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2024-11-20 Final PacketNOTICE OF MEETING -.. 11/20/2024 November 20, 2024 MEETING MINUTES OF CALHOUN COUNTY COMMISSIONERS' COURT MET IN A REGULAR MEETING AT 10:00 A.M. IN THE COMMISSIONERS, COURTROOM IN THE COUNTY COURTHOUSE AT 211 S. ANN STREET SUITE 104 PORT LAVACA, CALHOUN COUNTY, TEXAS. THE FOLLOWING MEMBERS WERE PRESENT: t Richard Meyer David Hall (Judge Pro Tem)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 Commissioner Vern Lyssy. 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Joel Behrens 4. General Discussion of Public Matters and Public Participation. Commissioner Vern Lyssy read Judge Richard Meyer's funeral arrangements. Steve Marwitz, Russell Cain, Jack Wu, Erin Clevenger, Candice Villarreal, Jonas Titus and Christian with Congressman Cloud's office gave their condolences to Judge Meyer's family and said a few words remembering Judge Meyer. Page 1 of 4 NOTICE OF MEET ING -- 11/20/2024 5. Approve November 13, 2024 Commissioners' Court Meeting Minutes. (RHM) SECONDER: David Hall, Commissioner P, AYES: Commissioner Hall, Lyssy, ;F 6. Consider and take necessary action to approve a Proclamation declaring November, 2024 as National Hospice and Palliative Care Month in Calhoun County. (RHM) pass 7. Consider and take necessary action on the Release of Retainage, Payment application No 15 - Final in the amount of $52,221.83 to BLS Construction, for the Calhoun County Combined Dispatch Facility. (DEH) Scott Mason explained the Release of Retainage RESULT: APPROVED [UNANIMOUS] MOVER:: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Commissioner Hall, Lyssy, Reese 8. Consider and take necessary action to approve MOU between Calhoun County ISD and Calhoun County in reference to Truancy stipend for JP 1 Clerk in the amount of $7,000.00 for the period of January 1, 2025 through December 31, 2025 with the option to extended the agreement for three (3) annual renewals and authorize all appropriate signatures. (DEH) RESULT: APPROVED, [UNANIMOUS] MOVER: David Hall, Commissioner Pct. SECONDER: Gary Reese, Commissioner Pct 4 AYES: Commissioner Hall, Lyssy, Reese 9. Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of $75.00. (RHM) RESULT. APPROVED [UNANIMOUS] MOVER:.. Gary Reese, Commissioner Pct,4 SECONDER: David Hall, Commissioner Pct I` AYES: ' Commissioner Hall, Lyssy, Reese Page 2 of 4 NOTICE OF MEETING—11/20/2024 10. Consider and take necessary action to reschedule the Wednesday, December 26, 2024 Regular Commissioners Court Meeting to Monday, December 30, 2024 and cancel the January 1, 2025 Regular Commissioners Court meeting, due to the Christmas and New Year Holiday schedule. (RHM) to strike through the word cancel, as the court will be sworn in January 1, 2025 iULT: APPROVED [UNANIMOUS] VER: David Hall, Commissioner Pct 1 ONDER: Joel Behrens, Commissioner Pct 3 S: commissioner Hall, Lyssy, Reese 11. Accept Monthly Reports from the following County Offices: a) Justice of the Peace Pct 2 — October, 2024 RESULT: APPROVED [UNANIMOUS] MOVER: JoelBehrens,' Commissioner Pct 3 SECONDER: Gary Reese„Commissioner Pct 4 AYES:' Commissioner Hall, Lyssy, Reese, 12. 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: Commissioner Hall, Lyssy, Reese Page 3 of 4 NO ICE OF MEETING—1-1/20/2024 13. Approval of bills and Davroll. (RHM) MMC Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Commissioner Hall, Lyssy, Reese Indigent Healthcare: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct4 AYES: Commissioner Hall, Lyssy, Reese County Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct•4 AYES: - Commissioner Hall, Lyssy, Reese Page 4 of 4 All Agenda Items Properly Numbered. Contracts Completed and Signed All 1295's Flagged for Acceptance (number of 1295's _) i 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 Ve/YIY/X�^ 2024, the packet forthe ao dayof IU(��/f�,d�CY1�l 2024Commissioners' Court Regular. Session was submitted from the Calhoun County Judge's office to the Calhoun County Clerk's Office. -L u Calhoun Countyjudge/Assistant mFri ki iki-C NOTICE OF MEETING -- 11/20/2024 Richard H. Meyer County judge David Hall, Commissioner, Precinct 1 Vern Lyssy, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING The Commissioners' Court of Calhoun County, Texas wdl meet on Wednesday, November 20, 2024 at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 104, Port Lavaca, Calhoun County, Texas. AGENDA The subject matter of such meeting is as follows: 1. Call meeting to order. 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation. LLLATGELD O'CO.CCKM NOV 14 2024 C®UNQCERIfwNCAI.NOUN AUNTY, TE7(g5 5. Approve November 13, 2024 Commissioners' Court Meeting Minutes. (RHM) 6. Consider and take necessary action to approve a Proclamation declaring November, 2024 as National Hospice and Palliative Care Month in Calhoun County. (RHM) Consider and take necessary action on the Release of Retainage, Payment application No 15 - Final in the amount of $52,221.83 to BLS Construction, for the Calhoun County Combined Dispatch Facility. (DEH) 8. Consider and take necessary action to approve MOU between Calhoun County ISD and Calhoun County in reference to Truancy stipend for JP 1 Clerk in the amount of $7,000.00 for the period of January 1, 2025 through December 31, 2025 with the option to extended the agreement for three (3) annual renewals and authorize all appropriate signatures. (DEH) 9. Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of $75.00. (RHM) Page 1 of 2 NO FICE OF MFF ING — 11/20/2024 10. Consider and take necessary action to reschedule the Wednesday, December 2024 Regular Commissioners Court Meeting to Monday, December 30, 2024 and c9neel"the January 1, 2025 Regular Commissioners Court meeting, due to the Christmas and New Year Holiday schedule. (RHM) 11. Accept Monthly Reports from the following County Offices: a) Justice of the Peace Pct 2 — October, 2024 12. Consider and take necessary action on any necessary budget adjustments. (RHM) 13. Approval of bills and payroll. (RHM) Richard H. Meyer, County dge Calhoun County, Texas A copy of this Notice has been placed on the inside bulletin board of the Calhoun County Courthouse, 211 South Ann Street, Port Lavaca, Texas, which is readily accessible to the general public during regular business hours. This Notice shall remain posted continuously for at least 72 hours preceding the scheduled meeting time. For your convenience, you may visit the county's website at www.calhouncotx.org under "Commissioners' Court Agenda" for any official court postings. Page 2 of 2 # 04 NOTICE OF MEETING—1.1/20/2024 November 20, 2024 MEETING MINUTES OF CALHOUN COUNTY COMMISSIONERS' COURT MET IN A REGULAR MEETING AT 10:00 A.M. IN THE COMMISSIONERS' COURTROOM IN THE COUNTY COURTHOUSE AT 211 S. ANN STREET SUITE 104 PORT LAVACA, CALHOUN COUNTY, TEXAS. THE FOLLOWING MEMBERS WERE PRESENT: t Richard Meyer David Hall (Judge Pro Tem)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 Commissioner Vern Lyssy. 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Joel Behrens 4. General Discussion of Public Matters and Public Participation. Commissioner Vern Lyssy read Judge Richard Meyer's funeral arrangements. Steve Marwitz, Russell Cain, Jack Wu, Erin Clevenger, Candice Villarreal, Jonas Titus and Christian with Congressman Cloud's office gave their condolences to Judge Meyer's family and said a few words remembering Judge Meyer. Page 1 of 10 Calhoun County Commissioners Court Public Participation Form NOTE: This Public Participation Form must be presented to the County Clerk or Deputy Clerk prior to the time the agenda item (or items) you wish to address are discussed before the Court. Instructions: Fill out all appropriate blanks. Pleas rprint or write legibly. NAME: ADDRESS: TELEPHONE: PLACE OF EMPLOYMENT: EMPLOYMENT TELEPHONE:] 1�'r� Do you represent any particular group or organization? YES P 0 (Circle one) If you do represent a group or organization, please provide the name, address and telephone number of the group or organization: i Which agenda item (or items) do you wish to address? _ " d.i-J r In general, are you for or against the agenda item (or items)? I hereby swear that any statement 1 make will be the truth, and nothing but the truth, to the best of my knowledge and ability. Signature: Calhoun County Commissioners Court Public Participation Form NOTE: This Public Participation Form must be presented to the County Clerk or Deputy Clerk prior to the time the agenda item (or items) you wish to address are discussed before the Court. Instructions: Fill o I appropriate blllan�k Please print or write legibly. ADDRESS: TELEPHON PLACE OF E EMPLOYMENT TELEPHONE: Do you represent any particular group or organization? YES NO (Circle one) If you do represent a group or organization, please provide the name, address and telephone number of the roup or org ni tion: Which agenda item (or items) do you wish to address? In general, are you for or against the agenda item (or items)? I hereby swear that any statement 1 make will be the truth, and nothing but the truth, to the Signature: GOVERNOR GREG ABBOTT November 19, 2024 The Honorable David Hall County Commissioner, Precinct No. 1 Calhoun County 211 S. Ann Street, Suite 301 Port Lavaca, Texas 77979 Dear Commissioner Hall: In response to your request and pursuant to Chapter 3100 of the Texas Government Code and Title 4 of the U.S. Code §7, flags of the State of Texas and the United States of America in Calhoun County may be lowered to half-staff immediately in honor of the life and public service of Calhoun County Judge Richard Meyer, who passed away while in office. Flags should return to full -staff at sunset on the day of his memorial service or interment once it is set by his family. Individuals, businesses, municipalities, counties, and other political subdivisions and entities in the surrounding area may fly flags at half-staff during the same period as a sign of honor and respect. The First Lady and I extend our prayers of comfort for the family during their time of grief and urge all Texans to honor the service of Judge Meyer to his community and the State of Texas. Respectfully, zol Greg Abbott Governor AC:gsd POST OFFICE BOX 12428 AosTIN, TEXAS 78711512-463-2000 (VOICE) DIAL 7-1-1 FOR RELAY SERVICES # 05 NOTICE OF MEETING - 11/20/2024 5. Approve November 13, 2024 Commissioners' Court Meeting Minutes. (RHM) "RESULT: APPROVED [UNANIMOUS] ; MOVER: Gary Reese, Commissioner Oct SECONDER: David Hall, Commissioner Pct 1. AYES: Commissioner Hall, Lyssy, Reese Page 2 of 10 NOTICE OF MELTING — 11/13/2024 Richard H. 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, November 13, 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 N ey r, agunty Judge Calhoun County, Texas Anna Goodman, County Clerk Page 1 of 1 NOTICE OF MEETING—1.1/13/2024 November 13, 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 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. Bill Putnam expressed his concerns with electronic voting machines. Shannon Parker with TDEM explained future grant opportunities and FEMA grant increase for future disasters. Page 1 of 5 NOTICE Of- MEETING—11/13/2024 5. Approve November 6, 2024 Commissioners' Court Meeting Minutes. (RHM) RESULT.,". APPROVED [UNANIMOUS] `. MOVER Vern Lyssy, Commissioner. Pct 2: SECONDER: Gary Reese;; Commissioner. pct4 AYES; Judge Meyer,:Commissioner Hall, Lyssy,Behrens.'Reese 6. Consider and take necessary action to award qualified bidder on Bid No. 2024.09 - Calhoun County Bill Sanders Park - Swan Point Bulkhead & Pier Construction. (GDR) 7. Consider and take necessary action to authorize utilization of $139,700 of GOMESA funds for the Matagorda. Bay Mitigation Trust - Swan Point Bulkhead/Pier Project, Contract No. 034, due to Increase of material costs. (GDR) RESULT• APPROVED'[UNANIMOUS] ? MOVER: David Hall, Commissioner Pct 1: SECONDER. ;; Gary Reese, Commissioner Pct.4 AYES: ." ]udge Meyer;; Commissioner Hall, Lyssy,;,Behre* Reese. 8. Consider and take necessary action to authorize the use of Jail Telephone Commissioned Funds for the purchase to update the jail body camera system software with server. (RHM) table 9. Consider and take necessary action to authorize all four Road & Bridge precincts to apply for credit with Holt Truck Centers. (GDR) RESULT. APPROVED [UNANIMOUS] MOVER: Joel'Behrens, Commissioner Oct 3 SECONDED:'.. Gary Reeser Commissioner Pct 4 AYES: " Judge Meyer, Canmissioner Hall,"Lyssy;:Behrens; Reese Page 2 of 5 NOTICE OF MEETING—11/13/2024 10. Consider and take necessary action to award the bids for Insecticides for Mosquito Control, Bid Number 2025.01, for the period January 1, 2025 through December 31, 2025. (RHM) Cy au; �yssy, oenre 11. Consider and take necessary action to award the bids for Road Materials, Bid Number 2025.02, for the period January 1, 2025 through December 31, 2025. (RHM) 12. Consider and take necessary action to award the bids for Asphalts, Oils & Emulsions, Bid Number 2025.03, for the period January 1, 2025 through December 31, 2025. (RHM) Page 3 of 5 NOTICE OF MEETING—11/13/2024 13. Consider and take necessary action to award the qualified bidder for Bid Number 2024.10 — Annex Building Roof Improvements Project for Calhoun County, Texas. (RHM) 14. Consider and take necessary action to award the Request for Qualifications for Engineering, Architectural and Surveying Services for the CMP Cycle 29 Grant, GLO Contract No. 25-003- 009-E702 — New Amenities at Bill Sanders County Park, RFQ 2024.11. (RHM) Commissioner Reese recommended awarding the RFQ to Urban EngineePing..: RESU,LT:. APPROVED.. [UNANIMOUS} MOVER: Joel Behrens, Commissioner'Pct 3 - SEC01140111 . _ Gary Reeser Commissioner Pct 4 AYES: Judge Meyer, Commissioner;Hall, Lyssy, BehrensrReese 15. Consider and take necessary action to issue a County credit card to EMS Assistant Director Clint Macek with a credit limit of $5,000. (RHM) RESULT APPROVED[UNANIMOUS] MOVER. David Hall, Comriiissigner . ct 1 SECONDER: Veal Lyssy, Commissioner -Oct 2 AYES'; ]udge Meyer; Commissioner Hafl, Lyssy Behrens; Reese 16. Consider and take necessary action to lift or retain the county burn ban. (RHM) pass Page 4 of 5 NO I-ICF OF MEETING-11/13/2024 17. Accept Monthly Reports from the following County Offices: a) Justice of the Peace Pct 1- October, 2024 b) Justice of the Peace Pct 3 - October, 2024 c) Justice of the Peace Pct 4 - October, 2024 d) Justice of the Peace Pct 5 - October, 2024 e) County Clerk - October, 2024 f) District Clerk - October, 2024 g) County Treasurer - May and July, 2024 h) Sherlfrs Department - October, 2024 i) Floodplain Administration - October, 2024 RESULT APPROVED [UNANIMOUS] MOVER. Vern Lyssy Commissioner Pct 2- SECONDER: '• David Hall, Commissioner Pct i AYES: Judge Meyer .Commissioner Hall, Lyssy,;Behrens; :Reese 18. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT APPROVED' [UNANIMOUS] MOVER Gary Reese,. COminlssloner Pct.4 SECONDER, 7oel Behrens; Commissioner pct 3 AYES: Judge'Meypri Commissioner Hall, lyssy;: Behrens; Reese 19. Approval of bills and payroll. (RHM) MMC`Bilis:; RESULT APpROVED.[UNANIMOUS] MOVEii. David Hall, Commissioner pet 1 SECONDER: VernLyssy, Commissioner Pct.2 .. AYESE Judge Meyer;. Commissioner, all Lyssy; _Behrens, Reese County BIIIS: _ < - RESULT: APPROVED [UNANIMOUS] MOVER. David Hall, Commissioner. Pct 1 .SECONDER:_- Vern Lyssy, Comrnissiioner Pct 2 AYES:, Judge Meyer; Com'missloner Hall; Lyssy, Behrens; Reese Adjourned 10:30am Page 5 of 5 # 06 ' NOTICE OF MEETING - 1.1/2.0/2024 6. Consider and take necessary action to approve a Proclamation declaring November, 2024 as National Hospice and Palliative Care Month in Calhoun County. (RHM) pass Page 3 of 10 HOSPICE OF SOUTH TEXAJ National Hospice and Palliative Care Month - November 2024 PROCLAMATION WHEREAS, for more than 40 years, hospice has helped provide comfort and dignity to millions of people, allowing them to spend their final months at home, surrounded by the people important to them; WHEREAS, the hospice model is built on an interdisciplinary, team -oriented approach to treatment and support, including expert medical care, quality symptom control, and comprehensive pain management as a foundation of care; WHEREAS, beyond providing clinical treatment, hospice attends to the patient's emotional, spiritual and social needs, and provides family services like caregiver training, respite care, and bereavement support; WHEREAS, community -based palliative care, which delivers expertise to improve quality of life through pain and symptom control and other support, can be provided at any time during serious illness, and given that hospice organizations are some of the best providers of community -based palliative care; WHEREAS, in an increasingly fragmented and broken health care system, hospice is one of the few sectors that demonstrates how health care can - and should - work at its best for the people it serves; WHEREAS, over the course of the last two decades, we have seen increasing access of hospice care by Black and Hispanic Medicare beneficiaries, yet NHPCO recognizes that continued efforts to improve care to diverse communities is essential; WHEREAS, data shows significant changes in patient diagnoses, calling for innovation in how hospices provide care to those in need; WHEREAS, hospice and palliative care organizations are advocates and educators about advance care planning that help individuals make decisions about the care they want; NOW, THEREFORE, be it resolved that I, Richard H. Meyer, Calhoun County Judge, by virtue of the authority vested in me by Calhoun County, Texas, do hereby proclaim November, 2024 as National Hospice and Palliative Care Month and encourage all Americans to increase their knowledge about person -centered, holistic care for all individuals facing serious and life -limiting illness, discuss their health care wishes with those they care about, and mark this month with appropriate learning and sharing. Adopted the 20th day of November, 2024 Richard H. Meyer, County Judge David E. Hall Commissioner, Precinct 1 Joel M. Behrens Commissioner, Precinct 3 Attest: Anna Goodman, County Clerk By: Deputy Clerk Vern L. Lyssy Commissioner, Precinct 2 Gary D. Reese Conunissioner, Precinct 4 I NOTICE OF MEETING--11/20/2024 7. Consider and take necessary action on the Release of Retainage, Payment application No 15 - Final in the amount of $52,221.83 to BLS Construction, for the Calhoun County Combined Dispatch Facility. (DEH) Scott Mason explained the Release of Retainage RESULT: APPROVED'[UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Commissioner Hall, Lyssy, Reese Page 4 of 10 Debbie Vickery From: David.Hall@calhouncotx.org (David Hall) <David.Hall@calhouncotx.org> Sent: Wednesday, November 13, 2024 12:18 PM To: debbie.vickery@calhouncotx.org Subject: Fwd: RecPay No. 15-Final - Calhoun County Combined Dispatch Facility Sent from David's iPhone David Hall Commissioner Precinct 1 Calhoun County Office 361-552-9242 Cell 361-220-1751 Begin forwarded message: From: demi.cabrera@calhouncotx.org Date: November 13, 2024 at 12:17:29 PM CST To: david.hall@calhouncotx.org, smason@gwengineers.com Cc: gking@gwengineers.com, angela.torres@calhouncotx.org, Accounting BLS <accounting@blsconstruction.com>, William Key <wiIlia m.key@ blsconstruction.com>, candice.villarreal@calhouncotx.org, anthonyg@gwengineers.com, Accounting BLS <accounting@blsconstruction.com> Subject: RE: RecPay No. 15-Final - Calhoun County Combined Dispatch Facility David, this is what I came up with, you can change it as needed. 