Class Pay Code J 12636 FUSION CLOUD SERVICES, LLC Invoice# Comment Tran Dt Inv Dt Due Dt -Check D Pay Gross Discount No -Pay Net 28432130%/ 01/31/20.01/31/2002/15/20. 1,090.10 0.00 0.00 1,090,10 r,J TELEPHONE SERVICES Vendor Totals Number Name .Gross Discount No -Pay Net 12636 FUSION CLOUD SERVICES, LLC 11090.10 0.00 0.00 11090,10 Ventlor# Vendor Name Class Pay Code G0401 GULF COAST DELIVERY f Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net JAN2022 01/31/20, 01/3112001/31120 150.00 0.00 0.00 150.00 DELIVERY SERVICES Vendor Totals Number Name Gross Discount No -Pay Net G0401 GULF COAST DELIVERY 150.00 0.00. 0.00 150.00 Vendor# Vendor Name Class Pay Code / G1210 GULF COAST PAPER COMPANY ✓ M Invoice# Comment Tran 01 Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 21718a4u/ 01/25/20 01/18/20 02/17/20 753.49 0.00 0.00 753,49 V`f .SUPPLIES 9171730/ 01/25/20: 01/1812002/17/20 20.67 0.00 0.00 20.67 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPER COMPANY 774.16 0,00 0.00 774.16 Ventlor# Vendor Name Class Pay Code H0032 H + H SYSTEM, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross 036676 / Discount No -Pay Net 01/31/20 01/19120 01/31/20 43.94 0.00 0.00 43.94 SUPPLIES Vendor Totals Number Name Grass Discount No�Pay Net H0032 H + H SYSTEM, INC. 43.94 0.00 0.00 43.94 Vendor# Vendor Name Class Pay Code 10334 HEALTH CARE LOGISTICS INC ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Pay Gross Discount No -Pay Net file:///C:/Users/elieiman/ct)si/mernmed.cDsinet.com/u98547a/data 5/tmn ew5rwnnrt5Rr6A 7/1/1)1)" Page 8 of 18 308275172 ✓ 01/31/20 12JI3120 01/07120, 31100.00 0,00 0.00 3.100,00,/ SUPPLIES 308305400 V1 01/31120 01/06/20 01/31/20 31 A0 0.00 0.00 31.80 SUPPLIES Vendor TotalsNumber Name Gross Discount No -Pay Net 10384 HEALTHCARE LOGISTICS INC 3,131.80 0.00 0.00 31131.80 Vendor# Vendor Name Class Pay Code 12380 HEALTH SOLUTIONS DIETETICS v1 Invoice# Comment Tran Dt Inv Dt Due Ot Check Dtr Pay Gross Discount No -Pay Net 013122 01131/20. 01/3112001131/20. 3,000.00 0.00 0.00 3,000.00 DIETICIAN SERVICES Vendor Totals Number Name Gress Discount No -Pay Net 12380 HEALTH SOLUTIONS DIETETICS 3,000.00 0.00 0.00 3,000.00 Vendor#Vendor Name Class Pay Code 12932 INTRADO Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 23OT71 01/31/20.11/30/2012/30/20 655,91 0.00 0100 655.91 t% HOUSE CALLS Vendor Totals Number Name. Gross Discount No -Pay Net 12932 INTRADO 655.91 0.00 0.00 655.91 Vendor# Vendor Name Class Pay Code 11108 ITERSOURCE CORPORATION ✓,/ Invoice# / Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 711448 v/ 02/01/20 02/01/20 02/01/20 250.00 0.00 0.00 250.00 y/ SUPPORT SERVICES FEB 22 Vendor Total. Number Name Gross .Discount No -Pay Net 11108 ITERSOURCE CORPORATION 250.00 0.00 0,00 250.00 Vendor# Vendor Name Class Pay Code 14296 J &.K SERVICES Invoice# .Comment Tran Dt Inv Dt Due Dt CheckD-PayGross Discount No -Pay Net 003960 01131120. 12/02/2001/02/20 895.00 0.00 0.00 895.00 SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 14296 J & K SERVICES 895.00 0.00 0.00 895.00 Vendor# Vendor Name Class Pay Code 11796 LUBY'S FUDDRUCKERS RESTAURANTS V/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net INV00005219 ✓01/17/2012/3l/2001/30/20.. 27,973.01 0.00 0.00 27,973.01 ✓'� DECEMBER 2021 Vendor Totals Number Name Gross Discount No -Pay Net 11796 LUBY'S FUDDRUCKERS RESTAURANTS 27,973.01 0.00 0.00 27,973.01 Vendor# Vendor Name Class Pay Code 10972 MG TRUST V Invoice# Comment Tran Dt Inv Dt Due Ot Check D, Pay Gross Discount No -Pay Net 012722 01/31120 01/27/20 01/27/20 640.85 0.00 0.00 640.86 PAYROLLDEDUCT Vendor Totals Number Name. Gross Discount No -Pay Net 10972 M G TRUST 640.86 0.00 0.00 640.86 Vendor# Vendor Name Class Pay Code / M2178 MCKESSON MEDICAL SURGICAL INC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net file:///C:/Users/eheiman/cpsi/Menuned.ci)sinet.com/u98547a/data 5/tmn cw5rennrt5R664 2/anm� Page 9 of 18 18968871 ✓ 01/31/20 01/17/20 02/01/20 416.14 /gUPPLIES 19010917 r/ 01/31/20 01/28120 02112/20 69.01. SUPPLIES 12056482 V1 01/31/20. 0113112002115/20 2.30 FINANCE CHARGES Vendor Totals Number Name Gross M2178 MCKESSON MEDICAL SURGICAL INC 487.45 Vendor# Vendor Name / Class Pay Code M2310 MEDELA INC ✓ M. Invoice# Comment Tran Di Inv Dt Due Dt 7000756177J 01/31/2001/1212001/31/20 Check D, Pay Gross 103.59 SUPPLIES Vendor Totals Number Name Gross M2310 MEDELA INC 103.59 Vendor#Vendor Name / Class M2827 MEDIVATORS ✓ M Pay Code Invoice# Comment Tian Dt Inv Dt Due Dt 90919478 1/ 01/31/20.05/25/20 01131120. Check O Pay Gross 195.00 p^UPPLIES 90985982 `/ 01/31/2(t06/20/2001131/20. 17.00 SUPPLIES 91003770 V,/01/31/2008/04/2009/03/20. 195.00 SUPPLIES Vendor TotalE Name Gross M2827 MEDIVATORS 407.00 Vendor# Vendor Name / Class M2470 MEDLINE INDUSTRIES INC ✓ M Pay Code Invoice# Comment Train Dt Inv Dt Due Ot 1982333836 ✓ 01/28/20.01/12/2002118/20 Check D Pay Gross -342.31 SUPPLIES 1982184470VI 01/28/2001/12/2002118/20 604.35 SUPPLIES 0.00 0.00 416.14 ✓ 0.00 0.00 69.01 ✓ 0.00 0.00 2.30 ,/ Discount No�Pay Net 0.00 0.00 487.45 Discount No -Pay Net 0.00 0100 103,59 Discount No -Pay 0.00 0.00 Discount No -Ray 0.00 0,00 0.00 0.00 0.00 0.00 Discount No -Pay 0.00 0.00 Discount No -Pay 0.00 0.00 0.00 0.00 1982184481 d 01/28120 0111PJ20 02/18120 1,942,89 0.00 SUPPLIES 1982780640✓ 01/31/2001/14/2002108/20. 251.78 0.00 SUPPLIES 1982889433f 01/3112001/15/2002/09/20_ 115.12 SUPPLIES 1982889432✓ 01/31/20, 01115/2002/09/20. 63.72 SUPPLIES 1982805914V/ 01/31/20, 0111512002/09/20 185.24 SUPPLIES 1952889434 ✓ 01/31/20,01/15/2002/09/20 75.38 SUPPLIES 1983134715 ,/ 01/31/20 01/18/20 02/12/20 83.28 SUPPLIES 1983134717 V/ 01/31/2001/18/2002/12/20 987.08 SUPPLIES 1983134716 v/ 01131/2001/18/2002/12/20. 214.97 SUPPLIES 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Net 103,59 Net 195.00 17.00 195.00 ✓/ Net 407.00 Net / 342.31 ✓ 604.35 1,942.89 .� 251.78 ✓ 115.12 63.72 185.24 ✓ 75.38 V�// 83.28 ✓ 987.08 214.97 ✓ file:///C:/Users/eheiman/ci)si/memmed.cosinet.com/u98547a/data 5/tmo cw5renort58664... 2/3/2022 Page 10 of 18 1983122750 f 01131/2001/1812002/12/20 366.35 0.00 0.00 SUPPLIES 19833931871% 01/31/20 01/19/20 02/13/20 24.99 0.00 0.00 SUPPLIES 1983393185 ✓ 01/31/20.01/19/2002/13/20 55.44 0.00 0.00 SUPPLIES 1983552955 v1 01/31/20,01/19/2002/13/20, 1,554.55 0.00 0.00 S PPLIES 1983393808 ti 01/31/2001/19/2002/13120 375.70 0.00 0.00 SUPPLIES 1983347480 V1 01/31120 01119120 02/13/20 601,05 0.00 0.00 SUPPLIES 1983393188 I,! 01/31/20, 01119/2002113120 44,44 0.00 0.00 SUPPLIES 1983393183,/ 01/31/2001/1912002/13/20, 154.15 0.00 0.00 SUPPLIES / 1983393184 �,r' 01131/20, 01/1912002113120 92.96 0100 0.00 SUPPLIES 1983347483 V/ 01/31/20,01/19/2002/13120 30.54 0.00 0.00 SUPPLIES 1983393199 z 01/31/20. 01/1912002113/20 3,484.95 0.00 0.00 SUPPLIES 1983393189 t// 01/31/2001/19/2002/13/20 680.07 0.00 0.00 SUPPLIES 1983393182 ✓ 01131/20 01/19/20 02/13/20 548.17 0.00 0.00 SUPPLIES Vendor Totals:Number Name Gross Discount No -Pay M2470 MEDLINE INDUSTRIES INC 12,779.48 0.00 0.00 Vendor# Vendor Name Class Pay Code / 10963 MEMORIAL MEDICAL CLINIC J Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Grass 012722 01/31/20 01127/20 01/27/20, 170.00 PAYROLLDEDUCT Vendor Totals Number Name Gross 10963 MEMORIAL MEDICAL CLINIC 170.00 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Pay Gross 809325 01/31120: 01125/2002J04120, 21.46 SERVICE CHARGE 7803974v/ 01 /31/20 01/26/20 02105/20 95.73 INVENTORY 7802660 ✓ 01/31/2001/2612002105/20 97.18 /INVENTORY 7805669 Discount No -Pay 0.00 0.00 Discount No -Pay 0.00 0.00 Discount. No -Pay 0.00 0.00 0.00 0:00 0.00 0.00 01131 /20 01/26/20 02/05/20. 28.79 0.00 /INVENTORY 780SD39 ✓ 01/31/20: 01/26/20 02105/20. 3,251.16 0.00 INVENTORY 7805417 01/31/20 01/26/20 02/OS120- 254.62 0.00 INVENTORY 7802658 ✓ 01/31/20 01/26/20 02105/20 15.83 0.00 0.00 0.00 0.00 0.00 366.35 55.44 t/ 1,554.55 � 375.70 t// 501.05 44.44 V 154.15 ✓ 92.96 ✓ 30.54 / 3,484.95 680.07 , 548.17 ✓ Net 12,779.48 Net 170.00 Net 170.00 Net / 21.46 V 95.73 97A8 Y 28.79 e% 3,251.16 254.62 16.83 file:///C:/Users/0lieiman/cpsi/memmed.ci)sinet.com/u98547a/data 5/tmD ow5renort5R664__ 2/3/20?2 Page 11 of 18 INVENTORY 7805672 ✓ 01181/20. 01126/2002105/20: 393.73 0.00 0.00 / 393.731/ INVENTORY 7805670 01/31/20 01/26/20 02J05120. 31,30 0.00 0.00 31.30 ✓ �/INVENTORY 7806063V 01/31/2001/2612002/O5/20. 11322.98 0.00 0.00 1,322.98 INVENTORY 7802661 �% 01/31/20. 01126/2002JOS120 180.47 0,00 0.00 180.47 /INVENTORY 7805671 �/' 01131/20. 01126/20.02105/20, 104.79 0.00 0A0 1,984.79✓ INVENTORY 7802659,// 01/31/20.01/26/2002/05/20 56.13 0.00 0.00 66.13 ✓ /INVENTORY 7805418 01/31/20. 01/26/2002105/20 732.92 0.00 0.00 732.92 /INVENTORY 7810855 ✓ 01/31/20 01/27/20 OPJ06120. 925.07 0.00 0.00 925.07 fNVENTORY 7807759 t/ 01/31/2001/27/2002/06/20 239.53 0.00 0.00 239.53 INVENTORY 8334 f 01/31/20, 01/27/20 OPJ06120, -2,679.56 0.00 0.00 -2,679.56 1// CREDIT / 7807760 ✓ 01131 /20 01/27/20 02/06/20. 