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2024-06-05 Final PacketNOTICE OF MEETING-6/05/1.024 June 5, 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. County Judge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at loam 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 7 ' NOTICE OF MFF.TING — 6/05/2024 5. Approve May 22, 2024 and May 29, 2024 Commissioners' Court Regular Meeting Minutes. (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. Approve May 20, 2024 Commissioners' Court Special Workshop Meeting Minutes. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Approve May 20, 2024 Commissioners' Court Executive Session Meeting Minutes. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 8. Hear MMC Report. (RHM) Erin Clevenger gave the report for MMC 9. Consider and take necessary action to authorize Commissioner Reese to utilize $7,262 in GOMESA funds to cover additional material costs for the Boggy Bayou Nature Park, Phase II, GILD CMP Cycle 26 Grant No. 24-089-000-E345. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to approve the Infrastructure Development Plat (IDP) for Simple Stay, LLC and if approved, authorize the County Judge and Commissioner Behrens to sign the IDP. (JMB) pass Page 2 of 7 NOTICE OF MEETING — 6/05/2024 11. Consider and take necessary action to authorize Kelley Ashley, Children Librarian to accept the Lewis R & Juaniece Madden Foundation Grant in the amount of $25, 000. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 12. Consider and take necessary action to approve the Preliminary Plat of the Luna Subdivision, (Replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision according to the plat recorded in Volume Z, Page 385 of the Calhoun County Plat Records) Ysidro Benavides Survey, Abstract No. 38 of Calhoun County, Texas. (VLL) pass 13. Consider and take necessary action for Tyrone Harris to be issued a county credit card with a $5,000.00 Monthly limit. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action to authorize Dina Sanchez, Calhoun County Library Director to sign the service agreement with Xerox. (RHM) APF Gar) )ER: Joel liiMr iarwva� sioner'Pct 4 issioner Pct 3 issioner Hall, Ly 15. Consider and take necessary action to cancel the June 26, 2024 Regular Commissioners Court Meeting to allow the Judge and Commissioners to attend the South Texas County Judges and Commissioners Association Conference in South Padre Island and the October 23, 2024 Regular Commissioners Court meeting to allow the Judge and Commissioners to attend the 102nd Annual County Judges and Commissioners Association of Texas Conference in San Marcos. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 7 NOTICE OF MEETING- 6/05/2024 16. Public hearing on Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. (GDR) Closed regular session at 10:10 Henry Danysh explained Petition to Vacate. Opened regular session at 10:11 17. Consider and take necessary action on Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 18. Consider and take necessary action on road closure of the south portion of Haterius Park and designate the North portion as a one-way street between the hours of 2:00 pm- 12:00 am on June 30, 2024 during the Firework Display provided by Bayside Community Church. (JMB) RESULT: APPROVED[UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pitt 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 19. Consider and take necessary action to approve the preliminary plat of Bayshore Ranchettes. (JMB) Terry Ruddick explained the preliminary plat. RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 20. Consider and take necessary action to accept the Agreement for Professional Services with Urban Engineering for Engineering Services in the amount of $35,000 for Calhoun County Bill Sanders Memorial Park Pavilion and authorize Commissioner Reese to sign all documentation. (GDR) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 4 of 7 NOTICE OF MEETING—6/05/2024 21. Consider and take necessary action on allowing Fema to use the Calhoun County Library as a Disaster Recovery Center for the weather event on May 13th, 2024 and authorize the County Judge to sign. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: = David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 22. Discuss and take necessary action to open credit accounts with United Vision Logistics. (VLL) pass 23. Public hearing on Petition to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records. (VLL) pass 24. Consider and take necessary action to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records. (VLL) pass 25. Consider and take necessary action to approve the preliminary Plat of Luna Subdivision (a replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision). (VLL) pass 26. Consider and approve amending the G&W Engineers, Inc. contract amount for engineer services, regarding the GLO CDBG-MIT Contract No. 22-085-014-D245, from $1,358,844.75 to $1,358,844.00. (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 7 ' N0110E 01= MEETING- 6/05/2024 27. Consider and take necessary action to award qualified bidder on Bid No. 2024.05 - Seadrift Drainage Improvements Project - GLO Contract No. 22-085-014-D245 for Calhoun County, Texas. (GDR) Zachary Roach with G&W explained and recommended the court' award the bid to Lester Contracting. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 28. Consider and take necessary action to award qualified bidder on Bid Number 2024.07 - Magnolia Beach - Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas. (DEH) Court awarded to the lowest bidder, Staff Concrete Constructionand GOMESA funds will be used for construction. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall; Lyssy, Behrens, Reese 29. Consider and take necessary action to approve of the Infrastructure Development Plat (IDP) of Jery Edgett Commercial RV Development and if approved, authorize the County Judge and Commissioner Hall to sign the IDP. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 30. 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 6 of 7 ' NOTICE OF MEETING- 6/05j2024 31. Approval of bills and payroll. (RHM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: ' David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 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 10:28am Page 7 of 7 PACKET COMPLETION SHEET All Agenda Items Properly Numbered x vl' Contracts Completed and Signed All 1295's Flagged for Acceptance (number of 1295's All Documents for Clerk Signature Flagged (All documents needing to be attested to need to be signed day of Commissioner's Court.) On this S-I-h day of 2024, the packet for the h_ day of �l l t t1�- 2024 Commissioners' Court Regular Session was su mitted from the Calhoun County Judge's office to the Calhoun County Clerk's Office. f Calhoun County Judge/Assis nt AGEND NOTICE OF MEETING-6/05/2024 NOTICE OF ]Rich2rd H. Meyer County judge David 1-Iall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 MEETING The Commissioners' Coin r f Calhoun County, Texas will meet on Wednesday, June 5, 2024 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at x 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: AT t3- 93FILED O'CLOCK '- i M 1. Call meeting to order. 2. Invocation. MAY 31 2024 3. Pledges of Allegiance. ccuNrt,I c W988�_NyoNy/pTY;�rei�ijas 4. General Discussion of Public Matters and Public Participation. S. Approve May 22, 2024 and May 29, 2024 Commissioners' Court Regular Meeting Minutes. (RHM) 6. Approve May 20, 2024 Commissioners' Court Special Workshop Meeting Minutes. (RHM) 7. Approve May 20, 2024 Commissioners' Court Executive Session Meeting Minutes. (RHM) 8. Hear MMC Report. (RHM) 9. in GOMESA funds to cover additional material costs for the Consider and take necessary action to authorize Commissioner Reese to utilize $7,262 Phase II, GLO CMP Cycle 26 Grant No. 24-089-000-E345. (GDR)Boggy Bayou Nature Park, 10. Consider and take necessary action to approve the Infrastructure Development Plat (IDP) for Simple Stay, LLC and if approved, authorize the County Judge and Commissioner Behrens to sign the IDP. (JMB) Page 1 of 3 I NOl ICE OF MEETING — 6/05/20Z4 11. Consider and take necessary action to authorize Kelley Ashley, Children Librarian to accept the Lewis R & Juaniece Madden Foundation Grant in the amount of $25, 000. (RHM) 12. Consider and take necessary action to approve the Preliminary Plat of the Luna Subdivision, (Replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision according to the plat recorded in Volume Z, Page 385 of the Calhoun County Plat Records) Ysidro Benavides Survey, Abstract No. 38 of Calhoun County, Texas. (VLL) 13. Consider and take necessary action for Tyrone Harris to be issued a county credit card with a $5,000.00 Monthly limit. (RHM) 14. Consider and take necessary action to authorize Dina Sanchez, Calhoun County Library Director to sign the service agreement with Xerox. (RHM) 15. Consider and take necessary action to cancel the June 26, 2024 Regular Commissioners Court Meeting to allow the Judge and Commissioners to attend the South Texas County Judges and Commissioners Association Conference in South Padre Island and the October 23, 2024 Regular Commissioners Court meeting to allow the Judge and Commissioners to attend the 102"d Annual County Judges and Commissioners Association of Texas Conference in San Marcos. (RHM) 16. Public hearing on Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. (GDR) 17. Consider and take necessary action on Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. (GDR) 18. Consider and take necessary action on road closure of the south portion of Haterius Park and designate the North portion as a one-way street between the hours of 2:00 pm- 12:00 am on June 30, 2024 during the Firework Display provided by Bayside Community Church. (JMB) 19. Consider and take necessary action to approve the preliminary plat of Bayshore Ranchettes. (JMB) 20. Consider and take necessary action to accept the Agreement for Professional Services with Urban Engineering for Engineering Services in the amount of $35,000 for Calhoun County Bill Sanders Memorial Park Pavilion and authorize Commissioner Reese to sign all documentation. (GDR) 21. Consider and take necessary action on allowing Fema to use the Calhoun County Library as a Disaster Recovery Center for the weather event on May 13th, 2024 and authorize the County Judge to sign. (RHM) 22. Discuss and take necessary action to open credit accounts with United Vision Logistics. (VLL) Page 2 of 3 NOTICE OF MEETING — 6/05/2024 23. Public hearing on Petition to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records. (VLL) 24. Consider and take necessary action to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records. (VLL) 25. Consider and take necessary action to approve the preliminary Plat of Luna Subdivision (a replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision). (VLL) 26. Consider and approve amending the G&W Engineers, Inc. contract amount for engineer services, regarding the GLO CDBG-MIT Contract No. 22-085-014-D245, from $1,358,844.75 to $1,358,844.00. (RHM) 27. Consider and take necessary action to award qualified bidder on Bid No. 2024.05 - Seadrift Drainage Improvements Project - GLO Contract No. 22-085-014-D245 for Calhoun County, Texas. (GDR) 28. Consider and take necessary action to award qualified bidder on Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas. (DEH) 29. Consider and take necessary action to approve of the Infrastructure Development Plat (IDP) of Jery Edgett Commercial RV Development and if approved, authorize the County Judge and Commissioner Hall to sign the IDP. 30. Consider and take necessary action on any necessary budget adjustments. (RHM) 31. Approval of bills and payroll. (RHM) i Richard H. Meyer, County Judo Calhoun County, Texas A copy of this Notice has been placed on the inside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the. general public during regular business hours. 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 ore under "Commissioners' Court Agenda" for any official court postings. Page 3 of 3 # 04 NOTICE Of= MEETING -6/05/ 024 June 5, 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 loam 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 28 # 05 i NOTICE OF MEETING - 6/0512024 5. Approve May 22, 2024 and May 29, 2024 Commissioners' Court Regular Meeting Minutes. (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 28 The Commissioners' Court of Calhoun County, Texas met on Wednesday, May 22, 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. — 4V // - IN -- Ric and Meyer, County J dge Calhoun County, Texas Anna Goodman, County Clerk VA f",,f� Deputy Clerk NOTICE OF MEETING-5/22_/2024 May 22, 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 1Q4 PORT LAVACA, CALHOUN COUNTY, TEXAS. THE FOLLOWING MEMBERS WERE PRESENT: Richard Meyer County Judge David Hall Commissioner Pct 1 Vern Lyssy Commissioner Pct 2 Joel Behrens Commissioner Pct 3 Gary Reese Commissioner Pct 4 (ABSENT) Anna Gpodman By: Kadie Smith County Clerk Deputy Clerk The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting was called to order at 10:00am by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. Judge recognized plaque the County received for their 50 years of Membership with TAC. Page 1 of 6 NOTICE OF MEETING — 5/2.2/2024 5. Accept May 1, 2024 and May 15, 2024 Commissioners' Court Minutes. RESULT. APPROVED:`[UNANIM.OUS] :MOVERR Vern Lyssy; CommiSsioner;Pct 2 SECONDER: Gary Reese; Com ssioner Pct 4 AYESt 7iidge Meyer, Commissioner`Hall, Lyssy, Behrens; Reese, 6. Consider and take necessary action to approve the revised Interlocal agreement with the Texas Department of Public Safety for the Failure to Appear Program and authorize the County Judge to sign. (RHM) RESULT: APPROVED [UNiQNIM0U5] MOVER . VernLyssy, Comher missioPct 2 S CONot David Hall;, Cornmissioner Pct-1 AYES Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Consider and take necessary action on report from Friends of the Port O'Connor Library on the library expansion. (GDR) B. Consider and take necessary action to authorize 5D Steakhouse to sell alcohol/mixed beverages at the Port O'Connor Chamber of Commerce Fireworks Display July 6, 2024 and authorize Judge Meyer to sign TABC letter of authorization. (RHM) RESULT ; APPROVED [UNANIMOU. S] MtSVER -David. Hall Commissioner Pct 1 SECONDSit: Vern.Lyssy, Commissioner Pct 2 AYES; Judge Meyer, Commissioner Hall, Lyssy,: Behrens, Reese., 9. Consider and take necessary action to approve Change Order 1 for the Replacement of North and South Bridges on Brighton Road, Bid Number 20123.07 and authorize all appropriate signatures. (DEH) hESULT.::: APPROVED [UNANIMOUS] MOVER David Hall; Commissioner Pc't 1 SECONDER; ; Joell'Behrens:Commissioner Pct 3 AYES. Judge Meyer, Commissidner Hall, Lyssy, Behrens, Reese Page 2 of 6 NOTICE OF MEETING-5/22/202.4 10. Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of $75.00. (RHM) RESULT APPROVED [UNANIMOUS] . IJIOiII�ft. y Vern. Lyssy, Commissioner Pet 2 S•EEONDER: Joel belrens, Commissioner..Pct 3 A1f,ES: Jud a Meyer, Commissioner Hall, Cys5y, 8 hrens, Reese.;' :. 11. Consider and take necessary action to authorize Kelley Ashley, the Calhoun County Children's Librarian to apply for the Lewis and Juaniece Madden Foundation grant for the Summer Reading Program. (RHM) 12. Consider and take necessary action to approve the March and April donation, surplus/salvage and waste lists. (RHM) RESULT• APPROVED [UNANIMOUS] MOVER Gary Reese, Comn718s1oner Pct 4 S.ECO146ER. -Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner°Hall, L"yssy, Behrens, Reese' 13. Consider and take action to accept donation of real property by Duane E. Miller of 17.8" of Lot Seven (7) and all of Lot Eight (8), Bock One Hundred Forty Two (142), Bayside Beach Unit 2, according to plat of said subdivision recorded in Volume Z, Pag 40, and amended in Volume Z, Page 124, Plat Records of Calhoun County, Texas (DEH) R�sULT• = APPROVED [UNANIMOUS] M,OVOR: David Hall, Commissioner Pct 1 SECONDER. 'nary Reese, Commissioner. Pct 4 AYES; - Judge;Meyer, Commissioner':Hall, Lyssy, Behrens, Reese; 14. Consider and take necessary action on insurance proceeds check from VFIS in the amount of $3,805.00 for damages to an EMS Vehicle on 3/15/24. (RHM) RESULT APPROVED [UNANIMOUS] MOVER• `" Ravid Hall; Commissioner Pct 1 SECONOEFL , V4n Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall;: Lyssy, Behrens, Reese Page 3 of 6 NOTICE OF MEETING-- 5/22/2024 15. Consider and Take Necessary Action on Hiring the Communications Director for the Calhoun County Combined Dispatch Center. (RHM) RESUL APPROVED [UNANIMOUS,] MOVER° p.:.avid Hall; Commissioner Pct. 1 SECOCVpEiI_i Vern Lyssy, Commissioner Pet 2 AYES Judge Meyer, Commissioner: Hall,,Lyssy, Behrens, Reese: " 16. Consider and take necessary action to proclaim the week of May 19 — 25, 2024 Emergency Medical Service Week. (RHM) Dustlit 7erikins recognized ,his team and eXpressed'his 6ratituddla thetburt RESULT APPROVED [UNANIMOUS] MDVEIR David Hell, Cortimmissipner Pct 1 SECONDER' Vern Lyssy, Gommissioner.Pet 2 AYESr - Judge Meyer, Commissioner -;Hall, Lyssy, Behr errs, Reese 17. Consider and take necessary action to accept the check in the amount of $3200.00 from Golden Crescent RAC on behalf of Erwin Silva Palomo, to be used to pay for his AEMT course. (RHM) R6SU4`f' APPROVED [UNANImOUS� I' VER Di. avid:Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYESk -Judge Meyer, Comn7lssipner;Hall, Lyssy, Behrens, Reese` 18. Consider and take necessary action to approve the Preliminary Plat of the Lelta Subdivision, (Replat of Lots 1-3 and 10-12 in Block A of Port O'Connor Townsite according to the plat recorded in Volume 2, Page 001 of the Calhoun County Plat Records) Santiago Gonzales Survey, Abstract No.18 of Calhoun County, Texas. (GDR) Henry Ranysh w�tH: G&W explained the preliminarypiat. =; RESULT, , APPROVED [UNANIMOUS] R+iOVER:: Joel Behrens; Commissioner Pct 3 SEODNDER Gary Reese, Commissioner Pct 4 AYES. Judoe Meyer, Commissioner HaII;;Lyssy, Behrens, Reese_;;: 19, Consider and take necessary action to approve the Preliminary Plat of the Luna Subdivision, (Replat of Lots 6-9 of the Knipling Farm Subdivision according to the plat recorded in Volume Z, Page 385 of the Calhoun County Plat Records) Ysidro Benavides Survey, Abstract No. 38 of Calhoun County, Texas. (VLL) pass Page 4 of 6 NOTICE OF MEETING — 5/22/2024 20. Hear report from Calhoun County EMS. (RHM) Dustin 7.enki6s gave the report. 21. Accept Monthly Reports from the following County Offices: 1) County Clerk — April, 2024 11) Tax Assessor -Collector — April, 2024 iii) Texas Agrilife Extension Service — April 2024 (1) 4-H and Youth Development (2) Agriculture and Nature Resources (3) Family and Community Health (4)Coastal and Marine RESULT APPROVED [UNANIMOUS] MOVER Vern Lyssy; Com'miSsioner Pct 2 SECONDER: Gary Reese, Commissioner PGt 4 AYES Judge Meyer, Commissioner Hall, tyssy Behrens, Reese'.:" 22. Approval of bills and payroll. (RHM) MMO Bills RESULT: APPROVED [UNANIMOUS] is KONVER _ ,. David Hail; Commissioner Pct 1 SBCONpER, Vern Lyssy, Commissloner.Pct 2 AYi=S Judge Meyer, Commission..& Hall, Lyssy, Behrens, Reese' -: County Bills: RESULT. APPROVED [UNANIMOUS] MOVER T, David Hall, Comm(ssioner Oct 1 $GONDiR Vern ayssy, Commissioner Pct 2 AYES. Judge Meyer, Commissioner Hall; Lyssy, Behrens, Reese Page 5 of 6 NOTICE OF MEETING --5/27_/2024 23. Consider and take action on any necessary budget adjustments. (RHM) RESULT, ;:. APPROYfrD [UNANIMOUS] M0 IRR - Cary Reese, Commissioner Pct 4 . SCONDEIA. Joel Behehs, Commissioner? ct 3 BYES Judge Meyer, Commissioner; Wail, Lyssy, Behrehs, Rowe; SUPPLEMENTAL AGENDA The subject matter of such meeting is as follows: 24. Consider and take necessary action to approve the Ratification of the Judge's declaration of Local Disaster. (RHM) Adjourned 10:45am Page 6 of 6 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, May 29, 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. f l Ric and Meyer, County Judge Calhoun County, Texas Anna Goodman, County Clerk Iw- - Deputy Clerk Page 1 of 1 NOTICE OF MEETING — 5/29/2024 May 29, 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 (ABSENT) 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 loam by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. n/a Page 1 of 4 NOTICE OF MEETING-- 5/2.9/2024 5. Consider and take necessary action to authorize Dina Sanchez, Calhoun County Library Director to sign the service agreement with Xerox. (RHM) pass 6. Consider and take the necessary action to approve the Final Plat of Indianola Club Grounds.(DEH) Terry Ruddickexplained the final plat. RESULT APPROVED[UNANtMOUS] MOVER.Joel Behrens, Commissioner Pct 3 $OCONDrER: Gary. Reese, Commissioner Ptt 4 AYES: - Judge Meyer; Commissioner. Hall, Behrens, Reese 7. Consider and take necessary action to accept the check in the amount of $5432.58 from Golden Crescent RAC on behalf of Matthew Hooten, to be used to pay for his AEMT course. (RHM) B. Consider and take necessary action to proclaim the Month of June as Men's Health Month. (RHM) Page 2 of 4 NOTICE OF MEETING — 5/29/2024 9. Consider and take necessary action to close Water Street, between 13th Street and the POC Fishing Center west of 15th Street and 14th Street between Commerce Street and Water Street Friday, July 26, 2024 between the hours of 7:00 p.m. - Midnight and Saturday, July 27, 2024 1:00 p.m. - 7:30 p.m. in Port O'Connor, Texas. (GDR) RESULT:.. APPROVED [UNANIMOUS] MOVER; , David Hall, Commissioner Pct 1 SECONDER: Gary. Reese, Commissioner Pct 4: AYES: Judge Meyer, Commissioner Hall, Behrens, Reese 10. Consider and take necessary action on re -appointment of Jack Campbell, Jr. to the West Side Calhoun County Navigation District. (GDR) REESUO' APPROVED [UNANIMOUS]" MOVER:. Joel Behrens, Commissioner Oct 3 SECONDER^ GaryReese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Behrens, Reese 11. Consider and take necessary, action to authorize Commissioner Reese to apply for Texas GLO CMP Cycle #30 grant to expand King Fisher Beach Park by purchasing the property immediately to the north of King Fisher Beach Park and authorize Judge Meyer to sign all documentation. GOMESA funds will be utilized for the matching funds. (GDR) RESULT. APPROVED:'[UNANIMOUS. MOVER: David Hall Coinmissloner'Pct 1 SECONDER. Joel Behrens Commissioner Pct 3 AYES: Judge Meyer, Commissioner H611, Behrens, Reese 12. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT: APPROVED [UNANIMOUS] MVER: Cary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, 6arnissioner'13ct 3 AYES. Jud9e Meyer, Commissioner Hall, Behrens, Reese Page 3 of 4 NOTICE OF MEETING — 5/29/207.4 13. Approval of bills and payroll. (RWM) riCr r Adjourned 10:12am Page 4 of 4 # 06 NO FICE OF MEETING — 6/05/2024 6. Approve May 20, 2024 Commissioners' Court Special Workshop Meeting Minutes. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy,'Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3' AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 28 The Commissioners' Court of Calhoun County, Texas met on Monday, May 20, 2024 at 10:30 a.m. for Special Workshop 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. 4 Richard Meyer, Cou Judge Calhoun County, Texas Anna Goodman, County Clerk ukulAw Deputy Clerk WORKSHOP — 5/20/24 May 20, 2024 MEETING MINUTES 9`b�ICo� OF CALHOUN COUNTY COMMISSIONERS' COURT MET IN A SPECIAL WORKSHOP AT 10:30 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 County Judge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk The subject matter of such meeting is as follows: Hear recommendations from the Combined Dispatch Advisory Board on the posltion for the Calhoun County Communications Director for the Combined Dispatch Center. Consider and take necessary action If needed. Page 1 of 1 NUTICF OF MEEFING-6/05/2024 7. Approve May 20, 2024 Commissioners' Court Executive Session Meeting Minutes. (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 4 of 28 The Commissioners' Court of Calhoun County, Texas met on Monday, May 20, 2024 at 10:00 a.m. for an Executive Session in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, ]Port ]Lavaca, Calhoun County, Texas. Attached are the true and correct minutes of the above referenced meeting. Richard Meyer, County udge Calhoun County, Texas Anna Goodman, County Clerk May 20, 2024 MEETING MINUTES OF CALHOUN COUNTY COMMISSIONERS' COURT MET IN AN EXECUTIVE SESSION 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 3oel Behrens Gary Reese (ABSENT) Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. Countyjudge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at 10:03am by Judge Richard Meyer 2. Public Comment. 3. Open Executive Session, regarding Memorial Medical Center temporarily pausing their current 18 month loan repayment schedule. 4. Executive Session: The Commissioners' Court shall go into Executive Session as authorized by V.T.C.A Government Code Chapter 551, Subchapter D. Following is the subject matter of the executive session and the Specific Section of the Open Meetings Act permitting discussion/deliberation in Executive Session. Section §551-071. A government body may conduct a closed meeting for consultation with their attorney. 5. Reconvene Open Session. Meeting was called to order at 10:45am by Judge Richard Meyer 6. Consider and take necessary action on matters discussed in the Executive Session. Commissioners' agreed to pause the payment and revisit next year. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Adjourn. 10:46am NOTICE OF MEETING 6/05/2024 8. Hear MMC Report. (RHM) Erin Clevenger gave the report for MMC Page 5 of 28 MEMORIAL MEDICAL oQj CENTER So Much... So Close! INTERIM CHIEF EXECUTIVE OFFICER REPORT To the Memorial Medical Center Board of Managers May 2024 a FINANCIAL IQ PP: CJPP Year 8 First Half IGT Payment will settle June 0. This IGT responsibility totals $3,289,700.73. See spreadsheet for further breakdown and expected return on investment. The second half IGT payment will be due in December for the same amount. o Loan Repayment: MMC Administration and Board Attorney Anne Marie Odefey met with the Commissioners' Court in an Executive Session on May 20tt'to discuss temporarily pausing our loan repayments to the county. The court granted this request and will revisit loan repayments at the beginning of 2025. We have paid back $1,500,000 of the $3,000,000 borrowed. o Respiratory Biofire: Most commercial payers plus Medicare/Medicaid stopped paying for Respiratory Pathogen Panel testing, which includes the Respiratory Biofire. This is a high cost item that we cannot afford to provide with no reimbursement, and patients will not want to pay cash prices. We will stop offering this testing after our current stock is depleted. There are other alternatives available in order to maintain consistent standards of care. Our Biofire equipment will still be utilized for GI and Blood Culture testing. a FACILITY UPDATES o ER Remodel Project: The remodel is underway. Cabinetry is complete and the ER flooring is near full completion. Business Office flooring will be replaced in June. Aesthetic and IT projects should be completed by the first week of June. We will schedule a social media reveal. All projects are being funded by the MG and Lillie A Johnson Foundation Grant. o Monthly Lunch and Learn: This month's Lunch and Learn was "The Next Level of Women's Health" with OB/Gyn physician Frank Hinds, MD; Farah Janak, RT(R)(M) Director of Diagnostic Imaging, and our Rehab Director Penny Goulden, PT, DPT. Next month's topic will be related to Disaster Preparedness with emphasis on Hurricanes. o Hospital Week: We celebrated Hospital Week May 13-1711 with daily activities: • Monday: Ice Cream Sundaes sponsored by Port Lavaca Nursing & Rehab ■ Tuesday: Health Fair • Wednesday: Employee Breakfast and Awards • Thursday: Fruit Cups sponsored by Calhoun Home Health & Trinity Shores • Fridav: Hamburger Luncheon • COMMUNITY IMPACT o Student Internship Program: We launched a new summer student internship program to give high school students an opportunity experience healthcare business administration. These interns will work closely with the business side of the hospital rather than our more traditional clinical setups, assisting with clerical tasks and projects. We had 17 students apply and they will start in June. o Health Fair: We hosted our annual health fair on Tuesday, May 15th. We had 53 booths set up! o EMS Week: We made a visit to Calhoun County EMS to deliver a gift for EMS week and extend our thank you for the working partnership between the two organizations. Are you prepared for hurricane season? Join us for a Hurricane Preparedness Lunch and Learn with our local advisors. This event will provide you with the knowledge and tools you need to be ready for any emergency. Don't wait until it's too late. Save the date and be prepared! 2 June 19, 2024 ©12PM -1PM p Memorial Medical Center Community Room Lunch is provided to all attendees MEMORIAL MEDICAL j CENTER So Much... So Close,! SUMMER ADMINSTRATIVE INTERNSHIP FOR HIGH SCHOOL STUDENTS This internship will offer high school students an opportunity to gain valuable hands on experience in healthcare and business administration. Summer interns will work closely with the business side of the hospital, assisting with appropriate clerical tasks and projects. This type of internship provides valuable knowledge as they are making career path choices, can enhances their college and scholarship applications, as well as their resumes. INTERNSHIP DETAILS Memorial Medical Center will sign off on all volunteer hour forms for local organizations. Plus, each intern can receive a college and scholarship recommendation form for good performance. Application Deadline: May 24, 2024 Internship Dates: June 10, 2024 - July 26, 2024. Internship Shift Times: 8AM -12PM or 12PM - 4PM Shifts Per Week: Minimum one (1) shift per week. Flexible with summer vacations Eligibility: High School Students (10th -12th Grade) PARTICIPATING DEPARTMENTS • Accounting • Adminstration • Health Information Management • Human Resources • Nursing Adminstration SIGN UP DETAILS Scan the QR Code and fill out the %ivn form requesting to participate. PLEASE BE ADVISED THAT THIS IS NOT A PATIENT CARE INTERNSHIP. THIS IS A SELECTIVE INTERNSHIP AND WE WILL NOT BE ABLE TO ACCEPT ALL APPLICANTS. FOR MORE INFORMATION CALL (361) 552-0258 April 2024 Financial Presentation Admissions Inpatient Days Swing Bed Days Observation Hours Traditional Medicare %i Emergency Room Visits Outpatient Visits^ Clinic Visits Total Surgery Cases* Total Radiology Procedures - Total Laboratory Procedures° Total Rehab Procedures, Memorial Medical Center Executive Summary For The Month Ended April 30, 2024 OperationsPrimary Drivers to Incr/(Decr) Incr/(Decr) % Incr/(Decri Incr/(Decr) % From From From From April 2024 March 2024 March 2024 March 2024 April 2023 April 2023 April 2023 44 47 (3) -6.4% j 64 (20) -31.3% 1 183 151 32 21.2% 't 163 20 12.3% T 75 37 38 102.7% ',' 8 67 837.5% 1,554 1,427 127 8.9% t 2,280 (726) -31.8% .� 18.9% 19.0% -0.1% •0.7% 18.0% 0.9% 5.0% 'r 793 810 (17) -2.1% 739 54 7.3% 2,350 2,027 323 15.9% '''. 2,063 287 13.9% t 3,020 2,628 392 14.9% t 2,287 733 32.1% T 75 56 19 33.9% '+r' 65 10 15.4% 1 2,607 1,548 59 3.8% 1,607 - 0.0% 41,700 38,943 2,757 +■' 7.1% ■' 39,924 1,776 4.4% 1,223 1,187 36 3.0% t 1,379 (156) -11.3% j • mdnd.. ar.n. a & amp.uea ^Ryhlntlans iW & WO Wb) Lea Admbdom&ERN.@ Financials April Financial Highlights • Gross patient revenue (GPR) • GPR increased $1.1 million to $7.3 million in April • Medicare payer mix (Traditional and Managed Care) decreased .94%to 41.35% in April when compared to March, while Private Pay decreased 1.10% to 9.30% in April compared to 10.40% in March • Net patient revenue (NPR) NPR increased $7981(to $2.8 million in April • Other operating revenue • 340B revenue was $52K compared to $83K in March • Net of expenses 340B income was $20K compared to $54K in March • Salaries, wages and benefits (SWB) • SWB increased $246K to $1.65 million; on a per calendar day basis SWB decreased 21.46% • Agency staffing expense decreased $324 in April • Total agency staffing costs were $13,229 compared to $13,553 in March • Supplies expense as a percent of gross patient revenue decreased in April to 5.41% from 5.44% in March • This ratio has averaged 5.32% over the last 12 months • Overall operating expenses increased $402K in April • Net Loss for April was ($61,046) compared to a Net Loss of ($479,865) in March • EBITDA Net Income for April was $12,347 compared to EBITDA Net Loss of ($406,433) in March Memorial Medical Center Income Statement by Operating Unit For The Month Ended April 30, 2024 Revenue Current Period Nursing Hospital Clinics Homes Combined 708,047 - 708,047 Inpatient Revenues 3,500,281 $794,160 - 4,294,441 Outpatient Revenues 2,329,213 - 2,329,213 ER Revenues - 6,913,402 6,913,402 Resident Revenues 6,537,541 794,160 6,915,402 14,245,103 Total Patient Revenue 3,539,891 254.658 - 3,794,549 174,874 8,208 - 183,082 (161,6861 - - (161,686) 674,521 - - 674,521 4,227,600 262,866 4,490,466 2,309,941 531,294 6,913,402 9,754,637 40,922 52,532 - 93,454 2,350,864 583,926 6,913,402 %848,091 Hospital Current Period Nursing Clinics Homes Combined 987,369 236,839 - 1,224,208 347,731 74,115 - 422,846 267,299 247,345 - 514,644 397,506 68,746 - 466,252 353,436 14,239 - 367,675 4,360 - - 4,360 49,183 - - 49,193 52,770 34,815 - 87,585 Revenue Deductions Contractuals Charity Indigent Care DSH/UCC/DSRIP Bad Debt Total Revenue Deductions Net Patient Revenue Other Operating Revenue Total Operating Revenue Operating Expenses Salaries & Wages Employee Benefits & PR Taxes Professional Fees Purchased Services Supplies Insurance Utilities Other Expenses - 7,146,828 7,146,828 Nursing Home Fee 2,459,654 676,099 7,146,828 10,282,581 Total Operating Expenses 57,149 16,000 73,149 Depreciation Year to Date Nursing Hospital Clinics Homes Combined 2,810,652 - 2,810,652 12,375,692 $ 2,476,373 - 14,852,065 9,602,374 - 9,602,374 - 26,432,116 26,432,116 24,788,718 2,476,373 26,432,116 53,697,207 13,291,460 693,907 - 13,985,367 1,236,109 32,786 - 1,268,895 4,400 - - 4,400 (646,742) - - (646,742) 2,710,280 - 2,710,280 16,595,506 726,693 17,322,199 8,193,212 1,749,680 26,432,116 36,375,008 120,226 295,241 - 415,467 8,323,438 2,044,921 26,432,116 36,790,475 Hospital Year to Clinics Date Nursing Homes Combined 3,969,967 880,872 - 4,850,839 1,058,290 210,710 - 1,269,000 1,087,040 1,020,106 - 2,107,146 21569,023 185,270 - 1,754,293 1,395,782 78,912 - 1,474,694 14,959 - - 14,959 179,345 - - 179,345 217,104 116,690 - 333,794 - 27,330,936 27,330,936 9,491,510 2,492,560 27,330,936 39,315,006 229,789 64,000 - 293,789 2,516o802 692,099 7,146,828 10,355,729 Total Expenses 9,721,299 2,556,560 27,330,936 39,608,795 (165,939) (108,273) (233,426) (507,638) Net Operating Income/(Loss) 11,407,861) (511,639) (898,820) (2,818,320) Non Operating Income / (Exp) 23,976 - - 23,976 Investment Income 88,949 - - 88,949 (244) - - (244) Interest Expense (1,130) - - (1,130) (0) 74,393 - 74,393 Contributions and Grants 39,227 141,841 - 181,068 - - - - Stimulus Funds - - - - - - 348,467 348,467 Nursing Home Program - 1,358,985 1,358,985 23,732 74,393 348,467 446,592 Total Non -Operating Revenue 127,046 241,841 1,358,985 1,627,871 (142,207) (33,880) 115,041 (61,046) Total Net Income/(Loss) (2,280,8151 (369,7981 460,165 (1,190,4491 Current Period Actual This Budget This Month Month Last Year 708,047 932,008 681,759 4,294,441 3,839,160 3,592,508 2,329,213 2,272,240 2,569,162 6,913,402 5,569,062 6,198,952 14,245,103 12,612,470 13,042,391 3,794,549 3,452,654 3,839,502 183,082 786,035 250,487 - 24,869 5,145 (161,686) (170,835) (183,686) 674,521 65,000 678,660 4,490,466 4,157,724 4,590,108 9,754,637 8,454,746 8,452,273 93,454 194,581 198,653 Memorial Medical Center Income Statement- Combined For The Month Ended April 30, 2024 Revenue Year to Date Actual YTD Budget YTD Last Year YTD Inpatient Revenues 2,810,652 3,728,032 3,206,712 Outpatient Revenues 14,852,065 15,356,641 14,330,468 ER Revenues 9,602,374 9,088,961 9,563,182 Resident Revenues 26,432,116 22,276,247 24,814,262 Total Patient Revenue Revenue Deductions Contractuals Charity Indigent Care DSH/UCC/DSRIP Bad Debt Total Revenue Deductions Net Patient Revenue Other Operating Revenue 9,848,091 8,649,327 8,650,926 Total Operating Revenue Actual This Month Current Period Budget This Month Last Year 1,224,208 1,311,756 1,208,652 421,846 432,262 416,498 514,644 430,619 320,683 466,252 492,013 415,805 367,675 371,545 364,167 4,360 7,000 5,254 49,183 45,600 44,291 87,585 117,391 132,890 Operating Expenses Salaries & Wages Employee Benefits & PR Taxes Professional Fees Purchased Services Supplies Insurance Utilities Other Expenses 7,146,828 5,834,957 6,397,494 Nursing Home Fee 10,282,581 9,043,143 9,305,734 Total Operating Expenses 73,149 100,078 75,791 Depreciation 10,355,729 9,143,222 9,381,525 (507,638) (493,895) (730,599) 23,976 2,050 6,624 (244) (1,199) (348) 74,393 83,353 1,449 53,697,207 50,449,881 51,914,624 13,985,367 13,810,617 15,355,000 1,268,895 3,144,142 1,191,427 4,400 99,477 7,777 (646,742) (683,339) (734,744) 2,710,280 260,000 1,949,505 17,322,199 16,630,898 17,768,965 36,375,009 33,818,983 34,145,659 415,467 778,323 706,960 36,790,475 34,597,306 34,852,619 Year to Date Actual YTO Budget YTD Last Year YTD 4,850,839 5,247,023 4,811,565 1,269,000 1,729,050 1,648,755 2,107,146 1,722,475 1,700,477 1,754,293 1,968,053 1,734,983 1,474,694 1,486,181 1,414,182 14,959 28,000 18,532 179,345 182,400 174,749 333,794 469,563 565,788 27,330,936 23,339,828 25,608,430 39,315,006 36,172,574 37,677,461 293,789 400,313 302,855 Total Expenses 39,608,795 36,572,886 37,980,316 Net Operating Income/(Loss) (2,818,320) (1,975,580) (3,127,697) Non Operating Income Investment Income 88,949 8,200 20,528 Interest Expense (1,130) (4,795) (2,991) Contributions and Grants 181,068 333,413 536,384 Stimulus Funds - - - 348,467 418,024 396,082 Nursing Home Program 1,358,985 1,672,095 1,584,328 446,592 502,228 403,807 Total Non -Operating Revenue 1,627,871 2,008,914 2,138,249 (61,046) 8,333 (326,792) Total Net Income / (Loss) (1,290,449) 33,333 (989,448) MoM 6 e� ^ariSX mrvom iL -1k m mX m-�em rg ry j ddM N r dtl 'aVm N g O� N °iK d d LL Y m m e g ry� m LK g Q P ry m Q T d«m gg n oiKd cd N dN e i z mg� eyjem P e1 e y o a �N � b m$ o m Q b O (J �mn De _ V W •E Pm mn q mrv�8m �o N 9nm:W .°.mu ry n' d „�¢mF^ebmNm� m §"N�'"� it gy o d m AIL Q N Q Q sOs �1 m P n O mt ammd'm,:tm N O O T 10 0 N N 1A Q Q P Q T T � �ri da d P C O Y P .mi mn.+m n pm Pm .nN+m W "r m N ug u n d KddQ m ueivm 4� n S� ni I q d ^ P N N X X 9� X X N X N HH T T M N N n PI N T P � b C N M •Ntl eN1 ei n Q m S N � tD e N eme O N P O N F •O N r n N W Wq C O Q N N S � m W T T^ m� N� N •O Q O O N P M m Q M N Q m N M N 1WW1 F O y� P P Y y m ••• A N e1 b T_ S Q "� T b Q '1 F N C "+ n� Q 1� M � LL � N N N N N N Np N N N N N N N N N N N N N N N K N N N N N N p P � N ' P N W n O n W •QO V N 1� M n n P e01 N W N N n 1.1 Wn OF ry b N N nN T N 1� M1 b Q O W Q Q W •V b 1•! 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W N T P W T O T 1•W'1 N 1 a p P e'1 N N C S t•1 M� n b q O •y ryW O m m• T N� N N pn� •�l b N T •/� •'• T •'1 1� W n T n G � b b h n� M N C N N f� y � y� N 1p O 10 � en4 V r T S N rl Q T O T� W M N q 1: T N O (C.1 O n Y MY�� 0 S S •V O O Q O M O Q N W I m N O P S ON1 M O1 N F Q • •W'• W N mWP P m N n m e y Iys W N (•In S m N H N T S m M ei tlt C T � T b n N O f� T O N� N eh'1 N N m I•�T 1O •D V � � e 1� N Q N�� W r'JI N N N IV m b O GI b N S N W O T W Q 16 N V1 '1 •R N In0 M W Q Yf � N S V O• VI N p N N W O M N 10 W T n n Q m N n W S O T O O1 WW b O M pN N O N O� W N YI W O �Gpi ^I n T 0 m r e`i W •I ^ � m •y N N N •O 1� N V M — m •V M T „ n v 414 P M N N N g 9�C ' O 6 •y C C tyi m 6 Oh � 41 �n \ V E V� b 6 J c a ooa F C F w f Z £ U H F F N W NW N eX1 N R n N T m O N N N O1 C p~p�� N N C O M m G 1ND n N M N N P e W1 W O ei ri TV •mD P �' C 4 W m Q_ h Y N T N O N •Ym n @W N A W N P N T p W N N H 1WO N 0 M E b 9 W O @ N S Y1 O@ O 0 N N ' N N `• eM• P S O T W •G S O T m O T L t 60 F O M Nn @ 10 O W 1I S1I�� n pj N pWNpW T L 1t n p O Np mO O •'� 1.1 � N' N n C T T S Q r N W M mWm p� M G Y' bl O Q T Q Q P T M N M m M W W N y y;� W m N N h W N E 9 L •'� T N CC W n N m e ry a b := N e o WpWp pbp e N n Nn o m m yp� m b+ n v m ryry m L= O Q N mGm n N tl N O N O V Z N W N N V Im•1 M N n M 0e N P N T N N O W F O pN V qry O N qO m m N O m O q W ei N P m V m !� G w P e'1 O N 1� e N n N N N W @ W ry e N m N T N N W n O N O Q n N n W P n N E IY1 v m n e{ 1p n N m y IM Q n Memorial Medical Center Trending Balance Sheet At April 30, 2024 04/30/21 0/31/13 05/30/23 07/32/23 08/31/23 09/30/23 10/31/23 11/30/23 12/31/23 01/32/24 02/29/24 03/31/M 04/30/14 Assets Cash and Cash lieutenants 7,006,507 7.729.165 6,376.990 6.390,278 9W2.115 6,017,42E 7,623,795 7,576.958 5.091.941 5,310,161 4,611.198 4,480,708 4,019,876 Private Waiver Clearing Account 433 433 433 433 433 434 435 435 436 436 437 437 438 MM Clink Construction Account 537 538 538 538 S38 539 540 540 541 542 S43 543 544 Nursing Home Accounts Z555,457 ;999,360 3,220,384 1.403,865 792.498 1,298,957 1,199735 659,SW 1.174.619 3,117,890 1,189,01, 1,538,597 1,661,455 nmt Total Cash and Investments Total 9,862,905 10,729,496 9,598,331 7,803,114 8,795,535 1,317,353 8,609,500 8,237,194 6,267,536 8,429,029 5,800,190 6,OW,335 5,692,313 AIR - Patient -MMC 10,579,800 1L661,695 1L483,195 12,209,144 12,689636 12,936.568 1L361,104 23,355,427 12,940,061 1L546,a84 13,916,373 14,244.715 15,697,627 A/R- Patient -MMC Clinic 6 a m& 594.379 5891 611.267 523,793 537,178 577,982 709,999 656.328 689272 601.297 621,360 M2,118 Allowance -Contractual, (II50] 3861 (9.141.251) (9,167,946) (95S4S67) (10,235407) 110.265.626) 19,003.40) (10613,049) (9911 1321 (9791.190) (10664.778) (11,178,146) 112.114,5061 Patient AIR, Net 2.716,960 3,114,923 3,301,369 3,264.844 2.9751023 3,208,120 3,235.618 3A51,577 3,654,257 3A50.169 4,052,793 3.697,929 4,225,238 Recevable - Other 7,273,282 7,347,482 9,119.00 9,100,505 9,276,188 9,556,515 7,873.02 8,566,03 20,814,747 11,802736 12,00,177 1LS61,219 12,979,632 Receivable -and Parry (113,0401 (113,040) (113,040) (113.0401 (123.040) (113,0401 (23.5551 (23.5551 (38.0401 (38,040) (38,040) ORWO) 1361040) Receivable- Nursing Hame 18.665,899 18,125,786 24,953,730 25,132,960 25,273,218 25,723,952 15.63),58) 25.974,746 26,251,639 25,251,607 25,454,175 25,693,591 26,870,149 Inventory 1,615,495 1,S%,094 1.S46,732 1,561,9a6 1,582.012 1,529,201 1,531,356 1,567. 07 1,528,600 L517,168 1,08,807 1,644,525 2,621,30 Prs lds 6gT,S92 60.681 732,888 726,502 717,613 64a,437 651.386 702,717 384,063 439,684 450.088 446,934 4MS64 Other Asseb Total Other Current Assets 18,139,220 27,610,005 36,239.410 36,428,913 36,735,991 37,335,965 35,710,465 36797,548 30,941.659 38,503.155 99.675,20 40,308.229 41,909,494 Total Linnet Assets 40,719,132 41,464,323 49,142,114 47A96,871 48,505,539 47,1161,438 47,655,58] 46,476,618 48,863,453 50,382,35E 49,513,189 50.016,482 51,827,046 mtking Capital 24263,192 ]],266,W1 4304,820 11,34ZWS 30,986,619 10,617,380 10,070,899 9,559490 9,606,491 9,180,822 9,136,725 3,756,022 8,794,125 Cun¢ne flatie 129 3.37 1.30 131 1.29 129 2.27 ]RS 1.24 1.22 223 1.21 1.20 Pmperty, Plant and Equipment 29,303,034 29342,053 29,353,163 29,365,414 29,393,317 29,431,01E 29,57;995 29,663,614 29,702,841 29,702,841 29,718,536 29,718,536 29,718,536 Aaumuleted Depreciation 12943/5541 (2L510763) (2;5865121 (2L662201) (22,138316) 1238143M) (22891825) 1239693001 (23043958) (23,117.967) 123,191,436) (23,M4,599) (23,33770) Total Capital Assets, Net 6,868,480 6,831,300 6,766,650 6,703.213 6,655.W3 6.626,768 6,681,270 6,694,306 6.Malen 6,584,874 6,527.100 6,453,938 6,380,789 Oefemed Outflowt of hesources L5241019 E,S2g049 2,524.049 2.514,049 2,524,049 2.524,049 2,524,019 2,524,049 2.SEa,W9 L5211W9 2,524,049 2,524,049 2.524,019 Talal Assels 50,121,665 50,019,675 50,432,516 56,724,237 $7,685,590 5).22155 56,860.BW 57,694.9/3 50,041S3115 59,491,275 59,579,338 58,9MA69 60,]3;,U4 Re turn on Assets -el% 0.0% -D1% 0.0% -am -0.89 -0.Se .0.9% -07% pats -0JY. -0.7% 0..6% 04/30/23 05/31/23 06/30/23 W/31/g3 08/31/13 09/30/23 W/IMS; 11/30/E3 12/31/23 01/31/24 0211912A 03/31/24 0413D/m Liabilitiesa Long Term Debt, Current 183,005 171,256 158.779 151,95E 138,185 127,579 125,803 111,914 201,821 91.501 89,151 80,772 72,367 Note Peyeble-Related Party, Current 3,000,000 3,a0o,020 3,000,000 2,650,000 L700,000 ;559,000 ;400,000 2,250,000 1,100.0m Lgso' 0 1,800,000 1,650,000 1,500,000 Amounts Payable 2,230,939 976,825 1.688,W8 986,537 2,190,149 691,413 1,071,912 1,335,787 762,176 1,155,576 858,578 896,609 1,05959B O.I.N.ning Home 24,267,225 25,154,184 32,238,263 31,050,603 31,538,308 3;BS7,896 39,026,236 33,936.291 35,124,014 36,379,639 35,609,498 37,188,889 39g l.cell NH INS W/H (3,5291 (3,529) (3,529) (3,529) 13.529) (3,529) 13,529) (3,529) 13,529) (3,5291 (3,5n) (3,529) (3,5291 Awrued lnmrgevernmental Transfer 316,186 404.667 213,079 95,223 183,724 (469,8511 (391,350) (312,846) (234,347) (155,845) 66,598 245,09 223,601 Refundable Prgvider Relief Fund - NH - - - - - - - - - - - UnearnedlndigentCare - - - (4,7111 - - - SA66 - - - - Payable - Est. and Perry Payor Settlement (736,348) (677,041) (706,404) Pali ll501 255528 280,678 208,258 391,964 67,000 11,986 (29,549) (17S,605) (187,403) Awrued Payroll 713,784 673,421 756,159 885.197 1.012,439 650,035 666,957 736,097 872,222 11022,161 1.216,210 661,148 657,26% Aecrued a.neNts 402,799 496,689 492,253 4]8,)SB SOL2el 558,112 478.332 472,9251 46i,793 741ASO 78L525 815,149 737.699 Ascrued Sales Tax 1,825 1.826 1.783 2684 1.876 1,731 L074 2,051 2.036 1.885 1,977 1,923 2.067 Total Current Uabllilies 29.455,950 30,198522 37,837,293 36,154,866 37,517,921 37,244,059 37,584,699 39,917,128 39,256,961 41,201.530 40,391,464 41.260,460 43,032,921 Long Term Debt Lang To son Lease, Net of Current 58,419 SSA19 50,419 59,419 58,419 58,419 58,419 58.419 38.419 54,408 54,408 54,408 54.406 Pen514n Most 13978 605) (3,952.00) 13 9260051 (390090S) (3874 8051 13,848,805) (3 82;805) 13 796 0051 137708051 (3 ]44 805) (3,718,809) (3,692,005) (306,805) Total Len, Term 13,920,386) (3,8%,3R6) (3,858,386) (3,842,386) (3,916,396) (3,790,386) (3,764,386) (3,738,386) (3.712,3861 13,690,397) (3,664,3971 (3,638,397) (3,912397) Total Liabilities IL535,563 26,303,936 33,968,907 32,312,479 33,701,534 33,453,67E 33.030,31E 35.178.742 35,544,5T5 37,53L131 36.797,067 37,622,063 39,410,514 Deterred lnikws of Renounces 6,859.445 6,782,342 6,781,606 6,721,099 6,711,059 6,711,099 6,705,667 6,705,667 6705,667 6,705,667 6,7OS,667 6,705,667 6,705,667 Debtto-Asse48otio 64.6% 65.]9 657% 60..8% 70.19 May 21.3% 72.6% 71.0% 74.3% 74.19 75.19 76.0% AsianNot Net Assete, Beginning 18,705,746 18,705,744 19,705,744 18,705,744 16,705,744 18,705,744 19.70,744 16,705,744 18,705,744 15,796,149 15,796,149 15,796,149 15,796,149 Increa,e /IOe[mase) (989087) 1972 346) (1 023 5E11 Il WS 186) 12,432.782) (1 868 254) (1370910) (2.695.1731 (2909,5951 (521,667) (649,5381 (1.129,4031 I1,190,449) Net Assets, Ending 17,716,657 17,733,395 17,682,223 17.700,558 17,272.962 16,837,490 16,334.934 15,810,571 15,795,149 15,274,482 15,146,611 14,666,745 14,605.700 Total Liabilities and Net Assets 50.111,665 50.819.675 58.431.816 56.724.07 57,685.590 57.001,295 56.960501 5].694.913 58.016.385 59.19L2]5 58.579,338 98.994,4fi9 fi0.)31.881 Debt-to-Equily Ratio 183 1.87 Z.30 Z.20 2.34 2.39. 2.48 265 2.67 2.89 Z.87 3.02 3.16 Memorial Medical Center Days Cash on Hand For The Month Ended April 30, 2024 Cash and Cash Equivalents: April May June July August September October November December January February Match April Cash and Cash Equivalents 7,006,507 7,729,165 6,376,980 6,398,278 8,002,115 6,017,422 7,613,795 7,576,959 5,091,941 5,310,161 4,612,198 4,480,708 4,029,876 Private Waiver Clearing Amount 433 433 433 433 433 434 435 as 436 436 437 437 433 MM Clinic Construction Amount 537 538 538 538 538 539 540 540 541 542 543 543 544 Investments Total Cash and Investments 7,007,477 7,730,135 6,377,950 6,399,249 8,003,087 6,018,395 7,614,769 7,577,934 5,092,917 5,311,139 4,612,179 4,481,688 4,030,85E Salaries & Wages 1,20%652 1,168,344 1,123,405 1,181,537 1,235,027 1,168A21 2,238,876 1,153,990 1,193,977 2,273,066 1,261,454 1,292,109 1,224,208 Employee Benefits &PR Taxes 416,498 397,528 418,029 398,361 418,919 444,133 423,716 412,124 433,427 178,607 460,207 208,340 421,846 Professional Fees 320,683 549,444 367,839 506,818 378,841 377.827 480,882 452,88E 466,627 649,659 493,852 458,991 514,644 Purchased Services 415,905 437,354 425,744 422,52E 487,127 450,977 435,361 471,979 534,296 43086 452,066 401,289 466,252 Supplies 364,167 411,813 358,5U8 336,540 413,311 365,223 428,948 406,194 404,818 369,766 395,820 341A34 367,675 Insurance 5,254 5,677 5,677 5,677 6,453 7,423 7,423 4,653 6,406 2,952 3,650 3,997 4,360 Utilities 44,291 46,815 46,091 46,706 0,720 90,469 47,723 48,014 45,960 42,361 43,601 44,200 49,183 Other Expenses 132,890 172,49E 143,621 138,903 122,965 128,003 163,090 104A37 94,938 82028 81,239 82,942 87585 Total Expenses 2,908,240 3,189,467 2,980,914 3,OS7,064 3,095,362 3,040,476 3,216,009 3,054,153 3,170,339 3,033:126 3,081,889 2,733,302 3,135,753 Days In Perlad 30 31 30 31 31 30 31 30 31 31 29 31 30 Total Cash and Cash Equivalents 7,007,477 7,130,135 6,377,950 6,399,249 8,003,087 6,018,395 7,624,769 7,577,934 5,092,917 5,311,139 4.612,178 4,481,688 4,030,856 Operating Expenses(without 2,832,449 3,113,258 2,813,165 2,981,375 3,019,247 2,964,487 3,216.009 3,054,153 3,170,339 3,033,126 3,091,889 2,713,301 3,135,733 employer tax credit) Len Depreciation Daily Expenses (Expenses Divided 94,415 10OA28 93,772 96,173 97.395 98,816 103,742 101,805 102,269 97,843 106,272 88,171 104,525 By 8Of Days) Days Cash on Hand Ratio 74.2 77.0 68.0 66S $2.2 60.9 73.4 74A 49.0 54.3 43A 50.8 38.6 Cash and Investments less Private 7,OD6,507 7,729,165 6,376,980 6,398,278 8,002,115 6,027,422 7,613,795 7,576,958 5,091,941 5,310,161 4,611,198 4,480,708 4,029,876 Waiver Cash Adjusted Days Cash on Hand 74.2 77.0 68.0 66.5 SZ.1 60.9 73A 74A 49.8 SU 43.4 50.8 30.6 Financial Drivers Memorial Medical Center Payer Mix MMC (Hospital) Payer Mix As of April 30, 2024 Medicare -Traditional re Blue Cross . HMO / PPO & Workers Comp err 25.0 20.0 15.0 10.0 ® Medicare -Managed Care ® Commercial 13 Month Trend Medicaid ® Private 9 .2 4 — 5.0 0.0 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 Medicare-Traditional ... B^- Medicare -Managed Care -- Medicaid Blue Cross Commercial —&-Private —&—HMO / PPO & Workers Comp Memorial Medical Center Medicare Traditional vs. Managed Care Comparison Medicare Traditional vs. Managed Care 13 Month Trend 50.0 45.0 42.0 43.8 42.4 , -- 0 -- 44.7 - 43.0 1 44 2 �•�-. 405 '�d�ye,�: .2 41.8.. 43,0,E 42.6 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 --«Medicare-Traditional —0—Medicare-Managed Care —we--Total Memorial Medical Clinic Payer Mix Memorial Medical Center (Clinic) As of April 30, 2024 Medicare- Traditonal a Medicare- Manage Care _. Medicaid a Blue Cross m Commercial a Private ■ HMO/PPO & Workers Comp 13 Month Trend 30.0 27.0 25.6 25.1 211466.8 25.0 '�, w .�.....-.2-..w 2 22.9 23.6 2.9 23.9 ./25� 23.2 20.6Z21.2 `'-, s .20 021.2 18.7 178 0 .1 1. 820.0 16.4 16.0 15.2 18.3 18. 17.9 54 1.56 14J 14.3 173 -. 15.0 11.6 114 12.4 10.1 _..�-.- �....TM""<,,, 10.2 101 10.8 10.0 8.1 9.9 10.0 ,.,,✓.,. �,.,�a, 8.9 9 3 8.5 8t4 I 7.9 . 6.3 q g q B 4'6 5�4 5.9 5',q 4'.9 4.4 4 9 4.8 5.2 4.6 _ .,�<.. 5.2 4i9,--- 6.5 515 / I 4.0 i 5.4 5.0 0.0 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 -Medicare-Traditonal -Medicare-Manage Care -Medicaid -Blue Cross -Commercial -Private -HMO/PPO & Workers Camp Memorial Medical Center Hospital Accounts Receivable Quality Indicators Accounts Receivable By Payor 16.000,000 16.000.000 14.000,000 12,000.000 IDIOM,= 8,000,000 61000,000 4,a00,000 21000,000 Apr-23 May43 1--23 1.1-23 Au843 5, 23 0a-23 N- 23 0ec-23 Jan-24 Feb-24 Marv21 4pr24 ■Medicare -Medicaid •Blue Cross Blue Shield wCommercial ■Private Pay BVeteran Affairs a Motor Vehicle Accidents Medicare Aging < 60 Days Blue Cross < 90 Days 69% 92% 88% 0% 8]9t 99% em %X 93% 92% 92% 90% 06% 94% 94% 93% 9m 95% 06% 0.0 3Y6 am 80% 09% 84% 80% 76% Ox 300.0% 90% 9 a ON BO 1.Ox 0.OY= 70.0Y6 ]O 0M Go ON 60.0% so.aY. 50.0% 40.0% 40.0%, 30.m: 30m6 20 ON z00% Mo% 10.0% 0.0% am Medicaid Aging < 90 Days Commercial <90 Days 1000% 93% 93X 90% 0]% 83X 82% 92X 90% 92% 90X B]% a6% loom83% 90.04E 90.0Y: 86% so'. BODY ]m 7m 66% 6M 7005E ]Y OY 600% 60.0% 40.OY 10.0Y1 30 S0.0Y ! (. : I: 2o.0% 10.0% 1o.ov. P 44 Veteran Affairs < 90 Days Motor Vehicle Accidents <90 Days 100.0% 07% e9% 97% 92% 9p,0% 84% 90 ON am 80.a% 63% 691 58% 80.0% 66% 65% 6]% ]4% 71% 74% 56% OIX 2m 69% 53% 49% 49% 60% 59X ]0.0% 30% ]0.a9: 60.m: 36X Sa.OY; 'a Ore 40.0E 4on% 30 ON I0.0): 30.0% to 10.aw am5 - " M1' ;l'� N' M1r' "' ti PV 5pe'1 \.><' \`2• P9' YsOOr t\°4 O°0 \C 4°P cY'S P95 PQ� \yeY \.0 V� P'� � O` Y O°jL 1TC 4' ed PQ Memorial Medical Center Accounts Receivable Agings Aging 0-30 31.60 1 61.90 1 91.120 1 121-150 1 151-180 1 181-365 1 Total Grass % Over 120 Days I % Over 90 Days % Under 60 Days V. Under 90 Days Total Apr-17 3,596,820 1,887,117 1,343,950 698,284 391,335 182,383 958,124 9,058,003 16.936 24.6% 60.5% 75.4% Apr-23 4,914,144 1,622,594 1,063,392 904,300 476,421 225,184 1,346,994 10.543,029 19.4% 28.0% 61.9% 72.0% May-23 5,392,333 1,721,776 1,044,527 876,163 791,735 376,975 1,422,416 11,625,925 22.3% 29.8% 61.2% 70.2% Jun-23 5,592,263 1,955,318 1,103,470 916,757 839,840 562,901 1,476,877 12,447,425 23.1% 30.5% 60.6% 69.5% Jul-23 5,149,973 1,899,264 1,205,658 802,561 SIZ714 414,791 1,587,411 11,572,374 21.7% 28.7% 60.9% 71.3% Aug-23 5,368,397 2,089,705 2,255,235 1,014,329 717,505 418,821 1,842,127 22,706,109 23.4% 31.4% 58.7% 68.6% Sep-23 5,463,113 2,210,826 1,363,783 1,092,846 816,811 477,619 1,551,092 12,976,090 21.9% 30.4% 59.1% 69.6% Oct-23 5,262,717 1,584,795 1,195,527 1,054,657 903,710 692,659 1,703,317 12,397,382 26.6% 35.1% 55.2% 64.9% Nov-23 5,850,431 2,342,820 991,646 937,375 767,202 580,291 1,894,811 13,364,576 24.3% 31.3% 61.3% 68.7% Dec-23 4,985,479 2,669,288 1,583,706 914,920 764,097 389,021 1,644,964 12,951,473 21.6% 28.7% 59.1% 71.3% Jan.24 4,911,560 1,994,115 1,867,154 1,086,211 560,670 462,874 1,676,067 22,558,651 21.5% 30.1% 55.0% 69.9% Feb-24 5,492,085 2,460,298 1,399,867 1,447,438 926,368 392,650 1,811,234 23,928,940 22.5% 32.9% 57.1% 67.1% Mar-24 4,383,922 2,766,567 1,688,608 1,135,565 1,294,319 874,721 2,113,670 14,257,371 30.0% 38.0% 50.2% 62.0% Apr-24 5,272,467 2,071,511 1,964,646 1,324,411 1,056,420 1,189,354 2,831,524 15,710,334 32.3% 40.7% 46.7% 59.3% Medicare Sep-17 1,655,132 426,033 182,349 35,908 5,783 19,655 53,433 2,378,292 3.3% 4.8% 87.5% 95.2% Apr-23 2,128,639 371,045 98,669 57,879 9,001 13,794 122,016 2,800,043 5.1% 7.2% 89.3% 92.8% May-23 2,551,956 224,289 106,771 32,708 51,583 40,120 239,679 3,147,106 7.4% 8.4% 88.2% 91.6% Jun-23 2,687,213 506,867 66,277 52,227 18,055 5,884 121,643 3,458,165 4.2% 5.7% 92.4% 94.3% Jul-23 2,513,803 338,583 126,819 60,734 51,788 14,069 139,505 3,245,300 6.3% 8.2% 87.9% 91.8% Aug-23 2,504,407 480,159 83,947 75,971 47,650 22,017 146,265 3,360,417 6.4% 8.7% 88.8% 91.3% Sep-23 2,380,789 688,768 171,080 42,321 43,668 25,695 162,304 3,514,626 6.6% 7.8% 87.3% 92.2% Oct-23 2,641,427 347,080 135,729 84,640 31,189 31,871 185,280 3,457,117 7.2% 9.6% 86.4% 90.4% Nov-23 2,726,661 687,167 59,583 38,560 47,895 35,972 199,106 3,794,944 7.5% 8.5% 90.0% 91.5% Dec-23 2,197,452 591,325 277,593 26,082 2D,513 17,286 203,205 3,333,456 7.2% 8.0% 83.7% 92.0% Jan-24 2,342,537 386,029 237,360 30,6SS 12,659 25,036 219,028 3,253,305 7.9% 8.8% 83.9% 91.2% Feb-24 2,433,018 794,758 113,220 50,514 18,579 10,527 221,204 3,641,820 6.9% 8.3% 88.6% 91.7% Mar-24 1,994,012 716,934 317,555 90,566 31,802 17,927 221,527 3,380,323 8.0% 10.47. 80.2% 89.6% Apr-24 2,311,180 379,041 359,550 160,383 54,580 33,521 235,386 3,533,642 9.2% 13.7% 76.1% 86.3% Medicaid Aug-17 460,814 355,303 115,759 32,474 7,570 2,527 2,963 977,411 1.3% 4.7% 83.5% 95.3% Apr-23 444,556 74,778 32,666 4,556 879 710 33,353 591,499 5.9% 6.7% 87.8% 93.3% May-23 613,131 106,171 19,987 22,116 2,920 60 35,577 798,962 4.7% 7.5% 90.0% 92.5% Jun-23 595,741 135,835 32,153 16,491 9,980 3,722 59,099 853,020 8.5% 10.5% 85.8% 89.5% Jul-23 490,628 199,878 71,264 14,562 30,866 13,768 57,462 878,428 21.6% 13.3% 78.6% 86.7% Aug-23 535,487 160,785 95,176 67,170 8,569 13,851 70,492 951,530 9.8% 16.8% 73.2% 83.2% Sep-23 707,722 122,546 114,122 58,694 57,209 5,151 88,438 1,153,871 13.1% 18.2% 72.0% 81.8% Oct-23 467,505 135,280 25,280 34,915 14,812 30,601 48,713 757,107 12.4% 17.0% 79.6% 83.0% Nov-23 588,110 133,380 35,489 24,872 19,411 12,279 62,638 876,178 10.8% 23.6% 82.3% 86.4% Dec-23 552,580 115,574 74,586 32,383 7,294 1,637 45,015 808,070 6.7% 8.2% 82.6% 91.8% Jan-24 568,530 98,554 45,516 33,720 7,553 2,863 30,811 787,547 5.2% 9.5% 84.7% 90.5% Feb-24 490,255 146,378 44,891 14,067 19,158 2,916 26,637 744,302 6.5% 8.4% 85.5% 91.6% Mar-24 352,716 185,044 72,304 21,801 5,765 12,011 30,934 680,575 7.2% 30.4% 79.0% 89.6% Apr-24 390,942 147,222 111,233 40,015 14,102 10,962 34,097 748,573 7.9% 13.2% 71.9% 86.8% BCBS Jul-18 293,552 25,273 22,415 4,663 4,641 1,022 1,147 351,714 1.9% 3.3% 90.6% 96.7% Apr-23 674,429 53,245 11,602 15,863 27,670 11,253 28,395 822,456 8.2% 10.1% 88.5% $9.9% May-23 710,256 2124297 27,943 2,445 6,891 1,060 27,508 988,400 3.6% 3.8% 93.3% 96.2% Jun-23 595,580 60,185 11,738 14,451 2,619 4,239 27,297 716,109 4.8% 6.8% 91.6% 93.2% Jul-23 654,068 86,774 17,349 8,279 14,496 2,497 37,600 821,064 6.6% 7.7% 90.2% 92.3% Aug-23 634,397 169,926 35,958 10,215 5,811 10,500 43,077 909,874 6.5% 7.6% 88.4% 92.4% Sep-23 696,274 143,155 100,761 28,197 18,129 5,811 51,884 1,044,211 7.3% 10.0% 80.4% 90.0% Oct-23 470,942 37,716 42,812 21,503 16,445 2,951 35,940 628,308 8.8% 12.2% 81.0% 87.8% Nov-23 530,568 79,250 11,518 3,643 13,998 3,119 20,113 662,208 5.6% 6.2% 92.1% 93.8% Dec-23 440,771 103,155 29,352 7,444 9,145 4,324 18,522 612,714 5.2% 6.4% 88.8% 93.6% Jan-24 486,524 76,603 41,207 8,348 4,588 10,956 24,212 652,438 6.1% 7.4% 86.3% 92.6% Feb-24 498,460 74,377 14,366 3,059 5,170 - 19,415 614,846 4.0% 4.5% 93.2% 95.5% Mar-24 449,914 52,977 29,070 6,742 814 2,853 18,084 560,454 3.9% 5.1% 89.7% 94.9% Apr-24 658,382 53,970 42,726 18,428 - 589 15,905 790,001 2.1% 4.4% 90.2% 95.6% G:\Finance Share\2024\04-APRIL\AR Monthly Analysis Board Packet - April 2024 Memorial Medical Center Accounts Receivable Agings Aging 0-30 31.60 1 61-90 1 91-120 1 121-150 1 151-180 1 181.365 1 Total Gross % Over 120 Days I % Over 90 Days I %Under 1 60 Days I % Under 90 Days Commercial (VA &MVA seperated out starting October 2020) Feb-17 1,153,728 303,202 157,302 62,901 45,604 24,5B1 95,421 1,842,739 9.0% 12.4% 79.1% $7.6% Apr-23 736,132 273,755 107,193 36,656 49,808 39,804 143,712 1,387,061 16.8% 19.5% 72.8% 80.5% May-23 649,828 302,063 90,570 50,771 54,589 37,166 157,066 1,342,052 18.5% 22.3% 70.9% 77.7% Jun-23 800,739 34ZI42 114,706 62,030 30,726 46,735 158,136 1,555,214 15.1% 19.1% 73.5% 80.9% Jul-23 755,308 334,430 204,989 60,737 47,624 27,798 182,588 1,613,475 16.0% 19.8% 67.5% 80.2% Aug-23 718,192 367,857 163,691 56,179 27,897 21,757 180,668 2,536,240 15.0% 19.6% 70.7% 81.4% Sep-23 844,164 330,346 120,475 71,080 33,937 35,258 131,075 2,566,335 12.8% 17.3% 75.0% 82.7% Oct-23 867,962 244,832 200,114 115,938 59,594 28,764 114,564 1,631,769 22.4% 19.5% 68.2% 80.5% Nov-23 941,606 600,361 81,351 112,533 71,174 42,772 112,762 1,962,559 11.6% 17.3% 78.6% 82.7% Dec-23 928,921 720,859 415,509 86,335 39,377 84,109 130,341 2,405,450 10.6% 14.1% 68.6% 85.9% Jan-24 818,165 579,472 495,445 310,186 95,444 33,360 205,535 2,537,607 13.2% 25.4% 55.1% 74.6% Feb-24 1,122,142 545,765 432,264 407,301 208,321 59,710 183,922 2,958,426 15.3% 29.0% 56.4% 71.0% Mar-24 781,924 716,022 381,087 290,130 306,313 144,073 240,843 2,860,392 24.2% 34.3% 52.4% 65.7% Apr-24 1,121,006 561,550 523,701 240,490 261,391 238,289 335,554 3,281,980 25.4% 32.8% 51.3% 67.2% Private Pay Mar-19 788,848 1,011,617 B31,644 259,046 192,429 117,192 896,868 4,097,643 29.4% 35.8% 43.9% 64.2% Apr-23 770,566 797,348 768,782 755,683 367,744 146,505 948,359 4,554,988 32.1% 48.7% 34.4% 51.3% May-23 660,391 830,895 760,233 731,498 657,202 267,313 988,164 4,895,695 39.1% 54.0% 30.5% 46.0% Jun-23 708,518 860,129 847,812 736,194 742,704 482,770 1,031,245 5,409,373 41.7% 55.3% 29.0% 44.7% Jul-23 599,380 867,379 754,858 630,456 354,668 336,751 1,087,960 4,631,462 38.4% 52.0% 31.7% 48.0% Aug-23 684,152 902,533 825,522 765,096 600,193 343,430 1,304,025 5,324,951 42.2% 56.6% 27.9% 43.4% 5ep-23 630,337 767,528 793,787 846,581 635,814 378,319 1,038,262 5,090,629 40.3% 56.9% 27.5% 43.1% Oct-23 591,979 801,084 758,164 775,322 741,306 570,437 1,202,719 5,441,009 46.2% 60.5% 25.6% 39.5% Nov-23 737,692 693,535 787,030 734,278 605,353 480,764 1,461,194 5,499,846 46.3% 59.7% 26.0% 40.3% Dec-23 697,283 889,800 640,008 782,359 651,038 279,669 1,197,886 5,138,043 41.4% 56.7% 30.9% 43.3% Jan-24 542,497 756,691 839,779 604,512 440,341 353,868 1,169,305 4,705,993 41.7% 54.6% 27.6% 45.4% Feb-24 663,735 827,308 737,684 823,783 59Z191 319,412 1,300,905 5,265,018 42.0% 57.7% 28.3% 42.3% Mar-24 596,637 842,989 816,879 693,881 841,392 611,686 1,543,063 5,946,527 50,491 62.1% 24.2% 37.9% Apr-24 593,624 773,425 781,679 808,160 686,862 866,928 2,086,865 6,597,542 55.2% 67.4% 20.7% 32.6% Veteran Affairs Apr-23 137,916 35,430 29,579 16,437 12,199 13,117 63,818 308,496 28.9% 34.2% 56.2% 65.8% May-23 158,073 19,011 32,031 21,724 15,254 9,209 66,080 321,381 28.2% 34.9% 55.1% 65.1% Jun-23 153,460 20,089 3,735 28,372 20,954 15,254 57,409 299,173 31.3% 40.7% 58.0% 59.3% Jul-23 114,950 21,208 308 745 6,279 4,996 55,951 204,437 32.9% 33.2% 66.6% 66.8% Aug-23 265,638 96,203 9,247 308 336 274 56,344 428,350 23.3% 13.4% 84.5% 86.6% Sep-23 183,823 139,720 51,305 6,363 308 336 36,987 418,833 9.0% 10.5% 77.2% 89.5% Oct-23 370,BOB 5,612 9,218 8,273 6,325 290 48,768 249,194 22.2% 25.5% 70.8% 74.5% Nov-23 282,919 97,047 3,485 9,279 8,502 5,384 34,033 440,650 10.9% 13.0% 86.2% 87.0% Dec-23 160,896 206,333 94,578 316 9,330 1,996 31,213 504,663 8.4% 8.5% 72.8% 91.5% Jan-24 122,460 88,191 160,289 52,418 84 9,392 22,210 455,043 7.0% 18.5% 46.3% 81.5% Feb-24 252,858 40,902 49,866 101,156 35,878 84 26,785 507,530 12.4% 32.3% 57.9% 67.7% Mar-24 140,988 221,008 40,902 34,204 60,675 39,100 26,855 563,732 22.5% 28.5% 64.2% 71.5% Apr-24 173,433 87,318 114,164 33,555 31,244 13,337 51,131 504,182 19.0% 25.6% 51.7% 74.4% Motor Vehicle Accidents Apr-23 21,907 6,992 14,902 17,226 9,118 - 8,342 78,487 22.2% 44.2% 36.8% 55.8% May-23 48,698 27,049 6,992 14,902 4,296 22,048 8,342 132,327 26.2% 37.5% 57.2% 62.5% Jun-23 51,012 30,071 27,049 6,992 14,902 4,296 22,048 156,370 26.4% 30.8% 51.9% 69.2% Jul-23 21,837 51,012 30,071 27,049 6,992 24,902 26,344 178,207 27.1% 42.2% 40.9% 57.8% Aug-23 26,124 12,253 41,694 39,389 27,049 6,992 41,246 194,747 38.7% 58.9% 19.7% 41.1% Sep-23 20,014 18,763 12,253 39,619 27,745 27,049 42,142 187,585 51.7% 72.8% 20.7% 27.2% Oct-23 52,094 13,190 24,310 14,067 34,039 27,745 67,432 23ZS77 55.5% 61.5% 28.0% 38.5% Nov-23 42,875 52,080 13,190 14,209 871 - 4,965 128,190 4.6% 15.6% 74.1% 84.4% Dec-23 8,576 42,240 52,080 - 27,399 - 18,782 149,077 31.0% 31.0% 34.1% 69.0% Jan-24 31,846 8,576 47,558 46,372 - 27,399 4,965 166,716 19.4% 47.2% 24.2% 52.8% Feb-24 30,617 30,811 8,576 47,558 47,071 - 32,364 196,997 40.3% 64.5% 31.2% 35.5% Mar-24 67,730 31,592 30,811 8,241 47,558 47,071 32,364 265,367 47.9% 51.0% 37.4% 49.0% Apr-24 23,900 68,985 31,592 23,380 8,241 25,728 72,587 254,414 41.9% 51.1% 36.5% 48.9% G:\Finance Share\2024\04-APRIL\AR Monthly Analysis Board Packet - April 2024 Memorial Medical Center Accounts Receivable Agings Aging 0-30 31.60 61-90 91-I20 121-150 151-180 I81-365 Tetel Gross % Over % Over % Under % Under 1 1 1 1 1 1 1 120 Days 90 Days I 60 Days 90 Days I Alllnsured Jul-17 3,361,811 1,022,884 325,400 130,623 91,194 89,145 152,956 5,174,014 6.4% 9.0% 84.7% 91.0% Apr-23 4,143,578 815,246 294,610 148,617 109,676 78,678 398,635 5,988,042 9.8% 12.3% 82.8% 87.7% May-23 4,731,942 890,881 284,294 144,665 134,534 109,662 434,252 6,730,229 10.1% 12.2% 83.5% 87.8% Jun-23 4,883,744 1,095,188 255,658 180,563 97,136 80,132 445,632 7,038,052 8.9% 11.4% 85.0% 88.6% Jul-23 4,550,593 1,032,885 450,800 172,106 158,046 78,030 499,451 6,940,912 10.6% 13.1% 80.4% 86.9% Aug-23 4,684,245 1,287,173 429,713 249,232 117,313 75,391 538,092 7,381,158 9.9% 13.3% 80.9% 86.7% Sep-23 4,832,776 1,443,299 569,996 246,265 180,997 99,300 512,830 7,885,462 10.1% 13.2% 79.6% 85.8% Oct-23 4,670,737 783,711 437,364 279,336 162,404 122,222 500,598 6,956,373 11.3% 15.3% 78.4% 84.7% Nov-23 5,112,739 1,649,285 204,616 203,097 161,850 99,527 433,617 7,864,730 8.8% 11.4% 86.0% 88.6% Dec-23 4,288,296 1,779,488 943,697 132,561 113,059 109,352 447,078 7,813,430 8.6% 10.3% 77.7% 89.7% Jan-24 4,370,063 1,237,424 1,027,375 481,699 120,329 109,005 506,762 7,852,657 9.4% 15.5% 71.4% 84.5% Feb-24 4,827,350 1,632,990 662,183 623,655 334,177 73,238 510,329 8,663,922 10.6% 17.9% 74.6% 82.2% Mar-24 3,787,285 1,923,578 871,728 441,685 452,927 263,035 570,608 8,310,844 15.5% 20.8% 68.7% 79.2% Apr-24 4,678,844 1,298,086 1,182,967 516,251 369,558 322,426 744,659 9,112,791 15.8% 21.4% 65.6% 78.6% `Months in Green represent the highest %of AR <90 days (best performance month as a %) since trend report tracking started in Jan 2017 G:\Finance Share\2024\04-APRIL\AR Monthly Analysis Board Packet -April 2024 Memorial Medical Center Clinic Accounts Receivable Quality Indicators Accounts Receivable By Payor 900.000 600,w. ]ODp00 GOD,GOD 500,00D 400,000 lDD,9Do I 100,000 = Apr-23 MaN23 1...23 Jul-23 Au0-33 Se0-23 0.23 Nam23 Deox3 3amN ieb34 W,U Apn24 E Medicare aMedicaid •Blue Cross Blue Shield ■Commercial ■Private Pay Medicare < 60 Days mn.n¢c 90.0% seo% T35% 16.o:G 65.a% 62.6% 60.0% g!q% 50.fi% SL6% 54.0% 31.4% p6J% 50.0% 43.6% 4p,p% 4i.!% 30.1% 90.0% 30.094 30O% 30 o;G G.m4 ,L� 1Y t�5 YM1 YM1 Y� YY ;LM1 YM1 15 15 M16 Y5 4•Q <2S N` �' rj°' •t° o° �° off' . c� <s> xd Medicaid <90 Days IOD.0,1 90.0,14 a0091. ]0.0% 385%52.,% 467% G0.0% 43.0% 41.9% 40.8% 38.9% 40.M 38.1% 50.0% 0.0% 0 0% 300N )D,o% Y" Y' �:4A p:L'r :4A J:u' ", ti tQ ti Cd <fi \� 1 PJG Y' 0� � Oo "I,,' Blue Cross <90 Days 300.0% 9%wl. ]0.6% 65.%i 64.1% sew's s6.6% 47.7% 36.!%51.a% 40.9% S0A% ]0.0Y: 38.3% 43A% 31.4% 33.3% G0.0% 5003: 4ec,c, 30m 300% 1v m: 0.03 ,ryA 'IA :1M1 1� 1 ^ M1M1 '1 Yy ,+ti ;LM1 } ' ti h6 pd Sy>�\J3 P� qp � l`_ � 43' 4e Commercial < 90 Days 100.0% 90.0% 90.0)i 61.7% 67.3% 70.3% 59.6% fiq,4% 70.0% 55.9% 42.0%45.2% 46.4% 43.8% 43.9% 60.0F 36.3% 50a14 40.0% 300% 2D W.I.. io 0% 0.0%. Memorial Medical Clinics Accounts Receivable Agings Aging 0.30 71.60 6140 91-120 121-150 151-180 131.365 Total Gross % Over % Over % Under Yo Dnder 1 1 1 1 1 1 120 Days 90 Days 60 Days 90 Days total Jan-18 489,483 12,415 9,784 10,329 1,798 1,725 (7,453) 518,080 -0.8% 1.2% 96.9% 98.8% Apr-23 162,614 48,644 35,497 36,004 42,491 31,444 149,241 505,933 44.1% 51.2% 41.8% 48.8% May-23 181,081 28,582 26,393 25,559 23,007 18,185 151,960 454,767 42.5% 48.1% 46.1% 52.9% Jun-23 166,525 j 40,389 19,887 18,214 21,152 19,559 163,782 449,508 45.5% 49.5% 46.0% 50.5% Jul-23 186,035 34,785 26,856 15,092 16,896 18,332 173,659 471,655 44.3% 47.5% 46.8% 52.5% Aug-23 260,786 15,106 18,848 23,269 11,593 16,359 181,210 527,072 39.7% 44.1% 52.3% 55.9% Sep-23 209,124 77,246 7,810 13,320 21,950 11,837 199,119 540,456 43.1% 45.6% 53.0% 54.4% OCt-23 258,758 55,740 25,865 20,052 20,732 3,771 223,665 608,582 40.9% 44.1% 51.7% 55.9% Nov-23 323,745 84,643 48,822 42,539 (796) 5,444 208,880 713,277 29.9% 35.9% 57.3% 64.1% Dec-23 245,538 103,879 53,826 32,582 26,496 1,897 196,389 659,607 34.1% 38.9% 53.0% 61.1% Jan-24 294,226 57,066 54,046 44,668 24,828 23,107 190,610 688,551 34.6% 41.1% 51.0% 58.9% Feb-24 359,402 101,679 35,140 42,484 38,847 20,097 206,826 804,475 33.0% 38.3% 57.3% 61.7% Mar-24 122,222 138,546 96,098 24,915 28,228 30,553 184,076 624,639 38.9% 42.9% 41.7% 57.1% Apr-24 361,698 34,437 70,282 67,412 17,183 23,771 70,613 645,396 17.3% 27.7% 61.4% 72.3% Medicare Aug-19 126,263 2,130 766 559 (82) 265 2,029 131,931 1.7% 2.1% 97.3% 97.9% Apr-23 36,061 3,938 799 1,662 4,410 5,965 25,042 77,878 45.5% 47.6% 51.4% 52.4% May-23 49,871 5,153 4,713 3,236 4,379 3,025 55,236 125,613 49.9% 52.4% 43.8% 47.6% Jun-23 61,057 10,430 4,784 3,133 1,988 1,247 53,905 136,543 41.8% 44.196 52.4% 55.9% Jul-23 50,161 9,636 7,499 4,375 3,239 1,105 52,097 128,112 44.1% 47.5% 46.7% 52.5% Aug-23 71,504 3,412 2,980 661 2,768 3,207 29,286 113,817 31.0% 31.6% 65.8% 68.4% Sep-23 68,238 1,458 2,557 2,811 686 2,648 32,530 110,928 32.3% 34.9% 62.8% 65.1% Oct-23 67,386 14,641 11,568 2,986 3,312 5,601 56,525 162,019 40.491. 