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2022-12-14 Final PacketC�•\I.II��I�.A �t�ll�V�I�I�(��\I\II��I�\I�I��"C�i�I�I� I� All Agenda Items Properly Numbered tll ntracts Completed and Signed 1295's flagged for Acceptance (number of 1295's Z_) _ All Documents for Clerk Signature Flagged On this, p� day of 2022 a complete and accurate packet for ti✓of 2022 Commissioners Court Regular Session Day Month was delivered from the Calhoun County Judge's office to the Calhoun County Clerk's Office. &W-U Calhoun County Judge/Assistant COMMISSIONERSCOURTCHECKLIST/FORMS AGENDA NOTICE OF MEETING--12/14/2022 Rich2rd H. Meyer County judge David Hall, Commissioner, Precinct 1 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 Wednesday, December 2022 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 7104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: AT V U FILED,, w Rn /Call meeting to order. DEC 0 2022 47. Invocation. Vf ,_A NS HD40r r BY: OU '� Pledges of Allegiance. s General Discussion of Public Matters and Public Participation. ✓' 5. Consider and take necessary action to approve the contracts with the following awarded bidders for insecticides for Mosquito Control, Bid Number 2023.01 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) dam. Adapco, LLC h: Clarke Mosquito Control Products, Inc. L" Rentokil North America INC, dba Target Specialty Products d. ES OPCO USA LLC, dba Veseris ` . Consider and take necessary action to approve the contracts with the following awarded bidders for Asphalts, Oils and Emulsions, Bid Number 2023.02 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) a. Cleveland Asphalt Products, Inc. b. Martin Asphalt Company c. P Squared Emulsion Plants, LLC Page 1 of 3 NOTICE OF MEETING--12/14/2022 7. Consider and take necessary action to approve the contracts with the following awarded bidders for Road Materials, Bid Number 2023.03 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) e Marek & Marek Truck Wash, INC. dba Frank Marek Trucking 9f K-C Lease Service, INC., dba Matagorda Construction & Materials e Quality Hot Mix, Inc. if Vulcan Construction Materials, LLC e. Blades Group, LLC 'f Waller County Asphalt, Inc. Midtex Materials, LLC Consider and take necessary action to approve Shirley & Sons Construction Co., Inc.`s Pay Estimate (Invoice #3367) for the Magnolia Beach (21st Street) and Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project. Attached is the Recommendation for Payment No. 1 for $28, 098.00 along with the Contractor's Conditional Waiver and Release on Progress Payment. (DEH) kf Consider and take necessary action to approve Change Order No. 1 to the Magnolia Beach (21s' Street) and Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project and authorize the County Judge to sign all necessary documents. (DEH) Consider and take necessary action to Accept and Approve the new 457(b) plan for employees with VOYA and authorize County Judge to sign the following agreements: Plan Services, IRC Section 457 Directed Trustee Account Agreement and the Plan Sponsor Investment Advisory Access Agreement. By executing these documents, the Court is authorizing the deferred compensation to be effective. Business with VOYA and Ameriprise were previously approved in Commissioner's Court on August 3, 2022. (RHM) Ali Consider and take necessary action to approve Dedication of Public Right of Way Easement for Access from Brian K. and Blan M. Willoughby to Calhoun County and authorize Commissioner Lyssy to sign all necessary documents. (VLL) 12. Consider and take necessary action to approve the extension for the contract between Calhoun County and Janik Alligators LLC for the Green Lake Project Alligator Management and Nuisance Control for the contract year beginning January 1, 2023 and authorize the County Judge to sign all necessary documents. (GDR) 13. Accept Monthly Reports from the following County Offices: County Clerk — November 2022 1C District Clerk — November 2022 ill. Justice of the Peace, Precinct 1— November 2022 `tv Justice of the Peace, Precinct 2 — November 2022 v Justice of the Peace, Precinct 4 — November 2022 vC Sheriff's Office — November 2022 Page 2 of 3 I NOTICE OF MEETING —12/14%2022 "Y4. Consider and take necessary action on any necessary budget adjustments. (RHM) c 5. Approval of bills and payroll. (RHM) Richard H. Meyer, County J e 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.cal houncotx.or^ under "Commissioners' Court Agenda" for any official court postings. Page 3 of 3 NOTICE OF MEETING — 12/14/2022 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 REGULAR TERM 2022 § DECEMBER 14, 2022 BE IT REMEMBERED THAT ON DECEMBER 14, 2022, THERE WAS BEGUN AND HOLDEN A REGULAR MEETING OF COMMISSIONERS' COURT. The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting was called to order at 10 a.m. 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. n/a Page 1 of 5 NOTICE OF MEETING — 12/14/2022 5. Consider and take necessary action to approve the contracts with the following awarded bidders for insecticides for Mosquito Control, Bid Number 2023.01 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) a. Adapco, LLC b. Clarke Mosquito Control Products, Inc. c. Rentokil North America INC, dba Target Specialty Products RESULT: APPROVED [UNANIMOUS]' MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 6. Consider and take necessary action to approve the contracts with the following awarded bidders for Asphalts, Oils and Emulsions, Bid Number 2023.02 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) a. Cleveland Asphalt Products, Inc. b. Martin Asphalt Company c. P Squared Emulsion Plants, LLC RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Consider and take necessary action to approve the contracts with the following awarded bidders for Road Materials, Bid Number 2023.03 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) a. Marek & Marek Truck Wash, INC. dba Frank Marek Trucking b. K-C Lease Service, INC., dba Matagorda Construction & Materials c. Quality Hot Mix, Inc. d. Vulcan Construction Materials, LLC f. Waller County Asphalt, Inc. g. Midtex Materials, LLC RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 5 NOTICE OF MEETING — 12/14/2022 8. Consider and take necessary action to approve Shirley & Sons Construction Co., Inc.'s Pay Estimate (Invoice #3367) for the Magnolia Beach (211 Street) and Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project. Attached is the Recommendation for Payment No. 1 for $28, 098.00 along with the Contractor's Conditional Waiver and Release on Progress Payment. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to approve Change Order No. 1 to the Magnolia Beach (21s* Street) and Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project and authorize the County Judge to sign all necessary documents. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to Accept and Approve the new 457(b) plan for employees with VOYA and authorize County Judge to sign the following agreements: Plan Services, IRC Section 457 Directed Trustee Account Agreement and the Plan Sponsor Investment Advisory Access Agreement. By executing these documents, the Court is authorizing the deferred compensation to be effective. Business with VOYA and Ameriprise were previously approved in Commissioner's Court on August 3, 2022. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to approve Dedication of Public Right of Way Easement for Access from Brian K. and Blan M. Willoughby to Calhoun County and authorize Commissioner Lyssy to sign all necessary documents. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 5 NOTICE OF MEETING — 12/14/2022 12. Consider and take necessary action to approve the extension for the contract between Calhoun County and Janik Alligators LLC for the Green Lake Project Alligator Management and Nuisance Control for the contract year beginning January 1, 2023 and authorize the County Judge to sign all necessary documents. (GDR) RESULT:. APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Accept Monthly Reports from the following County Offices: i. County Clerk — November 2022 ii. District Clerk — November 2022 III. Justice of the Peace, Precinct 1 — November 2022 iv. Justice of the Peace, Precinct 2 — November 2022 v. Justice of the Peace, Precinct 4 — November 2022 vi. Sheriff's Office — November 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct i AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. 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 I AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 5 NOTICE OF MEETING— 12/14/2022 15. Approval of bills and payroll. (RHM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Indigent Healthcare RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned 10:13 a.m. Page 5 of 5 # 05 NOTICE OF MEETING — 1.2/14%1022 5. Consider and take necessary action to approve the contracts with the following awarded bidders for insecticides for Mosquito Control, Bid Number 2023.01 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) a. Adapco, LLC b. Clarke Mosquito Control Products, Inc. c. Rentokil North America INC, dba Target Specialty Products d ES nnrn i ice i r dba v,,seri. a� �o of cwa'c ¢c,�ocrvcacna RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 12 Mae Belle Cassel From: demi.cabrera@calhouncotx.org (demi.cabrera) <demi.cabrem@calhouncotx.org> Sent: Tuesday, December 6, 20221:54 PM To: MaeBelle.Cassel@calhouncotx.org; richard.meyer@calhouncotx.org Cc: cindy.mueller@calhouncotx.org; Erica.Perez@calhouncotx.org Subject: Agenda Item - Insecticides for Mosquito Control Contracts - December 14, 2022 Good Afternoon, Please place the following item on the Commissioners Court Agenda for December 14, 2022: • Consider and take necessary action to approve the contracts with the following awarded bidders for Insecticides for Mosquito Control, Bid Number 2023.01, for periods January 1, 2023 thru December 31, 2023 and authorize the County Judge to sign all necessary documents. • Adapco, LLC • Clarke Mosquito Control Products, Inc. • Rentokil North America INC, dba Target Specialty Products • ES OPCO USA LLC, dba Veseris Thank you, flp_rni Cabrizra Calhoun C,ountg ;98,si.,tant Tluditor 361-553-461.3 361-553-4614 (fax) Calhoun County Texas Adapco, LLC INSECTICIDES FOR MOSQUITO CONTROL ANNUAL SUPPLY CONTRACT BID NUMBER 2023.01 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT 41 THIS CONTRACT, made and entered into this �S 1 1 day of December , 20 23 by, and between the County of Calhoun (hereinafter called "County') and ADAPCO, LLC (hereinafter called "Contractor/Hauler") W ITN ESS ETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for INSECTICIDES FOR MOSQUITO CONTROL, Bid Number 2023.01 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Insecticides for Mosquito Control as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACT/HAULER (IN INK): AP DATE: 12/08/2022 INITIALS OF COUNTY (IN INK): 4W4A DATE: / 0 --/4/- zZ— d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered bythe Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all insecticides/products ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the insecticides/products ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said insecticides/products from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACTOR/HAULER (IN INK): AP DATE: 12/08/2022 INITIALS OF COUNTY (IN INK): A� DATE: _/L- �% t z IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023. COUNTY: CALHOUN COUNTY By: Honorable Richard H. keyer Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: ADAPCO. LLC By: tQrtG7ry/�ioirCS� Print Name: Andy Pierce Title: Sr. VP of Sales Address: 100 Colonial Center Parkway Suite 170 Lake Mary, FL 32746 ATi CAL ANf By: Prir Title: ATTEST: F111L11K01l41101 By: Print Name: Kathy Russell Title: Contract Manager CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there we no interested parties. CERTIFICATION OF FILING Certificate Number: 2022-962507 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. ADAPCO,LLC Lake Mary, FL United States Date Filed: 12/08/2022 2 Name of governmental entity or state agency that is a party tote contract for w Ich the form Is being filed. Calhoun County, TX Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023.01 Insecticides for Mosquito Control 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Azelis Americas, LLC Westport, CT United States X 5 Check only if there is NO Interested Party. 6 UNSWORN DECLARATION My name is Jason Trurnbetta and my date of birth is My address is 100 Colonial Center Parkway Suite 170 Lake Mary FL 32746 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Seminole County, State of Florida , on the 8th day of December, 20 22 (month) (year) Signature of VXhorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.eb87ef42 Page 1 of 1 MCQRp0 !'1 CERTIFICATE OF LIABILITY INSURANCE MMIDONYM DATE 08/2022 12/GB/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc.FAX c/o 26 Century Blvd P.O. Box 305191 AICNNo 1-877-945-7378 No; 1-888-467-2378 A DRIESS, certificates@willis.com INSURER 5 AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA INSURERA: Indian Rarbor Insurance Company 36940 INSURED INSURER B : ADAPCO, LLC 100 Colonial Center Parkway, Suite 170 INSURER C: INSURER D: Lake Mazy, FL 32746 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: W2685385B REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER D POLICYNUMBER POUCYEFF MWDDrrYYY POLICY EXP is la UMrrS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [81 OCCUR DA O RENTED PREMISES Ea occurrence $ 100,000 MEDEXP(Anycnaperson) $ 5,000 A y US00076793LI22A 11/15/2022 11/14/2023 PERSONAL& ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLI ES PER: GENERALAGGREGATE $ 2,000,000 GENT PRODUCTS-COMPIOPAGG $ 2,000, 000 X PRO- POLICY PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY (Per accident) $ OWNED F7 SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTVDAMAGE Paraxidenl $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCES3 LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOWPARTNERIEXECUTIVE Y� OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBEREXCLUDED7 (Mandatory in NH) NIA E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS be. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD III, Additional Remarks Schedule, maybe attached if more space Is required) BE: Annual Supply Contract for Insecticides for Mosquito Control, Hid Number 2023.01 January 1, 2023 thru December 31, 2023 Calhoun County is included as an Additional Insured as respects to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Calhoun County, Tx 202 S ANN ST, STE B �� Port Lavaca, TX 77979 0)1988.2016 ACORD CORPORATION. All riahts reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD as zo: 23414262 aATea: 2767378 Clarke Mosquito Control Products, Inc. INSECTICIDES FOR MOSQUITO CONTROL ANNUAL SUPPLY CONTRACT BID NUMBER 2023.01 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT �1uqjiTHIS CONTRACT, made and entered into this '34h�day of December 20_ZQ22by, and between the County of Calhoun (hereinafter called "County") and Clarke Mosquito Control Products. Inc. (hereinafter called "Contractor/Hauler") WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for INSECTICIDES FOR MOSQUITO CONTROL, Bid Number 2023.01 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Insecticides for Mosquito Control as described In the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly Incorporate same herein as if fully set forth verbatim in this Contract: Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii, Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACT/HAULER (IN INK DATE: 12/7/2022 INITIALS OF COUNTY (IN INK): _DA-2-? d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all insecticides/products ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the insecticides/products ordered within twenty-four (24) hours from the time of the order orthe date and time specified by the County, the County reserves the right to cancel the order and re -order the said insecticides/products from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACTO RULER (IN INK): +-� DATE: 12/7/2022 INITIALS OF COUNTY (IN INK): DATE: / -t- IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December COUNTY: CALHOUN COUNTY By: Honorable Richard H. &I Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: By. au�=— i drirrt ame: Julie Reiter Title: VP HR & Sustainable Development Address: 675 Sidwell Court St. Charles, IL 60174 ATTEST: CALHOUN COUNTY CLERK C")`� m0§ ANNAGOODMAN ^ CAL1'Gl? By:KA �1 0�1 6 Ah, Print Name: WAAL 1 " I ATTEST: By: .A--� C� 2 Print Name: Angie Gaul Title: Customer Care Specialist CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos, I 4 and 6 if there are Interested parties. ��FB� ILP� QR4(�lr Complete Nos. 1, 2, 3, 5, and 0If there are no interested ponies, CEERS•MATION OF FILING Certificate Number: 1 Name of business sti ty filing form, and the city, elate and country of the business entity's place of business, 2022-962339 Clarke Mosquito Control Products, Inc. St. Charles, IL United States Date Flied: 12/07/2022 ame of governmental entity oe state agency that Is a party to t. a contract for which7 e form is - _ - being filed. Calhoun County Date Acknowledged: Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the convect, 2023.01 Insecticides for Mosquito Control 4 Name of Interested Party City, State, Country (place of business) Nature of Interest (check applicable) Controlling - lntermedIM 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name Is n ft,• id•• , and my dale of birth is. i My address is '� c« rx,.l,.. , if Rn17e USA I (city) (state) (zip code) (country) • declare under penalty of perjury that the foregoing is true and correct. Executed In Kane ,. _ _„County, Slate of _ Imnaia . on the 7ih day of December .20_22_. (month) (year) t/ Sig ature of authorized agent of contracting business entity (Declarant) Forms orov(ded by Texas Ethics Commission www.ethics.state.tx.us varelnn vas 1 aha7ofa9 A� " CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDYYYY) 2/2812022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HUB International Midwest Limited 55 East Jackson Boulevard Chicago IL 60604 CONTACT NAME: CSU Chicago - Midwest PHONE Eat: 312-922-5000 aAc No: E-MAIL ADDRESS: CSUChicago@hubintemational.com INSURERSAFFORDING COVERAGE NAIC# INSURER A: National Union Fire Insurance Company of Pittsburg19445 INSURED Clarke Mosquito Control Products, Inc. Clarke Environmental Mosquito Management, Inc. INSURERS: Navigators Specialty Insurance Company 36056 INsuRERc: Navigators Insurance Company 42307 675 Sidwell Court INSURER D: INSURER E: St. Charles IL 60174 NSURER F: COVERAGES CERTIFICATE NUMBER: 508619805 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR D POLICYNUMBER POLICY EFF MMMDIYYYY POLICY EXP MMIDDIYYYY LIMITS D X I COMMERCIAL GENERAL LIABILITY CH22NP3ZO39441C 3/1/2022 3A/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR O GE TORENTEO PREMISES Ea occurrence $300,000 X MED EXP (Any one person) $ 25.000 Pollution Legal Liability PERSONAL B ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 GEN'L PRODUCTS-COMP/OP ASS $2,000,000 X POLICY [X ] jECT L LOC Pollution Legal Liab $1.000,000 OTHER: C AUTOMOBILE LIABILITY FA19NCP02119202 3/1/2022 3/1/2023 COMBINED SINGLE LIMIT Ea accident $1.000,000 BODILY INJURY (Per Person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLYNAUTOS X HIRED NON -OWNED AUTOSONLYAUTOS ONLY BODILY INJURY (Peraaitleni $ Pe�acc tlentDAMAGE $ B X UMBRELLALIAB X OCCUR CH22NP3ZO39441C 3/1/2022 3/1/2023 EACH OCCURRENCE $10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTION$n $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA WC012-05-6817 WC012-05-6818 3/1/2022 3/1/2022 3/1/2023 3/1/2023 X STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS be. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Pollution Legal Liability includes coverage for Third Party On -site, Third Party Off -site, Hostile Fire and Building Equipment, Products Pollution, Contractors Pollution and Transportation Cargo. Calhoun County is Included as additional insured under General Liability, on a primary and non-contributory basis, when agreed in a written contract, subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Calhoun County 211 S Ann St, Suite 301 Port Lavaca TX 77979 AUTHORIZED REPRESENTATIVE &,, / I j ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Rentokil North America Inc., dba Target Specialty Products INSECTICIDES FOR MOSQUITO CONTROL ANNUAL SUPPLY CONTRACT BID NUMBER 2023.01 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT IqLk� f THIS CONTRACT, made and entered into this day ofceMbt 20 by, and between the County of Calhoun (hereinafter called "County") and A'l MA MerCec T-AC •.'i-Rh A (hereinafter called "Contractor/Hauler"). jar-5e+ -speci4i� T( ro3u'rT— W ITN ESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for INSECTICIDES FOR MOSQUITO CONTROL, Bid Number 2023.01 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Insecticides for Mosquito Control as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: I. Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically ��prjjovvided for in such amendment. n INITIALS OF AWARDED CONTRACT /HAULER {IN INK): 1'Vl DATE: o� I70 ova INITIALS OF COUNTY (IN INK): DATE: ,L •-/50'- a r _ d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all insecticides/products ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the insecticides/products ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said insecticides/products from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACT/HAULER (IN INK):1- DATE: 1216 JI d0ao2 INITIALS OF COUNTY (IN INK): DATE: Z`t4 zv IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January COUNTY: CALHOUN COUNTY By: Honorable Richard H. M Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: 1DSA Tesge+ 5Peet'43t rodu fs By: Print Name: it i 5 ft6anC' �.a Title: VpCfor- �.LlSiwMP_r ,seryieN le—P Address: QLAS AV,FvSt QCLK U A AT CAI AN By: Prig Title: %-..Df ATTEST: �f'cTc(�. 'Sf1Pc�l�1 By: Print Name: Title:a CERTIFICATE OF LIABILITY INSURANCE I DATEs/vzo21120 2 1 zz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS '. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED previsions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this oartiecate does not confer noble to the certificate holder in lieu of such endursement(s)• PRODUCER Edgewood Partners Insurance Center 5909 Peachtree Dunwoody Road, Suite 800 Atlanta GA 30328 INSURED Rentokil North America, Inc. dba Griffin Pest Control (REN641) 1125 Berkshire Blvd., Suite 150 Wyomissing PA 19610 COVERAGES CERTIFICATE NUMBER: 14774DB713 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' sueR---" - _ "- POLICY EFF ! dZDAI EXP ILTN' 1 LIM" TYPECFINSURANCE POLICYNUMBEN MMMD1YYYY MNVOD i A X COMMERCIALGENERALUABILITY OOLG27240331 1011/2022 10/1/2023 EACHOCCURRENCE II5,oW,WO I' �CLAIMSMADE NA"GT'Td"RErTrEp— Otl0_ OCCUR ! �,PREMISEBjEe_,gaal(Ly5_cej,,, 55,000 .......... ..................... .___' " ^ i I i MEO E%P (ITAmr ane�ers�_ $ 5,000 PERSONAL&ADV INJURY $5000000 GEN L AGGREGATE LIMIT APPUES PER > GENERALAGGREGATE $ 5,000 000 X POLICY PRO-LOC JECT rvPRODUCTS�COMPIOPAGG S5,000,000 x_ ( OTHER: g C AUTOMOBILE LIABILITY ; 31CAS1044402 10/1/2022 10/1/2023 i COMBINED SINGLE LIMIT g3,000,000 eaJ W.. C -; 131CA61094502 j 10/1 /2022 I 1,1112023 X i ANYAUTO .IEe .. ,. BODILY INJURY (Per person) S _— .�.._1 OWNED I SCHEDULED ''1., BODILY INJURY(PeraWdent) $ ......'AUTOS ONLY , ;AUTOS ") HIRED "ON -OWNED - PROPf=RTV QAMAGE $ AUTOS ONLY (AUTOS ONLY _... 3$. B';X UMBREUALWB� XOLLUR '�, XOOG27238420 10/112022 10/1l2023 EACH OCCURRENCE 155,000000 ~i MEW LIAR CLAIMS -MADE i ',, i ( iAGGREGATE $5000000 .. E DEC , X RETENTION ' i S p ;WoRKERSCOMPENSAMN 131WCI1044202 10/1/2022 10/1l2023 IX 13TgTUTE_y C `>,ANDEMPLOYERS'LIABILRY YIN J 134WCI1044302 10/112022 1011/2023 °ANYPROPRIETORIPARMERIE%ECUTNE i NIA $200D 000 ;ELEACHACCIDENT ""'"' OFFICERIMEMBEREXCLUDED9 I(MandMory In NN) EL DISEASE -FA EMPLOYEE. $2,000,000 III Bs, OeecdhB,mder ?DES RIPTION OF OPERATIONS h.Imv E.L. DISEASE -POLICY LIMB S200000D A EMM&Omission$UOMry 4IOGLG27240331 10/1/2022 10/1/2023 EBsh lnddenUA99 $5,000,000 E ! ComelCllant Coverage N N P.001.000988898-01 1011/2022 10/1/2023 I ;Each Osswence $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101, AddMI.M Remade S.t.d.I.,,n.y b aeaM.d If reare.,.. Is.,.I.d) CERT!F!CATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Calhoun County 315 W. Green Street Marshall MI 49068 AUTHORMDREPRESENTATIVE 01988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1.- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 2 3, 5, and 6 if there are no Interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-941065 Target Specialty Products Houston, TX United States Date Filed: 2 Name of governmental entity or state agency that Is a party to the contract for which the form Is 10/05/2022 being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract 2023.01 Annual Supply Contract For Insecticides For Mosquito Control 4 Name of Interested Party City,State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Myers, John Reading, PA United States x Gelling, Bruce Reading, PA United States x Coyle, Jason Reading, PA United States X Helt, David Santa Fe Springs, CA United X States 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Klrstl Rodney and my date of birth is Houston Tx 77055 US My address is i , (city) (state) (zip coda) (wuntry) I declare under penalty of perjury that the foregoing is true and correct. Executed In Harris county, State of Texas _ on thel Oth day of 1Oth 2022 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Fnrma nrovided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.562b30bd # 06 NOTICF_ OF MFFTING — 1.2/14/2022 6. Consider and take necessary action to approve the contracts with the following awarded bidders for Asphalts, Oils and Emulsions, Bid Number 2023.02 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) a. Cleveland Asphalt Products, Inc. b. Martin Asphalt Company c. P Squared Emulsion Plants, LLC RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, CommssionerPct 2 SECONDER: Joel Behrens, Commissioner Pct 3' AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 12 Mae Belle Cassel From: demi.cabrera@calhouncotx.org (demi.cabrera) <demi.cabrera@calhouncotx.org> Sent: Tuesday, December 6, 20221:41 PM To: MaeBelle.Cmsel@calhouncotx.org; richard.meyer@calhouncotx.org Cc: cindy.mueller@calhouncotx.org; Erica.Perez@calhouncotx.org Subject: Agenda Item - Asphalts, Oils & Emulsion Contracts - December 14, 2022 Good Afternoon, Please place the following item on the Commissioners Court Agenda for December 14, 2022: • Consider and take necessary action to approve the contracts with the following awarded bidders for Asphalts, Oils and Emulsions, Bid Number 2023.02, for periods January 1, 2023 thru December 31, 2023 and authorize the County Judge to sign all necessary documents. • Cleveland Asphalt Products, Inc. • Martin Asphalt Company P Squared Emulsion Plants, LLC Thank you, q)i I)ji Gabh�ra Calhoun Gountg tant fluditor 561-553-4613 561-553- 1e6l* (fat.) Calhoun County Texas Cleveland Asphalt Products, Inc. ASPHALTS, OILS AND EMULSIONS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.02 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT THIS CONTRACT, made and entered into this 1`+�%of J/e-C'� 2 P,- , 20` by, and between the County of Calhoun (hereinafter called "County") and Cleveland ps0YA14 Produc,45, u(m. (hereinafter called "Contractor/Hauler'). WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ASPHALTS, OILS AND EMULSIONS, Bid Number 2023.02to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Asphalts, Oils and Emulsions as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: I. invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACTO {HAULER (IN INK): ( If DATE: 12/12/2022 INITIALS OF COUNTY (IN INK): DATE: I2-1y�- 2 L. d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Farce Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all products/materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the products/materials ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said products/materials from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACT HAULER (IN INK): - DATE: 12/12/2022 INITIALS OF COUNTY (IN INK): DATE: /2 —/�f - 7 -2— IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023. COUNTY: CALHOUN COUNTY By: Honorable Richard H. Mey r Calhoun County judge Calhoun County Courthouse 211SAnn St 3rd Floor, Ste 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: Cleveland Asphalt Products, INC. ,nG;'ir`J Print Name: Clayton Moore Title: Sales Address: PO Box 1449 Shepherd Texas77371 ATTEST: CALHOUN COUNTY CLERK ANNAGOODMAN M/L5, Print Name: I r Title: ME r� I ATTEST: Print Name: LeeAnnAils Title: Office Manager AC p® CERTIFICATE OF LIABILITY INSURANCE DAT211212022 1z/1z/zozz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER Bowen, Miclette &Britt Insurance Agency, LLC 2800 North Loop West, Suite 1100 Houston TX 77092 CONTCONTACT Sara Montoya AICNNO Eat: 713-880-7100 nlc No),713-880-7166 AID, ADDRESS: smontoya@bmbinc.com INSURER(S) AFFORDING COVERAGE NAICN INSURERA: Admiral Insurance CO 24856 INSURED INSURER B: Clearblue Insurance Company 28860 Cleveland Asphalt Products, Inc. P O Box 1449 INSURER C: Texas Mutual Insurance Company 22945 INSURER D: Shepherd TX 77371 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1740580951 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypE OFINSURANCE ADDLSUBR S POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY E%P MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y FEIPPL2184907 8112022 8/112023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE 1XI OCCUR DAMAGE TO RENTED PREMISES F. occurrence $300,000 MED EXP(Any one person) $25,000 PERSONAL B ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 GEN'L %t POLICY PRO- JECT 71 LOD PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y A01YTX001249-04 8/12022 8/112023 COMBINED SINGLE LIMIT Ea accidied) $ 100E 0E0 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per aodident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Peraccidenl $ NON -OWNED HIRED AUTOS AUTOS A UMBRELLA LIAR X OCCUR Y N FEIEXS2185007 8112022 8/1/2023 EACH OCCURRENCE $3.000,000 AGGREGATE $3,000,000 X EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ G WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y 0001182110 8112022 8/112023 X PER STATUTE OERH ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L. DISEASE -EA EMPLOYE $1000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing Contact Person as shown above. General Liability: Blanket additional insured Ongoing Operations per form #CG 2026 07 04 Blanket additional insured Completed Operations per form #CG2037 1001 Blanket waiver of subrogation per form #ECC-320-0712 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Calhoun County 211 S. Ann St., Suite 301 Port Lavaca TX 77979 AUTHORIZED REPRESENTATIVE s� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-947245 Cleveland Asphalt Products, INC. Shepherd, TX United States Date Filed: 10/21/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023.02 Annual Supply Contract for Asphalt, Oils and Emulsions 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is Clayton Moore and my date of birth is My address is PO Box 1449 Shepherd TX 1 77371 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in San Jacinto County, State of 'Texas on the 21s1 day of Octoh°r , 20 22 (month) (year) -Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.8b4250f1 Martin Asphalt Company ASPHALTS, OILS AND EMULSIONS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.02 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT THIS CONTRACT, made and entered into this day of Uil'i , 20 'A by, and between t e �county f Calhoun (hereinafter called "County") and (hereinafter called "Contractor/Hauler'). WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ASPHALTS, OILS AND EMULSIONS, Bid Number 2023.02 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Asphalts, Oils and Emulsions as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: i. Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment.T� / INITIALS OF AWARDED CONTRAC�HAULER (IN INK): 0tl DATE: Ld. L�� L� INITIALS OF COUNTY (IN INK): 4- DATE: /L' /9 Z z T T d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure' shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all products/materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the products/materials ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said products/materials from the vendor which submitted the next lowest bid and can deliverwithin twenty-four (24) hours orthe date and time specified bythe County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACj91R/HAULER (IN INK): _� ` DATE:../,Aa.'._1.,.�C�s[�S� INITIALS OF COUNTY (IN INK): -f� DATE: 2 Z IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on DecemE COUNTY: CALHOUN COUNTY 1 R By: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 S Ann St 3rd Floor, Ste 301 Port Lavaca TX 77979 ATTEST: CALHOUN COUNTY CLERK ANNAGOODMAN n ifiw Print I i �/ SMIth Title:vvla.M' WA ATTEST, Print Name: 1 J Ei .f� CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 Of 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. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2022-962249 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Martin Asphalt Company HOUSTON, TX United States Date Filed: 12(07/2022 Date Acknowledged: 2 i i Name of 9 vernmental entity or state agency t at Tis a party to the contract for which the form is being filed. CALHOUN COUNTY, TEXAS 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023.02 ASPHALTS, OILS, EMULSIONS Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary j I. i I I I i i i i 5 Check only if there is NO Interested Party. R b UNSWORN DECLARATION f My name is v l+- s n 4 and my date of birth is My address is 'L .—�Cy/�],ff�f= Y' (pity) (stale) (zip code) (country) . j I declare under pens y f perjury that the foregoing is true and correct. State on the day of Executed in County, of (month) (year) ore of authorized agent of contracting business entity ASj(Declarant) -Forms provided by Texas Ethics Commission A� " CERTIFICATE OF LIABILITY INSURANCE 5/1/2023 DATE(MM/DDYYYV) 8/11/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LOCKTON COMPANIES 2100 ROSS AVENUE, SUITE 1400 DALLAS TX 75201 214-969-6700 ON NAMTACT PHNE FAX COIN AC No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC If INSURER A : ** *SEE ATTACHMENT * ** INSURED 1302028 Martin Resource Management Corporation (See Listing Page 2) INSURER B:ACEAmerican Insurance Com an 22667 INSURER c: Westchester Fire Insurance Company 10030 INSURER D: Hamilton Insurance Designated Activity Company PO Box 191 INSURER E: Kilgore TX 75663 INSURER F: CnVERArFS * CERTIFICATE NUMBER: 16403439 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF MMIDDNWY POLICY EXP MM/OD/YVYY LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR Y N XSLG72485531 5/l/2022 5/1/2023 EACH OCCURRENCE $ 1000000 PREMISES (Fa ocourence s 1000000 X MED EXP (Any one person) s Not Applicable POLLUTION LIABILITY $IM-SIR PERSONAL BADVINJURY $ 1,000,000 X AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 GEN'L PRODUCTS -COMP/OPAGG $ 2 000 000 X POLICY ❑ PRO-JECT 1-1 LOC $ OTHER: B AUTOMOBILE LIABILITY N NT ISAH25561478 5/1/2022 5/1/2023 COMBINED SING LE LIMIT Ea accident $ 5,000,000 BODILY INJUflV (Per person) $ XXXXXXX X ANY AUTO BODILY INJURY (Per accident) $ XXXXXXX X OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOSONLV PPe accident AMAGE $ XXXXXXX $XXXXXXX C D X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE N N G27550271008 ENGXSH1224845 5/1/2022 5/l/2022 5/1/2023 5/1/2023 EACH OCCURRENCE $ 10,000,000 AGGREGATE s 10.000.000 DED I X I RETENTION $0 $ XXXXXXX WORKERS COMPENSATION ANY AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIM In (Mandatory In NH)H) EXEXCLUDED?�N N/A N See Attached 5/1/2022 5/1/2023 X STATUTE ER E.L. EACH ACCIDENT _ a 1000,000 E.L. DISEASE- EA EMPLOYEE $ 1000 000 E.L. DISEASE -POLICY LIMIT $ 1000000 If yes, describe under DESCRIPTION OF OPERATIONS below D EXCESS AUTOMOBILE - N N GVE100124709 5/1/2022 5/1/2023 LIMIT$5,000,000 LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) rcoTICIrATP men nFa CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16403438 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Calhoun County 211 S. ANN ST. ST 301 PORT LAVACA TX 77979 AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD P Squared Emulsion Plants, LLC ASPHALTS, OILS AND EMULSIONS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.02 Beginning January 1, 2023 and Ending December 31, 2023 r ONTRACT THIS CONTRACT, made and entered into this i day of December , 2022 by, and between the County of Calhoun (hereinafter called "County") and P Squared Emulsion Plants, LLC _ _ (hereinafter called "Contractor/Hauler"), WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ASPHALTS, OILS AND EMULSIONS, Bid Number 2023.02 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement, and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Asphalts, Oils and Emulsions as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: i. Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACT/HAULER (IN INIQ: - DATE: �i INITIALS OF COUNTY (IN INK): DATE. �Z _��/,-2 Z- d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Docurn, w 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered bythe Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all products/materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the products/materials ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said products/materials from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACTOR/HAULER(IN INK):. DATE:,_/__,G. INITIALS OF COUNTY (tN INK): __.. __ DATE. IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, COUNTY: CALHOUN COUNTY By: — Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 2115 Ann St 3rd Floor, Ste 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: P Squared Emulsion Plants, LLC By: — Print Name: Dane Ginnis Title: Partner/CFO Address: 516 South McLennan Loop, Elm Mott, Texas 76640 M ATTEST: r CALHOUN COUNTY CLERK,, o ANNA GOODMAN e9LHO t� By'�/ Print Name: - EM0 i�� // �� Title: I✓1Ah V , rum � ATTEST: By: Print Name: Amber Young Title: Office Manager CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties, OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 2022.961985 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. P Squared Emulsion Plants, LLC Elm Mott, TX United States Date Filed: 12/07/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County, Texas Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023.02 Annual Supply Contract for Asphalts, Oils and Emulsions 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling TIntemnediary 5 Check only if there is NO Interested Party. ❑ X '� 6 UNSWORN DECLARATION My name is Amber You n j and my date of birth is, No My address is 516 South McLennan Loop, Elm Mott, Texas.76640 USA - (street) (city) (stale) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in McLennan County, State of Texas on the %th day of Decembe;0 22 (month) (Year) Signature of authorized agent of c racting bus e s entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.ebB7ef42 ��. a MINI ACORO°° CERTIFICATE OF LIABILITY INSURANCE lla� F DATE(MWDDIYYYY) 12/30/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur Blake Insurance 850 Central ParkwayEast Ste 108 Plano, TX 75074 NAMEACT Chris Fribourg _ PHON a (972)335 4115 plc. NA: (972)633.0477 E-MAIL �� — tezas.com ADDRESS: chris@abigtoxas.com INSURER(S) AFFORDING COVERAGE NAICIf INSURERA: Evanston lnsuranceCom and_ 135378 INSURED P Squared Emulsions, LLC & EMT Properties, LLC, Start at 65, LLC DBA P2 Emulsions INSURERS: Mercury County Mutual Insurance �_ 94 !293 -- INSURERC: Texas Mutual Insurance Company INSURER D: r 616 S Mclennan Loop INSURER E: Elm Mott, TX 76640.3586 INSURER F : _I COVERAGES CERTIFICATE NUMBER: 00009549-390257 REVISION MHMRFR• 49 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IITR TYPE OF INSURANCE AOOL STIR POLICY NUMBER POLICYEFF MMIDDIYYYY POLICY EXP MMlO LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7XI OCCUR MKLV4PBC002325 -12131/2021 112131/2022 EACHOCCURRENCE rPREV SES E curtence is 1 000000 5 1 OO OOO MEDEXP (Anyoneperss.) S $000 �GEN-L X�r n PERRONAL B ADVINJURY S 1000000 AGGREGATE LIMIT APPLIES PER. POLICY a jECT �� LOC OTHER: GENERAL AGGREGATE 5 2.000,000 PRODUCTS-COMP/OPAGG 5 2 00O 000 j S B AUTOMOBILE X X LIABILITY ANY AUTO OWNED A AUTOS ONLY X UTOSULED HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BA420000015089 01/0312022 0110312023 NEEatlEEDISINGLELIMIT 5 1 000000 BODILY INJURY (Per person) S BODILY INJURY (Pet accitlent) S PROP aacc YDAMAGE S A X UMBRELLA LIAR EXCESS LIAO X OCCUR CLAIMS -MADE MKLV4EUL103643 12/31/2021 12/3112022 EACH OCCURRENCE S 1,000,000 AGGREGATE OED I X I RETENTIONS 10000 5 C AND EMPLOYERS'LIABILITY0002025344 ANVPROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory In NH) I! es, Eeecnbe under DESCRIPTION OF OPERATIONS below NIA 0110312022 07103120231�LE IE.L. ATUTE ETH- CHACCIDENT 5 1,000,DOO EASE -EA EMPLOYEE S 1,000,000 DISEASE - POLICY LIMIT 5 1,000000 I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached U more apace Is required) CALHOUN COUNTY 211 S. ANN ST., SUITE 301 Port Lavaca, TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by CAF on 12130/2021 at 12:13PM # 07 NOTICE OF MEETING - 1.2/14/20?_2 7. Consider and take necessary action to approve the contracts with the following awarded bidders for Road Materials, Bid Number 2023.03 for the period January 1, 2023 through December 31, 2023 and authorize the County Judge to sign all necessary documents. (RHM) a. Marek & Marek Truck Wash, INC. dba Frank Marek Trucking J. K-C Lease Service, INC., dba Matagorda Construction & Materials c. Quality Hot Mix, Inc. d. Vulcan Construction Materials, LLC f. Waller County Asphalt, Inc. g. Midtex Materials, LLC RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 12 Mae Belle Cassel From: demi.cabrera@calhouncotx.org (demi.cabrera) <demi.cabrera®calhouncotx.org> Sent: Tuesday, December 6, 20221:39 PM To: MaeBelle.Cassel@calhouncotx.org; richard.meyer@calhouncotx.org Cc: cindy.mueller®calhouncotx.org; Erica.Perez@calhouncotx.org Subject: Agenda Item - Road Materials Contract - December 14, 2022 Good Afternoon, Please place the following item on the Commissioners Court Agenda for December 14, 2022: Consider and take necessary action to approve the contracts with the following awarded bidders for Road Materials, Bid Number 2023.03, for periods January 1, 2023 thru December 31, 2023 and authorize the County Judge to sign all necessary documents. Marek & Marek Truck Wash, Inc. dba Frank Marek Trucking • K-C Lease Service, Inc. dba Matagorda Construction & Materials • Quality Hot Mix, Inc. • Vulcan Construction Materials, LLC • Blades Group, LLC • Waller County Asphalt, Inc. • Midtex Materials, LLC Thank you, ftmi Cabrs ra Calhoun Countg ,0.�s siant auditor 561-555-4613 361-553-4614 (fax) Calhoun County Texas Marek & Marek Truck Wash, Inc. Dba Frank Marek Trucking ROAD MATERIALS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.03 Beginning January 1, 2023 and Ending December 31, 2023 CO ACT jfA THIS CONTRACT, made and entered into this � day of (� e r C �1 e� 20_A,;1, by, and between the County of Calhoun (hereinafter called "County") and F4—LLV.Iz h(iCAfC,19 (hereinafter called"Contractor/Hauler"). W ITN ESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ROAD MATERIALS, Bid Number 2023.03 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Road Materials as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: i. Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; Ill. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACT /HAULER (IN INK •� DATE: INITIALS OF COUNTY (IN INK): DATE: 't — d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure' means a delay encountered bythe Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Flauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the material(s) ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and tirne specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACT/HAULER (IN INK): DATE: 1 a - INITIALS OF COUNTY (IN INK): 4 DATE: z_._ IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023. COUNTY: CALHOUN COUNTY By: Honorable Richard H. MeWr Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: F r'a r, l<(� h'l cL ra4c Tr �(`r Ica na By Print Name: F r A n k l.J . YYl d re k Title: p f-t t ; CA 4 '� Address: F. rU R n )6 G `-I i L 1 ccc.,meDj Ty- -)-�N3-2 ATl CAL AN I By: Print Name: Wdi ' Ni tK Title: (AU R ATTEST: By: Print Name: aJ Chin Ite' POi/CLS Title: Ff3F?Pr7 .� z ^. Lal11l7lete Nos 1- o and 6 it thel'e are ¢veoeslad parneq Complete h>s 1, 2; 5 and 6 if there are no intarested parlos a y^ � �Y CERTIFICATION OF Ff1 Pf fG _ 1 Name rfi leu5mess eitoty FiUng form, and the citystage arld country oi�the baseness anllty s of business. place certificate, Number:j Marek S Marek Truck Wash, h1c. dha Frank Marek Trucking 2022-9P2935 El Campo, TX United States 2 Nafne of ro' ertmenta een;rty ar s%are agency iha! is a party o the euneract fov wlti �e form being filed, Nate Fined; ]s 121 )12022 Calhoun County, Texas Date Acknowledged: 3 Provide the identification n4mbst, used by the govefnniantel entity or sta e agent)] to hac~or description Of the seevices, goods, or other prop=_t'ty to oe p Oolded Mile. tha conlrkkct. itierldiy the oontr'Ack, and Provide a 2023.03 1/1/2023 - 12/31/23 Annual Supply Contract for Roar{ fvlaretials, Bid IVtlmher 2023.03 ._ ..J....-............. Name of Intet'ested Paety .�T City, State Country ipaace orr business) (cri opplic abfe) `'S N �SaYSlre Of fitfeYesF .��.. Concro3Ulsg lnta,•nstdiasY _—„TT.... 6 Check only if there is fVo interested party. (.x t_ .._�. _.....�_.-.-.._..._�,._—�.-...s._....f—_._ G UP4511- ORN DECLARATION My narn- 6 �y�C.p 4 � j and my i dale of birth is >a 1011 address i (city`r (state) (zip code) (wunuyl I declare under penalty of perjunY that the foregoing is true and correct. Executed in r f� n�j County, State of �re ;c{ on the'Wn day of ) CT.20 . !monthl C/ear) Signature: of aoahorized agont of Cannacting business enfiy __.. (Declarant) n rn,riAorl I CIilin.- ram..,«...,_ .. ..... ..................___.— .- - �...._........�.._ - evvvvv.euuc5.sra[e.tx.us Version V3.5.1.eb87ef92 MAREAND-01 CERTIFICATE OF LIABILITY INSURANCE HALE A E(MMID022 DIYYYY) DATE (MMID022 12/912 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Anco Insurance PO BOX 3889 Bryan, TX 77805 CONT9AMeACT Sarah Hronek, ACSR (AICNNo, Ext: (979) 774-6281 (AIC, No):(979) 774-5372 AI oaIESS: hronek@anco.com INSURERS AFFORDING COVERAGE NAIL # INSURERA:Oklahoma Surety Co. 23426 INSURED Marek And Marek Truck Wash Inc dba Frank Marek Trucking P. O. Box 1664 El Campo, TX 77437 INSURER B:Employers MutualCasual Co 21415 INSURER C ASUI Indemnity CO. 22314 INSURERD:Texas Mutual Insurance Company 22945 INSURER E: INSURER F: COVERAGES rFRTIFICATF NUMRFR- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER POLICVEFF MMIDD(MMADDrYYYYi POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 06GL001087740 101112022 10/112023 EACH OCCURRENCE $ 1,000,000 pREMISE5 s c. noa $ 300,000 MED EXP (Any oneperson) $ 0 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ aEaT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOPAGG 2,O0o,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AU�RRTE�O��S ONLY X AUTHOSD X AUTOS ONLY X AUTOS ONLY SE41673 101112022 101112023 COMBINED SINGLE LIMIT Ea accident) 1,000,000 $ BODILY INJURY Per erson $ BODILY INJURY Per accident $ Peraccltleol AMAGE $ $ C X UMBRELLA LIAR EXCESS LIAS X OCCUR CLAIMS -MADE NHAO99551 1011/2022 101112023 EACH OCCURRENCE S 5,000,000 AGGREGATE S 5,000,000 DED I X I RETENTION$ D $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AFFICEOR/M�MBERE%CLUER)EED? ECUTIVE ❑ (Mantlalorym NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 0001279554 101112022 101112023 R OTH- PEU STAT E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) RE: Supply contract for road materials, Bid #2023.03 Certificate holder has been added as Additional Insured on General Liabliby Policy #06GL001087140 rFRTIFICATF HOI nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Countyof Calhoun Texas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 202 S Ann St. Port Lavaca, TX 77979 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy No. 06-GL-001087140 OKLAHOMA SURETY COMPANY ML 12 14 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION -ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The County of Calhoun Texas (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability caused, in whole or in part, by your performance of ongoing operations for that insured. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by written "insured contract', the insurance afforded to such additional insured will not be broader than that which you are required by the written "insured contract' to provide for such additional insured. This amendment applies only when you have agreed by written "insured contract' to designate the person or organization listed above as an additional insured subject to all provisions and limitations of this policy. ML 12 14 0413 Includes copyrighted material of Insurance Services Office, Page 1 of 1 Inc., with its permission K-C Lease Service, Inc. dba Matagorda Construction & Materials ROAD MATERIALS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.03 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT _ 1�" THIS CONTRACT, made and entered into this day of `)`lC,PYYI!JCJ 20 ZZ by, and between the County of Calhoun (hereinafter called "County") and K-C Lease Service, Inc DBA (hereinafter called "Contractor/Hauler"). Matagorda WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ROAD MATERIALS, Bid Number 2023.03 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Road Materials as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACT%�/HAULER (IN INK): DATE: I Z FS ZZ INITIALS OF COUNTY (IN INK): O/"f,DATE: /Z.—/L/-7-2_ d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the material(s) ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACTO HAULER (IN INK): /f C DATE: I2 INITIALS OF COUNTY (IN INK): DATE: 2 'ZZ IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed bytheir authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023. COUNTY: CALHOUN COUNTY By: Honorable Richard H. er Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: K-C Lease Service, Inc DBA Matagorda Construction & Materials By: /tea-�� Print Name: G IZnn ATi CAL AN[ By: PrintName: KMI(!, ,II Y l* Title: ATTE_ -"C Lease Service, Inc DBA Matagorda Construction & Materials Print Name:1Vl�n�a Title: (tnff-&L NI CtI1G qA —r __ Title: 15D(�1411 Address: I Z- 5 H 35 rJ a Ct� 7X D(llq CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-943004 K-C Lease Service, Inc. DBA Matagorda Construction & Materials Bay City, TX United States Date Filed: 10/11/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023.03 Road Materials 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Krauskopf, Bruce Louise, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION Gl� Cha lUfe s My name is n t1 ,and my dale of birth is li G c QQ My address is i71 Z, 514 355 ,]JQ Gt� ,TX lgglq usp (street) J (A) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Ciao() UW County, State of on the II 'khda o/ny�_ , 20 jQQq (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.8b4250f1 ,��..., KCLEA-1 OF ID* ORO' CERTIFICATE OF LIABILITY INSURANCE DATE D 10111/11/202222 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER 832.449.3232 NQAE?cT Janice Bloise Energy Insurance Group LLC 'PHONE 832-4493232 �FAX832.449-3061 P.O. Box 963 (aC No EMT. (AD No): Richmond, TX 77406 - —6nt00 ever l05 roU com Ee Scott Kulcak AOORkSa j _ _9Y _9 P• dba T & Material _.. INSURER(S)AFFOROINGCOVERAGE INSURERA Everest Indemnity Ins. Co. INSURER 8, Everest Denali Insurance Co. ,.,,,,,,,,.Texas Mutual Insurance Co INSURER E : rnvecsAr_ee cermrrA rc A,naaece. RFVIQlnm MUMIRFR. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AUUL I6UBR. POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL AB urY XI EACHOCCUR 0D O_0.000MMERCIAL _. XOCCUR -_rDAMACE TORENTED .. 1QQQ_O.QCLAIMS-MADE X X ENIML00027.221 �08/1512022 _-_1, Prima ryNonContri6 ENML00027.221 08/1512022108/15/2023 MEpEXPnyonoponionLA 5000 A) Poll ENIML00027.221 081151202210811512023 PERSONAL&ADVINJURYs 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 26,000,000 5 X POLICY I PELT LOG PRODUCTS - COMPIOP AGO 2,000,000 $ Pollution 1,000,000 OTHER 5 B - COMBINED SINGLE LIMIT 1,000,000 $ AUTOMOBILE LIABILITY X IANY AUTO _ X _ - X ENICA00033-221 108/15I2022�08/15/20231 (En arcidenl). _— —._. BODILY INJURYPor Fan'Min_�S _ - ._._______ .... OWNED I SCHEDULED X_ X BODILY INJURY( Pe accmentl. $ AUTOS ONLY i AUTOS X HIREop X NON -OWNED P eOPERdTYIDAMAGE lP 1 __._I AUTOS ONLY __. AUTOS ONLY I _ __ ----'---- A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 EXCESS LAB CLAIMS -MAUL XXENlC00026-221 08/1512022 08/1512023� AGGREGATE, _._ 5,000,060 __. _..... DED RETENTIONS C WORKERS COMPENSATION I X L$ ATUTE ERH...... AND EMPLOYERS' LIA9ILITY YIN X 0001135153 08/15/2022 08/1512023 E.L.EACH ACCIDENT 1,000 000 $ ANY PROPRIETOMPART19ERIIEXECUTIVE O FlOERIMFIMBER EXCLUDED' I,NIA ( endatory n NH) EL DISEASE EA EMPLOYEE( 1,000,000 $ 'It es, describe under OPERATIONS hel E.L. DISEASE - POLICY LIMIT i 1,000,000 D 0 SCRIPTI N OF '46MS109831 09/15/2022 08115/2023ILIMIT 500,000 �Equipmentllllll RentLease 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES LACORD 101, Additional Remarks Schedule, may be attached it more space Is regWred) Blanket Additional Insured & Waiver of Subrogation on the General Liability, Business Auto & Umbrella Liability with a Blanket Waiver of Subrogation on the Worker's Compensation where their interest may appear by a written contract. 30 Day NOC. Umbrella Policy Follows Form. Calhoun County 202 S Ann St. STE B Port Lavaca, TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Quality Hot Mix, Inc. ROAD MATERIALS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.03 Beginning January 1, 2023 and Ending December 31, 2023 12/13/2022 09:11 9795435088 QUALITY HOT MIX PAGE 02 t: CONTRACT //l� THIS CONTRACT, made and entered into this � day of Ae'—O2a b 20 1Lby, anbetween the county of Calhoun (hereinafter called "County") and 1k 1)�[ � Y Y ll(hereinafter called "Contractor/Hauler"). WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ROAD MATERIALS, Bid Number 2023.03 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Road Materials as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: Invitation to Bid, Instructions and Term of Contract; General Conditions; iii. Bid Specifications and Conditions; iv, Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACT�/'HAULER (IN INK): J L5 DATE: « I3 Zz INITIALS OF COUNTY (IN INK): _/0/ ( DATE: Z- 12/13/2022 09:11 9795435088 QUALITY HOT MIX PAGE 03 d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the material(s) ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACT HAULER (IN INK): �V DATE: 2. I �b INITIALS OF COUNTY (IN INK): _ '4 DATE: 1.7--111 Z Z 12/13/2022 09:11 979543508E QUALITY HOT MIX PAGE 04 IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authori2ed agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023, COUNTY: CALHOUN COUNTY By: onorable Richard H. Mey . Calhoun County Judge Calhoun County Courthouse 2115 Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: By; I Print Title: Address:- PO �Ox (,?-yti �,�CQIMv6 Xj 77 N3 7 ATI CAI ANI By: .,W ATTEST: By: Prir Title: �1RAEag22 12/13/2022 09:11 9795435088 QUALITY HOT MIX PAGE 05 CERTIFICATE OF INTERESTED PARTIES FORM 1295 >.a1 Complete Nos. 1- d and 6 N there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 2, 5, and 6 it there are no Interested pares. CERTIFICATION OF FILING Certificate Number: 2022-963786 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Quality Hot Mix, Inc. EI Campo, TX united states Date Filed: 12/13/2022 2 Name g0 rnmental entity or state agency that is a party to the contract for amlch the to= is being filed. Calhoun County, Texas Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or Identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023 Road Materials Road Materials 4 Name of Interested Parry City, State. Country (place of business) Nature of interest (check applicable) ConfrollingTimertnedlary Snyder, Jeff El Campo, TX United States X 5 Check only if there is NO Interested Party. ❑ a UNSWORN DECLARATION jj1�,D C My name is �e T F :J AI I'' , and my date of�binh is My address is wri l'.� C-9d"wb 1 X 7%q;7 4SA - (alreeN (chy) (slate) (zip code) (country) I declare under penalty of paduury that the foregoing Is true and Correa. ,t r} Executed In V A , 7 County. Stele of �. on the 1rday of C'kA `202 A-,. (month) (year) Signature of authorized age (osdara:d) g usiness entity Forms provided by Texas Ethics Commission mmm.ethics.state.tx.us Version V3.5.1.3ac8Bbct) QUALHOT-01 r CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDf6128120 lYYYI THIS CERTIFICATE IS ISSUED AS q MATTER OF INFOR2812022 MATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H� O p THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be d It SUBROGATION IS WAIVED, Sublect to the ta..a.—A ......tea.____..._ . PRODUCER Texas Associate 1120 Capital of T Bid 3-390 Austin. TX 7RTAa INSURED Quality Hot Mix, Inc. Quality Hot Mix Trucking, Inc. P.O. Box 1244 El Campo, TX 77437 IS COMMERCIAL GENERAL LL40JL17Y CLAIMS -MADE FAI OCCUR L AGGREGATE UMI7gppLIES PER: POLICY ❑ ipt9LQT LOC mardis pollciae may require an endorsement. A statement an d ortain . 475-1 BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS lY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, REDUCED By PAID CLAIMS. 7/9/2022 I 7/9/2023 AAyNy 000 ONLY NE 310.2N334175 A(U��Irr�II�pp3WyU.�L�EEEO 71912022 7/9/2023 �U��T@@OA�S AUTO3 ONLY HOTO$ONLy I UMBRELLA LIAO X OCCUR EXCESSUke CLAIMS -MADE CUP.6J32332A 719/2022 DIED X RETENnoNa 1D.OnD 7IN2023 YOI �SFOOD7719715 NIA 719/2022 7/8/2023 DESCRIPTION OF opERA11ONSILOCATmN3 / VEHICLE$ (pCOR0101, AdNtlonel RnreAa 9eA rtlule,.l,ry pp pacNetl n mate epr�r Ie.eRyirod) Calhoun County Auditor's Office 211 S. Anh Streat SURE 301 Port Lavaca, TX 77979 ACORD 25 (2o16/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CAN BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, REPRESENTATIVE Z0 39Cd The ACORD name and logo are registered marks of ACORDCORD XIW 10H Aiiivno reserved. 8809EV96L6 TZ:60 ZZOZ/82/ZL Vulcan Construction Materials, LLC ROAD MATERIALS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.03 Beginning January'l, 2023 and Ending December 31, 2023 CONTRACT THIS CONTRACT, made and entered into this day of ! 20 Z Zby, and between the County of Calhoun (hereinafter called "County") and ` VQVUV\ (6ry-J) AA\(YN nACAVoytUkS (hereinafter called"Contractor/Hauler"). LGC W ITN ESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ROAD MATERIALS, Bid Number 2023.03 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Road Materials as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: 1. Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv.Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRAC /HAULER(ININK):DATE: 12 /7/Zo�2 INITIALS OF COUNTY (IN INK): DATE: d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered bythe Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the material(s) ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACT/HAULER (IN INK): J� DATE: 12 1 i / 1 OVI INITIALS OF COUNTY (IN INK): - DATE: IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023. COUNTY: CALHOUN COUNTY I By: Honorable Richard H. eyer Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: \ jWw\ Con5LYuAwy-1 Aare Vlaks , LGC Print Name: ,}J1�(n I (/y✓GY Title: ncq%� Address: Wtl) I -C L.,V iUA Mute 5 5-0c) AT1 CAI ANI By: v� I ATTEST: By: /l %yy��%nn'LE? ',✓ P Print Name: IVIX Layne Manri,,✓La Title: CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-950316 Vulcan Construction Materials, LLC San Antonio, TX United States Date Filed: 10/31/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023.03 Annual Supply Contract for Road Materials 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Vulcan Construction Materials, LLC San Antonio, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is , J \% ct and my date of birth is , �FUVYG"L C'� p Myaddressis IU)bi. ILZiM�(Xl Pl(1(QrS1f"50D JIAV1Ay\kf Aio 'T-� , (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed inCounty, State of on the �) day of O(,+ , 20-!Z—. (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.dlb92728 a� �® CERTIFICATE OF LIABILITY INSURANCE ATE D12(0812022Dnrrv) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 'Marsh USA, Inc. 10lnverness Center Parkway CONTACT NAME: PH AX AICNNo Ext: AIC No): E40AIL ADDRESS: Suite 400 Birmingham, AL 35242 _ Attn: Laura.G.MCLaughlin@mamh.eom INSURERS AFFORDING COVERAGE NAIL# INSURER A: Old Republic Insurance Co 24147 CN 1 02620992-SW-REG-22-23 INSUREDVulcanConstruction Materials, LLC INSURER B: NIA NIA INSURER C : PO Box 385014 INSURER D : Birmingham, AL 35238-5014 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-005517650-01 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUSR INSD MD POLICYNUMBER POLICY EFF MMIDD/YYYY) POLICY EXP flMMIDDA`YYYl LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY312014-22 0110112022 01/01/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ X MED EXP(Any one person) $ Contractual Subject to$50,000 SIRIclem PERSONAL &ADV INJURY $ X AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1,000,000 GEN'L POLICY JECT PRO -LOG $ OTHER: A AUTOMOBILE LIABILITY MWTB312011-22 01/0112022 0110112023 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANVAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBEREXCLUDED1 � (Mandatory In NH) NIA MWC312015-22 0110112022 01/0112023 X PEft OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEEI $ 1,000,000 If yes, descdbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is required) RE: Bid No. 2023.03 - Certificate Holder is included as additional insured as their interest may appear on the Automobile Liability and General Liability policies evidenced herein, but only with respect to liability caused, in whale or in pad, by operations of the Named Insured, where required by signed contract. Calhoun County 211 South Ann Street Suite 301 Pod Lavaca, TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Waller County Asphalt, Inc. ROAD MATERIALS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.03 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT THIS CONTRACT, made and entered into this day of �FNBrfs 20 by, and between the County of Calhoun (hereinafter called "County") and �L J 1� 1. AtC* it 146. (hereinafter called "Contractor/Hauler"). WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ROAD MATERIALS, Bid Number 2023.03 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Road Materials as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; Ill. Bid Specifications and Conditions, iv. Bid Form; v. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRA HAULER (IN INK): F@— DATE: !a'4 • QCW INITIALS OF COUNTY (IN INK): DATE: 1 Z —/1f — 2-- d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the Insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties If such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event con;tituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the material(s) ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and reorder the said material(s) from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The Invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACTOR/HAULER (IN INK): •— Lb: - DATE:,�aZ•[ 'X . INITIALS OF COUNTY (IN INK): DATE: IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed bytheir authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023. COUNTY: CALHOUN COUNTY By: Honorable Richard H. M r Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: tl By: 2 / = Print �Naame: Title: Vie�l' A TAM /_ ' ..r .i �4 ATl CAI ANI By: A, EET. CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1 - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-945774 Waller County Asphalt, Inc. Hempstead, TX United States Date Filed: 10/18/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023.03 Road Materials 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. ❑ X 6 UNSWORN DECLARATION My name is F-Qiii -7bAYd%0ti3 and my date is ••--pofrrbirth My address is 2701O FR1e69W-A/QZ F�AS ooft%p , =_, %wqs,— , u"SA. (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Exec A I my, late of TG7C145 on the L& day of 007b&Uf, , 20-7? ""tt rt'rr SANDRA Z. UHEREK (month) (year) `=ORpaV P�Q i t 7,: Notary public, State of Texas `\ q Comm. NotaryxIDr 12d76882g23 Signature of au orize gent of contracting business entity eclaranQ Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.81n4250f1 coR� CERTIFICATE OF LIABILITY INSURANCE 13AIRCNmD"M 12I06P2022 THIS CERTIFICATE 0ISSUED ASA MATTER OP INFORMATION ONLYAND CONFERS NO N OWM UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMAMWELY OR NEUATIVELYAMEND, EXTEND OR ALTER THE COYERAGEAFFORDED BY THE POLICIES BELOW. THE CERTIFICATE OF INSURANCE DOES NOT CONSTRUIEA CONTRACT BETWEEN THE ISSUING INSURER)S),AUTHORMN REPREBENTATNE OR PRODUCER AND THE CERTIFICATE HOLDER. MMMAW. If the MMIMIe holder -an AMML MURIA the NBUBROMATION Ui WAIVED, subjectto tlletemm and ca dMon oTNe PONCA this oerdgwb does not coda d his WON coditete hoMer In BID dsudh must have ADDITIONAL IMBUED- ;—mlolons or be OndemaA. COIWO polldes map (Mira an endorsement. A statementon endomama PRODUCER, B*Wamwda 5676 NWF Freeway SMm0460 HMIOM TX nGM OaWt Stadler (71S)4SS-0700 lffj p1TISSB-2214 Baysbetrb Lowe VUWMMAFMF=MCDVEPACE A: CIRdM Oak Rm Ina. CO. M114a 21016 W&m® WAwCow*/AWtmk Him. DMA: Nadler Cou*Aspme Ndler Count' CamEldbn, LLC. 22010 FeBBmund Rd. H=Vsftd TX 77446 mug=Bl Travelem Pmpft Casually Company cfAmedm 21674 BBC: TMdo McNBZNetleIry W. CA 22BSD IMRmeRo: y: COYERAOEA `f.®rvIRG7E mLMRERt 22-26 MaSW RENmON MUMRPR THIS INTOCERTIFYINATTNE POUCES OF INSURANCELWED BELOWHAVEBEEN 'BMW TOTHEDNIWMEDNAMEDABOYEFORTHEPMICYPM WD WDICATED. NOlN1DWTANDINOMIY REWIREIRENETERMORCONDITOM OFANYCONIRACTOR OTHER DDWMIBO'NRTH RESPECT70 MICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.TME INSURANCE AFFORDED SYTHE POLICIES DESORMW HEREIN 15SMECTTOALLTHETERM% EXCLDBIONSANDOOrIDnWNSOF SUCH POMCML UMRSSHOWN MAY HIM! BEEN REDUCED BY PAIDCUUML 7YPaeFOm11Rwm Carl W&I PDYCYMIIIREI B INIODDRIM UNITS A 4=WWA GBMRALINBMW GAaONM11 Is OCCUR AID 146149-COF 041OV2022 041OVII025 6M.B000LNUUNCB s 1.0W,000 '�TDAa c MOGW(Ana mP a SOCURN0 M 6,� PWAMnaADVIMAW GEIEIALAaGNENATE M Imcco OBILADQREd1TELUrrrAPPLUMPER POKY ®,ECP ❑Lac Dn®e a 2,111110,00) FACIUCS,CWWAGG t 2.000,000 a B AUIOYaRte0ANv1Y ANYAUTO �' AY�� AUOONY AUTONOMY BAOSf46186 OPm1M2 010D7 fibsoftle a 1,000,000 BODWINAIRY(RPPllmll s BODHYIMMOr a a s 8 IImoto"MAB wimu 0 O.y.BR =RWA DB CUP-08146T22 00112022 OL rAn PACMOCI[RVANCE M 1.000.000 TB s 1.000.000 RETBIIION s 110,000' s aaoeoLDrels,Lueanr ANYRIORUflORIPIRMEVEECVIIVE Will OFFOERNABMER -, 4,-CHNI �W08)1 ow-, M OFOPORATIMbWo MIA EL EACHAOCMM a M ELq R-FOLICYUW s C Pollution Llabft PPK2399M 04I0112022 0410112028 Conuaelae POIINOOR $1,000.0c0 OBBMMONOFCPEPATUMBIUMAMMIYE1Olp8 pLWR0lm,aenmlw RemNb SrAo4m. mybe emNa �PONmGOae) CRRTM1TCATE NOLDRD CANCELLATION SNOULDAWOF TNBASOYE DE MMEO POLICIES BE CANCELLED BEFORE TKE EMRATION DATETNBREOR N04TCa WILL BB DWiMMD IN co mCOunly ACCORDANCEWRNTKEPOLICYPRCWSIONS. 202SAIMSL.STEB AUTHOR= mTnS Pod Lam TX ne79 016SB,0016ACORO CORPORATION. All NShmmaervaa. ACORD 26(2016=) The ACORD nanm and 106o are molafsmd marks otACORO MidTex Materials, LLC ROAD MATERIALS ANNUAL SUPPLY CONTRACT BID NUMBER 2023.03 Beginning January 1, 2023 and Ending December 31, 2023 CONTRACT J44" THIS CONTRACT, made and entered into this day of 20),�- by, and between the County of Calhoun (hereinafter called "County") and 4T/J CIk /&—. fziAls / t c (hereinafter called "Contractor/Hauler"). WITNESSETH: WHEREAS, the Contractor/Hauler did on November 2, 2022, submit a BID for ROAD MATERIALS, Bid Number 2023.03 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial Jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perform all of the work and to deliver the Road Materials as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: i. Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; iii. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRACT/HAULER (IN INK): r/ DATE: ff 3 INITIALS OF COUNTY (IN INK): DATE: lZ—/c/ Z L d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents. 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure. "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler. Without limiting the generality of the foregoing, "Force Majeure" shall include, but not 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. Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliverthe material(s) ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRACT/HAULER (IN INK): 2 ? DATE: .--/-) 8 2 INITIALS OF COUNTY (IN INK): / DATE: /'Z -/4/ Z Z IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on January 1, 2023 and end on December 31, 2023. COUNTY: CALHOUN COUNTY By:gf�n� Honorable Richard H�✓-- Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: Print Name: /lw,,z �i,/,,f, .T— Title: e ,:4jt Address:_/' ' g&,z 1F7 dye Ar CAI AN By: Print Name:�V tl VI/l Title: ATTEST: By: V-fineyV I�t�'� Print Name: nU`til P. )SkGi Title: CERTIFICATE OF INTERESTED PARTIES FORM 129 loft, Complete Nos.1 - 4 and B if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 2 % 5, and G If there are no interested parties. CERTIFICATION ATI4Ri OF FILING I Name of business entity filing form, and She ally, state and country of the business antity's place of business, Certificate Number; Midtex Materials LLC 2022-9,52522 FAYETTEVILLE, TX United States pate Filed; 12l0$/2022 2 Name of governments entity or state agency tfisf is a party 4o tlfi3 coniracY far which the prep is being filed, Calhoun County, Texas pate Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the servloco, goods, or other property to be provided under the contract. 2023.03 Annual Supply Contract for Road Materials 4 Name of Interested Party City, State, Country (place of business) Natureofinterest (check applicable) Controlling intermediary -- --_ - _ Midtex Materials, LLC Fayetteville, TX United States X 5 Check only if there is NO Interested Party. n 5 UNSWORN DECLARATION _- -.... _. _ _ .. .- My name is,and my date of birth is -' My address Is ? (city)r (state) (ziW code) (country) I declare under penalty of perjury that the foregoing Is true and correct. Executed in i'� -p. e ak-= County, State of C" 2 , on the <� ---r -__ dayoF� ut;,r�F;M,20'2 (month) (year) f Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethlcs Cnmmlccinn «Hi- .., ,._ Version V3.5.1,eb87ef42 MID-MAT-01 EVELYN .gISS n CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 1 1218/218I2022 THIS CERTIFICATE IS ISSUED AS A MA17ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER cr Evelyn Stein, ACSR Anco Insurance PO Box 3889 Bryan, TX 77806 PHONE - ppX A/c, No, Eat: (979 774-6212 A c, No:(979) 7745372 anco.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: EMC Insurance COS 21415 INSURED Mid -Tex Materials LLC K3 Transport LLC INSURER B: Texas Mutual Insurance Company 22945 INSURER C: INSURER D: PO BOX 187 Fayetteville, TX 78940 INSURER E: INSURER F: nano,^s, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS0. TYPE OFINSURANCE ADDL NSD SUBR POLICYNUMSER POLICY EFF POLICY EXP UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX] OCCUR 5D41674 2/6/2022 2/512023 DAM IgETORaGil EID 500,000 $ MED EXP An one erecn S 10,000 PERSONALSADVINJURY S 1,000,000 GEML AGGREGATE LIMrr APPLIES PER: GENERAL AGGREGATE g 2,000,000 PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY mg: LOC S OTHER: A AUTOMOBILE LIABILITY COMBINED SING7L-IMIT 11000-000 (Ea accident) $ ANY AUTO SE41674 215/2022 2/512023 BODILY INJURY Per arson $ OWNED OWNED X SCHEDULED SCHEDULED ALMS ONLY AUTOS BODILY INJURY Peraccident $ EEpp AU7'09 ONLY AR ONLY pp Parr aoGtlenU MAGE $ $ A X UMBRELLA LIAR X OCCUR EACHOCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 EXCESS UAB CLAIMS -MADE 6J41674 21512022 2/512023 DED I X I RETENTION$ 10,000 $ B WORKERS COMPENSATION X STER OTH- EERWI-OVE'UAUW YIN ANY PRWOPMREIETOR#+ARTNER,E%ECUTIVE 0001208761 2l6l2022 21612025 E.L. EACH ACCIDENT $ 1,000,006 (M91nEibryllMi BPNIR EXCLUDED? tYYee IOIy N NIA E.L. DISEASE - EA EMPLOYE S 1,000,000 OESQRIPnON OF OPERATIONS E.L. DISEASE -POLICY LIMIT 1,000,000 below A Equipment Floater SC41674 2/6/2022 21612 223 Equipment 46,442 A Motor Truck Cargo 5C41674 215/2022 2/5/2023 Cargo 102,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 11ACORD 101, Additional Remarks Schedule, may be whached a mom space is required) Certificate Holder is Hated as Adtlhional Insuretl on the General Liability and Business Auto policies as required by written contract Calhoun County, TX 202 South Ann street, SteS Port Lavaca, TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I� AUUKU Z3 (ZUTOIU3) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • 1: NO] ICE OF MEETING .. 12/14/2022 8. Consider and take necessary action to approve Shirley & Sons Construction Co., Inc.'s Pay Estimate (Invoice #3367) for the Magnolia Beach (21st Street) and Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project. Attached is the Recommendation for Payment No. 1 for $28, 098.00 along with the Contractor's Conditional Waiver and Release on Progress Payment. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5 of 12 G&WENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)562-4509 • f: (361)552-4987 TBPE Firm Registration No. F04188 December 6, 2022 Commissioner David Hall Calhoun County Precinct No. 202 S. Ann St. Port Lavaca, Texas 77979 RE: RECOMMENDATION FOR PAYMENT NO. 1 Magnolia Beach (21" Street) & Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project Dear Honorable Judge & County Commissioners, We have reviewed Shirley & Sons Construction Co., Inc.'s Pay Estimate No. 1 above referenced project and have enclosed Recommendation for Payment No. with the Contractor's Conditional Waiver and Release on Progress Payment. Please call if you have any questions. Sincerely, G & W Engineers, Inc. ��-Scott P. Mason, P.E. cc: Shirley & Sons Conshruction Co., Inc. Peggy Hall, Calhoun County Assistant Auditor file 9115.027 (Invoice # 3367) for the 1 for $28,098.00 along Engineering Consulting Planning Surveying OWNER's Project No. Project RECOMMENDATION OF PAYMENT ENGBQEER's Project No. 9115.027 Magnolia Beach (21st Street) & Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project CONTRACTOR Shirley & Sons Construction Co., Inc. Magnolia Beach (21st Street) & Contract for Indianola Fishing Piers Contract Date September 21, 2022 Application Date November 29, 2022 Period Start Date November 7, 2022 Application Amount $28,098.00 Period Ending Date November 29, 2022 To CALHOUN COUNTY Owner Attached hereto is the CONTRACTOR's Application for Payment for Work accomplished under the Contract through the date indicated above. To the extent that we have been present on the project site as outlined in our Engineering Agreement, we believe that the Application meets the requirements of the Contract Documents and includes the CONTRACTOR's Certificate stating that all previous payments to him under the Contract have been applied by him to discharge in full all of his obligations in connection with the Work covered by all prior Applications for Payments. In accordance with the Contract, the undersigned, subject to the limitation in the preceding paragraph, recommends payment to the CONTRACTOR of the amount due as shown below. G & W Engineers, Inc. Dated December 6 2022 By: P E. Scott P. Mason, P.E. I STATEMENT OF WORK Original Contract Price $ 80,000.00 Work to Date $ 31,220.00 Net Change Orders ( ) $ Amount Retained $ (3,122.00) Current Contract Price $ 80,000.00 Subtotal $ 28,098.00 Work to be Done $ 48,780.00 Previous Payments Recommended $ Amount Due This Payment $ 28,098.00 O & W ENGINEERS, M. 205 W. Live Oak St. Port Lavaca, Texas 77979 (361) 552-4509 o.... o.... u..� •.,+....nl�o Pun�F C,eIC,¢InAivnnlcflYFlnn Piu.e Hneriren<NirM1nlue RaM1aF Prn� rOftk% A Q m o ci c g /""1 2 W a to Pli _ N9 R •'�_ c m �eg�z Awm a vo �W yyo 4t c 1' o & �$ an E c12 c c_ 4 0 PE .85 8Eu 12 8 a Mi 04 q 46 N /0"N .. ; I ova /0"\ ; e @ § oCD � § j CD \ } § _ ` 26% 69. ® J r k k kci a0 c a ; t§/ J 7§ �I !a @ 2 o �a ;a 0 77� 0 0 0 ; 2 \ co_ o0 0 0 ;# §•) S B e S a # — ! / 0 / 'a\ ` a f ; « £ cu ] k q§ / E C t ° E « - - « ■ \ ) \ r / / _ 0 2 a. ) (2 k k i / \ / a N n to c1� 00 CONTRACTOR's CONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT THE STATE O LEX S COUNTY OF Project: Magnolia Beach (21" Street) & Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project for Calhoun County, Texas Job No. 9115.027 On receipt by the signer of" document of a check from CALHOUN COUNTY (makerof check) in the sum of $ 2� c)9b . payable to rle l Ams `cvi.Cis 3,nc, (payee orpayeesofcheck an when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position that the signer has on the property or easements of CALHOUN COUNTY (owner) located at Magnolia Beach (2181 Street) and Indianola Fishing Piers (location) to the following extent: Magnolia Beach (21' Street) & Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project (job description). This release covers a progress payment for all labor, services, equipment, or materials furnished to the property or to CALHOUN COUNTY (person with whom signer contracted) as indicated in the attached statement(s) or progress payment request(s), except for unpaid retention, pending modifications and changes, or other items furnished. Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the funds received from this progress payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project in regard to the attached statement(s) or progress payment request(s). 01025-2 rre SUBSCRIBED AND SWORN TO BEFORE ME by 1\ a N kt s S t+kr t on Ydt nvP Ic J 20to certify which witness my hand and seal ofoffice. MY0 Notary Public, State of Texas 26 01025-3 Z,G # 09 NO-IICE OF MEUING—1-2/14/2022 9. Consider and take necessary action to approve Change Order No. 1 to the Magnolia Beach (215t Street) and Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project and authorize the County Judge to sign all necessary documents. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, CommissionerOct 4 . AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 12 Agenda Item for Commissioner's Court — Wednesday, December 14, 2022 Consider and take necessary action to approve Change Order No. 1 to the Magnolia Beach (21" Street) & Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project and authorize the County Judge to sign. Mae Belle Cassel From: David.Hall®calhouncotx.org (David Hall) <David.Hall®calhouncotx.org> Sent: Wednesday, December 7, 2022 9:53 AM To: Mae Belle Cassel Subject: Fwd: Change Order No.1 - Mag. Beach (21st St) & Indianola Fishing Piers Attachments: Untitled attachment 00031.pdf; Request for Agenda Item.pdf Sent from David's iPhone David Hall Commissioner Precinct 1 Calhoun County Office 361-552-9242 Cell 361-220-1751 Begin forwarded message: From: gking@gwengineers.com Date: December 6, 2022 at 5:14:03 PM CST To: david.hall@calhouncotx.org, angela.torres@calhouncotx.org Cc: Shirley & Son's <ssconstruction@earthlink.net>, Peggy Hall <peggy.hall@calhouncotx.org>, cindy mueller <cindy.mueller@calhouncotx.org>, candice.villarreal@calhouncotx.org, demi.cabrera@calhouncotx.org, Scott Mason <smason@gwengineers.com> Subject: Change Order No. 1- Mag. Beach (21st St) & Indianola Fishing Piers 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. Commissioner Hall, Attached is Change Order No. 1 and an Agenda Item Request for Commissioner's Court for Wednesday, December 14, 2022 for the Magnolia Beach (21" Street) & Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project. Please let me know if you want the original Change Order or if you would like for Scott to take it to court on Wednesday with him. Thank you, Glynis King G&W Engineers, Inc. 205 W. Live Oak Port Lavaca, Texas 77979 361.552.4509 Calhoun County Texas ENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)552-4509 • f: (361)552-4987 TBPE Firm Registration No. F-4188 December 6, 2022 Commissioner David Hall Calhoun County Precinct No, 202 S. Ann St. Port Lavaca, Texas 77979 RE: CHANGE ORDER NO. 1 Magnolia Beach (21" Street) & Indianola Fishing Piers Hurricane Nicholas Rehabilitation Project Dear Honorable Judge & County Commissioners, Attached are three (3) copies of Change Order No. 1 for the above referenced project for review. Upon acceptance of these documents, please sign all three copies and return two copies to our office. Please call if you have any questions. Sincerely, G & W Engineers, Inc. Cott P. Mason, P.E. cc: Shirley & Sons Construction Co., Inc. Peggy Hall, Calhoun CountyAssistant Auditor file 9115.027 Engineering Consulting Planning Surveying CHANGE ORDER No. Onc (I) PROJECT Magnolia Reach (21st Streety& Itldianola Fishing Piets Hurricane Nicholas Rebabilitation Project DATE OF ISSUANCE EFFECTIVE DATE OWNER CALHOUN COUNTY mom. OWNER's Contract No. NN1 CONTRACTOR 8111RLEY & SONS CONSTRUCTION CO. , INC. ENGINEER C & W ENGINEERS, INC. Jobi{ al IS.027 — YOU are directed to make the PollOWing chang es in the Contract Docunnenis. � Reason Inn Change Order: Deduction for handrall post on Magnoiin 13caeh pier only, Attachments (List cloctnncnts supporting change) riginal Contract Price $ 80,1100.00 Net changes tiro" Previous Change Orders No. - - to No. S Contract Price prior to this Change Order 5 80,000.00 ----------------------------- Net IeMmSe (decrensc) of this Change Ordcr 5 (3,780.00) Contmel Price with all approved Change 01-de15 $ 76,220,00 Original Contract Times Substantial Completion; Ready for linal payment: Net changes Imill Previous Clllnlgc Ordcrs No. - to No. N/A — dra, Contract Times prior to this Change Order Substantial Completion: N/A Ready for Mini paymolt: Jags nodnc Net. Increase (decrease) of this Change Order N/A Contract Times with all approved Change Orcles Substantial Completion: N/A Ready for tinel payment-. daysm Jne, RECOMMENDED APPR ACCEPTED - By: By: i lnN .nlAmi zdS �.y I.L6'_F_ L S '10 / noon OWil mia,,l Sili ram 1 Cmmrtnw(Awk u.1 Sixnamnq G & W Engineers, Ioc. Calhoun County Shirley & Soils Construction Co., Inc. Date: l z 1141 Date: z z ) — Date: #10 NOTICE OF MFFTING — 12/14/2022 10. Consider and take necessary action to Accept and Approve the new 457(b) plan for employees with VOYA and authorize County Judge to sign the following agreements: Plan Services, IRC Section 457 Directed Trustee Account Agreement and the Plan Sponsor Investment Advisory Access Agreement. By executing these documents, the Court is authorizing the deferred compensation to be effective. Business with VOYA and Ameriprise were previously approved in Commissioner's Court on August 3, 2022. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner'Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 12 Mae Belle Cassel From: rhonda.kokena@calhouncotx.org (rhonda kokena) <rhonda.kokena@calhouncotx.org> Sent: Thursday, December 8, 202210:59 AM To: MaeBelle.Cassel@calhouncotx.org Subject: AGENDA ITEM FOR 12.14.22 Attachments: PLAN SPONSOR ADVISORY AGREEMENT-VOYA.pdf; IRC SECTION 457 TRUSTEE AGREEMENT-VOYA.pdf; 457b PLAN SERVICE AGREEMENT-VOYA.pdf Morning — Would you be so kind as to add the following to the next agenda? I will send over the originals to be signed by the Judge. To Accept and Approve the new 457(b) plan for employees with VOYA and authorize County Judge to sign the following agreements: Plan Services, IRC Section 457 Directed Trustee Account Agreement and the Plan Sponsor Investment Advisory Access Agreement. By executing these documents the Court is authorizing the deferred compensation to be effective. Business with VOYA and Ameriprise were previously approved in Commissioner's Court on August 3, 2022. Thank you - Rhonda S. Kokena Calhoun Co Treasurer 202 S. Ann Street, Suite A Port Lavaca, Texas 77979 361-553-4619 Calhoun County Texas 1 Voya Plan Sponsor Investment Advisory Access Agreement PLAN SPONSOR INVESTMENT ADVISORY ACCESS AGREEMENT ❑✓ Voya Retirement Insurance and Annuity Company This Agreement ("Agreement") is between the Voya company denoted above (hereinafter referred to as "Voya") and Calhoun County of the Calhoun County 457(b) Deferred Compensation Plan Plan/Contract No. 664FU9 located at Sponsor address 202 S Ann St. the plan sponsor "Plan"), Voya Port Lavaca, TX 77979 Effective Date: BACKGROUND A. Sponsor maintains the Plan, and has entered into a separate written agreement with Voya to provide investment options, recordkeeping and/or other administrative service to the Plan (the "Plan Services Agreement"); and B. Morningstar Investment Management LLC ("Morningstar') has developed proprietary, independent investment advice ("Managed by You") and managed account ("Have Morningstar Manage My Plan") services, provided over the Internet through the Morningstar Retirement Managersm platform ("Retirement Manager"); and C. Voya has entered into agreements with Morningstar to allow Voya to provide access to Retirement Manager services for participants of plans in which Voya acts as investment productprovider and/or recordkeeper (the "Morningstar Agreements'); and D. Sponsor desires to make available Retirement Manager services to participants in connection with the Plan; and E. Sponsor and Morningstar have entered into a separate agreement, the Plan Sponsor Investment Advisory Services Agreement, to provide Retirement Manager services to the Plan (the "Advisory Services Agreement"); and . F. Pursuant to the Advisory Services Agreement, Morningstar will enter into an agreement (the "Participant Advisory Services Agreement") with Plan participants to provide them with investment advisory services through Retirement Manager. 1 September 2019-Non •ERISAnot for use with solicitation TaskManager: DCPLNINSTL/MORNINGSTAR Sponsor and Voya, in consideration of their mutual promises and covenants contained herein, and of other good consideration duly received, hereby agree as follows: 1. VOYA SERVICES 1.1 Set-up and Maintenance (a) Set up services with Morningstar. (b) Maintenance services: refresh Plan business rules, participant information and profiles with Morningstar. (c) Standard reporting on participant activity. (d) Sponsor and participant customer service support services. 1.2 Retirement Manager Services Access. Voya hereby agrees to facilitate Sponsor's participants' access to Retirement Manager services provided by Morningstar. Only participants for whom Voya maintains account records shall be entitled to access Retirement Manager. 1.3 Limited Duties. Voya's duties under this Agreement are limited to facilitating access to Retirement Manager services and providing related administration and recordkeeping services. Sponsor agrees and acknowledges that Voya is not providing any investment advice under this Agreement, and that Voya is not responsible for any losses or claims arising or alleged to have arisen from the provision of investment advice by Morningstar. 2. SPONSOR RESPONSIBILITIES 2.1 Provision of Data. Sponsor agrees to provide accurate and timely data and understands that Voya will transmit such data to Morningstar. Voya shall not have any liability for Sponsor's failure to timely inform Voya or Morningstar, as applicable, of any changes to the Plan or participant data. Specifically, Sponsor shall: (a) Provide Plan information and rules to Voya and Morningstar that are necessary for set-up and promptly update this information if changes are made; and (b) Promptly provide to Voya any changes to Plan investment options or transaction rules. 2.2 Independent Decision. Sponsor has made its own determination to enter into this Agreement and to utilize Retirement Manager services from Morningstar. Sponsor is solely responsible for choosing to make Retirement Manager services available to its participants and has not relied upon Voya or any of its affiliates or its or their employees or representatives in making that decision. 2.3 Provision of Data to Morningstar. In connection with making Retirement Manager available to participants, Sponsor acknowledges and agrees that: (a) Voya will provide Plan and participant data to Morningstar for its use in providing Retirement Manager services; and (b) Morningstar is not required to continue to provide Retirement Manager if Voya terminates its relationship with Morningstar. (c) For enrollment information transmitted through Voya's Payroll/Administration application or through other electronic means, the Sponsor accepts responsibility for the transmission of the participant's election to adapt the Have Morningstar Manage My Plan service and further agrees to retain the signed participant enrollment form. In addition, Sponsor agrees to make participant enrollment documentation available within 3 business days, or within prescribed timeframe requested by a regulatory agency. 2 Seplember2019— Non •ERISA not for use with solicitation TaskManager: DULNINSTL/MORNINGSTAR 2.4 Sponsor Representations and Acknowledgments. In connection with making Retirement Manager available to participants, Sponsor hereby represents that it has entered into an Advisory Services Agreement directly with Morningstar, pursuant to which Sponsor acknowledged and, where necessary, consented to the following: (a) The data and advice are produced solely on the Plan and participant data provided to Morningstar by Voya and Morningstar is not responsible for any errors or omissions or incomplete data provided by Voya. (b) Retirement Manager services and the analysis, opinions and other information produced by Morningstar may only be used for purposes of assisting participants in making their retirement planning decisions and not for any other purposes. (c) If the Plan Sponsor wishes to make a change to the investment options available for the Have Morningstar Manage My Plan Service, it shall provide Voya with forty five (45) days' prior written notice thereof. If custom data collection is required, an additional ten (10) weeks prior notice is required to provide data collection and maintenance of such funds. 3. FEES There is no fee due from the Plan, the Plan Sponsor or Plan participants to either Voya or Morningstar in connection with the use of Retirement Manager. For the Plan Participants who select Have Morningstar Manage My Plan service, the fee schedule set forth below shall apply. Voya is hereby authorized to deduct fees from accounts of the participants who have elected the Have Morningstar Manage My Plan service in accordance with the following schedule: Select one Plan Asset Range Basis points payable to Morningstar Administrative and recordkeeping fee payable to Voya Less than $3 million 30 bps annually 30 bps annually ❑ $3 million to $10 million 28 bps annually 28 bps annually ❑ Over $10 million 25 bps annually 25 bps annually The fees paid to Morningstar Investment Management LLC and Voya contracts are reviewed annually and are subject to change based on the overall level of assets in the plan at that time. The Managed Account participant balances does not include any outstanding loans, any balance in a restricted investment, company stock, or any balance in a self -directed brokerage account. The Managed Account Fee is deducted from participant accounts on a calendar quarter basis. Such fee is prorated based on the number of days of enrollment in the service for the quarterly period. If the participant decide to leave the service, the final fee deduction will also be prorated based on the number of days enrolled in the service for the quarterly period. 4. TERM AND TERMINATION 4.1 Term. Except as otherwise provided herein, the term of this Agreement shall begin on the effective date and continue for an initial term of one (1) year unless terminated as forth in this Section. Upon expiration of the initial term, the Agreement will automatically renew for successive one (1) year terms unless otherwise terminated by either party pursuant to this Section, or unless one party notifies the other party in writing of their intent not to renew this Agreement within 90 days of the end of a term. (a) Termination for Convenience Clause This Agreement may be terminated by the Plan Sponsor at any time by providing (30) day written notice to Morningstar. 3 September 2019—Non •ERISA not for use with solicitation TaskManager: DCPLNINSTLIMORNINGSTAR 4.2 Breach. If either party materially breaches in the performance of any provision of this Agreement or the Plan Service Agreement, or is otherwise in noncompliance with any provision of this Agreement, and such breach is not cured within thirty (30) days of written notice of breach to the breaching party, the party giving such notice may terminate this Agreement by providing the breaching party with written notice of such termination. 4.3 AutomatIc Termination. The Agreement will automatically terminate upon written notice if (a) either party files a petition in bankruptcy, is adjudged bankrupt, or ceases to do business in the ordinary course; (b) Morningstar's registration as an investment adviser terminates, or is terminated, suspended, withdrawn or restricted so as to substantially impede performance of Retirement Manager hereunder; (c) this Agreement is assigned in violation of Section 7.7 or (d) the Agreement between Voya and Morningstar expires or is terminated for any reason. 4.4 Termination of Morningstar Agreement or Plan Services Agreement. In addition to any other termination, this Agreement will terminate automatically upon the termination of the Morningstar Agreement between Voya and Morningstar or the Plan Services Agreement between Voya and Sponsor, or the full withdrawal/case surrender of all amounts invested with Voya under the Plan. 4.5 Effect of Termination. Upon termination of this Agreement for any reason, Sponsor and participants shall no longer have to access to the Retirement Manager services. The Plan and Plan Participants' obligations to pay any fees accruing under this agreement before the effective date of termination, if applicable, will survive termination of this Agreement. Sections 6 and 7 hereof also shall survive the termination of this Agreement. 5. DISCLAIMER OF CERTAIN DAMAGES NEITHER PARTY SHALL BE LIABLE TO THE OTHER PARTY FOR ANY INDIRECT, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES, REGARDLESS OF THE FORM OF ACTION, WHICH MAY ARISE FROM THE PERFORMANCE, NONPERFORMANCE, BREACH OF WARRANTY, DEFAULT OR OTHER BREACH OF THIS AGREEMENT. 6. INDEMNIFICATION (a) VOYA Indemnification. Voya agrees to bold harmless and indemnify Sponsor, Sponsor's agents, officers and employees when acting on Sponsor's behalf, from every claim and demand to the proportionate extent that it results from Voya's negligence or wrongdoing or the negligence or wrongdoing of its representatives acting in that capacity in connection with this Agreement. (b) Sponsor Indemnification. Sponsor agrees to hold harmless and indemnify Voya, Voya's agents, officers and employees when' acting on Voya's behalf, from every claim and demand to the proportionate extent that it results from Sponsors negligence or wrongdoing or the negligence or wrongdoing of its representatives acting in that capacity in connection with this Agreement. 4 September 2019-Non -ERISA not for use with solicitation TaskManager: DCPLNINSTLIMORNINGSTAR 7. MSCELLANEOUS 7.1 Disclaimer. Sponsor agrees that Voya makes no warranties or guaranties of any kind regarding Retirement Manager, including access to Morningstar's web site. Sponsor shall not make any warranties or guarantees to participants with respect to Retirement Manager. 7.2 Notice. Each party will promptly provide the other with notice and copy of any litigation of which it becomes aware of involving the terms or Retirement Manager under this Agreement and/or any other notices or demands to be given under this Agreement. All such notices, demands or other communications hereunder shall be in writing and duly provided if sent certified mail, return receipt requested, addressed to the party to be notified or upon whom a demand is being made, at the addresses set forth in this Agreement or such other place as either party shall from time to time designate in writing. The date of service of a notice or demand shall be the receipt date on any certified mail receipt. Notices to Voya shall be sent to: Voya One Orange Way Attention Legal Department - CIS Windsor, CT 06095 Notices to Sponsor shall be sent to: Name: Richard Meyer Title: Trustee Address: 202 S Ann St. City, State, Zip: Port Lavaca, TX 77979 7.3 Governing Law; Jurisdiction. This Agreement shall be governed by the laws of the State of Connecticut, without regard to its conflicts of law provisions. The parties agree that any and all actions relating to this Agreement will be brought exclusively in the state and/or federal courts located in Hartford County, Connecticut, and that each party is subject to the personal jurisdiction of those courts. 7.4 Force Majeure. Neither party shall be liable to the other for any delays or damage or any failure to act due, occasioned, or caused by reason of restrictions imposed by any government or government agency, acts of God, strikes, labor disputes, action of the elements, or causes beyond the control of the party affected thereby. 7.5 Severability. If any provision of this Agreement shall be found to be illegal or invalid for any reason, the illegality of invalidity shall not affect the remaining parts of this Agreement and the remainder of the Agreement shall be construed and enforced as if said illegal or invalid provision had never been inserted herein. No party shall be required to perform any services under this Agreement that would violate any law, regulation or ruling. 7.6 Waiver; Amendment. A waiver or amendment of any provision of this Agreement or of a parry's rights or remedies under this Agreement must be in writing and signed by an authorized representative of both parties to be effective. Any waiver of the terns of this Agreement shall be effective only in the specific instance and for the specific purpose. 7.7 Assignment. This Agreement may not be assigned by either party without the prior written consent of the other party; provided that Voya may assign the agreement to an affiliate. Any assignment or attempted assignment of this Agreement in violation of this section is void. This Agreement shall be binding upon and inure to the benefit of the parties' permitted successors and assigns. 5 Seplember2019-Non •ERISA not foruse with solicitation TaskManager: DULNINSTL/MORMNGSTAR WHEREFORE, the Parties have signed below to indicate their acceptance of the terms and conditions of this Agreement. SPONSOR Voya Retirement Insurance and Annuity Company t Signature: Signature: Richard Meyer Name: Melissa M. McAuliffe Trustee Title: Title: Vice President Administration Date: / '—�'-/4( — )—o ZZ_ Date: 6 September 26i9— Non -ERISA not for use with solicitation TaskManager: DCPLNINSTUMORNINGSTAR Morningstar's INVESTMENT ADVISORY SERVICES AGREEMENT PLAN SPONSOR INVESTMENT ADVISORY SERVICES AGREEMENT This investment advisory services agreement and the exhibit(s) hereto (the "Agreement") is entered into as of ("Effective Date") by and between Morningstar Investment Management LLC, a Delaware limited liability company and an investment adviser registered under the Investment Advisers Act of 1940, with its principal place of business at 22 West Washington Street, Chicago, Illinois 60602 ("Morningstar"), and Calhoun County ("Plan Sponsor") with its principal place of business at 202 S Ann St. Port Lavaca, Tx 77979 WHEREAS Plan Sponsor maintains the Calhoun County 457(b) Deferred Compensation Plan (the "Plan"), a defined contribution plan that is intended to comply with certain provisions of the Internal Revenue Code; and WHEREAS Plan Sponsor has entered into a separate written agreement with Voya Retirement Insurance and Annuity Company or Voya Institutional Plan Services, LLC (the "Service Provider") to provide daily valuation, recordkeeping and other administrative services to the Plan, including access to Morningstar's investment advisory services, if Plan Sponsor so elects; and WHEREAS Plan Sponsor wishes to have Morningstar provide certain investment advisory services to and for the benefit of the Participants in Plan Sponsor's Plan, and Morningstar is willing to provide Plan Sponsor with such investment advisory services, subject to the terms and conditions of this Agreement; NOW, THEREFORE, in consideration of the mutual promises set forth herein, Morningstar and Plan Sponsor hereby agree as follows: DEFINITIONS The following definitions shall apply to this Agreement and to any exhibit(s) attached hereto. • Advice Service shall mean Fund specific non -discretionary investment advisory service provided to a Padicipant by Morningstar. • Advisory Services shall mean individually or collectively the Advice Service and the Managed Accounts Service, provided, however, that the Plan and Participants shall only receive those Advisory Services specifically selected by Plan Sponsor pursuant to this Agreement. The Advisory Services specifically exclude analysis of or advice regarding the potential local, state or federal tax consequences resulting from any investment advice or recommendation provided by Morningstar. • Initial Delivery Date shall mean that date on which the Advisory Services are made available to the Plan and its Participants pursuant to the terms of this Agreement. Momingstar Advice and MA Non-ERISA Agreement version 09-2019 TaskManager. DOPLNINSTUMORNINGSTAR • Managed Accounts Service shall mean Fund specific discretionary investment advisory service provided to a Participant by Morningstar. • Morningstar Services shall mean the services to be performed or delivered by Morningstar along with the Advisory Services, including the various modules described in this Agreement. Morningstar Services shall not include Advice Service or Managed Accounts Service. • Participant shall mean an individual who is enrolled or Is eligible to enroll in any Plan offering the Advisory Services. The parties acknowledge and agree that Morningstar reserves the right to exclude any Participant whose current age is greater than his or her retirement age. 2. MORNINGSTAR OBLIGATIONS a. Morningstar shall: (I) Provide the Advisory Services and the Morningstar Services to the Plan and its Participants pursuant to the terms and provisions of this Agreement; (ii) Act as a fiduciary to the Plan only to the extent of its provision of Advice Service or Managed Accounts Service to Participants, and not as a plan administrator or in any other capacity; and (iii) Retain final control and authority over the Advisory Services and Morningstar Services provided to the Participants. b. No Liability for Plan Benefits In providing the Advisory Services, Morningstar shall not be liable for any benefits due, or claimed to be due, under the Plan. C. Standard of Care. Morningstar will provide the Advisory Services at all times in good faith, and will use reasonable care, consistent with industry practices of similarly situated advisors, in providing the Advisory Services. Morningstar does not guarantee that the Advisory Services will be delivered without interruption, timely, error -free, or secure. Errors may occur in the software -based Advisory Services as a result of programming errors, database errors, or other causes. Morningstar will provide the Advisory Services with that degree of prudence, diligence, care, and skill which a prudent person rendering similar services as an investment advisor would exercise under similar circumstances. The provisions of this Agreement shall not be interpreted to imply any other obligation on the part of Morningstar to observe any other standard of care. Under certain circumstances, the federal and state securities laws impose liabilities on persons who act in good faith and nothing contained in this Agreement should be construed as a waiver or limitation of your rights under such laws. If Morningstar discovers any errors in providing the Advisory Services during the term of this Agreement, Morningstar shall investigate and correct such errors in a timely fashion. Morningstar shall promptly notify Plan Sponsor and Service Provider of such errors and the outcome of the investigation and action taken by Morningstar in accordance with our corporate Incident Management and Communications Policies. Morningstar Advice and MA Non-ERISA Agreement version 09-2019 TaskManager: DCPLNINSTUMORNINGSTAR 3. PLAN SPONSOR OBLIGATIONS a. Appointment of Morningstar as Investment Manager: Plan Sponsor, in its capacity as named fiduciary of the Plan, hereby appoints Morningstar as an "investment manager" with respect to any Participant who has an account Within the Plan, and has elected to enroll in the Managed Account Service. Morningstar shall provide Managed Account Services to such Participants by taking into account the Participant's age and the normal retirement age under the Plan, but shall not be required to take into account risk tolerances, other investments held outside the Plan, or other individual preferences of such Participant, unless such information is provided by the Participant. b. Provision of Data Plan Sponsor agrees to provide or cause Service Provider to provide accurate and timely data and understands that Morningstar will rely on such data to provide the Advisory Services. Momingstar shall not have any liability for Service Provider's or Plan Sponsor's failure to timely inform Morningstar or Service Provider, as applicable, of any changes to the Plan or Participant data. Therefore, Plan Sponsor shall or shall cause Service Provider to: Provide all necessary Participant census data and updates as requested by Morningstar or Service Provider in order for Morningstar to provide the services described in this Agreement; it. Provide Plan information and rules to Service Provider that are necessary for set-up services and promptly notify Service Provider with any updates to this information if changes are made; and iii. Promptly provide to Service Provider any changes to Plan investment options or transaction rules. c. Selection of Plan Investment Options Plan Sponsor shall: Select investment options offered under the Plan; H. Monitor and periodically review Plan investment options; and Ili. Determine if changes to Plan investment options are necessary. d. Cooperation Plan Sponsor shall fully cooperate with Morningstar in Morningstar's provision of the Advisory Services and Morningstar Services, in such manner as Morningstar may from time to time reasonably request. Such cooperation shall include accurately communicating to Participants the scope of the Advisory Services and Morningstar Services, and, in certain instances, the Participants' ultimate responsibility for investment decisions. e. Disclosure to Participants In addition to any disclosure required of Plan Sponsor in the applicable exhibit(s), Plan Sponsor shall disclose, or will cause Service Provider to disclose, to Participants in the Plan (a) the amount of any charges to the Participant's Plan account, (b) whether or not such charges will be imposed if the Participant does not use the Advisory Services, and (c) that any such charges may be allocated among various service providers to the Plan, including but not limited to Morningstar, to compensate them for the services they provide to the Plan. Upon Morningstar's request, Plan Sponsor shall provide Morningstar with copies of such disclosure, or shall direct Service Provider to provide such copies. f. Errors Plan Sponsor shall promptly notify Service Provider of any errors, incompleteness or untimeliness in any of the data, analyses, opinions or other information contained in the Advisory Services or the Morningstar Services about which Plan Sponsor becomes aware. MomingstarAdvice and MA Non-ERISA Agreennentvamion 09-2019 TaskManager. DCPW INSTUMORNINGSTAR g. Fund Universe The initial universe of funds for the Plan (the "Fund Universe") must be provided (or have previously been provided) to Morningstar by the Service Provider, no later than twelve (12) weeks prior to the Initial Delivery Date. Plan Sponsor agrees and acknowledges that any funds not included in the Fund Universe shall not be included in the recommendation given by Morningstar, and that any funds added to the Fund Universe after such date may not be included within the Morningstar Services on the Initial Delivery Date. If, after the Initial Delivery Date, Plan Sponsor intends to add funds to the Fund Universe or make a change to the investment options available for the Managed Accounts Service, it shall cause Service Provider to give Morningstar fourteen (14) days' prior written notice thereof, which notice shall include the name of the fund, the fund type (i.e. open-end fund or custom fund) and the fund identifier, such as the ticker symbol, cusip, or external fund identification number, as may be applicable. if custom data collection is required, Morningstar requires twelve (12) weeks prior notice. A plan has a sufficient set of funds if all of the following conditions are met: 1. There is at least one Large Blend fund OR; there is at least one Large Value fund AND at least one Large Growth fund; AND 2. There is at least one Stable Value/Fixed fund OR; there is at least one Cash fund AND at least one Bond fund Plan Sponsor acknowledges that all funds within a Plan's Fund Universe must be covered in Morningstar Inc.'s database in order for such Fund to be included in the Advisory Services. The Plan Sponsor acknowledges that the Service Provider may require additional time to complete the Fund Set Up. h. Proxy Voting Plan Sponsor represents that with respect to proxies attributable to securities held in Plan accounts, the Plan provides that the Plan Sponsor, the Plan trustee or the Participants shall be responsible for voting such proxies. Plan Sponsor agrees that Morningstar shall have no responsibility or liability for such proxy voting. 4. USE AND PROMOTION a. The Advisory Services shall be made available only to retirement plans duly established under the laws of the United States of America and to Participants that are citizens and/or legal residents of United States of America or its territories: b. The Advisory Services, or any portion thereof, may be used by Plan Sponsor and its Participants only for effecting retirement planning for Participants that elect to receive the Advisory Services. Any other use by the Plan Sponsor, including commercial use for the benefit of another person, is prohibited under this Agreement and shall be a material breach of this Agreement. Plan Sponsor shall take all commercially reasonable actions to ensure that there is no unauthorized use by its employees, agents, independent contractors, vendors or other third parties. Plan Sponsor shall immediately notify Morningstar of any actual or potential unauthorized use of which Plan Sponsor becomes aware. Plan Sponsor agrees to cooperate and provide reasonable assistance to Morningstar in connection with preventing and stopping any unauthorized use, of the data, analyses, opinions and other information contained in the Advisory Services or the Morningstar Services. MamingslarAdvice and MA Non-ERISA Agreemeniversion 09-2019 TaskManager. OCKNINSTUMORNINGSTAR C. . Approval of Promotion. Plan Sponsor may not mention or refer to Morningstar, the Advisory Services, the Morningstar Services, any of Morningstar's Intellectual Property or any of Morningstar's web sites in any correspondence, public announcements, advertising, marketing or promotional materials, announcements or events (collectively, the "Promotion Material") without Morningstar's prior written approval, except if such material was provided to Plan Sponsor for its incorporation into such Promotion Material. Plan Sponsor shall incorporate appropriate notice, attribution and disclaimer language into the Promotion Material, as Morningstar may specify in its review of the Promotion Material. Plan Sponsor shall have a limited license to use the Morningstar name, trademarks, service marks (the °Morningstar Marks") identified herein but, in each instance, only in the manner and format specified by Morningstar in writing in advance. The Morningstar Marks include: Morningstar® Retirement ManagersM Morningstar® hfC1R111HO R" Morningstar® Investment ProfileTMr Any Promotion Material using the Morningstar name or the Morningstar Marks shall include the following disclosure: 'The Morningstar name and trademarks are used, under license, from Morningstar Investment Management LLC. Morningstar Investment Management LLC is a registered investment adviser and a subsidiary of Morningstar, Inc. Morningstar Investment Management LLC is not an affiliate of Plan Sponsor." Morningstar has the authority to communicate to Participants the benefits of the Advisory Services through direct mail and email, and may require the Plan Sponsor to provide the Participant data necessary to make these communications, 5. CONFIDENTIALITY The parties acknowledge that in the course of their dealings hereunder, each may acquire information about the other, its business activities and operations, its technical information and its trade secrets, all of which are proprietary and confidential (the "Confidential Information"). Each party hereby agrees that: (a) all Confidential Information (including, but not limited to the terms of this Agreement) remains the exclusive property of the disclosing party; (b) it shall maintain, and shall use prudent methods to cause its employees and agents to maintain (and not to otherwise copy, publish, disclose or use other than as contemplated under this Agreement), the confidentiality and secrecy of the disclosing party's Confidential Information; and (c) it shall return or destroy all copies of the disclosing party's Confidential Information upon request of the disclosing party. Notwithstanding the foregoing, Confidential Information shall not include any information to the extent it: (t) is or becomes a part of the public domain through no act or omission on the part of the receiving party; (ii) is disclosed to third parties by the disclosing party without restriction on such third parties; (III) is in the receiving parry's possession, without actual or constructive knowledge of an obligation of confidentiality with respect thereto, at or prior to the time of disclosure under this Agreement; (iv) is independently developed by the receiving party without reference to the disclosing party's Confidential Information; (v) is released from confidential treatment by written consent of the disclosing party; or (vi) is required to be disclosed by court of competent jurisdiction; provided the receiving party gives the disclosing party prior written notice of such proposed disclosure sufficient to enable the disclosing party to obtain an appropriate protective order, if it so desires. Momingstar Advice and MA Non-ERISA Agreement version 09.2019 TasWanager. DULNINSTUMORNINGSTAR 6. OWNERSHIP Notwithstanding the rights granted under this Agreement, Plan Sponsor acknowledges and agrees that: (i) Morningstar retains sole and exclusive ownership over and all data, analyses, opinions, software, developments, inventions, processes, formulas, technology, designs, drawings, engineering, hardware configuration information or other information contained in the Advisory Services and the Morningstar Services ("Intellectual Property"), except the data referred to in (11) below, and that the Advisory Services and the Morningstar Services and all data, analyses, opinions and other information contained in it include valuable copyrighted and proprietary material of Morningstar; (it) Morningstar, Inc. retains sole and exclusive ownership rights in certain data contained within each of the Morningstar Services and the Advisory Services (the "Morningstar Data") and that the Morningstar Data contain the valuable copyrighted and proprietary material of Morningstar, Inc. (iii) Morningstar or Morningstar, Inc, as applicable, retains sole and exclusive ownership over the Intellectual Property; (iv) the Morningstar Services and Intellectual Property are being made available to the Plan Sponsor for the express purposes and use set forth herein and nothing contained herein transfers to Plan Sponsor any ownership interest in the Intellectual Property or the Morningstar Services and any software, pictures, images, materials, changes, materials, or other works of authorship provided contained therein or Intellectual Property; and (v) Plan Sponsor shall not have any rights in and to the Morningstar Services and Intellectual Property, except as specifically granted by this Agreement. Plan Sponsor has no right to make derivative works of the Morningstar Services, the Morningstar Data or the Intellectual Property in any form for use in any medium currently in existence or under development, now or in the future. Plan Sponsor shall not, at any time during or after the term of this Agreement: (1) contest or assist any third party in contesting the validity or enforceability of Momingstar's ownership of ail right, title and interest in and to the Morningstar Services and all corresponding intellectual property rights, or in Morningstar, Inc.'s ownership of all right, title and interest in and to the Morningstar Data and all corresponding intellectual property rights thereto; (ii) use the Intellectual Property, except as specifically authorized by this Agreement; (iii) use any trademark, service mark, trade name or corporate name that is a colorable imitation or confusingly similar to any of the Intellectual Property, except as expressly authorized by Morningstar in writing in advance; or (iv) contest or assist any third party in contesting the validity or enforceability of the Intellectual Property or the ownership of all right, title and interest in and to the Intellectual Property. To the extent Plan Sponsor is authorized to use any of the Intellectual Property, such use shall inure to the benefit of Morningstar or Morningstar, Inc., as appropriate. Plan Sponsor shall, at all. times during or after the term of this Agreement, execute any documents and take such other actions reasonably requested by Morningstar to confirm or protect Morningstar's and Morningstar, Inc.'s right, title and interest in and to the Morningstar Data or the Intellectual Property, as applicable, and any corresponding Intellectual property rights. 