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2022-06-13 Final Packet_ 911 Agenda Items Properly Numbered contracts Completed and Signed AI 1295's Flagged for Acceptance (number of 1295's J—) ✓✓✓ All Documents for Clerk Signature Flagged On this -"day of 2022 a complete and accurate packet for 1349- of U 2022 Commissioners Court Regular Session Day Month was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. 6&44� Calhoun County Judge/Assistant COMMI SSIONERSCOURTCHECKLIST/FORMS AGENDA NU Ii4 l li IV�t IN(_i of 1 Richard H. Meyer County judge David Ha11, Commissioner, Precinct I Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Monday, June 13, 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: FiLEO / AT O'CLOCK-2— .c; `i Call meeting to order. tllnvocation. `3�. Pledges of Allegiance. June 9 2o22 A N.4 u88C COUNTY CLER , CALHO,.P;1' <!BY En=, '' OcP;jIY 4General Discussion of Public Matters and Public Participation. t A. —f"5 `5. Consider and take necessary action to lift or retain the county burn ban. (RHM) b. Consider and take necessary action to approve the Request for Proposal, RFP 2022.07, for updating Calhoun County's Hazard Mitigation Plan Development and Grand Management Services in support of Calhoun County State and Federal Grants and authorize the County Auditor to advertise for these services. The RFP will be due before �2:00:00 pm on Wednesday, July 7, 2022, (RHM) 7/. Consider and take necessary action to authorize Commissioner Behrens to sign a rental agreement with United Rentals for a 2018 Freightliner bump Truck (10 — 14 yards). (JMB) 8.sConsider and take necessary action to transfer a 2004 Chevrolet Suburban VIN #1GNEC16Z44R208769, Asset # 541-0167 from department 310 to Precinct 3, R & B �560 assets. (JMB) '9. Consider and take necessary action to accept the donation of 960 postcards from Philip Thomae to the museum gift shop. (RHM) Page 1 of 2 (_)IIr 1 11 ` 11I' 1 r'ki t 'J.J'. K Consider and take necessary action to accept the attached list of donations for the month of May 2022 to the Calhoun County Library. (RHM) Consider and take necessary action to declare the attached list of items from the Calhoun County Library as Surplus/Salvage for the month of May 2022. (RHM) t2 Consider and take necessary action to declare the attached list of items from the Calhoun County Library as Waste for the month of May 2022. (RHM) ' Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (RHM) r4. Accept Monthly Reports from the following County Offices: District Clerk — May 2022 if. Justice of the Peace, Precinct 1— May 2022 ustice of the Peace, Precinct 2 — May 2022 !:f, ]ustice of the Peace, Precinct 3 — May 2022 v. Justice of the Peace, Precinct 4 — May 2022 t Consider and take necessary action on any necessary budget adjustments. (RHM) I& Approval of bills and payroll. (RHM) P Richard H. Meyer, County Jud 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 NOTICE OF MEETING — 6/13/2022 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Anna (woodman, County Clerk NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Monday, June 13, 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. 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. 5. Consider and take necessary action to lift or retain the county burn ban. (RHM) Burn ban retained per Judge Richard Meyer. 6. Consider and take necessary action to approve the Request for Proposal, RFP 2022.07, for updating Calhoun County's Hazard Mitigation Plan Development and Grand Management Services in support of Calhoun County State and Federal Grants and authorize the County Auditor to advertise for these services. The RFP will be due before 2:00:00 pm on Wednesday, July 7, 2022. (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 1 of 4 NOTICE OF MEETING — 6/13/2022 Consider and take necessary action to authorize Commissioner Behrens to sign a rental agreement with United Rentals for a 2018 Freightliner Dump Truck (10 —14 yards). (JMB) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to transfer a 2004 Chevrolet Suburban VIN #1GNEC16Z44R208769, Asset # 541-0167 from department 310 to Precinct 3, R & B 560 assets. (JMB) 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 accept the donation of 960 postcards from Philip Thomae to the museum gift shop. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to accept the attached list of donations for the month of May 2022 to the Calhoun County Library. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to declare the attached list of items from the Calhoun County Library as Surplus/Salvage for the month of May 2022. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 4 NOTICE OF MEETING — 6/13/2022 12. Consider and take necessary action to declare the attached list of items from the Calhoun County Library as Waste for the month of May 2022. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Accept Monthly Reports from the following County Offices: L District Clerk — May 2022 ii. Justice of the Peace, Precinct 1— May 2022 iii. Justice of the Peace, Precinct 2 — May 2022 iv. Justice of the Peace, Precinct 3 — May 2022 v. Justice of the Peace, Precinct 4 — May 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 4 NOTICE OF MEETING — 6/13/2022 16. Approval of bills and payroll. (RHM) Indigent RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese ILl.ul�] RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County 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 4 #5 NOTICE OF MEETING — 6/13/2022 Richard JH[.Mever County judge David Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 Anna Goodman, County Clerk NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Monday, June 13, 2022 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Smite 104, Port ]Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: 1. Call meeting to order. 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. 5. Consider and take necessary action to lift or retain the county burn ban. (RHM) Burn ban retained per Judge Richard Meyer. Page 1 of 12 #6 NOTICE OF MEETING — 6/13/2022 6. Consider and take necessary action to approve the Request for Proposal, RFP 2022.07, for updating Calhoun County's Hazard Mitigation Plan Development and Grand Management Services in support of Calhoun County State and Federal Grants and authorize the County Auditor to advertise for these services. The RFP will be due before 2:00:00 pm on Wednesday, July 7, 2022. (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 2 of 12 Calhoun County Emergency Management 211 South Ann Street, Suite 301 Port Lavaca, TX 77979-4249 Phone: 361-553-4400/Fax: 361-553-4444 e-mail: ladonna.thigpen@calhouncotx.org June 7, 2022 Commissioner's Court RE: Agenda Item Please place the following request on the Commissioners' Court agenda for June 13, 2022. Consider and take necessary action to approve the Request for Proposal, RFP 2022.07, for updating Calhoun County's Hazard Mitigation Plan Development and Grant Management Services in support of Calhoun County State and Federal Grants and authorize the County Auditor to advertise for these services. The RFP will be due before 2:00:00 PM, Wednesday, July 7, 2022. Thank you, LaDonna Thigpen V CALHOUN COUNTY, TEXAS REQUEST FOR PROPOSAL HAZARD MITIGATION PLAN DEVELOPMENT NJ1 GRANT MANAGEMENT SERVICES RFP 2022.07 SEALED RFPS WILL BE RECEIVED UNTIL 2:00:00 THURSDAY, JULY 7, 2022 AT THE OFFICE OF Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 31d Floor, Suite 301 Port Lavaca, Texas 77979 PUBLIC OPENING of the RFP will be conducted at 2:00 PM, Thursday, July 7, 2022 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, V Floor, Suite 301, Port Lavaca, Texas 77979. The RFPs will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all bidders that submitted a bid and will also be posted on the County's website (www.calhouncotx.org) under Bid Notices and Results, Results 2022 as soon as time permits. v 4 REQUEST FOR PROPOSAL Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive sealed proposals for: HAZARD MITIGATION PLAN DEVELOPMENT AND GRANT MANAGEMENT SERVICES, RFP 2022.07 Calhoun County is soliciting proposals for a consultant with expertise in Hazard Mitigation Planning to develop and prepare a Multi -Jurisdictional Hazard Mitigation Plan for Calhoun County and to apply for and manage the grant funds associated with the project. Calhoun County seeks to hire a consultant to develop and prepare a Multi -Jurisdictional Hazard Mitigation Plan for Calhoun County and participating taxing entities. The plan shall be compliant with the criteria set forth in the Robert T. Stafford Disaster Relief and Emergency Assistance Act, Public Law 93-288, 42 U.S.C. §5121, et seq. (the "Stafford Act"), as amended by the Disaster Mitigation Act of 2000, Public Law 106-390 ("DMA 2000"), and the requirements set forth under 44 C.F.R. Part 201, §201.6, and other applicable State and Federal requirements, as determined by the Federal Emergency Management Agency (FEMA). The Request for Proposal for Hazard Mitigation Plan Development and Grant Management Services, RFP 2022.07 can be downloaded from the County's website, www.calhouncotx.org, or by contacting Peggy Hall, Calhoun County Assistant Auditor at 361-553-4610 or peggy.hall@calhouncotx.org. SEALED RFPS ARE DUE ON OR BEFORE 2:00:00 PM, THURSDAY, JULY 7, 2022. At that time, all RFPs will be publicly opened and acknowledged in the County Judge's office in the Calhoun County Courthouse at 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. It is the responsibility of the submitting person or entity that the sealed proposal is received in a timely manner. Proposals received after the deadline will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting person or entity. All RFPs, consisting of one (1) original and four (4) copies must be delivered to the Office of the Calhoun County Judge in a sealed 9 x 12 or larger envelope, clearly marked on the outside: RFP 2022.07, Hazard Mitigation Plan Development and Grant Management Services Calhoun County does not accept faxed or emailed RFPs. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the RFP is received and the time the RFPs will be opened. Page 1 of 2 Sealed RFPs may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 3rd Floor, Suite 301 Port Lavaca, TX 77979 Calhoun County Commissioners Court reserves the right to waive any formality or irregularity, reject any or all RFPs and to accept the RFP deemed most advantageous to and in the best interest of Calhoun County. Calhoun County reserves the right to negotiate with any and all persons or entities submitting proposals, per the Texas Professional Services Procurement Act and the Uniform Grant and Contract Management Standards. Successful proposer must be able to meet all requirements set forth in the Request for Proposal. Calhoun County is an Affirmative Action/Equal Opportunity Employer. Calhoun 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. Calhoun County strives to attain goals for Section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C. 1701u) as amended. Contractor shall abide by all Local, State and Federal requirements within the RFP. Cindy Mueller County Auditor Calhoun County, Texas Page 2 of 2 RFP 2022.07 FOR HAZARD MITIGATION PLAN DEVELOPMENT AND GRANT MANAGEMENT SERVICES Calhoun County is issuing a Request for Proposal (RFP) from qualified consultant providers to perform all aspects of preparing and submitting to the Federal Emergency Management Agency (FEMA) a Hazard Mitigation Grant application, or other grant applications, for the development of an updated plan for Calhoun County. If the grant is approved, the consultant will develop the multi- jurisdicaitonal Hazard Mitigation Plan, which will address all natural and man made hazards that can affect this County. The purpose of this update is to renew data regarding potential hazards, revise mitigation actions for each partner entity and analyze the overall risk assessment for the County. The update will also be an opportunity to evaluate past mitigation actions and explore new means of mitigation potential hazard losses. The revisions must meet all state and federal requirements. The existing Calhoun County Hazard Mitigation Plan will be revised, updated and submitted to the Texas Division of Emergency Management (TDEM). A FEMA-approved hazard mitigation grant is required in order to develop the plan and the awarded consultant will have expertise in developing both Hazard Mitigation Assistance plans and grants. A Hazard Mitigation Plan is required for eligibility for grant funds through FEMA's pre -disaster grant programs such as Pre -Disaster Mitigion (PDM) and Flood Mitigation Assistance (FMA) and post - disaster grant programs such as Public Assistance (PA) and Hazard Mitigaiton Grant Programs (HMGP). Federal Grant Program awards funds to local governments and non-profit organizations to implement mitigation projects identified as part of a FEMA-approved hazard mitigation plan. All incorporated cities in Calhoun County are expected to be included in the update. Other entities (as required and/or allowed by law) such as School Districts, Soil and Water Conservations Districts located within Calhoun county are invited and encouraged to participate. The RFP assesses expertise in the planning process, experience in developing and updating risk and vulnerability assessments, analyzing previous mitigation actions and developing new strategies and the ability to provide quality public outreach to stakeholders and strategic partners. The consultant must have a working relationship with TDEM and FEMA and demonstrate experience in the review and editing process. 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. Page 1 of 4 Statement of Qualifications Calhoun County is seeking to contract with a well -qualified consultant provider experienced in revising and updating existing Hazard Mitigation Plans and grants/contracts application and management. Please provide the following information: • A brief history of the proposing entity, including general background, knowledge of and experience working with relevant agencies • Related experience in Hazard Mitigation Plans • Related experience in applying for and managing federally -funded projects • A description of work performance and experience with mitigation programs (include if projects were completed on schedule and references from current/past clients) • A description of the service provider's capacity to perform the requested work as well as resumes of all employees who will or may be assigned to provide services if your entity is awarded the RFP • A statement substantiating the service provider's resources and the ability to carry out the work requested in a timely manner. Proposed Cost of Services Provide your cost proposal to accomplish the scope of work stated above and for any additional services required. The proposal must include all costs that are necessary to successfully complete the requirements of this RFP. Please note that the lowest best proposal will not be used as the sole basis when awarding this RFP. Profit (either %/ actual cost) must be identified and negotiated as a separate element of the price of the contract. To comply, the proposer must disclose and certify in their proposal the percentage of profit being used. Evaluation Criteria Proposals received by the date and time due will be evaluated and ranked according to the following criteria: Criteria Experience Work Performance Maximum Points Points 30 30 Capacity to Perform 20 Proposed Cost 20 Total Maximum Points 100 Page 2 of 4 Contracting with small and minority businesses, women's business enterprises and labor surplus area firms: Small and minority businesses , women's business enterprises and labor surplus area firms are encouraged to participate in this RFP. If the awarded proposer is a prime contractor and may use subcontractors, the following affirmative steps are required of the prime contractor. 1. Placing qualified small and minority businesses and women's business enterprises on solicitation lists; 2. Assuring that small and minority businesses and women's business enterprises are solicited whenever they are potential sources; 3. Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses and women's business enterprises; 4. Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses and women's business enterprises; and 5. Using the services and assistance, as appropriate, of such organizaations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce. Submission Requirements Submit in the following order: • Statement of Qualifications • Proposal of Cost of Services — Initial Grant Application(s) and Updating Calhoun County's current Hazard Mitigation Plan • Affidavit • Certificate of Insurance —A copy of your current certificate of insurance for professional liabilty • Certification of Interested Parties, Form 1295 • Conflict of Interest Questionnaire, Form CIQ • Certification Regarding Debarment & Suspension and Other Responsibilty Matters • Certification Regarding Lobbying • Disclosure of Lobbying Activities • House Bill 89 • Residence Certification • System for Award Management — Consultant/Firm, and its Principals, must not be debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM) or the State of Texas Comptroller Debarred Vendor List. Include verification that your company as well as the company's principals are not listed (are not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date. Page 3 of 4 Deadline for Submission The complete proposal and all required information and forms, consisting of one (1) original and four (4) copies must be received in the Office of the Calhoun County Judge before 2:00:00 PM, Thursday, July 7, 2022. It is the responsibility of the submitting person/entity to ensure that the proposal is received in a timely manner. Proposals received after the deadline will not be considered for award, regardless of whether or not the delay was outside the control of the submitting person/entity. Calhoun County does not accept faxed or emailed RFPs. Sealed RFPs may be mailed or hand delivered to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street, Suite 301 Port Lavaca, TX 77979 The RFP must be delivered in a sealed 9 x 12 or larger envelope, clearly marked on the outside: RFP 2022.07, Hazard Mitigation Plan Development and Grant Management Services For questions regarding how to obtain the RFP, please contact Peggy Hall, Calhoun County Assistant Auditor at 361-553-4610 or by email at peggy.hall@calhouncotx.org. Calhoun County reserves the right to reject any and all bids to insure full compliance with applicable laws, to waive any formality or irregularity and to accept the RFP deemed most advantageous to and in the best interest of Calhoun County. Calhoun County reserves the right to negotiate with any and all persons/entities submitting proposals, per the Texas Professional Services Procurement Act and the Uniform Grant and Contract Management Standards. Successful proposer must be able to meet all requirements set forth in the Request for Proposal. Calhoun County is an Affirmative Action/Equal Opportunity Employer. Calhoun 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. Calhoun County strives to attain goals for Section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C. 1701u) as amended. Page 4 of 4 Rating Sheet Hazard Mitigation Plan Development and Grant Management Services Name of Respondent Evaluator's Name Date of Rating Rate the Respondent of the Request For Proposal (RFP) by awarding points up to the maximum listed for each factor. Information necessary to assess the Respondent on these criteria maybe gathered either from past :xperience with the Respondent and/or by contacting past/current clients of the Respondent Experience Factors Max.Pts. Score 1. Related Experience / Background with federally funded projects 10 2. Related Experience / Background with specific project type 10 3. References from current/past clients 5 4. Familiarity of County and Demographics 5 Subtotal, Experience 30 Work Performance Factors Max.Pts. Score 1. Submits and Responds to client requests in a timely manner 5 2. Past client projects completed on schedule 5 3. Work product is consistently of high quality with low level of errors 5 4. Past client projects have low level of monitoring findings/concerns 10 5. Manages projects within budgetary constraints 5 Subtotal, Performance 30 Capacity to Perform Factors Max.Pts. Score 1. Qualifications of Professional Administrators / Experience of Staff 5 2. Present and Projected Workloads 5 3. Quality of ProposalNVork Plan 5 4. Demonstrated understanding of scope of the Project 5 Subtotal, Capacity to Perform 20 Proposed Cost Factors Max.Pts. Score Proposed cost within project delivery and administration 20 Subtotal, Proposed Cost 40 TOTAL SCORE FROM EACH ABOVE CATEGORY Max.Pts. Score ❑ Experience 30 ❑ Work Performance 30 ❑ Capacity to Perform 20 ❑ Proposed Cost 20 Total Score 100 REQUIRED RFP FORMS Return the following when submitting your RFP • Statement of Qualifications • Proposal of Cost of Services for Initial Grant Application(s) and Updating Calhoun County's current Hazard Mitigation Plan • Affidavit • Certificate of Insurance - A copy of your current certificate of insurance that includes coverage for professional liability insurance • Certification of Interested Parties, Form 1295 • Conflict of Interest Questionnaire, Form CIQ If not applicable, mark "NA" and return with your RFP • Certification Regarding Debarment & Suspension and Other Responsibility Matters • Certification Regarding Lobbying • Disclosure of Lobbying Activities If not applicable, mark "NA" and return with your RFP • House Bill 89 • Residence Certification • System for Award Management — Consultant/Firm, and its Principals, must not be debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM) or the State of Texas Comptroller Debarred Vendor List. Include verification that your company, as well as the company's principals, are not listed (are not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date. INSERT STATEMENT OF QUALIFICATIONS • Statement of Qualifications (See page 2 of 4) Insert Cost Proposal Include the following with your Cost Proposal: • Fee(s) for Initial Grant Applications for updating Calhoun County's current Hazard Mitigation Plan • Fee(s) for Updating Calhoun County's current Hazard Mitigation Plan STATE OF TEXAS {} COUNTY OF {} (Type or Print Name) the of AFFIDAVIT being first duly sworn, deposes and says: that he or she is (Type or Print Title) (Type or Print Name of Company/Firm) principal address at (Type or Print Physical and Mailing Address) having its who submits herewith to Calhoun County the attached bid/proposal; that he or she is the person whose name is signed to the attached bid/proposal; that said bid/proposal is genuine; that the same is not sham or collusive; that all statements of fact herein are true; and that such bid/proposal was not made in the interest or behalf of any person, partnership, company, association, organization or corporation not herein named or disclosed. Affiant further deposes and says: that the bidder/proposer has not directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interests of Calhoun County, or of any other bidder/proposer, or anyone else interested in the bid/proposal contract; and that the bidder/proposer has not in any manner sought by collusion to secure for himself/herself/itself/themselves an advantage over any other bidder/proposer. Affiant further deposes and says: that prior to the public opening and reading of bids/proposals, said bidder/proposer: a) did not, directly or indirectly, induce or solicit anyone else to submit a false or sham bid/proposal; b) did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder/proposer or anyone else would submit a false or sham bid/proposal, or that anyone should refrain from submitting a bid/proposal or withdraw their bid/proposal; c) did not, in any manner, directly or indirectly, seek by agreement, communication or conference with anyone to raise or fix the bid price/proposal of said bidder/proposer or of anyone else, or to raise or fix any overhead, profit or cost element of their price/fee or of that of anyone else; d) did not give, offer to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid/proposal; and e) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative hereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent, thereof, to any individual or group of individuals, or to any official, employee or agent of Calhoun County prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained in this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and requirements contained in the bid/proposal. Signature of Affiant Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of , 20 Notary Public, State of Stamp/Seal Commission Expires _ INSERT CERTIFICATE OF INSURANCE • Return a copy of your current Certificate of Liability Insurance with your RFP. At this time, this copy does not require listing Calhoun County as an additional insured. This copy of your current insurance will provide proof that you carry at least the minimum required coverage. • Once an award is made, the awarded proposer shall provide Calhoun County a Certificate of Liability Insurance that reflects that Calhoun County is an additional insured. INSERT CERTIFICATE OF INTERESTED PARTIES FORM 1295 • Form 1295 must be filled out online, printed, signed and returned with your RFP. The copy included is a Sample Copy Only. See next page for help with Form 1295 CERTIFICATE OF INTERESTED PARTIES, FORM 1295 Form 1295 must be filled out online, submitted, printed, signed and returned with the RFP. 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: 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 RFP 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 2022.07 Hazard Mitigation Development and Grant Management Services On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, submit and print After printing, the respondent or an authorized agent of the respondent must sign and date. (all of #6 must be completed) 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 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. C 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. • 3 Provide the identification number used by the governmental entity or state agency to tffffffrrriii�������kP Identify the contract, and provide a description of the services, goods, or other property to be provided uie contract. 4 City, State, Country Nature of Interest (check applicable) Name of Interested Party (place of business) ' f • Controlling Intermediary 5 Check only if there'I terested Party. El 6 UNSWORN DECjthQ , N My name is V , and my date of birth is My addre4No , (street) (city) (state) (zip code) (country) �d under penalty of perjury that the foregoing is true and correct. \Executed in County, Slate of on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission w ethics.state.tx.us Revised 12/22/2017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 BACKGROUND Section 2252.908 was added to the Government Code by the 84" Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85" Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal he+i, v 12tiiC N.11, , r1 ic�� C 11 in i;,! ni I= );.h u:. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract or bid with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract or awards a bid with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Ethics Commission. CONFLICT OF INTEREST QUESTIONNAIRE FORM 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. 11 Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? FlYes E-1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes E-1 No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www. ethics. state.tx. us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code § 176.0010-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code & 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code G 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a —d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 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. 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, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Contractors Authorized Official Printed Name and Title of Contractor's Authorized Official Date Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a, bid/offer/application a. initial filing b. grant b. initial award _ b. material change c. cooperative agreement c. post -award d. loan For material change only: e. loan guarantee Year quarter E loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Prime Subawardee Name and Address of Prime: Tier , if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program NameMescription: CFDA Number, if applicable: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if' (if individual, last name, first name, MI): d(fferentfr»rn No. IOa) (last game, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 HOUSE BILL 89 VERIFICATION CERTIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2270.001 the undersigned representative of Representative (hereafter referred to as Company) being an Company or Business Name adult over the age of eighteen (18) years of age, verify that the Company named above, under the provisions of Subtitle F, Title 10, Texas Government Code Chapter 2270: 1. Does not currently boycott the country of Israel; and 2. Will not boycott the country of Israel during the term of the contract with Calhoun County, Texas. Pursuant to 2270.001, Texas Government Code: 1. 'Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means o for -profit sole proprietorship, organization, association, corporation, partnership, Joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. Signature of Representative Print Name & Title Date State law requires certification from a Company for contracts (which includes contracts formed through purchase orders) involving goods or services regardless of the amount. RESIDENCE CERTIFICATION 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) ❑ 1 certify that (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as INSERT SYSTEM FOR AWARD MANAGEMENT (SAM) RECORD SEARCH FOR COMPANY AND COMPANY'S PRINCIPAL(S) • Complete and return with your RFP • Include a printout of the search results that includes the record date REQUIRED CONTRACT PROVISIONS • Applicable contract provisions must be included in all contracts executed as a result of this RFP REQUIRED CONTRACT PROVISIONS 2 CFR 200.326 Contract provisions. The non -Federal entity's contracts must contain the applicable provisions described in Appendix II to Part 200—Contract Provisions for non -Federal Entity Contracts Under Federal Awards. The non -Federal entity's contracts must contain the applicable provisions described in Appendix II to Part 200—Contract Provisions for non -Federal Entity Contracts Under Federal Awards. All Contracts THRESHOLD PROVISION CITATION Contracts for more than the simplified acquisition threshold currently set at >$150,000 $150,000, which is the inflation adjusted amount determined by the Civilian (Simplified Agency Acquisition Council and the Defense Acquisition Regulations Council 2 CFR 200 Acquisition (Councils) as authorized by 41 U.S.C. 1908, must address administrative, APPENDIX II Threshold) contractual, or legal remedies in instances where contractors violate or breach (A) contract terms, and provide for such sanctions and penalties as appropriate. All contracts in excess of $10,000 must address termination for cause and for 2 CFR 200 >$10,000 convenience by the non -Federal entity including the manner by which it will be APPENDIX II effected and the basis for settlement. (B) Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of "funding agreement' under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or 2 CFR 200 None performance of experimental, developmental, or research work under that "funding APPENDIX II (F) agreement" the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government - wide exclusions in the System for Award Management (SAM), in accordance with 2 CFR 200 None the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR APPENDIX II part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension" SAM Exclusions contains the names of parties debarred, (H) suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. Records of non -Federal entities. The U.S. Department of Housing and Urban Development (HUD), Inspectors General, the Comptroller General of the United States, the Texas General Land Office (GLO), and the pass -through entity, or any of their authorized representatives, must have the right of access to any None documents, papers, or other records of the non -Federal entity which are 2 CFR 200.336 pertinent to the Federal award, in order to make audits, examinations, excerpts, and transcripts. The right also includes timely and reasonable access to the non -Federal entity's personnel for the purpose of interview and discussion related to such documents. Financial records, supporting documents, statistical records, and all other non - Federal entity records pertinent to a Federal award must be retained for a period of three years from the date of submission of the final expenditure report or, for Federal awards that are renewed quarterly or annually, from the date of the None submission of the quarterly or annual financial report, respectively, as reported to 2 CFR 200.333 the Federal awarding agency or pass -through entity in the case of a subrecipient. Federal awarding agencies and pass -through entities must not impose any other record retention requirements upon non -Federal entities. The only exceptions are the following: (a) If any litigation, claim, or audit is started before the expiration of the 3-year period, the records must be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken. (b) When the non -Federal entity is notified in writing by the Federal awarding agency, cognizant agency for audit, oversight agency for audit, cognizant agency for indirect costs, or pass -through entity to extend the retention period. (c) Records for real property and equipment acquired with Federal funds must be retained for 3 years after final disposition. (d) When records are transferred to or maintained by the Federal awarding agency or pass -through entity, the 3-year retention requirement is not applicable to the non -Federal entity. (a) Records for program income transactions after the period of performance. In some cases recipients must report program income after the period of performance. Where there is such a requirement, the retention period for the records pertaining to the earning of the program income starts from the end of the non -Federal entity's fiscal year in which the program income is earned. (0Indirect cost rate proposals and cost allocations plans. This paragraph applies to the following types of documents and their supporting records: indirect cost rate computations or proposals, cost allocation plans, and any similar accounting computations of the rate at which a particular group of costs is chargeable (such as computer usage chargeback rates or composite fringe benefit rates). (1) If submitted for negotiation. If the proposal, plan, or other computation is required to be submitted to the Federal Government (or to the pass -through entity) to form the basis for negotiation of the rate, then the 3-year retention period for its supporting records starts from the date of such submission. (2) If not submitted for negotiation. If the proposal, plan, or other computation is not required to be submitted to the Federal Government (or to the pass -through entity) for negotiation purposes, then the 3-year retention period for the proposal, plan, or computation and its supporting records starts from the end of the fiscal year (or other accounting period) covered by the proposal, plan, or other computation. Contracting with small and minority businesses, women's business enterprises, and labor surplus area firms. (a) The non -Federal entity must take all necessary affirmative steps to assure that minority businesses, women's business enterprises, and labor surplus area firms are used when possible. (b) Affirmative steps must include: None I (1) Placing qualified small and minority businesses and women's business 12 CFR 200.321 enterprises on solicitation lists; (2) Assuring that small and minority businesses, and women's business enterprises are solicited whenever they are potential sources; (3) Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses, and women's business enterprises; (4) Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's business enterprises; (5) Using the services and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce; and (6) Requiring the prime contractor, if subcontracts are to be let, to take the affirmative steps listed in paragraphs (1) through (5) of this section. Verification No Boycott Israel. As required by Chapter 2270, Government Code, CONTRACTOR hereby verifies that it does not boycott Israel and will not boycott Israel through the tens of this Agreement. For purposes of this verification, "boycott Israel" None means refusing to deal with, terminating business activities with, or otherwise taking Texas any action that is intended to penalize, inflict economic harm on, or limit commercial Government relations specifically with Israel, or with a person or entity doing business in Israel or in Code 2270.002 an Israeli -controlled territory, but does not include an action made for ordinary business purposes. Foreign Terrorist Organizations. Pursuant to Chapter 2252, Texas Government Code, [Company] represents and certifies that, at the time of execution of this Agreement neither [Company], nor any wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of the same (i) engages in business with Iran, Sudan, or None any foreign terrorist organization as described in Chapters 806 or 807 of the Texas Texas Government Code, or Subchapter F of Chapter 2252 of the Texas Government Code, rnme Government or (ii) is a company listed by the Texas Comptroller of Public Accounts under Sections Code 252.152 806.051, 807.051, or 2252.153 of the Texas Government Code. The term "foreign terrorist organization" in this paragraph has the meaning assigned to such term in Section 2252.151 of the Texas Government Code. Option Contract Language for contracts The contract award is contingent upon the receipt of CDBG-DR funds. If no such Optional awarded prior to funds are awarded, the contract shall terminate. Grant Award EO Clause for Construction Contracts > $10K including administration & engineering contracts associated with construction contracts THRESHOLD PROVISION CITATION Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, 41 CFR §60- >$10,000 "Equal Employment Opportunity" (30 FIR 12319, 12935, 3 CFR Part, 1964-1965 1.4(b) and Comp., p. 339), as amended by Executive Order 11375, "Amending Executive 2 CFR 200 Order 11246 Relating to Equal Employment Opportunity," and implementing APPENDIX II (C) regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor." 41 CFR 60-1.4 Equal opportunity clause. (b) Federally assisted construction contracts. (1) Except as otherwise provided, each administering agency shall require the inclusion of the following language as a condition of any grant, contract, loan, insurance, or guarantee involving federally assisted construction which is not exempt from the requirements of the equal opportunity clause: The applicant hereby agrees that it will incorporate or cause to be incorporated into any contract for construction work, or modification thereof, as defined in the regulations of the Secretary of Labor at 41 CFR Chapter 60, which is paid for in whole or in part with funds obtained from the Federal Government or borrowed on the credit of the Federal Government pursuant to a grant, contract, loan, insurance, or guarantee, or undertaken pursuant to any Federal program involving such grant, contract, loan, insurance, or guarantee, the following equal opportunity clause: During the performance of this contract, the contractor agrees as follows: (1) The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising, layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. (2) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. (3) The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. (4) The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. (5) The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. (6) The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (7) In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be canceled, terminated, or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. (8) The contractor will include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, that in the event a contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the contractor may request the United States to enter into such litigation to protect the interests of the United States. The applicant further agrees that it will be bound by the above equal opportunity clause with respect to its own employment practices when it participates in federally assisted construction work: Provided, that if the applicant so participating is a State or local government, the above equal opportunity clause is not applicable to any agency, instrumentality or subdivision of such government which does not participate in work on or under the contract. The applicant agrees that it will assist and cooperate actively with the administering agency and the Secretary of Labor in obtaining the compliance of regulations, and relevant orders of the Secretary of Labor, that it will furnish the administering agency and the Secretary of Labor such information as they may require for the supervision of such compliance, and that it will otherwise assist the administering agency in the discharge of the agency's primary responsibility for securing compliance. The applicant further agrees that it will refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965, with a contractor debarred from, or who has not demonstrated eligibility for, Government contracts and federally assisted construction contracts pursuant to the Executive Order and will carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by the administering agency or the Secretary of Labor pursuant to Part II, Subpart D of the Executive Order. In addition, the applicant agrees that if it fails or refuses to comply with these undertakings, the administering agency may take any or all of the following actions: Cancel, terminate, or suspend in whole or in part this grant (contract, loan, insurance, guarantee); refrain from extending any further assistance to the applicant under the program with respect to which the failure or refund occurred until satisfactory assurance of future compliance has been received from such applicant; and refer the case to the Department of Justice for appropriate legal proceedings. (c) Subcontracts. Each nonexempt prime contractor or subcontractor shall include the equal opportunity clause in each of its nonexempt subcontracts. (d) Inclusion of the equal opportunity clause by reference. The equal opportunity clause may be included by reference in all Government contracts and subcontracts, including Government bills of lading, transportation requests, contracts for deposit of Government funds, and contracts for issuing and paying U.S. savings bonds and notes, and such other contracts and subcontracts as the Director of OFCCP may designate. (e) Incorporation by operation of the order. By operation of the order, the equal opportunity clause shall be considered to be a part of every contract and subcontract required by the order and the regulations in this part to include such a clause whether or not it is physically incorporated in such contracts and whether or not the contract between the agency and the contractor is written. (f) Adaptation of language. Such necessary changes in language may be made in the equal opportunity clause as shall be appropriate to identify properly the parties and their undertakings. THRESHOLD PROVISION CITATION Compliance with the Davis -Bacon Act (40 U.S.C. 3141 etseq.) as supplemented by Department of Labor regulations (29 CFR part 5) and with the Copeland "Anti -Kickback" Act (18 U.S.C. 874; 40 U.S.C. 3145) as supplemented in Department of Labor regulations (29 CFR part 3): Davis -Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non -Federal entities must include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing >$2,000 wages specified in a wage determination made by the Secretary of Labor. In 2 CFR 200 addition, contractors must be required to pay wages not less than once a week. The non -Federal entity must place a copy of the current prevailing wage D APPENDIX II ( ) determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non -Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer >$100,000 on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not 2 CFR 200 less than one and a half times the basic rate of pay for all hours worked in excess APPENDIX 11 (E) of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended —Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non -Federal >$150,000 award to agree to comply with all applicable standards, orders or regulations 2 CFR 200 issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671 q) and the Federal APPENDIX 11 (G) Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid 2 CFR 200 for an award exceeding $100,000 must file the required certification. Each tier APPENDIX 11 (1) >$100,000 certifies to the tier above that it will not and has not used Federal appropriated and funds to pay any person or organization for influencing or attempting to influence 24 CFR an officer or employee of any agency, a member of Congress, officer or §570.303 employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier uo to the non -Federal award. All Section 3 covered contracts shall include the following clause (referred to as the Section 3 clause): A. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD -assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR part 135, which implement Section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and >$100,000 training positions, the qualifications for each; and the name and location of the 24 CFR §135.38 person(s) taking applications for each of the positions; and the anticipated date the work shall begin. D.The contractor agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR part 135. E. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR part 135. F. Noncompliance with HUD's regulations in 24 CFR part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. G.With respect to work performed in connection with Section 3 covered Indian housing assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (i) preference and opportunities for training and employment shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of Section 3 and section 7(b) agree to comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with section 7(b). A non -Federal entity that is a state agency or agency of a political subdivision of a state and its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the 2 CFR 200 item exceeds $10,000 or the value of the quantity acquired during the preceding APPENDIX II (J) fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. [78 FIR 78608, Dec. 26, 2013, as amended at 79 FIR 75885, Dec. 19, 2014] Mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the 42 U.S.C. 6201 Energy Policy and Conservation Act. Calhoun County, Texas General Conditions The General Conditions are part of this RFP CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law• Bidder/Vendor is advised that the Bid, RFP, RFQ, and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ, and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFQ and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ, and/or Contract is due. The Bid, RFP, RFQ, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ, and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ, and/or Contract in collusion with any other bidder/vendoror any official oremployee of Calhoun County, and that the contents of this Bid, RFP, RFQ, and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidder's/vendor's Bid, RFP, RFQ and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Page 1 of 13 Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ, and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ, and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ, and/or Contract will specify the date and time due. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ and/or Contract is received and the time the Bid, RFP, RFQ and/or Contract will be opened. A late delivery with an early postmark or deliveryof the Bid, RFP, RFQ and/or Contract to the wrong office will not suffice. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ, and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ, and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ or Contract. If the Bid, RFP, RFQ, and/or Contract is sent by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ, and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ, and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ and/or Contract price. Bids, Page 2 of 13 RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ, and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum. Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendor's performance under this Bid, RFP, RFQ and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes. Tax exempt forms will be furnished upon request to the Calhoun County Auditor's Office. Page 3 of 13 Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards• Calhoun County reserves the right to award this Bid, RFP, RFQ and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ, and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the solejudge in determining which Bid, RFP, RFQ and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ, and/or Contract based on lowest and/or best Bid, RFP, RFQ, and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ, and/or Contract" means a bid or offer providing the best value considering associated direct Page 4 of 13 and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment• The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ, and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFQ, and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet Page 5 of 13 specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Rejections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFC, and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFQ, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFC, and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFC, and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFC, and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFC, and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 84th Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 6 of 13 � a Y Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf_info_forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity' includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract' includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFQ, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFQ and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Bid, RFP, RFQ and/or Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than thirty (30) days after Calhoun County Commissioners Court approves a contract, or awards a Bid, RFP, and/or RFQ with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Page 7 of 13 " , Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ, and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFQ, and/or Contract submission and the time of execution of the Bid, RFP, RFC, and/or Contract. A print out of the search results, including principals, if any, from the System for Award Management (www.SAM.gov) that includes the record date must be included with the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFC, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Page 8 of 13 o. U Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ, Contract, order, and/or service. In the event a Bid, RFP, RFQ Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFQ, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFQ, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFQ, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and Page 9 of 13 1 be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Majeure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFC, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFQ, and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFC, and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFQ and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFQ, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFC, and/or Contract. Otherwise, Texas state and federal law shall apply. Page 10 of 13 Prohibition against Personal Interest in Bids. RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFQ, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ, and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ, and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFQ, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ, and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. General Liability ($100,000/$300,000 or greater) Workers' Compensation (at Statutory Limits) Employer's Liability ($1,000,000 or greater) Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) Professional Liability Insurance (if applicable) Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of Page 11 of 13 the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFC, and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFC, and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFC, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFC, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: Name, mailing address and business phone number of the protesting party; Appropriate identification of the Bid, RFP, RFQ and/or Contract being protested; A precise statement of the reasons for the protest; and Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. Page 12 of 13 If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFC, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or byjudicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Cindy Mueller Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: cindy.mueller@calhouncotx.org To request a Bid, RFP, and/or RFQ packet from Calhoun County, or information on how to obtain a packet, please contact: Peggy Hall Assistant Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 Email: peggy.hall@calhouncotx.org Bids, RFPs, and/or RFQs may also be viewed on Calhoun County's website, www.calhouncotx.org, under Bid Notices and Results. Page 13 of 13 NOTICE OF MEETING—6/13/2022 7. Consider and take necessary action to authorize Commissioner Behrens to sign a rental agreement with United Rentals for a 2018 Freightliner Dump Truck (10 —14 yards). (JMB) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 12 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Fort Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309 Email: icel.behrens(Oca)houncotx.ors Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for June 13, 2022. • Please Consider and Take Necessary Action to authorize Commissioner Behrens to sign rental agreement with United Rentals for a 2018 Freightliner Dump truck (10-14 yds). Sincerely, ?, Joel Behrens Commissioner Pct. 3 0United Rentals 8RNINCe 53P 8428 FUQUA 8T HOUSTON Tr 77075-3524 346-271-7224 409-942-4320 PAr m PRECINCT 3 i 24627 STATE HIGHWAY 172 PORT LAVACA TX 77979-6032 A h Office: 361-553-4612 Cell: 361-920-2173 CALHOUN COUNTY 211 S ANN ST PORT LAVACA TX RENTAL RESERVATION Customer # : 1255062 Reserved Date : 05/11/22 Scheduled Out : 06/20/22 10:00 AM Estimated In : 07/18/22 10:00 AM UR Job Loa : PRECINCT 3 UR Job # : 23 Customer Job ID: P.O. # : TBD Ordered By : JOEL BEHRENS Written By : ROGERIO ATKINSON Salesperson : ROGERIO ATKINSON 77979-4203 This is not an invoice Please do not pay from this document otY Equipment Description Minimum Day Week 4 Week Estimated Amt. 1 9527075 TRUCK DUMP 10-14 YARD CDL 676.70 1,644.94 4,236.85 4,239.85 UNIT # 10675766 MAKE FREIGHTLINER MODEL M2 106 DUMP YEAR 2018 SALES/MISCELLANEOUS ITHMS: Rental Subtotal: 4,236.85 Oty Item Price Unit of Measure Extended Amt. 1 DELIVERY CHARGE 450.000 EACH 450.00 1 PICKUP CHARGE 450.000 EACH 450.00 Sales/Mist Subtotal: 900.00 Agreement Subtotal: 5,136.85 COMMENTS/NOTES: Estimated Total: 5,136.85 CONTACT: JOEL BEHRENS CELL#: 361-920-2173 NOTICE: This Is note rental agreement. The rental of equipmentand any hems listed above is subjeet to evailablllty and subject to Ne mans and conditions of the Rental and Service Agreement, which are available at hhpslAvow.ungedmntals.WnViegaUmnialsemic tarms.US and which are incorponds I herein by reference. A COPY OF THE RENTAL AND SERVICE AGREEMENT TERMS AREAVAILAELE IN PAPER FORM UPON REQUEST. Page: 1 CERTIFICATE OF INTERESTED PARTIES FORM 1295 tnu Cmnplete Nos. 1 -4 and 6 if there are interested parties. OFFICE +U SE ONLY® Complete Nos. 1. 2. 3 5, and 6 if there ate no interested panes. CERTIFICATION OF FILING ^ert:ificafz Iumbaj- 1 Name of business entity filing form, and the city, state and country of the business en Ais place of business. )022-59458 i Urited Rentals (North America), Inc Stamford, CT United States Dax Filed: O6i O,r2022 2 Name of governmental entity or state agency that is a party to the contract for which b1E IOftlhis - be ng riled. Calhoun County Devx Acknowledged: a Provide the identification number used by the governmental entity or state agency to rratle or identify the contrztct, end provide it description of the services, goods, or other property to be provided underthe contract. Calhoun County Rent/sell construction equipment. Training 4 Name of Interested Parry —� City, State, country (place: of business) Nature of of intev (elect( applicable) C inc..11ing Intermediary Patel, Diren Houston, i'X Lined States X United Rentals, Inc. (parent company) STAMFORD CT United Stases X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is L 12E� f �T�G anc my idea of birth is, My address is (street) pity) tsmte) 'zip ode; (wuniry) I declare under penalty of perjury that the foregoing is true arid correct. Ex-xuted in fFA-R.k 1 5 _County, Slate of ZG-'XR� or the -i, day a I__ 31]vd-- . 2g Z. Z tmon:ul Ucaq Signature of authc-c: - ajern ' conuacting burwas; en; y (Decia m i-orms provtaea ay t exas tunics commission www.ethics,state.txxu Version V1.1.191b5.dc i NOTICE OF MEETING — 6/13/2022 8. Consider and take necessary action to transfer a 2004 Chevrolet Suburban VIN #1GNEC16Z44R208769, Asset # 541-0167 from department 310 to Precinct 3, R & B 560 assets. (JMB) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 12 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 —Office (361) 893-5346 — Fax (361) 893-5309 Email: icel,behrensna.calhouncotx.ors Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for June 13, 2022. • Please Consider and Take Necessary Action to transfer 2004 Chevy Suburban VIN# 1GNEC16Z44R208769 asset # 541-0167 from dept. 310 to Precinct 3, R & B 560 assets. Sincerely, Joel Behrens Commissioner Pct. 3 Calhoun County, Texas DEPARTMENTAL INVENTORY TRANSFER REQUEST FORM Requested By: COMMI55IONER JOEL BEHRENS Inventory Number Description Serial No. Transfer FromfTo Department 541-0617 2004 CHEVY SUBURBAN 1GNEC16Z44R208769 FROM DEPT. 310 TO DEPT. 560 #9 NOTICE OF MEETING — 6/13/2022 9. Consider and take necessary action to accept the donation of 960 postcards from Philip Thomae to the museum gift shop. (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 5 of 12 Mae Belle Cassel From: Vicki.Cox@calhouncotx.org (Vicki Cox) <Vicki.Cox@calhouncotx.org> Sent: Tuesday, June 7, 2022 8:58 AM To: Mae Belle Cassel Subject: donation Mae Belle, Please add the following agenda item for the next available Commissioner's Court: •Consider and take necessary action to authorize the donation of 960 postcards from Philip Thomae to the museum gift shop. Thanks! Vicki Cox Director Calhoun County Museum Calhoun County Texas #10 NOTICE OF MEETING — 6/13/2022 10. Consider and take necessary action to accept the attached list of donations for the month of May 2022 to the Calhoun County Library. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 12 Mae Belle Cassel From: dsanchez@cclibrary.org (Dina Sanchez) <dsanchez@cclibrary.org> Sent: Friday, June 3, 2022 4:33 PM To: Mae Belle Cassel Subject: Commissioner's Court Agenda for June 15th Attachments: CCLBScan.pdf 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 evening, can you please add this to the agenda for the next Commissioner's Court Meeting (June 15): 1. Consider and take necessary action to accept the attached list of donations for the month of May to the Calhoun County Library. 2. Consider and take necessary action to declare the attached list of items from the Calhoun County Library as surplus/salvage for the month of May 3. Consider and take necessary action to declare the attached list of items from the Calhoun County Library as waste for the month of May Thank you Calhoun County Texas Calhoun County Public Library Wvnv ccl,hrary ar3 200 W. Mahan I Port Lavaca, TX 77979 Ph: 361.552.7323 Fax: 361.552 5218 Report May 2022 The following materials have been donated to the Calhoun County Public Library System during the month of May 2022 Books Donor 23 Jennie James 4 Barry Hunter 1 Elaine Quesaba 13 Nai-Wen Chang 69 Unknown Paperbacks Donor 7 Elaine Quesaba 29 Barbara Nichols 5 Jeane Clark 80 Unknown DVD Donor 9 NoemiCruz 17 Unknown Others Donor $11.00 Donations to Port O'Connor Library $6.10 Donations to Seadrift Library #11 NOTICE OF MEETING—6/13/2022 11. Consider and take necessary action to declare the attached list of items from the Calhoun County Library as Surplus/Salvage for the month of May 2022. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 12 Calhoun County Public Library W"P.Y cc li Brety Ora 200 W. Mahan I Port Lavaca, TX 77979 Ph: 361.552.7323 Fax: 361.552.5218 Report May 2022 I would like the following to be declared Surplus/Salvage 46 Books 72 Paperbacks 6 DVD #12 NOTICE OF MEETING — 6/13/2022 12. Consider and take necessary action to declare the attached list of items from the Calhoun County Library as Waste for the month of May 2022. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 12 Calhoun County Public Library "M cOihrary erg 200 W. Mahan I Port Lavaca, TX 77979 Ph; 361 552,7323 Fax: 361,552,5218 Report May 2022 I would like the following items to be declared waste 23 Books #13 NOTICE OF MEETING-6/13/2022 13. Consider and take necessary action to declare the attached list of items from Memorial Medical Center as Surplus/Salvage. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 12 Calhoun County, Texas Surplus/Salvage Declaration Request Form Department Name: Memorial Medical Center— County Auction - JUNNE Requested By: Roshanda Thomas, Interim CE�_%'- '_Q Department Item Quantity Diagnostic Imaging cloth chairs (gray/blue) 4 ICU Waiting Room Sofas (nautical pattern) 2 ICU Waiting Room Guest Chairs (Blue) 2 ICU Waiting Room Guest Chair (nautical pattern) 1 ICU Waiting Room Ottoman (nautical pattern) 1 ICU Waiting Room Floor Lamp 1 M/S Waiting Rm 4 Seat Bench (green) 1 M/S Waiting Rm 3 Seat Bench (green) 2 OB Waiting Room Loveseat 2 OB Waiting Room Sofa 1 OB Waiting Room Cloth Chairs (maroon) 3 OB Waiting Room Coffee Table 1 ICU Patient Recliners 4 ICU Sleeper Chairs 3 OB Sleeper Chairs 2 OB Nightstands 4 OB Coffee Table 1 Med/Surg Sleeper Chairs 13 Med/Surg Nightstands 14 OR/PACU Cloth Chairs 8 Lab 2 chair/table combo (blue dot pattern) 2 Lab Patient Recliner (green) 1 Hallway by MRI 3 seat bench (green) 2 ER Waiting Rm Sofa/Table/Chair Combo (maroon) 2 ER Waiting Rm Single Chairs (maroon) 2 ER Waiting Rm Double Chairs (maroon) 4 ER Waiting Rm Triple Chairs (maroon) 2 ER Waiting Rm Guest Chairs (Dotted) 6 3rd floor lobby Pink 3 seat bench 1 3rd floor lobby Pink guest chair 1 #14 I NOTICE OF MEETING — 6/13/2022 14. Accept Monthly Reports from the following County Offices: i. District Clerk — May 2022 ii. Justice of the Peace, Precinct 1 — May 2022 III. Justice of the Peace, Precinct 2 — May 2022 iv. Justice of the Peace, Precinct 3 — May 2022 v. Justice of the Peace, Precinct 4 — May 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 10 of 12 *Treasurer Receipt Numbers: F2022MAY006, 007,012,027,045 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/3/2022 ACCOUNT NUMBER COURT NAME: DISTRICT CLERK MONTH OF REPORT: MAY YEAR OF REPORT: 2022 ACCOUNT NAME DEBIT CREDIT 1000-001-44190 SHERIFF'S SERVICE FEES $3,190.18 1000-001-44140 JURY FEES $140.00 1000-001-44045 RESTITUTION FEE $4.81 1000-001-44020 DISTRICT ATTORNEY FEES $0.00 1000-001-49010 REBATES -PREVIOUS EXPENSE $278.36 1000-001-49030 REBATES-ATTORNEY'S FEES $1,179.32 1000-001-44058 DISTRICT CLERK ELECTRONIC FILING FEES $0.00 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEES $81.11 1000-001-43049 STATE REIMB- TITLE IV-D COURT COSTS $0.00 DISTRICT CLERK FEES CERTIFIED COPIES $582.53 CRIMINAL COURT $223.84 CIVIL COURT $3,215.49 STENOGRAPHER $325.00 CIV FEES DIFF $0.00 1000-001-44050 DISTRICT CLERK FEES $4,346.86 1000-999-20771 FAMILY VIOLENCE FINE $0.00 1000-999-10010 CASH - AVAILABLE $9,220.64 2706-001-44055 FAMILY PROTECTION FEE $0.00 2706-999-10010 CASH - AVAILABLE $0.00 2740-001-45055 FINES - DISTRICT COURT $3,582.16 2740-999-10010 CASH - AVAILABLE $3,582.16 2620-001-44055 APPELLATE JUDICIAL SYSTEM $65.00 2620-999-10010 CASH - AVAILABLE $65.00 2648-001-44055 COURT FACILITY FEE FUND $260.00 2648-999-10010 CASH - AVAILABLE $260.00 2670-001-44055 COURTHOUSE SECURITY $332.04 2670-999-10010 CASH -AVAILABLE $332.04 2673-001-44055 CRT RECS PRESERVATION FUND- CO $90.98 2673-999-10010 CASH - AVAILABLE $90.98 2725-001-44055 LANGUAGE ACCESS FUND $39.00 2725-999-10010 CASH - AVAILABLE $39.00 2739-001-44055 RECORD MGMT/PRSV FUND - COUNTY $536.57 2739-999-10010 CASH -AVAILABLE $536.57 2737-001-44055 RECORD MGMT/PRSV FUND -DIST CLRK $84.56 2737-999-10010 CASH - AVAILABLE $84.56 2731-00144055 LAW LIBRARY $455.00 2731-999-10010 CASH - AVAILABLE $455.00 2663-001-44050 CO & DIST CRT TECHNOLOGY FUND $22.40 2663-999-10010 CASH-AVAILABL $22.40 7040-999-20740 BREATH ALCOHOL TESTING - STATE $0.00 7040-999-10010 CASH - AVAILABLE $0.00 2667-001-44055 CO CHILD ABUSE PREVENTION FUND $100.08 2667-999-10010 CASH - AVAILABLE $100.08 7502-999-20740 JUDICIAL & COURT PERSONNEL TRAINING FUND -STATE $30.00 7502-999-10010 CASH-AVAILABE $30.00 7383-999-20610 DNA TESTING FEE - County $0.55 7383-999-20740 DNA TESTING FEE - STATE $4.99 7383-999-10010 CASH - AVAILABLE $5.54 7405-999-20610 EMS TRAUMA FUND - COUNTY $24.13 7405-999-20740 EMS TRAUMA FUND - STATE $217.14 7405-999-10010 CASH - AVAILABLE $241.27 7070-999-20610 CONSOL. COURT COSTS - COUNTY $23.47 7070-999-20740 CONSOL. COURT COSTS - STATE $211.28 7070-999-10010 CASH - AVAILABLE $234.75 7072-999-20610 STATE CONSOL. COURT COSTS- COUNTY $91.60 7072-999-20740 STATE CONSOL. COURT COSTS- STATE $824.44 7072-999-10010 CASH -AVAILABLE $916.04 2698-001-44030-010 DRUG CRT FROG FEE - COUNTY (PROGRAM) $106.44 2698-999-10010-010 CASH - AVAILABLE $106.44 7390-999-20610-999 DRUG COURT FROG FEE - COUNTY (SVC FEE) $21.29 7390-999-20740-999 DRUG COURT FROG FEE - STATE $85.15 7390-999-10010-999 CASH -AVAILABLE $106.44 7865-999-20610-999 CRIM - SUPP OF IND LEGAL SVCS - COUNTY $0.33 7865-999-20740-999 CRIM - SUPP OF IND LEGAL SVCS - STATE $2.92 7865-999-10010-999 CASH - AVAILABLE $3.25 7950-999-20610 TIME PAYMENT - COUNTY $32.48 7950-999-20740 TIME PAYMENT - STATE $32.48 7950-999-10010 CASH - AVAILABLE $64.96 7505-999-20610 JUDICIAL SUPPORT -GRIM - COUNTY $1.45 7505-999-20740 JUDICIAL SUPPORT-CRIM - STATE $8.21 7505-999-10010 CASH - AVAILABLE $9.66 7505-999-20740-010 JUDICIAL SALARIES -CIVIL- STATE(42) $378.67 7505-999-10010-010 CASH AVAILABLE $378.67 2740-001-45050 BOND FORFEITURES $0.00 2740-999-10010 CASH - AVAILABLE $0.00 2729-001-44034 PRE-TRIAL DIVERSION FUND $0.00 2729-999-10010 CASH - AVAILABLE $0.00 7857-999-20610 JURY REIMBURSEMENT FUND- COUNTY $1.30 7857-999-20740 JURY REIMBURSEMENT FUND- STATE $11.74 7857-999-10010 CASH - AVAILABLE $13.04 7860-999-20610 STATE TRAFFIC FINE- COUNTY $0.00 7860-999-20740 STATE TRAFFIC FINE- STATE $0.00 7860-999-10010 CASH - AVAILABLE $0.00 7403-999-22888 DIST CRT - ELECTRONIC FILING FEE - CIVIL $210.00 7403-999-22991 DIST CRT- ELECTRONIC FILING FEE - CRIMINAL $23.98 CASH - AVAILABLE $233.98 -44050 DISTRICT CLERK FEES $198.09 -10010 CASH -AVAILABLE $198.09 44055 RECORD MGMT/PRSV FUND - COUNTY $123.80 -10010 CASH - AVAILABLE $123.80 44050 COUNTY JURY FUND $4.95 -10010 CASH -AVAILABLE $4.95 44055 COURTHOUSE SECURITY $49.52 -10010 CASH - AVAILABLE $49.52 44050 CO & DIST CRT TECHNOLOGY FUND $19.81 -10010 CASH - AVAILABLE $19.81 44050 COUNTY SPECIALTY COURT FUND $123.80 -10010 CASH - AVAILABLE $123.80 TOTAL: $519.98 7855-999-20784-010 DIST CRT - DIVORCE & FAMILY LAW - STATE $0.00 7855-999-20657-010 DIST CRT - DIVORCE & FAMILY LAW - COUNTY $0.00 7855-999-20792-010 DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - STATE $191.00 7855-999-20658-010 DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - COUNTY $9.00 7855-999-20740-010 DIST CRT - OTHER CIVIL PROCEEDINGS - STATE $87.90 7855-999-20610-010 DIST CRT - OTHER CIVIL PROCEEDINGS - COUNTY $4.63 7855-999-20790-010 DUE TO STATE - NONDISCLOSURE FEE $0.00 7855-999-10010-010 CASH - AVAILABLE $292.53 2677-999-20740-999 COUNTY DISPUTE RESOLUTION FUND $195.00 2677-999-10010-999 CASH - AVAILABLE $195.00 7858-999-20740-999 DIST CLK - DUE TO STATE CONSOLIDATED FEE 2022 $661.00 7858-999-10010-999 CASH AVAILABLE $661.00 TOTAL (Distrib Req to Oper Acct) $19,320.96 $18,800.98 DUE TO OTHERS (Distrib Req(s) attached) ATTORNEY GENERAL (RESTITUTION) 4.80 OUT -OF -COUNTY SERVICE FEES 1,615.00 REFUND OF OVERPAYMENTS 90.00 DUE TO OTHERS 0.00 TOTAL DUE TO OTHERS $1,709.80 REPORT TOTAL - ALL FUNDS 20,510.78 PLUS AMT OF RETURNED CKS 0.00 LESS: TOTAL TREASURER'S RECEIPTS (20,510.78) Revised 01/31/20 OVER / (SHORT) $0.00 DISTRICT COURT MAY STATE COURT COSTS REPORT 2022 MAY SECTION I: REPORT FOR OFFENSES COMMITTED COLLECTED COUNTY STATE 0111/20 - Present __ ;A 91.60 824.44 01/01/04 - 12/31/19 $234.75I: 23.48 211.27 09/01/01-12131/03 % wN - - 09/01/99 - 08/31 /01 - - 09/01/97-08/31/99- 09/01/95-08/31/97- 09/01/91-08/31/95 DNA TESTING FEES 5.54 0.55 4.99 EMS TRAUMA FUND 241.27 24.13 217.14 JUV. PROS. DIVERSION FEES JURY REIMBURSEMENT FEE $13.04 1.30 11.74 INDIGENT DEFENSE FUND $3.25 0.33 $2.93 STATE TRAFFIC FEES $0.00 - $0.00 DRUG CRT PROG FEE $212.88 $127.73 85.15 SECTION II: AS APPLICABLE STATE POLICE OFFICER FEES FAILURE TO APPEARIPAY FEES - - JUD. FUND-CONST. CO. CRT. JUD. FUND -STATUTORY CO. CRT. MOTOR CARRIER WEIGHT VIOLATIONS TIME PAYMENT FEE $64.96 32.48 32.48 DRIVING RECORD FEE JUDICIAL SUPPORT FEES $9.66 1.45 8.21 ELECTRONIC FILING FEE - CR $23.98 $23.98 TOTAL STATE COURT COSTS $1,725.37 $ 303.05 $ 1,422.32 CIVIL FEES REPORT MAY COLLECTED COUNTY STATE BIRTH CERTIFICATE FEES MARRIAGE LICENSE FEES DECL. OF INFORMAL MARRIAGE ELECTRONIC FILING FEE - CV $210.00 $210.00 NONDISCLOSURE FEES 0 $0.00 $0.00 JUROR DONATIONS JUSTICE CRT. INDIG FILLING FEES STAT PROB CRT INDIG FILING FEES STAT PROS CRT JUDIC FILING FEES STAT CNTY CRT INDIG FILING FEES STAT CNTY CRT JUDIC FILING FEES STAT CNTY CRT -JUDICIAL SUPPORT CONST CNTY CRT INDIG FILING FEES CNST CNTY CRT JUDIC FILING FEES DIST CRT DIV & FAMILY LAW _. $0.00 - - DIST CRT OTHER THAN DIV/FAM LAW 18'.. $200.00 9.00 191.00 DIST CRT OTHER CIVIL FILINGS 14'. $92.53 4.63 87.90 _ FAMILY PROTECTION FEE JUDICIAL SUPPORT FEE 13 $378.67 $378.67 JUDICIAL & COURT PERSONNEL TRANING FEE 16- $30.00 - $30.00 2022 STATE CONSOLIDATED FEE 10 $661.00 $661.00 COUNTY DISPUTE RESOLUTION FUND 195.00 195.00 TOTAL CIVIL FEES REPORT $ 1,767.20 $ 13.63 $ 1,753.57 TOTAL BOTH REPORTS $ 3,492.57 $ 316.68 $ 3,176.89 CALHOUN DISTRIBUTION COUNTY REQUEST 201 West Austin DR# 420 A 44716 PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: Anna Kabela Address: Title: District Clerk City: State: Zip: Phone: ACCOUNT NUMBER DESCRIPTION AMOUNT 7340-999-20759-999 District Clerk Monthly Collections - Distribution $18,800.98 MAY 2022 V# 967 TOTAL 18,800.98 Signature of Official Date CALHOUN COUNTY DISTRIBUTION 201 West Austin REQUEST Port Lavaca, Texas 77979 DR# 420 B 44716 PAYEE PAYOR Name: OFFICE OF THE ATTORNEY GENERAL Official: ANNA KABELA /Crime Victims Title: District Clerk Address: P. 0. Box 12198 City, State: Austin, TX Zip: 78711-2198 Phone: ACCOUNT NUMBER DESCRIPTION - AMOUNT 7340-999-20759.999 District Clerk Monthly Collections - Restitution $4.80 MAY 2022 V# 8874 TOTAL 4.80 Za �� Signature of Official Date ENTER COURT NAME' IJUSTICE OF PEACE NO. 1 ENTER MONTH OF REPORT - - - - MAY ENTER YEAR OF REPORT , CODE AMOUNT DASH BONDS 0.00 REVISED 02/022022 ADMINISTRATION FEE -ADMF 80.00 BREATH. ALCOHOL TESTING -BAT 0.00 CONSOLIDATEDCOURT COSTS -CCC 422.86 STATE CONSOLIDATED COURT COSY- 2020 5,052.67 LOCAL CONSOLIDATED COURT COST- 2020 1,140.95 COURTHOUSE SECURITY-CHS 43.29 .. CJP 0.00 - -` CIVIL JUSTICE DATA REPOSITORY FEE -CJDR 0.29 CORRECTIONAL MANAGEMENT INSTITUTE -CMI 0.00 - - CR 0.00 CHILD SAFETY -CS 0.00 CHILD SEATBELTFEE -CSBF 0.00 CRIME VICTIMS COMPENSATION .-CVC 0.00 - DPSCIFAILURETOAPPEAR- OMNI -DPSC 201.44 ADMINISTRATION FEE FTA/FTPI(aka OMNI)-2020 152.20 . ELECTRONIC FILING FEE -EEF 0.00 -"FUGITIVE APPREHENSION -FA 0.00 GENERAL: REVENUE -GR 0.00 CRIM-IND LEGAL-SVCS SUPPORT -IDF 21.14 JUVENILE CRIME& DELINQUENCY. JCD 0.00 JUVENILE CASE MANAGER FUND -JCMF 25.30 JUSTICE COURT PERSONNEL TRAINING -JCPT 0.00 JUROR SERVICE FEE -I 41.29 - LOCAUARREST FEES'-LAF 356.68 LEMI 0.00 LEDA 0.00 '. LEDO 0.00 - - - OCL 0.00 _ PARKS:& WILDLIFE ARREST FEES -PWAF 0.00 - - STATE ARREST FEES -SAF 91.11 SCHOOL CROSSINGICHILD SAFETY FEE'-. SOP 0.00 -. SUBTITLE C-. SUBC 52.96 STATE TRAFFIC FINES -EST 9.1.19. STF 2,062.77 " TABC ARREST FEES-TAF 0.00 TECHNOLOGY FUND -TF 42.29 - TRAFFIC -TFC 5.26 LOCAL TRAFFIC FINE-.2020 124.70 - THAC PAYMENT -TIME 9896 LOCAL &.STATE WARRAI COLLECTION SERVICEFE - DEFENSIVE DRIVINC DEFE _.DRIVING :EXAI FI STATE CONSOLIDATED LOCAL CONSOLIDATED '. FILING. FEE SMALI COPIES/CERTIF INDIGENT FE JUDGE PAY R SERI OUT-OF-COUNI 'ELECTRONIC FILIE EXPUNGEM EXPIREDRI '. ABSTRACT OF JU ALL WRI DES] LOC LICENSE $ WER PARKS BPWILDLI SEATEELT/UNRESTRAINED CH `OVERPAYM :TOTAL ACTUAL MONE PF DUE TO OTHERS DUE TO CCISD - 50 DUE TO DARESTIT REFUND OF OVERI OUT -OF -COUNTY S CASH BONDS TREASURERS REC CASH CHECKS,_M. FEE-2020 220.09 ID -TPDF 15.55 3-.WR14T 1,027.32 A-. CSRV 1,543.55 SE-DDC 40.10 FEE - OFF 1,317.19 PROV DL 0.00 EE -FFEE 0.00 EE = 2022 168.00 EE-:2022 264.00 IS-FFSC 0.00 'FEE-JF 0.00 LIES - CC 0.00 F or INDF 0.00 :E-JPAY 58.02 E -SFEE 375.00 ✓ICE FEE 0.00 -EEF CV 0.00 E -EXPG 0.00 tL-EXPR 0.00 .NT-AOJ 5.00 )P/WOE 150.00 E-DPSF 2,097.93. - - =S - FINE 6,176.00 ES--.LWF 0.00 _S PWF 2,151.00 IE-SEAT 0.00 NG-JCPT 0.00 - 1)-OVER 0.00 I) -OVER 0.00 N-I REST 0.00 IES-WSF. 59.00 FE - MEND 0.00 ECEIVED- -.. UIT11,11PY1 1,027.32 NTFEES 643.03 RECORD ON TOTAL PAGE OF HILL COUNTRY SOFTWARE MO REPORT NTFEES $384.29. RECORD ON TOTAL PAGE OF HILL COUNTRY SGFTWARE MOREPORT AMOUNT- 6 of Fine 00 JV Cases REASGNCLUDE DR REQUESTING DISBURSEMENT _ /TION'FUND __0.00_ 0.00 PILE SEINCLUDE D.R. REQUESTING DISBURSEMENT AYMENTS ' O.00. PLEASEINCLUDE DR. REDUESTINGDISBURSEMEM :RVICE FEE - O.00 MUOBEINCLUDE DR. REOUESTINGOISBURSEMEM 0:00 PLEASEINCLUDE D,R. REQUESTING DISBURSEMENT (IF REQUIRED) TOTAL DUE TO OTHERS $0.00` - EIPTS FOR MONTH AMOUNT )s&CREDIT CARDS $25,684.71 Calculate from ACTUAL Treasurces Receipts _ PT TOTAL TREAS. RECEIPTS $25884.71 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/2/2022 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: MAY YEAR OF REPORT: 0 ACCOUNT NUMBER ACCOUNT NAME AMOUNT CR 1000-001-45011 FINES 8,605.43 CR 1000-001-44190 SHERIFF'S FEES 1,380.03 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 40.10 CHILD SAFETY 0.00 TRAFFIC 129.96 ADMINISTRATIVE FEES 1,549.39 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44361 TOTAL ADMINISTRATIVE FEES 1,719.45 CR 1000-001-44010 CONSTABLE FEES -SERVICE 525.00 CR 1000-001-44061 JP FILING FEES 5.00 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 220.89 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 1,543.55 TOTAL FINES, ADMIN. FEES & DUE TO STATE $13,999.35 CR 2670-001-44061 COURTHOUSE SECURITY FUND $431.80 CR 2720-001-44061 JUSTICE COURT SECURITY FUND $10.82 CR 2719-001-44061 JUSTICE COURT TECHNOLOGY FUND $368.28 CR 2699-001-44061 JUVENILE CASE MANAGER FUND $25.30 CR 2730-001-44061 LOCAL TRUANCY PREVENTION & DIVERSION FUND $407.48 _CR 2669-001-44061 _ ---JUSTICE $8.15 CR 2728-001-44061 JUSTICE COURT SUPPORT FUND _ $200.00 CR 2677-001-44061 COUNTY DISPUTE RESOLUTION FUND $42.0 j_CR 2725-001-44061 LANGUAGE ACCESS FUND $24.00 STATE ARREST FEES DPS FEES 95.08 P&W FEES 0.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 95.08 CR 7070-999-20610 CCC-GENERAL FUND 42.29 CR 7070-999-20740 CCC-STATE 380.57 DR 7070-999-10010 422.86 CR 7072-999-20610 STATE CCC- GENERAL FUND 505.27 CR 7072-999-20740 STATE CCC- STATE 4,547.40 DR 7072-999-10010 5,052.67 CR 7860-999-20610 STF/SUBC-GENERAL FUND 2.65 CR 7860-999-20740 STF/SUBC-STATE 50.31 DR 7860-999-10010 52.96 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 82.51 CR 7860-999-20740 STF- EST 9/1/2019- STATE 1,980.26 DR 7860-999-10010 2,062.77 Page 1 of 3 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/2/2022 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: MAY YEAR OF REPORT: 0 CR 7950-999-20610 TP-GENERAL FUND 49.48 CR 7950-999-20740 TP-STATE 49.48 DR 7950-999-10010 98.96 Page 2 of 3 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/2/2022 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: MAY YEAR OF REPORT: 0 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 0.00 DR 7480-999-10010 0.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 2.11 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 19.03 DR 7865-999-10010 21.14 CR 7970-999-20610 TUFTA-GENERAL FUND 67.15 CR 7970-999-20740 TUFTA-STATE 134.29 DR 7970-999-10010 201.44 CR 7505-999-20610 JPAY- GENERAL FUND 5.80 CR 7505-999-20740 JPAY - STATE 52.22 DR 7505-999-10010 58.02 CR 7857-999-20610 JURY REIMB: FUND- GEN. FUND 4.13 CR 7857-999-20740 JURY REIMB. FUND- STATE 37.16 DR 7857-999-10010 41.29 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.03 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS.- STATE 0.26 DR 7856-999-10010 0.29 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND- STATE 0.00 DR 7502-999-10010 0.00 7998-999-20740 7998-999-20701 DR 7998-999-10010 7403-999-22889 DR 7403-999-22889 7858-999-20740 REVISED 02/02/2022 TRUANCY PREVENT/DIV FUND - STATE 7.78 JUVENILE CASE MANAGER FUND 7.78 15.55 ELECTRONIC FILING FEE - CV STATE 0.00 0.00 STATE CONSOLIDATED CIVIL FEE 168.00 168.00 TOTAL (Distrib Req to OperAcct) $23,806.21 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISO 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT: 0.00 OUT -OF -COUNTY SERVICE FI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 1,828.35 WATER SAFETY FINES 50.15 TOTAL DUE TO OTHERS $1,878.50 TOTAL COLLECTED -ALL FUNDS $25,684.71 LESS: TOTAL TREASUER'S RECEIPTS $25,684.71 OVER/(SHORT) $0.00 Page 3 of 3 CALHOUN COUNTY 201 West Austin PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: Address: Title: City: State: Zip: Phone: DISTRIBUTION REQUEST DR# 450 A 44714 Hope Kurtz Justice of the Peace, Pct. 1. ENTER COURT NAME: ENTER MONTH OF REPORT ENTER YEAR. OF REPORT CODE CASH BONDS '. ADMINISTRATION FEE ADMF: BREATH ALCOHOL TESTING BAT CONSOLIDATED COURT COSTS CCC STATE CONSOLIDATED. COURT COST- 2020 LOCAL CONSOLIDATED COURT COST- 2020 COURTHOUSE SECURITY CHS CJP OR .CHILD SAFETY -CS CHILD SEATBELT FEE - CSBF ; CRIME VICTIMS COMPENSATION - CVC '- DPSC/FAILURE TOAPPEAR '- OMNI - DPSC ADMINISTRATION FEE FTAIFTP(aka OMNI) 2020 'ELECTRONIC FILING FEE - EEF FUGITIVE APPREHENSION -FA GENERAL REVENUE -GR CRIM - IND LEGAL SVCS SUPPORT- OF JUVENILE. CRIME & DELINQUENCY -JCD JUROR. SERVICE FEE -JSF I - LOCAL ARREST FEES -LAF 1 LENU LEDA :. LEOC OCL' PARKS& WILDLIFE ARREST FEES -PWAF' STATE ARREST FEES SAFI 'SCHOOL CROSSING/CHILDSAFETY FEE - SCF :SUBTITLE C -SUBCI I STATE TRAFFIC FINES -EST 9,119-STF: 6: TABC ARREST FEES-TAF .'TECHNOLOGY FUND -TF ' 1 TRAFFIC -TFC LOCAL TRAFFIC FINE 2020' TIME TIME PAYMENT -TIME ';; 11 TIME PAYMENT REIMBURSEMENT FEE 202D'r T. :TRUANCY PREVENTION/DIVERSION FUND - TPDF LOCAL & STATE WARRANT FEES WRNT j 1,8! COLLECTION SERVICE FEE-MVBA CSRV I. 3,61 DEFENSIVE DRIVING :COURSE -DOGS DEFERRED FEE OFF 1 DRIVING EXAM FEE PROV OIL FILING FEE -FFEE STATE CONSOLIDATED CIVIL FEE - 2022 1, - LOCAL CONSOLIDATED CIVIL FEE-2022 2: :FILING FEE SMALL CLAIMS FFSC I. JURY FEE JF COPIES/CERTIFED COPIES- CC INDIGENT FEE. CIFF or INDF ' 2JUDGE PAY RAISE FEE JPAY I. V SERVICE FEE SFEE it OUT -OF -COUNTY SERVICE FEE ELECTRONIC FILING FEE EEF CV '- EXPUNGEMENTFEE-EXPG I. - EXPIRED RENEWAL EXPR ..ABSTRACT OF JUDGEMENT AOJ - ALL WRITS; WOP:/WOE.. if DPS'. FTA FINE - OPSF i. 1,21 LOCAL :FINES -FINE 7,7( LICENSE & WEIGHT FEES - LWF PARKS & WILDLIFE FINES- PWF ". SEATBELT/UNRESTRAINED CHILD FINE - SEAT - JUDICIAL &COURT PERSONNELTRAININGJCPT `: OVERPAYMENT (OVER $10)-OVER, OVERPAYMENT($10 AND LESS) -OVER!: RESTITUTION - REST PARKS & WILDLIFE -WATER SAFETY FINES-WSF :. MARINE SAFETY PARKS '& WILDLIFE MSO TOTAL ACTUAL MONEY RECEIVED �20 6:6: AM( TYPE TOTAL WARRANT FEES 1,8! .VENTER LOCAL WARRANT FEESC STATE WARRANT FEES $1,Of DUE TO OTHERS: AM( DUE TO CCISD-:50%.of Fine on JV cases DUE TO DA RESTITUTION FUND REFUND OF OVERPAYMENTS i OUT -OF -COUNTY SERVICE FEE CASH BONDS TOTAL DUE TO OTHERS $1 TREASURERS RECEIPTS FOR MONTH: AM( C_ AS_ _H CHECKS, M:O_.s & CREDI U CARDS $2D.6i TOTALTREAS: RECEIPTS:... $205: JUSTICE '.OF -PEACE NO.2 (" 2022 OUNT OF REVISED 02/02/2022 0.00 0.00:: -. 1.88 4.08. 1.83 8.20' 0.00 Dab 0.00' 0.00 0.00` DOD D.001 4.77 0.00 0.00, 0.00 0.00'. - 4.10' D.00' 2.17' D.DO' 8.20' 7.30' D.00 DOD D.00.; DOD DOD 3.80:: D.00 B11 B.30 DOD: B.20 1.77 7.92 9.31 7A5 2.33d 2-44 1.8B DI00; 7.78. D.DD D.D)' 7.D0' 1.00-' D.DO' D.001 0.00 DOD, 2.27 DOD D.00. 1.00, 1.00.... D.00` 1.00; DO0 7.344. 551: 1.00 700'. 100 3.00: 5.60' 100, ]00: )00; 10Q 3.88:.. LINT 2.44' L3L RECORDON TOTALPAGE OF HILL COUNTRY SOFTWARE MO REPORT 3.131RECORDONTOTALPAGE OF HILL COUNTRY SOFTWARE MO.REPORT - LINT 1.0f1" PLEASEwcLUDE GR. REnuEsnxc oiseunsiMExr J.00 PIFASEINCTO OR REQUESTING DISBURSEMENT 5.50 FLEASEINCLUDE OR.REOUESTINGDISBURSEMENT 1.OD PLFASEINCLUDE RILREOUEUIINGOISIBURSEMENT 1.OD PIEASEINCUUDE DRREOUESTINGDIBWIRSEMENT(IFREQUIRED) 5.50 LINT 1=Calculate from ACTUAL Treasure's Receipts 1.88 MONTHLYREPORT OF COLLECTIONS AND DISTRIBUTIONS 6/l/2022 COURT NAME: JUSTICE OF PEACE NO. 2 MONTH OF REPORT: 0 YEAR OF REPORT: 2022 ACCOUNTNUMBER ACCOUNTNAME AMOUNT CR 1000-001-45012 FINES 9,090.35 CR 1000-001-44190 SHERIFF'S FEES 1,801.15 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 0.00 CHILD SAFETY 0.00 TRAFFIC 49.69 ADMINISTRATIVE FEES 317.76 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44362 TOTAL ADMINISTRATIVE FEES 367.45 CR 1000-001-44010 CONSTABLE FEES -SERVICE 300.00 CR 1000-001-44062 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 237.15 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 3,521.88 TOTAL FINES, ADMIN. FEES & DUE TO STATE $15,317.98 CR 2670-001-44062 COURTHOUSE SECURITY FUND $189.29 CR 2720-001-44062 JUSTICE COURT SECURITY FUND $22.05 CR 2719-001-44062 JUSTICE COURT TECHNOLOGY FUND $188.72 CR 2699-001-44062 JUVENILE CASE MANAGER FUND $22.17 CR 2730-001-44062 LOCAL TRUANCY PREVENTION & DIVERSION FUND $125.65 CR 2669-001-44062 COUNTY JURY FUND $2.51 I CR 2728-001-44062 JUSTICE COURT SUPPORT FUND $175.00 CR 2677-001-44062 COUNTY DISPUTE RESOLUTION FUND $35,00 CR 2725-001-44062 ` LANGUAGE ACCESS"FUND $24(00_ STATE ARREST FEES DPS FEES 230.39 P&W FEES 2.