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2023-11-01 Final Packet
NOTICE OF MEET-ING---11/1/2023 November 1, 2023 MEETING MINUTES OF CALHOUN COUNTY COMMISSIONERS' COURT MET IN A REGULAR MEETING AT 10:00 A.M. IN THE COMMISSIONERS, COURTROOM IN THE COUNTY COURTHOUSE AT 211 S. ANN STREET SUITE 104 PORT LAVACA, CALHOUN COUNTY, TEXAS. THE FOLLOWING MEMBERS WERE PRESENT: Richard Meyer David Hall Vern Lyssy Joel Behrens Gary Reese (ABSENT) Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. CountyJudge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at 10:00am by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. n/a Page 1 of 4 NOTICE OF MEETING- 11/l./202:3 5. Consider and take necessary action to accept a survey from G & W Engineers as a true and correct representation of a Survey Plat showing 0.55-acre of Bayside Beach Subdivision, Volume Z, Page 27 of the Calhoun County Plat Records, Benito Morales Survey, Abstract No. 28, Calhoun County, Texas. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens; Reese 6. Consider and take necessary action on the General Interlocal Agreement between Calhoun County and the West Side Calhoun County Navigation District and authorize the County Judge to sign the agreement. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER:] Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2024.01 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials, Bid Number 2024.02 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. (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 2 of 4 I NOTICE OF MEETING—1.1/1/2023 9. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Asphalts, Oils and Emulsions, Bid Number 2024.03 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to approve the District Judges' order to appoint Candice A. Villarreal as County Auditor. (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 accept a check for $1,930.25 from Janik Alligators LLC for the 2023 Green Lake Project. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Approve the minutes of the October 18, 2023 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Accept Monthly Reports from the following County Offices: i. Tax Assessor -Collector — September 2023. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall,Lyssy, Behrens, Reese Page 3 of 4 NO] ICE OF MEETING—1.1/1./2023 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 15. Approval of bills and payroll. (RHM) MMC Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hail, 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, Behrens11 , Reese Page 4 of 4 C \I.I lil C �l 11N1 V I 1 C �.AI.AII: �Il ItZ' �� I" I ".�\C IMMUSIvi.I �I1IM I �II.I�:I� All Agenda Items Properly Numbered ' Z_ Contracts Completed and Signed IV L All 1295's Flagged for Acceptance �( (number of 1295's ) iV 1� All Documents for Clerk Signature Flagged (All documents needing to be attested to need to be signed day of Commissioner's Court.) On this day of � 2023, the packet for the 1 vv of �2023 Commissioners Court Regular Session was submitted from the Calhoun County Judge's office to the Calhoun County Clerk's Office. Calhoun County Judge/Assistant C:\Users\Maebelle.Cassel\Desktop\Agenda Templates\PACKET COMPLETION SHEET.Docx AGENDA I IK) i I I I ()IiV!l , 1 If"'') 1 1, :I%LU",. Richard lH . Meyer County Judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Meese, Commissioner,Precinct 4 NOTICE OF MEETING ING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, November 1, 2023 at:10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street,, Suite 104, Port ]Lavaca, Calhoun County, 'Texas. AGENDA The subject matter of such meeting is: as follows:-"k[���u Call meeting to order. OCT 2 1 ME K S �2: / Tnvocation. oo �, � '�;a : .tK' .• 'C EPU `3. Pledges of Allegiance. BY General Discussion of Public Matters and Public Participation. Consider and take necessary action to accept a survey, from G & W Engineers as a true and correct representation of a Survey Plat showing 0.55-acre of Bayside Beach, Subdivision, Volume Z, Page 27 of the. Calhoun County Plat Records, Benito Morales Survey, Abstract No. 28, Calhoun County, Texas. (DEH) Consider and take necessary action on the General Interlocal Agreement; between Calhoun County and the West Side Calhoun County Navigation District and authorize the County Judge to sign the agreement. (GDR) Consider and take necessary action to approve the. Specifications and the Invitation to Bid. Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid. Number 2024.01 for the period January 1, 2024 through December 31,. 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00.00 /PM, Thursday, November 30, 2023. (RHM) 4.Consider and take necessary action to approve the. Specifications and the Invitation to, BidPacket for the Annual Supply Contract for Road Materials, Bid: Number. 207-4.02. for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursdays November 30, 2023. (RHM) Page S of Z f',IU" ,_ F I\, 111 1 L I f RI/ /,1023 Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Asphalts, Oils and Emulsions, Bid Number 2024.03 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday,. November 30, 2023. (RHM) N Consider and take necessary action to, approve the District Judges' order to appoint Candice A. Villarreal as County Auditor. (RHM) 4�. Consider and take necessary action to accept a check for $1,930.25; from Janik Alligators � LLC'for the 2023 Green Lake Project'. (RHM) 12. Approve the minutes of the October 18, 2023 meeting. 33.Accept Monthly Reports from the following County Offices: L Tax Assessor -Collector— September 2023 14. Consider and take necessary action on any necessary budget adjustments.. (RHM) 15. Approval of bills and payroll. (RHM) Richard H. Meyer, Countffudge Calhoun County, Texas A, copy of this Notice has been placed on theoutside- bul'I'etin. board of the Calhoun County Courthouse, 23.1 South: Ann Street„ Port Lavaca, Texas, whichis readily accessible to the general: public at all times. This Notice shallremain posted continuously, for at least 72 hours preceding. the scheduled meeting time_ Poryour convenience, you. may visit the . county's website. at www.calhouncotx.oreunder"Commissioners'Court Agenda" for anyoff'clal court postings., Page oft; # 05 I N0I ICE OF MEET ING — 1.1/1/2023 5. Consider and take necessary action to accept a survey from G & W Engineers as a true and correct representation of a Survey Plat showing 0.55-acre of Bayside Beach Subdivision, Volume Z, Page 27 of the Calhoun County Plat Records, Benito Morales Survey, Abstract No. 28, Calhoun County, Texas. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 ` SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 12 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax(361)553-8734 Please place the following item on the Commissioners' Court Agenda for November 1st, 2023. • Consider and take necessary action to accept survey from G&W Engineers as a true and correct representation of Survey Plat showing 0.55 Acre of Bayside Beach Subdivision Volume Z, Page 27 of the Calhoun County Plat Records Benito Morales Survey Abstract No. 28 Calhoun County, Texas P" Sincerely,, David . Hall DEH/apt I37/575 CCO.R. IJ)/5)5 GCOR. LEGEND O EXISTING 5B' IRON ROD UNLESS N TED • SET V8' IRON ROD WITH PLASTIC CAP O.C.D.R. CALHOUN COUNTY DEED RECORDS C.C.O.R. CALHOUN COUNTY OFFICIAL RECORDS P.O.B. POINT OF BEGINNING L ] PLAT OR DEED CALL NOTE. BEARINGS SHOWN HEREON ARE TEXAS STATE PLANE SOUTH CENTRAL ZONE NAD'83 GRID BASED ON STATION HAPC-0219 ON ME RTN NETWORK. Y371575 CCO.R. SURVEY PLAT SHOWING 0.55 ACRE PART OF BAYSIDE BEACH SUBDIVSION VOLUME Z, PAGE 27 OF THE CALHOUN COUNTY PLAT RECORDS BENITO MORALES SURVEY ABSTRACT NO. 28 CALHOUN COUNTY, TEXAS BEING A PART OF BAYSIDE BEACH SUBDIVISION ACCORDING TO PLAT RECORDED IN VOLUME Z, PAGE 27 OF THE DEED RECORDS OF CALHOUN COUNTY, TEXAS AND ALSO BEING THE PROPERTY RECOGNIZED BY CALHOUN COUNTY AND THE CURRENT OWNERS AS LOT 15-18 IN BLOCK 511 OF THE SAID SUBDIVISION. G & W ENGINEERS, INC. • ENGINEERING • SURVEYING • PLANNING 205 W. LIVE OAK STREET y PORT LAVACA, TEXAS 77979 TBPELS FIRM NO.: 10022100 s (361) 552-4509: PORT LAVACA (979) 323-7100: BAY CITY I, HENRY A. DANYSH, REGISTERED PROFESSIONAL LAND SURVEYOR, 00 HEREBY CERTIFY THAT ME PLAT SHOWN HEREON AND A PROPERTY DESCRIPTION PREPARED REPRESENTS THE RESULT OF A SURVEY MADE ON THE GROUND UNDER MY DIRE ON ONE I G k WEN EERS. INC. HENRY A,�ANYSH REGISTERED PROFESSIONAL LAND SURVEYOR NO. 5088 BY: PROPERTY DESCRIPTION 0.55 ACRE STATE OF TEXAS } COUNTY OF CALHOUN } All of that certain tract or parcel containing 0.55 acre situated in the Benito Morales Survey, Abstract No. 28 of Calhoun County, Texas and being a part of Bayside Beach Subdivision according to plat recorded in Volume Z, Page 27 of the Deed Records of Calhoun County, Texas and also being the property recognized by Calhoun County and the current owners as Lot 15-18 in Block 511 of the said Subdivision. This 0.55 acre is more particularly described by metes and bounds as follows: BEGINNING at a 5/8 inch iron rod with plastic cap (N=13,390,152.39; E=2,764,986.43) set in the recognized Southwest line of Ocean Drive for the North corner of this 0.55 acre being described; THENCE South 38' 48' 20" East, with the recognized Southwest line of Ocean Drive, a distance of 200.00 feet to a 5/8 inch iron rod with plastic cap set for the East corner of this 0.55 acre being described; THENCE South 51' 11' 40" West, crossing a portion of Bayside Beach Subdivision, a distance of 120.00 feet to a 518 inch iron rod with plastic cap set for the South corner of this 0.55 acre being described; THENCE North 38' 48' 20" West, crossing a portion of Bayside Beach Subdivision, a distance of 200.00 feet to a 5/8 inch iron rod with plastic cap set for the West corner of this 0.55 acre being described; THENCE North 51' 11' 40" East, crossing a portion of Bayside Beach Subdivision, a distance of 120.00 feet to the PLACE OF BEGINNING, containing within these metes and bounds 0.55 acre. The bearings and coordinates recited herein are Texas State Plane South Central Zone NAD'83 Grid based on Station HAPC-0219 on the RTK network. This property description and a plat were prepared from a survey made on the ground under my direction on September 28, 2023. OF >l0,_ i G & W ENGINEERS, INC. i1 G' r ,"riyn 11a , jy, TBPELS FIRM NO. 10022100 s Henry A. Danysh Registered Professional Land Surveyor, No. 5088 1074MO1.doc # 06 i NOTICE OF MEETING - 11/1/2023 6. Consider and take necessary action on the General Interlocal Agreement between Calhoun County and the West Side Calhoun County Navigation District and authorize the County Judge to sign the agreement. (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 3 of 12 Gary D. Reese County Commissioner County of Calhoun Precinct 4 October 26, 2023 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for November 1, 2023. • Consider and take necessary action on General Interlocal Agreement between Calhoun County and the West Side Calhoun County Navigation District and authorize Judge Meyer to sign agreement. Sincerely, 01 �. Gary. Rees GDR/at P.O. Box 177 — Seadrift, Texas 77983 —email: gary.reese(dcalhouncomore — (361) 785.3141 - Pax (361) 785.5602 GENERAL INTERLOCAL AGREEMENT This General Interlocal Agreement (the "Agreement") is made and entered into by and between Calhoun County, Texas, hereinafter referred to as "County", and the West Side Calhoun County Navigation District, hereinafter referred to as "WSCCND". The County and WSCCND are referred to collectively herein as the "Parties". WITNESSETH In consideration the mutual covenants and agreements set forth herein, and other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, County and WSCCND hereby agree as follows: I. PURPOSE The purpose of this Agreement is to facilitate cooperation and encourage the efficiency and effectiveness of the Parties' respective operations and services by authorizing the broadest range of intergovernmental cooperation between the Parties. The County hereby agrees to provide agreed upon services to WSCCND to aid in the performance of WSCCND's governmental functions. Those services include, without limitation, excavation services related to WSCCND's environmental due diligence, permitting, and development of its real properties, including property WSCCND owns in Port O'Connor; Calhoun County, Texas, and other excavating and grading services on WSCCND properties. II. AUTHORITY AND GOVERNANCE The Agreement is entered into by the Parties pursuant to the Texas Interlocal Cooperation Act, Section 791.002, of the Texas Government Code. This Agreement shall be governed, construed, and applied in accordance with the laws of the State of Texas including, without limitation, the Texas Interlocal Cooperation Act. III. CONSIDERATION In consideration for the County providing the agreed upon services WSCCND hereby agrees to pay the County the sum of $1 per year due on the anniversary date of the execution of this Agreement. IV. TERM The term of this Agreement shall commence on the last date of execution hereof and shall terminate on the fifth (5a1) anniversary of said date, unless extended by mutual Agreement of the Parties. V. SPECIFIC APPROVAL REQUIRED Pursuant to Section 701.011 of the Texas Government Code, if the County enters into an interlocal agreement under which the County agrees to undertake projects for the construction, improvement, or repair of building, roads, streets, or other facilities, the Commissioners' Court of Calhoun County must pre -approve each such project, in writing. Any written pre -approval shall be given in a document separate from this Agreement and shall describe the type of project to be undertaken and identify the location of same. VI. SEVERABILITY If any provision of this Agreement is held by a court of law to be invalid, such invalidity shall not affect any other provisions of this Agreement which shall be construed and applied as if such invalid provision were not included. VII. MISCELLANEOUS This Agreement constitutes the entire written agreement between the County and WSCCND concerning the subject matter hereof, and supersedes any prior understandings or agreements, whether written or verbal. This Agreement and the terms hereof may only be amended, modified, or altered by written agreement executed by both Parties. In the event of a breach of the Agreement, the non -breaching part shall be entitled to recover from the breaching party reasonable and necessary attorneys' fees, costs, and expenses incurred in the enforcement of this Agreement. This Agreement shall be binding upon and inure to the benefit of the Parties hereto and their respective successors and assigns. (Signature Page Follows) EXECUTED IN DUPLICATE ORIGINALS TO BE EFFECTIVE AS OF THE LAST DATE OF EXECUTION NOTED BELOW. CALHOUN COUNTY, TEXAS By: Name: Its: Date: WEST SIDE CALHOUN COUNTY NAVIGATION DISTRICT Nam ack Campbell, Jrl Its: Chairman Date: October l8, 2023 # 07 N01 ICF CF MFFIING 111112023 7. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2024.01 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, CommissionerPct 2 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: Thursday, October 26, 2023 10:18 AM To: MaeBelle.Cassel@calhouncotx.org Subject: Agenda Items for Court 11/1/2023 - Annual Bids Good Morning, Can you please place the following items on the agenda for Commissioner's Court on November 1, 2023: • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2024.01 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bid will be due before 2:00:00 PM, Thursday, November 30, 2023. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials, Bid Number 2024.02 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Asphalts, Oils and Emulsions, Bid Number 2024.03 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bid will be due before 2:00:00 PM, Thursday, November 30, 2023. Thank you, D mi Cabnzra Calhoun County ,�lgzigtant -Nuditor 361-553-4613 361-553-¢614e UaX) Calhoun County Texas CALHOUN COUNTY, TEXAS INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL BID NUMBER: 2024.01 BID TERM: JANUARY 1, 2024 THROUGH DECEMBER 31, 2024 SEALED BIDS ARE DUE BEFORE: 2:00:00 PM, Thursday, November 30, 2023 AT THE OFFICE OF: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3`d Floor, Suite 301 Port Lavaca, Texas 77979 Public Opening of the Bids will be conducted immediately after the closing of the 2:00:00 PM deadline, Thursday, November 30, 2023 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas 77979. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all vendors that submitted a Bid and, as time permits, will be posted on the County's website (www.calhouncotx.org) under Public Notices, Bid Notices and Results, Results, 2023. Page 1 of 59 CONTENTS • Invitation to Bid (Page 3-4) • Return Instructions (Page 5) • General Conditions (Page 6-19) • Specifications (Page 20-26) • Contact, Billing and Location Information for Calhoun County Precincts (Page 27) • Required Forms to be returned when submitting a Bid (Page 28-49) If any Required Form is "Not Applicable', mark "NA" and include when submitting a Bid o Invitation to Bid Form (Page 29-35) o Vendor and Order Information Form (Page 36) o Affidavit (Page 37) o Conflict of Interest Questionnaire Form CIQ (Page 39) o Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 42) o Certification Regarding Lobbying (Page 43) o Disclosure of Lobbying Activities (Page 45) o House Bill 89 Verification (Page 46) o Residence Certification (Page 47) o W-9 (Page 48) o Material Information and Safety Data Sheet for each insecticide or product Bid on (Page 49) OTHER INFORMATION INCLUDED WITH THE INVITATION TO BID PACKET Current (2023) Awarded Bid Tabulation for the Annual Supply Contract for Insecticides for Mosquito Control for the period January 1, 2023 through December 31, 2023 (Page 51-56) Copy of Contract (to be completed AFTER the Bid is awarded) (Page 57-59) Page 2 of 59 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas, will receive SEALED BIDS for Insecticides for Mosquito Control for the County's Road and Bridge Precincts. BID NUMBER: 2024.01, ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Bids are for a one (1) year period: January 1, 2024 through December 31, 2024 The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Public Notices, Bid Notices and Results, Bid Notices, 2024) or by contacting Demi Cabrera, Assistant Auditor, at demi.cabrera@calhouncotx.org or 361-553- 4613. SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023. Immediately after the closing of the 2:00:00 PM deadline, all Bids will be publicly opened in the County Judge's office in the Calhoun County Courthouse at 211 South Ann Street, 3'd Floor, Suite 301, Port Lavaca, Texas. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. It is the responsibility of the submitting vendor to ensure that the sealed Bid is received in a timely manner. Calhoun County does not accept faxed or emailed Bids. Calhoun County accepts no financial responsibility for any cost incurred by any entity in the course of responding to the Bid. Bids received after the deadline will not be opened and will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting vendor. All bids (one original) must be delivered to the office of the Calhoun County Judge before 2:00:00 PM, Thursday, November 30, 2023 in a SEALED 9 x 12 or larger envelope and CLEAREY MARKED on the outside of the envelope: SEALED BID NUMBER 2024.01 ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the Bid is received and the 2:00:00 PM deadline. Bids shall include all requirements of the Invitation to Bid Packet for Bid Number 2024.01, Annual Supply Contract for Insecticides for Mosquito Control. SEALED BIDS MAY BE HAND DELIVERED OR MAILED TO: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street V Floor, Suite 301 Port Lavaca, TX 77979 Page 3 of 59 Calhoun County Commissioners Court reserves the right to waive any formality, technicality or irregularity, accept or reject any and or all Bids and to accept the Bid deemed most advantageous to and in the best interest of Calhoun County. The award of a Bid shall be made to the responsible vendor whose Bid is determined to be the most beneficial to Calhoun County, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid Packet. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit Bids. Candice Villarreal County Auditor Calhoun County, Texas Page 4 of 59 RETURN INSTRUCTIONS For Submitting a Bid for ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONROL Bid Number: 2024.01 Bid Period: January 1, 2024 through December 31, 2024 Return the following BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023 Check List for submitting your Bid: Return One (1) Original of only the following forms Be sure all of the below forms are included and completed, signed, dated and returned. If "Not Applicable", mark "NA" and include when submitting a Bid. The submitted Bid consists only of the following forms (only the below forms need to be returned) Invitation to Bid Form (Page 29-35) Vendor and Order Information Form (Page 36) Affidavit (Page 37) Conflict of Interest Questionnaire, Form CIQ (Page 39) Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 42) Certification Regarding Lobbying (Page 43) Disclosure of Lobbying Activities (Page 45) House Bill 89 Verification (Page 46) Residence Certification (Page 47) W-9 (Page 48) Material Information and Safety Data Sheet for each insecticide or product Bid on (Page 49) Do Not Fold any of the above information. Bid must be returned in a SEALED 9 x 12 or larger envelope clearly marked: SEALED BID NUMBER 2024.01—ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL If you send your bid by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2024.01—ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Sealed Bid may be hand delivered or mailed to: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 S. Ann Street 3rd Floor, Suite 301 Port Lavaca, TX 77979 Bid must be sealed (with the glue on the envelope or tape) Page 5 of 59 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFQ, and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFQ, and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ, and/or Contract is due. The Bid, RFP, RFQ, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ, and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ and/or Contract in collusion with any other bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidders/vendor's Bid, RFP, RFQ and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3`" Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ, and/or Contract will specify the date and time due. Page 6 of 59 The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ and/or Contract is received and the time deadline that the Bid, RFP, RFQ and/or Contract will be opened. A late delivery with an early postmark or delivery of the Bid, RFP, RFQ, and/or Contract to the wrong office will not suffice. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting bidder/vendor. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ, and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ, and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ, or Contract. If the Bid, RFP, RFQ, and/or Contract is sent by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ, and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ and/or Contract price. Bids, RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum or approved the addendum to be sent out by the Engineer with the approval from the County Commissioner or County Department in charge of the project. Page 7 of 59 Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmlessfrom all suits, actions, orfor personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendors liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFC, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidders/vendor's performance under this Bid, RFP, RFQ and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes under Section 151.309 of the Texas Tax Code. Tax exempt forms will be furnished upon request to the bidder/vendor. Tax exempt forms can be obtained from the Calhoun County Auditors Office. Bidder/vendor is to issue its Texas Resale Certificate to vendors and subcontractors for such items qualifying for this exemption, and further, bidder/vendor should state these items at cost. Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Page 8 of 59 Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ; and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ, and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the sole judge in determining which Bid, RFP, RFQ and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ and/or Contract based on lowest and/or best Bid, RFP, RFQ, and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ, and/or Contract" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ, and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ, and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFQ and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Page 9 of 59 Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFQ and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFQ, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFQ, and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFQ and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFQ and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 84th Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 851h Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 10 of 59 Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 ofthe Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf—info—forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFQ and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFQ and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission websiteto enterthe required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. A business entity will generate Form 1295 online after notification of award and submit with their signed contract. (See Attachment A to General Conditions) No laterthan thirty (30) days after Calhoun County Commissioners Court approves a contract with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFC, and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFC, and/or Contract submission and the time of execution of the Bid, RFP, RFQ and/or Contract. A print out of the search results that includes the record date showing that the Company, and its Principals, if any, have an active registration with the System for Award Management (www.SAM.gov) AND are not Page 11 of 59 debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM) must be included with the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFQ, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall renderthe order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ Contract, order, and/or service. In the event a Bid, RFP, RFQ, Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County Page 12 of 59 may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFC, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFC, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFC, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Maieure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFQ, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFQ, and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFQ and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Page 13 of 59 Waiver: No claim or right arising out of a breach of any Bid, RFP, RFQ and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFQ, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFQ and/or Contract. Otherwise, Texas state and federal law shall apply. Prohibition against Personal Interest in Bids. RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFQ, and/or Contract with Calhoun County, or shall befinancially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFQ, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ, and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ, and/or Contract. o General Liability ($100,000/$300,000 or greater) o Workers' Compensation (at Statutory Limits) o Employer's Liability ($1,000,000 or greater) o Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) o Professional Liability Insurance (if applicable) o Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall Page 14 of 59 be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of the bidder/vendoror constitute a waiver of any of the insurance requirements forthe Bid, RFP, RFQ and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditors office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ, and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFQ, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditors Office, in person or by certified mail return receipt requested prior to award. The written protest must include: o Name, mailing address and business phone number of the protesting party; o Appropriate identification of the Bid, RFP, RFQ, and/or Contract being protested; o A precise statement of the reasons for the protest; and o Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditors Office will attempt to resolve the protest, including at the County Auditors option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. If additional information is required, Calhoun County Commissioners Court will notifythe protesting partyto provide such information. The decision of Calhoun County Commissioners Court will be final. Page 15 of 59 Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFQ, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or by judicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 The Packet, Invitation for Bids, Request for Proposals and/or Request for Qualifications are posted on Calhoun County's website, www.calhouncotx.org, under Public Notices, Bid Notices and Results. Page 16 of 59 ATTACH M ENT A CALHOUN COUNTY, TEXAS GENERAL CONDITIONS CERTIFICATE OF INTERESTED PARTIES FORM 1295 A business entity will generate Form 1295 online after notification of award and submit with their signed contract. Form 1295 must be filled out and submitted online, printed, complete #6, signed and returned with the Agreement, Contract, or Lease. See Calhoun County, Texas — Policy of Compliance TO FILL OUT FORM 1295: Go to: https://www.ethics.state.tx.us/File 1. If you have an account, login and proceed with the processor if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2. Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only". 3. The Respondent or an authorized agent of the Respondent must sign and date the printed copy of the form (making sure all of #6 is completed). 4. The completed Form 1295 must be included with your Agreement, Contractor Lease, when it is submitted to Calhoun County. For help in filling out the form: #1 Name of Business Entity filing the form, and the City, State and Country of the Entity's place of business #2 Calhoun County, Texas (Also, if applicable, insert name of County Department) #3 • Contract number, if not given, can be the year or dates associated with the Agreement, Contract, Lease or if for a Bid, RFP, or RFQ, the Bid, RFP, RFQ number and dates the Bid, RFP, RFQ pertains to • Description is description of Agreement, Contract, Lease or name of Bid, RFP, RFQ On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, submit and print After printing, the respondent or an authorized agent of the respondent must sign and date (making sure all of #6 is completed) When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". Page 17 of 59 CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`V 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. 3 Provide the identification number used by the governmental entity or state agency to,.,t�yT, i *o Identify the contract, and provide a description of the services, goods, or other property to be provided contract. ZV/a 4 City, State, Country Nature of Interest (check applicable) Name of Interested Party (place of business) ♦ Controlling Intermediary 5 Check only if there' I terestedParty. ❑ 6 UNSWORNDECL N My name is �`` , and my date of birth is � My addre40 (street) (city) (state) (zip code) (country) d 4-�`J' Ender penally of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission w ethics.state.tx.us Page UvOt892122r2017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 and September 14, 2022 BACKGROUND Section 2252.908 was added to the Government Code by the 841h Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state.tx.us/whatsnew/elf_ info_form1295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. Page 19 of 59 SPECIFICATIONS FOR ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL BID NUMBER: 2024.01 BY ORDER of the Commissioners Court of Calhoun County, Texas, sealed Bids will be received for Insecticides for Mosquito Control for the County's Road and Bridge Precincts. Contact, billing and location for each Calhoun County Road and Bridge Precinct can be found on the Form: Contact, Billing and Location Information for Calhoun County Precincts INVITATION TO BID PACKET The complete Invitation to Bid Packet may be downloaded from the County's website, www.calhouncotx.org (under Public Notices, Bid Notices and Results, Bid Notices, 2024) or by contacting Demi Cabrera, Assistant Auditor, at demi.cabrera@calhouncotx.org or 361-553- 4613. The complete Invitation to Bid Packet must be used in preparing the Bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2024.01 ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL If the SEALED BID is sent by UPS, Fed Ex, or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2024.01 ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 A late delivery with an early postmark will not suffice. Page 20 of 59 Calhoun County is not responsible for the delivery of your Bid to the office of the County Judge or delivery to the wrong office. If you choose to send your Bid by postal delivery, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your Bid prior to the Bid due date and time. It is the responsibility of the submitting vendor to ensure that the sealed Bid is received in a timely manner. Calhoun County does not accept faxed or emailed Bids. Calhoun County accepts no financial responsibility for any cost incurred by any vendor in the course of responding to the Bid. Bids received after the deadline will not be opened and will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting vendor. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the Bid is received and the 2:00:00 PM deadline. No Bids will be accepted after the due date and 2:00:00 PM deadline has been reached. BID TERM The Bid shall be in effect for a period of one (1) year: January 1, 2024 through December 31, 2024. BID INFORMATION/REQUIREMENTS To submit a valid Bid, read the entire Invitation to Bid Packet for all requirements and required forms that must be included and returned with the submitted Bid. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a Bid. If you will not be submitting a Bid, we would appreciate you indicating on your "NO BID" response any requirements of this Bid request which may have influenced your decision to "NO BID". Calhoun County is not responsible for errors if the Bid forms are handwritten. It is recommended that all information submitted by the vendor on the Bid forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. INSECTICIDES FOR MOSQUITO CONTROL (Bid Item Listed or Eauivalent Bid Item #1: Mineral Oil BVA Mosquito Larvicide Oil — MC30 or Equivalent Bid Item #2: Malathion or Equivalent Bid Item #3: Malathion EW or Equivalent Bid Item #4: 30-30 ULV or Equivalent Bid Item #5: 31-66 ULV or Equivalent Bid Item #6: 31-67 ULV or Equivalent Bid Item #7: 4-4 ULV or Equivalent Page 21 of 59 Bid Item #8: 4-8 ULV or Equivalent Bid Item #9: Altosid 30 Day Briquets or Equivalent Bid Item #10: Altosid XR Extended Residual Briquets or Equivalent Bid Item #11: DeltaGard or Equivalent Bid Item #12: FourStar Sustained Release 45/90/180 Day Microbial Briquets or Equivalent Vendor may submit a Bid for any or all Insecticides for Mosquito Control or Equivalent. Vendor must be able to furnish Bid items under terms of these specifications and general conditions if vendor is awarded a Bid. Calhoun County is EXEMPT from all Sales Tax (county, city and state sales tax) and all Federal Excise Taxes, if applicable under Section 151.309 of the Texas Tax Code. Upon request, tax exempt forms will be furnished to the vendor by the County Auditor's Office. Vendor is to issue its Texas Resale Certificate to vendors or subcontractors for such items qualifying for this exemption. One (1) copy of the Material Information and Safety Data Sheet(s) listing the active ingredients and safety instructions for each insecticide or product the vendor is submitting a Bid on must be returned with the vendor's Bid. Bid Item Number (as on the Invitation to Bid Form) must be on each one. Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified by State and/or Federal Regulations. All charges, including, but not limited to, freight, handling charges, fuel surcharges and special delivery fees must be included in Bid price or clearly stated on Bid form. Additional charge listed separately, if any, will increase the amount of the Bid. Only other fees or charges listed on the Invitation to Bid form or separate page that is signed and dated by an authorized representative and returned by the vendor with their Bid and awarded as such to the successful vendor will be allowed to be included on the invoice when the awarded vendor submits the invoice for payment. Any exceptions and or variations from the specifications in this Bid document must be indicated on the Bid form or on a separate attachment to the Bid and labeled as such. Exceptions taken and/or variations made to the specifications and listed on the vendor's Bid or separate attachment may void the Bid. Insecticides for Mosquito Control shall be ordered in quantities as determined by each Calhoun County Commissioner. The request for a Bid on an insecticide or product does not guarantee that Calhoun County will purchase this insecticide or product during the Bid period. Calhoun County does not guarantee to purchase any minimum or maximum quantities. The insecticides or products will only be ordered as needed. Page 22 of 59 When required, all insecticides or products ordered will be delivered to the Calhoun County Precinct within 24 hours from time of order. In the event the awarded vendor is unable to deliver the insecticide(s) or product(s) ordered within 24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the said insecticide(s) or product(s) from the vendor which submitted the next lowest Bid that met specifications and can deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or other charges when cancelling an order. Vendor shall be required to notify Calhoun County in the event of unforeseen delay arising in the delivery of an order. In the event an order will not arrive at the Calhoun County Precinct at the designated time, Calhoun County shall have the right to refuse acceptance of the order and Calhoun County shall not be accessed any penalties, fees and/or other costs due to this refusal. In the event the vendor is unable to furnish any item within a reasonable time after an order is placed due to strikes, war or any reason beyond the vendor's and/or supplier's control, the County reserves the right to purchase these items from any source, without causing this contract to be cancelled. Calhoun County or the vendor have the right to cancel the delivery of an insecticide(s) or product(s) at any time due to weather, road conditions and/or machinery breakdown. No penalties, fees and/or other charges will be billed to Calhoun County if the delivery of an insecticide(s) or product(s) is cancelled by Calhoun County or the vendor due to weather, road conditions and/or machinery breakdown. The County reserves the right to refuse any order delivered for not being in compliance with the specifications, general conditions and/or the "Hazardous Communications Act", commonly known as the "Texas Right to Know Act". The vendor, at the vendor's cost, shall immediately remove the insecticide(s) or product(s) from the Calhoun County Precinct that are deemed unsatisfactory, and are not in compliance with the specifications, general conditions and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other charges will be billed to Calhoun County for the removal of the insecticide(s) or product(s) from the Calhoun County Precinct. Calhoun County reserves the right to conduct random sampling of pre -qualified insecticides or products for testing and to perform random audits of test reports. Calhoun County representatives may sample insecticides or products from the manufacturing plant, terminal, shipping container and any other source they deem necessary to insure reliability of the insecticides or products. If testing will be performed through a third party, the vendor will be required to allow the third party access to the facilities in order to acquire samples for testing. Regardless of results of any insecticide(s) or product(s) test required by Calhoun County, all costs incurred for such tests shall be paid for by the vendor. The award of a Bid will be voided if specifications, general conditions and instructions within this Invitation to Bid Packet are not followed. The Bid would then be awarded to the vendor which submitted the next lowest bid that met specifications and all requirements of the Invitation to Bid Packet. Page 23 of 59 All Calhoun County Precincts handle their own orders and order at different times; therefore, invoices shall be billed to each Calhoun County Precinct separately. Invoices shall not include other charges, including, but not limited to, freight, handling charges, fuel surcharges or special delivery charges, when invoiced unless these charges were noted on the Bid form or separate attachment and awarded as such. All invoices must be billed to Calhoun County to the attention of the Calhoun County Commissioner and Precinct ordering the insecticides or products. (See Contact and Billing and Location Information for Calhoun County Precincts) Bid item number and insecticide or product description per Bid specifications, awarded Bid price per unit, or other charge, if any other charge was included in the award, must appear on all invoices in order to be considered for payment. Listing the Bid item number and exact insecticide or product description as on the Invitation to Bid Form will avoid any confusion when the invoice is processed for payment. Invoices shall be free from sales tax (county, city or state sales tax) and federal excise taxes, if applicable. Invoices shall include a copy of the delivery ticket and/or packing slip that shows confirmation of delivery. It is understood that Calhoun County Commissioners Court reserves the right to accept or reject any and/or all Bids for any/or all insecticides, products and/or services covered in this Bid request and to waive informalities or defects in Bids, or to accept such Bids as it shall deem to be most advantageous and in the best interest of Calhoun County. Calhoun County Commissioners have the right to reject at any time any insecticide or product that is undesirable for Calhoun County. The County will not incur any fees, charges or penalties on the rejected insecticide or product. Calhoun County will evaluate and award the Bid based on lowest and best Bid meeting specifications and all requirements of the Invitation to Bid Packet. "Lowest and best' means a Bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid as it deems to be in the best interest of Calhoun County. Although the cost of insecticides or products to be provided is an essential part of the Bid, Calhoun County is not obligated to award a Bid (contract) on the sole basis of cost but will award to the vendor considered to be the best value to the Calhoun County. The Bid award shall be based on, but not necessarily limited to, the following factors: ■ Unit price ■ Extended price (that includes other charges, if any) • Special needs and requirements of Calhoun County Page 24 of 59 • Delivery • Compliance in returning and/or including all required forms ■ Results of testing samples (if required by Calhoun County) • Calhoun County's experience with insecticides or products Bid • Vendor's past performance record with Calhoun County If Bids are awarded, award information will be emailed to all vendors that submitted a Bid regardless if the vendor was awarded a Bid or not. Calhoun County Commissioners Court and the County Auditor's office work diligently to get this information to the vendors as soon as possible. To obtain results, or if you have any questions, please contact Demi Cabrera, Calhoun County Assistant Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4613, demi.cabrerac@calhouncotx.ore. As time permits, Bid awards will be posted on Calhoun County's website, www.calhouncotx.org, under Public Notices, Bid Notices and Results, Results, 2024. Once Bids are awarded by Calhoun County Commissioners Court, the County Auditor's Office will send the awarded vendor the following: (1) The contract; (2) A request for Form 1295, Certificate of Interested Parties; and (3) A request for the insurance requirements, Certificate of Insurance. All documents must be returned and accepted by Calhoun County Commissioners Court before the award will be complete, valid and in effect. Calhoun County or the vendor may cancel this contract at any time for any reason, provided a written notice is given. Should there be a change in ownership or management, the contract shall be cancelled unless a mutual agreement is reached with the new owner or manager to continue the contract with its present provisions and prices. Vendor understands that Calhoun County is a government entity subject to Texas State and Federal public information statutes. Vendor hereby waives any obligation to the release to the public of any documents submitted in accordance with the Bid. No person has the authority to verbally alter these specifications or any information within the Invitation to Bid Packet. Any changes will be made in writing (Addendum approved by Calhoun County Commissioners Court) and mailed and or emailed to each vendor that received a Bid packet. All disputes or protests will be held in Calhoun County, Texas. INSURANCE REQUIREMENTS Before commencing work under the contract, the vendor must furnish, at their own expense, certificates of insurance or other acceptable evidence from a reputable insurance company or companies acceptable to Calhoun County, licensed to write insurance in the State of Texas showing the contractor (vendor) is covered by insurance within the minimum limits of liability listed in the General Conditions that are included in this Invitation to Bid Packet and shall remain in force until all work under the contract is completed. If for any reason insurance coverage is not kept in force, all deliveries must be stopped until an acceptable Certificate of Page 25 of 59 Insurance is provided to the County. The County Auditor's office and the County Commissioners' should be provided with 30 days advance notice of changes or termination of coverage. The County shall be covered as an additional insured and the certificate of insurance must also include a waiver of subrogation in favor of the County. The vendor shall be responsible for any deductions stated in the policy. The vendor shall include all subcontractors as insured under its policies or shall furnish separate certificates of insurance and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements under this contract. Nothing contained in the insurance requirements shall be construed as limiting the extent of the vendor's responsibility for payment of damages resulting from operations under this contract. Any failure of the vendor to comply with the reporting provisions of the insurance policies shall not affect the coverage provided to the County. The insurance provided by the vendor shall be primary as respects to the County. Any insurance maintained by the County shall be excess of the vendor's insurance and shall not contribute to it. REQUIRED FORMS TO BE RETURNED WHEN SUBITTING A BID If any Required Form is "Not Applicable", mark "NA" and include when submitting a Bid. • Invitation to Bid Form (Page 29-35) • Vendor and Order Information Form (Page 36) • Affidavit (Page 37) ■ Conflict of Interest Questionnaire, Form CIQ (Page 39) ■ Certificate Regarding Debarment & Suspension and Other Responsibility Matters (Page 42) • Certification Regarding Lobbying (Page 43) • Disclosure of Lobbying (Page 45) • House Bill 89 Verification (Page 46) • Residence Certification (Page 47) • W-9 (Page 48) • Material Information and Safety Data Sheet for each insecticide or product Bid on (Page 49) Page 26 of 59 CONTACT, BILLING AND LOCATION INFORMATION FOR CALHOUN COUNTY PRECINCTS Calhoun County Precinct 1 Commissioner David Hall 305 Henry Barber Way (by the County Fairgrounds) Port Lavaca, TX 77979 Office Manager: Angela Torres Office: 361-552-9242 Fax: 361-553-8734 Location Stockpile: 305 Henry Barber Way, Port Lavaca, TX Calhoun County Precinct 2 Commissioner Vern Lyssy 5812 FM 1090 (Six Mile) Port Lavaca, TX 77979 Office Manager: Lesa Jurek Office: 361-552-9656 Fax: 361-553-6664 Location of Stockpile: 5812 FM 1090, Port Lavaca, TX Calhoun County Precinct 3 Commissioner Joel Behrens 24627 State Hwy 172 (Olivia) Port Lavaca, TX 77979 Office Manager: LynetteAdame Office:361-893-5346 Fax: 361-893-5309 Location of Stockpile: 24627 State Highway 172, Olivia TX Calhoun County Precinct 4 Precinct 4-P (Port O'Connor) Commissioner Gary Reese Trevor St off of Hwy 185 Port O'Connor, TX 77982 Office Manager: April Townsend Use same numbers as Seadrift (4-S) Location of Stockpile — Pct 4-P Barn #3: 93 Trevor Street off of Highway 185, Port O'Connor, TX Calhoun County Precinct 4 Precinct 4-S (Seadrift) Commissioner Gary Reese 104 E Dallas St PO Box 177 Seadrift, TX 77983 Office Manager: April Townsend Office: 361-785-3141 Fax: 361-785-5602 Location of Stockpile — Pct 4-S Barn #2: 448 Harbor Road, Seadrift TX Page 27 of 59 REQUIRED FORMS FORMS REQUIRED TO BE RETURNED WHEN SUBMITTING A BID Vendor must return the following forms: If any Required Form is "Not Applicable', mark "NA" and include when submitting a Bid o Invitation to Bid Form (Page 29-35) o Vendor and Order Information Form (Page 36) o Affidavit (Page 37) o Conflict of Interest Questionnaire Form CIQ (Page 39) o Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 42) o Certification Regarding Lobbying (Page 43) o Disclosure of Lobbying Activities (Page 45) o House Bill 89 Verification (Page 46) o Residence Certification (Page 47) o W-9 (Page 48) o Material Information and Safety Data Sheet for each insecticide or product bid on (Page 49) Must be included with your bid Bid Item Number (as on the Invitation to Bid Form) must be on each one Submitted Bid consists only of the above required forms Page 28 of 59 CALHOUN COUNTY, TEXAS INVITATION TO BID FORM ANNUAL SUPPLY CONTRACT FOR INSECTICIDES FOR MOSQUITO CONTROL Bid Number: 2024.01 January 1, 2024 through December 31, 2024 Vendor's Name & Address • Please Type or Print. If handwritten, must be in ink and legible. White out is not acceptable. • SEE SPECIFICATIONS AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS INSECTICIDES FOR MOSQUITO CONTROL (Bid Item Listed or Equivalent) Bid Item #1: Mineral Oil BVA Mosquito Larvicide Oil - MC30 - or Equivalent 5 Gallon Pail $ /per 5 Gallon Pail 50 Gallon Drum $ /per 50 Gallon Drum 55 Gallon Drum $ /per 55 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote $ /per $ /per «— List Name of Mineral Oil Page 29 of 59 Bid Item #2: Malathion - or Equivalent List Insecticide Name Active Ingredients: Malathion 96.5%; Other 3.5% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 5 Gallon Pail $ /per 5 Gallon Pail 55 Gallon Drum $ /per 55 Gallon Drum 260 Gallon Tote $ /per 260 Gallon Tote $ /per $ /per $ /per Bid Item #3: Malathion EW - or Equivalent List Insecticide Name Active Ingredients: Malathion 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Drum $ /per 30 Gallon Drum $ /per $ /per $ /per $ /per $ /per Page 30 of 59 Bid Item #4: 30-30 ULV - or Equivalent List Insecticide Name Active Ingredients: Permethrin 30%; Piperonyl Butoxide 30% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 5 Gallon Pail $ /per 5 Gallon Pail 30 Gallon Drum $ /per 30 Gallon Drum 55 Gallon Drum $ /per 55 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote $ /per $ /per Bid Item #5: 31-66 ULV - or Equivalent List Insecticide Name Active Ingredients: Permethrin 31.28%; Piperonyl Butoxide 66%; 4 x 1 Gallon $ /per Case (Case = 4x1 Gal Jugs) 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal lugs) 30 Gallon Drum $ /per 30 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote $ /per $ /per $ /per Page 31 of 59 Bid Item #6: 31-67 ULV - or Equivalent List Insecticide Name Active Ingredients: Permethrin 31.15%; Piperonyl Butoxide 66.85% 4 x 1 Gallon $ /per Case (Case = 4x1 Gal Jugs) 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Drum $ /per 30 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote $ /per $ /per $ /per Bid Item #7: 4-4 ULV - or Equivalent List Insecticide Name Active Ingredients: Permethrin 4.0%; Piperonyl Butoxide 4.0% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Tote $ /per 30 Gallon Tote 55 Gallon Drum $ /per 55 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote $ /per $ /per $ /per Page 32 of 59 Bid Item #8: 4-8 ULV - or Equivalent List Insecticide Name Active Ingredients: Permethrin 3.98%; Piperonyl Butoxide 8.48% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Tote $ /per 30 Gallon Tote 55 Gallon Drum $ /per 55 Gallon Drum 275 Gallon Tote $ /per 275 Gallon Tote $ /per $ /per Bid Item #9 Altosid 30 Day Briquets - or Equivalent List Insecticide Name Active Ingredients: (S) Methoprene 8.62% 400 Per Case $ /per case $ /per $ /per Bid Item #10: Altosid XR Extended Residual Briquets - or Equivalent List Insecticide Name Active Ingredients: (S) Methoprene 2.1% 220 Per Case $ /per case $ /per $ /per Page 33 of 59 Bid Item#11: DeltaGard - or Equivalent List Insecticide Name Active Ingredients: Deltamethrin 2% 2 x 2.5 Gallon $ /per Case (Case = 2x2.5 Gal Jugs) 30 Gallon Drum $ /per 30 Gallon Drum 250 Gallon Tote $ /per 250 Gallon Tote $ /per $ /per Bid Item #12: FourStar Sustained Release 45/90/180 Day Microbial Briquets or Equivalent f- List Insecticide Name Active Ingredients: Bacillus sphaericus 6%; Bacillus thuringiensis subspecies israelensis 1% 45 Day ----- 200 Per Case $ /per case 90 Day ----- 200 Per Case $ /per case 180 Day-----200 Per Case $ /per case $ /per $ /per Additional Bid Item: List Insecticide Name Active Ingredients: $ /per $ /per $ /per $ /per Page 34 of 59 Additional Bid Item: Ingredients: $ /per $ /per — List Insecticide Name The undersigned affirms that they are duly authorized to execute this Bid and that this company, corporation firm, partnership or individual has not prepared this Bid in collusion with any other vendor, that the contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this Bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with this Bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands and has followed all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date: Authorized Signature & Title: Printed Name & Title of Authorized Signature: Phone Number: Email: Exceptions and/or Variations from Specifications and/or additional Notes: Page 35 of 59 VENDOR AND ORDER INFORMATION FORM Please Type. If handwritten, must be in ink and legible Vendor's Name: Address: Remittance Address: Telephone: Fax: Email: Signature of Authorized Representative: Printed name of Authorized Rep: ORDER — CONTACT INFORMATION Order Contact Name & Title: Order Contact Telephone: Order Contact Fax: Order Contact Email: INVOICES — CONTACT INFORMATION For Invoice Inquiries: Contact Name & Title: Contact Telephone: _ Contact Fax: Contact Email: Page 36 of 59 STATE OF TEXAS {} COUNTY OF {} (Type or Print Name) the of AFFIDAVIT being first duly sworn, deposes and says: that he or she is (Type or Print Title) (Type or Print Name of Company/Firm) principal address at (Type or Print Physical and Mailing Address) having its who submits herewith to Calhoun County the attached bid/proposal; that he or she is the person whose name is signed to the attached bid/proposal; that said bid/proposal is genuine; that the same is not sham or collusive; that all statements of fact herein are true; and that such bid/proposal was not made in the interest or behalf of any person, partnership, company, association, organization or corporation not herein named or disclosed. Affiant further deposes and says: that the bidder/proposer has not directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interests of Calhoun County, or of any other bidder/proposer, or anyone else interested in the bid/proposal contract; and that the bidder/proposer has not in any manner sought by collusion to secure for himself/herself/itself/themselves an advantage over any other bidder/proposer. Affiant further deposes and says: that prior to the public opening and reading of bids/proposals, said bidder/proposer: a) did not, directly or indirectly, induce or solicit anyone else to submit a false or sham bid/proposal; b) did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder/proposer or anyone else would submit a false or sham bid/proposal, or that anyone should refrain from submitting a bid/proposal or withdraw their bid/proposal; c) did not, in any manner, directly or indirectly, seek by agreement, communication or conference with anyone to raise or fix the bid price/proposal of said bidder/proposer or of anyone else, or to raise or fix any overhead, profit or cost element of their price/fee or of that of anyone else; d) did not give, offer to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid/proposal; and e) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative hereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent, thereof, to any individual or group of individuals, or to any official, employee or agent of Calhoun County prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained in this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and requirements contained in the bid/proposal. Signature of Affiant Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 20 Signature of Notary Public Notary Stamp/Seal Page 37 of 59 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code 4176.0010-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code 4176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code S 176.006(a) and (a-1) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. rnrm nrnvided by T. a Fthins Cnmmicsinn w Mhlneq a tx.im Pager AjQfkRnn/9nv; CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. !J Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4j Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes E-1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes No 6 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Pagen'pigfA/30/2015 DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp, p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Page 40 of 59 Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. Page 41 of 59 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a—d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date Page 42 of 59 Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official Page 43 of 59 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g.,'RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 Page 44 of 59 Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a, bid/offer/application a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post -award d. loan For material change only: e. loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Prime Subawardee Name and Address of Prime: Tier , if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. individuals Performing Services (including address iJ' (ifindividual, last name, first name, M& different from No. 10a) (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) Page 45 of 59 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85" Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. I, (authorized official) , do herebyverifythe truthfulness and accuracy of the contents of the statements submitted on this certification underthe provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at ht�://comptroller.texas.gov/purchasing/publications/divestment.php Company Name Signature of Authorized Official Title of Authorized Official Printed Name of Authorized Official Date Page 46 of 59 RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. ❑ 1 certify that (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. (Company Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (City and State) ❑ Icertifythat (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as Page 47 of 59 Request for Taxpayer Give Form to the Farm (Rev. OCY!2ot8) Identification Number and Certification requester. Do not Depanmem of the Treasury send to the IRS. Iraemal Revenue service ► Go to wtmv ira.gov/Form W9 for instructions and the latest information. t Name (as shown on your Income tax mtum). Name is required on this line; do not leave this line blank. 2 Busineu nameldisregarded entity name, if different from above m 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see a c ❑ Individuaysole proprietor or ❑ CCorporation ❑SCorporation ❑ Partnership ❑TmsNestate instructions on page 3): d C single -member LLC Exempt payee code (d any) ❑ Limited liability company. Enter the tax classification (C-C corporation, S=S corporation, P=Partnership) 0- 0 Note: Check the appropriate box in the line above forthe tax classification ofthe single -member owner. Donotcheck Exemption from FATCA reporting LLC it the LLC la classed as a single -member LLC that is disregarded from the owner unless the owner of the LLC is LLC that Is code (if my) uanother not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that 0 is disregarded from the owner should check the appropriate box for the tax classification of its owner. k ❑ Other (see instructions) ► wrom*ro.�wmmww,eawmm rn•us� H 5 Address (number, street, and apt, or suite no.) See instructions. Requester's name and address (optional) CALHOUN COUNTY r$ 202 S ANN ST, PORT LAVACA TX 77979 6 City, state, and ZIP code 361-553-4610 FAX: 361-553-4614 7 Ust account number(s) here (optiona9 Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I social security number backup wilier, sole p For Indivproprietor, or ls,this this is generally your social security number (SSNr. However, fora resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other _ m - entities, It Is your employer Identification number (Elm. If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the Instructions for line 1. Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. ITS F-T— TF 1. The number shown on this form Is my correct taxpayer Identification number (or I am waiting for a number to be Issued to me); and 2.1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (a) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) Indicating that 1 am exempt from FATCA reporting is correct. Certification Instructions. You must cross out Item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part 11, later. w9n I Signature of Here U.S. person► Date► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and Its Instructions, such as legislation enacted after they were published, go to www.irs.gov1Fom lW9. Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an Information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITiN), adoption taxpayer identification number (ATIM, or employer Identification number (Elm. to report on an Information return the amount paid to you, or other amount reportable on an Information return. Examples of Information returns Include, but are not limited to, the following. • Form 1099-INT (Interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-6 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuition) • Form 1099-0 (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U.S. person (including a resident alien), to provide your correct TIN. ff you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What Is backup withholding, later. Cat No.10231X Form 1N-9 (Rev. 10-2018) Page 48 of 59 INSERT MATERIAL INFORMATION AND SAFETY DATA SHEETS Insert one (1) copy of the Material Information and Safety Data Sheet for each insecticide or product Bid on Bid Item Number (as on the Invitation to Bid Form) must be on each one Page 49 of 59 COPY OF CURRENT AWARDED BID TABULATION FOR THE CURRENT BID PERIOD January 1, 2023 through December 31, 2023 Page 50 of 59 A, m ti p V O tj A J D II N o o v u G 8 p:.. w N m O 8 N U N m Z '1 •ti m ti O z z z O O_I Z z tp N u_ c c c v' U2 O a u r Z U ❑ U � � a c w> v ';N p 0 ❑ ❑ ❑ ❑ O ❑ = Q ; N N: O z O z O z O z O z O z Z N 3 vt J 0 W Y N 2FQ- � a v O ti Z O U - 'o U Z � f rcv wo •Z .N ❑ ❑ o o ❑ ❑ ❑m ❑ ❑ ❑ ❑ O 0 y 9 'r'. o o e O o o O o N p 00 p E y �: Z Z N N Z Z z Z Z Z z 'L C P f Y C' 5 U G vXi C O O p N O o m m u u 2 33 m 1p�}}' o a o o 6 N LL d VF Z lR Z U4 ❑ Q y ti N ^ O Vl N N N y m N. m c O 10 > Q > Q m 6 .. •A E E °: N •� E r E E. a 3 p R a o p - p N m c c Q Q u c a E c p ° 9 c c o o° c o � •E ° o c q j0 O O N Yf l7 l7Li N N �: H N N N 4Nlf N ry N M X Vr X N O N O O ei 3 W � Z Z a 3 2 S �; Q Q ci A E :we E6 A E mM F 0 0 0 Lri 4 0 0 0 0 z 0 z z z 0ei E E m 2 2 E 0 0 0 0 0 z z z z z A E z t 0 z 0, OZ a 06 m m E m m m ai 0 0 0 N 0 0 m 0 0 0 z z z z z z z z 00 2 C 2 T . 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WxV CONTRACT THIS CONTRACT, made and entered into this day of and between the County of Calhoun (hereinafter 20_ by, called "County") and (hereinafter called "Contractor/Hauler") WITNESSETH: WHEREAS, the Contractor/Hauler did on November 30, 2023, submit a BID for INSECTICIDES FOR MOSQUITO CONTROL, Bid Number 2024.01 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 provided for in such amendment. INITIALS OF AWARDED CONTRACTOR/HAULER (IN INK) INITIALS OF COUNTY (IN INK): DATE: DATE: Page 57 of 59 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 CONTRACTOR/HAULER (IN INK) INITIALS OF COUNTY (IN INK): DATE: DATE: Page 58 of 59 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, 2024 and end on December 31, 2024. COUNTY: CALHOUN COUNTY 0 Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: By: Print Name: Title: Address: ATTEST: CALHOUN COUNTY CLERK ANNA GOODMAN 0 Print Name: Title: Page 59 of 59 � �a NOTICE OF MEETING—11/1/2023 8. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials, Bid Number 2024.02 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. (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 5 of 12 Mae Belle Cassel From: demi.cabrera@calhouncotx.org (demi.cabrera) <demi.cabrera@calhouncotx.org> Sent: Thursday, October 26, 2023 10:18 AM To: MaeBelle.Cassel@calhouncotx.org Subject: Agenda Items for Court 11/1/2023 - Annual Bids Good Morning, Can you please place the following items on the agenda for Commissioner's Court on November 1, 2023: • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2024.01 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bid will be due before 2:00:00 PM, Thursday, November 30, 2023. • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials, Bid Number 2024.02 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Asphalts, Oils and Emulsions, Bid Number 2024.03 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bid will be due before 2:00:00 PM, Thursday, November 30, 2023. Thank you, V mi Cabrrra Calhoun County ��si�tant g9udifior :5G7-553-�G13 5Gt-55.E-�Gi4 (faX) Calhoun County Texas CALHOUN COUNTY, TEXAS INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS BID NUMBER: 2024.02 BID TERM: JANUARY 1, 2024 THROUGH DECEMBER 31, 2024 SEALED BIDS ARE DUE BEFORE: 2:00:00 PM, Thursday, November 30, 2023 AT THE OFFICE OF: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 31 Floor, Suite 301 Port Lavaca, Texas 77979 Public Opening of the Bids will be conducted immediately afterthe closing of the 2:00:00 PM deadline, Thursday, November 30, 2023 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas 77979. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all vendors that submitted a Bid and, as time permits, will be posted on the County's website (www.calhouncotx.org) under Public Notices, Bid Notices and Results, Results, 2024. Page 1 of 65 CONTENTS • Invitation to Bid (Page 3-4) • Return Instructions (Page 5) • General Conditions (Page 6-19) • Specifications (Page 20-28) • Contact, Billing and Location Information for Calhoun County Precincts (Page 29) • Required Forms to be returned when submitting a Bid (Page 30-50) If any Required Form is "Not Applicable', mark "NA" and include when submitting a Bid o Invitation to Bid Form (Page 31-37) o Vendor and Order Information Form (Page 38) o Affidavit (Page 39) o Conflict of Interest Questionnaire Form CIQ (Page 41) o Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 44) o Certification Regarding Lobbying (Page 45) o Disclosure of Lobbying Activities (Page 47) o House Bill 89 Verification (Page 48) o Residence Certification (Page 49) o W-9 (Page 50) OTHER INFORMATION INCLUDED WITH THE INVITATION TO BID PACKET Current (2023) Awarded Bid Tabulation for the Annual Supply Contract for Road Materials for the period January 1, 2023 through December 31, 2023 (Page 51-62) Copy of Contract (to be completed AFTER the Bid is awarded) (Page 63-65) Page 2 of 65 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas, will receive SEALED BIDS for Road Materials for the County's Road and Bridge Precincts. BID NUMBER: 2024.02, ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS Bids are for a one (1) year period: January 1, 2024 through December 31, 2024. The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Public Notices, Bid Notices and Results, Bid Notices, 2024) or by contacting Demi Cabrera, Assistant Auditor, at demi.cabrera@calhouncotx.org or 361-553- 4613. SEALED BIDS ARE DUE BEFORE 2:00:00 PM, Thursday, November 30, 2023. Immediately after the closing of the 2:00:00 PM deadline, all Bids will be publicly opened in the County Judge's office in the Calhoun County Courthouse at 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. It is the responsibility of the submitting vendor to ensure that the sealed Bid is received in a timely manner. Calhoun County does not accept faxed or emailed Bids. Calhoun County accepts no financial responsibility for any cost incurred by any entity in the course of responding to the Bid. Bids received after the deadline will not be opened and will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting vendor. All bids (one original) must be delivered to the office of the Calhoun County Judge before 2:00:00 PM, Thursday, November 30, 2023 in a SEALED 9 x 12 or larger envelope and CLEAREY MARKED on the outside of the envelope: SEALED BID NUMBER 2024.02 ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the Bid is received and the 2:00:00 PM deadline. Bids shall include all requirements of the Invitation to Bid Packet for Bid Number 2024.02, Annual Supply Contract for Road Materials. SEALED BIDS MAY BE HAND DELIVERED OR MAILED TO: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3`d Floor, Suite 301 Port Lavaca, TX 77979 Page 3 of 65 Calhoun County Commissioners Court reserves the right to waive any formality, technicality or irregularity, accept or reject any and or all Bids and to accept the Bid deemed most advantageous to and in the best interest of Calhoun County. The award of a Bid shall be made to the responsible vendor whose Bid is determined to be the most beneficial to Calhoun County, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid Packet. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit Bids. Candice Villarreal County Auditor Calhoun County, Texas Page 4 of 65 RETURN INSTRUCTIONS For Submitting a Bid for ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS Bid Number: 2024.02 Bid Period: January 1, 2024 through December 31, 2024 Return the following BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023 Check List for submitting your Bid: Return One (1) Original of only the following forms Be sure all of the below forms are completed, signed, dated and returned. If "Not Applicable" mark "NA" and include when submitting a Bid. The submitted Bid consists only of the following forms (only the below forms need to be returned) Invitation to Bid Form (Page 31-37) Vendor and Order Information Form (Page 38) Affidavit (Page 39) Conflict of Interest Questionnaire, Form CIQ (Page 41) Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 44) Certification Regarding Lobbying (Page 45) Disclosure of Lobbying Activities (Page 47) House Bill 89 Verification (Page 48) Residence Certification (Page 49) W-9 (Page 50) Do Not Fold any of the above information. Bid must be returned in a SEALED 9 x 12 or larger envelope clearly marked: SEALED BID NUMBER 2024.02—ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS If you send your bid by UPS, FeclEx or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2024.02 — ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS Sealed Bid may be hand delivered or mailed to: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, TX 77979 Bid must be sealed (with the glue on the envelope or tape) Page 5 of 65 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFC, and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFQ, and/or Contract is released for bidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFC, and/or Contract is due. The Bid, RFP, RFQ, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFC, and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ and/or Contract in collusion with any other bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidders/vendor's Bid, RFP, RFQ and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3'' Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ, and/or Contract will specify the date and time due. Page 6 of 65 The cell phone in the County Judge's office or the cell phone of the County Auditors Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ and/or Contract is received and the time deadline that the Bid, RFP, RFQ and/or Contract will be opened. A late delivery with an early postmark or delivery of the Bid, RFP, RFQ and/or Contract to the wrong office will not suffice. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting bidder/vendor. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ, and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. If the Bid, RFP, RFQ and/or Contract is sent by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ, and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ and/or Contract price. Bids, RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum or approved the addendum to be sent out by the Engineer with the approval from the County Commissioner or County Department in charge of the project. Page 7 of 65 Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidders/vendors performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ, and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employers liability and auto insurance with adequate limits to cover bidders/vendors liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendors performance under this Bid, RFP, RFQ and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashiers checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes under Section 151.309 of the Texas Tax Code. Tax exempt forms will be furnished upon request to the bidder/vendor. Tax exempt forms can be obtained from the Calhoun County Auditors Office. Bidder/vendor is to issue its Texas Resale Certificate to vendors and subcontractors for such items qualifying for this exemption, and further, bidder/vendor should state these items at cost. Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Page 8 of 65 Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/orservices fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFC, and/or Contract on the basis of lowest and/or best Bid, RFP, RFC, and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the sole judge in determining which Bid, RFP, RFC, and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFC, and/or Contract based on lowest and/or best Bid, RFP, RFC, and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ and/or Contract" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ, and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFC, and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFQ and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Page 9 of 65 Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFQ and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFQ, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFQ and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFQ and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFQ and/or Contract to the Calhoun County Tax Assessor Collectorforthe payment of delinquent taxes. Certificate of Interested Parties— Form 1295 Section 2252.908 was added to the Government Code by the 841" Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 10 of 65 Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 ofthe Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf—info—forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFQ and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFQ and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enterthe required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. A business entity will generate Form 1295 online after notification of award and submit with their signed contract. (See Attachment A to General Conditions) No later than thirty (30) days after Calhoun County Commissioners Court approves a contract with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFC, and/or Contract submission and the time of execution of the Bid, RFP, RFQ and/or Contract. A print out of the search results that includes the record date showing that the Company, and its Principals, if any, have an active registration with the System for Award Management (www.SAM.gov) AND are not Page 11 of 65 debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM) must be included with the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFC, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun Countywill not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ, Contract, order, and/or service. In the event a Bid, RFP, RFQ, Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County Page 12 of 65 may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFQ and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFQ, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFQ, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel fordefault all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Majeure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFQ and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFQ and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFQ, and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Page 13 of 65 Waiver: No claim or right arising out of a breach of any Bid, RFP, RFO, and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFC, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code" as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFQ and/or Contract. Otherwise, Texas state and federal law shall apply. Prohibition against Personal Interest in Bids, RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFQ and/or Contract with Calhoun County, orshall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied ofthe company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFQ, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ, and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. o General Liability ($100,000/$300,000 or greater) o Workers' Compensation (at Statutory Limits) o Employer's Liability ($1,000,000 or greater) o Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) o Professional Liability Insurance (if applicable) o Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall Page 14 of 65 be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFQ and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ, and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFQ, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFC, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: o Name, mailing address and business phone number of the protesting party; o Appropriate identification of the Bid, RFP, RFC, and/or Contract being protested; o A precise statement of the reasons for the protest; and o Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditors option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditors Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. If additional information is required, Calhoun County Commissioners Court will notify the protesting partyto provide such information. The decision of Calhoun County Commissioners Court will be final. Page 15 of 65 Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFQ, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or by judicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 The Packet, Invitation for Bids, Request for Proposals and/or Request for Qualifications are posted on Calhoun County's website, www.calhouncotx.org, under Public Notices, Bid Notices and Results. Page 16 of 65 ATTACHMENT A CALHOUN COUNTY, TEXAS GENERAL CONDITIONS CERTIFICATE OF INTERESTED PARTIES FORM 1295 A business entity will generate Form 1295 online after notification of award and submit with theirs igned contract. Form 1295 must be filled out and submitted online, printed, complete #6, signed and returned with the Agreement, Contract, or Lease. See Calhoun County, Texas —Policy of Compliance TO FILL OUT FORM 1295: Go to: https://www.ethics.state.tx.us/File 1. If you have an account, login and proceed with the processor if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2. Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only". 3. The Respondent or an authorized agent of the Respondent must sign and date the printed copy of the form (making sure all of #6 is completed). 4. The completed Form 1295 must be included with your Agreement, Contractor Lease, when it is submitted to Calhoun County. For help in filling out the form: #1 Name of Business Entity filing the form, and the City, State and Country of the Entity's place of business #2 Calhoun County, Texas (Also, if applicable, insert name of County Department) #3 • Contract number, if not given, can be the year or dates associated with the Agreement, Contract, Lease or if for a Bid, RFP, or RFQ, the Bid, RFP, RFQ number and dates the Bid, RFP, RFQ pertains to • Description is description of Agreement, Contract, Lease or name of Bid, RFP, RFQ On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, submit and print After printing, the respondent or an authorized agent of the respondent must sign and date (making sure all of #6 is completed) When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only'. Page 17 of 65 CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. ♦ 3 Provide the identification number used by the governmental entity or state agency to,;t�y�/�y�k' Y identify the contract, and provide a description of the services, goods, or other property to be provided iiV a contract. 4 City, State, Country Nature of Interest (check applicable) Name of Interested Party (place of business) ;, ♦ J Controlling Intermediary 5 Check only if thereC I terested Party. ❑ s UNSWORN DEC♦t1IQ N My name is �`` , and my date of birth is My addre A"' 7 (street) (city) (state) (zip code) (country) , d under penally of perjury that the foregoing is true and correct. Executed in County, State of on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission w ethics.state.tx.us PageRIA& 552/22/2017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 and September 14, 2022 BACKGROUND Section 2252.908 was added to the Government Code by the 841h Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state.tx.us/whatsnew/elf_ info_form1295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. Calhoun County Commissioners Court will not consider for action any contract with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. Page 19 of 65 SPECIFICATIONS FOR ANNUAL SUPPLY CONTRACT FOR �:191_u1ur_I1a:ir_I�� BID NUMBER: 2024.02 BY ORDER of the Commissioners Court of Calhoun County, Texas, sealed Bids will be received for Road Materials for the County's Road and Bridge Precincts. Contact, billing and location for each Calhoun County Road and Bridge Precinct can be found on the Form: Contact, Billing and Location Information for Calhoun County Precincts INVITATION TO BID PACKET The complete Invitation to Bid Packet may be downloaded from the County's website, www.calhouncotx.org (under Public Notices, Bid Notices and Results, Bid Notices, 2024) or by contacting Demi Cabrera, Assistant Auditor, at demi.cabrera@calhouncotx.org or 361-553- 4613. The complete Invitation to Bid Packet must be used in preparing the Bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3`d Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2024.02 ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS If the SEALED BID is sent by UPS, Fed Ex, or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2024.02 ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3'd Floor, Suite 301 Port Lavaca, Texas 77979 A late delivery with an early postmark will not suffice. Page 20 of 65 Calhoun County is not responsible for the delivery of your Bid to the office of the County Judge or delivery to the wrong office. If you choose to send your Bid by postal delivery, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your Bid prior to the Bid due date and time. It is the responsibility of the submitting vendor to ensure that the sealed Bid is received in a timely manner. Calhoun County does not accept faxed or emailed Bids. Calhoun County accepts no financial responsibility for any cost incurred by any vendor in the course of responding to the Bid. Bids received after the deadline will not be opened and will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting vendor. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the Bid is received and the 2:00:00 PM deadline. No Bids will be accepted after the due date and 2:00:00 PM deadline has been reached. BID TERM The Bid shall be in effect for a period of one (1) year: January 1, 2024 through December 31, 2024 BID INFORMATION/REQUIREMENTS To submit a valid Bid, read the entire Invitation to Bid Packet for all requirements and required forms that must be included and returned with the submitted Bid. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a Bid. If you will not be submitting a Bid, we would appreciate you indicating on your "NO BID" response any requirements of this Bid request which may have influenced your decision to "NO BID". Calhoun County is not responsible for errors if the Bid forms are handwritten. It is recommended that all information submitted by the vendor on the Bid forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. Intentionally Left Blank Page 21 of 65 Materials shall meet or exceed "Texas Department of Transportation Current Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges" and/or Calhoun County requirements. ROAD MATERIALS (Bid Item Listed or Equivalent) Bid Item #1: Limestone —1/2 Inch to Dust or Equivalent Bid Item #2: Limestone — 3/4 Inch to Dust or Equivalent Bid Item #3: Item 247, Type A Limestone, Grade 2 [1 % Inch] or Equivalent Bid Item #4: Item 247, Type A Limestone, Grade 3 [1 % Inch] or Equivalent Bid Item #5: Item 265-2.2 Fly Ash or Equivalent Fly Ash that meets the requirements of DMS 4615 "Fly Ash for Soil Treatment" Class CS or F5, Delivered in pneumatic tankers with spreader bar Bid Item #6: Item 275, Cement or Equivalent 275-2.1, Hydraulic Cement Type 1 or Equivalent, Bulk (Pneumatic Tankers, Spreader Bar Needed) 275-2.1, Hydraulic Cement Type 1 or Equivalent, 47 lb. Bag (on Pallets) Bid Item #7 Item 302, Type PB, Grade 3 (Pre -Coated Rock) or Equivalent Bid Item #8 Item 302, Type PB, Grade 4 (Pre- Coated Rock) or Equivalent Bid Item #9 Item 302, Type PE, Grade 3 (Pre -Coated Rock), *Material Source out of * or Equivalent Bid Item #10 Item 302, Type PE, Grade 4 (Pre -Coated Rock), *Material Source out of * or Equivalent Bid Item #11 Item 302, Type E, Grade 5, Ice Rock (Non Coated Limestone Only) or Equivalent Bid Item #12 Item 330, Type D (Pre -Mix Limestone) or Equivalent Bid Item #13 Item 330 D, Pothole Repair, Limestone Rock Asphalt (LRA) or Equivalent The material will be used to construct a base course, a surface course, a level - up course, pothole repair, or any combination of these courses of the types and grade using a cold- mixed material consisting of native limestone rock asphalt (LRA) aggregate, fluxing material, water. LRA Mixture -Furnish LRA according to DMS-9210, "Limestone Rock Asphalt (LRA)", Item 330 D per the Surface Aggregate Classification plans as set forth by TXDOT Standard Specifications for Construction and Maintenance of Highways, Streets, and Bridges 2014. No material will be accepted that has been blended and stored on the producer's pad for more than 24 hours prior to loading and shipment. Bid Item #14 Item 334, Type D, Hot Mix Cold Laid Asphalt Concrete Pavement or Equivalent Material must meet or exceed Item 334, 4.1.2 JMF Table #5 Laboratory Mixture Design Properties found in the Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges. Bid Item #15 ASPPM 9202 Grade IV High Performance Cold Mix or Equivalent Bid Item #16 Item 432 Riprap, Section 2.3 Stone Riprap, 12" Limestone or Equivalent Vendor may submit a Bid for any or all material(s) for any location. Page 22 of 65 Vendor must be able to furnish Bid items under terms of these specifications and general conditions if vendor is awarded a Bid. Calhoun County is EXEMPT from all Sales Tax (county, city and state sales tax) and all Federal Excise Taxes, if applicable under Section 151.309 of the Texas Tax Code. Upon request, tax exempt forms will be furnished to the vendor by the County Auditor's Office. Vendor is to issue its Texas Resale Certificate to vendors or subcontractors for such items qualifying for this exemption. Pump and hoses, if applicable, are to be furnished by the vendor at no extra charge or the charge for the pump and hoses, if applicable, must be included in the Bid. Demurrage charges, if applicable, stated separately from the Bid price of the material will increase the amount of the Bid price for the material. Materials Bid must be broken down into price per unit and delivery price per unit. A fuel adjustment will be allowed, with a cap of 15% plus or minus, on the delivery price only as fluctuations in diesel prices occur as listed on http://www.eia.gov/petroleum/gasdiesel, using the Gulf Coast Region. The baseline price will be the price on this site on Monday, November 27, 2023 rounded to the nearest one -hundredth and thereafter the index will be adjusted and documented on Monday of each week after Bids are accepted. The allowable fuel adjustment will be calculated by subtracting the baseline price from the posted price for the Monday immediately prior to the delivery date of the material (if delivered on a Monday, the posted price on the Monday prior to delivery must be used), and if the difference is less than 5 cents no adjustment will be allowed; 5 cents to 9 cents a 1% plus or minus adjustment to the delivery price per unit; 10 cents to 14 cents a 2% plus or minus adjustment to the delivery price per unit; 15 to 19 cents a 3% plus or minus adjustment to the delivery price per unit; 20 to 24 cents a 4% plus or minus adjustment to the delivery price per unit and so on. A 1% adiustment will be made on the delivery price for every 5 cent increase or decrease from the baseline price, not to exceed 15% plus or minus. Vendor must include a copy of the document from the EIA.GOV website that was used to determine delivery price when invoicing Calhoun County and the calculations on the increase or decrease in the delivery price. Vendor will be required to deliver to all jobsites in Calhoun County as directed by the Commissioner of applicable Calhoun County Precinct. Jobsite can be road, field location or stockpile at designated Calhoun County locations. Miles from pit to stockpile and/or jobsite will be shortest legal route. Total Bid price, stated on the Invitation to Bid Form, shall include all fees, transportation costs and/or delivery fees to the designated Calhoun County Precinct stockpile orjobsites. Materials shall be ordered in quantities as determined by each Calhoun County Commissioner. Page 23 of 65 Calhoun County Precincts will put out needed signs and barricades for traffic control. Calhoun County Precincts will accept the number of trucks necessary to do a job on a most cost efficient basis, which could require various numbers of trucks. Any Vendor traveling on Calhoun County roads will not exceed its legal gross weight. Each load shall be weighed on a certified public scale. Truck and trailer shall be weighed empty at least once on each job run, or when a change is made due to changing truck, trailer, or other. Cost of weighing shall be paid by the hauler. Driver shall get a material company ticket from pit or location when loading. A copy of the scale weight ticket, material company ticket and company delivery ticket shall be given to the Calhoun County employee at the jobsite when load is inspected and dumped. Calhoun County Precincts will supervise the dumping of loads and a Calhoun County employee will sign the delivery ticket. The Calhoun County Precinct must receive a copy of the signed delivery ticket. Calhoun County shall have the right to pull sample loaded truck(s) to a certified scale of Calhoun County's choice for loaded weight, unload truck(s) and take empty weight on same scale to verify weights. Calhoun County shall pay for the weighing. Calhoun County legally accepts the materials after it is unloaded and approved by the Calhoun County Commissioner of said precinct. Any exceptions and or variations from the specifications in this Bid document must be indicated on the Bid form or on a separate attachment to the Bid and labeled as such. Exceptions taken and/or variations made to the specifications and listed on the vendor's Bid or separate attachment may void the Bid. The request for a Bid on a material does not guarantee that Calhoun County will purchase this material during the Bid period. Calhoun County does not guarantee to purchase any minimum or maximum quantities. The materials will only be ordered as needed. When required, all materials ordered will be delivered to the Calhoun County Precinct within 24 hours from time of order. In the event the vendor is unable to deliver the materials(s) ordered within 24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest Bid that met specifications and can deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or other charges when cancelling an order. Vendor shall be required to notify Calhoun County in the event of unforeseen delay arising in the delivery of an order. In the event an order will not arrive at the Calhoun County Precinct at the designated time, Calhoun County shall have the right to cancel the order or refuse acceptance of the order. Calhoun County shall not be accessed any penalties, fees and/or other costs due to this cancellation or refusal. Page 24 of 65 In the event the vendor is unable to furnish any item within a reasonable time after an order is placed due to strikes, war or any reason beyond the vendor's and or supplier's control, the County reserves the right to purchase these items from any source, without causing this contract to be cancelled. Calhoun County or the vendor have the right to cancel the delivery of a material(s) at any time due to weather, road conditions and/or machinery breakdown. No penalties, fees and/or other charges will be billed to Calhoun County if the delivery of a material(s) is cancelled by Calhoun County or the vendor due to weather, road conditions and/or machinery breakdown. The County reserves the right to refuse any order delivered for not being in compliance with the specifications, general conditions and/or the "Hazardous Communications Act", commonly known as the "Texas Right to Know Act". The vendor, at the vendor's cost, shall immediately remove the material(s) from the Calhoun County Precinct that are deemed unsatisfactory, and are not in compliance with the specifications, general conditions and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other charges will be billed to Calhoun County for the removal of the material(s) from the Calhoun County Precinct. Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified by State and/or Federal Regulations. Calhoun County reserves the right to conduct random sampling of pre -qualified materials for testing and to perform random audits of test reports. Calhoun County representatives may sample materials from the manufacturing plant, terminal, shipping container and any other source they deem necessary to insure reliability of the materials. If testing will be performed through a third party, the vendor will be required to allow the third party access to the facilities in order to acquire samples for testing. Regardless of results of any material(s) test required by Calhoun County, all costs incurred for such tests shall be paid for by the vendor. Specifications are not being met if materials are not delivered at the required temperatures or the time and date requested by Calhoun County's Commissioner are not met. The award of a Bid will be voided if specifications, general conditions and instructions within this Invitation to Bid Packet are not followed. The Bid would then be awarded to the vendor which submitted the next lowest Bid that met specifications and all requirements of the Invitation to Bid Packet. All Calhoun County Precincts handle their own orders; therefore, invoices shall be billed to each Calhoun County Precinct separately. All invoices must be billed to Calhoun County to the attention of the Calhoun County Commissioner and Precinct ordering the material(s). Bid item number and material description, as stated on the Invitation to Bid form, awarded material Bid price per unit and delivery price per unit must appear on all invoices in order to be considered for payment. Listing the Bid item number and exact material description as on the Invitation to Bid Form will avoid any confusion when the invoice is processed for payment. Page 25 of 65 No other charges, including, but not limited to, pump, hoses, special fees or after hour delivery fees, may be added to the awarded Bid price per unit and delivery price when invoiced unless these charges were noted on the Bid form or separate attachment and awarded as such. Invoices shall be free from sales tax (county, city or state sales tax) and federal excise taxes, if applicable. Invoices shall include a copy of the document from the EIA.GOV website that was used to calculate the increase or decrease in the delivery charge. Invoices shall show the calculation on how the increase or decrease in delivery price was reached. Invoices shall include a copy of the delivery ticket that shows confirmation of delivery. It is understood that Calhoun County Commissioners Court reserves the right to accept or reject any and/or all Bids for any/or all materials and/or services covered in this Bid request and to waive technicalities or defects in Bids, or to accept such Bids as it shall deem to be most advantageous and in the best interest of Calhoun County. Calhoun County Commissioners have the right to reject at any time any material that is undesirable for either road or jobsite location. If any material is rejected, the County will not incur in fees or charges on the rejected material. Calhoun County will evaluate and award the Bid based on lowest and best Bid meeting specifications and all requirements of the Invitation to Bid Packet. "Lowest and best" means a Bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid as it deems to be in the best interest of Calhoun County. Although the cost of materials(s) to be provided is an essential part of the Bid, Calhoun County is not obligated to award a Bid (contract) on the sole basis of cost but will award to the vendor considered to be the best value to the Calhoun County. The Bid award shall be based on, but not necessarily limited to, the following factors: ■ Unit price ■ Extended price (and other charges, if any) ■ Special needs and requirements of Calhoun County • Delivery • Compliance in returning (including) all required forms ■ Results of testing samples (if required by Calhoun County) ■ Calhoun County's experience with materials Bid ■ Vendor's past performance record with Calhoun County Page 26 of 65 If Bids are awarded, award information will be emailed to all vendors that submitted a Bid regardless if the vendor was awarded a Bid or not. Calhoun County Commissioners Court and the County Auditor's office work diligently to get this information to the vendors as soon as possible. To obtain results, or if you have any questions, please contact Demi Cabrera, Calhoun County Assistant Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4613, demi.cabrera@calhouncotx.org. As time permits, Bid awards will be posted on Calhoun County's website, www.calhouncotx.org, under Public Notices, Bid Notices and Results, Results, 2024. Once Bids are awarded by Calhoun County Commissioners Court, the County Auditor's Office will send the awarded vendor the following: (1) The contract; (2) A request for Form 1295, Certificate of Interested Parties; and (3) A request for the insurance requirements, Certificate of Insurance. All documents must be returned and accepted by Calhoun County Commissioners Court before the award will be complete, valid and in effect. Calhoun County or the vendor may cancel this contract at any time for any reason, provided a written notice is given. Should there be a change in ownership or management, the contract shall be cancelled unless a mutual agreement is reached with the new owner or manager to continue the contract with its present provisions and prices. Vendor understands that Calhoun County is a government entity subject to Texas State and Federal public information statutes. Vendor hereby waives any obligation to the release to the public of any documents submitted in accordance with the Bid. No person has the authority to verbally alter these specifications or any information within the Invitation to Bid packet. Any changes will be made in writing (Addendum approved by Calhoun County Commissioners Court) and mailed and or emailed to each vendor that received a Bid packet. All disputes or protests will be held in Calhoun County, Texas. INSURANCE REQUIREMENTS Before commencing work under the contract, the vendor must furnish, at their own expense, certificates of insurance or other acceptable evidence from a reputable insurance company or companies acceptable to Calhoun County, licensed to write insurance in the State of Texas showing the contractor (vendor) is covered by insurance within the minimum limits of liability listed in the General Conditions that are included in this Invitation to Bid Packet and shall remain in force until all work under the contract is completed. If for any reason insurance coverage is not kept in force, all deliveries must be stopped until an acceptable Certificate of Insurance is provided to the County. The County Auditor's office and the County Commissioners' should be provided with 30 days advance notice of changes or termination of coverage. The County shall be covered as an additional insured and the certificate of insurance must also include a waiver of subrogation in favor of the County. The vendor shall be responsible for any deductions stated in the policy. Page 27 of 65 The vendor shall include all subcontractors as insured under its policies or shall furnish separate certificates of insurance and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements under this contract. Nothing contained in the insurance requirements shall be construed as limiting the extent of the vendor's responsibility for payment of damages resulting from operations under this contract. Any failure of the vendor to comply with the reporting provisions of the insurance policies shall not affect the coverage provided to the County. The insurance provided by the vendor shall be primary as respects to the County. Any insurance maintained by the County shall be excess of the vendor's insurance and shall not contribute to it. REQUIRED FORMS TO BE RETURNED WHEN SUBITTING A BID If any Required Form is "Not Applicable", mark "NA" and include when submitting a Bid. • Invitation to Bid Form (Page 31-37) ■ Vendor and Order Information Form (Page 38) • Affidavit (Page 39) • Conflict of Interest Questionnaire, Form CIO (Page 41) ■ Certificate Regarding Debarment & Suspension and Other Responsibility Matters (Page 44) ■ Certification Regarding Lobbying (Page 45) ■ Disclosure of Lobbying (Page 47) • House Bill 89 Verification (Page 48) • Residence Certification (Page 49) • W-9 (Page 50) Page 28 of 65 CONTACT, BILLING AND LOCATION INFORMATION FOR CALHOUN COUNTY PRECINCTS Calhoun County Precinct 1 Commissioner David Hall 305 Henry Barber Way (by the County Fairgrounds) Port Lavaca, TX 77979 Office Manager: Angela Torres Office: 361-552-9242 Fax: 361-553-8734 Location Stockpile: 305 Henry Barber Way, Port Lavaca, TX Calhoun County Precinct 2 Commissioner Vern Lyssy 5812 FM 1090 (Six Mile) Port Lavaca, TX 77979 Office Manager: Lesa Jurek Office: 361-552-9656 Fax: 361-553-6664 Location of Stockpile: 5812 FM 1090, Port Lavaca, TX Calhoun County Precinct 3 Commissioner Joel Behrens 24627 State Hwy 172 (Olivia) Port Lavaca, TX 77979 Office Manager: Lynette Adame Office:361-893-5346 Fax: 361-893-5309 Location of Stockpile: 24627 State Highway 172, Olivia TX Calhoun County Precinct 4 Precinct 4-P (Port O'Connor) Commissioner Gary Reese Trevor St off of Hwy 185 Port O'Connor, TX 77982 Office Manager: April Townsend Use same numbers as Seadrift (4-5) Location of Stockpile — Pct 4-P Barn #3: 93 Trevor Street off of Highway 185, Port O'Connor, TX Calhoun County Precinct 4 Precinct 4-S (Seadrift) Commissioner Gary Reese 104 E Dallas St PO Box 177 Seadrift, TX 77983 Office Manager: April Townsend Office: 361-785-3141 Fax: 361-785-5602 Location of Stockpile — Pct 4-S Barn #2: 448 Harbor Road, Seadrift TX Page 29 of 65 REQUIRED FORMS FORMS REQUIRED TO BE RETURNED WHEN SUBMITTING A BID Vendor must return the following forms: If any Required Form is "Not Applicable", mark "NA" and include when submitting a Bid o Invitation to Bid Form (Page 31-37) o Vendor and Order Information Form (Page 38) o Affidavit (Page 39) o Conflict of Interest Questionnaire Form CIQ (Page 41) o Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 44) o Certification Regarding Lobbying (Page 45) o Disclosure of Lobbying Activities (Page 47) o House Bill 89 Verification (Page 48) o Residence Certification (Page 49) o W-9 (Page 50) Submitted Bid consists only of the above required forms Page 30 of 65 CALHOUN COUNTY, TEXAS INVITATION TO BID FORM ANNUAL SUPPLY CONTRACT FOR ROAD MATERIALS Bid Number: 2024.02 January 1, 2024 through December 31, 2024 Vendor's Name & Address • Please Type. If handwritten, must be in ink and legible. White out is not acceptable. • SEE SPECIFICATIONS AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS • MATERIALS BID MUST BE BROKEN DOWN INTO PRICE PER UNIT AND DELIVERY PRICE PER UNIT ROAD MATERIALS (Bid Item Listed or Equivalent) Bid Item #1: Limestone -1/2 Inch To Dust or Equivalent Price per ton / delivery price to County Stockpile and/orJobsite MINIMUM LOCATION UNIT MATERIAL DELIVERY TOTAL LOAD/ORDER Precinct 1 Ton I I I Precinct I Ton I I I I I I Precinct 3 Ton I i Precinct4-P I Ton I I I Precinct 4-S ; Ton Remarks: Bid Item #2: Limestone - 3/4 Inch To Dust or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER Precinct 1 I Ton I I Precinct 2 Ton Precinct 3 1 Ton I I I I I I I Precinct 4-P 1 Ton I I I Precinct 4-S ; Ton I I I I I Remarks: Page 31 of 65 Item #3: Item 247, Type A Limestone, Grade 2 [13/4 Inch] or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDE I I I I Precinct 1 I Ton I I I I I I I I Precinct ; Ton I Precinct 3 I Ton I iI Precinct 4-P I Ton I I I I I I Precinct4-S I Ton Remarks: Bid Item #4: Item 247, Type A Limestone, Grade 3 [3 3/4 Inch] or Equivalent Price per ton / delivery price to County Stockpile and/orJobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I I I I Precinct 1 Ton I Precinct I Ton I ' I Precinct 3 Ton I I I I I I Precinct4-P I Ton I I I I Precinct4-S I Ton I Remarks: Bid Item #5: Item 265-2.2 Fly Ash or Equivalent See Specifications, Bid Item #5 for more information on this material Priceper ton / delivery price to County Stockpile and/orJobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDE I Precinct 1 Ton I I I I i i i i i Precinct 2 Ton I Precinct 3 1 Ton I I I I I I I I Precinct 4-P I Ton I I I Precinct 4-S ; Ton Remarks: Page 32 of 65 Bid Item #6: Item 275, Cement or Equivalent 275-2.1, Hydraulic Cement Type 1, Bulk (Pneumatic Tankers, Spreader Bar Needed) 275-2.1, Hydraulic Cement Type 1, 47 lb Bag(Cost per Pallet List # of 47 Ib Bags on a Pallet Price per unit / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER 1 1 1 I 1 ' Precinct 1 1 Ton 1 1 I 1 1 1 of 47 lb 1 1 Bags on Pallet 1 1 Precinct Ton 1 1 1 of 471h1 1 1 1 Bags on Pallet 1 1 1 Precinct 3 Ton 1 of 47 lb 1 Bags on Pallet 1 Precinct 4-P 1 Ton 1 1 1 1 1 1 1 of 47 lb 1 1 1 1 1 Bags on Pallet 1 1 1 1 Precinct4-S ; Ton 1 I 1 1 of 4716 1 1 Bags on Pallet 1 Remarks: Bid Item #7: Item 302, Type PB, Grade 3 (Pre -Coated Rock) or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER 1 Precinct 1 1 Ton 1 I I I 1 1 Precinct 2 1 Ton I I 1 I 1 I 1 1 1 Precinct 3 1 Ton I 1 1 1 I 1 1 1 1 Precinct 4-P 1 Ton 1 1 1 1 1 Precinct 4-S 1 Ton 1 1 1 1 Remarks: Page 33 of 65 Bid Item #8: Item 302, Type PB, Grade 4 (Pre -Coated Rock) or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I Precinct 1 Ton Precinct Ton I I Precinct Ton I I I I I I I I Precinct 4-P I Ton I I I I I I I I I Precinct 4-S ; Ton I Remarks: Item 302, Type PE, Grade 3 (Pre -Coated Rock) Bid Item #9: *Material Source out of * or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I I I Precinct 1 1 Ton I I I I I I Precinct Ton I I I I Precinct Ton I I I I I Precinct4-P I Ton I I I I I I I I I Precinct4-S I Ton I Remarks: Item 302, Type PE, Grade 4 (Pre -Coated Rock) Bid Item #10: *Material Source out of * or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER i I Precinct 1 Ton I I I I I I I I I I Precinct 2 Ton I I ; I I I I Precinct 3 Ton I I I I I I i I I I I Precind4-P I Ton i I I I I I 13recinct4-S ; Ton I Remarks: Page 34 of 65 Bid Item #11: Item 302, Type E, Grade 5, Ice Rock (Non -Coated Limestone Only) or Equivalent Price per ton / delivery price to County Stockpile and/orJobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I Precinct 1 I Ton ! I I I i I I I I I I Precinct Ton I I I I I I I I ' I Precinct 3 I Ton i I I I 1 Precinct4-P I Ton I i i I i I i I I I I I I I Precinct4-S ; Ton I I I I I Remarks: Bid Item #12: Item 330, Type D (Pre -Mix Limestone) or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I Precinct 1 1 Ton I I I I I Precinct 2 ; Ton I I i I I I I Precinct 3 Ton I I I I Precinct4-P i Ton I I I i I I Precinct4-S ; Ton I I I I Remarks: Intentionally Left Blank Page 35 of 65 Bid Item #13: Item 330 D, Pothole Repair, Limestone Rock Asphalt (LRA) or Equivalent See Specifications, Bid Item #13 for more information on this material Price per unit / delivery price to County Stockpile and/or Jobsite (Ton and/or 50 lb Bag) MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I Precinct 1 ; Ton I I I 1 1 I I I 1 50 lb Bag 1 1 Precinct 2 1 Ton i I i i I I I 1 50 lb Bag 1 1 I I i i Precinct 3 1 Ton 1 1 1 1 1 I I I 1 SO lb Bag I 1 I I I 1 I 1 I Precinct 4-P I Ton I I I I I 1 50 lb Bag 1 1 1 1 1 I I Precinct 4-S I Ton , 1 50 lb Bag 1 1 1 1 1 Remarks: Bid Item #14: Item 334, Type D Hot Mix Cold Laid Asphalt Concrete Pavement or Equivalent See Specifications, Bid Item #14 for more information on this materia. Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER Precinct 1 1 Ton 1 1 1 1 Precinct 2 1 Ton 1 1 1 1 1 I I Precinct 3 1 Ton I I 1 Precinct4-P 1 Ton 1 I 1 Precinct4-S 1 Ton 1 1 1 Remarks: Bid Item #15: ASPPM 9202 Grade IV High Performance Cold Mix or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER Precinct 1 1 Ton 1 I I 1 I Precinct z l Ton I 1 1 1 1 Precinct 3 1 Ton 1 1 1 Precinct4-P 1 Ton I 1 1 1 Precinct4-S 1 Ton 1 1 1 Remarks: Page 36 of 65 Bid Item #16: Item 432, Riprap, Section 2.3 Stone Riprap, 12" Limestone or Equivalent Price per ton / delivery price to County Stockpile and/or Jobsite MINIMUM LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER I I Precinct 1 1 Ton I I I I I I I I I I I I I Precinct 2 1 Ton I I I I I I I I I I I Precinct 3 I Ton I I I I I I I I I Precinct 4-P I Ton I I I I I I I I I I I I Precinct4-S I Ton I I I I I I I I Remarks: The undersigned affirms that they are duly authorized to execute this Bid and that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other vendor, that the contents of this Bid as to prices, terms or conditions of said bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this Bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with this Bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date: Authorized Signature & Title: Type Name & Title of Authorized Signature: Phone Number: Email: Exceptions and or Variations from Specifications and/or additional Notes: Page 37 of 65 VENDOR AND ORDER INFORMATION FORM Please Type. If handwritten, must be in ink and legible Vendor's Name: Address: Remittance Address: Telephone: Fax: Email: Signature of Authorized Representative: Printed name of Authorized Rep: ORDER — CONTACT INFORMATION Order Contact Name & Title: Order Contact Telephone: Order Contact Fax: Order Contact Email: INVOICES — CONTACT INFORMATION For Invoice Inquiries: Contact Name & Title: Contact Telephone: _ Contact Fax: Contact Email: Page 38 of 65 STATE OF TEXAS 0 COUNTY OF 0 (Type or Print Name) the AFFIDAVIT being first duly sworn, deposes and says: that he or she is of having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at (Type or Print Physical and Mailing Address) who submits herewith to Calhoun County the attached bid/proposal; that he or she is the person whose name is signed to the attached bid/proposal; that said bid/proposal is genuine; that the same is not sham or collusive; that all statements of fact herein are true; and that such bid/proposal was not made in the interest or behalf of any person, partnership, company, association, organization or corporation not herein named or disclosed. Affiantfurther deposes and says: that the bidder/pro poser has not directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interests of Calhoun County, or of any other bidder/proposer, or anyone else interested in the bid/proposal contract; and that the bidder/proposer has not in any manner sought by collusion to secure for himself/herself/itself/themselves an advantage over any other bidder/proposer. Affiant further deposes and says: that prior to the public opening and reading of bids/proposals, said bidder/proposer: a) did not, directly or indirectly, induce or solicit anyone else to submit a false or sham bid/proposal; b) did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder/proposer or anyone else would submit a false or sham bid/proposal, or that anyone should retrain from submitting a bid/proposal or withdraw their bid/proposal; c) did not, in any manner, directly or indirectly, seek by agreement, communication or conference with anyone to raise or fix the bid price/proposal of said bidder/proposer or of anyone else, or to raise or fix any overhead, profit or cost element of their price/fee or of that of anyone else; d) did not give, offer to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid/proposal; and e) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative hereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent, thereof, to any individual or group of individuals, or to any official, employee or agent of Calhoun County prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained in this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and requirements contained in the bid/proposal. Signature of Affiant Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 20 Signature of Notary Public Notary Stamp/Seal Page 39 of 65 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code 4176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code S 176.006(a) and (a-1) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Fnrm nrnvided by Tevas Fthins Cnmmissinn .ww ethics state tr us CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICELISEONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. !J Name of vendor who has a business relationship with local governmental entity. 2 ❑ Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? ElYes F-1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes FIND 6 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Pag$tj"L6i /30/2015 DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Page 42 of 65 Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. Page 43 of 65 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date Page 44 of 65 Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying; in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Contractors Authorized Official Printed Name and Title of Contractor's Authorized Official Date Page 45 of 65 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enterthe full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 Page 46 of 65 Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial filing _ b. grant _ b. initial award _ b. material change c. cooperative agreement c. post -award d. loan For material change only: a. loan guarantee Year quarter I. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Prime Subawardee Name and Address of Prime: Tier_, if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ifapplicable: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if' (if individual, last name, first name, Ml): diferent,T»m No. 10a) (last name, first name, M1): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) Page 47 of 65 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85"' Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. I, (authorized official) , do hereby verify the truthfulness and accuracy of the contents of the statements submitted on this certification under the provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at https://comptroller.texas.gov/purchasing/publications/divestment.php Company Name Signature of Authorized Official Title of Authorized Official Printed Name of Authorized Official Date Page 48 of 65 RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ I certify that is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) ❑ 1 certify that (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as Page 49 of 65 Request for Taxpayer Give Form to the (Form Rev. October 2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.lrs.gov1FormW9 for Instructions and the latest Information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above m 3 Check appropriate box for federal tax clasaKcation of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codas apply only to following seven boxes. certain entities, not Intlhdtluals; see a Instructions an page 3): 0 ❑ IndMduaYmIa proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust estate 0 single -member LLC Exempt payee cads Of any) 0 ❑Limited liability company. Enter the tax classification (C=G corporation, S=S corporation, P=Partnerehip) ► `p Note: Check the appropriate box in the line above forthe tax classification of the single -member owner. Do not check Exemption from FATCA reporting LLC'd the LLC is classed as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code rf ( an y) T a' another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that IE is disregarded from the owner should check the appropriate box for the tax classification of its owner. Y. ❑ Other ("a instructions) ► wmrx.ro. w„w,nmmw✓m n.usl to a Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) y CALHOUN COUNTY 202 S ANN ST, PORT LAVACA TX 77979 6 City, state, and ZIP code 361.553.4610 FAX:361-563.4614 7 Ust account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I social security number backup withholding. For Individuals, this Is generally your social security number (SSN). However, fore resident alien, sole proprietor, or disregarded entity, see the Instructions for Part I, later. For other _ -Ell entities, it Is your employer Identification number (EIN). If you do not have a number, see How to get a 77N, later. or Note: If the account is In more than one name, see the Instructions for line 1. Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. F_T7 F—F-T-7—r Under penalties of perjury,) certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and 2.1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S. citizen or other U.S, person (defined below); and 4. The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting Is correct. Certification instructions. You must cross out Item 2 above if you have been noted by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. Sae the instructions for Part II, later. sign Signature of Here I U.S. person► Date► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Form W-9 and Its Instructions, such as legislation enacted after they were published, go to www1m.gov/FormiNg. Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an Information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN), Individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an Information return the amount paid to you, or other amount reportable on an Information return. Examples of Information returns Include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Cat No. 10231X • Form 1099-DIV (dividends, Including those from stocks or mutual funds) • Form 1099-MISO (various types of income, prizes, awards, or gross proceeds) • Form 1099-6 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-8 (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuitlon) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. ff you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form Vf-9 (Rev. 10-2018) Page 50 of 65 14191"919 CURRENT AWARDED BID TABULATION FOR THE CURRENT BID PERIOD January 1, 2023 through December 31, 2023 The County went out for Bids for Fly Ash due to no bids received in the original bid. That Current Bid Period for Fly Ash is May 10, 2023 through December 31, 2023 Page 51 of 65 CALHOUN COUNTY, TEXAS AWARDED Bids are Highlighted in Yellow BID TABULATION - AWARD ROAD MATERIALS ANNUAL SUPPLY CONTRACT, BID NUMBER: 2023.03 For the Period Beginning January 1, 2023 and Ending December 31, 2023 4.965 BASELINE PRICE ON OCTOBER 31, 2022 FOR DIESEL FUEL ADJUSTMENT ON DELIVERY PRICE (www.eia.gov/petroleum/gasdiesel) (Gulf Coast Area) Tie Bids: In the event of Tie Bids, the winning bid is determined per Texas Local Government Code 262.027(b). ROAD MATERIALS Bid Item #1: Limestone -1/2 Inch to Dust or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton NO BID NO BID NO BID NO BID MAREK & MAREK TRUCK WASH, INC. DBA FRANK MAREK TRUCKING Precinct Ton NO BID NO BID NO BID NO BID Precinct 3 Ton NO BID NO BID No BID NO BID Precinct 4-P Ton $4.50 $33.95 $38.45 25 TONS X Precinct 4-S Ton $4.50 $29.95 $34.45 25 TONS X Precinct 1 Ton $6.75 $29.10 $35.85 25 TONS X K-C LEASE SERVICE, INC. dba MATAGORDA CONSTRUCTION & MATERIALS Precinct 2 Ton $6.75 $29.10 $35.85 25 TONS X Precinct 3 Ton $6.75 $30.10 $36.85 25 TONS X Precinct 4-P Ton $6.75 $32.60 $39.35 25 TONS Precinct 4-S Ton $6.75 $29.60 $36.35 25 TONS Precinct 1 Ton $6.00 $38.06 $44.06 24 TONS MIDTEX MATERIALS, LLC Precinct 2 Ton $6.00 $38.06 $44.06 24 TONS Precinct 3 Ton $6.00 $38.06 $44.06 24 TONS Precinct 4-P Ton $6.00 $38.06 $44.06 24 TONS Precinct 4-S Ton $6.00 $38.06 $44.06 24 TONS Page 52 of 65 Bid Item #2: Limestone - 3/4 Inch to Dust or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND RENIARIB, IF ANY Precinct 1 Ton NO BID NO BID NO BID NO BID MAREK & MAREK TRUCK WASH, INC. DBA FRANK MAREK TRUCKING Precinct 2 Ton NO BID NO BID NO BID NO BID Precinct 3 Ton NO BID NO BID NO BID No BID Precinct 4-P Ton $4.50 $33.95 $38.45 25 TONS Precinct 4-S Ton $4.50 $29.95 $34.45 25 TONS X Precinct 1 Ton $12.00 $23.00 $35.00 24TONS X QUALITY HOT MIX, INC. REMARK" ALL DELIVERIES ARE IN END DUNIP TRAILERS. BELLY DUMP TRAILERS CAN BE REQUESTED & PROVIDED AVAILABLE Precinct 2 Ton $12.00 $23.00 $35.00 24TONS X Precinct 3 Ton $12.00 $23.00 $35.00 24TONS X Precinct 4-P Ton $12.00 $23.00 $35.00 24TONS X Precinct4-S --tIF Ton $12.00 $23.00 $35.00 24TONS Precinct 1 Ton $7.00 $29.10 $36.10 25 TONS K-C LEASE SERVICE, INC. dba MATAGORDA CONSTRUCTION & MATERIALS Precinct 2 Ton $7.00 $29.10 $36.10 25 TONS Precinct 3 Ton $7.00 $30.10 $37.10 25 TONS Precinct 4-P Ton $7.00 $32.60 $39.60 25 TONS Precinct 4-S Ton $7.00 $29.60 $36.60 25 TONS Precinct 1 Ton $6.00 $32.50 $38.50 24TONS COLORADO MATERIALS, LTD REIVIARKS: PICKUP L.00ATIKAN: HUNTER, TYC Precinct Ton $6.00 $32.50 $38.50 24TONS Precinct 3 Ton $6.00 $34.50 $40.50 24TONS Precinct4-P Ton $6.00 $38.50 $44.50 24TONS Precinct 4-S Ton $6.00 $34.50 $40.50 24TONS Precinct 1 Ton $6.00 $38.06 $44.06 24TONS MIDTEX MATERIALS, LLC Precinct 2 Ton $6.00 $38.06 $44.06 24TONS Precinct 3 Ton $6.00 $38.06 $44.06 24TONS Precinct 4-P Ton $6.00 $38.06 $44.06 24TONS Precinct 4-S Ton $6.00 $38.06 $44.06 24TONS Page 53 of 65 Bid Item #3: Item 247, Type A Limestone, Grade 2 [13/4 Inch] or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, If ANY Precinct 1 Ton NO BID NO BID NO BID NO BID MAREK & MAREK TRUCK WASH, INC. DBA FRANK MAREK TRUCKING Precinct 2 Ton NO BID NO BID NO BID NO BID Precinct 3 Ton NO BID NO BID NO BID NO BID Precinct 4-P Ton $4.00 $33.95 1 $37.95 25 TONS Precinct 4-S Ton $4.00 $29.95 $33.95 25 TONS X Precinct 1 Ton $12.00 $23.00 $35.00 24TONS X QUALITY HOT MIX, INC. REMARKS: AU. DELIVERIES ARE IN END DUIVIP TRAILERS. BELLY DUMP MAILERS CAN BE REQUESTED & PROVIDED IF IIVAILABE ": Precinct Ton $12.00 $23.00 $35.00 24TONS X Precinct 3 Ton $12.00 $23.00 $35.00 24TONS X Precinct 4-13 Ton $12,00 $ 23.00 $35.00 24 TONS X Precinct 4-S Ton $12.00 $23.00 $35.00 24TONS Precinct 1 Ton $6.15 $29.10 $35.25 25 TONS K-C LEASE SERVICE, INC. dba MATAGORDA CONSTRUCTION & MATERIALS Precinct 2 Ton $6.15 $29.10 $35.25 25 TONS Precinct 3 Ton $6.15 $30.10 $36.25 25 TONS Precinct 4-P Ton $6.15 $32.60 $38.75 25 TONS Precinct 4-S Ton $6.15 $29.60 $35.75 25 TONS Precinct 1 Ton $24.00 $13.00 $37.00 24 TONS COLORADO MATERIALS, LTD REMARKS: PICKUP LOC.ATiOIPI: NLII'1,SERY, TX Precinct 2 Ton $24.00 $12.00 $36.00 24TONS Precinct Ton $24.00 $14.00 $38.00 24TONS Precinct 4-P Ton $24.00 $15.00 $39.00 24 TONS Precinct 4-S Ton $24.00 $13.00 $37.00 24 TONS Precinct Ton $6.00 $38.06 $44.06 24TONS MIDTEX MATERIALS, LLC Precinct 2 Ton $6.00 $38.06 $44.06 24 TONS Precinct 3 Ton $6.00 $38.06 $44.06 24TONS Precinct4-P Ton $6.00 $38.06 $44.06 24TONS Precinct 4-S Ton $6.00 $38.06 $44.06 24 TONS Page 54 of 65 Bid Item #4: Item 247, Type A Limestone, Grade 3 [1 3/4 Inch] or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND RLIOARKS, IF ANY Precinct 1 Ton $12.00 $23.00 $35.00 24TONS X QUALITY HOT MIX, INC. REMARKS: ALL DELIVEMES ARE IN END DUMP TRAII..CRE. BELLY DUPRP TRAILERS CAN SEREQUESTED &PROVIDED IF AVAILABLE Precinct Ton $12.00 $23.00 $35.00 24TONS X Precinct 3 Ton $12.00 $23.00 $35.00 24TONS X Precinct4-P Ton $12.00 1 $23.00 1 $35.00 24TONS X Precinct 4-S Ton $12.00 $23.00 $35.00 24 TONS X Precinct 1 Ton $24.00 $13.00 $37.00 24 TONS COLORADO MATERIALS, LTD REIVIARKS: PICKUP L(KATION: NURSERY, TX Precinct 2 Ton $24.00 $12.00 $36.00 24TONS Precinct Ton $24.00 $14.00 $35.00 24TONS Precinct 4-P I Ton 1 $24.00 $15.00 $39.00 24TONS Precinct 4-S I Ton 1 $24.00 $13.00 $37.00 24TONS Bid Item #5: Item 265-2.2 Fly Ash or Equivalent Fly Ash that meets the requirements of DMS 4615 "Fly Ash for Soil Treatment" Class CS or FS Delivered in pneumatic tankers with spreader bar MINIMUM No Bids BIDDER LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER Received AMID REMARKS, IF ANY Precinct 1, 2, 3, Ton NO BIDS RECEIVED 4-P & 4-S Bid Item #6: Item 275, Cement or Equivalent 275-2.1, Hydraulic Cement Type 1, Bulk (Pneumatic Tankers, Spreader Bar Needed) 275.2-1, Hydraulic Cement Type 1, 47 lb Bag (Cost per Pallet) List If of 47 Ib Bags on a Pallet MINIMUM No Bids BIDDER LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER Received AND REMARKS, IF ANY Precinct 1, 2, 3, Tan 4-P & 4-S NO BIDS RECEIVED _ of 47 Lb Bags on Pallet Page 55 of 65 Bid Item #7: Item 302, Type PB, Grade 3 (Pre -Coated Rock) or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $64.00 $14.00 $78.00 25 TONS X QUALITY HOT MIX, INC. REMARKS: ALL DELIVERIES ARE IN ENE> DUMP _1 RAILERS. BELLY DUNIP TRAILERS CAN BE REQUESTED &+ PROVIDED IF AVAILABLE Precinct 2 Ton $64.00 $14.00 $78.00 25 TONS X Precinct 3 Ton $64.00 $14.00 $78.00 25 TONS X Precinct 4-P Ton $64.00 $14.00 $78.00 25 TONS X Precinct 4-S Ton $64.00 $14.00 $78.00 25 TONS X Precinct 1 Ton $50.00 $32.50 $82.50 24TONS COLORADO MATERIALS, LTD REMARKS: PICKUP LOCATION: HUNTER, Tx Precinct Ton $50.00 $32.50 $82.50 24TONS Precinct Ton $50.00 $34.50 $84.50 24TONS Precinct4-P Ton $50.00 $38.50 $88.50 24TONS Precinct4-S Ton $50.00 $34.50 $84.50 24TONS Precinct Ton $36.00 $53.90 $89.90 24TONS VULCAN CONSTRUCTION MATERIALS, LLC Precinct 2 Ton $36.00 $55.00 $91.00 24 TONS Precinct 3 Ton $36.00 $57.20 $93.20 24TONS Precinct 4-P Ton 1 $36.00 $55.00 $91.00 24TONS Precinct 4-S Ton $36.00 $55.00 $91.00 24TONS Precinct Ton $50.00 $45.15 $95.15 24TONS MIDTEX MATERIALS, LLC Precinct Ton $50.00 $45.15 $95.15 24TONS Precinct 3 Ton $50.00 $45.15 $95.15 24TONS Precinct 4-P Ton $50.00 $45.15 $95.15 24TONS Precinct 4-S Ton $50.00 $45.15 $95.15 24TONS Page 56 of 65 Bid Item #8: Item 302, Type PB, Grade 4 (Pre -Coated Rock) or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND RFIVIARKS,IF .ANY Precinct 1 Ton $65.50 $14.00 $79.50 25TONS X QUALITY HOT MIX, INC. ALL OELIVERIEs ARL UJ END DUMP TRAILERS. BELLY DJMAP TRAILERS CAN RE R'EQIJF` TED & PROVIDED IF .AVAILA„LE Precinct 2 Ton $65.50 $14.00 $79.50 25TONS X Precinct Ton $65.50 $14.00 $79.50 25TONS X Precinct4-P Ton $65.50 $14.00 $79.50 25TONS X Precinct 4-S Ton $65.50 1 $14.00 1 $79.50 25TONS X Precinct 1 Ton $50.00 $32.50 $82.50 24TONS COLORADO MATERIALS, LTD REMARKS: PICKUP 1_0CATI0N: 1-i IJN fER, TX Precinct 2 Ton $50.00 $32.50 $82.50 24TONS Precinct 3 Ton $50.00 $34.50 $84.50 24TONS Precinct4-P Ton $50.00 1 38.50 1 $88.50 1 24TONS Precinct 4-S Ton $50.00 $34.50 $84.50 24 TONS Precinct 1 Ton $35.00 $53.90 $88.90 24TONS VULCAN CONSTRUCTION MATERIALS, LLC Precinct 2 Ton $35.00 $55.00 $90.00 24TONS Precinct 3 Ton $35.00 $57.20 $92.20 24TONS Precinct4-P Ton $35.00 $55.00 $90.00 24TONS Precinct4-S Ton $35.00 $55.00 $90.00 24TONS Precinct 1 Ton $52.00 $45.15 $97.15 24 TONS MIDTEX MATERIALS, LLC Precinct Ton $52.00 $45.15 $97.15 24TONS Precinct 3 Ton $52.00 $45.15 $97.15 24 TONS Precinct 4-P Ton $52.00 1 $45.15 1 $97.15 24 TONS Precinct 4-S Ton $52.00 $45.15 $97.15 24 TONS Page 57 of 65 Bid Item #9: Item 302, Type PE, Grade 3 (Pre -Coated Rock) *Material Source out of * or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER No Bids Received BIDDER AND REMARKS, IFANI Precinct 1 Ton NO BIDS RECEIVED Precinct 2 Ton Precinct 3 Ton Precinct 4-P Ton Precinct 4-S I Ton Bid Item #10: Item 302, Type PE, Grade 4 (Pre -Coated Rock) *Material Source out of * or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER No Bids Received BIDDER AND REMARKS, IF ANY Precinct 1 Ton NO BIDS RECEIVED Precinct 2 Ton Precinct3 Ton Precinct 4-P Ton Precinct 4-S I Ton Bid Item #11: Item 302, Type E, Grade 5, Ice Rock (Non Coated Limestone Only) or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $18.48 $29.10 $47.58 25 TONS X K-C LEASE SERVICE, INC. CO MNSTRRUCTIOUCTIO DA CON & MATERIALS Precinct 2 Ton $18.48 $29.10 $47.58 25 TONS X Precinct 3 Ton $18.48 $30.10 $48.58 25 TONS x Precinct 4-P Ton $18.48 $32.60 $51.08 25 TONS X Precinct 4-S Ton $18.48 $29.60 $48.08 25 TONS x Precinct 1 Ton $30.00 $32.50 $62.50 24TONS COLORADO MATERIALS, LTD REMARKS: P1EiQ)P LXL).TI✓:DN: FIIt 11 FER, T" Precinct 2 Ton $30.00 $32.50 $62.50 24TONS Precinct Ton $30.00 $34.50 $64.50 24TONS Precinct4-P Ton $30.00 $38.50 $68.50 24TONS Precinct 4-S Ton $30.00 $34.50 $64.50 24 TONS Precinct 1 Ton $35.00 $30.00 $65.00 24 TONS QUALITY HOT MIX, INC. REMARKS: ALL DELIVERIES ARE IN END DUMP TRAILERS. REILLY DUMP TRAILERS CAN BE REQUESTED fx PROVIDED If- AVAILABLE Precinct Ton $35.00 $30.00 $65.00 24 TONS Precinct Ton $35.00 $30.00 $65.00 24TONS Precinct 4-P Ton $35.00 $30.00 $65.00 24TONS Precinct 4-S Ton $35.00 $30.00 $65.00 24TONS Page 58 of 65 Bid Item #12: Item 330, Type D (Pre -Mix Limestone) or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $70.00 $53.90 $123.90 24 TONS X VULCAN CONSTRUCTION MATERIALS, LLC Precinct Ton $70.00 $55.00 $125.00 24TONS X Precinct Ton $70.00 $57.20 $127.20 24TONS X Precinct 4-P Ton $70.00 $55.00 $125.00 24 TONS X Precinct 4-S Ton $70.00 $55.00 $125.00 24 TONS X Bid Item #13: Item 330, Type D, Pothole Repair, Limestone Rock Asphalt (LRA) or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM AWARD BIDDER LOAD/ORDER AND REMARKS, IF ANY NO BID NO BID NO BID NO BID Precinct 1 Ton 50 lb Bag $17.00 $0.00 $17.00 62 BAGS X 1 PALLET Ton NO BID NO BID NO BID NO BID Precinct 2 50 lb Bag $17.00 $0.00 $17.00 62 BAGS X 1 PALLET Ton NO BID NO BID NO BID NO BID Precinct 3 BLADES GROUP LLC 50 lb Bag $17.00 $0.00 $17.00 62 BAGS X 1 PALLET Ton NO BID NO BID NO BID NO BID Precinct 4-P 50 lb Bag $17.00 $0.00 $17.00 62 BAGS X 1 PALLET Ton NO BID NO BID NO BID NO BID Precinct 4-S 50 lb Bag $17.00 $0.00 $17.00 62 BAGS X 1 PALLET Intentionally Left Blank --Continued on next page Page 59 of 65 Bid Item #14: Item 334, Type D, Hot Mix Cold Laid Asphalt Concrete Pavement or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDMINIMUM ER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $100.00 $14.00 $114.00 25 TONS X QUALITY HOT MIX, INC. REIYtARKS: ALL DELIVERIES ARE IN ERID DUMP 'TRAILERS. BELLY DUMP TRAILE16 CANI BE. REQUESTED 8, PROVIDED IF A AILA13LE Precinct 2 Ton $100.00 $14.00 $114.00 25 TONS X Precinct 3 Ton $100.00 $14.00 $114.00 25 TONS X Precinct 4-P Ton $100.00 $14.00 $114.00 25 TONS X Precinct4-S Ton $100,00 $14.00 $114.00 25TONS X Precinct Ton $86.00 $37.50 $123.50 24TONS COLORADO MATERIALS, LTD REMARKS: PICKUP LOCATION: HUNTER, TX Precinct 2 Ton $86.00 $37.50 $123.50 24 TONS Precinct 3 Ton $86.00 $39.50 $125.50 24 TONS Precinct 4-P Ton $86.00 $43.50 $129.50 24 TONS Precinct 4-S Ton $86.00 1 $39.50 1 $125.50 24 TONS Precinct 1 Ton $95.00 $46.55 $141.55 25 TONS WALLER COUNTY ASHPALT, INC. Precinct 2 Ton $95.00 $47.08 $142.08 25 TONS Precinct 3 Ton $95.00 $42.35 $137.35 25 TONS Precinct 4-P Ton $95.00 1 $53.55 1 $148.55 1 25 TONS Precinct 4-S Ton $95.00 $52.85 $147.85 25 TONS Intentionally Left Blank -- Continued on next page Page 60 of 65 Bid Item #15: ASPPM 9202 Grade IV High Performance Cold Mix or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/OMINIMUM RDER AWARD BIDDER AND RENIARKS, IF ANY Precinct 1 Ton $105.00 $46.55 $151.55 25 TONS X WALLER COUNTY ASHPALT, INC. Precinct 1 Ton $105.00 $47.08 $152.08 25 TONS X Precinct 3 Ton $105.00 $42.35 $147.35 25 TONS X Precinct 4-P Ton $105.00 $53.55 $158.55 25 TONS X Precinct 4-S Ton $105.00 $52.85 $157.85 25 TONS X Bid Item #16: Item 432 Riprap, Section 2.3 Stone Riprap, 12" Limestone or Equivalent LOCATION Unit MATERIAL DELIVERY TOTAL LOMINIMUM AD/ORDER AWARD BIDDER AND REMARKS, IF ANY Precinct 1 Ton $28.00 $79.98 $107.98 24TONS X MIDTEX MATERIALS, LLC Precinct 1 Ton $28.00 $79.98 $107.98 24TONS X Precinct 3 Ton $28.00 $79.98 $107.98 24TONS X Precinct 4-P Ton $28.00 $79.98 $107.98 24TONS X Precinct 4-S Ton $28.00 $79.98 $107.98 24TONS X Page 61 of 65 CALHOUN COUNTY, TEXAS AWARDED BID TABULATION FLY ASH ROAD MATERIAL BID NUMBER: 2023.06 For the Period Beginning May 10, 2023 and Ending December 31, 2023 3.930 BASELINE PRICE ON March 20, 2023 FOR DIESEL FUEL ADJUSTMENT ON DELIVERY PRICE (www.eia.gov/petroleum/gasdiesel) (Gulf Coast Area) FLY ASH - ROAD MATERIAL (Bid Item Listed or Equivalent) Bid Item: Item 265-2.2 Fly Ash or Equivalent Non Spec Class C Fly Ash with Sulfur content greater than 6%, Delivered in pneumatic tankers with spreader bar LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM LOAD/ORDER BIDDER AND REMARKS, IF ANY Precinct 1 I I I Ton $ 50.00 $ 112.00 $ I 162.00 23.50 MIDTEX MATERIALS, LLC Remarks: I I I I I Precinct I Ton I $ 50.00 $ 112.00 ; $ 162.00 I 23.50 Precinct 3 Ton $ 50.00 $ 114.00 $ 164.00 23.50 Total Plus Fuel Surcharge & $100/hr Demurrage after 1 hour Precinct 4-P Ton $ 50.00 ; $ 116.00 ; $ 166.00 ; 23.50 I I 113recinct 4-S Ton I $ 50.00 ; $ 114.00 I $ 164.00 ; 23.50 Page 62 of 65 CONTRACT THIS CONTRACT, made and entered into this day of , 20_ by, and between the County of Calhoun (hereinafter called "County') and (hereinafter called "Contractor/Hauler'). W ITNESSETH: WHEREAS, the Contractor/Hauler did on November 30, 2023, submi a BID for ROAD MATERIALS, Bid Number 2024.02 to be used by County Precincts in Calhou nty, Texas. i. Inv' tion t Instructions ii. on , Bid Specification Bid Form; This instrument; of and covenant, it is vi. 14ffikoddencla or chajges to the foregoing documents agreed to by the parties 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 CONTRACTOR/HAULER (IN INK): DATE: INITIALS OF COUNTY (IN INK): DATE: Page 63 of 65 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 gen y of the foregoing, "Force Majeure" shall include, but not restricted to the foll ing types of events: acts of God or public enemy; acts of governme or regulat y authorities; fires, floods, epidemics or serious accidents; u w her conditions; strikes, lockouts, or other labor dispu d defaults b tractors. Any event constituting a Force Maje must rted by the Co or/ auler to the County in writing, wi in y-four hours, and discl the estimated length of delay, and cause of th 3) The Contrac Hau , requir ust deliver all materials ordered by the County wi twenty-four urs fro ti a of the order or the date and ti a sped by the County. a even a Contractor/Hauler is unable to e I(s) ordered with twenty-four (24) hours from the time of the order or the dat me specifie y the County, the County reserves the right to cancel the order the said material(s) from the vendor which ubmitted the next west bid and can deliver within twenty-four (24) hours or ate and time sp cified by the County. 4) In tha provision or portion thereof of any Contract Document shall be found o e 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): INITIALS OF COUNTY (IN INK): DATE:_ DATE: Page 64 of 65 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, 2024 and end on December 31, 2024. COUNTY: ATTEST: CALHOUN COUNTY 0 Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: Page 65 of 65 # 09 NC)I-ICE Of= MEE rING -- 1.1/1/1023 9. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Asphalts, Oils and Emulsions, Bid Number 2024.03 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern,Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 12 Mae Belle Cassel From: demi.cabrera@calhouncotx.org (demi.cabrera) <demi.cabrera@calhouncotx.org> Sent: Thursday, October 26, 2023 10:18 AM To: MaeBelle.Cassel@calhouncotx.org Subject: Agenda Items for Court 11/1/2023 -Annual Bids Good Morning, Can you please place the following items on the agenda for Commissioner's Court on November 1, 2023: • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Insecticides for Mosquito Control, Bid Number 2024.01 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bid will be due before 2:00:00 PM, Thursday, November 30, 2023. Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual Supply Contract for Road Materials, Bid Number 2024.02 for the period January 1, 2024 through December 31, 2024 and authorize the County Auditor to advertise for the bids. Bids will be due before 2:00:00 PM, Thursday, November 30, 2023. • Consider and take necessary action to approve the Specifications and the Invitation to Bid Packet for the Annual 1_ Supply Contract for Asphalts, Oils and Emulsions, Bid Number 2024.03 for the period January 1, 2024 through XTXr December 31, 2024 and authorize the County Auditor to advertise for the bids. Bid will be due before 2:00:00 PM, Thursday, November 30, 2023. Thank you, PD mi Cahra-ra Calhoun County , aWatnnt iluditor 3G1-553-4G13 3G1-553-�kGl4 (f aX) Calhoun County Texas CALHOUN COUNTY, TEXAS INVITATION TO BID ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS BID NUMBER: 2024.03 BID TERM: JANUARY 1, 2024 THROUGH DECEMBER 31, 2024 SEALED BIDS ARE DUE BEFORE: 2:00:00 PM, Thursday, November 30, 2023 AT THE OFFICE OF: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3'd Floor, Suite 301 Port Lavaca, Texas 77979 Public Opening of the Bids will be conducted immediately after the closing of the 2:00:00 PM deadline, Thursday, November 30, 2023 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas 77979. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. Award information will be sent to all vendors that submitted a Bid and, as time permits, will be posted on the County's website (www.calhouncotx.org) under Public Notices, Bid Notices and Results, Results, 2023. Page 1 of 53 CONTENTS • Invitation to Bid (Page 3-4) • Return Instructions (Page 5) • General Conditions (Page 6-19) • Specifications (Page 20-27) • Contact, Billing and Location Information for Calhoun County Precincts (Page 28) • Required Forms to be returned when submitting a Bid (Page 29-46) If any Required Form is "Not Applicable", mark "NA" and include when submitting a Bid o Invitation to Bid Form (Page 30-33) o Vendor and Order Information Form (Page 34) o Affidavit (Page 35) o Conflict of Interest Questionnaire Form CIQ (Page 37) o Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 40) o Certification Regarding Lobbying (Page 41) o Disclosure of Lobbying Activities (Page 43) o House Bill 89 Verification (Page 44) o Residence Certification (Page 45) o W-9 (Page 46) OTHER INFORMATION INCLUDED WITH THE INVITATION TO BID PACKET Current (2023) Awarded Bid Tabulation for the Annual Supply Contract for Asphalts, Oils and Emulsions for the period January 1, 2023 through December 31, 2023 (Page 47-50) Copy of Contract (to be completed AFTER the Bid is awarded) (Page 51-53) Page 2 of 53 INVITATION TO BID Notice is hereby given that the Commissioners Court of Calhoun County, Texas, will receive SEALED BIDS for Asphalts, Oils and Emulsions for the County's Road and Bridge Precincts. BID NUMBER: 2024.03, ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS Bids are for a one (1) year period: January 1, 2024 through December 31, 2024 The complete Invitation to Bid Packet can be downloaded from the County's website, www.calhouncotx.org (under Public Notices, Bid Notices and Results, Bid Notices, 2023) or by contacting Demi Cabrera, Assistant Auditor, at demi.cabrera@calhouncotx.org or 361-553- 4613. SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023. Immediately after the closing of the 2:00:00 PM deadline, all Bids will be publicly opened in the County Judge's office in the Calhoun County Courthouse at 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. Bids will be considered for award at a future meeting of the Calhoun County Commissioners Court. It is the responsibility of the submitting vendor to ensure that the sealed Bid is received in a timely manner. Calhoun County does not accept faxed or emailed Bids. Calhoun County accepts no financial responsibility for any cost incurred by any entity in the course of responding to the Bid. Bids received after the deadline will not be opened and will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting vendor. All bids (one original) must be delivered to the office of the Calhoun County Judge before 2:00:00 PM, Thursday, November 30, 2023 in a SEALED 9 x 12 or larger envelope and CLEAREY MARKED on the outside of the envelope: SEALED BID NUMBER 2024.03 ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the Bid is received and the 2:00:00 PM deadline. Bids shall include all requirements of the Invitation to Bid Packet for Bid Number 2024.03, Annual Supply Contract for Asphalts, Oils and Emulsions. SEALED BIDS MAY BE HAND DELIVERED OR MAILED TO: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3'd Floor, Suite 301 Port Lavaca, TX 77979 Page 3 of 53 Calhoun County Commissioners Court reserves the right to waive any formality, technicality or irregularity, accept or reject any and or all Bids and to accept the Bid deemed most advantageous to and in the best interest of Calhoun County. The award of a Bid shall be made to the responsible vendor whose Bid is determined to be the most beneficial to Calhoun County, taking into consideration the relative importance of price and other factors set forth in the Invitation to Bid Packet. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and Labor Surplus Area Firms are encouraged to submit Bids. Candice Villarreal County Auditor Calhoun County, Texas Page 4 of 53 RETURN INSTRUCTIONS For Submitting a Bid for ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS Bid Number: 2024.03 Bid Period: January 1, 2024 through December 31, 2024 Return the following BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023 Check List for submitting your Bid: Return One (1) Original of only the following forms Be sure all of the below farms are completed, signed, dated and returned. if "Not Applicable", mark "NA" and include when submitting a Bid. The submitted Bid consists only of the following forms (only the below forms need to be returned) Invitation to Bid Form (Page 30-33) Vendor and Order Information Form (Page 34) Affidavit (Page 35) Conflict of Interest Questionnaire, Form CIQ (Page 37) Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 40) Certification Regarding Lobbying (Page 41) Disclosure of Lobbying Activities (Page 43) House Bill 89 Verification (Page 44) Residence Certification (Page 45) W-9 (Page 46) Do Not Fold any of the above information. Bid must be returned in a SEALED 9 x 12 or larger envelope clearly marked: SEALED BID NUMBER 2024.03 —ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS If you send your bid by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2024.03 —ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS Sealed Bid may be hand delivered or mailed to: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, TX 77979 Bid must be sealed (with the glue on the envelope or tape) Page 5 of 53 CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFQ and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ and/or Contract. All parties agree that the venue for any litigation arising from this Bid, RFP, RFQ, and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid, RFP, RFQ, and/or Contract Forms: Once the Bid, RFP, RFQ, and/or Contract is released forbidding, Calhoun Countywill not answerany questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ, and/or Contract is due. The Bid, RFP, RFQ, and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ, and/or Contract in collusion with any other bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidders/vendor's Bid, RFP, RFQ, and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Submission of Sealed Bid, RFP, RFQ, and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ, and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ, and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3`d Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ and/or Contract will specify the date and time due. Page 6 of 53 The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ, and/or Contract is received and the time deadline that the Bid, RFP, RFQ, and/or Contract will be opened. A late delivery with an early postmark or delivery of the Bid, RFP, RFQ and/or Contract to the wrong office will not suffice. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting bidder/vendor. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ, and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ, or Contract) and the name of the Bid, RFP, RFQ or Contract. If the Bid, RFP, RFQ and/or Contract is sent by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid, RFP, RFQ, and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ, and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ and/or Contract price. Bids, RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid, RFP, RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum or approved the addendum to be sent out by the Engineer with the approval from the County Commissioner or County Department in charge of the project. Page 7 of 53 Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmlessfrom all suits, actions, orfor personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidders/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ, and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employers liability and auto insurance with adequate limits to cover bidder's/vendors liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendors insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendors performance under this Bid, RFP, RFQ, and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashiers checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes under Section 151.309 of the Texas Tax Code. Tax exempt forms will be furnished upon request to the bidder/vendor. Tax exempt forms can be obtained from the Calhoun County Auditor's Office. Bidder/vendor is to issue its Texas Resale Certificate to vendors and subcontractors for such items qualifying for this exemption, and further, bidder/vendor should state these items at cost. Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink ortypewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at any time to inspect said premises. Page 8 of 53 Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/orservices fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the "Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ, and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ, and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the sole judge in determining which Bid, RFP, RFQ, and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ, and/or Contract based on lowest and/or best Bid, RFP, RFQ and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ, and/or Contract" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ, and/or Contract is determined perthe Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ, and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ, and/or Contract: If the Bid, RFP, RFQ, and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Page 9 of 53 Obligation of the Bid, RFP, RFQ, and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery: All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) orfailure to meet specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Resections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFQ, and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFQ and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default maybe construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFQ and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFQ and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFQ, and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties —Form 1295 Section 2252.908 was added to the Government Code by the 84`" Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85`" Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Page 10 of 53 Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 ofthe Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf—info—forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity' includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFQ, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFQ and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enterthe required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. A business entity will generate Form 1295 online after notification of award and submit with their signed contract. (See Attachment A to General Conditions) No laterthan thirty (30) days after Calhoun County Commissioners Court approves a contract with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ, and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFQ, and/or Contract submission and the time of execution of the Bid, RFP, RFQ and/or Contract. A print out of the search results that includes the record date showing that the Company, and its Principals, if any, have an active registration with the System for Award Management (www.SAM.gov) AND are not Page 11 of 53 debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM) must be included with the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFQ, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFC, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/or free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solelyfrom funds available forthe purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ, Contract, order, and/or service. In the event a Bid, RFP, RFQ Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County Page 12 of 53 may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFQ, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFQ and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFQ, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrant that all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Maieure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFQ and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFQ, and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFQ, and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Page 13 of 53 Waiver: No claim or right arising out of a breach of any Bid, RFP, RFQ and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable Law: To the extent it is applicable, this Bid, RFP, RFO, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code' as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFQ and/or Contract. Otherwise, Texas state and federal law shall apply. Prohibition against Personal Interest in Bids, RFPs, RFQs, and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFC, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contracting with Calhoun County shall render the Bid, RFP, RFQ and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFQ, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFQ and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. o General Liability ($100,000/$300,000 or greater) o Workers' Compensation (at Statutory Limits) o Employer's Liability ($1,000,000 or greater) o Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) o Professional Liability Insurance (if applicable) o Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidders/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall Page 14 of 53 be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any mannerthe liability or obligations of the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFC, and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFQ and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFQ, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFQ, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: o Name, mailing address and business phone number of the protesting party; o Appropriate identification of the Bid, RFP, RFQ, and/or Contract being protested; o A precise statement of the reasons for the protest; and o Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditors Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Page 15 of 53 Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFQ, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or by judicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 The Packet, Invitation for Bids, Request for Proposals and/or Request for Qualifications are posted on Calhoun County's website, www.calhouncotx.org, under Public Notices, Bid Notices and Results. Page 16 of 53 ATTACHMENT A CALHOUN COUNTY, TEXAS GENERAL CONDITIONS CERTIFICATE OF INTERESTED PARTIES FORM 1295 A business entity will generate Form 1295 online after notification of award and submit with theirs igned contract. Form 1295 must be filled out and submitted online, printed, complete #6, signed and returned with the Agreement, Contract, or Lease. See Calhoun County, Texas — Policy of Compliance TO FILL OUT FORM 1295: Go to: https://www.ethics.state.tx.us/File 1. If you have an account, login and proceed with the processor if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2.. Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only'. 3. The Respondent or an authorized agent of the Respondent must sign and date the printed copy of the form (making sure all of #6 is completed). 4. The completed Form 1295 must be included with your Agreement, Contractor Lease, when it is submitted to Calhoun County. For help in filling out the form: #1 Name of Business Entity filing the form, and the City, State and Country of the Entity's place of business #2 Calhoun County, Texas (Also, if applicable, insert name of County Department) #3 • Contract number, if not given, can be the year or dates associated with the Agreement, Contract, Lease or if for a Bid, RFP, or RFQ, the Bid, RFP, RFQ number and dates the Bid, RFP, RFQ pertains to • Description is description of Agreement, Contract, Lease or name of Bid, RFP, RFQ On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, submit and print After printing, the respondent or an authorized agent of the respondent must sign and date (making sure all of #6 is completed) When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". Page 17 of 53 CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`0 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. ` 1. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. ♦ 3 Provide the identification number used by the governmental entity or state agency to tit kk' p identify the contract, and provide a description of the services, goods, or other property to be provided a contract. XIV a Q City, State, Country Nature of Interest (check applicable) Name of Interested Party (place of business) � ♦ Controlling Intermediary 5 ❑Check only if there " I terested Party. s UNSWORN DEC=L1� N My name is A� and my date of birth is � My addre , �-�`J' (street) (city) (state) (zip code) (country) Idcl�nder penally of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission w .ethics.state.tx.us PageRIAM(532/22/2017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 and September 14, 2022 BACKGROUND Section 2252.908 was added to the Government Code by the 84th Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state.tx.us/whatsnew/elf_ info _form1295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. Page 19 of 53 SPECIFICATIONS FOR ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS BID NUMBER: 2024.03 BY ORDER of the Commissioners Court of Calhoun County, Texas, sealed Bids will be received for Asphalts, Oils and Emulsions for the County's Road and Bridge Precincts. Contact, billing and location for each Calhoun County Road and Bridge Precinct can be found on the Form: Contact, Billing and Location Information for Calhoun County Precincts INVITATION TO BID PACKET The complete Invitation to Bid Packet may be downloaded from the County's website, www.calhouncotx.org (under Public Notices, Bid Notices and Results, Bid Notices, 2024) or by contacting Demi Cabrera, Assistant Auditor, at demi.cabrera@calhouncotx.org or 361-553- 4613. The complete Invitation to Bid Packet must be used in preparing the Bid. Calhoun County does not assume any responsibility for errors or misinterpretations resulting from the use of an incomplete Invitation to Bid Packet. SUBMISSION OF SEALED BIDS SEALED BIDS ARE DUE BEFORE 2:00:00 PM, THURSDAY, NOVEMBER 30, 2023 in the County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. ALL BIDS (one original) shall be delivered to the office of the Calhoun County Judge in a SEALED 9 x 12 or larger envelope and CLEARLY MARKED on the outside of the envelope: SEALED BID NUMBER 2024.03 ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS If the SEALED BID is sent by UPS, FedEx, or other delivery service, the outside of this envelope must be clearly marked: SEALED BID NUMBER 2024.03 ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS SEALED BIDS may be hand delivered or mailed to: Honorable Richard H. Meyer Calhoun County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, Texas 77979 A late delivery with an early postmark will not suffice. Page 20 of 53 Calhoun County is not responsible for the delivery of your Bid to the office of the County Judge or delivery to the wrong office. If you choose to send your Bid by postal delivery, it is recommended that you call the County Judge's office at 361-553-4600 to verify receipt of your Bid prior to the Bid due date and time. It is the responsibility of the submitting vendor to ensure that the sealed Bid is received in a timely manner. Calhoun County does not accept faxed or emailed Bids. Calhoun County accepts no financial responsibility for any cost incurred by any vendor in the course of responding to the Bid. Bids received after the deadline will not be opened and will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting vendor. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that shall be used in determining the time the Bid is received and the 2:00:00 PM deadline. No Bids will be accepted after the due date and 2:00:00 PM deadline has been reached. BID TERM The Bid shall be in effect for a period of one (1) year: January 1, 2024 through December 31, 2024 BID INFORMATION/REQUIREMENTS To submit a valid Bid, read the entire Invitation to Bid Packet for all requirements and required forms that must be included and returned with the submitted Bid. Calhoun County is always very conscious and extremely appreciative of the time and effort you have expended to submit a Bid. If you will not be submitting a Bid, we would appreciate you indicating on your "NO BID" response any requirements of this Bid request which may have influenced your decision to "NO BID". Calhoun County is not responsible for errors if the Bid forms are handwritten. It is recommended that all information submitted by the vendor on the Bid forms be typed. If handwritten, must be in ink and legible. White out is not acceptable. Asphalts, Oils and Emulsions shall meet or exceed "Texas Department of Transportation Current Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges" and/or Calhoun County requirements. ASPHALTS, OILS AND EMULSIONS (Bid Item Listed or Equivalent) Bid Item #1: Primer Oil or Equivalent Bid Item #2: P2 Prime Concentrate or Equivalent Bid Item #3: RC-250 or Equivalent -- Temperature must be no lower than 140' Bid Item #4: CRS-2 or Equivalent -- Temperature must be no lower than 150' and no higher than 180' Bid Item #5: P2 CWE-2 or Equivalent Page 21 of 53 Vendor may submit a Bid for any or all Asphalts, Oils and Emulsions or Equivalent for any location. Vendor must be able to furnish Bid items under terms of these specifications and general conditions if vendor is awarded a Bid. Calhoun County is EXEMPT from all Sales Tax (county, city and state sales tax) and all Federal Excise Taxes, if applicable under Section 151.309 of the Texas Tax Code. Upon request, tax exempt forms will be furnished to the vendor by the County Auditor's Office. Vendor is to issue its Texas Resale Certificate to vendors or subcontractors for such items qualifying for this exemption. Pump and hoses, if applicable, are to be furnished by the vendor at no extra charge or the charge for the pump and hoses, if applicable, must be included in the Bid. Demurrage charges, if applicable, stated separately from the Bid price of the product/material will increase the amount of the Bid price for the product/material. The Bid for any or all Asphalts, Oils and Emulsions must be broken down into price per unit and delivery price per unit. A fuel adjustment will be allowed, with a cap of 15% plus or minus, on the delivery price only as fluctuations in diesel prices occur as listed on http://www.eia.gov/petroleum/gasdiesel, using the Gulf Coast Region. The baseline price will be the price on this site on Monday, November 27, 2023 rounded to the nearest one -hundredth and thereafter the index will be adjusted and documented on Monday of each week after Bids are accepted. The allowable fuel adjustment will be calculated by subtracting the baseline price from the posted price for the Monday immediately prior to the delivery date of the product/material (if delivered on a Monday, the posted price on the Monday prior to delivery must be used), and if the difference is less than 5 cents no adjustment will be allowed; 5 cents to 9 cents a 1% plus or minus adjustment to the delivery price per unit; 10 cents to 14 cents a 2% plus or minus adjustment to the delivery price per unit; 15 to 19 cents a 3% plus or minus adjustment to the delivery price per unit; 20 to 24 cents a 4% plus or minus adjustment to the delivery price per unit and so on. A 1% adiustment will be made on the delivery price for every 5 cent increase or decrease from the baseline price, not to exceed 15% plus or minus. Vendor must include a copy of the document from the EIA.GOV website that was used to determine delivery price when invoicing Calhoun County and the calculations on the increase or decrease in the delivery price. Vendor will be required to deliver to all jobsites in Calhoun County as directed by the Commissioner of applicable Calhoun County Precinct. Jobsite can be road, field location or stockpile at designated Calhoun County locations. Miles from pit to stockpile and/orjobsite will be shortest legal route. Page 22 of 53 Total Bid price, stated on the Invitation to Bid Form, shall include all fees, transportation costs and/or delivery fees to the designated Calhoun County Precinct stockpile orjobsites. Products/materials shall be ordered in quantities as determined by each Calhoun County Commissioner. Calhoun County Precincts will put out needed signs and barricades for traffic control. Calhoun County Precincts will accept the number of trucks necessary to do a job on a most cost efficient basis, which could require various numbers of trucks. Any Vendor traveling on Calhoun County roads will not exceed its legal gross weight. Each load shall be weighed on a certified public scale. Truck and trailer shall be weighed empty at least once on each job run, or when a change is made due to changing truck, trailer, or other. Cost