95.73 0.00 0.00 95.73 INVENTORY 7807761 ✓/01/31/20: 01/27/20 02JO6120 54.04 0.00. 0.00 54.04 INVENTORY 78910854 01/31120. 01127/2002/06/20 8.55 0,00 0.00 / 8.55 ✓ /'INVENTORY 7807763 �/' 01131/20.01/2712002/06/20. 1,087.88 0.00 0.00 1,087.88 ✓ / INVENTORY J 7815136✓ 01/31/20� 01/3012002l09/20 59.06 0.00 0.00 59.06✓ .INVENTORY 7817282 v1 01/31/20 01/30/20 02/09/20 8.83 0.00 0.00 8.33 INVENTORY 7816384 01/31120,01/30/2002109/20 1,489.08 0.00 0.00 1,489.0B✓ INVENTORY 7816385 f 01/31/2001/30/2002/09/20. 822.02 0.00 0.00 / 822.02 INVENTORY 7815137 y/ 01/31/20. 01/30/20 02/09/20 274.21 0.00 0.00 274.21 /INVENTORY 7817281 01131/20 01/30/20 02JO9120 1.85 0.00 0.00 / 1.85 ✓' INVENTORY 7817283� 01/31/20,01/3012002/09/20 71.16 0.00 0.00 71.16✓ INVENTORY 7816382%/ 01/31/20 01/30/20 02/09/20 479.05 0.00 0.00 479.05 ✓ JNVENTORY 7821667 ✓! 01/31/20 01/31/2002/10/20. 135.81 0.00 0.00 135.81 INVENTORY / 9141 J 01/31/2001/31/2002/10/20. -236.96 0.00 0.00 -236.96 CREDIT 7818717 ✓/ 01/31l20,01/31/20.02/10/20. 53:99 0.00 0:00 53.99 INVENTORY file:///C:/Users/eheiman/cpsi/memmed.cvsinet.com/u98547a/data 5/tmn cw5rennrt5R664_ '):/1/)0?? Page 12 of 18 / 7818713 01/31/20 01/31/20 02/10/20 92.64 0.00 0.00 9264 /INVENTORY 7818718 ✓ 01/31/20. 01/31/20 02/10/20 54.04 0.00 0.00 / 64.04 � /INVENTORY 7821668 V 01/31/20.01/31/20 02/10/20 291.27 0.00 0.00 291.27 /INVENTORY 7818714 01/31/2001/31/2002/10/20. 59.06 0.00 0.00 59.06 INVENTORY 7818716 y/F 01/31/20.01/81/20 02/1o/2o, 348.85 0.00 0.00 / 348.85 ✓ INVENTORY 7818169 01/31/2001/31/2002/10/20 11,681.00 0.00 0.00 11,681.00 -� NVENTORY 7818715'I 01/31/20.01/31/2002JI 0/20 428.06 0.00 0.00 428.06 /INVENTORY 7818719�/ 01/3VW01/31/2002/10/20. 3.29 0,00 0.00 3.29 ,✓ I VENTORY CM15484 01/31120.01131/2002/10/20 -15.14 0.00 0.00 -15.14 CREDIT 7827635 ✓ 02/02/20 02/01/20 02111/20, 147.95 0.00 0.00 147.96 INVENTORY 7824073 ✓ 02/0 J20. 02(01/2002/11/20 642.08 0.00 0.00 642.08 INVENTORY / 7827634 ✓ 02/02/20 02/01/20 02/i t/2o_ 396.87 0.00 0:00 / 396.87 ✓ INVENTORY Vendor Totals Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 25,486.41 o.00 0.00 25,486.41 Vendor# Vendor Name Class Pay Code / 14124 MSH HEALTH SERVICES LLC J Invoice# Comment Tran Ot Inv Dt Due Dt Check Pay Gross Discount No -Pay Net MMC0014 (I1/31/2010/1112002121/20 4,500.00 0.00 0.00 4.500.00 % TRAVEL NURSE STAFFING(,lolg'Ipjl4)-21) kAgkmpn_ MMC0019 01/31/2011/01/2011/01/20, 4,500.00 0.00 0.00 4,500.00 LZ TRAVEL NURSE STAFFING is I2b^Io,Zb �21,�]ltp7,(k4py�- MMC0042 01131/20 01/26/20 01/26/20 6,421,25 0.00 0.00 6,421,25 t✓ TRAVEL NURSE STAFFING (II.14-I I-& it7?1G1LLW'0 _ MMC0041 01/31/20 01/26/20 01/26120 2,628.72 0,00 0.00 2,628.72 TRAVEL NURSE STAFFING I I W 7,01 M) bVKK . Vendor Totals Number Name Gross Discount No -Pay Net 14124 MSH HEALTH SERVICES LLC 18,049.97 0.00 0.00 18,049.97 Vendor# Vendor Name Class Pay Code M2659 MXR IMAGING, INC M Invoice# Comment Tran Dt Inv Dt. Due Ot Check O Pay Gross Discount No -Pay Net 8800856686 ✓ 01/31/20 01/21/20 02/20/20 154.33 0.00 0.00 / 154.331 SU PLIES 8800857017 01/31/2001/24/2002/23/20. 766.24 0.00 0.00 766.24 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net M2659 MXR IMAGING, INC 920.57 0.00 0100 920.57 Vendor# Vendor Name / Class Pay Code 13548 NACOGDOCHES TRANSCRIPTION ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net file:///C:/Users/eheiman/cosi/niemmed.cnsinet.com/u9R:547a/data 5/tmn (1.w5rrnnrtSRfrd a/z/on1^) Page 13 of 18 7609 / 01/31/2001131/2001/31/20, 310,52 0.00 0.00 310.52 TRASCRIPTION SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 13548 NACOGDOCHES TRANSCRIPTION 310.52 0.00 0:00 310.52 Vendor# Vendor Name Class Pay Code / 01500 OLYMPUS AMERICA INC M Invoice# /pomment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 32083933 V 01/3112001/18/2002/12/2o 194.03 0.00 0.00 194.03 ✓ SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 01500 OLYMPUS AMERICA INC 194.03 0.00 0.00 194.03 Vendor# Vendor Name / Class Pay Code OM425 OWENS &.MINOR „/ Invoice# C0 ment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 2071819925 r01/31120, 01/18/20 02117/20. 651.98 0.00 0.00 551.98 SUPPLIES ✓ Vendor Totals Number Name Gross. Discount No -Pay Net OM425 OWENS&MINOR 551.98 0.00 0.00 551.98 Vendor# Vendor Name Class Pay Code 11069 PABLO GARZA Invoice# Comment Tran Dt InvDt Due Dt. Check D-Pay Gross Discount No -Pay Net 013122 01/31/20. 01/31/2001/31120, 2,340.00 0.00 0.00 2,340.00 TRANSCRIPTION SERVICES L I lit- 112,TJ7q_) Vendor Totals Number Name Gross Discount No -Pay Net 11069 PABLO GARZA 2,340,00 0.00 0.00 2.340.00 Vendor# Vendor Name Class Pay Code 10152 PARTSSOURCE, LLC ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross 04187531 V/ Discount No -Pay Not 01/31/20 01/17/20 02/16120 52.53 0.00 0.00 52.53 SUPPLIES 4j 04190646 �� 01/31/20. 01/19/2002118/20 46.99 0.00 0.00 46,99 V SUPPLIES 04192295 ✓/01/31120 01/20/20 02119/20 72.58 0.00 0.00 72.58 ,SUPPLIES 4198592 ✓/ 010/2001/24/20 o2/23/20 222,81 0.00 0.00 222.81 VZ .SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net. 10152 PARTSSOURCE, LLD 394.91 0.00 0.00 394.91 Vendor# Vendor Name Glass Pay Gode. P2200 POWER HARDWARE ✓ W Invoice# / Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net A80330 ✓ 01131/2001/03/2002/23/20 3.95 0.00 0.00 3.95 ✓ SUPPLIES / A80322 ✓ 01/31/20, 01/0312002/23/20, 30,35 0.00 0.00 30.35 SUPPLIES A80955 01/3112001/24/2002/23/20 29.38 o.ao 0.00 29.38 SUPPLIES f B65382 ✓ 01/31/2001/24/2002/23/20 1.19 0.00 0.00 1.19 SUPPLIES Vendor Totals Number Name Grass. Discount No -Pay Net P2200 POWER HARDWARE 64.87 0.00 0.00 64.87 file:///C:/Users/0heiman/ongi/mP.mmpei oneinat e.nm/iiOR Sd7./Hato S/r..,., ,,... c,.,,„.. 40c4n n/I Innnn Page 14 of 18 Vendor# Vendor Name Class Pay Code P17PS PREMIER SLEEP DISORDERS CENTER 4,M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 113 ✓ 01/31/20. 01/31/2002/15/20 575.00 0.00 0.00 575.00 SLEEP STUDY Vendor Totals Number Name Gross Discount No -Pay Net P1725- PREMIER SLEEP DISORDERS CENTER 575.00 0.00 0.00 575.00 Vendor# Vendor Name Class Pay Code / 11080 RADSOURCE r/ Invoice# Comment Tran Dt Inv Dt Due Ol Check D Pay Gross Discount No -Pay Net SC62719 / 0113112009/12/2010/07/20 1,667.00 0.00 0.00 1,667.00 PURCHASE SERVICES SC62739 ✓ 01/31/20 09116/20 10/11/20 1,625.00 0.00 0.00 1,625.00 PURCHASESERVICES v/ Vendor Totals Number Name Gross Discount No -Pay Net 11080 RADSOURCE 3,202.00 0.00 0.00 3,292.00 Vendor# Vendor Name Class Pay Code / 50900 SAM'S CLUB DIRECT W Invoice# Comment Tran Dt Inv Dt. Due Dt Check D Pay Gross Discount No -Pay Net 004385 01/31/2012124/2o o2to8/20 103.86 0.00 0.00 / 103.86 SUPPLIES 005208 01/31/2012124/2002/08/20. 17.14 0.00 0.00 17.14 ror SUPPLIES 002953 01/31/2012128/2002108/20. 207.15 0.00 0.00 207.15 ✓ SUPPLIES 006168 01/31/2001/02/2002/08/20 118.84 0.00 0.00 / 118.84 ✓ SUPPLIES 005419 01/31120; 01/03/2002/08/20 58.08 0.00 0.00 58.08 ✓ SUPPLIES 005517 01131/20. 01/08/2002/08/20 215.32 0.00 0.00 215.32 f SUPPLIES 007859 01/31/2001/12/2002/08/20 97.16 0.00. 0.00 97.16. SUPPLIES 004633 01/31/20. 01/12/2002/08120 70.84 0.00 0.00 70.84 SUPPLIES 1/' Vendor Totals Number Name Gross Discount No -Pay Net S0900 SAM'S'CLUB -DIRECT 888.39 0.00 0.00 888.39 Vendor# Vendor Name Class Pay code / 51800 SHERWIN WILLIAMS yr W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 72660 01/31/200110312001/18/20, 57.58 0.00 0.00 57.58 SUPPLIES/ 74146 ✓ 01/31/20. 01106/2001121/20. 271.59 0.00 0,00 271.59 ✓" SUPPLIES 74757 ^� 01/31/20. 01/07/2001/22/20 25.45 0.00 0.00 25.46 1% SUPPLIES 78444 01/31/20 01/17/20 W01/20 648,67 0.00 0.00 648.67 f SUPPLIES. 78451 01/31/2001/17/2002101/20. 10.02 0.00 0.00 10.02 SUPPLIES 78436/ 01/3112001/17/2002/01/20 339.01 0.00 0.00 / 339.01 file:///C:/LJsers/eheiMan/Cnsi/Memmed_encinetcnm/hjgt5A7n/�latn S/tmn <,.a„A„,. rQAAA oi)P)(In) Page 15 of 18 SUPPLIES Vendor TotalENumber Name Gross Discount No -Pay Net 81800 SHERWIN WILLIAMS 1,352.32 0.00 0.00 1,352.32 Vendor# Vendor Name Class Pay Code S2001 SIEMENS MEDICAL SOLUTIONS INC ✓/ M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 116162114 V 01/31120 01/17/20 02/11/20 2.193.83 0.00 0:00 2,193.83 f MAINTENANCE CONTRACT Vendor TotalE Number Name. Gross Discount No -Pay Net S2001 SIEMENS MEDICAL SOLUTIONS INC 2,198.83 0.00 0.00 2,193.83 Vendor# Vendor Name Class Pay Code S2353 SMITHS MEDICAL ASD INC � Invoice# Comment Tran Ot Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 16544649 y/ 01/31/2001/21/2001/31/20 66.82 0.00 0.00 66,82 1% SUPPLIES Vendor TotalE Number Name. Gross Discount No -Pay Net S2353 SMITHS MEDICAL ASD INC 66:82 0.00 0.00 66.82 Vendor# Vendor Name Class Pay Code 10094 STDAVIDS HEALTHCARE Invoice# Commen Tran Dt Inv or Due Dt Check D Pay Gross Discount No -Pay Net MMCPL2021-11 V 01/31/20 01119/20 01/19/20 420.00 0.00 0.00 420.00 CONNECTIVITY FEE NOV 21 MMCPL202112. 01/31/2001126/2001126/20, 420.00 0.00 0.00 420.00,%� CONNECTIVITY FEE DEC 2021: Vendor TotalENumber Name Gross Discount No -Pay Net 10094 ST DAVIDS HEALTHCARE 840.00 0.00 0.00. 