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2024-08-21 Final PacketNOTICE OF MEETING — 8/21/2024 August 21, 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. None Page 1 of 5 NOTICE OF MEETING — 8/21/2024 5. Approve August 14, 2024 Commissioners' Court Regular 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 6. Consider and take necessary action for an extension agent to present V. G. Young Certificates to the Court. (RHM) Karen Lyssy and Emilee DeForest presented certificates to Judge, Meyer, and, 'Commissioner Behrens for the Leadership Academy. RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 7. Hearing to consider and take any necessary action on the proposed award to the lowest and best bidder for Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 for Calhoun County, Texas — Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order E-1, including any previously unconsidered evidence from responsive lower dollar bidders, if any, in accordance with the notice and protest procedures required under Local Government Code Section 262.027(c)(2)&(h). (DEH) Hunter with Playground Solutions explained proposal. Scott Mason with G&W Engineers asked both Hunter with Playground Solutions and Peyton with Fun Abounds questions regarding proposals sent in. Court agreed to table action for next week after further review from both parties' proposals. 8. Consider and take necessary action on insurance proceeds check from TAC in the amount of $9,545.75 ($14,545.75 — $5,000.00 deductible) for damages from Jail water leak on 04/29/24. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 2 of 5 NOTICE OF MEETING -- 8/21/2024 9. Consider and take necessary action to approve Calhoun County Fair Association to sell alcohol at the 2024 Calhoun County Fair. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 10. Consider and take necessary action to propose a new tax rate for 2024. (RHM) Court approved new tax rate of 0.622 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES. Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 11. Consider and take necessary action to set the date, time and location for the Public Hearing to adopt the 2024 proposed tax rate. (RHM) Court approved to set the hearing for September 4, 2024 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens; Reese 12. Consider and take necessary action to set the date, time and location tor the rumic Hearing to adopt the 2025 Calhoun County Budget. (RHM) Court approved to set the hearing for September4, 2024 RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 5 I NOTICE OF MEETING — 8/21/2024 13. Consider and take necessary action to approve the Memorandum of Understanding between Calhoun County EMS and Jump Aero Incorporated and authorize the Calhoun County EMS Director to sign. (REM) Dustin Jenkins explained that the Memorandum is just to explore the options and grants. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 14. Consider and take necessary action to approve the Hurt's Wastewater Managment, Ltd. Contract and authorize Calhoun County EMS Director to sign. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 15. Consider and take necessary action on Asbestos Abatement Proposal for 312 S. Ann St., Port Lavaca, TX and authorize the County Judge to sign. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese . 16. Consider and take necessary action to approve the I-Y 2024 Interlocal Agreement with Gulf Bend Center for Indigent care in the amount of $26,000.00 and authorize Judge Meyer to sign all documents. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese 17. Accept Monthly Reports from the following County Offices: i. Tax Assessor -Collector — July 2024 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 5 ' NOTICE OF MEETING — 8/21/2024 18. 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 19. Approval of bills and payroll. (RHM) Indigent Healthcare: RESULT: ` APPROVED [UNANIMOUS] MOVER: David.Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese MMC Bills: RESULT:, APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County Bills: RESULT, APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese SUPPLEMENTAL AGENDA The subject matter of such meeting is as follows: 20. Consider and take necessary action to approve the proposal with CFI Mechanical, Inc. to repair one chiller at the Calhoun County Courthouse for the amount of $35,250.00. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Oct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5 of 5 v All Agenda Items Properly Numbered v" Contracts Completed and Signed All 1295's Flagged for Acceptance (number of 1295's) v All Documents for Clerk Signature Flagged (All documents needing to be attested to need to be signed day of Commissioner's Court.) On this day of ,ac 20244, the packet for the t 64 day of L,11z2i1j 2024 Commissioners' Court Regular Session was submitted from the Calhoun County judge's office to the Calhoun County Clerk's Office. J)�L MOW. O Calhoun County judge/Asslst t GEND iNOIIC C_ Uf MIL KING 8/? 1./>014 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 MEETING The Commissioners'Court of Calhoun County, Texas will meet on Wednesday, August 21, 2024 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA � The subject matter of such meeting is as follows: AT 'V FILED o1CLOCI M 1. Call meeting to order. AUG 16 2024 2. Invocation. COUNT9CLERK &?g00 # g�Nn, TEXq;. 3. Pledges of Allegiance. °Es "G 4. General Discussion of Public Matters and Public Participation. 5. Approve August 14, 2024 Commissioners' Court Regular Meeting Minutes. (RHM) 6. Consider and take necessary action for an extension agent to present V. G. Young Certificates to the Court. (RHM) Hearing to consider and take any necessary action on the proposed award to the lowest and best bidder for Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 for Calhoun County, Texas — Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order E- 1, including any previously unconsidered evidence from responsive lower dollar bidders, if any, in accordance with the notice and protest procedures required under Local Government Code Section 262.027(c)(2)&(h). (DEH) 8. Consider and take necessary action on insurance proceeds check from TAC in the amount of $9,545.75 ($14,545.75 — $5,000.00 deductible) for damages from Jail water leak on 04/29/24. (RHM) 9. Consider and take necessary action to approve Calhoun County Fair Association to sell alcohol at the 2024 Calhoun County Fair. (RHM) Page 1 of 2 I No t 1 C I C11 ro Ll IfV(, 2�/1'1/2U) 41 10. Consider and take necessary action to propose a new tax rate for 2024. (RHM) 11. Consider and take necessary action to set the date, time and location for the Public Hearing to adopt the 2024 proposed tax rate. (RHM) 12. Consider and take necessary action to set the date, time and location for the Public Hearing to adopt the 2025 Calhoun County Budget. (RHM) 13. Consider and take necessary action to approve the Memorandum of Understanding between Calhoun County EMS and Jump Aero Incorporated and authorize the Calhoun County EMS Director to sign. (RHM) 14. Consider and take necessary action to approve the Hurt's Wastewater Managment, Ltd. Contract and authorize Calhoun County EMS Director to sign. (RHM) 15. Consider and take necessary action on Asbestos Abatement Proposal for 312 S. Ann St., Port Lavaca, TX and authorize the County Judge to sign. (RHM) 16. Consider and take necessary action to approve the FY 2024 Interlocal Agreement with Gulf Bend Center for Indigent care in the amount of $26,000.00 and authorize Judge Meyer to sign all documents. (RHM) 17. Accept Monthly Reports from the following County Offices: i. Tax Assessor -Collector — July 2024 18. Consider and take necessary action on any necessary budget adjustments, (RHM) 19. Approval of bills and payroll. (RHM) icFiard-H Meye -Cc^ 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. Page 2 of 2 PUBLIC HEARING — 9/04/2024 Richard H. Meyer County judge David Hall, Commissioner, Precinct i Vern Lyssy, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Cary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas will meet on Wednesday, September 4, 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, at 10:00 a.m. on September 4, 2024 on the 2025 Proposed Budget. This notice is in accordance with Section 111.007 and Section 111.0075 of the Texas Local Government code. The Public shall have the right to be present. 21-2� Richard H. Meyer, Coun 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 normal 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. Page 1 of 1 # 04 NOTICE OF MEETING — 8/7_1/)024 August 21, 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. None Page 1 of 17 # 05 NOl ICE OF MEETING... 8/2.1/2024 5. Approve August 14, 2024 Commissioners' Court Regular 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 2 of 17 NOTICE OF MEETING — 8/14/2024 Richard ]E',<. Meyer County judge ][David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Clyde Syma, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, August 14, 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. Richard Meyer, County Judge Calhoun County, Texas Anna Goodman, County Clerk omffiffffivi .-. Page 1 of 1 NOTICE OF MEETING — 8/9.4/2024 August 14, 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: (ABSENT) Richard Meyer David Hall (Judge Pro Tem)Vern. I.yssy (ABSENT) Joel Behrens Gary Reese (ABSENT) Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. CountyJudge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at 10am by Judge Richard Meyer 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Vern Lyssy 4. General Discussion of Public Matters and Public Participation. Judge Meyer and Commissioner Behrens are attending a Leadership academy and will graduate this Friday. Page 1 of 4 NOTICE OF MEETING — 8/14/2024 5. Approve July 31, 2024 and August 7, 2024 Commissioners' Court Regular Meeting Minutes. (RHM) RESULT AtSPROVED [UNANIMOUS= OVER: Gary Ree Mse; Comm.issior�er Pet 4 SECQNDER01- David HaII, Commissioner Pw AYES, ; Comrnlssloner HaII;:Lyssy, Reese 6. Consider and take necessary action to authorize Commissioner Behrens to sign a quote with Kraftsman Commercial Playgrounds for Installation of an ADA swing set. For the Olivia Haterius Park Infrastructure CMP grant #24-022-010-EO 19. (JMB) RESULT APPROVED [UNANIMOUS] MOVER:, David HaII; Corhmd-issioner P1 EC SONbER • Gary Reese, commissioner P±rt 4 AYES :; ` Commissioner Hall,'Lyssy, Reese 7. To Accept and Approve the following donations for the 2024 — 2025 school supply give-a- way that was held on August 4, 2024 at Drifters Hall: USA Debusk, LLC - $1200,00; Michael & Lisa Evans - $100.00; and various cash donations totaling $175.28 for a total amount of $1,475.28 to be deposited Into the Calhoun Co Sheriffs Motivation Fund. (RHM) RESULT. _ APPROVED [UNANIMOUS]' - ; MOVER ;:..; Gbry Reese; Commissioner Pct 4 SECONDER. - Nvid Hall., Corn Issloner Pct I AYES. Commissioner Hall, Lyssy, Reese 8. Consider and take necessary action to approve the proposal with Kayne Carriles dba Alpha Contracting signed by Commissioner Behrens for the construction build of a pavilion with foundation. For the Olivia Haterius Park Infrastructure CMP grant #24-022-010-EO 19. (JMB) RESULT. APPROVED [UNANIMOU5j MOVER Gary Reese, Commissioner RC 4 SECONDER; ' David.Hall Commissioner. Pct 1 AYES: Commissioner Hall, Lys sy, Reese 9. Consider and take necessary action to approve the Asbestos Abatement Proposal for 312 S. Ann St., Port Lavaca, TX in the amount of $3,500.00 with KMAC Construction Service, Inc. and authorize the County Judge to sign. (RHM) pass Page 2 of 4 NOTICE OF MEETING - 8/14/2024 10. Consider and take necessary action to approve the Revised Agreement for Professional Services in the amount of $38,000.00 with G & W Engineers, Inc. for County Parking Improvements at Court House, Museum and Port Lavaca Library. (RHM) 11. Consider and take necessary action to amend the 2024 Salary Order. (RHM) RESULT:. APPROVED [UNANIMOUS]. MQVER: David HaII;.;Commissioner Pct 1 SECONDER; Gary Reese,' Commissioner Pct'4 AYES: Cornmissiorter Hall, Lyssy, Reese 12. Calhoun County YMCA's Michele Morales and Tina Padron along with Texas Sea Grant Intern Reagan Teehan will give an update on the 2024 Calhoun County YMCA Environmental Summer Camp Program. (RHM) 13. Accept Monthly Reports from the following County Offices: i. Justice of the Peace, Pct 4 — July 2024 ii. Justice of the Peace, Pct 5 — July 2024 Ill. County Clerk — July 2024 iv. District Clerk — July 2024 V. County Treasurer — February, March and April 2024 A. County Treasurer — Statement of Balances — In Quarter 2024 vil. County Treasurer — Investment Report —1st Quarter 2024 RE&ULT, APPROVED tokwmduq.„FLit. MOVER: David H4111;. Commissioner Pct I SECONDER: Gary Reese, Corn 1s91aher Pd 4. AYES: Commissioner Hall L s y sy, Reese Page 3 of 4 NOTICE OF MEETING — S/14/2024 14. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT. APPROVE :Q [UNANIMOUS] MOVER: ' Gary Reese,,-_ Issloner.;pct4 SECONDER: David Walf; Commissioner Pet i AYES tdnnrrissioner HaII,Lyssy, Reese 15. Approval of bills and payroll. (RHM) MMC Bills: RESULT: ` ' APPROVED [UNANIMOUS] MOVER David Hails Commissioner Pct 1 SE..COLV'DER: Gary Reese, Commissioner Oct 4 AYES: Commissioner Hall, Lyssy, Reese County Bills;, RESULT APPROVED [UNANIMOUS] M VERB 'David Mall, Commissloner,Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES "' Commissioner. Hall, Lyssy, Reese SUPPLEMENTAL AGENDA The subject matter of such meeting is as follows: 16. Consider and take necessary action for the proposed award for Bid No. 2024.08 - Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 for Calhoun County, Texas —Texas General Land Office Contract No. 20-065-064-CI82 and Calhoun County 2020 CDBG-DR Contract Work Order No. E-1. (DEH) Adjourned 10:37am Page 4 of 4 # 06 N0110E OF MEEFING — 8/21/2024 6. Consider and take necessary action for an extension agent to present V. G. Young Certificates to the Court. (RHM) Karen Lyssy and Emilee DeForest presented certificates to Judge Meyer and Commissioner Behrens for the Leadership Academy. RESULT: ' APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 3 of 17 NOTICE OF MEETING 8/21/2024 7. Hearing to consider and take any necessary action on the proposed award to the lowest and best bidder for Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 for Calhoun County, Texas — Texas General Land Office Contract No. 20-065-064-C182 and Calhoun County 2020 CDBG-DR Contract Work Order E-1, including any previously unconsidered evidence from responsive lower dollar bidders, if any, in accordance with the notice and protest procedures required under Local Government Code Section 262.027(c)(2)&(h). (DEH) (Hunter with Playground Solutions explained proposal. Scott Mason with G&W Engineers asked both Hunter with Playground Solutions and Peyton with Fun Abounds questions regarding proposals sent in. Court agreed to table action for next week after further review from both parties' proposals. Page 4 of 17 "creatIngplayground memories filled with fun" A Presentation For... TE OF 4t BID NO. 2024.08 INFRASTRUCTURE AT LITTLE CHOCOLATE PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT Contact: Payton Newton Business Development Manager 361-230-3006 payton@fabplaygrounds.com www.fabplaygrounds.com Y Table ®f contents , LCB Playground Phase 2 Contract Documents.............................................................3 Section1.....................................................................................................6 Section2................................................................................................... 18 Section 2 Documents - COMPLETED...............................................................................................................19 Addendum#1.............................................................................................. 45 Addendum#2.............................................................................................. 51 Aboutfun abounds........................................................................................ 60 ProjectReferences............................................................................................................................................62 ContactList...........................................................................................................................................................65 funabounds Job Descriptions..........................................................................................................................66 funabounds Org Chart......................................................................................................................................67 WorkIn Progress.................................................................................................................................................68 Certificateof Insurance..................................................................................................................................70 funabounds Certifications.................................................................................................................................71 AboutBCI Burke.......................................................................................... 74 BurkeGenerations Warranty............................................................................................................................80 PlaygroundDesign Option#1.........................................................................................................................................81 DesignSummary...................................................................................................................................................82 31) Renderings.......................................................................................................................................................83 Featured Free -Standing Play Events..............................................................................................................89 Option#1 Pricing......................................................................................... 98 BidSchedule..........................................................................................................................................................99 Line -Item Estimate...........................................................................................................................................100 PlaygroundDesign Option#2.......................................................................................................................................109 DesignSummary..................................................................................................................................................110 3DRenderings.......................................................................................................................................................Ill Featured Free -Standing Play Events.............................................................................................................117 Option#2 Pricing........................................................................................127 BidSchedule........................................................................................................................................................128 Line -Item Estimate...........................................................................................................................................129 Scheduling& Lead Times...............................................................................................................................................136 Endof Bid Proposal.........................................................................................................................................................137 BidBond...............................................................................................................................................................................138 CONTRACT DOCUMENTS INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 FOR CALHOUN COUNTY, TEXAS WEST AUSTIN STREET PORT LAVACA, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C 182 and CALHOUN COUNTY 2020 CDBG-DR MAY 2024 This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program. VV&WW ENGINEERS. INC. 205 W. Live Oak • Port Lavaca, TX 77979 • 361-552-4509 CONTRACT DOCUMENTS FOR THE BID NO.2024.08 INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT FOR CALHOUN COUNTY, TEXAS WEST AUSTIN STREET PORT LAVACA, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-C182 MAY 2024 This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovely and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program Prepared by: G & W ENGINEERS, INC. 205 WEST LIVE OAK PORT LAVACA, TEXAS 77979 (361)552-4509 A•r�r * .. ...:......................:... SCOTT R MASON a'•. 127893 :`� Approved By: L_. �;cT,IVV-- Scott P. Mason, P.E. G & W Engineers, Inc. 1!. dt 2 Texas Serial No. 127893 Texas Registered Engineering Firm F-04188}S Date: Project No. 5310.01 le FORMS AND CONDITIONS FOR BID DOCUMENTS/CONSTRUCTION CONTRACTS *Section 2 Items are to be completed and provided by all bidders with sealed bid. ** Please attach / include original bid bond as the last item in the sealed bid package. SECTION 1 1. Invitation for Bids 2. Instruction to Bidders for Construction 3. Equal Opportunity Guidelines for Construction Contractors 4. Calhoun County Section 3 Policy SECTION 2 5. *Bid Schedule 6. *Specification Notes (Addendum Acknowledgement & Calendar Days) 7. *Statement of Bidder's Qualifications 8. *Conflict of Interest Questionnaire 9. *Certificate of Recovered Materials 10. *Certification Regarding Debarment & Suspension and Other Responsibility Matters 11. *Affidavit 12. *Certification of Bidder Regarding Civil Rights Laws and Regulations 13. *Contractor's Local Opportunity Plan 14. *Proposed Contracts Breakdown (expected subcontractors and labor classifications including Section 3 utilization) 15. *Certification for Business Concerns Seeking Section 3 Preference in Contracting and Demonstration of Capability 16. *Certification Regarding Lobbying 17. *Disclosure of Lobbying Activities and Instructions 18. *House Bill 89 Verification 19. *Residence Certification 20. *System for Award Management - (sam.gov) 21. *Bid Bond** SECTION 3 22. Standard Form of Agreement for Construction Contacts 23. General Conditions for Construction 24. Calhoun County General Conditions 25. Minority/Female Goals 26. Federal Labor Standards Provisions 27. Title 29 - Labor 28. Concerning Labor Standards and Prevailing Wage Requirements 29. Project specific Davis -Bacon Wage Decision 30. GLO Signage Requirements 31. Certificate of Interested Parties Form 1295 and Instructions 32. Section 504 Certification 33. Child Support Statement 34. Document No. 00417 - Trench Safety Systems Indemnity Agreement 35. Payment Bond 36. Performance Bond 3T Certificate of Liability Insurance 38. Section 3 Clause 39. HUD Examples of Efforts to Offer Training and Employment Opportunities for Section 3 Residents 40. GLO New Hires Section 3 Monthly Compliance Report 41. CDBG-MIT Section 3 Brochure Information Sheet 42. GLO Assurances for Construction Programs 43. GLO General Affirmations 44. Attorney's Review Certification 45. Contractor's Final Payment Affidavit 46. Change Order Form 47. Certificate of Construction Completion (COCC) 48. Governing Technical Specifications & Special Provisions SECTION 1 1. Invitation for Bids 2. Instruction to Bidders for Construction 3. Equal Opportunity Guidelines for Construction Contractors 4. Calhoun County Section 3 Policy Invitation to Bid Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive bids for: Bid Number 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182 The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. The Instructions for Bidders, Bid Form, Specifications, and other Contract Documents may be examined at G&W Engineers, Inc. at 205 W. Live Oak, Port Lavaca, TX 77979 and obtained from www.CiveastUSA.com. There is no charge to view or download the documents. Addendums and other announcements will be distributed via CivCastUSA to all plan holders. A Pre -Bid Conference will be held at 10:00 am, Tuesday, June 4th, 2024 at Little Chocolate Bayou Park Pavilion at West Austin St., Port Lavaca, Texas. Potential bidders are strongly urged to attend. Sealed Bids may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 31' Floor, Suite 301 Port Lavaca, TX 77979 All bids must be delivered to the Office of the Calhoun County Judge in a sealed 9 x 12 or larger envelope and clearly marked on the outside of the envelope, or the UPS/FedEx/other Delivery Service envelope: Sealed Bid — Bid Number 2024.08 - Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182. Sealed Bids consisting of one (1) USB flash drive and one (1) original and four (4) printed copies of the complete bid and required forms are DUE BEFORE 2:00:00 PM local time, TUESDAY JULY 2, 2024 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 31 Floor, Suite 301, Port Lavaca, Texas. At this time, all bids will be publicly opened and read aloud in the conference room located in the County Judge's office. It is the responsibility of the submitting bidder to ensure that their sealed bid is received in a timely manner. Calhoun County does not accept faxed or emailed bids. Calhoun County accepts no financial responsibility for any cost incurred by any bidder in the course of responding to the bid. Bids received after the date and time the bids are due will not be accepted and will be returned unopened; regardless of whether or not the delay was outside of the control of the submitting bidder. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the 2:00:00 pm deadline. Bidders must submit with their bid a bid bond, issued by an acceptable surety, or a certified check, payable to Calhoun County, in the amount of not less than five percent (5%) of the total bid submitted. Bids submitted without the required security will not be considered. All contractors and subcontractors must be cleared (not suspended or debarred) prior to any formal action authorizing the award of a contract to the contractor and for the duration of the project. Calhoun County reserves the right to reject any or all bids or to waive any informalities in the bidding and to award to the responsible bidder submitting the best qualified acceptable bid who, in the opinion of Calhoun County, offers the bid in the best interest of the County. Bids may be held by Calhoun County for a period not to exceed sixty (60) days from the date of the bid opening for the purpose of reviewing the bids and investigating the bidder's qualifications prior to the contract award. The successful bidder will be required to purchase and furnish a Performance Bond and a Payment Bond, each in the full amount of the contract, written by a responsible surety company authorized to do business in the State of Texas, as required by Article 5160, V.A.T.C.S., as amended by H.B. 344, passed by the 561h Legislature, Regular Session, 1959. The successful bidder shall begin work on receipt of the Notice to Proceed and shall complete the work within the Contract Time. Work is subject to liquidated damages. The project to be constructed will be financed with assistance from the General Land Office (GLO) under the U.S. Department of Housing and Urban Development Community Development Block Grant - Mitigation (CDBG-MIT) program and is subject to all applicable Federal and State laws and regulations. Attention is called to the fact that not less than, the federally determined prevailing Davis -Bacon and Related Acts wage rate, as issued by the Department of Labor and contained in the contract documents, must be paid on this project. In addition, the successful bidder must ensure that employees and applicants for employment are not discriminated against because of race, color, religion, sex, sexual orientation, gender identity, or national origin. Adherence to the Calhoun County Section 3 Policy is required for all contracts. Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of age, race, color, religion, sex, sexual orientation, gender identity, national origin, handicapped status or limited English proficiency in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises and Labor Surplus Area Firms are encouraged to submit bids. Candice Villarreal County Auditor Calhoun County, Texas INSTRUCTIONS TO BIDDERS FOR CONSTRUCTION The project to be constructed will be financed with assistance from the General Land Office (GLO) under the U.S. Department of Housing and Urban Development Community Development Block Grant - Mitigation (CDBG-MIT) program and is subject to all applicable Federal and State laws and regulations. Calhoun County is the subrecipient of the grant funding and is hereby referred to as "County". Use of Separate Bid Forms These contract documents include a complete set of bid and contract forms which are for the convenience of the bidders and are not to be detached from the contract document, completed or executed. Separate bid forms are provided for your use. 2. Interpretations or Addenda No oral interpretations will be made to any bidder. CNUiNttK no later man n:UU pm, June /, ZUZ4. Sucn questions may De suom¢tea on www.CivcastUSA.com Questions and Answers (Q&A). It is the Bidder's responsibility to verify receipt of such questions by the ENGINEER. Interpretations or clarifications considered necessary by ENGINEER in response to such questions will be issued by Addenda and distributed via CivCastUSA to all plan holders. Addenda may also be issued to modify the Bidding Documents as deemed advisable by OWNER or ENGINEER. Any oral and other interpretations or clarifications provided by ENGINEER or OWNER at the pre -bid meeting will be without legal effect until a formal written Addenda is issued by ENGINEER. 3. Inspection of Site Each bidder should visit the site of the proposed work and should become acquainted with the existing conditions and facilities, the difficulties and restrictions pertaining to the performance of the contract. The bidder should thoroughly examine and become familiar with the drawings, technical specifications and all other contract documents. The contractor by the execution of the contract shall in no way be relieved of any obligation under it due to failure to receive or examine any form or legal document or to visit the site or the conditions existing at the site. The County will be justified in rejecting any claim based on lack of inspection of the site prior to the bid. 4. Alternate bid items No alternate bids or bid items will be considered unless they are specifically requested by the technical specifications. 5. Bids a. All bids must be submitted on the forms provided and are subject to all requirements of the Contract Documents, including the Drawings. b. All bids must be regular in every respect and no interlineation, excisions or special conditions may be made or included by the bidder. C. Bid documents, including but not limited to the bid, the bid bond(s), the contractor's certifications. Certification of Bidder Regarding Civil Rights Laws and Regulations. Certification of Efforts to comply with Section 3, Local Opportunity Plan, Conflict of Interest Questionnaire, Affidavit of Prime Bidder, Certification Regarding Lobbying and Disclosure of Lobbying Activities, Proposed Contract Breakdown, Certificate of Recovered Materials, Certification Regarding Debarment and Suspension and Other Responsibility Matters, System for Award Management (sam.gov) search, House Bill 89, Residence Certification, and the Statement of the Bidder's Qualifications, shall be sealed in an envelope and clearly labeled with the words "Sealed Bid — Bid Number 2024.08 - Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182", name of bidder and the date and time of bid opening. The County may consider as irregular any bid on which there is an alteration of or departure from the bid form and, at its option, may reject any irregular bid. e. If a contract is awarded, it will be awarded to a responsible bidder on the basis of the lowest/best bid and the selected alternate bid items, if any. The contract will require the completion of the work in accordance with the contract documents. (See page 69 Section: Awards for the definition of lowest/best found in the County Purchasing Act in this package.) 6. Bid Modifications Prior to Bid Opening a. Any bidder may modify its bid by submitting a modification or supplemental bid at any time prior to the scheduled closing time for receipt of bids, provided such modification or supplemental bid is received by the County prior to the closing time. The modification or supplemental bid should not reveal the original bid price but should provide only the addition, subtractions or other modifications to the original bid so that the final prices or terms will not be known by the County until the sealed bid is open. a. A bid bond in the amount of 5% of the bid issued by an acceptable surety shall be submitted with each bid [for contracts greater than $100,000]. A certified check or bank draft payable to Calhoun County, Texas may be submitted in lieu of the Bid Bond. b. The bid bond or its comparable, will be returned to the bidder as soon as practical after the opening of the bids. 8. Statement of Bidders Qualifications Each bidder shall submit on the form furnished for that purpose a statement of the bidder's qualifications. The County shall have the right to take such steps as it deems necessary to determine the ability of the bidder to perform its obligations under the contract, and the bidder shall furnish the County all such information and data for this purpose as it may request. The right is reserved to reject any bid where an investigation of the available data does not satisfy the County that the bidder is qualified to carry out properly the terms of the contract. 9. Unit Price The unit price for each of the several items in the bid shall include its pro rate share of overhead so that the sum of the products obtained by multiplying the quantity shown for each item by the unit price bid represents the total bid. Any bid not conforming to this requirement may be rejected as informal. Special attention is drawn to this condition, as the unit prices will be used to determine the amount of any change orders resulting from an increase or decrease in quantities. 10. Corrections: Erasures or other corrections in the bid must be noted over the signature of the bidder. 11. Time for Receiving Bids a. Bids received prior to the advertised hour of opening shall be kept securely sealed. The officer appointed to open the bids shall decide when the specified time has arrived and no bid received thereafter will be considered. 12. Submission of Bids a. All bids must be sealed in a 9 x 12 or larger envelope & clearly marked on the outside of the envelope, or the UPS/FedEx/other Delivery Service envelope: Sealed Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-C182. b. Bids shall consist of one (1) USB flash drive, one (1) original and four (4) printed copies of the complete bid and required forms which are Due Before 2:00:00 pm, Tuesday, July 2, 2024. C. Sealed Bids must be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3ro Floor, Suite 301 Port Lavaca, TX 77979 d. It is the responsibility of the submitting bidder to ensure that their sealed bid is received in a timely manner. Calhoun County does not accept faxed or emailed bids. Calhoun County accepts no financial responsibility for any cost incurred by any bidder in the course of responding to the bid. Bids received after the date and time the bids are due will not be accepted and will be returned unopened, regardless of whether or not the delay was outside of the control of the submitting bidder. e. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the 2:00:00 pm deadline. 13. Opening of Bids The County shall, at the time and place fixed for the opening of bids, open each bid and publicly read it aloud, irrespective of any irregularities therein. Bidders and other interested individuals may be present. 14. Withdrawal of Bids Bidder may withdraw the bid before the time fixed for the opening of bids, by communicating its purpose in writing to the County. Upon receipt of such notice, the unopened bid will be returned to the bidder. The bid guaranty of any bidder withdrawing his bid will be returned promptly. 15. Award of Contract/Reiection of Bids a. The contract will be awarded to the responsive, responsible Bidder submitting the lowest/best bid. The bidder selected will be notified at the earliest possible date. The County reserves the right to reject any or all bids and to waive any informality in bids received where such rejection or waiver is in its interest. b. The County reserves the right to consider as unqualified to do the work any bidder who does not habitually perform with his own forces the major portions of the work involved in construction of the improvements embraced in this contract. 16. Execution of Agreement/Performance and Payment Bonds a. Performance Bonds - Requires all prime contractors which enter into a formal contract in excess of $100,000 with the State, a county, or a municipality; a department, board, or agency of the state, a county, or a municipality; and a school district or a subdivision thereof, to obtain a Performance Bond in the amount of the contract before commencing with work b. Payment Bonds- Requires all prime contractors which enter into a formal contract with the State, a county, or a municipality; a department, board, or agency of the state, a county, or a municipality; and a school district or a subdivision thereof, to furnish to the governmental entity a payment bond in the amount of the contract. The payment bond must be filed within 30 days from the date of the Notice of Award: Municipalities: If the contract is in excess of $50,000, a payment bond is required. Counties: If the contract is in excess of $25,000. a payment bond is required. C. The failure of the successful bidder to execute the agreement and supply the required bonds within thirty (30) days from the date of the notice of award -or within such extended period as the County may grant, shall constitute a default and the County may, at its option either award the contract to the next lowest responsible bidder, or re -advertise for bids. In either case, the County may charge against the bidder the difference between the amount of the bid, and the amount for which a contract is subsequently executed irrespective of whether this difference exceeds the amount of the bid bond. If a more favorable bid is received through re -advertisement, the defaulting bidder shall have no claim against the County for a refund. 17. Wages and Salaries Attention is particularly called to the requirement of paying not less than the prevailing Davis Bacon Related Acts (DBRA) wage rates specified in the Contract Documents. These rates are minimums to be paid during the life of the contract. It is therefore the responsibility of the Bidder to inform themselves as to local labor conditions. 18. Equal Employment Opportunity Attention is called to the requirements for ensuring that employees and applicants for employment are not discriminated against because of race, color, religion, sex, sexual orientation, gender identity, or national origin, and other civil rights requirements. 19. Certification Regarding Lobbying Contractors who apply or bid for an award of $100,000 or more shall provide the required certification that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer of employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 USC § 1352. 19. System for Award Management (SAM) All contractors and subcontractors must be searched on www.sam.gov and cleared (not suspended or debarred) prior to any formal action authorizing the award of a contract to the contractor. Equal Opportunity Guidelines for Construction Contractors Note: To be included in bid packet and distributed at the preconstruction conference (optional) 1. What are the responsibilities of the offeror or bidder to ensure equal employment opportunity? For contracts over $ 10,000, the offeror or bidder must comply with the "Equal Opportunity Clause" and the "Standard Federal Equal Opportunity Construction Contract Specifications." 2. Are construction contractors required to ensure a legal working environment for all employees? Yes, it is the construction contractor's responsibility to provide an environment free of harassment, intimidation, and coercion to all employees and to notify all foremen and supervisors to carry out this obligation, with specific attention to minority or female individuals. 3. To alleviate developing separate facilities for men and women on all sites, can a construction contractor place all women employees on one site? No, two or more women should be assigned to each site when possible. 4. Are construction contractors required to make special outreach efforts to Section 3 or minority and female recruitment sources? Yes, construction contractors must establish a current list of Section 3, minority and female recruitment sources. Notification of employment opportunities, including the availability of on-the-job training and apprenticeship programs, should be given to these sources. The efforts of the construction contractors should be kept in file. 5. Should records be maintained on the number of Section 3 residents, minority and females applying for positions with construction contractors? Yes, records must be maintained to include a current list of names, addresses and telephone numbers of all Section 3, minority and female applicants. The documentation should also include the results of the applications submitted. 6. What happens if a woman or minority is sent to the union by the Contractor and is not referred back to the Contractor for employment? If the unions impede the construction contractor's responsibility to provide equal employment opportunity, a written notice should be submitted to GLO. 7. What efforts are made by construction contractors to create entry-level positions for Section 3 residents, women and minorities? Construction contractors are required to develop on-the-job training programs, or participate in training programs, especially those funded by the Department of Labor, to create positions for Section 3 residents, women and minorities and to meet employment needs. 8. Are any efforts made by the Contractor to publicize their Equal Employment Opportunity (EEO) policy? Yes, the construction contractor is responsible for notifying unions and sources of training programs of their equal employment opportunity policy. Unions should be requested to cooperate in the effort of equal opportunity. The policy should be included in any appropriate manuals, or collective bargaining agreements. The construction contractor is encouraged to publicize the equal employment opportunity policy in the company newspaper and annual report. The Contractor is also responsible to include the EEO policy in all media advertisement. 9. Are any in-service training programs provided for staff to update the EEO policy? At least annually a review of the EEO policy and the affirmative action obligations are required of all personnel employees of a decision -making status. A record of the meeting including date, time, location, persons present, subject matter discussed, and disposition of the subject matter should be maintained. 10. What recruitment efforts are made for Section 3 residents, minorities and women? The construction contractor must notify, both orally and in writing, Section 3, minority and female recruitment sources one month prior to the date of acceptance for apprenticeship or other training programs. 11. Are any measures taken to encourage promotions for minorities and women? Yes, an annual evaluation should be conducted for all minority and female personnel to encourage these employees to seek higher positions. 12. What efforts are taken to insure that personnel policies are in accordance with the EEO policy? Personnel policies in regard to job practices, work assignments, etc. should be continually monitored to insure that the EEO policy is carried out. 13. Can women be excluded from utilizing any facilities available to men? No, all facilities and company activities are non -segregated except for bathrooms or changing facilities to ensure privacy. 14. What efforts should be utilized to include minority and female contractors and suppliers? Take affirmative steps to ensure that small, minority, and women owned businesses are included on all lists for contractors/service providers. Solicit these businesses when issuing RFPs and RFQs and soliciting construction bids. Divide project activities into small tasks to allow participation. Keep records of all offers to minority and female construction contractors. 15. If a construction contractor participates in a business related association that does not comply with equal opportunity affirmative action standards, does that show his/her failure to comply? No, the construction contractor is responsible for its own compliance. 16. Can a construction contractor hire a subcontractor who has been debarred from government contracts pursuant to EEO? No. The construction contractor must suspend, terminate or cancel its contract with any Subcontractor who is in violation of the EEO policy. 17. What effort has been taken by the construction contractor to monitor all employment to insure the company EEO policy is being carried out? The construction contractor must designate a responsible individual to keep accurate records of all employees that includes specific information required by the government. CALHOUN COUNTY SECTION 3 POLICY Calhoun County Section 3 Policy In accordance with Section 3 of the U.S. Housing and Urban Development (HUD) Act, Calhoun County agrees to implement the following steps, which, to the greatest extent feasible, will provide job training, employment and contracting opportunities for low- and very low-income persons residing in the community in which HUD funds are spent and to businesses that provide economic opportunities for these persons. A. Introduce and pass a resolution adopting this plan as a policy to strive to attain goals for compliance to Section 3 regulations by increasing opportunities for employment and contracting for Section 3 residents and businesses. B. Assign duties related to implementation of this plan to the Calhoun County Civil Rights Officer. C. Notify Section 3 residents and business concerns of potential new employment and contracting opportunities as they are triggered by HUD Community Development Block Grant (CDBG) awards through the use of public hearings and related advertisements; public notices; bidding advertisements and bid documents; solicitations and contracts; notification to local business organizations; local advertising media, including public signage; project area committees and citizen advisory boards; local HUD offices; regional planning agencies; and all other appropriate referral sources. D. Maintain a list of those businesses that have identified themselves as Section 3 businesses for utilization in CDBG funded procurements, notify those businesses of pending contractual opportunities, and make this list available for general county procurement needs. E. Maintain a list of those persons who have identified themselves as Section 3 residents and contact those persons when hiring/training opportunities are available through grant awards or contractors. F. Require that all prime contractors and subcontractors with contracts over $100,000 commit to this plan as part of their contract work. The County will monitor the contractors' performance with respect to meeting Section 3 requirements and require that they submit requested reports to the appropriate agency. G. Submit reports as required by a funding agency regarding contracting with Section 3 businesses and/or employment as they occur; and submit reports within federal fiscal year requirements that identify and quantify Section 3 businesses and employees. H. Maintain records, including copies of correspondence, memoranda, etc., which document all actions taken to comply with Section 3 regulations. As officers and representatives of Calhoun County, we the undersigned have read and fully agree to this plan and become a party to the full implementation of the plan. Approved this 171h day of February 2021. Type text here t Richard H. Meyer, C 'ty Judge David Hall Calhoun County Commissioner, Pct. 1 Vern Lys Calhoun County Commissioner, Pct. 2 . C r� C&C 70el MJ Behrens Gary Rees Calhoun County Commissioner, Pct. 3 Calhoun Co ty Commissioner, Pct. 4 Attest: Anna Goodman, County Clerk By: Deputy Clerk SECTION 2 5. *Bid Schedule 6. *Specification Notes (Addendum Acknowledgement & Calendar Days) 7. *Statement of Bidder's Qualifications 8. *Conflict of Interest Questionnaire 9. *Certificate of Recovered Materials 10. *Certification Regarding Debarment & Suspension and Other Responsibility Matters 11. *Affidavit 12. *Certification of Bidder Regarding Civil Rights Laws and Regulations 13. *Contractor's Local Opportunity Plan 14. *Proposed Contracts Breakdown (expected subcontractors and labor classifications including Section 3 utilization) 15. *Certification for Business Concerns Seeking Section 3 Preference in Contracting and Demonstration of Capability 16. *Certification Regarding Lobbying 17. *Disclosure of Lobbying Activities and Instructions 18. *House Bill 89 Verification 19. *Residence Certification 20. *System for Award Management — (sam.gov 21. *Bid Bond** *Section 2 Items are to be completed and provided by all bidders with sealed bid. ** Please attach I include original bid bond as the last item in the sealed bid package. BID SCHEDULE Playground Option #1 PROJECT NAME: BID NO. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065.064-C182 DUE DATE: JULY 2, 2024 BEFORE 2:00:00 P.M. BIDDER NAME: fun abounds, Inc. - Payton Palmer -Newton BASE WORK SCOPE: The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. MCI Item If ITEM DESCRIPTION ITEM BID _UNIT PRICE TOTAL BID PRICE UNIT QUANTITY 1 MOBILIZATION, INSURANCE AND BONDS LS 1 $7,306.00 $7,306.00 PER PLANS AND SPECIFICATIONS 2 TEMPORARY PROJECT SIGNAGE PER LS 1 $550.00 $550.00 PLANS AND SPECIFICATIONS DEMOLITION OF ENGINEERED WOOD 3 FIBER (EWF) (APPDX. 12" THICK) AND SF 7,575 $1.35 $10,226.25 TRANSFER TO AREAS WITHIN PARK PER PLANS AND SPECIFICATIONS. TYPE D, CRUSHED LIMESTONE, 8.5" 4 THICK AFTER COMPACTED IN PLACE TO SF 7,575 $5.75 $43,556.25 95% COMPLETE IN PLACE PER PLANS AND SPECIFICATIONS GEO-GRID OR GEO-FABRIC INSTALLED 5 ON TOP OF BASE MATERIAL COMPLETE SF 7,575 $0.55 $4,166.25 IN PLACE PER PLANS AND SPECIFICATIONS RUBBER SURFACING 3.5" THICK 6 COMPLETE IN PLACE PER PLANS AND SF 7,575 $20.00 $151,500.00 SPECIFICATIONS NEW PLAYGROUND STRUCTURE(S) MEETING THE MINIMUM REQUIREMENTS AS SET FORTH IN THE PLANS AND SPECIFICATIONS AND WITHIN THE AREAS LISTED. THIS 7 INCLUDES A SUPER STRUCTURE, SWING LS 1 SET, MERRY-GO-ROUND, STEM PLAY, $479,421.00 $479,421.00 ELECTRONIC GAME AND MUSIC PLAY. CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT PACKAGE REQUIRED. TWO -POST HIP SHADE STRUCTURE (15' X 22' X 10') CORRISION RESISTANT PACKAGE REQUIRED AND WIND $13,150.00 $26,300.00 8 RESISTANT PACKAGE REQUIRED. EA 2 INCLUDES CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. SINGLE -POST SQSHADE STRUCTURE (16') CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT 9 PACKAGE REQUIRED. INCLUDES EA 1 $10,950.00 $10,950.00 CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. TOTAL BASE BID $733,975.75 "Submission of a bid tab with "Clarifications" or "Exclusions" and/or any other stipulations will not be accepted. It shall be the bidder's responsibility to provide a complete bid and ask any questions necessary to clarify any bid items or relevant concerns within the questions period. **The award will be based on the BASE BID and the Owner reserves the right to determine the most advantageous and best bid for the project. **'The Calhoun County Commissioners Court shall be the sole judge in determining which bid will be the most advantageous to Calhoun County. SPECIFICATION NOTES The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. The BIDDER, in compliance with the invitation for bids for Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project— GLO Contract No. 20-065-064-C182 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 150 consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $500.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1, 2024.08 LCB Playground Phase 2 - Addendum No. 1 - Recieved 6/13/2024 2. 2024.08 LCB Playground Phase 2 - Addendum No. 2 - Recieved 6/25/2024 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 Installation Premier Outdoor Installations Rubber Surfacing Spectraturf 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: fun abounds, Inc. - Payton Palmer -Newton Address: 114 Venice Street, Sugar Land, TX 77478 Phone: 361-230-3006 EIN or Tax ID No.: 36-4766562 Signature: 7A4zd�", Name and Title: Office Manager Email: ellie@fabplaygrounds.com 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: 06/26/24 Bidder (Legal Name of Firm): fun abounds, Inc. Date Organized: 2005 Name of Owner(s): Leigh Walden Address: 114 Venice Street Sugar Land, TX 77478 Date Incorporated 05/06/2013 Federal ID Number: 36-4766562 Number of Years in contracting business under present name 19 List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Contract Please see attached WIP (work in progress) Amount $ Completion Date Supply and installation of playgrounds, site amenities, Type of work performed by your company: and safety surfacing Total Staff employed by Firm (Break down by Managers and Trades on separate sheet): 6 employees Have you ever failed to complete any work awarded to ov u? ❑ Yes X 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 X 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 M 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 $ MoNr Completed City of Sinton - Inclusive Park $548,886.00 June 2024 January 2024 *Completed project pictures for each project attached in separate document equipment available for this contract: We have the avaliabilitV of all equipment necessary to complete Are you in compliance with all applicable EEO requirements? X Yes ❑ No (If no, please attach summary of details on a separate sheet.)) (Optional) Minority Business Reporting Information: Owner's Race: Owner's Ethnicity: Owner's Gender: Female Are you a Section 3 business? (see below) ❑ Yes \eNo 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 Wells Fargo Address: 2700 S Price Rd. 3rd FI Contact Name: Laurie Schmidt City & State: Chandler, AZ Zip: 85286 Phone Number: 480-674-2812 Credit available: $ 250,000 Has the firm or predecessor firm been involved in a bankruptcy or reorganization? ❑ Yes X 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. N/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. N/A Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. See FAB Office - Job Descriptions attached Leigh Walden, Owner Printed Name and Title fun abounds, Inc. Company Name Notary Statement: / yy LJo vjudeg being duly sworn, says that helshe is the G� 1 Posrtiont'ritle of :tftn abouhnL (Firm Name), and hereby swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/She hereby authorizes and requests any person, firm, or corporation to furnish any information requested by Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications Subscribed and sworn before me this �` day of ,Ltl Notary Public j .yam ► Ellie Chi ril d� l^s _ = V htyCom215 Explms. Signature OfW to No, �36711 IY19 Printed Name 04/14/25 My Commission Expires. The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001, CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business: relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. jJ Name of vendor who has business relationship with local governmental entity. fun abounds, Inc. z Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. N/A Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts Aand B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes rX No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? 171 Yes ER No 6 Describe each employment or business relationship thatthe vendor named in Section I maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. N/A 6 Check this box if the vendor has given the local government officer or afamily member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 ff-&� 'N' 06/26/24 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics. state. tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code § 176.001(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 a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code § 176.003(a)(2)(A) and( ): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) thevendor: (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; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregatevalue of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code § 176.006(a) and 0-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and`, (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.athics.state. tx. us Revised 11/30/2015 CONTRACTOR'S CERTIFICATION of RECOVERED MATERIAL ACKNOWLEDGEMENT 1, Ellie Mason (Principal's Name)_ of fun abounds, Inc. (Company Name) , (hereinafter called "Contractor"), acknowledge the recovered material bidding requirements found in 2 CFR 200.322 that requires the Contractor to procure those items designated in the guidelines of the Environmental Protection Agency (EPA) at 40 CFR 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition. I also acknowledge that this requirement shall apply to items purchased (1) where the Contractor purchases in excess of $10,000 of the item under this contract; or (2) where during the preceding fiscal year, the value of the quantity acquired was in excess of $10,000. Finally, I acknowledge the attached list of recovered materials included in the bid documents. (For up-to-date listing, please go to https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg- program#directory) Ellie Mason, Office Manager Printed Name and Title C%i 91 Signature 06/26/24 Date USE OF RECOVERED MATERIAL Please check one: ❑ Recovered materials are included in this bid: Materials included ❑ Recovered materials are not reasonably available in a reasonable period of time. Recovered materials fail to meet reasonable performance standards, which are determined on the basis of the guidelines of the National Institute of Standards and Technology, if applicable. ❑ Recovered materials are only available at an unreasonable price. Ellie Mason, Office Manager Printed Name and Title Signature 06/26/24 Date CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his/ her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this cel iification. 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. Ellie Mason Name and Title of Authorized Agent C?& 9".&91 Signature of Authorized Agent 06/26/24 I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION_ Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive depal 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) 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 rainimrun 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, 1 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 repoli 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 repel i 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 eel iification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This celtification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to principate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of eel Hfications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. STATE OF TEXAS {j AFFIDAVIT COUNTY OF Fort Bend {} Leigh Walden being first duly sworn, deposes and says: that he or she is (Type or Print Namel the President of fun abounds, Inc. having its (Type or Print Tine) (Type or Print Name or Company/Firm) principal address at 114 Venice Street, Sugar Land, TX 77478 (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 mannersought by collusion to secure for himself/herself/itself/themselves an advantage overany other bidder/proposer. Afflant 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 notilive, offer to give, nor Intends to give at anytime hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor; or service to any official, employee or agent of Calhoun County in connection with the submitted bid/proposal; and e) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative hereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent, thereof; to any individual or group of individuals, or to any official, employee or agent of Calhoun County prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained In this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and reou—Iro)r1ents contained in the bid/proposal. SC`-----""' Signet lent Leigh Walden; President Printed Name and Title of Affiant SWORN TO AND SU65CRIBED BEFORE( ME by the above Affiant; who, on oath, slates that the facts contained in the above are true and correct, this TO day of J ft)e 20141. Nutary 5ramp/seal Signature of Notary Public ERE] Lyklrrenn Expiresrtt CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) fun abounds, Inc. 114 Venice St. Sugar Land, TX 77478 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. XYes 0 No The undersigned hereby certifies that: The Provision of Local Training. Employment, and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). 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? Yes XNo Ellie Mason, Office Manager NAME AND TITLE OF SIGNER (Please type) 91 06/26/24 SIGNATURE DATE CONTRACTOR'S LOCAL OPPORTUNITY PLAN fun abounds, Inc. agrees to implement the following specific affirmative action steps (name of company) directed at increasing the utilization of lower income residents and businesses within Calhoun County. A. To ascertain from the County's CDBG program official the exact boundaries of the project area and where advantageous, seek the assistance of local officials in preparing and implementing the affirmative action plan. B. To attempt to recruit from within the county the necessary number of lower income residents through: local advertising media, signs placed at the proposed site for the project, and community organizations and public or private institutions operating within and servicing the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Concentrated Employment Program, Hometown Plan, or the U.S. Employment Service. C. To maintain a list of all lower income residents who have applied either on their own or on referral from any source, and to employ such persons, if otherwise eligible and if a vacancy exists. D. To insert this plan in all bid documents and to require all bidders on subcontracts to submit an affirmative action plan including utilization goals and the specific steps planned to accomplish these goals. E. To ensure that subcontracts (greater than $10,000), which are typically let on a negotiated rather than a bid basis in areas other than the covered project area, are also let on a negotiated basis, whenever feasible, in a covered project area. F. To formally contact unions, subcontractors, and trade associations to secure their cooperation in this effort. G. To ensure that all appropriate project area business concerns are notified of pending sub -contractual opportunities. H. To maintain records, including copies of correspondence, memoranda, etc., which document that all of the above affirmative action steps have been taken. I. To appoint or recruit an executive official of the company or agency as Equal Opportunity Officer to coordinate the implementation of this plan. J. To maintain records concerning the amount and number of contracts, subcontracts, and purchases which contribute to objectives. K. To maintain records of all projected work force needs for all phases of the project by occupation, trade, skill level, and number of positions and to update these projections based on the extent to which hiring meets these Local Opportunity objectives. As officers and representatives of fun abounds, Inc. 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 Ellie Mason Printed Name Office Manager I rtle 06/26/24 Date Instructions for Proposed Contracts Breakdown and Estimated Project Workforce Breakdown Proposed Contracts Breakdown Type of Contracts— list all construction, materials, or othertypes of subcontracts (for example: electrical, plumbing, concrete, boring, etc.) No. of Contracts — Number of contracts under this category Approximate Total Dollar Amount — Total amount of each contract Estimated No. to Local Business — Number of contracts awarded to local businesses and Section 3 businesses Estimated $ Amount to Local Business - How many dollars will be spent locally for each type of contract? For example: will you hire any local employees or subcontractors? Estimated Project Workforce Breakdown Work Classifications — Classification of project employees as defined on Wage Rate Total Estimated Positions — List the number employees for each work classification will you need on this project Number of Positions Currently Filled — List the number of estimated positions you currently have filled Number of Positions Not Filled — List the number of estimated positions you currently do not have filled Number of Positions to Fill with Low to Moderate Income (Section 3) Residents — List the number of local residents earning low to moderate incomes that you plan to employ to fill the estimated positions not filled PROPOSED CONTRACTS BREAKDOWN Type of Contracts No. of Contracts Approx. Total Dollar Amount Estimated No. to local Business Estimated $ Amount Local Business Installation of Equipment 1 $175,000.00 0 TBD Installation of Rubber Surfacing 1 $150,000.00 0 TBD 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 General Laborer 8-10 8-10 0 0 k ls 8-10 8-10 Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program CERTIFICATION FOR BUSINESS CONCERNS Seeking Section 3 Preference in Contracting and Demonstration of Capability Economic Opportunities for Low and Very Low -Income Persons Grantee/Subrecipient: Contract Number: Date: CONTRACTOR INFORMATION Name of Business I fun abounds Address of Business 1114 Venice St, Sugar Land, TX 77478 Type of Business:® Corporation ❑ Partnership ❑ Non -Profit ❑ Sole Proprietorship ❑ Joint Venture Consortium Attach the following documentation as evidence of Section 3 eligible status: (Definition of 'Section 3 Business Concern" in 24 CFR 135 describes the three alternative qualifications.) For Business claiming status as a Section 3 resident -owned enterprise: ® Copy of resident lease ❑ Copy of evidence of participation in a public assistance program For business entity as applicable: ❑ Copy of Articles of Incorporation ❑ Assumed Business Name Certificate ❑ List of owners/stockholders and % ownership of each appointed officers ❑ Organization chart with names and titles and brief function statement ❑ Copy of receipt of public assistance ❑ Other evidence ❑ Certificate of Good Standing ❑ Partnership Agreement ❑ Corporation Annual Report ❑ Latest Board minutes ❑ Additional documentation For business entity claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business(es): *The work required for this project is specialized and requires extensive List of subcontracted Section 3 business(es) and subcontract amount training and certifications; however, should additional miscellanous labor be needed then we will be willing to explore local assistance.* For business claiming Section 3 status, by claiming at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employment with the business: List of all current full-time employees ❑ PHA/IHA Residential lease less than 3 years from day of employment ❑ List of employees claiming Section 3 status ❑ Other evidence of Section 3 status less than 3 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 17 List of all contracts for the past two years Payton Newton Authonze Name and- rgn re Attested By: Cye,�, w4zd6rL ❑ Statement of ability to comply with public policy 711 /2024 (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 Ellie Mason, Office Manager Printed Name and Title of Contractor's Authorized Official 06/26/24 Date *24 C.F.R. 87 App. A, available at https://www.gpo.gov/fdsys/granule/CFR-2011-title24-voll/CFR-2011-title24- vol1-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. 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 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. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., `RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 4040-0013. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (4040-0013), Washington, DC 20503 Approved by OMB 4040-0013 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden 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 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: fun abounds inc. 114 Venice St Sugar Land, TX 77478 Congressional District, if known: Congressional District, if known: 6. Federal Departure en;kj 7. deral P m Name/Description: A Nu if cable: 8. Federal Action Nu er, ifAwar own: 10. a. Name and Address Lobbying b. In duals Perfor 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: l/ disclosure of lobbying activities is a material representation of fact upon which reliance was placed print Name: Payton Newton 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: Business Development Manager Congress semiannually and will be available for public inspection. Any person who fails to file the required Telephone No.: 361-230-3006 Date: 7/1/2024 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 85th 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. Ellie Mason 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://com ptroller.texas.gov/purchasing/publications/divestment.php fun abounds, Inc. Company Name C=l Ellie Mason Signature of Authorized Official Office Manager Printed Name of Authorized Official 06/26/24 Title of Authorized Official Date Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) 'Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ I certify that I=I is a "Nonresident Bidder" of Texas (Company Name) as defined in Government Code §2252.001 and our principal place of business is (City and State) I certify that fun abounds, Inc (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Ellie Mason, Office Manager Printed Name and Title of Authorized Agent 06/26/24 Date is a "Resident Bidder" of Texas as Insert System for Award Management (SAM) Record Search for company and company principal(s). • Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principals are not listed (are not debarred) through the System for Award Management. MILSAM.00v° [/ Requests Q Notifications no Vlorkepzce Ej Sign Out Home Search Data Bank Data Services Help Search All V.Imds '.. eg.!60GNG20QD2 Select Domain + Entity Information shoving 1-1 of 1 resuhs - EUNADOUNDS,INC •IDAssigned All Entity Information. Unique Eck, lD Physlaal Admess JZ18PN%3JM95 114 VENICE 51, SUGAR IANU, T% 77478 USA Entities 'Disaster. Response Registry seemts perpnge (. 1 0i t i 25 Responsibility/Qualification Exclusions filter By —. Saved Searches Actions sonbv '. Relee�mxe Entity Assigned Date Jun 3,2024 11-1 *\r Hume Search Data Bank Data Services Help Get Unique Entity Ib 0 0 Get Started Eater Entity Start Data Validation Receive _w i� s - j 114 VENICE ST SUGAR LAND, TX 77478-325+4 USA Complete Validation Year of Incorporat €an 2013 State rst Incorporation TX 0 Get Unique Entity ID BID BOND No. 471401 KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, fun abounds, Inc. as PRINCIPAL, and Merchants National bonding Company Inc. , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Local Public Agency", in the penal sum of Five Percent of the 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 July 2, 2024 , for BID NO. 2024.08 — INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT — GLO CONTRACT NO. 20- 065-064-C182 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 end day of July 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. (SEAL) Attest: Attest; Attest: Countersigned z fun abounds, Inc. (SEAL) Affix Corporate Seal Merchants National Bonding Compa By: 0 ❑e krct ,• Affix �CorDwate Seal * Attorney -in -Fact, State of Texas Page 1 of 2 CERTIFICATE AS TO CORPORATE PRINCIPAL I, C iW e, LA --th , certify that I am the Secretary of the Corporation named as Principal in the bid om bond; that L'1P %,µ1 wcudPe1 who signed the said bond on behalf of the Principal was then iPVeSii deJ 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. Fe'�My X�L on EVIres 0014FM5 I13149.133036711 * Power -of -attorney for person signing for Surety Company must be attached to bond. Please attach I include original bid bond as the last Item in the sealed bid package. Page 2 of 2 Bond If: 471401 M.ERCHANTS�� 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 Celled the 'Companies") do hereby make, constitute and appoint, individually, Maryana Zhuk their true and lawful Attomey(s)-in-Fact, to sign Its name as surety(les) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments In the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted In any actions or proceedings allowed by law, This Powerof-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 Merchants National 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 Attomeys-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 aut hority, hereby given to the Attomey-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 understood that consenting to the Slate 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 2nd day of July • 2024 L•'•'•........ • • G ••• .� MERCHANTS BONDING COMPANY (MUTUAL) ION `-,•�Pt •,,,,,A� e, � aO�NCOMERCHANTS NATIONAL BONDING, INC. �, : nRp ORs;; o :. :,0: i.PPOq '•:9,; d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY 2003 :,� p y� 1933 ♦? By STATE OF IOWA (((//// Presrdenr 774- COUNTY OF DALLAS ss. On this 26th day of June 2024 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies, and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. --,—�� II V'�IA40 Penn[ Miller II o e Commission Number 787952 My Commisslon Expires /ONA January 20, 2027 Diary P c anon of rotary's commission not invalidate this instrument) 1. William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.. do hereby cendy that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full farce and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my, hand and affixed the seal of the Companies on this 26th day of June 2024 .........11 ----- iPOJpgQ' ac.. _e_ Fo . POA 0018 (1/24) � ="~ -a- o: a: 1933 Secretary r ADDENDUM NO.l to the CONTRACT DOCUMENTS FOR BID NO.2024.08 INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 FOR CALHOUN COUNTY, TX WEST AUSTIN STREET PORT LAVACA, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-C182 And CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1 JUNE 13, 2024 en' Ueers 'I Prepared by: G&W Engineers, Inc. 205 West Live Oak Port Lavaca, Texas 77979 (361) 552-4509 SCOTT R MASCN ......................... ,;'•._ 1 2 7 £3 3 3 ram. G & W Engineers, Inc. Texas Registered Engineering Finn F-04188 Project No. 5310.011e Page ! of 2 Texas Serial No. 127893 Date: 06 • l q• Zq Clarifications to the original Contract Documents, Contract Drawings and/or Specifications have been deemed necessary, and in certain cases, revisions to the original Contract Documents, Contract Drawings and/or Specifications are required. If discrepancies and/or inconsistencies exist between these specified revisions and the original Contract Documents, Contract Drawings and/or Specifications, said Addendum No. 1 shall govern. CLARIFICATIONS: 1. Forms required with proposal as part of the bid package will be acceptable with signature using electronic signature. 2. The meeting minutes and RFI answers shall be incorporated into the Contract Documents. 3. This project is tax exempt and a certificate will be supplied to awarded contractor. 4. EWF (mulch) from playground shall be stockpiled owner to decide on location and it must be clear from obstructing vehicles, storm drainage, play, walking trail and accessible for owner to transport during or after construction. 5. Wind resistant in the bid schedule, as well as, the drawings, does not mean TDI approved products. It is a request that structures shall be manufactured, designed and resistant to reasonable winds. Engineer's seal and signature along with windstorm inspection is not required to be incorporated into the project or pricing. At a minimum, it shall be capable of resisting tropical storm force winds by design with out removal of the canopy material. 6. Canopy material, more specifically, its attachment to the structure will be required to have quick connect/disconnect hardware. 7. An artistic, realistic or simplified rendition of the improvements shall be provided with the sealed bid. 8. At a minimum and in addition to clarification 7 above, catalogue excerpt of all of the proposed equipment shall be provided with the sealed bid. 9. Rubber surfacing "design" or rendition is preferred and can be included in clarification number 7, or provided separately, but shall not be a required submission with the sealed bid. 10. Bidder shall be required to provide adequate supporting documentation with sealed bid that the proposed equipment meets the minimum requirements of the drawing. This includes but not limited to: age range, capacity, ADA events, etc. Page 2 of 2 ADDENDUM NO. 1 Quac 13, 2024) frlrnnnirinrc m 1la/u Chao m ft., CmmVPm40lam.... dlirarcrnenls Plmrc 2 Calbmm Cm 0,b1.n5310VA G&W ENGINEERS. INC. 205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)552-4509 • f: (361)552-4987 TBPE Firm Registration No. F4188 • TBPLS Firm Registration No. 10022100 June 04, 2024 — 10:00 A.M. G&W Project #: 5310.01le Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — PRE -BID Conference — MEETING MINUTES Held at Park under Pavillion Attendees: See Attached Sign in Sheet Scott Mason (SM) opened up the meeting and welcomed everyone who was in attendance. Proceeded to introduce Commissioner Hall (DH). SM also suggested that we discuss all of the front-end documents first and then would go over drawings at the end. SM explained that this is grant project and that there are very specific requirements for the grant. Proceeded to inform everyone that all questions would be would be answer at this meeting to the best of SM ability. It was also explained that any answer given at the meeting was verbal at this time and that an addendum would be issued and that will be the final answers. SM also notified bidders that the cut- off day and time for last questions regarding the bid documents is under the instructions to bidders. From that point no answers to questions will be provided. Also, it was discussed that all questions after this pre -bid conference would need to come in CivCastUSA Q/A section format to SM. SM began discussing some of the specific grant requirements which included conformance to the Davis Bacon Wage Rate requirements. SM discussed that it will be the contractor's responsibility to verify their payroll and compliance and submit required forms on a weekly basis. SM discussed that all forms will be required to submitted that are noted in the package even if they are believed to be not applicable. SM confirmed bid due date and explained that 2:00:00 p.m. is strict and not a second after. Explained that bids are due at this time and date to the judge's office and that it is located on the third floor at the court house. SM explained that bids will have to be submitted in the proposal provided in the bid package and no other formats will be allowed. SM discussed the requirement for the bidder to specify the amount of calendar days on provided form and that a bid bond or cashier's check was required. SM asked if there were any further questions concerning the matters that had been discussed up to that point. At that time there were no further questions as the question concerning discussion to this point. SM continued the meeting by discussing the budget for the projects. SM proceeded to let bidders know that the construction budget for the project is $700,000.00. SM discussed that it will be up to the bidders to determine what vision, theme and layout will be best. At a minimum it will need to include the parameters outlined in the documents and drawings. SM explained that the bids will be considered based on lowest but more importantly the best bid. It was told to attendees, that submitting a bid low Engineering Consulting Planning Surveying m m CD CD 7 W, E a w90 ° °' '° m 0 a. wa a �' o c 0 2� Cw w F ffl w m o o m e w y M e o o T � ? w PF' ^. o• w c w Z , F y a• a y m a w w y :' a o. o y �, A- m � y a' .c. Z mm = a.