42.2% 50.6% 57.8% Nov-23 72,964 20,032 14,968 8,390 2,678 3,094 58,122 180,249 35.4% 40.1% 51.6% 59.9% Dec-23 58,561 10,039 9,733 11,248 2,483 5,913 56,408 154,387 42.0% 49.3% 44.4% 50.7% Jan-24 51,210 6,558 5,535 4,112 9,018 1,377 59,242 237,052 50.8% 53.8% 42.2% 46.2% Feb-24 76,319 15,478 4,398 4,105 3,274 8,258 58,076 169,908 41.0% 43.4% 54.0% 56.6% Mar-24 33,088 8,844 8,820 705 1,714 1,277 55,721 110,169 53.3% 53.9% 38.1% 46.1% Apr-24 89,702 6,458 5,128 4,796 1,023 827 16,135 224,069 14.5% 18.4% 77.5% 81.6% Medicaid Feb-18 180,174 2,576 2,454 2,616 108 268 (603) 187,593 -0.1% 1.3% 97.4% 98.7% Apr-23 26,396 21,209 20,683 23,420 10,166 16,435 57,834 276,144 47.9% 61.2% 27.0% 38.8% May-23 25,617 11,451 13,338 13,624 13,882 2,633 43,262 123,808 48.3% 59.3% 29.9% 40.7% Jun-23 25,248 12,128 8,873 13,259 13,866 15,780 54,961 144,114 58.7% 67.9% 25.9% 32.1% Jul-23 26,019 19,704 11,614 10,676 10,906 11,923 58,100 148,942 54.3% 61.5% 30.7% 38.5% Aug-23 46,258 20,380 25,914 7,902 6,864 8,500 52,554 158,372 42.9% 47.9% 42.1% 52.1% Sep-23 26,077 27,962 22,863 13,931 8,559 6,782 61,776 167,951 45.9% 54.2% 32.2% 45.8% Oct-23 37,876 14,886 17,351 23,256 13,955 7,442 69,196 183,962 49.2% 61.9% 28.7% 38.1% Nov-23 57,050 27,276 16,178 11,637 21,124 13,765 68,257 215,287 47.9% 53.3% 39.2% 46.7% Dec-23 35,878 38,958 22,685 13,859 9,443 20,529 76,709 21sa6o 48.9% 55.3% 34.3% 44.7% Jan-24 51,767 21,290 29,872 22,181 15,812 7,870 96,265 245,057 48.991 58.0% 29.8% 42.0% Feb-24 83,456 23,063 19,902 31,306 22,289 14,954 99,867 294,738 46.5% 57.1% 36.1% 42.9% Mar-24 21,847 46,079 29,732 20,384 17,146 13,621 90,481 239,289 50.7% 59.2% 28.4% 40.8% Apr-24 63,498 13,934 29,985 27,987 9,615 13,412 62,899 221,330 38.8% 52.5% 35.0% 48.5% BCBS Mar-19 25,847 9,402 43 145 (1,332) 1,565 (2,571) 33,100 -7.1% -6.6% 106.5% 106.6% Apr-23 8,770 4,376 3,418 2,458 11,660 561 12,043 43,286 56.1% 61.7% 30.4% 38.3% May-23 19,011 3,320 4,208 3,364 2,402 5,554 17,829 55,688 46.3% 52.3% 40.1% 47.7% Jun-23 10,409 7,277 2,704 1,128 2,679 2,430 19,971 46,598 53.8% 56.2% 38.0% 43.8% Jul-23 9,845 1,285 5,016 2,659 1,073 2,679 19,687 42,244 55.5% 61.8% 26.3% 38.2% Aug-23 30,003 1,139 1,279 4,763 2,701 781 21,878 62,544 40.5% 48.2% 49.8% 51.8% Sep-23 13,232 11,767 1,174 1,088 4,410 2,328 21,843 55,842 51.2% 53.1% 44.8% 46.9% Oct-23 41,894 5,622 8,675 984 840 5,097 23,397 86,509 33.9% 35.0% 54.9% 65.0% Nov-23 46,717 11,047 5,349 8,777 250 200 26,077 98,417 27.0% 35.9% 58.7% 64.1% Dec-23 19,242 10,499 3,274 1,038 5,269 490 25,726 65,537 48.0% 49.6% 45.4% 50.4% Jan-24 13,829 1,549 2,470 2,459 (313) 5,213 22,563 47,771 57.5% 62.6% 32.2% 37.4% Feb-24 24,537 6,005 929 1,249 2,361 (503) 27,313 61,891 47.1% 49.2% 49.3% 50.8% Mar-24 6,034 5,273 3,485 738 1,027 1,979 26,034 44,570 65.2% 66.8% 25.4% 33.2% Apr-24 28,290 1,582 3,394 1,849 388 900 10,696 47,099 25.4% 29.4% 63.4% 70.6% 6:\Finance Share\2024\04-APRIL\AR Monthly Analysis Board Packet - April 2024 Memorial Medical Clinics Accounts Receivable Agings Aging 0.30 31-60 1 61-90 1 91-120 1 121-150 1 151-180 1 181.365 1 Total Grass I % Over 120 Days % Over 90 Days % Under 60 Days % Under 90 Days commercial Feb-18 206,928 (201) 397 1,458 - 1,836 (3,675) 206,743 -0.9% -0.2% 100.0% 100.2% Apr-23 35,332 9,606 7,624 6,013 9,828 3,353 73,123 144,880 59.6% 63.7% 31.0% 36.3% May-23 30,805 23,751 4,112 5,327 3,983 4,445 51,220 113,642 52.5% 57.2% 39.2% 42.8% Jun-23 35,113 7,089 10,436 2,204 4,433 3,164 53,950 115,390 52.9% 54.8% 36.3% 45.2% Jul-23 40,700 9,135 3,641 8,834 3,401 Z566 46,933 115,211 45.9% 53.6% 43.3% 46.4% Aug-23 53,621 8,333 8,709 8,727 9,399 3,758 68,922 161,471 50.8% 56.2% 38.4% 43.8% Sep-23 35,330 32,049 5,162 5,334 7,478 9,652 73,939 168,944 53.9% 57.1% 39.9% 42.9% Oct-23 46,847 18,987 11,891 3,308 2,775 825 54,342 138,975 41.7% 44.1% 47.4% 55.9% Nov-23 68,390 20,672 16,248 11,724 3,293 2,751 53,590 - 176,669 33.8% 40.4% 50.4% 59.6% Dec-23 45,954 26,444 13,025 6,840 5,256 2,929 48,905 149,344 38.2% 42.8% 48.5% 57.2% Jan-24 87,518 9,045 13,251 12,236 3,893 5,323 47,592 177,857 31.9% 38.3% 54.3% 61.7% Feb-24 107,671 32,330 5,065 9,302 9,169 Z463 49,525 215,516 28.4% 32.7% 65.0% 67.3% Mar-24 26,006 47,013 34,812 2,667 6,134 7,213 43,505 167,349 34.0% 35.6% 43.6% 64.4% Apr-24 99,289 10,304 22,697 28,982 2,020 5,708 19,579 188,579 14.5% 29.8% 58.1% 70.2% Private Pay Feb-18 152,357 5,922 6,490 5,992 1,186 (513) 2,832 174,264 2.0% 5A% 90.8% 94.6% Apr-23 56,055 9,514 2,973 2,449 6,427 5,129 (18,801) 63,745 -11.4% -7.5% 102.9% 107.5% May-23 55,777 (5,092) 22 7 (1,639) 2,529 (15,587) 36,016 -40.8% -40.8% 140.7% 140.8% Jun-23 34,698 3,465 (6,910) (1,510) (1,813) (3,063) (19,005) 5,863 -407.3% -433.1% 651.D% 533.1% Jul-23 59,309 (4,975) (914) (11,451) (1,723) 60 (3,259) 37,147 -13.0% -43.8% 146.3% 143.8% Aug-23 59,400 (18,158) (10,033) 1,216 (10,138) 112 8,470 30,868 -5.0% -1.1% 133.6% 101.1% Sep-23 66,246 4,010 (23,947) (9,843) 816 (9,523) 9,032 36,791 0.9% -25.9% 191.0% 125.9% 00-23 64,755 1,605 (23,620) (10,482) (151) (35,195) 20,204 37,117 13.1% -15.1% 178.8% 115.1% Nov-23 78,623 5,617 (3,921) 2,011 (28,142) (14,366) 2,835 42,656 -93.0% -88.3% 197.5% 188.3% Dec-23 85,903 17,938 51109 (1,4031 4,043 (27,955) (21,3581 72,278 -48.8% -50.7% 143.7% 150.7% Jan-24 89,903 18,624 2,917 4,680 (3,582) 3,324 (35,052) 80,814 -43.7% -37.9% 134.3% 237.9% Feb-24 67,418 24,803 4,845 (3,478) 1,954 (5,075) (27,945) 62,422 49.9% -55.5% 147.7% 155.5% Mar-24 35,248 31,338 19,250 421 2,207 6,463 (31,665) 63,261 -36.3% -35.7% 105.3% 135.7% Apr-24 80,918 2,158 9,079 3,797 4,138 2,924 (38,697) 64,318 -49.2% -43.3% 129.2% 143.3% All Insured Oct-19 280,920 26,512 38,307 4,230 3,754 9,621 15,080 378,424 7.5% 8.6% 81.2% 91.4% Apr-23 106,559 39,130 32,524 33,554 36,064 26,314 168,042 442,188 52.1% 59.7% 32.9% 40.3% May-23 225,304 33,675 26,371 25,552 24,646 15,656 167,547 418,750 49.6% 55.7% 38.0% 44.3% Jun-23 131,827 36,924 26,797 19,724 22,965 22,621 182,787 443,645 51.5% 55.9% 38.0% 44.1% Jul-23 126,726 39,760 27,769 26,543 18,619 18,272 176,818 434,508 49.2% 55.3% 38.3% 44.7% Aug-23 201,386 33,264 28,882 22,053 21,731 16,247 172,640 496,204 42.4% 46.9% 47.3% 53.1% Sep-23 142,878 73,236 31,756 23,163 21,133 22,410 190,088 503,665 46.2% 50.8% 42.9% 49.2% Oct-23 194,003 54,135 49,485 30,534 20,882 18,965 203,461 571,465 42.6% 47.9% 43.4% 52.1% Nov-23 245,122 79,026 52,743 40,528 27,345 19,811 206,046 670,621 37.8% 43.8% 48.3% 56.2% Dec-23 159,635 85,940 48,716 32,985 22,452 29,852 207,748 587,329 44.3% 49.9% 41.8% 50.1% Jan-24 204o324 38,442 51,128 39,988 28,410 19,783 225,662 607,737 45.1% 51.6% 39.9% 48.4% Feb-24 291,984 76,876 30,295 45,963 36,993 25,172 234,771 742,053 40.0% 46.2% 49.7% 53.8% Mar-24 86,974 107,208 76,848 24,494 26,021 24,090 215,741 561,377 47.4% 51.7% 34.6% 48.3% Apr-24 280,780 32,279 62,203 63,614 13,045 20,947 109,310 581,078 24.6% 35.6% 53.9% 64.4% -Months in Green represent the highest %of AR <90 days (best performance month as a %) since trend report tracking started in Jan 2017. G:\Finance Share\2024\04-APRIL\AR Monthly Analysis Board Packet - April 2024 Memorial Medical Center April 2024 Inpatient and Emergency Room Statistics Average Daily Census 16.00 14.00 12.00 10.00 all 8.00 6.00 4.00 l; 2.00 Jan Feb March April May June July Aug Sept Oct Nov Dec :a2021 12.10 8.66 8.61 11.50 8.71 7.77 9.48 12.29 14.57 6.61 6.00 8.03 N 2022 11.0 9.4 8.9 8.1 8.1 6.2 5.5 6.9 7.5 7.5 8.1 7.2 ® 2023 8.6 7.0 7.2 6.4 6.6 8.1 6.4 6.6 6.6 9.9 11.5 10.8 i 2024 9.2 10.3 6.8 9.0 • Admissions are the Prim ary driver to Inpatient gross revenue • Average daily census was 9.0, or .5 lower than target of 9.5 • Inpatient gross revenue was$708 thousand on budget of$932 thousand Emergency Room Visits Jan Feb March April May June July Aug Sept Oct as 2021 650 614 684 744 734 705 842 990 818 690 ri2022 902 565 606 670 745 733 787 709 742 754 ®2023 755 638 764 739 837 773 837 835 863 742 s 2024 745 792 830 793 • Emergency room visits are the Prima re driver to emergency room gross revenue • Emergency room visits were 793, or 48 higher than target of 745 • Emergency room gross revenue was $2.33 million on a budget of $2.27 million • Gross revenue is not netted down for payer contracts or cost based reimbursement i Nov Dec 623 750 825 734 859 858 3,000 2,500 2,000 1,500 1,000 Soo w 2021 m 2022 a 2023 W 2024 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 A 2021 J 2022 ® 2023 n 2024 Memorial Medical Center April 2024 Census Charts Outpatient Visits 4 Jan Feb March April May June July Aug Sept 2,008 1,750 2,308 2,226 2,136 2,471 2,243 2,577 2,205 2,339 1,924 2,568 2,185 2,073 2,200 2,087 2,338 2,182 2,232 2,016 2,280 2,063 2,274 2,286 2,165 2,493 2,206 2,091 2,090 2,027 2,350 Clinic visits are the prima ry driver to outpatient gross revenue Outpatient visits were 2,350, or 50 higher than target of 2,300 Outpatient gross revenue was $4.29 million on a budget of $3.84 million Clinic Visits Oct 2,331 2,200 2,194 Nov Dec 2,185 2,375 2,100 2,171 2,162 1,993 i! Y g I {n� Jan Feb March April May June July Aug Sept Oct Nov Dec 2,985 2,335 2,921 2,940 2,689 2,914 2,651 3,431 2,605 2,614 2,470 2,484 3,157 2,429 2,985 2,679 2,564 2,808 2,651 3,112 2,852 2,839 2,760 2,647 2,588 2,459 2,773 2,287 2,735 2,677 2,538 3,129 2,754 2,890 2,959 2,551 2,873 2,895 2,628 3,020 • Clinic visits were 3,020, or 490 lower than target of 3,500 • Clinic gross revenue was $794K compared to $410K in March, a 93.5% increase in gross revenue • Increased and sustained clinic visits at a target of 3,500 per month will produce downstream volume and would lift financial results 120 100 80 60 40 20 02021 n 2022 ® 2023 ® 2024 Memorial Medical Center April 2024 Downstream Statistics Surgery and Endoscopy Cases Cpp � 5 4 Jan Feb March HII April n' May June July 74 59 59 73 84 71 80 63 71 86 69 91 90 65 68 50 70 65 76 86 71 52 75 59 77 Aug Sept Oct Nov Dec 96 81 94 89 92 78 84 71 66 67 89 93 67 63 56 • Surgery and endoscopy cases were 77, or 5 lower than target of 82 • Outpatient cases - 70 • Inpatient cases - 5 • C-Sections cases - 2 Memorial Medical Center Inpatient Volume Indicators Admissions by Unit 13 Boo i 40I 110 zoo 32 [t 13J1 _ 150 _291 100 a'g 180' i,ry 0 2022 YTO 2023 YTD 2024 YTD u Medical/Surgical/ICU wObstetrics n Swing Bed Admissions Patient Days by Unit ,250 1 � ,000 800 58 ksyh, 600 400 s tryy ' 0]3 F]34 tg 756 200 2022 YTD 2023 YTD 2024 YTD U Medica1/5u1gicaVICU o0bstetrics ,Swing Bed Average Daily Census 10.00 1411 1207J b'F}r 0.64 v 6.00 { n� 0.55� kx ,er 'OAe 4.00 I I�' id1 2.00 I20. T590 j. 62a5 `.Y ., 1'tg"`i' 0.00 l012 YTD 2023 YTD 2024 YTD :I Medical/Surgical/ICU nObstetrics c5wing Bed Average Length of Stay ----. 14.00 13.151 12.00 9 90 : 30.00 yµ 8 06 B.OD .00 yt �560'i `' 1384- IS t 397I i35�. 4.00 .;? 2.00 0.00 193 ( i 11 k4 ; I r twi 2.00 83 2022 YTD 2023 YTD 2024 YTD n Medical/Surgical/ICU ®Obstetrics riSwing Bed Memorial Medical Center Operating Statistics 13-Month Trends 3,000 Outpatient Statistical Trends 2,493 2,500 �5 2,350 2,274 2,286 2,ifii ✓' •ti,2,206 2,194 2,16E a 2,000 1,500 1,000 837 837 835 863 859 ass ]39 ]]3 ]42 745 792 830 793 Soo 199 211 233 239 249 243 2211 2]q 305 305 . 0 Apc.23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 OCF23 Nov.23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 —Outpatient Visits •—a— Emergency Room Visits specially Clinic Visits --- Linear(Emergency Room Visits( --- Linear (Specialty Clinic Visits( • Outpatient, emergency room and specialty clinic visits combined were 3,448, compared to 3,142 in March • The following key downstream statistics, Surgery, Endoscopy, Radiology, Laboratory and Rehab produce revenue for the Hospital system • The primary driver to elevating these specific statistics is to increase Clinic visits Surgery and Endoscopy Cases 100 93 90 89 ✓ ,p 86 t; ✓ 80 76 i i• j ]5 ]] 70 6g �y i6], 63 , 60 A� 56 59 � �+ 52" 50 40 30 20 10 D Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-13 Deo23 Jan-24 Feb-24 Mar-24 Apr.24 —a--Surgery & Endoscopy — Target -82 • surgery and Endascopy cases were 77, or 5 less than target of 82 Memorial Medical Center Operating Statistics 13-Month Trends Radiology Procedures 2,500 1,939 2,000 1,>39 1,))1 1,]39 3,733 ,a15 1,]25 1 1,:: •"`v,.,,. 1,60) --g_e......., 1.512 ate. 1,444 1,952 1,548 1,607 1.500 y< 1.000 500 0 Aprv23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 0ec-23 Ian-24 Feb-24 Mar-24 Apt-24 �Radiology Procedures m Target.1,600 • Radiology procedures were 1,607, or 7 more than target of 1,600 Laboratory Tests s0,aoo 47,410 45p00 44,767 04,048 42,100 43,244 ,,:-r,'r.,, 4`3,268 42,443 39,92J✓�'�"015 41,933 4Q3,700 38,943 4a,o00 V 35,000 30.000 25,000 20,000 1s,0o0 I0,000 5,060 a Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 NOV-23 Oec-23 Jan-24 Feb-24 Mar-24 Apr-24 �Laboratory Tests - Target - 40,050 • Laboratory tests were 41,700, or 1,650 more than target of 40,050 Rehab Services Procedures 2,000 1 1,946 ,891 1.800 ; 1,671 . 1,605 11600 '360 1,364 1,416 1 bti 3,197 1,223 1,200 1,000 Sao Soo 400 200 0 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Ocb23 NOV-23 Oeo23 Jan-24 Feb-24 10ar-24 Apr-24 -Rehab Services Procedures - Target -1,400 • Rehab service procedures were 1,223, or 277 less than target of 1,400 Rehab Services Breakdown: • Physical Therapy -939 • Occupational Therapy -113 Speech Therapy -171 Physician Revenue 3 Year Trend Comparison Memorial Medical Center Physician Revenue Trend For The Month Ended April 30, 2024, 2023, & 2022 Amount Amount Comparision %Comparision Comparision %Comparision 2024 YTD 2023 YTD 2022 YTO 2024 to 2023 2024 to 2023 2024 to 2022 2024 to 2022 Memorial Medical Center Clinic 000966 Theo Truong 363,543 290,953 311,375 72,590 24.9% 52,168 16.8% 001367 Michael Pfeil - 1,651 314,268 (1,651) -100.0% (314,268) -100.0% 002099 Traci Shefcik 510,687 394,154 341,107 216,532 29.6% 169,579 49.7% 002927 Michael Gaines 548,643 458,909 224,151 89,734 19.6% 324,492 144.8% 011005 William Crowley 1,311,613 1,445,814 2,216,601 (134,202) -9.3% (804,988) -38,0% 019000 Ric Arroyo -Diaz 720,830 667,188 1,079,911 53,642 8.0% (359,081) -33.3% 022000 Peter Rojas - 538 168,552 (538) -100.0% (168,552) -100.09/ 041574 Frank Hinds 827,633 692,232 627,490 235,401 19.6% 200,143 31.9% 041596 Mercedes' Schultz- - 149,634 546,581 (149,634) -100.0% (546,581) -100.0% 058001 Courtne Thurlkill 256,923 202,525 188,931 54,398 26.9% 67,992 36.0% 097445 Pete: Papapetrou - - - 0 0.0% 0 0.0% 100118 Joseph Jenkins 901,482 634,424 669,023 267,058 42.1% 232,459 34.7% 102218 Marshall. Cook - - 1,153 0 0.0% (1,153) .100.0% 320001 Shanna Odonnell 529,835 354,147 434,258 175,688 49.6% 95,577 22.0% 041597 David Hobson 55,499 219,440 - (163,941) -74.7% 0 100.0% 310002 Tasha Norman 149,576 - - 149,576 100.0% 0 100.0% 310000 Marcelina Rupley 60,668 - - 60,668 100.0% 0 100.0% 001596 Shanme Martinez 48,862 - - 48,862 100.0% 0 100.0% 840766 Nuila-Crouse Richard 162,256 - - 162,256 100.0% 0 200.0% 985045 Chau Minh Uong 297,237 241,295 (297,237) -200.0% (241,295) -100.0% 6,448,050 5,808,848 7,264,696 639,202 11.0% (816,646) -11.2% 25.5% 21.0% 26.9% 4.5% 21.3% -1.4% -5.3% Hospitalist 013006 Hospitalist 951,289 5,639,041 4,786,031 (4,687,751) -83.1% (3,834,741) -80.1% 951,289 5,639,041 4,786,031 14,687,751) -83.1% (3,834,741) -80.1% 3.8% 20.4% 17.7% -16.6% -81.6% -14.0% -78.9% Port Lavaca Clinic 000983 Michael Caughron 121,281 147,387 119,592 (26,106) -27.7% 1,689 1.4% 001126 Nirtas Kwi Timu 285,083 427,074 555,450 (142,991) -33.2% (270,367) -48.7% 012000 Jeannine Griffin 185,008 181,656 296,484 3,353 1.8% (101,476) -35.4% 013001 Leigh Anne Falcon 357,870 413,743 591,855 (55,873) -13.5% (233,984) -39.5% 050001 John Wright 509,134 625,560 1,075,210 (116,426) -18.67. (566,076) -52.6% 001668 Ibrom Destiny 116,524 101,449 90,149 15,075 14.9% 26,375 29.3% 002686 Brown Victoria 84,413 41,898 - 42,515 101.5% 84,413 100.0% 097121 John Clinton 81,565 109,691 209,736 (28,126) -25.6% (128,170) 41.1% Specialty Clinic 000548 Haresh Kumar 001965 George Osuchkwu 013000 Don Paul Bunnell 050002 John Wright (Woundcare) 059000 Kurtis Krueger 065005 Lam Peter 068000 Clemmons Andrew 525225 Azhar Malik MD 002835 Smith Hannah 000514 DU Yong 001151 Jerry Followwill 7.4% 10.9% -0.5% -7.1% 41,483 31,266 23,118 10,217 32.7% 18,365 79.4% 63,772 44,668 37,702 19,104 42.8% 26,070 69.1% 174 100,946 106,256 (100,772) -99.8% (106,082) -99.8% 548,454 112,257 - 436,197 100.0% 548,454 100.0% 17,369 19,329 3,133 (1,960) -10.1% 14,236 454.4% 81,557 44,565 71,615 36,992 100.0% 9,942 13.9% 35,400 98,305 12,021 (62,906) -64.0% 23,379 194.5% 21,032 39,605 36,607 (18,573) -46.9% (15,575) -42.5% 33,643 26,338 - 7,305 27.7% 33,643 100.0% • 4,439 29,852 (4,439) -100.0% (29,852) -100.0% 14,071 14,071 100.0% 14,071 100.0% 859,595 525,990 320,304 333,606 63.4% 539,291 168.4% 3.4% 1.9% 1.2% 1.5% 78.6% 2.2% 186.3% Page 1 of 2 Memorial Medical Center Physician Revenue Trend For The Month Ended April 30, 2024, 2023, & 2022 Amount Amount Comparision %Comparision Comparision %Comparlsion 2024 VTD 2023 YTD 2022 YTD 2024 to 2023 2024 to 2023 2024 to 2022 2024 to 2022 Coastal Medical Clinic 000806 William McFarland - - 320 0 0.0% (320) -100.0% 000809 Delgado Ana - 12,613,00 11058 (12,613) -100.0% (1,058) -200.0% 011000 McFarland, Tim R 36,025 76,121 (36,025) -100.0% (76,121) -100.0% 48,638 77,499 (48,638) -100.0% (77,499) -100.0% 0% 0% 0% 0% -100.0% 0% -100.0% Independent 310001 Cummins Michelle 51,779 79,273 136,576 127,495) -34.7% (84,798) -62.1% 51,778 79,273 136,576 (27,495) -34.7% (84,7981 -62.1% 0.2% 0.3% 0.5% -0.1% -2&6% -0.3% -59.6% Other Medical Staff 002372 Gerber Bernard 291,534 324,092 211,899.00 (32,558) -10.055 79,635 37.6% 012100 Donald Breech 81,072 106,293 189,375.37 (25,221) -23.7% (108,303) -57.2% 001003 Gustave Sandigo 1,756 1,370 4,123.02 386 28.2% (2,357) -57.4% 001645 Mark Yeakley - - - 0 0.0% 0 0.0% 807077 Nilesh Patel - 1,006 397.00 (1,006) -100.0% (397) -100.0% 900000 Dakshesh Parikh 4,256 25,562 23,852.00 (21,306) -83.4% (19,596) -82.2% 989112 Peter Powaser 23,172 38,869 36,797.48 (15,698) -40.4% (13,626) -37.0% 002205 Sanjeev Bhatia - 1,407 1,324.00 (1,407) -100.0% (1,324) -10D.0% 001306 lose Valladares 15,273 236,900 168,950.00 (221,627) -93.6% (153,677) -91.D% 1.6% 2.7% 2.4% -1.0% -38.0% Total E/R Physicians 27.7% Other Ordering Physicians Other Ordering Physicians 13.4% 19.4% 12.4% -6.0% .30.9% 1.0% 8.2% Totals 25,307,598 27,659,796 26,998,136 (2,352,198) -8.50% (1,690,538) -6.26% Page 2 of 2 Productivity Benchmarking Report Score Mod SurgIICU NurserylOB Nurse Armin Case Management Infusion Services Emergency Room Risk Management I Infection Prevention / Employee Health Surgery All Nursing Diagnostic Imaging Lab Pharmacy Rehab Services e. MMC Clinic Clinic PFS Clinics Dietary, Environmental Services Plant/Slo Mad Security Admin Fiscal Acct PFS HIM IT Purchasing -CS Indigent Care Covid Related: Door Screeners Totals Memorial Medical Center Productivity Monthly Totals April 2024 Target Target Target Target Actual FTE's SM FTE's SM FTE's BM FTE's BM FTE's 90% 82.5% 75% 50% Worked 5 4 3 2 Goal Min Requirements 16.52 17.74 18.51 20.65 28.11 ® 1 2.20 2.30 2.40 2.51 8.52 ® 1 5.23 6.27 7.43 10.69 5.40 ® 4 3.52 4.11 4.70 6.09 0.98 5 - - - - - FALSE 10.13 10.55 10.97 12.07 9.53 ® 5 1.25 1.41 1.57 2.24 0 5 7.52 6.52 9.53 11.99 8.54 3 46.39 50.92 55.09 66.25 61.08 ® 2 10.08 10.55 11.01 13.36 9.45 ® 5 15.10 15.81 16.61 20.05 19.98 ® 2 4.69 5.17 5.65 6.78 3.62 ® 5 5.31 5.24 5.18 6.22 6.44 1 35.18 36.76 38.35 46.40 22.70 13.52 24.24 14.47 25.79 15.42 30.47 19.38 24.63 8.25 (. 3 5 36.22 38.71 41.21 49.86 32.88 ® 5 4.11 4.40 4.69 5.79 9.36 ® 1 14.73 15.24 15.74 18.05 13.70 5 4.60 5.33 6.11 7.88 5.61 i 3 3.14 3.53 3.92 2.01 3.33 4 26.58 28.50 30.47 33.73 32.00 ® 2 6.48 7.02 7.57 9.26 5.33 5 3.46 3.78 4.10 6.55 4.46 ® 2 13.99 15.44 16.88 21.08 15.29 (B 4 4.43 4.79 5.15 6.20 4.41 $ 5 1.54 1.86 2.18 3.45 2.72 ® 2 2.49 2.93 3.36 5.55 2.69 (9) 4 1.75 1.75 1.75 1.75 1.75 7 3 34.15 37.57 40.99 53.83 36.65 Q0 4 8.42 8.11 G:1Flnance Share12024\04-APRIL\CFO FOLDER1New Productivity Staffing Report - April 2024 >90% 82.50% 76% 50% 5 4 3 2 Benchmarks 178.52 192.46 206.11 250.07 Actual Worked FTE 203.05 203.05 203.05 203.05 13.94 13.65 43.96 260.00 240.00 220.00 200.00 203.0 — '— 180.00 160.00 140.00 5 >90% m Benchmarks 170.52 —Adual Worked FTE 203.05 Productivity Benchmarking 4 82.50% 192.45 303A5 3 75% 206.11 203.05 2 50% 250.07 203.05 GAFinance Shan312024104-APRILICFO FOLDER\New Productivity Staffing Report - April 2024 County Indigent Healthcare Report `IHS Source Totals Report Issued 05/16/24 Calhoun Indigent Health Care Batch Dates 05/01/2024 through 05/01/2024 For Vendor: All Vendors Source Description Amount Billed Amount Paid Expenditures 0.00 0.00 Reimb/Adjustments Grand Total Source Totals Report Detail Invoice # Source DOS Amount Billed Amount Paid Grand Totals 0.00 0.00 0 invoices listed. 0 line items listed. NO INVOICES FOUND FOR THIS TIME FRAME! Expenses 4,166.67 Co -Pays < 0.00 > 4,166.67 S�itr�y ANS Source Totals Report Issued 05/16/24 Calhoun Indigent Health Care Batch Dates 02/01/2024 through 05/0112024 For Vendor: All Vendors Source Description Amount Billed 14 Mmc - Hospital Outpatient Expenditures Reimb/Adjustments Amount Paid 108.00 60.50 108.00 60.50 Grand Total 108.00 60.50 Expenses 16,666.68 Co -Pays < 0.00 > 16,727.18 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 4 0 1 4 April 1 0 0 2 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 1 10 2 5 16 Monthly Avg 0 1 0 0 1 December 2023 Active 4 Number of Charity patients 249 Number of Charity patients below 50% FPL 117 Number of Charity patients who meet State Indigent Guidelines 109 Calhoun County Pharmacy Assistance Patient Caseload 2024 Approved Refills Removed Active Value January 6 18 0 7 $9,662.15 February 0 0 0 10 $0.00 March 3 9 0 17 $8,345.67 April 5 15 0 20 $8,332.53 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 $26,340.35 Monthly Avg 1 4 5 $2,195.03 December 2023 Active 36 Cash Flow Projections Memorial Medical Center 7 Month Cash Flow Projection May-24 .Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Cash On Hand - Operating & Money Market (Beginning of Month) $ 2,641,297 $ 2,334,126 $ 794,916 $ 1,077,087) $ (1,359,258) $ 1,407,258) $ (1,689,429) CASH INFLOWS: Cash AR Receipts - Hospital $ 2,385,000 $ 21386,000 $ 2,385,000 $ 2,385,000 $ 2,385,000 $ 2.385,000 $ 2,385,000 Cash AR Receipts - Clinic $ 376.000 $ 376,000 $ 375,000 $ 376,000 $ 375,000 $ 375,000 $ 375,000 Other Cafeteria $ 17.600 $ 17,600 $ 17.600 $ 17,600 $ 17,500 $ 17,600 $ 17,500 340E $ 170,000 $ 170,000 $ 170,000 $ 170.000 $ 170,000 $ 170,000 $ 170,000 Bank Interest Earned $ 21,000 $ 21,000 $ 21,000 $ 21,000 $ 21,000 $ 21,000 $ 21,000 MG & Lillie A Johnson Grant Funds Nursing / Clinic Grant Money $ 75,000 Employee Retention Tax Credit TOTAL Operating Cash Activity. $ 3,043,500 $ 2,968,500 $ 2,968,500 $ 2,968,500 $. 2,968,600 $ 2,968,600. $ 2.968,500 QIPP Year 5 IGT Reconciliation Disproportionate Share Hospital (DSH) $ 340,000 Uncompensated Care (UC) Medicare Cost Report Settlement- 2022 Medicare Interim Reimbursement - 2023 $ $ $ $ $ $ $ QIPP $ 310 329 $ 544,600 $ 310,329 $ 310,329 $ 544,600 $ 310,329 $ 310,329 TOTAL Supplemental. Activity- $ 310,329 $ 884,600 $ 310,329 $..` 310,329. $ 544500 $ 310,329 $ 310,329 Total Cash Inflow $ 3,353,829 $ 3,863,000 $ 3,278,829 $ 3,278,829 $ 3,513,000 $ 3,278,829 $ 3,278,829 CASH OUTFLOWS: Operating Expenses Accounts Payable $ 2,238,000) $ (2,238,000) $ (2,238,000 $ 2,238,000 $ 2,238,000 $ 2,238,000) $ (2,238,000) Payroll $ (780,000) $ (780,000) $ (780,000) $ 780.000) $ (780,000) $ (780,000) $ (780,000) Payroll Taxes $ (268,000) $ 258,000 $ 258,000 $ 258,000 $ 288,000 $ (268,000) $ (258,000) Retirement $ 196,000) $ 195,OOD $ (195,000) $ (195,000) $ 195,000 $ 195,000 $ (195,000) 340E $ 50,000 $ 50,000 $ (50,000) $ 50,000 $ (50,000) $ (50,000) $ (50,000 Leases $ $ $ $ $ $ $ MMC New Equipment Purchases $ $ $ $ $ $ $ MMC New Equipment Purchases-2023 $ (40,000) $ (40,000) $ (40,000) $ (40,000) $ 40,000) $ (40,000 $ 40,000 Est NH Cash receipts in Cash due NH Grant Imaging Equipment funds to be spent) Medicare Interim Overpayment - 2023 RHC Stimulus (funds to be spent) 340E Drug Compliance Overpayment 2019 DSH Refund Of Overpayment Payback of Advance Payments $ $ $ $ $ $ $ TOTAL Operating Activity $(3,661,000) $ 3,561,000 $(3,561,000) $(3,661,00D $(3,681,000) $ 3,561,000).$3,661,000 Supplemental IGT Programs DSH - Pass 1 & 2 - $116,894, Pass 3 - $163,216 UC DSRIP RAPPS-$41,552, CHIRP-$89,790 $ (131,342) UHRIP QIPP Semi-annual and Reconciliations Pymts. $ (3,289,701) pj28�,0171) TOTAL Supplemental Activity $' $. 3,421,042 $ $ $ $ TOTAL CASH PAID OUT $ (3,561,000) $ (6,982,042) $ (3,661,000) $ (3,561,000) $ 3,561,000) $ (3,561,000) Cash Increase (Decrease) $ 207,171) $ 3,129,042 $ 282,171 $ 282,171 $ 48,000) $ 282,171) Loan Additional Borrowing (Repayment) $; - $:: - ' >$ '' $ --$'$ - -` Cash on Hand (End of Month) $ 2,334,126 $ (794,916) $ (1,077,087) $ (1,359,258) $ (1,407,258) $ 1,689,429) $ (1,971,600 Cumulative Borrowed From County $ 1,600,000 $ 1,500,000 $ 1,500,000 1 $ 1,500,000 1 $ 1,500,000 1 $ 1,500,000 1 $ 1,500,000 5/23/2024 CHECK REGISTER: 04.01-24 THRU 04-30.2024 BANK COOS CK# DATE AMOUNT PAYEE NOTES A/P 203554 4/3/2024 53.61 ADTCOMMERCIAL FIREMONITORING A/P 203555 4/3/2024 15,903.78 AIRGAS USA, LLC-CENTRAL DIV OXYGEN -RESP CARE A/P 203556 4/3/2024 419.97 AMAZONCAPITAL SERVICES VARIOUS DEPT EXPENSES A/P 203557 4/3/2024 87.O0 AMBU INC MEDICALSUPPLES A/P 203558 4/3/2024 23,266.56 BECKMAN COULTER INC LABORATORY SUPPLIES A/P 203559 4/3/2024 83.79 CALHOUN COUNTY FUEL A/P 203560 4/3/2024 265.29 CAPTTALONE VARIOUS DEPT EXPENSES A/P 203561 4/3/2024 25,660.00 CARRIER CORPORATION CHILLER LEASE A/P 203562 4/3/2024 248.44 COW GOVERNMENT, INC ITSUPPUES/EQUIPMENT A/P 203563 4/3/2024 38.80 CENTRAL DRUG PHARMACY INVENTORY A/P 203564 4/3/2024 593.69 CHEMAQUA WATERTREATMENT A/P Z03565 4/3/2024 2,628.67 CITY OF PORT LAVACA UTILITIES -WATER A/P 203566 4/3/2024 0.00 VOIDED VOIDED A/P 203567 4/3/2024 320.00 COLONIAL PENN UFE INSURANCE PATIENT REWINDS A/P 203568 4/3/2024 243.90 CONMED CORPORATION SURGICALSUPPUES A/P 20356D 4/3/2024 2,777A8 COOPER SURGICAL INC SURGICALSUPPLIES A/P 203570 4/3/20Z4 419.00 CYGNUS MEDICAL LLC SURGICALSUPPUES A/P 203571 4/3/2024 728.66 DEWITT POTH&SON OFFICESUPPLIES A/P 203572 4/3/2024 489.85 DIRECfV ENTERTAINMENT HOLDINGS TELEVISION SERVICES A/P 203575 4/3/2024 144,932.37 DISCOVERY MEDICAL NETWORK INC PHYSICIAN SERVICES A/P 203574 4/3/2024 344.38 DONNSTRINGO EMPLOYEE REIMBURSEMENT A/P 203575 4/3/2024 143.92 ENVIED MEDICALSUPPLIES A/P 203576 4/3/2024 7,441.70 EVIDENT CONSULTING SERVICES A/P Z0M77 4/3/2024 108.30 FEDERAL EXPRESS CORP. FREIGHT A/P 203578 4/3/2024 600.00 FIRETRON, INC ANNUAL MONITORING A/P 203579 4/3/2024 8,177.39 FISHER HEALTHCARE LABORATORY SUPPLIES A/P 203580 4/3/2024 82.23 FRONTIER TELEPHONE A/P 203531 4/3/2024 876.84 FUSION CLOUD SERVICES, LLC TELEPHONE A/P 203582 4/3/2024 306.00 GAILBROTHERS PATIENTREFUND A/P 203583 4/3/2024 5,080.91 DES ADMINISTRATORS, INC EMPLOYEE INSURANCE A/P 203584 4/3/2024 66.74 GETINGE USA SALES LLC SURGICALSUPPLIES A/P 203585 4/3/21124 8,959.20 GLAKOSMITHKUNEPHARMACUETICAL PHARMACY INVENTORY A/P 203586 4/3/2024 93.77 GRAINGER PLANT SERVICES SUPPLIES A/P 203587 4/3/2024 700.O1) GUERBET, LLC LABSUPPLIES A/P 203588 4/3/2024 1,687.62 GULFCOAST PAPER COMPANY HOUSEKEEPING SUPPLIES A/P 203589 4/3/2024 68.74 HILL -ROM COMPANY, INC MEDICAL EQUIP/SUPPLIES A/P 20359D 413/20M 344.3E JENISESVETUK EMPLOYEE REIMBURSEMENT A/P 203591 4/3/2024 120.00 PATIENTREFUND A/P 203592 4/3/2024 120.OD PATIENTREFUND A/P 20359S 4/3/2024 0.00 VOIDED VOIDED A/P 203594 4/3/2024 12,301.79 MCKESSON MEDICALSURGICAL INC LABSUPPUES A/P 203595 4/3/2024 285.00 MEDI-DOSE, INC PHARMACY SUPPLIES A/P 203596 4/3/2024 0.00 VOIDED VOIDED A/P 203597 4/3/2024 9,595.40 MEDUNE INDUSTRIES INC MEDICALSUPPLIES A/P 203598 4/3/2024 380.24 MICROTEK MEDICAL INC SURGICALSUPPLIES A/P 203599 4/3/2024 315.58 MMCAUXIUARY GIFT SHOP PAYROLLDEDUCF A/P 203600 4/3/2024 0.00 VOIDED VOIDED A/P 203601 4/3/2024 31,609.61 MORRIS & DICKSON CO, LLC PHARMACY INVENTORY A/P 203602 4/3/2024 344.38 NINAGREEN EMPLOYEE REIMBURSEMENT A/P 2036D3 4/3/2024 972.20 ORTHO CLINICAL DIAGNOSTICS LABORATORYSUPPUES A/P 2036" 4/3/2024 1,725.00 PUCPR, LLC CPR CERTIFICATIONS/TRAINING A/P 203605 4/3/2024 3,50D.00 RADSOURCE SERVICEAGREEMENT A/P 2036DS 4/3/2024 2,324.90 REPUBLIC SERVICES, INC. TRASH SERVICES A/P 203607 4/3/2024 345.78 SAM'S CLUB DIRER MISCELLANEOUS SUPPLIES A/P 203608 4/3/2024 1,320.00 SOUTH TEXAS BLOOD &TISSUE CON BLOOD A/P 203609 4/3/2024 246.15 SPARKLIGHT INTERNET/CABLE A/P 203610 4/3/2024 550.00 STANFORD VACUUM SERVICE GREASETRAP A/P 203611 4/3/2024 907.12 STERIS CORPORATION SURGICALSUPPUES A/P 203612 4/3/2024 27.00 TELEFLEX MEDICAL MEDICAL SUPPLIES A/P 203613 4/3/2024 168.00 MPATIENTREFUND A/P 203614 4/3/2024 422.20 TRIOSE, INC FREIGHT A/P 203615 4/3/2024 0.00 VOIDED VOIDED A/P 203616 4/3/2024 10,499.86 UNIFIRST HOLDINGS INC LAUNDRY A/P 203617 4/3/2024 4,796.76 VELOCITY EHS ANNUAL MSDS SUBSCRIPTION A/P 203618 4/3/2024 19D.94 WAI RE MEDICAL 211 INC RESPIRATORYEQUIP A/P 203619 4/3/2024 120.00 M PATIENTREFUND A/P 203620 4/3/2024 12,500.00 WOUND CARESPECIALISTS WOUND CARE SERVICES A/P 203624 4/2/2024 0.00... VOIDED CHECK••• VOID A/P 203675 4/10/2024 369.52 AIRGAS USA, LLC-CENTRAL DIV OXYGEN -RESP CARE A/P 203676 4/10/20Z4 215.04 ALCO SALES & SERVICE CO MEDICAL SUPPLIES A/P 203677 4/10/2024 77.99 AMAZON CAPITAL SERVICES VARIOUS DEPT EXPENSES A/P 205678 4/10/2024 233.37 AMERISOURCEBERGEN DRUG CORP PHARMACY INVENTORY A/P 2133679 4/10/2024 594.00 AZALEA HEALTH EHR PROCESSING FEES A/P 203620 4/10/2024 273.25 BECTON, DICKINSON&CO)BD) SURGICALSUPPLIES A/P 203681 4/10/Z024 3,575.64 BIO-RAD LABORATORIES, INC DIAGNOSTICSUPPLIES A/P ZD3682 4/10/2024 393.00 BOSTON SCIENTIFIC CORPORATION MEDICALSUPPLIES Page 1 of 6 BANK CODE CKIf DATE AMOUNT PAYEE NOTES A/P 203683 4/10/2024 2,640.00 CALHOUN COUNTY EMS EMS A/P 303684 4/10/2024 469.93 COW GOVERNMENT, INC. 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ADVERTISING A/P 203715 4/10/2024 3,660.00 SURGICALDIRECT SOUTH SUPPUES A/P 203716 4/10/2024 3,150.00 TRAVEL NURSE ACROSS AMERICA ER NURSE STAFFING A/P 203717 4/10/3024 98.48 TRIWHOLESALE CO. 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4/17/2024 346.01 CALHOUN COUNTY FUEL A/P 203743 4/17/2024 199.003WON, LLC CREDENTIALNG A/P 203744 4/17/2024 1,650.00 ACUTE CARE INC RFID FEE A/P 203745 4/17/2024 142.18 AMAZON CAPITALSERVICES VARIOUS DEPT EXPENSES A/P 203746 4/17/2024 1,353.45 AMERISOURCEBERGEN DRUG CORP PHARMACY INVENTORY A/P 203747 4/17/2024 134.50 AQUA BEVERAGE COMPANY WATER A/P 203748 4/17/2024 1,1S5.00 AVENONETWORKS DELL/SOFTWARE A/P 203749 4/17/2024 0.00 VOIDED VOIDED A/P 203750 4/17/2024 2,528.00 BECKMAN COULTER INC LABORATORYSUPPUES A/P 203751 4/17/2024 2,041.68 8I0-MD LABORATORIES, INC DIAGNOSTIC SUPPLIES A/P 203752 4/17/2024 150.0D CABLES AND SENSORS MEDICAL SUPPUES A/P 203753 4/17/2024 60,604.62 CNIZENS MEDICAL CENTER ANESTHESIA SERVICES A/P 203754 4/17/2024 220.00 CLSI LOCKBOX LAB SUPPLIES A/P 203755 4/17/2024 31,386.00 COASTALOFFICESOLUTONS ER RECEPTION RENOVATION A/P 203756 4/17/2024 80S.51 COCA COLA SOUTHWEST BEVERAGES BEVERAGES A/P 203757 4/17/2024 501.72 COMBINED INSURANCE PAYRDLLDEDUCT A/P 203759 4/17/2024 1,990.00 DA&E CAH MEDICARE REIMBURSEMENT A/P 203759 4/17/2024 456.28 DETAR HOSPITAL U11ORATORYSERVICES A/P 203760 4/17/2024 1,578.99 DEWITT POTH&SON OFFICE SUPPLIES A/P 203761 4/17/2024 SD,311.25 DIAMOND HEALTHCARE CORP PURCHASED SERVICES -BEHAVIORAL HEALTH A/P 203762 4/17/2024 90,779.87 DISCOVERY MEDICAL NETWORK INC PHYSICIAN SERVICES A/P 203763 4/17/2024 1,030.00 DOWELL PEST CONTROL PESTCONTROL A/P 203764 4/17/2024 1,372.60 DSHS CENTRAL 09 MC2004 LABORATORY SERVICES A/P 203765 4/17/2024 2,271.00 E FRIEDMAN ASSOCIATES INC PLANT SERVICES SUPPLIES A/P 203766 4/17/2024 29,568.58 EVIDENT CONSULTING SERVICES A/P 203767 4/17/2024 5,459.26 FISHER HEALTHCARE LABORATORY SUPPLIES Page 2 of 6 BANK CODE CK4 DATE A/P 20370 4/17/2024 A/P 203769 4/17/2024 A/P 203770 4/17/2024 A/P 203771 4/17IM24 A/P 203T/2 4/17/2024 A/P 203773 4/17/2024 A/P 203774 4/17/2024 A/P 203AS 4/17/2024 A/P 203776 4/17/1024 A/P 203777 4/17/2024 A/P 203778 4/17/2024 A/P 203779 4/17/2024 A/P 20378D 4/17/2024 A/P 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INC 1,200AD PADRON WELDING SERVICE 300.00 POC ELECTRIC, LLC 2,729.76 PRESS GANEY ASSOCIATES, INC. 2,905.58 PRO ENERGY PARTNERS LLC 66.00 RAPID PRINTING LLC 1,S0IA0 REFUGIO COUNTY MEM. HOSPITAL 4,038.24 SIEMENS FINANCIAL SERVICES 410.00 SIGN AD, LTD. 9,132.65 SINGLETON ASSOCIATES, P.A. 290.00 SKIP'S RESTAURANT EQUIPMENT 4,934.00 SOUTH TEXAS BLOOD & TISSUE CEN 1,842.00 SPARKLIGHT 19,673.84 SPBSCUNICALEQUIPMENTSRVC 350.00 STANFORD VACUUM SERVICE 3,308.51 STERICYCLE, INC 202.80 STERISCORPORATION 20.721.85 TEXAS ASSOCIATION OF COUNTIES 7,054.00 TEXAS MUTUAL INSURANCE CO 3,173.32 UNIFIRSTHOLDINGS INC 8,950.OD VICTORIA MEDICAL FOUNDATION 785.36 NICOLE BARNETT 4,936.51 AIRGAS USA, LLC-CENTRAL DIV 973.24 AUMED INC. 217.09 AMAZON CAPITALSERVICES 4,661.27 BAXTERHEALTHCARE 1,656.12 BAYER HEALTHCARE 19,348.26 BECKMAN COULTER INC 1,699.00 CERVEY, LLC 20,226.13 CUNICAL PATHOLOGY LABS 2,295.10 CORROHEALTH, INC. 31,560.8E CULINARY CONCESSIONS LLC 684.65 CULLIGAN U LTRAPURE INC. 51.47 OETARHOSPITAL 628.03 OEWITTPOTH&SON 97,689.32 DISCOVERY MEDICAL NETWORK INC 477.50 ECUNICAL WORKS LLC 40,062.50 EMERGENCY STAFFING SOLUTIONS 5,500.00 EQUALIZE RCM SERVICES 10.99 EQUIFAX WORKFORCE SOLUTIONS 8,657.35 EVIDENT 545.00 FASTHEALTH CORPORATION 3,631.39 FIRST INSURANCE FUNDING 0.00 VOIDED 4,481.95 FISHER HEALTHCARE 12,675.54 GE HEALTHCARE 204.83 GE PRECISION HEALTHCARE, LLC 700.0 GUERBET, LLC 815.29 GULF COAST PAPER COMPANY 4,610.52 HEALTHCARE FINANCIAL SERVICES 120.96 HEALTHSTREAM, INC. 573.53 HEWLETT-PACKARD 255.67 HILL -ROM COMPANY, INC 472.50 HOLOGIC INC 23,663.00 HOSPITALCARE CONSULTANTS INC. 15,004.03 HUNTER PHARMACY SERVICES NOTES AUDITING FEES TELEPHONE COPIERLEASE REPORTS/SUDES HOUSEKEEPING SUPPLIES -COIL CLEANER FOODSUPPLIES LEGALSERVICES CUNICTELEHEALTH SHREDDING VENTCLEANING EMPLOYEE MILEAGE REIMBURSEMENT LABORATORYSERVICES TRANSLATION SERVICES MISCELLANEOUS SUPPLIES PAYROLLOEDUCT MEDICALSUPPLIES PAYROLL DEDUCTIONS PAYROLLDEDUCT VOIDED VOIDED PHARMACY INVENTORY SURGICALSUPPUES PIANTSERVCIES- PIPE HANDRAILS INSTALLATION PROFESSIONALFEES FUEVPIANT OPS/ENERGY SERVICES MISCELLANEOUS PRINTING INVENTORY PHARMACY DIAGNOSTIC IMAGING EQUIP LEASE ADVERTISING ONSITE SERVICES RADIOLOGY DIETARY LABOR- INSTALL DISHWASHER BLOOD INTERNET/CABLE PM CONTRACT GREASE TRAP WASTE DISPOSAL SURGICALSUPPLIES WORKERS COMP LAUNDRY 2024 MEMBERSHIP DUES, MULTIPLE CUNIC STAFF EMPLOYEE PAYROLL CHECK OXYGEN -RESP CARE MEDICALSUPPLIES VARIOUS DEPT EXPENSES MEDICAL/NURSING SUPPLIES MEDICAL/CT SUPPLIES LABORATORYSUPPLIES LICENSE FEE LABORATORY SERVICES CODING SERVICES DIETARYSERVICES WATER IABORATORYSERVICES OFFICESUPPUES PHYSICIAN SERVICES EMIR PHYSICIANSERVICES CODING & BILLING SERV FEE ANCILLARY CONSULTING SERVICES WEBSITE HOSPITAL INSURANCE VOIDED LABORATORY SUPPLIES EQUIP LEASE & MED SUPPLIES EQUIP LEASE & MED SUPPLIES LAB SUPPLIES HOUSEKEEPING SUPPLIES LEASE EMPLOYEE EDUCATION RENTAL/DOCUMENTATION FEE MEDICAL EQUIP/SUPPLIES RADIOLOGYSUPPLIES PHYSICIAN SERVICES PAYROLL Page 3 of 6 BANK CODE CKIf DATE AMOUNT PAYEE NOTES A/P 203853 4/24/2024 736.S61NOVALON PROVIDER INC. SCHEOULIN05ERVICE A/P 203854 4/24/1024 155.00 INRAD NEEDLES A/P 203855 4/24/2024 60.00 INTOXIMETERS INC LABORATORY SUPPLIES A/P 203856 4/24/2024 85.62 JACKSON COUNTY HOSPITAL PHARMACY INVENTORY A/P 203857 4/24/2024 9,000.00 JINOALXLLC REVENUE CYCLE MANAGEMENT A/P 203858 4/24/2024 22.33 LABCORP OF AMERICA HOLDINGS LABORATORYSERVICES A/P 203959 4/24/2024 624.35 LEGALSHIELD PAYROLL DEDUCT A/P 203860 4/24/2024 SWAG MANAGED CARE PARTNERS INC. PROFESSIONALFEES A/P 203861 4/24/2024 250.84 MARISSAALMAN2AR EMPLOYEE EXPENSE REIMBURSEMENT A/P 203862 4/24/2024 1,524.97 MCKESSON MEDICAL SURGICAL INC LAB SUPPLIES A/P 203863 4/24/2024 0.00 VOIDED VOIDED A/P 203864 4/24/2024 2,696.37 MEOUNE INDUSTRIES INC MEDICALSUPPUES A/P 2038M 4/24/2024 318.40 MELSTAN, INC. PLANTSERVICES SUPPLIES A/P 203866 4/24/20M 583.83 MIMI NGUYEN EMPLOYEE REIMBURSEMENT A/P 203867 4/24/2024 23.69 MOMENTUM RENTAL&SALES PLANTSERVCIES SUPPLIES A/P 20386B 4/24/2024 0,00 VOIDED VOIDED A/P 203869 4/24/2024 42,266.25 MORRIS & DICKSON CO, LLC PHARMACYINVENTORY A/P 203870 412412OU 25,595.83 MITTUALOFOMAHA MONTHLY PREMIUMS -SUPPLEMENTAL EMPI A/P 203871 4/24/2024 295.22 NACOGDOCHES TRANSCRIPTION TRANSCRIPTION A/P 203872 4/24/2024 240.00 NEOGENOMICS LABORATORIES LAB SERVICES A/P 203873 4/24/2024 472.50 OCCUPRO LLC PROVIDERLICENSE A/P 203874 4/24/2D14 1,125.00 OLYMPUS AMERICA INC SURGICAL SUPPLIES A/P 203875 4/24/2024 1,846.60 ORTHOCUNICALDIAGNOSTICS LABORATORYSUPPUES A/P 203876 4/24/2024 3,084.00 PARAREV REV INTEGRITY PROG/ QTRLY PROCESSING A/P 203877 4/24/2024 152.90 PARTSSOURCE, LLC MEDICAL EQUIP REPAIR SUPPUES A/P 203878 4/24/2024 277.49 PITNEY BOWES INC POSTAGE/ RENTAL MAIL MACHINE A/P 203879 4/24/2024 1,791.67 RAOSOURCE SERVICE AGREEMENT A/P 203880 4/24/2024 180.00 RAPID PRINTING LLC MISCELLANEOUS PRINTING A/P 203881 4/24/2024 185.22 SHERWIN WILLIAMS PLANTSERVICE SUPPLIES A/P 203138E 4/24/2024 5,000.00 SOUTHEASTTEXAS HEALTH SYS QUARTERLY DUES A/P 203883 4/24/2024 420.00 ST DAVIDS HEALTHCARE CONNECTIVITY FEE A/P 203884 4/24/2024 3,628.40 STRYKER SALES CORP MEDICAL EQUIPMENT/SUPPLIES A/P 203885 4/24/2D24 6,130.42 T-SYSTEM, INC PHYSICIAN TRACKING LICENSE A/P 203886 4/24/2024 2,625.00 TEXAS A&M CONTINUING EDUCATION/TRAINING A/P 203887 4/24/2024 13,700.00 TEXAS ELITETHERAPY TEAM LLC STAFFING-PHYSICALTHERAPY A/P 203888 4/24/2024 494.39 THIRD COAST DISTRIBUTING LLC PIANTSERVOES SUPPLIES A/P 203889 4/24/2024 3,467.50 TRIAGE, LLC AGENCYSTAFFING A/P 203890 4/24/2024 10,264.61 UNIFIRST HOLDINGS INC LAUNDRY A/P 203891 4/24/2024 23.67 WEBPT, INC SUBSCRIPTION A/P 203892 4/24/2024 416.00 WEST COAST MEDICAL RESOURCES SURGICALSUPPUES A/P 203893 4/24/2024 23,501.33 WOLTERS KLUWER S YR CONTRACT SENTRI 7. NURSING ADMIN A/P SOD590 4/5/2024 965.59 AMERISOURCE 340E EXPENSE A/P 500591 4/2/2024 3,539.65 MCKESSON 340 B EXPENSE A/P 500592 4/12/2024 420.66 AMERISOURCE 3408 EXPENSE A/P 500593 4/9/2024 4,329.79 MCKESSON 340 B EXPENSE A/P 500594 4/16/2024 3,10126 MCKESSON 3408 EXPENSE A/P 500595 4/1S/2024 679.53 AMERISOURCE 3408 EXPENSE A/P 500596 4/26/2024 303.90 AMERISOURCE 340E EXPENSE A/P 500597 4/23/2024 1,611.37 MCKESSON 340 BEXPENSE A/P SOOS98 4/22/2024 678.99 AMERISOURCE 340EUPENSE A/P SM600 4/30/2024 8,444.11 MCKESSON 3408 EXPENSE A/P 7W130 4/5/2024 10.00 WIRE OUT KNOX TECHNOLOG REBATE ACCOUNT CONFIRMATION A/P 7W131 4/19/2024 1,913.05 WEBFILE TAX PYMT SALES TAX A/P 800500 4/4/2024 1SA47.67 HEALTHEQUITY EMPLOYEE WAGE WORKS A/P 800501 4/4/2024 24,06.24 HPHG EMPLOYEE INSURANCECLAIM PAYMENTS A/P BWS02 4/1/2024 128,734.52 IRS USATAXPYMT PAYROLLTAXFS A/P 8W503 4/12/2024 10,960.25 HPHG LLC EMPLOYEE INSURANCE CLAIM PAYMENTS A/P 800504 4/12/2024 1,170.74 HPHG LLC EMPLOYEE INSURANCE CLAIM PAYMENTS A/P 800505 4/12/2024 48,711.58 HPHG LLC EMPLOYEE INSURANCE CLAIM PAYMENTS A/P BWS06 4/12/2024 34,206.14 HPHG LLC EMPLOYEE INSURANCE CLAIM PAYMENTS A/P BOD507 4/12/2024 1,322.83 HEALTHEQUITY INC EMPLOYEEWAGEWORKS A/P 800508 4/12/20M 570.69 EXPERTPAY CHILOSUPPORT A/P 800509 4/12/2024 66,570.23 HPHG LLC EMPLOYEE INSURANCE PREMIUMS A/P 000510 4/8/2024 0.03 HPHG LLC EMPLOYEE INSURANCEADJUSTMENT A/P 800511 4/15/2024 275,260.53 TCDRS EMPLOYEE RETIREMENT A/P 800512 4/25/2024 221,228.32 IRS USATAXPYMT PAYROLLTAXES A/P 800513 4/26/2D24 1,272.83 HEALTHEQUITY EMPLOYEEWAGE WORKS A/P 800514 4/26/2024 570.69 EXPERTPAY CHILDSUPPORT A/P 800515 4/29/2024 126,084.86 IRS USATAXPYMT PAYROLLTAXES A/P 800516 4/29/2024 69,685.87 HPHG PREMIUM EMPLOYEE INSURANCE PREMIUMS A/P 901117 4/5/2024 189.48 PAY PLUS 3RD PARTY PAYOR FEE A/P 91)1138 4/5/2024 75.67 FOMSFDMS PYMT CREDIT CARD PROCESSING FEE A/P 901119 4/5/2024 32.45 FOMS FONG PYMT CREDIT CARD PROCESSING FEE A/P 901120 4/4/2024 19.20 PAY PLUS 3RD PARTY PAYOR FEE A/P 901121 4/3/2024 5.29 PAY PLUS 3RD PARTY PAYOR FEE A/P 901122 4/3/2024 341.70 MERCHANT BANKCD DISCOUN CREDIT CARD PROCESSING FEE A/P 901123 4/3/2024 19.95 MERCHANT BANKCD DISCOUN CREDIT CARD PROCESSING FEE A/P 9U312A 4/3/2024 0.06 MRCHANT BNKCD FINCL ADI CREDIT CARD PROCESSING FEE A/P 901125 4/3/20M 184.00 MERCHANT BANKCD FEE CREDIT CARD PROCESSING FEE INSURANCE Page 4 of 6 BANK CODE CKR DATE AMOUNT PAYEE A/P 901126 4/3/2024 9.95 MERCHANT BANKCD FEE CREDITCARD PROCESSING FEE A/P 901127 4/3/2024 23.31 MERCHANT BANKCD INTERCH CREDIT CARD PROCESSING FEE A/P 901128 4/2/2024 136.64 PAY PLUS 3RD PARTY PAYOR FEE A/P 901129 4/2/2024 31.9D AUTHNEFGATEWAY BILLING 3RD PARTY PAYOR FEE A/P 901230 4/l/2024 213.03 PAY PLUS 3RD PARTY PAYOR FEE A/P 901131 4/11/2024 54.79 PAY PLUS 3RD PARTY PAYOR FEE A/P 901132 4/10/2024 66.66 PAY PLUS 3RD PARTY PAYOR FEE A/P 901233 4/10/2024 900.18 TSYS CCMACHINEFEES A/P 901134 4/10/2024 129.00 TSYS CCMACHINEFEES A/P 901135 4/10/2024 27.85 TSYS CC MACHINE FEES A/P 901136 4/10/2024 315.79 TSYS CC MACHINE FEES A/P 901137 4/10/2024 325.82 T5YS CC MACHINE FEES A/P 901136 4/10/2024 1,294.73 TSYS CC MACHINE FEES A/P 901139 4/10/2024 1,353.34 TSYS CC MACHINE FEES A/P 901140 4/10/2024 283.92 TSYS CC MACHINE FEES A/P 901141 4/9/2024 11.80 PAY PLUS 3RD PARTY PAYOR FEE A/P 901142 4/9/2024 117.37 CLEARGAGE PATIENT FINANCING SERVICE A/P 901143 4/8/2024 3.64 PAY PLUS 3RD PARTY PAYOR FEE A/P 903144 4/19/2024 16AS PAY PLUS 3RD PARTY PAYOR FEE A/P 90114S 4/18/2024 52.16 PAY PLUS 3RD PARTY PAYOR FEE A/P 901146 4/17/2024 12.40 PAY PLUS 3RD PARTY PAYOR FEE A/P 901147 4/16/2024 7,31 PAY PLUS 3RD PARTY PAYOR FEE A/P 901149 4/15/2024 112.60 PAY PLUS 3RD PARTY PAYOR FEE A/P 901149 4/15/2024 45.64 FDMS CCMACHINELEASE A/P 901150 4/15/2024 40.03 FDMS CCMACHINELEASE A/P 901151 4/15/2024 120.09 FDMS CC MACHINE LEASE A/P 901152 4/15/2024 80.06 FDMS CC MACHINE LEASE A/P 901153 4/26/2024 235.09 PAY PLUS 3RD PART/ PAYOR FEE A/P 901254 4/25/2024 554.86 PAY PLUS 3RD PARTY FAVOR FEE A/P 902155 4/24/2024 402.59 PAY PLUS SRO PARTY PAYOR FEE A/P 901156 4/23/2024 34.90 PAY PLUS 3RD PARTY PAYOR FEE A/P 901157 4/22/2024 68.75 PAY PLUS 3RD PARTY PAYOR FEE A/P 901167 4/30/2024 158.42 PAY PLUS 3RD PARTY PAYOR FEE A/P 901168 4/29/2024 457.93 PAY PLUS 3RD PARTY PAYOR FEE A/P 901169 4/26/2024 3,753.48 WIRE OUTCBNA CITIBANK CREDIT CARD PAYMENT A/P M1130A 4/12/2024 275.52 PAY PLUS 3RD PARTY PAYOR FEE A/P TOTALS 2,622,740.29 NHG 209 4/3/2024 621.86 MMCOPERATING NHG 210 4/74/2024 21,216.60 MMCOPERATING NHF 249 4/3/2024 7,021.SS MMCOPERATING NHF 244 41312ON 301.90 MMCOPERATING NHF 245 4/10/2024 2,379.01 MMCOPERATING NHF 246 4/24/2024 10,890.73 MMCOPERATING NHB 271 4/3/2024 8,341.55 MMCOPERATING NHB 272 4/3/2024 693.15 MMCOPERATING NHB 275 4/10/2024 25,123.35 MMCOPERATING NHB 274 4/24/2024 12,918.38 MMCOPERATING NHC 334 4/3/2024 6,196.77 MMCOPERATING NHC 335 4/3/2024 972.37 MMCOPERATING NHC 336 4/10/2024 13,338.04 MMCOPERATING NHC 337 4/10/2024 1,000.00 TUSCANY VILLAGE NHC 338 4/24/2024 9,682.18 MMC OPERATING GPM 1017 4/24/2024 4,548.60 MMCOPERATING BSL 1040 4/3/2024 826AB MMC OPERATING BSL 1041 4/24/2024 20,732.56 MMCOPERATING GPP 1115 4/18/2024 10,364.27 ASHFORD TUS 1151 4/3/2024 23,808.13 MMCOPERATING TILLS 1152 4/3/2024 3,150.00 SOLERA TILLS 1153 4/24/2024 21,486.76 MMCOPERATING NHA 1235 4/3/2024 22,405.01 MMCOPERATING NHA 1236 4/3/2024 70,78 MMCOPERATING NHA 1237 4/24/2024 34,871.14 MMCOPERATING NHS 1297 4/3/2024 6,724.64 MMCOPERATING NHS 1299 4/3/2024 738.98 MMCOPERATING NHS 1299 4/10/2024 20,883.28 MMCOPERATING NHS 13M 4/24/2024 10,488.12 MMC OPERATING NURSINGHOMETOTALS 292,231.20 ICP 012632 4/I2/2024 4,166.67 MEMORIAL MEDICAL CENTER ICP 12633 4/12/2024 30.25 MEMORIAL MEDICAL CENTER ICPTOTAL 4,196.92 A/P 203621 4/3/2024 461.40 BETHANY SENIOR LIVING A/P 203622 4/3/2024 3,823.03 GOLDENCREEK HEALTHCARE A/P 203623 4/3/2024 10,747.88 TUSCANYVILLAGE A/P 203725 4/10/2024 46,963.69 BETHANY SENIOR LIVING A/P 203726 4/10/2024 3,264.00 BROADMOOR AT CREEKSIDE PARK A/P 209727 4/10/2024 105,849.38 GOLDENCREEK HEALTHCARE pa-yM Page 5 of 6 BANK CODE Can DATE AMOUNT PAYEE A/P 203728 4/10/2024 1,065.26 GULF POINTE PLAZA A/P 203729 4/10/20M 16,975.20 THE CRESCENT A/P 203730 4/10/2024 39,875.92 TUSCANY VILLAGE A/P 203812 4/17/20M 1,691.36 BROADMOORATCREEKSIOE PARK A/P 203813 4/17/2024 2W.28 FORTBEND HEALTHCARE CENTER A/P 203814 4/17/2024 4,041.81 GOLDENCREEKHEALTHCARE A/P 203815 4/17/2024 95.88 GULF POINTE PLAZA A/P 203816 4/17/2024 4,489.00 SOLERAWESTHOUSTON A/P 203817 4/17/2024 320,000.00 TUSCANYVILLAGE A/P 203894 4/Z4/2024 78,942.20 BETHMY SENIOR LIVING A/P 2MB95 4/24/2024 104,787.55 GOLDENCREEKHEALTHCARE A/P 203896 4/24/2024 3,060.00 SOLERAWESTHOUSTON A/P 203897 4/24/207A 6,03800 THE CRESCENT A/P 203898 4/24/2024 7,679.91 TUSCANYVILLAGE NURSING HOME AP TOTALS 760,855.75 P/R 63413 4/12/2024 1,n1.08 Pay Period03/22/24-04/04/23 P/R 63414 4/12/2024 133.95 Pay Period 03/22/24A4/04/23 P/R 63415 4/12/2024 2,510.69 Pay Perlod03/22/24.04/W/23 P/R 63416 4/12/2024 198.79 Pay Period 03/22/24-04/04/23 P/R 63417 4/26/2024 912.41 Pay Period W/05/24-a4/18/24 P/R 63418 4/26/2024 832.13 Pay Period 04/05/24-04/18/24 P/R 999999 4112IN24 366,473.31 Pay Period 03/22/24414/W/23 P/R 999999 4/26/2024 392,574.96 Pay Period W/05/24-04/18/24 P/R TOTALS 765,408.12 A/P 198687 4/12/2024 (274A6) LIU HUO LIANG A/P 198694 4/1Z/W24 I25.00) IOHN R PERE A/P 198703 4/12/2024 (22.65)AETNA A/P 198766 4/1Z/2024 (10.40) AGUIRREIONATHAN A/P 198781 4/12/2024 (13.80) CASTROARREOLA MA BUEN A/P 199278 4/11/2024 (499.00) 3WON, LLC Voided AP Checks (845.01) Grand Total 4,435,187.27 NOTES Pate 6 of 6 MEMORIAL MEDICAL CENTER GROSS PAYROLL REPORT - APRIL 2024 PRTitle SECURITY SUPERVISOR OPERATOR LICENSED VOCATIONAL PURCHASING AGENT REGISTERED NURSE REGISTERED NURSE LICENSED VOCATIONAL REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE DIRECTOR OF INPT SVC EXECUTIVE ASSISTANT LICENSED VOCATIONAL MEDICAL LAB TECH MEDICAL TECHNOLOGIST LAB ASSISTANT MEDICAL LAB TECH REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CLINICAL IT SPCLST REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE INTERIM CEO LVN REGISTERED NURSE OCCUPATIONAL THERAPY LICENSED VOCATIONAL NURSE PRACTITIONER REGISTERED NURSE REGISTERED NURSE CERTIFIED NURSE AIDE CERTIFIED NURSE AIDE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE STUDENT NURSE TECH CASE MANAGER/UR/DP REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE PRDeptName SECURITY CLINIC FS MEMORIAL MEDICAL CLINIC CENTRAL SUPPLY MED/SURG MED/SURG OBSTETRICS MED/SURG OBSTETRICS EMERGENCY ROOM MED/SURG ADMINISTRATION SURGERY LABORATORY LABORATORY MMC CLINIC - LABORATORY LABORATORY MED/SURG OBSTETRICS EMERGENCY ROOM MED/SURG ADMINISTRATION -CLINICAL SERVIC OBSTETRICS OBSTETRICS OBSTETRICS OBSTETRICS OBSTETRICS ADMINISTRATION MED/SURG MED/SURG OCCUPATIONAL THERAPY MED/SURG MEMORIAL MEDICAL CLINIC MED/SURG MED/SURG MED/SURG MED/SURG EMERGENCY ROOM MED/SURG MED/SURG MED/SURG MED/SURG MED/SURG UTILIZATION REVIEW ICU MED/SURG OBSTETRICS MED/SURG PRTotGross 3576.95 2874.22 4034.39 2674.19 5379.64 7529.44 4369.17 7555.31 7009.3 6776.98 7517.8 4507.2 5265.66 5242.63 240 3662.25 5751.79 2455.14 491 5126.96 630.94 6656.08 5505.14 3018.14 959.01 885.5 7467.99 14366.16 850.78 7665.99 7345.6 5183.06 16027.15 7118.62 4762.06 3434.83 1008.69 1592.29 5636.12 5638.05 4560.16 4401.32 210.89 6190.39 4900.31 7912.14 6850.15 452.5 REGISTERED NURSE REGISTERED NURSE CERTIFIED NURSE AIDE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CERTIFIED NURSE AIDE REGISTERED NURSE LVN REGISTERED NURSE INFUSION NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CLINICAL COORDINATOR REGISTERED NURSE LICENSED VOCATIONAL NURSE PRACTITIONER CERTIFIED NURSE AIDE DIRECTOR OF QUALITY REG PHARM TECH SUPER NURSE PRACTITIONER REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE PREADMISSION NURSE REGISTERED NURSE HIM SPECIALIST REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CERTIFIED STERIL TEC MATERIALS MNGMT MNGR CENTRAL SUPPLY TECH DIRECTOR REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE TRAUMA COORDINATOR REGISTERED NURSE REGISTERED NURSE MLT REGISTERED NURSE LAB ASSISTANT REGISTERED NURSE LAB ASSISTANT SURGERY MED/SURG MED/SURG EMERGENCY ROOM MED/SURG MED/SURG MED/SURG MED/SURG MED/SURG OBSTETRICS INFUSION CLINIC ICU MED/SURG EMERGENCY ROOM MEMORIAL MEDICAL CLINIC ICU MED/SURG HOSPITAL CAMPUS RHC MED/SURG ADMINISTRATION -CLINICAL SERVIC PHARMACY MEMORIAL MEDICAL CLINIC ICU OBSTETRICS ICU ICU ICU ICU SURGERY SURGERY HEALTH INFORMATION MANAGEMENT OBSTETRICS OBSTETRICS OBSTETRICS SURGERY CENTRAL SUPPLY CENTRAL SUPPLY EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM EMERGENCY ROOM MED/SURG EMERGENCY ROOM EMERGENCY ROOM ADMINISTRATION -CLINICAL SERVIC EMERGENCY ROOM EMERGENCY ROOM LABORATORY EMERGENCY ROOM LABORATORY EMERGENCY ROOM LABORATORY 2241.88 5556.61 1971.42 486.56 931.25 5986.25 2107.89 446.88 5125.83 8740.61 6695.55 8672.93 7430.08 971.94 5870.12 5124.81 3597.95 23840.14 2412.46 6232 4024.07 9403.78 7588.79 4862.74 975.57 676.25 3727.63 6752.1 4620.64 6698.41 3200 7368.12 1823.2 1858.53 2850.08 4927.4 1123.5 8799.02 4527.03 4764.72 8657.95 864 1442.82 10057.53 5915.76 4576.05 7104.87 777 1342.14 2356.13 5622.7 LAB ASSISTANT LABORATORY MEDICAL LAB TECH LABORATORY CHEMISTRY/BB SPVS LABORATORY MEDICAL LAB TECH LABORATORY MLT LABORATORY MEDICAL ASSISTANT HOSPITAL CAMPUS RHC MEDICAL TECHNOLOGIST LABORATORY LAB ASSISTANT LABORATORY REGISTERED NURSE EMERGENCY ROOM MEDICAL TECH LABORATORY LAB ASSISTANT LAB COORDINATOR MEDICAL LAB TECH LAB ASSISTANT MEDICAL LAB TECH LAB ASSISTANT REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE REGISTERED NURSE CENTRAL SUPPLY TECH REGISTERED NURSE CERTIFIED NURSE AIDE REGISTERED NURSE RADIOLOGICAL TECH RECEPT/SECRETARY XRAY TECHNICIAN RADIOLOGY TECH RADIOLOGY TECH RADIOLOGIC TECH RADIOLOGICAL TECH LEAD MAMMO TECH NUCLEAR MED TECH RADIOLOGICAL TECH RADIOLOGICAL TECH PHARMACYTECH PHARMACY TECHNICIAN PHARMACY TECHNICIAN RECEPTIONIST INS COORDINATOR RECEPTIONIST MEDICAL ASSISTANT CERTIFIED NURSE AIDE LICENSED VOCATIONAL MEDICAL ASSISTANT RECEPTIONIST RECEPTIONIST RECEPTIONIST REFERRAL SPECIALIST OPERATOR COLLECTIONS CLERK OPERATOR LABORATORY LABORATORY MMC CLINIC - LABORATORY LABORATORY LABORATORY LABORATORY MED/SURG MED/SURG ICU MED/SURG CENTRAL SUPPLY MED/SURG MED/SURG EMERGENCY ROOM DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING DIAGNOSTIC IMAGING PHARMACY PHARMACY PHARMACY MEMORIAL MEDICAL CLINIC PATIENT FINANCIAL SERVICES CLINIC FS MEMORIAL MEDICAL CLINIC MED/SURG MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC CLINIC FS MEMORIAL MEDICAL CLINIC CLINIC FS MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC PATIENT FINANCIAL SERVICES CLINIC FS 2471.01 5648.38 7714.13 4020.26 8668.9 2521.85 7842.51 1530.38 1432.51 2765.75 1867.88 6305.31 2814.75 1854 4543.27 2248.12 4254.25 4709.5 4987.39 452.5 1941.73 2003.64 2490.58 5792.08 5594.88 2706.04 2782.67 3921.3 878 4827.5 6203.2 5206.08 7306.69 5050.66 4827.68 3241.6 1320.34 3290.77 1702.35 2652.47 2329.55 2107.37 1774.06 3949.37 518.4 2790.64 1441.8 2935.21 2716.31 2597.3 2387.28 2755.77 NURSE PRACTITIONER MEDICAL ASSISTANT NURSE PRACTITIONER MEDICAL ASSISTANT MEDICAL ASSISTANT LICENSED VOCATIONAL MEDICAL ASSISTANT MEDICAL ASSISTANT REFERRAL SPECIALIST MEDICAL ASSISTANT OFFICE COORDINATOR MEDICAL ASSISTANT LVN RECEPTIONIST CLINICAL SUPERVISOR RECEPTIONIST MEDICAL ASSISTANT NURSE PRACTITIONER COTA DIRECTOR REHAB SRVCS PHYSICAL THERAPIST OFFICE COORDINATOR REGISTERED NURSE PTA TEAM LEAD PTA REGISTERED NURSE MEDICAL ASSISTANT THERAPIST CIHCP COORDINATOR DIRECTOR OF HIM HIM SPECIALIST PHYSICAL THERAPIST RECORDS IMAGING TECH REGISTERED NURSE DIRECTOR OF HIM BIRTH REGIDIS ANALYS MEDICAL ASSISTANT MEDICAL ASSISTANT DIRECTOR OF DIETARY OPERATOR FOOD SERVICE STAFF FOOD SERVICE STAFF FOOD SERVICE STAFF FOOD SERVICE STAFF FOOD SERVICE STAFF FOOD SERVICE STAFF PLANT OPS TEAM LEAD PLANT OPS SPECIALIST DEPARTMENT ASSISTANT PLANT OPS SPECIALIST ES AIDE ES AIDE MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC HOSPITAL CAMPUS RHC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC HOSPITAL CAMPUS RHC MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC CLINIC FS MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC CLINIC FS MEMORIAL MEDICAL CLINIC CLINIC FS MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC OCCUPATIONAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY PHYSICAL THERAPY MEMORIAL MEDICAL CLINIC PHYSICAL THERAPY PHYSICAL THERAPY OBSTETRICS HOSPITAL CAMPUS RHC BEHAVIORAL HEALTH INDIGENT CARE PROGRAM HEALTH INFORMATION MANAGEMENT HEALTH INFORMATION MANAGEMENT PHYSICAL THERAPY HEALTH INFORMATION MANAGEMENT EMERGENCY ROOM HEALTH INFORMATION MANAGEMENT HEALTH INFORMATION MANAGEMENT MEMORIAL MEDICAL CLINIC MEMORIAL MEDICAL CLINIC DIETARY CLINIC FS DIETARY DIETARY DIETARY DIETARY DIETARY DIETARY PLANT OPERATIONS PLANT OPERATIONS PLANT OPERATIONS PLANT OPERATIONS ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES 8883.16 2292.82 8461.63 2833.44 540.46 3323.5 2339.05 3005.92 3050.12 1982.63 3103 2933.12 4566.23 2327.78 5807.18 1942.13 2816.73 11538.47 360 9660.81 7332.8 2140.9 6056.83 5106.44 6376 6725.6 2566.2 4790.4 3040 3961 2025.31 6241.6 1541.03 1159.51 992.16 2225.32 2608.23 2023.38 5877.8 1955.73 4007.5 3292.99 2002.85 3230.9 2886 2709.51 4283.82 2790.24 2461.75 2597 1978 2099.28 ES AIDE SECURITY OFFICER ES AIDE ES AIDE ES TEAM LEAD ES AIDE PLANT OPS SPECIALIST ES AIDE FLOOR TECHNICIAN ES AIDE ES SUPERVISOR FOOD SERVICE STAFF ES AIDE ES AIDE ES AIDE FOOD SERVICE STAFF FLOOR TECHNICIAN ES AIDE OR AIDE SECURITY OFFICER SECURITY OFFICER DIRECTOR OF PLANT OP SURGERY MANAGER DIRECTOR PERIOPERATIVE RN FINANCIAL COUNSELOR REGISTERED NURSE REGISTRATION CLERK INFUSION SVC COORD BILLING CLERK INFUSION SERV. COOR. ER CLERK REGISTRATION CLERK RECEPTIONIST CASHIER -SWITCHBOARD INS ADJUDICATOR MEDICARE COORDINATOR REGISTRATION CLERK ER CLERK ER CLERK ADMIN ASSISTANT DIRECTOR OF REV/BILL REGISTERED NURSE REG CLERK TEAM LEAD ER CLERK PRACTICE ADMIN REGISTERED NURSE MEDICAID COORDINATOR PERIOPERATIVE RN REGISTERED NURSE DIRECTOR REGISTRATION CLERK ENVIRONMENTAL SERVICES SECURITY ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES PLANT OPERATIONS ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES DIETARY ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES DIETARY ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES SURGERY SECURITY SECURITY PLANT OPERATIONS SURGERY ADMINISTRATION -CLINICAL SERVIC SURGERY INDIGENT CARE PROGRAM SURGERY PFS - REGISTRATION INFUSION CLINIC PATIENT FINANCIAL SERVICES INFUSION CLINIC PFS - REGISTRATION PFS - REGISTRATION PHYSICAL THERAPY PATIENT FINANCIAL SERVICES PATIENT FINANCIAL SERVICES PATIENT FINANCIAL SERVICES PATIENT FINANCIAL SERVICES PFS - REGISTRATION PFS - REGISTRATION ADMINISTRATION -CLINICAL SERVIC PATIENT FINANCIAL SERVICES SURGERY PFS - REGISTRATION PFS - REGISTRATION MEMORIAL MEDICAL CLINIC EMERGENCY ROOM PATIENT FINANCIAL SERVICES SURGERY ICU DIAGNOSTIC IMAGING PATIENT FINANCIAL SERVICES 1791.38 2616.68 1927.18 2711.92 2176.59 1920 3258.21 596.75 2392 1859 3325.01 3185.33 1888 2476 2578.4 2672.1 2354 2797.85 2506.59 786.25 2974.07 8790.6 8353.6 240 7806.28 3214.06 6162.68 969 2375.73 3588.69 2174.13 1362.25 3379.14 1929.23 2445.66 3566.87 2888.68 2038.26 2699.61 1282.94 3321.2 5456.4 1472.63 4460.54 2437.21 6963.05 6209.89 2548.09 5862.02 4662.07 7285.72 2194.34 I.T. DIRECTOR IT SYSTEM ANALYST IT SYSTEM ANALYST ACCOUNTANT LAB ASSISTANT MEDICAL ASSISTANT ACCOUNTS PAYABLE ACCOUNTANT CONTROLLER ACCOUNTANT CEO CFO HR MANAGER HR GENERALIST SPEC PROJ/MKGT MGR INFORMATION TECHNOLOGY 7009.3 INFORMATION TECHNOLOGY 52%08 INFORMATION TECHNOLOGY 6458.82 ACCOUNTING 3811 LABORATORY 1093.72 MEMORIAL MEDICAL CLINIC 2247.2 ACCOUNTING 2815.08 ACCOUNTING 5915.73 ACCOUNTING 7538.48 ACCOUNTING 4687.5 ADMINISTRATION 26018.28 ADMINISTRATION 13886.16 HUMAN RESOURCES 4825 HUMAN RESOURCES 3311.74 BUSINESS DEVELOPMENT 4626.92 $ 1,114,946.70 # 09 NOTICE OF MEETING — 610512024 9. Consider and take necessary action to authorize Commissioner Reese to utilize $7,262 in GOMESA funds to cover additional material costs for the Boggy Bayou Nature Park, Phase II, GLO CMP Cycle 26 Grant No. 24-089-000-E345. (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 6 of 28 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May22, 2024 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE -AGENDA ITEM Dear Judge Meyer. Ja/�..t��r�e5 Please place the following item on the Commissioners' Court Agenda for May 99, 2024. • Consider and take necessary action to authorize Commissioner Reese to utilize $7,262 in GOMESA funds to cover additional material costs for the Boggy Bayou Nature Park, Phase II, GLO CMP Cycle 26 Grant No. 24-069- 000-E345. Sincerely, �O Gary D.k s GDR/at P.O. Box 177 — Seadrift. Texas 77983 — email: earv.reesencalhouncom.ore — (361) 785.3141 — Fax (361) 785-5602 # 10 NOTI(T OF MEETING - 6/05/2024 10. Consider and take necessary action to approve the Infrastructure Development Plat (IDP) for Simple Stay, LLC and if approved, authorize the County Judge and Commissioner Behrens to sign the IDP. (JMB) pass Page 7 of 28 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309 Email: ioel.behrens(a)calhouneotx.or4 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for June 5, 2024. Consider and take necessary action to approve the development plat for Simple Stay, LLC. in Calhoun County, TX. Sincerely, Z !" �� Joel Behrens Commissioner Pct. 3 m E:wb F n ti ,n Lp'1aAM..4cNMlr:gigt'?ni"" F :.a u' q .. E ',9b 1 KIE ,CbPfF3:b �Y,BGY—, � W EeYe xxBgPllelxEm W ' lf Met `.'�ui/evie. me nwNomav umin EMoeoMPx O qa EMCPIIPi EI1dA 09.MY11UL880NBIgE ET �B1 M:11E94t81AMH 2 q _mg WEt.� E{144\��1 f6B81 E6E90ff90MEMINIVPYLEgd ',off'"�� awE ma EiC11Y998EC1pX -70 .60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 too-yr W.3. a 11 26 Plan Table of Contents ProjeCtNa'ne: Hydrology Studio v 3.0.0.32 05-30-2024 BasinModel Schematic...................................................................................................................................... 1 Hydrographby Return Period............................................................................................................................ 2 2 - Year HydrographSummary .................................................................................................................................. 3 Hydrograph Reports Hydrograph No. 1, Rational, Pre DA 1 (Total Site).................................................................................... 4 Tcby TR55 Worksheet........................................................................................................... 5 Hydrograph No. 2, Rational, Post DA 1(Unimproved),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 6 Tcby TR55 Worksheet.............................................................................................. 7 Hydrograph No. 3, Rational, Post DA 2 (Improved area)............................................................................ 8 HydrographNo. 4, Pond Route, pond.................................................................................................... 9 Detention Pond Reports- POND FOR DIRT_........................................................................... 10 Design Storm Report- IDF Based - Synthetic, 6-hr..................................................................... 14 25 - Year Hydrograph Summary ................................................................. ...................................................... ......... 15 Hydrograph Reports Hydrograph No. 1, Rational, Pre DA 1 (Total Site).................................................................................. 16 Hydrograph No. 2, Rational, Post DA 1(Unimproved),,,,,,,,,,,,,,,,,,,,,,,,,,;,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 17 Hydrograph No. 3, Rational, Post DA 2 (Improved area),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 18 HydrographNo. 4, Pond Route, pond ......................... ..................... .......................... ....................... .. 19 Design Storm Report- IDF Based - Synthetic, 6-hr..................................................................... 20 100 - Year HydrographSummary ................................................................................................................................ 21 Hydrograph Reports Hydrograph No. 1, Rational, Pre DA 1 (Total Site).................................................................................. 22 Hydrograph No. 2, Rational, Post DA 1(Unimproved),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 23 Hydrograph No. 3, Rational, Post DA 2 (Improved area),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 24 Hydrograph No. 4, Pond Route, pond.................................................................................................. 25 Design Storm Report- IDF Based - Synthetic, 6-hr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 26 OFReport ......................................................................................................................................................... 27 PrecipitationReport .......................................................................................................................................... 28 Basin Model Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 Pre DA s (Total Site) Post DA l(Unimproved) Post DA 2 (Improved area) j I pond Hydrograph by Return Period Hydmloay SWdio v 3.0.a32 Project Name: 05-30-2024 Hyd. No. Hydrograph Type Hydrograph Name Peak Outnow(cfs) 1-yr 2.yr 3-yr S-yr 10-yr 25-yr 50•yr 100yr 1 Rational Pre DA 1 (Total Site) 8.797 14.13 17.43 2 Rational Post DA 1(Unimproved) 6.555 10.53 12.99 3 Rational Post DA2(improved area) 3.748 6.047 7.473 4 Pond Route pond 0.102 0.218 0.290 Hydrograph 2-yr Summary HydrologyS olio v3.0.0,32 project Name: 05-30.2024 Hyd. No. Hydrograph 7jrpe Hydrograph Name Peak Plow (cfs) Time to Peak (l rs) Hydrograph Volume (cult) Inflow Hyd(s) Maximum Elevation (ft) Maximum Storage (cuft) 1 Rational Pre DA 1 (Total Site) 8.797 0.33 10,556 — 2 Rational Post DA t(Unimproved) 5.555 0.33 7,868 — 3 Rational Post DA2(Improved area) 3.748 0.17 2,249 — 4 Pond Route pond 0.102 0.33 2,026 3 11.14 2,200 Hydrograph Report Project Name: Hydrology Studio v 3.0.0.32 05-30.2024 Pre DA 1 (Total Site) Hyd. No.1 Hydrograph Type = Rational Peak Flow = 8.797 cfs Storm Frequency = 2-yr Time to Peak = 0.33 hrs Time Interval = 1 min Runoff Volume = 10,556 cuft Drainage Area = 7.0 ac Runoff Coeff. = 0.3" Tc Method = TR55 (See Worksheet) Time of Conc. (Tc) = 20.0 min OF Curve = Port Lavaca OF 2023.idf Intensity = 4.19 in/hr Freq. Corr. Factor = 1.00 Asc/Rec Limb Factors = 1/1 • composite C Worksheet AREA(aa) C DESCRIPTION 7.0 0.30 Un(Ww d 7.0 0.30 Qp = 8.80 cfs 10 g 8 -_..-. _...___ __.....----._..-.. --- -- - 7 _ -- il ----- i 6 a 4 3 -___ - -- ---._..---------------- -- ----.._._..,; 2 0 i 0 10 20 30 40 Time (min) Tc by TR55 Worksheet Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 DA 1 (Total Site) Hyd. No.1 Rational Segments Description A _ a C To (min) Shoot Flow Description Manning'sn 0.027 0.013 0.013 Flow Length (it) 100 2-yr, 24-hr Precip.,(in) 228 2.28 2.28 Land Slope (°.G) .37 Travel .Time .(min) 5.78 0.00 0.00 5.78 Shallow Concentrated Flow Flow Length (ft) 838.69 Watercourse Slope (%) 0.37 0.00 0.00 Surface Description Unpaved Paved Paved Average Velocity (ft/s) .98 Travel Time (min) 14.24 0.00 0.00 14.24 Channel Flow X-sectional. Flow Area.(sgft) Wetted Perimeter (ft) Channel Slope (%). Manning'sn 0.013 0.013 0.013 Velocity (ft/s) Flow :Length .(ft) Travel Time (min) 0.00 0.00 0.00 0.00 Total Travel Time 20 min E Hydrograph Report Hydrology Studio v 3.0.0.32 Post DA I(Unimproved) Project Name: 05-30-2024 Hyd. No. 2 Hydrograph Type = Rational Peak Flow = 6.555 ofs Storm Frequency = 2-yr Time to Peak = 0.33 hrs Time Interval =1 min Runoff Volume = 7,866 cult Drainage Area = 5.216 ac Runoff Coeff. = OX To Method = TR55 (See Worksheet) Time of Conc. (Tc) = 20.0 min IDF Curve = Port Lavaca IDF 2023.idf Intensity = 4.19 in/hr Freq. Corr. Factor = 1.00 Asc/Rec Limb Factors = 1/1 Composite C Worksheet ARW80) C DESCRIPTION 6216 0.20 unimpmva0 5:216 0.0D Qp = 6.56 cfs 7- 6- 4- a 3- 0- -- 0 10 20 30 40 Time (min) Tc by TR55 Worksheet Hydrology Studio v 3.0.0.32 DA 1(Unimproved) Rational Segments Description Sheet Flow Description Manning's n Flow Length.(ft): 2-yr, 24-hr Precip. (in) Land Slope (%) Travel Time.(min) Shallow Concentrated Flow Flow Length (it) Watercourse Slope(°k). Surface Description Average Velocity (ft/s) Travel Time (min) Channel Flow Xsectiona(:Flow Area (sgft) Wetted Perimeter (it) Channel Slope (%) Manning's n Velocity (ft/s) Flow Length (ft) Travel Time (min) Total Travel Time 0.027 0.013 0.013 100 2.28 2.28 2.28 .37 6.78 0.00 0.00 838.69 0.37 0.00 0.00 Unpaved Paved Paved .98 14.24 0.00 0.00 0.013 0.013 0.013 0.00 0.00 0.00 7 Project Name: 05-30-2024 Hyd. No. 2 Tc:(min).- 6.78 14.24 0.00 20 min Hydrograph Report Hydrology Studio v 3.0.0.32 Post DA 2 (Improved area) Project Name: 05-30.2024 Hyd. No. 3 Hydrograph Type = Rational Peak Flow = 3.748 c% Storm Frequency = 2-yr Time to Peak = 0.17 hrs Time Interval = 1 min Runoff Volume = 2,249 cult Drainage Area = 1.784 ac Runoff Coeff. = 0.37* To Method = User Time of Cone. (To) = 10.0 min OF Curve = Port Lavaca IDF 2023.idf Intensity = 5.68 in/hr Freq. Corr. Factor =1.00 Asc/Rec Limb Factors =1/1 • Composite C Wodrsheet AREA(ec) C DESCRIPTION 0.665 0.50 improved 0.666 0.30 unimproved 0.433 0.30 Pand 1.T60 aa7 Qp as 3.75 cfs a i I az- - --, - - .- 0 .—(.1. 0123456 2 I . . I ITI 1—r-1—I I 3 4 5 6 7 8 9 10 11 I . 1 12 13 14 15 16 1 17 18 19 20 Time (min) Hydrograph Report Project Name. Hydrology Studio v 3.0.0.32 05-30-2024 pond Hyd. No. 4 Hydrograph Type = Pond Route Peak Flow = 0.102 oft Storm Frequency = 2-yr Time to Peak = 0.33 hrs Time Interval =1 min Hydrograph Volume = 2,026 cult Inflow Hydrograph = 3 - DA2 (Improved area) Max. Elevation =11.14 ft Pond Name = POND FOR DIRT Max. Storage = 2,200 cult Pond Routing by Storage Indication Method Centerofmass detention time = a61 hn Op = 0.10 cfs 9 Pond Report Hydrology Studio v 3.0.0.32 POND FOR DIRT Project Name: 05-36-2024 Stage -Storage User Defined Contours Stage I storage Table Stage (ft) Elevation (10 ContourAma (900 Incr. Stotage (cuft) Total Storage (cuft) Description Input Bottom Elevation, ft 10.98 0.00 10.98 10,639 0.000 0.000 Voids (P/o) 100.00 0.21 11.19 17,753 2,981 2,981 Volume Celo < Ave End Area 0.41 11.39 18,873 3,663 6.644 Stage -Storage 11.4 -----_ -._ __.__._.-_...__.__.. .------------- ------------ - 0.4 -: 11.35 ------------------._...---- __..._..�.��- --.-__._._------------- --------- - - 0.35 --—----____._._..------ '- 0.3 -- -- 0.25 - —0.20.1 a 11.05 ----- --- -------- -- -.-_ ----.—.-- — --- 0.05 11 ----- ----- -:-- —----_— 0 0 1000 2000 3000 4000 5000 6000 Total Storage (cuft) — 2-yr — 25-yr—100-yr — Contours 10 Pond Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 POND FOR DIRT Stage -Discharge Orifice Culvert/Orifices Culvert Perforated Riser Rise, in 12 Hole Diamater,,in : Span, in ' 12 No holes - No. Barrels 1 Invert Elevation, R Invert Elevation, it 10.98 Height it Orifice Coefficient, Cc 0.60 Orifice Coefficient, Co> Length, ft: 20 Barrel Slope,%a .5 `. N-Value,n': 0.013 Weir Weirs Riser Ancillary 1 2 3 `- Shape / Type,:: ' ` Exfiltration, inlhr Crest Elevall ft- Crest Length, ft. Angle, deg - Weir Coefficient. Ow Stage -Discharge ----- ---- .. _ _.. ._.. 0 OAS 0.1 0.15 0.2 0.25 0.3 035 0.4 OAS 0.5 0.55 0.6 0.65 0.7 0.75 0.8 0.85 0.9 0.95 1 Discharge (cfs) Top of Pond —.2-yr — 25-yr—100-yr — Pond Outflow Pond Report Project Narre: Hydrology Studio v 3.0.0.32 05-30-2024 POND FOR DIRT Stage -Storage -Discharge Summary stage (tt) Elev. (tt) Storage (CUR) Culvert (cis) Orifices, oft Riser (cfs) Weirs, cfs Pf Riser (cfs) Exgl (cfs) User (cis) Total (cfs) 1 2 3 1 2 1 3 0.00 10.98 0.000 0.000 0.000 0.21 11.19 2,981 0.175 oc 0.175 0.41 11.39 6,644 0.514 oc 0.514 Suffix key, k=7nfefwnfml,as=ouilef Wnfrat s=submergo weir 12 Pond Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 POND FOR DIRT Pond Drawdown N Co l0 R N C G O O o 0 o Stage (ft) Co l0 V N M l0 V O O O O O O O O N t0 tD V O O O O o G O O O N m m n e ui C N I-- C F L � r i= � c 0 o LL LL Z a a M N E c 0 O VI N M N N N N N ro uo v N O O O O M f — (4) A013 13 Design Storm Report Hydrology Studio v 3.0.0.32 Storm Distribution: IDF Based - Synthetic, 6-hr Custom Storm filename: 05-30-2024 Storm Total Rainfall Volume (in) Duration 1-yr d 2-yr 3-yr 6yr 10-yr 25-yr 50yr 100yr Gins 3.49 4.15 0 5.18 6.03 -1.25 8.16 9.13 Incremental Rainfall Distribution, 2-yr Time Precip Time Precip Time Precip Time Precip Time Precip (hrs) (in) (hrs) (in) (hrs) (in) (hrs) (in) (hrs) (in) 2.50 0.014352 2.68 0.020797 287 0.041010 3.05 0.083363 3.23 0.027394 252 0.014751 270 0.a21730 288 0.045179 3.07 0.070272 3.25 0.025872 2-53 0.015176 2.72 0.022760 Z90 0.050313 3.08 0.060666 3.27 U24522 255 0.015631 2.73 0.023902 292 0.056774 3.10 0.053348 3.28 0.023316 2.57 0.016117 2.75 0.025178 2.93 0.085123 3.12 0.047606 3.30 0.022232 258 0.016638 2.77 0.026610 295 0.076279 3.13 0.042991 3.32 0.021252 2.60 0.017200 2.78 0.028229 297 0.091827 3.15 0,039207 3.33 0.020363 262 0.017805 2.80 0.030076 298 0.114747 3.17 0.036052 3.35 0.019652 Z63 0.018461 2.82 0.032198 3.00 0.151260 3.18 0.033383 3.37 0.018809 US 0.019173 2.83 0.034664 3.02 0.130688 3.20 0.031099 3.38 0.018126 2,67 0.019948 2.85 0.037561 3.03 0.102088 3.22 0.029121 3.40 0.017497 5 4 ------------------._.._.._----` 4 3 - --_--_ ..._. ___._ ____._._._ --------------------------...3 c c _ n i3 2 -. _.. _.__._ -.._:._..-.____.- _--___-_._-. _-2 0 0 0 1 2 3 4 5 6 Time (hrs) 14 Hydrograph 25-yr Summary Project Name: 05-30-2024 Hyd MI00y Studio Hyd. No. v 3.0.0.32 Hytlro9reph Type Hydrograph Name Peak Flow (of$) Timeto Peak (hm) Hydrograph Volume (cug) Inflow Hyd(s) Maximum Elevation (ft) Maximum Storage (cuft) 1 Rational Pre DA 1 (Total Site) 14.13 0.33 16,955 2 Rational Post DA1(Urimproved) 10.53 0.33 12,634 3 Rational Post DA2(Improvedarea) 6.047 0.17 3,628 — 4 Pond Route pond 0.218 0.33 3,393 3 11.22 3,517 15 Hydrograph Report Project Name: Hydrology Studio v 3.0.0,32 05-30.2024 Pre DA 1 (Total Site) Hyd. No. 1 Hydrograph Type = Rational Peak Flow = 14.13 cfs Storm Frequency = 25-yr Time to Peak = 0.33 hrs Time Interval = 1 min Runoff Volume = 16,955 cuft Drainage Area = 7.0 ac Runoff Coeff. = 0.3* Tc Method = TR55 (See Worksheet) Time of Conc. (Tc) = 20.0 min IDF Curve = Port Lavaca IDF 2023.idf Intensity = 6.73 inthr Freq. Corr. Factor = 1.00 Asc/Rac Limb Factors =111 * Composite C Worksheet AREA(se) C DESCRIPTION 7.0 0.30 UN.Pm ea 7.0 a." Qp = 14.13 cfs 16 _._ ..._._ __-_-_ ._...__.. __-..__-.-_---- ---- -------- -------.. --- .---, 15 ---.-.. L_..----..----- -.-�.--------- ------..._..J 14 - 13 -''__.-------...----- ------------------'. -----._ -. 12 .__........-------------��--- ---. -- — 10 _.-. _._-----_.-------- ----- --� --— --�----- --__ ..- i K cr 7- 6- -__---_. `-----___.. 4 ------ - - -- 3 0 0 10 20 30 40 Time (min) 16 Hydrograph Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 Post DA I (Unimproved) Hyd. No. 2 Hydrograph Type = Rational Peak Flow = 10.53 cfs Storm Frequency = 25-yr Time to Peak = 0.33 hrs Time Interval =1 min Runoff Volume =12,634 cult Drainage Area = 5.216 ac Runoff Coeff. = 0.3` To Method = TR55 (See Worksheet) Time of Conic. (Tc) = 20.0 min OF Curve = Port Lavaca OF 2023.idf Intensity = 6.73 in/hr Freq. Corr. Factor = 1.00 Asc/Rec Limb Factors =1/1 Composite C Worksheat AREA)aa) C DESCRIPTION $216 0.30 Unlmpmve0 5216 0.30 Qp = 10.53 cfs 12. __.. -_. _------------.. 10 9 __- ____ ...___.. _------. -_----- ----------------..__._—..._.- 7 -._ - ------ - - -- ti a ......... _-...-..-._-... _-- -- — ----- 4 ---_. 3 -------- --- 2 --------------------- -------- -. 0 0 10 20 30 40 Time (min) 17 Hydrograph Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 Post DA 2 (Improved area) Hyd. No. 3 Hydrograph Type = Rational Peak Flow = 6.047 Cis Storm Frequency = 25-yr Time to Peak = 0.17 hrs Time Interval = 1 min Runoff Volume = 3,628 cult Drainage Area = 1.784 ac Runoff Coeff. = 0.37* Tc Method = User Time of Conc. (Tc) =10.0 min OF Curve = Port Lavaca IDF 2023.idf Intensity = 9.16 in/hr Freq. Corr. Factor = 1.00 Asc/Rec Limb Factors = 1/1 " Composite C Worksheet AREA(aC) C DESCRIPTION 0.665 0.60 Improved 0.686 0.3o m .proved 0.433 0.30 Pond 1.784 0.37 Qp = 6.05 cfs 4 i I_ —;— -- ...__..__... _... .._.- -- 2 - ----- -< ---- —li -- 0r�—.—�. i 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Time (min) 18 Hydrograph Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 pond Hyd. No. 4 Hydrograph Type = Pond Route Peak Flow = 0.218 cis Storm Frequency = 25-yr Time to Peak = 0.33 hrs Time Interval = 1 min Hydrograph Volume = 3,393 cuft Inflow Hydrograph = 3 - DA 2 (Improved area) Max. Elevation = 11.22 ft Pond Name = POND FOR DIRT Max. Storage = 3,517 cult Pond Routing by Storage indication Method Center ofmass detention time = 6.00 hrs Qp = 0.22 cfs 1s Design Storm Report Hydrology Studio v 3.0.0.32 Storm Distribution: OF Based - Synthetic, 6-hr Custom Storm filename: 05-30-2024 Storm Total Rainfall Volume (in) Duration 1-yr 2-yr 3-yr 5-yr 10-yr 25-yr 50-yr 100-yr 6 hrs 3.49 4.15 0 5.18 6.03 7.25 8.16 913 Incremental Rainfall Distribution, Myr Time PmCIP Time Precip Time Precip Time Prsclp Time Precip (hrs) (in) (hrs) (in) (hrs) (in) (hrs) (in) (hrs) (in) 250 0.025085 2.68 0.035028 287 0.065501 3.05 0.132022 3.23 0.045008 2.52 0.025710 2-70 0.036447 288 0.071818 3.07 0.110608 3.25 0.042715 263 0.026374 2.72 0.038009 290 0.079646 3.08 0.095649 3.27 0.040677 266 0.027082 2.73 0.039740 292 0.089594 3.10 0.084305 3.28 0.038852 257 0.027838 2.75 0.041667 293 0.102643 3.12 0.075511 3.30 0.037209 2.58 0,028846 2.77 0.043826 295 0.120458 3.13 0.068499 3.32 0.035721 260 0,029514 2.78 0.046265 297 0.146111 3.15 0.062780 3.33 0.034366 Z62 0.030447 2.60 0.049042 298 0.185875 3.17 0.058027 3.35 0.033127 263 0.031455 2.82 0.052233 3.00 0.254595 3.18 0.054014 3.37 0,031990 265 0.032547 2.83 0.055939 3.02 0.215021 3.20 0.050580 3.38 0.030941 267 0.033733 2.85 0.060299 3.03 0.163613 3.22 0.047607 3.40 0.029972 i 8 j 9 t^G.. a 2 ._--- - ._...___-- -.._-..__., -----. 1 - -_ -. --__-_....-. __: __. _-__ --___._ --- ._..__..--------- 0 0 0 1 2 3 4 5 6 Time (hrs) 20 Hydrograph 100-yr Summary Hvdml sWdiev3ftee2 Project Name: 05-30-2024 Hyd. No. Hydmgmph Type Hydrograph Name Peak Plow (ofs) Time to Peak (h1s) Hydrogmph Volume (ouft) Inflow Hyd(s) Maximum Elevation (ft) Maximum Storage (ouft) 1 Rational Pre DA 1 (Total Site) 17.43 0.33 20,919 — 2 Rational Post DA 1(Unimproved) 12.99 0.33 15.588 — 3 Rational Post DA 2 (Improved area) 7.473 0.17 4,484 — 4 Pond Route pond 0.290 0.33 4,245 3 11.26 4.332 21 Hydrograph Report Hydrology Studio v 3.0.0.32 Pre DA 1 (Total Site) Project Name: 05-30.2024 Hyd. No. 1 Hydrograph Type = Rational Peak Flow = 17.43 cis Storm Frequency =100-yr Time to Peak = 0.33 hire Time Interval = 1 min Runoff Volume = 20,919 cult Drainage Area = 7.0 ac Runoff Coeff. = 0.3* Tc Method = TR55 (See Worksheet) Time of Conc. (Tc) = 20.0 min IDF Curve = Port Lavaca OF 2023.idf Intensity = 8.30 in/hr Freq. Corr. Factor = 1.00 Asc/Rec Limb Factors =1/1 " Composite C WOdisheet AREA(PQ C DESCRIPTION 7.0 030 unimproved 7.0 aao Op =17.43 cfs 20 18- _.... - . __ .._._.--.;..-.._ I 17 —, 16 ------------ —_ 16 -------_--__ _..___- ----------'—'-.. ---------'---------------. 14 — ---`- 13 _._._.._------.___.__.......... ..... -----. .-------- 12 __.-_ --- ---------=--- --�. a 9 --- --—:_— -- — 7 --...-_--_- 6 _...._ _--. -__ --.--- --------- --._—.-.--_______. — 5 ------— --- -----_.. 4 -_.. __..-. ....-._ --_:.._...-----._......_...._.-----.-. -..-_..__..-.._.... ._... �_---.__ ._._.. 3 -_.-__-_ _. ._ -. _.._ --_-_ -_-___.---:.__. 