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2024-03-27 Final PacketNOTICE OF MEETING- 3/27/2024 March 27, 2024 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: 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 am 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 6 NOTICE OF MEETING — 3/27/2024 5. Approve the minutes of the March 20, 2024 regular meetings. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 6. Consider and take necessary action to proclaim the month of April, 2024 as Child Abuse Prevention Month. (RHM) Mari& Walton with The Harbor spoke. Judge Meyer read proclamation. . RESULT: " ` APPROVED [UNANIMOUS] MOVER: Richard Meyer, County Judge SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judcle Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action to proclaim the month of April, 2024 as Sexual Assault Awareness Month. (RHM) Jennifer Hahn with The Harbor spoke. Judge Meyer read proclamation. RESULT: APPROVED [UNANIMOUS] MOVER: Richard Meyer, County Judge SECONDER: Joel Behrens, Commissioner Pct 3 ` AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Consider and take necessary action to accept the attached list of donations to the Calhoun County Library for the months of January and February. (RHM) RESULT: ' APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 9. Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Surplus/Salvage for the months of January and February. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 6 NOTICE OF MEETING — 3/27/2024 10. Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Waste for the months of January and February. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to approve reappointment of the following Memorial Medical Center Board Members for another term April, 2024 — March, 2026. (RHM) • Michael Chavana • Shelia Dierschke • Dallas Franklin • Kay McPherson • Reynaldo Tuazon RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER:' Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to close a portion of Main Street in Port O'Connor, Texas from the intersection of 2nd Street/State Highway 185 & Main Street; west 150 feet on May 25, 2024; and July 13, 2024 for street dances. (GDR) John Harper asked the court to consider approving and asked to add July 6th to the list of dates for Street Dances. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 13. Consider and take necessary action to authorize Kathy Pullin, sponsor of "Give Domestic Violence the Boot", to use King Fisher Beach Pavilion. September 27 - 28, 2024 for the annual fundraiser benefiting Calhoun County Harbor Children's Alliance. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 6 NOTICE OF MEETING. 3/27/2024 14. Consider and take necessary action to approve the Specifications and Contract Documents for Bid No. 2024.05 Seadrift Drainage Improvements Project for Calhoun County, Texas - Texas General Land Office Contract No. 22-085-014-D245 and to authorize G & W Engineers, Inc. and the County Auditor to advertise for bids. A pre -bid meeting shall be held at 10:00 am, Tuesday, April 16, 2024 at Calhoun County Precinct #4 Office. Sealed Bids will be due before 2:00:00 pm, Thursday, May 9, 2024 at the County Judge's Office. (GDR) Scott and Maria with G&W explained specifications of 6 million dallar.project. RESULT: APPROVED [UNANIMOUS] MOVER: Gary, Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action to transfer to IT and remove from inventory from Precinct 4 Road & Bridge inventory number 24-0478, Lenovo Yoga Laptop. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 16. Consider and take necessary action accept the Supplemental Agreement for Professional Services in the amount of $5,900 with Urban Engineering for Cultural Resources Services for Green Lake Park Development Phase 1, and authorize Judge Meyer to sign all documentation. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 17. Consider and take necessary action to approve the Letter of Agreement to retain Higgins, Inc. as the Architect for the First Responder Training Facility building project and authorize the Director of EMS to sign this agreement. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 6 NOTICE OF MEETING 3/27/2024 18. Consider and take necessary action to add "IT Certification" as a special license paid at the same rate as the Paramedic License ($0.58/hr) and added to the License Differential list. Approval of qualifying certifications will be at the discretion of the County IT Director when individuals are recommended by a Department head. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 19. Discuss and take necessary action to renew aerobic septic system service contract for Six Mile Volunteer Fire Department with Victoria Precision Products and allow Commissioner Vern Lyssy to sign. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner'Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 20. Consider and take necessary action to award qualified bidder on Bid No. 2024.04 Recycle Waste Transfer Station Project and allow Commissioner Vern Lyssy to sign any and all paperwork. (VLL) Scott Mason explained and gave the court his recommendation. Commissioners'awarded bid to ConMetal Contractors. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 21. Accept Monthly Reports from the following County Offices: I. Calhoun County Tax Assessor — February 2024 RESULT: APPROVED [UNANIMOUS] MOVER: , Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: ' Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5 of 6 NC)TICE OE MEETING — 3/27/2024 22. Consider and take necessary action on anv necessary budoet adiustments. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 23. 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 Indigent Healthcare RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese CountyBills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned 10:50am Page 6 of 6 AGENDA I NU I IC I Ot VII I f llvlG 3i l/J_02/I County judge David Hall, Commissioner, Precinct 1 Vern iyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Clary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, March 27, 2024 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 PILED AT q-' 5— O'CLOCK—J�—P9 The subject matter of such meeting is as follows: 1. Call meeting to order. MAR Ng2 2pp2M COUNTY CLERK CAL110<QN COUNTY, TEXq� 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. 5. Approve the minutes of the March 20, 2024 regular meetings. (RHM) 6. Consider and take necessary action to proclaim the month of April, 2024 as Child Abuse Prevention Month. (RHM) 7. Consider and take necessary action to proclaim the month of April, 2024 as Sexual Assault Awareness Month. (RHM) Consider and take necessary action to accept the attached list of donations to the Calhoun County Library for the months of January and February. (RHM) 9. Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Surplus/Salvage for the months of January and February. (RHM) 10. Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Waste for the months of January and February. (RHM) Page 1 of 3 No[!('[ OF NMI HN6 11. Consider and take necessary action to approve reappointment of the following Memorial Medical Center Board Members for another term April, 2024 — March, 2026. (RHM) • Michael Chavana • Shelia Dierschke • Dallas Franklin • Kay McPherson • Reynaldo Tuazon 12. Consider and take necessary action to close a portion of Main Street in Port O'Connor, Texas from the intersection of 2nd Street/State Highway 185 & Main Street; west 150 feet on May 25, 2024; and July 13, 2024 for street dances. (GDR) 13. Consider and take necessary action to authorize Kathy Pullin, sponsor of "Give Domestic Violence the Boot", to use King Fisher Beach Pavilion. September 27 - 28, 2024 for the annual fundraiser benefiting Calhoun County Harbor Children's Alliance. (GDR) 14. Consider and take necessary action to approve the Specifications and Contract Documents for Bid No. 2024.05 Seadrift Drainage Improvements Project for Calhoun County, Texas - Texas General Land Office Contract No. 22-085-014-D245 and to authorize G & W Engineers, Inc. and the County Auditor to advertise for bids. A pre -bid meeting shall be held at 10:00 am, Tuesday, April 16, 2024 at Calhoun County Precinct #4 Office. Sealed Bids will be due before 2:00:00 pm, Thursday, May 9, 2024 at the County Judge's Office. (GDR) 15. Consider and take necessary action to transfer to IT and remove from inventory from Precinct 4 Road & Bridge inventory number 24-0478, Lenovo Yoga Laptop. (GDR) 16. Consider and take necessary action accept the Supplemental Agreement for Professional Services in the amount of $5,900 with Urban Engineering for Cultural Resources Services for Green Lake Park Development Phase 1, and authorize Judge Meyer to sign all documentation. (GDR) 17. Consider and take necessary action to approve the Letter of Agreement to retain Higgins, Inc. as the Architect for the First Responder Training Facility building project and authorize the Director of EMS to sign this agreement. (RHM) 18. Consider and take necessary action to add "IT Certification" as a special license paid at the same rate as the Paramedic License ($0.58/hr) and added to the License Differential list. Approval of qualifying certifications will be at the discretion of the County IT Director when individuals are recommended by a Department head. (RHM) 19. Discuss and take necessary action to renew aerobic septic system service contract for Six Mile Volunteer Fire Department with Victoria Precision Products and allow Commissioner Vern Lyssy to sign. (VLL) 20. Consider and take necessary action to award qualified bidder on Bid No. 2024.04 Recycle Waste Transfer Station Project and allow Commissioner Vern Lyssy to sign any and all paperwork. (VLL) Page 2 of 3 No11(I 01 fV11 11 IlNU S12// 01),l 21. Accept Monthly Reports from the following County Offices: i. Calhoun County Tax Assessor — February 2024 22. Consider and take necessary action on any necessary budget adjustments. (RHM) 23. Approval of bills and payroll. (RHM) r a;� l Richard H. Meyer, County Jud Calhoun County, Texas A copy of this Notice has been placed on the outside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public at all times. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.org under "Commissioners' Court Agenda" for any official court postings. Page 3 of 3 #5 I NO61"ICF OF MEETING-3/27/2024 5. Approve the minutes of the March 20, 2024 regular meetings. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: judge Meyer, Commissioner Hall Lyssy, Behrens, Reese Page 2 of 20 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern ]Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, "Texas met on Wednesday, March 20, 2024, 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. Ri hard H. Meyer, Co Judge Date Calhoun County, Texas Anna Goodman, County Clerk W&&-Aw 41e'puty Clerk 3-**27 -Z y Date Page 1 of 1 NOTICE Of- MEE-TING -- 3/20/2024 March 20, 2024 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. County Judge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at 10am 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 I of 6 NOTICE OF MEETING — 3/20/2024 5. Approve the minutes for the March 6, 2024 and March 13, 2024, regular meetings. (RHM) .RESU[UNANIMOUS]US] LT• _i APPROVED MOVER. <- Vern Lyssy, Commissioner Pd 2 . SEEOhIDER David Hall,: Cornmissioner.Pct i AYE5; Judge Meyer, Commissioner`Hall; Lyssy, Behrens, Reese 6. Consider and take necessary action to approve Consulting and GASB 84 Services with StevenLCrain Consulting, LLC and authorize the County Judge or County Auditor to sign engagement letters. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER David Hall, Commissioner. Pct 1 SECONDER Gary Reese, Coffimissioner PC 4 AYES• Judge Meyer, Commissioner- all, 4ssy, Behrens, Reese 7. Consider and take necessary action to add "IT Certification" as a special license paid at the same rate as the Paramedic License ($0.58/hr) and add to the License Differential list. (RHM) pass 8. Consider and take necessary action to request that the County Auditor conduct the audit of Sheriff's FY 2023 Asset Forfeiture Funds as required by Code of Criminal Procedure Article 59.06 and sign. (RHM) RESULT APPROVED [UNANIMOUS] MOVERVern Lyssy, Commissioner Pct 2411 SS DER. - David Hall; Commissloner Pct 1 A s: Judge Meyer, Commissioner all Lyssy, Behrens, Reese ; 9. Consider and take necessary action to accept and have Judge Meyer sign the memorandum of understanding with Lavaca County to house inmates at the Calhoun County Jail at the rate of $55.00 per day. (RHM) 'RESULT: APPROVED [UNANIMOUS] MOWER: ." Vern Lys , Comm. issioner Oct. 2 ;SECONDER David Halh Commissioner Pct 1' AYES: ;Judge Meyer, Gommissioner'Hall, Lyssy, Behrens, Reese-; Page 2 of 6 NOTICE OF MEETING-3/20/2024 10. Consider and take necessary action to accept anonymous donation to the Sheriff's Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of $75.00. (RHM) RESULtr APPROVED [UNAfVIMOUS:y MIDVEW GaryReesd, Commissioner PGt 4 SECONDI=R ,]eel Behrens, Commissioner Pet 3 AYES: Judge Meyer, CAmmissio"ner.Ha)I, Lysy, Behrens, Reese 11. Consider and take necessary action on surplus/salvage of attached list from Road and Bridge, Precinct #1. (DEH) RESiJL7; '. APPROVED [UNANIMOUS] MOVER Joel Behrens, Whmissioner Pet 3 ` SECONDER: David Hall, Comm-Ag loner Pet: 1 AYES Judge Meyer, CorriMl5sionec Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action on closing a portion of a public beach, Miller Point Pavilion, for one day as provided by Texas Local Government Code Section 24.902 for Crystal Patterson on May lath, 2024 for one day. (DEH) RESULT APPROVED [UNANIMOUS] M.0VER. :: David. Hall; Commissioner; Pet 1 SEGONbER Joel 6elirens,.Commissio�ier.Pct3 AYES judge Meyer, Commissioner Hall, Gyss'y, Behrens, Reese ILL 13. Consider and take necessary action to approve Change Order No. 7 for the Calhoun County Combined Dispatch Facility Project for Calhoun County, Texas and authorize County Judge to sign. (DEH) RESULT MOVER. APPROVED [UNA. NIM.OUS] ]oel.Behrens, Commissioner PcY 3 RECoNDER: Gary Reese,. Commissioner PCt 4 AYES: Judge Meyer, Commissioner.,Hall, Lyssy, Behrens, Reese` 14. Consider and take necessary action to accept donation to the County Historical Commission for the Half Moon Reef Lighthouse from Jay Cuellar in the amount of $20.00. (RHM) RESUI,t. APPROVED [UNANIMOUS] MOVER .` Vern Lyssy, Commissioner,Pct Z SECONDER: Gary Reese, Commissioner Pet 4 . AYES, "Judge Meyer, CommisslRner'_Hall,' Lyssy, Behrens, Reese:: Page 3 of 6 NOl"ICE OF MEETING — 3/20/2024 15. Consider and take necessary action to accept the insurance proceed check from TAC in the amount of $2,316.41 (4816.41 — 2,500.00 deductible) for damages to a Sheriff Office Vehicle on 02/21/2024. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER David' Hall; Commissioner Pct 1 SECONDER Gary Reese, Commissioner Pct4 AYES. Judge Meyer, CommissionerHall Lyssy, Behrens, Reese: .- 16. Consider and take necessary action to adopt a Resolution appointing the Chief Appraiser (or his/her designee) of the Calhoun County Appraisal District to calculate the tax rates for the 2024 tax roll. (RHM) RESULT APPROVED [UNANIMOUS] MOVER c Gary Reese, Commissioner PCt 4 RE'CONDER Joe Behrens, Commissioner Pct 3 AYES 7udge'Meyer, :Commissioner Hall, Lyssy,'Behrens, Reese 17. Consider and take necessary action to approve the Preliminary Plat American Townsite Subdivision, Tracts 452X and 453X, Resubdivision No. 1. (GDR) 18. Consider and take necessary action to approve the name change of a section of Boyd Road between Farik Road and Whatley Road, to Mae Belle Cassel Road. (GDR) RESULT APPROVED [UNANIMOUS] MOVER; Vern Lyssy; Commissioner Pct 2 SECOA�IER David Hall; Commissioner Pc't 1' AYES: Judge iWeyer, Commissiane .1H Lyssy, Behrens, Reese 19. Consider and take necessary action to approve the Preliminary Plat of the Cady Subdivision, (Replat of Lot 1100B of the Replat of Lot 1100 of the American Townsite Company Subdivision - Slide 696A of the Calhoun County Plat Records) Basibio Maldonado Survey, Abstract No. 19 Calhoun County, Texas. (GDR) RESULT, APPROVEp,tUNANIMOUS] MQ1[ER Gary Reese, Commissioner P,ct 4 SL ONDER ]:del Behrens;. Commissioner.Pct 3 AYE$; Mtge :Meyer; CommissionerHdll, Lyssy;..Behrens; Reese, Page 4 of 6 NOTICE OF MEETING — 3/20/2024 20. Public hearing on Petition to vacate a part of Tract 20 of the Phillips Investment Company Subdivision according to the plat recorded in Volume Z, Page 35 of the Calhoun County Plat Records. (VLL) Regular session Closed at 1p:33am H®nry Danysh.expiamed p±tit�on #n vacate Regular session Opened at 10.34am 21. Consider and take necessary action to vacate a part of Tract 20 of the Phillips Investment Company Subdivision according to the plat recorded in Volume Z, Page 35 of the Calhoun County Plat Records. (VLL) 22. Consider and take necessary action to approve the Preliminary Plat of Chavana Subdivision. (VLL) 23. Consider and take necessary action to approve the Preliminary Plat of Thigpen Subdivision. (VLL) 24. Consider and take necessary action to submit the application for renewal of the General Land Office Coastal Lease, GLO ID: CL20040003, and allow Commissioner Vern Lyssy to sign any and all paperwork. (VLL) Page 5 of 6 I NOTICE OF MEETING —3/20/2024 25. Accept Monthly Reports from the following County Offices; 1. Calhoun County Clerk — February 2024 RESULT. APPROVED CommI slontl t 5ECONDER• AYES,4 26. Consider and take necessary action on any necessary budget adjustments. (RHM) 27. Approval of bills and payroll. (RHM) Adjourned 10:42am Page 6 of 6 #6 i NOTICE 01= MEETING - 3/27/2024 6. Consider and take necessary action to proclaim the month of April, 2024 as Child Abuse Prevention Month. (RHM) FMariaWalton with The7Meyer, oke. Judge Meyer read mation. T: APPRANIMOUS] R: Richaunty Judge DER: Vern Lsy,omissioner'Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 20 Child Abuse Prevention Month Proclamation Whereas child abuse prevention is a community problem and finding solutions depends on involvement among people throughout the community; and Whereas statistics of children who are abused and neglected escalate each year; and Whereas the effects of child abuse are felt by whole communities and need to be addressed by the entire community; and Whereas effective child abuse prevention programs succeed because of partnerships created among social service agencies, schools, religious organizations, law enforcement agencies and the business community; and Whereas youth -serving prevention programs offer positive alternatives for young people and encourage youth to develop strong ties to their community; and Whereas all citizens should become more aware of child abuse and its prevention within the community, and to become involved in supporting parents to raise their children in a safe, nurturing environment; Now, therefore, we, the Commissioners' Court of Calhoun County, Texas, do hereby proclaim the month of April 2024 as Child Abuse Prevention Month in all of Calhoun County, Texas and we commend this observation to all citizens. Approved this 27th day of March 2024. Calhoun County Commissioner, Pct. 1 Joel M. Behrens Calhoun County Commissioner, Pct. 3 Attest: Anna Goodman, County Clerk By: Deputy Clerk ichard H. Meyer, County Judge azAr��_ Vern Lyssy Calhoun County Commissioner, Pct. Gary Rees Calhoun County Commissioner, Pct. 4 ' NOTICE OIF MFFTING — 3/27/2024 7. Consider and take necessary action to proclaim the month of April, 2024 as Sexual Assault Awareness Month. (RHM) Jennifer Hahn with The Harbor spoke. Judge Meyer read proclamation. RESULT: APPROVED [UNANIMOUS] MOVER: Richard Meyer, County Judge SECONDER: Joel Behrens, Commissioner Pct 3 AYES: "Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 20 Sexual Assault Awareness Month Proclamation Whereas sexual assault affects every person of Calhoun County, Texas, as a victim, survivor or as a family member, significant other, neighbor or coworker of a victim or of a survivor; and Whereas many citizens of Calhoun County, Texas are working to provide quality services and assistance to sexual assault survivors; and dedicated volunteers help staff 24-hour hotlines, respond to emergency calls and offer support, comfort and advocacy during medical exams, criminal proceedings, and throughout the healing process; and Whereas Calhoun County, Texas staff and volunteers of sexual assault programs are promoting prevention education by offering training to schools, churches, and civic organizations, as well as medical, mental health, law enforcement, education and criminal justice personnel regarding sexual assault issues; and Whereas it is vitally important that continued educations efforts to provide information about prevention and services for sexual assault be supported and enhanced; and Whereas it is critical to intensify public awareness of sexual assault, to educate people about the need for citizen involvement in efforts to reduce sexual violence, to increase support for agencies providing sexual assault services, and to increase awareness of the healing power of creative expression; and Whereas The Harbor requests public support and assistance as it continues to work toward a society where all women, children and men can live in peace, free from violence and exploitation; Now, therefore, we, the Commissioners' Court of Calhoun County, Texas do hereby proclaim the month of April 2024 as Sexual Assault Awareness Month in all of Calhoun County, Texas and we commend this observation to all citizens. Approved this 27th day of March 2024. ."vim nau Calhoun County Commissioner, Pct. 1 MORRIS$, Joel M. Behrens County Commissioner, Pct. 3 Attest: Anna Goodman, County Clerk By: Deputy Clerk t Richard H. Meye County Judge Vern Lyssy Calhoun County Commissioner, Pct. 2 Gary D. Reese Anty Commissioner, Pct. 4 NOIICF OF MH FlNG — 3/27/2024 8. Consider and take necessary action to accept the attached list of donations to the Calhoun County Library for the months of January and February. (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 5 of 20 Calhoun County Public Library System (361) 552-7323 200 W, Mahan Port IIavaca,1baas 77979 Report January 2024 The following materials have been donated to the Calhoun County Public Library System during the month of January 2024 Books Donor 56 Unknown 5 Norma Lutraan 1 Charles Willoughby 1 Kim Smith 4 Linda Ward 1 Linda Orrick 1 Wanda Flisowski Paoerbacks Donar 32 Unknown 1 Nedra Rutherford 1 Mary Oats DVO Donor 23 Unknown Others Donor $50.00 HEB Donation Calhoun County Public Library System (361) 552,7323 200 W. Mahan Port Lavaca, 'Y m 77979 Report February 2024 The following materials have been donated to the Calhoun County Public Library System during the month of February 2024 Books Donor 200 Unknown 2 Barry Hunter 1 Pat Ekstrom 4 Charles Willoughby Paperbacks Donor 19 Unknown 8 Michelle Brown DVD Donor 5 Barry Hunter Others Donor 28 Magazines Arpitha Prasad #9 I NO TICS OE MEETING — 3/27/)024 9. Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Surplus/Salvage for the months of January and February. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 20 Calhoun County Public Library System (361)552-7323 200 W. Mahan Port Lavaca, Ibxas 77979 Report January 2024 I would like the following to be declared Surplus/Salvage 21 Books 18 Paperback 19 DVDs Calhoun County Public Library System (361) 552-7323 200 W. Mahan Port Lavaca, TBxas 77979 Report February 2024 I would like the following to be declared Surplus/Salvage 42 Books 9 Pbks #10 NOTICE OF MEETING -- 3/27/2024 10. Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Waste for the months of January and February. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 20 Calhoun County Public Library System (361) 552-7323 200 W Mahan Port Lavaca,l8xas 77979 Report January 2024 I would like the following items to be declared waste 3 Books 8 Pbk Calhoun County Public Library System (361) 552-7323 200 W. Mahan Port Lavaca, lbxas 77979 Report February 2024 I would like the following items to be declared waste 28 Books #11 NOTICE OE MEETING — 3/27/2024 11. Consider and take necessary action to approve reappointment of the following Memorial Medical Center Board Members for another term April, 2024 — March, 2026. (RHM) • Michael Chavana • Shelia Dierschke • Dallas Franklin • Kay McPherson • Reynaldo Tuazon RESULT: APPROVED [UNANIMOUS] MOVER: Vern'Lyssy, Commissioner'Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 20 Consider and take necessary action to approve reappointment of the following Memorial Medical Center Board Members for another term April, 2024 — March, 2026. • Michael Chavana • Shelia Dierschke • Dallas Franklin • Kay McPherson • Reynaldo Tuazon # 12 NOTICE OF MEETING - 3/27/2024 12. Consider and take necessary action to close a portion of Main Street in Port O'Connor, Texas from the intersection of 2nd Street/State Highway 185 & Main Street; west 150 feet on May 25, 2024; and July 13, 2024 for street dances. (GDR) John Harper asked the court to consider approving and asked to add July 6th to the list of dates for Street Dances. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 20 Gary D. Reese County Commissioner County of Calhoun Precinct 4 March 18, 2024 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 March 27, 2024. • Consider and take necessary action to close a portion of Main Street in Port O'Connor, Texas from the intersection of 2nd Street/State Highway 185 & Main Street; west 150 feet on May 25, 2024; July 8, 2024; and July 13, 2024 for street dances. Sincerely, >� 0, R, Gary Deese GDR/at Unsteadiness P.O. Box 177 — Seadrift, Texas 77983 — email: aary.reesc r calhouncomore - (361) 785-3141 — Fax (361) 785.5602 March 18, 2024 Dear Commissioner Reese, I am requesting permission to close half of 2nd Street and Main Street in Port O'Connor, Texas to have street dances on May 25, 2024; July 6, 2024; and July 13, 2024. We would like to have outdoor dances as we have in past years with portions of the proceeds going to benefit the POC Volunteer Fire Department, fireworks, etc. Liability insurance has been supplied. Thank you, John Harper Client#: 1979740 KIMBEOR ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/18/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED previsions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Will Nikodym USI Southwest 1(ME;CT P ONE ED: 713 490-4600 AN Na; 713.490-4700 9811 Katy Freeway, Suite 500 E oAls. will.nikodym@usi.com Houston, TX 77024 855874-1450 IrborIn 9anceC NAICR Company INauaeaA:lndlan Harbor Insurance Company 36940 INSURED Kimber Oilfield Services, LLC; Daddy PI INSURER B : P.O. Box 490 INSURER C: INSURER D: Carrizo Springs, TX 78834 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID 1�gEXCLUSIONS LTRR TYPE OF INSURANCE DD BUB POLICY NUMBER MMIDUIYY YY RF F�CLLAIMS. MMIODIYYYY UMTTS APXB,I,IPD MERCIALGENEALIABILITY CIAIM&-MADE OCCUR Ded:2,500 OLS21981124 11/0212023 11/021202 EACH OCCURRENCE $1000000 EAES reae $106000 MEDEXP(Anyone erwn $5000 PERSONALBADVINJURY S1000000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY ECT ElLOC OTHER: GENERALAGGREGATE s2,000,000 PRODUCTS -COMPIOP AGO s2000,000 S AUTOMOBILEUABILITY ANY AUTO AUTO&OONLY AUTOEULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT BODILY INJURY (Per person) S BODILY INJURY(Peraeddenl) S PROPERTYDAMAGE P r,eddenl S 5 UMBRELLA LIAB EXCESS I"CLAIMS-MADE HOCCUR EACH OCCURRENCE $ AGGREGATE 5 DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOIUPARTNERIEXECUTIVE YIN OFFICERIMEMB RE EXCLUDED? (Mandatory In NH) H yyea. deavibe under DESCRIPTION OF OPERA TONS below NIA IPER I OTH- I STATUTE E.L. EACH ACCIDENT 5 E.L. DISEASE - EA EMPLOYEE 5 E.L. DISEASE -POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tOL Addlllanal Remark, Schedule, may be attached If more apace is required) General Liability Policy includes Additional Insured endorsement forms CG2010 07041 CG2037 0704 and Waiver of Subrogatlon endorsement form CG2404 0509, each on a blanket basis when required by written contract. General Liability Policy includes 30 Day Notice of Cancellation endorsement form SLOL417 0617 on a blanket basis when required by written contract. General Liability policy Is Primary and Noncontributory when required by written contract, subject to form CG2001 0413. GeneralLiabilitypolicy Includes endorsement (See Attached Descriptions) Calhoun County 202 S. Ann St. Ste. B Port Lavaca, TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. on rights reserved ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #5440700691M44069885 JXTHN DESCRIPTIONS (Continued from Page 1) 1 SLGL624 0617 Pollution Exclusion- Exception for Extended Time Element- $1M limit and endorsement form 162 0609 Underground Resources & Equipment Coverage- $1M limit. SAGITTA 25.3 (20161031 7 of #13 I NOTICE OF MEETING — 3/27/2024 13. Consider and take necessary action to authorize Kathy Pullin, sponsor of "Give Domestic Violence the Boot", to use King Fisher Beach Pavilion. September 27 - 28, 2024 for the annual fundraiser benefiting Calhoun County Harbor Children's Alliance. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner_Pct 1 AYES:. Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 10 of 20 Gary D. Reese County Commissioner County of Calhoun Precinct 4 March 19, 2024 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 March 27, 2024. • Consider and take necessary action to authorize Kathy Pullin, sponsor of "Give Domestic Violence the Boot", to use King Fisher Beach Pavilion September 27 — 28, 2024 for the annual fundraiser benefiting Calhoun County Harbor Children's Alliance. Sincerely, Aary ReeVGD. se GDR/at P.O. Box 177 — Seadrift. Texas 77983 — email: earv.reese r calho i� ncotx.org — (36I) 785-3141 — Fax (36I) 785-5602 April Townsend From: pullinpremiumbbq@gmail.com (Kathy Pullin) <pullinpremiumbbq@gmail.com> Sent: Tuesday, March 19,2024 12:39 PM To: nancy.pomykal Cc: Gary Reese; April Townsend; m.walton@theharborvc.org Subject: Re: Give Domestic Violence the Boot September 28- 2024 UTION: This email originated from outside of the organization. Do not click links or open attachments unless Good morning all, We are very excited about this year! Just a simple correction I will begin set UP on the 27th. with the event being the 28th. Thank you al I for your support! On Tue, Mar 19, 2024, 1 1:42 AM nancy.pontykal <nancv.pomvlcal a calhouncotx.org> wrote: Good morning, I hope you are doing well this beautiful first day of Spring. (59 degrees ?) Everything in POC is good. (well, maybe not everyone) that's why my office is starting to get real busy. Lol! This email is a reminder that Pit Master, Kathy Pullin , sponsor of "Give Domestic Violence the Boot" has scheduled her third Calhoun County fundraiser for Saturday, September 28, 2024, at the Kingfisher Beach Pavilion. She will need the pavilion on Friday, September 28 as well, to set up and prepare the venue. Her goal is to make this fundraiser an annual event on the last Saturday of September at the same location. More and more people are getting involved and that's a good thing. The funds go to Calhoun County Harbor Children's Alliance and Victim Center to help victims of Domestic Violence and eventually build a shelter for those in need. It is truly a deserving cause. I am requesting the location proposal be placed on the Commissioner's Court next agenda for approval. I do understand that the event will need Commissioner's Court approval each year. That can be arranged with no problem. Your assistance is sincerely appreciated. If you have any questions or concerns please contact me at the above email address or give me a call. Best regards, Jardge Navi.crJ, Porc.rJ, teal Justice of the Peace Pct. 5 #14 ' NO] I CF OF ME FJ ING - 3/27/2024 14. Consider and take necessary action to approve the Specifications and Contract Documents for Bid No. 2024.05 Seadrift Drainage Improvements Project for Calhoun County, Texas - Texas General Land Office Contract No. 22-085-014-D245 and to authorize G & W Engineers, Inc. and the County Auditor to advertise for bids. A pre -bid meeting shall be held at 10:00 am, Tuesday, April 16, 2024 at Calhoun County Precinct #4 Office. Sealed Bids will be due before 2:00:00 pm, Thursday, May 9, 2024 at the County Judge's Office. (GDR) Scott and Marla with G&W explained specifications of 6 million dollar project. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 11 of 20 Gary D. Reese County Commissioner County of Calhoun Precinct 4 March 21, 2024 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 March 27, 2024. Consider and take necessary action to approve the Specifications and Contract Documents for Bid No. 2024.05 Seadrift Drainage Improvements Project for Calhoun County, Texas — Texas General Land Office Contract No. 22-085-014-D245 and to authorize G & W Engineers, Inc. and the County Auditor to advertise for bids. A pre -bid meeting shall be held at 10:00 am, Tuesday, April 15, 2024 at Calhoun County Precinct #4 Office. Sealed Bids will be due before 2:00:00 pm, Thursday, May 9, 2024 at the County judge's Office. Sincerely, T 'o-Q Gary D. Reese GDR/at P.O. Box 177 —Seadrift. Texas 77983 — email: earv.mesefrdcalhouncote.ora - (361) 785-3141 — Fax (361) 785-5602 Mae Belle Cassel From: gking@gwengineers.com Sent: Monday, March 25, 2024 10:50 AM To: 'Gary Reese' Cc: 'April Townsend'; 'demi.cabrera'; 'candice villarreal'; arnold.hayden@calhouncotx.org; 'Katy Sellers'; marlaj@gwengineers.com; 'Veronica Pauda'; smason@gwengineers.com; MaeBelle.Cassel@calhouncotx.org Subject: RE: Request for Agenda Item - CDBG-MIT Bid Documents CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Good Morning, The links below are for the plans and specifications for court approval on March 27t^ Specifications Link: https://www.d ropbox.com/scl/fi/o024t5lyd i ipa d 7v4vagt/FOR-COURT-APPROVAL-Sead rift-Dra i nage-I m pr-Pro iect-G LO- CDBG-MIT-No.-22-085-014-D245.pdf?rlkev=z57vkhc428a6meaaevtuykl3l&dl=0 Plans Link: https://www.d ro pbox.com/scl/fi/fmo5dsefi lO8wftafy7e7/Fu I I-pla n-set-FOR-COURT-APPROVAL-Sead rift-Dra i nage-Imp r- Proiect-D245. pdf?rl key=kkfbb39ets2t19gOm bm ba8341&d I=0 Thank you, Glynis King G&W Engineers, Inc. 205 W. Live Oak Port Lavaca, Texas 77979 361.552.4509 From: smason@gwengineers.com <smason@gwengineers.com> Sent: Thursday, March 21, 2024 8:28 AM To: Gary Reese <Gary.Reese @calhouncotx.org> Cc:'April Townsend' <a pril.townsend@calhouncotx.org>; 'demi.cabrera'<demi.cabrera@calhouncotx.org>;'candice villarreal' <candice.villarreal@calhouncotx.org>; arnold.hayden@calhouncotx.org; 'Katy Sellers' <katy@ksbr-Ilc.com>; 'Glynis King' <gking@gwengineers.com>; marlaj@gwengineers.com;'Veronica Pauda' <veronica@ksbr-Ilc.com> Subject: Request for Agenda Item - CDBG-MIT Bid Documents Importance: High Commissioner Reese, We would like to request an agenda item for the Seadrift GLO CDBG-MIT project for consideration of approval at the March 27, 2024 court meeting. Consider and take necessary action to approve the Specifications and Contract Documents for Bid No. 20Z4.05 Seadrift Drainage Improvements Project for Calhoun County, Texas — Texas General Land Office Contract No. 22-085-014-D245 and to authorize G & W Engineers, Inc. and the County Auditor to advertise for bids. A pre -bid meeting shall be held at 10:00 am, Tuesday, April 16, 2024 at Calhoun County Precinct #4 Office. Sealed Bids will be due before 2:00:00 pm, Thursday, May 9, 2024 at the County Judge's Office. Marla is in conference and we plan to get her to sign the cover page to the contract documents tomorrow. After she signs we will send them to you along with the signed plans via a drop box link for the agenda packet. Excited to kick this one off finally. Thank you! Scoff- P. Masvw, P.E. Lead Project Engineer G&W Engineers, Inc. CONTRACT DOCUMENTS FOR BID NO.2024.05 SEADRIFT DRAINAGE IMPROVEMENTS PROJECT GLO CONTRACT NO. 22-085-014-D245 FOR CALHOUN COUNTY, TEXAS MARCH 2O24 A PROJECT FUNDED THROUGH A GENERAL LAND OFFICE (GLO) CDBG--MITIGATION (MIT) GRANT - GLO CONTRACT NO. 22-085-014-D245 V OX rr ENGINEERS. INC. 205 W. Live Oak • Port Lavaca, TX 77979 • 361-552-4509 CONTRACT DOCUMENTS FOR Bill NO.202;4.05 SEADRIFT DRAINAGE IMPROVEMENTS PROJECT GLO CONTRACT NO.22d085-014-D245 FOR CALHOUN COUNTY, TEXAS MARCH 2O24 Prepared by: G & W ENGINEERS, INC. 205 WEST LIVE OAK PORT LAVACA, TEXAS 77979 (361)552-4509 G & W Engineers, Inc. Texas Registered Engineering Pima r•94188 Project No. 5910.013a Approved By: Marla Jaselc, P.E. Texas Serial No83938 Date: �1t4 FORMS AND CONDITIONS FOR BID DOCUMENTS/CONSTRUCTION CONTRACTS *Section 2 Items are to be completed and provided by all bidders with sealed bid. ** Please attach / include original bid bond as the last item in the sealed bid package. SECTION 1 1. Invitation for Bids 2. Instruction to Bidders for Construction 3. Equal Opportunity Guidelines for Construction Contractors 4. Calhoun County Section 3 Policy SECTION 2 5. *Bid Schedule 6. *Specification Notes (Addendum Acknowledgement & Calendar Days) 7. *Statement of Bidder's Qualifications 8. *Conflict of Interest Questionnaire 9. *Certificate of Recovered Materials 10. *Certification Regarding Debarment & Suspension and Other Responsibility Matters 11. *Affidavit 12. *Certification of Bidder Regarding Civil Rights Laws and Regulations 13. *Contractor's Local Opportunity Plan 14. *Proposed Contracts Breakdown (expected subcontractors and labor classifications including Section 3 utilization) 15. *Certification for Business Concerns Seeking Section 3 Preference in Contracting and Demonstration of Capability 16. *Certification Regarding Lobbying 17. *Disclosure of Lobbying Activities and Instructions 18. *House Bill 89 Verification 19. *Residence Certification 20. *System for Award Management - (sam.gov) 21. *Bid Bond** SECTION 3 22. Standard Form of Agreement for Construction Contacts 23. General Conditions for Construction 24. Calhoun County General Conditions 25. Minority/Female Goals 26. Federal Labor Standards Provisions 27. Title 29 - Labor 28. Concerning Labor Standards and Prevailing Wage Requirements 29. Project specific Davis -Bacon Wage Decision 30. GLO Signage Requirements 31. Certificate of Interested Parties Form 1295 and Instructions 32. Section 504 Certification 33. Child Support Statement 34. Document No. 00417 - Trench Safety Systems Indemnity Agreement 35. Payment Bond 36. Performance Bond 37. Certificate of Liability Insurance 38. Section 3 Clause 39. HUD Examples of Efforts to Offer Training and Employment Opportunities for Section 3 Residents 40. GLO New Hires Section 3 Monthly Compliance Report 41. CDBG-MIT Section 3 Brochure Information Sheet 42. GILD Assurances for Construction Programs 43. GILD General Affirmations 44. Attorney's Review Certification 45. Contractor's Final Payment Affidavit 46. Change Order Form 47. Certificate of Construction Completion (COCC) 48. Governing Technical Specifications & Special Provisions SECTION 1 1. Invitation for Bids 2. Instruction to Bidders for Construction 3. Equal Opportunity Guidelines for Construction Contractors 4. Calhoun County Section 3 Policy Invitation to Bid Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive bids for: Bid Number 2024.05 - Seadrift Drainage Improvements Project The project shall consist of ditch improvements including vegetation removal, regrading, reshaping and channel liner; removal and replacement of culverts; installation of storm sewer; bridge construction and roadway reconstruction associated with the drainage improvements in Seadrift, Texas. The Instructions for Bidders, Bid Form, Specifications, and other Contract Documents may be examined at G&W Engineers, Inc. at 205 W. Live Oak, Port Lavaca, TX 77979 and obtained from www.CivcastUSA.com. There is no charge to view or download the documents. Addendums and other announcements will be distributed via CivCastIJSA to all plan holders. A Pre -Bid Conference will be held at 10:00 am, Tuesday, April 16, 2024 starting at the Calhoun County Precinct #4 office, 104 East Dallas, Seadrift, Texas and continuing to the project site. Potential bidders are strongly urged to attend. Sealed Bids may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, TX 77979 All bids must 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, or the UPS/FedEx/other Delivery Service envelope: Sealed Bid — Bid Number 2024.05 - Seadrift Drainage Improvements Project. Sealed Bids consisting of one (1) USB flash drive and one (1) original and four (4) printed copies of the complete bid and required forms are DUE BEFORE 2:00:00 PM local time, THURSDAY MAY 9, 2024 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 31 Floor, Suite 301, Port Lavaca, Texas. At this time, all bids will be publicly opened and read aloud in the conference room located in the County Judge's office. It is the responsibility of the submitting bidder to ensure that their 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 bidder in the course of responding to the bid. Bids received after the date and time the bids are due will not be accepted and will be returned unopened, regardless of whether or not the delay was outside of the control of the submitting bidder. 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. Bidders must submit with their bid a bid bond, issued by an acceptable surety, or a certified check, payable to Calhoun County, in the amount of not less than five percent (5%) of the total bid submitted. Bids submitted without the required security will not be considered. All contractors and subcontractors must be cleared (not suspended or debarred) prior to any formal action authorizing the award of a contract to the contractor and for the duration of the project. Calhoun County reserves the right to reject any or all bids or to waive any informalities in the bidding and to award to the responsible bidder submitting the best qualified acceptable bid who, in the opinion of Calhoun County, offers the bid in the best interest of the County. Bids may be held by Calhoun County for a period not to exceed sixty (60) days from the date of the bid opening for the purpose of reviewing the bids and investigating the bidder's qualifications prior to the contract award. The successful bidder will be required to purchase and furnish a Performance Bond and a Payment Bond, each in the full amount of the contract, written by a responsible surety company authorized to do business in the State of Texas, as required by Article 5160, V.A.T.C.S., as amended by H.B. 344, passed by the 56'h Legislature, Regular Session, 1959. The successful bidder shall begin work on receipt of the Notice to Proceed and shall complete the work within the Contract Time. Work is subject to liquidated damages. The project to be constructed will be financed with assistance from the General Land Office (GLO) under the U.S. Department of Housing and Urban Development Community Development Block Grant - Mitigation (CDBG-MIT) program and is subject to all applicable Federal and State laws and regulations. Attention is called to the fact that not less than, the federally determined prevailing Davis -Bacon and Related Acts wage rate, as issued by the Department of Labor and contained in the contract documents, must be paid on this project. In addition, the successful bidder must ensure that employees and applicants for employment are not discriminated against because of race, color, religion, sex, sexual orientation, gender identity, or national origin. Adherence to the Calhoun County Section 3 Policy is required for all contracts. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of age, race, color, religion, sex, sexual orientation, gender identity, national origin, handicapped status or limited English proficiency 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 INSTRUCTIONS TO BIDDERS FOR CONSTRUCTION The project to be constructed will be financed with assistance from the General Land Office (GLO) under the U.S. Department of Housing and Urban Development Community Development Block Grant - Mitigation (CDBG-MIT) program and is subject to all applicable Federal and State laws and regulations. Calhoun County is the subrecipient of the grant funding and is hereby referred to as "County". Use of Separate Bid Forms These contract documents include a complete set of bid and contract forms which are for the convenience of the bidders and are not to be detached from the contract document, completed or executed. Separate bid forms are provided for your use. 2. Interpretations or Addenda No oral interpretations will be made to any bidder. All questions about the meaning or intent of the Bidding Documents are to be submitted to the ENGINEER IN WRITING and must be received in the office of the ENGINEER no later than 5:00 pm, April 19, 2024. Such questions may be submitted on www.CivcastUSA.com Questions and Answers (Q&A). It is the Bidder's responsibility to verify receipt of such questions by the ENGINEER. Interpretations or clarifications considered necessary by ENGINEER in response to such questions will be issued by Addenda and distributed via CivCastUSA to all plan holders. Addenda may also be issued to modify the Bidding Documents as deemed advisable by OWNER or ENGINEER. Any oral and other interpretations or clarifications provided by ENGINEER or OWNER at the pre -bid meeting will be without legal effect until a formal written Addenda is issued by ENGINEER. 3. Inspection of Site Each bidder should visit the site of the proposed work and should become acquainted with the existing conditions and facilities, the difficulties and restrictions pertaining to the performance of the contract. The bidder should thoroughly examine and become familiar with the drawings, technical specifications and all other contract documents. The contractor by the execution of the contract shall in no way be relieved of any obligation under it due to failure to receive or examine any form or legal document or to visit the site or the conditions existing at the site. The County will be justified in rejecting any claim based on lack of inspection of the site prior to the bid. 4. Alternate bid items No alternate bids or bid items will be considered unless they are specifically requested by the technical specifications. 5. Bids All bids must be submitted on the forms provided and are subject to all requirements of the Contract Documents, including the Drawings. b. All bids must be regular in every respect and no interlineation, excisions or special conditions may be made or included by the bidder. C. Bid documents, including but not limited to the bid, the bid bond(s), the contractor's certifications, Certification of Bidder Regarding Civil Rights Laws and Regulations, Certification of Efforts to comply with Section 3, Local Opportunity Plan, Conflict of Interest Questionnaire, Affidavit of Prime Bidder, Certification Regarding Lobbying and Disclosure of Lobbying Activities, Proposed Contract Breakdown, Certificate of Recovered Materials, Certification Regarding Debarment and Suspension and Other Responsibility Matters, System for Award Management (sam.gov) search, House Bill 89, Residence Certification, and the Statement of the Bidder's Qualifications, shall be sealed in an envelope and clearly labeled with the words "Bid Documents", the project's contract number, name of bidder and the date and time of bid opening. d. The County may consider as irregular any bid on which there is an alteration of or departure from the bid form and, at its option, may reject any irregular bid. e. If a contract is awarded, it will be awarded to a responsible bidder on the basis of the lowest/best bid and the selected alternate bid items, if any. The contract will require the completion of the work in accordance with the contract documents. Bid Modifications Prior to Bid Opening a. Any bidder may modify its bid by submitting a modification or supplemental bid at any time prior to the scheduled closing time for receipt of bids, provided such modification or supplemental bid is received by the County prior to the closing time. The modification or supplemental bid should not reveal the original bid price but should provide only the addition, subtractions or other modifications to the original bid so that the final prices or terms will not be known by the County until the sealed bid is open. a. A bid bond in the amount of 5% of the bid issued by an acceptable surety shall be submitted with each bid [for contracts greater than $100,000]. A certified check or bank draft payable to Calhoun County, Texas may be submitted in lieu of the Bid Bond. b. The bid bond or its comparable, will be returned to the bidder as soon as practical after the opening of the bids. 8. Statement of Bidders Qualifications Each bidder shall submit on the form furnished for that purpose a statement of the bidder's qualifications. The County shall have the right to take such steps as it deems necessary to determine the ability of the bidder to perform its obligations under the contract, and the bidder shall furnish the County all such information and data for this purpose as it may request. The right is reserved to reject any bid where an investigation of the available data does not satisfy the County that the bidder is qualified to carry out properly the terms of the contract. 9. Unit Price The unit price for each of the several items in the bid shall include its pro rata share of overhead so that the sum of the products obtained by multiplying the quantity shown for each item by the unit price bid represents the total bid. Any bid not conforming to this requirement may be rejected as informal. Special attention is drawn to this condition, as the unit prices will be used to determine the amount of any change orders resulting from an increase or decrease in quantities. 10. Corrections: Erasures or other corrections in the bid must be noted over the signature of the bidder. 11. Time for Receiving Bids a. Bids received prior to the advertised hour of opening shall be kept securely sealed. The officer appointed to open the bids shall decide when the specified time has arrived and no bid received thereafter will be considered. 12. Submission of Bids a. All bids must be sealed in a 9 x 12 or larger envelope & clearly marked on the outside of the envelope, or the UPS/FedEx/other Delivery Service envelope: Sealed Bid No. 2024.05 — Seadrift Drainage Improvements Project — GLO Contract No. 22-085-014-D245. b. Bids shall consist of one (1) USB flash drive, one (1) original and four (4) printed copies of the complete bid and required forms which are Due Before 2:00:00 pm, Thursday, May 9, 2024. C. Sealed Bids must be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3rd Floor, Suite 301 Port Lavaca, TX 77979 d. It is the responsibility of the submitting bidder to ensure that their 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 bidder in the course of responding to the bid. Bids received after the date and time the bids are due will not be accepted and will be returned unopened, regardless of whether or not the delay was outside of the control of the submitting bidder. e. 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. 13. Opening of Bids The County shall, at the time and place fixed for the opening of bids, open each bid and publicly read it aloud, irrespective of any irregularities therein. Bidders and other interested individuals may be present. 14. Withdrawal of Bids Bidder may withdraw the bid before the time fixed for the opening of bids, by communicating its purpose in writing to the County. Upon receipt of such notice, the unopened bid will be returned to the bidder. The bid guaranty of any bidder withdrawing his bid will be returned promptly. 15. Award of Contract/Rejection of Bids a. The contract will be awarded to the responsive, responsible Bidder submitting the lowest/best bid. The bidder selected will be notified at the earliest possible date. The County reserves the right to reject any or all bids and to waive any informality in bids received where such rejection or waiver is in its interest. b. The County reserves the right to consider as unqualified to do the work any bidder who does not habitually perform with his own forces the major portions of the work involved in construction of the improvements embraced in this contract. 16. Execution of Agreement/Performance and Payment Bonds a. Performance Bonds - Requires all prime contractors which enter into a formal contract in excess of $100,000 with the State, a county, or a municipality; a department, board, or agency of the state, a county, or a municipality; and a school district or a subdivision thereof, to obtain a Performance Bond in the amount of the contract before commencing with work b. Payment Bonds- Requires all prime contractors which enter into a formal contract with the State, a county, or a municipality; a department, board, or agency of the state, a county, or a municipality; and a school district or a subdivision thereof, to furnish to the governmental entity a payment bond in the amount of the contract. The payment bond must be filed within 30 days from the date of the Notice of Award: • Municipalities: If the contract is in excess of $50,000, a payment bond is required. • Counties: If the contract is in excess of $25,000, a payment bond is required. C. The failure of the successful bidder to execute the agreement and supply the required bonds within thirty (30) days from the date of the notice of award -or within such extended period as the County may grant, shall constitute a default and the County may, at its option either award the contract to the next lowest responsible bidder, or re -advertise for bids. In either case, the County may charge against the bidder the difference between the amount of the bid, and the amount for which a contract is subsequently executed irrespective of whether this difference exceeds the amount of the bid bond. If a more favorable bid is received through re -advertisement, the defaulting bidder shall have no claim against the County for a refund. 17. Wages and Salaries Attention is particularly called to the requirement of paying not less than the prevailing Davis Bacon Related Acts (DBRA) wage rates specified in the Contract Documents. These rates are minimums to be paid during the life of the contract. It is therefore the responsibility of the Bidder to inform themselves as to local labor conditions. 18. Equal Employment Opportunity Attention is called to the requirements for ensuring that employees and applicants for employment are not discriminated against because of race, color, religion, sex, sexual orientation, gender identity, or national origin, and other civil rights requirements. 19. Certification Regarding Lobbying Contractors who apply or bid for an award of $100,000 or more shall provide the required certification that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer of employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 USC § 1352. 19. System for Award Management (SAM) All contractors and subcontractors must be searched on www.sam.gov and cleared (not suspended or debarred) prior to any formal action authorizing the award of a contract to the contractor. Equal Opportunity Guidelines for Construction Contractors Note: To be included in bid packet and distributed at the preconstruction conference (optional) 1. What are the responsibilities of the offeror or bidder to ensure equal employment opportunity? For contracts over $ 10,000, the offeror or bidder must comply with the "Equal Opportunity Clause" and the "Standard Federal Equal Opportunity Construction Contract Specifications." 2. Are construction contractors required to ensure a legal working environment for all employees? Yes, it is the construction contractor's responsibility to provide an environment free of harassment, intimidation, and coercion to all employees and to notify all foremen and supervisors to carry out this obligation, with specific attention to minority or female individuals. 3. To alleviate developing separate facilities for men and women on all sites, can a construction contractor place all women employees on one site? No, two or more women should be assigned to each site when possible. 4. Are construction contractors required to make special outreach efforts to Section 3 or minority and female recruitment sources? Yes, construction contractors must establish a current list of Section 3, minority and female recruitment sources. Notification of employment opportunities, including the availability of on-the-job training and apprenticeship programs, should be given to these sources. The efforts of the construction contractors should be kept in file. 5. Should records be maintained on the number of Section 3 residents, minority and females applying for positions with construction contractors? Yes, records must be maintained to include a current list of names, addresses and telephone numbers of all Section 3, minority and female applicants. The documentation should also include the results of the applications submitted. 6. What happens if a woman or minority is sent to the union by the Contractor and is not referred back to the Contractor for employment? If the unions impede the construction contractor's responsibility to provide equal employment opportunity, a written notice should be submitted to GLO. 7. What efforts are made by construction contractors to create entry-level positions for Section 3 residents, women and minorities? Construction contractors are required to develop on-the-job training programs, or participate in training programs, especially those funded by the Department of Labor, to create positions for Section 3 residents, women and minorities and to meet employment needs. 8. Are any efforts made by the Contractor to publicize their Equal Employment Opportunity (EEO) policy? Yes, the construction contractor is responsible for notifying unions and sources of training programs of their equal employment opportunity policy. Unions should be requested to cooperate in the effort of equal opportunity. The policy should be included in any appropriate manuals, or collective bargaining agreements. The construction contractor is encouraged to publicize the equal employment opportunity policy in the company newspaper and annual report. The Contractor is also responsible to include the EEO policy in all media advertisement. 9. Are any in-service training programs provided for staff to update the EEO policy? At least annually a review of the EEO policy and the affirmative action obligations are required of all personnel employees of a decision -making status. A record of the meeting including date, time, location, persons present, subject matter discussed, and disposition of the subject matter should be maintained. 10. What recruitment efforts are made for Section 3 residents, minorities and women? The construction contractor must notify, both orally and in writing, Section 3, minority and female recruitment sources one month prior to the date of acceptance for apprenticeship or other training programs. 11. Are any measures taken to encourage promotions for minorities and women? Yes, an annual evaluation should be conducted for all minority and female personnel to encourage these employees to seek higher positions. 12. What efforts are taken to insure that personnel policies are in accordance with the EEO policy? Personnel policies in regard to job practices, work assignments, etc. should be continually monitored to insure that the EEO policy is carried out. 13. Can women be excluded from utilizing any facilities available to men? No, all facilities and company activities are non -segregated except for bathrooms or changing facilities to ensure privacy. 14. What efforts should be utilized to include minority and female contractors and suppliers? Take affirmative steps to ensure that small, minority, and women owned businesses are included on all lists for contractors/service providers. Solicit these businesses when issuing RFPs and RFQs and soliciting construction bids. Divide project activities into small tasks to allow participation. Keep records of all offers to minority and female construction contractors. 15. If a construction contractor participates in a business related association that does not comply with equal opportunity affirmative action standards, does that show his/her failure to comply? No, the construction contractor is responsible for its own compliance. 16. Can a construction contractor hire a subcontractor who has been debarred from government contracts pursuant to EEO? No. The construction contractor must suspend, terminate or cancel its contract with any Subcontractor who is in violation of the EEO policy. 17. What effort has been taken by the construction contractor to monitor all employment to insure the company EEO policy is being carried out? The construction contractor must designate a responsible individual to keep accurate records of all employees that includes specific information required by the government. CALHOUN COUNTY SECTION 3 POLICY Calhoun County Section 3 Policy In accordance with Section 3 of the U.S. Housing and Urban Development (HUD) Act, Calhoun County agrees to implement the following steps, which, to the greatest extent feasible, will provide job training, employment and contracting opportunities for low- and very low-income persons residing in the community in which HUD funds are spent and to businesses that provide economic opportunities for these persons. A. Introduce and pass a resolution adopting this plan as a policy to strive to attain goals for compliance to Section 3 regulations by increasing opportunities for employment and contracting for Section 3 residents and businesses. B. Assign duties related to implementation of this plan to the Calhoun County Civil Rights Officer. C. Notify Section 3 residents and business concerns of potential new employment and contracting opportunities as they are triggered by HUD Community Development Block Grant (CDBG) awards through the use of public hearings and related advertisements; public notices; bidding advertisements and bid documents; solicitations and contracts; notification to local business organizations; local advertising media, including public signage; project area committees and citizen advisory boards; local HUD offices; regional planning agencies; and all other appropriate referral sources. D. Maintain a list of those businesses that have identified themselves as Section 3 businesses for utilization in CDBG funded procurements, notify those businesses of pending contractual opportunities, and make this list available for general county procurement needs. E. Maintain a list of those persons who have identified themselves as Section 3 residents and contact those persons when hiring/training opportunities are available through grant awards or contractors. F. Require that all prime contractors and subcontractors with contracts over $100,000 commit to this plan as part of their contract work. The County will monitor the contractors' performance with respect to meeting Section 3 requirements and require that they submit requested reports to the appropriate agency. G. Submit reports as required by a funding agency regarding contracting with Section 3 businesses and/or employment as they occur; and submit reports within federal fiscal year requirements that identify and quantify Section 3 businesses and employees. H. Maintain records, including copies of correspondence, memoranda, etc., which document all actions taken to comply with Section 3 regulations. As officers and representatives of Calhoun County, we the undersigned have read and fully agree to this plan and become a party to the full implementation of the plan. Approved this 17t' day of February 2021. f Richard H. Meyer, C ty Judge David Hall Calhoun County Commissioner, Pct. 1 Vern Lysiv Calhoun County Commissioner, Pct. 2 Joel MJ Behrens Gary Rees Calhoun County Commissioner, Pct. 3 Calhoun Cou ty Commissioner, Pct. 4 Attest: Anna Goodman, County Clerk i I l Deputy Clerk SECTION 2 5. *Bid Schedule 6. *Specification Notes (Addendum Acknowledgement & Calendar Days) 7. *Statement of Bidder's Qualifications 8. *Conflict of Interest Questionnaire 9. *Certificate of Recovered Materials 10. *Certification Regarding Debarment & Suspension and Other Responsibility Matters 11. *Affidavit 12. *Certification of Bidder Regarding Civil Rights Laws and Regulations 13. *Contractor's Local Opportunity Plan 14. *Proposed Contracts Breakdown (expected subcontractors and labor classifications including Section 3 utilization) 15. *Certification for Business Concerns Seeking Section 3 Preference in Contracting and Demonstration of Capability 16. *Certification Regarding Lobbying 17. *Disclosure of Lobbying Activities and Instructions 18. *House Bill 89 Verification 19. *Residence Certification 20. *System for Award Management - (sam.gov 21. *Bid Bond** *Section 2 Items are to be completed and provided by all bidders with sealed bid. ** Please attach / include original bid bond as the last item in the sealed bid package. BID SCHEDULE PROJECT NAME: BID NO. 2024.05 — SEADRIFT DRAINAGE IMPROVEMENTS PROJECT DUE DATE: MAY 9. 2024 BEFORE 2:00:00 P.M. BIDDER NAME: BASE WORK SCOPE: The project shall consist of ditch improvements including vegetation removal, regrading, reshaping and channel liner; removal and replacement of culverts; installation of storm sewer; bridge construction and roadway reconstruction associated with the drainage improvements in Seadrift, Texas. Base Bid Item # TxDOT ITEM CODE ITEM DESCRIPTIONt BID QUANTITY UNIT PRICE TOTAL BID PRICE 1 0104 6017 REMOVING CONC (DRIVEWAYS) 44 2 01106001 EXCAVATION(ROADWAY) 657 3 01106002 EXCAVATION (CHANNEL) 242 4 01326005 EMBANKMENT(FINAL)(ORD COMP)(TY C) 116 5 01326999 EMBANK(CHANNEL)(FINAL)(OC)(C) 539 6 01626002 BLOCK SODDING 1269 7 01646005 BROADCASTSEED (PERM)(URBAN)(SANDY) 9905 8 0247 6057 FL BS (CMP IN PLC)(TYE GR1-2)(FNAL POS) CY 291 9 0260 6012 LIME (HYD, COM OR QK(SLURRY) OR QK(DRY) TON 16 10 0260 6079 LIME TRT (SUBGRADE)(6") SY 1365 11 03106027 PRIME COAT (MC-30 OR AE-P) GAL 335 12 03166001 ASPH (MULTI OPTION) GAL 447 13 0316 6246 AGGR (TY-PB GR-3 SAC-B) CY 13 14 0400 6005 CEM STABILBKFL CY 1959 15 04006008 CUT & RESTOR ASPH PAVING SY 2206 16 0409 6002 PRESTR CONC PIU18 IN SQ)(HPC) LF 576 17 0420 6014 CL C CONC(ABUT)(HPC) CY 39.2 18 0422 6008 REINF CONC SLAB (SLAB BEAM)(HPC) SF 2080 19 0425 6010 PRESTR CONC SLAB BEAM (55612) LF 395 20 0432 6003 RIPRAP (CONC)(61N) CY 15 21 0432 6033 RIPRAP (STONE PROTECTION)(181N) CY 219 22 0450 6018 RAIL (TY T631) LF 208 23 0460 6002 CMP (GAL STL 18 IN) LF 15 24 0462 6005 CONC BOX CULV (4FTX4FT) LF 52 25 0462 6007 CONC BOX CULV (5FTX3FT) LF 166 Base Bid Continued Item # TxDOT ITEM CODE ITEM DESCRIPTION ITEM UNI BID QUANTITY UNIT PRICE TOTAL BID PRICE 26 0462 6008 CONC BOX CULV (5FTX4FT) LF 1058 27 0462 6009 CONC BOX CULV (5FTX5FT) LF 396 28 0462 6015 CONC BOX CULV (7 FT X 4 FT) LF 204 29 0462 6021 CONC BOX CULV (BFTX6FT) LF 42 30 0462 6022 CONC BOX CULV (8FTX7FT) LF 34 31 0464 6005 RC PIPE (CL III)(24 IN) LF 12 32 04656074 INLET(COMPL)((PSL)(RC)(5FTX5FT) EA 4 33 04656076 INLET(COMPL)((PSL)(RC)(6FTX6FT) EA 8 34 0465 6559 INL(CMP)(PAZD-CZ)(FG)(4FTX4FT- 3FTX3FT) EA 9 35 0466 6101 HEADWALL (CH - PW - 0) (DIA= 36 EA 1 36 0466 6182 WINGWALL (PW -1) (HW=7 FT) EA 2 37 0466 6183 WINGWALL (PW -1) (HW=8 FT) EA 2 38 0466 6208 WINGWALL (SW-0) (HW=S FT) EA 14 39 0466 6216 WINGWALL (PW) (HW=S FT) (MOD) EA 1 40 0467 9001 SET (TY II) (18 IN) (HOPE) (3: 1) (P) EA 24 41 0467 9002 SET (TY II) (30 IN) (HOPE) (3: 1) (P) EA 6 42 0496 6041 REMOV STR (LARGE) EA 4 43 0496 6042 REMOV STR (SMALL) EA 13 44 04966050 REMOV STR (DRIVEWAY CULVERT) EA 20 45 05006001 MOBILIZATION LS 1 46 0502 6999 BARRICADES, SIGNS AND TRAFFIC HANDLING LS 1 47 0506 6038 TEMP SEDMT CONT FENCE (INSTALL) LF 763 48 0506 6039 TEMP SEDMT CONT FENCE (REMOVE) LF 763 49 0506 6040 BI EG EROSN CONT LOGS (INSTL) LF 2250 50 0506 6043 BIODEG EROSN CONT LOGS (REMOVE) LF 2250 51 0530 6003 INTERSECTIONS (SURF TREAT) SY 172 52 05306004 DRIVEWAYS(CONC) SY 110 53 0530 6006 DRIVEWAYS (SURF TREAT) SY 102 54 05306016 DRIVEWAYS (BASE) SY 323 Base Bid Continued Item # TxDOT ITEM CODE ITEM DESCRIPTION ITEM BID UNIT PRICE TOTAL BID PRICE UNIT QUANTITY 55 0540 6001 MTL W-BEAM GD FEN (TIM POST) LF 92 56 05406016 DOWNSTREAM ANCHOR TERMINAL SECTION EA 4 57 05446001 GUARDRAIL END TREATMENT (INSTALL) EA 4 58 0644 6001 IN SM RD SN EA 15 SUP&AMTY10BWG(1)(SA)(P) 59 0644 6076 REMOVE SM RD SN SUP&AM EA 15 60 0658 6073 INSTL OM ASSM (OM- EA 8 2Y)(WC)GND(BI) 61 0752 6004 TREE TRIMMING / BRUSH REMOVAL(CHANNELS) AC 1.11 62 0752 9999 TREE AND BRUSH REMOVAL (CHANNEL) AC 1.13 63 07606001 DITCH CLEANING AND RESHAPING (FOOT) LF 5484 64 09996001 ENGINEERED TURF(HYDROTURFZ OR EQUIV) SF 40675 65 0999 6002 MODIFY SEAWALL PANEL FOR OUTFALL EA 4 66 3076 6043 D-GR HMA TY-D PG70-22 (LEVEL -UP) TON 192 67 41226004 THERMO PIPE(18")(HDPE)(TY S)(CSB) LF 644 68 4122 6005 THERMO PIPE(24")(HDPE)(TY S)(CSB) LF 316 69 41226006 THERMO PIPE(36")(HDPE)(TY S)(CSB) LF 49 70 4122 6021 THERMO PIPE(30")(HDPE)(TY S)(CSB) LF 569 71 50486002 FLOATING TURBIDITYBARRIER(FUR & INST) LF 90 72 5048 6003 FLOATING TURBIDITY BARRIER (REMOVE) LF 90 73 7218 6013 PIPE ENCASEMENT (12" STL) LF 32 Total Base Bld (Base Bid +$60,000.00 Testing Allowance) _ ALTERNATE BID #1 REPLACES ITEM 0999 6001 ENGINEERED TUR Item # TxDOT ITEM CODE ITEM DESCRIPTION ITEM UNIT BID QUANTITY UNIT PRICE TOTAL BID PRICE A01 0432 6002 1 RIPRAP (CONC)(51N) Cy 619 OWNER'S OPTION A— 9TH ST LEFT DITCH CONCRETE LINER additional work Item I TxDOT ITEM I ITEM DESCRIPTION # CODE ITEM UNIT BID UANTITY UNIT PRICE TOTAL BID PRICE BOl I B0432 6003 RIPRAP (CONC)(61N) CY 227 OWNERS OPTION A + $4,000.00 Allowance = SPECIFICATION NOTES The project shall consist of ditch improvements including vegetation removal, regrading, reshaping and channel liner; removal and replacement of culverts; installation of storm sewer; bridge construction and roadway reconstruction associated with the drainage improvements in Seadrift, Texas. The BIDDER, in compliance with the invitation for bids for Bid No. 2024.05 — Seadrift Drainage Improvements Project — GLO Contract No. 22-085-014-D245 for Calhoun County, Texas, having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies in accordance with the contract documents, within the time set forth herein. These price(s) are to cover all expenses incurred in performing the work required under the contract documents, of which this bid is a part. These price(s) are firm and shall not be subject to adjustment provided this bid is accepted within sixty (60) days after the time set for receipt of bids. BIDDER hereby agrees to commence work under this contract on or before a date to be specified in a written "Notice to Proceed" to be issued by the COUNTY and to substantially complete within consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $500.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. 2. SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Subcontractor The undersigned hereby declares that he has visited the site and has carefully examined the contract documents relative to the work covered by the above bid. Bidder Name: Address: Phone: EIN or Tax ID No.: Signature: Name and Title: STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information it desires. Date: Bidder (Legal Name of Date Organized:_ Name of Owner(s):_ Date Incorporated Federal ID Number: Number of Years in contracting business under present name List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Contract Amount $ Completion Date Type of work performed by your company: Total Staff employed by Firm (Break down by Managers and Trades on separate sheet): Have you ever failed to complete any work awarded to you? ❑ Yes ❑ No (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? ❑ Yes ❑ No (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the past five years or that was still in effect during the five-year period or is still in effect? ❑ Yes ❑ No (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance): Project Amount $ Mo/Yr Completed Major equipment available for this contract: Are you in compliance with all applicable EEO requirements? ❑ Yes ❑ No (If no, please attach summary of details on a separate sheet.)) (Optional) Minority Business Reporting Information: Owner's Race: Owner's Ethnicity: Owner's Gender: Are you a Section 3 business? (see below) ❑ Yes ❑ No Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the County'sjurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low-income persons. Bank References Address: Contact Name: City & State: Zip: Phone Number: Credit available: $ Has the firm or predecessor firm been involved in a bankruptcy or reorganization? ❑ Yes ❑ No (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto alljudgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Signed this day of 20 Signature Printed Name and Title Company Name Notary Statement: being duly sworn, says that he/she is the Position/Title of (Firm Name), and hereby swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporation to furnish any information requested by Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications. Subscribed and sworn before me this day of , 20. Notary Public Signature Printed Name My Commission Expires: , The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFRCEUSEONLY 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 aid die 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, Loral Government Code. An offense under this section is a misdemeanor. tJ Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you areilling 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 71h business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 31 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? Yes FlNo 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 famity member of the officer AND the taxable Income is not received from the local governmental entity? Yes F-1 No 6 Describe each employment or business relationship that the vendor named in Section I 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 ❑Checkthis box if the vendor has given the local government officer or afamiy 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 entry Data Form provided by Texas Ethics Commission www.ethics.state. tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http:Uwww.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 .4 176.003(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 ora 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) acontract 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 aggregatevalue 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) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state. tx.us Revised 11/30/2015 ;.