840.00 Vendor# Vendor Name Class Pay Code S3960 STERICYCLE, INC � / Involce# Comment Tran Dt Inv Dt Due Ot Check D, Pay Gross Discount No -Pay Net 4010691523 / 01/31/20 01 /20/20 02/19/20 2.570.76 0.00 0.00 2,570,76 ✓ f SERVICES Vendor TotalE Number Name Gross Discount No -Pay Net S3960 STERICYCLE, INC 2.570.76. 0.00 0.00 2,570.76 Vendor# Vendor Name Class Pay Code 14300 STRYKER: COMMUNICATIONS ,!/ Invoice# Comment Tran. Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 012822 01/31/2001128/2001/28/20. 16,183.33 0.00 0.00 15,183.33.✓ DEPOSIT Vendor TotalE Number Name Gross Discount No -Pay Net 14300 STRYKER COMMUNICATIONS 16,183.33 0.00 0.00 16,183.33 Vendor# Vendor Name Class Pay Code 10735 STRYKER SUSTAINASILITY ✓f Invoice# omment Tran Dt Inv Dt Due Dt � Check Db Pay Gross Discount No -Pay Net 4354479 01/31/20 01/21 /20 02/20/20 170.71 0.00 0.00 17031 «{f SUPPLIES Vendor Total$ Number Name Gross Discount No -Pay Net 10735 STRYKER SUSTAINABILITY 170.71 0.00 0.00 170.71 Vendor# Vendor Name Class Pay Code 12476 SUN LIFE FINANCIAL „✓+ Involce# Comment Tran Dt Inv Dt Due Dt Check D• Pay Gross Discount No -Pay Net 012622 01131/2001/2612002/10/20 8,785.24 0.00 0.00 8.785.24 file:///C:/Users/eheiman/cnsi/memmerl.cnsinet rnm/n9R547a/Aat9 S/r.,, , Page 16 of 18 PAYROLLDEDUCT Vendor Total, Number Name Grass Discount No -Pay Net 12476 SUN LIFE FINANCIAL 8,785.24 0.00 0.00 8,785.24 Vendor# Vendor Name Class Pay Coda 14212 SURGICAL DIRECT SOUTH Invoice# Comment. Tran Dt Inv Dt Due Dt Check D- Pay Gross Discount No -Pay Net , ,/ 8702 ✓ 01131,20. 01/25/2002123120 2,010.00 0.00 0.00 2.010.00 SUPPLIES Vendor Totals Number Name. Gross Discount No -Pay Net 14212 SURGICAL DIRECT SOUTH 2,010.00 0.00 0.00 2,010.00 Vendor# Vendor Name Class Pay Code T0420 TELEFLEX MEDICAL ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9504983248 f 01/31/20. 01/20/2002/19/20 239.00 0.00 0.00 239.0o� SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net T0420 TELEFLEX MEDICAL 239.00 0.00 0.00 239.00 Vendor# Vendor Name Class Pay Code 10765 TEXAS HOSPITAL ASSOCIATION / Invoice# Comment Tran Dt Inv Dt Due Dt. Check D Pay Gross Discount No -Pay Net 010122 01/31/20 01/27/20 01127/20 7,915.00 0.00 0.00 7,915.00 COMPASS Vendor Totals Number Name Gross Discount No -Pay Net 10765 TEXAS HOSPITAL ASSOCIATION 7,915.00 0.00 0.00 7.915.00 Vendor# Vendor Name Class Pay Code 13880 TEXAS SELECT STAFFING Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Grass Discount No -Pay Net 001910251079IN 01/3112001/27/2001/27/20 4,078,80 0.00 0.00 4,078.80 TRAVEL LAB STAFFING I j es k ILL-. Vendor Totals Number Name Gross Discount No -Pay Net 13880 TEXAS SELECT STAFFING 4,078.80 0.00 0.00 4,078,80 Vendor# Vendor Name Class Pay Code / 14224 THE TACT CORPORATION OF NYC I/ Invoice# Co meet Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 9266702160 12/28/20 12/24/20 02r22/20. 5p,,7,6/0:00 I ) 0.00 000 5,760.00 TRAVEL NURSE STAFFING L 12-j ILi- 1LI Iq Z I Vendor Totals Number Name Gross Discount No -Pay Net 14224 THE TACT CORPORATION OF NYC 5,76000 0.00 0.00 5,760.00 Vendor# Vendor Name Class Pay Code / 14208 TRUSTED HEALTH, INC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net INV7858 ✓/01/31120, 01122/2001/22/20. 8,478.13 0.00 0.00 / 8,478,13 ✓ TRAVEL NURSE STAFFING CI J IS - �' "(,t �27,, 4ygk(t1W 6 Vendor Totals Number Name Gross Discount No -Pay Net 14208 TRUSTED HEALTH, INC 8,478,13 0.00 0.00 8,478.13 Vendor# Vendor Name Class Pay Code U1064 UNIFIRST HOLDINGS INC Invoice# Carr�ment Tran Dt Inv Dt Due Dt Check D Pay Gross. Discount No -Pay Net 8400386549 �/ Ot/2s/2001/24/2002118/20 2,219.03 0.00 0.00 2,219.03 v 1 LAUNDRY 8400386524 v/ 01/25/9001/24/2002/18/20. 40.10 0.00 0.00 / 40.10 file;///C:iUsers/eheiman/ensi/memtned.ensinet-comhr9R547A/data S1tmn 9/4/1f»1 Page 17 of 18 LAUNDRY / 8400386523 ✓ 01125/2001/24/2002118/20. 45.15 0.00 0.00 45,15 V LAUNDRY 8400386353 ✓ 01/31/2001/20/2002/14/20. 127.23 0.00 0.00 127.23 LAUNDRY. 8400386867✓ 01/31/2001/27/2002/21/20 177.79 0.00 0.00 177.79 LAUNDRY 8400386666 v/ 01/31/20.01/27/2002J2t/20 211.42 0.00 0.00 211.42,% I At INDRY 7 8400386864 01131/2001/27/2042/21/20 34.90 0.00 0.00 34.90 / LAUNDRY 8400386901 J 01/31/20,01/27120 02/21/20 83.76 0.00 0.00 83.761/ LAUNDRY 8400386865,/ 01/31/2001127/2002121/20. 137.13 0.00 0.00 137.13 f LAUNDRY 8400386868✓ 01/31/2001/27/2002/21/20 199.32 0.00 0.00 199.32 LAUNDRY 8400386887 ,//01/31120 01/27120 02121120 1,854.09 0.00 0.00 1,854.09 LAU DRY 1400386//2 7 01/31/20: 01/27/2o o2/2l/20. 79.43 0.00 0.00 79A3 LAUNDRY Vendor Totals Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 5,209.35 0.00 0.00 5,209.35 Vendor# Vendor Name Class Pay Code 12400 UPDOX LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check O Pay Gross Discount No -Pay Net INVO0312966 of 01/31/20, 01/31/2001/31/20. 880.01 0.00 0.00 / 880.01 ✓ EFAX Vendor Total, Number Name. Gross Discount. No -Pay Net. 12400 UPDOX LLC 880,01 0.00 0.00 880.01 Vendor# Vendor Name Class Pay Code U2000 US POSTAL SERVICE Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount NO -Pay Net 013122 01/31/2001/3112001/31120 2,200.00 0.00 0.00 2,200.00 POSTAGE Vendor Total:. Number Name - Gross Discount No -Pay Net U2000 US POSTAL SERVICE 2,200,00 0.00 0:00 2,200.00 Vendor# Vendor Name Class Pay Code 11280 VICTORIA ADVOCATE Z Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 0237962 01/3112001/31/2001/31120: 48.50 0.00 0.00 48.50 NEWSPAPER SERVICES . Vendor Totals Number Name Gross Discount No -Pay Net. 11280 VICTORIA ADVOCATE 48.50 0.00 0.00 48.50 Vendor# Vendor Name / Class Pay Code. 12208 WAGEWORKS �/ Invoice# Comment Tran Dt Inv Dt Due Dt Check.D• Pay Gross Discount No -Pay Net INV3369661 01/25/2001/24/2002/23/20. 50.00 0.00 0.00 / 50.00 ✓ 012722 01/31/20 01127/20 01/27/20 3,620.62 0.00 0.00 3,620.62 PAYROLLDEDUCT file:///C:/Users/eheiman/enoi/rnemmed.ensinet_vom/n9R547n/data 5/tmn nw5rannrrSR6ti4 Page 18 of 18 Vendor TotalE Number Name Gross Discount No -Pay Net 1=8 WAGEWORKS 3,670.62 0.00 0.00 3,670.62 Report Summary Grand Totals: Gross Discount No -Pay Net 478,930.27 0.00 0.00 478,930.27 P9 1 wrn�Hw� <�00 ki. 0o> $y11- 3 APPROVED Oki FEB 0 3 2022 BY COUN T Y AUDITOR CALitC,Ui i r"_t,,t 4 1 4 3 i �i • G l , file:///C:/Users/eheiman/cnsi/memmed.cnsinet.com/u98547a/data 5/tmn cw5renort58664... 2/3/2022 02/07/2022 MEMORIAL MEDICAL CENTER 09:51 AP Open Invoice.Ust Dates Through: Vendor# Vendor Name Class 14306 SAM SUPPORT Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay 020722 02/07/2022 02/07/2022 02t0712022 RENEWAL PEE Vendor Totals: Number Name Gross 14308 SAM SUPPORT 799.99 i7i*{tnr@;iamia�ar( Grand Totals: Gross Discount 799.99 0.00 APPROVED ON FEB 0 7 2022 BY COUNTY AU©iTOO . CALHOUN OOUNINV fi"46 0 ap_open_lnvoice.template Pay Code Gross Discount No -Pay Net 799.99 0.00 0.00 799.90 Discount No -Pay Net 0.00 0.00 799.99 No -Pay Net 0.00 799.99 PV1 DATE: 02/01/22 TIME: 10:29 PATIEDT A9R!EER PAYEE ILAFE ---- --- Tx ARID20001 TGTF-W ........................................... TOTAL APPROVED ON FEB 0 7 2022 9Y COUNTY AUDITOR •CALHOUN COUNTY, TEXAS Y-MORIA.L MEDICAL CEMTER PAGE I EDIT LIST PGR DATIES? BERMS MINCH! APMEDTT PAY PAT DATE A'/101171 CODE ME DEMUITI0 G5 In _---.............. ------- .......................................................... . 072E21 290,00 9 MOD POE 77979 270.00 2M 00 MSKESSON co.pmy: e000 MEMORIAL MEDICAL CENTER AP 815 N VIRGINIA STREET PORT LAVACA TX 77979 STATEMENT AMT DUE REMITTED VIA ACH DEBIT Statement for information only National Account 6 filling Due Receivable r3 )ate Date Number Reference As of: 02/04/2022 DC: 8115 Territory: Customer: 632536 Date: 02/0512022 Cash Description Discount Page: 002 To e 8=0 stub As of: I Mail to: AMT States Cust: Date: 0 Amount P Amounl (gross) F (net) IF column legend: - P = Past Due Item, F = Future Due Item, blank = Current Due Item "OTAL: National Aces 632336 M6dOPoAL MEDICAL CENTER Subtotals: 11.702.46 USD 'uture Due: 0.00 or It Paid By 02108/2022, US Fast Due: 0.00 Pay This Amount: 11.468.44 USD of ASt Payment 2,451.97 If Paid After 02f08/2022, DI 18107/2017 Pay this Amount: 11,702.46 USD U! 2 98 61993-7'> 1�04ti a. h68- 4 APPROVED ON FEB 0 7 2022 BY COUNTY AUI)TOR CALHOUN COUNTY, TEXAS � Ax/ For AR Inquiries please contact 800-867-0333 MWESSON STATEMENT Company: 6000 HEB PHCY 0434/MEM MED PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CENTER Statement for information only VICKY KALISEK a15 N VIRGINIA ST PORT LAVACA. TX 77979 As of: 02/04/2022 DC: ails Temtory: 400 Customer. 