7. TERM AND TERMINATION a. Term The term of this Agreement ("Initial Term") shall begin on the Effective Date and shall continue for one (1) year from the Initial Delivery Date unless the term ends earlier as otherwise provided for under this Section 7. This Agreement shall automatically renew for successive periods of one (1) year each ('Renewal Term") after the Initial Term and each Renewal Term unless either party provides written notice of non -renewal to the other party no later than ninety (90) days prior to the expiration of the Initial Term or any Renewal Term, as the case may be. b. Termination Upon Default or Insolvency if either party defaults in the performance of, or is in non- compliance with, any provision contained in this Agreement (including, but not limited to, any uncured insolvency or the like), and such default is not cured within thirty (30) days after written notice thereof is given to the defaulting party, the party giving such notice may then give further written notice which shall terminate this Agreement as of the date specked in such notice. Mamingslarftke and MA Non•ERISA Agreemantversion 09-2019 TaskManager. OCKNINSTUMORNINGSTAR C. I erminatlon upon I ermmatlon of Agreement between Morningstar ana ServlCe Nroyiaer or vian Sponsor and Service Provider This Agreement will terminate automatically upon (i) the termination of the agreement between Morningstar and the Service Provider under which Morningstar provides the Service Provider with certain retirement services, including, but not limited to, any of the Advisory Services or Morningstar Services described herein, or (ii) the termination of the agreement between Plan Sponsor and Service Provider under which Service Provider provides certain recordkeeping and administrative services to the Plan. d. Effect of Termination Upon expiration or termination of this Agreement for any reason, all rights granted to Plan Sponsor hereunder shall terminate immediately and all Participants shall no longer have access to the Advisory Services or the Morningstar Services. Expiration or termination of this Agreement for any reason shall not affect Plan Sponsor's or their Participants' obligation to pay any and all fees and other amounts due and payable or relieve Plan Sponsor of any liability for breach of this Agreement. a. Fees During the term of this Agreement (including any Renewal Term), the Participants and/or the Plan Sponsor, as the case may be, shall pay the applicable fees that are set forth on Exhibit A attached hereto and made part hereof. b. Collection Authorization and Payment Terms The parties hereby agree that Service Provider shall deduct all applicable fees from the Participant accounts and is hereby authorized to remit such fees to Morningstar. The parties agree and acknowledge that Service Provider shall deduct and remit the applicable Managed Accounts Fees in periodic installments in arrears. f�Z V7:&]A►11rTlwk ., a. Representations of Morningstar Morningstar represents and warrants to Plan Sponsor that it is an investment adviser registered with the Securities and Exchange Commission under the Investment Advisers Act of 1940 and, to Morningstar's knowledge (a) it has all rights in and to all the Intellectual Property necessary to market, distribute the Advisory Services and the Morningstar Services in accordance with the terms of this Agreement; (b) this Agreement is binding on Morningstar; and (c) Momingstar's entry into this Agreement does not violate any prior obligation or agreement of Morningstar. Morningstar represents and warrants to Plan Sponsor that the Advisory Services will (a) apply generally accepted investment theories; (b) be diversified to minimize risk of large losses; (c) be designed to provide varying degrees of long-term appreciation and capital preservation through a mix of equity and fixed income based on participant's age, retirement date or life expectancy; and (d) change the asset allocation and associated risk levels over time to become more conservative with increasing age. Morningstar Advice and MA Non•ERISA Agreement version 09-2019 TaskManager. DCPLNINSTLIMDRNINGSTAR 7 b. Representations of Plan Sponsor Plan Sponsor represents and warrants to Morningstar that (a) Plan Sponsor has the authority and power to enter into and comply with its obligations under this Agreement and the rights and licenses necessary to enter into and perform its obligations under this Agreement; (b) this Agreement is binding on Plan Sponsor; (c) Plan Sponsor's entry into this Agreement does not violate any prior obligation or agreement of Plan Sponsor; (d) the individual signing this Agreement and any exhibit(s) thereto on behalf of Plan Sponsor is a named fiduciary of Plan or is authorized to sign on behalf of the Plan Sponsor in its capacity as a named fiduciary of Plan and is authorized to sign on behalf of the Plan Sponsor; (e) consistent with the terms and conditions contained in all governing documents of Plan Sponsor's Plan with respect to the voting of proxies, Plan Sponsor, the Plan Trustee or the Participants will vote proxies for securities held in any investment account for which Morningstar may provide advice hereunder, and (f) the instruments under which the Plan is maintained authorize the use of Plan assets to pay any fees for which the Participant is responsible as provided in this Agreement. 10. DISCLAIMERS a. Data Disclaimer Morningstar will use commercially reasonable efforts to ensure that the data, analysis, opinion, and other information contained in the Advisory Services or the Morningstar Services are correct. Although gathered from sources believed to be reliable, Plan Sponsor acknowledges that Morningstar cannot guarantee the accuracy of the data or information used to provide the Services. The completeness and timeliness of all data and information used to provide the Services is dependent upon the sources of such data and information, which are outside of Morningstar's control. b. Disclaimer of Warranties EXCEPT AS EXPRESSLY SET FORTH IN SECTION 9 ABOVE, MORNINGSTAR PROVIDES NO WARRANTIES, EITHER EXPRESS, IMPLIED OR OTHERWISE WITH RESPECT TO THE SERVICES DELIVERED PURSUANT TO THIS AGREEMENT, OR THE SOFTWARE COMPRISING THE SERVICES, AND TO THE EXTENT PERMITTED BY LAW, MORNINGSTAR DISCLAIMS THE IMPLIED WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE AND MERCHANTABILITY WITH RESPECT TO SUCH SERVICES. C. Acknowledgement of Limitations on Recommendations Plan Sponsor acknowledges and agrees that in formulating recommendations through the Advisory Services, Morningstar will only consider investment options offered by the Plan Sponsor's Plan. As a result, the Advisory Services may not be comprehensive because it may not recommend use of investment options that otherwise might be appropriate investments but that are not offered through Plan Sponsors Plan. 11. ' ' LIMITATION OF LIABILITY The following Limitations of Liability shall be'sppliceble: a. Limitation of Damages EXCEPT AS OTHERWISE PROVIDED BY LAW, AND EXCEPT FOR DAMAGES ARISING AS A RESULT OF A PARTY'S WILLFUL MISCONDUCT OR BREACH OF FIDUCIARY DUTY, EACH PARTY'S AGGREGATE LIABILITY FOR ANY DIRECT DAMAGES ARISING UNDER OR IN ANY WAY RELATING TO THIS AGREEMENT, THE ADVISORY SERVICES, AND MORNINGSTAR SERVICES PROVIDED HEREUNDER (WHETHER ARISING IN CONTRACT, TORT, OR ANY OTHER LEGAL THEORY) SHALL BE LIMITED TO ONE MILLION DOLLARS ($1,000,000). EXCEPT AS OTHERWISE PROVIDED BY LAW, AND FOR DAMAGES ARISING FROM A PARTY'S WILLFUL MISCONDUCT, IN NO EVENT WILL THAT PARTY BE LIABLE TO THE OTHER FOR ANY PUNITIVE, INCIDENTAL, CONSEQUENTIAL, SPECIAL OR SIMILAR DAMAGES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. b. Plan Sponsors Rights Under Securities Laws Nothing in this Agreement is intended to or shall waive any rights to which Plan Sponsor is specifically entitled under the securities laws of the United States. Morningstar Advice and MA Non-ERISA Agreement version 99-2919 TaskManager. DULNINSTUMORNINGSTAR 8 12. ENHANCEMENTS AND MODIFICATIONS Morningstar reserves the right in its sole discretion to enhance, modify, or provide upgrades (collectively "Changes") of the Morningstar Services or Advisory Services from time to time. 13. ACCESS AND TECHNICAL REQUIREMENTS Method of Access Morningstar shall provide Participants with access to Morningstar Retirement Manager via Service Provider's call center or via the Internet through an HTTP connection, which connection shall be established and maintained by Service Provider for Plan Sponsor's benefit. Technical Requirements for access to Morningstar Retirement Manager: Browsers: • Microsoft® Internet Explorer 7.0 and above • Chrome 8.0 • Safari 5.0 • Firefox 7.0 System Requirements: • Windows® XP, Vista, Windows 7 • Mae@ OS X® • JavaScript and Cookies must be enabled • Adobe Acrobat Reader 4.0 and above (free version) or 5.0 and above (fully paid version) • Sun's Java Plug-in - J28E Java Runtime Environment (JRE) version 1A.2 or higher Security: • 128 bit encryption Pop -ups: • In order to view certain pages in the Retirement Manager site, pop -ups much be enabled. Morningstar reserves the right to change the above -referenced technical requirements as certain browser versions become obsolete or outdated or as new versions are released. 14. RESEARCH, EDUCATION, AND MEASUREMENT MODULES Plan Sponsor will be provided access to Morningstar's Research Module, Education Module and Measurement Module. The Research Module will consist of reports and information concerning Funds within the Fund Universe. The Education Module will consist of articles, information and interactive planning tools. The Research Module and the Education Module will be made available to the Plan Sponsor and Participants that have agreed to receive the Advisory Services, and may not be offered outside of this Agreement. The Measurement Module will be made available to the Service Provider who may then provide access to the Plan Sponsor. Morningstar reserves the right in its sole discretion to modify, add, or delete data points in the Research Module, the Education Module, and the Measurement Module. Momingstar Advice and MA Nan-ERISA Agreement version 09019 TaskManager- OCKNINSTUMORNINGSTAR 15. INVESTMENT PROCESS AND RESTRICTIONS a. Investment Process Upon receipt from the Service Provider of personal and financial data for a Participant ("Participant Data"), if a Participant has selected the Advisory Services, Morningstar will use the Funds made available by the Plan Sponsor to create a portfolio with an asset allocation composition (each a "Participant Portfolio"). Morningstar will analyze the Funds to determine which particular Funds will be assigned to a Participant Portfolio. If the Participant has indicated an instruction that his or her Participant Portfolio not include a particular Fund ("Restriction") which Morningstar deems unreasonable, Morningstar shall not be required to deliver a Participant Portfolio for that Participant. b. Self -directed Brokerage Accounts Morningstar shall have no duty to provide the Advisory Services with respect to assets held within a Self -directed Brokerage Account. 16. RETIERMENT STRATEGY REPORT Morningstar will provide information about the Advisory Services to the Participants through a Retirement Strategy Report in its standard design with current supported plan types and functionality and any subsequent global modifications, enhancements, or upgrades. Plan Sponsor has authorized Service Provider to deliver to Morningstar such Participant data as is required to create and deliver the Retirement Strategy Report to Participants. Morningstar agrees that it shall not use any such Participant data for any purpose other than providing the services expressly described herein. If requested, Plan Sponsor will provide Morningstar with the company logo to be used in this Retirement Strategy Report and otherwise where appropriate, for marketing purposes. MomingstarAdvice and MA Non-ERISA Agreement version 09-2019 TaskManager. DULNINSTUMORNINOSTAR - 10 17. MISCELLANEOUS a. Notices All notices or other communications shall be in writing and be delivered in person, or sent by certified mail, return receipt requested, overnight courier service, facsimile or e-mail to such addresses or numbers as may be stipulated in writing by the parties pursuant hereto. Unless otherwise provided, notice will be effective on the date it is officially recorded as delivered by return receipt or equivalent or by facsimile confirmation date. b. Entire Understanding: Partial Invalidity This Agreement, along with any exhibit(s) or other attachments hereto, sets forth the entire understanding between the parties and supersedes any and all oral or written agreements between the parties as to the subject matter of this Agreement. If any provision of this Agreement shall to any extent be held to be invalid or unenforceable, the remainder of the Agreement, or the application of such provisions as to which it is not held to be invalid or unenforceable, shall not be affected thereby, and each provision shall be valid and be enforced to the fullest extent permitted by law. C. Modification This Agreement may be modified only in a document signed by both parties. d. Assignment The parties' benefits and obligations in this Agreement shall not be assigned without the prior written consent of the other party. This Agreement shall apply to, inure to the benefit of, and be binding upon the parties hereto and upon their permitted successors in interest and assigns. The parties acknowledge that there are no intended third party beneficiaries of this Agreement. e. No Waiver: Force Mateure The failure of one party to require the other to perform hereunder shall in no way affect the first party's right to require such performance thereafter, nor shall the waiver by either party of a breach of any Agreement provision be deemed a waiver of any succeeding breach of that provision or a waiver of the provision itself. In no event shall one party be liable to the other for any delay or failure to perform hereunder if the delay or failure is due to causes beyond the reasonable control of that party. f. Injunctive Relief Each party acknowledges that the other's legal remedies (including the payment of damages) would not adequately compensate the non -breaching party for the other's breach of this Agreement regarding ownership, use, copying, distribution, confidentiality or nondisclosure, as applicable, of the Morningstar Services or the Advisory Services (or any part thereof), the Intellectual Property, or Confidential Information and that it would suffer continuing, irreparable injury as a direct result of such breach. Therefore, in the event of any such breach or threatened breach, the non -breaching party may seek entry of any injunctive relief necessary to prevent or cure such breach (including temporary and preliminary relief, and relief by'order of specific performance), without posting of bond or other security or proof of irreparable harm. g. Arbitration Any dispute under this Agreement shall be settled by binding arbitration in Chicago, Illinois before a panel of three impartial arbitrators under the rules of the American Arbitration Association. Such panel shall consist of an actuary, an attorney and an employee benefit consultant, each of whom shall have had at least ten (10) years of professional experience in the administration of participant -directed defined contribution plans similar to the Plan. In any such arbitration, each party shall bear its own costs, expenses and attorneys' fees. The arbitration award may be enforced in any court having jurisdiction over the parties and the subject matter of the arbitration, and the parties irrevocably submit to the nonexclusive jurisdiction of the Superior Court of the State of Illinois, and the United States District Court for the Northern District of Illinois, in any action to enforce an arbitration award. h. Choice of Law and Venue Except as provided in Section 17(g), all disputes arising under this Agreement or its performance shall be determined exclusively under the laws of the State of Illinois without regard to its conflict of laws provisions. MomingslarAdvice and MANon-ERISAAgreementversion 09-2019 TaskManager. OCKNINSTUMORNINGSTAR 11 I. Acknowledgment of Receipt of Morningstar's Disclosure Statement Plan Sponsor acknowledges that it has received Momingstar's Form ADV Part 2 prior to entering into this Agreement. j. Survival of Rights Termination or cancellation of this Agreement for any reason shall not relieve either party of obligations that accrued prior to termination or cancellation, or of obligations that by their nature are intended to survive this Agreement, including but not limited to obligations in connection with warranties and confidential information. k. Counterparts This Agreement may be signed in two counterparts, which together shall form a single agreement as if both parties had executed the same document. IN WITNESS WHEREOF, the parties have entered into this Agreement as of the date set forth above. Calhoun County (Plan Sponsor) Morningstar Investment Management LLC: By: By: Name: Richard Meyer Title: Trustee Date: [ Name: Daniel Needham Title: President and Chief Investment Officer Date: MomingstarAdvioe and MANon-ERISA Agreement vandon 09-2019 TaskManager. DCPLNIN81VMORNINGSTAR 12 EXHIBITA There is no fee due from the Plan, the Plan Sponsor or Participants to either the Service Provider or Morningstar in connection with the use of Morningstar Retirement Manager. For the Managed Accounts Service, the fee schedule set forth below shall apply. Fees will be assessed daily on a pro -rated basis for the services being used. Service Provider is hereby authorized to deduct fees from Participant accounts in accordance with the following schedule: Select one Plan Asset Range RLess than $3 million $3 million to $10 million Over $10 million Basis points payable to Morningstar: 30 by per annum 28 by per annum 25 by per annum In addition to the fees set forth above, the Plan, Plan Sponsor or Participants may also pay an administrative and recordkeeping fee to the Service Provider. The fees are reviewed annually and are subject to change (fees may be lowered but will not be raised) based on the overall level of assets in the plan at that time. MomingstarAdvice and MANon-ERISAAgreemeMversion 09-2D19 TaskManager- DCKNINSTUMORNINGSTAR 43 IRC SECTION 457 DIRECTED TRUSTEE ACCOUNT AGREEMENT THIS DIRECTED TRUSTEE ACCOUNT AGREEMENT (the "Agreement'), effective as of between Calhoun County (the "Employer'D in its capacity employer and as the party authorized and responsible under state or local law for maintaining the Calhoun County 457(b) Deferred Compensation Plan Plan (the 'Plan") and Voya Institutional Trust Company, as the directed trustee (the "Trustee"). WITNESSETH: WHEREAS, the Employer has adopted and maintains the Plan in accordance with the requirements of Section 457(b) of the Internal Revenue Code of 1986, as amended ("Code"), for the benefit of the employees therein described; and WHEREAS, the Employer has established or desires to establish a Trust account in accordance with Section 457(g) of the Code constituting a part of the Plan, pursuant to which assets are held to provide for the funding of and payment of benefits under the Plan; and WHEREAS, the Employer has the power and authority to manage and control the assets of the Plan; and WHEREAS, the Employer has engaged an affiliate of the Trustee to provide recordkeeping services to the Plan ("Recordkeeping Affiliate"); and WHEREAS, the Employer wishes to appoint the Trustee as Trustee of the Plan in accordance with the terms and conditions of this Agreement. NOW, THEREFORE, the Employer on behalf of the Plan and the Trustee, each intending to be legally bound, agree as follows: SECTION I - ESTABLISHMENT AND OPERATION OF TRUST ACCOUNT 1.1 Appointment and Acceptance of Trustee/Affiligkii, The Employer hereby establishes with the Trustee a trust account consisting of such sums of money and such other property acceptable to the Trustee as shall from time to time be paid or delivered to the Trustee, and'hereby appoints the Trustee as Trustee with respect to the assets held pursuant to this Agreement as such assets shall exist from time to time (the "Account'). The Account shall not include any property or asset other than the assets delivered to and accepted by the Trustee from time to time. For purposes of this agreement, plan assets invested through the Program in a self -directed brokerage account shall also be considered to be part of the Account. The Trustee shall have no responsibility for any property until it is received and accepted by the Trustee, or for any property of the Plan not delivered to the Trustee and accepted by the Trustee to be a part of the Account. The Trustee hereby accepts its appointment, acknowledges that it assumes the duties established by this Agreement, and agrees to be bound by the terms contained herein. The Employer hereby acknowledges that an affiliate of the Trustee, the Recordkeeping Affiliate, acts on behalf of the Tmstee as the Trustee's agent for purposes of carrying out the Trustee's responsibilities under this Agreement. 1.2 Trustee Responsibilities. The Trustee shall receive and hold the assets on behalf of Plan participants and beneficiaries in accordance with the terms of this Agreement. The duties of the Trustee hereunder as Trustee shall be to act solely in accordance with the instructions of the Employer or Authorized Parties in accordance with Sections 2.2 and 2.3 of this Agreement ("Authorized Instructions'). Nothing in this Agreement is intended to give the Trustee any discretionary responsibility, authority or control with respect to the management or administration of the Plan or the management of the assets of the Plan. Further, the Trustee is not a party to the Plan and has no duties or responsibilities other than those that may be expressly contained in this Agreement. In any case in which a provision of this Agreement conflicts with any provision in the Plan, this Agreement shall control. Irc 457(b) Directed Trustee Account Agreement 12-9-2021 1.3 Exclusive Benefit. Except as may be permitted by law, by the terms of the Plan, or by this Agreement, at no time prior to the satisfaction of all liabilities with respect to participants and their beneficiaries under the Plan shall any part of the Account be used for or diverted to any purpose other than for the exclusive benefit of the participants and their beneficiaries. The assets of the Account shall be held for the exclusive purposes of providing benefits to participants of the Plan and their beneficiaries and defraying the reasonable expenses of administering the Plan and the Custody Account. 1.4 Limitation of Liability. Neither the Trustee nor its agents shall be liable for any acts or omissions of another person other than the negligent acts or omissions of its own employees and agents. The Trustee shall not be responsible for the title, validity or genuineness of any asset or any Loan Document received by it or delivered by it pursuant to this Agreement and shall be held harmless in acting upon any notice, request, direction, instruction, consent, certification or other instrument believed by it to be genuine and delivered by the proper party or parties. 1.5 Contributions. The Trustee shall receive contributions or other amounts for deposit to the Plan that are delivered to the Trustee or its designated agent for deposit to or for the benefit of the Plan. In accordance with Authorized Instructions, the Trustee shall transmit contributions received for the purpose of settling the PlaWs investment transactions. The Employer shall have sole duty and responsibility for the determination of the accuracy or sufficiency of the contributions to be made under the Plan and for the transmittal of contributions or other amounts to the Plan. The Trustee shall have no duty or responsibility (a) to determine the amounts to be contributed to or transferred to the Plan or on behalf of the participants of the Plan, (b) to collect any contributions or transfers to the Plan or to enforce the collection of any such contributions or transfers, or (c) for the adequacy of amounts deposited to the Fund to meet and discharge any of the Plan's liabilities. 1.6 Return of Contributions. Notwithstanding any other provision of this Agreement (a) contributions made by the Employer based upon mistake of fact may be returned to the Employer. The Trustee shall return contributions under this Section 1.6 only in accordance with Authorized Instructions and the Trustee shall have no duty to determine whether the return of such contributions is permitted under this Section 1.6 and the Plan. 1.7 Distributions. The Trustee shall make distributions and disbursements from the Account solely in accordance with Authorized Instructions. The Trustee shall not have any responsibility or duty under this Agreement to see to the proper application of any payment, to determine the tax effect of any payment, or to determine whether a distribution or disbursement to any person paid in accordance with Authorized Instructions is appropriate under the terms of the Plan and applicable law. - 1.8 Compliance with Law. The Account is intended to be tax-exempt under Section 501(a) of the Code and this Agreement is intended to comply with Section 457(g) of the Code. The Employer represents that it intends that the Plan constitute an eligible deferred compensation plan under Section 457(b) and Section 414(d) of the Code. The Employer agrees to immediately notify the Tmstee if the Plan ceases to be so eligible. SECTION 2 — AUTHORITIES 2.1 Authority to Execute Agreement. The Employer hereby certifies that it has the power and authority to enter into this Agreement on behalf of the Plan. The person(s) signing below on behalf of the Employer as Authorized Parties warrant, as individuals, that each is an authorized to act on behalf of the Employer all signatures are genuine and the persons indicated are authorized to sign. 2.2 Authorized Parties. The Employer shall concurrently with the execution of this Agreement, furnish the Trustee or the Recordkeeping Affiliate with a written list of the names, signatures, and extent of authority of all persons authorized to direct the Trustee and otherwise act on behalf of the Employer under the terms of this Agreement as "Authorized Parties." Such persons designated by the Employer to act on its behalf hereunder are "Authorized Parties". The Trustee shall be entitled to rely on and shall be fully protected in acting upon directions, instructions, and any information provided by an Authorized Party until notified in writing by the Employer of a change of the identity or extent of authority of an Authorized Party. 2.3 Authorized Instructions. All directions and instructions to the Trustee from an Authorized Party ("Authorized Instructions') shall be in writing, transmitted by mail (including electronic mail) or by facsimile. The -2- Trustee shall be entitled to rely on and shall be fully protected in acting in accordance with all such directions and instructions which it reasonably believes to have been given by an Authorized Party and in failing to act in the absence thereof. 2.4 Participant -Directed Brokerage Accounts. The Trustee shall, if so directed by the Employer, segregate all or a portion of the Fund held by it into one or more separate investment accounts to be known as "Participant -Directed Brokerage Accounts." Whenever a Participant is directing the investment and reinvestment of a Participant -Directed Brokerage Account, the Participant shall have the powers and duties which an Investment Manager would have under this Agreement if an Investment Manager were then serving and the Trustee shall be protected to the same extent as it would be protected under this Agreement as to directions or the absence of directions of an Investment Manager. The broker shall provide confirmation of each order to the Recordkeeping Affiliate, which shall maintain records in such form as to satisfy reporting requirements of the Plan SECTION 3 - POWERS AND DUTIES 3.1 General Powers and Duties of Trustee. In administering the Account, the Trustee shall be specifically authorized to: (a) In accordance with Authorized Instructions, receive, hold and maintain custody of, and disburse assets held in the Account; (b) Hold securities or other assets in book entry form or through another agent or nominee, including without limitation in an omnibus account arrangement, provided that the Trustee's records indicate that such securities or other property are held for the exclusive benefit of the Plan and its participants and beneficiaries; (c) Make distributions and disbursements from the Account and carry out related tax withholding remittance and reporting obligations under Federal, state and local law, (d) Appoint domestic agents, sub -trustees, sub -Trustees or depositories (including affiliates of the Tmstee) as to part or all of the Account, except that the indicia of ownership of any asset of the Account shall not be held outside the jurisdiction of the District Courts of the United States; (e) Collect income payable to and dividends or other distributions due to the Account and sign on behalf of the Plan any declarations, affidavits, and certificates of ownership required to collect income and principal payments; (f) 'Collect proceeds from assets of the Account that may mature or be called; (g) Until Authorized Instructions are received, hold the assets of the Account uninvested, or invest the assets of the Account in bank accounts of any bank, and the Trustee may retain any earnings on such deposits as part of its compensation for services hereunder; (h) Submit or cause to be submitted to the Employer all information received by the Trustee regarding ownership rights pertaining to property held in the Account; (i) To the extent not delegated by the Employer to an investment manager, exercise all voting rights relating to securities held in the Account as directed by the Employer; provided that, with respect to securities allocated to the accounts of Participants, if directed by the Employer in writing, the Trustee or its Recordkeeping Affiliate shall provide to the designated proxy tabulator the data necessary to cause to be provided to each Participant who has shares of such securities credited to his or her account a copy of the notice and all proxy solicitation materials together with a voting instruction form for return to the proxy tabulator, and the Trustee shall vote the shares as directed by each Participant and shall not vote shares for which it has not received instructions from a Participant. Unless the Employer instructs the Trustee to vote shares not voted by Participants, the Trustee shall not be liable and shall be held hamiless for not voting such shares. -3- G) Commence or defend suits or legal proceedings and represent the Account in all suits or legal proceedings in any court or before any other body or tribunal as the Trustee shall deem necessary to protect the Account provided, however, that the Trustee shall not be obligated to do so unless it has been indemnified by the Employer and the Plan against all expenses and liabilities sustained in connection with such action; (k) Employ suitable agents and legal counsel and, as part of its reimbursable expenses under this Agreement, pay their reasonable compensation and expenses. The Trustee shall be entitled to rely on and may act upon advice of counsel on all matters, and, if the use of such counsel is authorized by the Employer, the Trustee shall be without liability for any action reasonably taken or omitted pursuant to such advice; (1) Make, execute and deliver any and all documents, agreements or other instruments in writing as is necessary or desirable for the accomplishment of any of the powers and duties in this Agreement; and (m) Retain and engage one or more affiliates of the Trustee to perform, at no additional cost to the Plan, the duties and responsibilities of the Trustee; and (n) Generally take any action, whether or not expressly authorized, which the Trustee may deem necessary or desirable for the fulfillment of its duties hereunder. SECTION 4 - INVESTMENT OF THE ACCOUNT 4.1 Investment of the Account. The assets of the Account shall be invested and reinvested among the investments selected by the Employer. The self -directed brokerage account will be considered one investment. The Employer shall have sole responsibility for the investment and reinvestment of the assets of the Account, except to the extent that the Plan permits participants to provide investment direction to the Plan's recordkeeper with respect to the investment of their individual accounts among investment options selected by the Employer. The Trustee shall have no duty or responsibility for (i) selecting or providing advice with respect to the selection of any investment options offered under the Plan, (ii) determining or reviewing any securities or other property purchased for or held by the Plan, or (iii) providing advice with respect to the purchase, retention, redemption, or sale of any securities or other property for the Plan. SECTION 5 - REPORTING AND RECORDKEEPING 5.1 Records and Reports. The Trustee shall keep accurate records of all assets and loan documents delivered to and from the Account for at least six years following the date of such transaction. The Trustee shall provide a report of the assets of the Account including the loan documents held in the Account to the Employer from, time to time, but at least annually. The Trustee may rely on the fair market value of the property of the Account as reported to it by authorized parties shall be fully protected in relying on such values. 5.2 Review of Reports. It within ninety (90) days after the Trustee mails to the Employer a statement with respect to the Account, the Employer has not given the Trustee written notice of any exception or objection thereto, the statement shall be deemed to have been approved and, in such case, the Trustee shalt not be liable for any matters in such statements. The Employer or its agent, upon giving prior written notice to the Trustee, shall have the right at its own expense to inspect the Trustee's books and records directly relating to the Account during normal business hours. Trustee shall be reimburseditsactual costs for making such books and records available for inspection. 5.3 Non -Account Assets. The duties of the Trustee shall be limited to the assets held in the Account, and the Trustee shall have no duties with respect to property or assets held by any other person including, without limitation, any trustee or other Trustee for the Plan. The Employer hereby agrees that the Trustee shall not serve as, and shall not be deemed to be, a co -trustee or co -Trustee under the circumstances, and shall have no co -fiduciary liability for any other person, trustee, Trustee or other entity. If permitted by the Plan, the Trustee or the Recordkeeping Affiliate shall hold custody of plan loan notes in accordance with the terms of the Administrative Services Agreement to the extent such services are elected by the Employer thereunder. If a third party is chosen to administer plan loans on behalf of the Plan, the Employer and/or Named Fiduciary acknowledges that it is -4- responsible for making arrangements necessary to maintain such assets in a separate trust and the Trustee shall not be held responsible in any way for such plan loans. SECTION 6 - COMPENSATION EXPENSES TAXES INDEMNIFICATION 6.1 Compensation and Expenses. (a) Compensation. The Trustee shall be entitled to compensation for services under this Agreement as set forth in the fee schedule as contained in or incorporated by reference into the Administrative Services Agreement or similar document where plan fees are described and as otherwise provided for in this Agreement. The Employer acknowledges that the Trustee may increase the amount of compensation on an annual basis with sixty (60) days' prior written notice to the Employer. (b) Interest on Uninvested Cash. The Trustee shall also be entitled to receive as part of its compensation any amounts earned under Section 3.l(t) related to earnings on deposits. Such earnings shall include earnings on uninvested cash related to Plan contributions and earnings on uninvested cash pending distribution, or earnings on cash otherwise held uninvested as directed by Employer. The Trustee may keep any number of bank accounts to receive and hold for a reasonable time contributions or other amounts to be invested; or amounts redeemed to pay a distribution or disbursement. The Trustee may credit amounts to any such bank account, which may commingle the Plan's amounts together with amounts of other retirement plans. The expenses, including bank fees and charges, of any account are the obligation of the entity that keeps the account, and will not be charged against the Fund. The income (if any) from the account is additional compensation to the Trustee, and the Trustee may share such income with its affiliates. The Trustee will receive float income (as described herein) and will retain that float income as partial compensation for the services the Trustee renders hereunder. For each kind of float compensation, the Trustee generally earns a rate of return comparable to money-market or short-term investment returns. (i) Contributions The Trustee uses a bank account to receive and hold contributions or other amounts to be invested in the Fund. The Trustee is unable to invest contributions or other amounts until Authorized Instructions are received in good order. The Trustee receives float income during any waiting period for Authorized Instructions. For Authorized Instructions received in good order by the close of the New York Stock Exchange (normally 4:00 p.m. Eastern Time), the Trustee will process the contributions or other amounts on that business day. For Authorized Instructions received in good order after the close of the New York Stock Exchange, the Trustee will process the contributions or other amounts on the next business day. (ii) Distributions The Trustee will receive float income in connection with distributions and disbursements during the period of time commencing when an amount is redeemed from the Fund to fund a distribution or disbursement check and ending when the check is paid. The Trustee's agent mails the check within three business days from the day that an amount is redeemed from the Fund (c) Authorization. The Trustee shall also be authorized to charge and collect expenses incurred by it in the discharge of its duties under this Agreement in accordance with Section 3.1. The Trustee is authorized to charge and collect from the Account any and all such fees and expenses, unless the Employer objects within 30 days of receiving notice of the Trustee's intent to collect its fees and expenses from the Account. 6.2 Tax Obli agations. To the extent an Authorized Party has provided necessary information to the Trustee, the Trustee may use reasonable efforts to assist such Authorized Party to notify the Employer of any responsibility for payment of taxes, withholding, certification and reporting requirements, claims for exemptions or refund, interest, penalties and other related expenses of the Account ("Tax Obligations"). Notwithstanding the foregoing, the Trustee shall not have any responsibility or liability for any Tax Obligations now or hereafter imposed on the Employer or the Account by any taxing authorities, domestic or foreign, except as provided by -5- applicable law. To the extent the Trustee is responsible under any applicable law for payment of any Tax Obligation on behalf of the Account, the Employer shall cause the appropriate Authorized Party to inform the Trustee of all Tax Obligations, shall direct the Trustee with respect to the performance of such Tax Obligations, and shall provide the Trustee with all information required by the Trustee to meet such Tax Obligations. 6.3 Indemnification. The Employer, and to the extent permitted by law, the Plan, shall indemnify and hold harmless the Trustee from all claims, liabilities, losses, damages and expenses, including reasonable attorney's fees and expenses (including Tax Obligations) incurred by the Trustee in connection with this Agreement, except as a result of the Trustee's own negligence or willful misconduct. 6.4 Force Maieure. The Trustee shall not be responsible or liable for any losses to the Account resulting from nationalization, expropriation, devaluation, seizure, or similar action by any governmental authority, de facto or de jure; or enactment, promulgation, imposition or enforcement by any such governmental authority of currency restrictions, exchange controls, levies or other charges affecting the Accounfs property; or acts of war, terrorism, insurrection or revolution; or acts of God; or any other similar event beyond the control of the Trustee or its agents. 6.5 Survival. This Section Six (6) shall survive the termination of this Agreement. SECTION 7- AMENDMENT, TERMINATION RESIGNATION REMOVAL 7.1 Amendment. The Trustee may amend this Agreement as necessary to comply with the provisions of applicable law and regulations. The Trustee shall deliver written notice of any such amendment to the Employer. Other amendments may be made by written agreement signed by the parties hereto. 7.2 Removal or Resignation of Trustee. The Trustee may be removed with respect to all or part ofthe Account upon receipt of sixty (60) days' written notice from the Employer. The Trustee may resign as Trustee hereunder upon sixty (60) days' written notice delivered to the Employer. In the event of such removal or resignation, the successor Trustee will be appointed by the Employer, and the retiring Trustee shall transfer the Account, less such amounts as may be reasonable and necessary to cover its compensation and direct expenses including but not limited to, a pro -rota share of the fees described in Section 6.1. In the event the Employer fails to appoint a successor Trustee within sixty (60) days of receipt of written notice of resignation, the Trustee reserves the right to seek the appointment of a successor Trustee from a court of competent jurisdiction. The Employer shall indemnify the Trustee from any costs incurred by the Trustee in seeking such appointment. The Trustee shall continue to serve as plan trustee until the new plan trustee is either appointed by the Employer, or if that appointment is in question, by a court of competent jurisdiction as described herein. The Trustee shall have no duties, responsibilities or liability with respect to the acts or omissions of any successor trustee. 7.3 Merger or Consolidation of Trustee. Any entity into which the Trustee may be merged or with which it may be consolidated, or any entity resulting from any merger or consolidation to which the Trustee is a party, or any entity succeeding to the custody business of the Trustee, shall become the successor of the Trustee hereunder, without the execution or filing of any instrument or the performance of any further act on the part of the parties hereto. 7A Plan Termination. Upon termination of the Plan, the Trustee shall distribute all assets then constituting the Account, less any fees and expenses payable from the Account, pursuant to the instructions of the Employer. The Trustee shall be.entitled to assume that such distributions are in full compliance with and not in violation of the terms of the Plan or any applicable law. 7.5 Property Not Transferred. The Trustee reserves the right to retain such property as is not suitable for distribution or transfer at the time of the termination of the Plan or this Agreement and shall hold such property for the benefit of those persons or other entities entitled to such property until such time as the Trustee is able to distribute or transfer such property. The Employer shall indemnify the Trustee from any costs incurred by the Trustee for retaining the property until it can be distributed or transferred. Upon the appointment and acceptance of a successor Trustee, the Trustee's sole duties shall be those of a Trustee with respect to the property not transferred. -6- 7.6 Termination of Administrative Services Agreement or Investment Agreement. Notwithstanding the notice requirements in Section 7.2, in the event the Administrative Services Agreement between the Employer and/or the Employer and the Recordkeeping Affiliate is terminated, this Agreement shall terminate simultaneously with the termination of the Administrative Services Agreement without further notice from any party hereunder to the others. For purposes of this section, the Investment Agreement, if applicable, shall be subject to the terms of this section in addition to or in the absence of an Administrative Services Agreement. SECTION 8 - ADDITIONAL PROVISIONS 8.1 Assignment or Alienation. Except as may be provided by law, the Account shall not be subject to any form of attachment, garnishment, sequestration or other actions of collection afforded creditors of the Employer, participants or beneficiaries under the Plan. The Trustee shall not recognize any assignment or alienation of benefits unless an Authorized Instruction is received. 8.2 Governing Law. This Agreement shall be construed in accordance with and governed by the laws of the state of the Employer but the assets of the Account shall be held in the State of Connecticut. 8.3 Necessary Parties. The Trustee reserves the right to seek a judicial or administrative determination as to its proper course of action under this Agreement. Nothing contained herein will be construed or interpreted to deny the Trustee or the Employer the right to have the Tmstee's account judicially determined. To the extent permitted by law, only the Trustee and the Employer shall be necessary parties in any application to the courts for an interpretation of this Agreement or for an accounting by the Trustee, and no participant under the Plan or other person having an interest in the Account shall be entitled to any notice or service of process. Any final judgment entered in such an action or proceeding shall, to the extent pemtitted by law, be conclusive upon all persons. The Employer shall indemnify the Trustee for any costs incurred by the Trustee in seeking such judgment. 8.4 Notices. All notices and other communications hereunder shall be in writing and shall be sufficient if delivered by hand or if sent by telefax or mail (including electronic mail), postage prepaid, addressed: (a) If to the Trustee: Melissa McAuliffe Vice President Voya Retirement Operations One Orange Way, C3N Windsor, Connecticut 06095.4774 With copy to: J. Denise Jackson President Voya Institutional Trust Company One Orange Way, C4R Windsor, Connecticut 060954774 (b) If to the Employer: Richard Meyer 202 S Ann St. Port Lavaca, TX 77979 The parties may, by like notice, designate any future or different address to which subsequent notices shall be sent. Any notice shall be deemed given when received. -7- 8.5 No Third Party Beneficiaries. The provisions of this Agreement are intended to benefit only the parties hereto, their respective successors and assigns, and participants and their beneficiaries under the Plan. There are no other third party beneficiaries. 8.6 Execution in Countemarts. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original and said counterparts shall constitute but one and the same instrument and may be sufficiently evidenced by one counterpart. 8.7 Shareholder Communication. Until such time as the Trustee receives a written notice to the contrary with respect to a particular security, the Trustee may release the identity and the address of the Trust to the security issuer which requests such information pursuant to the Shareholder Communications Act of 1985 for the specific purpose of the direct communication between such security issuer and shareholder. IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the effective date set forth above. Name of Em ye By: Name: Richard Meyer Title: Trustee Voya Institutional Trust Company By. � k%Gtowt� Name: J. Denise Jackson Title: President -8- Plan Services Agreement THIS AGREEMENT (the "Agreement") is entered into effective as of the date signed bythe Employer, by and between Voya Retirement Insurance and Annuity Company, a corporation organized under the State of Connecticut, and its affiliated entities, agents or its subcontractors (collectively the "Service Provider" or "Voya") and Calhoun County ("Employer", "Plan Sponsor" or "Client"), (collectively, the "Parties.") The Plan Sponsor or Client is referenced herein as "You" and "Your." Client has agreed to enter into a relationship with Voya under which Voya will provide certain services to the Participants, beneficiaries and alternate payees (collectively, the "Participants") under the Plan(s) sponsored by Client and listed below (the "Plan"). These services will apply to all Plans unless You Indicate otherwise in this Agreement. Plan Type(s)/Names (Required) ❑ 403(b) Plan Name ❑ 401(a) Plan Name ❑ 401(kp Plan Name [Y457(b) Governmental Plan Name Calhoun County 457(b) Deferred Compensation Plan If this is a governmental 401(k) Plan, the Employer understands and acknowledges that the Plan must have been In existence on May 6, 1986. voy � PLAN SERVICES AGREEMENT - SERVICE PROFILE VOVAO L PLAN CONTACT INFORMATION (Please Print) Note that Voya will rely exclusively on this Plan Contact Information for purposes of verifying the names of individuals who are authorized to provide direction on behalf of the Plan. Voya shall have no duty to Inquire into the actual authority of such individuals listed below and Employer shall be responsible for communicating any changes to this Plan Contact Information. Plan Sponsor/Trustee Name Richard Meyer Title Trustee E-mail dchard.meyer(a)calhouncotx.or Phone (361)553-4600 Fax Plan Sponsor/Trustee Name Title Phone Plan Sponsor/Trustee Name Title Phone E-mail Fax E-mail ❑ Additional Plan Sponsor/Trustee contacts outlined In attachment. Authorized Plan Representative (Primary HR contact that will be given access to Voya's Plan Sponsor Website.) Name Rhonda Kokena Title E-mail rhonda.kokenaa()calhouncotx.org Phone (361)553A618 Fax Page 2of 37 Order#200398 TEM Bundied 12/01/2021 TM: DCPLNINSTUPLANINIT If You have not completed the Voya Application for Group Annuity, please complete the following information. If the Voya Application for Group Annuity is submitted, the information in this section will be disregarded. Address 202 S Ann St. City Port Lavaca Employer TIN 746001923 Type of Entity State TX Zip 77979 Tax -Exempt Employer 501(c)(3) Organization (IRS tax exempt status letter required to be submitted for organization formed after 10/9169) ❑ Healthcare ❑ Education ❑ Church ❑ Other Not -for -Profit Governmental Organization tEState, local, county, municipality ❑ Healthcare ❑ Public School: ❑ K-12 ❑ Higher Education 403(b) 401(a) 401(k) 457(b) Governmental Check If Your Plans) are NOT subject to ERISA 1 ❑ 1 ❑ 1 ❑ 1 Always Non-ERISA PLAN INFORMATION (Please read the attached "Description of Services" and check all that apply to Your Pian(s).) ❑ This Plan replaces an existing Voya Plan. If checked, please provide Plan ❑ This Plan is related to an existing Voya Plan. If checked, please provide Plan ❑ Link Plans on the Plan Sponsor/Trustee Website Third Party Provider 0403(b) ❑401(a) ❑401(k) ❑457(b)Governmental By completing this section You are electing to have the services identified below provided by: (enter name of service provider) Voya is authorized to share with this service provider the Plan information that they request in writing. ❑ Plan Document ❑ Testing Services, please identify applicable tests ❑ 5500 Master Aggregator Service Provided by (If Planwithease.com® Is the provider, a separate agreement is required.) Indicate Plans ❑ 403(b) ❑ 401(a) ❑ 401(k) ❑ 457(b) Governmental Online distribution services are not available for Plans using a Master Aggregator Service for in-service withdrawals/hardship withdrawals/termination distributions. Page 3 of 37 Order #200338 TEM Bundled 12/0112021 TM: DCPLNINSTL/PLANINIT PLAN INFORMATION (Continued) Deferral Method: (If You elect the Dollar Amount or Both option, Your Plan(s) must allow for deferrals up to the maximum IRS limits. The Percent option is the only option available if the Plan has elected Automatic Account Re -alignment Services.) NOTE: Dollar amount option not available independently if Plan has elected automatic enrollment or automatic rate escalator service. Percent DoliarAmount Both 401(k) ❑ ❑ ❑ 403(b) ❑ ❑ ❑ 457(b) ❑ tQ ❑ Catch-up Contribution Method [:]Percent [vf Dollar Amount ❑ Both ❑ N/A Enrollment/Education Communication — Choose One: [iEnrollment/Education Brochure ❑ Sponsor Enrollment Campaign' 'Sponsor Initiated Enrollment Campaign is not available If Your Plan has an automatic enrollment feature or utillzes Voya's Enhanced Notification Service. This service will not be available until after Voyo's recordkeeping services are active for ongoing enrollments. Voya will provide the enrollment and education brochure for You to distribute to Your employees during Implementation. Please note that these materials were created to assist plan sponsors with the plan enrollment process and do not otherwise replace ormodify any existing obligation to furnish regulatory communlcations to individuals. Employer Match-Voya's Online Enrollment Center Your Plan's match Is an important component in helping Your employees save for retirement. Voya utilizes Your match formula to populate Voya's Online Enrollment Center, to help Your employees establish their retirement savings goals. Please Indicate Your match formula below. (Note, If You do not have a match formula as outlined below, the formula will not show on Voya's Online Enrollment Center.) ❑ 403(b) Match the first % of contributions up to the first % of pay and (if applicable) match % of contributions on the next % of pay up to a maximum of $ annually. ❑ 401(k) Match the first % of contributions up to the first % of pay and (If applicable) match % of contributions on the next % of pay up to a maximum of $ annually. ❑ 457(b) Governmental Match the first %of contributions up to the first % of pay and (If applicable) match % of contributions on the next % of pay up to a maximum of $ annually. If You do not complete Your match formula above and if Voya has Your Plan document we will obtain Your match formula stated In the Plan document and will use this information unless You indicate otherwise below. Important to note, Your Plan document may state matching is discretionary so an amendment Is not needed if Your match changes from year to year, so please be sure to include the match disclosed to Your Plan Participants as directed above. The match formula will remain on Voya's Online Enrollment Center unless we are notified of a change. It Is Your responsibility to inform Voya if Your match formula is modified. g No, I do not want Voya to pre -populate our Plan(s) match information on Voya's Online Enrollment Center. Page of37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTLIPLANINIT PLAN INFORMATION (Continued) Participant Eligibility Tracking (Required if Enhanced Notice Service was priced into the Plan, if using any Participant Investment Advisory Services program or Asset Allocation Made Easier as ODIA.) ❑Yes tENo Automatic Enrollment Service (Required forAutomatic Account Re -alignment.) ❑ Voya Automatic Enrollment Service OR ❑ Both Voya Automatic Enrollment and Automatic Rate Escalator Service Account Re -alignment Services (Choose one or both.) ❑ Automatic Account Re -alignment (not available to 401(a) Plans or Plans not subject to ERISA) (Automatic Enrollment must be elected above and deferral method must be percent only.) Participants deferring less than the Plan's automatic enrollment deferral rate or maximum automatic escalation rate (If applicable) will be re -enrolled in accordance with the Plan's requirements and have their deferral rate increased (if applicable) unless they opt out of account re -alignment. NOTE: This service Is not available to Plans offering tracittional after-tax contributions. ❑ Investment Reset (ERISA Plans only) — Participant's account balances will be re -directed to the ODIA fund for the Plan within thirty (30) calendar days from the date indicated below, unless the Participant has opted out. (Not available for Plans which utilize both Self -Directed Brokerage Account and permit Roth deferrals, or Plan's that utilize Asset Allocation Made Easter as the ODIA.) Automatic Account Re-alignment/Investment Reset services elected above will occur one time unless indicated below: ❑ Apply service on an annual basis (will run on some month and day of each year) Required Information: Participant Notification Start Date: _ / _ / (Must not be earlier than sixty (60) calendar days after implementation date.) Automatic Account Re -alignment and Investment Reset will occur thirty (30) calendar days after this date. Participant Address Change — Active Participant address change Information will be provided to Voya by the Plan Sponsor unless You check the box below. ❑ Participant Address change information will be provided by Participants via the Participant Website. NOTE: This election is not permitted if the Plan has elected the following services: Automatic Enrollment Participant Eligibility Tracking, Payroll Integration Service, Paperless Distributions /Withdrawals or Paperless loans. Temporary PIN Delivery If You would likethe abilityfor Participants to requesttemporary PINS from Voya and receive them electronically using Your organization's e-mail domain, provide the domain(s) registered specifically to Your organization (example: @organizationname.com) below: @calhouncotx.org Participant Online Beneficiary Storage If elected, Participants can enter or update beneficiary information through the Participant Website for the Plan Sponsor's review and approval. Please note that Plan Sponsor sign off is required for all death benefit payments from the Plan as Voya is not serving as the book of record for Participant beneficiary designations. [i'Yes For Non-ERISA Plans where spousal consent requirement does not apply, the Plan Sponsor elects to require consent if the Participant/Account Holder resides in a community property state. ❑ 403(b) ❑ 401(a) ❑ 401(k) R457(b) Governmental Page 5 of 37 Order#200338 TEM Bundled 12/012021 TM: OCPLNINSTUPLANiNIT PLAN INFORMATION (Continued) Withdrawals and Distributions Check all that are applicable. (For Plans using a MosterAggregator Service, orlegacy vendors, paperless services are not available, so leave blank. if paperless services are not used, Your approval will be required.) 