�❑'awe � am�;aw� � �°:+�F� oar .O � '�i O' � � R 6 v. '0 D• £' � N O �. a O Vi tlq S ° y N ci SD o o o o. PRE -BID MEETING Bid No. 202408-Infrastructure at Lima Chocolate Bayou County Park Playground Improvement Phase 2 Project- GLO Contract No. 20-055-084-C182 for Calhoun County, Texas June 4, 2024 10.00 a.m. Please Print Company Name Representative Email Address Phan. No. 1. rafisw,{ a_ TL.oMs.s yt kr - sWl a .cowl Bit-S16- 40 2. �a�grownd so ut>.ons d� Tx px r�G KAMdff @ p&W,. Coves 'RAI —"logy— ?�I) j,- W V I i Lujal CAJ o^ t 5. ��gyrnrl� L vl f3a0"i-7SI a"t20@ W- 5575' ]. d'_W ��L�IINi` $ IJ �' .2c5�>J SJ'nw5on WL'h-tn a2l5. coM 3bI-5'�2— Sa 5. 9. 10, 11. 12. Page 1 17105310.011. CA C A 7 f0 I ADDENDUM NO.2 to the CONTRACT DOCUMENTS FOR BID NO.2024.08 INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 FOR CALHOUN COUNTY, TX WEST AUSTIN STREET PORT LAVACA, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO.20-065-064-C182 And CALHOUN COUNTY 2020 CDBG-DR CONTRACT WORK ORDER NO. E-1 DUNE 259 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. 5310.011e Page I of 2 Texas Serial No. 127893 Date: 04 • 2 i 2 y Clarifications to the original Contract Documents, Contract Drawings and/or Specifications have been deemed necessary, and in certain cases, revisions to the original Contract Documents, Contract Drawings and/or Specifications are required. If discrepancies and/or inconsistencies exist between these specified revisions and the original Contract Documents, Contract Drawings and/or Specifications, said Addendum No. 2 shall govern. Table of Contents SECTION 3 — Item #29 INSERT: Attached Prevailing Wage Rates Page 2 of ADDENDUM NO.2 (June 25, 202J) h/rmVaclnre nl bfafa Ch aw,Nn)mr Couan PmkPhr)'grmadI P,',menv Pkva C'idbomr Cnnnzp (Job 5310.OJJ ) "General Decision Number: TX20240045 01/05/2024 Superseded General Decision Number: TX20230045 State: Texas Construction Type: Heavy Counties: Aransas, Austin, Calhoun and Goliad Counties in Texas. HEAVY CONSTRUCTION PROJECTS Note: Contracts subject to the Davis -Bacon Act are generally required to pay at least the applicable minimum wage rate required under Executive Order 14026 or Executive Order 13658. Please note that these Executive Orders apply to covered contracts entered into by the federal government that are subject to the Davis -Bacon Act itself, but do not apply to contracts subject only to the Davis -Bacon Related Acts, including those set forth at 29 CFR 5.1(a)(1). lIf the contract is entered Executive Order 14026 linto on or after January 30, generally applies to the 12022, or the contract is contract. (renewed or extended (e.g., an The contractor must pay loption is exercised) on or all covered workers at ]after January 30, 2022: least $17.20 per hour (or the applicable wage rate listed on this wage determination, if it is higher) for all hours spent performing on the contract in 2024. lif the contract was awarded onl. Executive Order 13658 for between January 1, 2015 andl generally applies to the January 29, 2022, and the I contract. [contract is not renewed or The contractor must pay alli lextended on or after January covered workers at least 130, 2022: $12.90 per hour (or the applicable wage rate listed) on this wage determination, if it is higher) for all hours spent performing on that contract in 2024. The applicable Executive Order minimum wage rate will be adjusted annually. If this contract is covered by one of the Executive Orders and a classification considered necessary for performance of work on the contract does not appear on this wage determination, the contractor must still submit a conformance request. Additional information on contractor requirements and worker protections under the Executive Orders is available at http://www.dol.gov/whd/govcontracts. Modification Number Publication Date 0 01/05/2024 SUTX2005-023 09/08/2005 Rates Fringes Asphalt Distributor Operator ..... $ 12.57 ** Asphalt paving machine operator .........................$ 11.60 ** Asphalt Raker ....................$ 10.63 ** Asphalt Shoveler .................$ 9.23 ** Broom or Sweeper Operator ........ $ 9.32 ** Bulldozer operator ...............$ 11.69 ** CARPENTER ........................$ 11.70 ** Concrete Finisher, Paving ........ $ 11.64 ** Concrete Finisher, Structures .... $ 10.23 ** Concrete Rubber ..................$ 9.00 ** Crane, Clamshell, Backhoe, Derrick, Dragline, Shovel Operator .........................$ 12.00 ** Flagger ..........................$ 8.60 ** Form Builder/Setter, Structures .......................$ 10.51 ** Form Setter, Paving & Curb ....... $ 9.48 ** Foundation Drill Operator, Truck Mounted ....................$ 14.58 ** Front End Loader Operator ........ $ 10.62 ** Laborer, common ..................$ 8.91 ** Laborer, Utility .................$ 9.21 ** MECHANIC (Undefined) .............$ 12.18 ** Motor Grader Operator Fine Grade ............................$ 15.15 ** Motor Grader Operator Rough ...... $ 12.95 ** Pavement Marking Machine Operator .........................$ 13.32 ** Pipelayer ........................$ 9.71 ** Roller Operator, Pneumatic, Self -Propelled ...................$ 8.90 ** Roller Operator, Steel Wheel, Flat Wheel/Tamping...............$ 9.30 ** Roller Operator, Steel Wheel, Plant Mix Pavement ...............$ 10.59 ** Scraper Operator .................$ 9.85 ** Servicer............. .........$ 11.18 ** Spreader Box Operator ............ $ 13.00 ** Traveling Mixer Operator ......... $ 12.67 ** Truck Driver Single Axle Heavy...$ 10.87 ** Truck Driver Single Axle, Light ............................ 10.85 ** Truck driver, lowboy -Float ....... $ 13.70 ** Truck Driver, Tandem Axle, Semi -Trailer. ....................$ 10.05 ** Work Zone Barricade Servicer..... $ 9.63 ** WELDERS - Receive rate prescribed for craft performing operation to which welding is incidental. ** Workers in this classification may be entitled to a higher minimum wage under Executive Order 14026 ($17.20) or 13658 ($12.90). Please see the Note at the top of the wage determination for more information. Please also note that the minimum wage requirements of Executive Order 14026 are not currently being enforced as to any contract or subcontract to which the states of Texas, Louisiana, or Mississippi, including their agencies, are a party. Note: Executive Order (ED) 13706, Establishing Paid Sick Leave for Federal Contractors applies to all contracts subject to the Davis -Bacon Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2017. If this contract is covered by the ED, the contractor must provide employees with 1 hour of paid sick leave for every 30 hours they work, up to 56 hours of paid sick leave each year. Employees must be permitted to use paid sick leave for their own illness, injury or other health -related needs, including preventive care; to assist a family member (or person who is like family to the employee) who is ill, injured, or has other health -related needs, including preventive care; or for reasons resulting from, or to assist a family member (or person who is like family to the employee) who is a victim of, domestic violence, sexual assault, or stalking. Additional information on contractor requirements and worker protections under the ED is available at https://www.dol.gov/agencies/whd/government-contracts. Unlisted classifications needed for work not included within the scope of the classifications listed may be added after award only as provided in the labor standards contract clauses (29CFR 5.5 (a) (1) (iii)). The body of each wage determination lists the classification and wage rates that have been found to be prevailing for the cited type(s) of construction in the area covered by the wage determination. The classifications are listed in alphabetical order of ""identifiers"" that indicate whether the particular rate is a union rate (current union negotiated rate for local), a survey rate (weighted average rate) or a union average rate (weighted union average rate). Union Rate Identifiers A four letter classification abbreviation identifier enclosed in dotted lines beginning with characters other than ""SU"" or ""UAVG"" denotes that the union classification and rate were prevailing for that classification in the survey. Example: PLUM0198-005 07/01/2014. PLUM is an abbreviation identifier of the union which prevailed in the survey for this classification, which in this example would be Plumbers. 0198 indicates the local union number or district council number where applicable, i.e., Plumbers Local 0198. The next number, 005 in the example, is an internal number used in processing the wage determination. 07/01/2014 is the effective date of the most current negotiated rate, which in this example is July 1, 2014. Union prevailing wage rates are updated to reflect all rate changes in the collective bargaining agreement (CBA) governing this classification and rate. Survey Rate Identifiers Classifications listed under the ""SU"" identifier indicate that no one rate prevailed for this classification in the survey and the published rate is derived by computing a weighted average rate based on all the rates reported in the survey for that classification. As this weighted average rate includes all rates reported in the survey, it may include both union and non -union rates. Example: SULA2012-007 5/13/2014. SU indicates the rates are survey rates based on a weighted average calculation of rates and are not majority rates. LA indicates the State of Louisiana. 2012 is the year of survey on which these classifications and rates are based. The next number, 007 in the example, is an internal number used in producing the wage determination. 5/13/2014 indicates the survey completion date for the classifications and rates under that identifier. Survey wage rates are not updated and remain in effect until a new survey is conducted. Union Average Rate Identifiers Classification(s) listed under the UAVG identifier indicate that no single majority rate prevailed for those classifications; however, 100% of the data reported for the classifications was union data. EXAMPLE: UAVG-OH-0010 08/29/2014. UAVG indicates that the rate is a weighted union average rate. OH indicates the state. The next number, 0010 in the example, is an internal number used in producing the wage determination. 08/29/2014 indicates the survey completion date for the classifications and rates under that identifier. A UAVG rate will be updated once a year, usually in January of each year, to reflect a weighted average of the current negotiated/CBA rate of the union locals from which the rate is based. WAGE DETERMINATION APPEALS PROCESS 1.) Has there been an initial decision in the matter? This can be: * an existing published wage determination * a survey underlying a wage determination * a Wage and Hour Division letter setting forth a position on a wage determination matter + a conformance (additional classification and rate) ruling on survey related matters, initial contact, including requests for summaries of surveys, should be with the Wage and Hour National Office because National office has responsibility for the Davis -Bacon survey program. If the response from this initial contact is not satisfactory, then the process described in 2.) and 3.) should be followed. With regard to any other matter not yet ripe for the formal process described here, initial contact should be with the Branch of Construction Wage Determinations. Write to: Branch of Construction Wage Determinations Wage and Hour Division U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 2.) If the answer to the question in 1.) is yes, then an interested party (those affected by the action) can request review and reconsideration from the Wage and Hour Administrator (See 29 CFR Part 1.8 and 29 CFR Part 7). Write to: Wage and Hour Administrator U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 The request should be accompanied by a full statement of the interested party's position and by any information (wage payment data, project description, area practice material, etc.) that the requestor considers relevant to the issue. 3.) If the decision of the Administrator is not favorable, an interested party may appeal directly to the Administrative Review Board (formerly the Wage Appeals Board). Write to: Administrative Review Board U.S. Department of Labor 200 Constitution Avenue, N.W. Washington, DC 20210 4.) All decisions by the Administrative Review Board are final. 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Omx D �I Nm Npn o 0NwClc Omp Fn mm'm 9r9� -4 `/�1 ^1 A nmN X �N NOZ Z D9 yN X� F J m e .wiDy w ti y2y p 60S RZj =j _00p � TO �m wyn m-mm p 9Nm m F� ^�R ayZN Tg 0 U)n im^ w Oyc +?m pyDm cramp n �cov_m'sD San wA a 3m yzya (� S�w m amm> x><m m m'a ma9 �To N y m m p O n n O m z -a_IOm� OT D o na Tm yz-a_i0 —� m0z m�m a3 RI �'mpz<z a n ngpD=1z, r cOr m m y D W °H osZ. o, Dlz F. v n mr�m :o�z Omo OO y( N 2 3 T jam 3f�ampm w 3;� yDy N m = o w A ra m C 3 m ma0 mxp y w o o B� m ram d O s2 0 zON n as r mmm M oOw 3a� 1°N N'ny Hwy 'w c oa cmx zam �o as cTo zamn y p fla �G CpT ozx mN m00 j 3N aNa w D? <m - yx 'm" xn w o x cm Or 9 m �_ m z N m 3e NO OOac 9r' A N �no N i'w Nny n Omw Texas Historically Underutilized Business (HUB) Certificate CertificateNlD Number: 1364766562200 Approval Date: February 14, 2023 Scheduled Expiration Date: February 28, 2026 In accordance with the Memorandum of Agreement between the CITY OF HOUSTON and the Texas Comptroller of Public Accounts (CPA), the CPA hereby certifies that fun abounds, Inc. has successfully met the established requirements of the State of Texas Historically Underutilized Business (HUB) Program to be recognized as a HUB. This certificate printed February 14, 2023, supersedes any registration and certificate previously issued by the HUB Program. If there are any changes regarding the information (i.e., business structure, ownership, day-to-day management, operational control, addresses, phone and fax numbers or authorized signatures) provided in the submission of the business; application for registration/certification into the City of Houston's program, you must immediately (within 30 days of such changes) notify the City of Houston's program in writing. The CPA reserves the right to conduct a compliance review at any time to confirm HUB eligibility. HUB certification may be suspended or revoked upon findings of ineligibiliy. If your firm ceases to remain certified in the City of Houston's program, you must apply and become certified through the State of Texas HUB program to maintain your HUB certification. Statewide HUB Program Statewide Procurement Division Note: In order for State agencies and institutions of higher education (universities) to be credited for utilizing this business as a HUB, they must award payment under the CertificateNlD Number identified above. Agencies, universities and prime contractors are encouraged to verify the company's HUB certification prior to issuing a notice of award by accessing the Internet (https://mycpa.cpa.state.tx.us/tpasscmblsearch/index.jsp) or by rnntacting the Hue Program at 512-463-5872 or toll -free in Texas at 1-888-863-5881. B2Gnow - t fi CITY OF HOUSTON i c_ 6 Office of Business Opportunity Sylvester Turner, ,BfISMESS.\PO Mayor fun abounds, Inc. t is duly certified as a Women Business Enterprise (WBE) Certified Categories: Cetlfiration Number. 20.2-11596 t NAICS 423910: PLAYGROUND EQUIPMENT AND SUPPLIES MERCHANT WHOLESALERS 1� Director of Office of Business Opportunity ..::_ .�.. ...._ 6. r:...ru........ rxn...ra... .Mi. d.nmw Sew,rma6ae 0eamm,mn NNmared ti lamlheMWOBEnmYat�IX Oe Nm'e teN!®lion fsnb Page I of I I!I ® ® ' ® ® 11 1 littps://houston.mwdbe.com/Functions/Certification/Communications/LetterCertificateView.asp?XID=9717&ViewType=SingleLetter&CertificationlD236... 2f 13/2020 �a ,zecreation and Pad , Let it be known that PAYTON PALMER-NEV has met the requirements of the standards set 1 National Certification Board and is hereby granted certification as Certified Playground Safety In Oct CHAIRPERSON Certified Pia round — - . Safety Inspector c —' NRPA PRESIDENT AND CEO Novl About BCT Burke 114 Venice, Sugar Land, TX. 77478 Main 855-226-8637 / Fax 281-265-0043 HISTORY As we celebrate over 100 years of making play, we look at our past to inspire and guide us and into the future as we use research and innovation to help us make the very best play, playground, outdoor fitness and recreation equipment in our history. Inspired by our legacy of innovation, customer service and creativity and continuing to challenge ourselves through exploration, analysis and continuous improvement, " we fulfill our mission of bringing Play That Moves You to communities around the world. We invest in our people, our products and in the communities in which we live and work. We're more than a century old and just getting started. Our history begins not with play, but don't worry, we get there. It begins with a weather-stripping company, J.E. Burke Company, in 1920. Started by John Edward and Ethlyn Burke on the family farm in Fond du Lac, Wisconsin, the company still stands on the land where it all began. By the late 1920's, Burke began manufacturing playground equipment and our true calling came to be. Through three generations of the Burke family, their successor, and now President and CEO Michael Phelan, BCI Burke Company has and continues to stand by J.E. Burke's original commitment to superior quality, outstanding service and constant innovation. With each year, Burke's products continue to inspire growth, foster development and help communities and families get outdoors together. Trademarks) are the property of BCI Burke Company. © BCI Burke Company 2021. PJI rights reserved. MORE THAN A CENTURY OF PLAY Guided by our legacy of innovation, customer service and creativity, we are making the very best and most innovative playground, outdoor fitness and recreation products in our history! Our founder J.E. Burke set the course more than a century ago and we're taking his vision and making It even biggerl Through research, analysis and continuous improvement, we're designing products and playspaces that bring Play That Moves You® to communities for more fun, movement, engagement and development! Play is our passion, our mission and our business and we can't wait for you to Join Our Movement. SCIBURVE.COM .Bunke 800.2GG.1250 At Burke, movement is our mantra. It drives our purpose and ignites our passion to bring the best in playground design and the most innovative, developmentally rich play, outdoor fitness and recreation products. Our research and testing push us to create new and unique ways to challenge children, families, schools, communities, teams and individuals to move, to grow and to play. Play fosters opportunities for connection between generations and with our peers, provides growth and togetherness and moves us in so many ways. Join Our Movement® and experience the many ways play can move you. PLAY FOR 14EALT14 Movement is life and is one of the most important aspects in overall health and wellness for people of all ages and abilities. Burke has playground and fitness offerings that engage everyone in all stages of life to move. Our Nucleus® and Intensity® playgrounds feature a fusion of play that helps children engage in active play throughout the day for enhanced growth and developmental opportunities. ELEVATE® Fitness Course brings obstacle course fitness to a whole new level and is poised to engage children 5-12, teenagers and adults. ACTIVATE® Fitness Circuit and INVIGORATE® Dynamic Fitness are a great way to add events to a fitness trail or create a space for outdoor exercise. Our variety of fitness equipment wil I meet you where you are in your fitness journey and challenge you to be more. PLAY FOR YOUR MIND Playful experiences are learning experiences and children at play are developing a wide -variety of skills that range from problem solving and cognitive planning to memory and self -regulation. Each and every time a child plays they are contributing positively to their cognitive development and setting themselves up for future success. PLAY FOR CONNECTION Play provides us with common experiences, shared laughter and true connection. It brings communities together and helps us return to the simplicity of basic human connection and kindness. Parks and recreation spaces are critical because they lay the groundwork for the intergenerational engagement, interaction and development we all seek. Products such as Novo® Playful Furniture, with interesting pieces that can be used in a variety of ways, foster those opportunities by creating a space where everyone can interact and play together in their own way. The Konnection® Swing revolutionizes connection by promoting face-to-face connections and playing together. Every person of every age and ability brings their own unique experiences that enhance the collective and moves us all through play. PLAY FOR MOTION Motion play creates a childhood experience like no other by creating movement for children of all abilities and providing developmental benefits, including increased spatial awareness, inner ear stimulation and balance. Motion can be a source of calm for children with sensory processing differences while providing delight and excitement for children of all ages. PLAY FOR DEVELOPMENT Play is the work of childhood and helps children express themselves, monitor their emotions and develop a sense of identity that fuels their self-esteem and shapes their world view. Creating environments that foster this growth is at the heart of what we do at Burke and helps to teach resiliency and perseverance, all skills that transcend the playground and help children to develop into successful and healthy adults. BCIBURKE.COM Surim 800.266:1250 HANDCRAFTED IN AMERICA'S HEARTLAND Walk through our Fond du Lac, Wl manufacturing facility and you will see playgrounds coming to life through the hands of our people In the age of assembly lines, we work to combine efficiency with a personal touch that makes every playground special Bringing quality playgrounds to communities like yours is Work That Moves Us, and we hope the playgrounds we make move you too. SUPERIOR SERVICE Customer Service is'a hallmark of Burke and we take pride in the fact that when you call, we answer. We have factory -direct customer service representatives that are available to answer questions, help with replacement parts or field inquiries about Installations. YOUR BUIZO REPRESENTATIVE Burke Representatives are passionate about b[inging play to your community and helping you design your perfect play environment! They are knowledgeable and experienced about the entire playground process from site evaluation to design to maintenance and will work with you beyond installation to make sure your playground is, and remains, all you dreamed! BOBURKE.COM Burke 800.266.1250 PLAY THAT MOVES YOU Trademark(s) are the property of BCI Burke Company. 0 BCI Burke Company 2020. All rights reserved. Discover the value of investing in a Burke Playground: KOREKONNECT® DIRECT -BOLT CLAMP SYSTEM: Nucleus® features our Industry -leading KoreKonnect direct -bolt clamp system resulting in the strongest and most accurate connection system ever. Factory located connection points make for easy, precise installation and an error -free fit. Best of all, KoreKonnect is covered for 100 years under our non -prorated Generations Warranty®. DIRECT -BOLT CONNECTION SYSTEM: Intensity®, ELEVATE® Fitness Course, ACTIVATE® Fitness Circuit and Synergy* feature Burke's trusted direct -bolt connection that uses a durable, straightforward direct -bolt system to ensure a trouble -free installation and provide the necessary strength to accommodate the demands of playing children. Like our KoreKonnect system, Direct -Bolt connections are covered for 100 years under our Generations Warranty. EZKONNECT® DECK MOUNTING SYSTEM: Our exclusive self -leveling deck attachment and factory CNC construction allows for faster and more precise location of decks during installation. The 2-bolt per corner deck attachment increases overall structure strength and stability. PLATFORMS: Burke's oversized non -slip platforms are constructed of heavy-duty punched steel that can support more than 2 tons. Our vinyl coating is California compliant, free of lead and other hazardous heavy metals. TAMPER -RESISTANT STAINLESS STEEL HARDWARE: All hardware is covered for 100 years under our Generations Warranty. PREMIUM POWDER COATINGS: Our industry -leading powder coatings and finishes prevent fading, last longer and deter rust. We also offer a "coastal package" powder coat system. This special powder coat system for metal components and upright posts will provide additional corrosion and chemical protection along with added longevity to the color and gloss retention of the powder coated parts. Contact your Burke Representative for more information on colors, price and warranty. COMPOUND PLASTICS WITH UV-20: You'll get long wear and bright, vibrant colors that hold up for years thanks to our thick, durable rotomolded plastics with UV-20 protection. This is why we can cover them for 15 years under our non -prorated Generations Warranty. CLIMBING CABLES: Our climbing cables are flexible enough to provide movement, yet strong enough to last. Our ropes are made from 6 polyester cords with steel reinforcement wrapped around a synthetic fiber core. Each cord contains 8 galvanized steel strands tightly covered with polyester multi -fibers. Our RopeVenture® cables consist of 6 strands, each containing 24 stainless steel reinforcing strands within a nylon sleeve, wrapped around a solid nylon core. ALUMINUM CONNECTORS: Swivel connectors at the end of our ropes allow assembly at any angle with no unwanted twists in the net. The aluminum fittings used to secure thejoints are swaged in place to prevent any movement between the rope and fittings that could cause wear. BCIBURKE.COM Bunke $00.2GG.1250 The Longest and Strongest warranty in the industry BCI Burke Company, LLC ('Burke") warrants that all standard products are warranted to be free from defects in materials and workmanship, under normal use and service, for a period of one (1) year from the date of shipment. We stand behind our products. In addition, the following products are warranted, under normal use and service from the date of shipment as follows: • One Hundred (100)Year Limited Warranty on aluminum and steel upright posts (including Intensity', Synergy^^, Nucleus®, Voltage`", Little Buddies", ELEVATF®, ACTIVATE'•, INVIGORATET^^) against structural failure due to corrosion, deterioration or workmanship. • One Hundred (100)Year Limited Warranty on KoreKonnecfx clamps against structural failure due to corrosion, deterioration or workmanship. • One Hundred(100) Year Limited Warranty on Hardware (nuts, bolts, washers) • One Hundred (100)Year Limited Warranty on bolt -through fastening and clamp systems (Synergy^', Intensity°, Nucleus®, Voltage®, Little Buddies®, ELEVATE®). • Twenty -Five (25)Year Limited Warranty on spring assemblies and aluminum cast animals. • Fifteen (15)Year Limited Warranty on structure platforms and decks, metal roofs, table tops, bench tops, railings and barriers against structural failure due to materials or workmanship. • Fifteen (15)Year Limited Warranty on all plastic components including StoneBorders against structural failure due to materials or workmanship. • Ten (10) Year Limited Warranty on ShadePlay Canopies fabric, threads, and cables against degradation, cracking or material breakdown resulting from ultra -violet exposure, natural deterioration or manufacturing defects. This warranty is limited to the design loads as stated in the specifications. • Ten(10) Year Limited Warranty on NaturePlai Boulders and GFRC products against structural failure due to natural deterioration or workmanship. Natural wear, which may occur with any concrete product with age, is excluded from this warranty • Ten(10) Year Limited Warranty on Full Color Custom Signage against manufacturing defects that cause delamination or degradation of the sign, Full Color Custom Signs also carrya two (2) year warranty against premature fading of the print and graphics on the signs. • Five(5) Year Limited Warranty on lntensityx and RopeVenture° cables and LEVEL X® flex bridge against premature wear due to natural deterioration or manufacturing defects. Determination of premature wear will be at the manufacturer's discretion. • Five (5)Year Limited Warranty on moving parts, including swing components, against structural failure due to materials or workmanship. • Five (5)Year Limited Warranty on PlayEnsemble•' cables and mallets against defects in materials and workmanship. • Three (3)Year Limited Warranty on electronic panel speakers, sound chips and circuit boards against electronic failure caused by manufacturing defects. The warranty stated above is valid only if the equipment is erected in conformity with the layout plan and/or installation instructions furnished by BCI Burke Company, LLC using approved parts; have been maintained and inspected in accordance with BCI Burke Company, LLC instructions. Burke's liability and your exclusive remedy hereunder will be limited to repair or replacement of those parts found in Burke's reasonable judgment to be defective. Any claim made within the above stated warranty periods must be made promptly after discovery of the defect. A part is covered only for the original warranty period of the applicable part. Replacement parts carry the applicable warranty from the date of shipment of the replacement from Burke. After the expiration of the warranty period, you must pay for all parts, transportation and service charges. Burke reserves the right to accept or reject any claim in whole or in part. Burke will not accept the return of any product without its prior written approval. Burke will assume transportation charges for shipment of the returned product if it is returned in strict compliance with Burke's written instructions. THE FOREGOING WARRANTIES ARE EXCLUSIVE AND IN LIEU OF ANY OTHER WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTY OR MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IF THE FOREGOING DISCLAIMER OF ADDITIONAL WARRANTIES IS NOT GIVEN FULL FORCE AND EFFECT, ANY RESULTING ADDITIONAL WARRANTY SHALL BE LIMITED IN DURATION TO THE EXPRESS WARRANTIES AND BE OTHERWISE SUBJECT TO AND LIMITED BY THE TERMS OF BURKE'S PRODUCT WARRANTY. SOME STATES DO NOT ALLOW THE EXCLUSION OF CERTAIN IMPLIED WARRANTIES, SO THE ABOVE LIMITATION MAY NOT APPLY TO YOU. Warranty Exclusions: The above stated warranties do not cover: "cosmetic" defects, such as scratches, dents, marring, or fading; damage due to incorrect installation, vandalism, misuse, accident, wear and tear from normal use, exposure to extreme weather; immersion in salt or chlorine water, unauthorized repair or modification, abnormal use, lack of maintenance, or other cause not within Burke's control; and Limitation of Remedies: Burke Is not liable for consequential or Incidental damages, including but not limited to labor costs a lost profits resulting from the use of or inability to use the products or from the products being incorporated in or becoming a component of any other product. If, after a reasonable number of repeated efforts, Burke is unable to repair or replace a defective or nonconforming product, Burke shall have the option to accept return of the product, or part thereof, if such does not substantially impair its value, and return the purchase price as the buyer's entire and exclusive remedy. Without limiting the generality of the foregoing, Burke will not be responsible for labor costs involved in the removal of products or the Installation of replacement products. Some states do not allow the exclusion of incidental damages, so the above exclusion may not apply to you. The environment near a saltwater coast can be extremely corrosive. Some corrosion and/or deterioration is considered "normal wear" in this environment. Product installed within 500 yards of a saltwater shoreline will only be covered for half the period of the standard product warranty, up to a maximum of five years, for defects caused by corrosion. Products installed in direct contact with saltwater or that are subjected to salt spray are not covered by the standard warranty for any defects caused by corrosion. Contact your local Burke Representative for warranty information regarding Burke Turfs and Burke Tile products. Terms of Sale Pricing: Prices published in this catalog are in USD, are approximate and do not include shipping & handling, surfacing, installation nor applicable taxes. All prices are subject to change without notice. Contact your Burke representative for current pricing. Payments are to be made in USE. Weights: Weights are approximate and may vary with actual orders. Installation: All equipment is shipped unassembled. For a list of factorycertifiedinstallers in your area, please contact your Burke representative. Specifications: Product specifications in this catalog were correct at the time of publication. However, product improvements are ongoing at Burke, and we reserve the right to change or discontinue specifications without notice. Loss or Damage In Transit: A signed bill of lading is our receipt from a carrier that our shipment to you was complete and in good condition upon arrival. Before you sign, please check the Bill of Lading carefully When the shipment arrives to make sure nothing is missing and there are no damages. Once the shipment leaves our plant, we are no longer responsible for any damage, loss or shortage. For more information regarding the warranty, call Customer Service at 920-921-9220 or 1-800-356-2070. 01/2021 BUBURKE.COM Surim 800.2GG.1250 ,'iv...ra�hf� fill2tl WltMf4h° Burke PLAY THAT MOVES 70U Option #1 114 Venice, Sugar Land, TX. 77478 Main 855-226-8637 / Fax 281-265-0043 Burke PLAY THAT MOVES YOU SCISURKE.COM • 800.266.1290 DESIGN SUMMARY fun abounds is very pleased to present this Proposal for consideration for the Calhoun County Inclusive Playground located in Port Lavaca. BCI Burke Company, LLC has been providing recreational playground equipment for over 100 years and has developed the right mix of world -class capabilities to meet the initial and continuing needs of Calhoun County Precinct 1. We believe our proposal will meet or exceed your project's requirements and will deliver the greatest value to you. The following is a summary of some of the key elements of our Proposal: • Project Name: Calhoun County Inclusive Playground • Project Number: 125-181066-2 • User Capacity: 431 • Age Groups: 5 to 12, 2 to 12 • Dimensions: 112' 9"x68' 3" • Designer Name: Kathleen Yttri fun abounds has developed a custom playground configuration based on the requirements as they have been presented for the Calhoun County Inclusive Playground playground project. Our custom design will provide a safe and affordable playground environment that is aesthetically pleasing, full of fun for all users and uniquely satisfies your specific requirements. In addition, proposal # 125-181066-2 has been designed with a focus on safety, and is fully compliant with ASTM F1487 and CPSC playground safety standards. We invite you to review this proposal for the Calhoun County Inclusive Playground playground project and to contact us with any questions that you may have. Thank you in advance for giving us the opportunity to make this project a success. Proposal 125-181066-2 1 6/27/2024 • + e ,4 LSD: H, . K I :::�f r"x 0 � Calhoun County Inclusive Playground Pert La�aca. TX 77979 DESIGNED FOR AGES! 0612712024 fun aboundsDesigner. 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F.A d ❑ N L° v `d E o .. a y t o e5 d dvQ90��9U .C� EW'vvd �Og k' 72 y w i o G o'o t $ m o E p d m 0 1= Es a c ao.5 i v = o M. o dgo O E I II vdi a3y - J uimm3 ter_. 91 o d d a ■ ■ ) - ) ( w mu 1S' Schedul i Burk4a PLAY THAT MOVES YOU & Lead Times *All Dates are Tentative Due to Weather* • Current Manufacturing Lead Time o 9-11 Weeks • Shipping / Transit o 1-2 Weeks • Installation Team Mobilize and Arrive On -Site o 1-2 Weeks • Entire Playground Installation (Including site prep; equipment; shade units; surfacing) o 4-5 Weeks • Approximate Project Completion Lead Time from Time of Order: o 15-20 Weeks 114 Venice, Sugar Land, TX. 77478 Main 855-226-8637 / Fax 281-265-0043 Thank you for allowing us to present this proposal to you. We would love the opportunity to "create playground memories filled with fun" for TE �e t ti� ) OF r 114 Venice St, 5ugar Land, TX 77478 361-230-3006 payton@fabplaygrounds.com www.fabplaygrounds.com Burke PLAY THAT MOVES YOU. BCIBURKE.COM • 600.266.1250 • CHARCOAL . SKY WHITE • BLUE O BLUE/WHTIE COGNITIVE So many life skills are learned through play! Skills such as cognitive planning, mastering newconcepts, problem solving and expression are developed naturally through play events like climbing, sliding and spinning, CLIMBING Climbing brings adventure and challenge to the playground while providing necessary developmental benefits such as balance, agility, upper and lower body strength and decision -making skills! When children climb, they develop confidence and take age appropriate risks that help build skills that will help them throughout their lives. PLAY VARIETY This design offers the perfect solution for a great playspace and ensures that the necessary and age -appropriate play components are included. Wth various slides, climbers and spinning events, kids will be able to enhance physical fitness while having fun playing. Mt, �+ puhd3 4 W STEMPLAY'" Children Team through play and Burke's oewStem71ayh^ collection fosters learning in a fun and child -directed wayl Taking concepts of engineenng and science and bringing these outside into an open enviionm¢M creates a place where children can develop creativity, problem calving and explore their connectedness to the eutdocrv.oid. Studies have shown outdoor learning can increase test scores and improve physical, emotional and mental health. MOVMNT® INCLUSIVE MOVMW is an electronic game that Is povnered by people. Users power up the game and dive into the numerous game options from single player to multi -player and IndPddual achievement to team spirit, ts a huge video game that disguises exercise as entertainment and fosters healthy competition and cletermiration. With i.w versions, everyone can play and be challenged at their level. SWINGING The joy of swinging is a childhood staple and kids LOVE it! Best of all, it has so many developmental benefits, including inner ear development, spatial awareness and sensory integration. CRUISER COBRA SLIDE® CORKSCREW MOVMNTQD INCLUSIVE PLAYENSEMBLE® CIRQUE DRUMS KONNECTION'SWING '. EVOLUTION® ARCH CLIMBER VOLTA® INCWJSIVE SPINNER PROPOSAL #0 125-181000-1 CAL14OUN COUNTY INCLUSIVE PLAYGROUND -A� P7 1(-z u F r x x k f 3rF- t tz n 1� AV 1 t ��I }j � Y e �i a d... �..... is _. l PROPOSAL #- 125-181000-1 '' • OR Lp 7 W 7 r :77`,�'4- 11 s ♦L— ry y r� a t /P is i jP 1 Lays i�'Y. jr4 �4 S3:v. .ti3 PARK PLACE R EC REATION DESIGNS P.O. Box 18186 1 San Antonio, Texas 78218 Local: (210) 821-5878 1 Toll Free: (800) 626-0238 Email: fun@miracleparkplace.com I www.miracleparkplace.com BuyBoard Contract #592-19 CALHOUN COUNTY, TEXAS BID NUMBER 2024.08 INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT SUBMISSION DEADLINE: TUESDAY, JULY 21 2024 2:00 PM SUBMITTED BY: PARK PLACE RECREATION DESIGNS, INC. ROBERT K. AHRENS, PRESIDENT TML BuyBoard Contract #679-22: Parks and Recreation Equipment, Products, and Installation Services Please note: Design services are not offered under the BuyBoard contract. CONTRACT DOCUMENTS FOR THE BID NO.2024.08 INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT FOR CALHOUN COUNTY, TEXAS WEST AUSTIN STREET PORT LAVACA, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT N0.20-065-064-C182 MAY 2024 This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovely and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program G & W Engineers, Inc. Texas Registered Engineering Finn F-04188 Project No. 5310.01 le Prepared by: G & W ENGINEERS, INC. 205 WEST LIVE OAK PORT LAVACA, TEXAS 77979 (361)552-4509 Approved By: SCOTT P. MASON .....:........................ 127893 ,�'f Scott P. Mason, P.E. �+', yq Texas Serial No. 127893 QS• Date: SECTION 2 5. *Bid Schedule 6. *Specification Notes (Addendum Acknowledgement & Calendar Days) 7. *Statement of Bidder's Qualifications S. *Conflict of Interest Questionnaire 9. *Certificate of Recovered Materials 10. *Certification Regarding Debarment & Suspension and Other Responsibility Matters 11. *Affidavit 12. *Certification of Bidder Regarding Civil Rights Laws and Regulations 13. *Contractor's Local Opportunity Plan 14. *Proposed Contracts Breakdown (expected subcontractors and labor classifications including Section 3 utilization) 15. *Certification for Business Concerns Seeking Section 3 Preference in Contracting and Demonstration of Capability 16. *Certification Regarding Lobbying 17. *Disclosure of Lobbying Activities and Instructions 18. *House Bill 89 Verification 19. *Residence Certification 20. *System for Award Management — (sam.gov 21. *Bid Bond** *Section 2 Items are to be completed and provided by all bidders with sealed bid. ** Please attach / include original bid bond as the last item in the sealed bid package. BID SCHEDULE PROJECT NAME: BID NO.2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182 DUE DATE: JULY 2. 2024 BEFORE 2:00:00 P.M. BIDDER NAME: Park Place Recreation Designs, Inc BASE WORK SCOPE: The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. Item # ITEM DESCRIPTION ITEM UNIT BID QUANTITY " UNIT PRICE ' TOTAL BID PRICE 1 MOBILIZATION, INSURANCE AND BONDS PER PLANS AND SPECIFICATIONS LS 1 $18,400.00 $18,400.00 2 TEMPORARY PROJECT SIGNAGE PER PLANS AND SPECIFICATIONS LS 1 $1,500.00 $1,500.00 DEMOLITION OF ENGINEERED WOOD 3 FIBER (EWF) (APPDX. 12"THICK) AND TRANSFER TO AREAS WITHIN PARK PER SF 7,575 $0.88 $6,666.00 PLANS AND SPECIFICATIONS. TYPE D, CRUSHED LIMESTONE, 8.5" 4 THICK AFTER COMPACTED IN PLACE TO 95%COMPLETE IN PLACE PER PLANS SF 7,575 $6.60 $49,995.00 AND SPECIFICATIONS GEO-GRID OR GEO-FABRIC INSTALLED 5 ON TOP OF BASE MATERIAL COMPLETE IN PLACE PER PLANS AND SF 7,575 $0.14 $1,060.50 SPECIFICATIONS RUBBER SURFACING 3.5" THICK 6 COMPLETE IN PLACE PER PLANS AND SF 7,575 $21.00 $259,075.00 SPECIFICATIONS (ALTERNATE: 4" THICKNESS) NEW PLAYGROUND STRUCTURE(S) MEETING THE MINIMUM REQUIREMENTS AS SET FORTH IN THE PLANS AND SPECIFICATIONS AND WITHIN THE AREAS LISTED. THIS 7 INCLUDES A SUPER STRUCTURE, SWING LS 1 $392,856.00 $392,856.00 SET, MERRY-GO-ROUND, STEM PLAY, ELECTRONIC GAME AND MUSIC PLAY. CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT PACKAGE REQUIRED. TWO -POST HIP SHADE STRUCTURE (15' X 22' X 10') CORRISION RESISTANT PACKAGE REQUIRED AND WIND 8 RESISTANT PACKAGE REQUIRED. EA 2 $23,609.50 $47,219.00 INCLUDES CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. (ALTERNATEDESIGNJ SINGLE -POST SQ SHADE STRUCTURE (16') CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT 9 PACKAGE REQUIRED. INCLUDES EA 1 $22,882.00 $22,882.00 CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. (ALTERNATE DESIGN) TOTAL BASE BID $699,653.50 *Submission of a bid tab with "Clarificatinna" or ••Fv�li��i"ee•• �.,a r....._.. _.�_- _.:_..,_.. _ ... . . -- -�•r waic, 5zrywunonn wni not oe accepted. ¢ shall be the bidder's responsibility to provide a complete bid and ask any questions necessary to clarify any bid items or relevant concerns within the questions period. **The award will be based on the BASE BID and the Owner reserves the right to determine the most advantageous and best bid for the project. ***The Calhoun County Commissioners Court shall be the sole judge in determining which bid will be the most advantageous to Calhoun County. PARK PLACE R E C R E A T k 0 N 0 E S I G N 5 P.O. Box 18186 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: www.miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County, Texas Project: Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 1. Mobilization, Insurance, and Bonds QTY MODEL OR PART NUMBER DESCRIPTION UNIT PRICE TOTAL ': PRICE 1 BONDS Payment and Performance Bonds $18,400.00 $ 18,400.00 PRE-TAX TOTAL OF ALL $ 1>},41Will) SALES TAX (if applicable) 0.00% $ GRAND TOTAL - $ f8,400:O1i' • Pricing is for materials/delivery. Installation is not included unless priced above. • If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings — Local Building Permits — Payment/Performance Bonds — TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. • Prices are valid for 30 days after which they are subject to chance. Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. • A 3% fee will be added for payment by credit card. Please issue all purchase orders and payments to Park Place Recreation Designs, Inc. Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Authorized by: x Printed Name Signature Date Page 1 of 1 2024.07.02 Little Chocolate Bayou County Park i.xlsa PARK PLACE PF R E P.O. Box 18186 1 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 40 Email: fun@miracleparkplace.com I Web: www.miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County, Texas Project: Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 2. Temporary Project Signage CITY MODEL OR PART NUMBER DESCRIPTION UMT TOTAL PRICE PRICE 1 SIGNAGE Project Construction Sign $ 1,500.00 $ 1,500.00 PRE-TAX TOTAL OFALL $ 1,500.00 SALES TAX (if applicable) 0.00% $ - GRAND TOTAL $ 1,600.00 • Pricing is for materialsldelivery. Installation is not included unless priced above. • If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings — Local Building Permits — Payment/Performance Bonds — TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. • Prices are valid for 30 days after which they are subject to change Any work not specifically mentioned in this proposal as being Included shall be deemed excluded. The customer will be responsible for any taxes owed. ' A 3% fee will be added for payment by credit card. Please issue all purchase orders and payments to Park Place Recreation Designs, Inc. Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Authorized by: x Printed Name Signature Date Page 1 of 1 2024.0702 Lade ch..Iare Bayou county Park 2.xdsx PARK PLACE P.O. Box 18186 1 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: www.miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County, Texas Project: Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 3. Demolition of Engineered Wood Fiber (EWF) and Transfer to Areas Within Park CITY MODEL OR PART NUMBER DESCRIPTION UNIT PRICE TOTAL PRICE 7575 DEMO Remove existing Engineered Wood Fiber and transfer to areas $ 0.88 within park as directed by county staff. Price per square foot. $ 6,666.00 PRE-TAX TOTAL OF ALL $ 6,666.00 SALES TAX (if applicable) 0.00% $ GRAND TOTAL $ 6,666.00 • Pricing is for materials/delivery. Installation is not included unless priced above. • If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings — Local Building Permits — Payment/Performance Bonds — TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. • Prices are valid for 30 days after which they are subject to change Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. • A 3% fee will be added for payment by credit card. Please issue all purchase orders and payments to Park Place Recreation Designs, Inc. Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Authorized by: x Printed Name Signature Date Page 1 of 1 2024.0702 Lime Ch=late Bayou County Park 9.xlsx PARK PLACE F E 7 7 Ern -,c>hi 7S!.aN P.O. Box 18186 1 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: www.miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County, Texas Project: Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 4. Type D, Crushed Limestone, 8.5" Thick After Compacted in Place CITY MODEL OR PART NUMBER DESCRIPTION UNIT PRICE TOTAL PRICE 7575 BASE Delivery and installation of crushed limestone rock base. $ 6.60 $ 49,995.00 Compacted to bring site elevation to within 4" of grade. PRE-TAX TOTAL OF ALL $ 49,995.00 SALES TAX (if applicable) 0.00% $ GRAND TOTAL $49,995.00 • Pricing is for materials/delivery. Installation is not included unless priced above. • If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings — Local Building Permits — Payment/Performance Bonds — TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. • Prices are valid for 30 days after which they are subject to change Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. • A 3% fee will be added for payment by credit card. Please issue all purchase orders and payments to Park Place Recreation Designs, Inc. Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Authorized by: x Printed Name Signature Date Page 1 of 1 2024.07.02 Little chocolate Bayou county Park 4.xlsx PARK PLACE P.O. Box 18186 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: www.miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County, Texas Project: Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 5. Geo-Grid or Geo-Fabric Installed on top of Base Material CITY MODEL OR PART NUMBER DESCRIPTION UNIT PRICE TOTAL PRICE 7575 FABRIC Delivery and installation of Geotextile Fabric on top of $ 0.14 $ 1,060.50 compacted base material. Price per square foot. PRE-TAX TOTAL OF ALL $ 1,060.50 SALES TAX (if applicable) 0,00% $ GRAND TOTAL $ 1,060.50 • Pricing is for materials/delivery. Installation is not included unless priced above. • If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings — Local Building Permits — Payment/Performance Bonds — TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. • Prices are valid for 30 days after which they are subject to change Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. • A 3% fee will be added for payment by credit card. Please issue all purchase orders and payments to Park Place Recreation Designs, Inc. Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Authorized by: x Printed Name Signature Date Page 1 of 1 2024 07.02 Little Chocolate Bayou county Far, 5 xisx PARK PLACE 6• E C P E A - ,_, , C E_ 13 ra ; P.O. Box 18186 1 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: www.miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County, Texas Project Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 6. Rubber Surfacing CITY7ffo DESCRIPTION UNIT TOTAL PRICE PRICE nd installation of Poured -In -Place Rubber Surfacing 75750% (full) color. 4" thickness to provide recommended falltection for proposed play structure. Price per square foot. $ 21.00 $ 159,075.00 te: Bid specification called for 3.5" thickness. 0.00% $ 159,075.00 $159 075.00 1 rtiang is Tor materials/delivery. Installation is not included unless priced above. If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings — Local Building Permits — Payment/Performance Bonds — TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. Prices are valid for 30 days after which they are sublect to change. Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. A 3% fee will be added for payment by credit card. Authorized by: PRE-TAX TOTAL OFALL SALES TAX (if applicable) GRAND TOTAL issue all purchase orders and payments to Park Place Recreation Desig Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Page 1 of 1 2024.0702 Little Chocolate Bayou county Park 6 Bax PARK PLACE P.O. Box 18186 � San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: w .miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County Texas Project: Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 7. New Playground Structure(s) Meeting Minimum Requirements OTY MODEL OR PART NUMBER DESCRIPTION UNIT PRICE TOTAL PRICE 1 KC14399 Custom Kids' Choice Inclusive Playsystem, Ages 5-12 Please see note below re: coastal coatings. $ 230,472.00 $ 230,472.00 1 SWINGS 6 Seat Arch Swing Frame with Integrated Shade $ 19,461.00 $ 19,461.00 4 2840 Slash Proof Belt Swing Seat (8' top rail) $ 152.00 $ 608.00 1 2740 Inclusive Swing Seat $ 1,537.00 $ 1,537.00 1 2760 Generation Swing Seat $ 1,254.00 $ 1,254.00 1 307 Inclusive Whirl $ 15,845.00 $ 15,845.00 1 MR8097802 Dennis Inclusive Seesaw $ 8,375.00 $ 8,375.00 1 4501 Concerto Tall Chimes $ 5,945.00 $ 5,945.00 1 4502 Concerto Vibes $ 5,929.00 $ 5,929.00 1 4505 Concerto Spin Cabasas, Large $ 1,472.00 $ 1,472.00 1 4507 Concerto 3-Congas $ 2,900.00 $ 2,900.00 1 451 Panel Insert Post FS $ 600.00 $ 600.00 1 714715206 Magical Music Insert $ 2,422.00 $ 2,422.00 1 4539 Miracle Museum G000aaalll $ 7,750.00 $ 7,750.00 1 4536 Miracle Museum Curiosity Thrilled the Cat $ 7,500.00 $ 7,500.00 1 4538 Miracle Museum My Cup of Tea $ 7,250.00 $ 7,250.00 1 4535 Miracle Museum Momentum Corridor $ 8,994.00 $ 8,994.00 1 4534 Miracle Museum Grand Gallery $ 17,036.00 $ 17,036.00 1 4533 Miracle Museum Dynamics Lab $ 6,814.00 $ 6,814.00 1 4532 Miracle Museum Odyssey Hall $ 10,221.00 $ 10,221.00 1 463704 Miracle Museum Tranquility Corner $ 1,525.00 $ 1,525.00 1 70471316B TCX Hex/Triangle Perforated Panel $ 1,795.00 $ 1,795.00 1 70471314B TCX Oval/Square Perforated Panel $ 1,795.00 $ 1,795.00 EQUIPMENT SUBTOTAL $ 367,600.00 1 DISCOUNT BuyBoard Proposal #679-22 Discount $ 91,875.00 EQUIPMENT SUBTOTAL AFTER DISCOUNT $ 275,625.00 1 FREIGHT 1 $ 18,006.00 $ 18,006.00 TOTAL EQUIPMENT DELIVERED $ 293,631.00 Continued on Page 2 Page 1 of 2 2024,0702 Lime ch..Iate saym corny P.` 7.1s. PARK PLACE P.O. Box 18186 1 San Antonio, Texas 78218 Toll Free: (800) 626-0238 I Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: www. miracleparkplace.com BuyBoard Contract#679-22 Page 2 July 2, 2024 Calhoun County Texas Quote #: Bid No. 2024.08 •rolect Little Chocolate Bayou County Park Playground Improvements Phase 2 :em: 1. New Playground Structure(s) Meeting Minimum Requirements QTY MODEL OR PART NUMBER DESCRIPTION UNIT TOTAL PRICE PRICE SUBTOTAL FROM PAGE 1 $ 293,631.00 1 INSTALL Installation of Equipment 00 Please note: Playsystem structure and freestanding equipment include a coastal primer coating or installations in close proximity to saltwater environments. EQUIPMENT AND INSTALLATION SUBTOTAL $ 392,866.00 SALES TAX (if applicable) 0.00% $ GRAND TOTAL $ 392,856.00 • Pricing is for materials/delivery. Installation is not included unless priced above. If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings —Local Building Permits — Payment/Performance Bonds — TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. Prices are valid for 30 da s after which the are sub'ect to Chan e. Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. A 3%fee will ea dded for payment by credit card. Authorized by: issue all purchase orders and payments to Park Place Recreation Desig Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Date Page 2 of 2 2024.07 02 Little Chocolate Bayou County Park 7 xlsx PARK PLACE Ft E C? E A CD t-.i P.O. Box 18186 1 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: wvvw.miracleparkplace.com BuyBoard Contract #679-22 Date: July 2, 2024 Quote: Bid No. 2024.08 Customer: Calhoun County, Texas Proiect: Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 8. Two Post Hip Shade Structure (Alternate) Corrosion Resistant, Wind Resistant OTY MODEL OR PART NUMBER DESCRIPTION UNIT PRICE TOTAL PRICE 2 ORION USA Shade Orion 23' x 15' with 8' entry Two Post Sail Shade Structure with curved cantilever arms. Extreme 32 fabric, coastal primer with powder coated frame, stainless steel attachment hardware. Recessed base plate construction. $17,746.00 $ 35,492.00 1 ENG DWG Texas Engineer Sealed Drawings $ 750.00 $ 750.00 EQUIPMENT SUBTOTAL $ 36,242.00 1 FREIGHT $ 1,227.00 TOTAL EQUIPMENT DELIVERED $ 37,469.00 1 INSTALL Installation of Equipment $ 9,750.00 $ 9,750.00 PRE-TAX TOTAL OF ALL $ 47,219.00 SALES TAX (if applicable) 0.00% $ GRAND TOTAL $47,219.00 • Pricing is for materials/delivery. Installation is not included unless priced above. • If not priced above and if required, the following items and associated costs/fees will be the responsibility of the customer: Engineer Sealed Drawings - Local Building Permits - Payment/Performance Bonds - TDLR Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. • Prices are valid for 30 days after which they are subject to change Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. • A 3% fee will be added for payment by credit card. Please issue all purchase orders and payments to Park Place Recreation Designs, Inc. Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Authorized by: x Printed Name Signature Date Page 1 of 1 2024,0702 Lircle Chocolate Bayou County Park 8xisx PARK PLACE R E c'. R E n r-r r_l C , I 4d;11P.O. Box 18186 1 San Antonio, Texas 78218 Toll Free: (800) 626-0238 1 Local: (210) 821-5878 Email: fun@miracleparkplace.com I Web: www.miracleparkplace.com 0BuyBoard Contract #679-22 Date: July 2, 2024 Customer: Calhoun County, Texas Quote: Bid No. 2024.08 tmLect Little Chocolate Bayou County Park Playground Improvements Phase 2 Item: 9. Single Post Square Shade Structure (Alternate) Corrosion Resistant, Wind Resistant CITY MODEL OR PART NUMBER DESCRIPTION UNIT TOTAL ICE USA Shade Arbor 17' x19' with 8' entry Single Post Sail Shade PRPRICE 1 ARBOR Structure, Extreme 32 fabric, coastal primer with powder coated frame, stainless steel attachment hardware. Recessed base plate $17,359.00 $ 17,359.00 construction. 1 ENG DWG Texas Engineer Sealed Drawings $ 750.00 $ 750.00 1 FREIGHT EQUIPMENT SUBTOTAL $ 18,109.00 $ 613.00 TOTAL EQUIPMENT DELIVERED $ 18,722.00 1 INSTALL Installation of Equipment $ 4,160.00 $ 4,160.00 PRE-TAX TOTAL OF ALL $ 22,882.00 SALES TAX (if applicable) 0.00% $ GRAND TOTAL $22,882.00 Pricing is for materials/delivery. Installation is not included unless• priced above. If not priced above and if required, the following items and associated costs/fees will be the responsibility of the — Local Building Permits — Payment/Performance Bonds — TDLR customer: Engineer Sealed Drawings Registration/Review/Inspections. Each item, along with its fee/cost, will be listed separately. • Prices are valid for 30 da s after which they are subject to change. Any work not specifically mentioned in this proposal as being included shall be deemed excluded. The customer will be responsible for any taxes owed. • A 3% fee will be added for payment by credit card. Please issue all purchase orders and payments to Park Place Recreation Designs, Inc. :] Terms: 50% down payment with signed quote. Municipalities/School Districts purchase orders accepted as authorization. Authorized by: x Printed Name c Page 1 of 1 2024 07 02 little Chocolate Bayou County Park 9 xi. SPECIFICATION NOTES. The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. The BIDDER, in compliance with the invitation for bids for Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project— GLO Contract No. 20-065-064-C182 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 150 consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $500.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: 1. Addendum No. 1 2. Addendum No. 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 Demo of existing EWF surfacing, playground installation OTS Construction Services PIP rubber surfacing installation FlexiTurf, LLC 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: Park Place Recreation Designs, Inc. Address: PO Box 18186, San Antonio, TX 78218 Phone: (210) 821-5878 office, (210) 531-6477 mobile EIN or Tax Signature: Name and Title: Marilyn Ahrens, Vice President 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: 6/25/2024 Bidder (Legal Name of Firm): Park Place Recreation Designs, Inc. Date Organized: 10/1/1980 Name of Owner(s): Robert Ahrens President. Marilyn Ahrens, Vice President Address: Physical: 4225 Woodburn Dr San Antonio TX 78218 Mailing: PO Box 18186, San Antonio TX 78218 Date Incorporated 9/10/1984 Federal ID Number: 74-2336170 Number of Years in contracting business under present name 44 List all other names under which your business has operated in the last 10 years: None. Work Presently Under Contract: Contract Amount $ Completion Date Medina Valley ISD New Elementary Schools $1 039 000 est. July 2024 Comal ISD New Elementary Schools, Playground Renovations $650 000 est. August 2024 Northside ISD Westwood Terrace Elementary $319,000 est. July 2024 Type of work performed by your company: Playground design and installation outdoor amenities Total Staff employed by Firm (Break down by Managers and Trades on separate sheet) 7: (3) managers, (4) office staff, sales representatives (5) full-time installation subcontractors. Have you ever failed to complete any work awarded to you? Yes ❑X 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 XM 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 �X 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 $ MoNr Completed New Braunfels ISD Design -Build Services contract $2,705,000 January 2024 June 2024 Major equipment available for this contract: Installation crews will use skid -steer loader/excavators. Are you in compliance with all applicable EEO requirements? ❑X Yes ❑ No (If no, please attach summary of details on a separate sheet.)) (Optional) Minority Business Reporting Information: Owner's Race: Owner's Ethnicity: Owner's Gender: Are you a Section 3 business? (see below) ❑ Yes ® No Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the County'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: Frost Bank, 1155 NE Interstate 410 Loop Contact Name: Jake Ladd City & State: San Antonio Zip: Texas Phone Number: (210) 220-4168 Credit available: $ 750,000 Has the firm or predecessor firm been involved in a bankruptcy or reorganization? ❑ Yes X❑ 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. List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Signed this / day of J (A- / 20 Zf Signature Marilyn Ahrens, Vice President Printed Name and Title Park Place Recreation Designs, Inc. Company Name Notary Statement Alt c`ey'-S being duly sworn, says that he/she is the 11(OP PmS,&& 4Position/Title of (Firm Name), and hereby swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporation to furnish any information requested by Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications. Subscribed and sworn before me this I !�O- day of 202 Notary Public IXv\ !� Signature NDSON EXPIRES028ytLwr✓� 2486102 =NOTARY Printed Name My Commission Expires: The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE LISEONLY 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 176.001(1-a) with a local governmental entity and the Date Received vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. t Name of vendor who has a business relationship with local governmental entity. Park Place Recreation Designs, 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 on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. NONE. Name of Officer ±1 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes E-1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes ED No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. 6 ❑ Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). Signature of vendor dtng business with the govemmental entity Date Orm PrGvlueu uy iexas tines commission www.ethics.state.tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at hftp://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code 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: ##k (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code & 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a requestfor proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www. ethics. state.tx. us Revised 11/30/2015 CONTRACTOR'S CERTIFICATION of RECOVERED MATERIAL ACKNOWLEDGEMENT 1, Marilyn Ahrens (Principal's Name) of Park Place Recreation Designs, Inc. (Company Name), (hereinafter called "Contractor"), acknowledge the recovered material bidding requirements found in 2 CFR 200.322 that requires the Contractor to procure those items designated in the guidelines of the Environmental Protection Agency (EPA) at 40 CFR 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition. I also acknowledge that this requirement shall apply to items purchased (1) where the Contractor purchases in excess of $10,000 of the item under this contract; or (2) where during the preceding fiscal year, the value of the quantity acquired was in excess of $10,000. Finally, I acknowledge the attached list of recovered materials included in the bid documents. (For up-to-date listing, please go to https://www.epa.gov/smm/comprehensive-procurement-guideline- cpg-prog ram#directory) Marilyn Ahrens, Vice President Printed Name and 'tie Si' nature Date USE OF RECOVERED MATERIAL Please check one: ❑X Recovered materials are included in this bid: Materials included Miracle Recreation is ISO 14001 certified: Steel, plastic. Surfacing: Rubber ❑ Recovered materials are not reasonably available in a reasonable period of time. ❑ Recovered materials fail to meet reasonable performance standards, which are determined on the basis of the guidelines of the National Institute of Standards and Technology, if applicable. ❑ Recovered materials are only available at an unreasonable price. Marilyn Ahrens, Vice President Prim Name and T' 1 Signature Date CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his/ her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this 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 (I) (a- d) of this certification. Marilyn Ahrens, Vice President Name and Title of Authorized Agent ?�nN k'Lud� - Signature of Wuthorized Agent --7-1-Z Date I 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. 18, 1986, appear at 51 FR 6370, 3 CFR, 1996 Comp., P. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive depaltments and agencies shall participate in asystem fordebarment 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. I 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 repoli 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 repol i to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a celiification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, or voluntarily excluded from participation in the SRF program. This celtification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to principate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of cc 1 iifrcations. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. STATE OF TEXAS {) COUNTY OF BEXAR IN AFFIDAVIT Marilyn Ahrens being first duly sworn, deposes and says: that he or she is (Type or Print Name) the Vice President of Park Place Recreation Designs Inc. having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at Physical: 4225 Woodburn Dr., San Antonio, TX 78218. Mailing: PO Box 18186, San Antonio, TX 78218 (Type or Print Physical and Mailing Address) who submits herewith to Calhoun County the attached bid/proposal; that he or she is the person whose name is signed to the attached bid/proposal; that said bid/proposal is genuine; that the same is not sham or collusive; that all statements of fact herein are true; and that such bid/proposal was not made in the interest or behalf of any person, partnership, company, association, organization or corporation not herein named or disclosed. Affiant further deposes and says: that the bidder/proposer has not directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interests of Calhoun County, or of any other bidder/proposer, or anyone else interested in the bid/proposal contract; and that the bidder/proposer has not in any manner sought by collusion to secure for himself/herself/itself/themselves an advantage over any other bidder/proposer. Affiant further deposes and says: that prior to the public opening and reading of bids/proposals, said bidder/proposer: a) did not, directly or indirectly, induce or solicit anyone else to submit a false or sham bid/proposal; b) did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder/proposer or anyone else would submit a false or sham bid/proposal, or that anyone should refrain from submitting a bid/proposal or withdraw their bid/proposal; c) did not, in any manner, directly or indirectly, seek by agreement, communication or conference with anyone to raise or fix the bid price/proposal of said bidder/proposer or of anyone else, orto raise or fix any overhead, profit or cost element of their price/fee or of that of anyone else; d) did notgive, offer to give, nor intends to give at anytime hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to any official, employee or agent of Calhoun County in connection with the submitted bid/proposal; and e) did not, directly or indirectly, submit their bid/proposal price or any breakdown thereof, or the contents thereof, or divulge information or data relative hereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent, thereof, to any individual or group of individuals, or to any official, employee or agent of Calhoun County prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained in this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and requirements cdinh bid/poposal. L Signature of Affiant Marilyn Ahrens, Vice President Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of 20Z- yP PRIA SOLMUNDSON Signature of Notary Public MY COMMISSION EXPIRES MAY 31, 2028 or NOTARY ID: 132486102 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Park Place Recreation Designs, Inc. PO Box 18186 San Antonio, TX 78218 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. Ye No The undersigned hereby certifies that: The Provision of Local Training Employment and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). 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? Yes No NAME AND TITLE OF SIGNER (Please type) Marilyn Ahrens, Vice President SIGNATURE UDATE CONTRACTOR'S LOCAL OPPORTUNITY PLAN Park Place Recreation Designs, Inc agrees to implement the following specific affirmative action steps (name of company) directed at increasing the utilization of lower income residents and businesses within Calhoun County. A. To ascertain from the County's CDBG program official the exact boundaries of the project area and where advantageous, seek the assistance of local officials in preparing and implementing the affirmative action plan. B. To attempt to recruit from within the county the necessary number of lower income residents through: local advertising media, signs placed at the proposed site for the project, and community organizations and public or private institutions operating within and servicing the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Concentrated Employment Program, Hometown Plan, or the U.S. Employment Service. C. To maintain a list of all lower income residents who have applied either on their own or on referral from any source, and to employ such persons, if otherwise eligible and if a vacancy exists. D. To insert this plan in all bid documents and to require all bidders on subcontracts to submit an affirmative action plan including utilization goals and the specific steps planned to accomplish these goals. E. To ensure that subcontracts (greater than $10,000), which are typically let on a negotiated rather than a bid basis in areas other than the covered project area, are also let on a negotiated basis, whenever feasible, in a covered project area. F. To formally contact unions, subcontractors, and trade associations to secure their cooperation in this effort. G. To ensure that all appropriate project area business concerns are notified of pending sub -contractual opportunities. H. To maintain records, including copies of correspondence, memoranda, etc., which document that all of the above affirmative action steps have been taken. I. To appoint or recruit an executive official of the company or agency as Equal Opportunity Officer to coordinate the implementation of this plan. J. To maintain records concerning the amount and number of contracts, subcontracts, and purchases which contribute to objectives. K. To maintain records of all projected work force needs for all phases of the project by occupation, trade, skill level, and number of positions and to update these projections based on the extent to which hiring meets these Local Opportunity objectives. As officers and representatives of Park Place Recreation Designs Inc 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 provi ions / P . Signature lJ Marilyn Ahrens Printed Name Vice President Title Date Instructions for Proposed Contracts Breakdown and Estimated Project Workforce Breakdown Proposed Contracts Breakdown Type of Contracts— list all construction, materials, or other types of subcontracts (for example: electrical, plumbing, concrete, boring, etc.) No. of Contracts — Number of contracts under this category Approximate Total Dollar Amount — Total amount of each contract Estimated No. to Local Business — Number of contracts awarded to local businesses and Section 3 businesses Estimated $ Amount to Local Business - How many dollars will be spent locally for each type of contract? For example: will you hire any local employees or subcontractors? Estimated Project Workforce Breakdown Work Classifications — Classification of project employees as defined on Wage Rate Total Estimated Positions — List the number employees for each work classification will you need on this project Number of Positions Currently Filled — List the number of estimated positions you currently have filled Number of Positions Not Filled — List the number of estimated positions you currently do not have filled Number of Positions to Fill with Low to Moderate Income (Section 3) Residents — List the number of local residents earning low to moderate incomes that you plan to employ to fill the estimated positions not filled PROPOSED CONTRACTS BREAKDOWN Type of Contracts No. of Contracts Approx. Total Dollar Amount Estimated No. to local Business Estimated $ Amount Local Business Construction 2 $231,700.00 0 TBD 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 Supervisor 2 2 0 0 Laborer 9 9 0 0 Totals 11 11 0 0 Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program CERTIFICATION FOR BUSINESS CONCERNS Seeking Section 3 Preference in Contracting and Demonstration of Capability Economic Opportunities for Low and Very Low -Income Persons Grantee/Subrecipient: Contract Number: Date: CONTRACTOR INFORMATION Name of Business Address of Business Type of Business: ❑ Corporation ❑ Partnership ❑ Non -Profit ❑ Sole Proprietorship ❑ Joint Venture Consortium Attach the following documentation as evidence of Section 3 eligible status (Definition of °Section 3 Business Concern° in 24 CFR 135 describes the three alternative qu For Business claiming status as a Section 3 resident -owned enterprise: ❑ Copy of resident lease ❑ Copy of receipt of public assistance ❑ Copy of evidence of participation in a public El Other evidence assistance program For business entity as applicable: ❑ Copy of Articles of Incorporation ❑ Assumed Business Name Certificate ❑ List of owners/stockholders and % ownership of each appointed officers Organization chart with names and titles and brief function statement ❑ Certificate of Good Standing ❑ Partnership Agreement ❑ Corporation Annual Report ❑ Latest Board minutes ❑ Additional documentation For business entity claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business(es): ❑ List of subcontracted Section 3 business(es) and subcontract amount For business claiming Section 3 status, by claiming at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employment with the business: ❑ List of all current full-time employees ❑ PHAIIHA Residential lease less than 3 years from day of employment ❑ List of employees claiming Section 3 status ❑ Other evidence of Section 3 status less than 3 Years from date of employment Evidence of ability to perform successfully under the terns and conditions of the proposed contract: ❑ Current financial statement ❑ Statement of ability to comply with ❑ List of owned equipment public policy ❑ List of all contracts for the past two years Authorized Name an igna ure Date Attested By: (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 Contra is Authorized Official Marilyn Ahrens, Vice President Printed Name and Title of Contractor's Authorized Official Date *24 C.F.R. 87 App. A, available at https://www.gpo.gov/f`dsys/granule/CFR-2011-title24-voll/CFR-2011-title24- vol1-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 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. 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, city, state and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 4040-0013, Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (4040-0013), Washington, DC 20503 Approved by OMB 4040-0013 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 1. Type of Federal 2. Status of Federal Action: 3. Report Type: Action: a. bid/offer/application a. initial filing a. contract Q- 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: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 6. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (if individual, last name, first name MI): (last name, first name, MI): d v 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name: by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C.1362. This information will be reported to the Title: Congress semiannually and will be available for public inspection. Any person who fails to file the required Telephone No.: Date: disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85th 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) Marilyn Ahrens do hereby verify the truthfulness contents of the statements submitted on this certification under thand accuracy of the e provisions of Subtitle tTitle ss ss 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 nhn Company Name rn unm Cnb Signature of Author z d Official Printed Name of Authorized Official Vice Title of Authorized Official Date RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) 'Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ I certify that (Company Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (City and State) Park Place Recreation Q I certify that Designs, Inc. is a "Resident Bidder" of Texas as (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Marilyn Ahrens, Vice President 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. Lnsr,,dared fir lha d n,lh,... ou Dre [1, 2023, H 51.1X1 P I RK PUCE REC'REIT10 \ DES'IGVS. fVC. - l SAM.00v- PARK PLACE RECREATION DESIGNS, INC. Unique Entity ID HUUNRCMK3HJ9 Registration Status Active Registration Physical Address 4225 Woodburn DR San Antonio, Texas 78218.5036 United States CAGE/NCAGE OSBZ6 Expiration Date Dec 10, 2024 Mailing Address 4225 Woodburn DR P.O. Box 18186 San Antonio, Texas 78218.5036 United States Purpose of Registration All Awards Doing Business as Division Name Division Number (blank) (blank) (blank) Congressional District State / Country of Incorporation URL Texas 35 Texas I United States http:ilwww.miracleparkplace.com Registration Dates Activation Date Submission Date Initial Registration Date Dec 13, 2023 Dec 11, 2023 Jan 10, 2002 Entity Dates Entity Start Date Fiscal Year End Close Date Jan 1, 1980 Mar 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 responsibilityiqualification 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 Corporate Entity (Not Tax Exempt) Business or Organization (blank) Profit Structure For Profit Organization Jun 24, 2024 09:39 41 PM GWT hnPr://s,neymven1m O1UUNRGNK311J9A,,,Di,,, an,d/ Page1,y2 Lustopdare I firu ih a.lhrura on D, If, 2023 u111 tit (o' Socio-Economic Types P IRK PL.ICE RECRE,I P[ON DESIGFS INC, Check the registrant's Reps & Carts, if present, under FAR 52.212.3 or FAR 52.2194 to determine if the entity is an SBA -certified HUBZons 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 Yes No EFT Indicator CAGE Code 0000 OSBZ6 Electronic Business 4225 Woodburn MARILYN AHRENS, Vice President San Antonio, Texas 78218 United States ROBERT AHRENS AHRENS 4225 Woodburn San Antonio, Texas 78218 United States Government Business P. P. O. Box 18186 ROBERT AHRENS, President San Antonio, Texas 78218 United States MARILYN AHRENS AHRENS P. O. Box 18186 San Antonio, Texas 78218 United States Past Performance 9. ROBERT AHRENS AHRENS MARILYN AHRENS AHRENS P. O. Box 18186 San Antonio, Texas 78218 United States P. O. Box 18186 San Antonio, Texas 78218 United States NAICS Codes Primary NAICS Codes NAICS Title Yes 713990 All Other Amusement And Recreation Industries 314910 Textile Bag And Canvas Mills 713940 Fitness And Recreational Sports Centers Product and Service Codes PSC PSC Name 7830 Recreational And Gymnastic Equipment This entity does not appear in the disaster response registry. Jun 24. 