190813 Date: 02/05/2022 Due National Account 36 Receivabler )eta Date )ate Number Reference Description :ustomer Number 190813 HEB PHCY 0434/MEM MED PHS 12/0212022 02/08/2022 7322097201 2017043674 1151nveice 3F column legend: P = Past Due Item, F = Future Due Item, blank = Current Due Item 'OTAL- Customer Number 190813 HEB PHCY 0434/M@d MED PHS Subtotals: drture Due: 0.00 If Paid By 0210812022, ,ast Due: 0.00 Pay This Amount: ast Payment 16,953.36 If Paid After 02/00/2022, 11/31/2022 Pay this Amount: APPROVED ON FEB 0 7 2022 BY COUNTY AUDITOR CALHOUN COUNTY. TEXAS Cash Discount 0.06 3.04 USD Page: 001 To r accc stub As of: Mall to: AMT State Cust: Date: 0 Amount P Amoun (grow) F (net) 3.04 DI Ut 2,98 USD DI DI 3.04 LSD UI For AR inquiries please contact 800-867-0333 MSKESSON Company: 8000 WALMARf 1098/MEdI MED PHS MEMORIAL MEDICAL CENTER VICKY KALISEK a 4 5 N VIRGINIA ST PORT LAVACA TX 77979 STATEMENT AMT DUE REMITTED VIA ACH DEBIT Statement for information only As of: 02/04/2022 DC: 8115 Territory., 400 Customer:. 256342 Date: 0210512022 National Account 52e538 3IIe Due NumbReceler r Cash )ate Date Number Reference Description Discount :ustomer Number 256342 WALMART 1098IMEM Mm PHS 11 f31/2022 02/08/2022 7321533266 24295311 115Invoice 11/31/2022 02/08/2022 7321533267 24318013 1151nvoice 11/31/2022 02/0812022 7321533268 24425213 1151nvoice 11/31/2022 02/08/2022 7321760192 0128220900 1151nvoice l2/01/2022 02/08/2022 7321859594 24486382 115Invoice 12/01/2022 02/08/2022 7322026222 0131221007 115Invoice 12/0212022 02108/2022 7322114016 24576801 1151nvoice 12/02/2022 02/08/2022 7322302644 0201220929 1151nvalce 12/03/2022 02108/2022 7322410778 24602483 1151nvoice 12/0312022 02108/2022 7322410780 24602483 1151nvoice 12104/2022 02/00/2022 7322637121 24672477 1151nvofce 12/04/2022 02f06/2022 7322637122 24714490 1151nvofce 12/0412022 02108/2022 7322788338 0203220920 1961nvoice ,F column legend: P = Past Due Item, F = Future Due Item, blank = Current Due Item 'OTAI: Custor Number 256342 WALINAfTf Custom, 1098/MEM M® PHS Subtotals: 'vture Due: 0.00 It Paid By 02108/2022, last Due; 0.00 Pay This Amount: Ast Payment 16,953.36 If Paid After 02108/2022, 11/3112022 Pay this Amount: FEB 0 7 2022 11.36 11.36 54.18 11.36 8.32 0.03 5.68 5.09 0.39 34.94 7,136.46 USD Page: 001 Amount P (9raw) F 0.16 568,18 568.01 2,709.11 566.06 416.10 0.16 1.30 284.03 254.35 0.09 19.65 1,747.18 6,993.75 USD 7,136.46 USD DVCouW7YAUDITOR For AR Inquiries please contact 800-867-0333 CALHpUN COUNTY, TEXAS To 1 accc stub As of: Mail to; AMT State Cust: Dale: 0 Amoun (net) 1 551 551 2,65• 551 40' 1 271 241 1 1i 1,71; v DI U: of Dt Uf MEXESSON cam0any: 6000 HEB PHY FC 490/MEM MC PHS MEMORIAL MEDICAL CENTER VICKY KAUSEK 815 N VIRGINIA ST PORT LAVACA TX 77979 STATEMENT AMT DUE REMITTED VIA ACH DEBIT Statement for information only As of: 02/04/2022 DC: 8115 Territory: 400 Customer: 464450 Date: 02/05/2022 Ming )ate Due Date ReceivableNational Account H8 36 Number Reference Description ;ustomer Number 464450 HEB PHY FC 490/MEM MC PHS )2/01/2022 02/08/2022 7321959527 55x314641 1151nvoice 12/0112022 02108/2022 7321859528 55x314663 115Invoice )2/03/2022 02108/2022 73223821BB 55x319676 II5tnvoice )2103/2022 02/08/2022 7322382190 55x319713 115lnvoice 12/03/2022 02/08/2022 7322382191 55x319714 1151nvoice )2/03/2022 02/08/2022 7322382193 55x319721 1151nvoice 12/04/2022 0210B/2022 7322615518 55021938 1151nveice IF column legend: P = Pest Due Item, F = Future Due Item, blank = Current Due Item "ETAL- Customer Number 464450 HEES.PHY FC 490/MEM MC PHS Subtotals: 'mute Due: 0.00 last Due: Oleo Lost. Payment 16,953.36 It /31 /2022 APPROVED ON FEB 0 7 2022 I1 Paid By 02108/2022, Pay This Amount: If Paid After 02/0812022, Pay this Amount: Cash Discount Page: 001 (9r�)t F To e acco stub As of: I Mail to: AMT Sfalei Cast: Date: 0: Amount (net) 34.95 1.747.63 1, 71, 40.36 2.017.84 1,977 9.23 461.57 45, 0.47 23.51 2: 0.52 26.11 2'. 0.25 12.59 1i 3,42 171.20 167 4,460.45 USD VDu UE 4,371.25 USD Di! Da 4,460.45 USD U8 BY COUN-117YAUDITOR < > CALHOUN COUNTY,TH4AS For AR Inquiries Tease contact 800-867-0333 MWESSON Company: e900 CVS PHCY 7475/MEM Me PHS MEMORIAL MEDICAL CENTER VICKY KALISEK 815 NVIRGINIA ST PORT LAVACA TX 77979 STATEMENT AMT DUE REMITTED VIA ACH DEBIT Statement for information only As of: 0210412022 DC: 8115 Territory: 400 Customer. 835438 Date: 02/05/2022 Page: 001 To L accc stub As of: Mail to: AMT Statel Cust: Date: 0 idling ational MOP 696 Receivable Omer' Cash Amount P Amounl Date )ate bate Number Reference Description Discount (gross) F (net) lustomer Number 835438 CVS PHCY 7475/MEM MC PHS 1210312022 02108/2022 732255BB89 1558707 115Invoice 2-05 102.51 10( )F column legend: P = Past Due Item, F = Future Due Item, blank = Current Due Item -OTAL, Customer Number 835438 CVS PHCY 7475/MB4 MC PHS iF Subtotals: 102.51 USD :uture Due: 0.00 DL If Paid By 02/0812022, Ut Last Due: 0.00 Pay This Amount: 100.46 USD Dit ast. Payment 16,953.36 If Paid After 02108/2022, DL 11131/2022 Pay this Amount: 102,51 USD UE APPROVED ON FEB 0 7 2022 13y COUNTY AUDITOR CALHOUN COUNTY, TEXAS k lvkle--� For AR inquiries please contact 800-867-0333 Al AmeriisourceBergen° STATEMENT Statement Number: 62458178 Date: 02-04-2022 AMERISOURCEBERGEN DRUG CORP 12727 W. AIRPORT BLVD. SUGAR LAND TX 77478.6101 DEA: RA0289276 866451-9655 WALGREENS #12494 340B MEMORIAL MEDICAL CENTER 100135'. 1302 N VIRGINIA ST PORT LAVACA TX 77979,2509 Sat - Fn AMERISOURCEBERGEN P.O. Box 905223 Not Yet CHARLOTTE NC 28290.5223 Currant: Past Du Total Dr Account Account Activity Document Due Reference Purchase Order Document Original Last Receipt Date Date Number Number Type Amount 01-31-2022 02-11-2022 3081826954 164531 Invoice 224.51 01-31-2022 02-11-2022 3081826955 164532 Invoice 9.32 01-31-2022 02-11-2022 3081826956 164533 Invoice 188.58 01-31-2022 02-11-2022 3081826957 164534 Invoice 0.09 02-01-2022 02-11-2022 3082002383 164587 Invoice 496.70 02-01-2022 02-11-2022 3082002384 164588 Invoice 1.84 02-03-2022 02-11-2022 3082276945 164600 Invoice 1.17 02-04-2022 02-11-2022 3082416073 164608 Invoice 63.60 02-04-2022 02-11-2022 3082416074 164609 Invoice 47.44 Current 1-15 Days 1 16-30 Days 31-60 Days 61-90 Days 9142 1,033.25 0.00 0.00 0.00 A.00 APPROVED ON FEB 0 7 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Reminders Due Date 02-11-2622 CT l O1 � \Cjj� MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT --- January31, 2022 - February 06, 2022 Date Bank.DescriptIon 1/31/2022 PAY PLUS ACHTRANS 452579291101000694477134 2/1/2022 PAY PLUS ACHTRANS 452579291 101000695657786 2/1/2022 MCKESSON DRUG AUTO ACHACH04896119 910000271 2/2/2022 PAY PLUS ACHTRANS 452579291 101000696529869 2/2/2022 AUTHNET GATEWAY BILLING 1210252421040000199 2/3/2022 TSYS/TRANSFIRST CHARGEBACK 41399801368397 61 2/3/2022 PAY PLUS ACHTRANS 452579291101000697956355 2/3/2022 MERCHANT BANKCD FEE 97116091388791000015490 2/3/2022 MERCHANT BANKCD. FEE 971160910883 91000015480 2/3/2022 MERCHANT BANKCD INTERCHNG 97116091388791000 2/3/2022 MERCHANT BANKCD DISCOUNT 971160913887910000 2/3/2022 MERCHANT BANKCD DISCOUNT 971160910883 910000 2/4/2022 EXPERTPAY EXPERTPAY 746003411.91000012747672 2/4/2022 AMERISOURCE BERG PAYMENTS 0100007768 2100002 2/4/2022 MEMORIAL. MEDICAL PAYROLL 746003411 113122650 2/4/2022 IRS USATAXPYMT 220243561253112 6103601000221 Anthony Richardson Memarial Medical Center PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT— ESTIMATED ACHS Date Description 115 2072 ACH Payment TEXAS COUNTY ORS. RECEIVABLE 041921000024329 EX- , Anthony Richardson Memorial Medical Center MMC Notes -3rd Party Payor Fee - 3rd Party Payor Fee -340B Drug Program Expense - 3rd Party Payor Fee - 3rd Party Payor Fee - Credit Card Processing Fee -3rd Party Payor Fee -CreditCardProcessing Fee - Credit Card Processing Fee - Credit Card Processing Fee - Credit Card Processing Fee - Credit Card Processing Fee -Child SupportPayment - 340B Drug Program Expense - Payroll - Payroll Taxes February 7,2022 01 Vmv k GG - Retirement Funding February 7,. 2022 MMC Notes APPROVE!.) ON FEB 07 2022 CALF ODUN COLINTTy,, TEXAS Kc,t- re mfnt x/I S/a a DateMme 02-01-2022 J 01:16 PM Submitted By Pay Date 01.31-2022 Employee Deposits $64,502.52 Employer Contributions $98,688.64 Group Term Life Premiums $0.00 Total $163,191.16 Comments Payroll File January 2022 Retirement Upload.xlsx Page 1 of 1 RECENEDBYTHE COUNTY AUDITOR ON FEB 0 3 M 02/03/2022 MEMORIAL MEDICAL CENTER �,p�}{OU1�t�PJNTV. TEXAS AP AP Open Invoice List Dates Through: 02/24/2022 Vendor# Vendor Name Class Pay Cade 11816 ASHFORD GARDENS Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross 013122 01/31120 01131/20 02124/20 6,255.68 DECEMBER UHC QIPP PAYME Vendor Totals Number Name Gross 11816 ASHFORD GARDENS 6,255.68 Report Summary Grand Totals: Gross Discount 6,255.68 0.00 APPROVED ()N FED 0 3 2022 BY COUNTY.AUDITOR CAL7 I01I,l r:;l�li4 Y THXAS 0 ap_open_invoice.template Discount No -Pay Net 0.00 0.00 6,255.68 Discount No -Pay Net 0.00 0.00 6,255.68 No -Pay Net 0.00 6,255.68 file:///C:/Users/eheiman/cpsi/memmed.cpsinet.com/u98547a/data 5/tmD cw5report85715... 