The URL can be used to link to this page

2022-04-20 Final PacketAll Agenda Items Properly Numbered Contracts Completed and Signed O'All 1295's Flagged for Acceptance ' (number of 1295's ) llll fYAll Documents for Clerk Signature Flagged On this�Kkday of 2022 a complete and accurate packet for 261kof 2022 Commissioners Court Regular Session Day onth was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Calhoun County Judge/Assistant COMMISSIONERSCOURTCHECKLIST/FORMS AGENDA NOTICE OF MEETING-4/20/2022 6. Consider and take necessary action to approve an Order Prohibiting Outdoor Burning. (RHM) PASS 7. Consider and take necessary action to authorize Commissioner Hall to advertise for sale at auction Public Property PID 76152 located in the Blue Heron Subdivision. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to approve a contract between the District Attorney's Office and Thomson Reuters for the West Proflex Account for the Law Library and the West Proflex Account for the District Attorney's Office. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to amend the Calhoun County Solid Waste/Recycling Center Site Operation, Waste Handling and User Fees. (VL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to approve the Six Mile Volunteer Fire Department to apply for a Texas Forestry Grant for $20,000. (VL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Public Hearing concerning a Petition to Vacate a portion of Lots 1, 2, 3, and 4, Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. (GDR) Closed meeting at 10:06 Terry Ruddick explained petition to vacate. Opened meeting at 10:08 Page 2 of 4 NOTICE OF MEETING — 4/20/2022 12. Consider and take necessary action on a Petition to Vacate a portion of Lots 1, 2, 3, and 4, Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. (GDR) 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 award the bid for Rebid — Lane Road Drainage Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. B-1. Scott Mason explained the rebid and the Court awarded the bid to IRB Services LLC. 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 approve the engagement of Armstrong Vaughan and Associates, PC, Certified Public Accounts, to perform the audit of the County's financial statements for the year ending December 31, 2021 at an estimated fee of $52,845 and authorize the County Judge to sign. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action to reappoint the following County Park Board members for two-year terms, expiring in February 2024: Allan Berger, Chair; Teri Elliot, Precinct 1; Linda Bournias, Precinct 2; and Dwayne Fishbeck, Precinct 4. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. Consider and take necessary action to declare the attached list of miscellaneous computer and electrical supplies in the County Auditor's Office as Waste. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 4 NOTICE OF MEETING—4/20/2022 17. Consider and take necessary action to declare the attached lists of equipment from Memorial Medical Center 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 18. Consider and take necessary action to transfer the attached list of equipment from Justice of the Peace, Precinct 3 to IT. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 19. Accept Monthly Reports from the following County Offices: i. Justice of the Peace, Precinct 3 — March 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 20. Consider and take necessary action on any necessary budget adjustments. (RHM) 2022: RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 21. 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, Reese Indigent Healthcare RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 10:22a.m. Page 4 of 4 NOTICE OF MEETING-4/20/2022 Richard H. Meyer County judge David Hall, Connrmnssnoner, Precinct I Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary ]Reese, Commissioner, Precinct 4 Anna Goodman, County Cleric 1Caddie Smith, Deputy Cleric NOTICE OF MEETING The Commissioners'Court of Calhoun County, Texas will meet on Wednesday, April 20, 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 at 10:00a.m. by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag- Commissioner Gary Reese Texas Flag- Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. N/A Page 1 of 18 NOTICE OF MEE I ING — 4/20/2022 Richard H. Meyer County ty judge David Mall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 (nary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, April 20, 2022 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Finn Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA /� V' FILED (� UL. M The subject matter of such meeting is as follows: AT ' ✓ O'CLOCK Call meeting to order. APR 14 2022 as M o00 uiyrr,r c Invocation. er. oui 13. Pledges of Allegiance. General Discussion of Public Matters and Public Participation. 5 Read an invitation from the University of Houston to attend the °2022 Fueling the Future Summit" at the UHV Northwest Center on April 27, 2022 From 9 am to 4 pm. 6. Consider and take necessary action to approve an Order Prohibiting Outdoor Burning. (RHM) 7/. Consider and take necessary action to authorize Commissioner Hall to advertise for sale at auction Public Property PID 76152 located in the Blue Heron Subdivision. (DEH) Consider and take necessary action to approve a contract between the District Attorney's Office and Thomson Reuters for the West Proflex Account for the Law Library and the West Proflex Account for the District Attorney's Office. (RHM) KJS. Consider and take necessary action to amend the Calhoun County Solid Waste/Recycling /Center Site Operation, Waste Handling and User Fees. (VL) 'io. Consider and take necessary action to approve the Six Mile Volunteer Fire Department to apply for a Texas Forestry Grant for $20,000. (VL) Page 1 of 2 NOTICE OF MEETING—4/20/2022 CI()5-4>- 11 Public Hearing concerning a Petition to Vacate a portion of Lots 1, 2, 3, and 4, Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. (GDR) CConsider and take necessary action on a Petition to Vacate a portion of Lots 1, 2, 3, and 4, Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. (GDR) 13. Consider and take necessary action to award the bid for Rebid — Lane Road Drainage Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. B-1. (GDR) / 'f4. Consider and take necessary action to approve the engagement of Armstrong Vaughan and Associates, PC, Certified Public Accounts, to perform the audit of the County's financial statements for the year ending December 31, 2021 at an estimated fee of $52,845 and authorize the County Judge to sign. (RHM) Consider and take necessary action to reappoint the following County Park Board members for two-year terms, expiring in February 2024: Allan Berger, Chair; Teri Elliot, /Precinct 1; Linda Bournias, Precinct 2; and Dwayne Fishbeck, Precinct 4. 'r6. Consider and take necessary action to declare the attached list of miscellaneous �computer and electrical supplies in the County Auditor's Office as Waste. (RHM) 17'. Consider and take necessary action to declare the attached lists of equipment from Memorial Medical Center as Waste. (RHM) r8. Consider and take necessary action to transfer the attached list of equipment from Justice of the Peace, Precinct 3 to IT. (RHM) % Accept Monthly Reports from the following County Offices: �� rReJustice of the Peace, Precinct 3 - March 2022 Z0. Consider and take necessary action on any necessary budget adjustments. (RHM) '�1. Approval of bills and payroll. (RHM) Richard H. Meyer, Cou dge Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.org under 'Commissioners' Court Agenda' for any official court postings. Page 2 of 2 #5 NOTICE OF MEETING-4/20/2022 5. Read an invitation from the University of Houston to attend the "2022 Fueling the Future Summit' at the UHV Northwest Center on April 27, 2022 From 9 am to 4 pm. Judge Richard Meyer read invitation. Page 2 of 18 LINIV ERSITy OF HOUSTON -VICTORIA CENTER FOR REGIONAL COLLABORAi ION YOU ARE INVITED TO JOIN US FOR A DYNAMIC DAY OF DISCUSSION DESIGNED TO PREPARE THE REGION FOR A PROMISING AND PROSPEROUS FUTURE TOPICS INCLUDE BROADBAND DEVELOPMENT, INNOVATIVE MARKETING, REGIONAL SYNERGIES AND DEVELOPING THE WORKFORCE OF TOMORROW. INCLUDES REFRESHMENTS, NETWORKING LUNCHEON & SUMMIT (MATERIALS www.accelerationbydesign.com/fueling-the-future-2022 FOR MORE INFORMATION CONTACT. HFIDI SHOOI<I UHV CG1,,:S61.-3549491 SCoo1J1 a]i1hl eal. oq�ilrod IONIII ,IN, EN IAC, ELER/�TION BV DIrSIGN D, 1606.6112513 f i,rralicr Iola 'tqaccele2 icn icson.mm #6 NOTICE OF MEETING — 4/20/2022 6. Consider and take necessary action to approve an Order Prohibiting Outdoor Burning. (RHM) PASS Page 3 of 18 NOTICE OF MEETING—4/20/2022 7. Consider and take necessary action to authorize Commissioner Hall to advertise for sale at auction Public Property PID 76152 located in the Blue Heron Subdivision. (DEH) RESULT: APPROVED[UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 18 Mae Belle Cassel From: david.hall@calhouncotx.org (David Hall) <david.hall@calhouncotx.org> Sent: Thursday, April 14, 2022 8:08 AM To: MaeBelle.Cassel@calhouncotx.org Subject: agenda item Sorry I didn't get this to you yesterday. The day was extremely busy I'm guessing the agenda item could be something like: consider and take necessary action to authorize the advertisement and auction of public property PID 76152 located in Blue Heron Subdivision Commissioner David E. Hall Calhoun County Precinct 1 (Physical) 305 Henry Barber Way (Mailing) 202 S. Ann Port Lavaca, Texas 77979 361-552-9242 office 361-553-8734 Fax 361-220-1751 Cell Vow CONFIDENTIALITY NOTICE: This is a CONFIDENTIAL COMMUNICATION. DO NOT disseminate, distribute, use or copy this communication if you have received this message in error and/or are not the intended recipient. DESTROY all copies of the original and contact the sender by reply email or by calling Calhoun County Precinct 1 Office at361-552-9242. Calhoun County Texas 0 NOTICE OF MEETING-4/20/2022 S. Consider and take necessary action to approve a contract between the District Attorney's Office and Thomson Reuters for the West Proflex Account for the Law Library and the West Proflex Account for the District Attorney's Office. (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 5 of 18 Letti Johnson From: Kirsten.Stewart@thomsonreuters.com (Stewart, Kirsten (Government)) <Kirsten.Stewart@thomson reuters.com> Sent: Monday, April 4, 2022 1:04 PM To: 'letti johnson' Subject: FW: Form 1295 Exemption Hi Letti, Please see below. Let me know if you need anything else. Thanks, Kirsten From: Thomas, Dana C. (TR General Counsel)<dana.thomas@thomsonreuters.com> Sent: Monday, April 4, 2022 12:48 PM To: Stewart, Kirsten (Government) <Kirsten.Stewart@thomsonreuters.com> Subject: Form 1295 Exemption To whom it may concern, West Publishing Corporation d/b/a West, a Thomson Reuters business is exempt from completing Form 1295 with the State of Texas due to the following: Thomson Reuters is a publicly traded business entity. Thanks, Dana rad Contract Analyst Thomson Reuters - Office of General Counsel dana.thomas@tr.com www.thomsonreuters.com Sensitivity: Confidential Criminal District Attorney ' Calhoun County, Texas _ „"t, RANDY R. CRIDER DAN W. HEARD - SARA M. RODRIGUEZ lit' esttgator Assistant Criminal District Attornec ALICIA E GONZALES P.O. Box 1001 • 211 South Ann Street CHRISTY BROWN DUNN Victim Assistance Coordinator Port Lavaca, Texas 77979 Assistant Criminal District Attornec (361) 553-4422 • Fax (361) 553-4421 W.A.(BILL) WHITE Assistant Criminal District Attornec April 8, 2022 Hon. Richard Meyer Calhoun County Judge Calhoun County Commissioners Court RE: Thomson Reuters Renewal Dear Richard Meyer and Commissioners: This letter is to request approval for a new contract between our office and Thomson Reuters for a new agreement on the West Proflex Account for the Law Library and the West Proflex Account for the District Attorney's Office. The new lease agreement amount Will decrease from the current amount paid. Accordingly, please place this item on the next available Commissioner's Court agenda. Thank you for your attention to this matter. Very Dan W. Heard Criminal District Attorney For Calhoun County, Texas DWH:Ij Order Form Order ID: Q-02838000 THOMSON REUTERS Contact your representative kirsten.stewart@thomsomeuters.com with any questions. Thank you. Sold To Account Address Shipping Address Billing Address Account#: 1000644874 Account#: 1000644874 Account #: 1000644874 CALHOUN COUNTY LAW LIBRARY CALHOUN COUNTY LAW LIBRARY CALHOUN COUNTY LAW LIBRARY PATRON ACCESS PATRON ACCESS PATRON ACCESS _ _� _R@91�T . rX "Customer" Da h 2D2 xS. ptrs n $} 025. Nt15t Ord-LAua Tx11g1 Por+ L""a -j9 4ork �a�aut, -Tx T) lq9 This Order Form is a legal document between Customer and A. West Publishing Corporation to the extent that products or services will be provided by West Publishing Corporation, and/or B. Thomson Reuters Enterprise Centre GmbH to the extent that products or services will be provided by Thomson Reuters Enterprise Centre GmbH. A detailed list of products and services that are provided by Thomson Reuters Enterprise Centre GmbH and current applicable IRS Certification forms are available at: hirpsWwwwrr.com/forderingink West Publishing Corporation may also act as an agent on behalf of Thomson Reuters Enterprise Centre GmbH solely with respect to billing and collecting payment from Customer. Thomson Reuters Enterprise Centre GmbH and West Publishing Corporation will be referred to as "Thomson Reuters", "we" or `bur," in each case with respect to the products and services it is providing, and Customer will be referred to as "you", or "your" or "Client". Renewal Order Governing Agreement. Access to any new or renewal products set forth in this Order Form is governed by the same terms and conditions as your previous order form that contained the product(s) you are renewing Renewal Products Monthly Charges in Monthly Material Agreement effect prior to Charges for Renewal Renewal # Renewed Product # Deal ID # Initial Effective Term Renewal Effective Renewal Date (Months) Bari, Year 40757482 West Profox 0000098750 $1,149. 15 $1,206.61 1 4/1/2022 36 Renewal Terms Renewal Term Monthly Charges will be based on the Monthly Charges in effect at the end of the month before the Renewal Term starts Renewal Term Monthly Charges begin at the end of your Minimum Term or current Renewal Term. The Renewal Temr will continue for the number of complete calendar months identified in the Renewal Temr column above. You are also responsible for all Excluded Charges as defined below If your Minimum Term is longer than 12 months, then your Monthly Charges for each year of the Minimum Term are displayed in the Attachment to the Order Form Yost Renewal Terms At the end of the Renewal Term, your Monthly Charges will increase by 7%. Thereafter, the Monthly Charges will increase 7% every 12 months unless we notify you of a different rate at least 90 days before the annual increase. You are also responsible for all Excluded Charges as defined below. Either of us may cancel the Post -Minimum Term subscription by sending at least 60 days written notice. Send your notice of cancellation to Customer Service, 610 Opperman Drive, P.O. Box 64833, Eagan, MN 55123-1803. Federal Government Subscribers Optional Minimum Term. Federal government subscribers that chose a multi -year term, may exercise the option to implement those additional years pursuant to federal law. Miscellaneous Applicable Law. If you are a state or local goverrunental entity, your state's law will apply and any claim may be brought in the state or federal courts located in your state. If you me a non-govemmental entity, this Order Form will be interpreted under Minnesota state law and any claim by one of us may be brought in the state or federal courts in Minnesota. If you are a United States Federal Government Customer, United States federal law will apply and any claim may be brought in any federal court. Charges, Payments & Taxes. You agree to pay all charges in full within 30 days of the date of invoice. You are responsible for any applicable sales, use, value added tax (VAT), etc. unless you are tax exempt. If you are a non -government customer and fail to pay your invoiced charges, you are responsible for collection costs including attorneys' fees. Excluded Charges And Schedule A Rates. If you access products or services that are not included in your subscription you will be charged our then -current rate (`Excluded Charges"). Excluded Charges will be invoiced and due with your next payment. For your reference, the current Excluded Charges schedules are located in the below link Excluded Charges may change from time -to -time upon 30 days written or online notice. We may, at our option, make certain products and services Excluded Charges if we are contractually bound or otherwise required to do so by a third party provider or if products or services are enhanced or if new products or services are released after the effective date of this ordering document. Modification of Excluded Charges or Schedule A rates is not a basis for termination under paragraph 10 of the General Terms and Conditions. eBilling Contact. All invoices for this account will be emailed to your e-Billing Contact(s) unless you have notified us that you would like to be exempt from e-Billing. Page 1 of Credit Verification. If you are applying for credit as an individual, we may request a consumer credit report to determine your creditworthiness. If we obtain a consumer credit report, you may request the time, address and telephone number of the agency that supplied the credit report. If you are applying for credit on behalf of a business, we may request a current business financial statement from you to consider your request. Returns and Refunds. You may return a print product to us within 45 days of the original shipment date if you are not completely satisfied. Please see http://static.leealsolutions.thomsmtreuters.com/static/retums-refimds.ndf or contact Customer Service at 1-800-328-4880 for additional details regarding our policies on returns and refunds. Product Specific Terms. The following products have specific terms which are incorporated by reference and made part of this Order From if they apply to your order. They can be found at httns//static leealsolutions thomsoureuters com/static/ThomsonReuters-General-Terms-Conditions- PST.ndf. If the product is not part of your order, the product specific terms do not apply. If there is a conflict between product specific terns and the Order Form, the product specific terns control. -Campus Research -Contract Express -Hosted Practice Solutions •ProView eBooks *Time and Billing • West km Software • West LegalEdcenter •Westlaw • Westlaw Doc & Form Builder • Westlaw Paralegal • Westlaw Patron Access • Westlaw Public Records Acknowledeement: Order ID: 0-02838000 Signature of Authorized Representative for order Title Date This Order Form will expire and will not be accepted after 5/15/2022. Page 2 of 3 Attachment Order ID: Q-02838000 THOMSON REUTERS Contact your representative kirsten.stewart@thomsonreuters.com with any questions. Thank you. Payment, Shipping, and Contact Information Payment Method: Order Confirmation Contact (#28) Payment Method: Bill to Account Contact Name: Rodriguez, Sara Account Number: 1000644874 Email: sara.mdriguez@calhouncotx.org Shipping Information: ¢Billing Contact Shipping Method: Ground Shipping - U.S. Only Contact Name Sara Rodriguez Email sara.rodriguez@calhouncotx.org Account Contacts Account Contact First Name Account Contact Last Name Account Contact Email Address Account Contact Customer T e Description Material Product Year 1 /° incr Year 2 % incr Year 3 % Year 4 0/ Year 5 # Name Monthly Yr 1 2 Monthly Yr 2 3 Monthly incr Monthly incr Monthly Charges Char es Charges Yr 3-4 Char ea Yr 4-5 Charges 40757482 West Profl, $1206.61 5.00°/1 $1266.94 5.00% $1330.29 N/A I N/A Pricing is displayed only for the years included in the Renewal Tenn. Years without pricing in above grid are not included in the Renewal Tenn. Refer to your Order Form for the Post Renewal Term pricing. Page 3 of 3 Order Form Order ID; Q-02838000 THOMSON REUTERS" Contact your representative kirsten.stewart@thomsomeuters.com with any questions. Thank you. Said To Account Address Shipping Address Billing Address Account#:. 1000644874 Account#: 1000644874 Account#: 1000644874 CALHOUN COUNTY LAW LIBRARY CALHOUN COUNTY LAW LIBRARY. CALHOUN COUNTY LAW LIBRARY PATRON ACCESS PATRON ACCESS PATRON ACCESS 299 iW3tiAFF-F;iNN S'T ^2 �T 9^ d0&0.�V1 3c 2D2 S.Hwn S} §@I_50v3 "Customer d3& 20 Z. S. yNSt' of+lR�a TK I I`1'1 Pof4 LaoarA 1 In f4 LaVacd 'C '1'19'1`i This Order Form is a legal document between Customer. and A. West Publishing Corporation to the extent that products or services will be provided by West Publishing Corporation; and/or B. Thomson Reuters Enterprise Centre GmbH to the extent that products or services will be provided by Thomson Reuters Enterprise Centre GmbH A detailed list of products and services that are provided by Thomson Reuters Enterprise Centre GmbH and current applicable IRS Certification forms me available at: https'//www.tr.com/trorderingial West. Publishing Corporation may also act as anagent on behalf of Thomson Reuters Enterprise Centre GmbH solely with respect to billing and collecting payment from Customer. Thomson Reuters Enterprise Centre GmbH and West Publishing Corporation will be referred to as "Thomson Reuters", -we" or "our," in each case with respect to the products and services it is providing, and Customer will be referred to as "you", or "your" or "Client". Renewal Order Governing Agreement Access to any new or renewal products set forth in this Order Form is governed by the same terms and conditions as your previous order form that contained the product(s) you are renewing Renewal Products Monthly Charges in Monthly Material Renewed Product Agreement Deal ID # effect prior to Charges for Renewal Renewal # # Renewal Initial Effective. Term Effective. Renewal ` Date (Months) - Date Year 40757482 West Frolics 0000098750 $1,149.15 $1,206.61 4/l/2022 36 Renewal Terms Renewal Term Monthly Charges will be based on the Monthly Charges in effect at the end of the month before the Renewal Term starts. Renewal Term Monthly Charges begin at the end of your. Minimum Term or current Renewal Term The Renewal Termwill. continue for the number of :complete calendar months identified in the Renewal Term column above. You are also responsible for all Excluded Charges as defined below if your Minimum Term is longer than 12 months, then your Monthly Charges for each year of the Minimum Term are displayed in the Attachment to the Order Form Post Renewal Terms At the end of the Renewal Term, your Monthly Charges will increase by 7%. Thereafter, the Monthly Charges will increase 7% every 12 months unless we notify you of a different rate at least 90 days before the annual increase. You are also responsible for all Excluded Chmges as defined ` below. Either of us may cancel the Post -Minimum Temt subscription by sending at least 60 days written notice. Send your notice of cancellation to Customer Service, 61.0 Opperman Drive, P.O. Box 64833, Eagan, MN 55123-1803: Federal Government Subscribers Optional Minimum Term. Federal government subscribers that chose amulti-year term, may exercise the option to implement those additional years pursuant to federal law. Miscellaneous Applicable Law. If you are a state or local goverrunental entity, your state's law will apply and any claim may be brought in the state or federal courts located in your state. If you are a non -governmental entity, this Order Form will be interpreted under Minnesota state law and any claim by one of us may be brought in the state or federal. courts in Minnesota If you are a United States Federal Government Customer, United. States federal law will apply and my claim may be brought in any federal court. Charges, Payments & Taxes. You agree to pay all charges in full within 30 days of the date of invoice. You are responsible for any applicable sales, use, value added tax (VAT), etc. unless you are tax exempt. If you are a non -government customer and fail to pay your invoiced charges, you are responsible for collection costs including attorneys' fees. - Excluded Charges And Schedule A Rates. If you access products or services that are not included in your subscription you will be charged our then -current rate ("Excluded Charges") Excluded Charges will be invoiced: and due with your next payment For your reference, the current Excluded Charges schedules are located in the below link Excluded Charges may change from time -to -time upon 30 days: written or online notice. We may, at our option, make certain products and services Excluded Charges if we are contractually bound or otherwise required to do so by a third party provider or if products or services .are enhanced or if new products or services are released after the effective date of this ordering document. Modification of Excluded Charges or Schedule A rates is not a basis for termination under paragraph 10 of the General Terms and Conditions. eBilling Contact. All invoices for this account will be emailed to your e-Billing Contact(s) unless you have notified us that you would like to be exempt from e-Billing. 'Page l of3' Credit Verification. If you are applying for credit as an individual, we may request a consumer credit report to determine your creditworthiness. If we obtain a consumer credit report, you may request the name, address and telephone number of the agency. that supplied the credit report. If you are applying for credit on behalf of a business,. we may request a current business financial statement from you to consider your request Returns and Refunds. You may return a print product to us within 45 days of the original shipment date if you are not completely satisfied. Please see Imp://static.leealsolutions thomsonreuters com/static/renmis-refimds bdf or contact Customer Service at 1-800-328-4880 for additional details regarding our policies on terms and refunds. Product Specific Terms. The following products have specific terms which are incorporated by reference and made part of this Order Form if they apply to your order. They can be found at hos'//static legalsolutions thomsonreuters com/static/ThomsonReuters-General Terms -Conditions PST ndf If the product is not part of your order, the product specific terms do not apply. If there is a conflict between product specific terms and the Order Form, the product specific terms control. -Campus Research -Contract Express -Hosted Practice Solutions •ProView eBooks -Time and Billing -West km Software • West LegalEdcenter •Westlaw •Westlaw Doc &Form Builder •Westlaw Paralegal •Westlaw Patron Access • Westlaw Public Records Acknowledeement:. Order ID: 0-02838000 - Signature of Authorized Representative for order Title Printed Name Date This Order Form will expire and will not be accepted after 5/15/2022. Page of THOMSpN REUTERSAttachment Order ID: Q-02838000 " Contact your representative ki rsten. stew art@tho mso are uters. com with anyquestions. Thank you. Payment, Shipping, and Contact Information Payment Method: Order Confirmation Contact (#28) Payment Method: Bill to Account Contact Name: Rodriguez, Sara Account Number: 1000644874 Emailsua.rodriguez@calhouncotx.org Shipping Information: eBilling Contact Shipping Method: Ground Shipping - U.S. Only Contact Name Sam Rodriguez Email sara.rodriguez@calhouncotx.org Account Contacts Account Contact First Name Account Contact Last Name Account Contact Email Address Account Contact Customer T u e Descri tion Material Product Year 1 % incr Year 2 % mCY Year 3 % Year 4 % Year 5 . p Name Monthly Yr l-2 Monthly Yr 2-3 Monthly incr Monthly incr Monthly Charges Char es Char es Yr3-4 Charges Yr4-5 Chan es 40757482.`West Proflex... $1206.61 5.00% $1266.94 5.00% 1..$1330.29 1 N/A I N/A- N/A I N/A Pricing is displayed only for the years mcluded in the Renewal Tenn. Years without prmmg. in above grid are not included in the Renewal Term. Refer to " your Order Form for the Post Renewal Term pricing. - Page of THOMSON REUTERSOrder Form Order ID: Q-02837716 ,-•�` " Contact your representative kirsten.stewart@thomsomeuters.com with any questions. Thank you. Sold To Account Address Account#: 1000129201 CALHOUN COUNTY CRIMINAL DISTRICT ATTORNEY PO BOX 1001 211 S ANN ST STE 302 PORT LAVACA TX 77979-4249 US "Customer" Order Form is a legal Shipping Address Account#: 1000129201 CALHOUNCOUNTY CRIMINAL DISTRICT ATTORNEY PO Box 1001 211 S ANN ST STE 302 PORT LAVACA TX 77979-4249 US Customer and Billing Address Account#: 1000129201 CALHOUN COUNTY CRIMINAL DISTRICT ATTORNEY PO Box 1001 211 S ANN ST STE 302 PORT LAVACA, TX 77979-4249 A. West Publishing Corporation to the extent that products or services will be provided by West Publishing Corporation, and/or B. Thomson Reuters Enterprise Centre GmbH to the extent that products or services will be provided by Thomson Reuters Enterprise Centre GmbH. A detailed list of products and services that are provided by Thomson Reuters Enterprise Centre GmbH and current applicable IRS Certification forms are available at: https://www.tr.com/norderingillL West Publishing Corporation may also act as an agent on behalf of Thomson Reuters Enterprise Centre GmbH solely with respect to billing and collecting payment from Customer. Thomson Reuters Enterprise Centre GmbH and West Publishing Corporation will be referred to as "Thomson Reuters", "we" or `bur," in each case with respect to the products and services it is providing, and Customer will be referred to as "you", or "you" or "Client". Thomson Reuters General Terms and Conditions apply to all products ordered, except print and is located at hqp://tr.wni/TemsandCoiiditions. In the event that there is a conflict of terms between the General Terms and Conditions and this Order Form, the terms of this Order Form control. This Order Form is subject to our approval. Thomson Reuters General Terms and Conditions for Federal Subscribers is located at https�Hstatic Iegalsolutions thomsonreuters coin/static/Federal-ThomsoiiReuters General Terms Conditions ldf In the event that there is a conflict of terms between the General Terms and Conditions and this Order Form, the terms of this Order Form control. This Order Form is subject to our approval. ProFlex Products See Attachment far details. Material # Product Monthly Charges Minimum Terms Months 40757482 West Proflex $1,272.00 36 Minimum Terms You subscription is effective upon the date we process your order ("Effective Date") and Monthly Charges will be prorated for the number of days remaining in that month; if any. You subscription will continue for the number of months listed in the Minimum Term column above counting from the first day of the month following the Effective Date. Your Monthly Charges during the first twelve (12) months of the Minimum Term are as set forth above. If your Minimum Term is longer than 12 months, then you Monthly Charges for each year of the Minimum Term are displayed in the Attachment to the Order Farm. At the end of the Minimum Term, your Monthly Charges will increase by 7%. Thereafter, the Monthly Charges will increase 7%every 12 montl unless we notify you of a different rate at least 90 days before the annual increase. You are also responsible for all Excluded Charges. Excluded Charges may change after at least 30 days written or online notice. Either of us may cancel the Post Minimum Term subscription by sending at least 60 days written notice. Send your notice of cancellation to Customer Service, 610 Oppennan Drive, P.O. Box 64833, Eagan, MN 55123- 1803. Federal Government Subscribers Optional Minimum Term. Federal government subscribers that chose a multi -year Minimum Term, those additional months will be implemented at your option pursuant to federal law. Banded Product Subscriptions. You certify your total number of attorneys (partners, shareholders, associates, contract or staff attorneys, of counsel, and the like), corporate users, personnel or full -time -equivalent students is indicated in this Order Form. Our pricing for banded products is made in reliance upon you certification. If we learn that the actual number is greater or increases at any time, we reserve the right to increase your charges as applicable. Miscellaneous Applicable Law. If you are a state or local governmental entity, your state's law will apply and any claim may be brought in the state or federal courts located in your state. If you we a non -governmental entity, this Order Form will be interpreted under Minnesota state law and any claim by one of us may be brought in the state or federal courts in Minnesota. If you are a United States Federal Government Customer, United States federal law will apply and any claim may be brought in any federal court. Charges, Payments & Taxes. You agree to pay all charges in full within 30 days of the date of invoice. You are responsible for any applicable sales, use, value added tax (VAT), etc. unless you are tax exempt. If you are a non -government customer and fail to pay your invoiced charges, you are responsible for collection costs including attorneys' fees. Page I of Excluded Charges And Schedule A Rates. If you access products or services that are not included in your subscription you will be charged our then -current rate ("Excluded Charges"). Excluded Charges will be invoiced and due with your next payment. For your reference, the current Excluded Charges schedules are located in the below link Excluded Charges may change from time -to -time upon 30 days written or online notice. We may, at our option, make certain products and services Excluded Charges if we are contractually bound or otherwise required to do so by a third party provider or if products or services are enhanced or if new products or services are released after the effective date of this ordering document. Modification of Excluded Charges or Schedule A rates is not a basis for termination under paragraph 10 of the General Terms and Conditions. htto://static.leealsolutions.thomsonreaters coni/static/aereementlplan-2-nro-govt-a e�12df ¢Billing Contact. All invoices for this account will be entailed to your e-Billing Contact(s) unless you have notified us that you would like to be exempt from e-Billing. Credit Verification. If you are applying for credit as an individual, we may request a consumer credit report to determine your creditworthiness. If we obtain a consumer credit report, you may request the time, address and telephone number of the agency that supplied the credit report. If you are applying for credit on behalf of a business, we may request a current business financial statement from you to consider your request. Returns and Refunds. You may return a print product to us within 45 days of the original shipment date if you are not completely satisfied. Please see 1h //static leaalsolutions thomsonreuters coin/static/retums-refundskdf or contact Customer Service at 1-800-328-4880 for additional details regarding our policies on returns and refunds. Product Specific Terms. The following products have specific terms which are incorporated by reference and made part of this Order Fomr if they apply to your order. They can be found at lilWs:Hstatic.legalsolutions.thomsonreuters com/static/ThomsonReuters-General-Tenns-Conditions- PST ndf. If the product is not part of your order, the product specific terms do not apply. If there is a conflict between product specific terns and the Order Form, the product specific terms control. -Campus Research -Contract Express -Hosted Practice Solutions •ProView eBooks -Time and Billing • West km Software • West LegalEdcenter • Wesflaw • Wesdaw Doc & Form Builder • Westlaw Paralegal • Wesdaw Patron Access • Wesdaw Public Records Acknowledeement: Order ID: 0-02837716 Signature of Authorized Representative for order Printed Name Date This Order Form will expire and will not be accepted after 5/15/2022. Page 2 of 3 Attachment Order ID: Q-02837716 THOMSON REUTERS Contact your representative kirs ten. stew art@tho or s onreuters. co at with any questions. Thank you. Payment, Shipping, and Contact Information Payment Method: Order Confirmation Contact (H28) Payment Method: Bill to Account Contact Name: Rodriguez, Sara Account Number: 1000129201 Email: sara.rodriguez@calhouneotx.org Shipping Information: eBilling Contact Shipping Method: Ground Shipping - U.S. Only Contact Name Sam Rodriguez Email sara.rodriguez@ealhouncotx.org ProFlex Multiple Location Details Account Number Account Name Account Address -Action 211 S ANN ST STE 302 1000129201 CALHOUN COUNTY PORT LAVACA New TX 77979-4249 US ProFlex Product Details -. Quantity Unit Service Material H Description 1 Each 40757482 West Proflex 4 Attorneys 42510228 Westlaw Edge National Primary Law, Enterprise access, Government 4 Attorneys 42077755 Wesdaw All Analytical, Enterprise access, Government 4 Attorneys 41933475 Wesdaw, Litigation Collection, Enterprise access, Government 4 Attorneys 42010202 Gvt - Form Builder For Government (Westlaw PROTM) 4 Attorneys 42566958 Gvt - WL4G O'Connor's (WestlawPROTM) 4 Attorneys 41974282 Gvt Drafting Assistant For Government (Westlaw PROTM) Account Contacts Account Contact First Name Account Contact Last Name Account Contact I Email Address Account Contact Customer Type Description Sara I Rodriguez I sara.rodriguez@calhouncotx.org EML PSWD CONTACT Lapsed Products Sub Material Active Subscription to be Lapsed 40757481 West Proflex 42077754 Westlaw All Analytical, Enterprise access, Government 41974283 Gvt Drafting Assistant For Government (Westlaw PROTM 42010204 Gvt - Form Builder For Government (Westlaw PROTM) 41933477 Westlaw Litigation Collection, Enterprise access, Government 42566959 Gvt- WL4G O'Connor's (WestlawPROTM) 42510229 Westlaw Edge National Primary Law, Enterprise access, Government Ch- n 'no Mlolmom Tn.m Material Product Year 1 % incr Year 2 % incr Year 3 % Year 4 % Year 5 H Name Monthly Yr 1 2 Monthly Yr 2 3 Monthly incr Monthly iner Monthly Charges Char es Charges Yr 3-4 Charges Yr 4-5 Char es 40757482 West Proflex $1,272.00 5.00% $1335.60 5.00% $1402.38 N/A N/A N/A N/A Charges During Minimum Term Pricing is displayed only for the years included in the Minimum Term. Years without pricing in above grid are not included in the Minimum Term. Refer to your Order Form for the Post Minimum Term pricing. Page 3 of 3 Order Form Order ID: Q-02837716 THOMSON REUTERS" Contact your representative kirsten.stewart@thomsomeuters.com with any questions. Thank you. Sold To Account Address Account#: 1000129201 CALHOUN COUNTY CRIMINAL DISTRICT ATTORNEY PO BOX 1001 211 S ANN ST STE 302 PORT LAVACA TX 77979-4249 US "Customer" Shipping Address Account#: 1000129201 CALHOUN COUNTY CRIMINAL DISTRICT ATTORNEY PO Box 1001 211 S ANN ST STE 302 PORT LAVACA TX 77979-4249 US Customer and Billing Address Account#: 1000129201 CALHOUN COUNTY CRIMINAL DISTRICT ATTORNEY PO Box 1001 211 S ANN ST STE 302 PORT LAVACA, TX 77979-4249 A. West Publishing Corporation to the extent that products or services will be provided by West Publishing Corporation, and/or B. Thomson Reuters Enterprise Centre GmbH to the extent that products or services will be provided by Thomson Reuters Enterprise Centre GmbH. A detailed list of products and services that are provided by Thomson Reuters Enterprise Centre GmbH and current applicable IRS Certification fomrs are available at: https://www.tr.com/trorderineinfo West Publishing Corporation may also act as an agent on behalf of Thomson Reuters Enterprise Centre GmbH solely with respect to billing and collecting payment from Customer. Thomson Reuters Enterprise Centre GmbH and West Publishing Corporation will be referred to as "Thomson Reuters", "we" or `bur," in each case with respect to the products and services it is providing, and Customer will be referred to as "you", or "your" or "Client". Thomson Reuters General Terms and Conditions apply to all products ordered, except print and is located at htto://tr.com/TemsandConditions. In the event that there is a conflict of terms between the General Terms and Conditions and this Order Form, the terms of this Order Form control. This Order Form is subject to our approval. Thomson Reuters General Terms and Conditions for Federal Subscribers is located at https://static.legalsolutions thomsoareuters coin/static/Federal-ThomsonReuters-General-Terms-Conditions t)df In the event that there is a conflict of terms between the General Terms and Conditions and this Order Form, the terms of this Order Form control. This Order Form is subject to our approval. ProFlex Products See Attachment for details Material # Product Monthly Charges Minimum Terms Months 40757482 West Proflex $1,272.00 36 Minimum Terms Your subscription is effective upon the date we process your order ("Effective Date") and Monthly Charges will be prorated for the number of days remaining in that month, if any. Your subscription will continue for the number of months listed in the Minimum Term column above counting from the first day of the month following the Effective Date. Your Monthly Charges during the first twelve (12) months of the Minimum Term are as set forth above. If your Minimum Term is longer than 12 months, then your Monthly Charges for each year of the Minimum Term are displayed in the Attachment to the Order Form. ++ _ Post Minimum,Termsi2 At the end of the Minimum Term, your Monthly At will increase by 7%. Thereafter, the Monthly Charges will increase 7% everyy 12 months unless we notify you of a different rate at least 90 days before the =net increase. You are also responsible for all Excluded Charges. Excluded Charges may change after at least 30 days written or online notice. Either of us may cancel the Post Minimum Term subscription by sending at least 60 days written notice. Send your notice of cancellation to Customer Service, 610 Opperman Drive, P.O. Box 64833, Eagan, MN 55123- 1803. Federal Government Subscribers Optional Minimum Term. Federal government subscribers that chose a multi -year Minimum Term, those additional months will be implemented at your option pursuant to federal law. Banded Product Subscriptions. You certify your total number of attorneys (partners, shareholders, associates, contract or staff attorneys, of counsel, and the like), corporate users, personnel or full -time -equivalent students is indicated in this Order Form. Our pricing for banded products is made in reliance upon your certification. If we learn that the actual number is greater or increases at any time, we reserve the right to increase your charges as applicable. Miscellaneous Applicable Law. If you are a state or local governmental entity, your state's law will apply and any claim may be brought in the state or federal courts located in your state. If you are a non -governmental entity, this Order Form will be interpreted under Minnesota state law and any claim by one of us may be brought in the state or federal courts in Minnesota. If you are a United States Federal Government Customer, United States federal law will apply and any claim may be brought in any federal court. Charges, Payments & Taxes. You agree to pay all charges in full within 30 days of the date of invoice. You are responsible for any applicable sales, use, value added tax (VAT), etc. unless you are tax exempt. If you are a non -government customer and fail to pay your invoiced charges, you are responsible for collection costs including attorneys' fees. Page 1 of 3 Excluded Charges And Schedule A Rates. If you access products or services that are not included in your subscription you will be charged our then -current rate ("Excluded Charges"). Excluded Charges will be invoiced and due with your next payment. For your reference, the current Excluded Charges schedules are located in the below link Excluded Charges may change from time -to -time upon 30 days written or online notice. We may, at our option, make certain products and services Excluded Charges if we are contractually bound or otherwise required to do so by a third party provider or if products or services me enhanced or if new products or services are released after the effective date of this ordering document. Modification of Excluded Charges or Schedule A rates is not a basis for termination under paragraph 10 of the General Terms and Conditions. litto:Hstatic.leealsolutions.thomsonreuters.com/static/aereemetit/plan-2-p<or og vt-a eg ncies 1df ¢Billing Contact. All invoices for this account will be emailed to your e-Billing Contact(s) unless you have notified us that you would like to be exempt from e-Billing. Credit Verificatiaa If you are applying for credit as an individual, we may request a consumer credit report to determine your creditworthiness. If we obtain a consumer credit report, you may request the name, address and telephone number of the agency that supplied the credit report. If you are applying for credit on behalf of a business, we may request a current business financial statement from you to consider your request. Returns and Refunds. You may return a print product to us within 45 days of the original shipment date if you are not completely satisfied. Please see hftn //static leaalsolutions thomsonreuters coin/static/retums-refimds pddf or contact Customer Service at 1-800-328-4880 for additional details regarding our policies on returns and refunds. Product Specific Terms. The following products have specific terms which are incorporated by reference and made part of this Order Form if they apply to your order. They can be found at Ittms://static leaalsolutions thomsonreuters corn/static/ThomsonReuters-General-Terms-Conditions- PST.ndf. If the product is not part of your order, the product specific terms do not apply. If there is a conflict between product specific terms and the Order Form, the product specific terms control. -Campus Research •Contract Express -Hosted Practice Solutions -ProView, eBooks -Time and Billing • West km Software • West LegalEdcenter •Westlaw • Westlaw Doc & Form Builder • Westlaw Paralegal • Westlaw Patron Access • Westlaw Public Records Acknowledbema.t: Order ID: 0-02837716 C±�//. Signature of AuthoriAd Represet6fivol for order A, me,1 R r- Printed Name l 7 � a a — Title Date This Order Form will expire and will not be accepted after 5/15/2022. Page 2 of 3 Attachment Order ID: Q-02837716 THOMSONREUTERS" Contact your representative kirs ten. stew art@thoms onreuters. com with any questions. Thank you. Payment, Shipping, and Contact Information Payment Method: Order Confirmation Contact (028) Payment Method: Bill to Account Contact Name: Rodriguez, Sara Account Number: 1000129201 Email: sara.rodriguez@calhouncotx.org Shipping Information: eBilling Contact Shipping Method: Ground Shipping - U.S. Only Contact Name Sara Rodriguez Email sara.rodriguez@calhouncotx.org .ProFlex Multiple Location Details Account Number Account Name I Account Address . Action 211 S ANN ST STE 302 1000129201 CALHOUN COUNTY PORT LAVACA New TX 77979-4249 US ProFlex Product Details Quantity Unit Service Material # Description 1 Each 40757482 West Proflex 4 Attorneys 42510228 Westlaw Edge National Primary Law, Enterprise access, Government 4 Attorneys 42077755 Westlaw, All Analytical, Enterprise access, Government 4 Attorneys 41933475 Westlaw, Litigation Collection, Enterprise access, Government 4 Attorneys 42010202 Gvt - Form Builder For Government (Westlaw PROTM 4 Attorneys 42566958 Gvt - WL4G O'Connor's (WestlawPROTM 4 Attorneys 41974282 Gvt Drafting Assistant For Government (Westlaw PROTM) ' Account Contacts Account Contact First Name Account Contact I Last Name Account Contact I Email Address Account Contact Customer Type Description Sara I Rodriguez I samrodriguezAcalhouncom.org I EML PSWD CONTACT - Lapsed Products Sub Material Active Subscription to be Lapsed 40757481 West Proflex 42077754 Westlaw All Analytical, Enterprise access, Government 41974283 Gvt Drafting Assistant For Government Westlaw PROTM 42010204 Gvt - Form Builder For Government Westlaw PROTM) 41933477 Westlaw Litigation Collection, Enterprise access, Government 42566959 Gvt- WL4G O'Connor's (WestlawPROTM) 42510229 Westlaw Edge National Primary Law, Enterprise access, Government Charges Durmff Minimum Term Material Product Year 1 a/o incr Year 2 % a/o incr Ycar3 % Year 4 % Year 5 Monthly Monthly Monthly incr Monthly incr Monthly # Name Charges Yr 1 2 Charges 2 3 Cha es Yr 3-4 Charges Yr 4-5 Char es 40757482 Wes[Proflex $1,272.00 5.00% $1335.60 5.00% 1 $1402.38 N/A N/A N/A N/A Charges During Minimum Term - Pricing is displayed only for the years included in the Minimum Term. Years without pricing in above grid me not included in the Minimum Term. Refer to your Order Form for the Post Minimum Tenn pricing. Page 3 of 3 #9 NOTICE OF MEETING-4/20/2022 9. Consider and take necessary action to amend the Calhoun County Solid Waste/Recycling Center Site Operation, Waste Handling and User Fees. (A) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 18 Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 April 11, 2022 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca. TX 77979 RE: AGENDA ITEM Dear Judge Meyer: �b,�rte. ov rf* N CpGHTY of C��'aoJ; Please place the following item on the next Commissioners' Court Agenda (361) 552-9656 Fax (361) 553-6664 • Consider and take necessary action to amend the Calhoun County Solid Waste/Recycling Center Site Operation, Waste Handling & User Fees Since el , Vern Lyssy VL/f CALHOUN COUNTY USER FEES HOUSEHOLD TRASH & METAL ONLY COM ERCIAL BRUSH ONLY BY APPOINTMENT NO CONSTRUCTION, DEMOLITION OR BURN BARRELS ACCEPTED APPLIANCES MUST BE OIL FREE AND COMPRESSORS REMOVED MINIMUM FEE $10 MIXED WASTE - 16'TRAILER ............................................................ $"100 PICKUP -SMALL TO FULL SIZE ................................................ ............ $20-$30 COUCHES............................................................................... $15 EACH RECLINERS ............................................................................. $10 EACH MATTRESSES .......................................................................... $5410 EACH TIRES, NO RIMS, UP TO 17 ............................................................ $3EACH BRUSH - PICKUP or UP TO 16'TRAILER ............................................... 1$10-$201 APPLIANCES -OIL FREE ............................................................. $10 EACH NO PAINTS, LIQUIDS, CHEMICALS OR CYLINDERS ACCEPTED EFFECTIVE 'APRIL 20, 2022 SALES TAX APPLIES TO ALL SERVICES CALHOUN COUNTY RECYCLING CENTERS MAIN LOCATION: 900 LANDFILL ROAD, PORT LAVACA, TX 77979, 361-552-7791 HOURS: FRIDAY 8-5, SATURDAY 8-5 MOBILE TRAILERS EACH MONTH REMOVED HOURS MONDAY-THURSDAY PORT O'CONNOR: PRECINCT 4 SITE, 93 TREVOR ST SEADRIFT: PRECINCT 4 OFFICE SITE REMEMBER, IF ANY MOBILE UNIT IS FULL, YOU MAY USE THE MAIN LOCATION LOCATED AT 900 LANDFILL ROAD The following items are accepted as recycling at the Calhoun County Recycling Center: ALL RECYCLABLES CAN BE CO -MINGLED, NO SORTING REQUIRED CORRUGATED CARDBOARD -PLACE IN BIN, CUT TO SIZE METALS: STEELITIN CANS MUST BE CLEAN, RINSED ALUMINUM CANS NO ELECTRONICS PLASTICS: #147 NO TOYS el PETS- SODA, WATER BOTTLES MUST BE CLEAN, RINSED p2 HDPE- NATURAL- MILK, WATER JUGS NO MOTOR OIL, PESTICIDE, HERBICIDE, ANTIFREEZE 92 HDPE- COLORED- SOAP, CLOROX, SHAMPOO CONTAINERS No Styrofoam No GLASS NO PLASTIC BAGS NO SHREDDED PAPER PAPER: WHITE—SHEETSONLY—NO SHREDDED PAPER MIXED- JUNK MAIL, COLORED PAPER, CEREAL BOXES, ENVELOPES ALL PAPER MUST BE DRY — NO SHREDDED MAGAZINES/CATALOGUES NEWSPAPER AND INSERTS CORRUGATED CARDBOARD- DRY, FLATTENED, NO WAX, NO STYROFOAM-PLEASE CUT TO FIT 2'XZ' YOUR RECYCLING WILL NOT BE ACCEPTED IF DIRTY, LIDS NOT REMOVED. IF THE PLASTIC DOES NOT HAVE A RECYCLE SYMBOL/NUMBER ON THE BOTTOM --WE DO NOT ACCEPT WE DO NOT ACCEPT PLASTIC BAGS, SHREDDED PAPER, GLASS, PESTICIDE/HERBICIDE, MOTOR OIL OR ANTIFREEZE CONTAINERS. PLEASE EMPTY ALL PLASTIC BAGS AND PLACE LOOSELY IN APPROPRIATE BINS. BAGS CAN BE RETURNED TO YOUR LOCAL HEB FOR RECYCLING. THE RECYCLING TRAILERS ARE PROVIDED TO YOU FUNDED BY A GRANT FROM THE TCEQ THROUGH THE GOLDEN CRESCENT REGIONAL PLANNING COMMISSION. PLEASE FOLLOW THE RULES SO THAT WE CAN CONTINUE TO PROVIDE THIS SERVICE TO YOU, THE TAX PAYERS OF CALHOUN COUNTY. YOU ABUSE, YOU LOSE. SINGLE STREAM RECYCLING RULES 1. MATERIALS ACCEPTED TOGETHER: PLASTICS, #1-5 & #7—RINSED, LIDS REMOVED (No Styrofoam #6) PAPER- WHITE, COLORED, MAGAZINES, CATALOGS, PHONE BOOKS, NEWS PAPER, JUNK MAIL, FOOD/DRINK BOXES (NO SHREDDED PAPER), CORRUGATEDCARDBOARD-CUTTO'FIT 2'x2' TIN/ALUMINUM CANS- RINSED 2. MATERIALS NOT ACCEPTED: LIQUIDS, GARBAGE, GLASS, STYROFOAM, ALL PLASTIC SHOPPING/TRASH BAGS, SHREDDED IPAPER, TOYS, ,LIGHT BULBS, MOTOR OIL OR HERBICIDE/INSECTICIDE. CONTAINERS, FOOD CONTAMINATES, OTHER METALS, BOOKS, ELECTRONICS NOTE: YOU DO NOT HAVE TO SORT ITEMS. PLEASE PLACE ALL ACCEPTABLE MATERIALS' LOOSELY IN ANY AVAILABLE BIN —DO NOT LEAVE RECYCLABLES ON THE GROUND, IF TRAILER IS FULL, YOU MAY BRPNG TO'THE MAIN LOCATION --- 900 LANDFILL ROAD- FOR INFO:361`552-9656 CALHOUN COUNTY RECYCLING CENTER SINGLE STREAM PLEASE READ AND FOLLOW ALL DIRECTIONS ON TRAILERS/BINS WE DO NOT ACCEPT,PLASTIC'BAGS 0F ANY KIND PLEASE UNLOAD PLASTIC.BAGS;AND PLACE RECYCLABLES LOOSELY IN A BIN ALL CLEAN BAGS', CAN BE TAKEN TO HEB OR WALMART CORRUGATED CARDBOARD MUST BE FLATTENED, CUT TO SIZE AND SEPARATED, PLACED IN CORRECT; LABELED BIN.OR DELIVERED TO MAIN LOCATION FOR BALING ALL OTHER CARDBOARD'' SUCH AS CEREAL BOXES, NEWSPAPER, PAPER, (NO SHREDDED PAPER) MAGAZINES, TIN AND ALUMINUM•CANS AND PLASTICS 1-7, (NO #6 STYROFOAM) MAYBE PLACEDIIN B'INSTOGETHER,NO MORE SORTING' REQUIRED `REMOVE ALL LIDS"ON`PLAST[C CONTAINERS ALL PLASTIC AND CANS MUST BE RINSED „ NOT FOLLOWING THESE DIRECTIONS WILL RESULT IN THE PROGRAM BEING DISCONTINUED IN YOUR COMMUNITY' FOR MORE INFO-361-552-9656 CALHOUN COUNTY, TEXAS SOLID WATTE/RECYCLING CENTER 900 LANDFILL ROAD -PORT LAVACA, TEXAS SITE OPERATION, WASTE HANDLING AND USER FEES 1. This fatility is no -longer operated as , -a landfill and the amount and type -of waste is limited. We QO NOT accept.construction, demolition or commercial waste. This facility is owned and.operated by and for the citizens of Calhoun County only. 2. HOURS OF OPERATION: Friday---8:00--5:00 Saturday --- 8:00--5,:00 Closed on all County Holidays 3. RULES FOR TRANSPORTING: All waste must be bagged or in containers for ease of unloading. Loose waste will not be accepted and must betaken to the Victoria Regional Landfill, All waste should be covered and or secured to prevent loss on roadways. 4. USM FEES,, The following fees will be charged based on the type and quantity of waste brought to this site. Charges for quantities of mixed material types will be at the highest fee. All charges will be computed by the site attendant based on the following guidelines. We do not accept debit or credit cards. Household Waste A. Compactable: Minimum fee (one 33 gal'. trash bag)......... ........................................... ........$10 Per Pickup Loads (level in FullSize ......... ......... ........ $30 Short Bed ............... ......... ....... 520, Small .......... ......... ........... .......$20 No Burn Barrels Accepted (waste must be bagged) B. Bulk Waste Couch......... .................................................... ........... .:r. .......... ........$15 Recliners ......... ......... .........$10 Mattresses (each piece) Single ......... .... ......... s$5 Queen/Double/King ......... ....:.... .......!: ....... . ;$lU Appliances! (each) Water Heaters, Washers, Dryers, Stoves, DishWashers......:. $10 Refrigerators; Freezers, AC Units (compressors removed)::.. ....$10 Tires: Call for current pricing and acceptable sizes Brush: ' Per pickup .:: ......... ......? .. .......$10 Per 16 ft. trailer ...... ......... ......... ...........$10 $20 CHANGED No stumps trunks accepted larger than 12 in: diameter No; commercial tree trimmers allowed —must use Victoria County.Brush Site, call REMOVED 361897_1500 Auto waste: Antifreeze, Filters, Motor ail, Hydraulic Oil, Auto Batteries Scrap Iron, Metals: Same as trash (does not includeappliances) COMMERCIAL BRUSH BY APPOINTMENT ONLY, CALL 361-552-9656 ADDED Accounts can be set up to be billed monthly and due within 10 days. Failure to pay within 10 days will result in loss of dumping privileges. 5ECYLING`N(TfCE:` There Will not be a charge for most recyclable items which ar_e delivered to the Recycling Center and that are separated and placed in specially marked containers for recycling. See attendant for information and instructions. Items accepted for recycling are: 1. Corrugated Cardboard 2. Food Packaging Cardboard (cereal boxes, tissue boxes, etc.) 3. Office Paper, (no shred) 4. Newspapers 5. Magazines, Catalogs 6. Tin Cans 7. Aluminum Cans S. #1-S, #7 Plastic Containers 6. WATSE MUSTSt'SEWATED INTO THE FOLLOWING CATEGOMES ' Oompactable Metals Furniture, Bedding Wire Barrels, empty and flattened only,, Automotive Brush, Yard Waste 7• PROHIBITED ITEMS: Basically any item designated by the EPA and TCEQ as "Hazardous Material" is restricted from disposal, such as: • Asbestos • Ballasts • Capacitors.. • Herbicides, Insecticides,Fungicides • Freon • PCB's,. ; -Paint • Construction, Heavy Equipment Tires Liquids • Cylinders. • Fire Extinguishers Please refer questions and comments concerning solid waste and the operation of the facility to the Precinct 2 Office, Commissioner Vern Lyssy at 361-552-9656.' FEDERAL AND STATE DIRECTIVES MANDATE THESE PROCEDURES FOR THE DISPOSAL OF SOLID WASTE. PLEASE HELP US MAINTAIN COMPLIANCE BY GIVING US YOUR SUPPORT AND COOPERATION. Calhoun County Solid Waste/Recycling Center 361-552-7791' #10 NOTICE OF MEETING — 4/20/2022 10. Consider and take necessary action to approve the Six Mile Volunteer Fire Department to apply for a Texas Forestry Grant for $20,000. (VL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 18 Vern L Calhoun County Commissioner, Precinct #2 5812 FM 1090 �J�bS�cc or rE+�N Port Lavaca, TX 77979 t J G�� yJJ Oi C� April 4, 2022 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: (361) 552-9656 Fax (361) 553-6664 Please place the following item on the next Commissioners' Court Agenda • Consider and take necessary action to approve the Six Mile Volunteer Fire Department to apply for a Texas Forestry Grant for $20,000 Sincerely, Vern Lyssy VL/Ij #11 NOTICE OF MEETING-4/20/2022 11. Public Hearing concerning a Petition to Vacate a portion of Lots 1, 2, 3, and 4, Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. (GDR) Closed meeting at 10.06 Terry Ruddick explained petition to vacate. Opened meeting at 10:08 Page 8 of 18 I I'UbI I C 11EARIf 6 '?j2U/ U: ) Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Deese, Commissioner, Precinct 4- The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, April 20, 2022 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse, 211 S. Ann Street, Sure 104, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Court will hold a Public Hearing in the Commissioners' Courtroom, 211 S. Ann Street, Suite 104, in Port Lavaca, Texas, on April 20, 2022 at 10:00 a.m. regarding a Petition to Vacate a portion of Lots 1, 2, 3, and 4, Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. This notice is in accordance with Section 111.007 and Section 111.0075 of the Texas Local Government code. I G chard H. Meyer, Co Judge Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.org under "Commissioners' Court Agenda" for any official court postings. U [LED /� , AT I_✓,pi'CLOCK_JLM APR 14 2022 Page 1 of 1 Gary D. Reese County Commissioner County of Calhoun Precinct 4 April 13, 2022 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for April 20, 2022. • Public Hearing concerning Petition to Vacate a portion of Lots 1, 2, 3, and 4 Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. Sincerely, Gary. Reese GDR/at P.O. Box 177 — Seadrift. Texas 77983 — email: earv.reesera calhouncomore — (361) 785.3141 — Fax (361) 785-5602 #12 NOTICE OF MEETING — 4/20/2022 12. Consider and take necessary action on a Petition to Vacate a portion of Lots 1, 2, 3, and 4, Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 18 Gary D. Reese County Commissioner County of Calhoun Precinct 4 April 13, 2022 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for April 20, 2022. • Consider and take necessary action on Petition to Vacate a portion of Lots 1, 2, 3, and 4 Block 154 and the adjoining six-foot wide strip of the adjacent alley in the Port O'Connor Townsite. Sincerely, Gary. Re e GDR/at P.O. Box 177 —Seadrift, Texas 77983 —email: aarv.reese a calhouncom.ore — (361) 785-3141 —Fax (361) 785-5602 • • U81 Land Surveying+Aerial Imaging aw.oi991 PETITION TO VACATE A Portion of Lots 1,2,3 & 4, Block 164 and a 6' strip of the adjoining alley, Port O'Connor Townsite THE STATE OF TEXAS} THE COUNTY OF CALHOUN) KNOW ALL MEN BY THESE PRESENTS: That the undersigned being the designated agent of the owners of the property described as Lots 1, 2, 3 and 4, Block 154 and the adjoining G' wide strip of the adjacent alley, Port O'Connor Townsite as recorded in Volume 2, Page 1 of the Deed Records of Calhoun County, Texas do hereby petition the Calhoun County Commissioner's Court to Vacate said tract of land, in accordance with Sections 206 and 207 of the Subdivision Regulations and Recreational Vehicle Park Regulations Adopted by Calhoun County Commissioner's Court on November 29, 2004 and amended on December 13, 2007. The property is proposed to be re -platted in accordance with a plat submitted to the Calhoun County Commissioner's Court. The petition will be considered by the Calhoun County Commissioner's Court on April 20, 2022 at 10:00 am TerT. Nddick, R.P.L.S. Urban Surveying, Inc. 2004 N. Commerce Victoria, TX 77901 361-578-9837 S23716.03 Victoria San Antonio Cuero 2004 N. Commerce Victoria, TX 77901 12661 Silicon Drive San Antonio, TX 78249 104 E. French Street Cuero, TX 77954 urbansurveying.com 361-578-9837 210-267-8854 361-277-9061 Firm 1/10021100 Firm it: 10193843 Firm 110021101 4 ,q N -gyp m N VACATE AND ABANDON A PORTION OF PUBLIC ROAD n IN PORT O'CONNOR, CALHOUN COUNTY, TEXAS �w A Motion was made by Commissioner Gary Reese and seconded by Commissioner Joel Behrens =� v to Vacate and Abandon a portion of a public road in Port O'Connor, Calhoun County, Texas as a shown on the following Order with exhibits attached. Commissioners Hall, Lyssy, Behrens and Reese voted in favor of the motion. ORDER DECLARING CLOSURE OF A PORTION OF PUBLIC ROAD IN PORT O'CONNOR, CALHOUN COUNTY, TEXAS WHEREAS, on the 2151 day of July, 2021, the Commissioner's Court of Calhoun County, Texas considered the request of Harry P. Pond and Ritchey H. Pond, in their respective capacities as the Independent Co -Executors of the Estate of Gladys Carolyn Pond, Deceased, being property the owner in Precinct 4 of Calhoun County, Texas, to abandon and vacate the following portion of a public road in Port O'Connor, Calhoun County, Texas more fully hereinafter described and as shown on Exhibit "A" which is attached to this order and incorporated by reference. WHEREAS, Texas Transportation Code §251.051 vest in the Commissioner's Court the authority to abandon and vacate a portion of the road; and WHEREAS, the Commissioners have not previously classified the subject road as either a first class or second class road; and WHEREAS, the Commissioner's actions to abandon or vacate the road have not been enjoined or sought to be enjoined by any party; and WHEREAS, proper notice of the petition to abandon and vacate the road has been posted at the Courthouse door of Calhoun County, Texas and at other places in the vicinity of the affected route, being at the mail box station in Port O'Connor, Texas and on the property at the 1 portion of the road to be abandoned and vacated, for at least twenty (20) days before the date the application was made to the Court; and WHEREAS, the Commissioners have voted unanimously to abandon and vacate the portion of the road described on the attached Exhibit "A"; and WHEREAS, all requirements of Texas Transportation Code §251.051 and §251.052 have been complied with in declaring said road to be abandoned and vacated. NOW, THEREFORE, ON MOTION DULY MADE BY Commissioner Gary Reese and SECONDED by Commissioner Joel Behrens, and upon said Motion having been approved by the Commissioner's Court in a properly posted public meeting; IT IS ORDERED AND DECREED, that Calhoun County does hereby CLOSE, ABANDON and VACATE that portion of road described on the attached Exhibit "A IT IS FURTHER ORDERED AND DECREED that on the date this Order is signed, title to the portion of road closed by this Order is vested in Harry P. Pond and Ritchey H. Pond, in their respective capacities as the Independent Co -Executors of the Estate of Gladys Carolyn Pond, Deceased, the owner of the property that abuts the portion of the closed road, pursuant to Texas Transportation Code §251.058(b). IT IS FURTHER ORDERED AND DECREED that a copy of this Order is to be filed in the Official Records of Calhoun County, Texas and a duly filed copy of the Order shall serve as the official instrument of conveyance of the closed portion of the road, Port O'Connor, Calhoun County, Texas from CALHOUN COUNTY to the respective owners of the abutting property as set forth hereinabove, pursuant to Texas Transportation Code §251.058(b). EFFECTIVE the 215t day of July, 2021. 2 ATTESTED TO BY: ANNA GOODMAN CALHOUN COUNTY CLERK ... 'I i 1. CALHOUN COUNTY, TEXAS H NORABLE RICHA MEYER, CALHOUN COUNTY JUDGE Deputy Clerk 0.015 ACRES THE STATE OF TEXAS) THE COUNTY OF CALHOUN) BEING a 0.015 acre tract of land situated in the Townsite of Port O'Connor, Calhoun County, Texas out of Block 154 and being a portion of a 20-foot Alley as part of the Port O'Connor Townsite according to the established map or plat thereof as recorded in Volume 2, Page 001 of the Deed Records, Calhoun County, Texas, said 0.015 acre tract being more particularly described by metes and bounds as follows: BEGINNING at a found 5/8" steel rebar with yellow plastic cap stamped "URBAN SURVEYING, INC." along the southeast line of the aforesaid 20-foot Alley marking a common corner between Lots 4 & 5, Block 154 of the aforesaid Port O'Connor Townsite and being the west corner of that certain tract of land described by Instrument to Gladys Carolyn Pond as recorded in Instrument No. 2020-01071 of the Official Public Records, Calhoun County, Texas for the south corner of the herein described tract; THENCE, North 26`36'24" West, over and into said 20-toot Alley, a distance of 6.50 feet to a point marking the west corner of the herein described tract; THENCE, North 63"22'00" East, continuing across said 20-foot Alley, a distance of 101.18 feet to a point along the southwest line of Park Avenue (a 60-foot Right -of -Way) marking the north corner of the herein described tract; THENCE, South 26*08'43" East, along the southwest right-of-way line of said Park Avenue, a distance of 6.50 feet to a point marking the north corner of Lot 1, Block 154 of said Port O'Connor Townsite and being the north corner of the aforementioned Pond Tract for the east corner of the herein described tract; THENCE, South 63°22'00" West, along the southeast line of said 20-foot Alley, with the northwest line of said Pond Tract, a distance of 101.13 feet to the POINT OF BEGINNING, CONTAINING within these metes and bounds a 0.015 acre tract of land, more or less. Basis of Bearing is based an Subdivision Plat recorded in Volume 2, Page 1 of the Deed Records, Calhoun County, Texas. The foregoing legal description and accompanying survey plat were prepared from an actual survey made on the ground under my supervision in May, 2021 and are true and correct to the best of my knowledge and belief. "'� —1 05/25/2021 Urban Surveying, Inc. By: Michael K. Williams Registered Professional Land Surveyor Texas No. 6616 S23716.01 EXHIBIT .V ,A„ a Page 1 EXHIBIT �La BEING A 0.015 ACRE TRACT OF LAND SITUATED IN THE TOWNSITE OF PORT SITE O'CONNOR, CALHOUN COUNTY, TEXAS OUT OF BLOCK 154 AND BEING A cE £ PORTION OF A 20-FOOT ALLEY AS PART OF THE PORT O'CONNOR TOWNSITE ACCORDING TO THE ESTABLISHED MAP OR PLAT THEREOF AS RECORDED IN VOLUME 2, PAGE 001 OF THE DEED RECORDS, CALHOUN COUNTY, TEXAS. z � M � LEGEND -G, PORT PP O'CONNOR me wfl e. lmn,In mPI.K. VICINITY MAP PX2E • FOUNDWDISELRE6AR m wATERvuvE 0 µwxDl£ \ SS PMYCXPOLE """"""""' A➢PROMMAULDGiIDNOF ILDPP.S FSR 5 26'OB'43" E mLL CLm6xEeDIRECTRIC "usI^ 6.50' IN pD'oo'oD" E 0,001 66cORD 6EARwD 6DIsrucE ' END. 1J AIS PIPE w 0. WV 6-$2'1, �011 q FSR -0 qd0 �� RESIDENCE WOOD DEL% "'T'' s y� 5 63 OVER CONCRETE NO. �- 2D METALe PIPE 'BENT' 'f FSR SHED '+ \ ✓ ¢ N� "yam TG o N 26'36'24" W "usl"PP A, f E : 6.50' a ' ° 'F. : cONCP LOT 2 POINT OF � d 5 J BEGINNING WARRANTY D LOT 1 V,35 PANEL CORRECTION SPECIAL POND DEED BOX HARRY P. POND JR. METAL '� TO PP • SHED ° GIADTS LAflDLVN POND \ END END. AY✓ LOTS 1. T 3 AND 4 BLOL. 1. PIPE PIPE 6 O\ \ INSTRDMEM PUBLIC ibJU OFFICIAL PUBUC COUNTY TEXAS, y CALH MAR 2.20 TEAS Of P MAR 12 2020 \ LO mW.a aR LOT 4$ °�\ LOT 3 g'? (SHADX ED) LOT 5 HE WOODEN DECK B L 0 C K 1 5 4 $$ AE G oN� E1 FSR fX@p4 NYLOOO Tip(nl' CWQ 4J"D 14TiG9�: uU'6 O/OC TMlM7G Kp OG�@ Laub I IN190 CV16 rawlnN"bo.6in 69M1.L1 um (ccwGRT "F 4ffm�l EA'MLa PANEL NOTE EST USI' ME SURVEY WAS COMPLETED WITHOUT THE BENEFIT OF AN ABSTRACT OF TITLE. THERE MAY BE BASEMENTS, OR OTHER / MATTERS, NOT SHOWN. Oi'C BASIS OF BEARING IS BASED ON PLAT RECORDED IN VOLUME 2, PAGE OI. DEED RECORpS, CALHOUN OUN CWNTT, TE%A5, THE ABOVE PLAT AND ACCOMPANYING LEGAL DESCRIPTION WERE PREPARED FROM AN ACTUAL SURVEY MADE ON THE GROUND UNDER MY SUPERVISION IN MAY, 2021 AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. 15 SIGNED: � 05125/2021 BY: MICHAEL K. WILLIAMS REGISTERED PROFESSIONAL LAND SURVEYOR TEXAS No. 6616 A A GRAPHIC SCALE IN FEET Land Surveying+Aerial Imaging A.TE%AS (361)579AB3T FIRMM I� TEXAS (36n 27IA061 FIRM AI rONIOL TEXAS (21malff-IISM FIRM a1 DRAWN BY: MKW JOB NO.: S23716.01 60 "AR Page 2 Applicaxnts, Marry P. pond, .Tr; and Ritchey H. Pond, in their respective capacities as the Independent co -Executors of the Estate of Gladys Carolyn Pond, Deceased, said instate being the owner of the xeul property described. as Lot$ 0110 (a,), TWO (A Three (s), and Vour (4.)) in Block One Hundred FMY Four (154), of the Port O'Connor Townaite, to Calhoun, County, Texas, According to the plat of said Townsite of Record in Volume x, Page 00,1, of the Dead Records ofCalhoun CountyTekas,andincludingalliuiprovemento situated thereon, hereby petition the Comrnissioner'a Court to abandon the NlOw%g portion of certain designated public rondin said county pursuant to Texas Transportation Code section 251.05b to --wit: All of that certain tract or parcel of land belnB a 0.01.5 acre truer of land situated In the Townsite of Port: O'Connor, Calhoun County, Texas, out of Block i f,4 and being a portion of a 20xi'ocat alley as part of the port O'Connor Townsite according to the established map or plat thereof as recorded in 'Volume 2, Page oox, of the Deed Records of Calboun Alt of that Certain tract or parcel of land being a 0.015 acre tract of land situated in the Townsite of port O'Connor, Calboun County, Texas, out of Block 184 and being a portion of a 20-focat alley aff part of the Dort O'Connor Townsite according to the established map or plat thereof as recorded in 'Volume 2, Page 0017 of the heed Records of Calhoun Couxxty, Texas. This o.ot5 acm tract of 14nd is more particularly describedbymetes andbounds on the attached FAtbit "A." t. In support hereof, the undersigned parties, Harry P. Pond, Jr. and Ritchey H. Pond, in their ,respective mpacities as the Independent co- Ecutors of the Pstate of Gladys Carolyn Pond, Deceased, said Estate being the owner ofthe real property described as We One (t), Two (2), Three (a), and Dour (41 in Block One. Hundred Fifty -Four (164), of the Port O'Commor TownsitEs, In Calhoun County, Texas, According to. the Plat of Said Townsite ofRerrd ixt Volume 24 Page ool, ofthe Heed ittuvanis of Calhoun County, Texas, will show the Court that: Pi' W WHEREFOR& the undetar$aedpardat Harry P, pond, Jr. and Ritchey R. Pond, in their Na rive capacities as the TWo poudeat co -Executors of the Wisto of Gladys Carolyn : iAaceased, odd Enste bob* the owner of the real pa+op0rW4j oribret as law One (tX Two (gb't'hmo Wt and trour(4), in Block One Huadrod F*-Fstrr ("40 of the .tort Manor'Ibwneit% in Calhoun County, Texas, AmalimS to the plat of Said Townsite of Record iu V01ut00 Er Page 001, of the Deed Ards of Calhoun C aunty# Tamer tomy that, after pm"r nottm of this petition to abandon tits following portion of a, pertain roadway in said 0001tly putsaent to Texas T�importation Code sections agt.ost .dud atyt.oB2 has been posted at the Courthouse door of Calhoun Coe Wo Texas, and, at other places in the vicinity of the aff ided route and on thesiteof the portion of the road to bo abandonedes required bylaw, thattWoRonorabloOmminionWoCourtentoranorderabandoaing that portion of the road desafmd above, to the Applitants, pursuant to sections 281.051 and 2M,08e of the Texas Tcaupportatian Code. 8. Consider and take necessary action to abandon a 0,015-arse tract of land situated in the Tnwnsite of Port O'Connor, Calhoun County, Texas, out of Block 154 and being a portion of a 20-foot alley as part of the Port O'Connor Townsite aaccoNing to the established map or plat thereof as recorded in Volume 21 Page Opt, of the Deed Records of Calhoun County, Texas. (OR) RESULT: APPROVED JUNANIMOt$S] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Mall, Lyssy, Behrens, Reese #13 NOTICE OF MEETING — 4/20/2022 13. Consider and take necessary action to award the bid for Rebid — Lane Road Drainage Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. B-1. Scott Mason explained the rebid and the Court awarded the bid to 71116 Services LLC. 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 18 Gary D. Reese County Commissioner County of Calhoun Precinct 4 April 13, 2022 Honorable Richard Meyer Calhoun County judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear judge Meyer: Please place the following item on the Commissioners' Court Agenda for April 20, 2022. • Consider and take necessary action to award the bid for Rebid - Lane Road Drainage Improvements for Calhoun County, Texas under Texas General Land Office Contract No. 20-065-064-C162 and Calhoun County 2020 CDBG-DR Contract Work Order No. B-1. Sincerely, Gary D. Reese GDR/at P.O. Box 177 — Seadrift. Texas 77983 — email: ggrv.rces01calhmmcou.oM — (361) 7853141 — Fax (361) 785.5602 B 8 8 S 4 8 S g a 8 8 8 8 $ $ 1 y W y Y� 2 8 8 8 0 0S S S S O 8 y ? O 0 N ryo g0 yO cam w 8 8 80. 0. 0 08 8 8 E �Z 8 8 8 8 a x= 8 8 8 8 8 8$ e ;N s s 81 8 8 8 8 E 8 8$ $ Ow Os n$ 8. 