of weighing shall be paid by the hauler. Driver shall get a product/material company ticket from pit or location when loading. A copy of the scale weight ticket, product/material company ticket and company delivery ticket shall be given to the Calhoun County employee at the jobsite when load is inspected and dumped. Calhoun County Precincts will supervise the dumping of loads and a Calhoun County employee will sign the delivery ticket. The Calhoun County Precinct must receive a copy of the signed delivery ticket. Calhoun County shall have the right to pull sample loaded truck(s) to a certified scale of Calhoun County's choice for loaded weight, unload truck(s) and take empty weight on same scale to verify weights. Calhoun County shall pay for the weighing. Calhoun County legally accepts the product/material after it is unloaded and approved by the Calhoun County Commissioner of said precinct. Any exceptions and or variations from the specifications in this Bid document must be indicated on the Bid form or on a separate attachment to the Bid and labeled as such. Exceptions taken and/or variations made to the specifications and listed on the vendor's Bid or separate attachment may void the Bid. The request for a Bid on a product/material does not guarantee that Calhoun County will purchase this product/material during the Bid period. Calhoun County does not guarantee to purchase any minimum or maximum quantities. The products/materials will only be ordered as needed. When required, all products/materials ordered will be delivered to the Calhoun County Precinct within 24 hours from time of order. In the event the vendor is unable to deliver the product/material ordered within 24 hours from time of order, Calhoun County reserves the right to cancel the order and re -order the said product/material from the vendor which submitted the next lowest Bid that met specifications and can deliver within 24 hours from time of order. Calhoun County shall not incur any penalties, fees and/or other charges when cancelling an order. Page 23 of 53 Vendor shall be required to notify Calhoun County in the event of unforeseen delay arising in the delivery of an order. In the event an order will not arrive at the Calhoun County Precinct at the designated time, Calhoun County shall have the right to cancel the order or refuse acceptance of the order. Calhoun County shall not be accessed any penalties, fees and/or other charges due to this cancellation or refusal. In the event the vendor is unable to furnish any item within a reasonable time after an order is placed due to strikes, war or any reason beyond the vendor's and/or supplier's control, the County reserves the right to purchase these items from any source, without causing this contract to be cancelled. Calhoun County or the vendor have the right to cancel the delivery of a product/material at any time due to weather, road conditions and/or machinery breakdown. No penalties, fees and/or other charges will be billed to Calhoun County if the delivery of a product/material is cancelled by Calhoun County or the vendor due to weather, road conditions and/or machinery breakdown. The County reserves the right to refuse any order delivered for not being in compliance with the specifications, general conditions and/or the "Hazardous Communications Act", commonly known as the "Texas Right to Know Act". The vendor, at the vendor's cost, shall immediately remove the product/material from the Calhoun County Precinct that are deemed unsatisfactory, and are not in compliance with the specifications, general conditions and/or do not meet State and/or Federal Regulations. No penalties, fees, and/or other charges will be billed to Calhoun County for the removal of the product/material from the Calhoun County Precinct. Safety Data Sheets and Placards, if applicable, must be furnished at the time of delivery as specified by State and/or Federal Regulations. Calhoun County reserves the right to conduct random sampling of pre -qualified products/materials for testing and to perform random audits of test reports. Calhoun County representatives may sample products/materials from the manufacturing plant, terminal, shipping container and any other source they deem necessary to insure reliability of the product/materials. If testing will be performed through a third party, the vendor will be required to allow the third party access to the facilities in order to acquire samples for testing. Regardless of results of any products/materials test required by Calhoun County, all costs incurred for such tests shall be paid for by the vendor. Specifications are not being met if products/materials are not delivered at the required temperatures or the time and date requested by Calhoun County's Commissioner are not met. The award of a Bid will be voided if specifications, general conditions and instructions within this Invitation to Bid Packet are not followed. The Bid would then be awarded to the vendor which submitted the next lowest Bid that met specifications and all requirements of the Invitation to Bid Packet. All Calhoun County Precincts handle their own orders; therefore, invoices shall be billed to each Calhoun County Precinct separately. Page 24 of 53 All invoices must be billed to Calhoun County to the attention of the Calhoun County Commissioner and Precinct ordering the product/material. Bid item number and product/material description, as stated on the Invitation to Bid form, awarded product/material Bid price per unit and delivery price per unit must appear on all invoices in order to be considered for payment. Listing the Bid item number and exact product/material description, as on the Invitation to Bid Form, will avoid any confusion when the invoice is processed for payment. No other charges, including, but not limited to, pump, hoses, special fees or after hour delivery fees, may be added to the awarded Bid price per unit and delivery price when invoiced unless these charges were noted on the Bid form or separate attachment and awarded as such. Invoices shall be free from sales tax (county, city or state sales tax) and federal excise taxes, if applicable. Invoices shall include a copy of the document from the EIA.GOV website that was used to calculate the increase or decrease in the delivery charge. Invoices shall show the calculation on how the increase or decrease in delivery price was reached. Invoices shall include a copy of the delivery ticket that shows confirmation of delivery. It is understood that Calhoun County Commissioners Court reserves the right to accept or reject any and/or all Bids for any/or all products/materials and/or services covered in this Bid request and to waive technicalities or defects in Bids, or to accept such Bids as it shall deem to be most advantageous and in the best interest of Calhoun County. Calhoun County Commissioners have the right to reject at any time any product/material that is undesirable for either road or jobsite location. If any product/material is rejected, the County will not incur any return freight, fees or any other charges on the rejected product/material. Calhoun County will evaluate and award the Bid based on lowest and best Bid meeting specifications and all requirements of the Invitation to Bid Packet. "lowest and best' means a Bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid as it deems to be in the best interest of Calhoun County. Although the cost of products/materials to be provided is an essential part of the Bid, Calhoun County is not obligated to award a Bid (contract) on the sole basis of cost but will award to the vendor considered to be the best value to the Calhoun County. The Bid award shall be based on, but not necessarily limited to, the following factors: • Unit price ■ Extended price (and other charges, if any) ■ Special needs and requirements of Calhoun County Page 25 of 53 • Delivery ■ Compliance in returning (including) all required forms • Results of testing samples (if required by Calhoun County) ■ Calhoun County's experience with products/materials Bid ■ Vendor's past performance record with Calhoun County If Bids are awarded, award information will be emailed to all vendors that submitted a Bid regardless if the vendor was awarded a Bid or not. Calhoun County Commissioners Court and the County Auditor's office work diligently to get this information to the vendors as soon as possible. To obtain results, or if you have any questions, please contact Peggy Hall, Calhoun County Assistant Auditor, 202 S. Ann St., Suite B, Port Lavaca, Texas 77979, or by phone or email, (361) 553-4613, demi.cabrera@calhouncotx.org. As time permits, Bid awards will be posted on Calhoun County's website, www.calhouncotx.org under Public Notices, Bid Notices and Results, Results, 2024. Once Bids are awarded by Calhoun County Commissioners Court, the County Auditor's Office will send the awarded vendor the following: (1) The contract; (2) A request for Form 1295, Certificate of Interested Parties; and (3) A request for the insurance requirements, Certificate of Insurance. All documents must be returned and accepted by Calhoun County Commissioners Court before the award will be complete, valid and in effect. Calhoun County or the vendor may cancel this contract at any time for any reason, provided a written notice is given. Should there be a change in ownership or management, the contract shall be cancelled unless a mutual agreement is reached with the new owner or manager to continue the contract with its present provisions and prices. Vendor understands that Calhoun County is a government entity subject to Texas State and Federal public information statutes. Vendor hereby waives any obligation to the release to the public of any documents submitted in accordance with the Bid. No person has the authority to verbally alter these specifications or any information within the Invitation to Bid packet. Any changes will be made in writing (Addendum approved by Calhoun County Commissioners Court) and mailed and or emailed to each vendor that received a Bid packet. All disputes or protests will be held in Calhoun County, Texas. INSURANCE REQUIREMENTS Before commencing work under the contract, the vendor must furnish, at their own expense, certificates of insurance or other acceptable evidence from a reputable insurance company or companies acceptable to Calhoun County, licensed to write insurance in the State of Texas showing the contractor (vendor) is covered by insurance within the minimum limits of liability listed in the General Conditions that are included in this Invitation to Bid Packet and shall remain in force until all work under the contract is completed. If for any reason insurance coverage is not kept in force, all deliveries must be stopped until an acceptable Certificate of Insurance is provided to the County. The County Auditor's office and the County Commissioners' should be provided with 30 days advance notice of changes or ter An a 2ipof g3 coverage. The County shall be covered as an additional insured and the certificate of insurance must also include a waiver of subrogation in favor of the County. The vendor shall be responsible for any deductions stated in the policy. The vendor shall include all subcontractors as insured under its policies or shall furnish separate certificates of insurance and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the requirements under this contract. Nothing contained in the insurance requirements shall be construed as limiting the extent of the vendor's responsibility for payment of damages resulting from operations under this contract. Any failure of the vendor to comply with the reporting provisions of the insurance policies shall not affect the coverage provided to the County. The insurance provided by the vendor shall be primary as respects to the County. Any insurance maintained by the County shall be excess of the vendor's insurance and shall not contribute to it. REQUIRED FORMS TO BE RETURNED WHEN SUBITTING A BID If any Required Form is "Not Applicable", mark "NA" and include when submitting a Bid. • Invitation to Bid Form (Page 30-33) • Vendor and Order Information Form (Page 34) • Affidavit (Page 35) • Conflict of Interest Questionnaire, Form CIQ (Page 37) ■ Certificate Regarding Debarment & Suspension and Other Responsibility Matters (Page 40) • Certification Regarding Lobbying (Page 41) • Disclosure of Lobbying (Page 43) ■ House Bill 89 Verification (Page 44) • Residence Certification (Page 45) • W-9 (Page 46) Page 27 of 53 CONTACT, BILLING AND LOCATION INFORMATION FOR CALHOUN COUNTY PRECINCTS Calhoun County Precinct 1 Commissioner David Hall 305 Henry Barber Way (by the County Fairgrounds) Port Lavaca, TX 77979 Office Manager: Angela Torres Office: 361-552-9242 Fax: 361-553-8734 Location Stockpile: 305 Henry Barber Way, Port Lavaca, TX Calhoun County Precinct 2 Commissioner Vern Lyssy 5812 FM 1090 (Six Mile) Port Lavaca, TX 77979 Office Manager: Lesa Jurek Office: 361-552-9656 Fax: 361-553-6664 Location of Stockpile: 5812 FM 1090, Port Lavaca, TX Calhoun County Precinct 3 Commissioner Joel Behrens 24627 State Hwy 172 (Olivia) Port Lavaca, TX 77979 Office Manager: Lynette Adame Office:361-893-5346 Fax: 361-893-5309 Location of Stockpile: 24627 State Highway 172, Olivia TX Calhoun County Precinct 4 Precinct 4-P (Port O'Connor) Commissioner Gary Reese Trevor St off of Hwy 185 Port O'Connor, TX 77982 Office Manager: April Townsend Use same numbers as Seadrift (4-S) Location of Stockpile — Pct 4-P Barn #3: 93 Trevor Street off of Highway 185, Port O'Connor, TX Calhoun County Precinct 4 Precinct 4-S (Seadrift) Commissioner Gary Reese 104 E Dallas St PO Box 177 Seadrift, TX 77983 Office Manager: April Townsend Office: 361-785-3141 Fax: 361-785-5602 Location of Stockpile — Pct 4-S Barn #2: 448 Harbor Road, Seadrift TX Page 28 of 53 REQUIRED FORMS FORMS REQUIRED TO BE RETURNED WHEN SUBMITTING A BID Vendor must return the following forms: If any Required Form is "Not Applicable', mark "NA" and include when submitting a Bid o Invitation to Bid Form (Page 30-33) o Vendor and Order Information Form (Page 34) o Affidavit (Page 35) o Conflict of Interest Questionnaire Form CIQ (Page 37) o Certification Regarding Debarment & Suspension and Other Responsibility Matters (Page 40) o Certification Regarding Lobbying (Page 41) o Disclosure of Lobbying Activities (Page 43) o House Bill 89 Verification (Page 44) o Residence Certification (Page 45) o W-9 (Page 46) Submitted Bid consists only of the above required forms Page 29 of 53 CALHOUN COUNTY, TEXAS INVITATION TO BID FORM ANNUAL SUPPLY CONTRACT FOR ASPHALTS, OILS AND EMULSIONS Bid Number: 2024.03 January 1, 2024 through December 31, 2024 Vendor's Name & Address • Please Type. If handwritten, must be in ink and legible. White out is not acceptable. • SEE SPECIFICATIONS AND GENERAL CONDITIONS FOR COMPLETE REQUIREMENTS • PRODUCTS/MATERIALS BID MUST BE BROKEN DOWN INTO PRICE PER UNIT AND DELIVERY PRICE PER UNIT ASPHALTS, OILS AND EMULSIONS Item 300, Asphalts, Oils and Emulsions (Bid Item Listed or Equivalent) Bid Item #1: Primer Oil or Equivalent Price per gallon / delivery price to County Stockpile and/orJobsite PRODUCT/ DEMURRAGE, LOCATION Unit MATERIAL I DELIVERY TOTAL IF ANY I I I i I$ Per Hour Afterl 1 I Gallon I I I I Free Hours ' ' ' ' '$ Per Hour After 2 Gallon I Free Hours ' ' ;$ Per Hour Afterl 3 1 Gallon 1 I I I—FreeHours I I I I !$ Per Hour Afterl 4-P Gallon I i 1 Free Hours 4-S 1 Gallon Remarks: _ Per Hour After l Free Hours Page 30 of 53 Item #2: P2 Prime Concentrate or Equivalent Price per gallon / delivery price to County Stockpile and/orJobsite PRODUCT/ DEMURRAGE, LOCATION Unit MATERIAL DELIVERY TOTAL IF ANY 1 1 1 1 1 !$ Per Hour After Precinct 1 Gallon 1 I i— Free Hours I I I 1 I ; 1 1$ Per Hour After Precinct 2 1 Gallon I I I 1 Free Hours I 1 ; !$ Per Hour After Precinct 3 1 Gallon 1 1 1 Free Hours ' 1 ' l$ Per Hour After Precinct 4-P ; Gallon 1 Free Hours I 1 I I I I I 1 I 1 '$ i Per Hour After Precinct 4-S I Gallon I I I I Free Hours Remarks: Bid Item #3: RC-250 or Equivalent Temperature must be no lower than 1400 Price per gallon / delivery price to County Stockpile and/orJobsite PRODUCT/ LOCATION Unit MATERIAL DELIVERY 1 Precinct 1 Gallon 2 Gallon 3 i Gallon 4-P 1 Gallon 4-S ; Gallon Remarks: DEMURRAGE, TOTAL IF ANY !$ Per Hour After ;— Free Hours !$ Per Hour After I Free Hours 1 l$ Per Hour After I Free Hours l$ Per Hour After Free Hours 1 !$ Per Hour After Free Hours Page 31 of 53 Item #4: CRS-2 or Equivalent Temperature must be no lower than 150° and no higher than 180P Price per gallon / delivery price to County Stockpile and/or Jobsite PRODUCT/ DEMURRAGE, LOCATION Unit MATERIAL DELIVERY TOTAL IFANY I 1 1 �$ Per Hour After Precinct 1 Gallon ;_ Free Hours I 1 1 '$ Per Hour After Precinct 2 1 Gallon I I I 1 Free Hours 1 1 Per Hour After Precinct 3 1 Gallon 1 1 1 1 Free Hours 1 1$ Per Hour After Precinct 4-P Gallon Free Hours 1$ Per Hour After Precinct4-S 1 Gallon i 1 I 1 I I — Free Hours Remarks: Item #5: P2 CWE-2 or Equivalent Price per gallon / delivery price to County Stockpile and/or Jobsite PRODUCT/ DEMURRAGE, LOCATION Unit MATERIAL DELIVERY TOTAL IF ANY 1 1 1 1 1 1 l$ Per Hour After Precinct 1 Gallon !—Free Hours 1 1 1 1 1 Per Hour After Precinct 2 ; Gallon ; ; ;_ Free Hours I I I 1 1 1 1$ Per Hour After Precinct 3 ; Gallon Free Hours i 1$ Per Hour After Precinct 4-P 1 Gallon 1 1 1 1 Free Hours i 1$ Per Hour After Precinct 4-S I Gallon I I Free Hours Be sure to read, complete, sign and date the next page Page 32 of 53 The undersigned affirms that they are duly authorized to execute this Bid and that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other vendor, that the contents of this Bid as to prices, terms or conditions of said Bid have not been communicated by the undersigned nor by their employees or agents to any official, employee or agent of Calhoun County or any other person engaged in this type of business prior to the official opening of this Bid. The undersigned affirms that they have not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with this Bid. The undersigned affirms that they have read the entire Invitation to Bid Packet and fully understands and has followed all requirements. FAILURE TO SIGN BELOW SHALL DISQUALIFY THE BID Date: Authorized Signature & Title: Type Name & Title of Authorized Signature: Phone Number: Email: Exceptions and or Variations from Specifications and/or additional Notes: Page 33 of 53 VENDOR AND ORDER INFORMATION FORM Please Type. If handwritten, must be in ink and legible Vendor's Name: Address: Remittance Address: Telephone: Fax: Email: Signature of Authorized Representative: Printed name of Authorized Rep: ORDER — CONTACT INFORMATION Order Contact Name & Title: Order Contact Telephone: Order Contact Fax: Order Contact Email: INVOICES — CONTACT INFORMATION For Invoice Inquiries: Contact Name & Title: Contact Telephone: Contact Fax: Contact Email: Page 34 of 53 STATE OF TEXAS 0 COUNTY OF 0 (Type or Print Name) the (Type or Print Title) principal address at AFFIDAVIT being first duly sworn, deposes and says: that he or she is of having its (Type or Print Name of Company/Firm) (Type or Print Physical and Mailing Address) who submits herewith to Calhoun County the attached bid/proposal; that he or she is the person whose name is signed to the attached bid/proposal; that said bid/proposal is genuine; that the same is not sham or collusive; that all statements of fact herein are true; and that such bid/proposal was not made in the interest or behalf of any person, partnership, company, association, organization or corporation not herein named or disclosed. Affiant further deposes and says: that the bidder/proposer has not directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interests of Calhoun County, or of any other bidder/proposer, or anyone else interested in the bid/proposal contract; and that the bidder/proposer has not in any manner sought by collusion to secure for himself/herself/itself/themselves an advantage over any other bidder/proposer. Affiant further deposes and says: that prior to the public opening and reading of bids/proposals, said bidder/proposer: a) did not, directly or indirectly, induce or solicit anyone else to submit a false or sham bid/proposal; b) did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder/proposer or anyone else would submit a false or sham bid/proposal, or that anyone should refrain from submitting a bid/proposal or withdraw their bid/proposal; c) did not, in any manner, directly or indirectly, seek by agreement, communication or conference with anyone to raise or fix the bid price/proposal of said bidder/proposer or of anyone else, or to raise or fix any overhead, profit or cost element of their price/fee or of that of anyone else; d) did not give, offer to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid/proposal; and e) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative hereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent, thereof, to any individual or group of individuals, or to any official, employee or agent of Calhoun County prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained in this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and requirements contained in the bid/proposal. Signature of Affiant Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 20 Signature of Notary Public Notary Stamp/Seal Page 35 of 53 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code 4 176.001 (1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code G 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code § 176.006(a) and (a-1) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, ore family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. =orm provided by Texas Ethics Commission www.ethics.state.tx.us CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. 11 Name of vendor who has a business relationship with local governmental entity. 2 ❑ Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 4j Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? F]Yes E]No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? F] Yes E-1 No 6 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us paftrWiV/30/2015 DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive departments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Page 38 of 53 Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. See. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for goverment -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. See. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. Page 39 of 53 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a — d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date Page 40 of 53 Certification Regarding Lobbying (To be submitted with each bid or offer exceeding $100,000) The undersigned certifies, to the best of his or her knowledge and belief, that (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language paragraph 1 and 2 of this anti -lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Signature of Contractors Authorized Official Printed Name and Title of Contractors Authorized Official Date Page 41 of 53 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub awardee, e.g., the first sub awardee of the prime is the tat tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Sub awardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services,and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348- 0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB 0348-0046 Page 42 of 53 Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a, initial filing _ b. grant _ b. initial award _ b. material change c. cooperative agreement c. post -award d. loan For material change only: e. loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter _ Prime _ Subawardee Name and Address of Prime: Tier_, if Known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, ifapplicable: 8. Federal Action Number, ifknown: 9. Award Amount, ifknown: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individua1,, last name, first name, Ml): dfferenifrom No. 10a) (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title: U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) Page 43 of 53 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 851h Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli - controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. I, (authorized official) , do hereby verify the truthfulness and accuracy of the contents of the statements submitted on this certification underthe provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below: 1) Does not boycott Israel currently; 2) Will not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at https://comptroller.texas.gov/purchasing/publications/divestment.php Company Name Signature of Authorized Official Title of Authorized Official Printed Name of Authorized Official Date Page 44 of 53 RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001(3) "Nonresident bidder" refers to a person who is not a resident. ❑ Icertifythat (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. (Company Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (City and State) ❑ I certify that (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a "Resident Bidder" of Texas as Page 45 of 53 W'9 Request for Taxpayer Give Foes, to the Farm (Rev. October 2018) Identification Number and Certification requester. Do not Daparimant oldie Treasury send to the IRS. Into W Revenue Service ► Go to www.1M.goV1FormW9 for instructions and the latest information. 1 Name in shown on your income lax return). Name is required on this line; do not leave this line blank. 2 Business namoldieregarded entity name, if different from above m 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to m following seven boxes. certain entities, not individuals; see a o ❑ IndMduaVwle proprietor or ❑ CCorporation ❑ 3Corporation ❑ Partnership ❑ Trustlestate instructions on page 3): single -member LLC Exempt payee code (it any) 0 ❑ Limited liability company. Enter the tax classification (C-C corporation, S=S corporation, P=Partnership) ► `o Note: Check the appropriate box in the line above forthe tax classification of the single -member owner. Do not check Exemption from FATCA reporting z LLC 8 the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that cotle (d any) R Is disregarded from the owner should check the appropriate box for the tax classification of its owner. Y ❑ Other (see instructors) ► rroau..w.�ama.n.usj y 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 8 CALHOUN COUNTY rn 202 S ANN ST, PORT LAVACA TX 77979 6 City, state, and ZIP code 361.553.4610 FAX:361.553.4614 7 Ust account numbers) here (optional) Elfti Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number backup withholding. For Individuals, r this this is generally your social security number (SSNr. However, fora resident alien, sole proprietor, or disregarded entity, see the instructions for Part 1, later. For other FM _ m - entities, It Is your employer Identification number (EIN). If you do not have a number, see How to ge[ a TIN, later. or Note: if the account is in more than one name, sea the Instructions for line 1. Also see What Name and I Employer identification number Number To Give the Requesterfor guidelines on whose numberto enter. IT-1 F-T- —T-T- 1. The number shown on this forth Is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and 2.1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that i am no longer subject to backup withholding; and 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this forth (d any) Indicating that I am exempt from FATCA reporting is correct. Certlgeadon Instructions. You must cross out Item 2 above It you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you ere not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. bign I Slgnature of Here U.S. parson► Date► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and Its Instructions, such as legislation enacted after they were published, go to w vw.lrs.gov1Fbmi Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an Information return with the IRS must obtain your correct taxpayer Identification number (rIN) which may be your social security number (SSN), individual taxpayer Identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return. Examples of information returns Include, but are not limited to, the following. • Farm 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231x Form W-9 (Rev.10-2018) Page 46 of 53 CURRENT AWARDED BID TABULATION FOR THE CURRENT BID PERIOD January 1, 2023 through December 31, 2023 Page 47 of 53 CALHOUNCOUNTY, TEXAS AWARDED Bids are Highlighted in Yellow BID TABULATION - AWARD ASPHALTS, OILS AND EMULSIONS ANNUAL SUPPLY CONTRACT, BID NUMBER: 2023.02 For the Period Beginning January 1, 2023 and Ending December 31, 2023 4.965 BASELINE PRICE ON OCTOBER 31, 2022 FOR DIESEL FUEL ADJUSTMENT ON DELIVERY PRICE (www.eia.gov/petroleum/gasdiesel) (Gulf Coast Area) Tie Bids: In the event of Tie Bids, the winning bid is determined per Texas Local Government Code 262.027(b). ASPHALTS, OILS AND EMULSIONS Item 300, Asphalts, Oils and Emulsions Bid Item #1: Primer Oil or Equivalent Price per gallon / delivery price to County Stockpile and/or Jobsite LOCATION Unit PRODUCT/ DELIVERY TOTAL DEMURRAGE AWARD BIDDER MATERIAL AIND REMARKS, IF ANY $80 per hour after 2 Precinct 1 Gallon $2.65 $0.20 $2.85 free hours. X CLEVELAND ASPHALT $80 per hour after 2 Precinct 2 Gallon $2.65 $0.20 1 $2.85 free hours. X PRODUCTS, INC. REMARKS: $80 per hour after 2 PRICES EASED ON MINIMt1M 3000 GALLON Precinct 3 Gallon $2.65 $0.20 $2.85 free hours. X LOAD, FOR SMALLER KUANI-IIIES PLEASE I AH 800-33,4-017 . IJRNED $80 per hour after 2 DfUJ IED PAW ERiAL CAN NDr BE RE Precinct 4-P Gallon $2.65 $0.20 $2.85 free hours. X FOR CREDIT. $80 per hour after 2 Precinct 4-S Gallon $2.65 $0.20 $2.85 free hours. X $70 per hour after 2 Precinct 1 Gallon $3.60 $0.25 $3.85 free hours $70 per hour after 2 Precinct 2 Gallon $3.60 $0.25 $3.85 free hours MARTIN ASPHALT COMPANY $70 per hour after 2 Precinct 3 Gallon $3.60 1 $0.25 $3.85 free hours 5000 CAI.LOI4 M!P]IINli,J 17n $70 per hour after 2 Precinct 4-P Gallon $3.60 $0.25 $3.85 free hours $70 per hour after 2 Precinct 4-S Gallon $3.60 1 $0.25 $3.85 free hours Page 48 of 53 Bid Item #2: P2 Prime Concentrate or Equivalent Price per gallon / delivery price to County Stockpile and/or Jobsite LOCATION Unit PRODUCT/ DELIVERY TOTAL DEMURRAGE AWARD BIDDER MATERIAL AND REMARKS, IF ANY Included 1.IE $80 per hour after 2 Precinct 1 Gallon $2.24 ItENUU l<q. $2.24 free hours x P SQUARED EMULSION PLANTS, LLC Included SEE $80 per hour after 2 REMARKS: Precinct 2 Gallon $2.24 RF.P11ARKS $2.24 free hours x i.InlNINILEA MMIKER DEL VERY: 5000 GAL. 7., DEILIVELY CNER X50 INIILES OjBIrC-II'D ADTAMONAL CHARGES, Included ,w $80 per hour after 2 s, aUNIP C IAasE. (MUC IN , Cr:ARCE)$80 Precinct 3 Gallon $2.24 REMARKS $2.24 free hours x A. RUSH n;ARGE(rr.UC H!C C1IARGF)$80/HR s. ^ErURN La,AD5 (IRO aaNG CHARGE)! Included 'SEE $80 hour after 2 SUftIFrf M CF,ARG; F-R.Ol9 CELIVI RING per SREIv:iT LINE, Precinct4-P Gallon $2.24 HEMIAR1<5 $2.24 free hours x O.SNIALLERQUAN1rnESAVAILABLE, SUB.IECf TO FREIGHT DIFFERENr:Al OF 50.25/GAL LESS Included SEE $80 per hour after 2 ri;Are Sow GAL. Precinct4-S Gallon $2.24 FREPrARKS $2.24 free hours x Bid Item #3: RC-250 or Equivalent Price per gallon / delivery price to County Stockpile and/or Jobsite LOCATION Unit PRODUCT/ DELIVERY TOTAL DEMURRAGE AWARD BIDDER MATERIAL AND REMARKS, IF ANY $70 per hour after 2 Precinct 1 Gallon $3.50 $0.25 $3.75 free hours x $70 per hour after 2 Precinct 2 Gallon $3.50 $0.25 $3.75 free hours x MARTIN ASPHALT COMPANY $70 per hour after 2 Precinct 3 Gallon $3.50 $0.25 $3.75 free hours x REIVIAFRK : 5(10 GALLON MrnnMUNI $70 per hour after 2 Precinct 4-P Gallon $3.50 $0.25 $3.75 free hours x $70 per hour after 2 Precinct 4-S Gallon $3.50 $0.25 $3.75 free hours x $80 per hour after 2 Precinct 1 Gallon $4.40 $0.20 $4.60 free hours CLEVELAND ASPHALT $80 per hour after 2 Precinct 2 Gallon $4.40 $0.20 $4.60 free hours PRODUCTS, INC. RLMARIK, $80 per hour after 2 LF.K1-s LIASE',) ON VII NINgUI 150eo GALLON Precinct 3 Gallon $4.40 $0.20 $4.60 free hours LOAD, FOR SMALLER Q� IA141I I II-S PLEASE CALL 8G0-3;au-0177. $80 per hour after 2 Precinct 4-P Gallon $4.40 1 $0.20 1 $4.60 free hours 3ILur1E ? VAN RIAC Cr"AN LIul E,I;. RS"naRNro FOP, CI EDfE. 1 1 $80 per hour after 2 Pretinct 4-S Gallon $4.40 $0.20 $4.60 free hours Page 49 of 53 Bid Item #4: CRS-2 or Equivalent Temperature must be no lower than 150° and no higher than 180° Price per gallon / delivery price to County Stockpile and/orJobsite LOCATION Unit PRODUCT/ DELIVERY TOTAL DEMURRAGE AWARD BIDDER MATERIAL AND REMARKS, IF ANY $80 per hour after 2 Precinct 1 Gallon $2.65 $0.20 $2.85 free hours X CLEVELAND ASPHALT $80 per hour after 2 Precinct 2 Gallon 1 $2.65 $0.20 1 $2.85 free hours X PRODUCTS, INC. $80 per hour after 2 Precinct 3 Gallon $2.65 $0.20 $2.85 free hours X PRICES BASED ON ulrauw:!NI 5000 GALLON LOAD, POR SMALLER OUnnnTrlES ^LEASE CALL scna3a-0::n. $80 per hour after 2 Precinct 4-P Gallon $2.65 $0.20 $2.85 free hours X LAW rFo M.AFERIAL CANNOT 6;- RE_ I U Rit.ED FOR CR-Di T. $80 per hour after 2 Precinct 4-S Gallon $2.65 $0.20 $2.85 free hours x $70 per hour after 2 Precinct 1 Gallon $2.70 $0.25 $2.95 lfree hours $70 per hour after 2 Precinct 2 Gallon $2.70 $0.25 $2.95 free hours MARTIN ASPHALT COMPANY $70 per hour after 2 Precinct 3 Gallon $2.70 $0.25 $2.95 free hours REIVIA?I<5: 5000 GALLON I1,10IN(AIII-10A $70 per hour after 2 Precinct 4-P Gallon $2.70 $0.25 $2.95 free hours $70 per hour after 2 Precinct 4-S Gallon $2.70 $0.25 1 $2.95 free hours Bid Item #5: P2 CWE-2 or Equivalent Price per gallon / delivery price to County Stockpile and/or Jobsite LOCATION Unit PRODUCT/ DELIVERY TOTAL DEMURRAGE AWARD BIDDER MATERIAL AND REMARKS, IF ANY nc u e SEE $80 per hour after 2 Precinct 1 Gallon $3.29 REMARKS $3.29 free hours X P SQUARED EMULSION PLANTS, LLC nc u e SEE $80 per hour after 2 REMARKS, Precinct Gallon $3.29 REMARKS $3.29 Ifree hours X 1. 