�.]��4ay21:191 21671vill Ire] Line TX.i.I�I�7�•7ar_t1�:7m UTOKUTC.Ti 1��I►iel�10:1Z lu I, (Principal's Name)_ of (Company Name) (hereinafter called "Contractor"), acknowledge the recovered material bidding requirements found in 2 CFR 200.322 that requires the Contractor to procure those items designated in the guidelines of the Environmental Protection Agency (EPA) at 40 CFR 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition. I also acknowledge that this requirement shall apply to items purchased (1) where the Contractor purchases in excess of $10,000 of the item under this contract; or (2) where during the preceding fiscal year, the value of the quantity acquired was in excess of $10,000. Finally, I acknowledge the attached list of recovered materials included in the bid documents. (For up-to-date listing, please go to https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg- program#directory) Printed Name and Title Signature Date USE OF RECOVERED MATERIAL Please check one: ❑ Recovered materials are included in this bid: Materials included ❑ Recovered materials are not reasonably available in a reasonable period of time. ❑ Recovered materials fail to meet reasonable performance standards, which are determined on the basis of the guidelines of the National Institute of Standards and Technology, if applicable. ❑ Recovered materials are only available at an unreasonable price. Printed Name and Title Signature Date 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 celiification. 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 (I) (a- d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION_ Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive depaltments and agencies shall participate in a system for debarment and suspension from programs and activities involving Federal financial and nonfinancial assistance and benefits. Debarment or suspension of a participant in a program by one agency shall have government -wide effect. (b) Activities covered by this Order include but are not limited to: grants, cooperative agreements, contracts of assistance, loans, and loan guarantees. (c) This Order does not cover procurement programs and activities, direct Federal statutory entitlements or mandatory awards, direct awards to foreign governments or public international organizations, benefits to an individual as a personal entitlement, or Federal employment. Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and repo li 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 repoli 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 celiification 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 celtification 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 principate 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 celiification. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. STATE OF TEXAS 0 COUNTY OF 0 (Type or Print Name) AFFIDAVIT being first duly sworn, deposes and says: that he or she is the 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. Affiant further deposes and says: that the bidder/proposer has not directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interests of Calhoun County, or of any other bidder/proposer, or anyone else interested in the bid/proposal contract; and that the bidder/proposer has not in any manner sought by collusion to secure for himself/herself/itself/themselves an advantage over any other bidder/proposer. Affiant further deposes and says: that prior to the public opening and reading of bids/proposals, said bidder/proposer: a) did not, directly or indirectly, induce or solicit anyone else to submit a false or sham bid/proposal; b) did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder/proposer or anyone else would submit a false or sham bid/proposal, or that anyone should refrain from submitting a bid/proposal or withdraw their bid/proposal; c) did not, in any manner, directly or indirectly, seek by agreement, communication or conference with anyone to raise or fix the bid price/proposal of said bidder/proposer or of anyone else, or to raise or fix any overhead, profit or cost element of their price/fee or of that of anyone else; d) did not give, offer to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid/proposal; and e) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative hereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent, thereof, to any individual or group of individuals, or to any official, employee or agent of Calhoun County prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained in this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and requirements contained in the bid/proposal. Signature of Affiant Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 20 Notary Stamp/Seal Signature of Notary Public CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) CERTIFICATION BY BIDDER [BidderEparticipated in a previous contractor subcontract subject to Civil Rights Laws and Regulations. Yes 0 No The undersigned hereby certifies that: 0 The Provision_of Local Training Employment and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). 0 The Equal Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended? 0 Yes 0 No NAME AND TITLE OF SIGNER (Please type) SIGNATURE DATE CONTRACTOR'S LOCAL OPPORTUNITY PLAN agrees to implement the following specific affirmative action steps (name of company) directed at increasing the utilization of lower income residents and businesses within Calhoun County. A. To ascertain from the County's CDBG program official the exact boundaries of the project area and where advantageous, seek the assistance of local officials in preparing and implementing the affirmative action plan. B. To attempt to recruit from within the county the necessary number of lower income residents through: local advertising media, signs placed at the proposed site for the project, and community organizations and public or private institutions operating within and servicing the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Concentrated Employment Program, Hometown Plan, or the U.S. Employment Service. C. To maintain a list of all lower income residents who have applied either on their own or on referral from any source, and to employ such persons, if otherwise eligible and if a vacancy exists. D. To insert this plan in all bid documents and to require all bidders on subcontracts to submit an affirmative action plan including utilization goals and the specific steps planned to accomplish these goals. E. To ensure that subcontracts (greater than $10,000), which are typically let on a negotiated rather than a bid basis in areas other than the covered project area, are also let on a negotiated basis, whenever feasible, in a covered project area. F. To formally contact unions, subcontractors, and trade associations to secure their cooperation in this effort. G. To ensure that all appropriate project area business concerns are notified of pending sub -contractual opportunities. H. To maintain records, including copies of correspondence, memoranda, etc., which document that all of the above affirmative action steps have been taken. I. To appoint or recruit an executive official of the company or agency as Equal Opportunity Officer to coordinate the implementation of this plan. J. To maintain records concerning the amount and number of contracts, subcontracts, and purchases which contribute to objectives. K. To maintain records of all projected work force needs for all phases of the project by occupation, trade, skill level, and number of positions and to update these projections based on the extent to which hiring meets these Local Opportunity objectives. As officers and representatives of we the undersigned have read (name of company) and fully agree to this Plan and the County's Section 3 Plan, and become a party to the full implementation of the program and its provisions. Signature Printed Name Title Date Instructions for Proposed Contracts Breakdown and Estimated Project Workforce Breakdown Proposed Contracts Breakdown Type of Contracts - list all construction, materials, or other types of subcontracts (for example: electrical, plumbing, concrete, boring, etc.) No. of Contracts - Number of contracts under this category Approximate Total Dollar Amount - Total amount of each contract Estimated No. to Local Business - Number of contracts awarded to local businesses and Section 3 businesses Estimated $ Amount to Local Business - How many dollars will be spent locally for each type of contract? For example: will you hire any local employees or subcontractors? Estimated Project Workforce Breakdown Work Classifications - Classification of project employees as defined on Wage Rate Total Estimated Positions - List the number employees for each work classification will you need on this project Number of Positions Currently Filled - List the number of estimated positions you currently have filled Number of Positions Not Filled - List the number of estimated positions you currently do not have filled Number of Positions to Fill with Low to Moderate Income (Section 3) Residents - List the number of local residents earning low to moderate incomes that you plan to employ to fill the estimated positions not filled PROPOSED CONTRACTS BREAKDOWN Type of Contracts No. of Contracts Approx. Total Dollar Amount Estimated No. to local Business Estimated $ Amount Local Business ESTIMATED PROJECT WORKFORCE BREAKDOWN Work Classifications Total Estimated Positions No. of Positions Currently Filled No. of Positions not Filled No. of Positions to fill with LMI Resident (Section 3) Totals Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program CERTIFICATION FOR BUSINESS CONCERNS Seeking Section 3 Preference in Contracting and Demonstration of Capability Economic Opportunities for Low and Very Low -Income Persons Grantee/Subrecipient Contract Number: Date: CONTRACTOR INFORMATION Name of Business Address of Business Type of Business:® Corporation ❑ Partnership ❑ Non -Profit ❑ Sole Proprietorship ❑ Joint Venture Consortium Attach the following documentation as evidence of Section 3 eligible status: (Definition of 'Section 3 Business Concern" in 24 CFR 135 describes the three alternative qualifications.) For Business claiming status as a Section 3 resident -owned enterprise: ❑ Copy of resident lease ❑ Copy of evidence of participation in a public assistance program For business entity as applicable: ❑ Copy of At of Incorporation ❑ Assumed Business Name Certificate ❑ List of owners/stockholders and % ownership of each appointed officers ❑ Organization chart with names and titles and brief function statement ❑ Copy of receipt of public assistance ❑ Other evidence ❑ Certificate of Good Standing ❑ Partnership Agreement ❑ Corporation Annual Report ❑ Latest Board minutes ❑ Additional documentation For business entity claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business(es):. ❑ List of subcontracted Section 3 business(es) and subcontract amount For business claiming Section 3 status, by claiming at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employmerd with the business: ❑ List of all current full-time employees ❑ List of employees claiming Section 3 status ❑ PHAIIHA Residential lease less than 3 years ❑ Other evidence of Section 3 status less than 3 from day of employment years from date of employment Evidence of ability to perform successfully under the terms and conditions of the proposed contract: ❑ Current financial statement ❑ List of owned equipment ❑ List of all contracts for the past two years Authorized ame and Signature Attested By: ❑ Statement of ability to comply with public policy Date (Corporate Seal) CERTIFICATION REGARDING LOBBYING COMPLIANT WITH APPENDIX A TO 24 C.F.R. PART 87* (To be submitted with each bid or offer exceeding $100,000) Certification for Contracts, Grants, Loans, and Cooperative Agreements: The undersigned certifies, to the best of his or her knowledge and belief, that (1) 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. (2) 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. (3) The undersigned shall require that the language of this 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 section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Statement for Loan Guarantees and Loan Insurance: The undersigned states, to the best of his or her knowledge and belief, that: If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. As the duly authorized representative of the Contractor, I hereby certify that the applicant will comply with the above applicable certification. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official Date *24 C.F.R. 87 App. A, available at https://www.gpo.gov/fdsys/granule/CFR-2011-title24-voll/CFR-2011-title24- voll-part87-appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee 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 followup 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 subawardee, e.g., the first subawardee of the prime is the 1 st 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 "subawardee," 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. 4040-0013. 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 (4040-0013), Washington, DC 20503 Approved by OMB 4040-0013 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for Dublic burden disclnsire) 1. Type of Federal 2. Status of Federal Action: 3. Report Type: Action: a. bid/offer/application a. initial filing a. contract b. initial award b. material change b. grant c. post -award c. cooperative For material change only: agreement Year quarter d. loan Date of last report e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Prime Subawardee Enter Name and Address of Prime: Tier , if Known: Con ressionalDistrict,ifknown: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (if individual, last name, first name, MI): (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Title: Congress semi-annually and will be available for public inspection. Any person who fails to file the required Telephone No.: Date: 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) HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85`h 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 Printed Name of Authorized Official Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ 1 certify that (Company Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is ❑ I certify that (City and State) (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a 'Resident Bidder" of Texas as Insert System for Award Management (SAM) Record Search for company and company principal(s). Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principals are not listed (are not debarred) through the System for Award Management. KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, as PRINCIPAL, and , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Local Public Agency', in the penal sum of Dollars, ($ ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated for BID NO. 2024.05 — SEADRIFT DRAINAGE IMPROVEMENTS PROJECT — GILD CONTRACT NO. 22-085-014-D245 FOR CALHOUN COUNTY, TEXAS. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within thirty (60) days after the said opening, and shall within the period specified therefor, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above parties have executed this instrument this day of the name and corporate seal of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. Countersigned By — * Attoi (SEAL) (SEAL) Attest: By: Affix Corporate Seal Attest: By: Attest: .may-u I -I au, amLe U1 i exas go Affix Corporate Seal Page 1 of 2 bond; that then CERTIFICATE AS TO CORPORATE PRINCIPAL certify that I am the Secretary of the Corporation named as Principal in the bid who signed the said bond on behalf of the Principal was of said corporation; that I know his/her signature, and his/her signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, on behalf of said corporation by authority of its governing body. Title: * Power -of -attorney for person signing for Surety Company must be attached to bond. Please attach / include original bid bond as the last item in the sealed bid package. Corporate Seal Page 2 of 2 SECTION 3 22. Standard Form of Agreement for Construction Contracts 23. General Contract Conditions for Construction 24. Calhoun County General Conditions 25. Minority/Female Goals 26. Federal Labor Standard Provisions 27. Title 29 Labor 28. Concerning Labor Standards and Prevailing Wage Rate Requirements 29. Project specific Davis -Bacon Wage Decision 30. GLO Signage Requirements 31. Certificate of Interested Parties Form 1295 and Instructions 32. Section 504 Certification 33. Child Support Statement 34. Document No. 00417 — Tench Safety Systems Indemnity Agreement 35. Payment Bond 36. Performance Bond 37. Certificate of Liability Insurance 38. Section 3 Clause 39. HUD Examples of Efforts to Offer Training & Employment Opportunities for Section 3 Residents 40. GLO New Hires Section 3 Monthly Compliance Report 41. CDBG-MIT Section 3 Brochure Information Sheet 42. GLO Assurances for Construction Programs 43. GLO General Affirmations 44. Attorney's Review Certification 45. Contractor's Final Payment Affidavit 46, Change Order Form 47. Certificate of Construction Completion (COCC) 48. Governing Technical Specifications & Special Provisions Standard Form of Agreement for Construction Contracts THIS AGREEMENT made this the day of , by and between (a corporation organized and existing under the laws of the State of ) (a partnership consisting of 1 (an individual trading as 1 hereinafter called the "Contractor", and CALHOUN COUNTY, TEXAS hereinafter called the"County." WITNESSETH, that the Contractor and the County for the considerations stated herein mutually agree as follows: ARTICLE 1. Statement of Work. The Contractor shall furnish all supervision, technical personnel, labor, materials, machinery, tools, equipment and services, including utility and transportation services, and perform and complete all work required for the construction of the Improvements embraced in the Project; namely Bid No. 2024.05 — Seadrift Drainage Improvements Project — GLO Contract No. 22-085-014-D245 for Calhoun County, Texas for the Community Development Block Grant — Mitigation (CDBG- DR) project, all in strict accordance with the contract documents including all addenda thereto, numbered dated and all as prepared by G&W Engineers, Inc. acting and in these contract documents preparation, referred to as the "Engineer'. ARTICLE 2. The Contract Price. The County will pay the Contractor for the performance of the Contract in current funds, for the total quantities of work performed at the unit prices stipulated in the Bid for the several respective items of work completed subject to additions and deductions in amount of ($ ). ARTICLE 3. The Contract. The executed contract documents shall consist of the following components: a. This Agreement b.Addenda c. Invitation for Bids d. Instructions to Bidders e. Signed Copy of Bid f. General Conditions g. Calhoun County Conditions h. Special Conditions g. i. Performance Bond j. Payment Bond k. Technical Specifications I. Drawings m. Other ARTICLE 4. Performance. Work, in accordance with the Contract dated shall commence on or before as established in an official letter notification to the contractor called "Notice to Proceed" and Contractor shall complete the WORK within consecutive calendar days thereafter. The date of completion of all WORK is therefore established by the Notice to Proceed Letter This Agreement, together with other documents enumerated in this ARTICLE 3, which said other documents are as fully a part of the Contract as if hereto attached or herein repeated, forms the Contract between the parties hereto. In the event that any provision in any component part of this Contract conflicts with any provision of any other component part, the provision of the component part first enumerated in this ARTICLE 3 shall govern, except as otherwise specifically stated. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed in tri 1_p icate original copies on the day and year first above written. (The Contractor) CALHOUN COUNTY (County) Name/Title: Richard H. Meyer, County Judge Corporate Certifications I, , certify that I am the of the corporation named as Contractor herein; that who signed this Agreement on behalf of the Contractor, was then of said corporation; that said Agreement was duly signed for and in behalf of said corporation by authority of its governing body, and is within the scope of its corporate powers. Corporate Seal (Corporate Secretary) Please indicate above with N/A to all blanks above if LLC and authorized person signature at Corporate Secretary. GENERAL CONDITIONS - PART I FOR CONSTRUCTION 1. Contract and Contract Documents a. The project to be constructed pursuant to this contract will be financed with assistance from the General Land Office (GLO) through the Community Development Block Grant — Mitigation (CDBG-MIT) fund and is subject to all applicable Federal and State laws and regulations. b. The Plans, Specifications and Addenda shall form part of this contract and the provisions thereof shall be binding upon the parties as if they were herein fully set forth. 2. Definitions Whenever used in any of the Contract Documents, the following meanings shall be given to the terms here in defined: (a) The term "Contract" means the Contract executed between Calhoun County, hereinafter called the "County" and Name of Construction Co.), hereinafter called "Contractor", of which these GENERAL CONDITIONS, form a part. (b) The term "Project Area" means the area within the specified Contract limits of the Improvements contemplated to be constructed in whole or in part under this contract. (c) The term "Engineer" means (G & W Engineers Inc.), Engineer in charge, serving the County with architectural or engineering services, his successor, or any other person or persons, employed by the County for the purpose of directing or having in charge the work embraced in this Contract. (d) The term "Contract Documents" means and shall include the following: Executed Contract, Addenda (if any), Invitation for Bids, Instructions to Bidders, Signed Copy of Bid, General Conditions, Special Conditions, Technical Specifications, and Drawings (as listed in the Schedule of Drawings). 3. Supervision By Contractor (a) Except where the Contractor is an individual and personally supervises the work, the Contractor shall provide a competent superintendent, satisfactory to the Engineer, on the work at all times during working hours with full authority to act as Contractor's agent. The Contractor shall also provide adequate staff for the proper coordination and expediting of his work. (b) The Contractor shall be responsible for all work executed under the Contract. Contractor shall verify all figures and elevations before proceeding with the work and will be held responsible for any error resulting from his failure to do so. 4. Subcontracts (a) The Contractor shall not execute an agreement with any subcontractor or permit any subcontractor to perform any work included in this contract until Contractor has verified the subcontractor has been cleared (not suspended or debarred) to participate in federally funded contracts. (b) No proposed subcontractor shall be disapproved by the County except for cause. (C) The Contractor shall be as fully responsible to the County for the acts and omissions of his subcontractors, and of persons either directly or indirectly employed by them. (d) The Contractor shall cause appropriate provisions to be inserted in all subcontracts relative to the work and required compliance by each subcontractor with the applicable provisions of the Contract. (e) Nothing contained in the Contract shall create any contractual relation between any subcontractor and the County. (� Contractors are encouraged to subcontract with Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms. 5. Fitting and Coordination of Work The Contractor shall be responsible for the proper fitting of all work and for the coordination of the operations of all trades, subcontractors, or material suppliers engaged upon this Contract. 6. Payments to Contractor (a) Partial Payments 1) The Contractor shall prepare the requisition for partial payment as of the last day of the month and submit it, with the required number of copies, to the Engineer for approval. The amount of the payment due the Contractor shall be determined by adding to the total value of work completed to date, the value of materials properly stored on the site and deducting (1) five percent (5%) of the total amount, to be retained until final payment, and (2) the amount of all previous payments. The total value of work completed to date shall be based on the estimated quantities of work completed and on the unit prices contained in the agreement. The value of materials properly stored on the site shall be based upon the estimated quantities of such materials and the invoice prices. Copies of all invoices shall be available for inspection of the Engineer. 2) Monthly or partial payments made by the County to the Contractor are advanced for the purpose of assisting the contractor to expedite the work of construction. The Contractor shall be responsible for the care and protection of all materials and work upon which payments have been made until final acceptance of such work and materials by the County. Such payments shall not constitute a waiver of the right of the County to require the fulfillment of all terms of the Contract and the delivery of all improvements embraced in this Contract complete and satisfactory to the County in all details. (b) Final Payment 1) After final inspection and the acceptance by the County of all work under the Contract, the Contractor shall prepare the requisition for final payment which shall be based upon the careful inspection of each item of work at the applicable unit prices stipulated in the Contract. The total amount of the final payment due the Contractor under this Contract shall be the amount computed as described above less all previous payments. 2) Before paying the final estimate, County shall require the Contractor to furnish releases or receipts from all subcontractors having performed any work and all persons having supplied materials, equipment (installed on the Project) and services to the Contractor. The County may make payment in part or in full to the Contractor without requiring the furnishing of such releases or receipts and any payments made shall in no way impair the obligations of any surety or sureties furnished under this Contract. 3) Any amount due to the County under Liquidated Damages, shall be deducted from the final payment due from the contractor. (c) Payments Subject to Submission of Certificates Each payment to the Contractor by the County shall be made subject to submission by the Contractor of all written certifications required of it and its subcontractors. (d) Withholding Payments The County may withhold any payment due the Contractor as deemed necessary to protect the County, and if so elects, may also withhold any amounts due from the Contractor to any subcontractors or material dealers, for work performed or material furnished by them. The foregoing provisions shall be construed solely for the benefit of the County and will not require the County to determine or adjust any claims or disputes between the Contractor and its subcontractors or material dealers, or to withhold any moneys for their protection unless the County elects to do so. The failure or refusal of the County to withhold any moneys from the Contractor shall in no way impair the obligations of any surety or sureties under any bond or bonds furnished under this Contract. 7. Changes in the Work (a) The County may make changes in the scope of work required to be performed by the Contractor under the Contract without relieving or releasing the Contractor from any obligations under the Contract or any guarantee given pursuant to the Contract provisions, and without affecting the validity of the guaranty bonds, and without relieving or releasing the surety or sureties of said bonds. All such work shall be executed under the terms of the original Contract unless it is expressly provided otherwise. Additionally, all such change orders must be approved by CDBG-MIT prior to execution of same. (b) Except for the purpose of affording protection against any emergency endangering health, life, limb or property, the Contractor shall make no change in the materials used or in the specified manner of constructing and/or installing the improvements or supply additional labor, services or materials beyond that actually required for the execution of the Contract, unless in pursuance of a written order from the County authorizing the Contractor to proceed with the change. No claim for an adjustment of the Contract Price will be valid unless so ordered. (c) If applicable unit prices are contained in the Contract, the County may order the Contractor to proceed with desired unit prices specified in the Contract; provided that in case of a unit price contract the net value of all changes does not increase the original total amount of the agreement by more than twenty-five percent (25%) or decrease the original total amount by more than twenty-five percent (25%) for municipalities and eighteen percent (18%) for counties without the written consent of the contractor. [Texas Local Government Code Section 252.048(d) and Section 262.031(b)] (d) Each change order shall include in its final form: 1) A detailed description of the change in the work. 2) The Contractor's proposal (if any) or a confirmed copy thereof. 3) A definite statement as to the resulting change in the contract price and/or time. 4) The statement that all work involved in the change shall be performed in accordance with contract requirements except as modified by the change order. 5) The procedures as outlined in this Section for a unit price contract also apply in any lump sum contract. 8. Claims for Extra Cost (a) If the Contractor claims that any instructions by Drawings or otherwise involve extra cost or extension of time, he shall, within ten days after the receipt of such instructions, and in any event before proceeding to execute the work, submit his protest thereto in writing to the County, stating clearly and in detail the basis of his objections. No such claim will be considered unless so made. (b) Claims for additional compensation for extra work, due to alleged errors in ground elevations, contour lines, or bench marks, will not be recognized unless accompanied by certified survey data, made prior to the time the original ground was disturbed, clearly showing that errors exist which resulted, or would result, in handling more material, or performing more work, than would be reasonably estimated from the Drawings and maps issued. (c) Any discrepancies which may be discovered between actual conditions and those represented by the Drawings and maps shall be reported at once to the County and work shall not proceed except at the Contractor's risk, until written instructions have been received from the County. (d) If, on the basis of the available evidence, the County determines that an adjustment of the Contract Price and/or time is justifiable, a change order shall be executed. 9. Termination Delays and Liquidated Damages Right of the County to Terminate Contract for Convenience County may at any time and for any reason terminate Contractor's services and work at County's convenience upon providing written notice to the Contractor specifying the extent of termination and the effective date. Upon receipt of such notice, Contractor shall, unless the notice directs otherwise, immediately discontinue the work and placing of orders for materials, facilities and supplies in connection with the performance of this Agreement. Upon such termination, Contractor shall be entitled to payment only as follows: (1) the actual cost of the work completed in conformity with this Agreement plus (2) such other costs actually incurred by Contractor as are permitted by the prime contract and approved by County. There shall be deducted from such sums as provided in this subparagraph the amount of any payments made to Contractor prior to the date of the termination of this Agreement. Contractor shall not be entitled to any claim or claim of lien against County for any additional compensation or damages in the event of such termination and payment. Right of the County to Terminate Contract for Cause If the Contractor fails to fulfill in a timely and proper manner its obligations under this Agreement, or if the Contractor violates any of the covenants, conditions, agreements, or stipulations of this Agreement, the County shall have the right to terminate this Agreement by giving written notice to the Contractor of such termination and specifying the effective date thereof, which shall be at least five days before the effective date of such termination. In the event of termination for cause, all finished or unfinished documents, data, studies, surveys, drawings, maps, models, photographs and reports prepared by the Contractor pursuant to this Agreement shall, at the option of the County, be turned over to the County and become the property of the County. In the event of termination for cause, the Contractor shall be entitled to receive reasonable compensation for any necessary services actually and satisfactorily performed prior to the date of termination. Notwithstanding the above, the Contractor shall not be relieved of liability to the County for damages sustained by the County by virtue of any breach of contract by the Contractor, and the County may set-off the damages it incurred as a result of the Contractor's breach of contract from any amounts it might otherwise owe the Contractor. 2 CFR 200 APPENDIX II(B) (a) Liquidated Damages for Delays. If the work is not completed within the time stipulated in the applicable bid for Lump Sum or Unit Price Contract provided, the Contractor shall pay to the County as fixed, agreed, and liquidated damages (it being impossible to determine the actual damages occasioned by the delay) the amount of $500 for each calendar day of delay, until the work is completed. The Contractor and Contractor's sureties shall be liable to the County for the amount thereof. (b) Excusable Delays. 1) The right of the Contractor to proceed shall not be terminated nor shall the Contractor be charged with liquidated damages for any delays in the completion of the work due to: 2) Any acts of the Government, including controls or restrictions upon or requisitioning of materials, equipment, tools, or labor by reason of war, national defense, or any other national emergency; 3) Any acts of the County; 4) Causes not reasonably foreseeable by the parties to this Contract at the time of execution which are beyond the control and without the fault or negligence of the Contractor, including, but not restricted to, acts of God, terrorism, war, acts of another Contractor in the performance of some other contract with the County, fires, floods, epidemics, quarantine, restrictions, strikes, freight embargoes, and weather of unusual severity such as hurricanes, tornadoes, cyclones and other extreme weather conditions. 5) Provided, however, that the Contractor promptly notifies the County within ten (10) days in writing of the cause of the delay. Upon receipt of such notification, the County shall ascertain the facts and the cause and extent of delay. If, upon the basis of the facts and the terms of this contract, the delay is properly excusable, the County shall extend the time for completing the work for a period of time commensurate with the period of excusable delay. 10. Assignment or Novation The Contractor shall not assign nor transfer, whether by assignment or novation, any of its rights, duties, benefits, obligations, liabilities, or responsibilities under this Contract without the written consent of the County. No assignment or novation of this Contract shall be valid unless the assignment or novation expressly provides that the assignment of any of the Contractor's rights or benefits under the Contract is subject to a prior lien for labor performed, services rendered, and materials, tools, and equipment supplied for the performance of the work under this Contract in favor of all persons, Contractors, or corporations rendering such labor or services or supplying such materials, tools, or equipment. 11. Technical Specifications and Drawings Anything mentioned in the Technical Specifications and not shown on the Drawings or vice versa, shall be of like effect as if shown on or mentioned in both. In case of difference between Drawings and Technical Specifications, the Technical Specifications shall govern. In case of any discrepancy in Drawings, or Technical Specifications, the matter shall be immediately submitted to the County for review. Contractor shall be liable for any issues or expenses in the event the discrepancy is not submitted to the County. 12. Shop Drawings (a) All required shop drawings, machinery details, layout drawings, etc. shall be submitted to the Engineer in 3 copies for approval sufficiently in advance of requirements to afford ample time for checking, including time for correcting, resubmitting and rechecking if necessary. The Contractor may proceed, only at Contractor's own risk, with manufacture or installation of any equipment or work covered by said shop drawings, etc. until they are approved and no claim, by the Contractor, for extension of the contract time shall be granted by reason of his failure in this respect. (b) Any drawings submitted without the Contractor's stamp of approval will not be considered and will be returned to him for proper resubmission. If any drawings show variations from the requirements of the Contract because of standard shop practice or other reason, the Contractor shall make specific mention of such variation in his letter of transmittal in order that, if acceptable, suitable action may be taken for proper adjustment of contract price and/or time, otherwise the Contractor will not be relieved of the responsibility for executing the work in accordance with the Contract even though the drawings have been approved. (c) If a shop drawing is in accordance with the contract or involves only minor adjustment in the interest of the County not involving a change in contract price or time, the engineer may approve the drawing. The approval shall not relieve the Contractor from responsibility to adhere to the contract or for any error in the drawing. 13. Requests for Supplementary Information It shall be the responsibility of the Contractor to make timely requests of the County for any additional information which should be furnished by the County under the terms of this Contract, and which is required in the planning and execution of the work. Such requests may be submitted from time to time as the need approaches, but each shall be filed in ample time to permit appropriate action to be taken by all parties involved so as to avoid delay. Each request shall be in writing, and list the various items and the latest date by which each will be required by the Contractor. The first list shall be submitted within two weeks after Contract award and shall be as complete as possible at that time. The Contractor shall, if requested, furnish promptly any assistance and information the Engineer may require in responding to these requests of the Contractor. The Contractor shall be fully responsible for any delay in his work or to others arising from his failure to comply fully with the provision of this section. 14. Materials and Workmanship (a) Unless otherwise specifically provided for in the technical specifications, all workmanship, equipment, materials and articles incorporated in the work shall be new and the best grade of the respective kinds for the purpose. Where equipment, materials, articles or workmanship are referred to in the technical specifications as "equal to" any particular standard, the Engineer shall decide the question of equality. (b) The Contractor shall furnish to the County for approval the manufacturer's detailed specifications for all machinery, mechanical and other special equipment, which he contemplates installing together with full information as to type, performance characteristics, and all other pertinent information as required, and shall likewise submit for approval full information concerning all other materials or articles which he proposes to incorporate. (c) Machinery, mechanical and other equipment, materials or articles installed or used without such prior approval shall be at the risk of subsequent rejection. (d) Materials specified by reference to the number or symbol of a specific standard, shall comply with requirements in the latest revision thereof and any amendment or supplement thereto in effect on the date of the Invitation for Bids, except as limited to type, class or grade, or modified in the technical specifications shall have full force and effect as though printed therein. (e) The County may require the Contractor to dismiss from the work such employee or employees as the County or the Engineer may deem unqualified. 15. Samples, Certificates and Tests (a) The Contractor shall submit all material or equipment samples, certificates, affidavits, etc., as called for in the contract documents or required by the Engineer, promptly after award of the contract and acceptance of the Contractor's bond. No such material or equipment shall be manufactured or delivered to the site, except at the Contractor's own risk, until the required samples or certificates have been approved in writing by the Engineer. Any delay in the work caused by late or improper submission of samples or certificates for approval shall not be considered just cause for an extension of the contract time. (b) Each sample submitted by the Contractor shall carry a label giving the name of the Contractor, the project for which it is intended, and the name of the producer. The accompanying certificate or letter from the Contractor shall state that the sample complies with contract requirements, shall give the name and brand of the product, its place of origin, the name and address of the producer and all specifications or other detailed information which will assist the Engineer in making a prompt decision regarding the acceptability of the sample. It shall also include the statement that all materials or equipment furnished for use in the project will comply with the samples and/or certified statements. (c) Approval of any materials shall be general only and shall not constitute a waiver of the County's right to demand full compliance with Contract requirements. After actual deliveries, the Engineer will have such check tests made as he deems necessary in each instance and may reject materials and equipment and accessories for cause, even though such materials and articles have been given general approval. If materials, equipment or accessories which fail to meet check tests have been incorporated in the work, the Engineer will have the right to cause their removal and replacement by proper materials or to demand and secure such reparation by the Contractor as is equitable. (d) Except as otherwise specifically stated in the Contract, the costs of sampling and testing will be divided as follows: 1) The Contractor shall furnish without extra cost, including packing and delivery charges, all samples required for testing purposes, except those samples taken on the project by the Engineer; 2) The Contractor shall assume all costs of re -testing materials which fail to meet contract requirements; 3) The Contractor shall assume all costs of testing materials offered in substitution for those found deficient; 4) The County will pay all other expenses. 16. Permits and Codes (a) The Contractor shall give all notices required by and comply with all applicable federal and state laws, ordinances, and codes of the Local Government. All construction work and/or utility installations shall comply with all applicable ordinances, and codes including all written waivers. Before installing any work, the Contractor shall examine the drawings and technical specifications for compliance with applicable ordinances and codes and shall immediately report any discrepancy to the County. Where the requirements of the drawings and technical specifications fail to comply with such applicable ordinances or codes, the County will adjust the Contract by Change Order to conform to such ordinances or codes (unless waivers in writing covering the difference have been granted by the governing body or department) and make appropriate adjustment in the Contract Price or stipulated unit prices. (b) Should the Contractor fail to observe the foregoing provisions and proceed with the construction and/or install any utility at variance with any applicable ordinance or code, including any written waivers (notwithstanding the fact that such installation is in compliance with the drawings and technical specifications), the Contractor shall remove such work without cost to the County. (c) The Contractor shall at his own expense, secure and pay for all permits for street pavement, sidewalks, shed, removal of abandoned water taps, sealing of house connection drains, pavement cuts, buildings, electrical, plumbing, water, gas and sewer permits required by the local regulatory body or any of its agencies. (d) The Contractor shall comply with applicable local laws and ordinances governing the disposal of surplus excavation, materials, debris and rubbish on or off the Project Area and commit no trespass on any public or private property in any operation due to or connected with the Improvements contained in this Contract. (e) The Contractor will be required to make arrangements for and pay the water, electrical power, or any other utilities required during construction. (f) During construction of this project, the Contractor shall use every means possible to control the amount of dust created by construction. Prior to the close of a day's work, the Contractor, if directed by the County, shall moisten the surrounding area to prevent a dusty condition. 17. Care of Work (a) The Contractor shall be responsible for all damages to person or property that occur as a result of its fault or negligence in connection with the prosecution of the work and shall be responsible for the proper care and protection of all materials delivered and work performed until completion and final acceptance. (b) The Contractor shall provide sufficient competent watchmen, both day and night, including Saturdays, Sundays, and holidays, from the time the work is commenced until final completion and acceptance. (c) In an emergency affecting the safety of life, limb or property, including adjoining property, the Contractor, without special instructions or authorization from the County is authorized to act to prevent such threatened loss or injury. Contractor shall follow all instructions of County. (d) The Contractor shall avoid damage as a result of his operations to existing sidewalks, streets, curbs, pavements, utilities (except those which are to be replaced or removed), adjoining property, etc., and shall be responsible for completely repairing any damage thereto caused by the operations. (e) The Contractor shall shore up, brace, underpin, secure, and protect as maybe necessary, all foundations and other parts of existing structures adjacent to, adjoining, and in the vicinity of the site, which may be in any way affected by the excavations or other operations connected with the construction of the improvements included in this Contract. The Contractor shall be responsible for the giving of any and all required notices to any adjoining or adjacent property owner or other party before the commencement of any work. The Contractor shall indemnify and save harmless the County from any damages on account of settlements or the loss of lateral support of adjoining property and from all loss or expense and all damages for which the County may become liable in consequence of such injury or damage to adjoining and adjacent structures and their premises. 18. Accident Prevention (a) No laborer or mechanic employed in the performance of this Contract shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his health or safety as determined under construction safety and health standards promulgated by the Department of Labor. (b) The Contractor shall exercise proper precaution at all times for the protection of persons and property and shall be responsible for all damages to persons or property, either on or off the site, which occur as a result of his prosecution of the work. (c) The Contractor shall maintain an accurate record of all cases of death, occupational disease, or injury requiring medical attention or causing loss of time from work, arising out of and in the course of employment on work under the Contract. The Contractor shall promptly furnish the County with reports concerning these matters. (d) The Contractor shall indemnify and hold harmless the County from any claims for damages resulting from property damage, personal injury and/or death suffered or alleged to have been suffered by any person as a result of any work conducted under this contract. (e) The Contractor shall provide trench safety for all excavations more than five feet deep prior to excavation. All OSHA Standards for trench safety must be adhered to by the Contractor. (f) The contractor shall at all times conduct work in such a manner as to ensure the least possible inconvenience to vehicular and pedestrian traffic. At the close of the work each day, all streets where possible in the opinion of the County, shall be opened to the public in order that persons living in the area may have access to their homes or businesses by the use of the streets. Barricades, warning signs, and necessary lighting shall be provided to the satisfaction of the County at the expense of the Contractor. 19. Sanitary Facilities The Contractor shall furnish, install and maintain ample sanitary facilities for laborers. As the needs arise, a sufficient number of enclosed temporary toilets shall be conveniently placed as required. Drinking water shall be provided from an approved source, so piped or transported as to keep it safe and fresh and served from single service containers or satisfactory types of sanitary drinking stands or fountains. All such facilities and services shall be furnished in strict accordance with existing and governing health regulations. 20. Use of Premises (a) The Contractor shall confine equipment, storage of materials, and construction operations to the contract limits as shown on the drawings and as prescribed by ordinances or permits, or as may be desired by the County, and shall not unreasonably encumber the site or public rights of way with materials and construction equipment. (b) The Contractor shall comply with all reasonable instructions of the County and all existing federal, state and local regulations regarding signs, advertising, traffic, fires, explosives, danger signals, and barricades. 21. Removal of Debris. Cleaning, Etc. The Contractor shall, periodically or as directed during the progress of the work, remove and legally dispose of all surplus excavated material and debris, and keep the Project Area and public rights of way reasonably clear. Upon completion of the work, he shall remove all temporary construction facilities, debris and unused materials provided for work, and put the whole site of the work and public rights of way in a neat and clean condition. 22. Inspection (a) All materials and workmanship shall be subject to inspection, examination, or test by the County and Engineer at any and all times during manufacture or construction and at any and all places where such manufacture or construction occurs. The County shall have the right to reject defective material and workmanship or require its correction. Unacceptable workmanship shall be satisfactorily corrected. Rejected material shall be promptly segregated and removed from the Project Area and replaced with material of specified quality without charge. If the Contractor fails to proceed at once with the correction of rejected workmanship or defective material, the County may by contract or otherwise have the defects remedied or rejected materials removed from the Project Area and charge the cost of the same against any Monies which may be due the Contractor, without prejudice to any other rights or remedies of the County. (b) The Contractor shall furnish promptly all materials reasonably necessary for any tests which may be required. All tests by the County will be performed in such manner as not to delay the work unnecessarily and will be made in accordance with the provisions of the technical specifications. (c) The Contractor shall notify the County sufficiently in advance of back filling or concealing any facilities to permit proper inspection. If any facilities are concealed without approval or consent of the County, the Contractor shall uncover for inspection and recover such facilities at Contractor's expense, when so requested by the County. (d) Should it be considered necessary or advisable by the County at any time before final acceptance of the entire work to make an examination of work already completed, the Contractor shall on request promptly furnish all necessary facilities, labor, and material. If such work is found to be defective in any important or essential respect, due to fault of the Contractor or subcontractors, the Contractor shall defray all the expenses of such examination and of satisfactory reconstruction. If, however, such work is found to meet the requirements of the Contract, the actual cost of labor and material necessarily involved in the examination and replacement, shall be reimbursable and if completion of the work of the entire Contract has been delayed, a suitable extension of time will be approved. (e) Inspection of materials and appurtenances to be incorporated in the improvements included in this Contract may be made at the place of production, manufacture or shipment, whenever the quantity justifies it, and such inspection and acceptance, unless otherwise stated in the technical specifications, shall be final, except as regards to: (1) latent defects, (2) departures from specific requirements of the Contract, (3) damage or loss in transit, or (4) fraud or such gross mistakes as amount to fraud. Subject to the requirements contained in the preceding sentence, the inspection of materials as a whole or in part will be made at the Project Site. (f) Neither inspection, testing, approval nor acceptance of the work in whole or in part, by the County or its agents shall relieve the Contractor or its sureties of full responsibility for materials furnished or work performed not in strict accordance with the Contract. 23. Review by County The County and its authorized representatives and agents shall have access to and be permitted to observe and review all work, materials, equipment, payrolls, personnel records, employment conditions, material invoices, and other relevant data and records pertaining to this Contract, provided, however that all instructions and approval with respect to the work will be given to the Contractor only by the County through its authorized representatives or agents. 24. Final Inspection When the Improvements included in this Contract are substantially completed, the Contractor shall notify the County in writing that the work will be ready for final inspection on a definite date which shall be stated in the notice. The County will make the arrangements necessary to have final inspection commenced on the date stated in the notice, or as soon thereafter as is practicable. 25. Deduction for Uncorrected Work If the County deems it not expedient to require the Contractor to correct work not done in accordance with the Contract Documents, an equitable deduction from the Contract Price will be made by agreement between the Contractor and the County and subject to settlement, in case of dispute, as herein provided. 26.Insurance The Contractor shall not commence work under this contract until all required insurance under this paragraph has been secured and approved by the County. These minimum insurance coverage requirements supercede the Calhoun County, Texas General Conditions minimum insurance cover requirements. (a) Worker's Compensation Insurance: The Contractor shall procure and shall maintain during the life of this contract Worker's Compensation Insurance as required by the State of Texas for all of his employees to be engaged in work at the site of the project under this contract and, in case of any such work sublet, the Contractor shall require the subcontractor similarly to provide Worker's Compensation Insurance for all of the employees to be engaged in such work unless such employees are covered by the protection afforded by the Contractor's Worker's Compensation Insurance. (b) Contractor's Public Liability and Property Damage Insurance and Vehicle Liability Insurance. The Contractor shall procure and shall maintain during the life of this contract Contractor's Public Liability Insurance, Contractor's Property Damage Insurance and Vehicle Liability Insurance in the following amounts: 1) CONTRACTOR shall have, (or purchase) and shall maintain in force during the duration of the Work, coverage for the hazard of explosion, collapse and underground shall be included. Coverage for independent contractor's liability, contractual liability, products/completed operations liability, personal injury and broad form property damage shall also be included. Completed operations liability shall be kept in force for at least one (1) year after the date of final completion. Coverages shall have at least the following limits: General Aggregate $2,000,000 Products -Completed Operations Aggregate $1,000,000 Personal and Advertising Injury $1,000,000 Each Occurrence $1,000,000 Fire Damage $ 50,000 2) ADDITIONAL insured ALL POLICIES (Except for Workman's Compensation/Employers Liability) will name CALHOUN COUNTY as an additional insured for all insurance requirements, by policy endorsement, along with COUNTY's Employees and OWNER's Engineer (G&W Engineers, Inc.) as ADDITIONAL INSURED and must provide coverage to the maximum extent permitted by law. The additional insured endorsements shall be on the ISO CG2010 11185 form or CG 2010 (10/93) in combination with CG 2037 of CG 2033, or suitable form equivalent. 3) Automobile Liability CONTRACTOR shall have (or purchase) and shall maintain in force, for the duration of the Work, coverage cars and trucks owned, rented, hired, or leased, and others of non -ownership nature used by employees in and around or in connection with the particular Contract. Coverage shall have at least the following limit Combined Single Limit $1,000,000 4) Builders Risk Insurance CONTRACTOR shall have (or purchase) and shall maintain in force during the duration of the Work, coverage for, but not limited to, fire, lightning, windstorm, tornado, hurricane, and hail. Coverage shall be in the amount of 100 percent complete value basis on the insurable portions of the project for the benefit of OWNER, CONTRACTOR, and all subcontractors, as their interests may appear. 5) Deductible No deductible on any coverage in excess of $500.00 per occurrence is acceptable. 6) In the event OWNER is notified of cancellation of all or any part, OWNER may stop all Work on the Contract or secure insurance at its will and charge CONTRACTOR the cost thereof deducting the cost from CONTRACTOR's funds. (c) Proof of Insurance: The Contractor shall furnish the County with certificates showing the type, amount, class of operations covered, effective dates and date of expiration of policies. Such certificates shall also contain substantially the following statement: "The insurance covered by this certificate will not be canceled or materially altered, except after ten (10) days written notice has been received by the County." 27. Warranty of Title No material, supplies, or equipment to be installed or furnished under this Contract shall be purchased subject to any chattel mortgage or under a conditional sale, lease -purchase or other agreement by which an interest is retained by the seller or supplier. The Contractor shall warrant good title to all materials, supplies, and equipment installed or incorporated in the work and upon completion of all work, shall deliver the same, together with all improvements and appurtenances constructed or placed by Contractor, to the County free from any claims, liens, or charges. Neither the Contractor nor any person, firm, or corporation furnishing any material or labor for any work covered by this Contract shall have any right to a lien upon any improvement or appurtenance. Nothing contained in this paragraph, however, shall defeat or impair the right of persons furnishing materials or labor to recover under any law permitting such persons to look to funds due the Contractor. The provisions of this paragraph shall be inserted in all subcontracts and material contracts and notice of its provisions shall be given to all persons furnishing materials for the work when no formal contract is entered into for such materials. 28. Warranty of Workmanship and Materials Neither the final certificate of payment nor any provision in the Contract nor partial or entire use of the improvements included in this Contract by the County or the public shall constitute an acceptance of work not done in accordance with the Contract or relieve the Contractor of liability in respect to any express warranties or responsibility for faulty materials or workmanship. The Contractor shall promptly remedy any defects in the work and pay for any damage to other work resulting therefrom which shall appear within a period of N 21 months from the date of final acceptance of the work. 29. Job Offices (a) The Contractor and its subcontractors may maintain such office and storage facilities on the site as are necessary for the proper conduct of the work. These shall be located so as to cause no interference to any work to be performed on the site. The County shall be consulted with regard to locations. (b) Upon completion of the improvements, or as directed by the County, the Contractor shall remove all such temporary structures and facilities from the site, and leave the site of the work in the condition required by the Contract. 30. Partial Use of Site Improvements The County may give notice to the Contractor and place in use those sections of the improvements which have been completed, inspected and can be accepted as complying with the technical specifications and if in its opinion, each such section is reasonably safe, fit, and convenient for the use and accommodation for which it was intended, provided: (a) The use of such sections of the Improvements shall in no way impede the completion of the remainder of the work by the Contractor. (b) The Contractor shall not be responsible for any damages or maintenance costs due directly to the use of such sections. 31. Contract Documents and Drawings The County will furnish the Contractor without charge 31 copies of the Contract Documents, including Technical Specifications and Drawings. Additional copies requested by the Contractor will be furnished at cost. 32. Contract Period The work to be performed under this contract shall commence within the time stipulated by the County in the Notice to Proceed, and shall be fully completed within calendar days thereafter. 33. Liquidated Damages Since the actual damages for any delay in completion of the work under this contract are impossible to determine, the Contractor and his Sureties shall be liable for and shall pay to the County the sum of five hundred dollars ($ 500, as fixed, agreed and liquidated damages for each calendar day of delay from the above stipulated time for completion. ADMINISTRATIVE REQUIREMENTS 34. Local Program Liaison For purposes of this Agreement, the County Engineer or equivalent authorized person will serve as the Local Program Liaison and primary point of contact for the Contractor. All required progress reports and communication regarding the project shall be directed to this liaison and other local personnel as appropriate. 35. Access to Information (a) The U.S. Department of Housing and Urban Development (HUD), Inspectors General, the Comptroller General of the United States, the General Land Office (GLO), and the County, or any of their authorized representatives, shall have access to any documents, papers, or other records of the Contractor which are pertinent to the CDBG-MIT award, in order to make audits, examinations, excerpts, and transcripts, and to closeout the County's CDBG-MIT contract with GLO. 2 CFR 200.336 (former 24 CFR 85.36(i)(10)) The Office of the Comptroller General of the United States, the Government Accountability Office, the Office of Inspector General, or any authorized representative of the U.S. Government shall also have this right of inspection. (b) Contractor shall include the substance of this clause in all subcontracts it awards. 36. Records Retention (a) The Contractor shall retain all required records for three years after the County makes its final payment and all pending matters are closed. 2 CFR 200.333 (former 24 CFR (85.36(i)(11)) (b) Contractor shall include the substance of this clause in all subcontracts it awards. FEDERAL REQUIRMENTS 37. Resolution of Program Non -Compliance and Disallowed Costs In the event of any dispute, claim, question, or disagreement arising from or relating to this Contract, or the breach thereof, including determination of responsibility for any costs disallowed as a result of non-compliance with federal, state or CDBG- MIT program requirements, the parties hereto shall use their best efforts to settle the dispute, claim, question or disagreement. To this effect, the parties shall consult and negotiate with each other in good faith within 30 days of receipt of a written notice of the dispute or invitation to negotiate, and attempt to reach a just and equitable solution satisfactory to both parties. If the matter is not resolved by negotiation within 30 days of receipt of written notice or invitation to negotiate, the parties agree first to try in good faith to settle the matter by mediation administered by the American Arbitration Association under its Commercial Mediation Procedures before resorting to arbitration, litigation, or some other dispute resolution procedure. The parties may enter into a written amendment to this Contract and choose a mediator that is not affiliated with the American Arbitration Association. The parties shall bear the costs of such mediation equally. [This section may also provide for the qualifications of the mediator(s), the locale of meetings, time limits, or any other item of concern to the parties.] If the matter is not resolved through such mediation within 60 days of the initiation of that procedure, either party may proceed to file suit. 38. Compliance with Davis -Bacon Act All laborers and mechanics employed upon the work covered by this Contract shall be paid unconditionally and not less often than once each week, and without subsequent deduction or rebate on any account (except such payroll deductions as are made mandatory by law and such other payroll deductions as are permitted by the applicable regulations issued by the Secretary of Labor, United States Department of Labor, pursuant to the Anti -Kickback Act hereinafter identified), the full amount due at time of payment computed at wage rates not less than those contained in the wage determination decision of said Secretary of Labor (a copy of which is attached in Section 3, Item 24 and herein incorporated by reference), regardless of any contractual relationship which may be alleged to exist between the Contractor or any subcontractor and such laborers and mechanics. All laborers and mechanics employed upon such work shall be paid in cash, except that payment may be by check if the employer provides or secures satisfactory facilities approved by the County for the cashing of the same without cost or expense to the employee. For the purpose of this clause, contributions made or costs reasonably anticipated under Section 1 (b) (2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of Section 5.5 (a) (1) (iv) of Title 29, Code of Federal Regulations. Also for the purpose of this clause, regular contributions made or costs incurred for more than a weekly period under plans, funds, or programs, but covering the particular weekly period, are deemed to be constructively made or incurred during such weekly period. The Contractor and its subcontractors shall not, by any means, induce any person employed in the construction, completion, or repair of public work, give up any part of the compensation to which he or she is otherwise entitled. The County must report all suspected or reported violations to GLO. 39. Conflicts of Interest (a) Governing Body. No member of the governing body of the County and no other officer, employee, or agent of the County, who exercises any functions or responsibilities in connection with administration, construction, engineering, or implementation of CDBG-MIT award between GLO and the County, shall have any personal financial interest, direct or indirect, in the Contractor or this Contract; and the Firm shall take appropriate steps to assure compliance. (b) Other Local Public Officials. No other public official, who exercises any functions or responsibilities in connection with the planning and carrying out of administration, construction, engineering or implementation of the CDBG-MIT award between GLO and the County, shall have any personal financial interest, direct or indirect, in the Contractor or this Contract; and the Contractor shall take appropriate steps to assure compliance. (c) The Contractor and Employees. The Contractor warrants and represents that it has no conflict of interest associated with the CDBG-MIT award between GLO and the County or this Contract. The Contractor further warrants and represents that it shall not acquire an interest, direct or indirect, in any geographic area that may benefit from the CDBG-MIT award between GLO and the County or in any business, entity, organization or person that may benefit from the award. The Contractor further agrees that it will not employ an individual with a conflict of interest as described herein. 40. Debarment and Suspension (Executive Orders 12549 and 12689 The Contractor certifies, by entering into this Contract, that neither it nor its principals are presently debarred, suspended, or otherwise excluded from or ineligible for participation in federally -assisted programs under Executive Orders 12549 (1986) and 12689 (1989). The term "principal" for purposes of this Contract is defined as an officer, director, owner, partner, key employee, or other person with primary management or supervisory responsibilities, or a person who has a critical influence on or substantive control over the operations of the Contractor. The Contractor understands that it must not make any award or permit any award (or contract) at any tier to any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension." A contract award (see 2 CFR 180.220) must not be made to parties listed on the government -wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. 2 CFR 200 APPENDIX II (H) 41. (For Contracts that exceed $100,0001 Byrd Anti -Lobbying Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award of $100,000 or more must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non -Federal award. Contractor shall file the required certification: 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 of this 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. 2 CFR 200 APPENDIX 11 (1) and 24 CFR §570.303 42. (For Contracts > $100K1 Overtime Requirements No Contractor or subcontractor contracting for any part of the Contract work which may require or involve the employment of laborers or mechanics, including watchmen and guards, shall require or permit any laborer or mechanic in any workweek in which he is employed on such work to work in excess of 40 hours in such work week unless such laborer or mechanic receives compensation at a rate not less than one and one-half times his basic rate of pay for all hours worked in excess of 40 hours in such work week, as the case may be. 2 CFR 200 APPENDIX 11 (E) 43. Equal Opportunity Clause Comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§16811683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.§794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other non- discrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, 0) the requirements of any other nondiscrimination statute(s) which may apply. During the performance of this contract, the Contractor agrees as follows: (a.) The Contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The Contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. (b.) The Contractor will, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive considerations for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. (c.) The Contractor will not discourage or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. (d.) The Contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. (e.) The Contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, "Equal Employment Opportunity," and of the rules, regulations, and relevant orders of the Secretary of Labor. (f.) The Contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (g.) In the event of the Contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. (h.) The Contractor will include the portion of the sentence immediately preceding paragraph (a) and the provisions of paragraphs (a) through (h) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The Contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, That in the event a Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency the Contractor may request the United States to enter into such litigation to protect the interests of the United States. 41 CFR §60-1.4(b) And 2 CFR 200 APPENDIX II (C) 44. Section 109 of the Housing and Community Development Act of 1974. The Contractor shall comply with the provisions of Section 109 of the Housing and Community Development Act of 1974. No person in the United States shall on the ground of race, color, national origin, religion, or sex be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with funds made available under this title. 