2/3/2022 Page 1 of 1 COUffiYAUMMON 02'fEER g MEMORIAL MEDICAL CENTER 2022 AP Open Invoice List 0 09:72 Due Dates Th hap open_invoice.template � 02/2 20 ��un roug . C"AWWWai Class Pay Code 11828 SOLEHA WEST HOUSTON Involceit Comment Tran DF Inv Dt Due Dt Check 0 Pay Gross Discount 012422 01/31120 01/24/20 02124/20 5,296.00 0.00 TRANSFER NN IYISUtOlf1U- p!Pak dVil671 rer� I1� UW—(- 0FLh_+Y 012522 01/3112001/25/2002/24/20. 2,330.56 0,00 TRANSFER Lt 013121 01/31/2001/31/2002/24/20 2,458.88 0.00 DECEMBER UHC QIPP PAYME Vendor Totak Number Name Gross Discount 11B28 SOLERA WEST HOUSTON 10,085.44 0.00 Report Summary Grand Totals: Gross Discount No -Pay 10.085.44 0.00 0.00 APPROVED Oro FEB 0 3 2022 CABSS COUNTY AUDITOR T-\AS No -Pay Net 0.00 5.296.00 0.00 2,330.56 II 0,00 2.458.88 No -Pay Net 0.00 10,085.44 Net 10,085.44 file:///C:/Users/eheiman/cpsi/memmed.cDsinet.com/u98547a/data 5/tmn cw5renort30467 2/4/7m77 Page i of 1 RECEIVED BY THE COUNTY AUDITOR ON 02UMoA 3 Z022 MEMORIAL MEDICAL CENTER 09:08 AP Open Invoice List 0 CgLHOUNCOUNTY,TEXAS Due Dates Through:02/24/2022 ap_open_invoice.template Vendor# Vendor Name Class Pay Code 11820 FORTBEND HEALTHCARE CENTER Invoice# Comment Tran. Dt Inv Dt Due Dt Check D-Pay Gross Discount No -Pay Net 013122 01/$1/2001/31/2002/24/20 2,531.20 0.00 0.00 / 2,531.20 v/ DECEMBER UHC QIPP PAYME Vendor Totals Number Name Gross Discount No -Pay Net 11820 FORTBEND HEALTHCARE CENTER 2,531.20 0.00 0.00 2,531.20 Report Summary Grand Totals: Gross Discount No -Pay Net 2,531.20 0.00 0.00 2,531.20 APPROVEp ON FEe 0 3 2022 CAOG-ICO "I ALID 0R OUA! T }' TroAS file:///C:/Users/eheiman/epsi/memmed.cosinet,com/u98547a/data 5/tmD cw5reoort34872... 2/3/2022 Page 1 of 1 RECEIVED 6Y THE COUNTY AUDITOR ON @� MEMORIAL MEDICAL CENTER Ftr9.0 2 022 AP Open Invoice List Due Dates Through: 02/24/2022 0 ap_open_involce.template CALHOMdWWrycJGEUMe Class Pay Code 11832 BROADMOOR AT CREEKSIDE PARK Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay 012622 01/31/2001/26/200i12//2,'4/20 255.88 0.00 00.00 TRANSFER ft IYVG.1V1*U wil 40!Atj_ h�b YUwkL W&I \/ 013122A 01/31/20 01/31/20 02124/20 185.50 0.00 0.00 TRANSFER N It 013122B 01/31120 01/31/20 02124120 2,585.44 0.00 0.00 DECEMBER UHC QIPP PAYME 013122 01/31/20 01/31/20 02/24/20 371.00 0.00 0.00 TRANSFER u It Vendor Totale Number Name Gross Discount No -Pay 11832 BROADMOOR AT CREEKSIDE PARK 3.397.82 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 3,397.82 0.00 0.00 ,APPROVED ON FEB 0 3 2022 BY COUNTY AUDITOR CALHOUN ccanarr, TEXAS Net 255.88 185.60 ✓ 2,585.44 f 371.00 f Net 3,397.82 Net 3,397.82 file:///C:/Users/eheiman/epsi/memmed.cpsinet.com/u98547a/data 5/tmn cw5renort62084... 2/3/2022 RECEIVED BY THE COUNTY AUDITOR ON FEB 0 3 2022 02/03/2022 MEMORIAL MEDICAL CENTER C&% N';AIN COUNTY,TEW AP Open Invoice List 0 Due Dates Through: 02l24/2022 ap_open_invoice.template Vendor# Vendor Name Class Pay Code 11824 THE CRESCENT Invoice# Comment Tran Ot InvDt Due Dt Check DPay Gross Discount No -Pay 013122 01131MO0113112002/24/20 2,079.20 0.00 0100 DECEMBER UHC QIPP PAYME Vendor Totals Number Name Gross Discount No -Pay 11824 THE CRESCENT 2,079.20 0,00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 2,079,20 0.00 0.00 APPROVED ON FEB 0 3 2022 SYCOW ra.UDITOR CALHCVi•t rn�Ji�`I TEXAS Page I of 1 Net 2,079.20 Net 2,079.20 Net 2,079.20 file:///C:/Users/eheiman/cpsi/memmed.cnsinet.com/u98547a/data 5/tmn cw5renort58247... 2/1120".. II BCBVF:UByns 0"W AM-s ®N FEB 0 3 2U�2 02/03/2022 MEMORIAL MEDICAL CENTER CWVUN000NTY,TEW AP Open Invoice List 0 Due Dates Throu h• 02/24/2022 ap_open_invoice.tempiate 9. Vendor# Vendor Name Class Pay Code 11836 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount 011322 01/31/2001/13/2002/24/20 537.77 0.00 TRANSFER N{I IYlNJYLKU, qLj -Ip wo hh WpK r. OnUR.l1�-x 011422 01/31/20 01114120 02/24/20 458.86 0.00 U TRANSFER µ It 011822A 01/31/20 01/18/20 02/24/20 497.48 0.00 TRANSFER k %I 011822 01/31/20 01/18/20 02/24/20 1,651.01 0.00 TRANSFER It It 011922 01131/20 01/19/20 02124/20 23,210.52 0.00 TRANSFER it it 012722 01/31/20 01/27/20 02/24/20 2,715.37 0.00 TRANSFER tc 1( 012822A 01/31120 01/28/20 02/24/20 266.41 0.00 TRANSFER " rt 012822 01/31/2001/28/2002/24/20. 3,043.17 0.00 TRANSFER It �I 013122. 01/31/20 01/31/20 02/24/20 4.226.74 0.00 DECEMBER UHC OIPP PAYME Vendor Totale Number Name Gross Discount 11836 GOLDENCREEK HEALTHCARE 36,607.33 0.00 Report Summary Grand Totals: Gross Discount No -Pay 36,607.33 0.00 0.00 APPROVED ON FEB o 3 2022 gY COUM T Y AI JDITOFI cALHct ral rnUrtTv. r EXAS Page 1 of 1 No -Pay Net / 0.00 537.771/ U0 458.86 ✓ 0.00 497.48 Lf 0.00 0.00 0.00 0.00 0.00 0.00 No -Pay 0.00 1,651.01 �/ 23,210.52 2.715.37 266.41 t/ 3,043.17 4,226.74 v.- Net 36,607.33 Net 36,607.33 file:///C:/Users/eheiman/cpsi/menuned.cpsinet.com/u98547a/data 5/tmn cw5renort.50961 )/3017197 Page 1 of 1 RC-CEM3D BY THE COUNTY AUDITOR ON 02/00 3 2022 MEMORIAL MEDICAL CENTER 09:10 AP Open Invoice List 0 Due Dates Through: 02/24/2022 ap_open_invoice.template c^.n }iti�itao latfie Class Pay Code 12696 GULF POINTE PLAZA Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 011422 01131/20 01/14/20 02/24/20 693.22 0.00 0.00 693.22 CC TRANSFER NN jyl%VlULf2 lltl f�10�/i1�1c1. ik1' WM-(- 0Kit.--fivy 012022 0113112001/2012002/24/20 13,872.00 0.00 0.00 13,872.001/ TRANSFER 012422 01/31/2001/24/2002/24/20 6,642.29 0.00 0.00 6,642.29 ,/ TRANSFER It 012522 01/31/20 01/25/20 02/24/20 4,425.00 0.00 0.00 4,425.00 I/ TRANSFER IL It 012522A 01131/20 01/25120 02/24/20 20,940.22 0.00 0.00 20,940.22 ✓ TRANSFER tL 012622 01/31/20 01/26/20 02/24120 2,889.82 0.00 0.00 2,889.82✓ TRANSFER It I t 012722A 01/31/2001/27/2002/24/20 3,485.00 0.00 0.00 / 3,486.00 ✓ TRANSFER tl ,t 012722 01/31/20 01/27/20 02124/20 1,113.00 0.00 0.00 1,113.00 TRANSFER tt t 012822 01/31/20 01/28/20 02/24/20 601.81 0.00 0.00 601.81 ,✓ TRANSFER It I, 013122 0V31/2001/3119002/24/20 1,865.94 0.00 0.00 1,865.94 DECEMBER UHC OIPP PAYME Vendor Total.- Number Name Gross Discount No -Pay Net 12696 GULF POINTE PLAZA 56.528,30 0.00 0.00 55,528.30 Report Summary Grand Totals: Gross Discount. No -Pay Net 56,528.30 0.00 0.00 56,528.30 APPROVED ONJ FEB 0 3 2022 aYGOwl m:At1DITOR CALI.h=.i i,d ". it!" .1'lAS file:///C:/Users/eheiman/cpsi/menuned.cDsinet.com/u98547a/data 5/tmn cw5rennrt26719 Page I of 1 IIECEIVW BY'MF COUNTY ors QAUDITOR 17z�97 PP ZOZZ MEMORIAL MEDICAL CENTER 09:21 AP Open Invoice List 0 CALHOUNCOUNly'lum Due Dates Through: 02/24/2022 ap_open_invoice.template Vendor# Vendor Name Class Pay Code 13004 TUSCANY VILLAGE Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 011422 01/31/20 01/14/20 02/24/20. 872.17 0.00 0.00 / 872.17 TRANSFER No jK0V6a(.0 p4pt dq"IGa� fD hi•NItC. 0 y1.'�'iL^r' 011422A 01/31/20 01/14/20 02/24/20 2,195.00 0.00 (JJ 0.00 2,195.00 TRANSFER tt it 011822 01131/20 01/18120 02/24/20 8,007.74 0.00 0.00 BMT74 ✓! TRANSFER It n 011822E 01/31120 01/18/20 02124120 6,678.00 0.00 0.00 6,678.00 +� TRANSFER L% tt 011922 01/31/20 01/19/20 02/24/20 10,620.54 0.00 0,00 10,620.54 „r TRANSFER tt it 012022 01/31/20 01/20/20 02/24/20 3,606.44 0.00 0.00 3,606,44 ✓l TRANSFER " t t 012022A 01/31/20 01120/20 02/24/20 2,195.00 0.00 0.00 2,195.00 TRANSFER 11 11 012122 01/31/20 01/21/20 02/24/20. 742.00 0.00 0.00 742.00 ✓� TRANSFER It. It 012122A 01/31/20 01121/20 02/24/20 76.80 0.00 0.00 76,80 TRANSFER 11 tt 0124228 01/31/20 01/24/20 02124120 18,521.71 0.00 0.00 18,521.71t,/� TRANSFERU le 012422A 01/31/20 01/24/20 02/24/20 904.62 0.00 0.00 904.62 TRANSFER k 11 012422C 01131 /20 01125/20. 02/24/20 2,597.00 0.00 0.00 2.597.00 ti TRANSFER tl N. 012522A 01/31/20 01/25/20 02/24/20 5,565.00 0.00 0.00 5,565,00 TRANSFER It It 012522 01/31/2001125/2002/24/20 9,429.07 0.00 0.00 / 9,429.07 TRANSFER 11, tt 012622 01/31120 01/26/20 02/24/20 282.33 0100 0.00 282.33 6� TRANSFER 4 it 012722A 01/31/2001/27/20,02/24/20 9,219.00 0.00 0,00 9,219.00 TRANSFER k tt 012722 01/31120 01/27/20 02124/20 556.50 0.00 0.00. 556.50 TRANSFER it.. i1 013122 01/31/20 01/31/20 02/24/20 742.00 0.00 0.00 742.00 t% TRANSFER 013121A 01/31/20 01/31/20 02/24120 3,670.24 0.00 0.00 3,670.24 DECEMSER UHO OIPP PAYME Vendor Totale Number Name Gross Discount No -Pay Net APPROVEDo1N 13004 TUSCANYVILLAGE 86;4B1,16 0.00 0.00 86,481.16 Report Summary Grarjdrga&3 2022 Gross Discount No -Pay Net 86,481,16 0.00 0.00 86,481.16 BY COUNTY AUDITOR CALHt')UIV t71AJHT'/, TEXAS file:///C:/Users/eheimatl/epsi/memmed.cpsinet.coln/u98547a/data 5/tmo cw5renort22564__. 7/3/7077. Page 1 of 1 (�>GI,w»ii Ir,',(')yN8N4A11 t 00, ff,BAQ2JN MEMORIAL MEDICAL CENTER 09:04 AP Open Invoice List 0 Due Dates Through 02/24/2022 ap_open_invoice.template "`dorMVen� Uendorr N�amee Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment. Tran Ot Inv Dt. Due Dt Check D Pay Gross Discount 011322 ' 9,905.52 0.00 011422 TRANSFER ''0II r11/31/2001/13/2002/24/20 N l' 1Y1�11Y1i1tcL Q66YdJ'^'N"jtj, k h 01/31/20 01/14/20 02/24/20 ll(la(„ 1,032,22 *A_h 0.00 U TRANSFER t1 11 011822 01/31/20 01118/20 02/24/20 5,565.00 0.00 TRANSFER R. (r 01iS22A 01131/20 01/18/20 02/24120 2,227.36 0.00 TRANSFER it 11 012422 01131/20 01/24120 02/24/20 2,040.50 0.00 TRANSFER It It 012622 01/31/20 01/25/20 02/24/20 26,452.50 0.00 TRANSFER tt II 012622A 01131/20 01/26/20 02124/20 891,20 0.00 TRANSFER it it 012622 01/31/20 01/26/20 02/24/20 57,903.42 0.00 TRANSFER y 11 012822E 01/31/20 01/28/20 02/24/20 5,750.50 0.00 TRANSFER (( 11 012822 01/31/20 01/28/20 02/24120 4,436,41 0.00 TRANSFER It it 012822A 01/31120 01/28/20 02124/20 742.00 0.00 TRANSFER It 11 013122A 01/31120 01/31/20 02/24/20 5,000.39 0.00 TRANSFER 013122 01/31/20. 