1. Consider and take necessary action on the Release of Retainage, Payment application No 15 - Final in the amount of $52,221.83 to BLS Construction, for the Calhoun County Combined Dispatch Facility. Thank you, From: David. Hall@calhouncotx.org (David Hall) (mailto:David.Hall@calhouncotx.org] Sent: Wednesday, November 13, 202412:09 PM To: smason@gwengineers.com Cc: gking@gwengineers.com; angela.torres@calhouncotx.org; Accounting BLS <accounting@blsconstruction.com>; William Key <william.key@blsconstruction.com>; demi.cabrera@calhouncotx.org; candice.villarreal@calhouncotx.org; anthonyg@gwengineers.com; Accounting BLS <accounting@blsconstruction.com> Subject: Re: RecPay No. 15-Final - Calhoun County Combined Dispatch Facility Hmm I thought I sent in an agenda item. Did you by chance send me the wording? I'm looking now Sent from David's iPhone David Hall Commissioner Precinct 1 Calhoun County Office 361-552-9242 Cell 361-220-1751 On Nov 13, 2024, at 11:47 AM, smason@gwengineers.com wrote: CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. David, noticed were this wasn't on the agenda today. Could we ensure it is on the agenda for November 201h please sir? Thank you, Scoff-P. MayQw, P.E. Lead Project Engineer G&W Engineers, Inc. From: gking@gwengineers.com <gking@gwengineers.com> Sent: Thursday, November 7, 2024 9:09 AM To: David.Hall@calhouncotx.org; angela.torres@calhouncotx.org Cc: 'BLS Accounting' <accounting@blsconstruction.com>; William Key <william.kev@blsconstruction.com>; demi.cabrera@calhouncotx.org; candice.villarreal@calhouncotx.org;'Scott Mason' <smason@gwengineers.com>; anthonvg@gwengineers.com Subject: RE: RecPay No. 15-Final - Calhoun County Combined Dispatch Facility Commissioner Hall, Please see attached Subcontractors Final Waivers for this project. They were over- looked and not included with the pay request. So sorry for the inconvenience. I will run them over to you in a little while. Thank you, Glynis King G&W Engineers, Inc. 205 W. Live Oak Port Lavaca, Texas 77979 361.552.4509 From: gking@gwengineers.com <gking@gwengineers.com> Sent: Wednesday, November 6, 20241:51 PM To: 'David. Ha ll@calhouncotx.org' <David.Hall@calhouncotx.org>; 'angela.torres@calhouncotx.org' <angela.torres@calhouncotx.org> Cc:'BLS Accounting' <accounting@blsconstruction.com>; William Key (william.kev@blsconstruction.com) <william.key@blsconstruction.com>; 'demi.cabrera@calhouncotx.org' <demi.cabrera@calhouncotx.org>; 'candice.villarreal@calhouncotx.org' <candice.villarreal@calhouncotx.org>;'Scott Mason' <smason@gwengineers.com>; 'anthonyg@gwengineers.com' <a nthonvg@gwengi nee rs.com> Subject: RecPay No. 15-Final - Calhoun County Combined Dispatch Facility Commissioner Hall, Attached is Recommendation for Payment No. 15-Final for the Calhoun County Combined Dispatch Facility. I will drop off the originals to you this afternoon. Also, please put on agenda for Commissioner's Court for November 13, 2024. Thank you, Glynis King G&W Engineers, Inc. 205 W. Live Oak Port Lavaca, Texas 77979 361.552.4509 Calhoun County Texas Calhoun County Texas Calhoun County Texas G&WENGINEERS, INC. �205 W. Live Oak • Port Lavaca, TX 77979 • p: (361)552-4509 • f: (361)552-4987 TBPE Firm Registration No. F04188 November 6, 2024 Commissioner David Hall Calhoun County Precinct No. I 202 S. Ann St. Port Lavaca, Texas 77979 - RE: RECOMMENDATION FOR PAYMENT NO. 15-FINAL Calhoun County Combined Dispatch Facility Dear Honorable Judge & County Commissioners, We have reviewed BLS Construction, hic.'s Application for Payment No. 15 for the above referenced project. All work is complete and enclosed is Recommendation for Payment No. 15-Final for $52,221.83. This amount is for the balance of the retainage and for services between July 25, 2024 Hnd' August 14, 2024. The Contractor's Guarantee and the Contractor's Conditional enclosed Please call if you have any questions. Sincerely, G & W Engineers, Inc. CALMason, P.E. cc: BLS Construction, Inc. Demi Cabrera, Calhoun County Assistant Auditor file 5310.020 Waiver and Release on Final Payment are Engineering Consulting Planning Surveying No. 15-Final RECOMMENDATION OF PAYMENT OWNER's Project No. ENGINEER's Project No. 5310.020 Project CALHOUN COUNTY COMBINED DISPATCH FACILITY CONTRACTOR BLS CONSTRUCTION, INC. Contract for COMBINED DISPATCH FACILITY Contract Date June 7, 2023 Application Date August 14, 2024 Application Amount $52,221.83 Period Start Date July 25, 2024 Period Ending Date August 14, 2024 To COUNTY OF CALHOUN Owner Attached hereto is the CONTRACTOR's Application for Payment for Work accomplished under the Contract through the date indicated above. To the extent that we have been present on the project site as outlined in our Engineering Agreement, we believe that the Application meets the requirements of the Contract Documents and includes the CONTRACTOWs Certificate stating that all previous payments to him under the Contract have been applied by him to discharge in full all of his obligations in connection with the Work covered by all prior Applications for Payments. In accordance with the Contract, the undersigned, subject to the limitation in the preceding paragraph, recommends payment to the CONTRACTOR of the amount due as shown below. G & W Engineers, Inc. Dated November 6 2024 B ? r/� Y� G/�� ,{ 9'. Scott P. Mason, P.E. STATEMENT OF WORK Original Contract Price $ 1,877,350.00 Work to Date $ 1,885,183.00 Net Change Orders (11) $ 11,837.30 Amount Retained $ Current Contract Price $ 1,889,187.30 Subtotal $ 1,885,183.00 Credit to Allowance not used $ 4,004.30 Previous Payments Recommended $ (1,832,961.17) Amount Due This Payment $ 52,221.83 G & W ENGINEERS, INC 205 W. Live Oak St. Port Lavaca, Texas 77979 (361)552-4509 R"Psy No. 15-Final-Calhloun Co. Combined Dispatch Facility Application and Certificate for Payment .__...._...-- .. ___..., F. 211 South Ann Street, Suite 301 .,n,nuan iomay ,urmamu mspatcu APPLICATION NO: o15 Distribution to: Facility Port Lavaca, TX. 77979 PERIOD T0: August I4, 2024 OWNER: 312 W Live Oak St FROM Port Lavaca, TX. 77979 CONTRACT FOR: General Consimction ARCHITECT: VIA ARCHITECT: CONTRACTOR: BLS CaenfleAd CONTRACT DATE: June 07, 2027 CONTRACTOR: G&W Engineers PROJECT NOS: 5310.020/887/ 207 Pahre, Streetn. Street FIELD: ❑ El Campo, TX. 77437 TX OTHER:❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made far payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been AIA Document G703* Continuation Sheol, is attached. completed in accordance with the Contract Documents, that all amounts have been paid 1. ORIGINAL CONTRACT SUM by the Contractor for Work for which previous Certificates for Payment were issued and ................................................................................ S I,877 35U.00 payments received fr r e , wn '� tint rat current payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS................................................................. S7,833.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line l x 2)................... ..,.,......_....,__................... $1,885183.00 By: Date: An h t I4 2024 4. TOTAL COMPLETED SSTORED TO DATE (Cohan. Gnn G703)................. $1,885,183.00 State of.. To., u,�lo�...nr, S. RETAINAGE: a. 0 County of: Wharton ��.�q H E R RF %of Completer) Work (Column D+E on G703) Subscribed mgJ sworn to before ( a:'ptPOY Pig `FJ' a $0.00 me this �`(' day ofhljus-27 Is 0 o of Stored Material S N = (Cohmni I'm. 0703) $0.90 Notary Public: Heather Reeo" 0 `. q F +P ' c OFI9 Total Relamin a Lines 5a+ 5b or Total in Column l of B ( ................ S0.0o My Commission expires: F'�IgOr e?' ; 9. TOTAL EARNED LESS RETAINAGE................................................................... $1,885183.00 ARCHITECT'S CERTIFICATE FOR PAYMENT'' 'iserva (Linea Less Line 5 Total) ung an In accordance with the Contract Documents, based on on -site observations and the data T. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ S 1,832,961.17 comprising this application, the Architect certifies to the Owner that to the best of the (Line 6 fnm prior Certificate) Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is 8. CURRENT PAYMENT DUE.......................................................................... $5222183 entitled to payment of the AMOUNT CERTIFIED. 9, BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNTCERTIFIED.....................................................................$52,221.83 (Line 3 less Line 6) $0.00 (Attach explanation ifanmaat cer'Itfieddi1fus Awn the amount appheA. fatial alingmrs na(iii., APPIicaNm, and tat the Cost! an.,, Street thol as'e changed to cos fors, with the amount certrfred.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: [Total changes approved in previous months by Owner $12,187.30 S4,354.30 Total approved this Month $0.00 $0.00 TOTALS $12,187.39 S4,354.30 NET CHANGL•Sby ChaneOrder $7,833.00 It... Noses: Data. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to tiny rights of the Owner or ConVxctor under this Contract. 3 and 1992. All rights reaerveE. 9ho AnnIcan lasglut. of Amason This document was produced at 09.45:01 ET on 0/11412024 andai ie AIA Contract oacumentO To. al Service. To .pit copyright ' the AIA Logo. and "AIA 111112024, I. not far.... I., n. (3B9ADA4B) � � 1 • I rJ �yl� Continuation Sheet Application and Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION DATE: August 14, 2024 containing Contractor's signed certification is attached. PERIOD T0: Use Column I on Contracts where variable retainaee fnr Iinp itprwc mw a 1" An ust 14 2024 A B >C I U.U2U C D E I F G H I WORK COMPLETED ITEM DESCRIPTION OF SCHEDULED MATERIALS PRESENTLY TOTAL COMPLETED AND / BALANCE TO RETAMAGE FROM NO. WORK VALUE PREVIOUS APPLICATION THIS PERIOD STORED STOREDTODATF. (C-C) FINISH (IF VARIABLE D+E (NOT IN D OR E) (D+E+F) (C -G) RATE) 1 hrsumnce/Bonds 67300.00 67300.00 0.00 0,01 67,300.00 100.00% 0.00 0,00 6,730.00 2 Dnm ster, Port -a -can 10,500.00 10500.00 0.00 0.00 I0500:00 , 10000%4 . 0,00 ,73 3 General Conditions 57,020.78 57,020.78 0.00 0.00 57020.78 100.00°/p 0.00 5,702.08 Allowances 4 Construction 35,000.00 35,000.00 0.00 0.00 35,000.00 100.00% 0.00 3.500.00 Allowances Interior 5 Room 5,000.00 5,000.0 0.00 0.00 51000.00 100.00%p 0.00 500.00 6 Excavation/Dirlwork 158341.69 158,341.69 0.00 '00 158.341.69 100.00./ 0.00 15834.17 7 Ulilities Civil 9.200.00 9200.00 0.00 0.00 9,20U.00 100.00% 0,00 920.W 8 Concrete Foundation 102.00 195.702.00 ODD 0.00 195702.00 100.00% 0.00 19570.2U 9 Concrete Pavia 20220200.00 20,200.00 0.00 0.00 20200.00 100.00% 0.00 2020.00 Framing Materials/Labor, Metal 10 Studs Plywood 130390.44 130390.44 0.00 0.00 130390.44 100.00%1 0.06 13.039.04 II FRP Shectrock 27004.04 27,004.04 0.an ODD 27,004.04 100.00% 0.00 2700.40 12 Painting,17603.47 17603.47 0.00 0.00 17,603.47 100.00% 0.00 1760.35 13 Structural 28,596.97 28,596.97 0.00 0.00 28596.97 100.00% 0.00 2,959.70 teili Slnwhnal Steel & 14 Erection 161,536.00 161536.00 0.00 0.00 161,536.00 100.00% 0.00 16153.60 15 TPO Roof & Blocking90 371.00 90 371.00 0.00 TOO 90 371.00 100.00% 0.00 9 037.10 Doors/Door 16 Frames/Hardware 47,435.00 47435.00 0.00 0.00 47,435.00 100.00% 0.00 4743.50 17 Overhead Doors 12,295.00 12,295.00 0.00 0.00 12 295,00 100.00% 0.00 1 229.50 18 Cabinetr/Milhvoik 21 OOD.00 21,000.0 0.00 0.00 21,000.001 100.00% 0.do 2 100.00 19 Mason 62,880.00 62,880.00 0.00 0.00 62880.00 100.00% O.OU 6288.00 20 Dam 1'oofin 8 000.00 8 000.00 0.00 0.00 8,000.00 I00.00°/p 0.00 800.00 21 Smcco 13948.00 13,948.00 0.00 0.00 t3948.00 100.00°/a 0.00 1,394.80 �•pma... rasa.moa,saou,laar,no.vartl,'gas end 1992. All rights massed. 'Thm American Inellule of lvchllecls;''American Institute of Aholdt.le;'AK.' the AIA With. red 'AIA Conlrecl0acuman(s' are Iratlema4s of The American Inalilule of Architects. This d-coraml wee pmduoed at 09.42:12 ET on 0&14/2024 antler Order No.2114450280 which mplrsa on 1lit 112M4, Is out far resale. O licensed for on"ime use only, and may only be used In aomrdance Man the AIA contract Documents°Terms of SeMce. To mpwt c Veer Notes: opyrhht violations, email doGnfo@alaconlmc6.com. (3NADMO) A B C D E F G H I WORK COMPLETED ITEM DESCRIPTIONOF SCHEDULED MATERIALS PRESENTLY TOTAL COMPLETED AND BALANCE TO RETAMAGE FROM NO. WORK VALUE PREVIOUS APPLICATION THIS PERIOD I STORED STORED TO DATE (G+C) FINISH (IF VARIABLE D+EI (NOT IN D OR E) (D+E+F) (C-G) RATE) 22 113lectrical 169392.00 169,392.00 0.00 0.00 169,392.00 100.00% 0.00 16939.20 23 Phnnbin Sewer 67,783.90 67 783.90 0.00 0.00 67 783.90 100.00% 0.00 6,778.39 24 Plumbing Water 33,386.10 33,386.10 0.00 0.00 33 386.10 100.00% 0.00 3,338.61 25 MechanicaVHVAC 209357.00 209.357.00 0.00 0.001 209,357.00 100.00% 0.00 20935.70 26 Flooring 5044.82 59,144.82 0.00 0.001 59,144.82 100.00% 0,00 5.914.48 27 Blinds 1281.79 1,281.79 0.00 0.00 1,281.79 100.00% 0.00 128.18 28 Plague with install 1000,00 1,000.00 0.06 0.00 11000.00 100.00% 0.00 100.00 29 Fire Extin uishem 3.770.00 3 770.00 0.00 0.00 3,770.00 100.00% 0.00 377.00 Toilet Partitions & 30 Accessories --10 390 00 10 390.00 0.00 0.00 10390.00 100.00% 0.00 1,039.00 31 Glass Storefront 38,500.00 38,500.00 0.00 0.00 38,500.00 100.00% 0.00 3,950.00 32 Striving 4,550.00 4,550.00 0.00 0.00 4,550.0D 100.00% 0.00 455.00 33 Sodding 3,100.00 3100.00 0.00 0.00 3100.00 luu.ou% 0.00 310.00 34 Clean tip 2,500.00 2,500.0 0.00 0.00 21500.00 100.00% 0.00 250.00 35 Overhead 93 870.00 93,870.00 0.00 0.00 93.870.00 100.00% 0.00 9 387.00 36 CO#1 Sidewalks 11 150.00 11 150.00 0.00 0.00 11150.00 100.00% 0.00 1,115.00 COIk2 Change Toilet 37 Partitions to SS 1037.3D 1,037.30 0.00 0.00 1.,037.30 100.00% 0.00 103.73 CO#3 Credit for 38 2 Tiees on Contract -350.00 -350.00 0.00 0.00 -350.00 100.00% 0.00 -35.00 Credit for Allowance 39 not used -4 004.30 .4,004.30 0.00 0.00 -4 004.30 100.00% 0.00 -400.43 GRANGTOTAL $I A85183.00 $1885183.00 $0.00 $0.00 $1885,183.00 100.00% $0.00 $188518.30 wyagnow IcbJ, IWOO. IWOO. IWU(.19 , lute, 1983 and 1992. At rights d oods' era trademarks of The Amedcan InstiWie of Architects. This document was or for One-time use only, and may only 8e Weed In aecm bdro. Math the AIACwlrmd Ooc (309AUMD) CONTRACTOR's CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT THE STATE OF TEXA § COUNTY OF § Project: CALHOUN COUNTY COMBINED DISPATCH FACILITY. Job No. 5310,020 On receipt by the signer of this document of a check from CALHOUN COUNTY (maker of check) in the sutra of $52, Z2-1 , 5?3 payable to —BLS C.Okj� IC--Boh II hL (payee or payees of check) and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position that the signer has on the property or easements of CALHOUN COUNTY (owner) located at 312 W. Live Oak Street, Port Lavaca, Texas (location) to the following extent: CALHOUN COUNTY COMBINED DISPATCH FACILITY. (job clescriptign). This release covers the final payment to the signer for all labor, services, equipment, or materials furnished to the property or to CALHOUN COUNTY (person with whon2 signer contracted). Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the fiords received from this final payment to promptly pay in frill all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project up to the date of this waiver and release. 017000-3 Signed By: Print Nanie Title: R SUBSCRIBED AND SWORN TO BEFORE ME, by Wit(i6Lm 4� , on -NAN14 14 , 202q to certify which witness my hand and seal of office. � i `auuuunn„� ER RFC"',� P = z = Notary Public, State o['Texas yrFOF A .: My Commission Expires: . G%73200 ry0 . F O 017000-4 SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor') represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier'), in the amount of $ 870.00 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 7nzn023 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined DIspalch Facility Job#887 (the "Project") owned by Calhoun County, Port Lavaca, TX. _ (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid in hill all its subcontractors, vendors, suppliers„ materialmen, laborers, or other persons or entitles providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all flen claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien In connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities Furnishing services, labor, or materials in connection with the Contract. S. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: 09/18/2024 Signature: Printed Narne: Company: Title. MICHAEL R NEELY 3E CONTRACTING VP NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. ACKNOWLEDGMENT State of TEXAS County of HARRIS 1, a Notary Public for the above County and State, certify that MICHAEL R NEELY personally came before me this day and acknowledged that they are the VP [title] of 3E CONTRACTING [company name], Witness. hand and official seal this 18 day of SEPTEMBER 2024, J� ., hlu Notary _1� My Commission Expires: 01/31/26 bllc " ;ra ANGIE REE No ry ID 01•MCKEN 2 in Notary In g10752982 My Commission Expires January 31. 2026 CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT Project Calhoun Co. Dispatch PA#3 ,lob No. PAM& (3EC #23-226) On receipt by the signer of this document of a check from BLS construction (maker of check) in the sum of $ 870.00 payable to 3E contracting (payee or payees of check) and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, Of - statute related to claim or payment rights for persons in the signer's position that the signer has o11 the property of Calhoun Co. (owner) located at 312 W. Live Oak St. Angelton TX (location) to the following extent: Waterproofing (job description). This release covers the final payment to the signer for all labor, services, equipment, or. materials furnished to the property or to BLSConstruction (person with whom signer contracted). Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the funds received from this final payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project up to the date of this waiver and release. Date 05/17/24 3E Contracting (Company name) gy _(Signature) Partner (Title) STATE OF TEXAS COUNTY OF Harris This instrument was acknowledged before me on this nth Michael R Neely (name), Partner day of May 20 24 , by job title) of _tunuhauy uau,c�. AN I Notary It) 010752982 @E NNOT Y PU IC, STATE OP TEXAS My Commis�n Expires or January 313t, 2026 SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), in the amount Of $ 9,190,00 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 8112r23 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined Dispatch Facility Job#887 (the "Project") owned by Calhoun County, Port Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided In connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor orOwner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. S. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: tf 25l Signatu Printed Company: Title: �t2Sld�ST� NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. State of Te'IAy - .n NTi )_ County of I��V\h I, a Notary Public for the above County and State, certify that pws nally came before me this day and acknowledged that they are the [title] of 07 [company name . W' ness my hand and official seal this"!L'—day of WLA- 0A1 ®/ _Or�,��lcaryPublic S_ My Commission Expires: �V oo�rl�`JJ��{{``�� `0n011 i N E R 9p P F` •'.J325D929... Tease si p + v4u,m 1-0 CtGcoU.Vt%��%t�.rY�S�-v'U�CbC7j'1, corn SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), In the amount of $ S,o72.a5 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 81112024 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined Dispatch Facility JobAaa7 (the "Project") owned by Calhoun County, Port Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2._ a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3, a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present orfuture law, against either of the Contractor or Owner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically 0 waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. S. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge thatthe Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: r' l Signature:; vr�� Printed Name:, Company: Title: NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. ACKNOWLEDGMENT State of County of I, a Notary Public for the above County and State, certify that personally came before me this day and acknowledged that they are the [title) of [company name]. Witness my hand and official seal this _ day of 202_ Notary Public My Commission Expires: SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE Theundersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), in the amount Of $ 160.00 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 612912024 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project (mown as and located at Calhoun County Combined Dispatch Fadlity Job#8B7 (the "Project") owned by Calhoun Caunty, Port Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which Is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as weli.as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2, a undersigned Subcontractor has been paid In full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entitles providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4, a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor orOwner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically I waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. S. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner trom any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be. entitled to rely upon the truth and accuracy thereof. Dated: Signature: Printed Name: Company: ,g Oak Title: NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. State of County of I, a Notary Public for the above County and State, certify that personally came before me this day and acknowledged that they are the [title] of [company name]. Witness my hand and official seal this _ day of , 20'L_ Notary Public My Commission Expires: SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), in the amount of $ 22,935.71 as full and final settlement underthe Master Subcontractor Agreement and applicable Statement of Work dated 6/21/2023 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined Dispatch Facility Jobp887 (the "Project") owned by Calhoun County, Port Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any otherwritten or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entitles. 3. a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entitles providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. 5. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: 2L Signature: Printed Name: /'nvsn o �jS �AhV1 fl I( Q Company: l f1n 0 Y Q kc—+ Title: yjKLr NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. State of �-eK4S ACKNOWLEDGMENT County of I-Jk &W+DV\ I, a Notary Public for the above County and State, certify that fl �s ca-h pets ally camel I fo a me t ip day end acknowledged that the are the title] Of (� [company H7No Hess my hand and fficial seal this _ ay of 202� Public My Commission Expires: SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), in the amount of $8,274.01 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 6/21/2023 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project (mown as and located at Calhoun County Combined Dispatch Facility Job#887 (the "Project") owned by Calhoun County, Port Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, forthe labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present orfuture law, against either of the Contractor or Owner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. 5. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: /O Signature: Printed Name:—?>lrlAVK, &p�(-�����, ...[_ (� Company: �� cC1MQD ca � 1 v� Title: r+ 0 U"�T`® NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS, THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. ACKNOWLEDGMENT State of T\ �,fL Countyof Nmc n I, a Notary Public for the above County and State, certify that --PVfaK SV?- 6[ L personally came bef re met is dayand acknowledged that they are the ( )n [title] of ( Q„_[company name . W' n ss my hand and official seal this i—day of 202 It Notary Public My Commission Expires: \. �\A R RFC'.,. = z — .• QE �F 9�p,. ti � SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier'), in the amount of $ 675.00 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 511612024 _ (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined Dispatch Fatuity Job#887 (the "Project") owned by Calhoun County, Pon Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically ��Ukk" co waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. 5. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: L] � Signature: Printed Name: Company: Title: NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT 15 ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. ACKNOWLEDGMENT State of �XQ,$� County of ],a Notary Public for the above County and State, certify that Wmil tt X n p Z personal y e before fine this day and acknowledged that they are the Ai I? [title] of [company name]. W'tness my hand and official seal thisQday of 202_ Notary Public My Commission Expires: Notary Pubh,., State of Texas '+ •vc° Crow. Emir,., 06-05-2024 i 2509294 SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor') represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), in the amount of $17,829.20 as full and final settlement underthe Master Subcontractor Agreement and applicable Statement of Work dated 612112023 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined Dispatch Facility Job#887 (the "Project") owned by Calhoun County, Port Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, forthe labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid In full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. I 5. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: I c aoa Signature: Printed Name: -be yAy'er�2V\1�Qt� Company: c { U Title: ��S1Grt'✓i� NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. Texas ACKNOWLEDGMENT State of County of�1 I, a Notary Public for the above County and State, certify that hve-r euyssx pers ally came befor�j me this daY and acknowledged that they are the title] of TR7�l) E� QGCVIG C [company name]. Wit ess my hand and official seal this day Of ,SP_(]�Q�iM j-,2Q,� , 202 �l Notary Public My Commission Expires: OF LIEN AND The undersigned subcontractor (the "Subcon fully paid and has received final payment frog this Subcontractor Unconditlonal Final Release and of $ +,moo 0o as full and final settlem( applicable Statement of Work dated 6/21/2024 undersigned Subcontractor and BLS CONSTF project known Calhoun C:C.ouniv Combined Dlaoafch FaGi(v JoW87 TX. DR FINAL at Waiver dderthe nts and warrants that it has been on for Payment accompanying Is "Lien Wavier"), in the amount ster Subcontractor Agreement and the "Contract') between the relating to the construction and located at _ (the "Project") owned by (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned subcontractor and Contractor Have fully settled all terms and conditions of the Contract, Including any amendments or modlficatGctns theretd, as well as any other written or oral commitments, agreements, and/or understandings in connecrytion with the Project. 2, a undersigned Subcontractor his' -been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and m terials provided in connection with the Contract, Including all work performed or ally materi#ls provided by Its subcontractors, vendors, suppliers, tnaterialmen, laborers, or other persons or entities. 1 3, a undersigned Subcontractor has paid in fully all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection wi h the Contract on the part, of any person or entity; and no claims, demands, or lions have Been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Con4act. 4. a undersigned Subcontractor releases and discharges Compactor and Owner from all claims, demands, or causes of action, Including but not limited tolall lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner in connection with the';Cotixract. Tht{ undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to Ijen In connection with the Contract against Contractor, Owner, Owner's property, artd the Project, and also specifically waives, to the full extent allowed by law, all 11 Contract by the undersigned Subcontractor's laborers, and all other persons or entities fur with the Contract, 5, a undersigned Subcontractor shall indemnify, from any action, proceeding, arbitration, clz Contract, and to the full extent permitted by C fees incurred by the Contractor and Owner in The undersigned Subcontractor makes the for knowledge thatthe Contractor and Owner shall be Dated: Signature: Printed Name: NOTICE: THIS DOCUMENT WAIVES AND RELEASES BOND RIGHTS UNCONDITIONgLIY, AND STATES THAI RIGHTS. THIS DOCUMENT 15 WORCEABLE AGAINST BEEN PAID. IF YOU HAVIZISI IT$t I N PAID, USE A CONE State of ` county of I, a Notary Public for the above County and personal came before me this day and acknowled of `S l nib`"i5 [company of � 31 4 202_4 My Commission Expires: i0 1 M AARWINE PUBLICF TExAS76a32-5�es ai-20-2n25 or rights of lien in connection with the tort, suppliers, vendors, materialmen, !iced, labor, or materials In connection and hgld harmless Contractor and Owner and, I1t1n, or right to lien relating to the pay ani costs, expenses, and/or attorney's resentaklons and warranties with full rely upob the truth and accuracy thereof. i STOP PAYMENT NOTICE, AND PAYMENT HAVE qEEN PAID FOR GIVING UP THOSE IF YOU ISIGN IT, EVEN IF YOU HAVE NOT 4L WAIVER AND RELEASE FORM. are -- &ti T rY,-%It 111 : hand and officipf�eal this J- day Unconditional Waiver and Release on Final Payment Property Code § 53.284 NOTICE: This document waives rights unconditionally and states that you have been paid for giving up those rights. It is prohibited for a person to require you to sign this document if you have not been paid the payment amount set forth below. If you have not been paid, use a conditional release form. Identifying Information Project Address: 312 West Live Oak St., Port Lavaca, TX 77979 Job or Contract No: 887 Job Name: Calhoun County Combined Dispatch Building The signer of this document has been paid in full for all labor, services, equipment, or materials furnished to the property or to BLS Construction. Inc. on the property of Calhoun County located at 312 West Live Oak St., Port Lavaca, TX 77979 The signer therefore waives and releases any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position. The signer warrants that the signer has already paid or will use the funds received from the final payment to promptly pay In full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project up to the date of this waiver and release. Company Name: Claimant's Signature: Claimant's Representative Name: Chad Dempster Claimaint's Representative Title: Director of Finance Date of Signature: 1" ,g,2 c-F zo l State of a_"u County ofILt �1�i� Subscribed and sworn to before me this day of t d, 02, c- (year). Notary Public r Ii7�� ul)- "i �� �v� My commission expires i .? t` ;%o 3 AND"A J. HAYES '�`Pp1v�'L9�fi=Notary Public, State of Tex"'• /^t •` -; Comm. Expires 12-15-2025 :"°je,oe Kc Notary lD 125116079 Conditional Waiver and Release on Final Payment Property Code § 53.284 Identifying Information Project Address: 312 West Live Oak St., Port Lavaca, TX 77979 Job or Contract No: 887 Job Name: Calhoun County Combined Dispatch Building On receipt by the signer of this document of a check from BLS Construction, Inc. in the sum of $ 21 124.56 payable to K&P Construction Services and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position that the signer has on the property of Calhoun County located at 312 West Live Oak St., Port Lavaca, TX 77979 to the following extent: Commercial Remodel. This release covers a final payment for all labor, services, equipment, or materials furnished to the property or to (person with whom signer contracted). Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer. The signer warrants that the signer has already paid or will use the funds received from the final payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project in regard to the attached statement (a) or progress payment request (s). Company Name: Claimant's Signature: Claimant's Representative Name: Chad Dempster Claimaint's Representative Title: Director of Finance Date of Signature: - V4 �S'�i %�-y —o- State of Tx County of /:1.f 4 Subscribed and sworn to before me this / 57 day of 690 , (year). Notary Public nd- My commission expires Fe ANDREA J. HAYES Notery Public, State of Taxes Comm. Expires 12-16.2026 Notary ID 125118079 SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), in the amount of $ 9,835.10 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated aizu2023 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined Dispatch Facility Job#887 (the "Project") owned by Calhoun County, Port Lavaca, TX. _._ _ (the "Owner"). in consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the. Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner in connection with the Contract on the part of any person or entity; and no claims, demands, or (lens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4, a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner in connection with the Contract, The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materiaimen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. S. e undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: —A) c D d' Signature:✓�'�' "�'� "�"/%' Printed Name: Kellar f%P„h'� Company: aL�--- Title: f ec.t* t-0 P, j 7 rz.a 0 i"e.0 NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID, IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM, ACKNOWLEDGMENT State of � County of��«��� V� I, a Notary Public for the above County and State, certify that Brendr No scf n E f personally came before me this day and acknowledged that they are the 5ei ieinrry -1tpuF j rrrr" [title] of Kor A 12- PLum13r t u' Y'` [company namel. Witness my ban Ic and official seal day of `,6' l Notary Public My Commission Expires: � () d'i, -1 =4/AV �(�P41r JOANNA GARCIA Notary lD 015 My CommissioJ. n E ExpP ires %lt OFF August 12, 2026 SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier"), in the amount of $ 2,200.00 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 612412024 (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC, relating to the construction project known as and located at Calhoun County Combined Uspalch Facility dobi1887 (the "Project") owned by Calhoun County, Port Lavaca, TX. (the "Owner"). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings In connection with the Project, 2. a undersigned Subcontractor has been paid In full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by Its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entitles. 3. a undersigned Subcontractor has paid in full all Its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entitles providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner In connection with the Contract on the part of any person or entity, and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4, a undersigned Subcontractor releases and discharges Contractor and owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner in connection with the Contract. The undersigned subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entitles furnishing services, labor, or materials in connection with the contract. 5. a undersigned subcontractor shall Indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees Incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. DatedASA Signature: �n( ��-1�U\ Printed Name: Company: Title: NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM, ..���yp--�� ACKNOWLEDGMENT State of ►�+� as County of l ' al �A Ct A Asp � I, a Notary Public for the above County and State, certify that ' V A OCOLAnAQ!�- personally ---before me this day and acknowledged that they are the OIrJf_.d1!_ [,._title 1 of [company name]. Witness my hand and official seal this; day Of,gb'i,20 _ ' > ary Public My Commission Expires: 9✓ .� � f ,Uu,4q, apa,, JO ANN 0. MAREK y°i • ••";rg%Notary Public, State of Texas 91•. 14NF COMM, Expires 09-1 W024 p�[„�` Notary 10 132676667 SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor) represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Lien Wavier'), in the amount of $a.eso.00 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 8212028 _ (together, the "Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined Dispatch FacAity Job4887 (the "Project") owned by Calhoun County, Port Lavaca, TX. (the "Owner'). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1, a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amend ments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings In connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid in full all its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services; labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner In connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present orfuture law, against either of the Contractor orowner in connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers; vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. 5. a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall he entitled to rely upon the truth and accuracy thereof. Dated:' Printed Name: Company: Title: NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS, THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. .� ACKNOWLEDGMENT State of County of�t1Cti���i \ I, a Notary Public for the above County and State, certify that person came before me this day and acknowledged that they are the [title] of Ily [company name]. Wit ess my hand and official seal this a day of 202! i L� _ r I (�I -" , TIFFANY-SEALE �`.�'i� =Notary Purilio, Siata of Texas My Commission Expires: o: , yQ40 Comm. Expires 09.0a-2o26 '�„�,,.` Notery IR t289dS973 1) SUBCONTRACTOR FINAL UNCONDITIONAL WAIVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that it has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien,Waiver (this "Lien Wavier"), in the amount of $ B,sae.ao as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 612112023 (together, the "Contract') between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County combined Plapalch Facility Job#BB7 (the "Project') owned by Calhoun County, Port Lavaca, TX. (the"Owner"). in consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1, a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings in connection with the Project. 2. a undersigned Subcontractor has been paid in full from the Application for Payment accompanying this Lien Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entitles, 1 3, a undersigned Subcontractor has paid in full all Its subcontractors, vendors, suppliers, materialmen, laborers, or other persons or entities providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner In connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4. a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner In connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien in connection with the Contract ` 1 against Contractor, Owner, Owners property, and the Project, and also specifically 1 1 waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the 1 4 Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials in connection with the Contract. 5, a undersigned Subcontractor shall indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any casts, expenses, and/or attorney's fees incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Dated: , 1 Signature: - 1 Printed Name: \'l0cigs \c cq Company: y1Q!A7 \i�,[`i (\S Y 1 l�ri�A� Title: � \r NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. 