403(b) 401(a) 401(k) 457(b) Governmental Online Plan Sponsor/Trustee approval is required ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes []NO [-]Yes [RNo for in-service withdrawals (hardship/unforeseeable emergency withdrawals not available for paperless processing). Online Plan Sponsor/Trustee approval Is required for ❑ Yes ❑ No ❑ Yes [:]No [:]Yes ❑ No ❑ Yes RrNo termination distributions. If you check "No," above, availability of the paperless distribution processing service is subject to Voya approval. The Withdrawal/Distribution Fee will be deducted from Participant Investment selections on a pro rate basis for each in-service/ hardship withdrawal and termination distribution processed unless You check the box below, ❑ Bill the Plan Sponsor/Trustee for. Participant Withdrawal/Distribution Fee ❑ 403(b) ❑ 401(a) ❑ 401(k) ❑ 457(b) Governmental The ODRO Processing Fee will be deducted from Participant investment selections on a pro rate basis for each ODRO processed unless You check the box below. ❑ Bill the Plan Sponsor/Trustee for ODRO Processing Fee ❑ 403(b) ❑ 401(s) ❑ 401(k) ❑ 457(b) Governmental Mandatory Distributions for Terminated Participants — If permitted under Your Plan(s) for vested account balances between $1,000 and $5,000 Voya will utilize Voyb's IRA Rollover product under the terms of the Automatic Rollover/Mandatory Distribution Agreement, unless You provide an alternative provider below. Voya will take direction from You the Plan Sponsor or its designee to initiate mandatory distributions for terminated Participants.) ❑ Non Voya IRA for the following Plans ❑ 403(b) ❑ 401(a) ❑ 401(k) ❑ 457(b) Governmental IRA Provider Contact Name Address city State Zip Loans Are loans permitted under the Plan(s)? ❑ 403(b) ❑ Yes ❑401(a) ❑Yes ❑401(k) ❑Yes r457(b) Governmental [►gYes If "Yes," for any Plan, please complete the following information. Note: You are responsible for ensuring that the Plan information provided below is in accordance with Your Plan's loan program. The information below will apply to all applicable Plans unless otherwise indicated. The Loan Initiation Fee will be deducted from Participant investment selections on a pro rate basis for each loan processed unless You check the box below. ❑ Bill the Plan Sponsor/Trustee for the Participant Loan Initiation Fee ❑ 403(b) ❑ 401(a) ❑ 401(k) ❑ 457(b) Governmental The Voya Annual Loan Administration Fee will be deducted annually from the Participant Investment selections on a pro rate basis for each outstanding loan. Page 6of37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT PLAN INFORMATION (Continued) Loans (Continued) Types of Loans Allowed NOTE: PLEASE COMPLETE — INFORMATION NOT TYPICALLY FOUND IN PLAN DOCUMENTS. If the following information differs by Plan type, please attach a separate document identifying the Plan and the following information. one Total number of loans allowed (Regardless of type) — (4 maximum, regardless of loan type) Loan Types: one Number of General Purpose loans Duration 57 months (not to exceed 57months) one Number of Residential Loans —If no residential loans allowed ongoing, are there any takeover residential loans? ❑ Yes ❑ No Duration 360 months (not to exceed 360 months) eYes ❑ No Online Plan Sponsor/Trustee approval Is required for processing a loan (Residential not available for paperless processing and will require Your approval). If you check "No," above, availability of the paperless loan processing service is subject to Voya approval. Loan Repayment Methods for active Participants will be made by Payroll deduction unless you opt out below. ❑ In lieu of above, ACH debit loan repayments will be deducted from the Participant's bank account for all active and separated from service Participants (deductions will be made on a monthly basis). Loan payments will continue after the Participant has separated from service until a full distribution has been processed from the Participant's account. (If You elect this option, Participants will not be able to take a loan if they have a defaulted loan outstanding.) For Payroll Deduction Loans, Participants that are separated from service will not be permitted to continue loan repayments unless elected below. ❑ Yes — allow Participants separated from service to continue to repay loans (option will apply automatically lfACHelected for active Participants above). Note: If elected You must ensure that Your Plan loan program allows for this option. If allowed, loan repayments mustbe submitted via ACH, Debit by the Participant Loan Interest Rate Monitoring — Voya will use the Prime Interest Rate published in the Wall Street Journal unless the alternative Index is selected below. ❑ Moody's Corporate Bond Yield Average -Monthly Corporate Please select a Loan Interest Rate Adjustment Factor. Rf 0% ❑ .5% ❑ 1% ❑ 1.5% ❑ 2% ❑ 2.5% ❑ Other % Designated 403(b)(7) Loan Investment Option (403(b) Loans only) The designated 403(b)(7) loan Investment option is and name. Fund must be offered in the Plan and cannot be the fixed or stable value funds). fund number The designated 403(b)(7) investment option is to be used to initially fund a loan. To the extent the amount in the designated 403(b)(7) loan investment option is insufficient to fund a loan, money will be withdrawn from the Participant's other investment options on a pro rate basis and allocated to the designated 403(b)(7) loan investment option. If this is still Insufficient to fund a loan, an exchange from the 403(b)(1) annuity will be processed automatically. Page7of37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT PLAN INFORMATION (Continued) Loans (Continued) Restrictions (complete If applicable): Plan Level Loan Restrictions (applies regardless of loan type): One Loan per months (rolling period of occurrence) Loans per ❑ month ❑ quarter []semi-annual ❑ annual (will default to Plan year period unless ❑ Calendar Year elected) General Purpose Loan Restrictions: One Loan per months (rolling period of occurrence) Loans per ❑ month ❑ quarter ❑ semi-annual []annual (will default to Plan year period unless ❑ Calendar Year elected) Residential Loan Restrictions: One Loan per months (rolling period of occurrence) Loans per ❑ month ❑ quarter ❑ semi-annual ❑ annual (will default to Plan year period unless ❑ Calendar Year elected) VOYA INSTITUTIONAL TRUST COMPANY (Additional service agreement will apply.) Z Yes (If "Yes," please complete Information below.) • Directed Trustee services (Voya Trust serves as Trustee) • Custodial arrangement (The Plan has appointed Individual Trustees and Voya will serve as Custodian of the Plan's assets) ❑ 403(b) ❑ 401(a) ❑ 401(k) Q457(b) Governmental ❑ Custodial Arrangement ❑ Custodial Arrangement ❑ Custodial Arrangement ❑ Custodial Arrangement ❑ Directed Trustee Services ❑ Directed Trustee Services Qbirected Trustee Services ADDITIONAL SERVICES (Please Indicate Your preference for any of the following services for Your Plants).) Please note additional service agreements maybe required for some of the options below and additional fees may apply. Please refer to "Your Program Highlights and Fee Summary" or the Individual agreements for these services for fee information. Financial Counseling Services — available to active and terminated employees as part of the standard service offering through a Voya Financial Advisors, Inc., a Voya affiliated broker dealer and investment advisor. E] No, I do notwant my active and terminated employees to have Financial Counseling Services as part of the services available to them. Participant Investment Advisory Services program — May include both a professionally managed account option with a Participant level fee and an online, point in time advice service at no additional charge. NOTE: Additional service agreement is required in order for this service to be implemented. ❑ No, I do not want to offer a Participant Investment Advisory Services program. Fiduciary Services — ERISA Plans only — Separate agreement may be required with the vendor providing this service. Services not provided by Voya but by a vendor of Your choosing. Does Your Plan utilize an outside fiduciary that will have authority to act on behalf of the Plan? Select all that apply: ❑ 3(16) - Firm Name: ❑ 3(38)-Firm Name: Page 8 of37 Order #200338 TEM Bundled 12/012021 TM: DCPLNINSTUPUANINIT ADDITIONAL SERVICES (Continued) Self -Directed Brokerage Account — Supplemental investment alternative for Plan Participants. Voya Institutional Trust Company is required to be appointed as directed Trustee or custodian for this service. ❑ 403(b) ❑ 401(a) ❑ 401(k) ❑ 457(b) Governmental If "Yes," do You have an existing self -directed brokerage account? ❑ Yes ❑ No If "Yes," do You want to transfer in -kind? ❑ Yes ❑ No Self -Directed brokerage account provider(s) (indicate If different by Plan type): Voya Fixed Account Transfer Provision (Applies Only to Plans which elect the Self Directed Brokerage Account and/or Asset Allocation Made Easier Program) Transfers from the Voya Fixed Account are subject to either an "equity wash "or "percentage limitation" provision as described in the Information Booklet. Equity Wash applies on transfers from the Voya Fixed Account, unless Self Directed Brokerage Account (SDBA) and/or Asset Allocation Made Easier (AAME) programs are elected. These programs allow the Contract Holder to select the percentage limitation provision, in lieu of Equity Wash (not available to Plans that have elected to use a stable value option). For the Percentage Limitation provision, the percentage available to be transferred out of the Fixed Account will never be less than 10% of the amount in the Fixed Account on January 1 of a calendar year. We may allow a higher percentage. Equity Wash provision will apply on transfers from the Voya Fixed Account unless Percentage Limitation Is elected below. Percentage Limitation ❑ For additional Information on the Fixed Account Transfer Restrictions, please refer to the Group Annuity Contract and/or Funding Agreement provided at contract issuance. Blended Rate Accounting for Fixed Investment Option —Service available with the Voya Fixed Account Option only. Service availability is subject to Voya approval. (Not available to 403(b) Plans.) ❑ Yes Number of outside carriers STATEMENTS AND REPORTS Sponsor Logo — Place our company logo on'Sponsor and Participant statements and Websites. (Logo must be received electronically and meet Voya design requirements.) ❑ Yes Non-ERISA Participant Fee Disclosure Election (Non-ERISA plans Only) ❑ I elect to have Participant Fee Disclosure reports (in accordance with DOL §2550.404a-5) posted monthly to Sponsor Web, Participant Web and Third Party Administrator Website (if applicable). a PAYROLL INFORMATION (Please complete the followinginformationsoVoya can properlysetupYourPlanforongoingcontributions.) Do You use an external payroll vendor? ❑ Yes © No If "Yes" will Your payroll vendor be submitting Your file on Your behalf?' (Payroll Integration) ❑ Yes ❑ No 'If "Yes," It Is required that loan repayments match the expected payment amount Please provide Your payroll vendor's contact Information. Payroll Provider Contact Name Contact Phone Number Contact E-mail Address Page 9of37 Order#200338 TEM Bundled 12/01/2021 TM: XPLNINSTUPLANINIT PAYROLL INFORMATION (Continued.) Internal Payroll Contact (Employer contact for contributions) Name Clard Atkinson Title E-m ailclarri.atkinson@calhouncotx.org Phone (361) 553-4450 Extension Fax Select the payroll frequency for contributions and loan repayments. (Check all that apply.) Weekly Bi-Weekly Semi -Monthly Monthly Annually Cannot be used for loan repayments 403(b) ❑ ❑ ❑ ❑ N/A 401(a) ❑ ❑ ❑ ❑ ❑ 401(k) ❑ ❑ ❑ ❑ N/A 457(b) Governmental ❑ 0 ❑ ❑ N/A Number of Payrolls if You have more than one ❑ Yes 0 No Do You want Voya to maintain Participant data by division/sub-location? (Required if You will be submitting payroll contributions from multiple bank accounts.) Division/Sub-location Name Division/Sub-location Name Division/Sub-location ❑Yes ❑No If You have division/sub-locations, do You want Voya to segregate reporting by division/sub4ocation?(Censusdata must be maintained with each payroll submission if electing this service.) Payment Method —Your Plan(s) will beset up with ACH Debit unless You select an alternative method below. (If You have multiple bank accounts, please provide the following information for each account.) Type of account ❑ Checking ❑ Savings Please complete the following banking information or Include a copy of a voided check: Bank Name ABA Routing # (must be 9 digits) Account # Division/Location Name Alternative Payment Methods ❑ ACH Credit — Plan Sponsor/Trustee initiates electronic transfer of funds. RrWire Transfer— Plan Sponsor/Trustee initiates transfer of funds via Federal Wire System. Payroll Reporting—Voya provides a Payroll Feedback File and report with Participant -level payroll data as well as additional information, depending upon the services You select for Your Plan(s). Voya provides notification via e-mail when a file/report is made available. Please provide an e-mail address. (Allow up to three contacts.). These should either be Your Authorized Plan Representative, or individuals You have authorized to receive Plan information for Your Plan(s). If contacts differ based on Plan type, please identity the Plan type along with the e-mail address. E-mail Address(es) (It is Your responsibility to notify Voya of contact Information changes.) clard.atkinson@calhouncotx.org ❑ Please indicate if You want the file sent via e-mail to the contacts identified below. Page 10 of37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANIN1T RECORD KEEPING EXPENSES (Please review Your Program Highlights and Fee Summary for details on Your record keeping expenses.) SELECTION REQUIRED AS APPLICABLE (The below pricing options may not apply Ifusing a DallyAsset Charge (DAC)). Asset Based Fee Annual asset based fee — This fee is charged in quarterly Installments unless the Fee Levelization' feature is selected in which the fee Is charged in monthly installments. t1 Participant Deduction ❑ Bill Plan Sponsor 'If using Fee Levelization then Participant Deduction must be selected. Fund Revenue Requirement This fee is charged in quarterly installments. ❑ Participant Deduction ❑ Bill Plan Sponsor Annual Case Fee Annual fixed dollar fee — This fee is charged in quarterly installments. ❑ Participant Deduction ❑ Bill Plan Sponsor Annual Per Participant Fee Annual fixed dollar fee charged per Participant with an account balance — This fee Is charged in quarterly installments. ❑ Participant Deduction ❑ Bill Plan Sponsor Note., Any deduction from Participant accounts will be deducted across all fund and source balances, excluding the Self Directed Brokerage Account if applicable. PLAN SPONSOR/TRUSTEE ACCOUNTS — This option will be used to temporarily Invest assets due to the absence of investment direction from the Plan Sponsor. The Voya Government Money Market Fund — Class A will be established as the Plan Sponsor?rustee Account to hold assets until instructions are received. (It Is possible to experience account reductions as a result of investing in the Voya Government Money Market Fund — Class A due to market fluctuation and/or Contract expenses.) If You prefer another investment option please Indicate it below. Stable Value and Target Date options are not available as a Plan Sponsor/Trustee Account. The investment option selected below must be an Investment option selected within Your Plan. Investment Option (100%) The following two Holding Accounts will be established for Your Plan(s) (as applicable) • Plan Asset Holding Account (not intended for ongoing prefunded contributions) • Forfeiture Account PagellofW Order 4200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT DEFAULT INVESTMENT OPTION — This option will be used to temporarily invest assets due to the absence of investment direction from a Participant. Please select an option below. The investment option selected below must be an investment option selected within Your Plan. You may not choose a stable value option as the default investment option. Assets will be invested In the selected fund until such time that a Participant makes investment allocation changes and/or fund transfers, or If applicable, opts out of the discretionary managed account option under Participant Investment Advisory Services program. ❑Yes F]No If the Plan is subject to ERISA, the default investment option elected below is Intended to be a Qualified Default Investment Alternative (OD IA). (Required for Plans participating in the Investment Reset service — not available to 457(b) Governmental Plans.) Target Date Suite My Compass Index moderate (All available investment options within the suite must be selected. Investment allocations will be based on a Participant's date of birth and not the anticipated retirement age as they are designed.) ❑ The discretionary managed account option under a Participant Investment Advisory Services program (Note: Separate Agreement required — Can only be selected if noted as a QDIA) ❑ Other Investment Option (100%) ❑ Asset Allocation Made Easier (Note: Separate Agreement required —Can only be selected if noted as a QDIA) For Plans choosing Voya's Automatic Enrollment service and Asset Allocation Made Easier as the Default Investment Option, the Voya Fixed Account will be the Plan's temporary investment Instruction unless the Plan Sponsor directs Voya to use an alternative investment option. (Target date or Lifestyle funds not eligible). This Fund will hold assets applied to accounts between the time that Participants become eligible and the date thatthey are defaulted into the Asset Allocation Made Easier portfolio. Once defaulted, any balance in this temporary investment will be reallocated according to the model portfolio. Alternative investment option: _ investment option under the Plan.) (100%— Must be a currently available PLAN INSTALLATION/ASSET TRANSFER (Please select a method for Voya to manage the transfer of Your Plan's assets and please provide Your current Plan provider's information if applicable.) ❑ Check if Start-up Plan Prior Provider Firm Nati1 Contact Name Unknowr E-mail Phone (877)677-3678 Prior Provider Contract(Plan # Asset Transfer F1 Option 1— Map Plan assets (preferred method) — Participant accounts are established with account information from the prior provider, Including enrollment status in a managed account service (ifopplicable) and Plan assets are invested according to mapping instructions provided. Participant accounts that were enrolled in the Plan's managed account service at the time of asset transfer will be mapped to the managed account service made available to the Plan Participants at Voya (if applicable). TfDo not map managed account service enrollment ❑ Option 2 — Participants are provided the opportunity to enroll Into the Plan(s) and select their own Investment options. Those Participants who do not affirmatively electto enroll in the Plan will be defaulted into the Plan's Default Investment Option indicated in this Agreement. NOTE: this option is not permitted in conjunction with Investment Reset service if date of reset is upon implementation. Page 12 of 37 Order #200338 TEM Bundled 1210112021 TM: DULNINSTUPLANINIT REQUIREMENTS Information Sharing Agreement Applicable to 403(b) Plans If this Agreement covers a 403(b) Plan, the Plan Sponsor acknowledges that the 403(b) Plan under which is funded by 403(b) annuity contract(s) and/or 403(b)(7) custodial accounts issued or administered by VRIAC ("the Voya Contracts", for purposes of this appendix) permits contract exchanges and that the Voya Contracts are available to receive both ongoing contributions and contract exchanges underthe 403(b) Plan. Information sharing as described in this appendix applies to the Voya Contracts issued on behalf of a Participant or beneficiary (pursuant to sections 1.403(b)-(2)(b) (3) and (12) of the Final Treasury Regulations) pursuant to an exchange from a prior issuer's 403(b) contract as described in section 1.403(b)-10(b) of the Treasury Regulations under the Plan Sponsor's 403(b) Plan. Plan Sponsor and VRIAC agree to share with each other the following information from time to time: • Information necessary for the Voya Contracts, or any other contract to which contributions have been made by the Plan Sponsor under the 403(b) Plan on behalf of the Participant or beneficiary, to satisfy section 403(b), including information concerning the Participant's employment, if applicable, and information thattakes into accountthe Participant or beneficiary's other section 403(b) contracts or qualified employer Plans (such as whether a severance from employment has occurred for purposes ofthe distributions restrictions in §1.403(b)-6 of the Final Treasury Regulations and whetherthe hardship withdrawal rules of §1.403(b)-6(d)(2) are satisfied). • Information necessary for the Voya Contracts, or any other contract to which contributions have been made by the Plan Sponsor under the 403(b) Plan on behalf of the same individual, to satisfy other tax requirements (such as whether a Plan loan satisfies the conditions in Internal Revenue Code section 72(p)(2) so that the loan is not a deemed distribution under section 72(p)(2)). • Any other Information required to comply with the applicable laws and regulations. • The Plan Sponsor agrees to comply with the Final IRS 403(b) regulations which were generally effective January 1, 2009. • The Plan Sponsor agrees to provide Voya with a list of all issuers approved to issue 403(b) contracts to Participants or beneficiaries under the 403(b) Plan and Voya agrees to cooperate with respect to sharing information as described in this section. The Plan Sponsor agrees to identify VRIAC and/or Voya Institutional Trust Company as an approved Investment Provider and the Voya Contracts as available under the Plan to receive both ongoing contributions and contract exchanges in a written Plan as required by the January 1, 2009 403(b) regulations or any extension of such date.. • The Plan Sponsor agrees to partner with Voya and other approved Providers and, and if applicable, any third party administrators to develop both procedures and agreements to share Participant information, as required by the 403(b) regulations, including the Information mentioned above, and any other Information necessaryto comply with the new 403(b) regulations. • The Plan Sponsor agrees to establish a written Plan that covers both required elements and any optional features and to amend the Plan as may be necessary from time to time. • The Plan Sponsor agrees to review any applicable state laws and local laws and collective bargaining agreements regarding any provisions about exchanges of Participant 403(b) accounts. • Voya agrees to request information regarding a prior 403(b) contract from the prior issuer atthe time of an exchange into any Voya Contracts and provide information to any successor issuer in any subsequent exchange transaction out of any Voya Contracts. In the absence of available information regarding all or any portion of a 403(b) contract, Voya shall rely on the rules described in §1.403(b)-6(d)(3) of the Final Treasury Regulations. Page 13 of37 Order#200338 TEM Bundled 12/012021 TM: DCPLNINSTVPLANINIT PLAN SERVICES AGREEMENT - DESCRIPTION OF SERVICES VOYRRINANCIAL OPTIONAL SERVICES 1. Participant Eligibility Tracking Service A. How it works This Service is required if using Participant Investment Advisory Service or Asset Allocation Made Easier as the Plan's Qualified Default Investment Alternative. Contribution Rate Change service also required for this service. The Plan must be active on Voya's record keeping platform for the Eligibility Service to begin. Until this service begins, Voya is not responsible for providing notification to Participants. if elected, Voya will review Your Plan documentto ensure compatibility with the service, and evaluate Participant eligibility based on the definition of eligibility and entry dates as outlined in the Plan document. This service is subject to Voya approval. At the time You transition the Plan to Voya, You will decide whether an employee is eligible for Your Plan. Once the implementation of Your Plan with Voya is complete, Voya will evaluate eligibility for newly eligible Participants based on the Plan's definition of eligibility and entry dates. Participants will be notified of their eligibility once they have completed all requirements outlined in Your Plan document. Notices of eligibility will be sent to Participants thirty (30) days prior to their Plan entry date. If the census data is provided to Voya less than thirty (30) days prior to a Participant's entry date, then the notices will go out once census data is received. Non -enrolled Participants will receive reminder notices of their eligibility, Including information on how to enroll, on each anniversary of their eligibility date. Eligibility notification for Employer contributions will be reported to Your payroll directly and not to the Participant. The notification for Employer contributions will be provided on the Payroll Feedback File that Is sentjust prior to the Participants entry date. This will be based on your Payroll Feedback File delivery schedule. If eligibility requirements are immediate we will provide notification as soon as administratively feasible. This service supports monitoring of part-time employee eligibility when the employee classification is identified and tracked as its own group in Voya's recordkeeping system. The eligibility service functionality can include the part-time exclusion in accordance with applicable law. Voya must receive applicable hours on an ongoing basis to support this provision unless plan elected Voya's equivalency hours option. You understand and acknowledge that Voya in providing this service is not exercising any discretion and is therefore not acting as a fiduciary when providing this administrative service. You are ultimately responsible for final determination of eligibility for Plan participation. B. Your responsibilities In addition to providing timely and accurate Information for this service, You will be responsible for the following: Upon transition of the Plan to this service, You will provide Voya with anniversary year to date and Plan year to date hours for all employees through the effective date of this Agreement. Subsequent submission of hours will be required on a pay period to date basis. • You are responsible for monitoring the Plan entry date window. You are responsible for notifying Voya of all rehired employees so that employee status can be reflected properly with Voya • You are responsible for notifying Voya when Participants in an ineligible classification move to an eligible classification so Voya's systems will recognize these employees accordingly. • You are responsible for submitting to Voya census data for eligibility tracking for all employees with each payroll. If census data is not submitted with each payroll, Voya will not provide this service. Therefore, You will be responsible for tracking eligibility until such time as census data is submitted to Voya. C. What's not covered This service is not available to You if Your Plan document contains any one of the following provisions: • Participant eligibility notification will be limited to the employee deferral contribution type. Participants will not receive written notification of eligibility to make non -deferral contributions. • Eligibility of an Employee to receive Employer contributions prior to an Employee's eligibility to make deferrals. • Account allocation conditions for a contribution (e.g., last day, 1000 hour, etc.). • This service does not include monitoring of eligible classes of employees (e.g., union employees). • Eligibility with an entry date Immediately after working 1000 hours (where completion of computation period not required). • Different eligibility criteria by more than 4 groups. • Different eligibility criteria for deferral sources. Page 14 of 37 Order #200338 TEM Bundled 12/01/2021 TM: DCPLNINSTL/PLANINIT OPTIONAL SERVICES (Continued) 2. ACH Debit If elected in the Service Profile, an electronic funds transfer is Initiated from Your bank account(s) specified in the Service Profile A. Obligation of the Plan Sponsor/Trustee Voya is authorized to promptly execute Plan Sponsor/Trustee instructions received via the Internet or U.S. Mail in a format acceptable to Voya. Voya processes requests the same day if received by Voya prior to the close of the New York Stock Exchange (NYSE) on any daythe NYSE is open and transfer funds to the operating account at JP Morgan Chase Bank in New York. By providing bank account Information for ACH Debit and signing this Agreement, the Plan Sponsor/rrustee authorizes Voya access to the customer bank account information that is included in the Service Profile for the purpose of executing an ACH Debit each time that remittance information is received for processing by Voya. All instructions received after this time will be deemed to have been received on the next Business Day. B. Cancellation or Amendment Voya shall use reasonable efforts to act on authorized requests to cancel or amend instructions received provided that such requests are received in a timely manner. However, Voya assumes no liability if the request for amendment or canceliatlon cannot be satisfied. C. Errors Voya shall assume no responsibility for failure to detect any erroneous instructions provided that Voya complies with the instructions as received. It shall be Your responsibility to notify Voya that a user ID and password are no longer valid or secure. D. Fees for Rejected ACH Debits In the event Your bank notifies Voya that it is unable to process an ACH Debit and such reject results in a fee being charged to Voya by either Your bank or Voya's bank, You agree that You shall reimburse Voya for all fees and expenses associated with the rejected ACH Debit. E. Terms of Use Voya will provide You with instructions for the use of the ACH Debit service and reserves the right to modify the processes and workflows from time to time with notice to You. 3. Automatic Enrollment Service/Automatic Rate Escalator Service The Contribution Rate Change Service is required for this service. The Plan must be active on Voya's record keeping platform for the Automatic Enrollment / Automatic Rate Escalator Service to begin. Until this service begins, Voya is not responsible for providing notification to Participants. If the Automatic Enrollment Service is elected, Voya will automatically enroll Participants thirty (30) calendar days after all Plan requirements are met. If You have elected the Participant Eligibility Tracking Service this will he the Participant's Plan entry date. If the Plan's service or entry date requirements together are 1 month or less for any Participant In the Plan, Automatic Enrollment will occur thirty (30) calendar days after the entry date. If the Plan is not using the Participant Eligibility Tracking Service the Automatic Enrollment date will be thirty (30) calendar days from the time census is provided to Voya, The thirty (30) calendar day period shall start on the date that Voya generates the notice before It is mailed to Participants and automatic enrollment will occur after the thirty (30) day period is complete unless the Participant opts,out of the service. If the Automatic Rate Escalator Service is also elected, Voya wilt automatically increase the deferral percentage for Participants who have been automatically enrolled. Participants will also be reminded fourteen (14) calendar days prior to being automatically enrolled or increased. If Your Plan currently does not contain provisions which would permit automatic enrollment, please contactYourdocument provider to amend Your Plan Document. Once the Plan Document has been amended, Voya will be able to offer this feature. Election of this feature in the Service Profile does not add this service to the Plan. This service would begin once the implementation of Your Plan with Voya is complete. As fiduciary, You acknowledge that You are responsible for ensuring that the Automatic Enrollment Service complies with Your state laws in regards to wage withholding. The payroll withholding laws of Your state should be reviewed to determine if deductions without an employee's written consent are permitted, prior to implementation of this program. 4. Automatic Account Re -alignment Service Automatic Enrollment Service and/or Automatic Rate Escalator Service must be elected in order to apply the Automatic Account Re -alignment Service. This service will apply to Participants In the Plan that have not affirmatively opted out of the re- alignment. This would Include Participants who are eligible but not participating In the Plan, as well as those with an election less than the percentage identified in the Plan. If Your Plan offers multiple elective contribution sources (i.e. pre-tax and Roth), then the Participant's deferral rate in these sources will be combined for the purpose of determining their total current contribution rate. Any increase made will apply to the pre-tax deferral money source. NOTE: This service is not available to Plans offering traditional after-tax contributions. Participant notification shall be sent on the date indicated In the Service Profile providing the Participant the opportunity to opt out of the re -alignment service. If no action is taken on behalf of the Participant within thirty (30) calendar days beginning on the notification start date, and the Participant's deferral rate is below the Plan's automatic enrollment rate then the modified automatic Page 15 of37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTLIPLANINIT OPTIONAL SERVICES (Continued) deferral will be applied to the Participant's account and reported on the next scheduled payroll feedback file. For a Plan that has Automatic Rate Escalator Service, the deferral rate escalation schedule will be applied thirty (30) calendar days after the Participant Notification Start Date indicated in the Service Profile. The actual increase will take effect on the date indicated in the Plan. Please note that any Participant who has deferred the maximum amount allowed by the Plan within thirty (30) calendar days of the Participant Notification Start Date will not be included in the Automatic Account Re -alignment Service. S. Investment Reset Service (only available to Plans subject to ERISA) This service is not available in conjunction with option 2 in the Plan Installation/Asset Transfer section of this Agreement, or If Asset Allocation Made Easier is used as the QDIA for the Plan. To elect this service the Plan must have a Qualified Default Investment Alternative (QDIA) as the default option. If elected, Voya will automatically invest existing and future amounts in a Participant's account in the QDIA unless the Participant has opted out. The Investment Reset Service will apply to all active Participants, regardless of whether the Automatic Account Re -alignment Service applies to their account under the Plan. This service will not apply to inactive Participants in the Plan. Investment reset applies to all funds in which a Participant may Invest except those funds that have specific trading restrictions or are subject to advisory services. Examples of these funds include, but are not limited to funds under a Participant Investment Advisory Services program, Asset Allocation Made Easier, Guaranteed Accumulation Account, Self -Directed Brokerage Option, Company Stock or Voya Lifetime Income Protection Program. 6. Investment Allocation of Future Contributions and Interfund Exchanges You have the ability to place restrictions on the frequency by which a Participant can make investment allocation changes for their future contributions or interfund exchanges. Please contact Your Voya representative if You wish to implement these limits. Note: Any employer directed sources will not allow for interfund exchanges or future investment allocation changes by the Participant 403(b) Plans only You authorize our acceptance of Participant initiated exchanges between the 403(b)(1) fixed annuity contract and the 403(b)(7) custodial account, or vice versa, under Your Plan, 7. Temporary PIN Delivery Voya requires a PIN for phone services and first time online account registration. Participants are sent a PIN via U.S. Mall after enrollment. Temporary PINS can be delivered to Employees at Your organization's email address when an email domain registered to Your organization Is provided. 8. Online Beneficiary Storage If elected, (a) Voya will store Participant's beneficiary information that the Participant enters into Voya's Participant Website on a prospective basis only, (b) Voya will not accept Participant beneficiary Information submitted on paper forms unless the request is from a married Participant electing a non -spousal beneficiary. Please note that Plan Sponsor sign off is required for all death benefit payments from the Plan as Voya is not serving as the book of record for Participant beneficiary designations. It is Your responsibility to ensure that the beneficiary designations are in compliance with the Code and Your Plan document. You are responsible for the administration of any spousal consent requirements. 9. Statement Messaging If Your Plan has either Floor Offset (i.e., the benefit underthis Plan Is reduced by benefits accrued under another Plan sponsored by the same employer) or Permitted Disparity (i.e., this Plan Includes a formula for allocation of certain employer contributions based on the permitted disparity (Social Security Integration) rules), Voya has the ability to include a standard message explaining either of these items on Your Participant statements. Please contact Your Voya representative if You wish to review any of these options. 10. Paperless Loans, Withdrawals and Distributions (Not available if Your Plan uses a Master Aggregator Service, or Your Plan has legacy vendors.) If You indicated in the Service Profile that Your approval is not required for loans and distributions, You desire that Voya process electronic claims for Plan distributions without requiring written instructions. A. Paperless loans, withdrawals and distributions Voya will process electronic claims for Plan loans, withdrawals and distributions without requiring written instruction. All census data requested in this Agreement must be provided to Voya within the agreed upon timeframe in order for Voya to provide this service. If census data Is not provided as requested, then this service will be discontinued. B. Process loan, withdrawal and distribution claims For Your Plan, Your procedures and rules for processing electronic loan, withdrawal and distribution claims are and will be set by this section and Your Plan document together with any further Instructions You furnish to Voya. C. Paperless procedure You instruct Voya to process claims on the following basis: If the claim states facts that meet all requirements of a form (including a computer -based form) and the most recent computer record You furnish does not state a relevant fact contrary to the claim, You approve the claim and instruct Voya to pay it. If a claim fails to meet a requirement of the form (or states a fact contrary to the most recent computer record), Voya will not process the claim. Page 16 of 37 Order #200338 TEM Bundled 12/012021 TM: DCPLNINSTUPLANINIT OPTIONAL SERVICES (Continued) D. Severance from employment You instruct Voya to process a claim for a termination distribution if the most recent computer record You furnished shows a termination date that is the same as or earlier than the date Voya processes the claim. If a termination date is not received, Voya will not process the claim for a termination distribution. E. Vesting For each Participant, You will furnish computer records (including actual hours, if applicable) sufficient to enable Voya to compute a Participant's vested percentage under the Plan solely from those records. You instruct Voya that the absence of a computer record means that You instruct Voya that the Participant may not receive a paperless loan, withdrawal or distribution. F. No spouse's consent You confirm that Your Plan does not provide for a qualified Joint and survivor annuity or qualified preretirement survivor annuity, and does not require a spouse's consent to any distribution, withdrawal or loan. G. Transactions that cannot be paperless Some transactions will not be processed in a paperless manner and will require Your approval. Some examples of these transactions Include: • Residential loans • Loans requiring additional criteria to qualify (i.e. must meet hardship for loan) • Hardship withdrawals • Unforeseeable Emergency withdrawals • Death benefit payments H. Risks You represent, warrant, and covenant that You made a carefully considered decision to assume, and will continue to consider, the risks of using the paperless loan, withdrawal and distribution service. Beyond forgeries and other frauds, these risks include (but are not limited to) risks that Voya will pay a claim that You, had You evaluated the claim other than under this Agreement's procedures, would not have approved. You may end this service with one week's notice in writing to Voya. If the United States Department of Labor revokes or changes, or an ERISA Advisory Opinion or Information Letter or a court decision calls Into question, either the conclusion or the reasoning of either question or answer D-2 of Interpretive Bulletin 75-8 (29 C.F.R. § 2509.75-8/0&A-D-2), Voya may end this service on one Business Day's notice to You. STANDARD SERVICES 1. Plan Document Unless otherwise elected In the Service Profile section, Voya will furnish a Plan document (using Voya's document) ("Plan Documents"), based on Your current Plan and instructions. Voya will prepare restatements as required under the Code and applicable regulations and procedures. The Plan Sponsor understands and expressly acknowledges that Voya exercises no discretion with respect to the restatement of its Plan Document and all changes to the Plan document incorporated into the restatement are being made at the direction of the Plan Sponsor. Non -regulatory (or discretionary) amendments are available upon request for an additional fee as outlined in Your Program Highlights and Your Fee Summary. 2. Plan Communication and Enrollment Services You must provide Participants with either an enrollment / education brochure, or the Sponsor initiated enrollment email. Both communications connect to Voya's digital educational experience ("the Digital Experience"), which includes Plan Highlights, product disclosure material, fund one -page summaries and fund performance. Participants will be Informed thatfund prospectuses are available by calling Voya's Customer Care Center. The Digital Experience is available in both English and Spanish, however, some materials may only be available In English as noted on the Digital Experience. Voya will conduct group meetings virtually and/or onsite to explain Your Plan to employees based on your Plan demographics. The online enrollment service allows Participants to enroll on the internet, and can be accessed at any time by Participants. Voya will provide You with an automated report showing Participants who have enrolled via the internet. It is Your responsibility to update the payroll system to reflect these Participant enrollments. Please ensure these employees are eligible to participate in the Plan before sending Voya payroll contributions. Submission of census data Is not required for this service. 403(b) Plans only You have responsibility for providing Your employees with any "Universal Availability" notices required under the Code and related Regulations for which the Plan is subject. Page 17 of 37 Order #200338 TEM Bundled 12/01/2021 TM: XPLNINSTUPLANINIT STANDARD SERVICES (Continued) 3. Contribution processing services You must furnish all requested census data before the date contributions are submitted to Voya. Upon receipt in Good Order, Voya will allocate contributions to Participants under the Plan. Contributions will be acknowledged in writing to You within two (2) Business Days of receipt. If the corresponding data file is not received in a timely fashion and is not in Good Order, You will be notified. If contributions and the corresponding data file are sent prior to the establishment of Participant accounts or are not received in Good Order, the contributions will be held uninvested up to ten (10) Business Days. If account(s) are not established within ten (10) Business Days or the contributions and corresponding data file continue not in Good Order, the contributions will be returned to You. Department of Labor regulations require that contributions and loan repayments (other than union dues) withheld from an employee's wages or paid to the employer by a Participant must be sent to the Plan on the earliest date these contributions can reasonably be separated from the employer's general assets. Small Plans, Plans with fewerthan 100 Participants atthe beginning of the Plan year, may avail themselves of a safe harborthat permits such assets to be deposited no later than the 7th Business Day following the day on which the contributions are received by the employer, or the 7th day following the date that such amounts would have been payable to the employee in cash. Specific rules apply for when 457(b) deferral elections can begin. Generally the requirement is that the election be made by the last day of the month prior to the month in which the deferral is implemented. You are responsible for ensuring that payroll contributions representing the deferral elections are made in compliance with this requirement. You understand that once contributions are made to the Plan, they can only be distributed based on the Plan distribution rules. You are responsible for clearly communicating to employees the time frame for opting out of the Plan. A. What's not covered Voya requires one electronic fund transfer per payroll file. Multiple locations may result in a pricing change. Any variation of this requirement will not be processed. Voya's services do not include computing or monitoring: • employer matching contributions with each payroll: and contributions under a new -comparability or age -weighted formula. B. Voya has no responsibility for missed or late contributions You must remit contributions in a timely manner in accordance with Your Plan and applicable law. Notwithstanding anything in this Agreement to the contrary, Voya will have no duty or authority to collect any contributions. Voya will have no duty or authority to inform You or anyone of any facts concerning any contributions that were not remitted to Voya, or that were remitted late. C. Return of contributions for mistake of fact Voya will, on Your written instruction, return to You contributions that You instruct were made by Your mistake of fact. You will pay Voya's processing fee based on our standard hourly rates to process Your instructions. Any return of contributions will be subject to loss, and applicable Investment fees and charges (including deferred sales charges). D. Computing allocation amounts For an additional fee upon Your request, Voya will calculate the amounts that will be allocated among Participants based on the census data that You provide and the amount that You have decided to contribute. Voya will compute the allocation amounts only for integrated or pro rate profit sharing contributions and year-end match at a set percent that does not change. E. Partnership allocation (if applicable) You alone are responsible for determining and making partnership allocations (if any). F. External payroll vendor If You elect to have Voya work with an external payroll vendor, You must notify the payroll vendor that Voya will contact them. Your payroll vendor may require Your authorization to work directly with Voya. Voya's ability to work with Your external payroll vendor is dependent upon the vendor's willingness to do so. 4. Plan Required Communications Voya shall furnish eligible plan communications to participants in accordance with the requirements contained In the Department of Labor (DOL) Default Electronic Disclosure Final Rule. Those communications that cannot be provided electronically will be delivered in paper format via U.S. Postal Service. Participants in 403(b) Non-ERISA Plans, or Plans linked to a 403(b) Non-ERISA Plan will receive their statement via U.S. Mail. A. Overview Except as otherwise provided by this Agreement, Voya will use its records to generate the following reports: Participant statements will be generated and posted online quarterly, accessible via the Participant Website. Participant activity confirmations for recurring and non -recurring transactions will be posted to the Participant Website. Page 18 of37 Order#200338 TEM Bundled 12/01/2021 TM: XPLNINSTUPLANINIT STANDARD SERVICES (Continued) Participants with an email address on file will be mailed an Initial Paper Notice identifying the email address to be used for electronic delivery notification. Participants can change their email address or opt out of electronic delivery by updating their preferences on the Participant Website or speaking with a customer service representative. Subsequently, these Participants will receive an electronic Notice of Internet Availability, indicating a communication is ready for viewing on Participant Website. If a Participant does not have an email address on file, or opted out of receiving communications electronically, then communications will be mailed to the participant's address of record using the U.S. Postal Service. Plan level confirmations Including transactional activity will be made available to You via paper as well as the Plan Sponsor Website. Sponsor Activity Report will be made available to You via the Plan Sponsor Website. B. Valuation Voya will compute the value of individual Participant accounts as of each Business Day. C. Payroll Feedback File Payroll feedback files and reports are posted to the Plan Sponsor Website coinciding with Your payroll frequency. If You have multiple payroll frequencies, this report will be based on the most frequent payroll. If reporting is requested separately by division/sub-location in the Service Profile, feedback files will be available on one frequency only. S. Investment Fund and Product -Level Prospectuses Regulatory Documents, which include fund and product -level prospectuses, reports and supplements, will be delivered electronically via Sponsor Web. The documents are delivered both on an annual, and ad hoc basis, as required. Each time a new document is posted for review an e-mail will be sent. 6. Ad Hoc Mailing Services Upon request, Voya may perform ad hoc mailing services in accordance with Your direction on behalf of the Plan. In performing ad hoc mailing services, You agree that Voya is not a fiduciary within the meaning of ERISA, the Investment Advisers Act of 1940, or any state law. Moreover, You agree that Voya can rely conclusively upon any and all information provided by You, and shall not be liable for any errors In connection with the ad hoc mailing services that arise from such erroneous information. There may be an additional charge for these services. 7. Automatic Account Rebalance A. Overview This service is available to all Participants with a balance. It allows Participants to establish scheduled periodic account rebalancing to their current Investment allocations. B. Howitworks Participants may make the automatic rebalance election through the Voya Participant Website, the Voice Response System (VRS) or by speaking with a customer service associate (CSA). At the Participant's elected frequency, (which can be set up for quarterly, annually, or semi-annually) fund balances will be automatically re -aligned according to the Participant's current investment election percentages. Any Interim transfers or investment elections made by the Participant will turn off the functionality. When the Participant processes a transaction through the Participant Website, a pop up message alerts the Participant that the automatic rebalance will be cancelled. C. Restrictions Some fund(s) may not be available for automatic account rebalance. This service will not bean option for Participants who are enrolled in the discretionary managed account option of a Participant Investment Advisory Services program„ Asset Allocation Made Easier, Self Directed Brokerage Account or Voya Lifetime Income Protection Program. CONVERSELY, Participants who are enrolled in the automatic account rebalance feature who subsequently enroll in a discretionary managed account option of a Participant Investment Advisory Service program, Asset Allocation Made Easier or Voya Lifetime Income Protection Program will have this feature turned off. S. Contribution Rate Change Service This service allows Participants to make contribution rate changes via the Participant Website. You must furnish Voya current Participant contribution rates. NOTE: Voya's systems will allow these changes to be entered by Participants at any time. If Your Plan document restricts the frequency by which a change can occur, this would be monitored via Your payroll process. Voya will provide You automated reporting showing Participants who have modified their contribution rate via the Participant Website. It is Your responsibility to update Your payroll system to reflect these new deferral rate changes. Page 19 of37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT STANDARD SERVICES (Continued) 9. Participant Directed Contribution Rate Escalator A. Overview The Contribution Rate Escalator allows Participants to elect automatic increases in deferral rates by logging onto the Participant Website and indicating the frequency and amount of the deferral increase. B. How it works Voya will send a reminder to the Participant 14 calendar days prior to the automatic increase. The Contribution Rate Escalator does not apply to catch-up contribution elections. If there is a conflict between a Participant's Contribution Rate Escalator election and the Plan's limits, the Participant's rate Increase will be cancelled. 10. Loans If permitted under the Plan, Voya will process loans in accordance with information outlined in the Service Profile, Plan document and applicable loan policy/loan provisions. Loan payoffs received by ACH debit or check, if applicable, are subject to a seven business day hold which may impact loan availability during that period. A. General Purpose Loan Term Section 72(p) of the Code requires Plan loans to be repaid in full no later than five (5) years from the date of the loan (except for loans used to acquire principal residence of the Plan Participant). Accordingly, it is necessary to provide for a loan repayment term that is less than sixty (60) months in order to meet this requirement. B. Loan Default Monitoring Voya will actively monitor loans. You confirm that Your Plan document and applicable loan policy or provisions define the cure period for missed loan repayments as the last Business Day of the calendar quarter following the calendar quarter In which the loan payment was due (the "Cure Period") and that You have adopted the Cure Period as the default period on all existing and future loans. Loans will be defaulted under the following conditions: • Participants are behind in their payment schedule where any payment is not paid in full before the end of the Cure Period in which the payment was due. • A loan is not paid off by the last Business Day of the month following the month of its maturity date. You must follow the loan amortization schedule generated by Voya for repayment. Voya will not code a loan as in "default" in any year after the year the default actually occurs. Reports to Plan Sponsor — You will receive the following reports on a monthly basis (as applicable): • Missed Loan Payment Report • Delinquent Loans Warning Report • Loans Past Maturity Date Report • Deemed/Offset Loans Report • Payroll Feedback File and Report (based on payroll -frequency) Notification of Default to Participants —Voya will provide the Participant with the following (as applicable): • Warning letters (notffying ofpast maturity date or missed payment as of last quarter) • Loan Default Confirmation C. Loan Interest Rate Monitoring Service Voya will update the loan interest rate on the Plan based on the information You furnished in the Service Profile. The loan interest rate for Your Plan will be updated on the first Business Day of the month following the month in which a change in the index occurs. It is Your responsibility, at all times, to determine whether this loan interest rate formula continues to be appropriate for the Plan, and for notifying Voya of any changes in the method used to set the loan Interest rate. D. Loan Approval All loan requests must be approved online through the Plan Sponsor Website. While signed paperwork should be returned to Voya, the Plan's online approval is still valid if such paperwork is not returned to Voya. Voya may rely conclusively on any direction provided by the Authorized Plan Sponsor Representative (as elected In the Service Profile) or any designated approver. E. Loans not limited to specific source or fund Voya processes plan loans from the Funds in a participant's account on a pro -rats basis. Plan loans cannot be processed from a specific fund or source. Unless otherwise directed in writing by a plan sponsor or stated within the terms of a plan document, Voya shall process participant loans from all available sources under a plan. Page 20 of 37 Order#200338 TEM Bundled 12/01/2021 TM: DULNINSTUPLANINIT STANDARD SERVICES (Continued) 11. Voya's Notice Service — Participant Notification The following Services shall be provided by Voya subject to Sections 2.1, 9.1 and 9.3 of this Agreement. In addition all Participant data necessary to perform the Notice Service must be provided to Voya no later than sixty (60) days prior to any regulatory notification timing requirement. The Plan must be active on Voya's record keeping platform for the Voya's Notice Service to begin. Until this service begins, Voya is not responsible for providing notification to Participants. Standard Service This service (as well as Participant Eligibility Tracking) is required if Plan Is using any Participant Investment Advisory Services Program or Asset Allocation Made Easier as QDIA, or Automatic Account Re -alignment Service. If elected, Voya will provide regulatory notices to covered employees for a Plan that offers any combination of the following: • Qualified Default Investment Alternative (QDIA) • Automatic Enrollment Service with or without Automatic Rate Escalator Service • Participant Eligibility Tracking Service for a Plan with an ADP/ACP safe harbor allocation method Initial Notices provide Participants with an explanation of the respective feature and may include the following: the percentage of employees' pay to be contributed to the Plan, the investment option(s) available, and the default investment If an employee chooses not to enroll and select an Investment option. The notice will also advise employees of their right to revoke the automatic withholding (if applicable) and their rights to increase, decrease or stop contributions and instruction on how to do so. Annual Notices are required to be provided to Participants who have been default enrolled into a QDIA fund and/or are automatically enrolled, or subject to an automatic Increase schedule. These notices will remind Participants of their deferral amounts and of their right to increase, decrease or stop these contributions, also including the procedure to do so. Note that Voya will not provide: • Annual notices required for an ADP/ACP safe harbor. • Initial QDIA Notices if Automatic Enrollment Service and Eligibility Tracking Service not used. • Notices to Participants defaulted into a QDIA fund who were enrolled prior to the addition of the notification Service with Voya (unless data Is provided by the Prior Recordkeeper or Plan Sponsor at time of conversion). • Annual notices to Participants automatically enrolled prior to transition to Voya where Voya did not receive such data upon transition. • Notices to Participants who have made an affirmative election out of automatic enrollment. 