45. Davis -Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non -Federal entities must include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. The non -Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non - Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. 2 CFR 200 APPENDIX II (D) 46. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non -Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. 2 CFR 200 APPENDIX II (E) 47. Section 504 Rehabilitation Act of 1973, as amended. The Contractor agrees that no otherwise qualified individual with disabilities shall, solely by reason of his/her disability, be denied the benefits of, or be subjected to discrimination, including discrimination in employment, under any program or activity receiving federal financial assistance. 48. Age Discrimination Act of 1975 The Contractor shall comply with the Age Discrimination Act of 1975 which provides that no person in the United States shall on the basis of age be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. 49. Non Segregated Facilities The Contractor certifies that he does not and will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not and will not permit his employees any segregated facilities at any of his establishments, or permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. As used in this paragraph the term "segregated facilities" means any waiting rooms, work areas, rest rooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, or otherwise. 50. The Provision of Local Training Employment and Business Opportunities (a) To the greatest extent feasible opportunities for training and employment be given lower income residents of the project area and contracts for work in connection with the project be awarded to business concerns which are located in, or owned in substantial part by persons residing in the area of the project. See also GLO Section 3 Policy and "Exhibit G" on the GLO-DR website. (b) The Contractor will include this clause in every subcontract for work in connection with the project. 51. [If this Contract is greater than $100,0001 Economic Opportunities for Section 3 Residents and Section 3 Business Concerns. (a) The work to be performed under this Contract is subject to the requirements of section 3 of the Housing and Urban Development (HUD) Act of 1968, as amended, 12 U.S.C. 1701u (section 3). The purpose of section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD -assisted projects covered by section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. (b) The parties to this Contract agree to comply with HUD's regulations in 24 CFR part 135, which implement section 3. As evidenced by their execution of this Contract, the parties to this Contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. (c) The Contractor agrees to send to each labor organization or representative of workers with which the Contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the Contractor's commitments under this section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. (d) The Contractor agrees to include this section 3 clause in every subcontract subject to compliance with regulations in 24 CFR part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The Contractor will not subcontract with any subcontractor where the Contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR part 135. (e) The Contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the Contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be directed, were not filled to circumvent the Contractor's obligations under 24 CFR part 135. (f) Noncompliance with HUD's regulations in 24 CFR part 135 may result in sanctions, termination of this Contract for default, and debarment or suspension from future HUD assisted contracts. (g) With respect to work performed in connection with section 3 covered Indian housing assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this Contract. Section 7(b) requires that to the greatest extent feasible (i) preference and opportunities for training and employment shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of section 3 and section 7(b) agree to comply with section 3 to the maximum extent feasible, but not in derogation of compliance with section 7(b). 24 CFR §135.38 52. Gender Neutral - Gender References When necessary, unless the context clearly requires otherwise, any gender -specific or gender -neutral term in this Contract (for example, he, she, it, etc.) is to be read as referring to any other gender or to no gender. 53. Patent Riahts and Inventions Contractor shall comply with the requirements and regulations pertaining to patent rights with respect to any discovery or invention which arises or is developed in the course of or under such contract. (2 CFR 200 Appendix II (f) and Rights to Inventions in 37 CFR Part 401). Rights to Inventions Made Under a Contract or Agreement - If the Federal award meets the definition of "funding agreement" under 37 CFR §401.2 (a) and the Subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that "funding agreement," the Subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. 54. Enerov Efficienc The Contractor shall comply with the mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (42 U.S.C. 6201). (2 CFR 200 Appendix II (h)). 55. System for Award Management (SAM) All contractors and subcontractors must be searched AND cleared (not suspended or debarred) prior to authorization to work on the project. 56. Solid Waste Disposal Act Contractor must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. 57. Procurement of Recovered Materials (a) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA- designated items unless the product cannot be acquired- 1. Competitively within a timeframe providing for compliance with the contract performance schedule; 2. Meeting contract performance requirements; or 3. At a reasonable price. (c) Information about this requirement, along with the list of EPA -designate items, is available at EPA's Comprehensive Procurement Guidelines web site, httos://www.er)a.gov/ 58. Domestic Preference a. As appropriate and to the extent consistent with law, Contractor should, to the greatest extent practicable, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). b. For purposes of section (a) above i. "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. ii. "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer -based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. STATE REQUIREMENTS 58. Verification No Bovcott Israel As required by Chapter 2270, Government Code, CONTRACTOR hereby verifies that it does not boycott Israel and will not boycott Israel through the term of this Agreement. For purposes of this verification, "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. 59. Foreian Terrorist Oraanizations Pursuant to Chapter 2252, Texas Government Code, [Company] represents and certifies that, at the time of execution of this Agreement neither [Company], nor any wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of the same (i) engages in business with Iran, Sudan, or any foreign terrorist organization as described in Chapters 806 or 807 of the Texas Government Code, or Subchapter F of Chapter 2252 of the Texas Government Code, or (ii) is a company listed by the Texas Comptroller of Public Accounts under Sections 806.051, 807.051, or 2252.153 of the Texas Government Code. The term "foreign terrorist organization" in this paragraph has the meaning assigned to such term in Section 2252.151 of the Texas Government Code. ENVIRONMENTAL CONDITIONS 60. [For Contracts > $150K1 Clean Air Act and the Federal Water Pollution Control Act The Contractor or subcontractor shall comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). 2 CFR 200 APPENDIX 11 (G) 61. Lead -Based Paint The Subrecipient agrees that any construction or rehabilitation of residential structures with assistance provided under this Agreement shall be subject to HUD Lead -Based Paint Regulations at 24 CFR 570.608, and 24 CFR Part 35, Subpart B. Such regulations pertain to all CDBG-assisted housing and require that all owners, prospective owners, and tenants of properties constructed prior to 1978 be properly notified that such properties may include lead -based paint. Such notification shall point out the hazards of lead -based paint and explain the symptoms, treatment and precautions that should be taken when dealing with lead -based paint poisoning and the advisability and availability of blood lead level screening for children under seven. The notice should also point out that if lead -based paint is found on the property, abatement measures may be undertaken. The regulations further require that, depending on the amount of Federal funds applied to a property, paint testing, risk assessment, treatment and/or abatement may be conducted. 62. Flood Disaster Protection In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 U.S.C. 4001), the Subrecipient shall assure that for activities located in an area identified by the Federal Emergency Management Agency (FEMA) as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained as a condition of financial assistance for acquisition or construction purposes (including rehabilitation). 63. Other Conditions Any special conditions such as mitigation measures will be carried out as instructed by the Environmental Review Record. Enter Mitigation Measures from County Environmental Review Record as applicable 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 orto any official or employee of Calhoun County priorto 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, RFQ$, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ, and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ and/or Contract will specify the date and time due. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ, and/or Contract is received and the time 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, RFO, 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, FeclEx 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. Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ, and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFQ and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendor's performance under this Bid, RFP, RFQ and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes 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 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 anytime to inspect said premises. Testing. Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the 'Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ, and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the 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. 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 Countytaxes 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 far the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 84`h 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. 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_form 1295. 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. Govern menfa ransparft ency is ffie—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 theirsigned 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, RFC, and/or Contract submission and the time of execution of the Bid, RFP, RFC, 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 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 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 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. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFC, 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, RFC, 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, RFO, and/or Contractwith 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 of the company, corporation, firm, partnership, or individual contractingwith 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/vendors current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFO, 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, RFO, 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, RFO, and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFO, and/or Contract. o General Liability ($100,000/$300,000 or greater) o Workers' Compensation (at Statutory Limits) o Employers 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 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, 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, 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 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 notify the protesting partyto provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, 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 If 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. 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 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, log in and proceed with the process or if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2. Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only". 3. The Respondent or an authorized agent of the Respondent must sign 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, Contract or 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 RFC, 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". 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. 4 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 tyk o identify the contract, and provide a description of the services, goods, or other property to be provided e contract. V 4 City, State, Country :Nature of Interest (check applicable) Name of Interested Party (place of business) ♦ Controlling Intermediary 5 ❑Check only if there' 1 terested Party. 6 UNSWORN DECyLt@ N My name is �`` , and my date of birth is My addre:�� , (street) (city) (state) (zip code) (country) ,der penalty of perjury that the foregoing is true and correct. *'S 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 Revised 12/2212017 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. MINORITY/FEMALE GOALS AND TIMETABLES The female employment goal is effective as of April 1980 and is currently 6.9%. The percentages for minority participation in Texas are: Texarkana Area: Texarkana & Bowie Co. 19.7 Non-MSA Counties of Camp, Cass, Lamar, Morris, Red River & Titus 20.2 Tyler -Longview Area: Longview, Gregg Co. & Harrison Co. 22.8 Tyler & Smith Co. 23.5 Non-MSA Counties of Anderson, Angelina, Cherokee, Henderson, Marion, Nacogdoches, Panola, 22.5 Rusk, San Augustine, Shelby, Upshur & Wood Beaumont -Port Arthur Area: Beaumont, Port Arthur, Orange, Hardin Co., Jefferson Co., & Orange Co. 22.6 Non-MSA Counties of Jasper, Houston, Newton, Sabine, & Tyler 22.6 Houston Area: Bryan, College Station & Brazos Co. 23.7 Galveston, Texas City & Galveston Co. 28.9 Houston, Brazoria Co., Fort Bend Co., Harris Co., Liberty Co., Montgomery Co. & Waller Co. 27.3 Non-MSA Counties of Austin, Burleson, Calhoun, Chambers, Colorado, DeWitt, Fayette, Goliad, 27.4 Grimes, Jackson, Lavaca, Leon, Madison, Matagorda, Polk, Robertson, San Jacinto, Trinity, Victoria, Walker, Washington, & Wharton Austin Area: Austin, Hays Co., Travis Co., & Williamson Co. 24.1 Non-MSA Counties of Bastrop, Blanco, Burnet, Caldwell, Lee & Llano 24.2 Waco- Killeen, Temple Area Killeen, Temple, Bell Co. & Coryell Co. 16.4 Waco & McLennan Co. 20.7 Non-MSA Counties of Bosque, Falls, Freestone, Hamilton, Hill, Lampasas, Limestone, Milam & Mills 18.6 Dallas, Fort Worth Area: Dallas, Fort Worth, Collin Co., Dallas Co., Denton Co., Ellis Co., Hood Co., Johnson Co., Kaufman 18.2 Co., Parker Co., Rockwall Co., Tarrant Co. & Wise Co. Sherman, Denison & Grayson Co. 9.4 Non-MSA Counties of Cooke, Delta, Erath, Fannin, Franklin, Hopkins, Hunt, Jack, Montague, 17.2 Navarro, Palo Pinto, Rains, Somervell, & Van Zandt Wichita Falls Area: Wichita Falls, Clay Co. & Wichita Co. 12.4 Non-MSA Counties of Archer, Baylor, Cottle, Foard, Hardeman, Wilbarger & Young 11.0 Abilene Area: Abilene, Callaghan Co., Jones Co. & Taylor Co. 11.6 Non-MSA Counties of Brown, Coleman, Comanche, Eastland, Fisher, Haskell, Kent, Knox, Mitchell, 10.9 Nolan, Scurry, Shackleford, Stephens, Stonewall & Throckmorton San Angelo Area: San Angelo & Tom Green Co. 19.2 Non-MSA Counties of Coke, Concho, Crockett, Irion, Kimble, McCullough, Mason, Menard, Reagan, 20.0 Runnels, San Saba, Schleicher, Sterling, Sutton & Terrell San Antonio Area: Laredo & Webb Co. 87.3 San Antonio, Bexar Co., Comal Co. & Guadalupe Co. 47.8 Non-MSA Counties of Atascosa, Bandera, Dimmit, Edwards, Frio, Gillespie, Gonzales, Jim Hogg, 49.4 Karnes, Kendall, Kerr, Kinney, La Salle, McMullen, Maverick, Medina, Real, Uvalde, Val Verde, Wilson, Zapata & Zavala Corpus Christi Area: Corpus Christi, Nueces Co. & San Patricio Co. 41.7 Non-MSA Counties of Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak & 44.2 Refugio Brownsville, McAllen, Harlingen Area: Brownsville, Harlingen, San Benito & Cameron Co. 71.0 McAllen, Pharr, Edinburg & Hidalgo Co. 72.8 Non-MSA Counties of Starr & Willacy 72.9 Odessa, Midland Area Midland & Midland Co. 19.1 Odessa & Ector Co. 15.1 Non-MSA Counties of Andrews, Crane, Glasscock, Howard, Loving, Martin, Pecos, Reeves, Upton, 18.9 Ward & Winkler El Paso Area: El Paso & El Paso Co. 57.8 Non-MSA Counties of Brewster, Culbertson, Hudspeth, Jeff Davis & Presidio 49.0 Lubbock Area: Lubbock & Lubbock Co. 19.6 Non-MSA Counties of Bailey, Borden, Cochran, Crosby, Dawson, Dickens, Floyd, Gaines, Garza, 19.5 Hale, Hockley, King, Lamb, Lynn, Motley, Terry & Yoakum Amarillo Area: Amarillo, Potter Co. & Randall Co. 9.3 Non-MSA Counties of Armstrong, Briscoe, Carson, Castro, Childress, Collingsworth, Dallam, Deaf 11.0 Smith, Donley, Gray, Hall, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Parmer, Roberts, Sherman, Swisher, & Wheeler Federal Labor Standards Provisions U.S. Department of Housing and Urban Development Office of Davis -Bacon and Labor Standards A. APPLICABILITY The Projector Program to which the construction work covered by this Contract pertains is being assisted by the United States of America, and the following Federal Labor Standards Provisions are Included In this Contract pursuant to the provisions applicable to such Federal assistance. (1) MINIMUM WAGES (i) All laborers and mechanics employed or working upon the site of the work will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account (exceptsuchpayroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR Part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereat) due at time of payment, computed at rates not less than those contained In the wage determination of the Secretary of Labor (which is attached hereto and made a part hereof), regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made orcosts reasonably anticipated for bona fide fringe benefits under Section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subjectto the provisions of 29 CFR 55(a)(1)(iv); also, regular contributions made or costs Incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs, which cover the particular weekly period, are deemed to be constructively made or incurred duringsuch weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics performingwork In more than one classification may be compensated at the rate specified for each classification for the time actually worked therein; Provided, that the employer's payroll records accuratelyset forth the time spent in eachclassification in which work is performed. The wage determination (including any additional classification and wage rates conformed under 29 CFR 5.5(a)(1)(10 and the Davis -Bacon poster (WH1321)) shall be pasted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place, where It can be easily seen by the workers. (II) Additional Classifications, (A) Any class of laborers or mechanics which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. HUD shall approve an additional classification and wage rate and fringe benefits therefor only when the following criteria have been met: (1) The work to be performed by the classification requested is not performed by a classification in the wage determination; (2) The classification is utilized in the area by the construction industry; and (3) The proposed wage rate, Including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (B) If the contractor, the laborers and mechanics to be employed In the classification (If known), or their representatives, and HUD or its designee agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), a report of the action taken shall be sent by HUD or its designee to the Administrator of the Wage and Hour Division ("Administrator"), Employment standards Administration, U.S. Department of Labor, Washington, D.C. 20210.. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise HUD of its designee or will notify HUD or Its designee within the 30-day period that additional time Is necessary. (Approved by the Office of Management and Budget ("OMB") under OMB control number 1235-0023.) (C) In theevent the contractor, the laborers or mechanics to be employed in the classification or their representatives, or HUD or its designee do notagree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), HUD or Its designee shall refer the questions, including the views of all interested parties and the recommendation of HUD or its designee, to the Administrator for determination. The Administrator, or an authorized representative, will Issue a determination within 30 days of receiptand so advise HUD or its designee or will notify HUD or its designee within the 30-day period that additional time is necessary. (Approved by the Office of Management and Budget under OMB Control Number 1235-0023.) form HUD-4010 (07/2021) Previous editions are obsolete Page 1 of5 ref. Handbook 1344.1 (D) The wage rate (including fringe benefits, where appropriate) determined pursuant to subparagraphs (1)(11)(8) or (C) of this paragraph, shall be paid toall workers performing work In the classification under this Contract from the first day on which work is performed in the classification. (iii) Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which Isnot expressed as an hourly rate, the contractor shall efther pay thebeneflt as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. (iv) If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona tide fringe benefits under a plan or program, Provided, that the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. (Approved by the OfficeofManagement and Budget under OMB Control Number 1235.0023.) (2) Withholding.. HUD or its designee shall, upon Its own action or upon written request of an authorized representative of the U.S. Department of Labor, withhold or cause to be withheld from the contractor under this contractor any other Federal contract with the same prime contractor, or any other Federally -assisted contract subject to Davis -Bacon prevailing wage requirements which Is held by the same prime contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee or helper, employed or working on the site of the work, all or part of the wages required by the contract, HUD or Its designee may, afterwrltten notice to the contractor, sponsor, applicant, or owner, take such action as maybe necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. HUD or its designee may, after written notice to the contractor, disburse such amounts withheld for and on account of the contractor or subcontractor to the respective employees to whom they are due. The Department of Labor shall make such disbursements in the case of direct Davis -Bacon Act contracts. (3) Payrolls and basic records. (1) Maintaining Payroll Records. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification(s), hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in Section 1(b)(2)(8) of the Davis -Bacon Act), dally and weekly number of hours worked, deductions made, and actual wages paid. Whenever the Secretary of Labor has found, under 29 CFR 5.5(a)(1)(iv), that the wages of any laborer or mechanic Include the amount of any costs reasonably anticipated in providing benefits under a plan or program described In Section 1(b)(2)(B) of the Davis -Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred In providing such benefts.. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. (Approved by the Office of Management and Budget under OMB Control Numbers 1235-0023 and 1215-0018) ((I) Certified Payroll Reports. (A) The.contractor shall submit weekly, foreach week in which any contract work is performed, a copy of all payrolls to HUD or its designee If the agency is a party to the contract, but if the agency is not such a party, the contractor will submit the payrolls to the applicant sponsor, or owner, as the case may be, for It to HUD or Its designee. The payrolls submitted shall setout accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(I), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead, the payrolls only need to include an individually identifying number for .each employee (e.g., the last four digits of the employee's social security number). The required weekly payroll information may be submitted in any form desired. Optional Form WH-347 is available for thispurpose from the Wage and Hour Division Web site at https;//www,dol.gov/agencies/whd/forms or Its successor site. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. form HUD-4010 (07/2021) Previous editions are obsolete Page 2 of 5 ref. Handbook 1344.1 Contractors and subcontractors shall maintain the full social security number and current address of each covered worker,and shall provide them upon request to HUD or Its designee If the agency is a parry to the contract, but If the agency is not such a party, the contractor will submit the payrolls to the applicant sponsor, or owner, as the casemaybe, for transmission to HUD or Its designee, the contractor, or the Wage and Hour Division of the U.S. Department of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this subparagraph for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to HUD a its designee, (Approved by the Office of Management and Budget under OMB Control Number 1235-0008.) (B) Each payroll submitted shall be accompanied by a "Statementof Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the personsemployed under the contract and shall certify the following: (1). That the payroll for the payroll period contains the information required to be provided under 29 CFR S.S(a)(3)(li), the appropriate information is being maintained under 29 CFR 5.5(a)(3)(i), and thatsuch information is correct and complete; (2). Thateach laborer or mechanic (Including each helper, apprentice, and trainee) employed on the contract duringthe payroll period has been paid the full weekly wages earned, without rebate, eitherdirecdy or Indirectly, and thatno deductions have been made either directly or indirectly from the full wages earned,. other than permissible deductions as set forth in 29 CFR Part 3; (3) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified In the applicable wage determination Incorporated into the contract; and (C) Theweeklysubmission of a properly executed certification set forth on the reverse side of Optional Form WH347 shall satisfy the requirement for submission of the "Statement of Compliance" requiredby subparagraph (a)(3)(ii)(b). (u) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under Section 1001 of Title 18 and Section 3729of Title 31 of the United States Code. (III) The contractor or subcontractor shall make the records required under subparagraph (a)(3)(1) available for Inspection, copying,. or transcription by authorized representatives of HUD or its designee or the U.S. Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available, HUD or Its designee may, after written notice to the contractor, sponsor, applicant, or owner, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. (4) Apprentices and trainees. (i) Apprentices. Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor,. Employmentand Training Administration, Office of Apprenticeship Training, Employer and Labor Services, orwith a State Apprenticeship Agency recognized by the Office, or if aperson is employed in his or liar first 90days of probationary employment as an apprentice in such an apprenticeship program, who Is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency (where appropriate), to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices tojourneymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate,who is notregistered or otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted Linder the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing construction on project In a locality other than that In which its program is registered, the ratios and wage rates (expressed In percentages of thejourneyman's hourly rate)specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice mustbe paid at not less than the rate. specified In the registered program for the apprentice'slevel of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits In accordance with the provisions of the apprenticeship program, _ form HUD-4010 (07/2021) Previous editions are obsolete Page 3 of 5 ref. Handbook 1344.1 If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed an the wage determination for the applicable classification, If the Ad mintstrator determines that a different practice prevails for the applicable apprentice classification, fringe benefits shall be paid In accordance with that determination. In the event the Office of Apprenticeship Training,. Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved; III) Trainees. Except as provided in 29 CPR 5.16, trainees will not bepermitted to work at less than the predetermined rate for the work performed, unless they are employed pursuant to and individually registered In a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on thejob site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at notless than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed an the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wagerate on the wagedetermination which provides for less than full fringe benefits for apprentices. Any employee listed an the payroll at trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than theapplicablewage rate on the wage determination for the work actually performed. In addition, any trainee performing work on the job site In excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate onthe wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program Is approved. (111) Equal employment opportunity. The utilization of apprentices, trainees, and journeymen under 29 CPR Part.5 shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CPR Part 30. (5) Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CPR Part 3, which are incorporated by reference in this Contract. (6) Subcontracts. The contractor or subcontractor will insert in any subcontracts the clauses contained In subparagraphs(1) through (11) in this paragraph (a) and such other clauses as HUD or its designee may, by appropriate instructions, require, and a copy of the applicable prevailing wage decision, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in this paragraph. (7) Contract termination; debarment. A breach of the contract clauses in 29 CFR 5.5 maybe grounds for termination of the contractand for debarment as a contractor and a subcontractor as provided in 29 CPR 5.12. (8) Compliance with Davis -Bacon and Related Act Requirements. All rulings and Interpretations of the DaVls-Bacon and Related Acts contained in 29 CPR Parts 1, 3, and 5 are herein incorporated by reference in this Contract. (9) Disputes concerning laborstandards. Disputes arising out of the labor standards provisions of this Contract shall notbe subject to the general disputes clause of this Contract. Such disputes shall be resolved in accordance with the procedures of the U.S. Department of Labor set forth in 29 CPR Parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and HUD or its designee, the U.S. Depattmentof Labor, or the employees or their representatives. (10) Certification of Eligibility. O By entering into this Contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an Interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Actor 29 CPR 5.12(a)(1) or to be awarded HUD contracts or participate In HUD programs pursuant to 24 CPR Part 24, form HUD-4010 (07/2021) Previous editions are obsolete Page 4 of 5 ref. Handbook 1344.1 (0) No partof this Contract shall be subcontracted to any person or firm ineligible For award of a Government contract by virtue of Section 3(a) of the Davis -Bacon Actor 29 CFR 5.12(a)(1) or to be awarded HUD contracts or participate in HUD programs pursuant to 24 CFR Part 24. (iii) Anyone who knowingly makes, presents, or submits false, fictitious, or fraudulent statement, representation or certiflcatfon Is subject to criminal, civil and/or administrative sanctions, including fines, penalties, and Imprisonment (e.g., 18 U.S.C. §§ 287, 1001, 1010, 1012, 31. U.S.C. §§ 3729, 3802. (11) Complaints, Proceedings, or Testimony by Employees. No laborer or mechanic, to Whom the wage, salary, or other labor standards provisions of this Contract are applicable, shall be discharged or In any other mennerdiscriininated against by the contractor or any subcontractor because such employee has filed any complaint or instituted or caused to be instituted any proceeding or has testified or is about to testify In any proceeding under or relating to the labor standards apolice till a under this Contract to his employer. B. CONTRACT WORN HOURS AND SAFETY STANDARDS ACT The provisions of this paragraph (b) are applicable where the amount of the prlme contract exceeds $100,000. As used in this paragraph, the terms "laborers" and "mechanics" include watchmen and guards. (1) Overtime requirements. No contractor or subcontractor contractingfor any part of the contract work, which may require or involve the employment of laborers or mechanics, shall require or permit any such laborer or mechanic in any workweek in which the individual Is employed on such work to work in excess of 40 hours in such workweek, unless such laborer or mechanic receivescompensation at a rate not less than one and one-half times the basic rate of Pay for all hours worked in excess of 40 hours in such workweek. see 2e CfR ss 5.8 (at for cunent rate (2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the cidal—set torm in subparagraph B(1) of this paragraph, the contractor, and any subcontractor responsible therefor, shall beaiable for e unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of k done undercontract for theDistrictof Columbia or a territory, to such District or to such territory) for liquidated dam es.Such liquidated damages shall be computed with respect to each individual laborer or mechanic, Includ Ing watchm and guards, employed In violation of the clause set forth In subparagraph B(1) of this paragraph, in the sum 27 r each calendar day on which such individual was required or permitted to work In excess of the standard workwee of 40 hours without payment of theovertime wages required by the clause set forth in subparagraph B(1) of this paragraph. In accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. § 2461 Note); the Department of Labor adjusts this civil monetary penalty for inflation no later than January 15 each year. (3) WRhholdingfor unpaid wages and liquidated damages. HUD or its designee shall, upon its own action or upon written requestof an authorized representative of the U.S- Department of Labor, withhold or cause tohe withheld from any moneys payable on account ofwork performed by the contractor or subcontractor under any such contract, or any other Federal contract with the same prime contract, or any other Federally -assisted contract subject to the Contract Work Hours and Safety Standards Actwhicli is held by the same prime contractor,such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages, as provided in the clause set forth in subparagraph B(2) of this paragraph. (4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in subparagraph B(1) through (4) of this paragraph and also clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in subparagraphs B(1) through (4) of this paragraph. C. HEALTHANDSAFETY The provisions of this paragraph (c) are applicable where the amount of the prime contract exceeds $200,000. (1) Nola borer or mechanie shal I be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his or her health and safety, as determined under construction safety and health standards promulgated by the Secretary of Labor by regulation. (2) The contractor shall comply with all regulations Issued by the Secretary of Labor pursuant to 29 CFR Part 1926 and failure to comply may result In imposition of sanctions pursuant to the Contract Work Hours and Safety Standards Act, (Public Law 91-54, 83 Stat 96), 40 U.S.C. § 3701 at seq. (3) The contractor shall include the provisions of this paragraph in every subcontract, so that such provisionswill be binding on each subcontractor. The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Urban Development or die Secretary of Labor shall direct as a means of enforcing such provisions. Previous editions are obsolete Page 5 of 5 form FIUD-4010 (07/2021) ref. Handbook 1344.1 Title 29: Labor PART 3—CONTRACTORS AND SUBCONTRACTORS ON PUBLIC BUILDING OR PUBLIC WORK FINANCED IN WHOLE OR IN PART BY LOANS OR GRANTS FROM THE UNITED STATES Contents §3.1 Purpose and scope. §3.2 Definitions. §3.3 Weekly statement with respect to payment of wages. §3.4 Submission of weekly statements and the preservation and inspection of weekly payroll records. §3.5 Payroll deductions permissible without application to or approval of the Secretary of Labor. §3.6 Payroll deductions permissible with the approval of the Secretary of Labor. §3.7 Applications for the approval of the Secretary of Labor. §3.8 Action by the Secretary of Labor upon applications. §3.9 Prohibited payroll deductions. §3.10 Methods of payment of wages. §3.11 Regulations part of contract. AUTHORITY: R.S. 161, sec. 2, 48 Stat. 848; Reorg. Plan No. 14 of 1950, 64 Stat. 1267; 5 U.S.C. 301; 40 U.S.C. 3145; Secretary's Order 01-2008; and Employment Standards Order No. 2001-01. SOURCE: 29 FIR 97, Jan. 4, 1964, unless otherwise noted. §3.1 Purpose and scope. This part prescribes "anti -kickback" regulations under section 2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c), popularly known as the Copeland Act. This part applies to any contract which is subject to Federal wage standards and which is for the construction, prosecution, completion, or repair of public buildings, public works or buildings or works financed in whole or in part by loans or grants from the United States. The part is intended to aid in the enforcement of the minimum wage provisions of the Davis -Bacon Act and the various statutes dealing with federally assisted construction that contain similar minimum wage provisions, including those provisions which are not subject to Reorganization Plan No. 14 (e.g., the College Housing Act of 1950, the Federal Water Pollution Control Act, and the Housing Act of 1959), and in the enforcement of the overtime provisions of the Contract Work Hours Standards Act whenever they are applicable to construction work. The part details the obligation of contractors and subcontractors relative to the weekly submission of statements regarding the wages paid on work covered thereby; sets forth the circumstances and procedures governing the making of payroll deductions from the wages of those employed on such work; and delineates the methods of payment permissible on such work. §3.2 Definitions. As used in the regulations in this part: (a) The terms building or work generally include construction activity as distinguished from manufacturing, furnishing of materials, or servicing and maintenance work. The terms include, without limitation, buildings, structures, and improvements of all types, such as bridges, dams, plants, highways, parkways, streets, subways, tunnels, sewers, mains, powerlines, pumping stations, railways, airports, terminals, docks, piers, wharves, ways, lighthouses, buoys, jetties, breakwaters, levees, and canals; dredging, shoring, scaffolding, drilling, blasting, excavating, clearing, and landscaping. Unless conducted in connection with and at the site of such a building or work as is described in the foregoing sentence, the manufacture or furnishing of materials, articles, supplies, or equipment (whether or not a Federal or State agency acquires title to such materials, articles, supplies, or equipment during the course of the manufacture or furnishing, or owns the materials from which they are manufactured or furnished) is not a building or work within the meaning of the regulations in this part. (b) The terms construction, prosecution, completion, or repair mean all types of work done on a particular building or work at the site thereof, including, without limitation, altering, remodeling, painting and decorating, the transporting of materials and supplies to or from the building or work by the employees of the construction contractor or construction subcontractor, and the manufacturing or furnishing of materials, articles, supplies, or equipment on the site of the building or work, by persons employed at the site by the contractor or subcontractor. (c) The terms public building or public work include building or work for whose construction, prosecution, completion, or repair, as defined above, a Federal agency is a contracting party, regardless of whether title thereof is in a Federal agency. (d) The term building or work financed in whole or in part by loans or grants from the United States includes building or work for whose construction, prosecution, completion, or repair, as defined above, payment or part payment is made directly or indirectly from funds provided by loans or grants by a Federal agency. The term includes building or work for which the Federal assistance granted is in the form of loan guarantees or insurance. (e) Every person paid by a contractor or subcontractor in any manner for his labor in the construction, prosecution, completion, or repair of a public building or public work or building or work financed in whole or in part by loans or grants from the United States is employedand receiving wages, regardless of any contractual relationship alleged to exist between him and the real employer. (f) The term any affiliated person includes a spouse, child, parent, or other close relative of the contractor or subcontractor; a partner or officer of the contractor or subcontractor; a corporation closely connected with the contractor or subcontractor as parent, subsidiary, or otherwise, and an officer or agent of such corporation. (g) The term Federal agency means the United States, the District of Columbia, and all executive departments, independent establishments, administrative agencies, and instrumentalities of the United States and of the District of Columbia, including corporations, all or substantially all of the stock of which is beneficially owned by the United States, by the District of Columbia, or any of the foregoing departments, establishments, agencies, and instrumentalities. [29 FIR 97, Jan. 4, 1964, as amended at 38 FIR 32575, Nov. 27, 1973] §3.3 Weekly statement with respect to payment of wages. (a) As used in this section, the term employee shall not apply to persons in classifications higher than that of laborer or mechanic and those who are the immediate supervisors of such employees. (b) Each contractor or subcontractor engaged in the construction, prosecution, completion, or repair of any public building or public work, or building or work financed in whole or in part by loans or grants from the United States, shall furnish each week a statement with respect to the wages paid each of its employees engaged on work covered by this part 3 and part 5 of this title during the preceding weekly payroll period. This statement shall be executed by the contractor or subcontractor or by an authorized officer or employee of the contractor or subcontractor who supervises the payment of wages, and shall be on the back of Form WH 347, "Payroll (For Contractors Optional Use)" or on any form with identical wording. Copies of Form WH 347 may be obtained from the Government contracting or sponsoring agency or from the Wage and Hour Division Web site at http://Www.dol.govlesalwhd/formslwh347instr.htm or its successor site. (c) The requirements of this section shall not apply to any contract of $2,000 or less (d) Upon a written finding by the head of a Federal agency, the Secretary of Labor may provide reasonable limitations, variations, tolerances, and exemptions from the requirements of this section subject to such conditions as the Secretary of Labor may specify. [29 FIR 97, Jan. 4, 1964, as amended at 33 FIR 10186, July 17, 1968; 47 FIR 23679, May 28, 1982; 73 FIR 77511, Dec. 19, 20081 §3.4 Submission of weekly statements and the preservation and inspection of weekly payroll records. (a) Each weekly statement required under §3.3 shall be delivered by the contractor or subcontractor, within seven days after the regular payment date of the payroll period, to a representative of a Federal or State agency in charge at the site of the building or work, or, if there is no representative of a Federal or State agency at the site of the building or work, the statement shall be mailed by the contractor or subcontractor, within such time, to a Federal or State agency contracting for or financing the building or work. After such examination and check as may be made, such statement, or a copy thereof, shall be kept available, or shall be transmitted together with a report of any violation, in accordance with applicable procedures prescribed by the United States Department of Labor. (b) Each contractor or subcontractor shall preserve his weekly payroll records for a period of three years from date of completion of the contract. The payroll records shall set out accurately and completely the name and address of each laborer and mechanic, his correct classification, rate of pay, daily and weekly number of hours worked, deductions made, and actual wages paid. Such payroll records shall be made available at all times for inspection by the contracting officer or his authorized representative, and by authorized representatives of the Department of Labor. (Reporting and recordkeeping requirements in paragraph (b) have been approved by the Office of Management and Budget under control number 1215-0017) [29 FIR 97, Jan. 4, 1964, as amended at 47 FIR 145, Jan. 5, 19821 §3.5 Payroll deductions permissible without application to or approval of the Secretary of Labor. Deductions made under the circumstances or in the situations described in the paragraphs of this section may be made without application to and approval of the Secretary of Labor: (a) Any deduction made in compliance with the requirements of Federal, State, or local law, such as Federal or State withholding income taxes and Federal social security taxes. (b) Any deduction of sums previously paid to the employee as a bona fide prepayment of wages when such prepayment is made without discount or interest. A bona fide prepayment of wages is considered to have been made only when cash or its equivalent has been advanced to the person employed in such manner as to give him complete freedom of disposition of the advanced funds. (c) Any deduction of amounts required by court process to be paid to another, unless the deduction is in favor of the contractor, subcontractor, or any affiliated person, or when collusion or collaboration exists. (d) Any deduction constituting a contribution on behalf of the person employed to funds established by the employer or representatives of employees, or both, for the purpose of providing either from principal or income, or both, medical or hospital care, pensions or annuities on retirement, death benefits, compensation for injuries, illness, accidents, sickness, or disability, or for insurance to provide any of the foregoing, or unemployment benefits, vacation pay, savings accounts, or similar payments for the benefit of employees, their families and dependents: Provided, however, That the following standards are met: (1) The deduction is not otherwise prohibited by law; (2) It is either: (i) Voluntarily consented to by the employee in writing and in advance of the period in which the work is to be done and such consent is not a condition either for the obtaining of or for the continuation of employment, or (ii) provided for in a bona fide collective bargaining agreement between the contractor or subcontractor and representatives of its employees; (3) No profit or other benefit is otherwise obtained, directly or indirectly, by the contractor or subcontractor or any affiliated person in the form of commission, dividend, or otherwise; and (4) The deductions shall serve the convenience and interest of the employee. (e) Any deduction contributing toward the purchase of United States Defense Stamps and Bonds when voluntarily authorized by the employee. (f) Any deduction requested by the employee to enable him to repay loans to or to purchase shares in credit unions organized and operated in accordance with Federal and State credit union statutes. (g) Any deduction voluntarily authorized by the employee for the making of contributions to governmental or quasi - governmental agencies, such as the American Red Cross. (h) Any deduction voluntarily authorized by the employee for the making of contributions to Community Chests, United Givers Funds, and similar charitable organizations. (i) Any deductions to pay regular union initiation fees and membership dues, not including fines or special assessments: Provided, however, that a collective bargaining agreement between the contractor or subcontractor and representatives of its employees provides for such deductions and the deductions are not otherwise prohibited by law. Q) Any deduction not more than for the "reasonable cost" of board, lodging, or other facilities meeting the requirements of section 3(m) of the Fair Labor Standards Act of 1938, as amended, and part 531 of this title. When such a deduction is made the additional records required under §516.25(a) of this title shall be kept. (k) Any deduction for the cost of safety equipment of nominal value purchased by the employee as his own property for his personal protection in his work, such as safety shoes, safety glasses, safety gloves, and hard hats, if such equipment is not required by law to be furnished by the employer, if such deduction is not violative of the Fair Labor Standards Act or prohibited by other law, if the cost on which the deduction is based does not exceed the actual cost to the employer where the equipment is purchased from him and does not include any direct or indirect monetary return to the employer where the equipment is purchased from a third person, and if the deduction is either (1) Voluntarily consented to by the employee in writing and in advance of the period in which the work is to be done and such consent is not a condition either for the obtaining of employment or its continuance; or (2) Provided for in a bona fide collective bargaining agreement between the contractor or subcontractor and representatives of its employees. [29 FIR 97, Jan. 4, 1964, as amended at 36 FIR 9770, May 28, 19711 §3.6 Payroll deductions permissible with the approval of the Secretary of Labor. Any contractor or subcontractor may apply to the Secretary of Labor for permission to make any deduction not permitted under §3.5. The Secretary may grant permission whenever he finds that: (a) The contractor, subcontractor, or any affiliated person does not make a profit or benefit directly or indirectly from the deduction either in the form of a commission, dividend, or otherwise; (b) The deduction is not otherwise prohibited by law; (c) The deduction is either (1) voluntarily consented to by the employee in writing and in advance of the period in which the work is to be done and such consent is not a condition either for the obtaining of employment or its continuance, or (2) provided for in a bona fide collective bargaining agreement between the contractor or subcontractor and representatives of its employees; and (d) The deduction serves the convenience and interest of the employee. §3.7 Applications for the approval of the Secretary of Labor. Any application for the making of payroll deductions under §3.6 shall comply with the requirements prescribed in the following paragraphs of this section: (a) The application shall be in writing and shall be addressed to the Secretary of Labor. (b) The application need not identify the contract or contracts under which the work in question is to be performed. Permission will be given for deductions on all current and future contracts of the applicant for a period of 1 year. A renewal of permission to make such payroll deduction will be granted upon the submission of an application which makes reference to the original application, recites the date of the Secretary of Labor's approval of such deductions, states affirmatively that there is continued compliance with the standards set forth in the provisions of §3.6, and specifies any conditions which have changed in regard to the payroll deductions. (c) The application shall state affirmatively that there is compliance with the standards set forth in the provisions of §3.6. The affirmation shall be accompanied by a full statement of the facts indicating such compliance. (d) The application shall include a description of the proposed deduction, the purpose to be served thereby, and the classes of laborers or mechanics from whose wages the proposed deduction would be made. (e) The application shall state the name and business of any third person to whom any funds obtained from the proposed deductions are to be transmitted and the affiliation of such person, if any, with the applicant. [29 FIR 97, Jan. 4, 1964, as amended at 36 FR 9771, May 28, 19711 §3.8 Action by the Secretary of Labor upon applications. The Secretary of Labor shall decide whether or not the requested deduction is permissible under provisions of §3.6; and shall notify the applicant in writing of his decision. §3.9 Prohibited payroll deductions. Deductions not elsewhere provided for by this part and which are not found to be permissible under §3.6 are prohibited. §3.10 Methods of payment of wages. The payment of wages shall be by cash, negotiable instruments payable on demand, or the additional forms of compensation for which deductions are permissible under this part. No other methods of payment shall be recognized on work subject to the Copeland Act. §3.11 Regulations part of contract All contracts made with respect to the construction, prosecution, completion, or repair of any public building or public work or building or work financed in whole or in part by loans or grants from the United States covered by the regulations in this part shall expressly bind the contractor or subcontractor to comply with such of the regulations in this part as may be applicable. In this regard, see §5.5(a) of this subtitle. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM CONTRACTOR'S CERTIFICATION CONCERNING LABOR STANDARDS AND PREVAILING WAGE REQUIREMENTS TO (appropriate recipient) DATE PROJECT NUMBER (if any) C/O PROJECT NAME The undersigned, having executed a contract with for the construction of the above -identified project, acknowledges that: (a) The Labor Standards provisions are included in the aforesaid contract, (b) Correction of any infractions of the aforesaid conditions, including infractions by any subcontractors and any lower tier subcontractors, is Contractor's responsibility. that: (a) Neither Contractor nor any firm, partnership or association in which it has substantial interest is designated as an ineligible contractor by the Comptroller General of the United States pursuant to Section 5.6(b) of the Regulations of the Secretary of Labor, Part 5 (29 CFR, Part 5) or pursuant to Section 3(a) of the Davis -Bacon Act, as amended. (b) No part of the aforementioned contract has been or will be subcontracted to any subcontractor if such subcontractor or any firm, corporation, partnership or association in which such subcontractor has a substantial interest is designated as an ineligible contractor pursuant to any of the aforementioned regulatory or statutory provisions. Contractor agrees to obtain and forward to the aforementioned recipient within ten days after the execution of any subcontract, including those executed by subcontractors and any lower tier subcontractors, a Subcontractor's Certification Concerning Labor Standards and Prevailing Wage Requirements executed by the subcontractors. 4. Certifies that: (a) The legal name and the business address of the undersigned are: (1) A SINGLE PROPRIETORSHIP 1 (3) A CORPORATION ORGANIZED IN THE STATE OF (2) A PARTNERSHIP 1 (4) OTHER ORGANIZATION (Describe) (e) The names, addresses and trade classifications of all other building construction contractors in which the undersigned has a substantial LIT"W By (Contractor) [INSERT Project Specific Wage Decisionl 3/20/24, 9:57AM SAM.gov "General Decision Number: TX2O240O45 01/05/2024 Superseded General Decision Number: TX20230045 State: Texas Construction Type: Heavy Counties: Aransas, Austin, Calhoun and Goliad Counties in Texas. HEAVY CONSTRUCTION PROJECTS Note: Contracts subject to the Davis —Bacon Act are generally required to pay at least the applicable minimum wage rate required under Executive Order 14026 or Executive Order 13658. Please note that these Executive Orders apply to covered contracts entered into by the federal government that are subject to the Davis —Bacon Act itself, but do not apply to contracts subject only to the Davis —Bacon Related Acts, including those set forth at 29 CFR 5.1(a)(1). ]If the contract is entered 1. Executive Order 14026 linto on or after January 30, 1 generally applies to the 12022, or the contract is 1 contract. 1 [renewed or extended (e.g., an 1. The contractor must pay 1 loption is exercised) on or l all covered workers at 1 lafter January 30, 2022: 1 least $17.20 per hour (or 1 I [ the applicable wage rate 1 I 1 listed on this wage 1 I 1 determination, if it is 1 I 1 higher) for all hours [ I 1 spent performing on the [ 1 l contract in 2024. 1 JIf the contract was awarded onl. Executive Order 13658 for between January 1, 2015 andl generally applies to the 1 1January 29, 2022, and the 1 contract. 1 )contract is not renewed or 1. The contractor must pay alll [extended on or after January 1 covered workers at least 1 130, 2022: 1 $12.90 per hour (or the I I 1 applicable wage rate listed) I 1 on this wage determination,) I 1 if it is higher) for all l I 1 hours spent performing on 1 I 1 I I that contract in 2024. I The applicable Executive Order minimum wage rate will be adjusted annually. If this contract is covered by one of the Executive Orders and a classification considered necessary for performance of work on the contract does not appear on this wage determination, the contractor must still submit a conformance request. Additional information on contractor requirements and worker protections under the Executive Orders is available at http://www.dol.gov/whd/govcontracts. Modification Number Publication Date 0 01/05/2024 https://sam.gov/wage-delemination/TX20240045/0 115 3/20/24,9:57AM SAM.gov SUTX2OO5-023 09/08/2005 Rates Fringes Asphalt Distributor Operator ..... $ 12.57 ** Asphalt paving machine operator .........................$ 11.60 Asphalt Raker ....................$ 10.63 ** Asphalt Shoveler .................$ 9.23 ** Broom or Sweeper Operator ........ $ 9.32 ** Bulldozer operator ...............$ 11.69 ** CARPENTER ........................$ 11.70 ** Concrete Finisher, Paving ........ $ 11.64 ** Concrete Finisher, Structures .... $ 10.23 ** Concrete Rubber ..................$ 9.00 ** Crane, Clamshell, Backhoe, Derrick, Dragline, Shovel Operator .........................$ 12.00 ** Flagger ..........................$ 8.60 ** Form Builder/Setter, Structures .......................$ 10.51 ** Form Setter, Paving & Curb ....... $ 9.48 ** Foundation Drill Operator, Truck Mounted ....................$ 14.58 ** Front End Loader Operator ........ $ 10.62 ** Laborer, common ..................$ 8.91 ** Laborer, Utility .................$ 9.21 ** MECHANIC (Undefined) .............$ 12.18 ** Motor Grader Operator Fine Grade ............................$ 15.15 ** Motor Grader Operator Rough ...... $ 12.95 ** Pavement Marking Machine Operator .........................$ 13.32 ** Pipelayer ........................$ 9.71 ** Roller Operator, Pneumatic, Self —Propelled ...................$ 8.90 ** Roller Operator, Steel Wheel, Flat Wheel/Tamping...............$ 9.30 ** Roller Operator, Steel Wheel, https://sam.gov/wage-deteminadon/TX20240045/0 2/5 3/20/24,9:57AM SAM.gov Plant Mix Pavement ...............$ 10.59 ** Scraper Operator .................$ 9.85 ** Servicer .........................$ 11.18 ** Spreader Box Operator ............ $ 13.00 ** Traveling Mixer Operator ......... $ 12.67 ** Truck Driver Single Axle Heavy ... $ 10.87 ** Truck Driver Single Axle, Light ............................$ 10.85 ** Truck driver, lowboy —Float ....... $ 13.70* Truck Driver, Tandem Axle, Semi —Trailer .....................$ 10.05 ** Work Zone Barricade Servicer..... $ 9.63 ** WELDERS — Receive rate prescribed for craft performing operation to which welding is incidental. ** Workers in this classification may be entitled to a higher minimum wage under Executive Order 14026 ($17.20) or 13658 ($12.90). Please see the Note at the top of the wage determination for more information. Please also note that the minimum wage requirements of Executive Order 14026 are not currently being enforced as to any contract or subcontract to which the states of Texas, Louisiana, or Mississippi, including their agencies, are a party. Note: Executive Order (ED) 13706, Establishing Paid Sick Leave for Federal Contractors applies to all contracts subject to the Davis —Bacon Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2017. If this contract is covered by the ED, the contractor must provide employees with 1 hour of paid sick leave for every 30 hours they work, up to 56 hours of paid sick leave each year. Employees must be permitted to use paid sick leave for their own illness, injury or other health —related needs, including preventive care; to assist a family member (or person who is like family to the employee) who is ill, injured, or has other health —related needs, including preventive care; or for reasons resulting from, or to assist a family member (or person who is like family to the employee) who is a victim of, domestic violence, sexual assault, or stalking. Additional information on contractor requirements and worker protections under the ED is available at https://www.dol.gov/agencies/whd/government—contracts. Unlisted classifications needed for work not included within the scope of the classifications listed may be added after award only as provided in the labor standards contract clauses (29CFR 5.5 (a) (1) (iii)). https://sam.gov/wage-detemination/TX20240045/0 3/5 3/20/24, 9:57AM SAM.gov The body of each wage determination lists the classification and wage rates that have been found to be prevailing for the cited type(s) of construction in the area covered by the wage determination. The classifications are listed in alphabetical order of ""identifiers"" that indicate whether the particular rate is a union rate (current union negotiated rate for local), a survey rate (weighted average rate) or a union average rate (weighted union average rate). Union Rate Identifiers A four letter classification abbreviation identifier enclosed in dotted lines beginning with characters other than ""SU"" or ""UAVG"" denotes that the union classification and rate were prevailing for that classification in the survey, Example: PLUM0198-005 07/01/2014. PLUM is an abbreviation identifier of the union which prevailed in the survey for this classification, which in this example would be Plumbers. 0198 indicates the local union number or district council number where applicable, i.e., Plumbers Local 0198. The next number, 005 in the example, is an internal number used in processing the wage determination. 07/01/2014 is the effective date of the most current negotiated rate, which in this example is July 1, 2014. Union prevailing wage rates are updated to reflect all rate changes in the collective bargaining agreement (CBA) governing this classification and rate. Survey Rate Identifiers Classifications listed under the ""SU"" identifier indicate that no one rate prevailed for this classification in the survey and the published rate is derived by computing a weighted average rate based on all the rates reported in the survey for that classification. As this weighted average rate includes all rates reported in the survey, it may include both union and non —union rates. Example: SULA2012-007 5/13/2014. SU indicates the rates are survey rates based on a weighted average calculation of rates and are not majority rates. LA indicates the State of Louisiana. 2012 is the year of survey on which these classifications and rates are based. The next number, 007 in the example, is an internal number used in producing the wage determination. 5/13/2014 indicates the survey completion date for the classifications and rates under that identifier. Survey wage rates are not updated and remain in effect until a new survey is conducted. Union Average Rate Identifiers Classification(s) listed under the UAVG identifier indicate that no single majority rate prevailed for those classifications; however, 100% of the data reported for the classifications was union data. EXAMPLE: UAVG—OH-0010 08/29/2014. UAVG indicates that the rate is a weighted union average rate. OH indicates the state. The next number, 0010 in the example, is an internal number used in producing the wage determination. 08/29/2014 indicates the survey completion date for the classifications and rates under that identifier. A UAVG rate will be updated once a year, usually in January of each year, to reflect a weighted average of the current negotiated/CBA rate of the union locals from which the rate is based. https://sam.gov/wage-detemination/TX20240045/0 4/5 3/20/24, 9:57AM SAM.gov WAGE DETERMINATION APPEALS PROCESS 1.) Has there been an initial decision in the matter? This can be: * an existing published wage determination * a survey underlying a wage determination * a Wage and Hour Division letter setting forth a position on a wage determination matter * a conformance (additional classification and rate) ruling On survey related matters, initial contact, including requests for summaries of surveys, should be with the Wage and Hour National Office because National Office has responsibility for the Davis —Bacon survey program. If the response from this initial contact is not satisfactory, then the process described in 2.) and 3.) should be followed. With regard to any other matter not yet ripe for the formal process described here, initial contact should be with the Branch of Construction Wage Determinations. Write to: Branch of Construction Wage Determinations Wage and Hour Division U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 2.) If the answer to the question in 1.) is yes, then an interested party (those affected by the action) can request review and reconsideration from the Wage and Hour Administrator (See 29 CFR Part 1.8 and 29 CFR Part 7). Write to: Wage and Hour Administrator U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 The request should be accompanied by a full statement of the interested party's position and by any information (wage payment data, project description, area practice material, etc.) that the requestor considers relevant to the issue. 3.) If the decision of the Administrator is not favorable, an interested party may appeal directly to the Administrative Review Board (formerly the Wage Appeals Board). Write to: Administrative Review Board U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 4.) All decisions by the Administrative Review Board are final. END OF GENERAL DECISION" https://sam.gov/wage-determination/TX20240045/0 515 GLO SIGNAGE REQUIREMENTS All signs shall be placed in a prominent, visible public location at the construction site, and legible from at least three (3) feet distance. Permanent signage is required on any public building or facility funded under this Contract. Please refer to the plans and specifications for further details. For other construction projects (e.g., water transmission lines, sewer collection lines, drainage, roadways, housing rehabilitation) funded under this Contract, temporary signage shall be placed in a prominent location at the construction project site or along a major thoroughfare within the locality. All signage required shall contain the following: "This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Program." 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 Ri Weill 2 161- Go to: https://www.ethics.state.tx.us/File 1. If you have an account, log in and proceed with the process or if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2 Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only". 3. The Respondent or an authorized agent of the Respondent must sign 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. #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 Bid No. 2024.05 — Seadrift Drainage Improvements Project - GLO Contract No. 22-085-014-D245 On #4 and #5, comolete only the one that aoolies to #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". 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 countryof the business.` entity's place of business. 2 Name of governmental entity or state agency that Is a party to the contract for which theform is being filed. f s Provide the identification number used by the governmental entity or state agency to tjjjj�...