1 � �f� ACKNOWLEDGMENT State of �-�°4,G.S County of \� i C IR\0 \ 1, a Notary Public for the above County and State, certify that 2� pe Onally came b ore me this day and acknowledged that they are the 2S, a [title] of1� fLt����t%q))Rt\` company name, Witness my hand and official seal this�ey of �c C�c 202 5 Notate ry Public My Commission Expires: FOf t��A .131391.'b 04.23-2� \,.... '"fil n11%00,0 SUBCONTRACTOR FINAL UNCONDITIONAL WAVER OF LIEN AND RELEASE The undersigned subcontractor (the "Subcontractor") represents and warrants that It has been fully paid and has received final payment from the Application for Payment accompanying this Subcontractor Unconditional Final Release and Lien Waiver (this "Uen Wavier"), In the amount of $ 8.e37.10 as full and final settlement under the Master Subcontractor Agreement and applicable Statement of Work dated 612112023 (together, the 'Contract") between the undersigned Subcontractor and BLS CONSTRUCTION, INC. relating to the construction project known as and located at Calhoun County Combined DIVatcb Fee ity Jobp687 (the "Project") owned by Cemoun county. Part terea. TY. (the 'Owner'). In consideration for this final payment, and other good and valuable consideration, receipt of which is acknowledged, the undersigned Subcontractor makes the following representations, warranties, and guarantees: 1. a undersigned Subcontractor and Contractor have fully settled all terms and conditions of the Contract, Including any amendments or modifications thereto, as well as any other written or oral commitments, agreements, and/or understandings In connection with the Project. 2. a undersigned Subcontractor has been paid In full from the Application for Payment accompanying this Uen Waiver, for the labor, services, and materials provided in connection with the Contract, including all work performed or any materials provided by its subcontractors, vendors, suppliers, matertalmen, laborers, or other persons or entities. 3. a undersigned Subcontractor has paid In full all its subcontractors, vendors, suppliers, matertalmen, laborers, or other persons or entitles providing services, labor, or materials to the Project; there are no outstanding claims, demands, or rights to liens against the undersigned Subcontractor, the Project, or the Owner In connection with the Contract on the part of any person or entity; and no claims, demands, or liens have been filed against the undersigned Subcontractor, the Project, or the Owner relating to the Contract. 4, a undersigned Subcontractor releases and discharges Contractor and Owner from all claims, demands, or causes of action, Including but not limited to all lien claims and rights, that the undersigned Subcontractor has, or might have, under any present or future law, against either of the Contractor or Owner In connection with the Contract. The undersigned Subcontractor hereby specifically waives and releases any lien or claim or right to lien In connection with the Contract against Contractor, Owner, Owner's property, and the Project, and also specifically waives, to the full extent allowed by law, all liens, claims, or rights of lien in connection with the Contract by the undersigned Subcontractor's subcontractors, suppliers, vendors, materialmen, laborers, and all other persons or entities furnishing services, labor, or materials In connection with the Contract. 5. a undersigned Subcontractor shall Indemnify, defend, and hold harmless Contractor and Owner from any action, proceeding, arbitration, claim, demand, lien, or right to lien relating to the Contract, and to the full extent permitted by law, shall pay any costs, expenses, and/or attorneys fees Incurred by the Contractor and Owner in connection therewith. The undersigned Subcontractor makes the foregoing representations and warranties with full knowledge that the Contractor and Owner shall be entitled to rely upon the truth and accuracy thereof. Signature: o0 Printed Name: Company: Title: NOTICE: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL WAIVER AND RELEASE FORM. ACKNOWLEDGMENT State of � P')CS 5 County of5� Cdlb� nil t I, a Notary Public for the above County and state, certify that personally came before me this day and acknowledged that they are the hang Y [tiUel of A OD F+ [company name]. Witness my hand and official seal this20lay Of 202 N tary Public My Commission Expires: 0q 1Dq wog NOTICE 01= MEETING - 11/20/2024 8. Consider and take necessary action to approve MOU between Calhoun County ISD and Calhoun County in reference to Truancy stipend for JP 1 Clerk in the amount of $7,000.00 for the period of January 1, 2025 through December 31, 2025 with the option to extended the agreement for three (3) annual renewals and authorize all appropriate signatures. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct I SECONDER: Gary Reese,; Commissioner Pct 4 AYES: Commissioner Hall, Lyssy, Reese Page 5of10 Debbie Vickery From: David.Hall@calhouncotx.org (David Hall) <David.Hall @calhouncotx.org> Sent: Wednesday, November 13, 2024 12:25 PM To: debbie.vickery@calhouncotx.org Subject: Agenda item Can you please place the following on next week's agenda? I'll have the MOU for court after Monday's school board meeting Consider and take necessary action to approve MOU between Calhoun County ISD and Calhoun County in reference to Truancy stipend forJP1 Clerk and authorize all appropriate signatures. Thanksil Sent from David's iPhone David Hall Commissioner Precinct 1 Calhoun County Office 361-552-9242 Cell 361-220-1751 Calhoun County Texas GENERAL INTERLOCAL AGREEMENT FOR THE JUVENILE CASE MANAGER THE STATE OF TEXAS COUNTY OF CALHOUN This INTERLOCAL AGREEMENT (the "Agreement") is made pursuant to chapter 791 of the Texas Government Code (The Interlocal Cooperation Act) and is entered into by and between CALHOUN COUNTY ("County"), acting by and through its governing body, the Calhoun County Commissioners Court, and the CALHOUN COUNTY INDEPENDENT SCHOOL DISTRICT, PORT LAVACA, TEXAS ("CCISD"), acting by and thought its governing body, the Calhoun County Independent School District School Board. WITNESSETH In consideration of the mutual covenants and agreements set forth in this Contract, and other good and valuable consideration stated herein below, County and City hereby mutually agree as follows; ARTICLE 1. PURPOSE It is the purpose of this contract to improve and encourage the efficiency and effectiveness of the County and CCISD by authorizing the fullest range of intergovernmental cooperation. Specifically, the County is hereby contracting and agreeing with CCISD to perform certain governmental functions and services. These governmental functions and services include the juvenile case manager and processing of truancy cases in the justice of the peace court. This agreement is only for the juvenile case manager. CCISD agrees to reimburse the County for expenses incurred by the County in performance of this Agreement. This reimbursement shall be monetary or in -kind services between CCISD and the County. The County must have prior written approval for in -kind reimbursement from CCISD. ARTICLE H. AUTHORITY This Contract is entered into by the parties hereto, pursuant to the Texas lnterlocal Cooperation Act, Section 791.002 of the Texas Government Code. The authority for the legislation is set out in said Interlocal Cooperation Act. This Contract shall be governed by and subject to the laws of the State of Texas and, specifically, any of the terms and conditions of this Contact are subject to and shall be construed in accordance with the construction of the Texas lnterlocal Cooperation Act recited hereinabove. ARTICLE Ill. CONSIDERATION In consideration for the County providing the governmental functions and services as set out hereinabove, CCISD hereby agrees to pay the County the sum of one- $7,000.00 per year. This yearly sum is due on the anniversary date of the execution of this Contract. ARTICLE IV. TERMS AND CONDITIONS Unless mutually initiated, cancelled, or terminated earlier, with thirty (30) days written notice, this Agreement shall commence on January 1, 2025. This Agreement shall expire at midnight on December 31, 2025. This contract maybe extended for three (3) annual renewals with the renewal fees and payments for each successive year. Each party paying for the performance of governmental functions or services must make those payments from current revenues. 2 of 4 ARTICLE V. SEVERABILITY If any provision of the Contract is held invalid, such invalidity shall not affect other provisions or applications of the Contract which can be given effect without the invalid provision or application, and to that end, the provisions of this Contract are declared to be severable. ARTICLE VI. TERMINATION If CCISD defaults in the payment or any obligation in the Agreement, Calhoun County is authorized to terminate this Agreement immediately without notice. It is understood and agreed that either party may terminate this Agreement prior to the expiration of the terms set forth above, without cause, upon thirty (30) days prior written notice to the other party. ARTICLE VII. NOTICE Any notice required to be given under the provisions of this Agreement shall be in writing and shall be served when it shall have been deposited, enclosed in a wrapper with the proper postage thereon, and duly registered or certified, return -receipt requested, in a Unites States Post Office, addressed to the parties at the following addresses: To Calhoun County: Calhoun County 211 S. Ann Street, Suite 300 Port Lavaca, TX 77979 Attn: County Judge To CCISD: CCISD Either party may designate a different address by giving the other party ten (10) days written notice. ARTICLE VIII. PRIOR NEGOTIATIONS The parties agree that this Agreement contains all of the terms and conditions of the understanding of the parties relating to the subject hereof. All prior negotiations, discussions, correspondence and preliminary understandings between the parties and others relating hereto are superseded by this Agreement. ARTICLE IX. VENUE Exclusive venue for any action arising out of or related to this Agreement shall be in Calhoun County, Texas. ARTICLE X. MISCELLANEOUS PROVISIONS This instrument constitutes the entire Agreement between the County and CCISD relating to the rights and obligations assumed. Any oral or written representations or modifications concerning this instrument shall be of no force and effect excepting a subsequent modification in writing signed by both parties. This Agreement may be executed in duplicate counterparts, each having equal force and effect of an original. This Agreement shall become binding and effective only after it has been authorized and approved by both parties, as evidenced by the signature of the appropriate authority, pursuant to an order of the Commissioners Court of the County and the council of CCISD authorizing such execution. This Agreement supersedes any prior understandings or written or oral agreements between the parties respecting the subject matter of this Contract. No amendment, modifications, or alteration of the terms of this Contract shall be binding unless it is in writing, dated subsequent to the date of this Contract, and duly executed by the parties to this Contract. If, as a result of a breach of this Contract by either party, the other party employs an attorney or attorneys to enforce his rights under this Contract, then the defaulting party agrees to pay the other parties' reasonable attorney's fees and costs incurred to enforce this Contract. This Contract shall be binding upon and inure to the benefits of the parties hereto, their respective heirs, executors, administrators, legal representatives, successors and assigns. SIGNATURE PAGE TO FOLLOW 3 of 4 EXECUTED IN DUPLICATE ORIGINALS, retained by each party hereto. Effective the_ day ofU�, 2024. CALHOUN COUNTY, TEXAS CALHOUN COUNTY ISD By: Richard H. eyer, County Judge By: Bill Shrader, President of the Board ATTEST: By: David �l, Commi loner, Precinct 1 n J By: By: Vern Oyssy, gommissioner, Precinct 2 By: Jo4jBehrens, Commissioner, Precinct 3 By: Gary Rkese, Commissioner, Precinct 4 ATTEST: By: Anna Goodman, County Clerk, Calhoun County, Texas 4of4 # 09 NOTICE OF MEETING-11/20/2024 9. Consider and take necessary action to accept anonymous donation to the Sheriffs Office to be deposited into the Motivation account (2697-001-49082-679) in the amount of $75.00. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct`4 SECONDER: David Hall, Commissioner Pct 1 AYES: Commissioner Hall, Lyssy, Reese Page 6 of 10 ' NOTICE OF MEETING— 11/20/2.024 10. Consider and take necessary action to reschedule the Wednesday, December 26, 2024 Regular Commissioners Court Meeting to Monday, December 30, 2024 and cancel the January 1, 2025 Regular Commissioners Court meeting, due to the Christmas and New Year Holiday schedule. (RHM) Correction to be made to the date Wednesday, December 25, 2024 and 'to strike through the word cancel, as the court will be sworn in on January 1, 2025 RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct S SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Commissioner Hall, Lyssy, Reese Page 7 of 10 NOTICE OF MEETING - 11/20/2024 11. Accept Monthly Reports from the following County Offices: a) Justice of the Peace Pct 2 — October, 2024 RESULT: APPROVED [UNANIMOUS], MOVER: Joel'Behrens,ICommissioner Pct 3 SECONDER: Gary Reese,' Commissioner Pct 4 AYES: Commissioner Hall, Lyssy, Reese Page 8 of 10 ENTER MONTH OF REPORT ENTER YEAR OF REPORT CIVIL JUSTICE DATA REPOSITORY FEE - CORRECTIONAL MANAGEMENT INSTITUTE CNII ORAFFA PARKS S WILDLIFE ARREST FEES - STATE ARREST FEE: .SCHOOL CROSSING/CHILD SAFETY FEE SUBTITLE C - STATE TRAFFIC FINES -EST 9.1,1 SMALL FEE - I ALL I 1 ...cnrnimcrvl ""S ULEB$) OVER RESTITUTION -REST A § PARKS & WILDLIFE -WATER SAFETY'FINES-WSF . "� 4 MARINE SAFETY PARKS&WILDLIFE -MSO �L' 4 TOTAL ACTUAL MONEY RECEIVED 55:4&3,95F TYPE:.. TOTALWARRANTFEES AMOUNi.. 163.37 ENTER LOCAL WARRANT FEES RECORD ON TOTAL PAGE OF HUCOUNTWWFnvARE No REFORT STATE WARRANT FEES. $53.37 RECORDONTOTAL PAGE OF HnL=NTRySGFT AG,WN,roar DUE TO OTHERS: AMOUNT DUE TOCCISD-50%ol Fins On JV cases TO D RESTITUTION FUND ,-,,:004 P�nsE UILLUce oa pEpuEsnxcas6uasEle:xr EFUNDUE REFUND REFUNOOF OVERPAYMENTS F OVERPAYMENTS 0.00 KEASE "CLOGE 0R. PEOUESTING DSRURSEUENr SERVICE FEE O.00PLEASE wcluLe OR pepupsrlxc olspuRSEUExr CASH&OUT-OF-COUNTY CASH BONDS 0.00 PLEASE INCLUDE OR KIISTINO USBUAWWW TOTAL DUE TO OTHERS 0.00 -PLM6E INCLUDE p0.REGUE6TINGp6RUp6ElAENi xFpEGUIPEpI sp,0p TREASURERS RECEIPTSFOR MONTHI. AMOUNT 9ASMg WRDKS]M,;;e�&+CHS{�T $sue-.,1.;L TOTAL TREAg. RECEIPTS .5:CAlculuk from ACTUAL Treaeu.h Receipts - 3:95 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 11/l/2024 COURT NAME: JUSTICE OF PEACE NO. 2 MONTH OF REPORT: October YEAR OF REPORT: 2024 ACCOUNTNUMBER ACCOUNTNAME AMOUNT OR 1000-001-45012 FINES 2,315.61 OR 1000-001-44190 SHERIFF'S FEES 184.91 OR 1000.001-44362 OR 1000-001-44010 OR 1000.001-44062 OR I000.001-44090 OR 1000-001-49110 OR 1000-001-44322 OR 1000-001-44145 OR 1000-999-20741 OR 1000-999-20744 OR 1000-999-20745 OR 1000-999-20746 OR 1000-999-20770 ADMINISTRATIVE FEES DEFENSIVE DRIVING 0.00 CHILD SAFETY 0.00 TRAFFIC 26.58 ADMINISTRATIVE FEES 105.75 EXPUNGEMENT FEES 0.00 MISCELLANEOUS 0.00 TOTAL ADMINISTRATIVE FEES 132.33 CONSTABLE FEES -SERVICE 450.00 JP FILING FEES 0.00 COPIES / CERTIFIED COPIES 0.00 OVERPAYMENTS (LESS THAN $10) 0.00 TIME PAYMENT REIMBURSEMENT FEE 75.00 SCHOOL CROSSING/CHILD SAFETY FEE 0.00 DUE TO STATE -DRIVING EXAM FEE 0.00 DUE TO STATE-SEATBELT FINES 0.00 DUE TO STATE -CHILD SEATBELT FEE 0.00 DUE TO STATE -OVERWEIGHT FINES 0.00 DUE TO JP COLLECTIONS ATTORNEY 700.27 TOTAL FINES, ADMIN. FEES & DUE TO STATE $3,858.12 OR OR 2670-001-44062 271-001-44062 COURTHOUSE SECURITY FUND $46.02 OR 29 JUSTICE COURT SECURITY FUND $3.07 OR 269-001-44062 JUSTICE COURT TECHNOLOGY FUND $42.33 OR 273030-001-44062 -001-44062 JUVENILE CASE MANAGER FUND $6.36 OR 2669-001 44062 LOCAL TRUANCY PREVENTION & DIVERSION FUND $37.57 OR 272§.1�)01 44LlQ� COUNTY JURY FUND __ J7S1I� CGyUR Upp¢RT Pt1ND�TM $0 75 CR CR 67 +007 440� uN �,DI61JRS6fUxibN``FUNf�.- $7�O it i I ANGIJA(3ND _ STATE ARREST FEES DPS FEES P&W FEES 16.37 TABC FEES 0.00 OR 7020-999-20740 0.00 TOTAL STATE ARREST FEES 16.37 OR 7070-999-20610 CCC-GENERAL FUND OR 7070-999-20740 CCC-STATE 12.27 DR 7070-999-10010 11042 OR 7072-999-20610 STATE CCC- GENERAL FUND 122.69 OR 7072-999-20740 STATE CCC- STATE 46.59 DR 7072-999-10010 419.29 OR 7860-999-20610 STF/SUBC-GENERAL FUND 465.88 OR 7860-999-20740 STF/SUBC-STATE 1.60 DR 7860-999-10010 30.42 32,02 OR 7860-999-20610 STF- EST 9/l/2019- GENERAL FUND OR 7860-999.20740 STF- EST 9/1/2019- STATE 15.59 DR 7860-999-10010 374.04 389.63 Page 1 of 2 MONTHLY REPORT OF COLLECTIONS AND DISTRIBUTIONS 11/1/2024 COURT NAME: JUSTICE OF PEACE NO. 2 MONTH OF REPORT: October YEAR OF REPORT: 2024 OR 7950-999-20610 TP-GENERAL FUND 0.00 OR 7950-999-20740 TP-STATE nnn DR 7950-999-10010 0.00 OR 7480-999-20610 CIVIL INDIGENT LEGAL-GEN. FUND 0.00 OR 7480-999-20740 CIVIL INDIGENT LEGAL -STATE 0.00 DR 7480-999-10010 0.00 OR 7865-999-20610 CRIM-SUPP OF IND LEG SVCS-GEN FUND 0.61 OR 7865-999-20740 CRIM-SUPP OF IND LEG SVCS-STATE 5.52 DR 7865-999-10010 6.13 OR 7970-999-20610 TUFTA-GENERAL FUND 26.67 OR 7970-999-20740 TUFTA-STATE 53 33 DR 7970-999-10010 80.00 OR 7505-999-20610 JPAY - GENERAL FUND 1.84 OR 7505-999-20740 JPAY - STATE 16.56 DR 7505-999-10010 18.40 OR 7857-999-20610 JURY REIMB. FUND- GEN. FUND 1.P3 OR 7857-999-20740 JURY REIMB, FUND- STATE 11.04 DR 7857-999-10010 12 27 OR 7856-999-20610 CIVIL JUSTICE DATA REPOS.- GEN FUND 0.02 OR 7856-999-20740 CIVIL JUSTICE DATA REPOS.- STATE 0.19 DR 7856-999-10010 0.21 OR 7502-999-20740 JUD/CRT PERSONNEL TRAINING FUND -STATE DR 7502-999-10010 .00 0 0.00 7998-999-20740 TRUANCY PREVENT/DIV FUND - STATE 1.07 7998-999-20701 JUVENILE CASE MANAGER FUND DR 7998-999-10010 1.07 2,13 7403-999-22889 ELECTRONIC FILING FEE - CV STATE DR 7403-999-22889 .00 0 0.00 7858-999-20740 STATE CONSOLIDATED CIVIL FEE 126.00 126.00 TOTAL (Distrib Req to OperAcct) $5,463.95 DUE TO OTHERS (Distrib Req Attchd) CALHOUN COUNTY ISD DA - RESTITUTION 0.00 REFUND OF OVERPAYMENTS 0.00 OUT -OF -COUNTY SERVICE FE 0.00 CASH BONDS 0.00 PARKS & WILDLIFE FINES 0.00 WATER SAFETY FINES 0.00 0.00 TOTAL DUE TO OTHERS $0.00 TOTAL COLLECTED -ALL FUNDS $6,463.95 LESS: TOTAL TREASUER'S RECEIPTS $5,463.95 OVER/(SHORT) $0.00 Page 2 of 2 CALHOUN COUNTY 201 West Austin PAYEE Name: Calhoun County Oper. Acct. Address: City: State: Zip: Phone: Signature f offi Date DISTRIBUTION REQUEST DR# 450 A 45597 PAYOR Official: Thomas Dio Title: Justice of the Peace, Pct. 2 #12 ' NOTICE OF MEETING — -11/20/2024 12. Consider and take necessary action on any necessary budget adjustments. (RHM) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER:,, Joel Behrens, Commissioner Pet 3 AYES: Commissioner Hall, Lyssy, Reese Page 9of10 z 3 m n O z I W m m n Z A E. z O O zz O c A 0 O 1 a r a to O wt»E»rei+ O O o T N t/i E9 (A O O O o T f9 O NPAN m Gi z m: 0 9` a a m i a m: z: 0 z: z 3 o: m: 0: a: 1: 3 m; z; o? 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Approval of bills and payroll. (RHM) MMC Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct.1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: - Commissioner Hall, Lyssy, Reese Indigent Healthcare: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall,, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Commissioner Hall, Lyssy, Reese County Bills: RESULT: APPROVED [UNANIMOUS]; MOVER: David Hall, Commissioner Pct 1 SECONDER: ;' Gary Reese,' Commissioner Pct4 AYES:" Commissioner Hall, Lyssy, Reese Page 10 of 10 > �> o o� xyr Spa >> n Hm ?m Aym Aym wm Zm wM Zn g a $ $ z z m zm a w 0 0 0 0 �S m y y cm =' ° y m y t 0 P P n A a N N N N O O n O O O O O O N N nr 6 O R cz cz a cz n n mr- mr- m0 m0 D D m o y C O -- m> m> m> m> pm Am �m Am _ , m m r < O r � N }� P T O O O O O W N I P P J OJ, J J O O O 3 3 N O IJ non m mzz-im mA >W DD 00 mCmnwmm y > 0 , 3o n() a0QOmA�C:c0O:z m ° wn _m wo S. 