2024 09:39:45 Pbl G.NT hnps:/G...... v/emiirgZUNRC,WK3l/J9/coreDomhmms=n,dl Pnge3 f2 KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Park Place Recreation Designs, Inc. as PRINCIPAL, and SureTec Insurance Company , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Local Public Agency', in the penal sum of Five Percent of Greatest Amount Bid By Principal----- Dollars, ($ 5% GAB ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, thatwhereas the Principal has submitted the Accompanying Bid, dated July 2, 2024 , for BID NO. 2024.08 — INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT — GLO CONTRACT NO. 20- 065-064-C182 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 2nd day of uT Iy 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. (SEAL) Attest: �NkAi Attest: Attest: Countersigned 0 Park Place Recreation Designs, Inc. ��• - `,�i,�,,�aJ SureTec Insurance Company By: AA :- 0 Affix Corporate Seal Affix Corporate Seal Attorney -in -Fact, State of Texas Pagel of 2 CERTIFICATE AS TO CORPORATE PRINCIPAL I, f "r UIKI l �A / fl akV , certify that I am the Secretary of the Corporation named as Principal in the bid bond; that ^� p06,0+ �. LY LVtf , who signed the said bond on behalf of the Principal was then Ptt51 ✓ -f' f�r 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: s� d ��- * Power -of -attorney for person signing for Surety Company must be attached to bond. Please attach / include original bid bond as the last item in the sealed bid package. Corporate Seal Page 2 of 2 POA# 4221025 JOINT LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That SureTec Insurance Company, a Corporation duly organized and existing under the laws of the State of Texas and having its principal office in the County of Harris, Texas and Markel Insurance Company (the "Company"), a corporation duly organized and existing under the laws of the state of Illinois, and having its principal administrative office in Glen Allen, Virginia, does by these presents make, constitute and appoint: Paul C. Adam, Peter S. Batjer, Joseph P. O'Connor, Lisa W. Friend, Susan D.B. Muniz, Alan N. Sisk, Mard James, Shannon Dunaway, Tammy A. Friddle, Amy Taylor Their true and lawful agent(s) and attorney(s)-in-fact, each in their separate capacity if more than one is named above, to make, execute, seal and deliver for and on their own behalf, individually as a surety orjointly, as co -sureties, and as their act and deed any and all bonds and other undertaking in suretyship provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: Ten Million and 00/100 boilers ($10,000,000.00) This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolutions adopted by the Board of Directors of SureTec Insurance Company and Markel Insurance Company: "RESOLVED, That the President, any Senior Vice President, Vice President, Assistant Vice President, Secretary, Assistant Secretary, Treasurer or Assistant Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile signature, which may be attested or acknowledged by any officer or attorney, of the company, qualifying the attorney or attorneys named in the given power of attorney, to execute in behalf of, and acknowledge as the act and deed of the SureTec Insurance Company and Markel Insurance Company, as the case may be, all bond undertakings and contracts of suretyship, and to affix the corporate seal thereto." IN WITNESS WHEREOF, Markel Insurance Company and SureTec Insurance Company have caused their official seal to be hereunto affixed and these presents to be signed by their duly authorized officers on the 15m dayof February , 2023 . SureTec Insurance Company SUPANc P `\VRAN, 1, 5 N n��`�.QiNost;- i rJ}�1�./JJ/�j/�/f. `. 9 WrW - `Y� _Y�/• SEAL '> B �K� Y Michael C. Keimig, President '� 1 .,Zip, •~` '% State of Texas County of Harris On this 15th dayof February , 2023 A. D., before me, a Notary Public of the State of Texas, in and for the County of Harris, duly commissioned and qualified, came THE ABOVE OFFICERS OF THE COMPANIES, tome personally known to be the individuals and officers described in, who executed the preceding instrument, and they acknowledged the execution of same, and being by me duly sworn, disposed and said that they are the officers of the said companies aforesaid, and that the seals affixed to the proceeding instrument are the Corporate Seals of said Companies, and the said Corporate Seals and their signatures as officers were duly affixed and subscribed to the said instrument by the authority and direction of the said companies, and that Resolutions adopted by the Board of Directors of said Companies referred to in the preceding instrument is now in force. IN TESTIMONY WHEREOF, I have hereunto set my hand, and affixed my Official Seal at the County of Harris, the day and year first above written. E. Mgt �A9y EEM d d 0: TexasBy: , aVa Xl # 1v34: `^,oGJ f le E. McClary, Notary Publice� 'a 1 9, 2026 I r y commission expires 3/29/2026 L' We, the undersigned Officers of SureTec Insurance Company and Markel Insurance Company do herby certify that the original POWER OF ATTORNEY of which the foregoing is a full, true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF, we have hereunto set our hands, and affixed the Seals of said Companies, on the 2nd dayof July 2024 ,$ur sura Company j /1 B M. Br6nt Beaty, A istant Secretary { Any Instrument Issued in excess of the penalty stated above is totally void and without any validity. 4221026 For verification of the authority of this Power you may call (713)812-0800 on any business day between 8:30 AM and 5:00 PM CST. Markel Insurance Company 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 Box 149104 Austin, TX 78714- 9104 Fax#:512-490-1007 Web: http://www.tdi.state.tx.us 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. 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W K^ ~n W H LU Zw Y Q W Q U co Z Y W o Z M �❑N Lu U W � W Q�e mr CLQ� 7� Z LU U j Y 1 1� a 0 �� 0 1 00 N .N N U � O Ln V, W r� E 4-J W J o L c E N X O-0 v C: U O lC O mN _I L L Ua0a N i CL Si a OD N O U LA ra X F- U f6 J L . 0- 3 w a C y�j CY � O•- O O 6 L U h C lu m m. iiv y N Q Clo W Y H y 10 N N c Y$ 6 Gi WM m C L t � m m OO L O L C-O� O O a C O BO .OS. p _L Y V N C GI L CY O t O C M'Ma m V .wo L Y E 4 .c N O C N N M 2 (n L N ou a 0! = Y L0 O � m u Nv�M O� Q � a+ OCL 00 OWv ac0 'O oj�Yo. t.0 v. H Q O y h CONTRACT DOCUMENTS FOR THE INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 FOR CALHOUN COUNTY, TEXAS WEST AUSTIN STREET PORT LAVACA, TEXAS TEXAS GENERAL LAND OFFICE CONTRACT NO. 20-065-064-C182 and CALHOUN COUNTY 2020 CDBG-DR MAY 2024 This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Disaster Relief Program. NGINEERS, INC. 205 W. Live Oak • Port Lavaca, TX 77979 • 361 552-4509 FORMS AND CONDITIONS FOR BID DOCUMENTS/CONSTRUCTION CONTRACTS *Section 2 Items are to be completed and provided by all bidders with sealed bid. ** Please attach / include original bid bond as the last item in the sealed bid package. SECTION 1 1. Invitation for Bids 2. Instruction to Bidders for Construction 3. Equal Opportunity Guidelines for Construction Contractors 4. Calhoun County Section 3 Policy SECTION 2 5. *Bid Schedule 6. *Specification Notes (Addendum Acknowledgement & Calendar Days) 7. *Statement of Bidder's Qualifications 8. *Conflict of Interest Questionnaire 9. *Certificate of Recovered Materials 10. *Certification Regarding Debarment & Suspension and Other Responsibility Matters 11. *Affidavit 12. *Certification of Bidder Regarding Civil Rights Laws and Regulations 13. *Contractor's Local Opportunity Plan 14. *Proposed Contracts Breakdown (expected subcontractors and labor classifications including Section 3 utilization) 15. *Certification for Business Concerns Seeking Section 3 Preference in Contracting and Demonstration of Capability 16. *Certification Regarding Lobbying 17. *Disclosure of Lobbying Activities and Instructions 18. *House Bill 89 Verification 19. *Residence Certification 20. *System for Award Management - (sam.gov) 21. *Bid Bond** SECTION 3 22. Standard Form of Agreement for Construction Contacts 23. General Conditions for Construction 24. Calhoun County General Conditions 25. Minority/Female Goals 26. Federal Labor Standards Provisions 27. Title 29 - Labor 28. Concerning Labor Standards and Prevailing Wage Requirements 29. Project specific Davis -Bacon Wage Decision 30. GLO Signage Requirements 31. Certificate of Interested Parties Form 1295 and Instructions 32. Section 504 Certification 33. Child Support Statement 34. Document No. 00417 - Trench Safety Systems Indemnity Agreement 35. Payment Bond 36. Performance Bond 37. Certificate of Liability Insurance 38. Section 3 Clause 39. HUD Examples of Efforts to Offer Training and Employment Opportunities for Section 3 Residents 40. GLO New Hires Section 3 Monthly Compliance Report 41. CDBG-MIT Section 3 Brochure Information Sheet 42. GLO Assurances for Construction Programs 43. GLO General Affirmations 44. Attorney's Review Certification 45. Contractor's Final Payment Affidavit 46. Change Order Form 47. Certificate of Construction Completion (COCC) 48. Governing Technical Specifications & Special Provisions Invitation to Bid Notice is hereby given that the Commissioners Court of Calhoun County, Texas will receive bids for: Bid Number 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182 The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. The Instructions for Bidders, Bid Form, Specifications, and other Contract Documents may be examined at G&W Engineers, Inc. at 205 W. Live Oak, Port Lavaca, TX 77979 and obtained from other announcements will be distributed via CivCastLISA to all plan holders. www.CivcastUSA.com. There is no charge to view or download the documents. Addendums and A Pre -Bid Conference will be held at 10:00 am, Tuesday, June 4th, 2024 at Little Chocolate Bayou Park Pavilion at West Austin St., Port Lavaca, Texas. Potential bidders are strongly urged to attend. Sealed Bids may be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 31 Floor, Suite 301 Port Lavaca, TX 77979 All bids must be delivered to the Office of the Calhoun County Judge in a sealed 9 x 12 or larger envelope and clearly marked on the outside of the envelope, or the UPS/FedEx/other Delivery Service envelope: Sealed Bid — Bid Number 2024.08 - Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182. Sealed Bids consisting of one (1) USB flash drive and one (1) original and four (4) printed copies of the complete bid and required forms are DUE BEFORE 2:00:00 PM local time, TUESDAY JULY 2, 2024 in the County Judge's office, Calhoun County Courthouse, 211 South Ann Street, 3'" Floor, Suite 301, Port Lavaca, Texas. At this time, all bids will be publicly opened and read aloud in the conference room located in the County Judge's office. It is the responsibility of the submitting bidder to ensure that their sealed bid is received in a timely manner. Calhoun County does not accept faxed or emailed bids. Calhoun County accepts no financial responsibility for any cost incurred by any bidder in the course of responding to the bid. Bids received after the date and time the bids are due will not be accepted and will be returned unopened, regardless of whether or not the delay was outside of the control of the submitting bidder. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the 2:00:00 pm deadline. Bidders must submit with their bid a bid bond, issued by an acceptable surety, or a certified check, payable to Calhoun County, in the amount of not less than five percent (5%) of the total bid submitted. Bids submitted without the required security will not be considered. All contractors and subcontractors must be cleared (not suspended or debarred) prior to any formal action authorizing the award of a contract to the contractor and for the duration of the project. INSTRUCTIONS TO BIDDERS FOR CONSTRUCTION The project to be constructed will be financed with assistance from the General Land Office (GLO) under the U.S. Department of Housing and Urban Development Community Development Block Grant - Mitigation (CDBG-MIT) program and is subject to all applicable Federal and State laws and regulations. Calhoun County is the subrecipient of the grant funding and is hereby referred to as "County". Use of Separate Bid Forms These contract documents include a complete set of bid and contract forms which are for the convenience of the bidders and are not to be detached from the contract document, completed or executed. Se arate bid forms are provided for Your use. 2. Interpretations or Addenda No oral interpretations will be made to any bidder, All questions about the meaning or intent of the Bidding Documents are to be submitted to the ENGINEER IN WRITING and must be received in the office of the ENGINEER no later than 5:00 pm June 7 2024. Such questions may be submitted on www.CivcastUSA.com Questions and Answers (Q&A). It is the Bidder's responsibility to verify receipt of such questions by the ENGINEER. Interpretations or clarifications considered necessary by ENGINEER in response to such questions will be issued by Addenda and distributed via CivCastUSA to all plan holders. Addenda may also be issued to modify the Bidding Documents as deemed advisable by OWNER or ENGINEER. Any oral and other interpretations or clarifications provided by ENGINEER or OWNER at the pre -bid meeting will be without legal effect until a formal written Addenda is issued by ENGINEER. 3. Inspection of Site Each bidder should visit the site of the proposed work and should become acquainted with the existing conditions and facilities, the difficulties and restrictions pertaining to the performance of the contract. The bidder should thoroughly examine and become familiar with the drawings, technical specifications and all other contract documents. The contractor by the execution of the contract shall in no way be relieved of any obligation under it due to failure to receive or examine any form or legal document or to visit the site or the conditions existing at the site. The County will be justified in rejecting any claim based on lack of inspection of the site prior to the bid. 4. Alternate bid items No alternate bids or bid items will be considered unless they are specifically requested by the technical specifications. Bids a. All bids must be submitted on the forms provided and are subject to all requirements of the Contract Documents, including the Drawings. b. All bids must be regular in every respect and no interlineation, excisions or special conditions may be made or included by the bidder. 10. Corrections: Erasures or other corrections in the bid must be noted over the signature of the bidder. 11. Time for Receiving Bids a. Bids received prior to the advertised hour of opening shall be kept securely sealed. The officer appointed to open the bids shall decide when the specified time has arrived and no bid received thereafter will be considered. 12. Submission of Bids a. All bids must be sealed in a 9 x 12 or larger envelope & clearly marked on the outside of the envelope, or the UPS/FedEx/other Delivery Service envelope: Sealed Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-C182. b. Bids shall consist of one (1) USB flash drive, one (1) original and four (4) printed copies of the complete bid and required forms which are Due Before 2:00:00 pm, Tuesday, July 2, 2024. C. Sealed Bids must be hand delivered or mailed to: Honorable Richard H. Meyer, County Judge Calhoun County Courthouse 211 South Ann Street 3ro Floor, Suite 301 Port Lavaca, TX 77979 d. It is the responsibility of the submitting bidder to ensure that their sealed bid is received in a timely manner. Calhoun County does not accept faxed or emailed bids. Calhoun County accepts no financial responsibility for any cost incurred by any bidder in the course of responding to the bid. Bids received after the date and time the bids are due will not be accepted and will be returned unopened, regardless of whether or not the delay was outside of the control of the submitting bidder. e. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative will be the official clock that shall be used in determining the time the bid is received and the 2:00:00 pm deadline. 13. Opening of Bids The County shall, at the time and place fixed for the opening of bids, open each bid and publicly read it aloud, irrespective of any irregularities therein. Bidders and other interested individuals may be present. 14. Withdrawal of Bids Bidder may withdraw the bid before the time fixed for the opening of bids, by communicating its purpose in writing to the County. Upon receipt of such notice, the unopened bid will be returned to the bidder. The bid guaranty of any bidder withdrawing his bid will be returned promptly. 15. Award of Contract/Reiection of Bids a. The contract will be awarded to the responsive, responsible Bidder submitting the lowest/best bid. The bidder selected will be notified at the earliest possible date. The County reserves the right to reject any or all bids and to waive any informality in bids received where such rejection or waiver is in its interest. Equal Opportunity Guidelines for Construction Contractors Note: To be included in bid packet and distributed at the preconstruction conference (optional) 1. What are the responsibilities of the offeror or bidder to ensure equal employment opportunity? For contracts over $ 10,000, the offeror or bidder must comply with the "Equal Opportunity Clause" and the "Standard Federal Equal Opportunity Construction Contract Specifications." 2. Are construction contractors required to ensure a legal working environment for all employees? Yes, it is the construction contractor's responsibility to provide an environment free of harassment, intimidation, and coercion to all employees and to notify all foremen and supervisors to carry out this obligation, with specific attention to minority or female individuals. 3. To alleviate developing separate facilities for men and women on all sites, can a construction contractor place all women employees on one site? No, two or more women should be assigned to each site when possible. 4. Are construction contractors required to make special outreach efforts to Section 3 or minority and female recruitment sources? Yes, construction contractors must establish a current list of Section 3, minority and female recruitment sources. Notification of employment opportunities, including the availability of on-the-job training and apprenticeship programs, should be given to these sources. The efforts of the construction contractors should be kept in file. 5. Should records be maintained on the number of Section 3 residents, minority and females applying for positions with construction contractors? Yes, records must be maintained to include a current list of names, addresses and telephone numbers of all Section 3, minority and female applicants. The documentation should also include the results of the applications submitted. 6. What happens if a woman or minority is sent to the union by the Contractor and is not referred back to the Contractor for employment? If the unions impede the construction contractor's responsibility to provide equal employment opportunity, a written notice should be submitted to GLO. 7. What efforts are made by construction contractors to create entry-level positions for Section 3 residents, women and minorities? Construction contractors are required to develop on-the-job training programs, or participate in training programs, especially those funded by the Department of Labor, to create positions for Section 3 residents, women and minorities and to meet employment needs. 8. Are any efforts made by the Contractor to publicize their Equal Employment Opportunity (EEO) policy? Yes, the construction contractor is responsible for notifying unions and sources of training programs of their equal employment opportunity policy. Unions should be requested to cooperate in the effort of equal opportunity. The policy should be included in any appropriate manuals, or collective bargaining agreements. The construction contractor is encouraged to publicize the equal employment opportunity policy in the company newspaper and annual report. The Contractor is also responsible to include the EEO policy in all media advertisement. 9. Are any in-service training programs provided for staff to update the EEO policy? At least annually a review of the EEO policy and the affirmative action obligations are required of all personnel employees of a decision -making status. A record of the meeting including date, time, location, persons present, subject matter discussed, and disposition of the subject matter should be maintained. 10. What recruitment efforts are made for Section 3 residents, minorities and women? The construction contractor must notify, both orally and in writing, Section 3, minority and female recruitment sources one month prior to the date of acceptance for apprenticeship or other training programs. CALHOUN COUNTY SECTION 3 POLICY As officers and representatives of Calhoun County, we the undersigned have read and fully agree to this plan and become a party to the full implementation of the plan. Approved this 171' day of February 2021. f Richard H. Meyer, C&6ty Judge Calhoun County Commissioner, Pct. Vern Lys Calhoun County Commissioner, Pct. 2 7oe1v' s Gary Rees Calhoun County Commissioner, Pct. 3 Calhoun Cou ty Commissioner, Pct. 9 Attest: Anna Goodman, County Clerk By: Deputy Clerk BID SCHEDULE PROJECT NAME: BID NO. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182 DUE DATE: JULY 2, 2024 BEFORE 2:00:00 P.M. BIDDER NAME: Playground Solutions of Texas Inc BASE WORK SCOPE: The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. Item# ITEM DESCRIPTION ITEM UNIT BID QUANTITY UNIT PRICE TOTAL BID PRICE 1 MOBILIZATION, INSURANCE AND BONDS PER PLANS AND SPECIFICATIONS LS 1 $10,500.00 $10,500.00 2 TEMPORARY PROJECT SIGNAGE PER LS 1 $1,800.o0 $1,800.00 PLANS AND SPECIFICATIONS DEMOLITION OF ENGINEERED WOOD 3 FIBER (EWF) (APPDX. 12" THICK) AND TRANSFER TO AREAS WITHIN PARK PER SF 7,575 .92 $6,989.25 PLANS AND SPECIFICATIONS. TYPE D, CRUSHED LIMESTONE, 8.5" 4 THICK AFTER COMPACTED IN PLACE TO 95%COMPLETE IN PLACE PER PLANS SF 7,575 $6.67 $50,525.25 AND SPECIFICATIONS GEO-GRID OR GEO-FABRIC INSTALLED 5 ON TOP OF BASE MATERIAL COMPLETE SF 7,575 .21 $1,620.00 IN PLACE PER PLANS AND SPECIFICATIONS RUBBER SURFACING 3.5" THICK 6 COMPLETE IN PLACE PER PLANS AND SF 7,575 $22.46 $170,134.50 SPECIFICATIONS NEW PLAYGROUND STRUCTURE(S) MEETING THE MINIMUM REQUIREMENTS AS SET FORTH IN THE PLANS AND SPECIFICATIONS AND WITHIN THE AREAS LISTED. THIS 7 INCLUDES A SUPER STRUCTURE, SWING LS 1 $419,797.83 $419,797.83 SET, MERRY-GO-ROUND, STEM PLAY, ELECTRONIC GAME AND MUSIC PLAY. CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT PACKAGE REQUIRED. TWO -POST HIP SHADE STRUCTURE (15' X 22' X 10') CORRISION RESISTANT PACKAGE REQUIRED AND WIND 8 RESISTANT PACKAGE REQUIRED. LEA2 $12,238.02 $24,476.04 INCLUDES CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION, SINGLE -POST SQSHADE STRUCTURE (16') CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT 9 PACKAGE REQUIRED, INCLUDES EA 1 $14,092.26 $14,092.26 CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. TOTAL BASE BID 5699,935.13 *Submission ofa hid rah with"Ciarificati..,.••,.r •m.._i.._:__-„__�,____. ... _. _. -- --• •••--••-• � dnwot any other slipmauons will not be accepted. It shall be the bidder's responsibility to provide a complete bid and ask any questions necessary to clarify any bid items or relevant concerns within the questions period. **The award will be based on the BASE BID and the Owner reserves the right to determine the most advantageous and best bid for the project. ***The Calhoun County Commissioners Court shall be the sole judge in determining which bid will be the most advantageous to Calhoun County. a G , 1 r pA,,jl 5 n spy �yf � • � Il" d�Ii •, A � � � f ! 02 uj 1Y 1 r r './ zz fin A& �kr e Oarr r tl t 9: °1 J a' 4 uu yr... m 3 In a v rn u 0 m mou V C 7 O L R a O R m d m co o F s a V � a v J P� N 91::.N'3tiAAL`d. / \ 2 J .� a .� m 2 �( § ( ` G�� § / \ --------------------------------- xl'VDVAVI iaod ONnO89AVId nOAV8 31VIO00H0 31llil ® o w ,D"a W Z X i m n oK io tiX a w m 6Xi Fs a a§m a H Z S X J S O a o w in m LL s 9 0 IL TIM--, r , I 1 1 1 i / f 5 a User Count Versus Capacity There is no official regulation to guide playground manufacturers in determining the number of users for each piece of playground equipment. Playworld calculates our number of users mindful of the number of kids who get actual play value, not just fit on the playground. The images below help show this difference. These were from a previous project where manufacturers submitted apples -to -apples designs. On the same playground, Playworld determined a user count of 171 whereas another manufacturer notated 254 users — an 83 count difference. In the first image, the white figures illustrate the 171 Playworld users. In the second image, the pink figures illustrate the additional 83 users that the other manufacturer accounted for. Let Kids Play! Because every child deserves to play June 25, 2024 Dear Playground Planner, Let Kids Play has carefully reviewed the playground design for Little Chocolate Bayou Playground, utilizing the principles laid out in the Inclusive Play Design Guide. I have outlined the inclusive attributes of this playground design for your benefit. This design meets the following top criteria that we look for in an inclusive design: Top Level Requirements • Include Sensory, Physical & Social Activities on the playground to create a rich environment for everyone. • Ensure multiple levels of challenge within each activity • Divide the space into zones • Has unitary surfacing • Has an orientation path Physical, Social, and Sensory This design does a great job of providing various physical, social, and sensory experiences. Physical Activities The Inclusive Play Design Guide recommends eight different types of physical play, and this design provides opportunities for all of them. There is spinning, sliding, rocking, jumping, swinging, climbing/strengthening/crawling, balancing, and "walking, running, and rolling." Sensory Activities There are seven different sensory systems, and we like to see five of them represented in an inclusive playground. We do not look for taste or smell in our reviews. This playground design incorporates the other five sensory systems: vestibular, proprioceptive, tactile, visual, and auditory. Attached is a list of what equipment in the design engages in what sensory system. 1 1 P a g e Other Inclusive Features 1. There are wide wheelchair access routes throughout the layout. 2. To support a child with autism, cozy spaces, cooperative play opportunities, opportunities to experience vestibular motion, and equipment that offers auditory experiences are crucial. This design meets all of these criteria. 3. To support a child who uses a wheelchair, there must be activities that put them in the middle of the play. This design meets this criteria. 4. Unitary surfacing is the number one requested element by parents with a child using a mobility device. With unitary surfacing, children can access the play elements easily. Recommendations 1. Consider adding a fence around the playground. Families with autistic children and families with multiple young children often will not visit playgrounds that do not have fences. 2. Add a spinning activity that will provide a level 2 and 3 challenge. My recommendations are The Double Decker Cone Spinner or the Unity SpinR. On the following pages, you will find descriptions of the top inclusive equipment in your design, a list of equipment sorted by sensory systems, and a range of challenges. On behalf of families who are raising children with disabilities, I would like to thank you for your commitment to inclusive play. Respectfully submitted, Mara Kaplan Let Kids Play! 412-334-2652 www.letkidsplay.com mara@letkidsplay.com 31Page Multiple Range of Challenge What does each level represent? Level 1: Provides the most support Level 2: Provides some support Level 3: Provides no support and requires motor play skills For more information on what each level means, see pages 50-51 of the Inclusive Play Design Guide. Range of Challenge Spinning Swinging Belt Seat 4D Rope Basket Swing Balancing Unity Stepper Climbing. Crawling, Strengthening Bambino Unity Stepper PlayCubes Transfer Station with Barriers Balancing Unity Stepper Climbing/Crawling/Strengthenin Beanstalk Climber Climbing Squares Block Climber Gator Climber P IayCu bes Playwood Climber Poly Climber Quito Rock Climber Silo Climber Solar Climber Steel Curve Climber ge Let Kids Play! Because every child deserves to play Equipment by Sensory Systems " 0 Sensory integration is the neurological process that organizes sensation from one's own body and the environment and makes it possible to use the body effectively within the environment. Sensory processing is the brain receiving, interpreting, and organizing input from all of the active senses at any given moment. Sensory Processing Disorder (SPD) SPD is a condition that exists when sensory signals don't get organized into appropriate responses. A person with SPD finds it difficult to process information received through the senses, which makes performing everyday tasks challenging. Because of motor clumsiness, social anxiety, auditory and visual disturbances, and balance and performance problems, SPD can make simple "play" difficult. Sensory Systems: These are part of the nervous system responsible for processing sensory information. A sensory system consists of sensory receptors, neural pathways, and parts of the brain involved in sensory perception TACTILE Touch is a perception resulting from activation of neural receptors, and a variety of pressure receptors respond to variations in pressure The system works when activity in a sensory receptor is triggered by a specific stimulus; this signal eventually passes to an area in the brain uniquely attributed to that area on the body and this allows the processed stimulus to be felt at the correct location. Equipment that enables children to engage the tactile system: • Cozy Cocoon • Climbing Squares Block Climber • Rhythm Spinner • Animal Tunes Panel AUDITORY Hearing is the ability to perceive sound by detecting vibrations, changes in the pressure of the surrounding medium through time, through an organ such as the ear. Auditory processing relies on how the brain interprets, recognizes and differentiates sound stimuli. • Bell Panel • Rhythm Spinner • Animal Tunes Panel • Concerto Congas • Concerto Vibes • Quito PROPRIOCEPTIVE Proprioception is the sense of the relative position of neighboring parts of the body and strength of effort being employed in movement. This sense is very important as it lets us know exactly where our body parts are, how we are positioned in space and to plan our movements. Examples of our proprioception in practice include being j able to clap our hands together with our eyes closed, write with a pencil and apply with correct pressure, and navigate through a narrow space. Equipment that enables children to engage the proprioceptive system: • Beanstalk Climber • Climbing Squares Block Climber • Gator Climber • PlayCubes • Playwood Climber • Poly Climber • Quito • Rock Climber • Silo Climber • Solar Climber • Steel Curve Climber • Unity Stepper • Transfer Station w/Barrier References: Playworld's Inclusive Play Design Guide 7 Senses Foundation Play and Playground Encyclopedia VESTIBULAR Explains the perception of our body in relation to gravity, movement and balance. The vestibular system is a unifying system. Equipment that enables children to engage the vestibular system: • Spin Cup • Cozy Cocoon • Trippple Racer Slide • Round Tube Slide • Mighty Descent • Rope Basket Swing • Belt Seat • Infant Seat • Accessible Swing Seat • Sling Seat • Aeroglider • Stationary Buttons • Unity Stepper VISUAL Sight or vision is the capability of the eyes to focus and detect images of visible light and generate electrical nerve impulses for varying colors, hues, and brightness. Visual perception is how the brain processes these impulses recognizing, differentiating and interpreting visual stimuli through comparison with experiences made earlier in life. Equipment that enables children to engage the visual system: • Scavenger Hunt Panel • Playwood Telescope • Quito Strong, durable and secure. • Durable rotomolded seat. • Rollercoaster-style harness -- easy to install and snap -locks into place for security. • No complicated belts, buckles, or straps. • Galvanized chains for maximum visibility and safety. • Choose 2 plastic colors. Page 7 of 7 Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 PlayExplorers.com rtay s1 rers DY PLAYWOPLD Materials: Sheet goods - HDPE Clamps - Aluminum Die Cast and powered coated Hardware -18-8 grade stainless steel tamper proof Hypnotize Insert— 3/16" screen printed polycarbonate Funhouse insert - 1/4" mirrored polycarbonate Very Buried Insert - Polycarbonate A-Maze-ing Insert - 3/16" Polycarbonate and Stainless Steel ball bearings Four -the -Win Insert - LLDPE CAPS Magical Music Insert - Stainless Steel interface buttons Slide and Solve Insert - 3/16" Polycarbonate Description Item Number Ages Space Required Size ground level Frame ZZPM4672 2-12 42'x44" 42'x44'x.75` (1,O6mx1,11m) (1,06mxl,llmx,02m) Deck laved Frame ZZPM4671 2-12 42"x44" 42'x44'x75' (1,06m x 1,11 m) (1,06m x 1,11 in x,02m) Gouno level Frame ZZCH4672 2-12 31"x44' 31"x44'X.75' gli x 1,11m) (078m x 1,11 m x(12m) Deck level Fame ZZCH4671 2-12 31'x44" 31"x44'x.75" (078mx1,11m) (0,78mxl,11mx,02m) Hymog7e linen ZZUN4674 212 24"x24' 24'x24'x3.5` (0,6m x 0.6m) (0,6m x 0,6m xp9m) Funhouselnsen ZZUN4675 2-12 24'x24' 24"x24"x3.5" login x0,em) (0,6m x 0.6m x,O9m) very Buried linen ZZUN4677 2-12 24"x24" 24"x24'x3.5' (0.6m x 08m) (q6m xg6m x,09m) A-Maze-Ing Insert ZZUN4673 2-12 24"x24" 24'x24'x3.5" (gfim x0.6m) (0.6mx0,6mx,09m) Four -The -Win Insert ZZUN4676 2-12 24"x24" 24'x24'0.5' (gfim x q6m) (O,6m x O.6m x,09m) Magical Music Insert ZZUN4679 2-12 24'x24' 24'x24"x3.5" (0,6m x 0,fim) (0,6m x 0,6m x,09m) Slide & Solve Ideal ZZUN467B 2-12 24"x24" 24"x24',3.5' (O.6m x 0,6m) (0,6m x 0,6m x,09m) `CSA and EN compliant versions available. See your Playworle represemagve for mom information Child Install Fall Height Play Evems Capacity Noun Weight NA 1 1 43.5 As (NA) (19,5kg) NA 1 1 42.5 Ibs (NA) ON) NA 1 1 31 - Ibs (NA) (14kg) NA 1 30 Ibs (NA) (13.61,9) NA 1 1 0.5 13.1 Its (NA) (5 of NA 1 1 0.5 20.3 the (NA) (9.2kg) NA 1 1 05 18 Ibs (NA) (Cl cut NA 1 1 0.5 13.3 his (NA) (6kg) NA 1 1 0.5 13.7 Ibs (NA) (6.2kg) NA 1 1 0.5 30 Its (NA) (136kg) NA 1 1 g5 16.5 Ibs (NA) (7.4n) Page 2 of 2 Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld.com - � PLAYWORLD The world needs elav: Inclusive play "ride" will be the talk of the town! Inclusive play component for a new or existing playground. Focal point of playground. Wheelchair accessible. Provides gentle rocking/gliding movement for everyone. Exterior: • Sleek, aerodynamic design screams action and fun! • Unique textured stepping platform on both ends provides an opportunity for more kids to play, increasing the swaying fun. • Back high rails allow adults to help guide and participate in the fun! Interior: • Full 5' (1,52m) wheelchair turning radius, which is ADA compliant. • Enough room for two wheelchair users to sit side -by -side. • Couches are located on each end for children and adults to enjoy the ride. • Table features comfort grip hand holds for added safety. Page l of Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 Playworld.com '*4-%— PLAYWORLD The world needs play: 5 Congas Vibes 3 Congas Let all kids play in perfect harmony. tel t 2 Congas Large Cabasa Medium Cabasa Small Cabasa The Concerto line of outdoor musical equipment allows children of all abilities to experience the joy and benefits of making music. Designed at a more accessible angle and height, these instruments can be played comfortably by all kids, including those with mobility devices. Both the Vibes and Chimes are tuned on a diatonic scale, which means that kids can achieve more accurate musical notes and learn to play real songs. Each has good sustain when struck with the attached rubber mallets, immersing children in sensory stimulation from the vibrations. Concerto Cabasas produce a metallic rattle as they spin, ranging in frequency depending upon drum size. Kids will keep the rhythm as others join in on the Congas, which differ in diameter and length to give each one a unique tone. Weldments Galvanized 1/8" steel plates; 1-5/16" OD 14-gauge & 1" oval 15-gauge steel tubing - All Components Plastic Panels 1/2" and 3/4" HDPE (high -density polyethylene) sheets - Cabasas - Vibes Hardware 18-8 Stainless Steel, Tamper resistant - All Components Coating Super durable, electrostatically applied powder coat - All Components Steel posts 5.00" OD x 11 gage galvanized steel tubing - Bongo post, 3.50" OD x 13 gage galvanized steel tubing - Chimes frame - Vibes post - Cabasas post Aluminum 6063 Aluminum - Chimes Congas ABS plastic Concerto installation requirements: Chimes and Vibes must be Installed OUTSIDE of the playground area in regions that follow CSA certification. This is in order to meet playground compliance since there are several issues with the instruments using mallets that will not meet the guidelines Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld.com %%ib-pLAyWORLD The world needs play: Environmentally friendly KPE products run entirely on the charge kids give them when they spin, push, and press music and sound effect wheels and buttons. KPE products are out -of -the -box ready with no wiring required. KPE consists of 4 unique electronic products: Rhythm Spinner, Animal Tunes, Drive -Away, and Nature Sounds! The epitome of "green" energy, these panels derive their power from the motion of the children playing with them. KPE brings affordable technology to new or existing playgrounds and is designed for children ages 2 to 12. Animal Tunes Full Panel Page 1 of 5 Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld.com ""`#-%-PLAYWORLD The world ... a. e, Spin the knob to power -up and play 10 different pieces of music. Hit the drum pads to play your own music along with one of the pre-recorded songs. A two -second recording feature allows children to talk, sing and shout into the microphone; their modified voice will play back when they hit the drum pads. Spin the knob in the reverse direction to change songs. Rhythm Spinner's open-ended play encourages imaginations to grow! Rhythm Spinner Half Pane/ Rhythm Spinner Freestanding • Inspires creative and cooperative play • Encourages imaginative play and growth through discovery • Promotes cause & effect play: the reward is music and sound effects • Out -of -the -box -ready; no additional wiring is required • Available in any of Playworld colors • Can be incorporated into a larger playground or as a freestanding event • Epitome of "green" energy • Electronic experience • ADA Accessible • Designed for children ages 2-12 Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld.com �PLAYWORLD The w rld needs play' Choose your vehicle, grab the steering wheel and you're off! Jump in the car, hop on a train, climb into a firetruck, board the boat or blast off in the spaceship! The Drive -Away panel encourages imaginative play with interaction and sound effects that correspond with each vehicle. The panel is charged with each turn of the steering wheel. Other sound effects include a radio, security alarm, horn and ignition. • Features a back panel depicting the front-end of a rotomolded car • Encourages imaginative play and growth through discovery • Promotes cause & effect play: the reward is music and sound effects Out -of -the -box -ready; no additional wiring is required Available in any of Playworld colors • Can be incorporated into a larger playground or as a freestanding event _._ Drive -Away •Epitome of "green" energy Freestanding • Electronic experience • ADA Accessible Designed for children ages 2-12 Lewisburg, PA 1 800.233,8404 +1.570.522.9800 1 Playworld.com pLAYWORLD PLAYCUBESO SENSORY PACKAGES Bristle Brush Ball Spin Inspire kids to explore the world around them! Each of our sensory additions features a new way for kids to strengthen their tactile, auditory, and visual senses as well as build their fine motor skills. These pieces add an extra touch of play to plastic PlayCubes structures, giving you an easy way to update or expand your community's play opportunities without increasing its footprint. Two PlayCubes Sensory Packages are available; one with Ball Spin, Bristle Brush, and Spiral Spin, and another with Embossed Spin, Hammered Spin, and Clicker Press. Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld.com %,%-pLAYWORLD ON The world needs play.' 21 PLAYCUBES° SENSORY PACKAGES CONTINUE. PLAYCUBES® SENSORY BASE INSERTS Sensory Base Inserts maybe used as replacements for your standard PlayCubes floor. DISCOVERY BASE This engaging insert gives kids a new window into the world around them! The center casting features holes of varying sizes for kids to look through. Flextread—sandwiched between two castings with zigzags, curves, and bumps —offers further tactile engagement around the edges. Color of the castings may be chosen from a variety of options. TEXTURED BASE Textured casting featuring bumps, waves, and scales encourages kids to explore as they trace their fingertips or press their palm against each pattern. Color may be chosen from a variety of options. PRODUCT ITEM WEIGHT `1s InIill Panel ZZUN8721 13lbs (6 kg) Sensory K8#1 ZMN8722 7Its (3 kg). Sensory Kit#2 ZZUN8723 61ins (3 kg) TexMred Base ZZUN8724 7lbs (3 kg) Discovery Base ZZUN0725 7Its (3 kg) Mighty Descent to PlayCubes° ZZUN8739 907Its (412 kg) Mighty Descentlo PlayCubese(41n SM) ZZUN8739SD 927 he(421 kg) Mighty Descelnwith Pliant Pass to PlayCubesv. ZZUN6741 12271bs (657 kg) Mighty Descent with fart Prieto PlayCubes'(4in SM) ZZUN87418D 1258 its(571 kg) Extension Support Post- 4 Cuba High. ZZUN8742 951bs ,(44 kg) Extension Sui Post- 4 Cube High(41n SM) ZZUN8742S0 891bs(41 kg) Wension Support Post- 4 Cube High (41n SM) (EN) ZZUN07435D 89Its (41 kg) Mighty Descent to PlayCubes° (EN) ZZUN8751 9071bs (411 kg) Mighty DesceMto PlayCubese(4in SM)(EN) ZZUN8751SD 936Its (425 kg) Mighty Descent With Push Pass to PlayCubes (EN) ZZUNB752 1227Its (557 kg) Mighty Descent with Pdsm Pass to PlayCubes°(41N SM)(EN) ZZUN875280— 1268 Its 1576 kg) Page 3 of 3 Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld.com "'ll,*-PLAYWORLD The world needs play: QUITO TM Quito (pronounced KEE-toe) is a freestanding net climber that takes kids on a journey to the center of the web. Inspired by Quito, Ecuador's capital city closest to the equator and the world's second -highest official capital city, Quito stands a towering 1 5.54'(4,74m) high. Its daring, distinctive design offers a commanding, compelling playground presence. Children will feel like geometric spelunkers as they climb, balance, and teeter their way in, over, and through the colorful center. With multiple points of entry, Quito includes an easy passage to the center, as well as a cozy space underneath. Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 I Playworld.com — %,"b— PLAYWORLD The world needs play' OUITO TM GORE DETAILS PRODUCT ITEM SPACE REQUIRED SIZE INSTALL HOURS WEIGHT USERS' ee = Quito'(Tile/Pourin Place Surtacing) ZM1123 31'Vx32'Y 19'5"x2C7'x15'6" 96 43271Lis (1962 kg) 56 (9,47m x 9,83m) (5,92m x 6,26m x 4,74m) Glii-ocse Fill Surfacing) ZWl124 31'1"x321" 19'5"x207'x 15'6" 96 4393 lbs(1992 kg) 56 (9,47m x9,83m) (5,92mx6,26mx4,74m) Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld.com �pLA`+vwWORLD The world needs Play.' RUST DEFENDER THE RUST DEFENDER PROCESS SUSTAINABILITY AND DURABILITY Developed after years of research, the Rust Defender Process is a complete system that helps to prevent the formation of rust on our products that feature steel and welds. The result of this rust prevention system is a product that is not only resistant to corrosion, but also prevents gloss and color fading over time, ensuring that it will look great for years to come. 1. STEEL TUBING Cold -formed, high -frequency weld tubing is manufactured from ASTM A570, Grade -A steel for superior strength. 2. INNER COATING Zinc -rich organic coating prevents the formation of red rust on the inside of the tubing. 3. LEAD-FREE ZINC GALVANIZING Zinc galvanizing keeps rust from creeping under the powder -coated surface should it become scratched or scuffed. 4. CONVERSION COATING This coating is applied to prevent the formation of oxidation (white rust). 5. CLEAR ORGANIC COATING This additional barrier prevents corrosion and creates a uniform surface for the application of powder coating, providing a smooth and shiny surface. S. EPDXY/POLYESTER PRIMER Weld areas and flat plates are coated with a specially formulated epoxy/polyester primer to encapsulate the weld area, deterring the formation of corrosion. This primer is identical to the primer that is used on heavy construction equipment. Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 7. SUPER DURABLE POLYESTER POWDER COATING Our powder coating is completely lead-free and has been tested for 3,000 hours of UV exposure to meet the demand of the harsh tropical sun. 8. TUMBLED EDGES All edges on flat sheet plates are rounded to provide a smooth, clean surface for the application of powder coating and to prevent edge rusting. These rounded edges, created by our 3600 tumbling process, also remove the possibility of sharp edges that might lead to injury. 9. ALUMINUM POST CAPS Our post caps seal the system, further preventing the formation of rust. Unlike steel (which rusts) and plastic (which breaks), our caps are made from durable aluminum. 10. MAINTENANCE KIT It should be noted that routine maintenance is an additional and necessary part of the process. In order to prolong the lifespan of our products and keep them looking new, materials for maintenance are provided with each Challengers' and Playmakers` playsystem in order to address scratches, scuffs and vandalism. Playworld.com `. PL A ORLD /"`The world needs play: Features Climb in, swirl, rock, repeat The Swirl Saucer encourages imaginative play and cooperation among children of all ages. Children can climb in and pretend they are astronauts on a rocket in outer space or the captain of a pirate ship sailing the Atlantic Ocean. The possibilities are endless with the Swirl Saucer. The Swirl Saucer is accessible to children of all abilities making it a perfect addition to inclusive playgrounds. Description Item Number Swirl Saucer ZD710503 Materials: Coating - Powder -coated Steel Ages Space Required Size Fall Height Play Events Child Capacity Install Hours Weight 2-12 21 5"x21"5' 3'5"x3'5'x2'1' 2'11 3 3 170lbs (5,53m x 6 53m) (1,04m x 1,04m x 0,33m) (0,33m) (75hg) "GSA and EN compliant versions available. See your Playwodd apresentative for more Information. Page 1 of 1 Lewisburg, PA 1 800.233.8404 1 +1.570.522.9800 1 Playworld,com ^%,im-pLAYWORLD The world needs play: CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Playground Solutions of Texas, Inc. 2024-1182637 Southlake, TX United States Date Filed: 07/01/2024 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 be property to provided under the contract. 20-065-064-C182 Playground Equipment, Shade Systems, Surfacing 4 Name of Interested Parry City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Playground Solutions of Texas Southlake, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Hunter Barnard and my date of birth is My address is Houston TX 77007 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Harris County, State of Texas ,on the 1st day of JUIy 2024 (month) (year) J' g Signature of authorized agent of contracting business entity (Declarant) Fnrmc nrovirlad h Texas EthicsC y ommisslon Www.ethlcs.state.tx.us Version V4.1.0.d378aba0 LITTLE CHOCOLATE BAYOU PLAYGROUND Design Number: 24-14539A - Bill Of Material Ref. No. Part No. Description Quantity 40 ZZUN4793 CONSTRUCTION PANEL INSERT 1 Barriers 41 ZZPM4658 PLAYWOOD ACCESS GATES 2 42 ZZPM4659 PLAYWOOD WALL BARRIER 1 Climbers 43 ZZPM7086 CLIMBING SQUARES BLOCK CLIMBER (24in) 1 44 ZZPM7439 ROCK CLIMBER (48in DECK) 1 45 ZZPM7657 SOLAR CLIMBER (361n & 30in DECKS) 1 46 ZZPM7948 SILO CLIMBER (24in DECK) 1 47 ZZPM8100 BEANSTALK CLIMBER (36in DECK) 1 48 ZZPM8256 48in PLAYWOOD CLIMBER 1 49 ZZPM8338 STEEL CURVE CLIMBER(TRIPPPLE SLIDE) 1 50 ZZUN8727 PLAYCUBE- GROUND LEVEL 3 51 ZZUN8747 PLAYCUBES- ABOVE GROUND- 3 SIDED CONNECTION 1 52 ZZUN8761 POLY CLIMBER -SMALL 2 Balance 53 ZZUN7136 UNITY STEPPER - SMALL 7 54 ZZUN7137 UNITY STEPPER - MEDIUM 6 55 ZZUN7138 UNITY STEPPER - LARGE 1 56 ZZUN7140 STATIONARY BUTTONS (12in) 4 57 ZZUN7146 STATIONARY BUTTONS (18in) 3 58 ZZUN7147 STATIONARY BUTTONS (24in) 2 Roofs & Arches 59 ZZPM4714 17ft HEX HAT SHADE 3 60 ZZPM9698 16ft SHADE CANOPY 1 61 ZZPM9727 PM HEX HAT POST BRACES 2 Additional Tool & Maintenance Kits 62 ZZUN1471 INSTALLER HARDWARE KIT 1 63 ZZUN9930 PIPE SYSTEMS MAINTENANCE KIT W/ AEROSOL 1 64 ZZXX0678 LABEL KIT- COMPOSITE STRUCTURE - ASTM 1 65 ZZXXGNGUIC GENERAL INSTALLERS GUIDE 1 PLAyWORLD Friday, June 21, 2024 Page 2 of 2 Playworld.com i U v C IO N o E rlco d U v LL W m ❑ M N j rl c y N E L a E J O ❑ O z z a O N K Z Q 0 0 o O o O O o 0 0 o O O O ID O O O O O m O M O O O O O N O O O O O O O O O O O O .-i 0 0 0 0 0 0 O O 0 0 0 0 0 0 0 O G O O O O tV 0 0 0 0 0 0 o 0 O o o in 0 O 0 ui 0 o 0 o 0 O 0 O O o o O 0 O 0 o 0 0 0 0 o o 0 in 0 in 0 in o in O O ,n O .-I O O O N m M O O M v O 7 [D V- .+ 0 0 0 0 LD N co N m N .-i n n E u ti o d �2 m O N W O d• O O N I;rGo O O M N m T �D N M o � OJ O CO n N ID M Op N M OJ .+ 01 I� n O O V � 1 1� rl d• ,D .-i 7 m .ti d• .4 .4 Il n O m O N M Of � OJ d• ti 01 .�i N N O M O M M w .-i .ti .y ^ �p 3O`F D rl �..j �••� /1' N v v vw a v v vOja Lyy L'' l Lyy v ! 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N a W M E w0+� M N M 0 0 0 O N O m U y 0 0 0 0 06 0 C G Uj C V N .+ O U N O N Li O Lq O O O W 0 C O M O a O N 7 M N 0 0 0 0 O M F v1 N 7 y f N C rn lr1 n .-+ CY M I� O .-i N O. N M N w O^i 7 N m UO 0, u O m LL O Y y O O+ C n 7 0 y O O � C D M aE � U y a rn C N a Y O 7D dU u Go m a ce v ^ O) Y m n . M m rn m o 'y o 00 mmN" + � o N N y V O O .�� wE==a�caa as j Q y -E -yy Z E Z Z Z Z U U U U ate+ O E F- 49 3 o c c U � wp C N m V' V) H z U w v a I- z Z Z 9 W W OOO W>maz Lnm = ztn 4 m c ��¢��=w Ovz a " zzz=o=Wv~i�� o v a 0 0 0 Q �0 `' LL F Q Q f 2 W m z � O fn m .. .. a Z a s g C7 rn R" M Ln a C N E H U O .tea .�-i I� O n O Z Ep z O' n v m o+ .. rn Xo cX7 Z u m >> 7 C a a 7 X X a my my r� f� INV 'IMw o o^ ^ n n n n n o cz Q f m 991 �E v PLA`(13 UND S G► �U i 100NS OF TEXAS ISO Certified Playworld is proud to be ISO certified by SGS, the world's leading inspection, verification, testing, and certification company. ISO (International Organization for standardization) is an independent, international organization that develops and promotes market -relevant INTERNATIONAL IPEAA PLAY EQUIPMENT MANUFACTURERS ASSOCIATION MEMBER IPEMA Playworld is a founding member of the International Play Equipment Manufacturers Association (IPEMA), a member -driven organization whose mission is to assist in providing safe environments for children to play. In the interest of playground safety, IPMEA provides a third -party certification service, whereby a designated independent laboratory (TUV America) validates a participant's certification of conformance to the following standards: ASTMI Standard F1487: Standard Consumer Safety Performance Specification for Playground Equipment for Public Use CAN/CSA Z614: Guidelines on Children's Play Spaces and Equipment ASTM F1292: Standard Specification for Impact Attenuation Under and Around Playground Equipment. The use of the corresponding IPEMA certification logos signify that Playworld has received written validation from an independent laboratory that the products associated with the use of the logo conform with the requirements of the indicated standard. 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: July 1st, 2024 Bidder (Legal Name of Firm): Playground Solutions of Texas Inc. Date Organized: 06/11/2018 Name of Owner(s): Christina Jones Address: PO Box 92458 Southlake TX. 92458 Date Incorporated 06/11/18 Federal ID Number: 83-0845409 Number of Years in contracting business under present name 6 years List all other names under which your business has operated in the last 10 years: N/A Work Presently Under Contract: Contract Amount $ Completion Date Waxahachie ISO STEAM Elementary $273,840.00 10/01/2024 Assembly Park Plano TX $590,938.00 07/31/2024 City of Big Springs Comanche Trail Park $749,717.00 10/01/2024 Type of work performed by your company: Playground Equipment/Surfacing/Site Amenities/Installation Total Staff employed by Firm (Break down by Managers and Trades on separate sheet)7 8 Have you ever failed to complete any work awarded to ov u? dyes No X (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? ]Yes -, No X (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 X (If yes, list and ezplaln such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance): Project Amount $ Mo/Yr Completed The Church of the Cross Grapevine TX $251.000.00 05/01/2024 City Park Breckenridge TX 5350 227 00 04/01/2024 �elebree chi Dallas TX 180.308.14 04/15/2024 Major equipment available for this contract: Playworld Playgrounds -USA Shade Canopies - Vitriturf PIP Surfacing Are you in compliance with all applicable EEO requirements? :E X Yes No (If no, please attach summary of details on a separate sheet.)) (Optional) Minority Business Reporting Information: Owner's Race: Caucasian Owner's Ethnicity : White Owner's Gender: Female Are you a Section 3 business? (see below) ❑ Yes 2� No Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the County'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: 2300 Southlake Blvd Contact Name: _Celia Manilla City & State: Southlake TX Zip: _76092 Phone Number: 8171-3502 Credit available: $1250.000.00 Has the firm or predecessor firm been involved in a bankruptcy or reorganization? Res JJo X (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) years and brief explanation of claim and outcome. Attach resumes for the principal members) of your organization, including the officers as well as the proposed superintendent for the project. Hunter Barnard Sales Consultant Printed Name and Title Playground Solutions of Texas, Inc. Company Name Notary Statement: n f �1 Uvi4er PDar r being duly sworn, says that he/she is the��WS Cgvl Asrl�Position/Title of rI.Yj ero!n o vn fee 5 ihL (Firm Name), and hereby swears that the answers to the foregoing questions and all stateMents therein contained are true and correct. He/she hereby authorizes and requests any person, firm, or corporation to furnish any information requested by Calhoun County in verification of the recitals comprising this Statement of Bidder's Qualifications. Subscribed and sworn before me this day of Uc} i`I 202,14. Notary Public Erw�-;' xr °�MICHAEL N KOUTSANELLOS Signature +° Notary ID #133895141 n ^ I"n I ��r , r"^ n I �� My Commission Expires Ij (UI WG �I; L,lYvri August 5, 2026 Printed Name ? My Commission Expires: The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. Signed this 1st day of July 2024 Signature Hunter Barnard Sales Consultant Printed Name and Title Playground Solutions of Texas, Inc. Company Name Notary Statement: being duly sworn, says that a is the Position/Title of (Firm Name), and h swears that the answers to the foregoing questions and all statements therein contained are true and correct. He/ ereby authorizes and requests any person, firm, or corporation to furnish any information requested by Calhoun C in verification of the recitals comprising this Statement of Bidder's Qualifications. Subscribed and sworn before me this day of Notary Public Signature Printed Name My Commission Expires: The penalty for making false is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.leg is.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.0010-a): 'Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or tee 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; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (1) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code & 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or, (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission w W.ethics.state. tx.us Revised 11/30/2015 CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his/ her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within athree-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this celiification. d. Have not within athree-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. Hunter Barnard, Sales Consultant 07/01 /2024 Name and Title of Authorized Agent Date F ulan , i?a . �izdi Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. 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 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 repol i 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. See. 7. The Director of the Office of Management and Budget shall repoli to the President within three years of the date of this Order on Federal agency compliance with the Order, including the number of exceptions made under Section 2(c), and shall make recommendations as are appropriate further to curb fraud, waste, and abuse. Implementation in the SRF Programs A company or individual who is debarred or suspended cannot participate in primary and lower -tiered covered transactions. These transactions include SRF loans and contracts and subcontracts awarded with SRF loan funds. Under 40 C.F.R. 32.510, the SRF agency must submit a cel iification stating that it shall not knowingly enter into any transaction with a person who is proposed for debarment, suspended, declared ineligible, of voluntarily excluded from participation in the SRF program. This celtification is reviewed by the EPA regional office before the capitalization grant is awarded. A recipient of SRF assistance directly made available by capitalization grants must provide a certification that it will not knowingly enter into a contract with anyone who is ineligible under the regulations to principate in the project. Contractors on the project have to provide a similar certification prior to the award of a contract and subcontractors on the project have to provide the general contractor with the certification prior to the award of any subcontract. In addition to actions taken under 40 C.F.R. Part 32, there are a wide range of other sanctions that can render a party ineligible to participate in the SRF program. Lists of debarred, suspended and otherwise ineligible parties are maintained by the General Services Administration and should be checked by the SRF agency and all recipients of funds directly made available by capitalization grants to ensure the accuracy of cc iifications. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. STATE OF TEXAS {} AFFIDAVIT COUNTY OF u��jS {} 1y -cr PAward being first duly sworn, deposes and says: that he or she is �" (Type or Print Name) the �� hC� comes 1 ��C4N't of P� �i� r�� C�� (71%tS f �'J<Iti5 (nti , having its (Type or Print Title) r��1 'A(Ty1p`e or Print Name of Company/Firm) principal address at��Q L3DX 9LI q7J hsiA rN /tt(/ie, TY 9Z_q655- (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 rnnnprtion 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 a*ygquirements contained in the bid/proposal. nted 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 k' day of c)U kA 20i"—. SpA �CAbm TSANELL05 Signf N a P lic i n Notary ID tf133895141 My Commission Expires +for+ August 5, 2026 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Playground Solutions of Texas Inc PO Box 92458 Southlake TX, 76092 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. Yes X No The undersigned hereby certifies that: The Provision of Local Training Employment and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). The Eaual 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? Yes 0 X No NAME AND TITLE OF SIGNER (Please type) Hunter Barnard Sales Consultant SIGNATURE DATE DATE Y1 Ua24a� 07/01/2024 Instructions for Proposed Contracts Breakdown and Estimated Project Workforce Breakdown Proposed Contracts Breakdown Type of Contracts— list all construction, materials, or other types of subcontracts (for example: electrical, plumbing, concrete, boring, etc.) No. of Contracts — Number of contracts under this category Approximate Total Dollar Amount —Total amount of each contract Estimated No. to Local Business — Number of contracts awarded to local businesses and Section 3 businesses Estimated $ Amount to Local Business - How many dollars will be spent locally for each type of contract? For example: will you hire any local employees or subcontractors? Estimated Project Workforce Breakdown Work Classifications — Classification of project employees as defined on Wage Rate Total Estimated Positions — List the number employees for each work classification will you need on this project Number of Positions Currently Filled — List the number of estimated positions you currently have filled Number of Positions Not Filled — List the number of estimated positions you currently do not have filled Number of Positions to Fill with Low to Moderate Income (Section 3) Residents — List the number of local residents earning low to moderate incomes that you plan to employ to fill the estimated positions not filled Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program CERTIFICATION FOR BUSINESS CONCERNS Seeking Section 3 Preference in Contracting and Demonstration of Capability Economic Opportunities for Low and Very Low -Income Persons Grantee/Subrecipient: Contract Number: Date: CONTRACTOR INFORMATION Name of Business Address of Business Type of Business: ❑ Corporation ❑ Partnership ❑ Non -Profit ❑ Sole Proprietorship ❑ Joint Venture Consortium Attach the following documentation as evidence of Section 3 eligible status: (Definition of "Section 3 Business Concern' in 24 CFR 135 describes the three alternative qualifications.) For Business claiming status as a Section 3 resident -owned enterprise: ❑ Copy of resident lease ❑ Copy of receipt of public assistance ❑ Copy of evidence of participation in a public ❑ Other evidence assistance program For business entity as applicable: []Copy of Articles of Incorporation ❑ Assumed Business Name Certificate List of owners/stockholders and % ownership of each appointed officers ❑ Organization chart with names and titles and brief function statement ❑ Certificate of Good Standing ❑ Partnership Agreement ❑ Corporation Annual Report ❑ Latest Board minutes ❑ Additional documentation For business entity claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business(es): ❑ List of subcontracted Section 3 business(es) and subcontract amount For business claiming Section 3 status, by claiming at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employmentwith the business: ❑ List of all current full-time employees ❑ PHA/IHA Residential lease less than 3 years from day of employment ❑ List of employees claiming Section 3 status ❑ Other evidence of Section 3 status less than 3 years from date of employment Evidence of ability to perform successfully under the terms and conditions of the proposed contract: ❑ Current financial statement ❑ List of owned equipment ❑ List of all contracts for the past two years Authorized Name and Signature Attested By: ❑ Statement of ability to comply with public policy Date (Corporate Seal) 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. a. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 4040-0013. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (4040-0013), Washington, DC 20503 HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85th 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) Hunter Barnard , 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 Playground Solutions of Texas, Inc. Company Name YY aQiz� Hunter Barnard Signature of Authorized Official Sales Consultant Printed Name of Authorized Official 07/01 /2024 Title of Authorized Official Date We are thrilled for the opportunity to be your PARTNER in PLAY! Scan the QR Code below to view a virtual presentation of the project with 3D images, a fly- byvideo, product information, and more! • More Partners Policies • Terms of Use • Privacy Policy • Restricted Data Use • Freedom of Information Act • Accessibility Customer Service • Help • Check Entity Status • Federal Service Desk • External Resources • Contact 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 reproducing or disposing of this information a 07/01/2024 Information (CUI). All individuals viewing, re required to protect it in accordance with Insert System for Award Management (SAM) Record Search for company and company principal(s). Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principals are not listed (are not debarred) through the System for Award Management. KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, PLAYGROUND SOLUTIONS OF TEXAS INC. as PRINCIPAL, and LEXON INSURANCE COMPANY , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Local Public Agency", in the penal sum of Five Percent of Amount Bid Dollars, ($ 50% of 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 July 2 2024 . for BID NO. 2024.08 — INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT— GLO CONTRACT NO. 20- 066-064-C182 FOR CALHOUN COUNTY, TEXAS. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein afterthe 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 28th day of June 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. (SEAL) Attest: �IYIU4 4, ga,� Attest: J � (;� /'� C Attest ] J Countersigned a PLAYGROUND SOLUTIONS OF TEXAS, INC. (SEAL) Christina Jones, President/Owner Affix Corporate Seal By: LEXON INSURANCE COMPANY Affix r,orFbrate _ -Seal By: q9nCz1A .vim J nnifer Williams, Attorney -In -Fact SOMPO INTERNATIONAL POWER OF ATTORNEY �' 11118 KNOW ALL BY THESE PRESENTS, that Endurance Assurance Corporation, a Delaware corporation ("EAC"), Endurance American Insurance Company, a Delaware corporation ("EAIC"), Lexon Insurance Company, a Texas corporation ("LIC"), and/or Bond Safeguard Insurance Company, a South Dakota corporation ("BSIC"), each, a "Company" and collectively, "Sompo International," do hereby constitute and appoint: Susan A. Welsh, Sandra M. Winsted, Christina L. Sandoval, Judith A. Lucky- Eftfmov, Aerie Walton, Derek J. Elston, Jennifer Williams, Selena Wood, Eric D. Sauer, Bartlomiej Siepierski, Barbara Pannier, Rachel Fore, Kristin L. Hannigan, Samantha Chierici, Corinne Chapman, Jean Torres, Roger Paraison, Nicholas Kertesz, Dartonya Wright, Tara A. Maquinto, Richard Casa, Aaron D. Griffin, Therese M. Jackson, Robert Nachreiner as true and lawful Attorney(s)-In-Fact to make, execute, seal, and deliverfor, and on its behalf as surety or co -surety; bonds and undertakings given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating to such bonds or undertakings provided, however, that no single bond or undertaking so made, executed and delivered shall obligate the Company for any portion of the penal sum thereof in excess of the sum of One Hundred Million Dollars ($100,000,000.00). Such bonds and undertakings for said purposes, when duly executed by said attorneys) -in -fact, shall be binding upon the Company as fully and to the same extent as if signed by the President of the Company under its corporate seal attested by its Corporate Secretary. This appointment is made under and by authority of certain resolutions adopted by the board of directors of each Company by unanimous written consent effective the 301h day of March, 2023 for BSIC and LIC and the 17th day of May, 2023 for EAC and EAIC, a copy of which appears below under the heading entitled "Certificate". This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the board of directors of each Company by unanimous written consent effective the 30" day of March, 2023 for BSIC and LIC and the 17" day of May, 2023 for EAC and EAIC and said resolution has not since been revoked, amended or repealed: RESOLVED, that the signature of an individual named above and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached, IN WITNESS WHEREOF, each Company has caused this instrument to be signed by the following officers, and its corporate seal to be affixed this 25th day of May, 2023. Endurance Assurance Corporatio , By,�, Richard ADnel:.SVF,&,Senior Counsel Endurance American �. Ingurrce'Srippt}rlyj By. ,d;L%, ��f�� i.i� 4P,. Richard Aooel:.S+✓PRSenior Counsel Lexon Insurance Company Bond Safeguard mmviIurcCpar By: ByIn &, Lf Ric and Appel;ni C ._eunsel Ric Appel;,SVP&,$enir \CKNOWLEDGEMENT 'yam A 11. SOUTH DAKOTA * J _, p, INSURANCE COMPANY On this 25th day of May, 2023, before me, personally came the above signatories known to me, who being duly sworn, did depose and say that he/thaV$'I ttfugicer of each of the Companies; and that he executed said instrument on behalf of each Company by authority of his offi'Ta der th by we of each Company; s --.,.A oo, By: Amy ylor Not ublic MYCommissffn Expires 319/27,- CERTIFICATE ayy .•' Cap' I, the undersigned Officer of each Company, DO HEREBY CERTIFY that: 1. That the original power of attorney of which the foregoing is a copy was duly executed on behalf of each Company and has not since been revoked amended or modified; that the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the whole thereof; 2. The following are resolutions which were adopted by the board of directors of each Company by unanimous written consent effective 30'h day of March, 2023 for BSIC and LIC and the 171h day of May, 2023 for EAC and EAIC and said resolutions have not since been revoked, amended or modified: "RESOLVED, that each of the individuals named below is authorized to make, execute, seal and deliver for and on behalf of the Company any and all bonds, undertakings or obligations in surety or co -surety with others: RICHARD M. APPEL, MATTHEW E. CURRAN, MARGARET HYLAND, SHARON L. SIMS, CHRISTOPHER L. SPARRO, and be it further RESOLVED, that each of the individuals named above is authorized to appoint attorneys -in -fact for the purpose of making, executing, sealing and delivering bonds, undertakings or obligations in surety or co -surety for and on behalf of the Company." 3. The undersigned further certifies that the above resolutions are true and correct copies of the resolutions as so recorded and of the whole thereof. IN WITNESS. WHEREOF, I have hereunto set my hand and affixed the corporate seal this L day of f?a 1 - 20 . By: Daniel S. rie, e retary NOTICE: U. S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL lOFACI No coverage is provided by this Notice nor can it be construed to replace any provisions of any surety bond or other surety coverage provided. This Notice provides information concerning possible impact on your surety coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency'. OFAC has identified and listed numerous foreign agents, front organizations, terrorists, terrorist organizations, and narcotics traffickers as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's website — httos:l/www.trewuryaov/resource-center/sanctions/SDN-List. In accordance with OFAC regulations, if it is determined that you or any other person or entity claiming the benefits of any coverage has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, any coverage will he considered a blocked orfrozen contract and all provisions of any coverage provided are immediately subject to OFAC. When a surety bond or other farm of surety coverage is considered to be such a blocked or frozen contract, no :oaymentsnorpremium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments may also apply. Any reproductions are void. Surety Claims Submission: LexonClaimAdministrationPsompo-intl.com Telephone: 615-553-9500 Mailing Address: Sompo International; 22890 Lebanon Road; Mount Juliet, TN 37122-2870 PROJECT NAME: BID NO. 2024.08— Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20-065-064-C182 DUE DATE: JULY 2, 2024 BEFORE 2:00:00 P.M. BIDDER NAME: Kraftsman. LP dba Kraftsman Commercial Playgrounds and Water Parks BASE WORK SCOPE: The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. BASE BID Item # ITEM DESCRIPTION ITEM UNIT BID QUANTITY UNIT PRICE TOTAL BID PRICE 1 MOBILIZATION, INSURANCE AND BONDS LS 1 PER PLANS AND SPECIFICATIONS $44,092.99 $44,092.99 2 TEMPORARY PROJECTSIGNAGE PER LS 1 $1, 705. 97 $1,705.97 PLANSAND SPECIFICATIONS DEMOLITION OF ENGINEERED WOOD 3 FIBER (EWF)(APPDX.12"THICK) AND SF 7,575 $1.98 $14,998.50 TRANSFER TO AREAS WITHIN PARK PER PLANS AND SPECIFICATIONS. TYPE D, CRUSHED LIMESTONE, 8.5" 4 THICK AFTER COMPACTED IN PLACE TO SF 7,575 95% COMPLETE IN PLACE PER PLANS $11.50 $87,112.50 AND SPECIFICATIONS GEO-GRID OR GEO-FABRIC INSTALLED 5 ON TOP OF BASE MATERIAL COMPLETE SF 7,575 $0.39 $2,954.25 IN PLACE PER PLANS AND SPECIFICATIONS RUBBER SURFACING 3.5" THICK 6 COMPLETE IN PLACE PER PLANS AND SF 7,575 $26.65 $201,873.75 SPECIFICATIONS NEW PLAYGROUND STRUCTURE(S) MEETING THE MINIMUM REQUIREMENTS AS SET FORTH IN THE PLANS AND SPECIFICATIONS AND WITHIN THE AREAS LISTED. THIS 7 INCLUDES A SUPER STRUCTURE, SWING LS 1 SET, MERRY-GO-ROUND, STEM PLAY, $291,671.19 $291,671.19 ELECTRONIC GAME AND MUSIC PLAY. CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT PACKAGE REQUIRED. TWO -POST HIP SHADE STRUCTURE (15' X 22' X 10') CORRISION RESISTANT PACKAGE REQUIRED AND WIND 8 RESISTANT PACKAGE REQUIRED. EA 2 $19,005.60 $38,011.20 INCLUDES CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. SINGLE -POST SQ SHADE STRUCTURE (16') CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT 9 PACKAGE REQUIRED. INCLUDES EA 1 $16,440.34 $16,440.34 CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. TOTALBASE BID $698,860.69 ouamission or a wo tan with' ciantications" or" Exclusions' and/or any other stipulations will not be accepted. It shall be the bidder's responsibility to provide a complete bid and ask any questions necessary to clarify any bid items or relevant concerns within the questions period. "The award will be based on the BASE BID and the Owner reserves the right to determine the most advantageous and best bid for the project. """The Calhoun County Commissioners Court shall be the sole judge in determining which bid will be the most advantageous to Calhoun County. SPECIFICATION NOTES The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. The BIDDER, in compliance with the invitation for bids for Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project— GLO Contract No. 20-065-064-C182 for Calhoun County, Texas, having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies in accordance with the contract documents, within the time set forth herein. These price(s) are to cover all expenses incurred in performing the work required under the contract documents, of which this bid is a part. These price(s) are firm and shall not be subject to adjustment provided this bid is accepted within sixty (60) days after the time set for receipt of bids. BIDDER hereby agrees to commence work under this contract on or before a date to be specified in a written "Notice to Proceed" to be issued by the COUNTY and to substantially complete within consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $500.00 for each consecutive calendar day. I hereby acknowledge the receipt of the following addenda: Addendum1. 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. Tyee of Work Subcontracted Name of Subcontractor H-0 tc64d- i A f tics •e-�I �� --�:wws4A,5 n z2 i-efzs " -J 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: Kraftsman LP Address: 19535 Haude Rd Spring, TX 77388 Phone: 281.363.9599 EIN or Tax ID No.: 25-04388158 Name and Title: Email:_infopkraftsmanplay.com 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. Dater Bidder (Legal Name of Firm): Kraftsman. LP dba Kraftsman Commerical Playgrounds and Water Parks Date Organized: 1981 Name of Owner(s): Mark Soderberg, Michelle Soderberg, Kris Soderberg, Korey Soderberg Address: 19535 Haude Rd Sprino TX 77388 Date Incorporated N/A Federal ID Number: 26-0438158 Number of Years in contracting business under present name 17 List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Contract Amount $ Completion Date see attached Type of work performed by your company: Playground and splash park design, sales, and installation/construction as well as other park amenities (shade, shelter, furnishings). Total Staff employed by Firm (Break down by Managers and Trades on separate sheet): Please see resumes for employees Have you ever failed to complete any work awarded to you? ❑ Yes >< No (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? ❑ Yes >< No (If yes, please attach summary of details on a separate sheet.) Has your organization had any disbarments or suspensions that have been imposed in the past five years or that was still in effect during the five-year period or is still in effect? ❑ Yes R No (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) M List the projects most recently completed by your firm (include project of similar importance): Project Amount $ Mo/Yr Completed Fun Island Plavoround Citv of Port Arthur. TX TX 2023 Major equipment available for this contract: We will provide all necessary equipment to complete project Are you in compliance with all applicable EEO requirements? X Yes ❑ No (If no, please attach summary of details on a separate sheet.)) (Optional) Minority Business Reporting Information: Owner's Race: Owner's Ethnicity: Owner's Gender: Are you a Section 3 business? (see below) ❑ Yes N No Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the County'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: 815 Walker Street Suite 1350 Contact Name: Nicole Bunn, Sr VP City & State: Houston, Texas Zip: 77002 Phone Number: 713-232-2526 Credit available: $ Has the firm or predecessor firm been involved in a bankruptcy or reorganization? ❑ Yes X 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. N/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. N/A Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. Kris Soderberg, VP Printed Name and Title Kraftsman Commercial Playgrounds and Water Parks Company Name Not ry State nt: ff t2i S OA QdZ�P�2 being duly sworn, says that he/she is the f P Position/Title of dur -*rKk" , I.-19 (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 Zpday of K bt - , 20d Notary Public Signature Printed Name 10,-.X J.��(t✓l(C.V' My Commission Expires: ------------------ T®NIA D. BENNETT MY COMMISSION EXPIRES o{ °° AUGUST 16, 2027 NOTARY ID:11653873 The penalty for making false statements is prescribed in the U. S. Criminal Code, 18 U.S.C. 1001. Kraftsman Commercial Playgrounds and Water Parks is a successful, family -owned and operated business with over 40 years of experience providing recreational solutions in Texas, Oklahoma, and Louisiana. Our customers and their clients are Kraftsman's number one concern when designing, constructing, and/or supplying recreational facilities and products. We pride ourselves in providing professional service and attention during all phases of a project: planning assistance, turnkey construction, and maintenance after completion of the project. Kraftsman represents and installs several lines of high -quality playground and park equipment. Our product lines include traditional and non-traditional play structures for all age groups; safety surfacing; park amenities such as tables, benches, and litter receptacles; fitness and sports equipment; park shelters and pavilions; shade canopies; skate ramps and rails; water slides and SplashParks. We are your complete park equipment and service solution. OUR HISTORY 1981 - Kraftsman Playground and Park Equipment is started by Michelle and Mark Soderberg as a retail sales and manufacturer of residential wood playgrounds. 