2 —._--------- 0 --T � 0 r—,—� 10 20 30 40 Time (min) 22 Hydrograph Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 Post DA 1(Unimproved) Hyd. No. 2 Hydrograph Type = Rational Peak Flow = 12.99 cfs Storm Frequency = 100-yr Time to Peak = 0.33 hrs Time Interval = 1 min Runoff Volume = 15,588 cult Drainage Area = 5.216 ac Runoff Coeff. = 0.3` To Method = TR55 (See Worksheet) Time of Conn. (Tc) = 20.0 min OF Curve = Port Lavaca OF 2023.idf Intensity = 8.30 in/hr Freq. Corr. Factor = 1.00 Asc/Rec Limb Factors = 1/1 Composite C Workshe It AREA(..) C DESCRIPTION 6.216 0.30 Urimpmved 6.216 0 30 Qp =12.99 cfs 14 ._.. _._ -_._._ . _... ---_._..-- 13.. 8 w 7- 6- 4- 3- 2 _...- ---- ---___— 0- 0 10 20 30 40 Time (min) 23 Hydrograph Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 Post DA 2 (Improved area) Hyd. No. 3 Hydrograph Type = Rational Peak Flow = 7.473 cis Storm Frequency =100-yr Time to Peak = 0.17 hrs Time Interval = 1 min Runoff Volume = 4,484 cuft Drainage Area = 1.784 ac Runoff Coeff. = 0.37* To Method = User Time of Conic. (Tc) = 10.0 min OF Curve = Port Lavaca OF 2023.idf Intensity = 11.32 Whir Freq. Corr. Factor = 1.00 Asc/Rec Limb Factors =1/1 * Composite C Worksheet AREAtee) C DESCRIPTION 0.e5e 0.50 improved 0.6e6 D30 unimproved oaaa 0.30 Pq 1T8a 0.3T Qp = 7.47 cfs 8 - - -- -- - -- — - - -- ----- — -- i O 2- 0 0 1 2 3 4 5 6 7 8 9. 10 11 12 13 14 15 16 17 18 19 20 Time (min) 24 Hydrograph Report Project Name: Hydrology Studio v 3.0.0.32 05-30-2024 pond Hyd. No. 4 Hydrograph Type = Pond Route Peak Flow = 0.290 cfs Storm Frequency =100-yr Time to Peak = 0.33 hrs Time Interval = 1 min Hydrograph Volume = 4,245 cuft Inflow Hydrograph = 3 - DA 2 (Improved area) Max. Elevation = 11.26 ft Pond Name = POND FOR DIRT Max. Storage = 4,332 cuft Pond Routing by Storage indication Method Centerofmass detention time = 5.33 hrs Op = 0.29 cfs Time (hrs) — DA 2 (Improved area)— pond 25 Design Storm Report Hydrology Studio v 3.0.0.32 Storm Distribution: OF Based - Synthetic, 6-hr Custom Storm filename: 05-30-2024 Storm Total Rainfall Volume (in) Duration 1-yr 2-yr 3-yr 5-yr 10-yr 25yr 50yr V 100-yr 6 hrs 3.49 4.15 0 5.16 6.03 7.25 8.16 9.13 Incremental Rainfall Distribution, 100-yr Time Precip Time Precip Time Precip TimePrecip Time Pracip (hrs) (in) (hrs) (in) (hm) (in) (hrs) (in) (hrs) (in) 260 0.031569 2.68 0.043690 2.87 0.080603 3.05 0.162119 3.23 0.055793 252 0.032334 2.70 0.045414 2.88 0,088252 3.07 0.135883 3.25 0.053015 253 0.033147 2.72 0.047311 2.90 0.097770 3.08 0.117286 3.27 0.050545 265 0.034012 2.73 0.049410 292 0.109S89 3.10 0.103441 3.28 0.048333 2.57 0.034935 2.75 0.051745 2.93 0.125851 3.12 0.092745 3.30 0.046339 2.58 0.036922 2.77 0.054362 2.95 0.147786 3.13 0.084237 3.32 0,044532 2.60 0.036980 2.78 0.057315 297 0.179691 3.15 0.077307 3.33 0.042886 262 0.038118 2.80 0.060677 298 0.229967 3.17 0.071551 3.35 0.041360 2.63 0.039345 2.82 U64538 3.00 0.319281 3.18 0.066694 3.37 0.039996 2.65 0.040674 2.83 0,069024 3.02 0.267456 3.20 0.062538 3.38 0.038720 2.67 0.042117 2.85 0.074301 3.03 0.201691 3.22 0.058940 3.40 0.037538 --- ------ ----- ---. 10 8-- ---_-._------ 8 6 2 v R M p5 -- ---- ---- ------ -- 5 v' 3 4 _..._. ....-._- _._------------ -- -- ----- i 4 3- 2 0 o 0 1 2 3 4 5 6 Time (hrs) 26 OF Report IDF filename: Port Lavaca IDF 20233clf Equation Coefficients Intensity = B 1(To + D)4E (inlhr) 1yr 2yr 3yr 5yr 10yr 2rw 50yr 100yr B 426644 44.2504 0.0000 47.7516 61.9749 57.6096 62.6069 17.4731 D 9.3000 8.5000 0.0000 7.5000 7.1000 6.6000 6.3000 6.1000 E 0.7268 0.7037 0.0000 0.6794 0.6080 0.6545 0.6488 0.6424 To Intensity Values (iNhr) (min) 1yr 2yr Syr 5yr 10yr 25yr 50yr 100•yr Cf 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 5 6.17 7.09 0 &69 9.83 11.58 12.98 14.38 10 4.96 5.68 0 5.83 7.80 9.16 10.24 11.32 15 4.20 4.80 0 5.76 6.57 7.71 8.81 9.52 20 3.66 4.19 0 5.02 5.74 6.73 7.51 8.30 25 3.27 3.74 0 4.49 5.12 6.01 6.70 7.42 30 296 3.39 0 4.07 4.65 5.46 6.09 6.74 35 271 3.11 0 3.74 4.27 5.02 5.60 6.20 40 2.51 2.88 0 3.47 3.96 4.66 5.20 5.76 45 2.34 2.69 0 3.24 3.71 4.36 4.87 6.39 60 2.20 2.53 0 3.04 3.49 4.10 4.58 5.08 55 207 2.38 0 Z88 3.30 3.88 4.34 4.81 60 1.96 2.26 0 273 3.13 3.69 4.12 4.57 Cr = ccm elw Factor eppllw fp Rar x al MafhOtl rvaMcaeladenf. Port lavaca, Texas, USA - 100yr - 50yr - 25yr -10yr 5yr -- 2yr ®1yr v s 10 15 20 25 30 35 40 45 50 55 60 Time (min) 27 Precipitation Report Precipitation filename: SamplePrecip.pcp Hydrology Studio v 3.0.0.32 (Rainfall totals in Inches) 05-30-2024 Active 1-yr 2-yr 3-yr 5ryr 70yr 25yr 60-yr 100yr Active J J J SCS Storms > SCS Dimensionless Storms SCS 6hr 1.20 1.50 0 1.86 218 2.64 3.01 3.41 Type 1, 24-hr 1.82 2.28 0 Z85 3.31 3.94 4.43 4.94 Type IA, 24-hr 1.82 2.28 0 2.86 3.31 3.94 4.43 4.94 Type II, 24-hr 1.82 2.28 0 2.85 3.31 3.94 4.43 4.94 Type 11 FL, 24-hr 1.82 2.28 0 Z85 3.31 3.94 4.43 4.94 Type III, 24-hr 1.82 2.28 0 2.85 3.31 3.94 4.43 4.94 Synthetic Storms > IDF-Based Synthetic Storms 1-hr 1.96 2.26 0 2.73 3.13 3.69 4.12 4.67 2-hr 2.49 2.90 0 3.54 4.09 4.85 5.42 6.04 3-hr 2.83 3.33 0 4.09 4.73 5.64 6.32 7.05 6-hr J 3.49 4.15 0 5.18 6.03 7.25 8.16 9.13 12-hr 425 5.14 0 6.51 7.65 9.27 10.46 11.76 24-hr 5.16 6.33 0 8.16 9.66 11.81 13.38 15.11 Huff Distribution > 1st Quartile (0 to 6 hrs) 1-hr 0.76 0.98 0 1.33 1.61 2.01 2.34 2.69 2hr 0.89 1.14 0 1.50 1.80 2.25 2.60 2.99 3-hr 0.98 1.24 0 1.59 1.90 2.33 2.68 3.07 6-hr 1.20 1.50 0 1.86 2.18 2.64 3.01 3.41 Huff Distribution > 2nd Quartile (>6 to 12 hrs) 8-hr 0 0 0 0 0 0 0 0 12-hr 0 0 0 0 0 0 0 0 Huff Distribution > 3rd Quartile (>12 to 24 hrs) 18-hr 0 0 0 0 0 0 0 0 24-hr 0 0 0 0 0 0 0 ❑ Custom Storms > Custom Storm Distributions My Custom Storm 1 0 0 0 0 0 0 0 0 My Custom Storm 2 0 0 0 0 0 0 0 0 My Custom Stomp 3 0 0 0 0 0 0 D 0 -My Custom Sion 4 0 0 0 0 0 0 0 0 My Custom Storm 5 0 0 0 0 0 0 0 0 My Custom Sion 6 0 0 0 0 0 0 0 0 My Custom Storm 7 0 0 0 0 0 0 0 0 My Custom Storm 8 0 0 0 0 0 0 0 0 My Custom Storm 9 0 0 0 0 0 0 0 0 My Custom Storm 10 0 0 0 0. 0 0 0 0 23 Precipitation Report Cont'd Rainfall totals in Inches Active 1-yr 2yr Syr Active J Huff Indiana >Indianapolis 30-m1n 0.99 1.19 0 1-hr 1.21 1.46 0 2-hr 1.46 1.77 0 3-hr 1.57 1.90 0 6-hr 1.92 2.31 0 12-hr 0 0 0 24-hr 0 0 0 Huff Indiana >Evansville 30-min 0.99 1.19 0 1-hr 1.21 1.46 0 2-hr 1A6 1.77 0 3-hr 1.57 1.90 0 6-hr 1.92 2.31 0 12-hr 0 0 0 24-hr 0 0 0 Huff Indiana > Fort Wayne 30-min 0.90 1.19 0 1-hr 1.21 1.46 0 2-hr 1.46 1.77 0 3-hr 1.57 1.90 0 6-hr 1.92 2.31 0 12-hr 0 0 0 24-hr 0 0 0 Huff Indiana > South Bend 30-min 0.99 1.19 0 1-hr 1.21 1.46 0 2-hr 1.46 1.77 0 3-hr 1.57 1.90 0 6-hr 1.92 231 0 12-hr 0 0 0 24-hr 0 0 0 29 Precipitation filename: SamplePrecip.pcp 05-30.2024 5yr 10-yr 25yr 50-yr 100-yr J V 1.44 1.63 1.89 2.08 2.28 1.81 2.08 2A5 2.75 3.06 222 757 3.05 3.44 3.85 238 276 3.30 3.75 4.21 2.88 3.36 4.01 4.56 5.13 0 0 0 0 0 0 0 0 0 0 1.44 1.63 1.89 2.08 2.28 1.81 2.08 2.45 2.76 3.06 2.22 2.57 3.05 3.44 3.85 2.38 2.76 3.30 3.75 4.21 2.88 3.36 4.01 4.56 5.13 0 0 0 0 0 0 0 0 0 0 1.44 1.63 1.89 2.08 2.28 1.81 2.08 2.45 2.75 3.06 2.22 2.57 3.05 3.44 3.85 2.38 2.76 3.30 3.75 4.21 2.88 3.35 4.01 4.56 5.13 0 0 0 0 0 0 0 0 0 0 1.44 1.63 1.89 2.08 2.28 1.81 2.08 2.45 2.75 3.06 2.22 2.57 3.05 3.44 3.85 2.38 276 3.30 3.75 4.21 2.88 3.36 4.01 4.56 5.13 0 0 0 0 0 0 0 0 0 0 Precipitation Report Cont'd Precipitation filename: SamplePrecip.pcp Rainfall totals in Inches 05-30-2024 Active 1yr 2-yr 3-yr Syr 10ryr .25yr 50yr 100:yr Active d V d NRCSStorms > NRCS Dimensionless Storms NRCS MSE1, 24-hr 2.72 3,27 0 4.07 4.72 5.63 6.37 7.15 NRCSMSE2,24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NRCS MSE3, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NRCS MSE4,.24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NRCS MSES, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 T15 NRCS MSES, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NOAA-A, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NOAA-S,24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NOAA-C,24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NOAA D,.24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NRCC-A, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NRCGB, 24-hr 2.72 3.27 0 4.07 4.72 543 6.37 7.15 NRCC-.C, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 NRCC-D; 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 CA-1, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 CA-2 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 CA-3,.24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 CA-4, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 CA-5, 24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.15 CA-6,24-hr 2.72 3.27 0 4.07 4.72 5.63 6.37 7.16 FOOT Storms > Florida DOT Storms FOOT,1-hr 0 2.14 2.36 258 292 3.35 3.66 3.95 FOOT, 2-hr 0 2.70 3.00 3.26 3.69 4.24 4.64 5.00 FOOT, 4-hr 0 3.28 3.76 4.00 4.80 6.50 6.20 6.80 FOOT, 8-hr 0 3.76 4.32 4.80 5.60 6.20 7.20 8.00 FOOT, 24-hr 0 4.28 4.75 5.21 6.11 7,53 8.78 10.20 FOOT, 72-hr 0 5.44 6.10 6.74 7.98 9.92 11.60 13.40 SFWMD, 72-hr- 0 5.44 6.10 6.74 7.98 9.92 11.60 13AD Austin Storms >Austio Frequency Storms Austin Zone 1, 24-hr 0 4.14 0 5.51 6.84 8.90 10.69 12.80 Austin Zone 2, 24-hr 0 4.05 0 5.38 6.65 8.59 10.28 12.23 30 ' NOTICE OF MEE] ING - 6/05/2024 11. Consider and take necessary action to authorize Kelley Ashley, Children Librarian to accept the Lewis R & Juaniece Madden Foundation Grant in the amount of $25, 000. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 28 Debbie Vicke From: dsanchez@cclibrary.org (Dina Sanchez) <dsanchez@cclibrary.org> Sent: Monday, May 27, 2024 11:56 AM To: debbie.vickery@calhouncotx.org Subject: Commissioner's Court Agenda Follow Up Flag: Follow up Flag Status: Completed (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, can you please add the following to the agenda for Commissioners Court: Consider and take necessary action to authorize Kelley Ashley, Children Librarian to accept the Lewis R & Juaniece Madden Foundation Grant in the amount of $25, 000. Thank you, Dina Sanchez Calhoun County Library Director (361)552-7323 Calhoun County Texas 1 #12 ' NOTICE OF MEEI ING — 6/05/2024 12. Consider and take necessary action to approve the Preliminary Plat of the Luna Subdivision, (Replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision according to the plat recorded in Volume Z, Page 385 of the Calhoun County Plat Records) Ysidro Benavides Survey, Abstract No. 38 of Calhoun County, Texas. (VLL) pass Page 9 of 28 From: vern.lyssy@calhouncotx.org (vern lyssy)[mailto:vern.lvssv@calhouncotx.org] Sent: Thursday, May 23, 2024 9:43 AM To: Lesa Jurek <lesa.iurek@calhouncotx.org> Subject: Fwd: Agenda item for May 29th Sent from my Whone Begin forwarded message: From: hdanysh@gwengineers.com Date: May 23, 2024 at 9:14:23 AM CDT To: vern.lyssy@calhouncotx.org Subject: Agenda item for May 29th CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. May 23, 2024 Commissioner Lyssy, Please place the following item on the agenda for May 29, 2024: 1. Consider and take necessary action to approve the Preliminary Plat of the Luna Subdivision, (Replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision according to the plat recorded in Volume Z, Page 385 of the Calhoun County Plat Records) Ysidro Benavides Survey, Abstract No. 38 of Calhoun County, Texas. Respectfully submitted, Henry A. Danysh, RPLS G & W Engineers, Inc. Calhoun County Texas Calhoun County Texas Calhoun County Texas Calhoun County Texas X fE 2� A Yp4 +A jQ t gg9 .i"A fR a @y$ Aa A� Py� a 1 R E• if peAy A R F AA 9 A gR z WESTERLUND GRADE ROAD E m ua++; VIM. AMW __%_______________ 6] ump u[ a#nuv u[ L� s mi ' (7, S•PY n§a'i �i § A ssmm 1.� �•n e s" m vrJi 0 d Z z z Fcn�1 1 I'AT-� C C ,LE'EEP_______ 3.L11sLL5 - PAMA r Z m R_----_—_—----r,+,&0--- Z� 6 �9> IP Rl yo sF z 88 Pyy _yy •• O N RI 'Ci TA p5p I < p xl NI.Lv_m---------------- 33S55ns a�p94 9^W{rn a Ig^i e=N� €I I avor n b I €€R� L_____________gR"_____"�_�______ .SBSCI 3.L I.CSSLC i A..- i .WVB .LB501 " ---- I. 3 .59501 m*uun u[__ ixanara unun a Gros R I ; V nrnlud aaw, ,aoroe g a Csc m a$mo' �s�0N a a €Agea RIN F'^c $ $•A.i >Al sli o g. §sm fI IG gsma €rN 9 - . IiN N m ER - i i 9 O - A_ _____________________________ „' m .secR. W A � °z . n 4 3,Z4,•Syfg , Rn axmn A, i ) G & W ENGINEERS, INC. - A AOq;i; rt o m T m $ m • ENGINEERING • SURVEYING • PLANNING • II yl �b o 0 o O p o 209 W. LIVE OAK T9PSS R0NM NO.:PONT 1aD221 0 TEXAS Ay]y PRELIMINARY PLAT . (]fin SS: -,SON: PORT LARACA (979) 323-710: NAY OTY K x #13 NO] ICE OF MEETING — 6/05/2024 13. Consider and take necessary action for Tyrone Harris to be issued a county credit card with a $5,000.00 Monthly limit. (RHM) RESULT: APPROVED EUNANIMOUS] MOVER. Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 10 of 28 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: RICHARD MEYER, COUNTY JUDGE SUBJECT: CREDIT CARD DATE: May 29, 2024 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: June 5 AGENDA FOR MARGH 6, 2024 * Consider and take necessary action for Tyrone Harris to be issued a county credit card. $5000.00 Monthly limit Sincerely, Bobbie Vickery Calhoun County Sheriff #14 ' NOl ICE OF MEETING-6/05/2024 14. Consider and take necessary action to authorize Dina Sanchez, Calhoun County Library Director to sign the service agreement with Xerox. (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 11 of 28 xerox Business Solutions Southwest Dahill Office Technology Corporation ("Company') SALES $ SERVICE AGREEMENT CUSTOMERNAME is ,. .. i .. COUNTY OF CALHOUN CUSTONERNAME COUNTY OF CALHOUN ADDRESS -: 200 W. MAHAN ST _ -ADDREAW CALHOUN COUNTY LIBRARY 200 W MAHAN ST ORY,STAWMP - PORT LAVACA, TX 77979 CIIY STATSEP PORT LAVACA, TEXAS 77979 BILLTOCONTACT.PERWN DINA SANCHEZ :8Bl"TOPRONENUMBER 3815527323 Al LTCPAAIL i SA CHEZ@CCLIBRARY .ORORG SHIPTOCONTACTPERSON; DINA SANCHEZ SHIPTOPHONENUMBER 3615527323 SHIPTOEMAIL DSANCHEZ@CCLIBRARY. SALESPERSON -, Hitt, Mark CUlTONEREURCNASEOROERR COMPANYREFERENCES. 20299996 , SERVMECONTRACT v New MPR.CONmACi ceNrRACTBI WNTIIACTF CEASEsP'AYMENT ' `SERVICE PAYMENT MPS PAYMENT S139.00 Monthly Included in Lease N/A TERMS OF PAYMENT: Her TEN (10) DAYS FOR CASH SALE AND ALL OTHER INVOICES NET THIRTY (3O) DAYS FROM DATE OF INVOICE CITY MODEUPRODUCTi11 LOCATION ,: . ': DESCRIPTION METER POOLS PRICE TOTAL PRICE CALHOUN COUNTY EC80361-12 BSW: Plat Rate Included in 1 EC8036H2 LIBRARY 200 W MAHAN Coloc Flat Rate Lease Included in Lease 5T SUBTOTAL See Lease Cl SEE PRODUCT SCHEDULE (SCHEDULE A) ❑SEE TRADE-IN EQUIPMENT I LEASE RETURN FORM SPECIAL SERVICES FEES $0.00 NOTE 7 ADJUSTMENT DETAILS The ServicalMPS Escalation Rate is 0%. OTHER ADJUSTMENTS $0.00 'CONTRACT TYKE _ - >EFP.ECTNE'D`A3'E9 TRANSACTION TYPE ❑ CASH SALE ❑ RENTAL TERM IN MONTHS SO Months Actual start date based on Leese fMV(SLO) @ LEASE ❑ MAINTENANCE ONLY PROPOSED START DATE delivery or lease commencement. "tIDNTRAOT fiERM9 ' ` . ". `• • i 3.. ` - NOTES SERVICE - MPS ❑p ❑ Ali parts, labor; drums and supplies; excluding paper and staples ❑ ❑ All parts and labor, Including drums; excluding supplies, paper, and staples ❑ ❑ Includes other (indicate) NODELIPOOL ` 1BRGjeLtiIVHAAOE, , Lai�INCWDED -EXTRA LONG aowaLY 'EXTRA LONO , BASEERONCY - OVO. FRONCY. BLACRVOWME ,VgLpMEDCOLOR OdVIMOBMTE _ VOLVNE fMTE MT ECiW6Nx Flat Rate 1,000 SW antl COLORPages Combined NA NA 'NA t.:�.um Menury NA Ta lsl VPlUmP IPdUd" Nr S0 md.n:1,000 Allroonzed;Wnatme acknowledges terms/conditions and expiration dales or meter readings. The terms and Conditions On the face and reverse side o'(nis agreement conecey se forth the entire agreement bowmen parties. AUTHORIZED CUSTOMER SIGNATURE: ©M 1_ It•'+�' [) TITLE: �( a1a.4'�y : `'�: O•'z+ y l e"T; x SIGNER'S NAME (PRINTED): XDATE: X DEC approved Val. P7.S.2023 Eff.0tive 911712020 Page 1 of 4 COMPANY SALES: �i "C oGL! DATE: Iniliel X z,;.� CEC approvoE Vef. P1.5.2023 EHeafiva 9117a023 Page 2 of 4 Sales and Service Terms and Conditions t. V lbillons, The first page of this Sales Order/Service Agreement is referred to herein as the 'Cover Page.* The Cover Page and these Term and Conditions, along with a listing of additional products on Product Schedule (if attached), and or any other attachments referenced on the Cover Page represent the agreement (the'Agreemenf) between Company and the Customer (-Porfli as Identified on the Cover Page of this Agreement, wife respect ta the acquisition of those Products and the Service for such Produce.-Praduds' shall mean the equipment ("Equlpmanr) and any Software ('Application Software) identified on the Cover Page antllor an Product Schedule. 2. Scats. This Agreement may be executed for. a) A SALE of Produce. It a SALE, Company hereby offers to sellNcense and Customer hereby accepts to purchaseAlcense those Products In me quantity and for the price indicated on the Cover Page (ai Product Schedule). Payment hunts am set foM In Section 7, below. Title ro the Equipment will transfer to Customer upon deliveyor b) A LEASE of Products. If a LEASE, Customer will execute a separate lease agreement with a third parry lessor Mich Will fund the purchosefficense of the Products in the quantity indicated on the Cover Page (andor Product Schedule) for the benefit of Customer. The lease will be between Customer and a Ihirbpany lessor. Company will not be a pony to the lease. Upon execution of a lease agreement between Customer and third -party lessor, the Customer shall be responsible to lessor to satisfy the terms and condlgons of the lease;-0r c) A RENTAL of Products. If a RENTAL, Company hereby offers to rent and Customer hereby accepts to pay for those Products In the quantity and for the price Indicated on the Cover Page (.note, Product Schedule). Payment terms are set forth in Section 7, below. Tide will remain with the Company throughout the Term as Indicated on the Cover Page. Customer agrees to obtain adequate insurance coverage sufficient to cover the full replacement value of the rental equipment while In Customers possession, and to have Company named as the loss payee. Unless otherwise stated in the Cover Page. the rental is non -cancellable for the stated term, 3. DelNary and Installation. Unless sionsled otherwise on the Cover Page, the Company shall deliver and install the Products, at the location specified by Customer on the Cover Page union: It) Customer has not made available at that address a suitable place of installation asspecl0ed by the Company; or (2) Customer has not made available suitable electrical service in accordance Win the Underwriter's Lab ('UC) or manufacturer's (9) parts for Scanners. I pant may be new, repml or paper. Supplies are to this Agreemenl. Cuslomi be billed for shipping, In provided outside Comps Chet Is automatically toll, 7. standard 8.501' copy. No or counterclaim. if any paym lesser rate as is the maximu or errore or local amount as'N a the be at be used with be supported and serviced using data ate Include product registration. meter any. The automatic data transmission 11 be may to to Supplies. Any devices not silty (60) days. prior t0 its [dad for therein: The meter count at Installation or, In the case of owned printers, at assessment, will be used for to date of Company's invoice or; 0 the parties have agreed the thlyd-pady, lessor will contact the service tees due all other sums when due and payable. Any Monfely Payment engtiae Customer to Services and Supplies for a go and will be billed In advance. In addition, Customer agrees to pay the Overage Rote for each PnnUCapy that filch amount shall be billed In arrears and Is payable as indicated on the Cover Page. A PdnVCopy is defined as )pay all sums when due shall be absolute and unconditional and Is not subject to any abatement, offset, defense pony may charge, and Customer will pay a late fee of 5%of the amount due or$25, whichever is greater (or such es, without recourse, for any non-payment. Unless otherwise stated an the Cover Page, Company may increase pony retalhs thenght to have all or some of the amounts due hereunder billed and/or collected by third parties. If IMnistralive fee, In accordance with Company's currently published feeschedule, which is subject to change from try, you will be responsible for, Indemnify and hold Company harmless from, all applicable taxes, fees or charges d penalties) assessed by any governmental entity an you, the Equipment, this Agreemenl, oribe amounts payable ustomer will pay when due, either directly to the taxing authority ur to Companyupon demand, all razes, fines and ad upon. Company's Income. ,g the Term. other a nonexclusive, non•Vareferable Ili to use In the U.S.: (a) software and accompanying documentation as a separate line Item In this Agreement ('Application Software') (including its accompanying documentation), as e Software' and'Applicatlan Softvare'are referred m collectively as'Liconeed Software. Customer has no other eased Software; (2) activate Licensed Software delivered with the Equipment in an Inactivated state; at (3) allow lely with Company andror Its licensors (who will be considered third -parry beneficiaries of this Section). Licensed Iyated If: (x) Company is denied access to periodically most Such coda; Is) Customer Is notified of a default under note: (I) if Customer no longer uses or poesasses the Equipment; or (if) upon the expiration or termination of this Its Ilcansom warrant that Licensed Software will be free from enact or that its operation will be uninterrupted. The ,d by a clicl wrap or shdnkwrep license agreement or otherwise made subject to a separate license agreement. Is Included with Me Equipment. Diagnostic Software is a valuable Veda squat of Company or its Lkenscm. Title r right to use. Diagnostic Software, and Customer will not access, use, reproduce. distribute or disclose Diagnostic Ras to the Equipment b remove or diastole Diagnostic Software if Customer is no longer receiving Service from iness hours. ipany, (or a designated servicart will provide the software suppan set forth below ('Software Support'). For Base AM canectweiy relerre l to as -Releaser. Each Release will be considered ueensed smeware nplementatlon aid Releasemay requireCustomer to procure, alCustomers expense, additional Company or another entity. Initials CEC approved yen P1.5.2023 Effective 9/17/2023 Page 3 of 4 and ent a. CUSTOMERS CON TENTANOCUSTOMERA10 Port the Sho icon hi .rider. Cusotserr it the "Murderasset.that such its tenladdm materido notProvided dsh Company in Connection Cobh this Agreement grothatory or obscene doethodae Company holates any a Services ha s. regulations Customer indsof thirdts party, such Conlenlantl export materials tlo not antl shutter,intainany Content that (n Islibelous,moral defamatory or obscene antllor (IB Infringes on or violates any applicable laws, regulations or rights of a INrO party, Including without IImAaUon, export laws, or any proprietary, intellectual property, Contract moral or privae, fight or any other third party right. b. XEROX TOOLS. 'Xerox Tools- means certain Xerox proprietary touts (including any modifications. enhancements and Centaurs works) used by Company to provide whom Services Xerox and its licensors will at all times retain all right, title and interest in and to Xonex Tools Including without limitation, all intellectual property fights therein, and, except as expressly sal forth herein or as set forth in aStatement of Work (SOW) where limited access its the Xerox Device Manager (XOM) may be granted for a specific purpose, no rights of use, access or operate the Xerox Tools are granted to Customer. Xerox Tools will be installed and operated only by Company or its authorized agents.. If required for royalty reporting purposes. Company may disclose Customers name and address to Xerox anchor the third -party licensor of certain Xerox Tools. Customer win not dwompile or reverse engineer any Xerox Tools, or allow others o engage in Same. Customer will have access to reports generated by Me Xerox Tools and Storetl in a provided database as seffonh in the applimble SOW. Company may remove Xerox Tools at anytime in Company's sets discretion, provided that the removal of Xef*x Tools will not affect Company's obligations to perform Services, and Customer shall reasonably facilitate such removal. If Xerox Tools are Included as pad of the Services, May may be used by Customer only in Conjunction with such Services. C. LIMITED LICENSE TO ASSESSMENTS AND REPORTS. Customer may duplicate and disuibule assessments andfor reports prepared by Company pursuant to this Agreement only for Customers Internal business purposes. Any recommendations and processes described In assessments and/or moods may only be Implemented by Company for Customer and, if implemented. used by Customer only for Customers Internal business purposes. d. NO GRANTS TO CUSTOMER. Customer agree. Mat, except as sat forth expressly In this Agreement, no other rights or licenses are granted to Customer, Further. the rights granted to CusioMar in this Section shall Immaclately tomorrow if Customer defaults hereunder with respect to any of Its obligations related to Such grant. 14, CONFIDENTIAL INFORMATION. Information exchanged under this Agreement will be treatedas confidential If It is identified as continental at disclosure or if the Circumstances, of disclosure would indicate to a reasonable person that the information should ba treated as Confidential ('Confidential information'). The terms and Condition of this Agreement are Confidential Information of Company and Customer, and each pony, agrees not to disclose any of the foregoing without the other parry's pdorwrilten consent Confidential Information will be protected using a reasonable degree of who to prevent unauthorized use or cisclosura for Iwo (2) years from the termination or expiration of this Agreement under which such Confidential Information was eisctosed, whichever occurs later; provided, however, wnfidentiallry with respect to Vatic secrets and Xerox Tools will not expire. These obligations of Confidentiality will not apply to any Confidential Informaton that: (1) was in the public domain prior to, at the time of, or subsequent to the date of disclosure through no fault of the receiving parry; (2) was rightfully In the receiving parry's possession or the possession of any third party free of any obligation of Confidentiality; (3) was developed by the receiving parry's employees independently of and without reference to any of the other pamys Confidential Information; or (4) where disclosure Is required by lax or a government agency. Upon expiration or termination of this Agreement, such parry will return to the Curator, if requested. destroy, all Confidential Information of the other in Its possession or control, except such Confidential Information as may be reasonably necessary to exercise rights that SUN termination of this Agreement. 15. Warronly. Customer acknowledges that the Products covered by this Agreement were selected by Customer based upon its awn judgment. COMPANY MAKES NO REPRESENTATIONS OR WARRANTIES. EXPRESS OR IMPLIED, ORAL OR WRITTEN, INCLUDING, WITHOUT LIMITATION, IMPLIED WARRANTIES OF NON -INFRINGEMENT, IMPLIED WARRANTIES OF MERCHANTABILITY; OR FITNESS FOR A PARTICULAR PURPOSE, ALL OF WHICH ARE SPECIFICALLY AND UNRESERVEDLY EXCLUDED. 18. LIMITATION OF LIABILITY. IN NO EVENT, SHALL COMPANY BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL DAMAGES, INCLUDING WITHOUT LIMITATION LOSS OF PROFITS, OR PUNITIVE DAMAGES WHETHER BASED IN CONTRACT, TORT, ORANY OTHER LEGALTHEORY AND IRRESPECTIVE OF WHETHER COMPANY HAS NOTICE OF THE POSSIBILITY OF SUCH DAMAGES. IN NO EVENT SHALL COMPANY BE LIABLE TO CUSTOMER FORANY DIRECT DAMAGES IN EXCESS OF THE FEES PAID FOR SERVICES UNDER THIS AGREEMENT BY CUSTOMER TO COMPANY DURING THE SIX-MONTH PERIOD IMMEDIATELY PRECEDING THE EVENT THAT GAVE RISE TO THE CLAIM. 17. Oefauth Remedies. Any of the following events or conditions shall Constitute an Event of Default under this Agreement: (a) failure by Customer to make payment when due of any indebtedness to Company or for the Products: whether or not arising under this Agreement, without notice or demand by Company; IS) breach by Customer of any obligation herein; or (c) if Customer Ceases doing business as a going ConCom. If Customer defaults, Company may; (1)'require future Services, Including Supplies, be paid for In advance. (2) require Customer to immediately pay the amount of the remaining unpaid balance of the Agreement. (3) terminate any and all agreements with Customer, and/or (4) pureue any other remedy reminded at law or In equity. In the Event of Default, remaining payment amounts due will be Calculated using the avarage of the last six months' bllling or the amount sat forth on the few of the Agreement. whichever Is greater, multiplied by the remaining months of the Agreement, to Compensate for lose of bargain and not as a penalty. Customer agrees that any delay or failure of Company to enflame Its right under this Agreement does not prevent Company from enforcing any such right at a later time. All of Company's rights and remedial survive the termination of this Agreement, to the event of a dispute arising out of this Agreement or the Products listed herein, should it prevail, Company shell be entitled to Collection of Its reasonable costs and ett arl fees incurred in defending or enforcing this Agreement. whether of not litigation Is Commenced. 18. Assthnment Customer may Mat sell,transfer, or assign this Agreement without the prior written Consent ofCompany. Company may sell, assignor transfer this Agreement 19. Nolires. All notices required or permitted under this Agreement shall be by overnight counter such party at the address set forth in this Agreement, or at such other address as such party may designate in writing from Ume to time, Any notice from Company to Customer shell be effective two days after It has bean sent via overnight Coudec - 20. indemnification. Each party, if promptly notified by the other and given the night to control the defense, shall indemnity, defend and hold hams as Iha other party. its aff4iares, and Nets respective omwrs, directors, agents, successors, and assigns, from and against all claims by a third parry for losses, damages, Costs or Ilabliity of any kind (including expanses and reasonable legal fees) that a counfinaily "ards such party ('Claims) for bodily injury (Including death)and damage to real or langible property, to the extent proximately mused by the negligent acts or emissions. or willful misconduct of the indemnifying party (or Its affiliates) In connection with this Agreement. 21. Fex,SI.cW n a Exeoulton. A food or electronically transmitted version of this Agreement maybe considered the original and Customerwill not have the right to challenge in Court the authenticity or binding effecl of any foxed or scanned Copy or signature thereon. Time Agreement may be signed In count spadsand all Counterpane will be nsidered and Constitute the same Agreement. 22. Warranty to Execute. Each party represents and warrants to the other, as an essential part oCo f this Agreement, Nat (if it Is duty organized and validly existing and in good standing under the laws of the slate of its incorporation or formation; (it) this Agreement has been duly authorized by all appropriate Corporate action for signature; and (Ili) the individual signing this Agreement Is duty authorized to do so. 23. Miscellaneous. (a) Choice of Law. This Agreement shall be governed by the laws of Ns, state of TX (wimoul regard to the confided of laws or principles of such stales); (b) Jury Trial. CUSTOMER EXPRESSLY WAIVE TRIAL BY JURY AS TO ALL ISSUES ARISING OUT OF OR RELATED TO THIS AGREEMENT; (c) Entire Agreement. This Agreement Constitutes the entire agreement between the parties with regards W the subject matter herein and Supersedes all prior agreements, proposals or negotiations, whether oral or written; (it) Enforceability. If any provision of this Agreement Is unenforceable, illegal or invalid, the remaining provisions will remain in fug force and effect; (a) Amendments. This Agreement may not be amended of modified except by writing signed by me pandas; provided Customer agrees that Company Is authorized. without notice to Customer, to supply missing informelldn or=net obvious errors provided that such change does not materially alter Customers obligations; in Force Majeure. Company shall not be responsible for delays or ....,........ce...,.....,...adL.,,rw.,.I„nL..rty M, alrikaa. aeCldanla. Climate Conditions. oars availability. unsafe travel Conditions.orothar reasons beyond Company's Control. Initials 4 O}X :ii Bye. ' CEC approved Ver. P1.5,2023 Effective e11712023 Page 4 of 4 Xerox Financial Services LLC State and Local Government x 201 Merritt 7 Norwalk, CT 06851 Cost Per Image Agreement Supplier Name&Address: paNilomuTesgaalaaydarsonneo-etoo iH IQW.S.11oxooaenAatclU,Tx2622a Agreement No: owner: XEROX FINANCIAL SERVICES LLC— 201 Merritt 7, Norwalk, CT 06851 Full Legal Name: COUNTY OF CALHOUN Phone Number: 3615527323 Billing Address: 200 W. MAHANST City: PORT LAVACA I State: TX Zip: 77979 Contact Name: OINA SANCHEZ Contact Email: DSANCHEZ@CCUBRARY,ORG Accounts. Payable Contact Name: DINA SANCHEZ Accounts Payable Contact Email: OSANCHEZQCCUBRARY.ORG r Quantity I Model and Description Quantity Model and Description ® See Attached Schedule A Equipment Location (if different from Billing Address): ,i Meter/Pool Name: Allowance: Excess Rate: I Meter/Pool Name: Allowance: Excess Rate: Excess Image Charge Billing Frequency (Monthly if not noted): ® See Attached Schedule A Initial Term: (IN MONTHS) 60. months $139.00 Monthly (plus applicable taxes) ✓Fair Market Value Purchase Option.CFMV9 BY YOUR SIGNATURE BELOW, YOU ACKNOWLEDGE THAT YOU ARE ENTERING INTO A NON -CANCELLABLE AGREEMENT AND THAT YOU HAVE READ AND AGREED TO APPLICABLE TERMS AND CONDITIONS SET FORTH ON PAGES 1 AND 2 (AND 3IF APPLICABLE) HEREOF. /A"LLL Authorized Signer X: / \/� ` l / �L(01Nk Federal Tax ..ID: (Require X - LD ooIRa Print .Name X U] Y\a W� c+-,e'� %1 s� Titla`.X/ �,..,��it ary v''ytcAc - oate(9 D.Le Ic)S aoay. Accepted Byi Xerox Financial Services LLC Name and Title: Date: a. uammnons. me woros ro. no 1.ul. mean mes ry,uen.,neum ..v ... , uom, ....... ,� ��_, .. v=, •_ You or XFS, and "Parties" means both You andXFS.-Supplier'means the entity identified as"Supplier'above 'Acceptance Date means the de installed and operating satisfactorily. "Agreement" means this Cost Per Image Agreement, including any attached EgWpnentSchedule: "Comment forth In Our first invoice, for facilitating an orderly transition and to provide a uniform billing cycle. "Discount Rate' means 3%per annum. "Er and in any attached Equipment schedule; plus any Software (defined to section 3 hereofl, attachments; accessories, replacements, replaceme Charges" means the applicable excess image charges. "Interim Period"means the period, if any, between the Acceptance Date and the Commen Payment multiplied by the number of days in the Interim Period. "Payment" means the Payment specified above, which may include an amou account for the Monthly Image Allowances listed above, the Excess Charges (unless otherwise agreed by You, Supplier and XFS), Takes and othe "Maintenance Agreement" means a separate agreement between You and Supplier for maintenance and support purposes. "Origination Fee which Youagree to pay, covering origination, documentation, processing and other initial costs. 'Term" means the Interim Period, if any, to, extension terms. "UCC' means the Uniform Commercial Code of the State(s) where XFS must file UCC-1 financing statements to perfect Its inter, charge on behalf of the Supplier to cover their costs of shipping supplies to You. 2. Agreement, Payments and Late Payments. You agree and represent that the. Equipment was selected, configured and negotiated by. You request, XFS will acquire same from Supplier to lease to You hereunder and You agree to lease same from XFS. The Initial Term commences on t as invoiced by Us according to the frequency set forth above. You agree to pay Us all sums due under each Invoice via check, Automated Cli from Your bank account by the due date. With Our consent, alternate forms of payment may be accepted subject to a nominal fee. If any Pa will pay a late charge ofthe greater of 5%of the amount due or$25, not to exceed the maxlmum amount permitted by law. We will make ar practices in accordance with any applicable prompt payment laws In the state of Your formation once You provide notice thereof. For each applicable fee, not to exceed $35, Restrictive covenants on any method of payment will are unenforceable. 3. Equipment and Software. To the extent that the. Equipment Includes intangible property or associated services such as software licenses, su acknowledge and agree that XFS is not the licensor of such Software, and therefore has no right, title or Interest in it and You will comply thr ('Software License") with the supplier of the Software ("Software Supplier'). You are responsible for determining with the Supplier whether an, the Software Supplier(s) no later than 30 days after the Acceptance Date, YOU AGREE THE EQUIPMENT IS FOR YOUR LAWFUL BUSINESS USE HOUSEHOLD OR FAMILY PURPOSES, AND IS NOT. BEING ACQUIRED FOR RESALE. You will not attach the Equipment as a fixture to real estate 4. Non -Cancellable Agreement. EXCEPT FOR A NON -APPROPRIATION EVENT AS DESCRIBED IN SECTION 21 HEREOF, THIS AGREEMENT CAN END OF THE INITIAL TERM. YOUR OBLIGATION TO MAKE ALL PAYMENTS IS ABSOLUTE AND UNCONDITIONAL AND NOT SUBJECT TO DI a or the Maintenance Agreement to I XFS agree will be Invoiced by XFS. f $225 billed on Your first invoice, n plus any subsequent renewal or ght Fee" means a fee that We may and supplied by Supplier. At Your or makeany permanent alterations to it. of Its due date, You THE OR S. End of Agreement Optlons. If a $1 Purchase Option is designated, You will be deemed to have marched Your option to purchase the Equipment as of the Acceptance Date. If an FMV purchase option is designated, You are not in default and If You provide no greater than 150 days and no less than GO days' written notice prior to the end of term to XFS, You may, at the end of the Initial Term or any renewal term ("End Date"), either (a) purchase all, but not less than all, of the. Equipment by paying its fair market value, as determined by XFS In its sole but reasonable discretion ("Determined FMV"), plus Taxes, or return the Equipment within 30 days of the End Date, at Your expense, fully Insured, to a continental US location XFS shall specify. You cannot return Equipment marathon 30 days prior to the End Date without Our consent. If We consent, We may charge You, in addition to all undiscounted amounts due hereunder, an early termination fee. If You have not elected one of the above options, this Agreement shall renew for successive 1-month terms.. Either parry may terminate the Agreement as of the end of any renewal term on 30 days' prior written notice and by taking one of the actions Identified in (a) or lb) in the preceding sentence of this section, Purchase options shall be exercised with respect to each item of Equipment on the day Immediately following the date of expiration of the Term of such item, and by the delivery atsuch time by You to XFS of payment, In form acceptable to XFS, of the amount of the applicable purchase price. Upon payment of the applicable amount, XF5 shall transfer Our interest in the Equipment to You on an "AS IS, WHERE IS," "WITH ALL FAULTS" basis, without representation or warranty of any kind 6. Equipment Delivery and Maintenance; You should arrange with Supplier to have the Equipment delivered to You at the location(s) specified herein, and You agree to execute a Delivery & Acceptance Certificate at XFS's request (and confirm same vle telephone and/or electronically) confirming when You have received, inspected and irrevocably accepted the Equipment, and authorize XFS to fund Supplier for the Equipment. If You fall to accept the Equipment, You shall no longer have any obligations hereunder.. Equipment may not be moved to another physical location or removed from service without XFS's prior written consent, which shall not be unreasonably withheld or delayed. You shall permit XFS or its agent to Inspect Equipment and any maintenance records relating thereto during Your normal business hours upon reasonable notice. You represent You have entered Into a Maintenance Agreement to maintain the Equipment in good working order in accordance with the manufacturers maintenance guidelines and to provide You with Equipment supplies. You acknowledge that XFS Is acting solely as an administrator for Supplier with respect to the billing and collecting of the charges under any Maintenance Agreement. XFS IS NOT LIABLE FOR ANY BREACH BY SUPPLIER OF ANY OF ITS OBLIGATIONS TO YOU, NOR WILL ANY OF YOUR OBLIGATIONS HEREUNDER BE MODIFIED, RELEASED OR EXCUSED BY ANY ALLEGED BREACH BY SUPPLIER. 7. Equipment Ownership, Labeling and UCC Filing. If and to the extent a court deems this Agreement to be a security agreement under the UCC; and otherwise for precautionary purposes only, You grant XFS a first priority security Interest in the Equipment as defined on the first page hereof In order to secure Your performance hereunder. Unless a $1 Purchase Option is applicable, XFS is and shall remain the sole Owner of the Equipment, except the Software. You authorize XFS to file a UCC financing statement to show, and to do all other acts to protect, Our interest in the Equipment. You agree to pay any filing fees and administrative costs for the filing of such financing statements. You agree to keep the Equipment free from any liens or encumbrances and to promptly notify XFS if there is any change in Yourorganization such that a rattling or amendment to XFS's financing statement against You becomes necessary. S. Equipment Return.lfthe Equipment is returned to XFS; it shall be In the some condition as when delivered to You, except for "ordinary wear and tear" and, If not in such condition, You will be liable for all reasonableexpenses XFS Incurs to return the Equipmeottosuch condition. Tl$SOLELYYOURRE$PONSIBILITYTOSECUREANYSENSITIVEDATAANDPERMANENTLY DELETE SUCH DATA FROM THE INTERNAL MEDIA STORAGE PRIOR TO RETURNING THE EQUIPMENT TO XFS: YOU SHALL HOLD XFS HARMLESS FROM YOUR FAILURE TO SECURE AND PERMANENTLY DELETE ALL SUCH CUSTOMER DATA AS OUTLINED IN THISSECTION. XFS; Your Supplier or an XFS affiliate may, but are not required to, offer to securely remove all data from all disk drives or magnetic media upon return of the Equipment for an additional fee to cover the cost of the service and/or any replacement pacts required. 9. Meter Readings and Annual Adjustments. You agree that Meter Reading submittal is covered by the Maintenance Agreement. At any time after 12 months from the Commencement Date and for each successive 12-month period thereafter during the. Term, XFS may increase Your Payment and the Excess Charges by amaximum of fifteen percent (15%) of the then -current Payment therefor and You agree to pay such increased amounts. 10. Assignment. YOU MAY NOT ASSIGN, SELL, PLEDGE, TRANSFER, SUBLEASE OR PART WITH POSSESSION OF THE EQUIPMENT; THIS AGREEMENT OR ANY OF YOUR RIGHTS OR OBLIGATIONS. UNDER THIS AGREEMENT (COLLECTIVELY "ASSIGNMENT-1 WITHOUT XFS'S PRIOR WRITTEN CONSENT, WHICH SHALL NOT BE UNREASONABLY WITHHELD, BUT SUBJECT TO THE SOLE EXERCISE OF XFS'S REASONABLE CREDIT DISCRETION AND EXECUTION OF ANY NECESSARY ASSIGNMENT DOCUMENTATION. If XFS agrees to an Assignment, You agree to pay the applicable assignment fee and reimburse XFS for any costs We incur in connection with that Assignment. XFS may sell; assign or transfer all or any part of the Equipment, the Agreement, and/or any of Our rights at no cost to You. XFS's assignee will have the same rights that We have to the extent assigned, however XFS shall remain liable for Our obligations: YOU AGREE NOT TO ASSERT AGAINST SUCH ASSIGNEE ANY CLAIMS, DEFENSES, COUNTERCLAIMS, RECOUPMENTS, OR SET -OFFS THAT YOU MAY HAVE AGAINST XFS, and You agree to remit Payments to such Assignee if so designated. XFS agrees and acknowledges that any Assignment by Us will not materially change Your obligations hereunder. 11. Taxes. You have represented to XFS that You are currently, and shall continue to be, a tax-exempt entity. In the event You are no longer tax-exempt (or are unable to provide proof thereof to XFS), You Mill be responsible for, all applicable taxes, fees or charges (including sales, use, personal property and transfer taxes father than net income taxes), plus interest and penalties) assessed by any governmental entity on You, the Equipment, this Agreement, or the amounts payable hereunder (collectively, "Taxes"), which will be included. in Our invoices to You unless You provide proof of Your tax-exempt status no later than thirty (30) days following the commencement of this Agreement. Regardless of Your tax-exempt status; XFS reserves the right to pass through, and You agree to pay, any such Taxes that are actually assessed by the applicable State on XFS as the Owner of the Equipment For jurisdictions where certain taxes are calculated and paid at the time of agreement initiation, You authorize XFS to finance and adjust Your Payment to Include such Taxes over the Term. Unless and until XFS notifies You In writing to the contrary, the fallowing shall apply to personal property taxes. and returns. If an FMV purchase option is applicable, XFS will file all personal property, tax returns covering the Equipment, pay the personal property taxes levied or assessed thereon, and collect from Your account all such personal property taxes. As compensation for Our internal and external costs In the administration Oftaxes related to this Agreement, You agree to pay Us a processing fee by asset per year during the. Term, lax Administration Fee", not to exceed the: maximum permitted by applicable. law. XFS MAKES NO WARRANTY, EXPRESS OR IMPLIED, REGARDING THE TAX OR ACCOUNTING TREATMENT OF THIS AGREEMENT. 12, Equipment Warranty Information and Disclaimers. XFS HAS NO INVOLVEMENT IN THE DESIGN; MANUFACTURE, SALE, DELIVERY, INSTALLATION, USE OR MAINTENANCE OF THE EQUIPMENT. THEREFORE, XFS DISCLAIMS, AND YOU WAIVE SOLELY AGAINST XFS, ALL EQUIPMENT WARRANTIES, EXPRESS OR IMPLIED, INCLUDING,: BUT NOT LIMITED TO; THE IMPLIED WARRANTIES OF MERCHANTABILITY, NON-INFA!NGEMENT AND FITNESS FOR PARTICULAR PURPOSE, AND XFS MANES NO REPRESENTATIONS WHATSOEVER, INCLUDING, BUT NOT LIMITED TO, THE EQUIPMENT'S SUITABILITY, FUNCTIONALITY, DURABILITY OR CONDITION. Since You have selected the Equipment and Supplier, You acknowledge tha lyau are aware of the name of the manufacturer of each item of Equipment, Supplier's contact information, and agree that You will contact manufacturer and/or Supplier for a description ofanywarranty. rights You may have under the Equipment supply contract, sales order, crotherwise. Provided Youare notin default hereunder XFS hereby assigns to You any Equipment warranty rights We mayhave againstSupplier or manufacturer thereof. lithe Equipment Is returned to XFS or You are in default, such rights are deemed reassigned by You to XFS. IF THE EQUIPMENT IS NOT PROPERLY INSTALLED, DOES NOT OPERATE AS WARRANTED, BECOMES OBSOLETE, OR IS UNSATISFACTORY FOR ANY REASON, YOU SHALL MAKE ALL RELATED CLAIMS SOLELY AGAINST MANUFACTURER OR SUPPLIER AND NOT AGAINST XFS, AND YOU SHALL NEVERTHELESS CONTINUETO PAY ALL PAYMENTS AND OTHER SUMS PAYABLE UNDER THIS AGREEMENT. 13. Liability and Indemsllfication; XFS IS NOT RESPONSIBLE FOR ANY LOSSES, DAMAGES,EXPENSES OR INJURIES OF ANY KIND OR TYPE, INCLUDING, BUT NOT LIMITED TO, ANY SPECIAL, INDIRECT, INCIDENTAL. CONSEQUENTIAL OR PUNITIVE DAMAGES (COLLECTIVELY, "CLAIMS") TO YOU OR ANY THIRD PARTY CAUSED BY THE EQUIPMENT OR ITS USE. To the extent permitted by applicable law, You assume the risk of liabllityfor,. and hereby agree to Indemnify and hold safe and harmless, and covenant to defend, XFS. its employees, officers and agents from and against: (a) anyand all Claims (including legal expenses of every kind and nature) arising out of the aueptance or rejection, ownership, leasing, possession, operation, use, return or other disposition of the Equipment; and (b) any and all loss or damage of or to the Equipment. Nelther sentence in this Section shall apply to. Claims arising directly and proximately from XFS's gross negligence or willful misconduct. 14. Default and Remedies, You will be in default hereunder If We do not receive Payment within 30 days after Its due date; or You breach any other material obligation hereunder or any other agreement with Us IFYou default, and such default continues for 10days after We provide notice to You, Warmly, In addition to other remedies (Including disabling or repossessing Equipment and/or requesting Supplier to cease performing under the Maintenance Agreement),. Immediately require You to do one or more of the following; as liquidated damages for loss of bargain and not as a penalty, pay the sum of (pall amounts then due, plus Interest from the due date until paid at the rate In accordance with the laws. of Your. State of: formation covering state agencies and the applicable codes covering political subdivisions; (H) pay all remaining Payments in the Term, discounted to date of default at the Discount Rate; (IN) the Equipment's booked residual or [Trot purchased, require You to return the Equipment as provided herein; and (iv) Taxes. The substantially prevailing parry shall pay all reasonable costs, including attorneys' fees and disbursements, in any litigation to enforce thisAgreement.. 1S, Risk of Loss and Insurance. You assume and agreeto bear the entire risk of loss, theft, destruction or other Impairment of the Equipment upon delivery. You, at Your own expense, (!) shall keep Equipment insured against loss or damage at a minimum of full replacement value thereof, and (11) shall carry liability Insurance against bodily injury, including death, and against property damage in the amount acceptable to us (collectively, "Required Insurance"). All such Equipment loss/damage insurance shall be with lender's loss payable to "XFS, its successors and/or assigns, as their interests may appear," and shall be with companies reasonably acceptable to XFS. XFS shall be similarly named as an additional Insured on all relevant liability insurance policies. The Required Insurance shall provide for 30 days' orlor notice to XFS of cancellation. YOU MUST PROVIDE XFS OR OUR DESIGNEES WITH SATISFACTORY WRITTEN. EVIDENCE. OF REQUIRED INSURANCE WITHIN 30 DAYS OF THE ACCEPTANCE DATE 37. Finance tease and Customer Waivers; Unless this Agreement Is designated to ZA. Customer waives Its rights as a lessee under UCC 2A Sections SOB-522. 18. Original and Sole Controlling Document, No Modifications Unless in Wrltli representations or statements not included herein are not part of this Agreement representative and by XFS's authorized representative (an original manual signatu electronic signature) shall be marked "original" byXF5 and shall constitute the only Agreement may be created except by the possession or transfer of the copy marked SHALL BE BINDING ON XFS, AS THE TERMS AND CONDITIONS OF THIS AGREEMENT AGENTS AND ARE NOT AUTHORIZED TO MODIFY OR NEGOTIATE THE TERMS OF SIGNED BY AUTHORIZED REPRESENTATIVES OF THE PARTIES AND NO PROVISION! from You will not be a waiver or modification of the terms of this Agreement. You name, agreement numbers, serial numbers and other Equipment Information, Indus s, If an FMV purchase option Is designated on the first page hereof, XFS's residual Interest in such Equipment (herein due to XFS hereunder, or (it) the Determined FMV immediately prior to the loss or damage. NO LOSS OR DAMAGE TO NDER THIS AGREEMENT, BUT XFS SHALL APPLY ANY INSURANCE PROCEEDS TO REDUCE THE REMAINING AMOUNTS rble for performance under this Seaton In the event the applicable Insurance carrierfails or refuses to pay any claim. sorized, executed and delivered by the Parties in accordance with all applicable laws, rules, ordinances and regulations stions required in connection herewith) and is valid, legal and binding in accordance with its terms. The person(s) signing of their governing body and hold theoffices indicated below their signatures, each of which are genuine. You agree to sow; which shall accurately represent Your financial condition, and You authorize ITS to obtain credit reports on You in resents that it Is subject to, and shall abide by, the Xerox Corporation anti -discrimination, equal employment and other secs and the ethics and compliance policies found at https://myw.xerox.com/en-us/about/corporate-citizenship/ethL,.6 have a $1 purchase option, the parties agree this Agreement shall be construed as "finance lease" under UCC Article ig. This Agreement constitutes the entire. agreement between the Parties as to the subjects addressed herein, and Ind are not binding on the Parties. You agree that an executed copy of this Agreement that is signed by Your authorized �e or such signature reproduced by means of a reliable electronic form, such as electronic transmission of a facsimile or riglnal document for all purposes. To the extent this Agreement constitutes UCC chattel paper, no security Interest In this "original" by XFS. IFA PURCHASE ORDER OR OTHER DOCUMENT IS ISSUED BY YOU, NONE OF ITS TERMS AND CONDITIONS EXCLUSIVELY GOVERN THE TRANSACTION DOCUMENTED HEREIN. SUPPLIER AND ITS REPRESENTATIVES ARE NOT OUR 'HIS AGREEMENT; THIS AGREEMENT MAY NOT BE AMENDED OR SUPPLEMENTED EXCEPT IN A WRITTEN AGREEMENT CAN BE WAIVED EXCEPT IN A WRITING SIGNED. BY XFS. XFS's failure to object to terms contained In any communication authorize XFS to Insert or correct missing Information on this Agreement, including but not limited to Yourproper legal ling Equipment substitutions orpardal substitutions communicated to Us bythe Supplierso long as there is no material Impact Page 2 of 4 XFS-SLG-CPI1-08.01.23 11. Non -Appropriation. This Section Is applicable only if the inclusion of a non -appropriation provision is legally required. Your obligation to pay all amounts due hereunder is contingent upon approval of the appropriation of funds by Your governing body. In the event funds are not appropriated for any forthcoming Fiscal period equal to amounts due hereunder, and You have no other funds legally available to be allocated to the payment of Your obligations hereunder, You may terminate this Agreement effective on the first day of such fiscal period ('Termination Date") if: (a) You have used due diligence to exhaust all funds legally available; and (b) XFS has receivedwritten notice from You at least thirty (30) days before the Termination Date. At XFS's request, You shall promptly provide supplemental documentation as to such non -appropriation. Upon the occurrence of such non -appropriation, You shall not be obligated for any Payment(s) for any fiscal period for which funds have not been so appropriated, and You shall promptly deliver the Equipment to the Dealer (or such other party as We may designate) as set forth in the return provisions hereof. SnS�lnlJ Page 3 of 4 XFS-SLG-CPI1-08,01.23 This Equipment Schedule "A" is attached to and becomes a part of the Agreement Number listed below, between Xerox Financial Services LLC and the undersigned Customer. Agreement Number: „•'�. �..Artl� �� S �. I , >x t'.11£"ut°N� - ...£ ��5` ! .�-��J.i'"�rtl E LI Quantity Model and Description Location Meter Pools COUNTY OF CALHOUN 7 EC80381-12 CALHOUN COUNTY LIBRARY 200 W B&W: Flat Rate MAHAN ST Color: Flat Rate PORT LAVACA, TEXAS 77979 _Teiist12"�''` Name Allowance Excess Rate Excess Frequency Name Allowance Excess Rate. Excess Frequency EC80381-12 FLAT RATE 1.000 SWfCCLORPAGES COMBINED NA NA Quantity I Model and Description I Equipment Location I This Schedule W is hereby verified as correct by the undersigned Customer Customer: COUNTY OF CALHOUN Authorized Signal a x: •"r1uh1�1tV.^V•,J(�01 1—+-CN Dalux of ._ dI \, Name: X 0 ► Ln �� TID g) L i to r ar y iY-r or Page 4 of 4 XFS-SLG-CPI3-08.01.23 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of l Complete Nos, 1- 4 and 6 if 'here are interested parties. OFFICE USE ONLY Complete NOS. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country at the business entity's place of business. Dahill Office Technology Corporation (Legal Name) dba Xerox Business Solutions Southwest 2024-1168971 San Antonio. TX United States Date Filed: 05/3012024 3 Name of governmental m ty or state agency that Is a parry to t comract or w ch being filed. Calhoun County Library Date Acknowledged: 3 Provide the Identification number used by the governments] entity or stairs agency to track at Identify the contract, and provide a description of the services, goods, or other property to be prOVlded under the contract. Contract Approval Contract Approval 4 Nature of interest Name Of Interested Party City, State, Country (place at business) (check applicable) Controlling Intermediary Daniels , Dana San Antonio, TX United States X Hilts, Mark San Antonio, TX United Stales X a Check only it there Is NO Interested Parry. ❑ 6 UNSWORN DECLARATION My name is Dana Daniels and my date of birth ls-_�-___., My address is .■ (street) (city) (state) (zip cods) (munuy) i declare under penally of perjury that the foregoing is true and correct, Executed', BeXar County, state of Texas , on the 36 day of May 2g 24 (mom'h) (year) tura'7AIIrI�' Signature of authorized agent of contracting business entity (Declarant) ��,,,, www.cm,usime.u.us Version V4.1.0.0788bao #15 NOTICE OF MEF_TING-6/05/2024 15. Consider and take necessary action to cancel the June 26, 2024 Regular Commissioners Court Meeting to allow the Judge and Commissioners to attend the South Texas County Judges and Commissioners Association Conference in South Padre Island and the October 23, 2024 Regular Commissioners Court meeting to allow the Judge and Commissioners to attend the 102nd Annual County Judges and Commissioners Association of Texas Conference in San Marcos. (REIM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall,, Lyssy; Behrens, Reese Page 12 of 28 TEXAS ASSOCIATION ofCOUNTIES South Texas County Judges and Commissioners Association Annual Conference Mb June 24, 2024 - June 27, 2024 multi -day © 03:00 PM - 11:00 AM South Padre Island Convention Centre 7355 Padre Blvd South Padre Island, TX 78597 ® Contact the V.G. Young Institute of County Government at (979) 845-4572. For attendee and vendor registration please visit the County Progress Website. County Progress Website icebook.com/TexasCounties) O(https://www.instagram.com/texascounties/) X(https://twitter.com/TexasCounties) in(http://www.tinked[n.com/Compa Copyright C 2024 TAC Copyright Information TEXAS ASSOCIATION ofCOUNTIES 102nd Annual County Judges and Commissioners Association of Texas Conference M October 21, 2024 - October 24, 2024 multi -day © 09:00 AM - 05:00 PM Embassy Suites by Hilton San Marcos Hotel Conference Center Contact Michele EWerz or Sam Burke at (800) 456-5974, Contact Us OVERVIEW #16 NOTICE OF MEETING — 6/05/2024 16. Public hearing on Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. (GDR) Closed regular session at 10:10 Henry Danysh explained Petition to Vacate. Opened regular session at 10:11 Page 13 of 28 PUBLIC HEARING — 6/05/2024 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct* NOTICE OF PUBLIC HEARING The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, June 5, 2024 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse, 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Court will hold a Public Hearing in the Commissioners' Courtroom, 211 S. Ann Street, Suite 104, in Port Lavaca, Texas, on June 5, 2024 at 10:00 a.m. regarding a Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. This notice is in accordance with Section 111.007 and Section 111.0075 of the Texas Local Government code. r 7 Ri hard H. Meyer, County dge Calhoun County, Texas A copy of this Notice has been placed on the inside bulletin board of the Calhoun County Courthouse, 211 south Ann Street, Port Lavaca, Texas, which is readily accessible to the general public during regular business hours. 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, AT 9FILED 01K N MAY 31 2024 COUNTY CLERK NCAfHSUN COUNTY, TEXAS �� OEW1Tr' ft/v' Page 1 of 1 #17 NO IICE OE MEETING — 6/05/2024 17. Consider and take necessary action on Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. (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 14 of 28 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May 29, 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 June 5, 2024. • Consider and take necessary action on Petition to Vacate Lots 1-3 and 10-12 in Block A of the Port O'Connor Townsite recorded in Volume 2, Page 001 of the Calhoun County Plat Records. Sincerel y, GDR/at RO, Box 177 —Seadrift. Texas 77983 —email: earv.reeseninalhouncomore — (361) 785-3141 —Fax (361) 785.5602 #18 ' N0110E. OF MEETING - 610512024 18. Consider and take necessary action on road closure of the south portion of Haterius Park and designate the North portion as a one-way street between the hours of 2:00 pm- 12:00 am on June 30, 2024 during the Firework Display provided by Bayside Community Church. (JMB) RESULT: APPROVEb [UNANIMOUS] MOVER: II'Joel Behrens, Commissioner Oct 3 SECONDER: Gary Reese, Commissioner'Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 15 of 28 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 —Fax (361) 893-5309 Email: joetbehrens0,calhouncotx.org Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for June 5, 2024. Consider and take necessary action on road closure of the south portion of Haterius Park and designate the North portion as a one-way street between the hours of 2:00 pm — 12:00 am on June 30, 2024 during the Firework Display provided by Bayside Community Church. Sincerely, �+ Joel Behrens Commissioner Pet. 3 � t AA -f L $ to 400* wfx 'in ^Nx. `ifii tu`! ^ N k. S }' ✓� �� s� flJ ®yyyy Mt a �T t i� #19 ' NOTICE OF MEETING - 61051202.4 19. Consider and take necessary action to approve the preliminary plat of Bayshore Ranchettes. (JMB) Terry Ruddick explained the preliminary plat. RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner kt 3 SECONDER; Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 16 of 28 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas 77979 — Office (361) 893-5346 — Fax (361) 893-5309 Email: ioel.behrensncathouncotx.org Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Meyer: Please place the following item on the Commissioner's Court Agenda for June 5, 2024. Consider and take necessary action to approve the preliminary plat of Bayshore Ranchettes. Sincerely, Joel Behrens Commissioner Pct. 3 • us' Land Surveyiing Since 1991 May 28, 2024 Joel Behrens County Commissioner Precinct #3 24627 State Highway 172 Port Lavaca, TX 77979 RE: Bayshore Ranchettes Dear Commissioner Behrens, Please consider this letter as my request to have the following item placed on the June 5, 2024 Commissioner's Court agenda: Consider and take necessary action to approve the Preliminary Plat of Bayshore Ranchettes. If 1 can provide additional information, please do not hesitate to contact me. Sin rely, TerryT• mWdick, R.P.L.S. C.E.O. (514769.02) Victoria San Antonio Cuero 2004 N. Commerce Victoria, TX 77901 12661Silicon Drive San Antonio, TX 78249 104 E. French Street Cuero, TX 77954 urbansurveying.eom 381-578-9837 210-267-8654 361-277-9061 Firm 9: 10021100 Firm 4:10193843 Firm t: 10021101 o tal lkt� i�.A�...—aL/ FS 'g, - a1v ... .... .... PRELIMINARY PLAT BAYSHORE RANCHETTES NOTICE OF MEE I ING -- 6/05/2024 20. Consider and take necessary action to accept the Agreement for Professional Services with Urban Engineering for Engineering Services in the amount of $35,000 for Calhoun County Bill Sanders Memorial Park Pavilion and authorize Commissioner Reese to sign all documentation. (GDR) 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 28 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May 29, 2024 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA 17EM Dear Judge Meyer: Please place the following item on the Commissioners' Court Agenda for June 5, 2024. • Consider and take necessary action to accept the Agreement for Professional Services with Urban Engineering for Engineering Services in the amount of $35,000 for Calhoun County Bill Sanders Memorial Park Pavilion and authorize Commissioner Reese to sign all documentation. Sincerely, r\ '�)Z, Gary D. Reese P.O. Box 177 - Seadrift. Texas 77983 email: eary.reese «.calhouncorx.ore - (361) 785-3141 Fax (361) 785-5602 ♦�V RBAN ♦ e n g i n e e r i n g AGREEMENT FOR PROFESSIONAL SERVICES Date: May 29, 2024 Professional Firm: Urban Engineering TREF# F-160 2004 N. Commerce St. Victoria, Texas 77901-5510 Tel No. (361) 578-9836 Project Name/Location: Calhoun County Bill Sanders Memorial Park Pavilion Swan Point Road Seadrift, Calhoun County, Texas Scopelintent and Extent of Services: I. Surveying Services A. Topographic Survey Project No.: E25470.02 Client: Calhoun County Attn: Mr, Gary Reese Calhoun County Commissioner Precinct #4 P.O. Box 177 Seadrift, TX 77983 1. Perform a topographical survey of the project area. II. Engineering Services A. Construction Plans 1. Design and prepare construction plans and specifications for the construction of a 30' x 50' pavilion. 2. Submit the construction plans for the project for ADA review, filing and inspection. Calhoun County will be responsible for the payment of the ADA fee. B. Bidding and Contract Administration 1. Prepare contract & bidding documents, oversee the bidding process and perform contract administration. III. Geotechnical Investigation Services A. Testing 1. Perform preliminary testing services of the project area and provide recommendations. Special Conditions: 1. The topographic survey will be performed by Urban Engineering through a subcontract with Urban Surveying, Inc 2. Geotechnical Investigation Services will be performed by Urban Engineering through a subcontract with T.S.I. Laboratories, Inc. Page 1 of 3 Fee Arrangement: Surveying Services Topographic Survey $2,750.00 (fixed fee) Subtotal $2,7%00 Geotechnical Investigation Services Preliminary testing services $6,250.00 (fixed fee) Subtotal $6,250.00 Engineering Services Design & Prepare Construction Plans $19,500.00 (fixed fee) Bidding $ 2,600.00 (fixed fee) Contract Administration $ 3,900.00 (fixed fee) Subtotal $26,000.00 MGM Reimbursable fees, which include Governmental review fees, prints and postage, will be billed at actual cost +10%. 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 after the invoice date. if the invoice is not paid within 30 days, Urban Engineering may, withoutwaiving any claim or right againstthe 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. Urban Engineer'ng TREE# F-16 (Signature) Matt A. Glaze, P.E.Nice President (Printed Name/Title) s�f�Y (Date) Calhoun County A(Signatur k) Gary Reese/Calhoun County Commissioner Pct #4 (Printed Name/Title) (Do � 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 forthe 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 anyway connected with the performance by any of the parties above named of the services under this agreement, excepting only those damages, liabilities or costs 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 agreement with 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 thatwould 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 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1041 Cornplete Nos. I.4 and 6 it there are interested parties. OFFICE USE ONLY Complote Nos, 1, 2, 3, 5, and 6 If there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business, 2024-1167610 Victoria Engineering, Inc. dba Urban Engineering Victoria, TX United States Date Filed: 05/29/2024 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun Courtly, 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. LIE Job #E25470.02 Engineering Services for Calhoun County Bill Sanders Memorial Park Pavilion 4 Name of Interested Party City, State, Country (place of business) Nature of interest (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 Fromme, 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 my date of birth is USA My address is , (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing Is true and correct. Victoria Texas 29th May 24 Executed in County, State of , on the _day of , 20— (month) (year) Ignature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V4.1.0.078aba0 #21 Nor i(..E OF MEETING - 6/0.5/2024 21. Consider and take necessary action on allowing Fema to use the Calhoun County Library as a Disaster Recovery Center for the weather event on May 13th, 2024 and authorize the County Judge to sign. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER': David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 18 of 28 DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY LICENSE/USE AGREEMENT — USE OF REAL PROPERTY/FACILITIES I. Parties: The Parties to this License and Use Agreement ("Agreement') are the Federal Emergency Management Agency, U.S. Department of Homeland Security ("FEMA") and Calhoun County Public Library ("Licensor"). FEMA and Licensor are referred to collectively in this Agreement as the "Parties." II. Authority: This Agreement is authorized under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5201 (b). III. Purpose: FEMA desires to use, and the Licensor agrees to permit FEMA to use the following described property (hereinafter referred to as the "Premises") at no cost to FEMA: Calhoun County Public Library 200 W Mahan St Port Lavaca, TX 77979 IV. Scope: The Licensor will authorize FEMA the use of the premises identified above for the following purposes: Disaster Recovery Center (DRC) for Individual Assistance to receive members of the public for the purpose of providing information such as status of applications and general information on FEMA disaster assistance. Other Federal, State, local and voluntary organizations may also use the Premises to provide similar information on their programs. FEMA Staff and DRC visitors are permitted to access and use the parking adjacent to the Premises. FEMA staff and DRC visitors are permitted to access and use the interior premises provided by the Licensor. Operating hours will be 7am-7pm, seven days a week. V. Duration: This Agreement shall become effective upon execution, and expire no later than 30 July 2024, unless terminated prior to that date with 10 calendar days' notice being given by either party. This Agreement may be extended by mutual consent of the parties. License and Use Agreement Page 1 of 5 FEMA — State of Texas FEMA — DR - 4781 VI. Duties and Responsibilities: A. Licensor shall: 1. At no cost to FEMA, maintain the Premises in good repair and condition, and supply utilities including heat, air conditioning, light, ventilation, sanitation, trash removal, and cleaning services during the period of this Agreement unless FEMA enters into separate agreements to provide for utility, sanitation and cleanings services; 2. Provide FEMA with any keys, access codes, or other instruments necessary to access the Premises, as needed by FEMA, and coordinate with FEMA to assist with limiting the access of third parties; 3. Maintain at Licensor's own expense existing electrical service, internet/Wi-Fi, and all other utilities including water and sewer for the duration of this Agreement, unless separately metered and contracted for by FEMA under separate agreements; 4. Permit FEMA to install, if necessary, electrical and telecommunications upgrades with the approval of the Licensor, which will become the property of the Licensor upon termination of the lease and not be removed by FEMA; Permit FEMA to provide, as necessary, office furniture and equipment for its use. This property and other removable property provided by FEMA necessary to carry out the intended use of the Premises will remain FEMA property in the exclusive control and authority of FEMA in accordance with FEMA 119-7-1, and will be removed by FEMA upon termination of this agreement; 6. Permit FEMA to make other minor alterations to the Premises such as the installation of signage, which will be removed upon termination of the Agreement; and 7. Maintain insurance for liability, and for loss of or damage to the property, arising from the wrongful or negligent acts or omissions of third parties. B. FEMA shall: 1. Maintain the Premises in clean and orderly condition; 2. Surrender the Premises in the same state and condition as it was in at the commencement of FEMA use and occupancy, excepting normal wear and tear, excluding upgrades made in accordance with paragraph VI.AA above, License and Use Agreement Page 2 of 5 FEMA — State of Texas FEMA — DR - 4781 and including the removal of any items installed in accordance with VI.A.5 and 6 above; 3. Provide for any required security or cleaning services under separate contract at FEMA expense; and 4. Permit the Licensor to enter the Premises with approval of the designated FEMA Point of Contact, or as otherwise coordinated for routine entry or shared use, as described in paragraph IV of this Agreement. VII. Non -Fund Obligating Agreement: Nothing in the Agreement shall authorize FEMA to obligate or transfer any funds in connection with FEMA's use and occupancy of the Premises. Any additional work or activity that would require the transfer of funds or the provision of goods or services among the parties will require execution of a separate agreement and will be contingent upon the availability of the appropriated funds. Such activity must be independently authorized by appropriate statutory authority. This Agreement does not provide such authority. VIII. Liability: Licensor and the United States each agree to be responsible for the negligent or wrongful acts or omissions of their respective employees arising under this Agreement. The parties agree -- subject to any limitations imposed by law, rule, or regulation -- to cooperate in good faith to resolve any claims promptly and, whenever appropriate, without litigation. For all claims or suits arising under this Agreement, each party's legal representatives will provide the other's legal representatives with copies of any documents memorializing such claims within seven (7) calendar days of receipt. Nothing in this Agreement shall be construed as a waiver of any sovereign immunity by the United States. The Federal Tort Claims Act provides the exclusive monetary damages remedy for all allegedly wrongful or negligent acts or omissions by Federal employees within the scope of their employment. IX. Compliance with Applicable Law: The Licensor shall comply with all Federal, state, and local laws applicable to either the Licensor as owner or the Premises (including, without limitation, laws applicable to construction, ownership, alterations, or operations), and the Licensor will obtain and maintain all required permits, licenses, and similar items, at no cost to FEMA. X. Applicable Law: Federal law shall govern this Agreement and any dispute or claim arising from it. XI. Warranty for Use of Premises: Licensor warrants that the Premises may be used for the purposes intended by FEMA as License and Use Agreement Page 3 of 5 FEMA — State of Texas FEMA — DR - 4781 described in this Agreement. Nothing in this Agreement shall be construed to create a duty on FEMA to inspect the Premises for toxic material or any latent hazardous environmental conditions that could affect FEMA's intended use of the Premises. Any known hazardous environmental conditions that could affect FEMA's use of the Premises, known to the Licensor, must be disclosed to FEMA. XII. Integrated Agreement: This Agreement contains the entire agreement of the parties. No agreement outside of this document can alter these provisions. Any changes to this Agreement must be made in writing with the mutual consent of the parties. XIII. Points of Contact: a. The FEMA Point of Contact is: Laurie Arterburn External Support Branch Director, Logistics 800 N Loop 288 Denton, TX 76209 (202) 374-0163 Laurie.Arterburn(a,fema.dhs.gov b. The Licensor's Point of Contact is: LaDonna Thigpen Emergency Management Coordinator 200 W Mahan St Port Lavaca, TX 77979 (361) 550-1615, ladonna.thigpen a,calhouncotx.org XIV. Other Provisions: Nothing in this Agreement is intended to conflict with current law or regulations or the directives of DHS/FEMA. If a term of this Agreement is inconsistent with any such authority, then that term shall be invalid, but the remaining terms and conditions of this Agreement shall remain in full force and effect. XV. Effective Date: The terms of this agreement will become effective on the date of signature of the authority representatives of both parties. XVI. Modification: License and Use Agreement Page 4 of 5 FEMA — State of Texas FEMA — DR - 4781 This agreement may be modified upon the mutual written consent of the parties. XVIL Approved by: For the or: r Ri hard EI. Meyer Calhoun County Judge Date For the Federal Emergency Management Agency: RUSSELL E Digitally signed by RUSSELLE GARSIDE GARSIDE Date: 2024.05.3011:33:22-05.OW Name 'I the Date License and Use Agreement Page 5 of 5 FEMA — State of Texas FEMA — DR - 4781 # 22 NOTICE 0[7 MEETING -- 6/05/2024 22. Discuss and take necessary action to open credit accounts with United Vision Logistics. (VLL) Pass Page 19 of 28 Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 May 29, 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 next Commissioners' Court Agenda (361) 552-9656 Fax (361) 553-6664 • Discuss and take necessary action to open credit accounts with United Vision Logistics I UVL TERMINAL #:086 UVL TERMINAL CONTACT: Amanda Sruber To provide an accurate invoice, please complete the following items: Date: 5/22/24 Customer: Calhoun County Pct 2 1. What reference information should appear on your invoice? Please provide example next to selected items if available. ❑ Purchase Order # if You regfdrethis, we don'l ❑ APE # ❑ Well Charge ❑ Other(s) 2. UVL provides a standard waybill as proof of delivery. What additional backup paperwork is needed with your invoice? i.e., Shipper's BOL, Scale Ticket, etc. NJA 3. Do you have any additional invoice requirements not listed above? 4. Preferred delivery method of invoices? ❑ Paper ❑ Electronic/Portal Portal Information 0 E-mail E-mail Address: iesa.jurek@calhounclox.org Company's standard reference document can be submitted in lieu of completing page 2 of UVL's Credit Application. However, UVL requires the firm's legal name and signature on page 2 acknowledging Terms and Conditions. Remit Credit Application and Customer Billing Information To: United Vision Logistics E-mail: new.custamei uvlo nsticsxom Fax: 337-839-4104 www-uvlo" is[ic_.cnm 1 of J UVL TERMINAL #: UVL TERMINAL CONTACT: Amount of Credit Requested: $10 000 Firm's Legal Name: The County of Calhoun Texas DBA Name: Customer's Phone #: 361-552-9656 Customer's Fax #: 361-553-6884 Billing Address: 5812 FM 1090 N City, State, Zip: Port Lavaca. TX 77979 #different from Billing Address Physical Address: Same City, State, Zip: Contact E-mail Address, lesa.jurek(aa.calhouncotx.oro Type of Business: County Road & Bridge (Please be specific) ❑ Corporation ❑ Partnership ❑ LLC ❑ Proprietorship Is this a Public Company? ❑ Yes ❑ No State of Incorporation: Date Business Started: Federal ID #: 74-6001923 D&B#: MC# Subsidiaries or Affiliations: President/CEO: Controller: Accounts Payable Contact: Lesa Jurek Email: lesa.iurek a0calhouncotx org TRADE REFERENCES NOTE: Trade references must be relative to the last 90 days of business activity. Please include In this list at least one transportation company as a reference. COMPANY NAME CITY, STATE PHONE, EMAIL, & FAX# 2. 3. 4. APPLICANT HEREBY CERTIFIES THAT THE INFORMATION CONTAINED HEREIN IS COMPLETE AND ACCURATE. THIS INFORMATION HAS BEEN FURNISHED WITH THE UNDERSTANDING THAT IT IS TO BE USED TO DETERMINE THE AMOUNT AND CONDITIONS OF THE CREDIT TO BE EXTENDED. FURTHERMORE, APPLICANT. HEREBY AUTHORIZES UNITED VISION LOGISTICS TO RESEARCH CREDIT THROUGH THE ABOVE TRADE REFERENCES AND/OR A CREDIT-REPORTING AGENCY TO VERIFY INFORMATION CONCERNING CREDIT EXPEREINCE. ALL INVOICES RENDERED BY UNITED VISION LOGISTICS ARE NET SO DAYS, UNITED VISION LOGISTICS RESERVES THE RIGHT TO ASSESS ONE AND ONE-HALF PERCENT (WI-1.) PER MONTH ON PAST DUE INDEBTEDNESS FOR COLLECTION, HANDLING, LATE FEES AND INTEREST. IN THE EVENT UNITED VISION LOGISTICS RETAINS THE SERVICES OF LEGAL COUNSEL OR A COLLECTION AGENCY TO COLLECT ANY OUTSTANDING INDEBTEDNESS, APPLICANT SHALL BE RESPONSIBLE FOR REASONABLE ATTORNEY AND COLLECTION AGENCY FEES OR COSTS. SIGNATURE: PRINTED NAME: Vern LVssy TITLE: Commissioner COMPANY: Calhoun County, Pct. 2 DATE: SIGNATURE: — PRINTED NAME: TITLE: DATE: www.L1611,l"lic" wnI 2 of 2 # 23 NOTIC;F OF MEETING -- 6/05/2024 23. Public hearing on Petition to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records. (VLL) pass Page 20 of 28 Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 May 29, 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 agenda for June 05, 2024: (361) 552-9656 Fax (361) 553-6664 Public hearing on Petition to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records I PUBLIC HEARING — 6/05/2024 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 will meet on Wednesday, June 5, 2024 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse, 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. NOTICE IS HEREBY GIVEN that the Calhoun County Commissioners' Court will hold a Public Hearing in the Commissioners' Courtroom, 211 S. Ann Street, Suite 104, in Port Lavaca, Texas, on June 5, 2024 at 10:00 a.m. regarding a Petition to Lots 6=9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records. This notice is in accordance with Section 111.007 and Section 111.0075 of the Texas Local Government code. Richard H. Meyer, County Judge Calhoun County, Texas A copy of this Notice has been placed on the inside. bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public during regular business hours. 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. AT �� FILED O'CLOCK�1q MAY 31 2024 COUNr"C4A'&jf O�ojOJ#,ANUN1Y,TE.yAg 11EPUlY: �� q H� " �IGUf! C�� Page 1 of 1 # 24 NOTICE 01= MEETING — 6/05/2024 24. Consider and take necessary action to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records. (VLL) pass Page 21 of 28 Vern L Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 May 29, 2024 Honorable Richard Meyer Calhoun County Judge 211 S,•Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: a�si,.tc or rf v n�LMrr Of CnV�oJ; Please place the following item on the agenda for June 05, 2024: (361) 552-9656 Fax (361) 553-6664 • Consider and take necessary action to Vacate Lots 6-9 of the Knipling Farm Subdivision recorded in Volume Z, Page 385 of the Calhoun County Plat Records # 25 NOTICE OF MEETING — 6/0.`.i/2024 25. Consider and take necessary action to approve the preliminary Plat of Luna Subdivision (a replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision). (VLL) pass Page 22 of 28 Vern Lyssy Calhoun County Commissioner, Precinct #2 5812 FM 1090 Port Lavaca, TX 77979 May 29, 2024 Honorable Richard Meyer Calhoun County Judge 211 &'Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer: stnt[ oe r r �GhrY os cn"��o Please place the following item on the agenda for June 05, 2024: (361) 552-9656 Fax (361) 553-6664 • Consider and take necessary action to approve the preliminary Plat of Luna Subdivision (a replat of Lot 6 and part of Lot 7 of the Knipling Farm Subdivision) �g6 Y 8�R F 9iR Cg n I BRgdgR i$5 @ p a g ptl • adg� € � �� 9� �� pS R�& $ag 5 pp Rd ;q WESTERLUND GRADE ROAD B m I5591n2 W ei%io• m u es• ss n mrere.o..a e TO s N w� r d S: y Fy E� M�aH C) -92 ie S W &s ,5 aCl m C d ZA a 'g G z O 1�1 §Y E ^i •t (O Fy C Z b 0 Vl __________________Zm _^'rw x_____________. .____------______________1FLLS5[£____. D n c z O R— — — — — — — — — — 'P- D rOJ, LI 1 is y-- R m y pp pp65pp g : i a4g5gE§ nil Q ^� • IR W B�2aAFA9�j� �pgpe �C°n •m a •- tl I zI \ n But ___ N_'_G_SI_________ _-3vt}LSIS___- x m i �• e�§§ ; ' Spy Y[O� s¢� i-1§fuo�ea i 9 d��i 4j$ 9 gggWi Z n CggR�g�1Etl 9p £�a0 $i�N ��plp G80 i R i > 5 i 8 Fa id �iut W Pmre p_ O i : i i ------------ ______sn______ _____ �e------------------ n°------�'8 ,v y I ,a5o2 Texor—_____ T_________�_aS� ___________T{i isst's _—____, -I �t�a ----- van— anon a aroo I ga ff C 3LVARd NK MW $$•yH � *H k �� pu s B=J RR e•y� ��. >� mo 3 a � >re�� I III I o g n __ .SB49r m✓B P� ©. C 4; m `a z A, AG'ILB 3.Zl,B€SE5 ---------aP;------------ o o a^:TI:. a age g F 4 H a 4 �:�, •� •��'iD- � - � - G & W ENGINEERS, INC. - o AOgi'`A" '^ • ENGINEERING • SURVEYING • PLANNING • II °> ? ^ i > ~ 0 0 o D 205 W. LIVE OAK S1REEi, PORT IAVACA. TE%A5 ]I9)9 o rn A O o b O u MPLS FlRM NM: ICO221 W PRELIMINARY PLAT (081) 55t-V:109: POST LAVACA (§]§I ]21-n55: ear uTr s # 26 ' N0110E 0i- MEETING — 6/05/2024 26. Consider and approve amending the G&W Engineers, Inc. contract amount for engineer services, regarding the GLO CDBG-MIT Contract No. 22-085-014-D245, from $1,358,844.75 to $1,358,844.00. (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 23 of 28 AMENDMENTI THIS AMENDMENT, entered into this 5th day of JUNE 2024, by and between COUNTY OF CALHOUN COUNTY, hereinafter called the "Subrecipient", acting herein by Honorable Richard H. Meyer, County Judge, hereunto duly authorized, and G&W Engineers, Inc., Tax Identification Number 74-2051265, hereinafter called "Provider", acting herein by Brian P. Novian P.E., President, procured in conformance with Texas Government Code Chapter 2254, Subchapter A, "Professional Services" and 2 C.F.R. 200 regulations. WITNESSETH THAT: WHEREAS, Subrecipient desires to amend an existing Engineer Services Contract effective as of March 30, 2022 in conformance with its Request for Qualifications, for General Land Office Contract No. 22-085-014-D245 "Subrecipient's Contracf; and WHEREAS, Subrecipient desires to engage Provider to render certain services in connection with this solicitation related to GLO projects owned by the Subrecipient. NOW THEREFORE, the parties do mutually agree to add and amend the existing contract as follows: 3.01 CONTRACT LIMIT, FEES, AND EXPENSES AMENDMENTI Provider will be compensated on a negotiated fee basis, for an amount not to exceed the amount of One Million, Three Hundred Fifty -Eight Thousand, Eight Hundred Forty -Four DOLLARS and Zero CENTS (1,368,844.00), reimbursable in increments as shown in the Benchmarks in Attachment C for the type of work performed. The Professional Engineering Services Fee shall not exceed the maximum amount available for such services as prescribed by the Subrecipient Agreement, the GLO, HUD or any governing law, for the term of this contract. The Subrecipient agrees to pay Provider in accordance with The Prompt Pay Act, Tex. Govt. Code Ch. 2251. Other Terms Unchanggd. All other terms and conditions of the Agreement shall remain unchanged. IN WITNESSETH HEREOF, the parties have hereunto set their hands and seals. COUNTY OF CALHOUN COUNTY G&W ENGINEERS, Inc. BY: BY: Z% 11, Richard H. Meyer, County ge Brian P. Novian, P.E,IPresident NOTE: This document has important legal consequences. Please consult with your legal cmmeel with respect to its completion or mndleraenn END OF PAGE NOT ICE OF MEETING — 610512024 27. Consider and take necessary action to award qualified bidder on Bid No. 2024.05 - Seadrift Drainage Improvements Project - GLO Contract No. 22-085-014-D245 for Calhoun County, Texas. (GDR) Zachary Roach with G&W explained and recommended the court' award the bid to Lester Contracting. RESULT: - APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 24 of 28 Gary D. Reese County Commissioner County of Calhoun Precinct 4 May 30, 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 June S, 2024. • Consider and take necessary action to award qualified bidder on Bid No. 2024.05 — Seadrift Drainage Improvements Project — GLO Contract No. 22-085-014-D245 for Calhoun County, Texas. Sincerely, Av. R,,. Gary Reese GDR/at F.O. Box 177 —Seadrift. Texas 77983 — email: garv.reese0mcalhouncomora - (361) 785-3141 —Fax (361) 785.5602 G&WENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)552-4509 • f: (361)552-4987 TBPE Firm Registration No. F04188 May 30, 2024 Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 31d Floor, Suite 301 Port Lavaca, TX 77979 RE: LETTER OF RECOMMENDATION Bid No. 2024.05 — Seadrift Drainage Improvements Project GLO Contract No. 22-085-014-D245 for Calhoun County, Texas 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., Wednesday, May 9, 2024, at which time Bids were publicly opened and read aloud. The enclosed Bid Opening Table and Bid Itemized Table indicate there were a total of two (2) bidders submitting bids with the "Apparent Low Bidder" for the Base Bid being Lester Contracting, hnc. We have worked with Lester Contracting, Inc. on previous projects and they have proven to be qualified and capable of performing the required work. Therefore, we recommend that the Construction Contract be awarded to Lester Contracting, Inc. for the Base Bid Amount of $6,096,538.50. If the County concurs with this recommendation, and upon your direction, we will prepare a Construction Contract package immediately and deliver it to Lester Contracting, Inc. Please call me @ (361) 552-4509 if you have any questions. Sincerely, G & W Engineers, Inc. �' Scott P. Mason, P.E. Enclosures: Bid Opening & Bid Itemized Tables cc: Katy Sellers, KSBR-LLC file 5310, 013a Engineering Consulting Planning Surveying 0 & W Engineers, Inc. BID OPENING TABLE Date: May 9, 2024 205 W. Live Oak Time: 2:00 p.m. Port Lavaca, TX 77979 BID NO. 2024.05—SEADRIFT DRAINAGE IMPROVEMENTS PROJECT—GLO CONTRACT NO. 22-085-014-D245 FOR CALHOUN COUNTY, TEXAS DESCRIPTION LESTER CONTRACTING, INC. K-C LEASE SERVICE INC DBA MATAGORDA CONSTRUCTION & MATERIALS BID BOND YES YES ACKNOWLEDGES ADDENDUM NO.1 YES YES TOTAL BASE BID (Base Bid+$60,000.00 Testing Allowance) $6,096,538.50 $6,430.316.00 ALTERNATE BID #1 (Replaces Item 0999 6001 Engineered Turf) $340,450.00 $303,310.00 OWNERS OPTION A+$4,000.00 Allowance $135,660.00 $122,040.00 CALENDAR DAYS 650 500 Page 1 5310.013a G & W Engineers, Inc. ITEMIZED BID TABULATION Date: May 91 2024 205 West Live Oak Street Time: 2:00 p.m. Part Lavaca, Texas 77979 Jab No, 5310.013. BID NO.2024.05-SEADRIFT DRAINAGE IMPROVEMENTS PROJECT-GLO CONTRACT NO. 22-085-014-13245 FOR CALHOUN COUNTY, TEXAS BASE BID ITEM NO. TXDOT ITEM CODE DESCRIPTION JTQTY]l LESTER CONTRACTING, INC. K-C LEASE SERVICE INC IDEA MATAGORDA CONSTRUCTION & MATERIALS UNIT PRICE AMOUNT- UNIT PRICE 'AMOUNT 1 01046017 REMOVING CONC (DRIVEWAYS) SY 44 $75.00 $3,300.00 $62.00 $2,728.00 2 01106001 EXCAVATION (ROADWAY) CY 657 $39.00 $25,623.00 $50.00 $32,850.00 3 01106002 EXCAVATION (CHANNEL) CY 242 $170.00 $41,140.00 $356A0 $86,152.00 4 01326005 EMBANKMENT(FINAL)(ORD COMP)(TY C) CV 116 $130.00 $15,080A0 $165.00 $19,140.00 5 01326999 EMBANK(CHANNEL)(FINAL)(OC)(TY C) CY 539 $200.00 $107,800.00 $200.00 $107,800.00 6 01626002 BLOCKSODDING SY 1269 $36.00 $45,684.00 $10.00 $12,690.00 7 01646005 BROADCASTSEED(PERM)(URBAN)(SANDY) SY 9905 $0.50 $4,952.50 $2.00 $19,810.00 8 02476057 FL BS(CMP IN PLC)(TYE GR1-2)(FNAL POS) CY 291 $142.00 $41,322.00 $220.00 $64,020.00 9 02606012 LIME (HYD, COM OR QK(SLURRY) OR QK(DRY) TON 16 $375.00 $6,000.00 $615.00 $9,840.00 10 02606079 LIME TRT(SUBGRAOE)(6") SY 1365 $10.00 $13,650.00 $27.00 $36,855.00 11 103106027 PRIME COAT(MC-30 OR AE-P) GAL 335 $9.00 $3,015.00 $34.00 $11,390.00 12 03166001 ASPH(MULTI OPTION) GAL 447 $13.00 $5,811.00 $12.00 $5,364.00 13 03166246 AGGR(TY-PB GR-3 SAC-B) CY 13 $1,300.00 $16,900.00 $850.00 $11,050.00 14 04006005 CEM STABIL BKFL CY 1959 $112.00 $219,408.00 $172.00 $336,948.00 15 04006008 CUT& RESTOR ASPH PAVING SY 2206 $180.00 $397,080.00 $100.00 $220,600.00 16 04096002 PRESTR CONC PIL(18 IN SQ)(HPC) LF 576 $342.00 $196,992.00 $372.00 $214,272.00 17 04206014 CL C CONC(ABUT)(HPC) CY 39.2 $5,000.00 $196,000.00 $5,750.00 $225,400.00 18 04226008 REINF CONC SLAB (SLAB BEAM)(HPC) SF 2080 $105.00 $218,400.00 $103.00 $234,240.00 19 04256010 PRESTR CONC SLAB BEAM(5SB12) LF 395 $740.00 $292,300.00 $728.00 $287,560.00 20 04326003 RIPRAP(CONC)(61N) CY 15 $920.00 $13,800.00 $950.00 $14,250.00 21 04326033 RIPRAP(STONE PROTECTION)(181N) CY 219 $470.00 $102,930.00 $300.00 $65,700.00 22 04506018 RAIL(TY T631) LF 208 $145.00 $30,160.00 $90.00 $18,720.00 23 04606002 CMP(GAL STL 181N) LF 15 $160.00 $2,400.00 $125.00 $1,875.00 24 04626005 CONC BOX CULV(4FTX4FT) LF 52 $600.00 $31,200.00 $635.00 $33,020.00 25 04626007 CONC BOX CULV(SFTX3FT) LF 166 $660.00 $109,560.00 $580.00 $96,280.00 26 04626008 CONC BOX CULV(SFTX4FT) LF 1058 $820.00 $867,560.00 $618.00 $653,844.00 27 04626009 CONC BOX CULV(5FTXSFT) LF 396 $875.00 $346,500.00 $690.00 $273,240.00 28 04626015 CONC BOX CULV(7 FT X 4 FT) LF 204 $1,000.00 $204,000.00 $875.00 $178,500.00 29 04626021 CONC BOX CULV(8FTX6FT) LF 42 $1,500.00 $63,000.00 $1,100.00 $46,200.00 30 04626022 CONC BOX CULV(8FTX7FT) LF 34 $1,600.00 $54,400.00 $1,300.00 $44,200.00 31 04646005 RC PIPE(CL 111)(24 IN) LF 12 $200.00 $2,400.00 $250.00 $3,000.00 32 04656074 INLET(COMPL)((PSL)(RC)(5FTXSFT) EA 4 $12,000.00 $48,000.00 $6,800.00 $27,200.00 33 04656076 INLET(COMPQ((PSL)(RC)(6FTX6FT) EA 8 $19,000.00 $152,000.00 $7,500.00 $60,000.00 34 04656559 INL(CMP)(PAZD-CZ)(FG)(4FTX4FT-3FTX3FT) EA 9 $10,000.00 $90,000.00 $9,000.00 $81,000.00 35 04666101 HEADWALL (CH -PW-0)(DIA=36IN) EA 1 $10,000.00 $10,000.00 $10,000.00 $10,000.00 36 04666182 WINGWALL (PW- 1) (HW=7 FT) EA 2 $37,000.00 $74,000.00 $23,000.00 $46,000.00 37 04666183 WINGWALL (PW- 1) (HW=8 FT) EA 2 $37,000.00 $74,000.00 $26,000.00 $52,000.00 38 04666208 WINGWALL (SW-0) (HW=5 FT) EA 14 $11,000.00 $154,000.00 $13,000.00 $182,000.00 39 104666216 WINGWALL (PW) (HW=S FT)(MOD) EA 1 $8,000.00 $8,000.00 $18,000.00 $18,000.00 40 04679001 SET(TY 11)(18 IN) (HOPE)(3: 1)(P) EA 24 $1,900.00 $45,600.00 $1,100.00 $26,400.00 41 04679002 SET(TY 11)(30 IN) (HDPE)(3: 1)(P) EA 6 $3,000.00 $18,000.00 $1,500.00 $9,000.00 42 04966041 REMOV STR(LARGE) EA 4 $7,500.00 $30,000.00 $3,000.00 $12,000.00 43 0496 6042 REMOV STR (SMALL) EA 13 $700.00 $9,100.00 $500.00 $6,500.00 44 04966050 REMOV STR(DRIVEWAY CULVERT) EA 20 $1,200.00 $24,000.00 $500.00 $10,000.00 45 05006001 MOBILIZATION LS 1 $275,000.00 $275,000.00 $100,000.00 $100,000.00 46 05026999 BARRICADES, SIGNS AND TRAFFIC HANDLING LS 1 $16,000.00 $16,000.00 $50,000.00 $50,000.00 47 05066038 TEMPSEDMTCONT FENCE (INSTALL) LF 763 $8.00 $6,104.00 $5.00 $3,815.00 48 05066039 TEMP SEDMT CONT FENCE (REMOVE) LF 763 $3.00 $2,289.00 $1.00 $763.00 Page 1 oR Inc G B W engineer:, St ITEMIZED BID TABULATION Date: may 9, m24 205 Wes[ five Oak Sheet Time: 2:00 p.m. Port Lavaca, Texas 77979 Jab No. 5310.013a BID NO.2024.05 -SEADRIFT DRAINAGE IMPROVEMENTS PROJECT -GLO CONTRACT NO.22-085-014-D245 FOR CALHOUN COUNTY, TEXAS BASE BID CONVD, ITEM NO. TXDOT ITEM - CODE DESCRIPTION UNIT CITY. - LESTER CONTRACTING, INC. K-C LEASE SERVICE INC DBA MATAGORDA CONSTRUCTION & MATERIALS UNITPRICE AMOUNT UNITPRICE AMOUNT 49 0506 6040 BIODEG EROSN CONT LOGS (INSTL) (811) LF 2250 $8.00 $18,000.00 $6.00 $13,500.00 50 05066043 BIODEG EROSN CONT LOGS (REMOVE) LF 2250 $3.00 $6,750.00 $1.00 $2,250.00 51 05306003 INTERSECTIONS (SURF TREAT) SV 172 $70.00 $12,040.00 $25.00 $4,300.00 52 05306004 DRIVEWAYS(CONC) SV 110 $150.00 $16,500.00 $130.00 $14,300.00 53 05306006 DRIVEWAYS (SURF TREAT) SV 102 $70.00 $7,140.00 $40.00 $4,080.00 54 05306016 DRIVEWAYS (BASE) SV 323 $40.00 $12,920.00 $40.00 $12,920.00 55 0540 6001 MTL W-BEAM GD FEN (TIM POST) LF 92 $120.00 $11,040.00 $90.00 $8,280.00 56 05406016 DOWNSTREAM ANCHOR TERMINAL SECTION EA 4 $3,500.00 $14,000.00 $1,800.00 $7,200.00 57 05446001 GUARDRAIL END TREATMENT (INSTALL) EA 4 $5,600.00 $22,400.00 $1,500.00 $6,000.00 58 06446001 IN SM RD SNSUP&AMTY30BWG(1)(SA)(P) EA 15 $300.00 $4,500.00 $350.00 $5,250.00 59 06446076 REMOVE SM RD SN SUP&AM EA 15 $150.00 $2,250.00 $100.00 $1,500.00 60 06586073 INSTIL OM ASSM(OM-2Y)(WC)GND(BI) EA 8 $350.00 $2,800.00 $250.00 $2,000.00 61 07526004 REETRI BRUSH RFMQVAI (CHAN AC 1.11 $64,000.00 $71,040.00 $30,000.00 $33,300.00 62 07529999 TREE AND BRUSH REMOVAL (CHANNEL) AC 1.13 $65,000.00 $73,450.00 $75,000.00 $84,750.00 63 0760 6001 IDITCH CLEANING AND RESHAPING (FOOT) LF 5484 $17.00 $93,228.00 $15.00 $82,260.00 64 09996001 JENGINEERED TURF(HYDROTURFZ OR EQUIV) SF 40675 $14.00 $569,450.00 $40.00 $1,627,000.00 65 09996002 MODIFY SEAWALL PANEL FOR OUTFALL EA 4 $10,000.00 $40,000.00 $30,000.00 $120,000.00 66 30766043 1 D-GR HMA TV-D PG70-22(LEVEL-UP) TON 192 $320.00 $61,440.00 $130.00 $24,960.00 67 41226004 THERMO PI PE(18") (H DPE)(TY S)(CSB) LF 644 $120.00 $77,280.00 $120.00 $77,280.00 6B 41226005 THERMO PI PE(24") (H DPE)(TY S)(CSB) LF 316 $150.00 $47,400.00 $160.00 $50,560.00 69 41226006 THERMO PIPE(36")(HDPE)(TY S)(CSB) LF 49 $220.00 $10,780.00 $230.00 $11,270.00 70 41226021 THERMO PIPE(30")(H DPE)(TY S)(CSB) LF 569 $230.00 $130,870.00 $210.00 $119,490.00 71 50486002 FLOATING TURBIDITY BARRIER(FUR & INST) LF 90 $90.00 $8,100.00 $75.00 $6,750.00 72 50486003 FLOATING TURBIDITY BARRIER (REMOVE) LF 90 $22.00 $1,980.00 $10.00 $900.00 73 72186013 PIPE ENCASEMENT (12"STL) LF 32 $210A0 $6,720.00 $250.00 $8,000.00 Total Base Bid (Base Bid+$60,000.00 Testing Allowance) $6,096,538.50 $6,430,316.00 ALTERNATE BID #1(REPLACES ITEM 0999 6001 ENGINEERED TURF) ITEM NO. TXDOT ITEM CODE DESCRIPTION UNIT QTY. LESTER CONTRACTING, INC. K-C LEASE SERVICE INC DBA MATAGORDA CONSTRUCTION & MATERIALS _ - UNIT PRICE AMOUNT UNITPRICE - AMOUNT A01 04326002 1 RIPRAP(CONC)(51N) CY 619 $550.00 $340,450.00 $490.00 $303,310.00 OWNER'S OPTION A - 9TH ST LEFT DITCH CONCRETE LINER (additional work) ITEM TXDOT ITEM - LESTER CONTRACTING, INC. K-C LEASE SERVICE INC DBA MATAGORDA - DESCRIPTION UNIT CITY. CONSTRUCTION & MATERIALS NO. ::CODE UNITPRICE AMOUNT. UNITPRICE I AMOUNT - B01 B04326003 RIPRAP(CONC)(61N) CV 227 $580.00 $131,660.00 $520.00 $118,040.00 OWNERS OPTION A+$4,000.00 Allowance = $135,660.00 $122,040.00 Calendar Days 650IF 500 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: K-c- t FAIL 5EAVIc=r CoA-W- G7 on +a MF T Qr c s 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 DESCRIPTION ITEM UN17 810 QUANTITY UNIT PRICE TOTAL BID PRICE 1 0104 6017 REMOVING CONC (DRIVEWAYS) 2 01106001 EXCAVATION (ROADWAY) 3 01106002 EXCAVATIONiCHANNEL) CY 242 4 01326005 EMBANKMENT(FINAL)(ORD COMP)(TY C) CY 116 5 0132 6999 EMBANK(CHANNEL)(FINAL)(OC)(TY C} CY 539 o° o° LTD 0 6 01626002 BLOCK SODDING SY 1269 IQ, 7 0164 6005 BROADCAST SEED (PERM)(URBAN)(SANDY) SY _ 9905 8 0247 6057 FL BS (CMP.IN PLC)(TYE GR1-2)(FNAL POS) CY 291 a � (� ° ° (.> 'A C) � © " 9 0260 6012 LIME.(HYD, COM OR QK(SLURRY) OR QK(DRV) TON 16 0 10 0260 6079 _ LIME TRT (SUBGRADE)(6") SY 1365 j "' 36, - 11 03106027 PRIME COAT (MC•30ORAE-P) GAL 335 ��),"` if 12 03166001 ASPH (MULTI OPTION) GAL 447 13 0316 6246 AGGR (TY-PB GR-3 SAC-B) CY 13 gyp, °� i l o j 0, ° 14 0400 6005 CEM STABIL BKFL CY 1959 } �d 'y o. !(tl 8 as i5 0400 6008 CUT & RESTOR ASPH PAVING SY 2206 16 0409 6002 PRESTR CONC PIQ18 IN SO)(HPC) LF 576 "'} 'a ° " 2 1, 4 , 17 04206014 CLCCONC(ABUT)(HPC) CY 39.2 `s 7�Q,.�u .2;1 Ll")0.°� 18 04226008 REINF CONC SLAB (SLAB BEAM)(HPC SF 2080 oe n 3 �,'-(�i _ 19 0425 6010 PRESTR CONC SLAB BEAM (5S812) LF 395 -7 d 9 7, 20 0432 6003 RIPRAP iCONC)(61N) CY 15 Y21 vWP 04326033 RIPRAP(STONE PROTECTION)(181N) CY 219 'ypp,°� bS�700," 22 0450 6018 RAIL (TY T631) LF 208 C{ p °' -7 R D,'' 23 .. 0460 6002 CMP (GAL 5TL 18 IN) LF 15 I cZ. C , °�' l 97 $ , -24 0462 6005 CONC BOX CULV (4FTX4FT) LF 52 ? oo -3 3 0'd 0 no 25 04626007 CONC BOX CULV (5FTX3FT) LF 166 na S r�O , g (>/ ASO Base Bid Continued Item # TxDOT ITEM CODE REM DESCRIPTION ITEM UNIT BID OUANTITY UNIT PRICE TOTAL BID PRICE 26 D462 6008 CONC BOX CULV (5FTX4FT) LF 1058 (s I Q oa ` g (,, y ° 27 0462 6009 CONC BOX CULV (5FTX5FT) LF 396 (Q 0. `+^� '7 14 0 28 0462 6015 CONC BOX CULV (7 FT X 4 FT) LF 204 i 5 . °' i S' ,�0 o . °o 29 0462 6021 CONC BOX CULV (8FTXGFT) LF 42 �� U �, "� H (:, r0 0 30 0462 6022 CONC BOX CULV (8FTX7FT) LF 34 { p 0. o' W N 2 0 0 oa 33. 04646005 RC PIPE (CL 111)(24 IN) LF 12 aSv,°a '3raC5O.°� 32 04656074 INLET(COMPL)((PSL)(RC)(SFTX5F7) EA 4 (�ij°p _°" �-7a00, 33 04656076 INLET(COMPLj((PSL)(RC)(6FTXfiFT) EA 8 - S-O0,°✓ (t;0 n(-,)o.on 34 0465 6559 INL(CMP)(PAZD-CZ)(FG)(4FTX4FT- 3FTX3FT) EA 9 �, q�Ope. as �' h{ uaU. 35 D4666101 HEADWALL (CH - PW - 0) (DIA= 36 IN) EA 1 06 36 _ 04666182 WINGWALL (PW - 1) (HW=7 FT) EA 2 Oc° 37 04666193 WINGWALL(PW-1).(HW-8FT) EA 2 38 0466 6208 WINGWALL (SW-0) (HW=S FT) EA 14 f 3 pp p _ s a .2 DO 0, 39 04665216 WINGWALL(PW) (HW=5 FT) (MOD) EA 1 19 (,j�� f goo c,) 40 C467 9001 SET (TY IQ (18 IN) (HOPE) (3: 1) (P) EA 24 ( 1 O o ° ` Z (p L/ 41 0467 9002 SET (TY IQ (30.IN) (HOPE) (3: 1) (P) EA 6 J S-o)o' °° C'( ©o 0 42 04966041 REMOV STR (LARGE) EA 4 3,.c>oo.°a 1�,000. 43 049fi 6042 REMOV S7R (SNAIL) EA 13 Coo , 44 04906050 REMOV STR (DRIVEWAY CULVERT) EA 20 $-vo- 45 05006001 MOBILIZATION LS 1 46 05026999 BARRICADES, SIGNS AND TRAFFIC HANDLING LS 1 S0 o©a.c� 47 05066038 TEMP SEDMTCONT FENCE (INSTALL) LF 763 5 ° a FIS° 48 05066039 TEMP SEDMT CONT FENCE (REMOVE) LF 763 (, °a j(, 00 49 05066040 BI ,DEG EROSN CONT LOGS (INSTL) LF 2250 i 50 0506 6043 BIODEG EROSN CONT LOGS 51 0530 6003 INTERSECTIONS (SURF TREAT) 52 0530 6004 DRIVEWAYS (CONC} SV 110 i 3 "a I q 300, 53 05306006 DRIVEWAYS (SURF TREAT) SY 102 +-� (i, °i y O fo. ° o 54 05306016 DRIVEWAYS (BASE) SY 323 Base Bid Continued Item TxDOT ITEM ITEM DESCRIPTION ITEM BID UNIT PRICE TOTAL BID PRICE # CODE UNIT QUANTITY 55 0540 6001 MTL W-BEAM GO FEN (TIM POST) LF 92 Q p ° ° 0 ;I ••-' 56 05406016 DOWNSTREAM ANCHOR TERMINAL EA 4 ) 9o0, SECTION 577 05446001 GUARDRAIL ENDTREATMENT EA 4 ) S Lei?. %�C,CC+t> , (INSTALL) 58 06446001 SUPB:AMTY108WG(1)(SA)(P) EA 15 5"t>. S-0 59 0644 6076 REMOVE SM RD SN SUP&AM EA 15 0 6D 0658 6073 INSTL OM ASSM (OM- EA B S-p o' °-^ e�. 2Y)(WC)GND(61) 61 07526004 TREE TRIM MING/BRUSH AC 1.11 na jC? (>( n, ory 1Ot� REMOVAL(CHANNELS) fit 07529999 TREE AND BRUSH REMOVAL AC 1.13 -],�j- DO0.°`� (CHANNEL) 63 0760 6001 DITCH CLEANING AND RESHAPING LF 5484 (FOOT) 64 _ 0999 6001 _ ENGINEEREDTURF(HYDROTURFZ SF 40675 4 rJ.°o I Fa-7 pOl> °a OREQUIV) 65 09996002 MODIFY SEAWALL PANEL FOR EA 4 °a ° OUTFALL 66 307660,13 D.GR HMATY-D PG70-22 (LEVEL -UP) TON 192 zjp,°L :ILI 1 CaO 67 41226004 THERMO PIPE(18")(HDPE)(TY S)(CSB) LF 644 , a� oo Ti, a<� 68 4122 6005 THERMO PIPE(24")(HDPE)(TY 5)(CSD) LF 916 69 4122 6006 THERMO PIPE(35")(HOPE)(TY 5)(CSS) LF 49 '0, p j Q 70 4122 6021 THERMO PIPE(30")(HOPE)(TY S)(CSB) LF 569 A \ O . °a {, 'A � U a° 71 5048 6002 FLOATING TURBIDITY BARRIER(FUR LF 90 "? ,�` (� & INST) 72 5048 6003 FLOATING TURBIDITY BARRIER LF 90 (REMOVE) 73 72196013 PIPE ENCASEMENT(12"STL) LF 3.2 °" g Q07C`�.00 Total Base Bid (Base Bid +$60,000.00 Testing Allowance)_ -L ALTERNATE BID #1 REPLACES ITEM 0999 6001 ENGINEERED TURF) Item # TXDOT ITEM I CODE ITEM DESCRIPTION I REM I UNIT BID QUANTITY UNIT PRICE TOTAL BID PRICE A01 1 0432 6002 RIPRAP (CONC)(51N) I Cy 619 '-f 9_ 0, °� OWNER'S OPTION A--9TH ST LEPT DITCH CONCRETE LINER additional work Item # TxDOT ITEM CODE ITEM DESCRIPTION ITEM UNIT BID QUANTITY UNIT PRICE TOTAL BID PRICE 801 B00.32 6003 RIPRAP (CONC)(61N) CY 227 cj E} 00 I 0 1-1 OWNERS OPTION A + $4.000.00 Allowance ,Oy0 ua 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 forbids for Bid No. 2024,05— Seadrift Drainage Improvements Project — Gt.O 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 Soo consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquldated 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. T ripe of Work Subcontracted Name of Subcontractor C'�CL�+�.GLS 4 \lE�o�,.sr,t-l.5 eels �'an +ruc-�ic� 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: k r— crASe. SF7uv1< tin:C i->VzP* Au TA60R t\ (40J9E0CD010 -r 1�1,4TC21.a L5- Address: 7 i � `' l-1)S So,rrp C,?Y CITY TA' 77 �!1 ci Phone: q7q -32`` 9flt ElN or Tax ID No.: Signature: Name and Email: 6-1_ENA2 L MCAnBPryGrrY Lodi 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: S` - 9 ' � y Bidder (Legal Name ofFirm):K-aI ASE�Ffit,/I(W,' r)f7a nrarAirrzna cry-�rf?urTI0n->taifrrRl4r.S Date Organized: 1143 NameofOwner(s): T390CE KRAJSl<0h>F Address: 1'71a SH 7S" Scu%H r6ar (—:rrY rY 771Y11-1 Date Incorporated 19R3 Federal ID Number 7`/98)?7F 6- Number of Years in contracting business under present name E!? List all other names under which your business has operated in the last 10 years: Nl° Work Presently Under Contract: Contract Amount $ Completion Date 5Ffl T kJ�C11 A. !>�Y' IMPt2dJCM CN7-$ 13 SM ZUwE r1 Elyd4jrr+R Pt-4pfl_.1,EJEE 'ALPA SooK :)JNC- poA14 ,aLc-en J. i AA r/oJ aoa.q Type of work performed by your company: Can An 0- Total Staff employed by Firm (Break down by Managers and Trades on separate sheet); Mlrn./AA GR� 1/J r�FFi�£ , / SV oQfrw-tare f r# 7-ROCK C.A\05RS I o Wcdl-CU /.4Q Have you ever failed to complete any work awarded to ov u? Yes [j 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 v 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 $ MolYr Completed Major equipment available for this contract: .r Are you in compliance with all applicable EEO requirements? ©'Yes Q No (If no, please attach summary of details on a separate sheet.)) (Optional) Minority Business Reporting Information: Owners Race: Owner's Ethnicity: Owner's Gender: r Are you a Section 3 business? (see below) a Yes WN[f 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's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low-income persons. Bank References Address: _ni: W i�omrIB77 t6,.rtc U 7iN21- Contact Name: r,'N,n I Jll(RKt 401ER, City&State: Xr rtC- '1-X Zip: 77r/rS Phone Number: 479-6`er-2h71 Credit available: $ l M �` Has the firm or predecessor firm been involved in a bankruptcy or reorganization? ❑ Yes Q No (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. A� List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. AvIA Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project.4. (,)", , S A,,, cc o t. D Sioned this g i-h_ day of M Ly . 20,44 . Sionature Printed Name and Title �G /-CA.SG aElLJfGE /!✓c. Z]6� n•!N-raG.ccr�� ('oic.lrR�cT'�oav t„n.as Gi�^�A�-� (!OIT1 ao D Name Notary Statement: f.FN/j C1414.4764VS j , being duly sworn, says that he/she is the r Positionfritle of L� ="`""""; p nc (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 (k day of 'NN Pr yl , 20,1;j_. Notary Public (( 4- i nature oENi$EtAONAGUE ,r;• .,,.., NOTARYPUBLIC Printed Norne ' i!:, �''' I04 qpt Tgxas3 ive '�rt••.,yemm Hp•oe•o8.2025 My Commission Expires: �ti wvrn'+w 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, 941h Log., Regular Sesslan. OFFICEUSEONLY 0ato Racaivad This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.o6i(1-0) with a local governmental entity and the vendor meets requirements under Section 176A06(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 tine vendor becomes aware of facts that require the statement to be riled.. See Section 176.006(a,t), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176,006, Local Government Code. An offense under this section is a misdemeanor. t of —vendor who has a business relationship with local governmental entity. F/ 4 2 Check this box if you arefillingan update to aproviously filed questionnaire. (The law requiresthat you file an updated date on which completed questionnaire with the appropriate filing amhority not later than the 71h business day after the you became aware that the originally filed questionnaire was incomplete or inaccurate.) IVIA Pj Home of local government officerabout whomthe informationis being disclosed. �rf Name of Off leer ALI 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. Completesubporla Astrid B for each employment or business relationshiptlescribed. Attachadditionalpages tothlsForm CIO as necessary. A. Is the local government officer at a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes F No Al B. Is the vendor receiving or likely to receive taxable income, other than Investment income, from or at the direction of the local government off leer or a lamlly member of the officer AND the taxable Inoome iS not received from the twat governmental entity? FlYes No N� 6 Describe each employment or business relationship that the vendor named In Section I maintains with a corporation at other business entity with respect to which the local government officer serves as an officer or director, or hot& an ownership interest of one percent or more. AJ/ 6 ❑Check this box ifthe vendor has given the local governmentofficer orafamily member o(the officer one e((more giits described in Section 176.0D3(a-t). �q. as described in Section 176.003(a)(2)(6), excluding gifts Signaturs_ of vendor doing bUSMOSS Wfln me governmental angry Date Form provided by Texas Ethics Commission www.efhres.stare'N us Revised CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplote copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes,logis.statO.tx.us/ Docsll-G/htmlLG,176,htm. For easy reference, below are some of the sections cited on this form, t oral Governmetd Code 1-1 76001(1-a1: "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) atransaction that is subject to rate or fee regulation by a federal, state, or local governmental entity Oran agency of a federal, state, or local governmental entity; (B) a transaction conducted at price and subject to forms 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 Govemment Code ff 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: eft (2) the vendor: (A) has an employment or other business relationship with the ceal government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,5ca during the 12-momh period preceding the datethat tho officer becomes aware that (i) acontract between the lccW governmental entity and vendor has been executed; or (if) the local governmental entity is considering entering into a contract with the vendor; (B) has given to ale local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in thel2-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 00901 and (a•11 (a) A vendor shall file completed conflict of interest questionnaire little vendor has a business relationship with a local govemmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, ore family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one ormore 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 forproposals 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.envcs.srare.uMs —1— •-•-- CONTRACTOR'S CERTIFICATION of RECOVERED MATERIAL ACKNOWLEDGEMENT K-C Lease Service Inc dba Matagorda Construction & Materials I, (r'1 N cHrn�O[Es s (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 hffps:llwww.epa.gov/smm/comprehensive-procurement-guideline-cpg- program#directory) / (rL cNN CA10MaLe S5 l ( Printed Name and Title Signature ( -9-2`/ 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. ail ecovered materials are only available at an unreasonable price. Printed Name and T�tlfa Signature Date CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the L:xecutive Order 12549, the prospective primary participant certifies to the best of his/ her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract tinder a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribety, 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 cmuncrated in paragraph (1) (b) of this cc I iificatiow d. Have not within a three-year period preceding this application/ proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a- d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source- The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 F11 6370, 3 CFR, 198E Comp., p. 189, unless otherwise noted. By the authority vested in me as Putsident by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal progrants, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section I(c), Executive depa I intents 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 butarc 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. See. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Fallow 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 taw, 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 firm 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 delermination 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 orManagement 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. S. 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 ofautmnating 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 repoli periodically to the Director on implementation of this Order, with the first report due within two years of die 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 die effective administration of the guidelines. See. 7. The Director of the Office of Management and Budget shallrepoli 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 shallmake recommendations as are appropriate further to curb fraud waste, and abuse. Implementation in the Site Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. Those transactions include SRF loans and conhnots and subcontracts awarded with SRF loan funds. Undor 40 C.RR..32.510, the SRF agency must submit a cal iification stating that it shall not knowingly entor into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program, This eeltification 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 cc I iifications. Additional References C 40 C,F.R. Put 32: EPA Regulations on Debarment and Suspension. STATE OF TEXAS {} AFFIDAVIT COUNTY OF CA c OooAy {} (> i-r n)/d CMnR r'i rZc S being first duly sworn, deposes and says: that he or she is IType or Print Name) - S _t�,rc. W]irn t(-c Lr,� e sFa�t u the rrFNF-f2AL MAk)AfiE A, of n nR rqA c•r207kr,,tIr having its (Type or Print Titlel (Type or Print Name of Company/rlrm) principal address at 1-I rD W "s C Sc t [ 1a (7A " Ct-rY Tx of 7 ri 1 c{ (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 notgive, offerto give, nor intendsto 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, 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. Afflant 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 (�Il CM A-MFYI C[S ii w 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 M r1 V ZB�• nc ,cc un an 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 CEW IFICATION 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 (inelude ZIP Code} K-C Lease Service Inc I i S H 3 dha Matagorda Construction & Materials Qr-\� c T X 'c x -17 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject. to Civil Rights Laws and Regulations. `0'"Yes 0 No ,,The undersigned hereby certifies that: b/The Provision of Local Training Employment, and Business Ogoortunitaii clause (Section 3 provision) is included in the Contract. A written Section plan (Local Opportunity Plan) was prepared and submitted as part of the bid . proceedings (If bid equals or exceeds $100,000). `O/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 NAME AND TITLE OF SIGNER (Please type) \ �r�Lr`r+lN`GNRM31-CSC i�-C�✓(-,'aq�r�pn�Pc.�ix\ SIGNATURE 1 DATE r CONTRACTOR'S LOCAL OPPORTUNITY PLAN K-C Lease Service Inc dba Matagcrda Construction & Materials 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 then 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. K-C Lease Service Inc As officers and representatives of dba Matagorda Construction & Materials we the undersigned have read (name of company) and fully agree to this Plan and the County's Section 3 Plan, and become a parry to the full implementation of the program and its provisions. Signature (,46A)v✓ C0/9A191-E'f.S Printed Name Tiller 4 ` ` - '-- Date Instructions for Proposed Contracts Breakdown and Estimated Project Workforce Breakdown Proposed Contracts Breakdown Type of Contracts —list all construction, materials; orother types of subcontracts(forexample; 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 g1timated 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 AS«�a K Cyrtt C.ti= 1 AM � C,pw A.C..i_ I es©ice.. 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 ✓Pc`6j�.VYEhDNrfi � � FvR<<ri,a.,i✓ 02 cZ. f� t*iOt RATa.R � fo r�� W .7 E3pP, S r Totals s Texas General Land Office Community Development Black 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 Cxantae/Subrecipient: Contract Number: Date: CONTRACTOR INFORMATION Name of Business I k-c AE,eSr 5er7urce,w.c.�y a rn a mr 62a t Address of Business Type of Business: aCorporation ❑ Partnership ❑ Non -Profit ❑ Sale Proprietorship ❑ Joint Venture Consortium Attach the following documentation as evidence of Section 3 eligible status: (Definition of 'Section 3 Business Concern' in 24 CPR 135 describes the three alternative qualifications.) For Business claiming status as a Section 3 resident•owned erdarpdse: ❑ Copy of resident lease ❑ Copy of evidence of participation in public NA assistance program For business entity as applicable: ❑ Copy of Articles of Incorporation ❑ Assumed Business Name Certificate ❑ List of ownersistockholders and % ownership of each appointed officers n Organization chart with names and titles and brief function statement ❑ Copy of receipt of public assistance ❑ Other evidence O Certificate of Good Standing Mr�❑ 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 atleast 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employment with the business: List of all current full-time amployees ❑ List of employees claiming Section 3 status ❑ PHNIHA Residential lease lass than 3 years N/F ❑ 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 rVj,�9 ❑ List of all contracts for 1 e sl two years ut arrzeName and Signature Attested By: Statement of ability to comply with public policy S" 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 S - R -.? -1 Date *24 C.F,R. 87 App. A, available at https://www.gpo.govlfdsys/granulelCFR-2011-title24-voll/CFR-201l-title24- voil-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 awardlloan 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 iCpo ravama Mr niHir. hurden disclosure} 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 /Af' Year quarter d. loan Date of last report e, loan guarantee r t� f, loan insurance 4. Name and Address of Reporting Entity: S. If Reporting Entity in No. 4 is Subawardee, Prime Subawardee Enter Name and Address of Prime: __. Tier , if Known: /t / jl Congressional District If known: Congressional District if known: B. Federal Department/Agency: 7. Federal Program NamelDescription: / CFDA Number, ifapplicable: B. Federal Action Number, if known: 9. Award Amount, if known: $ /1,A1 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, MI): IA,1119 �t , 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 placed Print Name: by the tier above when this transaction was made or entered Into. This disclosure is required pursuant to 31 Title: 6-0,4 U.S.C. 1362. This information will be reported to the Congress semi-annually and will be available for public 5 ' k'�2 / Inspection. Any person who falls to file the required Telephone No.: g 7g-3234"If 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 y 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) /: L. Eiy,J CNlalg0l_css , 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 os://co m otrol I e r.texas.gov/pu rch a si na/ou blicati o n s/d ivest ment. oh p K-C Lease Service Inc ' • - . .._, dba Matagorda Construction & Materials Company Name Signature of Authorized Official Printed Name of Authorized Official Title of Authorized Official Date Pursuant to Texas Government Code §2252.001 of 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. (d) "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. LJ I certify that is a "Nonresident Bidder" of Texas lCampanp Nnn,e) as defined in Government Code §2252.001 and our principal place of business is Wily aml Saic) K-C Lease Service Inc dba Matagorda Construction & Materials ❑� I certify that n is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2262.001. Signature of Authorized Agent printed Name and Title of Authorized Agent c_ 9`.) Date 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. f3113*61i!1�7 KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, KCLaaaLlLe w Ino.dbaMat�ardaCoosW,ImandMaterials as PRINCIPAL, and Travelers Casualty and Su* CompanyofAmerica _ , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Local Public Agency', in the penal sum of Fli Percent (6)ofthe Greatest MnoontBld Dollars, ($ 5% of GAS ), 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 W2024 , for BID NO. 2024.06 — SEADRIFT DRAINAGE IMPROVEMENTS PROJECT — GLO CONTRACT NO. 22-066.014•13245 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 sth day of Mav _ 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. KC Leese SWce, Inc.. dba Matagorda Construction and Matedas (SEAL) Glenn Chamldess•Gonarai Manager, Attest. By:z 4 Affix Corporate Seal C W. CERTIFICATE AS TO CORPORATE PRINCIPAL I Misty Joyce , certify that 1 am the Secretary of the Corporation named as Principal in the bid bond; that Glen Chambles5 , who signed the said bond on behalf of the Principal was then Manager 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: `ref r ° Power -of -attorney for person signing for Surety Company must be attached to bond. Please attach 1 include original bid bond as the last item in the sealed bid package. r1gfgor Mt Seal Page 2 of 2 CHAS CORNETT 830.643 9902 r. • 15s + yearor experience in building and. managing the construction of civil warps including Inass earthwork, subgradc, improvements, concrete and asphalt pavements, bridges, retaining walls, and underground utilities. • Plaved kcv roles on projects including estitrrating,award, buyout, pumbasc orders, submittals, schedules, pay estimates, change orders, conflict resolution, and closeout to Final acceptance and pavn,cnt. • Proficient in tlic use of the following software: • FICSS Heavy Bid (estimating softwtuc) • Plan -Swift (plan take -off softvarc) ■ Blucbcant Revu (plan take -off software) ■ Excel • Prtmavent PG • vimrponit (aecounttngsoftware) • I1CSS heavy Job (project nttulagemcot soN:warc) ■ ;11so some experience in the use ofthc following software: • AGTEK (earthwork program) • On -Screen (plan take -off software) 1996— 1999 SAM I IQUS'TON STATE UNIVERSITY Huntsville, TIC 1998 — 1999 VICTORIA COLLEGE, Vfunuia, TX • Business Administration ' f — 1 tt+cS KrtT - h,•C tf-n$c' $ERJICE 1NG, 604 �ta'r1r(.vn OA CONSTP Qr.rLO uJ I M^ TGR I14t.a 20 i g-- 2o21 ANGEL BROTHERS ENTERPRISES/TEXAS MATERIALS • Administered project management, estimating, and scheduling functions for ongoing, construction projects including: 35NI project in Frio County consisting of 18'rules of asphaltic roadway rehabilitation including subgrade improvements, drainage structures, and management ofvatious subcontractors. 81,1 project in Travis County consisting of 2.5 miles of raadtvav rcconsoucuon, multiple drainage structures, and new Midge construction. • Bid 'I'XI7OT projects monthly start to Finish in the value range of 1 M to 30N1. 2018 — 2(119 LANE CONSTRUCTION /(SALINI-IMPREGILO) FStimating various TXDOT hcmjy highway and private projects in the Austin/San Antonio Arca. Project values estimated range from 5071 to '_oOM. Pcrfortncd talte-offs, site investigations, produce paving plans, produced thorough reports for upper manngement facilimung efficient csumate reviews, built estimates, built quote systems and other estimating functions as needed. Performed various estimaring functions for the design build Texas High Speed Rail prtrjcct. This project value currently is estimated to be in the 15-20 Billion dollar range, Completed estunating functions pertaining to Concrete Paving, Drainage, SW31? items, NIOT, and other various items as needed. N orked closely with design engineers regarding project constraints and feasibility basal on field experience. 2015 20 t 8 AMC TXCI , New Braunfels TIC 78132 • Administered project management, estimating, and including: scheduling functions for ongoing, constriction projects Comal C:oumty Mend Beam Cuatd Fence anti Culvert Repair iistimated and managed other various projects such ss concrete repair, new concrete replacement, concrete. ramp installation, tilt wall repair, metal building erection, garage eonsuvction, decks, mitt low water crossings. 2011— 2015 TEXAS STERLING CONSTRUCTION CO. Project Manager/Estimator a Adminnstered project management, estimating, and scheduling funcrons for ongoing construction projects inchmding: n NTTA PGBTP Eastern Expansion Section 29 — Rowlett, $579M, six lane toll -way on new right of way; excavation and embankment of more than I AM CY, 95,000 SF of MSE retaining walls, structural concrete work including 2 bridges requiring more than 68,000 SF of bridge deck. 28,000 LF of Storm Sewer and 200,000 SY of CRCP Paving, Other work items included landscaping, striping, large road sign structures, and roadway illumination. • MOUNTAIN CREEK PARKWAY — TXDOT - $31.2 M, four lane divided highway construction: excavation and embankment of more than 200.000 cy; 145,000 SY CRCP paving; 13.000 SF retaining walls; 97,000 sf bridge deck, and 18,000 LF or storm drain. Other work items included landscaping. striping, large road sign structures, signals. and roadway illumination. • Stinson Airport — San Antonio TX, Runway rehabilitation 5M, Airport work including earthwork, drainage, waterline, electrical, illumination, sub -grade, conorete and asphalt paving. • Estimated City, State, Federal. Private, ,joint Venture, and Design Build Projects, Have been it key element in the estimating department which has turned in over I Billion Dollars worth of work at over a 10% win rate. Have been directly involved in the capture of more than 200 million dollars in contracts for Texas Sterling Construction in the Dallas and San Antonio areas. 2007 — 2011 'PEXAS STERLING CONSTRUCTION CO. Project Coordinator/junior Manager/,Junior Fsnmanpr Y AdminlNtered project management, estnnating, and scheduling functions for Ongoing construction projects including: • 'rx00'I"; Tarrant County STATE HIGHWAY 199 — TXDOT - $31.4 M, Construction of 5 miles of new frontage roads and multiple intersections; excavation and embankment of more than 300.000 cy: 200,000 SY CRCP paving, 60.000'I'NS asphalt paving; 230.000 SY lime stabilization. Other work items included multiple box culvert crossings, storm drain, landscaping, bridges, walls, striping, large road sign structures, signals, and roadway illumination. 2U06 -2007 WOLF CONSTRUCTION. Construction Forctnan/1quipment Operator/Site Surveyor Manage surveying and construction of site work for various building, irrigation, and landscape installations. 2005— 2000 AUSTIN BRIDGE AND ROAD. Equipment Operator Operate and maintain quarry and aggregate producing facility in Geo,getown'rx. 2003 -2005 CORNETT LANDSCAPING. Owner/Operator 14anage the installation Intl maintenance of landscaping for residennat and commercial properties in doe Sae Ntarcos T \ and surrounding areas, 1999 — 2003 UNITED STATES NAVY. YEOMAN ■ Administrative and document controls for the engineering and weapons deparinients onboard file U.S.S. Abraham Lincoln (CVdNa 72) aircraft carrier. 1998 — 1999 WILD BORE UTILITIES, Foreman/Equipment Operator Operate and maintain directional boring machine for the installation of various underground utilin' conduit installations. GLENN A CHAMBLESS :7C 10595 FM 2268 • Bay City, Texas 77414 0) 979.241 2232 (C) -�[. glcnn_clmmblcssfryyahoo.com ...., SllitlNIA ItV PRO F1 U Highly motivated and performance-drivai professional with broad experience in all aspects of service, sales and management. played an integral role in the negotiation, acquisition and management of clients. Creative and resourceful with hey talents in formulating and implementing initiatives to support territory management and problems solving. Exceptional relationship builder with proven expertise in identifying new opportunities. •-a Onat errvtt _ 1(liv Cu•I ttl isr. —� — • Strategic Business Planning and Execution • Sales Leadership l Now Business Development • First Aid, CPR, and workplace safety certified • Account Acquisition and Retention • Excel, Ward, Heavy Bid Operate heavy equipment: Dozer, Excavator, Skid Steer, Dump Trucks, Motor Grader. Heavy Haul Truck. Tractor & Scraper Client Education i Training and presentations Independent Decision Making Leadership and Supervision Team Building! Staff Coaching and Mentoring CAREER OVERVIEW Matagorda Construction and Materials. • Bay city, TX GENERAL MANAGER 2010-present • Project management & Company management • Oversee company financials • Manage and supervise all day-to-day operations. 25-30 employees. Dispatcher. Mechanics. Equipment operators & office personal, + Outside sales for the larger jobs, • Coordinate materialsforciviljobs. Bay City Sand, Inc. • Bay City, TX VICE PRESIDENT 2004-2010 • Managed and supervised all day-to-day operations. • Maintained complete and accurate records regards safety, adherence and reporting Over see all drivers & operators. • Financials • Experienced in operations near high pressure gas and high voltage electrical utilities • Manage all sales & schedule all orders. • Operate various heavy equipment if needed. S&S parms • Bay City, TX FARM FOREMAN 2001-2004 • Operated, trained and maintained associated machinery and equipment Interpreted and executed instructions according to specific scoped of work • Extensive demanding tasks requiring personal physical excursion • Directly supervised, trained and evaluated 15 assigned employees • Experience handling and dispersing chemicals for defoliating and fertilizing • Sales for all out of state customers during harvest season. • Operate various equipment. High School Diploma GLENN M. CHAMBLESS mfl 10595 FM 2268 • Bay City, Texas 77414 (a 979.241.2232 (C)' o glenn _ chamblcss[7yahoo.com First Aid, CPR and workplace safety certified Supervisor Drug & Alcohol Abuse & Reasonable Suspicion Training Safety Orientation Cnu se presented by various Chemical Plants Texas Friendly Hospitality Program's Customer Service Training Program Management classes. 2317 CR 117 Wharton, TX 77488 - 979-359-0960 Misty@ m atagordaco ncrete. C0m Skilled financial leader knowledgeable about accounting practices, principles and requirements. Successfully maintains compliant, accurate and cost-effective financial operations for two businesses. Over 19 years in field with stellar record of achievement. EXPERIENCE 12/2002 — CURRENT SECRETARY/TREASURER, K-C LEASE SERVICE, INC 10/2004 — CURRENT CONTROLLER, MATAGORDA CONCRETE, LLC 04/2001 —04/2007 SPECIALIST E-4, UNITED STATES ARMY RESERVE EDUCATION 052000 HIGH SCHOOL DIPLOMA, BAY CITY HIGH SCHOOL 122004 ASSOCIATE OF ARTS, WHARTON COUNTY 1R. COLLEGE SKILLS • Managed bookkeeping and accounting systems and completed data entry with accuracy and efficiency. • Processed accurate payroll for 50 staff and submitted direct deposits with Cyma. • Maintained detailed administrative and procedural processes to improve accuracy and efficiency. • Reconciled monthly statements and transactions to keep records accurate and current. • Assisted with month -end and year-end closings to support accounting system accuracy. • Evaluated open accounts to look for past -due balances and pursue collection strategies. • Advised leadership on HR-related issues, including vacation and sick time, benefits, job services and employment discrepancies. • Developed hiring and recruitment policies to drive transparent and fair hiring process for selecting candidates on basis of merit and relevance with job. • Coordinated communications, including taking calls, responding to emails and interfacing with clients. BID SCHEDULE PROJECT NAME: BID NO. 2024.06 — SEADRIFT DRAINAGE IMPROVEMENTS PROJECT DUE DATE: MAY 912024 BEFORE2:00:00 P.M. BIDDER NAME: /FV hT(jJA _r sU!_ G . 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 Ite�m TxOOT (ITEM ITEM DESCRIPTION IIjTEM _ BID QUANTITY _-_--- _ UNIT PRICE TOTAL. BID PRICE 1 0104 6017 REMOVING CONC (DRIVEWAYS) SY 44 '75 00 3, 3bC3 Ou 2 01106001 EXCAVATION (ROADWAY) CY 657 �Q O(7 25 00 Gi 3. 3 01106002 EXCAVATION (CHANNEL) CY 242 A 0132 6005 EMBANKMENT (FINAL)(ORD COMP)(iYC) CY 116 .00 IS O)sQ.°o 5 0132 6999 EMBANK (CHANNEL)(FINAL)(OC)(TY CY 539 no On 6 01626002 BLOCKSODDING SY 1269 7 0164 6005 BROADCAST SEED (PERM)(URBAN)(SANDY) SY 9905 . rJb 8 0247 6057 FL BS POS) (CMP IN PLC)(TYE GR1-2)(FNAL CY291 1 2 _ Ob ) 2 ' mG 9 0260 6012 LIME (HYD, COM OR QK(SLURRY) OR QK(DRY) TON 16 i7S 09 6,C O. 00 10 02606079 LIME TRT(SUBGRADE)(6") SY 1365 11 03106027 PRIME COAT (MC-30 OR AE-P) GAL 311 Lj.tlO ,OiS'Oa 12 03166001 ASPH(MULTIOPTION) GAL 447 13 00 5,g1(,00 13 03166246 AGGR(TY-PBGR-3SAGB) CY 13 1�JUi?DG �Hgpp,00 14 04006005 CEM STABIL BKFL CY 1959 1122-00 ,2tlj 4%, oo 15 0400 6008 CUT & RESTOR ASPH PAVING SY 2206 %20oo 3q-.7 030 00 16 04096002 PRESTR CONC PIL(18 IN SQ)(HPC) LF 576 7 oo �� cJ92,r�o 1.7 0420 6014 CL C CONC(ABUT)(HPC) CY 39,2 15,000. n0 18 04226008 REINF CONC $LAS ISLAS .BEAM (HPC) SF 2080 ! l ci.'08 19 D425 6010 PRESTR CONC SLAB BEAM (5SB12) LF 395 7740.00 Zst 2 367,0, 100 20 04326003 RIPRAP(CONC)(61N) CY 15 2 oo 13, 'p�j00 a 21 04326033 RIPRAP(STONE PROTECTION)(18IN) CY 219 g7000 Jdz 93a,o0 22 04506018 RAIL (TYT631) LF 208 4T.00 23 0460 6002 CMP (GAL STL IS IN) LF 15 /60. 00 4qiJLi. ao 24 0462 6005 CONC BOX CULV (4FTX4FT) LF 52 600.00 31, 2l>000 25 0462 6007 CONC BOX CULV (5FTX3FT) LF 166 660.60 /0q, 5,6a 00 Base Bid Continued Item #� TxDOT ITEM CODE ITEM DESCRIPTION ITEM UNIT BID QUANTITY UNIT PRICE TOTAL BID PRICE 26 0462 BOOS CONC 8pk CULV (SFTX4FT) LF 1058 U0 Uo27 62 6009 CONC BOX CULV (SFTXSFT) LF 396 28 0462 GO35 CONC BOX CULV (7 FT X 4 FT) LF 204 1A) cc, ov 29 0462 6021 CONC BOX CULV (8FTX6FT) LF 42., (03 ao 30 0462 6022 CONC BOX CULV (BFTX7FT) LF 34 / � [7D _ CJ' 00 31 04646005 RC PIPE (CL 111)(24 IN) LF 12 7�7C7pO ,.f Cgp 32 04656074 INLET(COMPL)((PSL)(RC)(SFTXSFT) EA 4 a ioc pa 06,00o-mo 33 04656076 INLET(COMPL)((PSL)(RC)(6FTX6FT) EA 8 )41,000,co 15 0C7p•� 34 04656559 INL(CMP)(PAZD-CZ)(FG)(4FTX4FT- 3FTX3FT) EA 9 10,000.00 g0,.otitj. 35 04666101 HEADWALL(CH -PW-0)(DIA=36 IN EA 1 J 36 04666182 ---- WINGWALL(PW -1) (HW=7 FT) EA 2 77,00D.OD A Ci�t7 QQ 37 0466 6183 WINGWALL (PW -1) (HW=S FT) EA 7 ?e 000 on -741 Uw. a) 38 04666208 WINGWALL (SW-0) (HW=S FT) EA 14 f� 000[3e 1a4oC)ii.00 39 04666216 WINGWALL (PW) (HW=S FT) (MOD) EA 1 7000,QD g1000. 00 40 0467 9001 SET (TY II) (18 IN) (HOPE) (3: 1) (P) EA 24 17l): Ob 41 0467 9002 SET (TY II) (30 IN) (HDPE) (3: 1) (P) EA G (}4v, pp ��, Q M 42 0496 6041 REMOV STIR (LARGE) EA 4 43 0496 6042 REMOV STIR (SMALL) EA 13 �C7U 44 04966050 REMOV STR (DRIVEWAY CULVERT) EA 20 12ev. XOcD 45 05006001 MOBILIZATION LS 1 2�75"QW. cr3%S� 4D 46 0502 6999 BARRICADES, SIGNS AND TRAFFIC HANDLING LS 1 60 47 05066038 TEMP SEDMT CONT FENCE (INSTALL) LF 763On 48 0506 6JBIOOEG EMP SEDMTCONT FENCE REMOVE) LF 763 3 oo o0 49 0506 6IO EG EROSN CONT LOGS (INSTL) LF 2250 (a, 00 Via,00a: 60 SO 0506 60 _REMOVE) EROSN CONT LOGS_._._. LF 2250 3.0 51 05306003 INTERSECTIONS (SURF TREAT) SY 172 7aQp O 52 05306004 DRIVEWAYS (CONIC) SY 110 53 05306006 DRIVEWAYS (SURF TREAT) SY 102 54 05306016 DRIVEWAYS (BASE) SY 323 a a.2 g�O q0 Base Bid Continued 0 D ITEM ODEE CODE ITEM DESCRIPTION ITEM UNIT BID QUANTITY UNIT PRICE TOTAL BIO PRICE 55 0540 6001 MTL W-BEAM.GD FEN (TIM POST) LF 92 56 0540 6016 DOWNSTREAM ANCHOR TERMINAL EA 4 SECTION 3, 5 na ad (� ?. bD 57 0544 6001 GUARDRAIL END TREATMENT (INSTALL) EA 4 CCr�',,r/(Zj 00 58 0644 0001 IN SM RD SN SUP&AMTY108WG(1) 5A)(P) EA 15 co 1 �ytj�o.00 59 0644 6076 REMOVE SM RD SN SUP&AM EA 15 60 0658 6073 INSTL OM ASSM (OM- 2V WCGND(BI) EA 8 61 0752 6004 TREE TRIMMING / BRUSH REMOVAL(CHANNELS) AC 1.11 ,I �/y� M -co 62 0752 9999 TREE AND BRUSH REMOVAL (CHANNEL) AC 113 . �pr( ,OD 63 07606001 DITCH CLEANING AND RESHAPING (FOOT) LF 5484 .0 2 $, a2 64 09996001 ENGINEERED TURF(HYDROTURFZ OR EQUIV) SF 40675 �r.�, OC? 65 09996002 MODIFY SEAWALL PANEL FOR OUTFALL EA 4 o rz co ,0 66 30766043 D-GR HMATY-D PG70-22 (LEVEL -UP) TON 192 90Ate t 00 67 41226004 THERMO PIPE(18")(HDPE)(TY S)(CSB) LF 644 go00 68 41226005 THERMO PIPE(24")(HOPE)(TY S)(CSB) LF 316 /SQ,, dD L/60. co 69 4122 6006 THERMO PIPE(36")(HDPE)(TY S)(CSB) LF 49 2W to %), 7X &D 70 41226021 THERMO PIPE(30")(HDPE)(TYS)(CSB) LF 569 ,yQ 71 50486002 FLOATING TURBIDITY BARRIER(FUR LF 90 & INST) 6.00 00 72 SO48G003 FLOATING TURBIDITY BARRIER REMOVE) LF 90 2 pp 0. 61� fe 73 7218 6013 PIPE ENCASEMENT (12" STL) LF 32� p, 60 6 _ZC. 00 Total Base Bid (Base Bid +$60,000.00 Testing Allowance) _ 4 0q jp r;-3? Sp ALTER ID #1 REPLACES ITEM 0999 6001 ENGINEERED TUR Item # TXDOT ITEM DESCRIPTION UNIT QUANTITY I Y UNIT PRICE TOTAL BID PRICE A01 04326002 RIPRAP(CONC)(51N) CY 619 jSC�.� �� ..�$'(�,co OWNER'S OPTION A- 9TH ST LEFT DITCH CONCRETE LINER additional work Item # TxDOT ITEM DESCRIPTION CODE IT ITEM UNIT BID IiB TITY UNIT PRICE TOTAL BID PRICE B01 B0432 6003 RIPRAP (CONC)(61N) CY 227 %:0.00 OWNERS OPTION A+ $4,000.00 Allowance - �3� (a�� 00 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 — Gh0 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 _lpyp consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $600.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: t. dd &on �k --L 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. 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: To. 29ox evCn tOlx2T 4-Am(A) 72 —771 Phone-- I36f) $52- 3D-Z4 EIN or Tax ID No,: 74• / J?� f2 Signature: i Name and Title:__ ��AOf 44094rS Email: ✓'a,ndv� �PS�es'Grrr�^ac{f'nc�� 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. Data:. 115h f zoom_ Bidder (Legal Name of Firrm):_Ler¢& %orr�au Date Organized:_ jg59 Name of par# �a�I-X �Zgtiei Date Incorporated 1676, FederallDNUmber 1-7q 6e7&13g-9 Number of Years in contracting business under present name �a List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Contract Type of work performed by your company: Amount $ Completion Date i��ciLar�g — 414'7,5-n •" `1lzb74 e+ as ai -7,aDa _7LFq.1)0 12-j z4' criJi� �ans�rw-f�a� Have you ever failed to complete any work awarded to ou? [J Yes do (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 2 No (if yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that heen imposed in the past five years or that was still In effect during the five-year period or Is still in effect? ❑ Yes aav 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$ MoNrComnteted Major equipment available for this contract: Are you in compliance with all applicable EEO requirements? Yes 0 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 Gander: Are you a Section 3 business? (see below) in Yes k( oO Section 3 Business Concerns; a) Businesses that are 61 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's jurisdiction that identifies themselves as Section 3 Business Concerns because they provide economic opportunities for low- and very low-income persons. Bank Referencesv�ov Address: /a .< da _S1 Contact Name: City & State: Zip: 7771901 Phone Number: d/ - 2� Credit available: Has the firm or predecessor firm been Involved in a bankruptcy or reorganization? 0 Yes f1'60 (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto all judgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) yearn and brief explanation of claim and outcome. Attach resume($) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Sianed this 7� day of .207,4 Signature YawAOAZ� - Printed Name and Title 16p z . Company Name No ry Statement: Pei y ,,'Ai �s being duly sworn, says that he/she is the �� Li t' Positionlritle Of 16""r1L �yy;� I, (Firm Name), and hereby swears than a answer the foregoing questions and all statements therein contain�etrue 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 K day of — Pal , 20 Z4' . Notary Public 'T DIANNE 01*14 tart'10 411640SI na ur CALES Notary mi kon Expi6 My Cammisslon Expires January 19, 2027 D1li y'e- /t1�5 Printed Name My Commission Expires: �7 The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.G. 1001, t CONT inc. P.O. Box 986 • Port Lavaca - TX • 77979 • (361) 552-3024 - FAX (361) 552.4049 OWNED EQUIPMENT Cat 330 Excavator Cat 329L Excavator Cat 3250 Excavators (2) Cat324L Excavator Cat 320CL Excavator Cat316 Excavator Cat314 Excavator Cat308 Excavator Cat307 Excavator Cat 05K Dozer Cat D5M Dozer Cat D6K Dozer (3) Cat 06N Dozer (2) Cat 140M Motorgraders (2) Cat 140H Motorgrader Cat 120H Motorgrader Cat 120M Motorgrader Haul Truck with 50 Ton lowboy 14 C.Y. Tandem axle Dump Trucks (9) 20 C.Y End or Belly Dumps (4) Pickups Crew Trucks Air Compressors with Hoses Centrifugal Pumps with Hoses Timber Dragline and Crane Mats Note: HEAVY EQUIPMENT Cat420F Backhoe/Loaders(2) Cat430 Backhoe/Loader Cat 924F 2 - G.Y. Loaders (2) Cat 926 Loader Cat950 Loader Cat 725 Articulating Dump Truck Cat Compact Track Loaders (5) Smooth & Sheepfoot Compactors Tractor & Shredder or Offset Disc Rental Equipment as Needed TRUCKS One Ton Truck with Gooseneck Trailer 2,000 Gallon Water Truck 3,000 Gallon Water Trucks (5) MISCELLANEOUS EQUIPMENT Electric & Pneumaft Tools Tool Sheds or Job Shacks Chain Saws Concrete Breakers Compactors Generators We lease or rent equipment as needed to supplement our owned equipment. 41y boomientsA.Cl nwumcntsM'ord Oocumcnuir'ormsrCorporstJNuip List 1 0510N24 3:11 PNI c � m Ap AM 3 �U§ # w z2 k � k /0 co ! J != } 0 j§ k) r k�) 7}7 |! ` }} �\ \) )k !! /! !! ,. ,ga �� \\ ! §$ �� \\ ) } CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, earn Lag., Regular Session. CIFFICEUSEONLY This questionnaire Is being flad in accordance with Chapter 17a, Local Government Code. by a vendor wile has a business relationship as defined by Section 176,001(1-a) with a local govonanentat entity and the Dale Received vendor meets requirements under Section 176.006(a). By law INS quesllormalre must be filed with the records administrator of she local governmental ontity nol later than the jai business day after the date die vandor becomes awaro of facts that require die statement to be filed. See Section 176.006 (a•Sj. Local Government Code A vendor commits an offenss if the vendor knowingly violates Section 176 0M Local Government Ccda. An offense under flits section is a misdameanor. t Name of vendor who has a business relationship with local governmental entity. Nora 2 Q Check this box if you are filing an update to a previously Bled questiontredre.(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.) 3 Name of local government officer abeutwhomthe Information Isbeing disclosed. Name of Officer a 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 relationshfp wish the local government officer. Complete subpartsAand8foreachemploymentorbusinessrelationshipdescribed, Attach additional pages to this Form CIO as necessary. NJA 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? a Yes ED No B. Is the vendor receiving or likely to receive taxable income, other than Investment income, from or at the direction of the local government officer or a family member of the offeerAND the taxable Income is not received from the local governmental entity? Yes No 6 Describeeachem o p employment that the vendor namedinSectiontmaintains writhe earparstionor 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. �I A e ❑Check this box If the vendor has given the local government officer or a family member of the officer one or more gifts as described In Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-t). C 7 ' �tIV,,,, 5 � 7-9Z. 5lgnalure of vendor doing business with the govemmenta entity . Dale Form provided by Texas Ethics Commission www.ethics.state. tx,us Revised iwo,2ois CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176of the Local Government Code maybe found at htip://www.statuiLs.legis.state.tx.us� Oocs/1-G/him/1-G.176.1tim. For easy reference, below are some of the sections cited on this form, Local Government Code 1176.001(1 a): "Business relationship" means aconnection between two or more parties based on commercial activity of one of the parties. The term does not include aconnection 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 Govemment Code S 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) a contract between the local governmental entity and vendor has been executed; o (fi) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12•month period preceding the dale the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (If) 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 acompleted conflictof interest questionnaire if the vendor hasa 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 data 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, respunsetoarequest 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.ethlcs.staie.tx,us Revised 4118012etS CONTRACTOR'S CERTIFICATION of RECOVERED MATERIAL ACKNOWLEDGEMENT I, arvnK A= (Principal's Name)_ of 4%GZ 6arX7UVV6 J--g • (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 hops:/Iwww.epe.gov/smmlcomprehensive-procurement-guideline-cpg- program#directory) o Pnn d- e,and Tftp,� • itle f�rhz[r ih'u9lWh2 Signature Date USE OF RECOVERED MATERIAL Please check one: Recovered materials are included in this bid: Ej?Aet'erials included covered materials are not reasonably available in a reasonable period of time. Recovered materials fall 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. �✓w", i7/ Wa - r n ✓IL�C Printe me and Title Signature" 1A Ap. rt 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 it public (federal. state, or local) transaction or contract under a puhlic transaction; violation of federal or stale 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 agovernmentai entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this cc[ iitication. d, Have not within a three-year period preceding this application/ proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a- d) of this certification. Name and Title of Authorized Agent Si�eofAuthorized Agent 5%7/ ZOZ4 Date l am unable to certify to the above statements. My explanation is attached. DEBARMENT & SUSPENSION Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 19, 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 ofparticipants 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 depu l tments 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)'rhis 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.'ro the extent permitted by law, Executive departments and agencies $hall: (a) Follow government -wide criteria and govcrmnent-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 parry 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 shotdd be granted only infi•equently. See.