8 8 8 8 8 8 8 s. 9N S o J 0 o g 0 8 e N a o v 0 s s s s m s a c U V� si N 2 h w 8 8 8 y 8 8 4� 0 0 $ a z � a 9 9 q gg E x S g6 2P v E e w a a a a a w m mm fi F i a w m a cN� dS� �3d 33� U�S Yf � 8 8 8o N» m R M S Ogg ¢5 g 8 o a o 0 0 0 0 0 0 0 _ � w �e4 8 8 8 S 8 8 0 8 8 8 o o R S S$ A 8d d5 h § o $ S S $ V O 2 � 0 8 o o S S 8 8 8 8o »» m S S S S e o0 o S S 8 8 a 8 8 R $ 8 W 8 z "�- N0 0 m0& - Ew 'a, o0 o 8 8 $. S S^ S S 8 8 S S 8 8 o 0$ a 0 8 = aOl t JA w o 0 o a 8 8 p 8» 4 0 8 r. S n a z a j N a q v_ 3 8 B Q _ 5 a 2 'p�E s W 622'0 O v 5 i 5 B� a 9 2� 6� 4I�zY" 4 '8 5 m IYs rc 3 ac a�. S m g a wz `¢ a wu a a aI Is a a a aI a fga 8 8 S 8 8 S d 8 6 U O YH � « w w fr 8 8 8 v s ea 8 y � � 8 � F 8 J c z 7 0 0 0 N w 8 8 8 8 o fr h 0 0 0 y¢ 5 Y z « x « 0 o m n o P- S n asp" s 2 a s 8 8 8 8 z g g E a �L z � S a � J 0 gg g a g y y O o _ o fZ �A -z S. S.A 8 8 3$ S 8 S E � J O 8 S y rv_ w w w $fr I g o S M g " x � � a 8 T-12- o a o g g 8 �R 8 g m E « w < n w n H a 8 s 8 B 80 o o a m x o c g 0 0 0 0 o a 8 o g 8 g w � S � 8 8 E o < w o w � 0 z o _ U 7.1 5 E m a Q a m m @ F2 N 0 y�2 U N p O O g O O O m N } } Y > ) ) ) > Y } ! ! } } ! yob m J `y photo Imhof Y >a Y>>> C .y2 Aspy 1� $ o m m OdN d pilots "v '° > ) ) > ) Y > ) m Vi K � f9 A f9 U w E g $ o o C {ap �e`+ o m vmOi o fO o ry a v v m m v N N u v a a i v v a i a J w w 0 0 u E ^d O P N m N 08. O � U e a o a 9 a � K QQ m 0 0 0 p 6 6 6 U U N U ',E a O 9 rri U g K d G&WENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)552-4509 • f: (361)552-4987 TBPE Firm Registration No. F04188 April 13, 2022 Commissioner Gary Reese Calhoun County Precinct No. 4 361.785.3141 RE: LETTER OF RECOMMENDATION REBID - Lane Road Drainage Improvements for Calhoun County, Texas Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. B-1 Dear Honorable Judge & County Commissioners, Bids for construction of the above referenced project were received at the County Judge's office until 2:00:00 p.m, Thursday, March 31, 2022, at which time Bids were publicly opened and read aloud. The enclosed Bid Opening Table and Bid Itemized Table indicate there were a total of six (6) bidders submitting bids with the "Apparent Low Bidder" being JRB Services LLC. We have not had the privilege of working with this company but based on our research they appear to be qualified and capable of performing the required work. Therefore, we recommend that the Construction Contract be awarded to JRB Services LLC for the low bid amount of being the Base Bid plus Option A, Option B and Option C with the acceptance of the 1295 as submitted JRB Services LLC and to be corrected by JRB Services LLC prior to contract execution. If the County concurs with this recommendation, and upon your direction, we will prepare a Construction Contract package immediately and deliver it to JRB Services LLC for processing. Please call me @ (361) 552-4509 if you have any questions. Sincerely, G & W Engineers, Inc. Scott P. Mason, P.E. Enclosures: Bid Opening Table & Bid Itemized Table cc: Katy Sellers — Grant Admin, KSBR file 5310.011b Engineering Consulting 0 Planning Surveying JRB SERVICES LLC RE -BID LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 CONTRACT DOCUMENTS FOR THE REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-C182 and CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 FEBRUARY 2022 This project is hnded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The fiords have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program. v oc rr ENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • 361-552-4509 SET NO. CONTRACT. DOCUMENTS U191M TMo REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-C182 and CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 FEBRUARY 2022 This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of I -lousing and Urban Development through the Community Development Block Grant Disaster Relief Program. Prepared by: G & W ENGINEERS, INC. 205 WEST LIVE OAK PORT LAVACA, TEXAS 77979 (361)552-4509 Approved By: G & W Engince's, Inc. Scott P. Mason, P.E. Texas Registered Engineering Firm F-04188 Texas Serial No. 127893 Project No. 5310.011b Date: l),7, Its, -,'�_ TABLE OF CONTENTS 00020 Invitation to Bid 00120 Instructions to Bidders CONTRACT FORMS: 00300 Bid 00410 Bid Bond Required with Bid Submittal • Affidavit • Certificate of Interested Parties, Form 1295 • System for Award Management — (sam.gov) Certification Regarding Debarment & Suspension and Other Responsibility Matters Certification Regarding Lobbying Disclosure of Lobbying Activities Conflict of Interest Questionnaire, Form CIQ • House Bill 89 Verification • Residence Certification • GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 • Document No. 00416 - Noncollusion Affidavit • Document No. 00420 — Bidder Qualification Statement • Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations 00412 Certifications Forms to be submitted with the executed Contract • Assurances — Construction Programs • Document No. 00415 — Contractor's Corporate Resolution • Document No. 00417 - Trench Safety Systems Indemnity Agreement • Document No. 00430 - Contractor's Local Opportunity Plan • Document No. 00440 - Contractor's Subcontract/Workforce Breakdown • Section 504 Certification —Policy of Nondiscrimination on basis of Disability • Concerning Labor Standards and Prevailing Wage Rate Requirements 00500 Agreement Between Owner and Contractor • Contract Provisions • General Affirmations • Nonexclusive List of Applicable Laws, Rules, and Regulations Section 3 Clause 00510 Attorney's Review Certification 00610 Construction Performance Bond 00620 Construction Payment Bond CONDITIONS OF THE CONTRACT: 00700 General Conditions of the Construction Contract 00705 Calhoun County General Conditions 00810 Supplementary Conditions 00820 Bond and Insurance Requirements 00821 Project Requirements 00824 Specific Requirements 00825 Federal Labor Standards Provisions & Title 29: Labor 00830 Prevailing Wage Rates (TX20220045) Page 1 of 2 5310.011 b TECHNICAL SPECIFICATIONS: DIVISION 1- GENERAL REOUIREMENTS: 01025 Application for Payment Requirements 01340 Shop Drawings, Product Data, and Samples 01410 Inspection, Testing, and Guarantee 01500 Temporary Facilities 01525 Trench Excavation Safety Requirements 01700 Contract Closeout Requirements DIVISION 2 - SITE WORK: 02050 Demolition 02110 Clearing and Finish Grading 02200 Pipe Trench Earthwork 02202 Trenching and Backfilling 02500 Concrete Pavement 02505 Gravel Surfaced Areas 02507 Crushed Limestone Area 02508 Cement Stabilized Shell Base 02512 Asphaltic Concrete Pavement 02575 Surface Replacement 02720 Storm Sewer Concrete Pipe/Box Culverts 02725 Storm Sewer Corrugated Polyethylene Pipe 02845 Site Signage 02921 Hydro -Mulch Seeding DIVISION 3 - CONCRETE: 03100 Concrete Formwork 03200 Concrete Reinforcement 03300 Cast -In -Place Concrete 03342 Finishing, Quality Control, and Tolerances END OF TABLE Page 2 of 2 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive bids for: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Disaster Relief Grant Program. Bids shall be for the furnishing of all labor, materials, equipment, plant and superintendence, for performing the Work for the installation of approximately 24,953 LF of drainage channel ditches, 1782, LF of storm sewer pipe, 350 CY of rock rip -rap, and reconstruction of gravel roads all in accordance with the Plans and Specifications. Specified Work is set out in Document No. 00300 of these Contract Documents. Bid documents may be examined at Calhoun County Auditor's Office, Courthouse Annex II, 202 S. Ann St, Suite B, Port Lavaca, TX or G&W Engineers, Inc. at 205 W. Live Oak, Port Lavaca, TX and obtained from www.CivcastUSA.com. There is no charge to view or download the documents. Addendums and other announcements will be distributed via CivCastUSA to all plan holders. A Pre -Bid Meeting shall be held at 10:00 am, Thursday, March 10, 2022 at the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Texas. All plan holders and/or potential Bidders are STRONGLY urged to attend. Social distancing and masks will be required. SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, MARCH 31, 2022. At that time, all bids will be publicly opened and read aloud at the County Judge's office in the Calhoun County Courthouse at 211 South Ann Street, 3`d Floor, Suite, 301, Port Lavaca, Texas. All bids must be delivered (one original unbound bid and three unbound copies) to the Office of the Calhoun County Judge in a sealed 9x12 or larger envelope and clearly marked REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. Calhoun County does not accept faxed or emailed bids. Any bids received after the due date and time will be returned unopened. Sealed bids may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, I'd Floor, Suite 301 Port Lavaca, TX 77979 00020-1 The Award of the Construction Contract, which is anticipated to be within sixty (60) calendar days of the Bid Date specified above, shall be made to the responsible Bidder submitting the lowest, qualified, acceptable Bid who, in the opinion of CALHOUN COUNTY, offers the Bid in the best interest of the County. All contractors/subcontractors that are debarred, suspended or otherwise excluded from or ineligible for participation on federal assistance programs may not undertake any activity in part or in full under this project. A Bid Bond in the amount of 5% of the greatest amount bid, issued by an acceptable surety, shall be submitted with each bid. A certified check payable to CALHOUN COUNTY, TEXAS may be submitted in lieu of the Bid Bond. Attention is called to the fact that not less than, the federally determined prevailing (Davis -Bacon and Related Acts) wage rate, as issued by the Department of Labor and contained in the contract documents, must be paid on this project. In addition, the successful bidder must ensure that employees and applicants for employment are not discriminated against because of race, color, religion, sex, sexual identity, gender identity, or national origin. Adherence to the grant recipient's Section 3 Policy is required for contracts and subcontracts in excess of $100,000.00. Commissioners Court reserves the right to waive any formality or irregularity, reject any or all bids and to accept the bid deemed most advantageous to CALHOUN COUNTY. CALHOUN COUNTY, TEXAS is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit bids. Cindy Mueller, County Auditor Calhoun County, Texas END OF DOCUMENT 00020-2 DOCUMENT NO.00120 INSTRUCTIONS TO BIDDERS .01 DEFINED TERMS: Terms used in these Instructions to Bidders, which are defined in the General Conditions of these Specifications, have the meanings assigned to them in the General Conditions. Certain additional terms used in these Instructions to Bidders have the meanings indicated below which are applicable to both the singular and plural thereof. a. OWNER Whenever the term "OWNER" is used in these Specifications, it shall be construed to mean CALHOUN COUNTY. b. ENGINEER Whenever the term "ENGINEER" is used in these Specifications, it shall be construed to mean G & W ENGINEERS, INC. C. BIDDER Whenever the term "BIDDER" is used in these Specifications, it shall mean anyone who submits a BID directly to OWNER as distinct from a sub -bidder, who submits a BID to a BIDDER. d. Successful BIDDER Whenever the term "Successful BIDDER" is used in these Specifications, it shall be construed to mean the lowest, responsible and responsive BIDDER to whom OWNER (on the basis of OWNER's evaluation as hereinafter provided) makes an award. e. WORK Whenever the term "Work" is used in these Specifications, it shall be construed to mean the Item(s) set out in Document No. 00300 of these Contract Documents. .02 COPIES OF BIDDING DOCUMENTS: a. Complete sets of the Bidding Documents in the number and for the purchase price, if any, stated in the Advertisement or Invitation to Bid may be obtained from ENGINEER only. b. Complete sets of Bidding Documents must be used in preparing Bids. Neither OWNER nor ENGINEER assume any responsibility for errors or misinterpretations resulting from the use of incomplete sets of Bidding Documents. 00120-1 C. ENGINEER, in malting copies of Bidding Documents available on the above terms, does so only for the purpose of obtaining BIDS for the Work and does not confer a license or grant for any other use. .03 QUALIFICATIONS OF BIDDERS: To demonstrate qualifications to perform the Work, each BIDDER must be prepared to submit within five days after Bid Opening, upon OWNER'S request, detailed written evidence such as financial data, previous experience, present commitments and other such data as may be called for below. Each BID must contain evidence of BIDDER's qualification to do business in the state where the Project is located or covenant to obtain such qualification prior to award of the contract. .04 EXAMINATION OF CONTRACT DOCUMENTS AND SITE: a. It is the responsibility of each BIDDER before submitting a BID to do the following. 1. Examine thoroughly the Contract Documents and other related data identified in the Bidding Documents (including "technical data" referred to below). 2. Visit the site to become familiar with and satisfy BIDDER as to the General, local and site conditions that may affect cost, progress, performance or famishing of the Work. 3. Consider federal, state and local Laws and Regulations that may affect cost, progress, performance or furnishing of the Work. 4. Study and carefully correlate BIDDER's knowledge and observations with the Contract Documents and such other related data. 5. Promptly notify ENGINEER of all conflicts, errors, ambiguities or discrepancies which BIDDER has discovered in or between the Contract Documents and such other related documents. If discrepancies and/or inconsistencies exist between the Specifications and the Drawings, the Specifications shall govern unless otherwise noted on the Drawings. b. Refer to the Supplementary Conditions for identification of the following. 1. Reports of explorations and tests of subsurface conditions at or contiguous to the site which have been utilized by ENGINEER in preparation of the Contract Documents. BIDDER may rely upon the general accuracy of the "technical data" contained in such reports but not upon other data, interpretations, opinions or information contained in such reports or otherwise relating to the subsurface conditions at the site, nor upon the completeness thereof for the purposes of bidding or construction. 00120-2 2. Drawings of physical conditions in or relating to existing surface and subsurface structures (except underground facilities) which are at or contiguous to the site that have been utilized by ENGINEER in preparation of the Contract Documents. BIDDER may rely upon the general accuracy of the "technical data" contained in such drawings but not upon other data, interpretations, opinions or information shown or indicated in such drawings or otherwise relating to such structures, nor upon the completeness thereof for the purposes of bidding or construction. Copies of such reports and drawings will be made available by OWNER to BIDDER on request. Those reports and drawings are not part of the Contract Documents, but the "technical data" contained therein upon which BIDDER is entitled to rely as provided in Paragraph 4.02.A of the General Conditions has been identified and established in the Supplementary Conditions. BIDDER is responsible for any interpretation or conclusion drawn from any "technical data" or any such data, interpretations, opinions or information. C. Information and data shown or indicated in the Contract Documents with respect to existing Underground Facilities at or contiguous to the site is based upon information and data furnished to OWNER and ENGINEER by owners of such underground facilities or others, and OWNER and ENGINEER do not assume responsibility for the accuracy or completeness thereof unless it is expressly provided otherwise in the Supplementary Conditions. d. Provisions concerning responsibilities for the adequacy of data furnished to prospective BIDDERS with respect to subsurface conditions, other physical conditions and Underground Facilities, and possible changes in the Contract Documents due to differing or unanticipated conditions appear in Paragraphs 4.02, 4.03 and 4.04 of the General Conditions. C. Before submitting a BID each BIDDER will be responsible to obtain such additional or supplementary examinations, investigations, explorations, tests, studies and data concerning conditions (surface, subsurface and underground facilities) at or contiguous to the site or otherwise, which may affect cost, progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences or procedures of construction to be employed by BIDDER and safety precautions and programs incident thereto or which BIDDER deems necessary to determine its BID for performing and furnishing the Work in accordance with the time, price and other terms and conditions of the Contract Documents. f. On request, OWNER will provide each BIDDER access to the site to conduct such examinations, investigations, explorations, tests and studies as each BIDDER deems necessary for submission of a BID. BIDDER must fill all holes and clean up and restore the site to its former conditions upon completion of such explorations, investigations, tests and studies. 00120-3 g. Reference is made to the Supplementary Conditions for the identification of the general nature of work that is to be performed at the site by OWNER or others (such as utilities and other prime contractors) that relates to the work for which a BID is to be submitted. On request, OWNER will provide to each BIDDER for examination access to or copies of Contract Documents (other than portions thereof related to price) for such work. h. The submission of a BID will constitute an incontrovertible representation by BIDDER that BIDDER has complied with every requirement of this Article 4, that without exception the BID is premised upon performing and furnishing the Work required by the Contract Documents and applying the specific means, methods, techniques, sequences or procedure of construction that may be shown or indicated or expressly required by the Contract Documents, that BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities and discrepancies that BIDDER has discovered in the Contract Documents and the written resolutions thereof by ENGINEER is acceptable to BIDDER, and that the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performing and furnishing the Work. .05 AVAILABILITY OF LANDS FOR WORK, ETC.: The lands upon which the Work is to be performed, rights -of -way and easements for access thereto and other lands designated for use by CONTRACTOR in performing the Work are identified in the Contract Documents. All additional lands and access thereto required for temporary construction facilities, construction equipment or storage of material and equipment to be incorporated in the Work are to be obtained and paid for by CONTRACTOR. Easements for permanent structures or permanent changes in existing facilities are to be obtained and paid for by OWNER unless otherwise provided in the Contract Documents. .06 INTERPRETATIONS AND ADDENDA: a. All questions about the meaning or intent of the Bidding Documents are to be submitted to the ENGINEER IN WRITING and must be received in the office of the ENGINEER no later than 5:00 pm on March 22, 2022. Such questions may be submitted by facsimile (361-552-4987) or email (smason c ,gwen<?ineers.com). It is the Bidder's responsibility to verify receipt of such questions by the ENGINEER. Interpretations or clarifications considered necessary by ENGINEER in response to such questions will be issued by Addenda mailed or otherwise delivered to all parties recorded by ENGINEER as having received the Bidding Documents. b. Addenda may also be issued to modify the Bidding Documents as deemed advisable by OWNER or ENGINEER. C. Any oral and other interpretations or clarifications provided by ENGINEER or OWNER at the pre -bid meeting will be without legal effect until a formal written Addenda is issued by ENGINEER. 00120-4 .07 BID SECURITY: a. Each BID must be accompanied by Bid Security made payable to OWNER in an amount of five percent of BIDDER's maximum Bid Price and in the form of a certified check or a Bid Bond (on form attached) issued by a surety meeting the requirements of Paragraph 5.0I.13 of the General Conditions. Power -of -Attorney for person signing for surety must be attached to Bid Bond. b. The Bid Security of Successful BIDDER will be retained until such BIDDER has executed the Agreement, furnished the required contract security and met the other conditions of the Notice of Award, whereupon the Bid Security will be returned. If the Successful BIDDER fails to execute and deliver the Agreement and furnish the required contract security within fifteen days after the Notice of Award, OWNER may annul the Notice of Award and the Bid Security of that BIDDER will be forfeited. The Bid Security of other BIDDERS whom OWNER believes to have a reasonable chance of receiving the award may be retained by OWNER until the earlier of the seventh day after the Effective Date of the Agreement or the sixtieth day after the Bid Opening, whereupon Bid Security furnished by such BIDDERS will be returned. Bid Security with BIDS which are not competitive may be returned within seven days after the Bid Opening. .08 CONTRACT TIMES: The term "Contract Times" is defined in Paragraph 1.0l.A.14 of the General Conditions. The number of days within which, or the dates by which, the Work is to be completed and ready for final payment are set forth in the Agreement (or incorporated therein by reference to the attached Bid). .09 LIQUIDATED DAMAGES: Provisions for liquidated damages, if any, are set forth in the Agreement. 10 SUBSTITUTE AND "OR -EQUAL" ITEMS: The Contract, if awarded, will be on the basis of materials and equipment described in the Contract Drawings or specified in these Specifications with consideration of possible substitute or "or -equal" items. Whenever it is indicated in the Contract Drawings or specified in these Specifications that a substitute or "or -equal" item of material or equipment may be ftirnished or used by CONTRACTOR, if acceptable to ENGINEER, application for such acceptance will not be considered by ENGINEER until after the Effective date of the Agreement. The procedure for submission of any such application by CONTRACTOR and consideration by ENGINEER is set forth in Paragraphs 6.05 of the General Conditions and may be supplemented in the General Requirements. 00120-5 .11 SUBCONTRACTORS, SUPPLIERS AND OTHERS: a. If the Supplementary Conditions require the identity of certain Subcontractors, Suppliers and other persons and organizations (including those who are to furnish the principal items of material and equipment) to be submitted to OWNER in advance of specified date prior to the Effective Date of the Agreement, apparent Successful BIDDER, and any other BIDDER so requested, shall within five days after Bid Opening submit to OWNER a list of all such Subcontractors, Suppliers and other persons and organizations proposed for those portions of the Work for which such identification is required. Such list shall be accompanied by an experience statement with pertinent information regarding similar projects and other evidence of qualification for each such Subcontractor, Supplier, person or organization if requested by OWNER. OWNER or ENGINEER, who after due investigation, has reasonable objection to any proposed Subcontractor, Supplier, other person or organization, may before the Notice of Award is given request apparent Successful BIDDER to submit an acceptable substitute without an increase in Bid Price. If apparent Successful BIDDER declines to make any such substitution, OWNER may award the contract to the next lowest BIDDER that proposes to use acceptable Subcontractors, Suppliers and other persons and organizations. The declining to make requested substitutions will not constitute grounds for sacrificing the Bid Security of any BIDDER. Any Subcontractor, Supplier, other person or organization listed and to whom OWNER or ENGINEER does not make written objection prior to the giving of the notice of Award will be deemed acceptable to OWNER and ENGINEER subject to revocation of such acceptance after the Effective Date of the Agreement as provided in Paragraph 6.06 of the General Conditions. In contracts where the Contract Price is on the basis of Cost -of -the -Work Plus a Fee, apparent successful BIDDER, prior to the Notice of Award, shall identify in writing to OWNER those portions of the Work that such BIDDER proposes to subcontract and after the Notice of Award may only subcontract other portions of the Work with OWNER's written consent. C. CONTRACTOR shall not be required to employ any Subcontractor, Supplier, other person or organization against whom CONTRACTOR has reasonable objection. .12 BID FORM: a. The Bid Form is included with the Bidding Documents. Additional copies may be obtained from ENGINEER. b. All blanks on the Bid Form must be completed by printing in irk or by typewriter C. BIDS by corporations must be executed in the corporate name by the president or a vice-president (or other corporate officer accompanied by evidence of authority to sign) and attested by the secretary or an assistant secretary. Authorization of this person to sign for corporation shall be evidenced by a properly executed CONTRACTOR's Corporate Resolution, the form of which is included in the Bidding Documents. The corporate address and state of incorporation must be shown below the signature. 00120-6 .13 d. BIDS by partnerships must be executed in the partnership name and signed by a partner, whose title must appear under the signature and the official address of the partnership must be shown below the signature. e. All names must be typed or printed in black ink below the signature. f The BID shall contain an acknowledgment of receipt of all Addenda (the numbers of which must be filled in on the Bid Form). g. The address and telephone number for communications regarding the BID must be shown. h. Evidence of authority to conduct business as an out-of-state corporation in the state where the Work is to be performed shall be provided in accordance with Paragraph .12 c. above. State contractor license number, if any, must also be shown. SUBMISSION OF BIDS: SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, MARCH 31, 2022. All bids must be delivered to the Office of the Calhoun County Judge in a SEALED a 9 x 12 or larger envelope and clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1, with the name and address of BIDDER, and accompanied by the Bid Security and other required documents. a. If the BID is sent through the mail or other delivery system the sealed envelope shall be enclosed in a separate envelope with the notation 'BID ENCLOSED" on the face of it. A late delivery with an early postmark will not suffice. b. The County is not responsible for the delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery, then it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid date and time. c. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the bid is received and the time the bid will be opened. The door to the County Judge's office will be closed once the due time and date has been reached and no other bids will be accepted. d. Calhoun County accepts no financial responsibility for any cost incurred by any vendor in the course of responding to these specifications. e. Faxed or e-mailed bids will NOT be accepted. f The Bidding Documents may be retained by BIDDER. An unbound copy of the Bid Form is to be completed and submitted with the Bid Security and any additional data that may be called for elsewhere in these Bidding Documents. 00120-7 .14 MODIFICATION AND WITHDRAWAL OF BIDS: a. BIDS may be modified or withdrawn by an appropriate document duly executed (in the manner that a BID must be executed) and addressed and delivered to the County Judge prior to the Bid Opening. b. If, within twenty-four hours after BIDS are opened, any BIDDER files a duly signed, written notice with OWNER and promptly thereafter demonstrated to the reasonable satisfaction of OWNER that there was a material and substantial mistake in the preparation of its BID, that BIDDER may withdraw its BID and the Bid Security will be returned. Thereafter, that BIDDER may be disqualified from further bidding on the Work to be provided under the Contract Documents. 15 OPENING OF BIDS: BIDS will be opened and (unless obviously non -responsive) read aloud publicly at the place where BIDS are to be submitted. An abstract of the amounts of the base BIDS and major alternates (if any) will be made available to BIDDERS after the opening of BIDS. .16 BIDS TO REMAIN SUBJECT TO ACCEPTANCE: All BIDS will remain subject to acceptance for sixty days after the day of the Bid Opening, but OWNER may, in its sole discretion, release any BID and return the Bid Security prior to that date. .17 AWARD OF CONTRACT: a. OWNER reserves the right to reject any or all BIDS, including without limitation the rights to reject any or all nonconforming, nonresponsive, unbalanced or conditional BIDS and to reject the BID of any BIDDER if OWNER believes that it would not be in the best interest of the Project to make an award to that BIDDER, whether because the BID is not responsive or the BIDDER is unqualified or of doubtful financial ability or fails to meet any other pertinent standard or criteria established by OWNER. OWNER also reserves the right to waive all informalities not involving price, time or changes in the Work, waive technicalities, and to negotiate contract terms with the Successful BIDDER. b. The Calhoun County Commissioners Court shall be the sole judge in determining which bid will be the most advantageous to Calhoun County. C. Discrepancies between the multiplication of units of Work and unit prices will be resolved in favor of the unit prices. Discrepancies between the indicated sum of any column of figures and the correct sum thereof will be resolved in favor of the correct sum. Discrepancies between words and figures will be resolved in favor of the words. d. In evaluating BIDS, OWNER will consider the qualifications of BIDDERS, whether or not the BIDS comply with the prescribed requirements, and such alternates, unit prices and other data, as may be requested in the Bid Form or prior to the Notice of Award. 00120-8 C. OWNER may consider the qualifications and experience of subcontractors, Suppliers, and other persons and organizations proposed for those portions of the Work as to which the identity of Subcontractors, Suppliers, and other persons and organizations must be submitted as provided in the Supplementary Conditions. OWNER also may consider the operating costs, maintenance requirements, performance data and guarantees of major items of materials and equipment proposed for incorporation in the Work when such data is required to be submitted prior to the Notice of Award. f. OWNER may conduct such investigations as OWNER deems necessary to assist in the evaluation of any BID and to establish the responsibility, qualifications and financial ability of BIDDERS, proposed Subcontractors, Suppliers and other persons and organizations to perform and furnish the Work in accordance with the Contract Documents to OWNER's satisfaction within the prescribed time. g. If the contract is to be awarded, it will be awarded to lowest BIDDER whose evaluation by OWNER indicated to OWNER that the award will be in the best interests of the Project. h. If the contract is to be awarded, OWNER will give Successful BIDDER a Notice of Award within sixty days after the day of the Bid Opening. .18 CONTRACT SECURITY: Paragraph 5.01 of the General Conditions and the Supplementary Conditions set forth OWNER's requirements as to performance, payment and other Bonds. When the Successful BIDDER delivers the executed Agreement to OWNER, it must be accompanied by the required Bonds. .19 SIGNING Or AGREEMENT: When OWNER gives a Notice of Award to the Successful BIDDER, it will be accompanied by the required number of unsigned counterparts of the Agreement with all other written Contract Documents attached. Within fifteen days thereafter CONTRACTOR shall sign and deliver the required number of counterparts of the Agreement and attached documents to OWNER with the required Bonds. Within ten days thereafter, OWNER shall deliver one fully signed counterpart to CONTRACTOR. .20 WAGES AND SALARIES: CONTRACTOR shall pay not less than the prevailing wage rates if specified in the Contract Documents. These rates are minimums to be paid during the life of the Contract. It is therefore the responsibility of the BIDDER to inform themselves as to local labor conditions. .21 00705 — CALHOUN COUNTY GENERAL CONDITIONS: Reference Document No. 00705 00120-9 .22 EQUAL EMPLOYMENT OPPORTUNITY: CONTRACTOR shall ensure that no discrimination will occur against employees and applicants for employment because of their ethnic background, gender, age, religious practice, familial status, disability, or limited English language proficiency. .23 PROJECT FUNDING: This project is fiurded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program .24 CERTIFICATE OF INTERESTED PARTIES (FORM 1295): Calhoun County Commissioners Court WILL NOT consider for action any Bid, RFP, RFQ and/or contract with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. .25 SYSTEM FOR AWARD MANAGEMENT. CONTRACTOR must not be debarred or suspended from the Excluded Parties List System (EPLS) in the System for Award Management (SAM) and must have an active registration with the System for Award Management (www.SAM.gov). Include verification that your company is registered and that the company's principal is not listed (is not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date. CONTRACTOR is responsible to verify that Subcontractors are not debarred or suspended from the Excluded Parties List System (EPLS) in the System for Award Management (SAM) and must have an active registration with the System for Award Management (www.SAM.gov). END OF DOCUMENT 00120-10 Addendum No. 2 03/28/2022 BID , hereinafter called "BIDDER", (Legal Firm Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". Terms used in this BID are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Working Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.:` Date Received: b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 Addendum No. 2 03/28/2022 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. e. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Addendum No. 2 n3/2F /2n?? BASE BID Baseline A: Station 0+00 to 145+50 Item # Item Description Quantity Unit Price Total Bid Price 1 Furnishing Mobilization and Insurance for the BASE BID project scope as per plans and 1 LS i J l)Ur� wo s ecifications 2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) for BASE BID project limits for the duration of �), (�V CO the entire project per plans andspecifications 3 Traffic control and barricading for the BASE BID 1 LS project limits for the duration of the entire project7( OU as per plans andspecifications. 4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the BASE BID project p( limits of the Base Bid and as called upon in the / drawings as per plans andspecifications 5 Regrading and digging of existing channel to a 3,300 LF bottom width of 20 feet and sloping embankment at a 4:1 slope and stockpiling spoil materials into 3 habitat mounds including labor, equipment and materials for a complete installation as per plans andspecifications 6 Regrading and digging of existing channel to a 11,080 LF bottom width of 15 feet and sloping embankment at a 3:1 slope and trucking of material to designated site including labor, equipment and materials for a complete installation as per plans ands ecifications 7 Installation of 18" diameter HDPE corrugated 44 LF storm sewer pipe, open cut, including labor, 3� W L J I /I II� 0 `j�/ equipment and materials for a complete installation as per plans andspecifications. 8 Installation of 36" diameter HDPE corrugated storm sewer pipe, open cut, including labor, 334 LF _ �'� 35 L� equipment and materials for a complete J 1 installation as per plans andspecifications. 9 Installation of 48" diameter HDPE corrugated 168 LF storm sewer pipe, open cut, including labor, S(4U uU l iA ) y j� /41/ (To I`1 equipment and materials for a complete installation as per plans andspecifications. 10 Installation of 60" diameter HDPE corrugated 240 LF storm sewer pipe, open cut, including labor, JJ 0U L equipment and materials for a complete 7 installation as perplans andspecifications. i l Installation of 8" Diameter Rock Rip -Rap, including labor, equipment and materials for a 300 CY C� �� Law w complete installation as per plans and s ecifications. CI1I111133 Addendum No. 2 03/28/2022 BASE BID CONTINUED Item # Item Description Quantity Unit Price Total Bid Price 12 Installation of 36" Diameter HDPE 22.5 Deg. 2 EA Fitting including labor, equipment and materials 5 2 for a complete installation as per plans and s ecifications. 13 Installation of 36" Diameter HDPE 45 Deg. 2 EA Fitting including labor, equipment and materials j r I� !�J boo � for a complete installation as per plans and s ecifications. 14 Installation of 36" Diameter HDPE 90 Deg. I EA Fitting including labor, equipment and materials Ii" for a complete installation as per plans and s ecifications. 15 Installation of 36" Diameter HDPE Tee V17t-ting I EA including labor, equipment and materials for a UO „,� Ip complete installation as per plans and 1CjUJ Ir s ecifications. 16 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 18" Diameter including labor, equipment and materials for a complete installation as per plans andspecifications. 17 Reconstruction of existing gravel/limestone 135 SY roadway including labor, equipment and materials for a complete installation as per plans and s ecifications. 18 Hydromulch seeding of excavated and disturbed areas including labor, equipment and materials for 12 AC a complete installation as per plans andspecs. TOTAL BASE BID J $✓ J I v gJ TOTAL BASE BID CALENDAR DAYS 100 BASE BID DEDUCTION Item # Item Description Quantity Unit Price Total Bid Price D1 Deduction (difference) from Base Bid Item 6 for 1 LF disposing of spoils onsite in lieu of trucking lD (l l'0 material to off -site disposal area. Priced as a deduction per linear feet of ditch. TOTAL DEDUCTION BASE BID $ I J� U V t1U /LF 00300-4 Addendum No. 2 03/28/2022 OPTION A (Baseline A: Station 145+50 to 160+00 Item # Item Description Quantity Unit Price Total Bid Price Al Furnishing Mobilization and Insurance for the OPTION A project scope as per plans and 1 LS Lo �t� LID specifications A2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) for OPTION A project limits for the duration of the entire project per plans andspecifications A3 Traffic control and barricading for the OPTION A project limits for the duration of the entire project 1 LS as per plans andspecifications. / A4 Removal and disposal of all existing driveway and roadway culverts within the OPTION A project 1 LS (� ( �J �� (,(b, limits of the Base Bid and as called upon in the 7 drawings as per plans andspecifications A5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION A l V� project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications A6 Regrading and digging of existing roadside 2,710 LF ditches "V" bottom and sloping embankment at a i,` LID U W 3:1 slope including labor, equipment and f li materials for a complete installation as per plans andspecifications A7 Installation of 18" diameter HDPE corrugated 20 LF storm sewer pipe, open cut, including labor, �� `0 equipment and materials for a complete lV 1� installation as per plans andspecifications. A8 Installation of 24" diameter HDPE corrugated storm sewer pipe, open cut, including labor, 185 LF 22 I\ equipment and materials for a complete installation as per plans andspecifications. A9 Installation of 36" diameter HDPE corrugated 150 LF storm sewer pipe, open cut, including labor, MY' LF J d 7 ,/e 1 50 equipment and materials for a complete installation as per plans ands ecifications. A10 Installation of 8" Diameter Rock Rip -Rap, including labor, equipment and materials for a 50 CY complete installation as per plans and specifications, All Installation of 36" Diameter HDPE 22.5 Deg. Fitting including labor, equipment and materials 2 EA f� ll;(1. for a complete installation as per plans and , I f specifications. 00300-5 Addendum No. 2 03/28/2022 OPTION A CONTINUED Item Quantity Unit Total Bid Description Price Price Al2 Installation of 36" Diameter HDPE Tee Fitting 2 EA including labor, equipment and materials for a ,11) complete installation as per plans andi�W specifications. A13 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 24" Diameter including labor, l rrVVll �d equipment and materials for a complete installation as per plans andspecifications. A14 Installation of24" Diameter HDPE Tee Fitting 4 EA including labor, equipment and materials for a ' �� t� /� Ci�y1 D complete installation as per plans and / (f IN specifications. A15 Installation of24" Diameter HDPE Reducer 2 EA Fitting to 18" Diameter including labor, i 1� C� UU CiJ equipment and materials for a complete I 1 A installation as per plans andspecifications. A16 Reconstruction of existing asphalt roadway 615 SY including labor, equipment and materials for a 1X complete installation as per plans and / specifications. A 17 Hydromulch seeding of excavated and disturbed areas including labor, equipment and materials for 1.5 AC sw Lp A6 a complete installation as per plans and specs. TOTAL OPTION A TOTAL OPTION A CALANDAR DAYS Addendum No. 2 03/28/2022 OPTION B Baseline B: Station 1+00 to 18+00 Item # Item Description Quantity Unit Price Total Bid Price B1 Furnishing Mobilization and Insurance for the OPTION B project scope as per plans and 1 LS kkt)0 .`"'LS Flat s ecifications B2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) i01✓S [ 60 for OPTION B project limits for the duration of the entire project per plans andspecifications B3 Traffic control and barricading for the OPTION B project limits for the duration of the entire project I LS 4-/t t�Nv�l/d. [ S 1 410.00 as per plans andspecifications. B4 Removal and disposal of all existing driveway and roadway culverts within the OPTION B project 1 LS limits of the Base Bid and as called upon in the drawings as per plans andspecifications B5 Removal including truck hauling of all excess I LS spoil materials generated from the OPTION B project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications B6 Regrading and digging of existing roadside 3,123 LF ditches "V" bottom and sloping embankment at a f Q0 U' W 31/ 3D. 3:1 slope including labor, equipment and 1U, materials for a complete installation as per plans ands ecifications B7 Installation of 18" diameter HDPE corrugated 223 LF storm sewer pipe, open cut, including labor, UU �� CC I equipment and materials for a complete I ^' installation as per plans andspecifications. B8 Hydromulch seeding of excavated and disturbed areas including labor, equipment and materials for 2 AC A f UD a complete installation as per plans andspecs. I��O� TOTAL OPTION B $ S 3 TOTAL OPTION B CALANDAR DAYS 45 00300-7 Addendum No. 2 03/28/2022 OPTION C (Baseline A: Station 160+00 to 187+00 Item # Item Description Quantity Unit Price Total Bid Price C1 Furnishing Mobilization and Insurance for the OPTION C project scope as per plans and 1 LS 'll ��1/� ��b� INU• s ecifications C2 Furnishing, implementing and maintaining a Storm Water Pollution Prevention Plan (SWPPP) 1 LS 6 S 5 �( for OPTION C project limits for the duration of the entire project per plans andspecifications C3 Traffic control and barricading for the OPTION C project limits for the duration of the entire project 1 LS �� ` Ld as per plans andspecifications. C4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION C project �j(� (� ixl S to limits of the Base Bid and as called upon in the drawings as per plans andspecifications C5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION C project limits in which the property owner wishes vy� (0 �� J Up to have the material removed completely from the property as per the plans andspecifications C6 Regrading and digging of existing roadside 4,740 LF ditches "V" bottom and sloping embankment at a U 3:1 slope including labor, equipment and U materials for a complete installation as per plans 1 and s ecifications C7 Installation of 18" diameter HDPE corrugated 418 LF storm sewer pipe, open cut, including labor, c I I 5)UL equipment and materials for a complete • J1 J Y installation as per plans andspecifications. C8 Hydromulch seeding of excavated and disturbed areas including labor, equipment and materials for 2 AC 117(� W �/ a complete installation as per plans andspecs. TOTAL OPTION C $ , TOTAL OPTION C CALANDAR DAYS +++++++++++++++++++++++++++++++++++++++++++-H-++++++++++++++++++++++++++++++ The 5% Bid Bond is based on the GREATEST AMOUNT BID which is the sum of the Base Bid + Total Options "A", "B" and "C". r 22 GREATEST AMOUNT BID (Base Bid +Total Options "A", `B" and "C"): $ `P J TOTAL CALENDAR DAYS (Base Bid +Total Options "A", "B" and "C"): [tllxilI11.3 Addendum No. 2 03/28/2022 +ttttt.......... F+tttt.........tttt+F........ ++++tt............ttttttt The award will be based on the Base Bid with consideration of the Option A, Option B & Option C. 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are included and made a condition of this BID a. Required Bid Security in the form of M h R � M" b. Affidavit C. Certificate of Interested Parties, Form 1295 d. System for Award Management — (sam.gov) e. Certification Regarding Debarment & Suspension and Other Responsibility Matters f. Certification Regarding Lobbying g. Disclosure of Lobbying Activities h. Conflict of Interest Questionnaire, Form CIQ i. House Bill 89 Verification j. Residence Certification k. GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 1. Document No. 00416 - Noncollusion Affidavit in. Document No. 00420 — Bidder Qualification Statement n. Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations Submit one original and three copies of this bid and forms listed above. Please do not fold, bind or staple sets. Bids must be returned in a Sealed 9 x 12 or larger envelope clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064- C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Submit Sealed Bid Before 2:00:00 PM, Thursday, March 31, 2022 to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 3`d Floor, Suite 301 Port Lavaca, TX 77979 00300-9 Addendum No. 2 03/28/2022 8. Communications about this BID shall be directed to IBIDDER's address indicated below. SUBMITTED this 1 day of �J lL ` ,V 1 2022. Attesting Signature: Name: Title: -t Legal Firm Name: Business Addres : Phone Number: lL Facsimile Number: i C E-Mail Address (optional): l dq i, V I a b S 6, gjya1, f oy v i State of Incorporation, if applicable: State Contractor License No.: 1110_IZII-211141JUT 1_Re" 00300-10 BID BOND (COS4s O k) KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, as PRINCIPAL, and , as SURETY are held and firmly bound unto (CALHOUN COUNTY, TEXAS) hereinafter called the "Local Public Agency", in the penal sum of Dollars, ($ ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated , for: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20.065-064-C182 AND CALHOUN COUNTY 2020 CDBG- DR CONTRACT WORK ORDER NO. B-1. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within sixty (60) days after the said opening, and shall within the period specified therefor, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above parties have executed this instrument this day of , the name and corporate seal of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. (SEAL) (SEAL) Attest: By: Affix Corporate Seal Attest: By: Affix Corporate Seal Attest: By: Countersigned By * Attorney -in -Fact, State of Texas STATE OF TEXAS {} AFFIDAVIT COUNTY OFCALHOUN {} BEFORE ME, the undersigned authority, on this day personally appeared J0 4 �U br known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not bid thereon. affirm that I am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business priorto the official opening of this Bid. Af Printed Name and Title of Affiant Name of Bidder Address Phone Number Fax Number Email Address I I Il SWORN TO AND SUBSCRIBED BEFOR E by the above are true and correct, this day of _ "M Wa LIZ ANDERS ap®� Notary i #800744 My Commission Expires .)cr W1 August 22, 2024 Notary Affia , who, on oath, states that the facts contained in the fLp 20A�.L, n and for Texas CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1 - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 2022-862895 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. JRB Services LLC. Ganado, TX United States Date Filed: 03/21/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. REBID- Lane Road Drainage Improvements- TX GLO 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. 20-065-064-C182 Ditch cleaning and culvert installation. 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. ❑ 6 UNSWORN DECLARATION My name is and my date of birth is My address is VI A,(,l,JIA b , -, / US �I' ,j (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct.3 Executed in ��,SUI I County, State of T�,Xas on the✓ - day of Yl0' t 20da. (month) (year) sigVurLy of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc Insert System for Award Management (SAM) Record Search for company and company principal(s). • Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principles are not listed (are not debarred) through the System for Award Management Business Name: JRB SERVICES LLC. Business Address: 4840 STATE HIGHWAY 172 Ganado Texas 77962 Date: 03-30-2022 Purpose of Letter The purpose of this letter is to formally appoint an Entity Administrator for the named Entity and to attest to the accuracy of the information contained in the entity registration. Designation of Entity Administrator I, JAKE BAKER, the below signed individual, hereby confirm that the appointed Entity Administrator is an authorized officer, agent, or representative of the Entity. This letter authorizes the appointed Entity Administrator to manage the Entity's registration record, its associated users, and their roles to the Entity, in the System for Award Management (SAM). Entity Covered by this Letter DUNS® Number: 030885815 Legal Business Name: JRB SERVICES LLC. Physical Address: 4840 STATE HIGHWAY 172 Ganado Texas 77962 Entity Administrator Contact Information Full Name: Major Robertson Phone Number: 408-418-8433 Email Address: Renewal@SAM.Directory Page 1 of 3 Business Name: JRB SERVICES LLC. Business Address: 4840 STATE HIGHWAY 172 Ganado Texas 77962 X Third -Party Agent Designation For the purpose of registering with the United States Government through the online System for Award Management (SAM), I do hereby authorize Major Robertson, 408-418-8433, 900 E Main St. Floor 2, Louisville KY 40206, Renewal@SAM.Directory (Designated Third -Party Agent) to act on behalf of the Entity fisted above. This authorization permits the Designated Third -Parry Agent to conduct all normal, common business functions within SAM while binding the signatory to all actions conducted and representations made as a result of authorization granted herein. I have checked the Third -Party Agent Designation box and completed the above information to indicate that the designated Entity Administrator is a third -party agent. Attestation I, the below -signed, attest to the following: • All information contained in this letter is complete and accurate. • The designated Entity Administrator listed above has an individual SAM User Account created with the email address provided in this letter. • The banking information provided for Electronic Funds Transfer on the Financial Information Page in the SAM.gov registration for the Entity above is correct and accurate. Respectfully, Title: President Full Name: JAKE BAKER Email Address: jrbservices85@gmail.com Legal Business Name: JRB SERVICES LLC. Business Physical Address: 4840 STATE HWAY 172 Ganado Texas 77962 Signature: JA Page 2 of 3 Business Name: JRB SERVICES LLC. Business Address: 4840 STATE HIGHWAY 172 Ganado Texas 77962 TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of County of IF UJLL- This in nt s n�wledged before me tht ' ay of (month), aoa aYear), by (name of officer or agent, title or officer or agent) of (name of entity). Personally Known Produced Identification /� Type of ID and Number on ID �� ►r e—a— ��_A) Se (Seal) WANDERS Notary ID #8007444 My Commission Expires August 22, 2024 Y 1 Signavic of Notary (iz' AiAe!�S- Name of Notary (Typed, Stamped or Printed) Notary Public, State of Page 3 of 3 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. 110-bbv- &'Idwt. Name and Title of Authorized Agent u rgnature of Authorized Agent 3 3J dw Date I am unable to certify to the above statements. My explanation is attached. Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to Influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require thatthe language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C.. § 1352(as amended by the Lobbying Disclosure Act of 1995). The Contractor, Virn\ I�Cortifies or affirms the truthfulness and accuracy of each statement of its ce ification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 at seq., apply to this certification and disclosure, if any. vale Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for nuhlie harden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial filing _ b. grant _ b. initial award _ b. material change c. cooperative agreement c. post -award d, loan For material change only:. e. loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporti End 5. If Reporting Entity in No. 4 is Subawardee, Enter Prime _ Subawardee Name and Address of Prime: _ Tier ,if Kno n: Con ressi nal istrict, if k own: Con ressional District, if known: 6. Federal Depa tme Ageney: 7. ederal Program Name/Description: CFDA Number, if applicable: S. Federal Action er, ifkn t : 9. Award Amount, ifknmvn: I 10. a. Name and Addr ss of Lobbying Reg trant b. Individuals Performing Services (including address J' (/f individual,last name, firvi name, Ml): dr,'/ferent,inm No. 10a) (last name, firs( name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title:-t ll\ I Op I d� 3o U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.3(0Date: qv�� 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) CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section Is a misdemeanor. relationship with local governmental entity. 1J Name of vendor wh has a bF(lac a1c� 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 2J Name of local government officer about whom the Information is being disclosed. n �� \yL.. Name of Officer 4J Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government off lcer or a family member of the officer AND the taxable income is not received from the local governmental entity? F] Yes No 6 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership Interest of one percent or more, s ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 )w Signatuto of vendor doing business with the governmental entity Diate Form provided by Texas Ethics Commission www.elhics.stale.lx.us Revised 11/30/2015 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 851h Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. I, (authorized official) Ja h T b r , do hereby verifythe truthfulness and accuracy of the contents of the statements submitted on this certification under the provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at https://comptroller.texas.gov/purchasing/publications/divestment.php S Signature of Authorized Official Printed Name of Authorized Official Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. ❑ I certify that (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) I certify that 0 "tl V J " " is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. Signature of Atlthori�ed Agent and Title of Authorized Agent Date Granlee/Subrecipient. I Include du's documanl in allapplicable via packers. Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Set 3 Economic Opportunities for Low and Very Low -Income Persons THE BIDDER REPRESENTS AND CERTIFIES AS PART OF ITS BID/OFFER THAT IT: ❑ Is a Section 3 Business Concern. A Section 3 Business Concern means a business concern: I . That is 51 %or more owned by Section 3 Resident(s); or 2. Whose permanent, full-time employees include persons, at least 30%of whom are currently Section 3 Residents, or 3. That provides evidence of a commitment to subcontract in excess of 25%of the dollar value of all subcontracts to be awarded to Section 3 Business Concerns, that meet the qualifications set forth in paragraphs 1 or 2 herein. LPIs NOT a Section 3 Business Concern, but who has and will continue to seek compliance with Section 3 by certifying the following efforts to be undertaken. EFFORTS TO AWARD SUBCONTRACTOR TO SECTION 3 CONCERNS (Check ALL that apply) ❑ By contacting business assistance agencies, minority contractors associations and community organizations to inform them of the contracting opportunities and requesting their assistance in identifying Section 3 businesses which may solicit bids for a portion of the work. ❑ By advertising contracting opportunities by posting notices, which provide general information about the work to be contracted and where to obtain additional information, in the common areas of the applicable development(s) owned and managed by the Housing Authority. ❑ By providing written notice to all known Section 3 Business Concerns of contracting opportunities. This notice should be in sufficient time to allow the Section 3 Business Concerns to respond to bid invitations ❑ By following up with Section 3 Business Concerns that have expressed interest in the contracting opportunities. ❑ By coordinating meetings at which Section 3 Business Concerns could be informed of specific elements of the work for which subcontract bids are being sought. ❑ By conducting workshops on contracting procedures and specific contracting opportunities in a timely manner so that Section 3 Business Concerns can take advantage of contracting opportunities. ❑ By advising Section 3 Business Concerns as to where to seek assistance to overcome barriers such as inability to obtain bondi ng, lines of credit, financing, or insurance and aiding Section 3 Businesses in qualifying for such bonding , financing, insurance, etc.... ❑ Where appropriate, by breaking out contract work into economically feasible units to facilitate participation by Section 3 businesses. ❑ By developing and using a list of eligible Section 3 Business Concerns. ❑ By actively supporting and undertaking joint ventures with Section 3 Businesses. EFFORTS TO PROVIDE TRAINING AND EMPLOYMENT TO SECTION 3 RESIDENTS ❑ By entering into a "first source" hiring agreements with organizations representing Section 3 Residents. ❑ By establishing training programs, which are consistent with the requirements of the Department of Labor, specifically for Section 3 Residents in the building trades. By advertising employment and training positions to dwelling units occupied by Category 1 and 2 residents. ❑ By contacting resident councils and other resident organizations in the affected housing development to request assistance in notifying residents of the training and employment positions to be filled. ❑ By arranging interviews and conducting interviews on the job site. ❑ By undertaking such continued job -training efforts as may be necessary to ensure the continued employment of Section 3 Residents previously hired for employment opportunities. ❑ By posting job vacancies in Work -In -Texas or with my local Workforce Solutions Center. Contractor NamelBusiness Name: Authorized Representative Name: Signature: ovlaa LU �04V Date: J I�fi l aOAA DOCUMENT NO.00416 V ( NON -COLLUSION AFFIDAVIT State of A J County of I' I being first duly sworn, deposes and says that: l . He is �Wt MR of V V S Wes; the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) �j Subscribed and sworn to me thisdo— day of Me By: otary Public My commission expires o4r4Y �"4 LIZ ANDERS : n Notary ID #8007444 +. y My Cammission Expires END OF DOCUMENT 'Tor} August 22, 2024 11ZI111ral DOCUMENT NO. 00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached shtets. The Bidder may submit any additional information it desires. Date Incorporated: U Federal"ID Number: -9 �� Number of Years in contracting business under present name List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Type of work performed by your company: Have you ever failed to complete any work awarded to you? 0 Yes "9 No (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? 0 Yes H No (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the pXst five years or that was still in effect during the five year period or is still in effect? 0 Yes No (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance): Amount $ Mo/Yr Completed contract: Are you in compliance with all applicable EEO requirements? kes 0 No (If no, please attach summary of details on a separate sheet.) nn40n_i Are you a Section 3 business? (see below) ❑ Yes "o Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipient's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low income persons. Bank Ref dc� Address: C I �I %L+Contact Name: tlG� City & State: zip: Phone Number: Credit available: $ , 6 U Has the firm or predecessor firm been involved in a bankruptcy or reorganization? 8 Yes (4 (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. /V/k List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. N Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent fAr the project. Printed Name a9d Title: Wi Q M U Company N S , tern t: / / , bein duly sworn says/ �h,�t he/she is the Position/Title of , I A � I - -- (L( (Firm Name), and hereby swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY in verification of the recitals comprising this Bidder's Qualifications Statement. Subscribed and sworn before me this ay ofA"20 Notary Public lIZ ANDERS Slgnatur : Notary lD Na007444 My Commission Expires Printed Name: S is August ZZ, 2024 My Commission Expires: The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. END OF DOCUMENT t k. c � CL 2 me k y.: w k § c V. Contract lists • 01-09-2020 South Texas Operating Project $34,250.00 • 03-10-2020 South Texas Operating Project $53,000.00 • 05-20-2021 South Texas -Operating Project $511,120.00 • 11-014021 South Texas Operating Project $99,325.00 • 03-2022 A-1 RV Park $250,000.00 Ganado, TX 77962 1 1361) 781-2148 1 jrbseMces85@gmaii.com JAKE BAKER PROFESSIONAL Skilled Heavy Equipment Operator with 11 years of construction experience. Knowledgeable SUMMARY in wide range of trenchers, backhoes and diggers. Detail -oriented Business Owner/Operator that meets day-to-dayand long-term strategic planning needs. E19 • Land Clearing • Excavation and Backfilling • Critical Thinking • Decision Making • Equipment Repair • Problem Solving • Team Communication • Dependable and Punctual WORK HISTORY OWNER/OPERATOR 02/2012 to Current JRB Services LLC., Ganado, Texas • Workflow Management • Heavy Lifting • PPE Usage • Equipment Transportatio • Reviewed plansandinspected ongoing construction to keep work-in line with project goals • Carried out day -day -day duties accurately and efficiently. • Created plans and communicated deadlines to ensure projects were completed on time. • Completed diligent equipment inspections, repairs and maintenance actions to prolong life of each piece of machinery. • Kept machinery in proper working order by repairing and replacing malfunctioning parts. • Drove vehicles to and from work sites and maintained clean driving record. • Trained in diverse pieces of equipment and useful attachments. • Operated range of heavy equipment on regular basis with advanced skill. INSTRUMENTATION TECHNICIAN 05/2011 to 02/2012 Oilfield Instrumentation, .Layfeyette , Louisiana Install and service instrumentation on drilling rigs. Perform service and maintenance on equipment. MECHANIC 02/2009 to 05/2011 Jackson Electric Cooperative, Ganado, Texas • Replaced damaged, missing or defective parts with new and refurbished components. • Analyzed and located malfunctions in brakes, motors, switches and control systems. •_Performed diagnostic and troubleshooting .procedures to find and identify -root causes of mechanical issues. • Maintained functionality and reliability of engines, machines and systems through regular diagnostic checks. • Disassembled defective parts to make proper repairs. • Corrected unsafe conditions in work areas and immediately reported correctable condition to supervisor. • Tested newly installed equipment to determine proper functionality and compliance with regulations. • Inspected and tested equipment to locate worn and damaged parts. WELL TREATMENT TECHNICIAN 07/2008 to 0212009 Midco Service Supply, Ganado. Texas Treated wells with chemical. Performed daily duties needed. MECHANIC 04/2007 to 07/2008 Brannan Paving Victoria, Texas • Replaced damaged, missing or defective parts with new and refurbished components. • Analyzed. and. located. malfunctions in brakes, motors, switches and control systems. • Performed diagnostic and troubleshooting procedures to find and identify root causes of mechanical issues. • Maintained functionality and reliability of engines, -machines -and systems through regular diagnostic checks. SHOP HAND 0212005 to 04/2007 Krestas Boats & Motors, Edna, Texas • Sweep floors. —Wash boats. • Maintain shop duties. MOVIE THEATER EMPLOYEE 06/2004 to 02/2005 AMC Theatres, Sugarland, Texas • Scanned patrons' tickets, reported invalid tickets to supervisor and assisted patrons to assigned seats. • Provided assistance to guests with special needs and helped with seat accommodations. • Assisted in verifying staff credentials, granting access to generally restricted areas. • Welcomed gueststotheater with friendly demeanor and smile and directed to screening rooms. • Maintained lobby, hallway and auditorium cleanliness using various sanitation practices. • Directed patrons to specific venue locations, restrooms and will -call window. • Monitored and kept emergency exit pathways clear and accessible during show. • Assisted theater vendors with necessary setup tasks. FARM HAND 08/2003 to 05/2004 3M Farms, Laward, Texas Used grease guns and oil cans to lubricate and adjust farm equipment. Drive tractor. Plowed fields for planting. HEAVY EQUIPMENT SPOTTER 05/2002 to 07/2002 L&P Pipeline And Construction, Ganado, Texas Spotter for heavy equipment. Welders helper. EDUCATION Industrial Nigh school, Vanderbilt, TX High School Diploma, 05/2004 LANGUAGES English Debbie Billings 5137 Fm 822 Edna, TX 77957 361.781.0553 Rloudy_de1 cihotmail.com Objectives To be a valued partner in the banking, bookkeeping, or clerical arena. Education Diploana froni G}anado &1igh School (S/ 1983) Experience 4:DS:<{ne Acda xta{-;es'/F;nrykslsc rl>cz' (1 /:14 Present) ,1R13 Services (0ilfield and General Corzstructiozi) Invoicing, data entry, payroll, office manager i�i'i3cSn 1Vtietaza8a /�'. lexical (2000 --20091 _ victoria Orthopedic Surgery (Surgery_ Group) • Office manager of 3 years ... Opened/Closed Clinic Attended Phones/ Managed appointments • Checked in/out.padents • Pull Charts, filed paperwork, Data entry. • Made deposits and assisted nurses as needed/Payroll (ni.- ce, PNabefaler. (1993-2000) Gartado Medical Center (Physician Clinic) Attended Phones/ managed appointments Checked in/out patients • Pull Charts, filed paperwork, Data entry • Handled cash and worked with'public (1988-1993) Citizens State Bank (13anking) • Teller services/Attended Phones • Loan Department/data entry/Opened Certificates of Deposit • New Accounts/Assisted Cashier • Handled large cash flow/Worked with public Resume: Debbie Billings Skills • Bookkeeping • Proficient in QuickBooks • Basic MS Office Ability to quickly master new software Volunteer Ulioak • Church Secretary for LaWard United Pentecostal Church Helping Hands • Southbrooke Manor nursing home Page 7. 361,781.0553 DOCUMENT NO. 00450 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND D ESS VVl F BIDDER (include ZIP Code) CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. VYes ❑ No The undersigned hereby certifies that: ❑ The Provision of Local Training Employment and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportuynity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). k ❑ The Equal Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). N/A ❑ The Section 603 clause is included in the contract N ik Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended? El Yes CI No NAME AND TITLE OF SIGNER (Please type) 30 L fke�- Pr�Sick� SIGNATURE D TE 00450-1 NOTICE OF SPECIAL MEMBERS' MEETING OF JRB SERVICES, LLC A LIMITED LIABILITY COMPANY To the members of JRB Services, LLC ("Company"): A special meeting of Company Members, will be held at 4840 State Highway 172, Ganado, Texas 77962, at 12:00p.m. on the 30th day of March 2022. The purpose of the meeting is to consider the following: • Conduct business over the matter of the REBID -LANE ROAD DRAINAGE IMPROVEMENTS for Calhoun County, Tx bid and to go over other daily operations for JRB Services, LLC. Dated: 30 March 2022 Meredith Baker, Secretary GREEN DREAM INTERNATIONAL RE -BID LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 9 Cover Letter Calhoun County Calhoun County Courthouse 211 South Ann Street, 3rd Floor, Suite 301 Port Lavaca, TX 77979 Attn: Honorable Richard H. Meyer, County Judge SUBJECT: Contract 420-065-064-C182; Lane Road Drainage Improvements Dear Mr. Meyer, Green Dream International (GDI) is pleased to submit our proposal for the above mentioned bid. GDI has more than 12 years of constriction experience working with public agencies from federal government agencies, all the way to state and local governments in Texas. We have successfully completed over 500+ contracts for the Federal Government alone (all states) and an equal number of state and local agencies throughout the nation and including Texas. In our proposal, we have covered the required bid documents as well as providing a brief introduction of our company experience including those in Texas. We think that our proposal exceeds the requirements as set by the County and provides a balanced combination of quality and price. Thus, we look forward to working with you on this project. Should you have further questions, please contact Adam Cole, at telephone number 469-706-9097 Ext:102 or e-mail a.cole@gdicompany.com. Sincerely yours, Varand Vartanian, President Green Dream International 222 West Las Colinas Blvd., Suite 1650E, Office 1727, Irving, TX 75039 Office: 469-706-9097 DUNS: 831374546 1 CAGE: 5PJH6 I EIN: 46-0522758 GRIERDRE�iI�I runtrac � 065064-C182 Table of Contents Cover Letter.................................................................................................................................. ii 1. Company Experience............................................................................................................ I 1.1 Qualifications and Experience.......................................................................................... 1 1.2 Public Clients & Contracts............................................................................................... 2 1.3 Financial Stability............................................................................................................. 4 1.4 Personnel Experience........................................................................................................ 5 2. Past Performance & References........................................................................................... 6 2.1 Reference 1....................................................................................................................... 6 2.2 Reference 2....................................................................................................................... 6 2.3 Reference 3....................................................................................................................... 6 2.4 Reference 4....................................................................................................................... 7 2.5 Reference 5....................................................................................................................... 7 2.6 Reference 6....................................................................................................................... 7 3. Forms & Other Requested Information.............................................................................. 8 3.1 Bid Form........................................................................................................................... 8 3.2 Bid Bond........................................................................................................................... 9 3.3 Affidavit..........................................................................................................................10 3.4 TEC Form 1295.............................................................................................................. 11 3.5 System for Award Management Records....................................................................... 12 3.6 Certification Regarding Debarment & Suspension and Other Responsibility Matters.. 13 3.7 Certification Regarding Lobbying.................................................................................. 14 3.8 Conflict of Interest Questionnaire, Form CIQ................................................................ 15 3.9 House Bill 89 Verification.............................................................................................. 16 3.10 Residence Certification................................................................................................... 17 3.11 GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3.................................................................................... 18 3.12 Document No. 00416 - Noncollusion Affidavit............................................................. 19 3.13 Document No. 00420 — Bidder Qualification Statement ................................................ 20 3.14 Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations..................................................................................................................... 21 _r REAM ^atract #20 065 064-C182 Bai yocvt e�2rrm LrwY ... 1. Company Experience 1.1 Qualifications and Experience Since 2009, Green Dream International LLC (GDI), has been providing construction services and supplies to various federal and state/local agencies and institutions in Texas and throughout the Continental US. We have successfully performed over 515 contracts with the federal government alone and an equal number of projects with various state and local governments in Texas and other states. Green Dream International (GDI) specializes in civil horizontal construction and road construction and maintenance. We use experienced managers and highly skilled field personnel, complemented with the right equipment to guarantee quality and safety, and on -time and on -budget project delivery. Our experience and resources span the full spectrum of public agency construction needs. COMPANY INFORMATION UNIQUE FEATURES These include: • Roadways and small bridge construction • Asphalt and Concrete Paving • Demolition • Mass Excavation & Landscaping • Earthworks and Grading • Flatworks and Drainages • Landfills and Erosion Control Civil Constructions. GDI's construction services encompasses all facets of civil works. We have helped many public sector clients with urban sites and roadway improvement projects. We offer our clients direct access to a team of highly qualified and experienced civil construction specialists offering consultancy services in preliminary work, building design, construction management as well as construction supervision and maintenance work. Asphalt Work. From removing and replacing an asphalt roadway or parking lot, to paving roads and intersections, GDI's Asphalt teams have the experience and resources to meet more than your s ru expectations. The asphalt materials we use are made from the highest available quality at the lowest price. Some of our capabilities to provide asphalt services are: ✓ Asphalt Paving ✓ Tar and chip seal ✓ Striping ✓ Highways and Roads ✓ Seal Coating ✓ Overlay ✓ Driveway Installation ✓ Asphalt Maintenance ✓ Pothole Repair ✓ Asphalt Milling ✓ Crack Filling ✓ Resurfacing Concrete Work. GDI provides concrete solutions for customers in the public sector in Texas and many other states. Our services include all phases of concrete civil and structural works such as estimation, layout, formwork, reinforce concrete, and finishing works. Below are some of the works we have been doing: ✓ Parking Lots ✓ Curbs & Gutters ✓ Retaining Walls ✓ Roadways ✓ Driveways ✓ Approaches ✓ Drainage and Culverts ✓ Sidewalks ✓ Slabs 1.2 Public Clients & Contracts GDI has over 515 contracts from federal agencies and an even larger number of contracts from state and local agencies in Texas and other states throughout the nation. Below is a partial list of our past and present government customers: List of Federal Clients: • Department of the Army (20 Bases and Centers) • Department of the Air Force (9 Bases & Centers) • Department of the Navy (5 Bases & Centers) • Department of State (5 Embassies and Centers) • United States Department of Agriculture (USDA) • Defense Information Systems Agency (DISA) • Federal Bureau of Prisons (FCI and USMCFP) • Department of Education • NASA (NASA Shared Services Center) • US Fish & Wildlife Service • Social Security Administration • Bureau of Land Management • U.S. Customs and Border Protection 0 Federal Law Enforcement Training Center List of Clients in the State of Texas: • Texas Department of Criminal Justice • City of Houston • Lower Colorado River Authority • City of Navasota • Ponderosa Forest Utility District • City of Killeen • Texas State Railroad • City of Seguin • Montgomery County • City of Waco • Guadalupe County • City of Garland • Bell County • City of Round Rock • Ector County • City of Lubbock • Collin County • City of Fort Stockton • Denton County • Bay City • Orange County • Aransas County Coverage of Federal Contracts: (Source: US Government Website usaspendin2.2ov1 (State and Local covers all states in Continental US) Geographical Coveraue of Contracts in Texas: 1.3 Financial Stability With over 11 years of experience, GDI has successfully executed over 515 contracts with the Federal Government plus over 850 contracts with state and local governments, and educational systems (schools and universities). Having performed so many contracts successfully speaks toward our sound and stable financial system. Having strong accounts with our 2 banks, Wells Fargo Bank and Citizens Bank, provides us with full support on our contracts. Our bonding capacity is already at 9 million dollars with our 3 bonding companies, and we enjoy an overall $10 million line of credit from a number of our financial backers. GREEA D?Rg�IAm 1.4 Personnel Experience Texas Area Manager: Abd Obeid With a BS in Civil Engineering and MS in Engineering Management from Gannon University (Erie, PA), Mr. Obeid Career reflects over 10 years of experience in project management of construction alone, in addition to his other related experiences. Mr. Obeid supervision experience ranges from construction of stadiums to infrastructure projects such as rail road construction as well as design management. Mr. Obeid manages our operations in the State of Texas and oversees over 5 other civil engineers as well as 14 project managers/superintendents in the State. Lead Project Manager: Lawrence Reid Career reflects over 30 years of experience in project management of construction, telecommunications, design, maintenance, and quality assurance in the highly competitive industries of civil construction, telephone and data services and real estate development. Possess a demonstrated record of success in construction management, telecommunications, process improvement, business expansion, cost reduction, and profit generation. Safety Manager: Paul Barb With over 15 years of experience in safety and quality control in construction projects to include sanitary sewer, utilities, large scale horizontal construction projects, .... with extensive knowledge of safety requirements and procedures that need to be in place for all different types of projects. Familiar with commercial as well as public projects including federal MILCON projects. Quality Control Manager: William L. Hoover Twenty -Eight+ years of experience directly related to Global, DOD, MIL -CON, Industrial, Commercial, Energy, utilities, EPC I Design Build management and Quality Control. Experienced with FAR's, Primavera, MS Project, EM385, Davis Bacon, RS Means, RMS, QCS, QCP, CQM, DOD, NAVFAC, USACE, USAF, DOE, GMO, MDA, MATOC, SATOC, FRR, IDIQ, CQM procedures and requirements. Accomplished in Quality Control, Engineering, Preconstruction, Safety and Monitoring. Other personnel The following personnel manage heavy equipment operations in our Texas projects: • Clay Parker, Chief Heavy equipment operator - 50 years of experience • Bill Armstrong, Heavy equipment operator - 40 years of experience • Ryan Moses, Heavy equipment operator - 25 years of experience �+.rwui.e.