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J�J W H W W n lfi 3 a' Oo O u O P U A O N A J O O O J 0 0 0 ! ! § 2 7 | � \ k ! - - ! k\ |/ } /7; ,\ § e I r ()) ((\ \ ){2 §§}mmv ( ` § o - O O o m m s -zi y O n P ng. v O 0 D 9 a ^ 3 3 � z 0 � O o y^ n m r O n n X o O Z 'n z a z m y m �w 'z A v 0 < �D A F o H z N N ro z 3 Soi A < f3, J 3< gc ti o< Z< a0 00 n rw am O � o N O N N O A N A O N C O� N to N N u O A O A P O O S P W O O 0o Oi C O MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR --November 20,202 TOTALS TO BE APPROVED - TRANSFERRED FROM ATTACHED PAGES T,OTJSLPAYABLES,PAYROLLANDELECTRONItBANK PAYMENTS TOTAL TRANSFERS�BETWEEN,EUNQS $• 314,286,7D�. TOTALNURSINGH,OME U,P.L',EXPFNSES 'rO7ALINTER+66VERNMENT7TRANSFERS _ $ GRANQT,O7ALDISBURSENIENTdkPPROUEQ:NoVBmber20,2024 $, 2,93d749S,95: MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---November 20, 2024 PAYABLES AND PAYROLL 11/14/2024 Weekly Payables 11/14/2024 Citibank Credit Card -see attached (Ednl 11/18/2024 McKesson-3408 Prescription Expense 11/18/2024 Amerisource Bergen-3408 Prescription Expense 11/18/2024 Amerisource Bergen-34011 Prescription Expense 11/18/2024 Amerlsource Bergen-34013 Prescription Expense 11/18/2024 Amerisource Bergen-34011 Prescription Expense 11/18/2024Payroll Liabilities -Payroll Taxes 11/18/202A Payroll Prosperity Electronic Bank Payments 11/18/2024 90 Degree Benefits - employee insurance claims 11/18/2024 Sales Tax -October 2024 11/18/2024 TCORS October Retirement 11/18/2024 Pay Plus -Patient Claims Processing Fee 11/18/2024 AmedSoame Bergen Overage 12/18/2024. Credit Card Processing Fee 11/18/2024 Credit Card Lease fee 11/18/2024 Health Equity -HSA Contributions TOTAPPAYABLES;PA4YRQLXQNAiLEC?RONIGBQNiCPAYtVIEdTS _ TRANSFERS BETWEEN FUNDS-MMC 11/18/2024 Transfer from Prosperity Operating Account to Prosperity Money Market TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 11/14/2024 MMC Operating to. Broadmoor-Correction of Insurance payment deposited into MMC Operating in error 11/14/2024 MMC Operating to The Crescent -Correction of insurance payment deposited into MMC Operating in error 11/14/2024 MMC Operating to Golden Creek Healthcare-Correctlon of Insurance payment deposited into MMC Operatingin error 11/14/2024. MMC Operating to Gulf Pointe Plaza - Correction of Insurance Payment deposited Into MMC operating in error 11/14/2024 MMC Operating to Tuscany Village -Correction of insurance payment deposited Into MMC operating in error f�47/,ALt;TJ1AN5PER5�BETWEEN`FUNOS ... _. NURSING HOME UPI. EXPENSES 11/18/2024 Nursing Home UPL-Cantex Transfer 11/18/2024 Nursing Home UPI.-Nexlon Transfer 11/18/2024 Nursing Home UPL-HMG Transfer 11/18/2024 Nursing Home UPL-Tuscany Transfer 11/18/2024 Nursing Home UPL-HSLTransfer QIPP CHECKS TO MMC. 11/18/2024 Ashford - Molina QTR4QIPP Payment 11/18/2024 Broadmoor-MolinaQTR4 QIPP Payment 21/18/2024 Crescent - Molina QTR4 QIPP Payment 12/18/2024 Fort send - Molina QTR4 QIPP Payment 11/1B/2024 Solera - Molina QTR4 QIPP Payment 11/18/2024 Golden Creek -Superior QTR4 QIPP Payment 11/18/2024 Bethany -Superior QTR4 QIPP Payment 11/18/2024 Tuscany- Molina QTR4 QIPP Payment TRANSFER OF FUNDS BETWEEN NURSING HOMES 11/18/2024 Crescentto Tuscany -Tuscany insurance payment deposited into Crescent in error 499,082.28 2,060.80 1,406.36 122.45 60.53 1,814.00 276,28 116,206.50 365,948.87 44,977AS 2,454.87 181,896.35 319.92 60.53 7,493.14 285.82 1,526.16 250,000.00 20,983.40 5,551,20 4,414.61 0.21 33,336.28 894,729.23 94,335.30 44,187.71 237,856.82 45,914.49 10,534A6 2,344.83 2,901.78 9,299.14 3,135.70 21,810.04 13,596.24 5,182.20 14,500.00 $ i,zzS;aa2as rroy'4 UIiSiNGHOME UPUE)7p 14SE4 :::. _.. �` 1, 93f327t94 YOTAI'INTERtGd1fERNMENT'fNSP!5FEg5, $ GNQND.TOTAL 0159URSENii N �SdANpRO. Eb,NQ'vetii4e726 ZbZ4 : S �;95 99b.9B' RECEIVED BY THE COUNTY AUDITOR ON NOV 14 2024 MEMORIAL MEDICAL 11/14/2024 CENTER 0 10:46 AP Open Invoice List CALHOUN COUNTY, TEAS ap_open invalce.template Due Dates Through: 11/29/2024 Vendor#/ Vendor Name Class Pay Cade 11283 ,/ ACE HARDWARE 15521 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 103124 10/31/20210/31120211/251202 686.50 0.00 0.00 686.66� Vendor Totals: Number Name Gross Discount No -Pay Net 11263 ACE HARDWARE 15521 686.58 0.00 0.00 686.56 Vendor# Vendor Name Class Pay Code 10950 ACUTE CARE INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INV2055 11l04/20211/20/20211/20/202 11400.00 0.00 0.00 1,400.00 / V Vendor Totals: Number Name Gross Discount No -Pay Net 10950 ACUTE CARE INC 1,400.00 0:00 0.00 1,400.00 Vendor# /Vendor Name Class Pay Code A1680 j AIRGAS USA, LLC-CENTRAL DIV M Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 9164998423 10/29/20210/24/20219/23/202 175.29 0.00 0.00 175.29 V1 J 9155244578 10/311202 10/31/202 11/25/202 2,580.41 0100 0100 2,580,41 J J5511991764 10/31/202 10/31/202 11/2W02 286.11 0.00 0.00 286A1 OCTOBER RENTAL PERIOD J 5511991559 10/3I/20210/31/20211/25/202 1,051.38 0.00 0.00 1,051.38 'OCTOBER RENTAL PERIOD 5511991188 11/13/20210/31/202111251202 585.23 0.00 0.00 585.23 Vendor Totals: Number Name Gross Discount No -Pay Net At 680 AIRGAS USA, LLC - CENTRAL DIV 4,678.42 0.00 0.00 4,678,42 Vendor# Vendor Name Class Pay Code 15936 J� Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J SERAL10001 11113/2021110020211106/202 323.48 0.00 0.00 323.48 � Vendor Totals: Number Name Gross Discount No -Pay Net 15936 323.48 0.00 0.00 323.48 Vendor# Vendor Name Class Pay Code A1705 J ALIMED INC. M Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net RPSV004356147 10129/20210/28120211/12/202 67.86 0.00 0.00 67AS J Vendor Totals: Number Name Grass Discount No -Pay Net A1705 ALIMED INC.. 67.86 0.00 0.00 67.88 Vendor#I Vendor Name Class Pay Cade 14028 V AMAZON CAPITAL SERVICES J1P30KFYCCC36 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 10/2M021Oi25120211/24/202 97.28 0.00 0.00 87,28 r 1M9L1JVGWWL6 10/29/2021027/202111261202 35.04 0-00 0.00 35.04 J. J1C1V7HPVIPVM 11105/20211/02/20211/29.202 -0.40 0.00 0.00 440 J ,I1VDOMQQF1G9G 1110520211/02/20211/29/202 -32.22 0.00 0.00 -32.22 J11G49VWRHLNQ 11/05120211/02120211/291202 -1.83 0.00 0.00 -1.83 J J 1YDWXJ473WIY 11/05/20211/02/20211/29I202 -10A2 0.00 0.00 -10.12 Vendor Tetala: Number Name Gross Discount No -Pay Net 14028 AMAZON CAPITAL SERVICES 77.75 0.00 0.00 77.75 Vendor# /Vendor Name Class Pay Code A-1°/ASPEN SURGICAL PRODUCTS INC M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Nat J CD3295936 11111120210102/202111011202 397.62 0,00 0.00 397Z2 / J Vendor Totals: Number Name Grose Discount No -Pay Net Al 551 ASPEN SURGICAL PRODUCTS INC 397,52 0.00 0.00 397.52 Vendor# /Vendor Name Class Pay Code B1150 J BAXTER HEALTHCARE W Invoice# Comment TramDt Inv Dt Due Dt Check D1 Pay Gross Discount No -Pay Net f82943541 10102/20210/01/20210/26/202 631.20 0.00 0.00 / 631.20 ✓ ,! 12962936 11111/20208/31/20211/23/202 32,49 0.00 0.00 32A9 J 82829764 11/11/20209/04/20211123/202 3,071AU 0.00 0.00 3,071,40 J $2965233 11/11/202 10/07/202 11123/202 42.75 0.00 0.00 42.75 J -J 82984206 11/11/202 10/10/202 11/24/202 43.52 0.00 0.00 43.52 J J 12990236 11111/20210126120211/23/202 6.62 0.00 0.00 5,62 J 11111/20210/29/20211/231202 3,071.40 0.00 0100 3,071.40 ,// 02949,105 f 8UUU83071066 11 /11/202 10/29/202 11123/202 627.63 0.00 0,00 627.63 83085045 11/11120210/3l/20211/25/202 113.12 0.00 0.00 113.12 83093170 11111/20211/01120211/26I202 631.20 0.00 0.00 631.20 / 83090763 111111202 11101/202 111261202 3,071.40 0.00 0.00 3,071.40 ✓ Vendor Totals: Number Name Gross Discount No -Pay Net 81150 BAXTER HEALTHCARE 11,341.63 0.00 0.00 11,341.63 Vendor#/Vendor . Name Class Pay Code 11544 V BAY STORAGE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 20240266 11/11120211/01/20211123/202 2,820.00 0.00 0.00 2.820.00 / STORAGE CONTR 12124.5125 r/ Vendor Totals: Number Name Gross Discount No -Pay Not 11544 BAY STORAGE 2,820.00 0.00 0.00 2,820.00 Vendor#/ Vendor Name Class Pay Code 81220 J BECKMAN COULTER INC M Invoice# Comment TranDI Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net J 111662172 11/04120211/02/2021127N202 5,717,82 0.00 0.00 5,717.82 ,/ .� 111662170 11104120211/02/202111271202 1,528.71 0.00 0.00 1,528.71 1/ J 111664872 11/11/20211/04120211/29/202 111665815 11111 /20211104120211129/202 J 111665176 11111120211/04120211/291202 J 111664676 11/121202 11/04/202 11/29/202 Vendor Totals: Number Name 81220 BECKMAN COULTER INC Vendor#/ Vendor Name Class Pay Code 11072 J BIO-RAD LABORATORIES, INC Invoice# Comment Tran Ot Inv Dt. Due Dt Check Dt Pay J 907731435 11113120210/29120211/20/202 Vendor Totals: Number Name 11072 BIO-RAD LABORATORIES, INC Vendor# /yenclor Name Class Pay Code 14753 / BIOMERIEUX, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay /1213378412 J 11112/20211/07/20211 /12/202 Vendor Totals: Number Name 14753 BIOMERIEUX, INC Vendor# endor Name Class Pay Code B1665 , BOSTON SCIENTIFIC CORPORATION M Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay J 702831566 11113/20210/31/20211/131202 Vendor Totals: Number Name B1655 BOSTON SCIENTIFIC CORPORATION Vendor# Vendor Name Class Pay Code C1048 J CALHOUN COUNTY w Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay J 53179865 10131/20210/26120211127/202 �AaCap i.teu V - opt. J 53182027 10Q/31/202t�11,0��/28/2021(11///271202 � 10 J 53179956 10131 2283 202 it112712 2 J/ 53179667 1001, ^ 10/7,8/2020211127,�, r' W 53179666 101311/200L2102V18/20211/27/202 A�MWL� d� Vendor Tatals: Number Name C1048 CALHOUN COUNTY Vendor# endor Name �cARDINAL Class Pay Code C1325 HEALTH 414, INC. W Invoice# Comment Tran Ot. Inv Dt Due D! Check Dt Pay J 8003658551 111051202 11/041202 11/291202 Vendor Totals: Number Name 01325 CARDINAL HEALTH 414, INC. Vendor / Vendor Name Cease Pay Cade 14260'`/ CAREFUSION SOLUTIONS, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay 87.80 0.00 0.00 87.50 J 603.09 0.00 0.00 603.09 ,// 829.98 0.00 0.00 829.98 f 1,469.67 0.00 0.00 1,469.67 J Gross Discount No -Pay Net 10,236.77 0.00 0.00 10,236.77 Gross Discount No -Pay Net 358.12 0.00 0.00 358.12 j Gross Discount NaPay Net 358.12 0.00 0.00 358.12 Gross Discount No -Pay Not 6,403.87 0.00 0.00 8,403.87J Gross Discount No -Pay Net 8,403.87 0.00 0.00 8,403.87 Grass Discount No -Pay Net 408.00 0.00 0.00 408.00 J Gross Discount No -Pay Net 408.00 0.00 0.00 408.00 Gross Discount No -Pay Not 2D.87 0.00 0.00 20.87 J 8.28 0.00 0.00 8.28 J/ 795.12 0.00 0.00 795.12 V 1,606.05 0.00 0.00 1,606.05 37,081.43 0.00 0.00 37,081.43 J Gross Discount No -Pay Net 39,511.75 0.00 0.00 39,511.75 Gross Discount No -Pay Net 263.52 0.00 0.00 263.52� Gross Discount No -Pay Net 263.52 0.00 0.00 263.52 Gross Discount No -Pay Net. J 10023029599 11/11120206108120211/23/202 2.00 0.00 O.OD 2.00 J 70001632962 ✓ 11111/202 071311202 111231202 130.04 0.00 0.00 130.04 J 10023576970 11/11/20209/09I20211/23/202 2.00 0.00 0.00 2.00 Vendor Totals: Number Name Gross Discount No -Pay Net 14260 CAREFUSION SOLUTIONS, LLC 134.04 0.00 0.00 134.04 Vendor#/ Vendor Name class Pay Code 10641 J CARESFIELD Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 514425 10/29/20210/24/20211/23/202 495.74 0.00 0.00 495.74 514468 10/29/20210/24/20211/23/202 495.74 0.00 0.00 495.74 ✓ J0004582 11/11/20210130/20211/29/202 -495.74 0.00 0.00 -495.74 ✓ Vendor Totals: Number Name Gross Discount No -Pay Net 10541 CARESFIELD 495.74 0.00 0.00 495.74 Vendor# /Vendor Name Class Pay Code Cl.. COW GOVERNMENT, INC. M Invoice# Comment Tran Dt Inv Dt Due Ot Check Ot Pay Gross Discount No -Pay Net ,l AS29Z9D 11/06/20210/25/20211124/202 2,033.97 0.00 0.00 2.033.97� Vendor Totals: Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMENT, INC. 2,033.97 0.60 0.00 2,033.97 Vendor# Vendor Name Class Pay Code 133M J COCA COLA SOUTHWEST BEVERAGES Invoice# Comment Tran Dt Inv DI Due Dt Check Ot Pay Gross Discount No -Pay Net / 44127507009 11111/20211111/20211/24/202. J 811.28 0.00 0,00 611.28 Vendor Totals: Number Name Gross Discount No -Pay Net 13336 COCA COLA SOUTHWEST BEVERAGES 611.28 0.00 0.00 611.28 Vendor# Vendor Name Class Pay Code 10043 „/ CROSS COUNTRY STAFFING Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 7382896 11/12/20210/25120211124/202 1,920.00 0100 0.00 11920.00 Vendor Totals: Number Name Gross Discount No -Pay Net 10043 CROSS COUNTRY STAFFING 1,920.00 0.00 0.00 1.920.00 Vendor# Vendor Name Class Pay Code J D1200 OETAR HOSPITAL W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net DTR2410018 11111/20211/04120211/241202 831.34 0,00 0.00 831.34 Vendor Totals: Number Name Gross Discount No -Pay Net 01200 DETAR HOSPITAL 831.34 0.00 0.00 831,34 Vendor#/ Vendor Name Glass Pay Code 10368 DEWITT POTH &. SON Invoice# Comment Tran Ot Inv Dt Due Ot Chock Dt Pay Gross Discount No -Pay Net ' 7643080 101011202 08113/202 09/07/202 79.74 0.00 0.00 79.74J SUPPLIES j 7730150 11/061202 10131 =2 11/251202 462.22 0.00 0,00 462.22 Vendor Totals: Number Name Gross Discount No -Pay Net 10368 DEWITT POTH & SON 541.96 0.00 0.00 541.96 Vendor#/Vendor Name Class Pay Code 11011 �/ DIAMOND HEALTHCARE CORP Invoice#. Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gros: J IN20056409 10/311202 11/01/202 11/261202 19,166.67 JIN20056408 OCTOBER 2024 CPR 10/31120211/01/20211/26/202 33,132.9E OCT 'AO%4 biw V\wov Vendor Totals: Number Name Gross 11011 DIAMOND HEALTHCARE CORP 52.299.66 Vendor# JVendor Name. Class Pay Code 10789 v DISCOVERY MEDICAL NETWORK INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Di Pay Gross JMMC103124 114,632.04 r�111,It//11/2002210130/20211//p233/202 I Q - �� om Vendor Totals: Number Name Gross 10789 DISCOVERY MEDICAL NETWORK INC 114,632.04 Vendor# Vendor Name Class Pay Code 14832 J DR JOHN CLINTON Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Bross .J 110524 10/31120211/05/20211/23/202 2.700.00 1011. 10 I W11A 4 l0► ►� - 10113124 Vendor Totals: Number Name- Gross 14632 OR JOHN CLINTON 2,700,00 Vendor# Vendor Name Class Pay Code 14924 J DR. 71MU KWI Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross J 110524 10/31120211/05120211123/202 4,200.00 OCTOBER CALL Vendor Totals: Number Name 14924 DR. TIMU KWI Vendor# Vendor Name Class Pay Code El 090 J EDWARDS LIFESCIENCES M Invoice# Comment Tran Dt Inv D1 .Due Dt Check Dt Pay J 13868136 11/13/20210/31120211/131202 Vendor Totals: Number Name E1090 EDWARDS LIFESCIENCES Vendor# Vendor Name Class Pay Code 11284J EMERGENCY STAFFING SOLUTIONS Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay J 43712 11112120211/15120211/251202 1-11J`W Vendor Totals: Number Name 11284 EMERGENCY STAFFING SOLUTIONS Vendor#1 Vendor Name Class. Pay Code 14136+r EPI-EDWARD PLUMBING Comment Tran Dt Inv Dt Due Dt Check Ot Pay JInvoice# 68090 10/01 /202 09119120211 /23/202 Vendor Totals: Number Name 14135 EPI-EDWARD PLUMBING Vendor# Vendor Name Class Pay Code 14708 EQUALIZE RCM SERVICES Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay J 537082 11/13/20208/01/20209/05/202 av Gross 4,200,00 Discount No -Pay Net / 0.00 0.00 19,166.67 J 0.00 0.00 33,132,99 J Discount No -Pay Net 0.00 0.00 52;299.66 Discount No -Pay Net 0.00 0.00 114,632.04 ` ✓ Discount No -Pay Net 0.00 0.00 114.632,04 Discount No -Pay Net 0.00 0.00 2,700.00 t/ Discount No -Pay Net 0.00 0.00 2,700.00 Discount No -Pay Nei 0.00 0.00 4,200.00 f Discount No -Pay Net 0.00 0.00 4,200.00 Gross Discount No -Pay Net 133.20 0.00 0.00 133.201/ Gross Discount No -Pay Net 133.20 0.00 0.00 133,20 Gross Discount No -Pay Net 40,062.50 0.00 0.00 40,062.50 Gross Discount No -Pay Net 40,062.60 0.00 0.00 40,062.50 Gross Discount No,Pay Net 440.00 0.00 0.00 440.00� Gross Discount No -Pay Net 440.00 0.00 0.00 440.00 Gross Discount No -Pay Net 5,582.88 0.00 0.00 5,582.88 Vendor Totals: Number Name Gross Discount No -Pay Net 14708 EQUALIZE RCM SERVICES 6,582.88 0.00 0.00 5.582.88 Ventlor# Vendor Name Class Pay Code 10689 J FASTHEALTH CORPORATION Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 11A24MMCA 11/1112021110120211/161202 495.00 0.00 0.00 495:00� Vendor Totals: Number Name Gross Discount No -Pay Net 10689 FASTHEALTH CORPORATION 495.00 0.00 0.00 495.00 Ventlor# Vendor Name Class Pay Code F1400J FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J6216791 10129/20210/17/202111161202 5,310.00 0.00 0.00 5,310.00 Vendor Totals: Number Name Gross Discount WPay Net F1400 FISHER HEALTHCARE 5,310.00 0.00 0.00 5.310.00 Vendor#/ Vendor Name Class Pay Code 11183 J FRONTIER Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / J/ 080224 08113/2020810220211/241202 -1.297.25 0.00 0.00 -1,297.25 J .f 082324 09109/2020812320211/24/202 -39.36 0.00 0.00 -39.36 J J 092324 10/01/20209113120211/241202 -13.66 0.00 0.00 -13.56 ✓/ J 091924A 11/0520209119120211/24202 -14.00 0.00 0.00 -14.00 J 1 110224 111131202 111102J202 111261202 2,771.26 0.00 0.00 2,771.26 J Vendor Totals: Number Name Gross Discount No -Pay Net 11183 FRONTIER 1,407.09 0.00 0.00 1,407.09 Vendor# Vendor Name Class Pay Code 12948 J GREAT AMERICA FINANCIAL SVCS Invoice# Comment Tran Dt Inv Dt Due DI Check Dt Pay Gross Discount No -Pay Net 37792982 11/0&202. 1110120211124/202 9,854.00 0.00 0.00 9,854,00 `/ Vendor Totals: Number Name Grass Discount No -Pay Net 12948 GREAT AMERICA FINANCIAL SVCS 9,854.00 0.00 0.00 0,854.00 Vendor# /Vendor Name Class Pay Cade 00401 ✓ GULF COAST DELIVERY Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 103024 11/01/20210/3020211/29202 50.00 0.00 0.00 50.00 �ol41 aq ` J Vendor Totals: Number Name Gross Discount No -Pay Net G0401 GULF COAST DELIVERY 50.00 0.00 0.00 50.00 Vendor# Vendor Name Class Pay Code / G1210GULF COAST PAPER COMPANY M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 1 2588253 10/231202102920211128/202 V 718.64 0.00 0.00 718.641/ Vendor Totals: Number Name Gross Discount No -Pay Net G1210 GULF COAST PAPER COMPANY 718.64 0.00 0.00 718.64 Vendor# Vendor Name Class Pay Code J 14872 HOLLAND & KNIGHT LLP Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 33507111 11113/20211/05120211/131202 760.50 0.00 0.00 760.60 J Vendor Totals: Number Name Gross Discount No -Pay Net 14872 HOLLAND & KNIGHT LLP 760.50 0.00 0.00 760.50 Vendor# Vendor Name Class Pay Gods 15208 HOSPITAL CARE CONSULTANTS INC.. Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net J 6686 11/12/202 11115/202 11125/202 23,663.00 0.00 0.00 23,663.00 I.16-Vr-/ ./ Vendor Totals: Number Name Gross Discount No -Pay Net 15208 HOSPITAL CARE CONSULTANTS INC. 23,663.00 0.00 0.00 23,663.00 Vendor# Vendor Name Class Pay Gods 10922 J HUNTER PHARMACY SERVICES Invoice# Comment Tran Dt Inv Ot Due Ot Check Dt Pay Grass Discount No -Pay Net 46238 11/11/20210/3V202 11/23/202 15,078.35 0.00 0.0D 15,078.35,/ Vendor Totals: Number Name Gross Discount No -Pay Net 10922 HUNTER PHARMACY SERVICES 15.078.35 0.00 0.00 15,076-.35. Vendor# Vendor Name Class Pay Code 14976 INOVALON PROVIDER INC. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J24MO149667 11/11/20211/08120211/231202 736.56 0.00 0.00 736.56� Vendor Totals. Number Name Gross Discount No -Pay Net 14976- INOVALON PROVIDER INC. 736.56 0,00 0.00 736.66 Vendor#/ Vendor Name Class Pay Code. 11260 j INTOXIMETERS INC M Invoice# Comment Tran Dt Inv Dt Ova Dt Check Dt Pay Gross Discount No -Pay Net J BR0065034 11/12/20211/07/20211/24/202 714.50 0100 0.00 714.50 J Vendor Totals: Number Name Gross Discount No -Pay Net 11260 INTOXIMETERS INC. 714.50 0.00 0.00 714.50 Vendor#/ Vendor. Name Class Pay Cade 14540 JINDAL X LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 202425061 10/31/202. 11112120211/251202 0.000.00 0.00 0.00 9,000.00 / J Vendor Totals: Number Name Gross Discount No -Pay Net 14540 JINDAL X LLO 91000.00 0.00 0.00 91000.00 Vendor# Vendor Name Class Pay Coda Wl372. /JOHN B WRIGHT LLC Invoice# Comment Tran Dt Inv OI Due Dt Check Dt Pay Gross Discount No -Pay Net I J 110524 10/3VP0211/051202111231202. 1,500,00 0.00 0.00 1,500.00 OCT GALL Vendor Totals: Number Name Gross Discount No -Pay Net W1372 JOHN B WRIGHT LLC 1,50o.00 0.00 0.00 1,600.00 Vendor#I Vendor Name class Pay. Cade M2176 J MCKESSON MEDICAL SURGICAL INC Invoice# Comment Tran Dt Inv Dt Due Ol Check Dt Pay Gross Discount No -Pay Net J 22871083 11/11/20211/06/20211/23/202 247.78 0.00 0.00 247.78 J Vendor Totals: Number Name Gross Discount No -Pay Net M2178 MCKESSON MEDICAL SURGICAL. INC 247.78 0100 0,00 247.78 Vendor# Vendor Name Class Pay Cade M2470 J MEDLINE INDUSTRIES INC M Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net J 2342311358 10/01/20210/31/20211125/202 141.01 0.00 0.00 141.01 J 2342015377 .� 10/30/20210129/20211/23/202 198.68 0.00 0.00 198.68 " J 2342015376 10/30/20210129120211123/202 92.23 0.00 0.00 92.23 J 2342015378 10/30/202 10/29/202 11/23/202 57.97 0.00 0.00 57.97 J J 2342015379 10/30/20210129120211/23/202 6.88 0.00 0.00 6.88 J J2342143249 10/30/20210/30120211/24/202 152.T7 0.00 0.00 152.77 J J2342143246 10/301202 101301202 11124/202 492.74 0.00 0.00 492.74 J2342143247 10/30/20210/30/20211/24/202 10.93 0.00 0.00 10.93 J J 2342143252 10/30/202 10/30/202 11/241202 49.83 0.00 0.00 49.83 ✓ J 2342143255 10/30120210130/20211/24/202 4,687.03 0.00 0.00 4,687.03 J 2342143248 10/30/20210/30/202111241202 44.08. 