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 232.39 CR 7070-999-20610 CCC-GENERAL FUND 84.19 CR 7070-999-20740 CCC-STATE 757.69 DR 7070-999-10010 841.88 CR 7072-999-20610 STATE CCC- GENERAL FUND 167.41 CR 7072-999-20740 STATE CCC- STATE 1,506.65 DR 7072-999-10010 1,674.06 CR 7860-999-20610 STF/SUBC-GENERAL FUND 4.41 CR 7860-999-20740 STF/SUBC-STATE _ 83.70 DR 7860-999-10010 88.11 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 25.53 CR 7860-999-20740 STF- EST 9/l/2019- STATE 612.77 DR 7860-999-10010 638.30 Page 1 of 2 6/1/2022 COURT NAMEi,:,' STICE OF PEACE NO. 2 MONTH OF REPORT .i " YEAR OF REPORT: 2022 CR 7950-999-20610 TP-GENERAL FUND 69.66 CR 7950-999-20740 TP-STATE 69.65 DR 7950-999-10010 139.31 CR -1480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CR 7480-999-20740 CIVIL. INDIGENT LEGAL -STATE 0.00 DR 7480-999-10010 0.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 4.41 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 39.69 DR 7865-999-10010 44.10 CR 7970-999-20610 TL/FTA-GENERAL FUND 134.92 CR 7970-999-20740 TL/FTA-STATE 269.85 DR 7970-999-10010 404.77 CR 7505-999-20610 JPAY-GENERAL FUND 13.23 CR 7505-999-20740 JPAY - STATE 119.04 DR 7505-999-10010 132.27 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 8.82 CR 7857-999-20740 JURY REIMB. FUND- STATE 79.38 DR 7857-999-10010 88.20 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.08 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS.- STATE 0.70 DR 7856-999-10010 0.78 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND- STATE 0.00 DR 7502-999-10010 0.00 7998-999-20740 TRUANCY PREVENT/DIV FUND - STATE 16.17 7998-999-20701 JUVENILE CASE MANAGER FUND 16.17 DR 7998..999-10010 32.33 7403-999-22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 7858-999-20740 STATE CONSOLIDATED CIVIL FEE 147.00 147.00 TOTAL (Distrib Req to OperAcct) $20,562.88 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENTS 15.50 OUT -OF -COUNTY SERVICE FL 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 42.50 WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $58.00 TOTAL COLLECTED -ALL FUNDS $20,620.88 LESS: TOTAL TREASUER'S RECEIPTS $20,620.88 REVISED 02/02/2022 OVER/(SHORT) $0.00 Page 2 of 2 CALHOUN COUNTY 201 West Austin PAYEE Name: Calhoun County Oper. Acct. Address: City: State: Zip: Phone: r DISTRIBUTION REQUEST DR# 450 A 44714 PAYOR Official: Hope Kurtz Title: Justice of the Peace, Pct. 2 ACCOUNT NUMBER - DESCRIPTION - AMOUNT 7542-999-20759-999 JP2 Monthly Collections - Distribution $20,562.88 0 2022 V# 967 TOTALI 20,562.88 6 /,3 of Official Date ENTER COURT NAME: JUSTICE OF PEACE NO.3 ENTER MONTH OF REPORT MAY ENTER YEAR OF REPORT 2022 2022 CODE AMOUNT CASH BONDS REVISED 02/02/2021 ADMINISTRATION FEE -ADMF 10.00 BREATH ALCOHOL TESTING - BAT CONSOLIDATED COURT COSTS -COG 270.22 STATE CONSOLIDATED COURT COST- 2020 1,569.85 LOCAL CONSOLIDATED COURT COST-2020 354.48 COURTHOUSE SECURITY -CHS 27.96 CJP CIVIL JUSTICE DATA REPOSITORY FEE -DJDR 0.44 CORRECTIONAL MANAGEMENT INSTITUTE-CMI CR CHILD SAFETY -CS CHILD SEATBELT FEE-. CSBF CRIME VICTIMS COMPENSATION-CVC DPSC/FAILURE TO APPEAR -OMNI-DPSC 4.36 ADMINISTRATION FEE FTA/FTP{aka OMNI)-2020 ELECTRONIC FILING FEE -EEF FUGITIVE APPREHENSION -:FA GENERAL REVENUE -GR GRIM- IND LEGAL SVCS SUPPORT -IDF 12.84 JUVENILE CRIME & DELINQUENCY -JCD JUVENILE CASE MANAGER FUND - JCMF 25.00 JUSTICE COURT PERSONNEL TRAINING -JCPT JUROR SERVICE FEE -JSF 27.94 . LOCAL ARREST. FEES -LAF 62.83 LEMI LEDA LEGG OCL PARKS& WILDLIFE ARREST FEES -PWAF - STATE ARREST FEES -SAF 97.73 - SCHOOL CROSSING/CHILD SAFETY FEE -SCF SUBTITLE C.-SUBC 164.93 STATE TRAFFIC FINES -EST 9.1.19-STF 1,083.09 TABC ARREST FEES -TAF - TECHNOLOGY FUND -TF 27.95 - -. TRAFFIC -TFC 17.43 LOCAL TRAFFIC FINE-2020 64.98 TIME .PAYMENT -TIME 18.64 TIME PAYMENT REIMBURSEMENT FEE- 2020 42.69 TRUANCY PREVENTION/DIVERSION FUND -TPDF 6.84 LOCAL& STATE WARRANT FEES -WRNT 271.14 COLLECTION SERVICE FEE-MVSA-CSRV 507.65 DEFENSIVE DRIVING COURSE-- DOC 50.00 - DEFERRED FEE - OFF 846.00 - DRIVING EXAM FEE- PROV DL :._FILING FEE -FFEE STATE CONSOLIDATED CIVIL FEE -2022 105.00 LOCAL CONSOLIDATED CIVIL FEE :-2022 165.00 - FILING FEE SMALL CLAIMS -FFSC - -'.JURY FEE -JF COPIES/CERTIFED COPIES: -CC INDIGENT FEE -CIFF or INDF JUDGE PAY RAISE FEE -JPAY 42.53 SERVICE FEE-SFEE 75.00 OUT -OF -COUNTY SERVICE FEE - ELECTRONIC FILING FEE -EEF CV EXPUNGEMENTFEE-.EXPG - EXPIRED RENEWAL -EXPR ABSTRACT. OF JUDGEMENT -AOJ ALL WRITS -WOP/WOE -. DPSFTA FINE .-DPSF 100.00 LOCAL FINES - FINE 2,369.17 LICENSE &:WEIGHT FEES-LWF ". PARKS & WILDLIFE FINES -PWF SEATBELT/UNRESTRAINED CHILD' FINE - SEAT J- JUDICIAL & COURT PERSONNEL TRAINING-JCPT OVERPAYMENT (OVER $10)-OVER OVERPAYMENT($10 AND LESS) - OVER RESTITUTION =REST `PARKS & WILDLIFE -WATER SAFETY FINES-WSF L-VO.4-21 - MARINE SAFETY PARKS .& WILDLIFE -MSO TOTAL ACTUAL MONEY RECEIVED TYPE: AMOUNT TOTAL WARRANT FEES 271.14 ENTER LOCAL WARRANT FEES 1 .0 RECORD ON TOTALPAGE OF HILL COUNTRY SOFTWARE MO. REPORT STATE WARRANT FEES $171.14 RECORD ON TOTAL PAGE OF HILL COUNTRY SOFTWARE MO. REPORT DUE TO OTHERS AMOUNT DUE TO CCISD-50% of fine on JV Cases _ 0.00 PLEASE INCLUDE D,R REQUESTING DISBURSEMENT DUE TO DA RESTITUTION FUND 0.00. PLEASE INCLUDE DR REQUESTING DISBURSEMENT REFUND OF OVERPAYMENTS 0.00 PLEASEINCLUDE D.R REQUESTING DISBURSEMENT OUT -OF -COUNTY SERVICE FEE 0.00 PLEASE INCLUDE DR REQUESTING DISBURSEMENT CASHBONDS 0.00 PLEASE INCLUDE DR REQUESTING DISBURSEMENT(IF REQUIRED) TOTAL DUE TO OTHERS 0100. - - TREASURERS RECEIPTS FOR MONTH: AMOUNT CASH, CHECK,M. a&CREDIT CARDS $8,421.69 Calculate from ACTUAL Treasurers Receipt TOTALTREAS. RECEIPTS $8421.68 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/1/2022 COURT NAME: JUSTICE OF PEACE NO.3 MONTH OF REPORT: MAY YEAR OF REPORT: 2022 ACCOUNTNUMBER ACCOUNTNAME AMOUNT CR 1000-001-45013 FINES 2,469.17 CR 1000-001-44190 SHERIFF'S FEES 377.93 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 50.00 CHILD SAFETY 0.00 TRAFFIC 82.41 ADMINISTRATIVE FEES 856.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44363 TOTAL ADMINISTRATIVE FEES 988.41 CR 1000-001-44010 CONSTABLE FEES -SERVICE 75.00 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 42.69 CR 1000-001-44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999-20741 DUE TO STATE -DRIVING EXAM FEE 0.00 CR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 CR 1000-999-20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 CR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 CR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 507.65 TOTAL FINES, ADMIN. FEES & DUE TO STATE $4,460.85 CR 2670-001-44063 COURTHOUSE SECURITY FUND $145.04 CR 2720-001-44063 JUSTICE COURT SECURITY FUND $6.99 CR 2719-001-44063 JUSTICE COURT TECHNOLOGY FUND $129.23 CR 2699-001-44063 JUVENILE CASE MANAGER FUND $25.00 CR 2730-001-44063 LOCAL TRUANCY PREVENTION & DIVERSION FUND $126.60 CR_ 2669-001-44063 COUNTY JURY FUND $2.53 CR 2728-001-44663 JUSTICE COURT SUPPORT FUND $125.00 CR 2677-001-44063 COUNTY DISPUTE RESOLUTION FUND $25.00 CR 2725-001-44063 LANGUAGE ACCESS FUND $15.00 STATE ARREST FEES DPS FEES 53.77 P&W FEES 0.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 53.77 CR 7070-999-20610 CCC-GENERAL FUND 27.02 CR 7070-999-20740 CCC-STATE 243.20 DR 7070-999-10010 270.22 CR 7072-999-20610 STATE CCC- GENERAL FUND 156.98 CR 7072-999-20740 STATE CCC- STATE 1,412.87 DR 7072-999-10010 1,569.85 CR 7860-999-20610 STF/SUBC-GENERAL FUND 8.25 CR 7860-999-20740 STF/SUBC-STATE 156.68 DR 7860-999-10010 164.93 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 43.32 CR 7860-999-20740 STF- EST 9/1/2019- STATE 1,039.77 DR 7860-999-10010 1,083.09 Page 1 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/1/2022 COURT NAME: JUSTICE OF PEACE NO. 3 MONTH OF REPORT: MAY YEAR OF REPORT: 2022 CR 7950-999-20610 TP-GENERAL FUND 9.32 CR 7950-999-20740 TP-STATE 9.32 DR 7950-999-10010 18.64 CR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 0.00 DR 7480-999-10010 0.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 1.28 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 11.56 DR 7865-999-10010 12.84 CR 7970-999-20610 TUFTA-GENERAL FUND 1.45 CR 7970-999-20740 TUFTA-STATE 2.91 DR 7970-999-10010 4.36 CR 7505-999-20610 JPAY-GENERAL FUND 4.25 CR 7505-999-20740 JPAY-STATE 38.28 DR 7505-999-10010 42.53 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 2.79 CR 7857-999-20740 JURY REIMB. FUND- STATE 25.15 DR 7857-999-10010 27.94 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS.- GEN FUND 0.04 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.40 DR 7856-999-10010 0.44 CR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND- STATE 0.00 DR 7502-999-10010 0.00 7998-999-20740 TRUANCY PREVENT/DIV FUND - STATE 3.42 7998-999-20701 JUVENILE CASE MANAGER FUND 3.42 DR 7998-999-10010 6.84 7403-999-22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 7858-999-20740 STATE CONSOLIDATED CIVIL FEE 105.00 105.00 TOTAL (Distrib Req to Oper Acct) $8,421.69 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT: 0.00 OUT -OF -COUNTY SERVICE FI 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 0.00 WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $0.00 TOTAL COLLECTED -ALL FUNDS $8,421.69 LESS: TOTAL TREASUER'S RECEIPTS $8,421.69 REVISED 02/02/2021-"Z�Z OVER/(SHORT) $0.00 Page 2 of 2 06-06-22;10:42 ;From:Calhoun County JP4 To:3615534444 ;3617852179 # 1/ 4 FAX COVER SHEET June 6, 2022 FROM: JUSTICE COURT PCT. 4 CALHOUN COUNTY 103 W. Dallas Street. P.O. Box520 Seadrift, Texas 77983 PHONE: 361-785-7082 FAX: 361-785-2179 TO: County Judge Office Ref: MAY Money Distribution Report FAX: 361-553-4444 Please give me a call if You have any questions. PAGES TO FOLLOW: _4_ INCLUDING THIS COVER PAGE Thank you, Patsy Spence, CLERK ,Judge "Wesley,. 3-lunt 06-06-22;10:42 ;From;Calhoun County JP4 To:3615534444 ;3617852179 # 2/ 4 00.00 120,00 $16.55 110.02 12.00 0.10 0.00 .405.05 12.00 6,00 ,z/,a0 75.00 e.0o 130;00 6vs,sv 0.00 ... 0a.00 i0A0 160.00 O.OD 1,a0080 7.60 DN.1@WEETIN0URDUR"E W D%MW WIINDDOOUNMMY 06-06-22;10:42 ;From:Calhoun County JP4 To:3615534444 ;3617852179 # 3/ 4 MONTMLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/6/2022 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: MAY YEAR OF REPORT: 2022 ACCOUNT NUMBER ACCOUNT NAME AMOUNT OR 1000-001.45014 FINES 1,388.59 OR 1000.001.44190 SHERIFF'S FEES 195.43 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 0.00 CHILD SAFETY 0.00 TRAFFIC 30.36 ADMINISTRATIVE FEES 60.00 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 OR 1000.001-44364 TOTAL ADMINISTRATIVE FEES 90.36 CR 1000-001-44010 CONSTABLE FEES•SERVICE 150.00 OR 1000-001-44064 JP FILING FEES 0.00 OR 1000-001.44090 COPIES / CERTIFIED COPIES 0.00 CR 1000-001.49110 OVERPAYMENTS (LESS THAN $10) 7.00 OR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 0.00 OR 1000-001.44145 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 CR 1000-999.20741 DUE TO STATE -DRIVING EXAM FEE 0.00 OR 1000-999-20744 DUE TO STATE-SEATBELT FINES 0.00 OR 1000-999.20745 DUE TO STATE -CHILD SEATBELT FEE 0.00 OR 1000-999-20746 DUE TO STATE -OVERWEIGHT FINES 0.00 OR 1000-999-20770 DUE TO JP COLLECTIONS ATTORNEY 505.20 TOTAL FINES, ADMIN. FEES & DUE TO STATE $2, 336.58 OR 2670-001-44064 COURTHOUSE SECURITY FUND $49.61 OR 2720-001-44064 JUSTICE COURT SECURITY FUND $3.00 OR 2719-001-44064 JUSTICE COURT TECHNOLOGY FUND $45.15 OR 2699-001-44064 JUVENILE CASE MANAGER FUND $15.00 OR 2730-001-44064 LOCAL TRUANCY PREVENTION & DIVERSION FUND $41.44 OR 2869-001-44064 COUNTY JURY FUND $0.83 CR' .2728-'001.44064. JUSTICE COURT SUPPORT FUND $100.00 CR .,2677-001-44064; .' COU,NTY,DI$PUTE RESOLUTION. FUND $20.00 OR 2725-'00l' 44084 LANGUAGE ACCESS FUND $12.OD STATEARRESTFEES DPS FEES 11.00 P&W FEES 0.00 TABC FEES 0.00 OR 7020-999-20740 TOTAL STATE ARREST FEES 11.00 OR 7070.999-20610 CCC-GENERAL FUND 12.00 OR 7070-999-20740 CCC-STATE 108.00 DR 7070-999-10010 120.00 OR 7072-999-20610 STATE CCC- GENERAL FUND 51.65 OR 7072-999-20740 STATE CCC- STATE 464.90 DR 7072-999-10010 518.55 CR 7860-999-20610 STF/SUBC-GENERAL FUND 3.00 OR 7860-999-20740 STF/SUBC-STATE 57.00 DR 7860-999.10010 60.00 OR 7860.999.20610 STF- EST 911/2019- GENERAL FUND 15.24 OR 7860-999.20740 STF- EST 9/l/2019- STATE 389.71 DR 786D-999-10010 405.95 Page 1 of 3 06-06-22;10:52 ;From:Calhoun County JP4 To:3615534444 ;3617852179 # 4/ 5 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/6/2022 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: MAY YEAR OF REPORT: 2022 CR 7950-999.2060 TP-GENERAL FUND 37.50 CR 7950-999.20740 TP-STATE 37.50 DR 7950.999.10010 75.00 Page 2 of 3 06-06-22;10:42 ;From:Calhoun County JP4 To;3815534444 ;3617852179 # 4/ 4 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 6/6/2022 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: MAY YEAR OF REPORT: 2022 OR 7480.999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 CR 7480.999.20740 CIVIL INDIGENT LEGAL -STATE 0.00 DR 7480.999.10010 0.00 CR 7865499-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 0.60 CR 7865-999.20740 CRIM-SUPP OF IND LEG SVCS-STATE 5.40 DR 7865-999-10010 6.00 CR 7970-999.20610 TL/FTA-GENERAL FUND 30.00 CR 7970-099-20740 TL/FTASTATF- 60.00 DR 7970.999.10010 90.00 OR 7505-999.20610 JPAY - GENERAL FUND 1.60 OR 7505-999.20740 JPAY-STATE 16.20 DR 7505-999.10010 18.00 CR 7857-999.20610 JURY REIMB. FUND. GEN. FUND 1.20 OR 7857-999.20740 JURY REIMB. FUND. STATE 10.80 DR 7857-999.10D10 12.00 OR 785&999-20510 CIVIL JUSTICE DATA REPOS: GEN FUND 0.01 OR 7856.999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.09 DR 7856-999-10010 0.10 OR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND. STATE 0.00 DR 7502-999-10010 0.00 7998-999-20740 TRUANCY PREVENT/DIV FUND - STATE 3.00 7998.999.20701 JUVENILE CASE MANAGER FUND 3.00 OR 7898-899-10D10 6.00 7403-999.22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 785&999.20740 STATE CONSOLIDATED CIVIL FEE 84.00 84.00 TOTAL (Distrib Req to OperAcct) $4.028.20 DUE TO OTHERS (Distrib Reg Attchd) CALHOUN COUNTY ISO 0.00 DA- RESTITUTION 0.00 REFUND OF OVERPAYMENT: 0.00 OUT -OF -COUNTY SERVICE F1 0.00 CASH BONDS 0.00 PARKS 8: WILDLIFE FINES 0.00 WATER SAFETY FINES 6.60 TOTAL DUE TO OTHERS $0.00 TOTAL COLLECTED -ALL FUNDS $4,028.20 LESS: TOTALTREASUER•S RECEIPTS $4,028.20 REVISED 02/02/2021 OVER48HORT) $0.00 Page 3 of 3 #15 NOTICE OF MEETING — 6/13/2022 15. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 11 of 12 G m Ma a m z I 0 N V O n O C z A M c C m z 0 a r 0 W IJ O N IBM PE N �own°�iw "WW'�ya�y m J fp f0 (0 A may' O O O N (OJT 0 mom c p>c0') D z A Z m Z O -M, am) O �crz"m A ci O � m cam-- m M z� C P3P1 v r m 0 ITI 0 0000000 �Tef z� M O 0000000 fA 00f W A0 W J PR A N 000 f0 fA f9 EA w 00f 0 0fA w W 0 w A A (0 0 0 m tp O N w w A N W� •� M 0 00 00 00 t0 J Q 0 O 0 N O W 0 I0 c 0 n m m m a C z 0 rx `' 1 z a 3 m fB z m m m A O fOlt N W ~ o <nooe vzc�= n m m O = A co -1 Z z O n M O D m v_ ys ev zc`y' z m a n m m z z z z 0000 z z z z z x im o O o 0 0 0 0CA O o o 0 o o Oi» �j O O O co i T F 000 m z m v 3 m 3 g V ,z°, z m'', m r; m W Z, z N �I O 0 m � k M i z m v: m: m Z: OE i; 03 ~ N O �'o 1 O $ DN m j 3 o � m m (n T mzz 0oo 300 m m r o N 0 c a 0 0 a n r r- w tow 0 000 0 0 0 coo 0 0 0 oy T O O O O N O O o 0 0 0 0 Co00 a O Ooo^ 1 M: M. m Z: 0 Z: o M€ m mE ° m: '1e z OE � C fZN e O c z N t! e c 0 n m m m n C VL r z m, C pi m a; m r'0 z i! i 3! m Z! N -1! Z zi a: a° m m y O m; o0� oC z z z �O N oG) zz oto�o c v a m m m a r C O #16 NOTICE OF MEETING—6/13/2022 16. Approval of bills and payroll. (RHM) Indigent RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 12 of 12 C H H r x 0 z m x N O E9?+ 0 g0N>ME wH W �Zz�t �Nz£°x9�' N COC � H H 0 O H t4 z tj Omy X h]m e�([/]H xSd Hx[+Jw 01 mv� 0 H H 7J H W H W to w 0 x i D H H n k H w 00 a+ x r x za H CU H H H 3 r vz, W z H n x w H k r m d H w w 3 C ro 0 O z H b ro y y y y ro ro ro ro ro rozrorororozzza�x H i? N O] W H UI H Ol N H �P 01 N Ui W T N O O H H N N �p 61 iP 1p W P A A �O p� w lD �O w w VI O lli iP w H VI N N UI O w w lfi UI N UI w H �P H N H C\ MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR --June 13 2022 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIO BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDS' TOTAL NURSING HOME UPL_EXPENSES.. $ 626,758M *x $, 469,847 62 - I/ $ 652,549,24 ✓ TOTAL INTER -GOVERNMENT TRANSFERS 85,44692 GRAND TOTAL DISBURSEMENTS APPRED June 13, 2022 $. 178480Lii MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---June 13 2022 PAYABLES AND PAYROLL 6/8/2022 Weekly Payables 339,846.89 6/8/2022 Allyson Swope -transcription services 3,213.00 6/8/2022 Calhoun County -Voyager Fuel Card 138.07 6/10/2022 Payroll Liabilities for supplemental payroll -Payroll Taxes 236.48 6/10/2022 Supplemental Payroll 935.62 Prosperity Electronic Bank Payments 6/6/2022 Credit. Card & Lease Fees 32.45 6/20/2022 Sales Tax for May 2022 1,421.02 6/15/2022 TCDRS May Retirement 180,918.66 81"IM2 Pay Plus Patient Claims Processing Fee 215.34 TOTAL PAtYABGES PAYRQLL,AND ELECTF, 9NlO'BANK PAYMENTS' $ •626,7a&53 TRANSFERS BETWEEN FUNDS-MMC 6/9/2022 Transfer from Money Market Account to MMC Operating 350.000.00 TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 6/8/2022 MMC Operating to Ashford -correction of NH QIPP payment deposited into 6,391.95 MMC Operating 618/2022 MMC Operating to Solera-correction of NH insurance and QIPP payment 8,465.00 deposited into MMC Operating 8/8/2022 MMC Operating to Fort bend -correction of NH QIPP payment deposited into 2,484.90 MMC Operating 6/8/2022 MMC Operating to Broadmoor-correction of NH insurance and QIPP payment 1,817.19 deposited Into MMC Operating 6/812022 MMC Operating to Crescent -correction of NH QIPP payment deposited into 2,152.47 MMC Operating in error 6/812022 MMC Operating to Golden Creek -correction of NH insurance and QIPP 5,239.99 payment deposited into MMC Operating in error 6/8/2022 MMC Operating to Gulf Pointe Plaza -correction of NH insurance and QIPP 34,930.59 payment deposited into MMC Operating 618/2022 MMC Operating to Tuscany Village -correction of NH insurance and QIPP 29,078.66 payment deposited Into MMC Operating 6/812022 MMC Operating to Bethany -correction of NH Insurance payment deposited 29,286.77 into MMC Operating in error TOTAL TRANSRSBETWSEN,FUNDS $, 468,0752 i lk I I I :1;I I lk"i NI iri l =111,9» #Nj 21 Z FI-*a 6/10/2022 Nursing Home UPL-Cantex Transfer 281,188A9 6/10/2022 Nursing Home UPL-Nexion Transfer 64,176.47 6/1012022 Nursing Home UPL-HMG Transfer 47,821.65 6/1012022 Nursing Home UPL-Tuscany Transfer 38,855.11 6/10/2022 Nursing Home UPL-HSL Transfer 81,737.22 QIPP CHECKS TO MMC 6/10/2022 Ashford 47,953.16 6/10/2022 Broadmoor 18,652.39 6/1012022 Crescent 15,972.29 6110/2022 Fort Bend 19,293.05 611012022 Solera 18,765.74 6110/2022 Tuscany 28,133.67 TOTAL; NURSINGkOME UPL EXPENSES $, 662r54524, INTER -GOVERNMENT TRANSFERS 6/10/2022 IGT RAPPS to be paid June.23, 2022 85,446.92 �TQTAtiN1iEWt3OVEItNMEIJTTRAN6FERS zV 85,440''92' ORAND'TOTAL;613I3t9RSENiENTS AFPPROV,E0, June.43, 2622 $ 1,78A,6p2s21, Page 1 of 12 RECEIVED BY THE COUNTY AUDITOR ON 2022 MEMORIAL MEDICAL CENTER 2fik 0 AP Open Invoice List 12:28 ap_open_Invoice.template C/uNOUN GAUNT`/, TF-r1hR Due Dates Through: 06/30/2022 VVendor# Vendor141 Class Pay. Code 10659 AABB ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1001192764 06/07/20 06/06/20 06/07/20 316.00 0.00 0.00 at6.00 ✓`" BLOOD BANK BOOK Vendor Totals Number Name Gross Discount No -Pay Net 10659 AABB 316.00 0.00 0.00 316.00 Vendor# Vendor Name Class Pay Code 11283 ACE HARDWARE 15521 Invoice# Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross Discount No -Pay Net 16484D 05/31/20 OW05/20 05/30/20 3.59 0,00 0.00 _ 3,59 I% SUPPLIES 164997 ✓ 05/31/20 05/10/20 06/04/20 18.75 0.00 0.00 18.75 1,-'- SUPPLIES 165162 �" 05131/20. 05/16/2006110/20 25.99 0.00 0.00 25.99 SUPPLIES 165198 05/31/20 05/17/20 08/11/20 8.59 0.00 0.00 6.59 SUPPLIES 165404 ✓� 05/31/20 05/25/20 06/19/20 3.99 0.00 0.00 3.99 v-r� SUPPLIES 165423 05/31/20 05/25/20 06/19/20 26.99 0.00 0.00 26.99 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11283 ACE HARDWARE 15621 87.90 0.00 0.00 87.90 Vendor# Vendor Name Class Pay Code At 680 Al RGAS USA, LLC-CENTRAL DIV ✓' M Invoice# Comment Tran Dt Inv of Due Dt Check D Pay Gross Discount No•Pay Not 9126302721 1%" 06/07/20 05/25/20 06/19/20 323.04 0.00 0.00 323.04 y/ OXYGEN Vendor Totals Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC - CENTRAL DIV 323,04 0.00 0.00 323.04 Ventlor# Vendor Name Class Pay Code 61150 BAXTER HEALTHCARE v'� W Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 75170444 `% 05/31/20 05/20/20 06/14/20 816.94 0.00 0.00 816.94 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net B115D BAXTER HEALTHCARE 816.94 0.00 0.00 816,94 Vendor# Vendor Name Class Pay Code M2485 BAYER HEALTHCARE ,j M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 6009864484 / 05/31/20 05/25/20 06/06/20 581.88 0.00 0.00 581.88 SUPPLIES Vendor Total:Number Name Gross Discount No -Pay Net M2485 BAYER HEALTHCARE 581.88 0.00 0.00 681.88 Vendor# Vendor Name Class Pay Code B1220 BECKMAN COULTER INC ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross Discount No -Pay Net file:///C:/Users/ltrevino/cpsilmeinmed.cpsinet.com/U88125/data_5/tmp_cw5reportl 198688... 