1983 - Commercial sales added 1986 - Incorporated as Playkraft, Inc. dba Kraftsman Playground & Park Equipment;100% ownership by Michelle Soderberg 1996 - Discontinued manufacturing and focused on acting as a manufacturers representative and providing installation service for commercial playground and park equipment 2002 - Introduced Water Parks (SplashParks). SplashParks are a popular and proven way to utilize public recreation facilities, either as an alternative to pools or as a companion to pool areas. 2007 - Business reorganized as Kraftsman LP (dba Kraftsman Commercial Playgrounds and Water Parks), as a partnership for continuation of and replacement for Playkraft, Inc. Michelle Soderberg - 26% ownership o Mark Soderberg -25%ownership c Kris Soderberg -24%ownership c Korey Soderberg - 24% ownership o KPPE,LLC,general partner -1%ownership 2013 - Kraftsman achieves sales of $10 million 2018 - Kraftsman achieves sales of $20 million 2019 - Kraftsman receives the following sales award from Superior Recreational Products First Place - SRP Shelter Sales of the Year o First Place - SRP Recycled Playgrounds Sales of the Year o First Place - SRP Overall Sales o First Place - SRP Site Amenities Sales of the Year o First Place - SRP Playground Sales of the Year o Second Place - SRP Shade Sales of the Year 2020 - Kraftsman receives the following sales awards from Superior Recreational Products o SRP President's Award o SRP Diamond Club Award 2021 - Kraftsman receives the following sales awards from Superior Recreational Products o SRP Diamond Club Award o SRP Site Amenities Top Sales 2022 - Kraftsman achieves sales of $30 million and receives the following sales awards from Superior Recreational Products o SRP Diamond Club Award o SRP Site Amenities Top Sales [fill A7 749 SERVICE KREW A full-time Service Manager to handle any possible challenges that might arise after project completion WAREHOUSING CAPABILITIES Kraftsman owns and maintains a warehouse over 10,000 sq. feet in size with one Warehouse Manager and one Warehouse Associate. This facility enables the reception and storage of products to eliminate the need to handle these functions at the jobsite. Inventory necessary for most service and repairs is also maintained at this warehouse. CERTIFICATIONS • AFO Aquatic Facility Operator • CPSI Certified Playground Safety Inspector • NPSI National Playground Safety Institute • NPCA National Playground Contractors Association • Superior Recreational Products - Certified Manufacturer Installer • Water OdysseyTM by the Fountain People (equipment manufacturer) AFFILIATIONS • AWBD- Association of Water Board Directors • CAI - Community Association Institutes: Houston, Dallas, Austin, San Antonio • NRPA - National Recreation and Park Society • NPCA - National Playground Contractor Association • TAA - Texas Apartment Association • TASB - Texas Association of School Boards • TASBO - Texas Association of School Business Officials • ASLA- American Society of Landscape Architects: Texas Chapter • THA- TexasHousingAssociation • TML-Texas Municipal League • TPPC - Texas Public Pool Council • TRAPS - Texas Recreation and Parks Society • AIA - Texas Society of Architects • OML- OklahomaMunicipalLeague • SWPRTI - Southwest Parks and Recreation Training Institute • GHBA - Greater Houston Builders Association • AGC - Association of General Contractors • ORPS - Oklahoma Recreation and Parks Society SANDY JENKINS SCOTT BRADLEY MERRIE TALLEY Parks & Recreation Dept. Parks Superintendent Principal/Owner City of San Antonio City of La Porte Talley Landscape Architects, Inc. 114 W. Commerce,10th Floor 604 W Fairmont Parkway 7637 Highway 36 N San Antonio, TX 78283 La Porte, TX 77571 Rosenburg, TX 77471 903-237-1037 281-470-5141 281-341-5601 DAVID MILLS TARA KLEIN ADAM BREWSTER Senior Architect Owner Architect City of Dallas Four & One LLC Dunaway Associates, L.P. 1500 Marilla Street, 6FN 25344 Coons Road 550 Bailey Avenue, Ste. 400 Dallas, TX 75201 Tomball, TX 77375 Fort Worth, TX 76107 214-670-1805 281-217-1113 817-632-4768 SHAWN BLACKBURN COLLEEN SIMPSON CHRIS SAGER Parks & Recreation Director Parks & Recreation Director Parks Manager City of Bay City City of Port Aransas City of Lockhart 1901 5th Street 710 W Avenue A PO Box 239 Bay City, TX 77414 Port Aransas, TX 78373 Lockhart, TX 78644 979-323-1660 361-317-2473 512-398-6452 PATSCHNEIDER KATHLEENOWNBY LISAJOHNSON Landscape Architect Executive Director Project Manager City of San Antonio SPARK School Park Program City of Houston PO Box 839966 900 Bagby, 2nd Floor 2999 South Wayside San Antonio, TX 78283 Houston, TX 77002 Houston, TX 77023 210-207-8466 832-393-0911 832-393-8081 Contract Amount Completion Date Dublin City Park Repairs $ 44,633 Jul-24 Mont Belvieu Metal Building $ 460,036 Jul-24 Bridge City Intermediate - Swings $ 308,448 Jul-24 Dalhart Waterslide $ 77,060 Jul-24 Palmer Elementary- Slide Replacement $ 23,301 Jul-24 Spring Lakes - Gate 3 Playground $ 29,882 Jul-24 Chandler Creek HOA Playground $ 57,980 Jul-24 Charlton Pollard - Swings $ 21,647 Jul-24 Lakeview Splash - Music $ 32,678 Jul-24 Bridge City - Shade Replacement $ 5,313 Jul-24 Calhoun Co. Olivia Haterius Park Swing $ 15,201 Jul-24 Highpoint at Wynnewood Playground Job $ 49,103 Jul-24 Hueni Family Park - Playground $ 62,998 Jul-24 LEMMON AVE. STREETSCAPE $ 94,612 Jul-24 Olsen Park Playground $ 64,944 Jul-24 SFA Early Childhood - Playground $ 232,024 Jul-24 Reserve at Shiloh Playground $ 45,540 Jul-24 Beaumont Botanical Gardens $ 29,039 Jul-24 Chambers Co. George W. Carver Park $ 87,096 Jul-24 Clear Creek Community Church Playgrounc $ 265,265 Jul-24 Del Valle ISD CDC Playground $ 301,454 Jul-24 Doornbos Park - Gable Shelter $ 205,102 Jul-24 Sallas Splash Filtration system $ 430,312 Jul-24 Summit Pool Improvements $ 49,712 Jul-24 Olsen Elementary Playground Relocation $ 30,840 Aug-24 Simon Minchen Park Phase 2 $ 255,524 Aug-24 City of Huntsville - Pool Slide $ 66,803 Aug-24 Port Aransas ISD - Post & Slide $ 10,313 Aug-24 Woodland Park Basketball Court $ 133,705 Aug-24 Barshop Jewish Community $ 90,191 Aug-24 Tanglewood Park Improvements $ 90,171 Aug-24 Villa Romel Park $ 213,614 Aug-24 Costa Palms Playground $ 106,983 Aug-24 Pure Vida Playground $ 127,026 Aug-24 Bridgestone MUD Park $ 1,371,682 Aug-24 Plainview City Park Playground & Yalp $ 572,604 Aug-24 San Gabriel Splash Plaza $ 559,758 Aug-24 Sheldon Ridge Park $ 495,812 Aug-24 RECENT PROJECTS SURFSIDE JETTY PARK PLAYGROUND Surfside Beach, TX Customer Name: Bra7oria County Parks Cost: $223,000 Project Scope: Installation of new recycled playground, border timbers, ramps, engineered wood fiber and amenities. Also included was a custom 60' x 40' x 12' hip - shade canopy. BUFFALO RUN PARK PLAYGROUND Missouri City, TX Customer Name: City of Missouri City Cost: $183,000 Project Scope: Removal of existing playground and replaced with new nature-themed play structure to accent the natural feel of the park and surrounding area. The playground includes separated 2 to 5 and S to 12 year -old main features and includes freestanding play and amenities. BILL SANDERS MEMORIAL PARK PLAYGROUND Seadrift, TX Customer Name: Calhoun County Parks Cost: $129,000 Project Scope: New installation of a recycled pirate ship themed play structure and two -bay swings Kraftsman collaborated with the county on this project and found value with the county preparing the pad prior to Kraftsman's arrival for installation.. PURE VIDA AMENITY CENTER PLAYGROUND Seadrift, TX Customer Name: Holigan Investments Cost: $127,000 Project Scope: Installation of a new recycled playground for children aged 2 go 12 along with multiple freestanding play items. The plans for this project were provided by the owner/architect team and Kraftsman designed and installed the new playground in the defined area. COSTA PALMS AMENITY CENTER PLAYGROUND Rockport, TX Customer Name: Holigan Investments Cost: $107,000 Project Scope: Installation of a new recycled playground for children aged 2 go 12. The plans for this project were provided by the owner/architect team and Kraftsman designed and installed the new playground in the defined area, including the utility scope to ensure the play area remains dry and in optimal conditions for years to come. RECENT PROJECTS LOCKHART PARK RENOVATIONS & IMPROVEMENT Lockhart, TX Owner: Chris Sager Cast: $395,000 Completed: Spring 2021 Project Scope: Design and installation of playground units and shade structures at parks in Lockhart including the following: City Park, Nueces Park, Youth Sports Complex, Lion's Park, Navarro Springgs Park, Santos Arredondo Park, La Fleur Sports Complex, and Ed Braun Park. CLEBURNE BLEACHER SHADES Cleburne, TX Owner: Aaron Dobson Cost: $155,000 Completed: Spring 2020 Project Scope: Design and installation of various size shades at the bleachers at the Cleburne Sports Complex. CLEBURNE BASEBALL PLAYGROUND Cleburne,TX Owner: Aaron Dobson Cost: $45,000 Completed: Summer 2020 Project Scope: Design and installation of a baseball themed play unit at Cleburne Sports Complex. SPRING CONDO AUSTIN SHADE I & II Austin,TX Owner: Martin Weinkove Cost: $60,000 Completed: Spring 2019 Project Scope: Design and installation of two shade structures at the condo pool. Pu Desig t (28 0 Ch ) 353-9599 i ides)@kraftsmanplay.com 1.1*61:11k .i] ial�l#►jl� TiMBERGLEN SPLASHPARK Dallas, TX Owner: City of Dallas Cost: $1.2 Million Completed: Summer 2019 Project Scope: Supply and installation of Splash Park with filtration system, custom shades, and shelters. CRESENT PARK SPLASHPARK Cresent, OK Owner: City of Cresent Cost: $123,000 Completed: Spring 2018 Project Scope: Design and installation of Splash Park that included features which can be changed at a later date. GENE HOWE NEIGHBORHOOD SPLASHPARK Amarillo, TX Owner: City of Amarillo Cost: $200,000 Completed: Spring 2018 Project Scope: Design and installation of marsh themed Splash Park, with shade, seating, and fitness equipment. ZUBE PARK SPLASHPARK Hockley,TX Owner: Harris County Precinct 3 Cost: $500,000 Completed: Spring 2016 Project Scope: Design and installation of Splash Park with shade and site amenities. D. P'r c KI i,nukienK RECENT PROJECTS LIGHTHOUSE BEACH Port Lavaca, TX Owner: City of Port Lavaca Cost: $42,500 Completed: Spring 2021 Project Scope: Installation of a 47'x47'x47' triangular sail shade canopy over an existing splash pad, installed by Kraftsman. HILTON SCHOTT PARK Humble, TX Owner: City of Humble Cost:$178,000 Completed: Summer 2020 Project Scope: Installation of large play structure and 70'x40' shade structure covering the play equipment. The shade canopy was structurally engineered with piers. Due to the large size of the steel members, lifting equipment was used. HIRSCH MEMORIAL Humble, TX Owner: City of Humble Cost: $238,000 Completed: Spring 2021 Project Scope: Project was purchased to mimic Hilton Schott Park (see above) due to the customer's satisfaction with the first project. Included slightly different play equipment. Included two 3-bay swings with their own independent shade coverings integrated into the swing frame. BRIDGESTONE PARK Spring,TX Owner: Bridgestone HOA Cost: $65,000 Completed: Fall 2015 Project Scope: Installation of two large sail structures and three additional cantilever shade structures over existing play equipment. D BRIDGESTONE POOL Spring,TX Owner: Bridgestone HOA Cost: $90,000 Completed: Spring 2017 Project Scope: Installation of a large shade canopy over existing pool. Design included 13 columns and 8 pieces of triangular fabric. Columns were moved into the area using a 130-ton crane. (281) 353 9599 M'biIIonS@kraftsrnanpIay.com RECENT PROJECTS JAMES DRIVER PARK RENOVATION Houston, TX Owner: D.L. Meacham Construction, LP Cost: $100,000 Completed: Winter 2023 Project Scope: Installation of a 2-12 play structure by SRP, an Ascend 9' rope climber, 2-seater retro rocket, swings of various sizes, engineered wood fiber, mats, and removal/proper disposal of existing equipment. WOODFOREST NEIGHBORHOOD PARK Montgomery, TX Owner: Johnson Development Cost: $177,000 Completed: Spring 2022 Project Scope: Installation of a custom Magic Mountain play structure by Lappset, multiple swing bays with various types of swings, a Flora Grasshopper seesaw, spinners, various site amenities, and engineered wood fiber. OLD FAIR PARK Fredericksburg, TX Owner: Fredericksburg Rotary Club Cost: $567,000 Completed: Winter 2021 Project Scope: Installation of a custom barn themed play unit by SRP, Orbit Spinner, Yalp Memo, Yalp Sutu Wall, 4 bay swing set, and 2 shades. FLATONIA SPLASH PARK Flatonia,TX Owner: City of Latonia Cost: $120,000 Completed: Spring 2020 Project Scope: Installation of a 1,593 square -foot oval Splash Park with a single pass system. This project consists of 12 features. SUMUEL PARK SPLASH PARK Rockdale, TX Owner: City of Rockdale Cost: $218,000 Completed: Fall 2019 Project Scope: Installation of a 1,500 square -foot Splash Park featuring a recirculation system and 3 shades. This project consists of 12 features. 'LM KoreyS(_)K nplay.com RECENT PROJECTS LIZ CARPENTER SPLASHPARK/FOUNTAIN Austin, TX Owner: City of Austin Cost: $1.14 Million Completed: Spring 2011 Project Scope: Rebuild of filtration system for popular fountain. DALLASSPRAYGROUNDS Dallas, TX Owner: City of Dallas Cost: $7.3 Million Completed: Summer 2019 Project Scope: Construction of six Splash Parks including shades, shelters, and all mechanical/filtration. ZUBE PARK SPLASHPARK Hockley, TX Owner: Harris County Precinct 3 Cost: $500,000 Completed: Summer 2016 Project Scope: Design and installation of Splash Park with shade and site amenities SPLASH FACTORY Dallas, TX Owner: City of Grand Prairie Cost: $700,000 Completed: Summer 2020 Project Scope: Design and installation of Splash Park MILK PARK SPLASHPARK Conroe, TX Owner: City of Conroe Cost: $575,000 Completed: Summer 2017 Project Scope: Design and installation of Splash Park with filtered system, shade structure, and seating RECENT PROJECTS LiNCOLN PARK SPLASHPARK San Antonio, TX Owner: City of San Antonio Cost:$350,000 Completed: Spring 2018 Project Scope: installation of Splash Park with filtration system. GENE HOWE NEIGHBORHOOD SPLASHPARK Amarillo, TX Owner: City of Amarillo Cost: $200,000. Completed: Spring 2018 Project Scope: Installation of marsh themed Splash Park, with shade, seating, and fitness equipment. FREEPORT SPLASHPARK Freeport, TX Owner: City of Freeport Cost: $223,000 Completed: Summer 2018 Project Scope: Design and installation of Splash Park with fun features and glow domes. The city wanted a park that could be used day and night. ZUBE PARK SPLASHPARK Hockley, TX Owner: Harris County of Precinct 3 Cost: $500,000 Completed: Spring 2016 Project Scope: Design and installation of Splash Park with shade and site amenities. )00PARR PARK SPLASHPARK Grapevine, TX Owner: City of Grapevine Cost: $335,000 Completed: Spring 2012 Project Scope: Design and installation of Splash Park with decorative deck coating, pergola, and pavilion. Designed to match design of existing adjacent playground. FUN ISLAND PLAYGROUND Port Arthur, TX Scope: Design and installation of large and small shipwrecked them play structures with coastal corrosi protection featuring slides, climber and interactive play panels. The pla area additionally features a 4-bay swingset also with the coastal corrosion protection package. The poured in place rubber surfacing is bright and colorful with a custom themed design. The seating area includes rectangular tables under a custom hip shade. Benches were also Installed: October 2023 Project Cost: $750,000 Owner: City of Port Arthur BROOKSHIRE AMPHITHEATER Brookshire, TX Scope: Design and installation of a custom 30' x 40' wave bandshell amphitheater, made of high -quality laminated wood, for hosting concerts and celebrations. The project also includes a custom concrete foundation with 6" thick concrete pad and reinforced rebar under the amphitheater itself, and the 1,774 sq. ft. dance floor. An aluminum above ground enclosure was also installed for electrical wiring. Installed: July 2023 Project Duration: 10 Months Project Cost: $565,000 Contact: Brookshire EDC Jeremiah Hill, jeremiah@hiilforbrookshire.com Address: Across from 4029 St St. Brookshire, TX 77423 DOORNBOS INCLUSIVE PARK Nederland, TX Scope: Design and installation of an inclusive playground for children of all abilities. Features include a custom steel playground with ramps and accessible rockin' glide, play panels, a roller table that stimulates sensory and physical play, inclusive merry go round, musical instruments, cozy pod spinner, inclusive swings and team swing. The custom themed poured in place rubber enables easy access to all parts of the playground and the custom flower shades and butterfly panel toppers complement the theme of the park, Completed: November 2023 Project Duration: 7 Months Project Cost: $540,000 Owner: City of Nederland Toby Latiolais, tlatiolais@ci.nederland.tx.us Address: 2301 Avenue H Nederland, TX. 77627 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, 94th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed in accordance with Chapter 176, Loral Government Code, by a vendor who pate Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. Avendor commits an offense if the vendor knowingly violates Section 176 006, Local Government Code. An o ense un er vs section is a misdemeanor. - jJ Name of vendor who has a business relationship with local governmental entity. Kraftsman, LP dba Kraftsman Commercial Playgrounds & Water Parks 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 on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. N/A Name of Officer 4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary, A. Is the local government. officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? L] Yes E:1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? 71 Yes rX-1 No S Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. N/A 6 ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Sect' 176 03(a)(2)(B), excluding gifts described in Section 176.003(a-1). :f :S 7 &g11104Y Si doing lau the ah a of vep6e with governmental entity I Data! :2116 Form provided by Texas Ethics Commission,/ www.ethics.state.tx.us Revised 11130/2015 CONTRACTOR'S CERTIFICATION of RECOVERED MATERIAL ACKNOWLEDGEMENT I, _ Kris Soderberg (Principal's Name) _ of Kraftsman LP (Company Y Name) , (hereinafter called "Contractor"), acknowledge the recovered material bidding requirements found in 2 CFR 200.322 that requires the Contractor to procure those items designated in the guidelines of the Environmental Protection Agency (EPA) at 40 CFR 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition. I also acknowledge that this requirement shall apply to items purchased (1) where the Contractor purchases in excess of $10,000 of the item under this contract; or (2) where during the preceding fiscal year, the value of the quantity acquired was in excess of $10,000. Finally, I acknowledge the attached list of recovered materials included in the bid documents. (For up-to-date listing, please go to https://www.epa.gov/smm/comprehensive-procurement-guideline- c pg- p ro g ra m#d i re ct o ry) 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. x❑ Recovered materials fail to meet reasonable performance standards, which are determined on the basis of the guidelines of the National Institute of Standards and Technology, if applicable. ❑ Recovered materials are only available at an unreasonable price. 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 civiljudgment 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 cel iification. d. Have not within a three-year period preceding this application/ proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (I) (a- d) of this certification. Kris Soderberg, VP Name and Title of Authorized Agent I am unable to certify to the above statements. My explanation is attached. STATE OF TEXAS {} COUNTY OF Harris AFFIDAVIT {} TKris Soderberg being first duly sworn, deposes and says: that he or she is (Type or Print Name) the VP of Kraftsman LP having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at 19535 Haude Rd, Spring, TX 77388 (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 mannersought by collusion to secure for himself/herself/itself/themselves an advantage overany 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 a yand/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions uks contained in the bid/proposal. Kris Soderberg, V Printed Name ar0fitle 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 tT N e Zp TONIA D. BENNETT MY COMMISSION EXPIRES AUGUST 16,202T a)NOTARY ID; i1653ST3 Signature of Notary Public CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 11246 and Federal Laws Requiring Federal Contractor to adopt and abide by equal employment opportunity and affirmative action in their hiring, firing, and promotion practices. This includes practices related to race, color, gender, religion, national origin, disability, and veterans' rights. NAME AND ADDRESS OF BIDDER (include ZIP Code) Kraftsman LP dba Kraftsman Commercial Playgrounds & Water Parks 19535 Haude Rd Spring, TX 77388 CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. Yes Xlo The undersigned hereby certifies that: /O The Provision of Local Training. Employment and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). The Egual 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? Yes X No Kris Soderberg, VP NAME AND TITLE OF SIGNER (Please type) 4`1 1A ",� 4 A S1614tTUATE CONTRACTOR'S LOCAL OPPORTUNITY PLAN Kraftsman LP agrees to implement the following specific affirmative action steps (name of company) directed at increasing the utilization of lower income residents and businesses within Calhoun County. A. To ascertain from the County's CDBG program official the exact boundaries of the project area and where advantageous, seek the assistance of local officials in preparing and implementing the affirmative action plan. B. To attempt to recruit from within the county the necessary number of lower income residents through: local advertising media, signs placed at the proposed site for the project, and community organizations and public or private institutions operating within and servicing the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Concentrated Employment Program, Hometown Plan, or the U.S. Employment Service. C. To maintain a list of all lower income residents who have applied either on their own or on referral from any source, and to employ such persons, if otherwise eligible and if a vacancy exists. D. To insert this plan in all bid documents and to require all bidders on subcontracts to submit an affirmative action plan including utilization goals and the specific steps planned to accomplish these goals. E. To ensure that subcontracts (greater than $10,000), which are typically let on a negotiated rather than a bid basis in areas other than the covered project area, are also let on a negotiated basis, whenever feasible, in a covered project area. F. To formally contact unions, subcontractors, and trade associations to secure their cooperation in this effort. G. To ensure that all appropriate project area business concerns are notified of pending sub -contractual opportunities. H. To maintain records, including copies of correspondence, memoranda, etc., which document that all of the above affirmative action steps have been taken. I. To appoint or recruit an executive official of the company or agency as Equal Opportunity Officer to coordinate the implementation of this plan. J. To maintain records concerning the amount and number of contracts, subcontracts, and purchases which contribute to objectives. K. To maintain records of all projected work force needs for all phases of the project by occupation, trade, skill level, and number of positions and to update these projections based on the extent to which hiring meets these Local Opportunity objectives. As officers and representatives of Kraftsman LP we the undersigned have read (name of company) and gfully agree his; n and County's Section ro r n rovi ns. Signature Kris Soderberg Printed Name VP Title Date 3 Plan, and become a party to the full implementation of the PROPOSED CONTRACTS BREAKDOWN Type of Contr-77 No f ^ .o Contracts ^VFIUA• iuiai estimated No. to Estimated $ Dollar Amount local Business Amount Local $135,0001 p $120,000 1 ESTIMATED PROJECT WORKFORCE BREAKDOWN IS Totaf Estimated No. of Positions No. of Pc Classifications Positions Currently Filled not Filled 0 1 No. of Positions to fill with LMI Resident! Laborer, common section 5 5 0 0 SE ity 5 5 0 0 der ope ator 1 1 0 0 11 1 11 I 0 --r- 0 Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program CERTIFICATION FOR BUSINESS CONCERNS Seeking Section 3 Preference in Contracting and Demonstration of Capability Economic Opportunities for Low and Very Low -Income Persons Grantee/Subrecipient: Contract Number: Date: CONTRACTOR INFORMATION Name of Business raftsman, LP dba Kraftsman Commercial Playgrounds and water Parks Address of Business ! tg535 Haude Rd Spring, 5 77388 Type of Business:❑ Corporation XI Partnership ❑ Non -Profit ❑ Sole Proprietorship ❑ Joint Venture Consortium Attach the following documentation as evidence of Section 3 eligible status: (Definition of "Section 3 Business Concern" in 24 CFR 135 describes the three alternative qualifications.) For Business claiming status as a Section 3 resident -owned enterprise: ❑ Copy of resident lease ❑ Copy of evidence of participation in a public assistance program For business entity as applicable: ❑ Copy of Articles of Incorporation ❑ Assumed Business Name Certificate ❑ List of owners/stockholders and % ownership of each appointed officers ❑ Organization chart with names and titles and brief function statement ❑ Copy of receipt of public assistance ❑ Other evidence ❑ Certificate of Good Standing ❑ Partnership Agreement ❑ Corporation Annual Report ❑ Latest Board minutes ❑ Additional documentation For business entity claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business(es): IX List of subcontracted Section 3 business(es) and subcontract amount For business claiming Section 3 status, by claiming at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residenk within 3 years of date of first employment with the business: 17 List of all current full-time employees ❑ PHA/IHA Residential lease less than 3 years from day of employment ❑ List of employees claiming Section 3 status ❑ Other evidence of Section 3 status less than 3 years from date of employment Evidence of ability to perform successfully under the terms and conditions of the proposed contract: ❑ Current financial statement ❑ List of owned equipment ❑ List of all contracts for the X Kris Soderbera Attested By: ❑ Statement of ability to comply with public policy (a 2 DatEf (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 lic77ion., S" n tur f Con tor's Authorized Official Kris Soderber , VP Printed Name and Title of Contractor's Authorized Official �� Date *24 C.F.R. 87 App. A, available at https://www.gpo.gov/fdsys/granule/CFR-2011-title24-volt/CFR-2011-title24- vol1-part87-appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. 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 public burden disclosure 1. Type of Federal 2. Status of Federal Action: 3. Report Type: Action: a. bid/offer/application a. initial filing contrac a 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: N/A N/A 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: B. Federal Action Number, if known: 9. Award Amount, if known: N/A $ 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 placed Print Name: Kris Soderbe 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: VP Congress semi-annually and will be available for public inspection. Any person who fails to file the required 281-353-9599 Zotf Telephone No.: Date: disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97) HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 85' 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, orwith 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) _Kris Soderberg 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 httos:Hcomptroller texas gov/purchasing/publications/divestment oho Kraftsman, L dba Kr ft! Compan e Sign to of Authorized' VP Title of Authorized Official Parks Printed Name of Authorized Official RESIDENCE CERTIFICATION Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) 'Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. ❑ 1 certify that (Company Name) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (City and Stale) ® I certify that Kraftsman, LP is a 'Resident Bidder" of Texas as (Company N.) defined in Government Code §2252.001. Signature of Aut rized Agent Kris Soderberg, VP Printed Name and Title of Authorized Agent Date An ohicial website of the United States government Here's how you know Important Reps and Certs Update Show Details x See All Alerts Mar 1, 2024 Planned Maintenance Schedule Show Details X May 21, 2024 �''_SAKGov® o oa a Home Search Data Bank Data Services Help Search All Words e.g. 1606N020Q02 Saved Searches Select Domain All Domains + Filter By _ Keyword Search For more information on how to use our keyword search, visit our help guide Simple Search Search Editor OAny Words All Words OExact Phrase e.g.1606N020Q02 "Kraftsman, 1p" _ x Federal Organizations Enter Code or Name s Status „ ® 0 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 ICU I). All individuals viewing, reproducing or disposing of this information are required to protect it in accordance with 32 CFR Part 2002 and GSA Order CIO 2103.2 CUI Policy. BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, Kraftsman, LP as PRINCIPAL, and SureTec Insurance Comnanv , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Local Public Agency", in the penal sum of Five Percent Greatest Amount Bid Dollars, ($ 5%GAB ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, thatwhereas the Principal has submitted the Accompanying Bid, dated July 2, 2024 , for BID NO. 2024.08 — INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT —GLO CONTRACT NO. 20- 065-064-C182 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 end day of July 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. (SEAL) LP (SEAL) Attest: By: Wvv Affix Corporate Seal Sure ec Insurance Com any Attest: By: Kathryn Ulrich, Receptionist emus M. Descant, Jr., Attorney -in -Fact Affix Corporate Seal Attest: By: P .q CountL//� By�/ ° Dennis M.Descant, Jr., Attome -in-Fact, State of Texas * Attorney -in -Fact, State of Texas Page 1 of 2 CERTIFICATE AS TO CORPORATE PRINCIPAL - Jf IA certify that I am the Secretary of the Corporation named as Principal in the bid bond; that , who signed the said bond on behalf of the Principal was then of said corporation; that I know his/her signature, and his/her signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, on behalf of said corporation by authority of its governing body. Title: * Power -of -attorney for person signing for Surety Company must be attached to bond. Please attach / include original bid bond as the last item in the sealed bid package. Corporate Seal Page 2 of 2 POA# 4221073 JOINT LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That SureTec Insurance Company, a Corporation duly organized and existing under the laws of the State of Texas and having its principal office in the County of Harris, Texas and Markel Insurance Company (the "Company"), a corporation duly organized and existing under the laws of the state of Illinois, and having its principal administrative office In Glen Allen, Virginia, does by these presents make, constitute and appoint: Jeffrey L. Brady, Dennis M. Descant, Jr., Cheryl A. Sanders, Michael Inman, Timothy John Brady Their true and lawful agent(s) and attorney(s)-In-fact, each in their separate capacity if more than one Is named above, to make, execute, seal and deliver for and on their awn behalf, individually as a surety or jointly, as co -sureties, and as their act and deed any and all bonds and other undertaking in suretyship provided, however, that the penal sum of anyone such instrument executed hereunder shall not exceed the sum of: Fifty Million and 00/100 Dollars ($50,000,000.00) This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolutions adopted by the Board of Directors of SureTec Insurance Company and Markel Insurance Company: "RESOLVED, That the President, any Senior Vice President, Vice President, Assistant Vice President, Secretary, Assistant Secretary, Treasurer or Assistant Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile signature, which maybe attested or acknowledged by any officer or attorney, of the company, qualifying the attorney or attorneys named in the given power of attorney, to execute in behalf of, and acknowledge as the act and deed of the SureTec Insurance Company and M arkel Insurance Company, as the case maybe, all bond undertakings and contracts of suretyship, and to affix the corporate seal thereto." IN WITNESS W HEREOF, Markel Insurance Company and SureTec Insurance Company have caused their off KlaI seal to be hereunto affixed and these presents to be signed by their duly authorized officers on the 17th day of September , 2021 . SureTec Insurance Company ANOFC ;x`x��k lull", vx p`' n 'y,r—'^',. ,Jt{'9/�x�>raBY: j2 (110kZ-.i Yq� SEp1L A`By. `o 1 rState Michael C. Keimig, President of Texas —^� " frzjrrrt*ut0"xS*x, County of Harris: On this 17th day of September , 2021 A. D„ before me, a Notary Public of the State of Texas, in and for the County of Harris, duly commissioned and qualified, came THEABOVE OFFICERS OFTHE COMPANIES, tome personally knownto be the individuals and officers described in, who executed the preceding instrument, and they acknowledged the execution of same, and being by me duly sworn, disposed and said that they are the officers of the said companies aforesaid, and that the seals affixed to the proceeding instrument are the Corporate Seals ofsaid Companies, andthe said Corporate Seals and their signatures asofficers were duly affixed and subscribed to the said instrument by the. authority and direction of the said companies, and that Resolutions adopted by the Board of Directors of said Companies referred to In the preceding instrument is now in force. IN TESTIMONY WHEREOF, I have hereunto set my hand, and affixed my Official Seal at the County of Harris, the day and year first above written. to kEN71atl 4 / ��r ° *'r 'Try ix C:iC, Sure o'T¢ias R�� h)tttat/I�#rrs3 r9 6uh �� By: $i ., .r .f"C.'�'(�1"..,a 1 '}} tlhtnig",ot F'xpiras - %{nla havez, Notary Public,.r' ar St�P't'^i"tiy( 1f)�-L{}i1y ommission expires 9/30/2024 We, the undersigned Officers of SureTec Insurance Company and Markel Insurance Company do herby certify that the original POWER OF ATTORNEY of which the foregoing Is a full, true and correct copy is still in full farce and effect and has not been revoked. IN WITNE55 WHEREOF, we have hereunto setour hands, and affixed the Seals of said Companies, on the 2nd day of July 2024 ®cinsur nce ny f ...___. MarJcel Insurance Company M.BTAtBeatV,AssistfntSecretarY I Andrew Marquis, Assil Cr ry Any Instrume nt Issued in excess of the penalty stated above Is totally void and without anyvalidity. 4221073 For ve rification of the authority d this Power you may call g13 1812.0800onany business day between 8:30AM and 5:00 PM CST. 1. 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 Box 149104 Austin, TX 78714- 9104 Fax#:512-490-1007 Web: httg://www.tdi.state.tx.us 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. SIC TX Rider TDI Required Notices rev 07_2022 Page 1 of 1 «.«...... ��..«� �� y» m m r yr 3 or Z vCD v n o w � m m 0 z -4n x0 : N � (D o o v 0 A MON .� �p gg, v C) 'vi"t lae'gag 3 '! ,Ski, 4?� O µ mtQ� �d:o,< i'M�� is 1 P � v�Y ':3 YC i� 'U: �xu v 0 (D N a 8 a e� 4 >#z ry \11 1bt pla�woll onup BID SCHEDULE PROJECT NAME: BID NO.2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project - GLO Contract No. 20.065-064-C182 da�Difg>all apRrlNfsb6 $v�tUodFojects on an annual basis, fomefiams rnof�valid�ometime slightly less BASE WORK SCOPE: The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. w� UNIT. � UANTITY- � " �UIY�T PRICE ^ TOTq,L�BID,PRIOE+ ` 1 MOBILIZATION, INSURANCE AND BONDS PER PLANS ANDSPECIFICATIONS LS 1 $15,781.48 $15,781.48 2 TEMPORARY PROTECT SIGNAGE PER PLANS AND SPECIFICATIONS 1 $2,016.13 $2,016.13 DEMOLITION OF ENGINEERED WOOD 3 FIBER (EWF) (APPDX. 12"THICK)AND TRANSFER TO AREAS WITHIN PARK PER SF 7,575 $1.70 $12,877.50 PLANS AND SPECIFICATIONS. TYPE D, CRUSHED LIMESTONE, 8.5" 4 THICK AFTER COMPACTED IN PLACE TO 95%COMPLETE IN PLACE PER PLANS SF 7,575 $3.02 $22,876.50 AND SPECIFICATIONS GEO-GRID OR GEO-FABRIC INSTALLED 5 ON TOP OF BASE MATERIAL COMPLETE SF 7,575 $0.54 $4,090.50 IN PLACE PER PLANS AND SPECIFICATIONS RUBBER SURFACING 3.5" THICK 6 COMPLETE IN PLACE PER PLANS AND SF 7,575 $22.108 $167,467.53 SPECIFICATIONS NEW PLAYGROUND STRUCTURES) MEETING THE MINIMUM REQUIREMENTS AS SET FORTH IN THE PLANS AND SPECIFICATIONS AND WITHIN THE AREAS LISTED. THIS 7 INCLUDES A SUPER STRUCTURE, SWING LS 1 $187,192.41 SET, MERRY-GO-ROUND, STEM PLAY, $187,192.41 ELECTRONIC GAME AND MUSIC PLAY. CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT PACKAGE REQUIRED. TWO -POST HIP SHADE STRUCTURE (15' X 22' X 10') CORRISION RESISTANT PACKAGE REQUIRED AND WIND 8 RESISTANT PACKAGE REQUIRED. EA 2 $17,526.78 $35,053.56 INCLUDES CUTTING EXISTING CONCRETE AS REQUIRED FOR FOUNDATION INSTALLATION. SINGLE -POST SQ SHADE STRUCTURE (16') CORRISION RESISTANT PACKAGE REQUIRED AND WIND RESISTANT 9 PACKAGE REQUIRED. INCLUDES EA 1 $14,763.13 CUTTING EXISTING CONCRETE AS $14,763.13 REQUIRED FOR FOUNDATION INSTALLATION. TOTAL BASE BID $462,214.79 "Submission of a bid t h 'th "Cl 'f a ari ications or Exclusions and/or any other stipulations will not be accepted. It shall be the bidder's responsibility to provide a complete bid and ask any questions necessary to clarify any bid items or relevant concerns within the questions period. •'The award will be based on the BASE BID and the Owner reserves the right to determine the most advantageous and best bid for the project. '"The Calhoun County Commissioners Court shall be the sole judge in determining which bid will be the most advantageous to Calhoun County. The project shall consist of demolition of existing EWF surface, reconstructing a new playground base material to receive geo-fabric and rubber surfacing, installation of three new shade structures, and a new playground equipment as more described in the contract documents and bid package. The BIDDER, in compliance with the invitation for bids for Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project —GLO Contract No. 20-065-064-C182 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 119 consecutive calendar days as stipulated in the specifications. BIDDER further agrees to pay as liquidated damages, the sum of $500.00 for each consecutive calendar day. 1 hereby acknowledge the receipt of the following addenda: 1. acknowledged 2. acknowledged 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 Construction Recreation Install 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: The Playwell Group Address: 203A TX-46 E, Borene, TX 78006 Phone: 800-726-1816 EIN or Tax ID No.: 75-2658108 Signature: Name and 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: 7.1.2024 Bidder (Legal Name of Firm): The PlayWell Group Date Organized: Name of Owner(s): Address: 203A TX-46 E, Borene, TX 78006 Date Incorporated Federal ID Number: 75-2658108 Number of Years in contracting business under present r List all other names under which your business has operated in the last 10 years: Work Presently Under Contract: Contract Various Projects estimated at $8 million dollars Amount $ Completion Date Type of work performed by your company: Supply and Installation of Playground and Shade Total Staff employed by Firm (Break down by Managers and Trades on separate sheet): Have you ever failed to complete any work awarded to you? ❑ Yes © No (If yes, please attach summary of details on a separate sheet. Include brief explanation of cause and resolution) Have you ever defaulted on a contract? ❑ Yes ❑x 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 ❑x No (If yes, list and explain; such list must include disbarments and suspensions of officers, principals, partners, members, and employees of your organization.) List the projects most recently completed by your firm (include project of similar importance): Project Amount $ Mo/Yr Completed We install approximately $30M worth of projects on an annual basis, Major equipment available for this contract: PtaycraftSystems and Modern Shade Are you in compliance with all applicable EEO requirements? © Yes ❑ No (If no, please attach summary of details on a separate sheet,)) (Optional) Minority Business Reporting Information: Owner's Race: Owner's Ethnicity: Caucasian White Owner's Gender: Male Are you a Section 3 business? (see below) ❑ Yes d No Section 3 Business Concerns: a) Businesses that are 51 percent or more owned by Section 3 residents; b) Businesses whose permanent, full-time employees include persons, at least 30 percent of whom are currently Section 3 residents, or within three years of the date of first employment with the firm were Section 3 residents; c) Businesses that provide evidence of a commitment to subcontract in excess of 25 percent of the dollar amount of all subcontracts to be awarded to businesses that meet the qualifications described above; or d) Businesses located within the County'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: Provided if needed City & State: Zip: Credit available: $ Contact Name: one Number: Has the firm or predecessor firm been involved in a bankruptcy or reorganization? ❑ Yes © No (If yes, please attach summary of details on a separate sheet.) List on a sheet attached hereto alijudgements, claims, arbitration proceedings, or suits pending or outstanding against bidder over the last five (5) years with amount of claim and brief description. List on a sheet attached hereto all lawsuits or requested arbitration with regard to construction contracts which bidder has initiated within the last five (5) years and brief explanation of claim and outcome. Attach resume(s) for the principal member(s) of your organization, including the officers as well as the proposed superintendent for the project. WIC- lase 511 (�`�- Printed Name and Title Company Name Notary Statement: \ \v Gym . being duly sworn, says that he/she is the �nMc�\�5+� PositioNTitle 4A.r, of — co (Firm Name), and hereby swears that the answers to the foregoing questions and all statemen s th rein contained re 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 'Z day of vim\ \y , 20-2�L. Notary Public _ Signature wup BELINDA ARMIJO Texas '7e Comm. �0- Notary Public, State ofll S IQ Printed Name Expires 01.21-2028 � " "neWNotary ID 132321691 My Commission Expires:"135-28, 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.S. 23, adth Leg., Regular Session. OFFICE115EONLY This questionnaire is being filed in accordance with Chapter 176, Local Government. Code, by a vendor who Date Received has a business relationship as defined by Section 176,001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental angry not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be tiled. See Section 176.006(a-1), Local Government Code. A vendor commits an offense If the vendor knowingly violates Section 176.006, Loral Government Code. An offense under this section is, a misdemeanor. !J Name of vendor who hays business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer 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 relationship with the local government officer. Complete subpartsAandBfor each employment orbusiness retationshipdescribed. Attach additional pagesto this Form CIO as necessary, A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes FlNo B. Is the vendor receiving or likely to receive taxable income, other than investment Income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? 71 Yes No 51 Describe each employment or business relationship that the vendor named in Section I maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more, 6 DCheck this box if the vendor has given the local government officer or afamily member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www,ethics.state.tx.us Revised 11/3012015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx,us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code S 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Govemment Code 5176.003(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 off icerora 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-mon1h period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local govemmentofficer orafamily member ofthe off leer one ormore gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code 6176.006(a) and (a-1) (a) Avendor shall file a completed conflictof interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, ora family memberof the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission wvnv.ethics.state.tx.us Revised 11/30/2015 CONTRACTOR'S CERTIFICATION of RECOVERED MATERIAL ACKNOWLEDGEMENT I, (Principal's Name)_ of The Playwell Group (Company Name) pin called "Contractor"), acknowledge the recovered material bidding requiremen s oun m 6 Iha�` requires the Contractor to procure those items designated in the guidelines of the Environmental Protection Agency (EPA) at 40 CFR 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition. I also acknowledge that this requirement shall apply to items purchased (1) where the Contractor purchases in excess of $10,000 of the item under this contract; or (2) where during the preceding fiscal year, the value of the quantity acquired was in excess of $10,000. Finally, I acknowledge the attached list of recovered materials included in the bid documents. (For up-to-date listing, please go to https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg- program#directory) Printed Name and Title Signature Date USE OF RECOVERED MATERIAL Please check one: ❑ Recovered materials are included in this bid: Materials included ❑ Recovered materials are not reasonably available in a reasonable period of time. Fxj Recovered materials fail to meet reasonable performance standards, which are determined on the basis of the guidelines of the National Institute of Standards and Technology, if applicable. ❑ Recovered materials are only available at an unreasonable price. Printed Name and Title Signature Date CERTIFICATION REGARDING DEBARMENT & SUSPENSION AND OTHER RESPONSIBILITY MATTERS In accordance with the Executive Order 12549, the prospective primary participant certifies to the best of his/ her knowledge and belief, that its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction or records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this eel iification. d. Have not within a three-year period preceding this application/ proposal had one or more public transactions (federal, state, or local) terminated for cause of default. e. Acknowledge that all sub -contractors selected for this project must be in compliance with paragraphs (I) (a- d) of this certification. Name and Title of Authorized Agent Signature of Authorized Agent I am unable to certify to the above statements. My explanation is attached. Date DEBARMENT & SUSPENSION_ Executive Order 12549--Debarment and Suspension Source: The provisions of Executive Order 12549 of Feb. 18, 1986, appear at 51 FR 6370, 3 CFR, 1986 Comp., p. 189, unless otherwise noted. By the authority vested in me as President by the Constitution and laws of the United States of America, and in order to curb fraud, waste, and abuse in Federal programs, increase agency accountability, and ensure consistency among agency regulations concerning debarment and suspension of participants in Federal programs, it is hereby ordered that: Section 1. (a) To the extent permitted by law and subject to the limitations in Section 1(c), Executive depal tments and agencies shall participate in a system fordebarment 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 patty 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. 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 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 repo I i periodically to the Director on implementation of this Order, with the first report due within two years of the date of the Order Sec. b. 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 repol i 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 cc I tifrcation 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 ce 1 iifrcations. Additional References C 40 C.F.R. Part 32: EPA Regulations on Debarment and Suspension. STATE OF TEXAS {} AFFIDAVIT COUNTYOF Calhoun {} Nate Parker being first duly sworn, deposes and says: that he or she is (Type or Print Name) the Sales Consultant of The Playwell Group having its (Type or Print Title) (Type or Print Name of Company/Firm) principal address at 203A TXA6 E, Borene, TX 78006 (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 anyoverhead, profit or cost element of their price/fee or of that of anyone else; d) did notgive, 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 prior to the official opening of this bid/proposal. Affiant further deposes and says: that the bid price(s) or proposed fees contained in this bid/proposal have been carefully checked and is submitted as true and correct, agrees to furnish any and/or all items/services upon which bid prices or proposed fees are awarded and upon the conditions and requirements contained in the bid/proposal. Signature of Affiant Printed Name and Title of Affiant SWORN TO AND SUBSCRIBED BEFORE ME by the above Affiant, who, on oath, states that the facts contained in the above are true and correct, this day of Notary Stamp/Seal Signature of Notary Public 20 CONTRACTOR CERTIFICATIONS U.S. Department of Housing and Urban Development CERTIFICATION OF BIDDER REGARDING CIVIL RIGHTS LAWS AND REGULATIONS INSTRUCTIONS CERTIFICATION OF BIDDER REGARDING Executive Order 1124B 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. The Playwell Group 203A TX-46 E, Borene, TX 78006 NAME AND ADDRESS OF BIDDER (include ZIP Code) CERTIFICATION BY BIDDER Bidder has participated in a previous contract or subcontract subject to Civil Rights Laws and Regulations. Yes 0 No The undersigned hereby certifies that: The. Provision of Local Training. Employment, and Business Opportunities clause (Section 3 provision) is included in the Contract. A written Section 3 plan (Local Opportunity Plan) was prepared and submitted as part of the bid proceedings (if bid equals or exceeds $100,000). , 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? Yes 0 No NAME AND TITLE OF SIGNER (Please type) SIGNATURE DATE CONTRACTOR'S LOCAL OPPORTUNITY PLAN The PlaywellGroup agrees to implement the following specific affirmative action steps (name of company) directed at increasing the utilization of lower income residents and businesses within Calhoun County. A. To ascertain from the County's CDBG program official the exact boundaries of the project area and where advantageous, seek the assistance of local officials in preparing and implementing the affirmative action plan. B. To attempt to recruit from within the county the necessary number of lower income residents through: local advertising media, signs placed at the proposed site for the project, and community organizations and public or private institutions operating within and servicing the project area such as Service Employment and Redevelopment (SER), Opportunities Industrialization Center (OIC), Urban League, Concentrated Employment Program, Hometown Plan, or the U.S. Employment Service. C. To maintain a list of all lower income residents who have applied either on their own or on referral from any source, and to employ such persons, if otherwise eligible and if a vacancy exists. D. To insert this plan in all bid documents and to require all bidders on subcontracts to submit an affirmative action plan including utilization goals and the specific steps planned to accomplish these goals. E. To ensure that subcontracts (greater than $10,000), which are typically let on a negotiated rather than a bid basis in areas other than the covered project area, are also let on a negotiated basis, whenever feasible, in a covered project area. F. To formally contact unions, subcontractors, and trade associations to secure their cooperation in this effort. G. To ensure that all appropriate project area business concerns are notified of pending sub -contractual opportunities. H. To maintain records, including copies of correspondence, memoranda, etc., which document that all of the above affirmative action steps have been taken. 1. To appoint or recruit an executive official of the company or agency as Equal Opportunity Officer to coordinate the implementation of this plan. J. To maintain records concerning the amount and number of contracts, subcontracts, and purchases which contribute to objectives. K. To maintain records of all projected work force needs for all phases of the project by occupation, trade, skill level, and number of positions and to update these projections based on the extent to which hiring meets these Local Opportunity objectives. As officers and representatives of we the undersigned have read (name of company) and fully agree to this Plan and the County's Section 3 Plan, and become a party to the full implementation of the program and its provisions. Signature Printed Name 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 Estimated Positions — List the number employees for each work classification will you need on this project Number of Positions Currently Filled — List the number of estimated positions you currently have filled Number of Positions Not Filled — List the number of estimated positions you currently do not have filled Number of Positions to Fill with Low to Moderate Income (Section 3) Residents — List the number of local residents earning low to moderate incomes that you plan to employ to fill the estimated positions not filled PROPOSED CONTRACTS BREAKDOWN Type of Contracts No. of Contracts Approx. Total DollarAmount T Estimated No. to local Business Playwell Group Estimated $ Amount Local Business Various Projects estimated at $12 million dollar. ESTIMATED PROJECT WORKFORCE BREAKDOWN Work Classifications Total Estimated Positions No. of Positions Currently Filled No. of Positions not Filled No. of Positions to fill with LMI Resident Section 3 Totals Texas General Land Office Community Development Block Grant(CDBG) Disaster Recovery Program CERTIFICATION FOR BUSINESS CONCERNS Seeking Section 3 Preference in Contracting and Demonstration of Capability Economic Opportunities for Low and Very Low -Income Persons Grantee/Subrecipient: Contract Number: Date: CONTRACTOR INFORMATION Name of Business The Piaywell Group Address of Business 1203A TX-46 E Borene TX 78006 Type of Business: ❑ Corporation ❑ Partnership ❑ Non -Profit ❑ Sole Proprietorship ❑ Joint Venture Consortium Attach the following documentation as evidence of Section 3 eligible status: (Definition of'Section 3 Business Concern' in 24 CFR 135 describes the three alternative qualifications.) For Business claiming status as a Section 9 resident -owned enterprise: ❑ 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 List of owners/stockholders and % ownership. of each appointed officers Organization chart with names and titles and brief function statement ❑ Copy of receipt of public assistance Other evidence ❑ Certificate of Good Standing ❑ Partnership Agreement ❑ Corporation Annual Report ❑ Latest Board minutes ❑ Additional documentation For business entity claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business(es): rl List of subcontracted Section 3 business(es) and subcontract amount For business claiming Section 3 status, by claiming at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employment with the business: List of all current full-time employees ❑ PHNIHA Residential lease less than 3 years from day of employment ❑ List of employees claiming Section 3 status ❑ Other evidence of Section 3 status less than 3 years from dale of employment Evidence of ability to perform successfully under the terms and conditions of the proposed contract: ❑ Current financial statement ❑ List of owned equipment ❑ List of all contracts for the past two years Authorized ame and Signature Attested By. ❑ Statement of ability to comply with public policy Date (Corporate Seal) CERTIFICATION REGARDING LOBBYING COMPLIANT WITH APPENDIX A TO 24 C.F.R. PART 87" (To be submitted with each bid or offer exceeding $100,000) Certification for Contracts, Grants, Loans, and Cooperative Agreements: The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Statement for Loan Guarantees and Loan Insurance: The undersigned states, to the best of his or her knowledge and belief, that: If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. As the duly authorized representative of the Contractor, I hereby certify that the applicant will comply with the above applicable certification. Signature of Contractor's Authorized Official Printed Name and Title of Contractor's Authorized Official Date `24 C.F.R. 87 App. A, available at https://www.gpo.gov/fdsys/granule/CFR-2011-title24-voll/CFR-2011-title24- voll-part87-appA. Published Apr. 1, 2011. Accessed Aug. 1, 2018. INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 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 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. 6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. ,According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 4040.0013. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (4040-0013), Washington, DC 20503 Approved by OMB 4040-0013 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure) 1. Type of Federal 2. Status of Federal Action: 3. Report Type: Action: a. bid/offer/application a. initial filing a. contract a b. initial award a b. material change a 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: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying b. Individuals Performing Services (including Registrant address if different from No. 10a) (if individual, last name, first name, MI): (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature: disclosure of lobbying activities is a material representation of fact upon which reliance was placed print Name by the tier above when this transaction was made or entered Into. This disclosure Is required pursuant to 31 U.S.C. 1352. This information will be reported to the Title: Congress semiannually and will be available for public inspection. Any person who falls to file the required Telephone No.: Date: disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7.97) HOUSE BILL 89 VERIFICATION FORM Certification Required by Texas Government Code Section 2270.001 The 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, orwith 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 The Playwell Group Company Name Signature of Authorized Official Printed Name of Authorized Official Title of Authorized Official Date Pursuant to Texas Government Code §2252.001 et seq., as amended, Calhoun County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contract; pertinent provisions of §2252.001 are stated below: Sec. 2252.001 (3) "Nonresident bidder" refers to a person who is not a resident. (4) 'Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate, parent company or majority owner has its principal place of business in this state. ❑ 1 certify that (Company Nam.) is a "Nonresident Bidder" of Texas as defined in Government Code §2252.001 and our principal place of business is (City and Sww) I certify that The Playwell Group (Company Name) defined in Government Code §2252.001. Signature of Authorized Agent Printed Name and Title of Authorized Agent Date is a'Resident Bidder" of Texas as Insert System for Award Management (SAM) Record Search for company and company principal(s). Include a printout of the search results that includes the record date and verification that the Company, Corporation, Firm or Partnership's principals are not listed (are not debarred) through the System for Award Management. BID BOND KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, as PRINCIPAL, and , as SURETY are held and firmly bound unto CALHOUN COUNTY, TEXAS hereinafter called the "Local Public Agency", in the penal sum of Dollars, ($ ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted the Accompanying Bid, dated , for BID NO. 2024.08 — INFRASTRUCTURE AT LITTLE CHOCOLATE BAYOU COUNTY PARK PLAYGROUND IMPROVEMENTS PHASE 2 PROJECT —GILD CONTRACT NO. 20- 065-064-C182 FOR CALHOUN COUNTY, TEXAS. NOW, THEREFORE, the Principal shall not withdraw said Bid within the period specified therein afterthe opening of the same, or, if no period be specified, within thirty (60) days after the said opening, and shall within the period specified therefor, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Local Public Agency in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Local Public Agency the difference between the amount specified in said Bid and the amount for which the local Public Agency may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS THEREOF, the above parties have executed this instrument this day of , the name and corporate seal of each corporate party being hereto affixed and these present signed by its undersigned representative, pursuant to authority of its governing body. (SEAL) Attest: By: Attest: By: Attest: Countersigned 0 0 (SEAL) Affix Corporate Seal Affix Corporate Seal * Attorney -in -Fact, State of Texas bond; that then CERTIFICATE AS TO CORPORATE PRINCIPAL Page 1 of 2 certify that I am the Secretary of the Corporation named as Principal in the bid who signed the said bond on behalf of the Principal was of said corporation; that I know his/her signature, and his/her signature thereto is genuine; and that said bond was duly signed, sealed, and attested to, on behalf of said corporation by authority of its governing body. Title: * Power -of -attorney for person signing for Surety Company must be attached to bond. Please attach / include original bid bond as the last item in the sealed bid package. Corporate Seal Page 2 of 2 SECTION 3 22. Standard Form of Agreement for Construction Contracts 23. General Contract Conditions for Construction 24. Calhoun County General Conditions 25. Minority/Female Goals 26. Federal Labor Standard Provisions 27. Title 29 Labor 28. Concerning Labor Standards and Prevailing Wage Rate Requirements 29. Project specific Davis -Bacon Wage Decision 30, GLO Signage Requirements 31. Certificate of Interested Parties Form 1295 and Instructions 32. Section 504 Certification 33. Child Support Statement 34. Document No. 00417 —Tench Safety Systems Indemnity Agreement 35. Payment Bond 36. Performance Bond 37. Certificate of Liability Insurance 38. Section 3 Clause 39. HUD Examples of Efforts to Offer Training & Employment Opportunities for Section 3 Residents 40. GLO New Hires Section 3 Monthly Compliance Report 41. CDBG-MIT Section 3 Brochure Information Sheet 42. GLO Assurances for Construction Programs 43. GLO General Affirmations 44. Attorney's Review Certification 45. Contractor's Final Payment Affidavit 46. Change Order Form 47. Certificate of Construction Completion (COCC) 48. Governing Technical Specifications & Special Provisions 203A TX-46 Standard Form of Agreement for Construction Contracts THIS AGREEMENT made this the tat day of July 2024 , by and between The Playwell Group (a corporation organized and existing under the laws of the State of Te%8s ) (a partnership consisting of ) (an individual trading as ) hereinafter called the "Contractor", and CALHOUN COUNTY, TEXAS hereinafter called the "County." WITNESSETH, that the Contractor and the County for the considerations stated herein mutually agree as follows: ARTICLE 1. Statement of Work. The Contractor shall furnish all supervision, technical personnel, labor, materials, machinery, tools, equipment and services, including utility and transportation services, and perform and complete all work required for the construction of the Improvements embraced in the Project; namely Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-C182 for Calhoun County, Texas for the Community Development Block Grant — Mitigation (CDBG- DR) project, all in strict accordance with the contract documents including all addenda thereto, numbered 1and2 dated June 131h 2024 and JuneMhWN , all as prepared by G&W Engineers, Inc. acting and in these contract documents preparation, referred to as the "Engineer". ARTICLE 2. The Contract Price. The County will pay the Contractor for the performance of the Contract in current funds, for the total quantities of work performed at the unit prices stipulated in the Bid for the several respective items of work completed subject to additions and deductions in amount of Four Hundred and Sixty-two Thousand, two hundred ($ $462,214.79 ). ARTICLE 3. The Contract. The executed contract documents shall consist of the following components: a. This Agreement b. Addenda c. Invitation for Bids d. Instructions to Bidders e. Signed Copy of Bid f. General Conditions g. Calhoun County Conditions h. Special Conditions g. I. Performance Bond j. Payment Bond k. Technical Specifications I. Drawings m. Other ARTICLE 4. Performance. Work, in accordance with the Contract dated July 1 2024 , shall commence on or before as established in an official letter notification to the contractor called "Notice to Proceed" and Contractor shall complete the WORK within 11s consecutive calendar days thereafter. The date of completion of all WORK is therefore established by the Notice to Proceed Letter This Agreement, together with other documents enumerated in this ARTICLE 3, which said other documents are as fully a part of the Contract as if hereto attached or herein repeated, forms the Contract between the parties hereto. In the event that any provision in any component part of this Contract conflicts with any provision of any other component part, the provision of the component part first enumerated in this ARTICLE 3 shall govern, except as otherwise specifically stated. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed in triplicate original copies on the day and year first above written. The Playwell Group (The Contractor) cM CALHOUN COUNTY (County) By Name/Title: Richard H. Meyer, County Judge Corporate Certifications I, , certify that I am the of the corporation named as Contractor herein; that who signed this Agreement on behalf of the Contractor, was then of said corporation; that said Agreement was duly signed for and in behalf of said corporation by authority of its governing body, and is within the scope of its corporate powers. Corporate Seal (Corporate Secretary) Please indicate above with N/A to all blanks above if LLC and authorized person signature at Corporate Secretary. GENERAL CONDITIONS - PART I FOR CONSTRUCTION 1. Contract and Contract Documents a. The project to be constructed pursuant to this contract will be financed with assistance from the General Land Office (GLO) through the Community Development Block Grant— Mitigation (CDBG-MIT) fund and is subject to all applicable Federal and State laws and regulations. b. The Plans, Specifications and Addenda shall form part of this contract and the provisions thereof shall be binding upon the parties as if they were herein fully set forth. 2. Definitions Whenever used in any of the Contract Documents, the following meanings shall be given to the terms here in defined: (a) The term "Contract" means the Contract executed between Calhoun County, hereinafter called the "County" and Name of Construction Co.), hereinafter called "Contractor", of which these GENERAL CONDITIONS, form a part. (b) The term "Project Area" means the area within the specified Contract limits of the Improvements contemplated to be constructed in whole or in part under this contract. (c) The term "Engineer" means (G & W Engineers, Inc.), Engineer in charge, serving the County with architectural or engineering services, his successor, or any other person or persons, employed by the County for the purpose of directing or having in charge the work embraced in this Contract. (d) The term "Contract Documents" means and shall include the following: Executed Contract, Addenda (if any), Invitation for Bids, Instructions to Bidders, Signed Copy of Bid, General Conditions, Special Conditions, Technical Specifications, and Drawings (as listed in the Schedule of Drawings). 3. Supervision By Contractor (a) Except where the Contractor is an individual and personally supervises the work, the Contractor shall provide a competent superintendent, satisfactory to the Engineer, on the work at all times during working hours with full authority to act as Contractor's agent. The Contractor shall also provide adequate staff for the proper coordination and expediting of his work. (b) The Contractor shall be responsible for all work executed under the Contract. Contractor shall verify all figures and elevations before proceeding with the work and will be held responsible for any error resulting from his failure to do so. 4. Subcontracts (a) The Contractor shall not execute an agreement with any subcontractor or permit any subcontractor to perform any work included in this contract until Contractor has verified the subcontractor has been cleared (not suspended or debarred) to participate in federally funded contracts. (b) No proposed subcontractor shall be disapproved by the County except for cause. (C) The Contractor shall be as fully responsible to the County for the acts and omissions of his subcontractors, and of persons either directly or indirectly employed by them. (d) The Contractor shall cause appropriate provisions to be inserted in all subcontracts relative to the work and required compliance by each subcontractor with the applicable provisions of the Contract. (e) Nothing contained in the Contract shall create any contractual relation between any subcontractor and the County. (f) Contractors are encouraged to subcontract with Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms. 5. Fitting and Coordination of Work The Contractor shall be responsible for the proper fitting of all work and for the coordination of the operations of all trades, subcontractors, or material suppliers engaged upon this Contract. 6. Payments to Contractor (a) Partial Payments 1) The Contractor shall prepare the requisition for partial payment as of the last day of the month and submit it, with the required number of copies, to the Engineer for approval. The amount of the payment due the Contractor shall be determined by adding to the total value of work completed to date, the value of materials properly stored on the site and deducting (1) five percent (5%) of the total amount, to be retained until final payment, and (2) the amount of all previous payments. The total value of work completed to date shall be based on the estimated quantities of work completed and on the unit prices contained in the agreement. The value of materials properly stored on the site shall be based upon the estimated quantities of such materials and the invoice prices. Copies of all invoices shall be available for inspection of the Engineer. 2) Monthly or partial payments made by the County to the Contractor are advanced for the purpose of assisting the contractor to expedite the work of construction. The Contractor shall be responsible for the care and protection of all materials and work upon which payments have been made until final acceptance of such work and materials by the County. Such payments shall not constitute a waiver of the right of the County to require the fulfillment of all terms of the Contract and the delivery of all improvements embraced in this Contract complete and satisfactory to the County in all details. (b) Final Payment 1) After final inspection and the acceptance by the County of all work under the Contract, the Contractor shall prepare the requisition forfinal payment which shall be based upon the careful inspection of each item of work at the applicable unit prices stipulated in the Contract. The total amount of the final payment due the Contractor under this Contract shall be the amount computed as described above less all previous payments. 2) Before paying the final estimate, County shall require the Contractor to furnish releases or receipts from all subcontractors having performed any work and all persons having supplied materials, equipment (installed on the Project) and services to the Contractor. The County may make payment in part or in full to the Contractor without requiring the furnishing of such releases or receipts and any payments made shall in no way impair the obligations of any surety or sureties furnished under this Contract. 3) Any amount due to the County under Liquidated Damages, shall be deducted from the final payment due from the contractor. (c) Payments Subject to Submission of Certificates Each payment to the Contractor by the County shall be made subject to submission by the Contractor of all written certifications required of it and its subcontractors. (d) Withholding Payments The County may withhold any payment due the Contractor as deemed necessary to protect the County, and if so elects, may also withhold any amounts due from the Contractor to any subcontractors or material dealers, for work performed or material furnished by them. The foregoing provisions shall be construed solely for the benefit of the County and will not require the County to determine or adjust any claims or disputes between the Contractor and its subcontractors or material dealers, or to withhold any moneys for their protection unless the County elects to do so. The failure or refusal of the County to withhold any moneys from the Contractor shall in no way impair the obligations of any surety or sureties under any bond or bonds furnished under this Contract. 7. Changes in the Work (a) The County may make changes in the scope of work required to be performed by the Contractor under the Contract without relieving or releasing the Contractor from any obligations under the Contract or any guarantee given pursuant to the Contract provisions, and without affecting the validity of the guaranty bonds, and without relieving or releasing the surety or sureties of said bonds. All such work shall be executed under the terms of the original Contract unless it is expressly provided otherwise. Additionally, all such change orders must be approved by CDBG-MIT prior to execution of same. (b) Except for the purpose of affording protection against any emergency endangering health, life, limb or property, the Contractor shall make no change in the materials used or in the specified manner of constructing and/or installing the improvements or supply additional labor, services or materials beyond that actually required for the execution of the Contract, unless in pursuance of a written order from the County authorizing the Contractor to proceed with the change. No claim for an adjustment of the Contract Price will be valid unless so ordered. (c) If applicable unit prices are contained in the Contract, the County may order the Contractor to proceed with desired unit prices specified in the Contract; provided that in case of a unit price contract the net value of all changes does not increase the original total amount of the agreement by more than twenty-five percent (25%) or decrease the original total amount by more than twenty-five percent (25%) for municipalities and eighteen percent (18%) for counties without the written consent of the contractor. [Texas Local Government Code Section 252.048(d) and Section 262.031(b)] (d) Each change order shall include in its final form: 1) A detailed description of the change in the work. 2) The Contractor's proposal (if any) or a confirmed copy thereof. 3) A definite statement as to the resulting change in the contract price and/or time. 4) The statement that all work involved in the change shall be performed in accordance with contract requirements except as modified by the change order. 5) The procedures as outlined in this Section for a unit price contract also apply in any lump sum contract. 8. Claims for Extra Cost (a) If the Contractor claims that any instructions by Drawings or otherwise involve extra cost or extension of time, he shall, within ten days after the receipt of such instructions, and in any event before proceeding to execute the work, submit his protest thereto in writing to the County, stating clearly and in detail the basis of his objections. No such claim will be considered unless so made. (b) Claims for additional compensation for extra work, due to alleged errors in ground elevations, contour lines, or bench marks, will not be recognized unless accompanied by certified survey data, made prior to the time the original ground was disturbed, clearly showing that errors exist which resulted, or would result, in handling more material, or performing more work, than would be reasonably estimated from the Drawings and maps issued. (c) Any discrepancies which may be discovered between actual conditions and those represented by the Drawings and maps shall be reported at once to the County and work shall not proceed except at the Contractor's risk, until written instructions have been received from the County. (d) If, on the basis of the available evidence, the County determines that an adjustment of the Contract Price and/or time is justifiable, a change order shall be executed. 9. Termination. Delays, and Liquidated Damages Right of the County to Terminate Contract for Convenience County may at any time and for any reason terminate Contractor's services and work at County's convenience upon providing written notice to the Contractor specifying the extent of termination and the effective date. Upon receipt of such notice, Contractor shall, unless the notice directs otherwise, immediately discontinue the work and placing of orders for materials, facilities and supplies in connection with the performance of this Agreement. Upon such termination, Contractor shall be entitled to payment only as follows: (1) the actual cost of the work completed in conformity with this Agreement plus (2) such other costs actually incurred by Contractor as are permitted by the prime contract and approved by County. There shall be deducted from such sums as provided in this subparagraph the amount of any payments made to Contractor prior to the date of the termination of this Agreement. Contractor shall not be entitled to any claim or claim of lien against County for any additional compensation or damages in the event of such termination and payment. Right of the County to Terminate Contract for Cause If the Contractor fails to fulfill in a timely and proper manner its obligations under this Agreement, or if the Contractor violates any of the covenants, conditions, agreements, or stipulations of this Agreement, the County shall have the right to terminate this Agreement by giving written notice to the Contractor of such termination and specifying the effective date thereof, which shall be at least five days before the effective date of such termination. In the event of termination for cause, all finished or unfinished documents, data, studies, surveys, drawings, maps, models, photographs and reports prepared by the Contractor pursuant to this Agreement shall, at the option of the County, be turned over to the County and become the property of the County. In the event of termination for cause, the Contractor shall be entitled to receive reasonable compensation for any necessary services actually and satisfactorily performed prior to the date of termination. Notwithstanding the above, the Contractor shall not be relieved of liability to the County for damages sustained by the County by virtue of any breach of contract by the Contractor, and the County may set-off the damages it incurred as a result of the Contractor's breach of contract from any amounts it might otherwise owe the Contractor. 