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2025-01-29 Final PacketNOTICE OF MEETING - -1/29/2.025 January 29, 2025 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: Vern Lyssy David Hall Ronald Best Joel Behrens Gary Reese Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting was called to order at 10am 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Joel Behrens County Judge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk 4. General Discussion of Public Matters and Public Participation. Court wishes Commissioner Hall a Happy Birthday. Page 1 of 6 NOTICE OF MEETING— 1/29/2025 5. Approve December 11, 2024 and January 22, 2025 Commissioners' Court Meeting Minutes. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese,Commissioner Pct.4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 6. Consider and take necessary action to approve a resolution recommending support for the advancement and funding of advanced nuclear technology by the 89th Legislature of the State of Texas. (VLL) Heather Lyons with DOW explained the advancement and asked the court for support. Court approved the resolution. RESULT: APPROVED`[UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 7. Consider and take necessary action to approve the UniFirst Customer Service Agreement for Uniforms for Calhoun County Building Maintenance Employees. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES:' Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 8. Consider and take necessary action to declare Inventory Item 665-0209, Manitowoc Indigo Ice Machine and Storage Bin, Serial Number 1120018694/1101322954, as waste and remove from Calhoun County Extension Office Inventory. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES:: Judge Lyssy, Commissioner Hall, Best, Behrens,'Reese Page 2 of 6 NOTICE OF MEETING — 1/2.9/2025 9. Consider and take necessary action to approve the contract with Weaver & Jacobs Constructors, Inc. for Bid No. 2024.06 — Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) pass 10. Consider and take necessary action to approve Amendment #1 to the Short Form of Agreement Between Owner and Engineer for Professional Services with G&W Engineers, Inc., in connection to the Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, County Judge SECONDER: Gary Reese,Commissioner Pct'4 AYES:` Judge Lyssy, Commissioner Hall, Best, Behrens, Reese' 11. Acknowledge the corrected Fuel baseline price for the Fly Ash Road Material Bid Tabulation. The gasoline price of $2.665 on January 13, 2025 was used instead of the diesel price of $3.321.(VLL) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Ronald Best, Commissioner Pet 2 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 12. Consider and take necessary action to authorize Commissioner Behrens to sign the 2025 maintenance Contract with Hurts Wastewater Management for Precinct 3 septic system. (JMB) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct 1 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 13. Consider and take necessary action to declare the attached list of items for the Calhoun County Constable PCT 4 as Waste. (GDR) pass Page 3 of 6 ' NOTICE_ OF MEE1 ING—1/29/2025 14. Consider and take necessary action to issue a Credit Card with a limit of $2500.00 for Racheal Crober, Lieutenant, at the Calhoun County Detention Center. (VLL) RESULT: APPROVED [UNANIMOUS], MOVER: David Hall, Commissioner Pct SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 15. Consider and take necessary action to change the position title, job description and pay from salary to hourly for jail administration. (VLL) RESULT: APPROVED'[UNANIMOUS] MOVER: David Hall, Commissioner Pct l SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 16. Consider and take necessary action to approve the contract with MidTex Materials, LLC for Fly Ash — Road Material, Bid Number 2025.04 for the period February 12, 2025 thru December 31, 2025 and authorize the County Judge to sign all necessary documents. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 17. To acknowledge and accept the correction of Judge's name on the resolution for Lone Star Grant 2025 #5183101 and allow Judge Lyssy to sign. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct.4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 18. Consider and take necessary action to receive the Petition for the creation of the Calhoun County Hospital District. (VLL) Anne Marie Odefey explained the process of moving forward. Court ` approved to accept the petition. RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct'4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 4 of 6 NOTICE OF MEETING—1/29/2025 19. Consider and take necessary action to Accept grant from the Matagorda Bay Mitigation Trust in the amount of $249,926.00 for the replacement of the Little Chocolate Bayou restrooms and authorize all appropriate signatures on Contract number 077. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, CommissionerPct 3 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 20. Consider and take necessary action to approve attached surplus salvage for 2016 Bomag BW138D Serial Number 101650341034 to be used for trade for purchase of 2019 Bomag BW211ZD serial number 101586081540 and approve all appropriate signatures. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct I SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 21. Consider and take necessary action on any necessary 2024 budget adjustments. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 22. Consider and take necessary action on any necessary 2025 budget adjustments. (VLL) No action taken Page 5 of 6 NOTICE OF MEEFING — 1/29/2025 23. Approval of bills and payroll. (VLL) MMC Bills: RESULT: APPROVED_[UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese,Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens,"Reese Indigent Health Care: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct I SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 2024 County Bills: RESULT: APPROVED[UNANIMOUS] MOVER: David Hall,' Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct'4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese 2025 County Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct i SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hail, Best, Behrens,: Reese Adjourned 10:43am Page 6 of 6 ✓ All Agenda Items properly Numbered Contracts Completed and Signed U' All 1295's Accepted v All Documents for Clerk Signature Flagged (All documents needing to be attested to need to be signed day of Commissioner's Court.) On this -- day of I' 2025, the packet for the -- day of Q 2025 Commissioners' Special Regular Session was sub fitted fro i he Calhoun County Judge's office to the Calhoun County Clerk's Office. 7 , Calhoun County Judge/Assis ant AGEND I NO !101 OE `,A I ETING -1/2 9/2015 Vern L. lLyssy County judge David Hall, Commissioner, Precinct 1 Ronald ]Best, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 NOTICE OF MEETING - - T'he Commissioners' Court of Calhoun County, Texas will meet on Wednesday, January 29, 2025 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 AT V iLC® The subject matter of such meeting is as follows: 61 1. Call meeting to order. 2. Invocation. 3. Pledges of Allegiance. 4. General Discussion of Public Matters and Public Participation JJAN 2 4 2025 COUNTY,-p`vIRINNA IJ�U�fVNry �1FWIT+• }�/� 5. Approve December 11, 2024 and January 22, 2025 Commissioners' Court Meeting Minutes. (VLL) 6. Consider and take necessary action to approve a resolution recommending support for the advancement and funding of advanced nuclear technology by the 89th Legislature of the State of Texas. (VLL) 7. Consider and take necessary action to approve the UnTirst Customer Service Agreement for Uniforms for Calhoun County Building Maintenance Employees. (VLL) 8. Consider and take necessary action to declare Inventory Item 665-0209, Manitowoc Indigo Ice Machine and Storage Bin, Serial Number 1120018694/1101322954, as waste and remove from Calhoun County Extension Office Inventory. (VLL) 9. Consider and take necessary action to approve the contract with Weaver & Jacobs Constructors, Inc. for Bid No. 2024.06 — Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) 10. Consider and take necessary