6/8/2022 Page 2 of 12 109763017 / 05/20/20 03/16/20 06/24/20 147.38 0.00 0.00 SUPPLIES 109910615 ,/' 05/31/20 05/25/20 06/24/20 164.61 0.00 0.00 SUPPLIES / 109918738 ✓ 05/31/20. 05131/2006125120 3,874.83 0.00 0.00 CONTRACT 109928834 i,% OB/07/20 06/02/20 06/27/20 434.71 0.00 0.00 SUPPLIES 109928798 J 06/07/20 06102/20 06/27/20 977,57 0.00 0100 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay B1220 BECKMAN COULTER INC 51599.10 0.00 0.00 Vendor# Vendor Name , Class Pay Code 13892 BLUE CROSS BLUE SHIELD REFUND / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross A211615601 05131/20. 05/09/2006/24/20 983.29 B211138301 05/31/20 05/09/20 06/24/20 983,29 A212989301 05131 /9n 0511 IWO 06/24/20 132.83 B21266701 05/31/20 06/01/20 06/24/20 68.53 147.38 I 164.61 f 3,874.63 434.71 ✓ 977,57 Net 5.699.10 Discount No -Pay Net 0.00 0.00 98329 ✓'� 0.00 0.00 963.29 ✓! 0.00 0.00 132.83 ✓ 0.00 0.00 68.53 v{� Vendor Totals Number Name Gross Discount No -Pay Net 13B92 BLUE CROSS BLUE SHIELD REFUND 2,167.94 0.00 0.00 2,167.94 Vendor# Vendor Name Class Pay Code B1650 BOSART LOCK & KEY INC �� M Invoice# Comment Tran Dt Inv Dt Due DI Check D Pay Gross Discount No -Pay Net 124265 05/31/20A5127/2006/26120 62.40 0.00 0.00 52.40 v, SUPPLIES Vendor Total, Number Name Gross Discount No -Pay Net B1650 BOSART LOCK & KEY INC 52.40 0.00 0.00 52.40 Vendor# Vendor Name Class Pay Code 11295 CALHOUN COUNTY INDIGENT ACCOUN ,-' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 060622 06/07/20 06/06/20 06/07/20 10.00 0.00 0,00 Itim .� INDIGENT Vendor Totals Number Name Gross Discount No -Pay Net 11295 CALHOUN COUNTY INDIGENT ACCOUN 10.00 0.00 0.00 10.00 Vendor#Vendor Name Class Pay Code 14464 % Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 204322 05/31/20 06/01/20 06/24/20 61.00 0,00 0.00 81.00 REFUND Vendor Totals Numbar Name Gross Discount No -Pay Net 14464 81.00 0.00 0.00 81.00 Vendor# Vendor Name Class Pay Code 14452 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 194515 05/31/20 05/09/20 06/24/20 80.00 0.00 0.00 80.00 r/ REFUND file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88l25/data 5/tmp_ew5report1198688.., 6/8/2022 Page 3 of 12 165662 05/31120 05/09/20 06124/20 80.00 0.00 0.00 80.00 REFUND Vendor Totals Number Name Gross Discount No -Pay Net 14452 160.00 0.00 0.00 16o.00 Vendor# Vendor Name Class Pay Code 10105 CHRIS KOVAREK ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 63 ✓/ 06/07/20 06/02/20 06/16/20 80.00 0.00 0.00 80.00 ✓ •' SOCIAL SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 10105 CHRIS KOVAREK 80.00 0.00 0.00 80.00 Vendor# Vendor Name Class Pay Code 10786 CLINICAL PATHOLOGY 4,/r Invoice# Comment Tran Dt Inv Dt Due Di Check D Pay Gross Discount No -Pay Net 176562022050 05/31 /20 05/31/20 06/25/20 13,864.63 0.00 0.00 13,864.63 PATHOLGOY SERV Vendor Total; Number Name Gross Discount No -Pay Net 10786 CLINICAL PATHOLOGY 13,864.63 0.00 0.00 13,864.63 Vendor# Vendor Name Class .Pay Code 13572 COMMUNITY INFUSION SOLUTIONS ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 1020220615 ✓ 06/07/20 06/03/20 06/13/20 10,321.98 0.00 0.00 10,321.96 ✓' INFUSION SERVICES Vendor TotaVNumber Name Grass Discount No -Pay Net 13572 COMMUNITY INFUSION SOLUTIONS 10,321.98 0.00 0.00 10.321.98 Vendor# Vendor Name Class Pay Code 10060 DETAR. HOSPITAL v�( ICP ' Invoice# Comment Tran Dt Inv Dt Due or Check D Pay Gross Discount No -Pay Net _ DTR2202020 05/3V2003/01/2004/01l20 10.56 0,00 0.00 10.56 1,. ,// LAB SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 10060 DETAR HOSPITAL 10.56 0.00 0.00 10.56 Vendor# Vendor Name Class Pay Code 11011 DIAMOND HEALTHCARE CORP „f Invoice# Com/I ant Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net IN20055230A ✓ 05/31/200610112006126/20 31,444.58 0.00 0.00 31.444.58 4✓`- BEHAV HEALTH MAY 22 INV20055231A✓" 05/31/20 06/01/20 06126/20 19,166.67 0.00 0.00 19,166.67 / ✓ MAY 22 CPR Vendor Totals Number Name Gross Discount No -Pay Net 11011 DIAMOND HEALTHCARE CORP 50,611.25 0,00 0.00 50,61125 Vendor# Vendor Name Class Pay Code 10789 DISCOVERY MEDICAL NETWORK INC ,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net MMC053122 �/ 06/07/20 05/31/20 06101/20 130,335.04 -0.00 0.00' 130,336.04 PHYSICIAN SERVICES Mraj 14-- 31 Vendor Totals Number Name Gross Discount No -Pay Net 10789 DISCOVERY MEDICAL NETWORK INC 130,335.04 0,00 0.00 130,835.04 Vendor# Vendor Name Class Pay Code 11291 DOWELL PEST CONTROL Invoios# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.corn/u88125/data_5/tmp_ew5report119868 8... 6/8/2022 Page 4 of 12 9864 f' 06/07/20 06/01/20 06/26/20 65.00 0.00 0.00 65,00 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 W1167 ELITECH GROUP INC (WESCOR) ✓f W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 785696 ✓`05/31/20 05/24/20 06/24/20 74.16 0.00 0.00 74.16 Vendor Totals Number Name Gross Discount No -Pay Net W1167 ELITECH GROUP INC(WESCOR) 74,16 0.00 0.00 74.16 Vendor# Vendor Name Class Pay Code F1100 FEDERAL EXPRESS CORP. W Invoice# CJment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 962284176 ,/ 05131/2004/07/2006/2420 2.72 0.00 0.00 2.72 ✓' PREY LATE FEE Vendor Totals Number Name Gross Discount No -Pay Net F1100 FEDERAL EXPRESS CORP. 2.72 0.00 0.00 2.72 Vendor# Vendor Name _ Class Pay Code F1400 FISHER HEALTHCARE yr M Invoice# , Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2846719 ✓ 05/31/20 05/15/20 06/24/20 37.26 0.00 0.00 37.26 1✓ SUPPLIES 3284528 ✓ 05/31/20 05/3120 06/25/20 246.18 0.00 0.00 246.18 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 283.44 0.00 0.00 283.44 1 Vendor# Vendor Name Class Pay Code 11184 FLDR DESIGNS LLC Invoice# Comment Tran Ot Inv Ot Due Dt Check 0 Pay Gross Discount No -Pay Net 15404 ��� 05/31120 10/12/20 06/24/20 435,00 0100 0100 435.00 vim" PTBROCHURES 15417 i,/' 06/07/20 12/21/20 01120/20. 435.00 0.00 0.00 435.00 BROCHURES Vendor Totals Number Name Gross Discount No -Pay Net 11184 FLDR DESIGNS LLC 870.00 0.00 0.00 870.00 Vendor# Vendor Name Class Pay Code 11183 FRONTIER Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 060222 061082006102/200612720 1,166,80 0.00 0.00 1,166.80 TELEPHONE Vendor Totals Number Name Gross Discount No -Pay Net 11183 FRONTIER 1,166.80 0.00 0.00 1,166.8Q Ventlor# Vendor Name Class Pay Code 12948 GREAT AMERICA FINANCIAL SVCS ✓ Invoice# Comment Tran or Inv DI Due Dt Check D Pay Gross Discount No -Pay Net 31779123 t,/ 06/07/200610612006/30120 10,252.18 0.00 0100 10,252.18 LEASE Vendor Totals Number Name Gross Discount No -Pay Net 12948 GREAT AMERICA FINANCIAL SVCS 10,252.18 0.00 0.00 10.252,18 Vendor# Vendor Name Class Pay Code file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5repolt1198688... 6/8/2022 Page 5 of 12 G1210 GULF COAST PAPER COMPANY of M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2239511 �/ 05/31/20 05/24/20 06/24/20 45.11 0.00 0.00 45,11 ✓ ! SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Not 01210 GULF COAST PAPER COMPANY 45.11 0.00 0.00 45A 1 Vendor# Vendor Name Class Pay Code H1100 HAYES ELECTRIC SERVICE ,I` W Invoice# Corn ant Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net A222050402 ,/ 05/31/2005/31/2006124/20 149.99 0.00 0.00 149,99 DOD WP CONT STATION A222051102 05/31/20 05/31/20 06/24/20 ✓ 220.00 0.00 0.00 220.00 LABOR /BUCKET TRUCK rrAK , A2220505061,% 05/31120 05/31/20 06/24/20 125.00 0.00 0.00 125.00 fir` IA g LABOR/EXHAUST FAN A2220500lld „/ 05/31/2005/31/2006124/20 603.73 0.00 0.00 603.73V LABORIBUCKET TRUCK Vendor Total: Number Name Gross Discount No -Pay r Net H1100 HAYES ELECTRIC SERVICE 1,098,72 0,00 0.00 1,098,72 Ventlor# Vendor Name , Class Pay Code t 11552 HEALTHCARE FINANGIAL SERVICES `/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Grass Discount No -Pay Net 100613055 ✓ 05/31/20 05/07/20 06124120 4,919.41 0.00 0100 4,919.41 LEASE 100613657 �/ 05/31/20 05/07/20 00/24/20 7,447,86 0.00 0.00 7,447.86 ✓' LEASE 100613658 ,/ 05/31/20 05/07/20 06124120 1,797,44 0.00 0.00 1,797.44 ✓! LEASE 100613656 ✓/ 05/31/200510712006/24/20 7,154.17 0.00 0.00 7,154,17 v1 LEASE Vendor TotalENumber Name Gross Discount No -Pay Net 11552 HEALTHCARE FINANCIAL SERVICES 21,318.88 0,00 0.00 21,318.88 Vendor# Vendor Name Class Pay Code H0031 HEB CREDIT RECEIVABLES DEPT308 Invoice# Comment Tran Dt Inv of Due Dt Check D Pay Gross Discount No -Pay Net 21328 06/07/20 06/06/20 06/06/20 2,990.00 0.00 0.00 2,990.00 VAC CONFIDENCE GRANT RE , 053122 06108/20 05131/20 06/25/20 1,626.77 0.00 0.00 1,626.77 y% DIETARY SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net H0031 HEB CREDIT RECEIVABLES DEPT300 4,616.77 0.00 0.00 4,616.77 Vendor# Vendor Name Class Pay Code / 10530 HUMANA HEALTHCARE PLANS ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 194554 n5/31/P005/09/2006/24120 123.48 0.00 0,00 123,48 Vendor TOfaN. Number Name Gross Discount No -Pay Net 10530 HUMANA HEALTH CARE PLANS 123.48 0.00 0.00 12148 Vendor# Vendor Name Class Pay Code 11200 IRON MOUNTAIN Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net file:///C:Nsers/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report 1198688... 6/8/2022 Page 6 of 12 GPJV353✓ 05131/20 05/31/20 06/24/20 652.44 0.00 0100 652.44 SHRED SERVICES Vendor Totals Number Name Gross Discount No -Pay Net 11200 IRON MOUNTAIN 652.44 0.00 0100 652.44 Vendor# Vendor Name Class Pay Code J0150 J & J HEALTHCARE SYSTEMS, INC V' Invoice# Comment Tran Dt Inv Of Due Dt Check D, Pay Gross Discount No -Pay Net 929560691 f' 05/31/20 OBJ31120 06/30/20 525.99 0.00 0.00 525.99 SUPPLIES v Vendor Totals Number Name Gross Discount No -Pay Net J0150 J & J HEALTH CARE SYSTEMS, INC 525.99 0.00 0.00 525,99 Vendor# Vendor Name Class Pay Code 14460 Invoice# Comment Tran Of Inv of Due of Check D Pay Gross Discount No -Pay Net 196760 05/31120 06/01/20 06/24/20 10.36 0.00 0.00 10.36 REFUND 203937 05/81/20 06/01/20 06124120 67.36 0.00 0.00 67.36 REFUND Vendor Totals Number Name Gross Discount No -Pay Net 14460 77.72 0.00 0.00 77.72 Vendor# Vendor Name Class Pay Cade 12628 LEGATO r/ Invoice# Comment Tran of Inv of Due Of Check D Pay. Grass Discount No -Pay Net C2347 0513112004/30/2006/24/20 1,512.80 0.00 0.00 1,512.60 N' HEALTH FAIR TEMPLATE Vendor Totals Number Name Gross Discount No -Pay Net 12628 LEGATO 1,512.60 0.00 0.00 1,512.60 Vendor# Vendor Name Class Pay Code 10972 M G TRUST J Invoice# Comment Tran Of Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net ! 060622 06/07/20 061OW20 06/15/20 640.86 0.00 0.00 640.86 PAYROLL DEDUCTS Vendor Totals Number Name Gross Discount No -Pay Net 10972 M G TRUST 640.86 0.00 0.00 640.86 Vendor# Vendor Name Class Pay Code M2178 MCKESSON MEDICAL SURGICAL INC �+ Invoice# Comment Tran of Inv Ot Due Of Check 0- Pay Gross Discount No -Pay Net 19$53722 V" 05/31/20 05/05/20 06/24/20 451.34 0.00 0.00 451.34 SUPPLIES / 19428164 J 05/31/2005/26/2006/10/20 86.70 0100 0,00 86.70 � SUPPLIES Vendor Total. -Number Name Gross Discount No -Pay Net M2178 MCKESSON MEDICAL SURGICAL INC 538.04 0.00 0.00 538.04 Vendor# Vendor Name Class Pay Code 11141 MEDICAL DATA SYSTEMS, INC. ,j Invoice# Comment Tran of Inv Ot Due Of Check D Pay Gross Discount No -Pay Net 171741 05/31/20 05/31/20 06/25/20 802,44 0.00 0.00 802.44 ✓'. V�' COLLECTION FEES Vendor Totals Number Name Gross Discount No -Pay Net 11141 MEDICAL DATA SYSTEMS, INC. 802.44 0.00 0.00 802.44 , Vendor# Vendor Name Class Pay Code file:///C:/Users/itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report1198688... 6/8/2022 Page 7 of 12 M2470 MEDLINE INDUSTRIES INC ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2210711631 V1 05/31/20 05/01/20 06/24/20 11098.81 0.00 0.00 1,098.81 SU7LIES 2209656924 ✓" 05/31/20. 05/03/2006124/20 4,122.17 0.00 0.00 4.122.17 SUPPLIES i 22115799859 .f G5131120. 05/17/2006/11/20 158.05 0.00 0.00 158.05 SUPPLIES Vendor Total.- Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 5,379.03 0.00 0.00 5,379.03 Vendor# Vendor Name Class Pay Code 10963 MEMORIAL MEDICAL CLINIC ,:/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 060622 06/07/20 06/06/20 06/15/20 120,00 0.00 0.00 120.00 PAYROLL DEDUCT , Vendor Totals Number Name Gross Discount No -Pay Net 10963 MEMORIAL MEDICAL CLINIC 120,00 0.00 0.00 120.00 Vendor#Vendor Name Class Pay Code 14456 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 177347 06/31/2D 05/17/20 00/24/20 50.00 0.00 0.00 50.00 REFUND 198947 ,% 05/31 /20 05/17/20 06/24/20 50.00 0.00 0.00 50.00 REFUND v/ Vendor Totals Number Name Gross Discount No -Pay Net 14456 100.00 0.00 0.00 100,00 Vendor# Vendor Name Class Pay Code 12096 NEOGENCMICS LABORATORIES ,/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 3014690 ✓1 05131/2011/3012D 06/24/20 1,320.00 0,00 0.00 1,320.00 4/ LAB SERVICES 4734677 f 05/31 /20 09/30/20 06/24/20 180.00 0.00 0.00 180.00 "Z LAB SERVICES , 4904856 r,% 05/31/201113012006124/20 1.980,00 0,00 0.00 1.980.00 r+� , LAB SERVICES 4994448 V1 05/31/2012/3l/2006/24/20 3,486.00 0.00 0,00 3,486.00 a!� LAB SERVICES j 3728291 mil. 06/07120 10/31120 11130120 670.00 0.00 0.00 870.00 v� ) AS SERVICES 4821354 06107/20 10/31/20 11130/20 1.530.00 0.00 0.00 1,530.00 LAB SERVICES Vendor Total: Number Name Gross Discount. No -Pay Net 12096 NEOGENOMICS LABORATORIES 9.366.00 0.00 0.00 9.366,00 Vendor# Vendor Name Class Pay Code 11155 PARA �i Invoice# Comment Tran Dl Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net 10034 ./ 05/31/20 12/01/20 06/24/20 950.00 0.00 0.00 950.00 PRICE TRANSPARENCY 10586r,/ 05/31/20 03/01120 06/24/20 3,084.00 0.00 0.00 3,084.00✓ REVENUE INTEGRITY PROGR 10650 ✓ 05/31/20 03/01/20 05/24/20 950.00 0.00 0.00 950,00 file:///C:/Users/ltrevinolcpsilmemmed.cpsinet.com/u88125/data 5/tmp_cw5reportl198688... 6/8/2022 Page 8 of 12 PRICES TRANSPARENCY Vendor Totals Number Name Gross Discount No -Pay 11155 PARA 4,984.00 0.00 0.00 Vendor# Vendor Name Class Pay Code P22DO POWER HARDWARE e/f W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay A84244A ✓`� 06/08/20 05/04/20 05/14/20. 72.97 0.00 0.00 SUPPLIES A84237✓ 06/08/20 06/04/20 05/14/20 11.99 0.00 0.00 ,SUPPLIES A84920 .Z 06/08/20 06/25/20 06/04/20 3.00 0.00 0.00 SUPPLIES Vendor TotalENumber Name Gross Discount No 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-Pay 11251 RAPID PRINTING LLC 1.637.25 0.00 0.00 Vendor# Vendor Name Class Pay Code 11764 ROBERT RODRIQUEZ Invoice# Comment ✓Tran Dt Inv Dt Due Ot Check D Pay Grass Discount No -Pay 060222 06(07/20 06/02/20 06/15/20 25.11 0.00 0.00 MILEAGE 060622 06/07/20 06/06/20 06/15/20 26,50 0.00 0.00 MILEAGE Vendor Totals Number Name Gross 11764 ROBERTROORIOUEZ 51.61 Vendor# Vendor Name Class Pay Code 81800 SHERWIN WILLIAMS 1r W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 29041 ✓ 00/07/20 05/26/20 06/10/20 935.51 SUPPLIES Net 4.984.00 1 I Net 72.97 Net 87,96 Net 6.650.00 Net 5,650.00 Net 2,624.74 1j Net 2,624.74 Net 1,489.25 ✓' 48.o0 Net 1.537.25 Net 25.11 / 26.50 Discount No -Pay Not 0.00 0.00 51.61 Discount No -Pay Net 0.00 0.00 935.51 j file:///C:/Users/Itrevino/cpsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5report1198688... 6/8/2022 Page 9 of 12 29058 ,/ 06/07/20 OS/26/20 06/10/20 341.21 0.00 0.00 341.21 SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Not S1800 SHERWIN WILLIAMS 1,276.72 0.00 0.00 1276.72 Vendor# Vendor Name Class Pay Code 109$6 SIEMENS FINANCIAL SERVICES "Y Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net $6382200039910 ✓' OS/31/2005/30/2006/19/20 1,333.33 0.00 0.00 1,333.33 fir" LEASE Vendor Totak 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 Code 12472 SOMETHING MORE MEDIA, INC, rj Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1767 ✓ 05/31/20 05/31/20 06/24120 2,225.00 0.00 0.00 2,225.00 ADVERTISING , Vendor Total, Number Name Grass Discount No -Pay Net 12472 SOMETHING MORE MEDIA, INC. 2,225.00 0.00 0.00 2.225.00 Ventlor# Vendor Name Class Pay Code 11296 SOUTH TEXAS BLOOD & TISSUE CEN Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net CM7056 f' 05/31/20 05/31/20 06/25120 -946.00 0.00 0.00 -948.00 Vs` CREDIT 107023091 ��� 05/31/20 05/31/20 06/25/20 5,502.00 0.00 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Gross Discount No -Pay Net 11064 VELOCITY EHS 4,699.00 0.00 0.00 4,699.00 Vendor# Vendor Name f Class Pay Code 12208 WAGEWORKS v/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net J INV3817500 �,/ 05/3V2005126/2006/26/20 396.50 0.00 0.00 396.50 MONTHLY ADMIN/COMPLIANC L/"" Vendor Totals Number Name Gross Discount No -Pay Net 12208 WAGEWORKS 398.50 0.00 0.00 396.50 Vendor# Vendor Name Class Pay Code 10793 WAGEWORKS, INC, Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 060622 06/07/20 06/06/20 06/15/20 3.410.17 0.00 0.00 3.410.17 Vj PAYROLL DEDUCT Vendor Totals Number Name Gross Discount No -Pay Net 10793 WAGEWORKS, INC. 3,410,17 0.00 0.00 3,410.17 Vendor# Vendor Name Class Pay Code file:///C: /Users/ltrevino/cpsi/me.mmed.cpsinet.coin/u88125/data_5/tmp_cw5report1198688... 6/8/2022 W1189 WERLING ASSOCIATES INC �: W Invoice# Comment Tran Bt�Inv Dt Due Dt Check D- Pay Gross 7957 06/07/20 06/02/20 06/02/20 695.00 TSHHRAE WAGE/BENEFIT SU Vendor Totals Number Name Grass W1189 WERLING ASSOCIATES INC 695.00 Report Summary Grano Totals: Gross Discount 339,646.89 0.00 APPROVED ON JUN 0 8 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Discount No -Pay 0.00 0.00 Discount No -Pay 0.00 0.00 No -Pay 0.00 Page 12 of 12 Net / 695.00 ✓ Net 695.00 Net 339,646.89 f. file:!//C:/Users/Itrevino/cpsi/memmed.cpsinet.con-i/u88125/data_5/tmp_cw5report 1198688... 6/8/2622 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON JUN O S 2022 OB/OB/202022 MEMORIAL MEDICAL CENTER 0 OALHOU N �OY,lb AP Open Invoice List ap_open_Involce.template Dates Through: Vendor# Vendor Name Class Pay Code 10958 ALLYSON SWOPE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 060822 06108/20.06/08/20 06/08120. 3,213.00 0.00 0.00 TRANSCRIPTION SERVICES Vendor Totals Number Name Gross Discount No -Pay 10958 ALLYSON SWOPE 3,213.00 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 3,213.00 0.00 0.00 APPROVED ON JUN 08 2022 8Y COUNTY AUDITOR CALHOUN COUNTY, TE)" Net 3,213.00 Net 3.213.00 Net 3,213.00 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report2561599... 6/8/2022 Page I of I RECEIVED BY THE COUNITY AUDITOR ON JUNOW022 MEMORIAL MEDICAL CENTER 16:16 AP Open Invoice List CALH V -T7--" en e d'or Dates Through: o trr� ame Class Pay Code C1048 CALHOUN COUNTY w Invoice# Comment Tmn Ot Inv Dt Due Dt Check D Pay Gross 052422 O6/08/20.05/24/20 06/15/20 138.07 Vendor Totals Number Name Gross C1048 CALHOUN COUNTY 138.07 Report Summary Grand Totals: Gross Discount 138.07 0.00 APPROM ON JUN 08 2022 BY COUNTY ALIMOR CALHOUN COUNTY, TEXAS 0 ap_open_invoice.template Discount No -Pay Net 0.00 0.00 138.07 Discount No -Pay Net 0.00 0.00 138.07 No -Pay Net 0.00 138.07 file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report4656385... 6/8/2022 TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1.800-572-8683) "ENTER 9-DIGIT TAXPAYER IDENTIFICATION NUMBER" 0"ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" "IF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGIT TAX FILING YEAR" ❑"ENTER 2-DIGITTAX FILING ENDING MONTH" 1ST QTR - 03 (MARCH) -Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) - July, Aug, Sept 4TH QTR - 12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" E-16-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER #ta## ENTER: L:1 941 # $ 236.48 1 $ 144.40 $ 33.78 $ 58.30 CHECK 5 CALLED IN BY: CALLED IN DATE: CALLED IN TIME: F:1AP•Payroll FileslPayroll T9xes12022%#12 R2 MMC TAX DEPOSIT WORKSHEET 6.02.22 R1.xls 6/10/2022 iq RrWj WW2 - Pf'7m F.un= ... 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S=-x_GY Page j'G[e jT :CM.' :-C']-!_ti 2055E JRFES C ?Y.?S 555.e2 GMli-17 O;i17(22 au 2 941 RECITAX DEPOSIT FOR MMC PAYROLL PAY PERIOD: BEGIN PAY PERIOD: END PAY DATE: GROSS PAY: DEDUCTIONS: A/R ADVANC BOOTS SUNLIFE CRITICAL ILLNESS SUNLIFE ACCIDENT SUNLIFE VISION SUNLIFE SHORT TERM DIS BCSS VISION CAFE-D CAFE-H CAFE-P CANCER CHILD CLINIC COMEIN CREDUN DENTAL DEP.LF SUNLIFE TERM LIFE SUNLIFE HOSP INDEM FED TAX FICA-M FICA-0 FIRST C FLEX S FLX.FE GIFT S GRP-IN GTL HOSP-1 LEGAL OTHER NATIONAL FARM LIFE MED SURCHARGE PR FIN RELAY REPAY STONEOF STONE STONE2 STUDEN TSA-R UWIHOS TOTAL DEDUCTIONS NET PAY: TOTAL CAFE 125 PLAN: FAXABLE PAY: S 1,184.S3 $ 1,164.53 ••CALCULAT6e" Fmm MMC Rseee Difference °ICA - MED (ER) usw 5 16.69 -ICA- MED (EE) naw 5 16.89 $ 16.89 5 - ZICA - SOC SEC (ER) nxr. 5 72.20 :ICA • SOC SEC (EE) exv. S 72.20 S 72.20 3 -ED WITHHOLDING S 58.30 S 58.30 TAX DEPOSR: S 236.46 3 2364e FICA - MEDICARE xw. $ 33.78 $33.76 FICA -SOCIAL SECURITY I:.4n $ 144.40 $144.40 PREPARED EM FED WITHHOLDING S 58.30 $58.30 PREPARED DATE: TOTAL TAX: S 236.48 $236.48 $ - REVISED 31162014 TOTALS S 1.164.53 58.30 15.89 72.20 S 81,52 5 2zss1 S 935.62 Exempt Amt: Employees over FICASS Cap: S S S Payoode S - Employee Relm6.: TOTAL: $ Calllin Clevenger 611012022 012 82 MMC TAX DEPOSIT WORKSHEET 6.0222 RI Ms. TAX DEPOSIT WORKSHEEWIOQ022 MEMORIAL MEDICAL CENTER 0,4 VIVA PROSPERITY BANK y 0 , 9 ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT —DUNE 06, 2022-June 9, 2D22 Date Bank 69967 ion391 6/6/2022 PAY PLUS ACHTRAN5451579291102000699678391 MARC Notes mount Cr 6/6/2022 FpM5 FDMS PYMT 052-1601830-0004100012848373 -3rd Parry Payer Fee - Credit Card Processing Fee 5, ..0�92 ! j �•I+fi.. ,!4 .f>e `♦"' 6/7/2022 PAY PLUS ACHTRANS 452579291101000690836146 6/7/2022 -3rd Party Peyor Fee 32A5 4i32AS r'I- MCKESSON DRUG AUTO ACH ACH05048837910000167 - 34080rug Program Expense 8;38"6.4d S2f{'� 6/8/2022 PAY PLUS ACHTRAN5452579291101000692012717 6/9/2022 PAY PLUS A[HTRAN5452579291301000692A5468 - 3rd Parry Payer Fee - 3rd Parry Payor Fee , '.;� 32"4=� 216. 