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 rour months of the date of the guidelines issued under Section 6. The Director orthe 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 constiaited 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 die 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 currml 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 govermment-wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and repo[ i periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order See, 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. See. 7. The Director of the Office of Management and Budget shall repo) 1 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 finds. Under 40 C.F.R. 32.510, the SRF agency must submit a cot Nfication 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 cc It.ification is reviewed by the EPA regional office before the capitalization grant is awarded. Arecipient 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 oil 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.K. 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 chocked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy o f ce 1 iifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. STATE OF TEXAS {} COUNTY OF CAl/ houn {} AFFIDAVIT K1N6 j�%� y being first duly sworn, deposes and says: that he or she is r� trype ar Print Name) the _7fwaa.r lyl�lNac,fYL of _ko"T ,n> (or.�Uyyt, having its (Type or Print Tine) (Type or Print Nameof Company/Film) principal address at 34-17 4v4-4 3S 5pura - t mrif-w4tf9. ?L 774i4 (Type or Print Physical and Malling 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 securefor 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, offertogive, norintendsto giveat 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. Afflant 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 re irements contained in the bid/proposal. Si� f Affiant '=Vy' &trr - Printed Name and Title of A(Flant 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 0 cA 120 i r� Notary ID 04164066 *y��{{,,e�tnmtssion Expires Signature of Notary Public lrer t�, "anuary 19, 2027 CONTRACTOR CERTIFICATIONS U,S. Dep._.._.._...-----._.__� artment of Housing and Urban Development CERTIFICATION OF SIODER 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) Lesrm Grinv gcu2v� c . CERTIFICATION BY BIDDER Bidder has participated ,rr a previous contract or subcontract subject to Civil Rights Laws and Regulations. 0 es 0 No ho undersigned hereby certifies that: he 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). Ths,)sgual Qgportunily clause is included in the Contract (if bid equals or exceeds S10,00% Have you ever been or are you being considere d/r sanction due to violation of Executive Order 11246. as amended? 0 Yes 1p No NAME AND TITLE OF SIGNER (Please type) SIGNATURE DATE I'I CONTRACTOR'S LOCAL OPPORTUNITY PLAN ,1zz m, hNrr2a� V Tom. 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. S. 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 Erring meets these Local Opportunity objectives. As officers and representatives of .0 M72YL imrYCLp_e - 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 N %deS Printed Name lR&1Z12-7` l67sn 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 Fillad — 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 Position not Filled No. of Positions to fill with LMI Resident Secc�ttflon 3 rc..rw7 t� r.d� 2 2 kTotals:l 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 0pportunfties for Low and Very Low•lacome Persons raantea Su�brecipie—nt Contract Number Date: I CONTRACTOR INFORMATION Name( Addres. Type of �� u aum� vvum�c 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: 0 Copy of resident lease ❑ Copy of evidence of participation in a public assistance program For business entity as applicable: ❑ Copy of Articles of Incorporation Assumed Business Name Certificate R List of owners/stockholders and % ownership of each appointed officers ❑ Organizatlon chart with names and titles and brief function statement Copy of receipt of public assistance Other evidence �) A ❑ Certificate of Good Standing Partnership Agreement ❑ Corporation Annual Report ❑ Latest Boardminutes Ej 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 atleast 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of flrstemployment with the business: ❑ List of all current full-time employees ❑ List of employees claiming Section 3 status ) ❑ PHA/IHA 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 ❑ Statement of ability to comply with nl ❑ List of owned equipment public policy !v ❑ List of all contracts for the past two years Authorized Name an ig a ure ate Attested By: (Corporate Seat) 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 then 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 0britractor's Authorized Official NrHt l//?n/a cs- /A-� r'.f'/iah/w& Printed Name and Title of Contractors Authorized Official 5r)— 1 r;U Date "24 C.F.R. 87 App. A. available at https://www.gpo.gov/fdsys/granulelCFR-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. 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. 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 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, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. &. 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. 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. S. 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�0o13), Washington, DC 20603 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 disclosure) i 1. Type of Federal 2. Status of Federal Action: 3. Report Type: Action: a. bid/offertapplication 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: �A NJA Coggressiorral District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: 0V CFDA Nh�rnber, if applicable: 6. Federal Action Number, if known: 9. Award Amount, if known: IVA $A 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): 0�n N�A - 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 placed Print Name: nK 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: z.l /t]yp y{, _IgACongress semi-annually and will be available for public Inspection. Any person who fails to file the required Telephone No.: Date: 5 -b4 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 Chapter2270 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) WIII 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, orwith a person orentity 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) _ 2 mau objux:.S , 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) WIII not boycott Israel during the term of the contract; and 3) Is not currently listed on the State of Texas Comptroller's Companies that Boycott Israel List located at httos://comptroller.texasgov/purchasing/publications/divestment oho Company Name Signature of Authorized Official Printed Name of Authorized Official Title of Authorized Official Date Pursuant to Texas Government Cade §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252,001 et seq. of the Government Cade provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) "Resident bidder' refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ® I certify that is a "Nonresident Bidder" of Texas (Cbrnpnn1' Nonicl as defined in Government Code §2252.001 and our principal place of business is (Cary and Stale) i certify that �t9�r Gi4rac4tl�n-V t,.is a "Resident Bidder" of Texas as 4Compnny Nwne) defined In Government Code §2252.001. Sign ilture of Authorized Agen a" f Printed Name and Title of Authorized Agent Date 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. I t SAM.cow Entity Workspace Results I Total Results LESTER CONTRACTING INC Unique Entity Wi YSFTEM85M881 CAGE/NCAGE:IJMS4 Entity Status: Active Registration Doing Business As: Physical Address: 3677 STATE HIGHWAY 35 S PORT LAVACA 1 TX 77979-5584 USA Expiration Date: Nov 26, 2024 Purpose of Registration: All Awards May 07, 2024 08:04!32 PM GMT KNOW ALL MEN BY THESE PRESENTS, that we Lester Contracting, Inc. PO Box 986, Port Lavaca, Tx 77979 as Principal, hereinafter called the Principal, and Continental Casualty Company 151 N. Ftatildin Street, Chicago, IL 60606 a corporation duly organized under the laws of the State of Illinois as Surety, hereinafter called the Surety, are held and firmly bound unto Calhoun Counly 211 South Ann St., 3rd Flour Suite 301, Part Lavaca, Tx 77979 as Obligee, hereinafter called the Obligee. In the sum of 5:va Greatest Amount Bid Dollars( 5% GAB 1, For the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitteda bid }aid No. 2024.05 Seadrift. Drainage Improvements Project GLO Contract No. 22-085-014-D245 NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter Into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as maybe specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the .Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obliges the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this ._9fl7.__day of Mav 2024 (Witness) irl+ ► r , r io �. Lester Contracting, bir. rincipal) � (seal) By: — -- (Tllfe) Ken Lester Jr President Continental Casualty C.ampan (Surety) ` (Saal) Kristic Rodriguez (Titre) Attorney in NAr' —� printed In coapemilon with the American Institute of Architects (AIA) by the CNA Insurance Companies. Tito language in this document conforms exactly to the language used In AIA Document A310 - Bid Bond - February 1970 Edition. G-108041-A POWER OF ATTORNEY APPOINTING INDIVIDUAL. ATTORNEY -IN -FACT Know All Nleu By These Presents,'I'lut Continental Casualty Company, an Illinois Insurance company, National Fire Insurance Company of I-fartford, an Illinois insuratcc company, and American Casualty Company ol'Rending, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Cmnpanieti'), are duly organized and existing insurance eompanles having theirprincipal offices in the City of Chicago, and State or Illinois, and thin they do by virtue of the signatures and scals herein affixed hereby make, constitute and appoint (,airy (; rissom, Laurie J Barnes, Ronda Drown, Denise Dugan, James Russell, Ann Rodriguez, Kristie Rodriguez, Sharma Wu;ine.r, Coy 5underman, J D Steanson, Individually of Austin, TX, their trite and lawful Aeomcy(s)-in-Fact with fill power and authority hereby conferral to sign, seal and execute for (Intl on their behalf bonds, undertakings and other obligatory inshvments of similar nauuc - In Unlimited Amounts - and to bind them thereby as fully and to the same "lord as il'such instruments were signed by it duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. '['his power of Auomcy is made and executed pursuant to and by authority of file By -Laws and Resolutions, printed on the reverse hereof. duly adopted, as indicated, by ilia Boards of Directors of the insurance companies. 11, Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice Presidia t and their corpomle scuds in be hereto affixed on dais 29th day ol'Augusl, 2023. A�GA5Ugtrh 4 INSURppw oA N` fi canPgnATE �+ ig(,apPapq}�p � �r BEAL I mimic' Too NAPt Continental Casualty Company National Fite Insurance Company of Ilartf'ord American Casualty Company of Reading, Pennsylvania Larry Kasten Vice Presidenl Stale o1'South Dakotn, County of Minnchairn, ss: On this 29th day of August, 2023. belbre me personally came Lamy Kristen to me known, who, being by me duty swom, diet depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is it Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Ilartfard, an Illinois insurance company, and American Casually Company of heading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seats of said insurance eompanles; that the seals affixed to the said instrument are such corporate seats; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his namethcrelo pursuant to like authority, and acknowledges same to be the net and dead of said insurance companies. M.dENT �yson A`IuOARM My Commission Expires March 2, 2026 NI. Dent Notary Public CERTIFICATE 1, 1). Johnson, Assistant Secretary ofContirnental Casualty Company, an Illinois insurance company, National Fire Insurance Company of llarl'ord, an Illinois Insurance company„ and American Casualty Company of Reading, Pennsylvania. a Pennsylvania insurance company do hereby certify tl:at the flower of Attorney herein above set forth is still in force, and further certify than the Dy-Laws anal Resolutions of the Anard of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whercof I have hereunto subscribed my name and affixed the seal of the said insurance companion this 91h day of May, 2024. spy ohSUgtr}. tNSURp,iy, �L ,vaMroe �F _a cePPOFATE �� O R`� Mt�(,OPrU.4gr`O � • y ` ; V pi) SEAL � � July 2 1'�� Iasi NANt"r Continental Casualty Company National Fire Insurance Conpnny of Vil lf"oxl American Casualty Company of Reading, Pennsylvania , j jvv�� D. Johnson Assistant Secretary Form F6853-4-2023 Go to www.cnasuretv,com > Owner J Obligee services > Validate Bond Coverage, if. you want to verify bond authenticity. Authorizing By -Lets and Resolutions This prover of Attomcy is signed by Larry (Casten, Vice President of each of ilia CNA Cornpanics (as defined in the Power ol'Attontey), who ha; hesn authorized pursuant ul the below Bylaws and Rewlutimis to execute power ofosomcys on Irchnl f of each of the CNA Companies, ADOP'fISD BY THE BOARD OP DIRECTORS OF CONTINENTAL. CASUALTY COMPANY: This Power ofAttomcy is made And execute[[ pursuant. to and by authority of Ilse following resolution duly adopted by the Board orDbectors oflhe Company, in A meeting held oil May 12. 1995; "RESOLVED: Thor any Senior nr Orovp Vlac President may autlerizc kin o(ficcr to bign specific docunrenls. ngrccnrenls and instmments kin hahalfoftlte Conpml}' provided Ihnt Ihu name of such authorized officer and adescription of (lie documents, agrCamentb Dr inslmntauts Ihat such officer may sign will be provided in writing by the Senior or Croup Vice President to Ilia Secretary of like Company prior to such execution incoming CITCclivc," This Power of Ationicy is signed nut scaled try facsimile under and by Ilnc authority of Ihu follmving Resolution n[loptcd by the Board of Uirectors al'diu C[nnpnny by nnnn iamm wrhicn consent dated the 25"'i lycl'April, 2012: "iV11C1`ali, pia byhllvs llf 1hCCpflllDllly' llr npCC1IIC rtltipliElPll pf dla RDAYd of litl'eCEOtb has lllIIhOOY.Cf1 V:Iripll6 0(fICCf6 (ilia "AUl1lJaze[I OITIu:Is") In exCCU1L' Var11111F poiioics, bonds, undon2kings and outer obligatory instmmenis of pike natural and Whurcas, frllm Hato to unto. the signature of the Authorized oniicurs. in inc idon to being providers in original, hard copy fio nor, may he movided von facs milcut otherwise In killcicctmnieformal(collectively,"EicctronicSigaalures"):Nowthcrctoreheitresolved: pad [Ito FteclmnicSignature ofonyAuthorized Officer shalt be valid And bindinII on the Conlparry," This Pow'or of Attorney may In sighed by digital signature and scaled by n digital or olhenwisadcdronic-Ponnattcd corporate seal under And by llte authority of the following Resolution adopted by ilia Board or Directors of the Company by unanimous written consent dated the 271h day of April, 2022: "RESOLVED: Thal it is in ilia best interest of the Company In periodically ratify and confine any corporate docuntcnts signed by digital signatures and to ratify and confirm the use of a digial or otherwise eiccuonic-fannalted corporate seal, each to be considered the act and [lead of ilia Company" ADOPTED BY THE, BOARD OF DIRECTORS OP NATIONAL FIRE INSURANCE COMPANY OF I'IARI•FORD: "I ho, Power of Allornay is made and executed pursuant to and by nalhorhy of ilia following, resolution duly Adopted by the Board of Ditectors of fire Company by unanimous written consent dated May 10, 1995: "RESOLVED:. That any Senior or Gmup Vice President may mrhorize an Officer to sign specific dncumunls, agrecmcnts and instruments on bcludfof the Company provided that the name of such nuthedzed officar and a description of the documents, agreements m inslnmrcnls Ihal such oft➢cer may sign will be provided in writing by the Senior or Group Vice Prasident to the Secretary of Ihu Company prior (o saeh cxCrxrioll becenling CffacOve." 'Ibis lower of Attmnoy is signed And sealed by raesindle tinder and by the authority of the following Resolution adopted by die Board of Directors of the Company by unmlinrous written consern dated the 251" day of April, 2012: "Whereas, Oda hylmrs of dlc Company or specific resolution of the Board of Directors has authorized various officers the "Authorized Olfnxts') to oxucuui vnrimis policies, bonds, undertakings mad other obligatory instruments oflike nature; and Wherein. from Ilme to lime. Ilia signaluN of the Authorized Officers, in addiota, it, being provided in original. hnrd copy format, truly be provided via facsimile or otherwise in till elecrmilie formal (Collectively, "EICCI[DIItG SigaalUles'); Now Iberelbre be it resolved) [lint Ilia ElBolmnie Signnnur of Any Authorized Officer shot] be valid and binding on the Company." Thin Power of Altnmay may he signed by dimall signature mrcl scaled by a digital or otherwise cicclmnic-fomtatted corporate seal under And by the authority of ilia fallowing Resolution adopted by Ore Board of Directors critic Company by unanimous written consent dared the 27th day of April, 2022: "RESOLVED: That it is in the best interest of (lie Company la periodically ratify :red confirm :my corporate documents signed by digital signaiaws and to reify and Confirm the use of a digital or otherwise CladrONPforIllAllad corporal@ seal, each to be considered Ilic act and deed ofthe Compally ADOPTED BY TI IF BOARD 017 DIRECTORS OF AMERICAN CASUAL: fY COMPANY OF READING, PENNS YLVANIA: T'hts Power afAltoi ney is made and executed pursuant to and by nurharily of the following resolution duly ndopted by ill- Board or Dire cars of the Conrpany by unanimous w•rilteri consent dated May 10. 1995: 'RESOLVED: That any Scnioror Group Vice President may authorize An officer to sign specific docrmnents, agreements and instnmlCAbOft Inhalfnflbe Company provided that the naive of such authorized officer and a description of the documents, agreements or insiNmentb that such officer may sign will be pmvidcd in wifling by the Scrum or Group Vice President to die Secretly of the Company prior to such execution hcamniag effective[' This Power of Attorney is signed and scaled by 1'aesiniile under and by the authority elite following Resolution adopted by the Board of Directors of the Conrpany by umm�imnns written cpnsanl Anted Ilia 25"'day ol'April, 2012: "W hercils, die bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (lite "Authorized Off tears") to oxecute various pnlialos, lentos, undannkings uud ntlus rafilfgmon• insinunmlis of I Ike nature; and Wlmreas, tram lime to lima, the sigtmboa of ilie Anthorized Officers, in addition to being provided fat mi.inal, hard copy format, rally be provident Via facsimile or tal anwho fit nil cleclminu Ibrmat (collactivoly. "Eluulronic Signatures'): Now therefore be it resolved: that the Electronic Signtana orally Authorized OI(lw.cr Shall be valid and binding on the Conipnny." Tills Power of Alromey riay be signed by digital signature and sealed by it digital or othonvise cleclrianc-Ornkalled corporate seal under and by be loalenty of the fallowing Resolution adopted by the Bpnrd of Direcror of tic Company by unaninloos written coolant dared Ilia 27111 day of April, 2022: "RESOLVED: 'I"Ind. it is rat the best rnlcmst of the Company to periodically ratify [aid confirm any corporate documents signed by digital siminnacs and to ratify and confine the use of a digital or olhcnvise cicctmnic-ImmaOed cormnda seal, each to be emnidered the nut and deed of the Company." ' NOTICE OF MEEI ING — 6/05/2024 28. Consider and take necessary action to award qualified bidder on Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas. (DEH) RESULT: APPROVED[UN MOVER: David Hall, Comm SECONDER: Vern Lyssy, Comn AYES: Judge Meyer, Con uction. MOOS] ner Pct 1 )ner Pct 2 sioner Hall, Lyssy, Behrens, Reese Page 25 of 28 G&WENGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361 )552-4509 • f: (361 )552-4987 TBPE Firm Registration No. F04188 May 30, 2024 Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 S. Ann St., 3' Floor, Suite 301 Port Lavaca, TX 77979 RE: LETTER OF RECOMMENDATION Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas 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., Thursday, May'23, 2024, at which time Bids were publicly opened and read aloud: The enclosed Bid Opening Table and Bid Itemized Table indicate there were a total of six (6) bidders submitting bids with the "Apparent Low Bidder" being Staff Concrete Construction. We have not had the opportunity of working with Staff Concrete Construction 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 Staff Concrete Construction for $173,617.54. If the County concurs with this recommendation, and upon your direction, we will prepare a Construction Contract package immediately and deliver it to Staff Concrete Construction. Please call me @ (361) 552-4509 if you have any questions. Sincerely, G & W Engineers, Inc. cott P. Mason, P.E. Enclosures: Bid Opening & Bid Itemized Tables cc: file 9115.029 Engineering Consulting 0 Planning 0 Surveying G & W Engineers, Inc. BID OPENING TABLE Date: May 23, 2024 205 W. Live Oak Time: 2:00 p.m. Port Lavaca, TX 77979 Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement for Calhoun County, Texas Bidders Bid Bond Acknowledges Addendum No.1 Calendar Days Total Base Bid Carlson McClain Construction Company LLC YES N/A 30 $197,802.00 CCC Group Inc. YES N/A 140 $530,470.00 Geofill Material Technologies dba Pezzi Construction YES N/A 42 Written Amt. $186,356.32 Corrected Amt. $185,985.36 Shirley & Sons Construction Co., Inc. YES N/A 60 $250,224.00 Staff Concrete Construction YES N/A 90 $173,617.54 Boettcher Hlavinka Co., LLC YES N/A 45 $203,187.00 Page 1 9115.029 82 00 33 \_ \ /0 /{ | /} |\ . } _ { \ ) , .0 . / . � \ : { k \ Iff !IF PROJECT NAME: Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Project DUE DATE: Thursday, May 23, 2024 before 2:00:00 p.m. NAME: CCCGroup Inc. BASE WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. Item Quantity Unit Unit Price Total Bid Price 1. Furnishing all necessary equipment, 1 LS materials, and labor for Mobilization, $13,485 $13,485 demobilization, barricades, insurance, and bonds as per plans and specifications 2. Furnish all necessary materials, equipment 1 LS and labor for the demolition and removal of approximately 482 LF timber cap, 92 tie- $13,677 $13,677 back rods and 482 LF timber wailer in accordance with the drawings and specifications. 3. Furnish all necessary materials, 482 LF equipment, and labor for the installation of reinforced concrete bulkhead cap with $414 $199,548 periodic PVC drains approximately every 10 ft in accordance with the drawings and specifications. 4. Furnish all necessary materials, 482 LF equipment, and labor for the installation of a 3' wide sidewalk alongside the proposed $100 $48,200 concrete cap with minor grading of the produced cut material in accordance with the drawings and specifications. 5. Furnish all necessary materials, 92 EA equipment, and labor for the installation of stainless -steel tie -back rods connecting $1,730 $159,160 existing Deadman to propose cap in accordance with the drawings and specifications. 6. Furnish all necessary materials, equipment, 482 LF and labor for the installation of a timber $200 $96,400 wailer in accordance with the drawings and specifications. TOTAL BASE BID $ $530,470 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 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. 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 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement 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 140 consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. 2. SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Subcontractor The undersigned hereby declares that he has visited the site and has carefully examined the contract documents relative to the work covered by the above bid. Bidder Name: CCC Group Inc. Address: 6364 Hopkins Rd. Corpus Christi, TX 78409 Phone: 361-960-1237 EIN or Tax ID No.: rd -23� 1991 Signature: Name and Title: Group Manager Email Address: _justinm@cccgroupinc.com I-t7:101 G7 KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, CCC Group, Inc. as PRINCIPAL, and Philadelphia Indemnity Insurance Company , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", in the penal sum of Five Percent of the Amount Bid Dollars, ($ 5%of the Amount Bid ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated May 23, 2024 , Bid Number 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement 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 saveral seals this 23rd day of May, 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: Norma oups, Witness Attest: Countersigned Attorney -in -Fact, State of Louisiana CCC Group, Inc. d � (SEAL) (SEAL-) By: — and GenwW Vmmedte Seal Philall,#aIndein ityIn uranceCompany By: c, Kath "eu1 L. Berni, Attor ey-in-Fact Affix Corporate Seal By: PHILADELPHIA INDEMNITY INSURANCE COMPANY One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004-0950 Prover of Attorney KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint Gregory R. Weston, Kathleen L. Berni, George V. Arms, Jr.. Jean Viola and Elizabeth Hamrick. of Arthur J. Gallagher Risk Management Services. Inc. of Metairie, LA, its true and lawful Attorney -in -fact with full authority to execute on its behalf bonds, undertakings, recognizances and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind die Company thereby, in an amount not to exceed S50.000.000.00 This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 146 of November, 2016. RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of Ole Company: (1) Appoint Attomey(s) in Fact and authorize the Attomey(s) in Fact to execute on behalf of the Company bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof and to attach the seal of the Company thereto; and (2) to remove, at any time, any such Attomey-in-Fact and revoke the authority given. And, be it FURTHER RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any such Power of Attorney or certificate relating thereto by facsimile, and any such Power of Attorney so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 5TH DAY OF MARCH, 2021. 1927` Qe (Seal) ` Joh Gku b, President&CEO Philadelphia Indemnity Insurance Company On this S" day of March, 2021 before me came the individual who executed the preceding instrument, to me personally known, and being by me duly swom said that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed. Oommenweeltharoenneylvanla-Notery Sear Notary Public: Vanessa Mckenzie. Nalary Public MontgomeryCou* Mycommlaslon exPirsaNavember3.2024 Commission number 1366394 Member. Pann By",, m.ewlonMNOlirlet residing at: Bala Cynwyd, PA My commission expires: November 3, 2024 1, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify that the foregoing resolution of the Board of Directors and the Power of Attorney issued pursuant thereto on the 5 ° day March, 2021 are true and correct and are still in full force and effect. I do further certify that John Glomb, who executed the Power of Attorney as President, was on the date of execution of the attached Power of Attorney the duly elected President of PHILADELPHIA INDEMNITY INSURANCE COMPANY. In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this 23rd day of May. 2024 Edward Sayago, Corporate Secretary - PHILADELPHIA INDEMNITY INSURANCE COMPANY 9., 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. Founded in 1947, consolidated Name of Bidder: CCC Group, Inc. Date Organized: under CCC Group, Inc. in 1985. Address: Corporate: 5797 Dietrich Road. San Antonio. TX 78219 Date Incorporated: December 17. 1985 Nlailin2: P.O. Box 200350, San Antonio TX 782 0-0 5+0 Bidding Office: Corpus Christi Regional Office, 6364 Hopkins Rd, Corpus Christi, TX 78409 Phone 361-289.5155 Number of Years in contracting business under current name: 39 CONTRACTS ON HAND: Contracts Dollar Amount Completion Date American Soda LLC $51,866,666 Contract Date: 05/2023 Texas Lehigh Cement Company, LP $27,598,920 Contract Date: 12/2022 American Gypsum Company LLC $22,533,272 Contract Date: 06/2022 Refer to attached Current and Completed Projects List Over $1M (5 Year) Industrial construction, maintenance, fabrication and emergency repairs - Type of work performed by your company: civil. mechanical. structural. E&I - See attached Types of Worl< Performed 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 Buckeye Partners LP $80 79'1 521 03/2019 AccuTrans Inc $45 715 784 04/2021 Lehigh Mitchell $99 500 000 06/2023 Refer to attached Current and Completed Projects List Over $1M (5 Year) Proiect References and Marine Overview. Major equipment available for this contract: Refer to attached Company Owned Equipment & Vehicle List Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Hancock Whitney Bank Gems Pastor Credit $ Bank 713-951-7727 available: $14,437,000 reference: Gema.Pastor@hancockwhjtney.com The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this 14th by of May 20 24 by: (Signature) State of Texas County of Bexar General Counsel and secretary (Title) Before me, a notary public, on the 15th day of May, 2024 personally appeared Jason C. Zehner, known to me to $ if rs^hose fi is subscribed to the foregoing document and, being by me first duly sworn, declared that the statement therein ntaindd -�ro,"'Z, ••c1�ro Sherry K. Keller xti, 06-05? Notary Public uuumuuWptue�w\ Submitted by: Justin Melton, Estimator Tel. 361-850-2816 Mob. 361-960-1237 JustinM@cccgrouoinc.com Corpus Christi Regional Office 6364 Hopkins Rd. Corpus Christi, TX 78409 Tel. 361-289-5155 Fax 361-289-1404 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. Founded in 1947, consolidated Name of Bidder: CCC Group, Inc. Date Organized: under CCC Group. Inc. in 1985. Address: Corporate: 5797 Dietrich Road, San Antonio. TX 78219 Date Incorporated: December 17. 1985 Mailing: P.O. Box 200350. San Antonio TX 78220-0350 Bidding Office: Corpus Christi Regional Office, 6364 Hopkins Rd, Corpus Christi, TX 78409 Phone 361-289-5155 Number of Years in contracting business under current name: 39 CONTRACTS ON HAND: Contracts Dollar Amount Completion Date American Soda LLC $51,866,666 Contract Date: 05/2023 Texas Lehigh Cement Company, LP $27.598,920 Contract Date: 12/2022 American Gypsum Company LLC $22,533,272 Contract Date: 06/2022 Refer to attached Current and Completed Projects List Over $1M (5 Year) Industrial construction, maintenance, fabrication and emergency repairs - Type of work performed by your company: civil. mechanical. structural. E&I - See attached Types of Work Performed 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 Buckeye Partners. LP $80.791.521 03/2019 AccuTrans Inc $45,715 784 04/2021 Lehigh Mitchell $99,500,000 06/2023 Refer to attached Current and Completed Projects List Over $1M (5 Year). Proiect References and Marine Overview. Major equipment available for this contract: Refer to attached Company Owned Equipment & Vehicle List Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Hancock Whitney Bank Gema Pastor Credit $ Bank 713-951-7727 available: $14,437.000 reference: Gema.Pastor@hancockwhitney.com The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this tam y of May 20 24 by: _ (Signature) State of Texas County of Bexar General Counsel and Secrete" (Title) Before me, a notary public, on the 15th day of May, 2024 personally appeared Jason C. Zehner, known to me to g orsofthase 0 is subscribed to the foregoing document and, being by me first duly sworn, declare that the statement therein ntaindl Wb"t . . ."fro Sherry K. Keller UFkP 06-05'2 �o Notary Public llwwmmnnua' C1CCCIAGROUP INDUSTR List of Attachments > Fact Sheet > Current and Completed Projects List Over $1M (5 Year) > Types of Work Performed > Company Owned Equipment & Vehicle List > Project Experience • Project References • Marine Overview • Marine Port Projects > Accutrans Barge Fleeting > Buckeye STGT > COCC LMSR Layberth Dock > COCC Seawall Construction > Key Personnel • Executive Team • Doug House, Operational Executive - Corpus Christi • Jason West, Group Manager - Corpus Christi • Superintendents assigned upon project award > Hancock Whitney Bank Verification Letter Revised 05/10/2024 List of Attachments I Calhoun County Statement of Bidder's Qualifications I Page I 1 C CCCIAGRMP INDUSTRCONSTRUCTION Fact Sheet UEWIMIXWWTZINT�'� ME - Corporate Headquarters Date Founded 1947 Street Address 5797 Dietrich Road Incorporation Texas —Dec. 17, 1985 San Antonio, TX78219-3507 Ownership Private —100%ESOP Mailing Address PO Box 200350 DUNS 15-181-8457 —1R3 San Antonio, TX 78220-0350 Federal Tax ID 74-2391991 Tel, 210-661-4251 3-Year Average Volume $247M Fax 210-661-6060 3-Year Average Employees 1,105 Website www.cccgroupinc.com NAICS Codes 236210, 237990 Complex Size 28Acre —7Buildings SIC Codes 1541,1629 Shops at Headquarters 114,000 sq ft Dedicated to Fabrication, Engineering News -Record (ENR) Rank 2023 —#362 Machining & Hydraulics Shops Among Top 400 US Contractors Construction Equipment Division Safety Awards ABC STEP, American Company -Owned Vehicles & Equipment Sugar, Cemex, CSC, Logistics & Maintenance Shops in Duke Energy, Marathon, support of Industrial Construction Mosaic, SCOAR, STSC • Ariba Area of Expertise Industrial Construction • Avetta State & Local Licenses & Registrations Over 175 • Emptoris/ Global Procurement System (GPS) Domestic & International Offices 6 • FirstVerify Regions Served Throughout the U.S.& • GEP Smart Select Foreign Markets • Highwire (Formerly ConstructSecure) • ISNetworld - s � - + • . Jaggaer Experience Modification Rate (EMR) 0.82 • Oracle/!Supplier Safety Milestone Achieved May 2023 10M Manhours with • PEC Premier No Lost Workday Injuries • PowerAdvocate Quality Certificates Texas: ASME, NBBI • Purchasing Services Company (PSC) Florida:AISC • Veriforce ONE Suriname: ISO-9001 • Workdays�,, s Joe A. Garza President & CEO 2009 Leticia C. Mond Chief Financial Officer 1994 Roger W. Crider Chief Operations Officer 1983 Jason C.Zehner Secretary & General Counsel 2011 Michael S. Owens Vice President Operations 1989 Daniel C. Gary Vice President Strategic Development 1997 Clay E. Briscoe Vice President Operations Support 1992 Buddy Myers Vice President Industrial Services 1982 Monica L. Bradley Assistant Secretary & Vice President Human Resources 2003 Revised 04/12/2024 Company Profile Fact Sheet Page 1 CCCCIAGROUP INDUSTRCONSTRUCTION Current and Completed Projects List Over $11V! (5 Years CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page I 1 C CCCIAGR OUP P INDUSTRCONSTRUCTION Current Projects List Over $1M CI[ent� Job Narhe & Qesoriptio _ ontracfi ualue "� American Soda LLC American Soda: Project Argo -WY -Increase extraction capacity of soda ash in North America at its mining site located in Green River, Wyoming 05/15/23 $51,866,666 Texas Lehigh Cement Company, LP Texas Lehigh CC Slag Grinding Plant -TX -Construct new ball mill at slag grinding plant 12/29/22 $27,598,920 American Gypsum Company American Gypsum Vertical Roller Mill -NM 06/28/22 $22,533,272 Kennecott Utah Copper RTK Tank House Seismic Retrofit -South Jordan -UT 08/15/231 $20,980,233 SLSCO LTD SLSCO RGV-02 Border Wall Electrical Package -TX -Install Electrical Package for the RGV-02 Border Wall 12/07/20 $19,300,520 Gold Bond Building Products/National Gyp Gold Bond Eloy-AZ-Construction for New Wall Board Facility 08/27/22 $12,573,130 CEMEX Inc CEMEX Bronson Civil Primary Crusher System -FL -Civil construction of crusher area, conveyors C3 to C7, transfer towers TT1 to TTS, and electrical rooms ER-1 to ER-2 01/11/23 $9,453,107 [Confidential] [Confidential] RV DAP5 MES-FL-Conversion of DAP5 plant into MicroEssentials producing plant -Structural, Mechanical, and Piping 05/22/23 $8,946,100 Wieland Wieland -Pratt Power Distribution and motor Feeders -KY -Install electrical power distribution and motor feeders at a greenfield paper mill 12/19/22 $8,869,914 Kennecott Utah Copper KUC Shotcrete Plant -UT -Construction of Mixer Systems Shotcrete Batch Plant at 4590 Portal Yard 09/02/22 $7,310,433 [Confidential] [Confidential] Starbase-TX-Civil Dirt Work 01/01/23 $7,007,200 American Sugar Refining Inc (ASR Group) American Sugar # 8 Boiler Install -LA -Civil, Structural and Piping 05/22/23 $4,539,646 Eco Services Operation LLC ECO Maintenance -TX 01/01/23 $4,401,567 Aransas County Navigation District Aransas County Rockport Harbor Breakwater Repair -TX-Demolition and repair to existing breakwater pier 02/27/23 $4,250,131 CEMEX Inc CEMEX Victorville 1004 Electrical Works -CA -Electrical Construction Fdns Works for the Facility 12/04/23 $3,736,045 [Confidential] AT -[Confidential] WO -FL 01/01/23 $2,673,869 NRG Energy AP Texas Region NRG Misc WO -TX 06/08/23 $2,404,220 Kennecott Utah Copper Kennecott 2023 Outage -South Jordan -UT -Shutdown Labor Support 03/07/23 $2,140,495 CEMEX Inc Cemex Balcones Mine Exp. Scalping Electrical -TX -Scalping Area Electrical 06/05/23 $2,116,187 Alcoa World Alumina LLC Alcoa Maintenance -TX 01/01/23 $1,925,501 Ashland, Inc. Ashland CRO Misc Separated Green -TX 01/01/23 $1,911,436 Eco Services Operation LLC ECO Misc T&M Baytown -TX 03/03/22 $1,812,796 CPS Energy CPS Misc Projects T&M/LS-TX 01/01/23 $1,787,211 [Confidential] HT -[Confidential] WO -FL 01/01/23 $1,569,680 Florida Misc Shutdown Misc Shutdown Support WO -FL -Outage Services OH -FL 01/17/23 $1,392,981 McKay Mac McKay MISC WO -FL - 01/02/23 $1,117,852 Kennecott Utah Copper Rio Tinto Redundant Effluent Line -South Jordan -UT 12/20/22 $1,083,908 North American Mining Cc Dragline-NAMWO-FL 01/01/23 $1,078,412 James Hardie Building Prod James Hardie WO -FL 01/01/23 $1,073,337 Atlas Sand Construction Atlas Sand Conveyor Sleepers -NM -Overland Conveyor Flight 4 Sleepers 10/04/23 $1,050,910 Atlas Sand Construction Atlas Sand Conveyor -NM -Overland Conveyor Crossing 10/09/23 $987,600 Covanta Pasco Inc -Spring Hill FL Covanta Pasco RFC Replacement -FL -Temporary roof removal and replacement for crane installation, new crane and festoon access platforms 12/07/23 $955,848 CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page 1 2 GCCC GROUP INDUSTRIAL CONSTRUCTION Completed Projects List Over $1M (5 Years) Crl[ent Job Name & Descrlptron ' Contracf Value '" Date Vista Sand Vista Sand West Texas Plant -TX -Procurement and construction of a 02/23/18 $215,000,000 greenfield sand plant mining and processing facility. Scope of work included site preparation, conveying systems, silo erection, mechanical equipment installation (plate press, thickener, water pumps, dryers, screens), steel erection, piping and electrical installation. Lehigh Hanson Inc -Lehigh Lehigh Mitchell K4 Pkg 200-IN-Structural, Mechanical, and Civil Work to 05/10/21 $99,514,769 Southwest Cement complete a 2.6Mmtpy Cement Production Line Buckeye Partners L P Buckeye STGT Demolition -TX -Demo Graving Dock and Misc Piling; 03/05/19 $80,791,521 Excavation AccuTrans Inc AccuTRANS Barge Fleeting Area -TX -New Steel Bulkhead, Concrete Cap, 04/29/21 $45,715,784 Fendering, Mooring Piles, and Limestone Area Paving Pin Oak Taft LLC Pin Oak Taft Terminal Project-TX-Mechanical/Civil/Structural Construction 07/20/20 $29,469,688 and Procurement JSW Steel USA 1SW Plate Mill Upgrade Phase I T&M-TX-Re-Vamp and Expansion of 10/15/18 $27,148,782 Existing Plate Mill including Civil, Structural, Mechanical CEMEX Inc Cemex Balcones Mine Expansion -TX -Site Work and Foundations for Lhoist, 12/13/21 $26,195,382 Transfer and Scalping Areas Bedeschi America Inc Bedeschi Voestalpine Byproduct Management Phase 2-TX-Bedeschi 07/12/21 $14,500,006 Voestalpine Byproduct Management Phase 2 Florida Power & Light FP&L Emergency Generators-FL-FP&L Emergency Generators 08/22/22 $12,478,569 WestRock WestRock Woodyard Optimization Project -VA -Transfer Towers, Conveyors, 06/18/18 $12,136,501 Elevated Concrete Slabs [Confidential] [Confidential] Civil Dirt Work -TX 01/01/21 $10,258,066 CEMEX Inc Cemex Immokalee Sand Plant -FL -Civil Construction, Structural Steel and 01/28/21 $10,058,272 Mechanical Installation Thyssen Mining Inc Thyssen Barrick Civil Foundations 1-NV-Civil Foundations 1-Excavation, 07/02/18 $9,161,980 Formwork, Reinforcement, Concrete and Backfilling [Confidential] [Confidential] NW BHT Phase 1-FL-Phase 1 New Foundation Installation in 01/16/19 $8,085,120 Existing Tank Farm to Support New BHT System Installation [Confidential] [Confidential] Starbase-TX-Civil Dirt Work 01/01/211 $7,815,345 US Silica US Silica Lamesa New Construction T&M-TX-Plant New Construction 07/10/18 $7,672,376 Hawks Nest Hydro LLC Hawks Nest/Brookfield Outage -WV -Substations Upgrade, Surge Tank 06/03/20 $6,877,340 Repair, Surge Basin Rehab, and Valve Inspections and Repairs [Confidential] [Confidential] Gyp Stack Reactivation Pump Station -FL 10/22/20 $6,538,527 DDH North America Inc DDH Vernon OPS Phase 1 Power Distribution -TX -Power distribution for 10/14/22 $6,137,248 data center Air Liquide Large Industries Air Liquide Minnesota Liquefier ASU/NLU-MN-Civil work, concrete work, 08/21/19 $5,966,703 electrical grounding and utilities Joy Global Joy Global 2570W Tub Replacement -ND -Assembly and Installation of New 03/15/21 $5,923,068 Dragline Tub Base, Rails, Rack and Rollers for a BE 2570W Dragline [Confidential] [Confidential] Launch Mount Foundation-TX-Civil/Concrete work 05/29/23 $5,876,383 Eco Services Operation LLC ECO Maintenance -TX 01/01/21 $5,375,229 American Zinc Recycling AZR Cell House Demo -NC -Fire Remediation 05/06/19 $5,324,947 Corp DDH North America Inc DDH Pyote Buildings #1-#4-TX-Power Distribution for Data Center 08/22/22 $5,305,466 [Confidential] [Confidential] Civil Dirt Work -TX 01/21/19 $5,277,340 New Hope Power Company New Hope Florida Crystals Boiler Outage A-B-C-FL-Boiler Outage 05/14/23 104/15/191$5,110,588 $5,217,634 Thyssen Mining Inc Thyssen Head Frame and Hoist House Steel Erection -NV CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page 13 C-� CCCIAL GRGUP INDUSTRCONSTRUCTION Client JobName 'D t C ontract M t National Gypsum Company NGC Rock Unloading and Transfer Project -FL -Mechanical, Structural, and 05/15/18 $5,002,986 Foundation Installation of New Transfer Conveyors and Equipment CR Minerals CR Minerals Zap Ball Mill Expansion Pueblo -CO 11/16/20 $4,832,594 National Gypsum Company NGC Plant Restart -NC 03/09/18 $4,656801 [Confidential] [Confidential] Green Bay RO Mechanical -FL -Installation of Structural Steel 09/01/20 $4,654,515 and Equipment Setting Reading Anthracite Company Reading 7500 Dragline Relocate -PA -Dismantle and Rebuild I Marion 09/02/22 $4,460,360 7500 Dragline CEMEX Inc CEMEX 1002A VIC Civil Works -CA -Civil Construction of Victorville Electrical 08/20/22 $4,370p943 Modernization. Civil execution of electrical rooms as well as the cable rack foundations. Titanium Metals Corporation Timet Unit C8 Floor Replacements -NV -Replacement of 3rd and 4th floors 01/01/19 $4,309,328 in unit 8 Eco Services Operation LLC ECO Maintenance -TX 01/01/19, $4,153,357 Marathon Petroleum Marathon Asphalt and Dock Repairs -OH 07/08/19 $4,022,190 Corporation Gas Technology Institute/GTI GTI STEP SCO2 IOMW Pilot Plant-TX-GTI Supercritical Carbon Dioxide Pilot 01/05/21 $4,020,604 Plant Test Facility SA INEOS Nitriles PTC INEOS Maintenance -TX 01/01/19 $3,924,552 JSW Steel USA JSW Descaler Building and Temp Bridge Table -TX -Install a new descaler 10/15/18 $3,911,409 building with equipment and install a new temp bridge table Eco Services Operation LLC ECO Maintenance -TX 01/01/22, $3,896,432 Eco Services Operation LLC ECO Maintenance -TX 01/01/201 $3,892,263 [Confidential] [Confidential] Dedicated Maintenance Year 2-FL-[Confidential] Dedicated 04/16/20 $3,847,173 Maintenance Year 2 NABS US Invoices/Lafarge Lafarge Holcim SCR Install -TX -Installation of Heat Exchanger, SCR, Ducts 10/08/21 $3,756,215 Holcim and Piping CEMEX Inc Cemex 1006 Steel Supply-TX-Cemex/Lhoist 1006 Crusher Steel Supply 07/09/21 $3,637,218 INEOS Nitriles INEOS Maintenance -TX 01/01/21 $3,634,246 Red Rock Blofuels Red Rock Biofuels BOP Electrical & Instrumentation Supply -OR -BOP 09/14/20 $3,633,763 Electrical & Instrumentation Supply Titanium Metals Corporation Timet Unit C8 Floor Replacements -NV 01/01/20 $3,619,696 [Confidential] [Confidential] Dragline Maintenance -FL 03/19/19 $3,494,540 US Silica US Silica Crane Maintenance T&WLS-TX-Plant Maintenance Work 06/18/18 $3,492,32:1 [Confidential] [Confidential] OSHA Plumbing and Facilities Maintenance WO -FL 01/01/21 $3,294,442 ABB Enterprise Software Inc ABB Baybono GIS-FL-138W GIS Substation with Control Wiring -FL 04/12/21 $3,242,795 Carbonfree Caustic SPE LLC Carbonfree Caustic Evaporation Project -TX -Civil, Structural, Mechanical, 08/15/18 $3,212,760 Equipment Setting, Pipe to Install a New Caustic Evaporation Unit I Twin Pines Minerals LLC Twin Pines Minerals 480 Dragline Relocate -GA -Rebuild 480 Dragline 07/29/19 $3,090p472 US Silica US Silica Lamesa Plant Maintenance/Repair Work T&M/LS-TX 07/10/18 $3,071,354 [Confidential] [Confidential] 852 Dragline 67 Day Outage-FL-Misc Repairs on 852 01/06/22 $3,028,447 Dragline per [Confidential] RFQ Reading Anthracite Company Reading 7400 Dragline Relocate -PA -Dismantle and Rebuild I Marion 09/02/22 $2,998,018 7400 Dragline DDH North America Inc DDH Carterville Data Center Power -TX -Power distribution for data center 10/03/22 $2,990,600 BASF Corporation North BASF Brighton -CO -Upgrade Sealant Making Systems by Replacing Some 04/23/18 $2,95(, 724 America Batch Making Capacity With New Extruder and Inline Tinting Systems [Confidential] [Confidential] GHT Foundations Riverview -FL -Installation of Foundations 04/19/18 $2,950,062 for Granulation Hold Tank CEMEX Inc Cemex Immokalee Electrical -FL -Above Grade Electrical Installation of a 08/16/21 $2,926,5101 New Sand Plant CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page 1 4 CCCCON INDUSTRI AL GRGUIP Client ` =Contract lob Name & Qescnptlan .. Date ,= Value National Gypsum Company NGC Baltimore Stucco Cooler -MD -Civil, Structural, and Mechanical to Install a New Stucco Cooler, Building, and Ancillary Mechanical Equipment 01/30/19 $2,868,342 [Confidential] [Confidential] Stretch Press Pit Foundation -TX-Civil/Concrete/Sheet Piling 03/13/23 $2,865,762 Alcoa World Alumina LLC Alcoa Maintenance -TX 01/01/22 $2,766,290 Envirofocus Technologies LLC dba Gopher Resource Gopher Zone D Concrete and Liner Replacement-FL-Zone-0 Breach Concrete and Liner Replacement 07/26/21 $2,728,968 ABB Enterprise Software Inc ABB Pronghorn STATCOM Civil -CO -Foundations for a New STATCOM Substation 05/18/20 $2,698,281 [Confidential] [Confidential] SC-04 Bartow GHT-FL-Tank Foundations, Structural Steel and Piping for Wastewater 03/23/20 $2,685,478 INEOS Nitriles INEOS Maintenance -TX 01/01/20 $2,677,534 Gold Bond Building Products/National Gyp Gold Bond Apollo Beach Stucco Cooler -FL -Install of Foundations, Structure and Cooler 08/01/21 $2,654,497 [Confidential] OSHA Non -Taxable Misc Civil WO -FL -OSHA Non Taxable Misc Civil WO 01/01/19 $2,645,495 Titanium Metals Corporation Timet Unit C8 Floor Replacements -NV 01/01/22 $2,644,365 US Silica US Silica Crane New Construction -TX -Crane Project Construction 10/22/18 $2,639,102 PCL Civil Construction Inc PCL CSX Conveyor Repairs -MD -Repair Curtis Bay Conveyor and Misc 06/13/22 $2,624,250 DCO Albany Energy LLC OCO MDL Phosphate Recovery Project -FL -Mineral Reclaim Facility and Grounding 05/14/21 $2,599,279 North American Coal Corp. NAC Falkirk 4100 Shovel Relocate -ND -Falkirk 4100 Shovel Rebuild 05/06/19 $2,585,274 Covanta Pasco Inc -Spring Hill FL Covanta Pasco Expansion-FL-EPCM Expansion of Existing Waste Burning Power Plant 12/07/21 $2,543,618 CEMEX Inc Cemex Miami Tunnel Install -FL -Install Tunnel and Test Ring 08/18/21 $2,536,371 Benetech Inc Benetech RCD Replacement Project -LA -Remove and Replace RCD Posimetric Feeders 12/19/19 $2,529,258 Ball Metal Beverage Container Corp Ball COSMO Goodyear Project -AZ -Installation of Process Equipment Skids, Tanks and Associated CPVC Piping 02/10/18 $2,519,483 [Confidential] OSHA Plumbing and Facilities Maintenance WO -FL -OSHA Plumbing and Facilities Maintenance WO 01/01/19 $2,506,049 Kennecott Utah Copper Rio Tinto Kennecott Refinery Strl and Safety.Repairs-South Jordan, UT- Refinery -Strl and Safety Repairs 06/20/22 $2,470,807 Taprogge Taprogge CICTCS Strainer Modifications -NC -Fall Outage 08/01/21 $2,432,971 Wieland Wieland - PM - House Power and Lighting -KY -Install Electrical for House Power and Lighting at a Greenfield Paper Mill 08/29/22 $2,405,926 Martin Marietta Materials - Georgia Martin Marietta Bahama Rock Tub Change Out -Bahamas -Change Out Tub on 1450 Dragline-Bahamas 02/01/19 $2,390,560 521 EPIC Crude Terminal Cc LP EPIC 84 Inch Mono -Pile -TX -Install 84" Dia by 120' Monopile W A Fender System and Precast Concrete Cap 06/28/19 $2,348,976 Eco Services Operations Corp ECO Services SPCC Tank Farm Civil Structural Project -TX -Placement of Tank Containment Foundation and Pipe Rack 07/20/20 $2,329,391 [Confidential] [Confidential] Bucket Repairs -FL 03/19/19 $2,299,191 INEOS Nitriles INEOS Maintenance -TX 01/01/22 $2,294,225 Envirofocus Technologies LLC dba Gopher Resource Gopher Resources Storm Water Basin -FL -Erect Storm Water Basin 12/23/19 $2,250,674 Industrial Project Innovation LLC IPI/Navistar Texas Assembly Plant -TX -Equipment Installation for Navistar Truck Assembly Plan 08/26/21 $2,249,044 Hitachi Energy USA Inc Hitachi Energy GPL Lookout Statcom-TX-Electrical Construction 11/01/22 $2,236,876 [Confidential] OSHA Plumbing and Facilities Maintenance WO -FL -OSHA Plumbing and Facilities Maintenance WO 01/01/20 $2,213,981 [Confidential] AT -[Confidential] WO -FL 01/01/22 $2,156,402 Argos USA Corp Argos Martinsburg Spring 2023 Outage WO -WV -Remove and install buckets with new isolation pads. Reference 0861-0822 Rev 2 02/20/23 $2,149,981 CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page 1 5 GCCCAGRGUP INDUSTRICONSTRUCTION C(ient J&b ;irfte&Des0rIptI'on CoDntract value ' Sales O'Brien Sales O'Brien-AEP Permanent Conveyor -LA -Civil, Structural, Mechanical, 08/09/18 $2,122,790 Equipment Setting, Pipe to Install New Permanent Conveyor National Gypsum Company National Gypsum FT Dodge Stucco Cooler -IA -Mill Enclosure and Stucco 09/01/19 $2,111,395 Cooler American Zinc Recycling AZR CM Mooresboro-NC-AZR Mooresboro Construction Management 05/29/19 $2,106,370 Corp Dome Technology LLC Dome Technology Concrete Project -IL -Install Concrete Tunnel, Concrete 01/25/21 $2,092,391 Ring Beam and Concrete Slab on Grade Ciner Wyoming LLC Ciner Heat Exchanger and Crystallizer Pump Replacement -WY -Unit 4 Heat 07/20/20 $2,030,963 Exchanger Replacement and Replacement of Crystallizer Recirculation Pump CIVIC Steel Texas Misc. Jobs-CMC Steel-TX-Misc. Jobs-CMC Steel Texas -Seguin 01/01/18 $2,012,604 Covanta DADE Metal Covanta Demo and Replace Roof/Siding-FL-Demo and Replace 01/17/22 $2,008,952 Recovery LLC Roof/Siding for DMR Building [Confidential] [Confidential] NW BHT Phase 2-FL-Phase 2 New Containment Installation 01/16/19 $2,001,418 in Existing Tank Farm to Support New BHT System Installation Lhoist North America Lhoist North America Marble Falls Expansion Superstructure -TX- 07/09/20 $1,998,535 Superstructure Concrete Work for New Process Equipment, as Part of a New Kiln Line Expansion [Confidential] [Confidential] LOX Tank Steel and Elevated Slab -FL 05/15/22 $1,990,509 US Silica US Silica Lamesa PM Team -TX -Provide Site Project Management Team 08/22/18 $1,976,963 N E Construction LLP NE Construction Alexa Bulkhead -TX -Install new bulkhead and retaining 10/17/19 $1,957,497 wall Alcoa World Alumina LLC Point Comfort Alcoa Maintenance -TX 01/01/19 $1,932,591 [Confidential] [Confidential] WG-1 Spillway Towers -FL -Fabricate Two Spillway Towers, 03/01/20 $1,914,680 Install Two Tower Foundation and Install Two Towers The Doe Run Company Doe Run Hammer Mill Steel Support -MO -Hammer Mill Steel Support 06/24/22 $1,897,910 Remove and Replace DDH North America Inc DDH - IWS Anderson Data Center -SC -Install electrical, civil, and fencingfor 10/24/22 $1,871,387 new modular data center. Marathon Petroleum Marathon Tampa Electric Upgrade Project -FL -Installation of structural 11/26/18 $1,839,367 Corporation supports for cable trays Peabody Energy, Inc. Peabody 2570 Dragline Rail and Rollers -IN -Repair 2570 Dragline Tub 11/01/21 $1,800,878 Rails and Rollers Replacement CEMEX Inc Cemex Knoxville Civil Work -TN 02/15/21 $1,796,872 JSW Steel USA JSW OPI Package Inspection Work for Phase II -Open package inspection of 01/03/23 $1,773,504 Owner's existing plate mill equipment Air Products LLC Air Products Barrick Air Separation Plant PSA to TSA Conversion -NV- 02/19/18 $1,755,578 Convert Air Separation Plant PSA to TSA. Install Equip, Pipe, Insulate Pipe/Vessels and Install Sieve in TSA Vessels Lhoist North America Lhoist North America Marble Falls Expansion Civil Works Package -TX- 05/12/20 $1,746,539 Excavation and Foundation Work for New Process Equipment, as Part of a New Kiln Line Expansion [Confidential] HT -[Confidential] WO -FL 01/01/22 $1,689,190 New Hope Power Company New Hope FL Crystals Power Package Boiler -FL -Package Boiler at Florida 08/17/23 $1,687,477 Crystals Southwest Research SWRI Project Work-TX-SWRI Misc Project Work -TX 01/01/21 $1,684,994 Institute Kennecott Utah Copper Rio Tinto Kennecott Jacket Cooling Water -South Jordan, UT 06/06/22 $1,683,746 Kennecott Utah Copper Rio Tinto Kennecott Smelter- Dust Process Improvement -South Jordan, UT- 01/11/21 $1,675,948 -Dust Process Improvement American Zinc Recycling AZR Rockwood Outage -TN -Outage planning and management for AZR 02/07/19 $1,669,2951 Corp Rockwood CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page 1 6 GCCCON INDUSTRIAGRGUIP Client Joki Name& I)escrlptSah Gontracf ` x Value Date =x- Reynolds Metals Company Alcoa Lake Charles Shiploader Hurricane Repair -LA 09/10/20 $1,669,222 LLC Kennecott Utah Copper RTKC Smelter Shutdown -UT -Smelter Shutdown Electrical 01/23/23 $1,666,289 [Confidential] Dragline [Confidential] Third Rail Replacement -FL -Replace Third Rail 01/17/23 $1,646,209 Preferred Sands Of Preferred Sands -Maintenance -TX -Plant Maintenance/Repair Work 07/23/18 $1,592,698 Monahans LLC Alcoa World Alumina LLC Alcoa Maintenance -TX 01/01/21 $1,590,638 Florida Misc Work Orders JS-Misc Non Tax WO-FL-JS-Misc Non Tax WO 01/01/21. $1,567,273 North American CoalSabine Sabine RRR-TX-Rack, Rail, Roller Install 03/11/19 $1,565,934 A&P Trucking Heavy Hauling Black Hawk Coal BI-495 Shovel Relocate -WV -Relocate BE-495 Shovel -WV 06/12/23 $1,550,254 and Rigging Inc [Confidential] [Confidential] DAP 5 MES Conversion RV -FL -Installing Micro piles and 04/24/23 $1,549,579 multiple foundations WestRock West Rock Caustic Area Steel Replacement -SC -Caustic Area Steel 07/31/23 $1,517,972 Replacement Albemarle Corporation Albemarle Vespa Flash Dryer Replacement -TX -Demolition and 09/30/19 $1,458,906 Replacement of the 14th and 15th Street Vespa Flash Dryer Systems Twin Pines Minerals LLC Twin Pines Minerals Ohio 480 Dismantle -OH -Dismantle Ohio Dragline 07/23/19 $1,453,117 Citgo Refining & Chemicals Citgo Capital Projects -TX 01/01/19 $1,445,766 Cc LP Metso Outotec USA Inc Metso CSX Rail Car Dumper -MD -Electrical Demo and Installation for New 06/01/21 $1,439,866 Tandem Rail Car Dumper WestRock WestRock Truck Dump and Scales -VA -Excavations, Formwork, 06/03/19 $1,413,863 Rebar/Embeds and Concrete Placement DDH North America Inc DDH Ringo Data Center Power Big Lake-TX-GDA Ringo Building #1(and #2 10/03/22 $1,380,174 expected later as EW/CO). Power Distribution for Data Center. Voestalpine Texas ArcelorMittal Site Improvements -TX -Installation of owner supplied valves 10/06/22 $1,380,043 [Confidential] [Confidential] 0-1b Spillway -FL -Installation of concrete foundations & 12/19/22 $1,372,566 installation of structure steel and piping [Confidential] [Confidential] Insulation OSHA -FL 01/01/191 $1,371,928 [Confidential] [Confidential] GSE Concrete Foundations Phase 1-FL-Methane Farm and 05/31/22 $1,366,040 LOX Farm Timet Henderson Timet Unit 9 Wall and Floor Rehab -NV -Primary Furnace Repair Platform 09/26/18 $1,356,077 Black Mountain Sand Black Mountain Sand Tripper Conveyors -TX -Repair Tripper Conveyors at 04/05/21 $1,334,990 Black Mountain Sand Plant Talen Energy/Barney Davis Barney Davis Talen Energy East Wall Replacement -TX -Replace the Existing 02/03/20 $1,327,004 LLC Concrete East Wall at the Existing Spillway Corpus Christi Misc Jobs Corpus Misc Jobs -TX 01/01/19 $1,319,967 [Confidential] [Confidential] Wingate Concentrate Stacker -FL -Installation of Foundations, 02/04/19 $1,304,212 Erection of Stacker and Demo of Existing Stacker -FL Flint Hills Resources, LP FHR-Non-OCIP Projects CC-TX-FHR Non-OCIP Projects Corpus Christi, TX 01/01/20 $1,284.663 North American Mining Co Dragline-NAM WO -FL 01/01/22 $1,267,604 James Hardie Building James Hardie WO -FL 01/01/21 $1,255,857 Products [Confidential] [Confidential] Insulation OSHA -FL -[Confidential] Insulation OSHA -FL 01/01/201 $1,241,980 Citgo Refining & Chemicals Citgo Corpus Misc-TX 01/01/18 $1,222,981 Cc LP Citgo Refining & Chemicals Citgo Corpus Misc- 01/01/20 $1,181,742 Cc LP TX Joy Global Joy Global/KMC Mesa Support -AZ 03/01/19 $1,173,055 [Confidential] Phosphate OSHA WO -FL 01/01/18 $1,171,991 CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page 17 =� CCCAGRGUP INDUSTRICONSTRUCTION s Client �: Job�Name & 4escriRtioM �`0t7tCaGt y . Value Dade � , � Kennecott Utah Copper Rio Tinto Kennecott Blister Tapper 2-UT-Install Blister Tapper 2 and 3 with 10/18/21 $1,171,834 New Supports and Pipe [Confidential] [Confidential] Transport Ringwall Phonebooth Weldment-TX 06/03/23 $1,161,962 CLECO Cajun LLC CLECO Cajun Conveyor Modifications -LA -Remove and Reinstall Chutes and 11/07/19 $1,160,858 Hoppers -LA [Confidential] [Confidential] LOX Tank Farm Foundation Walls -FL 07/18/22 $1,158,219 Alcoa World Alumina LLC Alcoa Maintenance -TX - 01/01/20 $1,137,289 [Confidential] [Confidential] Dragline 16 Outage -FL 04/03/23 $1,134,884 Plycem USA LLC Elementia/PlyCem-Allura - Grinding Mill Station -NC -Install Structure, 11/01/21 $1,129,889 Conveyors, Equipment and Rotary Mill -NC Preferred Sands Of Preferred Sands Plant Construction -TX -Plant Construction -TX 11/12/18 $1,120,966 Monahans LLC [Confidential] [Confidential] Thermal Screening MSHA-FL-Installation of Concrete 04/20/21 $1,114,163 Foundation and Structural Steel -FL James Hardie Building James Hardie Prattville WO-AL-Misc Work Orders 02/14/23 $1,107,623 Products Westmoreland Resources Westmoreland Sarpy Creek Propel and Swing Repair -MT -Install New Propel 10/15/18 $1,101,516 Inc Girder and Refurbish Swings Axis Pipeline Construction AXIS PCG Marine Assistance -TX -Assist w/ Crane Barge and Push Boat 10/01/21 $1,087,550 Group Kennecott Utah Copper Rio Tinto Kennecott SPG Mechanical -UT -Install Shock Pulse Generators at 11/30/21 $1,066,983 RTK Smelter Hot Metals Building Ashland, Inc. Ashland Misc. Projects -TX 01/01/18 $1,064,446 James Hardie Building James Hardie Prattville WO-AL-Misc Work Orders 02/14/22 $1,049,792 Products JSW Steel USA JSW 20210perations Support -TX -Miscellaneous Projects Throughout the 02/24/21 $1,048,442 Plate Mill for Maintenance and Operational Needs Benetech Inc Benetech C5 and Plow Shelf Replacement -LA -Remove and Replace C5 03/23/20 $1,015,312 Conveyor and Rotary Plow Shelf Liner NRG Energy AP Texas Region NRG Misc WO-TX-Misc Conveyor Repairs 06/08/22 $1,008,163 CEMEX Inc Cemex Misc Projects T&M NC-T&M/LS RR 03/31/22 $1,005,379 Corpus Christi Misc Marine CRO Misc Marine No Color -TX 01/01/22 $1,001,199 Jobs CEMEX Inc Cemex 1005 Foundations-TX-Cemex/Lhoist 1005 Foundations 07/09/21 $991,704 [Confidential] [Confidential] NW Rail Substructure Replacement -FL -Replace 40001f of 01/10/22 $991,598 Ballast, Saoil, and Filter Fabric for Tracks 34 to 37 at the [Confidential] Facility. [Confidential] is to Supply all Material and the Removal and Installation of the Tracks. CEMEX Inc Cemex Knoxville Civil Work -TN 06/01/20 $984,763 Titanium Metals Corporation Timet Unit C8 Floor Replacements -NV 01/01/21 $983,182 Citgo Refining & Chemicals Citgo Corpus-TX-Citgo Corpus -TX 01/01/21 $975,144 Co LP Timet Henderson Timet Melt Shop Cooling System -Phase 1-NV 11/09/20 $959,126 Inmetco InmetcoOutage Planning Support-PA-Planningand scheduling for 02/17/20 $951,483 upcoming outage CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 01/29/2024 Current and Completed Projects List I Over $1M (5 Years) I Page 1 8 GCCCIAGRGUP INDUSTRCONSTRUCTION Types of Work Performed We excel in a variety of CONSTRUCTION CAPABILITIES: • Civil • Millwright Work • Concrete • Paving • Electrical & Instrumentation • Piping • Fabrication & Machining Rigging • Hydraulic Installation & Repair Structural Steel Erection • Marine Construction & Pile Driving Welding • Mechanical which allows us to offer SPECIALIZED SERVICES & EXPERIENCE: • Construction Management • Marine Construction • Dismantling • Mining Equipment Erection • Engineer, Procure, Construct (EPC) • Plant Expansions • Engineer, Procure, Construct, Manage • Process Upgrades (EPCM) • Site Development Services • Equipment Relocation • Specialized Equipment Installation • Maintenance • Turnarounds/Shutdowns to these and other MARKETS: • Aggregate • Manufacturing • Aluminum • Mining Machinery • Cement • Oil & Gas • Chemicals • Power • Coal • Shop Fabrication • Fertilizer • Transportation / Marine • Lime • Wood, Pulp & Paper Labor Skills • Boilermakers • Mechanics • Carpenters • Millwrights • Cement Finishers • Operators • Electricians . Painters • Instrument Fitters & Techs • Pipefitters • Ironworkers • Riggers • Laborers • Welders • Machinists Types of Work Subcontracted • Coating Applications • Metal Building Erection • Cross Country Pipelines • Refractory • Fencing • Roofing & Siding • Finished Carpentry • Slip Form Silos • HVAC/ Insulation • Sprinkler & Fire Protection Systems • Masonry • Sanitary Piping Revised 04/12/2024 Company Profile I Types of Work Performed I Page I 1 C-� CCCIAGRGUP INDUSTRCONSTRUCTION Company Owned Equipment & Vehicle List CRANES. Qty. Descriotion 1 Manitowoc 888-230 ton 2 Link Belt 248-200 ton 1 Link Belt 518-150 ton 1 Link Belt TCC750-75 ton 1 Link Belt TCC1100-110 ton 1 Link Belt 298-250 ton 1 Link Belt 348-300 ton 2 Link Belt RTC8080-80 ton 1 Grove RT765-65 ton 1 Link Belt RTC8065-65 ton 5 Link Belt RTC8050-50 ton 1 Link Belt RTC8030-30 ton 1 Link Belt TCC120-120 Ton CARRYDECKS Qsy, Descriotion 1 Broderson IC200-15 ton 1 Broderson IC35-4 ton FORKLIFTS QtL Descriotion 4 4-6K Forklifts 5 8-11K Industrial Forklifts 2 30-34K Yard Forklifts 7 8-10K Telescoping RT 4wd Forklifts 4 Electric Warehouse Forklifts- < 5K COMPACTORS Qtv. Descriotion 0 Remote Padfoots WHEEL LOADERS = Descriotion 0 Cat 988E Wheel Loader SKID STEER LOADERS QtK Descriotion 3 Skid Steer Loaders SACKHOES & EXCAVATORS Qty.