�ivb�.ry,7wrt�{(Lccsc., [�iv. 2. References: 2.1 Reference 1 2.2 Reference 2 2.3 Reference 3 • EHRA (Academy Development, Ltd.) 10011 Meadowglen Lane Houston, Texas 77042 • POC Name: Nancy Tran Phone: 713-337-7490 Email: ntran@ehrainc.com Award Date: 09/23/2021 Completion Date: 02/14/2022 Ponderosa Forest Utility District, Clearing and Grubbing to serve Bammel Oaks Green Dream International Page 19 222 West Las Colinas Blvd., Suite 1650E, Office 1727, Irving, TX 75039 +1469-706-9097 1 support@gdicompany.com I www.gdicompany.com Past Performance & References White Oak Creek Culvert Replacement White Oak Creek Culvert Replacement 10173-029 Montgomery County, Texas L Squared Engineering 3307 W. Davis Street, #100 Conroe, TX 77304 936-647-0420 Design Engineer: Levi Love, PE Office:936-647-0420 Email: Levi@UEngineering.co $255,570.00 Sept 20, 2021 Dec 2, 2021 The work consists of providing the necessary labor, materials, equipment, and supervision to replace the existing wastewater treatment plant access drive culvert as shown in the plans. Green Dream International Page 11 222 West Las Colinas Blvd., Suite 1650E, Office 1727, Irving, TX 75039 +1469-706-9097 I support@gdicompany.com I www.gdicompany.com r y ht� r 4 �aN - a r n a hr Ilk $ rv.# t� air Jul rt � y1J Y S P a S 3. Forms & Other Requested Information 3.1 Bid Form The Bid Form is attached oti tl a followingp fge ='` we Green Dream International LLC hereinafter called "BIDDER", (Legal Firm Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". 1. Terms used in this BID are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Working Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and careftilly studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: 1 2 Date Received: 03/25/2022 03/28/2022 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. e. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amormt in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Addendum No. 2 03/28/2022 BASE BID (Baseline A: Station 0+00 to 145+50) Item # Item Description Quantity Unit Price Total Bid Price 1 Furnishing Mobilization and Insurance for the 1 LS BASE BID project scope as per plans and $38,500.00 $38,500.00 specifications 2 Furnishing, implementing and maintaining a I LS Storm Water Pollution Prevention Plan (SWPPP) $3,300.00 $3,300.00 for BASE BID project limits for the duration of the entire project per plans andspecifications 3 Traffic control and barricading for the BASE BID 1 LS $3,300.00 $3,300.00 project limits for the duration of the entire project as per plans andspecifications. 4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the BASE BID project $22,000.00 $22,000.00 limits of the Base Bid and as called upon in the drawings as per plans and specifications 5 Regrading and digging of existing channel to a 3,300 LF bottom width of 20 feet and sloping embankment $22.00 $72,600.00 at a 4:1 slope and stockpiling spoil materials into habitat mounds including labor, equipment and materials for a complete installation as per plans andspecifications 6 Regrading and digging of existing channel to a 11,080 LF bottom width of 15 feet and sloping embankment $6.60 $73,128.00 at a 3:1 slope and trucking of material to designated site including labor, equipment and materials for a complete installation as per plans andspecifications 7 Installation of 18" diameter HDPE corrugated 44 LF storm sewer pipe, open cut, including labor, $165.00 $7,260.00 equipment and materials for a complete installation as per plans andspecifications. 8 Installation of 36" diameter HDPE corrugated 334 LF storm sewer pipe, open cut, including labor, $242.00 $83,248.00 equipment and materials for a complete installation as per plans andspecifications. 9 Installation of 48" diameter HDPE corrugated 168 LF $275.00 $46,200.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. 10 Installation of 60" diameter HDPE corrugated 240 LF storm sewer pipe, open cut, including labor, $352.00 $84,480.00 equipment and materials for a complete installation as per plans andspecifications. 11 Installation of 8" Diameter Rock Rip -Rap, 300 CY $242.00 $72,600.00 including labor, equipment and materials for a complete installation as per plans and specifications. 00300-3 Addendum No. 2 03/28/2022 BASE BID CONTINUED Item # Item Description Quantity Unit Price Total Bid Price 12 Installation of 36" Diameter HDPE 22.5 Deg. 2 EA $880.00 $1,760.00 Fitting including labor, equipment and materials for a complete installation as per plans and specifications. 13 Installation of 36" Diameter HDPE 45 Deg. 2 EA Fitting including labor, equipment and materials $880.00 $1,760.00 for a complete installation as per plans and specifications. 14 Installation of 36" Diameter HDPE 90 Deg. 1 EA Fitting including labor, equipment and materials $880.00 $880.00 for a complete installation as per plans and specifications. 15 Installation of 36" Diameter HDPE Tee Fitting 1 EA including labor, equipment and materials for a $880.00 $880.00 complete installation as per plans and specifications. 16 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 18" Diameter including labor, $880.00 $880.00 equipment and materials for a complete installation as per plans andspecifications. 17 Reconstruction of existing gravel/limestone 135 SY $88.00 $11,880.00 roadway including labor, equipment and materials for a complete installation as per plans and specifications. 18 Hydromulch seeding of excavated and disturbed 12 AC $1,870.00 $22,440.00 areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL BASE BID $ 547,096.00 TOTAL BASE BID CALENDAR:DAYS 60 BASE BID DEDUCTION Item # Item Description Quantity Unit Price Total Bid Price D 1 Deduction (difference) from Base Bid Item 6 for 1 LF disposing of spoils onsite in lieu of trucking $5.50 $5.50 material to off -site disposal area. Priced as a deduction per linear feet of ditch. TOTAL DEDUCTION BASE BID $ 5.50 /LF 00300-4 Addendum No. 2 03/28/2022 OPTION A (Baseline A: Station 145+50 to 160+00 Item # Item Description Quantity Unit Price Total Bid Price Al Furnishing Mobilization and Insurance for the I LS $13,200.00 $13,200.00 OPTION A project scope as per plans and specifications A2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) $1,650.00 $1,650.00 for OPTION A project limits for the duration of the entire project per plans andspecifications A3 Traffic control and barricading for the OPTION A I LS $1,650.00 $1,650.00 project limits for the duration of the entire project as per plans andspecifications. A4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION A project $5,500.00 $5,500.00 limits of the Base Bid and as called upon in the drawings as per plans andspecifications A5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION A $2,750.00 $2,750.00 project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications A6 Regrading and digging of existing roadside 2,710 LF ditches "V" bottom and sloping embankment at a $6.60 $17,886.00 3:1 slope including labor, equipment and materials for a complete installation as per plans andspecifications A7 Installation of 18" diameter HDPE corrugated 20 LF storm sewer pipe, open cut, including labor, $165.00 $3,300.00 equipment and materials for a complete installation as per plans andspecifications. A8 Installation of 24" diameter HDPE corrugated 185 LF storm sewer pipe, open cut, including labor, $198.00 $36,630.00 equipment and materials for a complete installation as per plans andspecifications. A9 Installation of 36" diameter HDPE corrugated 150 LF storm sewer pipe, open cut, including labor, $242.00 $36,300.00 equipment and materials for a complete installation as per plans andspecifications. A 10 Installation of 8" Diameter Rock Rip -Rap, 50 CY including labor, equipment and materials for a $220.00 $11,000.00 complete installation as per plans and specifications. All Installation of 36" Diameter HDPE 22.5 Deg. 2 EA Fitting including labor, equipment and materials $880.00 $1,760.00 for a complete installation as per plans and specifications. 00300-5 Addendum No. 2 03/2R/9n99 OPTION A CONTINUED Item Quantity Unit Total Bid Description Price Price Al2 Installation of 36" Diameter HDPE Tee Fitting 2 EA $880.00 $1,760.00 including labor, equipment and materials for a complete installation as per plans and specifications. A13 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 24" Diameter including labor, $880.00 $880.00 equipment and materials for a complete installation as per plans andspecifications. A14 Installation of 24" Diameter HDPE Tee Fitting 4 EA including labor, equipment and materials for a $880.00 $3,520.00 complete installation as per plans and specifications. A 15 Installation of 24" Diameter HDPE Reducer 2 EA Fitting to 18" Diameter including labor, $660.00 $1,320.00 equipment and materials for a complete installation as per plans andspecifications. A16 Reconstruction of existing asphalt roadway 615 SY including labor, equipment and materials for a $49.50 $30,442.50 complete installation as per plans and specifications. A17 Hydromulch seeding of excavated and disturbed 1.5 AC $1,870.00 $2,805.00 areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL OPTION A $ 172,353.50 TOTAL OPTION A CALANDAR DAYS 15 00300-6 Addendum No. 2 03/28/2022 OPTION B (Baseline B: Station 1+00 to 18+00) Item # Item Description Quantity ' Unit Price Total Bid , Price B1 Furnishing Mobilization and Insurance for the 1-Ls $11,000.00 $11,000.00 OPTION B project scope as per plans and specifications B2 Furnishing, implementing and maintaining a 1 LS $1,650.00 $1,650.00 Storm Water Pollution Prevention Plan (SWPPP) for OPTION B project limits for the duration of the entire project per plans andspecifications B3 Traffic control and barricading for the OPTION B 1 LS project limits for the duration of the entire project $1,650.00 $1,650.00 as per plans andspecifications. B4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION B project $3,300.00 $3,300.00 limits of the Base Bid and as called upon in the drawings as per plans andspecifications B5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION B $1,650.00 $1,650.00 project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications B6 Regrading and digging of existing roadside 3,123 LF ditches "V" bottom and sloping embankment at a $6.60 $20,611.80 3:1 slope including labor, equipment and materials for a complete installation as per plans andspecifications B7 Installation of 18" diameter HDPE corrugated 223 LF storm sewer pipe, open cut, including labor, $165.00 $36,795.00 equipment and materials for a complete installation as per plans andspecifications. B8 Hydromulch seeding of excavated and disturbed 2 AC $1,870.00 $3,740.00 areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL OPTION B $ $80,396.80 TOTAL OPTION B CALANDAR DAYS 10 00300-7 Addendum No. 2 03/28/2022 OPTION C (Baseline A: Station 160+00 to 187+00) Item # Item Description Quantity Unit Price Total Bid Price Cl Furnishing Mobilization and Insurance for the 1 LS $11,000.00 $11,000.00 OPTION C project scope as per plans and specifications C2 Furnishing, implementing and maintaining a 1 LS $1,100.00 $1,100.00 Storm Water Pollution Prevention Plan (SWPPP) for OPTION C project limits for the duration of the entire project per plans andspecifications C3 Traffic control and barricading for the OPTION C 1 LS project limits for the duration of the entire project $1,100.00 $1,100.00 as per plans andspecifications. C4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION C project $3,300.00 $3,300.00 limits of the Base Bid and as called upon in the drawings as per plans andspecifications C5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION C $1,650.00 $1,650.00 project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications C6 Regrading and digging of existing roadside 4,740 LF $6.60 $31,284.00 ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans andspecifications C7 Installation of 18" diameter HDPE corrugated 418 LF storm sewer pipe, open cut, including labor, $165.00 $68,970.00 equipment and materials for a complete installation as per plans andspecifications. C8 Hydromulch seeding of excavated and disturbed 2 AC $1,870.00 $3,740.00 areas including labor, equipment and materials for a complete installation as per plans and specs. TOTAL OPTION C $ $122,144.00 TOTAL OPTION C CALANDAR DAYS 10 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ , ++++++++ The 5% Bid Bond is based on the GREATEST AMOUNT BID which is the sum of the Base Bid + Total Options "A", "B" and "C". GREATEST AMOUNT BID (Base Bid +Total Options "A", "B" and "C"): $ 921,990.30 TOTAL CALENDAR DAYS (Base Bid +Total Options "A", "B" and "C"): 95 Days ...... "i............... .......... i i-I-1-1-I--F-F-H-.-I-............. The award will be based on the Base Bid with consideration of the Option A, Option B & Option C. T..T.... H..TT.f.Tff...I.ITIITTH.....II.TTTrIIII ........................ 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are included and made a condition of this BID: a. Required Bid Security in the form of b. Affidavit C. Certificate of Interested Parties, Form 1295 d. System for Award Management — (sam.gov) e. Certification Regarding Debarment & Suspension and Other Responsibility Matters f. Certification Regarding Lobbying g. Disclosure of Lobbying Activities h. Conflict of Interest Questionnaire, Form CIQ i. House Bill 89 Verification j. Residence Certification k. GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 1. Document No. 00416 - Noncollusion Affidavit in. Document No. 00420 — Bidder Qualification Statement n. Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations Submit one original and three copies of this bid and forms listed above. Please do not fold, bind or staple sets. Bids must be returned in a Sealed 9 x 12 or larger envelope clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064- C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Submit Sealed Bid Before 2:00:00 PM, Thursday, March 31, 2022 to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 3`d Floor, Suite 301 Port Lavaca, TX 77979 00300-9 C2n�tnun caki�ns AbOO this WD shall he ifected to BODtRI address indica SUl3X4 TTBD 6!s $0 davvf Tvtarch . ..... . Wit".. y .+ Tine:C/ :!attesting �ignatur8; f Name: Title; Legal Fi#1xi y�jatr e: Grkeat DYcaes Ic1teY�iational LI BusW8 AddressA,West U9,Cb7in sliiud .SiuEe1�50F 1?itmtt fi*iti#nbcr:. 469-706-'9097 Facsimile=Number02 a6 &44 su partC� d�oln an :com E�Mait �ildr�ss �ojitiie�al):. p °� p Y *r o gr,,To rparittion ifpmio�abl . rlrleansas St xte 0 ontractor Li4 eewe Np,: 3*16i4fy1773 END Of liC3CMMNT fi0313U-10 ITT PI Jfifi'l 3.2 Bid Bond p The Bid B n is attached. qn the following pagg. a K, KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Green Dream International, LLC as PRINCIPAL, and NGM Insurance Comoanv , as SURETY are held and firmly bound unto (CALHOUN COUNTY. TEXAS) hereinafter called the "Local Public Agency", in the penal sum of Five Percent (5%) of the Greatest Amount Bid Dollars, ($ Five Percent (5%) of the Greatest Amount Bid ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated March 31, 2022 , for: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG- DR CONTRACT WORK ORDER NO. B-1.. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within sixty (60) days after the said opening, and shall within the period specified therefor, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter Into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as maybe required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above parties have executed this instrument this 31st day of March. 2022 , the name and corporate seal of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. (SEAL) Attest: Green Dream International, LLC 53 in (SEAL) Affix Corporate Seal n,nnn ,......-....,,,. �.............. Affix ®NGM INSURANCE COMPANY POWER OF ATTORNEY A membe do Mein StrewtAneriw Group KNOW ALL MEN BY THESE PRESENTS: That NGM Insurance Company, a Florida corporation having its principal office in the City of Jacksonville, State of Florida, pursuant to Article IV, Section 2 of the By -Laws of said Company, to wit: "Article IV, Section 2. The board of directors, the president, any vice president, secretory, or the treasurer shall have the power and authority to appoint attorneys -in -fact and to authorize them to execute on behalf of the company and affix the seal of the company thereto, bonds, recognizances, contracts of indemnity or writings obligatory in the nature of a bond, recognizance or conditional undertaking and to remove any such attorneys -in -fact at any time and revoke the power and authority given to them. " does hereby make, constitute and appoint John D. Weisbrot, Nancy Nigro its true and lawful Attorneys -in -fact, to make, execute, seal and deliver for and on its behalf, and as its act and deed, bonds, undertakings, recognizances, contracts of indemnity, or other writings obligatory in nature of a bond subject to the following limitation: 1. No one bond to exceed Five Million Dollars ($5,000,000) and to bind NGM Insurance Company thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of NGM Insurance Company; the acts of said Attorney are hereby ratified and confirmed. This power of attorney is signed and sealed by facsimile tinder and by the authority of the following resolution adopted by the Directors of NGM Insurance Company at a meeting duly called and held on the 2nd day of December 1977. Voted: That the signature of any officer authorized by the By -Laws and the company seal may be affixed by facsimile to any power of attorney or special power of attorney or certification of either given for the execution of any bond, undertaking, recognizance or other written obligation in the nature thereof; such signature and seal, when so used being hereby adopted by the company as the original signature of such office and the original seal of the company, to be valid and binding upon the company with the same force and effect as though manually affixed. IN WITNESS WHEREOF, NGM Insurance Company has caused these presents to be signed by its Vice President, General Counsel and Secretary and its corporate seal to be hereto affixed this 7th day of January, 2020. NGM INSURANCE COMPANY By: UT 7829 Kimberly K. Law Vice President, General Counsel and Secretary State of Florida, County of Duval. On this 7th day of January, 2020, before the subscriber a Notary Public of State of Florida in and for the County of Duval duly commissioned and qualified, came Kimberly K. Law of NGM Insurance Company, to me personally known to be the officer described herein, and who executed the preceding instrument, and she acknowledged the execution of same, and being by me fully sworn, deposed and said that she is an officer of said Company, aforesaid: that the seal affixed to the preceding instrument is the corporate seal of said Company, and the said corporate seal and her signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Company; that Article IV, Section 2 of the By -Laws of said Company is now in force. IN WITN ESS WHEREOF, I have hereunto set my hand and affixed my official seal at Jacksonville, Florida this 7th day of January, 2020. I, Nancy Giordano -Ramos, Vice President of NGM Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by said Company which is still ' effect. IN WIT ES WHEREOF, I have hereunto set my hand and affixed the t Jacksonville, Florida this 31st day of March 1 2022 JV LV(/�T�-ty(n/ WARNING: Any unauthorized reproduction or alt 1 f thist t is p i \ _ TO CONFIRM VALIDITY of the attached ad p ase call 646. 111 TO SUBMIT A CLAIM: Send all correspondence to 55 We tre Keene, NH 034 A and Clahns. MAIN STREET Trusted AMERICA ciwtce` INSURANCE , I certify that at the Annual Meeting of the Directors of the NGM Insurance Company duly called and held at Jacksonville, Florida on March 11th, 2021, the following officers were elected and remain in office: CHRISTOPHER R. LISTAU.... ....... ............................. .. .............CHIEF EXECUTIVE OFFICER AND PRESIDENT THERESA E. BREUNIGSILBERNAGEL ............. ............SENIOR -VICE PRESIDENT, ENTERPRISE SOLUTIONS KIMBERLY K. LAW ........... ............................. VICE PRESIDENT, GENERAL COUNSEL & SECRETARY JOESEPH D. FREITAS ... - .......................................... VICE PRESIDENT, CHIEF FINANCIAL OFFICER & TREASURER DAVID S. MEDVIDOFSKY..................... ......... ........................... .........SENIOR VICE PRESIDENT, PRODUCT OPERATIONS RUTH C.:MUNGER, ANNA D PARKER, STACY JUELFS, KEVIN A COMIER,NANCY L. GIORDANO RAMOS, ROBERT T. HETZEL, SARAH C. BOURDEAU, PRIYESH A. PATEL, STEVEN C. KILINGERMANN, JR, CHRISTOPHER L. COX:: .................... ......... _ ......... VICE PRESIDENTS I further certify that the following statement of the Company is true as taken from the records of said Company as of December 31, 2020. ADMITTED ASSETS Bonds atAmortized Values ............. .....:$ Stocks at Market Value, ......... First Mortgage Loans:. ......... Real Estate ......... ........................ . Cash in Office and Banks .... Balance (Less than 90 Days) LIABILITIES ,927 Reserve for Losses..... ............................................... 0 ,249 Reserve for Loss Adjustment Expenses -......... ............ 0 ,000 Reserve for Unearned Premiums ........................... ............ 0 '505 Reserve for Other Underwriting Expenses ................53,817,249 ,462) Reserve for Taxes, Licenses, and Fees..,..,. ...... ...... 5,383,121 .556 Loss Drafts in. Transit ................................................... o ,550 Other Liabilities .......... .................... .............149,246,177 .933. Total Liabilities ........ .......... ....:......... 208,446,547 ,627 Policyholders: Surplus.. ................ ..............648,281;338 ,885 TOTAL............................................ ........_$856,727,885 Securities as deposited by law, included above = $ 5,523,585 I further Certify that the following is true and exact excerpt from Article IV, Section of the By -Laws of NGM insurance Company which is still valid and existing. The board of directors, the president, any vice president, secretary, or the treasurer shall have the power and authority to appoint attorneys - in -fact and to authorize them to execute on behalf of the company and affix the seal of the company thereto, bonds, recognizances, contracts of indemnity or writings obligatory in the nature of a bond, recognizance or conditional undertaking and to remove any such attorneys -in- fact at any time and revoke the power and authority given to them." SubsQqbed and sworn to before me on this ty day of March, 7 jA i n, Public State ��t Florida K.PentonommUon GG 92a597 es 1211712029. 69-1191 (3121) IN my WITNESS THEREOF I hereunto subscribe y n me and affix the sea of aid company s day of March, R2 aOu"ft s ER a 4 4fJ ih ttmv, belly K. Law 3.3 Affidavit s The Affidavit issafQ e on the following'page° : ;. vxrt otums Cl AFFibwVl7 CUUNTYOFCAILRgUN {}., Bl MAt ME, the undarsi@nsid authority,, do tN i tfay ersonolly;eppeared 'fin hra llu�alak knavtn to me fe bu the person whcisa ngme is subscribed to tide k lowln ff +ni0o, upon Oath saYs I am the Niagager, Sccretary, ar vther A, 6jjtaf"OfNe- or tiie Pr16dpal of t1* &ldddr 1htbe matterbfthe hidato which Ihis afftdavi@is.attached, and I have full other firmsln tWsame 46r 6 F'business; I tnd the pldd6r is not a rl rnher of shy truss, pool or combinatlon to control the price of supplies bid'on, � aeta inflyonc�any peYsan C+s hid ar r�dt i�1'dtijeru�rri. I Offjrhi khanf`am duly agthgdzed to asecute'this contract, that this company, coricbtatlon, firm,'pnrtriersttin or [ridf IduWhastiptTfreparedEh�= idin_colfrdsigh {tltanyath r pJdrier. I Further afflrrp that {he Bidder has not glvenf offered to give, nor Intends�to gveat_nny time heteafter a-rl econatnic Ooogrkuriilfy, future ogfip Q nC g{ft; 1' a grWity, special discount, tPip," tavar, or -service to a public servant in tok nection'wtth tk7e subir tted k Ed. The c4 item ;of this laid as to prIces, tg rns OrcbndJtloils of said bid have ]YdE h e(} commurnicoted:bythe undersfgnednor by any eiFipiogec-ar went to any o#litt po"Csgq ongaged In this type afi IJOO ss. prior to the offfetai apemtog of ihts Bid. Plaine of [3idde'r {�lttpny) green Dream lnternaldunal TLC Acf¢reis "2 ?e&tSas,Cnlinas.�Incl NSuize iG5Q1 Clffic� 7727. lrvin�,tX'T5039 USA Phone Numhor 4-Q 9tt9 paKMuMhOr 2(Y2 204iSAd4 Fnaff,Addre§s suppok@diccStt?aziycon 514ib1iN T4 ATf{� SE1b,SC�l�Et1 pP�tiE' �-±ty t�ie.dbove Afh� E,+Nhor �n �Eh, St`ate'z" that the FaGtS oditt�ltl�d in the' 15gvaara'true.andcorrect,ti2ls daytlf_ /�lY 11NNO _ t ytt� CaxAinl+4�°nIiH OF PRW�4Y}V;U41a; PPiFFr eEXJ E'ir(ati;wiAdi; N4isry Public .:-;%J'V.C.� V. ?L {ayrumhtlz9y�tE�Ir�S,:L��.G1262P Damn las an Nunre �sdaap ntaryPuuticinandfor i=ouitty�'eza9. 3.4 TEC Form 1295 CERTIFICATE OF INTERESTED PARTIES FORM 1295 .Complete Nws 0*prp ate intetaated palir�s, '.. `OPFICE U$e-61kY Coinpl¢tc No§J1, �, 9, 5, And'S 1# Inom.4iena iti#efesc d-pathes� CERT[FIGIATIQN or FILING Certi'Figatfl Numher: 1 opyng-tfii 'InpssentIOfiling #dim, �Nd:}lip Cltj+,state:anFY cpun4y;'at tlpe NlfE;Che¢B,kttlCtys pldo� aFhusiness. - Green Arear,intem#1onh 2b2-r30668tX: Efie, PA Unieed Statds bate hied: ' 2 Nameot,governmental entity or state agenayt at sa partyto the;❑bnlrautfetwRleh the Fong Is GW36i2022 Calhoun Couv, Taxas DateA.ckngwdedued 8 Peovide the idenLfi lifiYq Yi4lhlheY used tiY lhe;g6v¢Ml7lrientaC ehUty oi"state ageYie yto hacir or iilehYifythe 7contraof antl: ptoVldga descripiian ofifhe a$evFgpn,aods; oti+otflr jsroderty p? he providgd'under the dq,'ntract. t LO C[i�e-5F2`Cn frc# No. 20-0 wiib Lan Road ❑roage.linprovem p s a, Name dt'tilterested Party. GEty,'State, urmrry (Place &flhusMass) Natum,y ipiarflst". {chegGk'apRlieabJcS. Controlling :> I intermediary'. Ematta#3ha lry n, TX; ITS Bushav 1vluharale I l!ig> `P Cs CfSA x rt; 5 tifieoCt anlyiltihete is wd IrltisCe�'l�il Pally: x � �ldfSWClRM1{O��EjyGLAi2A[Tf4N a my date oibinh is; My address is � '"�,I@treekj jtityi (atate);sip cn'del j��ry} I declatednder penalty ❑f perjury that the.fa'regalnp Is hue a!ld coneet �r� n'/ rf EX&uted In t,❑1let}+; 5#ategf ','t" ,e , on the ay of4 9 F �k (obh1h) [yda?i `�Ik�tli4lUrp^eY.'I(�ilgrlZe{i�gLllt {+f Glnfraaing ]IL`YnBSS Cnaf�"� Forms provided by Taxas,,Eth(es Cntninission wwW.ethlestist8,ke.'hs;ps - 'Version 'V1.1.191t swc ®RERM ! kract#?Q 065 064-Ck82 GREER 3T2 pp //� t4li": v c},9u2 612CPAU L+2eeN'N 3.5 System for Award Management Records 3/30/2021 Entity Review I System for Award Management ./ SAM*Gov® Boris Sepe Log Out 0 ALERT: Each entity registration expiring between April land September So, zozl will have an additional 18o days added to its expiration date. Read more about the extension on Ind ® ALERT: SAM.gov will be dmvn for scheduled maintenance Saturday,04/10/2021 from S:oo AM to until PM. Register Entity Overview Purpose of Registration Core Data Asseltims Representations and Certifications Points of Contact Small Business Certification Submit Ragistr'ation - I Entity Review Subunit Registration Entity Review Green Decant International LLC DUNS: 831374546 CAGE Code: 5PJH6 Page Description You have completed all sections of your entity's registration in SAM. Please validate the information presented on this page is correct before continuing. Select Edit to make changes to the appropriate sections. If you are satisfied with the information entered, select Submit. DUNS Number: 831374546 D&B Legal Business Name: Green Dream International LLC Doing Business As: G D I Core Data Business & TIN Information: Business Information: Business Start Date: o6/26/2oo9 Fiscal Year End Close Date: 09/30 Company Division Name: Company Division Number: GDI Consul Corporate URL: Congressional District: PA 16 MPIN: *****dre8 Physical Address: Address Line 1: 32W STH ST STE N0607 City: Eric State/Province: PA Country: UNITED STATES ZIP/Postal Code: 16501 - 1338 Mailing Address: Address Line 1: 32 W 8TH ST STE N0607 City: Erie State/Province: PA Cannily: UNITED STATES ZIP/Postal Code: 16501 - 1338 Sensitive Identifiers: EIN: ***"*2758 IRS consent: Tax Payer Name: GREEN DREAM INTERN Address Line 1: 32 W 8TH ST STE N0607 us https://sam.gov/SAM/pages/secured/entity/entityReview.isf 1/11 3/30/2021 Entity Review I System for Award Management Address Line 2: City: Erie State: PA Country: UNITED STATES ZIP/Postal Code: 16501 - 1338 Type ofTax: Applicable Federal Tax Tax Year: (Mast Recent Tax Year) 2010 Name of Individual Executing Consent: VARAND VARTANIAN Title of the Individual Executing Consent: PRESIDENT Signature: VARAND VARTANL'N CAGE/NCAGE Code Entity's CAGE Code: 5PJH6 Does this entity have an Immediate Owner? No Does this entity have any Predecessors? No General Information Country of Incorporation: UNITED STATES State of Incorporation: AR Company Security Level: Highest Employee Security Level: Business Types Check the registrant's Reps & Corte, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA -certified HUBZone small business concern. Additional small business information maybe found in the SBA's Dynamic Small Business Search if the entity completed the SBA Supplemental Pages during registration. Entity Structure Other Profit Structure For Profit Organization EntityType Business or Organization Purpose of Registration All Awards Organization Factors Limited Liability Company Financial Information Do you accept credit cards as a method of payment? No Delinquent Federal Debt: No Account Details: CITIZENS BANK, NATIONAL ASSOCIATION - Cheeldng Electronic Funds M-snsfer: w https://sam.gov/SAM/pages/secured/entity/entityReview.jsf 2/11 3/30/2021 Entity Review System for Award Management Account Type: Checking Financial Institute: CITIZENS BANK, NA7 ABA Routing Number: '*""6150 Account Number: ...-8366 Lockbox Number: Automated Clearing House (ACH): ACH U.S. Phone: (814)833-1134 ACH Non-U.S. Phone: ACH Fax: ACH Email: Remittance Address: Remittance Name: Citizens Bank Address Line 1: 1128 state street Address Line 2: City: Erie State: PA Country: UNITED STATES ZIP/Postal Code: 16507 Executive Compensation Questions . _............... E In your business or organizations preceding completed fiscal year, did your business or organization (the legal entity to which this specific SAM record, represented by a DUNS number, belongs) receive both of the following: i. 8o percent or more of your annual gross revenues in U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements and 2. $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements? No Does the public have access to information about the compensation of the senior executives in your business or organization (the legal entityto which this specific SAM record, represented by a DUNS number, belongs) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Codeof1986? Not Selected Proceedings Questions ............ _.. Is your business or organization, as represented by the DUNS Number on this entity registration, responding to a Federal procurement opportunity that contains the provision at FAR 52.2o9-7, subject to the clause in FAR 52.209-9 in a current Federal contract, or applying for a Federal grant opportunity which contains the award term and condition described in 2 C.F.A. Zoo Appendix XII? No Does your business or organization, as represented by the DUNS number on this specific SAM record, have current active Federal contracts and/or grants with total value (including any exercised/unexercised options) greater than $10,oa0,000? Not Selected https://sam.gov/SAM/pages/secured/entity/entityReview.jsf 3111 3/30/2021 Entity Review I System for Award Management Within the last five years, had the business or organization (represented by the DUNS number on this specific SAM record) and/or any of its principals, in connection with the award to or performance by the business or organization of a Federal contract or grant, been the subject of a Federal or State (1) criminal proceeding resulting in a conviction or other acknowledgment of fault; (z) civil proceeding resulting in a finding of fault with a monetary fine, penalty, reimbursement, restitution, and/or damages greater than $5,000, or other acknowledgment of fault; and/or (3) administrative proceeding resulting in a finding of fault with either a monetary fine or penalty greater than $5,000 or reimbursement, restitution, or damages greater than $1oo,000, or other acknowledgment of fault? Not Selected SAM Search Authorization I authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes Assertions Goods & Serviees: NAICS Codes Selected ....._............ F�TT https://sam.gov/SAM/pages/secured/entity/entityReview.isf 4/11 3/30/2021 Entity Review I System for Award Management Product & Service Codes Selected PSC Description Size Metrics Worldwide• Annual Receipts (in accordance with 13 CPR 121): $ y500000 Number of Employees (in accordance with 13 CFR 12 121): Location IOntional)_ Annual Receipts (in accordance with 13 CFR 12i): $ Number of Employees (in accordance with 1g CFR 21): EDI Information Do you wish to enter EDI Information for your non -government entity? No https://sam.gov/SAM/pages/secured/entity/entityReview.jsf 5/11 3/30/2021 Entity Review I System for Award Management Disaster Response Information Do you wish to be included in the Disaster Response Registry? Yes Does your company require bonding to bid on Contracts? No Geographic Area Served: Any State Representations and Certifications Representations and Certifications I have read each ofthe FAR and DEARS provisions presented on this page. By submitting this certification, 1, Boris Sepe , am attesting to the accuracy ofthe representations and certifications contained herein, including the entire NAICS table. I understand that I may be subject to criminal prosecution under Section loot, Title 18 ofthe United States Code or civil liability under the False Claims Act if I misrepresent Green Dream International LLC in any of these representations or certifications to the Government. READ ONLY PROVISIONS - The following FAR and DFARS provisions are provided for you to read. They do not require completion of any data. Select the provision number to expand and review the fall test. When certifying to the information on this page, you are also certifying that you have read each one of these provisions. FAR 53203-11: Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions FAR 52.2o4-18: Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements - Representation FAR Szzoq:Lo_�. Prohibition on Contracting with Inverted Domestic Corporations. FAR 52.212-5_ Contract Terms and Conditions Required to Implement Statutes or Executive Orders -Commercial Items. FAR 5z.222-38: Compliance with Veterans' Employment Reporting Requirements FAR 52.222-5o: Combating Trafficking in Persons FAR 52i22 5Su Certification Regarding Trafficking in Persons Compliance Plan. FAR 52_2233. Biobased Product Certification FAR 52.225-20 Prohibition on Conducting Restricted Business Operations in Sudan -Certification FAR52.225_25: Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran - Representation and Certifications FAR 52227$: Royalty Information DFARS z5z2n9-:nngReserve Officer Training Corps and Military Recruiting on Campus -Representation. DFARS zS2.225_7-903: Report of Irtended Performance Outside the United States and Canada -Submission with Offer DEARS z5z.225_7_03I: Secondary Arab Boycott of Israel DEARS z52.225_7942: Authorization to Perform DEARS z5z225='LSo: Disclosure of Ownership or Control by the Government of a Country that is a State Sponsor of Terrorism. DEARS 252.229=7oiz: Tax Exemptions (Italy) -Representation. DEARS 251229_7Q13: Tax Exemptions (Spain) -Representation. DEARS rz5a.2a9_7oly Special Construction and Equipment Charges https://sam.gov/SAM/pages/secured/entity/entityReview.jsf 6/11 3/3012021 Entity Review I System for Award Management DFARS 252_z47-7Q23: Transportation of Supplies by Sea (Alternate I, II) USER COMPLETED PROVISIONS - The FAR and DEARS provisions shown below have been populated based on data you provided earlier in your registration. Please open and review each provision before you proceed from this page. If you need to correct any data, a link will be provided to the relevant page for editing. By maintaining an active entity registration in SAM, the entity complied with requirements to report proceedings data in accordance with PAR 52209-7 Information Regarding Responsibility Matters and with requirements to report executive compensation data in accordance with FAR 52 204-10 Reporting Executive Compensation and First -Tier Subcontract Awards. FAR 52203- Certificate of Independent Price Determination. FAR 52.204_3: Taxpayer Identification FAR 52.2o4_5: Women -Owned Business (Other Than Small Business) FAR 52.2oq_i73 Ownership or Control of Offeror FAR 52.2g_42w. Predecessor of Offeror FAR 5a nQ_4-zit, Covered Telecommunications Equipment or Services - Representation FAR 52.209-21. Prohibition on Contracting with Inverted Doinestic Corporations -Representation FAR 52.2o9_5: Certification Regarding Responsibility Matters FAR 52.209-n: Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law FAR 25 212-3. Offeror Representations and Certifications -Commercial Items (Nov 2020) The NAICS Codes you selected on the Goods and Services page of this registration are listed in the table under 52.212-3(c). Those NAICS Cade. for which you are identified as small serve to complete the small business concern representation in 52.212-3(c)(1). You are certifying to your size status for all the NAICS codes in the table. Please review it carefully. The Y/N answers are located in the "Small Business? column. A "Y' indicates "Small" and "N" indicates "Other than Small." This status is derived from the SBA's size standards based on the size mature you entered. The NAICS Codes shown are only those you selected. Use the "View More" button to see your entity's size status for any NAICS Code. PAR 52.2t4i4: Place of Performance -Seated Bidding FAR 52_2i5zie Place of Performance FAR 52.2Ac�r. Small Business Program Representations (Alternate 1) The NAICS Codes you selected on the Goods and Services page of this registration are listed in the table under 52.219-1(c). Those NAICS Codes for which you me identified as small serve to complete the small business concern representation in 52.219-1(c)(1). You are certifying to your size status for all the NAICS codes in the table. Please review it carefully. The Y/N answers are located in the "Small Busnnes.? column. A "Y" indicates "Small" and "N" indicates "Other than Small." This status is derived from the SBA's size standards based on the size metrics you entered. The NAICS Codes shown are only those you selected. Use the "View More" button to see your entity's size status for any NAICS Code. FAR 5231g-2: Equal Low Bids FAR 52.222-i8. Certification Regarding Knowledge of Child Labor for Listed End Products https://sam.gov/SAM/pages/secured/entity/entityReview.jsf 7111 3/30/2021 Entity Review I System for Award Management FAR 5s.222-2z: Previous Contracts and Compliance Reports FAR 25 z22-2,5_ Affirmative Action Compliance FAR z5 z22-48: Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment -Certification. FAR 25 222-5_:, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services - Certification. FAR 52.223-4. Recovered Material Certification FAR 52.223_Q Estimate of Percentage of Recovered Material Content for EPA -Designated Items (Alternate I) FAR 52.223i2u Public Disclosure of Greenhouse Gas Emissions and Reduction Goals -Representation. )•AR52.225-z: Buy American Certificate PAR 2.225_4. Buy American -Free Trade Agreements -Israeli Trade Act Certificate FAR 5222ri: Trade Agreements Certificate FAR z5 z26-2 Historically Black College or University and Minority Institution Representation FAR 522227-i5. Representation of Limited Rights Data and Restricted Computer Sothvare DFARS z52.2o4-7o16. Covered Defense Telecommunications Equipment or Services -Representation DFARS 2522o9-79o2: Disclosure of Ownership or Control by a Foreign Government DFARS z z5 2r6-7oo8: Economic Price Adjustment -Wage Rates or Material Prices Controlled by a Foreign Government - Representation. DFARS 2522z5_7oore Buy American--Balaace of Payments Program Certificate. DFARS 252225_7020: Trade Agreements Certificate. DFARS 252225_7935: Buy American Act --Free Trade Agreements --Balance of Payments Progr in Certificate DFARS z52.2z5_Z4.4. Prohibition on Acquisition of Commercial Satellite Services from Certain Foreign Entities --Representations. DFARS 252.247_7o22: Representation of Extent of Transportation by Sea Grants Certifications l..wT,q.• The Courts Certifications are a common set of certifications and representations reunited by Federal statutes or regulations in accordance with the grants guidance under Title 2 of the Code of Federal Regulations (2 CPR 200.208 Certifications and Representations). Those non -Federal entities who intend to apply for, or are already recipients of Federal grants or agreements, must read and agree to the corresponding certifications and representations. Registrants who reply yes to the following question me required to keep these certifications and representations current, accurate, and complete as part of their entity registration. Does Green Dream International LLC wish to apply for a Federal financial assistance project or program, or is Green Dream International LLC currently the recipient of funding under any Federal financial assistance project or program? No Points of Contact Mandatory Points of Contact: Accounts Receivable POC https://sam.gov/SAM/pages/secured/entity/entityReview.jsf 8/11 3/30/2021 Entity Review I System for Award Management Title: First Name: Varand Middle Name: S Last Name: Vananian Email: info@gdicompany.com US Phone: (814)616-7800 Extension: NON US Phone: Notes: Electronic Business POC Title: First Name: Versed Middle Name: S Last Name: Vartaman Email: info@gdicampany.com US Phone: (814)616-7800 Extension: NON US Phone: Notes: Address Line 1: 32 W 8TH ST STE N0607 Address Line 2: City: Erie State/Province: PA Country: UNITED STATES ZIP/Postal Code: 165ol Government Business POC Title: First Name: Varand Middle Name: S Last Name: Vartanian Email: info@gdicompany.com US Phone: (814)616-7800 Extension: NON US Phone: Notes: Address Line 1: 32 W 8TH ST STE N0607 Address Line 2: City: Erie State/Province: PA Country: UNITED STATES ZIP/Postal Cade: 16501 hftps:/Isam.gov/SAM/pages/secured/entity/entityReview.jsf 9/11 3/30/2021 Entity Review I System for Award Management https://sam.gov/SAM/pages/secured/entity/entityReview.jsf 10/11 GREER ERM .Contr .#20 065 064 G182 Y/N2fiWLHc� ti};O avL �g2eeru P�LNM14y 3.6 Certification Regarding Debarment & Suspension and Other Responsibility Matters CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. Varand Vartanian, President 03/28/2022 Name and Title of Authorized Agent Date (�®r Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. 3.7 Certification Regarding Lobbying Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) if any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be Included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction Imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, Green Dream International LLCcertlfies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 3,1 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any, Varand Vartanian, President Printed Name and Title of Contractor's Authorized Official 03/28/2022 Date 3.8 Conflict of Interest Questionnaire, Form CIQ CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B..23, 84th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed In accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. jJ Name of vendor who has a business relationship with local governmental entity. Green Dream International LLC 2j ❑ Check this box If you are filing an update to a previously filed questionnaire. .(Thelaw requires that you file anupdated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3J Name of local government officer about whom the Information is being disclosed. N/A Name of Officer IJ Describe each employment or other business relationship with the local government officer, or family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? F]Yes FIND B. Is the vendor receiving or likely to receive taxable income, other than Investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? F] Yes F-1 No 6 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. N/A 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section .e76.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 03/28/2022 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 GREER DR6/EAM LwiGu2M 7pw p2e PyPGcywy 3.9 House Bill 89 Verification n The House Bil§ Verification is attached on;th'e following" 4OUSE BILL B UERIFICATI:OPI FORM Certification ttaquired bq Teitas GavernmentCode 5estion70.001 ,The 85" Texas Legtslatore approved new legislation offcctive_september i, 2d17, which amends Texas Local Gauernment Ciktlt. $spt on 1, Suttitie F; 7itIe:70,"Gc vernmepit"Corte by adding ChOter 227i7 Which statesthat a government entity may not enter into azontract (which includes contracts"formed through purghasg orders) with a`campanyfor goods prsen ices unless fl a eantra t contains a utiritten veri# caFian` from'the company thatth: 1) ' aces not boycott.Israel; and 2J Wilt hot-bbycott IsTao[ duringthe;term nfthe 't¢ntfact` PiebuarttoSectiQj 7i3,(F(717_psaj,over'nmentCp e, 1 "Boycott Ifta l" me'aht refUMhp,.to rleal,with terminatir g business aetivltles :Wlth, Or ottfei'WN6 taking any aufldh that As intended to penaitze, infllct,economic;harm on, or Irmit,tornmerclal !relations sp`eci#idphy vJith Israel, otNlith"aaerson or"e��V"�gjhg bt{'sness to �sr=g'eJ.or in ayi #sraeli- contrclled terrltory; but does not "Include an actlon madefor ordinary business -purposes; -and 21 "tompatty ,moans a- for "profit sale proprietorship, organIntion, association, corporations parthei`sp,joihtyenturg,limitedpartnership,IlrtiiteiiliaiiilCty"panne'rs}�ip,oranyhmitedfljabrh£y. icompany, includinga Wholly owned suhsidiary; rajority�uned subs"lctiary,_ parnetcdrrpany or affili eoffhs�se ntitaesdYJiusinessassocia;tF`,oh5thate>Sj5ttoiTiakea,pr6fit 1,(authdr#edofff6ij) BushriaIyiuharalt doher?4yverifythetruthfliln sand: acguracy Of the contents of thestatements subm+tted on this seeYl#tcatian under the.prpuisions of%btitle: F, Title q, �oveinrtsent Ca"d'e Chapter 227p and that the'tolnpany narttf i# ttelp'w; ' 1j ;DoCs gt�t bttycoti Israel cufrentlyf" 2l 'Wtll-not boycott lsraeldurtngthe,term of`tbe-,cpnt ract; and ..� 3"l 1s Of curtefitly Ifsted'on" tti� Teha§ C-omt?trollers '0),mjpaiiiits, that Boyeott l5ra'el List located at https;lfcomptroller• texasFSovlpgrchasindgMblitatrot�/diuestment.phrt . Teen Dream liiternational 111`' Cnlrip2fiy Name � ,{ j t,. Signature of AU ho'hizect official 1'iinted NameotAuthorized Offietal rl 1.4 Title of Authorized 41clal Crate z 4 B.-44-V r-a &p2. ofie.," 3.10 Residence Certification _The Residence COY ificat oW is attached`on the follow ng page RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ I certify that is a "Nonresident Bidder" of Texas (Company. Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) ® I certify that Green Dream International LLC is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. f y 6� Signature of Authorized Agent Varand Vartanian - President Printed Name and Title of Authorized Agent 3/30/2022 Date 3.11 GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 Tlie Contractor Certification is a64cred on the following page Granteelsubreciplent: Include We document In all aplefleabb bidpackom Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Sec ion 3 Economic Opportunities for Low and Very Low -Income Persons THE BIDDER REPRESENTS AND CERTIFIES AS PART OF ITS BIDIOFFER THAT IT: Is a Section 3 Business Concern. A Section 3 Business Concern means a business concern: 1. That is 5l %or more owned by Section 3 Resident(s); or 2. whose permanent, full-time employees include persons, at least30%a of whom are currently Section Residents, or 3. That provides evidence of a commitment to subcontract in excess of 25%of the dollar value of all subcontracts to be awarded to Section 3 Business Concerns, drat meet the qualifications set forth in paragraphs t or 2 herein. ® Is NOT Section 3 Business Concern, but who has and will continue to seek compliance with Section 3 by certifying the following efforts to be undertaken. EFFORTS TO AWARD SUBCONTRACTOR TO SECTION 3 CONCERNS (Check ALL that apply) ❑ By contacting business assistance agencies, minority contractors associations and community organizations to inform them of the contracting opportunities and requesting their assistance in identifying Section 3businesses which may solicit bids for a portion of the work. ❑ By advertising contracting opportunities by posting notices, which provide general information about the work to be contracted and where to obtain additional information, in the common areas of the applicable development(s) owned and managed by the Housing Authority. ❑ By providing written notice to all known Section 3 Business allow the Section 3 Business Concerns to respond to Concerns of contracting opportunities. This notice should be in sufficient time to bid invitations By following up with Section 3 Business Concerns that have expressed interest in the contracting opportunities. By coordinating meetings at which Section 3 Business Concerns could be informed of specific elements of the work for which subcontract bids are being sought. By conducting workshops on contracting procedures and specific contracting opportunities in a timely manner so that Section 3 Business Concerns can take advantage of contracting opportunities. By advising Section 3 Business Concerns as to where to seek assistance to overcome barriers such as inability to obtain bondi ng, lines of credit, financing, or insurance and aiding Section 3 Businesses in qualifying for such bonding , financing, insurance, etc.... E] Where appropriate, by breaking out contract work into economically feasible units to facilitate participation by Section 3 businesses. ❑ By developing and using a list of eligible Section 3Business Concerns. ❑ By actively supporting and undertaking joint ventures with Section 3 Businesses. EFFORTS TO PROVIDE TRAINING AND EMPLOYMENT TO SECTION 3 RESIDENTS ❑ By entering into a "first source" hiring agreements with organizations representing Section 3 Residents. ❑ By establishing training programs, which are consistent with the requirements of the Department of Labor, specifically for Section 3 Residents in the building trades. ❑ By advertising employment and training positions to dwelling units occupied by Category I and 2 residents. ❑ By contacting resident councils and other resident organizations in the affected housing development to request assistance in notifying residents of the training and employment positions to be filled. ❑ By arranging interviews and conducting interviews on the job site. ❑ By undertaking such continued job -training efforts as may be necessary to ensure the continued employment of Section 3 Residents previously hired for employment opportunities. By posting job vacancies in Work -In -Texas or with my local Workforce Solutions Center. Contractor NamelBusiness Name: Green Dream International LLC Date: 03/28/2022 Authorized Representatly Name: Varand Vartanian Signature: B.,: .� Z A 3.12 Document No. 00416 - Noncollusion Affidavit The oncoll n Affidavit is attached the fq l&wing page, r 1)0 111 NT ATf3, 044'16 NQv�!C[7'l.Li aoT iAFFIDAVIT a�tate oh Pemt&yli}anla ) gnnfity:af F`rre 13ushrzZtiubaralC= , ljl lra'#Wy svrorti, sleCaa es'rrnd.says tlt€itt I. Yells M2 inl ber of Green l7rearra Internat anal tIC,ihe>i3lfil R 14 has pbrnktted the tttta4hed Rid; 1 14e the prepa ALiora mid QO ntems' 'OffIl� atac *d Bid �lud of all pertinent 6iecuntstanees`resiree ng such Bi F; 3. Such Bi4 ik Aqw: ',aiid Is ml pctllu0v P 9r Sham Bid, 4. Nelthof the said BIBMR 'attrr ally „a?" ttml bRicets, pefif0t, 64id ,. agonts, represents lyes, emti3oyeea or -parties intiitteut st;,'in lading this affiarifi; Sias irr t�t1y ?y' ollttder orz it3 i znaurtiVed`or ageeed ;duacil} o Ib7direcHy wiCh wnbtfter RI 7 EI ;; rn' peon Fir.sUBatu"a calit� ive �r �haut Bir4,,in dmindo4on with ttie Contr fob which Ihi- rtttachtil Ei3d has lie n,sri matted or to ra tf lalt'trikt lsi dut ,rtt cuiut6etion,'With such U4ntraot; or hasoin auy ntfutper directly or In oe#lyr_ 80tt8ht by aj 'Cement yr callus}on ur, ", , ut�c tion d tnfat`ence"with any:'�it r BYbLiTI , fu2tt UPperson to ix e prtco z liens !it the aitzt640 Id or of:aaty"o et 33Ii? I ficr fo x un.ovcrhead; profit of east aiemaant of fire did pr ki of ti e Bid OUe, bf fitly oClaat II D�7J R or Sn s ctue Ulluagh any ccliusiou, co spit' Oy ccuu fahcc, or iinla vful agcoerri rit,:any #tf1 a Gaga 1;pirrsi ;f"zti:+ITOU MI COUNTY (t "' E-) or any;, on interested in the: ropoaed G�rlft`�eti aucF, 5. Tile OrWc,#ir ltrrces qu6tod in the attgohod`>$ld ark, iiil antl fri er and-#t nPt taid$'eil by iffy 4ollusign; cpnspiracy coruvuance or tutlatrihri agcc meirE,Qn the paif pf the 11L2 a 9Y stay of i s'ageitts,, �ptesentarit es, pwt et's,' entplpyees, or'patties iu inuludrrig interest; (SigrlCtlj` r SrtlSseaiiietlartdst�lorntorrrethis t. tiay_of att'Ck R "` hl�tary polio 'My cottiniission expires 4 \ . rziMMCNAsu3u Sir�6fthsrv�.`�NIa. waTtpW sPN- .. Em®9 W�nr�, NSU�ty PLLbii¢ F�siaAuntY. r. 'N1Y eamMlErFilr4�tllt¢�2�22 G9:1#m185'.i1511'rLL111�Ei 138334fi l )u 01 PQC1!uIVI,Ei r 3.13 Document No. 00420 — Bidder Qualification Statement Thy Bidder Qualfcationtatemen is aachd on thevfollgwing page' vw DOCUMENT NO.00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary; questions may be answered on separate attached sheets. The Bidder may submit any additional information it desires. Date: 03/28/2022 Bidder (Legal Name of Firm): Green Dream International LLC Date Organized: 06/26/2009 Name of Owner(s): EmanRadha /Bushra Mubarak Address: 222 West Las Colinas Blvd., Suite 1650E, Office 1727, hying, TX 75039 Date Incorporated: 06/26/2009 Federal ID Number: 46-0522758 Number of Years in contracting business under present name 12 years List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Contract Date Type of work performed by your company: Construction, paving, grubbing, repair and pipeline work Total Staff employed by Firm (Break down by Managers and Trades on separate sheet): Have you ever failed to complete any work awarded to you? 0 Yes XNo (If yes, please attach summary of details on a separate sheet.. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? p Yes 79 No (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the past five years or that was still in effect during the five year period or is still in effect? 0 Yes X No (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance) Project Amount $ Mo/Yr Completed White Rock Park Hurricane Harvey Recovery Project $237,970.59 06/2020 Clearing and Grubbin to serve Villa Greens $162,533.41 03/202 Clearing an Gru mg to serve Bammel Oaks $110.925.00 02/202 2 Major equipment available for this contract: Are you in compliance with all applicable EEO requirements? XYes 0 No (If no, please attach summary of details on a separate sheet.) 00420-1 dj &ysfli7esses loeafed w}i�tinttae GFari#; F{eelpiarifa Jtifisdict#on that idelltifias ther�salues� as Septian 3 Bu #fire as fioncerns hecause`they'prtit�%1a` conpm€s o 0,crtc fife fOr ivw-.end vaf y lo.w income persons. Bank�Reisre�oes,' Address` . 39ft East Swe Street bootad Name: nary Callesa City.& atafe LIergyr+aae>PA dip. _ I I48 Pliorre Number.%243 e 2Ei3t3 Cresiit available:`. 15 OYitJ` He's this firm or pi le assor firm been'ihvo#vet in a tsarlKruptcy at re r anizat"scir f ©Yes, fitNo (If yes please attbic ummary of detahs onaasepare#O,aheet.? List are 4 shaet'at#ached hdreto.a0 juifgemen#s, claims, arbitratipn proGeadih& Of suits pending ai outsEantlirig against bidder overifi6 last five (5j years uvi}h.atr'autif of_claim`and;bhef dotoripfr'c h. List on'6.sheet attached hetato,all l6wsurt8or tequested arbP#ref wjth fegalg10 construotioni contracts Mikfbh Odkor hasp Initiated within the ;lad 6e (5), years and brief ed(planatiOh of claim and .outcome. ',, Attach esume(s�fprfhe pdncipal member( s)of your organlaation, Including thedffloefs as;lveil as the 6.foposed sVperjntendept far the prdjeot. Si r(r3dtYiis �36 da +af" �, .2t}�,�, Printed Marne and T ilia' � iiushra Nicbftrakr Treasurer Cpmpany Nartie�` GYaen`:Dresir�In't2rnsYrc�nal3.I:C Notary'Stpteman U.S E tt e-zx: being duty , s worn, says thathelshe Is the PositfunlTatle bf f� M Namej, � and ho7ebyswears the the ant" fo #h� fore , Irt0 jugs otjs�nd ail staternphts4herein cantainied aretr andaarredt, `HeIICe.her byauthorizes,an r4uesfs,and+persan,ftnn,orcoPps?fa#tprfto furnts4 any, information regdested by PALM SUiU CiUN7�` in Eerlflaation of the recito comprising this Siddees Quallficattons Statemen Sukiseg bed ands r met i s.. _ doY bt 1 t rd, PJo#ary<Publla= . rsarimfW�i!4#'�"!��VnN�:r+zmt,AYLzy- 5jgnature: �-- sm n.rvmaMpu�u�' eat _OcunkY, Phhtod'Nam®, _ camm ex faa �'+�12422 L'lrt..'d,... 1i°5 A MgAariv�s'� µarrival i3��49 Nry cornmiWon Wlres; jN/ cs Tibe psaeltyformaktpg ise�otatements is presc"rfbed Inthe /t,. Crlmine bode I W;S> : I E,~, END OF MCUM"' T 0 Contract Manager Dr. Emad Windi, with over 25 years of experience in Mechanical engineering, with specialty in storm water management and train surveying and grading will be leading this road maintenance effort. He would be the direct Point of Contact to government and Huron -Manistee National Forest authorities and coordinate all technical and managerial tasks with subcontractors. Name: Dr. Emad Windi Position: Project Manager Office Location: Erie, PA Role on Project: Oversight/Technical Lead Years of Experience: 25 years Years With Current g years Ern lo er: Experience Summary: See below Educational Ph.D. Mechanical Engineering / Background: University of Technology /Baghdad / 1996 Lecturer / Gannon University, Licensure and Certifications: Erie, PA Siemens Certified 2008 to Present GDI, Lead Technical Consultant /Project Manager 2007 - 2008 Areebel Co., Project Manager, USG (US Government) contract for Water Treatment Plant, Bucca, and Basra 132 kV Back Bone Feeder Expansion and rehabilitation Project. 2006 - 2007 Areebel Co., Project Manager, USG contract for Water Treatment Plant, Bucca Expansion and upgrade. 2005 - 2006 Areebel Co., Project Manager, USG contract for Baghdad District 813 Water Network rehabilitation. 2004 - 2005 Shams AL Sabah company, Project Manager, USG contract for 400kv Amara Substation rehabilitation. We have entered preliminary agreements with local vendors for man power to provide the needed resources. We have designated the main and alternative supplier, as mitigating measure to adapt to any unforeseen situation. We have Hallock Contracting Inc. as our main man power supplier, Green Contracting Inc. will act as stand by subcontractor to provide man power as well as equipment as needed. 17 1 Page GDI — Technical Proposal -"4 � GREER DRERM Operations / Construction / Maintenance / Quality / Safety Career reflects over 30 years experience in project management of construction, telecommunications, design, maintenance, and quality assurance in the highly competitive and regulated industries of telephone, cable television, data services and real estate development. Possess a demonstrated record of success in telecommunications, process improvement, business expansion, cost reduction, and profit generation. Expertise includes: • Project Management * Government Coordination * Budgeting * New Business Development * Cost Containment & Profit Growth * Facility Construction * Maintenance Operations * Contract Negotiations Authorized to work in the US for any employer WORK EXPERIENCE Contract Instructor Teleworld Staffing, Inc 2012 to 2014 Contract instructor for AT&T classes including Defensive Driving, Enhanced Loop Maintenance, Importance of Bonding & Grounding for OSP, Cable Locating, and Basic Leak Locating. Conduct classes for AT&T technicians. Enter results in AT&T reporting systems. Project Manager L Reid Consulting 2012 to 2014 Provide project management and inspection of street, sidewalk, and utility projects for Village of Violently, City of Jonestown, and Allen Engineering. Vice President Lookout Construction - Leander, TX 2004 to 2011 Manage construction projects of over $12 million for 5,000-acre real estate development project voted best master planned community by Austin Business Journal. Negotiate competitive contracts with contractors. Develop cost analysis and budgets for future projects Coordinate with engineers and contractors to keep projects on schedule and within budget. Coordinate with utilities companies to insure their facilities are designed and placed on schedule. Inspect contractors work for quality and completion. Insure compliance with state, county, and city environmental regulations and ordinances for all projects. Coordinate with city engineers and contractors to insure acceptance of improvements by the city. Inspect and approve invoices submitted. Develop cost analysis and justification for purchase of new equipment. Member of the homeowner's association architectural control committee with responsibility of inspecting building plans submitted and approve or return with commits. Assist with developing and revising deed restrictions and covenants for subdivisions. Manager Outside Plant Operations Central Texas Technologies - Austin, TX 2001 to 2004 Managed all design, construction and maintenance for telephone fiber to the premise, copper and cable television projects. Developed and managed training programs for cable locating, fiber to the premise, copper, and cable television for all technicians of Central Texas Technologies. Developed budgets for new construction and maintenance expense of all outside plant projects for Central Texas Technologies. Negotiated competitive contracts with contractors, successfully completing all projects on time and under budget. Initiated request for quotes, conducted purchase analysis, and negotiated contracts for equipment and custom components. Held responsible for, and successfully attained profits goals, expense goals, financial and operational planning, payroll, and employee performance. Developed staffing plans, prepared schedules, budgets, and time lines for new projects. Developed and implemented project management of all new commercial customer- projects for company. Effectively created process improvement to reduce cost, in order to increase revenue and improve customer sales. Director ATS Telecommunications Systems, Inc - Austin, TX 2000 to 2001 Managed all engineering and construction of telephone and cable television projects for company. Developed budgets for both capital and maintenance expense of all projects. Cultivated relationships with real estate developers and investors in order to create new business opportunities for ATS. Directed the efforts of employees and contractors to complete projects on time and within budget. Projects included placing central office equipment, placing underground TV and telephone cable, installation and maintenance of all facilities. Manager Construction SBC Communications Inc - Austin, TX 1998 to 2000 Managed a crew of 14 technicians. Saved capital and expense of $1.2 million per year by organizing and managing a cable -testing program. Trained and equipped new technicians. Completed rehabilitation projects of $2 million with contract and company technicians on time and under budget. Coordinated placing of underground, buried and aerial cable for rehab and new projects. Developed a training program with the City of Austin for traffic control and lane closures that resulted in a savings of $200,000 per year. Used ACAS, JMOS for construction projects. GREER D�RgIAIR YJwiGLl�iJ+� �/ow2��iry f�2Ean++Y 3.14 Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations DOCUMENT NO. 00450 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Cneen Dream International LLC 222 West Las Colinas Blvd., Suite 1650E, Office 1727, Irving, TX 75039 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. 11 Yes ❑ No The undersigned hereby certifies that: ❑ The Provision of Local Training Employment and Business Ocportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). ❑ The Equal Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). ❑ The Section 503 clause is included in the contract Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended? ❑ Yes IN No NAME AND TITLE OF SIGNER (Please type) Varand Vartanian, President SIGNATURE DATE 03/28/2022 [1I1LF I31 �ssl�iis� +�oave. �aetne Clgr.Aiw9 Green Dream International LLC 32 W. Sth St. suite no 607 Erie, PA 16501 November 2, 2021 Subject: Authority to sign To whom it may concern This is to certify that Mr. Varand Vartanian as the president of the company, is authorized to sign the bids on behalf of Green Dream International LLC. Respectfully yours Eman Radha Member of SDI CLYDE KAZMIR CONSTRUCTION INC RE -BID LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Addendum No. 2 03/28/2022 BID Clyde Kazmir Construction, Inc. hereinafter called "BIDDER", (Legal Firm Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". Terms used in this BID are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Working Days after the date of OWNER'S Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: 1 2 Date Received: 3.22.22 3.28.22 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 Addendum No. 2 03/28/2022 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. C. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNERS option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.B of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Addendum No. 2 03/28/2022 BASE BID Baseline A: Station 0+00`to 145+50 Item # Item Description Quantity Unit Price Total Bid Price 1 Furnishing Mobilization and Insurance for the 1 LS $31,500.00 $31,500.00 BASE BID project scope as per plans and specifications 2 Furnishing, implementing and maintaining a 1 LS 7,500.00 7,500.00 Storm Water Pollution Prevention Plan (SWPPP) for BASE BID project limits for the duration of the entire project per plans andspecifications 3 Traffic control and barricading for the BASE BID 1 LS 5,000.00 5,000.00 project limits for the duration of the entire project as per plans andspecifications. 4 Removal and disposal of all existing driveway and 1 LS 7,500.00 7,500.00 roadway culverts within the BASE BID project limits of the Base Bid and as called upon in the drawings as per plans andspecifications 5 Regrading and digging of existing channel to a 3,300 LF 46.00 151,800.00 bottom width of 20 feet and sloping embankment at a 4:1 slope and stockpiling spoil materials into habitat mounds including labor, equipment and materials for a complete installation as per plans andspecifications 6 Regrading and digging of existing channel to a 11,080 LF 22.00 243,760.00 bottom width of 15 feet and sloping embankment at a 3:1 slope and trucking of material to designated site including labor, equipment and materials for a complete installation as per plans andspecifications 7 Installation of 18" diameter HDPE corrugated 44 LF 96.00 4,224.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. 8 Installation of 36" diameter HDPE corrugated 334 LF 128.00 42,752.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. 9 Installation of 48" diameter HDPE corrugated 168 LF 202.25 33,978.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. 10 Installation of 60" diameter HDPE corrugated 240 LF 237.50 57,000.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. 11 Installation of 8" Diameter Rock Rip -Rap, 300 CY 124.00 37,200.00 including labor, equipment and materials for a complete installation as per plans and specifications. 00300-3 Addendum No. 2 03/28/2022 BASE BID CONTINUED Item # Item Description Quantity Unit Price Total Bid Price 12 Installation of 36" Diameter HDPE 22.5 Deg. 2 EA 1,084.00 2,168.00 Fitting including labor, equipment and materials for a complete installation as per plans and specifications. 13 Installation of 36" Diameter HDPE 45 Deg. 2 EA 1,084.00 2,168.00 Fitting including labor, equipment and materials for a complete installation as per plans and specifications. 14 Installation of 36" Diameter HDPE 90 Deg. 1 EA 1,084.00 1,084.00 Fitting including labor, equipment and materials for a complete installation as per plans and specifications. 15 Installation of 36" Diameter HDPE Tee Fitting 1 EA 1,700.00 1,700.00 including labor, equipment and materials for a complete installation as per plans and specifications. 16 Installation of 36" Diameter HDPE Reducer 1 EA 650.00 650.00 Fitting to 18" Diameter including labor, equipment and materials for a complete installation as per plans andspecifications. 17 Reconstruction of existing gravel/limestone 135 SY 75.00 10,125.00 roadway including labor, equipment and materials for a complete installation as per plans and specifications. 18 Hydromulch seeding of excavated and disturbed 12 AC 3,700.00 44,400.00 areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL BASE BID $ 684,509.00 TOTAL BASE BID CALENDAR DAYS 45 BASE BID DEDUCTION Item # Item Description Quantity Unit Price Total Bid Price DI Deduction (difference) from Base Bid Item 6 for 1 LF 10.00 10.00 disposing of spoils onsite in lieu of trucking material to off -site disposal area. Priced as a deduction per linear feet of ditch. TOTAL DEDUCTION BASE BID S 10.00 /LF 00300-4 Addendum No. 2 03/28/2022 OPTION A (Baseline A: Station 145+50 to 160+00) Item # Item Description Quantity Unit Price Total Bid Price Al Furnishing Mobilization and Insurance for the 1 LS $12,000.00 $12,000.00 OPTION A project scope as per plans and specifications A2 Furnishing, implementing and maintaining a 1 LS 16,530.00 16,530.00 Storm Water Pollution Prevention Plan (SWPPP) for OPTION A project limits for the duration of the entire project per plans andspecifications A3 Traffic control and barricading for the OPTION A 1 LS 7,500.00 7,500.00 project limits for the duration of the entire project as per plans andspecifications. A4 Removal and disposal of all existing driveway and 1 LS 3,500.00 3,500.00 roadway culverts within the OPTION A project limits of the Base Bid and as called upon in the drawings as per plans andspecifications A5 Removal including truck hauling of all excess 1 LS 2,000.00 2,000.00 spoil materials generated from the OPTION A project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications A6 Regrading and digging of existing roadside 2,710 LF 1.75 4,742.50 ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans andspecifications A7 Installation of 18" diameter HDPE corrugated 20 LF 96.00 1,920.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. A8 Installation of 24" diameter HDPE corrugated 185 LF 112.00 20,720.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. A9 Installation of 36" diameter HDPE corrugated 150 LF 128.00 19,200.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. A10 Installation of 8" Diameter Rock Rip -Rap, 50 CY 124.00 6,200.00 including labor, equipment and materials for a complete installation as per plans and specifications. All Installation of 36" Diameter HDPE 22.5 Deg. 2 EA 1,084.00 2,168.00 Fitting including labor, equipment and materials for a complete installation as per plans and specifications. 00300-5 Addendum No. 2 03/28/2022 OPTION A CONTINUED Item Quantity Unit Total Bid Description Price Price Al2 Installation of 36" Diameter HDPE Tee Fitting 2 EA 1,700.00 3,400.00 including labor, equipment and materials for a complete installation as per plans and specifications. A13 Installation of 36" Diameter HDPE Reducer 1 EA 650.00 650.00 Fitting to 24" Diameter including labor, equipment and materials for a complete installation as per plans andspecifications. A14 Installation of 24" Diameter HDPE Tee Fitting 4 EA 1,500.00 6,000.00 including labor, equipment and materials for a complete installation as per plans and specifications, A15 Installation of 24" Diameter HDPE Reducer 2 EA 550.00 1,100.00 Fitting to 18" Diameter including labor, equipment and materials for a complete installation as per plans andspecifications. A16 Reconstruction of existing asphalt roadway 615 SY 180.00 110,700.00 including labor, equipment and materials for a complete installation as per plans and specifications. A17 Hydromulch seeding of excavated and disturbed 1.5 AC 3,700.00 5,550.00 areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL OPTION A $ 223,880.50 TOTAL OPTION A CALANDAR DAYS 15 00300-6 Addendum No. 2 03/28/2022 OPTION B (Baseline B: Station 1+00 to 18+00 Item# Item Description Quantity Unit Price Total Bid Price B1 Furnishing Mobilization and Insurance for the 1 LS $5,000.00 $5,000.00 OPTION B project scope as per plans and specifications B2 Furnishing, implementing and maintaining a 1 LS 10,325.00 10,325.00 Storm Water Pollution Prevention Plan (SWPPP) for OPTION B project limits for the duration of the entire project per plans andspecifications B3 Traffic control and barricading for the OPTION B 1 LS 2,000.00 2,000.00 project limits for the duration of the entire project as per plans andspecifications. B4 Removal and disposal of all existing driveway and 1 LS 7,500.00 7,500.00 roadway culverts within the OPTION B project limits of the Base Bid and as called upon in the drawings as per plans andspecifications B5 Removal including truck hauling of all excess 1 LS 2,800.00 2,800.00 spoil materials generated from the OPTION B project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications B6 Regrading and digging of existing roadside 3,123 LF 1.75 5,465.25 ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans andspecifications B7 Installation of 18" diameter HOPE corrugated 223 LF 96.00 21,408.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. B8 Hydromulch seeding of excavated and disturbed 2 AC 3,700.00 7,400.00 areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL OPTION B $ 61,898.25 TOTAL OPTION B CALANDAR DAYS 10 00300-7 Addendum No. 2 03/28/2022 OPTION C Baseline A: Station 160+00 to 187+00) Item 4 Item Description Quantity Unit Price Total Bid Price Cl Furnishing Mobilization and Insurance for the 1 LS $7,500.00 $7,500.00 OPTION C project scope as per plans and specifications C2 Furnishing, implementing and maintaining a 1 LS 19,800.00 19,800.00 Storm Water Pollution Prevention Plan (SWPPP) for OPTION C project limits for the duration of the entire project per plans andspecifications C3 Traffic control and barricading for the OPTION C 1 LS 2,000.00 2,000.00 project limits for the duration of the entire project as per plans andspecifications. C4 Removal and disposal of all existing driveway and 1 LS 5,000.00 5,000.00 roadway culverts within the OPTION C project limits of the Base Bid and as called upon in the drawings as per plans andspecifications C5 Removal including truck hauling of all excess 1 LS 3,500.00 3,500.00 spoil materials generated from the OPTION C project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications C6 Regrading and digging of existing roadside 4,740 LF 1.75 8,295.00 ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans andspecifications C7 Installation of 18" diameter HDPE corrugated 418 LF 96.00 40,128.00 storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. C8 Hydromulch seeding of excavated and disturbed 2 AC 3,700.00 7,400.00 areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL OPTION C $ 93,623.00 TOTAL OPTION C CALANDAR DAYS 10 +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The 5% Bid Bond is based on the GREATEST AMOUNT BID which is the sum of the Base Bid + Total Options "A", `B" and "C". GREATEST AMOUNT BID (Base Bid +Total Options "A", `B" and "C"): $ 1,063,910.75 TOTAL CALENDAR DAYS (Base Bid +Total Options "A", `B" and "C"): 80 Addendum No. 2 03/28/2022 ...."....tttttttttt++++++++............tttttt........................... The award will be based on the Base Bid with consideration of the Option A, Option B & Option C. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++!!! 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. 7. The following documents are included and made a condition of this BID: a. Required Bid Security in the form of Bid Bond b. Affidavit C. Certificate of Interested Parties, Form 1295 d. System for Award Management — (sam.gov) e. Certification Regarding Debarment & Suspension and Other Responsibility Matters f. Certification Regarding Lobbying g. Disclosure of Lobbying Activities h. Conflict of Interest Questionnaire, Form CIQ i. House Bill 89 Verification j. Residence Certification k. GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 1. Document No. 00416 - Noncollusion Affidavit in. Document No. 00420 — Bidder Qualification Statement n. Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations Submit one original and three conies of this bid and forms listed above. Please do not fold, bind or staple sets. Bids must be returned in a Sealed 9 x 12 or larger envelope clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064- C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Submit Sealed Bid Before 2:00:00 PM, Thursday, March 31, 2022 to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 3`d Floor, Suite 301 Port Lavaca, TX 77979 00300-9 Addendum No. 2 03/28/2022 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this 31 st day of March ,2022. Authorized Signature: - Name: Kelly Kazmir Title: Vice - President Attesting Name: Jasmine Office Assistant Legal Firm Name: Clyde Kazmir Construction, Inc. Business Address: 1001 West Main Street Phone Number: 361.782.3594 Facsimile Number: E-Mail Address (optional): kelly@kazmirconst.com State of Incorporation, if applicable: Texas State Contractor License No. N/A END OF DOCUMENT 00300-10 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Clyde Kazmir Construction, Inc. as PRINCIPAL, and Lexon Insurance Company , as SURETY are held and firmly bound unto (CALHOUN COUNTY, TEXAS) hereinafter called the "Local Public Agency", in the penal sum of Five Percent of Total Amount Bid Dollars, ($ s%of TAB ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents, THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated Marsh 31, 2022 —, for: REBID? • LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO, 20.065.064•C182 AND CALHOUN COUNTY 2020 CDSG- DR CONTRACT WORK ORDER NO. B-1. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within sixty (60) days after the said opening, and shall within the period specified therefor, or If no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety ar sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter Into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, If the latter be in excess of the former, then the above obligation shall be void and of no affect, otherwise to remain In full force and virtue. IN WITNESS THEREOF, the above parties have executed this instrument this 17th day of lvlqrch, 2022 , the name and corporate seal of each corporate party being hereto affixed and these present signed by Its undersigned representative, pursuant to authority of Its governing body. (SEAL) Clyde Kazmir Construction, Inc. (SEAL) Attest: By: Affix Corporate Seal xhYlWW fi* Lexon Insurance Conlipaa Affix Corporate Seal. Attest ^ By: 1 A�:� ; � r fienjanun K I%arle uss Sean McCauley, Jr., AttquCey-In-Fact Countersigned By Not ReMc wired " Attorney -in -Fact, State of Texas • 00 � • A < INSURANCE POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS, that Endurance Assurance Corporation, a Delaware corporation, Endurance American Insurance Company, a Delaware corporation, Lexon Insurance Company, a Texas corporation, and/or Bond Safeguard Insurance Company, a South Dakota corporation, each, a "Company" and collectively, "Sompo International," do hereby constitute and appoint; Sean McCauley, Jr., Claudia NurTez, Benjamin K. Farley, Sam Duckett as true and lawful Attomey(s)- In-Fact to make, execute, seal, and deliver for, and on its behalf as surety or co -surety; bonds and undertakings given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating to such bonds or undertakings provided, however, that no single bond or undertaking so made, executed and delivered shall obligate the Company for any portion of the penal sum thereof in excess of the sum of ONE HUNDRED MILLION Dollars ($100,000,000.00). Such bonds and undertakings for said purposes, when duly executed by said attorney(s)-in-fact, shall be binding upon the Company as fully and to the same extent as if signed by the President of the Company under Its corporate seal attested by its Corporate Secretary. This appointment Is made under and by authority of certain resolutions adopted by the sole shareholder of each Company by unanimous written consent effective the 15ih day of June, 2019, a copy of which appears below under the heading entitled "Certificate". This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the sole shareholder of each Company by unanimous written consent effective the 15° day of June, 2019 and said resolution has not since been revoked, amended or repealed: RESOLVED, that the signature of an individual named above and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. June, 2019, IN WITNESS WHEREOF, each Company has caused this instrument to be signed by the following officers, and its corporate seal to be affixed this 15th day of Endurance Assurance Corporation Endurance American ,.. Ingunuice Lexon Insurance Company Bond Safeguard Inaurar)ce�Co J y yl ' Fprepairy V�r, , i ' �,rc./ 1 i �-r ` par ` Y y, By;/I,, By. 1(a .•,ii{ Richard Appal; ,tgVAA,�amdor Counsel Richard Appeh,S4P 8,a4enior Counsel oI Richard Appel; Senior' ouhsel Richard Appelf,SVP B•Senic @urance gy. ,n,j�,toral nl '+•a ,ml�can Ir7s4 '1ir�'�i "ANeq•=ao a.�� o� wsu%/�q� Y,- •.1 Q {� ,y°°P,`.(xreg ' q' aqlan•9RA�c� ,SOUTIi SbL®pA^3 SEA .,. SUR �4 '6�, ELAWAflE;'. 1996 Q- ,��iJ: INSURANCE c(f,JPANY•$ '�•,,,, ,.,,,,,, r`'", ,,,uu,n ns"•• ACKNOWLEDfggMENT On this 1514 day of June, 2019, before me, personally came the above signatories known to me, who being duly sworn, did depose and say that he/toy`hy" No{fjcer of each of the Companies; and that he executed sold instrument on behalf of each Company by authority of his a ii under th by ws of each Company," Y. ".,� a Amy aylor, No ublic My Commission Expires`5/9/z3 CERTIFICATE I, the undersigned Officer of each Company, DO HEREBY CERTIFY that: 1, That the original power of attorney of which the foregoing is a copy was duly executed on behalf of each Company and has not since been revoked amended or modified; that the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the whole thereof, 2. The following are resolutions which were adopted by the sole shareholder of each Company by unanimous written consent effective June 15, 2019 and said resolutions have not since been revoked, amended or modified: "RESOLVED, that each of the individuals named below Is authorized to make, execute, seal and deliver for and on behalf of the Company any and all bonds, undertakings or obligations in surety or co -surety with others: RICHARD M. APPEL, BRIAN J. BEGGS. CHRISTOPHER DONELAN, SHARON L. SIMS, CHRISTOPHER L. SPARRO, MARIANNE L. WILBERT ; and be It further RESOLVED, that each of the individuals named above is authorized to appoint attorneys -in -fact for the purpose of making, executing, sealing and delivering bonds, undertakings or obligations in surety or co- surety for and on behalf of the Company." 3. The undersigned further certifies that the above resolutions are true and correct copies of the resolutions as so ecor ad and of the whole thereof. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal this �_ day of 201L. By: Dan a S. L de, retary NOTICE, U. §, IRE6§URX DEPARTMENT'S OFFICE OF FOEELGN ASSETS CONTROL (ORAC) No Coverage is provided by this Notice nor can It be construed to replace any provisions of any surety bond or other surety coverage provided. This Notice provides Information concerning possible Impact on your surety coverage due to directives Issued by OFAC. Please read this Notice carefully,. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency". OFAC has identified and listed numerous foreign agents, front organizations, terrorists, terrorist organizations, and narcotics traffickers as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's webshe —hftn fltmasuN,Qovirt6risanctionsSDN-List. In accordance with OFAC regulations, if It Is determined that you or any other person or entity claiming the benefits of any coverage has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as Identified by OFAC, any coverage will be considered a blocked or frozen contract and all provisions of any coverage provided are immediately subject to OFAC, When a surety bond or other form of surety coverage is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments may also apply. Any reproductions are void. Surety Claims Submission: LexonClalmAdministration0sompo4ntl com Telephone: 615-653.9600 Mailing Address: Sompo International; 12890 Lebanon Road; Mount Juliet, TN 37122.2870 Texas Department of Insurance Strcon Co. No, 3211 License No, 006082 Certificate of Authority THIS IS'ITQ CLRTWY THAT' LEXON INSURANCE COMPANY (a Domestic Stock Casualty company) AUSTIN, TEXAS has complied with the laws of the State of Texas applicable thereto and is hereby authorized to transact the business of Liability other than Automobile; Fidelity & Surety; Burglary & Theft and Reinsurance on all lines authorized to be written on a direct basis insurance within the state of Texas, This Certificate of Authority shall be in full force and effect until it is revoked, cnncclechustv1?cntled according to law. IN TESTIMONY WHEREOF, witness my hand and seal of office at Austin, Texas, this I lth day of January A.D, 2013 ELEANOR KITZMAN CommI SfQIj^ QFINSUR CE BY Godwin Ohaec tesi, Director Company Licensing & Registration Commissioner's Order No. 12-0052 STATE OF TEXAS {} AFFIDAVIT COUNTY OF CALHOUN {} BEFORE ME, the undersigned authority, on this day personally appeared Kelly Kazmir, Vice -President known to me to be the person whose name is subscribed to the following, who, upon oath says: am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not bid thereon. I affirm that i am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this Bid. Affiant Kelly Kazmir. Vice -President Printed Name and Title of Affiant Name of Bidder (Company) Clyde Kazmir Construction, Inc. Address 1001 West Main Street Phone Number 361.782.3594 Fax Number Email Address kelly@kazmirconst.com SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this 30th day of March 2022 JASMINE ELIZABETH CAILIS Notary Public, State of Texas I!k':f°'r Comm. Expires 01-79.2028 Notary Public in and for Jackson County, Texas Notary ID 133541292 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-865073 Clyde Kazmir Construction, Inc Edna, TX United States Date Filed: 03/25/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County, Texas Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 20-065-064-C182 REBID - Lane Road Drainage Improvements - TX 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 Kell KaZmjr and my date of birth is My address is ,®,_. us (street) (ctty) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Jackson County, State of Texas ,on the 30 dayof March ,2o 22. (month) (year) Signature o utho ' ed agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc IV I Active ® Expired ® ID Assigned Expiration Date Address Update _.. Results per page < .1) of 1 > 25 I CLYDE KAZMIR CONSTRUCTION, INC. F—Du—Ns—1 Unique Entity ID: 102652674 Fs—Am7 Unique Entity ID: LRKNRIEPUVL3 CAGE/NCAGE: 8WTM3 Purpose of Registration: Alt Awards Address: 1001 W MAIN ST Edna, TX 77957-2436 USA Entity Status Expiration Date Active Feb 18, 2023 i v v Reset CJ Sort by Expiration Date Ascending DEBARMENT & SUSPENSION, Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in the as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements,. contracts of assistance, loans; and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a patty to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program, An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. See, 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines, See. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program, Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R, Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b, Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records; making false statements; or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (I) (b) of this certification. d. Have not within a three-year period preceding this application I proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a—d) of this certification, Kelly Kazmir, Vice -President March 30, 2022 Name and Title of Authorized Agent Date Si ure of Aulhorized Agent I am unable to certify to the above statements. My explanation is attached. Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation,' renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency; a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its Instructions. (c) The undersigned shall require thatthe language paragraph 1 and 2 of this anti -lobbying certification be Included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subreciplents shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U,S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, Clyde Kazmirconstmetion,inc.certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature_onVgctoes Authorized Official Kelly Kazmir, Vice -President Printed Name and Title of Contractor's Authorized Official March 30, 2022 Date Approved by OMB N/A Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for nubile burden disclosure) . 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a, initial filing _ b. grant b. initial award b. material change c. cooperative agreement C. post -award d. loan For material change only: e. loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter _Subawardee Name and Address of Prime: _Prime Tier_, if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ttf applicable: -8. Federal Action Number, tfknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. individuals Performing. Services (including address iJ' (rfGatividual,last nanie,fa-wname,.M& diyerentfrom No. I 0q) (last name, first name, MI): Information requested through f 2is thorized by title 31 U.S.C. section 135352. T This auThis au Signature: disclosure of lobbying activities is a material KO/Y' KBZDIir representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or Vice - President entered into. This disclosure is required pursuant to 31. Title: U.S.C.1382. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: 361-782-1821 Date: 3/30/22 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) CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 841h Leg., Regular Session. OFFICELISEONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Dale deceived has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Secllon 176.006s). By law this questionnaire must be filed with the records administrator of the local. governmental entity not later than the 7th business dayafter the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commlis an offense It the vendor knowingly violates Section 176.006, Local Government Gone. An offense under this section is a misdemeanor. Name of vendor who has a business relationship with local governmental entity. Kelly Kazmir 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate) 3 Nameoflocal government officer about whom the information is being disclosed. NA Name of Officer 4J Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship' described. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes F-1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes FIND 51 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an. ownership interest of one percent or more. s Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).: March 30, 2022 Signature of vendor ng busin the governmental entity Date Farm provided by Texas EthlcslCommission www.ethics.state.tx.us Revised 11/30/2015 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85th Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. I,(authorized official) KellyKaZmir, do hereby verify the truthfulness and accuracy of the contents of the statements submitted on this certification underthe provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at https://comptrolier.texas.gov/purchasing/publications/d!vestment.php Clyde Kazmir Construction, Inc. Company Name Kelly Kazmir SignatureyKAuthoried Official Printed Name of Authorized Official Vice - President Title of Authorized Official March 30, 2022 Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec, 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ 1 certify that is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) I certify that . Clyde Kazmir Construction, Inc. is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. Signatur=azmi ized. Aug nt KellyVice-President Printed Name and Title of Authorized Agent March 30, 2022 Date GrantealUmcipienC Include this documeni in anapplicabablapacgels. Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program Contractor Certification of Efforts to Fully Comply with Employment and Training Provislons o�Sec ion 3 Economic Opportunities for Low and Very Low -Income Persons THE BIDDER REPRESENTS AND CERTIFIES AS PART OF ITS BIDIOFFER THAT IT: ❑ Is a Section 3 Business Concern. A Section 3 Business Concern means a business cencern: 1. That is 51 %or more owned by Section 3 Resident(s); or 2. Whose permanent, full-time employees Include persons, at least30%of whom are currently Section 3 Residents, or 3. That provides evidence of a commitment to suboontiract In excess of 25% of the dollar value of all subcontracts to be awarded to Section 3Business Concerns, that meet the qualifications set forth In paragraphs 1 or 2 herein. ❑ Is NOT Section 3 Business Concern, but who has and will continue to seek compliance with Section 3 by certifying the following efforts to be undertaken. EFFORTS TO AWARD SUBCONTRACTOR (Check ALL TO SECTION 3 CONCERNS that apply) ❑ By contacting business assistance agencies, minority contractors associations and community organizations to inform them of the oontracting opportunities and requesting their assistance in identifying Section 3 businesses which may solicit bids for a portion of the work. By advertising contracting opportunities by posting notices, which provide general information about the work to be contacted and where to obtain additional information, in the common areas of the applicable developments) owned and managed by the Housing Authority. ❑ eyproviding written notice to all known Section 3 Business Concerns of contracting opportunities. This notice should be in sufficient time to allow the Section 3 Business Concerns to respond to bid invitations By following up with Section 3 Business Concerns that have expressed interest in the contracting opportunities. ❑ By coordinating meetings at which Section 3 Business Concerns could be informed of specific elements of the work for which subcontract bids are being sought. ❑ By conducting workshops on contracting procedures and specific contacting opportunities in a timely manner so that Section Business Concerns can take advantage of contracting opportunities. ❑ By advising Section 3 Business Concerns as to where to seek assistance to overcome barriers such as inability to obtain bondt rig, lines of credit, financing, or insurance and aiding Section 3 Businesses in qualifying for such bonding , financing, insurance, etc.... ❑ Where appropriate; by breaking out contract work into economically feasible units to facilitate participation by Section 3 businesses. ❑ By developing and using a list of eligible Section 3 Business Concerns. By actively supporting and undertaking joint ventures with Section 3 Businesses. EFFORTS TO PROVIDE TRAINING AND EMPLOYMENT TO SECTION 3 RESIDENTS ❑ By entering into a"first source"hiring agreements with organizations representing Section 3 Residents. ❑ By establishing training programs, which are consistent with the requirements of the Department of Labor, specifically for Section 3 Residents in the building kades. ❑ By advertising employment and training positions to dwelling units occupied by Category 1 and 2 residents. ❑ By contacting residents of the resident councils and other resident organizations in the affected housing development to request assistance in notifying training and employment positions to be filled. ❑ By arranging interviews and conducting interviews on the job site, By undertaking such continued job -training efforts as may be necessary to ensure the continued employment of Section 3 Residents previously hired for employment opportunities. ❑ By posting job vacancies. in Work -In -Texas or with my local Workforce Solutions Center. Contractor NameiBusinessName: Clyde Kazmir Construction, Inc. Date: March 30, 2022 Authorized Representative Name: Kelly Kazmir, Vice -President Signature: /ram' G / 4 DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of Texas County of Jackson j Kelly Kazmir , being first duly sworn, deposes and says that: 1. He is Vice President of Clyde Kazmir Construction, Inc. , the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any inarme , directly or indirectly, sought by agreement or collusion or cornmunication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any, person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) Vicd' President Title Subscribed and sworn to me this 30th day of March 2022 By: 1.4 kQnn' I h a Notary Public My commission expires "1 JASMINE ELIZABETH CALLIS Notary Public, State of Texas )ND OF DOCUMENT SV- Comm. Expires 01-19-2026 Notary ID 133541292 00416-1 DOCUMENT NO.00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information it desires. Date: March 30, 2022 Bidder (Legal Name of Firm): Clyde Kazmir Construction, Inc. Date Organized: 1961 Name of Owner(s): Clyde Kazmir Address: 1001 W Main St Edna Texas 77957 Date Incorporated: 1985 Federal ID Number: 74-24012064 Number of Years in contracting business:under present name 37 List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Contract Amount $ Completion Date Type of work performed by your company: Civil Site Services Donna Kazmir- Administrative Assistant Jasmine Callic -Offna Acdctant Di cfn Clark - Mprhn,;r nnr+i„ci�r4-nporntog Fabian Pereida - HSE Inspector David Copeland - Operator Oceil Ontiveros - Operator Vincent Perry - Operatnr Have you ever failed to complete any work awarded to ov u? 0 Yes B No (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? 0 Yes R No (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the past five years or that was still in effect during the five year period or is still in effect? 0 Yes R No (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners; members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance): Project Amount $ MoNr Completed Sandy Branch Solar $1,450,000.00 8121 Brazoria West Solar $1,250,000.00 11/21 Brazoria County Solar $ 3,000,000.00 1/22 Major equipment available for this contract: Excavator with thumb, Doer, Compactors Are you in compliance with all applicable EEO requirements? 0 Yes 0 No (if no, please attach summary of details on a separate sheet.) 00420-1 Are you a Section 3 business? (see below) ❑ Yes 9( No Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipient's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low income persons. Bank References Address: 102 N Wells Contact Name: _ City & State: Edna, Texas Zip: 77957 Phone Number: Credit available: $ 426,000.00 Lori Muschalek 361.782.3533 Has the firm or predecessor firm been involved in a bankruptcy or reorganization? 0 Yes R No (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Signed this 30th day of March 2022 x Signature• Printed Name d Title: Kelly Kazmir, Vice -President Company Name: Clyde Kazmir Construction, Inc. Notary Statement: Kelly Kazmir being duly sworn, says that he/she is the Vice President Position/Title of Clyde Kazmir Construction, Inc. (Firm Name), and hereby swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY in verification of the recitals comprising this Bidder's Qualifications Statement. Subscribed and sworn before me this 30th day of March , 2022 Notary Public JASMINE ELIZABETH CALLIS SignatureNotary Public, State of Texas Comm. Expires 01-19-2026 Printed Name: Jasmine Callis ' ,,," Notary ID 133541292 My Commission Expires; -, The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. END OF DOCUMENT 00420-2 DOCUMENT NO, 00450 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Clyde Kazmir Construction, Inc. 1001 West Main Street Edna, Texas 77957 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. X Yes ❑ No The undersigned hereby certifies that: • The Provision of Local Training. Employment and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). • The Equal Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). 10 The Section 503 clause is included in the contract Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended? ❑ Yes ® No NAME AND TITLE OF SIGNER (Please type) Kelly Kazmir, Vice -President SIGNATURE DATE March 30, 2022 z z 00450-1 K-C LEASE SERVICE INC dba MATAGORDA CONSTRUCTION & MATERIALS RE -BID LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Addendum No. 2 03/28/2022 BI(D K-C Lease Service Inc dba Matagorda Construction & Materials , hereinafter called "BIDDER", (Legal Firm Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-082 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". Terms used in this BID are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Working Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: 1_ 0. Date Received: 3-22.-aa 3-;I-ola2 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 Addendum No. 2 03/28/2022 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. C. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Addendum No. 2 03/28/2022 I Furnishing Mobilization and Insurance for the I LS BASE BID project scope as per plans and 30, o00°O 3 01000 pe snecifications 2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) for BASE BID project limits for the duration of the entire projectper plans and specifications 3 Traffic control and barricading for the BASE BID 1 LS project limits for the duration of the entire project j sue, °a S-00, ° o as per plans and specifications. 4 Removal and disposal of all existing driveway and I LS roadway culverts within the BASE BID project limits of the Base Bid and as called upon in the drawings as per plans and specifications 5 Regrading and digging of existing channel to a 3,300 LF bottom width of 20 feet and sloping embankment at a 4:1 slope and stockpiling spoil materials into Oo Y0• �f oe habitat mounds including labor, equipment and 13.71 00 O. materials for a complete installation as per plans ands cifiications 6 Regrading and digging of existing channel to a 11,080 LF bottom width of 15 feet and sloping embankment at a 3:1 slope and trucking of material to y 3.00 00 476,YH0. designated site including labor, equipment and materials for a complete installation as per plans and specifications 7 Installation of 18" diameter HDPE corrugated 44 LF storm sewer pipe, open cut, including labor, oe 130 o0 � 7 90 equipment and materials for a complete installation as per plans and specifications. 8 Installation of 36" diameter HDPE corrugated 334 LF storm sewer pipe, open cut, including labor, 3 0 00 1-3 y �' N a0 00 equipment and materials for a complete installation as per plans and specifications. 9 Installation of 48" diameter HDPE corrugated 168 LF storm sewer pipe, open cut, including labor, 10, 00 30 a y o 00 equipment and materials for a complete installation as per plans and specifications. 10 Installation of 60" diameter HDPE corrugated 240 LF storm sewer pipe, open cut, including labor, a 00 0 equipment and materials for a complete installation as er plans and specifications. 11 Installation of 8" Diameter Rock Rip -Rap, 300 CY including labor, equipment and materials fora ' S 0 o e k f 0 O0 e o complete installation as per plans and snecifications. 00300-3 Addendum No. 2 03/28/2022 BASE BID CONTINUED Item # Item Description Quantity Unit Price Total Bid Price 12 Installation of 36" Diameter HDPE 22.5 Deg. 2 EA Fitting including labor, equipment and materials 9OQ °` g00,00 for a complete installation as per plans and s ecifications. 13 Installation of 36" Diameter HDPE 45 Deg. 2 EA Fitting including labor, equipment and materials Q 0O.Oa $00. 00 for a complete installation as per plans and specifications. 14 Installation of 36" Diameter HDPE 90 Deg. I EA Fitting including labor, equipment and materials Q °o o° R 0 0. for a complete installation as per plans and 100• strecifications. 15 Installation of 36" Diameter HDPE Tee Fitting I EA including labor, equipment and materials for a mo IOD� 00 %" 000. complete installation as per plans and sriecifications. 16 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 18" Diameter including labor, S oD po s OD o0 equipment and materials for a complete installation as per plans and specifications. 17 Reconstruction of existing gravelAimestone 135 SY roadway including labor, equipment and materials 00 ! O o0 for a complete installation as per plans and s ecifications. 18 Hydromulch seeding of excavated and disturbed 12 AC areas including labor, equipment and materials for 1100 0 0° 107,000.00 a complete installation as per plans ands ecs. TOTAL BASE BID S 8 5771 0,7 0.00 TOTAL BASE BID CALENDAR DAYS s 0 BASE BID DEDUCTION Item # Item Description Quantity Unit Price Total Bid Price Dl Deduction (difference) from Base Bid Item 6 for 1 LF disposing of spoils onsite in lieu of trucking .01 . 0 1 material to off -site disposal area. Priced as a deduction per Linear feet of ditch. TOTAL DEDUCTION BASE BID $ .01 /LF 00300-4 Addendum No. 2 03/28/2022 Item #' ..., ' Al Furnishing Mobilization and Insurance for the 1 LS OPTION A project scope as per plans and 06 000. a o o 0. specifications A2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) o0 S 000. So00 Oo- for OPTION A project limits for the duration of ' the entire ro'ect r plans ands specifications A3 Traffic control and barricading for the OPTION A 1 LS project limits for the duration of the entire project y 00a., z/ 000• ° o as per plans ands specifications. A4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION A project 0 0 00 ' a 000. 1 oZ J�D o0 limits of the Base Bid and as called upon in the i drawings as per plans andspecifications A5 Removal including truck hauling of all excess I LS spoil materials generated from the OPTION A project limits in which the property owner wishes 191000. pO tat 00 0. o0 to have the material removed completely from the property as per the plans andspecifications A6 Regrading and digging of existing roadside 2,710 LF ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and 8.0� a �� 630. materials for a complete installation as per plans and specifications A7 Installation of 18" diameter HDPE corrugated 20 LF storm sewer pipe, open cat, including labor, 'raft oo a 400 ao equipment and materials for a complete installation as per plans and specifications. A8 Installation of 24" diameter HDPE corrugated 185 LF storm sewer pipe, open cut, including labor, Zj s oo a 4 17S 0� equipment and materials for a complete installation as per plans and specifications. A9 Installation of 36" diameter HDPE corrugated 150 LF storm sewer pipe, open cut, including labor, ' equipment and materials for a complete installation as per plans andspecifications. A10 Installation of 8" Diameter Rock Rip -Rap, 50 CY including labor, equipment and materials for a S-0 00 7SO O pO complete installation as per plans and specifications. All Installation of 36" Diameter HDPE 22.5 Deg. Fitting including labor, equipment and materials 2 EA °o o 0 0,° S� (O for a complete installation as per plans and r specifications. 00300-5 Addendum No. 2 03/26/2022 OPTION A CONTINUED Item Quantity Unit Total Bid Description Price Price Al2 Installation of 36' Diameter HDPE Tee Fitting 2 EA including labor, equipment and materials for a 3 pp o' ' b 00. complete installation as per plans and specifications. A13 Installation of 36" Diameter HDPE Reducer I EA Fitting to 24" Diameter including labor, ofl rD D e0 ,-D 0 equipment and materials for a complete installation as per plans andspecifications. A14 Installation of 24" Diameter HDPE Tee Fitting 4 EA including labor, equipment and materials for a DD complete installation as per plans and s ecifications. A15 Installation of 24" Diameter HDPE Reducer 2 EA Fitting to 18" Diameter including labor, o0 ]tea• o a �'/ oD . equipment and materials for a complete installation as per plans andspecifications. A16 Reconstruction of existing asphalt roadway 615 SY including labor, equipment and materials fora 3 S co g3 Das °' complete installation as per plans and specifications. A 17 Hydromulch seeding of excavated and disturbed 1.5 AC areas including labor, equipment and materials for S p O ° oZ a f4," a complete installation as per plans andspecs. TOTAL OPTION A $ g D /o� l Sp , ° ° TOTAL OPTION A CALANDAR DAYS co Addendum No. 2 03/28/2022 B 71, B 1 Furnishing Mobilization and Insurance for the 1 LS 0° o ° OPTION B project scope as per plans and 3o p o. 7poo, s ecifications B2 Furnishing, implementing and maintaining a I LS Storm Water Pollution Prevention Plan (SWPPP) 3 O p0.00 ?poa•pO for OPTION B project limits for the duration of the entire project per plans and specifications B3 Traffic control and barricading for the OPTION B 1 LS °o project limits for the duration of the entire project ( 000.6O f 000. as tier plans and specifications. B4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION B project 1010490. � t o� o0a.' limits of the Base Bid and as called upon in the drawings as tier plans andspecifications B5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION B project limits in which the property owner wishes (�� 000• (� DOO• to have the material removed completely from the as per the plans andspecifications B6 _property Regrading and digging of existing roadside 3,123 LF ditches "V" bottom and sloping embankment at a p0 m 3:1 slope including labor, equipment and materials for a complete installation as per plans and specifications B7 Installation of 18" diameter HDPE corrugated 223 LF storm sewer pipe, open cut, including labor, 1 7 S 00 301 pS °° equipment and materials for a complete installation as plans andspecifications. B8 Hydromulch seeding of excavated and disturbed including labor, and materials for 2 AC 0O 00 3OO O, areas equipment a complete installation as per plans andspecs. TOTAL OPTION B S TOTAL OPTION B CALANDAR DAYS 60 00300-7 Addendum No. 2 03/28/2022 . Cl Furnishing Mobilization and Insurance for the l LS OPTION C project scope as per plans and at000.°e a o0i7 p9 specifications C2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (S WPPP) 3 OFyO.ao 3 �p o� for OPTION C project limits for the duration of r r the entire project per plans and specifications C3 Traffic control and barricading for the OPTION C 1 LS e p project limits for the duration of the entire project IrSDp °O as per plants and specifications. C4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION C project 10000. so limits of the Base Bid and as called upon in the drawin as er plans andspecifications C5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION C P- 3/ project limits in which the property owner wishes to have the material removed completely from the nrnmrtv as ner the plans and specifications C6 Regrading and digging of existing roadside 4,740 LF ditches "V" bottom and sloping embankment at a °c qy�• 3:1 slope including labor, equipment and (p•pe o" materials for a complete installation as per plans and specifications C7 Installation of 18" diameter HDPE corrugated 418 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete / installation as perplans andspecifications. C8 Hydromulch seeding of excavated and disturbed 2 AC areas including labor, equipment and materials for a Complete installation as per plans ands cs. TOTAL OPTION C $ 100a 00 00 TOTAL OPTION C CALANDAR DAYS (PO ++++++ i i i i ++++++++-1-++++i +i-F-i-r-F+++rT.I .... rT++++!-+ ! i i-+++++++++ i i i +++r++4-� The 5% Bid Bond is based on the GREATEST AMOUNT BID which is the sum of the Base Bid + Total Options "A", `B" and "C". o° GREATEST AMOUNT BID (Base Bid +Total Options "A", "B" and "C"): $ TOTAL CALENDAR DAYS (Base Bid +Total Options "A", `B" and "C"): y ? 0 00300-8 Addendum No. 2 03/28/2022 -F+++t+tttttt++ttttt-I--FtttI!...-H-tttt++t+t++-Ftttt+tttttt++i-Fttrrrr-r-rTtttttt-I-i- The award will be based on the Base Bid with consideration of the Option A, Option B & Option C. 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are included and made a condition of this BID: a. Required Bid Security in the form of 5 /• DID 13oAND b. Affidavit C. Certificate of Interested Parties, Form 1295 d. System for Award Management — (sam.gov) e. Certification Regarding Debarment & Suspension and Other Responsibility Matters f. Certification Regarding Lobbying g. Disclosure of Lobbying Activities h. Conflict of Interest Questionnaire, Form CIQ i. House Bill 89 Verification j. Residence Certification k. GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 1. Document No. 00416 - Noncollusion Affidavit in. Document No. 00420 — Bidder Qualification Statement n. Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations Submit one orieinal and three conies of this bid and forms listed above. Please do not fold, bind or staple sets. Bids must be returned in a Sealed 9 x 12 or larger envelope clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064- C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Submit Sealed Bid Before 2:00:00 PM, Thursday, March 31, 2022 to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, Yd Floor, Suite 301 Port Lavaca, TX 77979 00300-9 Addendum No. 2 03/28/2022 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this 3 'fit day of A4oq gL 1.1 2022. Authorized Signature: Name: r; 4ENN CdAMCLESS Title: 114AN AGER. Attesting Name: CNRS C®R,vErf Title: r-S 1-1 MA'TOR K-C Lease Service Inc Legal Finn Namedba Matagorda Construction & Materials Business Address: 1-? 1 *% S I+ 3C SwTH %ARQTY TX 77 ytN Phone Number: R 7 Q- 72 3- 9411 Facsimile Number: E-Mail Address (optional): f ST'WATWO! t9 mL M IIRYGTY Cop" State of Incorporation, if applicable: Z2( State Contractor License No.: 6eZA END OF DOCUMENT 00300-10 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, K-CLeaseServa.[ncdbaMatagordaCttuconHMaeriais aans PRINCIPAL, and TravelersraualtyandSuretyCompanyofAtnerica , as SURETY are held and firmly bound unto Calhoun county,TX- lane Road Ditch Job hereinafter called the "Owner", in the penal sum of s% of the bidsubratted Dollars, ($ r A 1, lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated 3/31/2022 , forcalhoun county, TX - lace Road Subdivision - peer Seadrf TX - Ditch Digging NOW, THEREFOR, if the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within thirty (30) days after the said opening, and shall within the period specified therefore, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Owner in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Owner the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above -bounded parties have executed this instrument under th\giF'seaP seas. this 31st day of Much the name and corporate seal of eag§rty being hereto affixed and these present signed by its undersigned representative, pursuant autf o / governing body. _ K-C Lease Service. Inc dba Mata ~ `t artrucv a tkterlai-s Attest: By: Glen Chambless, General Manager Affix Corporate Seal Attest: By: Travelers Casualtyand Surety6PcTr"a ofAnRiw Afq% _Seai J:! Attest: By: Gordon Sorrel, Attorney in Countersigned By * Attorney -in -Fact, State of Texas Please attach / include original bid bond as the last item in the sealed bid package. Travelers Casualty and Surety Company of America AM Travelees Casualty and Sunaty Company TRAVELERS .1 I St. Pard Fire and urine Insurance company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies', and that the Companies do hereby make, constitute and appoint GORDON SORREL of EL CAMPO . Texas . their true and lawful Attomey(s}in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed bylaw. IN WITNESS WHEREOF, the Companies have caused this Instrument to be signed, and their corporate seals to be hereto affixed, this 21st day of April, 2021. 080 Stale of Connecticut City of Hartford as. On this the 21st day of April, 2021, before me personally appeared Robert L Raney, who acknowledged himself to be. the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, execued the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duty authorized officer. IN WITNESS WHEREOF, I hereunto set my hand and official seal : My Commission expires the 30th day of June, 20260 Anna P. Nowlk, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attomeys-in-Fact and Agents to act for and on behalf of the Comparry and may give such appointee such authority as hisor her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, rewgnizenees, contracts of indewfly, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her, and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, aryl Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and acopy thereof is filed in the office of the. Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of Indemnity, or wd0ng obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairmen, any Executive Vice President, any Senior Vice Pmstderd or any Vice President, arty Second Vice President, the Treasurer, any, Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duty attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duty executed. (under seal, it required) by one or more Attomeys-in-Fact and Agents pursuant to the -power prescribed in his ar her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it Is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, arty Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or PJtomeys-in- Fact for purposes orgy of executing and attesting bonds and undertakings and otter writings obligatory in the neturs thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shelf be valid end bkxMV upon the Company and any suchpower so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, dohereby certify that the above and foregoing is a true and correct copy of the Power of Attomey executed by said Companies, which remains in fullforceand efteet. Dated this 31st day of March 2022 ' Gee) Kevin E. Hugttes, Assiltant: Secretary To van*Oise aothentiidty of tics Poseur ofAKnmByi please calif as at2-6Afh421 3M. Please refer to th above-namedatmmelfs)-ia-Factand the dobA4s of the bond to xshlk* tick Powar ofAtO wmW Is aMQW. CERTIFICATE AS TO CORPORATE PRINCIPAL I, MIST-4 So4ce , certify that I am the Secretary of the Corporation named as Principal in the bid bond; that C LEAJ N Gr! AMi3 t-ESS who signed the said bond on behalf of the Principal was then MAmA-C-.IZ of said corporation; that I know hismer signature, and his/her signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, q9k if of said corporation by authority of its governing body. 1�onxxcata Title: 5wL ARr Tit �RER * Power -of -attorney for person signing for Surety Company must be attached to bond. STATE OF TEXAS {} AFFIDAVIT COUNTY OFCALHOUN {} BEFORE ME, the undersigned authority, on this day personailyappeared "gA/AI 0+019MI LESS known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit Is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not bid thereon. affirm that I am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this Bid. I!'-414 AfBant / C 1-CFAIA/ CHAM%11EJS t /�iiNRGL`R\ Printed Name and Title of Afflant f Name of Bidder (Company} < <t�u�GE rlvL t�gFk nnarnraitolt coNrraucsiau i M.eTieilFr.S Address ''7'' 'o 3S soo" W 77'VlN Phone Number 974 - 223 -49u Fax Number Email Address ESrIMAT)AO&@,MGMt3RYC.XTY CO^ SWORN TO AND SUBSCRIBED BEFORE ME by the.ayb��oveAfflant, who, on oath, states that the facts contained in the above are true and correct, this �6dcay of �/L 1 20= is`•aFn dot CEf�A ��Gt�p 4a�. tom' ]w•. w:�rB Qf s '` Comm. . oa•oa-2o25 Notary Public in and for Cs..Gounty, Texas CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-865690 K-C Lease Service, Inc. DBA Matagorda Construction & Materials Bay City, TX United States Date Piled: 2 Name of governmental entity or state agency that is a party to the contract for Which the Wrm Fis OW28/2022 being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. 20-065.064-C1B2 Lane Road Drainage Improvements Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling intermediary Bruce, Krauskopf Louise, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is & ,LF A/AI 040* if34 ES S and my date of birth is ._, Myaddressis 1%1a Sh} 3S sOaTH , ug errl/, TX 71q)4 ..USA . (street) (city) (state) (zip code) (caintry) I declare under penalty of perjury that the foregoing is true and correct. (- Executed in M ATf1 GO QQPr County, State of TIC , on the=ay of (�_, 20AL. (hwnth) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.etmcs.state.tx.us vciwun Calhoun Couuty, Texas POLICY OF COMPIAMCE SECTION 2252" TEXAS GOvERNNENT CODE Approved by Commissioners Court January 28,2016 Amended by Cominkshmers Court January 31, 2018 Ca n0 Section 2252.908 was added to the Government Code by the 80 Texas Legislature through the adoption of House Bill 1295. The Jaw states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is :provided to the county at: the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Farm 1285 with the state within 30 days of approving a contract with a business entity. Governmental transparency, is the objective of the law. Senate Rill 255 adopted by the 85e Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002, of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarisation of Form 1295 has been replaced by an unworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Eftes Commission promulgated rules to implement the law and established anonline portal https//wwwjAitw. a tx uslwhatsnwfelf info form1295.htm. A business entity will generate Form. 1295 online. Calhoun County will acknowledge online: the mzelpt of Form 1295 after a contract is executed. Within seven. business days, Form 1295 will be available for pubic viewing on tine Commission's website. Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless: It is accompanied by a completed, signed Form 1295 or a signed statement declining the provision of the law under which the business entity is exempt. No later then. 30 days after Commissioner's Court approves a contract or award's a bid with a non-exempt business entity, the County Clark will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. Insert System for Award Management (SAM) Record Search for company and company principal(s). • Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principles are not listed (are not debarred) through the System for Award Management An official website of the United States government Here's how you know You have 2 new aterrs ( l Show / Hide Alerts v -an.SAM*oov® . ,0 Search --- e.g.1606N020002 Search Results Saved Searches Select Domain Entity Information All Entity Information Entities Disaster Response Registry Exclusions Filter By Keyword Search For more information on how to use our keyword search, visit our help guide OAny Words O All Words Q 0 Exact Phrase Q ifr e.g.123456789, Smith Corp "K-C LEASE SERVICE, INC." x Classification Excluded Individual Excluded Entity Federal organizations Exclusion Type Exclusion Program Location Dates FC) No matches found We couldn'tfind a match for your search criteria. Please try another search or go back to previous results. Go Back 4) Feedback v u v Reset 0 Our Website Our Partners Policies Customer Service This is a U.S. General Services Administration General Services Administration Federal Government computer system that is "FOR OFFICIAL USE ONLY." This system is subject to monitoring. Individuals found performing unauthorized activities are subject to disciplinary action including criminal prosecution. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. Gk6W C44?413LlESS (MArok- ER) 3 -31 - aoa'L Name and Title of Authorized Agent Date ''-"Oze�f- gz r SigmahrteofAuthmized Agent I am unable to certify to the above statements. My explanation is attached. DEBARMENT & SUSPENSION, Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section i(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal, statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared Ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. Them is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of:represeMatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal ageney to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for,govenvnern-wide debarment. and suspension of contractors; chair the interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the Just report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order. prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the et 1ve administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget. shall report to the President within three years of the date of this Oiler on Federal agency compliance with the Order, including the numb of exceptions made under Section 2(c), and shallmake recommendations as are appropriate further to curb fraud, waste, and abuse. Implemrentation in the SRF Programs A company or individual who is debarred or suspended cannot pattieipste in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subrpntracds awarded with SRF loan funds. Under 40 C.F.R. 32.510. the SRF agency must submit.a. certification stating that it shall not larowingly enter into any transaction with a person who is proposed for debarment,: suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capi runtion Bred is awarded. A recipient of SRF assistance directly made available by QVftI=UQu grants must provide a certification that it will not knowingly enter into it contract with anyotm who is inaugible under" the regulations to participate in theproject; Contractors on tie project have: to pride asimilar Gmtficat30n prior to the award of a contract and subcontractors on project have to provide the general'contra0W with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party inaligibie to participate in the SRF program. Lists of debarred, w4paided and otherwise ineligible parties are maintained by the General' ServicesAdMillbhatiOn and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. AddiMmAi:Referauces C 40 C.F.R. pittt32; EPA; Regulations on Debarment and. Suspension. , (To be submitted vAth each bid or oft axcae ft $10 ,000) The undersigned oertifles, to the best of his or her knoxAedgis and belle#, that: (a) Info Federal appropriated funds have been paid or wits be, pekl, •by or on behalf of the undersigned. to any person fa'kdkwnokV or attempting to influence an officer oremployes of an agency, a'Member of Congress, an oft r°or. employee of Congress, or an empbyee of a tAstrtt�t of t' in oonnactbn with the awarft of any Federal act, the maidrtg of any Federal gran, to. meldilg of any Federal loan, the entering kft of any cooperative Wit, and the exteridon. neon, mmvel, amendment, or modification of any Federal contract, grant, ban, or cwWMtiaa agraenment. (b) if any funds other then Federal appropriated funds have been paid or Will be paid to any patean w influendng or attempting to NIUSnae an officer or errgloyee of any agenoy, a Mew of Cow, an ofticer or employee of Congress, or an employee of a Member of Congress in rowan vlritir tilt Federal oontract, great,'toan. or 000perOve agreement, the undweligned shall complete and submit Standard Form LL6, Thmiosure Form to Report Lobbying,' in acoordance WM ft ink. This certification is a material representation of fact upon which reliance was placed when was made orentered into. $Wmy4seion of this sen or is a preisctulsit+s for meldng or e transecOW imposed by 31, U.S,¢. $13§3 (as amended l y the LobWng Dbdebtue As t o The Contractor, . 1 .. n , caffas or affirms the t u#** sss and AWMGY of "oh sfatement,of ita oslflfipgtion anti dtsciosure. If any. tnaddttfon..the Onlrrs#or agn titsF. the pr'�o/JWslootis ol'311 Q.S.C. § 3M et seq.. a" to thiscergkation end dWosure; V gny, Signatrue of CoubvaWs Autherired Oteaiet GLf Ng cwAd3t?'LFSS�(k.4N A Grin% Printed Mameend't1f of Cis Ai d GDflfdei 3-3i-sass Date Approved byOMB 034:8-W46 Disrdosm of Lobbying AeHvidea Complete dtis form to disclose lobbyingaetivitasputaaeotto 37 U.S.C.1352 (See reverse, (or n bindemdisalOmm) 1. Type of Federal Action. 2. Status of Federal Action. Report Type: a. contract a. bwodermppiicatua s. irdfnil $liag _ b. grant b. initial award b. manorial change e, cooperative agreement e. post -award d ion Formaterial obaW only. e. loan gtmarantee Year gaaztar Clow hm mnca Dmoeflastreport 4. Name and Address ofleepurf{nglmitity: S./UR%MrdogFAtitylallo.4bsdmwwxlepisaw _Prime _Sabewardee NameaealAddressofprim: Tiar_, if Known: C aal:: iflarown: if 6.FederalDepartrnaatlAgamr. 7. Beder+d. ogramNa llncti�rHotr CFDANumber, ffopkable: & FederalAcdoa.Number>.1Si'erown: 9. Award Amount, jfbh im: s M 4. Namn:arrd Address of Lobbying: egtstrant b. Iaslitiflasls YerYmm ftvlces 8aroechai o orff'tadtvM01, h nama:Jl ar nacre, d wafiv r Ara. RV) 11. informAtim reiinestcd tbrough this farm is authadodby U& 31 UAC. seoGaa 1392. Thin Siguatarin .:. ditdesuft cf l aetividq b a tasteriat .....:.. repveseniaflmofiectupon Widebregancawas pieced Print Name:G1ENNGNAM61.ESS by the;der abovowbeatbfs transaction was made or ordered loWThkAscmasreIs tte81 Tft:--4 A&-4kl6 U&C:13S2. Thls3tdornmHon AIR bibreported to, the Gong semiarc�alty wglbeavagablefor public ,TaiaphmoNo.-.R'A-3a3-49i1 Date 3-3i ObAR inapecdon.Any gin ullsmMthersOlred diala�e basxbject to u dvg peualtY of u rhs�tSlB,et)e smi uet nbre than S1@i1:086 �r each srceh nre: Federaluse only AndmAzed farLocal Jle@rodaefton Surd Form-tltoav-7-477 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTNRIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change boa previous Ming, pursuing fitita 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make paytrteto N a31 lobbying entity forinflueny ncing or attempting to influence an otflcer or employee of any agency. a Member of Congress, an oWKW or employee of Congress, or an employee Of a Member of (ems In tont ed with a coveredFederal action. Complete all sterns that apply for troth the Initial fdittg and material change to the implementing guidance published by the Office of Management and Budget for additionail infam miloon.Refer 1. Identify the type of covered Federal action for which lobbying activity is andlor has been secured to influence the outcome of a covered Federal son=. 2. identify the status of the covered Federal action. 3. Identifythe appropriate classification of this report If this is a follow-up report caused by a material change to the information preufoush' reported, enter the yew and in which the chorge oee maned. Enter tie dabl of the last previously submWed report fry #W reporting entry forthis rovered Federet acclon. 4. Enter the tali name, address. city. State and zip code of the reporting entity. Include Congressional Disblct if known. Check the appropriate classification of the reporting entity ttet designates if it is, or expects to be; a prime or suhaward recipient Identity the berof the sub away dse. e.g.. the fast sub awattiee ofthe:prkne is the 1st tier. Subawands Include but are not limited to euboomracar, subgrants and contract awards under grants. S. If the organization filing the report in Item 4 checks 4Sub awardes,'than enter the full name, address, city, State and zip code of the prime Federal recipient. include Congressional District, it known. 6. Enter the name of the federal agency making the award or loan commitment Include at le .one Coast Gizatbnai level below agency name, if known. For example, Department of iranspgratiort. United States 7. Enter the Federal program name or description for the covered Federal soft (item 1). U known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, Icons, and loan commitments. 8. Enter the roost appropriate Federal dying number available for the Federal action identified M darn 1 (e.g., Request for Proposal (RFP) number; invitations for Bid (IFS) number; grant announcement ment member; the contract, grant, or ben'award number; the applicadWpneposal control number assigned by the Federal agency). Included prof es, e.g., *RFP-DE-90-001" 9. For a covered Federal actual where there has been an award or ban cormmlhne nt by the federal agency, enter the Federal amount of the award/loan commitment for the prime entity Identified in hem 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lodbylrg registrant under the Lobbying Disclosure /tat of 100 engaged by the reporting erdi}y ids im #ern 4to influence an covered Federal goon. Penter r Last the full mites Of the imlivimrat(s) performing setvrekAN include full address if diferant from 10(a). Nerve, First Neale, and MWdle frod (MI). 11. The MTXW SW sego and data the form. Print hislher name_ tiva_ and sal--.....,....a,s. CONFLICT OF INTEREST OUESTIONNAIRE For vendor doing business with local governmental entity This questionnaire reflects changes made to the [Bar by H.B. 23, 84th Leg., Regular Session. OFFlC This questionnaree is being tied in a0c0rdance, with Chapter 176, Local Govemmard Code, by a Data Reouved has a business miadorahip as defined by Section 176.001(1-a) with a local governments! entity the vendor meats requirements under Section 17e.w6(e). By law this questionnaire must be iffed with the records administrator of the local governmental not later than the A h business day after the date the vendor becomes aware of fads that regtdns the b be filed. See Section 176.003(a.1), Local Government Code. A vendor commits an offense if the vendor WwAdngiy violates Section 176.006, Loost Code. An offense under ft section is a misdemeanor. Name of vendor who has brightens relatlonship with local I Check this box if you we filing an update to a previousq completed questionnaire with the appropriate filing author you became mare that the originally filed questionnaire Name of local government officer about whom MA FORM CIO 41ala lotmmre. (The law requires that you file an updated It later than the 7th business day after to date on which Incomplete or inaccurate.) Isbeing disclosed. Nameof r Desorlbe each employment or other trust7Adescaflosany bile with the local govenanent ofttcer, or a officer, as tlescrfbed bySecUon 176.ot3(a 2)(Afamily re(ationsblp wUh tlis hoc Complete subpartsAand8foreachemployeennessrelationship described. Attechadd[Vo CIO as necessary. wb& A. Is the local government officer r a famffy member of the officer receiving or likely to receive taxable income, other than Investment Income, the vendor? a Yes F-� No B. Is the vendor receMrig or ' ey to receive taxable income, other than investment Income, from or at the dreirfim of the local government or a family member of the offwer AND the taxable Income is not received from the local governmental entry? F]Yes ' F-� No Describe each employment retetfonahill,OWthe vendor maned InScolbnImabttefnswith acorporation or other business entity with respect which the local government o serves as an officer or director, or holds an ownership Interest of one percent r more. ElCheck the box If this vendor given the local Wvemmentoftceror as described In Section 176 (a)(2)(B), exoftufing gifts dawbed 3-31-LA-L oxe , -." h..v,ww yr ...... a ... sawn www.euucs.stste.ix.us Revised 1IM?015 CONFLICT OF INTEREST OUESTIONNAiRE For vendor doing business with local governmental entity A complete copy of Chapter 176 of the Local Government Code may be found at http9/www statutes.legis.state.bc us/ Docs/LG/htm/LG 176.htm. For easy reference, below are some of the sections cited on this form. Loaf Cmverr-- Codem f>01f1 . "Business relationship° means a connection or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject -to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Govammant i6 77a falF2►b►►and f8► (a) A focal government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor., (A) has an employment or other business relationship with the local government officer ore family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (!)a contract between the local governmental entity and vendor has been axecwtad; or (ii) the local governmental entity is considering entering into a contract with the vendor, A has given to the bpi. government officer or a family member of the officer one or more gifts that have an aggregate value of morethan $100 in the l2-morith padod preeetfing the tlatethe officer becomes aware that: (1) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Goyerrtrie+tCcdelUMAOBfa►aWJa 1► (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with.a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.p53(a)(2HB), excluding any gift described by 8WHon 176.003(a-1); or (a-1) Th(3)h a family relationship with a local government officer of that local governmental entity. pletedconflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local govemmental entity an application, response to arequest forproposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the data the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. 'Orm provided by Texas 6119m .......o....asmw.,a.us Revised 1 V3012015 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 851 Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. 'Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. 1, (authorized official) LEN,tJ r11AMRL ES S do herebyverify the truthfulness and accuracy of the contents of the statements submitted on this certificationunder the Provisions of subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract, and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at httns://comptroller texas ¢ov/ urchasins/publications/divestmen oho K-C- LEASE SOAVILg Wc• Dupe MAfA/.o[flh r SrrQucTw�v d MdtfEl2tktS Comnanv M Signature of Authorized Official Printed Name o€Authorized Official Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. ❑ 1 certify that (4) "Resident bidder" refers to a person whose principal place of business is In this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. Is a "Nonresident Bidder" of Texas (C�Pany Name) as defined In Government Code §2252.001 and our principal place of business is IGty and state) K-r- l.&SB stRvv.E Wc. DOA/AA:rA&*0t0A cowrsnoc.Tiot+ FY 1 certify that A (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent is a "Resident Bidder" of Texas as 61.15A 7 CO&SO cs (MRaA4ER ) Printed Name and Title of authorized Agent �- 7-31-�aa Date Texas Cenral Land Office Community Development Block Grant (CDBG) Disaster Rek:oM Program Contractor Certification of Efforts to Fully Comply with Employment and Training Ptelri efts Of WON 3 Ecomma Opportunthes for Low artd Very Low -Income Persona THE BIDDER REPRESENTS AND CERTIFIES AS PART OF ITS BO OFFERTHAT IT: M is a Sedan 3 Business Concern. A Setbon 3 Business Can= mama a busneseccacem: 1. Thdis5l%ornmoamWbySediar3R%dder*yor 2. Wlmpem>anenthi inwanobyenm*ldepa=oatbW3D%ofwhaaamanra*aedon3ReddenV:or 3. That prMese eota omarlilmentbsabcankedineacessof25%ofthe duller v4nofalsahcorkedsinbeawudedto Seclai38usinessConcems, inparagrapfiator2hemin. IswTaSecim3& Caodn,totwhohosandvA=O hbseekmnpkmvlbSeclon3byoefiTftlwtekftenortto be underWcen. EFFORTS TO AWAtU)fijo ff TDSEC"rM 3 f 8 (G1rakALLjW,4 tyj ❑ Byeantac"buskressassisbncaagencies, mbo*conkadors aseaddens and camm nNyarg areIninfarmthearofto conhaC6rpopporftarNesattdtegtreslitg$refassesn &ODA Sedan 3br Wntbnaystd*bkhforaMbondtwwaik. ❑ Byadvaftgow*sftoppwkmdnbypodngraf ovAidrpraadapa� dmtnraftdmtftvMiobemmardedaaltsiherato obtain addifiortd kftmafrac in ire unman an areaedireappicable derrefopmenNA armed oWmanagad by On Hawing AL'ho* ❑ Bay awn d knm Sdan 3Bwm Caaofm*aft oWwknfsTics nobcaaad tie kr mb tfimb 3n 0encems In mspW to bidkwlforts By following upad h Sediiar 3 Busin ew Wawa; that haw opmesed kddestn the oarkad ing appabnlee ❑ By co rdnafagmeetkgsatwfichSedan38uameasCacemsocaWbenbnnedofVeftelemnisoftoworkforwhicchddkarkact ddsare beep Sought ❑ BycorKiadigworkshepsancantac6ppraeetkaesand spealcoarWingoiparluni esnaWeljrremoso1hatSedian3BMW Concerns can Inks ad wfte ofcontad ing dppahadles. ❑ By advising Secdon 3 BusinessCor"M as to where In seek assalance to mrave barrian such as kataft In obtain boM rog, Ines of out fitrearatg, orkmance and adng Sedan 3 Buarme s nquallykrg forsuch baraing , famdng, Insurance, elid ... •brtaealmgout comiradwakmtemrrdmicelybeside udisto bperidpalonbySedan 3buskheses. ❑ Sydevabpi md.u*vaidofeg**Sedon3Bu*mCdnodm ❑ Byadkve a andtadwW"jokdvwAseswlttSed on3&dwnes. EFpfiRT$3ifpRAV83ETBAY�t3:AlEA T<i+$lfflki3irfr{S ❑ By enbrkp nb a `fin wtace't ft aW wffi wg dzdmmp m*q Sed m 3 R ❑ By estabbbingtraft pgmms,which are m wMhthe regtaawmisdrtoDepdknentdf abor, simclicallyforSecion3 Redddrb in ttte.b dft trades. ❑ BY adverlairp enr�doynhnt uardrtg ptavUons b tlweang urvnaxrgiee byCategary f and 2 reskieals. Bycatbcfapraddentcomcileandotwmsfttdrwrii fkmnSredkcbdharsbgdevebpmarwbnqueda nnWft resklaft of th hiwp andemplaymtentpaiUons b be Red. ❑ By drengkpelerWmatkfmulducti kd idusdntojobsle. ❑ Byunderidcigdotr :jab'tr afiorbasmaybe neceaparytoensure ihe emplsyraeatof8e 3Redd" WM*for WRATAMOtTIONamifies• ❑ Bypftjobwacandes in WaWn-Temorwilh ylocal wafdaceSoO=Cdrier. Contractor ►k-t66a%to, 4tCE w[ 04R Cont - MATAGoOA (jo�vtl"ftW.'ReN'i'MA'S6R,WI.S 1>de: 3-3,-ADa;L- Authodzed Repreaegt do Name. G,.ENN G i4AM (ll-mS S Signature:/oC�`�"�L./r✓ DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of T/=)(A5 ) County of 4t,4TRGoRO/k ) C1 EN�u r.A4M fftiESS being first duly sworn, deposes and says that: K-e LEASp 58gVICE WC. bQA MR-rAGO¢OA 1. He is. / ANA6 of fvySTtutTloN +� nwTm%r+.s , the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this atliant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conferencewith any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OBVNER) or any person interested in the proposed Contract; and The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. AAhw* "K /qJ "gqTitle Subscribed and sworn to me this � day of �& xrd L , 2o),O— By: Notary Public My commission expires a "C2 : 02" VASEWWAGM NOFARYPtl X •�7' r• IN 133OW3 M;f^� xi 9t8teoftBxeS END OF DOCUMENT ' Comm . %48-2028 00416-1 DOCUMENT NO.00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information it desires. Date: 3-31• aoa2 Bidder (Legal Name of Firm): K-c cEwsa sEnvtta %uc. betas mamAOrRoA * vstswcnoN *-PA T V Q06s Date Organized: fo-Al-19$3 Name of Owner(s): ORvcf- kRwvsKcPP Address: Mix S14 3S SOOTH Date Incorporated: Federal ID Number: 1740-9,97fo ysa. Number of Years in contracting business under present name 3 9 OWS List all other names under which your business has operated in the last 10 years: All Work Presently Under Contract: Type of work performed by your company: 9-oa4 rawsTiAvcTio^J r �RR�NkGt= Have you ever failed to complete any work awarded to ov u? 0 Yes ff'IVo (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? 0 Yes "o (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the past five years or that was stilt in effect during the five year period or is still in effect? 0 Yes 4.90 (if yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance)'. Major equipment available for this contract: -MPtCK lbr; tooz> R SSA/—K*0e- Are you in compliance with all applicable EEO requirements? 11Yes 0 No (If no, please attach summary of details on a separate sheet.) 00420-1 Are you a Section 3 business? (see below) ❑ Yes "o Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at Waist 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipients jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low income persons. Bank References Address: lob w Ainy S[Sii rw Contact Name: CWi*Q%A% 6IAKNAUSER City & State: keana. -rx Zip: -Mgrg, Phone Number. q7q-16.48-,2641 Credit available: $ Tc>o K Has the firm or predecessor firm been involved in a bankruptcy or reorganization? 0 Yes eNo (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. '1 List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction „/q contracts which bidder has initiated within the last five (5) years and brief explanation of claim and 7 outcome. Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. -1 Printed Name and Title: Ga.evv cp.4MQLES S (MAuAGBR ) Company Name: K-r- tease SF.R✓tLE ivc. b%A MpgAWV,0h CMNZrRverl a-nA^1ERiA4-S Notary Statement: (r4cNN CMAMeLESJ beir JuIX s�rro 2, ,lrs that he/she is the tte Ms+N.4GFR POsiiiorvrof,: �`eeo`oEoeEm.u`,`4-mAi mi (Firm Nam), and hereby swears that the answers to the foregoing dons and all statements therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporati€ri to furnish any information requested by CALHOUN COUNTY in verification of the recitals comprising this Bidder's Qualifications Statement. Subscribed and sworn before me this f S� day of <f rr" i(, 20AzVb, Notary Public Signature, » c�'r4- Dmriwar E Printed Name: (.ei11 SP MGn'f�c �f i-t �. �'��' co�r,,•oa�zazs My Commission Expires:V--- The penalty for matingfalse statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. END OF DOCUMENT 00420-2 CHAS CORNETT 830-643-9962 ■ 15+ years of experience in building and managing the construction of civil works including mass earthwork, subgrade, improvements, concrete and asphalt pavements, bridges, retaining walls, and underground utilities. ■ Played key roles on projects including estimating, award, buyout, purchase orders, submittals, schedules, pay estimates, change orders, conflict resolution, and closeout to final acceptance and payment. ■ Proficient in the use of the following software: • HCSS Heavy Bid (estimating software) ■ Plan -Swift (plan take -off software) ■ Bluebeam Revu (plan take -off software) ■ Excel ■ Primavera P6 ■ Viewpoint (accounting software) ■ HCSS Heavy job (project management software) ■ Also some experience in the use of the following software: • AGTEK (earthwork program) ■ On -Screen (plan take -off software) 1996 —1998 SAM HOUSTON STATE UNIVERSITY Huntsville, TX 1998 — 1999 VICTORIA COLLEGE, Victoria, TX ■ Business Administration 2019— 2021 ANGEL BROTHERS ENTERPRISES/TEXAS MATERIALS ■ Administered project management, estimating, and scheduling functions for ongoing construction projects including 35M project in Frio County consisting of 18 miles of asphaltic roadway rehabilitation including subgrade improvements, drainage structures, and management of various subcontractors. 8M project in Travis County consisting of 2.5 miles of roadway reconstruction, multiple drainage structures, and new bridge construction. ■ Bid TXDOT projects monthly start to finish in the value range of 1M to 30M. 2018 — 2019 LANE CONSTRUCTION /(SALiNI-IMPREGILO) Estimating various TXDOT heavy highway and private projects in the Austin/San Antonio Area Project values estimated range from 50M to 200M. Performed take -offs, site investigations, produce paving plans, produced thorough reports for upper management facilitating efficient estimate reviews, built estimates, built quote systems and other estimating functions as needed. Performed various estimating functions for the design build Texas High Speed Rail project. This project value currently is estimated to be in the 15-20 Billion dollar range. Completed estimating functions pertaining to Concrete Paving, Drainage, SW3P items, MOT, and other various items as needed. Worked closely with design engineers regarding project constraints and feasibility based on field experience. 2015 — 2018 AMC TXCI , New Braunfels TX 78132 ■ Administered project management, estimating, and including scheduling functions for ongoing construction projects ■ Comal County Metal Beam Guard Fence and Culvert Repair • Estimated and managed other various projects such as concrete repair, new concrete replacement, concrete ramp installation, tilt wall repair, metal building erection, garage construction, decks, and low water crossings. 2011— 2015 TEXAS STERLING CONSTRUCTION CO. Project Manager/Estimator ■ Administered project management, estimating, and scheduling functions for ongoing construction projects including: ■ NTTA PGBTP Eastern Expansion Section 29 — Rowlett, $57.9M, six lane toll -way on new right of way; excavation and embankment of more than 1.4M CY, 95,000 SF of MSE retaining walls, structural concrete work including 2 bridges requiring more than 68,000 SF of bridge deck, 28,000 LF of Storm Sewer and 200,000 SY of CRCP Paving. Other work items included landscaping, striping, large road sign structures, and roadway illumination. ■ MOUNTAIN CREEK PARKWAY — TXDOT - $31.2 M, four lane divided highway construction: excavation and embankment of more than 200,000 cy; 145,000 SY CRCP paving, 13,000 SF retaining walls; 97,000 sf bridge deck, and 18,000 LF of storm drain. Other work items included landscaping, striping, large road sign structures, signals, and roadway illumination. ■ Stinson Airport — San Antonio TX, Runway rehabilitation 5M, Airport work including earthwork, drainage, waterline, electrical, illumination, sub -grade, concrete and asphalt paving. ■ Estimated City, State, Federal, Private, Joint Venture, and Design Build Projects. Have been a key element in the estimating department which has turned in over 1 Billion Dollars worth of work at over a 10% win rate. Have been directly involved in the capture of more than 200 million dollars in contracts for Texas Sterling Construction in the Dallas and San Antonio areas. 2007 — 2011 TEXAS STERLING CONSTRUCTION CO. Project Coordinator/Junior Manager/Junior Estimator e Administered project management, estimating, and scheduling functions for ongoing construction projects including. ■ TXDOT; Tarrant County STATE HIGHWAY 199 — TXDOT - $31.4 M, Construction of 5 miles of new frontage roads and multiple intersections; excavation and embankment of more than 300,000 cy; 200,000 SY CRCP paving, 60,000 TNS asphalt paving; 230,000 SY lime stabilization. Other work items included multiple box culvert crossings, storm drain, landscaping, bridges, walls, striping, large road sign structures, signals, and roadway illumination. 2006 -2007 WOLF CONSTRUCTION. Construction Foreman/Equipment Operator/Site Surveyor ■ Manage surveying and construction of site work for various building, irrigation, and landscape installations. 2005— 2006 AUSTIN BRIDGE AND ROAD. Equipment Operator ■ Operate and maintain quarry and aggregate producing facility in Georgetown Tx. 2003 -2005 CORNETT LANDSCAPING. Owner/Operator ■ Manage the installation and maintenance of landscaping for residential and commercial properties in the San Marcos TX and surrounding areas. 1999 — 2003 UNITED STATES NAVY. YEOMAN ■ Administrative and document controls for the engineering and weapons departments onboard the U.S.S. Abraham Lincoln (CVN 72) aircraft carrier. 1998 —1999 WILD BORE UTILITIES. Foreman/Equipment Operator ■ Operate and maintain directional boring machine for the installation of various underground utility conduit installations. MISTY JOYCE 2317 CR 117 Wharton, TX 77488 •979-358-0960 Misty@matagordaconcrete.com Skilled financial leader knowledgeable about accounting practices, principles and requirements. Successfully maintains compliant, accurate and cost-effective financial operations for two businesses. Over 19 years in field with stellar record of achievement. 12/2002 — CURRENT SECRETARY/TREASURER, K-C LEASE SERVICE, INC 10/2004 — CURRENT CONTROLLER, MATAGORDA CONCRETE, LLC 04/2001 —04/2007 SPECIALIST E-4, UNITED STATES ARMY RESERVE EDUCATION 052000 HIGH SCHOOL DIPLOMA, BAY CITY HIGH SCHOOL 122004 ASSOCIATE OF ARTS, WHARTON COUNTY JR. COLLEGE SKILLS • Managed bookkeeping and accounting systems and completed data entry with accuracy and efficiency. • Processed accurate payroll for 50 staff and submitted direct deposits with Cyma. • Maintained detailed administrative and procedural processes to improve accuracy and efficiency. • Reconciled monthly statements and transactions to keep records accurate and current. • Assisted with month -end and year-end closings to support accounting system accuracy. • Evaluated open accounts to look for past -due balances and pursue collection strategies. • Advised leadership on HR-related issues, including vacation and sick time, benefits, job services and employment discrepancies. • Developed hiring and recruitment policies to drive transparent and fair hiring process for selecting candidates on basis of merit and relevance with job. • Coordinated communications, including taking calls, responding to emails and interfacing with clients. DOCUMENT NO.00450 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULA 71ONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order I1240 and Federal taws Requiring Federal Contradw to adopt and abide by equal employment opportunity and afittmetive action in theirhiring, firing; and pr0mallon practices. This Includes practices related to face, color, gender, religion, national origin, disabiAty, and veterans' rights. NAME AND ADDRESS OF BIDDER (Include ZIP Code) K-C Lease Service Inc / 7/02 SH 3S-S00TN dba Matagorda Construction & Materials r34Le CITY TX 771-//'f CERTIFICATION BY BIDDER Bidder has participated in a. previous contract or suboontrect subjectto Civic Rights Laws and Regukdmns, des ❑ No The undersigned hereby certifies that. eThe Provision of Loom Tn►#cinch Emoioymera and Brasiness Qnmtituniiies clause (SseHon 3 provfsb� is indi Od' i me Contract. A wrfttan Sermon 3 plail'#most Opporkeft Planpoes prepared and mitfed'as part of the bid // proceedings (find equals or exceeds $100,000). he Ecuat Ogmduaity clause is included in the Contract (IT bid squats or exceeds $10,000). The. Section 503 clause is includedin the contract Have you ever been or are you being considered for sanction due'to violation of Brecuttve :Omer 1124$i as amerrtleti3 ❑ Yes Nr No NAME AND TITLE OF SIGNER (Please 4") reLENN CI4AM3LE5S �AAAPA(PEfZ> SIGNATURE DATE 3-3►-as 00450-1 DERRICK CONTRUCTION COMPANY INC RE -BID LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 DERRICK CONSTRUCTION COMPANY, INC 250 South Cove Harbor n - Rockport, TX 78382 r` www.derrickconstruction.net COPY # 3 SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064- C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 3rd Floor, Suite 301 Port Lavaca, TX 77979 Mailing Address P.O. Box 1046 Rockport, TX 78381 Phone 361.729.2423 Fax 361.729.1218 CONTRACT DOCUMENTS FOR THE REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-CI82 and CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 FEBRUARY 2022 This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program. Prepared by: G & W ENGINEERS, INC. 205 WEST LIVE OAK PORT LAVACA, TEXAS 77979 (361)552-4509 0 & W Engineers, Inc. Texas Registered Engineering Firm F-04188 Project No. 5310.01lb Approved By: Scott R Mason, P.E. Texas Serial No. 127893 Date: 92, lo. Z 2 Addendum No. 2 03/28/2022 BID Derrick Construction Company Inc. (Legal Finn Name) , hereinafter called "BIDDER', is submitting this Bid for Furnishing and Performing the Work specified herein as the REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-CI82 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". Terms used in this BID are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. 3. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Working Days after the date of OWNEWs Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date): Addendum No.: ADDENDUM NO. 1 ADDENDUM NO.2 Date Received: 03-22-22 03-28-22 b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 Addendum No. 2 03/28/2022 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. e. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Addendum No. 2 03/28/2022 BASE BID (Baseline A: Station 0+00 to 145+50 Item # Item Description Quantity Unit Price Total Bid Price I Furnishing Mobilization and Insurance for the I LS BASE BID project scope as per plans and specifications $65,000.00 65 000.00 2 Furnishing, implementing and maintaining a I LS Stone Water Pollution Prevention Plan (SWPPP) for BASE BID project limits for the duration of the entire project per plans andspecifications $24,000.00 $24.000.00 3 Traffic control and barricading for the BASE BID I LS project limits for the duration of the entire project as per plans andspecifications. $10,000.00E$6,500.00 4 Removal and disposal of all existing driveway and I LS roadway culverts within the BASE BID project limits of the Base Bid and as called upon in the drawin as per plans and specifications $6 500.00 5 Regrading and digging of existing channel to a 3,300 LF bottom width of 20 feet and sloping embankment at a 4:1 slope and stockpiling spoil materials into habitat mounds including labor, equipment and materials for a complete installation as per plans and specifications $22.04 $72,732.00 6 Regrading and digging of existing channel to a 11,080 LF bottom width of 15 feet and sloping embankment at a 3:1 slope and trucking of material to designated site including labor, equipment and materials for a complete installation as per plans and specifications $20.50 $249,300.00 7 Installation of IV' diameter HDPE corrugated 44 LF stone sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans and specifications. $345.15 $15.186.601 8 Installation of 36" diameter HDPE corrugated 334 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. $376.40 $125,717.60 9 Installation of 48" diameter HDPE corrugated 168 LF stone sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. $424.60 $71.332.80 10 Installation of 60" diameter HDPE corrugated 240 LF stone sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. $565.43 $135,703.20 11 Installation of 8" Diameter Rock Rip -Rap, 300 CY including labor, equipment and materials for a complete installation as per plans and specifications. s168.271 $50,481.00 00300-3 Addendum No. 2 03/28/2022 BASE BID CONTINUED Item # Item Description Quantity Unit Price Total Bid Price 12 Installation of 36" Diameter HDPE 22.5 Deg. 2 EA Fitting including labor, equipment and materials for a complete installation as per plans and specifications. $2,209.41 $4,418.82 13 Installation of 36" Diameter HDPE 45 Deg. 2 EA Fitting including labor, equipment and materials for a complete installation as per plans and specifications. $2.643.32 1 $5,286.64 14 Installation of 36" Diameter HDPE 90 Deg. 1 EA Fitting including labor, equipment and materials for a complete installation as per plans and specifications. $3,610.50 $3,510.50 15 Installation of 36" Diameter HDPE Tee Fitting i EA including labor, equipment and materials for a complete installation as per plans and specifications. $4.353.40 $4 353.40 16 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 18" Diameter including labor, equipment and materials for a complete installation as per plans andspecifications. $2,900.00 $2 900.00 17 Reconstruction of existing gravel/limestone 135 SY roadway including labor, equipment and materials for a complete installation as per plans and specifications. 288.15 1 $38,900.00 18 Hydromulch seeding of excavated and disturbed 12 AC areas including labor, equipment and materials for a complete installation as per plans andspecs. $4.446.04 $53,352.48 TOTAL BASE BID $ $938 675.04 TOTAL BASE BID CALENDAR DAYS 120 days BASE BID DEDUCTION Item # Item Description Quantity Unit Price Total Bid Price Dl Deduction (difference) from Base Bid Item 6 for 1 LF disposing of spoils onsite in lieu of trucking material to off -site disposal area. Priced as a deduction per linear feet of ditch. $8.00 $88 640.00 TOTAL DEDUCTION BASE BID $ $88,640.00 /LF 00300-4 Addendum No. 2 03/28/2022 OPTION A (Baseline A: Station 145+50 to 160+00 Item # Item Description Quantity Unit Price Total Bid Price A 1 Furnishing Mobilization and Insurance for the 1 LS OPTION A project scope as per plans and specifications $15 600.00 $15,500.00 A2 Furnishing, implementing and maintaining a I LS Storm Water Pollution Prevention Plan (SWPPP) for OPTION A project limits for the duration of the entire project per plans andspecifications $15.000.00 $16,000.00 A3 Traffic control and barricading for the OPTION A I LS project limits for the duration of the entire project as per plans andspecifications. $3,337.50 $3,337.50 A4 Removal and disposal of all existing driveway and I LS roadway culverts within the OPTION A project limits of the Base Bid and as called upon in the drawings as per plans andspecifications $4,835.07 $4 835.07 AS Removal including truck hauling of all excess I LS spoil materials generated from the OPTION A project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications $9,641.75 $9,641.75 A6 Regrading and digging of existing roadside 2,710 LF ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans ands cifiications $19.34 $52.411.40 A7 Installation of 18" diameter HDPE corrugated 20 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. $346.15 $6,903.00 A8 Installation of 24" diameter HDPE corrugated 185 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. $365.50 $67 617.50 A9 Installation of 36" diameter HDPE corrugated 150 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. $376.40 $56 460.00 A10 Installation of 8" Diameter Rock Rip -Rap, 50 CY including labor, equipment and materials for a complete installation as per plans and s ecifications. $168.27 $8 413.50 A I 1 Installation of 36" Diameter HDPE 22.5 Deg. 2 EA Fitting including labor, equipment and materials for a complete installation as per plans and specifications. $2 209.41 $4,418.82 00300-5 Addendum No. 2 vai cei <occ OPTION A CONTINUED Item Quantity Unit Total Bid Description Price Price Al2 Installation of36" Diameter HDPE Tee Fitting 2 EA including labor, equipment and materials for a complete installation as per plans and specifications. $4,353.40 $8.706.80 A 13 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 24" Diameter including labor, equipment and materials for a complete installation as per plans and specifications. 1 $2 900.00 $2,900.00 A 14 Installation of 24" Diameter HDPE Tee Fitting 4 EA including labor, equipment and materials for a complete installation as per plans and specifications. $1 827.60 7 310.00 A15 Installation of 24" Diameter HDPE Reducer 2 EA Fitting to 18" Diameter including labor, equipment and materials for a complete installation as per plans andspecifications. $1 543.00 $3 086.00 A16 Reconstruction of existing asphalt roadway 615 SY including labor, equipment and materials for a complete installation as per plans and s ecifications. $290.40 $178,598.00 A17 Hydromulch seeding of excavated and disturbed 1.5 AC areas including labor, equipment and materials for a complete installation as per plans andspecs. S6.846.00 I $10 269.00 TOTAL OPTION A $ $ 455 060.34 TOTAL OPTION A CALANDAR DAYS 90 d8 S 00300-6 Addendum No. 2 03/28/2022 OPTION B (Baseline B: Station 1+00 to 19+00 Item 0 Item Description Quantity Unit Price Total Bid Price Bl Furnishing Mobilization and Insurance for the 1 LS OPTION B project scope as per plans and specifications $7 535.00 $7,535.00 B2 Furnishing, implementing and maintaining a 1 LS Stoma Water Pollution Prevention Plan (SWPPP) for OPTION B project limits for the duration of the entire project per plans andspecifications $15.100.00 $15.100.00 B3 Traffic control and barricading for the OPTION B 1 LS project limits for the duration of the entire project as per plans andspecifications. $3,358.15 $3 358.15 B4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION B project limits of the Base Bid and as called upon in the drawinos as per plans andspecifications $4,866.00 $4,865.00 B5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION B project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications $9 600.75 $9,600.75 B6 Regrading and digging of existing roadside 3,123 LF ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans andspecifications $19.34 $60.398.82 B7 Installation of 18" diameter HDPE corrugated 223 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans and specifications. $345.15 $76,968.45 B8 Hydromulch seeding of excavated and disturbed 2 AC areas including labor, equipment and materials for a corn fete installation as per plans andspecs. g $13,692.00 TOTAL OPTION B $ $191 518.17 TOTAL OPTION B CALANDAR DAYS 30 da S 00300-7 Addendum No. 2 03/28/2022 OPTION C seline A: Station 160+00 to 187+00 Item # Item Description Quantity Unit Price Total Bid Price Cl Furnishing Mobilization and Insurance for the 1 LS OPTION C project scope as per plans and specifications $6,500.00 $6,500.00 C2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) for OPTION C project limits for the duration of the entire project per plans and specifications $12,450.00 12 450.00 C3 Traffic control and barricading for the OPTION C 1 LS project limits for the duration of the entire project as per plans andspecifications. $2 800.00 $2.800.00 C4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION C project limits of the Base Bid and as called upon in the drawings as per plans andspecifications $4.025.00 $4,025.00 C5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION C project limits in which the property owner wishes to have the material removed completely from the property as per the plans andspecifications $8,000.00 $8,000.00 C6 Regrading and digging of existing roadside 4,740 LF ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans and specifications $19.34 $91,671.60 C7 Installation of 18" diameter HDPE corrugated 418 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. $345.15, $144,272.70 C8 Hydromulch seeding of excavated and disturbed 2 AC areas including labor, equipment and materials for a complete installation as per plans andspecs. 6 846.00 TOTAL OPTION C $ 283 11.30 TOTAL OPTION C CALANDAR DAYS 45 days The 5% Bid Bond is based on the GREATEST AMOUNT BID which is the sum of the Base Bid + Total Options "A", "B" and "C". GREATEST AMOUNT BID (Base Bid +Total Options "A", "B" and "C")t $1,868,664.85 TOTAL CALENDAR DAYS (Base Bid +Total Options "A", "B" and "C"): 285 days 00300-8 Addendum No. 2 03/28/2022 ITT -r-i�i i 1 1 1 1-11 r+ 1 1 1 i 1 1 1-1 1 1 1 1-1--1 1 1 1-f-r-1 -I--I--I-+- .. The award will be based on the Base Bid with consideration of the Option A, Option B & Option C. 6. BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are included and made a condition of this BID: a. Required Bid Security in the form of Surety Bid Bond b. Affidavit C. Certificate of Interested Parties, Form 1295 d. System for Award Management — (sam.gov) e. Certification Regarding Debarment & Suspension and Other Responsibility Matters f. Certification Regarding Lobbying g. Disclosure of Lobbying Activities h. Conflict of Interest Questionnaire, Form CIQ i. House Bill 89 Verification j. Residence Certification k. GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 I. Document No. 00416 - Noncollusion Affidavit m. Document No. 00420 — Bidder Qualification Statement n. Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations Submit one orieinal and three copies of this bid and forms listed above. Please do not fold, bind or staple sets. Bids must be returned in a Sealed 9 x 12 or larger envelope clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064- C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Submit Sealed Bid Before 2:00:00 PM, Thursday, March 31, 2022 to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 31 Floor, Suite 301 Port Lavaca, TX 77979 00300-9 Addendum No.. 2 03/28/2022 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this 31 day of Authorized Signature: Name. Roy Johnson Attesting March Name: Derrick Johnsoff Title: Treasurer I Director Of Operations , 2022. Legal Firm Name: Derrick Construction Company Inc. Business Address: 250 S Cove Harbor Rockport, Texas 78382 Phone Number: 361-729-2423 Facsimile Number: 361-729-1218 E-Mail Address (optional): serenity@derrickconstruction.net State of Incorporation, if applicable: Texas State Contractor License No.: Charter No. 1146525 END OF DOCUMENT 00300-10 KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Derrick Construction Company, Inc. as PRINCIPAL, and The Cincinnati Casualty Company , as SURETY are held and firmly bound unto (CALHOUN COUNTY, TEXAS) hereinafter called the "Local Public Agency", in the penal sum of Five Percent of the. Greatest Amount Bid Dollars, ($ 5%G.A.B. ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents, THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated March 31at, 2022 , for: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20.085-064-C162 AND CALHOUN COUNTY 2020 CDBG- DR CONTRACT WORK ORDER NO. B-1. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within sixty(60) days after the said opening, and shall within the period specified therefor, or If no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, forthe faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, If the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above parties have executed this instrument this 31st day of 1%1111 March. 2022 the name and corporate seal of each corporate party being here 6 and these present signed by its undersigned representative, pursuant to authority of its vern' :11L)} Attest: By: Roy Johnson (Vice Presicle'n'ftr-111 er Allen Affix Corporate Seal Derrick Construction Company, Inc. Attest: By: Affix Corporate Seal co`�nati CdSG Attest: By: Countersigned CINCINNAT11:0 OHID : By Tricia. Balolong _ Off••• --- %�Je "Attorney -in -Fact, State of Texas CERTIFICATE AS TO CORPORATE PRINCIPAL 1, Shane Johnson certify that I am the Secretary of the Corporation named as Principal in the bid bond; that Roy Johnson who signed the said bond on behalf of the Principal was then Vice President of said corporation; that I know his/her signature, and his/her signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, on behalf of said corporation by authority of its governing body. 1%%1`QuGT/f S 'wi of Title: Shane Johnson I Corp. Secrerw_: Derrick Construction Company�fftc,�„j,.;: Power -of -attorney for person signing for Surety Company must be attached to bond. CINCINNATI INSURANCE COMPANIES SURETY BOND SEAL ADDENDUM The CINCINNATI CASUALTY COMPANY Due to logistical issues associated with the use of traditional seals during the COVID-19 pandemic, The Cincinnati Casualty Company ("Cincinnati") has authorized its Attomeys-in-Fact to affix Cincinnati's corporate seal to any bond executed on behalf of Cincinnati by any such Attorney -in -Fact by attaching this Addendum to said bond. To the extent this Addendum is attached to a bond that is executed on behalf of Cincinnati by its Attomey-in-Fact, Cincinnati hereby agrees that the seal below shall be deemed affixed to said bond to the same extent as if its raised corporate seal was physically affixed to the face of the bond. Dated this 24th day of March, 2020. The Cincinnati Casualty Company ,0,. , ice. p CINCINNATI, p OHIO ,a3 By: Stephen A. Ventre, Senior Vice President THE CINCINNATI INSURANCE COMPANY THE CINCINNATI CASUALTY COMPANY Fairfield, Ohio POWER OF ATTORNEY KNOWALL MEN BY THESE PRESENTS: That THE CINCINNATI INSURANCE COMPANY and THE CINCINNATI CASUALTY COMPANY, corporations organized under the laws of the State of Ohio, and having their principal offices in the City of Fairfield, Ohio (herein collectively called the "Companies"), do hereby constitute and appoint William Blanchard; James R. Reid; Nftlliam Mitchell Jennings; Aaron Endit Tdcia Balclong; Payton Blanchard; Lindsay Senior Gingras; Jessica Turner and/or Allison Cantu of Fort Worth, Texas their true and legal Attomey(s)-in-Fact, each in theirseparate capacity if more than one is named above, to sign, execute, seal and deliver on behalf of the Companies as Surety, any and all bonds, policies, undertakings or other like instruments, as follows: Any such obligations in the United States, up to Fifty Million Dollars and No/100 ($50,000,000.00). This appointment is made under and by authority of the following resolutions adopted by the Boards of Directors of The Cincinnati Insurance Company and The Cincinnati CasualtyCompany, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the President or any Senior Vice President be hereby authorized, and empowered to appoint Attorneys -in -Fact of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and may authorize any officer or any such Attorney -in -Fact to affix the corporate seal; and may with or without cause modify or revoke any such appointment or authority. Any such writings so executed by such Attomeys4n-Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. RESOLVED, that the signature of the President or any Senior Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary or Assistant Vice -President and the Seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company. IN WITNESS WHEREOF, the Companies have caused these presents to be sealed with their corporate seals,duly attested by their President or any Senior Vice President this 16th day of March, 202E �a L SEAL ^�SEAAI SEAL THE CINCINNATI INSURANCE COMPANY. axio oxix THE CINCINNATI CASUALTY COMPANY STATE OF OHIO )SS; COUNTY OF BUTLER ) �a On this 16th day of March. 2021 before me came the above -named President or Senior Vice President of The Cincinnati Insurance Company and The Cincinnati Casualty Company, to me personally known to be the officer described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of said Companies and the corporate seals and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporations. Keith Ctt, Attorney at Law Notary Public — State of Ohio My commission has no expiration date. Section 147.03 O.R.C. I, the undersigned Secretary or Assistant Vice -President of The Cincinnati Insurance Company and The Cincinnati Casualty Company, hereby certify that the above is the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Power of Attorney is still in full force and effect. Given under my hand and seal of said Companies at Fairfield, Ohio, this 31st day of March 2022 ea eNZI"KE% BN-1457 (3/21) DERRICK CONSTRUCTION COMPANY, INC 250 South Cove Harbor Rockport, TX 78382 www.derrickoonstruction.net CORPORATE RESOLUTION DERRICK CONSTRUCTION COMPANY, INC. I HEREBY CERTIFY IT WAS RESOLVED BY A QUORUM OF THE DIRECTORS OF DERRICK CONSTRUCTION COMPANY, INC. AT THE MEETING ON THE 20TH DAY OF JANUARY, 2021, THAT ROSE JOHNSON, PRESIDENT, ROY M. JOHNSON, VICE-PRESIDENT, AND DERRICK JOHNSON, TREASURE & DIRECTOR OF OPERATIONS BE AND HEREBY HAVE AUTHORIZATION TO EXECUTE ALL DOCUMENTS (INDIVIDUALLY OR TOGETHER) NECESSARY FOR THE TRANSACTION OF BUSINESS IN THE STATE OF TEXAS ON BEHALF OF DERRICK CONSTRUCTION COMPANY, INC. AND THAT THE ABOVE RESOLUTION WAS UNANIMOUSLY RATIFIED BY THE BOARD OF DIRECTORS AT SAID MEETING AND THE RESOLUTION HAS NOT BEEN RESCINDED OR AMENDED AND IS NOW IN FULL FORCE AND EFFECT; AND IN AUTHENTICATION OF THE ADOPTION OF THIS RESOLUTION, I SUBSCRIBE MY NAME F JANUARY 2021 SHANE JOHNSON, SECRETARY OF Derrick Construction Company Inc. Mailing Address P.O. Box 1046 Rockport, TX 78391 Phone l 361.729.2423 Fax 1361.729.1218 STATE OF TEXAS {} {} AFFIDAVIT COUNTY OF CALHOUN BEFORE ME, the undersigned authority, on this day personally appeared Roy Johnson known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not bid thereon. I affirm that I am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this Bid. Affiant Roy Johnson (Vice President) Printed Name and Title of Affiant Name of Bidder Address Phone Number Fax Number Derrick Construction Company Inc. 250 S Cove Harbor Rockport, Texas 78382 361-729-2423 361-729-1218 Email Address serenity@derrickconstruction.net SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this 31 day of March 20 22 . �S l Y SEREr�7IYDAWN ALL8�1 iDYi2eatt69s er Allen Aransas MOo EMk= Notary Public in and for County, Texas CERTIFICATE OF INTERESTED PARTIES m FORM 1295 iof 1 Complete Nos. 1- 4 and 6 if there are Interested parties. OFFICE USE ONLY Complete Nos, 1, z, 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. Derrick Construction Company Inc 2022-865931 Rockport, TX United States Date Filed:. 03/28/2022 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City Of Calhoun County, Texas Date. Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify thecontract, and provide a description of the services, goods, or other property to be provided under the contract. CALHOUN COUNTY 2020 CDBG-DR CALHOUN COUNTY 2020 CDBG-DR CONTRACT NOS - Installation of approx. 24,953 LF of drainage channel ditches,1782, LF of storm sewer pipe, 350 CY of rock ri -rap,& reconstruction of gravel road. 4 Name of Interested Party City, State, Country (piece of business) Nature of interest (check applicable) Controlling Intermediary G&W Engineering Port Lavaca, TX United States X 5 Check only it there is NO Interested Party, 6 UNSWORN DECLARATION My name is Roy Johnson and my date of birth is My address is United States Ismael) (city) y) (sate) (zip carte) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Aransas county, State of Texas 9n4he 3l day of March 2022 (month) (year) y !/ Sigtrlsture of orize gent of contracting business entity (Declarant) Forms nrnvidpd by To-<gg. Ethics Ca ssion www.ethlcs.state.tx,us Version V1.1.191b5edc ,Am.SAM.Gov® DERRICK CONSTRUCTION COMPANY, INC. ALER77 This entity is only available FOR OFFICIAL USE ONLY. DUNS Unique Entity ID SAM Unique Entity ID CAGE I NCAGE 786971374 KNJXK1384GLD7 1U3V4 Purpose of Registration Registration Status Expiration Date All Awards Active May 14, 2022 Physical Address Mailing Address 250 Cove Hbr N PO Box 1046 Rockport, Texas 78382.7457 Rockport,: Texas 78381-1046 United States United States Doing Business as Division Name Division Number (blank) (blank) (blank) Congressional District State/ Country of Incorporation URL Texas 27 Texas United States httpa/wwwAemiekeonstruetlon.net MPIN " 0341 Registration Dates Activation Date Submission Date Initial Registration Date May17, 2021 May 14, 2021 Aug 28, 2001 Entity Dates Entity Start Date Fiscal Year End Close Date Mar 1, 1990 Dec 31 Immediate Owner CAGE Legal Business Name (blank) (blank) Highest Level Owner CAGE Legal Business Name (blank) (blank) Executive Compensation In your business or organization's preceding completed fiscal year, did your business or organization (the legal entry to which this specific SAM record, represented by a DUNS number, belongs) receive both of the following: 1.80 percent or more of your annual gross revenues in U.S. federal contracts, subcontracts, loans, grants, subgrents, and/or cooperative agreements and 2. $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrents, and/or cooperative agreements? No Does the public have access to Information about the compensation of the senior executives in your business or organization (the legal entity to which this specific SAM record, represented by a DUNS number, belongs) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78c(d)) or seefian 6104 of the Internal Revenue Code of 1986? Not Selected Proceedings Questions Is your business or organization, as represented by the DUNS Number on this entity registration,. responding to a Federal procurement opportunity that contains the provision at FAR 52.209.7, subject to the clause in FAR 52.209-9 in a current Federal contract, or applying for a Federal grant opportunity which contains the award term and condition described in 2 C:F.R. 200 Appendix XII? Yes Does your business or organization, as represented by the DUNS number on this specific SAM record, have current active Federal contracts and/or grants with total value (including any exerclsed/unexamised options) greater than $10.000.000? No Within the last five years, had the business or organization (represented by the DUNS number an this specific SAM record) and/or any of Its principals, in connection with the award to or performance by the business or organization of a Federal contract or grant, been the subject of a Federal or State (1) criminal proceeding resulting In a conviction or other acknowledgment of fault; (2) civil proceeding resulting In a finding of fault with a monetary fine, penalty, reimbursement, restitution, and/or damages greater then $5,000, or other acknowledgment of fault; and/or (3) administrative proceeding resulting in a finding of fault with either a monetary line or penalty greater than $5,000 or reimbursement, restitution. or damages greater than $100,000, or other acknowledgment of fault? Not Selected I authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes Business Types Entity Structure Entity Type Organization Factors Corporate Entity (Not Tax Exempt) Business or Organization Limited. Liability Company Profit Structure For Profit Organization Socio-Economic Types Self Certified Small Disadvantaged Business Woman Owned Small Business Woman Owned Business Check the registrant's Reps S Carta, If present, under FAR 52,2123 or FAR 52.219.1 to determine if the entity is an SBA -certified HUBZone small business concern. Additional small business information may be found in the SSXs Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. Accepts Credit Card Payments Debt Subject To Offset Department Code No No (blank) EFT Indicator CAGE Code 0000 1U3V4 Electronic Funds Transfer Account Type Routing Number Lock Box Number Checking * " 3976 (blank) .Financial Institution Account Number CHARTER BANK Automated Clearing House .Phone (U.S.) Email Phone (non-U.S.) 3617907676 (blank) (blank) Fax 3617908920 Remittance Address DERRICK CONSTRUCTION CO., INC. PO Box 1046 Rockport, Texas 78381 United States EIN Type of Tax Taxpayer Name '9812 Applicable Federal Tax DERRICK CONSTRUCTION COMPANY INC Tax Year (Most Recent Tax Year) NamefTtle of Individual Executing Consent TIN Consent Date 2007 Vice President May 14, 2021 Address Signature 250 Cove Harbor ROYM JOHNSON Rockport, Texas 78382 ' Accounts Receivable POC D Z., apdxed bl'Karberlaa Reaaxal Speaal6r oa May 14.7011 m 11:13 AM DERRICK CONSTRUCTION COMPANY. INC. Delia Shedden, Accounts Receivable Dells@derrickconstructlon.nat 3617292423 Electronic Business R PO Box 1046 Roy M Johnson, MR Rockport, Texas 78301 moosel@derrickconstruction.net United States 3617292423 0 (Non -US Phone) Government Business R. PO Box 1046 Roy. M Johnson, MR Rockport, Texas 78381 mooset@derrickconstruction.net United States 3617292423 0 (Non -US Phone) Party. Performing Certification POC A PO Box 1046 Roy M Johnson, MR Rockport, Texas 78381 moosel@derrickconstruction.net United States 3617292423 0 (Non -US Phone) Past Performance S 260 S Cove Harbor Rey M Johnson, Mr PO Box 1046 moosel@derrickconstruction.net Rockport, Texas 78381 3617292423 United States Derrick S Johnson, Mr. PO Box 1046 derrick@deMckmnstwction.net Rockport, Twee 78381 3617292423 united States Company Security Level Highest Level Employee Security Level (blank) (blank) NAICS Codes Primary NAICS Codes Yes 213112 237120 237990 238990 483211 483212 488310 488390 Product and Service Codes PSC P100 P300 P400 P500 P999 V119 ht",'Ilswl gov/-n,ltyg&69713]41mnDo,a?nnou=Active NAICS Tiffe Support Activities For Oil And Gas Operations Oil And Gas Pipeline And Related Structures Construction Other Heavy And Civil Engineering Construction All Other. Specialty Trade Contractors Inland Water Freight Transportation Inland Water Passenger Transportation Port And Harbor Operations Other Support Activities For Water Transportation PSC Name Salvage- Preparation And Disposal Of Excess/Surplus Property Selvage -Marine Vessels Salvage- Demolition Of Buildings Salvage -Demolition OfStructurealFacilities (Other Than Buildings) Salvage -Other TransportationfTraveilRelocation- Transportation: Other Pryge30%4 LarnOnlnreJby Katherine Renewal SPeclofivf art May 14. 2021 w 11:13 AM DERRICK CONSTRUCTION COMPANY, INC. V124 TransportationrTravel/Relocatlon-Transportation: Marine Charter IGT Size Metrics Annual Revenue (from all IGTs) (blank) Worldwide Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR $6.00 121) 30 Location Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR (blank) 121) (blank) Industry -Specific Barrels Capacity (blank) Megawatt Hours (blank) Total Assets (blank) ar, t'.. fir ^.• 1,,' =l,il,•, � na r,• 777This entity did not enter the ED] Information 3; 33 Yes, this entity appears In the disaster response registry. States Counties Louisiana Mississippi Texas Metropolitan Statistical Areas Arryu://snm.gov/enfis•11869]1314/coreDufahmna=ActLm Page 4 of4 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. it. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. Roy Johnson IVice President Of Derrick Construction Co Inc. 03/31/2022 Name and Title of Authorized Agent Date Signat re o Authorized Agent I am unable to certify to the above statements. My explanation is attached. Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifles, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to Influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement (b) If any funds other than Federal appropriated funds have been paid or willbe paid to any person for Influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," In accordance with its instructions. (c) The undersigned shall require thatthe language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subreciplents shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered Into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Derrick Construction Company Inc. The Contractor, certifies or affirms the truthfulness and accuracy of each statement of its certIficatigirifind disclosure, if any. In addition, the Contractor understands and agrees that the provisions 941 U.S, §801 et seq., apply to this certification and disclosure, if any. Roy Johnson (Vice President) Printed Name and Title of Contractors Authorized Official 03-31-2022 Approved by OMB Disclosure of Lobbying. Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for nublic burden t1knlnsure) 0348.0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: A a. contract a. bidlofferlapplication a, initial filing _ b. grant .4 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 known: 6. Federal Department/Agency: 7. Federal Program NameMescription: CFDA Number, itrapplicable: 8. Federal Action Number, ttrknown: 9. Award Amount, ifknown: S 10.. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if• (if bre ivlehlal. last name, firsi name,: Ml): tl ffere:ttfraat Na: IOa) (last note, first nante, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: f disclosure of lobbying activities is a material T representation of fact upon which reliance was placed Print Name: Roy Johnson by the tier above when this transaction was made or entered Into. Tltis disclosure is required pursuant to 31 Title: Vice President U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available far public Telephone No.t361-729-2423 Date:03-31-2022 inspection. Any person who fails to rile 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) CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being flied in accordance with Chapter 176, Local Government Code, by a vendor who Dale Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). Bylaw this questionnaire must be filed with the records adminlstralor of the local governmental entity not later .than the 71h business day alter the dale the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. 1 Name of vendor who has a business relationship with local governmental entity. Derrick Construction Company Inc. z Check this box If you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. N/A Name of Officer 4J Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Completesubparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable Income; other than investment income, from the vendor? Yes F\4 No B. Is the vendor receiving or likely to receive taxable Income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental :entity? E]Yes No 6 Describe each employment or business relationship that the vendor named In Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership Interest of one percent or more. 6 ❑Check this box If the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.00 )(2)(B), excluding gifts described In Section 176.003(a-1). 7 Y 03-39-22 25� Si nature of vendor d ess withlhe overnmental entity Date Form provided by Texas Ethics Commission www.elhlcs.siate.ix.us Revised 11/3012015 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85th Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. 1, (authorized official) Roy Johnson do hereby verify the truthfulness and accuracy of the contents of the statements submitted on this certification under the provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at https•//comptroller texas goy/purchasing/publications/divestment ohp Derrick Construction Company Inc. Company Signature of Authorized Official Johnson Printed Name of Authorized Official Vice President 03-31-22 Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252,001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who Is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is In this state, including a contractor whose ultimate parent company or majority owner has its principal place of business In this state. ❑ I certify that is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and state) U/I certify that Derrick Construction Company Inc. is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. !�c7, SignatureAut orized t Roy Johnson (Vice President) Printed Name and Title of Authorized Agent 03-31-22 Date Grenledaubredpienl: Include INS dxumentInoil apP ce5kbid Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions o e on 3 Economic Opporitinites for Low and Very Low -Income Persons THE BIDDER REPRESENTS AND CERTIFIES AS PART OF ITS BIDIOFFER THAT IT: ❑ Is a Section 3 Business Concern. A Section 3 Business Concern means a business concern: 1. That is 51 %ermore owned by Section 3 Resident(s); or 2. Whose permanent, full-time employees include persons, atleast304Bofwhom are currently Section 3Residents, or 3. That provides evidence of a commitment to subcontract in excess of 25%of the dollar value of all subcontracts to be awarded to Section 3 Business Concerns, that meet the qualifications set forth In paragraphs 1 or 2 herein. ® Is NOT a Section 3 Business Concern, but who has and will continue to seek compliance with Section 3 by certifying the following efforts to be undertaken. EFFORTS TO AWARD SUBCONTRACTOR TO SECTION 3 CONCERNS (ChackALL that apply) ® By contacting business assistance agencies, minority contractors associations and community organizations to Inform them of the contracting opportunities and requesting their assistance in identilying Section 3 businesses which may solicit bids for a portion of the work. ❑ By advertising contracting opportunities by posting notices, which provide general information about the work to be contracted and More to obtain additional information, in the common areas.. of the applicable development(s) owned and managed by the Housing Authority. ❑ By providing written notes to all known Section 3 Business Concerns of contracting opportunities. This notice should be in sufficient time to allow the Section 3 Business Concerns to respond to bid invitations ❑ By following up with Section 3 Business Concerns that have expressed interest in the contracting opportunities. ❑ By coordinating meetings at which Section 3 Business Concerns could be informed of specific elements of the work for which subcontract bids are being sought. ❑ By conducting workshops on contracting procedures and specific contracting opportunities in a timely manner so that Section 3 Business Concerns can take advantage of contracting opportunities. ❑ By advising Section Business Concerns as to whereto seek assistance to overcome barriers such as inability to obtain bond! ng, lines of credit, financing, or insurance and aiding Seclion 3 Businesses in qualifying for such bonding , financing, Insurance, etc..., ❑ Where appropriate, by breaking out contract work into economically feasible units to facilitate participation by Section 3 businesses, ❑ By developing and using a list of eligible Section 3 Business Concerns. ❑ By actively supporting and undertaking joint ventures with Section 3Businesses. EFFORTS TO PROI11DE TRAINING AND EMPLOYMENT TO SECTION 3 RESIDENTS ❑ By entering into a "first source" hiring agreements with organizations representing Section 3 Residents. ❑ By establishing training programs, which are consistent Wlh the requirements of the Department of Labor, specifically for Section 3 Residents in the building trades. ® By advertising employment and training positions to dwelling units occupied by Category 1 and 2 residents. ❑ By contacting resident councils and other resident organizations in the affected housing development to request assistance Innoliying residents of the training and employment positions to be filled. ❑ By arranging interviews and conducting interviews on the job site. ❑ By undertaking such continued job -training efforts as may be necessary to ensure the continued employment of Section 3 Residents previously hived for employment opportunities. ❑ By posting job vacancies In Work -In -Texas or with my local Workforce Solutions Center. ContractorName/Business Name: Derrick Construction Company Inc. Dare: 03-31-22 Authorized Repress Name: y Johnson (Vice President) Signature: 7 z DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of Texas County of Aransas Roy Johnson being first duly sworn, deposes and says that: 1. He is Vice President of Derrick Construction Company Inc. , the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties in interes including this affiant. / 7 sFFa pMI)Aty �e�tt�N (Signed) y My� lon Roy Jol nso (Vice President) 12 W6 Title Subscribed and sworn to me this 31 day of March 2022 By: Notary Public My commission expires 02-20-2025 Serenity Allen END OF DOCUMENT 00416-1 DOCUMENT NO.00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information it desires. Date: 03-31-2022 Bidder (Legal Name of Firm):Derrick Construction Company Inc. Date Organized: 1990 Name of Owner(s): RoyJohnson�& Rose Johnson Address: 250 Coves Harbor Rockport, Texas 78382 PO Box 1046 Rockport, Texas 78381 Date Incorporated: 03.15.1990 Federal ID Number: 74-2569812 Number of Years in contracting business under present name 31+ List all other names under which your business has operated in the last 10 years. Work Presently Under Contract: Amount $ Completion Date ACND Bulkhead - Shore Guard & Earth Work 520K Ap012022 Type of work performed by your company: Marine Construction Total Staff employed by Firm (Break down by Managers and Trades on separate sheet): See Attached Company Resume Have you ever failed to complete any work awarded to ov u? D Yes )(No (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? 0 Yes )KNo (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the � Nst ofive years or that was still In effect during the five year period or is still in effect? D Yes (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance): Protect Amount $ MoNr Completed RM Walsdorf Inc Shore Guard & Earthwork & Breakwater Imorovments 312K March 2022 available for this contract: Derrick Construction owns a large variety of equipment & tools Are you in compliance with all applicable EEO requirements? )Oes D No (If no, please attach summary of details on a separate sheet.) 00420-1 Are you a Section 3 business? (see below) ❑ Yes XNo HUB {Woman Owned) Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipient's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low income persons. Bank References Charter Bank Address: 711 HWY 35 North Contact Name: Debbie Williams City & State: Rockport Zip: 78382 Phone Number: 90-7676 Credit available: $ 3M Has the firm or predecessor firm been involved in a bankruptcy or reorganization? 0 Yes XNo (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. N/A List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. N/A Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. N/A e�....e.r #W. 31 A�„ .s Marry on 22 Printed Name and Title: Roy Johnson (Vice President) Company Name: Derrick Johnson Notary Statement: Roy Johnson being duly sworn, says that he/she is the Vice President Position/Title of Derrick Construction Company Inc. (Firm Name), and hereby swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY in verification of the recitals comprising this Bidder's Qualifications Statement. Subscribed and sworn before me this 31 day of March 2022 Notary Public Signature:,--" U-_X)statErirnDawN AUEN r° ID �12a811898 "-- Serenit Allen �' My commissionE*tres Printed Name: y A01a1 February20,2026 My Commission Expires: 02-20-2025 , The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001 END OF DOCUMENT 00420-2 DOCUMENT NO. 00450 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This Includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Derrick Construction Company Inc. 250 S Cove Harbor Rockport, Texas 78382 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. V(Yes ❑ No The undersigned hereby certifies that: ❑ The Provision of Local Training. Employment, and Business.0000rtunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as pert of the bid proceedings (if bid equals or exceeds $100,000). ❑ The Equal Opportunity clause 1s Included in the Contract (if bid equals or exceeds $10,000). 0 The Section 503 clause is Included in the contract Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended? ❑ Yes VNo Roy Johnson (Vice President) NAME AND TITLE OF SIGNER (Plea type) �L 03-31-22 SIGNATURE DATE 00450-1 A. DERRICK CONSTRUCTION COMPANY Company Narrative Derrick Construction Company, Inc. (DCCI) is located in Rockport, Texas. Our headquarters lie on the Intercoastal Waterway which provides the means for expedited mobilization of all necessary equipment to any region along the Texas Gulf Coastline. DCCI is capable and willing to work in all regions along the Texas coast, including all bays, canals & estuaries located within those regions. All marine and land based equipment needed for the proper removal and disposal of submerged, derelict and abandoned structures as well as decommissioning and removal of offshore oil and gas facilities are readily available with Coast Guard approved & DCCI owned equipment. With our experienced and Certified Dive Team, we are able to complete bottom surveys to ensure the scope of work is completed. Our equipment is capable of mobilization into water as shallow as 2 %z ft. to deep waters along the coastline. DCCI is qualified and trained to properly and safely decommission oil and gas facilities, remove and dispose of pipelines and any submerged or derelict pilings and structures as outlined in this solicitation. DCCI has over 50 years of experience in the marine construction industry. DCCI has executed many regulated contracts with the Texas General Land Office, Texas Parks & Wildlife, Texas Railroad Commission and local Navigation Districts. DCCI has removed small & large platforms, boats, barges, vast pipelines, derelict pilings & structures. DCCI has strategically sunk barges for artificial reefs, built extensive bulkheads and marinas. DCCI is also very knowledgeable in the oil and gas industry.. We have completed scopes of work from the maintenance of platforms, installation and/or removal of pipelines, plug and abandonment of facilities to emergency oil spill cleanups. DCCI has been utilized as a general contractor for all scopes of marine cleanup & construction, as well as facilitate with the contract's coordinator to determine whether and how hazardous debris should be handled and disposed of with regulations. After Hurricane Katrina, DCCI completed a contract with Vintage Petroleum in Louisiana to remove & dispose of debris (some hazardous) blocking & prohibiting production of pipelines/facilities in the Houma, LA area. DCCI removed, sorted, transported all types of wet debris from the area & disposed of debris as specified by contract owner and regulations. The compressor stations, platforms & pipeline ruins were transported by barge to a facility to dispose of in accordance to contract while other debris was transported via land based equipment to sort and transport all debris to the appropriate disposal sites and/or recyclable material sites. Some of the debris removed included hazardous tank batteries, asbestos insulation from destroyed tanks, creosote piling, laid over platforms, remnants from destroyed structures, platforms, DERRICK CONSTRUCTION COMPANY pipelines and natural gas compressors from the shallow bayous of South Pass and West Bay (2-8 ft depth). Hurricane Harvey devastated the Texas Gulf Coast with a direct hit to Rockport, Texas where DCCI's Main Office is located. DCCI's crew's returned to work immediately after the storm had passed and started the clean up process. DCCI salvaged many vessels and assisted with dock demolitions, repairs and rebuilds. DCCI also assisted the electric companies with the removal of the broken power poles and power lines to the installation of the new power poles that had to be placed in the water for the surrounding towns. The Texas General Land Office awarded the debris clean up contract to DCCI to salvage and properly dispose of vessels that were destroyed by Harvey. DCCI had project sites in the Rockport and Dickinson, Texas to complete the scope of work which involved almost 200 vessels along the gulf coast. DCCI has vast experience in marine derelict structure removal and cleanup as well as land cleanup and is equipped to handle any level of cleanup along the Texas Gulf Coast. With our fleet of marine vessels to gather and transport debris to a designated sort/lay down facility on land, and our land based equipment to sort and transport all debris to the appropriate disposal sites and/or recyclable material sites, DCCI is experienced, equipped and prepared to facilitate any removal & cleanup projects. We at DCCI strive to maintain our project site locations with minimal environmental impact. DCCI completed a casing contract for BNP and the site was located within a sea turtle nesting zone on Maliki Beach north of Padre Island. During this experience, DCCI was instructed on patrolling for tracks and nests. On many occasions, the job was "on hold" as crews would wait significant periods of time for turtles to cross, etc. Extreme precautions were made to protect the sea turtles and their environment. Derrick Construction Co, Inc. is HUB certified (Certificate # 1742569812700). We are bonded and fully insured for all land and marine construction. -,-- DERRICK CONSTRUCTION COMPANY Company Profile Derrick Construction Company, Inc. (DCCI) is located in Rockport, Texas. DCCI is HUB certified and Woman Owned (Certificate 4 1742569812700). We are bonded and fully insured for all Land and Marine Construction. Derrick Construction began its legacy in the marine business in 1959 under the name Fulton Boat Yard. The company's name changed to Derrick Construction Company, Inc. and was incorporated under the laws of Texas in 1990. With many years in Marine Industry, Derrick Construction Company, Inc. has become extremely diversified in this field. DCCI is capable and willing to work in all regions along the Texas Gulf Coast, including all bays, canals and estuaries located in those regions. DCCI has successfully completed many debris removal, derelict vessel removal and disposal projects, and underwater pipeline installation and removal projects over the last 25 years. DCCI employs 30+ highly skilled and trained personnel, all of which live in close proximity to DCCI's office in Rockport, Texas. Of these employees, approximately 30 employees can be assigned to any location along the Texas Gulf Coast. The following is a list of our Board of Directors: President Rose Johnson Vice President Roy Johnson Treasurer Derrick Johnson Secretary Shane Johnson Derrick Construction Company's Corporate Office is located at 250 Cove Harbor South, Rockport, TX 78382. DCCI's mailing address is PO Box 1046, Rockport, TX 78381. We do also have the capabilities & equipment to set up mobile offices & quarters on location when and where needed. Derrick Johnson is the Director of Operations and Point of Contact for DCCI and is located at the Corporate Office in Rockport, Texas. If for any reason he is unable to be reached, you may call the office and speak to Roy Johnson (Vice President). Office Number: (361)729-2423 Email: derrick(i�derrickconstruction.net DERRICK CONSTRUCTION • COMPANY Company Resume: Derrick Johnson Name: Derrick Johnson Contact Information: Phone: 361-729-2423 E-mail: derrick caderrickconstruction.net Education, Certification, Business Management and Marketing Degree — North Wood And Licenses: University, Cedar Hill, Texas HAZWOPER Certification Transportation Workers Identification Credentials Holder OQ Certified Employment: Derrick Construction Company (1994 — Present) Director of Operations Skills/Service: Estimator Project and Safety Manager Mobilization and Demobilization Manager Site Coordinator Experience: Derrick has over 25 years of experience working and supervising various types of projects throughout the Texas Gulf Coast. Mr. Johnson has had direct oversight on the following projects: 2002 — assisted in removal of abandoned cabins and debris from Upper Laguna Madre to Aransas Bay for Coastal Conservation Association; 2004 to 2005 — excavated and constructed the harbor and boat lifts at the Flour Bluff Marina, Flour Bluff, TX; 2008 — provided land based support for major oil companies for drilling and work -over projects. 2010 — Dredged over 5000 foot of material out of the Aransas Pass Harbor and also the reconstruction of the San Patricio Navigation's Marina; 2014 — Major Repair Work at the Citgo Dock #6, Completed a Drilling Site Pad for Endeavor Natural Resources, and Removed over 4000 pilings for the Texas General Land Office in Galveston Bay, Texas; 2016 — Reconstructed the Rockport, Texas Beach Boat Ramp for the Aransas County Navigation District and removed a 10" pipeline for Cheniere Energy; 2017-2018 — Assisted several agencies in the Hurricane Harvey Disaster cleanup efforts. 2018 — Removed approximately 3000 tons of tires in Gatesville, Texas for the Texas General Land Office; Repaired several docks and breakwater walls due to Hurricane Harvey; decommissioned several pipelines in the local bays of Aransas County for the oil and gas companies. - DERRICK CONSTRUCTION COMPANY Company Resume: Roy Johnson Name: Roy Johnson Contact Phone: 361-729-2423 Information: E-mail: mooseI@derrickconstruction.net Education, Certification, Transportation Workers Identification Credential Holder And Licenses: Oil Spill & Response Certification Natural Disaster Certification OQ Certification Employment: Derrick Construction Company (1967 — Present) Vice President / Owner Skills/Service: Owner / Operator Estimator Risk Manager Facility and Project Manager Mobilization and Demobilization Manager Experience: Mr. Roy Johnson has been in the Marine Construction field for over 45 years. He has worked with the Texas General Land Office, Railroad Commission, Coastal Conservation Association and Army Corps of Engineers on all types of projects along the Texas Gulf Coast. Mr. Johnson has had direct oversight on the following major projects: 1970 - raised a sunken drilling rig from the 1CW at Aransas Pass Bridge and salvaged 150 to 175 boats and barges sunk during Hurricane Celia; 1970 — 1982 Contract Gauging for the following companies: Cities Services, LADD Petroleum, Patrick Petroleum, Genesis, Vintage Petroleum, Corpus Christi Oil and Gas, along with other independent oil and gas producing companies; 1982 — 1990 Assisted in the oil and gas business by laying pipeline, building and hooking up platforms, pipeline lease work; 2001 to 2003 — removed additional 200 tons of debris for CCA and TX GLO along the shoreline from Corpus Christi to Brownsville; 2005 — participated in cleanup efforts in Venice, Louisiana after Hurricane Katrina; 2007 — removed a sunken barge from Rio Hondo, Arroyo Colorado River for TX GLO; 2010 — Assisted in an Oil Spill cleanup in Aransas Bay; 2017-2018 — Assisted several agencies in the Hurricane Harvey Disaster cleanup efforts; oversaw the decommissioning of several pipelines in the Aransas County area for the oil & gas companies. DERRICK CONSTRUCTION COMPANY DCCI offers variety of services including but not limited to: Pile Driving and Removal Platform Fabrication and Installation Tug and Barge Leasing Well Guard Fabrication and Installation Maintaining Rig Locations Wellhead Hookups Pipeline Burial and Removal Plug & Abandonment of Wells Various Disaster Relief Efforts Mechanical & Hydraulic Dredging Vessel Salvage & Disposal Construction of Marinas and Docks Bulkhead Construction Sandblasting and Painting All Derrick Construction Company, Inc (DCCI) equipment is Coast Guard approved and DCCI owned. Our equipment is capable of mobilization into water as shallow as 2 % feet to the gulf waters. DCCI has executed many regulated contracts with the Texas General Land Office, Victoria Navigation District, Aransas County Navigation District, Texas Parks and Wildlife, Texas Railroad Commission and other surrounding Navigation Districts. DCCI has removed small and large platforms, all sizes of vessels, submarines, barges, vast amounts of pipelines, derelict pilings and structures. DCCI has strategically sunk barges for artificial reefs, built extensive bulkheads and marinas as well as emergency oil spill cleanup and P & A of wells. DCCI has been utilized as a general contractor for all scopes of marine clean up and construction, as well as properly disposing of hazardous debris. Whether considering the utilization of our large capacity cranes to Lill sunken vessels, our experience in demolition and removal of buildings, vessels, platforms, pipelines and various infrastructure remains after previous disasters, DCCI has the experience, capability and equipment needed to complete all aspects of the marine debris removal and disposal as well as all oil field related projects. DCCI has worked for many oil and gas companies such as EOG, Cinco Resources, Cheniere Energy, Southcross, Sabco, White Marlin, Vintage Petroleum,, Lamar Oil and Gas, Magnum Engineering, Neumin Production, BNP, Petro Hunt, Matagorda Resources, Copano Resources, Kinder Morgan and Gold King among others. Over the last 50 years, DCCI's main specialties have been pipeline installation, maintenance, and removal, bulkhead/boat ramp repair or replacement, vessel and debris removal and disposal, and mechanical/ hydraulic dredge work. DCCI is an environmentally conscious company that has not had any environmentally detrimental spills during operations. From the plugging jobs for the Texas Railroad Commission to the various projects we have completed for our oil and gas production clients, DCCI is extremely cautious when it comes to the environmental aspects of each project. Each project depicts its own unique environmental challenges and DCCI is well -versed in providing the proper equipment and procedures for each individual circumstance. DCCI has vast experience in marine derelict structure removal and cleanup as well as land clean up and is equipped to handle any level of cleanup along the Texas Gulf Coast. With our fleet of marine vessels to gather and transport debris to a designated sorulay down facility on land and our land based equipment to sort and transport all debris to the appropriate disposal sites and/or recyclable material sites, DCCI is experienced, equipped and prepared to facilitate any removal & cleanup projects. DERRICK CONSTRUCTION COMPANY Company Narrative Derrick Construction Company, Inc. (DCCI) is located in Rockport, Texas. Our headquarters lie on the Intercoastal Waterway which provides the means for expedited mobilization of all necessary equipment to any region along the Texas Gulf Coastline. DCCI is capable and willing to work in all regions along the Texas coast, including all bays, canals & estuaries located within those regions. All marine and land based equipment needed for the proper removal and disposal of submerged, derelict and abandoned structures as well as decommissioning and removal of offshore oil and gas facilities are readily available with Coast Guard approved & DCCI owned equipment. With our experienced and Certified Dive Team, we are able to complete bottom surveys to ensure the scope of work is completed'. Our equipment is capable of mobilization into water as shallow as 2 %x ft. to deep waters along the coastline. DCCI is qualified and trained to properly and safely decommission oil and gas facilities, remove and dispose of pipelines and any submerged or derelict pilings and structures as outlined in this solicitation. DCCI has over 50 years of experience in the marine construction industry. DCCI has executed many regulated contracts with the Texas General Land Office, Texas Parks & Wildlife, Texas Railroad Commission and local Navigation Districts. DCCI has removed small & large platforms, boats, barges, vast pipelines, derelict pilings & structures. DCCI has strategically sunk barges for artificial reefs, built extensive bulkheads and marinas. DCCI is also very knowledgeable in the oil and gas industry. We have completed scopes of work from the maintenance of platforms, installation and/or removal of pipelines, plug and abandonment of facilities to emergency oil spill cleanups. DCCI has been utilized as a general contractor for all scopes of marine cleanup & construction, as well as facilitate with the contract's coordinator to determine whether and how hazardous debris should be handled and disposed of with regulations. After Hurricane Katrina, DCCI completed a contract with Vintage Petroleum in Louisiana to remove & dispose of debris (some hazardous) blocking & prohibiting production of pipelines/facilities in the Houma, LA area. DCCI removed, sorted, transported all types of wet debris from the area & disposed of debris as specified by contract owner and regulations. The compressor stations, platforms & pipeline ruins were transported by barge to a facility to dispose of in accordance to contract while other debris was transported via land based equipment to sort and transport all debris to the appropriate disposal sites and/or recyclable material sites. Some of the debris removed included hazardous tank batteries, asbestos insulation from destroyed tanks, creosote piling, laid over platforms, remnants from destroyed structures, platforms, �--- DERRICK CONSTRUCTION COMPANY pipelines and natural gas compressors from the shallow bayous of South Pass and West Bay (2-8 ft depth). Hurricane Harvey devastated the Texas Gulf Coast with a direct hit to Rockport, Texas where DCCI's Main Office is located. DCCI's crew's returned to work immediately after the storm had passed and started the clean up process. DCCI salvaged many vessels and assisted with dock demolitions, repairs and rebuilds. DCCI also assisted the electric companies with the removal of the broken power poles and power lines to the installation of the new power poles that had to be placed in the water for the surrounding towns. The Texas General Land Office awarded the debris clean up contract to DCCI to salvage and properly dispose of vessels that were destroyed by Harvey. DCCI had project sites in the Rockport and Dickinson, Texas to complete the scope of work which involved almost 200 vessels along the gulf coast. DCCI has vast experience in marine derelict structure removal and cleanup as well as land cleanup and is equipped to handle any level of cleanup along the Texas Gulf Coast. With our fleet of marine vessels to gather and transport debris to a designated sorttlay down facility on land, and our land based equipment to sort and transport all debris to the appropriate disposal sites and/or recyclable material sites, DCCI is experienced, equipped and prepared to facilitate any removal & cleanup projects. We at DCCI strive to maintain our project site locations with minimal environmental impact. DCCI completed a casing contract for BNP and the site was located within a sea turtle nesting zone on Maliki Beach north of Padre Island. During this experience, DCCI was instructed on patrolling for tracks and nests. On many occasions, the job was "on hold" as crews would wait significant periods of time for turtles to cross, etc. Extreme precautions were made to protect the sea turtles and their environment. Derrick Construction Co, Inc. is HUB certified (Certificate # 1742569812700). We are bonded and fully insured for all land and marine construction. DERRICK CONSTRUCTION COMPANY Derrick Construction Company Employee List & Positions JOHNSON, ROSE President JOHNSON, ROY M Vice President JOHNSON, DERRICK S Exec Director of Operations & Treasure JOHNSON, SHANE M Corporate Secretary ALLEN, SERENITY Chief Financial Officer SMITH, MICHAEL Bid Estimator & Field Supervisor ORMAND, DEE ANNA Administrative Assistant, AP & Marine Compliance DAVIS, RYAN BOAT CAPTAIN MCDOWELL, ARNOLD T BOAT CAPTAIN GRIFFITH, SHANE Boat Captain/Superintendent OSGOOD, HEATHER K Clerical Assistant PETZOLD, AUSTIN DECK HAND YARDLEY, STEPHEN DECK HAND HUERTA, ANTHONY G Deckhand UEHLINGER, JR., ARTHUR J BID ESTIMATOR TURNER, DYLAN R Corporate Yard Foreman MATLOCK, TAMERA Human Resources POLANCO, NICHOLAS R DCCI MECHANIC WRIGHT, JACOB MECHANIC HELPER ODEN, KEVIN B Operator REICHERT., JAMES Operator SLAY, MICHAEL L OPERATOR WHITE, WILLIAM C OPERATOR MCLESTER, GRAY A Operator/Superintendent CRUZ, MICHAEL A. SKILLED LABORER ESPINOZA, RAIMONDO Skilled Laborer ESTRADA, LIBRADO A SKILLED LABORER FARRIS, GEORGE SKILLED LABORER HAVENS, ROYCE L SKILLED LABORER ORMAND, DALTON SKILLED LABORER ORMAND, TOMMY L Skilled Laborer PULLIN, JUSTIN SKILLED LABORER VANCE, BILLY SKILLED LABORER WOMBLE, THOMAS M SKILLED LABORER MATLOCK, T. L. Superintendent GIVENS, RICHARD WELDER Derrick Construction Company, Inc. PO Box 1046 Rockport, TX 78381 Office (361) 729-2423 Fax (361) 729-1218 250 South Cove Harbor Rockport, TX 78382 www.derrickconstruction.net Email: serenitytmderrickconstruction net Email: derrick@derrickconstruction.net LESTER CONTRACTING INC RE -BID LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-06S-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive bids for: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Disaster Relief Grant Program. Bids shall be for the furnishing of all labor, materials, equipment, plant and superintendence, for performing the Work for the installation of approximately 24,953 LF of drainage channel ditches, 1782, LF of storm sewer pipe, 350 CY of rock rip -rap, and reconstruction of gravel roads all in accordance with the Plans and Specifications. Specified Work is set out in Document No. 00300 of these Contract Documents. Bid documents may be examined at Calhoun County Auditor's Office, Courthouse Annex II, 202 S. Ann St, Suite B, Port Lavaca, TX or G&W Engineers, Inc. at 205 W. Live Oak, Port Lavaca, TX and obtained from www.CivcastUSA.com. There is no charge to view or download the documents. Addendums and other announcements will be distributed via CivCastUSA to all plan holders. A Pre -Bid Meeting shall be held at 10:00 am, Thursday, March 10, 2022 at the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Texas. All plan holders and/or potential Bidders are STRONGLY urged to attend. Social distancing and masks will be required. SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, MARCH 31, 2022. At that time, all bids will be publicly opened and read aloud at the County Judge's office in the Calhoun County Courthouse at 211 South Ann Street, Yd Floor, Suite, 301, Port Lavaca, Texas. All bids must be delivered (one original unbound bid and three unbound copies) to the Office of the Calhoun County Judge in a sealed 9x12 or larger envelope and clearly marked REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. Calhoun County does not accept faxed or emailed bids. Any bids received after the due date and time will be returned unopened. Sealed bids may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 31d Floor, Suite 301 Port Lavaca, TX 77979 00020-1 The Award of the Construction Contract, which is anticipated to be within sixty (60) calendar days of the Bid Date specified above, shall be made to the responsible Bidder submitting the lowest, qualified, acceptable Bid who, in the opinion of CALHOUN COUNTY, offers the Bid in the best interest of the County. All contractors/subcontractors that are debarred, suspended or otherwise excluded from or ineligible for participation on federal assistance programs may not undertake any activity in part or in full under this project. A Bid Bond in the amount of 5% of the greatest amount bid, issued by an acceptable surety, shall be submitted with each bid. A certified check payable to CALHOUN COUNTY, TEXAS may be submitted in lieu of the Bid Bond. Attention is called to the fact that not less than, the federally determined prevailing (Davis -Bacon and Related Acts) wage rate, as issued by the Department of Labor and contained in the contract documents, must be paid on this project. In addition, the successful bidder must ensure that employees and applicants for employment are not discriminated against because of race, color, religion, sex, sexual identity, gender identity, or national origin. Adherence to the grant recipient's Section 3 Policy is required for contracts and subcontracts in excess of $100,000.00. Commissioners Court reserves the right to waive any formality or irregularity, reject any or all bids and to accept the bid deemed most advantageous to CALHOUN COUNTY. CALHOUN COUNTY, TEXAS is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit bids. Cindy Mueller, County Auditor Calhoun County, Texas END OF DOCUMENT 00020-2 DOCUMENT NO.00120 INSTRUCTIONS TO BIDDERS .01 DEFINED TERMS: Terms used in these Instructions to Bidders, which are defined in the General Conditions of these Specifications, have the meanings assigned to them in the General Conditions. Certain additional terms used in these Instructions to Bidders have the meanings indicated below which are applicable to both the singular and plural thereof. MINEKSYNI ", Whenever the term "OWNER" is used in these Specifications, it shall be construed to mean CALHOUN COUNTY. b. ENGINEER Whenever the term "ENGINEER" is used in these Specifications, it shall be construed to mean G & W ENGINEERS, INC. C. BIDDER Whenever the term "BIDDER" is used in these Specifications, it shall mean anyone who submits a BID directly to OWNER as distinct from a sub -bidder, who submits a BID to a BIDDER. d. Successful BIDDER Whenever the term "Successful BIDDER" is used in these Specifications, it shall be construed to mean the lowest, responsible and responsive BIDDER to whom OWNER (on the basis of OWNER's evaluation as hereinafter provided) makes an award. e. WORK Whenever the term "Work" is used in these Specifications, it shall be construed to mean the Item(s) set out in Document No. 00300 of these Contract Documents. .02 COPIES OF BIDDING DOCUMENTS: a. Complete sets of the Bidding Documents in the number and for the purchase price, if any, stated in the Advertisement or Invitation to Bid may be obtained from ENGINEER only. b. Complete sets of Bidding Documents must be used in preparing Bids. Neither OWNER nor ENGINEER assume any responsibility for errors or misinterpretations resulting from the use of incomplete sets of Bidding Documents. 00120-1 C. ENGINEER, in making copies of Bidding Documents available on the above terms, does so only for the purpose of obtaining BIDS for the Work and does not confer a license or grant for any other use. .03 QUALIFICATIONS OF BIDDERS: To demonstrate qualifications to perform the Work, each BIDDER must be prepared to submit within five days after Bid Opening, upon OWNER's request, detailed written evidence such as financial data, previous experience, present commitments and other such data as may be called for below. Each BID must contain evidence of BIDDER's qualification to do business in the state where the Project is located or covenant to obtain such qualification prior to award of the contract. .04 EXAMINATION OF CONTRACT DOCUMENTS AND SITE: a. It is the responsibility of each BIDDER before submitting a BID to do the following. 1. Examine thoroughly the Contract Documents and other related data identified in the Bidding Documents (including "technical data,, referred to below). 2. Visit the site to become familiar with and satisfy BIDDER as to the General, local and site conditions that may affect cost, progress, performance or fiirnishing of the Work. 3. Consider federal, state and local Laws and Regulations that may affect cost, progress, performance or furnishing of the Work. 4. Study and carefully correlate BIDDER's knowledge and observations with the Contract Documents and such other related data. 5. Promptly notify ENGINEER of all conflicts, errors, ambiguities or discrepancies which BIDDER has discovered in or between the Contract Documents and such other related documents. If discrepancies and/or inconsistencies exist between the Specifications and the Drawings, the Specifications shall govern unless otherwise noted on the Drawings. b. Refer to the Supplementary Conditions for identification of the following. Reports of explorations and tests of subsurface conditions at or contiguous to the site which have been utilized by ENGINEER in preparation of the Contract Documents. BIDDER may rely upon the general accuracy of the "technical data" contained in such reports but not upon other data, interpretations, opinions or information contained in such reports or otherwise relating to the subsurface conditions at the site, nor upon the completeness thereof for the purposes of bidding or construction. 00120-2 2. Drawings of physical conditions in or relating to existing surface and subsurface structures (except underground facilities) which are at or contiguous to the site that have been utilized by ENGINEER in preparation of the Contract Documents. BIDDER may rely upon the general accuracy of the "technical data" contained in such drawings but not upon other data, interpretations, opinions or information shown or indicated in such drawings or otherwise relating to such structures, nor upon the completeness thereof for the purposes of bidding or construction. Copies of such reports and drawings will be made available by OWNER to BIDDER on request. Those reports and drawings are not part of the Contract Documents, but the "technical data" contained therein upon which BIDDER is entitled to rely as provided in Paragraph 4.02.A of the General Conditions has been identified and established in the Supplementary Conditions. BIDDER is responsible for any interpretation or conclusion drawn from any "technical data" or any such data, interpretations, opinions or information. C. Information and data shown or indicated in the Contract Documents with respect to existing Underground Facilities at or contiguous to the site is based upon information and data furnished to OWNER and ENGINEER by owners of such underground facilities or others, and OWNER and ENGINEER do not assume responsibility for the accuracy or completeness thereof unless it is expressly provided otherwise in the Supplementary Conditions. d. Provisions concerning responsibilities for the adequacy of data furnished to prospective BIDDERS with respect to subsurface conditions, other physical conditions and Underground Facilities, and possible changes in the Contract Documents due to differing or unanticipated conditions appear in Paragraphs 4.02, 4.03 and 4.04 of the General Conditions. e. Before submitting a BID each BIDDER will be responsible to obtain such additional or supplementary examinations, investigations, explorations, tests, studies and data concerning conditions (surface, subsurface and underground facilities) at or contiguous to the site or otherwise, which may affect cost, progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences or procedures of construction to be employed by BIDDER and safety precautions and programs incident thereto or which BIDDER deems necessary to determine its BID for performing and furnishing the Work in accordance with the time, price and other terms and conditions of the Contract Documents. f. On request, OWNER will provide each BIDDER access to the site to conduct such examinations, investigations, explorations, tests and studies as each BIDDER deems necessary for submission of a BID. BIDDER must fill all holes and clean up and restore the site to its former conditions upon completion of such explorations, investigations, tests and studies. 00120-3 g. Reference is made to the Supplementary Conditions for the identification of the general nature of work that is to be performed at the site by OWNER or others (such as utilities and other prime contractors) that relates to the work for which a BID is to be submitted. On request, OWNER will provide to each BIDDER for examination access to or copies of Contract Documents (other than portions thereof related to price) for such work. h. The submission of a BID will constitute an incontrovertible representation by BIDDER that BIDDER has complied with every requirement of this Article 4, that without exception the BID is premised upon performing and furnishing the Work required by the Contract Documents and applying the specific means, methods, techniques, sequences or procedure of construction that may be shown or indicated or expressly required by the Contract Documents, that BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities and discrepancies that BIDDER has discovered in the Contract Documents and the written resolutions thereof by ENGINEER is acceptable to BIDDER, and that the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performing and furnishing the Work. .05 AVAILABILITY OF LANDS FOR WORK, ETC.: The lands upon which the Work is to be performed, rights -of -way and easements for access thereto and other lands designated for use by CONTRACTOR in performing the Work are identified in the Contract Documents. All additional lands and access thereto required for temporary construction facilities, construction equipment or storage of material and equipment to be incorporated in the Work are to be obtained and paid for by CONTRACTOR. Easements for permanent structures or permanent changes in existing facilities are to be obtained and paid for by OWNER unless otherwise provided in the Contract Documents. .06 INTERPRETATIONS AND ADDENDA: a. the ENGINEER no later than 5:00 pm on March 22, 2022. Such questions may be submitted by facsimile (361-552-4987) or email (smason(a,eweneineers.com). It is the Bidder's responsibility to verify receipt of such questions by the ENGINEER. Interpretations or clarifications considered necessary by ENGINEER in response to such questions will be issued by Addenda mailed or otherwise delivered to all parties recorded by ENGINEER as having received the Bidding Documents. b. Addenda may also be issued to modify the Bidding Documents as deemed advisable by OWNER or ENGINEER. C. Any oral and other interpretations or clarifications provided by ENGINEER or OWNER at the pre -bid meeting will be without legal effect until a formal written Addenda is issued by ENGINEER. 00120-4 .07 BID SECURITY: a. Each BID must be accompanied by Bid Security made payable to OWNER in an amount of five percent of BIDDER's maximum Bid Price and in the form of a certified check or a Bid Bond (on form attached) issued by a surety meeting the requirements of Paragraph 5.01.13 of the General Conditions. Power -of -Attorney for person signing for surety must be attached to Bid Bond. b. The Bid Security of Successfiil BIDDER will be retained until such BIDDER has executed the Agreement, furnished the required contract security and met the other conditions of the Notice of Award, whereupon the Bid Security will be returned. If the Successfiil BIDDER fails to execute and deliver the Agreement and furnish the required contract security within fifteen days after the Notice of Award, OWNER may annul the Notice of Award and the Bid Security of that BIDDER will be forfeited. The Bid Security of other BIDDERS whom OWNER believes to have a reasonable chance of receiving the award may be retained by OWNER until the earlier of the seventh day after the Effective Date of the Agreement or the sixtieth day after the Bid Opening, whereupon Bid Security furnished by such BIDDERS will be returned. Bid Security with BIDS which are not competitive may be returned within seven days after the Bid Opening. .08 CONTRACT TIMES: The term "Contract Times" is defined in Paragraph 1.01.A.14 of the General Conditions. The number of days within which, or the dates by which, the Work is to be completed and ready for final payment are set forth in the Agreement (or incorporated therein by reference to the attached Bid). .09 LIQUIDATED DAMAGES: Provisions for liquidated damages, if any, are set forth in the Agreement. .10 SUBSTITUTE AND "OR -EQUAL" ITEMS: The Contract, if awarded, will be on the basis of materials and equipment described in the Contract Drawings or specified in these Specifications with consideration of possible substitute or "or -equal" items. Whenever it is indicated in the Contract Drawings or specified in these Specifications that a substitute or "or -equal" item of material or equipment may be furnished or used by CONTRACTOR, if acceptable to ENGINEER, application for such acceptance will not be considered by ENGINEER until after the Effective date of the Agreement. The procedure for submission of any such application by CONTRACTOR and consideration by ENGINEER is set forth in Paragraphs 6.05 of the General Conditions and may be supplemented in the General Requirements. 