12. Interfund Exchanges Voya has adopted an Excessive Trading Policy and monitors transfer activity. A violation of the policy could result in a restriction of electronic transfer privileges. Please review Voya's Excessive Trading Policy for more details. Fund level restrictions will apply If the Plan has elected the equity wash option and has made available competing investment options. Please review the Sponsor Information Booklet for more details. 13. Administrative Holds Restricting Participant Accounts (Administrative Holds): The Plan Sponsor directs Voya to place an administrative hold on a Participant's account upon receipt of a signed or draft domestic relations order (DROs) or joinder, federal tax levy, or upon the receipt of other types of court orders that assert a claim to Plan benefits. Placing an administrative hold on the Participant's account(s) will prevent the Participant from taking distributions, including loans. The Participant will continue to have the abil tyto make allocation changes and fund transfers to his/her account. With the exception of DROs, the restriction will remain on the account until such time that Voya is advised to remove the administrative hold either by the Plan Sponsor or upon receipt of a court order indicating that the matter has been resolved and the hold is no longer needed. Administrative holds placed on a Participant's account due to DROs shall remain on the account for a period up to 18 months, or if earlier, until the date Voya is advised to remove the administrative hold either by the Plan Sponsor or a court order Indicating that the matter has been resolved and the hold is no longer needed. If a subsequent order is received a new 18-month period will be activated. Notwithstanding the foregoing, with respect to Joinders Issued, the restriction will not be removed until Voya receives either: (1) a QDRO; (2) a court order vacating/dismissing the joinder; or (3) or a final judgment that awards the Participant all of the Plan benefits. 14. Power of Attorney, Guardianship or Conservatorships Voya will determine the validity of the documentation received relative to a power of attorney, guardianship or conservatorship. Once the documentation is determined to be in Good Order, Voya will set up or modify the existing account as directed in the documentation received. Page 21 of 37 Order #200338 TEM Bundled 12/012021 TM: DCPLNINSTUPLANINIT STANDARD SERVICES (Continued) 15. Plan Distribution Services A. Voya will compute minimum distribution amounts Voya will compute required minimum distribution (RMD) amounts required under IRC § 401(a)(9) based solely on the data You furnish to Voya and is recorded in Voya's record keeping system. Please refer to the Administrative Procedures Manual for further details. Voya will furnish You a report showing which Participants might be required to receive a distribution under IRC § 401(s)(9). You must review the report, confirm the data, and instruct Voya In writing of any discrepancies in the report. When You confirm the accuracy of the data in writing, Voya will accept this as Your direction to process distributions from the Plan in accordance with IRC § 401(a)(9). With respect to 403(b) Plans, Voya will calculate the RMD amount but not distribute the RMD amount unless the Participant requests such payment. For a Participant already receiving minimum distributions, You must (i) provide Voya specific written instructions to calculate and process the RMD and (ii) ensure that Your prior recordkeeper has provided Voya all necessary historical data on the Participant's minimum distributions. B. Withdrawals and distributions not limited to specific source or fund Voya processes withdrawals and distributions from the Funds in a participant's account on a pro-rata basis. Withdrawals and distributions cannot be processed from a specific fund or source. Unless otherwise directed in writing by a plan sponsor or stated within the terms of a plan document, Voya shall process withdrawals and distributions from all available sources under a plan. C. Services offered to retiring and exiting employees Voya shall offer specialized services to retiring and exiting Participants through registered representatives of Voya Financial Advisors, Inc. an affiliated broker -dealer (VFA). The registered representatives have specialized knowledge regarding options availabieto these Participants including the benefits of remaining in the Plan, specific distribution rules, taxation of distributions, investment alternatives and retirement planning. At the request of the Participant, these registered representatives may also explain and offer the rollover IRA products through VFA. If the Participant elects certain distribution options that result in the sale of an IRA product, Voya and its affiliates may receive additional revenue. In addition, employees of VFA may receive compensation in connection with a Participant who elects to remain invested in the Plan or who purchases an IRA product through VFA. In addition, retiring and exiting Participants will also have access to the online tool that active Participants may access, the Personal Financial Dashboard, so that they may aggregate, organize, and monitor their financial accounts in one convenient location. Individuals can call Voya at the toll -free number highlighted in the tool with any questions about this tool, and, should they ask for help with their broader financial needs, Voya has additional phone based services available through financial advisors registered with VFA. 16. Asset Consolidation Services Voya shall offer consolidation services to the Plan Participants to helpthem understand options available for consolidating outside qualified Plan accounts into the Plan. 17. Financial Counseling Services Financial counseling services are also available to active and terminated employees through VFA. These services, some of which are fee based, are provided by licensed financial advisors and, as agreed upon with the individual employee, include an analysis of the employee's complete financial situation and allowfor customized goal planning potentially incorporating retirement income planning, estate planning, social security and pension analysis. Fees for this service are charged directly to the employee and will not be withheld from any Plan Participant account. This service Is offered outside of the record keeping services described in this Agreement and is not subject to ERISA. In order to facilitate the delivery of the financial planning service, Voya may use the Participant data to the extent and for purposes authorized by the Participant whose data is being used. 18. Personal Financial Dashboard Participants will have access to an online tool, the Personal Financial Dashboard, so that they may aggregate, organize, and monitor their financial accounts In one convenient location. Individuals can call Voya at the toll -free number highlighted in the tool with any questions about this tool, and, should they ask for help with their broader financial needs, Voya has additional phone based services available through financial advisors registered with VFA. 19. Plan Accounts A. Plan accounts Voya will keep records of Plan accounts based on the information provided from time to time by or on behalf of You or Participants. The records will setforth transactions underthe Plan that affectthe balance of an Individual Participant's account. Voya will process the periodic repayment amountfor all Plan loans and the allocation of the repayment among the applicable investment alternatives, and will advise You of the resulting payroll deduction to be made for such purposes. Page 22 of 37 Order#200338 TEM Bundled 12/012021 TM: DCPLNINSTUPLANINIT STANDARD SERVICES (Continued) B. No accrual accounting Voya will record a change in a Plan account when it results Ina "purchase" or "redemption" of fund shares or other investment. Voya will not make or keep any record of a contribution receivable, distribution payable or similar accrual. All transactions are reported on a cash -accounting basis. 20. Non-discrimination Testing Services (ERISA Plans only) A. Non-discrimination testing If Your Plan is subject to one or more non-discrimination requirements under the Code. Voya will assist You in testing Your Plan's compliance with applicable requirements by taking the actions stated by the provisions below. Additional fees may apply for certain complex testing scenarios such as multiple test "runs" or where disaggregation is required. Where additional fees would apply, an estimate of these fees will be provided. Additional testing referenced above provided upon request only. B. Tests to be performed Unless otherwise elected in the Service Profile section, Voya will perform once each year Actual Deferral Percentage testing under IRC § 401(k)(3); Actual Contribution Percentage testing In accordance with IRC § 401(m); test for the Limit on Elective Deferrals under IRC § 402(g); and testing on the Annual Additions Limit in accordance with IRC § 415(c). Voya will not aggregate this Plan with any other Plan for testing purposes. Voya will not perform any test required or permitted under IRC § 401(a)(4), 414(s), or 410(b). Additionally, upon request, Voya will identify Highly Compensated Employees, perform a uniform Qualified Non -Elective/ Matching Contribution (QNEC/QMAC) calculation at year end, and offer one top-heavy test per year. C. You will furnish the necessary information You will complete and return to Voya the census data request package necessary to perform the above listed tests, in Good Order within 30 calendar days after Your Plan year-end. If Voya does not receive the requested census data in Good Order within 30 calendar days after Your Plan year-end, Voya is not responsible for completing the tests under IRC § 401(k)(3) or § 401(m) before the 2r/z month after Plan year-end original corrective -distribution deadline. Voya is not responsible for following up with You if Voya has not received the requested census data. D. Testing reports After the close of each Plan year, Voya will send You a report that says whether Your Plan has "passed" or "failed" each of the tests, and, If the ADP test or ACP test is not satisfied, what actions You may take to meet that test. You must Instruct any action You desire to meet any otherwise failed test. For "Interim" tests, Voya will send You the "passed" or "failed" report, but need not give detall on correction methods until the year-end report. E. Top-heavy testing If the Plan is the only Plan You ever maintained, Voya will perform top-heavy testing for any determination dates that occur after Voya became Your recordkeeper and has received all prior assets and records, and so long as Voya is the service provider on Your Plan's determination date. F. Top-heavy contributions , If the Plan Is top heavy, You musttimely make the required top-heavy contribution. G. No interim top-heavy tests Voya does not provide interim top-heavy tests under any circumstances. H. Interim ADP/ACP tests On Your written request, Voya will provide interim ADP and ACP testing. Please note: Interim testing based on year to date activity — hypothetical and projected calculations not available. 21. Form 5500 Services (ERISA Plans only) A. Form 5500 Unless otherwise elected in the Service Profile section, Voya will prepare the Form 5500 based upon information available for the Plan as of the end of the Plan year for Your review, approval and filing with the Department of Labor (DOL). The Form 5500 is prepared on a cash basis which is a reflection of the activity that occurs during the Plan year. Voya will not reflect accruals on the Form 5500. In accordance with DOL electronic filing requirements, Voya will provide the Form 5500 electronically to the person You designate. It is Your responsibility to ensure a designated individual's e-mail address is on file with Voya. Please note that services are performed only for activity reflected on Voya's records. Assets and/or records maintained elsewhere are not within the scope of Voya's services and may require You to secure services to ensure an accurate Form 5500 is prepared that combines all data for Form 5500 filing purposes. Page 23 of 37 Order #200338 TEM Bundled 12/012021 TM: DULNINSTUPLANINIT STANDARD SERVICES (Continued) B. Audit When ERISA so requires, You must engage an independent qualified public accountant. For example, if You have more than 100 eligible employees, ERISA might require You to engage an independent accountant to examine Your Plans' financial statements. Also, if more than 5 percent of Your Plans' investments are non -qualifying investments, ERISA might require You to engage an independent accountant to examine Your Plans' financial statements. Voya will not engage any accountant on behalf of You or Your Plan. C. Separate Account Annual Report You consent to receipt of the separate account annual statement which includes a statement of assets and liabilities of the separate account via the Plan Sponsor Website. 22. Plan Sponsor Website Authorized Plan Sponsor Representative The Authorized Plan Sponsor Representative that You Identified In the Service Profile is the person at Your organization who is authorized to initiate and update transactions, e.g., changes to "Mail Delivery Preferences" for Your Plan, and control "Access Authorization" to Your Plan and Participant Information made available electronically via the Plan Sponsor Website. The Access Authorization feature will also allow this contact to assign access to other individual users within Your organization and to determine the appropriate permission level of each subsequently authorized individual user to the Plan Sponsor Website. This contact will be responsible for monitoring the activities of each authorized user and permission level assigned to each of those individual users. Designating an Authorized Plan Sponsor Representative to the Plan Sponsor Website constitutes and shall be deemed an acceptance of the terms and conditions set forth in this Agreement. Activating, deactivating and changing an individual's access or transactional capabilities to the Plan Sponsor Website may be made by the Authorized Plan Sponsor Representative directly online. 23. Fee Disclosure A. Participant Fee Disclosure (ERISA Plans Only) Voya provides fee disclosure in accordance with DOL regulation §2550.404a-5. Voya also provides a data capture facility "Fee Data Entry (for 404a-5 Participant Disclosure)" available through the Plan Sponsor Website, to allow You to provide non- Voya Plan service fee information to Voya. This information is for fee disclosure reporting purposes only and will not support actual fee processing. Voya will post fee disclosure to the Sponsor and Participant Websites . B. Sponsor Fee Disclosure Post monthly Plan -level fee and expense disclosure reports (as outlined in DOL regulation§2550.408b-2) to the Plan Sponsor Website (and third party administrator website, if appropriate). 24. Default Investment Option/Immediate Deposit A. Default Investment Option For available investment options and applicable disclosure, please refer to the investment section of Your Program Highlights and Fee Summary. Please consider these options carefully, as You are making an Investment selection for the affected Participants. Please note Voya does not monitor the ongoing appropriateness of the investment(s). If a Qualified Default Investment Alternative (QDIA) is selected, Voya will provide notices to Participants regarding Your selection of a QDIA option in accordance with applicable regulatory guidance. Further, it Is Your responsibility to ensure that the Default Investment Option selected (or deemed selected) meets the applicable requirements of a "Qualified Default Investment Alternative" under Section 404(c)(5) of ERISA. The notices provided are described in the Section entitled: Voya's Notice Fulfillment Service -Participant Notices. B. Immediate Deposit Voya will establish a Participant account when assets or instructions are received for a Participantforwhom an account has not been established. You authorize Voya to obtain the required information from the Authorized Plan Sponsor Representative. Voya is directed to allocate the newly established Participant accounts using the default Investment option selected unless the Authorized Plan Sponsor Representative directs Voya to do otherwise. To establish Participant accounts using this feature, Voya requires Participant information to be received in a secure manner and meet Voya's file format and Good Order requirements. An electronic file is required. C. Target Date Sulte In choosing a target date suite of funds as the default investment option for future contributions, immediate deposit, or automatic enrollment, it is important to understand the following: Each Participant account will be assigned a specific portfolio and the portfolio assignment is determined using the date of birth for each Participant which must be provided by the prior provider or You. Page 24 of37 Order#20033a TEM Bundled 12/0112021 TM: DCPLNINSTUPLANINIT STANDARD SERVICES (Continued) You must work closely with the prior recordkeeper to ensure the accuracy of the dates of birth provided to Voya. If a date of birth is not available for a Participant, You hereby direct Voya to default the investment election to the most conservative fund in the target date suite for such Participant. If a date of birth that Voya received is determined to be inaccurate, please provide Voya with the correct date of birth. You accept responsibility for these investment directions on Participants' behalf consistent with the terms of the Plan, understand that any protection that might have been available under Section 404(c) of ERISA may not extend to this investment direction, and agree to indemnify and hold Voya harmless from any claim that may arise from Investing these funds as directed by You. 25. Plan Conversion A. Final valuation If You maintain an existing Plan, You must furnish and certify to Voya a final valuation from the Plan's prior recordkeeper as indicated in Section 2.2 of the Agreement, You must furnish all minimum distribution information, year-to-date conversion data, and a valuation for the prior Plan year-end. B. Year-to-date Information You must furnish to Voya all year-to-date information necessary for Voya to perform non-discrimination testing for Your Plan and prepare a draft of Your Plan's Form 5500 for the conversion year. if You do not furnish this data to Voya on conversion, Voya will not perform non -discrimination -testing services, and will not compile the draft Form 5500 for the conversion year. C. Sarbanes-Oxley If the parameters of the Sarbanes-Oxley Act are applicable, Voya will provide a copy of the Sarbanes-Oxley Act Details of Participant Notification Requirements, Key Points, and Sample Participant Black Out Notification which You can use as an aid in developing and distributing a Participant communication that meets the requirements set forth in the Sarbanes-Oxley Act. You will be responsible for complying with these requirements. D. Asset Transfer Voya will Invest the transferred assets in the investment option selected for the Plan Sponsor/Trustee Account elected in the Service Profile until Participant allocation instructions are received and are in Good Order. Transferred assets will be deposited as of the date the wire Is received by Voya if in Good Order and received prior to the close of the NYSE. Transferred Assets will be allocated to Participant accounts on the same day that allocation instructions are received if instructions are received in Good Order and prior to the close of the NYSE. Any interest earned pending allocation instructions will be posted to Participant accounts on a pro rate basis unless other instructions are provided. Allocation Instructions need to be received in a secure manner and meet Voya's file format and Good Order requirements. Voya is authorized to obtain the required information from the Authorized Plan Sponsor Representative, third party administrator or the prior provider. Instructions received in Good Order and after the close of the NYSE or on a non -Business Day will be processed the next Business Day.. If the instructions do not meet Voya's file format requirements, but are otherwise deemed to be in Good Order, Voya will process the transferred assets within three Business Days from the date the Instructions are received (if the instructions are received prior to the close of the NYSE). If Mapping is elected in the Service Profile, and transferred assets are received prior to Participant data, Voya will invest the transferred assets In the Plan Sponsor/Trustee Account according to the mapping Instructions provided in the Service Profile. The transferred assets will be invested as of the date the wire is received by Voya if a Plan level breakdown by fund is provided in Good Order. If no instructions are received, the Plan assets will be deposited into the Plan Asset Holding Account until a Plan level breakdown is received and in Good Order. 26. Definitions A. "Business Day" means any day the New York Stock Exchange (NYSE) is open for regular trading. A Business Day ends at 4:00 p.m. Eastern Time or, if earlier, the time that the NYSE closes trading, subject to the following paragraph. Voya may make reasonable rules, which maybe related to business convenience, governing the time of day afterwhich instructions will be treated as received on the next Business Day, and Voya may make different rules for different kinds of instructions. Without limiting the comprehensive effect of the foregoing, any Investment instruction afterthe earlier of 4:00 p.m. Eastern Time or the time that any Fund must value its assets and price its shares will be treated as received on the next Business Day. B. "Good Order" means that instructions, data, and funds (if applicable) are complete, accurate, and In an acceptable format and received at the appropriate location, thereby avoiding the need for any research or discretionaryJudgment to be applied. Instructions received by telephone, fax, mail or acceptable electronic formats must be received in Good Order before the close of the NYSE, generally 4:00 p.m. Eastern Time, to qualify as current Business Day instructions. Any Instructions or distribution requests deemed by Voya not to be in Good Order may be returned for correction and processed upon re -submission. Page 25 of 37 Order#20033a TEM Bundled 12/01/2021 TM: DCPLNINSTL/PLANINIT ® FINANCIAL RECITALS WHEREAS, Client desires that Voya perform the Plan administration and record keeping services ("Services") as defined herein, with respect to the Plan; WHEREAS, the fees for the Services to be provided, and the assumptions underlying such Services are setforth in this Agreement and attachments thereto; WHEREAS, the Parties wish to set forth in this Agreement their respective obligations and responsibilities; NOW, THEREFORE, in consideration of the foregoing and the mutual promises contained herein, and subject to the terms and conditions set forth below, Client and Voya hereby agree as follows: AGREEMENT 1.0 SERVICES The Parties have reached agreement on the Services to be rendered by Voya, and such Services, based upon the assumptions contained therein are set forth in the "Service Profile" and "Description of Services", attached. The Fees for such Services are set forth in this Agreement and in Your Program Highlights and Fee Summary. The Parties may, from time to time, amend, supplement, or replace the "Service Profile" and "Description of Services", or any portion thereof, as provided In Section 6 of this Agreement. 2.0 CLIENT RESPONSIBILITIES 21 Provision of Participant Data. Prior to the commencement of the Services and throughout the term of this Agreement, Client shall furnish or cause to be timely furnished to Voya all client information ("Client Information") and Participant data ("Participant Data"), in a format acceptable to Voya, necessary for Voya to perform the Services. Participant Data shall mean all records and information in electronic form needed to perform services pertaining to Participants, beneficiaries and alternate payees and their benefits under the Plan. Participant Data shall be supplied by Client, any agent of Client, Including but not limited to, any prior recordkeeper, trustee, custodian, broker/dealer, insurance company, mutual fund company, third party administrator and any other entity that provided services to the Plan, Participants or created by Voya or its subcontractors in the course of providing the Services. Client Information shall mean any and all data or information that is owned or developed by or licensed to Client and that is supplied to Voya by Client. Client Information may be stored and processed by Voya at any location and on any equipment owned or controlled by Voya (or Its subcontractor). 2.2 Plan Conversion Data. With respect to existing Plans, Participant Data shall Include minimum distribution information, year-to-date conversion data and the Plan's prior year-end valuation. The final valuation must be submitted to Voya no later than eight (8) weeks after all Plan records have been transferred from the prior recordkeeper. If this Information Is not timely supplied In a format acceptable to Voya, Voya may end this Agreement upon providing Client with one (1) week's advance written notice. Voya shall not be responsible for providing any Services hereunder until Client supplies an opening valuation in a format acceptable to Voya that reconciles all contributions to and benefit payments from the Plan 2.3 Accuracy and Completeness of Participant Data. Client shall be solely responsible for the accuracy and completeness of any such Client Information and Participant Data and shall promptly furnish or cause to be furnished accurate and complete Client Information and Participant Data to correct any inaccuracies or incompleteness with respect to Client Information and Participant Data previously provided to Voya. Client shall notify Voya in writing of any claimed error with respect to any Participant Data or report within thirty (30) days of discovering the claimed error. In no event will Voya be liable for correction of any such identified error to the extent that it resulted from erroneous Client Information or Participant Data. Voya will rely conclusively on any information provided by Client or Client's representative, and shall have no duty to inquire into and is not responsible for the authenticity or accuracy of such Information or the actual authority of such person to provide it. 2.4 Duty to Provide Data on Ongoing Basis. Client, as the Plan's administrator, shall furnish or cause to be furnished to Voya on an ongoing basis accurate, complete and timely information on all matters relating to: (1) the identity of employees as they become eligible to participate in the Plan, elect to participate in the Plan, and terminate from Client; and (II) the operation of the Plan generally, that impact the Services provided hereunder. Where a test or other optional service requires additional information, Voya shall have no obligation to perform such test or service until Client provides the required information. Page 26 of 37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT AGREEMENT (Continued) 2.S Participating Employers. Client represents, warrants and covenants to Voya that all participating employers in the Plan are listed in the Plan document, and that all participating Employers are treated as one employer for purposes of Section 414 of the Internal Revenue Code of 1986, as amended ("IRC" or the "Code"). 2.6 Plan is Not a Multiple -Employer or Multi -Employer Plan. Client represents, warrants, and covenants that the Plan is not a multiple -employer Plan described in IRC § 413 or a multi -employer Plan described in the Employee Retirement Income Security Act of 1974 ("ERISA") § 3(37) or IRC § 414(f). Client understands and acknowledges that Voya cannot provide record keeping services for either a multiple -employer Plan or a multi -employer Plan. 2.7 Selection of Investment Options. Client shall be responsible for the selection of investment options under the Plan. Voya shall have no responsibility or discretion under the terms of this Agreement for the selection or oversight of any investment options that may be available for investment of assets held in trust under the terms of the Plan. Investment information or investment materials that may be provided by Voya to Client are not intended to constitute nor should they be construed as the provision of Investment advice or Investment recommendations by Voya with respect to any Investment option that Client may consider making available for the investment of assets held in the trust. All investment options selected by Client are subject to Voya's Excessive Trading Policy. 2.8 Plan Qualification for 401 and 403(b) ERISA Plans. Client represents that the Plan is an employee pension benefit Plan that has eitherthrough the adoption of a prototype Plan document, a volume submitter Plan, or as an individually designed Plan, received an opinion letter, an advisory letter or a favorable letter of determination from the Internal Revenue Service (the "IRS") that indicates that the Plan meets the requirements of Section 401(a) or 403(b) of the Code and other provisions of the Code applicable to such Plan. Client represents that a trust has been established for this Plan In compliance with ERISA § 403 and IRC § 401, and a fidelity bond has been secured as required by ERISA. Client will immediately notify Voya if the foregoing representation is not true. To the extent the Plan is not qualified, or enters into a transaction that is prohibited by ERISA, Client shall be responsible for preparation and correction of the Plan with the Internal Revenue Service and, If applicable, the Department of Labor. Voya shall be under no duty to question the measures taken by Client pursuant to this Section 2.8. To the extent Voya agrees to provide Services relating to the correction of such errors, Client shall pay Voya its reasonable expenses incurred as provided in Section 3.2(b). 2.9 403(b) Plans. The Client acknowledges that Voya does not record keep Participants' 12/31/88 balances and therefore Voya will not.include this balance when determining amounts available for hardship or non•emergencywithdrawals. 210 Securities Filings. Clientis responsible for complying with all applicable securities laws.Wfthout limiting the comprehensive effect of the preceding sentence, Voya will not file any information regarding Your Plan with the United States Securities and Exchange Commission or any State securities regulator. All reasonable requests of Voya for information in support of Client's preparation of a securities filing shall be fulfilled by Voya within thirty (30) days. 3.0 SERVICE STANDARDS AND ERROR CORRECTION 31 Service Standards. Voya represents that (f) Its Services shall conform in all material respects with the "Service Profile" and "Description of Services"; and that (ii) it will use due care in providing the Services. The Services shall'conform to prevailing Industry standards for comparable services. 3.2 Error Correction. (a) Voya Error. Voya's responsibility with respect to providing the Services Is limited to correcting errors, within a reasonable time, which result from Its computer system malfunctions, Its staff errors or are otherwise caused by Voya's negligent acts. Voya shall make a good faith effort to correct any such error as soon as reasonably practicable after identification of the error when such correction is reasonably necessary and practical under the circumstances. (b) Client Error. Voya will attempt to correct, at Client's expense, processing errors resulting from Client, or Client's representative, or otherwise caused by the negligent acts of Client; provided that Client promptly notifies Voya of such error and furnishes all data to Voya reasonably necessary to make such corrections. Client shall pay Voya its reasonable expenses incurred in making such corrections. 4.0 COMPENSATION 41 General. In consideration for Voya's performance of the Services, Client agrees to pay Voya the Fees set forth In this Agreement, and in Your Program Highlights and Fee Summary. Voya's fees are separate from and In addition to any fees under any other agreement, including an Investment advisory agreement. 4.2 Effective Date of Fees. The Fees set forth In this Agreement, and In Your Program Highlights and Fee Summary, are effective as of the Effective Date of this Agreement. The Fees may be changed by Voya at any time by providing Client with at least sixty (60) days' advance written notice. 4.3 Record Keeping Fees. Client will pay, or cause the Plan to pay Voya the fees stated in Your Plan Highlights and Fee Summary. Page 27 of37 Order #200338 TEM Bundled 12/012021 TM: DCPLNINSTUPLANINIT AGREEMENT (Continued) 4.4 Payment of Fees. Client represents and warrants that the Plan provides that fees for services rendered to the Plan shall be paid by the Plan from Plan assets unless voluntarily paid for by the Plan Sponsor on behalf of the Plan. If Client does not pay a fee within sixty (60) days from the date of the first invoice, Client instructs Voya to automatically charge all fees due and all future charges without further notice against the Plan. 4.5 Bankruptcy. If Voya receives notice that Client is subject to a voluntary or involuntary bankruptcy liquidation, receivership, or rehabilitation proceeding, that notice is Client's instruction for Voya to collect all unpaid, accrued, and future service fees from Plan assets. 4.6 Plan Discontinuance. If Voya receives notice of Client's Plan discontinuance, the notice will constitute an Instruction for Voya to collect all pending and future service fees from Plan assets. 4.7 Additional Services. If Voya provides services in addition to those set forth in the "Service Profile" and "Description of Services", attached, Voya shall be entitled to be compensated in such amount as the Parties mutually agree in a written amendment to this Agreement, in addition, the charges under this Agreement do not include Voya's fees and expenses for any costs, including legal costs, associated with considering or responding to requests for documents, providing testimony, or participating in legal or regulatory proceedings as a result of the performance of the Services. Voya shall invoice Client separately for such reasonable fees and expenses. 4.8 Float. Voya and its affiliated companies earn income in the form of bank service credits on contributions awaiting Investment and on payments awaiting distribution from the bank accounts that Voya maintains (or "float"). The bank service credits are applied against the bank service fees that apply to the bank accounts thatVoya maintains and may not be redeemed for cash. Specifically, the bank accounts have been established to receive and hold fora reasonable time: • contributions or other amounts to be invested in Your Plan, or • amounts redeemed to pay a distribution or disbursement from Your Plan. Voya will receive income in the form of bank service credits (as described below) and offset such credits against bank service fees that are charged to Voya for the use of such bank accounts and for services provided by the banks for processing receipts or disbursements. Float Generated by Contributions. Voya uses a bank account to receive and hold contributions or other Plan deposit amounts to be invested. Contributions or other deposit amounts are held until instructions from a Plan representative who has been authorized to provide direction to Voya ("Authorized Instructions") are received in Good Order. Income in the form of bank service credits are earned on the bank account during any waiting period forAuthorized Instructions. For Authorized Instructions received in Good Order by the close of the New York Stock Exchange (normally 4:00 p.m. Eastern Time), contributions or other deposit amounts will be invested on that Business Day. For Authorized Instructions received In Good Order after the close of the New York Stock Exchange, contributions or other deposit amounts will be processed on the next Business Day. Float Generated by Distributions. Voya and/or one or more of its corporate affiliates receives income in the form of bank service credits in connection with distributions or disbursements that Voya pays on the Plan's behalf. The service credits accrue during the period beginning when an amount Is redeemed from the Plan's Investment to fund a distribution or disbursement check and ending when the check is presented for payment. Additionally, from time to time, the corporate affiliate of Voya may receive money market like rates of return on other deposit or short term investment products in which distributions may be held until such time as the check is presented for payment. 4.9 Transaction Processing Errors. Voya seeks to avoid transaction processing errors to the greatest extent possible, but Inadvertent errors do occur from time to time. When a transaction processing error for which Voya is directly responsible occurs, Voya will attempt to correct the error as soon as reasonably practicable after identification of the error. Once all necessary Information has been gathered, Voya will promptly take corrective action to put the Plan and Its Participants in a position financially equivalent to the position they would have been in if the Voya processing error had not occurred. Voya processes Your Plan's investment Instructions on an "omnibus" or aggregated basis. If Voya's correction of a Voya processing error results in a loss to Your Plan or its Participants, Voya will absorb the loss. If any gain results in connection with the correction of a Voya processing error, Voya will net any such gain against other losses absorbed by Voya and retain any resulting net gain as a component of its compensation for transaction processing services, including Its agreement to make Plan and Participant accounts whole for losses resulting from Voya processing errors. For more Information on Voya's error correction policy, please refer to attached Voya Retirement Insurance and Annuity Company's Policy for Correction of Processing Errors ("VRIAC Policy"). The VRIAC Policy and any updates to the VRIAC Policy Is posted in the Sponsor Disclosure section of Plan Sponsor Website. With respect to Voya processing errors described in this Agreement, Voya Institutional Plan Services, LLC adheres to the VRIAC Policy. Page 28 of37 Order #200338 TEM Bundled 12/01/2021 TM: DCPLNINSTVPLANINIT AGREEMENT (Continued) 410 Revenue Sharing. Client acknowledges and agrees that to the extent former or current affiliates of Voya perform services for the Plan, such affiliate may share any revenue received with Voya or may credit Voya for such revenue against amounts due from Voya to such affiliate. Such revenue sharing may include, but it is not limited to, revenue sharing in connection with investment management, brokerage or trustee/custodial services. 411 Other Compensation. Voya and its broker -dealer affiliate, Voya Financial Partners, LLC (VFP), have entered into contracts with certain investment funds and fund service providers (the "Funds") pursuant to which such Funds may compensate Voya and VFP for administrative and sub -transfer agency functions calculated with reference to the aggregate assets of the Plans of Voya's clients under management by such Funds and/or on a per -Participant basis investing in the Funds. In addition to the direct fees set forth in Your Program Highlights and Fee Summary, Voya's compensation shall include an additional fee equal to the amounts paid by the Funds. Any amounts payable by the Funds shall be paid directly to Voya. Arrangements under which such compensation is paid may includefees paid to VFP under a Fund's 12b4 distribution Plan, and/or service or sub -transfer agent arrangements paid to Voya. Voya reserves the right to modify the fees stated in Your Program Highlights and Fee Summary, to the extent that fees payable from the Funds cease or are modified other than as a result of changes in Participant investment allocations. Client hereby represents and warrants to Voya that either Client, or another fiduciary independent of Voya, have (I) made the decision on behalf of the Plan to invest in the investment funds listed in Your Program Highlights and Fee Summary or to offer the Investment funds as investment options under the Plan, as the case may be, and (it) been fully informed of, and approved of, such fee arrangement prior to making such investment decision. 412 Permitted Investment Disclosure. When Client signs this Agreement, or signs any amendment to this Agreement which further describes or changes Voya's compensation under the Agreement, this serves as a confirmation that Client has received the information contained In this Agreement or amendment, as applicable, and that Client approves of the use of the Permitted Investments along with any compensation to Voya and its affiliates that results from purchases of the Permitted Investments. For purposes of this Section, "Permitted Investments" include those Funds set forth in Your Program Highlights and Fee Summary, and any Participant loan(s). 413 Affiliated Investment Options. Investment options available underthis arrangement include both affiliated and unaffiliated Investment options. Affiliated investment options are (1) Investment options managed by Voya Investment Management LLC or other Voya affiliates, which may or may not be sub -advised by a Voya affiliate; and (11) funds managed by a Voya affiliate but that are sub -advised by unaffiliated third parties. Client acknowledges that Voya maytake the Investment management and other revenue earned from affiliated investment options and retained by Voya's affiliates into consideration in setting the fees outlined in Your Program Highlights and Fee Summary. Client also acknowledges that Voya, the Voya affiliates and Voya employees (including wholesaling employees) will earn more compensation when Voya-managed investment options are selected. Voya affiliates and Voya employees (Including wholesaling employees) will earn more compensation If Plan assets are invested In the Morningstar Wealth Management and Morningstar,Wealth Management Tax Sensitive Model Portfolio Programs. 4.14 Service Fees. Client acknowledges and agrees that to the extent a registered broker dealer has been appointed by the Plan, Voya may pay annual service fee compensation to the broker dealer. In turn, such compensation, or some portion thereof, may be paid by the broker dealer to its registered representative. Client further acknowledges and agrees that (1) such service representative shall not serve In the capacity of broker of record to the Plan until or unless duty designated as such by Client on behalf of the Plan and (it) neither the broker dealer nor such service representative is a fiduciary (within the meaning of Section 3(21)(A) of ERISA) with respect to the Plan. 5.0 TERM AND TERMINATION 51 Initial Term; Continuation. Upon execution by both Parties, this Agreement shall commence effective as of the date signed by Client (the "Effective Date") and shall remain In effect until it is terminated pursuant to this Section 5. (a) Without Cause, Either Party may terminate this Agreement at any time without cause by giving at least ninety (90) days prior written notice of such termination to the other Party. (b) With Cause. Either Party may terminate this Agreement at any time (1) for cause upon the breach of any material obligation or responsibility by the other Party which breach shall remain uncured for ninety (90) days after written notice thereof has been provided to the breaching Party bythe other Party, or (11) Immediately and without the necessity for notice, upon the bankruptcy, insolvency or similar filing or event by or against the other Party. 5.2 Cooperation with Transfer. In the event of any termination of this Agreement, Voya shall cooperate with Client in the transfer of Voya's obligations hereunder to a replacement service provider ("Discontinuance"). Voya shall prepare and transfer records in Voya's format, which may include electronic form, to the Client or the Client's designee. Voya will charge the Discontinuance fee specified in Your Program Highlights and Fee Summary. If Client does not pay the Discontinuance Page 29 of37 Order#200338 TEM Bundled 12/012021 TM: DCPLNINSTUPLANINIT AGREEMENT (Continued) fee within fifteen (15) calendar days of Client's request to end this Agreement, Client hereby instructs Voya to collect this fee from Plan assets before the distribution of the Plan assets. 6.0 AMENDMENTS TO THIS AGREEMENT Voya may amend this Agreement at anytime by providing Client with sixty (60) days advance written notice, subject to Section 4 relating to changes in fees. 7.0 CLIENT DIRECTIONS 7.1 Plan Sponsor Website Access. If Voya issues to Client, or to any representative designated by Client, user names, passwords or similar unique identifiers in order for Voya to verify the authenticity of certain transmissions of information, including directions or instructions, from Client or Client's representative, then Voya shall be entitled to rely upon any and all transmissions of Information under such password(s) or other unique identifier, and Client shall indemnify and hold harmless Voya from any and all liability arising from any act or omission by Voya in reliance upon transmissions of Information under the proper password or other unique Identifier, including but not limited to communications purporting to be directions or instructions which Voya reasonably believes to originate from Client or its authorized representative. 7.2 Access Authorization. Client agrees thatthe authorized Plan Sponsor Representative (the "PSR") will manage and control Client's user access to Plan and Participant electronic Information available via Voya's Plan sponsor Website ("Plan Sponsor Website"). The PSR will have the ability to assign access levels and permissions for other individual users within Client's organization. Client acknowledges and agrees that the PSR, and not Voya, is responsible for monitoring the activities of each authorized user and managing the permissions assigned to each user. Client shall notify Voya immediately in the event of any unauthorized access or use of the Plan Sponsor Website, or of any password or account, or any other known or suspected breach of security in connection with the Plan Sponsor Website. Client's use of the Plan Sponsor Website will be subject to the "Terms of Use" posted on such Website, which may be changed or updated by Voya at any time. 7.3 Plan Participant Account Information. Client acknowledges the sensitive and confidential nature of Plan Participant account informationthat may be accessed through the Plan Sponsor Website. Client agrees to safeguard against the unauthorized or inappropriate use or disclosure of Participant account Information accessed through the Plan Sponsor Website. Client shall Instruct individuals who may gain access or have access to such Participant account Information to utilize such access solely for the administration or operation of the Plan. Such data may not be copied, shared, discussed or otherwise disclosed, through any medium or with any person, except to the extent necessary to carry out Plan administration responsibilities Client agrees to defend, indemnify and hold harmless Voya against any and all liabilities, losses, costs, damages and expenses, specifically including, but not limited to, attorney's fees and related costs, which may in any way arise or result from or relate to Client's breach of its obligations under this Section 7. This Section 7.3 shall survive the termination of this Agreement. 7.4 Claims Relating to Internet Usage. Each Party warrants that the transmission, distribution, display, performance or publication of any material delivered by or through it In the manner, contemplated by this Agreement will not violate the copyright laws of the United States or any other jurisdiction, unlawfully infringe or interfere In any way with the intellectual property or rights of another, or contain libelous or indecent matter. Each Party will indemnify and defend the other Party from any and all losses arising out of, under or in connection with any third party claims relating to (1) content, provided by or through such indemnifying Party, whether of an editorial, advertising or other nature, including but not limited to, claims related to copyright, infringement, libel, indecency, false light, misrepresentation, Invasion of privacy or Image or personality rights, and (II) statements or other materials made or made available by readers of the content or by persons to whom the content is linked at the request of such indemnitor. 7.5 Confirmations. With the exception of confirmations concerning contributions and loan repayments, Client designates each Participant of the Plan to receive immediate confirmation of all other transactions with respect to such Participant. 8.0 LIABILITY 81 Insurance. Voya shall at all times during the term of this Agreement, at Its own cost and expense, carry and maintain commercially reasonable Insurance coverage. 8.2 Disclaimer of Certain Damages. NEITHER PARTY SHALL BE LIABLE TO THE OTHER PARTY FOR ANYINDIRECT, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES, REGARDLESS OF THE FORM OF ACTION, WHICH MAY ARISE FROM THE PERFORMANCE, NON-PERFORMANCE, BREACH OF WARRANTY, DEFAULT OR OTHER BREACH OF THIS AGREEMENT. 8.3 Damages. Subject to Section 9.2, Voya's aggregate liability for any and all claims, whether based on performance, non- performance, breach of contract or warranty, events of default, tort, strict liability or otherwise, shall be limited to direct damages attributable hereunder to the conduct of Voya. If Client properly terminates this Agreement due to Voya's material breach as provided in Section 5, Client's direct damages under this Section may include•the out-of-pocket costs incurred in securing a replacement contractor, or transferring the functions back to Client, but such damages shall not Page 30 of 37 Order #200338 TEM Bundled 12/01/2021 TM: DULNINSTUPLANINIT AGREEMENT (Continued) Include any ongoing costs of providing such replacement Services. Neither Party shall be liable to the other for damages of any type (other than late payment charges) with respect to any non-performance, breach or default which Is cured during the applicable cure period described in Section 5. 8.4 Force Majeure. Except for payment obligations hereunder, a Party's failure to perform any of Its obligations under this Agreement shall be excused if and to the extent such failure arises out of causes beyond the reasonable control of the non -performing Party. Such causes may include, but are not restricted to, (i) acts of God or the public enemy, acts of the government in either its sovereign or contractual capacity, acts of terrorism or war, fires or other loss of facilities, floods, epidemics, quarantine restrictions, strikes, freight embargoes, failure of a common carrier, breach of contract by suppliers or others, computer downtime, telephone system outage, delays or failures of access Involving the Internet, World Wide Web or similar services including network traffic and configuration problems therewith, or unusually severe weather, labor disputes, and call demand In excess of telephone capacity or operator capacity and similar occurrences; or (11) the acts or omissions of the other Party, including in the case of Voya, Its reliance upon Client directions or information, data documents or Instruments provided by Client or any Participant, provided, however, that In every such case the failure to perform must be beyond the reasonable control of the non -performing Party. 9.0 INDEMNIFICATION 91 Client's Indemnity ofVoya. Client shall beresponsible for any and all liabiliry,claims, damages, costs and expenses (including without limitation court costs and reasonable attorneys' fees) (collectively, "Losses"), and shall defend, indemnify, and hold Voya harmless from and against any and all Participant or third -party actions, suits, proceedings, claims or liability, arising from the performance or non-performance of this Agreement, including but not limited to (!)Client's negligence or willful misconduct, (11) Voya's performance of its obligations and provision of the Services pursuant to this Agreement and applicable law, or any Client direction, and (III) any act or omission of Client, any Plan or any fiduciary, trustee, Plan committee or any other service provider to a Plan that is unrelated to Voya, except to the extent that any such Loss arises out of or results from Voya's negligence, willful misconduct, bad faith or error in performing or not performing this Agreement. Voya shall have an obligation to take all reasonable steps to mitigate any Losses. In the event that Voya refuses or fails to take action to do so and such refusal or failure is unreasonable, Client shall be relieved of its responsibility to indemnify Voya hereunder. 9.2 Voya's Indemnity of Client. Voya shall indemnify and hold Client harmless from and against any and all Participant or third -party actions, suits, proceedings, claims or liability, directly arising from Voya's negligence, willful misconduct or bad faith in the performance or non-performance of the Services, or Voya's violation of applicable law. Client shall have an obligation to take all reasonable steps to mitigate any Losses. In the event that Client refuses or fails to take action to do so and such refusal or failure is unreasonable, Voya shall be relieved of its responsibility to indemnify Client hereunder. 9.3 Compliance with Client Directions. Notwithstanding anything to the contrary contained in Section 9.1 above, Client agrees that it shall be responsible for any and all Losses arising from Voya's performance (or non-performance) In accordance with this Agreement or any Client direction, unless such losses are due to Voya's negligence, willful misconduct or bad faith. 9.4 Liability for Plan Obligations. Client or the Plan shall remain solely, liable for all obligations and benefits payable under, the terms of the Plan and applicable law. 9.5 Participation in Defense. A Party may participate at Its expense in the defense of any action or claim which maybe asserted against it and for which such Party seeks indemnity pursuant to the provisions of this Section, or such Indemnified Party may assume the defense of such claim or action, including the right to settle or compromise any claim against It without the consent of the indemnifying Party, provided that in doing so it shall be deemed to have waived its rightto indemnification except in cases where the indemnifying Party has declined to defend the claim. Otherwise, the indemnifying Party shall have exclusive authorityto control the defense, conduct settlement negotiations and may settle an action, suit, proceeding or any matter for which indemnification is sought, without the indemnified Party's consent; provided, however that such settlement Includes a release of the indemnified Party with respect to the matter for which indemnification is sought. 9.6 Errors of Other Service Providers. Voya shall bear no obligation or responsibility for Losses caused by, arising from or related to any act or omission Including, but not limited to, errors, mistakes, willful misconduct, bad faith, fraud, negligent acts or omissions of any unrelated trustee, custodian, broker/dealer, insurance company, mutual fund company, third party administrator, prior recordkeeper or any other entity that provides, or has provided, services to the Plan. 10.0 CONFIDENTIAL INFORMATION 101 Confidential Information. Either Party may disclose ("Disclosing Party") Confidential Information (as defined below) to the other Party ("Non -Disclosing Parry") in connection with this Agreement. Such disclosure may include, but is not limited to, Employer making available to Voya certain employee information in such form as is mutually acceptable to the Parties. "Confidential Information" means and includes any and all information the Disclosing Party designates as being confidential or which, under the circumstances surrounding disclosure the Non-bisclosing Party should know that it Is treated as confidential by the Disclosing Party, and shall include the Standard Tools as described in Section Page 31 of37 Order#200338 TEM Bundled 121OV2021 TM: DCPLNINSTUPLANINIT AGREEMENT (Continued) 11.2. Subject to the foregoing sentence, Confidential Information.may Include, but is not limited to, the following: (1) non- public information concerning the Disclosing Party, its affiliates and their respective businesses, products, processes and services, including technical, marketing, agents, customer, financial, personnel, and planning information, (if) information of individuals, including financial, health and personal information, (if!) trade secrets, and (iv) any other information that is marked confidential. Except with respect to personally identifiable information, which shall be treated as Confidential Information under all circumstances, Confidential Information will not include (A) Information lawfully obtained or created by the Non -Disclosing Party independently of the Disclosing Party's Confidential Information and without breach of any obligation of confidence, or (B) information that enters the public domain without breach of any obligation of confidence. All Confidential Information shall remain the property of the Disclosing Party. All Confidentiai Information is provided AS - IS" and without any warranty, express, implied or otherwise, regarding the completeness, accuracy or performance of such Confidential Information. 10.2 Use and Disclosure of Confidential Information. The Non -Disclosing Party agrees that It will (i) disclose the Disclosing Party's Confidential Information only to its employees, agents, advisors, third party service providers, consultants and contractors who have a need to know and are bound by confidentiality terms no less restrictive than those contained In this Agreement, and (11) use the Disclosing Party's Confidential Information only for the purposes of performing its obligations under this Agreement The Non -Disclosing Party will use all reasonable care in handling and securing the Disclosing Party's Confidential Information and will employ all security measures used for its own proprietary information of similar nature. These confidentiality obligations will not restrict any disclosure of Confidential Information by order of a court or any governmental agency, provided that the Non -Disclosing Party shall cooperate in all reasonable respects with the Disclosing Party in seeking to prevent or limit disclosure and shall limit any such disclosure to the information actually required to be disclosed. 10.3 Period of Confidentiality. The restrictions on use, disclosure and reproduction of Confidential Information set forth in this Section 10 will, with respect to personally identifiable information and Confidential Information that constitutes a "trade secret" (as thatterm is defined under applicable law), be perpetual, and will, with respectto other Confidential Information, remain in full force and effect during the term of this Agreement and for three (3) years following the termination of this Agreement. 