0.00 0.00 44.08 J 2342143241 10/301202 10/30/202 11/241202 279.94 0.00 0.00 279.04 J J 2342143251 10/30/202 10130/202 11/24/202 104.04 0.00 0.00 104.04 J J2342143245 10130/20210/301202 41/24/202 30.92 0.00 0.00 30.92 J 2342148254 10130/20210130/20211124/202 282.85 0.00 0.00 282,85 J J 2342143243 10/30/202 10/30/202 111241202 13.14 0.00 0.00 13.14 J J/ 2342143250 10/30/20210/30/20211124/202 86.95 0.00 0.00 86.95 V �F 2342143244 10/30120210130/20211124/202 24.41 0.00 0.00 24.41 .� Vendor Totals: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 6.756,40 0.00 0.00 6.756.40 Vendont Vendor Name Class Pay Code. 12248 MEMORIAL MEDICAL CENTER Involceft Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 111324 11113120211113120211/131202 14.60 0.00 0.00 14.50 J Vendor Totals: Number Name Gross Discount No -Pay Net 12248 MEMORIAL MEDICAL CENTER 14.50 0.00 0.00 14.50 Vendont endor Name Class Pay Code M2621 MMC AUXILIARY GIFT SHOP W Invoice# Comment Tran Ot Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net J 111124 11111120211111120211/231202 126.03 0.00 0.00 125.03 / J Vendor Totals: Number Name Gross Discount No -Pay Net M2621 MMC AUXILIARY GIFT SHOP 126.03 0.00 0.00 125.03 Vendor# /Vendor Name Class Pay Code 10536 �/ MORRIS & DICKSON CO, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 2568660 10/29/20211123/20211/231202 22.37 0.00 0.00 22.37 J J 2654091 11/11/202 11/06/20211/23/202 30,27 0.00 0.00 30.27 N/ J2653449 11/11120211/0e/20211/23/202 4,692.92 0.00 0.00 4,892.92 V/ 2857187 11/11/20211106120211/231202 15.34 0.00 0.00 15.34 J2667188 11111/20211/06/202 11/23/202 81.60 0.00 0.00 81.50 / 2657169 11111/20211100/2021 V23/202 406.41 0.00 0.00 406.41 J 2657186 11111120211106/2021123/202 159.03 0.00 0.00 159.03 Vendor Totals: Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CO, LLC 5,607.84 0.00 0.00 6,607.84 Vendor# Vendor Name Class Pay Code 15940 /- Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net / SALNIC0002 11113/20211/05/20211113/20c 117.37 0.00 0.00 117.37 1 Vendor Totals: Number Name Gross Discount No -Pay Net 15940 117.37 0.00 0.00 117.37 Vendor# Vendor Name Class Pay Code 01500 J OLYMPUS AMERICA INC M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J37091976 10/01/20210/31/20211/25/202 201.88 0.00 0.00 201.88 � Vendor Totals: Number Name Gross Discount No -Pay Not 01500 OLYMPUS AMERICA INC 201.68 0.00 0.00 201.88 Vendor#Vendor Name Class Pay Cade 014164 ORTHO CLINICAL DIAGNOSTICS Invoice# Comment Tran Dt Inv Ot Due Dt Check Ot Pay Gross Discount No -Pay Net 1853777943 10/29/20210/28120211/27/202 329.05 0.00 0.00 329.05 Vendor Totals:. Number Name Gross Discount No -Pay Net 01416 ORTHO CLINICAL DIAGNOSTICS 329.05 0.00 0.00 329.05 Vendor# Vendor Name Class Pay Code 10152 PARTSSOURCE, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount NaPay Net J 05507347 10/29/20210/28/202111271202 18.89 0.00 0.00 18.89 05477294 11111120210/04120211103/202 18.89 0.00 0.00 / 18.89 Vendor Totals: Number Name Gross Discount No -Pay Net 10162 PARTSSOURCE, LLC 37.78 0.00 0.00 37.78 Vendor#1 Vendor Name Class Pay Code 10737 ./ - Invoice# Comment INVI427 Tran Dt Inv DI Due Dt I Itl 1120209/27/2021123/2022 Check Dt Pay Gross Discount No -Pay Net �f 1,548.14 0.00 0.00 1,548,14� Vendor Totals: Number Name Gross Discount No -Pay Net 10737 - 1,548.14 0.00 0.00 1,548.14 Vendor# Vendor Name. Class Pay Code S0905 PERFORMANCE HEALTH M Invoice# Comment J Tran Dt Inv Dt Due 01 Check Dt Pay Gross Discount No -Pay Net / IN98182518 11/05/20211104120211/29/202 55.98 0.00 0.00 55.98 / Vendor Totals: Number Name Gross Discount No -Pay Net S0905 PERFORMANCE HEALTH 55.98 0.00 0.00 55.98 Vendor# /Ventlor Name Class Pay Code 12480 �I PRO ENERGY PARTNERS LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J24100600 11/12/20210131120211/151202 2,121.84 0.00 0.00 2,121.84 J Vendor Totals: Number Name Gross Discount No -Pay Net 12480 PRO ENERGY PARTNERS LLC 2,121,84 0.00 0.00 2,121.84 Vendor# Vendor Name Class Pay Code 14536 j OLIVA PHARMA INC Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not J 76953149011 11/13120211107120211113/202 211.68 0.00 0.00 211.68� Vendor Totals: Number Name Gross Discount No -Pay Net 14536 QUVA PHARMA INC 211.68 0.00 0.00 211.68 Vendor#1Vendor Name Class Pay Code 15560 J R&R PETRO SERVICE. Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net J 2410682 11/11/20210129/202111281202 4,988.75 0.00 0.00 4,968.75 Vendor Totals: Number Name Gross Discount No -Pay Net 15560 R&R PETRO SERVICE 4,968.75 0.00 0.00 4,968.75 Vendor# Vendor Name class Pay Code 11251 j RAPID PRINTING LLC Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net J 26303 11112/20211/12/20211/27/202 65.00 0.00 0.00 05.00 J Vendor Totals: Number Name Gross Discount No -Pay Net 11261 RAPID PRINTING LLC 65,00 0.00 0.00 65.00 Vendor# / Vendor Name Class Pay Code 11024 J REED, CLAYMON, MEEKER & HARGET Invoice# Comment Tran DI Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 32570 11/11120211111120211/23/202 196.00 0.00 0.00 196.00 Vendor Totals: Number Name Gross Discount No -Pay Net 11024 REED, CLAYMON, MEEKER & HARGET 196.00 0.00 0.00 196.00 Vendor# Vendor Name Class Pay Cade 15264 J REPUBLIC PAIN SPECIALISTS Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Grass Discount No -Pay Net 38 11/13120209127120211/13/202 7,000.00 0.00 0.00 7,000.00 J Vendor Totals: Number Name Gross Discount No -Pay Net 15264 REPUBLIC PAIN SPECIALISTS 7,000.00 0.00 0.00 7,000.00 Vendor# Vendor Name Class Pay Code G0425 /ROBERTS, ODEFEY, WITTE & WALL W Invoice# .Comment Tran Dt Inv Dt. Due Dt. Check Dt Pay Gross Discount No -Pay Net 2036 11112120211111120211/21/202 1,347.50 0.00 0.00 1,347.50 / Vendor Totals: Number Name Grass Discount No -Pay Net! G0425 ROBERTS, ODEFEY, WITTE & WALL 1.347AO 0.00 0.00 1,347.50 Vendor#I Vendor Name Class Pay Cade S1700 `r SHARN INC M Invoice# Comment Tran Dt .Inv Dt Due Ol Check D1 Pay Gross Discount No -Pay Net JIN02369170 11/11/20211/06/20211/11/202 141.34 0.00 0.00 441.34 J Vendor Totals: Number Name Gross Discount No -Pay Net S1700 BHARN INC 141.34 0.00 0.00 141.34 Vendor# Vendor Name Class Pay Code S1800 J SHERWIN WILLIAMS W Invoice# Comment Tran Dt. Inv Dt Due Of Check Ot Pay Gross Discount No -Pay Net J 103124 11113/20210/31/20211115/202 529.96 0100 0.00 629.96 / V Vendor Totals:. Number Name Gross Discount No -Pay Net S1800 SHERWIN WILLIAMS 529.96 0.00 0.00 529,96 Vendor# /Vendor Name class Pay Code 11296 J SOUTH TEXAS BLOOD & TISSUE DEN Invoice# Comment Tran Of Inv Of Due. Of Check Dt Pay Gross Discount No -Pay Net JCM13497 11/04/20210/31/20211/25/202 -2,290.00 0.00 0.00 -2,290.001/ J 107044874 11/04/20210131/202111261202 3,769.00 0.00 000 3,769,00 Vendor Totals: Number Name Grass Discount No -Pay Net 11298 SOUTH TEXAS BLOOD & TISSUE CEN 1,479.00 0.00 0.00 1,479.00 Vendor# Vendor Name Class Pay Code 10494 J SPECTRACORP Invoice# Comment J INVI247 Tran Of Inv Of Due Of Check DI Pay Gross Discount No -Pay Net 11111/20209/27/20211/23/202 2.322.22 0.00 0.00 2,322.22� Vendor Totals: Number Name Gross Discount No -Pay Net 10494 SPECTRA CORP 2,322.22 0.00 0.00 2.322.22 Vendor#I Vendor Name Class Pay Code S3940 J STERIS CORPORATION M Invoice# Comment Tran Dl Inv Dt Due Of Check On Pay Gross Discount No -Pay Net. J13030861 11113/20211101120211/261202 216.40 0.00 0.00 218.40 Vendor Totals: Number Name Gross Discount No -Pay Net✓ S3940 STERIS CORPORATION 218.40 0.00 0.00 218.40 Vendor#I Vendor Name Class Pay code 14212 ./ SURGICAL DIRECT SOUTH Invoice# Comment Tran Dt Inv Of Due Dt Check Of Pay Gross Discount No -Pay Net J 9348 11AW2021029/2021112W202 6,025.00 0.00 0.00 6.025.00 J Vendor Totals: Number Name Gross Discount No -Pay Net 14212 SURGICAL DIRECT SOUTH 6,025.00 0.00 0.00 6,025.00 Ventlor# Vendor Name Class Pay Code 15244 J TEXAS ELITE THERAPY TEAM LLC Invoice# Comment Tran Of Inv Of Due D6 Check Dt Pay Gross Discount No -Pay Net 103124 11/11/20210131120211/23/202 23,900.00 0.00 0.00 23,900.00 Vendor Totals: Number Name Gross Discount No -Pay Net 15244 TEXAS ELITE THERAPY TEAM LLC 23.900.00 0.00 0.00 23,900.00 Vendor#I Vendor Name Class Pay Code T2204 J TEXAS MUTUAL INSURANCE CO W Invoice# Comment Tran Of Inv Of Due Ot Check Of Pay Gross Discount No -Pay Net 1006299665 10/3120211/05120211126/202 4.690.00 0.00 0.00 4,690.00 ► �� ► col 112,4 J Vendor Totals: Number Name Gross Discount No -Pay Net T2204 TEXAS MUTUAL INSURANCE CO 4,690.00 0.00 0.00 4,690.00 Vendor# /Vendor Name Class Pay Code T3130 `r TRI-ANIM HEALTH SERVICES INC M Invoice# Comment Tran Of Inv D1 Due Dt Check Dt Pay Gross Discount No -Pay Net J600524283 11106/202 10/30/202 11/24/202 137.99 0.00 0.00 137.99� Vendor Tolals: Number Name Gross Discount No -Pay Net T3130 TRI-ANIM HEALTH SERVICES INC 137.99 0.00 0100 137,99 Vendor# Vendor Name Class Pay Code C2510J TRUBRIDGE M Invoice# Comment Tran Dt Inv Of Due Dt Check Ot Pay Gross Discount No,Pay Net A2411061378 11/14/20211106120211/23/202 20,613.00 0.00 0.00 / 20,613.00 J J T2411081378A 11/14/202 11/08/202 11108/202 10,311.39 0.00 0.00 10,311.39 J Vendar Totals: Number Name Gross Discount No -Pay Net C2510 TRUBRIDGE 30,924,39 0,00 0M 30,924.39 Vendor# Vendor Name Class Pay Code U1064 J UNIFIRST HOLDINGS INC - Invoice# Comment Tran Ot Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net J 2921045881 11/04120210/31120211/25/202 2,532.64 0.00 0.00 2,532.64 J 2921045884 11/04/20210/31/20211/251202 162.14 0.00 0.00 162.14 J 2921045883 11/041202101311202111251202 372.12 0.00 0.00 372.12 J 2921045887 11/04120210131120211/251202 121.56 0.00 0.00 121.56, // 2921045879 11/04120210131/20211/251202 102.91 0.00 0.00 102.91 J 292104SB80 11/04/20210131/20211/25/202 176,93 0.00 0,00 176.93 � J2921045885 11104/202 10131/202 11125/202 181.78 0.00 0A0 181.78 J/ J 2921045882 11104/20210131120211/25/202 34.04 0.00 0.00 34.04 J J2921046083 11105120211/01/20211/26/202 749.54 0.00 0.00 749.54 J J 2921046082 11/05/20211/04120211/29/202 2.654.90 0.00 0.00 2,664,90 Vendor Totals: Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 7,098,56 0.00. 0.00 7,098.56 Vendor# Vendor Name Class Pay Code 12548 JWAGEWORKS. INC Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net J 1024TR116685 10/31/202 10/01/202 111231202 131.25 0.00 0.00 131.25 OCTOBER SERVICE PERIOD Vendor Totals: Number Name Gross Discount No -Pay Net 12548 WAGEWORKS, INC 131.25 0.00 0.00 131.25 Vendor#/Vendor Name Class Pay Code 11018 J WEBPT, INC Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net JINV588183 11112/20211112/20211/121202 10,355.22 0.00 0.00 10,355.22 / Vendor Totals: Number Name Gross Discount No,Pay Not 11018 WEBPT, INC 10.355.22 0.00 0.00 10,355,22 Vendor# / Vendor Name Class Pay Code 11110 �J WERFEN USA LLC Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net JInvoice# 9111664780 11/05120210,r31/202111251202 2,202.02 0.00 0.00 / 2,202,02 J j 9111666686 11/05120211/04/202111291202 Vendor Totals: Number Name 11110 WERFEN USA LLC Grand Totals: Gross Discount 499.082.28 0.00 1,092.91 0.00 0.00 1,092.91 ./ Gross Discount No -Pay Net 3,294.93 0.00 0.00 3,294.93 No -Pay Net 0.00 499,082.28 F- uccopy CITIBANK CORPORATE CARD Account Statement c..nm.zs, ca:4afo=um GBNCLEVeNOER pceo0m!nqu'rez: To,: Free 1 (800)•248.4553 tl mtemat'one• 1-(904}954-7314 Account Number XXXX-XXXX-XXXX-6228 TDDIT1Y 1•(877)SGS-7276 Summary of Account Activity Tole:Aat 1y $2.060.8o Send N0160o of B9Fng rurars and Customer sen^ce !nmrr'ee to: 07T.SANK NA POSOX6125, SIOUX FALLS SD57117.8125 Not an invoice, For your records ont , Wed'1 L'mt $20.000 Cash Aduaneo Uml $5p0o Statement Ciosng Date 11M312824 paya'n B""ng Pa.'ad 31 Transactfons NOTICE MEMO -TEM(S) LASTED BELOW ^--••—°•^�-= 10110 10109 5912 SM6874284102847905453 1 61PRMSRX50313 LEDGEWOOD NJ USA 370001/- 1824$19 10114 l0f11 9399 (IS134374286600067440707 2 NPDSNPDBARSAGCV FA:RFAX VA 22033 USA 2501/ NIISS60404 1N14 10N2 Well SM286MG2080058W140 3 AMA'CREDENTIAU'NG 800-021.8335L h11611 USA 44,00 10116 10n5 8734 55457374289052559007483 4 •MOXMETERSINC SAINT LOUTS MO 63148 USA 1.250.00 10f18 10117 S899 6643587429213292571DO59 5 NATIONALASSOC:AT:ONO FREMONT M: 49412 USA 3500V N97114 MS 10124 3503 55480774298039399048240 6 SHERATON WESTPORT LAKE SAINTLOUS MO 63146 USA 312,80 V 2959241 CHECK W: 10121nDZ4 I= 10M SM 0513437430560W09107604 7 NPDB NPD6.HRSAGOV FARFAX VA 2203E USA 250 ✓ N116910030 10131 1CM1 8999 554328643062043D4216519 8 AMA`CREDENMNG 800.621.83351 60011 USA 44.00 1' APPROVED ()f4 WWI 14 2024 B•a CLOUNTr AUDITOR ^AI_FIpUfJ CQUPIrY TEL NOTCE-SEE REVERSE SIDE FOR:MPORTANT INFORMATION Page i of _�, •= CTEANK.. N.A. C V S OUX FALLS 80 57117.3125 ERIN CLEVENGER 2028 ANN ST, STE A PORT LAVACA TX 77979.4204 MEMORI etRaM1ar� c D eLE"!1'ER XXXX-XXXX-XXXX-6228 kGCLt.��ng Date November 03. 2024 NOV 0 7 2024 ACCOUNTS PAYABLE 00010079643 Not an rewce Forym6recordsony. J J MEMORIAL MEDICAL CENTER PURCHASE ORDER Bill To: 915 N. VIRGINIA ST. Ship To: 815 N. VIRGH41A ST. PORT LAVACA, TX 77979 PORT LAVACA, TX 77979 PHONE: (361) 552-6713 PHONE: (361) 552-6713 FAX: (361) 552-0312 FAX:: (361) 5552-0312 Vendor Name: Date: It3" 1 2 t Vendor Address: Vendor Phone #: Vendor Fax P. P.O. # Account # ff initiated By: -yam Form # 9401 Date Required. Fspease# DepaNmM �}_����n/t r' DdiverTo YUIWV Line No. Qty. Catalog Number Description Unit Cost Unit Unit Meas. Extended I Cost 2 tic�tivtPr l� trAL viol 3 4 5 6 OPROVED '}t' 7 1 . IUZ'l B GA.LFiO�IN C;OUNFI I; TrXA.S 9 10 Est. Freight Est Total Cost TOTAL COST J ( V MEMORIAL MEDICAL CENTER PURCHASE ORDER Bill To: 915 N. VIRGINIA ST. Ship To: 815 N. VIRGINIA ST, PORT LAV. ,ICA, TX 77979 PORT LAVACA, TX 77979 PHONE: (361) 552-6713 PHONE: (361) 552-6713 FAX:' (361)552.0112 FAX: 1 (361)552.0312 Vendor Name: Vendor Address: Vendor Phone #: Vendor Fax #: P.O. # _ Account# Initiated B SRI ,Tilt. r.�ra►�rr_.�,i+�r>.. "� ,1 Est.Freight `'0 - NOTES: TOTALCT e� rye 10 n C e 5 d1/IG CAntaec Date: Dept Dimtor Quoted By. Dir. Nosing Buyer. ELA. Dir. Clinical Smicea MEMORIAL MEDICAL CENTER PURCHASE ORDER Rill To: 815 N. VIRGINIA ST. Ship To: 815 N. VIRGINIA ST. PORT LAVACA, TX 77979 PORT LAVACA, TX 77979 PHONE: , (361) 552-6713 PHONE: (361) 552-6713 PAX:' (361) 5/52�-0�382 FAX: /(3661)%552-0312 Vendor Name: "4 rye" t�F`. ;Date: �' lP ] a-�q Vendor Address: Vendor Phone #: Vendor Fax #: P.O. # r Account # Initiated Date Regoi"d Expense# Depamnent DeliverTo rormavq�s lino No. Qty. Catalog Number Description Unit Cost Unit Mess. Extended Cost l - P� _ P ov�� a5 2 .-AM q 1 "Coysf J 4 u 3 f "''�� r..(_ l' 1 4 - W v 4 I U t, 5 6 7 10 Est. Freight Est. Total Cost TOTAL COST Ll tP - 50 Contacr Date: Dept. Dimctar Quoted By. Dir. Nursing Buyer. Ma- Dir. Clinical Services MWESSON STATEMENT A. M: til15/2024 Pegm ONTo moue Prow amaft 10yM aee4ant, a0014t1ue, IN¢ Caw�r:4000 you, eluti wBA.ytiOrlpngle DC: 8115 Cuetem i INV SVyID: A. d: 11/15MG24 Poga: 002 Mall tm Cmnp: 30D0 MB.AOFIAI MEDICAL CB4THi ANT DUE N@dITT1D VIA ACH D®IT J Tertlta y: AP Statement for Intanaelba only AMT DUE aEMITTm VIA ACH DEBIT Stelement for Intonation only 815 N VMINN STgFET 032538 Lida: FONT IAVACA TX ]79]9 11r. DNo: 11/16/2024 Cunt: 632536 PIFASE CHECK ANY Dam: 1111612024- ITEMS NOT PAID lK) EN018 Gate: Dua flGaaA'"m .. Ome m1pr N r CMII- eionee OescNpllon DleooulA AaWGIVA t91aa•1 P AmaaM P. flKdVBOYt F (nm) F Numbet PF aammn bpntl: P e Pool Due Itan, F Mims D. Raw, EMn2 > Cunonl Duelmm TOTAL• NMWW Aaat 032636-MEMONAL. M®ICAL CENTER - ... -.. 11 - 1.435.09 USD - - Mo. Dum 0.00 .. _ . Om N Pem Oa TI.:. If Pam By 11119120M 'USD 1.406A6 Past Due: 0.00 Pay Tme Aauum: 1.406.36 USD - _ Dlm Iam N Pam IMe: 28.73 last Payment 2,45i:07 If Paid Aft. 1111912024, 0. a Pam IAIm 09107M017 - . Pay tMe AOreGA: 1,435.09- - USD - — USD - 1.435.09 J APPROVED ON a o z i .... �. NOV ] 8 2024 .. �p� �pTy p ))�� �jp CABHOIM� COIIN�Y.ITEtI For AR Inquiries please contact 800-867-0333 ML-lCt55vN STATEMENT AS of: 11/1SM024 Page: 001 To armor p opor a0tl8 to your a¢oum. delaoh mcl eetem INS Campvn: eom rub with your "ittonme '.DC: 8115 DomnoeJNV SUPPID: AS of: 11/15/2024 Pegs: U01 Ma9 le: Comp: 8000 WALMART f 098lMEM MED PHS AMT DUE-IMIM® VIA ACK DWT TeMtory; 70D1 MEMORIAL MEDICAL CENTER Stalwoun1. for information Only AMT DUE REMITTED VIA ACH DEBIT VICKY KALI69( n1(:.610 42 BtSlament for tMmma110n only 815 N VIN01NIA St Dato: 11f18/2024 Daten PORT IAVACA TX 77979 C.9; 256342 PLEASE CHECK ANY Dal. 111/6/2024 IT@.7S NOT PAID i+1 &TIn9 Oue IMceWObl eamni Aaount gapo CS01 Am ud P Anwum P PacatvWbk Dela Dete umber Mo. Dowription Cloward (grow) F (not) P NMObor Coomrn r Number 266342 WAWAN71098IMEM.MED PHS / iM1/2024 11/19/2024 7532566094 216962649 1151nvoka 0.02 0.95 0.93 d 7532588884 11111/2024 11/19/2024 7632568895 208082577 1151N.1 . 2.14 we.81 104.67 7532568805 I III IN024 1111MO24 7532660800 - 217037406 /161n,04" 5.26 202.98 257.72 � 7532668896 11/11/2024 11/19/2024 7532568807 212397189 1151nvoice 0.01 0.32 0.31 7532566897 11/11/2024 1111012024. 7532668890 212443630 1151nvokc 0.01 0.03 0.62 ✓ 7532668888 11/1112024. 11/111/2024 7532568899 215002663 tl5involw 0.03 0.03 J 7532SN699 11/12/2024 11/10/2024 7542872629 217266042 1151nvoice 0.83 41,42 40.59 J 7632872629 11/1212024 11/19/1024 7532872630 212443630 1151nvoine 0.01 0.32 0.31 J// 7632872630 11/13/9024 11/19/2024 7533121644 - 208939618 1181nvoice 6.62 331.12. 324.50 J 7533121644 11/13/2024 11/1912024 7533121645 208939618 It 6lnvcice 0.31 MASS . 15.16 ,//7533121645 11/13/2024 11110/2024 7533121646 21i357762 1151.01C9 0.04 1.90- 1.881533121846 11/13/2024 11/19/2024 7533121647 217419752 1151ireo14e 1.42 71.09 . 69-67 J 7533121647 11/13MO24 I111912024 7533121048 211413206 1151make 1.60 79.115 7025 J 7533121046 11/13/2024 11AP12024 7033121649 212501689 915I..1N, 1.60 - 78.95 75.25 J 7633121840 11/13/2024 /1119/2024 7533121650 2IMMS 1151ovolce 1.60 79:85- 78.2E JI 7533121660 11113/2024 11119/2024 7533121661 212447630 1151nmlee 0.01 0.32. 0.31 J 7533121661 11/13/2024 11/19/2024 7533121852 214944218 1151nvok.. 1.82 91.02- 0920 J/7633121652 11/15/2024 11/1912024 7SSS662815 217662805 1'161nvo1ce 5.30 204.76' 259.46 7530662815 PP column 1e9en6: P v PaSt Due gem, F e ROCKS COSS Rem. Work a Clmmt Doe 1Nm - -. APPROVED ON TOTAL Cu.Wamer NumM-256342 WAUAANT 100810N M M® ME -... Sul4atao 1,428.68 US0 MO. Due:. 0.00 couNOli.l JFIiEXA.Poo D MW on Tkw. CABY It Sold By 1111012024, USD 1.400.08 Peel DOe: 0.00 - Pay This AmmeBi 1,400.08 UM Dice loot 8 pid..lalm - 26.69 USK PAYmmd 0,116.79 U POIA SUN, 111/9/2024, - Due D PeW late: 11111/2024 - - Pay fhb Am4md1 1.428.68 U50 U8D 1.428.60 For AR Inquiries please contact 800-867-0333 MSKESSON A. of: 11/Ib 2024 PbeP: a01 To aneule Pmpa to youi STATEMENT Batul li MMoch and M.IMe come=nv: soon '. dubwM1k _y&vielnlllo04e IBC: 0115 As of: I1/1512024 Page: OOt C"camr INV SWPIO: Mall to: Came: 8000 CVS PNCY 103661M BA MC PNS AMT' DUE FW"TW VIA ASH D®n Tmltory: 7001 MEMORIAL MEDICAL OMTM s alelnenl'for InfonnatlOA only OUE VAt. A OMIT VICKY must t Cwlsmer; 635430 SMT Io�Ar lnllm®ma 815 N VIFRINIA ST Data: 11/16/2024 PpPi' IAVACA TX 77979 Coal: 836430-PIEASE CNMXO ANY D.W.1/116/2024 'UQAS NOTPAID (±) NoOw �N q�al�ePle Miawt Aaaam 9"6 Caen Amouml P A.9 P NmaFishk am:, Data Number lawaa. DeeoA911on Dlawwl (9roea F (w) F N.bw, CAM. Number 235430 CVS<PNCV 1035GINIM MC PNS 11/13/2024 11/t9/2024 7632948760 3666881 1151ne41c4 - 0.02 1.06 1.03 7632946780 O PF column fega ah ° ' P =. Paw Ow Neny F = F1Aum Ow. am, -blank = Conant Ow Nam TOTAL Ctm omnr Numhor $35430 CVS PNCV 103661110M MCE18 - - - --SubtatMx 1.05 USD F1A19e D. 0.00 Din N Paid On Thin: / If " N 1IM913024, USD 1.03 V NO Due: 0:00 Pay This Anmalll: 1.03 USD Otto Im 9 paw late: 0.02 last Paymam 3.558.66 NPaW-Aff r 111194024, 0w8 PMtl wm 10/21/2024 -- Pay fhb Alnauiil: 1.05 USD USD 1.05 APPROVE[) ON my ) 8 "'n CALLHO �Ur..oUMfY, TGNAS For AR Inquiries please contact 800-867-0333 M_ICCtiZOVN A. 4,1HSYL024 Page: 007 TOelsuritteawna our vile Prol STATEMENT rota a6,afo eagoto camww. eo. Nub-wAll y. re.Xtaeee am ails Cneto.er WV SUPPID: As of: 11115?2024 Pe9e: 001 MOB W. Camp: CVS PHCY 39230118M MC WE AMT CUE IIB,1iTf® VIA ACH DEBIT Tealt ory 7001 AI. MEDICAL CENtBt ) Slolemo0l lorinlolmolbn only W VIP ACH D®IT AMT CUE far VICKY00 VICKY KA4SEK J Cudo.O1: 535434 Info® statement iw Inleltedia0 only 015"N VIMNIA ST -Dole:/1116/2024 PDHT tAVACA TX 77979 Cud: 835434 PLEASE CHECK.ANY Dedo'. I IIIW2024 ITEMS NOT PAID (✓) a :.. Call D,w Heathrow.