���....k���p Identify the contract, and provide a description of the services, goods, or other property to be provided ue contract. a Name of Interested Party r Chace I ature of Interest (check applicable) Controlling Intermediary of business) (place of busfness) C 0 oxi g Check only iftheredQInterested Party. ❑ a UNSWORN015[- N My name is __ 3` and my date of birth is My eddre _ (street) (city) (stale) (zip codel (country) .l*a�`J`` rider penalty of Perjury that (he foregoing is true and correct. Executed in County, State of on the _ day of , 20 fmanih) (year) Signature of authorized agent of contracting business entity (Oeclarann ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission w .ethics.state.tX.us Revised 12R272g17 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 85'h 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. SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) (Address) City State Zip Telephone Number ( ) Voice TDD has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development's (HUD) regulations implementing Section 504 (24 CFR Part 8. dated June 2, 1988). CHILD SUPPORT STATEMENT FOR NEGOTIATED CONTRACTS AND GRANTS Under Section 231.006, Family Code, the vendor or applicant certifies that the individual or business entity named in this contract, bid, or application is eligible to receive the specified grant, loan, or payment and acknowledges that this contract may be terminated and payment may be withheld if this certification is inaccurate. Section 231.006, Family Code, specifies that a child support obligor who is more than 30 days delinquent in paying child support and a business entity in which the obligor is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least 25% is not eligible to receive payments from state funds under a contract to provide property, materials, or services; or receive a state -funded grant or loan. List below the name and ownership percentage of the individual or sole proprietor and each partner, shareholder, or owner with an ownership interest of at least 25% of the business entity submitting the bid or application. NAME OWNERSHIP BY % A child support obligor or business entity ineligible to receive payments described above remains ineligible until all arrearage have been paid or the obligor is in compliance with a written repayment agreement or court order as to any existing delinquency. The undersigned proposer certifies that he or she, is the proposing individual, or the sole proprietor of the proposing business, and is eligible under Section 231.006 of the Texas Family Code, to receive the payments of State funds which may be disbursed in connection with a contract arising from this solicitation, The undersigned each further acknowledges that a contract resulting from this solicitation may be terminated and payment may be withheld if the certification provided herein is found to be inaccurate. Signature - Company Official Printed/Type Firm Name Printed/Typed Name and Title Date r, ]�r1�171 CONTRACTOR: ENGINEER: PROJECT: DOCUMENT NO. 00417 TRENCH SAFETY SYSTEMS INDEMNITY AGREEMENT Calhoun County (company name) G & W Engineers, Inc., Port Lavaca, Calhoun County, Texas Bid No. 2024.05 — Seadrift Drainage Improvements Project — GILD Contract No. 22- 085-014-D245 for Calhoun County, Texas CONTRACTOR has entered into a contract with OWNER for the construction of the Project. ENGINEER has designed the Project on behalf of OWNER, but has not designed any trench safety systems for the Project that may be required by applicable federal, state and/or local laws. CONTRACTOR, in its contract with OWNER, has agreed to prepare, and to conform all trenching work to plans for trench safety systems meeting the standards of applicable laws. CONTRACTOR, as part of its consideration to OWNER for the contract for the construction of the Project, agrees that it will be solely responsible for compliance with its trench safety plans and with all applicable standards of federal, state and/or local laws relating to trench safety. CONTRACTOR further agrees to hold harmless, indemnify, and defend OWNER and ENGINEER, and all officers, agents and employees of either OWNER or ENGINEER, from and against any and all claims, demands or causes of action of any nature, character or description in connection with the presence, or in any way arising out of, the use or construction of trenches or trench safety systems as part of the Project. EXECUTED, this CONTRACTOR Officer's Title of Officer: (Contractor's Seal) day of 20 OWNER By: Officer's Name: Richard H. Meyer Title of Officer: Calhoun County Judge ENGINEER By: Engineer's Name: Marla Jasek, P.E. Title of Engineer: Proiect Engineer IAY/LTA 1A-0 N:36P17 KNOW ALL MEN BY THESE PRESENTS that: (Corporation / Partnership) and (Name of Contractor or Company) (Address) hereinafter called Principal, (Name of Surety Company) (Address) hereinafter called Surety, are held and firmly bound unto Calhoun County, Texas (Name of Recipient) 211 South Ann Street, Third Floor, Ste. 301, Port Lavaca, Texas hereinafter called OWNER, in the penal sum of $ Dollars, $ (Recipient's Address) in lawful money of the United States, for this payment of which sum well and truly to be made, we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents. THE CONFIDENTIALITY OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER, dated the _ day of a copy of which is hereto attached and made a part hereof for the construction of: Bid No. 2024.05 — Seadrift Drainage Improvements Project — GLO Contract No. 22-085-014-D245 for Calhoun County, Texas (Project Name) NOW, THEREFORE, if the Principal shall promptly make payment to all persons, firms, SUB -CONTRACTORS, and corporations furnishing materials for or performing labor in the prosecution of the WORK provided for in such contract, and any authorized extension or modification thereof, including all amounts due for materials, lubricants, oil, gasoline, coal and coke, repairs on machinery, equipment and tools, consumed or used in connection with the construction of such WORK, and all insurance premiums on said WORK, and for all labor, performed in such WORK whether by SUB- CONTRACTOR or otherwise, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the SPECIFICATIONS. PROVIDED, FURTHER, that no final settlement between the OWNER and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS WHEREOF, this instrument is executed in counter -parts, each on of (Number) which shall be deemed an original, this the day of ATTEST: M (Principal Secretary) (SEAL) (Witness as to Principal) (Address) ATTEST: a (Witness as to Surety (Principal) (Address) (Surety) (Attorney in Fact) (Address) (Address) (s) NOTE: Date of BOND must not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND. PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS that: (Name of Contractor or Company) (Address) hereinafter called Principal, and (Name of Surety Company) (Address) hereinafter called Surety, are held and firmly bound unto Calhoun County, Texas (Name of County) 211 South Ann Street, Third Floor, Ste. 301, Port Lavaca. Texas (County's Address) hereinafter called OWNER, in the penal sum of $ Dollars ($ _) in lawful money of the United States, for the payment of which sum well and truly to be made we bind ourselves, successors, and assigns, jointly and severally, firmly in these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER dated the day of a copy of which is hereto attached and made a part hereof for the construction of: Bid No. 2024.05 — Seadrift Drainage Improvements Project — GLO Contract No. 22-085-014-D245 for Calhoun County, Texas NOW THEREFORE, if the Principal shall well, truly and faithfully perform its duties in all the undertakings, covenants, terms, conditions, and agreements of said contract during the original term thereof, and any extensions thereof which may be granted by the OWNER, with or without notice to the Surety and during the one year guaranty period, and if he shall satisfy all claims and demands incurred under such contract, and shall fully indemnify and save harmless the OWNER from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the OWNER all outlay and expense which the OWNER may incur in making good any default, then this obligation shall be void, otherwise to remain in full force and effect. PROVIDED FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the SPECIFICATIONS. PROVIDED, FURTHER, that no final settlement between the OWNER and the Principal shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS WHEREOF, this instrument is executed in counterparts, each one of which shall be deemed an original, this the day of _ ATTEST: (Principal) By (s) (Principal Secretary) (SEAL) (Witness as to Principal) (Address) (Address) ATTEST: (Surety) By (Witness as to Surety) (Attorney in Fact) (Address) (Address) NOTE: Date of BOND must not be prior to date of Contract. If PRINCIPAL/CONTRACTOR is Partnership, all partners should execute BOND. [INSERT Contractor's Liability Insurance] Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program Code of Federal Regulations Title 24- Housing and Urban Development Volume; I Date:2003-04-01 Original Date: 2003-04-01 Title: Section 135.38- Section 3 Clause Context: Title 24- Housing and Urban Development. Subtitle B- Relating to Housing and Urban Development. Chapter 1- Office of Assistant Secretary for Equal Opportunity, Department. Part 135 Economic Opportunities for Low -and Very Low -Income Persons, Subpart B- Economic opportunities for Section 3 Residents and Section 3 Business Concerns. § 135.38 Section 3 clause. All section 3 covered contracts shall include the following clause (referred to as the section 3 clause): A, The workto be performed underthis contract is subject to the requirements of section 3 of the Housing and Urban Development Act of 1468, as amended, 12 U.S.C.1701u (section 3). The purpose of section 3 isto ensure that employment and other economic opportunities generated by HUD assistance or HUD -assisted projects covered by section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR part 135, which implement section 3. As evidenced by their execution of this contract, the patties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shal l begin. D. The contractor agrees to include this section 3 clause in every subcontract subject to compliance with regulations in 24 CFR part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The contractorwill not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR part 135. E. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR part 135, F. Noncompliance with HUD's regulations in 24 CFR part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. G. With respect to work performed in connection with section 3 covered Indian housing assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act (25 U.S,C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (1) preference and opportunities for training and employment shall be given to Indians, and Ili) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of section 3 and section 7(b) agree to comply with section 3 to themaximum extent feasible, but not in derogation of compliance with section 7(b). Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program [Code of Federal Regulations] [Title 24, Volume 1] [Revised as of April 1, 2003] From the U.S. Government Printing Office via GPO Access [CITE: 24CFR135.921 [Page 704-707] TITLE 24--HOUSING AND URBAN DEVELOPMENT CHAPTER I --OFFICE OF ASSISTANT SECRETARY FOR EQUAL OPPORTUNITY, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT PART 135--ECONOMIC OPPORTUNITIES FOR LOW- and VERY LOW-INCOME PERSONS Table of Contents Appendix to Part 135 I. EXAMPLES OF EFFORTS TO OFFER TRAINING AND EMPLOYMENT OPPORTUNITIES TO SECTION 3 RESIDENTS (1) Entering into ' ' first source" hiring agreements with organizations representing Section 3 residents. (2) Sponsoring a HUD -certified "Step -Up" employment and training program for - section 3 residents. (3) Establishing training programs, which are consistent with the requirements of the Department of Labor, for public and Indian housing residents and other section 3 residents in the building trades. (4) Advertising the training and employment positions by distributing flyers (which identify the positions to be filled, the qualifications required, and where to obtain additional Information about the application process) to every occupied dwelling unit in the housing development or developments where category I or category 2 persons (as these terms are defined in Sec. 135.34) reside. (5) Advertising the training and employment positions by posting flyers (which identify the positions to be filled, the qualifications required, and where to obtain additional information about the application process) in the common areas or other prominent areas of the housing development or developments. For HAs, post such advertising In the housing development or developments where category 1 or category 2 persons reside; for all other recipients, post such advertising in the housing development or developments and transitional housing in the neighborhood or service area of the section 3 covered project. (5) Contacting resident councils, resident management corporations, or other resident organizations, where they exist, in the housing development or developments where category 1 or category 2 persons reside, and community organizations in HUD assisted neighborhoods, to request the assistance of these organizations in notifying residents of the training and employment positions to be filled, (7) Sponsoring (scheduling, advertising, financing or providing in -kind services) a job informational meeting to be conducted by an HA or contractor representative or representatives at a location in the housing development or developments where category 1 or category 2 persons reside or in the neighborhood or service area of the section 3 covered project. (8) Arranging assistance in conducting job interviews and completing job applications for residents of the housing development or developments where category 1 or category 2 persons reside and in the neighborhood or service area in which a section 3 project is located. [[Page 705]] (9) Arranging for a location in the housing development or developments where category 1 persons reside, or the neighborhood or service area of the project, where job applications may be delivered to and collected by a recipient or contractor representative or representatives. (10) Conducting job interviews at the housing development or developments where category 1 or category 2 persons reside, or at a location within the neighborhood or service area of the section 3 covered project. (11) Contacting agencies administering HUD Youthbuild programs, and requesting their assistance in recruiting HUD Youthbuild program participants for the HA's or contractor's training and employment positions. (12) Consulting with State and local agencies administering training programs funded through ]TPA or JOBS, probation and parole agencies, unemployment compensation programs, community organizations and other officials or organizations to assist with recruiting Section 3 residents for the HA's or contractor's training and employment positions. (13) Advertising the jobs to be filled through the local media, such as community television networks, newspapers of general circulation, and radio advertising. (14) Employing a job coordinator, or contracting with a business concern that is licensed in the field of job placement (preferably one of the section 3 business concerns identified In part 135), that will undertake, on behalf of the HA, other recipient or contractor, the efforts to match eligible and qualified section 3 residents with the training and employment positions that the HA or contractor intends to fill. (15) For an HA, employing section 3 residents directly on either a permanent or a temporary basis to perform work generated by section 3 assistance. (This type of employment is referred to as ' 'force account labor" in HUD's Indian housing regulations. See 24 CFR 905.102, and Sec. 905.201(a)(6).) (16) Where there are more qualified section 3 residents than there are positions to be filled, maintaining a file of eligible qualified section 3 residents for future employment positions. (17) Undertaking job counseling, education and related programs in association with local educational institutions. (18) Undertaking such continued job training efforts as may be necessary to ensure the continued employment of section 3 residents previously hired for employment opportunities. (19) After selection of bidders but prior to execution of contracts, incorporating into the contract a negotiated provision for a specific number of public housing or other section 3 residents to be trained or employed on the section 3 covered assistance. (20) Coordinating plans and implementation of economic development (e.g., job training and preparation, business development assistance for residents) with the planning for housing and community development. Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program NEW HIRES SECTION 3 MONTHLY COMPLIANCE REPORT Reporting Mordh:�� Economic Cpporlunitiesfoi Low and Very Lowdrwome Persons This Corm is distributed to the General Contractor (GC) at the Pre -Construction Meeting. GC is also required to provide this form to any subcontractor firms that they anticipate hidng for this project CONTRACTOR INFORMATION Name of Business: Address of Business: Authorized Representative forthis contract: Authorized Signatory: ADDITIONALLY, PLEASE REVIEW AND COMPLY WITH STEPS 1.3 BELOW: with awarded project and deliver 2. When you hire a Section 3 resident in connection with this project, you must also complete this form and submit it to the Section 3 Coordinator identified above. Even it there were no new hires this form must be completed and submitted to the Section 3 C,`p inator identified above. n I have not hired any new employees during the reporting Month specified - I have hired F Section 3 employees and/or ❑ non -Section 3 employees during the reporting month shown here. The following is a list of the new hires and the trades: New Hire Name Job Category/Trade Full-time? Yes or No t. 2. 3. 4. Inave taxen one or more or the tonovang recruitment steps to hire aSection 3 Residentwith the highest training and employment priority ranking Provide a brief description of actions taken; ve taken steps to find a Section Resides tlicable targeted areas where the project(s)rassistancewill take place. Listare hI Placed signs or posters at prominent places in each of the above listed areas, Photographs were taken to document this action. have advertised to fill vacancy(ies) at thesile(s), where work is taking place, in connection with this project. Distributed employment flyer. to the administrative office of the local Public Housing Authority. ❑ Provided notice of posilions available to the Texas Workforce Commission for potential applicants. Provide copy of notice. ❑ Contacted employment referrals or Youthbuild Program referrals. List contacts: Contacted with applicable parties to ensure that any HUD Youthbuild programs currently operating in the project(s) area/ ❑ assistance will take place. ❑ Kept a log of all applicants and indicate the reasons why Section 3 Residents who applied were not hired. Retained copies of any employment applications completed by public housing, Section S certificate or voucher holders or other n Section 3 Residents. n Sent a notice about Section 3 training and employment requirements and opportunitles to labor organizations or to worker representatives with whom our firm has a collective bargaining or other agreement, 3. Vedfication ❑ I have attached proof of all checked items. Authorized Name and Signature Date/Tme Fleld Text Attested Byi 2 �n a'FC3 s$g sa.m FNBt 3 � mn v�Om m�omg�Ci E' Nw z cm d o y�ye =R o „33a `d So `.ca n mm�'03u b"a=e.o nn G 83 3 M.m 5 5. v_; s ry o Ll a o o � 3 m O{ << < O 3 N O N Q N W 9Qy( < < t OT..Y N 3 Q n�' M O N O.O N�CN�.] 0 'O _� ocy' M3 m m g`fl o N m y „ m dye E N a 3 3 N p+om�N�dg� e< a..Q2 s o art d . m n m s3 0 'm S. a� M A" 's . m M. T `� o a C N! J m q Imw- w O. 'm m a n N m p x Nn n c^Sw v m Z o.c wm N e o m 3'w� $. g o o O G N j j S a 9 P G 3 c'a a d C3 m 9 .mow O O m d pO 8 COC lh @ �' 0 �. q a S a a m m S N N. mam m '�3 O ^Om' �` mfiNe gF IG �s ASSURANCES - CONSTRUCTION PROGRAMS OMB Number: 4040.0009 Public reporting burden for (his collection of Information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of Information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, OC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Certain of these assurances may not be applicable to your project orprogram. if you have questions, please contact the Awarding. Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non -Federal share of project costs) to ensure proper planning, management and completion of project described in this application 2. Will give The awarding agency, the Comptroller General of the United States and, if appropriate, the Stale, the right to examine all records, books. papers. or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. WIN not dispose of, modify the use of, or change the terms of the real property title or other interest in the site and facilities without permission and Instructions from the awarding agency. WIII record the Federal awarding agency direcl&es and will include a covenant in the title of real property acquired in whole or in part with Federal assistance funds to assure non- discrimination during the useful life of the project. 4. Will comply with the requirements of the assistance awarding agency with regard to ilia drafting, review and approval of construction plans and specifications. 5. Will provide and maintain competent and adequate engineering supervision stills construction site to ensure that the complete work conforms with the approved plans and specifications and will furnish progressive reports and such other Infounallon as may be required by the assistance awarding agency or State. 6. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 8. Will comply with the Intergovernmental Personnel Act of 1970 (42 U-S.C. §§4728-4763) relating to prescribed standards of merit systems for programs funded under one of the 19statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F), 9. WIII comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C, §§4801 at seq.) which prohibits the use of lead -based paint in construction or rehabilitation of residence structures. 10. Wilt comply with all Federal statutes relating to non- discrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (a) Section 504 of the Rehabilitation Act of 1973, as amended (29) U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-51WI, which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P. L. 92-265), as amended relating to nondiscrimination on the basisof drug abuse: (Q the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L 91.616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912.(42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality at alcohol and tlmg abuse patient records: (h) Title Vill of the Civil Rights Act of 1968 (42 U.S.C. §§3601 at seq). as amended, relating to nondiscrimination in the sale, rental or financing of housing; (1) any other nondiscrimination provisions in the specific statue(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statde(s) which may apply to the application, Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7-97) Prescribed by OMB ClrcularA-102 11. Will comply, or has already complied, with the requirements of Titles fl and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91.646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and federally -assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 12, Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1608 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 13. Will comply, as applicable, with the provisions of the Davis - Bacon Act (40 U.S.C. §§276a to 276a4), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874). and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327- 333) regarding labor standards for federally -assisted construction subagieements. 14, Will comply with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special Road hazard area to participate in the program and to purchase flood insurance it the total cost of insurable construction and acquisition is $10,000 or more. 15, Will comply with environmental standards which may be prescribed pursuant to the following; (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P-L. 91- 190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 117381 (c) protection of wetlands pursuant to EO 11090; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (a) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 at seq.); (f) conformity of Federal actions to State (Clean Air) implementation Plans undar Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. %7401 at seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205). 16. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 at seq.) related to protecting components of potential components of the national wild and scenic rivers system. 17, Will assist the awarding agencyin assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended ('I6 U.S.C. §470). EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a-1 at seq). 18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit ActAmendments of 199B and OMB Circular No. A-133, "Audits of States, Local Governments, and Non -Profit Organizations." 19, Will comply with all applicable requirements of all other Federal laws, executive orders. regulations, and policies governing this program. 20. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act(TVPA) of 2000, as amended (22 U.S.C: 7104) which prohibits grant award recipients or a sub -recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is In effect (2) Proouring a commercial sex act during the period of time that the award Is in effect or (3) Using forced labor in the performance of the award or subawards under the award. SF-424D (ReV. 747) Back AllacLusnl C Pogo I or 10 GEN ERAL A IrR1 RIVIX11 NS For the purposes of this document, the term "governmental entities' shall have the same 1meaning as defined in Chapter 2251 of the Texas Goverment Code, To THE E.l'TENT WPLICABLL, Subrecipient affirms and agrees to the following, without exception: 1. Subrecipient represents and warrants that. in accordance with Section 2115A05 of the Texas Government Code, neither Subrecipient nor the firm, corporation, partnership, or institution represented by Subrecipient. or anyone acting for such it firm: corporation, palinership; or instihnioll has (1) violated any provision of the'rexm Free Enterprise and Antitrust Act of 1983, Chapter 15 orlhe Texas Business and Commerce Code, or (lie federal antitrust laws, or (2) communicated directly or indirectly the contents of this Contract or any solicitation response upon which this Contract is based to any competitor or alry outer person engaged in the same line of business as Subrecipient. 2_ If the Contract is for services. Subrecipient shall comply with Section 2155.4441 of the Texas Government Code, requiring the purchase or products and materials produced in the State of Texas in performing service contracts, but for contracts subject to 2 CPR 200, only to the estelrt such compliance is consistent with 2 CPR 200.319. 3. Under Section 23L006 of the Plunily Codej the vendor or applicant [Subrecipient] certifies that the individual or business entity named in this Contract bid or application is not ineligible to receive the specified grunt. loan, or payment and acknowledges that this Contract may be terminated and payment may be withheld if this certification is inaccurate. [Nat applicable to coniracts with governmental entities.] 4, A bid or an application for a contract. grant, or loan paid from suite funds must include the name and social security number of the individual or sole proprietor and each partner, shareholder, or owner with im ownership interest of at least 25 percent or the business entity submitting the bid or application. Subrecipient certifies it has submitted this information to the (if R ]Not applicable to contracts with governmental entities.] 5. If the Contract is for the purchase or lease of computer equipment. as defined by Texas Health and Safety Code Section 361.952(2), Subrecipient certifies that it is in compliance with Subehapter Y. Chapter 361 of the Texas Health and Safely Code, related to the Computer Equipment Recycling Progrun and the Texas Commission on Enviromnental Quality rules in Title 30 Texas .Administrative Code Chapter 328. 6. Subrecipient represents and warrants that it has not given, offered to give, nor intends to give as any tune lcreatler any economic opportunity, lidure employment, gill, loan. gratuity, special discount trip, favor, or service to a public servant in connection with the Contract. 7. Subrecipient agrees that any payments due under the Contract shall be applied towards any debt or delinquency that is owed by Subrecipient to the State of Texas. AtfarinmrlC Pag,e ± or ul S. Upon request of the (11.0, 3uhrecipiont shall provide copies of its most recent business continuity and disaster recovery plans. 9. If the Contract is for consulting services governed by Texas Govenuuent Code Chapter 2254, Subchapter B,in accordance with Section 2254.033 of the Texas Government Code, relating to consulting services, Subrecipient certifies that it does not employ an individual who has been employed bythe GLO or another agency at any time during the two years preceding the Subrecipients submission of its offer to provide consulting services to the GLO or, in the alternative Subrecipient, in its offer to provide consulting services to the GLO, disclosed the following: (i) the nature of the previous employment with the GLO or otherstate agency; (ii) the date the employment was terminated; and (iii) the annual rate of compensation for tine employment at the time of its termination. 10. If the Contract is not for architecture, engineering, or construction services; except as otherwise provided by statute, rule, or regulation, Subrecipient must use the dispute resolution process provided for in Chapter 2260 of the Texas Govenmtent Code to attempt to resolve any dispute arisingAIunder the Contract. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS A WVER OF SOVEREIGN IMMUNITY BY THE GLO OR, IF APPLICABLE, OF GOVERNMENTAL INIMUNITY BY SUBREC'IPIENT. 11. If the Contract is for architecture, engineering, or construction services, subject to Texas Government Code Section 2260.002 and Texas Civil Practice and Remedies Code Chapter 114,- and except as otherwise provided by statute, rule, or regulation, Subrecipient shell use the dispute resolution process provided for in Chapter 2260 of the Texas Government Code to attempt to resolve all disputes arising under this Contract. Except as otherwise provided by statute, rule, or regulation, in accordance with the Texas Civil Practice and Remedies Code, Section 114.005, claims encompassedby'rexas Government Coda, Section 2260.002(3) and Texas Civil Practice and Remedies Code Section 114.002 shall he governed by the dispute resolution process set forth below in subsections (a)-(d). NOTIHNG IN TIIIS SECTION SHALL. HE CONSTRUED AS A WAIVER OF SOVh;REI(N IMMl.[Nrl'Y BY THE GLO OR, IF APPLICABLE, OF GOVERNMENTAL IMMUNITY BY SUBRECIPIENT. a.. Notwithstanding Texas Goverunent Code, Chapter 2260.002(3) and Chapter 114.012 and any other statute or applicable law, if Subrecipient's claim for breach of contract cannot he resolved by the Parties in the ordinary course or business, Subrecipient may make a claim against the GLO for breach of contract mid the GLO may assert a counterclaim against Subrecipient as is contemplated by 'Texas Govermmcut Code, Chapter 2260, Subchapter H. In such event; Subrocipicnt must provide written notice to the GLO of a claim for breach of the Contract not later than the 180th day after the date of the event giving rise to the claim. 'lie notice must state with particularity: (1) the nature of the alleged breach; (2) the amount Subrecipient seeks as damages; and (3) the legal theory of recovery. b. The chief administrative officer, or if designated in the Contract, another officer of the GLO, shall examine tine claim and any counterclaim rend negotiate with Subrecipient in an effort to resolve them. The negotiation must begun no later than the 120th day after tic Affaclunud C Page 3 of 10 date the claim is received, as is contemplated by Texas Govcmnnent Code, Chapter 226q Section 2260.052. o. If the negotiation under paragraph (b) above results in the resolution of some disputed issues by agreement or in a settlement, the Parties shall reduce the agreement or settlement to writing and each Party shall sign the agreement or settlement. A partial settlement or resolution of a claim does not waive a Party's rights tinder this Contract as to the palls of the claim that are not resolved. d. If it chum is not entirely resolved under paragraph (b) above, on or before the 270th day after the date the claim is tiled with the GLO, unless the Parties agree in writing to an extension of time, the Parties may agree to mediate a claim made under this dispute resolution procedure. This dispute resolution procedure is Subrecipient's sole and exclusive process for seeking a remedy for an alleged breach of contract by the GLO if the Parties are ratable to resolve their disputes as described in this section. e. Nothing in the Contract shall be construed as it waiver of the slate's or the GLO's sovereign immunity, or, if applicable, the governmental htmiturily of Subrecipient. This Contract shall not constitute or he construed as a waiver of any of the privileges, rights, defenses, remedies, or immunities available to the Sate of Texas or Subrecipient. The failure to enforce, or any delay in the enforcement, of any privileges, rights, defenses, renedies, or immunities available to the State of Texas or, if applicable, of Subrecipient under this Contract or under applicable law shall not constitute a waiver Of such privileges, rights, defenses, remedies or immunities or be considered as a basis for estoppel. The GLO does not waive any privileges, rights, defenses, or immunities available to it by entering into this Contract or by its conduct, or by the conduct of any representative of the 01.0, prior to or subsequent to entering into this Contract. Subrecipient does not waive any privileges, rights, defenses, or immunities available to it by entering into this Contract or by its conduct, or by the conduct of any representative of the 01.O, prior to or subsequent to entering into this Contract. f. Except as Otherwise provided by statute, rule, or regulation, compliance with the dispute resolution process provided for in Texas Government Code, Chapter 2260, subchapter B and incorporated by reference in subsection (a)-(d) above is a condition precedent to the Subrecipient; (1) tiling suit pursuant to Chapter 114 of the Civil Practices and Remedies Code; or (2) initiating a contested case hearing pursuant. to Subchapter C of Chapter 2260 of the Texas Clovernment Code. 12. If Cbapter 2271 of the Texas Government Code applies to this Contract, Subrecipient verifies that it does not boycott Israel and will not boycott Israel during the terns of the Contract. 13. This Contract is contingent upon the continued availability of lawful appropriations by the Texas Legislature. Subrecipient understands that all obligations of the GLO under this Contract two subject to the availability of funds. If such funds are not appropriated or become unavailable, the GLO may ternihtate the ContrucL The Contrite( shall not be construed its creating a debt on behalf of the GLO in violation of Article IIL Section 49a of (lie Texas Constitution. AttachmenlC Page 4 or 10 14. Subrecipient certifies that it is not listed in the prohibited vendors list authorized by Executive Order 13224, 'Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Contruit, or Support Terrorism", published by lire United Slates Department ofthc'Troasury, Office of Foreign Assets Control. 15. In accordance with Section 669.003 of the Texas Government Code, relating to contracting with the executive head of a state agency, Subrecipient certifies that it is not (1) the executive head of the GLO, (2) a person who at anv tune during the four years before the effective date of the Contract was the executive head of the GLO, or (3) a person who employs a current or former executive head of the GLO. 16. Subrecipient represents and warrants that all statements and information prepared and submitted in confection with this Contract are current wnhplele, true, and accurate. Submitting a false statement or making a material misrepresentation during the performance of this Contract is a material breach of contract and may void the Contract or be grounds for its termination. 17. Pursuant to Section 2155.004(a) of the Texas Goverment Code, Subrecipient certifies that neither Subrecipient nor any person or entity represented by Subrecipient has received compensation front the GLO to participate in the preparation of the specifications or solicitation on which this Contract is based. Linder Section 2155.004(b) of the Texas Government Code, Subrecipient certifies that ale individual or business entity named in this Contract is not ineligible to receive the specified Contract and acknowledges tmat the Contract may be terminated and payment withheld if this certification is inaccurate. This Section does not prohibit Subrecipient from providingfree technical assistance. 18. Subtecipient represents and warrants that it is not engaged in business with Iran, Sudan, or a foreign terrorist organization, as prohibited by Section 2252.152 of the 'Texas Govenument Code. 19. In accordance with Section 2252.901 of the Texas Government Code, for the categories of contracts listed in that section, Subrecipient represents and warrants that none of its employees utcluding, but not lunited to, those authorized to provide services under the contract, were employees of the GLO during the twelve (12) month period irmnediately prior to the date of execution of the contract, Solely for prol'essiortal services contracts as described by Chapter 2254 of [lie Texas Government Code, Subrecipient further represents and warrants that if fonmer employee of the GLO was employed by Subrecipient within one year of the employee's leaving the GLO, then such employee will not perform services on projects with Subrecipient that the employee worked al while employed by are GLO. 20. The Contract shall be governed by and construed in accordance with the laws of the Slate of Texas, without regard to the conflicts of law provisions. The venue of anv suit arising under the Contract is fixed in any court of competent jurisdiction of Travis County, Texas, unless the specific venue is otherwise identified in a statute which directly nanhes or otherwise identities its applicability to any Party. Attachment C Page 5 of 10 21. IF THE: CONTRACT IS NOT FOR ARCHITECTURE OR ENGINEERING SERVICES GOVERNED BY TEXAS GOVERNMENT CODE CHAPTER 2254, SITBRECIPIENT, TO THE EXTENT ALLOWED BY LAW. SIIALL DEFEND, INDEMNIFY AND HOLD HARMLESS THE STATE OF 'TEXAS AND THE OLO; AND/OR 'THEIR OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES, CONTRACTORS, ASSIONERS, AND/OR DESIGNEES FROM ANY AND ALL LIABILITY, ACTIONS, CLAIMS, DEMANDS, OR SUIT'S, AND ALL RELATED COSTS, A'ITORNEY FEES, AND EXPENSES ARISING OUT OF, OR RESULTING FROM ANY ACTS OR OMISSIONS OF SUBRECIPIENT OR ITS AGENTS, EMPLOYEES, SUBCONTRACTORS; ORDER FULFILLERS, OR SUPPLIERS OF SUBCONTRACTORS IN THE, EXECUTION OR PERFORMANCE. OF THE CONTRACT AND ANY PURCHASE ORDERS ISSUED LENDER TIIE CONTRACT. TILE DEFENSE SHALL BE COORDINATED BY SUBRECIPIENT WITH THE OFFICE OF THE TEXAS A'1'1'ORNEY GENERAL WHEN TEXAS STATE AGENCIES ARE NAMED DEFENDANTS IN ANY LAWSUIT AND SUBRECIPIENT MAY NOT AGREE TO ANY SETTLEMENT WITIIOUT FIRST OBTAININO`l'HE CONCURRENCE NROM THE OFFICE; OF THE TEXAS A117ORNEY GENERAL. SUBRECIPTENT AND THE. GLO SHATZ FURNISH TIMELY WRITTEN NOTICE TO EACH OTHER OF ANY SUCH CLAIM. [Not applicable to contacts with governmental entities./ 22.IF THE CON'TRAC'1' IS FOR. ARCHITECTURE OR ENGINFITAING SERVICES GOVERNED BY TEXAS GOVERNMENT CODE CHAPTER 2254, SUBRECIPIENT, TO THE EXTENTALLOWED BY LAW, SHALL INDEMNIFY AND HOLD HARMLESS THE STATE: OF 'TEXAS AND THE: GLO, AND/OR THEIR OFFICERS, AGE;N'GS, EMPLOYEES, REPRESENTATIVES, CONTRACTORS, ASSIGNEES, AND/OR DESIGNEES FROM ANY AND ALL LLABILITTY, ACTIONS, CLAIMS, DEMANDS, OR SUITS, ,1ND ALL RELATED DAMAGES, COSTS, ATTORNEY FEES, AND EXPENSES TO THE EXTENT CAUSED BY, ARISING OUT OF, OR RESULTING FROM ANY ACTS OF NEGLIGENCE, INTENIION_9L TORTS, WILLFUL MISCONDUCT, PERSONAL INJURY OR DAMAGE TO PROPERTY, AND/OR OTHERWISE RELATED TO SUBRECIPIENT'S PERFORMANCE. AND/OR FAILURES TO PAY A SUBCONTRACTOR OR SUPPLIER BY THE SUBRECIPIENT OR 1T'S AGENTS, EMPLOYEES, SUBCONTRACTORS, ORDER FULFILLERS, CONSULTANTS LENDER CONTRACT TO SUBRECIPIENT, OR ANY OTHER ENTITY OVER WHICH THE CONTRACTOR EXERCISES CONTROL, OR SUPPLIERS OF SUBCONTR.AC71'ORS IN THE EXECUTION OR PERFORMANCE OF THE CONTRACT. THE DEFENSE SHALL BE COORDINATED BY SUBRECIPIENT WITH THE OFFICE OF THE; 'TEXAS ATI'ORNEY GENERAL WHEN 'TEXAS STATE AGENCIES ARP, NANIED DEFENDANTS IN ANY LAWSUIT .AND SUBRECIPIENT MAY NOT AGREE TO ANY SETTLEMENT WITHOUT FIRST OBTAINING THE CONCURRENCE FROM THE OFFICE OF THE 'TEXAS ATTORNEY GENERAL. SUBRECIPIENT AND T'HE GLO SHALL FURNISH 'TIMELY WRITTEN NO'l'ICF. '1'O EACH OTHER OF ANY SUCH CLAIM. [A/or applicable to contracts with governmental entities.] 23. TO THE EXTENT ALLOWED BY LAW, SUBRECIPIENT SIIALL DEFEND, INDEMNIFY, AND HOLD HARMLESS THE GLO AND THE STATE OF TEXAS FROM Attachment C Page 6of 10 AND AGAINSTANY AND ALL CLAIMS, VIOLATIONS. MISAPPROPRIATIONS OR TNFRINGF.MF,NT OF ANY PATENT, TRADEMARK, COPYRIGHT, TRADE SECRET OR OTHER INTELLECTUAL PROPERTY RIGHTS AND/OR OTIIER INTANGIBLE PROPERTY, PIJi;LiCITY OR PRIVACY RIGHTS, AND/OR IN CONNECTION WiTH OR ARISING FROM: (1) THE PERFORMANCE OR ACTIONS OF SUBRECIPIENT PURSUANT TO THIS CONTRACT; (2) ANY DELIVERABI:E, WORK PRODUCT. CONFIGURED SF.'RVICK OR OTHER SERVICE; PROVIDED HFRHIINDER; AND/OR (3) THE. GLO'S ANTI/OR SUBRECIPIENT'S USE OF OR .ACQUISITION OF ANY REQUESTED SERVICES OR OTHER ITEMS PROVIDED TO TIIE GLO BY S11HRF.CIPiENT OR OTHFRWISH'fO WHICH THE GLO HAS ACCESS AS A RFSUIII' OF SUBRECIPiFNT'S PERFORMANCE UNDER THE CONTRACT. SITBRECTPIENT AND TIIC GLO SHALL FURNISH TINKLY WRITTEN NOTICE TO EACH OTHER OF ANY SUCH CLAIM. SUBRFCIPIENT SHAIJ, HE IJABLH T'O PAY ALI, COSTS OF DEFENSE, INCI,TJDING ATTORNEYS' FEES. THE. DEFENSE, SHALT, BE COORDINATED BY SUBRECIPIENT WITH THE OFFICE OP TILE TEXAS A'l'I'ORNHY GENERAL (OAG) WHEN TEXAS STATE .AGRNCIFS ARE. NAMED DEFENDANTS IN ANY LAWSUIT AND SUBRFCIPIENT MAY NOT AGREE TO ANY SETTLEMENT WITHOUT FIRST OBTAINING TIIE CONCURRENCE FROM OAG. IN ADDITION, SUBRECIPIENT WILL REIMBURSE THE: C71.0 AND T'HF, STATE OF TEXAS FOR ANY CLAIMS, DAMAGES, COSTS, EXPENSES OR OTHER AMOUNTS, INCLUDING, BUT NOT LIMITED TO, ATTORNEYS' FEES AND COURT COSTS, ARISING FROM ANY SUCH CLAIM. IF THE GLO DKFERMINHS THAT A CONFLICT EXISTS BETWEEN ITS INTERESTS AND THOSE OF SUBRFCIPIENT OR IF THE GLO IS REQUIRED BY APPLICABLE LAW TO SELECT SEPARATE COUNSEL. TIIC GLO WILL BE PERMITTED TO SHLEC'T SHPARATF, C.O(INSEi; .AND SUBRECIPTF.NT WILT, PAY ALi. REASONABLE COSTS OF THE GLWS COTiNSET,. J,Vot applicable to contracts with governmental entities.] 24. Subrecipient has disclosed in writing to the GLO all existing or known potential conflicts of interest relative to the perfornnnce of the Contract. 25. Sections 2155.006 and 2261.053 of the Texas Government Code prohibit state agencies from acceplaig it solicitation response or awarding a contract that includes proposed financial participation by a person who, in the past live years, has been convicted of violating a lederal law or assessed a penalty in connection with a contract involving relief for Hurricane Rita, Hurricane Katrina, or any other disaster, as defined by Section 418.004 of the Texas Government Code, occurring alter September 24. 2005. Under Sections 2155.006 and 2261.053 of the Texas Government Code, Subrecipient certifies that the individual or business entity named in this Contract is not ineligible to receive the specified Contract and acknowledges that this Contract may be terminated and payment Withheld if this certification is inaccurate. 26. Subrecipient understands that the Gi.O will comply with the Texas Public Information Act (Chapter 552 of the Texas Government Code) as interpreted by judicial tidings and opinions of the Attonmey General of the State of Texas. Information, documentation. and other material related to this Contract may he subject to public disclosure pursuant to the Texas Public Infommalion Act. In accordance with Section 2252.907 of the Texas Government .atturhmentt C Page 7 ur 10 Code, Subrecipient shall make anv inforrttation created or exchanged with the State/GLO pursuant to the Contract, and not otherwise excepted from disclosure under the Texas Public Information Act. available in a format that is accessible by the public at no additional charge to the State or the GLO. 27. "11te person executing this Contract certifies that he/she is duly authorized to execute this Contract on his/her own behalf or on behalf of Subrecipieri and legally empowered to contractually bind Subrecipient to the terms and conditions of the Contract and related documents. 28. If the Contract is for architectural or engineering services, pursuant to Section 2254,0031 of the Texas Government Code, which incorporates by reference Section 271.904(d) of the Texas Local Government Code, Subrecipicnt shall perform services (1) with professional skill and care ordinarily provided by competent engineers or architects practicntg under the same or similar circumstances and professional license, and (2) as expeditiously as is prudent considering the ordinary professional shill and care of it competent engineer or architect. 29, The state auditor may conduct an audit or investigation estigation of any entity receiving funds from (lie state directly under the Contract or indirectly through a subcontract under the Contract. The acceptance of funds directly under the Contract or indirectly through a subcontract under [lie Contract acts as acceptance of the authority of the stale auditor, under the direction of the legislative audit committee, to conduct an audit or investigation in connection with thme funds. Under the direction of the legislative audit committee, an entity that is the subject of an audit or investigation by the state auditor must provide lice stale auditor with access to ally information the state auditor considers relevant to the investigation or audit. Subrecipicnt shall ensure that this paragraph concerning the authority to auditfmtds received indirectly by subcontractors through the Contract and the requirement to cooperate is included in any subcontract it awards. The GLO may unilaterally amend the Contract to comply with any rules and procedures of the state auditor in the implementation and enforcement of Section 2262,154 of fho Texas Government Code. 30. Subrecipicnt certifies that neither it nor its principals arc debarred, suspended proposal for debartuent, declared ineligible, or otherwise excluded from participation in the Contract by any state or federal agency, 31. Subrecipient expressly acknowledges that funds may not be expended in connection with the purchase of an automated infortnation system unless that systern meets certain statutory requirements relating to accessibility by persons with visual inpaimnents. Accordingly, Subrecipient represents and warrants to tine GLO that any technology provided to the GLO for purchase pursuant to this Contract is capable, either by virtue of features included within the technology or because it is readily adaptable by use with other technology, of providing equivalent access for effective use by both visual and non -visual means; presenting i ntomnation, including prompts used for interactive communications, in fonnats intended for Iron -visual use: and being integrated into networks for obtaining, retrieving and disseminating inforntation used by individuals who are not blind or visually impaired. For purposes of this Section, the phrase "equivalent access" means a substantially similar ability to communicate with or make use of the technology, either directly by features incorporated Attachment C Pape a ur 10 within the technology or by other reasonable means such as asslstive devices or services which would constitute reasonable accommodations under the Americans With Disabilities Act or similar state or federal laws. Examples of methods by which equivalent access may be provided include, hid are not limited to, keyboard alternatives to mouse commands and other means of navigating graphical displays, and customizable display appearance. 32. If the Contract is for the purchase or lease of covered television equipment, as defined by Section 361.971(3) of the Texas Health and Safety Code, Subrecipient certifies its compliance with Subehapter %, Chapter 361 of the Texas Health and Safety Code, related to the Television Equipment Recycling Progr<vn. 33. Pursuant to Section 572.069 of the Texas Goverment Cale, Subrecipient. certifies it has not employed and will not employ a former slate officer or employee who participated in a procurement or contract negotiations for the GLO involving Subrecipient within two (2) years after the date that the contract is sighed or the procurement is tenuinated or withdrawn. This certification only applies to former state officers or employees whose stale service or employment ceased on or after September 1, 2015. 34. The GLO does not tolerate any typo of fraud. 01.0 policy promotes consistent, legal, and ethical organizational behavior by assigning responsibilities and providing guidelines to enforce controls. Any violations of lean, agency policies, or standards of ethical conduct will he investigated, and appropriate actions will be taken. Subrecipient shall report any possible fraud, waste, or abuse that occurs in connection with (lie. Contract to the GLO's Fraud Reporting hotline at (877) 888-0002. 33.'Ihe requirements of Subchapter .1, Chapter 552, Governnment Code, may apply to this Contract and Subrecipient agrees that the Contract can be terminated if Subrecipient knowingly or intentionally fails to comply with a. requirement of that subchapter. 36. If Subrecipient. in its performance of the Contract, has access to a stale computer system or database, Subrecipient must complete a cybersecurity training program certified under Texas Govenmtent Code Section 2054,519, as selected by the GLO. Subrecipient Hurst complete the cybersecurity training program during the initial tent of the Contract and during any renewal period. Subrecipient must verity in writing to the GLO its completion of the cybersecurity training program. 37. Under Section 2155.0061, Texas Government Code, Subrecipient certifies that the entity narned in this Contract is not ineligible to receive the specified Contract and acknowledges that this Contract may be terminated and payment withheld if this certification is inaccurate. [Not applicable to contracis with governmental entities. ] 38. Subrecipient certifies that it does not require its customers to provide any documentation certifying the customer's COVID-19 vaccination or post -transmission recovery on entry, to, to gain access to, or to receive service from Suhrecipient's business. Subrocipicnt acknowledges that such a vaccine or recovery requirement would make Subrecipient ineligible for a state -tended contract. Attxdmwat C Pape 9 of 10 39. Pursuant to Government Code Section 2274.0102, Subrecipient certifies that neither it nor its parent company, nor any affiliate of Subrecipient or its parent company, is: (1) majority owned or controlled by citizens or governmental entities of Chiral, him, North horea, Russia, or any other country designated by the Govcnnor under Government Code Section 2274.0103, or (2) headquartered in any of those countries. 40. If Subrecipient is required to make a verification pursuant to Section 2274.002 of the Texas Government Code, Subrecipient verifies that Subrecipient does not boycott energy companies and will not boycott energy companies during the term of the Contract. If Subrecipient does not make that verification, Subrecipient must notify the GLO and state why the verification is not required. 41. If Subrecipient is required to make a verification pursumil to Section 2274.002 of the Texas Government Code, Subrecipient verifies that it (1) does not have a practice, policy, guidance, or directive that discriminates against a "firearm entity" or "firearm trade association" as those teats are defined in Texas Government Code section 2274.001 and (2) will not discrhnniate during the temp of the Contract against a firearm entity or firearm trade association. If Subrecipient does not make that verification, Subrecipient must notify the GLO and state why the verification is not required. 42. If Subrecipient is a "professional sports learn" as defined by Texas Occupations Code Section 2004.002, Subrecipient will play the United States national anthem at the beginning of each team sporting event held at Subreeipient's home venue or other venue controlled by Subrecipient for the event. Failure to comply with this obligation constitutes a default of this Contract, and immediately subjects Subrecipient to the penalties for default, such as repaytneml of money received or ineligibility, for additional nmoney. lit addition, Subrecipient may be debarred from contracting with the State. 'Cie GLO or the Attorney General may strictly enforce this provision. 43. To the extent Section 552.371 of the Texas Government Code applies to Subrecipient and the Contract, in accordance with Section 552.372 of the Texas Government Code, Subrecipient must (a) preserve all contracting infornation related to the Contract in accordance with the records retention requirements applicable to the GLO for the duration of the Contract, (b) no later than the tenth business day after the date of the GLO's request, provide to the GLO any contracting information related to the Contract that is in Subrecipient's custody or possession, and (c) on termination or expiration of the Contract, either (i) provide to flue GLO at no cost all contracting information related to tine Contract that is in Subrecipient's custody or possession or (ii) preserve the contracting infornation related to the Contract in accordance with the records retention requirements applicable to the GLO. Except as provided by Section 552.374(e) of the Texas Government Code, the requirements of Subchapter ,I, Chapter 552, Government Code, may apply to the Contract and Subrecipient agrees that the Contract may be terminated if Subrecipient knowingly or intentionally fails to comply with a requirement of that subchapter. 44. If the Contract is for consulting seriices governed by Chapter 2254 of the'1'exas Government. Code, Subrecipient. upon completion of the Contract, must give the GLO a compilation, in it err.d.m.-M V Page lour m digital medium agreed to by the parties, of all documents, Films, recordings, or reports Subrecipient compiled in connection with its perFomuntce under the Contract. ATTORNEY'S REVIEW CERTIFICATION Bid No. 2024.05 — Seadrift Drainage Improvements Project — GILD Contract No. 22-085-014-D245 for Calhoun County, Texas I, the undersigned, representative of the Calhoun County, do hereby certify as follows: the duly authorized and acting legal I have examined the attached contract(s) and surety bonds and am of the opinion that each of the agreements may be duly executed by the proper parties, acting through their duly authorized representatives; that said representatives have full power and authority to execute said agreements on behalf of the respective parties; and that the agreements shall constitute valid and legally binding obligations upon the parties executing the same in accordance with terms, conditions and provisions thereof. Attorney's signature: Print Attorney's Name: Texas State Bar Number: Date: CONTRACTOR'S FINAL PAYMENT AFFIDAVIT County: Calhoun County, Texas CDBG-MIT No: 22-085-014-D245 Contractor: Date: BEFORE ME, THE UNDERSIGNED AUTHORITY, on this day personally appeared who being duly sworn, on oath, says that he is a duly authorized representative of Contractor, and that all terms of the Contract for the completion of certain public works described Ias Bid No. 2024.05 — Seadrift Drainage Improvements Project — GLO Contract No. 22-085-014-D245 for Calhoun County, Texas have been satisfactorily completed and that ALL sums of money for payrolls, bills for material and equipment, and other indebtedness connected with the Work for the Owner or its property might in any way be responsible to the best of my knowledge and belief, have been paid or will be paid or otherwise satisfied within thirty days after receipt of final payment from the Owner, or within the period of time required by Article 601f, Vernon's Civil Statutes. Payments not made in full at the time of this affidavit are listed below. FINAL PAYMENTS pending as of this date hereof are: None Pending As Listed Below Individual or Co. Name Mailing Address Amount Owed Signature Title Affidavit must be signed by an individual owner or partner in partnership, or by a person authorized by by-laws or Board of Directors to sign for a corporation. If Contractor is a joint venture or partnership of individuals, either may sign, but if ajoint venture in which a corporation is a party, separate affidavits must be executed by each corporation and by each individual owner or partnership. In the event subcontractors, laborers, or material suppliers have not been paid in full, the Contractor shall list here on the amount owed and the name and address of each subcontractor, laborer, or material supplier to whom such payment is owed. Sworn and Subscribed before me this, the (SEAL) Notary Public in and for County, Texas day of _, 20 COMMUNITY DEVELOPMENT & REVITALIZATION The Texas General Land Office Construction Change Order Request NOTE: Texas Local Government Code Sec. 262.031 nCHANGESIN PLANS AND SPECIFICATIONS" regulations apply. Generally, a cumulative Ingress in the contract price in excess of 25%ore cumulative decreese in excess of 18%are disallowed. Subrecipient GLO Contract Number: Date: Engineer Name Address & Phone Subreciplent Name, Address, & Phone Number: Contractor Name, Address & Phone Number: Project #: Bid Package #: Change Order #: Contract Origination Date — Project Description: You are hereby requested to comply with the following changes from the contract plans and specifications. Item No. Description of Changes: Quantities, Units, Unit Prices, Change In Completion Decrease in Contract Price Increase in Contract Schedule etc. Price Change in Construction Contract Price Original Contract Price: Cumulative Previous Change Order(s) Total: Contract Price Prior to this Change Order: Not Increase/Decrease of this Change Order: oaa oucam < w nuu auu,uunm ernnua Change in Contract Time (Calendar Devsl Original Contract Time In Days: Net Change from Previous Change Order(s) in Days Contract Time Prior to this Change Order in Days Net Increase/Decrease of this Change Order In Days: Effective June 2020 Page 1 of 3 Contract Price with All 1 Approved Change Orders:rs: Cumulative Change in Contr Construction St COMMUNITY DEVELOPMENT & REVITALIZATION The Texas General Land Office Construction Change Order Request Contract Time with All Approved Change Orders in Days: Subrecipient Contract End Date: Construction Contract End Date: In this change order are subject to review by GLO-CDR. *This document may be executed prior to submission for GLO-CDR review, but all parties involved will be held responsible If the change order or amendment warranted as a result of this change order Is not in compliance with CDBG or HUD Requiremements Subrecipient Signature Engineer Signature Contractor Signature Subrecipient Nam and Title (Printed) Engineer Name and Subrecipient Signature Engineer Signature Contractor Signature Justification for Changa Order 1. Will this change order increase or decrease the number of beneficiaries? If there is a change, how many beneficiaries will be affected? 2. Effect of this change on the scope of work: 3. Effect on operation and maintenance costs: ❑ Increase [Decrease ❑ No Change Total LMI� ❑ Increase [Decrease El No Change ❑ Increase [Decrease El No Change 4. Are all prices In the change order dependent upon unit prices found In the original bid? ❑ Yes C No 5. Has the change created new circumstances or environmental conditions which may affect ❑ Yes C No the project's impact, such as concealed or unexpected conditions discovered during actual construction? _ Effective June 2020 Page 2 of 3 COMMUNITY DEVELOPMENT & REVITALIZATION The Texas General Land Office Construction Change Order Request 8. Is the Texas Council on Environmental Quality (TCEQ) clearance still valid (if applicable)? ❑ Yes C No 7. Is the CCN permit still valid? (sewer projects only) ❑ Yes E No 8. Are the disability access requirements/approval still valid (If applicable)? ❑ Yes C No 9. Are other Disaster Recovery contractural special condition clearances still valid? ❑ Yes E No If "no", explain: Disclaimer. The Texas General Land Office has made everyeffort to ensure the information contained on this form Is accurate and In compliance with the mostup-to-date CDBG-DR and/or CDBG-MIT federal rules and regulations, as applicable. Itshould be noted that the Texas General Land Office assumes no liability orresponsibllltyforany error or omission on thisform that may result from the interim period between the publication of amended and/orrevlsed federal rules and regulations and the Texas General Land offices standard review and updateschedule, Effective June 2020 Page 3 of 3 COMMUNITY DEVELOPMENT & REVITALIZATION The Texas General Land Office Certificate of Construction Completion Subrecipient: I I Contract #: This is to certify that a final Inspection of the project described below was conducted on Contract was entered into on between the oity/county of I -and I ifor the construction of This Is to further certify that: 1. The work has been completed In accordance with the plans and specifications and all addenda, change orders, and supplemental agreements thereto, with the following exceptions: 2. The sum of I , deducted from the final payment to the Contractor is a fair and equitable settlement for the foregoing excepted work. 3. The Contractor has presented on behalf of itself and Its sureties, satisfactory evidencethat he or she will repair, replace or make good any faulty workmanship and/or materials discovered In the work within a period of from this date, as provided in the Contract. 4. Amount of Original Contract: Cumulative Change Orders: Final Amount of Contract: Less Previous Payments: Less Deductions (from #2 above): FINAL PAYMENT (Balance): 5. The Final Payment in the amount above is now due and payable. 5. Final Quantities: Project Name Description Activity Code (dropdown) (from Performance Standard) (What Is your ActivIW) Quantity Metric (dropdown) Effective June 2020 Page 1 of 2 COMMUNITY DEVELOPMENT & REVITALIZATION i' The Texas General Land Office Certificate of Construction Completion Activity Code (dropdown) Project Name (from Performance Standard) Description (What Is your Activity?) Quantity Metric (dropdown) Certified by =ugmeei s of naw:a contractors signature 5ubrecl tents signature Engineer's Name and Title (Printed) Contractor's Name and Title (Printed Subrecipient Name and Title (Printed) Firm Disclaimer: The Texas General Land Office has made every effort to ensure the Information contained on this form Is accurate and In compliance with tine most up-to-date CDBG-DR and/or COBG-MIT federal rules and regulations, as applicable. It should be noted that the Texas General Land Office assumes no liability or responsibility for any error or omission on this form that may result from the Interim period between the publication of amended andlor revised federal rules and regulations and the Texas General Land offices standard review and update schedule. Effective June 2020 Page 2 of 2 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY GOVERNING TECHNICAL SPECIFICATIONS AND SPECIAL PROVISIONS ALL SPECIFICATIONS AND SPECIAL PROVISIONS APPLICABLE TO THIS PROJECT ARE IDENTIFIED AS FOLLOWS: NON-TXDOT GENERAL REQUIREMENTS: 01025 Application for Payment Requirements 01040 Project Coordination 01200 Project Meetings 01210 Allowances 01340 Shop Drawings, Project Data and Samples 01410 Inspection, Testing and Guarantee 01500 Temporary Facilities 01525 Trench Excavation Safety Requirements 01700 Contract Closeout Requirements NON-TXDOT SPECIFICATION: ITEM 999 ENGINEERED TURF (HYDROTURF Z OR EQUIVALENT) STANDARD SPECIFICATIONS: ADOPTED BY THE TEXAS DEPARTMENT OF ------------------------ TRANSPORTATION NOVEMBER 1, 2014. STANDARD SPECIFICATIONS ARE INCORPORATED INTO THE CONTRACT BY REFERENCE. ITEM 104 REMOVING CONCRETE ITEM 110 EXCAVATION (132) ITEM 132 EMBANKMENT(100)(160)(204)(210)(216)(260)(400) ITEM 158 SPECIAL EXCAVATION WORK (132) ITEM 162 SODDING FOR EROSION CONTROL (166)(168) ITEM 164 BROADCAST SEED (162)(166) ITEM 247 FLEXIBLE BASE (105)(204)(210)(216) ITEM 260 LIME TREATMENT(204)(210)(216)(300)(310)(520) ITEM 310 PRIME (300)(316) ITEM 316 SEAL COAT (210)(300)(302)(520) ITEM 400 EXCAVATION AND BACKFILL FOR STRUCTURES (110)(132)(401) (402) (403) (416) (420) (421) (423) ITEM 409 PRESTRESSED CONCRETE PILING (404)(405)(420)(421)(424) (425)(440) ITEM 420 CONCRETE SUBSTRUCTURES (400)(404)(421)(422)(426)(427) (440)(448) GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY ITEM 422 CONCRETE SUPERSTRUCTURES (421)(438)(440)(448)(454) ITEM 425 PRECAST PRESTRESSED CONCRETE STRUCTURAL MEMBERS (420) (421)(424)(426)(427)(434)(440)(442)(445)(448) ITEM 432 RIPRAP (247)(420)(421)(431)(440) ITEM 450 RAILING (421)(440)(441)(442)(445)(540) ITEM 460 CORRUGATED METAL PIPE (400) ITEM 462 CONCRETE BOX CULVERTS AND DRAINS (400)(420)(421)(424) (440)(464) ITEM 464 REINFORCED CONCRETE PIPE ((400)(464) ITEM 465 JUNCTION BOXES, MANHOLES AND INLETS (400(421)(440)(471) ITEM 466 HEADWALLS AND WINGWALLS (400)(421)(440) ITEM 467 SAFETY END TREATMENT 400)(420)(421)(432)(440)(442)(445) (460)(464) ITEM 496 REMOVING STRUCTURES ITEM 500 MOBILIZATION ITEM 502 BARRICADES, SIGNS, AND TRAFFIC HANDLING ITEM 506 TEMPORARY EROSION, SEDIMENTATION, AND ENVIRONMENTAL CONTROLS (161)(432)(556) ITEM 530 INTERSECTIONS, DRIVEWAYS, AND TURNOUTS (247)(260)(263) (275)(276)(292)(316)(330)(334)(340)<341>(360)(421)(440) <3076> ITEM 540 METAL BEAM GUARD FENCE (421)(441)(445) ITEM 544 GUARDRAIL END TREATMENTS ITEM 644 SMALL ROADSIDE SIGN ASSEMBLIES (421)(440)(441)(442) (445)(636)(643)(656) ITEM 658 DELINEATOR AND OBJECT MARKER ASSEMBLIES (445) ITEM 752 TREE AND BRUSH REMOVAL ITEM 760 CLEANING AND RESHAPING DITCH SPECIAL PROVISIONS: SPECIAL PROVISIONS WILL GOVERN AND TAKE SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION SPECIAL PROVISION PRECEDENCE OVER THE SPECIFICATIONS ENUMERATED HEREON WHEREVER IN CONFLICT HEREWITH. TO ITEM 162 (164---002) TO ITEM 247 (247---003) TO ITEM 300 (300--- 020) TO ITEM 316 (316--- 002) TO ITEM 340 (340--- 004) TO ITEM 341 (341--- 004) TO ITEM 421 (421--- 009) TO ITEM 440 (440--- 004) TO ITEM 441 (441--- 004) TO ITEM 442 (442--- 001) TO ITEM 464 (464--- 001) TO ITEM 502 (502--- 008) GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY SPECIAL PROVISION TO ITEM 520 (520--- 002) SPECIAL SPECIFICATIONS: ITEM 3076 DENSE -GRADED HOT -MIX ASPHALT <300><301><316><320><340> <341><342><347><348><520><585><3079><3081><3082><3096> ITEM 3096 ASPHALTS, OILS, AND EMULSIONS ITEM 4122 THERMOPLASTIC PIPE <400><401><467> ITEM 5048 FLOATING TURBIDITY BARRIER ITEM 7218 WATER MAINS AND SANITARY SEWERS GENERAL: THE ABOVE -LISTED SPECIFICATION ITEMS ARE THOSE UNDER ------- WHICH PAYMENT IS TO BE MADE. THESE, TOGETHER WITH SUCH OTHER PERTINENT ITEMS, IF ANY, AS MAY BE REFERRED TO IN THE ABOVELISTED SPECIFICATION ITEMS, AND INCLUDING THE SPECIAL PROVISIONS LISTED ABOVE, CONSTITUTE THE COMPLETE SPECIFICATIONS FOR THIS PROJECT. TxDOT Specifications are available online at: https://www.txdot.gov/businessiresources/txdot-specifications.htmi DIVISION 1- GENERAL REQUIREMENTS SECTION 01025 - APPLICATION FOR PAYMENT REQUIREMENTS In order for CONTRACTOR to receive Progress Payments under the Contract, the following items shall be submitted to ENGINEER for review. a. An Application for Payment, certified and sworn as correct by CONTRACTOR. b. A sworn certification of no claims and appropriate waivers of liens. Such certification and waivers shall be as found herein as the "CONTRACTOR's CONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT", and if applicable, the "SUBCONTRACTOR'S CONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT". 01025-1 THE STATE OF TEXAS COUNTY OF Project: BID NO.2024.05 - SEADRIFT DRAINAGE IMPROVEMENTS PROJECT - GLO CONTRACT NO.22-085-014-D245 FOR CALHOUN COUNTY, TEXAS Job No. 5310.013a On receipt by the signer of this document of a check from CALHOUN COUNTY (maker of check) in the sum of $ payable to (payee or payees of check) and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position that the signer has on the property or easements of CALHOUN COUNTY (owner) located in Seadrift, Texas to the following extent: Bid No. 2024.05 - Seadrift Drainage Improvements Project - GLO Contract No. 22-085-014-D245 for Calhoun County, Texas (job description). This release covers a progress payment for all labor, services, equipment, or materials furnished to the property or to CALHOUN COUNTY (person with whom signer contracted) as indicated in the attached statement(s) or progress payment request(s), except for unpaid retention, pending modifications and changes, or other items furnished. Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the funds received from this progress payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project in regard to the attached statement(s) or progress payment request(s). 01025-2 Signed By: Print Name: SUBSCRIBED AND SWORN TO BEFORE ME by on (CONTRACTOR'S NAME) 20_, to certify which witness my hand and seal of office. Notary Public, State of Texas 01025-3 THE STATE OF TEXAS COUNTY OF Project: BID NO.2024.05 - SEADRIFT DRAINAGE IMPROVEMENTS PROJECT - GLO CONTRACT NO.22-085-014-D245 FOR CALHOUN COUNTY, TEXAS Job No. 5310.013a On receipt by the signer of this document of a check from (maker ofcheck) in the sum of $ payable to (payee or payees ofcheck) and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position that the signer has on the property or easement of CALHOUN COUNTY (owner) located in Seadrift, Texas (location) to the following extent Bid No. 2024.05 - Seadrift Drainage Improvements Project - GLO Contract No. 22- 085-014-D245 for Calhoun County, Texas (job description). This release covers a progress payment for all labor, services, equipment, or materials furnished to the property or to (person with whom signer contracted) as indicated in the attached statement(s) or progress payment request(s), except for unpaid retention, pending modifications and changes, or other items furnished. Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the funds received from this progress payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project in regard to the attached statement(s) or progress payment request(s). 01025-4 (SUBCONTRACTOR'S NAME) Signed By: Print Name: Title: SUBSCRIBED AND SWORN TO BEFORE ME by , on 20_, to certify which witness my hand and seal of office. Notary Public, State of Texas END OF SECTION 01025-5 DIVISION 1 - GENERAL REQUIREMENTS SECTION 01040 - PROJECT COORDINATION .01 GENERAL: a. This section specifies administrative and supervisory requirements necessary for project coordination including, but not necessarily limited to: 1. Coordination. 2. Administrative and supervisory personnel. 3. General installation provisions. b. Progress meetings, coordination meetings and preinstallation conferences are included in Section 01200, 'Project Meetings." .02 COORDINATION: a. Coordination: Coordinate construction activities included under various sections of these Specifications to assure efficient and orderly installation of each part of the Work. Coordinate construction operations included under different sections of the Specifications that are dependent upon each other for proper installation, connection, and operation. Where installation of one part of the Work is dependent on installation of other components, either before or after its own installation, schedule construction activities in the sequence required to obtain the best results. 2. Where availability of space is limited, coordinate installation of different components to assure maximum accessibility for required maintenance, service and repair. 3. Make adequate provisions to accommodate items scheduled for later installation. 4. Prepare memoranda for distribution to each party involved outlining special procedures required for coordination. Include such items as required-- notices, reports and attendance at meetings. 01040-1 b. Administrative Procedures: Coordinate scheduling and timing of required administrative procedures with other construction activities to avoid conflict and ensure orderly progress of the Work. Such administrative activities include, but are not limited to, the following: Preparation of schedules. 2. Installation and removal of temporary facilities. Delivery and processing of submittals. 4. Progress meetings. 5. Project close-out activities. .03 SUBMITTALS: Any CONTRACTOR submitting proposals shall provide proposed organization charts, listing both home and field office personnel to be assigned to the project. a. Within 15 days of Notice to Proceed, submit a list of the CONTRACTOR's principal staff assignments, including the superintendent and other personnel in attendance at the site; identify individuals, their duties and responsibilities; list their addresses and telephone numbers. b. Post copies of the list in OWNER's office, the temporary field office, and at each temporary telephone. .04 GENERAL INSTALLATION PROVISIONS: a. Comply with manufacturer's installation instructions and recommendations to the extent that those instructions and recommendations are more explicit or stringent than requirements contained in Contract Documents. b. Inspect materials or equipment immediately upon delivery and again prior to installation. Reject damaged and defective items. C. Recheck measurements and dimensions before starting installation procedure. d. Install each component during weather conditions and point in project sequence that will ensure the best possible results. Isolate each part of the completed construction from incompatible material as necessary to prevent deterioration. e. Coordinate temporary enclosures with required inspections and tests to minimize the necessity of uncovering completed construction for that purpose. 01040-2 .05 CLEANING AND PROTECTION: a. During handling and installation, clean and protect construction in progress and adjoining materials in place. Apply protective covering where required to ensure protection from damage or deterioration at Substantial Completion. b. Supervise construction activities to ensure that no part of the construction, completed or in progress, is subject to harmful, dangerous, damaging, or otherwise deleterious exposure during the construction period. Where applicable, such exposures include, but are not limited to, the following: Excessive static or dynamic loading. 2. Excessive internal or external pressures. 3. Heavy traffic. 4. Vibration from adjacent activity. END OF SECTION 01040-3 DIVISION 1 - GENERAL REQUIREMENTS SECTION 01200 - PROJECT MEETINGS .01 GENERAL: a. This section specifies administrative and procedural requirements for project meetings including but not limited to: Preconstruction conference. 2. Preinstallation conferences. 3. Coordination meetings. 4. Progress meetings. .02 PRECONSTRUCTION CONFERENCE: a. Schedule a Preconstruction Conference and organizational meeting at the project site or other convenient location no later than 15 days after execution of the Agreement and prior to commencement of construction activities. Conduct the meeting to review responsibilities and personnel assignments with OWNER. b. OWNER, ENGINEER, CONTRACTOR and major subcontractors shall each be represented at the conference by persons familiar with and authorized to conclude matters relating to the Work. C. Discuss items of significance that could affect progress including such topics as: Tentative construction schedule. 2. Critical work sequencing. 3. Designation of responsible personnel. 4. Procedures for processing field decisions and Change Orders. 5. Procedures for processing applications for payment. 6. Distribution of Contract Documents. Submittal of shop drawings, product data and samples. 8. Preparation of record documents. 01200-1 9. Use of the premises. 10. Office, work and storage areas. 11. Equipment deliveries and priorities. 12. Safety procedures. 13. First aid. 14. Security. 15. Housekeeping. 16. Working hours. .03 PREINSTALLATION MEETINGS: a. Preinstallation meetings will be held prior to beginning installation of critical work items. These items include but are not limited to: 1. Prestressed concrete piles. 2. Cast -in -place concrete. 3. Erection of precast concrete panels. b. These meetings shall be attended by all persons involved in the supervision, inspection and quality control of the Work. Those required to attend are as follows: 1. OWNER's project ENGINEER and inspector. 2. CONTRACTOR's project engineer and Superintendent. 3. Subcontractor's Superintendent. 4. CONTRACTOR's quality control person. 5. Crew foremen. C. Agenda shall include: 1. Layout, horizontal and vertical control, etc. 2. Equipment and materials required. 01200-2 3. Specific methods to be used for installation. 4. Review of applicable Specification. .04 COORDINATION MEETING: a. OWNER reserves the right to schedule and conduct coordination meetings at his option. b. CONTRACTOR may conduct coordination meetings with his subcontractors, but OWNER shall be invited to such meetings. C. Review and solve operational conflicts between subcontractors, suppliers and/or OWNER's operations. .05 PROGRESS MEETINGS: a. OWNER reserves the right to schedule and conduct weekly meetings at his option. b. CONTRACTOR shall conduct progress meetings at the project site at regularly sch9duled intervals. C. Review and correct or approve minutes of the previous progress meeting. Review other items of significance that could affect progress. Include topics for discussion as appropriate to the current status of the project. d. Review progress since the last meeting. Determine where each activity is in relation to CONTRACTOR's construction schedule, whether on time or ahead or behind schedule. Determine how construction behind schedule will be expedited; secure commitments from parties involved to do so. Discuss whether schedule revisions are required to ensure that current and subsequent activities will be completed within the Contract Time. e. Review the present and future needs of each entity present, including such items as: Interface requirements. 