10A Injunctive Relief. The Parties agree that the breach, or threatened breach, of any of the confidentiality provisions of this Agreement may cause irreparable harm without adequate remedy at law. Upon any such breach or threatened breach, the Disclosing Parry will be entitled to injunctive relief to prevent the Non -Disclosing Party from commencing or continuing any action constituting such breach, without having to post a bond or other security and without having to prove the inadequacy of other available remedies. Nothing in this Section 10 will limit any other remedy available to either Party. 10.5 a. Security Standards. Plan Sponsor agrees that it shall comply, and shall cause each Participating Employer to comply, with Voya's minimum information security standards ("Security Standards") as needed to enable Voya to perform the Services. The Security Standards Include, but are not limited to, controls and practices designed to safeguard Participant accounts from potentially fraudulent activity. The current Security Standards have been received by Plan Sponsor prior to the Effective Date and will thereafter be provided to Plan Sponsor upon reasonable request. Voya may revise the Security Standards as it deems appropriate and shall use Its best efforts to provide Client with a copy of any such revision at least ninety (90) days prior to implementation of the resulting changes on the Voya System. Notwithstanding any other provision of this Agreement, Plan Sponsor's or a Participating Employer's failure to comply with the Security Standards shall relieve Voya of all liability for any Losses (as defined in Section 91) arising from such failure. Voya maintains industry standard data security controls for purposes of safeguarding Participant data on its recordkeeping platform. The standards may be revised from time to time and will become applicable as provided under the terms of this Agreement. A copy of this document is attached hereto and incorporated by reference. b. Voya agrees that it shall comply with the data security and privacy procedures as described in the Data Security Addendum, a copy of which is attached hereto and incorporated by reference. 11.0 RIGHTS IN DELIVERABLES AND INTELLECTUAL PROPERTY 111 Deliverables. Subject to the limitations set forth in this Agreement, Client shall have the right to use and reproduce, for its internal business purposes, the reports, records, documents, and other materials developed by Voya for Client pursuant to this Agreement. 11.2 Intellectual Property. Notwithstanding the foregoing, all of Voya's assets and technology developed prior to, or Independently from, the performance of Services under this Agreement and used by Voya in the performance of its business and which do not contain, and are not derived from, Client's Confidential Information, which may include, without limitation, Voya's software, upgrades and enhancements to software, written materials, tools, screen formats and designs, techniques, interactive design techniques, methodologies, report formats, interactive design formats, systems, and materials and know how (collectively "Standard Tools"), and Voya's property rights, proprietary interest, copyright and/or Page 32 of 37 Order #200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT AGREEMENT (Continued) license therein, together with Voya's intellectual property rights, shall remain the property of Voya, and, except as expressly set forth in this Section 11.2, nothing contained in this Agreement shall confer to Client any right, title or interest in the Standard Tools. If any Standard Tools are used or Incorporated into any deliverables produced by Voya in its performance of the Services hereunder, Voya hereby grants to Client a limited, perpetual, non-exclusive, worldwide, royalty -free, paid - up license to use, display, copy and modify such Standard Tools solely as necessary to use the associated deliverable for Its Intended purpose and solely under the terms of this Agreement. 12.0 COMPLIANCE WITH LAW 121 Filing of Tax Returns and Form 5500. If the Plan is required to file a Form 5500, although Voya may provide data used in such returns, forms or information, Voya shall not be responsible for the filing of any federal, state or local tax return, forms or information on behalf of Client or any Plan. 12.2 Plan Sponsor Required Fee Disclosure. Client acknowledges that Voya has disclosed In writing, to the best of Voya's knowledge, the information required to be provided to Client by 29 CFR g 2550.408b-2(c) (the "DOL Plan Sponsor Fee Disclosure Regulation"), in order for Client to conclude that Voya's compensation constitutes "reasonable compensation" under ERISA. Voya hereby represents that, prior to the date hereof, all such information was provided to Client, including, If applicable, fund prospectuses. 12.3 Additional Information. Voya shall disclose to Client all information related to this Agreement and the Services, including any compensation or fees received thereunder, that is requested by Client or by the administrator of any Plan in order to comply with the reporting and disclosure requirements of Title I of ERISA and the regulations, forms and schedules Issued thereunder. 13.0 SUBCONTRACTING AND ASSIGNMENT 131 Subcontracting. Voya may enter into one or more subcontracts in connection with the performance of the Services under this Agreement. Voya shall remain responsible for the performance of any subcontractor. 13.2 Assignment. Voya may assign any of its rights under this Agreement without the prior written consent of Client. 13.3 Information for Unrelated Financial Services. Voya may use information You or Your Participants furnish to contact them concerning unrelated financial-services products and services offered by Voya and/or its affiliates. You have no obligation concerning those products or services. 14.0 NOTICES 15.0 All notices, requests, demands and other communications required to be given hereunder shall be in writing and shall be deemed to have been duly given on the earlier of the day of delivery by hand or telephonic facsimile (duly receipted), or the day after sending by recognized overnight courier service or five (5) Business Days after mailing, certified or registered mail, return receipt requested, or electronically in each case to the Party for whom intended at the address specified in this Section. If to Voya: Voya Retirement Insurance and Annuity Company One Orange Way, C2N Windsor, CT 06095 Attn: Legal Department If to Client, Notice will be sent to the Plan Sponsor address on file. 151 Corporate Authority and Due Execution. Each Party represents that (i) it has the power and authority to execute, deliver and perform this Agreement and that the execution, delivery and performance of this Agreement have been duly authorized by all necessary action of its members, and (fi) this Agreement constitutes a legal, valid and binding obligation enforceable In accordance with its terms. 16.0 RELATIONSHIP OF THE PARTIES 161 General. The relationship between the Parties is that of independent contractors. None of the provisions of this Agreement shall be construed to create an agency, partnership orjointventure relationship between the Parties or the partners, officers, members or employees of the other Party by virtue of either this Agreement or actions taken pursuant to this Agreement. Page 33 of37 Order R200338 TEM Bundled 12/0112021 TM: OCPLNINSTUPLANINIT AGREEMENT (Continued) 16.2 Fiduciary Status. Client and Voya agree that neither Voya nor any of its affiliates shall be a fiduciary, in connection with the Services provided hereunder, within the meaning of ERISA, the Investment Advisers Act of 1940, or any state law, with respectto any Plan. Voya and its affiliates shall not have any discretion with respect to the management or administration of any Plan or with respect to determining or changing the rules or policies pertaining to eligibility or entitlement of any Participant in any Plan to benefits under such Plan. Voya and its affiliates also shall not have any control or authority with respect to any assets of any Plan, including the investment or disposition thereof. Client acknowledges that the Plan's authorized fiduciary is responsible for the selection of service providers and investment options and that (1) it is a fiduciary, within the meaning of ERISA, with respect to the Plan; (11) it is independent in all respects of Voya and all affiliates of Voya; and (ii) it has not relied on any advice or recommendation of Voya or any affiliates of Voya as a primary basis for making the decision to enter into this Agreement or with respect to the selection of particular investment options. Client acknowledges that to the extent mutual funds are made available as investment options underthe Plan, there may be one or more classes of shares with respect to each mutual fund and each class of shares may have different rules, requirements and expense ratios and Client has made the determination that the class of shares chosen for any Plan is the appropriate class and is suitable for such Plan. All discretion and control with respect to the terms, administration or assets of any Plan shall remain with Client or with the named fiduciaries under such Plan. 16.3 No Tax or Legal Advice. Client acknowledges and understands that in the course of providing Services under this Agreement, Voya shall not provide tax or legal advice to Client, the Plan or its Participants. 17.0 GENERAL PROVISIONS 17.1 No Waiver. A Party's failure at anytime to enforce any of the provisions of this Agreement or any right with respecttheretc, shall not be construed to be a waiver of such provision or right, nor to affect the validity of this Agreement. The exercise or non -exercise by a Party of any right under the terms or covenants herein shall not preclude or prejudice the subsequent exercise of the same or other rights under this Agreement. 17.2 Severability. The terms and provisions of this Agreement shall be severable. If any term or provision is held to be invalid or unenforceable, that term or provision shall be ineffective to the extent of such invalidity or unenforceability and the remaining terms and provisions shall continue in full force and effect. 17.3 Entire Agreement. Subject to the terms and conditions hereof., (1) this Agreement together with Its exhibits, schedules, and attachments contains the entire understanding of the Parties with respect to the provision of the Services; (11) there are no expectations, restrictions, promises, warranties, covenants, or undertakings other than those expressly set forth herein; and (iii) this Agreement supersedes all prior agreements and understandings between the Parties with respect to the Services. 17.4 No Third Party Beneficiaries. This Agreement is for the benefit of the Parties and their respective successors and permitted assigns. It is not intended to create a benefit to any third parties. 17.5 Governing Law. This Agreement shall be governed by and Interpreted and enforced in accordance with the laws of the State of Connecticut, without regard to the conflict of laws provisions thereof, except that when federal law exists on substantive matters requiring construction under this Agreement, such federal law shall apply In lieu of state law but only to the extent required by applicable federal laws, Including without limitation ERISA. 17.6 Survival of Obligations. The Parties' respective obligations under this Agreement which by their nature would continue beyond the termination or expiration of this Agreement, including, without limitation, those contained in the Sections entitled Compensation, Confidential Information, and Indemnification shall survive the termination or expiration of this Agreement. 17.7 Headings and Captions. All headings and captions contained in this Agreement are for convenience of reference only and shall not affect in any way the interpretation or meaning of this Agreement 17.8 Pronouns. Words used herein, regardless of the number and gender specifically used, shall be deemed and construed to Include any other number, singular or plural, and any other gender, masculine, feminine, or neuter, as the context requires. Page 34 of 37 Order #200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT VRIAC'S POLICY FOR CORRECTION OF INADVERTENT PROCESSING ERRORS As Your Plan's administrative service provider, Voya Retirement Insurance and Annuity Company ("VRIAC") has agreed to process transaction orders received in Good Order prior to market close from the Plan and Plan Participants, alternate payees and beneficiaries (collectively, "Participants") accurately and on a timely basis. We seek to avoid transaction processing errors to the greatest extent possible, but inadvertent errors do occur from time to time. Inadvertent processing errors are exclusively defined as incorrect or untimely processing by VRIAC employees of transactions that are received in Good Order. Inadvertent processing errors do not include errors made by Plan sponsors or third parties. VRIAC will correct any Identified inadvertent processing error caused by VRIAC (a "VRIAC inadvertent processing error") as soon as practicable, typically no later than five (5) Business Days after VRIAC has identified sufficient information to correct the error. VRIAC represents that in no event will VRIAC exercise discretionary authority or control over the correction of inadvertent processing errors in order to maximize gain or correct such error for VRIAC's own benefit or interest. Once a VRIAC inadvertent processing error has been Identified, we promptly take corrective action to put the Plan and its Participants in a position financially equivalent to the position they would have been in if the processing error had not occurred. This means that VRIAC will make the Plan whole for any loss to a Plan resulting from correcting a VRIAC processing error. If any gain to a Plan results in connection with a corrected transaction, VRIAC will keep that gain. The following examples illustrate the effect of the policy: When a Plan Participant directs that a certain dollar amount be contributed to his or her Plan account, VRIAC credits the number of investment units that dollar amount will purchase to the Participant's account on Day 1, the day the contribution is processed. The number of units is based on the unit's dollar value on Day 1, as set by the investment fund and communicated to VRIAC after market close. If an inadvertent error occurs, and VRIAC does not process the contribution until Day 2, VRIAC will determine the number of units that should have been credited on Day 1, using Day 1's unit price. if, on Day 2, the unit price has gone up, the dollar amount of the contribution will not be enough to cover the number of units the Participant should have received. VRIAC will make up the difference such that the Participant receives the number of units he or she would have received on Day 1 and VRIAC will absorb the loss. The Participant is not charged for any additional cost. However, if, on Day 2, the unit price has gone down, the amount of the contribution would purchase more units on Day 2 than It would have purchased on Day 1. In that circumstance, the Participant will receive the number of units he or she would have received on Day 1 had the transaction been processed and VRIAC will keep the excess as part of its overall fee for services under the contract. Regardless of whether there is a gain or a loss, the Participant receives the benefit of what he or she requested. When a Plan Participant makes a withdrawal request of a certain dollar amount from his or her account, VRIAC liquidates or sells the number of investment units needed in order to make the distribution. Thus, on Day 1, VRIAC typically would sell or liquidate investment units in the Participant's investment fund at Day 1's price to make the distribution. If, due to a VRIAC inadvertent processing error, VRIAC processes the instructions a day late, VRIAC will make sure that the Participant receives the dollar amount he/she requested. VRIAC will sell or liquidate the same number of units that would have been sold on Day 1 had the transaction been accomplished on Day 1. if the unit price has declined, liquidated units will have a lower value on Day 2 than they had on Day 1, which means that VRIAC must make up the difference so that the Participant receives the requested amount in full. In doing so, VRIAC will incur a loss, which it absorbs. On the other hand, if the market has gone up and the units have increased in value, VRIAC will sell the same number of units as it would have sold on Day 1, but the sales amount will be higher than the requested withdrawal. VRIAC will keep the excess as part of its overall fee. In either circumstance, the Participant receives the benefit of what he or she requested and bears no additional cost. VRIAC tracks the net financial experience of VRIAC's Correction Account and the effect of the corrections for each affected Plan on an annual basis and will make that information available in accordance with ERISA Section 408(b)(2). Any gains kept by VRIAC constitutes additional compensation for the services provided by VRIAC under its contract and VRIAC will report it in accordance With ERISA Section 408(b)(2). By executing an administrative services agreement with VRIAC, You are authorizing VRIAC's application of the error correction policy as described above to Your Plan in connection with the Plan administrative services that VRIAC will'provide. You have the right to terminate VRIAC's services in accordance with the terms of the administrative services agreement. Page 35 of 37 Order k200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT VOYA EMPLOYER'S ROLLOVER IRA Traditional IRA and/or ROTH IRA Automatic Rollover/Mandatory Distribution Agreement If you elect Voya's Automatic Rollover product, the following terms and conditions shall apply: Representations 1. Plan Sponsor maintains a qualified retirement Plan that contains a provision for the automatic rollover of mandatory distributions pursuant to Section 401(a)(31)(B) of the Internal Revenue Code (Code). The Plan's automatic rollover provision requires a terminated employee's vested accrued account balance of more than $1,000 but not more than $5,000 except as otherwise permitted under the Code and adopted by the Plan (the "Mandatory Distribution") to be automatically rolled over to an Individual Retirement Account or Annuity (IRA) under certain circumstances. Except for Plan assets that are considered "Roth" amounts, such amounts would be rolled over to a "traditional" IRA. The Plan also permits the automatic rollover of a Mandatory Distribution of Roth amounts held under the Plan to a separate Roth IRA. 2. Plan Sponsor will only direct the rollover of a Mandatory Distribution after providing the terminated employee with a written notification explaining the Participant's right to receive the amount in question or to have It transferred directly to an eligible retirement Plan and, absent an affirmative election from the Participant, the Plan Sponsor will automatically rollover the amount into a traditional IRA or Roth IRA. 3. Voya Retirement Insurance and Annuity Company (VRIAC) offers the Voya Employer's Rollover IRA product for use with Mandatory Distribution rollover contributions under Code Section 401(a)(31)(B) for traditional IRA and Roth amounts held under the Plan. VRIAC Is an insurance company properly authorized to Issue the Voya Employer's Rollover IRA product and the individual Certificates of Coverage under a group custodial annuity contract (individual contracts for Oregon residents) thereunder pursuant to IRC Section 408A. Except for Oregon residents, VRIAC's affiliate, Voya Institutional Trust Company, holds the group annuity contract as Custodian. Voya Institutional Trust Company is eligible to serve as Custodian of the traditional IRA and Roth IRA pursuant to Code Section 408(n). 4. VRIAC will not accept a combined Mandatory Distribution of $1,000 or less from the Plan into the Voya Employer's Rollover traditional IRA or Roth IRA. The actual amount of the Mandatory Distribution to be rolled over into the Voya Employer's Rollover traditional IRA or Roth IRA will be determined as of the date the transaction is processed subject to any applicable adjustments. 5. Amounts rolled over into the Voya Employer's Rollover traditional IRA or Roth IRA will be invested solely in VRIAC's Fixed Account and credited interest at rates determined by VRIAC. The annual rate will be at least 1% per year. The Fixed Account is designed to preserve principal and provide a reasonable rate of return consistent with liquidity and shall seek to maintain, over the term of the Investment, the dollar value that is equal to the amount invested in the product by the individual retirement Plan. 6. An Individual Account Establishment Fee of $20 will be deducted from each Voya Employer's Rollover IRA Certificate/Contract when it is established. An Individual Account Maintenance Fee of $20 will be deducted from each Voya Employer's Rollover IRA Certificate/Contract each year and upon a full withdrawal. These fees will apply separately to each traditional IRA and Roth IRA established for the Certificate/Contract Holder. The fees and expenses associated with the Voya Employer's Rollover IRA shall not exceed the fees and expenses charged by VRIAC for comparable individual retirement Plans established for reasons other than the receipt of a rollover distribution subject to the provisions of Code Section 401(a)(31)(B). 7. A Certificate of Coverage/Contract will be sent to each'pe6son for whom a traditional IRA and/or Roth IRA Is established. The Certificate/Contract Holder will have the right to enforce the terms of this contractual agreement establishing the Voya Employer's Rollover IRA or Roth IRA against VRIAC and Voya Institutional Trust Company as applicable). Authorization, Acknowledgement and Certification Plan Sponsor authorizes and directs VRIAC to roll over the Mandatory Distribution amount attributable to each terminated employee described on the reports submitted electronically to VRIAC (and any list(s) submitted to VRIAC in the future pursuant to this Automatic Rollover/Mandatory Distribution Agreement) with a combined traditional or Roth vested balance of more than $1,000 from the Plan Into the Voya Employer's Rollover traditional IRA or Roth IRA as applicable. Plan Sponsor authorizes VRIAC to issue a Voya Employer's Rollover traditional IRA or Roth IRA Certificate/Contract to each such terminated Participant. Plan Sponsor, to the best of its knowledge, certifies the accuracy of, and acknowledges that VRIAC, Voya Institutional Trust Company (as applicable) and their affiliates will rely exclusively on, the information provided by the Plan Sponsor including the terminated employee's name, social security number, date of birth and last known good address. Plan Sponsor certifies that the Mandatory Distribution(s) rolled over into the Voya Employer's Rollover traditional IRA or Roth IRA pursuant to this agreement does not exceed the maximum amount permissible under Section 401(a)(31)(B) of the Code or the Plan and that affected persons have been provided prior written notice of this pending rollover, Including the fees thatwill be deducted from the traditional or Roth IRA. To the extent that the Mandatory Distribution includes Roth amounts, the Plan Sponsor certifies thatthe Plan document orthe Plan's administrative policy permits the aggregation of the Roth and non -Roth amounts for purposes of the minimum Voya Employer's Rollover IRA contribution of greater than $1,000. Plan Sponsor agrees to hold VRIAC, Voya Institutional Trust Company (as applicable) and their affiliates harmless from any claim or action that may arise from establishing the Voya Employer's Rollover IRA or Roth IRA described above. Page 36 of 37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTL/PLANINIT IN WITNESS WHEREOF, the Parties hereto have duly executed this Agreement effective as of the date signed by the Employer below. VOYA RETIREMENT INSURANCE AND ANNUITY COMPANY Name Melissa M. McAuliffe Title Vice President. Operations Signature "�hA5u"'ry�G PLAN SPONSOR (SIGNATURE REQUIRED OF THE PERSON WHO CAN SIGN ON BEHALF OF THE EMPLOYER AS A PARTY TO THIS AGREEMENT), — Plan Sponsor/T Name (Please print.) Richard Meyer Signature_ Date�Z�-/ZZ- Plan Sponsor/Trustee Name (Please print.) Signature Date Plan Sponsor/Trustee Name (Please print.) Signature Date Page 37 of 37 Order#200338 TEM Bundled 12/01/2021 TM: DCPLNINSTUPLANINIT #11 NOTICE OE MEETING 12/14/2022 11. Consider and take necessary action to approve Dedication of Public Right of Way Easement for Access from Brian K. and Blan M. Willoughby to Calhoun County and authorize Commissioner Lyssy to sign all necessary documents. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner'Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 12 Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 December 8, 2022 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: (361)552-9656 Fax (361)553-6664 Please place the following item on the next Commissioners' Court Agenda • Consider and take necessary action to approve Dedication of Public Right of Way Easement for Access from Brian K. and Blan M. Willoughby to Calhoun County and allow Commissioner Lyssy to sign all necessary documents Sincerely,� Vern Lyssy VL/lj NOTICE OF CONFIDENTIALITYRIGHTS: IF YOU ARE A NATURAL PERSON, YOU NLA1' RENIOVE OR STRIKE ANY OR ALA. OF THE FOLLOWING INFORMATION FROM ANY INS TRIINIEN'l THAT TRANSFERS AN INTEREST IN REAR. PROPERTY BEFORE rr Is FILED FOR RECORD IN THE PUBLIC RECORDS: YOUR SOCIAL SECURITY' NUMBER OR YOUR DRIVER'S LICENSE NUMBER. Dedication of Public ROW Easement for Access Date: December 2, 2022 Grantor: Brian K. Willoughby and Blan M. Willoughby, a married couple Grantor's Mailing Address: Brian K. Willoughby and Blan M. Willoughby 668 Bay Meadow Dr. Port Lavaca, Texas 77979 Grantee: Calhoun County, Texas, a Texas a governmental entity Grantee's Mailing Address: Calhoun County, Texas 211 S. Ann Port Lavaca, Texas 77979 Easement Property: A Tract of land as further described in Exhibit "A" attached hereto. Easement Purpose: Continuation of a public Right -of -Way (ROW) for the benefit of the public. Consideration: The Grantee's acceptance of maintenance of the public Right-of=Way (ROW) for the benefit of the public. Reservations from Conveyance: None. Exceptions to Warranty: None. Grant of ROW Easement: Grantor, for the Consideration and subject to the Reservations from Conveyance and Exceptions to Warranty, grants, dedicates, and conveys to Grantee a ROW easement over, on, and across the Easement Property for the Easement Purpose, together with all and singular the rights and appurtenances thereto in any way belonging (collectively, the "ROW Easement"), to have and to hold the ROW Easement to Grantee forever. Grantor binds Grantor and Grantor's heirs, successors, and assigns to warrant and forever defend the title to the Easement in Grantee and Grantee's heirs, successors, and assigns against every person whomsoever lawfully claiming or to claim the Easement or any part thereof, except as to the Reservations from Conveyance and Exceptions to Warranty, to the extent that such claim arises by, through, or tinder Grantor but not otherwise. Duration of'Easement. The duration of the Easement is perpetual. Reservation of Rights. Grantor reserves for Grantor and Grantor's heirs, successors, and assigns the right to continue to use and enjoy the surface of the Easement Property for all purposes that do not interfere with or interrupt the use or enjoyment of the Easement by Holder for the Easement Purposes. Brian K. Willoughby t� Blan M. it ughby Accepted by: Calhoun County, Texas, a Texas a vernmental entity Vern Lyssy, Con"In3ACoirtirfrissioner. Precinct 2 STATE OF TEXAS COUNTY OF CALHOUN This instrument was acknowledged before me on 1 e2Iem W , 2022, by Brian K. Willoughby and Blan M. Willoughby. �`<Pnrp�''; DEBBIE BALDERA NY otar ublic, State of as �2.t. �. _ Notary public, state of Texas pF .'*�c Comm. Expires 10-15-2024 .�yrF tE` m lit Notary ID 12916398-3 STATE OF TEXAS COUNTY OF CALHOUN Before me, a licensed notary, on this day personally appeared Vern Lyssy, known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that Vern Lyssy executed the same as the act of Calhoun County, Texas, a "Texas a governmental entity. as its County Commissioner, Precinct 2, for the purposes and consideration therein expressed. Given under my hand and seal of office this 14"Wlday of December, 2022. MAE "I'E CA�SSEL C:' ...'. _• My NotM ID 0132012524 Expires May 14, 2023 PREPARED IN THE OFFICE OF: Roberts, Odefey, Witte & Wall, LLP 2206 Hwy 35 N P. O. Box 9 Port Lavaca, Texas 77979 Tel: (361) 552-2971 Fax: (361) 552-5368 AFTER RECORDING RETURN TO: Roberts, Odefey, Witte & Wall, LLP 2206 Hwy 35 N P. O. Box 9 Port Lavaca, Texas 77979 Tel: (361) 552-2971 Fax: (361) 552-5368 61, "� 4 "'t/ Notary Public, State of Texas 0.049 ACRES THE STATE OF TEAS) THE COUNTY OF CALHOUN) BEING a 0.049 acre tract of land situated in the Pedro Gonzales Survey, Abstract No. 18, Calhoun County, Texas and being a portion of a called 19.45 acre tract of land as described by Special Warranty Deed with Vendor's Lien dated March 7, 2013, conveyed from Norman L. Marshall, Sr. to Brian K. Willoughby and Blan M. Willoughby as recorded In Instrument No. 133514 of the Official Public Records, Calhoun County, Texas, said 0.049 acre tract of land being more fully described by metes and bounds as follows: BEGINNING at a found 2" pipe along the northwest line of said 19.45 acre tract, marking the south corner of a called 1.25 acre tract of land described by instrument to Charles A. Stock and Donna Stock as recorded in Volume 418, Page 40 of the Official Public Records, Calhoun County, Texas, the east corner of a called 1.90 acre tract of land described by instrument to Randy L. Boyd and wife, Debra J. Boyd as recorded in Instrument No. 2019-00167 of the Official Public Records, Calhoun County, Texas, and the west corner of a ingress/egress easement as described by instrument recorded in Instrument No. 118677 of the Official Public Records, Calhoun County, Texas for the west corner of the herein described tract; THENCE, North 53.12'15" East (North 55°00'00" East), with the common line between said 19.45 acre tract and said 1.25 acre tract a distance of 42.18 (42,06) feet to a found 5/8" steel rebar marking an exterior corner of said 1.25 acre tract and the south corner of a called 1.41 acre tract of land described by instrument to Brian K. Willoughby and Blan Willoughby as recorded in Instrument No. 143220 of the Official Public Records, Calhoun County, Texas for the north corner of the herein described tract; THENCE, South 18°40'55" East, into said 19.45 acre tract, a distance of 53.76 feet to a point along the southeast line of said ingress/egress easement for the east corner of the herein described tract; THENCE, South 53.12'I5" West, over said 19.45 acre tract with the southeast line of said ingress/egress easement a distance of 42.13 feet to a point marking the south corner of said ingress/egress easement for the south corner of the herein described tract; THENCE, North 18°43'46" West, continuing over and across said 19.45 acre tract with the southwest line of said Ingress/egress easement, a distance of 53.75 feet to the POINT OF BEGINNING, CONTAINING within these metes and bounds a 0.049 acre tract of land, more or less. Bearings are based on the Texas State Plane Coordinate System (NA0 831, South Central Zone (4204). This survey was adjusted using a combined scale factor of 1.00006594056322 (GEOIDI2A). The foregoing legal description and accompanying survey plat were prepared from an actual survey made on the ground under my supervision in August, 2022 and are true and correct to the best of my knowledge and belief. t YO07 ML 12/052022 Y..S Id41EL K. MMWAMl15 Urban Surveying, Inc. '•:; sale •^• i By: Michael K. Williams •p �e+4 Registered Professional Land Surveyor `'4r(�s.vmEtp••jo- Texas No. 6616 SUR`�' S25364.01 EXHIBIT,, A Page i Of #12 NO -FlU OF MEET ING — 12/14/2022 12. Consider and take necessary action to approve the extension for the contract between Calhoun County and Janik Alligators LLC for the Green Lake Project Alligator Management and Nuisance Control for the contract year beginning January 1, 2023 and authorize the County Judge to sign all necessary documents. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner,Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 12 CONTRACT EXTENSION AGREEMENT FOR THE GREEN LAKE ALLIGATOR MANAGEMENTNT & NUISANCE CONTROL 1 COUNTY OF CALHOUN WHEREAS, Calhoun County hereinafter called "COUNTY" and Jaoik Alligators LLC hereinafter called "JANIK" did enter into a CONTRACT AGREEMENT dated December 30, 2019 for the CONTRACT AGREEMENT beginning January 1, 2020 and ending December 31, 2020 In the CONTRACT AGREEMENT, the COUNTY did giant unto JANIK the option to renew yearly upon Commissioners Court approval prior to the end date of the. preceding contract and both the COUNTY and JANIK agme to the extension. THEREFORE, the CONTRACT AGREEMENT term shall be extended for an additional year, the additional year running from January 1, 2023 and continuing through December 31, 2023. COUNTY and JANIK agree that during the additional year, the CONTRACT AGREEMENT will continue as written. EXECUTED this the 14VV day of 2022. COUNTY: ATTEST: CAL'iY, TBXAS CAL/HJ�O�U�N�C�� COUNTY CLERK Richard A Mayer, Calhoun Judge By: Deputy Clerk Calhoun County, Texas For: 2118 Ann St, Ste 301 Port Lavaca TX 77979 OM1,49 0 7o'12i0AN 5L PAK Si imo 3244 CR 410 LANDOWNER'S AFFIDAVIT NEST STAMPS STATE OF TEXAS: COUNTY OF CALHOUN: Before me, the undersigned authority, on this day personally appeared Richard H. Meyer, known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard H. Meyer, I own/manage 6,461.08 acres in Calhoun County, Texas, known as Calhoun County Green Lake Project located about 10 miles from Port Lavaca, Texas and lying in the Howard Keton Survey A-265• LA Gueringer Survey A-259• I & G N R R Survey A170 & A172; Joseph Timmons A-147• John Pollan A-128• Manuela Venitz A-39; Manuel Lopez A-25. I have authorized Larry W. Janik to serve as my agent from June 01, 2023 until August 15, 2023, for purposes of arranging Department Surveys as deemed necessary (by TPWD) and collect the Alligator Nest Stamps allotted to me from thZas and Wildlife Department on my behalf. Richard H. Meyer Print Name 211 S. Ann St, Suite 301 Address Port Lavaca Texas 77979 Address Sworn to and subscribed before me by d J4on the 14�vday Of r�V'--f,�, 20 2.2, certified and witnessecay my hand and seal of official. " WE BELLE CASSEL My Notary ID # 132012524 +.�•...�.±'.: Expires May 14, 2023 Notary of Public, State of Texas MarBeIIGOrSLI Print Name My commission expires: ) 23 LANDOWNER'S AFFIDAVIT CITES HIDE TAGS STATE OF TEXAS: COUNTY OF CALHOUN: Before me, the undersigned authority, on this day personally appeared Richard H. Meyer, known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard H. Meyer. I own/manage 6,461.08 acres in Calhoun County, Texas, known as Calhoun County Green Lake Project located about 10 miles from Port Lavaca. Texas and lying in the Howard Keton Survey A-265: LA Guerin¢er Survey A-259• I & G N R R Survey A170 & A172• Joseph Timmons A-147, John Pollan A-128• Manuela Venitz A-39• Manuel Lopez A-25 I have authorized Larry W. Janik to serve as my agent from August 01, 2023 until September 01, 2023, for purposes of arranging Department surveys as deemed necessary (by TPWD) and collect the Alligator CITES Hide Tags allotted to me from the Texas Parks and Wildlife Department on my behalf. Signature i� Richard H. Meyer Print Name 211 S. Ann St. Suite 301 Address Port Lavaca, Texas 77979 Address Sworn to and subscribed before me by a�1,s{� ?� . on the I t day of 20 72 , certified and witnesa by my hand and seal of official. Notary of Public, State of Texas MAE BELLE CASSEL G pC'.��C nit55G My Notary ID # 132012524�I� \ '' '•. Expires May 14, 2023 Print Name P y My commission expires: S 1 4 23 CONTRACT EXTENSION AGREEMENT FOR THE GREEN LAKE PROJECT ALLIGATOR MANAGEMENT & NUISANCE CONTROL EXTENSION PERIOD JANUARY 1, 2023 through DECEMBER 31, 2023 Approved by Commissioners Court Wednesday, December 14, 2022 CONTRACT EXTENSION AGREEMENT FOR THE GREEN LAKE PROJECT ALLIGATOR MANAGEMENT&NUISAUISA NUISANCE CONTROL THE STATE OF TEXAS KG RN 8-4081RJ WIEREAS, Calhoun County hereinafter called "COUNTY" and Janik Alligators LLC hereinafter called JANW did enter into a CONTRACT AGREEMENT dated December 30, 2019 for the CONTRACT AGREEMENT beginning January 1, 2020 and ending December 31, 2020 In the CONTRACT AGREEMENT, the COUNTY did giant unto JANIK the option to renew yearly upon Commissioners Court approval prior to the end date of the. preceding contract and both the COUNTY and JANIK agree to the extension. THEREFORE, the CONTRACT AGREEMENT term shall be extended for an additional year, the additional year running from January 1, 2023 and continuing through December 3l, 2023. COUNTY and JANIK, agree that during the additional year, the CONTRACT AGREEMENT will continue as written. EXECUTED this the day of 2022. COUNTY: CAL COUNTY,TEXAS C Richard H. Meyer, County Judge Calhoun County, Texas 2119 Ann St, Ste 301 PottLavaca TX 77979 JANIK* ATTEST. CALHOUN COUNTY CLERK By: Deputy Clerk For: Anna Goodman, Calhoun County Clerk ATTEST: i Ey: Sig,4-70-A DAM 3244 CR 410 LANDOWNER'S AFFIDAVIT NEST STAMPS STATE OF TEXAS: COUNTY OF CALHOUN: Before me, the undersigned authority, on this day personally appeared Richard H. Meyer, known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard H. Meyer, I own/manage 6,461.08 acres in Calhoun County, Texas, known as Calhoun County Green Lake Proiect located about 10 miles from Port Lavaca, Texas and lying in the Howard Keton Survey A-265: LA Guerineer Survey A-259• I & G N R R Survey A170 & A1727 Joseph Timmons A-147: John Pollan A-128• Manuela Venitz A-39• Manuel Lopez A-25 I have authorized Lane W. Janik to serve as my agent from June 01, 2023 until August 15, 2023, for purposes of arranging Department Surveys as deemed necessary (by TPWD) and collect the Alligator Nest Stamps allotted tome from the Texas P ks and Wildlife Department on my behalf. Signature Sworn to and subscribed before me by of official. Richard H. Meyer Print Name 211 S. Ann St, Suite 301 Address Port Lavaca, Texas 77979 Address on the day 20_, certified and witnessed by my hand and seal of Notary of Public, State of Texas Print Name My commission expires: LANDOWNER'S AFFIDAVIT CITES HIDE TAGS STATE OF TEXAS: COUNTY OF CALHOUN: Before me, the undersigned authority, on this day personally appeared Richard H. Meyer, known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard H. Meyer, I own/manage 6,461.08 acres in Calhoun County, Texas, known as Calhoun County Green Lake Project located about 10 miles from Port Lavaca. Texas and lying in the Howard Keton Survey A-265• LA Gueringer Survey A-259• I & G N R R Survey A170 & A172• Joseph Timmons A-147_ John Pollan A-128• Manuela Venitz A-39• Manuel Lopez A-25 I have authorized Larry W. Janik to serve as my agent from August 01, 2023 until September 01, 2023, for purposes of arranging Department surveys as deemed necessary (by TPWD) and collect the Alligator CITES Hide Tags allotted to me from the Texas Parks and Wildlife Department on my behalf. Signature Richard H. Meyer Print Name 211 S. Ann St, Suite 301 Address Port Lavaca, Texas 77979 Address Sworn to and subscribed before me by on the day of , 20_, certified and witnessed by my hand and seal of official. Notary of Public, State of Texas Print Name My commission expires: CERTIFICATE OF INTERESTED PARTIES FORM 3.295 iofi 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. OFFICE USE ONLY CERTIFICATION OF FILING certificate Number: 2022-960924 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Janik Alligators LLC-USA El Campo, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Texas 12/04/2022 Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2023 2023 Greenlake Project Alligator Management and Nuisance Control Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. 6 UNSWORN DECLARATION'' wt ANII< My name is ,and my date of birth is .f FG M >. 7 7%37 uv aY My address is 1q (city) (state) (tip code) (country) I declare under penalty ofperjury that the foregoing is We and correct. �q F',(/ Executed in �!7 /�/� � � � County, Slate ofejT ,�, on the! day of OG L. 20RSf_� (month) (year) ZX • Si azure of uthor' ed agent of contracting business entity (Declarant) Cn.m� nrn.la�A A.. T........ L,AI�.. /.........:..wi.... ....... n. c elnln l., , VPr[inn V7 9; Pt1R%ef42 oy GREEN LAKE PROJECT ALLIGATOR MANAGEMENT AND NUISANCE CONTROL CURRENT YEAR AND PAST YEARS INFORMATION d Contract for the f. r Renewal approved by Commissioners Court December 22, 2021 RENEWAL OPTION FOR THE CONTRACT FOR GREEN LAKEPROJECT ALLIGATOR MANAGEMENT & NUISANCE CONTROL THE STATE OF TEXAS COUNTY OF CALHOUN WHEREAS, Calhoun County hereinafter called "COUNTY" and Janik Alligators LLC hereinafter called "JANW' did enter into a contract dated December 30, 2019 for the CONTRACT beginning January 1; 2020 and ending December 31, 2020 In the CONTRACT, the COUNTY did grant unto JANIK the option to renew yearly upon Commissioners Court approval prior to the end date of the preceding contract and both the COUNTY and JANIK agree to said renewal. THEREFORE, the CONTRACT tens shall be extended for an additional year, the additional year running from January 1, 2022 and continuing through December 31, 2022. COUNTY and JANIK agree that during the Additional Year, the contract will continue as written. EXECUTED this the ��ay of —AC— 2021. ,TEXAS Richard H. Meyer, Cal or lCountyJudge Cal ioun,County, Texas 211 S Ann St, Ste 301 Port Lavaca TX 77979 ATTEST: A GOQDMAN, CALHOUN COUNTY CLERK. '11y Deputy Jerk JANIK: JANIK AWGATORS LLC 'Larry W. J 1 Janik A ' o. 3244 C16410 El Campo TX Landowner's Affidavit NEST COLLECTION STATE OF TEXAS: COUNTY OF CALHOUN: Before me, the undersigned authority, on this day personally appeared Richard H. Meyer known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard H. Meyer . I own/manage 6,461.08 acres in Calhoun County (ies), Texas, known as Calhoun County Green Lake Proiect located about 10 miles from Port Lavaca, Texas and lying in the Howard Keton SurvevA-265: LA GuerinEerSurvey A-2S9• I & G N R R SurveVA170 & A172: Joseph Timmons A-147: John Pollan A-128• Manuela Venitz A-39• Manuel Lopez A 25 I have authorized _ Larry W. Janik to serve as my agent from June 01, 2022 until August 15, 2022, for purposes of arranging Department Surveys as deemed necessary (byTPWD) and collection of NEST STAMPS allotted tome from the Texas Parks and Wildlife Department on my behalf. r Signature Richard H. Meyer Print Name 211 S. Ann St, Suite 301 Address Port Lavaca, Texas 77979 Address Sworn to and subscribed before me by _,_ • 1 h.x. on the � 'day of i 20 ZL certified and witn •ed by my hand and seal of official. MAE BELLE- CASSEL ` MY NotaryiD # V20i2524 e.: `7•. • •��.�� Expires May 94, 2023 ••.,Mae,. 1�G w&� Notary �of Public, State of Texas Print Name / My commission expires: �f�j Landowner's Affidavit CITES TAGS STATE OF TEXAS: COUNTY OF CALHOUN: Before me, the undersigned authority, on this day personally appeared _ Richard H. Meyer . known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard H. Meyer,I own/manage 6,451.08 acres in Calhoun County (ies), Texas, known as Calhoun County Green Lake Proiectlocated about 10 miles from Port Lavaca. Texas and lying in the Howard Keton Survey A-265; LA GueringerSurvey A-259• I & G N R R SurvevA170 & A172: Joseph Timmons A-147• John Pollan A-128; Manuela Venitz A 39• Manuel Lopez A 25 1 have authorized Larry W. Janik to serve as my agent from August 01, 2022 until September 01, 2022, for purposes of arranging Department surveys as deemed necessary (by TPWD) and collection of CITES TAGS allotted to me from the Texas Parks and Wildlife Department on my behalf. t 4inature Richard H. Meyer Print Name 211 S. Ann St, Suite 301 Address Port Lavaca, Texas 77979 Address Sworn to and subscribed before me by ✓`f , on the .2t-.kday of (/1Q n9� P � 20 Z1, certified and wited by my hand and seal of official. Notary of Public, State of Texas MAE BELLE CASS a,F MyNotaiylD#132012524 '•;;;! Fxplres May 14, 2023 Print Name My commission expires: RENEWAL Contract for the Green Lake Project Alligator Management & Nuisance Control Beginning January 1, 2021 and Ending December 31, 2021 Renewal approved by Commissioners Court December 23, 2020 RENEWAL OPTION FOR THE CONTRACT FOR GREEN LAKE PROJECT ALLIGATOR MANAGEMENT & NUISANCE CONTROL THE STATE OFTEXAS COUNTY OFCALHOUN WHEREAS, Calhoun County hereinafter called "COUNTY" and Janik Alligators LLC hereinafter called "JANIK" did enter into a contract dated December 30, 2019 for the ODNTRACr beginning January 1, 2020 and ending December 31, 2020 In the CONTRACT, the COUNTY did grant unto JANIK the option to renew yearly upon Commissioners Court approval prior to the end date of the preceding contract and both the COUNTY and JANIK agree to said renewal. THEREFORE, the CONTRACT term shall be extended for an additional year, the additional year running from January 1, 2021 and continuing through December31, 2021. COUNTY and JANIK agree that during the Additional Year, the contract will continue as written. EXECUTED this the Z3Y ZL day of f+/ 2020. Richard H. Meyer, Calhou i C unty Judge Calhoun County, Texas 211 S Ann St, Ste 301 Port Lavaca TX 77979 ATTEST: AN JDMAN, �� I H UN COUNTY CLERK B .Deputy der c� El Campo TX 77437 Landowner's Affidavit Nest Collection STATE OF TEXAS: COUNT OF Calhoun Before me, the undersigned authority, on this day personally appeared Richard Meyer known by me to be a credible person, who being by me duIy swom, on oath deposes and says: "My name is Richard Meyer . I manage 6461.08 acres in Calhoun County (ies), Texas, known as Calhoun County Green Lake Project located about 10 miles from Port Lavaca. Texas and lying in the I have authorized Larry W. Janik to serve as my agent from June 01, 2021 until August 15, 2021, for purposes of arranging Department surveys as deemed necessary (by TPWD) and collection of nest stamps allotted to me from the Texas Parks and Wildlife Dnt on my behalf. r Signature Richard Meyer Print Name 211 S. Ann St. Address �% Port Lavaca. Texas 77979 Sworn to and subscribed before me by � �f.C� on z k day of A ✓ 20 , certified and witnessed by my hand and seal of cial. ;< MAE 6EI..LE CASSEL MY NDhW ID # 132012524 kya. Expires May 14, 2023 Notary of Public, State of Texas [t.t; i CIIIC &SScI (Print Name) My commission expires: Z 3 I I Landowner's Affidavit CITES TAGS STATE OF TEXAS: COUNT OF Calhoun Before me, the undersigned authority, on this day personally appeared Richard Meyer known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard Mayes I manage 6461.08 acres in Calhoun County (ies), Texas, known as Calhoun County Green Lake Project located about 10 miles from Port Lavaca. Texas and lying in the I have authorized Larry W. 7anik to serve as my agent from August 01, 2021 until September 01, 2021, for purposes of arranging Department surveys as deem sary (by TPWD) and collection of CITES TAGS allotted to me from the Texas Parks and Wil fe artment on my behalf. r Sigriatare U Richard Meyer Print Name 211 S. Ann St. Address Port Lavaca, Texas 77979 Sworn to and subscribed before me by I Gr,� on 2 3tA- day of Aid 20 2A certified and witnessed by my hand and seal o fiiciai. V r LAB "J p� �•_ MAEBELIEOASSEL Notary ID#iS2012624 `^-tMy - Ax a EVUvs May 14, 2023 Notary of Public, State of Texas hae g,%11, &r✓I (Print Name) My commission expires: S 4 23 CONTRACT Green Lake Project Alligator Management & Nuisance Control Beginning January 1, 2020 and Ending December 31, 2020 Approved by Commissioners Court December 30, 2019 Green Lake Project Alligator Management & Nuisance Control Contract This agreement is between Jamk Alligators LLC (hereinafter referred to as Janik) and Calhoun County (hereinafter referred to as County) for the management of alligators upon Calhoun County's Green Lake Project land and waters for a one-year term beginning January 1, 2020 and ending December 31, 2020, with the option to renew yearly. Sank agrees that all activities under this agreement shall be in compliance with rules established by Texas Parks and Wildlife Department and laws of the State of Texas. Jenik holds Nuisance control Alligator Permit Numbers NACPOl and NACP02 from the Texas Parks and Wfldh& Department (hereinafter referred to as TWPD). Jan& agrees to keep these permits current end in force at all times during the course of this agreement. Janik agrees to conduct surveys, including night count surveys and helicopter nest surveys, to effectively perform the needed alligator management and submit documentation to TPWD to secure all available alligator tags and nest stamps. All cost associated with the surveys will be the, responsibility of Janik. Jawk agrees to remove all alligators for which tags are received from TPWD, to remove all alligators deemed to be a nuisance, and to remove such alligator eggs as authorized by TPWD from the Omen Lake Project land and waters. The County grants only Janie and his employees authorization to enter the Green Lake Project land and waters as needed to execute this agreement. No guided hunts will be allowed on the Green Lake Project land and waters. No P party subbing of any portion of this contract will be allowed. Janik shall have sole rights to receive alligator nest stamps and to harvest alligator eggs from the Green Lake Project land and waters and all costs of alligator tags and stamps shall be borne by Janik. Janik agrees to pay to the County (per bid awarded December 23, 2019) the sum of $300 for each alligator nest harvested and 50% of all fonds received for each alligator harvested from the Green Lake Project land and waters prior to the end of October each calendar year. Janik agrees to pay the cost of each alligator CITES tag. Janik agrees that all equipment and supply cost associated with the harvest of alligator eggs and alligator removal will be its responsibility. Janilc agrees to provide copies of all documentation and maps showing alligator nest OPS coordinates to Calhoun County or its designated agent when submitted to TPWD. A copy of the alligator documentation required by TPWD along with sales receipts for the alligators will be provided to the County at the end of each collection season and 7aWk agrees to furnish the Calhoun County Auditor with any information needed to verify and confirm the payments made under this agreement. It is agreed that this agreement may be cancelled without cause by either party by providing 30 day written notice to the other party. The patties agree that this agreement shall not be changed or modified except by written agreement signed by both parties. This agreement is executed and will be performed in Calhoun county, Texas. Executed the 30'h day of December, 2019 Calhoun County, Texas 211 S. Ann, Suite 301 Port Lpv-Rc'3, Texas 77979 Meyer, CounWudge Janik Alligators LLC 3244CR 410 El Campo, Texasa74 of Landowner's Affidavit Nest Collection STATE OF T COUNTY OF daja/ ; Before me, the undersigned authority, on this day personally appeared Richard Meyer , known by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is Richard Meyer . I own / manage 6461.08 acres in Calhoun county (tes), Texas, known as Calhoun County Green Lake Protect located about_ _o miles from Port Lavaca_ Tuna and h4na in An r-r w A I have authorized Larry W. Janik to serve as my agent from June 01, 2020 until August 15, 2020, for purposes of arranging Department surveys as deemed necessary (by TPWD) and collection of nest stamps allotted to me from the Texas Parks and Wildlife Department o y behalf L Situlme Richard Meyer Prtnt Name F and su orn tocribed before i 020 • carolled �j601EBELLEal,y14,8�3�8I,�.V)� ~ mi�ID?I3=2KM 4 MMMAY14,20n 211 S. AnSuite 301 An. ddrm Port Lavaca TX 77979 Mycemmissioaexpires: 5 y3 Landownees Affidavit CITES TAGS STATE OF COUNTY OR _ Before me, the undersigned authority, on this day personally appeared Richard Weyer !mown by me to be a credible person, who being by me duly sworn, on oath deposes and says: "My name is appeared Richard Meyer . I manage 461.08 acres in Calhoun county (kes), Texas, known as Calhoun County Green Lake Protect located about 10 miles from _Port Lavaca Texas and lying in I have authorized Larry W. Janik to serve as my agent from August 01, 2020 until September 01, 2020, for purposes of arranging Department surveys as deemed necessary (by TPWD) and collection of CITES TAGS allotted to me from the Texas Parks and Wildlife Department ou behalf. stao.mR Richard Meyer PnintN�me 211 S. Alin, Suite 301 Ad&= Port Lavaca TX 77979 #13 NOTICE OF MEE i ING - 12/14/2022 13. Accept Monthly Reports from the following County Offices: I. County Clerk — November 2022 ii. District Clerk — November 2022 iii. Justice of the Peace, Precinct 1— November 2022 iv. Justice of the Peace, Precinct 2 — November 2022 v. Justice of the Peace, Precinct 4 — November 2022 vi. Sheriff's Office — November 2022 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 10of12 CALHOUN COUNTY CLERK MONTHLY REPORT RECAPITUATION NOVEMBER;2022 "OFFICIAL PUBLIC DESC GLCODE CIVIL/FAMILY CRIMINAL RECORDS PROBATE TOTAL DISTRICT ATTORNEY FEES 1000-44020 $ 169.79 $ 169.79 BEER LICENSE 1000-42010 $ - $ - COUNTY CLERK FEES 1000-44030 $ 392.00 $ 339.58 $ 9.986.50 $ 118.00 $ 10,836.08 APPEAL FROM JP COURTS 1000"030 $ - $ - COUNTY COURT ATLAW BIJURY FEE 1000.44140 $ - JURY FEE 1000-44140 $ - $ - $ - ELECTRONIC FILING FEES FOR E-FILINGS 1000-44058 $ - $ - $ - $ - $ - JUDGE'S EDUCATION FEE 1000-44160 $ - $ - $ - $ 5.00 $ 5.00 JUDGE'S ORDER/SIGNATURE 1000-44180 $ 26.00 $ - $ - $ 50.00 $ 76.00 SHERIFF'S FEES 1000-44190 $ 75.00 $ 250.49 $ - $ 50.00 $ 375.49 VISUAL RECORDER FEE 3000-44250 $ 72.88 $ 72.88 THE PAYMENT FEE. COUNTY "NEW 20201- 1000-04.932 $ 90.00 $ 90.00 COURT REFPORTER FEE 1000-44270 $ 175.00 $ - $ - $ 25.00 $ 200.00 RESTITUTION DUE TO OTHERS 100049020 $ - ATTORNEY FEES -COURT APPOINTED 1000-49030 $ - $ - APPELLATE FUNO(TGC)FEE 2620-44030 $ 35.00 $ 5.00 $ 40.00 COURTFACILITYFEE FUND 2648-44030 $ 140.00 $ - $ $ 20.00 $ 160.00 TECHNOLOGY FUND 2663-44030 $ 33.96 $ 33.96 COUNTYJURYFUND--NEW2020" 2669-44D30 $ 70.00 $ 8.49 $ $ 10.00 $ 88.49 COURTHOUSE SECURITY FEE 2670-44030 $ 140.00 $ 84.90 $ 366.00 $ 20.00 $ 600.90 COURT INITIATED GUARDIANSHIP FEE 2672-44030 $ 30.00 $ 30.00 COURT RECORD PRESERVATION FUND 2673-44030 $ - $ - $ - $ - COURTREPORTER SERVICEFUND•-NEW2020•• 267444030 $ 25.47 $ 25.47 RECORDS ARCHIVE FEE 2675-44030 $ 3,370.00 $ 3,370.00 COUNTYSPECIALTY COURT •-NEW2020-- 267644030 $ 169.79 $ 169.79 COUNTYDISPUTE RESOLUTION FUND 267744030 $ 105.00 $ - $ - $ 15.00 $ 120.00 DRUG& ALCOHOL COURT PROGRAM 2698-44030-005 $ - $ - JUVENILE CASE MANAGER FUND 2699-44033 $ - $ - FAMILY PROTECTION FUND 2706-44030 $ - $ - JUVENILE CRIME & DELINQUENCY FUND 2715-44030 $0.00 $ - LANGUAGEACCESSFUND 2725-0 030 $ 21.00 $ $ - $ 3.00 $ 24.00 PRE-TRIAL DIVERSON AGREEMENT 2729-44034 $ - $ - LAW LIBARYFEE 2731-44030 $ 245.00 $ 35.00 $ 280.00 RECORDS MANAGEMENT FEE -COUNTY CLERKK 2738-44380 $ - $ 3,420.00 $ 3.420.00 RECORDS MANGEM ENT FEE - COUNTY 2739-44030 $ 210.00 $ 212.24 $ 15.00 $ 437.24 FINES - COUNTY COURT 2740-45040 $ 2,964.35 $ 2.964.35 BOND FORFEITURE 2740-45050 $ - $ - STATE POLICE OFFICER FEES - STATE (DPS) (20%) 7020-20740 $ 0.88 $ 0.88 CONSOLIDATED COURT COSTS - COUNTY 7070-20610 $ - $ - CONSOLIDATED COURT COSTS -STATE 7070-20740 $ - $ - CONSOLIDATED COURTCOSTS-COUNTY '*NEW20207072-20610 $ 67.70 $ 67.70 CONSOLIDATED COURTCOSTS-STATE "NEW2020--7072-20740 $ 609.28 $ 609.28 JUDICIAL AND COURT PERSONNEL TRAINING - ST (100% 7502-20740 $ - $ - $ - $ - DRUG& ALCOHOL COURT PROGRAM - COUNTY 7390-20610 $ - $ - DRUG& ALCOHOL COURT PROGRAM -STATE 7390-20740 $ - $ - STATEELECTRONICFILINGFEE -CIVIL 7403-22887 $ - $ - $ - $ - STATE ELECTRONIC FILING FEE CRIMINAL 7403-22990 $ - $ - EMS TRAUMA -COUNTY (10%) 7405-20610 $ 45t80 $ 451.80 EMS TRAUMA - STATE (90%) 7405-20740 $ 50.20 $ 50.20 CIVIL INDIGENT FEE -COUNTY 7480-20610 $ - $ - $ - CIVILINDIGENTFEE -STATE 7480-20740 $ - $ - $ - JUDICIAL FUND COURT COSTS 7495-20740 $ - $ - JUDICIAL SALARY FUND- COUNTY (10%) 7505-20610 $ - $ - JUDICIAL SALARY FUND - STATE (90%) 7505-20740 $ - $ - 3UDICIALSALARY FUN D(CIVIL&PROBATE) -STATE 7505-20740-005 $ - $ - $ - TRAFFIC LOCAL (ADMINISTRATIVE FEES) 7538-22884,1000-44359 $ 0.85 $ 0.85 COU RT COST APPEAL OF TRAFFIC REG)JP APPEAL) 7538-22885 $ - BIRTH - STATE 7855-20780 $ 90.00 $ 90.00 INFORMAL MARRIAGES -STATE 7855-20782 $ 12.50 $ 12.50 JUDICIAL FEE 7855-20786 $ - $ - $ - $ - FORMAL MARRIAGES -STATE 7855-20788 $ 300.00 $ 300.00 NONDISCLOSURE FEE -STATE 7855-20790 $ - $ - $ - $ - $ - TCLEOSECOURTCOST -COUNTY (10%) 7856-20610 $ - $ - TCLEOSECOURTCOST -STATE (90%) 7856-20740 $ - $ - JURYREIMBURSEMENTFEE-COUNTY (10% 7857-20610 $ - $ - JURY REIMBURSEMENT FEE -STATE (90%) 7857-20740 $ - $ - CONSOLIDATED CRT COSTS . STATE (PR, FAME CV) SB437858-20740 $ 685.00 $ - $ 686.00 STATE TRAFFIC FI N E- COUNTY (5%) 7860-20610 $ - $ - STATE TRAFFIC HNE- STATE (95%) 7860-20740 $ - $ - STATE TRAFFIC FINE - COUNTY (4%) 9/1/2019 7860-20510 $ 0.57 $ 0.67 STATE TRAFFIC FINE - STA TE (96%) 91112019 7860-20740 $ 13.58 $ 12.58 1 aF2 TREMURER REPOFTSM2 P.11]D22 TREASURER REPORTS 1=2022 CALHOUN COUNTY CLERK MONTHLY REPORT RECAPITUATION NOVEMBER 2022 OFFICIAL PUBLIC DESC GLCODE. CIVIL/FAMILY CRIMINAL RECORDS PROBATE TOTAL INDIGENT DEFENSE FEE -CRIMINAL - COUNTY (10%) 7865-20610 $ - $ - INDIGENT DEFENSE FEE -CRIMINAL -STATE (90%) 7865-20740 $ - $ - TIME PAYMENT - COUNTY (50%) 7950-20610 $ - $ - TIME PAYMENT -STATE (SO%) 7950-20740 $ - $ - BAIL JUMPING AND FAILURE TOAPPEAR -COUNTY 7970-20610 $ - BAIL JUMPING AND FAILURE TOAPPEAR -STATE 7970-20740 $ - DUEPORTLAVACAPO. 9990-99991 $. 24.20 $ 24.20 DUE SEADRIFT PD 9990-99992 $ - $ - DUE TOPOINT COMFORT PD 9990-99993 $ -. $ DUE TO TEXAS PARKS &WILDLIFE. 