-.._._ ..____... OtBD" Coal, Fnedent P waIwKa meuM P fkaWehk I Dole Del. KWW Description MaeoVM (91aaa) F nd) F NOmpw I Carea.ey Nsinber 835434 CVS LOICY 8923/M13a Me WS 11/13/2024 11/19/9024 7532060877 3660562 1151nn.k. 0.01 0.32 0.31 J 7532986877 O PF column Ioge116: P - Pest Due It... ' E e Fulare Don Item, blank. Current Dud Rom TOTAb Customer Numbx885134 CYS PHCY89E3tt86AMCMill - SUMONOP 0.32 USO Mu. am 0.00 _ - Duo It Pakl Do Tlnw. J R PaM By 11119/2024 Use 0.31 and Late, 0.00. - Pay "to Aware: _ 0.31 Use 01. teal H "Id Wen 0.01 lad Peyment 466.20 - U Platt After. 1111912024, - - ' Due 11 WM W. - 11/04/2024 -- Pry flat,AmowR: - 0.32 -USD Use 0.32- . APPROVED ON NOV 18 209,1pp CAL BY TE%AS For AR Inquiries please contaCL 800-867-0333 MSKESSON STATEMENT As al' 11/15/2024 page: 001 To aman, prapar wait fo yootu .caamk .dekM am mui n lftla. ro ams: to. stub with your mmittancxr .- CVS:PHDL PHS. DC: 811fi Cuetonot Jw Bup01D: Ae 0: 11/16/2024 Page: 001 MaH to: C.W. 8000 6AL MEDICAL CEf4T9i MEDIC L S AMT DUE NEMITT® VIA ACH OMIT T oaHmY: ]00f Spmmant for Information Only VIA AM 0®IT AMT DUElot VICKY KALIS9( VICKY Cuefalndn 835437 inlrm StelameM for ipiPlAraOon enty N IA Dap: 11M82024 PO AVACVIMI )( PDNT tAVACA T% T]8]9 coat: 836437 RFASE CN8CK ANY Dal. 11/16/2024 ITEMSINOT-PAID (r) aN0rW1 Amami 6 MHlnp Due McONab Cab Amount P AmaralP AeuMblo DataDete Number Nation Wa DeacBmion Discount (91uso) F (nm) F Number 1111SM024 11/192024.. 7633137260 S605]03 11 St.." 0.09 4.41 4.32 J ]53313]260 O PF Colman legend: P = Past Due Item, F e M.D. Nem, bbuk= Curmm Due Item. - TOTAL' Cmt. Nmnher 836437 CVS PHCY 741WMM MO PXg 8uM01ala: 4.41 USD _.. .. KAM Dw:.. 0.00.. Due 11 WM Cn Mo . / It Pond By 11119/2024, USD 4.32 J Pam dw: 0.00 - Pay This Atmona 4.82 -USE) Disc lost N- paid W. u,stO.OB 11/1 ftymeIM024 - e.115J9 - If y this AAmowt:92024, Due If Ptltl tat. ' it/112024- � - - Pay iKia AmauM: - 4.4f UM t13p 4.41 APPROVED ON NOV NN1TT yy8 qq? f�li . +TT�pp qq CALLHOUNU C&NA 112PAS For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT Compel: esr. CVS MCV 7475/MBA Me MIS ALIT CUE HIM11 O VIA AC14 D®IT MEdCFKL MEDICAL C94TEa Statement far Ird... 11.0 only VICKI I(Au6EK -) a15 N VIMNIA ST PORT IAVACA TX 77970 A. of: 11/16/2024 PY .. 001 To en4ule Proper emdb w veer atewat,.ditseh ark never, this she, with Is w m ni t. DC: 8115 CWarnerlNV Suppla: As eft 11/15/2024 Pe6e: Oof Man to Co(nM BOao 76rdtny: 7001 AMT DUE IBAITT® VIA ACH DESIT Cupaner. 835430 SlatameM far informpt0n Mty Oata: 11/10/2024 Cup: SSM38 P1E16E CHECK -ANY Date: 11/1602024 ITEMS. NOT PAID (rt) v4 ImlmrM AIW Wt ¢I}R T6. Cseu Ameu01 P Amuint P Reee1VeN0 O�pa� Oeww Number seems Daeedi Weasel (Imes) F (.9 F Number Cuppnw Nambx 625439 CVS MCI 747511111611 MC MIS I G13/2024 110012024 7633123046 - 3668101 _ 1151nvolcs 0.01 0.03 0,62 "t 7633123040 0 M column lo9DyE P. Pap Dun Nam, F = FIA. Due Item, hlsnA . Cement Ow Item - TOTAL' Oupumer Number 635436 CVS MCI74TOMM NC MS swaMIC 0.63 USD i Dw: 0.00 _ Cu It Pant Ds This: it i By 1ty19/2024, USD 0.62 Pep Due: 0.00 lesy This A.":.' 0.02 USD Dhe Iom N pad lets: 0.01 Met pay^pat 6,115.79 U Paid After 11/19/2024, Duo H Ppd We: 11111/2024 - Poy'this AreeunL• 0.63 USD Use - 'M63- APPROVED ON NOV 18 20'4 CAHOUN.(tn]I TENAS For AR inquiries please. contact 800-867-0333 STATEMENT Statement Number: 68550271 AmerisourceBergen• nn,o. 11_ni:inw i oft AMERISOURCEBERGEN DRUG CORP WALGREENSCENTRALFILL#213i3340B 501 PATRIOT PARKWAY MEMORIAL MEDICAL CENTER 1005653561100566358 ftOANOKE T%]62624i3% 91000ALE EARNHARDT WAY 200 • NORTHIAKE T% ]8282-2389 DPA: RA0316958 r Sal -Fri Due in 7 days Bfi6-051-8655 V AMERISOURCESERGEN PG Sea 978740 OALLAS T% 1539]-6)40 Not Yat Due: 0.00 Current 112.45 Past 0. 0. 0 Teen Due: 11245 Account Salanee' 112.45 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 1628-2024 11-0&2024 31e36466fi3 m0]998668 Imaice 5.07 / 10-25-2024 11.0s2D24 31936"Isse 7MM05272 Mvoice 5.91 0.00 � 5.0] 1D-30.2029 11-062024 319391W63 )fiD602303a Invoice 31.27 0.00 f 5.0 1. 1"1-2024 11-08-2024 3194074818 7008031786 (twat. 12.17 0.00 3L2] 1&31-2024 11-08-2024 31%R2MW9 7MM42162 Imotce 18.92 0.00 � 11.1] t-0 i1-2029 11-08.2024 31843508fi] )008061826 Invoice 0.00 16.42 39.61 000 ✓ 39.61 Current 1-15 Days 16.30 Days 31.60 Days 81.90 Days 91.120 Days Over 120 Days 112.45 D.DO Doe - 0.00 0.00 ORD 0.00 Reminders APPROVED ON Due Date Amount NOV 18 NZd 11-0 2024 112.45 Total Due: 112.45 0y t�1 ry �pITpR COi1N AS % CALHOUN UV STATEMENT Statement Number: 68584335 AmensourceBergen- Date: 11.08-2024 l of AMERISOURCEBERGEN nRUC CORP WALGREENS CENTRAL RLL0213733409 100568356/1O0 03W 5m PATRIOT PARKWAY MEMORIAL MEDICAL CENTER ROANOKE T% 76262-6330 4100 DALE EARNHAROT WAY'200 NORTHLAKET T6282-2389 DEA: RA0316958AMER160URCEBERGEN J -I One In 7 days ;N1.v PO Box 9]8]40tDueOALLASU ]539]-8]40 nI60.5]ue: 0.00 Due: 60.53 Acceunl Balawe: 60.53 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 11.Od-2024 11-t&2024 3IW74UN ]W8062573 Invoce 4.08 0.W 4.09x, 1"4-2 4 11-1&W24 319e554]5] ]W80]6393 Invoire 27.O1 J 2]A1 11-05-z0za 11-15.2024 31W]tez82 T008ae521] Invoice 23..00 c.00 055 2.54 i L0&202A 11-1&2024 319C8]9202 7OO8097644 Invoice 1.66 0.00 � 1.55 1141]-W24 11.15.2024 3195032506 7008104321 invoice 2.72 0.00 2.72 11A8-2024 11-1&2024 3195189317 7008114297 1.01. 1.82 OW d 1.82 Current 1.15 Days 16.30 Days 31-60 Days 61.90 Days 91-1 W Oays Over 120 Days 0.53 0.00 0.00 0.00 O.0D p.W p,00 APPROVED ON ' Reminders Due Date Amount NOV 18 207E 11-15-2024 60.53 Total Due: 60.53 NTy UOnU�Urz��0. CALHOP AmeourceBe err STATEMENT Statement Number: 68617425 Date: 11-15-2024 1 of AMERISOURCEBERGEN DRUG CORP WALGREENS9124943408 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER 1001352U/037028186 SUGAR LAND U T747"101 13M N VIRGINIA ST • PORT LAVACA TI( 7797&2509 DEA' RA0289276 Sat -Fn Due in 7 days 666451-9655 AMERISOURCEBERGEN PO Box m223 CHARLOT7ENC 2M2 223 Not Yet Due: O.OD Cunene: 1.814.00 Peal Due: 0.00 TotamuC: 1.314.00 Acoount Balance: 1.814.00 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 11-11-2024 1182.2024 3195315127 ]008112881 Invoico 478.46 11-11-2n24 11-22.2024 3195316128 7008124549 Invoice 1,13].81 0.00 078.46 ✓ 11-11-2024 11.22-2024 3195315129 70081ll629 Invoice 12.12 0.00 1.137.91 ✓/ 11.13-2024 11.22-2024 319045860 70081,InS4 Invoice 91.70 0.00 1212 J/ 11.1 2=4 11-22-2024 3195641881 700814UM Invoice 1.24 0.00 91.70 J 1144.2024 11-22-2024 3195726M9 7008153286 Invoice 18.36 0.00 1.24 L2a 11-1&2024 11.2 2024 319597=4 7ON161334 Involve 0.00 ✓ Tom 74.21 O.W -� Currant 1.15 Days 1640 Days 3160 Days 61.90 Days 91.120 Days Over 120 Days 1.814.00 0.00 0.60 .0.00 ow 0.00 0.00 Thank You for Your Payment Reminders Date Amount APPROVED ON Due Date Amount 11-1&2024 (278565) NCCO��VNN1 A 211�,:TTy" 11.44D24 1,614.00 Total Due: 1,814.00 CA�NCIINUf:n A41 DIT?YA2 i J Amarsourice Si- U&US5Li31 Account Summary Aging Report DISC UMWILT14s FeW Is for Infoomfirsol ptn,sosard,, Please rater a UN Pmwaoadaalgen Salement of nawam far a aomylew lief downtandq invokes ant edjwstnsnwo.w. swoor, (xtthw Issunift.) avme6 interest. paemeaw andoth. caulfts Pisove We also That lrwolrsrs are clm wolordin, until orsnplels mrmoorl thereon Is received C..lOm. N.W, costsus, Mme c.mmt 1.7 -1: &16 - 16410 13145 4W 6-1-75 175 �jToWBnIarws 1005663% W&GRMENMN LFIL-021373 MOB I MM 0.00 OB 000aoo210251 — U628000 10. 0.0On MO'276.261[ APPROVED ON NOV 18 102.1 CAFHVO%UR .. M,K"T& S i r,_, ro BpWtw. WV. EW WI a a y. ai _l NI+mB .1 yt aunB-eaiuEu au _ pB• . - /YWB.. dU N]!ra myEw• s wmum r i.� ]- %%m+ lyls/m a w Bamuai laE ._, a%ymu IY!'i+'` a w pl lueomi y/IVMi. ss {� Imvlrsw nwvu" Ak ..lv / Nmi. u mu+miasB�, r WARM . + u N rpu -m -M. Iw. /ffi a • s !pN ri mx-lpquT NEIIpY t• Rf ._„ i] -iaB =. I I w+n a V]w W4W , o NIf/IW. ron a i is pLaf.. 41VEPN y 1vcwW 6Y'NnaWn.. P .. aa(_ ... .... I Vmu ]I Rryl. L. .�f 1M4LLMEWYYO v +M .. is M/:Y1B .YWIm INIYIN aiwwmaEwuaryliuwaWyw a 4a4,w f I VlVlet• _ b bNPpu BWxyi' v 3y �..... • W4. .iryyp L I).•-. M a.. la/x/_Ni 1pM.1 iwwi N[' v l,a r._" _ Nr . WIa/pM IHnw tl e•Vi1aM +1 p Bp pVNx a,INW 11 ] Iwa 1plan V,m• s E yalVm ' — - av Nm wlats oa _ _ a / v owYwow _ s mlwpa• KL rww YVam E IVII/.W+ U tqp MMR YS_ I .h !' N)!Am nT/w a t+' p aM lwSal] o I.A. awl tLtylyalaamplyW r ii� alrm, im•Nw a a amB lmoolW l l �sl B wB.alwuori. .E "p I%a+m •' y' W. •.wmp p ivnuav- �wbuuiww _wr �: "vra+m mymn r a d wmmm I nvra•. aykmiw ya ju _ o Bn ,.- am maTa .. �. i ai a my dniapi - 'm. aN4✓m. B •m _W;aw ylilWnloq"" . m." Iw64YIW6 I rT - -p f Y B i M4 �� adlv,u 1 O > ' n a ly> mu Wmyu. p II/IV,ON'. aN%m+ S m aPti.11u Mp EjININ VY[ p _j3I .k'Iwtiia . .# yw[ r a ,r: W NB{B I�VW IaiNn u I oN yWIBM NNsu. i a IW4n u4,ol fufYlw.'fwnu �. ..._"_^ 1'lw.Cv..._.... r. «. "Bs._?� a... vY,w•.._ _v4wl �J APPROVED ON NOV 9 Z024 y1 CABHOUN fMUANTY ITCEXAS TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) "ENTER 9-DIGIT TAXPAYER IDENTIFICATION NUMBER" 17"ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" ETIF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGIT TAX FILING YEAR" "ENTER 2-DIGITTAX FILING ENDING MONTH" 1ST QTR 03 (MARCH) -Jan, Feb, Mar 2ND QTR - 06 (JUNE) -Apr, May, June 3RD QTR - 09 (SEPTEMBER) -July, Aug, Sept 4TH QTR -12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" "6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER CALLED IN BY: CALLED IN DATE: CALLED IN TIME: ##" ENTER: ###f 0 0 941 # 0 $ 116,206.50 1 $ 61,641.32 $ 14,416.18 $ 40,149.00 S:\Finance SharelAP-Payroll FileslPayroll Taxes12024W24 R1 MMC TAX DEPOSIT WORKSHEET 11.14.24 1111812024 941 RECITAX DEPOSIT FOR MMC PAYROLL -r PAY PERIOD: BEGIN PAY PERIOD: END 1Uf72024 111,1,412Dz4 yyl PAY DATE: 71Y27/1Q2I GROSS PAY: $ 634,326,99 DEDUCTIONS: AIR 6 375.00 ADVANC BOOTS MUTUAL CRITICAL ILLNESS MUTUAL ACCIDENT IRS TAX MUTUAL SHORT TERM DIS MUTUAL VISION $ 027.68 CAFE-D $ 1,210.16 CAFE-N S 29,704.29 $ S CAFE-P CANCER CHILD $ 570.69 CLINIC 5 135.00 COMBIN $ 250.06 CREDUN $ - DENTAL S DEP-LF MUTUAL TERM LIFE s 1,226.91" MUTUAL HOSP INDEM $ 491.50 FED TAX S. 40,149.00 FICA-M 11 7,200.00 FICA-0 $ 30,620.68 FICA-M ADDITIONAL FIRST C FLEX S $ 4,682.30 FLX-FE 5- GIFTS 5 100.13 MUTUAL CRITICAL ILLNESS $ 974.23 MUTUAL ACCIDENT S 688.76 MUTUAL SHORT TERM DIS $ 1,704.47 LEGAL S 1,170.12. OTHER S 7,817.84 NATIONAL FARM LIFE $ 1,256.63 MED SURCHARGE $ -265.00 Blank RELAY REPAY STONEOF S 895.00 STONE STONE 2 STUDEN TSA-R $ 36,562.80 UWIHOS S TOTAL DEDUCTIONS: S 168,977.12 S xeuuuw1i31mrPDXt� ; Fwax 1 $ NET PAY: $ 386 34 7 L, TOTAL CAFE 126 PLAN: $ 37,219.43 $ 'ARABLE PAY: 1$ 497,106.56 $ 497,106.66 "CALCULATED- Fmm MMC R%m OlKwance :ICA-MED(ER) +.+sx S 7,208.05 9CA-MED(EE) ++sx $ 7,208.05 S 7.208.09 $ (0.04 ;ICA -SOC SEC (ER) 4:ax $ 30,820.61 !ICA - SOC SEC (EE) 4mx $ 30,820.61 $ 30.820.66 S (0.05 :ED WITHHOLDING S 40.149.00 S 40,149,00 REVISED 31182014 ADDITIONALCNII 600ITI0xALan11 TOTALS $ - IS 634,325.99 S S S 5 5 5 "a S 375.00 827.68 1,210.16 29,704.29 670.65 135.00 250.86 1,226.91 491.50 40149.00 7,208.09 30,820.66 4,682.30 100.13 974.23 688.76 1,704.47 1,170.12 7.817.84 1,266.63 265.00 $ 895.00 S - S - IS S 36,662.80 S - - 5 - 168.977.12 �civaulae7aAf+aakdlnnNnvicenerLgl $ $ 365,343.87 lYeAiGfINiDE111^�01101AO.WtOiR@ONT^ Exempt Amt: Employees over FICA -SS Cap: Michael Gaines Paycode S-Employee RDlmb.: TOTAL: $ TAXOEPOSIT: $ 116,206.32 S 116,20650 FICA -MEDICARE TWx S 14,416.10 $14,416,18 FICA -SOCIAL SECURITY vex $ 61,641.22 $61.641.32 PREPARED BY: FED WITHHOLDING S 40,149.00 $40,149.00 PREPARED DATE: TOTAL TAX: S 116,206.32 $116.206.50 $ Sadah Rubio 11/1812024 424 R1 MMC TAX DEPOSIT WORKSHEET 11.14,M; TAX DEPOSIT WORKSHEET 1IM512624 Run Date: 11/18/24 MEMORIAL MEDICAL CENTER Page 108 Time: 11:51 Payroll Register ( Bi-Weekly I P2REG Pay Period 11/01/24 - 11/14/24 Rur.' 1 Final Summary --- P a y C o it e E s m m a r Y-----------------------------------------a.- D e d u c t i o n s S u m m a r y-------------� PayCd Description Mrs 1071SRIHEIROICBI Gross I Code Anoust t REGULAR PAY-S1 9972.25 N N 11 237675.55 AIR 315.00i/A2 A/R3 t REGULAR PAY-91 1778.00 N N 11 N 85284,6E ADVANC AWARDS BCBSVI 1 REGULAR PAY•81 259,00 Y N 11 8959.91 BOOTS CAFE N CAFE-1 1 REGULAR PAY-S1 1.75 Y 2 N 11 02.01 CAF54 CAFE-3 CAFB-4 2 REGULAR PAY-52 2571,00 N N 11 70645Z CAPE-5 CAFE-C CAFR-D 1210.15V 2 REGULAR PAY-82 2.25 N 2 N. It 72.54 CAFE-F C.0-11 29704,2^ PB•I 2 REGULAR PAY-52 119.75 Y N N 4650.51 CAFE-L CAPE•F CANCER 2 REGULAR PAY-92 11.50 Y 2 N N 652.05 CHILD 570.69„ELINIC 135, OCIEDHB1N 25D.05✓ 3 REGULAR PAY-S3 14SIAS N N N 50293.32 CREDIIN ON AOV BENTAL 3 REGULAR PAY-S3 151.75 Y N H 6056.54 OEP-LF DIS-LF EAT 4 CALL BACK PAY 16,00 N 1 N 11 Y 849.65 EATCSE FENIAII 40149.O0,IFICA•N, 7208.09E 4 CALL BACK PAY 12,00 N 2 N I1 Y 597.66 FICA-0 30820.66AIRSTC FLEX 5 3942, BLV/ 4 CALL BACK PAY 8.00 4 3 A 11 Y 425.74 FLX FE FORT D FUTA C CALL PAY 1884.15 4 1 N It 3769.50 GIFT S 100.13,"T GRP-IN D DOUBLE TIME 15.50 N 1 N 11 1203.11 GIL EOSP-I NSA 639.491/ D DOUBLE TIME 32.00 N 2 N N 2657.56 ID TFT !RSTAX LEAF D DOUBLE TIME 42.25 N 3 N N 3565.30 LEGAL 355.62�4ASA 814.50,)=S 3592.71l/ D DOUBLE TII03 8.00 Y 3 9 N 1142.40 METVIS RISC F�I6C/ E EXTRA WAGES N N N II 1o,00 14HCSHR MOOACC 6e8.76 IiL 974.23✓ E EXTRA AGES N 1 N N 20.00 MOOI.ND 491.5 OOLIF 1226.9 STD 1704.47 ✓ E EXTRA WAGES N 1 N N N 220E.50 N,OOYIS 82i.63N4A7,FN.1 125616, TNE4 F F7RERA4 LEAVE 28.00 N 1 N N 995.32 FRI PHI.•• PR FIN I INSERVICE 18.00 4 1 N N 797,62 RELAY REPAY so K EXTEIIOED-ILLNESS-BANK 295.00 4 1 N N 7522.64 SCRUBS ST-71 P PAID -TINE -OFF 267.12 N 4 11 N 12595.44 SIONEW 895.0 ;IGNON TO4E ST09E2 P PAIB•TIME-OFF 1093.25 N 1 A It 28671.0E RIDDEN SILVACC SUNILL X CALL PAY 2 162.00 N I N N 324.0D SUNIND SD4LIF ��LL',`519 Y YMCA/CURVES N N IT N 15.00 SUNVIS SUACHG 255.0NfsA-1 E CALL PAY 3 96.00 N 1 N 11 288.00 SSA-2 jjSA-C TSA-P p PAID TIME OFF - PROBATION 8.00 N I N N 256,00 TSA-R 36562.80,910N UNIFOR 4225,13 ✓ t PHONE 6 DATA N N N N 20.00 trAMOS `-------------------- Grand Totals: 20113.87 --•••-- 1 Grass: J 534125.95 Oedactions; 160977.12 J Net: / 36534e.87 Checks Count:• FT 202 PT 10 Other 43 Female 225 Hale 29 Credit OYerArn; 12 EeroNet Term Total; 254 )1/u Lb C�L�� sleveBroakCa o.� Y4 � Mem001MMKa1COw, EIECTBoNICTMmmism !1� ll/W/20M . WMNLE TAKPYMTOO 6tevBer44k OTO Memlxkl MedlralTenMr MEMGRIBEMEORWCENTER. PROSPER" WK EI. ONICTRANSFERS MR OPERATING ACCOUNT—K."I, 20M- Nov 17,2024 j +- :. .• eMnMtlan mmm.939L 11000692244966P 3rd PwKPayw FM AmeOny 912W lied} �{{�/a�!��(� 1 80625896191MM102 340BDry Pmgmm Pl . k115.19 {` 1 VmarketWe 'MMOAWNE%DANRIMOMYwastOUMWl _ 1,M.0aam 9C,:)E oo, M M0254161451 -Cfe tQrd Pmc MFee 2,14140 - - - 159380133241961 .0 RCard Pryceasillg Fee WAZ 139980133240161 CINIIC WPM.Im Fn 1399a0t30299362 -Cr ftc.lop.amimlfee 1,U2A2 2,2U382 r 1 npI I3998M3323856]-Gedl[tYI4PIMmR1Ie F¢e 4NA6 } 13"MI36839261-OMKCafd Pro@ bt Poe WoR 210OW30I0M206 .DeymBTdica 122AI8.15 N,Pllav1t31226500 XMIUI Iniuranro GaM Paymmte 11.000.00 .,&.y, E TA•"' CENI£R TremfertRPr45peAryMMey Mwkyl 1.00, m gFp4. T IIOMM243153P -3rd P.MPayarR. ,Am 9 958aaRgloo U15-ElnppMu44Emylayer[MNWu1 1.38L16 ak14 8 - 906/433132100002 ACCBUEDIGTOSII 4UAT 4F t 11000695983D73P -3rd Pa0YFa9oe Fee .45A2 9- 1IOM597222MOP -3rd PaAy P4YoiF¢e ;ISM67 9 ae113122650080a-tlearyblmwenee [lalm Pd3menN- 2R130.W & WpU 1131Y465W-Xearyhlnsuranta CNli Pegmtmb E]8&90 iP 0 'PIUr113f2265W Ne ryhlnswpll[etlalmPnYmOnU OIDOOOT968210M02 310Rpgg NOEramppgA50 VpS3 9,9405D _ mlgz�RZSUG iTv;! 2,1E.5.65 1Bl.e% =41POM22229M CP ; redtCWMNgleal6fee M m MW04411MIZ22222221112 1W06 CCrreeddgI tGrMd MM,dMmee tloBam 94 rYp410M122it1R -[redll CaN MaMne4ase Fee 40.03 w 9l November 18:1027.✓y,.PfOJCLt OFF ��.eln.ay • �Y c� , IJ � 1; !d[4C!101z4 / Amyum -SaleaTaa 'V/ 2A54.9T . APPROVED ON MOM - Rw Mbera8, 2024 NOV 18 202r1 BY CQUI n AIIQITOp QALHQUPI AUNT T AS COMPTROLLEVEXASAW Beek Sales and Use Tax Texpaye MEMORIAL. MEDICAL CENTER. Address: 815 N VIRGINIAST, PORT.LAVACA TX 77979.3025 Tax Type: Safes and Use Tax Return Summary Original Return for Period Ending'10/3112024 (2410) Total Amount. Due and Payable may not reflect all payments or discounts. Please allow pending;payments 3-5 business days to process end appear on this. page. CREDITS.TAKEN Credits Taken Are you taking Credit to reduce taxes dua:an this return? Licensed Customs Broker Exported Sales, Did you refund sales tax for this riling period on Items exported outside the United States based on a Texas LiCenged.customs Broker Export Certifications? LOCATION SUMMARY Taxable: Subject to state Lots Toteliexes Sales Taxable gates Purchases Tax(Rate.0625) 00004 29,756 29,756 0 29.756 subtotal 29,756 20,756 0 29,756 Total Tax for Locations Total Tax. Due: Balance Due. Pending Payments: No No State Tax Due SubjecttoLocatia%LocalTa%Rate tocatTa%Due 1,8$9..75 29,756 0.02.008 $95.12 Si959.75 2%756 595.22 $2AS4.87 $2,454,87 $2;454,87 - $2.442.59 DateMme 11-04.2024/02:ii PM Submitted By ccievenger256 Pay Date 10.31-2024- Employee Deposits $74,591.42 Employer Contributions 5107,304.93 Oroup.Term Life.Premiums $0.00 Total $181,896.35- Comments Payroll File October 2024Retirement Upload.xlsx Plan StartDate EE Per Pay C ER Per Pay Cost 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $100.00 $25.00 2D24 Heath Equity Health Savings Account 1/1/2024 $147.91 $25.00 2024 Heath Equity Health Savings Account 7/1/2024 $0,00 $25.00 2024 Heath Equity Health Savings Account 10/1/2024 $25.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $60.00 $25.00 2024 Heath Equity Health Savings Account 9/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $10.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $25.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 8/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 2/1/2024 $25.