action to approve Amendment #1 to the Short Form of Agreement Between Owner and Engineer for Professional Services with G&W Engineers, Page 1 of 3 I NOTIr F OF iMF.F] IN("-- 1/ 9/202 Inc., in connection to the Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) 11. Acknowledge the corrected Fuel baseline price for the Fly Ash Road Material Bid Tabulation. The gasoline price of $2.665 on January 13, 2025 was used instead of the diesel price of $3.321. (VLL) 12. Consider and take necessary action to authorize Commissioner Behrens to sign the 2025 maintenance Contract with Hurts Wastewater Management for Precinct 3 septic system. (JMB) 13. Consider and take necessary action to declare the attached list of items for the Calhoun County Constable PCT 4 as Waste. (GDR) 14. Consider and take necessary action to issue a Credit Card with a limit of $2500.00 for Racheal Crober, Lieutenant, at the Calhoun County Detention Center. (VLL) 15. Consider and take necessary action to change the position title, job description and pay from salary to hourly for jail administration. (VLL) 16. Consider and take necessary action to approve the contract with MiclTex Materials, LLC for Fly Ash — Road Material, Bid Number 2025.04 for the period February 12, 2025 thru December 31, 2025 and authorize the County Judge to sign all necessary documents. (VLL) 17. To acknowledge and accept the correction of Judge's name on the resolution for Lone Star Grant 2025 #5183101 and allow Judge Lyssy to sign. (VLL) 18. Consider and take necessary action to receive the Petition for the creation of the Calhoun County Hospital District. (VLL) 19. Consider and take necessary action to Accept grant from the Matagorda Bay Mitigation Trust in the amount of $249,926.00 for the replacement of the Little Chocolate Bayou restrooms and authorize all appropriate signatures on Contract number 077. (DEH) 20. Consider and take necessary action to approve attached surplus salvage for 2016 Bomag BW138D Serial Number 101650341034 to be used for trade for purchase of 2019 Bomag BW211ZD serial number 101586081540 and approve all appropriate signatures. (DEH) 21. Consider and take necessary action on any necessary 2024 budget adjustments. (VLL) 22. Consider and take necessary action on any necessary 2025 budget adjustments. (VLL) 23. Approval of bills and payroll. (VLL) Vern Lyssy, County 3ud Calhoun County, Texas Page 2 of 3 Mu-IICF OF MI E I!'NG 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 ora under "Commissioners' Court Agenda' for any official court postings. Page 3 of 3 # 04 NOTICE OF MEETING—1/29/2025 January 29, 2025 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: Vern Lyssy David Hall Ronald Best Joel Behrens Gary Reese Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. Meeting was called to order at 10am 2. Invocation. Commissioner David Hall 3. Pledges of Allegiance. US Flag: Commissioner Gary Reese Texas Flag: Commissioner Joel Behrens County Judge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk 4. General Discussion of Public Matters and Public Participation. Court wishes Commissioner Hall a Happy Birthday. Page 1 of 20 # 05 NOTICE OF MEETING-1/29/2025 5. Approve December 11, 2024 and January 22, 2025 Commissioners' Court Meeting Minutes, (VLL) RESULT: APPROVED [UNANIMOUS]; MOVER: Joel Behrens, Commissioner Pct 3 SECONDER, Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 2 of 20 NOTICE OF MEETING— 12/11/2024 Vern L. ]Lyssy County judge David Hall, Commissioner, Precinct 1 Ronald Best, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 0'he Commissioners' Court of Calhoun County, ]Texas met on Wednesday, December 11, 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. ern L. Lyssy, County Judge Calhoun County, Texas Anna Goodman, County Clerk \OS COe j, °•. Deputy Clerk q`NOUN GO Page 1 of 1 NOTICE OF MEETING— 12/11/2024 December 11, 2024 MEETING MINUTES 9°E`° 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: (NOT PRESENT)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. CountyJudge Commissioner Pct i Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at 10am 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. none Page 1 of 6 I NOTICE OF IVIEETING— 12/11/2024 5) Approve December 4, 2024 Commissioners' Court Meeting Minutes. (VLL) [UNANIMOUS Ha ll, Ownii [on r Mt i Cf. 6) Consider and take necessary action to approve Consulting and GASB 84 Services with StevenLCraIn Consulting, LILC for fiscal year 2024 activity and authorize the County Auditor to sign engagement letters. (VLL) Nsloh, J.