999099994. $ - $. DUE TO TEXAS PARKS& WILDLIFE WATER SAFETY 9990-99995 $ - DUETOTABC 9990-99996 $ - DUE TOATTORNEY ADLITEMS 9990-99997 $ - DUE TOOPERATING/NSF CHARGES/DUE TO OTHERS 7120-20759 $. $.. $ (303.00) $ 1,000.00 $ 697.00 $ 2,319.00 $ 7641.00 $ 17,232.00 $ 1,401.00 $ 26,593.00 TOTAL FUNDS COLLECTED $ 26,593.00 (0.00) FUNDS HELD IN ESCROW: $ - AMOUNT DUE TO TREASURER(2DWS): $ 25,871.80 TOTAL RECEIPTS: $ 20,593,00AMOUNT DUE TO OTHERS (LESS SPS): $ 721.20 REGISTRY DEPOSITS CASH BONDS AND CERTIFICATES OF DEPOSIT CASH ON HAND: REGISTRY OF COURT FUNDS (PROSPERITY)__ BEGINNING BOOK BALf0ANCE /aiho2a - $ 77,464.62 FUND RECEIVED $ ,015015.0000 -BALANCE OF CASH BONDS- $ 82,808.50 DISBURSEMENTS $ 2,500.00 ENDING BOOK BALANCE 11/3e/2632 _ j $ 75,979.62 "OTHER REGISTRY ITEMS^ $ 13,196.12 -IBC CASH BOND CHECKS" $ 25.00 BANK RECONCILIATION REGISTRY OF COURT FUNDS ENDING BANK BALANCE 11/30/2022 $ 79,632.12 "TOTAL REGISTRY FUNDS` $ 75,979.62 OUTSTANDING DEPOSITS" $ - OUTSTANDING CHECKS" $ 3,652.50 Recancl/etl: $ - RECONCILED BANK BALANCE 11/30/2022 $ 75,979.82 -sas.00 sPam.un ou.re.r HELD IN TRUST - PROSPERITY BANK CD'S..: Date Issued Balance Purchases) Withdrawals Balance 10/3112022 Interest 11/30122 10440 1/24/2018 $ $ $ 10441 1/24/2018 $ $ 10442 1/24/2018 $ 1,276.99 $ 1.276.99 10443 1/25/2018 IS 1,276.99 $ 1,276.99 10444 1/25/2018 $ 9,643.44 $ 9,643.44 10445 1/25/2018 $ 9,643.44 $ 9.643.44 10446 1/25/2018 $ 9.643.44 $ 9,643.44 10449 6/9/1955 $ 20,366.27 $ 2.57 $ 20,368.84 10454 3/2/2018 $ 3,596.59 $ 3,596.59 10466 3/2/2018 $ 3,596.59 $ 3,596.59 10486 8/26/2020 $ 5,923.03 $ 13.44 $ 5,936.47 10495 12/22/2021 $ 34,159.29 1 $ 34,159.29 10496 12/22/2021 $ 34,159.28 1 $ 34,159.28 TOTALS: $ 133,285.35 1 $ 16.01 $ $ 133,301.36 I 20E2 S10AEPORTSWONTXLMUDRGR AND TREASURER REPGRT512U22.113022 TREASURER REPORTS 122202E * Treasurer Receipt Numbers: F2022NOV006, 012,026,033 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 12/1/2022 COURT NAME: DISTRICT CLERK MONTH OF REPORT: NOVEMBER YEAR OF REPORT: 2022 ACCOUNT NUMBER ACCOUNT NAME DEBIT CREDIT 1000-001-44190 SHERIFF'S SERVICE FEES $674.00 1000-001-44140 JURY FEES $126.60 1000-001-44045 RESTITUTION FEE $0.00 1000-001-44020 DISTRICT ATTORNEY FEES $0.00 1000-001-49010 REBATES -PREVIOUS EXPENSE $1.89 1000-001-49030 REBATES-ATTORNEY'S FEES $141.05 1000-001-44058 DISTRICT CLERK ELECTRONIC FILING FEES $0.00 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEES $4.64 1000-001-43049 STATE REIMB- TITLE IV-D COURT COSTS $0.00 1000-001-44050 1000-999-20771 1000-999-10010 2706-001-44055 2706-999-10010 2740-001-45055 2740-999-10010 2620-001-44055 2620-999-10010 2648-001-44055 2648-999-10010 2670-001-44055 2670-999-10010 2673-001-44055 2673-999-10010 2725-001-44055 2725-999-10010 2739-001-44055 2739-999-10010 2737-001-44055 2737-999-10010 2731-001-44055 2731-999-10010 2663-001-44050 2663-999-10010 7040-999-20740 7040-999-10010 2667-001-44055 2667-999-10010 7502-999-20740 7502-999-10010 7383-999-20610 7383-999-20740 DISTRICT CLERK FEES CERTIFIED COPIES $112.00 CRIMINAL COURT $7.23 CIVIL COURT $1,150.64 STENOGRAPHER $291.50 CIV FEES DIFF $0.00 DISTRICT CLERK FEES FAMILY VIOLENCE FINE CASH - AVAILABLE FAMILY PROTECTION FEE CASH - AVAILABLE FINES - DISTRICT COURT CASH - AVAILABLE APPELLATE JUDICIAL SYSTEM CASH - AVAILABLE COURT FACILITY FEE FUND CASH - AVAILABLE COURTHOUSE SECURITY CASH - AVAILABLE CRT RECS PRESERVATION FUND- CO CASH - AVAILABLE LANGUAGE ACCESS FUND CASH - AVAILABLE RECORD MGMT/PRSV FUND - COUNTY CASH - AVAILABLE RECORD MGMT/PRSV FUND -DIST CLRK CASH - AVAILABLE LAW LIBRARY CASH - AVAILABLE CO & DIST CRT TECHNOLOGY FUND CASH - AVAILABL BREATH ALCOHOL TESTING - STATE CASH - AVAILABLE CO CHILD ABUSE PREVENTION FUND CASH - AVAILABLE $1,561.37 $0.00 $2,509.55 $0.00 $0.00 $26.48 $26.48 $58.30 $58.30 $233.20 $233.20 $239.18 $239.18 $10.00 $10.00 $34.98 $34.98 $358.82 $358.82 $25.45 $25.45 $408.10 $408.10 $0.70 $0.70 $0.00 $0.00 $0.18 $0.18 JUDICIAL & COURT PERSONNEL TRAINING FUND -STATE CASH-AVAILABE $0.00 DNA TESTING FEE - County DNA TESTING FEE - STATE $0.00 $0.07 $0.59 7383-999-10010 CASH -AVAILABLE $0.66 7405-999-20610 EMS TRAUMA FUND - COUNTY $0.00 7405-999-20740 EMS TRAUMA FUND - STATE $0.00 7405-999-10010 CASH - AVAILABLE $0.00 7070-999-20610 CONSOL. COURT COSTS - COUNTY $0.97 7070-999-20740 CONSOL. COURT COSTS - STATE $8.71 7070-999-10010 CASH - AVAILABLE $9.66 7072-999-20610 STATE CONSOL. COURT COSTS- COUNTY $5.95 7072-999-20740 STATE CONSOL. COURT COSTS- STATE $53.52 7072-999-10010 CASH -AVAILABLE $59.47 2698-001-44030-010 DRUG CRT PROG FEE - COUNTY (PROGRAM) $0.06 2698-999-10010-010 CASH -AVAILABLE $0.06 7390-999-20610-999 DRUG COURT PROG FEE - COUNTY (SVC FEE) $0.01 7390-999-20740-999 DRUG COURT PROG FEE - STATE $0.04 7390-999-10010-999 CASH -AVAILABLE $0.05 7865-999-20610-999 CRIM - SUPP OF IND LEGAL SVCS - COUNTY $0.01 7865-999-20740-999 CRIM - SUPP OF IND LEGAL SVCS - STATE $0.11 7865-999-10010-999 CASH - AVAILABLE $0.12 7950-999-20610 TIME PAYMENT - COUNTY $128 7950-999-20740 TIME PAYMENT - STATE $1.27 7950-999-10010 CASH - AVAILABLE $2.55 7505-999-20610 JUDICIAL SUPPORT-CRIM - COUNTY $0.06 7505-999-20740 JUDICIAL SUPPORT-CRIM - STATE $0.32 7505-999-10010 CASH - AVAILABLE $0.38 7505-999-20740-010 JUDICIAL SALARIES -CIVIL - STATE(42) $42.00 7505-999-10010-010 CASH AVAILABLE $42.00 2740-001-45050 BOND FORFEITURES $0.00 2740-999-10010 CASH - AVAILABLE $0.00 2729-001-44034 PRE-TRIAL DIVERSION FUND $0.00 2729-999-10010 CASH - AVAILABLE $0.00 7857-999-20610 JURY REIMBURSEMENT FUND- COUNTY $0.18 7857-999-20740 JURY REIMBURSEMENT FUND- STATE $1.61 7857-999-10010 CASH - AVAILABLE $1.79 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 $0.00 7403-999-22991 DIST CRT - ELECTRONIC FILING FEE - CRIMINAL $0.87 CASH - AVAILABLE $0.87 1-44050 DISTRICT CLERK FEES $12.85 9-10010 CASH - AVAILABLE $12.85 1-44055 RECORD MGMT/PRSV FUND - COUNTY $8.03 9-10010 CASH - AVAILABLE $8.03 1-44050 COUNTY JURY FUND $0.32 9-10010 CASH - AVAILABLE $0.32 1-44055 COURTHOUSE SECURITY $3.21 9-10010 CASH - AVAILABLE $3.21 1-44050 CO & DIST CRT TECHNOLOGY FUND $1.28 9-10010 CASH - AVAILABLE $1.28 1-44050 COUNTY SPECIALTY COURT FUND $8.03 9-10010 CASH.- AVAILABLE $8.03 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 $48.50 7855-999-20658-010 DIST CRT -OTHER THAN DIVORCE/FAMILY LAW - COUNTY $1.50 7855-999-20740-010 DIST CRT - OTHER CIVIL PROCEEDINGS - STATE $9.50 7855-999-20610-010 DIST CRT - OTHER CIVIL PROCEEDINGS - COUNTY $0.50 7855-999-20790-010 DUE TO STATE - NONDISCLOSURE FEE $0.00 7855-999-10010-010 CASH - AVAILABLE $60.00 2677-999-20740-999 COUNTY DISPUTE RESOLUTION FUND $174.90 2677-999-10010-999 CASH - AVAILABLE $174.90 7858-999-20740-999 DIST CLK - DUE TO STATE CONSOLIDATED FEE 2022 $364.42 7858-999-10010-999 CASH AVAILABLE $364.42 TOTAL (Distrib Req to Oper Acct) $4,689.35 $4,655.62 DUE TO OTHERS (Distrib Req(s) attached) ATTORNEY GENERAL (RESTITUTION) 0.00 OUT -OF -COUNTY SERVICE FEES 75.00 REFUND OF OVERPAYMENTS 0.00 DUE TO OTHERS 0.00 TOTAL DUE TO OTHERS $75.00 REPORT TOTAL -ALL FUNDS 4,730.62 PLUS AMT OF RETURNED CKS 0.00 LESS: TOTAL TREASURER'S RECEIPTS (4,730.62) Revised 01/31/20 OVER / (SHORT) $0.00 DISTRICT COURT NOVEMBER STATE COURT COSTS REPORT 2022 NOVEMBER SECTION I: REPORT FOR OFFENSES COMMITTED COLLECTED COUNTY STATE 01/1/20-Present 5.95 53.52 01/01/04-12/31/19 -' '. $$.2R ":'. 0.92 8.28 09/01/01 - 12/31/03 0.02 0.19 09/01 /99 - 08/31 /01 0.03 0.24 09/01/97 - 08/31/99 - - 09/01/95-08/31/97- 09/01/91-08/31/95 - - DNA TESTING FEES 0.66 0.07 0.59 EMS TRAUMA FUND - - - JUV. PROB. DIVERSION FEES JURY REIMBURSEMENT FEE $1.79 0.18 1.61 INDIGENT DEFENSE FUND $0.12 0.01 $0.11 STATE TRAFFIC FEES $0.00 - $0.00 DRUG CRT PROG FEE $0.11 $0.07 0.04 SECTION II: AS APPLICABLE STATE POLICE OFFICER FEES FAILURE TO APPEAR/PAY FEES - - JUD. FUND-CONST. CO. CRT. ,„. Mir JUD. FUND -STATUTORY CO. CRT. MOTOR CARRIER WEIGHT VIOLATIONS TIME PAYMENT FEE $2.55 1.28 1.27 DRIVING RECORD FEE JUDICIAL SUPPORT FEES $0.38 0.06 0.32 ELECTRONIC FILING FEE -CR $0.87 $0.87 TOTAL STATE COURT COSTS $75.63 $ 8.59 $ 67.04 CIVIL FEES REPORT NOVEMBER COLLECTED COUNTY STATE BIRTH CERTIFICATE FEES MARRIAGE LICENSE FEES DECL. OF INFORMAL MARRIAGE ELECTRONIC FILING FEE - CV $0.00 $0.00 NONDISCLOSURE FEES 0 $0.00 $0.00 JUROR DONATIONS JUSTICE CRT. INDIG FILLING FEES STAT PROB CRT INDIG FILING FEES STAT PROB CRT JUDIC FILING FEES STAT CNTY CRT INDIG FILING FEES STAT CNTY CRT JUDIC FILING FEES STAT CNTY CRT -JUDICIAL SUPPORT CONST CNTY CRT INDIG FILING FEES CNST CNTY CRT JUDIC FILING FEES DIST CRT DIV & FAMILY LAW 0 $0.00 - - DIST CRT OTHER THAN DIV/FAM LAW 3 $50.00 1.50 48.50 DIST CRT OTHER CIVIL FILINGS. _0 $10.00 0.50 9.50 FAMILY PROTECTION FEE JUDICIAL SUPPORT FEE 1 - $42.00 $42.00 JUDICIAL & COURT PERSONNEL TRANING FEE 0 $0.00 - $0.00 2022 STATE CONSOLIDATED FEE 3 $364.42 $364.42 COUNTY DISPUTE RESOLUTION FUND 174.90 174.90 TOTAL CIVIL FEES REPORT $ 641.32 $ 2.00 $ 639.32 TOTAL BOTH REPORTS $ 716.95 $ 10.59 $ 706.36 CALHOUN DISTRIBUTION REQUEST COUNTY 201 West Austin DR# 420 A 44896 PAYEE Name: Calhoun County Oper. Acct. Address: City: State: Zip: Phone: PAYOR Official: Anna Rabela Title: District Clerk ACCOUNT NUMBER - DCSCRIWiION AMOUNT 7340-999.20759-999 District Clerk Monthly Collections - Distribution $4,655.62 NOVEMBER 2022 V# 967 z Signature of Official Date TOTAL 4,655.62 — �Z-Z I MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 12/1/2022 COURT NAME: JUSTICE OF PEACE NO.1 MONTH OF REPORT: NOVEMBER YEAR OF REPORT: 0 ACCOUNT NUMBER ACCOUNTNAME AMOUNT CR 1000-001-45011 FINES 5,124.19 CR 1000-001-44190 SHERIFF'S FEES 578.71 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 40.00 CHILD SAFETY 0.00 TRAFFIC 90.95 ADMINISTRATIVE FEES 967.51 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44361 TOTAL ADMINISTRATIVE FEES 1,098.46 CR 1000-001-44010 CONSTABLE FEES -SERVICE 150.00 CR 1000-001-44061 JP FILING FEES 0.00 CR 1000-001-44090 COPIES / CERTIFIED COPIES 0.00 CR 1000-001-49110 OVERPAYMENTS (LESS THAN $10) 2.00 CR 1000-001-44322 TIME PAYMENT REIMBURSEMENT FEE 85.70 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 978.60 TOTAL FINES, ADMIN. FEES & DUE TO STATE $8,017.66 CR 2670-001-44061 COURTHOUSE SECURITY FUND $294.60 CR 2720-001-44061 JUSTICE COURT SECURITY FUND $2.03 CR 2719-001-44061 JUSTICE COURT TECHNOLOGY FUND $243.63 CR 2699-001-44061 JUVENILE CASE MANAGER FUND $10.00 CR 2730-001-44061 LOCAL TRUANCY PREVENTION & DIVERSION FUND $294.42 CR 2669-001-44061 COUNTY JURY FUND $5.89 CR 2728.001 44061 JUSTICEICOURT SUPPORT FUND $175.00 CR 2677-001744061' COUNTY DISPUTE,RESOLUTION FUND $35.00" CR 2725-001 44061 LANGUAGE ACdEtS FUND $21,.00 STATE ARREST FEES DPS FEES 3828 P&W FEES 1.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 39.28 CR 7070-999-20610 CCC-GENERAL FUND 8.10 CR 7070-999-20740 CCC-STATE 72.90 DR 7070-999-10010 81.00 CR 7072-999-20610 STATE CCC- GENERAL FUND 370.47 CR 7072-999-20740 STATE CCC- STATE 3,334.22 DR 7072-999-10010 3,704.69 CR 7860-999-20610 STF/SUBC-GENERAL FUND 0.04 CR 7860-999-20740 STF/SUBC-STATE 0.71 DR 7860-999-10010 0.75 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 60.58 CR 7860-999-20740 STF- EST 9/1/2019- STATE 1,454.04 DR 7860-999-10010 1,514.62 Page 1 of 3 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 121112022 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: NOVEMBER YEAR OF REPORT: 0 CR 7950-999-20610 TP-GENERAL FUND 0.31 CR 7950-999-20740 TP-STATE 0.31 DR 7950-999-10010 0.52 Page 2 of 3 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 12/1/2022 COURT NAME: JUSTICE OF PEACE NO. 1 MONTH OF REPORT: NOVEMBER 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 0.41 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 3.64 DR 7865-999-10010 4.05 CR 7970-999-20610 TUFTA-GENERAL FUND 0.25 CR 7970-999-20740 TL/FTA-STATE 0.50 DR 7970-999-10010 0.75 CR 7505-999-20610 JPAY- GENERAL FUND 1.22 CR 7505-999-20740 JPAY-STATE 10.93 DR 7505-999-10010 12.15 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 0.81 CR 7857-999-20740 JURY REIMB. FUND- STATE 7.29 DR 7857-999-10010 8.10 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.01 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS: STATE 0.09 DR 7856-999-10010 0.10 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 2.03 7998-999-20701 JUVENILE CASE MANAGER FUND 2.03 DR 7998-999-10010 4.05 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 REVISED 02/02/2022 TOTAL (Distrib Req to Oper Acct) $14,616.39 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 1,568.17 WATER SAFETY FINES 37.40 TOTAL DUE TO OTHERS $1,605.57 TOTAL COLLECTED -ALL FUNDS $16,221.96 LESS: TOTAL TREASUER'S RECEIPTS $16,221.96 OVER/(SHORT) $0.00 Page 3 of 3 CALHOUN DISTRIBUTION COUNTY REQUEST 201 West Austin DR# 450 A 44896 PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: Hope Kurtz Address: Title: Justice of the Peace, Pct. 1 City: State: Zip: Phone: .ACCOUNT NUMBER DESCRIPTION.. AMOUNT 7541-999-20759-999 JP1 Monthly Collections - Distribution $14,616.39 NOVEMBER 0 V# 967 TOTALI 14,616.39 C !✓ Signature of Official Date ENTER COURT NAME JUSTICE OF PEACE N0.2 ENTER MONTH OF.REPORT 'w : November ENTER YEAR OF REPORT 2022 *',y-;. CODE _ AMOUNT BONDS 0.00 A'. E ' .ADMINISTRE-ADMF 0.00 BREATH AL H Gr B/,rT 0.00 CONS OLID ATEOU COC - 128.40. STATE CONSOLIDATED COO i2" ST 2020 732.56 LOCAL CONSOLIDATED COURT COST- 2020 165.42 COURTHOUSE SECURITY -CHS 12.85 - CJP 0.00 CIVIL JUSTICE DATA REPOSITORY 'FEE -CJDR 0.00 CORRECTIONAL MANAGEMENT INSTITUTE-CMI DAD CR DAD CHILD SAFETY - CS 0.00 CHILD.SEATBELT FEE -CSBF 0.03 CRIME VICTIMS COMPENSATION -CVC 0.03 DPSC/FAILURE TO APPEAR -OMNI-DPSC 87.38 ADMINISTRATION FEE FTAIFTP (aka OMNI} 2020 50.00 ELECTRONIC FILING FEE '-EEF 0.00 FUGITIVE APPREHENSION - FA 0.00 GENERALREVENUE-GR 0.00 CRIM- IND LEGAL SVCS SUPPORT -ADF 6.43 JUVENILE CRIME & DELINQUENCY -: JCD 0.00 JUVENILE CASE MANAGER FUND -JCMF 15.66 JUSTICE COURT PERSONNEL TRAINING -JCPT 0.00 JUROR SERVICE FEE-. JSF 12.85 LOCAL ARREST FEES - LAP 55.56 - LEMI 0.00 LEDA 0.00 LEOC 0.00 OCL 0.00 PARKS& WILDLIFE ARREST FEES -PWAF 5.00 ' STATE ARREST FEES - SAP 6.87 - SCHOOL CROSSING/CHILD. SAFETY FEE -SCF 0.00 SUBTITLE C-:SUBIC 0.00 STATE TRAFFIC PINES -EST 9.1.19-STF 188.75 - TABCARREST FEES -TAP 0.00 '. TECHNOLOGY FUND -TF 12.85 TRAFFIC -TFC 0.00 LOCAL TRAFFIC FINE-2020. 11.33 `. TIME PAYMENT -TIME 25.00 - .TIME PAYMENT. REIMBURSEMENT FEE-2020 92.96 TRUANCY PREVENTION/DIVERSION FUND .-TPDF 6.43 LOCAL & STATE WARRANT FEES - WRNT 36B.70 COLLECTION SERVICE FEE-MVBA'-CSRV 937.19 - DEFENSIVE DRIVING COURSE - ODIC 0.00 '. DEFERRED FEE -DFF 77.43 DRIVING EXAM FEE-PROVDL 0.00 FILING FEE -FFEE 30.00 STATE CONSOLIDATED CIVIL FEE -2022 231.00 LOCAL CONSOLIDATED CIVIL FEE -2022 363.00 .FILING FEE SMALL CLAIMS -FFSC 0.00 -'.JURY FEE -JF 0.00 COPIES/CERTIFED COPIES - CC 0.00 INDIGENT FEE -CIFF or INDF 0.00 JUDGE PAY RAISE FEE -JPAY 19.26 SERVICE FEE. -SFEE 460.00 OUT -OF -COUNTY SERVICE FEE 0.00 ELECTRONIC FILING FEE -EEFCV 0.00 -` EXPUNGEMENT FEE -EXPG 0.00 EXPIRED RENEWAL -EXPR 0.00 ABSTRACT OF JUDGEMENT -AOJ 0.00 ALL WRrrS WOP/ WOE 0.00 DPS FTA FINE -.DPSF 19B.00 LOCAL FINES - FINE 2,184.49 -LICENSE &WEIGHT FEES -LWF 0.00 PARKS '&WILDLIFE FINES-: PWF 104.00 - SEATBELTIUNRESTRAINED.CHILD FINE' -SEAT 0.00 -JUDICIAL & COURT PERSONNEL TRAININGJCPT 0.00 -• OVERPAYMENT (OVER $10)-:OVER 0.00 ` OVERPAYMENT.($10 AND LESS) - OVERI 0.00 RESTITUTION - REST 0.00 PARKS & WILDLIFE -WATER SAFETY FINES-WSF 0.00 MARINE SAFETY PARKS & WILDLIFE- MSO 0.00 TOTAL ACTUAL MONEY RECEIVED 58,579.35 TYPE: AMOUNT TOTAL WARRANT FEES 368.70 -ENTER LOCAL WARRANT FEES 200.00 RECORDONTOTAL PACE OF HILL COUNTRY SOFM'ARE MO,REPORT STATE WARRANT FEES $168.70 RECORDONTOTAL PAGE OF HILL COUNTRY SOFMARE MO. REPORT DUE TO OTHERS:. - AMOUNT. DUE TO CCISD-50%Of Fine on JV cam 0.00 PLEASE INCLUDE DR REQUESTING DISBURSEMENT DUE TO DA RESTITUTION FUND 0.06 PLEASE INCLUDE DR REQUESTING DISBURSEMENT REFUND OF OVERPAYMENTS 0.00 PLEASE INCLUDE DR REQUESTING DISBURSEMENT OUT -OF -COUNTY SERVICE FEE 0.00 PLEASE INCLUDE DR REQUESTING maeURSEMENT CASH BONDS 0.00 PLEASEINCLUDE DRREQUESTINGDISSURSEMENT(IFREQUIRED) TOTAL DUE TO OTHERS $0.00 TREASURERS RECEIPTS FOR MONTH, AMOUNT CASH, CHECKS, M.O. BCREDIT CARDS $8,578.35 Calculatefrom ACT UAL Treasurers Receipts TOTAL TREAS. RECEIPTS W 679.35 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 12/5/2022 COURT NAME: JUSTICE OF PEACE NO. 2 MONTH OF REPORT: November YEAR OF REPORT: 2022 ACCOUNT NUMBER ACCOUNT NAME AMOUNT CR 1000-001-45012 FINES 2,398.09 CR 1000-001-44190 SHERIFF'S FEES 400.02 ADMINISTRATIVE FEES: DEFENSIVE DRIVING 0.00 CHILD SAFETY 0.00 TRAFFIC 11.33 ADMINISTRATIVE FEES 127.43 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 CR 1000-001-44362 TOTAL ADMINISTRATIVE FEES 138.76 CR 1000-001-44010 CONSTABLE FEES -SERVICE 450.00 CR 1000-00144062 JP FILING FEES 30.00 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 92.96 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 937.19 TOTAL FINES, ADMIN. FEES & DUE TO STATE $4,447.02 CR 2670-00144062 COURTHOUSE SECURITY FUND $67.53 CR 2720-001-44062 JUSTICE COURT SECURITY FUND $3.21 CR 2719-001-44062 JUSTICE COURT TECHNOLOGY FUND $60.11 CR 2699-001-44062 JUVENILE CASE MANAGER FUND $15.66 CR 2730-001-44062 LOCAL TRUANCY PREVENTION & DIVERSION FUND $59.08 CR 2669-001-44062 COUNTY JURY FUND $1.18 CR 2728-001-44062 _ JUSTICE COURT SUPPORT FUND $275.00 11 CR 2677-001-44062 COUNTY DISPUTE RESOLUTION FUND $55.00 CR 2725-00144062 LANGUAGE ACCESS FUND $33.00 l STATE ARREST FEES DPS FEES 35.11 P&W FEES 1.00 TABC FEES 0.00 CR 7020-999-20740 TOTAL STATE ARREST FEES 36.11 CR 7070-999-20610 CCC-GENERAL FUND 12.84 CR 7070-999-20740 CCC-STATE 115.56 DR 7070-999-10010 128.40 CR 7072-999-20610 STATE CCC- GENERAL FUND 73.26 CR 7072-999-20740 STATE CCC- STATE 659.30 DR 7072-999-10010 732.56 CR 7860-999-20610 STF/SUBC-GENERAL FUND 0.00 CR 7860-999-20740 STF/SUBC-STATE 0.00 DR 7860-999-10010 0.00 CR 7860-999-20610 STF- EST 9/1/2019- GENERAL FUND 7.55 CR 7860-999-20740 STF- EST 9/1/2019- STATE 181.20 DR 7860-999-10010 188.75 Page 1 of 2 12/5/2022 CGv�(JRT;NAME: JUSTICE OF PEACE NO. 2 MONTH `OF"FiEPORT: November YEAR OF REPORT: 2022 CR 7950-999-20610 TP-GENERAL FUND 12.50 CR 7950-999-20740 TP-STATE 12.50 DR 7950-999-10010 25.00 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 0.64 CR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 5.79 DR 7865-999-10010 6.43 CR 7970-999-20610 TUFTA-GENERAL FUND 29.12 CR 7970-999-20740 TUFTA-STATE 58.24 DR 7970-999-10010 87.36 CR 7505-999-20610 JPAY - GENERAL FUND 1.93 CR 7505-999-20740 JPAY -STATE 17.33 DR 7505-999-10010 19.26 CR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 1.29 CR 7857-999-20740 JURY REIMB. FUND- STATE 11.56 DR 7857-999-10010 12.85 CR 7856-999-20610 CIVIL JUSTICE DATA REPOS.- GEN FUND 0.00 CR 7856-999-20740 CIVIL JUSTICE DATA REPOS.- STATE 0.00 DR 7856-999-10010 0.00 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 3.22 7998-999-20701 JUVENILE CASE MANAGER FUND 3.22 DR 7998-999-10010 6.43 7403-999-22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999-22889 0.00 7858-999-20740 STATE CONSOLIDATED CIVIL FEE 231.00 231.00 TOTAL (Distrib Req to Oper Acct) $6,579.35 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENTS 0.00 OUT -OF -COUNTY SERVICE FE 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 88.40 WATER SAFETY FINES 0.00 TOTAL DUE TO OTHERS $88.40 TOTAL COLLECTED -ALL FUNDS $6,579.35 LESS: TOTAL TREASUER'S RECEIPTS $6,579.35 I OVER/(SHORT) $0.00 Page 2 of 2 CALHOUN DISTRIBUTION COUNTY REQUEST 201 West Austin DR# 450 A 44900 PAYEE PAYOR Name: Calhoun County Oper. Acct. Official: Hope Kurtz Address: Title: Justice of the Peace, Pct. 2 City: State: Zip: Phone: ACCOUNT NUMBER - DESCRIPTION AMOUNT 7542.999-20759-999 JP2 Monthly Collections - Distribution $6,579.35 November 2022 V# 967 TOTAL 6,579.35 - / �/— Z-Z_ of Official /�% Date 12-05-22;12;08 ;From:Calhoun County JP4 To:3615534444 ;3617852179 FAX COVER SHEET December 05, 2022 FROM: JUSTICE COURT PCT, 4, CALHOUN COUNTY 103 W. Dallas Street, P.O. Box 520 Seadrift, Texas 77983 PHONE: 361-785-7082 FAX: 361-785-2179 TO: County Commissioner Court Office Attn: Mae Belle Cassel FAX; 361-553-4444 Fax Cover: Pages to Follow: _5_ Ref: November 2022—JP4 Monthly Money Distribution Report Please give me a call if you have any questions. Thank you, Patsy Spence, Court Clerk Judge 'Wesley J. Munt 12-05-22;12:08 ;From:Calhoun County JP4 DS.oD �1,EE 3DD0 75OD ;f p.0. nppVCp11NGEkYYAY[apM 00.1¢ppFprvxpWppYpC[MLM # 2/ 6 12-05-22;12;08 ;From;Calhoun County JP4 To;3615534444 ;3617852179 # 3/ 6 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 12/5/2022 ACCOUNT NUMBER OR 1000-001-45014 OR 1000-001-44190 OR 1000-001-44364 OR 1000-001-44010 CR 1000-001-44064 OR 1000-001-44090 OR 1000-001-49110 OR 1000-001-44322 OR 1000-001.44145 OR 1000.999-20741 OR 1000-999-20744 OR 1000-999-20745 OR 1000-999.20746 OR 1000-999-20770 COURT NAME: JUSTICE OF PEACE NO.4 i, MONTH OF REPORT: NOVEMBER ; YEAR OF REPORT: 2022 ADMINISTRATIVE FEES: DEFENSIVE DRIVING CHILD SAFETY TRAFFIC ADMINISTRATIVE FEES EXPUNGEMENTFEES MISCELLANEOUS OR 2670-001-44064 OR 2720-001-44064 OR 2719-001.44084 OR 2699-001.44084 OR 2730-001.44064 CR 2669-001.44064 CR`r'2728 001-44064 -CR. 2677461.44064 CR`/ 272&001-04064 STATEARRESTFEEES DPS FEES P&W FEES TABC FEES OR 7020-999-20740 OR 7070-999-20610 OR 7970-999-20740 OR 7070-999.10010 OR 7072-999-20610 CR 7072-999-20740 OR 7072-999.10010 OR 7860-999-20610 OR 7860-999-20740 OR 7860-999-10010 OR 7860-999-20510 OR 7860-999.20740 DR 7860-999.10010 ACCOUNT NAME AMbUNT FINES ;872,39 SHERIFF'S FEES 41.09 10.00 0.00 13.69 t ::.. 0.00 .... , 0.00 0.00 TOTAL ADMINISTRATIVE FEES 1.423.69 CONSTABLE FEES-$ERVICE 75,00 JP FILING FEES 0.00 COPIES / CERTIFIED COPIES 0.00 OVERPAYMENTS (LESS THAN $10) r'^. 0.00 TIME PAYMENT REIMBURSEMENT FEE "' 7.81 SCHOOL CROSSINGICHILD SAFETY FEE 0.00 DUE TO STATE -DRIVING EXAM FEE 0.00 DUE TO STATE-SEATBELT FINES 7 0.00 DUE TO STATE -CHILD SEATBELT FEE U.00 DUE TO STATE -OVERWEIGHT FINES ""';.0.00 DUE TO JP COLLECTIONS ATTORNEY 139.50 TOTAL FINES, ADMIN. FEES & DUE TO STATE $1,15848 COURTHOUSE SECURITY FUND JUSTICE COURT SECURITY FUND $0.00 JUSTICE COURT TECHNOLOGY FUND , $3h_:OB JUVENILE CASE MANAGER FUND ,$0.00 LOCAL TRUANCY PREVENTION & DIVERSION FUND :g42.60 COUNTY JURY FUND JUSTICE COURT SUPPORT FUND 125.00 COUNTY DISPUTE -RESOLUTION FUND $5.00 LANGUA'GE.ACCESS FUND 53,00 ni• 1.52 0.00 0.00 TOTAL STATE ARREST FEES CCC-GENERAL FUND CCC-5TATE 0.00 0.00 STATE CCC- GENERAL FUND STATE CCC- STATE ••• 475•:48 528.29 STFISUBC-GENERAL FUND ;'.`Q:00 STF/SUBC-STATE ; `0.00 0.00 r STF- EST 9/l/2019- GENERAL FUND 9.13 STF- EST 9/l/2019- STATE .219.04 228.17 Pogo 1 of 3 12-05-22;12:08 ;From:Calhoun County JP4 To:3615534444 ;3617852179 # 4/ 6 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 12/6/2022 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: NOVEMBER YEAR OF REPORT: 2022 CR 7960.999.20W TP-GENSAAL FUND CR 7950-999-20740 TP-STATE DR 7950-999-10010 0.00 Page 2 of 3 12-05-22;12:08 ;From:Calhoun County JP4 To:3615534444 ;3617852179 # 5/ 6 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 12/5/2022 COURT NAME: JUSTICE OF PEACE NO.4 MONTH OF REPORT: NOVEMBER YEAR OF REPORT: 2022 CR 7480.999 20610 CIVIL INDIGENT LEGAL-GEN. FUND . -0.00 CR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE t70.00 OR 7480-999-10010 0.00 CR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND Q.00 CR 7866-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE Q.00 DR 7865-999-10010 0.00 " CR 7970-999-20610 TL/FTA-GENERAL FUND 0.00 CR 7970-999.20740 TL/FTASTATE 0.00 DR 7970-99(J-10010 0.00 CR 7505.999-20610 JNAY - GENERAL FUND 0.00 CR 7505-999.20740 PAY -STATE 0.00 DR 7505-999.10010 0.00 CR 7857.999.20510 JURYREIMB.FUND-GEN. FUND 1.00 CR 7857-999-20740 JURYREIMB.FUND-STATE 0.00 OR 7857-999-10010 0.00 CR 7856-999.20610 CIVIL JUSTICE DATA REPOS: GEN FUND 0.00 CR 7856.999-20740 CIVIL JUSTICE DATA REPOS: STATE •0.00 DR 7856-999-10010 0,00 CR 7502-999.20740 JUO/CRT PERSONNEL TRAINING FUND- STATE " -0.00 DR 7502-999-10010 0.00 7998-999.20740 TRUANCY PREVENT/DIV FUND- STATE :.; 'U.00 7996-999-20701 JUVENILE CASE MANAGER FUND , 0.00 DR 7999-999.10010 0.00 7403-999-22889 ELECTRONIC FILING FEE - CV STATE 0.00 DR 7403-999.22880 0_00 7658-999-20740 STATE CONSOLIDATED CIVIL FEE 21.00 21.00 TOTAL (Distrib Req to OperAcco $2.090.75 DUE TO OTHERS (Distrib Req AKchco CALHOUN COUNTY ISO 0.00 DA - RESTITUTION 0.00 REFUND OF OVERPAYMENT; 0.00 CUT -OF -COUNTY SERVICE FE 0.00 CASH BONDS 0.00 ...........:.'' PARKS & WILDLIFE FINES 0.00 WATER SAFETY FINES 0.00 ' TOTAL DUE TO OTHERS TOTAL COLLECTED -ALL FUNDS $2,090.75 LESS: TOTAL TREASUER'S RECEIPTS $7.190.76 REVISED02/02/2021 OVER/(SHORT)- $0.00 Page 3 of 3 12-05-22;12:08 ;From:Calhoun County JP4 PAYEE Name: Address: City: State: Zip, Phone: CALH®UN COUNTY 201 West Austin Calhoun County Oper. Acct. gignaturo of OfficialDate To;3615534444 ;3617852179 # 6/ 6 DISTRIBUTION REQUEST DR# 450 A 4490o PAYOR Official: Wesley Hunt Title: Justice of the Peace, Pct. 4 . . SHERIFF'S OFFICE MONTHLY REPORT Nov-22 BAIL BOND FEE $ 375.00 CIVIL FEE $ 677.50 CASH BOND JP#1 $ 833.30 JP#2 $ 355.50 JP#3 $ 364.00 JP#4 $ 845.00 JP#5 SEADRIFT MUN. PC MUN $ 663.00 OTHER TOTAL: $ 4,113.30 #14 NOTICE OF MEETING 12/14/2022 14. 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 C ■ §- k � z @ $ § m= 2k �k �) K| / � - r m ») k m §) z ■ c§ 0 o % ak 0 § @ �) 2 m § o) d z �- m mz m� § §o § §\ §)_ Z\ g § &f; s § § § % mg _ G j § f) g 2 �) § §§ # », _�■ M= § mm= s __A■ = Z) Z� @■ @�§ � )�k � §§§ m z . § ) z _ c § ( k R A 2 ) § � / z 0 0 z N a 3 m m= z 0 m T �_ m JZ l = a m_ m n=_ 0 0=_ Z= N- Z � a= gA WO o m c �= z H W c F 0 z G) m D z m m 0 D r O O O O C z 0: m: s r ,11, a to O to O w O O O T O T a O 00 �3 rii�iee T Ss T O O O T T a O O O `m Et 3 y a n 1 O i � $ T 1 1 z Zo •z•1 1 � � 1 y a a aa• 1 v: M: a m W a r m N g, O Ez m ! o O 1 e z 1 � � 1 A 1 a 7 z i �JEEE.1F m M § ;s m 0 § ) z I §§ / 4 § zM 2 ■ » z 0 % B ■ MIA q \3 )2 m \ § § m m � z » @ n n ■ § ,§ § �22 )§ z it r, �00 m §)_ § §) ) k _ ` § § s § ■ � © 2 _ � I - --1 mm mm _B _B 0 0 MMIR m §§ M M 0 »55C3 � $ z § § k 0 ( A % A 2 § § q m k §§ § ■ � B � f § z _ k 0 t m q q 2 ) § k § k m N z n O c q O 0 N z m: m �I -zi 3 3: m Z= z Z 3€ me m O? e OE re om'- -zi 0 0 N O I� m z c v n m m m n c v . {-0 $§� \I } m m ■ R ; §§ 2� TI§� | §z \ § � v; m: § ■ 0: I § 2 � 7� m ; % z ■ m k: § 8 ■: 2 m: m )� � § ■ » n ■ � �� c! § z M: : §§ » «@�■ �§ 0 00 ■§ �■ m e■� e ��kBk § § k t $ � ) � s r all � I 7 � § ■ � z1141) § § Q ) j� � � (\()2 ,))j® ; oo-iq ` @°° /z>�- ));o0 }\�\� q2 § „ � k G &222§§7 )` 20060E ■ccoco § §22§22 B § § ) ) §§ $ #«m±«mom■ �2 « 2«@@«@a■ IM _ ■ �00M �®§ kk//8#r M z § ) ) _ k § § G j G § k 0 ( N q q 2 ) § ; ) �S, k J J m T m N C; T m W J m O 23 �J W m 0 0 0 IC r m� v 3 0 D 0 X O D m _cD rn nm v 9 z o �9z0zm mMG)mmCl) z � y v T 0m I eaa m� AO 0 3 O m rn T 0 0 c F :D f0 f0 fD f0 f0 :D t0 (D fp t0 t0 Z e zzzzzz 0 0 0 0 0 0 D00000 m ;u x �u w x zzzzzz Z Z Z Z Z Z 11�11�� 3 �n a df E9 (A E9 E9 T O O O O O fA fA fA EA EA T T 0 0 0 0 0 pp T FA A 00000 m �J O J N d0 m N O O O T T n (O� N a agWg W J O J N F tA0 N O O O m a N O z i m 3 i Z Z 0! m m O cf m m m k '0 m z 01 m F, m=JOE rnmwrno� JOE m N N A N O O O N N p �- OUm 0mti 3= ccx0Cl) ME V.Zm]r� Z= mmNmz ZZ M M Z z_ O 0mcf)a 3=_ T N>� ;u m=__ � v= m co>an3 fA = A > co z '2_ m n= = rME m m m m m t0 �O fD (O f0 'A �= i mzzzzz z o00000 0 ;00000 _ m w��A O2 z z z z z A o z N -< W a a T T = fA 0 fA 0 fA E9 EA EA EA 0 0 0 0 0 m=_ ze T z= 02 N N N a W- O im W W (00 fA W fA fA T = 0 S d/ Z;t0 N N zg Zi d0 a (O W W EA fA C3 T m m- z 3 a=m ME z IN z q_ i �+= m , m=__ b, I E rn z � Z a==_ z 3= n m__ O m v_ Z v p v; m! a; W m, Jz, I N A a m y e J mqO J m D O p O T O T N D D A G)m m m a 3 m z 3 m m'' z 00 a,, m z i m! m z Z zi a; F 3; z m; m V; 3 � m Ci X O p V' O C y m m z E m i Al NI w O a m m z m', m T A! -zi 3 m Z a i; N Z zi 3; m Ni �i A Z n 0 r: z m0)WW - 0 0 j KDrn-0m D 0 -0 D 3 _00 zm ,-u z O F m m m z � 0 z D r 0 n < Z D Z 9 a { Cl) m ea m m o zG) >3 m D m ^' > m z m 0 D z (O (O (O (O (O y m co co <o <ox zzzzz� 00000 n 0 0 0 Q D D D D D z z z z z 3 T �x EA EA EA EA fA m N Vt W N O O O W W N O O O a C'f O c Z i ve m: a: m€ Z:: Z€ W: Ae N3 m m 0 z N O z r w O W O m R 3 T m m o G i m i cn i N z z n m m 0 m Z 0 m 4 is n O m n Z . m � z m m n T z o 0 0 z z a� Al O m m Z 'U: 0 m T mE m Z -l: 3: � m z: O Z: m€ m m Zi me : m m m Ze m ye v: m: a: m: JZJ; Z N Je 03 Z v a m m m n r c v \(k\j}(� M B M -------8� �§ 0000000 _I � \000000§kk / ME �( S ■! k� > § �\ °§ m■ § Mi § M z M ■ m) < <§ ; m§ M) � k$ ��§ § - § ) ( ) � B§ m) cc °,.§ k§ 0\ | 4 S§ | ©«®m ) §.e ; 0 #0 )Xj { ME a k % 3■ N $ �ME �� / § $ §k 2 K| r o M m§ c § §) § v) - ■; m! 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Z Z a �i z m: m g C m N; a m; c; 3 z C m m m O C m x mi z m 0 fH m m m' m o x .u: 3 a3 m I 3: m Z= N �e z z: a 3: °< m: m re X Z R? � A C C i C 0 n m m m n c Z v c v Z O O V m 01 N N N N N N N a N N N N N (O W (p N O O O O O N O 0 0 0 C D W� D D r C Z� C A v �n7 xQ-UMZK>omolw`UO D ZF00zm-MO �N AQO p O D m m 0 N w m o o n k m A oo=o oc � � cnN D 0 o -o m a < N�kIPmM cDi>m -(n� c Z 1 m a N O z r z O O O m p C m 1-r c O m m D D y N N m W A m D D T 3 _ = O C L1 fp (O (O (O lD f0 fp fp (O <O y :O f0 (D fp (O f0 (O t0 t0 tp f0 C III z ZZZZZZZZZZZ J O O O O O O O O O O Dcpp)00GAA)cAA)0 O ppcpp)000 P D D D D D D D D D D T ZZZZZZZZZZZ ��-�-i--1-4-4-1�-i-ig W a r EA 4A EA fA fA fA fA Hi EA f9 T 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 _R =a EA O fA fA f9 0�1 E9 m O f9 T O O O O O O O Do N O T T T � � Z m Vi � 0 0 fA O EA EA N T Bs� Owl O m O O m 0 0) 0 N E T O O m N O O N O v > m p= N m= �= C m= D m z O a= T 3= m M __ " a A= 3 O = C 0= D a= Z Z_ - m G- M= Z G= 0 m� )= =_ m v Z m Z coi 'U = o "3' M= m= 0 o y Z 3 p a z= Z �' a C! = -I w m=_ fA O t9 o M T 0 m_ o oo z__ (M_ A5 M O cc T O T C 0 n 3 m m m In r C 3 i MMMR N W A~ 3 3 z z z 1 n m i .� m�A (n -0 i .� m z=� m ' HOmm faq W D _0 O z m < Z N 09 m UlI m O O O O O O A A D D 3 O-C—I -C—iDC v 1 1 0 �mmKm m nInD n Z� D - — A a Z Z m Nr mSa Z m , O c <o coocoma rzZZZZ j 00000 0 0 0 0 0 ZZZZ ZZ y Z Z Z Z Z r V = e as y ^� pip C� 000E �n T 0 0 yay T yy T a S T T l f9 ..MR O O fA O E9 fA fA O O O fA O fA E9 E9 1A E9 O O O O O fA EA T S T W 49 W EA T S T O O O T O p + O H O O 0 0 O O O p a caenn � cn�s' 9� T T 0 0 + O O O O O O O O W fA OT M W W Ui ['�T� fA0 0 0 0 E mT 0 0 O 0 0 O m go O z c v n m m m n C m= NwA� �+= () 0 m K 09 z= o z=_ c < a= z< 3 = c, m=_ m z 3 T O = G= a p z= o �= W° n o mzzz e COi- o oG)QG) m �- M= m m Z > D D m=_ Z ZZZZ C%= 0 o Z= u w a �= 0 y T W= W= a n r r 0= m=_ o 0000 3= H N&i E9 f9 w� m= o 0000 z= Z _ O �rf Ul V o V 0000 fA V O T C1= 'A O O O C3 T O O O = m a N O z n O C z 4 01 W W W W W W (O W W O N N W 0 0 0 0 0 0 Z -�KZ u,j30 A n W 0 x D m n m Z m n T x00Wn ; I m o z m N p0 -4 -'� T mui cva Opm m;oM �(D z m a �mn c c - 3 X N m m D N N O � f0 (O V7 N <O <O t0 7 (O (O (O (O f0 (O t0 mzzzzzzz p0000000 3 0000000 zizzzzzz Z Z Z Z Z Z Z a o � a w O � n r m 0 0 0 0 0 0 0 0 �s !fl fA f9 fA fA fA bl E9 T M 0 0 0 0 0 0 0 0 rn y i N o N y O O O W( O O O T 0 0 0 0 0 0 0 0 �e T OI O N y C� 00000000 p EA � EA EA EA (H T C9 00000000 O O O O O O O m N O Z m 3 0 c m m z i C n rn m m m n C v a M Ol wA T T a T M W n N V W N p Dm r < m v r0 oz cm OT mea a 0GEl c0 zN A 0 v m a�0 � 3 e m o000 v 300 0 Z z 1 O w N a w 3 0 O z � �n eii d1 fq a T O O EA E9 O O 9 mom d) ifl iA iA O O O O T 4 T 111-"'ATIII"'lll ffl W fA O O O O O 4 T T S N coo S V 7 a fR !fl T T m N O z F 01 O N N N N� W N W W W W 0 0 0 0 0 0 m 0 z c D O >��000 N z C Q. mmOG)mm F Q) -0 r— 0 M Z m � o m D n y co c r-�m-0 c�v0v D r m p A A N N 0 m z z z z z 00000 c) c) 0 c) c) zzzzz z z z z z a 3 a TL. i f9 f9 EA E9 f9 T T O O O O O C N C�9 fA N NT fA T ,Ta CyO O m A N O T J v m W 0 O A Z D �qz n a 3 O O 0 0 zz T T J A f!1 W W N Pn A ImJ O A M E A wiw S�S a N O z n n O c z q O OJ N A N W W W W O OJ N O O N N O O Q 0 -A Om 0-I � K >XMC.00OAD Z v_Cm t-ijC-VOmO r 2 O K OpmmzSm N a y o Aomm zm K ,�'mm<mca < AOzmm o!5 Z a�+ cf) Cn cn rz Cl) z m 3 p v m co A� mzzzzzzzzz� {� D 000000000 3Gpp�7G7��Gpp�Lpp�00000A y Z Z Z Z Z Z Z Z Z oe W i o O \ y 0 0 0 0 0 0 0 0 0 0 O o 00000000 [f�sC1 CZ9 ^+ fA ffl 4A fA T A y�N y�J N K N O W fA O O N O T N O O O W O O N W O T � n N N fA EA O EA &3 ffl fA T '� fA N EA M E9 E9 fA T N NZ' fA N N O W 0 0 0 N O� T Y u 9 I In v a m m m n r In v 0 o JO o ea J J J V y � O 0 n n 0 .. 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A a WE O W Wa O A AT t0 Off N N OD 00 ODo oWoo _ BOB A A a a r A 30 0 0 O c 4 v: m: a: 3 m: z: .4: C v a m m m a r c 0 z 0 m D A 3 m 1 0 a r v m T a m, z -I 0 O O O O n V J J J y O zzzz� 0000 0000 D D D D Z Z Z Z a apspp in aa� z � a$ W f w w T T 0000 �MR O O O O T �e W W O AO T T ggT s aN0 0 0 0 T � � T 0 a c T m m N c cn m 0 an m m m A m m z m z O O z a m 9 0 z 0 ra y Ap � O O O O OM w rn rn rn rn a T T m T m Z m m m m m m m m m m Z N N fN Cl) (1) ,ttLtt c c c c c n F) 1 1 m n o m m m m m T700000M. R n T T T T T < T T D T T � �"�nnn 71000001 m m m m m m A m m M m m m m m m 00000 z z z z z 00000 D fD (O (O (O (O 9 Lt (O (O t0 f0 t0 D fD (O f0 (O t0 Z O z z z z z z �00000 D GG)�()]0 G) G) Gp) D D D D D D zzzzzz H-I-I �-I y a -w a s� z �F»�cnww�q e; es a �i y51 w M T EA O to 0 EA fA fA f9 &3 E9 0 0 0 0 0 0 T a� z � rwsw"� Too T O 0000000 T N ba�wa v+ e_» f_» E» aasea m m o�o 0000 O O (T A W N mT T T T T T z .� mmmmm m m m m m z (N (D (n V1 (n m m c c c c c LLLL a c CD N N(n N 0 0 0 0 0 O m m m m m m m m m m m Z m 0 0 00011 N T T T T T a cn m T T a C (nmmmmmy y O O O O O 3 C m m" 0 v-0-Vvv A A X A A W m m m m m C 00000 zzzzz m m 00000 In r 0 0 0 0 0 0 a 0 ` C ` Z 000000 0 r 3 G) G) G) G;U) G;o) G) IQ D D D D D D O y zzzzz z a m 3 z y m S 4A iH fA EA 4A � O O O O O O Al O O O O O T az� J W (O (O W 0 m m Z m N 0 Z W C 0 0 m i 0 c Z m N N Id m r. m z c m v: m: 0: a: l: m: z: I: o z m z c m 0 a r t A t R 0000� N A W N p m m m m m m m m m m m m cn ( N cp L L L L m m m m m m m m 00009 m m m m 0 0 0 m m m D 3 m m m m m X X X m A A A m m m m m 0000 zzzz 0000 0CIO ON C) 0 z z z z 0000 0c�0c� zzzzzz a e g o 0 0 0 mE T 1 0 0 0 0 0000 1p� T 9 Fn a = 10 00 0�+ I 0 0 0 n O W I A O A O x a y 0 z v: ME a: X. m: Z: Z: 0: #15 ' NOTICE OF MEETING—12/14/2022 15. Approval of bills and payroll. (RHM) Adjourned 10:13 a.m. Page 12of12 1 � M O O 1( O ( O N .�� O N W n O Ot M lO H H N C H O W M M M O01 n 0�m ut Om01 H n m 1p M N H O �0 W W M O M N 01 01 1n 111H W nH ut H tit nt tit vt tit m � » vi ss N N N N N N N N N N O O O O O N N N N N q 01 01 O1 01 N O O O O O N N NNNNN W � aaaaawm aaaaamp 00000 � aaaaa a i1 i+ i1 i1 i1 w ao w i � E a O a a a w w HM a U E U C HH H w J E W E x aka F 00 E z w z W a a0 z PA N E L rti L W E E OU a cawa z a °Oa a H H H x AxEw r .a w wzoH� U MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR, December 14 2622 by:DC INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES HEB Pharmacy (Medimpact) Pharmacy Reimbursement 15.22 MMCenter (In -parent $or out -parent $2,097.90 t ER $0) 2,097.90 Memorial Medical Clinic 27.00 Singleton Associates, PA 65.76 SUBTOTAL 2,206.88 Memorial Medical Center (Indigent Healthcare Payroll and Expenses) 4,166.67 Subtotal 6,372.55 Co -pays adjustments for November 2022 Reimbursement from Medicaid 0.00 COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY UNIT PRICE TOTAL PRICE 1000-800-98722-999 Transfer to pay bills for Indigent Health Care $6,362.55 approved by Commissioners Court on12/14'/2022 1000-001-46010 November 30,-�N22 Interest ($2.66) $6,359.89 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 NDITI AND REQUEST THE COUNTY TREASURER TO PAY THE AS E O CATION. BY: 12/13/2022 APPROVED ON DEC 13 2022 COUNTY AUDITOR DEPAATMENT HEAD DATE ®IHS Source Totals Report Issued 12/07/22 Calhoun Indigent Health Care Batch Dates 12/01/2022 through 12/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 1,162.00 65.76 02 Prescription Drugs 15.22 15;22 08 Rural Health Clinics 27.00 27.00 14 'Mmc=Hospitalbutpatient ° 4,662.00 2,097.90 Expenditures 5,866.22 2,205.88 Reimb/Adjustments Grand Total 5,866.22 2,205.88 Expenses $4,166.67 Co -Pays < $10.00> Total $6,362.55 c�-�1� J la(8 fay V11,101,APPROVED tON DEC 13 2022 0Y CULi COU14TYTOR TEXAS CALHOUN ®IHS Source Totals Report Issued 12/07/22 Calhoun Indigent Health Care Batch Dates 02/01/2022 through 12/01/2022 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid 01 Physician Services 18,785.80 1,832.2E 01-2 Physician Services -Anesthesia 21634.o0 563.13 02 Prescription Drugs. 657.76 652.42 08 Rural Health Clinics `r 4,123:00 3391.43 13 Mmc - Inpatient Hospital 74,997.82 44,807.79 14 Mmc - Hospital Outpatient 81,923.04 34j232.46 15 Mmc - Er Bills 51,087.00 20,970.84 Expenditures 234,717.03 106,779.46 Reimb/Adjustments -308.61 -308.61 Grand Total 234,408.42 106,470.85 Expenses $75,666.26 $182,137.11 Co -Pays < $500.00 > Total $181,637.11 Calhoun County Indigent Care Patient Caseload 2022 Approved Denied Removed Active Pending January 1 0 0 7 5 February 1 0 1 7 4 March 0 0 0 7 6 April 0 1 0 7 3 May 0 0 0 7 3 June 1 0 1 7 3 July 0 1 0 7 2 August 0 1 1 6 1 September 0 1 2 4 1 October 0 0 1 3 1 November 0 2 0 3 7 December 1 YTD Monthly Avg 0 1 1 6 3 December 2021 Active 6 Number of Charity patients 204 Number of Charity patients below 50% FPL 75 Number of Charity patients who meet State Indigent Guidelines 48 Calhoun County Pharmacy Assistance Patient Caseload 2022 Approved Refills Removed Active Value January 2 6 0 28 $16,676.00 February 2 5 0 30 $14,616.00 March 12 7 0 42 $34,978.00 April 5 7 0 47 $42,159.00 May 8 3 0 55 $21,252.00 June 2 3 0 57 $12,186.00 July 7 3 0 64 $18,666.00 August 2 8 0 59 $16,358.00 September 1 5 0 60 $10,241.00 October November December YTD PATIENT SAVINGS $187,132.00 Monthly Avg 5 5 December 2021 Active 26 49 $20,792.44 0 RUN DATE: 12/06/22 MEMORIAL MEDICAL CENTER Tum: 12:05 RECEIPTS FROM 11/01/22 TO 11/30/22 GIL RECEIPT PAY CASH NUMBER DATE NUMBER TYPE PAYER AMOUNT PAGE 124 ECNR P RECEIPT AMOUNT NUMBER RUM ''50240.000'11/08/22 '646081 CA ::- 10.00 10.00 '"TOTAL+R 50240.000''CODNTY INDIGENT 'COPAYS - '10.00 DISC COLL GL CASR DATE IRIT CODE ACCOUNT 00/00/00 RAH 2 i Bill To: Calhoun County 815 N. Virginia St. Port Lavaca, Texas 77979 (361) 552-6713 Date: 12/8/2022 Invoice # 376 For: Nov-22 DESCfiPT10N ' AIYIfJUNT Funds to cover Indigent program operating expenses. $ 4,166.67 Total $ 4,166.67/ lb.LL ',i � 2 2 ANDREW DELOSSANTOS CONTROLLER { APPROVED OAI DEC 13 2022 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS N- b:a 'PROSPERITY BANW ,..4 Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13262 11/30/2022 `*4551 Page 1 of 2 [STATEMENT SUMMARY Public Fund Contractual Ckg w Int Account No `-4551 11/01/2072 Beginning Balance $5,902.62 2 Deposits/Other Credits r $15,431.31 6 Checks/Other Debits - $15,760.63 11/30/2022 Ending Balance 30 Days in Statement Period $5,573.30 Total Enclosures 7 DEPOSITS/OTHER Date Description Amounts, 11/04/2022 Deposit $15,428.65 11/30/2022 Accr Earning Pymt Added to Account $2.66 Check Number Date Amount Check Number Date Amount Check Number Date Amount 12567 11.10 $353.85 12571 11-18 $4,166.67 12573 11-18 $10,841.15 12570` 11-23 $187.49 12572 11.18 $75.95 12575" 11-29 $135.52 DAILY ENDINGBALANCE Date Balance Date Balance Date Balance 11.01 $5,902.62 11-18 $5,893.65 11-30 $5,573.30 11-04 $21,331.27 11-23 $5,706.16 11-10 $20,977.42 11-29 $5,570.64 EARNINGS SUMMARY Below is an itemization of the Earnings paid this period. Interest Paid This Period Interest Paid YTD MEMBER FDIC Prawn $2.66 Annual Percentage Yield Earned $24.97 Days in Earnings Period Earnings Balance 0.25 % 30 $12,945.38 NYSE Symbol "PB" MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---December 14 2022 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $ 693,924.09 L/ TOTAL TRANSFERS BETWEEN FUNDS, $ 71,844X6 TOTAL NURSING HOME UPL EXPENSES; $ 72% 93,47 TOTAL INTER -GOVERNMENT TRANSFERS $ GRAND TOTAL DISBURSEMENTS APPROVED December 14, 2022 $ 1',395,192:12 4" MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---December 14, 2022 PAYABLE$ AND PAYROLL 12/8/2022 Weekly Payables 368,008.04 12/8/2022 Patient Refunds 2,431.63 121812022 Citibank Credit Card -see attached 2,455.19 12/9/2022 Frontier -phone services 108.93 12/9/2022 Clearfly-phone 2,416.10 12/12/2022 McKesson-3408 Prescription Expense 13,168.17 12/12/2022 Amedsource Bergen-3408 Prescription Expense 1,127.69 12/1212022 Payroll Liabilities for supplemental payroll -Payroll Taxes 303.47 12/1212022 Supplemental Payroll 962.23 Prosperity Electronic Bank Payments 1215-1219122 Credit Card 8 Lease Fees 1,195.65 12/2012022 Sales Tax for November 2022 1,500.81 1211512022 TCDRS November Retirement 198,575.48 12/912022 Cleargage-Patient Financing Service 118.20 12/5-12/9/22 Pay Plus -Patient Claims Processing Fee 664.50 12/9/2022 E�pertPay-child support 888.00 TOTAL PAYABLES, PAYROLL AND ELECTRONIC_BANK PAYMENTS $ ¢83,924:09 , TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 12/812022 MMC Operating to Fort bend -correction of NH insurance payment deposited 2,528.50 into MMC Operating 12/812022 MMC Operating to Broadmoor-correction of NH insurance payment deposited 7,177.38 into MMC Operating 11202022 MMC Operating to Golden Creek -correction of NH insurance payment 7,461.79 deposited into MMC Operating in error 1218/2022 MMC Operating to Gulf Pointe Plaza -correction of NH insurance payment 30,826.10 deposited into MMC Operating 12/8/2022 MMC Operating to Tuscany Village -correction of NH insurance payment 11,593.00 deposited into MMC Operating 12I8/2022 MMC Operating to Bethany -correction of NH insurance payment deposited into 12,25719 MMC Operating in error TOTALTRANSFEI7S BETWEEN FUNDS $ 71,644 56 NURSING HOME UPL EXPENSES 12112/2022 Nursing Home UPL-Cantex Transfer 374,661.20 12/1212022 Nursing Home UPL-Nexion Transfer 67,520.98 12112/2022 Nursing Home UPL-HMG Transfer 117,123-98 1211212022 Nursing Home UPL-Tuscany Transfer 34,771.14 12/1212022 Nursing Home UPL-HSL Transfer 88,420.91 QIPP CHECKS TO MMC 12/12/2022 Ashford 16,589.54 12112/2022 Broadmoor 6,111.06 12/1212022 Crescent 4,228.87 12112/2022 Fort Bend 5,181,91 12/1212022 Solem 4,962.87 12/1212022 Tuscany 9,821.01 TOTAL NURSING HOME UPL EXPENSES $ 729,393.47 TOTAL INTER -GOVERNMENT TRANSFERS $ GRAND TOTALDI.SBURSEMENTS APPROVED December 14, 2022 $ 1395,762:12'I RECEIVEDBYTHE COUNTY AUDITOR ON DEC 0 8 2o22 12/08/2022 MEMORIAL MEDICAL CENTER CALt1WhspOUN7y. TEXAS AP Open Invoice List Due Dates Through:. 12/2312022 Vendor# Vendor Name Class Pay Cade 13180 ADVANCED STERILIZATION PRODUCT Invoice# Comment Tran Dt Inv Dt DueDt Check D Pay Gross 8020448099 ✓ 11/30/20 11/29/20 12/07/20 1,875.00 77FULLMF04 SERV AGREE Vendor Totals Number Name Gross 13180 ADVANCED STERILIZATION PRODUCT 1,875.00 Vendor# Vendor Name Class Pay Code 14532 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 111022 12107/20 11/10/20 12/10120 60.00 REFUND Vendor Totals Number Name Gross 14632 60.00 Vendor# Vendor Name Class Pay Code A0400 AUREUS RADIOLOGY LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 2820631 V 11/30/20 11/14/20 12/14/20 3,400.00 LAB STAFFING Ito 12 t- it 13122' ) &V I,Ity 2829088 11130/2011/21/2012121120 3,431.88 LAB STAFFING (1119- It lio' -yx-) Sin 6VY Vendor Totals Number Name Grass A0400 AUREUS RADIOLOGY LLC 6,831.88 Vendor# Vendor Name Class Pay Code A2600 AUTO PARTS & MACHINE CO. �,' w Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 997193 v/ 1113012011/22/2012/07/20 95.88 SUPPLIES MAINT Vendor Totals Number Name Gross A2600 AUTO PARTS & MACHINE CO. 95.88 Vendor# Vendor Name Class Pay Code B1150 BAXTER HEALTHCARE „' w Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross 77086572v 11/30/20 11/08/20 12103/20 338.31 SUPPLIES 12588010 1/ 11130/20 11126/20 1 PJ21/20 3.67 LATE FEE Vendor Totals Number Name Gross 31150 BAXTER HEALTHCARE 341.88 Vendor# Vendor Name Class Pay Code M2486 BAYER HEALTHCARE ✓� M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 6010290336 ✓ 11/30/20 11/21/20 12/07/20 628.06 SUPPLIES Vendor Totals Number Name Gross M2485 BAYER HEALTHCARE 828,06 Vendor#Vendor Name Class Pay Code B1220 BECKMAN COULTER INC v' M Page 1 of 16 0 ap_open_invoice.template Discount No -Pay Net 0.00 0,00 1,875.00 Discount No -Pay Net 0.00 0.00 1,875.00 Discount No -Pay Net 0.00 0.00 60.00 % Discount No -Pay Net 0.00 0.00 60.00 Discount No -Pay Net 0.00 0.00 3,400.00 U .. 0.00 0.00 3,431.88 v Discount No -Pay Net 0.00 0.00 C831.88 Discount No -Pay Net 0.00 0.00 95.88" Discount No -Pay Net 0.00 0.00 95.88 Discount No -Pay Net 0.00 0.00 $38.31 0.00 0.00 3,57 ✓'" Discount No -Pay Net 0.00 0,00 341.88 Discount No -Pay Net 0.00 0.00 828.06 Discount No -Pay Net 0.00 0.00 828.06 file:///C:/Users/ltrevino/cpsi/memmed. cpsinet.com/u88125/data_5/tmp_cw5report285052... 12/8/2022 Page 2 of 16 Invoice# Comment Tran Dt Inv Dt Due or Check ID Pay Gross Discount No -Pay Net 110269762= 1113012011/15/2012110/20 230.60 0.00 0.00 230.60 •� LAB SUPPLIES 6466179✓ 11/30/2011/25/2012@D/20 1,337.05 0.00 0.00 1.337.05 ✓' AS4/DXM 1040 LEASE f 110286489✓ 11/30/2011/28l2012/23120 501.24 D.00 0.00 501.24✓ LAB SUPPLIES 110287740 ✓' 11/30/20 11/28/20 12/23/20 233.24 0.00 0.00 233.24..-' LAB SUPPLIES 110285973 ✓` 11/30/2011/28/2012/23120 955.73 0.00 0.00 955.73 LAB SUPPLIES 110287220 V1 11/30/20 11/28/20 12/23/20 705.01 0.00 0.00 705.01 e' LAB SUPPLIES , Vendor Totale Number Name Gross Discount No -Pay Net B1220 BECKMAN COULTER INC 3,962.87 0.00 0.00 3,952.87 Vendor# Vendor Name Class Pay Code 13892 BLUE CROSS BLUE SHIELD REFUND v` Invoice# Comment Tran Dt Inv Dt Due Or Check D- Pay Gross Discount No -Pay Net 111022 12107/20 11/10/20 12/10/20 75A0 0.00 0.00 75.00 -` CHELSE EDWARDS REFUND Vendor Totals Number Name Gross Discount No -Pay Net 13892 BLUE CROSS BLUE SHIELD REFUND 75.00 0.00 0.00 75.00 Vendor# Vendor Name Class Pay Code 60437 C R BARD INC ✓ M Invoice# Comment Tran DI Inv Dt Due Or Check D Pay Gross Discount No -Pay Net 85098587 ✓ 11/30/20 11/16/20 12/16/20 339.15 0.00 0.00 339.15 " SUPPLIES Vendor Totale Number Name Gross Discount No -Pay Net B0437 C R BARD INC 339.15 0.00 0.00 339.15 Vendor# Vendor Name Crass Pay Code 11224 CABLES AND SENSORS ✓� Involce# Comment Tran DI Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 140862Y 11 I30/2011/2312012/23/20 113.00 0.00 0.00 113.001' SUPPLIES 140940✓ 11/301201112812011/28/20 60,00 0.00 SUPPLIES 0.00 60.00 „1 141010 w11/30120 11/29/20 12107/20 65.00 0.00 0.00 SUPPLIES Vendor Totale Number Name Gross Discount No -Pay 11224 CABLES AND SENSORS 238.00 0.00 0.00 Vendor# Vendor Name Class Pay Cade C1048 CALHOUN COUNTY W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 112422 11/30120 11/24/20 12114/20 120.43 0.00 0.00 FUEL Vendor Totals Number Name Grass Discount No -Pay C1048 CALHOUNCOUNTY 120.43 0.00 0.00 Vendor# Vendor Name Class Pay Code C1325 CARDINAL HEALTH 414, INC. v W Invoice# Comment Tran Dt Inv Or Due Ot Check 0 Pay Gross Discount No -Pay 8003020413 ✓ 11/30/20 11119/2012114/20 152.95 0.00 0.00 Net 238.00 Net 120.43 Net 120.43 Net 152.95 �-''- file:///C: /Users/ltrevino/cpsi/niemmed.cpsinet.com/u88l25/data_5/tmp_cw5report285052... 12/8/2022 Page 3 of 16 NUC MED SUPPLIES Vendor TotalENumber Name Gross Discount No -Pay Net C1325 CARDINAL HEALTH 414, INC. 162,95 0.00 0.00 152,95 Vendor# Vendor Name Class Pay Code C1992 COW GOVERNMENT, INC. v M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net FG280971/ 11/30/2011/2212012/22120 307.76 0.00 0.00 307.76 �'- SUPPLIES Vendor TotalE Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMENT, INC. 307.76 0.00 0.00 307.76 Vendor# Vendor Name Class Pay Code C1390 CENTRAL DRUG v" W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 112122 11/30/201112112012121/20 19,40 OAO 0.00 19.40 PHARMINVENTORY , Vendor TotalE Number Name Gross Discount No -Pay Net C1390 CENTRAL DRUG 19.40 0.00 0.00 19,40 Vendor# Vendor Name Class Pay Code C1600 CITIZENS MEDICAL CENTER , W Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 123120 11130/2D 12/3112001/01/20 31148 0.00 0.00 313.48 ✓� DIRECT CLIENT TRANS 093022 11/30/20 09/30/20 10/31/20 13.56 0.00 0.00 13.56 DIRECT CLIENT TRANS , 2022-4 12108/20 09115120 12/16120 62,279.80 0.00 0.00 62,279.80 CRNA COVERAGE AGRMENT. Vendor Totals Number Name Gross Discount No -Pay Net C1600 CITIZENS MEDICAL CENTER 62,606.84 0.00 0.00 62,608.84 Vendor# Vendor Name Class Pay Code 11030 COMBINED INSURANCE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 113022 11/3012011/30/20 12/01/20 561.74 0.00 0.00 561.74 ✓' PAYROLL DEDUCT INSURANC Vendor Total: Number Name Gross Discount No -Pay Net 11030 COMBINED INSURANCE 561,74 0.00 0.00 561.74 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 7008860 ✓ 11/30/201111612012111/20 6.31 0.00 0.00 6.31 ✓� .SUPPLIES 7009490r,/ 11/30/2011/16/2012/11120 170,28 0100 0.00 170.28 SUPPLIES 7013170 11/30/20 11/22/20 12/17/20 255.76 0.00 0.00 255.76 SUPPLIES Vendor Total: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SON 432.35 0.00 0,00 432.35 Vendor#Vendor Name Class Pay Code 10789 DISCOVERY MEDICAL NETWORK INC 4.; Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net MMC113022 ✓ 11130/2011/30/2012101120 102,666.62 0.00 0.00 102,666.62 PHYSICIAN SERVICES f te:///C:/Users/itrevino/cpsilmemmed.cpsinet.com/u88125/data 5/tmp_cw5report285052... 12/8/2022 Page 4 of 16 Vendor Totals Number Name Gross Discount No -Pay Net 10789 DISCOVERY MEDICAL NETWORK INC 102,666.62 0.00 0.00 102,666.62 Vendor# Vendor Name Class Pay Code W1167 ELITECH GROUP INC (WESCOR) ✓� W Invoice# Comment Tran of Inv Of Due Dt Check D Pay Gross Discount No -Pay Net 805565 ✓ 11130/2011/28/2012/07/20 247.70 0.00 0.00 247.70 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net W1167 ELITECH GROUP INC (WESCOR) 247.70 0.00 0.00 247.70 Vendor# Vendor Name Class Pay Code 14336 FIRETRON, INC Invoice# Comment Tran or Inv Of Due Dt Check D Pay Gross Discount No -Pay Net 237956 �'" 11/30/20 11/07/20 12/07/20 3,704,00 0.00 0.00 3,704.00 AIR HANDLERICABLE Vendor Totals Number Name Gross Discount No -Pay Net 14336 FIRETRON, INC 3,704.00 0.00 0.00 3,704.00 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE r'" M Invoice# Comment Tran of Inv of Due Dt Check D Pay Gross Discount No -Pay Net 6818928A ✓ � 11/01/20 12/10/20 01/04/20 154.08 0.00 0.00 154.08 r a' lab supplies 6868345 t/ 11/01/20 09/29/20 10/24/20 42A5 0.00 0.00 42,85v" SUPPLIES 8218828 11/30/2011/15/2012/10/20 457.50 0.00 0.00 457.50 .f LAB SUPPLIES 8218827 �/ 11/30/20 11/15/2012110120 19.81 0.00 0.00 19,81 .. LAB SUPPLIES . 83OD738 11/30/2011117/2012/12/20 523.31 0.00 0.00 523.31 ..r' LAB SUPPLIES 8375783,/ 11/30/2011121/2012/16/20 473.00 0.00 0.00 473.00.,-- SUPPLIES 8375785,% 11/30/20 11/21/20 12/16/20 903.94 0.00 0.00 903.94 v' SUPPLIES 8376784 ✓ 11/30/20 11121120 12/16/20 610.35 0.00 0.00 610.35 �..' SUPPLIES 8416131✓ 11/30/20 11/22/20 12117/20 430,43 0.00 0.00 430.43 y/ SUPPLIES 8453179 y' 11/30/20 11/ SW 12/18/20 104.65 0.00 0.00 104.65 y. - SUPPLIES 8453180 v'` 11/30/20 11123/20 12/18/20 193.33 0.00 0.00 193.33 U' SUPPLIES 8453178 . 11130/20 11/23/20 12118/20 128.54 0.00 0.00 128.54 SUPPLIES 8490486 V 11130/20 11/28/20 12123/20 297.87 0.00 0,00 297.87 SUPPLIES 8490484 tj% 11/3012011128/2012/23/20 -42.85 0.00 0.00 •42.85 „f CREDIT 8490485 / 11130/2011/28/2012/23/20 213.03 0.00 0.00 213.03 SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 4,509.84 0.00 0.00 4,509,84 file:)//C:/Users/ltrevino/cpsilmemmed.cpsinet.com/u88125/data 5/tmp_cw5report285052... 12/8/2022 Page 5 of 16 Vendor# Vendor Name Class Pay Code 14156 FUJI FILM / Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 91264294V 11/30120 11/29/20 12115/20 7,908.33 0.00 0.00 7.908.33 .i CONTRACT Vendor Totals Number Name Gross Discount No -Pay Net 14156 FUJI FILM 7,908.33 0.00 0.00 7,908,33 Vendor# Vendor Name Class Pay Code G1800 GLOBAL EQUIPMENT CO �' M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 119849157 V,. 11130/2011/17/2012/06/20 254.94 0.00 0.00 254.94 ER SUPPLIES . Vendor Total=Number Name Gross Discount No -Pay Nei G1800 GLOBAL EQUIPMENT CO 254.94 0.00 0.00 254.94 Vendor# Vendor Name Class Pay Code W1300 GRAINGER M Invoice# Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross Discount No -Pay Net 9508494276 ✓ 11/30/20 11/09/20 12/23/20 57.37 0.00 0.00 57.37 SUPPLIES MAINT . 9507854165 v) 11/30/20 11/09/20 12/28/20 -87.30 0.00 0.00 .87.30 CREDIT 9517517596+% 11/30/2011/17/2012/12/20 286.98 0.00 0.00 286.98-' SUPPLIES 951862068E .� 11130/20 11/18/20 12/13/20 89.80 0.00 0.00 89.80,,: - SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net W1300 GRAINGER 345.85 0.00 0.00 346.85 Vendor# Vendor Name Class Pay Code 11984 GUERSET, LLC v,. Invoice# Comment Tran Dt Inv of Due Dt Check D Pay Gross Discount No -Pay Net 18655108 4,' 11/30/20 11/23/20 11/23/20 350.00 0.00 0.00 350.00 Vendor Total: Number Name Gross Discount No -Pay Net. 11984 GUERBET, LLC 350.00 0.00 0.00 350.00 Vendor# Vendor Name Class Pay Code 12380 HEALTH SOLUTIONS DIETETICS 'f Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 113022 11 /30/20 11 WI= 12/15/20 3.400.00 0.00 ✓ 0.00 3,400.00 DIETARY CONSULTING Vendor Totals Number Name Gross Discount No -Pay Net 12380 HEALTH SOLUTIONS DIETETICS 3,400.00 0.00 0.00 3.400.00 Vendor# Vendor Name Class Pay Code 110031 HEB CREDIT RECEIVABLES DEPT308 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 112822 11/30120 11/28/20 12/20/20 1.336.31 0.00 0.00 1,336.31t-, GROCERIES Vendor Totals Number Name Gross Discount No -Pay Net H0031 HEB CREDIT RECEIVABLES DEPT308 1,326.31 0.00 0.00 11336.31 Vendor# Vendor Name Class Pay Code H1309 HILL -ROM COMPANY, INC -` M Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross Discount No -Pay Not file://(C:/Users/(trevino/cpsi/imemmed.cpsinet.com/u88125/data_5/tmp cw5report285052... 12/8/2022 Page 6 of 16 1583130" 11/30/20 11/21/20 12/07/20 323.50 0.00 0.00 323.50 RESPIR SUPPLIES Vendor Total -Number Name Gross Discount No -Pay Net H1399 HILL -ROM COMPANY, INC 323.50 0.00 0.00 323.50 Vendor# Vendor Name Class Pay Code 10530 HUMANA s-' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net 112222 IPJ07/201112212012/22/20 125.37 0.00 0.00 125.37 !" Vendor TotalsNumber Name Gross Discount No -Pay Net 10530 HUMANA 125.37 0.00 0.00 125.37 Vendor# Vendor Name Class Pay Code 11200 IRON MOUNTAIN :. Invoice# Comment Tran Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net GWHL658,_' 11/30/20 08/31/20 09/30/20 659.04 0.00 0.00 659.04 v' SHREDDING GXNK523 i/ 11/30/20 09/30120 1WO120 658,25 0.00 0.00 658.25 SHREDDING GZBD277 �i 11/30/20 10/31/20 11130/20 648.14 0,00 0.00 648.14 SHREDDING Vendor Totals Number Name Gross Discount No -Pay Net 11200 IRONMOUNTAIN 1,965.43 0.00 0.00 1,965.43 Vendor# Vendor Name Class Pay Code 11108 ITERSOURCE CORPORATION a Invoice# - Comment Tran Dt Inv Dt Due Dt Check D" Pay Gross Discount No -Pay Net 711664 ✓ 11130/20 12/01/20 12/01/20 250.00 0.00 0.00 250.00 MONTHLY PHONE SUPPORT Vendor Totals Number Name Gross Discount No -Pay Net 11108 ITERSOURCECORPORATION 250.00 0.00 0.00 250.00 Vendor# Vendor Name Class Pay Code 14316 JUNXION MED STAFFING ✓" Invoice# Comment Tran or Inv or Due Dt Check D- Pay Gross Discount No -Pay Net REVMEM011522 v' 12107/20 01120/20 02/04120 1,860.00 0.00 0.00 1,860.00 AMANDA DESHOTEL REVMEM012222 12107/2001/221200200/20 11,179.38 0.00 0.00 11,179.38 AMANDADESHOTEL kill, -r' -1) i ;.,.- REVMEM021322 12/07/2002125/2003112/20 1.821.25 0.00 0.00 1,821.25 :.- AMANDA DESHOTEL ^-I,,-- " - REVMEM022622 12107/20 03103/20 03/18/20 1,782.50 0.00 0.00 1,782.50 .� AMANDA DESHOTEL `741t - i" (-;,!, t r : - REVMEM050722 12/07/2005/15/2005/30120 1.821.25 0.00 0.00 1,821.25 ..-' AMANDA DESHOTEL r, 1I_ REVMEM060422 12107/20 06/15120 06130120 1,860.00 0.00 0.00 1,860.00-, AMANDA DESHOTEL REVMEM051422 12/0712006/15/2006/30/20 7,168.75 0.00 0.00 7,168.75 L-, AMANDA DESHOTEL 1 '6_1B- 5I1LI! %-' REVMMC061122 12/07/20 06/15/20 06/30/20 5,463,75 0.00 0.00 5,463.76 DESHOTEL Ujc, It I .._ .- . Vendor TotalsNumber Name Gross Discount No -Pay Net 14316 JUNXION MED STAFFING 32,956.88 0.00 0.00 32,956.88 Vendor# Vendor Name Class Pay Code file:///C:/Userslltrevillo/cpsilmemmed.cpsinet. com/ti88125/data_5/tmp_cw5report285052... 12/8/2022 Page 7 of 16 L0700 LABCORP OF AMERICA HOLDINGS M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 72549855 V 11/30/20 04/02120 04/27/20 190,74 0.00 0.00 190.74 tf _ LAB SERV 75013653 y: 11130/2011/26/2012/21/20 16,41 0.00 0.00 16.41 LAB SERV Vendor Totals Number Name Gross Discount No -Pay Net L0700 LABCORP OF AMERICA HOLDINGS 207.15 0.00 0A0 20715 Vendor# Vendor Name Class Pay Code 10972 M G TRUST ,/ Invoice# Comment Tran Dt Inv Dt Due or Check D Pay Gross Discount No -Pay Net 111822 11/3012011/18/20 '12101/20 640.86 0.00 0.00 640.86 ✓` PAYROLL DEDUCT . Vendor Total: 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 M1511 MARKETLAB, INC V' w Invoice# Comment Tran Dt Inv DI Due Dt Check D- Pay Gross Discount No -Pay Net IN01822454 Li. 11/30/20 11128/20 12107/20 102,13 0.00 0.00 102.13 -' SUPPILES Vendor Totals Number Name Gross Discount No -Pay Net M1511 MARKETLAB, INC 102.13 0.00 0.00 102.13 Vendor# Vendor Name Class Pay Code 14480 MARTIN ENRIQUEZ v" Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 2 11/30120 11130120 12101/20 1,525.50 0.00 0.00 1,525Z0 �..' STRIPIWAX f elkil -1 Dt r Vendor Totals Number Name Gross Discount No -Pay Net 14480 MARTIN ENRIQUEZ 1,525.50 0.00 0,00 1,625,50 Vendor# Vendor Name Class Pay Code M2310 MEDELA INC L/ M Invoice# Comment Tran 01 Inv Dt Due Dt Check Or Pay Gross Discount No -Pay Net 7001208474.! 11/30/2011/17/2012/07120 284.80 0.00 0,00 284.ft SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net M2310 MEDELA INC 284.80 0.00 0.00 284.80 Vendor# Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC yf M. Invoice# Comment Tran Ot Inv Ot Due Ot Check D Pay Gross Discount No -Pay Net 2239499484 ✓ 11/3012011116/2012111/20 726,69 0.00 0.00 726.691'' SUPPLIES 2239499487e / 11/30/20 11116/2012M 1/20 782.43 0.00 0.00 782.43 4,.i SUPPLIES 2239499488 v/ 1113012011116/2012/11/20 1,963,95 0.00 0.00 1,863.95,, SUPPLIES 2239451189✓ 11130/20 11/16/20 12111/20 14,040,00 0.00 0.00 14,040.00 y- SUPPLIES 22394511881/ 11/30/201 ill 8/2012111/20 33.41 0,00 0.00 33.41 SUPPLIES 2239499466 �/`- 11/30M 11/16/2012/11120 641.13 0.00 0.00 641.13 SUPPLIES file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_ew5report285052... 12/8/2022 Page 8 of 16 2239499483,, 11/30/20 11/16/20 12/11/20 132,92 0.00 0.00 132.92 SUPPLIES 2239451190✓ 11/30/2011/16/2012/11/20 13,231.09 0.00 MO 13,231.09 SUPPLIES 2239499485 11130120 11/16120 12/11/20 99.75 0.00 0.00 99.75✓` SUPPLIES 2239984643,E 11/30/20 11/18/20 12113/20 65.34 MO 0.00 65,34:'- SUPPLIES 223998462 k� ,. 11/30/20 11/18/20 12/13/20 33.55 0.00 0.00 33.5E SUPPLIES 2239865174 �,. � 11130/20 11/18120 12/13/20 185.96 0.00 0100 185,96 v'- SUPPLIES 2240183/01 ✓' 11/30/20 11/19120 12114120 39.95 0.00 0.00 39.95 ✓' SUPPLIES 224018310k,.'� 11/30/20 11/19120 12/14120 55.51 0.00 0.00 55.51�- - SUPPLIES 2240183102,/ 11/30/20 11/19120 12114/20 82.24 0.00 0.00 82.24...' SUPPLIES 2240516735 ✓ 11/30/20 11/22/20 12/17/20 -427,49 0.00 0.00 -427.49,- CREDIT 2240708528 ✓ 11130/2011123/20 12/18/20 47.28 0.00 0.00 47.28 ,.- SUPPLIES 2240708531 v ,. 11/30/20 11/23/20 12/18/20 134.64 0.00 0.00 134.64,` SUPPLIES 2240708526,/ 11/30/20 11/23/20 12/18/20 9.84 0,00 0.00 9.84�" SUPPLIES 2240708527,,' 11/30/20 11/23/20 12118120 74.23 0.00 0.00 74.23. - SUPPUES 2240708536 ✓ 11130/20 11/23/20 12/18/20 4,888.24 0.00 0.00 4,888.24 SUPPLIES 2240708530 v' 11/30/2011/23/2012/18/20 23.74 0.00 0.00 23.74 v SUPPLIES 2240491471 ✓ 1 11/30/?0 11/23120 12/18120 23.21 0,00 0.00 23.21 SUPPLIES 2240708524 ✓' 11/30/20 11/23/20 12/18120 156.51 0.00 0.00 156,51 ✓ SUPPLIES 2240708522,% 1113012011/2312012/78/20 37.59 0.00 0.00 37.59'+' SUPPLIES 2240591469 „/� 11 /30/20 11123/21) 12118120 427.49 0.00 0.00 427,49 u'I SUPPLIES 2240491470 ,/ 11130/2011/23/2012/18/80 23.21 0100 0.00 23.21 v' SUPPLIES 2240708533v 11/30/20 111231201 Ol 8/20 3424 0.00 0.00 3424 " SUPPLIES 2240708532 ✓ 11/30/20 11/23/2012118/20 28,844.08 0.00 0100 28,844.08 L" SUPPLIES 2240708529✓ 11130/2011/2W2012/18/20 893.61 0.00 0.00 893.61 ✓' SUPPLIES 2240708523 J 11/30/20 11/23/20 12/18/20 607.75 0.00 0.00 607.75 v SUPPLIES 2240948116✓' 11/30/2011/24/2012119/20 36.10 0.00 0.00 36.10 file:///C:/Users/ltrevino/epsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report285052... 12/8/2022 Page 9 of 16 SUPPLIES 2241138995 ✓ 11/30/2011128/2012123120 122.75 0.00 0.00 122.75 SUPPLIES Vendor TotaN Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 67,970.94 0.00 0.00 67,970.94 Vendor# Vendor Name Class Pay Code 10963 MEMORIAL MEDICAL CLINIC,, Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 111822 11130/2011/18l2012/01120 325.00 0.00 0100 326.00 ,:- PAYROLLDEDUCT Vendor Totals Number Name Gross Discount No -Pay Net 10953 MEMORIAL MEDICAL CLINIC 326.00 0.00 0.00 325.00 Vendor# Vendor Name Class Pay Code 14628 1 - Invoice# Comment • Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 110722 12/0712011/0712012/07/20 10.00 0.00 0.00 10A0 ✓ REFUND -CLINIC 110722A 12/07/20 11/07120 12/07/20 10.00 0,00 0.00 10.00 REFUND CLINIC Vendor Total: Number Name Gross Discount No -Pay Net 14628 20.00 0.00 0.00 20.00 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC v' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 8903642 4/ 11/30120 11/20/20 11/30/20 1,832.50 0.00 0.00 1,832.50v'- PHARMINVENTORY 8905022�/' 11130120 11/20/20 11/30/20 651.85 0.00 0.00 651.85" . PHARMINVENTORY 8903641 ./11/30/2011/20/2011130/20 874.39 0.00 0.00 874.39 "� PHARMINVENTORY 8903643 .