- Description 0 Cat 420 Backhoe 1 Cat 308 Mini Excavator 1 Case CX80E Mini Excavator 1 Cat 305 Mini Excavator OFFICE TRAILERS & VANS QtY Descriotion 44 Storage Van (48' - 53) 87 Shipping Container (20'- 401) AIR COMPRESSORS Qtl Descriotion 3 Electrics - 750CFM 7 Electrics - 500CFM 1 Diesels - 375CFM 6 Diesels - 185-210CFM WELDING MACHINES Qtv. Descriotion 68 250-400 Amp Diesels 8 500 Amp Diesels 4 4-pack Welding Skids 0 8-pack Welding Skids MARINE,& PILE DRIVING EQPT Qty- Descriotion 1 Delmag Diesel Drive Hammer - D46-32 1 Delmag Diesel Drive Hammer - D30-23 1 Delmag Diesel Drive Hammer - D12-32 0 Ape Vibro 150 Vibratory Driver/Extractor 1 Mkt HP185 Power Pack 0 Ape Vibro 150 Power Pack 3 Twin Screw Tugboats 2 120 x 55 Spud Crane Barges 3 Work Boats 1 Pontoon Boat and Trailer 3 Jon Boats VEHICLES Qty Descriotion 8 SUVs 170 Pickups, 1/2 ton thru 1 ton 3 Flatbed Trucks-1-2 ton 0 Truck Tractors 1 Service Trucks 4 Passenger Vans/Buses 5 Capacity Yard Trucks (Yard Mule) TRAILERS Qtx. Descriotion 1 55-ton Lowboy w/Booster Axle 1 Lowboys (Equipment Hauler) 7 Stepdecks (48'-53') 1 Floats (40'-48') 1 Wabash Weld Test Trailer (53') 14 Goosenecks, Flatbed (18'-27') 33 Goosenecks, Enclosed (20'- 36') 6 Utility Enclosed (8'-20') 43 Utility Trailers(8'-22') MISCELLANEOUS, Qty Descriotion 2 JLG Articulated Manlifts (Diesel) 45'-60' 1 Genie Articulated Manlift 80' 1 Genie Articulated Manlift 34' 1 Towable Boomlift 335' 14 Industrial Golf Carts-2 & 4 Passenger 26 Industrial Diesel ORVs-2 & 4 Passenger Revised 02/17/2024 CED I Company Owned Equipment & Vehicles List I Page 1 1 GCCC�AGRGU�P INDUSTR Project References - Marine Company: Buckeye Partners, LP Project Name: Buckeye STGT Location: Ingleside, TX Contract Value: j $81M Project Description: South Texas Gateway Terminal (STGT) demolition project, including demolition of graving dock and associated piling and excavation. Scope of work included construction of new cofferdam; demolition of 25 ft by 850 ft by 40 ft deep graving dock; installation of a 50 well dewatering system; and removal of approximately 1,000,000 cy of dirt, 7,000 cy of concrete, 4,500 If of sheet pile bulkhead with anchor wall, 2,000 miscellaneous steel and concrete piles ranging from 16 in to 48 in by 40 ft to 90 ft long. Contact Name: Chris Mills Email & Phone: CMills@buckeye.com 832-835-8049 Company: AccuTrans, Inc. Project Name: Barge Fleeting Area Location: Corpus Christi, TX Contract Value: $46M Project Description: Barge Fleeting Area project including demolition and construction of new steel bulkhead, concrete cap, fendering, mooring piles and limestone area paving. Scope of work included drive 2,000 LF of ZZ38 bulkhead sheet pile x 65' to 75' long; drive 750 LF of ZZ26 anchor sheet pile wall x 38' long; drive 300 LF of PAZ60/ZZ38 combiwall piling x 80' to 100' long; drive (29) 42" dia. x 100' long mooring pipe pile; drive (270) 24" to30" dia. x 80' to 110' long battered and plumb anchor piles; fabricate and weld 135 A -frame pile caps; fabricate and install 2,720 LF of water; install (216) j #18 and #20 tie rods x 50' to 120' long; place and compact 2,500 tons of limestone base; dredge and dispose of 92,000 CY of spoils; install (87) 20" OD cylindrical fenders x 8.2' long; and fabricate/weld (29) 42" dia. monopile tops with mooring bits. Contact Name: Ramiro Munoz Email & Phone: Ram@munozengrg.com 361-946-4848 Company: % Marathon Petroleum Company Project Name: Tampa Seawall Repair Location: Tampa, Florida Contract Value: ! $8.4M Project Description: Installation of sheetpilingto repair exiting seawall damaged during hurricane -FL Contact Name: Brent R. Foos, Marketing & Transportation Engineering Email & Phone: ; brfoos@marathonpetroleum.com 419-421-4146 CONFIDENTIAL DO NOT DISTRIBUTE OUTSIDE OF ADDRESSEE'S COMPANY CONFIDENTIAL Revised 09/26/2023 Project References I Marine I Page I 1 GCCC ON INDUSTRIAGRGU�P Marine Overview CCC Group has been providing various industries in the Gulf Coast Region, a wide range of superior marine construction services since the early 1960's. Focusing on serving our clients to the best of our ability, we have strategically located, permanent operations in Texas and Florida. These offices facilitate providing marine construction services along the entire Gulf Coast of the U.S. CCC Group's Marine Services utilize a variety of specialized equipment including push boats, both impact and vibratory pile hammers, in addition to work -barges and spud -barges capable of carrying 250-ton cranes. With over 55 years of working in marine construction, CCC Group has accumulated a vast amount of experience in many facets of this specialty work. f TYPICAL SCOPES OF WORK ■ Marine facilities • Dock facilities and breasting structures • Bulkheads ■ Wharves ■ Offshore fabrication • Riprap.and erosion control • Renovation services ■ Repair services • H-piles ■ Pipe piles ■ Monopiles ■ Sheet piling ■ Timber piling • Concrete piling cccgroupinc.com CCC GROUP INDUSTRIAL CONSTRUCTION Project Name: Miscellaneous Port Projects Location: Port of Corpus Christi, TX and Surrounding Area Client/Owners: AccuTrans, ADM, Buckeye, CITGO, EPIC, Flint Hills Resources, Kiewit, MODA, Signet Maritime, Valero, etc. Duration: Varies Approx. Contract: Varies Project Descriptions: • Breasting Panel Repairs and Installation • Breasting Structure Repairs and Installation • Fender Repairs and Installation • Mooring Dolphin Repairs and Installation • Pile Driving • Pile Removal • Underwater Repairs • Mooring Hook Maintenance, Repairs and Installation • Gangway Maintenance, Repairs and Installation • Loading Arm Removal, Repairs and Installation • Emergency Fender Installation and Rental following Allision Damage cccgroupinc.com C-� CCCIAGRGUP INDUSTRCONSTRUCTION Project Name: AccuTrans Barge Fleeting Area Location: Corpus Christi, TX Client/Owner: AccuTrans Inc. Duration: 24 Months Approx. Contract: $46M Project Description: Marine construction of Barge Fleeting Area project including demolition and construction of new steel bulkhead, concrete cap, fendering, mooring piles and limestone area paving. Scope of Work: • Drive 2,000 LF of ZZ38 bulkhead sheet pile x 65' to 75' long • Drive 750 LF of ZZ26 anchor sheet pile wall x 38' long • Drive 300 LF of PAZ60/ZZ38 combiwall piling x 80' to 100' long • Drive (29) 42" dia. x 100' long mooring pipe pile • Drive (270) 24" to 30" dia. x 80' to 110' long battered and plumb anchor piles • Fabricate and weld 135 A -frame pile caps • Fabricate and install 2,720 LF of waler • Install (216) #18 and #20 tie rods x 50' to 120' long • Place and compact 2,500 tons of limestone base • Dredge and dispose of 92,000 CY of spoils • Install (87) 20" OD cylindrical fenders x 8.2' long • Fabricate and weld (29) 42" dia. monopile tops with mooring bits cccgroupinc.com GCCC�AGROUP INDUSTR Project Name: Buckeye South Texas Gateway Terminal Demolition Location: Ingleside, TX Client/Owner: Buckeye Partners, LP Duration: 24 Months Approx. Contract: $81M Project Description: Demolition of a graving dock previously used to construct offshore platforms in a dry atmosphere 30 feet below sea level. Scope of Work: • Demolition of graving dock and associated piling and excavation • Construction of a new cofferdam • Included: Dewater the graving dock, included 82 each 36-in pipe and AZ38 sheet pile sections up to 120' long, 34 each 2-1/2" tie rods, 32,300 tons of clean crushed limestone and a deep well dewatering system. • Demolition of 250' x 850' x 40' deep graving dock ■ Included: Extraction of 106 each 42" pipe and 42 each AZ38 sheet piles driven as deep at EL -110 ft, 842 each 16" x 55' concrete piles, 503 each 24" x 65' pipe piles and 30,000 cy of heavily reinforced concrete • General site activities ■ Installation of a 50 well dewatering system ■ Removal of around 1,000,000 cy of dirt and another 7,000 cy of concrete; 4,500 If of sheet pile bulkhead with anchor wall; 2,000 each misc. steel and concrete piles ranging from 16" to 48" x 40' to 90' long. Challenges: Water infiltration occurred due to soil liquefaction resulting -from large vibratory hammers used to extract the piling. Solutions: CCC Group worked with the client and the engineering team to install additional improvements including further strengthening the cofferdam. cccgroupinc.com C-� CCCiAL GRGUP INDUSTRCONSTRUCTION Additional Project Photos Buckeye South Texas Gateway Terminal Demolition (Picture taken at onset of project in March 2019. ) cccgroupinc.com CCCONINDUSTR�AG ROUCONSTR�P Project Name: Light Medium Speed Roll-on Roll -off (LMSR) Layberth Dock Location: Corpus Christi, TX Client/Owner: City of Corpus Christi Duration: 4 Months Approx. Contract: $4.1M Project Description: CCC was responsible for this EPC fast -track construction of a new berthing facility for U.S. Navy ships. Since the Port of Corpus Christi is a "strategic military deployment seaport," the U.S. Navy designated this layberth facility for the U.S. Navy Ship Benavidez. It is one of several pre -positioned ships that are constantly maintained, equipped and kept at the highest state of readiness for rapid response deployment. Scope of Work: • Concrete pile supported dock facility • Three concrete pile breasting dolphins • Two concrete pile supported mooring dolphins • Roadway Drainage • Perimeter fencing/security • Lighting • Ship electrical hook up support cccgroupinc.com GCCCON INDUSTR� AL GRGU�P Additional Project Photos: City of Corpus Christi - LMSR Layberth Dock cccgroupinc.com CCCC�AGRGU�P INDUSTR Project Name: Seawall Reconstruction Location: Corpus Christi, TX Client/Owner: City of Corpus Christi Duration: 3 Years Approx. Contract: $32M Project Description: This project entailed rebuilding approximately 8,000 ft of seawall that protects downtown Corpus Christi from storm surges. Scope of Work: • Drove—13,270 LF of AZ-18 sheet pile • Placed 8,500 CYD of concrete • Specific elements of the project included ■ Construction of handicapped access ramps • Hydrostatic relief systems ■ New boat ramp ■ New storm water outfall structure ■ Beach replenishment ■ Asphalt paving Each phase of the project was completed ahead of schedule. cccgroupinc.com CCCC GRGVP INDUSTRIAL CONSTRUCTION Additional Project Photos: City of Corpus Christ - Seawall Reconstruction cccgroupinc.com G CCC IAGRCGUIP INDUSTR Personnel - Executive Team Joe A. Garza, President & Chief Executive Officer With a B.S. degree from Texas A&M University and a Juris Doctor degree in law from St. Mary's University School of Law, Joe began his construction career in 2009 when he joined CCC Group as General Counsel and Secretary. In that capacity, he provided legal and strategic advice in the pursuit and execution all projects as well as managed the Legal / Contracts and Risk Management departments. Since 2018, Joe has been serving as President and CEO of the company with responsibilities that include leadership and oversight of the entire CCC Group organization. Roger W. Crider, Chief Operations Officer With an Associates of Arts degree in Business Management from Blinn College and as a graduate of Marine Military Academy College Preparatory, Roger began his construction career in 1983 when he joined CCC Group. Roger has served the company in a variety of roles in multiple construction markets across the U.S. and internationally. Roger currently serves as Chief Operations Officer with responsibilities that include oversight and direction over all CCC Group operations. Leticia C. Mond, Chief Financial Officer / Vice President of Admin. Leticia is a graduate of the University of Texas San Antonio and a Certified Public Accountant. She began her construction career in 1992 and brought with her many years of invaluable experience when she joined CCC Group in 2021 where she currently serves as Chief Financial Officer and Vice President of Admin. Her primary responsibilities include providing direction and leadership for the financial operations. She is responsible for managing the Accounting, Human Resources, Information Technology and Facilities departments. Michael Owens, Vice President Operations With a Bachelors degree in Construction Science from Texas A&M University, Michael began his construction career in 1990 and join CCC Group in 1996. Over his 3-decade long career in construction, Michael has earned a specialty expertise in the management of structural marine construction projects. He has additionally gained diverse experience managing industrial construction projects in a wide range of industries, including petroleum, chemicals, aggregates, cement, coal, fertilizer, metals, general building, power, shop fabrication and transportation. Michael formerly served as Director Gulf Coast Operations and 17 years as Operational Executive of the Corpus Christi Regional office. Clay E. Brisco, Vice President Operations Support With a Bachelor of Science degree from San Angelo State University and various leadership development courses including Strategic Thinking and Management from the Wharton School, Executive Leadership and Strategies from the University of Texas, and Creative Leadership from Duke University, Clay is serving as Vice President of Operations Support for CCC Group since 2022. His construction career began in 1992 and he formerly held Vice President roles for national EPC and fabrication companies. He he has an extensive background in construction, procurement, estimating, project controls, quality and safety in the oil and gas, fabrication, power generation and maintenance services sectors. Revised 04/26/2024 Key Personnel I Executive Team I Page I 1 C CCC IAGRGUIP INDUSTR Buddy Myers, Vice President Industrial Services Buddy's construction career began in 1982 and with his industrial construction specialty, hejoined CCC Group in 2023 to lead the efforts with the National Electrical Business Unit. He has since been promoted to Vice President Industrial Services to expand his role in providing oversight and leadership to our Electrical Business Unit, the Construction Equipment Division as well as the Fabrication, Machining and Hydraulics Business Unit. Daniel C. Gary, Vice President Business Development and Marketing With a Bachelor of Science Construction Management degree from Purdue University and participation in the Project Management Excellence Program at Northeastern University, Daniel additionally holds a Project Management Professional (PMP) certification. His construction experience began in 1997 and started with CCC Group in 2012. Daniel's responsibilities include leadership and management of the business development and marketing teams, promoting a common approach and sound strategies to support the growth vision for CCC Group. Monica L. Bradley, Vice President Human Resources and Assistant Secretary With a Bachelor of Arts degreen in Speech Communications from San Houston State University and a Juris Doctorate Law degree from South Texas College of Law, Monica remains an active licensed attorney in good standing with the State Bar of Texas and is an experienced senior HR leader and employment attorney. Monica's construction experience began in 2003 and started with CCC Group in 2023. Her background includes working in various industries including power, energy, gas, manufacturing, engineering and construction and brings valuable perspective to focus on further building our HR resources. Jason C. Zehner, General Counsel / Secretary With a Bachelor of Arts degree from the University of Texas at Austin in 1994, a Juris Doctor degree from St. Mary's University School of Law in 2000 and a Board Certification in Commercial Real Estate Law in 2009, Jason currently serves as General Counsel, Corporate Secretary, Chairman of the Company's Ethics Committee and Board Nominations Committee, and member of the ESOP Administration Committee. Jason began his CCC Group career in 2011 and his primary responsibilities include advising and representing the company and its affiliates on all legal matters affecting CCC Group and its affiliates, with emphasis on construction contract negotiations, banking transactions, employment claims, field contract training, dispute resolution, real estate transactions and the negotiation, drafting and closing of corporate and business transactions. He oversees the Company's outside law firms and litigation in all jurisdictions in which the Company operatesas well as oversees the Company's contracts and licensing departments. Revised 04/26/2024 Key Personnel I Executive Team I Page 12 C-� CCC GROUINDUSTRIAL P Douglas J. House Operation Executive -- Conous Christi Certifications & Licenses I Career Overview MSHA Douglas has 32 years of construction experience, the last year functioning as OSHA 10 operational executive of the Corpus Christi Regional Office. Prior to his current role, Douglas functioned as an operations manager. Education &Training Select Project Experience B.S. Agricultural Development - Texas A & M University Operational Executive - Corpus Christi Regional Office Executive Program - Our Lady of Operational executive responsible for providing overall management direction for all the Lake University business unit functions; day-to-day administration; and profit/loss of business unit. Leadership Series Establishes business unit objectives; guides business development program; Primavera Project Planner manages placement and oversight of key field positions; and high-level oversight of project executions and operations functions. TEEX Excavation Safety Course Job Cost Specialist Training Prior to Joining CCC Group Levels 1 II III & IV Contracts Training Zachry Industrial, Inc. - San Antonio, TX QTRAX -Earned Value Quantity Operations manager responsible for relationships with third -party equipment Tracking System vendors, Zachry fleet operations, onsite asset management and executive teams to ensure timely flow of effective construction equipment to and from the site as well Microsoft Project OJT as the process of keeping them maintained and operational. Additionally Class A CDL with Doubles & responsible for forecasting needs for new projects using historical data and Triples, Tanker, HAZMAT workforce curves, and planning demobilization of assets whether from third party vendors, or company owned. Areas of Expertise Zachry Industrial, Inc. - San Antonio, TX Authorized Representative Operations support manager responsible for building and managing a team of craft Contract Administration specialists who are top in their discipline to support issues at the project level for a Environmental, Health & Safety portfolio of Industrial EPC projects. These craft specialists were dispatched from the Field Crew Management corporate office to address project and craft specific technical issues with owners Materials & Equipment Mgmt. and engineers as well as operational issues. Responsible for building a team of Planning &Scheduling turnover professionals to improve managing turnover for capital projects, ensuring the project was documented along the way; placement of over 130 Project Preconstruction Managers, Craft Superintendents and General Field Superintendents on projects as Procurement well as where they are to be assigned next; and executed leadership promotions Project Close -Out & Commission when applicable and supports Operations in many special initiatives. Project Controls TXI Cement - New Braunfels, TX Project Coordination Project executive for responsible for leading EPC project managers in building a new Quality Assurance/Quality Control cement plant complete with roller mill, preheater tower, kiln, ball mill, storage and Risk Management loadout facilities. Project Industry Experience Capitol Aggregates, LTD - San Antonio, TX Project manager and owner representative for capital construction as part of the Aggregates operations expansion plan. Worked on 5M+ tpy limestone rock crushing facility at Cement the Marble Falls Quarry, including a primary crushing plant; secondary fractionated Chemicals crushing plant; rail load out system with a re -rinse screen; and a 100-car rail load General Building out loop track. Subcontracted portion of project included a new 2100 sqft office Lime building and scale house and a new 7900 sqft shop/mechanics office building and Mining Machinery shop facility. Additionally responsible for disassembling, repairing and relocating a 600 tpd sand and gravel plant in Austin, Texas to a new mine nearby. The new location involved additional incorporation of a new 600 hp 12x12 marlin class dredge and dewatering wheel. Revised 03/19/2024 Personal Profile I Douglas J. House I Page I 1 C-� CCCIAGROUP INDUSTR Douglas J. House Continued Zachry Industrial, Inc. - San Antonio, TX Division controls manager responsible for leading division projects in controls processes including scheduling, cost earned value and document controls. He placed controls personnel on projects where they excelled; planned for careers and successorship with controls employees and analyzed monthly project reports and for reporting to Division Management; wrote controls process procedures for enhanced system performance on the projects and represented the Division in corporate functions; and responsible for leading and participating in proposal efforts. BASF - Port Arthur, TX Senior project controls manager for EPC integrated schedules and systems to provide mass information on projects. Led a team of 12 cost, schedule, earned value and document control professionals; participated in front-end constructability efforts; and developed contractual unit rates for use with the ZIPS system. Developed an EPC integrated schedule and set-up integrated systems to provide mass information on the project. He interviewed and hired qualified candidates for a controls team and trained new employees in control systems. Zachry Industrial, Inc. - San Antonio, TX - Additional Roles • Project Controls Manager • Cost/ Schedule Control Engineer • Piping Superintendent Assistant Revised 03/19/2024 Personal Profile I Doug J. House I Page 1 2 GCCCIAGRGUIP INDUSTR Jason M. West Group Manager Certifications & Licenses Career Overview Professional Engineer License Jason has 21 years of construction experience, currently functioning as group ACI Concrete Construction Special manager for marine and structural work while also serving as project manager. Inspector License Prior to his current role, Jason functioned solely as project manager. Education & Training Select Project Experience B.S. Civil Engineering - Texas I Aerospace Client - Brownsville, TX A&M University Project manager for new launch mount foundation and area paving. Scope of work WinEst Estimating Software included excavation and shoring; demolition of 24 each 24-in drilled piers; tying 700 Primavera P6 Professional Project tons of rebar; placement of 5,952 cy of concrete cap and area paving and 216 cy of Management Software Fondag concrete; and monitoring and protection of mass concrete pours. Work Prolog Construction Project performed on 24/7 schedule and within 9 weeks. Management Software AccuTRANS - Corpus Christi, TX Engineering Software: Project manager for barge fleeting area project including demolition, construction of AutoCAD, Rise 31), CWALSHT, L- new steel bulkhead, fendering, mooring piles and limestone area paving. Scope of Pile, SAP 2000 work included drive 2,000 If of ZZ38 bulkhead sheet pile x 65 ft to 75 ft long; drive 3D Lift Plan 750 If of ZZ26 anchor sheet pile wall x 38 ft long; drive 300 If of PAZ60/ZZ38 combiwall piling x 80 ft to 100 ft long; drive (29) 42 in dia. x 100 ft long mooring Areas of Expertise pipe pile; drive (270) 24 in to 30 in dia. x 80 ft to 110 ft long battered and plumb anchor piles; fabricate and weld 135 A -frame pile caps; fabricate and install 2,720 If Authorized Representative of waler; install (216) #18 and #20 tie rods x 50 ft to 120 ft long; place and Contract Administration compact 2,500 tons of limestone base; dredge and dispose of 92,000 cy of spoils; Environmental, Health & Safety install (87) 20 in OD cylindrical fenders x 8.2 ft long; and fabricate and weld (29) 42 Field Crew Management in dia. monopile tops with mooring bits. Materials & Equipment Mgmt. Buckeye Partners, LP - Ingleside, TX Planning & Scheduling Project manager for South Texas Gateway Terminal (STGT) demolition project, Preconstruction including demolition of graving dock and associated piling and excavation. Scope of Procurement work included construction of new cofferdam; demolition of 25 ft by 850 ft by 40 ft Project Close -Out & Commission deep graving dock; installation of a 50 well dewatering system; and removal of Project Controls approximately 1,000,000 cy of dirt, 7,000 cy of concrete, 4,500 If of sheet pile Project Coordination bulkhead with anchor wall, 2,000 miscellaneous steel and concrete piles ranging from 16 in to 48 in by 40 ft to 90 ft long. Quality Assurance/Quality Control Risk Management Flint Hills Resources - Corpus Christi, TX Project manager for various projects. Project Industry Experience Marathon Petroleum Corporation -Tampa, FL Aggregates Project manager for emergency installation of sheet piling to repair existing seawall Aluminum damaged during recent hurricane. Scope of work include the construction of 780 If Cement of anchored sheet pile bulkhead, including 70 ft long sheet pile, 320 If of temporary Chemicals shoring, 650 cy of concrete pile cap and 7,800 tons of limestone paving. Coal Chemtex International, Inc./M&G Chemical - Corpus Christi, TX Fertilizer Project manager for construction of the mechanical dredging operations for intake General Building and outfall structures including 14,500 cy of virgin soil to a final EL-15 ft. Metals Mining Machinery Chemtex International, Inc./M&G Chemical - Corpus Christi, TX Oil & Gas Project manager for the demolition of existing sheet piles and installation of new jumbo sheet pile walls and steel bulkheads at the intake and outfall structures Power including installation of 717 ft of 70 ft long sheet pile, 20 in x 80 ft anchor pipe Transportation piles, HP14 waler and a bent plate cap. Revised 10/06/2023 Personal Profile I Jason M. West i Page 1 1 C-� CCCIAGROUP INDUSTR Jason M. West Continued voestalpine Texas LLC - Gregory, TX Project manager for the hot briquetting iron plant core area foundations including two 115 ft diameter clarifiers, 20,000 sf cooling tower, 10,000 sf process water basin, 25,000 sf warehouse and miscellaneous sumps, water basins and pipe racks totaling 30,000 cy of concrete. Citgo Refining Chemicals Co., LP - Corpus Christi, TX Project manager for the maintenance repairs for crude loading arms at several ship and barge docks in the Port of Corpus Christi. ADM Grain Company- Corpus Christi, TX Project manager for the construction of a 20 ft x 40 ft pre-engineered metal building and miscellaneous concrete foundations. Valero Refining Texas, LP - Corpus Christi, TX Project manager for the construction of a 95 ft catwalk and corrosion protection repairs to ship dock #3, including the installation of 84 pile jackets. Port of Corpus - Corpus Christi, TX Estimating manager and project engineer for Viola Barge dock upgrades, which consisted of construction of a new 600 ft long barge dock including breasting structures, dredging, dock house, utilities, and general civil work. Interstate Grain Corporation - Corpus Christi, TX Estimating manager/project engineer for the rehabilitation of the existing ship dock. Project included 48 in to 60 in diameter drilled piers up to 110 ft deep, 84 in monopile breasting structures and roughly 1,000 cy of 8 ft thick concrete caps over water. Northern White Sand, LLC - Corpus Christi, TX Assistant project manager and estimating manager for the demolition of the existing dilapidated and submerged existing dock and construction of a new 500 ft long dock with five each 66 in x 100 ft monopile breasting structures, pile supported conveyor foundations and mechanical dredging. Valero Refining Texas, LP - Corpus Christi, TX Assistant project manager and estimating manager for the installation of 416 ft of anchored sheet pile bulkhead, one turning dolphin and 800 cy of concrete pile cap. Prior to Joining CCC Group Signet Maritime - Corpus Christi, TX Project manager for construction of 300 If steel sheet pile bulkhead with anchor wall. Flint Hills Resources - Corpus Christi, TX Project engineer for the construction of a new shop dock including a including a 3,200-sf dock, 1,900 sf trestle, two 84" diameter by 140' long monopiles with concrete cap and mooring hook capstans, 100 If of catwalk, floating dock, rehabilitation of two breasting structures and demolition of an existing hose tower and two caissons. WESTCO - Corpus Christi, TX Contractor that provided consultant services for marine construction including cost estimating, scheduling, peer reviews and construction management. Revised 10/06/2023 Personal Profile I Jason M. West I Page 1 2 �co IT January 10, 2024 CCC Group Inc. PO Box 200350 San Antonio, TX 78220 RE: CCC Group Verification Letter Please accept this letter as verification of CCC Group Inc's account noted below: Account Name: CCC Group Inc Account Number: 49272216 ABA Number: 113000968 Please contact me at 832-214-4809 orvia email at april.white@hancocl<whitney.com if you have any questions or need additional information. Best Regards, 10 April White Commercial Client Administrator STATE OF TEXAS 0 AFFIDAVIT COUNTYOF Bexar 0 Jason C. Zehner being first duly sworn, deposes and says: that he or she is (Type or Print Name) the General Counsel and Corporate Secretary of CCC Group, Inc. having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at 5797 Dietrich Rd. San Antonio, TX - Meiling Address PO Box 200350, San Antonio, TX 78220 (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 y and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and re, e uir m is tained in the bid/proposal. fSj nature of Affiant - Jason C. Zehner Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts above are true and correct, this 15th day of May 20 24 . Notary Stamp/Seal '—Signature of Notaryypublic Sherry K. Keller ID #191363-8 "�,C ' 19136a 9,,• 06.05.ZOrL� 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) CCC Group, Inc. PO Box 200350 San Antonio, TX 78220 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. dYes ❑ No The undersigned hereby certifies that: G( 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. C3�The Equal Employment Opportunity clause is included in the Contract (if bid equals or —/ exceeds $10,000). CY The Affirmative Action for Handicapped Workers clause is included in the contract. he Exhibit B — Assurances for Construction Programs is included in the Contract. C5 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 dNo NAME AND TITLE OF SIGNER (Please type) --� May 15, 2024 SIGNATTU Jason C. zehner DATE � Gene 1 Counsel and Secrelgary 8/03/2011 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO 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 / Contract CCC Group, Inc. # 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. NIA 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 CIO 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? N/A ❑ 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? N/A ❑ 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? N/A ❑ Yes ❑ No D. Describe each employment or business relationship with the local government officer named in this section. N/A 4• Sign o per on doing business with governmental entity Date Signed May 15. 2024 Jason C. Zehner, General Counsel and Secretary 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. Jason C. Zehner, General Counsel and Secretary May 15, 2024 Name and Title of Authorized Agent Date Agent I am unable to certify to the above statements. My explanation is attached. 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: NIA a. contract NIA Action: NIA 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: N/A NIA Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: N/A N/A CFDA Number, if applicable: 7. Federal Action Number, if known: 9. Award Amount, if known: NIA $ N/A 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): N/A N/A 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 YZehner placed by the tier above when this transaction Print Name: Jason was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1362. This Title: General Counsel and Secretary information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the 210-561-425I Telephone No.: Date: Mav 15, 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) Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 el .eeq. 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 as defined in Government Code §2252.001 and our principal place of business is �, l certify that Ci,, :md smi.y CCC Group, Inc. defined in Government Code §2252.001. Signature c Jason C.Zehner Printed Name and Title of Authorized Agent May 15, 2024 Date is a "Resident Bidder" of Texas as SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The Corporation 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) CCC Group, Inc. 5797 Dietrich Rd. Bexar County, Texas 78219 County State Zip Telephone Number ( 210 ) esa 4251 Voice ( ) TDD Jason C. Zehner has been designated to coordinate compliance all Federal statutes relating to nondiscrimination. RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 e t sey.. as amended, Calhoun County requests Residence Certification. §2252.001 el 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 as defined in Government Code §2252.001 and our principal place of business is /certify that CCC Group, Inc. defined in Government Code §2252.001. Signature r Jason C.Zehner Printed Name and Tit Ie of Authorized Agent May 15, 2024 Date is a 'Resident Bidder" of Texas as 3�-,4 the r 0lau wry CO.LtC CONTRACT DOCUMENTS FOR THE BID NUMBER 2024.07 MAGNOLIA BEACH - OCEAN DRIVE BULKHEAD CAP REPLACEMENT PROJECT FOR CALHOUN COUNTY, TEXAS APRIL 2024 Prepared by: G & W ENGINEERS, INC. 205 WEST LIVE OAK PORT LAVACA, TEXAS 77979 (361) 552-4509 G & W Engineers, Inc. Texas Registered Engineering Firm F-04188 Project No. 9115.029 Approved By: Ia * . c �............................". SCOTT �P. MASON ..... .... r, 127893 PtIlpcc� </CENSFp. ��a t\k�ON N� Scott P. Mason, P.E. Texas Serial No.127893 Date: 1 -1 J BID PROJECT NAME: Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Pro ect DUE DATE Thursday , MoV 23, 2024 before 2:00:00 O.M. NAME: BASE WORK SCOPE Is Bids are invited for items and quantities of work generally as follows: a new 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the Improvements, installation of new deadman fie -back rods and the replacement of existing timber whalers. Item quantity Unit Unit Price Total'Bld'Price `. 1. Furnishing all necessary equipment, 1 LS materials, and labor for Mobilization, demobilization, barricades, insurance, and $20,000.00 $20,000.00 bonds as per plans and specifications 2. Furnish all necessary materials, equipment 1 LS and labor for the demolition and removal of approximately 482 LF timber cap, 92 tie- $22.500.00 $22,500.00 back rods and 482 LF timber wailer in accordance with the drawings and specifications. 3. Furnish all necessary materials, 482 LF equipment, and labor for the installation of reinforced concrete bulkhead cap with $110.00 $53,020.00 periodic PVC drains approximately every 10 ft in accordance with the drawings and specifications. 4. Furnish all necessary materials, 482 LF equipment, and labor for the installation of a T wide sidewalk alongside the proposed concrete cap with minor grading of the $33.00 $15,906.00 produced cut material in accordance with the drawings and specifications. 5. Furnish all necessary materials, 92 EA equipment, and labor for the installation of stainless -steel tie -back rods connecting existing Deadman to propose cap in $890.00 $81,880.00 accordance with the drawings and specifications. 6. Furnish all necessary materials, equipment, 482 LF and labor for the installation of a timber $20.50 $9,881.00 wailer in accordance with the drawings and specifications. TOTAL BASE BID $ $203,187.00 SPECIFICATION NOTES Calhoun County is receiving Bids for items and quantities of work generally as follows: Bids are invited for items and quantifies of work generally as follows: A new482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman fie -back rods and the replacement of existing timber whalers. County to provide: i. 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 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cab Replacement 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 fime 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 45 consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. 2. SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project eke with his own forces end that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. I Turnkev for groiect 1 304 Construction, LLC. I to the work covered by the above bid. Bidder Name: Boettcher Hlavinka Co., LLC. Address: P.O. Box 1335, East Bernard, TX 77435 Phone: 979-253-1049cell 979-335-6031 office EIN or Tax Signature: Name and Email Address: joey.teatg' ue -hlhlavinka.com I w 1 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Boettcher Hlavinka Company, LLC as PRINCIPAL, and Merchants National Bonding, Inc. , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", in the penal sum of Five Percent of Greatest Amount Bid Dollars, ($ 5% ), 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 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement 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 21st day of May, 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; Attest: Kelby Clements, Witness Countersigned By . Attorney -in -Fact, State of (SEAL) (SEAL) By: Affix Corporate Seal 0 Affix Corporaie Merchants National Bonding, Inc. 7- Seal' By: Alexandria Petroski, Attomey- ❑-Fact _ , w 1 CERTIFICATE AS TO CORPORATE PRINCIPAL I, , certify that I am the , Secretary of the Corporation named as Principal in the within bond; that who signed the said bond on behalf of the Principal was then 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: " Power -of -attorney for person signing for Surety Company must be attached to bond. MERCHANTS BONDING COMPANY,. POWER OF ATTORNEY Know 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, Alexandria Petroskl; Ross Gunnels; Sally White; Teresa Martin their true and lawful Attorneys}in-Fact, to sign Its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other wditen instruments In the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts end executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attomey 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 MerchentsNabonat 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 Aftomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, 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 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 horhy hereby given to the Attorney -in -Fact Includes any and all consents for 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 undemlood 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 Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such Intent has been given to the 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 . •.• . • • •- • • • MERCHANTS BONDING COMPANY (MUTUAL) �pt10..... NO,CQ p• MERCHANTS NATIONAL BONDING, INC. ,hy,opPog9r�oy. �yO��pP0y9�-r*0 d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY c 2003 1933 .:•y , By ;may. act aJI�•.. .. ��1�p` . �jy....... �> � /P,-1d,,t STATE OF IOWA .,•• i?•.•••••' ••.•••.•� COUNTY OF DALLAS as. ' On this 3rd day of February 2024 , before me appeared Lamy 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. _ tiF9,Atm Perini Miller i Commission Number 787952 • • My Commission Expires IOWA January 20, 2027 11 ote bf�,, (Expiration of notary's commission does not Invalidate this Instrument) 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 sold Companies, which Is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereu ho set my hand and affixed the seal of the Companies on this 21st day of May , 2024 W. i z • • s Secretary �01, 2003 1933 .'ti: POA0018 (1/24) ""•'•" � u � MERCHANTS BONDING COMPANY. MERCHANTS NATIONAL BONDING, INC. - P.O. SOX 14498 • DES MOINES. IOWA 50306-3498 PHONE: (800) 678-8171 • FAX: (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 National Bonding, Inc. 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: Cali: 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 jiene unaqueia o necesita avuda? Si tiene un problema con una reclamacion o con su prima de seguro, (lame primero a su compania 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 en ingl6s) 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 compania de seguros o HMO. Si no to hace, podria perder su derecho para apelar. SUP 0032 TX (7/23) Para obtener informaci6n o para presentar una queja ante su compania de seguros o HMO: Merchants National Bonding, Inc. Llame a: Compliance Officer al (800) 671-8171 Telefono gratuito: (800) 678-8171 Correo electr6nico: regulatory@merchantsbonding.com Direction postal: P.O. Box 14498, Des Moines, Iowa, 50306-3498 El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionacia con los seguros o para presentar Una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una queja en: www.tdi.texas.gov Correo electr6nico: ConsumerProtection@tdi.texas.gov Direcci6n 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: 1939 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 Dollar Amount Completion Date Type of work performed by your company: General Contracting - Commercial & Residential Have you ever failed to complete any work awarded to you? Nope Have you ever defaulted on a contract? None List the projects most recently completed byy_our firm (include oroiect of similar importance): Project Donar mmoum MoNr Completed Barry & Karla Adkins: Barndominium $720,000 12/2023 City of Bay City: Ave K Recycling facility $536,971 6/2019 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 Project Engineer in verification of the recitals comprising this Statement of Bidder's Qualifications. Execute is 23rd day of May -_ , 2024. by: MProject Manager (Signature) (Title) I, , STATE OF TEXAS {} AFFIDAVIT COUNTY OF Joey Teague being first duly sworn, deposes and says: that he or she 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 coilusionto 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 o furnish any and/or all ftems/services upon which bid prices or proposed fees are awarded and upon the conditions of id requiremipnft contained in the bid/proposal. Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE MEpy the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this �__ day of _ 20 " BEN ELIZABETN HAYFIELD *n t'ure of Notary Public My Notary ID # 130947369 Expires January 3, 2025 '%'.e By:•.• 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:/Avww.ethlcs state.tx.uslFlle 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 q6 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 flllina 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 Bid Number 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Project On #4 and #5, corn&tt 2Wv the o e that ambs 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 Soft Complete Nos. 1- 4 and 6 it there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2024.1165197 Boettcher Hiavinka Company, LLC Edna, TX United States Date Filed: 05/22/2024 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2024.07 Concrete bulkhead Party 4 Name of Interested Pa City, State, Count lace of business Country (p j Nature of interest (check applicable) Controlling Intermediary Teague, Joey Vanderbilt, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Joey Teague and my date of birth is - My address is (street) (city) (state) (zip ode) (muntry) I declare under penalty of perjury that the foregoing is true and correct. Executed in Wharton county, State TX , on the 22 day of May 20 24 (nonth) (year) Sign re of a,fimliad agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V4.1.0.076aba0 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 CIO). These laws are codified In Chap. 176 of the Texas Local Government Code. What vendors/persons are subject to Chapter 1 TV • 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 bide, 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 CIO must be completed. Even if the vendor has no affiliation or business relationship with an officer or employee of the County, Form CIO 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 applloation 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 CIO 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 CIO. 2. Check box 9 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 slpneture is required in box #4 regardless of any other entry on the form. A copy of Chapter 176 of the Texas Local Government Code can be found at: hfto:Idwww.statutes.lodis.state.tx.us/SOTWOocsILGdhtm/LG.176.htm 8/03/2011 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO 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 / 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 r the to th dgi ly filed questionnaire becomes incomplete not later than the r businessjoffl or inaccurate.) 3. Name of local governmenr' hl fll ` ployment or business relationship. NdReofO IMer 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 CIO 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 pe doing bu ess h governmental entity 5/23/2024 Date Si d 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. See. 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. See. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. See. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. See. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (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. Joey Teague, PM 5/23/2024 Name and Title of Authorized Agent Date Q.L/ ,AN. Mature of Athorized Agent I am unable to certify to the above statements. My explanation is attached. INSERT DEBARMENT & SUSPENSION EXECUTIVE ORDER PDF HERE and It includes CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS HERE N/A 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. VYes ❑ No The undersigned hereby certifies that: V� 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. V� The Equal Employment Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). N(The Affirmative Action for Handicapped Workers clause is included in the contract. WKThe Exhibit B :—Assurances for Construction Programs is included in the Contract. H 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 111"No NAME AND TITLE OF SIGNER (Please type) Joey Teague, PM SIGN A E DATE / 5/22/2024 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. N. S' atur ' f Contractoft Authorized Official Joey Teague, PM Printed Name and Title of Contractor's Authorized Official 5/23/2024 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 or both the Initial filing and materiel 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 form, print his/her name, title, and telephne number. Joey Teague PM 979-253-1049 L 1 % - - AV- 5/23/2024 According to the Paperwork Reduction Act, asgendwrio V information unless it displays a valid OMB control Number. The valid OMB control number or are required tthis information corespond to a llectontionf is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time or 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 (034"046), 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 Dublic 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 bidtoffertapplication 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: District if know ACongressional sessional District, If known: 6. Federal Department/Agency: 7 ede Program Name/Description: CFDA Number, if applicable: 7. Federal Action Number, if known: 9. Award Amount, ifknown: $ 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (N individual, last name, first name, M!): (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U,S.C. section 1362. This disclosure of lobbying activities is a material g ure: r �� representation of fact upon which reliance was _l_' placed by the tier above when this transaction int N664e.• Joey Teague was made or entered into. This disclosure is required pursuant to 31 U.S.C.1362. This Information will be reported to the Congress Title: _EE j-PrD'eCt Manager semi-annually and will be available for public Inspection. Any person who fails to file the Telephone No.: 979-253-1049 Date:.,5/23/2024 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 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) 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 httys:/Icomi)troller.texas:gov/purchasine/oublications/divestment oho Boettcher Hlavinka Co., LLC. Company Name C ice, jew Printed Name of Authorized Official Project Manager 5/23/2024 Title of Authorized Official Date MIDENCE CERTIFlCATION 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.ml Stain) D I certify that Boettcher Hlavinka Co., LLC. is a "Resident Bidder" of Texas as (Company Nam.) defined in Government Code §2252.001. A. Signature o thori¢ ent Joey Teague, PM Printed Name and Title of Authorized Agent 5123/2024 Date ,. P 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 ) 253 - 117149 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 Lart,;ndaled by Jash,m Mayfield. Mar 11, 2024 w 09:09 PM .�.SAM.00ve BOETTCHERHLA VIN% CO LLC BOETTCHERHL"INKA CO LLC Unique Entity ID DWKPDKQ78ZB3 Registration Status Submitted Registration Physical Address 17405 Us 90A HWY East Bernard, Texas 77435-8267 United States CAGE/NCAGE (blank) Expiration Date Mar 11, 2025 Mailing Address 17405 Us 90A HWY East Bernard, Texas 77435-8267 United States Purpose of Registration Federal Assistance Awards Only Doing Business as Division Name Division Number (blank) (blank) (blank) Congressional District State / Country of Incerporetion URL Texas 22 Texas / United States 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 filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue 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 opportunitythat 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 $5,000, or other acknowledgment of fault; and/or (3) administrative proceeding resulting In a finding of fault with either a monetary fine or penalty greater than $5,000 or reimbursement, restitution, or damages greater than $100,000, or other acknowledgment of fault? Not Selected Page I of3 Las! updated by Jorhaa Mayfield ee Mar 11, 2024 ar 09:09 PM COLLC Active Exclusions Records? No I authorize my entity's non -sensitive information to be displayed in SAM public search results Yes Business Types Entity Structure Entity Type Organization Factors Other Business or Organization Limited Liability Company Profit Structure For Profit Organization Soclo-Economic Types Check the registrant's Reps & Carts, If present, under FAR 52.212-3 or FAR 52.219.1 to determine if the entity is an SBA<ertified 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 CAGE Code 0000 (blank) Electronic Funds Transfer _ Account Type Routing Number Lock Box Number Checking ""'"'55 (blank) Financial Institution Account Number PROSPERITY BANK ' "'93 Automated Clearing House Phone (U.S.) Email Phone (non-U.S.) 9795597350 josh.mayfield@hlavinka.com (blank) Fax (blank) .Remittance Address josh mayfield PO Box 1335 East Bernard, Texas 77435 United States EIN Type of Tax Taxpayer Name """5107 Applicable Federal Tax Boettcher Hlavinka Cc LLC Tax Year (Most Recent Tax Year) Name/Title 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 a 1. Joshua A Mayfield, Director of Construction josh.mayneld@hlavinka.com 9795597350 Mar 12. 2024 01:11:04.4M GMT hilps://smn.gov/entity/DWKPDKQ78ZB3/careDam?smtus=nid1 Page 2 of3 Las, updated by Joshua Mayfield on Mar 11, 2024 at 09:09 PM BO=CHERHLA VINKA CO LLC Electronic Business A 17405 US-90 Alt Joshua A Mayfield, Director of Construction East Bernard, Texas 77435 josh.mayfield@hlavinka.com United States 9795597350 Government Business A 17405 US-90 Alt Josh A Mayfield, Director of Construction East Bernard, Texas 77435 josh.mayfield@hiavinka.com United States 9795597350 NAICS Codes Primary NAICS Codes NAICS Title IGT Size Metrics Annual Revenue (from all IGTs) (blank) Worldwide Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR 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) This entity did not enter the EDI information This entity does not appear in the disaster response registry. Mar 12, 2024 01:11:04 AMGMT htlps.Ilsam.govlenriryl2)WKPDKQ78ZB3/roreDala?smaes=null Page 3 of3 Joey Teague 1314 CR 313E Vanderbilt, Tx. 77991 (979) 253-1049 Email: joey.teague@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 corn, milo, wheat operation. Manage all aspects - Pasture Management: 2500 acres. 4, 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 love, which is Construction. I find great pride in developing my means and methods of construction. I Oohlavinka.com 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. O, I want to work for a company that is successful, delivers quality like no other and thrives! A Company "V 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 $5001k-$1 mil in value) as well as commercial projects ranging from $1.5-$7,500,000 range. 1 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 M PROJECT NAME: Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Proiect DUE DATE: Thursda Ma 23 2024before 200:00 .m. NAME: a Oncre a An ruc Ion BASE WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. Item Quantity Unit Unit Price Total Bid Price 1. Furnishing all necessary equipment, 1 LS materials, and labor for Mobilization, 11,000 11,000 demobilization, barricades, insurance, and bonds as per plans and specifications 2. Furnish all necessary materials, equipment 1 LS and labor for the demolition and removal of approximately 482 LF timber cap, 92 tie- 11580 11580 back rods and 482 LF timber wailer in accordance with the drawings and specifications. 3. Furnish all necessary materials, 482 LF equipment, and labor for the installation of reinforced concrete bulkhead cap with 161.25 77722.50 periodic PVC drains approximately every 10 ft in accordance with the drawings and specifications. 4. Furnish all necessary materials, 482 LF equipment, and labor for the installation of 39.22 18904.04 a 3' wide sidewalk alongside the proposed concrete cap with minor grading of the produced cut material in accordance with the drawings and specifications. 5. Furnish all necessary materials, 92 EA equipment, and labor for the installation of stainless -steel tie -back rods connecting 494.50 45494 existing Deadman to propose cap in accordance with the drawings and specifications. 6. Furnish all necessary materials, equipment, 482 LF and labor for the installation of a timber 18.5 8917 wailer in accordance with the drawings and specifications. TOTAL BASE BID $ 173,617.54 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 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. 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 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement 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 90 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. 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. NA 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. Keith Staff dba Staff Concrete Construction Bidder Name: Address: 4703 John Stockbauer Dr. Victoria, TX Phone: EIN or Tax Signature: Name and Title: 361-212-5246 Gi ACGGnAn Keith Staff Owner Email Address: staff.dylan@yahoo.com 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) Keith Staff 4703 John Stockbauer Dr 77904 Victoria TX CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations ❑ No 1�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 0 No NAME AND TITLE OF SIGNER (Please type) Keith Staff Owner SIGNATURE— DATE 5122t24 INSTRUCTIONS FOR CONFLICTS OF INTEREST QUESTIONNAIRE [Form CIO] H,®, 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 related to a potential agreement, Form CIO must be completed. Whether the person initiates the discussion or the County initiates the discussions, Form CIO must be completed. Even if the vendor has no affiliation or business relationship with an officer or employee of the County, Form CIO 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 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 CIO 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. 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 required in box #4 regardless 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 legis 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 / Contract Keith Staff # 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 file has employment or business relationship. Not applicable 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. Signatdrel of l5fton doing business with governmental entity Date Signed STATE OF TEXAS {} AFFIDAVIT COUNTY OF Calhoun {) Keith Staff being first duly sworn, deposes and says: that he or she is iType or Print Name) the Owner of Staff Concrete Construction having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at 4703 John Stoftauer, Victoria TX 77904 frype 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 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 priorto the official opening of this bid/proposal. Affiant further deposes and says: thatthe 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 andntained in the bid/proposal. isDevine Staff My commission expires 1113012027 Signature of A nt Notary ID134662834 I Keith Staff Owner 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 Q_dayof NN101M 20 . Notary stamp/Seal Signatu otary Public 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. See. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING 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. Keith Start Owner Name and Title of Authorized Agent ?ature Sig of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date 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). Staff Concrete Construction The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. Stgn6t4re of Contractor's Authorized Official Keith Staff, Owner Printed Name and Title of Contractor's Authorized Official 5/22124 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. No lobbying activities 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 _ 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: N0 aapplicabl , No lobbying activities 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. f 0a) (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 1362. This Signature: disclosure of lobbying activities is a material ZAL representation of fact upon which reliance was placed by the tier above when this transaction Print Name: Keith Staff was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Title: Owner 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.: 361-212-5246 Date: 05/22/24 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 2270.002 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. Keith Staff 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 eov/purchasing/publications/divestment php Staff Concrete Construction Company Name Keith Staff Signature of'Authorized Official Printed Name of Authorized Official Owner Title of Authorized Official 5/22/24 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 (Cmnpany Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is D I certify that (City and State) Staff Concrete Construction is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. - ZAL Signature of Authorized Agent Keith Staff, Owner Printed Name and Title of Authorized Agent 05/22/24 Date SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY Staff Concrete Constuction 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) Keith Staff 4703 John Stockbauer Dr (Address) Victoria TX 77904 County State Zip 361-212-5246 Telephone Number ( ) Voice ( ) - TDD Dylan Staff has been designated to coordinate compliance all Federal statutes relating to nondiscrimination. Last updated by Keith Sta/lba Mar26, 2024 at 05.11 PM KE17HST4FF e.�i SAM*oove KEITH STAFF Unique Entity ID Registration Status Active Registration Physical Address 4703 John Stockbauer DR Victoria, Texas 77904.1904 United States CAGE/NCAGE 95P94 Expiration Date Mar 26, 2025 Mailing Address 4703 John Stockbauer DR Victoria, Texas 77904-1904 United States Purpose of Registration All Awards Doing Business as Division Name Division Number (blank) Staff Concrete Construction (blank) Congressional District State / Country of Incorporation URL Texas 27 Texas / United States (blank) Registration Dates Activation Date Submission Date Initial Registration Date Mar 28, 2024 Mar 26, 2024 Sep 14, 2021 Entity Dates Entity Start Date Fiscal Year End Close Date Nov 1, 1999 Dec 31 Immediate Owner CAGE Legal Business Name (blank) (blank) Highest Level Owner CAGE Legal Business Name (blank) (blank) Executive Compensation Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L.110.252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions. Proceedings Questions Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209.7, FAR 52.209.9, or 2. C.F.R. 200 Appendix XII. Their responses are displayed In the responsibility/qualification section of SAM.gov. Maintaining an active registration In SAM.gov demonstrates the registrant responded to the proceedings questions. Active Exclusions Records? No I authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes Business Types Entity Structure Entity Type Organization Factors Sole Proprietorship Business or Organization (blank) Profit Structure For Profit Organization May22, 2024 07:24:31 PMGMT hlps://sarn.gov/amity/X✓RBFC3CX295/coreDala?smtns—null Page 1 oj2 Lw1 updatedbyKvOh Stuff on Mar 26, 2024 at 05:/1 PM KETTHSTAFF Soolo-Economic Types Small Business Joint Venture Check the registrant's Reps & Carts, If present, under FAR 52.212.3 or FAR 52.219.1 to determine If the entity is an SBA-certi "ed HUBZone small business concern. Additional small business Information may be found in the SBA's Dynamic Small Business Sea ch If th entity completed the SBA supplemental pages during registration. Accepts Credit Card Payments Debt Subject To Offset No No EFT Indicator 0000 Electronic Business P Keith S Staff, Owner Government Business A Keith S Staff, Owner NAICS Codes CAGE Code 95P94 4703 John Stockbauer DR. Victoria, Texas 77904 United States 4703 John Stockbauer DR. Victoria, Texas 77904 United States Primary NAICS Codes NAICS Title Yes 237310 Highway, Street, And Bridge Construction 238190 Other Foundation, Structure, And Building Exterior Contractors 332312 Fabricated Structural Metal Manufacturing 332618 Other Fabricated Wire Product Manufacturing This entity does not appear in the disaster response registry. May 22, 202407.24.31 PMGMT hays://Barn.gov/en(ily/XJRBFC3CXR95/coreDaiu?status=null Page 2 of2 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: Staff Concrete Construction Date Organized: Address: 4703 John Stockbauer Dr 77904 Date Incorporated: Victoria TX Number of Years in contracting business under current name: 25 CONTRACTS ON HAND: 1999 Contracts Dollar Amount Completion Date Wharton Downtown Revitalization 332k July 2024 TxDOT Karnes FM 887 1.295M June 2024 TOOT Gollad445k Oct 2024 Crestwood Phase 3 1.549M June 2024 Type of work performed by your company: Concrete, demo, stromdrain 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 Crestwood Phase 2 $1.51 M Feb 2023 Victoria College Parking Lot $842k Feb 2024 Victoria Duck Pond $518k Dec 2023 Dairy Rd Reconstruction $1.33M Nov 2023 Major equipment available for this contract: Skidsteer, Backhoe, Mini Excvavator Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Credit $ 1.5M Bank First State Bank, Victoria TX John Stockbauer Dr. available: reference: Lolly Hamilton The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed th� day of May 2024. Owner by: (Signature) (Title) Resume Keith Staff President Education: Highschool Graduate Work experience: 1989-1992 Lakeland Construction 1992-1996 JMC 1996-1999 Mirage Staff Concrete Construction: 1999 - Current As owner/president of Staff Concrete Construction Keith has completed $95+ million of construction contracts as a subcontractor and general contractor for industrial plants, state (Txdot), county, city, and commercial specializing in concrete, stormdrain, demo, and dirtwork projects. Colton Staff Project Manager Education: Highschool Graduate Work experience: Edge Oil Field Services 2013-2015 Staff Concrete Construction June- Aug 2012-2013, 2015 - Current Since 2015 Colton has been a supervisor of 6 crews with over 30 employees. He has overseen the completion of over $45 million of construction contracts including Txdot subcontracts valued over $1 million e.g (TxDot FM1686) in 2020 and commercial construction of Nan Ya Houston building valued at $9.2 million. Laborer, foreman, supervisor, project manager for stormdrain, concrete flatwork, demo, and structural, excavating/dirtwork,landscaping. Dylan Staff Estimator/ Superintendent Education: University of Texas at Austin BA Economics Work experience: Staff Concrete Construction June- Aug 2012-2016, 2018, May 2020 - Current Laborer, foreman, supervisor, superintendent, estimator for $100M+ projects that include stormdrain, demo, concrete flatwork and structural, excavating/dirtwork, and landscaping. Superintendent for Port Lavaca Upper Dock Repair $297k, University of Houston at Victoria Kay's Grove $649k, 114 Imperial Dr. Dr. Office Parking Lot $122k, Leary Lane Sidewalk $377k, Yoakum 2021 Sidewalk Improvements $292k, Palacios Downtown Revitalization $211k, Victoria Entry Way Sign $47k, and Victoria College Wood Building Parking Lot $842k. References Brannan Paving Shaun Brannan 361-550-3800 sebrannan@yahoo.com Lester Contracting Trent Tagliabue 361-552-3024 trent@lestercontracting.com Victoria College Marty Deckard 361-582-2469 marts.decl<ard@victoriacolleve.edu City of Victoria Ken Gill 361-485-3381 kgili@victoriatx.gov University of Houston at Victoria Matt Alexander 361-550-6891 alexanderm@uhv.edu Lauger Companies Kevin Krueger 361-648-3161 kevin@laueerco.com Trade References Alamo Concrete Nick Hinojosa 361-550-7048 nhinoiosa@alamoconcrete.com South Texas Steel Michael Bartels 361-920-6454 mbartels@stssc.com White Cap Michael Greer 832-283-0365 Michaei.areer@whitecap.com PROJECT NAME: Bid Number i024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Project DUE DATE: i1 hursdav , MaY28, 2024'before 2c0000 ti,m NAME: Carlson McClain Construction Company LLC BASE WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. Item Quantity Unit Unit Price Total Bid Price 1. Furnishing all necessary equipment, 1 LS materials, and labor for Mobilization, $20,000.00 $20,000.00 demobilization, barricades, insurance, and bonds as per plans and specifications 2. Furnish all necessary materials, equipment 1 LS and labor for the demolition and removal of approximately 482 LF timber cap, 92 tie- back rods and 482 LF timber wailer in $19,000.00 $19,000.00 accordance with the drawings and specifications. 3. Furnish all necessary materials, 482 LF equipment, and labor for the installation of reinforced concrete bulkhead cap with periodic PVC drains approximately every $59.00 $28,438.00 10 It in accordance with the drawings and specifications. 4. Furnish all necessary materials, 482 LF equipment, and labor for the installation of a 3' wide sidewalk alongside the proposed concrete cap with minor grading of the $65.00 $31,330.00 produced cut material in accordance with the drawings and specifications. 5. Furnish all necessary materials, 92 EA equipment, and labor for the installation of stainless -steel tie -back rods connecting existing Deadman to propose cap in $935.00 $86,020.00 accordance with the drawings and specifications. 6. Furnish all necessary materials, equipment, 482 LF and labor for the installation of a timber $27.00 $13,014.00 wailer in accordance with the drawings and specifications. TOTAL BASE BID $ 197,802.00 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 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. County to provide: i. 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 2024.07 - Magnolia Beach - Ocean Drive Bulkhead Cap Replacement 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 3 daYS consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. N/A 2. N/A SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. Type of Work Subcontracted Name of Subcontractor N/A The undersigned hereby declares that he has visited the site and has carefully examined the contract documents relative w uio WUIM wvereu LJy me aoove oic. Bidder Name: Carlson McClain Construction Company LLC Address: PO Box 9517, The Woodlands, TX 77387 Phone: (936)828-7810 EIN orTax ID No.: 8 S-'LOS9 Signature: Name and Tit Logan Carlson, President Email Address: learsion@carlsonmcclain.com BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Carlson McClain Construction Company, LLC as PRINCIPAL, and Great Midwest Insurance Company , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", in the penal sum of Five Perceptof Total Amount Bid Dollars, ($ 5. of TAB ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated May 23 2024 1 Bid Number 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement 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 22nd day of May, 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. Carlson lain Construction Company, LLC(SEAL) (SEAL) Attest: By: L6 6A m R. CAlL 45o,v Affix Great Midwest Insurance Company Corporate Seal Attest: (,, By: - C.jMi,(.. Crosby Guercio, Witness hiyn Simckt, A orney-in-Fact Affix Corporate Seal Attest: By: Countersigned . ::.:.,.,.n: — * Attorney -in -Fact, State of Texas POWER OF ATTORNEY Great Midwest Insurance Company KNOW ALL MEN BY THESE PRESENTS, that GREAT MIDWEST INSURANCE COMPANY, a Texas Corporation, with its principal Houston, TX, does hereby constitute and appoint: an McCauley, Jr., Sam Duckett, Jeff Scott, Bridget Truxillo, Sarah Timmons, Ashlyn Simchik, Jarrod Yost, Alex Rausch, Liam Hackett, Rrlinc Ward true and lawful Attorneys) -in -Fact to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or tinge 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 MIDI SURANCE COMPANY, on the 1s' 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 Compa person or persons as Attorney -in -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or os obligatory in nature of a bond not to exceed Twenty -Five Million dollars ($25,000,000.00), which the Company might execute throu )[acted officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be as bi the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney -In -Fa nted, may be removed in the Company's sole discretion and the authority so granted may be revoked as specified in the Power of Afton Resolved, that the signature of the President and the seal of the Company may be of ked by facsimile on any power of attorney gran 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 s er or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and as; 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 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. OORPOSATESEAL ACKNOWLEDGEMENT GREAT MIDWEST INSURANCE COMPANY BY M "a' to , Mark W. Haushill President 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 instrun he executed said Instrument on behalf of the corporation by authority of his office under the By-laws of said corporation. s,g CHBISTINA BISHOP �3Notary PW; 0. state 01 Texes BY Comm, Explies 04-14.2025 Christina Bishop Notery iD 13109D488 Notary Public CERTIFICATE I, the undersigned, Secretary of GREAT MIDWEST INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY original Power of Attorney of which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolul set forth are now in force. and Sealed at Houston, TX this 22nd Day of May , 2024 r CORPORATE SEAL ._ -. _ BY Leslie K. - Secr Any person who knowingly and with Intent to defraud any insurance company or other person, files and application for insurance of clai any materially false Information, or corceaisfoirr the purpose of misleading, Information concerning any fact material thereto, comm" naurance act, which Is a crime and subJecis such person to criminal and civil penalties. Cortificate No. 15063 THIS IS TO CERTIFY THAT Texas Department of insurance Cotnpany No. 07-005785 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 COM SIO OF�INSU[R�ANC(E� (1� BY o Godwin Ohaec esi, Director Company Licensing & Registration N/A CERTIFICATE AS TO CORPORATE PRINCIPAL I, , certify that I am the Secretary of the Corporation named as Principal in the within bond; that who signed the said bond on behalf of the Principal was then 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: 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: Carlson McClain Construction Company LLC Date Organized: June 2022 Address: PO Box 9517 Date Incorporated: N/A The Woodlands, TX 77387 Number of Years in contracting business under current name: 2 CONTRACTS ON HAND: Contracts Dollar Amount Completion Date New Wavery Station C & G Clearing $650,000.00 8/25/2024 Enterprise Dock 4 Concrete Dock $660,000.00 6/30/2024 Eco Services Stand Pipe Repair $289 500.00 7/1/2024 Stewarts Creek Tributary Sheet Pile Project $2,320,000.00 9/1/2024 Type of work performed by your company: Heavy civil, marine construction Have you ever failed to complete any work awarded to you? Have you ever defaulted on a contract? No No List the projects most recently completed by your firm (include project of similar importance): Project Dollar Amount Mo/Yr Completed Moran Ranch Pond Rehabilitation $73,500.00 5/2024 Barton Creek Phase IV Detention Pond $358,161.50 4/2024 Williams Trail C&G / Detention $300,000.00 3/2024 Port of Houston Wharf 7 Earthwork $400,000.00 1/2024 Major equipment available for this contract: 308 Size Excavator, 92 HP Skid Steer, any misc. needed. Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Credit $ 500,000.00 Bank Frost Bank available: reference: The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed th' >zil _ da of M O `f 202d. by: President (Signature) (Title) STATE OF TEXAS »7 AFFIDAVIT COUNTY OF I tOiUTGo�13TLY {} 40 e4l & lfl-ILt,S dry being first duly sworn, deposes and says: that he or she is (Type or Print Name) the_ftesaoewr of C' xtsdv Wtc.c.1.4.cr✓ (a,ivwwf Wl havingits (Type or Print Title) (Type or Print Name of Company/Firm) principal address (Type or Print Physical and Mailing 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. Aff(ant 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 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 aj1d requirements contained in the bid/proposal. Siato&ffaant WAN a, CAg.t.cuol - r�Ytr-srneur Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE JE by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this 23' day of MAU 20 Z4 COURTNEYCARLSON tNBtStj1GP:$Rib6o32i My Commission Expires .rmember 77, xo2fi Signature of Not4K 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) Carlson McClain Construction Company LLC PO Box 9517 The Woodlands, TX 77387 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. I@ 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. IZ The Exhibit B — Assurances for Construction Programs is included in the Contract. IE 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) Logan Carlson President SIG RE DATE 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 trigger 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 related to 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 contracttpurchose 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 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 1 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 CIO. 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. S. Signature box. Person completing form must dale 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.sianature Is required in box #4 regardless of any other entry on the form A copy of Chapter 176 of the Texas Local Government Code can be found at: htloalwwwstatutes.leals.state.tx.us/SOTWDocsiLG/htm/LG.176.htm 0/03/2011 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. B / RFP 1 Contract Logan Carlson, Carlson McClain Construction Company LLC F 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 7s' 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 Si S ned t z CJC_: L� 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. 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. Logan Carlson President, Carlson McClain Construction Company LLC Name and Title of Authorized Agent Si ah re f6f Authorized Agent S/ 2 31e N 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). Carlson McClain Construction Company LLC The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 at��seq., apply to this certification and disclosure, if any. Slgnatuka,pf Contractor's Authorized Official Logan Carlson, President Printed Name and Title of Contractor's Authorized Official Date SlzZ.64 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 Disclosure of Lobbying Activities 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Man rawarec fnr nl Ihlin {...-.1..., .1:....1.....