00120-5 .11 SUBCONTRACTORS, SUPPLIERS AND OTHERS: a. If the Supplementary Conditions require the identity of certain Subcontractors, Suppliers and other persons and organizations (including those who are to furnish the principal items of material and equipment) to be submitted to OWNER in advance of specified date prior to the Effective Date of the Agreement, apparent Successful BIDDER, and any other BIDDER so requested, shall within five days after Bid Opening submit to OWNER a list of all such Subcontractors, Suppliers and other persons and organizations proposed for those portions of the Work for which such identification is required. Such list shall be accompanied by an experience statement with pertinent information regarding similar projects and other evidence of qualification for each such Subcontractor, Supplier, person or organization if requested by OWNER. OWNER or ENGINEER, who after due investigation, has reasonable objection to any proposed Subcontractor, Supplier, other person or organization, may before the Notice of Award is given request apparent Successful BIDDER to submit an acceptable substitute without an increase in Bid Price. If apparent Successful BIDDER declines to make any such substitution, OWNER may award the contract to the next lowest BIDDER that proposes to use acceptable Subcontractors, Suppliers and other persons and organizations. The declining to make requested substitutions will not constitute grounds for sacrificing the Bid Security of any BIDDER. Any Subcontractor, Supplier, other person or organization listed and to whom OWNER or ENGINEER does not make written objection prior to the giving of the notice of Award will be deemed acceptable to OWNER and ENGINEER subject to revocation of such acceptance after the Effective Date of the Agreement as provided in Paragraph 6.06 of the General Conditions. b. In contracts where the Contract Price is on the basis of Cost -of -the -Work Phis a Fee, apparent successful BIDDER, prior to the Notice of Award, shall identify in writing to OWNER those portions of the Work that such BIDDER proposes to subcontract and after the Notice of Award may only subcontract other portions of the Work with OWNER's written consent. C. CONTRACTOR shall not be required to employ any Subcontractor, Supplier, other person or organization against whom CONTRACTOR has reasonable objection. .12 BID FORM: a. The Bid Form is included with the Bidding Documents. Additional copies may be obtained from ENGINEER. b. All blanks on the Bid Form must be completed by printing in ink or by typewriter. C. BIDS by corporations must be executed in the corporate name by the president or a vice-president (or other corporate officer accompanied by evidence of authority to sign) and attested by the secretary or an assistant secretary. Authorization of this person to sign for corporation shall be evidenced by a properly executed CONTRACTOR's Corporate Resolution, the form of which is included in the Bidding Documents. The corporate address and state of incorporation must be shown below the signature. 00120-6 .13 d. BIDS by partnerships must be executed in the partnership name and signed by a partner, whose title must appear under the signature and the official address of the partnership must be shown below the signature. e. All names must be typed or printed in black ink below the signature. f. The BID shall contain an acknowledgment of receipt of all Addenda (the numbers of which must be filled in on the Bid Form). g. The address and telephone number for communications regarding the BID must be shown. h. Evidence of authority to conduct business as an out-of-state corporation in the state where the Work is to be performed shall be provided in accordance with Paragraph .12 c. above. State contractor license number, if any, must also be shown. SUBMISSION OF BIDS: SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, MARCH 31, 2022. All bids must be delivered to the Office of the Calhoun County Judge in a SEALED a 9 x 12 or larger envelope and clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1, with the name and address of BIDDER, and accompanied by the Bid Security and other required documents. a. If the BID is sent through the mail or other delivery system the seated envelope shall be enclosed in a separate envelope with the notation "BID ENCLOSED" on the face of it. A late delivery with an early postmark will not suffice. b. The County is not responsible for the delivery of your bid to the office of the County Judge or delivery to the wrong office. If you choose to send your bid by postal delivery, then it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your bid prior to the bid date and time. c. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the bid is received and the time the bid will be opened. The door to the County Judge's office will be closed once the due time and date has been reached and no other bids will be accepted. d. Calhoun County accepts no financial responsibility for any cost incurred by any vendor in the course of responding to these specifications. e. Faxed or e-mailed bids will NOT be accepted. f. The Bidding Documents may be retained by BIDDER. An unbound copy of the Bid Form is to be completed and submitted with the Bid Security and any additional data that may be called for elsewhere in these Bidding Documents. 00120-7 .14 MODIFICATION AND WITHDRAWAL OF BIDS: a. BIDS may be modified or withdrawn by an appropriate document duly executed (in the manner that a BID must be executed) and addressed and delivered to the County Judge prior to the Bid Opening. b. If, within twenty-four hours after BIDS are opened, any BIDDER files a duly signed, written notice with OWNER and promptly thereafter demonstrated to the reasonable satisfaction of OWNER that there was a material and substantial mistake in the preparation of its BID, that BIDDER may withdraw its BID and the Bid Security will be returned. Thereafter, that BIDDER may be disqualified from further bidding on the Work to be provided under the Contract Documents. .15 OPENING OF BIDS: BIDS will be opened and (unless obviously non -responsive) read aloud publicly at the place where BIDS are to be submitted. An abstract of the amounts of the base BIDS and major alternates (if any) will be made available to BIDDERS after the opening of BIDS. .16 BIDS TO REMAIN SUBJECT TO ACCEPTANCE: All BIDS will remain subject to acceptance for sixty days after the day of the Bid Opening, but OWNER may, in its sole discretion, release any BID and return the Bid Security prior to that date. .17 AWARD OF CONTRACT: a. OWNER reserves the right to reject any or all BIDS, including without limitation the rights to reject any or all nonconforming, nonresponsive, unbalanced or conditional BIDS and to reject the BID of any BIDDER if OWNER believes that it would not be in the best interest of the Project to make an award to that BIDDER, whether because the BID is not responsive or the BIDDER is unqualified or of doubtful financial ability or fails to meet any other pertinent standard or criteria established by OWNER. OWNER also reserves the right to waive all informalities not involving price, time or changes in the Work, waive technicalities, and to negotiate contract terns with the Successful BIDDER. b. The Calhoun County Commissioners Court shall be the sole judge in determining which bid will be the most advantageous to Calhoun County. C. Discrepancies between the multiplication of units of Work and unit prices will be resolved in favor of the unit prices. Discrepancies between the indicated sum of any column of figures and the correct sum thereof will be resolved in favor of the correct sum. Discrepancies between words and figures will be resolved in favor of the words. d. In evaluating BIDS, OWNER will consider the qualifications of BIDDERS, whether or not the BIDS comply with the prescribed requirements, and such alternates, unit prices and other data, as may be requested in the Bid Form or prior to the Notice of Award. 00120-8 e. OWNER may consider the qualifications and experience of subcontractors, Suppliers, and other persons and organizations proposed for those portions of the Work as to which the identity of Subcontractors, Suppliers, and other persons and organizations must be submitted as provided in the Supplementary Conditions. OWNER also may consider the operating costs, maintenance requirements, performance data and guarantees of major items of materials and equipment proposed for incorporation in the Work when such data is required to be submitted prior to the Notice of Award. OWNER may conduct such investigations as OWNER deems necessary to assist in the evaluation of any BID and to establish the responsibility, qualifications and financial ability of BIDDERS, proposed Subcontractors, Suppliers and other persons and organizations to perform and furnish the Work in accordance with the Contract Documents to OWNER's satisfaction within the prescribed time. g. If the contract is to be awarded, it will be awarded to lowest BIDDER whose evaluation by OWNER indicated to OWNER that the award will be in the best interests of the Project. h. If the contract is to be awarded, OWNER will give Successful BIDDER a Notice of Award within sixty days after the day of the Bid Opening. .18 CONTRACT SECURITY: Paragraph 5.01 of the General Conditions and the Supplementary Conditions set forth OWNER's requirements as to performance, payment and other Bonds. When the Successful BIDDER delivers the executed Agreement to OWNER, it must be accompanied by the required Bonds. .19 SIGNING OF AGREEMENT: When OWNER gives a Notice of Award to the Successful BIDDER, it will be accompanied by the required number of unsigned counterparts of the Agreement with all other written Contract Documents attached. Within fifteen days thereafter CONTRACTOR shall sign and deliver the required number of counterparts of the Agreement and attached documents to OWNER with the required Bonds. Within ten days thereafter, OWNER shall deliver one fully signed counterpart to CONTRACTOR. .20 WAGES AND SALARIES: CONTRACTOR shall pay not less than the prevailing wage rates if specified in the Contract Documents. These rates are minimums to be paid during the life of the Contract. It is therefore the responsibility of the BIDDER to inform themselves as to local labor conditions. .21 00705 — CALHOUN COUNTY GENERAL CONDITIONS: Reference Document No. 00705 00120-9 .22 EQUAL EMPLOYMENT OPPORTUNITY: CONTRACTOR shall ensure that no discrimination will occur against employees and applicants for employment because of their ethnic background, gender, age, religious practice, familial status, disability, or limited English language proficiency. .23 PROJECT FUNDING: This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program .24 CERTIFICATE OF INTERESTED PARTIES (FORM 1295): Calhoun County Commissioners Court WILL NOT consider for action any Bid, RFP, RFQ and/or contract with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. ✓ '25 SYSTEM FOR AWARD MANAGEMENT. CONTRACTOR must not be debarred or suspended from the Excluded Parties List System (EPLS) in the System for Award Management (SAM) and must have an active registration with the System for Award Management (www.SAM.gov). Include verification that your company is registered and that the company's principal is not listed (is not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date. CONTRACTOR is responsible to verify that Subcontractors are not debarred or suspended from the Excluded Parties List System (EPLS) in the System for Award Management (SAM) and must have an active registration with the System for Award Management (www.SAM.gov). END OF DOCUMENT 00120-10 Addendum No. 2 03/28/2022 BID lxsrm, CONTp1K.T. x- TNc,. hereinafter called "BIDDER", (Legal Firm Name) is submitting this Bid for Furnishing and Performing the Work specified herein as the REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. This BID is Submitted to the COUNTY OF CALHOUN, hereinafter called "OWNER". 1. Terms used in this BID are defined in the General Conditions or Document No. 00120 - Instructions to Bidders and shall have the meanings indicated in the General Conditions or Instructions. 2. BIDDER proposes and agrees, if this BID is accepted, to enter into an Agreement with OWNER in the form included in the Contract Documents to furnish and perform all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this BID and in accordance with the other terms and conditions of the Contract Documents. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This BID will remain subject to acceptance for Sixty (60) Calendar Days after the Bid Opening. BIDDER shall sign and deliver the required number of counterparts of the Agreement, including all required documents indicated by the Bidding Requirements, within Fifteen (15) Working Days after the date of OWNER's Notice of Award. 4. In submitting this BID, BIDDER represents, as more fully set forth in the Agreement, that: a. BIDDER has examined and carefully studied the Bidding Documents and the following Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and and Date): Addendum No.: J— z Date Received: 3 ot2 3 2az2, b. BIDDER has visited the site and is familiar and satisfied with the general, local and site conditions that may affect cost, progress, and furnishing and performing the Work. C. BIDDER is familiar and satisfied with all federal, state and local Laws and Regulations that may affect cost, progress, and furnishing and performing the Work. 00300-1 Addendum No. 2 03/28/2022 d. BIDDER is aware of the general nature of work, if any, to be performed by OWNER (or others) at the site in relation to the Work for which this BID is submitted. e. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents, and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for furnishing and performing the Work for which this BID is submitted. g. This BID is GENUINE and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation. BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham BID. BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding. BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over OWNER. 5. BIDDER agrees to complete the Work in accordance with the Contract Documents. a. BIDDER acknowledges that the amounts are to be shown in both words and figures, and in case of discrepancy, the amount in words shall govern. b. BIDDER acknowledges that the quantities are not guaranteed and final payment will be based on the actual quantities determined as provided in the Contract Documents. C. BIDDER acknowledges that, at OWNER's option and/or at OWNER's request, any of the quantities may be deleted, reduced, or increased based upon the respective Unit Prices. d. BIDDER acknowledges that Unit and Lump Sum Prices have been computed in accordance with paragraph 11.03.13 of the General Conditions. e. BIDDER agrees to furnish all necessary labor, superintendence, plant, machinery, equipment, tools, materials, insurance, services and all other requirements deemed necessary to complete the items of Work indicated on the following pages for the specific dollar amounts stated. 00300-2 Addendum No. 2 03/28/2022 BASE BID Baseline A: Station 0+00 to 145+50 Item # Item Description Quantity Unit Price Total Bid Price 1 Furnishing Mobilization and Insurance for the 1 LS BASE BID project scope as per plans and specifications MXWO V 50,W.to 2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) for BASE BID project limits for the duration of the entire proiect per plans andspecifications s 12000.0D :g iz omoo 3 Traffic control and barricading for the BASE BID I LS project limits for the duration of the entire project as per plans andspecifications. ODD °O }1 , MO. ofl 4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the BASE BID project limits of the Base Bid and as called upon in the drawings as per plans andspecifications P$,ODO•°D It 9.000.1 5 Regrading and digging of existing channel to a 3,300 LF bottom width of 20 feet and sloping embankment at a 4:1 slope and stockpiling spoil materials into habitat mounds including labor, equipment and materials for a complete installation as per plans andspecifications • 55 • oil Ig I, 500. 00 6 Regrading and digging of existing channel to a 11,080 LF bottom width of 15 feet and sloping embankment at a 3:1 slope and trucking of material to designated site including labor, equipment and materials for a complete installation as per plans andspecifications V70• ` $775; 600.06 7 Installation of 18" diameter HDPE corrugated 44 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete9� installation as per plans ands specifications. oo 0 8 Installation of 36" diameter HDPE corrugated 334 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete )Rd installation as per plans andspecifications. #63, 460.00 9 Installation of 48" diameter HDPE corrugated 168 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete 29S °p �9, S l�O• oa installation as er plans ands specifications. 10 Installation of 60" diameter HDPE corrugated 240 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete 4420•00 S)t)Q $b0.0D installation as per plans andspecifications. 11 Installation of 8" Diameter Rock Rip -Rap, CY 1300 including labor, equipment and materials for a complete installation as per plans and ZZS a0 $1G7, Ste-M specifications. 00300-3 Addendum No. 2 BASE BID CONTINUED Item # Item Description Quantity Unit Price Total Bid Price 12 Installation of 36" Diameter HDPE 22.5 Deg. 2 EA Fitting including labor, equipment and materials for a complete installation as per plans and s ecifications. ? 300.6D $6,600.0D 13 Installation of 36" Diameter HDPE 45 Deg. 2 EA Fitting including labor, equipment and materials for a complete installation as per plans and s ecifications. #.3bab.em 47,;z6o.Oo 14 Installation of 36" Diameter HDPE 90 Deg. 1 EA Fitting including labor, equipment and materials for a complete installation as per plans and s ecifications. vo. &V e ,2 T-0. OD 15 Installation of 36" Diameter HDPE Tee Fitting 1 EA including labor, equipment and materials for a complete installation as per plans and specifications. y#`,^Y&J.oa g5,,v( .00 16 Installation of 36" Diameter HDPE Reducer 1 EA Fitting to 18" Diameter including labor, equipment and materials for a complete installation as per plans andspecifications. i 700- � -f 7DU. °O 17 Reconstruction of existing gravel/limestone 135 SY roadway including labor, equipment and materials for a complete installation as per plans and specifications. Jrg.°D ' g go, 0a 18 Hydromulch seeding of excavated and disturbed 12 AC areas including labor, equipment and materials for a complete installation as per plans andspecs. 3 (, S^O. °D $Y3 gpo,co TOTAL BASE BID $ / 3q) 29$ oa TOTAL BASE BID CALENDAR DAYS 330 BASE BID DEDUCTION Item # Item Description Quantity Unit Price Total Bid Price D1 Deduction (difference) from Base Bid Item 6 for 1 LF disposing of spoils onsite in lieu of trucking material to off -site disposal area. Priced as a37 deduction per linear feet of ditch. TOTAL DEDUCTION BASE BID $ 37 e0 /LF 00300-4 Addendum No. 2 03/28/2022 OPTION A Baseline A: Station 145+50 to 160+00 Item # Item Description Quantity Unit Price Total Bid Price Al Furnishing Mobilization and Insurance for the 1 LS OPTION A project scope as per plans and IF700.0O $7,5`bpob specifications A2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) for OPTION A project limits for the duration of 3SU0 °o ?SCk7 the entire project per plans andspecifications A3 Traffic control and barricading for the OPTION A 1 LS project limits for the duration of the entire project as per plans ands ecifications.�%,(7oC�.aD�I,�CX)•°n A4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION A project limits of the Base Bid and as called upon in the 1�750' ov drawings as per plans andspecifications��' A5 Removal including truck hauling of all excess l LS spoil materials generated from the OPTION A project limits in which the property owner wishes to have the material removed completely from the>f,OgQ `h' s g��7p. eD property as per the plans andspecifications A6 Regrading and digging of existing roadside 2,710 LF ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans # 00 �O� g�O• ands specifications A7 Installation of 18" diameter HDPE corrugated 20 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete 00 92. installation as per plans andspecifications. A8 Installation of 24" diameter HDPE corrugated 185 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete $I ba'o #a installation as per plans andspecifications. •eo A9 Installation of 36" diameter HDPE corrugated 150 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete installation as per plans andspecifications. A10 Installation of 8" Diameter Rock Rip -Rap, 50 CY including labor, equipment and materials for a complete installation as per plans and specifications. All Installation of 36" Diameter HDPE 22.5 Deg. 2 EA Fitting including labor, equipment and materials for a complete installation as per plans and I -#33(O• CD specifications. 00300-5 Addendum No. 2 03/28/2022 OPTION A CONTINUED Item Quantity Unit Total Bid Description Price Price Al2 Installation of 36" Diameter HDPE Tee Fitting 2 EA including labor, equipment and materials for a complete installation as per plans and , s �/iJO. eD 91$m po specifications. A13 Installation of 36" Diameter HDPE Reducer l EA Fitting to 24" Diameter including labor, equipment and materials for a complete2, gSGt a�� od installation as per plans andspecifications. A14 Installation of 24" Diameter HDPE Tee Fitting 4 EA including labor, equipment and materials for a complete installation as per plans and specifications. A 15 Installation of 24" Diameter HDPE Reducer 2 EA Fitting to 18" Diameter including labor, equipment and materials for a complete ZOO. CD installation as per plans andspecifications.a'3 A 16 Reconstruction of existing asphalt roadway 615 SY including labor, equipment and materials for a complete installation as per plans and IS °`D 57,IVS.OD specifications. A17 Hydromulch seeding of excavated and disturbed 1.5 AC areas including labor, equipment and materials for .}�/,•�, pn 5 L/U0.0o a complete installation as per plans andspecs. TOTAL OPTION A $ 204 (�7co TOTAL OPTION A CALANDAR DAYS 00300-6 Addendum No. 2 03/28/2022 OPTION B Baseline B: Station 1+00 to 18+00 Item # Item Description Quantity Unit Price Total Bid Price Bl Furnishing Mobilization and Insurance for the 1 LS OPTION B project scope as per plans and 000.m #SOOQ.o' specifications p B2 Furnishing, implementing and maintaining a 1 LS Storm Water Pollution Prevention Plan (SWPPP) for OPTION B project limits for the duration of m 3.000,0° the entire project per plans andspecifications B3 Traffic control and barricading for the OPTION B 1 LS project limits for the duration of the entire project as per plansand specifications. B4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION B project limits of the Base Bid and as called upon in the drawings as per plans andspecifications B5 Removal including truck hauling of all excess 1 LS spoil materials generated from the OPTION B project limits in which the property owner wishes to have the material removed completely from the, SOS �� Ste. op properpropertv as per the plans andspecifications B6 Regrading and digging of existing roadside 3,123 LF ditches "V" bottom and sloping embankment at a 3:1 slope including labor, equipment and materials for a complete installation as per plans ,/ 0U�Z�� Y �D ands specifications B7 Installation of 18" diameter HDPE corrugated 223 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete 9%. installation as per plans andspecifications.ZO� B8 Hydromulch seeding of excavated and disturbed 2 AC areas including labor, equipment and materials for a complete installation as per plans andspecs. TOTAL OPTION B $ TOTAL OPTION B CALANDAR DAYS f0 00300-7 Addendum No. 2 03/28/2022 OPTION C Baseline A: Station 160+00 to 187+00 Item # Item Description Quantity Unit Price Total Bid Price C 1 Furnishing Mobilization and Insurance for the 1 LS OPTION C project scope as per plans and s ecifications'IO�, C2 Furnishing, implementing and maintaining a I LS Storm Water Pollution Prevention Plan (SWPPP) for OPTION C project limits for the duration of A5'.OGI7d' the entire proiect per plans andspecifications ✓'��`� C3 Traffic control and barricading for the OPTION C 1 LS project limits for the duration of the entire project as per plans ands specifications. ' Y,�/'/6w. z0 d C4 Removal and disposal of all existing driveway and 1 LS roadway culverts within the OPTION C project limits of the Base Bid and as called upon in the drawings as per plans andspecifications y, .e, C5 Removal including truck hauling of all excess I LS spoil materials generated from the OPTION C project limits in which the property owner wishes to have the material removed completely from the 7V $17. 960,6� property as per the plans andspecifications C6 Regrading and digging of existing roadside 4,740 LF ditches "V" bottom and sloping embankment at a 3: l slope including labor, equipment and materials for a complete installation as per plans andspecifications C7 Installation of 18" diameter HDPE corrugated 418 LF storm sewer pipe, open cut, including labor, equipment and materials for a complete 2V 92. c® , 5`�r"��(o 65 installation as per plans andspecifications. C8 Hydromulch seeding of excavated and disturbed 2 AC areas including labor, equipment and materials for 3fc�J�7L� o, a complete installation as per plans and specs. TOTAL OPTION C $ 54 to TOTAL OPTION C CALANDAR DAYS 3U +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The 5% Bid Bond is based on the GREATEST AMOUNT BID which is the sum of the Base Bid + Total Options "A", "B" and "C". GREATEST AMOUNT BID (Base Bid +Total Options "A", `B" and "C"): $ 4 766, Z97. 00 TOTAL CALENDAR DAYS (Base Bid +Total Options "A", "B" and "C"): 7W 00300-8 Addendum No. 2 03/28/2022 The award will be based on the Base Bid with consideration of the Option A, Option B & Option C. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ BIDDER agrees that the Work shall be completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. The following documents are included and made a condition of this BID: a. Required Bid Security in the form of Vap Bomb 5% GAB b. Affidavit C. Certificate of Interested Parties, Form 1295 d. System for Award Management — (sam.gov) e. Certification Regarding Debarment & Suspension and Other Responsibility Matters f. Certification Regarding Lobbying g. Disclosure of Lobbying Activities h. Conflict of Interest Questionnaire, Form CIQ i. House Bill 89 Verification j. Residence Certification k. GLO — Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions of Section 3 1. Document No. 00416 - Noncollusion Affidavit in. Document No. 00420 — Bidder Qualification Statement n. Document No. 00450 - Certification of Bidder Regarding Civil Rights Laws and Regulations Submit one original and three copies of this bid and forms listed above. Please do not fold, bind or staple sets. Bids must be returned in a Sealed 9 x 12 or larger envelope clearly marked: SEALED BID: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064- C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1 Submit Sealed Bid Before 2:00:00 PM, Thursday, March 31, 2022 to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, 3`d Floor, Suite 301 Port Lavaca, TX 77979 00300-9 Addendum No. 2 03/28/2022 8. Communications about this BID shall be directed to BIDDER's address indicated below. SUBMITTED this31 -51� da%y of AlAx&h , 2022• Authorized Signature: j Name: ) i/DV Attesting Signature: � Name: 7< 4AOy / 44Z-s Title: &AI Legal Firm Name: /rsme ,rovrxrW Ta Business Address: NY_ -V 779749 Phone Number: 02P7,4' Facsimile Number:16/�5; E-Mail Address (optional): / /Pc/rr��avh'nsc Levu, State of Incorporation, if applicable:g5 State Contractor License No.: A0 END OF DOCUMENT 00300-10 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we Lester Contracting, Inc. PO Box 986, Port Lavaca, Tx 77979 as Principal, hereinafter called the Principal, and Continental Casualty Company 151 N. Franklin Street, Chicago, IL 60606 a corporation duly organized under the laws of the State of Illinois called the Surety, are held and firmly bound „ntn Calhoun Cnunhr as Surety, hereinafter 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Tx 77979 as Obligee, hereinafter called the Obligee, in the sum of 5% Greatest Amount Bid Dollars( 5% GAB ) for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitteda bid for Re -Bid Lane Road Drainage Improvements for Calhoun County,. Texas -Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order No. B-1 NOW, THEREFORE, ifthe Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documentswith good and sufficient surety for the faithful performance of such Contract and for the promptpayment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amountspecified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 31st day of March 2022 (Witness) Lester Contracting, Inc. (Principal) (Seal) By. ✓✓ Ken Lester Jr. (Title) President Continental Casualty Company D /'t (Surety) (Seal) Leticia Ballejo 1U itness Witness By: o"�'1vv� ae Z Ana Rodriguez ( Attorney in Fact Printed in cooperation with the American Institute of Architects (AIA) by the CNA Insurance Companies. - The language in this document conforms exactly to the language used in AIA Document A310- Bid Bond- February 1970 Edition. G-108041-A Authorizing By -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company at a meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of Continental Casualty Company. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 2511' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or . othenvise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behatf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective," This Power of Attorney is signed by Paul T. Brufiat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of National Fire Insurance Company of Hartford. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25"' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Nov therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duty adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of American Casualty Company of Reading, Pennsylvania. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 2511' day of April, 2012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers")to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the Authorized Officers, in addition to being provided in original, bard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents,'rhat Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Gary Grissom, Randy Reynolds, Laurie J Barnes, Ronda Brown, Denise Dugan, James Russell, Ana Rodriguez, Kristie Rodriguez, Shanna Wagner, Coy Sunderman, Individually of Austin, TX, their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 22nd day of June, 2021. GA5tJq<Ty �P� 1NSURgyc c•„vANY OR, GORPOnAtem R y y 0 Z 2 SEAL $ JULY 31, oU Y �y �� r Lsoz �* tee? � HJIRIF� • Continental Casualty Company National Fire Insurance Company of Hartford American Ca Ity Company of Re ing, Pennsylvania Paul T. Bruflat ce President State of South Dakota, County of Minnehaha, ss: On this 22nd day of June, 2021, before me personally came Paul T. Bruflat to me known, who, being by me duly swom, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. .rrrrrrr„rr...rr,,.rr.r, t M. BENT f sEAL NOTARY �PUBLIC OWN OAKWA sERt S Irrrr,rrr,,,,,,rr,rrrwr,l J My Commission Expires March 2, 2026 M. Bent Notary Public CERTIFICATE I, D. Johnson, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 31st day of March, 2022. �(•,ASUgtT` INSUHq n �APANY op p �P 'ttt, yC zW CORPORATE D� N4 Y0q, FOR911 4 0 o c $ S¢y JULY n, M SEAL 1a97 � HPRtF� • � Form F6853-4/2012 Continental Casualty Company National Fire Insurance Company of Hartford American Casualty Company of Reading, Pennsylvania I j akvva-.� D. Johnson Assistant Secretary Go to www.cnasuretv.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. CERTIFICATE AS TO CORPORATE PRINCIPAL I. )6paA S)OK)E , certify that I am the Secretary of the Corporation named as Principal in the bid bond; that V&W 44. TM JP-. , who signed the said bond on behalf of the Principal was then JUXVU�W- of said corporation; that I know his/her signature, and his/her signature thereto is genuine: and that said bond was duly signed, sealed, and attested to, on behalf of said corporation by authority of its governing body. Corporate Seal Title: SETi27Y1/a / LL I v ' Power -of -attorney for person signing for Surety Company must be attached to bond. STATE OF TEXAS {} AFFIDAVIT COUNTY OF CALHOUN {} BEFORE ME, the undersigned authority, on this day personally appeared kov /1•'S1L-i2. J12 - known to me to be the person whose name is subscribed to the following, who, upon oath says: I am the Manager, Secretary, or other Agent or Officer or the Principal of the Bidder in the matter of the bids to which this affidavit is attached, and I have full knowledge of the relations of the Bidder with the other firms in this same line of business, and the Bidder is not a member of any trust, pool or combination to control the price of supplies bid on, or to influence any person to bid or not bid thereon. affirm that I am duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder. I further affirm that the Bidder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted bid. The contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this Bid. 9' U Affiant Printed Name and Title of Affiant Name of Bidder (Company)/CSTM r.oVVrRA TYAU Tie Phone Number 136,1 5!5z- 3e�4 Fax Number (3/0j� 50- Veilq Email Address t-AnotY /eSfercon�ravi' �. ram SWORN TO AND SUBSCRIBED BEFORE ME bythe above are true and correct, this �jEt day of _ DIANNE SCALES Notary ID #4164086 13 My Commission Exptrcs October 31, 2022 N .- : �::T.;;:•.�::ez;�suu�a�v::twtnw,�„:s1T•w1�.i, Affiant, who, on oath, states that the facts contained in the �Vl 20� . Notary Public in and for Texas CERTIFICATE OF INTERESTED PARTIES, FORM 1295 Form 1295 must be filled out online, printed, signed and returned. The copy included is a Sample Copy Only. See Calhoun County, Texas — Policy of Compliance (behind the sample copy of the form) TO FILL OUT FORM 1295, VENDORS MUST_ Go to: https://www.ethics.state.tx.us/File 1. If you have an account, log in and proceed with the process or if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2. Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only". 3. The Respondent or an authorized agent of the Respondent must sign the printed copy of the form. 4. The completed Form 1295 must be included with your bid when it is submitted to Calhoun County. For help in filling out the form: #1 Name of Business Entity filing the form, and the City, State and Country of the Entity's place of business #2 Calhoun County, Texas #3 REBID - Lane Road Drainage Improvements - TX GLO Contract No. 20-065-064- C182 On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies J #6 Fill in the correct information, submit and print After printing, the respondent or an authorized agent of the respondent must sign When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-865482 Lester Contracting, inc. Port Lavaca, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/28/2022 being filed. Calhoun County, Texas Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. TX GLO No.20-065-064-C182 REBID - Lane Road Drainage Improvements - TX GLO Contract No. 20-065-064-C182 4 Name of Interested Party City, State, Country ty, y (place of business) Nature of interest (check applicable) Controlling Intermediary Lester, Jr., Ken Port Lavaca, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION R My name is �o llgqb OVA and my date of birth is (�U`�II 11, It �1 Myaddressis Po 1)�X "4U� IJ 1� ({tv-i 3S Susilt �O�T Gaya i I>\ I (street) (city) (state) (zip code) (country) I declare under penalty of perjurythat the foregoing is true and correct. �i c nn Executed in �i' Yl�)NV� County, State of I�A 7 , on the �E day of MtkrM , 20 . (month) (year) Signature of authorized agent @ contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc Insert System for Award Management (SAM) Record Search for company and company principal(s). Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principles are not listed (are not debarred) through the System for Award Management X11 SAM,cov- Entity Workspace Results 1 Total Resu Its Lester Contracting, Inc. !aues, nique Entity ID:026959510 Physical Address: saMJ Unique Entity ID: YSFTEM85M881 3677 State Highway 35 S --- Port Lavaca, TX CAGE/NCAGE: IJMS4 77979-5584 USA Entity Status: Active Expiration Date: Nov 10,2022 Purpose of Registration: All Awards Mar 28, 202214:00:48 PM 3/28/22, 9:05 AM i l Active 0 Expired OID Assigned Expiration Date Address Update 1 I of l Lester Contracting, Inc. FDUNSJ Unique Entity ID: 026959510 SAM Unique Entity ID: YSFTEM85M881 CAGE/NCAGE: 1JMS4 Purpose of Registration: All Awards Results per page 25 Address: 3677 State Highway 35 S Port Lavaca, TX 77979-5584 USA EntityStatuS Active Expiration Dote Nov 10, 2022 SAM.gov I Entity Workspace Reset 0 Sort by Expiration Date Ascending https://sam.gov/workspace/em/entities/non-federal?statusCode=4 213 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84"' Texas Legislature through the adoption of House Bill 1295. The law states that the Comity may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85"' Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for l) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state,tx.us/wliatsnew/elf into form1295.1-ttm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contact is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun Comity Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract tinder a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a - d) of this certification. & )ESa-P, ,)rp-, . - )gA=V4VT Name and Title of Authorized Agent Signature of Authorized Agent 3 3i 2o;ZZ Date I am unable to certify to the above statements. My explanation is attached. DEBARMENT & SUSPENSION . Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shal I have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within fora• months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for Influencing or attempting to Influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be Included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification Is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, I izZ "cnw& VP-. , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31.P.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official L1ay 1,rsrm_-jP-. - rKGS7icArr- Printed Name and Title of Contractor's Authorized Official 3i/,2o2Z Date Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for oublic burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial filing _ b. grant _ b. initial award _ b. material change c, cooperative agreement c. post -award d. loan - For material change only: e.loan guarantee f. loan insurance Nf Year quarter Date of last report lA NIA N 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, En/ter _ Prime _ Subawardee Name and Address of Prime: Tier , if Known: Congressional District, If known: NIA Congressional District, if known: N IA 6. Federal Department/Agency: 7. Federal Program Name/Description: N CFDA Number, tfapplicable: NIA 8. Federal Action Number, ifknown: 9. Award Amount, lfknown: NIP, $ 14A 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address iJ' ((fu,dlvldual,last name,ft-wname, Ml): d1Q'erenifoinNo. IOa) (last name, first nalne, Ml): N/A N�p 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 /� 41. 5rM representation of fact upon which reliance was placed Print Name: K47V by the tier above when this transaction was made or 136"Otrr entered into. This disclosure Is required pursuant to 31 Title: Telephone No.: 3 ) 551'3)7-4 Date: 3 31 Z01Z U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for Influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all Items that apply for both the Initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if It is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime Is the 1st tier. Subawards Include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report In item 4 checks "Sub awardee;' then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, If known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal Identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e,g., "RFP-DE-90.001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity Identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to Influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of Information unless it displays a valid OMB control Number. The valid OMB control number for this Information collection is OMB No. 0348- 0046. Public reporting burden for this collection of Information is estimated to average 10 minutes per response, including time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of Information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICELISEONLY This questionnaire is being filed In accordance with Chapter 176, Local Government Code, by a vendor who Dale Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176,006, Local Government Code. An offense under this section is a misdemeanor. f Name of vendor who has a business relationship with local governmental entity. LEM- e Comwca v& :: 1 . 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was Incomplete or Inaccurate.) „ / �V 3 Name of local government officer about whom the Information is being disclosed. A10A16 Name of Officer 4J Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. �i A A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes F-1 No B. Is the vendor receiving or likely to receive taxable income, other than Investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes F-1 No 6 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership Interest of one percent or more. II/A 6 Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts ❑ described i Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). has 7 Signature of vendor doing business with the governmental entity Late Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/3012015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity A complete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Does/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code 4 176.0010 -a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that Is subject to rate or fee regulation by a federal, stale, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code 4176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results In the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (I) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code 6176.006(a) and (a-1I (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics. state.tx. us Revised 11/30/2015 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85th Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. [,(authorized official) _l11/ jESrL`R T2.. , do herebyverify the truthfulness and accuracy of the contents of the statements submitted on this certification underthe provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at httos://comptroller.texas.¢ov/purchasing/publications/divestment.pho Signature of Authorized Official Printed Name of Authorized Official /aezmbw 3/3/ 12022. Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. ❑ 1 certify that (4) "Resident bidder" refers to a person whose principal place of business is in this state, Including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. is a "Nonresident Bidder' of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) I certify that I131 L 6(uTAA6?=&is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252,001. - C 1A Signature of Authorized Agent Printed Name and Title of Authorized Agent 3131/Rn2.2 Date Giaatee/Sutveclpient Include INs cbcutnentina apt ppcabs bl paceld rTs. Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program Contractor Certification of Efforts to Fully Comply with Employment and Training Provisions o�flon 3 Economic Opportunities for Low and Very Low -Income Persons THE BIDDER REPRESENTS AND CERTIFIES AS PART OF ITS BID/OFFER THAT IT: ❑ Is a Section 3 Business Concern. A Section 3 Business Concern means a business concern: 1. That is 51 %or more owned by Section 3 Resident(s); or 2. Whose permanent, full-time employees include persons, at least 30%of whom are currently Section 3 Residents, or 3. That provides evidence of a commitment to subcontract in excess of 25%of the dollar value of all subcontracts to be awarded to Section 3 Business Concerns, that meet the qualifications set forth in paragraphs 1 or 2 herein. Is NOT a Section 3 Business Concern, but who has and will continue to seek compliance with Section 3 by certifying the following efforts to be undertaken. EFFORTS TO AWARD SUBCONTRACTOR (Check ALL that apply) TO SECTION 3 CONCERNS By contacting business assistance agencies, minority contractors assoclafions and community organizations to inform them of the contracting opportunities and requesting their assistance in identifying Section 3 businesses which may solicit bids for a portion of the work. By advertising contracting opportunities by posting notices, which provide general information about the work to be contracted and where to btain additional information, in the common areas of the applicable development(s) owned and managed by the Housing Authority. By providing written notice to all known Section 3 Business Concerns of contracting opportunities. This notice should be in sufficient fime to Ilow the Section 3 Business Concerns to respond to bid Invitations By following up with Section 3 Business Concerns that have expressed Interest in the contracting opportunities. By coordinating meetings at which Section 3 Business Concerns could be informed of specific elements of the work for which subcontract bids are being sought. By conducting workshops on contracting procedures and specific contracting opportunities in a timely manner so that Section 3 Business Concerns can take advantage of contracting opportunities. Vey advising Section 3 Business Concerns as to where to seek assistance to overcome barriers such as inability to obtain bond! ng, lines of credit, financing, or insurance and aiding Section 3 Businesses in qualifying for such bonding , financing, Insurance, etc.... Where appropriate, by breaking out contract work into economically feasible units to facilitate participation by Section 3 businesses. By developing and using a list of eligible Section 3 Business Concerns. By actively supporting and undertaking joint ventures with Section 3 Businesses. EFFORTS TO PROVIDE TRAINING AND EMPLOYMENT TO SECTION 3 RESIDENTS By entering Into a "first source" hiring agreements with organizations representing Section 3 Residents. By establishing training programs, which are consistent with the requirements of the Departrnent of Labor, specifically for Section 3 Residents in the building trades. By advertising employment and training positions to dwelling units occupied by Category 1 and 2 residents. By contacting resident councils and other resident organizations in the affected housing development to request assistance in notifying esidents of the training and employment positions to be filled. By arranging interviews and conducting interviews on the job site. By undertaking such continued job -training efforts as maybe necessary to ensure the continued employment of Section 3 Residents previously hired for employment opportunities. By posting job -sin Work -In -Texas or with my local Workforce Solutions Center. Contractor Name/Business Name: LE3rM CaN mewv&, ZNe,• Date: 3� 3r/2oxZ Authorized /Reepreessentativveeive N�, N A974'n.72. Signature: \ /�/ DOCUMENT NO.00416 NON -COLLUSION AFFIDAVIT State of -26A5 ) County of Cg1. 4&W ) ray asrm J2 . being first duly sworn, deposes and says that: 1. He is A2rAwT' of /AjrCk Gdvr/u 4M!,& +tom • , the BIDDER that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with another BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached Bid or of any other BIDDER, or to fix an overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against CALHOUN COUNTY (OWNER) or any person interested in the proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties i inter ,including this affrant. (Signed) — /'f�CR�d'rtl7' Title Subscribed and sworn to me this �� day of rCt-� 20 ZZ By. N/ U U Notary Public My commission expires ��' �' Z Ew= NE SCALESID #4164086ission Expireser 31, 20i2 END OF DOCUMENT 00416-1 DOCUMENT NO. 00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information it desires. Date: 3V 314-4z Bidder (Legal Name of Firm): lepm KhAa drillib Tic.. Date Organized: 140 Name of Owner(s): Fm.'re. Address: PD. & )e M. Awe A4VAM V 77499 Date Incorporated: 1970 Federal ID Number: 74. Mo76138 Number of Years in contracting business under present name 20 t List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Type of work performed by your company: 5;r7 W,,XX 5' Gf7Z2 t� Have you ever failed to complete any work awarded to you? 0 Yes U No (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? 0 Yes 9/No (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the past five years or that was still in effect during the five year period or is still in effect? 0 Yes "o (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance) Amount $ Mo/Yr Completed Major equipment available for this contract: lSa1l k771446t SylxT� Are you in compliance with all applicable EEO requirements? A'Yes 0 No (If no, please attach summary of details on a separate sheet.) 00420-1 Are you a Section 3 business? (see below) ❑ Yes io/No Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipient's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low income persons. Bank References Address: /01 SO A-W ISUN Contact Name: A4XW AAA City & State: G7oesA�7X Zip: :: 7gol Phone Number: (&I) 577L- GS'Slo Credit available: $ /,UDO, 000 Has the firm or predecessor firm been involved in a bankruptcy or reorganization? 0 Yes 00 (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Printed Name and Title: ,dal L4yTm?- clR.. — f�&n1r Company Name: I'alm co1rana &. �,e,. Notary Statement: gnu I.i.5iE'2 Tie... being duly sworn, says that he/she is the P"UtLwr Position/Title of /Etrx9 i!NON(R WV6, Zwe_- (Firm Name), and hereby swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporation to furnish any information requested by CALHOUN COUNTY in verification of the recitals comprising this Bidder's Qualifications Statement. Subscribed and sworn before me this day of µ'WA , 20 Notary Public DIANNE SCALES Rr a e Signature: Icy Notary ID #4164086 �tl . - 1 CS ,. My Commission Expires Printed Name: i/�l L.�! vrE�_ t<. October 31, ZDZZ My Commission Expires: U)- 5t - 2z- The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. END OF DOCUMENT 00420-2 DOCUMENT NO. 00450 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) L1-SM-e. 4ovTW v-J-ritlLa ea 6" q*k Paer MyAew TR -7 CERTIFICATION BY BIDDER Bidder has participat d in a previous contract or subcontract subject to Civil Rights Laws and Regulations. Yes ❑ No The undersigned hereby certifies that: The Provision of Local Training Employment and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). u The Ecual Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). PThe Section 503 clause is included in the contract Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended? ❑ Yes p' No NAME AND TITLE OF SIGNER (Please type) SIGNATU DATE 3�3r�,?U22 frz11r.1161ta au€u6fi`slat�menoi4i' ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040-0009 ware; uzrzareuzz Public reporting burden for this collection of Information is estimated to average 15 minutes per response, Including time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding the burden estimate or any other aspect of this collection of Information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Certain of these assurances may not be applicable to your projector program. If you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such Is the case, you will be notified. As the duly authorized representative of the applicant:, I certify that the applicant: 1. Has the legal authodly to apply for Federal assistance, and the institutional, managerial and financial capability (Including funds sufficient to pay the non -Federal share of project costs) to ensure proper planning, management and completion of project described in this application. 2. Will give the awarding agency, the Comptroller General of the United Slates and, if appropriate, the State, the right to examine all records, books, papers, or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will not dispose of, modify the use of, or change the terms of the real property title or other interest In the site and facilities without permission and instructions from the awarding agency. Will record the Federal awarding agency directives and will Include a covenant In the title of real property acquired In whole or in part with Federal assistance funds to assure non- discrimination during the useful life of the project. 4. Will comply with the requirements of the assistance awarding agency with regard to the drafting, review and approval of construction plans and specifications. 5. WIII provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications and will furnlsh progressive reports and such other information as may be required by the assistance awarding agency or Slate. 6. Will Initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of Interest, or personal gain. 8. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C, §§4728.4763) relating to prescribed standards of merit systems for programs funded under one of the 19 statutes or regulations specified In Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 9. WIII comply with the Lead -Based Paint Poisoning Prevention Act (42 U,S.C. §§4801 at seq.) which prohibits the use of lead -based paint in construction or rehabilitation of residence structures. 10. WIII comply with all Federal statutes relating to non- discrimination. These Include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 98-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681 1683, and 1685.1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29) U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which.prohibils discrimination on the basis of age; (a) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 as 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title Vill of the Civil Rights Act of 1968 (42 U.S.C. §§3601 at sect.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (1) any other nondiscrimination provisions in the specific statue(s) under which application for Federal assistance Is being made; and 0) the requirements of any other nondiscrimination statue(s) which may apply to the application. Previous Edition Usable Authorized for Local Reproduction Standard Form 4240 (Rev. 7-97) Prescribed by OMB Circular AA02 11. Will comply, or has already compiled, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91.646) which provide for fair and equitable treatment of persons displaced or whose properly is acquired as a result of Federal and federally-asslsted programs. These requirements apply to all Interests in real property acquired for project purposes regardless of Federal participation In purchases. 12. WIII comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or In part with Federal funds. 13. Will comply, as applicable, with the provisions of the Davis - Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safely Standards Act (40 U.S.C. §§327- 333) regarding labor standards for federally -assisted construction subagreements. 14, WIII comply with flood Insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93.234) which requires recipients In a special flood hazard area to participate In the program and to purchase good Insurance If the total cost of insurable construction and acquisition Is $10,000 or more, 15. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L, 91- 190) and Executive order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards In floodplains in accordance with EO 11988; (a) assurance of project consistency with the approved Stale management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 at seq.); (f) conformity of Federal actions to Stale (Clean Air) implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 at seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205). 16, WIII comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 at seq.) related to protecting components or potential components of the national wild and scenic rivers system. 17. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470). EO 11593 (Identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§46ga-1 at seq). 18, Will cause to be performed the required financial and compliance audits In accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non -Profit Organizations." 19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. 20, WIII comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub-reclplent from (1) Engaging In severe forms of trafficking in persons during the period of time that the award Is In affect (2) Procuring a commercial sex act during the period of time that the award Is in effect or (3) Using forced labor In the performance of the award or subawards under the award, SI TUR OF UTIZED CERTIFYING OFFICIAL TITLE APPLICANT ORGANIZATION DATE SUBMITTED 5F-424U (KSV. r-U O CaCK DOCUMENT NO.00415 CONTRACTOR'S CORPORATE RESOLUTION I hereby certify that it was RESOLVED by a quorum of the directors of L--StZit Cmirpwcarrv[a -1Qe,. (Name of Corporation) meeting on the 2B day of ,T mAxy 20 0c, , that Zw;-aM?L, jQ , �2estoGml7' , be, (Name of Principal) (Title) and hereby is, authorized to execute all documents necessary for the transaction of business in the State of Texas on behalf of the said A37a-k CwviWic W6v Jame'. and (Name of Corporation) That the above resolution was unanimously ratified by the Board of Directors at said meeting and that the resolution has not been rescinded or amended and is now in fill force and effect; and in authentication of the adoption of this resolution, I subscribe my name this day of me\i-M 'ZI 20 a1 . w 6 Secretary +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ If you are not a corporation, please check the box and sign below ❑ Company Name: Signed By: Print Name/Title: END OF DOCUMENT 00415-1 DOCUMENT NO.00417 TRENCH SAFETY SYSTEMS INDEMNITY AGREEMENT OWNER: Calhoun County CONTRACTOR: 1,erml2. 1'&Vr Q7n1G, ZZ, (company name) ENGINEER: G & W Engineers, Inc., Port Lavaca, Calhoun County, Texas PROJECT: REBID - LANE ROAD DRAINAGE IMPROVEMENTS FOR CALHOUN COUNTY, TEXAS - TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 AND CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. B-1. CONTRACTOR has entered into a contract with OWNER for the construction of the Project. ENGINEER has designed the Project on behalf of OWNER, but has not designed any trench safety systems for the Project that may be required by applicable federal, state and/or local laws. CONTRACTOR, in its contract with OWNER, has agreed to prepare, and to conform all trenching work to plans for trench safety systems meeting the standards of applicable laws. CONTRACTOR, as part of its consideration to OWNER for the contract for the construction of the Project, agrees that it will be solely responsible for compliance with its trench safety plans and with all applicable standards of federal, state and/or local laws relating to trench safety. CONTRACTOR further agrees to hold harmless, indemnify, and defend OWNER and ENGINEER, and all officers, agents and employees of either OWNER or ENGINEER, from and against any and all claims, demands or causes of action of any nature, character or description in connection with the presence, or in any way arising out of, the use or construction of trenches or trench safety systems as part of the Project. EXECUTED, this 31 day of m6krGx/\ 20 a CONTRACTOR OWNER By: &SM4 COVMA By. - Officer's Name: Officer's Name: Richard H. Meyer Title of Officer: AayrAAwr Title of Officer: Calhoun County Judie (Contractor's Seal) ENGINEER By: Engineer's Name: Scott P. Mason, P.E. Title of Engineer: Sr. Project Engineer END OF DOCUMENT 00417-1 DOCUMENT NO.00430 CONTRACTOR'S LOCAL OPPORTUNITY PLAN %t-SILt¢��T�tL, agrees to implement the following specific affirmative action steps directed at increasing the utilization of lower income residents and businesses within CALHOUN COUNTY, hereinafter called OWNER. A. To ascertain from OWNER's CDBG-DR program official the exact boundaries of the project area and where advantageous, seek the assistance of local officials in preparing and implementing the affirmative action plan. B. To attempt to recruit from OWNER the necessary number of lower income residents though local advertising media, signs placed at the proposed site for the project, and community organizations and public or private institutions operating within and servicing the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Concentrated Employment Program, Hometown Plan, or the U.S. Employment Service. C. To maintain a list of all lower income residents who have applied either on their own or on referral from any source, and to employ such persons, if otherwise eligible and if a vacancy exists. D. To require all subcontracts to have an affirmative action plan including utilization goals and the specific steps planned to accomplish these goals. E. To insure that subcontracts (greater than $10,000) which are typically let on a negotiated rather than a bid basis in areas other than the covered project area are also let on a negotiated basis, whenever feasible, in a covered project area. F. To formally contact unions, subcontractors, and trade associations to secure their cooperation in this effort. G. To insure that all appropriate project area business concerns are notified of pending sub - contractual opportunities. H. To maintain records, including copies of correspondence, memoranda, etc., which document that all of the above affirmative action steps have been taken. To appoint or recruit an executive official of the company or agency as Equal Opportunity Officer to coordinate the implementation of this plan. J. To maintain records concerning the amount and number of contracts, subcontracts, and purchases which contribute to objectives. 00430-1 K. To maintain records of all projected work force needs for all phases of the project by occupation, trade, skill level, and number of positions and to update these projections based on the extent to which hiring meets these Local Opportunity objectives. As officers and representatives of .Lamm c c',VmAe$� k' • , we, the undersigned, have read and fully agree to this Plan, and become a party to the fiill implementation of the program and its provisions. -Q) Wk Signature 'bW /4cr . Printed Name Date�3l� LOz2+ Title END OF DOCUMENT 00430-2 DOCUMENT NO. 00440 CONTRACTOR'S SUBCONTRACT/WORKFORCEBREAKDOWN .01 PROPOSED CONTRACTS BREAKDOWN Type or Contracts Number or Contracts Csthouted Total Dollar Amount Estimated % to Local Business Estimated $ Amount to Local Business tj oN� Cb m OS Totals: .02 ESTIMATED PROJECT WORKFORCE BREAKDOWN Work Classifications Total Estimated Positions No. Positions Currently Filled No. Positions Not Filled No. Positions to Fill with L/M Residents Sutrratvrsort� � � CD 2 VAYK,I f p 2 Z (b Totals: END OF DOCUMENT 00440-1 Instructions for Proposed Contracts Breakdown and Estimated Project Workforce Breakdown Proposed Contracts Breakdown for Section 3* Tyne of Contracts— list all construction, materials, or other types of subcontracts (for example: electrical, plumbing, concrete, boring, etc.) No. of Contracts —Amount of contracts under this category Approximate Total Dollar Amount — Total amount of each contract Estimated Percentage of Contract to Local Business — What percentage of each type of contract will be awarded to a Section 3 Business Concern (see below for definition)? For example: will you hire any local employees or subcontractors? Estimated $ Amount to Local Business - How many dollars will be spent locally for each type of contact? For example: will you hire any local employees or subcontractors? Estimated Project Workforce Breakdown Work Classifications —Classification of project employees as defined on Wage Rate Total Estimated Positions — List the number employees for each work classification wit] you need on this project Number of Positions Currently Filled — List the number of estimated positions you currently have filled Number of Positions Not Filled — List the number of estimated positions you currently do not have filled Number of Positions to Fill with Low to Moderate income Residents — List the number of local residents earning low to moderate incomes that you plan to employ to fill the estimated positions not filled *Definition of Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the Grant Recipient's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low income persons. SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The lzcr,.P (Mtmge;mA ,T,�__ does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) �S1aJ2ne>1Gt1T11�,. (Address) %D. & . q96 p,994-14106A Tk 7?q71 City State Zip Telephone Number (361 ) 5522 - 9024 Voice TDD A r,Ww q &D/Uc has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development's (HUD) regulations Implementing Section 504 (24 CFR Part 8. dated June 2, 1988). U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM CONTRACTOR'S CERTIFICATION CONCERNING LABOR STANDARDS AND PREVAILING WAGE REQUIREMENTS TO (appropriate recipient) /^ t Nlm �0�t/(.L,1 '�';Z,�rt� j1 ` 1 DATE PROJECT NUMBER (if any) �^ 06S_ . GJ g� C/O PROJ CTNAMELN19 POA '.'kUovf The undersigned, having executed a contract with CAWowU &WOTY for the construction of the above -identified project, acknowledges that: (a) The Labor Standards provisions are included in the aforesaid contract, (b) Correction of any infractions of the aforesaid conditions, including Infractions by any subcontractors and any lower tier subcontractors, Is Contractor's responsibility. 2. Certifies that: (a) Neither Contractor nor any firm, partnership or association in which it has substantial Interest is designated as an ineligible contractor by the Comptroller General of the United States pursuant to Section 5.6(b) of the Regulations of the Secretary of Labor, Part 5 (29 CFR, Part 5) or pursuant to Section 3(a) of the Davis -Bacon Act, as amended. (b) No part of the aforementioned contract has been or will be subcontracted to any subcontractor if such subcontractor or any firm, corporation, partnership or association in which such subcontractor has a substantial interest is designated as an ineligible contractor pursuant to any of the aforementioned regulatory or statutory provisions. 3. Contractor agrees to obtain and forward to the aforementioned recipient within ten days after the execution of any subcontract, including those executed by subcontractors and any lower tier subcontractors, a Subcontractor's Certification Concerning Labor Standards and Prevailing Wage Requirements executed by the subcontractors. 4. Certifies that: (a) The legal name and the business address of the undersigned are: c The name, title and address of the NAME owner, partners or officers or the uneersl nee TITLE are: ADDRESS KE-n, l.�,an,Tw• fir' III ibor'Dftve Fb2rc�wvncA Tk7�919 Mearsq Aaran. III oft-r *rve t9gai-AAu► Tk 77M fig Matip 0193 Agror6wo &NW mw & Sc2atTA A k8t*tA Qm lb -7 1 .,TA 999 4&572?2 /&vrpAC7:PV6 (Contractor) Date -3 Lester Contracting, Inc. Team Members Trent Tagliabue — Vice President/Estimator/Project Manager Trent has 20 years of construction experience and has been with LCI for 14 years. He holds a bachelors of business management degree from UHV. Trent has managed the successful completion of all types of heavy construction projects including site preparation, underground utilities, streets and more. Projects have ranged from small to several million dollars. Trent will be the project manager for the duration of this project. Josh Hiller— Field Superintendent Josh has 12 years of construction experience and has been with LCI for 5 years. His expertise includes project coordination and site supervision in all company operations. Josh has successfully completed all types of projects ranging from site preparation, underground utilities, streets and more. Josh will be the Field Superintendent for.the duration of this project and will be on -site 50% of the time. He also oversees other project for the company. Billy Anderson —Job Foreman/Operator Bill has 30 years of construction experience and has been with LCI for 5 years. His expertise includes operating equipment and managing projects from start to finish. Billy has successfully completed all types of road projects, parking lots and more. Billy will be the job foreman overseeing the earthwork, sitework and paving portions of this project. Luis Casteneda —Job Foreman/Operator Luis has 16 years of construction experience and has been with LCI for 15 years. His expertise includes underground utilities and operating equipment. Luis has successfully completed numerous underground utility projects from small to several million dollars. Luis will be the job foreman overseeing the underground utilities portion of this project. Chris Ochoa — Safety Manager/Quality Control Chris has 20 years of construction experience and has been with LCI for 8 years. His expertise includes soil testing, quality control and safety. Chris has been in and around construction his entire life and has worked on all types of construction projects. Chris will be the safety contact and QC manager for the duration of this project. Jose Alvarado — Field Engineer Jose has 21 years of construction experience and has been with LCI for 13 years. His expertise includes layout, establishing design and building GPS models. Jose has designed and built all types of projects from parking lots, roads. neighborhoods and entire building sites. Jose will be the field engineer for the duration of this project. } | !||| �E yƒ kk \(D inc. P.O. Box 986 • Port Lavaca • TX • 77979 • (361) 552-3024 • FAX (361) 552-4049 OWNED EQUIPMENT Cat 330 Excavator Cat 329L Excavator Cat 325D Excavators (2) Cat324L Excavator Cat 320CL Excavator Cat 316 Excavator Cat 314 Excavator Cat308 Excavator Cat307 Excavator Cat D5K Dozer Cat 05M Dozer Cat D6K Dozer (3) Cat D6N Dozer (2) Cat 140M Motorgraders (2) Cat 140H Motorgrader Cat 120H Motorgrader Cat 120M Motorgrader Haul Truck with 50 Ton Lowboy 14 C.Y. Tandem axle Dump Trucks (9) 20 C.Y End or Belly Dumps (4) Pickups Crew Trucks Air Compressors with Hoses Centrifugal Pumps with Hoses Timber Dragline and Crane Mats Note: HEAVY EQUIPMENT Cat 420F Backtioe/Loaders (2) Cat430 Backhoe/Loader Cat 924F 2 - C.Y. Loaders (2) Cat 926 Loader Cat 950 Loader Cat 725 Articulating Dump Truck Cat Compact Track Loaders (5) Smooth & Sheepfoot Compactors Tractor & Shredder or Offset Disc Rental Equipment as Needed TRUCKS One Ton Truck with Gooseneck Trailer 2,000 Gallon Water Truck 3,000 Gallon Water Trucks (5) MISCELLANEOUS EQUIPMENT Electric & Pneumatic Tools Tool Sheds or Job Shacks Chain Saws Concrete Breakers Compactors Generators We lease or rent equipment as needed to supplement our owned equipment My Documents/LCI Documents/Word Documents/Forms/Corporate/Equip List 1 12/02/21 12:08 PM #14 NOTICE OF MEETING — 4/20/2022 14. Consider and take necessary action to approve the engagement of Armstrong Vaughan and Associates, PC, Certified Public Accounts, to perform the audit of the County's financial statements for the year ending December 31, 2021 at an estimated fee of $52,845 and authorize the County Judge to sign. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 11 of 18 Mae Belle Cassel From: cindy.mueller@calhouncotx.org (cindy mueller) <cindy.mueller@calhouncotx.org> Sent: Tuesday, April 12, 2022 11:02 AM To: Mae Belle Cassel Cc: fraser@avacpa.com; Mike Peralta Subject: Agenda Item Request Attachments: Calhoun County 2021 Engagement Letter.pdf; AVA 1295 redacted.pdf Please place the following item on the agenda for April 20, 2022: • Consider and take necessary action to approve the engagement of Armstrong, Vaughan and Associates, PC, Certified Public Accountants, to perform the audit of the County's financial statements for the year ending December 31, 2021 at an estimated fee of $52,845 and authorize the County Judge to sign. Cindy Mueller County Auditor Calhoun County 202 S. Ann, Suite B Port Lavaca, TX 77979 V: 361.553.4610 F: 361.553.4614 Cindy. muellerCwcalhouncotx.ore Calhoun County Texas 1 Armstrong, Vaughan C-1' Associates, P. C. 40 Certified Public Accountants April 8, 2022 Calhoun County, Texas County Courthouse Annex II; 202.5. Ann, Suite B Port Lavaca, TX 77979 Dear County Commissioners and Management: You have requested that we audit the financial statements of the governmental activities, each major fund, and the aggregate remaining fund information of Calhoun County, as of December 31, 2021, and for the year then ended and the related notes to the financial statements, which collectively comprise Calhoun County's basic financial statements as fisted in the table of contents. In addition, we will audit the entity's compliance over major federal award programs for the period ended December 31, 2021. We are pleased to confirm our acceptance and our understanding of this audit engagement by means of this letter. Our audit will be conducted with the objective of our expressing an opinion on each opinion unit and an opinion on compliance regarding the entity's major federal award programs. The objectives of our audit of the financial statements are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes our opinion. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with auditing standards generally accepted in the United States of America (GAAS) and Government Auditing Standards will always detect a material misstatement when it exists. Misstatements, including omissions, can arise from fraud or error and are considered material if there is a substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a reasonable user based on the financial statements. The objectives of our compliance audit are to obtain sufficient appropriate audit evidence to form an opinion and report at the level specified in the governmental audit requirement about whether the entity complied in all material respects with the applicable compliance requirements and identify audit and reporting requirements specified in the governmental audit requirement that are supplementary to GAAS and Government Auditing Standards, if any, and perform procedures to address those requirements. Accounting principles generally accepted in the United States of America, (U.S. GAAP) as promulgated by the Governmental Accounting Standards Board (GASB) require that certain required supplementary information (RSI), such as management's discussion and analysis (MD&A) and budgetary comparison information be presented to supplement the basic financial statements. Such information, although not a part of the basic financial statements, is required by the GASB who considers it to be an essential part of financial reporting for placing the basic financial statements in an appropriate operational, economic, or historical context. As part of our engagement, we will apply certain limited procedures to Calhoun County's RSI in accordance with auditing standards generally accepted in the United States of America, (U.S. GAAS). These limited procedures will consist of inquiries of management regarding their methods of measurement and presentation, and comparing the information for consistency with management's responses to our inquiries. We will not express an opinion or provide any assurance on the RSI. The following RSI is required by generally accepted accounting principles and will be subjected to certain limited procedures, but will not be audited: 941 Rest Byrd Blvd., Suite 101 • Universal City, Texas 78148 Phone: 210-658-6229 • Pax: 210-659-7611 • Email: ini'o@avacpa.com • www.avacpa.com 1) Management's Discussion and Analysis 2) The Schedule of Revenues, Expenditures and Changes in Fund Balance- Budget and Actual - General Fund 3) Schedules of Contributions and Changes —Defined Benefit Pension Plan Supplementary information other than RSI will accompany Calhoun County's basic financial statements. We will subject the following supplementary information to the auditing procedures applied in our audit of the basic financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. We intend to provide an opinion on the following supplementary information in relation to the financial statements as a whole: 1. Comparative Balance Sheet and Statements of Revenues, Expenditures and Changes in Fund Balance - Major Funds 2. Combining Balance Sheets and Statements of Revenues, Expenditures and Changes in Fund Balance — Nonmajor Funds 3. Comparative Statements of Net Position, Statements of Revenues, Expenses and Changes in Net Position, and Statements of Cash Flows — Discretely Presented Enterprise Fund 4. Budgetary Comparison Schedules — Nonmajor Special Revenue Funds, Debt Service Fund 5. Combining Statement of Fiduciary Assets and Liabilities 6. Schedule of Expenditures of Federal Awards Schedule of Expenditures of Federal Awards We will subject the schedule of expenditures of federal awards to the auditing procedures applied in our audit of the basic financial statements and certain additional procedures, including comparing and reconciling the schedule to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and additional procedures in accordance with auditing standards generally accepted in the United States of America. We intend to provide an opinion on whether the schedule of expenditures of federal awards is presented fairly in all material respects in relation to the financial statements as a whole. Data Collection Form Prior to the completion of our engagement, we will complete the sections of the Data Collection Form that are our responsibility. The form will summarize our audit findings, amounts and conclusions. It is management's responsibility to submit a reporting package including financial statements, schedule of expenditure of federal awards, summary schedule of prior audit findings and corrective action plan along with the Data Collection Form to the federal audit clearinghouse. The financial reporting package must be test searchable, unencrypted, and unlocked. Otherwise, the reporting package will not be accepted by the federal audit clearinghouse. We will assist you in the electronic submission and certification. You may request from us copies of our report for you to include with the reporting package submitted to pass - through entities. The Data Collection Form is required to be submitted within the earlier of 30 days after receipt of our audits' reports or nine months after the end of the audit period, unless specifically waived by a federal cognizant or oversight agency for audits. Data Collection Forms submitted untimely are one of the factors in assessing programs at a higher risk. Audit of the Financial Statements We will conduct our audit in accordance with auditing standards generally accepted in the United States of America (U.S. GAAS), the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States of America; the audit requirements of Title 2 U.S. Code of Federal Regulations (CFR) Party 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). As part of an audit of financial statements in accordance with GAAS and Government Auditing Standards, we exercise professional judgment and maintain professional skepticism throughout the audit. We also: • Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. • Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity's internal control. However, we will communicate to you in writing concerning any significant deficiencies or material weaknesses in internal control relevant to the audit of the financial statements that we have identified during the audit. • Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluate the overall presentation of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation. • Conclude, based on the audit evidence obtained, whether there are conditions or events, considered in the aggregate, that raise substantial doubt about Calhoun County's ability to continue as a going concern for a reasonable period of time. Because of the inherent limitations of an audit, together with the inherent limitations of internal control, an unavoidable risk that some material misstatements may not be detected exists, even though the audit is properly planned and performed in accordance with U.S. GAAS and Government Auditing Standards of the Comptroller General of the United States of America. Please note that the determination of abuse is subjective and Government Auditing Standards does not require auditors to detect abuse. Our responsibility as auditors is limited to the period covered by our audit and does not extend to any other periods. We will issue a written report upon completion of our audit of Calhoun County's basic financial statements. Our report will be addressed to the governing body of Calhoun County. Circumstances may arise in which our report may differ from its expected form and content based on the results of our audit. Depending on the nature of these circumstances, it may be necessary for us to modify our opinions, add an emphasis -of -matter or other -matter paragraph(s) to our auditor's report, or if necessary, withdraw from the engagement. If our opinions on the basic financial statements are other than unmodified, we will discuss the reasons with you in advance. If, for any reason, we are unable to complete the audit or are unable to form or have not formed opinions, we may decline to express opinions or to issue a report as a result of this engagement. In accordance with the requirements of Government Auditing Standards, we will also issue a written report describing the scope of our testing over internal control over financial reporting and over compliance with laws, regulations, and provisions of grants and contracts, including the results of that testing. However, providing an opinion on internal control and compliance over financial reporting will not be an objective of the audit and, therefore, no such opinion will be expressed. Audit of Major Program Compliance Our audit of Calhoun County's major federal award program(s) compliance will be made in accordance with the requirements of the Single Audit Act, as amended; and the Uniform Guidance, and will include tests of accounting records, a determination of major programs in accordance with the Uniform Guidance and other procedures we consider necessary to enable us to express an opinion on major federal award program compliance and to render the required reports. We cannot provide assurance that an unmodified opinion on compliance will be expressed. Circumstances may arise in which it is necessary for us to modify our opinion or withdraw from the engagement. The Uniform Guidance requires that we also plan and perform the audit to obtain reasonable assurance about whether material noncompliance with applicable laws and regulations, the provisions of contracts and grant agreements applicable to major federal award programs, and the applicable compliance requirements occurred, whether due to fraud or error, and express an opinion on the entity's compliance based on the audit. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with GAAS, Government Auditing Standards, and the Uniform Guidance will always detect material noncompliance when it exists. The risk of not detecting material noncompliance resulting from fraud is higher than for that resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. Noncompliance with the compliance requirements is considered material if there is a substantial likelihood that, individually or in the aggregate, it would influence the judgment made by a reasonable user of the report on compliance about the entity's compliance with the requirements of the federal programs as a whole. As part of a compliance audit in accordance with GAAS and Government Auditing Standards, we exercise professional judgment and maintain professional skepticism throughout the audit. We also identify and assess the risks of material noncompliance, whether due to fraud or error, and design and perform audit procedures responsive to those risks. Our procedures will consist of determining major federal programs and, performing the applicable procedures described in the U.S. Office of Management and Budget OMB Compliance Supplement for the types of compliance requirements that could have a direct and material effect on each of the entity's major programs, and performing such other procedures as we considers necessary in the circumstances. The purpose of those procedures will be to express an opinion on the entity's compliance with requirements applicable to each of its major programs in our report on compliance issued pursuant to the Uniform Guidance. Also, as required by the Uniform Guidance, we will obtain an understanding of the entity's internal control over compliance relevant to the audit in order to design and perform tests of controls to evaluate the effectiveness of the design and operation of controls that we consider relevant to preventing or detecting material noncompliance with compliance requirements applicable to each of the entity's major federal award programs. Our tests will be less in scope than would be necessary to render an opinion on these controls and, accordingly, no opinion will be expressed in our report. However, we will communicate to you, regarding, among other matters, the planned scope and timing of the audit and any significant deficiencies and material weaknesses in internal control over compliance that we have identified during the audit. We will issue a report on compliance that will include an opinion or disclaimer of opinion regarding the entity's major federal award programs, and a report on internal controls over compliance that will report any significant deficiencies and material weaknesses identified; however, such report will not express an opinion on internal control. Management's Responsibilities Our audit will be conducted on the basis that management acknowledge and understand that they have responsibility: a. For the preparation and fair presentation of the financial statements in accordance with accounting principles generally accepted in the United States of America. b. For the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error; c. For identifying, in its accounts, all federal awards received and expended during the period and the federal programs under which they were received; d. For maintaining records that adequately identify the source and application of funds for federally funded activities; e. For preparing the schedule of expenditures of federal awards (including notes and noncash assistance received) in accordance with the Uniform Guidance; f For designing, implementing, and maintaining effective internal control over federal awards that provides reasonable assurance that the entity is managing federal awards in compliance with federal statutes, regulations, and the terms and conditions of the federal awards; g. For identifying and ensuring that the entity complies with federal laws, statutes, regulations, rules, provisions of contracts or grant agreements, and the terms and conditions of federal award programs, and implementing systems designed to achieve compliance with applicable federal statutes, regulations, and the terms and conditions of federal award programs; h. For disclosing accurately, currently, and completely the financial results of each federal award in accordance with the requirements of the award; i. For identifying and providing report copies of previous audits, attestation engagements, or other studies that directly relate to the objectives of the audit, including whether related recommendations have been implemented; j. For taking prompt action when instances of noncompliance are identified; k. For addressing the findings and recommendations of auditors, for establishing and maintaining a process to track the status of such findings and recommendations and taking corrective action on reported audit findings from prior periods and preparing a summary schedule of prior audit findings; 1. For following up and taking corrective action on current year audit findings and preparing a corrective action plan for such findings; in. For submitting the reporting package and data collection form to the appropriate parties; n. For making the auditor aware of any significant contractor relationships where the contractor is responsible for program compliance; o. To provide us with: 1) Access to all information of which management is aware that is relevant to the preparation and fair presentation of the financial statements including the disclosures, and relevant to federal award programs, such as records, documentation, and other matters; 2) Additional information that we may request from management for the purpose of the audit; 3) Unrestricted access to persons within the entity from whom we determine it necessary to obtain audit evidence; 4) A written acknowledgement of all the documents that management expects to issue that will be included in the annual report and the planned timing and method of issuance of that annual report, and 5) A final version of the annual report (including all the documents that, together, comprise the annual report) in a timely manner prior to the date of the auditor's report. p. For adjusting the financial statements to correct material misstatements and confirming to us in the management representation letter that the effects of any uncorrected misstatements aggregated by us during the current engagement and pertaining to the current year period(s) under audit are immaterial, both individually and in the aggregate, to the financial statements as a whole; q. For acceptance of nonattest services, including identifying the proper party to oversee nonattest work; r. For maintaining adequate records, selecting and applying accounting principles, and safeguarding assets; s. For informing us of any known or suspected fraud affecting the entity involving management, employees with significant role in internal control and others where fraud could have a material effect on compliance; t. For the accuracy and completeness of all information provided; u. For taking reasonable measures to safeguard protected personally identifiable and other sensitive information; and v. For confirming your understanding of your responsibilities as defined in this letter to us in your management representation letter. With regard to the schedule of expenditures of federal awards referred to above, you acknowledge and understand your responsibility (a) for the preparation of the schedule of expenditures of federal awards in accordance with the Uniform Guidance, (b) to provide us with the appropriate written representations regarding the schedule of expenditures of federal awards, (c) to include our report on the schedule of expenditures of federal awards in any document that contains the schedule of expenditures of federal awards and that indicates that we have reported on such schedule, and (d) to present the schedule of expenditures of federal awards with the audited financial statements, or if the schedule will not be presented with the audited financial statements, to make the audited financial statements readily available to the intended users of the schedule of expenditures of federal awards no later than the date of issuance by you of the schedule and our report thereon. As part of our audit process, we will request from management, written confirmation concerning representations made to us in connection with the audit. We may request assistance from your employees in preparing confirmations and that they will locate any documents or invoices selected by us for testing. If you intend to publish or otherwise reproduce the financial statements and make reference to our firm, you agree to provide us with printers' proofs or masters for our review and approval before printing. You also agree to provide us with a copy of the final reproduced material for our approval before it is distributed. Nonattest Services With respect to any nonattest services we perform, At the end of the year, we agree to perform the following: • Propose adjusting or correcting journal entries to be reviewed and approved by Calhoun County's management. • Assistance with preparation of the financial statements We will not assume management responsibilities on behalf of Calhoun County. However, we will provide advice and recommendations to assist management of Calhoun County in performing its responsibilities. Calhoun County's management is responsible for (a) making all management decisions and performing all management functions; (b) assigning a competent individual to oversee the services; (c) evaluating the adequacy of the services performed; (d) evaluating and accepting responsibility for the results of the services performed; and (e) establishing and maintaining internal controls, including monitoring ongoing activities. Our responsibilities and limitations of the nonattest services are as follows: • The nonattest services are limited to the items previously outlined. Our firm, in its sole professional judgment, reserves the right to refuse to do any procedure or take any action that could be construed as making management decisions or assuming management responsibilities, including determining account coding and approving journal entries. Our firm will advise Calhoun County with regard to tax positions taken in the preparation of the tax return, but Calhoun County must make all decisions with regard to those matters. Fees and Timing Deborah F. Fraser is the engagement partner for the audit services specified in this letter. Her responsibilities include supervising Armstrong, Vaughan & Associates, P.C.'s services performed as part of this engagement and signing or authorizing another qualified firm representative to sign the audit report. Our fees are based on the amount of time required at various levels of responsibility, plus actual out-of- pocket expenses. hwoices will be rendered every two weeks and are payable upon presentation. We estimate that our fee for the audit will be $52,845, plus an additional $3,500 for the CAFR (if applicable). We will notify you immediately of any circumstances we encounter that could significantly affect this initial fee estimate. Whenever possible, we will attempt to use Calhoun County's personnel to assist in the preparation of schedules and analyses of accounts. This effort could substantially reduce our time requirements and facilitate the timely conclusion of the audit. Other Matters During the course of the engagement, we may communicate with you or your personnel via fax or e-mail, and you should be aware that communication in those mediums contains a risk of misdirected or intercepted communications. Regarding the electronic dissemination of audited financial statements, including financial statements published electronically on your Internet website, you understand that electronic sites are a means to distribute information and, therefore, we are not required to read the information contained in these sites or to consider the consistency of other information in the electronic site with the original document. Professional standards prohibit us from being the sole host and/or the sole storage for your financial and non -financial data. As such, it is your responsibility to maintain your original data and records and we cannot be responsible to maintain such original information. By signing this engagement letter, you affirm that you have all the data and records required to make your books and records complete. The audit documentation for this engagement is the property of Armstrong, Vaughan & Associates, P.C. and constitutes confidential information. However, we may be requested to make certain audit documentation available to federal agencies and the U.S. Government Accountability Office pursuant to authority given to it by law or regulation, or to peer reviewers. If requested, access to such audit documentation will be provided under the supervision of Armstrong, Vaughan & Associates, P.C.'s personnel. Furthermore, upon request, we may provide copies of selected audit documentation to these agencies and regulators. The regulators and agencies may intend, or decide, to distribute the copies of information contained therein to others, including other governmental agencies. Further, we will be available during the year to consult with you on financial management and accounting matters of a routine nature. During the course of the audit, we may observe opportunities for economy in, or improved controls over, your operations. We will bring such matters to the attention of the appropriate level of management, either orally or in writing. We agree to retain our audit documentation or work papers for a period of at least five years from the date of our report. You agree to inform us of facts that may affect the financial statements of which you may become aware during the period from the date of the auditor's report to the date the financial statements are issued. At the conclusion of our audit engagement, we will communicate to the County Council the following significant findings from the audit: • Our view about the qualitative aspects of the entity's significant accounting practices; • Significant difficulties, if any, encountered during the audit; • Uncorrected misstatements, other than those we believe are trivial, if any; • Disagreements with management, if any; • Other findings or issues, if any, arising from the audit that are, in our professional judgment, significant and relevant to those charged with governance regarding their oversight of the financial reporting process; • Material, corrected misstatements that were brought to the attention of management as a result of our audit procedures; • Representations we requested from management; • Management's consultations with other accountants, if any; and • Significant issues, if any, arising from the audit that were discussed, or the subject of correspondence, with management. In accordance with the requirements of Government Auditing Standards, we have attached a copy of our latest external peer review report of our firm for your consideration and files. If any dispute arises among the parties hereto, the parties agree to first try in good faith to settle the dispute by mediation administered by the American Arbitration Association under its Rules for Professional Accounting and Related Services Disputes, before resorting to litigation. The costs of any mediation proceeding shall be shared equally by all parties. Client and accountant both agree that any dispute over fees charged by the accountant to the client will be submitted for resolution by arbitration in accordance with the Rules for Professional Accounting and Related Services Disputes of the American Arbitration Association. Such arbitration shall be binding and final. In agreeing to arbitration, we both acknowledge that, in the event of a dispute over fees charged by the accountant, each of us is giving up the right to have the dispute decided in a court of law before a judge or jury and instead we are accepting the use of arbitration for resolution. Please sign and return the enclosed copy of this letter to indicate your acknowledgment of, and agreement with, the arrangements for our audits of the financial statements compliance over major federal award programs including our respective responsibilities. We appreciate the opportunity to be of service to Calhoun County and believe this letter accurately summarizes the significant terms of our engagement. Very truly yours, Armstrong, Vaughan & Associates, P.C. RESPONSE: This letter c ec sets forth the understanding of Calhoun County. m Title: f ou-+^ Y -1 ZY" Date: tK -- ZO— Z OzZ_ WILF & HENDERSON, P.C. CERTIFIED PUBLIC ACCOUNTANTS Nk.,b,, d A mnm Institute dCMified Public Amounlants Member d Private Company Pm¢tkc 8e01.n Member of A ICPA Guvemmmd Audit Quality Center Report on the Firm's System of Quality Control October 14, 2020 To the Shareholders of Armstrong, Vaughan & Associates, P.C. and the Peer Review Committee of the Texas Society of Certified Public Accountants We have reviewed the system of quality control for the accounting and auditing practice of Armstrong, Vaughan & Associates, P.C. (the firm) in effect for the year ended March 31, 2020. Our peer review was conducted in accordance with the Standards for Performing and Reporting on Peer Reviews established by the Peer Review Board of the American Institute of Certified Public Accountants (Standards). A summary of the nature, objectives, scope, limitations of, and the procedures performed in a System Review are described in the standards at www.aicpa.orginrsummary. The summary also includes an explanation of how engagements identified as not performed or reported in conformity with applicable professional standards, if any, are evaluated by a peer reviewer to determine a peer review rating. Firm's Responsibility The firm is responsible for designing a system of quality control and complying with it to provide the firm with reasonable assurance of performing and reporting in conformity with applicable professional standards in all material respects. The firm is also responsible for evaluating actions to promptly remediate engagements deemed as not performed or reported in conformity with professional standards, when appropriate, and for remediating weaknesses in its system of quality control, if any. Peer Reviewer's Responsibility Our responsibility is to express an opinion on the design of the system of quality control and the firm's compliance therewith based on our review Required Selections and Considerations Engagements selected for review included an engagement performed under Government Auditing Standards, including a compliance audit under the Single Audit Act. As a part of our peer review, we considered reviews by regulatory entities as communicated by the firm, if applicable, in determining the nature and extent of our procedures. Opinion In our opinion, the system of quality control for the accounting and auditing practice of Armstrong, Vaughan & Associates, P.C. in effect for the year ended March 31, 2020, has been suitably designed and complied with to provide the firm with reasonable assurance of performing and reporting in conformity with applicable professional standards in all material respects. Firms can receive a rating ofpass, pass with deficiency(ies) or fail. Annstrong, Vaughan & Associates P.C. has received a peer review rating of pass. Wilf & Hender on, R C. 1810 Galleria Oaks • Texarkana, Texas 75503 a 903.793.5646 • Fax 903.792.7630 • www.wilhen.com CERTIFICATE OF INTERESTED PARTIES Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. 1 Name of business entity filing in, and the city, state and country of the Of business. Armstrong, Vaughan & Associates, P.C. Universal City, TX United States being filed. Calhoun County 3 Provide the identification number used by the governmental description of the services, goods, or other property to be pi AUDIT SERVICES Professional Auditing Services Name of Interested Parry 5 Check only if there is NO Interested Party. nX Mynameis Deborah F. Fraser or state agency to tr i under the contract. FORM 1295 1 Of OFFICE USE ONLY CERTIFICATION OF FILING Filed: Date Acknowledged: the contract, and City, State, Country (Place of business) and my date of birth is''W Myaddressis 941 W. Byrd Blvd., Suite 101 Universal City TX 78148 USA (street) (city) (state) (zip code) (country) I declare under penafty of perjury that the foregoing is true and correct. Executed in Bexar Texas County, State of ,onthe 12tyof April 26 22 (month) ( as y r) Signature of authorized agent of contracting business entity (Declarant) #15 NOTICE OF MEETING — 4/20/2022 15. Consider and take necessary action to reappoint the following County Park Board members for two-year terms, expiring in February 2024: Allan Berger, Chair; Teri Elliot, Precinct 1; Linda Bournias, Precinct 2; and Dwayne Fishbeck, Precinct 4. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 12 of 18 Mae Belle Cassel From: allanrberger@outlook.com (Allan Berger) <allanrberger@outlook.com> Sent: Wednesday, April 13, 2022 4:03 PM To: Mae Belle Cassel Subject: Park Board Terms Attachments: 220321 3 Status of Board Terms for 2022.pdf CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recoenize the sender and know the content is safe. Mae Belle, can you assist in getting onto upcoming Court Agenda: Fill expiring terms on County Park Board: Chair (incumbent Allan Berger) Precinct 1 (incumbent Teri Elliot) Precinct 2 (incumbent Linda Bournias) Precinct 4 (incumbent Dwayne Fishbeck) Terms would be for two years — Feb, 12024. All of these terms expired on February 1, 2022 . It is my understanding that each has communicated with respective Commissioner about their willingness to serve another term as was requested by Court. Thanks, Allan 713-829-2852 Park Board Terms — March 2022 Bylaws • The members shall serve staggered two-year terms pursuant to Texas Local Government Code Section 320.021(b). • Upon the expiration of the terms of membership, the resulting vacancy shall be filled by new appointment or reappointment by the Court for two years. Such terms shall expire February 1st of the year of expiration. • The officers of the Board shall be the Chairman, Vice -Chairman, Treasurer, and Secretary, each to be elected by majority vote of the membership, provided that the office of Secretary and Treasurer may be held by the same person. Current Status as of March 2022: Yellow highlight mean terms expires; Chair Allan Berger 2020 # Precinct 1 tied Elliot 2020 21 filled AD Moses term' Steven Dublin 2021-2022 Precinct 2 inda Bournias 2020-2111 Precinct 3 Liz Zarate 2021-22 Precinct 4 Charlene Terrell 2021-2022 Dwayne Fishbeck 2020 202� Officer Elections to be held in February: President— Allan Berger; term continues until Feb 20221 Vice President—currentlyvacant,� • Secretary— currently vacant; #16 NOTICE OF MEETING — 4/20/2022 16. Consider and take necessary action to declare the attached list of miscellaneous computer and electrical supplies in the County Auditor's Office as Waste. (RHM) RESULT: APPROVED[UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 13 of 18 April 11, 2022 To: Judge Meyer From: The office of the County Auditor Peggy Hall, Assistant Auditor Please place the following item on the Commissioners Court Agenda for April 20, 2022: Consider and take necessary action to declare a box of miscellaneous computer and electrical supplies in the County Auditor's Office as waste and authorize disposal of same. Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: County Auditor Requested By: Cindy Mueller Inventory Number Descri tion Serial No. Reason for Waste Declaration NA Box of miscellaneous NA Obsolete — no value computer and electrical IT verified no sensitive material supplies #17 NOTICE OF MEETING-4/20/2022 17. Consider and take necessary action to declare the attached lists of equipment from Memorial Medical Center 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 14 of 18 Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: Memorial Medical Center Storage Units -April 2022�-1/-�1 page 1 Requested By:Roshanda Thomas, Interim CEO ` Vlavvw+S Inventory Number Description Serial No. Reason for Waste Declaration i Of. Sad Tad9 No Longer Make Pene l ard,wl t alaok Once CMr No Longer Uucelltaken d ExNmal Doan No Langer Uredlamken 1 Black Office Chek(lab) Tom and broken wheal 1 Metal tray (PT) Old and wobbly 1 Lobby Chair No long., med stack exam room chair No longer used Over bed table No longer used Black office chair No longer used seat tom COUCH Nolongerused COUCH No bngerused Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: Memorial Medical Center Storage Units - April 2022 page 1 Requested By: Roshanda Thomas, Interim CE�SV`w. -La w Inventory Number Description Serial No. Reason for Waste Declaration 1 Nor Boo Tebla No Longer Make PNe/ Brokan 1 Block Office Chair NO Longer UaedlBroken d P emal Cows No Longer Undiftken 1 Black oMce chafr♦lab) Tom and brokanwhwl 1 Metal tray (PT) Old and wobbly 1 Lobby Chair No longer used #18 NOTICE OF MEETING — 4/20/2022 18. Consider and take necessary action to transfer the attached list of equipment from Justice of the Peace, Precinct 3 to IT. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 15 of 18 Calhoun County, Texas DEPARTMENTAL INVENTORY TRANSFER REQUEST FORM Requested By: JUSTICE OF THE PEACE, PCT. 3 Inventory Number Description Serial No. Transfer From/To Department HP ProDesk 600 G3SFF 2UA7391ZFF FROM: JP3 TO: IT #19 NOTICE OF MEETING — 4/20/2022 19. Accept Monthly Reports from the following County Offices: I. Justice of the Peace, Precinct 3 — March 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 16 of 18 ENTER MONTH OF REPORT IJUUTJCE OF PEACE N0.3 ENTER YEAR OF REPORT 2022 MARCH CODE AMOUNT 2022 CASH. BONDS ADMINISTRATION FEE -ADMF -REVISED 02/022021 1000 BREATH ALCOHOL TESTING - BAT . CONSOLIDATED COURT COSTS -.CCC 349.52 STATE CONSOLIDATEDCOURT COST- 2020 LOCAL CONSOLIDATED COURT COST- 2020 1,865.00 COURTHOUSE SECURITY -CHS 421.13 ' 34.94 CIVIL JUSTICE DATA. REPOSITORY FEE- CJP C JDR U.49 CORRECTIONAL MANAGEMENT .INSTITUTE CMI CR CHILD SAFETY - .CS CHILD' SEATBELT FEE -CSBF CRIME VICTIMS :COMPENSATION -CVC . DPSC/FAILURE TO APPEAR - OMNI -DPSC ADMINISTRATION FEE FTA/FTP (aka OMNI)- 2020 113.79 ELECTRONIC FILING FEE - EEF FUGITIVE APPREHENSION - FA GENERALREVENUE-GR CRIM-1NDLEGALSVCSSUPPORT.IDF 17.48 JUVENILE CRIME & DELINQUENCY - JED JUVENILE CASE MANAGER.FUND -JCMF JUSTICE COURT PERSONNEL TRAINING•JCPT 20.00 JURORS SERVICE FEE -JSF 34.98 LOCAL ARREST.FEES-LqF 11061 'LEMI LEDA LEOC PARKS& WILDLIFE ARREST FEES _POCL WAF 10.00 STATE ARREST FEES- SAF SCHOOL CROSSING/CHILD SAFETY: FEE-SCF 73.49 SUBTITLE C - SUED STATE TRAFFIC FINES -EST 9.1.19-STF 35.24 . TABC ARREST FEES -.TAF 1335.24 ,05 TECHNOLOGY FUND -TF 34.94 TRAFFIC -TFC LOCAL TRAFFIC FINE- 2020 3.52 - 8154 TIMEPAYMENT-TIME TIMEPAYMENT REl BURSEMENTFEE-2020 53.39 TRUANCYPREVENTION/DIVERSION FUND -TPDF 37.61 - - LOCAL STATE WgRRANT FEES - WRN 7 COLLECTION SERVICE FEE-MV13 89.66 . DEFENSIVE.DRIVING COURSECDDC 1,14040.00 `DEFERRED FEE - OFF - DRIVING FEE- PROV:DL .00 53434.00 -FILING FEE -FFEE STATE CONSOLIDATED CIVIL FEE-2022 LOCAL CONSOLIDATED CIVIL FEE 2022 105.00 - FILING FEE SMALL CLAIMS-FFSC 165.00 `JURY FEE -JF COPIES/CERTIFED.COPIES -CC INDIGENT FEE - CIFF 01 INDF JUDGE PAY RAISE FEE -JPAY I 52.43 SERVICE FEE-SFEE bUT OF -COUNTY SERVICEFEE 160.00 ELECTRONIC FILINGFEE- EEF CV 'EXPUNGEMENTFEE-.EXPG EXPIREDRENEWAll- .EXFIR ABSTRACTOFJUDGEMENT- AOJ ALL WRITS- WOP /WOE DPS FTA FINE -DPSF 290.00 - LOCAL .FINES- FINE LICENSE&:WEl HTFEES-LWF 4,841.31 PARKS&WILDLIFEFINES-PWF 'SEATBELT/UNRESTRg]NED CHILD. FINE.- 178.00 SEAT JUDICIAL & COURT PERSONNEL TRAINING.JCPT *OVERPAVMENT( OVER$10)-OVER ' OVERPAYMENT ($10 AND LESS) -OVER PARKS & WILDLIFE- RESTITUTION:- REST WATERSAFETY FINES-WSF / MARINE SAFETY PARKS&WILDLIFE.-MSO TOTAL. ACTUAL: MONEY RECEIVED 512.564.00- TAILWARRANTFEES _ AMOUNT q- 65 ENTER LOCAL WARRANT FEES 1 150.00 RECORD ONTOTAL PAGECF HILLCDUNT0.Y STATE WARRANT FEES SOFiWgREMD REPORT $239.65 RECORD ON TOTAL PAGE OrxuLCAuxTarsOFiWaREMo ETOCTHERS: REPG_ AMOUNT ETO CCISD-.50%Wfine on JV caaea - ETODARESTITUTION FUND- - 0.00 PLEASEwcwDE D.RREQUESnxcDISBURSEMENr `UND OF OVERPAYMENTS O.OD PLEASE INCLUDE D.R. REQUESTING DISBURSEMENT T-OF-COUNTY SERVICE FEE 0.00 RLFABEINCLUDE D.R. REQUESTING DISBURSEMENT iH BONDS O.00.PIEASE INCLUDE OR REQUESTING DISBURSEMENT TOTAL DUE TO OTHERS. 0.00 PLEASEINCLUDE DR. REQUESTING DISBURSEMENT(IFREQUIREDI $0.00 iASURERS RECEIPTS FOR MONTH: AMOUNT iH,.CHECKS,MOs&CREDIT CARDS $12,564.00 Calculate from ACTUAL TreasureYS Recelpts TOTAL TREAS. RECEIPTS m, RaA as MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 4/4/2022 COURT NAME: JUSTICE OF PEACE NO. 3 MONTH OF REPORT: MARCH YEAR OF REPORT: 2022 ACCOUNT NUMBER ACCOUNT NAME AMOUNT CR 1000-001-45013 FINES 5.158.01 CR 1000-001-44190 SHERIFF'S FEES 519.12 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 40.00 CHILD SAFETY 0.00 TRAFFIC 85.06 ADMINISTRATIVE FEES 544.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44363 TOTAL ADMINISTRATIVE FEES 669.06 CR 1000-001-44010 CONSTABLE FEES -SERVICE 150.00 CR 1000-001-44063 JP FILING FEES 0.00 CR 1000-001-44090 COPIES / CERTIFIED COPIES 0.00 CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 0.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 37.61 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 1,140.00 TOTAL FINES, ADMIN. FEES & DUE TO STATE $7,673.80 CR 2670-001-44063 COURTHOUSE SECURITY FUND $173.60 CR 2720-001-44063 JUSTICE COURT SECURITY FUND $8.74 CR 2719-001-44063 JUSTICE COURT TECHNOLOGY FUND $155.26 CR 2699-001-44063 JUVENILE CASE MANAGER FUND $20.00 CR 2730-001-44063 LOCAL TRUANCY PREVENTION & DIVERSION FUND $150.40 CR 2669-001-44063 COUNTY JURY FUND $3.01 CR 2728-001-44063 JUSTICE COURT SUPPORT FUND $125.00 11 CR 2677-001-44063 COUNTY DISPUTE RESOLUTION FUND $25.0011 SCR 2725-00144063 LANGUAGE ACCESS FUND _$15.00 STATE ARREST FEES DPS FEES 62.63 P&W FEES 2.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 64.63 CR 7070-999-20610 CCC-GENERAL FUND 34.95 CR 7070-999-20740 CCC-STATE 314.57 DR 7070-999-10010 349.52 CR 7072-999-20610 STATE CCC- GENERAL FUND 186.50 CR 7072-999-20740 STATE CCC- STATE 1,678,50 DR 7072-999-10010 1,865.00 CR 7860-999-20610 STF/SUBC-GENERAL FUND 1.76 CR 7860-999-20740 STF/SUBC-STATE 33.48 DR 7860-999-10010 35.24 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 54.36 CR 7860-999-20740 STF- EST 9/1/2019- STATE 1,304.69 DR 7860-999-10010 1,359.05 Page 1 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 4/4/2022 COURT NAME: JUSTICE OF PEACE NO. 3 MONTH OF REPORT: MARCH YEAR OF REPORT: 2022 CR 7950-999-20610 TP-GENERAL FUND 26.70 CR 7950-999-20740 TP-STATE 26.69 CR 7480-999-20610 CR 7480-999-20740 CR 7865-999-20610 CR 7865-999-20740 CR 7970-999-20610 CR 7970-999-20740 CR 7505-999-20610 CR 7505-999-20740 CR 7857-999-20610 CR 7857-999-20740 CR 7856-999-20610 CR 7856-999-20740 CR 7502-999-20740 7998-999-20740 7998-999-20701 7403-999-22889 7858-999-20740 REVISED 02/02/2021 0.00 0.00 0.00 0.00 0.00 151.30 DR 7950-999-10010 53.39 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CIVIL INDIGENT LEGAL -STATE 0.00 DR 7480-999-10010 0.00 CRIM-SUPP OF IND LEG SVCS-GEN FUND 1.75 CRIM-SUPP OF IND LEG SVCS-STATE 15.73 DR 7865-999-10010 17.48 TUFTA-GENERAL FUND 37.93 TUFTA-STATE 75.86 DR 7970-999-10010 113.79 JPAY - GENERAL FUND 5.24 JPAY - STATE 47.19 DR 7505-999-10010 52.43 JURY REIMB. FUND- GEN. FUND 3.50 JURY REIMB. FUND- STATE 31.48 DR 7857-999-10010 34.98 CIVIL JUSTICE DATA REPOS.- GEN FUND 0.05 CIVIL JUSTICE DATA REPOS: STATE 0.44 DR 7856-999-10010 0.49 JUD/CRT PERSONNEL TRAINING FUND- STATE 0.00 DR 7502-999-10010 0.00 TRUANCY PREVENT/DIV FUND - STATE 5.95 JUVENILE CASE MANAGER FUND 5.95 DR 7998-999-10010 11.89 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 STATE CONSOLIDATED CIVIL FEE 105.00 105.00 TOTAL (Distrib Req to Oper Acct) $12,412.70 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISO DA - RESTITUTION REFUND OFOVERPAYMENTE OUT -OF -COUNTY SERVICE FE CASH BONDS PARKS & WILDLIFE FINES WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $151.30 TOTAL COLLECTED -ALL FUNDS $12,564.00 LESS: TOTAL TREASUER'S RECEIPTS $12,564.00 OVER/(SHORT) $0.00 Page 2 of 2 # Zo NOTICE OF MEETING — 4/20/2022 20. Consider and take necessary action on any necessary budget adjustments. (RHM) 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 17 of 18 a m a m z I z m'', m; C; m; Z! CE m: m m v z 0 m 0 1 O z 3 G) z 0 r D m D 0 a r 00 0 O A y m T G' e 2 m, m T m Z 3; A 0 z a a: 3 m F m€ w a: m; T: a; a. 3 m; Z; C Ai Q 0 V j J W y 0 A x 0 0 o w e D m D OC D D A O m z m zvm r 0 m aae m z -0 21 D m j A A T WE 1 0 z as m meow= e z z z z 0000 c�cp)A00 D D D D z z z z En fA EA �n 0 0 0 T f9 (A fA 0 0 0 oWo�� Ci Q � a ffl ffl J T S O O W T EA E9 fA 2 0 Z m m m C 0 li Ra T pq F N O A N W N O 33oog n D m x v r z PO YYY m m z A A m m o O p mV) � C y m -0z r T Q) m 10 m m; z m m -zi Z 3 E � P m: Z ZE 3 m M3 0: m a: a v=_ C A v: EE 3 z AvA_ Y1E m m=_ o -I N- 2 m m z C m O a r M a 4 IN m 0= C z T o m= 9a z o ME m -1 I Z 3= m ME Z= z z a= z 3= � z m= 11 N m= m==_ v 0 Z= m v T m= y O -_ Ifa v A o n g - = a � a 0 Im i v= m= mo_ a= m= Z= -1= Z= 0= a 000e vo= o m �y K D cz< 5{ymea-a Z� m O T N A M= o o m=_ ._ a= m- Z= O O c Z = O= Z N N O N N ,CO _ W � � d d o_ A o 0 3 i 0= z m o 3 m T M_ -zi a 4 Z= z Z= m Z 0 = m 0= 3 m= m z Z S m z m O C A b O T � -01 a a a H a *n w N O O O O O c Z � N fail OONp N N N W O N H W O O I I 0! m: a: 3 m: JZ Z: V•' Z 0 n m m Z c 0 a 0 z 0 O m a 1 m m 1 0 D r 0 D cT � D r z O 0 -1 O c m m W EAU m m z m m z 1 s m: m z z2 a: m m€ a z€ c 0 n o€ m me m m a; z C �€ c 3: o A Z C G m 1 � a a � m � e Z a m #21 NOTICE OF MEETING — 4/20/2022 21. 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, Reese Indigent Healthcare RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned: 10:22a.m. Page 18 of 18 April 20, 2022 2022 APPROVAL LIST - 2022 BUDGET COURT MEETING OF BALANCE BROUGHT FORWARD FROM APPROVAL LIST REPORT PAGE 23 AFLAC APRIL PREMIUMS 2022 PRINCIPAL FINANCIAL GROUP APRIL 2022 PREMIUMS CALHOUN COUNTY INDIGENT HEALTH CARE TOTAL INVESTMENT ACTIVITY AND TRANSFERS BETWEEN FUNDS: 04/20/22 $124,917.00 P/R $ 2,604.08 P/R $ 1,531.28 $ 7,091.82C.-' S 7,091.82 1 TOTAL AMOUNT FOR APPROVAL: $ 136,144.18 0" MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ----April 20 2022 by:DC INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES HEB Pharmacy (Medimpact) Pharmacy Reimbursement 76.99 MMCenter (In -patient $0/ Out -patient $2.744.99 / ER $0) 2,774.99 Singleton Associates, PA 153.17 SUBTOTAL 3,006.15 Memorial Medical Center (Indigent Healthcare Payroll and Expenses) 4,166.67 Subtotal 7,171.82 Co -pays adjustments for March 2022 Reimbursement from Medicaid 0.00 COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY UNIT PRICE TOTAL PRICE 1000-800-98722-999 Transfer to pay bills for Indigent Health Care $7,091.82 approved by Commiso;Qners Court 'on 04%20/2022 1000-001-46010 rch 31, 2022 Interest ($1.45) "" $7, 090.37 COUNTY AUDITOR APPROVAL ONLY A HE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE F MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILAELE TO PAY 6HIS OBLIGATION. CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED EY ME IN GOOD Co AND REQUEST THE COUNTY TREASURER TO PAY HE ABO IGATION. / Y: G� 4/19/2022 G 25 p� O d EPARTMENT HEAD DATE PROSPERITY BANIV THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13350 03/01/2022 Beginning Balance 3 Deposits/Other Credits 6 Checks/Other Debits 03/31/2022 Ending Balance Total Enclosures -DEPOSITS/OTHER CREDITS ^> 31 Days in Statement Period Statement Date 3/31/2027 Account No '""•4551 Page 1 of 2 $5,461.47 $10,095.14 $10,102.60 $5,454.01 Date Description Amount tOroljb 03/04/2022 Deposit $10,073.69 03/24/2022 Deposit $20.00 *44 03/31 /2022 Accr Earning Pymt Added to Account $1.45 c Check Number Date Amount Check Number Date Amount Check Number Date Amount g 12517 03.22 $4,166.67 12519 03-23 $90.98 12521 03-31 $109.33 12518 03-22 $5,064.64 12520 03-23 S515.27 12523" M-28 $155.71 !tDAILY ENDING BALANCE Date Balance Date Balance Date Balance 03-01 $5,461.47 03.23 $5,697.60 03-31 $5,454.01 c 03-04 $15,535.16 03.24 $5,717.60 03-22 $6,303.85 03-28 $5,561.89 o= w� Below is an itemization of the Earnings paid this period. •` Interest Paid This Period $1.45 Annual Percentage Yield Earned 0.15 % Interest Paid YTD $2.92 Days in Earnings Period 31 C Earnings Balance $11,387.98 MEMBER FDIC NYSE Symbol "PB" Eel OIHS Issued 04/18/22 Source Description Source Totals Report Calhoun Indigent Health Care Batch Dates 04/01/2022 through 04/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Amount Billed Amount Paid 01 Physician Services 2,549.00 153.17 02 Prescription Drugs 76.99 76.99 14 Mmc- HospitalOutpatient 7,263.00 2,774.99 Expenditures 9,888,99 3,005.15 Reimb/Adjustments Grand Total 9,888.99 3,005.15 Expenses 4,166.67 7,171.82 Co pays <80.00> 7,091.82 Medicaid Reimbursements <0.00> 7,091.82 TOTAL 7.091.82 `; ®wS Source Totals Report Issued 04/18/22 Calhoun Indigent Health Care Batch Dates 02/01/2022 through 04/01/2022 For Source Group Indigent Health Care For Vendor. All Vendors Source Description Amount Billed 01 Physician Services 5,04300 01-2 Physician Services -Anesthesia 624.00 02 Prescription Drugs 196.94 O8 Rural Health Clinics 1,201.00 13 Mmc - Inpatient Hospital 57,628.82 14 Mmc-Hospital Outpatient 26,939.00 15 Mmc - Er Bills 28,833.00 Expenditures 120,558.82 Reimb/Adjustments -93.06 Grand Total 120,465.76 EXPENSES COPAYS Amount Paid 297.52 155.71 196.94 733.93 29,523.07 10,213.57 10,956.54 52,170.34 -93.06 52,077.28 12.500.01 64,577.29 MEDICAID REIMBURSEMENTS < > 64,387.29 TOTAL 64,387.29 4119/ZaZZ Bill To: Calhoun County 815 N. Virginia St. Port Lavaca, Texas 77979 (361) 552.6713 Date: 4/6/2022 Invoice # 368 For: Mar-22 DESCRIPTION AMOUNT Funds to cover indigent program operating expenses. L�- Anthony Richardson Interim CFO $ 4,166.67 Total $ 4,166.67 APPROVED ON APR 19 2f722 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS MEMORIAL MEDICAL CENTER CHECK REQUEST P CALHOUN COUNTY INDIGENT ACCOUNT Date Requested: 4/6/22 A FOR ACCT. USE ONLY Y APPROVEDON FImprestCash E []A/P Check �y APR 18 2022 Mail Check to Vendor E Y COUI&AUINTOR WN rEXA3 Return Check to Dept AMOUNT $80.00 G/L NUMBER: 50240000 EXPLANATION: TO TRANSFER INDIGENT CO -PAYS FROM OPERATING ACCOUNT TO THE INDIGENT REQUESTED BY: MAYRA MARTINEZ AUTHORIZED BY: RUN DATE: 04/05/22 MEMORIAL MEDICAL CENTER PAGE 150 TIME: 15:08 RECEIPTS FROM 03/01/22 TO 03/31/22 RCMREP G/L RECEIPT PAY CASH RECEIPT DISC COLL GL CASH NUMBER DATE ---------------------------------------------------.-.-----------------._---------.------------------------------------------.-...- NUMBER TYPE PAYER AMOUNT AMOUNT NUMBER NAME DATE INIT CODE ACCOUNT 50200,000 03/09/22 620428 IN CIGNA HEALTHCARE 62,70- 62.70- 00/00/00 RC 2 50200.000 03/D9/22 620450 IN AMA U S HEALTHCAR 134.96- 134.96- 00/00/00 RC 2 50200.000 03/11/22 620663 IN BOON CHAPMAN 164.05- 164.05- 00/00/00 RC 2 50200.000 03/11/22 620668 IN HUMANA 89.70- 89.70- 00/00/00 RC 2 50200.000 03/11/22 620671 IN FRINGE BENEFITS GRO 77.25- 77.25- 00/00/00 RC 2 50200.000 03/14/22 620924 IN COLONIAL PENN LIFE 50.00- 50.00- 00/00/00 RC 2 50200.000 03/14/22 620841 IN RESERVE NATIONAL IN .00 .00 00/00/00 RC 2 50200.000 03/15/22 620873 IN UNITED HEALTHCARE I 2596.58- 2596.58- 00/00/00 RC 2 50200.000 03/15/22 621015 IN UNITED HEALTHCARE 1 2596.58 2596.58 00/00/00 RC 2 50200.000 03/21/22 621479 IN UMR 305.04- 105.04- 00/00/00 RC 2 50200.000 03/21/22 621481 IN ONE 326.35- 326.35- 00/OD/00 RC 2 50200.000 03/21/22 621494 IN BOON CHUM - O/P 135.32- 135.32- 00/00/00 RC 2 50200.000 03/21/22 621496 IN BOON CUM - 0/P 24.65- 24.65- 00/00/00 RC 2 50200.000 03/21/22 621504 IN THE AMERICAN WORKER 184.14- 184.14- 00/00/00 RC 2 50200.000 03/21/22 621509 IN HUNA3IA 216.89- 216.89- 00/00/00 RC 2 50200.000 03/21/22 621511 IN MEOI SHARE 75.30- 75.30- 00/00/00 RC 2 50200.000 03/21/22 621513 IN MEDI SHARE 252.89- 252.89- 00/00/00 RC 2 50200.000 03/21/22 621523 IN BOON CHAPMAN - O/P 24.65- 24,65- 00/00/00 RC 2 50200.000 03/21/22 621525 IN BOON CHAPMAN - 0/P 37.57- 37.57- 00/00/00 RC 2 50200.000 03/22/22 621651 IN CIGNA HEALTHCARE 611,90- 611.90- 00/00/00 RC 2 50200.000 03/22/22 621706 IN CIGNA HEALTHCARE 731.27- 731.27- 00/00/00 RC 2 50200.000 03/31/22 622802 IN CIGNA HEALTHCARE .00 .00 00/00/00 RC 2 50200.000 03/31/22 622828 IN CIGNA HEALTHCARE 37.45- 37.45- 00/00/00 RC 2 50200.000 03/31/22 623167 IN UNITED HEALTHCARE N 148.30- 14B.30- 00/00/00 RC 2 **TGTAL** 50200.000 COMMERCIAL INS. •ADJ -436367.85 50240.000 03/02/22 619306 CA 10.00 10.00 00/00/00 KAH 2 50240.000 03/03/22 619632 CA 10.00 10.00 00/00/00 PLB 2 50240.000 03/03/22 619635 CA 10.00- 10.00- 00/00/00 PLB 2 5D240.000 03/04/22 619600 CA 10.00 10.00 00/00/00 PLB 2 50240.000 03/04/22 619636 CA 10.00 10.00 00/00/00 PLB 2 50240.000 03/08/22 619938 CA 10.00 10.00 00/00/00 PLB 2 50240,000 03/14/22 620585 CA 10.00 10.00 00/00/00 PLB 2 50240.000 03/14/22 620618 CA 10.00 10.00 00/00/00 PLB 2 SU240.000 03/29/22 622276 CA 10.00 1O.OD 00/00/00 PLB 2 50240.000 03/29/22 622277 CA 10.00 10.00 00/00/00 PLB 2 50210.000 03/29/22 622278 CA 10.00- 10.00- 00/00/00 PLB 2 50240.000 03/29/22 622318 CA 10.00 10.00 00/00/00 PLB 2 **TOTAL** 50240.000 COUNTY INDIGENT COPAYS q .004,,1) 50410,000 03/23/22 621774 CK TEXAS COMPTROLLER 0 21123.00 21123.00 00/00/00 PLB 2 **TOTAL** 50410.000 GENERAL CONTRIBUTION -OTHER REV 21123.00 50510.000 03/01/22 619270 CA CAFE 117.11 117.11 00/00/00 RAH 2 50510,000 03/01/22 619271 VI CAFE 195.51 195.51 00/00/00 KAN 2 50510.000 03/DS/22 619272 MC CAFE 79.26 79.26 00/00/00 BAN 2 50510.000 03/01/22 619273 AS CAFE 3.71 3.71 00/00/00 KAH 2 50510.000 03/01/22 619274 VI CURBSIDE 29.31 29.31 00/00/00 KAN 2 50510,000 03/02/22 619426 CA CAFE 96.26 96.26 00/00/00 XAH 2 50510.000 03/02/22 619427 VI CAFE 181.19 181.19 00/00/00 BAN 2 50510.000 03/02/22 619428 MC CAFE 119.32 119.32 00/00/00 KAM 2 R@I DATE: 04/05/22 MEMORIAL MEDICAL FROK /O1C CENTER 03/31/22 TIME: 15:08 G/L RECEIPT PAY CASE NUMBER DATE NUMBER TYPE PAYER ANm 50240.000 03/02/22 50240.000 03/03/22 50240.000 03/03/22 50240.000 03/04/22 50240.000 03/04/22 50240.000 01/08/22 50240.000 03/14/22 50240.000 03/14/22 50240.000 03/29/22 50240.000 03/29/22 50246.000 03/29/22 $0240,000 03/29/22 619306 CA 619632 CA 619635 CA 619600 CA 619636 CA 619938 CA 620585 CA 620618 CA 622276 CA 622277 CA 622278 CA 622318 CA **TOTAL** 50240.000 COO= INDIOW COPAYS PAGE 150 RCP@EP RECEIPT DISC LOLL GL CASE AMOORT MIR MAKE DATE IiIT CODS ACCOUNT 10.00 10.00 00/00/00 8AR 2 10.00 10.00 00/00/00 PLB 2 10.00- 10.00- 00/00100 PLB 2 10.00 10.00 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 10.00- 10.00- 00/00/00 PLB 2 10.00 10.00 00/00/00 PLB 2 80.00 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---April 20, 2022 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND: ELECTRONIC BANK PAYMENTS $ 472,539.20, TOTALTRANSFERS BETWEEN FUNDS _ $ 1,512,620.13 " TOTAL NURSING HOME UPL.EXPENSES $ 693,345 76 TOTAL INTER40VERNMENT TRANSFERS GRAND`TOTAL DISBURSEMENTS APPROVED,A ri120, 2022 $ 2;67@ 0.1,09,'i MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR --April 20, 2022 PAYABLES AND PAYROLL 4/18/2022 Weekly Payables 452,803.65 4/18/2022 McKesson-340B Prescription Expense 8,901.37 4/18/2022 Amerisource Bergen-3408 Prescription Expense 2,179.99 Prosperity Electronic Bank Payments 4/11-4/15/22 Credit Card & Lease Fees 6,853.42 4/12/2022 Cleargage-Patient Financing Service 10T89 4111-4115/22 Pay Plus -Patient Claims Processing Fee 460.48 4/15/2022 ExpertPay child support 1,228.40 Tf:OMAL PAY, 'A1 r PAYROLL ANDtLAGTRONIC BANFt 4?A`YMBN75 $ 47$, a35t20. TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 4/18/2022 MMC Operating to Ashford -correction of NH insurance, QIPP and Phase 4 216,625.32 ARP Rural payment deposited into MMC Operating 4118t2022 MMC Operating to Solera-correction of NH QIPP and Phase 4 ARP Rural 61,778.22 payment deposited into MMC Operating 4/18/2022 MMC Operating to Fort bend-correctlon on NH QIPP and Phase 4 ARP Rural 65,502.46 payment deposited into MMC Operating 4118/2022 MMC Operating to Broadmoor-correction of NH QIPP and Phase 4 ARP Rural 76,179.39 payment deposited into MMC Operating. 4/18/2022 MMC Operating to Crescent -correction of NH insurance, QIPP and Phase 4 63,654.97 ARP Rural payment deposited into MMC Operatingin error 4/1812022 MMC Operating to Golden Creek -correction of NH insurance, QIPP and Phase 437,399.41 4 ARP Rural payment deposited Into MMC Operating in error 4/18/2022 MMC Operating toGulf .Pointe Plaza correction of NH insurance, QIPP and 124,476.98 Phase 4 ARP Rural payment deposited into MMC Operating 4118/2022 MMC Operating to Tuscany Village -correction of NH insurance, QIPP and 141,183.87 Phase 4 ARP Rural payment deposited into MMC Operating 4/18/2022 MMC Operating to Bethany -correction of NH insurance. and Phase 4 ARP 244,784.08 Rural payment deposited into MMC Operating in error MEDICARE ADVANCE PAYMENT RECOUP 4/18/2022 Broadmoor to Golden Creek -correction of Broadmoor medical recoup taken 26,022.27 from Golden Creek 4118/2022 Crescent to MMC Operating -correction of Crescent medicare recoup taken 1,448,97 from MMC Operating 4/18/2022 Crescent to Golden Creek -correction of Crescent medicare recoup taken from 26,022.27 Golden Creek 4/18/2022 Solera to Golden Creek -correction of Balers medicare recoup taken from 26,022.27 Golden Creek TRANSFER OF FUNDS BETWEEN NURSING HOMES 4/1812022 Fort Bend -correction of MMC Clinic insurance payment deposited into Fort 35.65 Bend in error 4/18/2022 Gulf Pointe Plaza -PP -correction of Bethany Insurance payment deposited into 1.484,00 Gulf Pointe Plaza -PP in error TOTAL TRAli, 61iS. BE'r 04,1FUFIP NURSING HOME UPL EXPENSES 4/18/2022 Nursing Home UPL-Cantex Transfer 250,353.21 4/18/2022 Nursing Home UPL-Nexion Transfer 17,751.82 4/18/2022 Nursing Home UPL-HMG Transfer 79,870.97 4/18/2022 Nursing Home UPL-Tuscany Transfer 50,449.86 4/18/2022 Nursing Home UPL-HSL Transfer 199,361.96 NURSING HOME BANK FEES 4/15/2022 Ashford -Enhanced analysis fee 102.94 QIPP CHECKS TO MMC 4/18/2022 Ashford 30,485,84 4/18/2022 Broadmoor 12,638.B5 4/18/2022 Crescent 10,117.45 4118/2022 Fort Bend 12,341.56 4/18/2022 Solera 11,877.14 4/18/2022 Tuscany 17,894,17 TOTAL NURSING HOME UPL EXPENSES $ 693,3".76, TOTAL INTER-GOVERNMENTTRANSFERS? GRAND TOTAL Dl5BUR5riMENT,3'APPROVED A ri120, 2022 $ 2,67$,5029 Page 1 of 17 FIECEiyiy t3YTHE CoDtM AUDM)R ON APR 14 2022 MEMORIAL MEDICAL CENTER /t q�22v�22��- UUr1 t 1r AP Open Invoice List OAI}{p02 0 ap_open_invoice.template Due Dates Through: 06/05/2022 Vendor# Vendor Name Class Pay Code 13180 ADVANCED STERILIZATION PRODUCT Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net / 8020385222✓" 03/29/20 03/24/20 05101/20 3,000.00 0.00 0.00 3,000.00✓ CONTRACT Vendor Totals Number Name Gross Discount No -Pay Net 13180 ADVANCED STERILIZATION PRODUCT 3,000.00 0.00 0.00 3,000.00 Vendor# Vendor Name Class Pay Code 10958 ALLYSON SWOPE ✓ Invoice# Comment Tran. Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 033122 04/13/20 04/13/20 04113/20 3,048,75 0.00 0.00 3,048.75 ✓ TRANSCRIPTION SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 10958 ALLYSON SWOPE 3,048,75 0.00 0.00 3,048,76 Vendor# Vendor Name - Class Pay Code A0400 AUREUS RADIOLOGY LLC ✓/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2546358 ✓ 04/13/20 04/04/20 05/04/20 2,760.00. 0,00 0.00 2,760,00 ✓� LAB STAFFING 1311 V-311A 1J1)&'Wa"+.1. 2546263 ✓ 04/13/20 04/04/20 06/04/20 2,680.00 0.00 0.00 2,680.00 LAB STAFFING ( 311%- 51A 10P ) Sh(64y , 2648301 .i 04/13/20`04104/20 05/04/20 2,725.50 0.00. 0.00 2,725.50,/ LAB STAFFING 151IS- a1a41;�) t6441-V 2546410 04/13120 04/04/20 05/04/20 2,855.88 0.00 0.00 Z855.88 v. ' LAB STAFFING (31a.1 - 31 adlaz) 1ltwluh1 Vendor Total! Number Name Grass Discount No -Pay Net A0400 AUREUS RADIOLOGY LLC 11,021.38 0.00 0.00 11,021.38 Ventlor# Vendor Name Class Pay Code / 14088 AZALEA HEALTH ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross Discount No -Pay Net 71385 ,% 04/12/2002/01/2002101/20 550.00 0.00 0.00 550.00 MONTHLY PROCESSING FEE: - Ftb 73318 f' 04/1 W20 04101/20 04101/20 550.00 0.00 0.00 550.00 MONTHLY PROCESSING FEE: -At* I Vendor Totals Number Name Gross Discount No -Pay Net 14088 AZALEA HEALTH 1,100.00 0.00 0.00 1,100.00 Vendor# Vendor Name ; Class Pay Cade B1150 BAXTER HEALTHCARE �✓ W Invoice# Tran Dt Inv Dt Due Dt Check D, Pay: Gross Discount No -Pay Net /Comment 74446288 04/12/20 03/23/20 04/17/20 338.31 0.00 000 338.31 ./ SUPPLIES 74481367 v/ 04/12/20 03/28/20 04/22/20 41.91 0100 0.00 41.91 SUPPLIES 74531274 ✓ 04/12/20 03/31/20 04/26/20 110.91 0.00. 0.00 110.91 SUPPLIES 74634136 ✓ 04/12/20 03/31/20 04/25/20 42.29 0.00 0.00 42.29 SUPPLIES Vendor Totals Number Name Grass Discount No -Pay Net file:///C:/Users/ltrevino/cpsi/memmed.cpsinet,com/u881251data_51tmp_cw5report119212... 4/ 14/2022 Page 2 of 17 B1150 BAXTER HEALTHCARE 533,42 0.00 0.00 533.42 Vendor# Vendor Name Class Pay Code B1220 BECKMAN COULTER INC ./� M Invoice# Comment Tran Dt Inv Dt Due Dt Check Pay Gross Discount No -Pay Net 1098033971/ 04/06120 04/04120 04129/20 1.228.67 0.00 0.00 1,228,67 ✓ PPLIES 109802323 ✓ 04/06/20 04/04/20 04/20/20 2,279.54 0.00 0.00 2,279.54,% SUPPLIES 109802793 f 04/06/20 04/04/20 04/29/20 2,439.06 0.00 0.00 2,439.06 ✓r SUPPLIES 109802947 % 04/06/20 04/04/20 04/29/20 9,946.53 0.00 0.00 9,946.53 SS PPLIES 109806W 04/13/20 04/01/20 04/26/20 32.49 0.00 0.00 32.49 f' SUPPLIES 5455865 / 04113/20 04/05/20 04/30/20 6,249.42 0.00 9,60 f. 6,249.42 v LEASE/MAINT 109807136 �/` 04/13/20 04/05/20 04/30/20 303,68 0.00 0.00 303.68 ✓j Vendor Totals Number Name Gross Discount No -Pay Net 01220 BECKMAN COULTER INC 22,479.39 0.00 0.00 22,479.39 Vendor# Vendor Name Class Pay Cade 14753 SIOMERIEUX, INC .� Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net 1212762147 ,/ 04112120 04/12/20 0411PJ20 9,507.95 0.00 0.00 9,507.95 ,/ Vendor Totals Number Name Gross Discount No -Pay Net 14753 BIOMERIEUX, INC 9,507,95 0100 0.00 9,6077.96 Vendor# Vendor Name Class Pay Code B1650 BOSART LOCK & KEY INC ✓' M invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 123813 04/14/20 03/15/20 04/14/20 129.95 0.00 0.00 129.95 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Not B1650 BOSART LOCK & KEY INC 129,95 0100 0.00 129.95 Vendor# Vendor Name Class Pay Code 12740 BUILDING KID STEPS f Invoice# Comment Tran Dt Inv Dt Due Dt Check. D Pay Gross Discount No -Pay Net OUTPATIENTS 04/13120 04/01/20 04116/20 1,113.00 0,00 0.00 1,113,00 SPEECH THERAPY OUTPATIENTE 04/1312004/01/2004/16/20 163.00 0.00 0100 163.00 SPEECH THERAPY OUTPATIENTA 04/13/20. 04/01/2004/16/20 1,113.00 0.00 0.00 1,113,00 ✓�� SPEECH THERAPY OUTPATIENTD 04/13120 04/01/20 04/16120 11039.00 0,00 0.00 1,039.00 SPEECH THERAPY OUTPATIENTC 04/13/20 04/01/20 04116/20 1,052.00 0.00 0.00 1,052,00 SPEECH THERAPY Vendor Totals Number Name Gross Discount No -Pay Net 12740 BUILDING KID STEPS 4,480.00 0.00 0.00 4,480.00 Vendor# Vendor Name Class Pay Code �- 14120 CALHOUN COUNTY EMS V file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.corn/u881251data_5/tmpew5report119212... 4/14/2022 Page 3 of 17 Invoice# PIrnment Tian Ot Inv or Due Dt Check D Pay Gross Discount No -Pay Net 22030003v" 04/12/2004/06/2005/05120 3,960.00 0.00 0.00 3,960.00 TRANSFERS -MAR 22 1 a 15- 313111 ) _ Vendor Totals Number Name Gross Discount No -Pay Net 14120 CALHOUN COUNTY EMS 3,960.00 0.00 0.00 3,960.00 Vendor# Vendor Name Class Pay Code 11295 CALHOUN COUNTY INDIGENT ACCOUN //- Invoice# Comment Tran Dt Inv Di Due Ot Check D Pay Gross Discount No -Pay Net 040622 04/12/20. 04/06/20 04/07/20 80.00 0.00 0.00 80.00 INDIGENT CO PAYS Vendor Totals Number Name Gross Discount No -Pay Net 11295 CALHOUN COUNTY INDIGENT ACCOUN 80.00 0.00 0.00 80.00 Vendor# Vendor Name Class Pay Code C1992 COW GOVERNMENT, INC. M �/ Invoice# Comment Tran DI Inv Dt Due Di Check D Pay Gross Discount No -Pay Net T861.625 +.r1 0313012003123/2005/01/20 4,369.46 0.00 0100 4,359.46 SUPPLIES ►T tuxnkr, suprari-ival V348375 �� ` pL11 04/13/2004/01/2005101/20 5,176.00 0.00 0.00 5,176.00 Vendor Totals Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMENT, INC, 9,535.46 0.00 0.00 9,535.46 Ventlor# Vendor Name Class Pay Code 11202 CFI MECHANICAL INC ✓ Invoice# Comment Tran Dt Inv Ot Due Dt Check D' Pay Grass Discount No -Pay Not Sol5898 03/31/2003/3012004129/20 3,995.00 0.00 0.00 3,995.00 ANNUAL INSPECTION-CHILLE , Vendor Totals Number Name Gross Discount No -Pay Net 11202 CFI MECHANICAL INC 3,995.00 0.00 0.00 3,995,00 Ventlor# Vendor Name / Class Pay Code 10105 CHRIS KOVAREK r% Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 617 04/13/20 04/01/20 04/30/20 200.00 0.00 0.00 200.00 f PURCHASED SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 10105 CHRIS KOVAREK 200.00 0.00 0.00 200.00 Vendor# Vendor Name Class Pay Code / 13000 CLEARFLY ✓ Invoice# pomment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net INV416601✓ 04/141200410112004/15/20 1,194.79 0.00 0.00 1,194.79 TELEPHONE Vendor Totals Number Name Gross Discount No -Pay Net 13000 CLEARFLY 1,194.79 0.00 0.00 1,194.79 Vendor#Vendor Name Class Pay Code r 10786 CLINICAL PATHOLOGY "/ Invoice# Comment Tran Ot Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 176562022030 1/04/12/20 03/31 /20 04/25/20 25,546.54 0.00 0.00 25,546.54 PATHOLOGY SERVICES Vendor Totals Number Name Gross Discount No -Pay Not 10786 CLINICAL PATHOLOGY 25,546.54 0.00 0.00 25.546.54 Vendor# Vendor Name Class Pay Code / C1166 COASTAL OFFICE SOLUTONS ,/ W file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report119212... 4/14/2022 Page 4 of 17 Invoice# Comment Tran Dt Inv of Due Dt Check DPay Gmss Discount No -Pay Net OEOT198641 ,/ D4/13/20 04/04/20 04/14/20 272.00 0.00 0.00 J 272.00 ✓ SUPPLIES -faSK. ck&iy- OEOT199471 ,/ 04/13/20 04/04/20 04114120 108.57 0.00 0.00 108.57 SUPPLIES PrL-p„,}-,a ct`Vtl Wc5 Vendor Total; Number Name Gross Discount No -Pay Net C1166 COASTAL OFFICE SOLUTONS 380.67 0.00 0.00 380.57 Vendor# Vendor Name Class Pay Code 11029 COASTAL REFRIGERATION Invoice# Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net /Comment 032222 041131PO 03/22/20 04/22/20 J 5,428.00 0.00 0.00 f 8,428.00 ✓ LABOR - OB ICE MACHINE Vendor Tolah Number Name Gross Discount No -Pay Net 11029 COASTAL REFRIGERATION 5,428,00 0.00 0.00 5.428.00 Vendor# Vendor Name Class Pay Code 13572 COMMUNITY INFUSION SOLUTIONS r/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net IC20220416 ✓' 04/13/20 04/05/20 04/15/20 8,949.53 0.00 0.00 8,949.53 ✓� INFUSION SERVICES Vendor TotalENumber Name Gross. Discount No -Pay Net 13572 COMMUNITY INFUSION SOLUTIONS 8,949.53 0.00 0.00 8,049.63 Ventlor# Vendor Name Class Pay Code / C1970 CONMED CORPORATION .r M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 848251 04/12/20 04/06/20 04/12/20 SUPPLIES 215.06 0.00 0.00 215.06 Vendor Totals Number Name Gross Discount No -Pay Net. C1970 CONMED CORPORATION 215.06 0.00 0.00 215.06 Vendor# Vendor Name Class Pay Code 14080 CORROHEALTH, INC, v/ Invoice# /i Comment Tran Dt. Inv Dt Due Ot Check O Pay Gross Discount No -Pay Net 754239 ✓ 04/13/2004105/20 OSM5/20 1,761.16 0.00 0.00 1,761.15 r/'! HIM SERVICES Vendor Totals Number Name Gross Discount No -Pay Nei 14080 CORROHEALTH, INC. 1,761.15 0.00 0.00 1,761.15 Verdant! Vendor. Name Class Pay Code 11368 CYRACOM LLC v! Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2022009403,/' 04/12/2003/31/2004/30120 60145 0100 0.00 603.45 ,f INTERPRETATION SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 11368 CYRACOM LLC 603.45 0.00 0.00 603.45 Vendor# Vendor Name Class Pay Code 11116 DESIGNS FOR VISION, INC. ��• Invoice# Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net /.Comment 1653363 ✓ 04/1312004/04/2005/01/20 695.00 0.00 0.00 695.00 �/'• SUPPLIES I'LVIO(ifoxi �A•t�iMl.`7 VandorTotalENumber Name Gross Discount No -Pay Net 11116 DESIGNS FOR VISION, INC. 695.00 0.00 0.00 695.00 Vendor# Vendor Name Class Pay Code / 10368 DEWITT POTH & SON ,/ file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report119212... 4/14/2022 Page 5 of 17 Invoice# ,Comment Tran DI Inv of Due Dt Check D Pay Gross Discount No -Pay Net 6769870 �/ 03/30/20 03/28/20 04/29/20 151.84 0.00 0.00 161,84 ,SUPPLIES -rOhw 6770051 ✓/ 03/30/20 03/29/20 04/29/20 13.12 0.00 0.00 13.12 SUPPLIES t✓, w 6773780 ✓ 04/12/20 04/01/20 04/26/20 573.85 0.OD 0.00 573.85 y� SUPPLIES £a1L'I-(aPW,putSf $�pu `jl. 6778730 ✓ 04/12/20 04/05/20 04/30/20 36.39 0.00 0.00 / 36.39 ✓ SUPPLIES 10ay- 6779310 Y,r' 04/12/20 04/O6/20 05/01/20 107.02 0.00 0.00 _ 107.02 /�^-UPPLIES-{kh11% Jlitl(rt5j hVy hv) -PI(I 6781700 ./ 04/12/20. 04/07/20 05/02/20 102.86 0.00 0.00 102.86 SUPPLIES F067t ik''+t 11y0 Vltdh, MV1.10pu7 J 6772832 ,/ 04/12/20 04/07/20 05/02/20 97.92 0.00 0.00 97.92 SUPPLIES butkliA lnfiw(5 Vendor Totals Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SON 1.083.00 0.00 0.00 1,083.00 Vendor# Vendor Name Class Pay Code 10789 DISCOVERY MEDICAL NETWORK INC ✓� Invoice# Comment Tran of Inv of Due of Check D Pay Gross Discount No -Pay Net MMC033122 04/13/2003/3112004/01/20 126,569.71 0,00 0.00 126,569.71 ✓ PHYSICIAN SERVICES 11u.- 3 i Vendor Totals Number Name Grass Discount No -Pay Net 10789 DISCOVERY MEDICAL NETWORK INC 126,569.71 0,00 0.00 126,669.71 Vendor# Vendor Name Class Pay Code 11291 DOWELL PEST CONTROL V1 Invoice# Comment Tran Of Inv of Due Dt Check O Pay Gross Discount No -Pay Net 8611 04/12/20 03/30/20 04/24/20 66.00 0.00 0.00. 65.00 ✓ f PEST CONTROL Vendor Totals Number Name Gross Discount No -Pay Net 11291 DOWELL PEST CONTROL 65.00 0.00 0.00 65.00 Vendor# Vendor Name /Class Pay Code 11284 EMERGENCY STAFFING SOLUTIONS ✓ Invoice# Tran of Inv of Due Of Check D Pay Gross Discount No -Pay Net /Comment 41099 ✓ 04/12/20 03/31/20 04/10/20 3,600.00 0.00 0.00 3,600.00 ER PHYSICIAN STAFFING Vendor Totals Number Name Gross Discount No -Pay Net 11284 EMERGENCY STAFFING SOLUTIONS 31600.00 0.00 0.00 31600.00 Vendor# Vendor Name Class Pay Code C2510 EVIDENT r% M Invoice# Com/mant Tran of Inv of Due Dt Check Dr Pay Gross Discount No -Pay Net A2204051378 r/ M13120 04/05/20 04/30120 17,510,00 0.00 0.00 17,519.00 HARDWARE/TECH SUPPORT Vendor Totals Number Name Gross Discount No -Pay Net C2510 EVIDENT 17,519.00 0,00 O.00 17,519.00 Vendor# Vendor Name / Class Pay Cade - 10689 FASTHEALTH CORPORATION r/ Invoice# Coplment Tran of Inv of Due Dt Check Pay Gross Discount No -Pay Net 04A22MMC v 04/13/2004/01/20.04/16/20 495.00 0.00 0.00 495.00 WESSITE MONTHLY INVOICE Vendor Totals Number Name Gross Discount No -Pay Net file:///C:fUsers/Itrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report119212,.. 4/14/2022 Page 6 of 17 10689 FASTHEALTH CORPORATION 495.00 0.00 0,00 495.00 Vendor# Vendor Name Class Pay Code �/ 14336 FIRETRON, INC ✓ Invoice# (Comment Tran Dt Inv Ot Due Ot Check 0, Pay Gross Discount No -Pay Net 194365 �/ 03/29/20 00/28120 04/29/20 1,400.00 0.00 0.00 1,400.00 AFIRE PANEL MONITOR 194517 y 04/13/2003/29/2004/28/20 670,00 0.00 OA0 670,00 ✓� ANNUAL FIRE ALARM INSP Vendor Totals Number Name Gross Discount No -Pay Net 14336 FIRETRON, INC 2,070,00 0.00 0.00 2,070.00 Vendor# Vendor Name _ Class Pay Code F1400 FISHER HEALTHCARE M Invoice# omment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1301660 04/12/20 0%30/20 04/24/20 189.36 0.00 0.00 189.36 SUPPLIES 1353839 y/' 04/12/20 03/31 /20 04/25/20 293.01 0.00 0.00 293.01 SUPPLIES 1450093 ✓ 04/12/20 04/04/20 04/29/20 318.00 0.00 0.00 318.00 ✓r SUPPLIES 1450091 04/12/120 04/04/20 04/29/20 159.00 0.00 0.00 159.00 SUPPLIES 1450092 ✓ D4/12/20 04/04/20 04/29/20 318.00 0.00 0.00 318.00 �l J SUPPLIES 1246926 ✓ 04/13/20 03/29/20 04/23/20 567.06 0.00 0.00 567.06 ✓ SUPPLIES Vendor Total, Number Name Grass Discount No -Pay Net P1400 FISHER HEALTHCARE 1,844.43 0,00 0.00 1,844A3 Vendor# Vendor Name Class Pay Code / 11183 FRONTIER ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net , 040222 04/13/20 O-VO212004/26120 1,110.64 0.00 0.00 1,110,64 INTERNET 031922 04/14/2003119/2004/19/20 65.40 0.00 0.00 65.40 TELEPHONE Vendor Tolals Number Name Gross Discount No -Pay Net 11183 FRONTIER 1,176.04 0.00 0.00 1.176.04 Vendor# Vendor Name i Class Pay Code 12248 GREAT AMERICA FINANCIAL SVCS Invoice# Comment Tran Ot Inv Dt Due Dt Check DPay Gross Discount No -Pay Nat / 31389860 ✓ 04/14/20 04105/20 04130/20 10,124.07 0.00 0.00 10,124.07 ✓`� COPIER LEASE Vendor TotelENumber Name Gross Discount No -Pay Net 12948 GREAT AMERICA FINANCIAL 5VCS 10,124,07 0.00 0.00 10,124.07 Vendor# Vendor Name Class Pay Code G0401 GULF COAST DELIVERY Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net MAR2022 03131/20. 03/30/2004/29/20 100.00 0,00 0.DO 100.00 DELIVERY SERVICES Vendor Totals Number Name Gross Discount No -Pay Net G0401 GULF COAST DELIVERY 100.00 0100 0.00 100.00 Vendor#Vendor Name Class Pay Code file://!C:/[Jsers/ltrevino/cpsi/memmed.cpsinet.corn/u8 8125/data_5/tmp_cw5repoil119212... 4/ 14/2022 Page 7 of 17 G1210 GULF COAST PAPER COMPANY f M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2188475 ✓ 03/31/20 04/04/20 05/04/20 28.49 0.00 0= 28.49 ✓' S!UPPLIES .0560 04/13/20 03/31/20 04/30/20 221✓ 413.37 0.00 0.00 413.37 ✓� SUPPLIES Vendor Total. -Number Name Grass Discount No -Pay Net G1210 GULF COAST PAPER COMPANY 441.86 0.00 0.00 441.66 Vendor# Vendor Name Class Pay Code H1100 HAYES ELECTRIC SERVICE. w Invoice# Co/rgment Tran Dt Inv Dt Due Ot Check D Pay Grass Discount No -Pay Net A222031101 ✓ 04112/20 03111120 03/21/20 125.00 0.00 0.00 125.00 LABOR - ELECTRICAL/COMPF Vendor Totals Number Name Gross Discount No -Pay Net H1100 HAYES ELECTRIC SERVICE 125.00 0.00 0.00 125.00 Vendor# Vendor Name lass Pay Code 11552 HEALTHCARE FINANCIAL SERVICES Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 100596274 ✓ OM1120 03127/20 05/01/20 4.610.52 0.00 0.00 / 4,610.52 ✓ GEM/STERILIZER/PHONE 100598160 ✓4�L fU/ 04/12/20 04/01/20 372.39 0.00 0.00 372.39 yr 100598159 04/12/20:04/01/20 357.71 0.00 0.00 357.71 100598161 ✓ 04112/2004/01/2004/15/20 89.87 0.00 0.00 89.87 LATE FEE 100598158 J 04/12/2004/01/2004115/20 245.97 0.00 0,00 245.97 LATE FEE 100601834 ,/ 04/13/20 04/06/20 0,00/20 7,447.86 0.00 0.00 ,r 7,447.86 �✓ ASE 100801833 04/13/2004/08/2004/30/20 7,164.17 0.00 0100 7,154.17 /LEASE 100601835✓ 04/13/20 04/06/20 04/30/20 1,797.44 0.00 0.00 / 1,797.44 ✓ LEASE 100601832 „/ 04/13120 04/06120 05/01/20 4,919.41 0.00 0.00 4,919.41 LEASE Vendor Total. -Number Name Grass Discount No -Pay Net 11552 HEALTHCARE FINANCIAL SERVICES 26,995.34 0.00 0.00 26,995.34 Vendor# Vendor Name class Pay Code 10922 HUNTER PHARMACY SERVICES ✓ / Invoice# Comment Tran Dt Inv IN Due Dt Check D Pay Gross Discount No -Pay Net 4865 / 04/1312003/3112004/20/20 15,113.11 0,00 0.00 15,113.11 PROFFEES Vendor Totals Number Name Gross. Discount No -Pay Net 10922 HUNTER PHARMACY SERVICES 15,113.11 0,00 0.00 15,113.11 Vendor# Vendor Name Class Pay Code 11200 IRON MOUNTAIN Invoice# Comment Tran Dt Inv Dt Due Dt Check D* Pay Gross Discount No -Pay Net GLSX267 03/3112003/31/2004/30/20 641.30 0.00 0.00 541.30 / Vendor Total: Number Name Gross Discount No -Pay Net file;///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5reportl 19212... 4/14/2022 Page 8 of 17 11200 IRON MOUNTAIN 641.30 0.00 0.00 641.30 Vendor4 Vendor Name class Pay Code 11108 ITERSOURCE CORPORATION Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 711469 / 04/13/20 04/01/20 04/30/20 250.00 0.00 0.00 260.00 f ✓ ✓ KPPORT SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 11108 ITERSOURCE CORPORATION 250.00 0:00 0.00 250.00 Vendor# Vendor Name Class Pay Code 11600 LEGAL SHIELD y// Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net. 041522 04/13/20 04/15/20 04115/20 401.80 0.00 0100 401.80 PAYROLLDEDUCT Vendor Total,- Number Name Gross Discount No -Pay Not 11600 LEGALSHIELD 401.80 0.00 0.00 401.80 Vendor# Vendor Name Class Pay Code 10972 M G TRUST / Invoice# Comment Tran Dt Inv Dt. Due Dt Check D Pay Gross Discount. No -Pay Net 041122 04/13/20 04/11/20 04/30/20 640.86 0.00 0.00 640.86 PAYROLLDEDUCTS 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 Cade M2178 MCKESSON MEDICAL SURGICAL INC / Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 19240564 / 04/13/20 04/01/20 04116/20 32.52 0.00 0.00 32.52 v S/UPPLIES 19254853 04/13/20 04/06/20 04/21/20 ✓ 22.56 0.00 0,00 22.55 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net M2178 MCKESSON MEDICAL SURGICAL INC 55.08 0.00 0.00 55.08 Vendor# Vendor Name Class Pay Code 10613 MEDIMPACT HEALTHCARE SYS, INC, ✓/ AM Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net % 3D309118 J 04112/20 03/04/20 03/24120 13,44 0.00 0.00 13.44 t/ INDIGENT CARE Vendor Total: Number Name Gross Discount No -Pay Net 10613 MEDIMPACT HEALTHCARE SYS, INC. 13.44 0.00 0.00 13.44 Vendor# Vendor Name Class Pay Code M2827 MEDIVATORS J M Invoice# Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net /Comment 91296193 qr 04/13/20 04/04/20 04/30/20 400.00 0.00 0,00 400.00 SUPPLIES .. Vendor Totals Number Name Gross Discount No -Pay Net M2827 MEDIVATORS 400,00 0.00 0.00 400.00 Vendor# Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC M Invoice# Co ment Tran Dt Inv Dt Due Dt Check D• Pay Gross Discount No -Pay Net 2204126605 03131 /20 04/04/20 04/29/20 339.30 0.00 0.00 339.30 1� SUPPLIES 2203421195 % 04/12/20 03/23/20 04/17/20 3,296.03 0.00 0.00 3,296,03 .� file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report119212... 4/14/2022 Page 9 of 17 SUPPLIES 2204427746 ✓ 0411 PJ20 03/30/20 04/24/20 -6.68 0.00 0.00 -6,68 , CM 2201384412 2204544109 04/12/20 03/31/20 04/25/20 79.87 0.00 0.00 79.87 ./ SUPPLIES 2204544108 , ,/ 04/12/20 03/31/20 04/25/20 204.96 0.00 0.00 204.96 SUPPLIES 2204544110 DO 2/20 03131120 04/25/20 964,99 0.00 0.00 964.99 SUPPLIES 2204544111 �/' 04/12120. 03/31120 04/25/20 420.35 0.00 0.00 420,35 SU/PPLIES 2204956112 ✓ 04/12120,04/0212004/27120 43.05 0.00 0.00 43.05 l' SUPPLIES 2204956111 i/'/ 04/12/2004/0212004/27/20 2Z51 0.00 0.00 27.51 5Uf PLIES 22049561 O7 � 04/12/20 04/02/20 04/27/20 101.64 0.00 0.00 101.64 v``! SUPPLIES 2204956110 04/12/20 04/02/20 04/27/20 36•A2 0.00 0.00 36,42 f SUPPLIES , 2205124369 J J 04/1 PJ20 04/04/20 04/29/20 104.53 0.00 0.00 104.53 SUPPLIES 2205I P4373 „/ 04/12/20 04/04/20 04/29/20 197.16 0.00 0.00 197.16 SUPPLIES 2205506613 „� 04/12/20 04/06/20 05/01/20 189.22 MCI 0.00 18922 SUPPLIES v,./ 2205506625 ✓/ 04/12/2004/06/2005101/20 117,87 0.00 0.00 117.87 SUPPLIES 2205606612 / 04/12/20 04/06/20 05/01/20 32.36 0.00 0.00 $2.36 SUPPLIES 2205506616 ,! 04/12/20 04/O5/20 05/01/20 26.73 0.00 0.00 26.73 e/ SUPPLIES 22055066151/ 04/1 PJ20. 04/06/2005101120 49.98 0.00 0.00 49.98 SUPPLIES 2205506610 / 04/12/20 04/06/20 05/01/20 495.58 0.00 0.00 495.58 SUPPLIES 2205506611 ✓ / 04/12/2004/06/2005101/20 62,16 0.00 0.00 62,16 SUPPLIES 2205506621 ✓ 04/12/20 04/06/20 05/OV20 35.49 0.00 0.00 35,49 SUPPLIES 2205508614 �/ 04/12120 04/06/20 05/01/20 50.58 0.00 0.00 50.58 SUPPLIES 2205500624 04/12/20 04106/20 05/01/20 4.75 0.00 0.00 4.75 SUPPLIES 2206506622 „ X' 04/12/20 04/06/20 05/01120. 34.85 0.00 0,00 34.85 SUPPLIES 2205506623 f 04/12/2004106/2005/01/20 25.05 0.00 0.00 25.05`j SUj3PLIE9 2205506617E 04/1212004/06/2005/01/20 53.48 0.00 D.00 53.48 SUPPLIES 2905506619 ✓� 04/12/20 04/06/20 05/01/20 7,020.64 0.00 0.00 7,020,64 SUPPLIES file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report119212... 4/ 14/2022 Page 10 of 17 2204126606 ✓ 04/14/2003/29/2004123/20 113.10 0100 0.00 lmlo SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 14,120.95 0.00 0.00 14.120.95 Vendor# Vendor Name Class Pay Code 10963 MEMORIAL MEDICAL CLINIC ✓r Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 041122 04113120 04111/20 04130/20 180.00 0100 0.00 iso.00 y>✓ PAYROLLDEDUCTS Vendor Totals Number Name Gross Discount No -Pay Net 10963 MEMORIAL MEDICAL CLINIC 180.00 0.00 0.00 180.00 Vendor# Vendor Name / Class Pay Code 11604 MICHAEL PFIEL ✓/ Invoice# Comment Tian Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 040422 04/12/20 04/04/20 04/04/20 195.00 0.00 0.00 / 195.00 ,J NP RECERT FEE REIMSURSEI Vendor TotalsNumber Name Gross Discount No -Pay Net 11604 MICHAEL PFIEL 195.00 0.00 0.00 495.00 Vendor# Vendor Name Class Pay Code / 10791 MINDRAY DS USA, INC. t/ ' Invoice# Comment Tran or Inv Dt Due Dt Check DPay Gross Discount No -Pay Net /160/925944 / 04113/10 04/05/20 04/25/20 417.00 0.00 0.00 417.00 4/' SUPPLIES Vendor Totalr Number Name Gross Discount No -Pay Net 10791 MINDRAY DS USA, INC. 417,00 0.00 0.00 417.00 Vendor# Vendor Name Class Pay Cade M2621 MMC AUXILIARY GIFT SHOP ✓ w Invoice# Comment Tran Ot Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net 040822 04/12/20 04/06/20 04/00/20 229.54 0.00 0.00 229.54 PAYROLLDEDUCTS Vendor Totals Number Name Gross Discount No -Pay Net M2621 MMC AUXILIARY GIFT SHOP 229.54 0.00 0.00 229.54 Vendor# Vendor Name Class Pay Code / 10536 MORRIS & DICKSON CO, LLC ✓ Invoice# Comment Tran Dt Inv DI Due Dt Check D Pay Gross Discount No -Pay Net 8050280 ✓/04/12/20 04/01/20 04/11/20 433.90 0.00 0.00 433.90 f� INVENTORY 8055486 ,/� 04/12120 04/03/20 04/13/20 57.04 0.00 0100 57.04 ✓, INVENTORY / 8053321 +� 04/12/20 04/03/20 04/13/20 38.06 0.00 0.00 38.06 INVENTORY 8055487 ,11 04112/20 04/03/20 04/13120 1,929.60 0.00 0.00 1.929.50 ✓ INVENTORY 8053317 04/12/20 04/03/20 04/13/20 8.40 0.00 0.00 8.40 ✓'� INVENTORY 8053318 �/ 04/12120 04/03/20 04/13/20 170.55 0.00 0.00 178.55 INVENTORY 8053319 �% 04/12/20 04/03/20 04/13/20 592.49 0.00 0100 892.49 JNVENTORY 8058820 ✓f04112/20 04104/20 04/14/20 74,69 0.00 0.00 74.69 INVENTORY ft le:///C:/Users/Iti,evino/apsi/memmed.cpsinet.com/u88125/data_51tmp_cw5report 119212.,. 4/ 14/2022 Page 11 of 17 8056899 �.� 04/12/20 04/04/20 04/14/20 /INVENTORY 8059936 ✓ 04112/EO 04/04/20 04/14/20 INVENTORY 8056897 4,r/ 04/12/20 04/04/20 04/14/20 VENTORY 8059937 04/12/20 04/04/20 04/14/20 NVENTORY 8056898 04/12/20 04/04/90 04/14/20 INVENTORY 8070314 / 04/12120. 04/0612004116120 INVENTORY 8067584 v 04/12/20 04106/20 04/16/20 /INVENTORY 8067685 e/� 04/12/20 04/06/20 04/16/20 /INVENTORY 8067582 ,E 04/12/20 04/06/20 04/16/20 INVENTORY 8067583 ,% 04/1 N20 04/06/20 04/16/20 NVENTORY 8070313 04/12/20. 04/06/2004/16120 INVENTORY 4648 ✓/ 04/12120. 04106/2004/10/20 CREDIT 8067581 V/04112/20 O4/06/20 04/16/20 INVENTORY 8067680 ✓ 04/12/20 04/06/20 04/16/20 NVENTORY 8072615 04/1 PJ20 04107/20 04117120 /INVENTORY 8075782 / 04/12/20 04/07/20 04/17/20 )INVENTORY 8075781 ,/ 04/12/20 04/07/20 04/17/20 INVENTORY 8072617 ,,� 04/12/20 04/07/20 04/17/20 )INVENTORY 8072618 „✓ 04/12/20 04/07/20 04/17/20 JNVENTORY CM30706✓ 04/12/20 04/08120 04/18/20 CREDIT 801638217879938 / CM3D705 J 04/12120 04/08120 04/18/20 CREDIT INV 8016382 80802036 ✓ 04/12/20 04/10/20 04/20/20 INVENTORY 8082035 �,./ 04/12/20 04/10/20 04/20/90 INVENTORY 8082034 ✓/ 04/12/20 04/10/20 04/20/20 INVENTORY CM31120 �/ 04112/2004/11/2004/21/20 CREDIT INV 8026925 8083424 ,✓ 04/12120 04/11/20 04121/20 879.35 0.00 0.00 879.35 128.26 0.00 0.00 128.26,.E 5.01 0.00 0.00 5.D1 42.79 0.00 0.00 42.79 102.01 0.00 0.00 102.01 692.18 0.00 0.00 692.18 f 3.62 0.00 0.00 3.62 193.61 0.00 0.00 193.61 ✓� 185.28 0.00 0100 185.28 ,✓ 85.40 0.00 0.00 85,40 14.69 0.00 0.00 14,69 -82.42 0.00 0.00 -82.42 „✓ 752.89 0.00 0.00 752.89 �.Z 23.42 0.00 0.00 23.42. 249.99 0.00 0.00 249.99 231.02 U0 0.00 231.02 3,094.23 0.00 0.00 3,09423 92.46 0.00 0.00 92.46 ✓' 0.74 0.00 0.00 0,74 -230.27 0.00 0.00 -230.27 ✓r -210.61 0.00 0.00 -210.61 235,92 0.00 0.00 235.92---,� 11.25 OM 0.00 11.25.% 28.20 0.00 0.00 28.20 1/ -33.68 0.00 0.00 -33.68 87.44 0.00 0.00 87.44 ,✓� file;///C:/Users/Itrevino/epsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report119212... 4/14/2022 Page 12 of 17 /INVENTORY B085563 ✓ 04/12/20 04/11/20 04/21/20 810.50 0.00 0.00 810.50 INVENTORY 8083426 yr 04/12/2004/11/2004/21/20 657.28 0.00 0.00 557.28 INVENTORY 8086267 ,J� 04/12/2004/11/2004/21/20 261.00 0.00 0.00 261.00 ,/INVENTORY 8086265 ,/ 04/12/20 04/11/20 04/21/20 32,52 0.00 0.00 32.62,,,,- INVENTORY 808$425✓ 04/12/2004/11/2004121120 3.02 0.00 0.00 3.02 INVENTORY - 5574 i 04/12/20 04/11/20 04/21120 -143,37 0.00 0.00 -143,37 CREDIT 8091677 �/J 04113/20 04/12/20 04/22/20 728.02 0.00 0.00 728.02 , f JNVENTORY 8091876 ./ 04/13/20 04/12/20 04/22/20 823.85 0.00 0,00 823.85 INVENTORY 8090493 fir. 04/13/20 04/12120 04/22/20 1,447.10 0.00 0,00 1.447.10 ✓j INVENTORY Vendor TotalE Number Name Gross. Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 14,416.43 0.00 0.00 14,415.43 Vendor# Vendor Name Class Pay Code 13548 NACOGDOCHES TRANSCRIPTION y% Invoice# Comment Tran Dt Inv DI Due Dt Check U Pay Gross Discount No -Pay Net 7673 >/ 04/12/20 04/07/20 04/17/20 379.26 0.00 0,00 379.26 �„•% SERVICES Vendor Total;Number Name Gross Discount No,Pay Net 13548 NACOGDOCHES TRANSCRIPTION 37926 0.00 0.00 379.26 Vendor# Vendor Name Class Pay Code 14252 OLOOP TECHNOLOGY SOLUTIONS ✓ / Invoice# Comme I Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net INVAJONES0018 v03131120 03/30/20 04/29/20 6,103.44 0.00 0.00 6,103.44L'y TRAVEL NURSE STAFFING 1-3l1 Q - 3> ) 3" Vendor TotalE Number Name Grass Discount No -Pay Net 14252 OLOOP TECHNOLOGY SOLUTIONS 6,103.44 0.00 0.00 6.103,44 Vendor# Vendor Name- Class Pay Code 11155 PARA iJ/ Invoice# Comment Tran DI Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 10774 04/13/20 04/01/2D 05/01/20, 3,084.00 0.00. 0.00 3,084.00 REVENUE INTEGRITY PROGR Vendor Totals Number Name Gross Discount No -Pay Net 11155 PAPA 3,084.00 0.00 0.00 3,084.00 Vendor# Vendor Name / Class Pay Code P1800 PITNEYBOWESINC ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1020387746 / 04/13/20 03/27/20 04/26/20 207.00 0.00 0.00 207.00 W'�' POSTAGE Vendor Totals Number Name Gross Discount No -Pay Net P1800 PITNEY BOWES INC 207.00 0.00 0.00 207.00 Vendor# Vendor Name Class ! Pay Code P2200 POWER HARDWARE ,/' W file:///C:fUsers/Itrevino/cpsi/memined.cpsinet.com/u88l25/data 5/trnp__�cw5reportI19212... 