2 CFR 200 APPENDIX II(B) (a) Liquidated Damages for Delays. If the work is not completed within the time stipulated in the applicable bid for Lump Sum or Unit Price Contract provided, the Contractor shall pay to the County as fixed, agreed, and liquidated damages (it being impossible to determine the actual damages occasioned by the delay) the amount of $5l)0 for each calendar day of delay, until the work is completed. The Contractor and Contractor's sureties shall be liable to the County for the amount thereof. (b) Excusable Delays. 1) The right of the Contractor to proceed shall not be terminated nor shall the Contractor be charged with liquidated damages for any delays in the completion of the work due to: 2) Any acts of the Government, including controls or restrictions upon or requisitioning of materials, equipment, tools, or labor by reason of war, national defense, or any other national emergency; 3) Any acts of the County; 4) Causes not reasonably foreseeable by the parties to this Contract at the time of execution which are beyond the control and without the fault or negligence of the Contractor, including, but not restricted to, acts of God, terrorism, war, acts of another Contractor in the performance of some other contract with the County, fires, floods, epidemics, quarantine, restrictions, strikes, freight embargoes, and weather of unusual severity such as hurricanes, tornadoes, cyclones and other extreme weather conditions. 5) Provided, however, that the Contractor promptly notifies the County within ten (10) days in writing of the cause of the delay. Upon receipt of such notification, the County shall ascertain the facts and the cause and extent of delay. If, upon the basis of the facts and the terms of this contract, the delay is properly excusable, the County shall extend the time for completing the work for a period of time commensurate with the period of excusable delay. 10. Assignment or Novation The Contractor shall not assign nor transfer, whether by assignment or novation, any of its rights, duties, benefits, obligations, liabilities, or responsibilities under this Contract without the written consent of the County. No assignment or novation of this Contract shall be valid unless the assignment or novation expressly provides that the assignment of any of the Contractor's rights or benefits under the Contract is subject to a prior lien for labor performed, services rendered, and materials, tools, and equipment supplied for the performance of the work under this Contract in favor of all persons, Contractors, or corporations rendering such labor or services or supplying such materials, tools, or equipment. 11. Technical Specifications and Drawings Anything mentioned in 'the Technical Specifications and not shown on the Drawings or vice versa, shall be of like effect as if shown on or mentioned in both. In case of difference between Drawings and Technical Specifications, the Technical Specifications shall govern. In case of any discrepancy in Drawings, or Technical Specifications, the matter shall be immediately submitted to the County for review. Contractor shall be liable for any issues or expenses in the event the discrepancy is not submitted to the County. 12. Shop Drawings (a) All required shop drawings, machinery details, layout drawings, etc. shall be submitted to the Engineer in 3 copies for approval sufficiently in advance of requirements to afford ample time for checking, including time for correcting, resubmitting and rechecking if necessary. The Contractor may proceed, only at Contractor's own risk, with manufacture or installation of any equipment or work covered by said shop drawings, etc. until they are approved and no claim, by the Contractor, for extension of the contract time shall be granted by reason of his failure in this respect. (b) Any drawings submitted without the Contractor's stamp of approval will not be considered and will be returned to him for proper resubmission. If any drawings show variations from the requirements of the Contract because of standard shop practice or other reason, the Contractor shall make specific mention of such variation in his letter of transmittal in order that, if acceptable, suitable action may be taken for proper adjustment of contract price and/or time, otherwise the Contractor will not be relieved of the responsibility for executing the work in accordance with the Contract even though the drawings have been approved. (c) If a shop drawing is in accordance with the contract or involves only minor adjustment in the interest of the County not involving a change in contract price or time, the engineer may approve the drawing. The approval shall not relieve the Contractor from responsibility to adhere to the contract or for any error in the drawing. 13. Requests for Supplementary Information It shall be the responsibility of the Contractor to make timely requests of the County for any additional information which should be furnished by the County under the terms of this Contract, and which is required in the planning and execution of the work. Such requests may be submitted from time to time as the need approaches, but each shall be filed in ample time to permit appropriate action to be taken by all parties involved so as to avoid delay. Each request shall be in writing, and list the various items and the latest date by which each will be required by the Contractor. The first list shall be submitted within two weeks after Contract award and shall be as complete as possible at that time. The Contractor shall, if requested, furnish promptly any assistance and information the Engineer may require in responding to these requests of the Contractor. The Contractor shall be fully responsible for any delay in his work or to others arising from his failure to comply fully with the provision of this section. 14. Materials and Workmanship (a) Unless otherwise specifically provided for in the technical specifications, all workmanship, equipment, materials and articles incorporated in the work shall be new and the best grade of the respective kinds for the purpose. Where equipment, materials, articles or workmanship are referred to in the technical specifications as "equal to" any particular standard, the Engineer shall decide the question of equality. (b) The Contractor shall furnish to the County for approval the manufacturer's detailed specifications for all machinery, mechanical and other special equipment, which he contemplates installing together with full information as to type, performance characteristics, and all other pertinent information as required, and shall likewise submit for approval full information concerning all other materials or articles which he proposes to incorporate. (c) Machinery, mechanical and other equipment, materials or articles installed or used without such prior approval shall be at the risk of subsequent rejection. (d) Materials specified by reference to the number or symbol of a specific standard, shall comply with requirements in the latest revision thereof and any amendment or supplement thereto in effect on the date of the Invitation for Bids, except as limited to type, class or grade, or modified in the technical specifications shall have full force and effect as though printed therein. (e) The County may require the Contractor to dismiss from the work such employee or employees as the County or the Engineer may deem unqualified. 15. Samples. Certificates and Tests (a) The Contractor shall submit all material or equipment samples, certificates, affidavits, etc., as called for in the contract documents or required by the Engineer, promptly after award of the contract and acceptance of the Contractor's bond. No such material or equipment shall be manufactured or delivered to the site, except at the Contractor's own risk, until the required samples or certificates have been approved in writing by the Engineer. Any delay in the work caused by late or improper submission of samples or certificates for approval shall not be considered just cause for an extension of the contract time. (b) Each sample submitted by the Contractor shall carry a label giving the name of the Contractor, the project for which it is intended, and the name of the producer. The accompanying certificate or letter from the Contractor shall state that the sample complies with contract requirements, shall give the name and brand of the product, its place of origin, the name and address of the producer and all specifications or other detailed information which will assist the Engineer in making a prompt decision regarding the acceptability of the sample. It shall also include the statement that all materials or equipment furnished for use in the project will comply with the samples and/or certified statements. (c) Approval of any materials shall be general only and shall not constitute a waiver of the County's right to demand full compliance with Contract requirements. After actual deliveries, the Engineer will have such check tests made as he deems necessary in each instance and may reject materials and equipment and accessories for cause, even though such materials and articles have been given general approval. If materials, equipment or accessories which fail to meet check tests have been incorporated in the work, the Engineer will have the right to cause their removal and replacement by proper materials or to demand and secure such reparation by the Contractor as is equitable. (d) Except as otherwise specifically stated in the Contract, the costs of sampling and testing will be divided as follows: 1) The Contractor shall furnish without extra cost, including packing and delivery charges, all samples required for testing purposes, except those samples taken on the project by the Engineer; 2) The Contractor shall assume all costs of re -testing materials which fail to meet contract requirements; 3) The Contractor shall assume all costs of testing materials offered in substitution for those found deficient; 4) The County will pay all other expenses. 16. Permits and Codes (a) The Contractor shall give all notices required by and comply with all applicable federal and state laws, ordinances, and codes of the Local Government. All construction work and/or utility installations shall comply with all applicable ordinances, and codes including all written waivers. Before installing any work, the Contractor shall examine the drawings and technical specifications for compliance with applicable ordinances and codes and shall immediately report any discrepancy to the County. Where the requirements of the drawings and technical specifications fail to comply with such applicable ordinances or codes, the County will adjust the Contract by Change Order to conform to such ordinances or codes (unless waivers in writing covering the difference have been granted by the governing body or department) and make appropriate adjustment in the Contract Price or stipulated unit prices. (b) Should the Contractor fail to observe the foregoing provisions and proceed with the construction and/or install any utility at variance with any applicable ordinance or code, including any written waivers (notwithstanding the fact that such installation is in compliance with the drawings and technical specifications), the Contractor shall remove such work without cost to the County. (c) The Contractor shall at his own expense, secure and pay for all permits for street pavement, sidewalks, shed, removal of abandoned water taps, sealing of house connection drains, pavement cuts, buildings, electrical, plumbing, water, gas and sewer permits required by the local regulatory body or any of its agencies. (d) The Contractor shall comply with applicable local laws and ordinances governing the disposal of surplus excavation, materials, debris and rubbish on or off the Project Area and commit no trespass on any public or private property in any operation due to or connected with the Improvements contained in this Contract. (a) The Contractor will be required to make arrangements for and pay the water, electrical power, or any other utilities required during construction. (f) During construction of this project, the Contractor shall use every means possible to control the amount of dust created by construction. Prior to the close of a day's work, the Contractor, If directed by the County, shall moisten the surrounding area to prevent a dusty condition. 17. Care of Work (a) The Contractor shall be responsible for all damages to person or property that occur as a result of its fault or negligence in connection with the prosecution of the work and shall be responsible for the proper care and protection of all materials delivered and work performed until completion and final acceptance. (b) The Contractor shall provide sufficient competent watchmen, both day and night, including Saturdays, Sundays, and holidays, from the time the work is commenced until final completion and acceptance. (c) In an emergency affecting the safety of life, limb or property, including adjoining property, the Contractor, without special instructions or authorization from the County is authorized to act to prevent such threatened loss or injury. Contractor shall follow all instructions of County. (d) The Contractor shall avoid damage as a result of his operations to existing sidewalks, streets, curbs, pavements, utilities (except those which are to be replaced or removed), adjoining property, etc., and shall be responsible for completely repairing any damage thereto caused by the operations. (e) The Contractor shall shore up, brace, underpin, secure, and protect as maybe necessary, all foundations and other parts of existing structures adjacent to, adjoining, and in the vicinity of the site, which may be in any way affected by the excavations or other operations connected with the construction of the improvements included in this Contract. The Contractor shall be responsible for the giving of any and all required notices to any adjoining or adjacent property owner or other party before the commencement of any work. The Contractor shall indemnify and save harmless the County from any damages on account of settlements or the loss of lateral support of adjoining property and from all loss or expense and all damages for which the County may become liable in consequence of such injury or damage to adjoining and adjacent structures and their premises. 18. Accident Prevention (a) No laborer or mechanic employed in the performance of this Contract shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his health orsafety as determined under construction safety and health standards promulgated by the Department of Labor. (b) The Contractor shall exercise proper precaution at all times for the protection of persons and property and shall be responsible for all damages to persons or property, either on or off the site, which occur as a result of his prosecution of the work. (c) The Contractor shall maintain an accurate record of all cases of death, occupational disease, or injury requiring medical attention or causing loss of time from work, arising out of and in the course of employment on work under the Contract. The Contractor shall promptly furnish the County with reports concerning these matters. (d) The Contractor shall indemnify and hold harmless the County from any claims for damages resulting from property damage, personal injury and/or death suffered or alleged to have been suffered by any person as a result of any work conducted under this contract. (a) The Contractor shall provide trench safety for all excavations more than five feet deep prior to excavation. All OSHA Standards for trench safety must be adhered to by the Contractor. (f) The contractor shall at all times conduct work in such a manner as to ensure the least possible inconvenience to vehicular and pedestrian traffic. At the close of the work each day, all streets where possible in the opinion of the County, shall be opened to the public in order that persons living in the area may have access to their homes or businesses by the use of the streets. Barricades, warning signs, and necessary lighting shall be provided to the satisfaction of the County at the expense of the Contractor. 19. Sanitary Facilities The Contractor shall furnish, install and maintain ample sanitary facilities for laborers. As the needs arise, a sufficient number of enclosed temporary toilets shall be conveniently placed as required. Drinking water shall be provided from an approved source, so piped or transported as to keep it safe and fresh and served from single service containers or satisfactory types of sanitary drinking stands or fountains. All such facilities and services shall be furnished in strict accordance with existing and governing health regulations. 20. Use of Premises (a) The Contractor shall confine equipment, storage of materials, and construction operations to the contract limits as shown on the drawings and as prescribed by ordinances or permits, or as may be desired by the County, and shall not unreasonably encumber the site or public rights of way with materials and construction equipment. (b) The Contractor shall comply with all reasonable instructions of the County and all existing federal, state and local regulations regarding signs, advertising, traffic, fires, explosives, danger signals, and barricades. 21. Removal of Debris. Cleaning, Etc. The Contractor shall, periodically or as directed during the progress of the work, remove and legally dispose of all surplus excavated material and debris, and keep the Project Area and public rights of way reasonably clear. Upon completion of the work, he shall remove all temporary construction facilities, debris and unused materials provided for work, and put the whole site of the work and public rights of way in a neat and clean condition. 22. Inspection (a) All materials and workmanship shall be subject to inspection, examination, or test by the County and Engineer at any and all times during manufacture or construction and at any and all places where such manufacture or construction occurs. The County shall have the right to reject defective material and workmanship or require its correction. Unacceptable workmanship shall be satisfactorily corrected. Rejected material shall be promptly segregated and removed from the Project Area and replaced with material of specified quality without charge. If the Contractor fails to proceed at once with the correction of rejected workmanship or defective material, the County may by contract or otherwise have the defects remedied or rejected materials removed from the Project Area and charge the cost of the same against any Monies which may be due the Contractor, without prejudice to any other rights or remedies of the County. (b) The Contractor shall furnish promptly all materials reasonably necessary for any tests which may be required. All tests by the County will be performed in such manner as not to delay the work unnecessarily and will be made in accordance with the provisions of the technical specifications. (c) The Contractor shall notify the County sufficiently in advance of back filling or concealing any facilities to permit proper inspection. If any facilities are concealed without approval or consent of the County, the Contractor shall uncover for inspection and recover such facilities at Contractor's expense, when so requested by the County. (d) Should it be considered necessary or advisable by the County at any time before final acceptance of the entire work to make an examination of work already completed, the Contractor shall on request promptly furnish all necessary facilities, labor, and material. If such work is found to be defective in any important or essential respect, due to fault of the Contractor or subcontractors, the Contractor shall defray all the expenses of such examination and of satisfactory reconstruction. If, however, such work is found to meet the requirements of the Contract, the actual cost of labor and material necessarily involved in the examination and replacement, shall be reimbursable and if completion of the work of the entire Contract has been delayed, a suitable extension of time will be approved. (a) Inspection of materials and appurtenances to be incorporated in the improvements included in this Contract may be made at the place of production, manufacture or shipment, whenever the quantity justifies it, and such inspection and acceptance, unless otherwise stated in the technical specifications, shall be final, except as regards to: (1) latent defects, (2) departures from specific requirements of the Contract, (3) damage or loss in transit, or (4) fraud or such gross mistakes as amount to fraud. Subject to the requirements contained in the preceding sentence, the inspection of materials as a whole or in part will be made at the Project Site. (f) Neither inspection, testing, approval nor acceptance of the work in whole or in part, by the County or its agents shall relieve the Contractor or its sureties of full responsibility for materials furnished or work performed not in strict accordance with the Contract. 23. Review by County The County and its authorized representatives and agents shall have access to and be permitted to observe and review all work, materials, equipment, payrolls, personnel records, employment conditions, material invoices, and other relevant data and records pertaining to this Contract, provided, however that all instructions and approval with respect to the work will be given to the Contractor only by the County through its authorized representatives or agents. 24. Final Inspection When the Improvements included in this Contract are substantially completed, the Contractor shall notify the County in writing that the work will be ready for final inspection on a definite date which shall be stated in the notice. The County will make the arrangements necessary to have final inspection commenced on the date stated in the notice, or as soon thereafter as is practicable. 25. Deduction for Uncorrected Work If the County deems it not expedient to require the Contractor to correct work not done in accordance with the Contract Documents, an equitable deduction from the Contract Price will be made by agreement between the Contractor and the County and subject to settlement, in case of dispute, as herein provided. 26.Insurance The Contractor shall not commence work under this contract until all required insurance under this paragraph has been secured and approved by the County. These minimum insurance coverage requirements supercede the Calhoun County, Texas General Conditions minimum insurance cover requirements. (a) Worker's Compensation Insurance: The Contractor shall procure and shall maintain during the life of this contract Worker's Compensation Insurance as required by the State of Texas for all of his employees to be engaged in work at the site of the project under this contract and, in case of any such work sublet, the Contractor shall require the subcontractor similarly to provide Worker's Compensation Insurance for all of the employees to be engaged in such work unless such employees are covered by the protection afforded by the Contractor's Worker's Compensation Insurance. (b) Contractor's Public Liability and Property Damage Insurance and Vehicle Liability Insurance. The Contractor shall procure and shall maintain during the life of this contract Contractor's Public Liability Insurance, Contractor's Property Damage Insurance and Vehicle Liability Insurance in the following amounts: 1) CONTRACTOR shall have, (or purchase) and shall maintain in force during the duration of the Work, coverage for the hazard of explosion, collapse and underground shall be included. Coverage for independent contractor's liability, contractual liability, products/completed operations liability, personal injury and broad form property damage shall also be included. Completed operations liability shall be kept in force for at least one (1) year after the date of final completion. Coverages shall have at least the following limits: General Aggregate $2,000,000 Products -Completed Operations Aggregate $1,000,000 Personal and Advertising Injury $1,000,000 Each Occurrence $1,000,000 Fire Damage $ 50,000 2) ADDITIONAL Insured ALL POLICIES (Except for Workman's Compensation/Employers Liability) will name CALHOUN COUNTY as an additional insured for all insurance requirements, by policy endorsement, along with COUNTY's Employees and OWNER's Engineer (G&W Engineers, Inc.) as ADDITIONAL INSURED and must provide coverage to the maximum extent permitted by law. The additional insured endorsements shall be on the ISO CG2010 11185 form or CG 2010 (10/93) in combination with CG 2037 of CG 2033, or suitable form equivalent. 3) Automobile Liability CONTRACTOR shall have (or purchase) and shall maintain in force, for the duration of the Work, coverage cars and trucks owned, rented, hired, or leased, and others of non -ownership nature used by employees in and around or in connection with the particular Contract. Coverage shall have at least the following limit Combined Single Limit $1,000,000 4) Builders Risk Insurance CONTRACTOR shall have (or purchase) and shall maintain in force during the duration of the Work, coverage for, but not limited to, fire, lightning, windstorm, tornado, hurricane, and hail. Coverage shall be in the amount of 100 percent complete value basis on the insurable portions of the project forthe benefit of OWNER, CONTRACTOR, and all subcontractors, as their interests may appear. 5) Deductible No deductible on any coverage in excess of $500.00 per occurrence is acceptable. 6) In the event OWNER is notified of cancellation of all or any part, OWNER may stop all Work on the Contract or secure insurance at its will and charge CONTRACTOR the cost thereof deducting the cost from CONTRACTOR's funds. (c) Proof of Insurance: The Contractor shall furnish the County with certificates showing the type, amount, class of operations covered, effective dates and date of expiration of policies. Such certificates shall also contain substantially the following statement: "The insurance covered by this certificate will not be canceled or materially altered, except after ten (10) days written notice has been received by the County." 27. Warranty of Title No material, supplies, or equipment to be installed or furnished under this Contract shall be purchased subject to any chattel mortgage or under a conditional sale, lease -purchase orother agreement by which an interest is retained by the selleror supplier. The Contractor shall warrant good title to all materials, supplies, and equipment installed or incorporated in the work and upon completion of all work, shall deliver the same, together with all improvements and appurtenances constructed or placed by Contractor, to the County free from any claims, liens, or charges. Neither the Contractor nor any person, firm, or corporation furnishing any material or labor for any work covered by this Contract shall have any right to a lien upon any improvement or appurtenance. Nothing contained in this paragraph, however, shall defeat or impair the right of persons furnishing materials or labor to recover under any law permitting such persons to look to funds due the Contractor. The provisions of this paragraph shall be inserted in all subcontracts and material contracts and notice of its provisions shall be given to all persons furnishing materials for the work when no formal contract is entered into for such materials. 28. Warranty of Workmanship and Materials Neither the final certificate of payment nor any provision in the Contract nor partial or entire use of the improvements included in this Contract by the County or the public shall constitute an acceptance of work not done in accordance with the Contract or relieve the Contractor of liability in respect to any express warranties or responsibility for faulty materials or workmanship. The Contractor shall promptly remedy any defects in the work and pay for any damage to other work resulting therefrom which shall appear within a period of 12 months from the date of final acceptance of the work. 29. Job Offices (a) The Contractor and its subcontractors may maintain such office and storage facilities on the site as are necessary for the proper conduct of the work. These shall be located so as to cause no interference to any work to be performed on the site. The County shall be consulted with regard to locations. (b) Upon completion of the improvements, or as directed by the County, the Contractor shall remove all such temporary structures and facilities from the site, and leave the site of the work in the condition required by the Contract. 30. Partial Use of Site Improvements The County may give notice to the Contractor and place in use those sections of the improvements which have been completed, inspected and can be accepted as complying with the technical specifications and if in its opinion, each such section is reasonably safe, fit, and convenient for the use and accommodation for which it was intended, provided: (a) The use of such sections of the Improvements shall in no way impede the completion of the remainder of the work by the Contractor. (b) The Contractor shall not be responsible for any damages or maintenance costs due directly to the use of such sections. 31. Contract Documents and Drawings The County will furnish the Contractor without charge 3 copies of the Contract Documents, including Technical Specifications and Drawings. Additional copies requested by the Contractor will be furnished at cost. 32. Contract Period The work to be performed under this contract shall commence within the time stipulated by the County in the Notice to Proceed, and shall be fully completed within 118 calendar days thereafter. 33. Liquidated Damages Since the actual damages for any delay in completion of the work under this contract are impossible to determine, the Contractor and his Sureties shall be liable for and shall pay to the County the sum of five hundred dollars ($ 50U as fixed, agreed and liquidated damages for each calendar day of delay from the above stipulated time for completion. ADMINISTRATIVE REQUIREMENTS 34. Local Program Liaison For purposes of this Agreement, the County Engineer or equivalent authorized person will serve as the Local Program Liaison and primary point of contact for the Contractor. All required progress reports and communication regarding the project shall be directed to this liaison and other local personnel as appropriate. 35. Access to Information (a) The U.S. Department of Housing and Urban Development (HUD), Inspectors General, the Comptroller General of the United States, the General Land Office (GLO), and the County, or any of their authorized representatives, shall have access to any documents, papers, or other records of the Contractor which are pertinent to the CDBG-MIT award, in order to make audits, examinations, excerpts, and transcripts, and to closeout the County's CDBG-MIT contract with GLO. 2 CFR 200.336 (former 24 CFR 85.36(i)(10)) The Office of the Comptroller General of the United States, the Government Accountability Office, the Office of Inspector General, or any authorized representative of the U.S. Government shall also have this right of inspection. (b) Contractor shall include the substance of this clause in all subcontracts it awards. 36. Records Retention (a) The Contractor shall retain all required records for three years after the County makes its final payment and all pending matters are closed. 2 CFR 200.333 (former 24 CFR (85.36(i)(11)) (b) Contractor shall include the substance of this clause in all subcontracts it awards. FEDERAL REQUIRMENTS 37. Resolution of Program Non -Compliance and Disallowed Costs In the event of any dispute, claim, question, or disagreement arising from or relating to this Contract, or the breach thereof, Including determination of responsibility for any costs disallowed as a result of non-compliance with federal, state or CDBG- MIT program requirements, the parties hereto shall use their best efforts to settle the dispute, claim, question or disagreement. To this effect, the parties shall consult and negotiate with each other in good faith within 30 days of receipt of a written notice of the dispute or invitation to negotiate, and attempt to reach a just and equitable solution satisfactory to both parties. If the matter is not resolved by negotiation within 30 days of receipt of written notice or invitation to negotiate, the parties agree first to try in good faith to settle the matter by mediation administered by the American Arbitration Association under its Commercial Mediation Procedures before resorting to arbitration, litigation, or some other dispute resolution procedure. The parties may enter into a written amendment to this Contract and choose a mediator that is not affiliated with the American Arbitration Association. The parties shall bear the costs of such mediation equally. [This section may also provide for the qualifications of the mediator(s), the locale of meetings, time limits, or any other item of concern to the parties.] If the matter is not resolved through such mediation within 60 days of the initiation of that procedure, either party may proceed to file suit. 38. Compliance with Davis -Bacon Act All laborers and mechanics employed upon the work covered by this Contract shall be paid unconditionally and not less often than once each week, and without subsequent deduction or rebate on any account (except such payroll deductions as are made mandatory by law and such other payroll deductions as are permitted by the applicable regulations issued by the Secretary of Labor, United States Department of Labor, pursuant to the Anti -Kickback Act hereinafter identified), the full amount due at time of payment computed at wage rates not less than those contained in the wage determination decision of said Secretary of Labor (a copy of which is attached in Section 3, Item 24 and herein incorporated by reference), regardless of any contractual relationship which may be alleged to exist between the Contractor or any subcontractor and such laborers and mechanics. All laborers and mechanics employed upon such work shall be paid in cash, except that payment may be by check if the employer provides or secures satisfactory facilities approved by the County for the cashing of the same without cost or expense to the employee. For the purpose of this clause, contributions made or costs reasonably anticipated under Section f (b) (2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of Section 5.5 (a) (f) (iv) of Title 29, Code of Federal Regulations. Also for the purpose of this clause, regular contributions made or costs incurred for more than a weekly period under plans, funds, or programs, but covering the particular weekly period, are deemed to be constructively made or incurred during such weekly period. The Contractor and its subcontractors shall not, by any means, induce any person employed in the construction, completion, or repair of public work, give up any part of the compensation to which he or she is otherwise entitled. The County must report all suspected or reported violations to GLO. 39. Conflicts of Interest (a) Governing Body. No member of the governing body of the County and no other officer, employee, or agent of the County, who exercises any functions or responsibilities in connection with administration, construction, engineering, or implementation of CDBG-MIT award between GLO and the County, shall have any personal financial interest, direct or indirect, in the Contractor or this Contract; and the Firm shall take appropriate steps to assure compliance. (b) Other Local Public Officials. No other public official, who exercises any functions or responsibilities in connection with the planning and carrying out of administration, construction, engineering or implementation of the CDBG-MIT award between GLO and the County, shall have any personal financial interest, direct or indirect, in the Contractor or this Contract; and the Contractor shall take appropriate steps to assure compliance. (c) The Contractor and Employees. The Contractor warrants and represents that it has no conflict of interest associated with the CDBG-MIT award between GLO and the County or this Contract. The Contractor further warrants and represents that it shall not acquire an interest, direct or indirect, in any geographic area that may benefit from the CDBG-MIT award between GLO and the County or in any business, entity, organization or person that may benefit from the award. The Contractor further agrees that it will not employ an individual with a conflict of interest as described herein. 40. Debarment and Suspension (Executive Orders 12549 and 12689 The Contractor certifies, by entering into this Contract, that neither it nor its principals are presently debarred, suspended, or otherwise excluded from or ineligible for participation in federally -assisted programs under Executive Orders 12549 (1986) and 12689 (1989). The term "principal' for purposes of this Contract is defined as an officer, director, owner, partner, key employee, or other person with primary management or supervisory responsibilities, or a person who has a critical influence on or substantive control over the operations of the Contractor, The Contractor understands that it must not make any award or permit any award (or contract) at any tier to any parry which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, "Debarment and Suspension." A contract award (see 2 CFR 180.220) must not be made to parties listed on the government -wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. 2 CFR 200 APPENDIX II (H) 41. fFor Contracts that exceed $100 0001 Byrd Anti-Lobbvino Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award of $100,000 or more must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non -Federal award. Contractor shall file the required certification: The undersigned certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. 2 CFR 200 APPENDIX II (1) and 24 CFR §570.303 42. For Contracts > $100K1 Overtime Requirements No Contractor or subcontractor contracting for any part of the Contract work which may require or involve the employment of laborers or mechanics, including watchmen and guards, shall require or permit any laborer or mechanic in any workweek in which he is employed on such work to work in excess of 40 hours in such work week unless such laborer or mechanic receives compensation at a rate not less than one and one-half times his basic rate of pay for all hours worked in excess of 40 hours in such work week, as the case may be. 2 CFR 200 APPENDIX If (E) 43. Equal Opportunity Clause Comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§16811683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.§794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other non- discrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, 0) the requirements of any other nondiscrimination statute(s) which may apply. During the performance of this contract, the Contractor agrees as follows: (a.) The Contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The Contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. (b.) The Contractor will, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive considerations for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. (c.) The Contractor will not discourage or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. (d.) The Contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. (e.) The Contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, "Equal Employment Opportunity," and of the rules, regulations, and relevant orders of the Secretary of Labor. (f.) The Contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (g.) In the event of the Contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be canceled, terminated, or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. (h.) The Contractor will include the portion of the sentence immediately preceding paragraph (a) and the provisions of paragraphs (a) through (h) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The Contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, That in the event a Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency the Contractor may request the United States to enter into such litigation to protect the interests of the United States. 41 CFR §60-1.4(b) And 2 CFR 200 APPENDIX II (C) 44. Section 109 of the Housing and Community Development Act of 1974. The Contractor shall comply with the provisions of Section 109 of the Housing and Community Development Act of 1974. No person in the United States shall on the ground of race, color, national origin, religion, or sex be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with funds made available under this title. 45. Davis -Bacon Act, as amended (40 U.S.0 3141-3148) When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non -Federal entities must include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. The non -Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non - Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non -Federal entity must report all suspected or reported violations to the Federal awarding agency. 2 CFR 200 APPENDIX II (D) 46. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708) Where applicable, all contracts awarded by the non -Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision forcompliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. 2 CFR 200 APPENDIX II (E) 47. Section 504 Rehabilitation Act of 1973, as amended. The Contractor agrees that no otherwise qualified individual with disabilities shall, solely by reason of his/her disability, be denied the benefits of, or be subjected to discrimination, including discrimination in employment, under any program or activity receiving federal financial assistance. 48. Age Discrimination Act of 1975. The Contractor shall comply with the Age Discrimination Act of 1975 which provides that no person in the United States shall on the basis of age be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. 49. Non Segregated Facilities The Contractor certifies that he does not and will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not and will not permit his employees any segregated facilities at any of his establishments, or permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. As used in this paragraph the term "segregated facilities" means any waiting rooms, work areas, rest rooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local custom, or otherwise. 50. The Provision of Local Training. Employment and Business Opportunities (a) To the greatest extent feasible opportunities for training and employment be given lower income residents of the project area and contracts for work in connection with the project be awarded to business concerns which are located in, or owned in substantial part by persons residing in the area of the project. See also GLO Section 3 Policy and "Exhibit G" on the GLO-DR website. (b) The Contractor will include this clause in every subcontract for work in connection with the project. 51. [if this Contract is greater than $100,0001 Economic Opportunities for Section 3 Residents and Section 3 Business Concerns. (a) The work to be performed under this Contract is subject to the requirements of section 3 of the Housing and Urban Development (HUD) Act of 1968, as amended, 12 U.S.C. 1701 u (section 3). The purpose of section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD -assisted projects covered by section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. (b) The parties to this Contract agree to comply with HUD's regulations in 24 CFR part 135, which implement section 3. As evidenced by their execution of this Contract, the parties to this Contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. (c) The Contractor agrees to send to each labor organization or representative of workers with which the Contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the Contractor's commitments under this section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. (d) The Contractor agrees to include this section 3 clause in every subcontract subject to compliance with regulations in 24 CFR part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The Contractor will not subcontractwith any subcontractor where the Contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR part 135. (e) The Contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the Contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be directed, were not filled to circumvent the Contractor's obligations under 24 CFR part 135. (f) Noncompliance with HUD's regulations in 24 CFR part 135 may result in sanctions, termination of this Contract for default, and debarment or suspension from future HUD assisted contracts. (g) With respect to work performed in connection with section 3 covered Indian housing assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this Contract. Section 7(b) requires that to the greatest extent feasible (i) preference and opportunities for training and employment shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of section 3 and section 7(b) agree to comply with section 3 to the maximum extent feasible, but not in derogation of compliance with section 7(b). 24 CFR §135.38 52. Gender Neutral - Gender References When necessary, unless the context clearly requires otherwise, any gender -specific or gender -neutral term in this Contract (for example, he, she, it, etc.) is to be read as referring to any other gender or to no gender. 53. Patent Rights and Inventions Contractor shall comply with the requirements and regulations pertaining to patent rights with respect to any discovery or invention which arises or is developed in the course of or under such contract. (2 CFR 200 Appendix II (f) and Rights to Inventions in 37 CFR Part 401). Rights to Inventions Made Under a Contract or Agreement - If the Federal award meets the definition of "funding agreement" under 37 CFR §401.2 (a) and the Subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that "funding agreement;' the Subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. 54. Energy Efficiency The Contractor shall comply with the mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (42 U.S.C. 6201). (2 CFR 200 Appendix It (h)). 55. System for Award Management (SAM) All contractors and subcontractors must be searched AND cleared (not suspended or debarred) prior to authorization to work on the project. 56. Solid Waste Disposal Act Contractor must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. 57. Procurement of Recovered Materials (a) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA- designated items unless the product cannot be acquired- 1. Competitively within a timeframe providing for compliance with the contract performance schedule; 2. Meeting contract performance requirements; or 3. At a reasonable price. (c) Information about this requirement, along with the list of EPA -designate items, is available at EPA's Comprehensive Procurement Guidelines web site, httos://www.epa.gov/ 58. Domestic Preference a. As appropriate and to the extent consistent with law, Contractor should, to the greatest extent practicable, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). b. For purposes of section (a) above: L "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. H. "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer -based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. STATE REQUIREMENTS 58. Verification No Bovcott Israel As required by Chapter 2270, Government Code, CONTRACTOR hereby verifies that it does not boycott Israel and will not boycott Israel through the term of this Agreement. For purposes of this verification, "boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or In an Israeli -controlled territory, but does not include an action made for ordinary business purposes. 59. Foreign Terrorist Organizations. Pursuant to Chapter 2252, Texas Government Code, [Company] represents and certifies that, at the time of execution of this Agreement neither [Company], nor any wholly owned subsidiary, majority -owned subsidiary, parent company or affiliate of the same (i) engages in business with Iran, Sudan, or any foreign terrorist organization as described in Chapters 806 or 807 of the Texas Government Code, or Subchapter F of Chapter 2252 of the Texas Government Code, or (ii) is a company listed by the Texas Comptroller of Public Accounts under Sections 806.051, 807.051, or 2252.153 of the Texas Government Code. The term "foreign terrorist organization" in this paragraph has the meaning assigned to such term in Section 2252.151 of the Texas Government Code. ENVIRONMENTAL CONDITIONS 60. _[For Contracts > $150K] Clean Air Act and the Federal Water Pollution Control Act The Contractor or subcontractor shall comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). 2 CFR 200 APPENDIX 11 (G) 61. Lead -Based Paint The Subrecipient agrees that any construction or rehabilitation of residential structures with assistance provided under this Agreement shall be subject to HUD Lead -Based Paint Regulations at 24 CFR 570.608, and 24 CFR Part 35, Subpart B. Such regulations pertain to all CDBG-assisted housing and require that all owners, prospective owners, and tenants of properties constructed prior to 1978 be properly notified that such properties may include lead -based paint. Such notification shall point out the hazards of lead -based paint and explain the symptoms, treatment and precautions that should be taken when dealing with lead -based paint poisoning and the advisability and availability of blood lead level screening for children under seven. The notice should also point out that if lead -based paint is found on the property, abatement measures may be undertaken. The regulations further require that, depending on the amount of Federal funds applied to a property, paint testing, risk assessment, treatment and/or abatement may be conducted. 62. Flood Disaster Protection In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 U.S.C. 4001), the Subrecipient shall assure that for activities located in an area identified by the Federal Emergency Management Agency (FEMA) as having special flood hazards, flood insurance under the National Flood Insurance Program is obtained and maintained as a condition of financial assistance for acquisition or construction purposes (including rehabilitation). 63. Other Conditions conditions such as mitigation measures will be carried out as instructed by the Environmental Review Record. :ion Measures from Cminty Fnvirnnmc..+_: CALHOUN COUNTY, TEXAS GENERAL CONDITIONS General Conditions apply to all advertised Invitations to Bid (hereinafter called Bid), Request for Proposals (hereinafter called RFP), Request for Qualifications (hereinafter called RFQ), Contracts/Agreements/Leases (hereinafter called Contract); however these may be superseded in whole or in part by the scope, special requirements, specifications or special sections of Texas Government Code and/or Texas Local Government Code. Governing Law: Bidder/Vendor is advised that the Bid, RFP, RFQ and/or Contract shall be fully governed by the laws of the State of Texas and that Calhoun County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County Attorney concerning any portion of the Bid, RFP, RFQ and/or Contract. All parties agree thatthe venue for any litigation arising from this Bid, RFP, RFQ, and/or Contract shall be held in Port Lavaca, Calhoun County, Texas. Completion of Bid. RFP. RFQ. and/or Contract Forms,, Once the Bid, RFP, RFQ, and/or Contract is released forbidding, Calhoun County will not answer any questions except through an addendum that has been approved by Calhoun County Commissioners Court or at a mandatory pre -bid meeting. Complete, sign, and return to the Calhoun County Judge's Office the required number of Bid forms, RFP forms, RFQ forms, and/or Contracts, and any other required information by the day and time the Bid, RFP, RFQ and/or Contract is due. The Bid, RFP, RFQ and/or Contract must be signed and dated by an officer, employee or agent who is duly authorized to execute this Bid, RFP, RFQ and/or Contract, and affirms that this company, corporation, firm, partnership or individual has not prepared this Bid, RFP, RFQ, and/or Contract in collusion with any other bidder/vendor or any official or employee of Calhoun County, and that the contents of this Bid, RFP, RFQ and/or Contract as to prices, terms or conditions of said Bid, RFP, RFQ, and/or Contract have not been communicated by the individual signing nor by any employee or agent to any other person engaged in this type of business or to any official or employee of Calhoun County prior to the official opening of this Bid, RFP, RFQ and/or Contract. The use of liquid paper or white out is not acceptable and may result in the disqualification of the bidders/vendor's Bid, RFP, RFQ, and/or Contract. If an error is made, the bidder/vendor must draw a line through the error and initial each change. All responses typed or handwritten in ink must be clear and legible. Submission of Sealed Bid RFP RFQ and/or Contract: All Bids, RFPs, RFQs, and/or Contracts must be delivered to the County Judge's Office in a SEALED envelope. When submitting a SEALED Bid, RFP, RFQ and/or Contract the envelope must be taped and/or glued closed in order for it to be accepted as a SEALED Bid, RFP, RFQ and/or Contract. The bidder/vendor must submit the original and required number of copies of their completed Bid, RFP, RFQ and/or Contract and any additional required information/forms in a SEALED envelope to the Calhoun County Judge's Office, Calhoun County Courthouse, 211 South Ann Street, 3rd Floor, Suite 301, Port Lavaca, Texas. The Bid, RFP, RFQ, and/or Contract will specify the date and time due. The cell phone in the County Judge's office or the cell phone of the County Auditor's Representative is the official clock that will be used in determining the time the Bid, RFP, RFQ and/or Contract is received and the time deadline that the Bid, RFP, RFQ and/or Contract will be opened. A late delivery with an early postmark or delivery of the Bid, RFP, RFQ and/or Contract to the wrong office will not suffice. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be considered for award, regardless of whether or not the delay was outside of the control of the submitting bidder/vendor. The door to the County Judge's office will be closed once the due date and time has been reached and no other bids will be accepted. Calhoun County will not be responsible for the delivery of your Bid, RFP, RFQ and/or Contract to the office of the Calhoun County Judge. Calhoun County is not responsible for late deliveries due to postal mail or other mail delivery services delays. Calhoun County is not responsible for the delivery of the Bid, RFP, RFQ and/or Contract to the wrong office. Calhoun County does not accept faxed or emailed Bids, RFPs, RFQs, and/or Contracts. If the bidder/vendor would like to confirm the delivery of their Bid, RFP, RFQ and/or Contract, the bidder/vendor may call the Calhoun County Judge's office at 361-553-4600. Late Bids, RFPs, RFQs, and/or Contracts will not be accepted. Bids, RFPs, RFQs, and/or Contracts received after the deadline will not be opened and shall be considered void and unacceptable. Bids, RFPs, RFQs, and/or Contracts must be submitted in a SEALED 9 x 12 or larger envelope, addressed as follows: Richard H. Meyer, County Judge, Calhoun County Courthouse, 211 S. Ann St., Suite 301, Port Lavaca, TX 77979. The outside of the SEALED envelope must be clearly marked: SEALED BID (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. If the Bid, RFP, RFQ and/or Contract is sent by UPS, FedEx or other delivery service, the outside of this envelope must be clearly marked: SEALED Bid (RFP, RFQ or Contract) and the name of the Bid, RFP, RFQ or Contract. Withdrawal of Bid RFP RFQ and/or Contract: A bidder/vendor may withdraw their Bid, RFP, RFQ and/or Contract before Calhoun County's acceptance of the Bid, RFP, RFQ and/or Contract without prejudice to the bidder/vendor, by submitting a written request for its withdrawal to the Calhoun County Judge and mail or hand deliver to the address the Bid, RFP, RFQ and/or Contract was submitted to. A Bid, RFP, RFQ and/or Contract that was opened are not subject to amendment, alteration, or change for the purpose of correcting an error in the Bid, RFP, RFQ and/or Contract price. Bids, RFPs, RFQs, and/or Contracts containing an error may be offered "as is" or withdrawn by the bidder/vendor in accordance with applicable State Laws. Opening and Award of Bid RFP RFQ, and/or Contract: Bidders/vendors are invited to be present at the opening and awarding of the Bid, RFP, RFQ and/or Contract. Governing Forms: In the event of any conflict between the terms and provisions of these conditions, the Bid, RFP or RFQ specifications or contract, if applicable, shall govern. In the event of any conflict of interpretation of any part of this overall document, Calhoun County's interpretation shall govern. Addendums: When specifications are revised, the Calhoun County Auditor's Office will send each bidder/vendor that received a Bid, RFP, RFQ and/or Contract packet the addendum once it has been approved by Calhoun County Commissioners Court. No addendum can be sent out until Calhoun County Commissioners Court has approved the addendum or approved the addendum to be sent out by the Engineer with the approval from the County Commissioner or County Department in charge of the project. Indemnification/Hold Harmless: The successful bidder/vendor shall defend, indemnify and hold Calhoun County and its officials, agents, and employees harmless from all suits, actions, or for personal injury, death and/or property damage arising from any cause whatsoever, resulting directly or indirectly from bidder's/vendor's performance. Bidder/vendor shall procure and maintain, with respect to the subject matter of this Bid, RFP, RFQ and/or Contract, appropriate insurance coverage including, as a minimum, general liability and property damage, workers' compensation, employer's liability and auto insurance with adequate limits to cover bidder's/vendor's liability as may arise directly or indirectly from work performed under terms of this Bid, RFP, RFC, and/or Contract. Certification of such coverage shall name, by policy endorsement, Calhoun County as an additional insured and be provided to Calhoun County upon request. Waiver of Subrogation: Bidder/vendor and bidder's/vendor's insurance carrier shall waive any and all rights whatsoever with regard to subrogation against Calhoun County and its respective officials, employees, and insurers as an indirect party to any suit arising out of personal or property damages resulting from bidder's/vendors performance under this Bid, RFP, RFQ, and/or Contract. Insurers and all policies of insurance provided shall contain a provision and/or endorsement stating that the insurance carriers and underwriters waive all rights of subrogation in favor of Calhoun County and its respective officials, employees, and insurers. Bonds: If the Bid, or RFP, requires submission of bid or proposal guarantee and performance bond, there will be a separate page explaining those requirements. Bids or RFPs submitted without the required bid bond or cashier's checks are not acceptable. Taxes: Calhoun County is exempt from all sales tax (state, city and county sales tax) and federal excise taxes under Section 151.309 of the Texas Tax Code. Tax exempt forms will be furnished upon request to the bidder/vendor. Tax exempt forms can be obtained from the Calhoun County Auditor's Office. Bidder/vendor is to issue its Texas Resale Certificate to vendors and subcontractors for such items qualifying for this exemption, and further, bidder/vendor should state these items at cost. Pricing: Prices for all products/goods, services, and/or contracts shall be firm for the duration of the Bid, RFP, and/or Contract and shall be stated on the Bid, RFP, and/or Contract form. Prices shall be all inclusive. All prices must be written in ink or typewritten and must be legible. Pricing on all transportation, freight, and other charges are to be prepaid by the bidder/vendor and included in the Bid, RFP, and/or Contract prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, bidder/vendor must indicate the items required and their costs or forfeit the right to payment for such items. Additional charges added to the Bid, RFP, and/or Contract prices may void the Bid, RFP, and/or Contract. Where unit pricing and extended pricing differ, unit pricing prevails. Inspections: Calhoun County reserves the right to inspect any products/goods or service location for compliance with specifications and requirements and needs of the using department before accepting them. When applicable, Calhoun County reserves the right to enter upon any County leased premises at anytime to inspect said premises. Testing: Calhoun County reserves the right to test equipment, supplies, materials, and products/goods bid, proposed, and/or agreed upon for quality, compliance with specifications and ability to meet the needs of the user. Should the equipment, supplies, materials, products/goods and/or services fail to meet requirements and/or be unavailable for evaluation, the Bid, RFP, and/or Contract is subject to rejection. Material Safety Data Sheets: Under the "Hazardous Communications Act", commonly known as the 'Texas Right To Know Act", a bidder/vendor must provide to Calhoun County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the bidder/vendor to furnish this documentation will be cause to reject any Bid, RFP, and/or Contract applying thereto. Awards: Calhoun County reserves the right to award this Bid, RFP, RFQ, and/or Contract on the basis of lowest and/or best Bid, RFP, RFQ and/or Contract that met specifications in accordance with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one bidder/vendor, to reject any or all Bids, RFPs, RFQs, and/or Contracts and to be the sole judge in determining which Bid, RFP, RFQ, and/or Contract will be most advantageous to Calhoun County. Calhoun County will evaluate and may award a Bid, RFP, RFQ, and/or Contract based on lowest and/or best Bid, RFP, RFQ and/or Contract meeting specifications. "Lowest and/or best Bid, RFP, RFQ and/or Contract" means a bid or offer providing the best value considering associated direct and indirect costs, including transport, maintenance, reliability, life cycle, warranties, the county's past experience with the bidder/vendor and customer service after a sale. Calhoun County reserves the right to accept and/or reject any/all of the options Bid, any/all of the RFPs, any/all of the RFQs, and/or any/all of the Contracts as it deems to be in the best interest of the County. An award is final only upon formal execution by Calhoun County Commissioners Court. Per Local Government Code, Sec. 262.027, Calhoun County reserves the right to reject all Bids, RFPs, RFQs, and/or Contracts and to go out for new Bids, RFPs, RFQs, and/or Contracts. In the event of tie Bids, RFPs, RFQs, and/or Contracts, the winning Bid, RFP, RFQ, and/or Contract is determined per the Texas Local Governmental Code 262.027(b). Calhoun County, Texas is an Affirmative Action/Equal Opportunity Employer. The County does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or handicapped status in employment or the provision of services. Section 3 Residents, Minority Business Enterprises, Small Business Enterprises, Women Business Enterprises, and labor surplus area firms are encouraged to submit Bids, RFPs, RFQs, and/or Contracts. Assignment: The successful bidder/vendor may not assign, sell, sublease or otherwise transfer the Bid, RFP, RFQ and/or Contract without first obtaining the written approval of Calhoun County Commissioners Court. A change in ownership or management shall cancel the Bid, RFP, RFQ and/or Contract unless a mutual agreement is reached with the new owner or manager to continue the Bid, RFP, RFQ, and/or Contract under the awarded provisions and approved by Calhoun County Commissioners Court. Term of the Bid, RFP, RFQ. and/or Contract: If the Bid, RFP, RFQ, and/or Contract is intended to cover a specific time period, said time will be given in the specifications, instructions, and/or contracts. Obligation of the Bid. RFP, RFQ. and/or Contract: Bids, RFPs, RFQs, and/or Contracts are awarded only upon formal execution by Calhoun County Commissioners Court. If a contract is required, the Calhoun County Judge or other person authorized by Calhoun County Commissioners Court must sign the contract before it becomes binding on Calhoun County. No person is authorized to sign contracts until authorized by Calhoun County Commissioners Court. Calhoun County is not responsible for any contract signed without Commissioners Court approval. Delivery All items shall be shipped F.O.B. inside (or site location) delivery unless otherwise stated in the specifications. Default in promised delivery (without accepted reasons) or failure to meet specifications, authorizes Calhoun County to purchase supplies from the next lowest bidder/vendor that met specifications. Rejections: Articles not in accordance with samples and specifications must be removed by the bidder/vendor at the bidder's/vendor's expense. All disputes concerning quality of equipment, supplies, materials, products/goods, and/or services delivered under this Bid, RFP, RFQ and/or contract will be determined by Calhoun County Commissioners Court or their designated representative. Termination: Calhoun County reserves the right to terminate the Bid, RFP, RFC, and/or Contract for default if the bidder/vendor breaches any of the terms therein, including warranties of bidder/vendor or if the bidder/vendor becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper products/goods and/or services within the proper amount of time, and/or to properly perform any and all services required to Calhoun County's satisfaction and/or to meet all other obligations and requirements. Bids, RFPs, RFQs, and/or Contracts may be terminated without cause upon thirty (30) days written notice to either party unless otherwise specified. The bidder/vendor or Calhoun County must state therein the reasons for such cancellation. Calhoun County reserves the right to award cancelled Bid, RFP, RFQ, and/or Contract to the next lowest and best bidder/vendor that met specifications and is deemed to be in the best interest of Calhoun County. Delinquent Property Taxes: Calhoun County reserves the right to reject any Bid, RFP, RFC! and/or Contract submitted by a bidder/vendor owing delinquent property taxes to Calhoun County, Texas. If the bidder/vendor subsequently becomes delinquent in the payment of Calhoun County taxes this may be grounds for cancellation of the Bid, RFP, RFQ and/or Contract. Despite anything to the contrary, if the bidder/vendor is delinquent in payment of Calhoun County taxes at the time of invoicing, bidder/vendor assigns any payments to be made under this Bid, RFP, RFQ, and/or Contract to the Calhoun County Tax Assessor Collector for the payment of delinquent taxes. Certificate of Interested Parties — Form 1295 Section 2252.908 was added to the Government Code by the 8411 Texas Legislature through adoption of House Bill 1295. Senate Bill 255 adopted by the 85' Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contractwith a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal: https://www.ethics.state.tx.us/whatsnew/elf—info_forml295.htm. The law states that a County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) has been completed and provided to the County at the time the contract is considered for action by Commissioners Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract (Bids, RFPs, and/or RFQs also require Form 1295). The law does not apply to a Bid, RFP, RFQ, and/or Contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within thirty (30) days of approving a contract, and/or awarding a Bid, RFP, RFQ, and/or Contract with a business entity. Governmental transparency is the objective of the law. A business entity must generate Form 1295 online. A business entity must use the application at the Texas Ethics Commission website to enterthe required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number and date filed in the box marked "Office Use Only" located at the top right hand corner of the form. An authorized agent of the business entity must sign and complete the bottom portion of the printed copy of the form affirming under the penalty of perjury that the completed form is true and correct. Calhoun County Commissioners Court will not consider for action any Contract with a business entity unless it is accompanied by a completed and signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. A business entity will generate Form 1295 online after notification of award and submit with their signed contract. (See Attachment A to General Conditions) No later than thirty (30) days after Calhoun County Commissioners Court approves a contract with a business entity, the Calhoun County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. The Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after Calhoun County acknowledges receipt of the form. Debarment: Bidder/vendor certifies that at the time of submission of its (their) Bid, RFP, RFQ, and/or Contract, the bidder/vendor, as well as the bidder's/vendor's principals, are not on the federal government's list of suspended, ineligible or debarred bidders/vendors and that the bidder/vendor and its (their) principals have not been placed on this list between the time of the Bid, RFP, RFQ, and/or Contract submission and the time of execution of the Bid, RFP, RFC, and/or Contract. A print out of the search results that includes the record date showing that the Company, and its Principals, if any, have an active registration with the System for Award Management (www.SAM.gov) AND are not debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM) must be included with the bidder's/vendor's Bid, RFP, RFQ, and/or Contract. If bidder/vendor or its (their) principals are placed on this list during the term of the Bid, RFP, RFQ, and/or Contract, the bidder/vendor shall notify the Calhoun County Auditor. False certification or failure to notify may result in termination of the Bid, RFP, RFQ, and/or Contract for default. Invoices and Payments: All invoices are subject to approval by the Calhoun County Auditor's Office. Invoices shall be billed to Calhoun County to the attention of the County Department that the invoice pertains to and, if applicable, have all necessary backup information needed. Invoices shall be itemized (detailed) and free of sales tax (state, city and county sales tax) and federal excise taxes, if applicable. Invoices that are not billed to Calhoun County to the attention of the County Department that the invoice pertains to, not itemized (detailed) and/orfree of sales tax (state, city and county sales tax) and federal excise taxes, if applicable, may be returned to the bidder/vendor for corrections. Calhoun County will not incur any fees and/or charges for this request and/or delay in payment of the invoice(s) that was originally submitted incorrectly. Approval of payment of all invoices will be made once the purchase order and invoice(s) are properly and timely submitted to the Calhoun County Treasurer's Office by the appropriate County department. Each County department is responsible for submitting their purchase orders for payment to the Calhoun County Treasurer's Office by the deadline time and date set forth by the Treasurer's office. No payment can be made or mailed out until approved by Calhoun County Commissioners Court. Purchase order due dates/times and Commissioners Court dates/times are subject to change. Calhoun County's obligation is payable only and solely from funds available for the purpose of this purchase. Lack of funds shall render the order null and void to the extent funds are not available and any delivered but unpaid goods will be returned to the seller by the county. Gratuities: Calhoun County may, by written notice to the bidder/vendor, cancel any order and/or service without liability, if it is determined by Calhoun County that gratuities, in the form of entertainment, gifts, or otherwise were offered or given by the bidder/vendor, or any agent or representative of the bidder/vendor to any official, employee, or agent of Calhoun County with a view toward securing a Bid, RFP, RFQ Contract, order, and/or service. In the event a Bid, RFP, RFQ, Contract, order, and/or service is canceled by Calhoun County pursuant to this provision, the County shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by bidder/vendor in providing such gratuities. Warranty Product: Bidder/vendor warrants that products/goods sold to and/or services provided to Calhoun County shall conform to the highest commercial and/or professional standards in the industry and laws established by the U.S. Department of Labor, U.S. Department of Homeland Security, Occupational Safety and Health Administration and OSHA Act of 1970. In the event products/goods sold and/or services provided do not conform to OSHA Standards, where applicable, Calhoun County shall return the product/item for correction or replacement at the bidder's/vendor's expense. In the event that services do not conform to OSHA Standards, Calhoun County may immediately stop the services and seek reimbursement for said services at the bidder's/vendor's expense. In the event the bidder/vendor fails to make the appropriate correction within a reasonable time, correction made by Calhoun County shall be at the bidder's/vendor's expense. Bidder/vendor shall not limit or exclude any implied warranties and any attempt to do so shall render this Bid, RFP, RFC, and/or Contract voidable at the option of Calhoun County. Bidder/vendor warrants that the products/goods and/or services furnished and/or performed will conform to the specifications, scope of work, general conditions, drawings, and/or descriptions listed in the Bid, RFP, RFC, and/or Contract and to the sample(s) furnished by bidder/vendor, if any. In the event of a conflict between the specifications, scope of work, general conditions, drawings, and/or descriptions, the specifications shall govern. All products/goods must be new, in first class condition, unless otherwise specified. The design, strength and quality of materials must conform to the highest standards of manufacturing practice. Products/goods, and/or services supplied and/or performed under this Bid, RFP, RFC, and/or Contract shall be subject to Calhoun County's approval. Successful bidder/vendor shall warrantthat all products/goods and/or services shall conform to the proposed specifications and/or all warranties as stated in the Uniform Commercial Code and be free from all defects in material, workmanship and title. Any products/goods and are services found defective or not meeting specifications shall be picked up and promptly replaced or corrected to Calhoun County's satisfaction by the successful bidder/vendor at no expense to Calhoun County. Cancellation: Calhoun County shall have the right to cancel for default all or any part of the undelivered portion of an order and/or services if bidder/vendor breaches any of the terms hereof including warranties of bidder/vendor, or if the bidder/vendor becomes insolvent or files for protection under the bankruptcy laws. Such rights of cancellation are in addition to and not in lieu of any other remedies, which Calhoun County may have in law or equity. Calhoun County shall not incur any fees and/or charges related to the cancellation. The bidder/vendor shall be responsible for any fees and/or charges that are related to the cancellation. Force Majeure: Force Majeure means a delay encountered by a party in the performance of its obligations under this Bid, RFP, RFC, and/or Contract, which is caused by an event beyond the reasonable control of that party. Without limiting the generality of the foregoing, "Force Majeure" shall include but not be restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors. In the event of a Force Majeure, the affected party shall not be deemed to have violated its obligations under this Bid, RFP, RFC, and/or Contract, and the time for performance of any obligations of that party shall be extended by a period of time necessary to overcome the effects of the Force Majeure, provided that the foregoing shall not prevent this Bid, RFP, RFC, and/or Contract from terminating in accordance with the termination provisions. If any event constituting a Force Majeure occurs, the affected party shall notify the other parties in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. Waiver: No claim or right arising out of a breach of any Bid, RFP, RFQ, and/or Contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved party. Applicable law: To the extent it is applicable, this Bid, RFP, RFQ, and/or Contract shall be governed by the Uniform Commercial Code. Whenever the term "Uniform Commercial Code" is used it shall be construed as meaning the "Uniform Commercial Code' as adopted in the State of Texas as effective and in force on the date of this Bid, RFP, RFQ, and/or Contract. Otherwise, Texas state and federal law shall apply. Prohibition against Personal Interest in Bids RFPs RFQs and/or Contracts: No official, employee, or agent of Calhoun County shall have financial interest, direct or indirect, in any Bid, RFP, RFQ, and/or Contract with Calhoun County, or shall be financially interested, directly or indirectly, in the sale/lease to Calhoun County of any land, materials, supplies, or service, except on behalf of Calhoun County as an official, employee, or agent. Any willful violation of this section shall constitute malfeasance in office, and any official, employee, or agent guilty thereof shall be subject to disciplinary action under applicable laws, statutes and codes of the State of Texas. Any violation of this section, with the knowledge, expressed or implied of the company, corporation, firm, partnership, or individual contractingwith Calhoun Countyshall render the Bid, RFP, RFC, and/or Contract involved voidable by the Calhoun County Commissioners Court. Insurance: Proof (copy of bidder's/vendor's current insurance) of the below listed insurance may be required to be returned with the Bid, RFP, RFQ and/or Contract. As additional security for Calhoun County and as separate obligations of bidder/vendor not in conjunction with any other provisions of the Bid, RFP, RFC, and/or Contract, bidder/vendor agrees to carry and maintain during the term of the Bid, RFP, RFQ and/or Contract the minimum insurance coverages stated below. Before commencing work, the successful bidder/vendor shall be required, at his own expense, to furnish the Calhoun County Auditor within ten (10) days of notification of award with a certificate(s) of liability insurance (Form ACORD 25 or equivalent) showing, at least, the following minimum insurance coverage to be in force throughout the term of the Bid, RFP, RFC, and/or Contract. Higher rates and/or additional coverage may apply depending upon type of Bid, RFP, RFQ and/or Contract. o General Liability ($100,000/$300,000 or greater) o Workers' Compensation (at Statutory Limits) o Employer's Liability ($1,000,000 or greater) o Auto Insurance ($100,000 BIPP/$300,000 BIPO/$100,000 PD or greater) o Professional Liability Insurance (if applicable) o Farm Liability Insurance (if applicable) Coverages shall apply on an occurrence basis. The certificate(s) must reflect, by policy endorsement, that Calhoun County, Texas is an additional insured on all required policies. Each certificate of liability insurance (Form ACORD 25 or equivalent) to be furnished by successful bidder's/vendor's insurance agent shall include, by endorsement to the policy, a statement that a notice shall be given to the Calhoun County Auditor by certified mail thirty (30) days prior to cancellation, material change, or non -renewal in coverage. Calhoun County's receipt of or failure to object to any insurance certificates or policies submitted by the bidder/vendor does not release or diminish in any manner the liability or obligations of the bidder/vendor or constitute a waiver of any of the insurance requirements for the Bid, RFP, RFC, and/or Contract. Replacement certificate(s) of liability insurance (Form ACORD 25 or equivalent) evidencing continuation of such coverage and naming, by policy endorsement, Calhoun County as an additional insured, shall be furnished to the Calhoun County Auditor's office prior to the expiration of the current policies. Should bidder/vendor at any time neglect, refuse to provide, or cancel the insurance required, Calhoun County shall have the right to terminate the Bid, RFP, RFC, and/or Contract or pursue any remedy available by law. The insurance coverage requirements in the Bid, RFP, RFC, and/or contract will in no way be construed as limiting the scope of indemnification. OSHA Requirements: Bidder/vendor must meet all Federal and State OSHA requirements. The bidder/vendor hereby guarantees to Calhoun County that all materials, supplies, equipment and/or services listed on the Bid, RFP, RFQ, Contract, Purchase Order or Invoice shall conform to the requirements, specifications and standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970, as amended and in force at the date hereof. Protest Procedures: All protests and disputes will be held in Port Lavaca, Calhoun County, Texas. Any actual or prospective bidder/vendor who believes they are aggrieved in connection with or pertaining to a Bid, RFP, RFC, and/or Contract may file a protest. The protest must be delivered in writing to the Calhoun County Auditor's Office, in person or by certified mail return receipt requested prior to award. The written protest must include: o Name, mailing address and business phone number of the protesting party; o Appropriate identification of the Bid, RFP, RFC, and/or Contract being protested; o A precise statement of the reasons for the protest; and o Any documentation or other evidence supporting the protest and any alleged claims. The Calhoun County Auditor's Office will attempt to resolve the protest, including at the County Auditor's option, meeting with the protesting party. If the protest is successfully resolved by mutual agreement, written verification of the resolution, with specifics on each point addressed in the protest, will be forwarded to Calhoun County Commissioners Court. If the Calhoun County Auditor's Office is not successful in resolving the protest, the protesting party may request in writing that the protest be considered by Calhoun County Commissioners Court. Applicable documentation and other information applying to the protest will be forwarded to Calhoun County Commissioners Court, who will promptly review such documentation and information. If additional information is required, Calhoun County Commissioners Court will notify the protesting party to provide such information. The decision of Calhoun County Commissioners Court will be final. Public Information Act: All governmental information is presumed to be available to the public. Certain exceptions may apply to the disclosure of the information. Bidder/Vendor waives any obligation to the release to the public of any documents submitted in accordance with the Bid, RFP, RFQ, and/or Contract. Governmental bodies shall promptly release requested information that is not confidential by law, either constitutional, statutory, or by judicial decision, or information for which an exception to disclosure has not been sought. CALHOUN COUNTY AUDITOR To request information from Calhoun County, please contact: Calhoun County Auditor Calhoun County Courthouse Annex II 202 S Ann St, Suite B Port Lavaca, TX 77979 Phone: 361-553-4610 Fax: 361-553-4614 The Packet, Invitation for Bids, Request for Proposals and/or Request for Qualifications are posted on Calhoun County's website, www.calhouncotx.org, under Public Notices, Bid Notices and Results. ATTACHMENT A CALHOUN COUNTY, TEXAS GENERAL CONDITIONS CERTIFICATE OF INTERESTED PARTIES FORM 1295 A business entity will generate Form 1295 online after notification of award and submit with their signed contract. Form 1295 must be filled out and submitted online, printed, complete #6, signed and returned with the Agreement, Contract, or Lease. See Calhoun County, Texas —Policy of Compliance TO FILL OUT FORM 1295: Go to: https://www.ethics.state.tx.us/File 1. If you have an account, log in and proceed with the process or if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2. Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only". 3. The Respondent or an authorized agent of the Respondent must sign and date the printed copy of the form (making sure all of #6 is completed). 4. The completed Form 1295 must be included with your Agreement, Contract or Lease, when it is submitted to Calhoun County. For help in filling out the form: #1 Name of Business Entity filing the form, and the City, State and Country of the Entity's place of business #2 Calhoun County, Texas (Also, if applicable, insert name of County Department) #3 • Contract number, if not given, can be the year or dates associated with the Agreement, Contract, Lease or if for a Bid, RFP, or RFQ the Bid, RFP, RFQ number and dates the Bid, RFP, RFQ pertains to Description is description of Agreement, Contract, Lease or name of Bid, RFP, RFQ On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, submit and print After printing, the respondent or an authorized agent of the respondent must sign and date (making sure all of #6 is completed) When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". CERTIFICATE OF INTERESTED PARTIES FORM 1295 Complete Nos. 1 - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. 3 Provide the Identification number used by the governmental entity or state agency to tjjjjjj++++++�� kYidentify the contract, and provide a description of the services, goods, or other property to be provided le contract. 4 Name of Interested Party City, State, Country (place of business) ♦ ature of Interest (check applicable) Controlling Intermediary 5 Check only ifthere' I terested Party. ❑ 6 UNSWORN DEC f(♦`Tp\ N My name is � `" , and my date of birth is My addre� �`J` (street) (city) (stale) (zip code) (country) e`cll�e'Gnder penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY onn pmviaea by Texas ethics commission www.ethics.state.tx.us Revised 12/22/2017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 and September 14, 2022 BACKGROUND Section 2252.908 was added to the Government Code by the 841h Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85th Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https://www.ethics.state.tx.us/whatsnew/elf_ info _form1295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. MINORITY/FEMALE GOALS AND TIMETABLES The female employment goal is effective as of April 1980 and is currently 6.9%. The percentages for minority participation in Texas are: Texarkana Area: Texarkana & Bowie Co. 19.7 Non-MSA Counties of Camp, Cass, Lamar, Morris, Red River & Titus 20.2 Tvter-Longview Area: Longview, Gregg Co. & Harrison Co. 22.8 Tyler & Smith Co. 23.5 Non-MSA Counties of Anderson, Angelina, Cherokee, Henderson, Marion, Nacogdoches, Panola, 22.5 Rusk, San Augustine, Shelby, Upshur & Wood Beaumont -Port Arthur Area: Beaumont, Port Arthur, Orange, Hardin Co., Jefferson Co., & Orange Co. 22.6 Non-MSA Counties of Jasper, Houston, Newton, Sabine, & Tyler 22.6 Houston Area: Bryan, College Station & Brazos Co. 23.7 Galveston, Texas City & Galveston Co. 28.9 Houston, Brazoria Co., Fort Bend Co., Harris Co., Liberty Co., Montgomery Co. & Waller Co. 27.3 Non-MSA Counties of Austin, Burleson, Calhoun, Chambers, Colorado, DeWitt, Fayette, Goliad, 27.4 Grimes, Jackson, Lavaca, Leon, Madison, Matagorda, Polk, Robertson, San Jacinto, Trinity, Victoria, Walker, Washington, & Wharton Austin Area: Austin, Hays Co., Travis Co., & Williamson Co. 24.1 Non-MSA Counties of Bastrop, Blanco, Burnet, Caldwell, Lee & Llano 24.2 Waco, Killeen, Temple Area: Killeen, Temple, Bell Co. & Coryell Co. 16.4 Waco & McLennan Co. 20.7 Non-MSA Counties of Bosque, Falls, Freestone, Hamilton, Hill, Lampasas, Limestone, Milam & Mills 18.6 Dallas, Fort Worth Area: Dallas, Fort Worth, Collin Co., Dallas Co., Denton Co., Ellis Co., Hood Co., Johnson Co., Kaufman 18.2 Co., Parker Co., Rockwall Co., Tarrant Co. & Wise Co. Sherman, Denison & Grayson Co. 9.4 Non-MSA Counties of Cooke, Delta, Erath, Fannin, Franklin, Hopkins, Hunt, Jack, Montague, 17.2 Navarro, Palo Pinto, Rains, Somervell, & Van Zandt Wichita Falls Area: Wichita Falls, Clay Co. & Wichita Co. 124 Non-MSA Counties of Archer, Baylor, Cottle, Foard, Hardeman, Wilbarger & Young 11.0 Abilene Area: Abilene, Callaghan Co., Jones Co. & Taylor Co. 11.6 Non-MSA Counties of Brown, Coleman, Comanche, Eastland, Fisher, Haskell, Kent, Knox, Mitchell, 10.9 Nolan, Scurry, Shackleford, Stephens, Stonewall & Throckmorton San Angelo Area: San Angelo & Tom Green Co. 19.2 Non-MSA Counties of Coke, Concho, Crockett, Irion, Kimble, McCullough, Mason, Menard, Reagan, 20.0 Runnels, San Saba, Schleicher, Sterling, Sutton & Terrell San Antonio Area: Laredo & Webb Co. 87.3 San Antonio, Bexar Co., Corral Co. & Guadalupe Co. 47.8 Non-MSA Counties of Atascosa, Bandera, Dimmit, Edwards, Frio, Gillespie, Gonzales, Jim Hogg, 49.4 Karnes, Kendall, Kerr, Kinney, La Salle, McMullen, Maverick, Medina, Real, Uvalde, Val Verde, Wilson, Zapata & Zavala Corpus Christi Area: Corpus Christi, Nueces Co. & San Patricio Co. 41.7 Non-MSA Counties of Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak & 44.2 Refugio Brownsville, McAllen, Harlingen Area: Brownsville, Harlingen, San Benito & Cameron Co. 71.0 McAllen, Pharr, Edinburg & Hidalgo Co. 72.8 Non-MSA Counties of Starr & Willacy 72.9 Odessa, Midland Area: Midland & Midland Co. 19.1 Odessa & Ector Co. 151 Non-MSA Counties of Andrews, Crane, Glasscock, Howard, Loving, Martin, Pecos, Reeves, Upton, 18.9 Ward & Winkler El Paso Area: El Paso & El Paso Co. 57.8 Non-MSA Counties of Brewster, Culbertson, Hudspeth, Jeff Davis & Presidio 49.0 Lubbock Area: Lubbock & Lubbock Co. 19.6 Non-MSA Counties of Bailey, Borden, Cochran, Crosby, Dawson, Dickens, Floyd, Gaines, Garza, 19.5 Hale, Hockley, King, Lamb, Lynn, Motley, Terry & Yoakum Amarillo Area: Amarillo, Potter Co. & Randall Co. 9.3 Non-MSA Counties of Armstrong, Briscoe, Carson, Castro, Childress, Collingsworth, Dallam, Deaf 11.0 Smith, Donley, Gray, Hall, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Parmer, Roberts, Sherman, Swisher, & Wheeler Federal Labor Standards Provisions U.S. Department of Housing and Urban Development Office of Davis -Bacon and Labor Standards A. APPLICABILITY The Projector Program to which the construction work covered by this Contract pertains is being assisted by the United States of America, and the following Federal Labor Standards Provisions are Included In this Contract pursuant to the provisions applicable to such Federal assistance. (2) MINIMUM WAGES (1 All laborers and mechanics employed or working upon the site of the work will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR Part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment, computed at rates not less than those contained in the wage determination of the Secretary of Labor (which is attached hereto and made a part hereof), regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits under Section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of 29 CFR 5.5(a)(1)(iv); also, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs, which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics performingwork in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: Provided, that the employer's payroll records accurately set forth the time spent in each classification in which work Is performed. The wage determination (including any additional classification and wage rates conformed under 29 CFR 5.5(a)(1)(11) and the Davis -Bacon poster (WH1321)) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place, where it an be easily seen by the workers. (ii) Additional Classifications. (A) Any class of laborers or mechanics which is not listed in the wage determination and which Is to be employed under the contract shall be classified in conformance with the wage determination. HUD shall approve an additional classification and wage rate and fringe benefits therefor only when the following criteria have been met: (1) The work to be performed by the classification requested is not performed by a classification in the wage determination; (2) The classification Is utilized in the area by the construction industry; and (3) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (B) If the contractor, the laborers and mechanics to be employed in the classification (if known), or their representatives, and HUD or its designee agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), a report of the action taken shall be sent by HUD or its designee to the Administrator of the Wage and Hour Division ("Administrator"), Employment Standards Administration, U.S. Department of Labor, Washington, D.C. 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise HUD or its designee or will notify HUD or its designee within the 30-day period that additional time Is necessary. (Approved by the Office of Management and Budget ("OMB") under OMB control number 1235-0023.) (C) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, or HUD or Its designee do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), HUD or Its designee shall refer the questions, including the views of all interested parties and the recommendation of HUD or its designee, to the Administrator for determination. The Administrator, or an authorized representative, will Issue a determination within 30 days of receipt and so advise HUD or Its designee or will notify HUD or its designee within the 30-day period that additional time is necessary. (Approved by the Office of Management and Budget under OMB Control Number 1235-0023.) form HUD-4010 (07/2021) Previous editions are obsolete Page 1 of ref. Handbook 1344.1 (D) The wage rate (including fringe benefits, where appropriate) determined pursuant to subparagraphs (1)(ii)(B) or (C) of this paragraph, shall be paid to all workers performing work in the classification under this Contract from the first day on which work is performed in the classification. (III) Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which Is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. (iv) If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, Provided, that the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davfs-Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meetingof obligations under the plan or program. (Approved by the Office of Management and Budget under OMB Control Number 1235-0023.) (2) Withholding. HUD or Its designee shall, upon Its own action or upon written request of an authorized representative of the U.S. Department of Labor, withhold or cause to be withheld from the contractor under this contract or any other Federal contract with the same prime contractor, or any other Federally -assisted contract subject to Davis -Bacon prevailingwage requirements which is held by the same prime contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee or helper, employed or working on the site of the work, all or part of the wages required by the contract, HUD or its designee may, after written notice to the contractor, sponsor, applicant, or owner, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. HUD or its designee may, after written notice to the contractor, disburse such amounts withheld for and on account of the contractor or subcontractor to the respective employees to whom they are due. The Department of Labor shall make such disbursements in the case of direct Davis -Bacon Act contracts. (3) Payrolls and basic records. (1) Maintaining Payroll Records. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification(s), hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described In Section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made, and actual wages paid. Whenever the Secretary of Labor has found, under 29 CFR 5.5(a)(1)(iv), that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in Section 1(b)(2)(8) of the Davis -Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated In writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. (Approved by the Office of Management and Budget under OMB Control Numbers 1235-0023 and 1215-0018) (fi) Certified Payroll Reports. (A) The contractor shall submit weekly, for each week In which any contract work is performed, a copy of all payrolls to HUD or its designee If the agency is a party tothe contract, but if the agency is not such a party, the contractor will submit the payrolls to the applicant sponsor, or owner, as the case may be, for transmission to HUD or Its designee. The payrolls submitted shall set out accurately and completely all of the Information required to be maintained under 29 CFR 5.5(a)(3)(1), except that full social security numbers and home addresses shall not be included on weekly transmfttals. Instead, the payrolls only need to include an individually identifying number for each employee (e.g., the last four digits of the employee's social security number). The required weekly payroll information may be submitted in any form desired. Optional Form WH-347 is available for this purpose from the Wage and Hour Division Web site at hftps://www.dol.gov/agencies/whd/forms or its successor site. The prime _contractor Is responsible for the submission of copies _of payrolls by all_subcontractors. form HUD-4010(07/2021) Previous editions are obsolete Page Z of 5 ref. Handbook 1344.1 Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to HUD or its designee If the agency is a party to the contract, but if the agency is not such a party, the contractor will submit the payrolls to the applicant sponsor, or owner, as the case may be, for transmission to HUD or Its designee, the contractor, or the Wage and Hour Division of the U.S. Department of Labor for purposes of an Investigation or audit of compliance with prevailing wage requirements. It is not a violation of this subparagraph for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to HUD or its designee. (Approved by the Office of Management and Budget under OMB Control Number 1235-0009.) (B) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1) That the payroll for the payroll period contains the information required to be provided under 29 CFR 5.5(a)(3)(R), the appropriate information is being maintained under 29 CFR 5.5(a)(3)(i), and that such Information is correct and complete; (2) That each laborer or mechanic(including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or Indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than permissible deductions as set forth in 29 CFR Part 3; (3) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract; and (C) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH-347 shall satisfy the requirement for submission of the "Statement of Compliance" required by subparagraph (a)(3)(19(b)• (D) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under Section 1001 of Title 18 and Section 3729 of Title 31 of the United States Code. (III) The contractor or subcontractor shall me ke the records required under subparagraph (a)(3)(i) available for inspection, copying, or transcription by authorized representatives of HUD or Its designee or the U.S. Department of tabor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records a to make them available, HUD or Its designee may, after written notice to the contractor, sponsor, applicant, or owner, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. (4) Apprentices and Trainees. () Apprentices. Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or If a person is employed In his or her first 90 days of probationary employment as an apprentice In such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency (where appropriate), to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who Is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate an the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing construction on a project In a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of thejourneyman's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provlsions of the apprenticeship program. form HUD-4010 (07/2021) Previous editions are obsolete Page 3 of 5 ref. Handbook 1344.1 If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringe benefits shall be paid In accordance with that determination. in the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. ("a) Trainees. Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed, unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and participating In a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. in the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. (iii) Equal employment opportunity. The utilization of apprentices, trainees, and journeymen under 29 CFR Part 5 shall be In conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR Part 30. (5) Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR Part 3, which are incorporated by reference in this Contract. (6) Subcontracts. The contractor or subcontractor will Insert in any subcontracts the clauses contained in subparagraphs (1) through (11) in this paragraph (a) and such other clauses as HUD or its designee may, by appropriate Instructions, require, and a copy of the applicable prevailing wage decision, and also a clause req ulring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in this paragraph. (7) Contract termination; debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract and for debarment as a contractor and a subcontractor as provided in 29 CFR 5,12. (8) Compliance with Davis -Bacon and Related Act Requirements. All rulings and interpretations of the Davis -Bacon and Related Acts contained in 29 CFR Parts 1, 3, and 5 are herein incorporated by reference in this Contract. (9) Disputes concerning labor standards. Disputes arising out of the labor standards provislons of this Contract shall not be subject to the general disputes clause of this Contract. Such disputes shall be resolved in accordance with the procedures of the U.S. Department of Labor set forth in 29 CFR Parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and HUD or its designee, the U.S. Department of Labor, or the employees or their representatives. (10) Certification of Eligibility. (i) By entering into this Contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an Interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of Section 3(a) of the Davis -Bacon Actor 29 CFR 5.12(a)(1) or to be awarded HUD contracts or participate in HUD programs pursuant to 24 CFR Part 24. i form HUD-4010(07/2021) Previous editions are obsolete Page 4 of 5 ref. Handbook 1344.1 (0) No part of this Contract shall be subcontracted to any person or firm Ineligible for award of a Government contract by virtue of Section 3(a) of the Davis -Bacon Actor 29 CFR 5.12(a)(1) or to be awarded HUD contracts or participate in HUD programs pursuant to 24 CFR Part 24. (III) Anyone who knowingly makes, presents, or submits a false, fictitious, or fraudulent statement, representation or certification is subject to criminal, civil and/or administrative sanctions, including fines, penalties, and imprisonment (e.g., 18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §§ 3729, 3802. (11) Complaints, Proceedings, or Testimony by Employees. No laborer or mechanic, to whom the wage, salary, or other labor standards provisions of this Contract are applicable, shall be discharged or in any other manner discriminated against by the contractor or any subcontractor because such employee has filed any complaint or instituted or caused to be instituted any proceeding or has testified or is about to testify in any proceeding under or relating to the labor standards applicable under this Contract to his employer. B. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The provisions of this paragraph (b) are applicable where the amount of the prime contract exceeds $100,OW. As used in this paragraph, the terms "laborers" and "mechanics" include watchmen and guards. (1) Overtime requirements. No contractor or subcontractor contracting for any part of the contract work, which mayrequfre or involve the employment of laborers or mechanics, shall require or permit any such laborer or mechanic in any workweek in which the individual is employed on such work to work in excess of 40 hours in such workweek, unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of a o for all hours wrked in excess of 40 hours in such workweek. see i!a CFR ss rs5.for current 1. (2) Violation; [lability for unpaid wages; liquidated damages. In the event of any violation of the dauseeseL forinTn—'—' subparagraph B(1) of this paragraph, the contractor, and any subcontractor responsible therefor, shall be liable for)4 unpaid wages, In addition, such contractor and subcontractor shall be [fable to the United States (in the use of wyfk done under contract for the Districtof Columbia or a territory, to such District or to such territory) for liquidated dam Aes. Such liquidated damages shall be computed with respect to each Individual laborer or mechanic, including watchm96 and guards, employed in violation of the clause set forth in subparagraph B(1) of this paragraph, in the sum 4VTr each calendar day on which such Individual was required or permitted to work In excess of the standard workw-WeR on 40 hours without payment of the overtime wages required by the clause set forth In subparagraph B(1) of this paragraph. In accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. § 2461 Note), the Department of Labor adjusts this civil monetary penalty for inflation no later than January 15 each year. (3) Withholding for unpaid wages and liquidated damages. HUD or Its designee shall, upon its own action or upon written request of an authorized representative of the U.S. Department of Labor, withhold or cause to be withheld from any moneys payable on account of work performed by the contractor or subcontractor under any such contract, or any other Federal contract with the same prime contract, or any other Federally -assisted contract subject to the Contract Work Hours and Safety Standards Act which Is held by the same prime contractor, such sums as may be determined to be necessary to - satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages, as provided in the clause set forth in subparagraph B(2) of this paragraph. (4) Subcontracts. The contractor or subcontractor shall insert In any subcontracts the clauses set forth in subparagraph B(1) through (4) of this paragraph and also a clause requiring the subcontractors to Include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compile nce by any subcontractor or lower tier subcontractor with the clauses set forth in subparagraphs B(1) through (4) of this paragraph. C. HEALTHANDSAFETY The provisions of this paragraph (c) are applicable where the amount of the prime contract exceeds $100,000. (1) No laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous, or dangerous to his or her health and safety, as determined under construction safety and health standards promulgated by the Secretary of Labor by regulation. (2) The contractor shall comply with all regulations issued by the Secretary of Labor pursuant to 29 CPR Part 1926 and failure to comply may result in imposition of sanctions pursuant to the Contract Work Hours and Safety Standards Act, (Public Law 91.54, 83 Stat 96),40 U.S.C. § 3701 at seq. (3) The contractor shall include the provisions of this paragraph in every subcontract, so that such provisions will be binding on each subcontractor. The contractor shall take such action with respect to any subcontractor as the Secretary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions. form HUD4010 (07/2021) Previous editions are obsolete Page 5 of5 ref. Handbook 1344.1 Title 29: Labor PART 3—CONTRACTORS AND SUBCONTRACTORS ON PUBLIC BUILDING OR PUBLIC WORK FINANCED IN WHOLE OR IN PART BY LOANS OR GRANTS FROM THE UNITED STATES Contents §3.1 Purpose and scope. §3.2 Definitions. §3.3 Weekly statement with respect to payment of wages. §3.4 Submission of weekly statements and the preservation and inspection of weekly payroll records. §3.5 Payroll deductions permissible without application to or approval of the Secretary of Labor. §3.6 Payroll deductions permissible with the approval of the Secretary of Labor. §3.7 Applications for the approval of the Secretary of Labor. §3.8 Action by the Secretary of Labor upon applications. §3.9 Prohibited payroll deductions. §3.10 Methods of payment of wages. §3.11 Regulations part of contract. AUTHORITY: R.S. 161, sec. 2,48 Stat. 848; Reorg. Plan No. 14 of 1950,64 Stat. 1267; 5 U.S.C. 301; 40 U.S.C. 3145; Secretary's Order 01-2008; and Employment Standards Order No. 2001-01. SOURCE: 29 FR 97, Jan. 4, 1964, unless otherwise noted. §3.1 Purpose and scope. This part prescribes "anti -kickback" regulations under section 2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c), popularly known as the Copeland Act. This part applies to any contract which is subject to Federal wage standards and which is for the construction, prosecution, completion, or repair of public buildings, public works or buildings or works financed in whole or in part by loans or grants from the United States. The part is intended to aid in the enforcement of the minimum wage provisions of the Davis -Bacon Act and the various statutes dealing with federally assisted construction that contain similar minimum wage provisions, including those provisions which are not subject to Reorganization Plan No. 14 (e.g., the College Housing Act of 1950, the Federal Water Pollution Control Act, and the Housing Act of 1959), and in the enforcement of the overtime provisions of the Contract Work Hours Standards Act whenever they are applicable to construction work. The part details the obligation of contractors and subcontractors relative to the weekly submission of statements regarding the wages paid on work covered thereby; sets forth the circumstances and procedures governing the making of payroll deductions from the wages of those employed on such work; and delineates the methods of payment permissible on such work. §3.2 Definitions. As used in the regulations in this part: (a) The terms building or work generally include construction activity as distinguished from manufacturing, furnishing of materials, or servicing and maintenance work. The terms include, without limitation, buildings, structures, and improvements of all types, such as bridges, dams, plants, highways, parkways, streets, subways, tunnels, sewers, mains, powerlines, pumping stations, railways, airports, terminals, docks, piers, wharves, ways, lighthouses, buoys, jetties, breakwaters, levees, and canals; dredging, shoring, scaffolding, drilling, blasting, excavating, clearing, and landscaping. Unless conducted in connection with and at the site of such a building or work as is described in the foregoing sentence, the manufacture or furnishing of materials, articles, supplies, or equipment (whether or not a Federal or State agency acquires title to such materials, articles, supplies, or equipment during the course of the manufacture or furnishing, or owns the materials from which they are manufactured or furnished) is not a building or work within the meaning of the regulations in this part. (b) The terms construction, prosecution, completion, or repair mean all types of work done on a particular building or work at the site thereof, including, without limitation, altering, remodeling, painting and decorating, the transporting of materials and supplies to or from the building or work by the employees of the construction contractor or construction subcontractor, and the manufacturing or furnishing of materials, articles, supplies, or equipment on the site of the building or work, by persons employed at the site by the contractor or subcontractor. (c) The terms public building or public work include building or work for whose construction, prosecution, completion, or repair, as defined above, a Federal agency is a contracting party, regardless of whether title thereof is in a Federal agency. (d) The term building or work financed in whole or in part by loans or grants from the United States includes building or work for whose construction, prosecution, completion, or repair, as defined above, payment or part payment is made directly or indirectly from funds provided by loans or grants by a Federal agency. The term includes building or work for which the Federal assistance granted is in the form of loan guarantees or insurance. (e) Every person paid by a contractor or subcontractor in any manner for his labor in the construction, prosecution, completion, or repair of a public building or public work or building or work financed in whole or in part by loans or grants from the United States is employed and receiving wages, regardless of any contractual relationship alleged to exist between him and the real employer. (f) The term any affiliated person includes a spouse, child, parent, or other close relative of the contractor or subcontractor; a partner or officer of the contractor or subcontractor; a corporation closely connected with the contractor or subcontractor as parent, subsidiary, or otherwise, and an officer or agent of such corporation. (g) The term Federal agency means the United States, the District of Columbia, and all executive departments, independent establishments, administrative agencies, and instrumentalities of the United States and of the District of Columbia, including corporations, all or substantially all of the stock of which is beneficially owned by the United States, by the District of Columbia, or any of the foregoing departments, establishments, agencies, and instrumentalities. [29 FIR 97, Jan. 4, 1964, as amended at 38 FIR 32575, Nov. 27, 1973] §3.3 Weekly statement with respect to payment of wages. (a) As used in this section, the term employee shall not apply to persons in classifications higher than that of laborer or mechanic and those who are the immediate supervisors of such employees. (b) Each contractor or subcontractor engaged in the construction, prosecution, completion, or repair of any public building or public work, or building or work financed in whole or in part by loans or grants from the United States, shall furnish each week a statement with respect to the wages paid each of its employees engaged on work covered by this part 3 and part 5 of this title during the preceding weekly payroll period. This statement shall be executed by the contractor or subcontractor or by an authorized officer or employee of the contractor or subcontractor who supervises the payment of wages, and shall be on the back of Form WH 347, 'Payroll (For Contractors Optional Use)" or on any form with identical wording. Copies of Form WH 347 may be obtained from the Government contracting or sponsoring agency or from the Wage and Hour Division Web site at http://www.doLgov/esa/whd/forms/wh347instr.htm or its successor site. (c) The requirements of this section shall not apply to any contract of $2,000 or less. (d) Upon a written finding by the head of a Federal agency, the Secretary of Labor may provide reasonable limitations, variations, tolerances, and exemptions from the requirements of this section subject to such conditions as the Secretary of Labor may specify. [29 FIR 97, Jan. 4, 1964, as amended at 33 FIR 10186, July 17, 1968; 47 FIR 23679, May 28, 1982; 73 FIR 77511, Dec. 19, 2008) §3.4 Submission of weekly statements and the preservation and inspection of weekly payroll records. nFa)fic ;3r,-oekly statement required under §3.3 shall be delivered by the contractor or subcontractor, within seven days after the regular payment date of the payroll period, to a representative of a Federal or State agency in charge at the site of the building or work, or, if there is no representative of a Federal or State agency at the site of the building or work, the statement shall be mailed by the contractor or subcontractor, within such time, to a Federal or State agency contracting for or financing the building or work. After such examination and check as may be made, such statement, or a copy thereof, shall be kept available, or shall be transmitted together with a report of any violation, in accordance with applicable procedures prescribed by the United States Department of Labor. (b) Each contractor or subcontractor shall preserve his weekly payroll records for a period of three years from date of completion of the contract. The payroll records shall set out accurately and completely the name and address of each laborer and mechanic, his correct classification, rate of pay, daily and weekly number of hours worked, deductions made, and actual wages paid. Such payroll records shall be made available at all times for inspection by the contracting officer or his authorized representative, and by authorized representatives of the Department of Labor. (Reporting and recordkeeping requirements in paragraph (b) have been approved by the Office of Management and Budget under control number 1215-0017) [29 FR 97, Jan. 4, 1964, as amended at 47 FIR 145, Jan. 5, 1982] §3.5 Payroll deductions permissible without application to or approval of the Secretary of Labor. Deductions made under the circumstances or in the situations described in the paragraphs of this section may be made without application to and approval of the Secretary of Labor: (a) Any deduction made in compliance with the requirements of Federal, State, or local law, such as Federal or State withholding income taxes and Federal social security taxes. (b) Any deduction of sums previously paid to the employee as a bona fide prepayment of wages when such prepayment is made without discount or interest. A bona fide prepayment of wages is considered to have been made only when cash or its equivalent has been advanced to the person employed in such manner as to give him complete freedom of disposition of the advanced funds. (c) Any deduction of amounts required by court process to be paid to another, unless the deduction is in favor of the contractor, subcontractor, or any affiliated person, or when collusion or collaboration exists. (d) Any deduction constituting a contribution on behalf of the person employed to funds established by the employer or representatives of employees, or both, for the purpose of providing either from principal or income, or both, medical or hospital care, pensions or annuities on retirement, death benefits, compensation for injuries, illness, accidents, sickness, or disability, or for insurance to provide any of the foregoing, or unemployment benefits, vacation pay, savings accounts, or similar payments for the benefit of employees, their families and dependents: Provided, however, That the following standards are met: (1) The deduction is not otherwise prohibited by law; (2) It is either: (i) Voluntarily consented to by the employee in writing and in advance of the period in which the work is to be done and such consent is not a condition either for the obtaining of or for the continuation of employment, or (ii) provided for in a bona fide collective bargaining agreement between the contractor or subcontractor and representatives of its employees; (3) No profit or other benefit is otherwise obtained, directly or indirectly, by the contractor or subcontractor or any affiliated person in the form of commission, dividend, or otherwise; and (4) The deductions shall serve the convenience and interest of the employee. (e) Any deduction contributing toward the purchase of United States Defense Stamps and Bonds when voluntarily authorized by the employee. (f) Any deduction requested by the employee to enable him to repay loans to or to purchase shares in credit unions organized and operated in accordance with Federal and State credit union statutes. (g) Any deduction voluntarily authorized by the employee for the making of contributions to governmental or quasi - governmental agencies, such as the American Red Cross. (h) Any deduction voluntarily authorized by the employee for the making of contributions to Community Chests, United Givers Funds, and similar charitable organizations. (i) Any deductions to pay regular union initiation fees and membership dues, not including fines or special assessments: Provided, however, that a collective bargaining agreement between the contractor or subcontractor and representatives of its employees provides for such deductions and the deductions are not otherwise prohibited by law. 0) Any deduction not more than for the "reasonable cost" of board, lodging, or other facilities meeting the requirements of section 3(m) of the Fair Labor Standards Act of 1938, as amended, and part 531 of this title. When such a deduction is made the additional records required under §516.25(a) of this title shall be kept. (k) Any deduction for the cost of safety equipment of nominal value purchased by the employee as his own property for his personal protection in his work, such as safety shoes, safety glasses, safety gloves, and hard hats, if such equipment is not required by law to be furnished by the employer, if such deduction is not violative of the Fair Labor Standards Act or prohibited by other law, if the cost on which the deduction is based does not exceed the actual cost to the employer where the equipment is purchased from him and does not include any direct or indirect monetary return to the employer where the equipment is purchased from a third person, and if the deduction is either (1) Voluntarily consented to by the employee in writing and in advance of the period in which the work is to be done and such consent is not a condition either for the obtaining of employment or its continuance; or (2) Provided for in a bona fide collective bargaining agreement between the contractor or subcontractor and representatives of its employees. [29 FIR 97, Jan. 4, 1964, as amended at 36 FIR 9770, May 28, 1971] §3.6 Payroll deductions permissible with the approval of the Secretary of Labor. Any contractor or subcontractor may apply to the Secretary of Labor for permission to make any deduction not permitted under §3.5. The Secretary may grant permission whenever he finds that: (a) The contractor, subcontractor, or any affiliated person does not make a profit or benefit directly or indirectly from the deduction either in the form of a commission, dividend, or otherwise; (b) The deduction is not otherwise prohibited by law; (c) The deduction is either (1) voluntarily consented to by the employee in writing and in advance of the period in which the work is to be done and such consent is not a condition either for the obtaining of employment or its continuance, or (2) provided for in a bona fide collective bargaining agreement between the contractor or subcontractor and representatives of its employees; and (d) The deduction serves the convenience and interest of the employee. §3.7 Applications for the approval of the Secretary of Labor. Any application for the making of payroll deductions under §3.6 shall comply with the requirements prescribed in the following paragraphs of this section: (a) The application shall be in writing and shall be addressed to the Secretary of Labor. (b) The application need not identify the contract or contracts under which the work in question is to be performed. Permission will be given for deductions on all current and future contracts of the applicant for a period of 1 year. A renewal of permission to make such payroll deduction will be granted upon the submission of an application which makes reference to the original application, recites the date of the Secretary of Labor's approval of such deductions, states affirmatively that there is continued compliance with the standards set forth in the provisions of §3.6, and specifies any conditions which have changed in regard to the payroll deductions. (c) The application shall state affirmatively that there is compliance with the standards set forth in the provisions of §3.6. The affirmation shall be accompanied by a full statement of the facts indicating such compliance. (d) The application shall include a description of the proposed deduction, the purpose to be served thereby, and the classes of laborers or mechanics from whose wages the proposed deduction would be made. (a) The application shall state the name and business of any third person to whom any funds obtained from the proposed deductions are to be transmitted and the affiliation of such person, if any, with the applicant. [29 FR 97, Jan. 4, 1964, as amended at 36 FR 9771, May 28, 1971] §3.8 Action by the Secretary of Labor upon applications. The Secretary of Labor shall decide whether or not the requested deduction is permissible under provisions of §3.6; and shall notify the applicant in writing of his decision. §3.9 Prohibited payroll deductions. Deductions not elsewhere provided for by this part and which are not found to be permissible under §3.6 are prohibited. §3.10 Methods of payment of wages. The payment of wages shall be by cash, negotiable instruments payable on demand, or the additional forms of compensation for which deductions are permissible under this part. No other methods of payment shall be recognized on work subject to the Copeland Act. §3.11 Regulations part of contract. All contracts made with respect to the construction, prosecution, completion, or repair of any public building or public work or building or work financed in whole or in part by loans or grants from the United States covered by the regulations in this part shall expressly bind the contractor or subcontractor to comply with such of the regulations in this part as may be applicable. In this regard, see §5.5(a) of this subtitle. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM CONTRACTOR'S CERTIFICATION CONCERNING LABOR STANDARDS AND PREVAILING WAGE REQUIREMENTS TO (appropriate recipient) DATE 7/1/2024 The Playwell Group PROJECT NUMBER (if any) Texas General Land Office o. 20-065-064-C 182 C/O PROJECT NAME Infrastructure at Little Chocolate Bayou County Iaygrounu IrnNtuvernenfs rnase 2 The undersigned, having executed a contract with Calhoun County for the construction of the above -identified project, acknowledges that: (a) The Labor Standards provisions are included in the aforesaid contract, ontract Park (b) Correction of any Infractions of the aforesaid conditions, including infractions by any subcontractors and any lower tier subcontractors, is Contractor's responsibility. (a) Neither Contractor nor any firm, partnership or association in which it has substantial interest is designated as an ineligible contractor by the Comptroller General of the United States pursuant to Section 5.6(b) of the Regulations of the Secretary of Labor, Part 5 (29 CFR, Part 5) or pursuant to Section 3(a) of the Davis -Bacon Act, as amended. (b) No part of the aforementioned contract has been or will be subcontracted to any subcontractor if such subcontractor or any firm, corporation, partnership or association in which such subcontractor has a substantial Interest Is designated as an ineligible contractor pursuant to any of the aforementioned regulatory or statutory provisions. 3. Contractor agrees to obtain and forward to the aforementioned r executed by subcontractors and any lower tier subcontractors, a Requirements executed by the subcontractors. Certifies (a) The legal name and the business address of the undersigned are: The Playwell Group 203A TX-46 E, Borene, TX 78006 (1) A SINGLE PROPRIETORSHIP (2) APARTNERSHIP ten days after the execution of any subcontract, including those 's Certification Concerning Labor Standards and Prevailing Wage (3) A CORPORATION ORGANIZED IN THE STATE OF (4) OTHER ORGANIZATION (Describe) - - - - --- --- - NAME =u m mu unaersl ned are: TITLE ADDRESS tei I ne names, addresses and trade classifications of all other building constmrtinn rnntrndnm in -hi,,k tk, ,,. A.I-,...,,.., ,.__ - _..—_ntial Date By (Contractor) (INSERT Proiect Specific Wage Decision] GLO SIGNAGE REQUIREMENTS All signs shall be placed in a prominent, visible public location at the construction site, and legible from at least three (3) feet distance. Permanent signage is required on any public building or facility funded under this Contract. Please refer to the plans and specifications for further details. For other construction projects (e.g., water transmission lines, sewer collection lines, drainage, roadways, housing rehabilitation) funded under this Contract, temporary signage shall be placed in a prominent location at the construction project site or along a major thoroughfare within the locality. All signage required shall contain the following: "This project is funded by the Texas General Land Office of the State of Texas, to provide for disaster recovery and restoration of infrastructure for communities impacted by Hurricane Harvey. The funds have been allocated by the United States Department of Housing and Urban Development through the Community Development Block Grant Program." CERTIFICATE OF INTERESTED PARTIES FORM 1295 A business entity will generate Form 1295 online after notification of award and submit with their signed contract. Form 1295 must be filled out and submitted online, printed, complete #6, signed and returned with the Agreement, Contract, or Lease. See Calhoun County, Texas - Policy of Compliance Go to: https://www.ethics.state.tK.us/File If you have an account, log in and proceed with the process or if you do not have an account, follow the instructions to set up an account and then proceed with the process. 2 Submit and print a copy of the form which will contain a unique certification number and date submitted in the upper right hand box that is marked "Office Use Only'. 3. The Respondent or an authorized agent of the Respondent must sign and date the printed copy of the form (making sure all of #6 is completed). 4. The completed Form 1295 must be included with your Agreement, Contract or Lease, when it is submitted to Calhoun County. #1 Name of Business Entity filing the form, and the City, State and Country of the Entity's place of business #2 Calhoun County, Texas (Also, if applicable, insert name of County Department) #3 Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvement Phase 2 Project - GLO Contract No. 20-085-064-C182 On #4 and #5, complete only the one that applies to you #4 Fill in the correct information if this applies OR #5 Mark an X in the Box if this applies #6 Fill in the correct information, submit and print After printing, the respondent or an authorized agent of the respondent must sign and date (making sure all of #6 is completed) When you print you should see a Certificate Number and Date in the upper right hand box that is marked "Office Use Only". CERTIFICATE OF INTERESTED PARTIES FORM 1295 Complete Nos. 1 - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 2, 3, 5, and 6 if there are no interested parties. ♦`� 1 Nameof business entaything form, andthe city, stateand countryof the business entity's place of business, 2 Name of governmental entity or state agency that is a party to the contract which the form is being filed. 3 Provide the identification number used by the governmental entity or state agency to tjjjJJJrrrrrr�� kD identify the contract, and provide a description of the services, goods, or other property to be provided r e contract. V a Name of Interested Party City, State, Country ature of Interest (check applicable) (place of business) ♦'Ic Controlling Intermediary 5 Check only ifthere I terested Party. a UNSWORNDE54 N My name is +i� and my date of birth is _ My addre - (street) (city) (state) (zip code) (country) d nder penalty of perjury that the foregoing is true and correct. Executed in _ County, Sate of , on the __ day of 2p� (month) (year) Signature of authorized agent of contMCting business entity (Declarant) ADD ADDITIONAL PAGES AS NECESSARY FIff1Y, nfrxANUN M.r Tnvne C,F:nn ��.�r r www.ethics.stste.tx.us Revised 1212212017 Calhoun County, Texas POLICY OF COMPLIANCE SECTION 2252.908 TEXAS GOVERNMENT CODE Approved by Commissioners Court January 28, 2016 Amended by Commissioners Court January 31, 2018 and September 14, 2022 BACKGROUND Section 2252.908 was added to the Government Code by the 841h Texas Legislature through the adoption of House Bill 1295. The law states that the County may not enter into a contract with a business entity unless a Certificate of Interested Parties (Form 1295) is provided to the county at the time the contract is considered for action by Commissioner's Court. The term "business entity" includes a sole proprietorship, partnership or corporation (whether for -profit or non-profit). The term "contract" includes amendment, extension or renewal of an existing contract. The law does not apply to a contract between the County and another governmental entity or state agency. The county is required to file Form 1295 with the state within 30 days of approving a contract with a business entity. Governmental transparency is the objective of the law. Senate Bill 255 adopted by the 85'h Legislature Regular Session amended the law effective for contracts entered into or amended on or after January 1, 2018. Additional exemptions from Form 1295 requirement were added for 1) a contract with a publicly traded business entity, including a wholly owned subsidiary of the business entity, 2) a contract with an electric utility as defined by Section 31.002 of the Utilities Code, or 3) a contract with a gas utility as defined by Section 121.001 of the Utilities Code. Notarization of Form 1295 has been replaced by an unsworn statement under penalty of perjury by an authorized representative of the business entity. The Texas Ethics Commission promulgated rules to implement the law and established an online portal https:/Iwww.ethics.state.tx.us/whatsnew/elf info_form1295.htm. A business entity will generate Form 1295 online. Calhoun County will acknowledge online the receipt of Form 1295 after a contract is executed. Within seven business days, Form 1295 will be available for public viewing on the Commission's website. COMPLAINCE Calhoun County Commissioners Court will not consider for action any contract with a business entity unless it is accompanied by a completed, signed Form 1295 or a signed statement declaring the provision of the law under which the business entity is exempt. No later than 30 days after Commissioner's Court approves a contract with a non-exempt business entity, the County Clerk will file acknowledgement of receipt of the Form 1295 with the Texas Ethics Commission. SECTION 504 CERTIFICATION POLICY OF NONDISCRIMINATION ON THE BASIS OF DISABILITY The The Playwell Group does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. (Name) (Address) City State Zip Telephone Number ( ) Voice ( ) TDD has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development's (HUD) regulations implementing Section 504 (24 CFR Part 8. dated June 2, 1988). CHILD SUPPORT STATEMENT FOR NEGOTIATED CONTRACTS AND GRANTS Under Section 231.006, Family Code, the vendor or applicant certifies that the individual or business entity named in this contract, bid, or application is eligible to receive the specified grant, loan, or payment and acknowledges that this contract may be terminated and payment may be withheld if this certification is inaccurate. Section 231.006, Family Code, specifies that a child support obligor who is more than 30 days delinquent in paying child support and a business entity in which the obligor is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least 25% is not eligible to receive payments from state funds under a contract to provide property, materials, or services; or receive a state -funded grant or loan. List below the name and ownership percentage of the individual or sole proprietor and each partner, shareholder, or owner with an ownership interest of at least 25% of the business entity submitting the bid or application. NAME OWNERSHIP BY % 0 D°� A child support obligor or business entity ineligible to receive payments described above remains ineligible until all arrearage have been paid or the obligor is in compliance with a written repayment agreement or court order as to any existing delinquency. The undersigned proposer certifies that he or she, is the proposing individual, or the sole proprietor of the proposing business, and is eligible under Section 231.006 of the Texas Family Code, to receive the payments of State funds which may be disbursed in connection with a contract arising from this solicitation, The undersigned each further acknowledges that a contract resulting from this solicitation may be terminated and payment may be withheld if the certification provided herein is found to be inaccurate. — Company Official The Playweil Group Printed/Type Firm Name Robertson 7/1 /2024 Printed/Typed Name and Title Date DOCUMENT NO. 00417 TRENCH SAFETY SYSTEMS INDEMNITY AGREEMENT OWNER: Calhoun County CONTRACTOR: The Playwell Group (company name) ENGINEER: G & W Engineers, Inc., Port Lavaca, Calhoun County, Texas PROJECT: Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-C182 for Calhoun County, Texas CONTRACTOR has entered into a contract with OWNER for the construction of the Project. ENGINEER has designed the Project on behalf of OWNER, but has not designed any trench safety systems for the Project that may be required by applicable federal, state and/or local laws. CONTRACTOR, in its contract with OWNER, has agreed to prepare, and to conform all trenching work to plans for trench safety systems meeting the standards of applicable laws. CONTRACTOR, as part of its consideration to OWNER for the contract for the construction of the Project, agrees that it will be solely responsible for compliance with its trench safety plans and with all applicable standards of federal, state and/or local laws relating to trench safety. CONTRACTOR further agrees to hold harmless, indemnify, and defend OWNER and ENGINEER, and all officers, agents and employees of either OWNER or ENGINEER, from and against any and all claims, demands or causes of action of any nature, character or description in connection with the presence, or in any way arising out of, the use or construction of trenches or trench safety systems as part of the Project. EXECUTED, this 1 day of July , 20 24 CONTRACTOR OWNER 0 Officer's Name: Officer's Name: Richard H. Meyer Title of Officer: Title of Officer: Calhoun County Judge ENGINEER (Contractor's Sea]) By: Engineer's Name: Scott P. Mason, P.E. Title of Engineer: Proiect Engineer PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS that: The Playwell Group (Name of Contractor or Company) 203A TX46 E, Borene, TX 78006 (Corporation 1 Partnership) and (Address) hereinafter called Principal, (Name of Surety Company) (Address) hereinafter called Surety, are held and firmly bound unto Calhoun County, Texas (Name of Recipient) 211 South Ann Street, Third Floor, Ste. 301, Port Lavaca Texas (Recipient's Address) hereinafter called OWNER, in the penal sum of $ Dollars, $ in lawful money of the United States, for this payment of which sum well and truly to be made, we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents. THE CONFIDENTIALITY OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER, dated the _day of a copy of which is hereto attached and made a part hereof for the construction of: Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-C182 for Calhoun County, Texas (Project Name) NOW, THEREFORE, if the Principal shall promptly make payment to all persons, firms, SUB -CONTRACTORS, and corporations furnishing materials for or performing labor in the prosecution of the WORK provided for in such contract, and any authorized extension or modification thereof, including all amounts due for materials, lubricants, oil, gasoline, coal and coke, repairs on machinery, equipment and tools, consumed or used in connection with the construction of such WORK, and all insurance premiums on said WORK, and for all labor, performed in such WORK whether by SUB- CONTRACTOR or otherwise, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the SPECIFICATIONS. PROVIDED, FURTHER, that no final settlement between the OWNER and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS WHEREOF, this instrument is executed in _ which shall be deemed an original, this the day of ATTEST: By (Principal Secretary) (SEAL) (Principal) (Witness as to Principal) (Address) (Address) ATTEST: M (Witness as to Surety (Address) (Surety) (Attorney in Fact) (Address) counter -parts, each on of (Number) (a) NOTE: Date of BOND must not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND. PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS that: (Name of Contractor or Company) (Address) hereinafter called Principal, and (Name of Surety Company) (Address) hereinafter called Surety, are held and firmly bound unto Calhoun County. Texas (Name of County) 211 South Ann Street Third Floor Ste. 301 Port Lavaca Texas (County's Address) hereinafter called OWNER, in the penal sum of $ Dollars ($ _) in lawful money of the United States, for the payment of which sum well and truly to be made we bind ourselves, successors, and assigns, jointly and severally, firmly in these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER dated the day of a copy of which is hereto attached and made a part hereof for the construction of: Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-C182 for Calhoun County, Texas NOW THEREFORE, if the Principal shall well, truly and faithfully perform its duties in all the undertakings, covenants, terms, conditions, and agreements of said contract during the original term thereof, and any extensions thereof which may be granted by the OWNER, with or without notice to the Surety and during the one year guaranty period, and if he shall satisfy all claims and demands incurred under such contract, and shall fully indemnify and save harmless the OWNER from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the OWNER all outlay and expense which the OWNER may incur in making good any default, then this obligation shall be void, otherwise to remain in full force and effect. PROVIDED FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any way affect its obligation on this BOND, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the SPECIFICATIONS. PROVIDED, FURTHER, that no final settlement between the OWNER and the Principal shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS WHEREOF, this instrument is executed in each one of which shall be deemed an original, this the ATTEST: (Principal) (Principal Secretary) (SEAL) (Witness as to Principal) (Address) (Address) ATTEST: By (Witness as to Surety) (Address) (Surety) (Attorney in Fact) (Address) counterparts, day of _ NOTE: Date of BOND must not be prior to date of Contract. If PRINCIPAL/CONTRACTOR is Partnership, all partners should execute BOND. CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDlYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER ?THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. INSURER(S), AUTHORIZED IMPORTANT: H fhe certificate holder Is an ADDITIONAL INSURED, the policy& I must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. bstafe doors d. this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Cooper Risk Advisors, LLC LADDRE DT Bill Hodgkins PO Box 638 904 N Main Street gJ1-765-534-3152 ac R I t188 262 9217is: bllln wcoo enndiana.comLapel IN 46051p INSURED The Playwell Group, Inc. & Playworks, Inc. 203A Highway 46 E Boerne TX 78006 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAREVISION MED ABOVEFOR .THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REgUIREMEN7, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1.e B X COMMERCIAL GENERAL LIABILITY rVL16YNUMBER MMIUD.— MMIRDr ur LIMITS CLAIMS PPK2651454 2/1/2024 2/1/2025 EACHOCCURRENCE -MADE OCLUR X IS TO ED 1 Primarv/non-coot PREMISES Eso wurrenu 1 MED EXP(Any one per son) I GEML AGGREGATE LIMIT APPLIES PER: PERSONAL S ADV INJURY 5 X POLICY 1X jELOT E LOC GENERALAGGREGATE § OTHER: PRODUCTS - COMP/OPAGG § A AUTOMOBILE LIABILITY I § X ANYAUTO 34 UEC AA8084 y1/202q 2J7/2025 COMBINED SINGLE LIMIT Ea aodd.nl $ OWNED SCHEDULED AUTOS ONLY BODILY INJURY(P., person) § AUTOS X HIRED X NON -OWNED AUTOS ONLY BODILY INJURY (Par eccidaolj $ AUTOS ONLY I PROPERTY DAMAGE Per accident § B UMBRELLAIJ B X S OCCUR X EXCESS LIAS PUB899192 2/1/2024 7J7/2025 EACH OCCURRENCE CLAIMS -MADE §: DED X RETENTIONS AGGREGATE S; A AND EMPSCOMPENSAU` AND EMPLOYERS'LA BRTN Y YIN WEC AX5J19 2/1/2024 2/1/2025 § X PER OTH- MWROPRIETO;OFFICEIMEMBEREXC I34 I STATUTE ER UDED?ECUTIVE OFFICElir,,InN RE%LLUOEO? N N/A ❑I (Mandatory In NH) E. L. EACH ACCIDENT 51 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space Is requlr Id) G & W Engineers, INC. 205 W. Live Oak Port Lavaca, TX 77979 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. All rights reserved. Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program Code of Federal Regulations Title 24- Housing and Urban Development Date: 2003-04-01 Original Date: 2003-04-01 Title: Section 135.38- Section 3 Clause Context: Title 24- Housing and Urban Development. Subtitle B- Relating to Housing and Urban Development . Chapter 1- Office of Assistant Secretary for Equal Opportunity, Department. Part 135 Economic Opportunities for Low -and Very Low -Income Persons. Subpart B- Economic Opportunities for Section 3 Residents and Section 3 Business Concerns. § 135.38 Section 3 clause. All section 3 covered contracts shall include the following clause (referred to as the section 3 clause): A. The work to be performed underthis contract is subject to the requirements of section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (section 3). The purpose of section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD -assisted projects covered by section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. B. The parties to this contract agree to comply with HUD's regulations in 24 CFR part 135, which implement section 3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with the part 135 regulations. C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the contractor's commitments under this section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can seethe notice. The notice shall describe the section 3 preference, shall set forth m inimum number and job titles subject to hire, availa bility of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin. D, The contractor agrees to include this section 3 clause in every subcontract subject to compliance with regulations in 24 CFR part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR part 135. E. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR part 135 require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under 24 CFR part 135. F. Noncompliance with HUD's regulations in 24 CFR part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. G. With respect to work performed in connection with section 3 covered Indian housing assistance, section 7(b) of the Indian Self -Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (i) preference and opportunities for training and employment shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian -owned Economic Enterprises. Parties to this contract that are subject to the provisions of section 3 and section 7(b) agree to comply with section 3 to the maximum extent feasible, but not in derogation of compliance with section 7(b). Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program [Code of Federal Regulations] [Title 24, Volume 1] [Revised as of April 1, 2003] From the U.S. Government Printing Office via GPO Access [CITE: 24CFR135.92] [Page 704-707] TITLE 24--HOUSING AND URBAN DEVELOPMENT CHAPTER I --OFFICE OF ASSISTANT SECRETARY FOR EQUAL OPPORTUNITY, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT PART 135--ECONOMIC OPPORTUNITIES FOR LOW- and VERY LOW-INCOME PERSONS Table of Contents Appendix to Part 135 I. EXAMPLES OF EFFORTS TO OFFER TRAINING AND EMPLOYMENT OPPORTUNITIES TO SECTION 3 RESIDENTS (1) Entering into ' *first source" hiring agreements with organizations representing Section 3 residents. (2) Sponsoring a HUD -certified ' ' Step -Up" employment and training program for section 3 residents. (3) Establishing training programs, which are consistent with the requirements of the Department of Labor, for public and Indian housing residents and other section 3 residents in the building trades. (4) Advertising the training and employment positions by distributing flyers (which identify the positions to be filled, the qualifications required, and where to obtain additional information about the application process) to every occupied dwelling unit in the housing development or developments where category 1 or category 2 persons (as these terms are defined in Sec. 135.34) reside. (5) Advertising the training and employment positions by posting flyers (which identify the positions to be filled, the qualifications required, and where to obtain additional information about the application process) in the common areas or other prominent areas of the housing development or developments, For HAs, post such advertising in the housing development or developments where category 1 or category 2 persons reside; for all other recipients, post such advertising in the housing development or developments and transitional housing in the neighborhood or service area of the section 3 covered project. (6) Contacting resident councils, resident management corporations, or other resident organizations, where they exist, in the housing development or developments where category 1 or category 2 persons reside, and community organizations in HUD assisted neighborhoods, to request the assistance of these organizations in notifying residents of the training and employment positions to be filled. (7) Sponsoring (scheduling, advertising, financing or providing in -kind services) a job informational meeting to be conducted by an HA or contractor representative or representatives at a location in the housing development or developments where category 1 or category 2 persons reside or in the neighborhood or service area of the section 3 covered project. (8) Arranging assistance in conducting job interviews and completing job applications for residents of the housing development or developments where category 1 or category 2 persons reside and in the neighborhood or service area in which a section 3 project is located. [[Page 705]] (9) Arranging for a location in the housing development or developments where category 1 persons reside, or the neighborhood or service area of the project, where job applications may be delivered to and collected by a recipient or contractor representative or representatives. (10) Conducting job interviews at the housing development or developments where category 1 or category 2 persons reside, or at a location within the neighborhood or service area of the section 3 covered project. (11) Contacting agencies administering HUD Youthbuild programs, and requesting their assistance in recruiting HUD Youthbuild program participants for the HA's or contractor's training and employment positions. (12) Consulting with State and local agencies administering training programs funded through ]TPA or JOBS, probation and parole agencies, unemployment compensation programs, community organizations and other officials or organizations to assist with recruiting Section 3 residents for the HA's or contractor's training and employment positions. (13) Advertising the jobs to be filled through the local media, such as community television networks, newspapers of general circulation, and radio advertising. (14) Employing a job coordinator, or contracting with a business concern that is licensed in the field of job placement (preferably one of the section 3 business concerns identified in part 135), that will undertake, on behalf of the HA, other recipient or contractor, the efforts to match eligible and qualified section 3 residents with the training and employment positions that the HA or contractor intends to fill. (15) For an HA, employing section 3 residents directly on either a permanent or a temporary basis to perform work generated by section 3 assistance. (This type of employment is referred to as ' 'force account labor' in HUD's Indian housing regulations. See 24 CFR 905.102, and Sec. 905.201(a)(6).) (16) Where there are more qualified section 3 residents than there are positions to be filled, maintaining a file of eligible qualified section 3 residents for future employment positions. (17) Undertaking job counseling, education and related programs in association with local educational institutions. (18) Undertaking such continued job training efforts as may be necessary to ensure the continued employment of section 3 residents previously hired for employment opportunities. (19) After selection of bidders but prior to execution of contracts, incorporating into the contract a negotiated provision for a specific number of public housing or other section 3 residents to be trained or employed on the section 3 covered assistance. (20) Coordinating plans and implementation of economic development (e.g., job training and preparation, business development assistance for residents) with the planning for housing and community development. Texas General Land Office Community Development Block Grant (CDBG) Disaster Recovery Program NEW HIRES SECTION 3 MONTHLY COMPLIANCE REPORT Reporting Month L_—J Economic Opportunities for Low and Very Low -Income Persons This form is dishibuted to the General Contractor (GC) at the Pre -Construction Meeting. GC is also required to provide this form to any subcontractor firms that they anticipate hiring for this project - CONTRACTOR INFORMATION Name of Business: Address of Business: Authorized Representative for this contract: Authorized Signatory: ADDITIONALLY, PLEASE REVIEW AND COMPLY WITH STEPS t - 3 BELOW: 2. When you hire a Section 3 resident in connection with this project, you must also complete this form and submit it to the Section 3 Coordinator identified above. Even if there were no new hires this form must be completed and submitted to the Section 3 Coordj0rabr)dentifie abo I have not hired any new employees during the reporting Month specified. I have hired ❑ Section 3 employess and/or ! J non -Section 3 employees during the reporting month shown here. The following is a list of the new hires and the trades: New Hire Name Job Category/Trade Full-time? Yes or No 1. 2— — Men one or more of the following recrukment etc Provide a brief description of actions taken: areas areas: ❑ Placed signs or posters at prominent places in each of the above listed areas. Photographs were taken to document this action m work is taking place, in connection texas Houston Chronicle andtor Distributed employment flyers to the administrative office of the local Public Housing Authority. Provided notice of positions available to the Texas Workforce Commission for potential applicants. Provide copy of notice. Ej Contacted employment referrals or Youthbuild Program referrals. List contacts: ❑ Contacted with applicable parties to ensure that any HUD Youthbuild programs currently operating in the project(s) area/ assistance will lake place. ❑ Kept a log of all applicants and indicate the reasons why Section 3 Residents who applied were not hired. El Section copies of any employment applications completed by public housing, Section 8 certificate or voucher holders or other Section 3 Residents. Sent a notice about Section 3 training and employment requirements and opportunities to labor organizations or to worker ❑ representatives with whom our firm has a collective bargaining or other agreement. 3. Verification ❑ I have attached proof of all checked items. Authorized Name and Signature Attested By: DateRme Field _ Text C vt O M lT ♦ttl 3 m iE a ��c go.g bvg cv� G,O vS 3 gg8 .n7 a m� �.n gx`e..�».'o a0.58. oa a gnu 'r ¢35..e •`._. a vA '0 3F via �$o BE a ogga nE,msiE.9 s"". se w3 "g g"g e'aac m. 2 0= 3 IR IL a N w AL M g:52.R. s r '4 ryj C y n ds O. N C '� j O1 '�' m N d e 0 p 4] 'l: O C •T 5 �- i m o �. Y v m p• _ Q S n gym .8 ��': 3 e' y 3 `� S, m yy c 0 N. !� 3 n 8 g ` e e �' m L m N > > $ 'a m a. m — m' a C] m o S3' $ O'6' I o,a f0 Er Ed m a= c $ QO 3 m m' ^�, — a g .m. m �. H Q' •p tee' z O .OH. u n 3 g R l n S 3. c o' O. g_� q a9 6 y O �•j y(� � � IQ (3 O 39 d o O. � DSO vS o 0.m n�O�mo_�.m a 3 e n� u �N m �s 05 7] me y E o nw $$ m•e G Q r9 m O n Z 2 fn m o w 6 &� S d c a$ v - ELKS �5 B&3 I° 91 sp. n�c e a ura •awiara ysarsgaaK 1 ASSURANCES -CONSTRUCTION PROGRAMS OMB Numbar.4040MG9 Expiration Date: 117J2ef2025 Public reporting burden for this collection of information is estimated to average 1s 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 cellection of information, Ineluding suggestions for reducing this burden, to the Office of Management and Budget Paperwork Reduction Project (0348-0042), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Certain of these assurances may not be applicable to your project or program. it you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funs sufficient to pay the non -Federal share Of project costs) to ensure proper planning, management and completion of project described in this application. 2. Will give the awarding agency, the Comptroller Ganeml of the United States and, if appropriate, the State, the right to examine Sit records, books, papers, or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will not dispose of, modify the use of, or change the terms of the real property title or other interest in the site and facilities without permission and instructions from the awarding agency. Will record. the Federal awarding agency directives and will include a covenant in the title of real property acquired in whole or in part with Federal assistance funds to assure non- discrimination during the useful life of the project. 4. Will empty with the requirements of the assistance awarding agency with regard to the drafting, review arod approval Of construction plans and specifications. 5. +bill provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications slid will furnish progressive reports and such other Information as may be required by the assistance awarding agency or State, 6. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or Presents the appearance of personal or organizations[ conflict of interest, or personal gain. 0. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§472BA783) relating to prescribed standards of merit systems forprograms funded under one of the 19 statutes or regulations specified in Appendix A of OPh1's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpar F), 9. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §§4601 at seq.) which prohibits the use of lead -based paint in construction or rehabilitation of residence structures. 10, Will comply with all Federal statutes relating to non- discrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which Prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972. as amended (20 U.S.C. 161681 leS3, and 1685.1686). which prohibits discrimination on the basis of sex; (0) Section 504 of the Rehabilitation Act of 1973, as amended (29)U.S.C. §794), which prohibits dLsctiminatlon on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 056101.6197), which prohibits discrimination an the basis of age; (a) the Drug Abuse Once and Treatment Act of 1972 (P. L. 92-25% as amended relating to nondiscrfminaton on the basis of drug abuse; (0 the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L 91.616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (9) 9§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C, §§290 dd-3 and 290 ee 3). as amended, relating to confidentiality of alcohol and tlmg abuse patient records: (h) Title Vlll of the Civil Rights Act of 1958 (42 U.S.C. §§3601 at seq.), as amended, relating to nondiscrimination in me sale, rental or financing of housing; (I) any other nondiscrimination provisions in the specific statue($) under which application for Federal assistance is being made; and 0) the requirements of any other nondiscrimination stalue(s) which may apply to the application, Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7-97) Proscnbad by Or49 Circular A•102 11. Will comply, or has already complied, with the requirements of Tittes li and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and federally -assisted programs. Thew requirements apply to all interests in real property acquired for project purposes regardless of Federal participation In purchases. 