2. Time. 3. Sequences. 4. Site utilization. 5. Hours of work. 6. Hazards and risks. 01200-3 Housekeeping. 8. Quality and work standards. 9. Change Orders. 10. Documentation of information for payment requests. £ No later than three days after each progress meeting date, distribute copies of minutes of the meeting to each parry present and to other parties who should have been present. Include a brief summary, in narrative form, of progress since the previous meeting and report. g. Revise the construction schedule after each progress meeting where revisions to the schedule have been made or recognized. Issue the revised schedule concurrently with the report of each meeting. END OF SECTION 01200-4 DIVISION 1 - GENERAL REQUIREMENTS SECTION 01210 - ALLOWANCES PART I - GENERAL I.1 RELATED DOCUMENTS A. Drawings and general provisions of the Contract, including General and Supplementary Conditions and other Division Specification Sections, apply to this Section. 1.3 SUMMARY A. Section includes administrative and procedural requirements governing allowances. Certain items are specified in the Contract Documents by allowances. Allowances have been established in lieu of additional requirements and to defer selection of actual services, materials and equipment to a later date when direction will be provided to Contractor. If necessary, additional requirements will be issued by Change Order. B. Types of allowances include the following: 1. Testing allowances. 1.4 DEFINITIONS A. Allowance: A quantity of work or dollar amount included in the Contract, established in lieu of additional requirements, used to defer selection of actual services, materials and equipment to a later date when direction will be provided to Contractor. If necessary, additional requirements will be issued by Change Order. 1.5 SELECTION AND PURCHASE A. At the earliest practical date after award of the Contract, advise Engineer of the date when final selection of s e r v i c e p r o v i d e r described by an allowance must be completed to avoid delaying the Work. B. At Engineer's request, obtain proposals for each allowance for use in making final selections. Include recommendations that are relevant to performing the Work. 01210-1 C. Execute agreement from the designated service provider. 1.6 SUBMITTALS A. Submit proposals for purchase of services included in allowances, in the form specified for Change Orders. 1.7 INFORMATIONAL SUBMITTALS A. Submit invoices to show actual quantities of services provided for the project for use in fulfillment of each allowance. B. Submit time sheets and other documentation to show labor time and cost for coordination of allowance items that include installation as part of the allowance. C. Coordinate and process submittals for allowance items in same manner as for other portions of the Work. 1.8 COORDINATION A. Coordinate allowance items with other portions of the Work. Furnish templates/schedules as required to coordinate these services. 1.9 TESTING ALLOWANCES A. Use the testing allowance only as directed by Engineer for Owner's purposes and only by Change Orders that indicate amounts to be charged to the allowance. B. Contractor's overhead, profit, and related costs for products and equipment ordered by Owner under the testing allowance are included in the allowance and are not part of the Contract Sum. These costs include coordination, meetings, taxes, insurance, equipment rental, and similar costs. C. Change Orders authorizing use of funds from the testing allowance will include Contractor's related costs and reasonable overhead and profit margins. D. At Project closeout, credit unused amounts remaining in the allowance to Owner by Change Order. 1.10 ADJUSTMENT OF ALLOWANCES A. Allowance Adjustment: To adjust allowance amounts, prepare a Change Order proposal based on the difference between purchase amount and the allowance, multiplied by final measurement of work -in -place where 01210-2 applicable. Include installation costs in purchase amount only where indicated as part of the allowance. If requested, prepare explanation and documentation to substantiate distribution of overhead costs and other margins claimed. 3. Submit substantiation of a change in scope of work, if any, claimed in Change Orders related to unit -cost allowances. 4. Owner reserves the right to establish the quantity of work -in - place by independent quantity survey, measure, or count. B. Submit claims for increased costs because of a change in scope or nature of the allowance described in the Contract Documents, whether for the purchase order amount or Contractor's handling, labor, installation, overhead, and profit. Do not include Contractor's or subcontractor's indirect expense in the Change Order cost amount unless it is clearly shown that the nature or extent of work has changed from what could have been foreseen from information in the Contract Documents. 2. No change to Contractor's indirect expense is permitted for selection of higher- or lower- priced materials or systems of the same scope and nature as originally indicated. C. Deniable use of allowance, shall include: 1. Re -testing, additional services, additional trips, and additional overhead associated with failed test. Reference technical specification 01410. 2. Testing fees completed outside of normal business hours and days, which are the result of being behind schedule or lack of preparation and/or scheduling. 3. Invoices received after close-out of the project and retainage released. It shall be the CONTRACTOR's responsibility to ensure all invoices are paid and received prior to close out. PART 2 - PRODUCTS (Not Used) 01210-3 PART 3 - EXECUTION 3.1 DOCUMENTS/RESULTS A. All testing results shall be made available to ENGINEER at all times, and testing service provider shall provide a copy of results to ENGINEER at the time they are transmitted to CONTRACTOR. 3.2 PREPARATION A. Coordinate services for each allowance with related materials and installations to ensure that each allowance item is completely integrated and interfaced with related work. 3.3 SCHEDULE OF ALLOWANCES A. Allowance No. 1 (Base Bid) (Testing): Include the net sum of Sixty Thousand Dollars ($60,000.00) to be used as directed by the Engineer for making change orders associated with testing for the betterment of the project. All change orders using monies from this allowance will be coordinated and approved by the Owner prior to work being done. B. Allowance No. 3 (Owner's Option A) (Testing): Include the net sum of Four Thousand Dollars ($4,000.00) to be used as directed by the Engineer for making change orders associated with testing for the betterment of the project. All change orders using monies from this allowance will be coordinated and approved by the Owner prior to work being done. END OF SECTION 01210-4 DIVISION 1 - GENERAL REQUIREMENTS SECTION 01340 - SHOP DRAWINGS, PRODUCT DATA AND SAMPLES .01 GENERAL: a. Submit shop drawings, product data and samples required by specification sections. b. Shop drawings, product data and samples are not considered a part of Contract Documents. C. Schedule submissions at least 10 days before reviewed submittals will be needed. .02 CONTRACTOR RESPONSIBILITIES: a. Review shop drawings, project data and samples prior to submission. b. Verify: 1. Field measurements. 2. Field construction criteria. 3. Catalog numbers and other data. 4. Conformance with submission requirements. C. Coordinate each submittal with Contract Documents and the work requirements to prevent any delay in the work. d. CONTRACTOR's responsibility for errors and omissions is not relieved by ENGINEER's review of submittals. e. At time of submission and in writing, notify ENGINEER of submittal deviations from Contract Documents. f. CONTRACTOR's responsibility for deviations from Contract Documents is not relieved by ENGINEER's review of submittals, unless ENGINEER gives written acceptance of specific deviations. g. Begin no Work related to submittals until return of submittals with ENGINEER's stamp and initials or signature indicating review. h. Distribute copies after ENGINEER's review. 01340-1 .03 ENGINEER'S DUTIES: a. Review submittals with reasonable promptness to prevent any delay in the Work. b. Review for conformance with: 1. Design concept of project. 2. Contract Documents. C. Review of a separate item does not constitute review of an assembly in which the item functions. d. Return to CONTRACTOR those submittals which do not meet the requirements and require correction and resubmission. e. Affix stamp and initials or signature certifying review of submittal. f. Return reviewed submittals to CONTRACTOR for distribution. .04 PREPARATION REQUIREMENTS: a. Shop Drawings: 1. Preparation by a qualified detailer. 2. Sheet size same as Contract Drawings. 3. Identify details by reference to sheet and detail numbers on Contract Drawings. 4. Include on the drawing all information required for submission or prepare a transmittal letter. 5. Prepare one reproducible transparency and one opaque print of each shop drawing. b. Product Data: 1. Modify manufacturer's standard schematic drawings to delete or supplement information as applicable. 2. For manufacturer's catalog sheets, brochures, diagrams, schedules, performance charts, illustrations and other descriptive data: (a) Clearly mark each copy to identify pertinent materials, products or models. (b) Show dimensions and clearances required. 01340-2 (c) Show performance characteristics and capacities. (d) Show wiring diagrams and controls. 3. Include on the data all information required for submission or prepare a transmittal letter. 4. Prepare number of copies which the CONTRACTOR requires for distribution plus two copies to be retained by ENGINEER. C. Samples: Obtain office samples of sufficient size and quantity to clearly illustrate: (a) Functional characteristics of products or materials with integrally related parts and attachment devices. (b) Full range of color samples. 2. Erect field samples and mock-ups at the project site in an acceptable location. Construct each sample complete, including work of all trades required in finished work. 3. Include on transmittal letter all information required for submission. 4. Prepare the number of samples specified in specification sections. .05 SUBMISSION REQUIREMENTS: a. Submit shop drawings, product data and samples in the form and quantity specified. b. Accompany submittals with a transmittal letter in duplicate, as required. C. Include the following information for each submittal: 1. Date and revision dates. 2. Project title and number. 3. The names of: (a) ENGINEER (b) CONTRACTOR (c) Subcontractor (d) Supplier (e) Manufacturer (f) Separate detailer when pertinent. 01340-3 4. Identification of product or material. 5. Relation to adjacent structure of materials. 6. Field dimensions clearly identified as such. 7. Specification section number. 8. Applicable standards, such as ASTM number or Federal Specification. 9. A blank space, 4" x 4", for ENGINEER's review stamp. 10. Identification of deviations from Contract Documents. 11. CONTRACTOR's stamp, initialed or signed, certifying review of submittal, verification of field measurements and compliance with Contract Documents. .06 RESUBMISSION REQUIREMENTS: a. Shop Drawings: 1. Revise initial drawings as required and resubmit as specified for initial submittal. 2. Indicate on drawings any changes which have been made other than those requested by ENGINEER. b. Product Data and Samples: Submit new data and samples as required for initial submission. .07 DISTRIBUTION AFTER REVIEW: a. Distribute copies of shop drawings and product data which carry ENGINEER's stamp to: 1. CONTRACTORS file 2. Job site file 3. Record document file 4. Other prime CONTRACTORS 5. Subcontractors 6. Supplier 7. Fabricator b. Distribute samples as directed. After review, samples may be used in construction. END OF SECTION 01340-4 DIVISION 1- GENERAL REQUIREMENTS SECTION 01410 - INSPECTION. TESTING AND GUARANTEE .01 GENERAL: These requirements supplement those provided under Article 13 of the General Conditions. .02 INSPECTION: a. Inspector: A representative of ENGINEER or OWNER will be assigned authority to observe and inspect the Work. b. Working Dam: Inspectors are not required to work on Saturdays, Sundays or legal holidays. If CONTRACTOR plans work on a Saturday, Sunday or legal holiday, prior arrangements should be made for an inspector not later than 48 hours on the working days before the Saturday, Sunday or legal holiday. C. Uninspected Work: Any Work performed on Saturday, Sunday, or a legal holiday without benefit of any inspection may require removal and replacement if directed by ENGINEER. Removal and replacement will be completed at no additional cost. .03 TESTING: a. The cost of preparing and testing, and the cost of other laboratory services required for establishing the concrete mix, and redesigning the mix, if necessary, shall be borne by CONTRACTOR. See Section 01210 — Allowances. These tests shall also include, but not necessarily limited to: Compaction Testing, Concrete Strength Testing, Concrete Slump Testing, Subgrade Stabilization Depth Testing, Subgrade Gradation Testing, Base Material Testing, Asphalt Placement Testing and Density Testing. CONTRACTOR shall furnish at his own expense, suitable evidence that all the materials he proposes to incorporate into the Work are in accordance with the Specifications. Mill tests for reinforcing steel and cement will be acceptable if it is definite that the test sheets apply to the material being furnished. Manufacturer's or supplier's test results will be acceptable for such items as pipe and fittings, when it is definite that the materials being furnished is that to which the test results apply. Should CONTRACTOR fail to provide the above information, ENGINEER shall have the right to require tests to be made by OWNER's laboratory to obtain the information and the cost therefore shall be borne by CONTRACTOR. 01410-1 03/30/21 C. In any event, ENGINEER may have further tests made by commercial laboratory, or may make tests himself, to ensure that the Specifications are complied with by CONTRACTOR. Costs of these tests will be borne by CONTRACTOR. Should OWNER wish to have a third -party testing performed to confirm test results supplied by CONTRACTOR then those tests shall be paid for by OWNER, unless those results come back with unsatisfactory construction and/or materials. Should results come back unsatisfactory then the cost associated with the OWNER's testing shall be paid for by CONTRACTOR and retested at CONTRACTOR's expense. Work shall not commence further until OWNER and ENGINEER are provided evidence showing that unsatisfactory results and areas have been addressed and receiving passing results. .04 GUARANTEE: a. CONTRACTOR shall deliver to ENGINEER upon completion of all Work under the Contract his written guarantee, in the form of SECTION 01700 - CONTRACT CLOSEOUT REQUIREMENTS, made out to OWNER, guaranteeing all of the Work under the Contract to be free from faulty materials in every particular and free from improper workmanship; and against injury from proper and usual wear; and agreeing to replace or to re -execute without cost to OWNER such Work as may be found to be improper or imperfect; and to make good all damage caused to other Work or materials, due to such required replacement or re -execution. This guarantee shall be made to cover a period of one (1) year from the date of completion of all Work under this Contract, as evidenced by ENGINEER's final certificate. This guarantee must be furnished to ENGINEER and approved by ENGINEER before acceptance and final payment is made. b. CONTRACTOR shall provide OWNER with copies of all guarantees or warranties which have been made to CONTRACTOR by suppliers or subcontractors as required hereunder, together with an assignment of such warranties and guarantees to OWNER; however, such assignment shall not relieve CONTRACTOR of the responsibility (stated in subparagraph a. above) in case of failure of subcontractors or suppliers to fulfill the provisions of such warranties or guarantees. C. Neither the final certificate, nor payment, nor any provision in the Contract Documents shall relieve CONTRACTOR of responsibility for neglect of faulty materials or workmanship during the period covered by the guarantee. END OF SECTION 01410-2 03/30/21 DIVISION 1 - GENERAL REQUIREMENTS SECTION 01500 - TEMPORARY FACILITIES .01 FIELD OFFICE: If CONTRACTOR is required (or is so inclined) to provide a Temporary Field Office, said office shall be placed, unless otherwise approved in writing, at a site selected by CONTRACTOR and approved by ENGINEER. The building shall be weatherproof and be provided with doors and locks, electric illumination and adequate ventilation. The floor of the building shall be raised above the ground. A complete set of Contract Drawings and Specifications shall be kept in the temporary office throughout the construction period and shall be accessible for use by OWNER and ENGINEER. The building shall be maintained in a clean condition throughout the Contract period and shall be removed from the site upon completion of all Work. .02 SANITARY FACILITIES: CONTRACTOR shall make all arrangements and furnish all materials required to obtain any needed sanitary facilities and to satisfy the requirements of local or state health authorities, ordinances, and laws. .03 STORAGE OF MATERIALS: a. No materials shall be stored nor shall any equipment be parked on adjacent property without the expressed consent of owner of the property concerned. b. Secure and watertight storage facilities of suitable size with floors raised above the ground shall be provided for materials liable to damage from exposure to the weather. Other materials shall be stored on blocks off the ground. Materials shall be so placed as to permit easy access for inspection and identification. Any material which has deteriorated, become damaged, or otherwise unfit for use, shall not be used in the Work, and shall be immediately removed from the site by CONTRACTOR. Upon completion of all Work or when directed, CONTRACTOR shall remove storage facilities from the site. .04 TEMPORARY UTILITIES: CONTRACTOR shall arrange for and secure all temporary connections for water, electricity, gas and other services needed by him for the proper execution of his operations. Costs for these services shall be paid for by CONTRACTOR. 01500-1 .05 BARRICADES AND WARNINGS: a. The safety of the public shall of primary importance during construction. In all respects provisions for public safety shall be CONTRACTOR's responsibility. b. Should conditions be such that the public safety is involved, the Contractor shall provide warning lights which shall be kept burning between the hours of sunset and sunrise. Barricades and warnings shall be in accordance with Item 502, "Barricades, Signs and Traffic Handling" of the Standard Specifications for Construction and Maintenance of Highways, Streets, and Bridges, as adopted by the Texas Department of Transportation (November 2014 edition). END OF SECTION 01500-2 DIVISION 1- GENERAL REQUIREMENTS SECTION 01525 - TRENCH EXCAVATION SAFETY REQUIREMENTS 1I1te101►101 R.11 F This Specification shall govern all the Work under the Contract related to trench excavations which will exceed a depth of five feet. (I➢4E13N=WRON14)*q For all excavation of trenches which will exceed a depth of five feet, CONTRACTOR's trench excavation safety procedures shall in all respects meet the current standards established by the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA) on excavation, trenching and shoring, including, but not limited to, (Subpart P, Part 1926), of the Code of Federal Regulations, all of which are incorporated herein by reference. .03 RESPONSIBILITY: CONTRACTOR has the sole and exclusive responsibility for the sufficiency of the trench excavation safety systems utilized. CONTRACTOR shall specifically agree that neither OWNER nor ENGINEER has such responsibility, and CONTRACTOR will not rely on OWNER or ENGINEER or any of their representatives for inspection, design, supervision, construction or any other aspect of trench excavation safety protection. CONTRACTOR and its sureties shall defend, indemnify and hold harmless OWNER and its officers, agents, and employees from all suits, actions, or claims of any character, name and description including attorneys' fees and expenses brought for any injuries to persons or damages to property in connection with the negligence of CONTRACTOR in the inspection, design, engineering, supervision, construction, safety devices or other activity connected with the trench excavation safety protection under this Agreement. So much of the money due CONTRACTOR under this Contract as shall be considered necessary by OWNER may be retained for the use of OWNER, or in case no money is due, the sureties shall be held, until all suits, actions, and claims shall have been settled and satisfactory evidence to that effect furnished OWNER. CONTRACTOR and its sureties expressly agree to defend indemnify and hold harmless OWNER, its officers, agents, and employees in accordance with this clause regardless of whether the injury or damage is caused in whole or in part by or any condition of the OWNER's property. CONTRACTOR shall, at his own expense, investigate all such claims and demands, attend to their settlement or other disposition, defend all actions based thereon and pay all charges of attorneys and all other costs and expenses of any kind arising from any such liability, damage, loss, claims, demands, and actions. END OF SECTION 01525-1 DIVISION 1 - GENERAL REQUIREMENTS SECTION 01700 -CONTRACT CLOSEOUT REQUIREMENTS Before final acceptance by OWNER, the following items must be submitted and accepted by ENGINEER: a. Final Inspection completed b. Bound manuals of servicing or operating instructions with recommended lubricants for all equipment C. CONTRACTOR's Guarantee. CONTRACTOR shall deliver to OWNER, upon completion of all Work, his written guarantee, found herein as "CONTRACTOR'S GUARANTEE". This guarantee shall be made to cover a period of one (1) year from the date of completion of all Work, and must be furnished to and approved by OWNER before acceptance and final payment is made. Neither the final payment, nor any provision stated above, shall relieve CONTRACTOR of responsibility for neglect of faulty materials or workmanship during the period covered by the guarantee. d. All other guarantees and warranties properly assigned to OWNER CONTRACTOR shall provide OWNER with copies of all guarantees or warranties which have been made to CONTRACTOR by suppliers or subcontractors, together with an assignment of such warranties and guarantees to OWNER; however, such assignment shall not relieve CONTRACTOR of the responsibility (stated in his guarantee) in case of failure of subcontractors or suppliers to fulfill the provisions of such warranties or guarantees. Neither the final payment, nor any provision stated above, shall relieve CONTRACTOR of responsibility for neglect of faulty materials or workmanship during the period covered by the guarantee. e. CONTRACTOR's Conditional Waiver and Release on Final Payment CONTRACTOR shall deliver to OWNER, upon completion of all Work, a final sworn certification of no claims and waiver of liens. Such certification and waiver shall be found herein as the "CONTRACTOR's CONDITIONAL WAVIER AND RELEASE ON FINAL PAYMENT", and if applicable, the "SUBCONTRACTOR'S CONDITIONAL WAVIER AND RELEASE ON FINAL PAYMENT". f. Final Application for Payment. 01700-1 I, CONTRACTOR'S GUARANTEE , being of (hereinafter called "CONTRACTOR"), do hereby make the following statements to CALHOUN COUNTY (hereinafter called "OWNER") in relation to the completed project known as BID NO. 2024.05 - SEADRIFT DRAINAGE IMPROVEMENTS PROJECT - GLO CONTRACT NO. 22-085-014-D245 FOR CALHOUN COUNTY, TEXAS I guarantee... That all of the completed Work is free from faulty materials in every particular, That all of the completed Work is free from improper workmanship, and That no injury will occur from proper and usual wear, That OWNER has been assigned all guarantees and/or warranties originally made to CONTRACTOR by suppliers and subcontractors, if any. (Such assignment does not relieve CONTRACTOR of the responsibility stated in each guarantee and/or warranty in case of failure of suppliers or subcontractors to fulfill the provisions of such guarantees and/or warranties.) I agree... That the execution of the final certificate or the receipt of the final payment does not relieve CONTRACTOR of the responsibility for neglect of faulty materials or workmanship during the period covered by this Guarantee, To replace or to re -execute without cost to OWNER such Work as may be found to be improper or imperfect, and To make good all damage caused to other Work or materials, due to such required replacement or re -execution. This Guarantee is in effect as of the day of 20_, and shall cover a period of ONE (1) FULL YEAR from said effective date. (CONTRACTOR) Signed By: Print Name/Title: Date: 01700-2 CONTRACTOR'S CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT THE STATE OF TEXAS COUNTY OF Project: BID NO. 2024.05 - SEADRIFT DRAINAGE IMPROVEMENTS PROJECT - GLO CONTRACT NO.22-085-014-D245 FOR CALHOUN COUNTY, TEXAS Job No. 5310.013a On receipt by the signer of this document of a check from CALHOUN COUNTY (maker of check) in the sum of $ payable to (payee or payees of check) and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position that the signer has on the property or easements of CALHOUN COUNTY (owner) located in Seadrift, Texas (location) to the following extent: BID NO. 2024.05 - SEADRIFT DRAINAGE IMPROVEMENTS PROJECT - GLO CONTRACT NO.22-085-014-D245 FOR CALHOUN COUNTY, TEXAS 0ob description). This release covers the final payment to the signer for all labor, services, equipment, or materials furnished to the property or to CALHOUN COUNTY (person with whom signer contracted). Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the funds received from this final payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project up to the date of this waiver and release. 01700-3 Signed By: Print Name Title: SUBSCRIBED AND SWORN TO BEFORE ME by m office. (CONTRACTOR) 20_, to certify which witness my hand and seal of Notary Public, State of Texas My Commission Expires: 01700-4 THE STATE OF TEXAS § COUNTY OF § Project: BID NO. 2024.05 - SEADRIFT DRAINAGE IMPROVEMENTS PROJECT - GLO CONTRACT NO. 22-085-014-D245 FOR CALHOUN COUNTY, TEXAS Job No. 5310.013a On receipt by the signer of this document of a check from _ (maker of check) in the sum of $ payable to (payee or payees of check) and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position that the signer has on the property or easements of CALHOUN COUNTY (owner) located in Seadrift, Texas (location) to the following extent: BID NO. 2024.05 - SEADRIFT DRAINAGE IMPROVEMENTS PROJECT - GLO CONTRACT NO. 22-085-014-D245 FOR CALHOUN COUNTY, TEXAS 0ob description). This release covers the final payment to the signer for all labor, services, equipment, or materials furnished to the property or to (person with whom signer contracted). Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the funds received from this final payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project up to the date of this waiver and release. 01700-5 Signed By: Print Name Title: SUBSCRIBED AND SWORN TO BEFORE ME by on office. (SUBCONTRACTOR) 20_, to certify which witness my hand and seal of Notary Public, State of Texas My Commission Expires: END OF SECTION END OF DIVISION 01700-6 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY ITEM 999 HYDROTURF® Z ENGINEERED TURF SPECIFICATION PART 1: GENERAL 1.01 SUMMARY Specifications for the Engineered Turf component of the HydroTurf® Z System. 1.02 RELATED SECTIONS Section 3123 13 - Subgrade Preparation Section 0142 00 - HydroTurf Z References and Definitions Section 03 49 01 - HydroBinder° Infill Specification Section 03 05 59 - Penetrating Catalyzed Colloidal Silicate Concrete Treatment for HydroTurf 1.03 REFERENCES A. See Section 0142 00 - References and Definitions 1.04 SUBMITTALS Include the appropriate project submittal requirements and MQC Testing. Examples of potential submittal requirements are included in ,'the following; A. Pre -Production and Pre -Shipment - Submit to the Owner's Representative Certificate of Compliance: Certificate of Compliance shall indicate that the engineered turf meets or exceeds the property values in Table 1. Also, the turf fiber color / blend shall be indicated. Provide representative manufacturer Product Data Sheet. Provide one (1) representative product sample. Provide manufacturer's quality control program for the engineered synthetic turf component, including test procedures and frequency for this project. Provide Material Safety Data Sheets (MSDS) for the engineered synthetic turf and for the HydroBinder infill. Provide Installation Guidelines. Item 999 Engineered Turf - 1 v-1.18 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY B. Prior to mobilization of the Installer to the site, Contractor shall submit the following information from Geosynthetic Installer: Installation schedule. Installation capabilities, including: a. Information on equipment proposed for this project; b. Average daily production anticipated for this project; and C. Quality control procedures. Resume of the superintendent to be assigned to this project, including dates and duration of employment. Resumes of all personnel who will perform seaming/welding operations on this project, including dates and duration of employment. GEOSYNTHETICS INSTALLER PERSONNEL shall attend HydroTurf Z orientation prior to beginning the installation. C. During the installation, the Installer shall be responsible for the timely submission to the Owner's Representative of subgrade acceptance certificates, signed by the Installer, for each area to be covered with HydroTurf. PART 2: MATERIALS 2.01 DELIVERY, STORAGE AND HANDLING A. Delivery: Deliver materials to the site only after the Owner's Representative and the Owner approve required submittals. CQA Personnel shall observe and document that all rolls of delivered to the site have been properly identified with the following for Engineered Synthetic Turf: a. Manufacturer's name b. Product identification C. Lot number d. Roll number e. Roll dimensions Item 999 Engineered Turf - 2 v-1,18 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY CQA Personnel shall observe and document the following with regard to Engineered Synthetic Turf: L The synthetic turf is wrapped in rolls with protective covering. ii. The rolls are not damaged during unloading. iii. Protect the synthetic turf from mud, soil, dirt, dust, debris, cutting, or impact forces. iv. Each roll must be marked or tagged with proper identification. Separate damaged materials from undamaged materials and store at locations designated by the Owner until proper disposition of material is determined by the Owner and the Owner's Representative. Separate rolls without proper documentation and store until the Owner's Representative approval is received. B. On -Site Storage: Store in space allocated by the Owner. Protect from puncture, dirt, grease, water, moisture, mud, mechanical abrasions, excessive heat or other damage. Store the engineered turf on level prepared surface (not on wooden pallets). The prepared surface for the engineered turf should be graded to drain away from HydroTurf components. Stack the engineered turf no more than three rolls high. C. On -Site Handling: Use appropriate handling equipment to load, move or deploy engineered turf. Appropriate handling equipment includes cloth chokers / straps, and spreader bar for loading, spreader and roll bars for deployment. Dragging rolls and / or panels on the ground surface shall not be permitted. Do not fold engineered turf material. Folded material shall be rejected. The installer is responsible for storage, and transporting material from storage area to installation area. D. Damaged Engineered Synthetic Turf: Item 999 Engineered Turf - 3 v-1.18 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY Damaged engineered synthetic turf will be documented by the Owner's Representative. Damaged engineered synthetic turf shall be repaired, if approved by the owner's representative, in accordance with these specifications or shall be replaced at no additional cost to the Owner. 2.02 ENGINEERED SYNTHETIC TURF - HYDROTURF Z A. Manufacturer: Shaw Industries, Inc. The engineered turf component shall meet or exceed property values listed in Table 1 as an individual component and as the performance property as the HydroTurf Z system. Engineered synthetic turf shall be supplied by Watershed Geosynthetics as a component of the HydroTurf Z Revetment System, B. Substitutions None C. The engineered synthetic turf shall be comprised of the following components: Polyethylene monofilament yarn fibers Two polypropylene backing geotextiles Polyethylene coating with a polyethylene film extruded to the geotextile backing D. The polyethylene yarn shall conform to the color selected by the Owner per color coding provided under Section 1.04(A) (1). Item 999 Engineered Turf - 4 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY Table 1 — Property Values for Engineered Synthetic Turf Component of HydroTurf Z Property Test Method Required Value Yarn ASTM D1577 Polyethylene Monofilament Tufted Pile Height ASTM D5823 2.25 ± 0.25 inches Pile Weight ASTM D5848 34 ± 2.0 oz/yd2 Weight of Polyethylene Coating and Film ASTM D5848 18.4 ± 2.0 oz/ydz Total Weight ASTM D5848 58.9 ± 4.0 oz/ydz Yarn Tensile ASTM D2256 15 lbs (min) CBR Puncture ASTM D6241 700 lbs (min) Wide Width Tensile (MD / XMD) ASTM D4595 1000 lb/ft. (min) Aerodynamic Evaluation GTRI* Wind Tunnel 120 mph p UV Resistance and Stability of Engineered Synthetic Turf ASTM G147 ASTM G7 >60% Retained Tensile Strength at 100-year exposure (projected) Steady State Hydraulic Overtopping ASTM D7277 / ASTM D7276 25 f /sec velocity Matu ing's N Value ASTM D7277 / ASTM D7276 0.018 — 0.025 Interface Friction (Low Confining Stress Against Concrete Sand) ASTM C5321 22* min. (peak) Typical Roll Dimensions 12-ft (3.66-m) Wide x 300-ft (91.4om) Long (Roll Lengths may vary ±3% Roll Area (approximate) 3600 ftz (334.5-m2) * Georgia Tech Research Institute PART 3: EXECUTION 3.01 EXAMINATION A. Verify in writing that the surface on which the engineered synthetic turf will be installed is acceptable. In so doing the Installer shall assume full liability for the accepted surface. B. The beginning of installation means acceptance of existing conditions. The Installer shall be responsible for maintenance of the covered subgrade once installation of engineered synthetic turf begins. Item 999 Engineered Turf - 5 v-1.18 GLO-CDBG-MIT NO 22-055-014-D245 CALHOUN COUNTY 3.02 SURFACE PREPARATION A. Maintain the surface suitability and integrity until the HydroTurf installation is completed and accepted. B. Repair rough areas and any damage to the subgrade caused by installation. C. To avoid sharp bends in the engineered synthetic turf, bevel the leading edges of the anchor trenches and grade breaks. D. Subgrade shall be smooth, uniform, firm and unyielding, and free from rocks or other debris. No rocks or protrusions greater than 1/4-inch in diameter shall be exposed at the subgrade surface. 3.03 ENGINEERED SYNTHETIC TURF DEPLOYMENT AND INSTALLATION A. Engineered synthetic turf shall not be deployed: During precipitation; In the presence of excessive moisture; In areas of ponded water; In the presence of excessive winds; or In excessive heat or cold. B. The engineered synthetic turf shall be deployed without damage by equipment, handling, trafficking, leakage of hydrocarbons, or by other means. The engineered synthetic turf shall not be dragged. C. The synthetic turf is anchored to prevent movement by the wind (the Contractor is responsible for any damage resulting to or from windblown synthetic turf). D. The synthetic turf shall be deployed smooth and free of tension (but not loose), stress, folds, ripples / wrinkles, creases, and free of contaminants such as soil, grease, fuel, etc. The turf shall be in intimate contact with the underlying subgrade. E. The synthetic turf shall be deployed with the synthetic grass blades pointing towards the top of the slope on slopes greater than 12%. F. The panels shall be deployed in a manner to ensure that the turf filaments are pointing upslope and in the same direction as the adjacent panel. G. The engineered synthetic turf shall be secured with sand bag anchoring. Item 999 Engineered Turf - 6 V-r.rs GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY H. Synthetic turf seaming shall be performed as follows: The seam overlaps shall be 5-inch (min) and shall be shingled with the flow of water. The panel on the up -flow / upstream side shall have the overlap placed on top of the down -flow / downstream panel. Demonstrate the preparation methods and equipment utilized for removal of the salvage from the outside edge of the rolls of turf (i.e. trimming & cutting devices). Mechanical trimming and cutting devices will be utilized for salvage trimming. Box blades and knives shall not be utilized for salvage preparations. Fraying of geotextile strands when performing the removal of salvage is not acceptable. Frayed or loose edges and/or geotextile strands shall be cut off or removed. Seaming of the engineered turf component shall be performed by heat -bond welding. This is described as follows: a. The DemTech 4-inch, single -wedge welder (Model No. VM-20/4/A Pro -Wedge Welder 120V, VM20 Outfitted with 100-KIT/4SNC/A.2 Welding Kit, 4-in, 220V, S.S.) shall be used to heat -bond the seams. b. Since the temperature and speed controls of the DemTech VM-20 wedge welder are variable and can be increased / decreased depending on weather and environment conditions, the temperature and speed shall be confirmed with a trial seam. This trial seam shall be field tested. Trial seams shall be performed at the being of each day and during the day when the weather (i.e., temperature, humidity, etc.) conditions change. C. Trial seams shall be performed as outlined in the HydroTurf Installation Guidelines (most recent revision). d. Production field seaming shall be performed and verified in the same manner as trial seams. The production field seams shall be inspected every hour at a minimum. This inspection of the field seams shall be the same as the inspection for the trial seams. e. Production fusion seams shall be continuous and have no gaps. Any damage and defects (including burnouts) that occur during production seaming will be repaired as outlined in Section 3.03 (H) (5) and HydroTurf Installation Guidelines (most recent revision). Item 999 Engineered Turf - 7 v-1.18 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY g. All seams not passing the visual inspection shall be repaired. h. After seaming operations, the edges of the synthetic turf panels shall be sufficiently anchored with sandbags in the top of slope perimeter anchor trenches unless otherwise noted on the construction drawings. Repairs, caps and tie-ins of engineered turf shall be performed as follows: Repairs to engineered turf shall be completed by using 4- inch (min) overlapped heat -bonded seam. j. Tie-in seams along flatter slope (i.e. 15% or less) with length greater than 25 feet shall use the DemTech VM-20 single -wedge welder [Section 3.05 (H)(1)]. k. A hand-held Leister or other equivalent hot-air gun (with hand pressure) should be used in shorter or smaller concentrated areas (i.e., butt seams, caps or patches). 1. Hand leistering shall be field tested with a trial seam to confirm proper seaming in accordance with the HydroTurf Installation Guidelines (most recent revision). I. The top of slope anchor trenches shall be left open until seaming is completed of the engineered synthetic turf. Expansion and contraction of the engineered synthetic turf should be accounted for during installation. Prior to backfilling the top of slope anchor trench, the depth of penetration of the engineered synthetic turf into the anchor trench shall be verified by the Owner's Representative at a minimum of 100 foot spacing along the anchor trench. The anchor trench should be filled in the morning when temperatures are coolest to reduce bridging of the engineered synthetic turf. j• Installer shall backfill top of slope anchor trenches prior to placement of infill into the engineered synthetic turf component. This will minimize the creation of wrinkles while placing the infill. Bottom and side -slope anchor trenches shall not be backfilled until after infill placement. This will allow corrections in the field during the deployment of the engineered synthetic turf. Note that wrinkles will travel down the slopes and cannot be redistributed up slopes, so it is important that bottom and side -slope anchor trenches remain open so that pulling adjustments can be made. 3.04 EQUIPMENT ON THE ENGINEERED SYNTHETIC TURF A. Construction equipment on the deployed synthetic turf shall be minimized to reduce the potential for synthetic turf material puncture. Small Item 999 Engineered Turf - 8 v-1.18 GLO-CDBG-MIT NO 22-085-014-D245 CALHOUN COUNTY equipment such as generators shall be placed on scrap synthetic turf / geosynthetic material (rub sheets) above engineered synthetic turf. B. During Construction: On slopes exceeding 15% a. No equipment will be allowed until HydroBinder Infill is in place. On slopes less than 15% b. ATV type vehicles and/or rubber tracked skid steer machines will be allowed prior to infill placement if the tire / track ground pressure is less than 5 psi. Equipment operators shall inspect equipment rubber tires or tracks for sharp protrusions from foreign matter or tire/track damage, embedded rocks, or other foreign materials protruding from tires/track prior to driving on the synthetic turf. Equipment travel paths driven on synthetic turf shall be as straight as possible with no sharp turns, sudden stops or quick starts. Damage caused by having equipment on the engineered synthetic turf (i.e., tears, rips, punctures, wrinkles, ripples, movement, etc.) shall be the responsibility of the installer to repair. C. Post installation, no equipment shall be allowed on the HydroTurf until HydroBinder Infill is fully cured for 28 days: Driving should be limited and only in areas where the subgrade under the HydroTurf is well -compacted, firm and unyielding. Drivability tire / track (ground) pressures should be limited to less than 35 psi. Rubber tire and/or tracked vehicles or equipment only. On slopes flatter than 10%, allowable ground pressures may only be increased with the written approval of the POR. D. Any activity that may be identified during the course of construction by the POR, OWNER'S REPRESENTATIVE, or CQA PERSONNEL as being a possible danger to the integrity of the HydroTurf CS system will be prohibited regardless of any prior approval. Item 999 Engineered Turf - 9 v-1.18 CLO-CDBC-MIT NO 22-085-014-D245 CALHOUN COUNTY 3.05 MEASURMENT AND PAYMENT A. This item will be measured by the square foot of surface using the dimensions shown in the plans and is a plans quantity measurement. The quantity to be paid is the quantity shown in the proposal, unless modified and approved by the Engineer. Additional measurement or calculations will be made if adjustments of quantities are required. B. The work performed and materials furnished in accordance with this Item and measured as provided under "Measurement" will be paid for at the unit price bid for 'Engineered Turf." This price is full compensation for furnishing, hauling and placing the engineered turf, including the concrete anchors, equipment, labor, tools and incidentals. Payment for excavation of the concrete anchors will be included in the unit price of the engineered turb. END OF SECTION Item 999 Engineered Turf - 10 v-1.18 #15 N0IIC:F0FMF_FFING-3/27/2024 15. Consider and take necessary action to transfer to IT and remove from inventory from Precinct 4 Road & Bridge inventory number 24-0478, Lenovo Yoga Laptop. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: I Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 12 of 20 Gary D. Reese County Commissioner County of Calhoun Precinct 4 March 20, 2024 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 March 27, 2024. • Consider and take necessary action to transfer to 1T and remove from inventory from Precinct 4 Road & Bridge inventory number 24-0478, Lenovo Yoga Laptop. Sincerely, Gary. Ree e GDR/at P.O. Box 177 — SeadriR Texas 77983 — email: Pam.reesencalhouncotx.om — (361) 785-3141 — Pax (361) 785-5602 Calhoun County, Texas DEPARTMENTAL INVENTORY TRANSFER REQUEST FORM Requested By: COMMISSIONER GARY REESE, PCT4 R&B Inventory Serial Number Description No. Transfer From/To Department 24-0478 LENOVO YOGA 900 80 PFDF L82R Transfer from Pct. 4 R&B to IT MKOOHAUS #16 ' NOTICE OF MEE-FING -- 3/27/2024 16. Consider and take necessary action accept the Supplemental Agreement for Professional Services in the amount of $5,900 with Urban Engineering for Cultural Resources Services for Green Lake Park Development Phase 1, and authorize Judge Meyer to sign all documentation. (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 13 of 20 Gary D. Reese County Commissioner County of Calhoun Precinct 4 March 20, 2024 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 March 27, 2024. • Consider and take necessary action accept the Supplemental Agreement for Professional Services in the amount of $5,900 with Urban Engineering for Cultural Resources Services for Green Lake Park Development Phase 1, and authorize Judge Meyer to sign all documentation. Sincerely, F\ 1 �' R.` Gary D. Reese GDR/at P.O. Box 177 — Seadrift. Texas 77983 — email: earv.reese ei calhouncoix.ore — (361) 785-3141 — Fax (361) 785-5602 (', 11 g j n (-? E I' I 11 L2 AGREEMENT FOR PROFESSIONAL SERVICES Date: March 20, 2024 Professional Firm: Urban Engineering 2004 N. Commerce St. Victoria, Texas 77901-5510 Tel No. (361) 578-9836 Project Name/Location: Supplemental Cultural Resources Services Calhoun County Green Lake Park Improvements — Phase 1 Calhoun County, Texas Project No.: E23596.00 Client: Calhoun County Attn: Mr. Gary Reese Calhoun County Commissioner Precinct #4 P.O. Box 177 Seadrift, TX 77983 Scope/intent and Extent of Supplemental Cultural Resources Services: I. Cultural Resources Services 1. Administrative time required for plan reviews, meetings, mobilization, and reporting. Special Conditions: 1. Supplemental Cultural Resources Services will be performed by Urban Engineering through a subcontract with Gray & Pape, Inc. (See attached change order 2) 2. This agreement supplements the original agreement approved on May 18, 2022 between Calhoun County and Urban Engineering. Fee Arrangement: Supplemental Cultural Resources Services $5,900.00 (estimated) Billings/Payments: Invoices for Urban Engineering's services shall be submitted, at Urban Engineering's option, either upon completion of such services or on a monthly basis. Invoices shall be payable within 30 days afterthe invoice date. If the invoice is not paid within 30 days, Urban Engineering may, without waiving any claim or right against the Client, and without liability whatsoever to the Client, terminate the performance of the service. Late Payments: Accounts unpaid 30 days after the invoice date will be subject to a monthly service charge of 1.5% on the then unpaid balance. Changes or Modifications: Any changes or modifications to this Agreement must be in writing and approved by both Urban Engineering and the Client. Page 1 of 3 Urban Engineering TREF# F-1 a0 (Signature) Matt A. Glaze/Vice President (Printed Name/Title) (Date) Calhoun County (Signature) Richard H. Meyer/Calhoun County Judge Printed Name/Title) - z -7- ,.oaf (Date) Page 2 of 3 (Continued) TERMS AND CONDITIONS Urban Engineering shall perform the services outlined in this agreement for the stated fee arrangement. Access To Site: Unless otherwise stated, Urban Engineering will have access to the site for activities necessary for the performance of the services. Indemnification: The Client shall, to the fullest extent permitted by law, indemnify and hold harmless Urban Engineering, his or her officers, directors, employees, agents and subconsultants from and against all damage, liability and cost, including reasonable attorney's fees and defense costs, arising out of or in any way connected with the performance by any of the parties above named of the services under this agreement, excepting only those damages, liabilities orcosts attributable to the sole negligence or willful misconduct of Urban Engineering, Dispute Resolution: Any claims or disputes made during design, construction or post -construction between the Client and Urban Engineering shall be submitted to non -binding mediation. The Client and Urban Engineering agree to include a similar mediation agreementwith all contractors, subcontractors, subconsultants, suppliers and fabricators, thereby providing for mediation as the primary method for dispute resolution between all parties. Certificate of Merit: The Client shall make no claim for professional negligence, either directly or in a third -party claim, against Urban Engineering unless the Client has first provided Urban Engineering with a written certification executed by an independent design professional currently practicing in the same discipline as Urban Engineering and licensed in the State of Texas. This certification shall: a) contain the name and license number of the certifier; b) specify each and every act or omission that the certifier contends is a violation of the standard of care expected of a design professional performing professional services under similar circumstances; and c) state in complete detail the basis for the certifier's opinion that each such act or omission constitutes such a violation. This certificate shall be provided to Urban Engineering not less than thirty (30) calendar days prior to the presentation of any claim or the institution of any arbitration or judicial proceeding. Certifications, Guarantees and Warranties: Urban Engineering shall not be required to execute any document that would result in their certifying, guaranteeing or warranting the existence of conditions whose existence Urban Engineering cannot ascertain by a visual site inspection. Limitation of Liability: In recognition of the relative risks, rewards and benefits of the project to both the Client and Urban Engineering, the risks have been allocated such that the Client agrees that, to the fullest extent permitted by law, Urban Engineering's total liability to the Client for any and all injuries, claims, losses, expenses, damages or claim expenses arising out of this agreement from any cause or causes, shall not exceed the professional service fee in this agreement. Such causes include, but are not limited to, Urban Engineering's negligence, errors, omissions; strict liability, breach of contract or breach of warranty. Termination of Services: This agreement may be terminated by the Client or Urban Engineering should the other fail to perform its obligations hereunder. In the event of termination, the Client shall pay Urban Engineering for all services rendered to the date of termination, all reimbursable expenses, and reimbursable termination expenses. Ownership of Documents: All documents produced by Urban Engineering under this agreement shall remain the property of Urban Engineering and may not be used by the Client for any other endeavor without the written consent of Urban Engineering, Page 3 of 3 CHANGE ORDER 2 SUPPLEMENTAL CULTURAL RESOURCES SERVICES FOR TH)K GREEN LAKII; ENHANCEMENTS PROJECT Gray & Pape Project Number 22-94332.001 PREPARED FOR: COMPASS ENVIRONMENTAL, SOLUTIONS PREPARED BY: GRAY & PAPE, INC. JANUARY 22, 2024 This change order presents the costs for supplemental tasks which were not within the original scope for the project. The out -of -scope items include the following: • Administrative time in reviewing project plans with engineering to include in the cultural report. • Administrative time required to prepare for meeting with County and Parks Board personnel at the request of the Parks Board to review proposed amendments to park plans. • Mobilization time, meeting/field time and associated directs were required for the meeting. • Administrative time is needed for supplemental agency coordination regarding the revised park plans. This includes drafting slid submitting a coordination document to the 11IC detailing the revised construction plans along with recommendations regarding impacts to cultural resources. Au estimated $5,900.00 is requested to account for the out -of -scope items. If you have any questions or if you need additional information, please do not hesitate to contact me at (713) 542-0943. If you agree to the request, please sign where indicated below and return to my attention. Regards, Jan es Hughey Southeast Regional Manager Gray & Pape, Inc. 110 Avondale Street Houston, Texas 77006 Accepted by: i 'y`a Date: CERTIFICATE OF INTERESTED PARTIES FORM 3.295 lofl Complete Nos. 1 - 4 and 6 if there are interested parties. OFFICE USE ONLY Cnmplele Nos. 1, 2, 3, 5, and 6 if (here are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2024-1130317 Victoria Engineering, Inc. chat Urban Engineering Victoria, TX United Slates Date Filed: 03/01/2024 2 Name of governmental entity or state agency that fail party to the contract for which the form is being filch. Calhoun County, Texas Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. UE ,lot HE23596.00 Supplemental Cultural Resources Services performed by Urban Engineering through a subcontract with Gray & Pape, Inc. for Calhoun County Green Lake Part< improvements - Phase 1 4 Nature of interest Name of Interested Party City, state, Country (place of business) (check applicable) Controlling Intermediary Urban, Larry Corpus Christi, TX United States X Schmidt, Thomas Victoria, TX United States X Bridges, Ray Victoria, TX United States X Glaze, Matt Victoria, TX United States X Fronune, Cheyanne Victoria, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION Matt A. Glaze _ My name is ---- ,and any data of birth My address is USA (street) _.._.__-...- ("s) (city) (stale) (zip code) (counhY) I declare under penally of perjury that the foregoing is true and correct. Victoria Texas 1st March 24 Executer) in Count , State of _ _ Y , on the _—___day of _20_ _.._._ (manll) (year) Sgnalure of au lorizagent of contracting business entity (teclarahn) (D ..-:,.-- ..r , -- �s,,,..� �n u,uoawu www.eu uussmte.tX•l1S Version V3.5.1.9000C47f # 17 I NOTICE C)I= MEETIN(; — 3%27%)_024 17. Consider and take necessary action to approve the Letter of Agreement to retain Higgins, Inc. as the Architect for the First Responder Training Facility building project and authorize the Director of EMS to sign this agreement. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 14 of 20 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Tuesday, March 19, 2024 9:59 AM To: Mae Belle Cassel; debbie.vickery@calhouncotx.org Subject: Fwd: Calhoun County EMS Facility Letter of Agreement Attachments: Calhoun County EMS Facility - Letter of Agreement.pdf Mae Belle, Please place the following Letter of Agreement with Higgins, Inc. on the next Commissioners Court agenda for approval to sign. This is to retain Mr. Higgins as the Architect for the First Responder Training Facility building project. Thanks, Dustin From: "higginsinc@sbcglobal.net (Higgins, Inc.)" <higginsinc@sbcglobal.net> To: Dustin Jenkins<dustin.jenkins@calhouncotx.org> Date: Mon, 18 Mar 2024 18:51:07 +0000 (UTC) Subject: Calhoun County EMS Facility Letter ofAgreement CAUTION: This email originated from outside of the organization. Do not click links or open Mr. Jenkins, Please see the attached Letter of Agreement for the Calhoun County EMS Facility. Thank you, Laura Bard Higgins, Inc. 3100 Richmond Ave., Suite 407 Houston, TX 77098 O: 713 524-3444 J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org i (361)571-0014 Calhoun County Texas Higgins, Inc. 3100 Richmond Ave, Ste. 407 Houston, TX 77098 713-524-3444 hiaoinsincasbcglobal.net March 18, 2024 Mr. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Port Lavaca, TX 77979 RE: Design Services for Calhoun County First Responder Training Facility 705 Henry Barber Way Port Lavaca, TX 77979 Dear Mr. Jenkins Higgins, Inc. appreciates your request for this opportunity to provide design services for the project/address referenced above. This letter serves as a formal agreement between Higgins, Inc. and Dustin Jenkins, whereby Higgins, Inc. will provide professional design services and provide architectural documentation only, sufficient to apply for and secure a city building permit for a new metal building at 705 Henry Barber Way. The scope is based on drawings from and discussions with Dustin Jenkins on March 6, 2024. Fees to draft the architecture and respond to city comments for the project will be billed at hourly rates and are estimated to be $5,500.00. Work will commence upon receipt of a $2,500.00 retainer and executed contract. Fees are due upon delivery or accrued time at our hourly rates (see attached fee schedule). Design services will include the following: • Site Plan • Dimensioned floor plan • Construction notes and specifications • Code Analysis Not included: • Structural Design • Windstorm Engineering or inspections • MEP Design • Survey • Civil Design • Geotechnical Services • TAS Review and Inspection • Permitting or permit fees • Energy Code — additional fee if required • Any Site Visits Design Services for 705 Henry Barber Way Client to provide: • CAD files • Deed Restrictions to determine set backs • Survey This agreement identifies design functions to be performed as a part of the design of this project. Efforts have been made to include all anticipated design requirements; however, there may be unforeseen design needs. The estimated price range is based on minimal revisions to the understood scope of design services. Additional work, not contemplated at present, and not outlined in the above text, shall be billed at the hourly rates indicated. Additional work includes any client change to the architectural design scope as described above. The above fees do not include permitting, inspections, or other expenses, such as surveying, energy code compliance, city required forms and applications. All expenses incurred are billed at cost, plus 10 %. Expenses include but are not limited to travel, reproduction costs, delivery costs, and overdue account collection fees. This proposal may be withdrawn by Higgins, Inc. if not accepted/authorized within 30 days. We ask that you initial and date all the services requested and sign the following acceptance page. This agreement may be terminated in writing by either party at any time without cause. Payment shall be provided for services up to date of termination. If any portion of the retainer exceeds hours worked, the balance will be refunded upon termination of this agreement. We hope that this proposal will meet with your agreement and that we may provide you with our services. Should you have any questions, please do not hesitate to call us. Thank you again for taking the time to inquire about our service/fees for this project. Respectfully, HIGGINS, INC. By: Ciarinn M. Higgins President Attachments: 'Professional Fees Schedule" Page 2 of 4 Design Services for 705 Henry Barber Way Higgins, Inc. 3100 Richmond Ave. Ste. 407 Houston, TX 77098 713-524-3444 higginsinc@sbcglobal.net ACCEPTANCE OF AGREEMENT The fees, specifications and conditions stated here are satisfactory and are hereby accepted. Acceptance of the services desired is noted with initials and dated above. You are authorized to do the work as specified. I agree to the payments as specified. ACCEPTED BY: T. 1)%)c (Print name) (Company) FN )ct nl S AAA S 123/9 //2oz. I�. I It rcroA, D r- EMS -7 79 77 (City) I(State) (zip) PHONE: 3 6 I — 5-.g2 — 11 / D FACSIMILE: EMAIL: CIuS 41h6vn Ld?X,O)e Page 3 of 4 Design Services for 705 Henry Barber Way Higgins, Inc. 3100 Richmond Ave. Ste 407 Houston, TX 77098 713-524-3444 higginsinc@sbcglobal.net PROFESSIONAL FEES SCHEDULE JANUARY- DECEMBER, 2024 FEES SUBJECT TO CHANGE WITHOUT NOTICE Principal Construction administration Draftsman Secretarial Telephone Consultations Subsistence and other travel expenses, Long distance telephone charges, postage and freight, out-of-pocket expenses for other services Automobile Mileage (travel expense) Photographs (includes 2 copies) Letter/Legal size copies Reproductions/ Plots (24 x 36) Reproductions/ Plots (30 x 42) CD Rom copies Page 4 of 4 $250/hr $250/hr $180/hour $50/hour hourly rate Cost Plus 10% 670 per mile - $2.50 each $10 min./$0.20 each $9.55/ea sheet of first set, $2.50/ea sheet additional sets $13.10/ ea sheet of first set, $3.52/ ea sheet additional sets $15 each copy CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2024-1137060 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Higgins, Inc. Houston, TX United States Date Filed: 03/2012024 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 16 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. Architectural Services CCEMS First Responder Training Facility architectural drawings 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling. Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is /,a �'rn/ a, ��� arr �L /' q. and my date of birth is /Q 13 -r /( �f' L My address is 3I0o K_tP',,j Siegof �5-Te{n 71096 ash-. .Z. (street) (dry) (state) (zip code). (country) I declare under penalty ofperjurythat the foregoing is hue and correct. Executed in I 1 a r rl County, Stale of 1' K , onthe �: day of Ai� , 2g� (month) .(year) - Signature of authorized agent of contractingbusiness entity - (Declarant) Forms provided by Texas Et Ics Comm as on www.ethics.state.tx.us Version V3.5.1.5b35d027 W-9 Request for Taxpayer Give Form to the Form (Rev. October 2018) Identification Number and Certification 1 requester. Do not Depar"anlofthe Treasury send to the IRS. Intmnel Revenue Service ► Go to ww .hs.g0v/F0rmW9 for Instructions and the latest Information. 1 Name (as shown on your Income tax murn). Name Is required on this line; do not leave this line blank. Higgins, Inc. 2 Business name/disregarded entity name, if different from above same as above w 3 Check appropriate box for federal tax classification of the person whose name la entered on It% 1. Check only one of the 4 Exemptions (codes apply only to m following seven boxes. certain entities, not Individuals; see o ElIndividualtsole proprietor or [I C Corporation ❑v SCorporation ElPartnership ❑Trust/estate Instructions on page 3); d 0 single -member U_C Exempt payee code (if any) ❑ Limited liability company. Enter the tax classification (C=C corporation, 3=S corporation, P=Partnership) N. `o I Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting LLC If the LLC Is classified as a single -member LLC that Is disregarded from the owner unless the owner of the LLC Is LLC that is disregarded code Of any) a u another not from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that IS Is disregarded from the owner should check the appropriate box for the tax classification of Its owner. m ❑ Other (see Instructions) m.10w­mdu and U.S) q s Address (number, street, and apt. or suite no.) Sea Instructions. Requester's name and address (optionnil y 3100 Richmond Ave. Ste. 407 0 City, stale, and ZIP code Houston, TX 77098 7 List account number(s) hem (optional) Number Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this Is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the Instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. v0000n©oo� Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer Identification number (or I am waiting for a number to be Issued to me); and 2. 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 (f any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part II, later. aIvfl signature of U Here us.pareon► Date► 03/20/2024 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.gov/FomhW9. Purpose of Form An individual or entity (Form W-9 requester) who Is required to file an information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN), Individual taxpayer identification number (ITIN), adoption taxpayer Identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return. Examples of Information returns Include, but are not limited to, the following. • Form 1099-INT (Interest earned or paid) • Form 1099-DIV (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. It 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. 10231 % Form W-9 (Rev. 10-201 s) #18 NOTICE GE MEETING 3/27/2024 18. Consider and take necessary action to add "IT Certification" as a special license paid at the same rate as the Paramedic License ($0.58/hr) and added to the License Differential list. Approval of qualifying certifications will be at the discretion of the County IT Director when individuals are recommended by a Department head. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner'Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 15 of 20 Mae Belle Cassel From: Dustin.Jenkins@calhouncotx.org (Dustin Jenkins) <Dustin.Jenkins@calhouncotx.org> Sent: Wednesday, March 20, 2024 2:29 PM To: Mae Belle Cassel; debbie.vickery@calhouncotx.org Cc: Candice Villareal; Rhonda Kokena; Erika Rojas; ron.reger@calhouncotx.org Subject: Agenda Item for Next Commissioners Court Ron, How does this look for the rr Certification? Mae Belle, Please add Agenda Item #7 from today's Commissioner Court Agenda (March 20, 2024) to next weeks agenda as discussed in Commissioners Court and consider adding italicized section with approval from Ron. 7. Consider and take necessary action to add "IT Certification" as a special license paid at the same rate as the Paramedic License ($0.58/hr) and added to the License Differential list. Approval of qualifying certifications will beat the discretion of the County IT Director when individuals are recommended by a Department head. J. Dustin Jenkins, DMin, MBA, LP Director of Emergency Medical Services 705 Henry Barber Way Calhoun County, TX dustin.jenkins@calhouncotx.org (361)571-0014 Calhoun County Texas Proposed updated License Differentials — Commissioners Court Agenda March 27, 2024 License Differentials (per certification and if applicable) ➢ Pesticide/Herbicide $ 0.12 ➢ EMT Intermediate Certification $ 0.14 ➢ Vector $ 0.58 ➢ CDL $ 0.17 ➢ CDL-X (Hazmat endorsement) $ 0.26 ➢ K-9 $ 0.58 ➢ IT Certitleation j $ OA ➢ Paramedic License $ 0.58 ➢ Pesticide/Herbicide plus Vector $ 0.69 fat discretion of County IT Director when recommended by Deparhnent Head, #19 I NOTICF OF MEETING 3/27/2024 19. Discuss and take necessary action to renew aerobic septic system service contract for Six Mile Volunteer Fire Department with Victoria Precision Products and allow Commissioner Vern Lyssy to sign. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 16 of 20 Vern L Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 March 14, 2024 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: (361) 552-9656 Fax (361) 553-6664 Please place the following item on the next Commissioners' Court Agenda • Discuss and take necessary action to renew aerobic septic system service contract for Six Mile Volunteer Fire Department with Victoria Precision Products and allow Commissioner Vern Lyssy to sign. Sincerely, r Vern Lys/s/y VL/Ij Victoria Precision Products P.O. Box 3902 Victoria, TX 77901 "r * Thistustomer has chosen to Electronically Sign this contract. Date Printed: 3/18/2024 To: Calhoun Co Pct #2, Six Mile Fire Dept. Area: 16N Attention:Vern Lyssy Map Key, 16N 5812 FM1090 Port Lavaca, TX 77979 Installed by: Kehl Coldmey,.AS Insrall:5/9/2017 Contract with: Victoria Precision Products Warranty End:S/9/2019 Treatment Type: Aerobic/ Disposal: Surface Application MFG: Ecological Tanks, Inc /.Brand: Aqua Aire /S#>AA06108D Terms of Maintenance Contract 1.) Three (3) inspections a year (at least one every four months). Inspections include adjustm, electrical and other applicable component parts to ensure proper function. This includes inspe filters and diffuser operation. Replacement/repaircosts will be billed directly to the property ou employee will respond to a complaint within 48 hours. 2.) An effluent quality inspection consisting of a visual check for color, turbidity, scum overflow chlorine residual will betaken and reported as required by regulation. 3.) If any improper operation is observed, which cannot tie corrected at the time of the service writing of the conditions and estimated date of correction. 4.) The property owner is responsible for maintaining a chlorine residual of at least 0.1 mg1L in accomplished by using chlorine (calcium hypochlorite) tablets: for systems designed with a tabl for systems designed with a liquid chlorinator. Swimming pool tablets must notbe used in the ranieis Decause may cause corrosion of the components of the system. At the time of a servi will inform the property owner if the chlorinator does not contain sufficient tablets or liquid chic effectively disinfect the wastewater. 5.) Any additional visits, inspections or sample collections required by specific County Agencii agency in yourjurisdiction will not be covered by this policy. The required routine reporting of local authority, as required by OSSF regulation,. will be covered by this policy. The Aerobic Owner's Manual must be strictly followed or warranties are subject to invalidation. Tt above terms and does not include the cost of replacement components, chlorine or pumping of sit includes labor charges only for normal routine inspections and maintenance. Additional service c Service determined to be caused by abuse or neglect is not coveredby this policy. Failure to pay covered under a separate aerobic warranty, within thirty (30) days will void this contract. The property owner agrees to provide Victoria Precision Products, Inc. with all gate combinations, the system for the purpose of conducting routine inspections or service calls prior to the start date Precision Products, Inc. immediately if at any time gate combinations, keys, etc. change and provii signing this form, both Maintenance Provider and Property Owner agree to the terms of this policy. attempted inspection, a $126.00 re -inspection fee will be charged. Fees: Payable in advance of servi e: Date: -f� �stomec Tele ne om Work Cell _ Date: ° g Service Representative: ' Kelli Coldewey; OS0008881 E-Signed: Phone: (361) 576-2383 Fax: (361) 782-6675 n.com vppl@tisd.net 34 Royal. Road, Porte Lavaca, TX 77979 County: Calhoun Main Phone (361)212-9656 Email: Lesa.Jurek@calhouncotx,org Permit 2017-98 Agency: Victoria County Health Department 3visits -.per year - one every 4.months Id servicing of the mechanical, the control panel, air pumps,,air A Victoria Precision Products, Inc. examination for odors. A test for you will be notified immediately in system. This can be or liquid chlorine bleach designed for chlorine CEO or any other regulatory operation and function to the arrantyis strictly limited to the build-up. The Maintenance Policy are not covered by this policy. aptacement components, not s, etc. necessary to gain access to his. contract and notify Victoria he new combinations or keys. By property is not accessible on any Co Pct #2,. Six Mile Fire Dept. * CERTIFICATE OF INTERESTED PARTIES FORM 1295 j 1ot1 Complete Nos. 1- 4 and 6 if there are interested parties. i OFFICEUSE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. . CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place I. of business. F. p 2023-992110 Victoria Precision Products i Victoria, TX United States i Date Filed: 03/08/2023 -2 Name of governmental entity or state agency that is a party to the contract for which the form is, being filed. Calhoun County{ Date Acknowledged: g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods,.. or other property to be provided under the contract. 1130 Maintenance contract for an: aerobic treatment system. 4,: j- -. Nature of interest Name of interested'. Party -. City, State, Country (place of business) (check; applicable) Controlling TAntermedary I? { I t a i I i i 5. �6 Check only if there Is NO Interested Party, X UNSWORN DECLARATION My name i .E F. s.. \� E'gy�`�j -- and my date of, birth is Myaddress ie._ (street) (City) (state) (zip code) (country) t declare under penalty of perjury that the foregoing is true and correct. 1 t Executed in�J, Lt�o�. _. County, State of \-... _. on then. t da of.. ILC� . 2fk, `+, (month) (year):, i `\ ` Signature of authorized agent of corftracting � n=css entity V (Dedarentj I Forms provided by Texas Ethics Commission www.ethics.state.tx.us I Version V3.5.1.3ac83bs0 # zo NOTICE OE MEETING — 3/27/2024 20. Consider and take necessary action to award qualified bidder on Bid No. 2024.04 Recycle Waste Transfer Station Project and allow Commissioner Vern Lyssy to sign any and all paperwork. (VLL) Scott Mason explained and gave the court his recommendation.' Commissioners' awarded bid to ConMetal Contractors. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 17 of 20 Mae Belle Cassel From: Debbie.Vickery@calhouncotx.org (Debbie Vickery) <Debbie.Vickery@calhouncotx.org> Sent: Thursday, March 21, 2024 8:39 AM To: Mae Belle Cassel Subject: FW: Agenda Item Attachments: 3-27 RWTS Bid Award.pdf From: Lesa.Jurek@calhouncotx.org (Lesa Jurek) [mailto:Lesa.Jurek@calhouncotx.org] Sent: Wednesday, March 20, 2024 4:05 PM To: debbie.vickery@calhouncotx.org Cc: demi. cabrera <demi.cabrera@calhouncotx.org>;'Commissioner Vern Lyssy' <vern.lyssy@calhouncotx.org> Subject: Agenda Item Please add to next agenda Thank you and have a blessed day. o f fbae mawager CaLhouw Cou.wt�, Pot. 2 5212 i=M logo N Port "Vpon, TX 7� 361-552-J°656 361-553-6664 fax Calhoun County Texas Calhoun County Texas 1 Vern L sy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 March 20, 2024 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: (361) 552-9656 Fax (361) 553-6664 Please place the following item on the next Commissioners' Court Agenda • Consider and take necessary action to award qualified bidder on Bid No. 2024.04 Recycle Waste Transfer Station Project and allow Commissioner Vern Lyssy to sign any and all paperwork. Sincere , C Vern Lyssy VL/Ij G&WENGINEERS, INC. 206 W. Live Oak • Port Lavaca, TX 77979 p: (361)552-4509 • f: (361)552-4987 TBPE Firm Registration No. F04188 March 19, 2024 Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 3rd Floor, Suite 301 Port Lavaca, TX 77979 RE: LETTER OF RECOMMENDATION Bid No. 2024.04 — Recycle Waste Transfer Station Project Dear Honorable Judge & County Commissioners, Bids for construction of the above referenced project were received at the County Judge's office until 2:00 p.m., Tuesday, March 12, 2024, at which time Bids were publicly opened and read aloud. The enclosed Bid Opening Table indicates there were a total of five (5) bidders submitting bids. Based on the Base Bid and Owner's Option's 1 through 8 being considered and totaled, the "Apparent Low Bidder" is Con -Metal Contractors, Inc. We have not had the privilege of working with Con -Metal Contractors but based on our research, they appear to be qualified and capable of performing the required work. Therefore, we recommend that the Construction Contract be awarded to Con -Metal Contractors, Inc. for the Base Bid Amount plus Owner's Options 1 through 8. If the County concurs with this recommendation, and upon your direction, we will prepare Construction Contract package immediately and deliver it to Con -Metal Contractors, Inc. Please call me @ (361) 552-4509 if you have any questions. Sincerely, G & W Engineers, Inc. '5��ott P. Mason, P.E. Enclosures: Bid Opening Table & Itemized Bid Table cc: file 5310.023 Engineering Consulting Planning Surveying Ga W Entrees, Inu 9.5 W. LNe oat ITEMIZED BID TABLE PM u a®, rx nays Bid Number 2024.04- Recycle Wa6te Transfer Station Project for Calhoun DaN. MaeN Is.zpa rare2:. o.m. County, Texas JO NO.5]l0@3 BIB ITEM DESCRIPTION QTY KNIT Bp¢Ik1ler Hlavinka Co. Ste ConaWGOon, lm, Con -Halal Contactors, 1p4 OW. KAmlr CpnsWNpn, mu,. UNITPRICE AMOUNT UNITPRICE AMOUNT UNIT PRICE gMOUM UNIT PRICE AMOUNT gexca, Inc t Mohil¢allo,demobll'¢alion, be as, and lnaoance, t LB §],SOOAO ' mutrm Arm. UNITPRICE AMOUNT 54],]59.25 $9l,]5425 $26.000.00 $26,000.00 $35,600.00 S25 abut AelualAmL $10,000.00 $10,000.00 Building foundation complete In piece, including ¢elect fill $35,SWA0 2 as designed and incIW.a lncoa.mled... cress Push walla 1 ITS $313.500.00 $313,500.00 $328.1]1.2] §J28,1]1.2] E283,OBO.Oo $263,00000 $3]3,]15.00 E3]2,]25.00 $307,603.o1 $307,500.00 P. Alpne ned metal bulltling, ddlfg, 9-darsptem, and 3 roof. TWA Ham need. any engl.eatlng annuals, to aCeW ahmpad PEMB drawing¢fi.m menulaUua[ 1 LS $133,947.00 SN",4,W E195,00000 $195.000.00 E188,000.E0 $188,000.00 W22,500.00 E322,SOO— slo".W.00 $183,000.00 TOTAL BASE BIB E454,947.00 $570,923.62 OWNER'S OPTIONS $4T/,pp0.00 `Corrected Total E]30,)25.00 $601,00.00 Ot 02 0" thid, ainforead Ccncrele Pavement. a"IM1ic811mesbne pavement (complete in place antl In final paaiu.n). 3470 17,160 SF SF $17.00 $s.00 $68.990.00 sea Am 00 $12,20 N.60 $42,334.00 $82.360.00 $9.99 E6.57 $34,491.80 g112.741.20 $14.83 $9.60 $50,]66.10 518,936.00 $37 03 g8.94 $128p94.10 g119,09090 03 34'HOPE eloml". )) LF $107.00 S. "... $79.61 $6,129.97 $102.60 $7,90020 $129.00 E9,933.06 $153.20 $f 1,]98A0 04 05 15'HOPE abm, pipe, Preeaal wncale ea(et)end 0¢eMenl5 for 15'slorm Pipes . )] 2 EA $),g25.00 $S.e52.00 $14ASU $69.75 $2.70JS $5.370.75 $5.533.50 $51.95 E2,867.50 $4,000.15 $6.375.00 $103 R0 $1,925.00 $],948.g0 $3,850,00 $193.03 $5,81 L50 $t0,3g3.3t 23 gt12.00 O6 Prenel safety no ...ant rar24'atpml pipes. 2 EA $8,000.W $16,000.01) $2,929S0 $5,85900 $2,322.5o Eq,64500 §2,690.[O $5,380.00 $B,28Rs0 $12,565.00 O) DRlna9e aseles. General fillmeledBileyrads ln9,,asures of 370 LF $12.40 $4,588.00 EYL12 $10,03Qg0 $11.62 $9,289.40 $20.00 $]p00.00 $25]8 $B,542.30 OB m ex.avaletl 0ns0a etolefiels tram foundeUan exnva8.n aeplehle. 1 L5. $],000.00 g],000.Op $23,8]092 $29,9]DB2 inclutletl in ahova ilema $10.c00,00 $t0,0pp00 $14.700.00 $t4,]Bo,Bo CALENDAR DAYS i00 210 310 180 $$g TOTAL BASE BID• ALL OPTIONS $666,266.00 $752,526.06 $650,02.76 $9W,936.50 $819,054.61 CALHOUN COUNTY RECYCLE TRANSFER STATION REQUEST FOR PROPOSAL BLS CONSTRUCTION, INC. William Key 207 Fahrenthold Street William.key@blsconstruction.com El Campo, TX, 77437 TABLE OF CONTENTS BID FORM BID BOND STATEMENT OF BIDDER'S QUALIFICATIONS AFFIDAVIT CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS SYSTEM FOR AWARD MANAGEMENT CONFLICT OF INTEREST QUESTIONNAIRE, FORM CIO. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS CERTIFICATION REGARDING LOBBYING DISCLOSURE OF LOBBYING ACTIVITIES HOUSE BILL 89 VERIFICATION RESIDENCE CERTIFICATION SECTION 504 CERTIFICATION SYSTEM OF AWARD MANAGEMENT (SAM.GOV) BID Revised Addendum No. 1—02-28-2024 PROJECT NAME: Bid Number 2024.04 - Recycle Waste Transfer Station Project DUE DATE: Tuesday, March 12, 2024 before 2.00:00 p.m. NAME: WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramps. BASE BID Item Quantity Unit Unit Price Total Bid Price 1. Furnish all necessary equipment, 1 LS materials, and labor for mobilization, demobilization, barricades, and insurance. 2. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the building foundation complete in place, including select fill as designed and includes incorporated concrete push walls and in accordance with the drawings and specifications 3. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the pre-engineered metal building, siding, gutter system, and roof in accordance with the drawings and specifications. This item includes any engineering cost/fees to receive stamped PEMB drawings from manufacturer. Total Base Bid OWNER'S OPTIONS Item Quantity Unit Unit Price Total Bid Price Option 1) Furnish all necessary 3,470 SF equipment, materials, and labor for the installation of the 8" thick reinforced concrete pavement in accordance with the drawings and specifications OWNER'S OPTIONS Continued.. Item Quantity Unit Unit Price Total Bid Price Option 2) Furnish all necessary 17,160 SF equipment, materials, and labor for the installation of the 8" thick limestone pavement (complete in place and in final position) in accordance with the drawings and specifications Option 3) Furnish all necessary 77 LF equipment, materials, and labor for the installation of the 24" HDPE storm pipe in accordance with the drawings and specifications Option 4) Furnish all necessary 77 LF equipment, materials, and labor for the installation of the 15" HDPE storm pipe in accordance with the drawings and specifications Option 6) Furnish all necessary 2 EA equipment, materials, and labor for the installation of the precast concrete safety end treatments for 15" storm pipes in accordance with the drawings and specifications Option 6) Furnish all necessary 2 EA equipment, materials, and labor for the installation of the precast safety end treatments for 24" storm pipes in accordance with the drawings and specifications Option 7) Furnish all necessary 370 LF equipment, materials, and labor for the installation of the drainage swales in accordance with the drawings and specifications Option 8) Furnish all necessary 1 LS equipment, materials, and labor for the installation of the general fill material and site grading in accordance with the drawings and specifications. Use/reuse of excavated onsite materials from foundation excavation acceptable. Note: The award will be based on the BASE BID with consideration of the Owner's Options 1 through 8. The Owner reserves the right to choose all, none or any combination of the Owner's Options at their discretion. SPECIFICATION NOTES Calhoun County is receiving Bids for items and quantities of work generally as follows: Bids are invited for items and quantities of work generally as follows: A new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramp. County to provide: 1. Unsecured place to store contractor equipment and vehicles 2. Unsecured area to store excess materials required for construction. The BIDDER, in compliance with the invitation for bids for Bid Number 2024.04 - Recycle Waste Transfer Station Project, having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies in accordance with the contract documents, within the time set forth herein. These price(s) are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is a part. These price(s) are firm and shall not be subject to adjustment provided this Proposal is accepted within thirty (30) days after the time set for receipt of proposals. BIDDER hereby agrees to commence work under this contract on or before a date to be specified in a written "Notice to Proceed" to be issued by the County and to substantially complete within consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. Addendum One 2. SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Subcontractor The undersigned hereby declares that he has visited the site and has carefully examined the contract documents relative to the work covered by the above bid. Bidder Name: BLS Construction, Inc. Address: 207 Fahrenthold Street, El Campo, TX, 77437 Phone: 979-543-2696 EIN or Tax ID No.: 900920438 Signature: 61,)4ahZ / � Name and Title: William Key -President Email Address: william.key@blsconstruction.com BID BOND .,. £, CONSTRUCTION: KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, BLS Construction Inc as PRINCIPAL, and Merchants Bonding Company (Mutual) , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", in the penal sum of 5% Greatest Amount Rid Dollars, ($ 5% GAB ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated March 12, 2024 Bid Number 2024.04 - Recycle Waste Transfer Station Project for Calhoun County, Texas. NOW, THEREFOR, if the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within thirty (30) days after the said opening, and shall within the period specified therefore, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Owner in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Owner the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above -bounded parties have executed this instrument under their several seals this 12th day of March 2024 , the name and corporate seal of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. Attest: kvh a, Sat,.-, Attest:971911�__ Attest:' Kimberly Flores Countersigned By (� ^a ✓�c"� 2 * Attorney -in -Fact, State of Texas (SEAL) BLS Construction Inc gy. William Key (SEAL) Affix Corporate !ilr Seal By: Affix . Merchants Bonding Company (Mutuanor orate l Seal By: Ana Rodriquez Attorney-in'Fact CERTIFICATE AS TO CORPORATE PRINCIPAL I, Darian Dutcher , certify that I am the Secretary I , Secretary of the Corporation named as Principal in the within bond; that William Key who signed the said bond on behalf of the Principal was then President of said corporation; that I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, for and in behalf of said corporation by authority of this governing body. Corporate Seal Title: Secretary Power -of -attorney for person signing for Surety Company must be attached to bond. MERCHANTS 01 BONDING COMPANY;. POWER OF ATTORNEY E puw All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., :.;both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the � 'Companies") do hereby make, constitute and appoint, individually, Ana Rodriquez; Coy T Sunderman; Denise Dugan; JD Steanson; James Russell; Kristte Rodriguez; Ronda Brown; Sharma Wagner their true and lawful Altorney(s)-in-Fact, to sign its name as surely(tes) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments In the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted In any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By Laws adopter) by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantsNational Bonding, Inc., on October 16, 2015, "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and a(lach the seal of the Company (hereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing (he execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same farce and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, It is agreed that the power and out hority hereby given to the Attorney -in -Fact includes any and all consents far the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or Its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to (he Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 3rd day of February , 2024 .-e_ 2003 MERCHANTS BONDING COMPANY (MUTUAL) MERCHANTS NATIONAL BONDING, INC. d/b/a MERCHANTS NATIONAL INDEMNITY -EMMNNNITTYY COMPANY By /-W-� STATE OF IOWA �.•'� •.�....... \;�°- President COUNTY OF DALLAS as. "" ° • • ° On this 3rd day of February 2024 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing Instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. �� sm Penn! Miller �„.`:__"`-•.._,� o� Commission Number 787952 —_ % ` ~-- • ° My Commission Expires - IOWP January 20, 2027 `�, (Expiration of notary's commission does not Invalidate this Instrument) - •'� otarg"ribl�ti.,,,�� I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 12th day of March 2024 (IONq' '�y,'e,��'PDRgr•°y; � �O�OPpOR•V�,yyr°: 2003 1033 : �; Secretary POA0018 (1/24) "...... °' •° . x` N Ci ' u STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he/she desires. Name of Bidder: BLS Construction, Inc. Date Organized: October 1082 Address: 207 Fahrenthold Street, El Campo, TX, 77437 Date Incorporated: October 1982 Number of Years in contracting business under current name: 42years CONTRACTS ON HAND: Contracts Dollar Amount Completion Date See Attachment A Type of work performed by your company: Commercial Construction Have you ever failed to complete any work awarded to you? No Have you ever defaulted on a contract? No List the projects most recently completed by your firm (include project of similar importance): Project Dollar Amount Mo/Yr Completed See Attachment B Major equipment available for this contract: See Attachment C Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Credit available: Bank reference: See Attachment D The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the County of Calhoun in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this eighth -day of March 2024. by: U'14&4 L/ (Signature) President (Title) 9 s 9 E c Q y w E m U O p $$ € 8 E e •, � � a B �� a �-Pr afr g8� e � � � E E uY555i c= _ • • Eg � s, � � rc a � m.^€ 'gym" � pp. m so �t 9z L P ��w �z59 rv� fggii� 3 � E e E » m V » m fd Z A m m m m a a R R 0 mfi S o 0 0 F E s z m & » € n E 2 $ $ 35 y s Tm n o' • "g 3 � E t a �� w� cL .`ao `s ma 'mE $m o c � ES x ➢o g@ a. cg cc E • � s E ��e t LL y a o $ x S 5 u. fim' �n m•3x m23 rc3 waE 0 � €W3 0 PAST RELEVANT PROJECTS -ATTACHMENT B WHARTON COUNTY SOLID WASTE TRANSFER STATION GENERAL CONTRACTOR East Bernard, TX Completion Date:12/2022 Contract Amount: $350,953.03 Description: New 50' x 100' pre-engineered metal building to cover recycling material and equipment. WHARTON COUNTY SHERIFF TRAINING & EMERGENCY OPERATIONS CENTER CMAR Wharton, TX Completion Date: 10/22 Contract Amount: $531,332.44 Description: New construction of a 3,200 SF Training and Emergency Operations Center for the Sheriff's Office TRAVIS PARK PAVILION GENERAL CONTRACTOR Rosenberg, TX Completion Date: 07/2023 Contract Amount: $268,940.00 Description: New 95' x 125' pre-engineered structure for a basketball court PAST RELEVANT PROJECTS -ATTACHMENT B FORT BEND COUNTY FAIRGROUNDS -CANOPY ADDITON GENERAL CONTRACTOR Rosenberg, TX Completion Date: 04/2023 Contract Amount: $509,128.45 Description: New construction of a 14,250 sq. ft. pre engineered steel canopy addition for arena ARANSAS COUNTY NAVIGATION DISTRICT PAVILIONS GENERAL CONTRACTOR Rockport, TX Completion Date: 07/19 Contract Amount: $3,329,669.71 Description: Repair and reconstruct (4) existing pavilions 10,000 sq. ft. each from Hurricane Harvey damages l WHARTON REGIONAL AIRPORT a GENERAL CONTRACTOR Wharton, TX Completion Date: 03/21 Contract Amount: $646,639.65 Description: New construction of two 21,000 sq. ft. box hangars with 68x20 bif old hangar doors MAJOR EQUIPMENT AVAILABLE -ATTACHMENT C 2017 Caterpillar compact track loader 2014 Caterpillar track loader with bucket j I 2013 Caterpillar Mini excavator Generator Caterpillar broom attachment 2022 Agrotk Jackhammer for Skidsteer ATTACHMENT D BUSINESS REFERENCES Darren McCarthy (281) 725-4722 Fort Bend County Parks and Recreation Director Darren.McCarthy@fortbendcountytx.gov` 301Jackson Street, Suite 201 Richmond, TX, 77469 Shannon Srubar (979) 637-1581- Wharton County Sheriff shannon.srubar@co.wharton.tx.us 315 E Elm Street Wharton, TX 77488 Phillip Spenrath ((979) 532-2640 Wharton County Judge judge.spenrath@co.wharton.tx.us 309 E. Milam Street, Suite 300 Wharton, TX, 77488 BANK REFERENCES Linc Lutrick, President 979-543-2200 Prosperity Bank linc.lutrick@prosperitybankusa.com 1301 N Mechanic Street El Campo, TX, 77437 Chip Jenkins, CEO The First State Bank 206 North Street Louise, TX, 77455 979-648-2691 wrj@fsblouise.com BI � 4 x WORK EXPERIENCE Career History-18 Years BLS Construction, Inc. 2005-Present EXPERIENCE Wharton Co Solid Waste Transfer Station East Bernard, TX- New Construction Travis Park Pavilion Rosenberg, TX- New Construction Aransas Co Airport Drain Line Repair Rockport, TX- Repair Wharton Co Sheriff Training and Emergency Operations Center Wharton, TX- New Construction Aransas County Navigation District Pavilions Rockport, TX- Remodel Prosperity Bank -Port Lavaca Port Lavaca, TX. -New Construction El Campo Public Safety Headquarters El Campo, TX- New Construction Camp Aranzazu Rockport, TX. -New Construction SKILLS • Client & Project Team Communication • Client Focused Problem Solving • Accurate Project Estimations • Exceptional Project Management • Leadership • Team Management • Budget Management WORK EXPERIENCE Career History-5 Years BLS Construction, Inc.2018-Present EXPERIENCE Wharton Co Solid Waste Transfer Station East Bernard, TX- New Construction Travis Park Pavilion Rosenberg, TX- New Construction Aransas Co Airport Drain Line Repair Rockport, TX- Repair Wharton Co Sheriff Training and Emergency Operations Center Wharton, TX- New Construction Aransas County Navigation District Pavilions Rockport, TX- Remodel Prosperity Bank -Port Lavaca Port Lavaca, TX. -New Construction El Campo Public Safety Headquarters El Campo, TX- New Construction Camp Aranzazu Rockport, TX. -New Construction SKILLS • Client & Project Team Communication • Client Focused Problem Solving • Accurate Project Estimations • Exceptional Project Management • Leadership • Team Management • Budget Management &T•1L7A*4UA N IAa44dI Career History-21 Years BLS Construction, Inc. 2002-Present EXPERIENCE Wharton Co Solid Waste Transfer Station East Bernard, TX- New Construction Travis Park Pavilion Rosenberg, TX- New Construction Aransas Co Airport Drain Line Repair Rockport, TX- Repair Wharton Co Sheriff Training and Emergency Operations Center Wharton, TX- New Construction Aransas County Navigation District Pavilions Rockport, TX- Remodel Prosperity Bank -Port Lavaca Port Lavaca, TX. -New Construction El Campo Public Safety Headquarters El Campo, TX- New Construction Camp Aranzazu Rockport, TX. -New Construction SKILLS • Client & Project Team Communication • Client Focused Problem Solving • Accurate Project Estimations • Exceptional Project Management • Leadership • Team Management • Budget Management • Ensures Construction is done according to plans AFFIDAVIT F. 1 STATE OF TEXAS Texas {} AFFIDAVIT COUNTY OF Wharton {} William Key being first duly sworn, deposes and says: that he or she is (Type or Print Name) the President of BLS Construction, Inc. (Type or Print Title) (Type or Print Name of Company/Firm) principal address at 207 Fahrenthold Street, El Campo, TX, 77437 having its (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, offerto give, nor intendsto give at anytime hereafter anyeconomic 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, orthe 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 William Key -President 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 i�f71.Y 2014. r�'pr ay , DARIAN LAURAL DUTCHER r '{et r}�it?R ��L Signature of Notary Public ary-rub)ic, state of Taxas Comm, Expires 01-2&2027 Notary ID 134168719 CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS 3. A N' IN j x i v. r � Mli CONTRACTOR CERTIFICATIONS CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) BLS Construction, Inc. 207 Fahrenthold Street El Campo, TX, 77437 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. ® Yes ❑ No The undersigned hereby certifies that: ❑ The Non -Segregated Facilities clause (Section 109 provision) is included in the Contract. No segregated facilities will be maintained as required by Title VI of the Civil Rights Act of 1964. ® The Equal Employment Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). ❑ The Affirmative Action for Handicapped Workers clause is included in the contract. ❑ The Exhibit B — Assurances for Construction Programs is included in the Contract. ❑ The Exhibit D — State of Texas Assurance is included in the Contract. Have you ever been or are you being considered for sanction due to violation of Executive Order 11246- Equal Employment Opportunity, as amended? ❑ Yes ❑ No NAME AND TITLE OF SIGNER (Please type) William Key -President SIGNATURE !� DATE 3/8/2024 CONFLICT OF INTEREST FORM 8/03/2011 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Date Received Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.004(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 person becomes aware of facts that require the statement to be filed. See Section 176.004, Local Government Code. A person commits an offense if the person knowingly violates Section 176.004, Local Government Code. An offense under this section is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. RFB / RFP / Contract 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 the originally filed questionnaire becomes incomplete or inaccurate.) 3. Name of local government officer with whom filer has employment or business relationship. Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? ❑ Yes ❑ No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? ❑ Yes ❑ No C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? ❑ Yes ❑ No D. Describe each employment or business relationship with the local government officer named in this section. 4. Signature of person doing business with governmental entity � Date Signed (�3/8/2024 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a— d) of this certification. Wi4�; Nt Y4(4- wtsiokc�i Name and Title of A thorized Agent i Si e of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 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. See. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. See. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. 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. CONSTRUCTII7N CERTIFICATION REGARDING LOBBYING (To be submitted if the bid or offer exceeds $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, BLS Construction, Inc. , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. G(%�iturzi /� Signature of Contracto s Authorized Official William Key -President Printed Name and Title of Contractor's Authorized Official 3/8/2024 Date DISCLOSURE OF LOBBYING ACTIVITIES INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee 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, County, 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 subawardee, e.g., the first subawardee 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 "Subawardee," then enter the full name, address, County, 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) Enterthe full name, address, County, 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 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 1. Type of Federal Action: 2. Status of Federal 3. Report Type: a. contract Action: a. initial filing a b. grant a. a b. material change c. cooperative bid/offer/application agreement a b. initial award d. loan c. post -award e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Prime Subawardee Enter Name and Address of Prime: Tier if Known: BLS Construction, Inc. 207 Fahrenthold Street El Campo, TX, 77437 Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 7. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (if individual, last name, first name, MI): (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Sit li disclosure of lobbying activities is a material it representation of fact upon which reliance was placed by the tier above when this transaction Print Name: William Key was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Title: President information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the Telephone No.: 979-543-2696 Date: 3/8/2024 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) HOUSE BILL 89 VERIFICATION 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) William Key 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 BLS Construction, Inc. Company Name GrJ�uL Kq. William Key Signature of Authorized Official Printed Name of Authorized Official President 3/8/2024 Title of Authorized Official Date RESIDENCE CERTIFICATION CONSTRUCTION Pursuant to Texas Government Code §2252.001 etseq., 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. D 1 certify that is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) D I certify that BLS Construction, Inc. (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent William Key -President Printed Name and Title of Authorized Agent 3/8/2024 Date is a "Resident Bidder" of Texas as SECTION SO4 CERTIFICATION SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The County of Calhoun does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) BLS Construction, Inc. (Address) 207 Fahrenthold Street El Campo, TX, 77437 County State Zip Telephone Number ( 979 ) 543 - 2696 Voice ( 979 ) 543 - 5006 TDD Darian Dutcher has been designated to coordinate compliance all Federal statutes relating to nondiscrimination. A n V A u M p O M J 9' W � PC V U LL Q Q ;1 0 u � LL T u +' W W � l4J 1e1 N U o V C O j�j)f IW a .. V W � A u C V O O I O n aC N c b 1n' e W L 4G ii tlyi rt�t y� _N N h0 Q d' � Q OOODO Y w ;� Dedicated to Safety We develop a safety program for every construction project, are OSHA compliant, fully insured and bonded. 01-��, r; "M. F t 7 y THANK YOU We look forward to working with you. OFFICE 207 Fahrenthold Street El Campo, TX, 77437 979-543-2696 bisconstruction.com an BOETTCHER HLAWENRA CO. Bid Proposal for the Bid Number 2024.04 Recycle Waste Transfer Station Project for Calhoun County, Texas CONTRACT DOCUMENTS FOR THE BID NUMBER 2024.04 RECYCLE WASTE TRANSFER STATION PROJECT FOR CALHOUN COUNTY, TEXAS JANUARY 2024 205 W. Live Oak • Port Lavaca, TX 77979 • 361-552-4509 CONTRACT DOCUMENTS FOR THE BID NUMBER 2024.04 RECYCLE WASTE TRANSFER STATION PROJECT Iku CALHOUN COUNTY, TEXAS JANUARY 2024 Prepared by: G & W ENGINEERS, INC. 205 WEST LIVE OAK PORT LAVACA, TEXAS 77979 (361) 552-4509 Approved By: SCO77 R MASON G & W Engineers, Inc. / -colt P. Mason, P.E. Texas Registered Engineering Firm F-04188 f/ Texas Serial No. 127893 Project No. 5310.023 Date: Qf. z 5. Z j FORMS AND CONDITIONS FOR BID DOCUMENTS/CONSTRUCTION CONTRACTS 1. Advertisement and Invitation for Bids 2. Instruction to Bidders for Construction 3. Bid Form 4. Specification Notes 5. Bid Bond 6. Statement of Bidder's Qualifications 7. Affidavit 8. Certification of Bidder Regarding Civil Rights Laws and Regulations 9. Conflicts of Interest — Compliance with Copeland "Anti -Kickback" Act 10. Certification Regarding Debarment & Suspension and other Responsibility Matters 11. Certification Regarding Lobbying 12. Disclosure of Lobbying Activities and Instructions 13. House Bill 89 Verification Form 14. Residence Certificate 15. Section 504 Certification 16. System of Award Management (Sam.gov) 17. Certificate of Interested Parties - 1295 Form 18. Equal Opportunity Guidelines for Construction Contractors 19. Standard Form of Agreement (Construction Contract Agreement Form) 20. Corporate Certifications 21. General Contract Conditions 22. Calhoun County, Texas General Conditions 23. Attorney's Review Certification 24. Payment Bond 25. Performance Bond 26. Certificate of Liability Insurance 27. Technical Specifications *Items 3-16 are to be provided to and/or completed by all bidders and included with submission of bid. Please provide one (1) USB flash drive and one (1) original and four (4) copies of the complete bid schedule and required forms. Advertisement and Invitation to Bids Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive bids for: Bid Number 2024.04 - Recvcle Waste Transfer Station Protect The Project consists of a new 5,250 SF Recycling Transfer Station Building. The structure will be a pre- engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramps. The Instructions for Bidders, Bid Form, Specifications, and other Contract Documents may be examined at G&W Engineers, Inc. at 205 W. Live Oak, Port Lavaca, TX 77979 and obtained from www.CivcastUSA.com. There is no charge to view or download the documents. Addendums and other announcements will be distributed via CivCastUSA to all plan holders. A Pre -Bid Conference will be held at 10:00 AM, Thursday, February 15, 2024. Meeting location will start in the Commissioners Courtroom, Calhoun County Courthouse, 211 South Ann Street, 1a` Floor, Suite 104, Port Lavaca, Texas 77979. Potential bidders are strongly urged to attend. Bidders must submit with their bid a bid bond, issued by an acceptable surety, or a certified check, payable to Calhoun County, in the amount of not less than five percent (5%) of the total bid submitted. Bids submitted without the required security will not be considered. All contractors and subcontractors must be cleared (not suspended or debarred) prior to any formal action authorizing the award of a contract to the contractor and for the duration of the project. Sealed Bids may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 31 Floor, Suite 301 Port Lavaca, TX 77979 All bids must 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, or the UPSIFedExlother Delivery Service envelope: Sealed Bid — Bid Number 2024.04 Recycle Waste Transfer Station Project. Sealed Bids consisting of one (1) USB flash drive and one (1) original and four (4) printed copies of the complete bid and required forms are DUE BEFORE 2:00:00 PM local time, TUESDAY, MARCH 12, 2024 In the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, V Floor, Suite 301, Port Lavaca, Texas. At this time, all bids will be publicly opened and read aloud in the conference room located In the County Judge's office. It is the responsibility of the submitting bidder to ensure that their 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 bidder in the course of responding to the bid. Bids received after the date and time the bids are due will not be accepted and will be returned unopened, regardless of whether or not the delay was outside of the control of the submitting bidder. 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. Calhoun County reserves the right to reject any or all bids or to waive any informalities in the bidding and to award to the responsible bidder submitting the best qualified acceptable bid who, in the opinion of Calhoun County, offers the bid in the best interest of the County. Bids may be held by Calhoun County for a period not to exceed thirty (30) days from the date of the bid opening for the purpose of reviewing the bids and investigating the bidder's qualifications prior to the contract award. BID Revised Addendum No. 1—02-28-2024 PROJECT NAME: Bid Number 2024.04 - Recycle Waste Transfer Station Project DUE DATE. fuesday, March 12, 2024 before 2:00:00 mini NAME: WORK SCOPE is Bids are iRl ed for items and quantities of work generally as follows: a new 5,250 SF Recycling Transfer Station Building. The structures will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage Improvements, new limestone roadway pavement and concrete approach ramps. `BASE BIG1 Item Quantity Unit Unit Price Total Bid Price 1. Furnish all necessary equipment, 1 LS materials, and labor for $7,500.00 $7,500.00 mobilization, demobilization, barricades; and insurance. 2. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the building foundation complete in place, $313,500.00 $313,500.00 including select fill as designed and includes incorporated concrete push walls and in accordance with the drawings and specifications 3. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the pre-engineered $133,947.00 $133,947.00 metal building, siding, gutter system, and roof in accordance with the drawings and specifications. This item includes any engineering cost/fees to receive stamped PEMB drawings from manufacturer. Total Base Bid $464,947.00 OWNER'S OPTIONS Item Quantity Unit Unit Price Total Bid Price Option 1) Furnish all necessary 3,470 SF equipment, materials, and labor for the $17.00 $58,990.00 installation of the 8" thick reinforced concrete pavement in accordance with the drawings and specifications OWNER'S OPTIONS Continued.. Item Quantity Unit Unit Price Total Bid Price Option 2) Furnish all necessary 17,160 SF equipment, materials, and labor for the installation of the 8" thick limestone $5.00 $85,800.00 pavement (complete in place and in final position) in accordance with the drawings and specifications Option 3) Furnish all necessary 77 LF equipment, materials, and labor for the $8,239.00 installation of the 24" HDPE storm pipe in $107.00 accordance with the drawings and specifications Option 4) Furnish all necessary 77 LF equipment, materials, and labor for the installation of the 15" HDPE storm pipe in $76.00 $5,852.00 accordance with the drawings and specifications Option 5) Furnish all necessary 2 EA equipment, materials, and labor for the $7,425.00 installation of the precast concrete safety $14,850.00 end treatments for 15' storm pipes in accordance with the drawings and specifications Option 6) Furnish all necessary 2 EA equipment, materials, and labor for the installation of the precast safety end $8,000.00 $16,000.00 treatments for 24" storm pipes in accordance with the drawings and specifications Option7) Furnish all necessary 370 LF equipment, materials, and labor for the installation of the drainage swales in $12.40 $4588.00 accordance with the drawings and specifications Option 8) Furnish all necessary 1 LS equipment, materials, and labor for the installation of the general fill material and $7,000.00 $7,000.00 site grading in accordance with the drawings and specifications. Use/reuse of excavated onsite materials from foundation excavation acceptable. dote: The award wlllbe based on the BASE BID with consideration of the Owner's' Options 1 through 8. The'' Owner reserves the right to choose all, none or any combination of the Owner's Options at their discretiom SPECIFICATION NOTES Calhoun County is receiving Bids for items and quantities of work generally as follows: Bids are invited for items and quantities of work generally as follows: A new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramp. County to provide: 1. Unsecured place to store contractor equipment and vehicles 2. Unsecured area to store excess materials required for construction. The BIDDER, in compliance with the invitation for bids for Bid Number 2024.04 - Recycle Waste Transfer Station Prolect, having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies in accordance with the contract documents, within the time set forth herein. These price(s) are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is a part. These price(s) are firm and shall not be subject to adjustment provided this Proposal is accepted within thirty (30) days after the time set for receipt of proposals. BIDDER hereby agrees to commence work under this contract on or before a date to be specified in a written "Notice to Proceed" to be issued by the County and to substantially complete within 16o consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. Addenda #1 dated 2/28/2024 2. SUBCONTRACTORS, The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Subcontractor See Attachment The undersigned hereby declares that he has visited the site and has carefully examined the contract documents relative to the work Covered by the above bid. Bidder Name: Boettcher Hlavinka Co., LLC. Address: P.O. Box 1335 East Bernard, TX 77435 Phone: 979-335-6031 office 979-253-1049 cell EIN or Tax Signature: Name and Email Address: joey.teague@hlavinka.com Y, v m C s bio c c ` h a 00 c O Q C i c yc O. m j`/ w O Y � E Q u Y n w on O W E J LL C O qS ma Y a U Y m 7 Y v u w c U � W c U 00 a a a m N c N N N N N a m m m d m r, ti m n N LD Ol 00 n n cn j I'- -o m v rl c N 3 m c m O 7 t J m n L H a�-I O 00 a C b0 V J J a E o c 'O c ° 0 L E Ly L N 0 O U � w L _ O U m Y N 0 m V BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Boettcher Hlavinks Company, LLC as PRINCIPAL, and Merchants Bonding Company (Mutual) , as SURETY are hold and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", In the penal sum of Five Percent of oreatest Amount Bid Dollars, ($ s% ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, Jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated Bid Number 2024.04 - Recycle Waste Transfer Station Project for Calhoun County, Texas. NOW, THEREFOR, if the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, If no period be specified, within thirty (30) days after the said opening, and shall within the period specified therefore, or If no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Owner in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter Into such Contract and give such bond within the time specified, if the Principal shall pay the Owner the difference between the amount specified In said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be vold and of no effect, otherwise to remain in full force and virtue, IN WITNESS THEREOF, the above -bounded parties have executed this instrument under their several seals this sth day of March. 2024 , the name and corporate seal of each corporate party being hereto affixed and these present signed by Its undersigned representative, pursuant to authority of its governing body. Attest: 6ZOL Attest: n6d Js�-�cNzr_}i�arenCe ll L(SEAL) By; (SEAL) Affix Corporate Seat By: Affix %Corporate Merchants Bonding Co!mPany (Mutpal I - Seal Attest: _�1( By: qt^ Teresa Martin, Witness Alexandria Petroski, Attdiney-Ih-Fao1 Countersigned By * Attorney -In -Fact, State of .MERCHAC.TTS BONDING COMPANY,. POWER OF ATTORNEY Know All Pomona By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the Slate of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the 'Companies") do hereby make, constitute and appoint, Individually, Alexandria Palroskl; Roes Gunnels; Sally While; Teresa Martin their true and lawful Attornay(s)-In-Fact, to sign Its name as surely(les) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written Instruments In the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permuted In any actions or proceedings allowed by law. This power -of -Attorney Is granted and Is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors. of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantaNatlonal Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Atlomeye-In-Fool, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognlzanoss, contracts of Indemnity and other writings obligatory in the nature thereof." "rho signature of any authorized officer and the seat of the Company may be affixed by facsimile or elsolronlc transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations In favor of the Florida Department of Transportation only, It is agreed that the power and out horky hereby given to the Atlomey-In-Fact includes any and all consent$ for the release of retained percentages and/or Mel estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the Mal estimate to the Contractor and/or Its assignee, shall not relieve this surety company of any of Its obligations under Its bond. In connection with obligations In favor of the Kentucky Department of Highways only, It Is agreed that the power and authority hereby given to the Attorney -In -Fact cannot be modified or revoked unless prior written personal notice of such Intent has been given to the Commissloner- Department of Highways of the Commonwealth of Kentucky at least thlrty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this Instrument to be signed and sealed this 3rd day or February , 2024 . -. 15,., ._ MERCHANTS BONDING COMPANY(MUTUALI STATE OF IOWA COUNTY OF DALLAS as. On this 3rd day of did say that he Is Preside seats affixed to the forego of the Companies by auth dfbla MERCHANTS NATIONAL IND-EMNIITTY COMPANY By `�' � President February 2024 before me appeared Larry Taylor, to me personally known, who being by me duly sworn I MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the Instrument are the Corporate Seals of the Companies; and that the said Instrument was signed and sealed In behalf of their respective Boards of Directors. Perini Miller L_NoffW��,. Commission Number 7817952 My Commission Expires- lanuary20,2o27 C1 i �J I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing Is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which Is still In full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto POA 0018 (1124) hand and on this 8th day of ��-Hsu../ 1933 � C: Secretary March , 2024 . MERCHANTS k BONDING COMPANY. MERCHANTS BONDING COMPANY (MUTUAL) • P.O. BOX 14498 - DES MOINES. IOWA 50306-3498 PHONE; (800) 678-8171 • PAX: (515) 243-3854 Have a complaint or need help? If you have a problem with a claim or your premium, call your insurance company or HMO first. If you can't work out the issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company or HMO. If you don't, you may lose your right to appeal. To get information or file a complaint with your insurance company or HMO: Merchants Bonding Company (Mutual) Call: Compliance Officer at (800) 671-8171 Toll -free: (800) 671-8171 Email: regulatory@merchantsbonding.com Mail: P.O. Box 14498, Des Moines, Iowa 50306-3498 To get insurance information you may also contact your agent: Call: Mail: The Texas Department of Insurance To get help with an insurance question or file a complaint with the state: Call with a question: 1-800-252-3439 File a complaint: www.tdi.texas.gov Email: ConsumerProtection@tdi.texas.gov Mail: Consumer Protection, MC: CO-CP, Texas Department of Insurance PO Box 12030, Austin, TX 78711-2030 iTiene una queja o necesita ayuda? Si tiene un problema con una reclamation o con su prima de seguro, Ilame primero a su compahla de seguros o HMO. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre an ingles) pueda ayudar. Aun si usted presenta una queja ante el Departamento de Seguros de Texas, tambien debe presentar una queja a trav6s del proceso de quejas o de apelaciones de su compan(a de seguros o HMO. Si no to hate, podria perder su derecho para apelar. SUP 0032 TX (7123) Para obtener informacion o pare presentar una queja ante su compahfa de seguros o HMO: Merchants Bonding Company (Mutual) Liame a: Compliance Officer at (800) 671-8171 Telefono gratuito: (800) 678-8171 Correo electrbnico: regulatory@merchantsbonding.com Direccion postal: P.O. Box 14498, Des Moines, Iowa, 50306-3498 EI Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con los seguros o pare presenter una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una queja en: www.tdi.texas.gov Correo electronico: ConsumerProtection@tdi.texas.gov Direccion postal: Consumer Protection, MC: CO-CP, Texas Department of Insurance, PO Box 12030, Austin, TX 78711-2030 SUP 0032 TX (7/23) STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets.. The Bidder may submit any additional information he/she desires. Name of Bidder: Boettcher Hlavinka Co., LLC. Date Organized: Address: P.O. Box 1335 Date Incorporated: East Bernard, TX 77435 Number of Years in contracting business under current name: 71 CONTRACTS ON HAND: Contracts Residential home Dollar Amount 1939 Completion Date Hlavinka Equipment Co.: Re -surface Parking $94,750 4/2024 T&K Antique Auto/Office Renovation $398,550 5/2024 Type of work performed by your company: General Contracting - Commercial & Residential Have you ever failed to complete any work awarded to you? None Have you ever defaulted on a contract? None List the projects most recently completed by your firm (include project of similar importance): Project Dollar Amount Mo/Yr Completed Barry & Karla Adkins: Barndominium $720,000 12/2023 City of Bay City: Ave K Recycling facility $536,971 6/2019 City of Columbus: Visitor's Center $369,629 12/2017 TPWD Sea Center TX: New Flounder Bldg $695,403 12/19 Major equipment available for this contract: Dozer, Backhoe, Excavator, Skid steer, Loader, Forklift, Trucks, Compactor, Lifts Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Credit $ 5 million available: Bank reference: Prosperity Bank, East Bernard The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Calhoun County Protect Engineer in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed t d y of �af 2024- nn by: d llir/ / er< �OrS1�+ dG�O✓i (Signature) (Title) Josh Mayfield Construction/Operations Manager _E WHY I WANT TO BE HERE Josh.mayfield I want to work for Boettcher Hlavinka, because I want to be put in a situation where I can do what I @hlavinka.com love, which is Construction. I find great pride in developing my means and methods of construction. I want to work for a team where I can WIN. I want to work with a team that puts customers first and delivers an experience they cannot get anywhere else. A company where customers and clients WIN. I want to work for a company that is successful, delivers quality like no other and thrives! A Company that WINS. Win -Win -Win. I would be honored to have an opportunity at Boettcher Hlavinka Co. 979.559.7350 Q HOW I CAN ADD VALUE East Bernard, Tx I can bring a construction background, that is well versed in means and methods. I have held anywhere from 5-20 houses at a time (each ranging from $500k-$1 mil in value) as well as commercial projects ranging from $1.5-$7,500,000 range. I was not only steadfast in my build times, but I always delivered a quality finish! Most importantly, with happy customers! The past few years I have been in the customer service industry, and the knowledge and skills I have developed regarding customer relations and sales will propel me as a construction manager more than I could have ever imagined. I am excited to bring that new element back to building which is my true passion! WHERE I'VE BEEN OPERATIONS • Lead/Train a team of 10 to proficiently service and SELL gate service, garage door and MANAGER opener service/replacement, floor coatings, cabinet packages, storage solutions or Hero Garage complete garage transformations. April 2020 — April 2023 • Implement procedures that hold ourselves accountable to the highest level of customer service/satisfaction which has enabled us to achieve and maintain a 5-star rating and 100% customer satisfaction over our 3 years as an organization. • Analyze monthly P&L's, monthly budget reviews, fleet management, manage inventory, sales/technical/customer relations training, quality control, customer care, estimate jobs, submit proposals, and oversee any other daily operations. CONSTRUCTION • Executed the proper means and methods of construction to build a high -quality home and MANAGER maintained a strict schedule in order to meet deadlines while generating exceptional Coventry Homes customer building experience! April 2017 — April 2020 • Maintained positive customer relationships throughout build with happy closing surveys • Utilized problem solving skills to always keep the project moving in right direction and coordinating with trades, customers, and sales associate to ensure efficient team progress and communication. SUPERINTENDENT • On site manage to help assist in the construction of Commercial Projects and work Collier Construction efficiently with Project Manager to hold schedule while always delivering an outstanding May 2015 — April 2017 finished project to the owner. WHAT I'VE LEARNED CONSTRUCTION MANAGEMENT • Sam Houston State University, 2012-2015 Joey Teague 1314 CR 313E Vanderbilt, Tx. 77991 (979) 253-1049 Email: joeyteague@hlavinka.com Summary I have extensive experience most aspects of construction, agricultural business and management. My experience includes business management, employee supervision, hands on implementation. I am an accomplished welder, wood worker, fabricator, designer and pit master. I am also bilingual. Professional Experience Energy Star Inspector: Teague Construction Services, LLC. June 2021— Present - Private inspection service for commercial and residential Construction and existing structures. General Contractor/Project Manager: Boettcher Hlavinka Co., LLC. May 2011— Present Pricing, bidding and quoting materials and labor - Soliciting, hiring, supervising and coordinating sub -contractors - Development and implementation of Quality Control Plans - Scheduling and coordination of construction projects - Mobilization of equipment and personnel - On site supervision of projects Operations Manager: Teague Diversified 2002 — May 2011 - Construction Management - Facility design, employee supervision, materials purchasing, surveying, soil excavation - Supervision and management of concrete construction including: Management of cement batch plant, forming and placement of concrete, surveying, grading and concrete finish work - Farming: All aspects of farming - Variety selection, pest management, weed control, planting, irrigation management, soil management; harvesting operations - Hiring- day to day employee management - Management of Truck Fleet. Including dispatching and scheduling - Equipment Purchasing and Maintenance Oversight: Farm, trucking, and feedlot - Composting- Oversight and management of total operation - Sales and Marketing- Composting, livestock, feed stuff, and byproducts - Byproduct and Waste Management- Sales, transportation, regulation, and disposal of factory waste and by-products Owner: Texas Tastes BBQ Catering 2002 - 2011 Sales Manager: Hlavinka Equipment Company (Taft, Texas) 1999-2002 - Sales of all Case IH Products. - Shop Mechanic and Equipment Transportation Operations Manager Krackau Farms (New Braunfels Texas) 1996 -1999 - Dry land Farming: 3000 acre com, milo, wheat operation. Manage all aspects - Pasture Management: 2500 acres. - Seed / Fertilizer Sales and Distribution - Assistant Manager: 250 head Purebred Limousine Cattle Operation with artificial insemination embryo transfer Operations Manager San Antonio Livestock Show and Exposition 1995 - 1996 - Supervision of 300 plus workforce. - Over site of facilities, maintenance, event set up/tear down Ranch/ Farm Manager: Reddick Farms (Stockdale, Texas) 1993- 1996 - Farm Manager: 900 acre farming / pasture operation - Managed all aspects of 150 head cow / calf operation Education and Certification - Bachelors of Science - 1993 Animal Science: Texas A & M University- -Agriculture Teaching Certificate: 1996 Private Applicators License: 1996 CDL - Notary Public: Certification issued 3/2020 - Notary Signing Agent: Certification issued 4/2020 - Energy Star Building Inspector: Certification issued 6/2021 STATE OF TEXAS {} )� �AFFIDAVIT COUNTY OF (/ 1 A A�.Y1�3� {} Joey Teague being first duly sworn, deposes and says: that he orshe is (Type or Print Name) the Project Manager of Boettcher Hlavinka Co., LLC. , having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at 116 Pietzsch St. , East Bernard, TX (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, offerto give, nor intends to give at any time hereafterany 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, orto 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 r4quirements contained in the bid/proposal. of 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 6xr 20.2 WANAAWAgh MAYFIELD Signature of Notary Public MyNot fy ID# 130947369 ^F•o,,ET` Expires January 3,2025 CONTRACTOR CERTIFICATIONS CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Boettcher Hlavinka Co., LLC. P.O. Box 1335 East Bernard, TX 77435 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. WYes ❑ No The undersigned hereby certifies that: f The Non-Seareaated Facilities clause (Section 109 provision) is included in the Contract. No segregated facilities will be maintained as required by Title VI of the Civil Rights Act of 1964. The Equal Employment Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). 6�The Affirmative Action for Handicapped Workers clause is included in the contract. Lot The Exhibit B --Assurances for Construction Programs is included in the Contract. WThe Exhibit D — State of Texas Assurance is included in the Contract. Have you ever been or are you being considered for sanction due to violation of Executive Order 11246- Equal Employment Opportunity, as amended? ❑ Yes W No NAME AND TITLE OF SIGNER (Please type) Joey Teague, PM SIGNA E DATE 107e 3/12/2024 INSTRUCTIONS FOR CONFLICTS OF INTEREST QUESTIONNAIRE [Form CIQ] H.B. 914, passed during the 2005 Texas legislative session, as amended by H.B. 1491 passed in 2007, requires certain persons who wish to conduct business or be considered for business with a County to file a "conflict of interest questionnaire." The Texas Ethics Commission (TEC) created the conflict of interest questionnaire (FORM CIQ). These laws are codified in Chap. 176 of the Texas Local Government Code. What vendors/persons are subject to Chapter 176? • The word "person" includes a partnership, corporation or other corporate body, including those performing professional services. Such partnerships or corporations act through individuals, but it is the partnership or corporation that would be seeking to do business with the County. • Any "person" who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity • An agent of a person who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity • A vendor shall file a completed conflict of interest questionnaire if the person has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with an officer of that local governmental entity or a family member of the officer that results in taxable income. exceeding $2,500 during the 12 month period preceding the date a contract is executed or a contract is being considered; or (2) has given an officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value of more than $250 in the 12 month period preceding the date a contract is executed or a contract is being considered What triggers the requirement to file a "conflict of interest questionnaire"? When a person begins (1) contract discussions or negotiations with the County or (2) submits an application, response to request for proposals or bids, correspondence, or another writing relatedto a potential agreement, Form CIQ must be completed. Whether the person initiates the discussion or the County initiates the discussions, Form CIQ must be completed. Even if the vendor has no affiliation or business relationship with an officer or employee of the County, Form CIQ must be completed and submitted To what type of contracts does the bill apply? Any written contract and any implied contract, such as purchase orders, procurement card purchases, utility purchases, or any exchange of money or other consideration for some service or property. The monetary amount or value of the contract/purchase does not matter. When must a vendor file the conflict of interest questionnaire? No later than seven days after the date the person:. (a) begins contract discussions or negotiations with the County, or (b). submits an application or response to a request for proposals or bids, correspondence, or another writing related to a potential agreement with a County, or (c) becomes aware of an employment relationship with a local government officer or family member ofthe officer, or (d) becomes aware of a qualifying gift. What has to be revealed? Section 176.004 requires disclosure of a person's employment or business relationships. This includes each employment or business relationship with a corporation or other business entity with respect to which a local government officer services as an officer or director or holds an ownership interest of 10% or more. How do I go about filling out the Conflict of Interest Questionnaire form? Each number below corresponds with the number on FORM CIQ 2: 1. Fill in the full name of the person who is trying to do business with the County. If the person is a corporation, partnership, etc., then it is the name of that corporation, partnership, etc., that is required on Form CIQ. 2. Check box if the form is an update to a form previously completed. Updates are required by the 7th business day after an event that makes a statement in a previously filed questionnaire incomplete or inaccurate.. Updates are also required by September 1 of each year in which the person submits a proposal, bid or response to the County or begins contract discussions or negotiations with the County. 3. Complete this Section by listing the name of the local government officer (member of County Court or County Manager) with whom there is an affiliation to or business relationship and you checked the "Yes" box in Section 3 A, B, or C. If there is more than one local government officer (County Court or County Manager) with whom there is an affiliation or business relationship, more than one page two may be needed to provide information on each local government officer. 4. State whether the local government officer named on the form receives or is likely to receive taxable income, other than investment income, from the vendor filing the questionnaire. 5. State whether the filer receives or is likely to receive taxable income, other than investment income, from or at the direction of the local government officer named on the form AND the taxable income is not received from the local governmental entity. 6. Stale whether the filer is employed by a corporation or other business entity with which the local government officer serves as an officer or director or holds an ownership interest of 10% or more. 7. Describe each employment or business relationship with the local government officer named on the form. 8. Signature box. Person completing form must date and sign the form. If the form is being completed for a corporation, partnerships, etc., the person signing should be someone who is authorized to act on behalf of the corporation, partnership, etc. A signature is required in box #4 regardless of any other entry on the form. A copy of Chapter 176of the Texas Local Government Code can be found at: hftp://www.statutes.leais.state.tx.us/SOTWDocs/LG/htm/LG.176.htm 8/03/2011 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th OFFICE USE ONLY Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Date Received Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.004(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 person becomes aware of facts that require the statement to be filed. See Section 176.004, Local Government Code. A person commits an offense if the person knowingly violates Section 176.004, Local Government Code. An offense under this section is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. RFB / RFP I Contract 0 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 7t' business dayNrtheto thrigi ly filed questionnaire becomes incomplete or inaccurate.)3. Name of local government offhl fil ployment or business relationship. N e of OfIller This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? ❑ Yes ❑ No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? ❑ Yes ❑ No C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? ❑ Yes ❑ No D. Describe each employment or business relationship with the local government officer named in this section. 4. 00 Signature pe doing bu ess with governmental entity Date Si d INSERT DEBARMENT & SUSPENSION EXECUTIVE ORDER PDF HERE and it includes CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS HERE N/A CERTIFICATION REGARDING LOBBYING (To be submitted if the bid or offer exceeds $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, Boettcher Hlavinka Co. , 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 at seq., apply to this certification and disclosure, if any. / •W- SfaturVXf Contractc s Authorized Official Joey Teague, PM Printed Name and Title of Contractor's Authorized Official 3/12/2024 Date INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee 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, County, 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 subawardee, e.g., the first subawardee 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 "subawardee," then enter the full name, address, County, 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) Enterthe full name, address, County, State and zip code of the lobbying registrant underthe 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 form, print his/her name, title, and telephone number. —�wA .Inpv Tparmp PM A7A-953-1049 4'6 �a,,2,s e D- _ n�Y/ 3/12/2024 According to the Paperwork Reduction Act, as(afnendcd, 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 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 1. Type of Federal Action: 2. Status of Federal 3. Report Type: a. contract Action: a. initial filing _ b. grant a. b. material change c. cooperative bid/offer/application agreement b. initial award d. loan c. post -award e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Prime Subawardee Enter Name and Address of Prime: Tier , if Known: Congressional District, if knowN1 Aressional District, if known: 6. Federal Department/Agency: V J 7JFeder1L Program Name/Description: CFDA Number, if applicable: 7. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (if individual, last name, first name, Ml): (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1362. This ign ture: r— disclosure of lobbying activities is a material �OW representation of fact upon which reliance was placed by the tier above when this transaction int N e• Joey Teague was made or entered into. This disclosure is required pursuant to 31 U.S.C.1352. This Title: Project Manager information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the g7g_253-1049 3/12/2024 Telephone No.: Date: 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) 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. 1, (authorized official) Joey Teague, PM . 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://com ptroller.texas.gov/purchasi ng/pu blicatio ns/d ivestment. php Boettcher Hlavinka Co., LLC. Company Name Gg.q' Vie, /".N. Jol-�-11 //'Alao/L'" Name of Authorized Official Project Manager 3/12/2024 Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252,001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) 'Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. D I certify that (Company Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (Cityand smm) D I certify that Boettcher Hlavinka Co., LLC. is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. az / 12 Signature o thoriz ent Joey Teague, PM Printed Name and Title of Authorized Agent 3/12/2024 Date SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The General Contractor does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) Boettcher Hlavinka Co., LLC. (Address) 116 Pietzsch St. East Bernard, TX County State Zip Telephone Number (979 ) 335 - 6031 Voice (979 )�- 1049 TDD Josh Mayfield, DOC has been designated to coordinate compliance all Federal statutes relating to nondiscrimination. Insert System for Award Management (SAM) Record Search for company and company, principal(s). • Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principles are not listed (are not debarred) through the System for Award Management Last updated by Joshua Mayfield on Mar 11, 2024 at 09: 09 PM ROE7TCHERFILAVJNKA COLLC .01MILSAKoor BOETTCHERHLAVINKA CO LLC Entity ID i Status Registration 17405 Us 90A HWY East Bernard, Texas 77435.8267 United States Doing Business as (blank) Congressional District Texas 22 CAGE/NCAGE (blank) Expiration Date Mar 11, 2025 Mailing Address 17405 Us 90A HWY East Bernard, Texas 77435.8267 United States Division Name (blank) State / Country of Incorporation Texas / United States Purpose of Registration Federal Assistance Awards Only Division Number (blank) URL www.hlavinka.com Registration Dates Activation Date Submission Date Initial Registration Date (blank) Mar 11, 2024 Mar 11, 2024 Entity Dates Entity Start Date Fiscal Year End Close Date Feb 4, 2021 Dec 31 Immediate Owner CAGE Legal Business Name (blank) (blank) Highest Level Owner CAGE Legal Business Name (blank) (blank) Executive Compensation In your business or organization's preceding completed fiscal year, did your business or organization (the legal entity to which this specific SAM record, represented by a Unique Entity ID, belongs) receive both of the following: 1. 80 percent or more of your annual gross revenues in U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements and 2. $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements? No Does the public have access to information about the compensation of the senior executives in your business or organization (the legal entity to which this specific SAM record, represented by a Unique Entity ID, belongs) through periodic reports fled under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Not Selected Proceedings Questions Is your business or organization, as represented by the Unique Entity ID on this entity registration, responding to a Federal procurement opportunity that contains the provision at FAR 52.209-7, subject to the clause in FAR 52.209-9 in a current Federal contract, or applying for a Federal grant opportunity which contains the award term and condition described in 2 C.F.R. 200 Appendix XII? No Does your business or organization, as represented by the Unique Entity ID on this specific SAM record, have current active Federal contracts and/or grants with total value (including any exercised/unexercised options) greater than $10,000,000? Not Selected Within the last five years, had the business or organization (represented by the Unique Entity ID on this specific SAM record) and/or any of its principals, in connection with the award to or performance by the business or organization of a Federal contract or grant, been the subject of a Federal or State (1) criminal proceeding resulting in a conviction or other acknowledgment of fault; (2) civil proceeding resulting in a finding of fault with a monetary fine, penalty, reimbursement, restitution, and/or damages greater than $6,000, or other acknowledgment of fault; and/or (3) administrative proceeding resulting in a finding of fault with either a monetary fine or penalty greater than $5,000 or reimbursement, restitution, or damages greater than $100,000, or other acknowledgment of fault? Not Selected Last updated by Joshua Ma)f1e(d on Mar LI, 1024 at 09:09 PM Active Exclusions Records? BOEYMIERHLAVLNRA CO LLC No I authorize my entity's non -sensitive Information to be displayed in SAM public search results: Yes Business Types Entity Structure Other Profit Structure For Profit Organization Socio-Economic Types Entity Type Business or Organization Organization Factors Limited. Liability Company Check the registrant's Reps & Carts, if present, under FAR 52.2123 or FAR 52.219.1 to determine If the entity is an SBA-certifled HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. Accepts Credit Card Payments Debt Subject To Offset No No EFT Indicator 0000 Electronic Funds Transfer Account Type Checking Financial Institution PROSPERITY BANK Automated Clearing House Phone (U.S.) 9795597350 Fax (blank) .Remittance Address josh mayfield PO Box 1335 East Bernard, Texas 77435 United States CAGE Code (blank) Routing Number Lock Box Number " eee55 (blank) Account Number Email Phone (non-U.S.) josh.mayfield@hlavinka.com (blank) No IRA= EIN Type of Tax Taxpayer Name '"'e5107 Applicable Federal Tax Boettcher Hlavinka Co LLC Tax Year (Most Recent Tax Year) Namerritle of Individual Executing Consent TIN Consent Date 2023 Director Of Construction Mar 11, 2024 Address Signature 17405 Highway 90A Joshua Mayfield East Bernard, Texas 77435 Accounts Receivable POC P. Joshua A Mayfield, Director of Construction josh.mayfield@hiavinka.com Q7a55Q7x5n Last updated byJoA. Mayfield on Mar 11, 2014 at 09:09 PM Electronic Business CO LLC A Joshua A Mayfield, Director of Construction josh.mayfield@hlavinks.com 9795597350 Government Business A Josh A Mayfield, Director of Construction josh.mayfield@hlavinka.com 9795597350 NAICS Codes Primary NAICS Codes IGT Size Metrics Annual Revenue (from all IGTs) (blank) 17405 US-90Alt East Bernard, Texas 77435 United States 17405 US-90 Alt East Bernard, Texas 77435 United States NAICS Title Worldwide Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR 121) (blank) (blank) Location Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR 121) (blank) (blank) Industry -Specific Barrels Capacity Megawatt Hours Total Assets (blank) (blank) (blank) BID Revised Addendum No. 1-02-25-2024 PROJECT NAME: Bid Number 2024.04 - Recycle Waste Transfer Station Project DUE DATE: Tuesday, March 12, 2024 before 2:00:00 p.m. NAME: Clyde Kazmir Const., Inc. WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramps. BASE BID Item Quantity Unit Unit Price Total Bid Price 1. Furnish all necessary equipment, 1 LS $35, 500. 00 $25, 500. 00 materials, and labor for mobilization, demobilization, barricades, and insurance. 2. Furnish all necessary equipment, 1 LS $372, 725.00 $372, 725. 00 materials, and labor for the installation of the building foundation complete in place, including select fill as designed and includes incorporated concrete push walls and in accordance with the drawings and specifications 3. Furnish all necessary equipment, 1 LS $322, 500. 00 $322, 500. 00 materials, and labor for the installation of the pre-engineered metal building, siding, gutter system, and roof in accordance with the drawings and specifications. This item includes any engineering cost/fees to receive stamped PEMB drawings from manufacturer. Total Base Bid $720, 725. 00 OWNER'S OPTIONS Item Quantity Unit Unit Price Total Bid Price Option 1) Furnish all necessary 3,470 SF $14. 63 $50, 753.50 equipment, materials, and labor for the installation of the 8" thick reinforced concrete pavement in accordance with the drawings and specifications SPECIFICATION NOTES Calhoun County is receiving Bids for items and quantities of work generally as follows: Bids are invited for items and quantities of work generally as follows: A new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramp. County to provide: 1. Unsecured place to store contractor equipment and vehicles 2. Unsecured area to store excess materials required for construction. The BIDDER, in compliance with the invitation for bids for Bid Number 2024.04 - Recycle Waste Transfer Station Project, having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies in accordance with the contract documents, within the time set forth herein. These price(s) are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is a part. These price(s) are firm and shall not be subject to adjustment provided this Proposal is accepted within thirty (30) days after the time set for receipt of proposals. BIDDER hereby agrees to commence work under this contract on or before a date to be specified in a written "Notice to Proceed" to be issued by the County and to substantially complete within 6months/180 consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda 1. Addendum 1 SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Subcontractor Concrete and Building AAA Concrete The undersigned hereby declares that he has visited the site and has carefullv examined the contract documents relative to the work covered by the above bid. Bidder Name: Clyde Kazmir Construction, Inc. Address: 1001 West Main Street, Edna, Texas 77957 Phone: 361.782.3594 EIN or Tax ID No.: 74-24012064 Signature: Name and Title: Kelly Kazmir, Vice -President Email Address: kelly@kazmirconst.com EXECUTED IN DUPLICATE BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Clyde Kazmir Construction. Inc. as PRINCIPAL, and Great Midwest Insurance Company , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", in the penal sum of Five Percent (5%) of the Total Amount Bid Dollars, ($ 5% TAB ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated March 12, 2024 Bid Number 2024.04 - Recycle Waste Transfer Station Project for Calhoun County, Texas. NOW, THEREFOR, if the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within thirty (30) days after the said opening, and shall within the period specified therefore, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Owner in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Owner the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above -bounded parties have executed this instrument under their several seals this 8th day of March, 2024 , the name and corporate seal of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. Attest: Attest: t Attest: Alex Rausch, Mtness Countersigned 001 Attorney -in -Fact, State of Texas (SEAL) Clyde Kazmir Construction, Inc. (SEAL) By: Affix Corporate Seal .4 By: Affix Corporate Seal Great Mid"nsurr n a C Inpany � Sean cCa2ey,Jr., Attornsp. -Fact OWNER'S OPTIONS Continued.. Item Quantity Unit Unit Price Total Bid Price Option 2) Furnish all necessary 17,160 SF $4. 60 $78, 936. 00 equipment, materials, and labor for the installation of the 8" thick limestone pavement (complete in place and in final position) in accordance with the drawings and specifications Option 3) Furnish all necessary 77 LF $129.00 $9, 933.00 equipment, materials, and labor for the installation of the 24" HDPE storm pipe in accordance with the drawings and specifications Option 4) Furnish all necessary 77 LF $103.20 $7, 946.40 equipment, materials, and labor for the installation of the 15" HDPE storm pipe in accordance with the drawings and specifications Option 5) Furnish all necessary 2 EA $1, 925.00 $3, 850.00 equipment, materials, and labor for the installation of the precast concrete safety end treatments for 15" storm pipes in accordance with the drawings and specifications Option 6) Furnish all necessary 2 EA $2, 690.00 $5, 380. 00 equipment, materials, and labor for the installation of the precast safety end treatments for 24" storm pipes in accordance with the drawings and specifications Option 7) Furnish all necessary 370 LF $20. 00 $7, 400. 00 equipment, materials, and labor for the installation of the drainage swales in accordance with the drawings and specifications Option 8) Furnish all necessary 1 LS $10, 000.00 $10, 000. 