-�f u1VV11 VWYIVAYIG 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: Con ressionat District if known: 6. Federal DepartmentlAgency: 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, MO: (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: y disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Print Name: Logan Carlson was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Information will be reported to the Congress President Title: semi-annually and will be available for public Inspection. Any person who fails to file the Telephone No.: (936) 828-7810 Date: sli317.y 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. Fetleirai 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 851^ Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. I, (authorized official) Logan Carlson 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 httgs:Hcomptroller texas gov/purchasine/publications/divestment php Carlson McClain Construction Company LLC R__ President Official Logan Carlson Printed Name of Authorized Official 5 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 Suac) Carlson McClain Construction Company LLC D I certify that is a "Resident Bidder" of Texas as (Company Nama) defined in Government Code §2252.001. /Z_ Signature of AuthorlKWAgennt Logan Carlson, President Printed Name and Title of Authorized Agent LoGA-V X. �Lca f1 - Rif- Cs-cDt*I- Date SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY Carlson McClain Construction Company LLC 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) Carlson McClain Construction Company LLC (Address) Po Box 9517, The Woodlands Montgomery County, TX 77387 County State Zip Telephone Number ( 936 ) 828 7810 Voice ( ) - TDD Logan Carlson 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 ri N a h Q � u j A Aa 4mO m zu a 3 a _ x C e S $ "� 3 w v s J � C N630 a^ {f�) Y co) 0 BE BaYj. Permanent Address: 10805 W Timberwagon Circle Spring, TX 77380 EDUCATION: Logan R. Carlson Email: learlson@carlsonmeclain.com Call 828-7810 Texas A&M University, College Station, Texas Graduation: December 2012 Bachelor of Science in Construction Science PROFESSIONAL EXPERIENCE: I am a proven successful project leader with over $150MM worth of contracts completed. I have extensive knowledge in the heavy civil/marine/industrial construction sectors and have lead contracts with some of the largest private clients and public entities (Public Ports, Cities, Counties, USACE). Carlson McClain Construction Company LLC, Spring, TX President and Co -Founder June 2022-Present • Responsible for overall company operations including strategy, financial management, estimating, and project execution Orion Marine Group, Houston, TX Senior Project Manager September 2021 —August 2022 • Lead multiple project teams in the Gulf Coast region fi•om the Texas Gulf Coast to Southwest Louisiana • Manage cost budgets for multiple ongoing projects throughout the TX/LA coast • Prepare bids and estimates for heavy civil/marine projects up to S80MM • Responsible for business development duties with customers • Identify and pursue potential projects along the Gulf Coast • Provide project development services to customers from concept through final project completion • Mentor and contribute to the development of project managers and project engineers • Manage project schedules and contractual requirements for multiple projects Major Projects: • Indorama Ventures R&S Dock Rehab Pon Neches, TX December 2021-October 2022 Replacement of existing dock foundation, installation of 24" steel pipe piles, jacketed structures, steel trusses, precast concrete, and steel structure. Perform concrete restoration and installation of FRP under dock. TARGA Barge Docks 213413 Houston, TX September 2021-August 2022 Design -build project. Provide project development services from concept through final design. Installation of 18" prestressed precast concrete piles, 48" steel protection piles and breasting piles, precast prestressed box beams, and cast in place deck, assembly and installation of 4 marine loading arms, jacketed fender system, mechanical support. Various Marine Maintenance and Emergency Projects along the Gulf Coast From Corpus Christi, Texas to Lake Charles, Louisiana Projects include emergency marine infrastructure repairs, heavy marine lifts, replacement of marine fender systems, replacement of steel and timber protective and mooring dolphins, maintenance of marine loading anus and dock mounted hydraulic cranes, and the installation of cathodic protection systems. Project Manager May 2018 - September 2021 • Total responsibility for new build and upgrade heavy civil/marine projects up to $80MM • Lead overall operations of multiple crews, subcontractors, and 75+ employees • Prepare bids and cost estimates for marine projects up to $80MM using HCCS HeavyBid • Review and manage project schedules using Primavera P6 • Lead project team, field superintendents, surveyors, and foremen • Provide oversight for the procurement of materials for projects • Prepare and execute subcontracts for work not self -performed • Lead progress meetings with owners/owner's representatives • Review and manage invoices for completed and ongoing projects • Manage accounts receivables for invoiced projects • Responsible for monthly cost reporting/forecasting for publicly traded company responsibilities Major Projects: Sunoco Ship Dock 2 Rehab Nederland, TX June 2020-December 2020 Partial demolition of existing ship dock and breasting structures, installation of 24" precast pile dock extension piles, 24" precast dock piles, precast pile caps, cast in place dock extension, new cast in place breasting structures and cell fenders, assembly and installation of 4 hydraulic marine loading arms, 5 story hose tower structure with hydraulic crane Sunoco Ship Dock I Nederland, TX April 2020-April 2021 Demolition of existing ship dock, installation of new 400' bulkhead with 1:1 24" pipe pile tie back system. Installation of 36" cylindrical precast piles, 24" prestressed precast piles, 48"- 72" steel pipe piles, new fender system, precast pile caps, cast in place dock deck, new breasting dolphins with steel catwalks, 5 story hose rack system with hydraulic crane, assembly and installation of 5 marine loading arms, pile supported control building on land, cast in place concrete structures on land, piping supports, site paving with asphalt parking area KCS Railroad Beaumont Lift Bridge Fender System Replacement Beaumont, TX February 2020 — August 2021 Design -build project. Hurricane Harvey restoration project. Provided design services from concept through final design. Construction of 22 pipe piles up to 84" diameter, jacket fender structures, composite timber fenders, excavation of pile plugs, and placement of 2,000 cubic yards of concrete. Port of Houston CARE Terminal Fender Replacement Houston, Texas November 2019 — January 2021 Demolition of 1,200' of existing steel fender system. Construction of new 1,200+ of steel and timber fender system with H-pile foundations, steel hardware, and rubber fender elements. Successfully performed work on a working dock in service throughout the project. Covestro Cedar Bayou Shoreline Protection Baytown, Texas May 2019 — January 2020 Design build project. Project development services from concept through final design. Construction of 650'+ of steel sheet pile bulkhead with 1:1 h-pile batter tie back system to protect customer's admin building at risk of shoreline erosion encroaching on foundation, shoreline clearing, backfill, and vegetation replacement INEOS Oligomers Chocolate Bayou Barge Dock Upgrades Liverpool, Texas May 2018 — May 2019 Design -build project. Provided conceptual through final design services. Worked alongside Jacobs Engineering/Worley EPC contractor, construction of400'+ of steel sheet pile bulkhead utilizing existing tie back wall, installation cast in place concrete dock, 2 marine loading arms, 2 hydraulic cranes, new fender system, new dolphins, shoreline stabilization and site paving, mechanical bucket dredging and hydraulic offloading, construction of on -site DMPA. Successfully completed the project while the dock was in service so the customer could continue to earn revenue throughout the project. Houston Fuel Oil Ship Dock 5 Houston, Texas October 2016 — August 2018 Largest project in company history. Design -build project. Provided conceptual through final design services. Construction of 1,000'+ of combi-wall bulkhead with sheet pile tie back wall, installation of steel ship dock with cast in place concrete deck, 4 marine loading arms, 2 hydraulic cranes, full mechanical and electrical package, 72" — 78" mooring and breasting dolphins, site stabilization and paving, 600,000+ cubic yards of hydraulic dredging, and conventional installation of 1,000' pipeline bundle across the Houston/Jacintoport Channel. Various Marine Maintenance and Emergency Projects along the Gulf Coast From Corpus Christi, Texas to Lake Charles, Louisiana Projects include emergency marine infrastructure repairs, heavy marine lifts, replacement of marine fender systems, replacement of steel and timber protective and mooring dolphins, maintenance of marine loading arms and dock mounted hydraulic cranes, and the installation of cathodic protection systems. Assistant Project Manager Project Engineer January 2017 — May 2018 • Responsible for new build and upgrade heavy civil/marine projects up to $80MM • Manage operations of multiple crews, subcontractors, and 75+ employees • Prepare bids and cost estimates for marine projects up to $80MM using HCCS HeavyBid • Create and manage project schedules using Primavera P6 • Lead project team, field superintendents, surveyors, and foremen • Responsible for the procurement of materials for projects • Prepare subcontracts for work not self -performed • Lead progress meetings with owners/owner's representatives • Create and manage invoices for completed and ongoing projects • Responsible for monthly cost reporting/forecasting for publicly traded company responsibilities January 2013 — December 2016 • Manage overall project oversight for heavy civil/marine projects up to $80MM • Manage overall operations of multiple crews, subcontractors, and 50+ employees • Prepare cost estimates for marine projects up to $80MM using HCCS HeavyBid • Create and maintain project schedules using Primavera P6 • Provide managerial support for field superintendents, surveyors, and foremen • Solicit proposals and procure materials for marine projects up to $80MM • Attend construction meetings with owners/owner's representatives • Prepare owner invoices for completed and ongoing projects • Assist project manager with monthly cost reporting/forecasting and project status reviews • Perform QA/QC duties Major Projects: Kinder Morgan Export Terminal Pasadena, Texas May 2015 — May 2017 Demolition of existing sheet pile bulkhead, construction of 2,500'+ of new combi-wall and sheet pile bulkhead, new multi -level cast in place concrete ship dock with precast concrete pile foundation, 66" - 72" breasting and mooring dolphins, and 3 marine loading arms, new cast in place concrete barge dock with concrete pile foundation, and 500,000 cubic yards of hydraulic dredging. TARGA Ship Dock 4 Galena Park, Texas January 2013 - July 2014 Design -build project. Provided project development services from conceptual through final design. Demolition of existing wood ship dock, construction of new precast and cast in place concrete ship dock with precast concrete pile foundation, 18" to 72" steel pipe piles, multi level pipe rack platform, and 2 16" hydraulic marine loading arms, and 250,000+ cubic yards of hydraulic dredging. Various Marine Maintenance and Emergency Projects along the Gulf Coast From Corpus Christi, Texas to Lake Charles, Louisiana Projects include emergency marine infrastructure repairs, heavy marine lifts, replacement of marine fender systems, replacement of steel and timber protective and mooring dolphins, maintenance of marine loading arms and dock mounted hydraulic cranes, and the installation of cathodic protection systems. Knife River Corporation- South, Bryan, TX Estimating Assistant May 2012-December 2012 • Assisted in preparing proposals for civil construction projects up to $15 million • Performed quantitative takeoffs for estimators • Solicited proposals from suppliers and subcontractors • Created AutoCAD drawings for bridge structures • Led weekly internal construction scheduling meetings • Attended pre -bid meetings and bid openings • Assisted the entire construction team with daily operations The Whiting -Turner Contracting Company, Dallas, TX Project Engineer Intern • Worked on the Parkland Hospital Parking Garage • Created and managed bid packages for specific scopes of work • Managed subcontractor schedules • Managed punch lists • Created weekly reports for the owner • Completed quality control reports • Prepared requests for information • Assisted project team with daily field operations SOFTWARE SKILLS: • Primavera P6 • HCCS Heavybid • Autodesk AutoCAD • Microsoft Office • Spitfire Project Management CERTIFICATIONS: • TWIC Card • OSHA 30 Hour Certification • CPR and First Aid May 2011-December 2011 mmcclain@carlsonmcclain.com (346) 429 1147 Education: B.S. Degree, Construction Science with Urban Planning Minor (GPA: 3.3) Texas A&M University, College Station, TX — 2019 High School Diploma (GPA: 3.6) Klein Oak High School, Spring, TX - 2015 Employment History: June 2022 — Carlson McClain Construction Company LLC Present Houston, TX Chief Operating Officer • Responsible for overall project operations & execution 2020 — Orion Construction LP 2022 Houston, TX Project Manager Matthew McClain Chief Operating Officer • Worked with the Project Management Team and jobsite work crews to ensure the successful completion of on -going or new projects. • Assisted with the estimating and development of bid proposals for upcoming construction and services projects. • Managed project budgets to ensure project margin is met/exceeded. • Kept track with material to ensure procurement from suppliers meets schedule. Inventories, checks, examines and measures materials received to ensure quality and quantity. • Interpreted project plans and specifications and assists with the means and methods to complete the project efficiently. • Assisted the superintendent with day to day activities on jobsite as well as perform necessary tasks given by Project Manager. • Provided work control lines and elevations that are required for accurate measurement and correct installation of materials by crafts, i.e., forms for concrete pours, anchor bolts, piping hangers and supports, etc. • Assisted with survey to check as -built conditions that require the use of surveying techniques. • Provided topographic and cross-section surveys as required by planning and payment quantities and provides quantity calculations as required. • Maintained condition adjustment of surveying equipment. Coordinated surveying activities with the assigned engineer to meet the construction requirements. 2019 — Balfour Beatty Construction 2020 Dallas, TX Project Engineer • Responsible for the structure scope on the EPIC II Uber Regional Headquarters project • Collected, reviewed, and processed submittals related to the structure scope • Created & reviewed RFI's with Engineer for issues/questions to assist with the project • Generated material tracking log for material with lead time • Coordinated the delivery of over 100,000 lbs. of reinforcing steel to project site • Coordinated pre & post meeting logistics • Reviewed subcontractor applications for payment • Oversaw budgettorder tickets for self -performing concrete ordered during the project 2018 — Balfour Beatty Construction 2019 Dallas, TX Project Engineer • Assisted project team on a 26-story high rise (SKYHOUSE Frisco) building in Frisco, Texas • Reviewed submittals / RFI's with the engineer of record • Created and assisted with updating submittal log/RFI log • Lead a variety of meetings for project team • Collected and filed project closeout data and documentation for project • Assisted with responsibilities for HVAC & structural steel subcontractor's on project 2015 — Braemar Engineering Houston, TX Intern • Assisted engineering department with project scheduling • Assisted technical staff with administrative support Experience/Skills Include: • Managing & coordinating subcontractors through a project duration • Steel Pile driving- 24", 36", 48", and 72" diameter heavy steel piles and steel sheet piles over 100 feet long • Pre -Cast Concrete Pile Driving —18" & 36" diameter heavy concrete piles • Cast in place reinforced concrete foundations and piers • Mechanical Dredging • Bulkhead construction and fender installation • OSHA 30 • Transportation Worker Identity Card (TWIC) • Microsoft Office Bluebeam • Procore • BIM360 • AUTOCAD • Spitfire • Heavy Bid • Primavera P6 • Constructware • Texture Software (Accounting) Project List & Job Responsibilities: Indorama Ventures Dock Rehabilitation — Beaumont, TX Design -Bid -Build of an existing dock rehabilitation at the Indorama facility in Beaumont, TX. Project consists of concrete repair work of existing dock, driving steel pipe piles, and the installation of steel jacket structures with beam supports for the existing dock. Approximate Value - $4,500,000 Job Title: Project Manager • Tracked and maintained the project budget + Managed material procurement per approved design • Managed all premobilization submittals and RFI's • Created/implemented an execution plan, quality control plan, and inspection and test plan • Maintained communication between clientlEOR, Orion's PMT, and field personnel to ensure timely resolution of issues • Coordinated material logisitics • Coordinated field activities to ensure safe and timely completion in compliance with design and specifications • Created and maintained project schedules to ensure projects are on schedule, within budget, and in a timely manner • Lead weekly meetings and progress updates • Approved all invoices for payments weekly and ensure they are correctly labeled for accounting and job cost reports • Monitored job site safety to provide a safe work environment to the job site Citgo Clifton Ridge Terminal Barge Dock Repairs — Sulphur, LA Demolition and removal of existing steel pipe pile breasting dolphin and installation of new dolphin monopile as well as miscellaneous repair work on dock. Includes the removal and repair of handrails and plates on the dock. Approximate Value - $250,000 Job Title: Project Engineer Job Responsibilities: • Managed material procurement per approved design • Managed all premobilization submittals and RFI's • Created/implemented an execution plan, quality control plan, and inspection and test plan • Coordinated material logisitics • Created and maintained project schedules Targa New Barge Dock 2B-4B — Galena Park, TX Design -Build consisting of mechanical dredging of approx. 7700 cubic yards of material and installation of 2 new barge docks for the Targa Galena Park Facility. Project includes driving of concrete piles and forming and pouring cast -in -place concrete caps to support both docks, driving steel pipe piles, installing a front face steel/timber fender panels at each dock, and cast -in -place concrete foundations. Approximate Value - $7,000,000 Job Title: Project Manager Job Responsibilities: • Tracked and maintained the project budget • Managed material procurement per approved design • Managed all premobilization submittals and RFI's + Created/implemented an execution plan, quality control plan, and inspection and test plan • Maintained communication between client/EOR, Orion's PMT, and field personnel to ensure timely resolution of issues • Coordinated material logisitics • Coordinated field activities to ensure safe and timely completion in compliance with design and specifications • Created and maintained project schedules to ensure projects are on schedule, within budget, and in a timely manner • Lead weekly meetings and progress updates • Approved all invoices for payments weekly and ensure they are correctly labeled for accounting and job cost reports • Monitored job site safety to provide a safe work environment to the job site Vopak BDK/SDK #1 Monopile Install — Deer Park, TX The removal and replacement of three tri-pod steel piles with three 60" diameter steel monopiles. Includes splicing a pile top and welding on through mooring bit, rubrail, and top bollard on each pile. Approximate Value - $1,100,000 Job Title: Project Engineer Job Responsibilities: • Managed material procurement per design and specifications • Managed all submittals and RFI's • Created/implemented an execution plan, quality control plan, and inspection and test plan • Coordinated material logisitics • Created and maintained project schedules • Coordinated field activities to ensure safe and timely completion in compliance with design and specifications • Coordinated 310 party UT weld testing for splicing connection of piles + Lead weekly progress meetings and maintained production tracking • Maintained communication between client/EOR, Orion's PMT, and field personnel to ensure timely resolution of issues Vopak Firewater Pump Project — Deer Park, TX The installation of (11) 18" diameter steel pipe piles & (4) 24" diameter steel pipe piles to support a few walkway modules as well as a firepump platform at the Vopak Deer Park facility. Scope of work included driving (4) 48" diameter steel protection piles with fender wrap installation and crane support with subcontractor on setting modules and platforms weighing up to 40,OOOlbs. Approximate Value - $600,000 Job Title: Project Engineer Job Responsibilities: • Managed material procurement per design and specifications • Managed submittals and RFI's • Coordinated material and equipment logisitics • Coordinated field activities to ensure safe and timely completion in compliance with design and specifications • Mantained daily field notes and tracked progress throughout project duration • Maintained communication between Orion's PMT, Engineer, and field personnel to ensure timely resolution of issues • Created and maintained 3-week look ahead schedules • Identified and worked to resolve conflicts in the field Westlake Chemical D-Dock New Monopiles — Westlake, LA Design -Bid -Build for the removal of an existing barge slip eighteen pile wood cluster piles and installation of two new barge slip monopiles. Includes installation of (2) steel platform tops on each pile with stairs that run to the dock. Approximate Value - $250,000 Job Title: Project Engineer Job Responsibilities: • Managed material procurement per design and specifications • Managed submittals and RFI's • Coordinated material and equipment logisitics • Coordinated field activities to ensure safe and timely completion in compliance with design and specifications • Mantained daily field notes and tracked progress throughout project duration • Maintained communication between Orion's PMT, Engineer, and field personnel to ensure timely resolution of issues • Created and maintained 3-week look ahead schedules • Identified and worked to resolve conflicts in the field • Performed QA-QC on materials • Created and maintained as-builts • Attended weekly meetings and documented meeting minutes • Tracked and maintained the project budget Ascend Dock Repairs — Alvin, TX Repair work at 5 different dock locations within the Ascend Plant in Chocolate Bayou facility. Includes driving (10) 13 pile wood clusters, rewrapping existing wood clusters, and removing/installing new top bollards on tri-pod dolphins. Approximate Value - $300,000 Job Title: Project Engineer Job Responsibilities: • Tracked and maintained the project budget • Managed material procurement per design and specifications • Coordinated material and equipment logisitics • Maintained daily field notes and tracked progress throughout project duration • Maintained communication between Orion's PMT, Engineer, and field personnel to ensure timely resolution of issues • Identified and worked to resolve conflicts in the field • Performed QA-QC on materials Energy Transfer Partners Dock 2 — Nederland, TX Design -Build for the restoration and extension of the existing dock at the Energy Transfer plant in Nederland, TX. Included installation of a concrete pile / cap pipe rack, breasting/mooring dolphins, and new pile supported loading arm and hose tower foundations. Approximate Value - $7,000,000 Job Title: Project Engineer Job Responsibilities: • Managed material procurement per design and specifications • Managed submittals and RFI's • Coordinated material and equipment logisitics • Coordinated field activities to ensure safe and timely completion in compliance with design and specifications • Mantained daily field notes and tracked progress throughout project duration • Maintained communication between Orion's PMT, Engineer, and field personnel to ensure timely resolution of issues • Created and maintained 3-week look ahead schedules • Identified and worked to resolve conflicts in the field • Coordinated 31d party materials testing • Performed QA-QC on materials • Created and maintained as-builts • Attended weekly meetings and documented meeting minutes Energy Transfer Partners Dock 1 - Nederland, TX Design -Build for the demolition of an existing dock and installation of new ship dock for the Energy Transfer plant in Nederland, TX. Included installation of new fender system, breasting/mooring dolphins, 400 LF of new bulkhead waler system, new pile supported loading arm and hose tower foundations. Approximate Value - $12,000,000 Job Title: Project Engineer Job Responsibilities: • Created and maintained P6 schedule for project duration • Managed material procurement per design and specifications • Managed submittals and RFI's • Coordinated material and equipment logisitics • Coordinated field activities to ensure safe and timely completion in compliance with design and specifications • Mantained daily field notes and tracked progress throughout project duration • Maintained communication between Orion's PMT, Engineer, and field personnel to ensure timely resolution of issues • Created and maintained 3-week look ahead schedules • Identified and worked to resolve conflicts in the field • Coordinated 3ro party materials testing • Performed QA-QC on materials • Created and maintained as-builts • Attended weekly meetings and documented meeting minutes SEE ILL construction SEALED BID Bid Number 2024.7 Magnolia Beach Ocean Drive Bulkhead Cap Replacement Project Deliver to: Honorable Richard H Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3`d Floor Ste 301 Port Lavaca, Texas 77979 Proposer: Geofill Construction DBA Pezzi Construction 720 NAS Drive Corpus Christi, Texas Point of Contact Jan Puente 210-599-3100 ianggeofillconstruction.com 1 original 4 copies IUSB Geoh/l Material Technologies dba Geofill Construction Mailing Address P. O Box 1003, Cibo/o, TX 78108 9900 Doerr Lane, Schertz, TX 78154 210-599-3100 Fax 210-599-3107 N LIC PROJECT NAME: Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement Project DUE DATE: Thursday, May 23, 2024 before 2:00:00 p.m� NAME: BASE WORK SCOPE is Bids are invited for items and quantities of work generally as follows: a new 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. Item Quantity Unit Unit Price Total Bid Price 1. Furnishing all necessary equipment, 1 LS materials, and labor for Mobilization, demobilization, barricades, insurance, and bonds as per plans and specifications ] t' . L3/ (0 , 3c�_ 2. Furnish all necessary materials, equipment 1 LS and labor for the demolition and removal of approximately 482 LF timber cap, 92 tie- back rods and 482 LF timber wailer in accordance with the drawings and specifications., 3. Furnish all necessary materials„ 482 LF equipment, and labor for the installation of reinforced concrete bulkhead cap with periodic PVC drains approximately every 10 ft in accordance with the drawings and specifications. 6� J&&46% 4. Furnish all necessary materials, 482 LF equipment, and labor for the installation of a 3' wide sidewalk alongside the proposed concrete cap with minor grading of the produced cut material in accordance with the drawings and specifications. ir�r• �r �s S�.so 5. Furnish all necessary materials, 92 EA equipment, and labor for the installation of stainless -steel tie -back rods connecting existing Deadman to propose cap in accordance with the drawings and specifications. c,1 °' fa O 6. Furnish all necessary materials, equipment, 482 LF and labor for the installation of a timber wailer in accordance with the drawings and specifications. TOTAL BASE BID $ BID BOND KNOW ALL MEN BY THESE PRESENTS, that we Geofill Material Technologies, LC dba Pea! Construction as principal, hereinafter called the "Principal," and SURETEC INSURANCE COMPANY, as surety, hereinafter called the "Surety," are held and firmly bound unto Calhoun County as obligee, hereinafter called the Obligee, in the sum of a % of the greatest amount bid by Principal for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the principal has submitted a bid for Magnolia Beach Ocean Drive Bulkhead Cap Replacement 488 LF Bulkhead Cap Repair Proj No.: 2024-07 NOW, THEREFORE, if the contract be timely awarded to the Principal and the Principal shall within such time as specified in the bid, enter into a contract in writing or, in the event of the failure of the Principal to enter into such Contract, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. PROVIDED, HOWEVER, neither Principal nor Surety shall be bound hereunder unless Obligee prior to execution of the final contract shall furnish evidence of financing in a manner and form acceptable to Principal and Surety that financing has been firmly committed to cover the entire cost of the project. SIGNED, sealed and dated this 29st day of May 2024 SEAL Geofill Material Technologies, LLC dba Peai Construction (Principal) SURETEC INSURANCE COMPANY BY: Sa dra Garza Attorney -in -Fact POA #: 5334142 SureTec Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company'D, a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Hams County, Texas, does by these presents make, constitute and appoint Sandra Garza its true and lawful Attomey-in-fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for: Principal: Geofill Material Technologies, LLC dba Pezzi Construction Obligee: Calhoun County Amount: $ 150,000.00 and to,bind the Company thereby as fully and to the same extent as if such bond were signed by the President, scaled with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming ail that the said Attorney -in -Fact may do in the premises. Said appointment is made under and by authority of the following resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved that the President, any Vice- President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attomcy(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognirances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate rehiring thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seat shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on AP of April, 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its President, and its corporate seal to be hereto affixed this 3rd day of February, A.D. 2023. OA1111 SURETEC INSURANCE COMPANY By:. Michael C. K imig, Presiden State of Texas ss:County ofIiarris On this 3rd day of February, AD. 2023 before me personally came Michael C. Keimig, to me known, who, being by me duly sworn, did depose and say, that he resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument; that he knows the seal of said Company; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said Company; and that he signed his name thereto by like order. �•.Mr; •,� TANYA SNEEt) f � � �' No },y tary Public State of iexas `�, atH*� Commission#12857123t Commission Fxpires 03/30lT027 r Tony need,Rotary Public My commission expires March 30, 2027 I, M. Brent Beaty, Assistant Secretary of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Company, which is still in full force and effect; and furthermore, the resolutions of the Board of Directors, set out in the Power of Attorney are in full force and effect - Given under my hand and the seal of said Company at Houston, Texas this 21st d< of a / 2024 A.D. M B nt Beaty, Assistant Se retary Any instrument issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call (713) 812-0800 any business day between 8:30 am and 5:00 pm CST. SureTec Insurance Company IMPORTANT NOTICE Statutory Complaint Notice/Filing of Claims To obtain information or make a complaint: You may call the Surety's toll free telephone number for information or to make a complaint or file a claim at: 1-866-732-0099. You may also write to the Surety at: SureTec Insurance Company 9500 Arboretum Blvd., Suite 400 Austin, TX 78759 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at 1-800-252- 3439. You may write the Texas Department of Insurance at: PO Box149104 Austin, TX 78714-9104 Fax#.,512-490-1007 Web: http://www.tdi.texas.gov Email: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIMS DISPUTES: Should you have a dispute concerning your premium or about a claim, you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. Texas Rids 8/2019 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 482 LF Ocean Drive bulkhead cap replacement. The structure of the 'bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. 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 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement 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 4c�% 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: 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 NE Address: Phone: / D h`% % (3.4),o EIN or Tax ID No.: , - IZ%& �?%,)'3 Signature: Name and Email Add 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 desir s. %�c-cze G ?�Zl Nam�of Bidd y Date Organized:�� Address: Date Incorporated: Number of Years in contracting business under current name: -)e) 61 CONTRACTS ON HAND: � Contracts Dollar Amount Completion Date / d Type of work performed by your company: Have you ever failed to complete any work awarded to you? '9 Have you ever defaulted on a contract? /tjv List the projects most recently completed by your firm (include project of similar importance): Project Dollar Amount MoNr Completed 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 $ Bank available: % r'Yf reference:p, The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the A�/iitc.' in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this- d y of - 2` * by: (Signs re) (Title) PEZZI CONSTRUCTION CONTRACTS ON HAND: 1) Address: 13729Three Fathoms B; Corpus Christi Work: 60' 5" Cap Repair Install new Fiber Rods —replacing old rebar Cost: $7260 PCD: May 15-17, 2024 2) Address: 13830 Mizzen St; Corpus Christi Work: Retaining Wall Build Cost: $26,000 PCD: June 10-14 3) Address: 3319 Jamaica; Corpus Christi Work: Retaining Wall Build Cost: $23,956 PCD: ?? 4) Address: 15373 Yardarm Court; Corpus Chrisi Work: 120' Cap Repair Install new Fiber Rods —replacing old rebar Cost: $9600 PCD: July5-7 *PCD — Proposed Completion Date JOBS MOST RECENTLY COMPLETED 1) Address: 13734 Hawksnest; Corpus Christi Work: 13 Manta Rays installed Cost: $15,600 DOC: November2023 2) Address: 13781 Eaglesnest; Corpus Christi Work: 7 Manta Rays installed Breakouts and Patchbacks Cost: $12,575 DOC: February 2024 3) Address: 13750 A La Entrada; Corpus Christi Work: 11 Manta Rays installed 18' Cap Repair 6' Full Cap Repair Fiber Rods & Stirrups installed- replacing old rebar Cost: $20,525 DOC: February2024 4) Address: 15206Isabella Ct; Corpus Christi Work: 94' Cap Repair Fiber Rods & Stirrups installed - replacing old rebar 9 Screens replaced Cost: $13,965 DOC: Apri12024 5) Address: 13830 Mizzen St; Corpus Christi Work: 93' Cap Repair 3' Full Cap Repair Fiber Rods & Stirrups installed - replacing old rebar 6 Screens replaced Cost: $14,007 DOC: Apri12024 *DOC - Date of Completion LORENZO HERNANDEZ PROFESSIONAL BIOGRAPHY SE0 ILL PRODUCTION MANAGER construction Phone # - 210-995-5355 Email - lorenzo@geofillconstruction.com Geofill Construction 2006 to present Production Manager 2019-present, Project Manager 2016-2019, Superintendent 2006-2016 Lorenzo works as our Production Manager overseeing the success of construction projects ranging from ground up new construction to building alternations, rehabs, and renovations. Lorenzo utilizes his extensive, well-rounded background in coastal, multi -family, commercial, private, government and institutional construction. He provides direction and support to the Project Team while ensuring efficient productive projects that meet building requirements, quality standards and owner's expectations. Lorenzo has a long- standing reputation of delivering large scale construction projects to owners on time and within budget. His ability to connect with Owner's, Professionals, the Construction Team, and Subcontractors make him a huge asset to all our projects at Geofill. Professional Responsibilities Lorenzo has over 15 years of construction management experience and a keen ability in reading blueprints and resolving constructability issues. A few of his key responsibilities are, ✓ Participates in Pre -Con Kick off Meetings for ✓ Assists Team in establishing overall Work smooth production hand off. Plan for portfolio projects. ✓ Ensures output meets quality standards. ✓ Risk Mitigation Plans ✓ Enforces health and safety precautions. ✓ Budget Reviews ✓ Participate in Project Close Out Reviews ✓ CPM schedule review for projects ✓ Management/Supervision/Coordination of Project Managers & Superintendents Key Clients City of Aransas Pass Sherwin Williams Foresight Management City of Corpus Christi Starr Properties United Apartment Group City of Rockport University of Texas- Marine Science San Antonio Housing City of San Antonio Institute Authority Nueces County Venterra Living Seguin Housing Authority Sampling of Projects INSTITUTIONAL • UT Texas MSI - Lund VIP House. 3300 sq foot new construction, utilities, paving,concrete columns, timber framing, storefront wall, MEP and finish out. • UT Austin MSI UT Austin-MSI Job Order Contract)-33 coastal projects of various sizes and scopes ranging from new construction of Aviary, campus wide spalling project, Wetland restoration, Green House Lab renovation, Wet Lab Renovations, drainage project, interior & exterior restorations. • UT Austin MSI Beach Street Dorm Renovation- elevated structure -complete demo, two story restoration, new framing, MEP, interior finish out, store fronts, spalling repair, exterior paint. MULTIFAMILY • Avistar at Copperfield Burn Building New Construction. 6000 sq ft slab up, wood framing, MEP, utilities, finish out, drainage, paving • Refugio Place- New Metal Roofing at complex • Avistar Crest Apartment Burn Building New Construction. 31,000 sq ft living space rebuilt, slab, wood framing, MEP, finish out. • Oak Hollow Apartments Rehab-43 multi -story building, exterior renovation • Laurel Crossing Apartment Complex Rehab • Southshore Apartment Complex -Exterior Paint & Rehab • Avistar Boulevard Apartment Fire Rebuild-14,000 sq ft ground up reconstruction. GOVERNMENT • Travis County Parking Garage- SicallingRepair —6level repairs ofstructure • Horace Caldwell Observation Deck -New Construction-3000 sq ft, elevated concrete structure, 32 ft deep concrete piers, wood truss structure, MEP and finish out. City of Residence: Natalia OSHA RESPIRATORY OSHA 30 OSHA SCAFFOLD OSHA COMPETENT PERSON BI-LINGUAL SPANISH OSHA EXCAVATION RICHARD YORK GOe= /LL SUPERINTENDENT construction Phone # 361-249-0118 Email-workorder@pezziconstruction.com Geofill Construction dba PEZZI Construction -Superintendent (2020 to Present) Oversees day to day construction safety progress and activities at work site. KEY RESPONSIBILITIES • Works within budget guidelines • Conducts Progress Meetings with Owners, Subcontractors • Participate in Pre -Con Kick Off Meetings for smooth production hand off • Ensure quality control measures. • Ensures out\put meets quality standards. • Enforces health and safety precautions. • Comply with jobsite reporting requirements including daily reports and 3 weeks look ahead schedules. • Maintain Clean Job site. • Participate in Project Close Out • Assists Project Manager with Project Plan • Reviews all plans, specifications & general conditions. • Responsible for job start up processes, mobilization efforts, permits temporary facilities. • Responsible for overall progress & execution of project • Directs & Coordinates scheduling according to critical path schedule. • Conduct weekly subcontractor meetings. • Advise PM of CPM schedule updates, changes & delays • Collect Subcontractor Certified Payroll Notable Completed Projects Assigned or Co -Assigned to Pezzi 13750 A La Entrada Corpus Christi 18 ft Bulkhead Cap Repair & 6 ft Full Bulkhead Replacement, Fiber Rods and Stirrups 15206 Isabella St Corpus Christi 96 ft Bulkhead Cap Repair Fiber Rods and Stirrups, 9 screens 13830 Mizzen St Corpus Christi 93 Ft Bulkhead Cap Repair & Replacement, 6 screens 13734 Hawkensnest Corpus Christi 13 Mata Rays installed 13781 Eagles nest Corpus Christi Breakouts and Patchbacks Current repeat clients Padre Island Property Owners Association Cane Harbor Homeowners Association CCC Group Employment Superintendent and Lead Foreman • Standford Hobby Barge Project $800M • Hercules Project Gulf Marine Rigg -Lead Foremen $100M Certifications TWIA Card Heavy Equipment Operator Journeyman Electrician OHSA 10 vcuri« CONSTRUCTION About Pezzi MOWI&ON&WE Geofill Construction proudly acquired Pezzi in May 2023. Founded in 2009 by local entrepreneur John Pezzi, Pezzi specializes in high -quality bulkhead construction. We are proud to have retained the original Pezzi employees, ensuring continuity and preserving the local expertise and dedication that clients have come to trust. This acquisition combines our advanced expertise with Pezzi's strong local heritage enhancing our ability to deliver superior solutions and service to our clients. Services • Bulkhead Design and Construction • Bulkhead Repair and Maintenance • Seawall Installation and Repair • Erosion Control Solutions • Retaining Wall Construction • Dock and Pier Construction • Shoreline Stabilization • Marine Construction Consulting • Permitting Assistance • Inspection and Assessment Services STATE OF TEXAS 0 AFFIDAVIT COUNTY OF 44eZ,2,d2 0 <r"Jc- 3f l�aufg-) being first duly sworn, deposes and says: that he or she is )Type or Print Name) „Y theof IaO, 1 (Type or Print Title) (Type or Print Name of Company/Firm) principal address at �aJ` AA�%s'Lk�La-Q1 (Type or Print Mysi�d 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. S gnatui e o kff!ant 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 /.J� day of 4 d* 2042X. BRITNI JOHNSON ?%•''"' No P fate of Texas ) gaF0,%M a� Sign ture of Notary IN. r: omm. x 'Eav Aires 09-01-2024 3 muO Notary ID 12692189 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) �l CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. J2' Yes ❑ No The undersigned hereby certifies that: jd 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. �J The Equal Employment Opportunity clause is included in the Contract (if bid equals or exceeds $10,000). 'Ef The Affirmative Action for Handicapped Workers clause is included in the contract. ,p"` 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 2rNo NAME AND TITLE OF SIGNER (Please type) SIGNA,TURE DATE 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, goads, 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 ore 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 related to 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 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. 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. 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 required in box fl4 regardless of any other entry on the form. A copy of Chapter 176 of the Texas Local Government Code can be found at: http://www.statutes.loois.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 bXjsiness 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.) 3. Name of local government officer with whom filer has employment or business relationship. All - 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 7 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 Z 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 ET No D. Describe each employment or business relationship with the local government officer named in this section. n1%,4 4. Signature of person doing business with governmental Date Signed 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 parry 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. 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 Comiittee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and government -wide minimum due process procedures, and set forth other related details for the effective administration of the guidelines. Sec. 7. The Director of the Office of Management and Budget shall report to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a certification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This certification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to participate in the project. Contractors, on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification. d. Have not within a three-year period preceding this application / proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (1) (a— d) of this certification. Name_and Title bf Authorized Agent ignature of Authedzed Agent I am unable to certify to the above statements. My explanation is attached. Date 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, ?fit` , 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. r /S' ature of Contractor's Authorized Official Authorized Official 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 farm, 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 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, Ml): (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Print Name: was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Title: 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.: 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) ow, HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 851h Texas Legislature approved new legislation, effective September 1, 2017, which amends Texas Local Government Code Section 1, Subtitle F, Title 10, Government Code by adding Chapter 2270 which states that a government entity may not enter into a contract (which includes contracts formed through purchase orders) with a company for goods or services unless the contract contains a written verification from the company that it: 1) Does not boycott Israel; and 2) Will not boycott Israel during the term of the contract Pursuant to Section 2270.001, Texas Government Code: 1. "Boycott Israel' means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and 2. "Company" means a for profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. I, (authorized official) do hereby verify the truthfulness and accuracy of the contents of the statements submitted on this certification 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 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 Stata) D I certify that 0.PV ('li %Y`iCG 1(Jii --is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. Signature 06orizen{ Printed Name and Title of Authorized Agent Date SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The 'AP—ZZi 67�C h& C 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) 7s3/ /1%t25 County State Zip Telephone Number (o10) - (3/& Voice ( ) TDD c'°g� ?(�I: 1 'dttl. l 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 Lase updated by Sheila Karam m Mar 29, 2024 at 12:23 PM I.SAM,00v® GEOFILL MATERIAL TECHNOLOGIESLL.C. GEOFILL MATERIAL TECHNOLOGIES L.L.C. Unique Entity ID NJHJKKX16XZ8 Registration Status Active Registration Physical Address 9900 Doerr LN Schertz, Texas 78154-9402 States CAGE/NCAGE 6XSQ0 Expiration Date Mar 29, 2025 Mailing Address 9900 Doerr LN Schertz, Texas 78154-9402 United States Purpose of Registration All Awards Doing Business as Division Name Division Number Geofill Construction (blank) (blank) Congressional District State / Country of Incorporation URL Texas 21 Texas I United States hftps://www.goofiilloonstructlon.com/ Registration Dates Activation Date Submission Date Initial Registration Date Apr 12, 2024 Mar 29, 2024 Jul 20, 2020 Entity Dates Entity Start Date Fiscal Year End Close Date Jun 4, 2004 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 parodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue 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 $5,000, or other acknowledgment of fault; and/or (3) administrative proceeding resulting in a finding of fault with either a monetary fine or penalty greater than $5,000 or reimbursement, restitution, or damages greater than $100,000, or other acknowledgment of fault? Not Selected Page I of3 Active Exclusions Records? Entity Structure Corporate Entity (Not Tax Exempt) Profit Structure For Profit Organization Socio-Economic Types Veteran -Owned Business Entity Type Business or Organization Organization Factors Limited Liability Company Check the registrant's Reps & Cents, if present, under FAR 52.212-3 or FAR 52.219.1 to determine If the entity is an SBA -certified HUBZone small business concern. Additional small business information 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 CAGE Code 0000 6XSQ0 Electronic Funds Transfer - Account Type Routing Number Lock Box Number Checking "*`""'93 (blank) Financial Institution Account Number FROST BANK Automated Clearing House Phone (U.S.) Email Phone (non-U.S.) 7608985262 (blank) (blank) Fax (blank) Remittance Address GEOFILL MATERIAL TECHNOLOGIES L.L.C. 9900 Doerr Lane Schantz, Texas 78154 United States EIN -TM 2723 Tax Year (Most Recent Tax Year) 2019 Address 9900 Doerr Lane Schertz, Texas 78164 Accounts Receivable POC 0 Melissa Ones[, Accountant melissa@geofillconstruction.com 2105993100 May20, 202409:25:49PMGMT Baps://sa.gov/entiry/NJHJKKX16XZ8/coreData?status=nail Type of Tax Applicable Federal Tax Namelfitle of Individual Executing Consent Owner Signature Henry J Karam Taxpayer Name Geoflll Materials Technologies IIc TIN Consent Date Mar 29, 2024 Page 2 of3 Las„pdwt d by Sheila Kmam on Mar 29. 2024 at 12:23 PM GEOFILL MATERIAL TECHNOLOGIES L.L.C. Electronic Business R 9900 Doerr Lane Jan Puente, Manager Schertz, Texas 78154 jan@geofillconstruction.com United States 2105993100 Government Business £ 9900 Doerr Lane Jan Puente, Manager Schertz, Texas 78154 jan@geofillconstruction.com United States 2105993100 Sole Proprietorship POC P. Melissa Onset, Accountant melissa@geoSllconstruction.com 2105993100 NAICS Codes Primary NAICS Codes NAICS Title Yes 236220. Commercial And Institutional Building Construction 236116 New Multifamily Housing Construction (Except For -Sale Builders) 236118 Residential Remodelers 236210 Industrial Building Construction IGT Size Metrics Annual Revenue (from all IGTs) (blank) Worldwide Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR $18,000,000.00 121) 49 Location Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR (blank) 121) (blank) Industry -Specific Barrels Capacity Megawatt Hours Total Assets (blank) (blank) (blank) This entity did not enterthe EDI information Yes, this entity appears in the disaster response registry. Bonding Levels Dollars (blank) (blank) States Counties Metropolitan Statistical Areas Florida (blank) (blank) Louisiana Texas May 20, 2024 09:25:49 PM GMT hops:llsam.govlentityNJHJKKXI6=lcomDam?status=null Page 3 oj3 on PROJECT NAME: Bid Number 2024.07 — Magnolia Beach — Ocean Drive Bulkhead Cap Replacement "'Project DUE DATE: Thursda Ma 23 2024 before 2:00:00 .m. NAME: IrS L BASE WORK SC�s are invited for items and quantities of work generally as follows: a new 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. Item Quantity Unit Unit Price Total Bid Price 1. Furnishing all necessary equipment, 1 Ls materials, and labor for Mobilization, C 4 demobilization, barricades, insurance, and do2f , bonds as per plans and specifications 2. Furnish all necessary materials, equipment 1 LS and labor for the demolition and removal of approximately 482 LF timber cap, 92 tie --- back rods and 482 LF timber wailer inoou . accordance with the drawings and specifications. 3. Furnish all necessary materials, 482 LF equipment, and labor for the installation of 4 reinforced concrete bulkhead cap with periodic PVC drains approximately every 10 ft in accordance with the drawings and specifications. 4. Furnish all necessary materials, 482 LF �G equipment, and labor for the installation of 3' I a wide sidewalk alongside the proposed concrete cap with minor grading of the produced cut material in accordance with the drawings and specifications. 5. Furnish all necessary materials, 92 EA equipment, and labor for the installation of stainless -steel tie -back rods connecting b t existing Deadman to propose cap in accordance with the drawings and specifications. 6. Furnish all necessary materials, equipment, 482 LF and labor for the installation of a timber �,I wailer in accordance with the drawings and specifications. � TOTAL BASE BID 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 482 LF Ocean Drive bulkhead cap replacement. The structure of the bulkhead cap replacement will be a 24"x18" concrete cap and an adjacent 3' sidewalk. The other components of the bulkhead cap replacement project will be periodic PVC drains that transverse through the concrete cap, minor grading of the site to accommodate the improvements, installation of new deadman tie -back rods and the replacement of existing timber whalers. 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 forbids for Bid Number 2024 07 - Magnolia Beach Ocean Drive Bulkhead Cap Replacement 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 l 0 consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $300.00 for each consecutive calendar day. i hereby acknowledge the receipt of the following addenda: 1. (1/Ah 2. zA SUBCONTRACTORS. The undersigned BIDDER proposes that he will be responsible to perform major portions of the work at the project site with his own forces and that specific portions of the work not performed by the undersigned will be subcontracted and performed by the following subcontractors. The undersigned hereby declares that he has visited the site to the work covered by the above bid. Bidder N. Address: Phone: — 1 _� - Z2Z EIN or Ta.N { Signature: Name and Email Add BID BOND ( KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Shirley & Sons Construction Co., Inc. r- %,as PRINCIPAL, and Harco National Insurance Company , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Owner", in the penal sum of Five Percent of the Greatest Amount Bid Dollars, ($ 5% G.A.B. ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated May 23, 2024 , Bid Number 2024.07 - Magnolia Beach — Ocean Drive Bulkhead Cap Replacement 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 23rd day of May. 2024 , the name and corporate seal of each corporate party being % )ereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. (SEAL) Shirley& Sons Constructi o- Inc. Attest: By: (SEAL) nal , R. hirley, II, President Affix Corporate Seal Attest: By: Affix Corporate Harco National nsurance Company Seal Attest: By: / �^ N. Berry, ttor n-Fact Countersigned By i` I/ a N. Berry Attorney -in -Fact, State of T xas CERTIFICATE AS TO CORPORATE PRINCIPAL \�I G. D. Shirley , certify that I am the Secretaryof the Corporation named as Principal In the within bond; that Ronald R. Shirley. II 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: 4DLhirley, Secretary • Power -of -attorney for person signing for Surety Company must be attached to bond. Bond # N/A POWER OF ATTORNEY HARCO NATIONAL INSURANCE COMPANY INTERNATIONAL FIDELITY INSURANCE COMPANY Member companies of IAT Insurance Group, Headquartered: 702 Oberlin Road, Raleigh, North Carolina 27605 KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and appoint JAMES N. BERRY 1:571IMT.T11111110.1 their true and lawful attomey(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instmment(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018. "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attomeys4n-Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed:" IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY have each executed and attested these presents on this 31st day of December, 2018 ,'•"� tNStJg u4xi STATE OF NEW JERSEY STATE OF ILLINOIS + QtcO0194County of EssexCounty of CookL & ,ONOKenneth Chapman ''•.;%/�.."" 1 Executive Vice President, Haroo National Insurance Company �'"'�• ••"` and International Fidelity Insurance Company On this 31 at day of December, 2018 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written. JAmt4a. Shirelle A.Outley a Notary Public of New Jersey My Commission Expires April 4, 2023 CERTIFICATION I, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. �(N TESTIMONY WHEREOF, I have hereunto set my hand on this day, May 23, 2024 A02198 VAS 1 Irene Martins, Assistant Secretary IMPORTANT NOTICE To obtain information or make a complaint: You may contact Harco National Insurance Company at: 1-800-333-4167 You may also write to: Harco National Insurance Company c/o IAT Surety at: Attn: Claims Department One Newark Center, 201' Floor Newark, NJ 07102 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1-800-252-3439 You may write the Texas Department of Insurance: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 490-1007 Web: www.tdi.texas.2ov E-mail: ConsumerProtection(i�tdi.texas.eov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent or the company first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR BOND: This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE Para obtener informacion o para presentar una queja: Usted puede comunicarse con so Harco National Insurance Company al: 1-800-333-4167 Usted tambien puede escribir a Harco National Insurance Company c/o IAT Surety at: Attn: Claims Department One Newark Center, 201e Floor Newark, NJ 07102 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companies, coberturas, derechos o quejas al: 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas: P. O. Box 149104 Austin, TX 78714-9104 Fax:(512) 490-1007 Web: www.tdi.texas.gov E-mail: ConsumerProtection(a)tdi.texas.sov DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una dispute concerniente a su prima o a on reclamo, debe comunicarse con el agente o In compania primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI). UNA ESTE AVISO A SU FIANZA DE GARANTIA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. ACERTIFICATE OF LIABILITY INSURANCE OATEN"'�" 06114=4 THIS CERTICERTIFICATE DOE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO ROWS 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 BETYlEEN THE ISSUING MU.--. Q, AUTHOIt1iED REPRESENTATIVE OR PRODUCER. AND TN@('WWTTBh�Arew f.. the terms and conditions of tire policy, BERRY INSURANCE AGENCY P. O. BOX 130626 HOUSTON, TX 772IM25 INSURED may require an endorsement. A atatenu d on this osNReate does SHIRLEY 8 SONS CONSTRUCTION CO., INC. P.O. BOX 429 CLEVELAND.TX 77328.0429 OR OTHER DOCUMENT WITH RESPECT TO S DESCRIBED HEREIN 18 SUBJECT TO ALL A - ,.., --� .. 8 C CLASMINA a U OCCUR Y Y oEmAooREOATaUMnAPPUESPER POLILw X � Loc Auroaoau.etwlun X ANYAUTO A �OwNED AUTOS EO Y Y X HIREDAUTOS X r�rorr ED X UNBFMAAUAe X anomLLOB CLAINISMADE Y Y D IN WORM= COWeNSATNW AND EMPLOYERS LWOW" YIN �PICERRrMRExotu� ❑N NIA Y Memoey m NIB 72SOM251205 73AP8008579 F74274232MAR 05/2612023 04/30/2024 05/25/2023 NEDEW " 06/26/2024 PERSONALaADWOUM CENERALAOOREOATE PRODUCTS-OONPJOPADR EDV BODILY INJURYryZI—) 04/301202B BODILY NUURY(Par ocieM) 05f25=4 ,gGREGAo s 5.000 a 1.00%000 s 2,000,000 a 2,000,000 a 1.000.000 a a s a a B4O000� D 0002022422 f0f21/2023 X M 10121/2024 ELEACHAcaDENr t 1,000000 E I LCONTRACTORS POLLUTION I Y I Y I CPLMOL117M 05/25/2023105/26/2024I Each Pollution CorWltloo LhnO: SZA00.000 Ref: 000MOdwStilkheadCa.._.-...-------.'.•_•.•••••••••••••`•'•,,•,p'we�Peennymml P ReptecemeM Project Certleate Holder and any Other panties or Entitles are Included as Additional lmuned for both ongoing and Completed operations wtih pdroary 3 non. oonMlwMry wording, 30•Day Notice of Canceregan or MeWW Change and Waiver of Subrogation on a blanket basis as required by wdtien agreemam. CALHOUN COUNTY 211 SOUTH INN STREET, SUITE 301 PORT LAVACA, TX TWO SHOULD ANY OF E ABOVE BEKREBEB POLICIES BE CANCELLIEB BEFORE THE ONRATON�DATE ORBOP. NOME WILL DE DELIVERED IN ACCORDANCE WITH THE POIXYPROVIBNNiS. The ACORD name and logo are registered marks of ACORD 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:.Sk1dz'J t-�w.S C 1;SfMLi,�� ^�' Date Organized: +11-1 Address: ,I1-1 Date Incorporated: '`l e�1)32 Number of Years in contracting business under current name: l b CONTRACTS ON HAND: Contracts Dollar Amount Completion Date r2Uz Type of work performed by your company: M� ,Y,� x Gk*,Cyy Have you ever failed to complete any work awarded to you? Nd Have you ever defaulted on a contract? 04) List the projects most recently completed by your firm (include project of similar importance): ( ?roject I Dollar Amount Mo r Completed `._ A")* (iJ �lUb��l a--1 v,,I I ,-) Rh L+Lq bn V-1Q4 2.1u v,,1 14i 1 Major equipment available for this contract: `-It' 'EPlv4,W, (41-1 �Udkf, 3�3SWO<S�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 available: $ Bank 1) obt) reference: r Inn I The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Oto"e,( in verification of the recitals comprising this Statement of Bidder's Qualifications. Executed this T3 day of 20�1 pp by: (Signature) (Title) STATE OF TEXAS {} AFFIDAVIT COUNTY OF , {} being first duly sworn, deposes and says: that he or she is the p(T pe or Print N e) f I ies"AV1I}VuLt1Gt1 �i. C, having its (Type or Print itle) I(Type or Print Name of Comy�ny/Firm) principal address atjeue�uwi (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 a or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and require e s contained in the bid/proposal. Signature fiant n P inted Name and Tilde of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are t bis day of Zp, zoi,>.?Y °LAURAC.LEONARD NOTARY PUBLIC IDA 10831264 ;+ •..,.: ++. State of Texas `.:R....... Comm. Exp. 04472025 Notary Stamp/Seal 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) C 4,Co. mac. CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. 2 Yes ❑ No he undersigned hereby certifies that: he 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 xceeds $10,000). he Affirmative Action for Handicapped Workers clause is included in the contract. 2CST e Exhibit B — Assurances for Construction Programs is included in the Contract. he 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 mended? ❑ Yes NAME AND TITLE OF SIGNER (Please type) SIGNATURE DATE �� ;---Z1-2Ll 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 $2501n 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 related to 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 ?r response to a request for proposals or bids, correspondence, or another wilting related to a potential agreement with a County, or (c) becomes )ware 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. 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 flied 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. 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 Government Code by a person who has a business relationship as defined Date Received 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 erson doi g business with local governmental entity.7 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 71h business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3. Name of local government officerxi twhom 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 lZyeceive taxable income, other than investment income, from the filer of the questionnaire?❑ Yes 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 0-, No C. Is the filer of this questionnaire employed by a corporation or other business tity with respect to which the local government officer serves as an officer or director, or holds 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 en ity Date Signed Z 2 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 all individual as a personal entitlement, or Federal employment. 1( Sec. 2. To the extent permitted by law, Executive departments and agencies shall: (a) Follow government -wide criteria and government -wide minimum due process procedures when they act to debar or suspend participants in affected programs. (b) Send to the agency designated pursuant to Section 5 identifying information concerning debarred and suspended participants in affected programs, participants who have agreed to exclusion from participation, and participants declared ineligible under applicable law, including Executive Orders. This information shall be included in the list to be maintained pursuant to Section 5. (c) Not allow a party to participate in any affected program if any Executive department or agency has debarred, suspended, or otherwise excluded (to the extent specified in the exclusion agreement) that party from participation in an affected program. An agency may grant an exception permitting a debarred, suspended, or excluded party to participate in a particular transaction upon a written determination by the agency head or authorized designee stating the reason(s) for deviating from this Presidential policy. However, I intend that exceptions to this policy should be granted only infrequently. Sec. 3. Executive departments and agencies shall issue regulations governing their implementation of this Order that shall be consistent with the guidelines issued under Section 6. Proposed regulations shall be submitted to the Office of Management and Budget for review within four months of the date of the guidelines issued under Section 6. The Director of the Office of Management and Budget may return for reconsideration proposed regulations that the Director believes are inconsistent with the guidelines. Final regulations shall be published within twelve months of the date of the guidelines. Sec. 4. There is hereby constituted the Interagency Committee on Debarment and Suspension, which shall monitor implementation of this Order. The Committee shall consist of representatives of agencies designated by the Director of the Office of Management and Budget. Sec. 5. The Director of the Office of Management and Budget shall designate a Federal agency to perform the following functions: maintain a current list of all individuals and organizations excluded from program participation under this Order, periodically distribute the list to Federal agencies, and study the feasibility of automating the list; coordinate with the lead agency responsible for government -wide debarment and suspension of contractors; chair the Interagency Committee established by Section 4; and report periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order. Sec. 6. The Director of the Office of Management and Budget is authorized to issue guidelines to Executive departments and agencies that govern which programs and activities are covered by this Order, prescribe government -wide criteria and govermnent-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 tine Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate farther 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 fiends. 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 sinrilar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of certifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his / her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (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. -ALY"'10 S�ydp-1 omSlb o J Name and Title of Authorized Agent Signature of Authorized Agent S-U 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, i ^fie 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. 1 Signature of Contractor's Authorized Official lei Printed Name and T tle of Contractor's Authod. 5-23-z�1 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. / ? 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 this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, aperwork Reduction Project (0348-0046), Washington, DC 20503 Approved by OMB Disclosure of Lobbying Activities 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (..RP.P. rPVPr4P fnr nl lhlir hi rAcn Type of Federal Action: contract 2. Status of Federal Action: 3. Report Type: F (Driltial filing b. grant b. material change c. cooperative bid/offer/application ement b. initial award d. loan c. post -award e. loan guarantee f. loan insurance 4. Na a 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: ID,o. tud-A TX-n3'tf; 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, Ml): (last name, first name, Ml): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This SignayeJ� disclosure of lobbying activities is a material fu //66 !! representation of fact upon which reliance was placed by the tier above when this transaction I Q A�i� was made or entered into. This disclosure is Print Name: J required pursuant to 31 U.S.C. 1352. This L information will be reported to the Congress Title: YQS,w I semi-annually and will be available for public inspection. Any person who fails to file the �/ Telephone No.: �3' Z21- IVY Date: `23 - Ll 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: "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) _200Ad SkI1 r1 Pam' , 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 phr) Company Name iature of Authorized Official Printed Name of Authorized Official -D- Title of Authorized Official Date l RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 erseq., 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 (Compmy Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (Cin•and State) 9 1 certify that -t S Si �( is a Resident Bidder" of Texas as ( bmpany Name) defined in Government Code §2252.001. 4ZZ Signature of Authorized Agent (&a��,S�ly�Pl f V\6(I JP or Printed Name and Title of Authorized Agent S Z's - Z Date ,—,SECTION 504 CERTIFICATION 'OLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The Ir)j does admission or access to, or treatment or employment in, (Name) (Address) not discriminate on the basis of disability status in the its federally assisted programs or activities. �L , At) U,H Sir County k State Zip Telephone Number ( -11)) 'L - W_ Voice II (- 164'1 TDD 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 5/21124, 2:05 PM SAM.gov I Entity Workspace An official website of the United States government Here's howyou know y Important Reps and Certs Update Show Details x Marl, 2024 Entity Validation Processing Show Details X May 15, 2024 SAM*oov® Home Search Data Bank Data Services Help Entity Workspace Show Workspace For Non -Federal Entities Keyword Entity Status Work in Progress Registration O Submitted Registration t2 Active Registration OInactive Registration IDAssigned r Pending ID Assignment Expiration Date =SeeAlerts 0 00 El Get Started •, v httns://sam.gov/workspace/em/entities/non-federal?statusCode=4 1/3 5/21124, 2:05 PM FSD Number Address Update 1 of 1 Results per page i 25 SAM.gov I Entity Workspace SHIRLEY & SONS CONSTRUCTION CO., INC. Active Registration Unique Entity ID: Doing Business As: Purpose of Registration: KPIKEPZY7H21 SHIRLEY&SON AllAwards CONSTRUCTION CO INC CAGE/NCAGE 03EAl Physical Address: 15705 Hwy 787 West CLEVELAND, TX 77328 USA Feedback Our Website Our Partners About This Site Acquisition.gov Our Community USASpending.gov Release Notes Grants.gov System Alerts More Partners Policies Customer Service Terms of Use Help f Privacy Policy Check Entity Status Restricted Data Use Federal Service Desk Freedom of Information Act External Resources v v Reset 0 Sort by Expiration Date Ascendine Expiration Dote Mar 6, 2025 httos://sam.gov/workspace/em/entities/non-federal?statusCode=4 2/3 . 5121/24, 2:05 PM Accessibility SAM.gov I Entity Workspace Contact G S`k As WARNING This is a U.S. General Services Administration Federal Government computer system that is "FOR OFFICIAL USE ONLY." This system is subject to monitoring. Individuals found performing unauthorized activities are subject to disciplinary action including criminal prosecution. 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. Z�AM9 ov An official website of the U.S. General Services Administration httos://sam.gov/workspace/em/entities/non-federal?statusCode=4 3/3 # 29 NO] ICE OF MFF.-FING — 6/05/2024 29. Consider and take necessary action to approve of the Infrastructure Development Plat (IDP) of Jery Edgett Commercial RV Development and if approved, authorize the County Judge and Commissioner Hall to sign the IDP. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall,`Lyssy, Behrens, Reese Page 26 of 28 E S pa eei a�3 0 ®£ a ar3 a a sr m e a S'F 'qRm S a;e 3 F A 6qS 6 O $ Ea q 8 (saes or eEaaixo) 28 Sa 9 6 43L�4 �3 fzF'Id Is Iss R POND 111H, asa�os'si^s 'raB.09' ;�'yi�a• 4 s- �yN a spa a Eta re 9 es w,{ d{ r F s: EA o np € C �sY � � � 3rf•ry � e � �e am `acIso . Im 91 k 5 � : B�Ts �€� § $ : ^�€y : "s c ' HI w €fish � is u pp g gsAIM �Ho��a [[[ay�s�� s 4�9gIE?"z�e"F� �4 1.%pm� 'ea Min 9 �9TOR 'AW 4E6�?®HUM d� �369 8 8eS A£g.go p YSA -PIB I qIM ho Fyi ENV � o Rao a 19=1 E 9 50g��f i �Em�gg �g F9e� S��qp 33 JERY EDGETT. COMMERCIAL RV *_�= s=ea�rea e�-an.e N.=. 1-o11 r DEVELOPMENT ee CJ & w ENGINEERS. # 30 NOT ICE OF MEETING — 6105/202.4 30. 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 27 of 28 I 0 z W O O N Z z z 9� 00 zz e rn rn N w � a a aw0 wLU 0z og 0W 80 Ln a � CO m C w Mp wl OI N w� F Z O v a Z = C use �a� fA M i9 L" d' 00o O _M N N W 000 0 -W 7 Q OC o. 2W aZi a a =H W i N �> C =W rz z < =H a ui =_J g =a z z W z =W f �ooR v =� 7 z =W a =W Z z -=1 3 0 0 _W G u+ 0 W W ua o = UJ O = �0J C J =Q LU z C a 4a =Z ` O v z =W LL O H =� W Z N M__� 1121 0=W0 0 s 6 a 0 0 ;O ;z iW i� d W c M f0 o M N M N O N io�ro n m � Lo N N � 0 0 0 0 0 0 0 0 0 Wp WHJ ER fA di to fA Z �i i eS i- HH zzzzz � 9 9 � 9 O OOO(7 00000 z z z z z e a 0 rn M 0 0 m m m m W N N N z z w o w X coa U o7 OE z Q E O a a0 z N w 2 =O 2 w w ~ w O U w V O 1- M > H m M r ooNu�NooN t, N co co w 0 0 ro J Q F O F- V1 w U K w y J U O W U z w 2 w 2 W i z z 99 00 z z rn rn O !A 0 w J Q F O F U Z U w IL QW W a U. 