12, Will comply with the provisions of the Hatch Act (5 U-S.C. §§1501.1508 and 7324-7328) which limit the political activities Of employees whom principal employment activities are funded in whole or in part with Federal funds. 13. Will comply, as applicable, with the provisions of the Davis - Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S,C. §276c and 18 U.S.C. §874). and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327- 333) regarding labor standards for federally -assisted construction subagreements_ 14. Will comply with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood Insurance if the total cost of insurable construction and acquisition is $10,000 ormore. 15. Will Comply with environmental standards which may be prescribed pursuant to the following; (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91. 190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11090; (d) evaluation of Road hazards in floodplains in accordance with EO 11988; (a) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to State (Clean Air) implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 at seq.); (g) Protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205). 16. Will comply with iho Wild and Scenic Rivers Act of 1968 (16 U.S.C, §§1271 at seq.) related to protecting Components or potential components of the national wild and scenic rivers system. 17. Will assist the awarding agency in assuring compliance with Section IDS of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§4698-1 at seq). 19. Will cause to be performed fbe required financial and compliance audits In accordance with the Single Audit Act Amendments of 1996 and OMB Circular No, A-133, "Audits of States, Local Governments. and Non -Profit Organizations." 19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. 20. Will Comply with the requirements of Section 106(g) of the Trafncking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohlbits grant award recipients or a sdb-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sax act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award. SF424D (Rev. 7-97) Book Attadunmt C Page 1 or 10 For the purposes of this document, the term "governmental entities" shall have the same meaning as defined in Chapter 2251 of the Texas Government Code. 1'o THE Ea-I'ENT APPLICABLE, Subrecipient affirms and agrees to the following, without exception: 1. Subrecipient represents and warrants that, in accordance with Section 2155.005 of the Texas Government Code, neither Subrecipient nor the firm, corporation, partnership, or institution represented by Subrecipient, or anyone acting for such a firm, corporation, partnership, or institution has (1) violated any provision of the Texas Free Enterprise and Antitrust Act of 1983, Chapter 15 orthe Texas Business and Commerce Code, or the federal antitrust laws, or (2) communicated directly or indirectly the contents of this Contract or any solicitation response upon which this Contract is based to ally competitor or any other person engaged in the same line of business as Subrecipient. 2. If the Contract is for services, Subrecipient shall comply with Section 2155.4441 of the Texas GOVennmteld Code, requiring the purchase of products and materials produced in the State of Texas in perfomming service contracts, but for contracts subject to 2 CPR 200, only to the extent such compliance is consistent with 2 CFR 200.319. 3. Under Section 231.006 of the Family Code, the vendor or applicant [Subrecipient] certifies that time individual or business entity named in this Contract, bid or application is not ineligible to receive the specified grant, loan, or payment and acknowledges that Ibis Contract may be terminated and payment may be withheld if this certification is inaccurate. [Not applicable to contracts with governmental entities.] 4. A bid or an application for a Contract, grant, or loan paid from state funds must include the name and social security number of the individual or sole proprietor and each partner, shareholder, or owner with. all ownership interest of at least 25 percent of the business entitv submitting the bid or application. Subrecipient certifies it has submitted this information to the GM [Not applicable to contracts with governmental entities.] 5. if the Contract is for the purchase or lease of computer equipment, as defined by 'Texas lleallh and Safely Code Section 361.952(2), Subrecipient certifies that it is in compliance with Subchapter Y, Chapter 361 of time Texas Health and Safety Code, related to the Computer Equipment Recycling Program and Ole Texas Commission on Envirolunental Quality rules in Title 30 Texas Administrative Code Chapter 328. 6. Subrecipient represents and warrants that it has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment' gift, loan, gratuity, special discount, trip, favor, or service to a public servant fit connection with the Contract. 7. Subrecipient agrees that any payments due under Ole Contract shall be applied towards any debt or delinquency that is owed by Subrecipient to file State of'fesas. Allncha enl C Page 2 or to S. Upon request of the GLO, Subrecipient shall provide copies of its most recent business continuity and disaster recovery plans. 9. If the Contract is for consulting services govemed by Texas Govemment Code Chapter 2254, Subchapter B, in accordance with Section 2254.033 of the Texas Govenunent Code, relating to consulting services, Subrecipient certifies that it does not employ an individual who has been employed by the GLO or another agency at any time during the two years preceding die Subrecipient's submission of its offer to provide consulting services to the GLO or, in the allemative Subrecipient, in its offer to provide consulting services to the GLO, disclosed the following: (i) the nature of the previous employment with the GLO or other state agency; (ii) the date the employment was terminated; and (iii) the annual rate of compensation for the employment at the time of its temtination. 10. If the Contract is not for architecture, engineering, or construction services, except as otherwise provided by statute, rule, or regulation, Subrecipient must use the dispute resolution process provided for in Chapter 2260 of the Texas Govematuent Code to attempt to resolve any dispute arising under the Contract, NOTHING IN THIS SECTION SHALT., BE CONSTRUED AS A WAIVER OF SOVEREIGN IMMUNITY BY THE GLO OR, IF APPLICABLE, OF GOVERNMENTAL IMMUNITY" BY SUBRECIPIENT. 11. If the Contract is for architecture, engineering, or construction services, subject to Texas Govenunent Code Section 2260.002 and Texas Civil Practice and Remedies Code Chapter 114, and except as otherwise provided by statute, rule, or regulation, Subrecipient shall Ilse the dispute resolution process provided for in Chapter 2260 of the Texas Govenment Code to attempt to resolve all disputes arising under this Contract. Except as otherwise provided by statute, rule, or regulation, in accordance with the Texas Civil Practice and Remedies Code, Section 114.005, claims encompassed by Texas Govemment Code, Section 2260.002(3) slid Texas Civil Practice and Remedies Code Section 114.002 shall be governed by the dispute resolution process set forth below in subsections (a)-(d). NOTHING IN THIS SECTION SHALL BE CONSTRUED AS A WAIVER OF SOVEREIGN IMMUNITY BY THE GLO OR, IF APPLICABLE, OF GOVERNMENTAL IMMUNITY BY SUBRECIPIENT. a. Notwithstanding Texas Government Code, Chapter 2260.002(3) and Chapter 114.012 and any other statute or applicable law, if Subrecipient's claim for breach of contract cannot be resolved by the Parties in the ordinary course of business, Subrecipient may make a claim against the GLO for breach of contract and the GLO may assert a counterclaim against Subrecipient as is contemplated by 'Texas Govenunent Code, Chapter 2260, Subchapter B. In such event, Subrecipient must provide written notice to One GLO of a claim for breach of the Contract not later than the 180th day after the date of the event giving rise to the claim. The notice must slate with particularity: (1) the nature of the alleged breach; (2) the amount Subrecipient seeks as damages; and (3) the legal theory of recovery. b. the chief administrative officer, or if designated in the Contract, another officer of the GLO, shall examine the claim and any counterclaim and negotiate with Subrecipient in an eflbrt to resolve them. Tile negotiation must begin no later than the 120th day after the A1ledunmi C page J or 10 date the claim is received, as is contemplated by Texas Government Code, Chapter 2260, Section 2260,052. C. If the negotiation under paragraph (b) above results in the resolution of some disputed issues by agreement or in a settlement, the Parties shall reduce the agreement or settlement to writing and each Party shall sign tine agreement or settlement. A partial settlement or resolution of a claim does not waive a Party's rights under this Contract as to the parts of the claim that are not resolved. d. If a claim is not entirely resolved under paragraph (b) above, on or before the 270th day after the date the claim is filed with the GLO, unless the Parties agree in writing to an extension of time, the Patties may agree to mediate a claim made under this dispute resolution procedure. This dispute resolution procedure is Subrecipient's sole and exclusive process for seeking a remedy for an alleged breach of contract by the GLO if the Parties are unable to resolve their disputes as described ht this section. e. Nothing in the Contract shall be construed as a waiver of the state's or the GLO's sovereign immunity, or, if applicable, the governmental immunity of Subrecipient. This Contract shall not constitute or be construed as a waiver of any of the privileges, rights, defenses, remedies, or immunities available to tine State of Texas or Subrecipient. The failure to enforce, or any delay in the enforcement, of any privileges, rights, defenses, remedies, or immunities available to the State of Texas or, if applicable, of Subrecipient under this Contract or under applicable law shall not constitute a waiver of such privileges, rights, defenses, remedies or immunities or be considered as a basis for estoppel. The GLO does not waive any privileges, rights, defenses, or immunities available to it by entering into this Contract or by its conduct, or by the conduct of any representative of the GLO, prior to or subsequent to entering into this Contract. Subrecipient does not waive any privileges, rights, defenses, or immunities available to it by entering into this Contract or by its conduct, or by the conduct of any representative of the GLO, prior to or subsequent to entering into this Contract. Except as otherwise provided by statute, rule, or regulation, compliance with the dispute resolution process provided for in Texas Government Code, Chapter 2260. subchapter B and incorporated by reference in subsection (a)-(d) above is a condition precedent to the Subrecipient: (]) filing suit pursuant to Chapter 114 of the Civil Practices and Remedies Code; or (2) initiating a contested case hearing pursuant to Subchapter C of Chapter 2260 of the Texas Government Code. 12. If Chapter 2271 of tine Tcxas Government Code applies to this Contract, Subrecipient verifies that it does not boycott Israel and will not boycott Israel during the term of tine Contract. 13. This Contract is contingent upon the continued availability of lawful appropriations by the Texas Legislature. Subrecipient understands that all obligations of the GLO tinder this Contract are subject to the availability of funds. If such fiords are not appropriated or become unavailable, the GLO may terminate the Contract. The Contract shall not be construed as creating a debt oil behalf of the GLO in violation of Article IIL Section 49a of the Texas Constitution. Attachment C Page A or 10 14. Subrecipient certifies that it is not listed in the prohibited vendors list anthorized by Executive Order 13224, `Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit, or Support Terrorism", published by the United States Department of the Treasury, Office of Foreign Assets Control. 15. In accordance with Section 669.003 of the Texas Government Code, relating to contracting with the executive head of a state agency, Subrecipient certifies that it is not (1) the executive head of the GLO, (2) a person who at any time during the four years before the effective date of the Contract was the executive head of the GLO, or (3) a person who employs a current or former executive head of the GLO. 16. Subrecipient represents and warrants that all statements and information prepared and submitted in connection with this Contract are current, complete, true, and accurate. Submitting a false statement or making a material misrepresentation during the performance of this Contract is a material breach of contract and may void the Contract or be grounds for its termination. 17. Pursuant to Section 2155.004(a) of the Texas Government Code, Subrecipient certifies that neither Subrecipient nor any person or entity represented by Subrecipient has received compensation from the GLO to participate in the preparation of the specifications or solicitation on which this Contract is based. Under Section 2155.004(b) of the Texas Government Code, Subrecipient certifies that the individual or business entity named in this Contract is not ineligible to receive the specified Contract and acknowledges that the Contract may be terminated and payment withheld if this certification is inaccurate. This Section does not prohibit Subrecipient from providing free technical assistance. 18. Subrecipient represents and warrants that it is not engaged in business with Iran, Sudan, or a foreign terrorist organization, as prohibited by Section 2252.152 of the Texas Government Code. 19. In accordance with Section 2252.901 of the Texas Government Code, for the categories of contracts listed in that section, Subrecipient represents and warrants that none of its employees including, but not limited to, those authorized to provide services under the contract, were employees of the GLO during the twelve (12) month period immediately prior to the date of execution of the contract. Solely for professional services contracts as described by Chapter 2254 of the Texas Government Code, Subrecipient further represents and warrants that if a former employee of the GLO was employed by Subrecipient within one year of the employee's leaving the GLO, then such employee will not perform services on projects with Subrecipient that the employee worked on while employed by the GLO. 20. The Contract slmall be governed by and construed in accordance with the laws of the State of Texas, without regard to the conflicts of law provisions. The venue of any suit arising under the Contract is fixed in any court of competent jurisdiction of Travis County, Texas, unless the specific venue is otherwise identified in a statute which directly names or otherwise identifies its applicability to any Party. Attachment. C Page 5 of to 21. IF THE CONTRACT IS NOT FOR ARCHITECTURE OR ENGINEERING SERVICES GOVERNED BY TEXAS GOVERNMENT CODE CHAPTER 2254, SUBRECIPIENT, TO THE EXTENT ALLOWED BY LAW, SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS TIIE STATE OF TEXAS AND THE GLO, AND/OR THEIR OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES, CONTRACTORS, ASSIGNEES, AND/OR DESIGNEES FROM ANY AND ALL LIABILITY, ACTIONS, CLAIMS, DEMANDS, OR SUITS, AND ALL RELATED COSTS, ATTORNEY FEES, AND EXPENSES .ARISING OUT OF, OR RESULTING FROM ANY ACTS OR OMISSIONS OF SUBRECIPIENT OR ITS AGENTS, EMPLOYEES, SUBCONTRACTORS, ORDER FULFILLERS, OR SUPPLIERS OF SUBCONTRACTORS IN THE EXECUTION OR PERFORMANCE OF THE CONTRACT AND ANY PURCHASE ORDERS ISSUED UNDER THE CONTRACT. THE DEFENSE SHALL BE COORDINATED BY SUBRECIPIENT WITH THE OFFICE OF THE TEXAS ATTORNEY GENERAL WHEN TEXAS STATE AGENCIES ARE NAMED DEFENDANTS IN ANY LAWSUIT AND SUBRECIPIENT MAY NOT AGREE TO ANY SETTLEMENT WITHOUT FIRST OBTAINING THE CONCURRENCE FROM THE OFFICE OF THE TEXAS ATTORNEY GENERAL. SUBRECIPIENT AND THE GLO SHALL FURNISH TIMELY WRITTEN NOTICE TO EACH OTHER OF ANY SUCH CLAIM. [Not applicable to contracts with governmental entities.] 22.IF THE CONTRACT IS FOR ARCHITECTURE OR ENGINEERING SERVICES GOVERNED BY TEXAS GOVERNMENT CODE CHAPTER 2254, SUBRECIPIENT. TO THE EXTENT ALLOWED BY LAW, SHALL INDEMNIFY AND HOLD HARMLESS THE STATE OF TEXAS AND THE GLO, AND/OR THEIR OFFICERS, AGENTS, EMPLOYEES, REPRESENTATIVES, CONTRACTORS, ASSIGNEES, AND/OR DESIGNEES FROM ANY AND ALL LIABILITY, ACTIONS, CLAIMS, DEMANDS, OR SUITS, AND ALL RELATED DAMAGES, COSTS, ATTORNEY FEES. AND EXPENSES TO TIIE EXTENT CAUSED BY, ARISING OUT OF, OR RESULTING FROM ANY ACTS OF NEGLIGENCE, INTENTIONAL TORTS, WILLFUL MISCONDUCT, PERSONAL, INJURY OR DAMAGE TO PROPERTY, AND/OR OTHERWISE RELATED TO SUBRECIPIENT'S PERFORMANCE, AND/OR FAILURES TO PAY A SUBCONTRACTOR OR SUPPLIER BY THE SLBRECIPIENT OR ITS .AGENTS, EMPLOYEES, SUBCONTRACTORS, ORDER FULFILLERS, CONSULTANTS UNDER CONTRACT TO SUBRECIPIENT, OR ANY OTHER ENTITY OVER WHICH THE CONTRACTOR EXERCISES CONTROL OR. SUPPLIERS OF SUBCONTRACTORS IN TIIE EXECUTION OR PERFORMANCE OF THE CONTRACT. THE DEFENSE SHALL BE COORDINATED BY SUBRECIPIENT WITH THE OFFICE OF THE TEXAS ATTORNEY GENERAL, WHEN TEXAS STATE AGENCIES ARE NAMED DEFENDANTS IN ANY LAWSUIT AND SUBRECIPIENT MAY NOT AGREE TO ANY SETTLEMENT WITHOUT FIRST OBTAINING THE CONCURRENCE FROM THE OFFICE OF THE TEXAS ATTORNEY GENERAL. SUBRECIPIENT AND THE GLO SHALL, FURNISH TIMELY WRITTEN NOTICE TO EACH OTHER OF ANY SUCH CLAIM. [Not applicable to contracts with governmental entities.] 23. TO THE EXTENT ALLOWED BY LAW, SUBRECIPIENT SHALL DEFEND. INDEMNIFY, AND HOLD H.ARMLESS TIIE GLO AND THE STATE OF TEXAS FROM naaduaenr C Page 6 or 10 AND AGAINST ANY AND ALL CLAIMS, VIOLATIONS, MISAPPROPRIATIONS OR INFRINGEMENT OF ANY PATENT, TRADEMARK, COPYRIGHT, TRADE SECRET OR OTHER INTELLECTUAL PROPERTY RIGHTS !iND/OR OTHER INTANGIBLE PROPERTY, PUBLICITY OR PRIVACY RIGHTS, AND/OR IN CONNECTION WITH OR ARISING FROM: (1) THE PERFORMANCE OR ACTIONS OF SUBRECIPIENT PURSUANT TO THIS CONTRACT, (2) ANY DELIVERABLE, WORK PRODUCT, CONFIGURED SERVICE OR OTHER SERVICE PROVIDED HEREUNDER: AND/OR (3) THE GLO'S AND/OR SUBRECIPIENT'S USE OF OR ACQUISITION OF ANY REQUESTED SERVICES OR OTHER ITEMS PROVIDED TO THE GLO BY SUBRECIPIENT OR OTHERWISE TO WHICII THE GLO HAS ACCESS AS A RESULT OF SUBRECIPIENT'S PERFORMANCE UNDER THE CONTRACT. SUBRECIPIENT AND THE GLO SHALL FURNISH TIMELY WRITTEN NOTICE TO EACH OTHER OF ANY SUCH CLAIM. SUBRECIPIENT SHALL BE LIABLE TO PAY ALL COSTS OF DEFENSE, INCLUDING ATTORNEYS' FEES, THE DEFENSE SHALL BE COORDINATED BY SUBRECIPIENT WITH THE OFFICE OF THE TEXAS ATTORNEY GENERAL (OAG) WHEN TEXAS STA'IT AGENCIES ARE NAMED DEFENDANTS IN ANY LAWSUIT AND SUBRECIPIENT MAY NOT AGREE. TO ANY SETTLEMENT WITHOUT FIRST OBTAINING THE CONCURRENCE FROM OAG. IN ADDITION. SUBRECIPIENT WILL REIMBURSE THE GLO AND THE STATE OF TEXAS FOR ANY CLAIMS, DAMAGES, COSTS, EXPENSES OR OTHER AMOUNTS, INCLUDING, BUT NOT LIN41TPD TO, ATTORNEYS' FEES AND COURT COSTS, ARISING FROM ANY SUCH CLAIM. IF THE GLO DETERMINES THAT A CONFLICT EXISTS BETWEEN ITS INTERESTS AND THOSE OF SUBRECIPIENT OR LF THE GLO IS REQUIRED BY APPLICABLE LAW TO SELECT SEPARATE COUNSEL, THE GLO WILL BE PERMITTED TO SELECT SEPARATE COUNSEL AND SUBRECIPIENT WILL PAY ALL REASONABLE COSTS OF THE GLO'S COUNSEL. [Not applicable to contracts with governmental entities.] 24. Subrecipient has disclosed in writing to the GLO all existing or known potential conflicts of interest relative to the performance of the Contract. 25. Sections 2155,006 and 2261.053 of the Texas Government Code prohibit state agencies from accepting a solicitation response or awarding a contract that includes proposed financial participation by a person who, in the past five years, has been convicted of violating a federal law or assessed a penalty in connection with a contract involving relief for Hurricane Rita, Hurricane Katrina, or any other disaster, as defined by Section 418.004 of the Texas Government Code, occurring after September 24, 2005. Under Sections 2155.006 slid 2261.053 of the Texas Government Code, Subrecipient certifies that the individual or business entity named in this Contract is not ineligible to receive the specified Contract and acknowledges that this Contract may be terminated and payment withheld if this certification is inaccurate. 26. Subrecipient understands that the GLO will comply with the Texas Public hmfomtation Act (Chapter 552 of the Texas Government Code) as interpreted by judicial rulings and opinions of the Attorney General of the State of Texas. hutornmation, documentation, and other material related to this Contract may be subject to public disclosure pursuant to the Texas Public Infomratiou Act. In accordance with Section 2252.907 of the Texas Government Attachment C Page i of 10 Code, Subrecipient shall make any information created or exchanged with the State/GLO pursuant to the Contract, and not otherwise excepted from disclosure under the Texas Public Information Act, available in a format that is accessible by the public at no additional charge to the State or the GLO. 27. The person executing this Contract certifies that lie/she is duly authorized to execute this Contract on his/her own behalf or on behalf of Subrecipient and legally empowered to contractually bind Subrecipient to the terms and conditions of the Contract and related documents. 29. If the Contract is for architectural or engineering services, pursuant to Section 2254.0031 of the Texas Government Code, which incorporates by reference Section 271.904(d) of the Texas Local Goverment Code, Subrecipient shall perform services (1) with professional skill and care ordinarily provided by competent engineers or architects practicing under the same or shnilar circwnstances and professional license, and (2) as expeditiously as is prudent considering the ordinary professional skill and care of a competent engineer or architect. 29. The state auditor may conduct an audit or investigation of any entity receiving funds from the slate directly under the Contract or indirectly through a subcontract under the Contract. The acceptance of funds directly under the Contract or indirectly through a subcontract under the Contract acts as acceptance of the authority of the state auditor, under the direction of the legislative audit committee, to conduct an audit or investigation in connection with those funds. Under the direction of the legislative audit committee, an entity that is time subject of an audit or investigation by the state auditor must provide the state auditor with access to any information the state auditor considers relevant to the investigation or audit. Subrecipient shall ensure that this paragraph concerning the authority to audit finds received indirectly by subcontractors through the Contract and the requirement to cooperate is included in any subcontract it awards. The GLO may unilaterally amend the Contract to comply with any riles and procedures of the state auditor in the implementation and enforcement of Section 2262.154 of the Texas Government Code. 30. Subrecipient certifies that neither it nor its principals are debarred, suspended, proposed for debarment, declared ineligible, or otherwise excluded from participation in the Contract by any state or federal agency. 31. Subrecipient expressly acknowledges that funds may not be expended in connection with the purchase of an automated infomlation system unless that system nheets certain statunory requirements relating to accessibility by persons with visual impainuents. Accordingly, Subrecipient represents and warrants to the GLO that any technology provided to the GLO for purchase pursuant to this Contract is capable, either by virtue of features included within the technology or because it is readily adaptable by use with other technology, of: providing equivalent access for effective use by both visual and non -visual means; presenting information, including prompts used for interactive counnmications, ill fornats intended for non -visual use; and being integrated into networks for obtaining, retrieving, and disseminating information used by individuals who are not blind or visually impaired. For purposes of this Section, the phrase "equivalent access" means a substantially similar ability to communicate with or make use of the technology, either directly by features incorporated Atludnnmt C Page a or 10 within the technology or by other reasonable means such as assistive devices or services Which would constitute reasonable accommodations under the Americans With Disabilities Act or similar state or federal laws. Examples of methods by which equivalent access may be provided include, but are not limited to, keyboard alternatives to mouse commands and odler means of navigating graphical displays, and customizable display appearance. 32. If the Contract is for the purchase or lease of covered television equipment, as defined by Section 361.971(3) of the Texas Health and Safety Code, Subrecipient certifies its compliance with Subchapter T, Chapter 361 of the Texas Health and Safety Code, related to the Television Equipment Recycling Program. 33. Pursuant to Section 572,069 of the 'texas Government Code, Subrecipient certifies it has not employed and will not employ a former state officer or employee who participated in a procurement or contract negotiations for the GLO involving Subrecipient within two (2) years after tltc date that the contract is signed or the procurement is terminated or withdrawn. "his certificatimm only applies to former state officers or employees whose state service or employment ceased on or after September 1, 2015. 34. The GLO does not tolerate any type of fraud. GLO policy promotes consistent, legal, and ethical organizational behavior by assigning responsibilities and providing guidelines to enforce controls. Any violations of law, agency policies, or standards of ethical conduct will be investigated, and appropriate actions will be taken. Subrecipient shall report any possible fraud, waste, or abuse that occurs in connection with the Contract to the GLO's Fraud Reporting hotline at (877) 898-0002. 35. The requirements of Subchapter J. Chapter 552, Government Code, may apply to this Contract and Subrecipient agrees that the Contract can be temninated if Subrecipient knowingly or intentionally fails to comply with a requirement of that subchapter. 36. If Subrecipient, in its performance of the Contract, has access to a state computer system or database, Subrecipient must complete a cybersecurily training program certified under Texas Government Code Section 2054.519, as selected by the GLO. Subrecipient must complete the cybersecurily training program during the initial tern of the Contract and during any renewal period. Subrecipient must verify in writing to the GLO its completion of the cybersecurity training program, 37. Under Section 2155.0061, Texas Government Code, Subrecipient certifies that the entity named in this Contract is not ineligible to receive the specified Contract and acknowledges that this Contract may be terminated and payment withheld if this certification is inaccurate. [Not applicable to contracts with governumental entities.1 38. Subrecipient cerifies that it does not require its customers to provide any documentation certifying the customer's COVID-19 vaccination or post -transmission recovery on entry to, to gain access to, or to receive service from Subrecipient's business. Subrecipient acknowledges that such a vaccine or recovery requirement would make Subrecipient ineligible for a state -funded contract. Auachmad C Page 9 or 10 39. Pursuant to Government Code Section 2274.0102, Subrecipient certifies that neither it nor its parent company, nor any affiliate of Subrecipient or its parent company, is: (1) majority owned or controlled by citizens or governmental entities of China, Iran, North Korea, Russia, or any other country designated by the Governor under Government Code Section 2274.0103, or (2) headquartered in any of those countries. 40. If Subrecipient is required to make a verification pursuant to Section 2274.002 of the Texas Government Code, Subrecipient verifies that Subrecipient does not boveott energy companies and will not boycott energy companies during the temm of the Contract. If Subrecipient does not make that verification, Subrecipient must notify the GLO and state why the verification is not required, 41. If Subrecipient is required to make a verification pursuant to Section 2274.002 of the Texas Government Code, Subrecipient verifies that it (1) does not have a practice, policy, guidance, or directive that discriminates against a "firearm entity" or "tireamr trade association" as those ternrs are defined in Texas Government Code section 2274.001 and (2) will not discriminate during the term of the Contract against a firearm entity or Eireann trade association. If Subrecipient does not make that verification, Subrecipient must notify the GLO and state why the verification is not required. 42.If Subrecipient is a "professional sports leant" as defined by Texas Occupations Code Section 2004.002, Subrecipient will play the United States national anthem at the beginning of each team sporting event held at Subrecipient's home venue or other venue controlled by Subrecipient for the event. Failure to comply with this obligation constitutes a default of this Contract, and immediately subjects Subrecipient to the penalties for default, such as repayment of money received or ineligibility for additional money. In addition, Subrecipient may be debarred from contracting with the State. The GLO or the Attorney General may strictly enforce this provision. 43. To the extent Section 552.371 of the Texas Government Code applies to Subrecipient and the Contract, in accordance with Section 552.372 of the Texas Government Code, Subrecipient must (a) preserve all contracting information related to the Contract in accordance with the records retention requirements applicable to the GLO for the duration of the Contract, (b) no later than the tenth business day after the date of the GLO's request, provide to the GLO any contracting information related to the Contract that is in Subrecipient's custody or possession, and (c) on termination or expiration of the Contract, either (i) provide to the GLO at no cost all contracting information related to the Contract that is in Subrecipient's custody or possession or (ii) preserve the contracting information related to the Contract in accordance with the records retention requirements applicable to the GLO. Except as provided by Section 552.374(c) of the 'texas Government Code, the requirements of Subchapter J, Chapter 552, Goverment Code, may apply to the Contract and Subrecipient agrees that the Contract may be terminated if Subrecipient knowingly or intentionally fails to comply with a requirement of that subchapter. 44. If the Contract is for consulting services governed by Chapter 2254 of the Texas Government Code, Subrecipient, upon completion of the Contract, must give the GLO a compilation, in a Aftudvumf C rags to of to digital meditun agreed to by the Parties, of all documents, films, recordings, or reports Subrecipient compiled in connection with its performance under the Contract. ATTORNEY'S REVIEW CERTIFICATION Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-Cl82 for Calhoun County, Texas I, the undersigned, representative of the Calhoun County, do hereby certify as follows: the duly authorized and acting legal I have examined the attached contract(s) and surety bonds and am of the opinion that each of the agreements may be duly executed by the proper parties, acting through their duly authorized representatives; that said representatives have full power and authority to execute said agreements on behalf of the respective parties; and that the agreements shall constitute valid and legally binding obligations upon the parties executing the same in accordance with terms, conditions and provisions thereof. Attorney's signature: Print Attorney's Name: Texas State Bar Number: Date: CONTRACTOR'S FINAL PAYMENT AFFIDAVIT County: Calhoun County, Texas Contractor: The Playwell Group CDBG-MIT No: 20-065-064-C182 Date: 7/1 /2024 BEFORE ME, THE UNDERSIGNED AUTHORITY, on this day personally appeared who being duly sworn, on oath, says that he is a duly authorized representative of Contractor, and that all terms of the Contract for the completion of certain public works described as Bid No. 2024.08 — Infrastructure at Little Chocolate Bayou County Park Playground Improvements Phase 2 Project — GLO Contract No. 20-065-064-C182 for Calhoun County, Texas have been satisfactorily completed and that ALL sums of money for payrolls, bills for material and equipment, and other indebtedness connected with the Work for the Owner or its property might in any way be responsible to the best of my knowledge and belief, have been paid or will be paid or otherwise satisfied within thirty days after receipt of final payment from the Owner, or within the period of time required by Article 601f, Vernon's Civil Statutes. Payments not made in full at the time of this affidavit are listed below. FINAL PAYMENTS pending as of this date hereof are: None Pending As Listed Below Individual or Co. Name Mailing Address Amount Owed Signature Title Affidavit must be signed by an individual owner or partner in partnership, or by a person authorized by by-laws or Board of Directors to sign for a corporation. If Contractor is a joint venture or partnership of individuals, either may sign, but if a joint venture in which a corporation is a party, separate affidavits must be executed by each corporation and by each individual owner or partnership. In the event subcontractors, laborers, or material suppliers have not been paid in full, the Contractor shall list here on the amount owed and the name and address of each subcontractor, laborer, or material supplier to whom such payment is owed. Sworn and Subscribed before me this, the (SEAL) Notary Public in and for County, Texas day of _, 20 0 a U) N d 7 cr 01 Q.' C C O m L O 0 LA E U ° rn A t0 V s � a o d O d c 0 L •� 6 W F tl U 0 0 U U m 0 r X H E N tD W V 3 rn IL d C Q m y a a ¢ 0 C � N C Nd E A IL z C G R � A N N N 0 0 a U ¢ U Of W W m M ¢ ❑N a to O N Fx- N LL m A N C w o 4 T G Q A L d m d L E u y N U F O O 0 X 7 O U Z 7) O S Q U z w of O U LLI W W 7 Q ¢ U ¢ O a U d u u �Z 0 a U 0 U C C G E EE E .01 G a rt �z vWE O « 0 'O a m m fff N 0 m M 0 N O O O y W V d P d d a a 9 C O m C d d � a u tl1 A C � a � H O y � C a ad d E E T ti 3 a o rn N N d N d O T � C d � c � - M A w w E d c o - O 9 .q N �� W 6 0 R pr h u k 4 3t u I £E�. § \ § IAI ..k A , d d 40 { M i 1 r P i 1 ) I NOTICE OF MEETING -- 8/21/2024 8. Consider and take necessary action on insurance proceeds check from TAC in the amount of $9,545.75 ($14,545.75 — $5,000.00 deductible) for damages from Jail water leak on 04/29/24. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 5of17 Debbie From: Erica.Perez@calhouncotx.org (Erica Perez) <Erica.Perez@calhouncotx.org> Sent: Tuesday, August 13, 2024 8:20 AM To: 'To:'; 'Richard H. Meyer'; 'David Hall'; 'vern lyssy';joel.behrens@calhouncotx.org; 'Gary Reese' Cc' everett wood; Rachel Martinez Subject: Agenda Item - Insurance Proceeds - Jail Attachments: TAC Insurance Proceeds-Jail-04292024.pdf Debbie, Please add the following to the next available Commissioners Court agenda. • Consider and take necessary action on insurance proceeds check from TAC in the amount of $9,545.75 ($14,545.75 — $5,000.00 deductible) for damages from Jail water leak on 04/29/24. Thank you. Best regards, Erica Perez First Assistant Auditor Calhoun County 202 S. Ann, Suite B Port Lavaca, TX 77979 Phone: 361. 553.4612 Fax: 361.553.4614 Calhoun County Texas TEXAS ASSOCIATION OF COUNTIES RISK MANAGEMENT POOL -CLAIMS 76010 Detention Center 8/8/2024 PR20240586-1 Deductible $-5000.00 76010 t011"'t TEXAS ASSOCIAT110N OF COUNTIES FROST BANK RISK MANAGEMENT POOL -CLAIMS 30-sn1nD 1210 SAN ANTONIO STREETYF AUSTIN, TX 78701 L OO V 0 H DATE AMOUNT 8/8/2024 $ 9,545.75 3 PAY NINE THOUSAND FIVE HUNDRED FORTY-FIVE. AND 75 / 100 DOLI..ARS n VOID AFTER 180 DAYS N TO THE Calhoun County DROOER 211 S Ann St na' Port Lavaca TX779794203 TEXAS ASSOCIATION OF COUNTIES 76010 RISK MANAGEMENT POOL -CLAIMS Calhoun County 211 S Ann St Stp B Port Lavaca, TX 779794203 TO REOFIDFR CALL: (706) 327.9550 W W8FM1014M 03/23 # 09 NOTICE OF MEETING - 8/21%)024 9. Consider and take necessary action to approve Calhoun County Fair Association to sell alcohol at the 2024 Calhoun County Fair. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 6 of 17 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Richard Meyer Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Meyer, (361)552-9242 Fax(361)553-8734 Please place the following item on the Commissioners' Court Agenda for August 21st, 2024. • Consider and take necessary action to approve Calhoun County Fair Association to sell alcohol at the 2024 Calhoun County Fair. See map for locations Sincer David .Hall DE H/apt ri NOTICE OF PUBLIC HEARING 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, at 10:00 a.m. on September 4, 2024 regarding the 2024 Calhoun County Proposed Tax Rate. This notice is in accordance with Section 111.007 and Section 111.0075 of the Texas Local Government Code. The public shall have the right to be present and participate in such hearing. Richard Meyer, County Judge Calhoun County, Texas RICHARD H. MEYER Calhoun County Judge coF= 211 S. Ann Street, Suite 301 - Port Lavaca, Texas 77979 (361) 553-4600 - Fax (361) 553-4444 - Email: richard.meyer@calhouncotx.org OWNER OF PROPERTY AUTHORIZATION LETTER August 21, 2024 Texas Alcoholic Beverage Commission 2820 S Padre Island Drive, Suite 120 Corpus Christi, TX 78415 361-851-2531 Organization Name: Calhoun County Fair Association I hereby authorize Calhoun County Fair Association to sell beer at the following: Event Description: 2024 Calhoun County Fair Date (s) of Function: October 14 - 19, 2024 Time of Function: Location Address: 186 Henry Barber Way, Port Lavaca, TX 77979 Name of Property Owner: Calhoun County Name & Title: Richard H. Meyer, County Judge Signature: Phone: 361-553-4600 www.calhouncotx.org #10 I NOTICE OF MEETING-8/21/2024 10. Consider and take necessary action to propose a new tax rate for 2024. (RHM) Court approved new tax rate of 0.6222 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 7 of 17 CALHOUN COUNTY COMMISSIONERS' COURT ORDER FOR PROPOSED 2024 TAX RATES CALHOUN COUNTY, TEXAS STATE OF TEXAS § COUNTY OF CALHOUN § THAT ON THIS, THE 21st day of August, 2024, the Commissioners' Court of Calhoun County, Texas met in a regular term session in the Commissioners' Courtroom, 211 S. Ann St., Suite 104, Port Lavaca, Texas with the following members present: 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 And at said meeting, among other business, the Court did consider the following: ORDER PROPOSING A TAX RATE FOR TAX YEAR 2024 WHEREAS, Vernon's Texas Codes Annotated (VTCA) Tax Code 26.05 provides that the Calhoun County Commissioners' Court shall adopt the tax rates for the current year; and WHEREAS, it is necessary to levy ad valorem taxes on each $100 valuation of all taxable property in Calhoun County, Texas for the Tax Year beginning January 1, 2024, which will be due no later than January 31, 2025 at the tax rates set forth herein below; and WHEREAS, the Calhoun County Commissioners' Court has complied with all the requirements set forth in the Tax Code; now THEREFORE, BE IT ORDERED that the Calhoun County Commissioners' Court hereby adopts the following tax rates: Page 1 of 4 DEBT SERVICE: Vern Lyssy moved for a tax rate of $.0431 per $100.00 of taxable value for the purpose of Debt Service; and seconded by David Hall YES ABSTAIN NO ABSENT Richard H. Meyer CountyJudge X David Hall_ Commissioner, Pct. #1 X Vern Lyssy Commissioner, Pct. #2 _X_ Joel Behrens Commissioner, Pct. #3 X Gary Reese Commissioner, Pct. #4 X MOTION CARRIED: YES: X NO: ABSTAINING: ABSENT: MAINTENANCE AND OPERATIONS: Vern Lvssy moved for a tax rate of $.5791 per $100.00 of taxable value for the purpose of Maintenance and Operations; and seconded by David Hall YES ABSTAIN NO ABSENT Richard H. Meyer CountyJudge X David E. Hall, Commissioner, Pct. #1 X Vern Lyssy, Commissioner, Pct. #2 X Joel M. Behrens, Commissioner, Pct. #3 _X_ Gary D. Reese, Commissioner, Pct. #4 X Page 2 of 4 MOTION CARRIED: YES: X NO: ABSTAINING: ABSENT: TOTAL TAX RATE: Vern Lvssy , move that the property tax rate be increased by the adoption of a tax rate of $.6222 which is effectively an 12.78% increase in the tax rate; seconded by David Hall. YES ABSTAIN NO ABSENT Richard H. Meyer X CountyJudge David E. Hall Commissioner, Pct. #1 _X Vern Lyssy Commissioner, Pct. #2 X Joel M. Behrens Commissioner, Pct. #3 X Gary D. Reese Commissioner, Pct. #4 X MOTION CARRIED: YES: X NO: ABSTAINING:_ ABSENT: THIS TAX RATE WILL RAISE MORE TAXES FOR MAINTENANCE AND OPERATIONS THAN LAST YEAR'S RATE AND; THE TAX RATE WILL EFFECTIVELY BE RAISED BY 6.33% AND WILL RAISE TAXES FOR MAINTENANCE AND OPERATIONS ON A $100,000 HOME BY APPROXIMATELY $34.50. BE IT FURTHER ORDERED that the Calhoun County Commissioners' Court levy taxes in accordance with the foregoing tax rates and the provision of the law. AND BE IT FURTHER ORDERED that if for any reason, the action of the Calhoun County Commissioners' Court setting tax rates or levying taxes should be held ineffective by a court of competent jurisdiction, that this Order shall serve as evidence of the good faith of Calhoun County in attempting to comply with the law in as substantial a fashion as could be done under the circumstances, and as evidence that Calhoun County would have lawfully adopted a tax rate but for the conditions completely beyond control of Calhoun County. Page 3 of 4 County Judge Richard H. Meyer was authorized to sign ORDER and ACT and DEED of the Calhoun County Commissioners' Court, this the 21st day of August, 2024. 41; 2�zi �C� "-� Richard H. Meyer, County Judge * Vern Lvssv , moved that the property tax rate be increased by the adoption of a tax rate of $.6222 which is effectively an 12.78% increase in the tax rate; seconded by David Hall. Page 4 of 4 ' NOTICE OF MEETING - 8/21/2024 11. Consider and take necessary action to set the date, time and location for the Public Hearing to adopt the 2024 proposed tax rate. (RHM) Court approved to set the hearing for September 4, 2024 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 8 of 17 September 4, 2024 10:00 AM 211 S Ann St. Commissioners' Court Room Port Lavaca Tx 77979 I NOTICE OF MEETING — 9/21/2024 12. Consider and take necessary action to set the date, time and location for the Public Hearing to adopt the 2025 Calhoun County Budget. (RHM) Court approved to set the hearing for September 4, 2024 RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 9 of 17 September 4, 2024 10:00 AM 211 S Ann St Commissioners' Court Room Port Lavaca Tx 77979 I NOTICE OF MEETING — 8/21/2024 13. Consider and take necessary action to approve the Memorandum of Understanding between Calhoun County EMS and Jump Aero Incorporated and authorize the Calhoun County EMS Director to sign. (RHM) F enkins explained that the Memorandumis just to explore ons and grants.: APPROVED[UNANIMOUS] David Hall, Commissioner Pct 1 ER: Vern Lyssy, Commissioner'Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 10 of 17 Memorandum of Understanding Between Calhoun County, TX Emergency Medical Services Jump Aero Incorporated This Memorandum of Understanding (MOU) sets the understanding between the Calhoun County EMS and Jump Aero Inc. to collaborate on potentially providing Jump Aero's services to rural Calhoun County populations, visitors and residents. Background Jump Aero is a California -based aviation manufacturer that is building the world's fastest sustainable personal aircraft with a mission to enhance first response timeliness in rural and hard - to -reach communities. In times when seconds can mean the difference between life and death, Jump Aero's revolutionary platform can ensure a trained professional is on scene as quickly as possible. Calhoun County, an area with many remote and rural communities where ambulance and first response times can be above average due to long distances and terrain difficulties, Jump Aero's services can make a dramatic impact in saving lives of Texas residents and tourists. Purpose This MOU will solidify the working relationship between Jump Aero and the Calhoun County EMS with the purpose of partnering to apply for grants to support deployments of Jump Aero's service in Calhoun County and to work together to plan Jump Aero's future operations in Calhoun as well as the possibility of Jump Aero collaborating with the county's existing first response systems for the purposes of identifying potential testing and initial roll -out partnerships. Funding This MOU is not a commitment of funds, nor does it imply any future commitments of funds on behalf of the county of Calhoun, the State of Texas, or any of its partners. However, Jump Aero and Calhoun County agree to partner to apply for funding to support the deployment of Jump Aero's aircraft in Calhoun County. Duration This MOU is at -will and may be modified by mutual consent of authorized. This MOU shall become effective upon signature by the authorized officials and will remain in effect until modified or terminated by either of the partners or by mutual consent. Contact Information Dr. J. Dustin Jenkins, DMin, MBA, MTh, LP Calhoun County EMS Director 705 Henry Barber Way Calhoun County, TX(361) 571-0014 Dustin.Jenkins@calhouncotx.org Carl Dietrich President and CEO Jump Aero Inc 1150 Industrial Ave, Ste A, Petaluma CA, 94952 617 216-4032 carl@jumpaero.com Date: (Part ignature) Dr. . Dustin Jenkins, Calhoun County EMS (� Date: August 14, 2024 (Partner signature) Carl Dietrich, Jump Aero Inc. #14 NOTICE 01- MEETING - 8/21/2024 14. Consider and take necessary action to approve the Hurt's Wastewater Managment, Ltd. Contract and authorize Calhoun County EMS Director to sign. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judqe Meyer, Commissioner Hall, Lvssv, Behrens, Reese Page 11 of 17 Hurt"s Wastewater Management, Ltd. P.O. Brix 662 / 321 Hwy 172 Ganado, TX 77962 Date: 6/5/2024 To: Calhoun County EMS Station 6084 State Highway 186 E, Seadrift, TX 77083 County: Calhoun Installer: Russell McIntosh Agency: Victoria County Health Dept. - Environmental Mfg/Brand:-Norweco 960-600 gpd- Phone: (800) 841-3447 Fax: (361) 771-3462 www. hurtswastewater.com Contract Period Customer ID Start Date: 7/6/2024 1 1 - -2 End Date: 7/6/2026 Site: 6084 State Highway 185 E., Seadrift, TX 77983 (361) 552-1140 Email donne.hall@calhouncotx.org Permit. 2017-116 Installed: 7/6/2017 Hurt's Wastewater Management, Ltd. arranty Expired: 7/6/2019 3 visits per year -one every 4 months Subdivision: Map Key: Terms of Maintenance Contract - I.) Three (3) inspections per year (at least one every 4 Months). Inspections include adjustment and servicing of the mechanical, electrical and other applicable components to ensure proper function. This includes inspecting the control panel, aerators and filters. Replacement/repair costs will be charged directly to the homeowner. A Hurfs Wastewater Management, Ltd. employee will visit the site within 48 hours of a problem being reported. Inspections may be performed anytime during the month they are due, with a two week grace period before and after the month the inspections are due. 2.) The homeowner is responsible for maintaining a chlorine residual of at least 1.0 mg/L in the treatment system. This csh' be accomplished by using chlorine (calcium hypochlorite) tablets for systems designed with a tablet chlorinator. Swimming pool tablets must not be used in the aerobic system designed for chlorine tablets because they cause corrosion of the components of the system. At the time of a service inspection; the service representative will inform the homeowner if the Ltd. chlorinator does not contain sufficient tablets or liquid chlorine (whichever is applicable) to effectively disinfect the wastewater. 3.) The required routine reporting of system operation and function to the local authority, as required by OSSF regulation, will be covered by the policy. Any additional visits, inspections or sample collections required by specific County Agencies, TCEQ or any other regulatory agency in your jurisdiction will not be covered by the policy. 4.) The contract may be voided if NON -BIODEGRADABLE MATERIALS are used in the system. 5.) All Commercial systems will have a SOD and TSS test performed annually. Additional charges will be charged to owner for BOD and TSS testing. This warranty is strictly limited to the above terms and does not include the cost of replacement components, chlorine or pumping of sludge build-up. The maintenance policy includes labor charges only for normal routine inspections and maintenance. Additional service calls are not covered by the policy. Service determined to be caused by abuse or neglect is not covered by the policy. Failure to pay for service call, labor, and/or replacement components not covered under warranty,,#,, will void contract. VIOLATIONS include shutting off the electric current to the system for more than 24 hours, disconnecting the alarm system, restricting ventilation to the aerator, overloading the system above its rated capacity, introducing excessive amounts of harmful matter into the system, or any other form of unusual abuse, ' ""The homeowner agrees to provide-Hurt's Wastewater Management Ltd, with all gate combinations keys, etc. necessary to gain access to the system for the purpose of conducting routine inspections or service calls prior to the start date of this contract and notify Hurts Wastewater Management immediately with any changes and provide the new combinations or keys. By signing this form, both maintenance provider and homeowner agree to the terms of this policy. THIS POLICY DOES NOT INCLUDE PUMPING SLUDGE FROM UNIT IF NECESSARY. Please check your contract preference: $600-00 Service contract only; no chlorine (homeowner must install own chlorine) Home Owner: Date: "� �Z 7 Phone:_ Hurts Wastewater Managemep td.: f D #15 NOTICE 01= MEETING — 8/27./2024 15. Consider and take necessary action on Asbestos Abatement Proposal for 312 S. Ann St., Port Lavaca, TX and authorize the County Judge to sign. (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 12 of 17 "AC CONSTRUCTION SERVICES, INC. 9819 Ball Street SAN ANTONIO TEXAS 78217 Office — 210-599-6528 — Fax — 210-599-2824 July 25, 2024 TO: Calhoun County 211 S. Ann St. Port Lavaca, Texas 77979 RE: Asbestos Abatement 312 S. Ann St. ASBESTOS ABATEMENT PROPOSAL KMAC Construction Services, Inc, submits the following proposal for your review and consideration. SCOPE OF WORK: KMAC will provide labor, supplies, materials, equipment and standard insurance to accomplish the removal and disposal of asbestos containing window glazing throughout the house. Abatement will all be done using N.E.S.H.A.P. guidelines wet methods. A copy of the manifest will be provided to the owner at the completion of the project. All work will be performed following OSHA, EPA, TDH, Federal, State and local rules and regulations. PRICING: Our price for asbestos abatement is : S 3,500.00 EXCLUSIONS: Air Monitoring and Consulting Fees TDH Fees(Not Required) DURATION: 2 Days TERMS: Due Upon Completion (C.O.D.) If you have any questions regarding the above scope of work, please do not hesitate to contact me. Sincerely, Mark Mata Project Manager / Estimator Purchase Order #: '�O-Qq-8 s Please sign and return proposal if accepted: 14 Date CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, s, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 2024-1201609 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. KMAC Construction Services, Inc. San Antonio, TX United States Date Piled: 08/15/2024 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: g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2024-0085 Asbestos Abatement 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is Kevin McIntyre and my date of birth is _— My address is , -0—. —_ �— (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Bexar County, state of Texas on the16th day of August 2024 (month) (year) Signatu e f a sized agent of contracting business entity (Declarant) Forms provided by I exas ttnlcs commission Www.ethlcs.state.tx.us Version V4.1.0.48da51f7 #16 ' NOTICE OF MEETING — 8/21/2024 16. Consider and take necessary action to approve the FY 2024 Interlocal Agreement with Gulf Bend Center for Indigent care in the amount of $26,000.00 and authorize Judge Meyer to sign all documents. (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 13 of 17 CONTRACT between CALHOUN COUNTY and GULF BEND CENTER STATE OF TEXAS COUNTY OF CALHOUN WHEREAS, Calhoun County, hereinafter COUNTY, a political subdivision of the State of Texas, has determined that the expenditure of county funds proposed herein is one which serves a public purpose and has further determined that the State of Texas, by its Constitution or by its state statutes, either implicitly or explicitly, has conferred upon COUNTYthe authority, the power and the jurisdiction to accomplish the uses for said funds as proposed herein, infra. Having found the above elements fully satisfied, COUNTY may contract with a private nonprofit corporation so that they may use said public funds for the purposes contemplated herein, but only if the expenditure is to accomplish "county business" (which encompasses matters of general concern to county residents) and only if COUNTY assures itself that the funds to be transferred by this contract are subject to adequate contractual or other controls to ensure that expenditure of said county funds for the public purpose stated herein will be accomplished and so long as COUNTY received adequate consideration for the county funds to be provided by this contract. WHEREAS, GULF BEND CENTER, hereinafter referred to as GULF BEND CENTER is engaged in providing services to persons with chronic and persistent mental illness and mental retardation, including crisis response and stabilization services, outpatient mental health services, and renders support to the county and district courts in the determination of competency and case disposition involving persons with mental illness and mental retardation who are involved in the criminal justice system, as well as multiple community support services for persons with mental retardation. GULF BEND CENTER is thereby providing for the betterment of Calhoun County, and desires to enter into such a contract for the provision of certain services for the COUNTY; said services being considered by both parties to this contract as fair consideration from GULF BEND CENTER to COUNTYin exchange for the funds transferred hereby. IT IS THEREFORE AGREED THAT: 1. Payment by County: In consideration that the services described below to the residents of COUNTY, GULF BEND CENTER shall be entitled to a sum not to exceed $26,000.00 per annum. Such amount shall be disbursed by COUNTY to GULF BEND CENTER after January 1, 2024, upon written request for GULF BEND CENTER. 2. Insurance: The County will require documentation of General Liability insurance coverage, with adequate limits to be determined individually, depending on exposure. 3. Services: GULF BEND CENTER, hereinafter referred to as GULF BEND CENTER is engaged in providing services to persons with chronic and persistent mental illness and mental retardation, including crisis response and stabilization services, outpatient mental health services, and renders support to the county and district courts in the determination of competency and case disposition involving persons with mental illness and mental retardation who are involved in the criminal justice system, as well as multiple community support services for persons with mental retardation. 4. Term: The Term of this contract is to begin on January 1, 2024 and end on December 31, 2024, unless earlier terminated by either party on thirty -days written notice. 5. Effectiveness: This contract is effective upon approval by Order of the Calhoun County Commissioners' Court. 6. Relationship: The parties hereby agree that this is a contract for the administration of the Program and hereby renounce the existence of any other relationship. In no event shall COUNTY have any obligation or liability whatsoever with respect to any debts, obligations or liability of GULF BEND CENTER, and GULF BEND CENTER shall have no authority to bind COUNTY to any contract, matter or obligation. No duties of COUNTY are delegated to GULF BEND CENTER by this contract and any provision which is or may be held to be such a delegation shall be of no force or effect. 7. Modification; Termination: This contract may be amended, modified, terminated or released only be written instrument executed by COUNTY and GULF BEND CENTER, except as herein otherwise provided. CALHOUN� COUNTY By: " �y Date: GULF BEND CENTER r v � COUNTY: Richard H. Meyer Calhoun County Judge 211 S. Ann Street, Suite 301 Port Lavaca, Texas 77979 NOTICES GULF BEND CENTER Jeffery Tunnell Executive Director 6502 Nursery Drive Victoria TX 77901 CLERK'S CERTIFICATION I, Anna Goodman, County Clerk of Calhoun County, Texas, certify that the above contract was accepted and agreed to by the Commissioners' Court of Calhoun County on August 21, 2024. #17 NOTICE OF MEETING- 8/21/2024 17. Accept Monthly Reports from the following County Offices: i. Tax Assessor -Collector - July 2024 RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 14 of 17 SUMMARY TAX ASSESSOR -COLLECTORS MONTHLY REPORT JULY 2024 COLLECTIONS DISBURSEMENTS Title Certificate Fees 429 $ 5,707.00 Title Fees Paid TXDMV $ 3,562.00 Title Fees Paid County Treasurer Salary Fund $ 2,145.00 Motor Vehicle Registration Collections $ 173,745.15 Disabled Person Fees $ 55.00 Postage $ _ Global Additonal Collections $ Paid TXDMV $ 143,331.68 Paid TXDMV SP $ 20,187.08 Paid County Treasurer $ - Paid County Treasurer Salary Fund $ 5,982.90 DMV CCARDTRNSFEE $ 4,298.49 $ _ GL Additonal Collections $ - $ _ GLOBAL (IBC) Credit/Debit Card Fee's $ 4,346.36 GLOBAL Fees In Shortage of Collections $ (47.87) MERCH SERVICES STATEMENT $ Additional Postage - Vehicle Registration $ _ Paid County Treasurer -Additional Postage $ _ Motor Vehicle Sales & Use Tax Collections $ 476,123.94 Paid State Treasurer $ 476,123.94 Special Road/Bridge Fees Collected $ 22,610.00 Paid County Treasurer- R/B Fees $ 22,610.00 Texas Parks & Wildlife Collections $ 5,176.00 TPW GLOBAL CC TRANSACTION FEES $ 283.09 GLOBAL ADDITIONAL COLLECTIONS $ _ Paid Texas Parks & Wildlife $ 4,658.40 Paid County Treasurer Salary Fund $ 517.60 P&W CCARDTRNSFEE $ 283.09 GLOBAL Additonal Collections $ - GLOBAL (IBC) Credit/Debit Card Fee's $ 271.13 GLOBAL In Excess/Shortage of Collections $ 11.96 Boat/Motor Sales & Use Tax Collections $ 77,102.70 Paid State Treasurer $ 73,247.66 Paid County Treasurer, Salary Fund $ 3,865.14 TABC 5% CO COMMS FOR MONTH OF $ _ TABC 5% CO COMMS FOR MONTH OF $ _ Paid County Treasurer, Salary Fund $ _ County Beer & Wine Collections $ 175.00 Paid County Treasurer, County Beer & Wine $ 166.25 Paid County Treasurer, Salary Fund $ 8.75 INTEREST EARNED ON OFFICE ACCOUNT $ 168.07 Paid County Treasurer, Nev. East $ 0.11 Paid County Treasurer, all other districts $ 167.96 INTEREST EARNED ON PARKS AND WILDLIFE ACCOUNT $ 57.44 Paid County Treasurer, Interest on P&W Acc $ 57,44 INTEREST EARNED ON REFUND ACCOUNT $ 0.21 Paid County Treasurer, Interest on Refund Acc $ 0.21 Business Personal Property - Misc. Fees $ 217.83 Paid County Treasurer $ 217.83 Excess Funds $ - Paid County Treasurer $ - Overpayments $ 0.28 Current Tax Collections $ 173,698.25 Penalty and Interest - Current Roll $ 11,124.47 Discount for early payment of taxes $ 0.03 Delinquent Tax Collections $ 10,486.81 Penalty & Interest - Delinquent Roll $ 4,104.77 Collections for Delinquent Tax Attorney $ 14,386.48 Advance - FM & L Taxes $ 2.46 Advance - County AdValorem Taxes $ 197,431.80 Paid County Treasurer - Nay. East $ 206.93 Paid County Treasurer- all other Districts $ 1,773.36 Paid County Treasurer - Delinq Tax Atty. Fee $ 14,386.48 Payment in Lieu of Taxes $ - Paid County Treasurer - Navig. East $ Paid County Treasurer - All other Districts $ Special Farmers Fees Collected $ 75.00 Paid State Treasurer, Farmers Fees $ 75.00 Hot Check Collection Charges $ - Paid County Treasurers, Hot Check Charge $ _ Overage on Collection/Assessing Fees $ - Paid County Treasurer, overage refunded $ Escheats $ Paid County Treasurer -escheats $ TOTAL COLLECTIONS $ 976,297.49 TOTAL DISBURSEMENTS TOTAL OF ABOVE RECEIPTS PAID TO STATE AND COUNTY Tax Assessor -Collector $ 975,297.49 $ 975,297.49 1 RI HAR MEYER CounYy Judge #18 NOTICE OF MEETING — 8/21/2024 18. 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 15 of 17 k 0 z � z § � IL § -m■ k u « §k\ § § k \ \ j ! / B ■ § t ) � 2 2 Ix k (D k 7 2 2 |o :z :z �§ AL �§ §B k■k U\j §� :C4 :0 :z § B � § ■ k f j �) )o :z :z :§ :§ NJ W J d O. 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Approval of bills and payroll. (RHM) Indigent Healthcare: RESULT: APPROVED [UNANIMOUS] MOVER:' David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese MMC Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese County Bills: RESULT: APPROVED,[UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Vern Lyssy, Commissioner Pct 2 AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 16 of 17 zi O 116 O M 0� N r� O W R C ti ti l� H 1p W M al W m O H N H M O O @ b H W M xxuxaaa \\\\\\\ aaaaaar� A � C qO zW °� > d a Ow O F �C cxr 0. 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F u❑i O � Z a' U 9 a z 0 o 0 p o 0 ❑a �a U> C]� 0� M ef h h b b b b b z W w � o z � � MEMORIAL MEDICAL CENTER COMMIS316NERS COURT APRRoyAL+LIST FOR'= Audusf 21 2024! by:CT INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES HEB Pharmacy (Medimpact) Pharmacy Reimbursement 9.97 MMCenter (in -patient $or Out -patient $30.251 ER $0) 30.25 SUBTOTAL 40.22 Memorial Medical Center (indigent Healthcare Payroll and Expenses) 4,166.67 Subtotal 4,206.89 Co -pays adjustments for July 2024 0:�0 Reimbursement from Medicaid 0.00 COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY UNIT IPRICE TOTAL PRICE 1000-800-98722-999 Transfer to pay bills for Indigent Health Care $4,206.89 approved by Commisaionerp Court'on-08/2�1/2024 1000-001-46010 7u1y :31, '2024�InteresE ($10.79) $4,196.10 COUNTY AUDITOR APPROVAL ONLY THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY THIS OBLIGATION. I CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED BY ME IN GOOD CONDITION AND REQUEST THE COUNTY TREASURER TO PAY THE ABOVE BLI TION. BY: '� 8/21/2024 APPROVED UW /AU G 15 M4 l g�� pp N pUp QQpp CAN UNU COUNTY )TEXA DEPARTMENT HEAD DATE ®IHS Issued 08/12/24 Source Description Source Totals Report Calhoun Indigent Health Care Batch Dates 08/01/2024 through 08/01/2024 For Source Group Indigent Health Care For Vendor: All Vendors Amount Billed Amount Paid 02 Prescription Drugs 9.97 9.97 14 Mmc - Hospital Outpatient 64.00 30.25 Expenditures 73.97 40.22 Reimb/Adjustments Grand Total 73.97 40.22 Expenses 4166.67 Co Pays <0.00> 4,206.89 APPROVED ON AUooG 14 gq2��7702T4p CABLhYtOUNUCOU Yp'TEXAS OIHS Source Totals Report Issued 08/12/24 Calhoun Indigent Health Care Batch Dates 02101/2024 through 08/01/2024 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed 02 Prescription Drugs 08 Rural Health Clinics 14 Mmc - Hospital Outpatient Expenditures Reimb/Adjustments Grand Total Amount Paid 42.57 28.92 240.00 240.00 1,152.00 591.26 1,459.45 885.06 -24.88 -24.88 1,434.57 860.18 Expenses 29,166.69 Co Pays < 20.00 > 30,006.87 ti1,W �6' I to-�2oa 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 1 6 0 3 0 June 0 1 0 3 2 July 0 1 1 2 2 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 2 18 3 13 20 Monthly Avg 0 2 0 1 2 December 2023 Active 4 Number of Charity patients 232 Number of Charity patients below 50% FPL 125 Number of Charity patients who meet State Indigent Guidelines 116 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 5 15 0 22 $13,588.44 June 1 3 0 26 $3,567.00 July 2 6 0 28 $2,872.47 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 $46,368.26 Monthly Avg 2 6 11 $3,864.02 December 2023 Active 36 �� OAA ' ter. 815 N. Virginia St. Port Lavaca, Texas 77979 (361) 552-6713 Bill To: Calhoun County Funds to cover Indigent program operating expenses. i7svttJ Zvc .` 6\�n\t2�„ Lc1 Andrew De Los Santos Controller Date: 8/8/2024 Invoice ti 398 For: Jul-24 $ 4,166.67 Total $ 4,166.67 AUG 1522002244 0 CAgyONOU0`fR PAS 04 ;PROSPERITY BANK" *4460-4-0 Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 5 ANN ST STE A PORT LAVACA TX 77979 13218 7/31/2024 "'"'4551 Page 1 of 2 STATEMENT SUMMARY Public Fund Contractual Ckg w Int Account No �-"4551 07/01/2024 Beginning Balance $9,670.62 3 Deposits/Other Credits + $4,250.16 4 Checks/Other Debits - $8,402.82 07/31 /2024 Ending Balance 31 Days in Statement Period $5,517.96 Total Enclosures 6 DEPOSITS/GTHER CREDITS Date Description Amount 07/10/2024 Deposit $4,229.371-` 07/18/2024 Deposit $10.00 j 07/31/2024 Accr Earning Pymt Added to Account $10.79 Q Check Number Date Amount Check Number Date Amount 25 12636 07.10 $4,166.67 12638 07-23 $60.50 12637 07-23 $4,166.67 12639 07-23 $8.98 DAILY ENDING BALANCE Date Balance Date Balance Date Balance p 07-01 $9,670.62 07-18 $9,743.32 07.31 $5,517.96 i5 07-10 $9,733.32 07-23 $5,507.17 a ■� o EARNINGS SUMMARY N •• Below is an itemization of the Earnings paid this period. o Interest Paid This Period $10.79 Annual Percentage Yield Earned 1.51 % Interest Paid YTD $79.11 Days in Earnings Period 31 Earnings Balance $8,489.78 MEMBER FDIC Q NYSE Symbol "PB" M o MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---August 21 2024 PAYABLES AND PAYROLL 8/15/2024 Weekly Payables 374,262.00 8/19/2024 Sherwin Williams Critical 163.21 8/19/2024 Capital One Critical 955.69 8/19/2024 Third Coast Distributing LLC Critical 984.99 8/15/2024 Citibank Credit Card -see attached (Erin) 6,074.55 8/15/2024 CitiBank Credit Card -See attached (Steve) 874.26 8/19/2024 McKesson-340B Prescription Expense 10,708.30 8/19/2024 Amerisource Bergen-3408 Prescription Expense 3,155.74 8/19/2024 Payroll Liabilities -Payroll Taxes 177.42 8/19/2024 Payroll 606.43 8/19/2024 Health Equity- Wage Works employee FSA 7,225.21 Prosperity Electronic Bank Payments 8/19/2024 90 Degree Benefits - employee Insurance claims 20,130.00 8/19/2024 Sales Tax - July 2024 2,208.23 8/19/2024 TCDRS July Retirement 284,548.86 8/19/2024 Pay Plus -Patient Claims Processing Fee 441.37 8/19/2024 Credit Card Lease Fee 285.82 8/19/2024 Harland Clarke Check Order 60.36 8/19/2024 Credit Card Processing Fee 4,335.72 kpL;ifAfYfl BiCE-'.P`/i�/ROL�API6 F�.€,GTROiWf'C $A4NIG,6R iM1AENT,S . _ .' t617;Y9BrU TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 8/15/2024 MMC Operating to Ashford-UHC QIPP YR7 June 2024 8,495.73 8/15/2024 MMC Operating to Solera-UHC QIPP YR7 June 2024 2,624.83 8/15/2024 MMC Operating to Fort hend-UHC QIPP YR7 June 2024 2,655.10 8/15/2024 MMC Operating to Broadmoor-UHC QIPP YR7 June 2024 3,332.79 8/15/2024 MMC Operating to The Crescent-UHC QIPP YR7 June 2024 2,280.03 8/15/2024 MMC Operating to Golden Creek Healthcare -Correction of insurance payment deposited into MMC Operating in error/UHC QIPP YR7 June 2024 11,753.73 8/15/2024 MMC Operating to Tuscany Village -Correction of insurance payment deposited into MMC operating in error/UHC QIPP YR7 June 2024 16,034.95 8/15/2024 MMC Operating to Bethany -Correction insurance payment deposited into MMC Operating in error/UHC QIPP YR7 June 2024 64,592.50 ITOJt✓iL'.'�1{ANSiEFI'60WEENFUNDS NURSING HOME UPI. EXPENSES 8/19/2024 Nursing Home UPL-Cantex Transfer 727,228.12 8/19/2024 Nursing Home UPL-Nexion Transfer 49,080.57 8/19/2024 Nursing Home UPL-HMG Transfer 5,015.91 8/19/2024 Nursing Home UPL-Tuscany Transfer 135,325.73 8/19/2024 Nursing Home UPL-HSLTransfer 17,995,76 QIPP CHECKS TO MMC 8/19/2024 Ashford - Molina QIPP June Q3 & YR5 AD) 3 hospital portion 22,306.04 8/19/2024 Broadmoor -Molina QIPP June Q3 & YRS ADJ 3 hospital portion 8,30&82 8/19/2024 Crescent- Molina QIPP June Q3 & YR5 ADJ 3 hospital portion 6,118.20 8/19/2024 Fort Bend - Molina QIPP June Q3 & YRS ADJ 3 hospital portion 6,908.22 8/19/2024 Solera - Molina QIPP June Q3 & YRS ADJ 3 hospital portion 6,594.84 8/19/2024 Golden Creek - Superior June QIPP hospital portion 20,830.62 8/19/2024 Bethany -Superior June QIPP hospital portion 21,263.06 8/19/2024 Tuscany- Molina QIPP June Q3 & YRS ADJ 3 hospital portion 13,017.28 ITatAl�IV[JtiSyN_6PW,tlMDPLE`2ENSE3. _....,_...W_.--.,...�;'08.9.93a'J T — - — I1or44, +INTeiuuav�rthmALA BRAAID,TfMAL0156,UR$EMEN'�SrAPPIE49EFi�llugust.21,$02A"::'. - $. '1';,i'r�gr�,gD,rJB:`.✓.. RECEIVED BYTHE. COUNTY AUDMTOR ON 08115/2024 piny 15 2024 MEMORIAL MEDICAL CENTER 13:11 AP Open Invoice List 0 Due Dates Through: 09106/2024 ap_open_invoice.template amaHOUN Vendor# Vendor NCOUNTY, TEXAS / Class Pay Code 13180 "+ ADVANCED STERILIZATION PRODUCT kwoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount Nu -Pay Not 8020719271 0810 1/202 08/021202 091021202 879.90 0.00 0.00 879.90 Vendor Totals: Number Name Gross Discount No -Pay Net 13180 ADVANCED STERILIZATION PRODUCT 879.90 0.00 0.00 879.90 Vendor# / Vendor Name Class Pay Code At 660 "J' AIRGAS USA, LLC-CENTRAL DIV M JInvoice# Comment Tran DI Inv Dt Due Dt Check Ot Pay Grass Discount No -Pay Net 5509863905 06/13/20207/31/20208/301202 585.23 0.00 0.00 585.23 r OXYGEN Vendor Totals: Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC - CENTRAL DIV 605.23 0.00 0.00 585.23 Vendor# Vendor Name Class Pay Code 14028 -J AMAZON CAPITAL SERVICES Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net JInvoice# 167XFPFTTK7C 08/01/202 08/051202 091041202 76.89 0.00 0.00 76.89 r Vendor Totals: Number Name Grass Discount No -Pay Net 14028 AMAZON CAPITAL SERVICES 76.89 0.00 0.00 76.89 Vandor# /Vendor Name Class Pay Code A1360.,J AMERISOURCEBERGEN DRUG CORP W �. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 3183109125 07/31120207/28120208/10/202 740.00 0.00 0.00 740.00 Vendor Totals: Number Name Gross Discount No -Pay Net A1360 AMERISOURCEBERGEN DRUG CORP 740.00 0.00 0.00 740,00 Vendor# Vendor Name Class Pay Code 13244 ASD HEALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 804814647 08/01/20208/02120209/01/202 7.84 0100 0.00 7.84 Vendor Totals; Number Name Gross Discount No -Pay Net 13244 ASD HEALTHCARE 7.84 0.00 0,00 7,84 Vendor# Vendor Name Class Pay Code 01220 BECKMAN COULTER INC M Invoke# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 111471394 07124/202 08/08/202 09/021202 1,24174 0.00 0.00 1,241,74 J 1 111479919 08105/202 08/041202 091031202 453.84 0.00 0.00 453.84 111481462 08107/202 08/05/202 09/04/202 87.50 0.00 0.00 87.50 .� J 111481600 08/07/20208/05/20209/04/202 1.037.15 0.00 0.00 1,037.15 J 7366627 081131202 08/021202 08127/202 6,591.28 0.00 0.00 6,591.28 61i{I()Cj _alp Iz %/T31/2/-I -� 111487812 08/13/20208/07/20209/061202 5,759.11 0.00 0.00 5,759.11 Vendor Totals: Number Name Gross Discount No -Pay Net 81220 BECKMAN COULTER INC 15,170.62 0.00 0.00 15,170.62 Vendor#( Vendor Name Class Pay Code 11072 •,J 810-RAD LABORATORIES, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay j 907491100 08101/202 Gross Discount No -Pay Net ,/ 08/021202 09/02/202 889.16 0.00 0.00 889.16 Vendor Totals: Number Name Gross Discount No -Pay Net 11072 810-RAD LABORATORIES, INC 889.16 0.00 0.00 889.16 Vendor#/ Vendor Name Class Pay Code 138927 BLUE CROSS BLUE SHIELD REFUND / InvoiceH Comment Tran Dt Inv Dt Due DI Check Dt Pay SEASKY0001 Gross Discount No -Pay Net ,j 08/16/20208/06/20208/06/202 47.75 0.00 0.00 47,75 56382400061967 08/15/202 08/06/202 08120/202 4,039.24 0.00 0.00 4,03824 /Y Ra \hVo1G-� Vendor Totals: Number Name Gross Discount No -Pay Net 13892 BLUE CROSS BLUE SHIELD REFUND 4,085.99 0.00 0.00 4,085.99 Vendor# jVendor Name Class Pay Code 11224 CABLES AND SENSORS Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net `Invoice# 176847 08/01/20208/14/20208114/202 168.00 0.00 0.00 168.00 Vendor Totals: Number Name Gross Discount No -Pay Net 11224 CABLES AND SENSORS 168.00 0.00 0.00 168.00 Vendor# / Vendor Name Class Pay Code C1048 J CALHOUN COUNTY Vy Involcelt Comment Tran Dt Inv DI Due Dt Check Dt Pay J Gross Discount No -Pay Net 204373753066300 07/31/202 07126/202 08/251202 731.11 0.00 0.00 731.11 J 061824-071824 SERVICE PERIOD -1 O, \d U t ('_ - -1 204373753030019 07131/202 07/26/202 08/25/202 765.71 0.00 0.00 765.71 j 051724-061824 SERVICE PERIOD -A a � :'16N \t (A_ p-t- J 204373753031227 07131/20207/26/20208(25/202 8.47 0.00 0.00 8.47 052124-062024 SERVICE PERIOD gj i,,5 N �1�n;,r�� sk- J 204373753065367 07/31/20207126120208/25/202 J 1978 0,00 0.00 19.78 001824-071824 SERVICE PERIOD "O�kV' '� () L .,� 204373753029644 07/31/20207/26/2020\�8/25/202 19.97 0.00 0.00 19.97 / 051724-061824 (Y'p �-()& `A \ V � .1 204373753065594 07131/202 07126/202 08/25/202 36,914,24 0.00 0.00 36,914.24 j 061724-071724 \ j�I`�.At �,.�l (�;+'' i/ lX / J 204373753066044 07/31/20207/26/202`0~8�2 0)2 1,864.73 0.00 0.00 1,864.73 061824.071824 ��k� N \'y' J 204373753029656 07131/202 07/26/202 08/25/202 1,954.03 0.00 0.00 1,954.03 051724-061824 "ll �%', Vendor Totals; Number Name Gross Discount No -Pay Net C1048 CALHOUN COUNTY 42,279.04 0.00 0.00 42,278.04 Ventlor# Vendor Name Class Pay Code C1600 J CITIZENS MEDICAL CENTER W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 202423 07/311292 08/091202 081091202 Gross Discount No -Pay Net 61,950.26 0.00 0.00 61,950.26 Vendor Totals: Number Name Gross Discount No -Pay Net 01600 CITIZENS MEDICAL CENTER 61.950.26 0.00 0.00 61,950.26 Vendor#/Vendor Name Class Pay Code 15188 `/ CLARITY ENROLLMENT SOLUTIONS Involce# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J1699 08/01/202 08/01/202 08/31/202 348.00 0.00 0,00 348,00 „' Vendor Totals: Number Name Gross Discount No -Pay Not 15188 CLARITY ENROLLMENT SOLUTIONS 348.00 0.00 0.00 348.00 Vendor# Vendor Name Class Pay Code 14080 CORROHEALTH, INC. Invoice# Comment Tran Ot Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net J 918423 081011202 07131/202 08/30/202 2,371.80 0.00 0.00 2,371.80 Vendor Totals: Number Name Gross Discount No -Pay Net 14080 CORROHEALTH, INC. 2,371.80 0.00 0.00 2,371.80 Vendor# Vendor Name Class Pay Code 14400 J CULINARY CONCESSIONS LLC Invoice# Comment Train Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net j j INVOOD01461 07131120207131/20208/30/202 33,001,79 0.00 0.00 33,001.79 J Vendor Totals: Number Name Gross Discount No -Pay Net 14400 CULINARY CONCESSIONS LLC 33,001.79 0.00 0.00 33,001.79 Vendor# Name Class Pay Cade /Vendor „{ 10060 DETAR HOSPITAL fCP Invoice# Comment Than Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net ✓ ✓ OTR2407018 08/13/20208/08/20208/061202 733.52 0.00 0.00 733.62 J Vendor Totals: Number Name Gross Discount No -Pay Net 10060 DETAR HOSPITAL 733.52 0.00 0.00 733.52 Vendor#/Vendor Name Class Pay. Code 10368 �/ DEWITT POTH & SON Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 7625390 08/01/202 07/251202 08/191202 98.54 0.00 0.00 98.54 7633/270 08/14/202 08/06/202 08/311202 294.15 0,00 0.00 294.15 Vendor Totals: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SON 392.69 0.00 0.00 392.69 Vendor#/ Vendor Name Class Pay Code 1101'1 DIAMOND HEALTHCARE CORP Invoice# Comment Tran Dt Inv Ot Due DI Check DI Pay Gross Discount No -Pay Net ✓�� IN20056315 07/01/20208101/20208/31/202 31,144.59 0.00 0.00 31,144.58 BEV HEALTH JULY / J Vendor Totals: Number Name Gross Discount No -Pay Net 11011 DIAMOND HEALTHCARE CORP 31,144.58 0.00 0.00 31,144.58 Vendor# /Vendor Name Class Pay Code 10842 J DOOR CONTROL SERVICES, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J/ SMINVaSO718 08/06120200101/20208/31/202 2255.10 0.00 0.00 2,255.10 w Vendor Totals: Number Name Gross Discount No -Pay Net 10842 DOOR CONTROL SERVICES, INC 21255.10 0.00 0.00 2,255.10 Vendor# Nendor Name Class Pay Code 15240 ECLINICAL WORKS LLC Invofce# Comment Tran Dt Inv Ot Due Dt Check Dl Pay Gross Discount No -Pay Net / ✓ J 0003006892 08/07/202 08101/202 08/31/202 476.75 0.00 0.00 470.75 J Vendor Totals: Number Name Gross Discount No -Pay Net 15240 ECLINICAL WORKS LLC 476.75 0.00 0.00 476.75 Vendor#� Vendor Name Class Pay Code 11091, ECOLAB j Invoice# Comment Tran Dl Inv Dt Due Dt Check Dt Pay Gross Discount NaPay Net j 6347052578 08113120208/01/20208/31/202 220.00 0100 0.00 220.00 / Vendor Totals: Number Name Gross Discount No -Pay Net 11091 ECOLAB 220.00 0.00 0.00 220,00 Vendor# Vendor Name Class Pay Code I J F1400 FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net Jr 4271973 08/01/202 08/01/202 08/31/202 1,255.68 0.00 0.00 1,256,68 Jj M 4307200 08/01/202 08/02/202 08/27/202 814.60 0.00 0.00 814,80 v/ .1 4307201 08/01/202 08/02/202 09/01/202 156.46 0.00 0.00 156.48 ,f J4233543 08/14/20207/31/20208/301202 235.85 0.00 0.00 235.85 ✓ J 4271972 08114/202 08/01/202 08/31/202 8,238.26 0.00 0.00 8,238.26 J Vendor Totals: Number Name Gross Discount No -Pay Net F1400 FISHER HEALTHCARE 10,701.07 0.00 0.00 10,701.07 Vendor# /Vendor Name Class Pay Code G0906 J GE HEALTHCARE FIN SRVS W Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 100918155 08113/20207128120209/011202 4,610.62 0.00 0.00 4,610.52 J Vendor Totals: Number Name Gross Discount No -Pay Net G0906 GE HEALTHCARE FIN SRVS 4,610.52 0.0o 0.00 4,610.52 Vendor# /Vendor Name Class Pay Code 12404 -1 GE PRECISION. HEALTHCARE, LLC Involce# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 6002725804 08/01/20208/01/20208131/202 86.67 0.00 0.00 86.67 J6002725805 08101/202 08/01/202 08/31/202 2,422.50 OM 0.00 2,422.50 .!� 1/6002725810 08101/202 08/011202 08/31/202 5,665.83 0.00 0.0o 5,665.83 ✓ J 6002725806 08/011202 08/011202 08131/202 61.67 0.00 0.00 61.67 J J 6002725803 08/01 /202 08/01/202 08131/202 3.588.56 O.OD 0.00 3,588.58 ,/ J 6002726128 08/13/202 08/011202 08131/202 216.10 0.00 0.00 216.10 AUGUST SERVICE PERIOD Vendor Totals: Number Name Gross Discount No -Pay Net 12404 GE PRECISION HEALTHCARE, LLC 12,041.35 0.00 0.00 12,041.35 VendorN 1Vendor Name Class Pay Code W1300 ,/GRAINGER M Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net /Invoice# 9199646168 08/011202 07/30/202 08/29/202 30.40 0.00 0.00 30.40 \f Vendor Totals: Number Name Grass Discount No -Pay Net W1300 GRAINGER 30.40 0.00 0.00 30,40 Vendor#�Vendor Name Class Pay Code 12948 GREAT AMERICA FINANCIAL SVCS Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net /Involce# 37136421A 07131120208/02/20208/311202 10,397.34 0.00 0.00 10,397.34 Vendor Totals: Number Name Gross Discount No -Pay Net 12948 GREAT AMERICA FINANCIAL SVCS Vendor# Vendor Name Class Pay Code / G1210 J GULF COAST PAPER COMPANY M Invoice# Comment Tran Dt Inv Of Due Dt Check DI Pay J 2568981 08/01/202 08106/202 09/05/202 J 2558980 08/01/202 08/06/202 09/05/202 J 2558979 08101 /202 06/06/202 09/05/202 J 2558984 08/011202 06106/202 09/06/202 2568986 08/01/20208/06/20209/061202 Vendor Totals: Number Name G1210 GULF COAST PAPER COMPANY Vendor# /Vendor Name Class Pay Code 12380 ,/ HEALTH SOLUTIONS DIETETICS Invoice# Comment Tran Dt Inv Dt Due Dt Check Of Pay /070524A 08/13/202 08/08/202 08/08/202 { 1 Vendor Totals: Number Name 12380 HEALTH SOLUTIONS DIETETICS Vendor# Vendor Name Class Pay Code H0031 .! HEB CREDIT RECEIVABLES DEPT308 lnvolce# Comment Tran Dt Inv Dt Due Dt Check OI Pay 4477 08/151202 07/29/202 08/25/202 Vendor Totals: Number Name H0031 HEB CREDIT RECEIVABLES DEPT308 Vendor# Vendor Name Class Pay Code 14916 J HEWLETf-PACKARD lnvolce# Comment Tran Dt Inv Dt Due Dt Check Dt Pay. / J j 100000324601 07/23/20207/18/20209/01/202 SEPTEMBER Vendor Totals: Number Name 14916 HEWLETT-PACKARD Vendor# /Vendor Name Class Pay Code H1610 HOBBY LOBBY W Invoice# Comment Tran DI Inv Of Due Of Check Dt Pay J 073124 07131/202 07/311202 08115/202 Vendor Totals: Number Name H1610 HOBBY LOBBY Vendor# /Vendor Name Class Pay Code 10922 J HUNTER PHARMACY SERVICES r Invoice# Comment Tran Dt Inv Dt Due DI Check Of Pay 6113 07/311202 07131/202 08/201202 PHARM SALARY Vendor Totals: Number Name 10922 HUNTER PHARMACY SERVICES Vendor# Name Class Pay Code /Vendor 14976 J INOVALON PROVIDER INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay 24M0105913 OB/06/20208/06120209/05/202 10,397.34 0.00 0.00 19,397.34 Gross Discount No -Pay Net 62.98 0.00 0.00 62.98 62.98 0.00 0.00 e2.98 189.13 0.00 0.00 189.13 -� 62.98 0.00 0.00 62.98 1,439.28 0.00 0.00 1,439.28 Gross Discount No -Pay Net 1,817.35 0.00 0.00 1,817.35 Gross Discount No -Pay Net 3,400.00 0.00 0.00 3.400.00 Gross Discount No -Pay Net 3,400.00 0.00 0.00 3,400.00 Gross Discount No -Pay Net 71.85 0.00 0.00 71.85 J Gross Discount No -Pay Net 71.85 O.o0 0.00 71.85 Gross Discount No -Pay Net 573.53 0.00 0.00 573.53 Gross Discount No -Pay Net 573,53 0.00 0.00 $73.53 Gross Discount No -Pay Net 448.75 O.OD 0.00 448.75 Gross Discount No -Pay Net 448,75 0.00 0.00 448.75 Gross Discount No -Pay Net 14,936.01 0.00 0.00 14,936.01 Gross Discount No -Pay Net 14,986.01 0.00 0.00 14,936.01 Gross Discount No -Pay Nei 736.56 0.00 0.00 736.56 J SCHEDULIONG 1 I` I x I ��' I ,� �" Vendor Totals: Number Name Gross Discount No -Pay Not 14976 INOVALON PROVIDER INC. 736.56 0.00 0.00 736.56 Vendor# /Vendor Name Class Pay Code 14540 JINDAL X LLC Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net �202425030 07/31/202 08/08/202 08122/202 9,000.00 0.00 0.00 9,000.00 Vendor Totals: Number Name Gross Discount No -Pay Net 14540 JINDAL X LLC 9,000.00 0.00 0.00 9,000.00 Vendor#/.Vendor Name Class Pay Code 15608 d Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 13ELJOH0002 08/15/202 08/061202 08106/202 0.94 0.00 0.00 0.94 Vendor Totals: Number Name Gross Discount No -Pay Net 15608 0.94 0.00 0.00 0.94 Vendor#/Vendor Name Class Pay Code K0530 J KCI USA M Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 32677890 07117/20206113120207/13/202 1,070,08 0.00 0.00 1,070.08 J Vendor Totals: Number Name Gross Discount No -Pay Net K0530 KCI USA 1,070.08 0.00 0.00 1,070.08 Vendor# (Vendor Name class Pay Code L0700 V LABCORP OF AMERICA HOLDINGS M Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 80875660 08/18/202 07127/202 08/21/202 36.29 0.00 0.00 36.29 Vendor Totals: Number Name Gross Discount No -Pay Not L0700 LABCORP OF AMERICA HOLDINGS 36.29 0.00 0.00 3629 Vendor# / Vendor Name Class Pay Code L1640 J LOWE'$ BUSINESS ACCT/SYNCB W Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 080224 08115/20208/02/20208128/202 88&01 0.00 0.00 688.01 .f, Vendor Totals: Number Name Gross Discount No -Pay Net L1640 LOWE'$ BUSINESS ACCT/SYNCB 888.01 0.00 0.00 888,01 Vendor#% Vendor Name Class Pay Code 10972 " M G TRUST .Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J081224 08/151202 08/121202 08/121202 895.00 0.00 0.00 895.00 J Vendor Totals: Number Name Gross Discount No -Pay Net 10972 M G TRUST 895,00 0.00 0.00 895.00 Vendont Vendor Name Class Pay Code J M2178 MCKESSON MEDICAL SURGICAL INC Invoice# Comment Tram Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 21809374 08/01120203/07/20204/161202 233.51 0.00 0.00 233.51 J 21815895 08/01/20203106/90204/15/202 77.41 0.00 0.00 77.41 21766665 06/14/202 021271202 03/15/202 1,343.97 0.00 0.00 1,343.07 -/ 21782711 „J 08114/202 03/01/202 04/15/202 1,109.51 0.00 0.00 1,109.51 22223054 08/141202 06/12/202 07/15/202 180.56 0.00 0.00 180.56 ,/ Vendor Totals: Number Name Gross Discount No -Pay Net M2178 MCKESSON MEDICAL SURGICAL INC 2,944.96 0.00 0.00 2.944.98 Vendor# Vendor Name Class Pay Code 11141 MEDICAL DATA SYSTEMS, INC. Involce# Comment Tran Dt Inv Dt Due Ot Check DI Pay Gross Discount No -Pay Net ! ./ 192603 07/31/202 05/31/202 06/25/202 2,041.63 0.00 0.00 2,041.63 COLLECTION FEES 05124 J 192604 07/31/202 051311202 06/251202 2,62375 0.00 0.00 2,623.75 .>l / COLLECTION FEES 05/24 �i 193294 07/31/202 06/30/202 07/25/202 987.42 0.00 0.00 987.42 j .,' 193295 07/31/202 06/30/202 07/25/202 2,132.76 0.00 0.00 2,132,76 COLLECTION FEES 06/24 1193963 07/31J20206/30120207/25/2o2 67,46 0.00 0.00 67.46 .� Vendor Totals: Number Name Gross Discount No -Pay Net 11141 MEDICAL DATA SYSTEMS, INC. 7,853.02 0.00 0.00 7,863.02 Vendor# /Vendor Name Class Pay Code M2470 MEDLINE INDUSTRIES INC M Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net JInvoice# 2330193407 08/07/202 08/07/202 09/01/202 71.10 0.00 0.00 71.10 -� 2330193491 08/07/20208/07/20209/01/202 3,163.01 0.00 0.00 3,153.01 1/ 2330193414 08/07/202 08/07/202 09/01/202 7,429.17 0.00 0.00 7.429.17 � -f 2330191999 08107/202 08/071202 09/01/202 24.32 0.00 0.00 2432 J ,J 2330193412 08114/202 08107/202 091011202 95.10 0.00 0.00 95,10 ./ J 2330193411 08/14/202 08/07/202 09/01/202 101.42 0.00 0.00 101.42 J 2330193418 08/14/20208107/20209101/202 818.20 0.00 0.00 818.20 J 2330193400 08/14/202 08/07/202 09101/202 3.21 0.00 0.00 3.21 j J 2330193401 08/141202 08/07/202 09/01/202 2,612.12 0.00 0.00 2,612.12 �23330193423 08/14/202 08107/202 09/011202 119.10 0.00 0.00 119.10 � .,/2330193403 081141202 08/07/202 09/01/202 1,159.31 0.00 0.00 1,159.31 2330193422 08/141202 081071202 09/01/202 5,62 0.00 0.00 5.62 J 2330193416 08114/202 081071202 091011202 99.90 0.00 0.00 99.90 J 2330746458 08/14/202 00/10/202 09/04/202 30.92 0,00 0.00 30.92 J Vendor Totals: Number Name Gross Discount No -Pay Not M2470 MEDLINE INDUSTRIES INC 15,722.60 0.00 0,00 15,722.50 Vendor# VVendor Name Class Pay Code 12204 J MEMORIAL MEDICAL CENTER Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1/080824 08115/20208/08120208/08/202 14.50 0.00 0.00 14.50 J Vendor Totals: Number Name Gross Discount No -Pay Net 12204 MEMORIAL MEDICAL CENTER 14.50 0.00 0.00 14.50 Vendor# Vendor Name Class Pay Code 10963MEMORIAL MEDICAL CLINIC Invoice# Comment Tran Dt Inv Dt Due Of Check Dt Pay Gross Discount No -Pay Net 081224 08/15120208/12/202 119.00 0.00 0.00 119.00 Vendor Totals: Number Name Gross Discount No -Pay Not 10963 MEMORIAL MEDICAL CLINIC 119.00 0.00 0.00 119.00 Vendor#Vendor Name Class Pay Code 10764 `- I Comment Tran Dt Inv Dt Due Of Check DI Pay Gross Discount No -Pay Net JInvoice# 081324 08114/202 08/13/202 08113/202 249.08 0.00 0.00 249.08 ✓ Vendor Totals: Number Name Gross Discount No -Pay Nei 10764 249.08 0.00 0.00 249,08 Vendor# Vendor Name Class Pay Code 10536 MORRIS & DICKSON CO, LLC Invoice# Comment Tran Of Inv Of Due Dt Check Of Pay Gross Discount No -Pay Net / CM43084 .j 08113/202 07/30/202 08/09/202 -8.80 0.00 0.00 -8.80 2273188 08/131202 07/301202 08/09/202 352.10 0100 0.00 352,19 .,� 2273189 08/13/20207/30/20208/09/202 1,384.16 0.00 0.00 1,384,16 ,// J 2273187 08/13/202 07/30/202 081091202 6,21 0.00 0.00 6.21 ✓ SUPPLIES J 2270598 OBN 3l20207l31/20208/10/202 365.85 0.00 0.00 365.85 SUPPLIES J 2278599 08113/202 07131/202 08/1 =02 6.16 0.00 0.00 6.15 % SUPPLIES 2283347 081181202 08/011202 08111/202 994.42 0.00 0.00 994.42 SUPPLIES f 2280346 08/13/202 08/011202 08/11/202 88.07 0.00 0.00 88.07 ,I SUPPLIES 2283348 08/13/202 081011202 08/11/202 686,05 0.00 0.00 688.05 SUPPLIES 2289567 08/13/202 08/041202 08/141202 323.82 0.00 0.00 323.82 SUPPLIES / 2289566 08/13/202 08/04/202 08/14/202 853.41 0.00 0.00 $53.41 J 2293343 08/13/20208/051202081151202 416.63 0.00 0.00 415.63 SUPPLIES 2293342 08/13/20208/05/20208115/202 177.03 0.00 0.00 177.03 J 2293142 08/13/20208/05/20208/151202 5,550.92 0.00 0.00 5,550.92 J 2294346 06/13/202 08/05/202 08/15/202 2.38 0.00 0.00 2.38 1 .,/ 2293143 08113/202 08/051202 08/151202 1.01 0.00 0.00 4.01 J SUPPLIES 2299100 08113/202 08/06/202 08/06/202 116.96 0.00 0.00 116.96 J/ SUPPLIES 1 2299099 08/131202 081061202 08/16/202 440.69 0.00 0.00 440.69 .I 2303842 08/131202 08107/202 08/17/202 1,228.06 0,00 0.00 1,228.96 SUPPLIES J 2303438 08/13/20208107/20206/17/202 2303841 08113/202 08/07/202 08/171202 SUPPLIES �2302392 08113/20208/07120208/17/202 SUPPLIES J 2302527 08/13/20208107/20208/17/202 SUPPLIES J 2307707 08/131202 08/081202 08118/202 J 2307706 08/13/202 08/08/202 08/18/202 l 230770.5 d 08113/202 08108/202 08/18/202 Vendor Totals: Number Name 10536 MORRIS $ DICKSON CO, LLC Vendor Vendor Name Class Pay Code M2659MXR IMAGING, INC M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay J 8801168892 08/06120207126/20208/25/2D2 Vendor Totals: Number Name M2659 MXR IMAGING, INC Vendor#/Vendor Name 11472 OCCUPRO LLC Class Pay Code Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay ,1 36558 08107/202 08/071202 09/06/202 Vendor Totals: Number Name 11472 OCCUPRO LLC Vendor# Vendor Name Class Pay Code 01500J OLYMPUS AMERICA INC M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay J 36655051 08/01/202 08/07/202 09/06/202 Vendor Totals: Number Name 01500 OLYMPUS AMERICA INC Vendor#( Vendor Name Class Pay Code 11-166 J PARAREV Invoice# Comment .,� 916670 Tran Dt Inv Dt Due Dt 08/01/202 08/011202 08/31/202 Check Dt Pay Vendor Totals: Number Name 11155 PARAREV Vendor# Vendor Name Class Pay Code 10032 .� PHILIPS HEALTHCARE Invoice# Comment Tran Dt Inv Di Due Dt Check Dt Pay / J 9024840261 08/01/20202/21/20203/22/202 Vendor Totals: Number Name 10032 PHILIPS HEALTHCARE Vendor# jVendor Name Class Pay Code 12706 rl POC ELECTRIC, LLC l Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay r 4075 0811 M02 04/26/202 05/01/202 26.06 0.00 0.00 26.06 164.43 0.00 0.00 164.43 3520 0.00 0.00 35.20 40.22 0.00 0.00 40.22 �. 210.87 0.00 0,00 210.87 239.66 0.00 0.00 239.56 12.12 0.00 0,00 12.12 Gross Discount No -Pay Net 13,715.57 0.00 0.00 13,715.57 Gross Discount No -Pay Net 295.35 0.00 0.00 295.35 Gross Discount No -Pay Net 295.35 0.00 0.00 295.36 Gross Discount No -Pay Nei 486.68 0.00 0.00 486.68 J Gross Discount No -Pay Not 486.68 0.00 0.00 486.68 Gross Discount No -Pay Net 1,125.00 0.00 0.00 1,125.00 Gross Discount No -Pay Not 1,125.00 0.00 0.00 1,125.00 Gross Discount No -Pay Net 3,084.00 0,00 0.00 3,084.00 J Gross Discount No -Pay Net 3.064.00 0.00 0.00 3,084.00 Gross Discount No -Pay Nei 244.94 0.00 0.00 244.94� Gross Discount No -Pay Net 244.94 0.00 0.00 244.94 Gross Discount No -Pay Net 000.00 0.00 0.00 600.00 i Vendor Totals: Number Name Gross Discount No -Pay Net 12708 POC ELECTRIC, LLC 600.00 0,00 0.00 600.00 Vendor# /Vendor Name Class Pay Code 12480 J PRO ENERGY PARTNERS LLC Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Not J 24070600 OB/01/20208/08/20208/23/202 2,080,47 0.00 0.00 2,080.47 f Vendor Totals: Number Name Gross Discount No -Pay Net 12480 PRO ENERGY PARTNERS LLC 2,080.47 0.00 0.00 2,080.47 Vondor# Vendor Name Class Pay Code 16604 J - Involce# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J HERROS0001 08/15/202 08/071202 08107/202 120.00 0.00 0.00 120.00 j Vendor Totals: Number Name Gross Discount No -Pay Net 16604 120.00 0.00 0.00 120.00 Vendor# (Vendor Name Class Pay Code 11476 �/ SAMS CLUB / Involca# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net ./ 072024 08/14/20207/20/20208108/202 237.08 OAO 0.00 237.08. Vendor Totals: Number Name Gross Discount No -Pay Net 11476 SAMS CLUB 237,08 0.00 0.00 237,08 Vendor#%Vendor Name Class Pay Code 14716,1 SINGLETON ASSOCIATES PA Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net ,l 5315 08113/202 07131/202 07/31/202 11.00 0.00 0.00 11.00 .,I 5535 081131202 07/31/202 07131/202 237.60 0.00 0.00 237.60 ✓ 5148 08/13/202 08/01/202 08/011202 356.68 0.00 0100 356.68 U� J 5147 08113/202 08/01/202 08/01/202 120.01 0.00 0.00 120.01 ✓/ -J 10548 08/131202 08/01/202 08101/202 680.33 0.00 0.00 680,33 Vendor Totals: Number Name Gross Discount No -Pay Net 14716 SINGLETON ASSOCIATES PA 1,405.62 0.00 0.00 1.405.62 Vendor# Vendor Name Class Pay Code S2045 -J SOUTHEAST TEXAS HEALTH SYS W Invoice# Comment Tran Ot Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net J 26945 07/311202 07/01/202 07/311202 6,250.00 0.00 0.00 6,2%00 Vendor Totals: Number Name Gross Discount No -Pay Net $2345 SOUTHEAST TEXAS HEALTH SYS 6,260.00 0.00 0.00 6,250.00 Vendor#✓Vendor Name Class Pay Code C1010 SPARKLIGHT W Invoice# Comment Tran Ot Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net J/080124 08/131202 08/01/202 08/02/202 1,842,00 0.00 0.00 1,842.00 " INTERNET 0824 SERVICE PERIO[ „/080624 08/13/202 08106/202 08/07/202 404,06 0.00 0.00 404.05 ../ CABLE 0824 SERVICE PERIOD Vendor Totals: Number Name Gross Discount No -Pay Net 01010 SPARKLIGHT 2,246.06 0.00 0.00 2,246,05 Vendor# Vendor Name Class Pay Code 11772 J STERIS INSTRUMENT MANAGEMENT invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 2838092 08/13/202 06/07/202 09/06/202 Gross Discount 337.00 0.00 Vendor Totals: Number Name Gross 11772 STERIS INSTRUMENT MANAGEMENT 337.00 Vendor# endor Name Class Pay Code 15092 STEVE BROCK Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross J081424 0�^8�/,16120208/14/20208/14/202 383.02 EXPENSES UJ(� �1f�L.?� lI �TA I Z-y - "-I -� I --LI Vendor Totals: Number Name Gross 15092 STEVE BROCK 383.92 Vendor# Vendor Name Class Pay Cade 15244 TEXAS ELITE THERAPY TEAM LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross / J 073124 07131/202 07131/202 07131/202 15,650.00 Vendor Totals: Number Name Gross 15244 TEXAS ELITE THERAPY TEAM LLC 15,650.00 Vendor# endor Name Class Pay Code 14372 J4RIAGE, LLC Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross J JNV1796995708 08/07/202 08/02/202 09/011202 3,467.60 FAD STAFFING Vendor Totals: Number Name Gross 14372 TRIAGE, LLC 3,467.50 Vendor# /Vendor Name Class Pay Code 11067 ✓ TRIZETTO PROVIDER SOLUTIONS Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 35FK082400 08101/202 08/011202 08/26/202 1,687.97 Vendor Totals: Number Name Gross 11067 TRIZETTO PROVIDER SOLUTIONS 1.587.97 Vendor# /Vendor Name Class Pay Code 10841 ^+ TRUBRIDGE, LCC Invoice# Comment J T240801378 Tran Dt Inv Dt Due Dt Check Dt Pay Gross 08/14/2D208/08/202 9,592.34 Vendor Totals: Number Name Gross 10841 TRUBRIDGE, LLC 9,592.34 Vendor# Name Class Pay Code /Vendor 10885, TTUHSC - HEALTH.EDU Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross -J 2409425 08105/20208101/202 D8/31/202 6,026.51 SEPT CONT EDU SERVICES Vendor Totals: Number Name Gross 10885 TTUHSC • HEALTH.EDU 6,826.51 Vendor# /Vendor Name Class Pay Code U1064 UNIFIRST HOLDINGS INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross J 2921039091 08/01/202 08105/202 09/04/202 208.36 J 2921039090 08/01/202 08/051202 09/04/202 3,235.12 J 2921038891 08/05/202 00/01/202 08/31/202 318.12 Discount 0,00 Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 Discount O.OD Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 Discount 0.00 No -Pay Net 0.00 337.00 No -Pay Net 0.00 337.00 No -Pay Net 0.00 383.92 No -Pay Net 0.00 383.92 No -Pay 0.00 No -Pay 0.00 No -Pay 0.00 No -Pay 0.00 Net 15,650.00 Net 15.650.00 Net 3,467.60 Net 3,467.50 No -Pay Net 0.00 1,687.97 No -Pay Net 0.00 1,587.97 No -Pay 0.00 No -Pay 0.00 No -Pay 0.00 No -Pay 0.00 Net 9,692.34 Net 9.592.34 Net 6,82esl J Net 6,826.51 Discount No -Pay Net / 0.00 0.00 208.36 ,f 0.00 0.00 3,235.12 0.00 0.00 318.12 J ,J 2921038893 08105/202 08101/202 08/31/202 215.39 0.00 0.00 215.39 LAUNDRY J 2921038894 081051202081011202 O8/31/202 113.81 0.00 0.00 113.81 ' 2921030887 08/05/202 081011202 08131/202 134.20 0.00 0.00 134.20.E 2921038890 08/05/20208/01/202081311202 34.04 0.00 0.00 34.04 ✓ LAUNDRY J 2921038892 08/05/202 08/01/202 08/31/202 282.90 0.00 0.00 282.90 ✓ 2921038888 08/05/202 08/01/202 08/31/202 320,96 0.00 0.00 326.96 J LAUNDRY J 2921038889 08/05/20208/01/20208/311202 2,484.75 0.00 0.00 2,484.75J I 2921039418 08/131202 08/08/202 09/02/202 397.11 0.00 0.00 397.11 J 2921039417 081131202 08108/202 09/021202 34.04 0.00 0.00 34.04 ✓' Vendor Totals: Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 7,784.80 0.00 0.00 7,784.80 Vendor# Vendor Name Class Pay Code / 12400 */ UPDOX LLC Invoice# Comment Tran Ot. Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net ` -J INV00517339 07/31/20208/06/20209/061202 1,238.38 0.00 0.00 1,238.38 Vendor Totals: Number Name Gross Discount No -Pay Net 12400 UPDOX LLC 1,238.38 0.00 0.00 1.238.38 Vendor# Vendor Name Class Pay Code 11110 J WERFEN USA LLC Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net J 9111582878 08/01/202 08/07/202 09/01/202 1,953.00 0.00 0.00 1,953.00 J 9111586076 08101120208/12/20209/061202 1,253.79 0.00 0.00 1,253.79 ✓ Vendor Totals: Number Name Gross Discount No -Pay Net 11110 WERFEN USA LLC 3,206.79 0.00 0.00 3,206.79 mpor bGu inim-y Grand Totals: Gross Discount No -Pay Net 378,300.24 9.00 0.00 !78, . APPROVED ON AUG 1 5 2024 6Yr�UNryAppl .. �Gj.2 inD 1r��O(�. CALHOUN`CpUNTV, TEXAS ` -/ p. f '' 0 U o RECEIVED BY THE COUNTY AUDITOR ON AUG 10 2024 08/19/2024 MEMORIAL MEDICAL CENTER 11:26 CALHOUN COUNTY, TEXAS AP Open Invoice List Due Dates Through: 09/06/2024 Vendor# / Vendor Name Class Pay Code S1800./ SHERWIN WILLIAMS W Involoolt Comment Tran Ot Inv Dt Due Dt Check Dt Pay J 073124 08/161202 07131/202 08/201202 Vendor Totals: Number Name 81800 SHERWIN WILLIAMS Report Summary Grand Totals: Gross Discount 163.21 0.00 APPROVED ON AUG {1py9�220[g2t4 rit�aOt0�1U�IdNrT; 0 ap_open_lnvoice.template Gross Discount No -Pay Not 163.21 0.00 0.00 163,21 Gross Discount No -Pay Net 163.21 0.00 0.00 163.21 No -Pay Net 0.00 163.21 nEm�w Obl1N1*�rA'ly""004 MEMORIAL MEDICAL CENTER 0 08/1912024 71:24 AUG INS AP Open Invoice List ap_open_InvoieeJsmplate V y, r7 Due Dates Through: 09/00/2024 Vendorkj Vendor Name Nr a Class Pay Code 14064J CAPITAL ONECAWW Ore" Invoiceil Comment Then Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net JJJ 1656899187 08119/202 07/19/202 08113/202 955,69 0.00 0100 955.69� Vendor Totals: Number Name Gross Discount No -Pay Not 14064 CAPITAL ONE 955.69 0.00 0,00 955.69 Rcpert Summary Grand Totals: Gross Discount No -Pay Net 956,69 0.00 0.00 955.69 APPf M D ft AUG 112024 He'c"O BY TNe COONV ANCtt7Otit7N MEMORIAL MEDICAL CENTER 0 00119/2024 AUG i � 2024 AP Open Invoice List ap open_lnvoice.template 1126 Due Dates Through: 09/06/2024 VandAWOUN COUNI`" S Class Pay Cade Vendor# I THIRD COAST DISTRIBUTING LLC Net 15396 d Invoice# Comment Tmn Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay 0.00 984.99 J073124 08/16/20207131/20208/02/202 984.99 0.00 Gross Discount No -Pay Not Vendor Totals: Number Name 084.99 0.00 0.00 984.99 15398 THIRD COAST DISTRIBUTING LLC Rcport Summary Not Grand Totals: Gross Discount No -Pay 0.00 984,99 984,99 0.00 APPROM ON AUG gg y1�y9�2�0p2Y4 p CALNOVURUNTV,iT XAS 10 01 CITIBAIVK CORPORATE CARD Account Statement C0Mmb,uAJ prd Aa t Account Inciatrias; dtl Toll Frew. 1-(800)-24B4553 InImational. 1-(904)-954-7314 TDDrrTY-- 1-c877)-505-7276 Summary Of Account ACGWry ( .— ...... Not an invoice. For votir rp .h' Bond Notice Of0lilrng Errors and Customer Service Inquiries to: CITIBANK, N.A., P0 F30X 6125- SIOUX FALLS 80 5711746125 Transactions �-jT-.. ..... st Trans ** ......... ......... NOTICE MEMO ITEM(S) LISTED BELOW ........... 07M4 07103 9399 051313.. 7416SEM107177950 I NPOS NPDS.HRSAGOV FAIRFAX VA W10939767 22033 USA 2.50 07/11 07110 9399 OM34374`19360=093282 2 NPOB NPOB.HRSA.GCV FAIRFAX VA M111220M 22033 USA 62.50 07112 07110 9062 65457374ISSSIffi3f,313001 3 TEXAS HOSPDAL ASSOC AUSTIN TX 07/19 n7f19 am SS432864201202971427612 4 AWOREDENTIALING 600-92141335 IL 76701 USA 45.00 07n2 07119 03SS 091343742026=53482178 6 NpDo NpCBjjRqA GOV FAIRFAX 60611 USA 44.00 VA N111717412 22033 USA 2.50 07/22 D71i9 930 0134374202600063482251 6 NPDS NP3B.HREA.GOV FAIRFAX VA N111723760 22033 USA 240 O7/22 07/19 9399 01343742026OWS3482335 7 NPi)BNPDB.HRSAGOV FAIRFAX VA 22033 N11172605o USA 2.50 07/22 07/20 11909 5543266420220=958542 a AMA'CREDENTIALING 80MI-to35IL 60811 USA D7/22 07120 11999 59432W420220333295B674 9 AMA-CREDEN7IAUNG 800621-BMSIL 44.00 (17/23 07123 8999 65432864205204315477W 10 AMA'CREDENTIAUN3 1100-0121-833S IL 60511 USA 44.00 07124 OW23 93D9 0513437420MON62549692 11 NpDSNpDS.HRSAGOV VA FAIRFAX SWIl USA 44M N11189624a 22033 USA 2,60 07/29 D7127 3640 52704874210026,1631957159 12 GRAND HYATT SANANrONI SAMANTONIOTX AS00188 78205 USA 1,065.87 CHECK IN: W=024 07129 07W 3640 6270497421OD26463192434 13 GRAND WATrSANANTONI SANANTCNIOTX 48040350 78205 USA CHECK IN, 11742WWd NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Pogo I of 4 .. ....... . . ...... . ..... . - ....... ....... a tCITIBANK N.A. PO BOX 6125 ACCoUnt Number XXXX-XXXX-XXYX-5228 SIOUX FALLS $0 57117.6125 Statement Closing Date August 03, 2024 APPROVED ON AUG 15 Notaninvolm FOrYOZleCordsonly. ERIN CLEVENGER R&Q2024 rALWUN"WAS 202 8 ANN ST., STE A PORT LAVACA TX 77979-4204 00010079643 _-�.��,,..,,..v Iml SANANTONIO TX _.-5 UiA--—__�.._j 48040021 78206 USA 998A9 ..; ' 07/29 07/27 3640 62704874210026463IS3754 CHECKIN:07/2N2024 I 15 GFANOHYATTSANANTONI SANANTONIO TX 78205 USA g7q,g5 48040224 07/29 07727 3640 52704874210026463194358 CHECK IN: 07724Q024 76 RANG HYATT SAN ANTONI SAN ANTONIO TX480395V 78205 USA 915.67 „ y 07131 07730 5912 SV36874213162138460719 CHECK IN; 17 f-UPRINCHECKSRX60q/2024 182481115RX 5036 LEOGEWOpO NJ USA 1,050.0p 7p24079 I TOTALAMOUNT OF MEMOITEM(S): 56,074.551 Page 3 of 4 MEMORIAL MEDICAL CENTER PU RCUASE ORDER Bill To: 815 N. VIRGINIA ST- PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX:' (361)552-0312 Vendor Name: Vendor Address: Vendor Phone M Vendor Fax #: Ship To: 615 N. VIRG1NrA ST. PORT LAVACA, TX 77979 PHONE: (361)552-6713 FAX:J (361)552-0312 0 f � t Date: �b6'?- P.O. # Account # Initiated BY: Date Required Ezpense8 Department FOB#9401 OcliverTo Lino Qty, Catalog Number No. Description Unit Cost Unit Extended Meas, Cost 4 L� LT V (I�1 ' ��a'►C" in }' 6 _ AAA - f V�dti� C�wn .S c ,1 ✓ q L f C�c POP - f P WW Nao e 9'e+.4'1 K PDT - f pku �51 6fain Net,)) Mao) ,c 6C to A ifredac i (ivlar ; c, , , : ` , J I 4q rya Est. Freight Est, Total Cost NOTES: TOTAL COST Contact: Date: ' Dept. Dimtor Quoted By: -` Dir. Nursing Buyer. E.T.A. Dir, Clinical Services CFO _ Administrator �lN, Bill To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361)552-6713 FAX: (361)552-0312 Vendor Name: ± �� Vendor Address: MEMORIAL MEDICAL CENTER PURCf4ASE ORDER Ship To: $15 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361)552-6713 FAX: ii (361) 552-0312 Date: T2Y t P.O. # _ Vendor Phone #: Account # Vendor Fax #: Initiated R Est. Freight TOTAL COST 4q , tX42. ?- J1g3.Li`1 Bill To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX;, (361) 552-0312 Vendor Name: Vendor Address: Vendor Phone N: Vendor Fax #: MEMORIAL MEDICAL CENTER PURCHASE ORDER Ship To: 813 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361)552.6713 FAX: (361) 552-0312 Date: 26 A k' .2q P.O. # Account f -71244 2-A - LLatL 5, v 'T C, r� Rr �m) rk I 6 t) D 3o. - 2 0 5 V Q C. n 10 0 5 0 IL • NOTES, ght Est. Total Cost TOTAL 0)9 Contact: Date. Dept. Director Quoted By: ... Dir. Nursing Buyer: E.T.A. Dir. Clinical Services CFO Administratortttl� CITIBANK CORPORATE CARD Account Statement CammarcJ rd� • + v STTEVE BROCK C Account Inquiries! To)) Free: 1-(600)-248.4553 International: 1-(904)-854-7314 Account Numher: XXXX-XXXX-X7(y,}(_1615 TDDlT7Y. 1-(877)-505.7276 Summary of Account Activity Not an invoice. For your records only, ` I IAtI NIy _ $87428 Credit Llmll _._, 55000 Send Notice of Billing Emma and Customer Service Inquiries to- Cas4AdvanoolmilL—"'""—'"--50 CITIBANK, N.A., PO BOX 6125. SIOUX FALLS SD 57117.6125 Statement Ci05ing Oafe— -�`-- pg/03%2824 Onys In Blllinp psBcd .___.31, Transactions Post Tmns ' Date pate 7iCC a _...�._.—_ pazcdptloM.ora6on ......•........... — NOTICE MEMO ITEM(5)LISTTEDED BELOW "`••••'•• ••••'• 07129 07127 3040 52704874210026463194273 1 GRAND HYATT SAN ANTONI SANANTONIO TX78205 USA 874.26 -08040885 CHECKIN:07124I2024 �� • ••••• ••••..... TOTAL AMOUNT OF MEMO ITEM(S): 11874,26 I APPROVEo ON AUG 16 2014 C+��4WfJUN C � JN7V,) plAtt NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Pagel ot2 ...... _... _....., ....._.......... . ....... ...... ........ _.... ........ p�+'BInr °@'tee CITIBANK, N.A. f�aOM POSOX6125 Account Number XXXX-XXXX-XXXX-1615 SIOUX FALLS SD 57117-6125 Statement Closing Date August 03, 2024 STEVE BROrK 202 S ANN ST, STE A PORT LAVACA TX 77979.4204 00010079654 Net an Invoice. For your records only, MEMORIAL MEDICAL CENTER H'LJfl CUASE ORDER BUM: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361) 552-6713 FAX:' (361) 552-0312 Vendor Name: 1 �_ Vendor Address! Vendor Phone 0. Vendor Pax N: Ship To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PHONE: (361)552.6713 PAX: (361) 552-0312 Date: P.O. # Account P Initiated BY: Date Required Fkpeasee Departmmrnt DdivaTo Forat 99401 Qty. Catalog Number Daori non FNo._ F Unit Cost Uni! F.atetded - �� .�f• Mao. Curt lj� t „ Hata 3 6 - G -- g - 9 to NOTES; Est. Freight Est Total Cost TOTALCOST Y—lq';' 9 7 -Ryoces ME Contact: Date: Dept Director Quoted BY: Dir. Nursing Buyer. E.T.A aft. Cunicat Service CFO _ Mminisoatar_ ia'� MWESSON Coro'' rare MEMORIAL MEDICAL CENTER /J AP ✓ 815 N VfRGINIA STREET PORT IAVACA TX 17979 STATEMENT AMT DUE REMITTED VIA ACH OMIT Slelemenl fee Infommtion Only As of: 08/16/2024 Page: 002 TO assume proper credh to your seeded, detach and return Ild, stub with your mortarless DC: 8115 Customermer INV SupplD: As of: 00116/2024 Pape: 002 Mall I. Comp: 8000 Territory: AMT DUE REMITTED VIA ACH DEBIT Customer: 632536 3lalemenl Ior information only Data: 08/17/2024 Cud: 632536 PUZI SE CHECK ANY Date: 08117/2024 I S NOT PAID (✓) etlond Account e5r36 DIatn9 Due Number l Cash Amount P (..I) P Ruadhor to Data tlat0 Number Reference DeudptlOn Discount (Bross) F (ntQ F Number FF vnfumn Ie9e1M: P = Past Out Item, F = Future Duo Item, bfeMl = Curren Due Item TOTAL Noticed Aect 632536 MEMORIAL MEDICAL CENTER Suffield.: 10,926.80 USD Futum Due: O.OD Past Du.: 0.00 last Payment 2.451.97 08101/2017 sfi1l��tz +- 5°59 4 j-I1 7.LP`j.-.gU 9 0 Paid By 0812012024, Pay This Amount: 10,788.30 USD If Pald After 0812012024, Pay this Amount: 10,926.88 USD APPROVED ON AUG 19 2924 CA4NDUPf GOUNTK WAS For AR Inquiries please contact 800-967-0333 Due If Paid On Time: USD 10.708.30 Case feat If pad late: 218.68 Duo If Pont late: USD 10,926.88 g ( ("� ( 2L, 2 `-f MWESSON remnor aeon WALMART 10981MEM MED PI -IS MEMORIAL MEDICAL CENTER VICKY KALISW 816 N VIRGINIA ST PORT LAVACA TX 77979 STATEMENT A. of: 0811612024 Pagc Do, To emum proper credit to your eccouM, Meet, one Mum this stub with your romillance DC: 0116 Customer INV suppiti As of: 08/16/2024 Peg.: Dot mail to: C.P. 8000 AMT DUE REMITTED VIA ACH DEBIT Territory: 7001 Statement for Information only AMT DUE REMITTED VIA ACH DEBIT Customer, 266342 Statement for Iniurmminn only Data: 08/1712024 Cust: 256342 PLEASE CHECK ANY Date: 0811712024 ffW$ NOT PAID (+) 8011n9 Du. Cash Amount P Amoant P Ra.W.W. Data Dal. Number Reference Deactlption Comment (gross) P Iran F Number Customer Number 256342 00110/2024 08/2012024 0811012024 08/2012024 0011212024 08120/2024 U811212024 08/2012024 08112/2024 08120(2024 08112/2024 00/2012024 08112/2024 0812012024 08/12/2024 08/2012024 0811312024 08/20/2024 OBNW2024 0812012024 08113/2024 0812W2024 0011312024 00120/2024 0811312024 08120/2024 0011312024 U012012024 0803/2024 08120/2024 08113/2024 OW2012024 00113/2024 08120/2024 0811312024 0612012024 0811312024 06120/2024 08/1312024 0612012024 08/13/2024 00120/2024 08/1312024 00120/2024 0811412024 00120/2024 Doi 1412024 08/2012024 01IM412024 06120/2024 08114/2024 06/2012024 00/I4/21124 0812012024 06114/2024 06/2012024 00114/2024 06120/2024 080412024 0812012024 08(1412024 00120/2024 WALMART 1000IMB4 Mm 1513050639 7513050840 7514108327 75141OB320 7514108129 75141OB330 7514108331 7614108332 7614366024 7514386025 7514386026 7514300027 7514386028 7514366029 7614386030 7514386031 7514306032 7514366034 7514366035 7514366037 7514386038 7614386039 75146SBD91 7514656992 7514656993 7614668094 7614666995 7514656996 7514666997 7514656998 7514656999 PHIS 116604680 115mvolce 0.03 1.58 1.55'E ✓ 7513850539 203279868 1151nvo1co 0.01 0.32 0.31 It ./ 7513850640 2DS504554 1151nvaice (Loa DAIS k 207765029 1151nv01ce 0.02 1.06 1,04k ,/7514108327 7514108328 2076295DO II51nvoke 0.83 41.42 40.594' J7614108329 207699360 1151nvolc. 0.83 41.42 40.59 K ✓7514100330 207629506 1151mdo. 1.60 79.85 78.25X J7514108331 207813630 115invoice 15.68 784.22 766.54 k J 75141OB332 207924212 1151nvoice 0.01 0.63 0.62X ✓ 7514386024 200017725 1151nvoice 0.01 0.32 0.31)( ✓/7514386025 204644102 1151nvoiie 46.05 2,252.47 2,207.42> ./ 7514386026 205923916 1151nv.k. 0.01 0.32 0.31 X ✓7514386027 205987101 115lnvoice 0.02 0.95 0.93 R( ✓7514386023 116146156 1631nvc1ce 2.20 110.24 108.04 X „/7514386029 205504654 1151nva1c. 5.23 261.41 256.18k 116626876 1961nvoice 6.34 317.09 U10.75 k ,/.7514360030 �7514386031 116148618 1151nvo1co 4.30 214.05 210.55,> /7514380032 116270035 1151nvolce 0.01 0.32 0.31 X ✓ 7514306034 200769064 1631nvaite 0.04 1.90 "'C'x �1514386035 203279008 1151nvcice 0.01 0.32 0.30r -/7514386037 203400302 1151nvoica 0.01 0,63 0.62X ✓7514386038 116143499 1951nvoico 0.04 1.90 1.86 k 7514386039 116332519 115mvelc. OA4 1,90 1.86 X 7614656991 116396178 1151nvciae 0.02 0,95 0.93 A f 7514656992 207994362. 1151nvolea 1.66 82.84 01.18 x �7514656993 202360005 1151nvoicn 10.67 933.27 914.00 X 7514656094 205147848 1151moice 1.56 77195 76.39X ✓7514656995 205374099 1151nvoice 3.12 155.90 162.78 k 4/ 7514656996 116672418 1151nvoice 18.67 933.28 114,611( J/ 7514656997 200177784 11Shovel. 18.67 933.28 914.61 Y J 7514656995 204548065 115hWa. 17.12 855.76 036,64X ✓ 751465699P For AR Inquiries please contact 800-867-0333 STATEMENT G.'.vpoop WALMART 109811AEA4 MED PH$ AMT DUE REMITTED VIA ACH OMIT MEMORIAL MEDICAL CENTER ' VICKY KAUSEK Statement for information only ✓ / 815 N VIRGINIA ST J PORr LAVACA TX 77979 As of: 08/16/2024 Page: 002 To armure Proper madiK to your axoum, distant, and return this stub with your remManes OC: 8115 Customer INV 9 D: As of: 06/16/2024 Page: 002 "� Mail I. Comp: 8000 Tanilory: 7901 AMT DUE REMITTED VIA ACH DEBR Customer. 256342 Statement for information only Dote: 08/17/2024 Cust: 266342 PLEASE CHECK ANY Onto: 08117/2024 R948 NOT PAID (r( Billerg Due RoeelvaM�etlonal Acumnl WUP6 cash Dale Date Number Reforenca Douription Discount IV--) F Amount P Number (g 1 (rwp F Number 08/15/2024 08/2012024 7514923249 118364277 1151nvblce 0.04 1.90 1.86 X J 7514923249 0811512024 0812012024 7614923260 200817725 1151nvoine 0.01 0.32 0.31/( 7514923260 0811512024 08/2012024 7514923251 206692083 11511wblbe 1.56 77.95 76.39 X 7514923251 08/1512024 08/2012024 7514923252 207060963 1151nvpice 4.60 233.85 229.17 J( 7514923252 0611512024 0812012024 7514923253 204644102 1151nvoics 22.52 1.126.23 1, 103.71x ✓7514923253 08/15/2024 06120/2024 7S14023254 206089777 1151nvoic, 22.52 1,126.23 1.103.71X ✓7514923254 08/15/2024 0012012024 7514923256 203400302 1151nvb1ce 0.01 0.32 0.31- 7514923255 08116/2024 0013012024 7514923256 205141848 115lnvpico 0.01 0.32 0.31X / 7514923256 0811612024 0812012024 7514923257 205726489 1151nvbipe 0.02 0.95 0.93)( 7514923257 06/1512024 06120/2024 7514923256 206211124 1151nvolce 0.01 0,32 0.31 X ,� 7514923258 0611612024 00/2012024 7614923289 201014317 11slevoice 1.00 50.24 49.24N 7514923259 00/15/2024 00/20/2024 7514923200 205576447 1151nvolce 4.12 205.97 201.85 k 7514923260 PF column legaml: P e Past Due Item, F - Future Due flare, blank a Current Due Item TOTAL: Cupolner Number 268342 WALMART 10931MIi4 M® PH6 6uMomb: 10,913.03 USD Future Duo: 8.00 Dua If Paid On Time; If Paid By 0812012024, USD 10,694.72 Past Dun: 0.00 Pay This Amount: 10,694.72 USD Olen lop If paid Iola: Last Payment 6,341.07 If Paid After 2024, Due If Paitl Isle: 218,31 08/1212029 Pay this Amount: unl: 10,913.03 USD USD 10,913.03 APPRC>M ON �l i AU��G�N1 v r� u il ��c .,l}F"uf \ 9 ''7L.0O2T4�R GASi()j7N 'CfAN1IY.11F,Riw" For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 08115/2024 Pass: 001 TO aruum Proper credit W year account, detach end M. thtc Came=ar: 4000 stub with your monotones HIP FHCY WH5EIMEM MED FHS DC: 8115 Customer INV SupplD: A. W: 0811612024 Page: 001 Mall to: Core p: 8000 MEMORIAL MEDICAL CENTER AMT DUE REMITTED VIA ACH DEBIT Territory: 7001 / Statemenl for Information only AMT DUE RE4ITTED VIA ACH DEBIT VICKY KALISEK •l' Customer. 820405 Statement for information only 815 N VIRGINIA ST J PORT IAVACA TX 77979 Date: 0811712024 Cult 82D405 PLEASE CHECK ANY Oats: 08/17/2024 ITSOS NOT PAID Imo) Sitting Duo Reeoe.Wrl'o"onaAccount e Otar Dole Date Number Reference Description Cash Discount Amount P (gross) P Amo("d) P Numinew N (net) F Number Customer Number 820405 HER PHCY WHSWMEM MED PINS OB11212024 081ZO/2024 7513848943 62408-055-169648 1151nealee 0.10 S,Oi 4.912( 7513848943 06113/2024 08120/2024 7614200909 B2406-055-169885 1151nuolce 0.10 5.18 5.08), ]514200909 PF whimn issue: P = Past Due Item, F = Future Due Item, blank = Curtain Dun Item TOTAL Customer Number 820405 H® ANDY WHSEMBA M® R15 Subtotal.: IOAD USE, Future Duo: 0.00 Duo If Peld On Time: If Paid By 08120/2024, USD 9.99 1( Past Due: 0.00 Pay This Amount: 9.99 USD Dlw lost 0 Mid late: 0.20 Last Payment 0.341.07 0 Paid After 0812012024, Due It Pald late: 0811212024 Pay this Amount: 10.19 USD / Use I 10.49 APPROVED ON AUG 19 2024 <6 k<_ t I zc, 2-4 CAINBUNLINiY, WAS For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT rammm,v. e000 CVS PHCY 7416IMFM MC PHS AMT DUE REMITTED VIA ACH DEBIT MEMORIAL MEDICAL CENTHA / Statement tot Information only VICKY KALISEK Ins N VIRGINIA ST J PORT LAVACA T% 77979 As of: 00/16/2024 Page: 001 To ensure proper cad8 toyour account, delech and mtum this Aid, with year (sentence DC: 8115 Customer INV SupplD: As of: 08/1612024 Pegs: 001 Me" he Comp: B000 Territory: 7007 AMT DUE REMITTED VIA ACH DEBIT CUMomaa83543] Siatemenl far Intarmalion only Date: 0811712024 Cum: 835437 PLEASE CHECK ANY Out.: 0811712024 ITBAS NOT PAID (,) enonal neeoum ae Ceeb Amount P Amount P Reeeleable ®Plane Duo Reoelvabl r Data Dula Number Ralmence Description Discount (goo.) F Iran) F Number Customer Number 035437 CVS PHCY 74161MW MC PHS OBN4/2024 00/2012024 7614671591 3452164 1151nvone 0.07 3.66 3.59 /X n/ 7514671591 O PF column legend: P - and Dun (lam, F = Future Duo It... blank = Cement Due it.. TOTAL Disarmer Number 035437 CV8 PRICY 7418/1ABA MC MS SubtMali: 3.66 USD Fire. Dua: 0.00 If Paid By 0812012024, Past One: 0.00 Pay This Amount: Last Payment 8,341.07 If Peal After 0812012024, 08/12t2D24 Pay this Amount: APPROVED ON AUG GN11 9 202 CApI,HOUN COUNTYITEXAS Due If Paid On Time: USD 3.59 X v/ 3.59 USD Disc lost K'Id We: 0.0] Dua D Pald We: 3.66 USO USD / 3.66 For AR Inquiries please contact 800-867-0333 STATEMENT Statement Number: 68040943 AmerisourceBergem Date: 08-16-2024 1 of AMERISOURCEBERGEN DRUG CORP WALGREENS #12494 340E 1001352M 103702/1166 12727 W, AIRPORT BLVD. MEMORIAL MEDICAL CENTER / SUGAR LAND TX 77478-6101 V 1302 N VIRGINIA ST / PORT LAVACA TX 77979.2509 •/ Set- Fd Due In 7 days DEA: RA0289276 866451-9655 AMERISOURCEBERGEN PO Boa 006223 Not Yet Duo: 0.00 CHARLOTTE NC 28290.5223 Current 3.159.74 Pool Due: 0.00 Total Oua: 3.155.74 Account Balance: 3,155.74 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 00.12-2024 OB-23.2024 31114764665 7057301724 InY.I. 2.280.36 U.00 2.28B.TO - 00-12.2024 08.23.2024 31847B4666 7007308858 Invoice 238.09 D.00 238.09 00.124024 08,23.2024 3104784667 7007318169 Invoice 75.10 0.00 75.1D 00.12-2024 00-23.2024 31M784668 7007320207 Imolce 72,71 D.00 � 72.71 08.13.2024 08-23.2024 31M944579 7007326207 Invoice 137.30 D.00 ,/ 137.30 O&M-2024 08-23.2024 318494510D 7007326MB Imeiae 233.46 0,00 233.46 08-14-2024 08-23.2024 3185080913 7007337513 Invoice 17.61 0.00 -� -/ 11.61 0846.2024 08-23-2024 3185257235 7007344086 Invoice 93.11 0.00 ✓ 93.11 Cement 1.15 Days 16-30 Days 31.60 Days 61-90 Days 91.120 Days Over 120 Days 3.155.74 D.00 0.00 OAO 0.00 0.00 0,00 Thank You for Your Payment Reminders Date Amount APPROVED ON Due Date Amount OX16-2024 (6.259.36) 08-23.2024 3,155.74 AUG 19 2024 Total Due: 3,155.74 gy prV aM I CALfVON�f CnUN7N, TFXAd , t �� J ��C'lY tv... L.J-�6�.I +J'•r�.(� TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) "ENTER 9-DIGIT TAXPAYER 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-DIGIT TAX FILING YEAR" "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 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" E—"6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER CALLED IN BY: CALLED IN DATE: CALLED IN TIME: tk# ENTER: 0 0 941 # 0 $ 177.42 1 $ 100.86 $ 23.60 $ 52.96 # J:MP-Payrall Rles\Payroll Taxes12024Wt7 R2 MMC TAX DEPOSIT WORKSHEET 08.08.24.x1s 8/19/2024 941 RECITAX DEPOSIT FOR MMC PAYROLL x PAY PERIOD: BEGIN "YH28l20'2S{i' yQ PAY PERIOD: END ' 812�i2i}' '• PAY DATE: GROSS PAY: $ 1,077.68 DEDUCTIONS: AIR $ ADVANC BOOTS MUTUAL CRITICAL ILLNESS MUTUAL ACCIDENT IRS TAX MUTUAL SHORT TERM DIS MUTUAL VISION $ 3.36 CAFE-D $ 9.60 CAFE-H $ 107.89 $ CAFE•P CANCER CHILD S CLINIC $ COMBIN S CREOUN $ DENTAL S DEP-LF MUTUAL TERM LIFE $ - MUTUAL HOSP INDEM $ FED TAX $ 52.96 FICA-M S 11.80 FICA-0 S SO.43 FICA-M ADDITIONAL FIRST C FLEX $ 83.33 FLX•FE S GIFT 6 $ MUTUAL CRITICAL ILLNESS S MUTUAL ACCIDENT $ 9.44 MUTUAL SHORT TERM DIS $ LEGAL $ 7.80 OTHER $ NATIONAL FARM LIFE $ - MEDSURCHARGE S - Blank RELAY REPAY STONEDF § - STONE STONE STUDEN TSA-R S 75.44 UW/HOS S - TOTAL DEDUCTIONS: S 471.26 $ �9KOYXDwYCKflEPdtF"".. ^UM)Ne NET PAY: ' �ewoiw weal aePMn• �'. TOTAL CAFE 125 PLAN: 5264,18 Le $ TAXABLE PAY: $ 613.80 $ 813.60 "CALCULATED" From MMC Report Difference FICA - MED(ER) +ax $ 11.80 FICA - MED (EE) usx $ 11,80 S 11.80 $ - FICA - SOC SEC (ER) 620% $ 50,44 FICA - SOC SEC (EE) sx0x, $ 50.44 $ 50.43 S 0.01 FED WITHHOLDING $ 62.96 $ 52.96 S s REVISED YIW014 LE t TOTALS S 1,077.68 3.36 9.60 167.89 62.96 11.80 6OA3 83.33 9.44 7,00 76.44 ants 606.43 Exempt Amt: Employees over FICASS Cap: Michael Gaines Paycods S - Employee Relmb.: TOTAL: S TAX DEPOSIT: 3 177.44 S 17742 FICA -MEDICARE 2.00r $ 23.60 $23.60 FICA - SOCIAL SECURITY ,x+4x S 100,68 $100.86 PREPARED BY: Andre Flores FED WITHHOLDING S 52.96 $52,96 PREPARED DATE: 8119/2024 TOTAL TAX: $ 177.44 $177.42 $ 0.02 R17 R2 MMC TAX DEPOSIT WORKSHEET 08.08.24.x1s: TAX DEPOSIT WORKSHEET 81190024 Run Dale: 0811E)24 MEAOBIAL 112MC4i, CENTSER Pegs 3 Tire: 16:22 Payroll Register I B: Waekly I P2PEG Pay Period D7/26124 - 08/08/24 Run; 2 Pinar Stuary '-- Pay Code SURmary-------- PayC6 Description Hrs r......................................... �0TjSRjN2jxOjcTj Y. EXTENDED -ILLNESS -BANK 48.00 N N N N P PAID-TIME-OPP 8.00 N N N N '-•---------------•-- Grand :otala: 56,00--•---• ( Cross: Caecks Counc:- pI 2 PT Other ?male 2 Male ............................................................ --'--.......... • D e d u c t i o n s Gross Ccde Amount ..............A."-------------------- 850.08 A/R A/P.2 227.60 ADVANC AWARDS BOOTS CAFE F. CAFB-2 CAFE-3 CAFE-5 CAH--C CARE-F CAF:"-F. CAPE-7 CAP.-' CHILD CLINIC CREDON DO ADV DEP-LF Di5-1F FATCSR FEDTAX FrcA-O 50,43/FIP.STC FLX FE FORT D GIFT S GRANT GT6 HOSP-I ID TFT IRSTAX LEGAL NASA MEFVIS MiSC MCSHR MOOACC MOOPND M00LIF MOOVIS 1.361NATFML PHI PMI'AA RELAY REPAY SCRUBS SIGIZ STONDF STONE STU06N SUNACC SUNIND SUNLIF SUNVIS SUP.CHG TSA-2 TSA-C TSA-R 75.44 nmoN Ud/HOS S u m n a r y.............' A/R3 BCBSVI CAFE-1 CAPE-4 CAFE-D 9.60 16734CAFE-I CANCER COMIIN DENTAL EAT 52.96/FICA41 11.80J FLU E 83.331 FUTA GRP-IN HSA LEAF MUMEALS MISC/ 9.444MCOILL MOOM OTHER PR FIN SAGS Sr -TX STONE2 SUMI L S.sn TSA-1 TSA-P UNIFOR 1077.6W Deductions: 471.25J Net: 606.44) Credit OeeCAmt EeroNet Tern Total: 2 Zu2�- Memorial Medical Center n_ 1 Transfer Request Date; 8/39/2024 Aeceunt: Dperaling•4357 APPROVratb ON munto. USBANCORP.FSAJHRA/DCACCACC AUG 19 2024 CAPH'NG UNTV TVPAS Routing Number, Involce numbers S573311,6717099, 6747696,6764705;6783041,6818449 by: Caattlliinn Clevenger Date; 9 2 ��,tf�1 by:. "_ _ "`r' "'J.'t_�""-'"' iBY� ,�Q . `g`a Date: � r .. ,ns nwo u' s ws. wwmin - �roi s auww nw+ws snuwu r +r a Vurswr 44twm � uaxnowna vammu r nz 014 APPROVED ON AUG 19 2024 r,AQiiOtSIAR AS MEMORIAL MEDICAL CENTER PROSPERITY BANK ELECTRONIC TRANSPERS FOR OPERATING ACCOUNT— Aug 12, 2024. Aug 19,2024 ✓ pate GaAs Oescr1011On 8/16/202.4 PAY PLUS ACHTmn5000000032780893101=6942 8/16/2024 HEALTHEQUITY MC Hea1thEqu11356888920MIS 8/16/2024 EXPEATPAY EXPERTPAY>4MG341191OWD1525T282 8/16/2024 AMERISOURCE BERG PAYMENTS 010000))68 2100002 8/16/2024 MEMORIAL MEDICAL PAYROLL 1113411 113122650 9/15/2024 PAY PLUS ACHTrani G000GG0315853)4101000693L B/IS/2024 FOMS FOMS PYMT052-1743547 W0410MI2121M 8/15/2024 FDMS FDMS PYMT052-1T43548-CM 4100D1212218) 8/15(2024 FDMS FDMS PYMT052-2100911A004IW12122922 8/15/2024 FDMS FDMS PYMT 052Q237276-0004100012120661 B/IS/2024 TEXAS COUNTY DRS RECEIVABLE 0419 2100MIS83 6 8/14/2024 PAY PLUS ACHTrana 000DO00325S5207 IDION6917 8/14/2024 HARLANDCIARRE CHX ORDERS 18CX538102212R591 R/13/2024 PAY PLUS ACHTrani000000032R3689110100059% 8/13/2024 MCNESSON DRUG AUTO ACH ACH06125423 910000118 8/12/2024 PAY PLUS ACHTrani 000100032 111 IGI0006993 8/12/2.024 TSYS/TRANS UIST MERCH FEES 39300982S4161661 8/12/2024 TSYS/TRANSFIRST MERCH FEES 41399MI33241961 8/12/2024 TSYS/TRANSFIRST M68CH FEES 4139000133240161 8/12/2024 TSYS/rRAN5FIR5T MERCH FEES 41399801332393 61 8/12/2024 TSYS/TAANSFIMT MERCH FEES 4139990133238561 6/12/2024 TSYS/TBANSFIRST MERCH FEES 4139980136819761 MORE Notes -3rd Party Payor Fee EmpDedud/Employer CnntNhut -Child Support Payment 3400 Drug Frog.. ERPenie Payroll 3rd Party Payer Fee . Credit Card Machine Loose fee Credit Cartl Machine Leese Fee Call Card Machine Lease Fee -Credit Card Machine Lease Fee Netl.meAt Funding $to Party Payor Fee -Deposit Book Opomting 31d Perry Payor Fee 340E Drug Program Expense 31d Party Payor Fee -Cretllt Card Processing Fee -Credit Card Processing Fee Credit Card Procesiing Fee Credit Cartl Processing Fee Credit Card Processing Fee - Credit Card Processing Fee CPSt"Haidardlte Amount Check"b +165'AS✓ 9013 1,347.83 1.* 8G05 570.69 /FG.W Boos 6,259.36 /'Jt 5006 368,033.99 fjE. 1137.09-%' MDXIBY AOAG Mgsyl" 99b09 / IA4,548.86 1:5R" 6IX98'+ 45109 8,341.0) "AR90� Y16.1?t .99)e48r ATWA41 MAD. M9s2B*'/ 174,21111 ,. / oAQ& 8/19/2024 AAVAW De LOS $antOS Memgrul Medical CenWf 'pcW'C'rCit3ed�. OL1 $•114•ZL4CC. PROSPERITYBANX 0,4CA_ OY S. 0"1.'I-" C-r— ELECTRONIC TRANSFERS FOR OPERATING ACCOUNT ESTIMATED ACHS Data D..Sr;ptiqn APPROVED ON 8/20/2024 WESFILE TAX PYMT DO AUG 19 2024 Salei Tax \\ �j CAL9+oUF1FtOi`'uA{YEi'IXAS Andrew Oe Las Santos MemaNal MedlWl Center , I •.: U n 0n 0 Amount 2,208.23 �r i,Ztl8.33 ✓ 9011 1 U"U]I 90333 1 ^ N ) q (I .. it 901 1013 9013 '013 � 9013 9019 5006 1, 901133 9 9013 lA 9013 9013 9013 V n,r, 9013 9013 ] I- ,�rpporr. l� :pF yp OnC Date/Time 08-06.2024110:41 AM Submitted By cclevenger256 Pay Date 07-31-2024 Employee Deposits $75,679.18 Employer Contributions $108,869.68 Group Term Life Premiums $0.00 Total $184,548.86 Comments Payroll Flle July 2024 Retirement Upload.xisx CLC5E M141' COMPTROLLERJEXAS.GOV ^ Beck Sales and Use Tax Taxpayer: , MEMORIAL MEDICAL CENTER Address: 815 N VIRGINIA ST, PORT LAVACA TX 77979.3025 Tax Type: Sales and Use Tax Return Summary Original Return for Period Ending 07/31/2024 (2407) Total Amount Due and Payable may not reflect all payments or discounts. Please allow pending payments 3-5 business days to process and appear on this page. CREDITSTAKEN Credits Taken Are you taking credit to reduce taxes due on this return? Licensed Customs Broker Exported Sales Did you refund sales tax for this filing period on items exported outside the United States based on a Texas Licenced Customs Broker Export Certifications? LOCATION SUMMARY Lot# Total Texas Sales Taxable Sales 00004 26,901 26,901 SubTotal 26,901 26,9D3 Total Tax for Locations Taxable Subject to State Purchases Tax lRate.06251 0 26,901 0 26,901 Total Tax Due: Balance Due: Pending Payments: No No State Tax Due Subjectto Local Tax Rate Local Tax Due Locat Tax 1,681.31 26,901 0.02000 538.02 1,68131 26,901 538.02 $2,219.33 $2,219.33 $2,219.34 $2,208.23 RECEIVED BYT14 COUNTY AAU91TOM SN MEMORIAL MEDICAL CENTER 08/15/2024 0 13:15 AUG 15 2fv); AP Open Invoice List ap_open_involce.template Due Dates Through: 09/07/2024 Vendor#) Vendor 'tWOUN COUNTY, TRXA@ Class Pay Code J 11816 ASHFORD GARDENS Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 081324 08/14/20208/13/20209/07/202 8,495.73 0.00 0.00 8,495.73 �0G �rPP \ v U / J Vendor Totals: Number Name Gross Discount No -Pay Net 11818 ASHFORD GARDENS 8,495.73 0.00 0.00 8,495.73 RepoaI Sunimary Grand Totals: Gross Discount No -Pay Net 8,495.73 0.00 0.00 8,495.73 APPROVED ON AUG 15 2024 CALHOUN �OUNTY�ITIRAS RECEIVED BY THE COUNTY AUDITOR ON MEMORIAL MEDICAL CENTER 08/15/2024 0 13:16 AUG 15 ({v i AP Open Invoice List ap_open_Invoice.template Due Dates Through: 09/07/2024 Vendor# Vendor Nat�fl-,-�N�,{}��y Class Pay Code 11828 J SOLERA WEASLTFiHOUSTON ` / Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 081324 Discount No -Pay Net 08114/20208/13/20209/07/202 2,624.83 0.00 0.00 2,624.83 \P o lR 1t/ ulV A / Vendor Totals: Number Name Gross Discount No -Pay Net 11828 SOLERA WEST HOUSTON 2,624.83 0.00 0.00 2,624.83 F cjml I swmuary Grand Totals: Gross Discount No -Pay Net 2,624,83 0.00 0.00 2,624.83 APPP4M ON AUG 15 2024 CSOWt C)(JNfY IiE12l • rs 0811512024 MEMORIAL MEDICAL CENTER 13:16 AUG 15 2014. AP Open Invoice List Due Dates Through: 09/07/2024 Vendor? ndor NamGALHOUtNGDIA W,.TEZIW Class Pay Code 11820 FORTBEND HEALTHCARE CENTER Invoice# Comment Tran Dt Inv Di Due Or Check Dt Pa1 J 081324 08/14/202 08113/202 09/07/202 UV� r`i'Svr�e �Wf Vendor Totals: Number Name 11820 FORTBEND HEALTHCARE CENTER RepOr Gununary Grand Totals: Gross Discount APPAOVM. ON 2,655.10 0.00 AUG 15 202.4 CALHO t5u &I MIT? VkS 0 ap_open_invoice.template Gross Discount No -Pay 2,655.10 0.00 0.00 lAiross Discount No -Pay 2,655.10 0.00 0.00 No -Pay Net 0.00 2,655.10 Net 2.655.10� Net 2,655.10 RECEIVED BY THE 08/15/2024 COUNTY AUDITOR ON MEMORIAL MEDICAL CENTER 13:16 AUG 16 ZGL� AP Open Invoice List Due Dates Through: 09/07/2024 0 ap_openJnvolce.template Vendor# /Vendor Name i�.� �.7fy1�1 fry�y�1/ 7 y q Class Pay Code 11832 �/ BROADMOOFi7�9M?W u1C"IC7E PARK Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay 081324 08114/20208/13/20209107/202 3,332,79 0.00 0.00 U�10 �� Y � -�VY�� qb Lt-i Vendor Totals: Number Name Gross Discount No -Pay 11832 BROADMOOR AT CREEKSIDE PARK 3,332.79 0.00 0.00 Report Summery Grand Totals: APPROVED ON Gross Discount No -Pay Net 3,332.79 0.00 0.00 3,332.79 AUG 16 2024 CALNOMO 1NTY, I TE7(As Net 3,332.79 J Net V 3,3$2.79 Reoffm By coAlR�t 't QNI 08/1512024 MEDICAL CENTER AUGMEMORIAL r�U15 2o�a AP Open Invoice List 0 13:20 ap_open_invoice.template Due Dates Through: 09l07/2024 Vendor# Vendor NemaCAt-p CGy3 ", Class Pay Code J 11824 J THE CRESCENT / Invoice# Comment Tran Dt Inv Dt 081324 08/14/202 Due Dt Check Ct Pay Gross Discount No -Pay Net J 08/13/202 09/07/202 2,280.03 0.00 0.00 2,280.03 U"U la � u� 1 � vne,' nJI ✓, Vendor Totals: Number Name Gross Discount No -Pay Net 11824 THE CRESCENT 2,280.03 0.00 0.00 2,280.03 I4epmt 9tit,1111,11y Grand Totals: Gross Discount No -Pay Net APPROVED ON 2,280.03 0,00 0.00 2,280.03 A�UUGN15 2200274pq g CALNOUNDGpUNTV, ITEXAS RECEIIMEiDfiA171 M COUNWAIM-31TWON MEMORIAL MEDICAL CENTER 08/15/2024 0 A 13:17 AUG 1, 5 2024 AP Open Invoice List Due Dates Through: 09/07/2024 ap_open_invoice.tempiate Vendor# )Vendor Namt�oUN COUNTY, TEXAS Class Pay Code 11838 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / 080224 08114/20208/02/20209/07/202 7,752.00 0.00 0.00 7,752.00 1f\� :ipnw. wn�o Mrnu o 0,� \ (- 081324 r r 08/14/202 08/13/20209/07/202 4,001.73 0.00 0.00 4,001.73 WU W-1 Vendor Totals: Number Name Gross Discount No -Pay Net 11836 GOLDENCREEK HEALTHCARE 11,753.73 0.00 0.00 11,753.73 rtep3 rt Summary Grand Totals: Gross Discount No -Pay Net 11,753.73 0.00 0.00 11,753.73 APPROVED ON AUG 15 2024 CALHOU1d COUNTY, 9XAS AECOVEDDYTM 08/16/2024 COUNTY ADDI 111 ON MEMORIAL MEDICAL CENTER 0 13:18 AUG 15 20, 24 AP Open Invoice List ap_open_invoice.template Due Dates Through: 09/07/2024 Vendor#/ Vendor Nam MAEM Class Pay Code VILLAGE N�dWItlR 13004 J TUSCANY Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net J080524 08/14/202 08/05/202 09/07/202 21652,00 0.00 0.00 2,652.00 J 080224 08/14/202 08/05/202 09/071202 9,779.56 0.00 0.00 9,779.55 J 1 . %, J081324 08/14/202 08/131202 09/071202 3,603.40 0.00 0.00 3,603.40 UM(_) QT �)v u ti l -�vOb m-4 Vendor Totals: Number Name Gross Discount No -Pay Net 13004 TUSCANY VILLAGE 16,034.95 0.00 0,00 16,034.95 Ri pm SIumillary Grand Totals: Gross Discount No -Pay Net APPAW0 ON 16,034.95 0100 0,00 16,034.95 AUG g �N1fiy6d22[�24 p CALNOUtJ Gdl1NTY,IT�ifAS RECEIVEDDYTHE 08/15/2024 COUNTYAU01TWON MEMORIAL MEDICAL CENTER 13:17 AUG 1'�� AP Open Invoice List Due Dates Through: 09/07/2024 Vendor# ardor Nam�ee,,�A1'� Class Pay Code 12792 GETHANYSENI�"TEXAS Invoice# 080224 Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 08114/20208/02/20209/07/202 51,928.70 Discount 0.00 \ M - M - t, \on mmu 0x i(A.kn i 080224A 08/14/20208102120209/07/202 8,919.61 0.00 / 091324 3,746.19 0.00 J `10`811/4120(20�81133//200220`9/07/202 y� U',,,,k�1-'1 Vendor Totals: Number Name �" Gross Discount 12792 BETHANY SENIOR LIVING 64,592.50 0.00 AC..port Summary Grand Totals: Gross Discount No -Pay 64,592.50 0.00 0.00 APPROVED ON g AUG 15 1 5p2024 CALH0iMbUN1"7, IWKAS 0 ap_open_invoice.template No -Pay Net / 0.00 51,926.70 ✓% 0.00 8,919.61 " 0.00 3,746.19 f No -Pay Net 0.00 64,592.50 Net 64,592.50 M.Madalm0. 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Mp. W WWI I,W397 ]0,6)97 VIEWS [ H,A4AMryJ)M1 IW.94 wilco. MAXAO(N(OXt1P1a W141L1 - I»50 3A.30 VI4/lmtwlq[pUIGXYRNfILT"THW[C[M[NUI EC V141"H4'flU{ri13PWH&71N1�B1ftlN5�llW(N1L1, 9940U y �n�ay� •-. 'lIT3[114/ O ,/ / / .'.N325;1/': e,.9�2UD3O/::...'7r41C2(1✓ VUIµlI HHO-tCMO NCCUIMVMf lIK0µt3 Nf4013M9] - 9US iB 0I4IM24 NOMRN fOWNON HIMIMPMIN)611061tap118 C.I.A. , 8,O92Efi NITROµ UIK COMMVRI« At MCWMVMT]4mµ1191OY1] 19551. - 16.353.i3 NµoNNROMMUN11Y Il N(tWMPMi>e{mµ1191IXW 13,31),5111 ]9.913.51 NU/TOMQZ4 NO/U4301000N N((UIMIMI6Y6f104(IMlle - 13,3927, - .391,17 Vl]I10141UMPNPINS[OI4CUIMIMTSH)13614flalSl» - 95,N 3 � 39500 %t NWMb NIIMAMA INf fOfCMIMIMT5495Mf 810CM311f 435, it - VISO NOW, NUMBNM1(IUOIIBN(MIMPMTSI»4µ4mm10 21]5as , 311AO 1113I4l4 NMBPU N«UIMPMIS411I964INV11U759914 MAN80[AIIOHl1111a MNS IMN)1 14»U ] - / ,9W,W J ),9W.0IVEIN V 1/O/MLI NOVIr4 WtUfl(INNI(WMIMTB)61Ip41WC01M J y(i).W $M3, 09 283) 9,W4AB _ 99.5]0,08./ µ5J11l.U,/ 3.b14.f� p9Y.R6 J uftm A <a9LMJ 6.5949R / Ill Bµ TWAIE MLWA1 795.IWS5 241LA6 7.574.71 32.I0411.74 N9nm Sgµ6µ ]FgµA3 Balances Overview Account Name *4367 MEMORIAL MEDICAL- $2,190,486.94 $2,187,851.08 $2,190A86.94 $2,320,449.15 OPERATING *4366 MMC - CLINIC SERIES 2014 $545.91 $545.91 $545.91 $545,91 *4373 MMC -PRIVATE WAIVER WAIVER CLEARING $439.48 $439.48 $439.48 $439.48 *4381 MEMORIAL MEDICALINH $225,119.86 $352,072,24 $225,119.86 $221,646.02 ASHFORD *4403 MEMORIAL MEDICAL INH $164,703.83/ j $242,001.25 $164,703.83 $154,418,83 BROADMOOR *4411 MEMORIAL MEDICAL I NH / $234,633.73 { $259,082.73 $234,633.73 $250,366.21 CRESCENT ✓ *4438 MEMORIAL MEDICAL I SOLERA / J @ j $135,218.86/ $159,439.24 $136.218.86 $115,014.89 WEST HOUSTON V *4446 MEMORIAL / MEDICAL I NH FORT $36,674.99 J $36,674.99 $36,674,99 $36,674.99 BEND *4454 MEMORIAL MEDICAL INH GOLDEN CREEK $70,163.10 $73,598.72 $70,163.10 $47,966.14 HEALTHCARE *4651 CAL CO INDIGENT $10,352.73 $10,352.73 $10,352.73 $10,352.73 HEALTHCARE *5433 MMC -NH GULF POINTEPLAZA- $2,197.00 $2.197.00 $2,197.00 $1,703,68 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA- $6,115.91 $5,115.91 $5,115.91 $100,00 MEDICAREIMEDICAID *5506 MMC -NH BETHANY SENIOR $39,478.08 $57,294.50 $39,478.08 $14,631.21 LIVING *3407MMC -NH $148,443,01 $148.443.01 $148,443.01 $107,936.84 TUSCANY VILLAGE *3660 MMC -BETHANY $100.00 $100.00 $100.00 $100.00 SR LIVING - DACA MMC -MONEY $5,038.90 $5,038.90 $5,038.90 $5,038.90 MAR MARKET FUND Total Balance $3,268,712.33 $3,540,247.69 $3,268,712.33 $3,287,384.98 Report generated on OW 912024 07:57:23 AM CDT Page 2 of 2 Memorial Medical Center Nursing Home UPL Weekly NeNion Transfer Prosperity Accounts 8/19/2024 Fumunt Bglnnlnp .endlna TadaY.acShvnina Amav mBe Tnndened t. Nunlna NUMn Nome Numbee Mils. TMnNervOul Tranaler-In 0epWip Balanm Xpma/ 06 119,217.10 338,965.19 69.911.19 - 70.163.10 �1Y 09,OB0.97 Bank Balance 70,169.10 Vadame APPROVED ON leave In Balan<e t00.00 AUG 1 9 2024 9uperidrluna ]O e3p 69✓ IulYlnle¢,t 161.91 eeurin.InhrmaYwnlOrGaiden C k: Qygv �p �%NTY I`j�ITl,(y�G�� Aa6lnlerat Nalun Hmith ar Golden CIIA jjj CALHOUN ROLIIVIT, I IS 9Fp11ntereH W14 Fop. Bank N.A ABIm]BalanroRen,fer Nnt d9AB0.91 J N.N: OnNbab.. aj.Yer$S 0w w01 be n.m/ened to thenugg9 home. Natel: Each a,ccun,he, a bogie bubo,ra/SIOOtba,MMCdepodted,aayenamount. A..r.ved:' f iV AiLl,+-i..�lY..V.' drex Oa Co, Santo, 8/19/30M I:\xN Wea4lyinn,lenlNN Ua tlmder SummNYl]BN\NXU.Liramlel5ummary 9.19.A mmc wnnax CIPP/Comya L n11l1.eVl��uwtv�gl G1PP/Gmpl {11PP/CeTp$ QIPP/(pT 9 6.4011 GIPPn NHwRppN al5lali! Gm zxo IIIim✓ / / 01NIILxtlACH isrsttwnn6nGm'a0 iW04iY13f0900 p: Satlt9,t6 Y"Y,6W1: a+ P1414, .. ,f0i16.6l slIs e[vml6mfH6t69V 91 f9x69 S7&6R 51060 0/IL/30N WIRE ItUt H[IIIOM Nmllll{N/�0010tXG[[k NL I11.061.99 6/xlAztl R310 At01NCCUIMPML 15P.91SM SI W USIOR, 5•](y1G 5,EW M 6111/W1.=01"'ImP4i M(RCWP 132015WICIXO191, 023.00 - 3,213.00 6IIl1IDttl 19Y1I1MHSIImtG Ce 03P m mis,m3691391 2179961 V80,61 RII])mal tmf/ '01RU1G1G01P mt169999Rf01P91 1133410 1.336J0 ; ilm1A 1UMIXU9 HUlKOI Imnn MR liA1166f89ffl9 &SAIM 6,86110 al11mpGOIOLN1R111Upli MHIC 01P MOM 910OW13N Will.. SIXUTox x[[WMPMRt509, z.lM 1,pld / 1,m0pr 1190906 7,"027 01111201< Mn 11nI1XMPLYMlNry1911Y10)O9EWtM6 v 17%0M - 1730010 110,969.19 6991419 10.6N.9E 4,4tl24 30.010.63.f 19.060.9,/ Balances Overview Account Name •4357 MEMORIAL MEDICAL- $2,190,486.94 $2,187,851.08 $2,190,486.94 $2,320,449,15 OPERATING MMC •CLINIC SERI SERIES $545.91 $545.91 $545.91 $545.91 '4373 MMC - PRIVATE WAIVER CLEARING $439.48 $439.48 $439.48 $439.46 '4381 MEMORIAL MEDICAL/NH $225,119.86 $352,072,24 $225,119.86 $221,646.02 ASHFORD '4403 MEMORIAL MEDICAL/NH $164,703.83 $242,001.25 $164.703.83 $154,418.83 BROADMOOR '4411 MEMORIAL MEDICAL / NH $234,633.73 $259,082.73 $234,633.73 $250,366.21 CRESCENT '4438 MEMORIAL MEDICAL / SOLERA ( $135,218.86 $159,439.24 $135,218.86 $115,014.89 WEST HOUSTON '4446 MEMORIAL MEDICAL / NH FORT $36,674.99 $36,674.99 $36,674.99 $36,674.99 BEND '4454 MEMORIAL MEDICAL/NH GOLDEN CREEK $70,163.10 J $73;598.72 $70,163.10 $47,966.14 HEALTHCARE `4661 CAL CO INDIGENT $10,352.73 $10.352.73 $10,352.73 $10,352.73 HEALTHCARE '5433 MMC -NH GULF POINTEPLAZA- $2,197.00 $2,197.00 $2,197.00 $1,703.68 PRIVATE PAY '5441 MMC -NH GULF POINTEPLAZA- $5,115.91 $5,115.91 $6,115.91 $100.00 MEDICARE/MEDICAID '5506 MMC -NH BETHANY SENIOR $39,478.08 $57,294.50 $39,478.08 $14,631,21 LIVING *3407 MMC -NH TUSCANY VILLAGE $148,443.01 $148,443.01 $148,443.01 $107,936.84 •3660MMC -BETHANY $100.00 $100.00 $100.00 $100.00 SR LIVING - DACA *2998 MMC -MONEY $5,038.90 $5,038.90 $5,038.90 $5,038.90 MARKET FUND MAR Total Balance $3,268,712.33 $3,540,247.69 $3,268,712.33 $3,287,384.98 Report generated on 08119/2024 07:57;23 AM CDT Page 2 of 2 Memorial Metllcal [enter Nursing Home UPL Weekly HMG Transfer Prosperity gttaunt9 / 8/19/2074 J J ./ / rnxrw J nnw.Ml99e [wn9 b91nNry r,'ZZ mnn. xxpme x�men Be m[ fnn. eror /mMl r. n / m.• I u / Hunl M sa5].BI sas>al 9,m>m fo9xm e4Msfer bnX GNn[e f, 19].m VarYn[e Iee.e rn arms tm.m JJ r / adlune.a .Rnnnaam[ fm]m rnN. J ✓/nnllemtlta IIe Be An—M !<i1mINav ren61N NuMNHpne /Numbr bon f /T d Xanlp llome R�. 49.Uv0 .9J]eO d p01991 ,% 5,139.91 B,e6,91 f bn9 bYnee 5.11991 VNivnee Ierveln B.hn[e lm.m APPROVED ON Rdlex breMettnMbr tlmr s,a19.91 Xamnpnrernnanro•4wlPo.nbann rt AUG 192024 iOMl Tl1Nl9[R9 fdl].91 / NOrI: Pnlydvlanr<I vfoWrS{KOrw94l VvnlRfndto M[nunmph CA&Y0%UTU %%S Nd<): fe[a ettOVnrhaf a9nr[M:orueaj5lmrlglMM(drannNl re wren ve[oun[. ��cY�/r�)( Ate.' lL J' �lr'�1•�t m� � nndr'n dtefyMar B/lB/8011 L W x wnxV ingtN nN H V p IuaXer wmmmbJAtnN un inn tIM Lmmery B9 U< PANIC PO0.TION gIPP/Comp QIPP/WmP4 _ TM.O mf4Iut Tr4nzler•In gIPP/Comp] 1 QIP%C0mp3 BbPle QIPPTI NN PORTION 8/16/2024 HNB-ECHO HCCIAIMPMT)460034111 OM20IS96 140.51 340.51 RAN2024 NNO- ECHO HCCIAIMPMT 146003411440=700918 J/ 02111 - 153.01 8/14/2024 WIRE OUT HMG R04kpol3 SNP, LP-Commodal 5,153.A1 ✓ - 9/13/20]4 HNe- ECHO HCCIAIMPMT 046003411440M28028 1,020.00 / - 11020,00 51131ZD24 HNB- ECHO HCCIAIMPMT 746003411440000286928 - / 3A680 18 OD 8/1212024 HN8-ECHO HCCL4IMPMT 046003411440W226990 J J 306.88 - ]961R 5A57.01. 2.091.00 / 1,097.00,/ MMC PORTION gIPP/Camp QIPP/COmP4 4a0zferOul J Te4Rsfer.IP 1 QIPO/Compl ] QIPP/Camp➢ &upze QiPpm NA PORTION 8/16/1024 MERCNANTBANRCO DEPO511 NW2051066993W001 / S.01S91 - 5,01591 Q14/2024 WIPE OUT HMG P44kPatl 5Np, LPCommeEol 45,170011/ - - 45.170.87 5.015.91 / 5.015.91 SOA18.68 71I12,91 iliL/ Balances Overview Account Name •4357 MEMORIAL MEDICAL- $2,190,486.94 $2.187.851.08 $2,190,486.94 $2,320,449,15 OPERATING *4366 MMC - CLINIC SERIES 2014 $545.91 $545.91 $545.91 $545.91 *4373 MMC •PRIVATE WAIVER CLEARING $439.48 $439.48 $439.48 $439.48 •4381 MEMORIAL MEDICAL/NH $225,119.86 $352,072.24 $225,119.86 $221,646.02 ASHFORD '4403 MEMORIAL MEDICAL/NH $164,703.83 $242,001.25 $164,703.83 $154,418.83 BROADMOOR 04411 MEMORIAL MEDICAL / NH $234,633.73 $259,082.73 $234,633.73 $250,366.21 CRESCENT *4438 MEMORIAL MEDICAL/SOLERA@ $135,218.86 $159,439.24 $135,218.86 $115,014.89 WEST HOUSTON *4440 MEMORIAL MEDICAL! NH FORT $36,674.99 $36,674.99 $36,674,99 $36,674.99 BEND •4454 MEMORIAL MEDICAL/NH GOLDEN CREEK $70,163.10 $73,598.72 $70,163.10 $47,966.14 HEALTHCARE `4551 CAL CO INDIGENT $10,352.73 $10,352.73 $10,352.73 $10,352.73 HEALTHCARE `5433 MMC NH GULF POINTEPLAZA ✓ - ✓ $2,197.00 $2,197,00 $2,197.00 $1,703.68 PRIVATE PAY •5441 MMC •NH GULF POINTEPLAZA- z $5,115.91 / ��/ $5,115.91 $5,115.91 $100.00 MEDICAREIMEDICAID *5606 MMC -NH BETHANY SENIOR $39,478.08 $57,294.50 $39,478.08 $14,631.21 LIVING TUSC NYVILL TU5CANY VILLAGE $148,443.01 $148,443.01 $148,443.01 $107,936.84 SR'36LIVING - DACA MMC •BETHANY SR LIVING $100.00 $100,00 $100.00 $100.00 *2998 MMC -MONEY MARKET FUND MAR $5,038.90 $5.038.90 $5,038,90 $5,038.90 Total Balance $3,268,712.33 $3,640,247.69 $3,268,712.33 $3,287,384.98 Report generated on 08/19/2024 07:5723 AM CDT Page 2 of 2 Memorial Medical [enter Nursing Home VPk Weekly Tuscany Transfer Prosperity A[eounts / 8/1912024 J 1j WM^nV. .f /Amuue„u 9. mount I eea me vmdme �/ T—I lw 'V ^�N,ugra Nem. ui��r. :LLIDf % eWno- IM791A3 TYmhnoul /T... r L Id.EYN 11).69IAI IidlY 01 od M NdM I.flY)% 139.333.)3 ✓ BYk9nYt! IA3.Y9% V.rl.nY teweln9.l.nt! 100m Molln.lune.pl.nd YSGd19 Ire"m✓ APPROVED ON AUG 19 2024 AdNn,..11ln Yn.mrA, 3a" / Ne(<'OnrybINonrYo/ovYdiaa9w; 16t4anyrvr.dtod)nurrin9Abnt {pg+Y/� f�nI A 'T1�n AIII..d:1 B� Nere};)ndxmwlAa.abnrbNnnee ofSlltl;nal MMClroeuredrvPoY 9[mGAALHp C�� ICA✓15• 4ndmx P.IW S.me. 9/19N0!! MMC PORTION QIPP/ComP QIPP/Comp QIPP/Comp Transfer.O0L Transkr-In 3 QIPP/COmp2 3 4&1bps4 QIPPTI NH PORTION 6/16/2024 Deposit 57.97 57,57 1/16/2024 Olpolit - ;3,395.64 - 33,395.64 8/16/2024 HNe- ECHO HCCLAIMPMT 746003411440000201596 7,052.96 7,052.96 8/15/2024 HNS-ECHO HCODUMPMT 74SM3411440000261924 10403.90 - 10,40390 8/15/2024 HN6- ECHO HCCUIIMPMT 746M3411440006262;02 - 1912175 19,121.75 8/15/2024 NOV4A55OLU11ON HCCIAIMPMT 67620142=0159 - / 1SM 37 1,906.37 8/14/2024 WIRE OUT VILME POST ACUTE HEALTH SERVICE 127,691A2 I/ 8/i4j2024:NOIINAf♦EAL'NkAp MONNMCNd130B93391Wp01@, _ '" "§,Id1.1i �.6�76L35 �% I,99;:Oo,� '39L.88:t/10,19LB1f �i33,61i�Y8� �6;73i":43-,✓ 9/1212024 HN6-ECHO HCOAIMPMT 74600341144000P226740 3.475.27 / - 3,475.27 011212024 NOVITAS SOLUTION HCOAIMPMT 67620141p 183 - 53,677-- ✓ 53,677.34 12].691AZ Z/148,343.01. /6,782.35 1,965.00 35198 10,132.8E 13,D17.28 135325.73� Balances Overview Account Name *4357 MEMORIAL MEDICAL- $2.190,486.94 $2,187.851,08 $2,190,486.94 $2,320,449.15 OPERATING MMC •CLINIC SERIES 2014 SERIES $545.91 $545,91 $545.91 $545.91 *4373 MMC -PRIVATE WAIVER WAIVER CLEARING $439.48 $439.48 $439.48 $439.48 •4381 MEMORIAL MEDICAL INH $225,119.86 $352,072.24 $225,119.86 $221,646.02 ASHFORD *4403 MEMORIAL MEDICAL/NH $164,703.83 $242,001.26 $164,703.83 $154,418.83 BROADMOOR *4411 MEMORIAL MEDICAL/NH $234,633.73 $259,082.73 $234,633.73 $250,366.21 CRESCENT `4438 MEMORIAL MEDICAL ISOLERAQ $136,218.86 $159,439,24 $135,218.86 $115,014,89 WEST HOUSTON `4446 MEMORIAL MEDICAL I NH FORT $36,674,99 $36,674.99 $36,674.99 $36,674.99 BEND `4454 MEMORIAL MEDICAL GOLDEN CREEK GOLDE $70,163.10 $73,598.72 $70,163.10 $47,966.14 HEALTHCARE `4551 CAL CO INDIGENT $10,352.73 $10,352.73 $10,352.73 $10,352.73 HEALTHCARE •5433 MMC -NH GULF POINTEPLAZA- $2,197.00 $2,197.00 $2,197.00 $1.703.68 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA • $5,115.91 $5,115.91 $5,116.91 $100.00 MEDICARE/MEDICAID `5506 MMC -NH BETHANY SENIOR $39,478.08 $57,294.50 $39,478.08 $14,631.21 LIVING MMCNH TLLAGE / USCANV VILLAGE USC✓ / $148,443,01✓ $148,443.01 $148,443.01 $107,936.84 Sasso MMC-BETHANv SR LIVING • DACA $100.00 $100.00 $100,00 $100.00 *2998 MMC -MONEY MARKEiFUND MAR $5,038.90 $5,038.90 $5,038.90 $5,038.90 Total Balance $3,268,712.33 $3,540,247.69 $3,268,712.33 $3,287,384.98 Report generated on 08/1912024 07!5723 AM CDT Page 2 of Memorial Medical Conte, Nursing Home UPL Weekly HSLTransfer Prosperity Accounts 8/19/1024 p,Mpp. J N., J.ma.alpaanm3. J A.mpe a.51..1v / rp.alux n.Jia xuNryxeme NumMr L• /T.ollda/ N / 35.1d.J0 35..a5.lA✓ 39]59.a3 .� 39.A>BOB lT.$9$.i6 4nY 6Jl,nt. 19.J100B VwlJpte L<min Bxame IW.W Sppxwtuoe 31.36)OB J AUG 19 2024 NmJ: mlrem=w..NpJ.,stmoJ.�nee ve,,.)nJ<eJ..nr.wJmpne,�.. CAIHb�)IV C(JUNTI! (Tf<JiA'v` xws:ae<nw.a..enpJpxxrrele.a e)SsmmprA+titcepeuxelp epro wswm 1 W"...l 31035 Rp lnl..: SepJlmom AEjun Nlmainne ,Aml ]Y995.Y6✓, 1 A.prp..e:�:53 tcer J'-�Jy,1�bhX(j �n � AneewPo. w.s.nJw gvpazA I {NnweANirurten\xx 011-01 W—IVONMx'n'...n""' r 39A T[Rp�2919Y1 Vf4}m1lGntmelMnusmeAWmp UfSQ13f00p614 bV/N}I NOf%<[Op90UtNpII+nW�Ni lllV}65mf6911 4d/1nA WINEONPoR WVI4NN, ltC ]5.49.4 V11/20]I NIILNIYAS SOtM Mt NLVLN[[WMVMi I)pKUN1I30161 VVV 1}/20$INMON N[LW MEM}6}YlII3WJOIY MMCPORTION JLNi4LI9 9pP/Wmpl 9EP/COmp} APP/bmp9 Q1pP/fnmp44ptt QIPP TI PoRTON .kMNA} jZ Sfi9liAi NAMS.. iiq.06 : 3A9w l 1.Yva9 2.E<Y 68 I.IY 9l 10,6%96 2d65.S1 mM.96 Balances Overview Account Name *4357 MEMORIAL MEDICAL- $2,190,486.94 $2,187,851.08 $2,190,486.94 $2,320,449.15 OPERATING *4365 •CLINIC SERI20 SERIES 2014 $545.91 $545.91 $545.91 $546.91 *4373 MMC •PRIVATE WAIVER WAIVER CLEARING $439.48 $439.48 $439.48 $439.48 *4381 MEMORIAL MEDICAL/NH $225,119.86 $352,072.24 $225,119.86 $221,646.02 ASHFORD *4403 MEMORIAL MEDICAL/NH $164,703.83 $242,001.25 $164.703.83 $154,418.83 BROADMOOR *4411 MEMORIAL MEDICAL/NH $234,633.73 $259,082.73 $234,633.73 $250,366.21 CRESCENT *4438 MEMORIAL MEDICAL /SOLERA $135,218.86. $159,439.24 $135,218.86 $115,014.89 WEST HOUSTON *4446 MEMORIAL MEDICAL / NH FORT $36,674.99 $36,674.99 $36,674.99 $36,674.99 BEND *4464 MEMORIAL MEDICAL/ GOLDEN CREEK $70,163.10 $73,598.72 $70,163.10 $47,966.14 HEALTHCARE '4551 CAL CO INDIGENT $10,352.73 $10,352.73 $10,352.73 $10,352.73 HEALTHCARE *6433 MMC -NH GULF POINTEPLAZA- $2,197.00 $2.197.00 $2,197.00 $1,70168 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA- $5,115.91 $6,115,91 $6,115.91 $100.00 MEDICARE/MEDICAID *5506 MMC -NH BETHANY SENIOR ✓ ` $39,478.08,/ $57,294.50 $39,478.08 $14,631.21 LIVING *3407 MMC -NH TUSC TUSCANY VILLAGE $148,443.01 $148,443.01 $148,443.01 $107,936.84 *3680 SRLIVI -BETHANY SR LIVINGG • DACA $100.00 $100.00 $100.00 $100.00 RK MMC -MONEY MARKET FUND MA $5,038.90 $5.038.90 $5,038.90 $5,038.90 Total Balance $3,268,712.33 $3,540,247.69 $3,268,712.33 $3,287,384.98 Report generated on 0811912024 07:57:23 AM COT Page 2 of 2 MEMORIAL MEDICAL CENTER CHECK REQUEST p Memorial Medical Center Date Requested: 8/19/2024 A Y ARPROVED ON E AUG 19 2024 E CALHOt WRNMAS J AMOUNT: $ 22,306.04 EXPLANATION: Molina QIPP June, Q3 & Y5 Adj 3 FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: ;w4, r 8 ( i`1 (-20-Zkf P A Y E E ✓✓ MEMORIAL MEDICAL CENTER CHECK REQUEST Memorial Medical Center Date Requested: 8/19/2024 �104 1 1 41 AUG 19 2024 CAUdOCUNUC YINTY,ITENAS AMOUNT: $ 8,309.82 Z EXPLANATION: Molina QIPP June, Q3 & YS Ad) 3 / FOR ACCT USE ONLY ❑ Imprest Cash ❑ Alp Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: 11h�AVCc;o+`I"++�f' v116C�. c6,(ig(zc2-y P A Y E E J MEMORIAL MEDICAL CENTER CHECK REQUEST Memorial Medical Center Date Requested: 8/19/2024 ENNENNMe a e AUG 19 2024 CA Hf7' CSU��ITE�iAB J AMOUNT: $ 6,118.20/ EXPLANATION: Molina QIPP June, Q3 & Y5 Adj 3 ✓ FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept GA NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: c?)l�y 120zc� P A Y E E AMOUNT: MEMORIAL MEDICAL CENTER CHECK REQUEST Memorial Medical Center Date Requested: 8/19/2024 �e e nllr q 9 20?4 CAL 0%L,*U1d'6y, mt s J $ 6,908.22 EXPLANATION: Molina QIPP June, Q3 & Y5 Adj 3 l FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: P,l+cilzoz� MEMORIAL MEDICAL CENTER CHECK REQUEST P Memorial Medical Center Date Requested: 8/19/2024 A Y ArPro ON E AUG 11�yy92200p2��4aa E GABL 1041NUOUtlT`iliEA3 J AMOUNT: $ 6,594.84/ EXPLANATION: Molina QIPP June, Q3 & YS Adj 3 FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: C J MEMORIAL MEDICAL CENTER CHECK REQUEST P Memorial Medical Center Date Requested: 8/19/2024 A Y b ON E gg AU��GNN1ryry9 2uu02774��qq E CALH0W3NUCt)UNTY�IT&S AMOUNT: EXPLANATION: J S 20,830.62Z SuperiorJunej FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 J REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: �1 MEMORIAL MEDICAL CENTER P Memorial Medical Center A CHECK REQUEST Date Requested: Y PROVED ON E AUG N1 9 22002T4 R E CABHOUNOCOUNTV. IT�XAS J AMOUNT: $ 21,263.06 EXPLANATION: Superior June J 8/19/2024 FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept G/L NUMBER: 10255040 REQUESTED BY: Caltlin Clevenger � B AUTHORIZED BY:� LM P-�il9(2C2'- r MEMORIAL MEDICAL CENTER CHECK REQUEST P Memorial Medical Center Date Requested: 8/19/2024 A Y APPROM ON E AUG 19 2024 E C4 LH61WGOUNA lEM J AMOUNT: $ 13,017.28 EXPLANATION: Molina QIPP June, Q3 & Y5 Adj 3 FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept GA NUMBER: 10255040 REQUESTED BY: Caitlin Clevenger AUTHORIZED 8n} h ,{, �i„ ji �' yyh,�;{ Q 1�31 tl= 12c z.Y OIPP PM15 i0 MMC 8.19.21 QIPP Payment to MMC from Nursing Facilities Cme:Ne<ie..... tm.n ah4nme. NN NemeClklN CkI Pe e< GIN "MaM.lunW welcome, H011dnk. T(TT& ams Ashfordrle MMc•Pros nil seNt 10255010 22106.01 21,306.040r.rdme0rrit Crmm�t. Bo.dfi: Soler.rltV G.Iden O,ckre Birthsrit TUIIaese MMfiPre[Pnll 0 mus MMGPI.. edl irises MM6Pms nil 0 <mlin MMGRet m11 0 e<alln MMGPrav etl 0 4Miln MMGPrav ern 0 <ratln MMC �Pres eN 0 <radn 10E55040 9309.8E 102SMO 6118.20 4120.20 /21/E021Pon 10255010 10265040 10255010 10255010 20255W0 6909.PL 6 08.2E it 2024 6594.N4 65918 8/21/20}1 1.830.62 30,830.E N 2V}02n 21,V63.06 31263.0E /2V2024 13017.iH 13pV.}N J2U2024 TNaI: 63,2HA0 9I,093.6N 103,313.0E Approved: ANDREW DE LOS SANTOS V19/iot4 I NOTICE OF MEETING - 8/21/2024 SUPPLEMENTAL AGENDA The subject matter of such meeting is as follows: 20. Consider and take necessary action to approve the proposal with CFI Mechanical, Inc. to repair one chiller at the Calhoun County Courthouse for the amount of $35,250.00. (RHM) RESULT: APPROVED [UNANIM.OUS] MOVER: Vern Lyssy, Commissioner Pct 2 SECONDER: David Hall, Commissioner'Pct I AYES: Judge Meyer, Commissioner Hall, Lyssy, Behrens, Reese Page 17 of 17 To: Attn: CFI MECHANICAL9 INC. www.cfimechanical.com 6109 Brittmoore • Houston, TX 77041 P: (832) 467-8200 • F: (832) 467-8203 Calhoun County Date: 8-14-24 211 S Ann Street Port Lavaca, TX 77979 Proposal: 2024-3MS Everett Wood Location: Courthouse Job: Replace 3 condenser coils for chiller #2. Carrier 30RBF1106 Serial # 2018Q87669 CFI Mechanical, Inc. ("CFI") proposes to install and/or furnish the following described materiaVlabor for the above Project in accordance with the terms and conditions on the reverse side of this Service Proposal Fonn (this "Proposal"). Purchaser's execution and return of this Proposal, or Purchaser's written or verbal direction to CFI to proceed, or Purchaser's acceptance of any such material or labor furnished by CFI Mechanical, Inc., whichever occurs first, shall constitute Purchaser's agreement to and acceptance of this Proposal and the terms and conditions on the reverse side of this Proposal ("Terms"). CHOICE PARTNERS # 22-049MF05 Scope of work: Shut down and LOTO chiller #2. Disassemble condenser coil bank for circuit A and remove the leaking coils. Install 3 new OEM micro -channel E-coated condenser coils with new piping flanges and new seals. Replace the liquid line drier core and leak check the circuit. Pull a vacuum to 29" and charge the circuit with refrigerant. Start the chiller and complete a log sheet. Includes: 1. 3 new OEM micro -channel E-coated coils with new flanges and seals. 2. New drier core. 3. Nitrogen and trace gas. 4. New R-410a refrigerant charge for circuit A. 5. All work is priced for straight time hours. Price: $35,250.00 Includes Choice Partners Cooperative and is tax exempt. Does not include P&P bond (This Proposal, including any pricing contained in the Proposal, will only be valid for 15 days) Exclusions: Overtime Labor; Sales Tax, Electrical, Roofing, Cutting, Patching, Painting, Ceiling Work, Asbestos Abatement, Hazardous Material Removal/Disposal, Publicly Transmitted Illnesses Volatility, and any other services, materials, labor or work not expressly outlined in the Scope of Work set forth above. This Proposal does not include responsibility for the design of the systems, obsolescence, safety test, removal and reinstallation of valve bodies and dampers, repair or replacement necessitated by freezing weather, electrical power failure, low voltage, burned -out main or branch fuses, low water pressure, vandalism, misuse or abuse of the system(s), negligence of others (including Purchaser), failure of Purchaser to properly operate the system(s), requirements of governmental, regulatory or insurance agencies, or other causes beyond control of Seller. THIS ABOVE PROPOSAL AND TERMS ARE ACCEPTED: CALHOUN COUNTY ("Purcha ) r BY: TITLE: 'S-L 4, DATE: 2 ( ._ °h V CFI MECHANICAL. INC. ("Seller") BY: 914att Solomon TITLE: Account Manager DATE: 8-14-24 TX License # TACLA A016286C - Regulated by the 7)(Dept of License & Registration, P.O. Box 12157, Austin, TX 78711, 1-800-803-9202 7X License # MPL 40777-Regulated by TX Dept. of License & Registration, P.O. Box 4200 Austin, Texas 78765-4200 • CFI MECHANICAL9 INC. wvvw.cfiimechanical.com 6109 Brittmoore • Houston, TX 77041 P: (832) 467-8200 • F: (832) 467-8203 The price(s) shown above in the Scope of Work is due to CFI in full, lawful money of the United States of America within 15 days after date of invoice. Purchaser shall pay interest on any late payment from the date due until the date paid at the rate of 6% per annum, or the maximum rate allowed by law, whichever is less. Any attention to, or deviation from this Proposal involving extra work, cost of materials or labor will become an extra charge (fixed price amount to be negotiated or on a time and material basis at Seller's rates then in effect) over the sum stated in this Proposal. No additional work or repairs shall be required to be performed by Seller without a separate written agreement between Purchaser and Seller describing in detail the scope and costs of the work to be performed which is signed by both parties. TERMS AND CONDITIONS The acceptance of this Proposal is expressly limited to the following terms and conditions (the "Terms"). No attempted acceptance which varies or adds to the Tens shall be effective and any such counterproposal are hereby deemed rejected. Seller shall not be bound by terms additional to or different from those contained in these Tens unless such terms are expressly agreed to in writing and signed by Seller. These Terms represents the entire agreement between the parties and supersedes any prior or contemporaneous written or oral agreements, representations, or warranties. Purchaser shall provide Seller with timely access to areas and FROM AND AGAINST ALL CLAIMS, DAMAGES, LOSSES AND equipment and a safe environment in which to perform the Work, which EXPENSES, INCLUDING BUT NOT LIMITED TO ATTORNEYS'FEES, shall be performed during normal working hours of Seller. Purchaser ARISING OUT OF OR RESULTING FROM THE PERFORMANCE OF represents that it is not aware of any asbestos -containing or other WORK HEREUNDER, PROVIDED THAT SUCH CLAIM, DAMAGE, hazardous materials at the Project, Seller has no responsibility or LOSS OR EXPENSE IS CAUSED IN WHOLE OR IN PART BY AN liability for the investigation, detection, testing, removal, remediation ACTIVE OR PASSIVE ACT OR OMISSION OF PURCHASER, and/or encapsulation of any and all asbestos -containing or other ANYONE DIRECTLY OR INDIRECTLY EMPLOYED BY PURCHASER, hazardous materials at the site of the Project., Any investigation, OR ANYONE FOR WHOSE ACTS PURCHASE MAY BE LIABLE, detection, testing, removal, remediation and/or encapsulation of any REGARDLESS OF WHETHER IT IS CAUSED IN PART BY THE and all asbestos -containing or other hazardous material will be the NEGLIGENCE OF SELLER. responsibility of and at the expense of Purchaser, the Owneror others, 5. NOTWITHSTANDING ANYTHING TO THE CONTRARY, SELLER'S If Seller encounters any material believed to be asbestos -containing or TOTAL LIABILITY FOR WORK UNDER THE PROPOSAL OR FOR ANY other hazardous material, Seller may stop all work in the affected area OTHER WORK PROVIDED TO PURCHASER BY SELLER SHALL BE until Purchaser notifies Seller in writing that it is safe to proceed. Seller LIMITED TO AND SHALL NEVER EXCEED THE AMOUNT PAID TO shall have no responsibility or liability arising out of or related to, and SELLER UNDER THIS AGREEMENT. PURCHASER HEREBY WANES AND RELEASES ANY CLAIMS 6. If by any act or omission on Purchasers part or any act beyond the OR CAUSES OF ACTION FOR, THE PRESENCE, GROWTH OR reasonable control of Seller, the Sellers performance is delayed for a DEVELOPMENT OF MOLD OR MILDEW AT THE PROJECT, OR period of90 days or more, Seller shall have the option of terminating the FOR THE REMEDIATION OF ANY SUCH MOLD OR MILDEW, OR Work, and in case of such termination after Seller has partially performed ANY COSTS,EXPENSES, DAMAGES, OR LIABILITIES RELATED the Work, Purchaser agrees to pay Seller the portion of the total contract THERETO, EVEN IF SUCH MOLD OR MILDEW IS CAUSED IN price alhibutable to the Work installed, ordered or delivered as of the data WHOLE OR IN PART BY ANY DEFECTIVE LABOR OR MATERIAL of temtination, as well as any and all costs of tennination, including but FURNISHED HEREUNDER OR ANY BREACH OF THIS not limited to costs oftemiinating subcontracts or purchase orders, costs AGREEMENT. of work -in -progress, and costs of demobilization, and any and all delay Any Work found to be defective for a period of ninety (90) days from the damages incurred by Seller. date the material is installed or the Work is completed, shall at Sellers 7. Purchaser shall be responsible for securing the Work from loss and option, be repaired or replaced and such repair or replacement shall be protecting from damage and shall bear the dsk of loss with respect to all Purchasers sole and exclusive remedy. This warranty does not cover material installed and all material delivered to the Project. damage or defects caused by normal wear and tear, improper use or Notwithstanding the foregoing, the title to all material shall remain in the maintenance of the material by Purchaser, accident, fire, flood, natural Seller until payment in full is made by Purchaser. Purchaser shall insure disaster, act of vandalism or temodsm, or other causes beyond Sellers such materials against loss or damage in amount and manner sufficient reasonable control. This warranty does notcover replacementofbelts or to protect the interest of the Seller, and Seller shall be named as an filter maintenance. SELLER HEREBY EXPRESSLY DISCLAIMS ANY additional insured under such insurance. AND ALL IMPLIED OR STATUTORY WARRANTIES, INCLUDING 8. It is agreed the Seller reserves a contractual lien and security interest in BUT NOT LIMITED TO ANY WARRANTY OF MERCHANTABILITY all materfal furnished hereunder until the entire prtce to be paid and all OR FITNESS FOR INTENDED USE. othersums due Sellerhave been fully paid. Pumhasershall execute such Purchaser and Seller hereby waive any and all claims for incidental, financing statements or other documents requested by Seller as indirect, special, consequential, punitive or exemplary damages against necessary to perfect Sellers security interest. In the event of default in the other party, arising out of or related to the Work hereunder or any the making of any such payment, or in the event Purchaser becomes breach of the Tens hereof. The Seller will not be liable for any delays, insolvent, makes an assignmentfor the benefitofcreditors Orin the event costs, loss ordamages caused by or any delays due to fire, strikes, labor that a proceeding in bankmptcy or insolvency be instituted against troubles, governmental regulations (including orders, recommendations Purchaser, or voluntarily by Purchaser, Men at Sellers option, Seller, its or guidelines), the elements, virus, epidemic pandemic (including the agents, successors and assigns may, without notice or demand, resell Novel Comnavims), transportation delays, or any other causes beyond the materfal or any part thereof at either public or private sale. If the its reasonable control. unpaid balance due Seller under this agreement, including any interest TO THE FULLEST EXTENT PERMITTED BY LAW, PURCHASER due and damages resulting from Purchasers default, including any SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS SELLER, ITS affomeys' fees incurred and the expenses of resale, are not satisfied by AGENTS AND EMPLOYEES (EACH AN 'INDEMNIFIED PARTY-) proceeds of the sale, Purchaser agrees promptly to pay such deficiency. 7X License # TACLA A016286C- Regulated by the TX Dept of License & Registration, P.O. Box 12157, Austin, TX 78711, 1-800-803-9202 7X License # MPL 40777-Regulated by TX Dept. of License & Registration, P.O. Box 4200 Austin, Texas 78765-4200 CFI MECHANICAL, INC. www.cfimechanical.com If there is a surplus from the proceeds of the sale after the payment of the above items, it shall be paid to Purchaser. 9. In the event of any default by Seller, Purchaser shall give Seller written notice of default, and shall give Seller five (5) days from the date of Sellers receipt of such notice to cure or commence and diligently pursue cure of such default. 10. The rights, duties and obligations of the parties hereunder shall be governed and construed in accordance with the laws of the State of Texas, excluding any conflicts or laws or rules which would refer its interpretation to the laws of another jurisdiction. 11. At Seller's option, all claims, disputes, and other matters in question arising out of or relating to this Agreement, or the breach thereof, may be decided by arbitration, which shall be conducted in accordance with the Construction Industry Arbitration Rules of the American Arbitration Association then in effect, with a single arbitrator under regular track procedures unless otherwise elected by Seller. All arbitration proceedings or other legal proceedings will be in Houston, Texas. This agreement to arbitrate shall be specifically enforceable. It is agreed that the Work performed, and labor and/or materials furnished pursuant to this Agreement affects and involves interstate commerce. Any legal action against the Seller relating, or the breach of these Terms, shall be commenced within one (1) year from the date of the completion of the Work. The award rendered by the arbitrators shall be final and judgment may be entered upon it in accordance with the applicable law in the court having jurisdiction thereof. 6109 Brittmoore • Houston, TX 77041 P: (832) 467-8200 • F: (832) 467-8203 TX License #TACLAA016286C - Regulated by the TX Dept ofL1cense 8 Registration, P.O. Box 12157, Austin, 7X78711, 1-800-B03-9202 TX License # MPL 40777- Regulated by TX Dept. of License 8 Registration, P.O. Box 4200 Austin, Texas 78765-4200 CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested patties. 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. 2024-1202313 CFI Mechanical, Inc. Houston, TX United States Date Filed: 08/19/2024 Name of governmental entity or state agency that is a party tot 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 2024-3MS Replace 3 condenser coils for chiller 2 4 Name of Interested Parry City, State, Country (place of business) Nature of interest (check applicable( Controlling I Intermediary 5 Check only it there is NO Interested Party. X 6 LINSWORN DECLARATION My name is Roy Clzmar and my date of birth is _— My address is , _. _, —= J (street) (city) (state) (zip rode) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Harris County, State of TeXas , on the 19 day of August . 20 24 (month) (year) Signa6jj-e.of authorized agent of contrng business entity . (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V4.1.0.48da51f7