8,635.73 32.45 June 10, 2022 l` ! fl ') l^`J William Little, CFO l Memorial Medical Center }��µyls� p�•uy Zy CO PROSPERITY BANK 8 ' 6 3 y ELEC(RONICTRANSFERS FOR OPERATING ACCOUNT —ESTIMATED ACHS .. iit-- - Date OettriotiDn MMC Notes Amount 248-t 6/15/2022 ACH Payment TEXAS COUNTY ORS RECEIVABLE 041921000024329 - Retirement Funding '180,918.66 6/20/2022 ACH Payment WEBRLE TAX PYMT DO -Saks Tax 1. 48 6/23/2022 RAPP$IGT -RAPPS IGT .02 1,"6 %° 4 Y � •' 85,446.p2 267,786.60 Wll6am Little, CFO / June 10, 2022 Memorial Medical Center ' APPROVED ON JUNCO 2022 CAL O NCO NW TIM IroLD Data/Time 06.02-2022 / 12:12 PM Submitted By Pay Date 05-31-2022 Employee Deposits $71,509.47 Employer Contributions $109,409.19 Group Term Life Premiums $0.00 Total $180,918.66i-" Comments Payroll Pile May 2022 Retirement Upload.xisx 0 Confirmation: You Have Filed Successfully Sales and Use Tax TexpayerlD: UserlD:� Reference Number:' Date and Time of Filing: 06/07/2022,10:12:01 AM PAYMENT SUMMARY Electronic Check State Amount: $1,076,53 Local Amount: $344.49 Amount to Pay: $1,421.02 Electronic Check: $1,421.02 Period Ending 05/31/2022 (2205) Taxpayer Name: MEMORIAL MEDICAL CENTER Taxpayer Address: 815 N VIRGINIA ST PORT LAVACA, Tx 77979-3025 IF Address:: Payment Reference Number: Trace Number: t Entered By: Sarah Henderson Email Address: Telephone Number: (361) 552-0342 I Type of Bank Account: Checking Accountholder Name: Bank Routing Number: Bank Account Number: ••••••'•••• Payment Effective Date: 06/20/2022 CREDIT SUMMARY Credits Taken Are you taking credit to reduce taxes due on this return? No Licensed Customs Broker Exported Sales Did you refund sales tax for this filing period an items exported outside the United States based on a Texas Licenced Customs Broker Export Certifications? No LOCATION SUMMARY Lac# Total Texas Taxable Sales Taxable subject to State Subjectto Sales Purchases Tax(Hate.062s) State Tax Due Local Tax Lool Tax Rate Local Tax Due 00004 17311 17311 0 17311 1081.94 17311 0.02 346.22 subTotal 17311 17311 0 1T311 1081.94 17311 346.22 Total Tax for Locations $1,428.16 Total Tax Due: $1,428,16 Timely Filing Discount: -S7,14 Balance Due: S1,421.02 Pending Payments: -S0.00 Total Amount Due and Payable: $1,421.02 I J`4,. ( State amount due Is $1,076.53) ( Local amount due is $344.49 ) Transaction Summary . Transaction Complete Trace #:( Texas Health and Human Services Commission Memorial Medical Center Operating County 746003411 Payment Total $85.446AP Bank Routing and Account Number Settlement Date 6/23/2022 RAPPS Amount $85 446.92 Entered By Marley Moehri Page No: 7 m 7 Run Date: W612022 Run Time: 14:14:33 Marley ODonnell From: Texas Health and Human Services Commission <txhhs@public.govdelivery.com> Sent: Monday, June 06, 2022 1.47 PM To: Marley ODonnell Subject: RAPPS IGT Notification First Half of Year 2 (SFY23) ICAUTION: 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. TEVAS Health and Human Services RAPPS IGT Notification First Half of Year 2 (SFY23) HHSC is providing notification of the intergovernmental transfers (IGT) call for the first half of the Rural Access to Primary and Preventive Services (RAPPS) program Year 2. The calculations for IGT amounts by service delivery area (SDA) and by provider can be found on the RAPPS weooaae under "Suggested IGT - SFY 2023 (Year 2)". The IGT must be entered into TexNet no later than close of business June 22nd, 2022 with a settlement date of June 23rd, 2022. • This settlement date is non-negotiable. • The funds need to be placed in the "RAPPS" Bucket. • The amount that needs to be entered into TexNet is on Column E of the tab named "IGT by Provider" of the "Suggested IGT amounts per SDA and Provider" spreadsheet provided in the link above. • The IGT will be processed at that time and there will be no further revisions or redistributions of IGT suggestions should the aggregate IGT amount not fully utilize the available pool. Please ensure you double check the number while entering to ensure the correct number has been entered. TexNet instructions are available here. Send an email with a screen shot or PDF of the confirmation/trace sheet to PFDRAPPSPavments a hhs.texas gov. Please email any questions regarding this change or the calculation in general to PFD Hosoitalsc(ihhsc.state tx Us. You have subscribed to get updates about Texas Health and Human Services (HHS). For more information about HHS, please visit our website. Stay Connected M iJ/? (en espaRoq Q SHARE Subscriber Services Manage Preferences I Unsubscribe I Held This email wes sent to metionnell@mmcponiavzcs.ccm Laing gavDelivei,, Csrenunicaiions Cloed on beh::if cr i s%ac Hestih mild Hunan Services Commission 707IV. Sl. Suile v000 L Dn vrr, Co 80202 90VUELIVERYIP RAPPS Year 2 IGT by Provider Rural Access to Primary and Preventative Services Year 2 (State Fiscal Year 2023) IGT by Provider Total $ 13,707,201.96 $ 6,853,601.34 $ 6,853,600.62 Suggested Total IGT Second for Declaration of First Suggested Suggested IGT Intent after 10% IGT Payment Payment NPI Provider SDA (12 months) (1st 6 months) (2nd 6 months) 1497153589 Memorial Medical Center- Nueces $ 170,893.84 $ 85,446.92 $ 85,446.92 Page 1 of 1 Updated June 1, 2022 MONEY MARKET TRANSFER REQUEST PAYEE Memorial Medical Center Oneratine Date Requested: 06/09/22 AMOUNT $350,000.00 G/L NUMBER: JUN 00 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TOM EXPLANATION: TO TRANSFER $350,000.00 FROM MONEY MARKET ACCOUNT (*2998) TO MMC OPERATING (*4357) REQUESTED BY: Mayra Martinez AUTHORIZED BY: 6/912022 Search All DDA Account Number Treasury Center Data reported as of Jun 9, 2021 Current Balance Available Balance Collected Balance Prior Dav Balanc •4357 MEMORIAL MEDICAL $2.051.317.03 S2.181,301.24 S2.051,317.03 S1,890,402.3 CENTER -OPERATING •2998 MMC-MONEY MARKET $1,110,479.01 $1,110,479.01 S1,110,479.01 S1,110,479.0 FUND . indicale: Page generated an 0Gi09i2022. Copyright 2022 Prosponly Bank. https:/fpresperity olbanking.mmlonlineMessenger Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON JUN 0 8 2022 06/08/2022 MEMORIAL MEDICAL CENTER 0 imidi�UNCOUNTY.TEXA5 AP Open Invoice List ap_open invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11816 ASHFORD GARDENS , Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay 060222 06/08/20 O6/02/20 07/01/20 6,391.95 0.00 0.00 APR UHC QIPP Vendor Totals Number Name Gross Discount No -Pay 11816 ASHFORD GARDENS 61391,95 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 6.391.95 0.00 0.00 APPROVED ON JUN 0 8 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Net 6,391.95 Net 6,391.95 Net 6,391,95 file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report8864328... 6/8/2022 Page 1 of I RECEIVED BY THE COUNTY AUDITOR ON JUN 0 8 2022 06/08/2022 OALHOUry,PWNTY,TEXAS MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: 0 ap_open_invoice.template Vendor#Vendor Name / Class Pay Code 11828 SOLERA WEST HOUSTON Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount 060122 `0',6,//`08/20 06/01/20 07/01/20 6,000.00 0.00 TRANSFER Ntt IA&UVkKU_ i Arp6qU tpl+l Vuwu- ijaKth, , 060222 06I08/20 06/02/20 07/01/20 2,465.00 0.00 0 APR UHC QIPP Vendor Total: Number Name Gross 11828 SOLERA WEST HOUSTON 8,465.00 Report Summary Grand Totals: Gross Discount 8,465.00 0.00 JUN 0 8 2o22 BY COUNTY AUDITOR CA WOJJN DbUNyV, T_"40 No -Pay 0.00 0.00 Net 6,000.00 1, 2.465.00 I/ Discount No -Pay Net 0.00 0.00 8.465.00 No -Pay Net 0.00 8,465.00 file:///C:/Users/ltrevino/epsi/memmed.cpsinet.corn/u88125/data_5/tmp_cw5report2030360... 6/8/2022 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON JAM 2022 MEMORIAL MEDICAL CENTER AP Open Invoice List 11:18 CALHOUN COUNTY, TEXA$ Dates Through: Vendor# Vendor Name Class Pay Code 11820 FORTBEND HEALTHCARE CENTER Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross 060222 06/08/2D 06/02/2007/01/20 2,484.90 APR UHC QIPP Vendor Totals Number Name Grass 11820 FORTBEND HEALTHCARE CENTER 2,484.90 Report Summary Grand Totals: Gross Discount 2,484.90 O,OD JUN 0 8 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS 0 ap open involce.template Discount No -Pay Net 0.00 0.00 2,484.90 ✓ Discount No -Pay Net 0.00 0.00 2,484.90 No -Pay Net 0.00 2,484.90 file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.comlu88125/data_5/tmp_cw5report3746539... 6/8/2022 Page I of 1 RECEIVED BY THE COUNTY AUDITOR ON JUN 0 8 2022 MEMORIAL MEDICAL CENTER 06/08/2022 0 CALIj(}Illbl COUNTY, TEXAS AP Open Invoice List 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 060122 06/08/20 06/01/20 07/01/20 604.62 0.00 TRANSFER InSuvktuR. ► i jgWtj -Ir lb 11+t/nt. o�,yk� 060222 06/08/20 06/02/20 07/01/20 1,212.67 "'C/" APR UHC OIPP Vendor Total* Number Name Gross Discount 11832 BROADMOOR AT CREEKSIDE PARK 1,817.19 0.00 Report Summary Grand Totals: Gross Discount No -Pay 1,817.19 0.00 0.00 JUN 0 8 2022 By CALHOUN COUP AUDITOR No-Pay Net 0.00 604.52 . 0.00 1,212.67 No -Pay Net 0.00 1,817.19 Net 1,817.19 file:///C:/Userslltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report3919168... 6/8/2022 Page I of 1 RECEIVED BY THE COUNTY AUDITOR ON JUN 0 8 2022 06/08/2022 MEMORIAL MEDICAL CENTER 0 1•,pp�I�IN COUNTY. TEXAS AP Open Invoice List ap_open involce.template Dates Through: Vendor# Vendor Name Class Pay Code 11624 THE CRESCENT Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 060222 06108/2006/02/2007/01/20 2.152.47 0.00 0.00 2,152.47 j APR UHC QIPP Vendor Totals Number Name Gross Discount No -Pay Net 11824 THECRESCENT 2,152.47 0.00 0.00 2,152.47 Report Summary Grand Totals: Gross Discount No -Pay Net 2,152.47 0.00 0.00 2,152.47 EOM W JUN 0 8 2022 BY COUWYAUDROR CALHOUN COUNTY, MAO file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report6856195.., 6/8/2022 Page 1 of l RECEIVED BY THE COUNTY AUDITOR ON JUN 0 8 2022 06/08/2022 MEMORIAL MEDICAL CENTER 0 CAi 11t>;.IN COUNTY, TEXAS AP Open Invoice List ap_open_involce.lemplate Dates Through: Vendor# Vendor Name Class Pay Cade 11836 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 21722C 02/17/20 06/27/20 295.03 0.00 0.00 295.03 TRANSFER �0(5/31/20 Iv.ki 7iiSlIYRi1tP. P�nLh dcposi'�t-� iKt KMC- OIXM,l}.,v��xU 052722 Oj/31/2005/27/2006/27/20 136.35 0.00 0.00 136,35✓ TRANSFER \ II 0527226 05/31/20 05/27/20 00/27/20 677.81 0.00 0.00 677.81 TRANSFER 11 rr 052722A 05131/20 05/27/20 06127/20 46.74 0.00 0.00 46.74 TRANSFER It it 060222 06/08/20 06/02r20 07/01/20 4,084.06 0.00 0.00 4,084,06 APR VHC OIPP Vendor Totals Number Name Gross Discount No -Pay Net 118$6 GOLDENCREEK HEALTHCARE 5,259.99 0.00 0.00 5,230.99 Report Summary Grand Totals: Gross Discount No -Pay Net 5,239.99 0.00 0.00 5,239.99 y n1�, JUN 0 8 2022 BY TOR CAAU40UUN CWNTY.AUDI't£XAS file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report3907956... 6/8/2022 Page 1 of 1 D BE COUNTY AUDITy DITORON �U p8 22 MEMORIAL MEDICAL CENTER 0 11922 AP Open Invoice List 11/ ap_open invoice.template Dates Through: Cd1LM011 r�&]i� Aen`fiQX%me Class Pay Code 12696 GULF POINTE PLAZA Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 052722A 05131 /20 05127/20 06/27/20 294.16 0.00 0.00 294.16 TRANSFER N1tiMURVLLL VgKi&PD A7 Le� i4 11 IL upeYll-fin 052722 05131120 05/27120 0 27120 1,932.20 0.00 0.00 1,932.20 TRANSFER It It 052722B 05/31/20 05/27/20 06/27/20 41.80 0.00 0.00 41.80 TRANSFER tt 11 053122 05131/20 05131/20 06/27/20 10,187.89 0.00 0.00 10,187.89-/ TRANSFER 11 tt 060122 06108/2006/01/2007/01/20 20,641.72 0,00 0.00 20,641.72 4/ TRANSFER t1 tr 060222 061081200610212007/01/20 1,832.82 0.00 0.00 1,832.82 APR UHC QIPP , Vendor Totals Number Name Grass Discount No -Pay Net 12696 GULF POINTE PLAZA 34,930.59 0.00 0.00 34,930.59 Report Summary Grand Totals: Gross Discount No -Pay Net 34.930.59 0.00 0.00 34,930.59 A PRMMCW JUN 0 8 2022 1 Cgw�N coiner file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u8 8125/data_5/tmp_cw5report852685 0... 6/8/2022 Page I of I RECEIVED BY THE UNTY AUDITOR ON COIINN S 2022 MEMORIAL MEDICAL CENTER 0610i/2uu0220 11:20 COUNTY. TEXAS AP Open Invoice List CALHOUN Dates Through: Vendor# Vendor Name Class Pay Code 13004 TUSCANY VILLAGE 0 ap_open_invoice. template Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gress Discount 053122C 05/31/2005131/2006127/20 10,975.00 0.00 TRANSFER NIA 119 itwu MAi afrosiA.C1 16ab kmc 063122A 05/31/20 05/31/20 06/27/20 778.00 0.00 TRANSFER 1t 1` 0531228 05/3l/20 05/31/20 06/27/20 3,494,40 0.00 TRANSFER k 060122 06/08120. 06/01/2007101/20 10,081.47 0.00 TRANSFER It 060222 06/08/20 06/02/20 07/01 /20 3,749.79 0.00 APRIL UHC OIPP Vendor Totals Number Name Gross Discount 13004 TUSCANY VILLAGE 29,078.66 0.00 Report Summary Grand Totals: Gross Discount No -Pay 29,078,66 0.00 0.00 JUN 0 8 20?2 toji OUN O tAJ' ,, IIi No -Pay 0.00 0.00 0.00 0.00 I I 0.00 No -Pay 0.00 Not 10.975.00 ✓ 778.00 3,494.40 10,081.47 3,749.79 ✓/ Net 29,078,66 Net 29,078,66 file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.eom/u88125/data_5/tmp_cw5report6882725... 6/8/2022 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON JUN 0 8 2022 22 MEMORIAL MEDICAL CENTER 0 CALHOUI COUNTY, TEXAS AP Open Invoice List ap_open_Invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING .� Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 052722 05/31/20 05127/20 06127/20 1,167.00 0.00 0.00 1,167.00 1 ll TRANSFER NN'jnSL(ft _ pVjWA atpCi'Ird IK-`1/ M%V, apehAW . 052722A 05/31/2005/27/2006/27120 2,599,34 0.00 J 0.00 2,599,34 �f TRANSFER n to 052722B 05/31/20 05/27/20 06/27/20 8,140.94 0.00 0.00 / 8,140.94 v' TRANSFER n It , 053122 05/31/20 05/31/20 06/27/20 16,446,29 0.00 0.00 16,446.29%/ TRANSFER 1, 11 060122 06/08/20 06/01/20 07/01/20 933.20 0.00 0.00 93320 TRANSFER 4 1, v„r` Vendor Totals Number Name Gross Discount No -Pay Net 12792 BETHANY SENIOR LIVING 29,286.77 0.00 0.00 29,286.77 Report Summary Grand Totals: Gross Discount No -Pay Net 29,286.77 0.00 0.00 29,286.77 JUN 0 8 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TRMS file:!//C:lUserslltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report6672083... 6/8/2022 Memorial Medical Center Nursing Home UPL Weekly CantecTransfer ProSperlty Accounts 6/10/2022 rr.YmY. 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MULC!Mal y Iaaf I.Mas0 MMCI'aPT1aN 71WXLO0 7OOxeM1IO aw [Mnpi aw(mPIPi Ow/Wn WP( px mNn HXPO%mo - 1 S,POPw - 36310 "LIS - 37a00 an Man a,6a0.O1 Umax a,Rw.n 4Wxn IiEaal. s.U4xl :60T:e3, - 69207 - 98]A] J,01"2 1I - .0 13aAIS30 - 1Lw OW - 3..00 odo 3.600.00 33gaa32 10.60 Sw.60 ,},3'y.",`:,N,'':`Y. jss1lt�1 TnnN.Mn aw/GIeN qUI/CpmP2 aw/WMP9 aw/C9mPRMaPM mwTl XX IO0.11pN 6/6012 YMCCOMMVHnYPI HCCWIMPMI]460m41191Wm - s,931.]6 - z,931.16 6/6n/EP32 HEKTNHYMRHfVCNC[W3MPMC1]IECa36119aa2 - 31,3W.9) ]6,9n.91 N//SPI?ZAOUNANWfIKAlIM0UE61KN O1,pN0A161406016 - T,ifw War t/1/xPa NF.U.TNXUAUNNCNCNdMPMf i]IWW61MU463 - 6mam - now," 6/B/lau MgIN NCOIMN<CWMPM]PNIi306]]SW 4200 - 1713.34 - 3,16314 6/x/Em2 plNpwPgameNa HCQMMPM]]YAw11111aM - I,66a.00 - 4,666,00 6/9/2D22 WIRFOMCRNIFYHGITXCXRECFN]FR6111 19$79M 6/J/t911NMmMRWP00R?O[PA3LItN6[6'Oa5H31yW0 .. '36.U£I6 .� &Llsa63.... XMIN, uTPL Fauvc -AaTLK / "'Pons, P I1.a].0] taL93 a.a3as 46.)e]35 !RC 4f(ip]1 xxe-6MOYlCwM1M1]16ap19111100MiLw]6 NM11 MouNA616µtryCr+l,Mou1Mn41olx66nwmmu. Vanua N%TKNIYMHXI[WNPMIf]66Kf]CIWIJa 0`11OW CNI20ll MUM4MIK WX[CWMPMIIWMI ]1MYa191M NEWXNYMMI LYGXCXKMPMJ]LN1MliXa1} IMA)J NXa-6MOaac M ]YWNII'llmil]IlI fanKal pmaMMMUHCMCRWMPMI3Mwi1fw1111RL 6 r4nW WMMV"x"mi"wulI I]6Ha31u9MaY Wf/MPJ WIM W]4M1e MGl]XLMEL3NIFN M M9/30JlUMC WMMVXNYPLNLf W MPM611f WJ11191MG1 Mia2J YXCNMMVNIff PLMCLWMPMP]IMNHI[]ICIN 49/fit] MIMKIRbMMaNf<WM1Mf 3fOM]IXOIOt)9] eH(Nu AMIMOMMP[WJO4rjf9M]MtJ9llipiiflM00: low MMCIORION 11aaG>9�1 il9RMPln awl s mw/Camlx Olr/taM mw famplNYpM awn I NHKMW 190.63 190.61 ].6Y.W 3. F5J.W LUm 9e60R • Ia61AI • I.G).N ILl6a.]I w,260.)f lav "1.20 AWN 1031a.a 10,3b.]B o$wJ M,1i6.n 22,176.99 • 4i66.w 2,16669 ],w1m 1,903.a0 • %. MiNfs0 f / 11.p1W i]n30 1ykA1Q : Ii366.60 n$]ua asasla i6.a4.ss 4.Im.n ]6fil aaz1X 3]aMLK 49laa.n Im.100.a1 1M>LCO 3]Ffiibe a llLfl 6/10/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number l Name Groups Add Graup Account Type IDDA Data reported as of Jun 10 202: Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $4.012,218.74 $3,966,229.84 $4,012,218.74 $4,994,410,2 '4551 CAL CO INDIGENT $17,484.86 $17,484.86 $17,484.86 $17,484.E HEALTHCARE `4454 MEMORIAL MEDICAL / NH GOLDEN CREEK S88.528.23 $89,726.97 $68,528.23 531Q037.£ HEALTHCARE 44365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.40 S536.40 5536.40 $536.4 2014 '4357 MEMORIAL MEDICAL S2,178,985.47 $1,972,528.01 $2.178,985.47 $2,051,317.0 CENTER -OPERATING ,A373 MEMORIAL MEDICAL CENTER -PRIVATE $431.82 S431.62 S431.82 S431.E WAIVER CLEARING *4381 MEMORIAL MEDICAL 583,970.33 ✓ S145,124.73 $83,970.33 S148,564 CENTER! NH ASHFORD 4 MEMORIAL MEDICAL CENTER/NH $95.821.60 S125,645.56 $95,821.60 $72,228.E BROADMOOR 4 MEMORIAL MEDICAL $61,333.80 ✓� $83,182.17 $61.333,80 5154,472A CENTER/NH CRESCENT •4446 MEMORIAL MEDICAL $66,156.30 ,% $86,733.59 $66,156.30 S91,611.0 CENTER/NH FORT SEND •4438 MEMORIAL MEDICAL CENTER! SOLERA AT $95,191.26 f $111,673.42 $95,191 26 S96,949.0 WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,479.01 S1,110,479.01 S1.110.479.01 S1,110,479.0 FUND •5506 MMC-NH BETHANY $81,891.66 $82,099,50 $81,891.86 S480,034.2 SENIOR LIVING •5441 MMC -NH GULF POINTE PLAZA- $31,955.43 S31.955.43 $31.955.43 5139,958.E MEDICAREIMEDICAID '5433 MMC -NH GULF POINTE $32,363.79 $32,363.79 $32,303.79 $40,716.7 PLAZA- PRIVATE PAY '3407 MMC -NH TUSCANY $67,088.78 $76,064.58 $87,088.78 $279,588.1 VILLAGE 4 hltps:/lprosperity.olbanking.comlonlineMessenger try Memorial Medical Center Nursing Home UPI. Weekly Nexion Transfer ProsperityAaounts 6/10/2022 Prewe AtGmnt al61min6 Plndin2 TndaYn Blpnnin6 HUNn3HlR! NumWr Bdame ttenrllr-0ut /T.Me m Oe Yh BaldnR 280,651.62 ✓ 2a&SdB.Ofi 51,176A7 - Bdslam Bank Balance 88,528.23 Vatlmm • dWlln Babnm loom Su",GIPPAPdI bVj 34.223A5 Ij ff.. mt, bP .f.I$S,aWw 1to rhenunNp 6PRr. Narel: EPrM1 arcavntM1mdbvrebebmm�J$IddelGrMMC deOddnNroopen vGmunl JUN 10 2022 AO CALHOUN COUNNTUY,, 7�8 Amlunt rG BeTnndlmdrPNunIR APWIM,.# 1T36J/ May InRRR It"s ✓/ June lnllRrt ldlurteibn[e/rnnaferAml W.1M.dP_i Avnrvvld: J• / WIWAM1n2tE,a0 / 6Au/2P22 ANH MOWVy anrfen\NH VPt TWIfer%MM&rA2BIIVum\NH uvl banner Summery M.1012.Jn MM{PQIRWX qNP/bmpl OIP9/Cam91 0199/fam 2 gIPP(Com W u N10T1 NHOORiWN b/b/3p2$16YbfiMN3HR3TBMLO S1lARfdI9L]91BM91]9 930.00 9y(ry 6/6/IDi3 TST9NMNSRRITBXR SribR 9136N66MM91]9 - I,675A0 30µ3.9i ].MBM IeW9M31 16,009.50 (U.Imsj b/6/20i31SYb/{MNSi1R9TBXClISfIMEH36{4595{]691]9 - 3,43L33 - 6PMn NXB•F[NOMCMIMPMfAfN3111MOQV1C3616 - 3,03133 - MUM 3AD1.33 6/](2033 XN0-FCXONCCWMPMf ]ISW3011M00W]2G210 - 9,166.1] - 433M 6/)/30M WIOEXCM[XHFMLTMFRCO[P 13)036691b0001M1 - 1,800IM1 b/91"=WIREO NRMONRCOMArG1361MOEEB9l)9 - 1,{W.Po 7.MW 6/9/2022 WIREOUINFYION XE4]N,siG03MN(RFFI ussoo.os {/9/3021 MMPMf]16003011MOOW$033W - t<,901.0 - I7,,759 0 WWfM M b/9/]0A WIOfH{RfMIIF/.LTMFRCOFP S]M669ux1W13>0 - ],]bB.00 ],]sB00 6/9/30$$AOI SERIfMFNTSpNNF11M513139 X01891bi3 - 3,339.W / - 3,339.W SM,1'OOA6 061M.17 M.11092 7.M6b2 AMA 16A09d0 M.166.97 6/10/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number/ Name Groups Account Type Add Group t... Data reported as or Jun 10 202; Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $4,012,218.74 $3,966,229.84 $4.012,218.74 $4,994,410.2 '4551 CAL CO INDIGENT $17.484.86 $17.484.86 $17,484.86 517.484.E HEALTHCARE '4454 MEMORIAL MEDICAL I / NH GOLDEN CREEK $88,528.23 v $89,726.97 $88.528.23 5310,037.'< HEALTHCARE •4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES $536.40 5536.40 5536.40 $536.4 2014 '4357 MEMORIAL MEDICAL 52,178,985.47 $1,972,528.01 $2,178,985.47 52,051,317,C CENTER - OPERATING •4373 MEMORIAL MEDICAL CENTER - PRIVATE $431.82 5431.82 5431.82 5431.E WAIVER CLEARING '4381 MEMORIAL MEDICAL $83.970,33 5145,124.73 $83,970.33 $148,564,E CENTER/NH ASHFORD 14403 MEMORIAL MEDICAL CENTER/NH $95,821.60 $125,645.56 $95,621.60 $72,228c BROADMOOR *4411 MEMORIAL MEDICAL $61.333.80 $83.182.17 $61.333.80 5154,472.4 CENTER/NH CRESCENT •4446 MEMORIAL MEDICAL $66,156.30 $86,733.59 $66,156.30 $91,611.0 CENTER I NH FORT BEND '4438 MEMORIAL MEDICAL CENTER I SOLERA AT 595.191.26 5111,873.42 595,191.26 $96,949.0 WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,479.01 51,110,479.01 $1,110,479.01 51.110.479.0 FUND 15506 MMC-NH 13ETHANY $81,891.66 $82.099.50 $81,891.66 $480,034.2 SENIOR LIVING '5441 MMC+NH GULF POINTS PLAZA- $31.955.43 $31,955.43 $31,956.43 5139.958.E MEDICAREIMEDICAID 433 MMC-NH GULF POINTE $32.363.79 $32,363.79 $32,363479 $40,716.7 PLAZA -PRIVATE PAY '3407 MMC-NH TUSCANY $67,088.78 $76,064.58 $67,088.78 $279,588.1 VILLAGE t https:ltprosperity.olbanking.com/onlinaMessonger 111 Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity Accounts 6/10/2022 MWYM NMIn XWeen11l,,GG�� �" Win•./-.