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 2/1/2024 $163.25 $25.00 2024 Heath Equity Health Savings Account 10/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $50.00 $25.00 2024 Heath Equity Health Savings Account 2/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $100.00 $25,00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 3/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 9/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $25.00 $25.00 2024 Heath Equity Health Savings Account 7/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $0.00 $25.00 2024 Heath Equity Health Savings Account 1/1/2024 $20.00 $25.00 2024 Heath Equity Health Savings Account 2/1/2024 $0.00 $25.00 $751.16 $775.00 Total $1,526.16 Memorial Medical Center Transfer Request $ 250,000.00 Date: 11/18/2024 Prosperity Operating A[Wun= Account: Prosperity Money Market APPROVED ON NOV 18 ?0??;. Transfer from Prosperity Operating Account to Prosperity Money Market Account by: Michelle Cumberland Date: jja92024 Date: RECEIVED BY THE COUNTY AUDITOR ON 11N4I2024 NOV 14 M , MEMORIAL MEDICAL CENTER AP Open Invoice List 1o:ao Due Dates Through: 130/2024 �ALHOUN COUNTYTEXAS , Vendor# Vendor Nam Class Pay Code 11832 BROADMOOR AT CREEKSIDE PARK Invoice# Comment Tran Dt Inv Dt Due Dt Check On Pay Gross Discount J 110524 11/13/20211/05/20211130/2022 20,779.40 0.00 i nS. Pwvn - C� P . t n-tb rnmc, op� . � N _ur o r 110724 11/13/20211/07/20211/30/202 204.00 0.00 t L I Vendor Totals: Number Name Gross Discount 11832 BROADMOOR AT CREEKSIDE PARK 20,983.40 0.00 Grand Totals: Gross Discount No -Pay 20,983.40 0.00 0.00 APPRO1Pep ON NO1/14ZCl? CABHOCION NJ_ AUDI pp UPJ'N &3 0 ap open_Invoice.template No -Pay Net / 0.00 20,779.40 0.00 204.00 No -Pay Net 0.00 20,983.40 Net 20.983.40 RECEIVED BY THE COUNTY AUDITOR ON 71/14/2024 MEMORIAL MEDICAL CENTER NOVn 10:01 N1 4 / u-" AP Open Invoice List Due Dates Through: 11/3012024 ap_open_Invoice.lemplate Vendor# fJendor N4,�OUN COUNTY, TEXAS Class Pay Code 11824 THE CRESCENT Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net �Invoice# 110724 5.551.20 0.00 0.00 5,551.20 J / G11/13/20211iU7r'20211/30/202 Nm� 1 n �m Vendor Totals: Number Name ' �"'(✓ - Gross Discount No -Pay Net 11824 THE CRESCENT 5,551.20 0.00 0.00 5.551.20 Grand Totals: Gross Discount No -Pay Net 5,551.20 0.00 0.00 5,551.20 APPROVED ON NOV 14 q[D2pp CAgFFiiol!tl�rCTy1f 1 A''DI70AAS RECEIVED BY THE COUNTY AUDITOR ON NOV 14 ?o.' , MEMORIAL MEDICAL CENTER 11/14/2024 AP Open Invoice List 10:03 CALHOUN COUNTY, TEXAS Due Dates Through: 11/30/2024 Vendor# Vendor Name Class Pay Code J 11836 GOLDENCREEK HEALTHCARE Invoice# Comment Tran Dt Inv Dl Due Dt Check Dt Pay J110424 Gross Discount 11/13/20211/0420211/30/202 3,132.55 0.00 1t�S. V(n-(-.0 Qp. imb rnrnc-oQt,,;n Pxror f 110624A 11/13/20211/0620211/30/202 426.86 0.00 I / J 1106248 11n3r20211/0620211/30202 511.48 0.00 1 � •y J 110624 it/13/20211/06/20211/30/202 344.72 0.00 1 L t , Vendor Totals: Number Name Gross Discount 11836 GOLDENCREEK HEALTHCARE 4,414.61 0.00 Grand Totals: Gross Discount No -Pay 4,414.61 0.00 0.00 APPROVER ON NOV 14 2024 CAu Ol�tl DtlAtl�l T. qt,.c 0 ap_open_invoice.template No -Pay 0.00 Net 3,132.55 0.00 425.86 ./ 0.00 611.48 J 0.00 344.72 No -Pay Net 0.00 4,414.61 Net 4,414.61 RECEIVED BY THE COUNTYAtlDrrOR ON 11/1412024 MEMORIAL MEDICAL CENTER 1a:oa NOV 14 2r24 AP Open Invoice List Due Dates Through: 11130/2024 Vendorg Vendor Name CALHOUN COl1 " TEW Class Pay Code 12696 GULF POINTE PLAZA Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount J 110424 11/13/20211,''04/20211/30/202 0.21 0.00 Vendor Totals: Number Name 'l�(1MG a Gross`I n Discount 12696 GULF POINTE PLAZA 0.21 0.00 Grand Totals: Grass APPROVED ON 0121 NOv 14 20Z4 cABiirCOUNTY AUDITOR c�unly TEYAa Discount No -Pay 0.00 0.00 0 ap_open_Invotce.template No -Pay Net 0.00 0.21 / No -Pay Net 0.00 0.21 Net 0.21 RECEIVED BY THE COUNTY AUDITOR ON 11/14/2024 NOV 4' ZOG- MEMORIAL MEDICAL CENTER AP Open Invoice List 10:04 CALHOUN COUNTY, TEXAS Due Dates Through: t i/30/2024 Vendor Vendor# Vendor Name Class Pay Code 13004 VILLAGE JInvoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross 102924A 10129/20210/29/202 11130/202 13,680.00 Ins. pmt.GR tiIYM mmc,cp-b ONZrf-or- 1110424 11/13/20211/04/20211130/202 6,304.00 t t 1. J 110624 11/13/20211/06/202111301202 5,262.28 1L 110724 11113/20211/07120211/301202 9,090,00 Vendor Totals: Number Name Gross 13004 TUSCANY VILLAGE 33,336.28 Grand Totals: Gross Discount No -Pay 33,336.28 0.00 0.00 APPROVED ON NOV14';' BY COUNTY AUDITOR CALHOUId rOUH Y TEXAS 0 ap_open_invoice.template Discount 0.00 No -Pay 0.00 Nei / 13,680.00 J 0.00 0.00 5,304.00 J 0.00 0.00 5262.28 0.00 0.00 9,090.00 ✓ Discount No -Pay Net 0.00 0.00 33,336.28 Net 33,336.28 Al. M rm,, H UPt'm[er NUNP6 HPma UPI P/Pekry1tyA r9 nLLV P[[Pi PmePuns, ❑/l6/393< / V1 M� +w r..w l.ur. +.Prm+ r,ran.wwmuu� xm.r s3ll,r1 _ ,svuaM i1tL•,.s l.ar6,11 !]).991.99 er�e.m.r. uaen.0 Lar.ula+n. tNM +»,xn..n c,r rrMoue re nwroa, erMueM. 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LJtf 9WAA Balances Overview Account Name •4357 MEMORIAL MEDICAL- $2.036,568.47 $2,128,032.42 $2,036,568.47 $2,071,281.35 OPERATING *4365 MMC •CLINIC SERIES 2014 SERIES $547.97 $547.97 $547.97 $547.97 *4373 WAIVCLEARING PRIVATE WAIVER CLEARING $441.14 $441.14 $441.14 $441.14 `4381 MEMORIAL MEDICAL/NH $248,889.11 $263.815.61 $248,889.11 $179,060.96 ASHFORD •4403 MEMORIAL MEDICAL/NH $166,640.50 f $202,051.60 $166,640,50 $112,681.87 BROADMOOR *4411 MEMORIAL MEDICAL/NH $303,229.16 J $345,657.83 $303,229A6 $290,844.09 CRESCENT `4438 MEMORIAL MEDICAL I SOLERA @ $157,170.98 $175,536.09 $157,170.98 $115,375.71 WEST HOUSTON *4446 MEMORIAL / MEDICAL NH FORT $57,185.29 J $58,523.36 $57,185.29 $48,620.54 BEND *4454 MEMORIAL MEDICAL/NH GOLDEN CREEK $116,400.83 $122.382.12 $116,400.83 $54,436.07 HEALTHCARE *4551 CAL CO INDIGENT $9,706.51 $9,706.51 $9,706.51 $9,706.51 HEALTHCARE •5433 MMC -NH GULF POINTE PLAZA - $666.86 $666.86 $666.86 $100.00 PRIVATE PAY `5441 MMC -NH GULF POINTE PLAZA • $44,287.71 $44,312.71 $44.287.71 $40.501,63 MEDICAREIMEDICAID `5506 MMC •NH BETHANY SENIOR $59,691.70 $62,294.81 $59,691.70 $10,365.13 LIVING `USCAN VILL TUSCANY VILLAGE $243,139.02 $296,093.82 $243,139.02 $209,590.19 LIVING - DACA -BETHANY SR SR LIVING $100.00 $100.00 $100.00 $100.00 •2888 MMC -MONEY MARKET FUND $5,053,48 $5,053.48 $5,053.48 $5,053.48 Total Balance $3,449,718.73 $3.715,216.33 $3,449,718.73 $3,148,706.64 r Report generated on 11118/2024 08:40:11 AM CET Page 2 of 2 Memorial Medical Center Nursing Home UPL Weekly Nezion Transfer Prosperity Accounts 11/18/2024 j f I vmwea, Awbunt &4nnlry NuMn Neme Number aeMin{ iadaYaee{Innln{ AmauniWBenandmedlonunN{ BalarNe TraMenOut Tnruler-M Oe mlu eaynx Nnme / ,,., „ 115,I1a 9] 1E5,093A{ il6,1A5.9s � liad00.B3 91�335.3o J Sank 1ta,f00113 A. Varriant! twve In M." 10.00 Su0l11e101U.M14 21.910.W Haulm,m ,,tinn/m 6alden oek. Neaten Hwhb at Galden CWk Welbl0ry0lank, NA Note:OMybobnaln/avee$Y,Rylvlllbe non krWW rnemin,. ab." Nue": Eatb wmum bus barb kare 4510o tWA1MGdeansded 10 open arwunl. APPROVED ON NOV 18 2024 BY COUNTY AUDIT R CALHOUN COUNTY.T XAS ; WH weeur r—%1 XW UR Tumin SmmmjAsSE028ND UK nanrfer summrn 1119N ocurn.'et ISS.e9 NOa Nt[rat Adiurl Babme/namfee Amt 90335.ap JAowuvld v 1 5 eve Brack, 00 ll/tt/1024 MMCrOR11pN �.rct M'��.��. ENP/Gmpl lU:V t{ 5���s; Sys _ _ h!L(�9L9Yt TflQ GPPIGmpt WPp/CgpPl OIA/GmP3 dU N OIpPTI HNPO]IION IMNON15IWDLGOIPNNMSSseIMVi1 ll]IUMI{ IYMb01XatOCgliumlr:tl] I1lIN[A6NIW 11/E/tpiL MAIMXYIMN(v[M[[WWMIIIYApi111Nt13 6.U0.tl V.EP9V WLSfhVa lWfaeM(M(nn<MNgM2WlEN IlID]U)65 M la ' 20])5 Grote SI,5II31 M.�till t4MA0 SN10.0t 11:915,01 W1.1.1f llll[/AN ISYS/IMlls(IRSi[XfDO[i H)W.lwl.l ILMfIt li.so. 11]li/20li GOlO(XG(FYXNIIMIXCON UM1M...... SW W 9W 00 SUWf KOt KK[WMPMf "1500 1,]9{03 llfvfmM IN. WWI call. Itd IVU/N2{v/10[aYLN(MgN11fPlIIt OJW(WIOIXfM(NMC / l!$Wili6V 2225W - 313500 11/I]/Mtl GOIOtN[M![IINUMfMOtP ItNi5691WNEl! l0)9 14U/tllt<4010[NCvfFMNG 11 M1y pC OfP IttW569ITNI5N 1.0130 14U/MN NON2ASSOl1]IION XLWINDMi616DJ]{Sp%p156 l.fOwW 1W W 1111112G4 M[MINIIUMiN fv[IKfNIMPM(l9{EW NIUOUt 9J E.fl 9,83111 IU.1130f GVVDfbtnkSXnMUm[q[ON U2NH911MgR91 y0)]6 9]9tfi !UU/20M H[gtlll[IVVAI25VC 11C[WM1VM1Ii 11KGNttEllt 125119 1.35519 {159.(S ISS.C61. 'ICI 5.N Balances Overview Account Name *4357 MEMORIAL MEDICAL• $2.036,568.47 $2,128,032.42 $2.036,568.47 $2,071,281.35 OPERATING MMC - CLINIC SERIES SERIES 2014 $547.97 $547.97 $547.97 $647.97 MMC -PRIVATE WAIVER WAIVER CLEARING $441.14 $441.14 $441.14 $441.14 •4381 MEMORIAL MEDICAL / NH $248,889.11 $263,815.61 $248,889.11 $179,060.96 ASHFORD *4403 MEMORIAL MEDICAL/NH $166,640.50 $202,051.60 $166,640.50 $112,681.87 BROADMOOR *4411 MEMORIAL MEDICAL! NH $303,229.16 $345,657.83 $303,229.16 $290,844.09 CRESCENT •4438 MEMORIAL MEDICAL/SOLERA @ $157,170.98 $175,536.09 $157,170.98 $115,375.71 WEST HOUSTON *4446 MEMORIAL MEDICAL / NH FORT $57,185.29 $58,523.36 $57,185.29 $48,620,54 BEND •4464 MEMORIAL / MEDICAL/,NH GOLDEN GOLDEN CREEK $116,400.83 J $122,382.12 $116,400.83 $54.436.07 HEALTHCARE `4551 CAL CO INDIGENT $9,706.51 $9,706.51 $9,706.51 $9,706.51 HEALTHCARE •5433 MMC -NH GULF POINTE PLAZA • $666.86 $666.86 $666.86 $100.00 PRIVATE PAY '5441 MMC -NH GULF POINTE PLAZA. $44,287.71 $44,312.71 $44,287.71 $40,501.63 MEDICAREIMEDICAID *5506 MMC •NH BETHANY SENIOR $59,691.70 $62.294.81 $59,691.70 $10,365.13 LIVING TUSCANV VILLAGE TUSCA YVILL $243.139.02 $296,093.82 $243,139.02 $209,590.19 *3660 MMC•BETHANY SR LIVING SRLIVING - DACA $100.00 $100.00 $100.00 $100.00 *2998 MMC -MONEY MAR MARKET FUND $5,053.48 $5,053.48 $5,053.48 $5,053.48 Total Balance $3,449,718.73 $3,715,216.33 $3,449,718.73 $3,148,706.64 Report generated on 1 V70/202408:40:11 AM CST Page 2 of Memorial Medical Center Nursing Home UPL Weekly HMG Transfer Prosperity AccauMs 11/1812024 � � are Man / Aeewnl BeaInNM VeMIM AnpunlrOOe NVY Ilwe IluMer Wens Tnm1eNM_ (nmleNn t\IPnreO ee II V/ TranllenN la Tw1eYe0lLNJN4nnn IIweW Name Nn\Belen[e 000indal, 666.56 `uun� ,\al]I'(` nn BIIM[r ]eade Rtlinl Nlennnrentlereml __ aKl6 PnMr] •I[wnt Begmlq ]FmI MpM NUTWI aeYriee TnT1efLW !!.'MBIN l].aW Ot payy{ Tnnl inn pd re,16i ][ µ!0}.11 arrowrp Ba Tllnlgrnlle M1M7aMe VI 4%16}.}1 On\Nlmre y,]01.11 e..<varamlaennmwrpmn]uo: nueaW eawrlya[r.ss,ow inner uavMrer]leuenvrmsnane. nnn}: rw,m[wn,naiae.rreor.�,[<Wtrmmernm¢moenreromeea[ruw. APPROVED ON NOV 18 2024 tivuwreurrnmtrnwxuq rvrmrnwnanVW.Rx III T-111 111m1 11.1s21 nrwnt]w« Now ayun 44nn/fyuler Mn __ re.LT]I ielAl IR1NVi0.0 MAr3] Jbuare4: SCz sl.rr— aml��' .Insllo}r MMC PDPINH a. pMp/Come pIPP/fomp8 T.anskr•qul Twntlen� (HPP/GOmPl i gIPP/ComP3 &pp[a pIPPTI NN PORTION 11/ISkON NNO�ECHOHLCIAiMPMt )460W411 aJ00001J131d J9d d3 J98.93 tl/ISpOM HNB�ECHO HGCUMPMT )460031I14400001d1115 6BN NN 11/tl/MM WIRf OUTHMO Pakpor[30P.U<ommfinwl 430uaJ 6.S6Ltd 566.86 5663fi _- --- — -- -- - .... MMC PONION glPp/Lump RIPP/CO." Tr Or-n OOp)Compi 1 plPp/CPmP3 6OPW QlFPTi "PORTION 11/I5/101a MFRCNJNT MN¢OOFPOLa49daI65IBN9910WP1 3,)88.05 3,]BbAB !1114/2024 O.M1, 39,I60.12 39,166.]1 11/13/2P24 WIRE0UTNAW RU I,I5Nf,lP. CJmme! 31.80891 � I]/12/}024 A3FRb1ANI BdNx<00EPOLf n9W]85188999imn 1.234.91 1.99491 33308.96 / J61N.71 14 .7 39371.18 M ]58.5] d6.134.S7 Balances Overview Account Name '4357 MEMORIAL MEDICAL- $2,036.568.47 $2,128,032.42 $2,036,568.47 $2,071,281.35 OPERATING *4365 MMC -CLINIC SERIES 2014 SERIES $547.97 S547.97 $547.97 $547.97 *4373 MMC-PRIVATE WAIVER WAIVER CLEARING $441.14 $441.14 $441.14 $441,14 '4381 MEMORIAL MEDICAL NH $248,889.11 $263,815.61 $248.889.11 $179,060.96 ASHFORD *4403 MEMORIAL MEDICALI NH $166,640.50 $202,051.60 $166,640.50 $112,681,87 BROADMOOR `4411 MEMORIAL MEDICAL NH $303,229.16 $345,657.83 $303,229,16 $290,844.09 CRESCENT •4438 MEMORIAL MEDICAL/SOLERA@ $157,170.98 $175,536M $157,170.98 $115,375.71 WEST HOUSTON '4446 MEMORIAL MEDICAL/NH FORT $57,185.29 $58,523.36 $57,185.29 $48,620.54 BEND '4454 MEMORIAL MEDICAL/ GOLDEN CREEK $116,400.83 $122,382.12 $116,400.83 $54,436.07 HEALTHCARE *4551 CAL CO INDIGENT $9,706.51 $9,706.51 $9,706.51 $9,706.51 HEALTHCARE `5433 MMC -NH GULF POINTEPLAZA- $666.86 $666.86 $666.86 $100,00 PRIVATE PAY '5441 MMC -NH GULF POINTE PLAZA - $44,287.71 $44,312.71 $44,287.71 $40,501.63 MEDICAREIMEDICAID `5506 MMC -NH BETHANY SENIOR $59,691.70 S62,294.81 $59,691.70 $10,365.13 LIVING *3407 TUSCA YVILL TUSCANY VILLAGE $243,139.02 $296,093.82 $243,139.02 $209,590.19 • DACA -BETHANY SR LIVING SR LIVI S100.00 $100.00 $100.00 $100,00 '2898 MMC -MONEY MARKET FUND $5,063.48 $5,053.48 $5,053.48 $5,053.48 Total Balance $3,449,718.73 $3,715,216.33 $3,449,718.73 $3,148,706.64 Report generated on 11/1612024 08:40:11 AM CST Page 2 of 2 Memorial Medical Center Nursing Nome UPL Weekly Tus[any transfer Prosperity Accounts 11/18/2024 j J J J .rmYnn Ar[num YSU.us NYnglM0. Ta! Nma.[ m Home Nuelu ernna TnmNr m hanrMln 6r O.uN Oe 14 Tn .:'ry( 3. °Y',"j IIo,15]01 IIO,M).01 NlA19U ',le NnN YNm NV......Nome A)ASFCt J Y.k BeYrtt ]a1.119.W Vupnle rnv: mryeae.r.,aaw A.wv w,n NeemmhmN rere.nwues]vme. Nore}: Fmne,mumno,unmeeek,wuls]aouaenLN[ee.oueNro upmurcw+r. NOV 18 ?RL C �BHOUN� COtJt�ITY�� WA8 lem MB]Qn<e law Motliu Quunp. S.IU.]0 AaluaenlnuvRnmYrYn! ]UAsut �ew.a: 12.7 iw.eve,,aQ l45a/totn 1: 7,':` S��4i� w.. t-�. ...y L9QIPP/Came MMCPORTION mmm"m QIPP/COmPt, QIPP/temp QIPP/Camp Trarelel-0pt transfer -in 3 34&Witte 3 481apse QIPPTI NHPORTION OLUiIONHCCWMPMT67620142000p173 - 33,548.83 33,548.83 11/14/2014 "NO -ECHO HCCLNMPMT 746003411440000E98526 64,9E7.52 6g927.52 14/11/2024 WIRE OUT MLIAGE POST ACUTE HEMTH SERVICE. 28,696.12 13U.051.01 E8,696]2 11/13/2024 MOUMNF LTHCARMOUNM 0133746E42Y It 10,36$19 4L75 10,321.0 S,18L20 5,282.20 11113nO24 ""'ECHO HCCLAIMPMT746003411440000244342 - 11979.80 11/13/2024 NC%ATA550LUTIONHCCUWMPMT676201420000156 - 67.322.10 1,WA80 11/12/2024 Deposit 6],322I0 11/12r024 11NB-ECHONCCIAIMPMT7460 4IL440000271773 16.422.2E 16,422.2E - I 19,711.4E - 19,777.4E 110,057.01 243,039.0E 4275 10.32L64 518220 2378566 Balances Overview Account Name '4357 MEMORIAL MEDICAL- $2,036,568.47 $2,128,032.42 $2.036,568.47 $2,071.281.35 OPERATING *4365 MMC - CLINIC SERIES 2014 SERI $547.97 $547.97 $547.97 $547.97 *4373 MMC -PRIVATE WAIVER WAIVER CLEARING $441.14 $441,14 $441.14 $441.14 '4381 MEMORIAL MEDICALINH $248,889.11 $263,815.61 $248,889.11 $179,060.96 ASHFORD '4403 MEMORIAL MEDICAL/ NH $166,640,50 $202,051.60 $166,640.50 $112,681.87 BROADMOOR '4411 MEMORIAL MEDICALINH $303,229.16 $345.657.83 $303,229.16 $290,844.09 CRESCENT `4438 MEMORIAL MEDICAL I SOLERA @ $157,170.98 $175,536.09 $157,170.98 $115,375.71 WEST HOUSTON `4446 MEMORIAL MEDICAL I NH FORT $57,185.29 $58,523.36 $57,185.29 $48,620,54 BEND '4454 MEMORIAL MEDICAL INH GOLDEN CREEK $116,400.83 $122,382.12 $116,400.83 $54.406.07 HEALTHCARE '4551 CAL CO INDIGENT $9.706.51 $9,706.51 $9,706.61 $9,706.51 HEALTHCARE '5433 MMC -NH GULF POINTE PLAZA - $666.86 $666.86 $666.86 $100.00 PRIVATE PAY `5441 MMC -NH GULF POINTE PLAZA - $44,287.71 $44.312.71 $44,287.71 $40,501.63 MEDICAREIMEDICAID `5506 MMC -NH BETHANY SENIOR $59,691.70 $62,294.81 $59,691.70 $10,365.13 LIVING '3407 MMC TUSCANY VILLAGE USC VILLAGE $243.139.02 $296,093.82 $243,139.02 $209,590.19 '3660 MMC -BETHANY $100.00 $100.00 $100.00 $100.00 SR LIVING -DACA '2888 MMC -MONEY MARKET FUND $5,053.48 $5,053.48 $5,053.48 $5,053AB Total Balance $3,449,718.73 $31J15,216,33 $3,449,718.73 $3,148,706.64 Report generated on 11/1812024 08:40:11 AM CST Page 2 of 2 Memorial Medical Center Nursing Nome UPk Weekly NSLTransfsr ProspeNty Accounts t9/1gRg3a j j j Nun anemv eednNN NumW. 4Ln« nn,lev-0ul rlo MNlnn innvNnn tYvp.,,N Pv t rMeveSnviM�r wXM {moinue P. Tamhmaro / XmIn NMe ]A911A0 tlu,l 59 ft0.)1 - iA691.]0 J J i9,93aA9 wni Bdnnm f9.591.]0 WNMv le.r«n wl.m. saao s Iklaum,+ 11.999.}v all rce.IMln,c c`hOvknle[ale«I SAaa`'. txm(meOb We,w,linOFn".v. Nele}: ExFa+tOunt Flfnane P%an+enl SlW+Fo+M1,MCd�Pnrtfdnepenarc0un 1. APPROVED ON NOV 18 Cq�HOIINur(ry)Uj III ITQXAS uun.a«.� m. dm .vn ur:,nnn,a..�...,vro},an c.veneo sn,.,nav nas.a Falud ed,nn/rMd«Ant 95.915.q sleeewea,ero a/se/mn :VOaaO2. Xxe. ECHO IC<WAf%Jt4�4114OyaJltla W Ill. IM9.(CHO MC(..'W](f99)I111MX01NJJ1 Ivjwwt! wSpxW11KS"WH x =.116iW16WIM, 11/INWM W.'H 03 SOOI.wc.Is1111IJ13M Mlm WWm]911W xINVMµJVCKK(WMIAIt ItIKOJilIM162 IVll/m214nlmu344Nm1. KN O) $,IIPLIJ X5 11/lVmi! MISS-((MON[CNI.PW".31114 111191 Nlumi( wOC ourwnruvM1u xry l¢ IVIIIIOta xxa.[OloxuLVMvmr ll."ll..zlim 14V1t9]! NNe-IOION[(WM1IIA,I ]!{W 1111 upCWE)1]JI / IW11 1.01C,91 lo.]JO.O ✓ 50$10.TJ N i611 96 $9 NMCa01OICW r ^1uilcpai rnnlM.n (ura/camoJ INn/oamoa IJIro/yma9 wro/(emgau w (yron xxvonnox 3aays 90 1.19550 1.195.f0 1.15 uvt n J, ,JlO,ll 730I1 J]CJJ lryol 20OM ANOJI RStKN 3{,114>7 f1.996N 15.E50.11 J,Slsls `I Id119V Balances Overview Account Name •4357 MEMORIAL MEDICAL- $2,036,568.47 $2,128,032.42 $2,036,568.47 $2.071,281.35 OPERATING '4365 MMC - CLINIC SERIES 2014$547.97 $547.97 $547.97 $547.97 '4373 MMC -PRIVATE WAIVER CLEARING $441.14 $441.14 $441.14 $441.14 '4381 MEMORIAL MEDICAL INH $248,889.11 $263,815.61 $248,889.11 $179,060.96 ASHFORD '4403 MEMORIAL MEDICAL INH $166,640.50 $202,051.60 $166,640.50 $112,681.87 BROADMOOR '4411 MEMORIAL MEDICAL/NH $303,229.16 $345,657.63 $303,229.16 $290,844.09 CRESCENT '4438 MEMORIAL MEDICAL I SOLERA @ $157,170.98 $175.536.09 $157,170.98 $115,375.71 WEST HOUSTON *4446 MEMORIAL MEDICAL I NH FORT $57,185.29 $58,523.36 $57,185.29 $48,620.54 BEND '4454 MEMORIAL MEDICAL INH GOLDEN CREEK $116,400.83 $122382.12 $116,400.83 $64.436.07 HEALTHCARE *4551 CAL CO INDIGENT $9,706.51 $9,706.51 $9,706.51 $9,706.51 HEALTHCARE '5433 MMC -NH GULF POINTE PLAZA - $666,86 $666.86 $666.86 $100.00 PRIVATE PAY •5441 MMC -NH GULF POINTE PLAZA- $44,287.71 $44,312.71 $44.287.71 $40,501.63 MEDICAREIMEDICAID '5506 MMC -NH BETHANY SENIOR $59,691.70 $62.294.81 $59,691.70 $10.365.13 LIVING *3407 TUSCA Y VILL TUSCgNY VILLAGE $243,139.02 $296,093.82 $243,139.02 $209,590.19 SRLIVI -BETHANY SR LIVINGG*3660 - DACA $100,00 $100.00 $100.00 $100.00 *2998 MMC -MONEY MARKET FUND MAR $5,053.48 $5,053.48 $5,053.48 $5.053.48 Total Balance $3,449,718.73 $3,715,216.33 $3,449,718.73 $3,148,706.64 Report generated on 11/1812024 08:40:11 AM CST Page 2 or 2 P A Y E E AMOUNT: J MEMORIAL MEDICAL CENTER CHECK REQUEST Memorial Medical Center Date Requested: 11/18/2024 EXPLANATION: APPROVED ON NOV 18 Z11l4 CA PHI CO 1plll1 q, kS FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept $ 10,534.46 G/LNUMBER: 10255040 Molina Quarter 4 QIPP Payment J REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: �� MEMORIAL MEDICAL CENTER P Memorial Medical Center A CHECK REQUEST Date Requested: 11/18/2024 Y np ROVED OPf E NOV 1 8 702Q E CABBy CO GO,)AW."�,NAS AMOUNT: EXPLANATION: ./ FOR ACCi USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept $ 2,344.83 G/L NUMBER: 10255040 Molina Quarter 4 QIPP Payment J REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: Tks MEMORIAL MEDICAL CENTER CHECK REQUEST Fa Memorial Medical Center A Date Requested: 11/18/2024 1, 4ObOP1VEV ON E NOV 18 2024 E CALHOUNUCDLIA IT?PAS FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept AMOUNT: $ 2,901.78 `r G/L NUMBER: 10255040 EXPLANATION: Molina Quarter 4 QIPP Payment J REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: MEMORIAL MEDICAL CENTER CHECK REQUEST P Memorial Medical Center Date Requested: 11/18/2024 A Y PP44OVED mi E NOV 18 2024 E ADFIOUNUCO 1NI7Y 17XA3 FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept AMOUNT: $ 3,299.14 ✓ GA NUMBER: 10255040 EXPLANATION: Molina Quarter 4 QIPP Payment REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: P A Y E E AMOUNT: MEMORIAL MEDICAL CENTER CHECK REQUEST Memorial Medical Center Date Requested: 11/18/2024 EXPLANATION: APPROVED ON NOV 18 pi-! CALHD 1 r11),L, 011p, F, FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept $ 3,135.70 G/L NUMBER: 10255040 Molina Quarter 4 QIPP Payment J REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: IKS MEMORIAL MEDICAL CENTER CHECK REQUEST P Memorial Medical Center Date Requested: 11/18/2024 A Y E:D ON E gg NOooV 1 8 %,ipl^=ip E CALHOCI�1N ch(,l..V IT &4S FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑ Return Check to Dept AMOUNT: $ 21,810.04 f G/L NUMBER: 10255040 EXPLANATION: Superior Quarter 4 QIPP Payment J REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: �� P A Y E E AMOUNT: MEMORIAL MEDICAL CENTER v CHECK REQUEST Memorial Medical Center Date Requested: 11/18/2024 EXPLANATION: APPROVE-n ON NOv 18 C.ABH011l�3 fOIJAAw�EXAS FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor ❑Return Check to Dept $ 13,596.24 , G/L NUMBER: 10255040 Superior Quarter 4 QIPP Payment REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: �\ P A Y E E AMOUNT: MEMORIAL MEDICAL CENTER CHECK REQUEST Memorial Medical Center Date Requested: 11/18/2024 APPROVED ON NOV 18 '2�0?4BY UM CALHOurl CDUAT� TFXgS $ 5,182.20 EXPLANATION: Molina Quarter 4 QIPP Payment 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: OPPPMn TOMMC11.18.24 gIPP Pa ment to MMCfrom NurslnB Facilities Commissioner's Co at 1 NH Name Rom Bank Ante Ck# Payee GL4 u Molina Quartw4 1/20/2024 Superior Quarter4 TOTAL Dale A,hfoM Brpa9mpm C..nt Fartwd Salem Wden Creek Bethany Tusnrry P'.VaA Pros Orin, prof evil Pros eery Pros rit Pmsperi1v Pms only Promen MC-PrO eratl ros erit 0 va in ms nt 0 MV I-C-Pr. mperiry0peralin mspen 0.anon ros erity OpenGn re Operatin rmpenl annng 1OMM 10,5MA6 1o,534A6 11/2W2024 10255010 2,M4.03 2.M4M 11/20/2024 IMSSO40 10255040 /0255040 10255040 2901.78 2,901.78 11 20/2024 1299.14 3.299.14 11/20/2024 3113570 3,135.7011/20/2024 21.81004 21.810.04 11/20/2m4 102%m0 ]02550a0 Total: 13,0%.29 13,59.24 11/20/2024 5,183.30 9,162.20 I] 30/2024 21398.11 35406.32 6ZON.39 Approved: � Steve Broc ,= CFO 11/18/2024 MEMORIAL MEDICAL CENTER CHECK REQUEST P Tuscany f Date Requested: 11/18/2024 A Y E APPROVED ON E NOV 18 W4 9 At1NM BALHO t .rtllMry T _ AS AMOUNT: $ 14,500.60 EXPLANATION: Claim Paymwnt owed from Crescent to Tuscany FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check ❑ Mail Check to Vendor Return Check to Dept G/L NUMBER: 21400007 REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: -'!kN