4/14/2022 Page 13 of 17 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net a429- 03/21/20 03/18/20 04/30/20 21.29 0.00 0.00 21.29 A$R4g3, SUPPLIES -03T822A-,/ 03/21/20 03/18/20 04/30/20 A%24aA 11.91 0.00 0.00 11.91 SUPPLIES A83411 ,04/12/20 04/09/20 04119/20 9.25 0.00 0.00 9.25 ✓ SUPPLIES ASS417 ✓ 04/12120 04/11/20 04121120 1.50 0.00 0,00 1.50 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net P2200 POWER HARDWARE 43.95 0.00 0.00 43.95 Vendor# Vendor Name Class Pay Code P1725 PREMIER SLEEP DISORDERS CENTER ✓-' M Invoice# Comment Tran Ot Inv of Due DI: Check D Pay Gross Discount No -Pay Net 031622 04113120 04101/20 04116/20 2,225.00 0.00 0.00 2,225.00 SLEEP STUDY if 51a - 3 llr<)'Z) Vendor Totals Number Name Gross Discount No -Pay Net P1725 PREMIER SLEEP DISORDERS CENTER 2,225.00 0,00 0.00 2,225.00 Vendor# Vendor Name Class Pay Code 11932 PRESS GANEY ASSOCIATES, INC.,/ Invoice# Com/ment Tmn Dt Inv Di Due Dt Check D Pay Gross Discount No -Pay Net IND00524766 03/31/2003/31/2004/30/20 ✓ 2,523.70 0.00 0.00 2,523.70�%f CONTRACTFEES Vendor Totals Number Name Gross Discount No -Pay Net 11932 PRESS GANEY ASSOCIATES, INC, 2,523.70 0.00 0.00 2,523.70 Vendor# Vendor Name Class Pay Code 10896 QIAGEN INC Invoice# Comment Tran Ot Inv Dt Due Dt. Check D Pay Gross Discount No -Pay Net 998261363 / 04/12/2004/01/2005101/20 359.28 0.00 0.00 359.28 Vendor Totals✓ Number Name Gross Discount No -Pay Net. 10896 QIAGEN INC 35928 0.00 0.00 359.28 Vendor# Vendor Name Class Pay Code 11764 ROBERT RODRIQUEZ ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 040422 04/12/20 04/04/20 04/04/20 12.98 0.00 0.00 12.98 } REIMBURSEMENT Vendor Totals Number Name Gross Discount No -Pay Net 11764 ROBERT RODRIQUEZ 12.98 0.00 0.00 12.98 Vendor# Vendor Name Class Pay Code / 11252 RX WASTE SYSTEMS LLC ✓ Invoice# Comment Tran Dt Inv Dt Due Ot Check D, Pay Gross Discount No -Pay Net 3623 / 04/1020 04/01/20 04/26/20 60.00 0.00 0.00 f 60,00 WASTE Vendor Totals Number Name Gross Discount No -Pay Net 11252 FIX WASTE SYSTEMS LLC 60.00 0.00 0.00 60.00 Vendor# Vendor Name Class Pay Code / 10936 SIEMENS FINANCIAL SERVICES ,/ Invoice# Comment.- Tran Dt Inv Dt Due Dt. Check 0Pay Gross Discount No -Pay Net 66382200029698 ✓f 04/12/2003/30MO 04/19/20 1,333.33 0100 0.00 1,333.39r/'� LEASE tile:///C:lUserslltrevino/epsitntemnied.cpsinet.com/u88125/data 5/tmp_cw5report119212... 4/14/2022 Page 14 of 17 Vendor Total: Number Name Gross Discount No -Pay Net 10936 SIEMENS FINANCIAL SERVICES 1,333,33 0.00. 0.00. 1,333.33 Vendor# Vendor Name Class Pay Cade S2353 SMITHS MEDICAL ASO INC Invoice# Comment Tran Dt Inv or Due or Check D Pay Gross Discount No -Pay Net 16625009 .17 04/12/20 03/25/20 04/24/20 66.82 0.00 0.00 66.82 SUPPLIES 16633943 „%- 04/12/20 04/01/20 04/12/20 265.12 0.00 0.00 265.12 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net S2353 SMITHS MEDICAL ASO INC 331.94 0.00 0.00 331.94 Vendor# Vendor Name Class Pay Code 12472 SOMETHING MORE MEDIA, INC. „i Invoice# Comment. Tran Dt Inv or Due Dt Check D Pay Gross Discount No -Pay Net 1731 / 04/13/20 04101/20 04/16/20 2,985.00 0.00 0-00 2,985.00 MARKETING Vendor Totals Number Name Gross Discount No -Pay Net 12472. SOMETHING MORE MEDIA, INC. 2,985.00 0.00 0.00 2.985.00 Vendor# Vendor Name Class Pay Code 1129(3 SOUTH TEXAS BLOOD & TISSUE CEN „// Invoice# Comment Tram Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net CM6660 ' 04/12/2003/31/2004/25/20-1,422,00. 0.00 0.00 -1,422.00 CREDIT 107021570✓ 04/12/20 03/31/20 04/26/20 10,828.OD 0.00 0.00 10,828.00 BLOOD Vendor Total: Number Name Gross Discount No -Pay Net 11296 SOUTH TEXAS BLOOD & TISSUE CEN 9,406.00 0100 0.00 9,406.00 Vendor# Vendor Name Pay Code /Class 14148 SPECTRUM HEALTH PARTNERS, LLC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not APR23MMC22/ 04101/2003/30/2004129/20 25,848.00 0.00 0100 26,848.00 CFO STAFFING (jYl(�t-1,It al "iiy+i 1 2$r 9Vy}} Vendor Totals Number Name Gross Discount No -Pay Net 14148 SPECTRUM HEALTH PARTNERS, LLC 25,848.00 0,00 0.00 25,648.00 Vendor# Vendor Name Class Pay Code S2694 STANFORD VACUUM SERVICE M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 267322 04/13/20 03/27/20 04/30/20 485.00 0.00 OAO 435.00 ✓� GREASE TRAP PUMP , Vendor Totals Number Name Gross Discount NO -Pay Net S2694 STANFORD VACUUM SERVICE 485.00 0.00 0100 485.00 Vendor# Vendor Name Class Pay Code / S3960 STERICYCLE,INC ✓ Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net 4010826404 1,/''" 04/1312D 04101/2005101120 2,662.65 0.00 0.00 2,662.55`� MEDICAL WASTE DISPOSAL Vendor Total: Number Name Gross Discount No -Pay Net S3960 STERICYCLE, INC 2,662,55 0.00 0.00 2,662.56 Vendor# Vendor Name Class Pay Code S3940 STERIS CORPORATION M Invoice# Comment Tran Dt Inv or Due Dt Check D Pay Gross Discount No -Pay Net file:///C:/Userslltrevino/cpsi/memmed.cpsinet.com/u881251data_5/tmp cw5report119212... 4/14/2022 Page 15 of 17 1 D011556 ✓ 04/13/20 04/06/20 06/03/20 83.65 0.00 0.00 83.65 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net S3940 STERIS CORPORATION 83.65 0.00 0.00 83,65 Vendor# Vendor Name Class Pay Code 10735 STRYKER SUSTAINABILITY Invoice# Comment Tran Of Inv of Due Of Check D Pay Gross DIscount No -Pay Net 4324794 ✓F04/14/20 12/07120 01/06/20 -507.15 0.00 0.00 -507.15� CREDIT 40814 4348776 / 04/14120 01114/20 02/13120 3,049.07 0.00 0.00 3,049.07 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Not 10735 STRYKER SUSTAINABILITY 2,541.92 0.00 0.00 2,541.92 Vendor# Vendor Name Class Pay Code j' T2539 T-SYSTEM, INC ✓ W Invoice# Comment Tran of Inv of Due of Check D Pay Gross Discount No -Pay Net _ 711874 03/31/2003131/20 D4/30/20 6,130.42 0.00 .0.00 6,130.42 ✓' ER PHYSICIAN/NURSErrRACK Vendor TotalsNumber Name Gross Discount No -Pay Net T2539 T-SYSTEM, INC 6,130.42 0.00 0.00 6,130.42 Vendor# Vendor Name Class Pay Code T2204 TEXAS MUTUAL INSURANCE CO ,/� W Invoice# Comment Tran of Inv Of Due of Check D Pay Gross Discount ND -Pay Nat 1003575107E 04/12/20 04/01/20 04/21/20 4,067.00 0.00 0.00 4,067.00 f! WRK COMP INS Vendor Totals Number Name Gross Discount No -Pay Net T2204 TEXAS MUTUAL INSURANCE CO 4,067.00 D.00 0.00 4,067.00 Vendor# Vendor Name Class Pay Code 11039 THEBRATTONFIRM Invoice# Comment Tran Of Inv of Due Of Check O Pay Gross Discount No -Pay Net 040722 04/12/20 04/07/20 04/07/20 85.98 0.00 0.00 85.96 SERVICE Vendor Totals Number Name Gross Discount No -Pay Net 11039 THE BRATTON FIRM 85.96 0.00 0.00 85.96 Vendor# Vendor Name Class Pay Code 11908 TMSSOUTH,./f Invoice# Comment Tran Dt Inv Dt Due of Check D Pay Gross Discount No -Pay Net INV42907 / 03/3D/2003/23/2004/29/20 359.20 0.00 0.00 359.20 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11908 TMS SOUTH 359.20 0.00 0.00 359.20 Vendor# Vendor Name Class Pay Code 11067 TRIZETTO PROVIDER SOLUTIONS Invoice# Comment Tran of Inv of Due of Check D Pay Gross Discount No -Pay Net 35FK04220D,/ 04112120 04/01120 04/26120 1,682.62 0.00 0.00 11682,62 PATIENT STATEMENTS Vendor Totals Number Name Gross Discount No -Pay Net 11067 TRIZETTO PROVIDER SOLUTIONS 1,682.82 0.00 0.00 1,682.62 Vendor# Vendor Name Class Pay Cede U1064 UNIFIRST HOLDINGS INC r''! Invoice# Comment Tran of Inv of Due Dt Check D' Pay Gross Discount No -Pay Net file:///C:/Users/Itrevino/opsi/inemmed.cpsinet.com/u88125/data 5/tmp___qw5report119212... 4/14/2022 Page 16 of 17 8400391151 „! 03/29/20 03/28/20 04/29/20 2.262.99 0.00 0.00 2,262.99y/ LAUNDRY 8400391128 ✓ 03/29/20 03/28/20 04/29/20 89.82 0.00 0.00 89.82 LAUNDRY 8400391127 1// 03/29/20 03/28/20 04/29/20 45.15 0.00 0,00 45.15 LAUNDRY 6400391457 ✓/ 04/12/20 03/31/20 04/25/20 195.02 0.00 0.00 195.02 LAU DRY /100391454 04/12/20 03/31 /20 04/25/20 42.82 0.00 0.00 42,82 f LAUNDRY 840D391465 J 04112/20 03131/20 04/25120 137,15 0.00 0.00 137.15 LAUNDRY 8400391477 �J 04/72/2003/31/2004/25/20 1,937.96 0.00 0.00 1,937.96 LAUNDRY 8400391644 ,,,, 04/12/20 04/04/20 04/29/20 45.15 0.00 0.00 45.15 LAU DRY 8400391668 04/12/20 04/04/20 04/29/20 2,447.37 0.00 0.00 / 2,447.37 >/ LAU DRY 8400391646. 04/12120 04/04/20 04/20/2D 58.82 0.00 0.00 56.82 11' LAUNDRY 8400392009 ✓ 04/12/2004/07121)05/02/20 93.14 0.00 0.00 93.14 4% LAUNDRY 8400391977 ,/ 04/12/20 04/07/20 06/02/20, 170.80 0.00 0.00 170.80 LAUNDRY 8400391996 ✓/ 04/1312004/07/2005/02t20 1,853.08 0.00 0.00 1,853.08 LAUNDRY 8400391975 „% 04/13/20 04/07/20 05/02/20 42.82 0.00 0.00 42.82 LAUNDRY 8400391991 L,% 04/13/20 04/07120 05/02120 64.70 0.00 0.00 64.70 LAUNDRY 8400391979 ✓ 04/13/20 04/07/20 05/02/20 199.32 0100 0.00 199.32 LAUNDRY 8400391976 �' 04/13/20 04/07/20 05/02/20 198.59 0.00 0.00 198.59 LAUNDRY 8400391978 � j 04/13/20 04/07/20 05/02/20 150.46 0.00 0.00 150A6 LAUNDRY Vendor Totals Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 10,033.16 0.00 0.00 10,033.16 Vendor# Vendor Name Class Pay Code U1058 UNIFORM ADVANTAGE ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net SIV1219026ev 04/12/20 04106/20 04/21120 169.86 0.00 0.00 189.86 UNIFORMS Vendor Totals Number Name Gross Discount No -Pay Net U1066 UNIFORM ADVANTAGE 189.86 0.00 0.00 189.86 Vendor# Vendor Name Class Pay Code 12208 WAGEWORKS ,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check 0, Pay Gross Discount No -Pay Net 0322DR46779 ✓/ 04/12/20 03/31/20 04101/20 155.52 0.00 0.00 155.52 C0BRA Vendor Totals Number Name Gross Discount No -Pay Net file:///C:/Users/Itrevino/cpsi/memmed.cpsinet,com/u88125/data_5/tmp_cw5report119212... 4/ 14/2022 Page 17 of 17 12208 WAGEWORKS 155.52 0.00 0.00 Vendor# Vendor Name Class Pay Cade 10793 WAGEWORKS, INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 041122 04/13/20 04/11/20 04/30/20 3,487.43 0.00 0.00 PAYROLL DEDUCTS Vendor Total*Number Name Gross Discount No -Pay 10793 WAGEWORKS, INC. 3,487.43 0.00 0.00 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC ✓ / Invoice# DoTment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 9111139246AJ 04/14/20 04/04/20 04/20/20 8,555.12 0.00 0.00 SUPPLIES Vendor Total* Number Name Gross Discount No -Pay 11110 WERFEN USA LLC 8,555.12 0.00 0.00 Vendor# Vendor Name / Class Pay Code 11580 WILLIAM CROWLEY III, DO Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 040422 04/13/20 04/04/20 04/04/20 254.01 0.00 0.00 REFUND Vendor Total* Number Name Gross Discount No -Pay 11580 WILLIAM CROWLEY III, DO 254.01 0.00 0.00 Report Summary Grand Totals: Grass Discount No -Pay 452,803.65 0.00 0.00 APPROMON APR 18 2022 Coo N OUNry. TEXAS 155.52 Net 3,487,43 Net 3,487.43 Net 8,555.12 Net 8,555.12 Net 254.01 Net 254.01 Net 462,803,65 file:!//C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmpicw5report 119212... 4/14/2022 MSKESSON A8 ° 09ns/zezz Page: oez prapw amv ro your r STATEMENT aO ,m eo ouni, much mlum this stub with your reminisces aw,wm ea00 DC: 8115 As of: 04/15/2022 Page: 002 MEMORIAL MEDICAL CENTER AMT DUE RBAITI'ED VIA ACH D®Il Too.,: Mail to: Camp: 8000 AP Slntament for inlormallnn only AMT DUE REfv11TTED VIA ACM DEBIT Statement for intonation only N 1A 779REET 536 Customer. 63222 AVACVIRGI IC PORT IAVACA T% A919 PO pate: 04/tfi/2022 Cust: 632536 PLEASE CHECK ANY Date: 04/16/2022 R93S NOT PAID (�) DellDuo pMe pate ational Account 6 Receivable Numbx Rafemlma Desctlpli0n Discount Disc Amount P (gorse) F i Amount P Numberbb (reN F Number PF column latent: P = Pall Don Item, F e FIAUm 0. Item, blank = Concert Due Item TOTAL Nathaniel Acat 632636 MWORIAL MEDICAL CEt9TBt Sublatals: 9.083.24 USD Futum Due: o.OD Of Paid By 09/19I2022, Post Due: 9.49- Pay This Amount: 8.901.37 USD Last Rumored 2.451.97 If Paid After 0411912022, O6/07/2Ut7 Pay this Amaum: 9.083.24 USD 6, 178.81 258.411 = 1rtW7 -6G 5'/6.36 8., 90 1 3.'I a: APPROVF.DON APR 18 2022 BY CourftV Auotj� CALHOUN court w.7HNts For AR Inquiries please contact 800-867-0333 One If Pala On Time: USD 8,901.37 Ohio load 8 paid Ate: 181.8] 0. If Iaw tote: USD 9.083.24 / A n n � 1 ` MWESSON t:umpany_ tlY01I WALMART t098/MEM MED PHS MEMORIAL MEDICAL CENTER VICKY VALISE( 815 N VIRGINIA ST PORT IAVACA TX 77979 STATEMENT As o/: 04/15/2922 Page: Our To annual Winter c3ed8 to year xownl, dmaell and return Ibis stub w8h your rem8tence DC: 6115 As at: 04/1512022 Page:000 001 Mall te: Comp: 8 AMT DUE REMITTED VIA qCH DEBIT Territory: 400 Slelmnenl for InfarmatlOn only ANT DUE REhIITTEDform VIA DEBIT CuCustomer.inlarm256392 Statement tar anion OmyOIy Dale: 04/16/2022 Coal: 256342 PLEASE CHECK ANY Dale: 04/16/2022 ITWS NOT PAID (1) --- etlsnnl Account qpjv� 6 -- BilUn9 Dale Dat Dale Receivable Number Ofad�rS Ralerellca Description Cash, Dimmed Amount P (9.) F Amount (all) P F Rereiyabb Number Customer Number 256342 WALMARr 1096/M194 MED M. 04/11/2022 G411912022 7335461735 29773942 115lnvoice 11.54 576A3 565.29✓ 7335461735 04/11/2022 04I1912022 7335461736 29824555 1151nvolca 5.80 2.89.91 284.11./ 7335461730 04111/2022 04/19/2022 7335686421 04D8220738 1951nvoice 10.16 508.01 497.05✓ 7335666421 0411212022 04/19/2022 7335826267 80063782 11 Shoaice 14.11 705.45 691.34/ 7335826267 0411212022 04119)2022 733582626E 30063782 1Ishotiice 23.67 1,183.50 1,159.83✓ 7335826268 04/12/2022 04/19/2022 7335820269 30073320 1151nveise 0.02 0.95 0.93/ 7335826269 04/12/2022 04/19/2022 7335967049 0411221012 11 Slnvalce 0.03 1.58 1.55" 7335967049 04/13/2022 04/19/2022 7336064757 30137234 1151nvoice 16.00 848.82 831.64/ 7336064757 04/1W2022 04/19/2022 7336202774 0412220847 1951nvalc0 3.36 16B.13 164.77 ✓ 7336202774 04/13/2022 04/19/2022 7336202775 D419220850 11 SInvotco 0.84 42.11 41.27 / 7336202776 04/15/2022 04/19/2022 7336568265 30370531 11 Simonca 13.11 655.63 642.02 / 7336568205 001512022 04/19/2022 7336568288 30431364 1151nvaica 11.57 578.41 566,84 / 7336568288 0411512022 04/19/2022 7336714776 0414220826 1151mmto. 7.02 350.83 343.81/ 7336]44]]8 04116L2022 04/19/2022 73367t4777 041422OB51 1951nvoica 7.90 394.82 386.92 J 733671 d]>] PF column legend: P = Past D. Item, F = Future Due Item,. blank = Currant 0. Item TOTAb Culamer Number 266392 WAlM0.nf tOBB/M@a M® PH6 � SublMal¢ 6,304.98 USD Futam One: 0.00 If Pall By 04119/2022. Pant Due: 0.00 Pay Thin Amount: Iald Payment 7.206.08 It Red Attar 0411912022. 04/1112022 Pay are Amount: 6,178,07 USD 6.304.98 USD OW If P On Time: USD 6.178.87 Dix use B paid Isla: 126.11 0. If Asia U19: USD 0.304.98 AWROMON APR 19 2022 For AR Inquiries please contact 800-967-0333 14y00u O� CALHOUN 0 1 STATEMENT GenWnY' OOOO ' CVS PdCY 70061MWORIA PHS AMT DUE HWRJED VIA ACH DEBIT MEPAORIAL MEDICAL CENTER Statement for inlormalfon only VICKY KALISEK 815 N VIRGINIA PORT IAVACA TX 77979 As of; 04/15/2022 Page: 001 To ensure proper credit to your acee,unt, detach and return this stub with goer nm6tanee DC: 8115 As of: 04/15/2022 Page: 001 Mall to; Camp: 8000 Territory; 900 AMT DUE Hm VIA ACH D®IT m Cuale,er. 262202 Statement forr information only Data: 0411612022 Cust: 262252 PLEASE CHECK ANY Date: 0411612022 ITWS NOT PAID (r) 011irg Duo ReeeWaOlpmtanm ...on bu pu Cash Amount P Amount P Receivable Dale Date Number Reference, DescdPllon Discount (gram) F (net) F Number Customer Number 262252 CVS PHCY 700SIMMOMA MS 04/13/2022 04/19/2022 7336007204 1650006 1151nvoice 5.28 263.76 256.40✓ 7336067204 PF column legend: P = Past Due them, F = Future Due Item, blank = Current Due Item TOTAL' Cusomx Number 262252 CVS PHCY 70061MEMORIA W Subl nals: 203.76 USD Future Dam 0.00 Due D Pem On Timer It Pam By 04/19/2022, USO 258.46 Post Due: 0.00 Pay This Amount: 258.48 USD Dire lost 6 paid late: 5.28 last Payment 7,206.08 If PoId After 04/1912022, Due 0 Pom We: 04/1112022 Poy this Around: 263.76 USD USD/ 2263.76US Y 1w APPRO ON APR IS 2022 CALHOUN CCUBYGOUNTYN7 YTTp O For AR IngpiricS please Contact 800-867-0333 M5KE5$ON STATEMENT As W: 04/15/2022 Page: 001 To a ounce prop" "edK to your accound, datsch and return this club eight your ..him. r<mmm ecru DC: 8115 As ol: 09/15/2022 Pa001 Mal to: Comp:ge: 8000 HEB MY FC 4901MEM MC MS AMT DUE RE4ITTED VIA ACH DEBIT Tenftory: 400 MEMORIAL MEDICAL CENTER 51Wom.nt far informal... only AMT DUE REMITTED VIA ACH DEBIT VICKY KALISIX Customu. 464450 Statement for inlormalion only 015 N VIROINIA ST Dale: 04116/2022 PORT LAVACA TX 77979 CUM: 464450 PLEASE CHECK ANY Data: 04/16/2022 ITEMS NOT PAID (+) Oue Netlonel Amount iI?A 6 RacelvabbAmountCash A.1 P Amount P Reeelvable Oiling Data Date Number Relsrenue De"tylbn Discount — (gross) F (rat) F Number I� Custom" Number 464460 H® MY PC 498/MEM MC PNS 04/12/2022 04/19/2022 7335777434 55x439199 115fir,ft. 36.9E 1.844.16 1.007.28 7335]]]4.4 04/1W2022 04/19/2022 7335777435 55x439317 1161nvoic. 1.47 73.74 72.27✓ T335]]]435 _ 04/13/2022 04/19/2022 7336016803 55x441598 ISlnvolc. 0.0E 3.02 2.96 ✓ 7336016883 04/14/2022 04/1912022 7336287336 55x444205 1151nvoics 0.11 5.26 5.15 73362BT336 PF column Ngend: P = Pam Due Item, F = Future Due Area, blank = Cement Due Dom TOTAL. Customer Number 464450 N® MY PC 49"MFM MC PHS S.Molalc: 1.926.18 USD Future Due: 0.00 Due 11 Paid On Time: If And By 04119/2022, USD 1.887.66 Pant Due; 0.00 Pal, This Amount: 4,887.00 USD of. lost if peed ur", 38.52 Last Payment 7,206.08 If Paid Alter 04119/2022. Due If Pald Lite, 04/1 IM022 Pay this Amount: 1.926.18 USD USD 1.926.18 A'a'rRl1['. ON APR 18 2022 BY COUNTYAUbITOW. CALHOUN COUNTY, YL7fdB For AR Inquiries please Contact 800-867-0333 MWESSON STATEMENT co�n=e. eosn CVS PHCY ]4]5/MEM MC PHS AMT DUE RMITTED VIA ACH DEBIT MEMORIAL MEDICAL CENTER Statement for inlormallon only VICKY KAUSEK B15 N VIRGINIA ST FORT LAVACA TX 77979 As M: 04/15/2022 Pago: 001 To mmme paper credit to Your account, detach and retum this pus, with Your mnMance DC: 0115 As of: 04/1512022 Page: 001 Mall to: Comp: 8000 Tenths, 400 AMT DUE REMITTED VIA ACH DEBIT Statement for Inlotmalloo only Customs 835438 Dale: 04/16/2022 Cue: 835438 PLEASE CHWK ANY Data: 04/16/2022 1T6h1S NOT PAID (v) Due Neaelvable"allorel Aacounl �ibp�/T6 Cash Amount P Altmnl P =gVes 661ng Data Number 14efemnce _ Dewdpllon Discount (gms) F (rot) F Number — Cwtomer No~ 835438 CVS PNCY ]4]5/MFM MC MS 04113/2022 04/1912022 7336234703 1650182 1151nvoice MFC PR CORR OR RmiIn, Con 04/1312022 0411312022 7336285546 ]33628554] MFC PR CORR IN NuArIg Cor 0411312022 04/19/2022 PF column legend: P = Pset Ow Item, F = Future Dw Ilam. blank = Current Due Item Cuatom4r Number 835438 CVS PHCY ]4]6IMFM SuMa TOTAL: hu Future Dw: 0.00 II Peitl IN-04/18/2@2, S 49- Pat, This Amount: Net Dw. 7.206.08 II Fold After 04/1912022, LAst Payment lost, this Amount: 0411112022 11.]] 588,41 576.64,/ 7336234703 L�J 9.49- P 9.49� P ✓ 733G28554G 0.19 9.40 9.21 / ]33628564] 588,32 UST) Ow If Md On T(me: USD 676.30 576.36 USn Dien last X pre late: 11.96 Ow N Paid Lets: 588.32 USD LED 508.32 For AR Inquiries please contact 800-967-0333 NpRaVEDON APR 18 2022 CAALHODUN COUNTY, TMIJ 1 STATEMENT Statement Number: 62873259 AmensourceQergen- Date: 04-15-2022 1 of AMERISOURCEBERGEN ORUG CORP WALGREENS 10124043408 1001352841037028180 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER SUGAR LAND TX 77478.6101 1302 N VIRGINIA ST PORT LAVACA TX 77979-2509 Sal - I'd Due in l days DFA: RA0289276 866-451-9655 AMERISOURCEBERGEN P.O. Box 905223 Not Yet Due: 0.00 CHARLOTTENC 28290.5223 Cunced 2,179.99 Past Due: 0.00 Total Due 2,179.99 Account Balance: 2.179.99 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 04-11-2022 04.22-2022 308923/1436 165464 Invalce 1.951.71 0.00 1.051.711, 114-11-2022 04.22-2022 30BN72124 165510 Invoice 22.85 0.00 22.85 ' 0411.2022 04.22-2022 3HU72126 165511 1.1. 0.31 0.0 0.31 0 12-2022 04.22-2022 3089393873 105519 Imroiu: 85.70 0.00 85.711 1 413-2022 04-22-2022 3089536364 165524 Invoice 1.34 0.00 1.34 04-14.2022 04.22-2022 3089676541 165531 Imroice 34.50 0.00 34.50 ' 041-10.2022 0432-2022 W89676M lMS32 Invoice 0.09 0.00 0.09. 04-15-2022 04.22-2022 3089822753 105543 Involm B140 0,00 83,40 Current 1.15 Days - ---- 16 30 Days 31-60 Days 61-90 Days 91.120 Days Over 120 -- 1-- - - Days 2.179`99 0.00 0 00 0 60 __ 0.00 0.00 0.00 -1 k ou for Your Payment Reminders L142MY Amount / Due Date Amount (1,01992) A - / 0422-2022 2,179.00 Total Due: 2,179.99 APPRDVEUOtd APR 18 2022 t3Y OOUNW AUDrrOR CALHOUN COUNTY, TMM MEMORIAL MEDICAL CENTER PROSPEROYIANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT.-. Apol11, 2022 -ApNl 17, 2022 Date NOR Description MMC Notes 4/11/2022 PAY PLUS ACHTRANS 452579291101=692103582 Bid Party Forcer Fee 4/21/2022 TSYS/TRANSFIRST DISCOUNT 3930398254161661M - Credit Card Processor, Fee 4/11/202215VS/TMNSFIRST DISCOUNT 393009825899466110 - Credit Card Processing Fee 4/11/2U22 TSYS/TRANSNRST DISCOUNT 41399MU683976110 - Credlt Card Processing Fee 4/11/2022 TSYS/TRANSFIRST DISCOUNT 413998013323856110 . Credit Card Processing Fee 4/11/2022 TSYS/TRANSFIRST DISCOUNT 413MO13324016110 Credit Card Processing Fee 4/111W22 TSVS/TRANSFIRST DISCOUNT 413MO13323936110 Credit Card Processing Fee 4/11/M226YS/TMNSFIRSTOISCOUNT413998U33324196110 - Credit Card Processing Fee 4/11/2022 T5V5/TAANSFIRST DISCOUNT 4139MI1913376110 - Credlt Card Processing Fee 4/12/2022 PAY PLUS ACHTRANS 452579291101=692965459 3rd Pasty Payor Fee 4/12/2022 MCRESSON DRUG AUTO ACH ACHN985023910WDIM 340B Dm8 Pm8mm Expense 4/12/2022CLEARGAGE LLC CLEARGAGE, 31ID0%2MO1LIV1242 - Patient Financing SeNlce 4/13/2022 PAY PLUS ACHTRAN5452579291 101000693B41659 - Ord Party Payor Fee 4/14/2022 PAY PLUS ACHTRAN5452579291101=694819263 .3rd Part, Payor Fee 4/15/1022 PAY PLUS ACHTRAN54525792911010Q0695)64)56 - 3rd Party Payor Fee 4/15/2022 IRS USATABPYMT2202$0551063117 6103601000645 -Payroll Tases 4/35/20T2 ERPERTPAY E%PERTPAY 746(03411910110018400843 -Child Support Payment 4/15/2022E8PERTPAY EXPERTPAY 7460034119100001838)952 Child Support Payment 4/15/2022 AMERISOURCE BERG PAYMENTS 01000077682100002 - 3400 Dreg Program Expense 4/15/2022 MEMORIAL MEDICAL PAYROLL )4GW3411113122650 Paymll 4/15/2022 ISMS FONTS PYMT 052-1737276-M 410001251)16) - Credit Card Presetting Fee 4/15/2022 FONTS FONTS PYMT 052.1)435411-000410001251)265 - Credit Card Processing Fee 4/1512022 FOMS FONTS PYMT 052d743547-M 4300012512264 - Credit Card Processing Fee April 18, 2022 A.m.mr Ridlardmn Mar mql Medial Center T PyDLFt4� dy'13 22 GL. PROSPERITYBANN ELECTRONICTRANSFERS FOR OPERATING ACCOUNT— ESTIMATED AM Dog Desc ion 464ISU•76 •7+2(lc•I18 III O 014/ \ April 18, 2022 i > S 604 4 4 ! Anthony Richaldr3h4 8, 650 1 u Memorial Medical Center , APR 18 2022 & • 6 50. 1 9 AUDrrOR 0 ' 6511 • I CALHOUN COUNTY, NTY, TTOLA8 0^00 VFl NM 9"62 + c-4 Zu•6U + Amoun[ 56.84 42.9 129.00 201"S% T -095.4 1 6 3 • 1 IJ 95.48 85592 SlkoeQ "". 14:,EO . 1f 3,16fi:13 p l t,1 528:22 942.1 7.206. 1'29•OU 4. 776. 7u' 95^48 + 856^9Y + 3116W '6a'o� 5 r 16 6• 1 5 u:1 528.2f_ , 0147242q.t 335 fiO4 )2 1 1 7• 8 6 12U.08 120, 0 8 80.0m 46112 80.06 +. 464,150.76 4 0 • 02 + 6 •. 8,5.3. 4? i Wavont, 11 Uryr77�89 �CSYNS��W��4yy...' �„•�t: •-T^ T•^I Remnant 614 2U 614 211 + ''. I s 2244 A. 460^48 I07. 89 + I.228. 4i.1 - ... 8. 650^IY .. Page 1 of 1 04/14/202P MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 08:48 ap_open_invofce.lemplate Dates Through: Vendor# Vendor Name Class Pay Code 11816 ASHFORD GARDENS Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount 040622 04/13/20 04/06/20 05/06/20 16,240.00 0.00 11 TRANSFER �" I� r ij pIntJ d4{Nhl'laj, 1I" WIVE 0 �j',"��/,. 040722A 04/13/20 04/07/20 05/06/20 194,346:00 0.00 PHASE 4 ARP RURAL PAYMEP 040722 04/13120. 04/07/20 05/06/20 6,039.32 0.00 TRANFER Nil?W-WM 04 Vendor Total; Number Name Gross Discount 11816 ASHFORD GARDENS 216,625.32 0.00 Report Summary Grand Totals: Gross Discount No -Pay 216,625.32 0.00 0.00 OY COUNTY AUDITOR CALHOUN COUNTY, TE> S No -Pay Net 0.00 16,240.00 0100 194,346.00 0.00 6,039.32 No -Pay Net 0.00 216,625.32 Net 216,625,32 file:///C:/Userslitrevinolepsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report684043... 4/14/2022 MEMORIAL M ED ICAL CENTER ARP RURAL PAYMENTS WEIGHTED ARP iOR URBAN DISTRIBUTION. ALLOCATED PROVIDERNO. CNY 21P CODE COUNTY RURAL/URBAN ��TOT�DAYS (o.nj OR %-MEDICAID ARP RURAL A11RAI(int DAYS PAYMENTS ASHFORD HOUSTON ]]0)6 HARRIS URBAN 202 30,]83 34,565 ],6% 14A8% ' 394j346 D0.0ADM00R THE WDODIANpS ]]389 HARRIS URBAN 112 11,667 25,A7 2,917 5. 0% 73;654 CRESCENT SUGAR IAND 77478 FORT BEND URBAN 112 9,009 20,668 2,252 4.33% 56,874 FnRTRFNII ol1C[unuo,: -,"non ener aeon ......... Page 1 of 1 04/1412022 MEMORIAL MEDICAL CENTER 0 AP Open Invoice List 08:51 ap_open_Invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11028 SOLERA WEST HOUSTON Invoice# Comment Tren Dt Inv Dt Due Dt Check D Pay Gross Discount 040722 04/13/20 04/07/20 05/06/20 59,374.00 0,00 PHASE 4 ARP RURAL PMT 040722A 04/13/20 04/07/20 05/06/20 2,404.22 0.00 FEB UHC QIPP Vendor Total: Number Name Gross Discount 11828 SOLERA WEST HOUSTON 61,778.22 0.00 Report Summary Grand Totals: Gross Discount No -Pay 61,778.22 0.00 0.00 CALHOUN Cp " �3 No -Pay Net 0.00 59,374.00 0.00 2,404.22 No -Pay Net 0.00 61,778.22 Net 61,778.22 file:///C:lUserslitrevinolcpsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5report452423... 4/14/2022 MEMORIAL MEDICAL CENTER ARP RURAL PAYMENTS WEIGHTED ARP PROVIDER NO, CITY 21PCODE COUNTY RURAL/URBAN BEDS MEDICAID DAYS TOTAl0AY5 FORURRAN I ALLOCATED DISTRIBUTION- ARPRURAL (0.25)0R %-MEDICAID RURAL I1.01 PAYMENTS GAYS ASHFORD HOU90N 77076 HARRIS URBAN 202 30,785 34,565 7,695 14J8%1 BROADMOOR THE WOODIANDS TT389 HARRIS URBAN 112 11,667 25,737 2,917 5.60%� CRESCENT SUGAR LAND 77478 FORTBEND URBAN 112 91m 2D,668 2,252 4.33% FORT BEND ROSENBURG 07471 FORT REND URBAN 56 9,984 14,544 2A96 4.79%, Page 1 of 1 MEMORIAL MEDICAL CENTER 04/14/2022 0 08:47 AP Open Invoice List ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11820 FORTBEND HEALTHCARE CENTER Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount 040722 04/10/20 04/07/20 05/06/20 63.029.00 0.00 TRANSFER Vhalt.4 ftp P4"1 pgpm- 040722A 04/1 MO 04/07/20 05/06/20 2,473.46 0.00 TRANSFER &IPP .-Njf p{ ol, Vendor TotalsNumber Name Gross Discount 11820 FORTBEND HEALTHCARE CENTER 65,602.46 OAO Report Summary Grand Totals: Gross Discount No -Pay 65,502.46 0.00 0.00 O�CO COUNTY, TEXAS No -Pay Net / 0.00 63,029.00 ✓ 0.00 2,473.46 y/ No -Pay Net 0.00 65,502,46 Net 65.502.46 file:///C:/Userslltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report565093... 4/ 14/2022 MEMORIAL MEOICAL CENTER ARP RURAL PAYMENTS WEIGHTED ARP ALLOCATED PROVIDER NO. CITY 21P CODE COUNTY RURAL/URBAN BEDS MEDICAID DgYS TOTgLOgYS FOR UREA 0151RIBUTION- ARP RURAL URALOR %-MEDICAID PAYMENTS RURAL 1.D DAY$ ASHFORD HOUSTON 77076 HARRIS URBAN 202 30,)85 34,565 7,696 14A8%l " 1943g6 BROADMOOR THE WOODLANDS ))389 HARRIS URBAN 112 CRESCENT 11,fi6) 25,737 21917 S.fiO%' 93,654 SUGARM,ND )T4)B FORT BEND URBAN 112 9,009 20,668 2,252 4.33% 56.814 FpRTAFNII -�.. enccueiiu� •ter. �. .._ Page 1 of 1 MEMORIAL MEDICAL CENTER 04/14/2022 0 AP Open Invoice List 06:46 ap_open_involce.template Dates Through: Vendor# Vendor Name Class Pay Code 11832 BROADMOOR AT CREEKSIDE PARK , Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 040722A 04/07/20 04/07/20 05/06/20 2,525.39 0.00 0.00 FEB UHC QIPP PMT 040722 04/13/20 04/07/20 05/06/20 73,654.00 0.00 0.00 TRANSFER POASe to H'gpW.wt.i Vendor TotaleNumber Name Gross Discount No -Pay 11832 BROADMOOR AT CREEKSIDE PARK 76,179.39 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 76,179.39 0.00 0.00 P Net 2,525.39 ✓/ 73,654.00 ✓ Net 76.179.39 Net 76,179.39 file:///C:lUsers/ltrevinolepsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5 report903016... 4/14/2022 MEMORIAL MEDICAL CENTER ARPRURALPAYMENTS ASXFORO BROAOMOOR CRESCENT FORTSEND WEIGHTED ARP PROVIDER NO. CITY Z"CODE COUNTY AURAL/URBAN BFOS MEDIUJO DAYS T0TAL OAYS FORURBAN DISTRIBUTION. ALLORITED (D25(OR %-MEOICAID ARP RURAL RURAUl(R AYMEWS HOUSTON nO76 HARRLS THE WOODLANDS SUGARLAND ROSENBURG nabs 11498 n491 HARRIS FORT BEND GIIRT RCNII URBAN URBAN 202 112 172 30,785 11,669 9,1108 34565 25,737 20,668 T,fi96 2,91] 2,252 14.78%, 516M 433% 194.346 Page I of 1 04/1412022 08:51 Vendor# Vendor Name 11824 THE CRESCENT MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: Class Pay Code 0 ap_open_invoice.template Invoice# Comment Tran Ot Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net / 11824 04/07/20 04/07/20 05/06/20 66,874.00 0.00 0.00 56.874.00 r/ PHASE 4 ARP RURAL PMT 040522 04/13/20 04/05/20 05/06/20 4,410.32 0.00 0.00 4,410.32 TRANSFER W" j ASueRt'U:L p!0Kj Japjy t1a jkkv V 1011 040722A 04/1312004/07/2005/06120 1-,990.65 0.00 u0.00 1,990,65 TRANFER N lA v,,yfivrK 0 f (?lye 040722 04/13/20 04/07/20 05/06/20 380.00 0.00 0.00 380.o0 t„,,, TRANSFER tl 11 Vendor Totals Number Name Gross Discount No -Pay Net 11824 THE CRESCENT 63,654.97 0.00 0.00 63,654.97 Report Summary Grand Totals: Gross Discount No -Pay Net 63,654.97 0,00 0.00 63,654.97 APR 18 2022 8Y COUN7Y AUD1 TOR CALHOUN COUNTY, TEXAS file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88l25/data 5/tmp_ew5report681529... 4/ 14/2022 MEMORIAL MEDICAL CENTER ARPRURALPAYMENTS ASHfORO BROADMOOR CRESCENT FORT BEND WEIGHTED ARP PROVIDER NO. OLY 21PCODE COUNTY RURAL/URBAN OEM MEDICAIDOAYS TOTALOAYS FOR URBAN DISTRIBUTION- ALLOCATED (0.25)OR %-MEUICAIO ARP RURAL RURAL 10 DAYS PAYMENI5 w,iss 34,565 2,696 14.79%' THEWO LDLANDS 27389 HARRIS URBAN 112 11,662 25,737 2,912 5.60% SUGAR LAND 72478 FORTBEND URBAN 112 9,009 WASO 2,252 4,33% ROSENBURG 27421 FORTBEND URBAN 56 9,984 14.544 2,496 4.79% Page 1 of I jSIN owwUDITOR ON Ao�1JA4022 MEMORIAL MEDICAL CENTER AP Open Invoice List 0 .,�0&:,54 _ ap_open_invoice.template f5pt,i'tFX3UNfY M(Ag Dates Through: Vendor# Vendor Name / Class Pay Code 11836 GOLDENCREEK HEALTHCARE ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 040422 04/13/20 04/04/20 05/06/20 486.56 0.00 0.00 486.56 ✓ TRANSFER N t iftilitAt - PyWLj- AC(loyi}cj jnh Wgxj, Upt.n,-h 040722A 04/13/20 04/07/20 05/06l20 3,788.85 D.00 0.06 3,788.85 r/ TRANSFER- Nip }VjjW%_ Of GJW 040722 04/1312004/07/2005/06/20. 433,124.00 0.00 0.00 433,124.00� PHASE 4 ARP RURAL PAYMEP Vendor Total: Number Name Gross Discount No -Pay Net 11636 GOLDENCREEK HEALTHCARE 437,399.41 0.00 0.00 437,399,41 Report Summary Grand Totals: Gross Discount No -Pay Net 437,399.41 0.00 0.00 437,399.41 �{ � APPROWUON APR 1$ 2022 Cq"L OOUN C UWV, W8 file:///C:/Users/ltrevino/cpsi/memmed. cpsinet.com/u88125/data_5/tmp_cw5report5 80713... 4/14/2022 MEMORIAL MEDICAL CENRER ARP RURALPAYMEM$ - Page 1 of 1 MEMORIAL MEDICAL CENTER 04/14/2022 p AP Open Invoice List 08:50 ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 12696 GULF POINTE PLAZA Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 040422 0'4`/07/20 04/04/20 05/06/20 13,542.69 0.00 0.00 TRANSFER � 'kvxw IL4. ew r11!)� 1j. 3V ih'fJ MML vt"k,*y 040722 04107/20 04/07/20 06/06/20 1 $3,313.00 0.00 10.00 PHASE 4 ARP RURAL PMT 040522 04/13/20 04/05/20 05/06/20 17.562.09 0.00 0.00 TRANSFER to tr 040622 04/13/20 04/06/20 05/06/20 6,262.10 0.00 0.00 TRANSFER tt It 040722A 04/13/20 04/07/20 05/06/20 1.662.88 0.00 0.00 FES UHC OIPP PMT 040822 04/13/20 04/08120 05/06/20 2,124.22 0.00 0.00 TRANSFER k tl Vendor TotalE Number Name Gross Discount No -Pay 12696 GULF POINTE PLAZA 124,476.98 0.00 0.00 Grand Totals: BY COUNTY AUDITOR CALHOUN COUNTY, TMM Report Summery Gross Discount 124,476.98 0.00 Net // 13,542.69 ✓ 83,313.00 17582.09 6.252.10 1,662.88 2,124.22 Net 124,476.98 No -Pay Net 0.00 124,476.98 file:///C:/Users(ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report207573... 4/14/2022 MEMORIAL MEDICAL CENTER ARP AURAL PAYMENTS Page 1 of 1 MEMORIAL MEDICAL CENTER 04/14/2022 0 AP Open Invoice List 08:52 ap_open_Invoice.template Dates Through: Vendor# Vendor Name Class Pay Cade 13004 TUSCANY VILLAGE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net / 040522 04/13/20 D4/05/20 05/06/20 10,868,47 0.00 0.00 10,868.47 ✓ TRANSFER h/N jVj&u"Lf, pvbr&i Jtpooi1a jn-b MW4- q1,{5�_}iy�x_ 040622 04/13/20 04/06/20 05/06/20 9,272.01 0.00 1A.00 9,272.01 TRANSFER tt rI 040722A 04/13/20 04/07/20 05/06/20 3,563.99 0.00 0.00 / 3,563.99 ✓ + FES UHC QUIPP PMT 040722B 04/13/20 04/07/20 05/06/20 13,298.00 0.00 0.00 13,298.00 TRANSFER tt 1t . 040722 04/13/20 04/07/20 05/06/20 100,484.00 0.00 0.00 100,484.00 PHASE 4 ARP RURAL PMT l 040822 04/13/20 04/08/20 05/06/20 1,756.00 0.00 0.00 1,756.00 ✓/ TRANSFER I< it 040822A 04/13/20 04/08/20 05106/20 1,941.40 0.00 0.00 1,941.40 v' TRANSFER 1. 11 Vendor Total; Number Name Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 141,183.87 0.00 0.00 141,183.87 Report Summary Grand Totals: Gross Discount No -Pay Net 141,183.87 0.00 0.00 141,183.87 APR 18 2022 eY IDOUIRY AUorroR CALHOUN OGUNiV, TMS file:///C:/Userslitrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report889819... 4/ 14/2022 MEMDRIAL MEDICAL CENTER ARPRDMLPAYMENTS Page 1 of I 4/14/2022 MEMORIAL MEDICAL CENTER 0AP Open Invoice List 04/14 Dates Through: 0 ap_open invoice.template Vendor# Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net j 040622 04/13120 04/06/20 05/06/20 1,127.08 0.00 0.00 1,127.08J TRANSFER N� jftVkM1(L Mwll &Vj] j+ra 0-1 IlAilll 111XII, 1Y 040722 04/13/2004/07/2005106/20 243,657.00 0.00 0.00 243,057.00 PHASE 4 ARE RURAL PMT Vendor Total; Number Name Gross Discount No -Pay Net 12792 BETHANY SENIOR LIVING 244,784.08 0.00 0.00 244,784.08 Report Summary Grand Totals: Gross Discount No -Pay Net 244,784,08 0.00 0.00 244,784.08 is .,�. 'u �: APR 18 20Z2 By COUWY AUDMOR CALHOUN COUNTY, TOM file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report626098... 4/14/2022 MEMORIAL MEDICAL CENTER ARPRURALPAYMENTS PROVIDERNO. CRY ZIPCODE I COUNTY BEDS (MEDICAID DAVSI TOTAL DAYS I n�i0i351QN DIVRIBUrON. ALLOCATED ICAID I PARP RURAL AYMENTS Facility 10 Facility Name Total UHC Deposits 4811 Ashford 61,065.94 105818 Broadmoor 25,338.10 105314 Crescent 20,252.70 4628 Fort Bend 24,749.56 105006 Solaro 24,022.54 102W Golden Creek 38,107.75 100806 Gulf Pointe 16,800.11 103462 Tuscany 35,862.58 Bethany Total UHC Desosit 246,199,28 MNIC PORTION QIPP/COmP1 QIPP/Comp 2 QIPP/ComP3 QIPP/Comp4$ Lapse QIPPTI NH PORTION 48,987.30 12,078.64 55,026.620 6,039.320 20,287.32 5,050.78 22,812.710 2,525.390 16,271.40 3,981.30 18,262.030 1,990.650 19,802.64 4,946.92 22,276.200 2,473.460 19,214.10 4,808,44 21,618.320 2,404.220 30,530.06 7,577.69 34,318.905 3,788.845 13,474.34 3,325.77 15,137.225 1,662885 28,734.60 7,127.98 32,298.590 3,563.990 197,301.76 48,897.52 221,750.32 24,448.76 �.0 DS p6xRQ 11'@0�NT0 MM,CpF,PsIIgTING NEEDMIS$�F, sYME TS.Ty.0+INL��I 7G�NQM6 Itllq' �11gZlf?ftEQUE5T3 fi0f}EAC+�H)�N, U�iSING N0W1E FOR HIGHUffGFri'FEDYEL' ai pOt`t,TB FEB QIPP W IPP 61,065.94 25,338.10 20,252.70 24,749.56 24,022.54 38,107.75 16,800.11 35,862.58 246,199.28 fh05r. Y fflLF KIwAt Erica Perez From: mmartinez@mmcportlavaca.com (Mayra Martinez) <mmartinez@mmcportlavam.com> Sent: Monday, April 18, 202210:30 AM To: Erica Perez Subject: RE: Rural Payments 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 morning Erica, Last year MMC along with the nursing homes applied for a provider relief funds grand and were approved for the funds. The check request that were sent out is to give the nursing home their portion of the grant. Thank you, Mayra.MartUl,ek Memorial Medical Center Accountant 815 N Virginia. St Port Lavaca, TX 77979 Phone: 361.552.0450 Fax: 361.551.4504 From: Erica Perez[mailto:Erica.Perez@calhouncotx.org] Sent: Monday, April 18, 202210:17 AM To: Mayra Martinez <mmartinez@mmcportlavaca.cmn> Subject: Rural Payments CAUTION: This email originatecilrom outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Hi Mayra, Request for Transfer of Funds TamwrI omxw::uue anxllorz va3<r xm�u. CVAU2MIUU Bque:too 4: Ulan, WPP[a wR.eamrsem,ll ,vp<,�.x:rm..n>,nhs9 - PPmR.r 99fnze,lz UYinnu Uvnl] Momorwlmall. Unwr (mllry c.N<n wueY EylptHse. Wree4s�.L 1 N a rvdatv..m amwxe3a.m..r.nm.:..:r Eem mggMEMI 13,)0ZA1 ara.:r..w.e wwM>ruer OppLm L}N3Uil [R435]569 FR63515U CVUfrPLWOlU69 5 3.AIA1 Uue zo calaen oxk nom ]M brwamwr }hLIUE) FR6}5914] $ 1&IB]A3 FRfi153]U NUMC[W14U S 0.]BlAI o.To ove w cmae:: m,k Hour ]Io a rwam..r }/}0/]U3] It,].VJ ERU61313 CVUa00IXO1Ub9 $ 1WW Pv,wcnerr: w..k hour m.er9,am..r to It. CrttYf ]/I3/iUR FR6E5530S W.1,11 Ei16I y53M CVUPxWUO]6069 f 399,32 Toll to co lam [m 41rom IDe Burr amour Lz6/zou E16)4666) s 376246662 CoDAR30012MVI 9 s ...e 6Pwe. w<ez Imm mm... em Pm runt 19 xGEl EF16E02039 f I1I.95ZeZ F9I6I9ZON OMMMZN69 5 1)AS}8E ooew6Pwmcwn uom]xe awaam.or 3/31/zOxZ Ff]62113625 Ito,,561 ER6]U6}3 N0.NWWS6p69 $ 153.56 To.1. Oue ceyenweek Uomll:e Broremmr Creew (OIRI S 36AEI I) $ 1.2 To ODU.e lot W Memorial MaewN4ntm Rpprweeh): AVRAM<RTIN' m OMolbaa) 3W3 km 9ltll"xY; BMpMGpp... ToptllK cOWFN. ffR' Mwmk-x6pII.31:. n)mmw.: X"a"C" T.mawR:p„uNinnrnwun'. �,,..,9�R3�uE� lw: rohW APR 18 eRie +C&MM,R� exnfs Request for Transfer of Funds TNMlerp: Date Requested Fe" R[gY[MJb(. R[queitolf !mall Repu[al[lepRone numhea oNeNNoauunry fanllN pNenl N.me p.teelServYe N rypeMhvmenl M... !u[Ja F1p0.nMY1 3g_9QDy.@ A N/A N/A 3/23/2022 EET S$25". bWRDDQO 5) SM9] MF CRESEN2 N/A N/A 33320E fF2 $3m.,. W6ID61E4 EFT62I75958M. UDARN000000nm? 139.16 CAESMT a A 3/241202E Efi $2" E"U"02R NOAROW)1956) 362.69 Me Me CRESENT WA N/A NA 32420E EFT CVOAROWl196A 2N.34 ME[RESENT N/P N/P 3/34/IDEI EFT SB20.E5 976,68 E"Q890) fF26E89056 LVOMOWl19S2 938.39 INF [XESMI TMA\ 3AD984 I144N.9) Tobefllleeoulh Mem MMedlul CeMen D.N Rett a " A M..dhm ..AMAI NQ OaN4ltnnahn 4 20 202E FmmhfllNy. A...iAr$.T17- lhy: 'C INI AmeunL :IA4B;97 n•wnnaen.�m.D.Nm: Dateor Vanger. Ffam Faelliq: h nRh: �Tf— • ,T �� Amount - •fY APR 1$ 2022 6YCOUMYAUDITOR CALHOUN COUNW. IENAS Request for Transfer of Funds n.mfarI Del<Reque:led 01MO)3 P., RoAtas CeDARO9.'p19557 Requeped6): CMNne Heppe, R<W<etW'iemall (M(t i H_.ionHeekh.[Qm Pequ<etiee ... nombee 903d3241112 Obta..'Ceu., Memorim Mettle] Center Fatlllry Gold -Cook %NpMMnv FO DJtllolLrybe REp NM 2/26/2@2 Tvee of Pavme v.:nr<"e $ 13.]ol.Nl Nu 1 ![tleneeMe6Porx NNaIAm Nnlrl<I aptg5 f25]599 FT6 Efi635J599 WOARCC6019557 5 1702.0 Nola GoldloCmkfuen fire Ueunt 3/3L2D22 EPS253162 5 8.787A1 EFI6253762 C RG0W1955) 5 R.797A1 Due la Gotten Creek It, be Me C,.utr, 2 2R/2022 ER6261331 5 (36i0p] IM261333 LYDAROWR1955) $ 36i.W Ouem Ooden CreeY tram The Cratent 3 0. ER62553W 5 (399,521 FM2553D5 CV"AM19557 5 T. Due la 6oden Creek tram The Crettnl 111W2022 IM24 02 5 (59M FFI629W62 CVDAROD]2nw E 59.89 Duero Golden Creek Sewn The Crettnl 3/13/21122 EW6212036 $ 12.4!1222( EM2820M ry0Afl0.W19557 5 12,452,82 We to GoldM Creek lmm]he G,veient 3/21/IDJ2 EFT6253623 5 1253.561 EF%283623 ryWR0Wpt955] 5 253.56 Duero Got. Crmkbom lire Creature TOTAL $ (2GO22R)I 5 i6,022.2) ried!bMemlal book,coGMA MARDNa. [A,� umaE Mift :t 2 2217 ,)elrMtl, IIISt APPROMON APR 1$ 2022 BYCOUMYAUDITOR CAIHOUN COUNTY TEXAS Request for Transfer of Funds i,.mlm R: Daze Rpumea xx/x/zozx CVWn.n.170 putter Rouuas Rpunbe W. ca4lnaxewn veeuesmisemall Clr000n®xmm�MeauL eam RpuntNspM1ene number 9o3A724412 dNlnor.-, Memmhl Mellaal[entw Fadtity Golden C:aek ApW rr3aLCiuer Paalma Ham ` Dame r 3p6v41siunM,$j FO UIRMu F RIRODS LQMpmn rM1ftmunm um4n Ovl 0 r brol X noe m Guaen ernpk aom scut. wan U24/2033 EF3635]509 $ 13.]020) ti Un]509 C WoDN1017p $ I.A7 Xoualon Ouebealden4ee41mm Sclera Wnl UEU1032 fR6253M3 5 10,)01411 EFi6E53762 CVIIRAWW18170 $ BJBIAI Neualmr Dam Sclera Wan USB/IDSI FW4261333 $ 13fi)00 EFT636I3H CVMROMOxp ]ap $ 36ron HousOGaWenfreet Houston ubGOltlen Cmeklmm 3ole,aWn[ 2/23/3p23 [Ei6E55305 $ 1M9.521 Fiifix55305 CVMWOLU O{01)0 $ 399.9$ Houston to Dun W Dun to men emakpam min. wnl UI4/1032 Ffi6H6663 $ 59.89 EW0Eg666E [VOMWW101]II $ $9.09so 1.n . pun la GnlEen frepkon. 9olura on 10/303x EFi630x03a I $ I11A530x1 FFi620201q [VMRCgN101)0 $ 12,021.2 Huston. pueb4oMen [r0@Oem Satin Weai 3/$U10E3 Ef16x036$3 $ 135356f ER6E83613 CVOflROpq" l0l]0 $ x53.X Houplan TMAL $ 1E6.D22.2) $ 34,022.27 0 Memmlal "Holnl U2 Or: TOEe "Mod 2: T2 be"e o nee Y a 1 zpxx M1NYRR mbpnramm: pn Dom Fannb:APPROVEDGH Fatl01Y �G OXCflF[ - Ar NnOYnF. ,36.oEE:I npuaM nvmk.OereML Dale --I_ r: APR 18 2022 pmm w1hy: BY COUMY AUDITOF CAI HOUN COUNTY, TEW FORT BEND TRANSFER REQUEST PAYEE Memorial Medical Center Clinic Date Requested: 04/18/2022 APR 18 2022 BY COUNTY AUDITOR CALHOUN COUNTY, Tm " AMOUNT $35.65 G/L NUMBER: EXPLANATION: TO TRANSFER PAYMENT THAT BELONGS TO MM CLINIC REQUESTED BY: Mavre Martinez AUTHORIZED BY: 815 N Virginia, St Port Lavaca, TX 77979 Ph:361.552.0272 From: Simms, Tracy M. <TSimms0cantexcc.com> Sent: Tuesday, April 12, 2022 10:43 AM To: Caitlin Clevenger <cclevenaer@mmcoortlavaca.com>; Miller, Sara <smillerC@cantexcc.com> Subject: Re: deposit 4.8.22 CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you I recognize the sender and know the content is safe. Caitlin, The$,` OiOayment does not belong togofteBend or any of our facilities. Can you debit the account for the $35.657 Trace Simms, Cash Manager Cantex Continuing Care Network, Where 112 arc Cnmtnitted to Excellence 2537 Golden Bear Drive Carrollton, TX 75006 Tel: 214-954-4114, x115 Fax: 214-871-3057 minunsCa cantexce.com From: Caitlin Clevenger <ccleveneerCcammc orortlavaca.com> Sent: Tuesday, April 12, 2022 10:01 AM To: Miller, Sara <smilierPcantexcc.com>; Simms, Tracy M. <TSimms@cantexcc.com> Subject: [EXTERNAL MSG] deposit 4.8.22 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. If this Is believed to be SPAM or Phishing, forward email as an attachment to iunk(aloffice365.com. This message originated from outside your organization Good morning, Please see attached support for deposit made on 4.8.22. Please let me know if you have any questions. Thanks! GULF POINTE-4P TRANSFER REQUEST PAYEE Bethany Date Requested: 04/18/2022 � ; M, APR 18 2022 BY COUNTY AUDrrOf{ CALHOUNU COUNTY, TWS AMOUNT $1,484.00 G/L NUMBER: EXPLANATION To transfer ECHO payment that Belongs to Bethany REQUESTED BY: Mayra Martinez AUTHORIZED BY: Mayra Martinez From: Caitlin Clevenger Sent: Tuesday, April 12, 2022 2:33 PM To: Mayra Martinez Subject: FW: MARCH CASH $828,593.01 Attachments: ROUNTREE SEPT 2021 PMT.pdf; You have a new encrypted message from mpassmore@mmcportlavaca.com Will you make a note to withholA 1b0 from RiGlf pointe&,Iv0te,pdy and write check to° ethany its for an Echo payment that was missed. Thanksl The Information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws, It is intended only for the use of the person(s) named above. If you are not the Intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the Intended recipient, please contact the sender by reply email and destroy all copies of the original message and any attachments. Caitlin Clevenger Accountant Memorial Medical Center 815 N Virginia. St Port Lavaca, TX 77979 Ph: 361,552.0272 From: Tatum Gordon <tgordon@bethany-living.com> Sent: Tuesday, April 12, 202210:57 AM To: Misty Passmore <mpassmore@mmcportlavaca.com>; Caitlin Clevenger<cclevenger@mmcportlavaca.com> Cc: Aphton Taylor cataylor@lislfamily.net>; Gabe Pallanez <gpallanez@bethany-living.com> Subject: RE: MARCH CASH $828,593.01 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. Misty was able to forward me the remit can this be processed for a wire transfer please? I need clarification because in the past any payments that MMC received for B5L the funds are transferred and a remit is provided. Did something change that I need to be pulling remits? If so I need access to ALL portals so I can do this. From: Misty Passmore <moassmoreAmmcoortlavaca.com> Sent; Tuesday, April 12, 202210:50 AM To: Tatum Gordon <tgordonCrabethanv-living com> Subject: RE: MARCH CASH $828,593.01 Good Morning, Memorial Medical Center Nursing Home UPL Weekly CaniefTransfer Prosperity Accounts 4/18/2022 Mwunl NuAdwX[me NVmbrr PnNaua a0nnlna AM M4xaMNraa h d65.59 ✓ 3I,061.1A 96,31a03 lo6ry'a BttNnNi Am, NNn[[ Ill.ml.ix Bank &Ima 111,661.33 aj' wrlann .-kshalann Man MOUNAHBOIPP 016 16,305.39 AMEWGROOP P OMP 30,425.0 AN INTINUT FOR INTEREST MR INTEREST / "just 9[I4nc.9nnd4rAmt ","Cum✓ w ,.. ,-_ 34,9>64Y D,950.681/ 91,I61.M a 90790.03 % m.103.li Rang Rabnn 90,19003 Y/ Vatlma 16aV01n 601En<6 100.00 AMERIGROUP Flow" MWNATb wPP A 13,53&85� 6.92574 MEDICARE PAYMENT OWED TO GOLDEN CRIER 28,022.27 11 02,03/ 13,151.04 ✓ eL949.W / 1w 13830.139( 7,,01530 X68E61 / ,.SAWNUMEM 37,36601 a/31.002.33 IS IAZT52 y/ 4 'I N.R. Our.... yaw 5f,0WWlbpwtlnre4la M".OANne "" E4MuttwmlA-o N—muw A'SIMAKI MMCdsrAxvII.Acn Amon[ I\NN Wnkh Tnn r ..X ...ITnn11N5ummrry]1pl2UPrinNx UlliranOnSwnmrryd.l6.xLtlq IAnIMERUT R61MTIRIST MAR INTEREST Adiva[ falum/Tramler Aml U.1W.ST % 0,593.10 / 44,360.38 Dam Balann 62,59].10 ]fr V.0. SNVf In BlRanw loam AMERIGRWPIIf WPP 10,11a.45✓ MOUNAOIPPJ'S 5,54403 MmICARERxPAYMfMTOGOU3ENCREER 26.02122/ MIOICARERMAYMENr TOMM CONIC 1,45697V EANINTIREST MINTMEST MARINTERFSr ALAIR BsUrnAramler Nnt 44,360.3E 8,311.41 0a01DIFnce 3L551.45M Ws'W O 1.... FA NAD, Inso0 AMERIGRWPFEOQIPP , IZ34156 ✓ MOUNAFfOG.IPP 4)14 6.76183 PAYMENTOEEDNOSTOMMRINIC 3%65 IAN IMERM FEE INTEREST MAR IMERUT // Adjust OalancMramfer Amt 431L46 S/ U3.191.22 881428.16 nk B Baalms. 133.191.27 f Vatlan50 - L<arE In Ylance 100.0 MfDiGREREPAYMEMTOGOIDEN MEEK 26.02.27/ MWNAfE6DIPP (�❑p y a �] �]�j APR 2022 D j4 6,563.24 1 O AMWGROUPFEOGMP I1,977.14 Y WRRIMCNIM ITOMMC C11b IW.S6 EANIInfRM few,vs, FEBINTMEST !BYCaf1OtUNtaFfYV�A�6Uf5D/r9�rEO�4/R�� CALfMi�'�WILI Ir YEW VnLf�W�� MARINTEREST edlusa BAMn«Rnnderbmt 40.42W.16 7XITALTRANUNFLai 2)0.1f3 x1 APPr' dE / wn2xoMY RICNARD30N, NTFRIMaot 9/18/2022 01NN WNYNTamNxH4n\ 9ewnlead WaN,1,N6\1033Ypr0\N110m\ DRwNRa60014]Iglu 011]]4ll •Up9MN MMCPORQON TmAHfer•Ou1 TMmIa,tn QIPP/GmPI QIPP/CaROZ QIPPICOMP3 QIPPECOm MAT o QIPPTI 1/1L/3022 MIF41490UP QflPO QR]3NRIENTEESF#N5472210x r 33,pjC97,. 1:71131.70 .. 11. - -. 30,499JA 4ryyi0tl MMIm N[Olt%XCCUIMPMT PN13144361891300 I4,94.28 4/I2/2W2 Motlna HC613 CN IMPMTPN3020NN094NO - 1i16.5] 4/12R021Amgipoup l%9CHCMIMPM331]10398W 111000 3].772,68 4/12/2021 UNCCQMMUNItt PL NCCIA1MPMt 14fi003411919W0 II0,35 4/13/302y Amnlgr... IMCHCCGIMOMT317)1030]9113000 2.123.16 4/13/2023 UNCCOMMUNIWP\HCCYIMOMT74600341191HOW I'MO.p] 4/13/2013 UMCCOMMUNIWPLHUC IMPMT746003411910000 OLD 4/L}/!N] HOM4NACNA DIM NCMIMPMT l90160420009199I - 69.04 4/14/1022 WIRE OUT ASPIRANT HEALTH CAMCEMG LID 4/14/2022 Molina HC ofIX HCCWMPMTPN1316061899200 MI39 14139 41W2022 fnNmaN Pna NiaG IOL94 - 3LO61,i1 ,/ 94,)30.1) . 2).339A0 6.6915) 30 Nfi.N N 95906 P.N 1 NHPORTION VA'm LTILLN 1.236.57 3].)3L6p 110.56 2.N1.36 2,84041 0.16 6904 4/1112011 HICI{Y NCCUIMPMIl9096I42ON0195]390001G0 4/13/2022 MANAGEMDNET1718MMP)AMNOODON000429341 4/13/2022 UNCCOMMUNO)PLHCCWMPMT74iN34I191MO 4113/2022 HUMANACHAOISBHCCUIMPMT3905614200p01997 4/11/1021 WIRE OUT GNHA WEALTH WE CENTERS III 4/14/1021 TERROR 4JI512022 HUMAN& INS CO HCCWM?MT 350MISUM 005571%I 4/31/I032 MM COMMUOI NCMIMPMTPMI669RG0ASN00 41111JORZ UNCCOMMLUTION QCWMP AI670G13 480NUO 4/ll/1033 HOVITAS SOLUTION HUWMPMT6]6333930000A0 4/1491T22!IM.eN011ouPmRro6W1YY11eMef52%Ne6,N }3,t00o 4/11/2022 MRPSuppp enta NC IMPM17450034131243M 4/12/9022 UNCCOMMONNV Pi. HCYUIMPMi 74OW34U 919OU 4/12/2021 HUMANA INS m HCCWMPM) INS" a3p9905AI536 4/141G23 HUMANA CHA DISK HCCIMARP1,11-3VOM 000001945 1/13/1022 MANAOGO KCCUU 1a MN GPMM00000GNMIS0959 4/13/2022 HNCUHCOMMUCCUIMPM7]I6ml4111N001139000 411412022 WINE OMMUMITP HEALTH M CENTERS IN 1910000 4/M/2a22 CAREOUTGNIFXNGCTHGRE CENIFR3IN 4/14/2022 TE M 4/14/2022 UHCMGNDNRUGBMHf PMM 7460000009laODO 4/H/20)2 UNCmMplem N INCMIPMT7465D0YL343a4 4/I5/202) MRPSupplemmY N(CIAMIPMTT4fi00N13 1lA3aq r4 4/ll/30}2 MPIIna NCOIT%NCCGIMPMi PXV305T5034]80 41302i MIENIC9oupmpP,OLJtirtAfN]{Y 49fi6k7„f5aao. 411312022 MBNAGGNDN[il]18 MXSPMM0000ppPo000029111 4/14/2010 DWd 0Uf GMIX Xf8L1HGPE [fNILR5111 4p4/z02: QmmH 4N112031 M0NIIa NCWIXNCCUIMPMT pN149]1931594200 O JU2023 Molina HE R(iX HCCWMPMT PN14971432594200 4/I1p011 AmNIE,eup1MCN[[UIMPMi d13fi69415G i11000 4/11/2022 NOVNAS SOLUTION HMVIMF4767BIO 420000130 4/11/1022 NORTH HUMAM SVC NCCWMPMT 174MNA11300T3 4/11/3933iMIEfl10,R0UR ro1P0,f•7A,1([AS)I�fb12{WSlntog9.. 4/11/3021 Molina HC OU HCMCMIMT PNI411432 94100 4/12/4022 HUMAN INS TN HCCIAIMPMTPNI9B2MOR9 @00 1/I2/1922 HUMANA IMCOXUUIMPMT39096293W0000,964 9/IVHO0 HUMANA CHA 0158 HCCGIMPMG 3902624100001964 4113/201) HUM"AW"OE CN 0158 OEV171OMNSPM OMOCO62 40U119fi5 4/13/2022 MN COMMUDWRI 8EINSPMM 74,QC 411910ND a/13/IPii VXCCOMMUNItt TI XCCUIMIMT T4600p11910W0 ./102021 W3PEOUi GNIFR HFAITNGRECENifPG 111 4/14/1012 UHCCO 41151JO22 HNCCOMMUMSV PI NCCWMPMT 74603411 STOOD 171E 4/15/2R2 HUMANA INS COHCCWURMOMT09626300m551095 6/)S/20]2 HUMANA CMA01S6 NCMIMPMi2p96N/300001095 1a,961.30 MMCPORQON Try r..nOarin OSMICpmpt CYPIP/comp 2 @PP/Comps QIIT/Cnmpl&Yp. QIPPTI NHPORNON 1,857.I11 1.657A6 - I,961.77 1;963.73 - 1.793.22 1.391.3E - 1.621.15 1631.15 - 231,36 13936 -. 14A4441: 11,239A4 41761.71 llIS39K- 1 3{9a7. 7.204.96 - 7.204.16 - 3AMA9 3,06.40 - 55AV100 - 15,41A00 ' LAGGED - i'M000 3011499 - TOLIW:00 • all - 2001I9 • 1•370A0 - 3,3]0A0 - 6675,80 ` 7.440.00 / - - 8.97520 7,460A0 1 3>.950,6P t3,]60.19 14319.N &79&]] 1i63&86 ✓' 71,129 45 IONIC PORTION E.11.1_IAt T'nrls aT (_IQ QIPP/CGMP3 0I1/COmp2 Q]M/COMPS QIPP)COMP{W016 QIPPTI NN PORTION - 2,123.36 - 2,125.15 - 3,040.SO - 2.04051 • 1.011. 1,401.00 - LAM040:, I.DM Q. -1,205.70- 10.111,45 ?'e}o2,u3, - ]'Dow - 3,1395C - 3,964d5 - 1,96015 - 1,195.M 1,39500 - 1.172.0 - 1,172A0 - 33.13510 - 33,215.60 468.13' - 46&13 6,366.06 61166.06 13,356A4 - •• 9.95G.00 - 9.93600 - 3,20.25 3,]6D.I9 3,94333 - 1,343,3$ - 3,365.50 Y.6L0{ ✓ t1.9N,0> ./ 9AfeN 3105.i0 i/ 1 ]L0 MMCPORTIX4 r II.I..OR Tmeal\Pin WIP/tempi QIPP/C4mp2 QIPP/Camp] QIPP/COmp46M H QPPtI NH PORTION a3W 53 9.)06.51 93173Y,35 f0,9]0#6 2,7{Ll9` Ts,54456 1{367450' R1.54 6].4 0 ],P)5.30 - 3.GRZA5 12AD2A$ rv.fe Ii9LY K3 B 4>A3J MMCPONOON Tantn.0o, iranrler.ln QI1110.0 QIPP/CROI QIPP/GTP3 QIPPItCOM8YPY QIPpi NN "MON 6.921.91 - 6,92696 SAVU4 fifl9JE4 115. IIFIL3] 1,1 3.14.81 85 3.546:13 3,N7.96 -. 30.3Y9.31 10.44N44: L664af 31397.16 'sii917af yJ3k:Nj 1.]]3.00 i,>II.Op • 11.919.13 9.530,00 11,919.15 • B,N5.00 - OG zd90A0 S'mS' 05 - l2,eii 1179000 2,J91.Oa 2,838.61 - 121551.00 11.903.33 - - 2,618.61 - 1.33733.80 - 2,.00 3,3 ' 7.615,00 3,3$?.M11.80 11A023T 126A27.57 / JO.WA0 L5li IL912:L ✓ ll0 {Sq.N TOTA16 100.19&59 N].S6LR 69,OOR61 I),IOi36 T2,660.92 330,0p7.N1 4/18/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number! Name Groups Add Group Account Type Senrch All DOA Data reported as of Apr 18 202' Account Number Current Balance Available Balance Collected Balance Prior Day Belem Number of Accounts:15 $7,912,263.25 $7.866,542.96 $7,912,263.25 $8,411,859.0 •4651 CAL CO INDIGENT $52.612,57 $52,612.57 $52,612.57 $52,612,E HEALTHCARE '4454 MEMORIAL MEDICAL 1 NH GOLDEN CREEK $52,721.56 $54.216.56 $52.721.56 $52,357.t HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.25 $536.26 $536.26 $536.2 2014 '4357 MEMORIAL MEDICAL S5,870,731.36 55,812,670.47 55,870,731.36 $6.394,913.1 CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE $431.71 $431.71 $431.71 5431,7 WAIVER CLEARING '4381 MEMORIAL MEDICAL $111,441.22✓/ $111,547,18 $111,441.22 $111,544.1 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $90,790.03f $91.736.63 $90,790.03 $83,350.0 BROADMOOR '4411 MEMORIAL MEDICAL $87,593.10 ,/ $96,473.14 $87,593.10 S86,231.E CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $27,551.45 ✓ $27,686.45 $27,561.45 $27.551.4 CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER/SOLERA AT $133,191.27 S133,969.27 S133,191.27 S121,616.2 WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,015.19 $1,110,015,19 $1,110,015.19 $1,110,015.1 FUND '5506 MMC -NH BETHANY $199,461.96 S199,461.96 $199,461.96 S198.104.0 SENIOR LIVING '5441 MMC -NH GULF POINTE PLAZA. $4S,025.13 $45,025.13 $45,025,13 545,025.1 MEDICAREIMEDICAID '5433 MMC -NH GULF POINTE $51,910.94 $51.910.94 $51 910.94 $49,320.5 PLAZA -PRIVATE PAY •3407 MMC -NH TUSCANY $78,249.50 $78,249.50 $78.249.50 $78.249.: VILLAGE https://prosperity.olbanking.comlonitneMessenger 111 Memorial Medical Center Nursing Home UPL Weekly Negion Transfer Prosperity Accounts 4/18/2022 Pradom Account Beginning Pending iodaY iOlQlnnNg bnaunt to M Tninderred to N.M., NUN. Nome Numb--Balanw xranr/er-out bander-ln 0! Prlw Balance i Ham[ 103,752.So 60,793.06 17,751.82 - 5;721.56 17,751.82 Bonk B.I..e $2,721.56 Valance Now: Onlybakncesofaver1S,000 wdl be NonrHrndrP lMnunlnp dome. Now Z. Each a¢oon[ ha! o boar belenw of 5100 rho r bAs eC dlposibed be Open aawun t. APR 18 2022 BY COUNT! AUDrrOR CALHOUN COUNTY, TEXAS leave in Belame 100.00 SUPERIOR FES QIPP QV, 34,069.74 JAN INTEREST Fire INTEREST MAR INTEREST Adlusr Balanwfrrander Amt 17/ASL8ii M Appnev.d: ArMiCINY RICHARDSON, INTERIM CTO A/IB(2022 1:1NH Weeki,T—unkNH UPL Tnmler wmm.ryg022UPleNN UPL LmUer Summeryoa.le n.tic[ 411 111/EOli 15YSQRRNVIRST BBCO PURR 5436USS50769119 4Al/2= 4K.- IMN41R5TBRCOS11Mmull 55S8169119 4/ll/]0l3 NHB-FCm,glon ONCOMIl1600111161OWO1u0 4/)1f1031 TNS/3MNS91RST SU RI E410ums 523419 IN311 41E3/1011 ACH NOMMAS lEMENTSEHCC 4105523419 MINO1 4/1412OU WIRE OUT NEMOON HCCIAIMOWT OMEMI NCREE0000103 4/M(10II HIRE GUT NFgOH NEAlT1 R1 GGUlFX CflEFN 4114120II OopoW 4/15/20l2 HFRl1H HUM4N NC NCCPIMOMII7I600311/10111 MMCPORTION QIPP/Um94 Em.0R.OII I -INN E QIPP/tbmP3 QIPP/tempi QIPP/COMP! BOURN QIPPTI NNPORIION • 1,5750R - 1,5]9.08 - LSR92 - I58.93 - 1.909.16 - 2.90"1 1,955.39 1.95510 • M74A l,3]0.Bl RAMER 3,13B.N SA79306 - 41397.13 a,19].Il - 885.113 - 868,19 - 3644A% - 3045 68.18).O6 1].]S✓ l�E ✓ 1]]9fd1 4/18/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number Name Groups Add Group Account Type v Sea ch All DDA Data I Account Number Current Balance Avallablo Balance Collected Balance Number of Accounts: 15 $7,912,263.25 $7,866,542.96 $7,912,263.25 •4551 CAL CO INDIGENT $52.612,57 562,612.57 $52,612.57 HEALTHCARE '4454 MEMORIAL MEDICAL 1 $52,721.56 554,216.56 552,721.56 NH GOLDEN CREEK ,% HEALTHCARE '4365 MEMORIAL MEDICAL $536.26 5536.26 5536.26 CENTER • CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL $5.870,731.36 S5,812,670.47 $5,870,731.36 CENTER -OPERATING '4373 MEMORIAL MEDICAL 5431.71 5431.71 5431.71 CENTER - PRIVATE WAIVER CLEARING '43B7 MEMORIAL MEDICAL $111,441.22 $111,547.18 $111,441.22 CENTER / NH ASHFOR❑ '4403 MEMORIAL MEDICAL $90.790.03 $91,736.53 $90,790.03 CENTER/NH BROADMOOR '4411 MEMORIAL MEDICAL $87,693.10 896.473.14 587,59310 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL 527.551.45 S27,686.45 $27,551.45 CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER I SOLERA AT $133,191.27 $133.969.27 5133,191,27 WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,015,19 51,110,015.19 $1.110.015,19 FUND •5506 MMC-NH BETHANY $199,461.96 5199,461.96 S199,461.96 SENIOR LIVING 'S441 MMC •NH GULF POINTE $45,025.13 545,025.13 $45,025.13 PLAZA- MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE $51,910.94 551,910.94 551,910.94 PLAZA -PRIVATE PAY '3407 MMC-NH TUSCANY $78.249.50 $78,249,50 $78,249.50 VILLAGE httpsalprosperity.olbanking.comlonline Messenger as of Apr 18, 202; Prior Day Balane $8,411,859.c 552,612.E 552,357.1 $636.2 56,394,913A 5431.7 $111,544.1 583,350.0 $86,231,E $27,551.4 5121,6i&. 51,110,015.1 5198.104,L $45,025.1 549,320.5 $78,249.° 1 t/1 Memorial Medial Center Nursing Home UPL Weekly HMG Transfer Prosperity Acoounts 4/18/2022 PnWlw Amount nM Memo, BglnNry / Pmdinl TlndemGm Munber BLtn[! M1ntloAu[ /Tnwltnln a(uw.ldam In TYdv tN Innin Nbn(! HYnln Xamv 33.9Y802 ]A6J P3 3fi.J39.Rt - 31,910.9t 39,945.84 NM1ko. 91,91GN VVYnw lvary In Nbn[n, 110A0 EMOP MTMAT BELOXO3TOBC]XMY I.... WPPAIOBPEBOV! B �� 15,31Lo, 1.:.'sT no MAW MARIMIRM Adfml NhnnfinnnuMnl 31,9QN Pml°w Anmumt9Bv Ann,mAt NllnnxC PIMMC Tnndlmdto N,.Y..'A, Numbly Nlenw i rof, P inntln9n Cl..d Or Mi.. du OG tN Innin NYmn Nm! QA'K({�J- 38969.92 U.369.9I N,9A.13 - A9A33.13 /�.935.33 Nnt Nlmt! A3,62s.13 vadanw ReWNeMldmin'a M6W/MHHpewe F'alf: L1:iybWonmv/v✓vr$3, WpnW3e Mm/medlvlFenunln9Famf. W ry 3: Evd wmunl hm a Bne bNvntt vJ$ICO rM1vt MMC @p nRed m vpm attwnn. APR 18 2022 CAI.FiOUN GOUNTl°, leaveNB.1.— 3WA0 JMINRRE9T fielKIRM IREfi / 6dimt BaWw/rnwlnAlman erlun[ N,919.1E TOEALTG III ]9,R]09] mold: / MEHONTRI ON,INTENMCEO C/13fID31 I:txxwnW TNnumVlx unTnxh.summ.MN3zNPMxx urs T.ms..summ.nw.se 3Lx. 4/11/1011 NOCSWEEPIACH261 ZIND022OZ4146 SWEEP PH 91131102E HUMANA INS CO HOMMMPMT624932 WD000501153 4/13/2023 HUMANACHADISRHCCWIMPMT6249924200001992 4/14/2022 WIRE OUTHMO SERVICES, LSC 4/14/2022 HUMANRCHAOISBHCCIAIMPMT624981400W1908 4/15/1011 HUMANACNAOISBHCCIAIMPMT62493E4EOW01695 4/1112922 MERCHANT BANNCD DEPOSIT 496430SE000 MKOOl 4/12/ED31 HNB.ECHONCLIAIMPMT3460D34I144000022468 4/P/2D12 HNB.ECHO HCMIMPMT7460034/144IXXXQ59S54 41141201E WIRE OUT HMG SERVICES, LLC 41141203E C4po31t MMCFORTION gIPP/Comp 411`101 m04 Tu.0,,.O. TunA.In giPP/canP2 z WPP/cemP3 awl. 41PPT "PORTION 10,02560 - 1025.00 1.549A3 - 2,54903 21.329,53 - 21.529.53 .68 - 135.0 - 1j9090.00 3,590.00 3A63.53 36A39.84 4 / - - - - - 36A2184 MM[PORTON D3PP/Comp QIPP/C4mp4 TmMenO t MnNVIn wPp/CNn 1 1 MIFF/COmp3 &I6p30 CUP" NHPQNRON 5,446A0 - 5,446.0 31598.80 - 3,598.00 21,301.0E 22.381.02 19,369.93 - / - 13,499.31 / - 13,49931 28.069.9E 441925A3 d/ 44.92141 36,237.0 4135492 81.354.97 4(18I2022 Quick View Select Quick View Accounts Account Number l Name Account Type Search All JDDA Account Number Current Balance Number of Accounts: 15 $7.912,263.25 •4551 CAL CO INDIGENT $52.612.57 HEALTHCARE '4454 MEMORIAL MEDICAL I $52,721.56 NH GOLDEN CREEK HEALTHCARE '4365 MEMORIAL MEDICAL S536.26 CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL S5,870,731.36 CENTER -OPERATING '4373 MEMORIAL MEDICAL S431.71 CENTER -PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL $111.441.22 CENTER I NH ASHFORD '4403 MEMORIAL MEDICAL $90,790.03 CENTER/NH BROADMOOR •4411 MEMORIAL MEDICAL $87,593.10 CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $27,551.45 CENTER INH FORT BEND '4438 MEMORIAL MEDICAL $133,191.27 CENTER I SOLERA AT WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,015.19 FUND •5506 MMC -NH BETHANY $199,461.96 SENIOR LIVING '5441 MMC -NH GULF POINTE $45.025.13 ✓/ PLAZA - MEOICARE/MEDICAID '5433 MMC -NH GULF POINTE $51,910.94 ✓ PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY $78,249.50 VILLAGE https:ltprosperity.olbanking.com/onlinaMessonger Treasury Center Select Group Groups Atld Group Data reported as of Apr 18, 202; Available Balance Collected Balance Prior Day Balanc $7,866,542.96 $7,912,263.25 $8,411,859.0 $52,612.57 S52,612,57 $52,612.E S54,216.56 $52,721.56 $52,357.r $536,26 S5X26 $536.2 $5,812,670.47 $5,870,731.36 S6,394,913,1 S431.71 S431.71 S431.7 $111.547.18 $111.441.22 $111,544.1 $91,736.63 S90,790.03 $83,350.0 S96,473.14 S87,593.10 $86,231.E S27,686.45 $27.551.45 S27,551.4 S133,969.27 S133,191.27 3121,616.2 $1.110.015.19 S1,110,015.19 S1,110,015.1 $199.461.96 S199,461.96 S198104.0 S45,02.5.13 $45,025.13 $45,026.1 $51,910,94 $51.910.94 $49.320.11 $78,249.50 $78.249.50 $78,249.E i/1 Memorial Medical Center Nursing Nome UPL Weekly Tuscany Transfer Prosperity Accounts 4/18/1022 enrbm e[wunl Reelnnln( YN111ga '3� 1S¢.titi'� 5meec xan: WMeolanrei o/�eer5i00PMa6e elnl/medn Menu[sMPAane Nv[rl: [PrA rttaumhrs vOme6WPnno/S1MIhoIMM[JrpmxrilP VGwxrevn[. APR 18 2022 BY COUNTY AUDITOR CALHOUN COUNTY, 7VM a[nY B[lan[e Varpnn Llrvlln BllM[! MWN/PPe01P NM[RWROOP PPa OIPP M.." Otej 9.IaS.0 v,esan RmluMMa. Tnns@rcedw Rtliuq 4lm[e�rRmt Y/ 1PwveE: fill /y 1/IaRell PNiXONYgI(N INYFR CP MMC PORTION ! QIPP/Comp QIPP/Comp NPP/Camp Transfer•0ts Transfer -in 1 QIPP/COmpR 3 4&lapse QIPPTI NHPORTION 4/11/2022 NOVITAS SOLUTION HCCIAIMPMT 676201 420DODISO - 4,573.28 4,573.28 4/11/2022 AMERIGROUP CORPO E-PAYMENT EE52340566111000' _.. 19*868.93 1S1919.40 3,949.53 I7s894A7 2,97477 4/14/2022 WIRE OUT LINEAR ENTERPRISES, ILC 308,440.29 - _.. 4/14/2022 Deposit - 39,168.91 - 39,168.91 4/14/2022 HNO-ECHO HCCIAIMPMT 745UO3411440000294673 - 4,]32.90 - 4,732.90 / / / 108,440.29 ,/ 68,344.02 ,919.40 3,949.53 17,894.37 . 501449.86 4/18/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/Name Groups Add Group Account Type Search All DDA Data reported as of Apr 18. 202: Account Number Currant Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7,912,263.25 $7.866,542.96 $7,912,263.25 $8.411,8591 '4551 CAL CO INDIGENT $52.612.57 $52.612.57 $52.612.57 $52,612.E HEALTHCARE '4454 MEMORIAL MEDICAL I NH GOLDEN CREEK $52.721.56 $54,216.56 $52,721.66 $52,357.1 HEALTHCARE •4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.26 5536.28 S536.26 5536.2 2014 '4357 MEMORIAL MEDICAL 55,870,731.36 55,812,670.47 $5,870.731.36 56,394,913.1 CENTER - OPERATING -4373 MEMORIAL MEDICAL $431.71 $431.71 $431.71 $4313 CENTER - PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL $111,441.22 5111,547A8 $111,441.22 $111.544.1 CENTER/NH ASHFORD •4403 MEMORIAL MEDICAL CENTER/NH 590,790.03 $91,736.63 590,790.03 $83.350.1 BROADMOOR '4411 MEMORIAL MEDICAL $87,593.10 596,473.14 $87,593.10 $86,231.6 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $27.551,45 $27,686.45 $27,551.45 $27.551.4 CENTER/NH FORT BEND '4438 MEMORIAL MEDICAL CENTER I SCILERA AT $133,191.27 5133,969.27 S133,191.27 5121.616,4 WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,015.19 51.110.015.19 $1,110.015.19 51,110,015.1 FUND '5506 MMC-NH BETHANY $199.461.96 $199,46196 5199,461.96 5198,104.0 SENIOR LIVING '5441 MMC -NH GULF POINTE 545,025.13 $45,025.13 $45,025.13 545.025.1 PLAZA - MEDICARE/MEDICAID •5433 MMC -NH GULF POINTE 551,910.94 551.910.94 $51,910.94 $49,320.£ PLAZA - PRIVATE PAY •3407 MMC -NH TUSCANY $78,249.50 $78,249.50 578,249.50 578.249.1 VILLAGE https:/fprosperity.olbanking.com/onlinaMessonger V1 Memorial Medical Center Nursing Home UPL Weekly HSUransfer Prosperity Amounts 4/18/2022 Pm ..' P.n41y Amnmuoee A[wwl Bepnnln$ � _ � M.dlnw Trmllanedw fank8[hnw 1.1.461.91 l[lve in B.lance 10,0 1RN IKEREFT [E6INTEaw MARinmars, Adl.d Mi.n .ether 1 199.)61.9r nee: anrrbalenra 0/4vw$$.""b9 Iwnl/w[ wchenumm9b"t A t nxe P.FA<AP[fOMtbOl Pb01[b01on[[v/$IM IFotMMCd[cgi![d lommcrtuunC ANiNONYR n9ON. IN RIM 411,12.12 i�aellq �. •,li APR 18 2022 CANON COUNTY,TMg hu"''ayTnmkn\NI[ WlLmder 9ummny\jpi1UPMNM ullirmllwlummrrvw.lA]ttln MMCPORAIOH k. __ _ 4'v'...yn:41 m e) jp9liLL•Qy1 innder.n upplan Ho CIM/Cpmp2 WI/C6mpl QIPP/Camp661apu g19pT NN90R)ION 4/11/1022 HAAI)H HUMAN WC HCCWMPRT I)4600341330163 - 3,)O8.]0 3.70,20 4/IL]0}2 0epe91 - Mo.39 140.59 1/212022 Depo61 6,466.30 - EACH .30 .11114022 0@o91 - 45.448,90 - 45p43.90 4/li/2011 HNR-ECHO HMIAIMPMA)4600341144000]234362 U.007.60 12AW.60 4114JM22 WIRE OW BETHAW SENIOR WING.LED 115,}]1.]3 4/14/2022 Oep041 - 1.792.30 - 1,782.30 4/14/2022 D.PmLL - 16541,90 - 16,541.90 4/N/]03l 0ep0Y1 - 111,R0B]1 IlIj08 }1 4/15/l22 HOSPICEOA SOUTH PrymenU NF 11311]6S00II496 - 6A3A3 6B3.}l 4/1512022 HUHN HUWN WCHCO6MMPM)]24600241139162 - 674,14 61474 335,211.]3 199.36196 199 161.96 411812022 Treasury Center Quick View Select Quick View Accounts Select Group Amount Number/Name Groups Add Group Account Type Search All iDDA Data reported as of Apr 18, 202: Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $7.912,263.25 $7,866,542.96 $7,912,263.25 $8,411,859.0 '45 51 CAL CO INDIGENT $52.612.57 $52,612,57 $52,512.57 $52.512 HEALTHCARE '4454 MEMORIAL MEDICAL 1 $52,721.56 $54.216.56 $52,721.56 $52,357.' NH GOLDEN CREEK HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES S536.25 $536.26 S536.26 S535.< 2014 '4357 MEMORIAL MEDICAL $5.870,731.36 $5,812,670.47 S5.670,731.36 56,394,913.1 CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.71 $431.71 S431.71 $431.7 WAIVER CLEARING '4361 MEMORIAL MEDICAL $111.441.22 $111,547.18 $111,441.22 S111,544A CENTER / NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/NH $90,790.03 $91,736.53 $90.790.03 $83,350.0 BROADMOOR '4411 MEMORIAL MEDICAL S87,593.10 S96,473.14 $87,593.10 $86,231.E CENTER INH CRESCENT '4446 MEMORIAL MEDICAL $27,551.45 S27,686A5 $27,551.45 $27,551.4 CENTER / NH FORT BEND '443 MEMORIAL MEDICAL CENTER / SOLERA AT $133,191.27 $133,969.27 S133,191.27 S121,616,i WEST HOUSTON '2998 MMC-MONEY MARKET S1,110,015.19 S1.110.015.19 S1,110,015.19 S1,110,0151 FUND 'SSOfi MMC NH BETHANY $199,461.96 $199,461.96 S199,461.96 S198,104.0 SENIOR LIVING 41 MMC -NH GULF POINTE PLAZA - S45,025.13 545,025.13 $45.025.13 $45,025.1 MEDICAREIMEDICAID '5433 MMC-NH GULF POINTE $51,910,94 $51,910.94 $51,910.94 $49,320: PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY $78,249.50 $78,249.50 S78,249.50 $78,249.° VILLAGE https://prosperity.olbanking.com/onlineMossonger 1/1 ---------- M E. IVI 0 Q 1 A L 1\4 E D 1 CA L C. F-, 1\1 -11., F.. R, — f&6& F CK R E (it) E Slf MEMORIAL MEDICAL CENTER DaIF R--citiested: 4118122 A FOR ACCT. USE ONLY APFWMON D I i n prest Cash L7A/P Check APR 18 2022 1 [JM.oll Chcd(to Vendor 1 Lr—i Returii Ch�zck io llcpi ...... By COUNTY AuprroR LJ CALHOum COUNTY, TEXAS AMOUNT NUMBER: 10255040 CXPLAIVAPON: AMERIGROUP FEB QIPP It ,J.—F Mayra Martinez ,.. ------ ----- -- P MEMORIAL MEDICAL CENTER CHE"CK M%ik,i.EST Oath Requested: 4/18/22 FOR ACf_T. USE ONLY APPROVEDON cllmp7 est Cash L'A/PCheck --- APR 18 2022 CMail Check to Vendor BY COUNTY AUDITOR Return Check to Dept _._._-"'_CALHOUNCOUNTY,TWS L.___ -__.__._.___-- AfVOU:VT $12i63885 _ GJI- f•Ik11 E6f.-1 10255040 F,XPLAW'%TION: AMERIGROUP FEB QIPP ki t?UL., 'CEi 6r Mayra Martinez AOTHORIZ_ n I -- --- ._ ........... - - --—'--..._. .....-.__... -- _. ... .... .........-- NIE(aili,} IALMEDt1:-Al'i:EE`,IIFER-Crtsc 4- I I MEMORIAL MEDICAL CENTER I)ars Re.. �iesi:r:d: 4/18/22 A FOR .ACCT. USE Old LY Y — ��------_--� APPROVEDON ulmprestCash IF APR 18 2022 ❑A/PCheck 1-Nall 1'h1eck iJ Vendu E; BYCOUNTYAUDITOR jReturr; C:hed. Lo Depr _._.._.. __...._....._------------CALHOUNCOUNTY, TEXAS ------____._------_- G !. NMVIBEQ: 10255040 1 I`:HPLANAT!ON: AMERIGROUP FEB QIPP III-:: rl7i Mayra Martinez ,_Fi-, '1(17FFOL3P ! ME.IVIC)€�,``8A fMEDICAL UNTER - �wtBak MEMORIAL MEDICAL CENTER p: is Requested: 4/18/22 APPROUEDCW APR 18 2022 BYCOUNTYAUDWR CALHOUN COUNTY, TEMS FOR ACCT. USE ONLY DIrnprest Casii []A%N Che;k ❑Mail Check to Vendor LJRel:ur;i CC'.a.:(. cn 024if AMOUNT _ $12 341.56 G,/L NUM.-BER: 10255040 fk:'i•10N: AMERIGROUP FEB QIPP P Mayra Martinez ., r i4l °F+. B-: 1 " ._..._....._._____.._..._.__._. _____- ---._........ ....---._.__._-__ j\/1F OM W HECY REQUES'r F, MEMORIAL MEDICAL CENTER 4/18/22 A PORPACCT' USE CNIN APPROMON Imprest Cash APR 18 2022 ❑[]AjP Cfle(� Mail Check to VEI)d0l* By COUNTY AUDITOR i 7dRetwn I M:cf; is Dep, E CALHOUN COUNTY, TEXAS G/I' lmj[VISER: 10255040 AMOUNT AMERIGROUP FEB QIPP Mayra Martinez Amj'fi . ... ...... ..... . I,,,IEN/IOMAL IVIEDICAL. CENTFR V70 K�i U -. -T C K R E Q'� I 'S f, MEMORIAL MEDICAL CENTER p- o.lf;� Koquestp.d: 4/18/22 ------------ AMMON APR 18 2022 ByCOUNTY AUDITOR - ------ — -----.A6LHOUN COUNTY TWa —fZ6—RACCT. USE ON Ly LJ Irip. est Cash A/P Cheri; 1-11 fvj:jij Check to Vendor [-'Ref.um Ch.<k W DeP, AdViOU NIT 10255040 v X P LA Nt Al-i 0 Nl: AMERIGROUP FEB QIPP . ....... ........... -F! 1 L Mayra Martinez . ..... J a b mm ry Rpm Rpm m0 a nZ 9 y D mz N a u mOD OD am- m3 xz°z RA ym �m 3 m 2 z z O r o ° 0 N N N N N N 0 0 0 0 0 0 Oy O,j Oy Oy OCj 'r rn rn or rn Zn rZ Z0 Zm ym z�mm Za mD mD mD mmD mD Fm Fm Fm FmFm Fm S 2 2 i 2 T T T Q P P a a a a > a a w w w w w W 2 J N N P a P U wti3 nN3 E03 yti3 N3 O>' D D D D c D a D <Wn zwn mWn awn Wn �n rmm p<> 02' y�'D nD ND Zn n zn mnn an nn -]mx my x Z2 Dx D3 Owz Z577z nmD D pD > zm m �o y m mDm TOM mm Om F Z -�a m a �a a Fa 9a x� F z n n z Cn m m m m m Nm W J O D W U P M �o 6.in �o oe O N U O P O O O c 0 P P P N N N O O O n c Z jC Znzy] O -I m z n z z n n m m y A O O O a J n O a zc OCi z -vi v> r r r w y w A n w A n C 9 F r S z 2 y pn O O O m u a a c rn a a a rn a u a u a W u u w w u w u u w u w u w n N O O O O U U U a A A r O U a N N A A A O O O O O O O O p R n>n n zn zn zn zn g mr z z z z mn m� p�j = nr nr n� n� z z 00 u3 ->-1 z a A a a O m m n n n n m rm- tir �A > o 0 0 z z z� z y 9 g rr y ti 3 z y O z -y y °c c y -zi z m z m m m m Z y a a a D a 0 Z Z Z Z r m m m A A A A y w Z O { { K n O O O O A m EjpJ. o � N a > y � v o o � •No e Z � O .o :p NO > -7> > ODD 3> r'D �'D > > D D -0 n? oA1 oC a F �"z'� y mZ.Z.7 -zl .Z-7 -Zi -Z7 f-zi A H -Z'7 -{-zi -0 O Q W W A w O F D�_ W W w W W >� i� Z 92 P N X 0 O D n n m n O n 101 O O yN ` •L •C) a y £. y n J Z C C in r r n F a < r> m S 9 9 9 n Sm A a c A m y r r r r > c U N U N N `D V 1a IJ 4+ Co lIU V A � V N b O b 00 0 0 0 » ) \ )00 ! m m § ) § (� ( § ) \ ( § } \ � »9> \/\ §)/ [§§ (§ km{ \\ /(\ \ ; 2 m ! \ { § § § / \/ ) \ �( \ \ \!» j// \�\ \ 00\ ; § 7 Kmn � k � \ ) � �- } (}\ `f §°/ (- ! \ (} \ (( \ ~ �/ } 2 0 m 0 z 9 c Z a r rn o r m •a-7 _m < n ay r y cn O z 3 mw n r Z N m Z y�j v O z H c z a � r N y y N P P O U U U U W W W U U W 0 0 0 0 0 0 0 0 0 0 "r nr nr �n m tjz az 0z S2z n n n F -7p n y0 j0 y0 y0 C r pm ti N y S zv r nm nm nm v a K n m m m N a a a 0 0 0 W Oa ppa yW N N N y A A U J W J P P 1 W A A VUi J O J A U A A tUn A J P P D m z3 n m 03 a 10 m -CK n m a3 n m r; m g a W m -7 y n vs m n m r C a m vm pm �r,m mnw �y Ow y w W>y Oy SKW '..3w mw 3xa ma m� ry`0, nz Be ,Puma X= OC,o„ m .O mm Oma n m y az nc ?gym m c �ni� a 3 yr� as yOz mz <3 mZ m Z m O A U P W O N W N O Oa W U U N DJ JJ A J W J T Ce O O W J N P w O U y A O O A C m Z 'j 0 n m N 0 Mn Zm Z a ny D rm A D W m r A y z0 y W � n 0 o r n n S m � mp X z 0 m 0 D n a °z O C � ro- ncm- ray time m� ° �w a rm n n m ra a 0 P 8 8 C e O a O a3 m c my Z w A z n q A m � m m m v y P P P P P P P P P w P w w 4to w N O O O O O O O O O z 0 my a a a a a a z a -a7 m m O 10 Z Oy z �p W J N N tJn N VJi VJi U W '3 C 77�� cc: w O�KZXW Xc w aww mw mow w �w ww a�w �w 9 w Zw Caw ;-Omw ZAw AC'w w Z y 9 Pp m(a]> � a W A a a f) a mmw w w mw m mw mww Xw p w m w C0 A.T.O �,-ic 8 a A O 00 OO N N .r p A.O M,J OX 3w- Zin a J P P o yyw w j N m� ypy,� np-;a3 y-O7 "�a3 Zen A� -ac u w 3 rZ3 3 m3 m3 Ow O 3kram- <53 zr �mr r,x O= >m > mA0 cp- m O S= . yw n O qw Oa A w'< m w 0 rA Om Am a Za Z Z D -Zi w-7 a wm z r F ;°Z W Ce A to O Ce A V W �D P J S (n e m'Ap m m m3 0 s mm z z nCA] n "Z Z w w < p m m n 9 r c e c c O _ 9 A n O U > >' m a m Z wn s D s y w z cn- m _ m v A C Z C w < n r m m H O O O Z m m a a � n m m U U U W W U O O O O O O O P O O tOn p 6 n <3 <3 <3 <3 <3 <3 DT. C rp . xw_+m. <Oa0O�C �Ca �rD r p rr r0 i w9 C zC z z z z OO OO N A mA m> A �e ''� Z z Z n 0 n m m > m a a v n z s x s x x A z y U w N N W 0 J O O C 0 r N N O J VNi tJn �' P J j 3 F - 0n > -i D3 yD3 AD3 '-iO3 �3 -i Am 30m nm wm Orn aC9 ac9 `�' 39 'O �+D A3 amX mX x3 z3 i�m3 anm cyo cyC) rye cno m� Co -a Ply aw w C-w r -7N 0y W ;, > W n0 W �' W nwm Dnz ao -A]o �n�o 9 A� Nm Nm p0m r,cm m T4z Omw C]w ww JD Cc 9 wr) OCZy DZa OZD AZD D y'p xN .o y0a� �mT .gyms ajs 3�s = �z C)mn rA< wa< W O< A< G zwj ZDm u -i Z CA> Q xc y m p m rrm mm m A BOA y a yr - :z rzo mmo po o pa< F ;m0 H m o xw oo o LZ'1 F 3 yy v a o c o o z U � n v a O t w p W W W J U O O A A O Oa Ce O O O w O W N O N P O O O O C O a cA cA o02 o ym rOAyOnyz -a ym w 3 OX QD�nA�z7 0 y z N^ro Ey m m N>z z ° O O y z Z C Or D 2 S m m z U<_ T< O W J N �1 O P U O Q ry a T P P A N y v v r p m z m o A > x j n _ rt m N N m z m O N O w m O N y r � N o. n m as A Zm N Om� Oa q DSy OD OD a y $j Om yDrC �Z j SO c z o 0 2 r z7� pxz Cm m ZOO -zlO zaZ -1O z o ° O zA < mp ma ma 3 ;' C x vziDy A m Y mm�v py A� 50 W m D z h y y y m m z Z Z m O n n m 0 N < y z 0 N J O VNi V J 3 3 n O N A w C 1J O ao j6n m�o A °o >A nan n�cD y m'ooz Sw 9 A9m n m Ay �' �' Zv. D y-{r [*f y0 y-�'i C9J y^�1 CaJ x mu. a� O x O m? y ar m m: zoo w R C) wt8<n n CN' <i1 n 'R �FigN Ny m G o w D 9 0 9 O N F A O m w O P W W W W N N C3 N O O � rt� _G O O O O O O O C O O O O O O O mC m`c AC pC D Q y " N nn Vi n:4 c -� mn mn 0 9m .om �m zm m n - m0 m0 -70 -30 � � m 8 z Nmm Nm i � y m > °z ae a w 0 0 0 m3 m3 con nQ1 W �- nz mpr um U� r jn wA y w O z 3 0 0 ' o 0 X m m 3 3 m 0 r > v Or O A A U P P P w U w w w w O O O P O O N N N N N tUi� p c w 00 A m 9 O Dv DC C70 p0 C]0 D W < m 3 0 a Z m Z m r D r D r D Z m n '< FC m --7z -]z Om Om jD D� r n mn m Z7c Zm vm,3 w3 y3 zvc Z Om Om m z0 ZO ZO n U U P I p< N N O O D U T LJ\ N N N pJ� G Ip1 P A A U U U A N n O O O O > O W b .gym uPi U rt 'r py opy zy ; C); npy y 0 o Co Dm3r pr m_ rr n-3r 3r �- Or r O-�r N <o po mi3 mD wo`n n$ mw mAa -aa a mti N mAa 2 m 'n. N J A m U A N jCm r j`c m U N .OP P T m U N-i �m kZ W A myO OD D � D wyO 0 N O Q J - W O O A O A P P P �O W P P O U Da w n R O O O _6 O O O O O O C mC mC mC mC mC mC d 9y 'g z mn mn mn mn mn mn m �O AO AO AO AO n 0 U v�i i A w w U O A A J n b O O O yc a o m0 n 0 0 m y Qm z m n O Z b OC p� O rn n r�i K 9 r y c rmii y 6 n P A A W W W W W R o a o 0 0 0 0 0 0 0 0 r o r 6 rt 6 g 0 00 X y� g ry ro ro ry < m S m mK m �0 m �m �-mi �m nm o a 9 m o a C s z Ix z 9 n D Y Y < -1 fN &> b R+ m A O z m O G 9 m z z z z z m e z r 3 O 3 3 U O C N O N 9 a-'] OmDu 'O a -I OmDu zN y '-' 'D w w W w •-I IJ O N N� p� 0.Ou W Ka � ca D m m� 9 0 a� 0cr= mm3= ncrm--= mm>= �� -��= zN w a N o c> {� K'j nOm -7m O O O C o oA a0 03 `n mCOC mmCO z •pam anti O p n n -'� �- n D Z? Z z z a m 2 m D m m m c C C m O O a a A N z m Z p w y y O P N N U N W J •D � O N N N P W �O W �O N W O W O O O n 8 C C W w H 7a 3 3 < 3 e � o o m �n A O O w O m n O Z N D z < m a H N N O N O O O O O O n n n nb nZ ny x x x x m O m Z 3 y z 3^y v O o o o zA z O m O x n x n x n X n O m O y O O O O n n m m m z z { < < °z °z N W N N V�i T d A A L L O-Di mJm 3G'm yOm ym Dm ym ow Tm rnm O yz'� nm �m y No 0 Poj zOw mA A D ZA F p a j_ 0Oi Pc z [m(1 O m O RI m 0 n On <0 ZO<m bpt9- m0 m0 ZO ZO a � nu r mw N J N O O O N tJ to N O r 0 0 0 0 6 R tC+l = x n H o = o - z z Z � z D -z b b 8 8 8 0 O P ao 0 0 9 nd m m 'Ao n m $ z z � x we c ,bp O o b a b Z z O 9y i 9yn Mun yn mvzin ��n 3n -n .a D yn Zi SCn AC n Cn X co D Cn rrzi,n Z Gn myn m Cn r O A '{ O 0 yS r aAAA OyC �p�9A pA 3AA WAA m A y�C �C n m R yZ C'DG YC O�c DC yn0 rC mn0 n0 Fn0 yn0 'gym 00 DC7 mm m m Z C m y O O n =a '� A Z tnit r y y N C C n m -yi '� < N Z m > a z y b b q lA N DJ U lA U VI U lA lA wt U N O O O O N O Go P A N J p rt r0" 3 rn �� 'an 0M,, rC nr CD yin �M A n [A -d n� rm- y O < m -3r mr mr c c3 mC c c y c. 00 9 nm n 3 z`z 3 3 z z �a m m 9 nm > z X O ,tzi O nD D D >o Y y Z A A W o 0 O Z. O O p P > A A W A A A A N N n' q � CA OA CA OOA W A Cam mn'pn ',Z W G6_ Zm mD W m W 9X A9 A9 AD AD AD AD AD AD ^m Fo Ow_ mw mm mr 3n mr 3n mr mr 3n mr mr 3n mr 3n mr 3n > A y A Crw p y C G 3n G C Kn G C w W W A w F � N O O O O O O f�Il3 n Vl� 9 p A CO D o z N n r y ➢O yy > S S Fi '*� \G iAi, C o x .y—{ z b A 'DO A A �9 A A E A 9 D > Po u r < O A v H N m m m O N v z W N O N O N O N O N O N NO �OJ F C7 N N A v N — J W W A U O U W P J W ,p W lA O q b N N q O N N O A A O J Oa O O O %0 O A O a 90 go y ma m> = n AO a0 n n z z n n � o o ' � a c n 0 m D x+D Z r > i ry m Cm r 0 m y n m m a � A f] > X r 9 H Z N w m r h W U U U U U U In q P q O� n U vwi N N N_ N N N O q P q y r 6 N n� xn n-e n-� 00 DC aO0M S j00A w < < ay 4 >9>F yyE no no ow 9m F� �A ZKO j0 y AA tzn0 n.1 cD- v ZA A m m —7X mw yywr -_m •_m -n 0 AZ �'p O O YYm r'� Z� ZD ZD A Ov, K zr Z D > > 9 n nm nm c m J D• J J J W N - b - N Ca b N w N W w � A w O m Ce N N I O ry 0 w oe A u co o q oo U O W A.v W A ym W nC0 m� W Aam .A.m W R G!,Np W V1Tw_ m W W W n W D-JA Nw 0S2 �p 9NA z0 W >nw `�nCN n' Oo0 OD no Z:�0 r) wC mnm A mNea] man D03 O moK zx .xJ �n �n m<x x�m 3m w z oxf] 9 > m s7' �> < �Om m �O O�m u <W m Cna m-yi ZO a. Z3 j' a nm Z N o j m wj 8a A O c P J �O D P O W A W A J O W C• O O C O y t no no � r"a mD n 'ao 'av m n m n n y y a s � O 3 9 U n O H S m = S O H m m r0 m A CO c rn O r a m � y M U w to w lA w W lA U w lA W N w P P P W O P u O w w n n N N N N O O O O O Ibn O O 6 xn 3 r r ny ny ny n< rn r rm nz r A A r Onw r E $ y n 'n y D n CO Z yn "'� m y 61" y >T t`< DT of 9 T v0 D z S mm wy p o aOn Z zO ZO z0 Zy a a A,y n z m m� �y 'Ly -gym KO A z a m Z z z z zr z Z nD a A 3 rD- n n '< D a 3 'd rmo °z 3 z -Ai U N N < w yp u:WX Aw -9x x m x >>Wmmm 0� 0wwyn xmm a'O3� pm� w 0m W ozm pO z o � Mwo �30 py y_`r Owo o D rzWCzo y oUxA Ao oWwOa W N D Du rnN yaACn r.pD 3m-4 0 0 amT � m- m rng ZP p H m r m A<l$Tf Narnamo 9 op ( oO 0 rC Fr'< C On AyA > O m rnn m N 7a x > Z S O' N O w y O b W P Ge Ge Co V N �O W W U N N �O W J N N �O W J N IJ W iA M O P n n A O A O O v N N N N N N N N N N O O O O O O O O O O AO U F pa U !A P A A N W V P J O U P a a O 9 P P T N N N M P A N W W r O O O U N N p 6 rt vD+m o- OOx H ma mm3 n� ny 3 3 0 om y°z �y zo zo z A� Od O o z rz nn x z °z J P N N C C n zmm zm W w cm >Am a y n w w w w W p w N A m OA W L a p .Op w o -tom n� O� r� N AO -40 0 z mm "im A A O t�C77 or 8 z c n 3 P Oa o' m > m mm A O ° P 0 a ap ❑ `p DO v zv m n -z y a a o ❑ n 0 y yn m /J w C C n r M n n n > m r m m O C ti R n nm nm X y_ rn rn mS y� g,CynyA 3Z 3Z0Z AO n R� O-Zi On �-Zi r 3 3F cc �n n m 3y 3-7 vOn rS �O r.+. rS 20 rS e X y �y my wH jD �"'� DZ DS W W 0 O O ❑ r t r r{❑ w ;t z 'o a a a onD zc, z> 'zy a O O n A o o n n n m K �m nn n DF D Y A R 2 In to O P OUe m m A A A A b w W a ❑ Dm n n�� W -1aA m w& m W W W W W CA xF ;a ❑pp W X -i n D m �p A m j A Z A A A A A Dp A A 'O A tW*1m z' A O W y A W A to y a D w A y 9 W A 9, A A D W W W W W N r W n W 3 W W O W W C n S' O 7' T O O r W N 1� IJ 7J w a m W AOW P r ONO OOA K A W m M !A� yN X A Z V M.1y yy ❑ x Hon ViN U f] nN D [❑n y H y y H ti F m y A y y x w m m -Zi a W e O A R' O N A J A b to J W Oa P J J J a P Oa b b P W n a J A v. r c ca 3 r m a NO z A A g A H w o 0 0 0 o r m Q H O O O O y D H < E�� <mm m mm n mz a m'e P P F F r o A j -rC Y Z w r a D a D A �O m z a o 0 H 0 o m mA > > x y y ti H � D w w w w G O O o u O u O O u u N w N b Z 0 N tJn VJi VJi N w w c R 3 C u w N rt '3 v V b N 00 R 00 .z.�0 0 m 0 >0 is C N c w e C o a a m ? N n 0 O O !J A N n C 'O � C � u m W x 9 r z no D n = nw V H U P U N 41 b U N W lA N W b N O O n n 0 0 0 o O O ly y - a a $ m m 3 -Z3 y o � � m � y �o n e e y Z � m A K m A C v 3 m z w � o c a n < O z 3 O n a N N N U O O C O O O N _6 O O O. O n p p a 3 z3z ti O b � b 9 b b b n NnC7 nt7 m > m h n n A � o z � -i � N J 0 e � 0 0 0 F8 0 V m> > na O � C0 0 o c > > D a o 9 A X A c r N r N O � O N N O N N O S is ai o z0 z o v m a � m m i c � O e a � n Own mwn wn ryn 3n A A 3 C a p A 3 a a m F C z C C C C n O n O m m o n O a n O Z O 0 O 0 � ,r-, c z z r m o a a y n w J J P W n rt mr mrm- C Z Z m m 9 D nm p o v x C A � 0 0 � J J �GV S zo S S S 3� A A A W A ' N 'ay 'ay -� Mn An An 3n ' 3n 3n 3o 3� �o Fo Eo � �o A A A A 0 0 0 0 0 N N N N N N n a 0 c 0 o v � - a a 3 m 3 z m z o � O �p y � n byn 3� � yn n n nn O n � c m Z 6 H > o Z Am � m � � z 0 O P N P O C � N � I c a a Qc ' N Sn 3n cQ cQ cQ A A A p r r r c O N N O N N O N N n n 0 0 0 O O v 3 3 z m -1 2 O' S 3 w 8 z z c n O O e _ v v m m '3 Z Z H H o � 0 b 9 O V m A c7Ha rm mfm my n3n my 0 rn " n Dmr yD ^ m0 D O O H�Cn O nCn a a0Zan mC jnM n >. D >a PCOF md on c po0 nmD n0 90 m m mm m m iz z a m< Z 3 o n a O Z m y r Z i C 0 n m N n Z m a D Z n r D n n P A P A U W W O O O O O O r O O W A O J a O O O U N U O U Ce U A U N U J p psi r R d 6 w 2 m m O o v> O y w H A n r C C C C D D ° W n r r r r Z -yi ca zz 3 -yl 3 z C G y O n C n n n O n m 00 a a Z G H v Ni A F m n T y m z y n O a > z > n b n 'a vi z D0 C p O< y n O m O O� o N 0 0 0 0 0 8� o R S Po A A P z b R F A 3p A A �' A 0. C WG 0 o A A A W A A A ry A 0 N O Gam'- mC< na'- =�< >UC D0< >a`- Zom,< >a�- Zy< WM- mm nm� O.O< 9n m> -�n AD �on A> -en D 'fin AD mn .'A> H ig # < Ono mZO MZO mA0 "30 CO COo COo COo COo COo ,>a romp >XO '- ym .Z�m W 0...7m O_co v+zC y y_ N? 0 o =0a C!ng sA Yr W rw 3nw Za A A w w_ A oAn A 0> OH 37a yH my Fn my p n o0 n, z zn D O F F n a A A v y m > 7�7� < m G m N H Z m N N N N N N U 9 Z < z< n 03 n3 O A mm p o N o N O N o N 0 N 0 N r M z y z H H 0 c J P J al P b W �o U J N O p J O O O Oa A A A O u n a d_ 0