% 11/30/20 11/20/20 11/30/20 27.19 0.00 0.00 27.19 ,. PHARMINVENTORY , 8905021✓ 1113012011/20/2011130120 53.51 0.00 0.00 53.51 PHARMINVENTORY . 8907523 ,:- 11/30/20 11/21120 12/01/20 34.55 0.00 0.00 34.55, i PHARMINVENTORY , 8907520 11/30/20 11121/20 12101120 1.62 0.00 0.00 1,62 4' PHARMINVENTORY , 8907518 11/30120 11/21/20 12/01/20 63.55 0.00 0.00 63.55 PHARMINVENTORY , 8911039 ✓� 11/30120 11/21/20 12/01/20 43.92 0.00 0.00 43.92 PHARMINVENTORY 8907522v' 11/30120 11121/20 12/01/20 746,61 0.00 0.00 740.61 PHARMINVENTORY 8909930 v' 11/30/2011/21l2012/01/20 7.72 0.00 0.00 7,72 PHARMINVENTORY 8907521 11130120 11121/20 12101120 358.76 0.00 0.00 358.76 ; PHARMINVENTORY 8907519 ,' 11/30l2011/2112012/01/20 84.74 0.00 0.00 84.74 • ' PHARMINVENTORY . 8909929 11130/20 11/21/20 12/01/20 4.89 0.00 0.00 4.89 - file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report285052..• 12/8/2022 Page 10 of 16 PHARMINVENTORY 8913017, - 11130/2011122/2012/02120 PHARMINVENTORY 8916123" 11/30/20 11/22/20 12/02120 PHARMINVENTORY 8913016- 11/30/2011122/2012/02120 PHARMINVENTORY 8916124,` 11/30/20 11122120 12/02120 PHARMINVENTORY 8920182 11/30/20 11123/20 12103/20 PHARMINVENTORY 8920270. ' 11 /30/20 11/23/20 12/03/20 PHARMINVENTORY 8919679 'r 11/30/20 11/23/20 12/03/20 PHARMINVENTORY 8920269 v' 11/30/20 11/23/20 12/03/20 PHARMINVENTORY 8919536 ✓ 11/30/2011123/2012/03120 PHARMINVENTORY 8919537,/ 11/30/20 11/23/20 12/03120 PHARMINVENTORY 8920057..E 11/30/2011/23/2012/03120 PHARMINVENTORY 8920055 v' 11/30/20 11/23/2012103/20 PHARMINVENTORY 8920056 11/30/2011/23/2012103/20 PHARMINVENTORY 8924522 ,j 11/30/2011/2712012/07/20 PHARMINVENTORY 8924524 11/30/20 11/27/20 12/07/20 PHARMINVENTORY 8926612 ✓` 11/3012011/2712012/07/20 PHARMINVENTORY 8924525 .. 11/30/20 11/27/20 12/07/20 PHARMINVENTORY 8924523,' 11130/20 11/27/20 12107/20 PHARMINVENTORY 89266M3 ' 11/30/20 11/27/20 12/07/20 PHARMINVENTORY 89S0787.'� 11/30/20 11128/20 12/08120 PHARMINVENTORY 8930788 `` 11130/20 11/28/20 12108120 PHARMINVENTORY 3931105 " 1113012011/2812012/08/20 PHARMINVENTORY 8928151✓ 11/30/20 11/28/20 12/08/20 PHARMINVENTORY 8929633 ,.�` 11/30/20 11/28/2012/08/20 PHARMINVENTORY 8928152 ,.' 11/30/2011/28/2012108/20 PHARMINVENTORY 3.772.72 0.00 0.00 3,772.72 465.28 0.00 0.00 465.28 1.04 0.00 0100 1,04 895.82 0.00 0.00 895.82 ,_ 120.57 0.00 0.00 120.57 172.35 0.00 0.00 172.35 -� 0.52 0.00 0.00 0.52 6.74 0.00 0.00 6.74 i 26.78 0.00 0.00 26.78 -% 27.07 0.00 0.00 27.07 „- 959.38 0.00 0.00 959.38 ✓- 13.60 0.00 0.00 13.60, 140.89 0.00 0.00 140.89 ' 15.01 0.00 0.00 19.01 449.80 0.00 0.00 449.80 80.40 0.00 0.00 80.40 ,.- 90.89 0.00 0.00 90.89 .--' 3.74 0.00 0.00 3.74 - 849.64 0.011 MO 849.64 17.12 0.00 0.00 17,12 474.14 0.00 0.00 474A44' 48.82 0.00 0.00 48.92. 31.63 0.00 0.00 31.63., - 180.47 0.00 0.00 180.47= 31.05 0.00 0.00 31.05 - file:///C:/Users/ttrevino/cpsi/memmed.cpsinet.com/u88 t 25/data_5/tmp_cw5report285052... 12/8/2022 Paoe 11 of 16 8933846 11/30/20 11129/20 12109/20 74.69 0.00 0.00 74.69 PHARMINVENTORY 8936378, 11130/201-1/29/2012109/20 378.62 0.00 0.00 37B.62 PHARM INVENTORY " 89338471/ 11130/2011/29/2012/09/20 1,437.67 0.00 0.00 1,437.67,.E PHARMINVENTORY 8933843 11/30/20 11129/20 12/09/20 359.12 0.00 0.00 369.12 .-- PHARMINVENTORY 8933844 ' 11/30/2011/2912012/09/20 5.00 0.00 0.00 5.00 PHARMINVENTORY 8933845,' 11130/2011/29/2012109/20 489.16 0.00 0.00 459.16 -- PHARMINVENTORY 8933842. "' 11/3012011/29/2012/09120 7.10 0.00 0.00 7.10 PHARMINVENTORY 8935561' 11/30l2011/29/2012/09/20 180.47 0.00 0.00 180.47 .- PHARMINVENTORY 8936376= 11/30/2011129/2012109/20 101.65 0.00 0.00 101.65�-- PHARMINVENTORY 8936375 - 11/30120 11/29/20 12/09/20 98.14 0.00 0.00 98.14,.' PHARMINVENTORY 8936377 11/30120 11129/20 12/09120 976.03 0.00 0.00 976,03, PHARMINVENTORY Vendor Totals Number Name Gross Discount No -Pay Net 10536 MORRIS 8 DICKSON CO, LLC 17,782.92 0.00 0,00 17,782.92 Vendor# Vendor Name Class Pay Code M2659 MXR IMAGING, INC .- M Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Grass Discount No -Pay Net 8800966808 „ 11/30/2011/18/2012/18120 83.48 0.00 0.00 83.48 �• SUPPLIES RADIOL Vendor Totals Number Name Grass Discount No -Pay Net M2659 MXR IMAGING, INC 83.48 0.00 0.00 83.48 Vendor# Vendor Name Class Pay Code 12096 NEOGENOMICS LABORATORIES v-' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 5585507 v' 11/30/20 07/31/20 08/31/20 1,284.00 0.00 0.00 1,284.00 4-'- LAB SERV 5676589✓ 11/3012000131/2009/30/20 4,350.00 0,00 0.00 4,350,00 ..-' LAB SERV 5768381 ✓ 11/30/20 09/30/2010/31/20 1,620.00 0.00 0.00 1,620.00 v' LAB SERV 5854031,/ 11/30/20 10/31/20 11130120 630.00 0.00 0.00 630.00✓ LAB SERV 3814690A v` 11/30/20 12/06/20 12/15/20 -90.00 0.00 0.00 4;0.00 -' CREDIT Vendor Totals Number Name Gross Discount No -Pay Net 12096 NEOGENOMICS LABORATORIES 7.794,00 0.00 0.00 7,794.00 Vendor# Vendor Name Class Pay Code 00920 OFFICE DEPOT ✓� Invoice# Camment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 276192487001+/� 11/30/2011118/2012/07/20 159.98 0.00 0.00 159.98 -' SUPPLIES file:///C:/Users/Itrevino/cpsi/memmed.epsinet.com/u88125/data_5/tmp_cw5report285052... 12/8/2022 Page 12 of 16 276158502001 -` 11/30120 11/19/20 12/07/20 91.69 0.00 0.00 91.69 supplies 276192497001 ✓ 11/30/20 11/21/2012/07120 16.14 0.00 0.00 16.14 ✓ SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 00920 OFFICE DEPOT 267.81 0.00 0.00 267.81 Vendor#Vendor Name Class Pay Code 01416 ORTHO CLINICAL DIAGNOSTICS Invoice# Comment Tran Dt Inv Of Due Of Check 0 Pay Gross Discount No -Pay Net 1852696055 ✓J 1113012011/2212012/22/20 204,54 0.00 0.00 204.54 r% SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 01416 ORTHO CLINICAL DIAGNOSTICS 204.64 0.00 0.00 204.54 Vendor# Vendor Name Class Pay Code OM425 OWENS & MINOR ✓' Invoice# Comment Tran Dt Inv DI Due Of Check D Pay Gross Discount No -Pay Net 2080927104 ✓ 11/30/20 11/17/20 12/17/20 322.95 0.00 0.00 322.95 ✓' SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net OM425 OWENS & MINOR 322.95 0.00 0.00 322.95 Vendor# Vendor Name Class Pay Code P2200 POWER HARDWARE ✓ W Invoice# Comment Tran Of Inv Dt Due Dt Check D Pay Grass Discount No -Pay Net A90799 11/30/20 11/30/20 12/10/20 12.54 0,00 0.00 12.54 MAINT SUPPLIES , Vendor Totals Number Name Gross Discount No -Pay Net P2200 POWER HARDWARE 12.54 0.00 0.00 12S4 Vendor# Vendor Name Class Pay Code 11080 RADSOURCE v Invoice# Comment Tran Of Inv Of Due of Check D Pay Gross Discount NO -Pay Net SC32091222 `�. 11/30120 11/12120 12/07/20 1,791.67 0.00 0.00 1,791.67v` SERVAGREEMENT Vendor Totals Number Name Gross Discount No -Pay Net 11080 RADSOURCE 1,791.67 0.00 0.00 1,791.67 Vendor# Vendor Name Class Pay Code 11251 RAPID PRINTING LLC ✓ Invoice# Comment Tran Of Inv Of Due Of Check D Pay Gross Discount No -Pay Net 15471 ,/ 11/30/20 10/14/20 10124/20 124.00 0.00 0.00 124.00," BANNER-MAMMO i 15915 ✓` 11/30/20 11/21120 12/01/20 53.00 0.00 0.00 53.00 ,.- BUSINESS CARDS/HR Vendor Totals Number Name Gross Discount No -Pay Nei 11251 RAPID PRINTING LLC 177.00 0.00 0.00 177.00 Vendor# Vendor Name Class Pay Code 11764 ROBERT RODRIOUEZ %' Invoice# Comment Tran Of Inv Dt Due Of Check DPay Gross Discount No -Pay Net 113022 11/30120 11/30/20 12115/20 44,31 0.00 0.00 44.31 L/ TRAVEL REIMB(ILh#!'t`:-�KtfcI fJ 'a.ry:5r llty Vendor Totals Number Name Gross Discount No -Pay Net 11764 ROBERT RODRIQUEZ 44.31 0,00 0.00 44.31 Vendor# Vendor Name Class Pay Code file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report285052... 12/8/2022 Page 13 of 16 12436 SHANNA O'DONNELL, FNP N-, Invoice# Comment Tran Dt Inv Dt Due Or Check D Pay Gross Discount No -Pay Net 120522 12/08/20 12/05/20 12/15/20 888.00 0.00 0.00 888.00 DEA LICENSE RENEWAL Vendor TotalsNumber Name Gross Discount No -Pay Net 12436 SHANNA O'DONNELL, FNP 888.00 0.00 0.00 888.00 Vendor# VendorName Class Pay Code 10036 SIEMENS FINANCIAL SERVICES ,,.- Invoice# Comment Tran DI Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 56382300009090 / 11/3012011/24/2012/14/20 4,038.24 0.00 0.00 4,038.24 RENTAL NUC MED , Vendor Totals Number Name Gross Discount No -Pay Net 10936 SIEMENS FINANCIAL SERVICES 4,038.24 0.00 0100 4,038.24 Vendor# Vendor Name Class Pay Code S2220 SKIP'S RESTAURANT EQUIPMENT,/ W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 451660 V1 11/30/20 10/19/20 11119120 3.481.28 0.00 0.00 3,481.28 WASH PUMP DIETARY 451679 ✓✓ 11 /30/20 10/2512012/06/20 270.00 0.00 0.00 270.00 •' WASH PUMP LABOR DIETARY 451702 11/30/2011102120 12/06/20 990.75 0.00 0.00 990,75v � DISCHARGE HOSES Ventlor Totals NumberName Gross Discount No -Pay Net S2220 SKIP'S RESTAURANT EQUIPMENT 4,742.03 0.00 0.00 4,742,03 Vendor# Vendor Name Class Pay Code 10845 STAPLES ADVANTAGE ✓ Invoice# Comment Tran Dt Inv Dt Due Or Check Or Pay Grass Discount No -Pay Net 3524395918✓ 11/30120 11/30/20 12/07/20 45.78 0.00 0.00 45.79 SUPPLIES 3524395919 ✓ 11/30/20 11/30/20 12/07/20 55.85 0.00 0.00 55.85 SUPPLIES 3524395917 ✓ 11/30/20 11/30/20 12/07/20 29.37 0.00 0,00 29.37 ✓` SUPPLIES 3524395921 v` 1113012011/30/2012107/20 30.99 0.00 0.00 30.99 v' SUPPLIES 3524395920v` 11/30/20 11/30/20 1210712D 46.27 0.00 0.00 46.27 �.-- SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 10845 STAPLES ADVANTAGE 208.26 0.00 0.00 208.26 Vendor# Vendor Name Class Pay Code S3940 STERIS CORPORATION ` M Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Grass Discount No -Pay Net 10622210 ✓ 11130/20 11122120 12/17/20 202.80 0.00 0.00 202.80 - SURD SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net S3940 STERIS CORPORATION 202.80 0.00 0.00 202.80 Ventlor# Vendor Name Class Pay Code 14644 SUPERIOR HEALTHPLAN „/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 112222 1210712011/22/2012/22/20 183,48 0.00 0.00 183.48 REFUNL file:!//C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report285052... 12/8/2022 Page 14 of 16 Vendor Totals Number Name Gross Discount No -Pay Net 14644 SUPERIOR HEALTHPLAN 183.46 0.00 0.00 163.48 Vendor# Vendor Name Class Pay Code 14212 SURGICAL DIRECT SOUTH ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9834 11/30/20 11/22/20 12/22/20 2,280.00 0.00 0.00 2,280.00 SUPPLIES MED/SURG Vendor Totals Number Name Gross Discount No -Pay Net 14212 SURGICAL DIRECT SOUTH 2,280.00 0.00 0.00 2,280.00 Vendor# Vendor Name Class Pay Code 11908 TMS SOUTH v Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net INV65498 ✓� 1 M0120 11/18120 12/18120 740.76 0.00 0.00 740.76 .; SUPPLIES INV66017 ,j 11/30/20 11/23/20 12/23/20 565.76 0.00 0.00 565.76 y/ SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net 11908 TMS SOUTH 1,308.52 0.00 0.00 1,306.52 Vendor# Vendor Name Class Pay Code T3130 TRI-ANIM HEALTH SERVICES MC M Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross Discount No -Pay Net 65282559 11/30/20 11/17/20 12/12/20 421.93 0.00 0.00 421.93 �� SUPPLIES Vendor Totals Number Name Gross Discount No -Pay Net T3130 TRI-ANIM HEALTH SERVICES INC 421.03 0.0D 0.00 421.93 Ventlor# Vendor Name Class Pay Code U1064 UNIFIRST HOLDINGS INC ; Invoice# Comment Tran Dt Inv or Due Dt Check D Pay Gross Discount No -Pay Net 8400408495,% 11130120 11/14120 12109/20 44.80 0.00 0.00 44.80 LAUNDRY 8400408494 u' 11/30/20 11/14/20 12/09/20 48,15 0.00 0.00 48.15.�` LAUNDRY 8400408515 V 11/30120 11114/20 12109/20 2,492.42 0,00 0.00 2,492.42LI, - LAUNDRY 8400408847✓" 11/30/2011117/2012112/20 1,657.57 0.00 0.00 1.657.57 LAUNDRY 8400408822*" 1113012011/1712012/12/20 217.70 0.00 0.00 217.70 LAUNDRY 8400408824, ' 11/30/20 11/17/20 12/12/20 211.73 0.00 0.00 211.73 i LAUNDRY 8400408821 11130120 11/17/20 12/12/20 191.69 0.00 0.00 191.69 LAUNDRY 8400408841,E 11/30/20 11117/20 12/12/20 75.08 0.00 0.00 75.08 LAUNDRY 8400408862V 11/30/20 11117120 12/12120 107.80 0.00 0.00 107.60 LAUNDRY 8400408820 ✓ 11130/20 11/17/20 12112/20 32.01 0.00 0.00 32.01 v" LAUNDRY 8400408823 v' 11/30/2011/17/2012/12/20 210.71 0.00 0.00 210.71 _ LAUNDRY 8400409029 t'" 11130/20 11/21120 12/16/20 44.80 0.00 0.00 44.80 - file:///C:/Userslitrevino/cpsilmemmed.cpsinet. com/u88125/data_5/tmp_gw5 report285052... 12/8/2022 Page 15 of 16 LAUNDRY 8400409049 r, 11/30/20 11/21120 12/16/20 2,572.70 0.00 0.00 2,572.70 , LAUNDRY 8400409028 :! 11/30120 11/21120 12/16/20 40.15 0.00 0.00 48A5 - LAUNDRY 8400409345 u' 11/30/20 11/24/20 12/19/20 211.73 0.00 0.00 211,73 �.- LAUNDRY 8400409382.;' 11/30/20 11124/20 12119/20 100.30 0.00 0.00 100.30 ✓" LAUNDRY 8400409343 ,.11/30/20 11124/20 12/19/20 194.88 0.00 0.00 194.88 •_-' LAUNDRY 8400409344 L,'` 11/30120 11/24/20 12119/20 2.00.57 0.00 0.00 200.57 t1' LAUNDRY 8400409342 v" 11/30120 11/24/20 12/19/20 201.59 0.00 0.00 201.59 LAUNDRY 8400409367,-' 11/30/20 11/24/20 12/19/20 1,798.12 0.00 0.00 1,798.12 �:- LAUNDRY 8400409341 v' 11/30/20 11/24/20 12/19/20 32.01 0.00 0.00 32.01 LAUNDRY 8400409359✓ 11/30120 11/24/20 12/19/20 75.08 0.00 0.00 75.08r"" LAUNDRY 8400409537, ' 11130/2011/28/2012123/20 48.15 0.00 0.00 48.15`" LAUNDRY 8400409558 ' 11/30120 11128/20 12123/20 2,253.11 0.00 0.00 2,253.11 .' LAUNDRY 8400409538 ,-' 11130/2011/28/2612123/20 44.80 0.00 0.00 44.80 LAUNDRY Vendor Totals Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 13,115.65 0.00 0.00 13,115.65 Vendor# Vendor Name Class Pay Code 14192 UNITED HEALTHCARE.,,' Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 111022A 12107/20 11110/20 12/10120 2.20 0.00 0.00 2.20 �•' 111022 12/07/20 11/10/20 12/10/20 115.00 0.00 0.00 115.00 Vendor Totals Number Name Gross Discount No -Pay Net 14192 UNITED HEALTHCARE 117.20 0.00 0.00 117.20 Vendor# Vendor Name Class Pay Code 11280 VICTORIA ADVOCATE v' Invoice# Comment Tran Dt Inv Dt Due Ot Check D' Pay Gross Discount No -Pay Net 0280214 11/30/20 11/30/20 12/16/20 27.10 0.00 0,0D 27.10 NEWSPAPER Vendor Totals Number Name Gross Discount No -Pay Net 11280 VICTORIA ADVOCATE 27.10 0.00 0.00 27.10 Vendor# Vendor Name Class Pay Code 14656 VICTORIA COLLEGE ,j Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 33 12108/2012/02/2012/15120 35.00 0.00 0.00 35.00 NURSING CAREER FAIR Vendor Totals Number Name Gross Discount No -Pay Net file:///C:lUsers/ltrevino/epsi/memmed.cpsinet.com/u88125/data_5/tmp_ow5report285052... 12/8/2022 Page 16 of 16 14656 VICTORIACOLLEGE 35.00 0.00 0.00 Vendor# Vendor Name Class Pay Cade 14624 WELLMED MEDICAL MANAGEMENT v Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 112222 12107/2011/2212012122/20 117.60 0.00 0.00 Vendor Total: Number Name Gross Discount No -Pay 14624 WELLMED MEDICAL MANAGEMENT 117.50 0.00 0.00 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Gross Discount No -Pay 9111243250 ✓ 1113012011/15/2012/10120 1,571.67 0.00 0.00 CONTRACT Vendor Totals Number Name Gross Discount No -Pay 11110 WERFEN USA LLC 1,571.67 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 368,008.04 0.00 0.00 APPROVED ON gg D��;1"EppC 0 82''02T2pq CALHO 1UNgqLY"1TEXAS $5.00 Net 117.60 j Net 117,60 Net 1,571.67 Net 1,571.67 Net 368,008.04 file:///C:/Users/]trevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report285052... 12/8/2022 RECENED BY THE RUIWT jcM/A@y UOR ON TIME: 10:53 DEC 0 8 2022 PATIENT 'UOUN fgF MRFTEXAS ----------------------------- ARID=0001 TOTAL ____________________________, TOTAL DEC 08 2022 WEMORIAL MEDICAL CENTER EDIT LIST FOR PATIENT REFUNDS ARID-0001 PAY PAT DATE AMOUNT CODE TYPE DESCRIPTION -------------------------------------------- 120722 681.00✓ 5 REFUND FOR t 120722 100.00✓ 3 REFUND FOR 120722 920.47 J 3 REFUND FOR 120722 538.26 ✓ 2 REFUND FOR 120722 '---........-'------------------------------ 191,90 ✓ 2 REFUND FOR 2431.63 2431.63 PAGE 1 APCDEDIT GL IMM .......................... _cev'o byiL- ' .jUi,fi,` An f:il r ri ON CORPORATE CARD Account, Statement COMMOM131 ➢Ertl ACCOUM ROSHAN➢ASiHOMAS t)' a Account Inquiries: ((srS9� jl-1 Tall Free: 1-(600)-248.45M International: 1-(904)-954.7314 Account Number: XXXX-XXXX-XXXX-9457 TDDr-rY. 1-(877)595-7276 Summary of Account Activity Not an invoice. For your records only. Tetal PclMiy $2,455.19 CredlWmlt 515,000 Cash A4vonce Limll $0 Send Notice or Billing Errors and Customer Service Inquiries to: glalement Closing pate 121931202E CITIBANK, N.A., PO BOX 8125, BIOUX FALLS BC 5711743125 _ _.... _ . . Transactions """-"""""" NOTICE MEMO ITEM(S) LISTED BELOW .. ................. 11/07 11104 3513 SU366723OB263085561887 1 WESTIN(WESTINHOTELS) IRVING 7X 75939 USA y56i,04 Bum CHECK IN: 11MR022 85434 11/D7 1404 3692 55436872309163093251365 2 DOUBLETREE HOTELS AUSTIN TX 7875E USA .%4r17 IM9877 CHECK IN: 11102/2022 ISM877 11107 11/06 9399 051343723116000,1810063 3 NPDB NPDB.HRSA.GOV 800-767$732 VA 22033 USA N88587125 11107 11106 9399 0513437231150=810947 4 NPDB NPDB.HRSA.GOV a00-76746732 VA 22033 USA / 2.60 1 '" N88587161 ,/ 11/07 11106 9399 05134372311600a34a11028 5 NPOB NPOB.HRSA.GOV 800.767.6732 VA 22033 USA N88587184 �20.00 11/10 11109 7372 55429502313894158312454 6 SYSTEM131NC 4149770000 VA 22911 USA .,,00100 15831245 11/14 11111 0398 55500362315200127700952 7 AORN ING 3037S563D4 CO OD231 USA ,�225.00 �% 11/14 11112 $999 554328623162ODS52SS7834 8 AMA•CREDENTIADNG 800.627.83351E 60611 USA 1j54.00 V 7'1745 11114 9399 0513437231960WA16]9226 9 NPDB NPOB.HRSA.GOV 800.767.8732 VA 22033 USA 127.50 V NWM763 11/15 11114 9399 051343723196000416TEKs 10 NPDB NPDEMRSA.GOV WO.76745732 VA 22033 USA .,2.50 } NaaS01024 11/15 11114 9399 05134372319600041879481 11 NPOS NPDB-HRSA.GOV 600.767.6732 VA 22033 USA + 12.50 lI NBBe01/96 NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION t,. CITIBANK NA, PO BOX 6125 SIOUX FALLS SD 57117.6125 ROSHANDA S THOMAS 202 S ANN ST PORT LAVACA TX 779794204 P49q 104 Account Number XXXX-XXXX-XXXX Statement Closing Date December 03, 2022 00007905040 Not an Invoice. For your records only. 24 ha Leaf Or Melon C.vJhnmMlo(el t;n.;.l.rMa lincaa s, hamg1 of n imam0 my. me NO CWlomm BOmice Cotentin ipttZHd ham of WpamlemMtlprePml a wtarsalon Col COlpamk Laid. CanhNdar Crtdfl Lfne: Each Cand Wdel has an M WMA Cmdl Llne (a imitator wbkb may bA pass. pat Club Adranrea), whkh W me anthem amount Mar the Caldllalder out shalge at airy MOM. The sba OF Met Cardnddeys Credit ere (am Cash than, d any} b dekimmed by me Company and a a pelden al We total Cmeranyeredkum, . Te renum wftmalmW oceknotbb wnnecM, an Croup Lo and Company may rl Oumatr mangey m Ca•db knee by my day. em Cm 0 day Card WIa,h. r Bons. Our kM n no an me apdi mery day. 24 hours v Pay m Inc klephwc n umMr OpttAiN on N e Manor d Ne sblemenl Poymanfa; You may mays n payment to your bdrAdaally, bliW card ...m.ellna Irving CMldanvgeF.. Piaabe yak Nalrwn0 OlganfaWns dO not tame Ma CIIManaga online payment Wash. enablN tar camM1.1dels. IF prying by man, pkse anon .ulfkkni mnAllg Wrt, PICaSowdk your ammnt rumder pan Ne hanIW MO GM1ecIG For eOnually Oilledu¢nnm, plw¢O uo urc M elm en COmW ny aheaas payment IW all CmdhCMttbUWmw. Mxe tmcebm your mated W ie imp« loan of am pvicesHg ddlkr MJ 9.00 p.m. Easlem Tune, itWarbee caul eratltled as 01 Nat any. Paymellm nos abo Oo macro My Olxbwk mMtnlxivr, xim letterer, aCH uansml dlmct debk. and ether meV.ods. Call Me number on Mc Imnt 011hK sWMment for derYls. 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In ease dr rams. or Ouezuone Aamn year Bill: You are Mipanslble a., Inbgacng me aepum"'We" dMasal as You, amount gWMmmII..entrge.war you homm me sualumm d, IMARtt{ far me1Gh]nti9e Nat has net Me M[QMd, or MI returned merehandlse. YOU abeuld also miesW We pCcess Yyour r¢ceunl Blalement heeneeasy been a eased dl a a.,O or. h a lease, It, Imamyo. hmC bean (shin a —a slip, m net an. To be01n Me talent resem p tudmbon, 11 ealmawmrmmnmh Page of 4 • In Me Fluor ra to please Owen N down we dis"m MUMPtlo tead.e kh4MMe hill Met late,. Mothball. and Fault Us .[gold by Iha IndlWddal nmayyau OF the Iewlts al aeronaut • If you Wlumn memhan0ee andrctrad a.,me Mn poem 1, plaauallmr30 days Item Me does be been Mild W Me A'4wnt by Mem formed a spa at the ailing Mplga a ddms epacabd on Me hunt, will the eapy W Me Cade Qq pkaae a thol.. MI. In Me in am metal If Me memrant e .emus. sown by NC all W: to be In yor ern rotoapy py.l ause(ailsWrdred env tlocumnm me Account: X=-X.O;X.)0W.• Transactfons (con't) Post Tans 11115 N6880142D 11115 11115 8999 55432662319201472983290 13 4MA•OREDENTLgLING 600-621-8 IL it/18 11717 5251 55436972321263219729791 14 LIGHT BULB DEPOT 14 2W0. 06907 TX 26321972964 Page 3 of 4 Amount 22033 USA ;2,50 60611 USA 9100 t, 78219 USA �9A8 „ MEMO JEC 0 9 2022 tLHOU0dJCOUNry, Account: XXXX-X'0(X-XXXX Page 4 of 4 a Bill To: 815 N. VIRGINIA ST PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX: (361)552-0312 Vendor Name: Vendor Address: Vendor Phone #: Vendor Fax #: MEMORIAL MEDICAIL CENTER PURCHASE ORDER Ship To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX: �(3t61) 552-0312 Date: O � l 1 go oZ P.O. # Account # Initiated Date Required Expense tY Form # 9401 Department Denver To Line No. Qty. Catalog Number Description Unit Cost Unit Extended I �f4�p {knnuwl ' Meas. Cost 58�o.a� 3 'Tvio 4WA—m ��K tArt I�(.�e u -P�L4 t tlIt`a'YWPI�fY1 Ar 5 1 V PI)e> x / v O yyoo 6 i ()kD- y .• v aQV 7 Pob 9 idsn a SwqgfvLR3DY-- to No I av►� La'e4-aw- mo-K Do Est. Freight Contact: Date: Quoted By: Buyer. E.T.A Est. Total Cost Dept Director Dir. Nursing _ Dir, Clinical Services CFO TOTAL COST 2300- y %._-7. 1 MEMORIAL MEDICAL CENTER PURCHASE ORDER Bill To: 815 N. VIRGINIA ST PORT LAVACA, TX 77979 PHONE: (36I) 552-6713 FAX: (361) 552-0312 0 Vendor Name: Vendor Address: Vendor Phone #: Vendor Fax #: Ship To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX: (361) 552-0312 bate: 1 —11 no a a- r P.O. # Account # Initiated By: Date Required mpensc # Department DetiverTo Form # 9401 Line Qty. Catalog Number No. Description Unit Cost Unit Extended 1 586e iJ4 '• -- 4' U p ��✓�)nn �� Nib X 9 � 1WWL7 � Meas. Cost /' ��•`90 9 n 6 ;. + z 2.502-50 20 ^ i.1 0 + x,- p A Wzoze ' Vl PDb 4 1 , 0 0 i' • IJ ii + PD0X ^t�'��r��t 5 1 2- 5 U AMA 9 A x s-2— 6�r�L�t (e- 00 6 2-50 •� U 1 �i�) 2-5G + 7 9 1 . 11 t3 i t /�J✓"`'�� g 225- 00 + 1 &T& 5 9 p •lk l}C�-i�j )a 1.'N.1a �.t=,lt: �� It^'�n i_ �a,.r, tl l�,_ L'n,.rid,i �l(- '�'1�j •U 1J to Est. Freight Est. Total Cost NOTES: TOTAL COST Contact: Quoted By: Date: S A `C Dept, Direcu Dir. Nursing Buyer. I E.T.A. ' Dir. Clinical Services Page I of I "w"170? w gKojilm 12/09/2022 MEMORIAL MEDICAL CENTER 0 (;p7'�y {#[�[p S AP Open Invoice List ap_open_invoice.tomplate -" —'0%�0 �vr T� iE?( Dales Through: Vendor# Vendor Name Class Pay Code 11183 FRONTIER V Invoice# Comment Tran or Inv Dt Due Dt Check D Pay Gross Discount No -Pay Not 111922 12/09/2011119/20 12/13120 70.40 0.00 0.00 70.40 t/, PHONE 112322 12/09/2011123/2012/19/20 38.53 0.00 0.00 38.33 L"'' PHONE Vendor Totals Number Name Gross Discount No -Pay Net 11103 FRONTIER 108.93 0.00 O.OD 108.93 Report Summery Grand Totals: Gross Discount No -Pay Net 108.93 0.00 0.00 108.93 AP ` Oft ON DEC 0 9 2022 file:///C:lUsers/ltrevino/cpsi/memmed.epsinet.com/u881251data_51tmp_ew5report806166... 12/9/2022 Page l of I RECEIVED Ely THE 'COUNTYAUDrMR ON DEC 0 9 205 /2109/2022 MEMORIAL MEDICAL CENTER 0 Q'iLHOUj(F,gUNTY AP Open Invoice List rFxpg ap_open_invoica.template Dates Through: Vendor# Vendor Name Class Pay Cade 13000 CLEARFLY �/ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay INV464934 12109/20 11101/20 11/01120 1,208.05 0.00 0.00 NqV 22 PHONE INV472136 '/ 12/09/20 1V01/20 12/15/20. 1,208.05 0.00 0.00 PHONE Vendor TotalE Number Name Gross Discount No -Pay 13000 CLEARFLY 2,416.10 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 2,416.10 0.00 0.00 aAPOVM ON DEC 0 J 2022 cn�tiORWhRUff%9 Net 1,208.05 1,208.05 Net 2,416.10 Net 2,416.10 file:///C:/Users/ltrev ino/cpsi/memmed.cpsinet.COM/u88125/data_5/tmp_cw5report523639... 12/9/2022 MSKESSONSTATEMENT As of: 12/09/2022 P49e: 002 To ensure proper credit to your um xu I AP MEMORIAL MmICAI. CENTER BIS N VIRGINIA SHIER PpNI LAVACA I% 7]9]9 AM DUE REM ITT m VIA gCl1 OMIT SNaemonl Im Ink noallon only DC: Bt tS Tom[.,; Customer: 632536 amunt, "Sch and fetum this smb I your remittance As 12109R022 ,e: 002 Malll t.: Co.,: 8000 ANT DUE RFMITTED VIA ACH OMIT Slalem.nl for inf0mmI ,, only Data: 12/10; 2022 Billing Due Rec ablua0onal Account %Nmm Oat. Oale Number Fbll.renc. Descriptive psaunt W column legend. P = Part Due Item, F = Future Due Item, blank = Cti enl Due it.. TOTAL Nallorul Accl 632536 MFEtOPoAL MFpICAL CENTER - -- Sublolal.: 1:1.436.90 USD Future Due: 0,00 Past Due; 0 If Pald By 12/13/2022. Cunt: 632536 PUEASE CHECK ANY Dale: 12/10/2022 DEMS NOT PAID I�j Am sP Amount P NeceivehM (gross)) F F Number .00 Pay This Amount: 13.168.17 USD Last Payment 2,451.97 It Pald Alter 12/13/2022. 081071201> Pay this Amount: 13,A36.90 USD 0•C 13, 15P•66 + 9.51 + 13,168.1/ a: APPAov® ON g COt1 DEC 11y2 22022 c +Ol$f Ni`T.itTFj o Pnr AR IngUITicS please contact 800-867-0333 Due 11 Paid On Time: USD 13,168.17 Dine had it pals late: 268.]3 Due It Pale tat.: USE) l%436.90 �2fk-2 MWESSON WALMAITT 1098/lAW MED MS MEMORIAL MMICAI. CENTER VICKY KAI ISEK B15 N VIRDINIA ST PORT LAVACA TX 11979 STATEMENTAs eh 12/00/2022 VC: 8115 AMT DUE REMITTm VIA ACH DMIT Tends, 400 $1 a14111en1 n! 111101 nl alnrl Only Cuslemen 256342 Date: 12/10/2022 DaleDue Nallorel A his ° Date Dale Number Number Cuatomer Number 256342 WALMANT 1098/MEIA MED MS 12/0512022 12/1W2022 7382449561 12/05/2022 12/1312022 73B2449562 12/05/2022 12/tW2022 7382449563 12/0512022 12/13/2022 ]3824n9564 12/052022 12/13/2022 7382449505 12105/PO22 12/1312022 73826436011 12/OS/2022 12/1312022 73URG43609 12/0612022 12/1312U22 /382793278 12/0612022 12/13/2022 7:182793279 12/06/2022 12/13/2022 1382793280 12/0612022 12/1312022 7302793201 12107,2022 1211312022 7303070270 12/W12022 12/1312022 7303070272 W0712022 12/13/2022 7383251526 12/08/2022 121312022 7383371.132 12/08/9022 12/13/2022 7383377+133 12/08/2022 12/13/2022 7383377-134 121U0/2022 1211 W2022 73633 P435 12/08/2022 12113/2022 7383560501 12/0912022 12/1312022 7383651657 12/092022 12/13!2022 7383651659 1210912022 1211312022 7353651661 12109,202.2 12/13/2022 13TIM51002 6 .1 mttomnce Deactlplon Discount P49e: not To ensure proper cmd8 to your account, detach and return this stub with your remittance As of: 12109/2022 Page: 001 Mail to: Comp: Boon ANT DUE REMITTED VIA ACH OMIT Statement lot inimmation only CusL 256342 PLEASE CHECK ANY Dale: 121l OI2022 ITEMS NOT PAID (s( Amount P Amount P Receivable (gmas) F (..IT R Number 55542502 1151nveice 6.06 302.78 296.721/ 7382449561 .5582439 1151nvolco 15.83 191.62 175.19✓ /382449562 55625648 115mY.we 7.90 394.91 387.01 ✓ 73824496G3 5569643/ 1151nv.,. 12.40 2.120.11 2.077.11✓ /302449564 55764969 11shwwo 10.26 512.11 502.51✓/ 7382449565 56632065 1951nvoicu 3.1E 15T.93 154.TT./ 1302643600 6'549159 1951nvoice 1.14 57.08 55,94 ✓ 7382643609 55605411 1151nvmCe 0.01 0.63 0.62 ✓ 1.182793278 55805411 1151nv0icc 7.95 397.32 389.3T ✓ 7UB2793279 55876294 1151nvolce 15.83 191.62 115.19✓ 1382793280 55816294 1tsInvome 0.03 1,27 1.24 1/ /382193281 56041163 IlsImmvc 12.65 632.71 620.06✓ 11383070270 56041163 1151nvo¢e 0.01 0.63 0.02✓ 7362070272 S5983363 1151nvoi6e 8.02 401.23 393.21✓ 1383251525 560939n8 1151nvmce 17.50 2,374.01 2,327.37✓ 7383377432 56113750 1151nvoice 0.08 0.08✓ 7383377433 56185409 1151nvoiee 16.54 827.03 810.49 ✓ 7103377434 5618S409 I41nvolre 16.17 008.34 890.11✓ 7383377435 56132800 19'vinv0me OCR 095 0.93 1/ 7383560501 66240513 1151nvoic4 28.05 1A32.54 1,403.091/ 7303651057 56240513 1151mman 8.04 401.91 393.01 ✓ 2383651658 56311887 1151nvoic4 0.24 0.24 ✓ 7383651651 56311687 11 Glnvoicc 18.37 918,03 900.26 ✓ 7383651662 For AR Inyuiricz plcnse contact 800-867-0333 MSKESSON STATEMENT As of: 1210912022 Paco: 002 To ensure proper count to your account, &tech end return this w.e,�w sons Nub whh your remittance DC: 6115 As of: 12109/2022 Page: 002 WALMART MIS ANT DUE REMITTm VIA ADII DEBIT Territory; 400 Mail to: Comp: 6000 MEDWRd MEMORIAi. MEDICAL. CENTER Statement fur infurmalimi only AMT DUE REMITTED VIA DEBT VICNY KAI IBFX Customer. 25G3A2 Seleniumfar mlormation only imy 81.9 N VIRGINIA ST Date: 12110/2022 Mill LAVACA TX 77970 Cull: 256342 PLEASE CHWK ANY Date: 12/1012022 ITEMS NOT PAID (+) aping Due ON. Date Reea rabkN 11 net Aecoum btrggey G Number Reference Cash D.wmpllon Discoum Amount P (grew) F Amount P Ree.wabte (net) F Number PF column legend P = PAR Due Item. F = Future Due Item, block = Current Due Nam TOTAL Customer Number 256342 WALMART 109BOMEM MED PHS Subtolila: 13.427.20 JSD future Due: 0.00 Doc II Paid On Time: If Paid ay 1211312022, TIED 13.1 GB.6G✓� Past Due: 0.00 Any This Amount: 13.156.66 USD Diu fell it lid tire: f 269.54 Lcut Payment 7,263.10 If Paid Alter 12113/2022, Due If Paid late: 12/ 12105/2W2 Pay this Amount: 13A27.20 USO USD 13,427.20 /- For AR Inquiries plcasc contact 800-867-03 i MSKESSONSTATEMENT As 41: 121a912022 Page: 001 To anwre proper credit to you, eceono detach and return this area with your remblimce DC: 0115 As ad: 1210912022 Page: 001 CVS PHCY 74751MEbt MC PHS AMT DUE RI441rfhb VIA ACH Di Temltmy: 400 Mail to: Comp: 8000 MEMORIAL MEDICAL CtNTM Statement for 611ormallon only T DUE DEBIT ITTIlED VIAion VICKY KALISIEK 835438 Cus815 Sl for only N VIfiGINIA ST Date: 1211012022 21 012022 Date: 12/t 0/2022 FORT LAVAGA TX 72919 Cusb 835438 PLEASE CHIECK ANY Data: 12/10/2022 ITEMS NOT PAID I,) _._—... _. Billin9 Due Rec vehleNatlmwl Account �L�IT6 Dash Amount P Amount P Receivehb Data pate Number Retarenm Descriptionpl 4une _._(gross) F )rot) F Number Customs, Number 835438 CVS PHCY 7475/MHd MC PHS 12/07/2022 12/1312022 7383277089 2026665 1161nvoice 0.19 9.70 I 9.511/ 7383277089 �J PF column leggin@ P = Past 0. Item, F = Future Due Item, blank = Current pun Item TOTAL Cuaromar Numbn, 835438 CVS PHCY ]4]5/MEM MC PHS Subtmab: 9.70 USD Future Due: 0.00 Duo 11 Paid On Time: If and By 1211312022. USD 9.51 Peat Due: 0.00 Pay This Amount: 9.51 USD Dec lost it fund late 0.19 Last Payment 7,283.16 If Paid Afler 1211312022, Use It Paid late: 12IO6/2022 Pay this Amount: 9.70 USO USO 9.70 for AR Inquiries please contact 800-867-0333 alb STATEMENT Statement Number. 64236225 AmerisourceBergen Date: 12-09-2022 loft AMERISOURCEBEIIGI N DRUG CORP WALGREENS 912494 340E 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL LEN TER 1001352841037026186 SUGAR I AND I% 77478-6101 1302 N VIRGINIA ST PORT LAVACA TX 7I979.2509 - Ed own 7 daye DEASal 276 886.451-9655 866- 1-9655 AMERISOURCEBERGEN PO Box 905223 _ CHARLOTTE NC 28290 6223 Not Yet Due. 0.00 Current. 1,127.69 Past Due: am Total Due 1, 127.69 Aooauot Balanon 1, 12761) Document Due Reference Purchase Order Date Date Number Number 12 012022 12-45-2022 3114826329 168658 12 05-2022 12-16.2022 3114B26890 108660 12-05-2022 12-16-2022 3114MG891 160569 12-05.2022 12-W-2022 3114877614 168707 12.0542022 12-15-2922 3114677615 168708 12-06-2022 12-m-2022 3115029146 168717 12-06-2022 12-I&Q022 3116029147 168718 12-06-2022 12-16-2022 3116029148 IGN719 12 07-2022 12.1&2022 3115210671 100790 12 07-2022 12-16-2022 3115210672 168731 12-08-2022 12-16-2022 3115387911 168745 12 09.2022 12-16 202.2 3115563963 168754 1.15 Days 1 16.30 i, IZ] 69 Thank You for Your Payment Date Amount 12-09 2022 p,003.80l Document bwmru Invoice Inoonc 111MICr_ liwn.cc lo,al, 0 Invnu:n nvoir,C Invo¢e loI .W Invotrx 31-60 Days Original Last Receipt Amount Received Balance Amount 126.99 0,00 116.90✓ 35.00 0,00 35.011 250 0.00 2.50 88.99 0.00 98.99 11.64 0.00 11.64 66.41 am 66.41 529.16 0A0 529.16 0.10 0.00 0,10 173.00 0.00 173,00 0.31 0.00 0.31 35.08 0.00 35 u8 5&43 _ 0.90 59,43 _ 1 61-90 Days - 91-120 Days Over 120 Days 00D 000 Ir 000 0"1 Reminders Due Date APPROVED ON 12 16-20_ DEC 12 2022 CANCU0 10YAR19 6 t zrll2�2? TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800.572-8683) "ENTER 9-DIGITTAXPAYER IDENTIFICATION NUMBER" a"ENTER YOUR 4-DIGIT PIN" El"MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" E"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" ET6-DIGIT SETTLEMENT DATE" "l TO CONFIRM" ACKNOWLEDGEMENT NUMBER #### ENTER: a n 0 $ 30347 1 $ 155.92 $ 36.49 $ 111.07 cueer; s CALLED IN BY: CALLED IN DATE: CALLED IN TIME: F:WP-Payroll Files\Payroll Taxes12022\#25 R2 MMC TAX DEPOSIT WORKSHEET 12.01.22.xls 12112/2022 941 RECJTAX DEPOSIT FOR MMC PAYROLL PAY PERIOD: BEGIN PAY PERIOD: END PAY DATE: GROSS PAY: DEDUCTIONS: AR ADVANC BOOTS SUNLIFE CRITICAL ILLNESS SUNLIFE ACCIDENT SUNLIFE VISION SUNLIFE SHORT TERM DIS BCBS VISION CAFE-D CAFE•H CAFE.P CANCER CHILD CLINIC COMBIN CREDUN UEPITAL DEP-LF SUNLIFE TERM LIFE SUNLIFE HOSP INDEM FED TAX FICAdA FICA-0 FIRST C FLEX S FLX.FE GIFT S GRP-IN GTL HOSP-I LEGAL OTHER NATIONAL FARM LIFE MED SURCHARGE PR FIN RELAY REPAY STONEDF STONE STONE 2 STUDEN TSA-R UWIHOS TOTAL DEDUCTIONS NET PAY: TOTAL CAFE 126 PLAN. TAXABLE PAY: $ 1,257.52 $ 1257.52 "CALCULATED-- From MMC R.P.rt Difference FICA - MED (ER) sc S 18.23 FICA - MED (EE) <sx S 18,23 5 18.24 S (0.011 FICA - SOL SEC (ER) sss. S 77.97 FICA - SOC SEC (EE) cN'a S 77.97 S 77.98 S 0.01 FED WITHHOLDING $ 111.07 S 111.07 TAX DEPOSIT: S 30347 $ 30347 FICA -MEDICARE .-.+ $ 36A6 $3648 FICA -SOCIAL SECURITY u<os $ 155.94 $156.92 PREPARED BY: FED WITHHOLDING 5 111.07 S111,07 PREPARED DATE: TOTAL TAX: $ 303.47 $303.47 $ - REVISED 3118/2014 TOTALS 5 1.257.52 111.07 18.24 77.96 S c8.p2 c S 25$.29 $ S52.23 Exempt Arm Employees over FICA -SS Cap: S S S PeyooDe 5 - Employee Relmb.: TOTAL: $ Caitlin Clevenger 12/12/2022 #25 R2 MMC TAX DEPOSIT WORKSHEET 12.01 22 M., TAX DEPOSIT VVORKSHECT1211212022 Ru Dau::.-:2/2s ,»......_ 11EX:ram' CEt7T? Fa=a 'er. z �i== FiaSG •-- ° a ;r : a d t S. r. c: a . .............................................. 7 e d..-_......... ens Su�r.az7- ;r,1 ^°e:rpton �cs �i4 iE?}iE E:i:E'� �.css C=ie ;aou-= ...................................................................... ............................................ 'rr.??-'. ?E-GFF 12. H. Y N .i ,:... if%'::«. ti�7F.J: EC3Etii ECi?5 CiES is C.i?_ 1 .._. _. Es -SE ':7 S G?i\T SP.i-Sf wi,.. SING E_&:.L _ :i;7 _Nsir a_ ] c..";i. S!R:FG TS.". ..A: 3 Ef.Gi i'MCS Vns -3ta: _.ald cs.... _--.___ ' 2sa: 1:5 �.:. OE.a[L1C.".i: E5i.29 5m•; cc"e.-t? C _ks ccta_. .. � .: •-------_-..-.-.___.......................—'-----------------------.-......-..............................-_.......... n:,, ._..,._ 0A .:=4 : .,.... �7t MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT--- December 5, 2022 - December 11, 2022 Date Bank Description 12/9/2022 TRANSFMST LLC VMC SETTLE 41399801332385 611 12/9/2022 PAY PLUS ACHTRANS 45299293301000695643312 12/9/2022 EKPERTPAY E%PERTPAY 746003411 91000014400064 12/9/2022 CLEARGAGE LLC CLEARGAGE, IBYYE8NA6UI FCOM 242 12/9/2022 AMERISOURCE BERG PAYMENTS 0100007768 2100002 12/9/2022 MEMORIAL MEDICAL PAYROLL 746003411113122650 12/7/2022 PAY PLUS ACHTRANS 452579291 101000693877005 12/6/2022 PAY PLUS ACHTRANS 452579291 101000692738826 12/6/2022 MCKESSON DRUG AUTO ACH ACH05281260 910000144 12/6/2022 FDMS FDMS PYMT 052-2000500-0004100012744298 12/5/2022 PAY PLO$ ACHTRANS 452579291 101000691693399 12/5/2022 MERCHANT BANKCD DISCOUNT 971160910883 910000 12/5/2022 MERCHANT BANKCD DISCOUNT 971260913887 910000 12/5/2022 MERCHANT BANKCD FEE 971160913887 91OW018693 12/5/2022 MERCHANT BANKCD FEE 97116091088391000018693 12/5/2022 MERCHANT BANKCD INTERCH NG 971160913887 91000 12/5/2022 FDMS TOMS PYMT 052-1601830-0004100012224560 12/512022 FDMS FDMS PYMT 052-2000500ROO 4100012226156 MMC Notes Credit Card Processing Fee - 3rtl Party Payar Fee -Child Support Payment - Patient Financing Service -3408 Drug Program Expense -Payroll Taxes 3rtl Party Payer Fee -3rtl Party Payer Fee .3400 D .g Program Expense - Credit Card Processing Fee -3rd Party Payar Fee -Credit Card Processing Fee Credit Card Processing Fee Credit Ca rd Processing Fee Credit Card Processing Fee -Credit Card Processing Fee Credit Card Processing Fee Credit Card Processing Fee n )G eall.�/-`' Decmber II, 2022 ANDREW DE LOS SANTOS Memorial Medical Center ppvyWLd }LIPl • b2 C L PROSPERITYBANN ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT-- ESTIMATED ACHS Data Description 396. 648 2c 12/20/2022 ACH Payment WEBFILE TAX PYMT DO Sales Tax 5 L, 1, 3 4• 12/15/2022 ACH Payment TEXAS COUNTY UPS RECEIVABLE 041921000024329 - Retirement Funding _ I1 'I� (,L� UM(YJ-CD+aY- Q 1 l(i-, }& / l0iwyp\, December 12, 2022 'e • 8 ;, 1 c; ANDREW DE LOS SANTOS 2 • 8 66 - > `. Memorial Medical Center 2 866.55 2 , 8.5 0.00 1 Amount 402D0 437.34 0 3,003.1in 383,494.95* 85:26'i 33.12j 7,283.1619 5.36 2878.': �f9"95• 285.52 198.44 9.95 166.31 32.45 75.67 396,648.26 Amount _ 1•,500.81 s� 198,575.48 2 200,076 29 Cc N6 402•13it + 5.36 + 19. 95 + 285.52 19N•44 , 9.95 + l 6D—• I 32.45 75.6/ 1.195.0 .. pay ��us 54 85. 26 119 l 2ft. 16 664.9 GxrA3#r4�Y B8R^!iu I18.2p 1Ifl-1v a: 195. 67 6611 5 , , 88N•IlU , 11N^2U •866"� ,. Date/Time 12-06.2022/08:50AM Submitted By Pay Date 11.30-2022 Employee Deposits S78.488.45 Employer Contributions S120.087.03 Group Term Life Premiums $M00 Total $198.575.48 Comments Payroll File November 2022 Retirement Upload.xlss (2) Confirmation: YOU Have Filed Successfully Sales and Use Tax Period Ending 11/30/2022 (2211) Taxpayer ID: Taxpayer Name: Entered By: UserlD: MEMORIAL MEDICAL CENTER Email Address: Reference Number:: Taxpayer Address: Date and Time of Filing: 815 N VIRGINIA ST PORT LAVACA, Tx Telephone Number 12/0912022, 0923:17 AM 27979-3025 IF Address: 24 116.195.218 2WHAVl&43111MVI_137 Electronic Check Payment Reference Number:: Type of Bank Account: Checking State Amount: Sl,136.98 Trace Number: Accountholder Name: Local Amount: S363.83 Bank Routing Number: Amount to Pay: S1,500.81 Bank Account Number: Electronic Check: $1,500.81 Payment Effective Date: 12120/2022 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 on items exported oulside the United States based on a Texas Licenced Customs No Broker Export Certifications? LOCATION SUMMARY Total Texas Taxable subject to State SubJecttO Loce Taxable Sales State Tax Due Local Tax Rate Local Tax Due Sales Purchases Tax (Rate .0625) Local Tax 00004 38283 18283 0 lu$3 1t42.65 18283 O.C2 365.G6 SubTatal 18283 18283 0 18283 1142.69 18283 365.66 Total Tax for Locations $1,508.35 Total Tax Due: $1,509 35 Timely Filing Discount: - $7.54 Balance Due: S1,500.81 Pending Payments: - SO.00 Total Amount Due and Payable: $1,500.81 ( State amount due is S1,136.98) ( Local amount due is $363.83 ) Page I of 1 RECEIVED BY THE COUNTY AUDTTDR ON DEC 0 8 20ZZ 12/08/2022 ^,ALHOUIl MUNTY, TWS MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through; 0 ap_open_involce.template Vendor# Vendor Name Class Pay Code 11820 FORTBEND HEALTHCARE CENTER Invoice# Comment Tran DI Inv Dt Due Dt Check D Pay Gross Discount 113022 11/30/20 11130/20 12/31/20 2,528.50 0.00 ��11 TRANSFER Nt1 lyllwi-fl tt. I 1%vp� dipi6ld-}N11 ii_�-� . Vendor Total; Number Name Gross Dlscourd 1 11820 FORTBEND HEALTHCARE CENTER 2.528.50 0.00 Report Summary Grand Totals: Gross Discount No -Pay 2,528.50 0.00 0.00 DEC 0 8 2022 04H000UNT:t7EXAs No -Pay Net 0.00 2,528,50 , No -Pay Net 0.00 2,528.50 Net 2,528.50 file:///C:/Users/ltrevinolcpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report567919... 12/8/2022 Page 1 of 1 RECEIVED COUN7yAr7D�A ON I)EC O 8 2022 12/08/2022 MEMORIAL MEDICAL CENTER 0 ,JALNOIAV65gU" rEXg AP Open Invoice List ap_open_invoice.template y Dates Through: Vendor# Vendor Name Class Pay Code 11832 BROADMOOR AT CREEKSIDE PARK Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 113022 11/30/20 11/30/20 12/31/20 7,177,38 0.00 0.00 7,177.38 TRANSFER Vjj IltSt}y,-J U �?H/j-.jjj,0,i�xci tt'r.�r +Y',1,'�'— !! ul: u'r.T� Vendor Totals Number Name Gross Discount NiO-Pay Net 11832 BROADMOOR AT CREEKSIDE PARK 7,177.38 0.00 0.00 7,177.38 Report Summary Grand Totals: Gross Discount No -Pay Net 7.177.38 0.00 0.00 7,177.38 DEC 08 2022 CABHOUN GgUNTY;IT 'L file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report3 77125... 12/8/2022 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON DEC 0 8 2022 12/0812022 MEMORIAL MEDICAL CENTER 0 CAL1i[db``( COUNTY, TEXAS AP Open Invoice List ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11836 GOLDENCREEK HEALTHCARE*/ Invoice# Comment . Tran Dt Inv Dt Due Dt Check D* Pay Gross Discount No -Pay Net 1130220 11/30/2011130/2012131/20 3,541.44 0.00 0.00 3,541.44 1� TRANSFER NTf 191SUYnr1i'z Pf JPAA Tq•01aija� qV,, j1�.� %1 " 113022E 11130/20 11/30/20 12131/20 1,750.50 0.00 o.0(0 1,750.50 ✓ TRANSFER It tt 113022C 11/30120 11130/20 12131/20 2,169.85 0.00 0.00 2,169.85 ✓ TRANSFER It t' Vendor Total: Number Name Gross Discount No -Pay Net 11836 GOLDENCREEK HEALTHCARE 7,461.79 0.00 0.00 7,461.79 Report Summary Grand Tctals: Gross Discount No -Pay Net 7,461,79 0.00 0.00 7,461.79 DEC 08 2022 file:///C:IUserslltrevino/cpsi/memmed.cpsinet.com/u88125/data 5/tmp_cw5report694971... 12/8/2022 Page 1 of 1 RECEIVED By THE COUNTY AUDITOR ON DEt, MEMORIAL MEDICAL CENTER 6822 2 0 AP Open Invoice List 10:35 ap_open_invoice.template C.AIHOUN (AUNTY, T�7(� Dates Through: Vendor# Vendo ame Class Pay Code 12696 GULF POINTE PLAZA ✓ Invoice# Comment Tran Ot Inv Dt Due Ot Check D Pay Gross Discount No -Pay Net 113022A 11/30/2011/30/2012/31/20 5,772.90 0.00 0.00 5,772.90 L/ TRANSFER Nii ,14 y1'11 ,- S 113022C 11130120. 11130/2012/31/20 389.00 0.00 0.00 389.00 TRANSFER 11 113022B 11130/20 11/30/20 12/31/20 1,105.00 0.00 0.00 1,105.00 v" TRANSFER It It 113022 11/30/20 11/30120 12/31120 23,559.20 0.00 0.00 23,559.20 ✓I TRANSFER It Pr , Vendor Total; Number Name Gross Discount No -Pay Net 12696 GULF POINTE PLAZA 30,826.10 0.00 0.00 30,826.10 Report Summary Grand Totals: Gross Discount No -Pay Net 30,826.10 0.00 0.00 30,826.10 DEC 082022 BY CALHHOUNU CODA I RAS file:///C:/Userslltrevinolepsi/memnied.cpsinet.com/u88 l25/data_5/tmp_cw5 reportl44945... 12/8/2022 Page 1 of 1 NEC€JVED BY THE JOUNTY AUDITOR ON MEMORIAL MEDICAL CENTER D40 V 8 L()22 AP Open Invoice 0 10:46 List ap_open_Invoice,template Dates Through: 'AUl %NdommItdew* Class Pay Code 13004 TUSCANY VILLAGE Invoice# Comment Tran Dt Inv Dt Due Dt Check D- Pay Gross Discount No -Pay Net 113022 111130/20 11/30/20 12/31/20 11,593.00 0.00 0.00 11.593.00 L% TRANSFER Nil -Ins wou PI �IU L�lpmil d, -114' IWVL UP.-Ir--� y1()) Vendor Total: Number NameGross Discount No-PaS Net 13004 TUSCANY VILLAGE 11,593.00 0.00 0.00 11,593.00 Report Summary Grand Totals: Gross Discount No -Pay Net 11,593.00 0.00 0.00 11,593.00 APPFIpVED ON DEC NN7T0yy82022 CALBHOUtir COUN7/ flle:ll/C:/Users/ltrevino/cpsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5report407358... 12/8/2022 Page 1 of 1 RECEIVED BY THE COUNTY AUDITOR ON DEC 0 8 2022, 12/08/2022 CALHO OMIr,OUNTY, TEHAS MEMORIAL MEDICAL CENTER AP Open Invoice List Dates Through: 0 ap_open_I nvoice.template Vendor# Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING �/ Invoice# Comment Tran or Inv Dt Due Dt Check D Pay Gross Discount No -Pay 113022D 11/30/2011/30/2012/31/20 3,1112.00 0.00 0.00 TRANSFER VJA, -jW0V Kkj, vhi$j G1A�db1/iu� II jtt'h VJ11 0[tLl kj� . 1A 113022C 11/30/202/3 11/30/2011/20 6,029.50 0.00 TRANSFER tt 11 113022F 11/30/20 11/30/20 12/31/20 2,286.83 0.00 0.00 TRANSFER it It 113022E 1113012011/30/2012/31/20 637.65 0.00 0.00 TRANSFER o 113022E 11/30120 11130/20 12131/20 56,77 0.00 0.00 TRANSFER It R 11302022 11/3012011/30/2012131/20 135.04 0.00 0.00 TRANSFER 1, P Vendor Total; Number Name Gross Discount No -Pay 12792 BETHANY SENIOR LIVING 12,257.79 0.00 0.00 Report Summary Grand Totals: Gross Discount No -Pay 12.257.79 0.00 0.00 DEC 0 8 2022 Net 3,112.00 ✓ 6,029.50 ✓ 2,286.83 ✓ 637.66 ✓ 56.77 I/ 135.04 Net 12,257.79 Net 12,257.79 file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.coni/u88125/data 5/tmp_cw5report911949... 12/8/2022 Memorial Medical Center Nursing Home UPL Weekly CanteR Transfer Prosperity Accpun 12/12/2022 rw e.rinnmr Acn Munlnf Namr NumWr arbn<a }nnrlrrdl nrM1nln IA,IM.35 15295bll IIS.IIe oS, 1lweryftMF.ftA 127,11E50, 1E7.27250 +5,99101� go—wwffigrl I41.963.62✓ ltt, 65 1",955.1A , W.9I8.33a✓ 9o,B5]]tl t3.35b P9� F00 -,.._v_,,,_ 163,6W.19 r/ 163RIS Al W.3NSR/ J O T% /. 3° I 1 .I. m/fn 9rn: /Rrx-e.-m 1t3e+6,' 6•%i 8s<14a1d + b 'I . xm. an eoromn olnrc•Ss.IXtl w.uemvnlffnfaromenwurp wnr xWlt [plraewnl MlP6ue Wl:nelPf ErfOIMI M\I[pfnauleOfeeOen aerwnl (1XXn'frvl, lrnlle'a1HX NVL innvfn 5ummallli0l]:Oe.fmMrINNUV(trrnaer Summuv tl.]$ ]]rNv P.Imamr amenmfa eln,mxmaN xwm+ 119.: ]afi3 l/ 6an16xnee 1t9.: rR 53V Vanance tvpv:n Raana ILq WJ MOLLYAPCIORFR � 10,59950 {// Otloberlmnen 3f.il✓J xw.mb.rmmfa n.n✓ De[ambfl lnlfnal Adlmt Rapna/Irantler Am: 9v.93].11 ✓ w,lu 13 Link Bllan[e 0M) 11 wnifins.1mo, 1.0 M..",A 6.IIIA6y// 39,881.92 / OM9bM Interest L.tt✓ NorNnbenneerwt EW DeamMrlmant aai.a e,i.rnlrt•annerAm: I9,ulsT t,✓// 146.414.11 / 142,626.27 / Baneaalan:e laa,la 11 ✓ Vow— . fort N BID... loom / ✓ MOIMR Y]]RB] DEVOTED PNYMBMS TO TWGNY I'to I On DstPN, IE4reat 36.1E NMtlnbvr lMerM IPAD ✓ o«embm lMvreO Aainl etiv¢Mnmlar Aml Matti, 13,41.12 / 8.214.19 1 burl Babnm 13,Sz2.li Vargme laaveln 86YMe 3ooN MODNA 5.I9191�% O A.W.Mre3t Ilo7v/ Novembarleento US, ✓ Oett nnim mns Adiwl3al,naRnmleraM,l / A3P.111 I/ 9P.559S9 85,111.8E B]nl B,lan[e W.55959 Van,n[a t... 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PL N( llll,PMf]i6Will 19'210.'1 - 1, 1"11 Mll, ]3 :2/9/20IS4EAtN1 HH... llCILIIAIIAINAI lI.Wx411JW1: 1.9160C J ],945W 161.015.M W,l>4.54 r� [,413.fS I.OM.II a,962.5]• , 05.I11.68./ i0u6 675.10124 41LnSA5 33.4$9A6 7,S19.54 31.074.23 3M661]2 12/12/2022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number i Name Groups Auo Group, Account Type Search All ]DA _ Dow reparta0 as o1 Dsc 12. 2022 9 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 S7,080,904.11 $7,367.692.43 S7,080,904.11 57,101,889.30 '3FF0 GULF POINTE PLAZA- $10000 S10000 510000 5101j.00 DACA a54 MEMORIAL MEDICAL / NH GOLDEN CREEK S67.665.28 S74,822.75 $657.665.28 567,101 52 HEALTHCARE •a?s5 MEMORIAL MEDICAL CENTER - CLINIC SERIES $536.90 S636.90 S53690 S53i,'90 2014 '4357 MEMORIAL MEDICAL S6050.95662 S6.10540014 $6050, 956.62 S698460666 CENTER - OPERATING 'a373 MEMORIAL MEDICAL CENTER - PRIVATE S432.23 $$432.23 "a432.23 S432.23 WAIVER CLEARING '4381 MEMORIAL MEDICAL S115.278.63 / S187,399, 95 S115.27863 E41847.09 CENTER; NH ASHFORD ' 403 MEMORIAL MEDICAL CENTER/NH S46.143.1;1 ✓ $11,1.376.33 S•16.143.13 S21,536.11 SROADMOOR '4411 MEMORIAL MEDICAL 5148;1,1411,/ 5161.046. 0.1 SI-8.414.I 5'02.25896 CENTER / NH CRESCENT 'a446 MEMORIAL MEDICAL S13.522,12 S43,2380. $13.522.12 S4,407.42 CENTER i NH FORT BEND '4438 MEMORIAL MEDICAL CENTER i SOLERA AT / $90.559 59 l S i18.626.83 S90.559.59 $63.03327 WEST HOUSTON '2998 MIAC -MONEY MARKET S296.644.60 $296.644.61i 5296.644.60 5296.E,14 65 FUND '5506 MMC -NH BFTHANY S62.554 87 $88 902 19 S88,584 87 585.630 4S SENIOR LIVING •5aa1 MMC -NH GULF POINTE PLAZA- $95,665.11 $95,665 11 S95,665. 11 $78,467 04 NIEDICARE%MEDICAID '5433 MMC -NH GULF POINT E S21.708,77 S35.808.99 S21.706 77 S21 d65,25 PLAZA - PRIVAI E PAY ,ice 407 MMC -NH TUSCANY S4a 692. 15 $44 692.15 S44.692. 15 $33,821.77 VILLAGE https7iprosperity.oibanking.comlonlineMessenger tli Memorial Medical Center Nursing Home UPL Weekly Nexion Transfer Prosperity Acco is 12/12/2022 / PlMaue fiveart B."nnlrug vantlmB Today'e6eBInnMB Amount to Be Transferred!. Nursing Nurelna Home _ Number Babe¢ Av t (/Tr,aI.,-e .((evoNb Balance 111.40.6A 6),6209B - B+nl B+lmv 6,60 67,66:;5.]8 6)r510.98 f Yandn(¢ Ledvem B+bn(e 100010 Note 0."hot.. of oeer s5.".01ee tmeeferen r* he narrmN name Mole boon oemunI has a bore he1-ce of$IW 1roI MMCdepopled M *Pen a(wunt DEC 12 2022 r,A90(9l6&AW%QAS Onoba lntera[ IE%�/ November lnterat ]631+/ Bettm6fl Interco .1h Adlm[BahnteRrdnsterAmt 67i V A m.od IINMIWf0 1 15��21 (�(sm ANBBEWBEL066ANT06 1]/1)/1021 r Nn( Wrrth R.nem\ml UPLTunstrrsvmmwUwACetemhedxx UPI u,nner S,mmny 12.12 22 m. MMCMPIION - -+... _. .. -rax " :1'f%.� _. ^.^'1�� Tuhfi i Tondar.n GIPP/COmpl QO'P/Cp111P] QIPP/Camp] l4pn QIIP❑ NN POPTION Ct V} }J p156 ✓/ IVW20I3TSY5/SPTNSIIPST CP CD DIP f36M555676917 91 - 1.716W V19.W I$151MI IiN6. [CII� IICCIpIMPMi )06403ijj mW{p$1191$ W.fl. 59916 1}15$}O , IIGLTX IW FPN WC NCCWMPMT IU6 IAU3011 } 1.M6M LEM 06 13/6110$$ mpwH 4831.33 gB}].31 I2/6/2"1 qm lldlNpNni PFYWNT B030)03M]439 - �2ASO. 0650.00 1}I6/201$ WAIN, I1VWRWC HCCWMPMT I]W110161110111 ✓ '9,996_)1 19,966n 1N0RIL411 XXS WC6IPx[iU yy,i)90a SS1N)9I//I3001l11l WALTNnY PIUWNC M CCLR11�3IO .39 TSVSITNNPJA40O(P5436P5559169391 2,915" 2,}359 IItl/}0}$ T/M}011 GOIOFNCETIHEFLTMERCOfPlII035691WH15$a .i5P15 y.5 rtVI5W>S9N 9lWlIXH /14,99,39 / 1637, [33.W.4. 6>.Bi09B. n9M9P �/ 120212022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number 1 Name Groups Aac Group Account Type Suart:h l •^" 1 DDA Daly reperled as of Dec 1 2022 9 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $7.080.904,11 $7.367,692.43 $7,000,904.11 $7,101,889.30 •3660 GULF POINTE PLAZA- S100.00 S100 00 5100-09 5100.00 DACA '4454 MEMORIAL MEDICAL I NH GOLDEN CREEK ` S87.655.28 ,�/ ✓ $74.822.75 S67,665 28 $67.101 52 HEALTHCARE :1365 MEMORIAL MEDICAL CENTER - CLINIC SERIES S536.90 S536,90 S536.90 S536.90 2014 '4357 MEMORIAL MEDICAL S6,050,95661 S6,105400. 14 56,050,956.62 $6.284,606.66 CENTER -OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE S43223 S432.23 S43223 5.132 23 WAIVER CLEARING '4381 MEMORIAL'.IEDICAL S115.278.63 S187.39995 S115.278.63 S41.8!709 CENTER.; NH ASHFORD '4403 MEMORIAL MEDICAL CENTER!NH S46,143.13 S114,375.33 546,143 '.3 527.536.11 BROADMOOR •4411 MEMORIAL MEDICAL $148,41411 5161,04604 S148,414.11 S102,258.96 CENTER 1 NH CRESCENT •aaa6 MEMORIAL MEDICAL S13.522 12 $43.238.02 $13,622.12 $4,407.42 CENTER I NH FORT BEND '4436 MEMORIAL MEDICAL CENTER r SOLERA AT S90.55959 $118.626.83 $90.559.59 $63.033,27 WEST HOUSTON '�998 MMC-MONEY MARKET $296.644.c"0 S296.64460 S29664460 $296.644,60 f UNO 5506 MMC -NH BETHANY $88.584 87 S88,902.39 S68.584.87 S85,630.48 SENIOR LIVING '5a4 i MMC -NH GULF POINTE PLAZA - S95,665 11 S95.665. 11 S95,665 11 S78,467.04 MEDICARErMEDICAID '5433 NIMC-NH GULF POINTE S21,708.77 $35.80899 S21.708.77 52'465.25 PLAZA - PRIVATE PAY '3407 MMC-NH TUSCANY $44,69215 544.69215 S44.69215 S33.82177 VILLAGE slips:/lprosperity.olhanking.cam onlinet.lessenger 10 Memorial MediC21 Centel Nursing Home Upt Weekly HMG Transfer Prosperity Fccou 12/12/2022 vrnn lrl.n a,mr,e e.s lance xunlg x9m.—` - a.1126113 v.mas s.•.s en,� IM W Fmoum leM on9b9rmnren zee N9nmprinrarep is / W nmMnngnv ✓ Cdluu 9,l,r.te(rnnlle, Hnl H5999 f vra.l9m re m c..um n.9monrs r.,m„,s sr.ml,mE.. (- 6��_ fs.19555 110540, 91535.40 95.655 f1 95,525,60v/ Banl&lance ?f,B5511 vnuna Nme: omve.r.,[m ur or<r stao.,nw rr...,mrw m ]n<.mnn9 nan9. Narel: (v[h v6Y,nr Fo1 abambobnrtnl SlttllFol MMCE[NmMlavprna[munl DEC 12 7022 lea.mv en.nm low oa Wflnarva M ✓/ nw.mb,.mrmn am �/ wnmMnnrernr / aaiunb,lm,.pmml.ram. Ss9sw rorurawsr[u 3zv,u9w a9nmu.n: WW`ANi,.s r7"R�(1� nxnnrwosson rns 1f/t]/zpzx ,Inl I., v. mtrmnn wlL,nnrl.—n r:ottw.—.0 xxu9l t—ft S.--ua::: n.. MMC PORTION glpP/Cum, gIPP/COmpa Translen0ut Trandervin gIPP/CPmpl 2 gIPP/Camp3 61ap4e QIDD TI NH PORTION 11/5/2022 GR 1094 18.91E 911 12/5/2022 HN8 -ECHO HCCIAIMPMT 746003411 JJ0000272922 10911 108.11 INS/2022 HIS ECHO HCCLAIMPMT 7490034114400W212934 - I.Z3)63 - .337.63 12/6/2022 HNB ECHO NCCLAIMPMT 1, 1,36234 IV712022 74NO3411440Po0!2W09 HNB ECHDHCCIRIMPMT)400341144C 22G09 h."1 NBSC 24010 ILI/]033 HIS �[CXO NCCUIMPMi )4800]411 44CCN26a11 IYI t) - 19327 IVV20ZI NW $WEEP FAC N361 210W020934014 SWEEP iR I5;953>1 15.95371 12/9/2022 HIS ECHO HCCUIMPMT)46003411440000200018 50!35 50235 121V2022 HN9. ECHO HCCUIMPMT )4600341144(K(XN XIHI 1161 11.69 12/9!2022 HNB ECHO HCCUIMPM374GM34114J00L0254942 IS125 I53]5 lI/9/2022 HNB ECHO HCMI4IlMT?A5W3411440W0134S60 - 9121 98,27 I8.912.98 ,� 10.3534E 20.353.0E MMC PORTION - A QIPP/Comp gIPP/[OmP9 G '� Tran9er-0ut Ton QIPP/Camp3 2 QIPP/COmP3 Sup" Olpp Tl NHPORTION 12/5/2022 MERCHANT SANNCD OEPOSIT41"71 1888991WC01 31,21502 - 31.215.02 L215/102 HEALTH HUMAN SVC HCCLAIMPMT 174SM34113013 2 9,06E 55 9.062 SS 12/6/2022 0.p , 269)2 of - 36,82201 V912022 WIRE OUT HE.S65ERVICFS, ILC 13056G 121712022 MERCHANT BANKO OEPOSIT496t)85166fl9910.'VOS 1.1119, 1.171.93 lV9/2022 MERCHANT BMICO CHOW 495iHIS 13182 SHCC01 99160 9930 221912022 HEALTH HUMAN SVC HCCIA-MPMT IHEPo3J 1150132 4.204U 11 - 16,204.47 91569.01 115.826.6E 115g2B.62 1211212022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number i Name Groups Arir1 Coecp Account Type DDA - _- Data repurted as w Dec 12. 2022 9 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $7.080,904.11 $7,367.692.43 57,080,90411 $7,101,889.30 '3660 GULF POINTE PLAZA- 510000 $too no $100O0 5100.00 DACA '4454 MEMORIAL MEDICAL I NH GOLDEN CREEK 567,66528 S74,82175 567.665.28 $67.t0152 HEALTHCARE 4365 MEMORIAL NaEDICAL CENTER - CLINIC SERIES S53690 S53690 5536.90 S536.90 2014 '5357 MEMORIAL MEDICAL S6,C0O56.61 sa 105 CK) 14 56 050956.62 56. 184.606.66 CENTER - O?ERAFING 4373 MEMORIAL MEDICAL CENTER - PRIVATE p432.23 5132.23 &132.:3 $432.23 WAIVER CLEARING '4381 MEMORIAL MEDICAL $115.278.63 5187.399.95 5115,278.63 S41,84TC9 CENTER �NH ASHFORD '4403 MEMORIAL MEDICAL CENTERiNH Sd6, 143.13 5114.376.33 546,143. 13 521.53611 BROADMOOR '4411 MEMORIAL MEDICAL 5148,41411 $15104604 $148414.11 $102.25695 CENTER NH CRESCENT '4446 MEMORIAL MEDICAL 513.522 t2 5-13.25802 $13.522.12 C4.407A2 CENTER I NH FORT BEND '4436 MEMORIAL MEDICAL CENTER I SOLERA AT S90.55959 5118,62683 590.559.59 563.033.27 WEST HOUS YON A '2998 MMC -MONEY MARKET S296,644.6.0 5296.E-14.50 $296.644.60 5296.644 60 FUND '5506 MMC-NHBETHANY $88.584,87 586902.39 $88,584.87 $85.630.48 SENIOR LIVING -F44" PLAZA- I-H GULF POINTE Soy,o'6511 595.665 11 595,6a5.1i S78.467 nf. MEDICARE MEDICAID 1 'S433 GMC -NH GULF POINTE $21.708.77 y� 535.808 99 521.708.77 521,465.25 PLAZA - PRIVATE PAY :La MMC -NH TUSCANY 544.692.7°, S44 c92 15 $44,692. 15 S33.821 77 `TILLAGE Nips Ylprosperily.olbanking.com/onlineMessenger U 1 Memorial Medical Center Nursing Home VP1 Weekly Tuscany Transfer Prosperity Accounts 12/12/2022 P, Av.wm W.m� n. xvwMxv�n. xm. n�N%0mp u]>•,rf£9ov+.veexvnq.,•vdm menm,mpre-, xmr r mrn a:r,.�•m,. ee,r.nawe9l tuu m.+:earumhdm m va., vso.=• DEC 12 2022 c�i+o4SMM' S avWW n nmId r9 r9d, .e. mnln BM.n•. �xn xnm. 95.."Is a,]]114 Wn. B,Lna ,J.6911) Iss Vn,e / leneln&lane IWA. MOUNA 911t oI y/ Adjust e,h//nn/an ``4, Assist 3t]PtI. Aud—dl +Weu aSL / I v "OmIz ..M.o IMPAIM 12/5/2022 CN 1112 12/5/2022 Deposit 12/5/2022 HNB - ECHO HCCLAIMPMT 746003411 440"272096 12/5/2022 NOVITAS SOLUTION HCCLAIMPMT 676201420000191 12/6/2022 Deposit 12/7/2022 WIRE OUT LINEAR ENTERPRISES, LLC 12/8/2022 HNB - ECHO HCCI.AIMPMT 746DO3411440000200078 12/9/2022 MOLINA HEALTHCAR MOUNMCH 01IM34242000019 MMCPORTION QIpP/Camp QIPP/Comp QIPP/Camp Tnnsier.Out Tnnsler-In 1 Cupp/comp 2 3 4&L2pse QIPPTI NHPORTION 39.S65.77✓ - - - 10,351.w - 10.351.00 - 860.53 - 860.53 - 7,442.47 - 7.442,47 190,519.20 + 14.977.59 - 14,977.59 - 90.18 - 90.18 - 20,870.39 8,771.63 2,098.75 9,@7.01 1,049,38 220,084.97 . 7Z% 44,592.15.E B,771.63 2,098.75 9,821.01 34,771.15 12/1212022 Treasury Center Quick View Select Quick View Accounts Select Group Account Number,' Name Groups A,.^.d r3rnup Account Type ODA Dale reponed as ❑f D>c ' 1 :: 2 9 Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $7.080,904.11 $7,367,692.43 S7,080,90411 $7,101,889.30 `3660 GULF POINTE PLAZA- S14J.00 S100.00 510, 00 SICIO .00 DACA '4454 MEMORIAL MEDICAL I NH GOLDEN CREEK S67,665.26 S74.822.75 567,665.28 $67,10152 HEALTHCARE 'd365 MEMORIAL MEDICAL CENTER - CLINIC SERIES S536,90 S536.90 $536.90 $536.90 2014 -4357 MEMORIAL MEDICAL a6,050.956,62 $6,105.400. 14 S6 050.956,62 S6,284,606.65 CENTER- OPERATING -4373 MEMORIAL MEDICAL CENTER - PRIVATE 5432.23 S•132.23 $;132.23 5432.23 IhAIVER CLEARING '4381 MEMORIAL MEDICAL 5115,276.63 S187,399,95 S115278.63 $41,8.17 09 CENTER: NH ASHFORD '4403 MEMORIAL MEDICAL CENTER INH S46,143.13 $114,376.33 $46.143.13 S21,536. 11 BROADPd00R '4411 MEMORIAL MEDICAL Si48,4!4.11 $161,046. F.I. S148,414.11 $'02,25696 CENTER �NH CRESCENT '4446 MEMORIAL MEDICAL S1352212 W238,r2 $13.522.12 ;z,407,42 CENTER I NH FORT BEND "438 MEMORIAL MEDICAL CENTER; SOLERA AT 590,559 59 $1IS 626.83 S90 559 59 Sn"3.03. 27 WESTHOUSTON '2998 MNIC -MONEY MARKET S296,64 4 60 $296.644.61 S296.64.160 S29E644 60 FUND '5506 MNIC -NH BETHANY S88,584 87 $88,90239 $88,584 87 585,6304E SENIOR LIVING '5441 NINIC -NH GULF POINTE PLAZA• S95,5u'5.11 S95,665,11 $95,665. 11 S78,46704 MEDIC ARE, MEDICAID 'S433 MNIC -NH GULF POINTE $21.708.77 $35.808.99 S2t 108.77 521.465.25 PLAZA - PRIVATE PAY '3407 MIX -NH 7USCANY $44.692.15 544.692. 15 $44,692 15 $33.82 i.77 VILLAGE r htips:i/prosperity.olbanking,com2onlinerdessenger 1�1 Memorial Medical Center Nursing Home UPk Weekly H$LTransler Prosperity Accounts 12/12/2O2 Pnrbm 4[vavnl Bglnnln{ / Xunirs Nvme Nwnbe[ Nlvn ...2,t /fnminde a l�'a,o' l]Ix.lb r' 3]Ina,}G Blp}09l T. xv[c OnHOvlanm v/v.n Is"x-fl hr mrm,/— Grome nwm9 N+me .m[r}: Each orcv^r[er a rate ceo/ JlNmat SfNC dw1,r,d:o earn account DEC 12 2022 CALHO r4 COUNTY1 v.nNnr M.dlun Mount .a. rranalenrd lv Ban\ B.Ln[a \ir fern nrwbn[e OnohrHa:em: 36.81/ R—rater rmrnn 17.I1 Denmherinlenal v /� ed I I IT4I 11ii!I S L�r'.�'M II_\ axoexwo losvmps R/sxRoxl r 1xx wenlr rumronxx urt n.mtnsummarvuwltonrmbrr\xx VPurmnn w h., t:.rt SLIn MMCPOR11pN l.ad l:l0 Q1411OR,.1 DIII/Gm } CHICPI p /mmp1 Dlpp/6OmppRltpY GIIp 11 M1N IORIIDX 1})9/NI]} NC(UIMtMt )KNliili! V}:LII ].f5llf },9N.19 DNNEOM,'IW I1512 S @Own IS,}l}.IB U/5/ID1S IleO IA93L5.2,21.IN 51691.1s 51.693.18 II/5/IDiS NNB �fOI(L2CLPIM4Na ).:6p83<)a.!YnWi)}PRi � 3.91>JX 1.91)}6 i'J6/]0}] D1px6 16,62i.)0 11.2110 @ORO}} WIRE OUT FORT JWXC Gw. tIC 1p1.nRR INUSOSS 0,., - 46140 R/8)]0]S DO. 1. 1,6254A 1.625,48 ILy]0]] OtRO,T 2616511 ]e.165.0 1`J61]0]S HNB iCHO H¢UIMaArt il6Wli1l YW9C0]WS61 J1.1N./o / % I'M 7% 3)}A]R8. 81.IM.91 IB.aM.9l � 12M 212022 Treasury Center Quick View Select Owck View Accounts Select Group Account Number I Name Groups I Grp�p Accounl Type L acarcn �l '•" DDA Data reponad as of D, 17 2I727 b Account Number Current Balance Available Balance Collected Balance Prior Day Balance Number of Accounts: 15 $7.080.904,11 $7.367,692.43 $7,080,904.11 $7,101.889.30 '3680 GULF POINTE PLAZA - 5100 00 5100 00 510000 5100.00 DACA '44,94 NIEN40RIAL MEDICAL t NH GOLDEN CREEK 567.665 28 S74 822 75 $67.655,28 567, 101.52 HEALTHCARE '4365 MEMORIAL MEDICAL CENTER -CLINIC SERIES 5536.90 $536.90 $536.90 5536 90 2014 '4357 MEMORIAL MEDICAL SG,050956.62 SO 105.400 14 36,050.956 fit So 284,606.66 CENTER - OPERATING '4373 MEMORIAL MEDICAL CENTER -PRIVATE S432.23 543223 5432.23 543223 WAIVER CLEARING -4381 MEMORIAL MEDICAL $115,278.63 $187,399,95 S115.278.63 541,847.09 CENTER; NH ASHFORD »03 MEMORIAL MEDICAL CENTER/NH $46,14:113 5114.376.33 546.143.13 531,536. 11 SROADMOOR •»411 MEMORIAL MEDICAL St48414.11 5.1fil 0460» $148,11111 3102,25896 CENTER i NH CRESCENT '4448 MEMORIAL MEDICAL S13.52212 $43.23802 513.522A2 $4,40742 CENTER; NH FORT BEND '4438 MEMORIAL MEDICAL CENTER i SOLERA AT $90.559.59 5118,626 83 590.559 59 $63.033.27 WEST HOUSTON ' 998 Mf,IC -MONEY MARKET 5296.644 30 S296.644 60 5296.6-:.60 52961i1a 60 FUND 'S506 MMC -NH BETHA14Y 588.584.87 $88.902 39 588.584.67 $65.630 48 SENIOR LIVING 'S»»1 MMC -NH GULF POINTE PLAZA - 505.665 11 595, 665.11 595.665. 11 578,46704 MEDICARE/MEDICAID '5433 MMIC-NH GULF POINTE S21,708.77 535.80899 ,-",708.77 S2',466.25 PLAZA -PRIVATE PAY 'Z4n7 MMC -NH TUSCANY 544,692 15 544.692.15 544,692.15 $33.821 77 VILLAGE https liprosperity.olbanking.com: onlineMessenger 10 Molina QIPP Pymt. 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