— ... Iss! %ne 7) Consider and take necessary action to approve an Interlocal Agreement between Harris County Department of Education and Calhoun County for becoming a Choice Partner member and authorize the County Judge to sign all relevant documents. (VLL) .0vt K MO ER. �peWehOdw. Did cr Mv Ild Hall, AYES... gmg. 8) Consider and take necessary action to accept the attached list of Donations to the Calhoun County Library for the months of November 2024. (VLL) RES11�T" APPROVED [UNANIMOUS] _ M$kR Commissioner, P David Hall, N . . . . . . . . . . . . . ns, Commissioner all ffo 7. isSee 4, 9) Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Surplus/Salvage for the months of November 2024. (VLL) ER. �Zary Reese, n rnissioner CQrrimtssiorre Hall, LIVP Page 2 of 6 I NOTICE OF MEETING—12/11/2024 10) Consider and take necessary action to declare the attached list of items for the Calhoun County Library as Waste for the months of November 2024. (VLL) REULT APp(fOVUNAN'IMDU] ' MOVERHaIPrvmmissioner pc= s L?ONQEP noel iehre CornmissPanef'!3 AYES: ilssioher Hdll; Lyssy, Reece 11) Consider and take necessary action to authorize the use of Tribal Assistance Funds to pay for IT/Communication desks. Total cost is $33,444.40. (DEH) RESULT �' i4PPJ;OVEI?�UI�ANIMOUS].� � N>��IER oeG Behrens,-CommPssioner x �EONDE[:-arReesmmissi6ner P 11fS._ t !ro(nrrfissi6flet fall, LysSy, Reece v_ 12) Consider and take necessary action to approve the Magnolia Beach CAP Feasibility Cost Share agreement and authorize all appropriate signatures. (DEH) [tE$llli. i� RO�fEl JUMl ANIfi'ItaUS] s ;MO`iiER �gef BeYrrerisOi er Pck 5F SE NDE1 ary Rees rr9rfii 91 0-1, t4 � kflY j t orhro�aei6nef-HA 4 air eese k 13) Consider and take necessary action to approve Change Order No. 1 for the Seadrift Drainage Improvements Project Glo Contract No. 22-085-014-D245 for Calhoun County, Texas and authorize County Commissioner Reese to sign. (GDR) 14)Consider and take necessary action to approve the Texas Association of Counties (TAC) 2025 Liability Renewal Proposal for the period of 1/1/25—1/1/26 and authorize the County Judge to sign. (VLL) Page 3 of 6 NOTICE OF MEETING—12/11/2024 15) Consider and take necessary action to lift or retain the county bum ban. (VLL) 16) Consider and take necessary action to approve the field agreement between U.S Department of Agriculture, Animal and Plant Health Inspection Service and Texas A & M Agrilife Extension Service Wildlife Services and Texas Wildlife Damage Management Association, Inc and Calhoun County for the period of January 1, 2025 — December 31, 2025. (VLL) Dijd 1fI,.Commissioneh Pets SEDQNDEit• --_ Gary Reese; Commissioner Pct' /#Y�'5: �, Coltirni�si0ner Hall, Lyssy, Reese 17) Consider and take necessary action to approve the contract with the following awarded bidder for Insecticides for Mosquito Control, Bid Number 2025.01, for the periods January 1, 2025 thru December 31, 2025 and authorize the County Judge to sign all necessary documents: (VLL) • ES OPCO USA dba Veseris • Adapco, LLC • Clarke Mosquito Control Products, Inc. • Rentokil North America Inc., dba Target Specialty Products K Joef Belirens,'Comm�ssion>~i�aet 3 N>DER DaYI Ha�l,=Gpmmissipner P; CorttriisslQner Page 4 of 6 NOTICE OF MEETING—12/11/2024 18) Consider and take necessary action to approve the contracts with the following awarded bidders for Road Materials Bid Number 2025.02, for periods January 1, 2025 thru December 31, 2025 and authorize the County Judge to sign all necessary documents. (VLL) • Blades Group • K-C Lease Service dba Matagorda Construction & Materials • Marek & Marek Truck Wash dba Frank Marek Trucking • Quality Hot Mix • Vulcan Construction Materials, LLC • Waller County Asphalt, Inc. RE$�LT• ,� APPR4V�D_[t7NANIMbUS] MOUEfiry