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(RHM) MMC RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 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 10:28am Page 28 of 28 §( ) no k \ \\ I k m 0 § )2 §) m (\ \\ §/ \{ (� }} |§ § \ ( ) 9 BB . ) / � R � - . o ! \ \ \ \ G \• ) 0 a Xm oa o oa o zczi °zn °z� °zn m > m m rn a z z a m O `O A b n O O Z Si C0r ci m `>m c m 3 Xc C t_- a rm rb a a bb m SO �'n °b Z m ^Z r m m rr- H C b b a m �bp 0 o n o y z yz m a y m z O P P P P P P P lA P lA P Vi Vi W W W In W P y� P W w n O O �D VAi Vi V� y P P J N �p r F N N A A A O O O O O O p 6 O nn Zn r)a x0 mm Z nm °O 3 m < vb yb na nD xr m " a� pm me ° O y o CC2 nK T O A O Zm C 3 m m P A n Z y b as r - A y n n m m m n n p z 0 Z m m n n o � D) tt N U U O P W W O N O ry J V b a P VOi �O y �F � VWi T F F P W W T b b y w Ce W P Z y F n bUwrn O`Y nn °�°zW yn -� >'T°oo0u °�pOua zA�mymzzmzz C) Oa�ao ODg t- a rn-i A=i i -i r3 m V. 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ZnA ma3wsrW yWMmwar ywmaof n n n n n n 3 n � �Pg o CoCoCEo o �� Nw Nw yW a s F A J � v J w U W O O O O O O O U J N O J O N n a 0 0 0 R o o � o � 9 V y y 3 3 0 P P n N N r O O p R c n < z y 3 n rz m m m 2 n O n P 8 z z d O O 9 ~ e y jyb p y 3 3 3 z y | { ! £ \ � ( | 2 S ° a z o z o c O m � yy m z 0 I� n MWO mmwn yn `"yam �� yn y� on wn v Z,w Zno 3yAz b77>yZ��a inn 3;aarn yyzaaa Zan an mcn . n �n y z mfzj0 "O zm >zm np m np ZUm' DO yO < < nZ Z O O A n m 'm m C OC 0 z z j � D n N J � R Om r-1 a O mm -t n O-i -7 iy ny mr y C3 nm C OX C m0� y a m m zO a no ypyo mpy A N y w AjA y n y Z Z mC Z u O O O e °� a W o W 0 0 $ w w w w o Ian a N w C =;j< A n m� b� n m� b n �»� b n my b n Ay b n Xfy b n A� ay ay .'o� Ay a `^a 3o �O �n 3n 3n 3n 3n 0 3n 3n 3n 3n 3w CO co 3[, 3a Ca C0 o Ca o^. K C CC Z y z m m < m m iG N N IJ N N N C O O O N O N F � O b to O O A Oa A b b _ VAi W NN N N V W e c In N O MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---June S 2024 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES O`" ,43 ✓ [Fikih�Y4Pft1SI112rPgx+t36F;9333s✓ t"'►��h�i:Maonerxn+�r�tiit�s,� _.. _ T-' � .i MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---June 5.2024 PAYABLES AND PAYROLL 5/30/2024 Weekly Payables 215,931.37 5/30/2024 Patient Refunds 1012 78 5/30/2024 Uniform Advantage 115.75 5/31/2024 Hospital Care Consultants 23,663.00 6/3/2024 McKesson-3406 Prescription Expense 5,996.71 6/3/2024 Amerisource Bergen-340B Prescription Expense 362.80 6/3/2024 Payroll Liabilities -Payroll Taxes 123,023.35 6/3/2024 Payroll 361,208.05 Prosperity Electronic Bank Payments 6/3/2024 90 Degree Benefits - employee insurance claims 23,400.08 6/3/2024 Expert Pay- Child Support 570.69 6/3/2024 Pay Plus -Patient Claims Processing Fee 464.72 6/3/2024 Health Equity -HSA Contributions 1,272.83 t�O L iAf ld pf A�{R�701 AN17131fE fRlaN�di6 ryK4F 7EI�I LTS a }It ` d%0 TRANSFERS BETWEEN FUNDS-MMC 6/3/2024 Transfer from Nex8ank Money Market Account to Prosperity Operating Account 144,194.54 6/3/2024 Transfer from Prosperity Money Market Account to Prosperity Operating Account 106,724.68 TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 5/30/2024 MMC Operating to Golden Creek Healthcare -correction of nursing home Insurance payment deposited into MMC Operating In error 17,515.92 5/30/2024 MMC Operating to Tuscany Village -correction of nursing home Insurance payment deposited Into MMC operating in error 21,258.00 5/30/2024 MMC Operating to Bethany-correctian of nursing home insurance payment deposited into MMC Operating In error 44,639.38 ? PAL^TRRn�"! NURSING HOME UPL EXPENSES 6/3/2024 Nursing Home UPL.Cantex Transfer 477,629.36 6/3/2024 Nursing Home UPL-Nexfon Transfer 79,991.30 6/3/2024 Nursing Home UPL-HMG Transfer 7,091,89 6/3/2024 Nursing Home UPL-Tuscany Transfer 292,551.07 6/3/2024 Nursing Home UPL-HSLTransfer 133,700.40 TRANSFER BETWEEN FUNDS FROM NURSING HOMES TO MMC 6/3/2024 Golden Creek to MMC- MMC Insurance payment deposited into Golden Creek In error 65.40 6/3/2024 Gulf Pointe to MMC-MMC insurance payment deposited Into Gulf Pointe in error 218.13 INTER -GOVERNMENT TRANSFERS 6/3/2024 CHIRPS First half of VR41GTR- Pay byJune 18, 2024 $120,538.00 kN_ z FA,tf ,.,--iTSAP,,P¢D B�.. .-.—� 05130/20PA MEMORIAL MEDICAL CENTER 14:42 AP Open Irma. List Due Dates Through: 06/21/2024 Vendor# /Vendor Name Cleve Pay Code A1705 ALIMED INC. M Invoice# / Comment Tren Dt Inv qt Due DI Chock Ot. Pay RPSV004265336 04130,2024 04/162024 06MO12024 SUPPLIES Vendor Totals; .Number Name A1705 ALIMED INC. Ventlor# Vendor Nam Class Pey Cade 14028 AMAZON CAPITAL SERVICES /Invoica# Comment Tmn OR Inv Dc Due Ot CheckIX Pay J lJ3KVYPYHTRT 06/282024 0512MO24 06/152024 SUPPLIES Vendor Tolelo: Number Name 14028 AMAZON CAPITAL SERVICES Ventlor# Vendor Name Cleve Pay Cade 14088 J AZALEA HEALTH Invoice# Comment ?ran Dt Inv Dl Due DI Check Dt Pay J 102924 05/282024 04/022024 08212024 MONTHLY FEES opy t 1 �02 b4 Vendar Totals: Number Name 14088 AZALEA HEALTH Vendor# Vendor Name Class Pay Cade M2485 I. v BAYER HEALTHCARE M Invoke# Comment Tren Dt Inv Dt Due DI Check OR Pay / 6011143147 052812024 05/1412024 05/282024 SUPPLIES Ventlor Totals: Number Name M2485 BAYER HEALTHCARE Vendor# Vendor Name Clsss Pay Cade B1220 J BECKMAN COULTER INC M Invoice# Comment Tren Dl Inv Ot Due On Check Ot Pay f 111326336 05/242024 0512012024 06121/2024 SHIPPING „A8330�1 , 06/2812024 OW2112ON 06/1512024 �56 jCkpCI SUPPLIES Page 1 1 ap open involce.template Gross Discount No -Pay Net 162.13 0.00 0.00 162.13 1/ Gross Discount No -Pay Net 162.13 0.00 0.00 162.13 Gross Discount No -Pay Net 41.98 0.00 0.00 41.98 Grass Discount No -Pay Net 41.98 0.00 0.00 41.98 Gross Discount No -Pay Net 594.00 0.00 0.00 694.00 ✓ Gross Discount No -Pay Net 594.00 0.00 0.09 584.00 Groad Discount N.-Pay Not 1,380.10 0.00 0.00 1,380.10 v' Gross Discount No -Pay Net 1,380.10 0.00 0.00 1,380.10 Grose Discount No -Pay Net 179.63 0.00 0.00 179.63 1/ 1,484.00 0.00 0.00 1484.00 .l 0013012024 MEMORIAL MEDICAL CENTER 14:42 AP Open Invoice List Due Dates Through: 06/21/2024 JInvoice# Comment Train Dt Inv Dt Due OR Check Ot Pay 8488010 0612MO24 05/21/2024 06/1612024 SUPPLIES Vendor Totals: Number Name B1220 BECKMA14 COULTER INC Vendor# ( Vendor Name Class Pay Code. B1320 .J BEEKLEY CORPORATION M JInvolcek Comment Tran Dt Inv Dt Due Ot Check Ot Pay MIN0098034 OIU2912024 04/2WO24 06/1512024 SUPPLIES J MIN01OM62 OS12012024 05/16/2024 06116/2024 SUPPLIES Vendor Totals: Number Name B1320 BEEKLEY CORPORATION Vendorfl /Vendor Nome Class Pay Code 01040 J CALHOUN COUNTY vy /InvolcoN Comment Tren Dt Inv Ot Due Ot Check Dt Pay 1! 052424 OW3012024 05/2412024 06/24/2024 FUEL Vendor Totaa: Number Nam 01046 CALHOUN COUNTY Vandol /Vendor Name Class Pay Code 14004 ✓ CAPITAL ONE InvotoaN Common Tran Ot Inc, Dt Due DI Cheek Ot Pay ,r 1655731157 05/3012024 0 M912024 06/O1=4 SUPPLIES Vendor Totals: Number Name 140" CAPITAL ONE Vendorfl /Vendor Name Class Pay Code C1325 `/ CARDINAL HEALTH 414, INC, W Invoice@ Comment Town Dl Inv DI Due Ot Check Ed Pay J 8003513063 05129/2024 05111/2024 O6/21120M SUPPLIES .� 8003518971 0SUR020M 05/18/2024 06/12/2024 SUPPLIES Page 2 2 op open inveke.lemplale Gross Discount No -Pay Net / 1,936.15 0.00 0.00 1.935.15 J Gross Discount No -Pay Not 3,698.78 0.00 Son 3.698.78 Groan Discount No -Pay Net 398.00 0.00 0.00 308.00 `- 398.00 0.00 0.00 398.00 f Gross Discount Nb-Psy, Net 796.00 0,00 0.00 796.00 Gross Discount N.-Pay Net 128.24 OX 0,00 128.24 / Gross Dlecounl No -Pay Net 128.24 0.00 0.00 128.24 Gross Discount No -Pay Net 276.16 0.00 0.00 276.16 .y Grose Discount No -Pay Net 276.16 0.00 0.00 276.16 Grose Discount No -Pay Net 404.94 0.00 0.00 404.9,1 ✓� 321,60 0.00 0.00 321.68 J� OW3012024 14:42 MEMORIAL MEDICAL CENTER AP Open Invoice List Due Oates Through: 06/21/2024 Vendor Tolals: Number Name C1325 CARDINAL HEALTH 414, INC. Vendwo /Ventlar Name Class. Pay code 13336 J' COCA COLA SOUTHWEST BEVERAGES Involdo# Comment Tran Dt Inv Dt Due DI Cheek Olt Pay 41311619017 .� 05/2412024 05/16/2024 06121=24 BEVERAGES✓41311519022 05/24/2024 05/15I2024 06/21/2024 DEPOSITS ON RETURNS Vendor Totals: Number Nam. 13336 COCA COLA SOUTHWESTBEVERAGES Vendor# / Vendor Name Class Pay Code 10368 J DEWITT POTH&SON Invoice# Comment 'Tren Ot .Inv Dt Due Dt CheckDI Pay ,f 7505351 06/20/2024 05/22/2024 00/16/2024 SUPPLIES Ventlar Totals: Number Name 10368 DEWITT POTH&SON Vontlorq / Vendor Nome J Class Pay Code 11139 Invoice# J Comment Tren at Inv DI Due Dt Check DI Pay 052924 05129IM24 05/2912024 05/29/2024 MILAGE VendorTolals: Number Name 11139 VengoM Vandor Nema Clegg Pay Code 10240 J ECLINICAL WORKS LLC Iuvolae# Comment Tran Ot Im DI Duo Dt .Check Dt Pay 0002033735 05/28/20PA 0510112024 06/21/2024 EMIR MONTHLY MESSENGER Vendor Totals: Number Name 15240 ECLINICAL WORKS LLC Ventlor# /Vendor Name Class Pay Code 80501 J EVOOUA WATER TECHNOLOGIES LLC 3 ap_opan Invoice.templale Grose Discount No -Pay Net 726.62 0.00 0.01) 726,62 Grose Discount No -Pay Not 466.90 0.00 DOD 466.00 v� -126.00 0.00 0.00 -125.00 Y/ Grose Discount No -Pay Net 341.90 0.00 0.00 341.90 Gross Discount No-Pey Net 10.68 D00 0.00 10.68 ✓ Gross Discount No -Pay Net 10.68 0.00 0.00 10.68 Gross Discount No -Pay Net 168.84 0.00 0.00 168.84 Gross Discount No -Pay Net 168.84 DAD 0.00 168.84 Gmss Discount No -Pay Net 477.05 0.00 0.00 477.65 Gross Discount No -Pay Net 471.65 0.00 0.00 477.65 05/30/2024 MEMORIAL MEDICAL CENTER 14:42 AP Open Invoice Lust Due Dates Through: O1/2112024 Invoice# Comment Train Dt Inv Dt Due DI Check Dt Pay / ./ 906455972 05114/2024 05/07/2024 06/0112024 SUPPLIES Vendor Totals: Number Name 50601 EVOOUA WATER TECHNOLOGIES LLC Vendor# / Vander Name Class Pay Code P1100 J FEDERAL EXPRESS CORP. W Invoice# Comment Tran Dt Inv at Due Dt Check Dt Pay 040790843 05/30/2024 05/WJ2024 0W2712024 SHIPPING GOST J 049431.180 05130/2024 06/09/2024 06103/2024 SHIPPING y 060156201 051302024 0511612024 OW1012024 / SHIPPING 1 860683935 05/3012024 06/2312024 OW172024 SHIPPING VendorTotele; Numer Name F1100 FEDERAL EXPRESS CORP, Vendor# Vendor Name Close Pay Coda F1400 FISHER HEALTHCARE M Inveic a J Comment Tree Dt Inv Dt. Due DI Check Dt Pay 2042150 05/14/2024 05/0312024 052812024 / `✓ SUPPLIES 1926801 05/16/2024 04/3012024 0512512024 SUPPLIES ./ 185322fi 05/1612024 04/282024 05/212024 SUPPLIES ./ 2374267 05/282024 05/162024 OWI012024 SUPPLIES f 2374266 05/282024 051162024 06110/2024 SUPPLIES J 2409223 0512812024 05/1712024 06MI2024 SUPPLIES 2400222 OW282024 05M72024 0RM112024 SUPPLIES Page 4 ap_opan Jnvolce.templale Gross Discount No -Pay Net / 1,590A3 0.00 0.00 1,590.43 `✓ Gross Discount No -Pay Net 1,590.43 0.00 0.00 1,00.43 Gross Dlamunt No -Pay Net WAS 8.00 0.00 81AS 25.88 0.00 0.00 25.88 60.16 0.00 0.00 60.16 55.06 0.00 0.00 65.68� Gross Discount No -Pay Net 223.18 0.00 0.00 223.16 Gross Discount No -Pay Net 393.70 0.00 0.00 393.70 '1 176.43 0.00 0.00 176.43 :✓/ 124.97 omo 0.00 124.91 426.63 0.00 0.00 426.63 115.19 0.00 0.00 115.19 60.23 0.00 0.00 60.23 ✓/ 199.41 0.00 0.00 199.41 ./ 0013012024 14:42 MEMORIAL MEDICAL CENTER AP Open Invoice List Due Dates Through: 08/21/2024 Vendor Totals: Number Name F1400 FISHER HEALTHCARE Vendors Vendor Name Class Pay Code 11183 J FRONTIER Invoke# Comment Tran Ed Inv DI Due Of Check Dt Pay ,f 051924 05129/2024 05/1912024 06/1212024 TELEPHONE SERVICE Vendor Totals: Number Name 11183 FRONTIER Vendor# / Vendor Name Class Pay Cod. 14156 J FUJI FILM JInvoke# Comment Tran Ol Inv Ot Due Ot Check Of Pay 91488119 0t5�292024 05/252024 0821/2024 MAINTCONTRACT UI I LH - 1 I V4 1 Zj4 Vendor Totals; Number Name r 14166 FUJI FILM VendoM Vendor Nam Class Pay Cade 12636 FUSION CLOUD SERVICES, LLC Invulws Comment Than Ot Inv Ot Due 01 Check Ot Pay 1020182326 05129/2024 05/16/2024 06/21/2024 TELEPHONE Vendor Totele; Number Name 12636 FUSION CLOUD SERVICES, LLC Vendor# /yenaerName Class Pay Code 12404 .,/ GE PRECISION HEALTHCARE, LLC Involca# Comment Tram 01 Inv DI Due Ol Check Ot Pay J 6002659507 05/292024 05101/2024 06/21/2024 MEDRAD. STELLANT Vendor Totals: Number Name 12404 GE PRECISION HEALTHCARE. LLC Vendor# Vendor Neme Clan Pay Code W042 GLAXOSMITHKLINE PHARMACUETICAL Invoice# Comment Than Dt Inv Ot Due Ot Check Dl. Pay J 8263864187A (ISM02024 1011=On 11/1212022 FEDEERAL EXCISE TAX Page 5 5 sp_opsn Invoke.tomplate Gross Discount N.�Pay Net 1,496.56 0.00 0.00 IA96.% Gross. Discount No -Pay Not 56.40 0.00 0.00 S8.4D f Gross Discount No -Pay Not 56.40 0.00 0.00 56.40 Gross Discount No -Pay Net 7.908.33 0.00 0.0o 7,918.33 vj Grose Discount No-Pey Net 7,908.33 0.00 0.00 7,908.33 Gross Discuunl No -Pay Net 87542 0,00 0.00 875.42 1'f Gross Discount No-Pey, Net 875A2 0.00 0.00 875.42 Gross Discount No -Pay Net 204.83 0.00 0.00 1 204.83 V Gross Discount No -Pay Net 204.83 0.00 0.00 204.83 Gross Discount No -Pay Net 450.00 0.00 0.00 460.00 ✓ 05/3012024 MEMORIAL MEDICAL CENTER 14;42 AP Open Involco List Due Game Through: 06121/2024 Invaloaq Comment Town Dt Im, Dt Due DE Check Di Pay 8264155142A 05/3012024 10/042023 111042D23 FEDERAL EXCISE TAX Veosor Totals; Number Name 10642 GLAXOSMITHKLINE PHARMACUETICAL VondorN Vendor Name Class PRY Coda 01210 ✓ GULF COAST PAPER COMPANY M / InvoloeU Comment. Train Dt Inv Dt DueD1 Check Ol Pay J 2637522 05/2812024 0512WO24 06/20202A SUPPLIES Vendor Totals; Number Name G1210 GULF COAST PAPER COMPANY Vendoni Vendor Name Class Pay Code 10804 HEALTHCARE CODING& CONSULTING Invoicedit J14966 Comment Than Dt Inv Dt Due Ot Chock Dt Pay 0,5/2`0/202403/31/2024 0622A 1/20 J 15016 n PRO CLINIC AUDIT 4` coo-,, 101-l 05/2812024 OV302024^ 06/21/2024 CHARTS P(?P.i'. Vendor Totals: Number Name 10804 HEALTHCARE CODING & CONSULTING Ventlor# /,Vendor Nama Class Pay Code H041B 't/ HOLOGIC INC / Invoical/ Comment True 01 Inv OR Due OR Check Dl Pay �1 10941350 05128/2924 05/152024 05/282024 SUPPLIES Vendor Totals: Number Name H0416 HOLOGIC INC Veneer# /VandorNemo Class Pay Code 15208 J HOSPITAL CARE CONSULTANTS INC. Invoico9 Comment Tran Dl Inv Ot Due Dt Check OR Pay 6624 05/2812024 06M612024 00,621/2024 HOSPITALIST V�1'\ hn0i1-TY\-,'\VCR u, 6 ep open_ involce.teradate Gross Discount No -Pay Net 376.00 0.00 0.00 r 375.00 1 Gross Discount No -Pay Net 025.00 0.00 0.00 825.00 Gross Discount No -Pay Net 938.49 0.00 0.00 938.49..E Gross Discount NmPay, Net 938.49 0.00 0.00 938.49 areas Discount No -Pay Net 2,750.00 0.00 0.00 2,760.00 2000 0.00 0.00 204.00.i Groan Discount No -Pay Net 2,954.00 0.00 0.00 2,954.00 Gross. Discount No -Pay Net / 472.50 0.00 0.00 472.50 Gross .Discount No -Pay Net 472.50 Moo 0.00 472.60 Gross Discount No -Pay Net 23,663.00 0.00 0.00 23,663.00 "� 05/30/2024 MEMORIAL MEDICAL CENTER 14.42 AP Open Invoice List Due Dates Through: MY21/2024 Vendor. TmNs: Number Name 15208 HOSPITAL CARE CONSULTANTS INC. Vendpnt /Vendor Name Class Pay Code 14540 "1 JINDAL X LLC Involve# j Comment Tmn. Dt .Inv Dt Duo Di CheckDs Pay 202426007 05124/2024 05/162024 061212024 REVENUE CYCLE MGMT Vander Totals: Number Name 14540 JINDAL X LLC Vendor# Vendor Name Class Pay Code 10480 Involoes J Comment Ten Dt Inv Ot Due DI Check Or Pay CARL11,1005 0519I2024 OSJ=024 0621/2024 PT REFUND Vendor Totals: Number Name 16480 Vendpr# /Ventlor Neme Class Pay Code M1960 + MARTIN PRINTING CO by Comment Tmn Dt Inv Or Due Or Check Dt Pay JInvoice# 0188 D52212024 05/17/2024 06116/2024 SUPPLIES J 60159A 052812024 05ID62024 06/212024 SHIPPING BUSINESS CARDS Vendor Tetats: Number Noma M1950 MARTIN PRINTING CO Ventlor# Vendor Name Glass .Pay Cade M2178 MCKESSON MEDICAL SURGICAL INC Invoice# J22136401 Comment Tom Ol Inv DI Due Dt Check Dt Pay 052812024 06222024 06/062024 SUPPLIES 22146609 05292024 05/23/2024 08/072024 SUPPLIES Vendor Totals: .Number Name M2178 MCKESSON MEDICAL SURGICAL INC Vendors /Vondor Name Close Pay Code M2470 J MEOLINE INDUSTRIES INC M Page 7 7 eP open involce.template Gross Discount No -Pay Net 23,663.00 0.00 0.00 23.663.00 Gross Discount No -Pay Net 9,000.00 0.00 0.00 9.000.00 J Grose Discount No -Pay Net 9,000.00 0.00 0.00 9.000.00 Gross Discount N.-Pay, Net SBAI 0.00 0.0D 66.41 -r Gmee Discount No -Pay Net 66.41 ODD 0.00 66.41 Gross Discount NoBay Net 185.00 0.00 0.00 185.001 j 15.00 O.00 0.00 15.00 Gross Discount N.-Pay Net 200.00 0.00 0.00 200.00 Gross Discount No -Pry Net / 30.07 0.00 0.00 30.07 152.69 0.00 0.00 152.69 !' Gross Discount No -Pay Net 182.76 0.00 0.00 182,76 00/3012024 MEMORIAL MEDICAL CENTER g 14142 AP Open Invoice List ap open_ Invoice.lampleia Due Dates Through: 06/21/2024 Involve# Comment Than DI Inv Ol Due DI Check Dt Pay Gross DISOOUni No -Pay Net J 2310364964 06/15/2024 04/2412024 05/19/2024 1,420.35 0.00 0.00 f 1,420,35I / SUPPLIES J 2318288164 05/152024 04/242024 OW1912024 45.43 0.00 0.00 45,43 SUPPLIES 2318120296 05/152024 OWN12024 05/19/2024 220.00 0.00 0.00 220.00 l/ SUPPLIES J 2320483814 05/7512020 062512024 00119/2024 2,133.63 0.00 0.00 2,733.83 SUPPLIES J 2320483842 051152024 05/25/2024 OW1912024 684.94 0,00 0.00 664.04 J SUPPLIES 2320483813 05/15120M 05262024 06/10/2024 368.66 0.00 0.00 368.65 SUPPLIES J 2318973098 MIZO12024 0511412024 06108/2024 1.296.91 0.00 0.00 1,296.01 SUPPLIES .,% 2319061405 05202024 OWIS12024 061092024 1,213,21 0.00 0.00 1,213.21 SUPPLIES 2319061416 05/202024 05/1512024 06/092024 315.16 0.00 0.00 316,16 � SUPPLIES 2319001403 05/202024 W1512024 061092024 3,363.78 0.00 0.00 3,363.78 '✓! SUPPLIES 2318081417 06120/2024 05/15/2024 08/092024 108.45 0.00 0.00 106.45 SUPPLIES J 2319061418 05/202024 05/152024 06/082024 220.39 0.00 0.00 220.39 SUPPLIES 2319061420 05/2012024 05/1512024 061092024 275.69 0.00 0.00 276.89 SUPPLIES 2319886896 08=2024 05/222024 06116/2024 234.94 0.00 0.00 234.84 vF SUPPLIES J 2319885691 0522/2024 05222024 06/16/2024 621.10 0.00 0.00 621.10 -� SUPPLIES J 2319885688 95I2212024 05/2212024 061162024 1,191.93 0.00 0.00 1,191.93 SUPPLIES J 2318885694 05122/2024 05/22/2024 OWIB12024 .45.10 0.00 0.00 95.10 f SUPPLIES Page 8 0513012.024 MEMORIAL MEDICAL CENTER 9 14:42 AP Open Invoice List aP_oPen_invoice.lemplate Due Dates Threu9h: 06212024 Jleveling Comment Ten 01 Inv Dt We Ot Check Ot Pay Gross Discount No -Pay Net 2319880692 05122/2024 05=2024 O6I162024 109.18 0.00 0.00 / 109.18 ✓ SUPPLIES J 2319805699 05=2024 05/2212024 06/16/2024 4,946.75 0.00 0.00 4,946,75 SUPPLIES JJ 2319887200 05/22/2024 05122I2024 O6/182024 77172 0.00 0.00 772.72 SUPPLIES Vendor Totals: Number Nome Grass Discount No -Pay Net M2470 MEOLINE INDUSTRIES INC 19,515.69 0.00 0.00 19,515.69 VondoN4 j Ventlarfleme Class Pay Code 10536 MORRIS B DICKSON CO, LLC Invoice# Comment. Tree Ot Inv Ot Due Dt Check OR Pay Grass Discount No -Pay Net / . CM27298 05128/2024 05/212024 061212024 -293.92. 0.00 OAu .293.92 INVENTORYCREDIT J 2016782 05252024 0521/2024 06/212024 897.88 0.00 0.00 897.88 INVENTORY �2020772 0528IM24 O5/222024 06/2112024 42.49 0.00 0.00 42AD INVENTORY /) J 2021924 052812024 05122I2024 08/21/2024 2,742.08 0.00 0.00 f 2,742.0 J INVENTORY J2021510 06MOM024 05122/2024 061212024 1,907.78 0.00 0.00 1,907.78 INVENTORY J 2021925 05/2812021 05/222024 0621/2024 736.10 0.00 0.00 / 736.10 J INVENTORY 2028017 05282024 05232024 08/03/2024 66.68 0.00 0.00 86,68 JINVENTORY 2026070 05/2812024 062312024 061212024 1,061.50 0.00 0.00 1.061.50 v JINVENTORY � CM27716A 0513012024 OSW2024 O6MI20M -0.08 0.00 0.00 -0,08 INVENTORY Vondar Totals: Number Name Gross Discount No -Pay. Net 10536 MORRIS B DICKSON CO, LLC 7.180.61 0.00 0.00 7,180.51 Vendor# tendor Name Class Pay Code M2659 MXR IMAGING, INC M Page 05/30/2024 MEMORIAL MEDICAL CENTER 14'42 AP Open Invoice List Due Dates Thmu9h: 06/2V2024 JInvoice# Comment Tran DI Inv Dt Due Of Check Ot Pay 8801147883 05128/2024 0512012ON 06119/2024 SUPPLIES Vendor Totels: Number Name M2659 MXR IMAGING, INC Vendor# I Vardar Name J Class Pay Coda 10188 NATUSMEDICALINC nice# Comment Tour Ot Inv Ot Due Of Cheek Ot Pay 1041680391 0528/2024 04/19/2024 OW14MO24 SUPPLIES Vendor Tours: Number Name 10108 NATUSMEDICALINC Vendor# / /Vendor Name Class Pay Cade 01000 •f OLYMPUS AMERICA INC M Invoice# Comment Tom Ot Inv Dt Due Dt Chock Dt Pay J 36260067 05/212024 05/20/2024 06/142024 JSUPPLIES 36199498 05/29/2024 05/07/2024 06/01/2024 SUPPLIES Vendor Totals: Number Name 01500 OLYMPUS AMERICA INC Ventlor# / Vendor Name Class Pay Code 01416 ry( ORTHO CLINICAL DIAGNOSTICS Incite# Comment True Dt Inv Ot Due Di Check Dt Pay 41053545103 05/2012024 05/17/2024 06/162024 / -3 1853546975 SUPPLIES SUPPLIES 05/21/2024 05=12024 06/192024 1853550140 061=024 05/2112024 06/20/2024 Vendor Totals: Number Name O1416 ORTHO CLINICAL DIAGNOSTICS Ventlor# /Ventlor Name Class Pay Code. 50906 �f PERFORMANCE HEALTH M 10 ap-pporkinsmice.templare Gross Discount NaPay Net J 562.13 0.00 0.00 562.13 Gross. Discount Na-Pay Not 662.13 0.00 0.00 562.13 Gross Discount No -Pay Net 1,008.72 O.9D 0.00 1.008.72 Gross Discount No -Pay Net 1.008.72 0.00 0.00 1,008.72 Grose Discount No -Pay Net J 1.439.80 0.00 0.00 1,439.69 1.125.00 0.00 0.00 1,125.M Grose Discount NO -Pay Net 2,664.09 0.00 0.00 2.564.89 Omss Discount No -Pay Net 190.04 0.00 0.00 190.04 Vf 762.16 0.00 0.00 752.16 190.04 0.00 OAO 190.04 '•% Grace Discount N.Pay Net 1,132.24 0.00 Rau 1.132.24 06/30/2024 MEMORIALMEDICAL CENTER 14:42 AP Open Invoice List Due Dates Through: 06/212024 JInvomep Comment Then Dt Inv Ot Due Dt Check Dt Pay IND7642707 05/2212024 0512112024 06%5/2024 SUPPLIES Vendor Tmels: Number Name 50905 PERFORMANCE HEALTH Vendor; Vendor Name Class Pay Code 11080 RADSOURCE Comment Tmn Dt Inv Dt Due Dt Check Dt Pay ..,/Invoice; PSI001792 0612912024 051162024 W121/2024 SAMSUNG GU60A Vendor Totals: Number Name 11D80 RADSOURCE Vendor# `Vendor Name Class Pay Code 11024 t( REED, CLAYMON, MEEKER S HARGET J Invoice; Comment Than DI Inv Dt Due Dt Check Ot Pay ../ 31111 05122/2024 05/21/2024 06/20/2024 LEGALSVCS Vendor Total.: Number Name 11024 REED, CLAYMON, MEEKER S HARGET Vendol %Vandor Namo Class Pay Case 10554 r/ REPUBLIC SERVICES OB47 Involve; J0047001269087 Comment Than Dt Inv Cl Due Dt Check Cl pay 05129/2024 02/2012023 03126/2023 TRASH SERVICES ,1/0847001264918 062912024 03/26/2023 04/262023 TRASH SERVICCES J 0847001270027 0512D/2024 04/26/2023 05/262023 / TRASH SERVICES �/ 08470012]5132 061292024 O5/262023 00/2812023 SERVICES JTRASH 0847001280030 051292024 06/2612023 D712612023 J0847001285458 TRASH SERVICES 051292024 0712612023 001262023 TRASH SERVICES Page 11 11 ap open m"Ice.tomplate Gross Discount No -Pay Not 121.73 0.00 0.00 / 121.73 J Gross Discount No -Pay Net 121.73 0.00 0.00 121,73 Gross Discount No -Pay Net i 1.708.33 0,00 0.00 1,708:33 Gross Discount No -Pay NO 1,708.33 0.00 0.011 1,708.33 Grass Discount No -Pay Net 441.00 0.00 0.00 441.00 " Gross Dimmed ND -Pay Net 441.00 0.00 0.00 441.00 Gross Discount No -Pay Not / 943.84 0.00 0.00 943.84 943.84 0.00 0.00 943.84 y 043.84 0.00 0.00 943.64 v� 943.84 0.00 0.00 943.84 943.84 0.00 0.00 / 943.84 ti! 4,831.52 0.01D 0.00 -2.831.52 wf 05130/2024 MEMORIAL MEDICAL CENTER 14.42 AP Open Invoice List Due Dates Through: 06212024 Vendor Totele: Number Name 10554 REPUBLIC SERVICES#647 / Vondar# J l Vendor Name Class. Pay Code 50900 SAM'S CLUB DIRECT yV Comment Tren Ol Inv Dt Due Dt Check Dt Pay JInvoke# 032024 OW3012024 05202024 0810812024 DIETARY SUPPLIES Vandar Tatels: Number Name $0900 SAWS CLUB DIRECT /� Vendor# /vendor Nemo Class Pay Code $1405 SERVICE SUPPLY OF VICTORIA INC W JInvoice# Comment Tom Ot Inv DI Due DI Check Ili Pay 701224950 05/20/2024 0&1612024 0811=024 SUPPLIES Vandor Totals: Number Name 81405 SERVICE SUPPLY OF VICTORIA INC Vendor# /Vendor Name Class Pay Cade 52001 ./ SIEMENS MEDICAL SOLUTIONS INC M nk Comment Than Ot Inv OI Due Ot Check DI Pay ,�ve 118549507 05/242024 05/16/2024 061212024 SYMBIA EVO CONTRACT Vendor Totals: .Number Name 52001 SIEMENS MEDICAL SOLUTIONS INC Vendor# )Vendor Neme Class Pay Cade C1010 �/ SPARKLIGHT w Involco# Comment Than Ot Inv Ol Due Dt Check Dt Pay 1/051024 05129/2024 051I M024 06/1712024 CABLE Vendor Totals: Number Name C1010 SPARKLIGHT / Vendop! /Vandor Neme Class Pay Code 15230 -/ SPECIALTY PROFESSIONAL Invoke# J1240000128 Comment Then Dt Inv DI Due Dt Check DC. Pay 05QB12024 02MV2021 08/21/2024 AMBER HELZER 12 ap open_invoiw.kmplete Gross Discount No -Pay, Net 1,887.60 0.00 0.00 1,887.0 Gross Discount N"ay Net 357.30 0.00 0.00 357.30 Gross Discount No -Pay Not 357.30 0.00 0.00 357,30 Gross Discount No -Pay Net 7,500.00 0.00 0.00 / 7,500.00 V Gross Discount No -Pay Not 7,500.00 0.00 0.00 7,500.00 Gross Discount No -Pay Net 2,451.95 O.OD D.00 2,461.95 Val Gross Discount No Pay Net 2,461.95 0.00 0.00 2.451.95 Gross Discount N.-Pay Net J 14126 0.00 0.00 141.26 �l Gross Discount No-Pey Net 141.26 OAD 0.00 141.26 Gross Discount. No-Pey Net I 3,538.75 0.00 0.00 %538-75 `'� 05/3012024 MEMORIAL MEDICAL CENTER 14:42 AP Open Isvoloe Ust Due Dates Through: 06/21/2024 JInvoloo Comment Tom Dt Inv Ot Due Ot Check 01 Pay 1240000173 (IM02024 02JO912024 06212024 AMBER HELZER J1240000198 052812024 02/162024 00124/2024 AMBER BELZER �1240000240 0612812024 022/2312024 0012l/2024 AMBER HELZER J12400011300 052812024 03/012024 06/21/2024 AMBER BELZER J1240ON338 05/282024 0310812024 OOMM024 AMBER HELZER J12.40000303 05/28/2024 03/15/2024 081212024 / AMBER HELZER .J 1240DO0300 05/2812024 03/22/2024 06121/2024 J12400DD493 AMBER HELZER 0528/2074 04/052024 08121/2024 ( AMBER HELZER J 1240000544 0528/2024 041122024 06/21/2024 J1240000577 AMBER HELZER 05282024 04/192024 082112024 AMBER HELZER /1240000620 05282024 04/26/2024 06/212024 AMBER HELZER 124D000851 05/2812024 05/032021 06/21/2024 AMBERHELZER Vendor Totals: Number Name 15236 SPECIALTY PROFESSIONAL Vendor# Name Gees Pay code 10845 V STAPLES If Invoice# J 8072443947A Comment Tan Ot IIry Dt Due DI Check Ot Pay 0�5�/212\0.2-4.�;11/30/2023 SUPPLIES 11/3012023 Vendor Toteis: ..Number Name 10845 STAPLES Verdure Name Class Pay Cade 12704 ,endor �J r"AS BURNER B BOILER SERVICES Page 13 13 ap opea_Iavalce.templet. Grose Discount ND'PeY Net 4,940.00 DOD 0.00 4.940.00 f 3,776,26 COD 0.00 3.776.25 3,53B.75 0.00 0.00 3.08.75 3,705.00 0.00 0.00 3.705.00 �` J `✓ 3,515.00 0.00 0.00 3,515.00 3,633.76 0.00 0.00 3.633.75 2.505.00 O.OD 0.00 2,565.00 f 3,776.25 0100 BAD 3.776.25 V, 3,467.50 0.00 0.00 3,467.50 vl 3,538.75 0.00 0.00 3.538.75 2,493.75 0.00 0.00 2.493.75 Y/ 3.638.75 0.00 0.00 3,530,75 Gross Discount NgPey Net 46,627.50 040 0.00 46,027.50 Grose Discount N..Pay Net NAB 0.00 0.00 34.40 ..E Gass Discount Nc-Pey Net MAS 0.00 0.00 34AR 06/3012024 MEMORIAL MEDICAL CENTER 14.42 AP Open Involve List Due Dates Through: OM112024 Involcu# Comment Tom DI Inv Dt Due Dt Check Dt Pay 243606 05118/2024 05/1612024 OW1612024 SUPPLIES Vendor Totals:. Number Name 12704 TEXAS BURNER& BOILER SERVICES Vendor# sndor Name Class Pay Cade 10732 THERACOM, LLC Invoice# J Comment Tom Dt Inv Dt Due Dt Check Bit Pay 225237984301 05/262024 0511512024 06121/2024 INVENTORY Vendor Totals: Number Name 10732 THERACOM. LLC Vendor# Vendor Name Class Pay Code T2250 TK ELEVATOR CORPORATION M Jlnv.lc.# Comment Trsn Ot Inv Dt Due Ol CheckDt Pay 6002413791 0612912024 03/18QO20 06121/2024 / ELEVATOR REPAIR �/ 3007881B31 05/29/2024 05/0112024 08127/2024 ELEVATOR OIL & GREASE .,/5002463117 05/29/2024 051D92024 06121/2024 LABOR -CALLBACK ,J 6002465074 06/29/2024 06/142024 06/212024 LABOR -CALLBACK Vendor Totals: Number Name T2250 TK ELEVATOR CORPORATION Vendor# Vendor Name Class Pay Code T3130 .J TRI-ANIM HEALTH SERVICES INC M Comment Tom 01 Inv Dt Due Dt Check Dt Pay .,/Invoice# 6akntim02 05/282024 05122Z024 05/16/2024 SUPPLIES Vendor Totals: Number Name T3130 TRI-ANIM HEALTH SERVICES INC Vendor# Vendor Name Class Pay Code 11171 TRI-TECH FORENSICS, INC. 14 ap open involce.templala Gross Discount No -Pay Not 4.580.00 0.00 0.00 4.58040 `✓ Gross Discount NcPy Net 4.580.00 0.00 0.00 4,680.00 Grose Discount No -Pay Net ' 2,706.32 0.00 0.00 8.706.32 `f Gross Discount No -Pay Net 2,705.32 0.00 0.00 2,706.32 Grass Discount Nu -Pay Not 754.50 0.00 0.00 / 754.50 V 1,634.62 0.00 0.00 153462 V J 1,700.60 0:00 0,00 1,160.50 .mil 2,64015 0.00 0.00 2.640.75 Gross Discount No -Pay Net 8,690.37 0.00 0.00 6.690.37 Gross Discount N.-Pay Net 320,68 0.00 O.OD 320.60 „/� Gross Discount Na-Pay Net 320.60 0.00 0.00 $20.68 OW302024 MEMORIAL MEDICAL CENTER 14.42 AP Open Invaica List Due Dates Through: 060/2024 I omw Comment Ten Dt Inv Dt Due Or Check Dt Pay 01013236 06/1512024 04/302024 0512SIMM SUPPLIES Vendor Totals: Number Name 11171 TRI-TECH FORENSICS, INC. Vendorfl AmmorNmrs, Clew Pay Code 14372 4 TRIAGE,LLC Imulcay. Comment Torn Dt Inv Di .Due Ol Check Ot Pay IN111796083416 05/22/2024 05/17/2024 OB/172024 J INV7798967330 CONTRACT STAFF RAD 010l1y _ 5/11 WA 05/28/20Z4 05/2412024 061212024 CONTRACT STAFF RAO VentlorTotels: Number Name 14372 TRIAGE, LLC Vendor# Name //Vendor Class Pay Code 11067 -./ 7RIZETTO PROVIDER SOLUTIONS Involoee JSSFK052400 Comment Tmn Dt Inv Dt Due Dt Check Dt Pay 05/28/2D24 05101/2024 0621/2024 PTSTATEMENTS Vendor Total.: Number Name 11067 TRIZETO PROVIDER SOLUTIONS Vendor# JVendar Name Clow Pay Code C2510 TRUBRIDGE M Involoe# J1021500 VV Comment Tran Ot Inv Dt 0628/2024 06/24MO24 Due Ot Check Dt Pay 06/18/2024 ELEC CASE REPORTING VentlorTolale: Number Name C2610 TRUBRIDGE Vendor! /Vendor Name Clew Pay Code Ili90q I UNIFIRST HOLDINGS INC nvalcoq Command Tom DI Inv Dt Due Dt Check Ot Pay 2921032647 05128/2024 06/2012024 00/21/2024 LAUNDRY J 2021032649 0512812024 05120120M 0612IG024 LAUNDRY 15 ap_open Invoice,lemplato Grass Discount No -Pay Net 112.63 0.00 0.00 112.63 •.i, Grow Discount NaPay Not 112.63 0100 0.00 112.63 Gross 3,467.50 Docrount 0.00 No -Pay Net l J 0.00 3,467.50 3,407.50 0.00 0.00 3,467.60 yrr Grass Drawn.( ok,P.y Not 6,935.00 0.00 0.00 6,935.00 Gross Discount No -Pay Net 1,687.97 0.00 0.00 1,687.97 Gross Discount No -Pay Net 1,607,97 0.00 0.00 1,667.97 Grose Discount No -Pay Net 9,000.00 0.00 0.00 9,000.00 \� Gross Discount Na-Pay Net. 9,000.00 0.00 0100 9,000.00 Gross .Discount No•P8y Net f 3,366.39 0.00 0.00 3,366.39 102.07 0.00 0.00 102.07 V / OW30I2024 MEMORIAL MEDICAL CENTER 14.42 AP Open level. List Due Oates Through: 06121/2024 �Involcd# Comment Trent DI Inv Dt Due On Check Ol Pay 2921033002 05/2012024 06/232024 08117MO24 LAUNDRY ,J 2921033UN 05/28/2024 051232024 06/17/2024 LAUNDRY 1/29210MOOS 05128/2024 061232024 06/17/2024 LAUNDRY / J 2921OW003 0512MO24 05/23/2024 W17/2024 LAUNDRY 2921033000 05282024 05MI2024 06/172024 LAUNDRY J 2921033001 05282024 052312024 06/17/2024 LAUNDRY 2021032008 05/282024 05/232024 001172024 LAUNDRY J2921032900 05/2812024 06/232024 08117/2024 LAUNDRY 2021033223 05/282024 05/272024 06/212024 LAUNDRY ,/2021033224 05/282024 05127/2024 08/21/2024 LAUNDRY Vendor Totals: Number Nome U1064 UNIFIRST HOLDINGS INC Vendors Vendor Name Class Pay Code 11110 JWERPEN USA LLC Involcek Comment Trap Dt JIM DI Due Ot Check Dt Pay 1/9111492417 052912024 0425/2024 0512012024 SUPPLIES Vendor Totals: Number Name 11110 WERFEN USA LLC VendodF gander Name leader Class Pay Code 11400 COAST MEDICAL RESOURCES Invoicof JINV113609 Comment Tmn Dt Inv DI Due Dt Check Ot Pay 05/2212024 052112024 00202024 SUPPLIES Page 16 i6 ap open involoe.templale Grose Discount No -Pay Net �. 315.80 0.00 0.00 316.00� 303.14 0.00 0.00 303.14 113.81 0.00 0.00 113.81 282.90 0.00 0.00 262.90 v` 3,302.63 0.00 0.00 3,302.63 50.54 0.00 0.00 5U.54 134.68 0.00 0.00 134.68 222.42 0.00 0.00 V-2A2 3.107.96 0.00 0.00 3,107.95 102.07 0.00 0.00 102.07 ✓1 Gr0ss Discount NO -Pay Net 11,404.40 0.00 0.00 11,404AO Grose Discount No -Pay Net 298.20 0.00 0.00 298.20 Gross Dlaccunl No -Pay Net 298.20 0.00 0.00 290.20 Gress Discount No -Pay Net 1.950.00 9.00 0.00 1.950.00 05130/2024 14:42 Vendor Totals: Number 11400 Vendor# /vendor Noma 10658 �l WOUND CARE SPECIALISTS MEMORIAL MEDICAL CENTER AP Open Imotce List Due Dallas Through: 06/21/2024 Name WEST COAST MEDICAL RESOURCES Cues Pay Coda 17 ap oponJnvolce.templale Gross Discount No -Pay Net 1,950.00 0.00 0.00 1.950.00 Involce# Comment Tran Ot Inv Dt Due Ot Check Ot Pay Groee Discount No-Pey Net WCS00006703 05/2420M 05/182024 06/212024 18,25D.00 0.00 0.00 18.250.00 APRIL WOUND CARE SVCS Vendor Totals: Number Name Gross Discount No -Pay Net 10556 WOUND CARE SPECIALISTS 18,250.00 0.00 0.00 18,250.00 Grand Totals: Gross Discount No -Pay Net 215,931.37 0.00 0,00 215.931.37 APPROVED ON MAY 3 0 2024 CALHOIIM COUNN,IT[XAS RECEIVED BY THE COUNTY AUDITOR ON 0r/30/2024 MAY 3 0. �,+� MEMORIAL MEDICAL CENTER � t 8:21 AP Open Invoice List CJ1LHOUN COUNTY, TEXAS Due Dates Through: 06/22/2024 Vendor# Vendor Name Class Pay Code U1066 YUNIFORMADVANTAGE w / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay J SOV14978574 051301202 03/211202 04105/202 UNIFORMS RTN000719207 05/30/20203128/20204/10202 CREDIT 11/14/24 05/30/202 04/01/202 04/16/202 OVERPAYMENT REFUND Vendor Totals: Number Name U1056 UNIFORM ADVANTAGE Grand Totals: Gross Discount 115.75 0.00 APPROVED ON MAppYN3 0g2UO2T4pp CALLHOUNUC UNTY�'TEXAS 0 ap_open Invoice.template Gross Discount No -Pay Net 244.57 0.00 0.00 244.57 -123.24 0.00 0.00 r -123.24 ✓ -5.58 0.00 0.00 -5.58 ✓ Gross Discount No -Pay Net 115.75 0.00 0.00 115.75 No -Pay Net 0.00 115.75 RECEIVED BY THE COUNTY AUDITOR ON 05/3712024 MEMORIAL MEDICAL CENTER h List 72;57 MAY 3, 1 jV,l, 'AP Open 0 Due Cates. Through: OW22l2024 hrough:0 ao_open_invoice.template 60 and Aim coU� .ExA5 Class Pay Code 7620206 ,/HOSPITAL CARE CONSULTANTS. INC, Invoice# Comment Tran Dt Inv, Ot Due. Or Check Dt Pay Gross Discount No -Pay Net 0624 05/26120205/1SM02:06/211202 23.663.00 0.00 0.00 23,663.00 HOSPITALIST J6536 t 05/31/202051311202Y061101202 23,663.00 0.00 0.00 23,66300 `✓ HOSPITALIST L✓'/ i + Z ` A r„�ry Eu 1 t Vendor Totals: Number, Name Gross Discount No -pay Net 15206 HOSPITAL CARE: CONSULTANTS INC. 47,326.00 0.00 0.00 47,S26.00 R*pod Sytnm:am Grand Totals: Gross Discount No -Pay Net 47,326.00 0,00 -0.00 47,326.00 l 1 a �e � t tt Laos a RECEIVED BY THE RU14 DATE: 05/30/24 COUNTY AUDITOR ON MEMORIAL MEDICAL CENTER PAGE 1 TIME: 10:44 MAY 3 0 2024 EDIT LIST FOR PATIENT REFUNDS ARID-0001 APCDEDIT PATIENT PAY PAT NUMBER PAYEE NAPL"OUN COUNTY, TEXAS DATE AM.00RT CODE TYPE DESCRIPTION GL NVI - - _ - --------------------------_--_..._...._._-.--_.......-'-------------.--------....__._----_......_------------------- ✓ - 1590989 O1 052924 80.00 J 2 REFUND FOR- D TX 77979 1597232 01 ✓ 952924 855.77 .,� 1 REFUND FOR- •J 1602391 TX 77982 / 052924 77.01 ✓ 3 REFUND FOR - TA 77979 ARID4001 TOTAL 1012.78 ... -------------------------------------------- ........................ TOTAL Al"OVED ON 1012.7E MAY 3 0 ?024 rALNOl1M1N r0i,llT��AS MWESSON STATEMENT MEMORIAL MEDICAL CENTER / AMT DUE REMITTED VIA ACH DEBIT AP ✓✓✓1 IA STREET ./ Sletemenl for Information only FORTN AVACVIRGI PfN3T UVACA TX ]7BiB As of: 05/31/2024 Be; 8116 Customer INV SupplD Tomtsry: Customer. 632535 Date: 06/01/2024 Page: 002 To enders Dealer as6A to your asasuM,. dI met mtum this Oub with your momiamm As of: 05/31/2024 Page: 002 Me I. C.W. 8000 AMT DUE HEMDTED VIA ACH DEBIT Statement tear Information only Cost: 632536 P 8E CHECK ANY Date: 06/01/2024 1TH43 NOT PAID IV) BIIIIn9 pua Bes vablreti mal Account bSy16 Ceah Amount P Amount P WaeWaWo Dato Dsla Num Referems. Desetlpuom Moment aposs) F (not) F Numbar PP column legend, P - Peal Due Nam, F = Future Due Item, Wonk = Current Due it.. TOTAL Netimvd Accf 632636 MWORIAL MEDICAL CENTER 9uMotels: But. Duo: 0.00 If PSIS By 0610412024. Put Due: 0.00 Pay This Amount: Last Poymant 2,451.97 If Pold After 0619412024, 08/07/2017 Pry this Almost: 5=9f19°36 +. 9.03 + 2 7 ^ 2 3 + 11.09 + 5'r:9-'.91v. •� 1�' b 6,110,11 U3o 5,996.71 LED 3,119.11 USD AAPMOM ON JONp03 7�ory24 Qhvy")119N11'WAI I` Wk For AR. Inquiries please contact 800-867-0333 Due If Puld On Time: LED 122.40 Duo If Pelt We: USD 6119.11 131z�{ MSKESSON STATEMENT Cc.1.1 once WALMARL 1098/MF1A MED PHS �AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CENTER V✓//�J statement for Information only VICKY KALISIX Y 815 N VIRGINIA sT POW IAVACA TX 77979 As ot: 05/31/2024 Papo: 001 To and m proper cm48 le. your, ,added, dmeoh end store this DC: 8115 hub e8h your nowd", lcce Cumomer INV SupplD: As t: 05131 /Z020 Papa: 00 Territory: ]00f Maill to: Comp; 8000 AMT DUE REMITTED VIA ACH DEBIT Guidance,.. 256342 Statement for information only Data: 06/01/2024 Coal: 256342 PLEASE CHECK ANY Dale: 06/01)2024 REMS HOT MID 1,1 an, nk p to a R0.0 able Caah Ameunl P Amount P Necelvable Number Reference Deaidpllan Shadow (9mm) F .(nett F Numhm 05/20/2024 00104/2024 7498800023 05 06128/202A OB/04/2024 ]496800024 28/2p24 00/04/2024 7499600026 00/28/2p24 06/04/2024 7498810872 00/20/2024 00/04/2024 749DO67274 Ob1201202A g0104/202A 7499D67275 OB12812024 00/04/2024 7490057276 00/29/2024 00104/2024 7490202681 05/20/2024 08/04/2024 7499202682 05120/2024 08/04/2024 7499373940 05130/2024 08/04/2024 7490489907 05130/2024 06/04/2024 7499489970 05/30I2f120 08/04IT02A 14994098]2. 05/JO/2024 OB/04/202q 7499654783 05/31/2024 08/04/2024 7499755944 05/31/2024 08/04/2024 7499755946 05g1f2024 06/04/2024 7499907644 08/31/2024 06/04/2024 7499007645 PF column legend: P = peal Due item, F - Fuure Due. 200545552 200617725 200699102 200812389 200624308 200552341 200680910 200885686 200044292 200692601 201014317 201014317 201077442 201021699 201127703 201191509 201123686 201134741 Item, blank = 1151nv01a6 IISinvotce 1151nv0ice 1151nvolce 1951nvoloe 1951nvolca 1951nvcice 1151nvoice 1151nvolos /951nvo1ce 1151nymoe 1151nva1co i151nvoica 1951nvo1oe 1151mmoo 115fivrNae 1151nvaioo 1061nvo"¢e Current Due Imm 22.3L. 3 1.34 12.65 0.01 0.48 0A9 0.01 7.12 5,25 9.13. 37,33 18.67 0.01 0.05 1.34 ()Ai 5.61 1,118.55 60.99 032,45 0.49 23.88 34.63. 0.32 356.14 6.10 262.45 456.66. 1,866.53 933:26 0.32 2.27 66.99 0.32 250.43 ' 1,094.223( 7498800023 65.65% 7498800024 619.801( 7498800026 0,48 k.. 7498818872 23.40 7{ 7499057274 33.9411 7499057275 0.31k 7490057276 349.02*4 7499202681 0.10$ 7499202582 257.20k 7499313949 447.52k 7A99489951 1,829.20 X 74B9489970 914.811( 7499A89972 0.31K 7499654783 222k 7499755944 66.65X 7409755946 0.31K 7498907644 245.4 t( 74B8907645 Su61oleia: 61070.79 use Future Duo: 0.00 It Pam By ae/n4,2,2,, APPROVED ON Post Due: 0.00 Pay Thia Amount: 5,949.36 USD lien payment 10.247.64 JUN 03 2024 K Paid After 06104/2024, 99/2711.024 Pey this Amount: 6,070 79 USD1ppCAgONUA 6 Due It Paid On Tfine: USD 5.949.36 Dias had 6 pan led: 121.43 Due If Palo tam: U50 6.07019 For AR Inquiries plcase contact 800-867-0333 MWESSON STATEMENT rnpaAay, Woo HER PHCY 0434IMEM MED THS MEMORIAL MEDICAL CENTER AMT DUE REMITTED VIA ACH DEBIT VICKY KALISIX ,f Statement for inlormalio0 and y 016 N VIRGINIA ST ToRr LAVACA TX 77979 As of: 05/31/2024 DC: 8115 Customer INV SupplD: Tmll 7001 Custome,190813 Date: 06/01/2024 Page: 001 To anN1n pmpee areEp to,. groan!, tl"hol, am glum this stub with your emplane As al: 0513112024 Page: 001 Mail to: Camp: 8000 ART ME REMITTED VIA ACH DEBIT Statement for infontatton only Cast: 190813 PLEASE CHECK ANY Dole: 0810112024 ITEMS NOT PAID (✓( Data Dua Reerh aeAps one! Amount r38 Cash Amount P Amount P ReeWable te Dale Number Rtlenne Oexapllan Olxour4 (0ma( F (net) F Number C1Maner Number 190813 H® PROY 04341MEM MED PHS 0512912024 06/04/2024 7499205451 3969278 1151nuolae 0A$ 9.21 PF--famen '^vN: P = Red Ow Nem, F = Futue Due Item, blank - Currant Ouo Item TOTAL Customer Number t90813 X® PIICY 04341MEM M® PN9 fiubtaab: 9.21 USG Fulun Due: 0.00 It Pant. By OS/0412024, Post Duo: 0.00 Pay This Amami; 9.03 USD tart Payment 3.925.30 IT Pak After 0610412024, 05/20/2024 Pay this Anoson: 9.21 USD APPROVED ON U( 1�i4 oa 2UUo7i�apppp gy CRriouNfflouNTYw TEKAR 9.03 X 7499205451� De If Row On Time: r � use 9.03 ✓ Dix IOH IT paw let.: 0.18 D. If Paw late: USD 9.21 "I ty\+l�`tivi.^h..-ic"<.Gp•:. w\Nl,l4�:.I�. For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT �TOany: 0000 HW PHCY WHSFJMW MED PPS AMT DUE ReAITTED VIA ACH DEBIT MWORIIALiMEDICAL CETIIER Slslement for InfOrmallon only 815 N VIRGINIA ST �( PORT LAVACA T% 77979 As of: 05/31/2024 Pup: 001 To aeeere Prefer cmrdt to your aoowM, detach and mlum this DC; 8115 e remHt stub With yPlaree Customer ISupp10: As al: 05I3112026 Page: 00 Temltary: 70 7001 Mao fto,.Comp; 8000 AMT DUE REMITTED VIA ACH DEBIT Customer: 820405 Sielemell Inr information only Date: 06101/2024 Cust: 820405 PLEASE CHECI( ANY Date: 06101/2024 ITWS NOT PAID (0) IIn9 Dw Recelvabetl... I Account t3A353fi - into Dale Number RateRnee Daeodptlw - DIssmount Arotm) P tgmas) F gmeuM P ReceWlde tneD F Number Customer Numb, 020405 HER PNCY WH9®MPM M® MS -� 05/2812024 00/0412024 7498771820 82405455-160365 1151nvcice 0.28 13.76 13.48N 05/30/2024 06/04/2024 1409461660 82405 055-160903 1f51nvolce 7498771829 0.20 14.03 13.751f 7499401669:f� PF wtum0 10961e1; P = Peol Due flem, F a Future Dub He, dank = DUlroat Due Hem TOTAL• CUMulper Number 820405 HES PHCY WHSEiML9A M® PHIS subtotals: 27.79 USD Fulure am: 0.00 If Paid By 08I0412024, Due It Petit On Tlme: Past Due: 0.00. Pay This Ammer; 27.23. USD USD DiDI.tort H paitl lode:27.231 Lost Paymam 10,267.64 If Pall After 06I0/13029; 0.66 05127/2024 Pay thle Amount: 21.79 USD DbIt Peld tats: e USD 2L79 APPROVE,) ON J��rU�1NL403 2u?44 CAR0VNU&Ty,,4ry n TEq XAS n D For AR Inquiries please contact 800-867-0333 M5KESSCIN STATEMENT As or: 05/31/2024 Page: 001 To .roan proper ered8 10 your added, detach and nowns this .s'no : to" dub with Y. lemon OC: 9115 CVS PHCY Customer INV Su ID: MC M18 FF As of: 05131/2024 Page: 001 Mall to: Camp: 0000 MEMORIAL MEDICAL CENTER / AMT DUE VIA ACH DEBIT Territory: ]001 for info® VICKY ItALISf9C ✓ Statement for information only SEEK AMT DUE REMITTED VIA ACH DEBIT I 035437 N VIRGINIA ST 'V Statement for inlartnallon only note: 061 1`0 Date: 06/01/2024 PoRT IAVACA.TX ]79]9 Curt: 835437 PLEASE CHECK ANY Oat.: 06101/2024 n4AS NOT ]PAID (r) at BNne Oil. Nesstyshlra0onel Asomenl Wgy18 Cash Oata Dale Amount P Amount P Reoelvabou Number Noisome. pesedpBon Oleseunt (9rom) F (nit) F Number Cualemer Number 835437 CVS PNCY 7416/MBA Me PNS 06/29/2024 08/04/2024 7499375986 3276487 115lovdr. 0.23 11.32 11 09-1( 7499375906 PF column 1e9ond: P e Pas! Due Item, F m Future 0.4 then, bunk Curtail Uw item TOTAL CUNomer Number 808497 CVS RICY 74/OIMBA MC PHS Sublatah: 11.32 USE Futum Owl 0.00 Duo If Paid On. Tim.: If Paid By 0010412024. USD 11.091 Pant Dun: 000 Pay This Amount: 11.09 USD Dim loaf K paft! We: ind0.23 10,247.84 K Paid After 0610412024, Du. If Paid bete: 081 OA/2712024 /2024 Pay this Amount: 11.32 USD USD 11.32 APPROVED ON i n at. JIJN 0?;^24 ggY COoUNTY )(7 Ilpp CALHOl1N COUNTS TEXAg For AR Inquiries please contact 800-867-0333 ArrterirrisoureeBergew STATEMENT statement Number: 67522333 n.,— nc. Q4 amn 1 o11 AMERISOURCESERGEN DRUG CORP WALGREENS #12494 340B 12727 W. AIRPORT BLVD, MEMORIAL MEDICAL CENTER ✓ 1001352&1 /037028186 SUGAR LAND TX 77418.0101 1302N VIRGINIA BT PORT LAVACA TX 77079-2509 DEA: RA0289276 Set- Fri Due in 7 tlaya 866-451-9655 AMERISOURCEBERGEN PO Box 205223 CHARLOTTE NO 28290 5223 Not Yet Duo: 0.00 Current: 382.60 Pae1 Due: 0.00 Total Due' 362.60 Account Balance: 362.60 Account Activity Document Due Reference Date Date Number Purchase Order Document Original Last Receipt Amount Received Balance _ Number Typa Amount OS-28-202A OB-0]-2024 31]6445250 70088NG" Invoke 05-28.2024 06-07-2024 317644525/ 700662027 Invoke 23.48 0.00 23.46 05.2E-2024 BO-07- 2024 3176445262 7NO83SOM Invoice 89.44 0.00 8e44 89,44 05.28.2024 0.07.2024 3178445253 7006644990 Invoice 14.38 14.381430 0.00 OS-28.2024 06,07-2024 317GM4246 7005651709 Invoice 13 0.00 75.13 OSgfi2024 0607-2024 31769572W 7008688248 Invoice 23.45 0.00 23.45 CO.31.2024 08-07-2024 31TN572N 7006563104 Invoice 89.32 0.00 89,32 4742 BOB 47.42 Current 18.30Days 60a D 0 D20D s 3sz so o.oD D.m 0.001 0.00 0.0000, Ova, Thank -You for Your Payment .Reminders Reminders Date Date 7Amount APPROVED ON Due Date Amount 0831.2024 OB-07-2024 362.60 JUN 032924 362.60362.60 cALHOl1tiC�OUHiit'RiE]fAs l'�•„�_��s-w 0�..�en�i .+ TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) a"ENTER 9-DIGITTAXPAYER IDENTIFICATION NUMBER" "ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE# SIGN" "IF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGITTAX FILING YEAR" 0"ENTER 2-DIGIT TAX 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 (DECEM BER) - 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" "6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER CALLED IN BY: CALLED IN DATE: CALLED IN TIME: #!#Jt ENTER: �0 941 t $ 113,023.35 1 $ 60,095.16 $ 14,054.40 38,873.79 JIW-Payrail FIIasftyrell Taxss024W12 R1 MMC TAX DEPOSIT WORKSHEET 05.30.24.xls 8/3/2024 941 RECITAX DEPOSIT FOR MMC PAYROLL '•f PAY PERIOD: BEGIN PAY PERIOD: END PAY DATE: $ " d11Yi1U24 0.072024 ' 4 GROSS PAY: $ 524,276.42 DEDUCTIONS: AIR $ 138,46 ADVANC BOOTS MUTUAL CRITICAL ILLNESS MUTUAL ACCIDENT IRS TAX MUTUAL SHORT TERM DUE MUTUAL VISION $ 877.74 CAFE-D $ 1.202.94. CAPE-H $ 21,179.77 CAFE-P CANCER CHILD $ 570.69 CLINIC $ 150.00 COMBIN S 250.86 CREDUN S DENTAL $ DEP-LF MUTUAL TERM LIFE S 1,319.67 MUTUAL HOSP INDEM S 685.50 FEDTAX $ 38,873.79, FICA-M S 7,027.20 FICA-0 S 30,041.60 FICA-M ADDITIONAL FIRST C FLEX S $ 6.400.31 FLX-FE $ GIFT S $ 244,43 MUTUAL CRITICAL ILLNESS $ 1,100.61 MUTUAL ACCIDENT S 736.67 MUTUAL SHORT TERM DIS S 1,804.21 LEGAL S 1,179.78 OTHER S 2,000.68 NATIONAL FARM LIFE S 997,78 MEO SURCHARGE S 296.00 Blank RELAY REPAY STONEOF $ 895.00. STONE STONE 2 STUDEN TSA-R S 36,916.60 UWIHOS 3 TOTAL DEDUCTIONS: S 163.067.37 $ 1$ NET PAY: $ 361 208.05 •........ .-iXoulDwltlia�okl'�-s 1 TOTAL CAFE 126 PLAN: $ 39,635.76 S AXABLE PAY: $ 484,639.66 $ 484,639.66 "CA1,01-81E0" EmmI.IMCRee4e Difference 'ICA-MEO(ER) 'ICA - MED (EE) 10% $ ,.,s% $ 7,027.28 7,027.28 $ 7.027.20 S 0.08. 9CA . SOC SEC (ER). a Aux S 30,047.66 :ICA - SOC SEC ISE) a�ox $ 30,047.66 S 30.047.68 S 0.08 :ED WITHHOLDING $ 38,873.79 $ 38,873.79 $ REVISED 3/19/2014 NALCKil TOTALS $ 624,215.42 5 1a6.46 S - 5 S S S S 877.74 $ 1,282.94 $ 31,179.77 S - 5 S 570.69 S 150.00 $ 25D.86 5 - 5 . 5 - 5 1,179,67 S 585.50 5 38.873.19 $ 7,027.20 5 30,047.SP, 5 5 - $ 6.400.31 5 5 244.43 S 1,100.81 5 36.5", 3 S 1.684.21 S 1,179.76 S 2.09tl.66 5 997.75 5 2§5.00 S - 5 - 5 $ 895.00 S 5 S S 35.9i8.6P S S 163,06737 $ 381,208.05 Exempt Amt: Employees over FICA -SS Cap: Michael Gaines Paycode S - Employee Relmb.: TAX DEPOSIT: 5 113,023.07 a 113.023.36 FICA -MEDICARE FICA -SOCIAL SECURITY 10M $ +x xox $ 14,054.56 60,095.32 $14,054AO $60,095.16 PREPARED BY: FED WITHHOLDING $ 38,873.79 $38.873,79 PREPARED DATE: TOTAL TAX: $ 113,023.67 $113,D3,36 $ 0.32 TOTAL: S Andde Flores 6/312024 412 RI MMC TAX DEPOSIT WORKSHEET 06.30.24.xis; TAX DEPOSIT WORKSHEET 61312024 Run Dare: 05;31124 MEMORIAL 14EDICAL CENTE. Page 112 Tine: 15:15 Payroll Register I Hi -Meekly ) P2F.EG Pay Per'_M 05117/24 - 05110/24 Run` 1 Final Summary I— P a y C a d e S u m m a r y ....---- .............-_-.-.___-_-__------ , a d u C t i 0 n s S u n a a r y ...-....----� I PayCd Desnr*4 n Bra JOTjSMjNSjHOjCBj Gross I Code Amount . _.............. ............................... ...__..__._......_.....__......_....-...._..........__.....--_.-_____ _.___.... L REGULAR PAY-61 9840.Ct N N 11 206208.49 A/R 188.461A1R2 A/R3 1 REGULAR PAY-81 1652.00 N N N 11 770$5.75 ADVANC AWARDS BCBSVI I REGULARPAY-$1 203.50 N N Y 8008.59 ECOTS CAFE N CAFE-1 1 REGULAR PAY_ El 153.50 Y N N 5373.Z6 CAF 2 CAFE-3 CAFE-4 2 REGULAR PAY-02 2482.50 N N II 68068.72 CAFE-5 CAFE-C CA?E-D 12E2.94u 2 REGULAR PAY-S2 152,75 N N Y 7244.03 CAFE-F CAFE-F. 31119.77,=CAFE-I 2 REGULAR PAY-62 48, 25 Y N N 2462,5E CAPS-L CAFE-P CANCER 3 REGULAR PAY-93 1456.00 N N N 49734.11 CHILD 570.59� LINK 150: 00.kOMBIN 250.86,/ 3 REGULAR PAY-93 127.00 N N Y 6910.99 CREDUN DD ADV DENTAL 3 REGULAR PAY-53 75.50 Y N N 3921.69 DEP-LF DI5-LF EAT 4 CALL BACK PAY 22.09 4 1 N N Y 3003.38 EATCSR FEDTAX 38873.794`CA-N 7027.20•1 CALL BACK PAY 2040 N 2 N N Y 1263.37 FICA-0 30047.54FIESTC FLEX 5 4636.67.' 4 CALL BACK PAY 2.00 N 3 N N Y 103.07 FIX FE FORT D FUTA. C CALL JAY 2464.00 N I N N 49Z8.0C GIFT S 244.43JGRANT GRP-:N C DOUBLE TIME 15.50 N 1 N N 12$3.10 OIL HOSP-I HSA 763.64-' D DOUBLE :TIME 27.25 N 2 N N 2442.59 3D TFT IRSTAX LEAF D DOUBLE TIME 40.00 N 3 N 11 3725.2E LEGAL 272,78�1 ASA 901.00,4EALS :940.W D DOUBLE TIME .75 N 3 N Y 111.41 HEIVIS MISC RISC/ E EXTRA WAGES N N N N -1075.20 MM,CSNR MOOACC 736,67AWILL 1100.01," E EF.73A WAGES N 1 N it N 153850 MOOIND 585.SOJMDOLIF 1319,6VHCGE7D :884.21* F FUNERAL LEAVE 24.00 N 1 N 17 1003.92 MOMS 977.74JNAIDI 597,76JbTHER I INSERVICE 12.25 N 1 N V 535.55 PHI PHI"' PP, FIN K EXTENDED -ILLNESS -RANK 162.00 N 1 N 11 5022.58 RELAY REPAY SAMS P PAID -TIME -OFF 2280.00 N 1 N 11 64206:05 SCRUBS SIGNON ST-TX X CALL PAY 2 152.00 N 1 N 11 304.00 STONOF 095.0DJSTONE STONE2 2 CALL PAY 3 48.00 A 1 N H 144.00 STUDEN SUKACC MULL p PAID TIME OFF . PROBATION 64,00 N 1 N 4 986.64 SUNIND SUNLIF SU:3STI1 t PHONE 6 DATA N N 11 N 1760.00 SU7VIS SURCHG 295.00.4CSA-i TSA-2 TSA-C TSA-P TSA-R 359I8,6(1TUIION UNIFOR 60,DL.J DW/HUS ----....... •--...... Grand Totals; 20532.75 ------- I Gross: 524275.42J Deductions: 163061.37J retw^ p288:;Q%4-.. Checks Count:- FT 206 PT 12 Other 42 Female 233 Male 26 Credit OverAmt 8 Zerolat Tern Total: 259 •.......................... .............. ........................................ ........ _...._._...._._...------------------- . MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT.-- May 24,2024 June 2, 2024 Date Bank Desaiation 5/31/2024 PAY PLUS ACHTrans 000000024506283 1010006964 5/31/2024 HPHG LLC PORT LAVA MemMedCtr PKav 113122650 5/31/2024 AMERISOURCE BERG PAYMENTS 010ON7768 2100002 5/31/2024 HPHG LLC MEMOR PRE MemMedCtr PtLav 113UZ65 5/30/2024 PAY PLUS ACHTrans 000DUOD24335919 1010006949 5/29/2024 PAY PLUS ACHTmns 000000024230597 1010006935 5/28/2024 PAY PLUS ACH Trans DOD000024664659 1010006920 5/28/2024 MCKESSON DRUG AUTO ACH ACMD60174809100DO163 5/28/2024 IRS USATAXPYMT 270454912008389 6103601000838 5/24/2024 PAY PLUS ACHTrans 000000023901491 1010006909 5/24/2024 HPHG LLC PORT MOMMedClr PlLav 11312265005181. 5/24/2024 EXPERTPAY EXPERTPAY 746003411 91000013751832 5/24/2024 AMERISOURCE BERG PAYMENTS 0100007768 2100002 5/24/2024 MEMORIAL MEDICAL PAYROLL 746003411 113122650 MMCNotes - End Party Payer Fee - Health loome.ce Claim Payments - 340B Drug Program Expense Health Insurance Premium Payment -3rd Party Payer Fee - 3rd Party Payer Fee - 3rd Party Payer Fee - 3405 Omg Program. Expense Payroll Taxes. -3rd Party Payer Fee - Health Insurance Claim Payments Child Support Payment -340B Drug Program Expense -Payroll � 1 June 3, 2024 ANDREW DE LOS SANTOS Memorial Medical Center - �'P'-��,A' C,(\ S 2—G1.2LA C.0 CrN S.'2Z-Z.A Cf, PROSPERITY BANK ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT— ESTIMATED ACHS 710 097. 9«3 Date Oescrlotion 6/18/2024 CHIRPS PDT ANDDEW OE 1655ANT05 Memorial Medical Center - 1•n�5.41 a•oo MMC Notes CHIRPS FIRST HALF OF YR4 IGTR CPSI"HandwdUen Amount Check" q "Gk.?9l// 901199 30,859.26,* 80D528 798.78*- SOU606 66,943.54:i' 900529 11J!,g3! 901200 Z'Ya' 901201 19,%y17+/ 9D1202 30,247.64-r5 500607 165,667.08*-0r B00530 g_.91i931 % 901203 4,920.64 )(-X- 800531 n670%9a/ 800532 996.24 a✓}p'K- 500608 428,629.39-9' � 710,097,96 ✓ �'7C�1 V1 Jf 66 J79 4 1.52 + 2• 4 + 192.I/ + 9 1 = 9 0 4 4464., 4 2,-, 0 0=C CI11�c -J rof� Amount 5 7 0. 69 1201538.00s% 0°C 120,538.00 f Arrmuvl:u ON -' lone. 3, 2024 JUN 03 2024 CAQwoRRA MA6 0 G. 6 It • 7 2 i. C70.69 + 0i5^41 0 >•� :am 9 .9. ]y pqr ° Nuiou-. ss).m - �� ]wiuru PeWAE wuwo. X ur ne r bn F pSw. y4 SITY9 wa mm f .z m. iumnY _.o 4]ye]( iiWien )xwtim a pL. Nq)� 5/IYAIE 912N ryA4 Y fi pl]P f Ip /.4mi. xmm ; X.nw.lU6lPa Ln YI M N4m)f N4A). wvelna 1919 m)m ® IIW H)Nlp1f ] l VV I b). HIW)wr H1Wt0)<]60N5m9 nl 1p t e f y /]ma 5 A � a aA pI y1Vtm. H141wa wl)Mll] /ne )ano a n Y]4mrv.];N t o 1WV(N aWWi X I I pVf 5 /16pery 3114)wr xt]w)1! fag in)e: ] w v ummzar Ym/]m! ] a mq m m xi m o XP • n/ ]a sn/ a i oif n]mo]w. p Y)Ym)f:::] Ip.Nt!a ,]xx_,,. rfs o u r HHms. a/rym). )axasem 61,-1(Iy APPROVED ON JUN 03 2024 CRtyl N' CO - TE%A5 Start Date Benefit EE Per Pay Cost ER Per Pay Cost 1/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $100.00 $ 25.00 1/1/2024 Health Savings Account $147.91 $ 25.00 1/1/2024 Health Savings Account $41.67 $ 25.00 1/1/2024 Health Savings Account $60.00 $ 25.00 1/1/2024 Health Savings Account $10.00 $ 25.00 1/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $25.00 $ 25.00 1/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $0.00 $ 25.00 2/1/2024 Health Savings Account $163.25 $ 25.00 1/1/2024 Health Savings Account $50.00 $ 25.00 2/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $100.00 $ 25.00 1/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $0.00 $ 25.00 3/1/2024 Health Savings Account $0.00 $ 25.00 1/1/2024 Health Savings Account $25.00 $ 2&00 1/1/2024 Health Savings Account $0.00 $ 25.00 2/1/2024 Health Savings Account $0.00 $ 25.00 $722.83 $550.00 Memorial Medical Center Transfer Request 5 144,194.54 Date: 6/3/2024 Nexeank Money Market APPROVED ON Prosperity Operating Account JUN 0 3 2024 Transfer from NexBank Money Market Account to Prosperity Operating Account by: Michelle Cumberland Date: 6 3 2024 by: l'i fi�lG"� rr R tea.. a T' r��.. n .. I..n n Date:�- Memorial Medical Center Transfer Request S 106,724.69 Date: 6/3/2024 Prosperity Money M2rkeiggiggigg APPROVED ON Prosperity Operating Account JUN 03 711M Transfer from Prosperity Money Market Account to. Prosperity Operating Account by: Michelle Cumberland Date: 6/3/2024 by: 4 51 A 7'FLQ( c"-iJJ . ". )\ Date: l 3 Z R. dl� MM 05/30/2024 MAY 03UN MEMORIAL MEDICAL CENTER 10;55 AP Open Invoice List `0A+'L w0k*"1 f % Due Dates Through: 05/22/2024 VendorN Vendor Name Class Pay Code 11836 GOLDENCREEK HEALTHCARE Invoice8 Comment Tran Dt Inv Dt Due Dt Check Dt Pay 051424 06/24/202 05/14/202 06/221202 TRANSFER J 051424A 05124/20205/14/20206/221202 TRANSFER f 0514248 05/24/202 05/14/202 061221202 TRANSFER J 051424C 05/24/20205/14/202061221202 / TRANSFER J 051524 05/24/20205/151202.06/22/202 ! TRANSFER .! 051524A 05/24/202 05/15/202 06/22/202 TRANSFER 052124 05/301202 05121/202 06/22/202 TRANSFER 052124A 05/30/20205/21/20208/22/202 TRANSFER Vendor Totals: Number Name 11836 GOLDENCREEK HEALTHCARE >- m!na Grand Totals: Gross Discount APPROVED ON 17,515.92 0.00 p M�ApY�N3 0 1.0p2746R CALMOUN Cf�JUA ITEXAS Gross Discount 2,498.59 0.00 861.66 0.00 268.35 7,505.00 304.09 110A3 3,275.00 2,692.80 Gross 17,516.92 No -Pay 0,00 0.00 0.00 0.00 0.00 0.00 0.00 Discount 0:00 0 ap open_invoice.template No -Pay 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 No -Pay 0.00 Net 17,515Z Net i 2,498.59 J 861.66 '/ 268.35 .//. 7,505.00 J 304.09 l 110.43 3,275.00 2,692.50 J Net 17.515,92 RECEIVED BY THE COUNTY AUDITOR ON 05/30/2024 MEMORIAL MEDICAL CENTER 11:04 MAY 3 0 ?024 AP Open Invoice List Due Dates Through: 06/22/2024 Vendor# Vendor Name CALM" COUNTY, YEM Class Pay Code 13004 TUSCANY VILLAGE JInvoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay y' 051424 05/24/202 05/14/202 06122/202 J TRANSFER 062124A 05130/202 05/21/202 06/22/202 TRANSFER J052224 05/30/20206/21/20206/22/202 TRANSFER ,/052224A 05/30/20205/21/20206122/202 SUPPLIES Vendor Totals: Number Name 13004 TUSCANY VILLAGE Yt:_�:r_; .OJT TP .�• Grand Totals: Gross Discount 21,258.00 0.00 APPAOVED ON MApOY 0 0 2uu0��7724ppqq t;ALHOUN G01N'tY,IT AS 0 ap_open_i nvoice. template Gross Discount No -Pay Net J 2,040,00 0.00 0.00 2,040.00 16.560.00 0.00 0.00 16,660.00 d/ 2,250.00 0,00 0.00 2,250.00 ..,J 408.00 0.00 0.00 408.00 J Gross Discount No -Pay Net 21,258.00 0.00 0.00 21,258.00 No -Pay Net 0.00 21,258.00 REOEUM ®YTHE COUNTY AUDITOR ON 05/30/2024 MAY 8 0 2024 MEMORIAL MEDICAL CENTER 11:03 AP Open Invoice List CALHOUN COUNTYI�JtAE Due Dates Through: 06/22/2024 , Vendorti Vendor Name Class Pay Code 12792 BETHANY SENIOR LIVING Invoicelt Comment Tran Dt Inv Dt Due Dt Check Dt Pay J 061424 05/241202 05/14/202 06122/202 / TRANSFER .j 051524 05/24/202 05/151202 06/22/202 TRANSFER 051524A 051241202 05/15/202 06/221202 TRANSFER 051524B 05/24/20205/15/20206/22/202 TRANSFER 052024 05124120205/20/20206/22/202 / TRANSFER �( 052024A 05/30/202 05/20/202 06/22/202 TRANSFER 052124 05130/20205121/20206122/202 / SUPPLIES 052224 05/30/202 06/22/202 06/221202 SUPPLIES Vendor Totals: Number Name 12792 BETHANY SENIOR LIVING •iW5 �d F1'n.Y;9 [x Grand Totals: Gross Discount APPROVED ON 44,638.38 0.00 MAY ry3r 0 "r1;4 r;A%(WR C04�NTY1TEXAS 0 ap_open_Invoice.template Gross Discount No -Pay Net 1,636,01 0.00 0.00 1,636.01 3,264.00 0.00 0.00 3,264.00 80.35 0.00 0.00 80.35 ^✓' 0.27 0.00 0.00 0.27 12,771.85 0.00 0.00 12,771.85 2,711.39 0.00 0.00 2.711.39 J 22,529.31 0.00 0.00 22,529.31 J 1,645.20 0.00 0.00 1,645.20 "f Gross Discount No -Pay Net 44,638.38 0.00 0.00 44,638.38 No -Pay Net 0.00 44,638.38 MemGbl Medraf Canter NurflAg NOMO UPL W*QklY emee Tionsfer PIOIParlfy Aeraupb 83/2024 ,,,,w / J/ ww }b.3snl lmsmm »e:9bm� wµ.Mr ,r.an.,nn.woxwn /V nuu�l�. 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IJ59.9fi V/ Sx.f( ?f4 L561.0d, - 1.569.b iBx.ITI.M ISM, +b9] M.n - 69.SS9.12 6R,529122 Ed19.IE 1.193.10 £59J.10 Unnn IJ3891 6ANIS 6.a9i Pf v OEM VVV 6pe if.M J 5 EM SOWSfi,b x` IlA95a66J 116,156.01 MMCP()"ON loud 14Ru1 )mn,hm. 4110/0am 1 qIM/GmNf gIP1/Cwfip) Cupp enm'.4G5M gllP rl NHI.M.4 nlfl 15635 11RKQ Condo. ]S,SIVAS 15.96].M SR9s ee .'@ - Seem l,IOIN 5.Ip6.61 � tell.b 1..57.6E 111,E%ll _ ]69.@ 193.54 MUM - 0.937 E0 21113 aseJ Iss a3 3},)M24 3Ed90,N - £N619 £)NAS n.60L30 196I ZMAI l]N£62 J 19.1E / 9191E.00 A9%@ J y93o N S.IM £193.61 moM 1..91 11 MMMICT%N njp_(f,n M I jnnO,r.l glPv/LOmp181a0N glpP/Gmpl gllP/[empi gllp/COmp9led glpp ll xll ptlAYlOx L691.ol • 41 , - f.5)&95 6.599.93 awil 5.80].i3 Ea@% S.Y6000 N,M ba ]W.111.01 I - - H,SWi%iv 4ll'% a91.0a Mine - 13 - bn.46 SI0,00 ]E.ab 1,1w.W I.EW.W 6.1]O.DI fi.Ilp 00 - 2]?S].a6 11.11LA9 - 1.5MU - a EMU "IolOnto I,e1930 � lLE%AJ -_.._ npoo op mmem E" TJ!W{C;p43 T,+n,lanln gIPP/Co.pl gIPP/Cwapl q@P/Pomp] Cope/cam awpin q]PITI XNp.did .N N,1H.66 / 669t - All J SAAA] I.00P 90 - 10.16 650, - 260.16 t%ZOlA9 6500 J.9m4m , M7. / I,930.00 Won, 600.741 11061b J 33,16ff 0 via 1J11515 1.06E i0 11n66.i6 S l>136 i5 fIAN.61 MCOOR11Q4 dp3lfgi J Tp09L(D gIPIfCOm I CIPPJCOmpI glPv/Ctlmpl gIpPJCamDlabpv CIIPTI NX IORCON I1.69 II,IHAn/ I)l99 1,1.00 VVV/ MOSA 160,131E I50,00 • 1211$1.92 ' a,31519 12,151.02 - IN.39 4,251.49 "Im none 2011.95 - S6,.00 9,80.6E t0,119.pi U6 to ? 610.6E ' R,ise 21 234.10 ' NJ;t91 - 5.155.23 I,YMII / - 20.1219 2636.00 J 477973 e 636W nom 4.22 At TOTAU 19193LQ1 ii3.f9).11 e11 69).0 Balances Overview Account Name '4357 MEMORIAL MEDICAL CENTER- OPERATING $1,732,285.36 $1,862,397,61 $1,732,285.36 $1,732,285.36 `4365MEMORIAL MEDICAL CENTER- CLINIC SERIES 2014 $544.55 $544.55 $544.55 $544.55 '4373 MEMORIAL MEDICAL CENTER - PRIVATE WAIVER $438.38 $438.38 $438.38 $438.38 CLEARING *4381 MEMORIAL - MEDICAL CENTER I J/ NH ASHFORD $117,235.21 ✓ $121,195.21 $117,235.21 $117,235.21 04403 MEMORIAL MEDICAL CENTER 1 / NHBROADMOOR J $127,723.18 $146.572.59 $127,723.18 $127,723,18 '4411 MEMORIAL MEDICALCENTERI / NH CRESCENT $68,484.63 / $100,029.72 $88,484.63 $88,484.53 14438 MEMORIAL MEDICAL CENTER! / SOLERA AT WEST $93,793.37-/ $93,793.37 $93,793.37 $93,793.37 HOUSTON '4446 MEMORIAL MEDICAL CENTER/ J $52,784.38�� $52,784.38 $52,784.38 --- $52,784.38 NH FORT SEND *4454 MEMORIAL MEDICAL GOLDS$80,459.33 GOLDEN CREEK $83.462.15 $80,459.33 $80,459.33 HEALTHCARE 04561 CAL CO INDIGENT HEALTHCARE $9,658.74 $9,658.74 $9,658.74 $9,658.74 '5433 MMC -NH GULF POINTE PLAZA - PRIVATE PAY $4,774.78 $4,798.78 $4,774.78 $4,774.78 *5441 MMC -NH GULF POINTEPLAZA- MEDICAREIMEDICAID $7,191.89 $7,351.89 $7,191.89 $7,191.89 *5506 MMC -NH ---- BETHANYSENIOR LIVING $134,308.61 $144,392.39 $134,308.61 $134;308.61 USCMMC T• USCANY VILLAGE AGE $292,651.07 $293.612.73 $292651-.07 , $292,651.07 '3660 MMC .BETHANY SR LIVING -DACA $100.00 $100.00 $100.00 $100.00 '2066 MMC -MONEY MARKET FUND $111,724.68 $111,724.68 $111,724.68 $111,724.68 Total Balance $2,854,158.16 $3,032,857.17 $2,854,158.16 $2,864,158.16 Report generated en 06/03/2024 09:36:42 AM CDT Page 2 of Memorial Medical Center Nursing Home UPL Weekly Nezion Transfer Prosperity Accounts 6/3/2024 ✓ vrevlous / / N Aapunl ae8lnniq V 9 Nome Number Balanne Tran[IerhOut Tnna3eMn Hn lis 2M,532.82 235,2 0.35 80,206.86 Boating fdonne Nnn ]a r 0afden Creek' Nolan Health at Golden Creek Wet Few Bank, N A. Nale:Onybalanfb alteeT$$017010be Ira llavmdfa the nonln9 Aetna. Nafef: felh-.I.t has o basewlanm a/530 1haf MAICaf p Ured heap. aawnr. APPROVED ON JUN 03 2024 fending Tad.V, Be8lnnt, Are. re ...Be Tnndenadlp N.,,We / Bank BalaMe 00,459.31 yaronn Leevelnailance 100,00 AarillnHaart 152.4] / Meylnlerert 219.56 J� lane Interest Atliurt Balen[eRnnAarAm[ ]9.991.80 ,/ ANOBTWOELOSSANTo5�6/3/}BlA/3/1020 I:\NII W<ekly TNnalanVlN UVLLramler3ummuyV014\NN UFLTe+n[ler5ummary6.3.}a MMcvoxnon WPP/Wmpo innlN..nuJ hPntl9rv.yln gIPP/G ] OIPp(Cem i gIPP/[omPi Nn u gPP11 NHWRVON d1NPt1 IdOM IelXmml WIJ1M 95 JW0ii0WOXGt3.OY 5DISCS ,9fl DCA NJWJOfbNUTXpN[AITH0d16 A010MMN.0 g9lf.O 1/1WIWb qYl/IMHffIRST<R <D OIPN]bNS351)691191 1J1 d N14.33 1.414.31 AMOC1 CJaAAitl A," S119/1024 09Pai1 v vtpip f1,80>83 1plpNb T"WRAMM41 CR CO CEONf6Nl95O691>Il lDSm }D5.10 1/fl/t@I 16Y3/tWIPA3i CA CCD V 5116NS5551691111 936m 93600 lltd10360010M6 MA(Ati PAM DIP 12203569IkWN19 _ / Zm / 335 N0.3— AG N.MON J Balances Overview Account Name '4357 MEMORIAL MEDICAL CENTER- OPERATING $1,732,285.36 $1,862,397,61 $1,732,285.36 $1,732,285.36 '4365 MEMORIAL MEDICAL CENTER- CLINIC SERIES 2014 $544.55 $544.55 $544.55 $544.55 '4373 MEMORIAL MEDICAL CENTER - PRIVATE WAIVER $438.38 $438.38 $438.38 $438.38 CLEARING '4381 MEMORIAL ' MEDICAL CENTER I NH ASHFORD $117,235.21 $121,195.21 $117,235.21 $117,235.21 '4403 MEMORIAL MEDICAL CENTERI NH SROAOMOOR $127,723.16 $146,572.59 $127,723.18 $127,723.18 '4411 MEMORIAL MEDICAL CENTER NH CRESCENT $88,484.63 $100,029.72 $88,484.63 $8$484.63 '4438 MEMORIAL MEDICAL CENTER I SOLERAATWEST $93,793.37 $93,793.37 $93,793.37 $93,793.37 HOUSTON '4446 MEMORIAL MEDICAL CENTER NH FORT BEND $52,784.38 / $52,784.38 $52,784.38 $52,784.38 4464 MEMORIAL �. MEDICAL f NH GOLDEN CREEK f $80,459.33✓ $83,462.15 $80,459.33 $80,459.33 HEALTHCARE '4581 CAL CO INDIGENT HEALTHCARE $9,658.74 $9.658,74 $9,658.74 $9,658.74 '5433 MMC -NH GULF — POINTEPLAZA- PRIVATE PAY $4,774.78 $4,798.78 $4,774.78 $4,774.78 '5441 MMC -NH GULF POINTE PLAZA- MEDICAREIMEDICAID $7,191.89 $7,351.89 $7,191.89 $7,191.89 '5506 MMC -NH —' BETHANY SENIOR LIVING $134,308.61 $144,392.39 $134,308.61 $134,308.61 *3407 TUSCA YVILL TUSCANY VILLAGE $292,651.07 $293,612.73 $292,651.07 $292,651.07 '3660 MMC -BETHANY SR LIVING • DACA $100.00 $100.00 $100.00 $100.00 MARETFUNDMMC NEY MARKET FUND $111,724.68 $111,724.68 $111.724.68 $111,724.68 Total Balance $2,854,158.16 $3,032,857.17 $2,854,158.16 $2,854,158.16 Report generated on 06103/2024 09:36:42 AM CDT Page 2 of 3 Memorial Medical Center Nursing Home UPL WeeklVHMGTransfer ProsperityAccoUm s 6/3/2024 J � Pmlaul R[!<um BIHnMry Nunl Neme u,...h+r _4Yn[e Tnml+nOut / Tnnrlv.n OrMIM WI.111n[e V+111n Y+win Btlmv Anm mle.e Tnmlrn dw J PnHev1 Nweum 6Minrin6 Nunl Wm! Nunbw 4YrM Tnv4r-0q 3,]50.61 TnmlvJn CY+Qnretl Ip9t69 AQurtOlYn+eRnmlo Amt Peman[ pe eV I / 1.67I1V/ Ameunue Be J Tnn='. to )etl+• b in ilpnn NUNn[Neme j a ].191,19 J ).091.e9 r/ S,L56.W LnL &Yntt AIM Wn1ntt Mu11n61nISIm111nn Iw ON[Pan.. vl111. NPII: OWY b Wlel a 0r $X=.11M bmlren[tlto IA[nwLnP nqT+. Ze N FatA o[munl hn o bne 6v1mn a(11 M NVI MMC pvvile! u, eqn a[minl APPROVED ON JUN 03 7.0?4 CABHOUN COUNTY,ITEICAS Le+wln B+l+n [! I.. •tl6urtbhrK+/1nmllrlm[ )A9116./ TO)ALTRANA6e6 11)666) J ANaI1FW a[IMHMOS 1/»]atq I:INM Wllky111n1I1n4VNUilinn11116ulsmlrylMLVIMeILinnllle 5umm1ry6]]f MMCPQRTIQN QIPP/Comp QIPP/COmPA TranlEel.Gut C Ta.ifel-I. QIPP/Campl 3 QIPP/CemPl BUPIe QIPP TI- NHPORtION J/ 3.A) 2.47 3)9R9 2]9.23 1,882.30 1.882,20 MMC PORTION QIPP/Camp QIPP/CAmPA TPM)ePOm T n,T�} ll-Pn 41PP/COmpl 2 QIPP/Co.P3 AUple QIPPTI, NNPORTION 27,56 19.56 2.71031 2,710,31 5,)58.M 9/31/101d gdded TO4Kount 5/19/1624 HNB - ECHO NCCIAIMPMT)A600N11 440000232008 5/19/M24 HNS -ECHO HCCWMPMT746003411 4AMM232M8 5/14/2024 IIND • ECHO HCCWMPMt9460O3411 440000235691 5/31/1024 Added to Aerounl 5/31/102A MFRCNANi BANXCA DEP051T d96A7e51B8899100001 5/30/102A MIREDUTNMGBOAPON9NG,LP-CemmeH[al 5/30/1024 MERMAN BANKCD DEPOSIT I9M7852888991D0001 I Smil / 310.11 51ZB12024 MERCNAMBANKCDOEMSIA9M985l8889910000t J MGM V 32DW 5/24nD24 MERCHANT BANKCD DEPOSIT A9M)55]BBBP910P001 I719.91 3 )19 yE / 5,t9B.6A / 1.091.B9 109189 5.758.64 91496.18 9,496.48 Balances Overview Account Name `4357 MEMORIAL MEDICAL CENTER- OPERATING $1,732,285.36 $1,862,397.61 $1,732,285.36 $1,732,286.36 '4365 MEMORIAL MEDICAL CENTER - $544.55 $544.55 $544.55 $544.55 CLINIC SERIES 2014 '4373 MEMORIAL MEDICAL CENTER - PRIVATE WAIVER $438.38 $438.38 $438.38 $438.38 CLEARING '4301 MEMORIAL MEDICAL CENTER/ NHASHFORD $117,235.21 $121,195.21 $117,235.21 $117,235.21 '4403 MEMORIAL MEDICAL CENTER/ NHBROADMOOR $127,723.18 $146,572.59 $127.723.18 $127,723.18 '4411 MEMORIAL —' MEDICAL CENTER / $88,484.63 $100,029.72 $88,484.63 $88,484.63 NH CRESCENT `4438 MEMORIAL MEDICAL CENTER SOLERA AT WEST $93,793.37 $93,793.37 $93,793.37 $93,793.37 HOUSTON •4446 MEMORIAL' MEDICALCENTER/ $52,784.38 $52,784.38 $52,784.38 $52,784.38 NH FORT BEND '4454 MEMORIAL MEDICAL / NH GOLDEN CREEK $80,459.33 $83,462.15 $80,459.33 $80,459.33 HEALTHCARE •4561 CAL CO INDIGENT HEALTHCARE $9,658.74 $9,658.74 $9,658.74 $9,658.74 '5433 MMC -NH GULF POINTE PLAZA. / $4,774.78 $4,798.78 $4,774.78 $4,774.78 PRIVATE PAY 5441 MMC -NH GULF POINTE PLAZA- v $7,191.89 ✓ $7,351.89 $7,191.89 $7,191.89 MEDICAREIMEDICAID '5506 MMC -NH BETHANY SENIOR $134,308.61 $144,392.39 $134,308.61 $134,308.61 LIVING TUSCANY VILLAGE `USC NY VILLAGE $292651.07 $293,612.73 $292,651,07 $292,651.07 '3660 MMC -BETHANY SR LIVING -DACA $100.00 $100.00 $100.00 $100.D0 *2998 MMC -MONEY MARKETFUND $111,724.68 $111,724.68 $111,724.68 $111,724.68 Total Balance $2,854,158.16 $3,032,857.17 $2,854,158.16 $2,854,158.16 Repon genereled on 06/03@024 09:36:42 AM CDT Page 2 of 3 Memorial Medical Center Nursing Home UPL Weekly Tuscany Transfer Prosperity Accounts � R,rvlw• xb.m Dninma Npn: R zNuman Duna r1,1191 R Note:pnlYD9bn)nol pvn SS.tWx+lldrnan0rnramurnuru'roeen+r. Nob }; Earh e[mm, D 0, a bnn Dn)rnn e/al M Un! MM[ dipeMrd b wrn attaunr. JGTounlb Be rnaine V r••m)e.na b,� imb,an u•wum p• e, rw, ••a bmn miNn 9••m n9me '.ffpA9 39].6)I.OI Y9]•951.ai / BbF a>nnb 19iss39r Vanen<e b•veln Ubna tiara APPRbVED ON JUN 03 2024 CA%�y idOL4?%S RaluneabnnRumbnmr nsso.w✓ 4tIpREW pE 1p55RMp5 6/1/3019 MMCPORTION mom QIPP/Comp OIPP/Comp OIPP/Comp EM Ttansfet-Out Transfer-1 n 1 (11PP/EOmp2 3 4Mlapse OIPPTI NH PORTION. 5/311ZD24 Added to Account li/ 211.SO 211.30 5/01/3024 Check 1155 28,61T.70J - 5/31/2024 NOVITAS SOLUTION HCCUMMPMT 676201420000119 J7 15,903.41 15,903A3 4/30/3030 WORE OUT VILLAGE P051'ACUTfi HEALTH SERVICE 54,4M.05✓ S/30/2024 HN8-ECHOHCCIAIMPMT746 3411440000286978 - 7,919.21 , 7,919,21 h13013014 NOVITAS SOLUTION HCCLAIMPMT676201420000356 - 52,003.47 - 52,003.47 3/20/2024 Deposit 8.681,12 - 8,681.12 5/19/2024 Depost 13.900.00 13,500.M 5/28/2024 HNB • ECHO HCCUIIMPMT 746003411440000270943 8,414,26 8.414.16 5/24/1024 wire out village Poslacute he 106,994.95J 5/24/2024MIND -ECHO NCCLAIMPMT 74600341144G00W33691 1.484,85 - 1,484.85 5/24/2024 HN8-ECHO HCCIAIMPMT 746W3411440000233691 12,904.98 12,904.98 S124/2024 NOVITAS SOLUTION HCCLAIMPMT 676201420000ILO - �/ 156,537.95 ssc cal ac Balances Overview Account Name '4357 MEMORIAL MEDICAL CENTER- $1,732,285.36 $1,862,397.61 $1,732,285.36 $1,732,285.36 OPERATING '4365 MEMORIAL MEDICAL CENTER - $544.55 $544.55 $544.55 $544.55 CLINIC SERIES 2014 '4373 MEMORIAL MEDICAL CENTER - PRIVATE WAIVER $438.38 $438.38 $438.38 $438.38 CLEARING '4381 MEMORIAL MEDICAL CENTER 1 $117,235.21 $121,195.21 $117,235.21 $117,235,21 NH ASHFORD '4403 MEMORIAL MEDICAL CENTER/ $127,723.18 $146,572.59 $127,723.18 $127,723.18 NH BROADMOOR '4411 MEMORIAL MEDICAL CENTER/ $88,484.63 $100,029.72 $88,484.63 $88,484.63 NH CRESCENT '4438 MEMORIAL MEDICAL CENTER/ SOLERA AT WEST $93,793.37 $93,793.37 $93,793.37 $93,793.37 HOUSTON '4446 MEMORIAL MEDICAL CENTER $52.784,38 $52,784.38 $52,784.38 $52,784.38 NH FORT BEND '4464 MEMORIAL MEDICAL GOLDSN CREEK GOLDE $80,459.33 $83,462.15 $80,459.33 $80,459.33 HEALTHCARE '4851 CAL CO ' INDIGENT $9,658.74 $9,658.74 $9,658.74 $9,658.74 HEALTHCARE '5433 MMC -NH GULF POINTE PLAZA- $4,774.78 $4,798.78 $4,774.78 $4,774.78 PRIVATE PAY '5441 MMC •NH GULF POINTEPLAZA- $7,191.89 $7,351,89 $7.191.89 $7.191.89 MEDICAREIMEDICAID *5606 MMC •NH " BETHANY SENIOR $134,308.61 $144,392.39 $134,308.61 $134,308.61 LIVING *3407 TUSCMMC•LL •r ANY VILLAGE �,/ $292,651.07 ti/ $293,612.73 $292,651.07 $292,651.07 '3660 MMC -BETHANY SR LIVING -DACA $100.00 $100.00 $100.00 $100,00 '2085 ETFUND FUND MARKET $111,724.68 $111,724.68 $111,724.68 $111,724,68 Total Balance $2,854,168.16 $3,032,867.17 $2,854,158.16 $2,854,158,16 Report generated on 06103/2024 09:36:42 AM COT Page 2 of 3 Memorial Medical Center Nursing Nome UPL Weekly NSLTran$fer Prosperit6/3/2024 Accounts 6/g/202a pnNM1x[ J/ J Nunln Np PapwL odnNn ^— Btlrrn! TnNlendn YnnO " aL,)O1.M 6a5111364 nl )66.)N Mln: OmYbWpn[no/erc[$A0.V WI6e0ingnrlyfp Nenme. NOf!!:[![ryp[NWtM1mIM{06p1lptlOJ$1N 11otMMCtlfl..IldpnlleElo!➢fnp[[lunt. APPROVED ON JUN b 3 2024 BY CALHO C&WTT&S NMI, Me6nn ewk Belnn Ve•Nme L.I. In firbnee 13pd01A1 ILgb] <pell lnlele[1 39441 MrylnlertO 313.80 �/ lubeln)nnl RljmteabFp},"1n-/In�n(Llsram) MpnrcP: WNyi"((yLt„ %v �jA\ t/i 1 UN PNOP[W eILOi S4M0) 1 61111vA r I.\NN WnNYtumlprµx NL bMRN)—I VOPWN UPI M1nrfer SumaeT6).0 MMCPORTIOp RE ipOLCOuf hap}(91d0 ORP/Com01 yP9/Cvmp} OIPP/Cam03 y9P/Camgpp034 OIPPTI PUTPORTION wll/1011 AJ6MIOAHoyT )I).p 31]60 1/11/!OA NOS11[f 03)OIIIN NymmUN3111111850%913f D,13439 3.3f0.39 3/IIAOE{11[AL1111111MIN3VL11 CC1AIMIMT I)Iy0H1130161 /� ],IIO.I] 1.130.3E 3/ AMI MAC OUT PORT IAWO Ulf, tK I3L{0.S)3/ - 513M054 WIAFOU110ATLAVACANN.SL[ tW iq.6i ✓ , MOVIOSl OIO9u1 104)1R31 IOSM6.51 1/30(}014 ,TAPE ARNIM 14,501.SS w]0/EO}l Orymp ],05.93 MIMS 5/101lOta O4oaX1 J RSn.03 ]9.M.6I Srlw}0)1 OpeJf 9,111.1 9.336.60 lnwEOEA cn.AA A041 )/]0/ioi4 CU"A SEAT laupoR . 1/ER11014 NBC TWAT' TACA215 )Ill6%314]696 SWEEP fR I,gA1t0 0. W EVIEi{ XXI -C[NO NCQAIMOMT 11600//13 A1OYV]]Ofll SO].W S/L/lO14 WA( OUT IORT4VAG pN, ILC 111.110,51 103.60 103.00 SWAM OIENER � 9,I9a10 9.Y91.40 1941 014 VAPOR 1)9100) / - E3,91O01 1114/10E4 XOVITMMOTION NCCIAIMPMT67WI 4UA'R0110 NET NOf9ICC 011 .111.11 Nf {Il3Ii95W3T15! 1 }S.U165 ].19}A1 J 1331to W:ao1l )/l4/30N N111., NYMAX SVC XCRAIMIMf IIIK0lAIENNIE /313061 1.13061 S5.711R55./ IK"4,73 / 16PAA]3V/ Balances Overview Account Name `4367 MEMORIAL MEDICAL CENTER- $1,732.285.36 $1,862,397.61 $1,732,285.36 $1,732,285.36 OPERATING `4365 MEMORIAL ' MEDICAL CENTER - CLINIC SERIES 2014 $544.55 $544.55 $544.55 $544,55 `4373 MEMORIAL MEDICAL CENTER - PRIVATE WAIVER $438.38 $438.38 $438.38 $438.38 CLEARING `4381 MEMORIAL MEDICAL CENTER NH ASHFORD $117,235.21 $121,195.21 $117,235.21 $117,235,21 *4403 MEMORIAL MEDICAL CENTER/ $127,723.18 $146,572.59 $127,723.18 $127,723.18 NHBROADMOOR *4411 MEMORIAL ---' MEDICAL CENTER / NH CRESCENT $88,484,63 $100,029.72 $88,484.63 $88,484.63 *4438 MEMORIAL MEDISCILE AI AT WEST SOLERA AT WEST $93,793.37 $93,793.37 $93,793.37 $93.793,37 HOUSTON *4446 MEMORIAL MEDICAL CENTER $52,784.38 $52,784.38 $52,784.38 $52,784.38 NH FORT SEND *4464 MEMORIAL MEDICAL GOLDEN CREEK OLDEN $80,459.33 $83,462.15 $80,459.33 $80,459.33 HEALTHCARE `4551 CAL CO INDIGENT HEALTHCARE $9,658.74 $9,658.74 $9,658.74 $9.656.74 •5433 MMC -NH GULF POINTE PLAZA- $4,774.78 $4,798.78 $4,774,78 $4,774.78 PRIVATE PAY •5441 MMC -NH GULF POINTEPLAZA- $7,191.89 $7,351.89 $7,191.89 $7,191.89 MEDICAREIMEDICAID *5506 MMC -NH BETHANY SENIOR ,/ LIVING $134,308.61 $144,392.39 $134,308.61 $134,308.61 *3407 MMC -NH USC TUSCANY VILLAGE $292,651.07 $293,612.73 $292,651.07 $292,651.07 `3660 MMC -BETHANY SR LIVING -DACA $100.00 $100.00 $100.00 $100.00 *2998 MMC MARKETFUND -MONEY MARKE7FUND $111.724.68 $111,724.68 $111,724.68 $111,724.68 Total Balance $2,854,158.16 $3,032,857.17 $2.864,158.16 $2,854,158.16 Report generated on 06/03/2024 09:30:42 AM COT Page 2 of Creek P MMC I_1 MEMORIAL MEDICAL CENTER CHECK REQUEST Date Requested: Y 1iw ON E JUN Ok �2b24 E �AtttYX�Aw AMOUNT: EXPLANATION: $ 65.40 / 6/3/2024 FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 MMC patient claim money was deposited in their account / REQUESTED BY: Michelle Cumberland AUTHORIZED BY: Gulf Pointe Private MEMORIAL MEDICAL CENTER CHECK REQUEST P MMC Date Requested: 6/3/2024 A Y A MOVEO ON E gg JUNryN70yy3 2024 E ca1,FtiC,OUN`7V'11E3t,As FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept AMOUNT: $ 218.13 ✓ G/L NUMBER: 10255040 EXPLANATION: MMC patient claim money was deposited in their account REQUESTED BY: Michelle Cumberland AUTHORIZED BYAAIA ( - Transaction Summary Transaction Complete Trace #:000000008220811 Texas Health and Human Services Commission Memorial Medical Center Operating County 746003411 Payment Total $120.538.00 Bank Routing and Account Number 113122655 """'4357 Settlement Date 6/18/2024 CHIRP Amount $120,538.00 Entered By Andrew De Los Santos .L (S I -2-`f Page No: i of t Run Date: 61312024 Run The: 00:33:16