01/31/20 02/24/20 MEDICARE REPAYMENT Vendor Totals Number Name 12792 BETHANY SENIOR LIVING Report Summary Grand Totals: Gross Discount 147,353.40 0,00 AMIROVEDON FEB 0 3 2022 RY(3011, 1 YALIDITi]R CAt}IOL%N f t?lii,!7Y, T-E}J'S 25,406.38 0.00 No -Pay 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 Gross Discount No -Pay 147,353,40 0.00 0,00 Net 9,906,52 1,032.22 tf 5,565.00 ✓ 2,227.36 ✓ 2.040.50 ✓ 26,452.50 /✓ 891.20 t/ 57,903.42 1/ 6,750.50 1/ 4,435.41 V' -142.00 5.000,39 ✓� 25,406.$8 f Net 147,353.40 No -Pay Net 0.00 147,363.40 file:///C:/Users/eheiman/cpsi/mernmed.cpsinet.com/u98547a/data 5/tmn cw5renort74354__ 2/inng? Facility ID Facility Name Total UHC Deposits 4811 Ashford 63,822.40 105818 Broadmoor 26,396.80 105314 Crescent 21,225.92 4628 Fort Bend 25,782.08 105006 Solera 25,022.72 102540 Golden Creek 43,066.44 100806 Gulf Pointe 19,013.52 103462 Tuscany 37,425.60 Bethany Total UHC Desosit 261,755.48 MMC PORTION QIPP/Comp1 QIPP/Comp 2 QIPP/Comp3 QIPP/Comp4& Lapse QIPP TI 51,311.04 12,511.36 57,566.7 22,225.92 5,170.88 23,811.31 17,067.52 4,158.40 19,146.7 20,729.68 5,062.40 1 23,250.81 20,104.96 4,917.76 22,563.8, 34,612.96 8,453.48 38,839.71 15,281.64 3,731.88 17,147.51 30,085.12 7,340.48 33,755.31 210,408.84 51,346.64 236,082.16 DECEMBER UHC PAYMENT Request for Transfer of Funds Transfer A: please Attach, Dele ROgUesled 1/31/2022 Payer Medlare Mamma. Advice and FOR Requested by: FamnNmpos 11morRy4takenap6M an WegWmentorremupmm' Regnesto1'1 ¢mall 17Eo11lag£@TRlnll9D}aAt4;cpm • Paded Rune. DalaaFSavia and AnwuM W Payment Requestofl phena _ easeema rm number 361.553-0226 du RemiMaOw Adukw/o: cdey�Ee mmc of DIstrIMor6ounty Calhoun mmart,)nez mmc o Facility Memorial Medical 4nter Men, Name pE UIREO Date O/SeM[e AED DaMAfpavment Tfleofpavment FFI:eM:/EFTI AAtnunt0 pamlem ORmen CRedc Numhm Pal umber AMlon carded Enter Ramitts, Advim affill—R-1 fuMt6loy FUMa bI LQIQVBAqggm 1/12/2022 EFT (1,845.261 EFT6209311. MARMOOZO 9 1,843.26 1/13/2022 EFT (42887) EM621D757 NOARWM26869 428.97 1/13/2022 EFT (407.31) EFT6210586 UDARNW26869 407.31 1/49AM EFT (78.10) EFT6215145 UDARWMZ6869 78.10 1/2012022 EFT $ 389.41 EFF6217142 NOARW026869 389.41 1/211ZD22 EFT $ (4.988.21) EFT6219725 VDARWWZSS69 4.980.22 1/29 2022 EFT S 1,292.82E EME220748 CVDARD0002690 1.292.82 1/15/2022 EFT $ (1,030.541 EFT6222602 MOARM002600 1.010.54 1/25/2022 EFT $ (129,21) EFT6224335 NDAR000026869 229.21 1/27/2022 EM $ 1119.561 EM6225967 I NDAROWD26869 119.55 1/28/2022 1 EFT $ 139,8911 EM6227416 NDAR000026869 39.89 TOTAL (l0,]9].18 1D.747AR Request for Transfer of Funds Trans/era: Date Requested 1/31/2022 Pinse ANa,hr Payer Mediur¢ Mori tense Adviroand E08 Requested by: Faren Campos 11 m4nry b nYen aplrrsl m arorpryment or ,swum flequesl4rs small 13P.n91](44[N IPInCPP,1�4VlCa.fU1R a PatIM[NIIIIe, DIIe OISarYI[Cend AlllWneni Paen numb[, 361,552.0226 PTIPpquesl4rspb4ne assema mgne ,man 0.emltUnee Ativke tp: alera9per(Amm, olmla4,Couety Calhoun mmartbe,pmm< F.dle, Mempnel Medlol Center paNmN Name RE UIREO Po"LAR 4 AE UIR aleofP ant IYPe MPaymtnt Ameun[d Pwment sh emkbnro AdNro IRED Eh her 034 nNumber Ambn neMee. Em (Pmh 414rauntlal lbtmp mey8( 2/11/2022 EFT (11843.26) EFT6209311 E PAg000019557 ],843. 2/13/2022 EFT (M.871 EFT6210757 CVDAROOD019557 426 1 13/2022 EFT (407.311 EFT621o586 EVDAR0 19557 407 1/19/2022 EFT 178.10) EM6215145 EVDAR000019557 79, 1/20/2022 [" $ (369.411 EP76217141 EVDAROOD019557 389 11211202E EFT 5 (4,98 21) EFT6219725 EVDAR000019557 4,908, 1/24/2022 EFT 11,292.8E W622074B MOAR000019557 1,29E 1/25/2022 EFT 5 3030,54 EFT6222602 EVDAR000019557 1.030. 1/26/2022 EFT 5 (129.21) EFT6224335 JCVDAR000p19557 129. 1/I7/20E2 EFT $ 129.56) EFT6225967 MAR000019557 119. 1/19/2022 EFT 5 139.09) EFT6227416 IUDARM0019557 39, TOTAL 10.747.181 10,747. APPROVED ON FEB 07 21"2% CALHoundCOUN Y, tkM Request for Transfer of Funds Tlansler R: Date Requested 1/31/2022 Payee Medlcafe Requested by: Faren Camper Are,matme,:mall (a5onealeiPmmce nlavacatom Requesters phone number 361-552.OZ26 District or County Calhoun hdlity Memorial Mail Center Milan wham an mamma ment er remvFme levenverfammc OUWrfnee®mmrn Patlent Nama RE UIRED DaM MServke Dab a I/12/3022 ivee o7Pavment LOMMEFTI Amount Pavmentfbmon (l,"3.26 Clual Number claim Number Attlanneeded.EMmYn lumILLImPuml to Y QUKl EFT E176209311 CVDAR0000018170 11 893.2i 1/13/2021 EFF 4420.071 E176230757 CVOARW00018170 428.W 1/13/2022 EFT 4407.311 EF762105% CODAROW0010120 407.3: 1/19/2072 EFT 16.101 EFT6216145 CVDAR(10=18110 78.11 1/20/2022 EFT $ 189,41 ER6117141 CVDAROp00018170 389.4: 1121/2022 EFT $ (4.938.21) EFT6219725 CVOAR0000018p0 4,988.2: 1/24/2012 EFT $. (1,292.82) EFT6220748 CVOAR0000018110 2,292.8 U25/2022 EFT $ 11,030.141 E176222602 CVOARmm0Y18170 1,030.5• t/26/2022 EFT $ 129.22 EFT6224335 C11OAR00WO18170 129.2: 1/2]/2022 'E17 $ 1119.56) ER6225967 CVDAROO=18110 115.51 1/3 2W2 EFT $ 139.89 EFT6221416 CVDAP00000101T0 39.81 TOTAL 10.746.981 10.747.14 Facility: im Fa4111ty: FaWlilp: BN CAL Memorial Medical Center Nursing Home UPL Weekly Cantex Transfer Prosperity Accounts 2/7/2D22 P,nNee, TneaY, A.. Bnhni,,a AM PlMinr B.0-o Amoenr ro BeTnnf4n,4WXUNne NUN H�mm •'' Oe sxs ,., 3 36],655.15 16T,SSS.A 69.66508n✓ "765.09 / 14,435.82 Bang 8a0n.t 69,765,a8 v Vafima 4aremedanR MOUNADECQIPP ]00.00 MOUNAYR4AM 17,B62.24� 4,805.wVv AMERIGROUP DEC CAPP 32,547.30 IAN INTEREST M.61 FEB INTEREST AwalNnalsr / Adlm[ealan<eRrabslerAme 2{,y5B3 V BIOB�IInOOP / 93,50196l/ 93,401.96V 13,18853 ✓ 73,25853 / 39,564.52 Sant eelanm 73,290.53 t/ Vaxan<e Lml In BllanR INDD MOUNADECQIPP 7,310.37✓ MOUNA VR 4ADI1 2,oil M v/ AMEMGROUPDECOIPP 23.46926✓ MUNCOUEREPATMENTTO MMC 10,747.I8%/ IAN INTEREST 12.31 FEBINTEREST MARMTEREST Adlnit Bahnce/rmn,W Ann "'SK52 aa.�+_�, CtgaWW // / 73,429.66t/ 73,329.66 ✓38,069M / VVV 38,169.90 / 9,097,91 Bank BalanR 38169.% ✓ ValNnc! W.I. In J%lnR. two MOUNADECQIPP 5,940991// MOIINAYRIADII IA52.09 v BMERIGROUPOECOPP 10,81840 / MEDICARE REPAYMENT TO MMC 10,747.18�/ )AN INTEREST 23.33 FEB INTEREST MARINTERFSF AUIBN BaBnlaPranslerAm, / 9,037.91 T/ FOfk'�CI11tY f 85,138361/15.018,26f38.266,36 28,36636 ✓ 519".08 B.Rk Bd.n!! 28,366.36 VAxance leave In BelanR low MOUNAOECOIPP 7,114.46✓ MOUNA YR 4 AD12 2.O28.51✓ AMEAMROUPOECOIPP 13,1S1.98-/ I"INTENFST 7.21 FEB IREME17 MARINTNIS7 Milli BalanR/InnNU Am1 5,0"DB t% w}wthW,Hp'iDfB¢`y 137.066.% "6.966.88 , 59,65SA0 Y 50,759.80 26,153.19 Bank BaNnce Sa.759.80 Variance eReMBa1.n4B 100.40 APPROVEDD% 1 4 7 4 3 5• 8 J + + > 6 4 ° �7 MOUNAOECQIPP 7.00128✓ 0 7 2022 J + MOIINAYRAADll 1,877.64✓ FEB 9 9 Q 97 e i + MEOIGRE 5, 864 REPAYMENT ED MMC IT 10,747.18� 27.46 COUN`IY Au 1TO RS • 0 2 + FEB T BY COIJNT'�,`I' 2 6+ 2 5 3• 1 9 MARINTEREST CALHOUN + Atljurt BalanR/Tmnarer Amt 26,253.14, J 95, 2 15 e 5 2 TOTNTRANSF 95,ilS.Si Appmvetl: xbn: onhbaanre, elnrr. fs.a90wfube rmmleneero mrnwamaAamm. AN7HONY RICHAflOSQN, CFO 7/7/2022 xeN 2: Emn oaten! no, n m,e MIaR a EIB9 mR Al4Te a4b4ueN ro ePan n.,nw¢ IAxx weatryuanner,RxN uxn.mrN strrnaM3axx8mm+Mxx uvlmmor summary 9:.D2xx�Iv )11pM3 ugwxCT.WMrMTINeWSI]al6Ptlunam ily]0!] WIRE OYi GHttXNGIIXGPE[EN)fR3111 xxe- axq NIxGIMIRE'7M ,iEl4mm1]0113 ..TNMUMANSVLMCCWMIMt M.."I M.a ,kill bip91N ]IIOmI MANAOGNNMfT1}I2MX39MMOµ]9441 lilpml NWASwWT10NXNWMIMT476I1312Olmlm y3/2912 AMPIKPI.MtM9NGMIMPMTM6m3914A3M ]/1/1011 WlwggTGNTERNGMN "RE UWIR3111 7/7/]077 UnxMXe9114m<XGMIMPMSAYAMIS1AwT ]/MWti,MP4NANU.SifIG,AMb{Nf�C,Itpi�A}�7�'IWf,01i. 3/lIa0Y3 UNC[OMMYXIRPGMGCWMIMT]IGW311191MA^0 Sls/a022 pill ]/yib]a M411MM�AIMWMgIx5M2{�PIOIMeIAlgwMf' yfYiwa elAhpe4WIEMl04MYM(IR'{iS31o{III?MOIb 3/1/10t1 NUMANAINf COMC<UIMIMf3wµE9YA%Slw<i 112n(12 Wµf WiCAHRNNGITNCMF([XT5R3111 2/t/tM1 Melun.�nwTxuRMbyMugialwugq/,wm, qt{ ]/}12.22 ATd•p9uP me NCf4 MpMT3111µ39µ IIICW 2/2/iml YNCCOMMUAmpt NGMIMPW NRxM391192mw ]b/I022 01112 012022 UMINN[.1II.1e NCCNIMPMt14.MMI1IM3N 2M/2o22 NMIMMPNN41.NCCWMPMT31amM111AiM 214,101 MTUNM liWMUNMdixuw91bw1]SliMM41.. ]/IItb2:,AMlRlaljoulwnbnrYMtNteewwsseo Sllbo;. TOYALS I9i.5SSS5 - 19AM;w 4AH•lx: 1.11tf2. :l)Aµµ. 3iN1Ae los.m ul,Po ;elb.m a,elom - ! 9.111% w{M: ntry sJN,iY;e. lAOIJO" mim i'MM. ROME.M.. },90iw • '9pal95# MAi9.Vs 7Af4f0 :S2S4Aa�. isiBif I.µ}.4 µAISN 9/ N406 MMGPORIOM Nvr/a M j{a9lLg9j T.n.�'Jl�l,rylFnp NP!/mmpi. bpPl9.mX} WIPImrt93 W9V QUIP" ryN POR}IOX IA, UARRIt - eMGM t4.m MAR1.11 f,ONsl 99.6w') H. dl3W 6os9 etno • 3.9M3I S,w0.]0 6,71331 fi.11l.l) aaJm,l9 _ ..AS6.E1 " IA w 9.MOm ' PER" ii�9•Ib Y,?lO.V' M1.M fM�w. }Wri 2ANµ ltp3i. s16.