•v^�.e.T:.?c._ ,M-:�bk�q•r1'y„" ��� vmi.w tlmanewh WhNN PlMin[ Tremlemdw ndn a.tl.n,w o. pe. axn e.un. x x.m. F991.66 P,9]..03 15.9eb.15 ✓ - 3},361.19 /15,996.15 Vadmn a.win Lhnn 1W.➢0 IsoukeWPArd a'oxxi3 owetlwsHPn UV LU721 HNhaaN it. M.Yi,mnn lwelnbmt ✓� Ngwl Nlanu/rnmhr Dmt �YP0.19 FIsId. Lnpnntw9t .N,WM // hndln9 ]n,ulnntln eehm R]wH.law eu,rhNn dltleeretl M IN T •& Idxv! Nwtl Npme iH[.;; ISO,e;bE9 3LBI330 - 3L%S.W /31,935.90 Sunk LaMe 31.X5.13✓ VsAt. leneN bona 3sew NO., 0,11 MFsI—IF un$S,eW wdtWNwl.n.dm nanunl, nmr. Nplel: FatM1aawnthmaGweGNnnp/$LDOMmMMCfspa+nMwppnpnpnt. JUN 1 SYCOUNfY AUD17011 CALHOUN COUNTY, 5 E7fA9 MNinanu ass✓ Mrylnann II.II� IWe1Mla# pgen NhrcefrmAer4nt 33.ti950 MALTRWSFF0.S //��//••^^ss''//' a).pl.[S: Wi111FM ume,ao � 41D(1WI I:VIN WetVrM1mYen\MX OftinmMSummrgl]011VumwX WLinmhr3ummnryK.ILLII.W �T. IR l9 6/6/2022 AETNAA501 HCCWIMPMT 1921092790 SVXQC14589 6/7/2022 NOC SWEEP FAC H261219P0029219756 SWEEP PR 6/8/2422 WIRE OOT HMO SERVICES. uC 6/9/2022 PNC-ECHO HCCWMPMT]460034114100012]011615 6/9/2022 HNB-ECHO HCCWIMPMT745003411440000201369 6/9/2023 HIM - ECHO HCCIAIMPMT 746003411440600261369 B/6/3023 MEPCXANT BANBCD DEPQ$rt4964R51B8899100001 5/61202 MERCHANT HIXW DMT74G 964T85189899300091 6/6/2022 XNB•ECXO HCCWMPMT]960094114100W2B3]19 61912022 WIRE OMHMO SERWCES. UC 6/9/2022 MEAL NTSANBCDDEPOSIT496479518889110X01 MMC PORTON QIPP/C6mP SIIPP/WmPe hanLNf-0111 T,,,O,.ln I QIPP/C9mp1 2 CIRP/C0m93 sup. QNPTI NN PORTION 9,500,OO - 31500.00 22,265.22 - 12,265.12 8,5]4A1 - 63.03 - 6843 23.62 23.62 124.38 - 129A6 eS74.02 16,986.15 15,986.15 MMC PORTION QIPP/COMP QIPP/C4mP4 Ta0H4r-Out Transforv10 OPP/COmp1 2 QIPP/C0mp3 :upn QIPPTI NH POROON 19,627.66 - 19,627.66 9,77398 9,n3.88 211.05 - 111.06 110,326.29 2,322.91 2,322.91 130916.59 33.899.50 v31.635.50 xx8.90032 019x1.65 4T,8x1.65 611012022 Treasury Center Quick View Select Quick View Accounts Account Number) Name Account Type _ Select Group Groups Add Group Search All DDA Data reported as of Jun 10 202: Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: 15 $4,012,216.74 $3,966,229.84 $4,012,218.74 $4,994,410.2 '4551 CAL CO INDIGENT 517,484.86 $17,484.86 $17.484.86 $17,484.8 HEALTHCARE '4454 MEMORIALMEDICAL C NH GOLDENNCREEK / $88,528.23 $89,726.97 $88.528.23 $310,037.2 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES 5536A0 5536.40 5536.40 5536.4 2014 •4357 MEMORIAL MEDICAL S2,178,985.47 51,972,528.01 52,178,985A7 $2,051,317.0 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE 5431 82 $431,82 $431.82 5431.E WAIVER CLEARING '4381 MEMORIAL MEDICAL $83,970.33 5145,124.73 $83,970.33 5148,564„ CENTER/NH ASHFORD *4403 MEMORIAL MEDICAL CENTER/NH $95,821,60 5125,645.56 $95,821.60 $72,2284 BROADMOOR '4411 MEMORIAL MEDICAL $61,333,80 $83.182.17 $61,333.80 5154.472A CENTER I NH CRESCENT •4446 MEMORIAL MEDICAL $66,156.30 $86,733.59 $66,156.30 591A11.0 CENTER I NH FORT BEND '4438 MEMORIAL CENTER ER I SOSOLERA AT $95,191.26 $111,873.42 $95.191.26 $96,949.0 WEST HOUSTON 2998 MMC-MONEY MARKET $1,110.479.01 $1,110.479.01 $1,110.479.01 51,110,479.0 FUND •5508 MMC-NH BETHANY $81.691.06 $82.092.50 581,891.66 S480A34.2 SENIOR LIVING 'S441 MMC -NH GULF POINTE PLAZA- $31,955.43 ✓� $31,965.43 $31,955.43 5139.9581 MEDICAREIMEDICAID '5433 MMC -NH GULF POINTE $32,363.79 $32,363.79 $32,363.70 $40.716.7 PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY $67,088.78 $76.064.58 $67,088.78 5279,588.1 VILLAGE r hops://prosperity.albanking.com/onlineMessonger 1/1 Memorial Medial Center Nursing Nome UPL Weekly Tuscany Transfer ProsperityAc ount9 6(iolzo22 A—. 3N,M.31 NP4: anM W bnan of 9wSstw w1N0e wMlm.d ro tln n unM9nune. M1YIe l: faM owpUnf nvf o4ve Wonae pfSlMMetMMC<lpORtdIC(MI OtL Will. JUN 10 2022 BYCOUNTYAUOITtIR CALHOUN COUNTY, TOM MIWM3C e. Pondlai TaMI3nNm NvuY1a felWaGNBnIU.M.]t lw Ntp pW1,8Nuwa 6ZBN,'u.ia Bank&lanes 67,01135 a/ Nalanw WGIp WYtG IN.W MWNAN91 9,fW.90 av f M4e14RetlVyry U,WL]3 V- aal•niwaMertnnalerane NpMcaad: �'`r�+</� cnonmx WIWM1 ef11E, 6f1 6/6/2022 HNB-ECHO HCCIAIMPMT746003411440000283676 6/7/2022. MOUNAHEALTHCAR MOUNAACH 0109943742000016 6/7/2022 HNB-ECHO HCCLAIMPMT 746003411440000230740 6/9/2022 WIRE OUT LINEAR ENTERPRISES, LLC 6/9/2022 Molina HC of T%HCCLAIMPMT PN12757178944200 6/9/2022 HNB- ECHO HCCLAIMPMT 74GM341144D000201369 6/9/2022;AMERIGROUP CONPO E-PAYMENT EE52375529111000 MMCPORTION QIPP/Comp OIPP/Comp OIPP/Comp Transfer.Out Ymnster•In 1 Olpp/Camp2 3 461apse OIPPTI I NHPORTION 571.89 571.69 10,S89.50 8A72,39 Z11742. 9,530.94 1,058,56 20,222.40 - 20,222.40 248,104.33 - 4,415.73 4,415.73 20.522.35 10,522.35 20666.91 ,16536.55 4128.36 186OL73 2,064.18 248,104.33 66,988.78/ 25.010.93 6,245.48 28.133.67 33,955.11 6/10/2022 Quick View Select Quick View Accounts Account Number / Name Acccunl Type t Account Number Current Balance Number of Accounts: 15 $4,012,218.74 •4551 CAL CO INDIGENT $17,484.86 HEALTHCARE '4454 MEMORIAL MEDICAL I NH GOLDEN CREEK $86,528.23 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES 2014 '4357 MEMORIAL MEDICAL CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CENTERINH BROADMOOR '4411 MEMORIAL MEDICAL CENTER INH CRESCENT '4446 MEMORIAL MEDICAL CENTER/NH FORT BEND -4438 MEMORIAL MEDICAL CENTER I SOLERA AT WEST HOUSTON '2998 MMC-MONEY MARKET FUND 506 MMC -NH BETHANY SENIOR LIVING •5441 MMC -NH GULF POINTE PLAZA- MEDICARE/MEDICAID '5433 MMC -NH GULF POINTE PLAZA - PRIVATE PAY '3407 MMC -NH TUSCANY VILLAGE https:I/prosperity.olbanking.com/onllneMessenger $536,40 52,178,985.47 $431.82 $83,970.33 $95,821.60 $61,333.80 $66,166.30 595,191.26 $1.110,479.01 $81.891.66 $31,955.43 $32,363.79 $67,088.78 J Treasury Center $elect Group Groups Add Group Available Balance $3,966,229.84 $17,484.86 $89,726.97 $536,40 $1.972,528.01 $431.82 $145,124.73 5125,645.56 $83.182.17 $86.733.59 $111.873.42 51,110,479.01 $82.099.50 531,955.43 532,363.79 576,064.58 conectea Isalence $4,012,218.74 $17,484.86 $88,628,23 $536.40 52,178,985.47 $431,82 $83,970.33 $96,821.50 $61.333.80 $66.166.30 $95.191.26 S1,110,479.01 $81,891.66 S31,955.43 $32,363.79 $67,088.79 as of Jun 10. 202: Prior Day Balanc $4,994,410.2 517,484.E 5310,037,2 5536.4 52,051,317,17 5431.E $148,564,: $72,228.9 8154,472.4 $91,611.0 $96,949,C 51,110.479,C 5480,034.2 S139.958.E $40,716.7 S279,588.1 s 111 Memorial Medial Center Nursing Home UPL Weekly HSLTransfer Prosperity Accounts 6/20/2022 G[wunt xnc }: fNle—ef.wf$SCCexrah.hmN/Mdto hMnunNgbane. Nne wh nnuunthw ofineb.MwnofSlLO [M.MM[lfpp.ItMngM0N0Yh.. JUN 10 2022 CONTYAUDOR CAALLHOUN COUNTY, IT P", M.d. Nnwrl <aN ]..Mr.rt.am WAMWw v.n.n uxwlo uunm wi t.l....[ }nsa ✓� Mrvinhn.l ills lunelM.nn RlfurteJ.n[./fnvh.Mn[ .fl ]il.t} ✓ wuuss,: wlwuatrtnE no IMN WN Tu.MVlx uvllnmM{umMntlW]WneVINuvLrnnlrtSumm.nKto.lLJn 2 6/W2022 DCPWt 6/6/2022 Nat 61WN22 HNB- ECHO NCCUIMI 74MMU 660000133613 IIIHNO ECHO NCCUIMOMIf66pW111110WW03603 6/2/2022 HNB• ECHO NCCUIMPMT INUM 612M 13030 6n/2011 NWITAS SOLUTION HCCLUMPM561H6162WW126 IIW2022 D Mft 6/6/201] HW?ASSOLUNON M=AI WWI6µlA lISOI$ 9/9/1022 HLLLMTffl N4ICHTMIMOMf 1Ta50DMlIlD162 6/9/1022 WIRE OUT BFNIANY SENIOR LIVING, LIo MMCPOROOH i0Niif916 Tande,An 0n/ONWI 0PP/0a02 QIPP/COIIIP3 Oro/CNVARIU6P OFF" NH BGITIOH 6A31.A EMI.72 11,519.23 13,S13.x3 - S,V1330 5,719.a - 29.10 29.10 - 2,563.73 - 2.563.73 51127..59 - 5.12i.59 • uyotox sspOL02 9,IBOA9 4,fG0.39 - 665.56 - 665.96 390,16250 Li3i.23 �� DLMET 6110/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number Name Groups Add Grcup Account Type Search I All [DDA Data reported as of Jun 10 202; Account Number Current Balance Available Balance Collected Balance Prior Day Balanc Number of Accounts: l5 $4,012,218.74 $3,966,229.84 $4,012,218.74 $4,994,410.2 '4551 CAL CO INDIGENT $17,484,86 $17.484.86 $17,484.86 $17,484.E HEALTHCARE •4454 MEMORIAL MEDICAL 1 NH GOLDEN CREEK $88,528.23 $89.726.97 $88.528.23 $310,037.2 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.40 $536.40 $536.40 $53fi.4 2014 '4367 MEMORIALMEDICAL $2,178.985,47 51,972,528.01 52,178,985.47 $2,051,317_C CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER - PRIVATE $431 82 $431.82 $431.82 5431.E WAIVER CLEARING '4381 MEMORIAL MEDICAL $83,970.33 5145,124.73 $83,970,33 $148,564 CENTER/NH ASHFORD '4403 MEMORIAL MEDICAL CEN7ERINH $95,821,60 $125.646.66 $96,821.60 $72,226.5 BROADMOOR '4411 MEMORIAL MEDICAL $61,333.80 $83,182.17 $61,333.80 5154,472.4 CENTER/NH CRESCENT '4446 MEMORIAL MEDICAL $66,156.30 $86.733.59 $66,156.30 $91,611.0 CENTER INH FORT BEND '4438 MEMORIAL CENTER I SOLERA AT $95,191.26 $111,87342 $96.191.26 $96,949.0 WEST HOUSTON '2998 MMC-MONEY MARKET $1,110,479.01 51,110,479.01 $1,110.479.01 S1.110,479.0 FUND `5506 MMC-NHBETHANY $81,891.66 t% $82,099.50 $81,891.66 $480,034.2 SENIOR LIVING '5441 MMC,NH GULF POINTE PLAZA- $31,955A3 $31.955.43 $31,955.43 $139,958.E MEDICAREIMEDICAID '5433 MMC-NH GULF POINTE $32,363,79 $32,363.79 532,363.79 $40,716.7 PLAZA' PRIVATE PAY '3407 MMC -NH TUSCANY $67,088.78 $76.064.58 567,088,78 $279,588.1 VILLAGE https:/lprosperity.olbanking.com/ontineMessenger 1/1 I E, F ---------- - ------ EIVIORIAL I'MEDIC-Al.. CENTER " .' r �k) REC UEST- RGWNkA MEMORIAL MEDICAL CENTER 6/10/22 APPROVED ON JUN lo 2022 By COUNTY AUENOR CALHOUN COUINW-TEM FOR ACCT. USE ONLY 0 Imprest Cash ❑A/P Checl; [_] Mail Check to Vendor FiReturn Chcvck Lu F)e-pi AMOUNT GA NUMFIFR: 1OZ55040 t.XPIANArfON: . MOLINA QIPP- $16,245.35 AMERIGROUP QIPP- $31,707.81 ... . ....... Mayra Martinez MEMORIAL MEDICAL ;".ENTER P MEMORIAL MEDICALCENTER 19te f;ega;eshed; 6/10/22 --- __-----._.__., JUN 10 2022 E BY GOLIWY AUDITOR .. CALHOUN COUNTY, T M FOR ACCT. USE ONLY u Imprest Cash 17A/P Che_k 01 Mail r heck to Vendor DRerurn Check Lo Oapi AMOUi\T $18�652,39G/L NUMBER: 10255040 l-XPLAIWVE1 iN: MOLINA QIPP- $6,309.77 AMERIGROUP QIPP- $12,342.62 ---------------- s!')hl- Mayra Martinez p A y ............ — ----- -------- — MEMORIAL MEDIrl"Al- CFN'T'F*R f"HECK RLcQ.;,JE.S-F- bt6mi&f MEMORIAL MEDICAL CENTER 6/10/22 APPROVEDON JUN 10 2022 Y NTY UDITOR ------- CABLHCOOUNUCOUANTY, TEXAS FOR ACCT. U5E ONLY I'llinprost Cast,. []A,lp Check Mail Check to Vendor Ret.ofy) Chcclk Lo Dep; AMOUNT GVI NUFAEFR: 10255040 V.XPLAN;k'PON! MOLINA QIPP- $5,421.21 AMERIGROUP QIPP- $10,561.08 - - -------- Mayra Martinez BY ------- ------------ ------ . ...... - ----- --- - - - . ....... . PAEMORIAL MEDfC"Al- ("ENTIFER ('Ll R E Q lk -S-F P MEMORIAL MEDICAL CENTER A y Date Requested: 6/10/22 E APPROymoN E JUN 10 2022 -By COUNTY AUDITOR CALHOUN C FO R ACCT. LISECINLY DIMPI-est casil []A/P Check Mall Check to Vendor Return� Check to I)ep I AM,0UNIT $1929305 T MY 17. TWO G/I. NUMBER: 10255040 FXPLA!q,').Tf0,\f: MO LINA Ql PP. $6,534.75 AM ERIG RO U P QIP p- $12,758.30 ..... .... . By, Mayra Martinez AuTlvDfjIlF — — , -- p, a — y� - - --------- ... ........ p A --- ------- -- — ----- MEMORIAL MEDICAL CENTER MEMORIAL MEDICAL CENTER 6110/22 FOR AC0, USE ONLY APPROVOCK Ell rnprest. Cash JUN 10 26Z2 []A/P Chec-,, []M.,Il Check to Vendor 13y CoUmy AUDITOR 11 Return C hE ck Lu Depl -CALHOUN COUNTY, TEXAS ------ AMOUNT --.$18765.74 10255040 EXPLANATION: MOLINA QIPP- $6,356.84 AMERIGROUP QIPP- $12,408.90 Mayra Martinez WE AUTHORIA'Tr, frTf ----- --------- IN M. NAEKAORWI MEDICAL CINTER CHECK REQUEST MEMORIAL MEDICAL CENTER D.ltE.9equFstt'.'!: 6/10/22 FUR ACCI. USE ONLY A -11inprest Cash MOVED ON L jUN 10 2022 F]A/1),-heck 11 Mall Check to Vendor ByCOUNTY AUDITOR Return Check to Depi. CALHOUN COUNTY, TE(AS AFAIOL'fdT G/1-1,10106FR: 10255040 EXPLANATION: MOLINA QIPP- $9,530.94 AMERIGROUP QIPP- $18,602.73 By: Mayra Martinez 2 ........ ... MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL`LIST FOR ---June 13 2022 °i by:DC INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES HEB Pharmacy (Medimpact) Pharmacy Reimbursement 66.33 MMCenter (in -patient $ol out -patient $58.601 ER 60) 58.60 Port Lavaca Clinic Associates 103.63 Singleton Associates, PA 131.25 SUBTOTAL 369.81 Memorial Medical Center (indigent Healthcare Payroll and Expenses) 4,166.67 Subtotal 4,526.48 Co -pays adjustments for May 2022 (10A0) 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 $4,516.48 approved by Commissioners Court onz.06/13/2022 1000-001-46010 y-31, 202 Interest ($5.92) $4,510.56 COUNTY AUDITOR APPROVAL ONLY THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY THIS OBLIGATION. I CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME IN GOOD NDITION AND REQUEST THE COUNTY TREASURER TO PAY THE AB OBLIGATION. i B 6/10/2022 w b�' ez421 z a0 F 000 'Z = = DEPARTMENT HEAD DATE J ©IHS Issued 06/01/22 Source Description Source Totals Report Calhoun Indigent Health Care Batch Dates 06/01/2022 through 06/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Amount Billed 01 Physician Services 02 Prescription Drugs 08 Rural Health Clinics 14 Mmc - Hospital Outpatient Expenditures Reimb/Adjustments Grand Total APPROVED fi'+ ON JUN' n 20P BY COUNTY AUVROtd, CALHOUN COUNTYf 1'€ A, ' 2,125.00 66.33 185.00 188.00 2,580.14 -15.81 2,564.33 Expenses Copays Medicaid Reimbursements Total Amount Paid 131.25 66.33 103.63 58.60 375.62 -15.81 359.81 4,166.67 4,526.48 <10.00> 4516.48 <0.00> 4,616.48 4,516.48 to(Z4zz ` J w M 'PROSPERITY BANK THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13432 05/01/2022 Beginning Balance 2 Deposits/Other Credits 6 Checks/Other Debits 05/31/2022 Ending Balance Total Enclosures 31 Days in Statement Period Statement Date Account No $52,697.70 $7,096.29 $54,067.94 $5,726.15 7 5/31/2022 •'••4551 Page 1 of 2 Date Description Amount 05/06/2022 Deposit $7,090.37mp41nwn 05/31 /2022 Accr Earning Pymt Added to Account $5.92 Check Number Date Amount Check Number Date Amount Check Number Date Amount 12529 05.25 $28.97 12532• 05.25 $4,166.67 12534 05.25 $76.99 12530 05-25 $42,853.55 12533 05-25 $2,774.99 ' 12536• 05.25 $4,166.67 -4q�� BALANCE Date Balance Date Balance 05-01 $52,697.70 05.25 $5,720.23 05-06 $59,788.07 05-31 $5,726.15 •" Below is an itemization of the Earnings paid this period. •• Interest Paid This Period $5.92 Annual Percentage Yield Earned Interest Paid YTD $13.97 Days in Earnings Period Earnings Balance MEMBER FDIC 0.15 % 31 $46,435.59 NYSE Symbol "PB" MEMORIAL MEDICAL CENTER CHECK REQUEST a CALHOUN COUNTY INDIGENT ACCOUNT 0 Date Requested: 6/6/22 Y ON E JUN 0 8 2022 E AMOUNT $10.00 BY COUNPYAUDrron FOR ACCT. USE ONLY Imprest Cash nA/P Check Mai! Check to Vendor Return Check to Dept CAL40UN COUNTY, TWM G/L NU MBER: 50240000 EXPLANATION: TO TRANSFER INDIGENT CO -PAYS FROM OPERATING ACCOUNT TO THE INDIGENT REQUESTED BY: MAYRA MARTINEZ AUTHORIZED BY: RUN DATE: 06/06/22 MEMORIAL MEDICAL CENTER PAGE 199 TINE: 13:51 RECEIPTS FROM 05/01/22 TO 05/31/22 RCMREP GA RECEIPT PAY CASH RECEIPT NUMBER DATE OBBER TYPE PAYER AMOUNT AMOUNT NUMBER NAME DISC COLL GL CASH DATE INIT CODE ACCOUNT 50200.D00 05/06/22 626656 IN CIGNA HEALTHCARE 95.44- 95.44- 00/00/00 RC 50200.000 05/09/22 626680 IN CIGNA HEALTHCARE 75.11- 75.11- 00/00/00 RC 50200.000 05/09/22 626691 IN CIGNA HEALTHCARE 71.27- 71.27- 00/00/00 RC 50200.000 05/09/22 626694 IN CIGNA HEALTHCARE 26.75- 26.75- 00/00/00 RC 50200.000 05/09/22 626697 IN CIGNA HEALTHCARE 112.99- 112.99- 00/00/00 RC 50200.000 05/09/22 626699 IN CIGNA HEALTHCARE 45.37- 45.37- 00/00/00 RC 50200.000 05/09/22 626703 IN CIGNA HEALTHCARE 380.91- 380.91- 00/00/00 RC 50200.000 05/09/22 626710 IN CIGNA HEALTHCARE 169.92- 169.92- 00/00/00 RC 50200.000 05/09/22 626712 IN CIGNA HEALTHCARE 148.30- 148.30- 00/00/00 RC 50200.000 05/03/22 626734 IN ALLSAVERS 264.99- 264.99- 00/00/00 RC 50200.000 05/13/22 621391 IN CIGNA HEALTHCARE .00 .00 00/00/OD RC 50200.000 05/13/22 627393 IN CIGNA HEALTHCARE 76.40- 76.40- 00/00/00 RC 50200.000 05/13/22 627395 IN CIGNA HEALTHCARE 45.37- 45.37- 00/00/00 RC 50200.000 05/13/22 627397 IN CIGNA HEALTHCARE 169.49- 169.49- 00/00/00 RC 50200.000 05/13/22 627399 IN CIGNA HEALTHCARE 490.16- 490.16- 00/00/00 RC 50200.000 05/13/22 627403 IN CIGNA HEALTHCARE 120.91- 120.91- 00/00/00 RC 50200.000 05/13/22 627405 IN CIGNA HEALTHCARE 76.40- 76.40- 00/00/00 RC 50200.000 05/13/22 627407 IN CIGNA HEALTHCARE 115.34- 115.34- 00/00/00 RC 50200.000 05/13/22 627403 IN CIGNA HEALTHCARE 54.36- 54.36- 00/00/00 RC 50200.000 05/13/22 627411 IN CIGNA HEALTHCARE 492.46- 492.46- 00/00/00 RC 50200.000 05/16/22 627541 IN CIGNA HEALTHCARE 264.07- 264.07- 00/00/00 RC 50200.000 05/16/22 627543 IN CIGNA HEALTHCARE 75.97- 75.97- OD/00/00 RC 50200.000 05/16/22 627545 IN CIGNA HEALTHCARE 78.54- 78.54- OD/00/00 RC 50200.000 D5/16/22 627561 IN CIGNA HEALTHCARE 75.54- 75.54- 00/00/00 RC 50200.000 05/16/22 627563 IN CIGNA HEALTHCARE 100.50- 100.58- 00/00/00 RC 50200.000 05/19/22 627997 IN CIGNA HEALTHCARE 75.11- 75.11- 00/00/00 RC 50200.000 05/20/22 628134 IN CIGNA HEALTHCARE .00 .00 00/00/00 RC 50200.000 05/24/22 628437 IN ALL SAVERS 944.11- 944.11- 00/00/00 RC 50200.000 05/25/22 62B681 IN CIGNA HEALTHCARE 95.44- 95.44- 00/00/00 RC 50200.000 05/25/22 628698 IN CIGNA HEALTHCARE 160.07- 160.07- 00/00/00 RC 50200.000 05/25/22 628691 IN CIGNA HEALTHCARE 13.4B- 13.48- 00/00/00 RC 50200.000 05/25/22 629081 IN CIGNA HEALTHCARE 110.21- 110.21- 00/00/00 RC 50200.000 05/25/22 629083 IN CIGNA HEALTHCARE 86.46- 86.46- 00/00/00 RC 50200.000 05/26/22 629193 IN CIGNA HEALTHCARE 499.60- 499.60- 00/00/00 RC 50200.000 OS/27/22 629255 IN UMR 208.94- 2D8.84- 00/00/00 RC 50200.000 05/21/22 629258 IN INS 404.00- 404.00- 00/00/00 RC 50200.000 05/27/22 629282 IN 168.06- 168.06- 00/00/00 RC 50200.000 05/31/22 629354 IN CIGNA HEALTHCARE 355.12- 355.12- 00/00/00 RC 50200.000 05/31/22 629451 IN CIGNA HEALTHCARE 107.64- 107.64- 00/00/00 RC 50200.000 05/31/22 629720 IN UNITED HEALTHCARE 136.45- 136.45- 00/00/00 RC 50200.000 05/31/22 629871 IN UNITED HEALTHCARE C 102.75- 102.75- 00/00/00 RC 50200.000 05/31/22 629885 IN CIGNA HEALTHCARE 13.48- 13.48- 00/00/00 RC 50200.000 05/25/22 628607 IN CIGNA HEALTHCARE 13.48- 13.48- 00/00/00 TS **TOTAL** 50200.000 COMFISRCIAL INS. -ADJ -524397.15 50240.000 05/10/22 626673 CA m10.00 10.00 00/00/00 D m **TOTAL** 50240.000 COUNTY INDIGENT COPAYS 10.00 50410.000 05/11/22 626956 CR TRRAS COMPTROLLER 0 25355.28 25355.28 00/00/00 PLB **TOTAL** 50410.000 GENERAL CONTRIBUTION-OMR REV 25355.28 2 2 2 2 2 7 L 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1VIEI�ICAL �''� CENTER Bill To: Calhoun County 815 N. Virginia Sr. Port Lavaca, Texas 77979 (361) 552-6713 Date: 6/6/2022 Invoice # 370 For: May-22 DESCRIPTION I AMOUNT Funds to cover Indigent program operating expenses. $ 4,166.67 4,166.67 APPROVED ON Anthony Richardson JUN 10 2022 Interim CFO BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS January February March April May June July August September October November December Calhoun County Indigent Care Patient Caseload 2022 Approved Denied Removed Active Pending 1 0 0 7 5 1 0 1 7 4 0 0 0 7 6 0 1 0 7 3 0 0 0 7 3 YTD Monthly Avg 0 December 2021 Active 0 0 7 4 6 Number of Charity patients Number of Charity patients below 50% FPL 196 79 Calhoun County Pharmacy Assistance Patient Caseload 2022 January February March April May June July August September October November December Approved Refills Removed Active Value 2 6 0 28 $16,676.00 2 5 0 30 $14,616.00 12 7 0 42 $34,978.00 5 7 0 47 $42,159.00 8 3 0 55 $21,252.00 YTD PATIENT SAVINGS Monthly Avg December 2021 Active 6 6 40 $25,936.20 0 26 ©iHs Source Totals Report Issued 06/01/22 Calhoun Indigent Health Care Batch Dates 02/0112022 through 06/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 9,603.00 670.87 01-2 Physician Services -Anesthesia 624.00 155.71 02 Prescription Drugs 323.15 323.15 08 Rural Health Clinics 2,297.00 1,612.81 13 Mmc - Inpatient Hospital 57,628.82 29,523.07 14 Mmc - Hospital Outpatient 32,223.00 12,487.81 15 Mmc - Er Bills 39,165.00 15,605.94 Expenditures ,142,002.84 60,518.23 Reimb/Adjustments-138.87 -138.87 Grand Total 141,863.97 60,379.36 Expenses 20,833.35 81,212.71 Copays <250.00> 80,962.71 Medicaid Reimbursement <0.00> 80,962.71 Total 80,962.71 n _=n �_n nn pc3 nn ooa 00y3>3 oa oa g e Z Z Z O7msm Z�a OAmw Zyc �c �c =� K y lrt N w p- p.- yy A m AyC Fzo zn z z z w ro 3 y a a z z .n.7 ni ta- b N W N n O O O O 9 x c r -0° Km� Z v� "'� A a m z z- a y m b tit rn ° c n L N N U VJi W U A W n m w �m 00 ,O D D O > p� m O O 0 O 00 n r o O ,9 O H O < m m O m y O L m o z 0 9 � z r (yam O y Y 3 a N O -' u x x u rn N u NO w N A to J S b W IJ O nn oc yn O inn aDcZ yn cto nNn oco vn co mNO 3 p n $ nK yHw ma K N mo No Az �m'9 �Az o. <N r' Rn1y jbJb n In+]Jn tn<lo W •� m m 1% a yOO pN Ay OU Z'� Nr eZ Cl A -3= Do no myyw -rDimo D yin a Duo H m O;n n 3 m.m.7n n A rn z� A ow o y e o �w n 0 P N - - Co 9 O C W W d O IJ N `D O O O_ - n A 0 0 0 0 00 00 0 ° g xz az z _ --Di _ D y m o = y A N n o r yy ti O O n Z r y n -i H h O m r O m O � { C y w O o A 6 n 0 0 0 0 0 0 0 o a o o '- a n ry as a E F F z m •im a y > c�F a x o 0 o m m m g np z o N o cD- Ov r T+ y S -x1 S -xi S D D O T n 2 m a m o { z z z 3 R. 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