101NIFOU11A TANKER DELIVERY:500aGAL. a., nEI.IV€Ry OVER 2 0 MILESSUaJECTTO nc u e SEE $80 per hour after 2 AODITIOINAI. (HAICGES. Precinct Gallon $3.29 REMARKS $3.29 free hours X a. PUMP CHARGE fIRUCKINGCHAuse)s0 4. PUSH CHARGE(IRUG NIG CSARCE)$80/HR Included5. SEE $80 per hour after 2 RETURN LOADS (TROCI NG CHARGE): SUI3JFCTr0C1 IAN,GEs13011AoeuvERINC Precinct4-P Gallon $3.29 REMARKS $3.29 free hours X FRI°IGH11LINE, 6. SMALLER QUAIVri I iES AVAILABLE, SUBJECT Included To PRUGHT DIFFEREN I Al. Or $0.25/GAL LE55 SEE $80 per hour after 2 Tf!AN 5000 GAL Precinct 4-S Gallon $3.29 FIEMARKS 1 $3.29 free hours X Page 50 of 53 CONTRACT THIS CONTRACT, made and entered into this day of 20_ by, and between the County of Calhoun (hereinafter called "County") and (hereinafter called "Contractor/Hauler"). WITNESSETH: WHEREAS, the Contractor/Hauler did on November 30,2023, submit a BID for ASPHALTS, OILS AND EMULSIONS, Bid Number 2024.03 to be used by County Pr"incts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the folk understood and agreed by and between the parti a) The Contractor/Hauler is hereby grantedl jj the territorial jurisdiction of the City an egild trucks, and all other items poggl y to 11 Asphalts, Oils and Emulsions as des §1 43 ,�u' b) The Contract Docu.!-As sh Iude the s V vEhr, hereby expresslyficorporate sam ` ' 'Kin 11 ilk i. InvitationLid. Instructions dl sole and e'x2ijisj II furnish all pe, 4" _ffirm all of the and covenant, it is and privilege within r-labor, equipment, and to deliver the ,"xRhe Contract Documents. Ipwing documents, and this Contract does et forth verbatim in this Contract rm6f Contract; ii. ,4dii l CoAl ns; 011 -.. 11 p� iHY Bid Specificatiert onditi s; r s 141.Bid Form; c This instrument; #pd I`' addenda oTAhan es to the foregoing documents agreed to b the parties vi. `�Eiii o; � g g� g g Y 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 CONTRACTOR/HAULER (IN INK): DATE: INITIALS OF COUNTY (IN INK): DATE: Page 51 of 53 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 geneiity of the foregoing, "Force Majeure" shall include, but not restricted to W owing types of events: acts of God or public enemy; acts of governme Eal or regu tory authorities; fires, floods, epidemics or serious accidents; u vere eather conditions; strikes, -sue lockouts, or other labor disputes; and defau contractors. Any event constituting a Force Maje eported by tNeamctor/Hauler to the County in writing, WO enty-fo b24) hours, and dffsclose the estimated length of delay, and cause o e 3) The Contra hen ed, must deliver all products/materials ordered b. =the County w wenty- ) hours from the time of the order or the da' nd time specifie the C nty. In the event the Contractor/Hauler W " le t Lver the product . aterials ordered within twenty-four (24) hours Al - from the tim order o he date and time specified by the County, the County reserves t t to cancel the order and re -order the said products/materi from the vendor which submitted the next lowest bid and can iverwithin t ty-four (24) hours orthe date and time specified bythe County. 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: INITIALS OF COUNTY (IN INK): DATE: Page 52 of 53 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, 2024 and end on December 31, 2024. COUNTY: CALHOUN COUNTY M ATTEST: CALHOUN C _ NTY CLERK ANW AN Honorable Richard H. Meyer `UM1 Calhoun County Judge Print Calhoun County Courthouse �0 211SAnn St 3rd Floor, Ste 301 AA A.PH N Port Lavaca TX 77979 Address: Page 53 of 53 #10 I NOTICE OF MEETING - 11/1/2023 10. Consider and take necessary action to approve the District Judges' order to appoint Candice A. Villarreal as County Auditor. (RHM) VER: Vern Lyssy, Commissioner Pct2 ONDER: Gary Reese, Commissioner Pct :S: Judge Meyer, Commissioner Hal Page 7 of 12 COUNTY OF CALHOUN STATE OF TEXAS ORDER APPOINTING CANDICE A. VILLARREAL COUNTY AUDITOR We, Jack Marr, Kemper Stephen Williams and Julie Bauknight, Judges of the 24', 135t", and 267t" Judicial District Courts respectively of Calhoun County, Texas, and having jurisdiction in the County of Calhoun, State of Texas, which said County has a population of more than 10,000 inhabitants according to the last preceding Federal Census, this day having considered the appointment of an Auditor of Accounts and Finances for said County for a term of Two Years, beginning November 1, 2023 and ending October 31, 2025, do after consideration appoint Candice A. Villarreal County Auditor in and for Calhoun County, Texas for the said term and until her successor shall have been appointed and qualified. IT IS ORDERED that said Candice A. Villarreal shall before entering upon her duties, execute a good and sufficient bond as provided by law. IT IS FURTHER ORDERED that this appointment shall be recorded in the Minutes of the District Courts of Calhoun County, Texas; and the clerk is directed to certify the same to the Commissioners' Court of Calhoun County for observance. SIGNED AND APPROVED on this the day of October, A.D., 2023. YGZLt,ti�-- Marr, Judge, 24t" District /( e per Stephen Williams, Judge, 1351h District Julie Bauknight, Judge, 267' Di�tric FILED ATz_QDUCLOCK P, M OCT 2 5 20. 23 , ANNA.KABELA DISTRICT CLERK, CALHOUN COUNTY, TEXAS BY __ _DEPUTY �t• #11 NO FICE OF MEETING-11/1/2023 11. Consider and take necessary action to accept a check for $1,930.25 from Janik Alligators LLC for the 2023 Green Lake Project. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 12 i 2023 Invoice Calhoun CO. Greenlake Proiect Alligator nests; --------- 6 nests @ $300 each -------------------- $1800.00 Seasonal Alligator Harvest (see attached break down) $848.49 X .50% =---------------------------------------------------$424.25 (Minu state license fees) -------------------------------------- ($294.00) Paid by check#13782---------------------------------------------- $1930.25 3244 CR410 Rd Larry's Cell 979-332-1463 El Campo TX 77437 www.ianikalligators.com Jason's Cell 979-332-1399 979-543-5894 email ld.janik@yahoo.com ------------- ■■■E■S■■■SEEN ■■■■■■■■■■■■■ ENS■■■■■■■■■■ ENS■■■■■■■■■■ SS■S■©SS■SSSS z CD 4 e i �p3r� jl C7 w rn w ac d � r CD 00 o O O N m' 0 P w O � N o R. e �^ 6 fli U O J �O lO w w N N W ? W �O ■■■■■■■■■■■■■ ■■■■■■■■■■■■■� ■■■■■■■■■■■■■ _■■■■■■■■■■m ■■■■■■■■■■■■■• ■■■■■■■■■■■■■I _ ■■■■■■■■■■■■■ CJ w. rn w va cw O A B O y 00 11 # Zz NOTICF OF MEETING - 11/1/2023 12. Approve the minutes of the October 18, 2023 meeting. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 12 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern 1Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Meese, Commissioner, Precinct 4 The Commissioners'Court of Calhoun County, Texas met on Wednesday, October 18, 2023, at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port ]Lavaca, Calhoun County, Texas. Attached are the true and correct minutes of the above referenced meeting. Richard H. Meyer, Cou Judge Calhoun County, Texas Anna Goodman, County Clerk Zo'Z Date I I- I -w") Date Page 1 of 1 i NOTICE. OF MEETING-- 10/:18/2023 October 18, 2023 MEETING MINUTES OF CALHOUN COUNTY COMMISSIONERS` COURT MET IN A REGULAR MEETING AT 10:00 A.M. IN THE COMMISSIONERS, COURTROOM IN THE COUNTY COURTHOUSE AT 211 S. ANN STREET SUITE 104 PORT LAVACA, CALHOUN COUNTY, TEXAS. THE FOLLOWING MEMBERS WERE PRESENT: Richard Meyer David Hall Vern Lyssy Joel Behrens Gary Reese Anna Goodman By: Karla Perez The subject matter of such meeting is as follows: 1. Call meeting to order. County Judge Commissioner Pct i Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at 10:00am by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. Mr. Torres explained he has been helping veterans since relocating back to Calhoun County. Page 1 of 6 NOTICE OF MEETING—1-0/1-8/2023 5. Consider and take necessary action to approve a resolution naming Candice Villarreal as Calhoun County Auditor upon the retirement of current auditor, Cindy Mueller. (RHM) 6. Consider and take necessary action to approve the FY2024 Texas Indigent Defense Commission Formula Grant Request for Application resolution and authorize the County Judge to apply online. (RHM) RESULT" APPROVEOUj M(1VER. paved Ha11=Com[1 stoner Pit 1 COWER - Vern LysSy Commissioner Pct 2 AYES; Judge Meyer, Commissioner• Hal[, Lyssy, Behrens, Reese 7. Consider and take necessary action to approve a resolution expressing our support for the Texas Legislature to provide parents with school choice options for the education of their students in K —12. (RHM) 8. Consider and take necessary action to extend the feasibility contract with Texas A & M AgriLife to November 30, 2023. There is no additional cost associated with this extension. (RHM) RESULT, APPROVED [UNANIMOUS] MOVER Joel Behrens, Commissioner.Pct 3 :'.:' 9CONDI;R:: David Half Commissioner Pet 1 AYES. Judge Meyer, Cpr7i.missiorier Hall, Lyssy, Behrens, Reese; Page 2 of 6 NOTICE OF MEETING--10/18/20213 9. Consider and take necessary action to award the bid for the Brighton Road Bridge Replacement Project. (DEH) CoUrt approyed'to award the bid to"Constar Construction. `. RE5ULT. APPROVED [UNANIMOUS] MOVER: David Halls C6mmissld6er Pct 1 SECONDER -. Joel Behrens, Commissioner_Pct 3 AXES, 7ucfge.Meyer,, Cbmmissroner.--. Hall, Lyssy, Behrens, Reese 10.Consider and take necessary action to approve Cody Malaer's request to exercise his right for the option on renewing the specifications and agricultural lease agreement for the lease of the Event Center property, 194 acres, for dry land farming that is solely for planting, raising, and harvesting row crops and for no other purposes. The term of this agricultural lease agreement will be for three years with the option to renew for additional three-year terms upon the Commissioners' Court approval and authorize the County Judge to take any action deemed necessary. (VLL) RESU4T APPROVED [UNANIMOUS] MOVER Gary Reese, Commissioner Pct 4 SECONDER: Jo. ,Be hrens,.CQmmissioner:,Pct3 AYES: Judge.Meyer, Com. missioner-Hall; Lyssy, Behrens, Ree�e�'- 11. Consider and take necessary action to approve Kyle Malaer's request to exercise his right for the option on renewing the specifications and agricultural lease agreement for the lease of the Langdon Tract, 60 acres, for dry land farming that is solely for planting, raising, and harvesting row crops and for no other purposes. The term of this agricultural lease agreement will be for three years with the option to renew for additional three-year terms upon the Commissioners' Court approval and authorize the County Judge to take any action deemed necessary. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: • Vern Lyssy; Commissioner Pet 2 SECONDER; Gary Reese, om Cmissioner Pct 4 AYES. Judge Meyer, Commissioner H811; Lyssy, Behrens, Reese 12. Public Hearing regarding a petition to Abandon and Close 0.264 acres, being the undeveloped channel easement area between Lot No. 272 and Lot No. 273 of Sunilandings Phase 1, in the William Arnold League, Abstract 2 according to the established map and plat of said subdivision of record in Volume Z, page 527 of the map and plat records of Calhoun County, Texas. (Exhibit A attached). Public Hearing.opened at 10:21 Mr oedgood explained the;petition. Public Wearing closed at 1026 Page 3 of 6 NOTICE OF MEETING— 10/18/2023 13. Consider and take necessary action on a request to Abandon and Close 0.264 acres, being the undeveloped channel easement area between Lot No. 272 and Lot No. 273 of Sunilandings Phase 1, in the William Arnold League, Abstract 2 according to the established map and plat of said subdivision of record In Volume Z, page 527 of the map and plat records of Calhoun County, Texas. (Exhibit A attached). (JMB) 77 RESULT. APPR01/ED NIMOUSlu. Mpy fern Lyssy; Commissioner Pet 2 SEGOINDER� -Joel Behrens, Commissioner. Pct 3 kYES.. Judge Msyer, Corn $$IoherHall, LysSy, Behrens, Reese 14. Consider and take necessary action to accept insurance proceeds from TAC in the amount of $8,170.72 ($13,170.72 - $5,000 deductible) for Weather related damage on May 10, 2023 to the generator at the Calhoun County Airport. (RHM) RESULT APPROVED [UNANIMOUS] MOVER Vern.Lyssy; Commissioner Pct 2 SECONDER: ;nary Reese, Commissloner. Pct 4 AYES:; Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese:' 15. Consider and take necessary action to accept insurance proceeds from TAC in the amount of $5,440.47 ($7,940.47 - $2,500 deductible) for a Sheriff Department. vehicle accident on September 5, 2023. (RHM) RESULT APPROVED [UNANIMOUS].- NIGHER Venn. Lyssy; Comm stoner-Pct 2 SEC�?NbER David Hbll, Corn missioner°Pct AXES Judge Meyer, Commissioner Hall, Lyssy, Behrens; Reese; 16. Consider and take necessary action to authorize the Texas A & M AgriLife Extension Service to accept a quote from Victoria Communication Services for an AT&T FlrstNet Cellular plan due to the continued phone issues in the office and for emergency situations. (RHM) Page 4 of 6 I NOTICE OF MEETING - 10/18/2023 17, Consider and take necessary action to accept a check for $8,299.00 for the FY24 EMS Pass Through funds from the Golden Crescent Regional Advisory Council sor Trauma Service Area-S. (RHM) REULTY APPROVED [UNANIMOUS] Nl ComisoneeLr2d(Vern y SEGO DE- David lli. ommissfoher Pot 1 AYE6 Judge Meyer; C..ommisslonel Hall, 4yssy, Behrens, Reese 18. Consider and take necessary action to reappoint Jeana Bethany to the Gulf Bend Center Board of Trustees. (RHM) RESU�.T: AFVROVD CUh(ANIMgUS MQVEfI. Vern Lyssy; Cornrrri5sibner Pct 2 ECgNgER: Gary Reese,.Commigsioner Pct 4 AYES: JUbe Meyer, Cprhrnissioner_Hall� L*y, Behm4ns, Reese,+ 19.Accept Monthly Reports from the following County Offices: a. Justice of the Peace, Precinct — September 2023 b. Sheriff's Office — September 2023 c. Texas Agrilife Extension Service — August 2023 1. 4-H and Youth Development il. Agriculture and Natural Resources Ill. Family and Community Health iv. Coastal and Marine RESULT .APRROVED [UNANIMOUS] MOVER: Vern. Lyssy, Commissioner Pet 2 SECONDEf JoeFl3ehmnsi Com. missioner: Pct 3 AYES.-. Judge Meyer, COmmissionerH�II; Lyssy, Behreris, Reese 1H 20. Consider and take necessary action on any necessary budget adjustments. (RHM) none Page 5 of 6 NOTICE OF MEETING—10/18/2023 21.Approval of bills and payroll. (RHM) Az 14M6 Bllis: > RESULT: = APPROVED [UNANIMOUS] MCVER Davld Hall; Commissioner Pt 1 SEONDiER. Vern Lyssy, CorrrmssionerPct 2 - A1E9 ]. udge IKeyer, Cominisslonee>Hall, Lyssy, Behrens, Reese" Chun y Bli S. . RESULT: PROVeDIUNANIMOUS] MOVER - Vavid Half. COMmisslonPCt 1 SEGONDERi Uem Lyssy Commissioner Pct 2 AYES: fudge Meyer, Commissloner'Hall, Lyssy, Behrerss, Meese Adjourned 10:35 Page 6 of 6 #13 I NOTICE OF MEETING-; - 11/1/2023 13. Accept Monthly Reports from the following County Offices: i. Tax Assessor -Collector - September 2023. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 10 of 12 SUMMARY TAX ASSESSOR -COLLECTORS MONTHLY REPORT SEPTEMBER 2023 Title Certificate Fees 386 Title Fees Paid TXDMV Title Fees Paid County Treasurer Salary Fund Motor Vehicle Registration Collections Disabled Person Fees Postage Global Additonal Collections Paid TXDMV Paid TXDMV SP Paid County Treasurer Paid County Treasurer Salary Fund DMV CCARDTRNSFEE $ 1,716.66 GL Additonal Collections GLOBAL (IBC) Credit/Debit Card Fee's GLOBAL Fees In Excess/Shodage of Collections processed on 9/5123 Dep#172 Additional Postage -Vehicle Registration. Paid County Treasurer -Additional Postage Motor Vehicle Sales & Use Tax Collections Paid State Treasurer Special Road/Bridge Fees Collected Paid County Treasurer- RIB Fees Texas Parks & Wildlife Collections TPW GLOBAL CC TRANSACTION FEES GLOBAL ADDITIONAL COLLECTIONS Paid Texas Parks & Wildlife Paid County Treasurer Salary Fund P&W CCARDTRNSFEE $ 181.77 GLOBAL Additonal Collections $ - GLOBAL (IBC) CrediVDebit Card Fee's GLOBAL In Excess/Shortage of Collections BoatlMotor Sales & Use Tax Collections Paid Stale Treasurer Paid County Treasurer, Salary Fund TABC 6 % CO COMMS FOR MONTH OF AUGUST 2023 Paid County Treasurer, Salary Fund County Beer& Wine. Collections Paid County Treasurer, County Beer & Wine Paid County Treasurer, Salary Fund INTEREST EARNED ON OFFICE ACCOUNT Paid County Treasurer, Nev. East Paid County Treasurer, all other districts INTEREST EARNED ON PARKS AND WILDLIFE ACCOUNT Paid County Treasurer, Interest on P&W Ace INTEREST EARNED ON REFUND ACCOUNT Paid County Treasurer, Interest on Refund Am COLLECTIONS $ 6,395.00 $ 122,082.60 $ 45.00 11 $ 445,163.36 $ 17,280.00 $ 3,284.00 $ 181.77 $ 60,117.22 $ 55.00 $ 60.00 $ 252.10 $ 29.48 $ 0.30 DISBURSEMENTS $ 3,470.00 $ 1,925.00 $ 100,888.67 $ 15,650.75 $ 4,844.15 $ 1,731.08 $ (14.42) $ (972.53) $ 446,163.36 �i $ 17,280.00 $ 2,956.60 $ 328.40 $ 166.91 $ 14.86 $ 47,611.36 $ 2,505.86 $ 55.00 $ 57.00 $ 3.00 $ 0.07 $ 252.03 $ 29.48 $ 0.30 Business Personal Property - Misc. Fees Paid County Treasurer Excess Funds Paid County Treasurer Overpayments Current Tax Collections Penalty and Interest - Current Roll Discount for early payment of taxes Delinquent Tax Collections Penalty & Interest - Delinquent Roll Collections for Delinquent Tax Attorney Advance - FM & L Taxes Advance - County AdValorem Taxes Paid County Treasurer- Nev. East Paid County Treasurer - all other Districts Paid County Treasurer - Delinq Tax Atty. Fee Payment in Lieu of Taxes Paid County Treasurer- Navig. East Paid County Treasurer - All other Districts Special Farmers Fees Collected Paid State Treasurer, Farmers Fees Hot Check Collection Charges Paid County Treasurers, Hot Check Charge Overage on Collection/Assessing Fees Paid County Treasurer, overage refunded $ 24.22 $ 1.14 $ 44,664.24 $ 8,820.78 $ 6,091.43 $ 2,717.19 $ 12,459.67 $ 55.00 Escheats $ - Paid County Treasurer -escheats TOTAL COLLECTIONS $ 718,779.40 TOTAL DISBURSEMENTS TOTAL OF ABOVE RECEIPTS PAID TO STATE AND COUNTY i .L, n , KERRIBO D Tax Assessor -Collector $ 24.22 $ 1.22 $ 61,476.66 $ 22.79 $ 795.22 $ 12,469.57 55.00 $ 718,779.40 $ 718,779.40' 1 l D ICH H MEYEREYER County Judge m a I ul I, NOTICF OF MFF1-ING — 1.1/1/2023 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 11of12 3: O N z � d1 dl di EA T O o 0 0 m m z � v a m m -zi z 3 � m z � 3 m m v ;4 fA m z C C� m C O O `J m �@ m K 9 W m m N A W tA0 Z O oo<n e A Gn O-n O A ch ZZKcn N c'9r"N M v � m. 0 z � � Q m m c 3 S T z � a 0 0 z o� z z z z 0000 AO pOp 0p7 �0A7 z z z z a 3 NW -- - O0 9 W V! O fA O 0 w u p� Ol w o 0) A A N O v 0 0 Z v n m m m n r C O c O Z 0 m O C m 3 0 A 3 0 c z N O 0 O 90 W �1 v ms m co N cx v r cn 4 0 oT� 0 3 0) m c 3 1 0 N O O j N N 0 mrDxO I r r � OR S m c m O< 'N{ c x i O� O co i 00004 ,0000 e 1 0 0 0 0 1 0 0 0 0 17J ,Z7 ,Z1 ,'0 z z zz z y z � ram. )0 O O o ilia ,� JIP O O O O m m z -0: ° aE m -zi m:m i mz'; H -I; a 3: r m: m 3E m CCA 3 m? 3: z N m m 0 m 3 x9 m E z tm/N z Pl m m N N W O pA� N O O O p --log A V 0 2 0 0 m m W m y < 0 m zmom m a �c �+ <zK0`.°. 0zma y m,,, A N m D N e z z z z 0000 0 G) 0py 0 z z z z a r e z 0 0 N 9 3 eQ� BAR III c 0 n m m m n r C 0 k, l� CO 0 m om D A r � T = N V v r m CO Z e 00 GG) z z m m A 0 m m N 3 m 3 0 T z �a m 0 m a 3 m z 4 cc O a 000 � A;0 � AA z z z H a w Iz I� 0 to 0 v� to f» 0 0 0 lJim C !A fA EA T T 0 0 0 0 0 0 0 m N zz 11 .L 0 T 0 c 4 1 A D 8 H G)w0 �z< m (CO: < � ;ma + r Z - CC m A a 0 A o0 O m A Z j lM IA 00 000I N O m o z m o a m m -zi 3 m z _ z o m 0 tN m m m I v zz n n z Z N t- z 0 _ V- C)_ 05 c 0 Z m m m a r c 0 I m G= C z mB 2 I 3- rrn m Z= N -J= Z o a= z 3= a m= � C H 2 3 M= 3= Z= a =_ a m- m= Z _ aa i H N W W e Oa T T N`fil W W T mimicO a 0 #15 NOTICE OF MEETING 11/1/2023 15. Approval of bills and payroll. (RHM) MMC Bills 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 [UNANIM MOVER: David Hall, CommissionE SECONDER: .,..... Vern Lyssy, Commission, Judge Meyer, Commissionei Page 12 of 12 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR —November 01, 2023 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES TOTALPAYABLES PAYROLL AND ELECTRONIC, BANK PAYMENTS 1H453Tv�T TOTALTRANSFERS�BETNIEENFIENDS;, $ 4a T33.63 TOTAL NURSING HOME UPL EXPENSES $ 954;3H4.78: TOTALINTER.GOVERNMENTT,RAN$FERS _ $ MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR --November 01, 2023 PAYABLES AND PAYROLL 1012612023 Weekly Payables. 253,293.50 10/30/2023 Capital One -supplies 589.33 10/30/2023 Sam's Club Direct -dietary supplies 557.50. 1013012023 City of Pon Lavaca- ater 66.66 1013012023 Frontier -phone 70.40 1013012023 Fusion Cloud -phone 1,830.36 1013012023 McKesson-3408 Prescription Expense 6,745.20. 10/30/2023 Amerisource. Bergen-340B Prescription Expense 371.62 Prosperity Electronic Bank Payments 10/23-10/27123 Pay Plus -Patient Claims Processing Fee 443.21 10/2712023 ExpertPay- child support $70.69 TOTALPAYABLi5k-FlaYyliOLt<ANMELEGTRONIIIBANK- PAYMENTS $ 264,¢#¢T TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 10/2612023 MMC Operating. to Ashford -correction of NH. QIPP payment deposited into MMC 7,923.66. Operating 10/2612023 MMC Operating, to Solera-correction of NH QIPP payment deposited. into MMO 2,064,69'. Operating 10/26/2023 MMC Operating to Fort bend-correctlon of NH QIPP payment deposited'. into. 2,198.04 MMC Operating 10I28/2023 MMC Operating to Broadmoor-correction of NH QIPPpayment deposited. into. 2,652.16 MMC Operating 10/26/2023 MMC Operating. to. Crescent -correction of NH insurance and QIPP payment 11,098.75 deposited. into MMC Operating in. error 10/26/2023 MMC Operating to Golden Creek -correction of NH. insurance and QIPP 11,756.36 payment deposited into. MMC Operating in. error 1012612023 MMC Operating to Gulf Pointe Plaza-caneclion. of NH insurance and. QIPP 4,164.63 payment deposited Into. MMC Operating 10M6/2023 MMC Operating to Tuscany Village -correction of NH insurance and QIPP 3,935.87 payment deposited'. into MMC Operating 10126I2023 MMC Operating to Bethany -correction of. NH. insurance and QIPP payment 2,939.47 deposited into MMC Operating TOTI�p=tRAI�S,FER4_`BET4jlEEI�,FUNCIS: S ?f6,�'33-&l NURSING HOME UPL EXPENSES 1013012023 Nursing Home UPL-Dante%Transfer 297,044.89 10/30/2023 Nursing Home UPL-Nexion Transfer 95,611.73 10/3012023 Nursing. Home UPL-HMG Transfer 75,537.67 10/3012023 Nursing Home UPL:Tuscany Transfer 270,180.63 10130/2023 Nursing Home UPL-HSL Transfer 213,009.86 il`OT�CL't+IGRSIIVG E�QIVIL' i�F!L�aE�tPECLBE& $-95i,3$�,'L� TOTALmIlQ7EReG(3YI F NMENT TRANSFERS $ GRAN6'TOTAL.N1613URSE6f6NT9,APPkOVE6tt6ve6ibdt 04, 282& S 4,264 fi55 88 RECEINW00 10126/2023 11 COt6'PS1Y.1 E76Aa MEMORIAL MEDICAL CENTER AP Open Invoice List Due Dates Through: 11/17/2023 Vendor# Vendor Name Class Pay Cade / R1200 ADTCOMMERCIAL Invoice# Comment Tran Dt Inv Ot Due of Check DPay Gross / 152348240. 10124/2010/02/2010/27120 53.61 FIRE MONITORING Vendor Totals Number Name Gross R1200 ADTCOMMERCIAL 53.61 Vendor# Vendor Name Class Pay Code 14028 AMAZON CAPITAL SERVICES v' Invoice#, Comment Tran Dt Inv Dt Due or Check D* Pay Gross r 19W43P4P-QYDF aO 10/18/2010/08120 11/08/20 21.98 SUPPLIES 1XF6-TPDP-3N7Q oaf 10/24/20 10/18120 11/17/20 46.95 SUPPLIES Vendor Total:Number Name Gross 14028 AMAZON CAPITAL. SERVICES 68.93 Vendor# Vendor Name Class Pay Code A1360 AMERISOURCEBERGEN DRUG CORP ./ W Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross 3149392510 / 10/26120 10104/20 10110120 11,429.60 INVENTORY Vendor TotalsNumber Name Gross. A1360 AMERISOURCESERGEN DRUG CORP 11,429.60 Vendor# Vendor Name Class Pay Code 11756 AYA HEALTHCARE INC Invoice# Comment Tran: Dt Inv Dt Due Dt Check D Pay Gross. 3616965 ..° r 10/24/20 10/19/20 1111.6/20. 2,976.75 KARIANN DUNN W/E 10/1.2/23 ILJc4' Vendor Totals Number Name Gross 11766 AYA HEALTHCARE S INC 2,976.75 Vendor# Vendor Name Class Pay Code B1220 BECKMAN COULTER INC Z M Invoice# Comment Tran or Inv Dt Due Dt Check D Pay Gross 110800099 �f10/24/20 08/15/20 09/09120 1,288.46 CONTRACT 64743US 110920261 10124/2010/1212011106/20 272,99 SUPPLIES 110919014 6/ 10/24/20 10/16/20 11/10/20 362.28 SUPPLIES 110925212.1" 10124/2010/16/2011/12/20 920.55 SUPPLIES Vendor Totals Number Name Gross 51220 BECKMAN COULTER INC 2,844.27 Vendor# Vendor Name Class Pay Code B1320 BEEKLEY CORPORATION. f M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross MIN0036331 v/ 09121/20 09121/20 11/15120 796,00 SUPPLIES Page 1 of 11 0 ap_open jnvoice.lemplate Discount No -Pay Net 0.00 0.00 53.61 Discount No -Pay Net. 0100 D.00 53.61'.. Discount No -Pay Net. 0.00 0.00 21:.98 0.00 0:00 46.95 .r Discount No -Pay Net 0.00 0.00. 66.93 Discount No -Pay Not 0.00 0.00: 1.1,429.60 Discount. No -Pay Net 0.00 0.00 1'.1.,429.60 Discount No -Pay Net 0.00 0.00 2,976,75 Discount No -Pay Net 0.00 0.00 21976.75 Discount. No -Pay Net 0.00 0.00 1,288,45' 0.00 0.00 272.99 0.00 0.00 362.28. V 0.00 0.00 920,55 Discount No -Pay Net 0.00 0.00 2,844.27 Discount No -Pay Net 0.00 0.00 796.00 file://!C:iUserslltrevinolcpsilmemmed.cpsinct.com/u88125/data_5/tmp cw5report74983... 10/26/2023 Page 2 of 11 VendorTotalsNumber Name Gross. Discount No -Pay Net. B1320 BEEKLEY CORPORATION 796.00 0.00 0.00 795.00 Vendor#Vendor Name Pay Code /Class 13892 BLUE CROSS BLUESHIELD REFUND ✓' Invoice# Comment Tran Dt Inv Dt Due Dt. Check D' Pay Gross Discount No -Pay Net 245547✓ 10/26120 10/17/20 11/01/20 99.20 0.00 0.00 99.20 Y.+' PT REFUND DALLAS DZIERZA 243455✓ 1D/26/20 10/17120 11/01/20 114.37 0.00 0.00 114.37 ✓� PT REFUND DALLAS DZIERZA 246811 ✓ 10/26/2010/17/20 11101/20 54.64 0.00 0.00 54.64 m! PT REFUND SARAH BUSH 223115 10/26/20 10117120 11/01/20 71.52 0.00 0.00 71.52 PT REFUND CARLOS THURLK , r 243786 ✓ 10/26/2010/17/2011/01/20 71.52 0.00 0.00 71.52 PT REFUND CARLOS THURLK Vendor Totals Number Name Gross Discount No -Pay Net 13892 BLUE CROSS BLUE SHIELD REFUND 411.25 0.00 0.00 411..25 Vendor# Vendor Name Class Pay Code s 14120 CALMOONCOUNTY EMS cr' Invoice# Comment Tian Dt Inv Dt Due Dt Check D' Pay Gross Discount No -Pay Net. 2023.08. .-' 10/24/20 09/0112010/05/20 4,840.00 0.00 0.00 4,840.00 AUGUSTTRANSFERS. .. Vendor Totals Number Name. Gross Discount. No -Pay Net 14120 CALHOUN COUNTY EMS 4,840.00 0100 0.00 41840.00 Vendor# Vendor Name Class Pay Code 14260 CAREFUSION SOLUTIONS„LLC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net. 1002157010-6 ✓ 10/25/20 10/06/20 11101/20 2.00 0.00 0.00 2.00,,.p r' MAINT 1002157000.9 w'' 10/25120, 1:01OW2011/01/20 1,788.00 0.00 0.00 1.788.00 MAINT Vendor TotaIE Number Name Gross. Discount No -Pay Net 14260 CAREFUSION SOLUTIONS, LLC 1,790.00 0.00 0.00 1,790.00 Vendor#Vendor Name Class Pay Code 12768 CHEMAQUA ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross. Discount No -Pay Net 8420080 ✓ 10/2412010110/20 10/20/20 593.69 0.00 0.00 593.69 v^ ` WATER TREATMENT Vendor Total;Number Name Gross Discount No -Pay Net 12768 CHEMAQUA 593.69 0100 0.00 593.69 Vendor# Vendor Name Class Pay Code C1730 CITY OF PORT LAVACA H•` W Invoice# Comment Tran Dt Inv Dt Due Dt Check. D Pay Grass Discount No -Pay Net 101723 10126/20 10117120 11/06/20 135153 0.00 0.00 135.53 WATER -CLINIC 101723A 10126/20 10117120 11/06/20 690.02. 0.00: 0.00 690.02 WATER -MAIN .. 1017238 10/26/20 IDJ17/2011/06/20 2,35127 0.00 0.00 2,351.27 ✓� WATER -MAIN .. Vendor Totals Number Name Gross Discount No -Pay Net C1730 CITY OF PORT LAVACA 3,176.82 0.00 0.00 3,176.82 file:///C:/Userslltrevinolepsilmemmed.epsinet.coralu881251data_51tmp_ew5report74983... 10126/2023 Page 3 of 11 Vendor# Vendor Name Class Pay Code 10646 COVIDIEN ,/ Invoice# Comment Tran Dt Inv Dt Due Dt CheckDPay Gross 5870177122 - 10/24/20 10/03120 10/13/20 940.84 ENDO STITCH Vendor Totals Number Name Gross 10646 COVIDIEN 940.B4 Ventlor# Vendor Name Class Pay Code 14400 CULINARY CONCESSIONS LLC ✓� Invoice# Comment Tran Dt Inv Dt Due Dt Check D, Pay Gross. INV00000874. 10/24120 09/30120 10/30/20 32,608.36 CONTRACTFEE. Vendor Totals Number Name Gross 14400 CULINARY CONCESSIONS LLC 32,608.36 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH& SON d Invoice# Comment. Tract Dt Inv Dt Due Dt Check D Pay Gross 733203-1 ✓` 10124/20 10/11120. 11/05/20 39.64 SUPPLIES Vendor Totals Number Name Gross. 10368 DEWITTPOTH&SON 39.64 Vendor#Ventlor Name Class Pay Code 14800 DIRECTV ENTERTAINMENT HOLDINGS v' Invoice# Comment I Tran Dt Inv Dt Due or Check 0 Pay Gross 08886220SX231012 / 10/24/2010/t212010/31/20 481.00 SATELLITE Vendor Totals Number Name Gross 14800 DIRECTV ENTERTAINMENT HOLDINGS 481.00 Ventlor# Vendor Name Class Pay Code 11284 EMERGENCY STAFFING SOLUTIONS✓ Invoice# _ Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 42610 wf 10/24/20 101IS/20 10/25/20 40,062.50 PHYSICIAN SERV�,.'�-dy3i.� Vendor Totals Number Name Gross 11284 EMERGENCY STAFFING SOLUTIONS 40,062.50 Vendor# Vendor Name Class Pay Code. C2510 EVIDENT Yf M Invoice# Cam,.rt^tant Tran Dt Inv Dt Due Dt Check D Pay Gross T2310101378 ✓ 10/25/20 10/101220 10/11/20, 1(1,589.00 CODING/BUSINESS SERV T2310161378 +✓+ 10125/20 10116/20 10/17/20 10905.64 BUSINESS. SERV Vendor Totals Number Name Gross C2510 EVIDENT 21,494.64 Vendor# Vendor Name Class Pay Cade 15052 FAVORITE HEALTHCARE. STAFFING Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross /' 1463734 t,+' 10/25/2009/27/2010/15/20 2,351.25 LYSSA CORTINAS W/E9122/23 M Il../ 1464329 u.�"" 10/2512010/04/2011/01/20 4,655.00 LYSSA CORTINAS W/E 9/29122 P-1 / Discount Nc-Pay Net 0.00 0.00 940.84 � .. Discount No -Pay Net. 0.00 0.00 940.84 Discount No -Pay Net 0100 0.00 32,608.36 Discount No -Pay Net. 0.00 0.00 32,608.36 Discount No -Pay Net 0.00 0.00 39.64 ,. Discount No -Pay Net 0,00 0.00 39.64 Discount No -Pay Net 0.00 0.00 481_00, v' Discount No -Pay Net 0.00 0.00 481.00: Discount Nc-Pay Net. 0.00 0.00 40,062.50 'V'� Discount No -Pay Net. 0.00 0,00 40,062.50 Discount No -Pay Net 0.00 0.00 10,589.00• 60 0.00 0.00 10,905.64 Discount No -Pay Net. 0.00 0.00 21,494.64 Discount No -Pay Net. 0.00 0.00 2,361.25. 0.00 0.00 4,655.00 � , file:///C:/Userslltrevino/cpsi/memmed.cpsinet.com/u88125tdata_5/tmp_cw5report74983... 10/26/2023 Page 4 of I l 1465188 �/ 10/25120,10106/20 10/21/20 2.280,00 0,00 0.00 2,280.00. ,'e' LYSSA CORTINAS W/E 10/6/23 q' AJ 1466107 -�/ 10/25/20 10/18/20 11/02120 4.607.50 0.00 0.00 4,607.50 LYSSA CORTINAS ME 10/13/2 "i Vendor Totals Number Name Gross Discount No -Pay Net 15052 FAVORITE HEALTHCARE STAFFING 13,893,75 0,00 0.00 13,893.75 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE ,/'f M Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pey Gross Discount. No -Pay Net 671.7003 f 10124/2010/04/20 10/29/20 189.45 0.00 0.00 1.89.45 v. SUPPLIES 6753845 ,r'' 10/24/2010/05/2010/3o/2o 67.54 0.00 0.00 67.54 ,SUPPLIES 6753844 v"� 10/24/20 1.0/05/20 10/30/20 1,065.06 0.00 0.00 1.,065.06 V .SUPPLIES .. 6753843 ✓ 10/24/201010512010/30/20 1,065,06 Mo 0.00 1,065.06 ar'' SUPPLIES 6821515 ✓° 10/24/201010912011/03120. 3,890.36 0.00. 0.00. 3,890.36 SUPPLIES 68577111. 10/24/20 10/10120 11/04/20 79.80 0.00 0.00 79.80 SUPPLIES 6857780 wf 10124/201.0/10/2011/04/20 258,74 0.00 0.00 258,74 SUPPLIES 6857784. 10/24/20 10/10/20 11104/20 11365.51 0.00 0.00 1,365,51 SUPPLIES 6857783 10124/20 10110120 11/04120 350.16 0.00 0.00 35006 SUPPLIES .. 6857779 !r + 10/24/20 101101PO 11/04/20 656.88 0.00 000 tiwat; ✓ SUPPLIES .. Vendor Total; Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 8,988.56 0.00 0.00 81988.56 Vendor#Vendor Name Class Pay Code 12404 GE PRECISION HEALTHCARE, LLC r1 Invoice# Comment Tran Dt Inv Dt Due Dt Check. D-Pay Gross Discount No -Pay Not 6002507527 / 10/24/20 10/01/20 10/31/20 204.83 0.00 0.00 204.83 L f' MEDRAD VendorTotalENumber Name Gross: Discount No -Pay Net 12404 GE PRECISION. HEALTHCARE, LLC 204.83 0.00 0.00 204.83: Vendor# Vendor Name Class Pay Code 13148 GRACE FLOORING. AND GLASS. ,y°` Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 2467 y/ 10/24120101t2/20 10/12/20 6,464.50 0.00 0,00 6,464.50 VINYL PLANK INSTALL/HALF C Vendor Totals Number Name Gross. Discount No -Pay Net 13148 GRACE FLOORING AND GLASS 6,464.50 0.00 0.00 6,464.50 Vendor# Vendor Name Class Pay Code 10334 HEALTHCARE. LOGISTICS INC Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 309122659 w 10/24/20 0910MG 10/03/20 73.00. 0.00 0.00 73.00 ' SUPPLIES .. Vendor Totals Number Name Gross Discount No -Pay Net file:f!/C:(Userslltrevinolcpsi/memmed.cpsinet.com/u88125/data 5/tmp_ew5report74983.., 10/26/2023 Page 5 of 11 10334 HEALTH CARE LOGISTICS INC 73.00 0.00 0.00 73.00 Vendor# Vendor Name Class Pay Code 15084 KRISTIN SPENCER v,, Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 101323 10/26/20 10/13/20 11/01/20 20.00 0.00 0.00 20.00 PT REFUND KRISTIN SPENCE .. Vendor Totals Number Name Gross Discount No -Pay Net. 15084 KRISTINSPENCER 20.00 0.00 0.00 20.00 Vendar# Vendor Name Class Pay Code 15068 UPS HEALTHCARE rl� Invoice# CComment Tran Dt Inv Dt [)us Dt Check D' Pay Gross Discount. No -Pay Net 627142R ./ 10/25/20 10/12/20 11/01/20 3,249.00 0.00 0.00 3,249.00 •" DELICIAGARCIA I'rr+a- nee>� t 144-j�,,m0 1s?) - Vendor Totals Number Name Gross Discount No -Pay Net 15068 LRS HEALTHCARE 3.249.00 0.00 0.00 3,249.00 Vendor# Vendor Name Class Pay Coda 10972 M G TRUST r/� Invoice# Comment Tran Dt Inv Dt Due Dt Check D' Pay Gross. Discount No -Pay Net 102323 10/24/20 10/23/20 11101120 1,115.86 0.00 0A0. 