00 equipment, materials, and labor for the installation of the general fill material and site grading in accordance with the drawings and specifications. Use/reuse of excavated onsite materials from foundation excavation acceptable. Note: The award will be based on the BASE BID with consideration of the Owner's Options 1 through S. The Owner reserves the right to choose all, none or any combination of the Owner's Options at their discretion. POWER OF ATTORNEY Great Midwest Insurance Company KNOW ALL MEN BY THESE PRESENTS, that GREAT MIDWEST INSURANCE COMPANY, a Texas Corporation, with its principal in Houston, TX, does hereby constitute and appoint: Sean McCauley, Jr., Claudia Chavez, Sam Duckett, Katie Rooney, Jeff Scott, Bridget Truxillo, Sarah Timmons, Ashlyn Simchik, Jarrod Yost, Alex Rausch, Liam Hackett, Sterling Ward true and lawful Attorney(s)-In-Fact to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or tings obligatory in nature of a bond. This authority is made under and by the authority of a resolution which was passed by the Board of Directors of GREAT NCE COMPANY, on the 151 day of October, 2018 as follows: Resolved, that the President, or any officer, be and hereby is, authorized to appoint and empower any representative of the Company r person or persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or oth ngs obligatory in nature of a bond not to exceed Twenty -Five Million dollars ($25,000,000.00), which the Company might execute through elected officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be as bindil i the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney -In -Fact, )inted, may be removed in the Company's sole discretion and the authority so granted may be revoked as specified in the Power of Attorney. Resolved, that the signature of the President and the seal of the Company may be affixed by facsimile on any power of attorney grants the signature of the Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any sui er or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and seak certificate so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to be valid and binding on tf IN WITNESS THEREOF, GREAT MIDWEST INSURANCE COMPANY, has caused this instrument to be signed by its President, and e Seal to be affixed this 11th day of February, 2021. GREAT MIDWEST INSURANCE COMPANY BY t.', Mark W. Haushill President ACKNOWLEDGEMENT On this 11th day of February, 2021, before me, personally came Mark W. Haushill to me known, who being duly sworn, did depose that he is the President of GREAT MIDWEST INSURANCE COMPANY, the corporation described in and which executed the above instrurr he executed said instrument on behalf of the corporation by authority of his office under the By-laws of said corporation. CHRISTINA BISHOP $s�Natary Public, State of Tsxas BY � .� Comm. Expires 04-14.2026 Christina Bishop xr ro� Notary ID 131090488 Notary Public CERTIFICATE I, the undersigned, Secretary of GREAT MIDWEST INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY original Power ofAttorney of which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolut set forth are now in force. and Sealed at Houston, TX this 8th Day of March 2024 MR Leslie K. is Any person who knowingly and with intentto defraud any insurance company or other person, files and application for insurance of cla any materially false information,; or, coax:eals for the purpose of misleading, Information concerning any fact material thereto, commits insurance act, which is a crime and subjects such person to criminal and civil penalties. Texas Department of Insurance Certificate No. 15063 `` Company No.07-005785 THIS IS TO CERTIFY THAT Certificate of Authority GREAT MIDWEST INSURANCE COMPANY HOUSTON, TEXAS has complied with the laws of the State of Texas applicable thereto and is hereby authorized to transact the business of Fire; Allied Coverages; Inland Marine; Ocean Marine; Aircraft -- Liability & Physical Damage; Accident; Health; Workers' Compensation & Employers' Liability; Employers' Liability; Automobile --Liability & Physical Damage; Liability other than Automobile; Fidelity & Surety; Glass; Burglary & Theft; Forgery; Boiler & Machinery; Credit and Reinsurance on all lines authorized to be written on a direct basis insurance within the state of Texas. This Certificate of Authority shall be in full force and effect until it is revoked, canceled or suspended according to law. IN TESTIMONY WHEREOF, witness my hand and seal of office at Austin, Texas, this 20th dayof December A.D. 2010 MIKE GEESLIN Godwin Ohaechesi, Director Company Licensing & Registration STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he/she desires. Name of Bidder: Clyde Kazmir Construction, Inc. Date Organized: 1961 Address: 1001 West Main Street Date Incorporated: December 11, 1985 Edna, Texas 77957 Number of Years in contracting business under current name: Since 1985 CONTRACTS ON HAND: Contracts DollarAmount Completion Date Vic-tec - Victoria $1,017.613.30 April 15, 2024 Roads and Drainage Improvements Project - LaWard $4,104,182.70 April 10, 2024 Type of work performed by your company: Civil Site Work, Commercial and Residential Have you ever failed to complete any work awarded to you? No Have you ever defaulted on a contract? No List the projects most recently completed by your firm (include project of similar importance): Project Dollar Amount Mo/Yr Completed Rosedin BESS Station $1,586,009.85 7/28/2023 Cottonwood Bayou Solar Project $4 104 182.70 7/20/2023 Major equipment available for this contract: Dozer, Excavator, Grader and Compactor Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Credit $ 675,000.00 Bank McKenna Zacek Pustka available: reference: Bank President The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Calhoun county, Texas in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this 12th day of March 2024 by: Vice President (Signature) (Title) STATE OF TEXAS COUNTY OF 11 Jackson 0 AFFIDAVIT Kelly Kazmir being first duly sworn, deposes and says: that he or she is (Type or Print Name) the Vice - President of Clyde Kazmir Construction, Inc. having its (Type or Print Title) principal address at (Type or Print Name of Company/Firm) 1001 West Main Street, PO Box 554, Edna, Texas 77957 (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 tothe attached bid/proposal; that said bid/proposal is genuine; thatthe 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 anytime 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 Affiant Kelly Kazmir, Vice -President 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 12 th day of `01Wq„ JASMINE .LIZABETH CALLIS �;' • �. Notary Public, State of Texas SIM. e Comm. Expires 01.192026 Notary ID 13311 __-- March 2024 of Notary Public CONTRACTOR CERTIFICATIONS CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Clyde Kazmir Construction, Inc. 1001 West Main Street Edna, Texas 77957 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. IN Yes ❑ No The undersigned hereby certifies that: LK The Non -Segregated Facilities clause (Section 109 provision) is included in the Contract. No segregated facilities will be maintained as required by Title VI of the Civil Rights Act of 1964. IR The Equal Employment Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). 9 The Affirmative Action for Handicapped Workers clause is included in the contract. 19 The Exhibit B— Assurances for Construction Programs is included in the Contract. 0 The Exhibit D — State of Texas Assurance is included in the Contract. Have you ever been or are you being considered for sanction due to violation of Executive Order 11246- Equal Employment Opportunity, as amended? ❑ Yes I No NAME AND TITLE OF SIGNER (Please type) Kelly Kazmir, Vice -President March 12, 2024 SIGNATU E DATE 8/03/2011 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Date Received Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.004(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 person becomes aware of facts that require the statement to be filed. See Section 176.004, Local Government Code. A person commits an offense if the person knowingly violates Section 176.004, Local Government Code. An offense under this section is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. RFB / RFP / Contract Kelly Kazrnir 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 7tn business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3. Name of local government officer with whom filer has employment or business relationship. N/A Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? ❑ Yes ❑ No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? ❑ Yes ❑ No C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? ❑ Yes ❑ No D. Describe each employment or business relationship with the local government officer named in this section. 4. " Signature of ppFiblon do business with governmental entity Date Signed -March 12, 2024 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. Kelly Kazmir - Vice President Name and Title of Authorized Agent atur�o W \ e /AAuthorized—Agent �W 94 Date I am unable to certify to the above statements. My explanation is attached. CERTIFICATION REGARDING LOBBYING (To be submitted if the bid or offer exceeds $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, Clyde Kazmir Construction, inrcertifies 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. Signatur of Contractor's Authorized Official Kelly Kazmir, Vice -President Printed Name and Title of Contractor's Authorized Official March 12, 2024 Date INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee 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, County, 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 subawardee, e.g., the first subawardee 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 "Subawardee," then enter the full name, address, County, 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, County, 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 N/A Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 See reverse for public burden disclosure 1. Type of Federal Action: 2. Status of Federal 3. Report Type: a. contract Action: a. initial filing b. grant a. b. material change c. cooperative bid/offer/application agreement b. initial award d. loan c. post -award e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, _ Prime Subawardee Enter 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: 7. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (if individual, last name, first name, MI): (last name, first name, MI): 11. Information requested through this form is , authorized by title 31 U.S.C. section 1352. This Si natur disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Pri Name: Kelly Kazmir was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Title: Vice - President information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the Telephone No.: 361.782.3594 Date: 3n2124 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) HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 8511 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) Kelly Kazmlr . 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 htt ps://com ptro Ile r.texas.gov/purchasing/publications/d ivestm a nt. ph p Clyde Kazmir Construction, Inc. Company Name Official Vice - President Kelly Kazmir Printed Name of Authorized Official March 12, 2024 Title of Authorized Official Date Pursuant to Texas Government Code §2252.001 etseq., 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. D 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 shma) certify that Clyde Kazmir Construction, Inc. is a "Resident Bidder" of Texas as (Company Nam.) defined in Government Code §2252,001. -� Signature of Authorized ent Kelly Kazmir, Vice -President Printed Name and Title of Authorized Agent March 12, 2024 Date SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The Clyde Kazmir Construction, Inc. does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) (Address) W.Fa117, 1001 West Main Street Jackson Texas 77957 County State Zip Telephone Number ( 361 ) 782 - 3594 Voice ( ) TDD Kelly Kazmir has been designated to coordinate compliance all Federal statutes relating to nondiscrimination. e BID Revised Addendum No. 1 - 02.28-2024 PROJECT NAME: Bid Number 2024.04 - Recycle Waste Transfer Station Project DUE DATE: Tuesdav, March 12, 2024 before 2DQ:OO o;m> NAME: Rexco Inca WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramps. BASE 810 Item Quantity Unit Unit Price Total Bid Price 1. Furnish all necessary equipment, 1 LS materials, and labor for mobilization, demobilization, barricades, and insurance. $10,000.00 $10 000.00 2. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the building foundation complete in place, including select fill as designed and includes incorporated concrete push walls and in accordance with the drawings and specifications $307,500.00 $307.500.00 3. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the pre-engineered metal building, siding, gutter system, and roof in accordance with the drawings and specifications. This item includes any engineering cost/fees to receive stamped PEMB drawings from manufacturer. $183,900.00 $183,900.00 Total Base Bid 501 400.00 OWNER'S OPTIONS Item Quantity Unit Unit Price Total.Bid Price Option 1)Furnish all necessary 3,470 SF equipment, materials, and labor for the installation of the8" thick reinforced - concrete pavement in accordance with the drawings and specifications $37.03 $128,492.10 OWNER'S OPTIONS Continued.. Item Quantity Unit Unit Price Total Bid Price Option 2) Furnish all necessary 17,160 SF equipment, materials, and labor for the installation of the 8" thick limestone pavement (complete in place and in final position) in accordance with the drawings and specifications $6.94 $119,090.40 Option 3) Furnish all necessary 77 LF equipment, materials, and labor for the installation of the 24" HDPE storm pipe in accordance with the drawings and specifications $153.20 $11796.40 Option 4) Furnish all necessary 77 LF equipment, materials, and labor for the installation of the 15" HDPE storm pipe in accordance with the drawings and specifications 133:03 10 243.31 Option 6) Furnish all necessary 2 EA equipment, materials, and labor for the installation of the precast concrete safety end treatments for 15" storm pipes in accordance with the drawings and specifications $5 611.50 $11 223:00 Option 6) Furnish all necessary 2 EA equipment, materials, and labor for the installation of the precast safety end treatments for 24" storm pipes in accordance with the drawings and specifications Option 7) Furnish all necessary 370 LF equipment, materials, and labor for the installation of the drainage swales in accordance with the drawings and specifications Option 8) Furnish all necessary 1 LS equipment, materials, and labor for the installation of the general fill material and site grading in accordance with the drawings and specifications. Use/reuse of excavated onsite materials from foundation excavation acceptable. $14 700.00 $14 700.00 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 public (federal, state, or local) transaction or contract under 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. Dennis Redding / Executive Vice President Name and Title of Authorized Agent Signature of Authorized Agent 03/12/24 I am unable to certify to the above statements. My explanation is attached. Date SPECIFICATION NOTES Calhoun County is receiving Bids for items and quantities of work generally as follows: Bids are invited for items and quantities of work generally as follows: A new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramp. County to provide 1. Unsecured place to store contractor equipment and vehicles 2. Unsecured area to store excess materials required for construction. The BIDDER, in compliance with the invitation for bids for Bid Number 2024.04 - Recycle Waste Transfer Station Project, having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies in accordance with the contract documents, within the time set forth herein. These price(s) are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is a part. These price(s) are firm and shall not be subject to adjustment provided this Proposal is accepted within thirty (30) days after the time set for receipt of proposals. BIDDER hereby agrees to commence work under this contract on or before a date to be specified in a written "Notice to Proceed" to be issued by the County and to substantially complete within "150 i consecutive calendar days asstipulatedin the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. Addendum 1 Dated February 23,2024 2. SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Subcontractor None the undersigned hereby declares that he has visited the site and has carefully examined the contract document: relative to the work covered by the above bid. Bidder Name: Rexco, Inc. Address: 1104 Mildred Dr., Port Lavaca, TX 77979 Phone: 361-552-5371 EIN or Tax ID No.: 74-1467107 Signature: Name and Title: Dennis Redding/Executive vice President Email Address: dennis@rexcoinc.com BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Rexco, Inc, 1104 Mildred Dr, Port Lavaca, Tx 77979 as PRINCIPAL, and ContinentalICasualty Company , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", in the penal sum of 5% Greatest Amount Bid Dollars, ($ 5% (GAB) ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmiyiby these presents. THE CONDITION OF.THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated March 2, 2024 Bid Number 2024.04 - Recycle Waste Transfer Station Project for Calhoun County, Texas. NOW, THEREFOR, if the PrincipaM shall not withdraw said Bid within the period specified therein after the opening of the same, or, If no period be specified, within thirty (30) days after the said opening, and shall within the period specified therefore, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Owner in accordance with the Bid as accepted, and give bond with goad and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment o,F such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter intolsuch Contract and give such bond within the time specified, if the Principal shall pay the Owner the difference Between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above -bounded parties have executed this Instrument under their several seals this 12th day of March 2024 , the name and corporate seal of each corporate party being hereto affixed and these present sig ied by its undersigned representative, pursuant to authority of its governing body. Rexco, Inc. (SEAL) (SEAL) Attest l By: --i NN :..Affix Continental Casualty Company Corporate Seal:��: Attest: By: KristieRodriguez Witness James sseH AttomeymFact- Afix , ..Corporate Seal' Attest: By: Countersigned By ' Attorney -in -Fact, State of I i POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That ( Hartford, an Illinois insurance company, and Ar "the CNA Companies"), are duly organized and and that they do by virtue of the signatures and Gary Grissom, Laurie J Barnes, Wagner, Coy Sunderman, J D 5 of Austin, TX, their true and lawful Attar bonds, undertakings and other obligatory and to bind them thereby as fully and to the same all the acts of said Attorney, pursuant to the amh( This Power of Attorney is made and executed adopted, as indicated, by the Boards of Directors o. In Witness Whereof, the CNA Companies affixed on this 29th day of August, 2023. .ed,PORArs � /' SEAT- teal State of South Dakota, County of Minnehahs, as: On this 29th day of August, 2023, before me I resides in the City of Sioux Falls, State of South D National Fire Insurance Company of Hertford, an 1 Pennsylvania insurance company described in and seals affixed to the said instrument are such corpor insurance companies and that he signed his name t companies. My Commission Expires rtal Casualty Company, an Illinois insurance company, National Fire Insurance Company of Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called g insurance companies having their principal offices in the City of Chicago, and State of Illinois, rein affixed hereby make, constitute and appoint Brown, Denise Dugan, James Russell, Ana Rodriguez, Made Rodriguez, Sharma t, Individually ct with full power and authority hereby conferred to sign, seal and execute for and on their behalf of similar nature - In Unlimited Amounts - as if such instruments were signed by a duly authorized officer of their insurance companies and reby given is hereby ratified and confirmed. uant to and by authority of the By -Laws and Resolutions, printed on the reverse hereof, duly insurance companies. caused these presents to be signed by their Vice President and their corporate seals to be hereto a,)ZM Continental Casualty Company National Fire Insurance Company of Hartford X American Casualty Company of Reading, Pennsylvania JotiSun • Larry Kasten Vice President onally came Larry Kasten to me (mown, who, being by me duly sworn, did depose and say: that he is; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, ois insurance company, and American Casualty Company of Reading, Pennsylvania, a ich executed the above instrument; that he knows the seals of said insurance companies; that the seals; that they were so affixed pursuant to authority given by the Boards of Directors of said :to pursuant to like authority, and acknowledges same to be the act and deed of said insurance In &6e]�7 — 2, 2026 M. Bent Notary Public I, D. Johnson, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Laws and Resolutions of the Board of Directors of the insurance companies printed on the reverse hereof is still in fo ce. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 12th day of March, 2024. !D/j oe Continental Casualty Company National Fire Insurance Company of Hartford a American Casualty Company of Reading, Pennsylvania IBM ) D. Johnson Assistant Secretary Form F6853-4-2023 Go to www.cnasurety.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. Authorizing By -Laws and Resolutions This Power of Attorney is signed by Larry Kasten, Vice President of each ofthe CNA Companies (as defined in the Power of Attorney), who has been authorized pursuant to the below Bylaws and Resolutions to met ite power of attorneys on behalf of each of the CNA Companies. ADOPTED BY THE BOARD OF DIRECTORS OF C ONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors ofthe Company at a meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice P sident may authorize an officer to sign specific documents, agreements and instruments on behalf ofthe Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to he Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed and sealed by fusim ile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 2516 day of April, 012: "Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers") to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the authorized Officers, in addition to being provided in original, bard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, " lectronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company." This Power of Attorney may be signed by digital sigr store and sealed by a digital or otherwise electronic -formatted corporate seal under and by the authority ofthe following Resolution adopted by the Board of Director; of the Company by unanimous written consent dated the 27th day of April, 2022: "RESOLVED: That it is in the best interest of thCompany to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and confirm the use of a digital or otherwise elec nio-formatted corporate seal, each to be considered the act and deed ofthe Company." ADOPTED BY THE BOARD OF DIRECTORS OF N kjjONAL FIRE INSURANCE COMPANY OF HARTFORD: This Power of Attorney is made and executed pursue t to and by authority of the following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senioror Group Vice Pr, sident may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized office and a description of the documents, agreements or instruments dint such officer may sign will be provided in writing by the Senior or Group Vice President to �I1ra Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed and sealed by facsim Is under and by the authority of die following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 25'" day of April, 2012: "Whereas, the bylaws ofthe Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers") to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the j uthorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "E lemonic Signatures"); Now therefore be it resolved: that the Electronic Signature ofany Authorized Officer shall be valid and binding on the Company." This Power of Attorney may be signed by digital sign tore and sealed by a digital or otherwise electronic -formatted corporate seal under and by the authority of the following Resolution adopted by the Board of Director; ofthe Company by unanimous written consent dated the 27th day of April, 2022: "RESOLVED: That it is in the best interest of dip Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and confirm the use of a digital or otherwise electtonio4mratted corporate seal, each to be considered the am and deed of the Company." ADOPTED BY THE BOARD OF DIRECTORS OF A MERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA. This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Bored of Directors ofthe Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice Pr sident may authorize an officer to sign specific documents, agreements and instruments on behalf ofthe Company provided that the name of such authorized offrce}r and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by die Senior or Group Vice President tol." e Secretary ofthe Company prior to such execution becoming effective This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Bored of Directors of the Company by unanimous written consent dated the 25'° day of April, ; 012: "Whereas, the bylaws ofthe Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers") to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature of the j itithorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company." This Power of Attorney may be signed by digital signature and sealed by a digital or otherwise elentmnic-formatted corporate seal under and by the authority of the following Resolution adopted by the Board of Directors ofthe Company by unanimous written consent dated die 27th day of April, 2022: "RESOLVED: That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and confine the use of a digital or otherwise electronic -formatted corporate seal, each to be considered the act and deed ofthe Company." CERTIFICATE AS TO CORPORATE PRINCIPAL I, John Harrison certify that I am the Secretary of the Corporation named as Principal in the within bond; that Dennis Redding who signed the said bond on behalf of the Principal was then Exec. V.P. of said corporation; that I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, for and in behalf of said corporation by authority of this governing body. Corporate �%^ ( Seal Title: �N JiG .Vt?EL(L * Power -of -attorney for person signing for Surety Company must be attached to bond. STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he/she desires. Name of Bidder: Rexco, Inc. Date Organized: Feb. 1963 Address: 1104 Mildred Dr. Date incorporated: Feb. 1963 Port Lavaca, TX 77979 Number of Years in contracting business under current name: 61 CONTRACTS ON HAND: Contracts Dollar Amount Completion Date Alcoa Dike Resloping $1.1 Million 12/31/24 Formosa Retention Pond $2.5 Million 06/30/24 Bechtel Asphalt Paving $4.2 Million 12/31/24 Cheniere Raw Water Lake $5.3 Million 12/31/24 Type of work performed by your company: General Construction Have you ever failed to complete any work awarded to you? No Have you ever defaulted on a contract? No List the projects most recently completed by your firm (include project of similar importance): Project Dollar Amount MoNr Completed Cheniere Raw Water Lake $3.1 Million 11/2022 Bechtel Concrete Paving $1.2 Million 09/2022 Cheniere Fill Material $5 million 10/31/23 Alcoa Dike Resloping $1.2 million 11/2022 Major equipment available for this contract: Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Credit $ One million Bank available: reference: Wells Fargo The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Owner in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this 12th day of March , 2024. by 1(CCN iJL VicC plf4✓i (Signature) (Title) STATE OF TEXAS {} AFFIDAVIT COUNTY OF Calhoun {} Dennis Redding being first duly sworn, deposes and says: that he or she is (Type or Print Name) the Executive Vice President of Rexco, Inc. having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at 1104 Mildred Dr., Port Lavaca, TX 77979 (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, orto raise or fix any overhead, profit or cost element of their price/fee or of that of anyone else; d) did not give, offerto 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 Dennis Redding / Executive Vice President 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 12th LEAH STRAKOS ' q.star%MryID#3835568 a ••;•E,o�h+„� Expires August 12,202fi day of March , 20 24 of Notary Public CONTRACTOR CERTIFICATIONS CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Rexco, Inc., 1104 Mildred Dr., Port Lavaca, TX 77979 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. H Yes ❑ No The undersigned hereby certifies that: H"The Non -Segregated Facilities clause (Section 109 provision) is included in the Contract. No / segregated facilities will be maintained as required by Title VI of the Civil Rights Act of 1964. 19 The Equal Emolovment Ovoortunity clause is included in the Contract (if bid equals or exceeds $10,000). Q,*`The Affirmative Action for Handicapped Workers clause is includedin the contract. t�� e Exhibit B — Assurances for Construction Programs is included in the Contract. Ci ha Exhibit D — State of Texas Assurance is included in the Contract. Have you ever been or are you being considered for sanction due to violation of Executive Order 11246- Equal Employment Opportunity, as amended? ❑ Yes No NAME AND TITLE OF SIGNER (Please type) Dennis Redding / Executive Vice President 03/12/24 SIGNATURE DATE 8/03/2011 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th OFFICE USE ONLY Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Date Received Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.004(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 person becomes aware of facts that require the statement to be filed. See Section 176.004, Local Government Code. A person commits an offense if the person knowingly violates Section 176.004, Local Government Cade. An offense under this section is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. RFB / RFP / Contract 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 71 business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) with whom filer has employment or business relationship. 3. Name of local government TV Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? ❑ Yes Q/"No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? �,/ El Yes No C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? ❑ Yes Ly No D. Describe each employment or business relationship with the local government officer named in this section. n � 4. Signature of person doing business with governmental entity Date Sinned —) `a. INSTRUCTIONS FOR CONFLICTS OF INTEREST QUESTIONNAIRE [Form CIO] H.B. 914, passed during the 2005 Texas legislative session, as amended by H.B. 1491 passed in 2007, requires certain persons who wish to conduct business or be considered for business with a County to file a "conflict of interest questionnaire." The Texas Ethics Commission (TEC) created the conflict of interest questionnaire (FORM CIQ). These laws are codified in Chap. 176 of the Texas Local Government Cade. What vendors/persons are subject to Chapter 176? • The word "person" includes a partnership, corporation or other corporate body, including those performing professional services. Such partnerships or corporations act through individuals, but it is the partnership or corporation that would be seeking to do business with the County. • Any "person" who contracts or seeks to contractfor the sale or purchase of property, goods, or services with a local governmental entity • An agent of a person who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity • A vendor shall file a completed conflict of interest questionnaire if the person has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with an officer of that local governmental entity or a family member of the officer that results in taxable income exceeding $2,500 during the 12 month period preceding the date a contract is executed or a contract Is being considered; or (2) has given an officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value of more than $250 in the 12 month period preceding the date a contract is executed or a contract is being considered What triggers this requirement to file a "conflict of Interest questionnaire"? When a person begins (1) contract discussions or negotiations with the County or (2) submits an application, response to request for proposals or bids, correspondence, or another writing related to a potential agreement, Form CIO must be completed. Whether the person initiates the discussion or the County initiates the discussions, Form CIQ must be completed. Even if the vendor has no affiliation or business relationship with an officer or employee of the County, Form CIQ must be completed and submitted To what type of contracts does the bill apply? Any written contract and any Implied contract, such as purchase orders, procurement card purchases, utility purchases, or any exchange of money or other consideration for some service or property. The monetary amount or value of the contractipurchase does not matter. When must a vendor file the conflict of interest questionnaire? No later than seven days after the data the person: (a) begins contract discussions or negotiations with the County, or (b) submits an application or response to a request for proposals or bids, correspondence, or another writing related to a potential agreement with a County, or (c) becomes aware of an employment relationship with a local government officer or family member of the officer, or (d) becomes aware of a qualifying gift. What has to be revealed? Section 176.004 requires disclosure of a person's employment or business relationships. This includes each employment or business relationship with a corporation or other business entity with respect to which a local government officer services as an officer or director or holds an ownership interest of 10% or more. How do I go about filling out the Conflict of Interest Questionnaire form? Each number below corresponds with the number on FORM CIQ 2: 1. FIII In the full name of the person who is trying to do business with the County. If the person is a corporation, partnership, etc., then it is the name of that corporation, partnership, etc., that is required on Form CIQ. 2. Check box if the form is an update to a form previously completed. Updates are required by the 7th business day after an event that makes a statement in a previously filed questionnaire incomplete or inaccurate. Updates are also required by September 1 of each year in which the person submits a proposal, bid or response to the County or begins contract discussions or negotiations with the County. 3. Complete this Section by listing the name of the local government officer (member of County Court or County Manager) with whom there Is an affiliation to or business relationship and you checked the "Yes" box in Section 3 A, B, or C. If there Is more than one local government officer (County Court or County Manager) with whom there is an affiliation or business relationship, more than one page two may be needed to provide Information on each local government officer. 4. State whether the local government officer named on the form receives or is likely to receive taxable income, other than investment Income, from the vendor filing the questionnaire. 5. State whether the filer receives or is likely to receive taxable income, other than investment income, from or at the direction of the local government officer named on the form AND the taxable income Is not received from the local governmental entity. 6. State whether the filer is employed by a corporation or other business entity with which the local government officer serves as an officer or director or holds an ownership interest of 10% or more. 7. Describe each employment or business relationship with the local government officer named on the form. 8. Signature box. Person completing form must date and sign the form. If the form is being completed for a corporation, partnerships, etc., the person signing should be someone who is authorized to act on behalf of the corporation, partnership, etc. A signature is reaulred In box #4 reaardless of any other entry on the form. A copy of Chapter 176 of the Texas Local Government Code can be found at: htto://www.statutes.leals.state.tx.us/SOTWDocs/LG/htm/LG.176.htm Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 13 CFR Part 145. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211). Copies of the regulations are available from local offices of the U.S. Small Business Administration. (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) (1) The prospective primary participant certifies to the best of its knowledge and belief that it and its principals: (a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense 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 of 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; and (d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective primary participant shall attach an explanation to this proposal. Business Name Date 03/12/24 By Dennis Redding / Executive Vice President Name and Title of Authorized Representative Signature of Authorized Representative SBA Form 1623 (10-88) F^^e-d R�'P-m a -d-don This farm was electronically induced by Ellie Federal Fans, Inc. -2- INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause Is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If is is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms "covered transaction," "debarred," "suspended, "Ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is submitted for assistance in obtaining a copy of those regulations (13 CFR Part 145). 6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered Into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. 7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion —Lower Tier Covered Transactions," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the ineligibility of Its principals. Each participant may, but is not required to, check the Nonprocurement List. 9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters Into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. CERTIFICATION REGARDING LOBBYING (To be submitted if the bid or offer exceeds $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.G. § 1352 (as amended by the Lobbying Disclosure Act of 1995). The Contractor, Rexco, Inc. , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 33801 at seq., apply to this certification and disclosure, if any. Signal' a of Contractor's Authorized Official Dennis Redding / Executive Vice President Printed Name and Title of Contractor's Authorized Official 03/12/24 Date INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee 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, County, 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 subawardee, e.g., the first subawardee 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 "Subawardee," then enter the full name, address, County, 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, County, State and zip code of the lobbying registrant underthe 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 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 1. Type of Federal Action: 2. Status of Federal 3. Report Type: a. contract Action: a. initial filing 01 b. grant a. b. material change c. cooperative bid/offer/application agreement a b. initial award d. loan c. post -award e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Subawardee Enter Name and Address of Primer _✓Prime Tier , if Known: Congressional District, if known: Con ressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 7. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (if individual, last name, first name, MI): (last name, first name, MI): ' og 11. Information requested through this form is authorized by title 31 U.S.C. section 1362. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was 1 A placed by the tier above when this transaction ^ Print Name' 7�lh\ $ was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Title:�jePSI�r information will be reported to the Congress semiannually and will be available for public I'SS�,�3?' inspection. Any person who fails to file the Telephone No.: Date: 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) HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85`h 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) Dennis Redding 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.ph p Rexco, Inc. Company Name Dennis Redding Signature of Authorized Official Printed Name of Authorized Official Executive Vice President 03/12/24 Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 etseq., as amended, Calhoun County requests Residence Certification. §2252.001 etseq. 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. D I certify that (Company Nam.) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (city and state) D I certify that Rexco, Inc. is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. 51 Signature of Authorized Agent Dennis Redding / Executive Vice President Printed Name and Title of Authorized Agent 03/12/24 Date SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The Rexco, Inc. does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) Rexco, Inc. (Address) 1104 Mildred Dr. Calhoun, TX, 77979 County State Zip Telephone Number (361 ) 552 _ 5371 Voice ( ) TDD Dennis Redding has been designated to coordinate compliance all Federal statutes relating to nondiscrimination. An official website of the United States government Here's how you know .. i�.SAM*Gov® c/ a oo a Home Search Data Bank Data Services Help Search All Words e.g.1606N020Q02 I Saved Searches t 'Re —WO SCGf CAA Select Domain All Domains Filter By Keyword Search For more information on how to use our keyword search, visit our help guide Simple Search Search Editor O Any Words All Words OExact Phrase O e.g.1606N020Q02 Rexco _ Federal Organizations Enter Code or Name • Status ✓ Active 0 Inactive n Reset(!) Sort by Showing 1- 8 of 8 results Date Modified/Updated CLPG REXCO LLC Active Registration Entity Unique Entity ID CAGECode Physical Address Expiration Date NEZUU65LZ4Y1 96RR4 250 CALLE Feb 28,2025 FORTALEZA,SAN JUAN, PR 00901 Purpose of Registration USA All Awards REXCO EQUIPMENT, INC. Active Registration Entity Unique Entity ID CAGECode Physical Address Expiration Date H7ADJMF7LJ33 OKSF8 10995 High Life CT. Jan 9, 2025 SW, CEDAR RAPIDS, IA 52404 USA Purpose of Registration All Awards CLPG SJIP 1 LLC Active Registration " Entity Unique Entity ID CAGECode Physical Address Expiration Date UTH9L3TL4NL5 97MC8 250 CALLE Feb 7,2025 FORTALEZA,SAN JUAN, PR00901 USA P. J. ROSALY ENTERPRISES, LLC Active Registration Unique Entity ID CAGECode Physical Address UY6NDQSSYNK3 1PBR8 REXCO INDUSTRIAL PARK, 150 CALLE C ESQ B CARR 165, GUAYNABO,PR 00968 USA ISLANDWIDE LOGISTICS, INC Active Registration Purpose of Registration All Awards Entity Expiration Date Oct 18, 2024 Purpose of Registration All Awards Entity Unique Entity lD CAGECode Physical Address Expiration Date K968KWAMKD3 86BHG REXCO INDUSTRIAL Oct18, 2024 PARK,150 CALLE C ESQ. B CARR 165, GUAYNABO,PR 00968 USA REXCOANALYTICS LLC Active Registration Unique Entity ID CAGECode Physical Address NJQPFGUER3E5 83CN6 1400HANCOCK BLVD, APT 507, DAYTONA BEACH, FL 32114 USA TACTICAL MESH LLC Active Registration Purpose of Registration All Awards Entity Expiration Date Oct3, 2024 Purpose of Registration All Awards Unique Entity ID CAGE Code Physical Address J7FLF9JU6F56 6ZG23 REXCO INDUSTRIAL PARK, CALLE A #200, GUAYNABO, PR 00968 USA B BILLBOARD NC LLC ID Assigned Unique Entity ID ZFLDE3XZ84W9 1'of1 Physical Address REXCO INDUSTRIAL PARK, CALLE A #200 SUITE 300, GUAYNABO, PR 00968 USA Results per page i 25 Our Website About This Site Our Community Release Notes System Alerts Policies Terms of Use Privacy Policy Disclaimers Freedom of Information Act ,Accessibility Feedback Our Partners Acquisition.gov USASpending.gov Grants.gov More Partners Customer Service Help Check Entity Status Federal Service Desk External Resources Contact Entity Expiration Date Jul 18,2024 Purpose of Registration All Awards Entity Assigned Date Oct17,2022 ir NING U.S. General Services Administration Federal Government computer system that is "FOR OFFICIAL USE This system is subject to monitoring. Individuals found performing unauthorized activities are subject to ary action including criminal prosecution. This system contains Controlled Unclassified Information (CUI).All individuals viewing, reproducing or disposing of this information are required to protect it in accordance with 32 CFR Part 2002 and GSA Order CIO 2103.2 CUI Policy. BID Revised Addendum No. 1—02-28-2024 PROJECT NAME: Bid Number 2024.04 - Recycle Waste Transfer Station Pro'ect DUE DAT NUM ,. - ��Y, NAME: A — /3 G . WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramps. BASE BID Item Quantity Unit Unit Price Total Bid Price 1. Furnish all necessary equipment, 1 LS materials, and laborforp�(Q1D0C� P/QQO mobilization, demobilization, barricades, and insurance. 2. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the building foundation complete in place, of including select fill as designed and includes incorporated concrete push walls and in accordance with the drawings and specifications 3. Furnish all necessary equipment, 1 LS materials, and labor for the installation of the pre-engineered metal building, siding, gutter loot 000 k �g�jUO r system, and roof in accordance with the drawings and specifications. This item includes any engineering cost/fees to receive stamped PEMB drawings from manufacturer. Total Base Bid ` L ' 77, 000 OWNER'S OPTIONS Item Quantity Unit Unit Price Total Bid Price Option 1) Furnish all necessary 3,470 SF equipment, materials, and labor for the Jq installation of the 8" thick reinforced 43 4fi SOO concrete pavement in accordance with the drawings and specifications OWNER'S OPTIONS Continued.. Item Quantity Unit Unit Price Total Bid Price Option 2) Furnish all necessary 17,160 SF equipment, materials, and labor for the installation of the 8"thick limestone / r7W pavement (complete in place and in final position) in accordance with the drawings and specifications Option 3) Furnish all necessary 77 LF equipment, materials, and labor for the installation of the 24" HDPE storm pipe in �� !PU ! P 7, 90D accordance with the drawings and specifications Option 4) Furnish all necessary 77 LF equipment, materials, and labor for the installation of the 15" HDPE storm pipe in accordance with the drawings and / specifications Option 5) Furnish all necessary 2 EA equipment, materials, and labor for the installation of the precast concrete safety SD " end treatments for 15" storm pipes in accordance with the drawings and specifications Option 6) Furnish all necessary 2 EA equipment, materials, and labor for the installation of the precast safety end 3 0Z- 90 treatments for 24" storm pipes in i accordance with the drawings and specifications Option 7) Furnish all necessary 370 LF equipment, materials, and labor for the installation of the drainage swales in i r k 5QO. accordance with the drawings and specifications Option 8) Furnish all necessary 1 LS equipment, materials, and labor for the installation of the general fill material and f (1CluG{ 1 n site grading in accordance with the ou. oyt I'kM5 drawings and specifications. Use/reuse of excavated onsite materials from foundation excavation acceptable. Calhoun County is receiving Bids for items and quantities of work generally as follows: Bids are invited for items and quantities of work generally as follows: A new 5,250 SF Recycling Transfer Station Building. The structure will be a pre-engineered Metal building. The facility will have reinforced concrete foundation, various concrete (push) walls, grading of the site, drainage improvements, new limestone roadway pavement and concrete approach ramp. County to provide: 1. Unsecured place to store contractor equipment and vehicles 2. Unsecured area to store excess materials required for construction. The BIDDER, in compliance with the invitation for bids for Bid Number 2024.04 - Recycle Waste Transfer Station Project, having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies in accordance with the contract documents, within the time set forth herein. These price(s) are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is a part. These price(s) are firm and shall not be subject to adjustment provided this Proposal is accepted within thirty (30) days after the time set for receipt of proposals. BIDDER hereby agrees to commence work under this contract on or before a date to be soecifie_d in a written "Notice to Proceed" to be issued by the County and to substantially complete within , consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Sub ontractor %l/ GtJ The undersigned hereby declares that he has visited the site and has carefully examined the contract documents relative to the work covered by the above bid. Bidder Name: ( , V rl —1 f t-e t-c;� 1 QXn-LMC7Cb{3 , l f7C . Address: f. c). Oc)c As', Tbin�-Comf i(t , -T-X, Phone: _ J (2 I — 5-5a — 40 EIN orTe Signature Name and Title: V Cr 'R. 9�. Email Address: a^ m w.r S 4oll c mti AS,, � fc / i c . r 0K 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. du w T-e_re Z_ 0 Post," Name and Title of Au horized Agent ak2Z. Signature of Authorized Agent 31,'Q�gL Date I am unable to certify to the above statements. My explanation is attached. CERTIFICATION REGARDING LOBBYING (To be submitted if the bid or offer exceeds $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 Contractorch-�"�� �' 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 at seq., apply to this certification and disclosure, if any. pal l a -I goad Date 0348-0046 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for oublic burden disclosure) 1. Type of Federal Action: 2. Status of Federal 3. Report Type: ou a. contract Action: a. initial filing b. grant a. b. material change c. cooperative bid/offer/application agreement _& b. initial award d. loan c. post -award e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Prime Subawardee Enter Name and Address of Prime: Tier if Known: C011-��{R.� (!c,rfiruc{pr5, (nc . yp{Con.{i9lf, Tx on ressional District, if known: Congressional District if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 7. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. f0a) (if individual, last name, first name, Ml): (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This S' ture: _ disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction print Name:ss%Ca. ereZ was made or entered into. This disclosure is required pursuant to 31 U.S.C. the This information wthe ill be reported to Congress Title: semi-annually and will be available for public inspection. Any person who fails to file the Telephone No.t5w-c 5ebate: 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) 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) <JesstCGt., F r'c-'Z 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 Comptrollers Companies that Boycott Israel List located at https:Hcornptrollertexas.gov/purchasing/publications/divestment php Company Name GSsiccc.Pe r e r- Sidriature of Authorized Official l� Printed Name of Authorized Official M"6 03 0(a 2t9o�� Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 etseq., 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. D I certify that (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/ I certify that cQB t[#J 4ftJJ I6 5, In(. a'Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. Signature of horized Agent Printed Name and Title of Authorized Agent Date SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The 00 R — Me+A, I l,Uhli`UC6,InC•does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) I A4ebu—l��of17�)aG afS, �nC (Address) box C�S Ca�hoi�n 7 County State Zip Telephone Number (&(Q() 55a - q�2q-D-- Voice TDD LOrl7—tor rl Inc. has been designated to coordinate compliance all Federal statutes relating to nondiscrimination. STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he/she desires. Name of Bidder: _Con' metal Confrac%ors, (nc. Date Organized: 01003 Address: o'7 q A, ffm .3oE) q- Date Incorporated: o? cc fp 196 r-F LRVa ca , Zx 't -11-7 1 Number of Years in contracting business under current name: oP4 CONTRACTS ON HAND: Contracts Dollar Amount CmmnlPtinn natc Type of work performed by your company: fibundQ. om Steel S+rkC&b'S d24gn�, Have you ever failed to complete any work awarded to you? i hi n �— Have you ever defaulted on a contract? N n List the projects most recently completed by your firm (include project of similar importance): Project zeM A00 Rach'Wer MeW shei4er64r4 Dollar Amount I-6 4(9.Orl Mo/Yr Completed 07 Aoaa �')'. t/Am a-_r�aa�_„a..� r,.i. „� t/ 6.*n ,n , Major equipment available for this contract: Moo n'Vpu ner , 6wrn o 4-ruck:, jg v rn v w,*, . a r",e, Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Credit $ (. 0,311i available: Bank G reference: y6f bQnk, The undersigned Fj�reb authorize and regfiests any person, firm, or corporation to furnish any information requested by the (' ilnU �'6 in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this o2 day of ' , 200— 0 by' d9A9&J_ (Signat ) (Title) STATE OF TEXAS {} AFFIDAVIT COUNTY OFFl — {} Ou 1, tro fe re2 being first duly sworn, deposes and says: that he or she is (Type or Print Name) the +�Y e5ltl�l f— of Con- I` cfal Psa6i4prs, Inc . having its (Type or Print Title) (Type or—Priritnt Name of Company/Firm) / /r� [� / principal address at �� FIB'% ,' , r (�1tr( i+J( "�1l'%1q ; po Box as, ini &41- (Type or Print Physical and Mailing Address) "1-14.7 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, offerto give, nor intendsto 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�ents contained in the bid/proposal. Signatu of ant //J r' ra AL ez- lfl�re Slc�e,o � Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the abo a Affiant, who, on oath, states that the facts contained in the above are true and correct, this —L�—day of &) 200� Notary %�,*e- JESSICAryID PEAEZ Notary lD N73tfis62NMy Commission Expires July 17, 2026 Public CONTRACTOR CERTIFICATIONS CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability; and veterans' rights. ^NA —ME AND ADDRESS OF IDDER (include ZIP Code) Wn—&4e'+41 CbCI_LG}OI'5', =f1G or+- (Avaca Tk -11,1 "1 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. ❑ Yes E(No The undersigned hereby certifies that: a The Non -Segregated Facilities clause (Section 109 provision) is included in the Contract. No segregated facilities will be maintained as required by Title VI of the Civil Rights Act of 1964. 0 The Equal Employment Opportunity clause is included in the Contract Of bid equals or exceeds $10,000). 15 The Affirmative_ Action for Handicapped Workers clause is included in the contract. 19 The Exhibit B — Assurances for Construction Programs is included in the Contract. d The Exhibit D — State of Texas Assurance is included in the Contract. Have you ever been or are you being considered for sanction due to violation of Executive Order 11246- Equal Employment Opportunity, as amended? ❑ Yes R(No NAME AND TITLE Of SIGNER (Please type) P�SSi cam rdt-eZ ��r SIGNATURE DATE 8/03/2011 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Date Received Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.004(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 person becomes aware of facts that require the statement to be filed. See Section 176.004, Local Government Code. A person commits an offense if the person knowingly violates Section 176.004, Local Government Code. An offense under this section is a Class C misdemeanor. 1. Name of person doing business /nwith local governmental entity. oj+tty �e%tZ, 001I Inc. RFB / RFP / Contract # — (:ph. j&JCM, 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 the originally filed questionnaire becomes incomplete or inaccurate.) 3. Name of local government officer with h filer has employment or business relationship. Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? ❑ Yes 9 No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? ❑ Yes Wf No C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? ❑ Yes d No D. Describe each employment or business relationship with the local government officer named in this section. 4. SignatOre of person i usine with govepmental entity Date Sighed IMPORTANT - Please Read Outstanding cashier's checks are subject to state or territorial unclaimed property laws. If the cashier's check is lost, stolen, or destroyed, you may request a stop payment and reissuance: A stop payment and reissuance can only be completed within a branch location. As a condition of stop payment and reissuance, Wells Fargo Bank will require an indemnity agreement. In addition, for cashier's checks over $1,000.00, the waiting period before the stop payment and reissuance of an outstanding cashier's check may be processed is 90 days (30 days in the state of Wisconsin and 91 days in the state of New York). The waiting period can be avoided with the purchase of an acceptable surety bond. This can be purchased through Wells Fargo's approved insurance carrier or through an insurance carrier of the customer's choice. The cost of a surety bond varies depending on the amount of the bond and the insurer used. Surety bonds are subject to the insurance carrier's underwriting requirements before issuance. If the surety bond is not provided, the waiting period applies. Purchaser Copy - Page 2 of 2 0009511 11-24 CASHIER'S CHECK SERIAL#: 0851102101 Office AU # 1210(9) Remitter: ARTURO PEREZ ACCOUNT#: 4861-512861 Purchaser: ARTURO PEREZ Purchaser Account: xxxxxx5593 Operator l.D.: u475139 March 12, 2024 Funding Source: Paper Rands) PAYTOTHEORDEROF ***CALHOUNCOUNTY*** "Thirty -Two Thousand Five Hundred Twenty and 00/100 -US Dollars ** **$32,520.00** Payee Address: Memo: VOID IF OVER US $ 32.520.00 WELLS FARGO BANK, N.A. 699 STATE HWY35 S NON-NEGOTIABLE PORT LAVACA, TX 77979 FOR INQUIRIES CALL (480) 394-3122 Purchaser Copy - Page 1 of 2 FB004 (10/19) m4zaz 10152154 #21 NOTICE OF MEETING -- 3/27/2024 21. Accept Monthly Reports from the following County Offices: I. Calhoun County Tax Assessor — February 2024 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner±Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 18 of 20 SUMMARY TAX ASSESSOR-COLLECTOR'S MONTHLY REPORT FEBRUARY 2024 COLLECTIONS. DISBURSEMENTS Title Certificate Fees 330 $ 4,420.00 Title Fees Paid TXDMV $ 2,770.00 Title Fees Paid County Treasurer Salary Fund $ 1,650.00 Motor Vehicle Registration Collections $ 140,399.79 Disabled Person Fees $ 35.00 Postage $ - Global Addttonal Collections $ 27.75 Paid TXDMV $ 54,384.88 Paid TXDMV SP $ 16,623.01 Paid County Treasurer $ 62,346.74 Paid County Treasurer Salary Fund $ 5,170.15 DMV CCARDTRNSFEE $ 2,010.01 $ - GLAdditonalCollections $ 27.75 $ - GLOBAL (IBC) Credit/Debit Card Fee's $ 1,528.62 GLOBAL Fees In Excess of Collections $ 609.14 MERCH SERVICES STATEMENT $ - Additional Postage -Vehicle Registration $ - Paid County Treasurer -Additional Postage $ - Motor Vehicle Sales & Use Tax Collections $ 395,772.84 Paid State Treasurer $ 395,772.84 Special Road/Bridge Fees Collected $ 18,960.00 Paid County Treasurer- R/B Fees $ 18,960.00 Texas Parks & Wildlife Collections $ 3,980.00 TPW GLOBAL CC TRANSACTION FEES $ 137.54 GLOBAL ADDITIONAL COLLECTIONS $ - Paid Texas Parks & Wildlife $ 3,682.00 Paid County Treasurer Salary Fund $ 398.00 P&W CCARDTRNSFEE $ 137.54 GLOBAL Additonal Collections $ - GLOBAL (IBC) Credit/Debit Card Fee's $ 120.19 GLOBAL In Excess/Shortage of Collections $ 17.35 Boat/Motor Sales & Use Tax Collections $ 39,885.01 Paid State Treasurer $ 37,890.76 Paid County Treasurer, Salary Fund $ 1,994.25 TABC 5%CO COMMS FOR MONTH OF $ - TABC 5% CO COMMS FOR MONTH OF $ 55.00 Paid County Treasurer, Salary Fund $ 55.00 County Beer & Wine Collections $ 2,980.00 Paid County Treasurer, County Beer & Wine $ 2,831.00 Paid County Treasurer, Salary Fund $ 149.00 INTEREST EARNED ON OFFICE ACCOUNT $ 1,972.18 Paid County Treasurer, Nev. East $ 1.43 Paid County Treasurer, all other districts $ 1,970.75 INTEREST EARNED ON PARKS AND WILDLIFE ACCOUNT $ 28.38 Paid County Treasurer, Interest on P&W Ace $ 28.38 INTEREST EARNED ON REFUND ACCOUNT $ 0.33 Paid County Treasurer, Interest on Refund Ace $ 0.33 Business Personal Property - Misc. Fees $ 3,640.76 Paid County Treasurer $ 3,640.75 Excess Funds $ - Paid County Treasurer $ - Overpayments $ 3,528.70 Current Tax Collections $ 1,433,322.37 Penalty and Interest - Current Roll $ 27,676.26 Discount for early payment of taxes $ 2,112.74 Delinquent Tax Collections $ 13,317.92 Penalty & Interest - Delinquent Roll - $ 6,398.53 Collections for Delinquent Tax Attorney $ 4,679.96 Advance - FM & L Taxes $ - Advance- County AdValorem Taxes $ 1,450,005.83 Paid County Treasurer -Nev. East $ 1,169.45 Paid County Treasurer - all other Districts $ 30,955.76 Paid County Treasurer - Delinq Tax Atty. Fee $ 4,679.96 Payment In Lieu of Taxes $ - Paid County Treasurer - Navig. East $ - Paid County Treasurer -All other Districts $ - Special Farmers Fees Collected $ 20.00 Paid State Treasurer, Farmers Fees $ 20.00 Hot Check Collection Charges $ - Paid County Treasurers, Hot Check Charge $ Overage on CollectionlAssessing Fees $ - Paid County Treasurer, overage refunded $ Escheats - $ - Paid County Treasurer -escheats TOTAL COLLECTIONS $ 2,101,138.31 TOTAL TOTAL OF ABOVE RECEIPTS PAID TO STATE AND COUNTY On KERRIBOYDI Tax Assessor -Collector C $ 2,101,138.31 $ 2,101,138.31 t r RICHAR5 H MEYER County Judge # 22 I N01 ICE OE MEE-I ING — 3/)7/2024 22. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 19 of 20 F §w7®\ ■§5 » §� §- §aaaa §§ a ' ■ ) � � ' �S&� $$! | 2°' � . z _ |k �®M� „ ■ z § zm § ; 0j • ■§g 2 777 �§ em § ® )¢ �@ }§ § »# Z ■SG e :C4 ;o ;z :z :§ .L % .§ § j maak@■ §�B a §� §§aa2 §■ a §§aa2 a §§ k ■ MCC S& co§§ §z @d*2 :z \ §, 'w L ■ :B LU :z § b & § § kLU � )\ § :LLI w a z � z § � L a §we B�� §§ } §la § .■B § . § § z w w § § B � � ■ z ■ { k � 0 `z` r z W li a W G 00 m 16 C ae - 0 o Ww O o 0 = 00 W pC fA N N - yXW W O =t W 0�0 0 =~ w o C M O f7 O C =O W F<3 H fR = Zi coo wF»ua• o w =W �`r2 �,�, °Q W - .! J O O W = m m O O = .: ffi � 0 p =_ z z � g z CD 0 0 2 a = V N Z Z g O = Z e m ¢ = O F fu o = a a =_ Z U. LL _ W w = W z O C U =Z H w w __ H U =Z =W w IL w __ F =1 N =� Z W �MN -W y� CML Q �' moo o o 0 _ w goo m 0 t0 = = O O O fA = FD 6C _ L Whm = O Yy..II O t0 ep 10 � ('7 pppW��� ow» = ppWp = Z yZy W = Z W 0 0 W fA fA 0 fF 0 iH = W = � W 6B €a hm e IN d =W - S J J O O = W U. �ZZ� w O O =Z 00 2 =� to W �$1 mm¢ wrn O OC OC z O =W 3 Z_ =Q i _� W i O Z wLL0 =� � 6 W a = Z O 6 a H N ZO = F � = Z Im 19 a ca.� =W __ F p > = z 7' W op 04 W era o __ W 2 2 I \ LL, q 7 2 2 � //2 .§ ;�. .w ul - §� k ! § # 23 ' NOTICE. OF MFF FIN(-,..- 3/27/2024 23. 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 Indigent Healthcare RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County Bills RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Adjourned 10:50am Page 20 of 20 Mae Belle Cassel From: Cristina.Tuazon@calhouncotx.org (Cristina Tuazon) <Cristina.Tuazon@calhouncotx.org> Sent: Wednesday, March 20, 2024 4:44 PM To: david. hall; vern.lyssy@calhouncotx.org;joel.behrens@calhouncotx.org; gary.reese@calhouncotx.org; richard.meyer@calhouncotx.org; maebelle.cassel@calhouncotx.org; anna.goodman@calhouncotx.org; kaddie.smith@calhouncotx.org Subject: MMC Indigent Report Before Commissioner's Court March 27, 2024 Attachments: MMC CC 03272024.pdf Please read the first page at the Commissioner's Court Meeting on March 27, 2024. Thank you and have a blessed day. Compliance Auditor Calhoun County 361553 4615 Calhoun County Texas 1 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT ARPROVALdLIST: FOR March 27 2024 by:CT INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES MMCenter (in -patient $Or Out-paaent $30.25 / ER $0) 30.25 SUBTOTAL 30.26 Memorial Medical Center (Indigent Healthcare Payroll and Expenses) 4,166.67 Subtotal 4,196.92 Co -pays adjustments for February2024 0:00 Reimbursement from Medicaid 0.00 COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY UNIT PRICE TOTAL PRICE 1000-800-98722-999 Transfer to pay bills for Indigent Health Care $4,196.92 approved by Commissioners Court;on 03/27/2024 1000-001-46010 February 29,2024 Interest. ($10,89) $4,186.03 COUNTY AUDITOR APPROVAL ONLY THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY THIS OBLIGATION. Z CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME IN GOOD CONDITIIOONI AND REQUEST THE COUNTY TREASURER TO PAY BY: t 3/27/2024 APPROVED ON �ggyy MCCppAuuRNN2,0 ppp4 CALy0%WctN IDEPARTIAENT HEAD DATE ONS Source Totals Report Issued 03/18/24 Calhoun Indigent Health Care Batch Dates 03/01/2024 through 03/01/2024 For Vendor: All Vendors Source Description Amount Billed Amount Paid 14 Mmc - Hospital Outpatient 54.00 30.25 Expenditures 54.00 30.25 Reimb/Adjustments Grand Total 54.00 30.25 Expenses 4,166.67 Co -Pays < 0.00> 4,196.67 OPPROVED ON -31 MAR�7N2.0 p2�0Q244 ey HOU CAN CUNN,�7EXAS aIHS Source Totals Report Issued 03/18/24 Calhoun Indigent Health Care Batch Dates 02/01/2024 through 03/01/2024 For Vendor: All Vendors Source Description Amount Billed Amount Paid 14 Mmc- HospitalOutpatient 54.00 30.25 Expenditures 54.00 30.25 Reimb/Adjustments Grand Total 54.00 30.25 Expenses 4,166.67 Co -Pays < 0.00> 4,196.92 It'f(z-4 r, ECEIVE Calhoun County Indigent Care Patient Caseload 2024 Approved Denied Removed Active Pending January 0 3 2 1 7 February 0 3 0 1 5 March 0 0 0 0 0 April 0 0 0 0 0 May 0 0 0 0 0 June 0 0 0 0 0 July 0 0 0 0 0 August 0 0 0 0 0 September 0 0 0 0 0 October 0 0 0 0 0 November 0 0 0 0 0 December 0 0 0 0 0 YTD 0 6 2 2 12 Monthly Avg 1 0 0 1 December 2023 Active 4 Number of Charity patients 258 Number of Charity patients below 50% FPL 136 Number of Charity patients who meet State Indigent Guidelines 129 Calhoun County Pharmacy Assistance Patient Caseload 2024 Approved Refills Removed Active Value January 6 18 0 7 $9,662.15 February 0 0 0 0 $0.00 March 0 0 0 0 $0.00 April 0 0 0 0 $0.00 May 0 0 0 0 $0.00 June 0 0 0 0 $0.00 July 0 0 0 0 $0.00 August 0 0 0 0 $0.00 September 0 0 0 0 $0.00 October 0 0 0 0 $0.00 November 0 0 0 0 $0.00 December 0 0 0 0 $0.00 YTD PATIENT SAVINGS $9,662.15 Monthly Avg 1 2 1 $805.18 December 2023 Active 36 I THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13088 Statement Date 2/29/2024 Account No ."'4551 Page 1 of 2 Lr STATEMENTS SUMMARY Public Fund Contractual Ckg w lnt Account No **`"4551 02/01/2024 Beginning Balance $9,731.16 3 Deposits/Other Credits + $4,908.29 5 Checks/Other Debits - $9,053.54 02/29/2024 Ending Balance 29 Days in Statement Period $5,585.91 Total Enclosures 7 DEPOSITS/OTHERCREDITS Date Description Amount 02/01/2024 Deposit $10.00 1) C� z = 02/05/2024 Deposit $4,887.40 7eGYb 02/29/2024 Accr Earning Pymt Added to Account $10.89 Check Number Date Amount Check Number Date Amount Check Number Date Amount 12625 02-05 $4,166.67 12627 02.23 $658.90 12629 02-23 $26.93 12626 02.05 $34.37 12628 02.23 $4,166.67 DAILY ENDINGBALANCE Date Balance 02-01 $9,741.16 02-05 $10,427.52 Interest Paid This Period Interest Paid YTD MEMBER FDIC 121 A MM Date Balance 02-23 $5,575.02 02-29 $5,585.91 Below is an itemization of the Earnings paid this period. " $10.89 Annual Percentage Yield Earned $23.25 Days in Earnings Period Earnings Balance NYSE Symbol "PB" r N 0 7 O P�OON N M M V V N M 00 00 ti M O� M a 0 Q Q O� N N ul M O O R � ti Q Q Vi U} i? i/} i? � d4 b9 b9 b9 Yi fig aaaaa � www4 a q H p� 7r R F F z � a � a F a a � 0 a F maw [.w p N N N U F N Fi NN N N N w O m m m m a a F F mmm m m m ro aaaFw 0 0 0 m rloxNE,a waaow a aa°o N m EU x i m m 0 aaaz N a a m w W w 0 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---March 27, 2024 TOTALS TO BE APPROVED -TRANSFERRED FROM ATTACHED PAGES TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS TOTAL TRANSFERS BETWEEN FUNDS TOTAL NURSING HOME UPI. EXPENSES TOTAL INTER -GOVERNMENT TRANSFERS $ 874,611.S4 $ S45,9S8.14. $ 1,547,054.07 $ ./ GRAND TOTAL DISBURSEMENTS APPROVED March 27, 2024 $ 2,967,623.75 MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---March 27,202 PAYABLES AND PAYROLL 3/21/2024 Weekly Payables 330,565.69 3/25/2024 McKesson-340B Prescription Expense 2,178.29 3/25/2024 Amerisource Bergen-340B Prescription Expense 406.46 3/25/2024 Payroll Liabilities -Payroll Taxes 128,734.52 3/25/2024 Payroll 412,330.02 Prosperity Electronic Bank Payments 3/1/-3/22/24 Pay Plus -Patient Claims Processing Fee 396.56 TOTAL PAYABLES, PAYROLL AND ELECTRONIC BANK PAYMENTS $. 874,611.54 TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 3/21/2024 MMC Operating to Solera-correction of nursing home insurance and QIPP payment 59,691.52 deposited into MMC Operating 3/21/2024 MMC Operating to Fort bend -correction of nursing home QIPP payment deposited 6,634.54 into MMC Operating 3/21/2024 MMC Operating to Broadmoor-correction of nursing home QIPP payment deposited 70,053.25 into MMC Operating 3/21/2024 MMC Operating to The Crescent -correction of nursing home insurance and QIPP 48,566.67 payment deposited into MMC Operating 3/21/2024 MMC Operating to Golden Creek Healthcare -correction of nursing home insurance 169,836.02 and QIPP payment deposited into MMC Operating 3/21/2024 MMC Operating to Gulf Pointe Plara- correction of nursing home QIPP payment 19,219.26 deposited into MMC Operating 3/21/2024 MMC Operating to Bethany -correction of nursing home insurance and QIPP 171,956.88 payment deposited into MMC Operating TOTAL TRANSFERS BETWEEN FUNDS $ 545,958.14 NURSING HOME UPI. EXPENSES 3/25/2024 Nursing Home UPL-Cantex Transfer 1,009,047.29 3/25/2024 Nursing Home UPL-Nexion Transfer 158,066.09 3/25/2024 Nursing Home UPL-HMG Transfer 58,513.18 3/25/2024 Nursing Home UPI. -Tuscany Transfer 92,806.50 3/25/2024 Nursing Home UPI.-HSL Transfer 221,741.01 TRANSFER OF FUNDS BETWEEN NURSING HOMES 3/25/2024 Gulf Pointe to Broadmoor- Broadmoor insurance payments deposited into Gulf 6,880.00 Pointe in error TOTAL NURSING HOME UPL EXPENSES $ 1,547,054.07 TOTAL INTER -GOVERNMENT TRANSFERS GRAND TOTAL DISBURSEMENTS APPROVED March 27, 2024 $ 2,967,623.75 3121/24, 12:54 PM tmp_cw5repon4643562930798552322.html O;QAUOiTOREON MEMORIAL MEDICAL CENTER 12:y� A AR 2,4 2u24 AP Open Invoice List Due Dates Through: 04/15/2024 Vendor# Vendor Name Class Pay Code Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay 12281837// 03/21/202 03/11/202 041111202 SUPPLIES Vendor Totals: Number Name 10250 41MPRINT, INC. Vendor# Vendor Name Class Pay Code 13180 ADVANCED STERILIZATION PRODUCT Invoice# SCpmment Tran Dt Inv Dt Due Dt Check Dt Pay 8020638230 ✓ 03/20/202 03/14/202 03/20/202 SUPPLIES Vendor Totals: Number Name 13180 ADVANCED STERILIZATION PRODUCT Vendor# Vendor Name Class Pay Code 14028 AMAZON CAPITAL SERVICES Invoice# Comme t Tran Dt Inv Dt Due Dt Check Dt Pay 1JTJ-DNGO-J6TH 03120/202 03/09/202 04/081202 SUPPLIES 1 WPW-JYVX-HWF1 03/20/202 03/091202 04/08/202 SUPPLIES 1R67-LV4H-W467 03/201202 03/11/202 04/10/202 SUPPLIES 1 R1 C-WKM3-6LC7 ✓/ 03120/202 03/12/202 04/11/202 SUPPLIES Vendor Totals: Number Name 14028 AMAZON CAPITAL SERVICES Vendor# Vendor Name / Class Pay Code A1360 AMERISOURCEBERGEN DRUG CORP / W Invoice# omment Tran Dt Inv Dt Due Dt Check Dt Pay 67050556 03/21/202 03/15/202 03/21/202 FEE L LA -d Ghar�z) Vendor Totals: Number Name A1360 AMERISOURCEBERGEN DRUG CORP Vendor# Vendor Name / Class Pay Code A2218 AQUA BEVERAGE COMPANY t/ M Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay 130186 ✓ 03/20/20212/27/20201/21/202 / WATER 130189 .I 03/20/20212/27/202 01 /21 /202 / WATER 131799 ✓ 03/20/202 12/31/202 01/25/202 / FEE 137576 ✓ 03/20/202 02J08/202 03/04/202 WATER 137573./ 03/20/20202/08/20203104/202 / WATER 141296✓ 03/20/20202/29/20203/25/202 / FEE 141258 03/20/202 02/29/202 03/25/202 / FEE 131729 ✓ 03/21120212/31/20201/25/202 0 ap_open_invoice.template Gross Discount No -Pay Net / 325.34 0.00 0.00 325.34 Gross Discount No -Pay Net 325.34 0.00 0.00 325.34 Gross Discount No -Pay Net 362.94 0.00 0.00 362.94✓ Gross Discount No -Pay Net 362.94 0.00 0.00 362.94 Gross Discount No -Pay Net 37.38 0.00 0.00 37.38 86.97 0.00 0.00 86.97p,-' 150.96 0.00 0.00 150.96 36.78 0.00 0.00 36.78 Gross Discount No -Pay Net 312.09 0.00 0.00 312.09 Gross Discount No -Pay Net 233.57 0.00 0.00 233.57 Gross Discount No -Pay Net 233.57 0.00 0.00 233.57 Gross Discount No -Pay Net 39.50 0.00 0.00 / 39.50 as/ 50.00 0.00 0.00 50.00 r// 12.00 0.00 0.00 12.00 ./ 50.00 0.00 39.50 0.00 12.00 0.00 12.00 0.00 12.00 0.00 f Ie:IIIC:IUserslltrevino/cpsi/memmed.cpsinet.comlu881251data_5ltmp_cw5report4643562930798552322.html 0.00 0.00 0E011 0.00 0.00 50.00 V_ 39.50 12.00 r/ 12.00 ✓ d . 12.00 1112 3121/24, 12:54 PM tmp_cw5report4643562930798552322.html FEE 137572 03/21/202 02/08/202 03/04/202 60.50 0.00 0.00 60.50 WATER Vendor Totals: Number Name Gross Discount No -Pay Net A2218 AQUA BEVERAGE COMPANY 287.50 0.00 0.00 287.50, Vendor# Vendor Name Class Pay Code B1150 BAXTER HEALTHCARE,S W Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 82093415 03/01/202 03/12/202 04/06/202 143.11 0.00 0.00 143.11 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net B1150 BAXTER HEALTHCARE 143.11 0.00 0.00 143.11 Vendor# Vendor Name Class Pay Code / B1220 BECKMAN COULTER INC ✓ M Invoice# Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net �omment 111187907 03/12/202 03/04/202 03/29/202 10,360.28 0.00 0.00 10,360.28 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net B1220 BECKMAN COULTER INC 10,360.28 0.00 0.00 10,360.28 Vendor# Vendor Name Class Pay Code 10024 BECTON, DICKINSON & CO (BD) Invoice# C�6mment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 9112327-.. 