}0 ]39.N - i1;pf.lo i3A1FA urtu as ulu atiS;Nl. fl.4lAf /)93µSi J4Am.I3 4}µA! SS9.w fi4Il aifµa} M s0!}a01 B9y(9fOu1 yn qV� 9/bmp3 qV!/6NP1 NIP/4nll Wp, gIPPT � XHPoXSIOX ].SwAb ar999.µ !.}ss.m - $.as - 2,996m - 0.95cmAw - leu.00 A:a}I.m w.6laA, • 1}}S.m I xSWl/ dwl:Y'.. § g1b.M' S3,9Wf. qs%u1S6 IJH.Ra L161 Op", I).1m.19 - I,iNA4 I.OM,M: ma Alm imal 4m-W 11m. - {,wbx, : zini m '. ib.114.w /lson.0 / u,v.o J n.mno . AtlIZA m." am 1414 uu ] P 9A MMCPOR910N NPP/GmM TnTn t� iruVw.d NPP/C9mPl ,I NP)/pp9! Wp4 N9P11 XN90XIION - ;' 3 •, /,fi% EMPIRE, ..G...... ..- _ :..its' {. - 1,s99;M a -I" MAE" t.uux.. fpAx� IIIMm URix1�. IMMI sloe lxpxi, -.}Au.1] 7at39;. SilQai ME""" "Irvin ` SaRixLir '!(11µ/: 61Ae H aalA.n n...... I.NEAE SEEM R MMClo951oN NPP/ w r ,LAysT_Og, j(w5fµ{0 NPP/LairyS NM/4mP} qV!/Gwep {I.pu NMT MXPOIgIOM 9.N9A5 - 9. Ng .l ].N9.1l - 101awA0 - SOAwA] {µ 06! • 1]].95 1}].95 41.05 - 1]10, 1]9;t63.69 - t)wJd fp;lu� Ls]SA2. '2.MtAa i{;9a., - ZOW13 }AIi.15 3;n3:3° X17EM WUMI Alum 9Aw.w. 105.m G.m . 11914,IA, 1ANLIRA9 ]Sill 'iuM llx'{{ -I.µtAl - MIEIbi}. YI,lw. _..:.La0(h�, azTM.Ov ADIl 2AM:m- In;eaen / sxfsvm ✓n.utAl bssna u1Av tELEER.17 Aolr.. SSEA]LII HURCI.A1 1]1N9A3 29 wj iq 4f3 1 A ba 20/2022 Quick View Select Quick View Accounts Account Number / Name Account Type r Treasury Center Select Group Groups Fldd Group Account Number Current Balance Available Balance Collected Balance Prior Day Belem: Number of Accounts: 15 $7,562,747.70 $7,705,125.46 $7,562,747.70 $7,629.348.4 '4551 CAL CO INDIGENT HEALTHCARE S5,976.53 $5,976.53 S5.976.53 $41,525.2 '4454 MEMORIAL REDICAL! NH GOLDEN CREEK $58,398.18 $62,629.70 $58,398.18 c $52,730.,. HEALTHCARE •4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES $536.13 S536.13 $636.13 S536.1 2014 '4357 MEMORIAL MEDICAL CENTER - OPERATING $5,691,412.10 S5,780,498.23 S5,691,412.10 $5,973,600.1 '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.61 $431.61 S431.61 S431.E WAIVER CLEARING '4381 MEMORIAL MEDICAL $69.765.88 $78,944.34 $69,765.88 $21,371.1 CENTER/NH ASHFORD •4403 MEMORIAL MEDICAL $73,288.53 CENTER/NH $78,615.08 $73,288.53 S45,466.0 BROADMOOR '4411 MEMORIAL MEDICAL $38,169.90 $42,048.20 $38.169.90 $24,285.E CENTER/NH CRESCENT •4446 MEMORIAL MEDICAL. $28.366.36 $28,366.36 $28.366.36 $8,107.0 CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL / CENTER I SOLERA AT $58,759.80 ✓ $75,322.83 $58.769.80 $32,527.E WEST HOUSTON '2998 MMC-MONEY MARKET FUND S1,109,566.76 S1,109,566.76 $1,109,566.76 $1,109;566.7 15506 MMC-NH BETHANY SENIOR LIVING $279.706.02 $284,881.78 $279,706,02 S203,556.7 `5441 MMC -NH GULF POINTE PLAZA- $83,212.77 $87.905.66 $83,212,77 $74,030.1 MEDICARE/MEDICAID •5433 MMC -NH GULF POINTE PLAZA - PRIVATE PAY $1.561.58 $1.837.29 $1,561.58 $1,403.E '3407 MMC -NH TUSCANY VILLAGE $63,595.55 $67,564,96 $63.595.55 $40,209.1 hops://prosperily.ol banking.com/onlineMessenger r V1 Memorial Medical Center Nursing Home UPL Weekly Flexion Transfer Prosperity Accounts 2/7/2022 Asc0unl NOnineyH,�o�me Number .ems 4 Pro410ue Berinnlne ".571.53 NOW 00 bekn res 0 cver $5, 000 will be maejeared to the nmin9 home. Note 2: Each nmon[haea base heknce 75190 tha[MMEdevorlted [o a0en account. FEB 0 7 2022 BY COUNTY AUDITOR CALHOUN COUNTY, T�-:MF,' Ted.V's Ber(nnin8 Amountte Be Ttanelertedto NurOne Bank Balance 58,398.18 Valor.. leave in Balance 100.00 IAN IMEREST 11.04 FEB IMEREST MAR INTEREST AdleetBalanicirrane)ergmt 5�E/.20..119� Aoorwed: 1!l � Y V \/ ANTHONYRICHARBSON,M t 2512022 1:\NN Wee41Y PenslmgNN UPLTrantler5ummary\loll\febrmry\NN UPLTraPtler Summary 03.0)Ai.tln 2011021 p ... U02021 T91'S/IMN)NM1Si BNCC )11M2596H5550]6949 3(411022 ""nMNSSP53MCDSR M31M5550109139 31412023 MMLM HUIMN SVC HUMM9Mi 174IM341H0112 NN 9OR➢ON it% - i9>A3 21,122.62 ILIUM .8.11 Olc.l< )99A5 - MIS / 0,629.15 / Cp19.25 Bf,O)IS SO,I9B.10 V 51.290.10 2/'712022 Treasury Center Quick View Select Quick View Accounts Account Number/Name Select Group Groups Account Type Add Group [ODA Data reported as of Feb? 202: Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 16 $7,562,747.70 $7,705,125.46 $7,562,747.70 $7,629,340.4 '4551 CAL CO INDIGENT $5.976.53 $5,976.53 $5.976.53 $41,525,3 HEALTHCARE ,4454 MEMORIAL MEDICAL / NH GOLDEN CREEK$58.398.18 $62,629,70 $58,398.18 S62,730 S HEALTHCARE '4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES $636.13 $536.13 S536.13 $536.1 2014 '4357 MEMORIAL MEDICAL S5,691,412.10 S5,780,498.23 $5,691,412.10 S5,973,600A CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $431,61 $431.61 $431.61 S431.E WAIVER CLEARING `4381 MEMORIAL MEDICAL $69,765.88 $78.944.34 $69,765.88 S21;371.1 CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTER / NH $73,288.53 $78;615.08 $73,288.53 $45,466,C BROADMOOR '4411 MEMORIAL MEDICAL $38,169.90 $42,048.20 $38,169.90 $24,285,'. CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $28.366.36 $28,366.36 $28.366.36 S6,107.0 CENTER INH FORT BEND '4438 MEMORIAL MEDICAL CENTER! SOLERA AT $58.759.80 $75,322.83 $58,759,80 $32,527.S WEST HOUSTON '2998 MMC-MONEY MARKET S1,109,566.76 $1,109,566.76 S1,109,566.76 S1,109.5fi6.i FUND '5506 MMC -NH BETHANY SENIOR LIVING $279,706.02 S284.881.78 S279,706,02 $203,556.7 '5441 MMC-NH GULF POINTE PLAZA- $83.212.77 $87.905.66 $83,212.77 S74,030.1 MEDICARE/MEDICAID '5433 MMC •NH GULF POINTE PLAZA - PRIVATE PAY S1,561.58 $1,837.29 $1,561.58 $1,403.E '3407 MMO-NHTUSCANY $63,695.55 $67,564.96 $63,595.55 $40,209.1 VILLAGE r hltps;/lprosperity.olbanking.comlonlineMessenger 11i Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 2/7/2022 vr.wmn AGpYne BglrmirrE XYXIXINom u.�e. gdan aPM�e+BYt1'[iifiEM�i:YT "—._. 1ab9r.xe. Ae[Wnl XYf[Inf Home NrunA.r pktfremuvuuraEdNrl.rydE�aaa•^ �;; Pendfn6 RmmbNn C4cleared d Ila TWA tae nnln Balmn 1,3t3.97 - Ls61;0 Bank8DNntt I's6 .5% V.Mr. leanln YVntt 10000 VHIDENNFIED[OIDPGYMFNRINOOiFUf WILL OE WRn1Ery FO0TXISRMOVNThi ll1.bt AmvumY4 TNndemdte ,AN 1101BE3T 1.49 F[BINT[NEfT MAN NRNFST Mfurt Oebnv/rnnder4nt L339.93 y/ IaaNDW BatlnnlM Ptndlnl Pmovnt W Be YIaMn TrvndandH / amNrin - aUeered Be Na Tvda a80 lfln"Ibmw Trendemdty NYnln Nome '9,Dfl.Zt re,T9.21 83.113.TT 0I'll" / a3,10635 Benk&Lnu 63,212.D V Wrl9nm Leave 1n B313n[e 10,00 Nare:Onlybobn[n e(em$s.WOwAibehonUNrKry rhenunln9llvme. Nvhl: Fe[M1vttvvnthv[ vbmtbprvlrfe vj$IMtNm MMCdepvi[M[vpmm e[Nvnt. FEB 0 7 2U22 BY COUNTY AUDITOR CALHOUN COUNTY, TOAAS 3PNIXIEXEST 0.6x FFll INIFNE9r MAN IXTIXEW AAIvd B[IaneeRnndtr Nnl 13:106JS'✓ TOTAITWYRFRS yIY A roYea: AN}HONTM Shc:Cf 3/1/b21 l:\NN Wnityinnden\XX Vll Tnnder Summary\SDEl\febrvaMNX VP1Trmdv3ummaryOp.DTl3.rW 1/3]/2D22 HNB-ECHO HCCIAIMPMT]4600341144000DUO344 1/31/1012 HNB-ECNOHCCWMPMT746g03411440000160344 211/2022 HUMANA CRA 015E HCCIAIMPMT 62498242cORC6B1 W212012 WIRE OUT HMO SERVICES, LLC 2/4/2022 HNB-ECHO HCCINMPMT)460034114400D0246911 2/2/2022 WIREOUTHMGSERWCES,LLC 2/2/7022 HNB-ECHO HCCWIMPMT 746MM11440000270175 1/2/2022 NORI01ANJ3AHCCWMPMT67569242WW1002669 2/2/2022 HEALTH HUMAN SW HCOLAIMPMT 11460034113013 2 1/3/2022 O,P.It 1/3/2022 HNB - ECHO HCCLa1MPMT 746009411 MW00111314 2/4/2022 HNB - ECHO HCCLAIMPMT74600N11440000246911 2/4/2022 HEALTH HUMAN WC HCCLAIMPMT 1146OD341130132 "Mc PORTION NH OIPP/Comp46 han9fu-n OIPP/Cempl OIPP/Camp3. OR CAMP3 Laura OR, PORTION 225.41 - 22S.41 15.6B - 15.69 909.79 - 909.78 10,479.63 157.73 157.73 1,343.97 IO.p9.63 1,313.9) NH PORTION "4a2 12.769.73 74,979,12 - - 3,638.48 - 3.638.A. - 1,B43.1i 1,893,11 - 12,65311 - 1215,53.22 - 32,653,96 - 32,653.96 - 9,IE9.72 - 9,164.12 • 4,708.00 4.709.0o 4414.52 / 4.474.52 ]4,9)911 63,112.]] / 3311277 35A53.34 34,433.74 30. 56 217/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/Name Groups Account Type Atltl Group LDDA Data reported as of Feb 7 202: Account Number Current Balance Available Balance Collected Balance Prior Day Belenc Number of Accounts: 15 $7,562,747.70 $7,705,125.46 $7,562,747.70 $7,629,348.4 '4551 CAL CO INDIGENT S5.976.53 $5,976.53 $5,976.53 $41,525.2 HEALTHCARE '4454 MEMEDICAL NH GOLDENOLDEN CREEK / $58,398,18 $62,629.70 $58,398.18 $52,730.£ HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES S536.13 S536.13 $536.13 S536.1 2014 •4357 MEMORIAL MEDICAL S5,691,412.10 S5,780,498.23 S5,691,412.10 $5,973,000,1 CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.61 5431.61 $431.61 5431.E WAIVER CLEARING '4381 MEMORIAL MEDICAL $69,765.88 $78,944,34 $69,765.88 S21,371.1 CENTER INH ASHFORD '4403 MEMORIAL MEDICAL CENTER INH S73,288.53 $78,615.08 $73,288.53 $45,4661 BROADMOOR '4411 MEMORIAL MEDICAL $38.169.90 $42,048.20 $38,169.90 S24,285.E CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $28.366.36 $28,366.36 $28,366,36 S8,107.1 CENTER INH FORT BEND '4438 MEMORIAL MEDICAL CENTER /SOLERA AT S58,759.80 $75,322.83 $58,759.80 $32,527,S WEST HOUSTON '2998 MMC-MONEY MARKET $1,109,566.76 $1,109.566.76 S1,109,566.76 SIA09,566.7 FUND `5506 MMC-NH BETHANY $279.706.02 S284.881.78 $279,706.02 $203,556.7 SENIOR LIVING •5441 MMC -NH GULF POINTS PLAZA - $83 212 77 / ✓ $87,905.66 $83,212.77 S74,030.1 MEDICARE/MEDICAID .5433 MMC-NH GULF POINTE S1,561.58 ,� $1,837,29 $1,561.58 $1;403.E PLAZA - PRIVATE PAY '3407 MMC-NH TUSCANY $63.595.55 $67,564,96 $63,595.55 $40,209.1 VILLAGE hltps:/lprosperity.olbanking.com/onlineMessenger 91 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity ACCOuntb zh/zozz PtMauf MmuM 4finnlry NUN}y xema Nunes 41.n[. tt[ntln.W TI[OnyyWp afl,WO;I6 381,9tYAfi NM.:0.EWb.len<d O(cH$S,PMfrAlbe4un[j[R[[fm Me nunlnnnsc, NweP: foNn¢ount M1otubmPbNengejflW fAW MM[RNwrted[nep[n Prowl. APPROVED ON FEB Q 7 2022 BY COUNTY AUDITOR CALNOUN COUNTY, Tr=XAS Rmountm Ba Tnmlert.et. 63159555/ 4nX 46n[e 53,593,55• VaXann L.