1,115.86 yr' PAYROLLDEDUCT Vendor Totals Number Name Gross Discount No -Pay Net 10972 MG TRUST 1,115.86 0.00 0,00 1,1.15.86 Vendor# Vendor Name Class Pay Cade 1 10963 MEMORIAL. MEDICAL CLINIC ..s Invoice# Comment Tran Dt Inv Dt. Due Dt Cheek D Pay Gross Discount. No -Pay Net 102323 10/24/2010/2N2011/01/2O 140.00 0.00 0.00 1.40.00 PAYROLL DEDUCT .. Vendor TotalENumber Name Gross. Discount No -Pay Net 10963 MEMORIAL MEDICAL CLINIC 140,00 0.00 0.00 140,00 Vendor# Vendor Name Class Pay Code 15080.✓'`� Invoice# . Comment Tran Dt Inv Dt Due Ot Check D` Pay Gross Discount No -Pay Net. 181179 10126/20 10117/2D 11/01/20 120.00 0.00 0.00' 120.G0 PT REFUND Vendor TotalENumber Name Gross Discount No -Pay Net 15080 120.00 0.00 0.00 120.00 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLG V' Invoice# comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1027145A/ 10/24/20 09/10/20 09/20/20 40.00 0.00. 0.00 4D.00 w€"� SHORT PAID BALANCE - 1158283 V' 10124/20 10112120 10/22/20 353.02 0.00. 0.00 383.02 INVENTORY f, 1158282 ✓ 10124/20 10112/2010/22/20 0.10 0,00 0-.00 0.10 INVENTORY 1154964 ,/ 1.0/24/2010/1212010/22/20 3,351..75 0.00 0.00 3,351„75 :.INVENTORY 1164391/ 10124/2010115/20 10/25/20 794.06 0.00 0.00 794.05 INVENTORY 1163299 1/ 10/24/20 10/15/20 10/26/20 12.46 0.00 0.00 12.46 INVENTORY file:///C:/Users/ltrevinotcpsi/memmed.epsinet.com/u88125fdata 51tinp_cw5report74983... 10/26/2023 Page 6 of 11 1164392 voo 10/24/20 10/15/20 10/25/20 2,672.91 0.00 0.00 2,672.9ti INVENTORY 1172217 y✓* 10/24120 10117/20 1.0127/1-0 25.45 0.00 0.00. 25.45 INVENTORY .. 1172219 .�''r 10/24/2010/17/2010/27/20 51.87 0.00 0.00 51..87 a+°` JNVENTORY .. 1172218 f � 10/24/2010/7712010/27/20 5,325.42 0.00 0.00 5,325.42 INVENTORY .. 1180495 ,/'� 1012412010/18120 10/28/20 813,24 0.00 0,00 813.24 INVENTORY 1180496 v1 10/24/2010/1812010/28/20 639.93 0.00 0.00 639.93 INVENTORY .. ,r 1179566 F 10/24/20 10/18120 10/28/20 188.18 0.00 0.00 188.18 INVENTORY 1177738 oi' 10124/20 10118/20 10/28/20 8,492.35 0.00 0.00 8,492.85 INVENTORY .. 1177739 ,,/ 10/24/20 10/18120 10/28/20 41.46 0.00 0.00' _ 41.46' .r INVENTORY 1177737 „(' 10/24/20 10/18120 10/28/20 2.94 0.00 0.00 2,94 ,.. INVENTORY .. CM68236 e+r 10124/2010/1912010129/20 -0.02 0,00 0,00 -0.02 CREDIT � 11859061.1 10/24120 10/19120 10/29/20 1.55.14 0.00 0.00 155.14 INVENTORY 1186363 1.0/24C2010/19/2010/29/20 1,109.35 0.00 0.00 1.,109.35 INVENTORY 1182985 10124/20 10119/20 10/29120 389.09 0.00. 0.00 389.09 INVENTORY . CM68235 �/ 10/24/20 10/19/20 10/29/20 .0.12: 0.00 0.00 -0.12 w CREDIT 1187604 - 1012612010/20/2010130120 3,351.75 0.00 0.00 3,351..76 w} INVENTORY .. 1192650 w'"i 10/25/20 10/22120 11101/20 672.20 0.00 0.00 872.20 INVENTORY 11.92647 �,=^`- 10/25/20 10/22120 11101120 145.33 0.00 0.00 145.33 �✓" INVENTORY .. 1192648. ram 10/25/20 10/22/20 11/01/20 1.92 0.00 0.00 1.92 INVENTORY - 1192649 "� 10/25/2010/22/2011101/20 162,07 0.00 0.00 182.07'y,, ' INVENTORY .. 1195484 .✓'d 10/25/20 10123120 11102/20 3.24 0.00 0.00. 3.24 ` INVENTORY 1196858 ,,. 10/25/20 10123/20 11102/20 411.46 0100 0.00 41'.1.46 .INVENTORY 1195483/ 10/25/201.012312011/02/20 8.83 0.00 0,00 8.63 w-',- INVENTORY 1196859a" 10/2512010/23/2011/0212D 640.26 0.00 0.00- 64026 ww°� INVENTORY .. 9961968 10/26/20 08/23/20 09/02/20 3,611,54 0.00 0,00 3,611.54 INVENTORY .. 1008447 y,i 10/26/20 09/05/20 09/15/20 49.59 0.00 0.00 49.59 file;!//C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report74983... 10/26/2023 Page 7 of 11 INVENTORY Vendor TotalE Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 33,716.76 0.00 0.00 33,716.76 Vendor# Vendor Name Class Pay Code 15088 .T ✓,r Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net. r 254475 w/ 10126l2010103/2011/01/20 30.00 090 0,00 30.00 PT REFUDN Vendor Totals Number Name Gross. Discount No -Pay Net 15088 30.00: 0.00 0.00 30,00 Vendor# Vendor Name Class Pay Code 12388 NATIONAL FARM. LIFE INSURANCE VZ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 4065650 ,i"�'f 10/26/20 10/16/411/01/20 3,190,42 0.00 0.00 3,190.42 yf� LIFE WSUR Vendor Totals Number Name Gross. Discount No -Pay Net 1.2388. NATIONAL FARM LIFE INSURANCE 3,190.42 0.00 0.00 3,190.42 Vendor# Vendor Name Class Pay Code 01500 OLYMPUS AMERICA INC r M Invoice# Comment, Tran Dt Inv Dt Due Dt Check. D Pay Gross Discount. No -Pay Net. 35/40335 .+tp 10124/201.0/07/2011/01/20 1,125.00 0.00 0.00 1,125A0 "- CONTRACT ,. 35148398.+Y 10124/2010110/2011/04/20. 201.88 0.00 0.00 201..88 SUPPLIES .. Vendor Totals Number Name Gross Discount No -Pay Net 01500 OLYMPUS AMERICA INC 1.326.88: 0.00 0.00 1,326.88 Vendor# Vendor Name Class Pay Code 10152 PARTSSOURCE, LLC u// Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net. 0497071.9 10/24/20 10106/20111DS/20 144.08 0.00 00.00 144.09, SUPPLIES , Vendor Totals Number Name Gross Discount No -Pay Net 10152 PARTSSOURCE, LLC 144.08 0.00.. 0.00 t44.08. Vendor#Vendor Name Class Pay Cade P1800 PITNEY BOWES INC ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 1023953863 10/24/20 09l26/20 10126/20 207.00 0.00 0.00 207.00 POSTAGE .. 1.024035604/ 10/24/20 10/09/20 11/08120 104.99 0.00 0.00 104.99 F•%'"i INK CARTRIDGE ,. Vendor Total,Number Name Gross Discount No -Pay Net. P1800 PITNEY BOWES INC 311.99. 0,00 0.00 311,99 Vendor# Vendor Name Class Pay Code 14764 PL-CPR, LLC v/ Invoice. Comment Tran Dt Inv Dt Due Dt Chock D Pay Gross Discount No -Pay Net 259 ✓' 101251201012012011101120 525.00 0.00 0.00 525.00- ACLS 261 d'�' 10126/201012412011101120 250.OD 0.00 0.00 250.00 BLS CLASS Vendor Totals Number Name Gross Discount No -Pay Net 14764 PL-CPR, LLC 778.00 0.00 0.00 775.00 file:///C:/Userslltrevinolcpsilmemmed.cpsinet.comlu881251data_5ltmp_cw5report74983... 10/26/2023 Page 8 of 11 Vendor# Vendor Name .Class Pay Code 10372 PRECISION DYNAMICS CORP (PDC) "`- InvoieeM Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9354224305 ,.''+ 10/24/20 09/2112010/21/20 204.36 0,00 0,00 204.35 SUPPLIES 9354373750 , 10124120 10/09/20 11108/20 204.36 0.00 0.00 204.36 SUPPLIES 9354429196 y''- 10/2412010/16/201.1116/20 204.36 0.00 0.00 204.36 SUPPLIES .. Vendor Totals Number Name Gross Discount No -Pay Net. 10372'. PRECISION DYNAMICS CORP (PDC) 613.08 0-.00 0.00 013.08, Vendor# Vendor Name Class Pay Code 10896 QIAGEN INC Invoice# Comment Tran Dt Inv of Due Dt Check D Pay Grass Discount No -Pay Net. 998972615 y� 10/24/20 09/2912010/29/20 209.93 0.00 0.00 209.93 SUPPLIES 998976741 V 1 10/24/20 10/03/20 11102/20 209.93 0.00 0.00 209.93 SUPPLIES Vendor Totals Number Name Gross. Discount No -Pay Net 10896 OIAGEN INC 419.86 0.00 0.00 41.9.86 Vendor# Vendor Name Class Pay Code 11024 REED, CLAYMON, MEEKER & HARGET ,v Invoice# Comment Tran Dt Inv Dt Due Dt Check D• Pay Gross Discount No -Pay Net 29614 m°� 10/24/2010/17/20 11/05/20 95.00 OX0 0.00 95.00 LEGALSERV 29615 10124/20 10117/20 11/05/20 95:00 0.00 0.00. 95.00 �„-- LEGALSERVICES Vendor TotalsNumber Name Gross Discount No -Pay Net. 11024 REED, CLAYMON, MEEKER & HARGET 190.00 0.00 0.00 190.00 Vendor# Vendor Name Class Pay Code S2001 SIEMENS MEDICAL SOLUTIONS INC ✓" M invoice# Comment. Tran Dt. Inv Dt Due Dt Check DPay Gross Discount No -Pay Net 116447062 V 10/25/20 10/16/20 11110/20 2,375.92 0.00 0.00 2,375,92 SYM81A EVO Vendor Totals Number Name. Gross. Discount No -Pay Net S2001 SIEMENS MEDICAL SOLUTIONS INC 2,375.92 0.00 0.00 2,375.92. Vendor# Vendor Name Class Pay Code 10690 SIGN AD, LTD. us' - Invoice# Comment Tran Dt Inv Dt Due Dt Check or Pay Gross Discount No -Pay Net 293042 10/2612010116/20. 10/26/20 410.00 0.00 0.00 41.0.00 ti.✓"- ADVERTISING. Vendor Totals Number Name Gross Discount No -Pay Net 10699 SIGN AD, LTD. 410.00 0.00 0.00 410.00 Vendor# Vendor Name Class Pay Code 14716 SINGLETON ASSOCIATES PA Invoice# I/ Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net. 560.1 10�' 10124/2010/0512011/D1/20 8.39 0.00 0.00 8.39. RADIOLOLGY SERV Vendor Total=.Number Name Gross Discount No -Pay Net. 14716 SINGLETON ASSOCIATES PA 8.39 0.00 0.00 8.39 Vendor# Vendor Name Class Pay Code file:!//C:/Users/ltrevinolepsllmemmed.epsinet.eom/u881251data_51imp_cw5report74983... 10/26/2023 Page 9 of 11 11296 SOUTH TEXAS BLOOD & TISSUE CEN ✓ Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net. 107035253 ,." 10/24l2010/75/2011/09/20 4,953.00 0,00 0.00 4,953.00 BLOOD CM10708 „„s' 10/24/20 10/15/20 11109120 -2,640.00 0.00 0.00 -2,640.00 a><° CREDIT Vendor Totals Number Name Gross Discount No -Pay Net. 11296 SOUTH TEXAS BLOOD & TISSUE CEN 2,313.00 0.00 0.00 2.313.00 Vendor# Vendor Name Class. Pay Code C1010 SPARKLIGHT ✓'�. W Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 101423 10125/20 10/14120 10115120 137.86 0.00 0.00 137.88 PT CABLE 101623 10/25/20 10/16/20 10/17/20 132.61 0.00 0.00 132.61 6 CLINICCABLE. Vendor Totals Number Name Grass Discount No -Pay Net C1010 SPARKLIGHT 270.49 0.00 0.00 270.49 Vendor#Vendor Name Class Pay Code 10758 TEXAS SELECT STAFFING, LLC Invoice# Comment Tran Ot Inv Ot Due Dt Check D Pay Gross. Discount No -Pay Net 0022900 10/24/20 10119/20 10/20/20 4.097.50 0.00 0.00 4,097.50 BRANDON BATES WE lo/14/2 v T. Vendor TotalENumber Name Gross Discount No -Pay Net. 10758 TEXAS SELECTSTAFFING, LLC 4,097.50 0.00 0.00 4,097.50 Vendor# Vendor Name Class Pay Code 10732 THERACOM, LLC a% Invoice# Comment Tran Dt Inv Dt Due Ot Check D Pay Gross. Discount No -Pay Net 224367637.301 / IOt25/20 07/12/2010/10120 2.304.25 0.00 0.00 2,304.25 xa"" INVENTORY Vendor Totals Number Name Gross Discount No -Pay Net 10732 THERACOM, LLC 2,304.25 0.00 0.00 2,304.25 Vendor# Vendor Name Class Pay Code 13224 TORCH ✓� Invoice# Comment Tran Ot Inv Ot Due Dt l Check D Pay Gross Discount No -Pay Net 2229905 ,.v'' 10/24/20 05/28/20 07/28/20 6,375.00 0.00. 0.00 6,375.00 CFO SEARCH Vendor Totals Number Name Gross Discount No -Pay Net 13224 TORCH 6.375.00 0.00. 0.00 6,375.00 Vendor# Vendor Name Class Pay Code 13616 TRIOSE, INC Invoice# Comment Tran. Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net TRI166722 r�+°' 10/24/20 10/24/20 11108120 66.94 0.00 0.00. 66.94 .> FREIGHT TRI135293 10/25/20 10/20/2011/04/20 120.01 0.00 0.00. 120.01 FREIGHT .. TR11370701R10/26/2011/1112011/26/20 210.78 0.00 9.00 210.78 FREIGHT TRIlSS238. 10125/20 11/25/20 12/10/20 129.04 0.00 0.00 129.04 y. FREIGHT TR1138763 1012512012/01/201PJ16120 60.90 0.00 0.00 60.90: „a> FREIGHT file:!!/C:lUserslttrevinolcpsilmemmed.cpsinet.com/u88125/data 51tmp_ew5report74983... 10/26/2023 Page l0 of t 1 TRI142215 V1-1 10/25/200111312001/28/20 30.00 0.00 0.00 30.00 FREIGHT TRI144490 �/fi 10/25/2002/10/2002/25/20 46.77 0.00 0.00 46.77 FREIGHT TH1146857 +,. 1025/20 0311020 03/26/20 300.34 0.00 0.00 300.34 FREIGHT TRI147410 ,y/ 10/25/20 03117120 04/01/20 220.06 0100 Mu 220.06 FREIGHT TRI148098 10/25/20 03/24/20 04/08120. 276.19 0.00 0.00 276.19 ,4r' FREIGHT TRI153852 W,- 1025/2006/01/2006/16120 131.56 0.00 0.00 131.56 FREIGHT TRI155707 ✓,R 1=51200612212007/07120. 192.15 0.0o 0.00 102.15 �f FREIGHT TRI159310 ++ 10/25/2008102/2008/17120 63.21 Mo 0.00 63.21 EIGHT � . TRI160669 10/25/2008/17/2009/01/20 238:97 0.00 0,00 238.97 ;,»'"' FREIGHT TRI161877 10/25/2008/31/2009115/20 103.40 0.00 0.00 103.40 ✓"� FREIGHT TRI162450 ✓'� 10/25/20 09/07/20 09/22/20 336.43 0.00 0.00 336.43 ✓`f FREIGHT TRI162971 r/ 10/25120 09/12120 09/27120 90.76 0.00 0.00 90.76 ✓� FFREIGHT TR1163598✓ 10125/20 09119120 10/04/20 281A3 0.00 0.00 281_13'v"� FREIGHT Vendor TotaLNumber Name Gross Discount No -Pay Net 13616 TRIOSE, INC 2,896.64 0.00 0.00 2,898.64 Vendor#Vendor Name Class Pay Code 10885 TTUHSC-HEALTH,EDU� Invoice# Comment Train Dt Inv Ot Due Dt Check D Pay Gross Discount No -Pay Net 2309.425✓� 10/24/2008/012008/31/20 61826.51 0.00 0.00 6,826.51: CONT EDUCATION SERV .. Vendor TotelE Number Name Gross; Discount. No -Pay Net 10885 TTUHSC - HEALTH.EDU 6,826.51 0.00 0.00 6,826.51. Vendor# Vendor Name Class Pay Code U1054 UNIFIRST HOLDINGS INC Invoice# Comment Tran Dt Inv Ot DO Dt Check. D Pay Gross Discount No -Pay Net 2921016081/ 10/242010/1612011/1,0/20 2,890.65 0.00 0.00 2,a90.65 LAUNDRY 2921016082 v,r 1024/20. 10/16/20 11/1020 91.80 0.00 0.00 91.80 LAUNDRY 2921016417 10/2412010/19/2011/13/20 244,1.9. 0100 0.00 244,19 LAUNDRY 2921016416 � 10/24120 10/19/20 11/13120 298.08 0.00 0.00 298.08 LAUNDRY 2921016413 1/ 1012412010119/20 11/13/20 202.76 0.00 0.00 202.76 LAUNDRY 2921016418 ✓'f 1024/20 10l19I2011/13/20 228.21 0.00 MO 228.21. LAUNDRY 2921016414 ,/� 1012412010/19/2011/13120. 2,195.04 0.00 0.00 2,196.04 ; file:///C:/Userslltrevinolcpsilmemmed,cpsinet.coralu88125/data_5/tmp_cw5report74983... 10/26/2023 Page l I of 11 LAUNDRY 2921016412 ✓ 10124/20 10/19120 11/13/20 117.69 0.00 0.00 1.17.69 ✓"•� Lr>tUNDRY 2421016415 f 10/24/20 10/19/2D 11/13/20. 29.95 0.00 0.00 29.95 wi LAUNDRY 2921016419 ✓' 10/24/2010/19/2D 11/13/20 102.46 0.00 0.00 102-.46 "'• LAUNDRY .. / 2921016607 ✓ 10/26/20 1012WG 11/17/20. 2,774.03 0.00 0.00 2,774.03. at� LAUNDRY 2921016608 10/25/2010/23/20 11/17120 91.80 0.00 0.00 91.80- a LAUNDRY Vendor Total.- Number Name Gross Discount No -Pay Net U1064 UNIFIRSTHOLDINGSINC 9,266,66 0,00. 0.00 91266.66 Vendor# Vendor Name Class Pay Code V1471 VICTORIA RADIOWORKS, LTDs''� W Invoice# Comment Tran Dt Inv Dt Due Dt Check D` Pay Gross Discount No -Pay Net 23090223 10126/2009/30/2010130120 160.00 0100 0.00 160.00 ter` ADVERTSING .. Vendor Totals Number Name Gross Discount No -Pay Net V1471 VICTORIA RADIOWORKS, LTD 160.00 0.00 0.00 160.00. Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC v" Invoice# Comment Tran. Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 9111.398430 ,�� 10124/2010/13/2011/07120 1,571.67 0.00 0.00 1,571.67 CONTRACT .. Vendor Totals Number Name Gross Discount No -Pay .Net 11110 WERFEN USA LLC 1,571..67 0.00 0.00 1..571.67 Vendor# Vendor Name Class Pay Code 11400 WEST COAST MEDICAL RESOURCES w�'F' Invoice# Comment Tran Dt Inv Dt Due Dt Check 0 Pay Gross Discount No -Pay Net INV105284 y�` 10/24120. 10/16/20 11/15/20 895.00 0.00 0.00 895.00 SUPPLIES. .. Vendor Totals Number Name Gross Discount No -Pay Net 11400 WEST COAST MEDICAL RESOURCES 895.00 0.00 0.00 895.00 Vendor# Vendor Name Class Pay Code /". 10556 WOUND CARE SPECIALISTS v/ invoice# Comment Tran Dt Inv Dt Due Dt Check 0' Pay Gross Discount No -Pay Net. WCS00006282 *f10/2412010/01/2010/30120 13,925.00 0.00 0.00. 1.3,925.00 ,,,r•"` WOUNDCARESEPT23 Vendor Totals Number Name Gross Discount No -Pay Net. 10556 WOUND CARE SPECIALISTS 13,925.00. 0.00 0.00 13,925.00 Report Summary Grand Totals: Gross Discount No -Pay Net 253,293.50 0.00 0,00 253,293.50. P r i file:///C:/Users/ltrevino/cpsi/memmed.cpsinet.com/u88l25/data_5/tmp ow5report74983... 10/26/2023 Page 1 of 1 RECEIVED BY THE i 01WFY R+1..MirM MJ MEMORIAL MEDICAL CENTER 10/30/2023 0 1;3r4kfIIg7t''(gOttNirY,7E3S1 AP Open Invoice List ap_open_invoice.templale Dates Through: Vendor# Vendor Name Class Pay Code ,s ' 14064 CAPITAL ONE ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D-Pay Gross Discount No -Pay Net 101923 10/30/20 10/19/20 11113/20 589.33 0.00 0.00 589,33 q✓` SUPPLIES , Vendor Totale Number Name Gross Discount No -Pay Net 14064 CAPITAL ONE 889.33 0.00 0,00 589.33 Report Summary Grand Totals: Gross Discount: .. No -Pay Net 589.33 0.00 0.00 589.33 •,�% tile:!//C:lUserslltrevinolepsilmemmed.cpsinet.comlu881251data_51tmp_cwSreport51146... 10/30/2023 REceaVEe IWJWL ~ouwv 4Uw—" ON Pt i 3 p 2023 C,IY MV90U*N IFV,-6EOUtwr MEMORIAL MEDICAL CENTER 11:40 AP Open Invoice List. Oates Through: Vendor#Vendor Name �` Class Pay Code S0900 SAM'S CLUB DIRECT w Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross 102023 10/30/20 1012QI20 11/08120 557.50 SUPPLIES Vendor Total: Number Name Gross S0900 SAM'S CLUB DIRECT 557.50 Report Summary Grand Totals: Gross Discount 557.50 0.00 Page I of I 0 ap_open invoice.template Discount No -Pay Net fi 0-00 0.00 55750 Discount No -Pay Net 0.00 0.00 55750 No -Pay Net. 0.00 557.50 file:/HC:/Userslitrevinolcpsilmemmed.cpsinet.com/u881251data_51tmp_cw5report29333... 10/30/2023 AECEWED, BY THE ti.OUi IITYAUD90RON OCT 3 0 2023 MEMORIAL MEDICAL CENTER +c;hui 7 q �31%2m,.TEXliS' AP Open Invoice List 0 11:41 ap_open_invoice.template Dates Through. Vendor* Vendor Name Class Pay Code C1730 CITY OF PORT LAVACA W Invoice# Comment Tran. Dt Inv Dt Due Dt Check D Pay Grass Discount 101723B 10/26/20 10/17/201 V06/20 ^2;35722.. 0.00 WATER. -MAIN Cyj 0411 RI fdAj&AJ?_ 11141- 101723A 10/26120 10/17120 11106/20 $98:OB_, 0.00. WATER -MAIN if ty 101723 10/26120 10117/20 11/06120 J45,53— 0.00 WATER -CLINIC 1Y sg 101723C 10/30/20 10/17120 11/06/20 65.66 0.00 WATER -PT Vendor Totale Number Name Grosse�rr Discount C1730 CITY OF PORT LAVACA 3,342.48 0.00 Report Summary Grand Totals: Gros Discount No -Pay 3,2.48 0.00 0.00 Page l of 1 No -Pay Not 0.00 2,35t 0.00 .69042 0.00-135.53, U0. 66.66 No -Pay Not 0.00 3,242.48. Net 3.248 file:f//C:/Userslltrevino/cpsi/memmed.cpsinet.comlu88l25/data 51tmp_cw5reportl5495... 10/30/2023 Page I of I HE cwNav*1M0R ON MEMORIAL MEDICAL CENTER 10/30/2023 0 ,_ qiemy'/ftk"¢ "". Tc ,sy AP Open Invoice List ap_open invoice.template Dates Through: Vendor# Vendor Name Class Pay Code % 11183 FRONTIER Y Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 101923. 10/30/20 10/19/20 11/13/20 70.40 0.00 0.00 70.40 PHONE Vendor Totals Number Name Gross Discount. No -Pay Net 11183 FRONTIER 70.40 0.00 0.00 70.40 Report Summary Grand Totals: Gross Discount No -Pay Net 70.40 0.00 0.00 70.40 •1 ti ILI.r file:IIIC:1Userslltrevino/cpsilmemmed.cpsinet.com/u881251data_51tmp_cw5report 10257... 10/30.!2023 Page 1 of 1. a��DE,1v�tr �*av�+aro �l! rsusre�at a� 06710AA 3027 MEMORIAL MEDICAL CENTER AP Open Invoice List 1ID4ie0p j 'J COUWY 7SAS Dates Through: Vendor# Vendor Name Class Pay Code 12636 FUSION CLOUD SERVICES, LLC Invoice# Com ant Tran Dt Inv Dt Due Dt Check 0 Pay Gross 1029011416 10/30/2010/16/201111620 1..830.36 PHONE VendorTotalaNumber Name. Gross 12636 FUSION CLOUD SERVICES, LLC 1,830.36 Report Summary Grand Totals: Gross Discount 1.830,36 0.00 of f's 0 2023 0 ap_open_invoice.template Discount No -Pay Net ,,f 0.00 0.00 1,830.36..�" Discount No -Pay Net. 0.00 0.00 11830.36. No -Pay Net 0.00 1,830.36. file:1//C:fUserslltrevino/cpsi/menimed.cpsinet.com/u88125/data_5/tmp_cw5report6J309... 10/30/2023 MSKESSON STATEMENT Asa: 10/27/2023 �n,y: woo OC: 8115 M@AORIAL M®ICAL C1947"Ha AP ANT DUE REMME) VIA ACH D®rr Temitory: 815 N VIRGINIA STREET Statement for information only PORT LAVACA TX 77979 Cust.on,632536 Dda. 10/28/2023 Paw. 002 To emigre: i9ow ma68 to Your aeo0ad;. 6daaband od. It" dub with YOIm remNtanca. A. d:. 10/27/2023 Page: 002 Nan I. Comp:. 8000 AMT DUE REMITTED VIA. ACN DEBIT Statement for information. only Cad: 632536 PUBU E CHECK ANY OMW 10/2812023 ITEMS: NOT PAID (y) ational Accouut 6 - - Biaml Dw Necelvebl� Rithav Cash A.t P Amount P RemivabN Dda pale Numbm Rdwerlee Dascriplbn Olsouat (gross) F (m) F Numtwr PF mWmn 109-&. P e Pad Dm ILem, F n RAum Ow berm. blank a Current Due been TOTAL NdknMl AM 632536 MENIORIAL MEDICAL CEWnER SuMdals: 6.862.89 USO Future Dua•. 0.00 0w.11 Pda On Tlme:.. Pad Ow: 9.00 If Palo Ey 10/3t/2023, ,t'",! USO S.Te1S20,/ PaY This Amount: 6,745.20 USD Was bad D paid fat,. lad Payment 2,451.97 N Paid Altus 10131/2023, Ow IT Paid late; 13T.69. OB/0]Y201] PaY IMa Amount: 6.882.89 USD. USD 6082 89 ggYY OCT 33}}y0 M DALHC)COGI For AR Inquiries please contact 800-867-0333 I r-, MWESSON cma ,.Q.o WAWARr 1098/MEM MED PH MMORIAL MEDICAL CENTER / VICKY KALISEIc 815 N VIRGINIA S1 PORT I.AVACA T% 77979 STATEMENT AMT DUE REMITTED VIA ACH DEBIT Statement for Inlormallon. only As Wn 10127Y2023 Page: 001 TO armen, Proper creme to uk aga9nt,. dela0h MKI Mo. tti Me0 with y4. rem0lanea Dc, 8115. As W:. 10/27/2023 Pager 001 Tentm: roof Mail to: Comp: 8000 ANT DUE REMITTED VIA ACH DEBIT Customer. 256342 Slatement. 1-1 inl9e8alion omy Oats 10/2812023. Dean. 256342 PIBASE'_CHECK ANY Data:. 10128/2023'. ItEM5 NOT' PAID (r). mlellal Account 6 Cast, Amount P AmOUM. P RecefvaMe DateB 0 a N dab Rslerenee pescrlplteA Disewnl (9m®). F' (left F Number Customer Number 256342 WAUMAW 1D98/MEM MED MS' 10/23/2023 10/31/2023 7452827107 92785301 1151,vv01ee 18.28 913.20 895,62:/" 7452827107 '.. 1012312023 10/31/2023 7452849091 92966229 1151nvoice 15.97 798.49 782.52'.✓ 10/24/2023 10/31/2023 7453111354 93008231 1151mmice 23.2t 1.160.41. 1.137.20'." 7452.49091. 10/24/2023 10/31/2023 7453340089 93015013 1951nv01ce. 5.23 261.50. 7453171354 10/25/2023 10/31/2023 7453683449 89390331 Lt5lnvoice, 2.36 256.27-✓ 7453340069 10/25/2023 10/31/2023 7453683450 90145274 1151nvdce 1.30 117.99 69.51 1.15.63. 1` 7453683449. 10/262023 10/31/2093 7453741180 933a5893 IIS1.0ice 32.03 1.601.33 68..12.E 1.569.30 74536BUSO 10/26/2023 10/31/2023 7453741181 93385893 1151nvoice, t.02 50.78 v.` �{ 74537411.00 t 01Z]/2023 W/31/2023 7954010995 93443903 1151nv0ice 0.01 0.32. 49,74 )g53]4i16t 10/27/2023 10/31/2023 7454010396 03614176 1151nvoice. I6.00 799.93 0.31 733.93: 7454010395 10/27/2023 10/31/2023 7454010397 93514.176 II51.0ice 0.03 wP T454010396 10/27/2023 10/31/2023 7464167607 93479799 1.951nvolcs 20.24 1..27 1.24 74540.1039] 7464167607 10/2]M2023 10/31/2023 2454/67608 93434698 1951nvoice 0.1.1 11011.,80 991.58.f' 10/27/2023 10/31/2023 7454t57609 93450540 195Inv01ce 1.73 5,38 5.27 »•'r 74541676.08 10/27/2023 10/31/2023 7454190485 93386598 1151nvoice 86.38 84,85,E 7464167609 0.03 1.27 1.24 �.'' 7454790486 PIP column N0en4: P - Pest Due Item, F c R ann sue itwn, Menk = Come,, Due it.. TOTAL CUN00wr Needed 256342 WAIMAW 10981MEM. MED PNS SUMWeh: 6,800.24 UM FWwa Due: 0.00 D Pent By 10/3112023, Past Due: 0.00 Pay This Amre d:. last Paymnd 10,51.0.49 If Peld After 10/31/2023, 10/23/2023 Pay this Amoud: #NVOWD On tin 3 0 IFI CAM960511W. Due D PWd. 0n Tens: Use 6.742.ew'`/ 6.742.60 Use 01. lost 0 paid let.: 137.64 Due It PaMI late:. 6,880.24 USD USD ll, 116.8 80.24 ..W.V�LIWxT'94J; (iu4'LeJ_y.�li4, iU' For AR Inquiries please contact 800-867-0333. of: 10127/2023 MSKESSON STATEMENT Paw. 001 TO arwn p eper ene t he your rammed, detach and Mum, thie GamarY: 8000 Rub with, yprc mmillerca DC: 8115 CVS PHCY 9 MC PHS AMT DUE RINI TED VIA ACH DEBIT Territory: 7001 Aa. d: 1012712023 Pape: 001 Mail to: Comp. 8000 MEDICAL MEMORIAL IQL MEDICAL CBJTES Statement for information only AMT DUE REMIU 0 VIA ACH DEBIT 81S N VIRGINK Cu keedo 635430 315 N IA ST Statement for information only AVAC pate: 10/28/2023 POF1 lAVACA TX ]]9]9 Cud: 835438 PLEASE CHECK. ANY Ddt. 10/26/2023. D S NOT PAIDshi(y( Methnel A¢ount 8 r Daie9 [We NAmbmbltr Cad, Batemear, Oacripflon Discount Amount P (groa) F Anundt P ReuHeMa Ind) F Number Connoted Number 835435 CVS PHCY 1415/A13,1 MC MS 10/25/2023 10/31/2023 745361]]59 2]]9978 1151mmloe 0.05 2.65 � 2.60 wf 746361]]59 0 PF -IMP W90nM: P = Pad Due Item, F = Mum One Item, blank = Curd, Our Arm TOTAL Cult. NumbW 63649a CVS PNCY T415/M68 MC PH9. SubhMd 2.65 USD Mum 0. 0.00 Due It Mid On. Time:: If Pad BY IW31/2823, USD 2.60 Pat Out: 0.00 Pay Me Amoure: 2.60 USD Diae had A AM Isle: Led Payment 10,610.49 II PeM Alter 10/91/2029, 0.05 Due K hid Late: 10(23/2023 Pay this Ammmb 2.65 LED USD 2.66``� ` CH OCT3 W3 CA Fm For AR Inquiries please contact 800-867-0333 en' AmerIS011rceBer STATEMENT Statement Number: 66181866 g Date 1n-97_7n93 1. of 1 AMERISOURCEBERGEN DRUG CORP WALGREENS 0124N U08 12727 W. AIRPORT SLVD. MEMORIAL MEDICAL CENTER 1001352 1037028186 SUGAR LAND TX ] 478-0101 1302 N VIRGINIA ST PORT LAVACA TX 77979-2509 DEA: RA0289276 Sat -Fd'Due In 7 days 866461-9655 AMERISOURCEBERGEN PO Box 9052M CNARLOTTENC 2829MM Not Yet Due:. 0,00 Cunenl:. 371.62 Past Due: GAB TOW! Due: 371.62. Account BaNnw: 371.62: AccountActivity Document. Due Reference Purchase Order Document Original Last Receipt Amount Received. Balance Date Date Number Number Type Amount 10-2 2023 tt.p3-2023 N51369850 ]0041 .a Invdm 911.28 10.23-2023 1I-D-2023 3151369881 7004476426 Iwaice 244i 0:00. G0.AO 9328 10.234023 114Y2023 3151503B71 700H89973 Irwaim WAIL 24:41: 10-244023 1143-2023 3151680527 700n500585 Iwoice 65.98 000 : 3i80 3: 10.242023 11-03-2023 3751880528 7MM1391 Iwaice 23.62 0'00 5.96 10.25-2023 11.03-2023 31SIV2578 700850mis Invalm 3.]0 0.00 23:82. 10-2B-2023 11-012013 3131985389 M0452MS Involm WAS 0.00 -r 3.]U. 10.2&2023 11-034023 3161985530 7004520512 Invoce T3:82'. 0.000.00 2fiW;i5.82. r. 10.2]-2023 11-03.2023 3152135W9 7004533954 Invoice. M..57 : 1047-2023 11-0120:l 3IM135230 70040MOS Invoice 0.00 72.57 Y 2.09 0.00 2.09 Current 1.11 11a1s 16-10 Days 31-60 Days 61.90 Days 91-120 Days Over 1200 371.62 0.00 0.00 0.00 '. 0.00 0.001 Thank You for Your Payment 'Reminders Date Amount Due Date Amount 10.2A2023 (5 ]589]} 11-0b2023. 371.62 Vr: Total. Due.. "e?I OCT 3 9 zo xAAWMA aL�l3�I'�3 MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONICTRANSFERS FOR OPERATING ACCOUNT —Oct 23, 2023 -Oct 29, 2023. Data Bank Description 10/27/2023 WIRE OUT CBNA INCOMING SETTLEMENT ACCOUNT 10/27/2023 PAY PLUS ACHTrana 000000005076075. 1010006993 10/27/2023 EKPERTPAYERPERTPAY 746D0342191000U11471960 10/27/2023 AMERISOURCE BERG PAYMENTS 01000077682100002 10/27/2023 MEMORIAL MEDICAL PAYROLL 746003411113122650 10/26/2023 PAY PLUS ACHDans OOODOCONS37626 IDI0006971 10/25/2023 PAY PLUS ACHTrans 0000000048151431010006964 10/24/2023 PAY PLUS ACHTrans00000DD047074271020OD6954 10/24/2023 MCKESSON DRUG AUTO ACM. ACH057054449100DU127 10/23/2023 PAY PLUS ACHTran, WOODO004611906 1010006943 ANDRE W DE LOS SANTOS Memorial Medical Center CP MMCNotea Amount -Otillank Corporate Card: Payment $ 8,25909 - 3rd Party Payer Fee. $ 01ffi -Child Support Payment. - 34080m9 Program. Expense $ 5754.97" -Payroll $ 388,300.89 - 3rd Parry Payer Fee $ -f• - 31d Parry Payor Fee $ - 3rd Parry Payer Fee $ - 340D Dmg. Program Expense $ 10,51O49:r - 3rd Party Payer Fee $ Ali 413i648:34. 2023 ItIni 16.0•<6 99 41 i 13-91 , 45. 16 - ¢ P.4 57U`69 443-11 - 570.6.y 1 r 0. 1 5 Y, .. PROSPERITY BANK t6vm ail-1,61ts ti p r1 ELECTRONICTRANSFERS FOR OPERATING ACCOUNT - ESTIMATED ACHS 4 IA; ira dittivj Date OescdoNon 2a I.f' - +u m"�CNEK�� -{C�a• uai�wnb.Bu�xgRsu�B�r�e11➢,ri,llia*aYLia--i.�mLm @�•� p MMC.iotes Am unt irL m3-a.41F -aB; pay Iy tiring ) Lem- ; ANDREW DE LOS SANTOS F—� October 30, 2023. 5,. r, Memorial Medical Center Page I of I RECEt`JED BY THE „0UNTY'AUD1rOR ON MEMORIAL. MEDICAL CENTER 0�32023 0 ,A1Q�6/�' AP Open Invoice List. 1: 0 ap_open_invoice.template Dates Through: av p��gjtyj0,[{F1y.Q0[ioSirt[e ` Class Pay Code 11816 ASHFORDGARDENS ✓f Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net. 102423 10124/20 10124/20 11/24120 7,923.66 0.00 0= 7,923.66 UHC AUG OIPP .. Vendor Total: Number Name Gross. Discount No -Pay Net 11.81.8 ASHFORD GARDENS 7,923.66 0.00 0.00 7,923.56 Report Summary Grand Totals: Gross. Discount No -Pay Net 7,923.66 0.00 0.00 7,923.66 �� to ;r c• r file:///C:/Users/Itrevino/cpsi/memmed.cpsinet.com/u88l25/data 5/tmp_cw5report42289... 10/26/2023 RECEIVED RY 71fE C01r7,9Vry4UP31TORON OCT 2 6 2023 ._to�2g(202g MEMORIAL MEDICAL CENTER 0 11:09 11:09 itolPf.'FEXR4 AP Open. Invoice List ap_opan_invotce.template Dates Through: Vendor# Vendor Name / Class Pay Code 11828 SOLERA WEST HOUSTON *0 Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay 102423 10/24/20 10/24/20 11124/20 2,064.69 0.00 0.00 UHC AUG OIPP Vendor TotalsNumber Name Gross 11828 SOLERA WEST HOUSTON 2,064.69 Report Summary Grand Totals: Gross Discount 2,064.69 0.00 2:15i5 l':lx ►If OCT 2 5 2023 �. .J fir... Discount No -Pay 0.00 0.00 No -Pay 0.00 Page I of 1 Net 2,064,69 Net 2,064.69 Net 2,064.69 file:///C:/Users/itrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report58257... 10/26/2023 RE% t AVBy �1r THE bra Page 1 of 1 MEMORIAL MEDICAL CENTER AP Open. Invoice List Dates Through: Vendor# Vendor Name / Class Pay Code 11820 FORTBEND HEALTHCARE CENTER ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross. 102423 10124/20 10/24/20 11124/20 2.198.04 UHC AUG QIPP Vendor TotalsNumber Name Gross 11820 FORTBEND HEALTHCARE CENTER 2,198,04 Report Summary Grand Totals: Gross Discount 2,198.04 0.00 0 ap_open_invoice.template. Discount No -Pay Net 0.00 0.00 2,198.04 Discount. No -Pay Net 0.00 0.00 2,198.04 No -Pay Net 0.00 2,195.04 file:///C:/Userslltrevino/epsi/memmed.cpsinet.comlu88125/data 5/tmp_ew5report81992... 10/26/2023 Page I of 1 .qErEn�YEEea BYTtiE E7O@1dny AnIJBUOR ON MEMORIAL MEDICAL. CENTER 1OkE6, 62023 AP Open Invoice List. 11:09 Dates Through: am Class Pay Code 11832 BROADMOOR AT CREEKSIDE PARK r/ Invoice# Comment Tmn Dt Inv Dt Due Dt. Check or Pay Gross 102423 10/24/20 10/24/20 11/24/20 2,662.16 UHC AUG QIPP Vendor TotaN Number Name Gross 11832 BROADMOOR AT CREEKSIDE PARK 2,652.16 Report Summary Grand Totals: Gross. Discount 2,652.16 0.00 OCT 2 6 2023 0 ap_open_invoico.template Discount No -Pay Net 0.00 0.00 2,652.1.6- vF° Discount No -Pay Net 0.00 0.00 2,652.116 No -Pay Net 0.00 2,652.16'. file:/NC:/Users/Itrevino/cpsi/memmed.cpsinet.comlu881251data_51tmp_ew5report29679._. 10/26/2023 Page I of 1 HEGE1 FDBYTHE !qIANITY010DON '029A2462-1 MEMORIAL MEDICAL CENTER 0 11:1AP Open Invoice List. 2'£a'0C''W�14.7E1fr3 ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11824 THE CRESCENT Invoice# Comment Tran Dt Inv Dt Due Dt Check DPay Grass Discount No -Pay 101323 10/24/20 10/13/20 11/18/2d0 y_ a720I.00 0.00 0.00' TRANSFER jV 1-ft ➢1 AV fvpkj KfffjVeA _'jWkI��+ )&�kkt bWLp WN 102423 10/2412010/24/2.011/24/20 2,378.75 0.00 0�00 UHC AUG OIPP Vendor Totals Number Name Gross Discount No -Pay 11824 THECRESCENT 11.098.75' 0.00 0.00 Grand Totals: 9;[�tl�jr a 7 i11Y ld u_ Report Summary Grass Discount No -Pay 11,098.75 0.00 0.00 Net 8,720.00 2,378.75.. Net 11.,098.75. Net 11,098.75 file:IIIC:/Userslltrevino/cpsi/memrned.cpsinet.com/u881251data_51trnp_cw5report48234... 10/26/2023 RECEMa) W THE COd9NiX,At1DIIS�P O'PD OC f .2 6 ?023 MEMORIAL. MEDICAL CENTER 0 t1:12 AP Open Invoice List ap open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 11836 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Ot Inv Dt Due Dt Check D Pay Gross Discount No -Pay 101323C 1�0p/24/2010/13/2011/18/20 1,816A��2 0.00 0.00 TRANSFER � 1w14 '%pj0N1LW%Lj jgjxj C' 4MIt ieul1 1' A" k*?,L Uyp'CP,4N..— 101323E 10/24/20 1Ott 3120 11/18/20 2,585.18 0.00 0.06 TRANSFER to as 101323 10124/20 10113120 11/18/20 3,555.00 0.00 0.00: TRANSFER 101323A 10/2412010/1312011118/20 576.91 0.00 0.00 TRANSFER t° "t 101623B 10124120 10/16120 11/18120 122.89 0.00 0.00 TRANSFER 0 M1 101823 10/24120 10116120 11/1 B/20 239.11 0.00 0.00 TRANSFER tt I„ 101623A 10/2412010/16/2011/18120 261.39 0.00 0.00 TRANSFER 102423 1012412010/24120.11 /24/20 UHC AUG QIPP Vendor Totals Number Name 1.1835 GOLDENCREEK HEALTHCARE Report. Summary Grand Totals: Gross Discount 11,756.36 0.00 Page 1 of 1 Net 1,816.42'... 2,66518. „, ' 3.555.00. .-"'✓j 576.91 1.22.69 239.11.r"` 261.39 ✓°F 2,699.46 0.00 0.00 2,599.46 Gross Discount No -Pay Net 11,756.36 0.00 0.00 11,756,36. No -Pay Net. 0.00 11,758.36 file:///C:lUserslltrevino/cpsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5report77988... 10/26/2023 Page 1 of 1 PX-CENED BY THE C jM AUCM-OR ON OCT 2 6 2023 10/26/2023 MEMORIAL MEDICAL CENTER 0. �".31a@1tQ6LYJtl.1 ;9V' 7EW6 AP Open Invoice List ap_open_invoice.template Dates Through: Vendor# Vendor Name ,% Class Pay Code 12696 GULF POINTE PLAZA. w` Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 102423 10/24/20 10124120 11124120 1,998.78 0.00 0.00 1,998.73 W" AUG UHC OIPP 102423A 10/24/201 W24/2011/24/20 2,165,90 0.00 0.00 2,165.90 F UHC JULY OIPP Vendor TotalE Number Name Gross. Discount No -Pay Net 12606 GULF POINTE PLAZA 4,164.63. 0,00 0,00 4,164.63. Report Summary Grand Totals: Gross Discount No -Pay Net 4,164.63 0.00 0.00 4,1.64.63 file:///C:/Userslltrevinolcpsilmemmed.cpsinet.comlu881251data_51tmp_cw5report10652... 10/2612023 Page L of 1 RECEPJED By THE Z®� 10/26/2023 MEMORIAL MEDICAL CENTER 0 -AS AP Open Invoice List ap open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Cade 13004 TUSCANY VILLAGE Invoice# Comment Tran Dt Inv Dt Due Dt Check D Pay Gross. Discount. No -Pay 101623 10/24/20 10/16/20 11/18/20 697.93 0.00 0.00 TRANSFER IJ14 j3A1Aa1'n.p`3u.2, t"310 xi{,:1:41En„-{Iej 'lA1 'u"I'A'c 4),N'R�t�-,, 102423 10/24/20 10/24/20 11124/20 3.037,94 0.00 0!••'•••: UCH AUG OIPP Vendor Totals Number Name Gross Discount No -Pay 13004 TUSCANY VILLAGE 3,935.87 0.00 0.00 Report Summary Grand Totals, Gross Discount No -Pay 3,935.87 0.00 0.00 Net 897.93 3,037.94 Net 3,935.67 Net 3,935.87 file:)//C:/Userslltrevinolcpsilmemmed.cpsinet.comlu88125/data 51tmp_cw5report36973... 10/26/2023 � � Page 1 of 1 Ea � WON �/ e. .rE.Y .5 MEMORIAL MEDICAL CENTER 1'U S2G?�jgti..r 0 ;A.ti1 AP Open Invoice List t11 ap_open._invoice.template Dates Through: Vendor# Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment. Tran Dt Inv Dt Due Dt Check D Pay Gross Discount No -Pay Net 101723 10/2412010/17120 11/18/20 210.58 0.00 0.00 210.58'w+''f TRANSFER 1jui t715NWAv+1t'?1,Y'j d•i+f� tkfl� lAr+4. ytlrukr`��i:p. .. 102423 10124/20 10/24/20 11/24/20 2,728.89 0.00 10.00 2,728.89 e' AHC AUG QIPP Vendor TctalE.Number Name Grose Discount No -Pay Net. 12792 BETHANY SENIOR LIVING 2,939.47 0.00 0.00 2,939.47 Report Summary Grand Totals: Gross. Discount No -Pay Net 2,930.47 0.00 0.00 2,939A7 r 1 ' file:///C:IUsers/ltrevinolcpsi/memmed.cpsinct.com/u88125/data_5/tmp_cw5report77623... 10/26/2023 Memorial Med WI linter N0n10`Neme UPL We WVb mTmmsfar ftfF.NWA..M 10/30/2023 n.Wx. p..e 4GMYy 3 1]].H£flr eptllne wbrl {£IIY:n umeidd asaGo.n VM.nn Y.nAiY.nn. IW!a Yrnu YM1..J,mfuwrb. ]£G)911 f]Af]fI, � �ILIOf,{) wd,s.Mdm.Ym,un[ - uamn� G]pGG! /��% p/ DS165.63✓ a. Ven.xu u.Gos.a../ ,mnm Y.nY em,rc. IWw �ff µwenudR•m.br.ml. vfmu✓ wmvm�wf��9I ii>.Wfl] �11 [dSGI t. 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