03/01/20202/07/20203/08/202 273.25 0.00 0.00 273.25 y' SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10024 BECTON, DICKINSON & CO (BD) 273.25 0.00 0.00 273.25 Vendor# Vendor Name / Class Pay Code 14753 BIOMERIEUX, INC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1213215991V 03/12t20203/06/20204/06/202 14,687.57 0.00 0.00 14,687.57 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 14753 BIOMERIEUX, INC 14,687.57 0.00 0.00 14,687.67 Vendor# Vendor Name Class Pay Code B1650 BOSART LOCK & KEY INC M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 127767/ 03/20/202 03/06/202 04/04/202 56.80 0.00 0.00 66.80 W'/ KEYS 127786 ✓/03/20/20203/07/202.04/06/202 27.90 0,00 0.00 27.90✓ KEYS Vendor Totals: Number Name Gross Discount No -Pay Net B1650 BOSART LOCK & KEY INC 84.70 0.00 0.00 84.70 Vendor# Vendor Name Class Pay Code B1655 / BOSTON SCIENTIFIC CORPORATION ,/ M Invoice# omment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 997320303 03/01/202 02/20/202 03/20/202 332.00 0.00 0.00 332.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net Bl655 BOSTON SCIENTIFIC CORPORATION 332.00 0.00 0.00 332.00 Vendor# Vendor Name Class Pay Code C1992 COW GOVERNMENT, INC. M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net PW56574 / 03/01/202 02/29/202 03/301202 ✓SUPPLIES 7,795.20 0.00 0.00 7,795.20 / Vendor Totals: Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMENT, INC. 7,795.20 0.00 0.00 7,795.20 file:NC:/Userslitrevino/cpsi/memmed.cpsinet.com/u88125/data_5/tmp_cw5report4643562930798552322.html 2112 3121/24, 12:54 PM tmp_cw5report4643562930798552322.html Vendor# Vendor Name / Class Pay Code 13264 CERVEY, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 27277✓ 03119/202 03/05/202 03/30/202 1,699.00 0.00 0.00 11699.00 MONTHLY FEE Vendor Totals: Number Name Gross Discount No -Pay Net 13264 CERVEY, LLC 1,699.00 0.00 0.00 1,699.00 Vendor# Vendor Name Class Pay Code / 11720 CLINICAL COMPUTER SYSTEMS INC ✓ Invoice# Comsant Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 0BMN00001727 ✓ 03/21/202 02/01/202 04101/202 23,100.00 0.00 0.00 23,100.00 / 1� ANNUAL MAINTENANCE (4111 ay - a 1311 PS Vendor Totals: Number Name Gross Discount No -Pay Net 11720 CLINICAL COMPUTER SYSTEMS INC 23,100.00 0.00 0.00 23,100.00 Vendor# Vendor Name / Class Pay Code 10212 CLINICAL PATHOLOGY LABS �/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / / 2024OP-0 ,/ 03120/202 02129/202 03/29/202 15,761.81 0.00 0.00 15,761.81 r� LAB SERV Vendor Totals: Number Name Gross Discount No -Pay Net 10212 CLINICAL PATHOLOGY LABS 15,761.81 0.00 0.00 15,761.81 Vendor# Vendor Name Class Pay Code / 14080 CORROHEALTH, INC. Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 912886✓ 03/21/202 02/29/202 03130/202 2,121.05 0.00 0.00 2,121.05.�/ CODING Vendor Totals: Number Name Gross Discount No -Pay Net 14080 CORROHEALTH, INC. 2.121.05 0.00 0.00 2,121.05 Vendor# Vendor Name Class Pay Code / 14400 CULINARY CONCESSIONS LLC V- Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INV0000122102129/202 03/15/202 04/16/202 30,377.42 0.00 0.00 30,377.42 Vendor Totals: Number Name Gross Discount No -Pay Net 14400 CULINARY CONCESSIONS LLC 30.377.42 0.00 0.00 30,377.42 Vendor# Vendor Name / Class Pay Code 10060 DETAR HOSPITAL r/ CID Invoice# Cc ment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / DTR2402016 03/20/202 03101/202 04/01/202 614.07 0.00 0.00 614.07 d LAB SERV Vendor Totals: Number Name Gross Discount No -Pay Net 10060 DETAR HOSPITAL 614.07 0.00 0.00 614.07 Vendor# Vendor Name Class Pay Code 10368 DEWITT POTH & SON ✓ Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 748598-0✓ 03/20/20203/O6/20203/31/202 174.28 0.00 0.00 174.28� UPPLIES 748921-0 03/20120203/08/20204/02/202 31.97 0.00 0,00 31.97✓/ sSUPPLIES 748890-0 ✓ 03/20/20203/08/20204/O2/202 126.87 0.00 0.00 126.87✓ SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SON 333.12 0.00 0.00 333,12 Vendor# Vendor Name Class Pay Code / 14136 EPI-EDWARD PLUMBING/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net file:///C:/Users/ttrevino/cpsi/memmed.cpsinet.comIu88125/data_5/tmp_cw5report4643562930798552322.html 3112 3/21/24, 12:54 PM tmp_cw5report4643562930798552322.html 67172 03/20/20201104/20202/041202 285.00 0.00 0.00 285.00 BAC-FLO TEST Vendor Totals: Number Name Gross Discount No -Pay Net 14136 EPI-EDWARD PLUMBING 285.00 0.00 0.00 285.00 Vendor# Vendor Name Class Pay Code / 11944 EQUIFAX WORKFORCE SOLUTIONS ,d Invoice# omment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay 2059504564 03/20/202 03/08,202 04/07/202 10.99 0.00 0.00 CREDIT REPORTING Vendor Totals: Number Name Gross Discount No -Pay 11944 EQUIFAX WORKFORCE SOLUTIONS 10.99 0.00 0.00 Vendor# Vendor Name Class Pay Code 15320 Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay 263772 03/21/202 02/27/202 03/271202 52.85 0.00 0.00 PT REFUND Vendor Totals: Number Name 15320 Vendor# Vendor Name Class Pay Code 13804 EVERGREEN MEDICAL SERVICES Invoice# Com ent Tran Dt Inv Dt Due Dt Check Dt Pay EMSIN0000624 03101/20202/29/20203/29/202 SUPPLIES Vendor Totals: Number Name 13804 EVERGREEN MEDICAL SERVICES Vendor# Vendor Name Class Pay Code C2510 EVIDENT ✓ M Invoice# Co^Jment Tran Dt Inv Dt Due Dt Check Dt Pay T2403081378 �% 03/21120203/08/20204/02/202 taydo-'rrt9 I auWWA, yWLL% Vendor Totals: Number Name 02510 EVIDENT Vendor# Vendor Name Class Pay Code 10689 FASTHEALTH CORPORATION Invoice# C mment Tran Dt Inv Dt Due Dt Check Dt Pay 01 B24MMC 03/20/202 01/16/202 04115/202 ANNUAL ENCRYUPTION FEE Vendor Totals: Number Name 10689 FASTHEALTH CORPORATION Vendor# Vendor Name Class Pay Code F1300 FIRESTONE OF PORT LAVACA ✓ W Invoice# Comment Tran Dt Inv Dt Due Dt / Check Dt Pay 0085010 ,/ 03/20/20202/29/20203/201202 Gross Discount No -Pay 52.85 0.00 0.00 Gross Discount No -Pay 1,850.00 0.00 0.00 Net 10.99 Net 10.99 Net 52.85 Net 52.85 Net / 1,850.00 ✓ Gross Discount No -Pay Net 1,850.00 0.00 0.00 1,850.00 Gross Discount No -Pay Net / 9,990.87 0.00 0.00 9,990.87 Gross Discount No -Pay Net 9,990.87 0.00 0.00 %990.B7 Gross Discount No -Pay Net 1,095.00 0.00 0.00 1,095.00 Gross Discount No -Pay Net 1,096.00 0.00 0.00 1,096.00 Gross Discount No -Pay Net 399.00 0.00 0.00 399.00 SECURITY LIGHT Vendor Totals: Number Name Gross F1300 FIRESTONE OF PORT LAVACA 399.00 Vendor# Vendor Name / Class Pay Code F1403 FISHER & PAYKEL HEALTHCARE ✓ M Invoice# pomment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 92527155 03/121202 03/061202 04/06/202 640.00 SUPPLIES Vendor Totals: Number Name Gross F1403 FISHER & PAYKEL HEALTHCARE 640.00 Vendor# Vendor Name Class Pay Code F1400 FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross file:///C:/Users/ltrevino/cpsilmemmed.cpsinet.com/u88125/data_5/tmp_cw5report4643562930798552322.html Discount No -Pay Net 0.00 0.00 399.00 Discount No -Pay Net / 0.00 0.00 640.00 ,! Discount No -Pay Net 0.00 0.00 640.00 Discount No -Pay Net 4/12 3/21124, 12:54 PM tmp_cw5report4643562930798552322.html / 0087009✓ 03/01/20202/21/20203/17/202 340.73 0.00 0.00 340.73✓ 1s /suppu 0440495 ,/ 03121/202 03/051202 03/30/202 768.32 0.00 0.00 758.32 ✓/ / SUPPLIES 0440496 ✓ 03/21/20203/05/20203130/202 566.45 0.00 0.00 586.45 / SUPPLIES 0482394✓ 03/21/202 03106/202 03/31/202 19.81 0.00 0.00 / 19.81J / ✓ SUPPLIES / 0482396 03121/202 03/06/202 03/311202 2,751.83 0.00 0.00 2,751.83 wP / SUPPLIES / 0482395 �/ 03121/202 03/06/202 03/31/202 1,062.00 0.00 0.00 1.062.00 ✓ SUPPLIES 0523297 03/21/202 03/07/202 04/01/202 956.47 0.00 0.00 / 956.47�/ SUPPLIES 06A5403 03/21120203/12/20204/06/202 52.60 0.00 0.00 52.60 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 6,528.21 0.00 0.00 6,528.21 Vendor# Vendor Name Class Pay Code 10599 FORVIS W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2007972 OPJ29/202 02128/202 04/06/202 57,750.00 0.00 0.00 !/ 57,750.00 I/ AUDINT FINANCIAL STATEMENT! Vendor Totals: Number Name Gross Discount No -Pay Net 10599 FORVIS 57,750.00 0.00 0.00 57,760.00 Vendor# Vendor Name Class Class Pay Code 12404 GE PRECISION HEALTHCARE, LLC Invoice# C�°mment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 6002615643 �/ 03/20/202 03/01/202 03/31/202 204.83 0.00 0.00 204.83 MEDRAD Vendor Totals: Number 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 G1001 GETINGE USA✓ Invoice# ryomment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / ✓ 6-92509460 03120/202 03/04/202 03/20/202 445.00 0.00 0.00 445.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G1001 GETINGE USA 445.00 0.00 0.00 445.00 Vendor# Vendor Name Class Pay Code G1210 GULF COAST PAPER COMPANY M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 2512242--4/ 031201202 03/12/202 04/11/202 1,196.51 0.00 0.00 1,196.51 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPER COMPANY 1,196.61 0.00 0.00 1,196.51 Vendor# Vendor Name Class Pay Code H0416 HOLOGIC INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 10861987 V// 03120/202 03/05/202 03/20/202 3.414.00 0.00 0.00 3,414.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net H0416 HOLOGIC INC 3,414.00 0.00 0.00 3,414.00 Vendor# Vendor Name Class Pay Code / 10922 HUNTER PHARMACY SERVICES �/ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net file:///C:/Userslltrevino/cpsi/memmed.cpsinet.comtu88l25/data_5/tmp_pw5report4643562930798552322.html 5112 3121/24, 12:54 PM tmp_cw5report4643562930798552322.html / 5891 ,/ 03/19/20202/29/20203/201202 14,683.43 0.00 0.00 14,683.43 / ./ PHARM SALARY Vendor Totals: Number Name Gross Discount No -Pay Net 10922 HUNTER PHARMACY SERVICES 14,683.43 0.00 0.00 14,683.43 Vendor# Vendor Name / Class Pay Code 11260 INTOXIMETERS INC ✓ M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay / Gross Discount No -Pay Net 755478 �/ 03/20/202 03/06/202 03/31/202 360.00 0.00 0.00 360.00 / SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11260 INTOXIMETERS INC 360.00 0.00 0.00 360.00 Vendor# Vendor Name Class Pay Code / L0700 LABCORP OF AMERICA HOLDINGS J M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 79281684 03/20/20202/24/20203/20/202 26.29 0.00 0.00 26.29 LAB SERV Vendor Totals: Number Name Gross Discount No -Pay Net L0700 LABCORP OF AMERICA HOLDINGS 26.29 0.00 0.00 26.29 Vendor# Vendor Name Class Pay Code / 11600 LEGAL SHIELD ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 031524 03120/202 03115/202 04/15/202 1,173.00 0.00 0.00 1,173.00 / PAYROLLDEDUCT 021524 03/20/202 02/15/202 03/15/202 303.20 0.00 0.00 303.20 PAYROLLDEDUCT Vendor Totals: Number Name Gross Discount No -Pay Net 11600 LEGALSHIELD 1,476.20 0.00 0.00 1,476.20 Vendor# Vendor Name Class Pay Code 15200 MANAGED CARE PARTNERS INC. Invoice#/ Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 63651/ 03/21/202 04/01/202 04101/202 500.00 0.00 0.00 500.00✓ PROFESSIONAL FEES Vendor Totals: Number Name Gross Discount No -Pay Net 15200 MANAGED CARE PARTNERS INC. 500.00 0.00 0.00 500.00 Vendor# Vendor Name Class Pay Code / M2178 MCKESSON MEDICAL SURGICAL INC ✓ Invoice# Comment Tran Dt Inv Dt Due 01 Check Dt Pay Gross Discount No -Pay Net 21833521 1/ 03/20/202 03/13/202 03/28/202 41,65 0.00 0.00 41.55 / r/ SUPPLIES 21852069 ✓ 03/20120203/18/20204/02/202 115.31 0.00 0.00 115.31 r� SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net M2178 MCKESSON MEDICAL SURGICAL INC 156.86 0.00 0.00 156.86 Vendor# Vendor Name Class Pay Code 11612 MEDICAL AIR SERVICES ASSOC. 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PARTSSOURCE, LLC 392.08 0.00 0.00 392.08 Vendor# Vendor Name Class Pay Code 15352 Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 257843 ./ 03/21/202 02127/202 03127/202 3.18 0.00 0.00 3.18 / PT RFND 249126 ✓ 03/21/202 02/27/202 03/27/202 55.90 0.00 0.00 56.90 PT REFUND Vendor Totals: Number Name Gross Discount No -Pay Net 15352 59.08 0.00 0.00 59.08 Vendor# Vendor Name Class Pay Code P1800 PITNEY BOWES INC W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1024952645 03121/202 03/10/202 04/09/202 223.92 0.00 0.00 223.92✓ POSTAGE Vendor Totals: Number Name Gross Discount No -Pay Net P1800 PITNEY BOWES INC 223.92 0.00 0.00 223.92 Vendor# Vendor Name / Class Pay Code 14764 PL-CPR, LLC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 277� 03121/202 11/17/202 12/17/202 700.00 0.00 0.00 700.00 PALS 296� 03/21/202 03/11/202 04/01/202 1,200.00 0.00 0.00 / 1,200.00,p / PALS 297 ./ 03/21/202 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Vendor Totals: Number Name Gross Discount No -Pay Net 14716 SINGLETON ASSOCIATES PA 1,279.27 0.00 0.00 1,279.27 Vendor# Vendor Name Class Pay Code S2830 STRYKER SALES CORP M Invoice# C mment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9205727074 03/12/20203/05120204/05/202 907.10 0.00 0.00 907.10 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net S2830 STRYKER SALES CORP 907.10 0.00 0.00 907.10 Vendor# Vendor Name Class Pay Code T2539 / T-SYSTEM, INC.! W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 912975✓ 03/20/202 03/07/202 04/06/202 13,158.00 0.00 0.00 13,158.00 CALS BUNDLE/CLOUD Vendor Totals: Number Name Gross Discount No -Pay Net T2539 T-SYSTEM, INC 13.158.00 0.00 0.00 13,158.00 Vendor# Vendor Name / Class Pay Code 12704 TEXAS BURNER & BOILER SERVICES ✓ Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 24-3550 ✓ 03/01/20202/29/20203/29/202 6,090.00 0.00 0.00 6,090.00 DAMAGED PUMP- i Awwfe At_tL Ire plad- Vendor Totals: Number Name Gross Discount No -Pay Net 12704 TEXAS BURNER & BOILER SERVICES 6,090.00 0.00 0.00 6.090.00 Vendor# Vendor Name / Class Pay Code 14604 THE RAWLINGS COMPANY LLC ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 242602 � 03/21/202 02/29/202 03/21/199 104.13 0.00 0.00 104.13 / PT REFUND 241687 03/21/20202/29/20203/291202 121.48 0.00 0.00 121.48 PT REFUNL 244887 03/21/20202/29/20203/29/202 70.02 0.00 0.00 70.02 PT REFUND file:///C:/Usersiltrevino/cpsi/memmed.cpsinet.com/u88l25/data 5/tmp_ow5report4643562930798552322.html 10/12 3121/24, 12:54 PM tmp_cw5report4643562930798552322.html Vendor Totals: Number Name Gross Discount 14604 THE RAWLINGS COMPANY LLC 295.63 0.00 Vendor# Vendor Name / Class Pay Code 11908 TMS SOUTH Invoice# Tran Dt Inv Dt Due Dt Check Dt Pay Gross /Comment INV115372I 03/20/202 03/121202 04111/202 221.08 SUPPLIES Vendor Totals: Number Name Gross 11908 TMS SOUTH 221.08 Vendor# Vendor Name Class Pay Code 13616 TRIOSE, INC Invoice# / Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross TR1178712/ 03/21/202 03/06/202 03/21/202 263.41 FREIGHT Vendor Totals: Number Name Gross 13616 TRIOSE, INC 263.41 Vendor# Vendor Name Class Pay Code U1064 UNIFIRST HOLDINGS INC, Invoice# C mment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 2921026569 03/20/202 03/04/202 03/29/202 2,766.89 LAUNDRY 2921026570 03/20/202 03/04/202 03/29/202 102.07 }AUNDRY 2921026892 03/20l20203/07/20204/01/202 2,704.63 L)NUNDRY 2921026894 03120/202 03/07/202 04/01/202 314.87 DRY 2921026891✓ 03/20/202 03/071202 04/01/202 213.52 LAUNDRY 2921026895 ./ 03/201202 03/07/202 04/01/202 276.24 L UNDRY 2921026890 03/20/202 03/07/202 04/011202 113.20 LAUNDRY 2921026897 03/20/202 03/07/202 04/01 /202 112.14 UNDRY 2921026896 03/20/202 031071202 04/01/202 261.52 UNDRY 2921026893 03/201202 03/07/202 04101/202 29.95 LAUNDRY 2921027090/ 03/21/202 03/11/202 04/05/202 2,835.47 UNDRY 2921027091 03/21/202 03/11/202 04/05/202 102.07 LAUNDRY Vendor Totals: Number Name Gross U1064 UNIFIRST HOLDINGS INC 9,832.57 Vendor# Vendor Name Class Pay Code / 14624 WELLMED MEDICAL MANAGEMENT ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 262223 / 03/21/20202/28/20203/28/202 117.60 PT REFUND Vendor Totals: Number Name Gross 14624 WELLMED MEDICAL MANAGEMENT 117.60 Vendor# Vendor Name Class Pay Code 11110 WERFEN USA LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 9111461516 / 03/01/202 02/21/202 03/17/202 7,600.00 file:///C:/Users/Itrevino/cpsilmemmed.cpsinet.com/u88l25/data_5/tmp_cw5report4643562930798552322.html No -Pay Net 0.00 295.63 Discount No -Pay 0.00 0.00 Discount No -Pay 0.00 0.00 Discount 0.00 Discount 0.00 Net 221.08 Net 221.08 No -Pay Net / 0.00 263.41✓ No -Pay Net 0.00 263.41 Discount No -Pay 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Net 2,766.89 � 102.07�// 2,704.63 314.87 213.52 1/ 276.24 ✓ 113.20 0.00 0.00 112.14 ✓/ 0.00 0.00 261.52 ✓ 0.00 0.00 / 29.95 ✓ll 0.00 0.00 2,835.47 ✓ 0.00 0.00 102.07 ✓ Discount No -Pay Net 0.00 0.00 9,832.57 Discount No -Pay Net 0.00 0.00 117.60 Discount No -Pay Net 0.00 0.00 117.60 Discount 0.00 No -Pay 0.00 Net / 7.600.00 ✓ 11112 3121124, 12:54 PM tmp_cw5report4643562930798552322.htm1 CONTRACT Vendor Totals: Number Name Gross Discount No -Pay Net 11110 WERFEN USA LLC 7,600.00 0.00 0.00 7,600.00 Vendor# Vendor Name Class Pay Code / 11400 WEST COAST MEDICAL RESOURCES / Invoice# omment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INV708212 /1 03/01120201/04/20202/03/202 1,432.00 0.00 0.00 1,432.00 SUPPLIES Vendor Totals: Number Name Gross Discount No -Pay Net 11400 WEST COAST MEDICAL RESOURCES 1,432.00 0.00 0.00 1,432.00 Report Summary Grand Totals: Gross Discount No -Pay Net 330,565.69 0.00 0.00 330,565.69 APPROVED ON g MAR N21p2024 CALHOUNU COUNTY, I TEXAS file:NC:/Users/ltrevino/cpsilmemmed.cpsinet.com/u881251data 511mp_cw5report4643562930798552322.htm1 12112 MSKESSON STATEMENT .mnn„s: aeme MEMORIAL MEDICAL CENTER / AMT DUE REAUTTED VIA ACH DEBIT AP ✓ 815 N VIROINIA STREET Statement for information only PORT LAVACA TX 71979 As of: 0312212024 Page: 002 To eneum proper credit to your raourd, detach and return this stub with your mmglaua OC: 8115 As of: 03/22/2024 Page: 002 Columnar INV SupplD: Mall to: Co., 8000 Tomboy: AMT DUE RHdITTED VIA ACH DEBIT Customer. 632536 Statement for information only Date: 03/23/2024 Oust: 632536 PLEASE CHECK ANY Ode: 0312312024 MMS NOT PAID (�) ntlonal Account 38 Date Due Number " Refer Disc Amount P. Amount P Number Date Date Number Reference Description Discount (gross) F (net) F Number PF column legend: P = Past Due Item, F = Future Due Its., blank = Current Due Item TOTAL National Acts 632536 MWORIAL MEDICAL CENTER Subtotals: 2,222.98 USD Future Due: Past Due: last Payment 08107/2017 2, 046_,9 $,a-, 5•05- 121.92 + 4.36 + 2, 178.29 0.00 If Pam By 0312612024, 11.02- Pay This Amount: 2,451.97 N Paid After 0312012024, Pay ins Amount: APPROVED ON MAR 2 5 2024 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Due If Paid On Time: USD 2,176,29 J✓ 2,178.29 USD Dlsc lost N paid late: 44.69 Due If Paid late: 2.222.98 USD USD 2.222.98 -y- For AR Inquiries please contact 800-867-0333 �n�RCJJVIY STATEMENT As oh 03122/2024 Pugs: 001 To ensum proper aeaH t0 your account, distant, aml mum this cainmr: eons club with your mm„tance WALMART 1098/MB4 Mm PHS DC: 8115 Customer INV SUppID: As of: 03/22/2024 Page: 001 Mail to: Comp: 8000 MDNORIAL MEDICAL CMED, AMT DUE R6.11TTED VIA ACH OMIT Territory: 7001 VIA DEBIT VICKY KAUSEK statement for information only Statement for Informal on only 815 N VIRGINIA ST Custamer. 256342 PORT IAVACA TX 77979 Date: 0312312024 Curt: 256342 PLEASE CHECK ANY Date: 03/23/2024 REMB NOT PAID (.•) D9 Due N nicnei Account 6 teumberM Irfd7T Cash In Amount Amount P Reoelveble al Number Reference Descdptlon Discount (gross) F (net) F Number Customer Number 256342 WALMARr 10981MEM MM PHS 03/1812D24 03/26/2024 7484128901 109565646 1151nvoice 0.02 0.95 0.93✓ ✓ 7484128901 03118/2024 03/26/2024 7484128902 109605264 1151m,mcre 1.21 60.32 59.11✓ ✓ 7484128902 03/18/2024 03/26/2024 7484128904 109644060 1151nvoice 0.02 0.95 0.93 ✓ ✓ 7484128904 03/18/2024 03/26/2024 7464128905 109711965 1151nvoice 0.01 0.32 0.31 J✓ 7484128905 03/18/2024 03/26/2024 7484155812 109764279 1151nvoice 0.02 0.95 0.93✓✓ 7484155812 03/18/2024 03/26/2024 7484357617 109572455 1951nvoice 0.01 0.32 0.31 ✓ ✓ 7484357617 03/1812024 0312612924 7484357618 109650411 1951nvoice 0.41 20.58 20.17✓✓ 7484357618 03/19/2024 03/26/2024 7484507388 109819217 1151nvoice 19.63 981.71 962.08✓✓ 74845073BB 03119/2024 03125/2024 7484526382 109900949 1151nvoice 1.26 62.85 61.59✓ ✓ 7484526382 03/1912024 03126/2024 7484696189 109826029 1951nvcice 0.41 20.58 20.17✓✓ 7484696189 03/2012024 03/26/2024 7484792337 109973101 1151nveice 13.38 668.86 655.48 ✓ ✓ 7484792337 03/20/2024 03126/2024 7484792338 110034114 1151nvoice 0.01 0.32 0.31✓ ✓ 7484792338 03/2112024 03126/2024 7485058653 110106306 1151nvoice 6.24 262.13 256.89✓✓ 7485056653 03/2212024 03/26/2024 7485318453 110220178 1151nveice 0.03 1.27 1.24 ✓✓ 7485318453 03/22/2024 03/2612024 7485318454 110283027 1151nvoice 0.02 0.95 0.93 4 ✓ 7485318454 03/22/2024 03/26/2024 7485325631 1ID296146 1161nvoice 0.09 4.74 4.65✓ ✓/ 7485325631 03/22/2024 03126/2024 7485493979 110232882 1151nvo1ce 0.02 0.95 0.93✓ V 7485493979 PF column legend: P = Net Due it... F = Future Due Item, blank = Current Dee Item TOTAL Cusomer Number 25fiY62 WAIMARI' 108a/MFM M® Pas Subtotals: 2.088.75 USD Future Due: 0.00 Due if Pald On Time: if Paid By 0312612024, USD 2,046.96 ✓ Past Due: 0.00 Pay This Amount: 2,046.96 USD Dise lost if paid late: 41.79 Lan Payment 14.828.46 If Paid After 0312612024, Dua If Paid Iate: 0311812024 APPROVED Pay this Amount: 2,088.75 USD USD 2.086.75 ON -�- MAR 2 5 2024 I•Zs12y BY COUNTY AUDITOR For AR Inquiries please contact 800-867-0333 CALHOUN COUNTY, TEXAS MSKESSON Campwy. 8000 CVS PHCY 8923IME4 MC MS MEMOMAL MEDICAL CENTH3/ VICKY KAUSEK 615 N VIRGINIA ST PORT LAVACA TX 77979 STATEMENTA. oFi 0312212024 DC: 8116 Customer INV SupplD: AMT DUE REMITTED VIA ACH D®IT Territory: 7001 Statement for information only Customer. 835434 Data: 03123/2024 Page: 001 To aname proper camel to your assumed, Oetach east .1. this stub with year mmOtance As of 0312212024 Page: 001 Mail to: cont 8000 AMT DUE REMITTED VIA ACH DEBIT Statement tar information only Cost: 835434 PLEASE CHECK ANY Date: 0312312024 REMS NW PAID (+) ailing Due Receivable usional Account ¢I3rtl245r 6 Cash Amount P Amount P ReeeWabla Dat Date Date Number Referee Deamiption Discount (gross) F (net) F Number Customer Number 835434 CVS PHCY 8923/MERI MC PINS 03/1812024 03118/2024 748454164D MM PR CORK CR Pricing Car 11.02. P ✓ 11.02- P 7484541640 03116/2024 03/26/2024 7484541641 MFC PR CORK IN Pricing Car 0.22 11.23 ✓ 11.01 T484541841 03/20/2024 03/2612024 7464830240 3117147 1151nvoiee 0.10 5.16 5.06✓ ✓y484830240 PF eolumn legend: P = Past Due Item, F = Future Due Item, blank = Current Due Item TOTAL Custaner Number 835d34 CVS PHCY 89231MEM MC PHS Sublmals: 5.37 USD Future Duo: 0.00 If Peld By 0312612024, Pam Due: 11.02- Pay. This Amount: last Payment 14.828.46 If Pape After 0312612024, 03/18/2024 Pay this Amount: APPROVED ON MAR 2 5 2132-4 Due If Paid Do Time: USO 5.05✓ .� 5.05 USD Diu test H Paid late: 0.32 Due If Paid We: 5.37 USD USD I -5.37 31 2 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 03/22/2024 Page: 001 To ... proper credit to your account, detach and return this Co.,, e000 stub with your remittance CVS FHCY MC Be: 6115 Customer INV SBppID: MSCustomer As of: 03/22/2024 Page: 001 Mail to: Comp: 6000 DUE REMITTED VIA ACH DEBIT Territory: 7001 MEMOWAL MEDICAL CCENTERMEShot emenl for infaelian only ✓ m AMT DUE REMITTED VIA ACH DEBIT VICKY KAUSE)k IX Cunamer. 835437 Stalemenl for information only 815 N VIRGINIA ST Dale: 03123/2024 PORT IAVACA TX 77979 Curt: 835437 PLEASE CHI ANY Date: D312312024 I S NOT PAID (+) Oiling Due RaceWablrallonei Account bwps Cash Amount P Amount P Receivable Dale Date Number Reference Description Dlsomat (gross) F (net) F Number Customer Number 835437 CVS PHCY 7416IMM MC MS 0312012024 03/26/2024 7484982770 3115732 1151nv0ice 0.19 9.64 9.45 ✓ /%484982770 03/20/2024 03/26/2024 7484982771 3115732 1151nvdce 2.30 114.77 112.47✓ r/7484982771 B PF column legend; P = And Due Item, F = Future 0. Item, blank = Cursed Due Item TOTAL Customer Number 835437 CVS PHCY 7416IMEM MC PINS Subtotals: 124.41 USD Future Due: 0.00 Dan If Pald On Time: If Past By 0312612024, USD 121.92 ✓�✓ Past Due: 0.00 Pay This Amount: 121.92 USD Disc lest 8 paid late: 2.49 Last Payment 14,82B.46 If Paid After 0312612024, Due If Paid late: 03118/2024 Pay this Amount: 124.41 USD USD 124.41 APPROVED ON MAR 2 5 2024 6Y COUNTY AUDITOR For AR Inquiries lease contact 800-867-0333 CALHOUN COUNTY, TMS 9 P MSKESSONSTATEMENT As of: 0312212024 trade: 001 To ensure Proper matlN to your account, detach sad return this c.crnl. Sao. stub with your remittance CVS PHCY 74761MW MC MS 0C: 8115 Customer INV Supp1D: As of: 03122/2024 Page: 001 Mail to: Comp: 8000 MEMORIAL MEDICAL CENTER ANT DUE REMITTED VIA ACH DEBIT Territory: 7001 Statement for information only ITTED VIAion ACH DEBIT At T DUEment VICKY MUM 815 N VIRGINIA ST Customer. 835438 tamer only POW LAVACA T% 77979 Dote: 03123/2024 Cud: 835438 PIFASE CHECK ANY Dale: 03/23/2024 ITBBS NOT PAID (�) Billing Due atonal Account RR��44SStt6 /teceWabl UMEI` Cash Amount P Amount P RecaWahIs Data Date Number Reference Oewription Discount (g.as) F (net) F Hamber Cos. Number 835438 CV8 PHCY ]4]5/k1E18 MC PHS 03/2112024 03/26/2024 7484979946 31175]] 1151nooice 0.09 4.45 4.36 1/ 7484970946 O PF column legum& P =. Past Due it... F = Future Due Item, blank - Current Due It.. TOTAL Cumwner Number 835438 CVS PXCY ]4TSIMFM MC PH8 Subtotals: 4.45 USD Future Due: 0.00 D Paid By 0312612024, Past Due: 0.00 Pay This Amount: last Payment 14.828.46 It Paid After 0312612024, 03/18/2024 Pay this Amount: APPROVED ON MAR 2 5 2074 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS Due If Paid On Time: / USD 4.36✓✓ 4.36 U50 Old, lest 9 Pool late: 0.09 Due If Pald Late: 4.45 USD USD 4.46 > For AR Inquiries please contact 900-867-0333 STATEMENT Statement Number: 67103162 AmerisourceBergen- Date: 03-22-2024 1 of AMERISOURCEBERGEN DRUG CORP WALGREENS #12494 340E 1001352841037028186 12727 W. AIRPORT BLVD, MEMORIAL MEDICAL CENTER✓' SUGAR LANDTX 7747841101 1302NVIRGINIAST PORT LAVACA TX 77979.2509 DEA: RA0289276 Sel- Fri Due in 7 Jays 866-451-9655 AMERISOURCEBERGEN PO Box 905223 Not Yet Due: 0.00 CHARLOTTE NC 28290-5223 Cune rt: 406.46 Past Due: 0.00 TOto Due: 406.46 Account Belence: 406.46 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 63-18-2024 03.29-2024 3168321826 7005979070 Invoice 34.18✓ 0.00 34.18 03.16.2024 03-29-2024 316BU1827 7005990830 Invoice 69.64✓ 0.00 69.64 03-18-2024 0349-2024 3168321828 7005999491 Invoice 158.31W 0.00 158.31 03.18-2024 03.29-2024 316021820 7005989486 Invoice 1.35V 0.00 1.15 03-194024 03-29-20N 316MO8196 7006006589 Inveico 21.15 ✓ 0.00 2,.IS 0e-20-2024 03-29-2024 3168540109 7MG015242 Invoice 44.61 V 0.00 44.61 03-21-2024 03-29.2024 3168786017 7006025452 Invoice 68.36J 0.00 66.36 03.22-2024 03-29.2D24 3168947658 7006035676 Invoice 8.86 ✓ 0.00 a.88 Current 1-16 Days 16-30 Days 3"0 Days 61.90 Days 91.120 Days Over 120 Days 406.48 0.00 0.00 0Aa 0.00 0.00 0.00 Thank You for Your Payment Reminders Date Amount Due Date Amount 03.22-2024 unsASt 03-29-2024 406.46 Total Due: ' 406A6. ..r.. AP ONE MAR 25 2024 2 (?s BY COUNTY AUDITOR CALHOUN COUNTY. TEXAS / TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) "ENTER 9-DIGITTAXPAYER IDENTIFICATION NUMBER" F7"ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" F"IF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGIT TAX FILING YEAR" "ENTER 2-DIGITTAX FILING ENDING MONTH" 1ST QTR - 03 (MARCH) - Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) - July, Aug, Sept 4TH QTR - 12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" El "6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER CALLED IN BY: CALLED IN DATE: CALLED IN TIME: #### ENTER: ###L L� $ 128,734:5 1 $ 66,927.26 $ 15,652.36 $ 46,154.90 # J:1AP-Payroll HeMPayroll Tazes120241#7 R1 MMC TAX DEPOSIT WORKSHEET 03.21.24.XIS 3/2512024 941 RECITAX DEPOSIT FOR MMC PAYROLL PAY PERIOD: BEGIN PAY PERIOD: END PAY DATE: GROSS PAY: DEDUCTIONS: AIR AOVANC BOOTS MUTUAL CRITICAL ILLNESS MUTUALACCIDENT IRS TAX MUTUAL SHORT TERM DIS MUTUAL VISION CAFE-D CAFE-H CAFE-P CANCER CHILD CLINIC COMBIN CREDUN DENTAL DEP-LF MUTUAL TERM LIFE MUTUAL HOSP INDEM FED TAX FICA-M FICA-0 FICA-M ADDITIONAL FIRST C FLEX S FLX-FE GIFT S MUTUAL CRITICAL ILLNESS MUTUALACCIDENT MUTUAL SHORT TERM DIS LEGAL OTHER NATIONAL FARM LIFE MEDSURCHARGE Blank RELAY REPAY STONEOF STONE STONE STUDEN TSA-R UWIHOS TOTAL DEDUCTIONS NET PAY: TOTAL CAFE 125 PLAN: TAXABLE PAY: $ 539,736.06 8 539,716.06 FICA - MED(ER) -CALCULATED-, 7;826.17 FrOM MMC Report Difference FICA - MED(EE) ,.sx S 7.826.17 S 7.826.18 S (0.01) FICA -SOC SEC (ER) szow $ 33,463.64 FICA -SOC SEC(EE) ezcx $ 33,463.64 S 33,463.63 S 0.01 FED WITHHOLDING $ 46.164.90 S 46,154.90 TAX DEPOSIT: 5 _ 12S_73452 5 128.734.52 FICA -MEDICARE znwn S 15.652,34 S15,652.36 FICA -SOCIAL SECURITY ,z.4x S 66,927.28 $66.927.26 PREPARED BY: FED WITHHOLDING S 46,154.90 $46,154.90 PREPARED DATE: TOTAL TAX: $ 128,734.52 $128,734,52 $ REVISED 31182014 TOTALS S 539,736.06 $ 300.00 Employees over FICA -SS Cap: Roshanda Thomas Michael Gaines Paycode S - Employee Reimb.: TOTAL: $ 570.69 46,164.90 7,826.18 33,463.63 119.S7 2,083.11 36,887.96 127,406.04 412,330.02 Exempt Amt: Andrie Flores 3/25/2024 n7 R1 MMC TAX DEPOSIT WORKSKEET 03.21.24-Is; TAX DEPOSIT WORKSHEET 312512024 Rua Date: 03/22/24 MEMORIAL MEDICAL CENTER Page 110 Time: 15:45 Payroll Register ( Bi-Weekly I P2REG Pay Period 03/OB/24 - 03/21/24 Run' 1 Fina' Summarc `.- P a y C o d e S u n n a r Y---------------------- ----------_.._...-- D a d u c t i o P. S ?ayCd --------------------------------------------- Description Mrs 1011SHIWEIH01CBI Gross I Code s Amount u n n a r y-------------. 1 REGULAR PAY-S1 9,24.25 -`-------- N N ---------------........................................ it - 224185.60 A/R 300.00VA/R2 ........... .._. A/R3 1 REGG.AR PAY-S1 1889.00 N N 11 N 39040.63 ADVANC AWARDS BCBSVI 1 REGOAIAR PAY-S1 234.50 Y N 11 6857.76 BOOTS CAPE E CAFE-1 2 REGUAR PAY-S2 2729.00 N N 31 74263.23 CA?E-2 CAPE-3 CAFE-4 2 REGULAR PRY-S2 7.50 N N N N 301.BB CAFE-5 CAFE-C CAFE-D 2 REGULAR PAY-S2 96.75 Y N N 3651.67 CAFE-F CAPE-F. CAFB-I 3 REGULAR PAY-S3 1520.50 N N 11 i3073.19 CAFE-L CANCER 3 REGULAR PAY-83 10.25 N M N N 510.25 CHILD 570.69,A.LIMIC �CAFE-P CONAIN 3 REGULAR PAY-S3 77.50 Y N N 3529.29 CREDUN DO ADV DENTAL 4 CALL BACK PAY 24.00 N 1 N N Y 585.66 DEP-LF DIS-LF 6AT CALL BACK PAY 39.75 N 2 N 11 Y 1649.39 EATCSM FEDTAX 46154.9041CA-M 7d26.1B.% 4 CALL BACK FAY 10.00 N 3 R N 1' 463.76 FICA-0 33463.63 FIRSTC FLEX S CALL BACK FAY .25 Y 2 N N Y 17.40 FIX FE OP.T D FUTA CALL PAY 2340.00 N 1 N 11 4680 AO GIFT S 119.5 RANT GRP-IN D DOUBLE TIME 7.00 N 2 N N 420.44 GTL HOSP-I FSA 0 DOUBLE TIME 7.75 N 3 N F. 641.55 3D TFT 2RSTAX LEAF E EXTRA WAGES N N N N -600.0O LEGAL NASA NEW 1568.271 E EXTRA WAGES N 1 N N N 1444.50 METVIS MISC N3SC/ F FWN RAL LEAVE 72.00 N 1 N N 2268.48 IMCSHR MOGACC MOOILL . C11S3RVCCE 36.50 N 1 N N 1405.35 M,OOIND MCOLIF MOOSTD SNSERV10E 9.25 Y 1 N N 458.04 KOOVIS NATFMD OTHER J JURY LEAVE 2.00 N 1 N N 55,22 PHI PHI"` PR FIN K EXTENDED -ILLNESS -RANK 80.00 N N 11 N 3389.00 RELAY REPAY SANS K EXTENDED -ILLNESS -BANK 382.00 N 1 N N 10519.48 SCRUBS SIGNOS ST-TX P PAID -TIME -OFF 182.39 N N N N 7019.13 STONDF STONE STON62 P PAID -TIME -OFF 1666.00 N l N N 49299.16 BIDDEN SUNACC SUNPL K CALL PAY 2 160.00 N 1 N N 320.00 BONING SUNLIF SUNSTD Z CALL PAY 3 96.00 N 1 N N 298.00 SUNVIS SURCRG TSA-1 TEA-2 TSA.-C TSA-P TSA-R 36897,96JTUTION UNIFOR 514.84J U6/HOS `-------------------- Grand Totals: 21294.14------- f Gross: 539736.06J Deductions: 127406.04d Net: 412330.02J P61 da}a.:• 3'7A' vF Checks Cam-:- FT 210 PT 14 Other 43 Female 238 Male 28 Credit OverAmt 16 ZeroNet Tam Total: 266 � `................................................................................................................................ 1 T 3f2� I2.�f- Rua Date: C3125/24 MEMORIAL PEDICAN CENTER BI-WEEKLY Page - TLne: 10:13 •+++ Check Register •+*+ P2D'STF Pap Period C3i08i24--03/2./24 Rum 1 Type=NET/0000001 OPMTING - PROSPERITY NUR. Sane Amount CHECK NON, DATE 60387 REBECCA OVALLE 1141.07 00063408 03/29/24 00041 CAiL LEE KING 1342.88 DD 03/29/24 00083 SYLVIA A VARGAS 1263.84 DO 03/29/24 OD113 JACLYN CARP.3CN 1190.54 DO D3/29/24 00132 SANDRA A BRAN 1228.47 DD 03/29/24 00192 3RENDA D PENA 1234.32 DD 03/29/24 00337 BILLIE F DUCKKORTR 2621.09 DO 03/29/24 00392 NON'CA T CARR 1744.77 DO 03/29/24 00399 LINDA J TiJERiNA 2341.20 CD O3/29/24 00401 VELMA J P'13 2439.20 DO 03/29/24 00417 SHERRY I KING 2657.13 DO 03/29/24 00423 CORN V STRINGO 2695.96 DD 03/29/24 00492 PAN, FIKAC 1690,42 DD 03/29/24 00531 CYNTHIA L PUSHING 1831.55 OD 03/29/24 00681 RILLA RE.NE3 NCO' i906.08 OD 03/29/24 00692 DEBORAH E 14I7MBERT 402.86 DO 03/29/24 00697 MARIA C FAP.IAS 1372.44 DO 03/29/24 00707 KIMBERLY RESENOEZ 2002.62 DO 03/29/24 00895 EM'LIE DIANE WILKEY 1353.01 DO 03/29/24 01015 SUSAN3 SMALLEY 102.51 OD 03/29/24 0117E PA71RICIA LAUREN HERMES 2594.90 DO 05/29/24 01192 SHARDS M SPF3KS 506.95 DO 03/29/24 0'_234 JHN'SE N SVETLIK 2391.28 DO 03/29/24 0'.241 FTNDY PACE 2252.44 DO 03/29/24 G1367 MARILYN A SANDERS 381.83 OD 03/29/24 0.451 JENNIFER L ZISSA 937.07 DO 03/29/24 G_791 RAUSIVINAP J MONDAY 2149.89 DO 03/29/24 02011 ERIN R CLEVENGER 4119.38 DO 03/29/24 02014 AGAPITA C 01M 709.54 DO 03/29/24 02021 ERIKA OSORNIA-SANCHEZ 2700.00 DD 03/29/24 02022 ;6vJla4 J GRIGGS 2817.92 DO 03/29/24 02064 ANNA LAURA GARCIA 1842.95 DD 03/29/24 02099 TRACI Y. SNEFCIK 3167.41 DD 03/29/24 02112 LESLIE T.-AMAS 2733.06 DO 03/29/24 02132 JASMINE RUIZ 1812.81 DD 03/29/24 02135 NORMA ALLISON 1011.88 DO 03/29/24 02136 TAWNY ESQUIVEL 299.75 DO 03/29/24 0215? K]STINE STRELCZYK 1279.69 DD 03/29/24 02156 A.'UBREY S BOLT 427.47 DO 03/29/24 02162 MIRIAM PA17C4 2014.3E DO 03/29/24 G2169 JENSICA KNIGHT 2107.01 DO 03/29/24 02153 TIN' 7ENGLAR 1776.20 DD 03/29/24 02201 CORRIN"s VILLEGAS 1426.28 DD 03/29/24 02271 DAWN J RUBENIK 2331.15 DO 03/29/24 02381 NICOLAS TIJER'NA 874.24 OD 03/29/24 02302 CATHERINE MARTS DEC'LOS 447.25 DO 03/29/24 O2303 CONTIIE P. PADIERNA 2731.03 DD 03/29/24 22315 NINA 1.1 GREEN 2326.72 DD 03/29/24 ,022 RICK OSCRNIA 377.85 DO 03/29/24 02346 JEANETTE L FALCON 04.67 DO 03/29/24 02416 JANELL': SCOTT 1671.77 DO 03/29/24 C2435 SAMANTTHA TANTON 799.66 DD 03/29/24 02511 6.4GOALEN.A SEPULVEDA 547.83 DD 03/29/24 Run Date: 03/25/24 MEM.ORIAL MEDICAL CENTER BI-WEEKLY Page ?1me: 10:13 ... Check Register t2+2 P2DISTF ^ Pay Period 03/08/24--03/21/24 Run.: 1 7}me=10 :0000001 OPERA"TING - PROSPERITY Hum. Name Amount CHECK NOR DATE 02535 STEFANIE A SOLIZ 40.96 OD 03/29/24 02552 VERONICA RAGUSIN 2263.01 DO 03/29/24 02612 MEG:HAV WELL 855.06 OD 03/29/24 02622 JESUSA RARIE 3EHAVIDES 736.62 DO 03/29/24 02678 NELISSA NESLON'EY 1702.98 DO 03/29/24 02701 HONDA GOHLKE 3002.81 DO 03/29/24 02719 DAW71 N MCCLELLAND 2544.27 DO 03/29/24 02720 ELDA Id LUEPA 2794.44 DO 03/29/24 02733 ROBIN N PLEDGER 3235.69 DO D3/29/24 02794 HEATHER L MUTCHM 2201.12 DO 03/29/24 02812 3R:TTANY N RUDDICK 1848.43 DO 03/29/24 029P7 MAR2A F LCNCOR2A :398.09 DO 03/29/24 02927 Y.ICR.AEL L GAIN'ES 3355.65 DO 03/29/24 02296E DOROTHY J REN'DON 869.73 DO 03/29/24 02970 DIANNE C ATKINSON 2404.84 DO 03/29/24 03864 JACQUELINE P. HERRERA 1549.89 DO 03/29/24 05003 CCURTNE D THURLKILL 3094.E4 DO 03/29/24 0500E REGINA A MARTIOEZ 2524.83 DO 03/29/24 05007 JAMIE K NEYLANC 1621.E9 DO 03/29/24 05264 SARA WHITE 415.35 DO 03/29/24 05345 ERICA NCUYEN 838.6E DO 03/29/24 05641 ANANDA R KEY 2296.':4 DD 03/29/24 07123 CYNTHIA GUERRA 1708.00 DO 03/29/24 C7147 CHAR A VORCE 2E83.56 DO 03/29/24 07878 DIANA C SAUCEDA 1254.47 DO 03/29!24 11197 CATHRRINE A SAENZ 2598.46 DO 03/29!24 1:412 COURTNEY L MORKOVSKY 1118.03 DO 03/29/24 12011 KIMBERLY J REYNA 463.99 DO 03/29/24 12115 LISA J EINOJOSA 1031.63 DO 03/29/24 12129 M,IC_AEL HEPDIES 1848.71 DO 03/29/24 :2609 1AELIN R LoA 640.79 DO 03/29/24 15097 KYLE L DANIEL 2981.49 DO 03/29/24 '5131 SAVANNAH HARLEY 2003.05 DD 03/29/24 15139 KRISTEN HICOLE BALLARD 1999.0E DD 03/29/24 '51E3 KELSEY EEINOLD 4020.05 DD 03/29/24 75171 JESSICA BARRON 771.56 DD 03/29/24 15236 YESSENIA L GIVIUDOS 453.67 DO 03/29/24 1529E DAWN M MA.RE( 2100.22 DD 03/29/24 15909 JULIE NGUYEN 6799.03 DO 03/29/24 15915 3RIANNE J KEY 2176.99 DO 03129/24 20012 Aims LOREDO 701.86 OD 03/29/24 20112 YULMA FATP-ICA RODRIGUEEZ 20.48 DO 03/2912, 201=4 SOPHIR PI PECENA 257.60 DO 03/29/24 20148 JENIIFER CMIPEAN 1053.5E DO 03/29/24 '0156 ERIN ASHLEY WISDOM 2066.79 DO 03129/24 20168 JOS'IUA PEPPERS 7BO.02 DO 03/29/24 20104 MELISSA MIMIC) 852.9E DO 03/29/24 20206 KELLI 3 GOFF 2173.38 DO 03/29/24 20207 S.H?'MA G 1ARTL 2849.85 DO 03/29/24 2024E M-LANIE CORTEZ 2155.73 OD 03/29/24 26272 ANCELA YEAGER 2633.23 DD 03/29/24 2G294 JESSICA D NALT..M 10".ae DO 03/29/24 20324 PATP.IM STRIBLEY 2292.71 DO 03/29/24 20343 SAVANNA. N SOCAP.RAS 915.93 DO 03/29/24 P.ut Date: 03;25/24 4EMOESAL NE,. CAI CENTER BI•WEc"KLI' Page 3 Tire: 1C:13 ••*• Check Register ++•• P2DISTF Pay Period 03108/24--03/22/24 Rut: 1 Tyne=NET/0000001 OPERATING • PROSPERITY Its. Ease Amount CHECK NUM DATE 20456 SAYDI r. ST CT IR. 117.74 DD 03/29/24 20494 3EIANN S PA.SSMORE 1331.27 DD 03/29/24 20759 JAY,!: SADLER 1627.98 DD 03/29/24 20786 JAYLIN RAMIREZ 3B7.70 DO 03/29/24 20797 3ETHA21N M DIGGS 2314.15 DD 03/29/24 20857 JOSHUA LOPEZ 757.07 OD 03/29/24 20577 CHERYL L TESCH 2914.04 OD 03/29/24 20980 SAVANA LENTO 911.29 OD D3%29/24 21450 DIAU; E LEAL 1734.96 DD 03/29/24 71629 JACOBY R CRAWFORD 1794.40 DD 03/29/24 22493 ERI'.TAA'Y E NAVARRO 2124.41 DD 03/29/24 25022 AMBER. L LOYA 726.24 DO 03j29/24 28034 KC43STINA. A B'UEVGER 582.33 ON 03/29/24 28120 JESSICA V SELVERA 962.47 DD 03/29/24 29199 KELLY A SCBOTT 2287.90 DD 03/29/24 30491 ARLEEN JUDD 424.61 DD 03/29/24 31035 STACIE L EPLEY 2033.BB DD 03/29/24 Ti054 IDEA L LAMMBORN 1037.23 DD 33/29/24 3:099 ARACELY Z GARCIA 1072.39 UP 03/29/24 31219 LAUREN PHILLIPS 1559.93 DD 03/29/24 K241 MONICA SALAZAR 206.86 DD 03/29/24 31251 CYITdIA L BIAS 2471.15 OD 03/29/24 31313 KATHERINE LYNN JI.MENEZ 2253.68 DD 03/29/24 3:319 STACY L FARMER 1763.23 DO 03/29/24 31463 TOWARD E MATUTA 2809.83 D➢ 03/29/24 3'506 RACFSL A REFFNER 2511.65 DO D3/29/24 31821 KAYLA Y. ALVAREZ 1640.04 D➢ 03/29/24 3811E EBYSTELLA ? KTSIAH 1256.76 DO 03/29/24 3842F JULIAN HEYSQUIERDO 1122.31 DD 03/29/24 41062 CF.'EYENNE NESSA 165.0E DD 03/29/24 41112 AMASTASIA L PEREZ 1039.45 DO 03/29/24 41171 TO013 M. TRE'VINO 898.55 DO 03/29/24 4'219 GUADALUPE OLL\TEZ 837.46 DO 53/29/24 4''225 LESLIE A CRAIGEN 827.:1 DD 03/29/24 4:236 PAMELA K VA!WOY 1525.69 DD 03j29/24 41251 SARA YSARBO 814.51 DO 03/29/24 4:261 3ERNICE AGUILeR 1127.95 DO 03/29/24 42265 BERENICE LUGO B19.55 DO 03/29/24 41274 KAREN GAIRI 1282.69 DD 03/29/24 41275 PAMELA R HARMON 1074.29 DD 03/29/24 4:297 ALISA D VILLARREAL 769.09 DD 03/29/24 4:347 AD3'ANNA ➢ STRAKOS 954.17 DO 03/29/24 4:418 ANGEL M. CASSEL 1072.62 DO 03/29/24 4E426 TASRA NOR:MAN 3678.59 DO 03/29/24 4:506 JOSS?AT LUGO TORRES 896.49 DD 03/25/24 4'_546 SFAIMEI MARTINET 3291.42 DO 03/29/24 41612 SONJA A GL'AJARDO 1223.68 DD 03/29/24 41617 JACQUKINE M RARTINEZ 937.28 DD 03/29/24 42705 KELSEY R TAYLOR 1026.78 DD 03/29/24 41896 RENAE MIC3ELLE EMERY 710.30 DD 03/29/24 4'_B57 RDXANNA MU:IO2 1015.16 DD 03129/24 41901 JUANITA R MILLER. 1345.10 DD 03/29/24 42953 KAYLENN TRRVTKD 705.55 OD 03/29/24 42106 CERTSTY S1L'iAS 1274.32 DD 03/29/24 P.uD Bate: 03!25/24 MEMORIAL MEDICAL CENTER BI-WEEDY Page 4 T'rte: 10:13 ^++ Check Register +^+ P2DISTP ?ay Period 03/08/24--03!2'/24 Sur: 1 ;'Yoe-IET '0000001 OPERATING - PROSPERITY Num.. Name Amouac CHECK \7. DATE 42112 SQCOF.RO C GONZALES 1105.99 DO 03/29/24 42122 LET AMA C3AVANA 1807.01 DO 03/29/24 42125 MARTA LUCY CALZADA 1006.42 DO 03/29/24 42304 MINI ". NGUYEN 2451.97 GO 03/29/24 42536 FkRIAH A SOCARP.AS 799.93 DO 03/29/24 42820 MARIA D CHAVEZ 1138.39 DD 03/29/24 42342 SFAN7NA S 0 03-HELL 3380.30 DO 03129/24 50148 PEh,V GOULDEN 3558.49 DO 03/29/24 501f3 BRIT"l EY MICHELLE ZAMORA 215.73 ON 03/2912i 55282 JACOB W HAMILTON 2914.45 GO 03/29/24 50310 JAS4I4E GRIGSBY 989.25 DD 03/29/24 5,3546 MELANIE E SAWAYOA 2212.22 DD 03/29/24 55573 DEANIA R DAVIS 1626.39 DO 03129/24 50596 BETTY S DAVIS 2309.72 DD 03/29/24 50719 DEBRA K MUSTERED 2524.32 DO 03/29/24 50928 ANLNA GERDES 1050.75 DO 03/29/24 53541 JACLYN B MARTI 1370.03 ON 03/29/24 54021 KONICA A ESCALAIn 1365.60 OD 03/29/24 55025 LEA C RESENOE2 1536.36 DD 33/29/24 55026 IRENE B PEREZ 301.43 DD 03/29/24 ES127 APRIL N4 KUBAIA 2372.73 DD 03/29/24 55234 ELOTZA SDTO 614.6E DD 03/29/24 55371 BLANCA HERNANDEZ 401.69 DO 03/29/24 55382 SHANON JACILDO 517.50 GO 03/29/24 55658 _a0AN WILKE 885.01 DO 03/29/24 58115 BECKY MARIE SEE 1200.54 DO 03/29/24 58510 RITA L FOLENSZ'Y 694.42 OD D3/29/24 60112 ROBERT A RODRIQUEZ 2238.40 DD 03/29/24 60131 NORA OVALLE 879.57 DO 03/29/24 60145 REGINA ZAMDRA 1764.13 DO 03/29/24 60156 DANIELLE :4 KALISEK 1131.54 DO 03/29/24 6026E IRA R SHARP 817.19 DO 03/29/24 60i89 JASON J LOYA 1226.79 DO 03/29/24 6061E DOROTHY A LONGORIA 10BIAI DD 03/29/24 62322 AW4 Z:SIGHY 1598.86 DO 03/29/24 63193 M.ICFA3L SOCA..W 1318.88 DO 03/29/24 63450 VIRGINIA C BERNIARDINO 995.84 DO 03/29/24 63846 JUAN ?GORES 1253.54 DD 03/29/24 6510C FELICITA BONTJZ 723.84 DO 03/29124 65125 MARTHA. CUMPEAA 830.04 DO 33/29/24 65127 VERONICA ORTIZ 924.03 DO 03/29/24 65136 TINA RORANEK 1371.05 DO 03/29/24 65118 MARTA INIGUIZ 780.60 DO 03/29/24 6513, ELTA OLACHIA. 1124.08 DO 03/29/24 95129 SLVTPA SAN2CHEZ 831.21 DO 03/29/24 65205 JUAN3A SANTTIYAN 769.36 DO 03/29/24 65213 LEE SIKERLY 1246.08 DO 03/29/24 65247 010A CASCILLD 526,25 DD 03/29/24 65269 NATALIE BAP.EFIELD 566.59 DO 03/29/24 55315 :LVA RODP.TGUEZ 779.99 OD 03/29/24 65393 24N.ONA A PEREZ 1223.65 DD 03/29!24 65453 AVALIA L FLOREES 1368.38 DO 03/29/24 6546E rk.RIA I VEIOZ 786.23 DD 03/29/24 65496 RROSA RODRIGUEZ 1027.61 DO 03/29/24 Run. Cate: 03/25,24 MEHOETAI MEDICAL CENTER BI-WEEKLY Page 5 Tine: 10:11 •••• Check Register +••• P2DISTP Pay Period 03/08!24--03/21/24 Run: I Igoe-NET/0000001 OPERATING - PROSPERITY Nut. Name Amours[ CHECK NN: DATE 65513 RARIA MORALES 1028.14 DO 03/29/24 65705 DON3TILA HERRERA 1096.52 DO 03/29/24 55715 WIA R GOME2 966.59 DO 03/29/24 65745 !ARIA L-JLSA RODRIG'JEZ 12e4.60 DO 0/29/24 65865 MIA F LEDEZMA 966.23 OD 03/29/24 6836e DOMITILA GARCLA 206.3E DD 03J29124 68568 CHRISTOPHER RUMERFORD 1094.65 OD CS/29/24 68792 HAZAP.IO DIAZ HERNANDEZ 2324.12 DO 03/29/24 70119 SARA N BLEDSOE 3075.48 OD 03/29/24 73719 GLORIA N REID 2634,24 DO O3/29/24 74159 CAROL VILLARREAL 1184.73 DO 03/29/24 75190 RIKA MILLER 2198.06 DO 03/29/24 76076 ALEXANDRIA Y KNISLEY 354.79 DD 03/29/24 75115 JEM1NIFER R CARLOCK 772.51 DD 03/29/24 76120 RACHEL CANALES 1387.54 DO 03/29/24 7513E KAREN D GARCIA 843.91 00 03/25/24 7E210 ZOE VILLARREAL 37B.75 DO 03/29/24 76300 AID.A JIMENZZ 986.9E DO 03/29/24 76308 CHRISTELLA A\T 52NDEJO 366.42 DD 03f29/24 76313 PAMEELA L BARTON 996.41 DO 03/29/24 T6403 KATRINA A PO:KLUDA 1314.91 DO 03/29/24 76647 CHERYL A SEE Z106.1a DO 03/25/74 76706 GREGORY E I40UJ:E5 826.20 DO 03/29/24 76B54 EARY PATTERSON U46.67 DD 03/29/24 7E985 VANESSA TRISTAN 386.89 DO 03/29124 77646 FAREN A GONZALES 1292.95 DO 03/29/24 78420 F.IS71' R PASSMDRE 1993.85. DO 03/29/24 7B05P KYAAN J POWER 532.13 DD 03/29/24 78072 D„'TNA M. RAWLINGS 1686.37 DO 03/29/24 ;Blue ALEXA QJINTANILLA 1066.07 DO 03/29/24 78287 MARLSSA O ALF'ANZAR 3611.49 OD 031291.4 78336 JESSICA L GLOVE.? 1976.20 DO 03/29124 70566 MELISSA K GEE 1009.29 DO 03/29/24 78764 AMEY D UDLEY 2000.66 DD 03/29/24 78781 KR?STEP R MA.CHICEK 2140.65 DD 03/29/24 78787 FARM I JANA.K 2813.24 DO 03/29/24 78897 DAYLE J ROBINSON 862.68 DO 03/23/24 80008 AM D BESIO 2556.76 DD 03/29/24 80141 JEANNIE ORTA 1922.57 DO 03/29/24 8092E B2YAN HOBGOOD 1961.98 DO 03/29/24 82227 CAITLIN A CLEVENGER 1404.98 DO 03/29/24 86482 MEGAN M. RARPER 913.84 DO 03/29/24 BE575 ELSA HERRERA. 859.94 DO 03/29/24 66125 LISA M TREVINO 1175.44 DD 03/29/24 8814E NICHPLLE C049ERLAND 2133.47 DO 03/29/24 88321 ANDREN OR LOS SANTOS 2784.40 DO 03/29/24 98435 JOE GARCIA 1E57.05 DO 03/29/24 90320 ROSFANDA S THO1L45 6392.21 DO 03/29/24 i0929 STE'VE BROCK 5020.00 DD 03/29/24 93231 AADRIE N FLDRES 1848.74 DO C3/29/24 ?3241 S.ARIAH N RLRIO 12E2.28 DD 03/29/24 ?8756 ADRIh.NNA M GALVAN 1713.30 DD 03/29/24 412330.02 0•C MEMORIAL MEDICALCENTER f X11 PROSPERITY BANK ELECTRONICTRANSFERS FOR OPERATING ACCOUNT —Mar 10, 2024. March 24,2024 e" 2.39 66.94 + Da" 9anY0esn"eLOn MTi)\ [Notes CP51'Ha Amuune Cln 27 ° 0 1 1 3/22/2024 WIRE OUT CHINA INCOMING SETTLEMENT ACCOUNT .OUBank Corporate Card Payment, 1.130.14.f 32.5 3/U/2024 PAY PLUS ACKrans 0000000129393111010006965 -3M Party Pe,r Fee 09A2+ 3/22/2024 AMERISOURCE BERG PAYMENTS 01000077682100002 - 340B Dreg P..ram Expense 406.05 30•26 3/n/2D24 PAY PLUS ACHTram000000011833382101=6956 .3rd Party Payer Fee A6:94a 3/Nl/2024 WEBFIIPTAKPYMTDDM2p50T2T1321000020591 .5ales Tax 1,962.55 .j� �9� y�__,/^ 3/20/2024 PAY PLUSACRT.nx0WWC01772I2441010006945 -3rd Party P.,, Fee 9791 ,y+r _ 3/19/2024 PAY PLUS ACHTrans0000000E761842010101106934 .3rd Party Payoriee d253 9/19/2024 MCKESSON DRUG AUTO ACH ACH059164919100W133 - 940B Ore, Pro,man Expense 14,02RA64 173+96>'i',i + 3/18/2024 PAY PLUS ACHTmox01Ag690V5>W91010005921 -3rd P.,Payar Fee e3D 264 3/18/2024 IRS USATAKPYMT 27044795140GO756100IM818 -Payroll Tans 120.212.62 15 Lr- 14 - 3/19/2024 HPHG LLC PORT LAVA MemMedCtr Pure 113122650 . Health Insurance Premium Payment 35,022.27 %, 06!Ij !j - 1+961.5'> - 1 It B'L th II 6 - 120+21r6% - >5+02, L'i - 39676 � 396-56 ST3.963.6Sa/ 3 9 6J 6 - Q °Ul) x \ l>d e ,Ci._Ja^,W�-_ _ y M3Kh 25, 2024 TF. A"VE F.� �a•%9 •'�.� (�(/ ANDREW DELOS 5ANTOS +41F NTpI114,xi 03. 13. 2.q LL Memmlal Medical Center PROSPERILYBANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT -ESTIMATED ACHS Data Descrigorion MMCNatea Amount APPROVED 0.00 ON { d3bk ,'FICA IL , \ Martin 25, 2024 MA" 2 5 2024 ANOREWDE LOS SANTOS MemoUal Medial Center BY COUNTY AUIWOR CALHOUN COUNM TgXA.; 3/21124, 12:11 PM tmp_pw5report8037543125457575935.htmI RECEIVED BY THE MEMORIAL MEDICAL CENTER �E ON 0 12, jj AP Open Invoice ap_open_invoice.template 1�NR 2 12024 Dates Through:: Vendor# Vendor Name Class Pay Code CALMON C(WIj€f14*MftT HOUSTON Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 031324 03/19/20203/13/20204/15/202 'jVjWWn.u, 1,428.00 0.00 0.00 / 1,428.00 TRANSFER N{I plye.4 40(4ilect IVNA' t W&L ltYy+_�- . 031924 03/19/20203/19/20204/19/202 58.263.52 do 0.00 58,263.52 YEAR 6 COMPONENT Vendor Totals: Number Name Gross Discount No -Pay Net 11828 SOLERA WEST HOUSTON 59.691.52 0.00 0.00 59,691.52 peri 6u�mrn.ry Grand Totals: Gross Discount No -Pay Net 59,691.52 0.00 0.00 59,691.52 APPROVED ON MAR �NN277yy12024 CALHOUN COUA I7KAS file:///C:/UserslltrevinolcpsVmemmed.cpsinet.com/u88125/data_5/tmp_cw5report8O37543125457575935.html 1/1 3/21/24, 12:10 PM tmp_cw5report7565272302223998892.htm1 03/ VEDBYTHE 2Llry'AUDITORON MEMORIAL MEDICAL CENTER 12:10 AP Open Invoice List MAR 21 2024 Dates Through: V77enndor# Vendor Name Class Pay Code 1 ti&OU I WF, jf#ffHCARE CENTER Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 031924 03/19/20203/19120204/19/202 YEAR 6 COMPONENT Vendor Totals: Number Name 11820 FORTBEND HEALTHCARE CENTER RePC, ri sumerr,I Grand Totals: Gross Discount 6,634.54 0.00 APPROVED ON MAR 2 12024 CABLHOl1N COUNTI; T�%!1€i Gross Discount 6,634,54 0.00 Gross Discount 6,634.54 0.00 No -Pay 0.00 0 ap_open_invoice.tempiate No -Pay 0.00 No -Pay 0.00 Net 6,634.54 Net 6,634.54 Net 6,634.54 file:///C:lUsers/itrevinolcpsilmemmed.cpsinet.com/uBB126/data 5/tmp_cw5report7565272302223998892.htmi 1/1 3/21/24, 12:10 PM tmp_cw5report5266039008671786223.html RECEIVED BY THE 03/mbUY AUDITOR ON MEMORIAL MEDICAL CENTER 12:1'MAR 21 AP Open Invoice List 2024 Dates Through: Vendor# Vendor Name / Class Pay Code 1C1ft¢IOUf*fWU, CREEKSIDE PARK ✓ Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 031924 03/19/202 03/19/202 04/19/202 YEAR 6 COMPONENT Vendor Totals: Number Name 11832 BROADMOOR AT CREEKSIDE PARK R?jxo 1 sJwim)8ry Grand Totals: Gross Discount 70,053.25 0.00 APPROVED ON MAR 2 12024 CALHOUN COUNTY,1'TEXA6 0 ap_open_invoice.template Gross Discount No -Pay Net / 70,053.25 0,00 0.00 70,053.25 ✓ Gross Discount No -Pay Net 70,053.25 0.00 0.00 70,053.25 No -Pay Net 0.00 70,053.25 file:l//C:/Users/ltrevino/cpsi/memmed.cpsinet.com/uB8125/data_5/tmp_cw5report5266039008671786223.html 1/1 3/21/24, 12:11 PM tmp_cw5report3431266603023146771.html RECEIVED BY THE OR ON MEMORIAL MEDICAL CENTER 03/2�MTYAUD1 12i1 MAR 2; y 2024 AP Open Invoice List 0 ap_open_invoice.template Dates Through: Vendor# Vendor Name Class Pay Code Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net / 031424 0t3/19/20203/14/20204/15/202 11,390.00 0.00 0.00 11,390.00 ✓ TRANSFER NR PASU Pl4Ku- tt LL pyVk'I AE�'USi7.r,I, 1hT+ MMnC OpUk-r•�� 031924 03/19/20203/19/20204119/202 37,176.67 b 0.00 0.00 37,176.67✓ YEAR 6 COMPONENT Vendor Totals: Number Name Gross Discount No -Pay Net 11824 THE CRESCENT 48,566.67 - 0.00 0.00 48,566.67 R.'pGrti :%dltTiillEiftt Grand Totals: Gross Discount No -Pay Net 48,566.67 0.00 0.00 48,566.67 APPROVED ON MAR UN2Ty1 p2024 CALHOUN COUN1YtTXAB 61e:11/C:tUsers/ltrevinolepsilmemmed.cpsinat.com/u88l25/data_Sltmp_cw5report3431266603023146771.html 1/1 3/21/24, 12:23 PM tmp_cw5report8454737708045053719.html * MEMORIAL MEDICAL CENTER 03/ Ai 0 AP Open Invoice List 12:23 MAR 212024 Dates Through: ap_open_invoice.template Vendor# Vendor Name Class Pay Code 11L8p ALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 031124 03/19/202 03/11/202 04/15/202 43.25 0.00 0.00 43.25 ✓ TRANSFER IJµ Ilyofto_ FyWj dtp%jAnd lk-W KWLL QIQti1<y W) 031224C 03/19/202 03112/202 04/15/202 56,082.44 0.00 0.00 56,082.44 TRANSFER It tt 031224 03/19/20203/12120204/15/202 3,160.00 0.00 0,00 3,160.00� TRANSFER It 1t . 031224A 03119/202 03/12/202 04/15/202 3,723.53 0.00 0.00 3,723.53✓ 031224D TRANSFER 03/19/202 03/121202 04/15/202 3,559.51 0.00 0.00 3,559.61 .d TRANSFER tt 11 031224E 03/19/20203/12120204/15/202 4,345.00 0.00 0.00 4,345.00 TRANSFER II It 031324 03/19/202 03113/202 04/15/202 576.78 0.00 0.00 576.78 TRANSFER tt It 031924 03/21/20203/19/20204/19/202 98,345.51 0.00 0.00 / 98,345.511/ YEAR 6 COMPONENT Vendor Totals: Number Name Gross Discount No -Pay Net 11836 GOLDENCREEK HEALTHCARE 169,836.02 0.00 0.00 169,836.02 R opoi z SurrZ.rnary Grand Totals: Gross Discount No -Pay Net 169,836.02 0.00 0.00 169.836.02 APPROVED ON g MpOUNTY,I A�RR 27y1g2024 CALHOUN CT0 file:!//C:lUsers/itrevinolcpsilmemmed.cpsinet.com/u88l25/data_5/tmp_cw5report8454737708045053719.html Ill 3121/24, 12:09 PM tmp_cw5report958836330715599105.html RECEIVED BY THE 0§QWff44uD1rOR DN MEMORIAL MEDICAL CENTER "MAR 212024 AP Open Invoice List Dates Through: Vendor# Vendor Name Class Pay Code CiLMWN COUMGEXWLAZA Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount 031924 03/19/202 03/19/202 04/19/202 19,219.26 0.00 YEAR 6 COMPONENT Vendor Totals: Number Name Gross Discount 12696 GULF POINTE PLAZA 19,219.26 0.00 Repm9. Summitry Grand Totals: Gross Discount No -Pay 19,219.26 0.00 0.00 APPROM ON MpA�RN2ry1 22p0224pp CALHOUN COUNT`7, TEXAS 0 ap_open_invoice.lemplate No -Pay Net 0.00 19,219.26 No -Pay Net 0.00 19,219.26 Net 19.219,26 file:///C:/Users/ltrevino/cpsi/memmed.cpsinat.comtuB8l25/data_5/tmp_cw5report958836330715599105.html 1/1 3/21/24, 12:17 PM tmp_cw5report3653252847856520385.html RECENEOBYTHE COUNTVAUDMRON 03/21/2024 MEMORIAL MEDICAL CENTER 0 12:1 iVIAR 2:12024 AP Open Invoice List ap_open_invoice.template Dates Through: 8ALNc7UtY Wl7t` WnjwS Class Pay Code 12792 BETHANY SENIOR LIVING Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 031224A 03/19/202 03/12/202 04/16/202 39,105.88 0.00 0.00 39,105.88 TRANSFER NR insurtirtce. FOWtdep9s+{ed jK_6 WU t, orow..+V1 031224 03/19/20203/12/20204/15/202 19.528.71 0.00 0.00 19,528.71 TRANSFER A rt 031324 03/19/20203/13/20204/151202 69.72 0.00 0.00 69.72 TRANSFER 11 r. 031924 03119/202 03/19/202 04/19/202 113,252.57 0.00 0.00 113,252.57✓ YEAR 6 COMPONENT Vendor Totals: Number Name Gross Discount No -Pay Net 12792 BETHANY SENIOR LIVING 171,956.88 0.00 0.00 171,956.88 ItepCfY S WTIDi'Al ", Grand Totals: Gross Discount No -Pay Net 171.956.88 0.00 0.00 171,956.88 ,APPROVED ON g MAR UN21pZ024 CALH011N COUNT`/,I %a file:///C:IUserslltrevino/cpsi/memmed.cpsinet.com/u881251data_5ltmp_cw5report3653252847856520385.html 1/1 QIPP Year 6 Comp 1 Allocation Reconciliation United Healthcare Total MMC Portion 255,377.17 Total NH Portion 321,387.69 Total UHC Prosperity Deposit $ 576,764.85 Ashford Gardens —I $ 319,292.15 Amount that MMC keeps from Prosperity Deposit Total Refund $ (38,213.21) Toal Owed to UHC $38,213.21 NH Portion 50% Sept Oct -1,592.22 Nov Dec Jan -1,592.22-1,592.22-1,592.22 Feb -1,592.22-1,592.22 March April May June July August Total MMC Portion 50% -1,592.22 -1,592.22-1,592.22-1,597-22 -1,592.22-1,592.22 -9,553.30 NH Portion 70% -9,553.30 MMC Portion 30% -2,229.10 -2,229.10 -2,229.10 -2,229.10 -2,229.10-2,229.10 --9,374.62 -955.33 -955.33 -955.33 -955.33 -955.33-955.33 -5,732.98 = Withhold$22,92793front NH Wire Transfer Total Total NH Portion -38,213.21 -22,927.93 Broadmoor Total MMC Portion -15,285.28 Total Refund $ 116,755.41 NH Portion 50% Sept Oct 4,864.81 Nov Dec Jan 4,864.81 4,864.81 4,864.81 Feb 4,864.81 4,864.81 March April May June July August Total MMC Portion 50% 4,864.81 4,864.81 4,864.81 4,864.81 4,864.81 4,864.81 29,188.85 Portion 703 29,188.85 M MMC Portion 0% - _ 6,810.73 6((810.73 6,810.73 6,820.73 6,810.73 6,810.73 40,864.39 2,918.89 2,918.89 2,918.89 2,918.89 2,918.89 2,918.89 17,513.31 Total 116,735.41 Total NH Portion 70,053.25 Total MMC Portion 46,702.16 Crescent Total Refund $ 61,961.11 NH Portion 50% Sept Oct 2,582.71 Nov Dec Jan 2,581.71 2,581.71 2,581F21 Feb 2,581.71 2,581.71 March April May June July August Total MMC Portion 50% 2,581.71 2,581.71 2,581.71 2,581.71 2,581.71 2,581.71 15,490.28 M Portion 70% MMC Portion 30% 3,614.40 3,614.40 3,614.40 3,614.40 3,624.40 3,614.40 15,490.28 21,686.39 1,549.03 1,549.03 1,549.03 1,549.03 1,549.03 1,549.03 9,294.17 Total 61,961.11 Total NH Portion 37,176.67 Page 1 of 3 Fort Bend Total MMC Portion 24,784.44 Total Refund $ 11,057.56 NH Portion 50% Sept Oct 460.73 Nov 460.73 460.73 Dec _ .Jan 460.73 Feb March April May June July August Total MMC Portion 50% 460.73 460.73 460.73 460.73 460.73 460.73 460.73 460.73 2,764.39 NH Portion 70% 2,764.39 MMC Portion 30% 645.02 645.02 645.02 645.02 645.02 645.02 3,870.15 276.44 276.44 276.44 276.44 276.44 276.44 1,658.63 Total 11,057.56 Total NH Portion 6,634.54 Solera Total MMC Portion 4,423.02 Total Refund $ 97,105.87 < _ NH Portion 50% Sept Oct 4,046.08 Nov 4,046.08 4,046.09 Dec 4,046.08 Jan Feb March April May June July August Total MMC Portion 50% 4,046.08 4,046.08 4,046.08 4,046.08 4,046.08 4,046.08 4,046.08 4,046.08 24,276.47 NH Portion 70% 24,276.47 MMC Portion 30% 5,664.51 5,664.51 5,664.51 5,664.51 5,664.51 5,664.51 33,987.05 2,427.65 2,427.65 2,427.65 2,427.65 2,427.65 2,427.65 14,565.88 Total 97,105.87 = Total NH Portion 58,263.52 Golden Creek Total MMC Portion 38,842.35 Total Refund $ 196,691.01 NH Portion 50% Sept Oct 8,295.46 Nov 8,195.46 8,195.46 Dec 8,195.46 Jan 8,1A.46 Feb March April May June July August Total MMC Portion 50% 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 98,345.51 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 8,195.46 98,345.51 Total 196,691.01 - Total NH Portion 98,345.51 Tuscany Total MMC Portion 98,345.51 Total Refund $ (117,259.39) Total Owed to UHC $117,259.39 NH Portion 5091 Sept Oct -4,885.81 Nov -4,885.81 4,885.81 Dec Jan Feb -4,885.81-4,885.81 March April May June July August Total MMC Portion 50% -4,885.81 4,985.81-4,885.81 -4,885.81 -4,885.81 -4,985.81 -4,885.81 -4,885.81 -4,885.81 -4,885.81 -4,885.82 -4,885.81 -4,885.81-4,885.81 -58,629.70 -4,885.81 -4,885.81 -4,885.81 -4,885.81-4,885.81 -58,629.70 = Total -117,259.39 Page 2 of 3 Gulf Pointe Total Refund NH Portion 50% MMC Portion 50% NH Portion 100% Bethany Total Refun �/ NH Portion 50% MMC Portion 50% NH Portion 65% MMC Portion 35% Withhold $58,M.70 from NH Wire Transfer $ 32,947.31 Sept Oct Nov Dec Jan Feb March April May June July 1,372.80 1,372.80 1,372.80 2,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 1,372.80 Total NH Portion •58,628.70 Total MMC Portion-58,629.70 August 2,745.61 2,745,61 Total Total NH Portion Total MMC Portion Total 13,728.05 13,728.05 5,491.22 32,947.31 19,219.26 13,728.05 $ 215,719.19 Sept Oct 8,988.30 8,988.30 Nov Dec Jan Feb March April 8,988.30 8,988.30 8,988.30 8,988.30 8,988.30 8,988.30 8,989.30 8,988.30 8,988.30 8,988.30 8,988.30 8,988.30 8,988.30 8,988.30 May June 8,988.30 8,988.30 8,988.30 8,988.30 July August Total 89,883.00 89,883.00 11,684.79 11,684.79 23,369.58 6,292.82 6,291.81 12,583.62 Total 215,719.19 Total NH Portion 113,252.57E / Total MMC Portion 102,466.62 Page 3 of 3 Memorial Medical Center Nursing Home UP1. Weekly Centex Transfer P.."Ity Pccounis 3/25/2024 / .vlrnl n MY^nv ux n v SW.j+ uYxv'e �Yx+l...nmxnxw.i t,a.n ll 115,11, t, t1,1115i^ . OO.IS..I. 13.)]3.N J Vnl+nn Ym Fe+hnp ne. F,+ryYI+,+„ 191.3,J Nbrv+ry Nl+nn Im.31� aeon W.^nmmnnaml nnsa� W'_gtljlj_e�x4�?k;,;� / uaAsvrz fn6, zxs a)�+.vecs� nsA]s.w � / ox4st0As V O+n\BYIMe ]Ss.016.x0 Y n+ln 4l+nn IWm +nu+ry Flmn }1n91r/ I+anq Fnnn I00.}a +elnBOn..nrtrv.n.,+m� r uulnas .y} J q} ]01.916 <5119JASI65dbJ,]II BS +I4)1F+5 x03.331Ae ✓ +NBY+rw +IO.110+0 Y+n l^ea.nn Imo OYm p+S.nm.ex+ele)un+n]fIf Rluw ]amq Fl+ml l+l )3 ✓� Fe —'an.. 11000 Rq_. gpvi 54]5019 / S4e5].51 01.01056 J aOw�aWne/Innl•raml bI.SILM 01.J15)0 / w.Y13.56 B+N na— f1,J15.2B 0I w—,r1Yua Imm +nuq Mann lot" M1Brvq FYml X '�li�.�i(V�,1!go3�\ilY x4'ni BY+neRn mM1r.ml wAI1.0f w}ss.lB Y tS111 V //ill.+lS.w // IIJ.WIJS �/ 513.031.00 . ���yy0 ++.11Nlrr B+nS Bn+w IIJ.a02Js HHH Y nMWw no. 87.773-44 + 2245510 C;ti + ,403,311.64 81•013.56 + 212,4388 6U .,. APPROVED ON MAC? 2 5 2024 +er.nFnnn ne)f� i+hrv+rlM+ml xi691 I1Y COUNTY AUDITOR agml00nnRnnM aM x1:axRw {P CALHOUN COUNTY, TEXAS mat ValmleS NxOREW OElOE 59N]05 3/1 /�S EYxa Y.\N, W np 1—mArx.11 noon 1—gtrcu W x nl\ unYn 1—m t 11 u I TXH Wn NT le(SUI DownloaewonmearymalmAXCMxX Bank Download 3.1e743E4 24 Pale1 MMCPORl1ON wA y0z ]'flpilt(i}W Tnneler-In QIPP/COmPI QIPP/Cpmp3 QIPP/QMP3 Qlpp(Clmpamad. yPPTI NMPORTION IRUED34 GfGllH 3{,il6.Il ✓ InU7MXB CCMO MCCWMIM()4EWMIIa4W'L30)l)1 E4p 14 1401d ,V2024 NWR 1ONNVUIICUNEVIOD }I01 9a)fl 943.5} MM024 VI.E. 3/31/t03a WIRL OV]KM3OROMM1MGMffNRRMD III.H I.Eo 3/3N0E{ XXB-F[MO MCCGIMPMT]I6COHI140CCO1N160 - lW M 04.16 USal VNCCOMMUNMILNIXNMPJWG - 7.I6 ),Ib 420000W1M UEO/EOIa NW MIMp�I IiII..136 VON. B6,191. 06,099,61 - C.Eal MXB CCWMIMIMWJMIIMPoa1001)6 39ab - 393.80 Million Cold MU 3/IP/1034 VMC COMMUNIrypI NCCWMPM]1n6DLa1t91OJ1O � 31 }) / - 34.2I iK.])).13 B).T3.M BT'n3u. i vM=' I TNufa 4% /TIJ MMCFORTION OIPP/CCI QIPP/Comp3 QIPP/Gmp3 OUP/@mp4bum. QPPn NHPOMM CaI 4.211.11 ✓- MUM34 XNB-FCXOMCWMPMTM1W1au YSWMlild LHl.l9 1.531.15 MUM: DX CCOMMUXT'PIMUWMPM(nHNtall9lPN IMM R3803 MIOURGIVA HWMHVMAHfiVCALTH"RMINUMIII l3DMl / 1,565.03 - 3.585.03 MU1034 WIAEOUTGNTFIMF<LT14AEfENIFAs 111 IW.010.16 3/ENOI{ D,,dW LlaO.ao - ).l6p.Op MMM4 MNB-ECXO XCCWMPMI]afW141194p]gl36UW OEM MMDU NXB-ASSOKKCWMPAIt1APW311634�OCI - 13LSO 21.11 - 331.50 50 MUM]a N0V11K101MONNC<WMPML6)P35NENWW 160566.>O I60,566)0 MO/01a 813.93 WOWUAitedXWAhfORCCUIMPMITMIL124IN 151B. 1,5>S.LV NUAYNAINS (OMIXWMPMTa313]1I5 B3Ob]590E 1.]9].W 2,290 pp Vl%= 3/iMM HNB- ECHO HCCWMPMT]{CWMllM ]O,W.91 - ]O,BBR91 U1M0A MHB KGOHCf 233M %,Hlot 15,3n3.9) 3/1MOE{VN[COMMVNT'PLM[IWMIMIHW1MLL91tlM PLHCCM6WNIlaaMIL91 W 3/IMON (131A] - 6,13].K 1 HUNNUMCHUMBLMCCWMPM(HYLMll9tWW 3/IMDN XUAUX.f CIM01fONUUIMPM3a363510)a]DX011 � Z 7,465A0 1SEMA6lJ u{st0.os 3E6 s1o05 �• / MMC m Tnn�Igr4V3 / MP3ION OIPpIComPI OIIP(COmpl OIPP/CLm 3 OIp1/Comp66Ypu yPPTI XNPORTION MIMM Olen 131 3,u612 ✓ 1I M9N60UNONUIIUMNf PMMRIXbSCN316B41 4REl.W 4,221,00 V2M024I DEVOHOMMN PMCCWMPW UW W MICHU 0 6.El 683200 a/lI/20N D3V0]EOXWID IKCWMPMt 21% omill LR601.W - 1I.61,100 3/22,201{ VMC1OMMU..ILHCMIMPMOaWMIIIU*00 L3%]2 II%]I AIW ]6.93L35 10.93Li5 WIREOYTGNRY Mf41XC4R[CLMf KIII Million.11MEWOWMNNCfWCHNICE TIES E, 19y]N.53 MUNIN MUNIa ODOINVOG 21 }},101 UMo4 no all.. p}" V1UMMNMMi{b.1GOfCUIMPMT2 ul1NIGIM 316.51 329.0o 33//ElMU1MOEta4 R[ODNXFA0.I1TNNPPNMCCMfWIMMPPMMT3 i1PV}E619B6H s,.,l0Bs...W l]V0E{OWROXMPMMIMi 339n1E - S.M401) oW10 lW 2•SW22 /3M{ Man, nAWO0 4,4W.Po MOSa N0RKSONXX<WMOMfi]6R342=IW ]RIW.H - E5I,I60.22 4,650....0 in3a MUMUpBM<WMIM43%U96atl lo M,838CD IOCINEa MN WI3%ll !}..0to - {4..,350p9 321L 3/NNBFEC0NNOGMClC1XPIMMICAfOWNM6PWMHT 326.57 336.57 Ummu UMCOMMUMCCWMPM7WUl29lW OW XKM NUMdialNIXUIMpMI I79YH1WR bWHAI 162 6,p6136 iI VM2M p:WW1 XfVy- 3/IUU]OE{-ECMO X<WMN1WU6 .21 6 [Uf63R /WN4 ON. MEBONFMTM PXCOUWPUT1UNdU)z 9 10A11W 19024 0411 Po !/IMDN YfMMll /IBMoRECOMMUXVPLMIXUIMPMT]abWi11111Mro 0 0.1i50 143.0 ----- B,U3d2MINIMIZE 910.0 M.851.65 k40�0.# - am uu ps3+*�3Y` o w a.-.•.-:4rCl=li Il1011lllt / TJn_Lle"I" ORTIOH MMCp ypP/Compl QIPp/Cpmp3 OIP ,ap3 QIPPIONEPCiYPIe OIPPTI RHMUMN EQI Uxi 212 3,sY.s]✓ 3n3/lON UK COMMUNE, It KKCWMPM] NW}Hll91RW / LIW.R 3nM014 NuouTGXTEM HEMMGRE CENU E 45.11100/ 'Ill ggNl 1)a6W , S,M.W Militia.N1VIIKSIXYIgN XIXUIMIMt6>56{9 a10]W150 ]},H6.94 72,946.0 U19/N3fM/,XIO[MIpNUI]2BMMf IMMOD�IOCOla2Hai - 3016W All EUN1{UXCWMMUNINPLMCCWMIMT )46WN119IWp }y}} 3.0N50 NWME4 UMCWMMVHRe PIN[CUIMPMI]aKO341IMCOOD 12.yA 221.22 // / 9B 9457.5, n0 OLDN.561 ll,01336 . _• Tpn,f.,DUL Tnnelenln MMCPO0.TION QIPP/Odmpl QIPP/famp2 ylI/fumPf ypp/fumpLLYpY gIPPTI NH PORTION 3AM024 Chi* U% 13H.H 3/IVIDN UMCWMMUUWPLNCMIMPMI14mmll91WW all LUUJI - m LIN{ NOVRKSOWTIOXXfCWMPM(62631041W%IW- - 1.154.31 MUM WIR INUTIONRi HEALMGBECFNTEE1111 3f2MW4 OI RUm MIJMN NpVRK 50W11oN N[fUIMPMT6)61W 4CW]IW - 3>.Oil. 1II4W U2U2034 HVMAM91Xf COMCCWMpMT{NN3W43LW15101 VIEW - 37.123.19 VIUM24 HUMNRIXSCOKCWMPWIIIM3"..IIW 401503 - 1.)65.00 NZUW24 NUMAMCHAORBMCCIM41)%O4I13 4B4O45.W �- MNB-ECHOHCCWMPM])96"Cooll 1,11985 3.)SO.WWOM24 W3661. U1W10NMINCOMCUMPM43)IHU0 379.85 MO/lON MYMAMCMOVB MCILVMPMTU]6W54t00WU , },NSW - 2,,761 U29n0N MVMWAIMffO MCMIMPMTU6E0Ma C3W0]5)W 4%5 pl I,65,W 3/19/2024 XUM6NACM40QbHIXUIMPMl4l]USW 4]WWN !,6)QW 311IM24 HNB-CMOMIXWMPM)76 Ul144W IWU6 InUs, },165.0 670.0 211911024 UNRCOM94THOME XCMIMPM2NWl)alll}a3III IW.W 5.402.59 3/IUMN VMCWMMUNI39PLMCCWMPMT)a6WN1191WW U4% - 180.00 311WW24 VMCfOMMUNRTPIMCMIMPWI1 H1191M 11.0 .00 II695 3/IMOU HVMANACMAOISBMCCUUNOW4363701541000011 41 1240 - n,975.00 85,731.41 212,413.61 JzueW / „ .axnw.nms...n.�nmmw romweL .N7.M nawx m.. oe.,ua.es.u:as:a:< " smAu wsam.s3 vws.wLsa Lw9 w1.l0 c e,aneee even mew Account Name '4357 MEMORIAL MEDICAL CENTER• $2,261,768.33 $2.360,071.20 $2.261,768.33 $1,959,112.66 OPERA71NO '4305 MEMORIAL MEDICAL CENTER- $542.50 $542.50 $542.50 $542.50 CLINIC SERIES 2014 '4373 MEMORIAL MEDICAL CENTER• PRIVATE WAIVER $g36.73 $436.73 $436.73 $436.73 CLEARING '4381 MEMORIAL / MEDICALCENTER/ „ $88,335.27 $124,071.85 $88,335.27 $121,387.84 NH ASHFORD '4403 MEMORIAL _------------- MEDICALCENTERI $2251036.80 $277,064.46 S225,036.80 $222,903.91 NHBROADMOOR J '4411 MEMORIAL MEDICAL CENTER / $410.376.45 ,./ $449,561.26 5410,376.45 $359,485.60 NH CRESCENT '4438 MEMORIAL MEDICAL CENTERI✓ / SOLERAATWEST $213.062.35 J $230,766.30 5213,062.35 $91,690.29 HOUSTON '4446 MEMORIAL MEDICAL ✓ $81,315.28 / $90.411.64 $81.315.28 $82.097.03 NH NHFOR FORT REND V '4454 MEMORIAL MEDICINH GOLDS CREEK CREEK $158,616.79 $158.616.79 $158,616.79 S178,934.70 HEALTHCARE HEALTH '5433 MMC -NH GULF POINTE PLAZA • $100.00 $100.00 $100.00 $100.00 PRIVATE PAY '6441 MMC -NH GULF POINTE PLAZA• $65.493.18 $73.908.04 $65.493.18 $57.908.80 MEDICAREIMEOICAID '5506 MMC -NH BETHANY SENIOR $222.403.82 $222.403.82 $222,403.82 $159.058.30 LIVING '3407 Y MMC • VILLAGE TUSC $92,906.50 $252,827.54 $92.906.50 S158,253.57 '3660 MMC-BETHANY SR LIVING -DACA $100.00 $100.00 $100.00 $100.00 MIND MARKE MAR MIND- D $608,191.31 $608.191.31 $608.191.31 $608,191.31 Total Balance $4,428,685.31 $4,849,073.34 $4,428,685.31 $4,000,203.24 ReP049ennmo4 enn2ga62406:54,56 W CDT Page 2 of Memorial Medical Center Nursing Home UPL Weekly NeRion Transfer Prosperity Accounts 3/25/2024 ➢ evl➢m 11a➢unt BaQlnnlnQ 54,928.09 ✓ 54,3)).39 -1 N➢ce: Ony Febncas of over 55,00p will ba tmnr(emd tP the nunln➢home. Nate S: EotF o[munr Fnia bntt F4bn[e a/$1 W t6atMMCdePeflfed tP oPm a[<eunt. APPROVED ON MAR 2 5 2024 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS TodaYS Beginning sonount to Be Tranda,td to Nursing 158,616.)9 Banb Balen[e I58,filfi.)9 Vetlenca leave In Balance 100.00 lanmryln[arctt 246.88 Februar, Interest 203.82 ✓✓✓/ Adjust Balance/rranirer Mnt 358AB608 .JA rAppreved, NNOREW OE l05SANTOfi 3/1$/2024 I\NH W,,W,T riftol HH UPUnmlerEummsry\2@aWH UPI Tr -der Sommer, 3.25.24 MMCFORTIO, D , Oil a0p/CompR 3 T,,KW4Y a9p/am91 QIPPIcam 1 ap9/Lom93 BY95N OIp9TI XH 90RTION WEIMER Chek= MIlT.9l USUME6 WIRE OIII NERION HMITX!/p/R COW EN CRIER HC 39.051,4$ ME= Oepp WE'RE 99,636,6E IRI/SOI9 00WENCREEBNLMTMERCOLp lEE0l569lIXjW 9pyp1 400.00 3Rl/MIS NOWASOIONONXCCWMpMT67609IeMllISO "MR., 49,66889 EEMIA Sp95.W , 3.W5.00 RAWCRCODUVISM555Bi691I91 MOM? i5Y5pMHS61R5i CRCDDIp HHMSJJM69II9I Hl.3l Sq.33 9110/M39 3/101E016 NNB-E[NOXCCIAIM9Mf l96W391193fmR R,156S0 o,3H.30 176 Ul9/MER XNB ffHOMCfWMpMC1RKOlMi4COT10106 263.15 38B.I5 Ul9/MI4 OOMSNC IEMIS6CCCVI 555 HR.M 9b.W IHCClATPW lSLp UI8/M34 MTW.NOIXCCNMpMf ISBM359NSI0.'99I6g51 / I.NOAO / E.)00.00 59AD.39 68.066.03 . iSB.Ofifi 09 / eelellGes Vvelvluw Account Name '4337 MEMORIAL MEDICAL CENTER• $2,261,768.33 $2.360.071.20 $2,261,768.33 57,959,112.66 OPERATING '4365 MEMORIAL MEDICAL CENTER- $542.50 $542.50 $542.50 $542.50 CLINIC SERIES 2014 '4373 MEMORIAL MEDICAL CENTER• PRIVATE WAIVER $436.73 $436.73 $436.73 $436.73 CLEARING i '4381 MEMORIAL MEDICAL CENTER I $88,335.27 5724,071.85 $88.335.27 S121,387.84 NH ASHFORD '4403 MEMORIAL MEDICAL CENTER I $225,036.80 $277.084.46 $225,036.80 $222,903.91 NHBROADMOOR 'Nit MEMORIAL MEDICALCENTERI $410,376.45 $449,561.26 $410.376,45 $359,485.60 NH CR93CENT Y438 MEMORIAL MEDICALCENTERI SOLERAAT WEST $213.062.35 $230.766.30 $213.062.35 $91,690.29 HOUSTON '4446 MEMORIAL MEDICALCENTERI $81,315.28 $90,411.54 $81,315.28 582,097.03 NN FORT BEND / MEDICLINHMEMORIAL V/ GOLDEN CREEK GOLDEN C EN $158.616.79 $168,616.79 $158.616.79 5178,934.70 HEALTHCARE R '5433 MMC -NH GULF POINTS PLAZA• $100.00 $100.00 5100.00 $100.00 PRIVATE PAY '5441 MMC -NH GULF POINTEPLAZA- $65,493.18 $73,908.04 $65.493.18 $57.908.80 MEDICAREIMEDICAID '5506 MMC -NH BETHANY SENIOR $222,403.82 5222,403.82 $222,403.82 $159,058.30 LIVING '3407 MMC TUSCANYVVILLAIL BE $92.906.50 5252,827.54 $92.906.50 S158,253.57 -BETHANY BDACA ETH $100.00 5100.00 $100.00 $100.00 SR LIVING SR LIVING • '2998M FUNOMC-MONEY MARKE $608,191.31 $BD8,191.31 $608.191.31 $608.191.31 Total Balance $4,428.686.31 $4,849,073.34 $4,428,685.31 $4,000,203.24 RePon aen faw4a 025¢o2+ uesaw aM COT Rate 2o12 Memorial Medical Center Nursing Home UPI. Weekly HMG Transfer Prosperity Accounts 3/25/202C 9rMeu1 gmeunl ro Be armum BWMIN / P<Mlnf Tnn96mdn y"Ps /n.a..,m o.wuu r.e.r.ef..nr,n eto/� x.n l.xunr stunner 3% wntwl.n(e 1W. vnwa lfrveln wlmn Ifi000 AEIun NOnttrtnmingmi 9ndem AmaunOlto Ruaunt 0<U / 9eMlry inmlemdlo NUMn M(me Numher wm1 le Ynml(rOW �lnnx(I`IO Cl(Oen(! Orooxb Todfir0erinn n9Nmn Muni,513.M / G81fD�f� .a �L6 rl II.Il1.0$ ILOII.Ol 63.393.16 - 69.41.3 $9,513.1e wnk wNe(f <93.1e .VY/ Vuxn[f .-., InI—rm.,GullP..1e11— Non:On/y Nfvn[nd/M(/SirWWNSOfStan MMto Nedra;nWW e. NMrl: COO ammtAm e0vrt Wbnce of 3lNmatMMCdeGdui<d (depm onawt APPROVED ON MAR t" BY COUNTY AUDITOK CALHOUN COUNTY, TEY,^,, leneN NNntt iW.W I tltlm OrymenlTnml<,LOB,udm%, 6.lNAe� 4djutl Nlmn/lnmlrrAnl 53,313.0 ✓ TOTALTRANirER3 yL3paa. 8e9wnd: L.,A� I(i: r—? �� •... Of LO3RRM03 I/13/1011 I:W..1`I nxen\NN UI Tnn11r15umm.rrW:NiN.1 rnnxp Summery, l9N MMC PORTION QIPP/ComP QIPP/ComP4 TrenAer•Out far - In QIPP/Campt 2 43PP/Comp3 &lapse QIPPTI NHPORTION 3/21/2024 WIRE OUT HMGfl Spat SNF LP Commetlul 18.61832v� - - w"i 3/22/2014 MERCHANTRANRCOOEPOSIT4967BS18889916 J. 3/2L2024 WMMEPO0El CHCCWMPMT3S0M3131021000 3/I212024 NORIDIANMEICClAIMPW63589242 017=96 3/21/2024 WIREOUTNMG R4bport SNF, U+. Commerlul 3/21/2024 Dopmit 3/21/2024 NORIOIANI3ANCCWMPM767589242W001503055 3/20/2024 MERCHANTMNRCO DEPOHT4968285188899100001 3/18/2024 NORIDIAN33ANCCWMPMT6258924200001256723 MMCPORTION QIPP/Cemp QIPP/CamP4 TrenSfer-Out T.00r.l" QIPP/COmpl 3 QIPP/CamP3 R,up50 QIPPTI NHPORTION 1.927.9s - 1,927.95 1,836.0 - 1,036.W 3,820A3 - 3.020.43 11,027.02, 2,961.62 - 2,961.62 46,365.76 - 46,365.76 925W 925100 7,116.42 / - T,556.42 // / ].02 11.0265.393.18 , 65.393.18✓ 29.645.39 65393.28 65,393.18 oelanLtle uvervlew Account Name '4357 MEMORIAL MEDICAL CENTER- $2.261,768.33 52,360,071.20 $2.261,168.33 51,959,112.66 OPERATING '4365 MEMORIAL MEDICAL CENTER- $542.50 $542.50 $542.50 $542.50 CLINIC SERIES 2014 '4373 MEMORIAL MEDICAL CENTER- $436.73 $436.73 $436.73 $436.73 PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICAL CENTER/ $88,335.27 $124,071.85 588,335.27 $121,387.84 NH ASHFORD 'NO3 MEMORIAL MEDICAL CENTER I $225,036.80 $277,064.46 $225,036.80 $222,903.91 NHBROAOMOOR '"It MEMORIAL MEDICAL CENTER $410,376.45 $449.561.26 $410,376.45 $369,485.60 NH CRESCENT ' 4 SMEMORIAL MEDICAL CENTER I 5213,062.35 5230,766.30 $213,062.36 591.690.29 SOLERA AT WEST HOUSTON '4446 MEMORIAL MEDICAL CENTER 581.315.28 590,411.54 $81,315.28 $82,097.03 NN FORT BEND '4454MEMORUIL MEDICAL I NH 5158,616.79 $158,616.79 $158,616.79 $178,934.70 GOLDEN CREEK HEALTHCARE 'S433MMC-NHGULF POINTE PLAZA- .i� $100.00 $100.00 $100.00 $100.00 PRIVATE PAY '6441 MMC -NH GULF POINTE PLAZA- $65,493.18 $73,908.04 $65.493.18 557,908.80 MEDICARE/MEDICAID '5506 MMC -NH BETHANY SENIOR $222.403.82 5222,403.82 $222,403.82 5159,058.30 LIVING '3407 -NH 592.906.50 5252,827.54 592,906.50 5158,253.57 TUSCMMC Y VILLAGEE '3660 MMC -BETHANY $100.00 $100.00 $I90.00 $100.00 SR LIVING -DACA '2998 MMC-MONEY $608,191.31 S60B,191.31 $608.191.31 $608,191.31 MARKETFUND Total Balance $4,428,685.31 $4,849,073.34 $4,42a,685.31 $4.000,203.24 Reyon 0ene(MC4 on OW251202408:W;N AM Car Papa 20l2 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity Accounts 3/2S/2024 Hwlw, Amunr BHInnN{ Nef<:OrvY B.W. olem.amas". sr.) ,Ilbrllenuninp Aome. Neh 2-fa omum has ,a,nBWmee D)9GbraatMMC CepwrtMmepen a:munt. APPROVED ON MAR ? r ssr'f8 By COUNTY AUDITOR CALHOUN COUNTY, TEXAS peMlnO .lmeunt„B, pr,nne,rmm eanB Baunu pLsossO va.ena E,are ABJ,nee 100.00 / Mlm[BalawRranrler0ml 9l OFEO J hap-d DE OEEPmOE 3/SS/S03< 3/22/2024 Check 1150 3/22/2024 HNB- ECHO HCCIAIMPMT 74600341144000(1 3/21/1D24 WIRE OUTVILLAGE POST ACUTE HEALTH SERVICE 3/22/2024 Deposit 3/21/2024 HNB- ECHO HCCIAIMPMT 746003411440000269160 3/21/2024 HNB- ECHO HCCLAIMPMT 7460034114400002691W 3/21/2024 HNB-ENO HCCIUQMPMT 74600341144000269531 3/21/2024 NOVITAS SOLUTION HCCUUMPMT 676201420OW150 3/20/2024 HNB-ECHO HCCIAIMPMT 74W0341144000D236630 96 MMCPORTION QIPP/Comp QIPP/Comp QIPP/Comp Transfer -Out ,/Transfer 1 QIPP/Comp2 3 491cipse QIPPTI NH PORTION 5,594.83 SSA - :3.410.50- I 247.74 247.74 - 947.84 - 947.84 - 10,150.90 - 10,150.90 - 39.596.04 - 39,596.04 - 4.267.07 4,267.07 - 10,436.38 10,436.38 - 27.160.53 - 27,160.53 Account Name '4357 MEMORIAL MEDICAL CENTER • $2,261,768.33 $2,360,071.20 $2,261.768.33 $1,959,112.66 OPERATING '4365 MEMORIAL MEDICALCENTER- $542.50 $542.50 $542.50 $542.50 CLINIC SERIES 2014 '4373 MEMORIAL MEDICAL CENTER • PRIVATE WAIVER $436.73 $436.73 $436.73 $436.73 CLEARING '4381 MEMORIAL MEDICAL CENTER $88,335.27 $124,071.85 $88,335.27 $121,387.84 NH ASHFORD '4403 MEMORIAL MEDICALCENTER/ S225,036.80 $277,064.46 $225,036.80 $222.903.91 NH SROADMOOR '4411 MEMORIAL MEDICAL CENTER $410,376.45 $449,561.26 $410.376.45 $359.485.6D NH CRESCENT '4438 MEMORIAL MEDICAL CENTER SOLERAAT WEST $213,062.35 $230,766.30 . $213.062.35 $91,690.29 HOUSTON '4446 MEMORIAL MEDICALCENTER/ $81.316.28 $90,411.54 S81,315.28 $82.097.03 NX FORT SEND '4454 MEMORIAL MEDICAL OLDS CREEK GOLDEN S158,616.79 $168,616.79 $158,616.79 S178,934,70 HEALTH RHEALTHCARE '5433 MMC -NH GULF POINTE PLAZA- $100.00 $100.00 $100.00 $100.00 PRIVATE PAY 'S4.11 MMC -NH GULF POINTE PLAZA- $65.493.18 $73,90B.04 $65,493.18 $57,908.80 MEDICARE/MEDICAID '5506 MMC -NH BETHANY SENIOR $222.403.82 S222,403.82 $222,403.82 S159,056.30 LIVING { — '3407 MMC Y VILLAGE V TUSCA YVILLAGE / $92,906.50 $252,827.54 S92,906.50 $15%253.57 '3660 MMC -SETHANY BETH $100.00 $100.00 $100.OD $100.00 'RUINING SR LIVING • DACA '2998M FUND MARKETFUND-MONEY $608,191.31 $608,191.31 S608.191.31 $608,191.31 Total Balance $4.428,685.31 $4,849,073.34 $4.428,685.31 $4,000,203.24 Report generated on 03'2 / 024 0513,50 AM COT Pape 2 of 2 Memorial Medical Center Nursing Home UPL Weekly HSLTrans(er Prosperity Accounts 3/25/2024 Naedan[ a[nwx v[tlMlm MUNM Nome / Numh[ Gbn[e IY3,3a1A9 Nomonrynommno/ore[SSAm nzme wnp[nearouenwnnvBm•r. Nate l: FONa[[amtNNOGon Glon[e aJ$1WMo[MMC aeppLteala Poma[[wmt. APPROVED ON MAR 2 5 2024 BY COUNTY AUDITOR CALHOUN COUNTY, TEXAS ve[anB Mnalore ..memlb8elnnJemate !oL 'aBe tool Babnn NUNn Name / S}}AB3.e} 223,T43.01 ✓ BankWma 3!},Cp3.Bi NNantt 4avein BaOn[e IW.W nnuarylMentl leWu[ry1MenJ )60.0]✓ IaI.N 4aim1hume(lnn�J1[rPmt 331.)<)Al 'J✓✓✓ Bavnne: ��.Dil4 61 fib t �C (\� �. ..umF Bauas.ma) sizur.N z:3xewaklrmmmaWn vvunmrm wmm[nvoawuurunmrnwmmanusu 3R3/SOS1 GecY 1019 UZU=4 NW11As NONMC)6aS1At HtA'THKUMANSVCKCCWMPWINWMIMIII Nzv.. MOVtORTGGNKLW UM. onrilWVW2 ENNVMANVCNCCWMPMiVA01<113016] MOM: P lUMID:w UlUMEI MMCPORiION 7O0BL.4W nn)lervin NPP/Camel OIPP/Ca P2 OIPPJQmP3 OIPP/M.PIAW.. OIPPM NNPOWION OAR.. 16,11La9 5,11.49 �>LIIL a 41 P6dl),lE 65.19tW 69,192g9 La)9A1 . 2.167 2161.9) },16).9393 S)d9). 9,693.ID 13])).M � 13,3LL6i 10.1.3ii.6! 3}1,3<LOl Y}L3<LO1./ Q.,d(1W5 Vverv.ww Account Name '4357 MEMORIAL MEDICALCENTER- $2.261,768.33 S2,360,071.20 $2,261,768.33 $1,959.112.66 OPERATING '4355 MEMORIAL MEDICAL CENTER • S542.50 $542.50 $542.50 $542.50 CLINIC SERIES 2014 '4373 MEMORIAL MEDICAL CENTER • $436.73 $436.73 $436.73 $436.73 PRIVATE WAIVER CLEARING '4381 MEMORIAL MEDICALCENTER/ $88.335.27 $124,071.85 $88,335.27 $121,387.84 NH ASHFORD 'M03 MEMORIAL MEDICAL CENTER / $225,036.80 $277.064.46 $225.036.80 $222,903.91 NHBROAOMOOR '"It MEMORIAL MEDICALCENTERI $410,376.45 $449,661.26 $410,376.45 $359,465.60 NH CRESCENT '4436 MEMORIAL MEDICALCENTER/ $213.062.35 $230,766.30 $213,062.35 S91,690.29 SOLERA AT W EST HOUSTON '4446 MEMORIAL MEDICAL CENTER / $81,315.28 S90,411.54 $81,315.28 S82,097.03 NHPORTSEND '44S4 MEMORIAL MEDICALINH $158,616.79 $158,616.79 $158,616.79 $178.934,70 GOLDEN CREEK HEALTHCARE '6433 MMC -NH GULF POINTE PLAZA- $100.00 $100.00 $100.00 $100.00 PRIVATE PAY '5441 MMC -NH GULF POINTE PLAZA- $65,493.18 $73,908.04 $65.493.18 $57,908.80 MEDICAREIMEDICAID -5506 MMC •NH BETHANY SENIOR ! $222,403.82,' / $222,403.82 $222.403.82 S159,058.30 LIVING - VVV $92,906.50 $252.827.54 $92,906.60 $158,253.57 TUSCA YVILL TUSCANV VILLAGE '3660 MMC -SETHANY $100.00 $100.00 $100.00 $100.00 SR LIVING - DACA '2098 MMC-MONEY S608,191.31 $608,191.31 $608,191.31 $608,191.31 MARKETFUND Total Balance $4.428,686.31 $4,849.073.34 $4,428,685.31 $4,000.203.24 Repa44enmale4 an 0325202408:58.50 PM CDT P8602.12 MEMORIAL MEDICAL CENTER CHECK REQUEST- gu�F Poit��� P /Broadmoor Date Requested: 3/25/2024 A Y E APPROVED FOR ACCT USE ONLY E ON ElImprest Cash h6pp) (t MAR 7 [ 292 1 ❑ A/P Check El Mail Check to vendor OY COUNTY AUDI OR CALHOUN COUNTY, rExA,, ❑ Return Check to Dept AMOUNT: $ 6,880.00 ✓ G/L NUMBER: 21700007 EXPLANATION: Claim payment transfer from Gulf Pointe to Broadmoor REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: c0 0 O nO 0 0 jC 3 m °> a 3 3 ti m� yK K K h � y{- yyry z z m m A G u C N C r y N 0 U W J N n ti g r a F cnif H O ti o n u J P P P u P P A O O O N O W N N N O N N p G. rtr 6 w 2 xx m C� Z tr- O yym O� � " A P � O W W w O R "'I •OP ( J A = W + N J S zo zn y IJ m O® O O A z w y A w y N p z N Z O r O r d u 00 j W C70 w ZN a'y aw cm ;�, ty*f UN r_ l7 P D IJ orE ZW pn pn p y ? 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