—in 4Nnm 1DO,o0 MONNADLOOVP LD,933.1t✓ M1fRIGROOP DEC OIPP 19,OL6Rt Rdimt4lm[ nfl[rF�/r� 33933.W 2/712022 .WMOXYNfHLnp}Ox,C O 1/31/2022 NOVITAS SOLUTION HCCIAIMPMT 676201 4200001" - 14,840.09 , 2/2/2022 WIRE OUTUNBAR ENTERPRISES, L 102,970.46 - - 2/2/2021 MOLINA HEALTHCAR MOUNAACH0102825942000024 • 11,622.70 9,335.04. 2,277.66 10,473.67' 2/3/2022 Deposit - 6,326.54 _ 2/4/2022 KS PLAN AOMINAT HCCLAIMPMT 1791120CM28753 - 2,200.00 2/4/2022 AMERIGROUPCORPO.E•PAYMENTE657305583111000 21,186.45 16,990.10 4,19635 19,0n.28 NH PORTION a15r29'. 7,324.49 14,840.08 1,13833 6,326,54 2,200.00 2,098.14 2/712022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number / Name Groups Add Group Account Type IF DDA Data reported as of Feb 7, 202' Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7,562,747.70 $7,705,125.46 $7,562,747.70 $7,629,348.4 '4551 CAL CO INDIGENT S5,976.53 $5,976.53 $5.976.53 541.525,2 HEALTHCARE '4454 MEMORIAL MEDICAL f NH GOLDEN CREEK $58,398.18 $62,629.70 $58,39818 $52,730.E HEALTHCARE '4365 MEMORIAL MEDICAL $536.13 S536.13 8536.13 S536.1 CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL $5,691,412.10 S5,780,498.23 $5,691,412.10 S5,973,600.1 CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.61 S431.61 $431.61 $431.E WAIVER CLEARING '4381 MEMORIAL. MEDICAL $69,765,88 S78,944.34 $69.765.88 $21,371A CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $73,268.53 $78,515.08 $73,288.53 $45,466.0 SROADMOOR •4411 MEMORIAL MEDICAL $38,189.90 S42,048.20 $38,169.90 $24,285,E CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $28,366.36 $28,366,36 $28,366,36 $8,107.0 CENTER/NH FORT BEND `4438 MEMORIAL MEDICAL CENTER / SOLERA AT $58,759.80 $75,322,83 S58,759.80 $32.527 c WEST HOUSTON '2998 MMC-MONEY MARKET S1,109,556.76 $1,109,566.76 S1,109,566.76 $1,109,566.7 FUND '5606 MMC-NH BETHANY $279,706.02 $284,881.78 S279,706.02 $203,556.7 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA - $83.212.77 $87,905,66 $83,212.77 $74,030.1 MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE S1,551.58 $1,837.29 51,561.58 $1,403.E PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY S63,595,56 J $67.564,98 $63,595,55. $40,209.1 VILLAGE https:lfprosperity,olbanking.com/onlineMessenger 111 Memorial Medial Center Nursing Home UPL Weekly HSLTransfer Prosperity ACCounts 2/7/2a22 Mmun! NurrMe Nvme Numeee Nafe: Onlrhdanrn RF.. A=wlllhe vMQarreeM rheavnlnplmmn Nofe3: Each armunrhas a hmeholMfee/5100 Ihd MMCJrpmlNd I. aaaunl. ,APPROVED OM FEB 0 7 2022 BY COUNTY ALIMOR CALHOUN COUNTY, TD(A$ Pendng M.dlwry Bank Man¢ Vitlan[e leave in eahn[e ]r9,Ta6M 10.0 amoumlA 9v TnMrmG W IRN INUR6r 15.69 PER INUR65T MARIMPRM adIW69almENO rylm[ M Sala APOmvea: ax1RaNY ARaSer� 1 1/]/1011 ELAN WmUY TmnJeft IK UPL TnmM Su—g00N2VNbMf(ANU VPLTnnVaSummary to anjo.Ju 1/1/2022 OPP.It 2/2/2022 WIRE OUT BETHANY SENIOR LIVING, LTD 2/2/2022 Dappsit 2/3/2022 OeP.Al 2/3/2022 DaP.RI 2/3/2022 OappsIt 2/3/2022 Deposit 2/3/2022 HOSPICE OF SOUTH Payments UP I13122650010053 2/4/2022 D.P.,% 228,627.88 10,339.00 24.475,90 492.00 32,776.62 85,551,39 38,109.57 487.06 16,149.27 4H PORTION 25.09' 13,199.53 tQ339.00 24,475.90 492.00 32,776.62 83,551.39 30.209.57 487.O5 76.245.27 226.627.66 279.606.01 27960642 2/712022 Treasury Center Quick View Select quick View Accounts Select Group Account Number/Name Groups Account. Type Adtl Group ♦', Search All LDDA Data reported as of Feb 7 202: Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7,562,747.70 $7,705,125.46 $7,562,747.70 $7,629,34B.4 '4551 CAL CO INDIGENT $5,976.53 $5,976.53 $5,976.53 $41,525.3 HEALTHCARE '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $68,396.18 $62,629.70 $58,398.18 $62,730.9 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES $536.13 $536.13 S536.13 $536.1 2014 '4357 MEMORIAL MEDICAL S5,691,412.10 S5,780,498.23 $5,691,412,10 $5,973,600.1 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $431,61 $431.61 S431.61 S431.E WAIVER CLEARING '4381 MEMORIAL MEDICAL $69,765.88 $78,944.34 $69,765.88 $21,371.1 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER t NH $73,288.53 $78,615.06 $73,288.53 $45,466.0 BROADMOOR '4411 MEMORIAL MEDICAL $38,169.90 $42,048.20 $38,169.90 $24,285,E CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $28.366.36 $28,366.36 $28,366.36 $8,107.0 CENTER INH FORT BEND •4438 MEMORIAL MEDICAL CENTER I SOLERA AT S58,759,80 $75,322.83 $58.769.80 $32,527.9 WEST HOUSTON '2998 MMC-MONEY MARKET $1.109,566.76 S1,109,566.76 $1,109.566.76 $1,109,566.7 FUND '5506 MIMIC -NH BETHANY $279,706,02 ✓ S284,8B1.78 S279,706.02 S203,556.7 SENIOR LIVING `5 41 MIMIC -NH GULF POINTE PLAZA- $83 212 77 $87,905.66 S83,212.77 S74A30.1 MEDICAREIMEDICAID '5433 MMC-NH GULF POINTE $1,561.58 $1,837.29 S1,561.58 $1,403.E PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY $63.595.56 $67,564.96 $63,595.55 $40,209.1 VILLAGE - 1 https:l/prosperity.olbanking.comfonlinaMessonger 1M IVIENIORIAL lir•,EDfCAL CENTER I::'HECI( REQUEST P n MEMORIAL MEDICAL CENTER—Jra.VEFWt� Data Requesi:ed; 2/7/22 A Y APPR®VEp ON E �. r��.�-- -_�_ FEB 0 7 2022 CAAL 00N COUNT�I�R FOR ACCT. USE ONLY 1-1Imprest Cash []A/P Check Mail Check to Vendor EIRetur n Check to Dept AMOUidT—$55,215,44—_ GA NUMBER: 10255040 N%PL ANATION: MOLINA DEC QIPP, MOLINA YR 4 ADJ 1, AMERIGROUP DEC QIPP i It[QL iF;SrED BY: Mayra Martinez AIJ"FI'GRf7FD BY: N NAIEMORIAL MEDICAL CENTER (--NECKREQUEST MEMORIAL MEDICAL CENTER — fwwwoor Datf Requested: 2/7/22 --- ------ -- A APPROVE[) ON FEB 07 2022 E By COUN-1 Y AUDITOR COUNTY, TEXAS FOR ACCT. USE ONLY D I m pres t Cash rjAjP Check Mail Check to Vendor Return Check to Dept AMOUNT —$22L464.47 G/L [qUMBFR: 10255040 F -XPI, . : MOLINA DEC QIpp, MOLINA YR4 ADJ 1, AMERIGROUP DEC QIPP Mayra Martinez A(J I- MEMORIAL IMEDICAL CENTER 'C lI CK REQUEST MEMORIAL MEDICAL CENTER - C.YtStrit-i-' Dale Requested: 2%7/22 A Y APPROVED OIi FEB 0 7 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS FOR ACCT. USE ONLY LImprest Casa; FIAJP Check li-Mail Check to Vendor Return C leck to Dept AMOUNT _$18 211,4BGA NUMBER. 10255040 EXPLAW!!AT!ON: MOLINA DEC QIPP, MOLINA YR 4 ADJ 1, AMERIGROUP DEC QIPP sxs:i2UF' Lf BY Mayra Martinez uAUTHORIZED Bl P A MEMORIAL MEDICAL CENTER (".HECK REQUES-r MEMORIAL MEDICAL CENTER — �Wk 64Lk Date Requested: 2/7/22 APPROVED:0N FEB 0 7 2022 BY COIJNWAUDITOR FoRACCT. USE ONLY Ellinprest Cash []A/P Check 11 Mail Check to Vendor Return Check to Depl: AMOUNT _,$22 495.05 GA NUMBER: 10255040 t1XPU\1QA1-!Ghj: MOLINA DEC QIPP, MOLINAYR 4ADJ 1, AMERIGROUP DEC QIPP Rl-'QU17S 1.11) BY: Mayra Martinez AUTHURUD BY: P A MEMORIAL MEDICAL CENIFER ("HECK REQUES-IF MEMORIAL MEDICAL CENTER - - Date. Requested: 2/7/22 APPROVED ON FEB 0 7 2022 - ---------- SYCOUN-IYAUDIT014 FOR ACCT. USE ONLY r-limprest Cash PA/P Check 11 Mail Check to Vendor OReturn Chccl; to Dept CALHOUN COUNTY, TEXAS AMOUNT 10255040 jAL1. 9 7 G/L N U KA BE R: i:XPI A-.NAl-!0N: MOLINA DEC QIPP, MOLI NA YR 4 ADJ 1, AM ERIGROU P DEC QIPP -- ---- - ----- ...... Cf QUESTEDRY� Mayra Martinez AU-,1-!CjRIZFD BY: -- -------- - ------ A PAEMORIAL MEDICAL CENTER CHECK REQUE'ST MEMORIAL MEDICAL CENTER —'FIAWUi�j IMIF Requested: 2/7/22 FOR ACCT. USE ONLY APPROVED ON Dimprest Cash FES 07 2022 FIA/P Check ❑ Mail Check to Vendor By COuNlYAUDITOR CALHOUN COUNTY, TEXAS Return Check to Dept $2 62.15 G/L NUMBER: iWiOLINT 10255040 EXPLANATION: _ _MOLINA DEC QIPP, AMERIGROUP DEC QIPP R:� Mayra Martinez By: AUTHCIRI.TFE) By — --- --- ---- ------- ----- -- I I o o I o 0 o o C I U 0 0 0 o ao 00 a N N N N L g F W w Q y Z U c w a, ZU UCL UHF Q Oti M4�m 4.0 20 F �F wOX wrm 7z '� i¢ m .:tn4 Cmp Cm0 N O N E O� O "E9 N O F O � F � z -1 > ryUj Q F 00.c7 w Z > O U o u > 0 d X X d d S U a L° v F V 90 U 0 N 0 N O V M O O N N 0 M 0 M O N u q w tri ti W � 47 ti R z� O Z 4 c4 U � U OU U or N o 0 d 0 � 0 a h r w w Z E- U U W w Z � $d zF �� Oz ¢i 6 y0. i= �z 2Z cFi u �v °o ti y Qo �Q S v p �¢ mf 5a a x x m m 5 oa OR OR mf w w w w m rm 0�m 6 v U Sz C 7 e m 2�I F ooh r r �ri h h � s v O W Y o , � 4 J z WOU 74F w 0 �zu F 4 04 a¢ a W z a C Cm7 v 0 U m h U e Y Q Q F H r F v m F U trW. 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