Reese, Csnnrol$.srol5er Pct 4 SECNbER�: Jpel felirensf-�ommi3Sioner PCC i1Ys: Abrmissione Hall,; Lyssy, Rees9 19) Consider and take necessary action to approve the contracts with the following awarded bidders for Asphalts, Oils & Emulsions, Bid Number 2025.03, for periods January 1, 2025 thru December 31, 2025 and authorize the County Judge to sign all documents. (VLL) Cleveland Asphalts Products • Martin Asphalt Company itESULT• :1►PF�ROVEp`CUNAN3MOUS� I IOVEi�y � 7oe1 Behrens, -Commissioner F?Pct;3 i i A SE�aNi1 G�tjY Reeser,Gommissioner PCt�TM' 3 _ AYESu Cinmi5sivner H�If, Lyssy, Reesea Page 5 of 6 NOTICE OF MEETING— 12/11/2024 20) Accept Reports from the following County Offices: a) Justice of the Peace Pct 1— November, 2024 b) Justice of the Peace Pct 2 — November, 2024 c) Justice of the Peace Pct 5 — November, 2024 d) District Clerk — November, 2024 e) County Clerk — November, 2024 f) Sheriff Department— November 2024 g) Floodpiain Administration — November, 2024 h) Treasurer's Reports - August and September 2024 i) Treasurer's Quarterly Statement of Balances - 3rd Quarter 2024 j) Treasurer's Investment Report - Quarter Ending September 2024 k) Auditor's - Department Cash Count Reports —11t and 2nd Quarter 2024 1) Auditor's - Department Audit Reports —1st and 2nd Quarter 2024 m) Auditor's - Department Audit Reports - Activity prior to 2024 n) Auditor's - Department Cash Count Report - Activity prior to 2024 �R�JLT. �c AF��tOVED [UINkNrMOUS�] .' MDFR Jgel`Bel�rens;6ommissioner)� 3Ei�NGER Gary Reese, Commissiiiner Rt� AYES• Commissioner Hall, Lyssy, f{ee 21) Consider and take necessary action on any necessary budget adjustments. (VLL) A�PRi�VED��1N>t1NTMOiJ�]i ° `� �llLT�� .vE�� ..� nary Deese, �ammis�(oher Pst� { � � r ��O�i�l:•R �°� '_�� _Blrhrens �mixtisslgnez Pct 3 �a��s�� ' .gel l�orrr�(ss(oneF�taU; L�ssy,.Reese � " s � 22) Approval of bills and payroll. (VLL) NiNiC BiSj 't3 j . R SIUI I?RRovEa [ N ICY�;tc�Y[d MMO Mall, GorL,is�itsir`PLtF s ni9Sioner !0-4 �Y�^�,a Gorrtm(ss(pner l-[�[It Lyss}�l��ese } K, � µ r Cbfinit Bills• r i x^w MOI(Eitr>-= �` [�2Vi�l H�II, C�sRlmis�jbner Poi 1 : ' �- =�1EC01�D�'ii• � lar�l�eese, mrsiissioner Pct� =" AY� {� °� �" �or0t0issioner_�{all, �yssy, Reessr ; : Adjourned 10:26am Page 6 of 6 NOTICE OF M{ETING--01./22/2025 Vern L. ]Lyssy County judge David Hall, Commissioner, Precinct I Ronny Best, Commissioner, Precinct 2 Joel Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 The Commissioners' Court of Calhoun County, Texas met on Wednesday, January 22, 2025, at 10:00 a.m. in the Commissioners' Courtroom in the County Courthouse at 211 S. Ann Street, Suite 101, Port Lavaca, Calhoun County, Texas. Attached are the true and correct minutes of the above referencedmeeting. Vern Lyssy, Cou y Judge Calhoun County, Texas Anna Goodman, County Clerk Deputy Clerk Page 1 of 1 NOTICE OF MEETING—1/22/2025 January 22, 2025 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: Vern Lyssy David Hail Ronald Best Joel Behrens Gary Reese (ABSENT) Anna Goodman By: Kaddie Smith The subject matter of such meeting is as follows: 1. Call meeting to order. Countyjudge Commissioner Pct 1 Commissioner Pct 2 Commissioner Pct 3 Commissioner Pct 4 County Clerk Deputy Clerk Meeting was called to order at loam by Judge 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. Judge Lyssy thanked Commissioners, TX DOT and Sheriffs office for keeping the roads safe during the winter storm. Page 1 of 7 NOTICE OF MEETING— 1/22/2025 5. Approve January 15, 2025 Commissioners' Court Meeting Minutes. (VLL) RESUir, 3 ` _` g #1PPytQYED [UNANIMQU$] Ri*d: T11Qi/E til Jgel.l3ehrEns; Commissioner - SECQ IDER Gary Reese,.Commissio i'Xpct 4 ESQ judge Lyssy; C©mmissiner Hail, Best, Behrens, Reese��,; -- " - 6. Consider and take necessary action to approve car-pooling in a county vehicle for an out of state Extension Professional Development trip to Georgia for food safety training at the University of Georgia (National Center for Home Food Preservation), and allow Megan Glidden, FCH Agent in Aransas County, Denise Goebel Family and Community Health Extension Agent, DeWitt County and Erika Bochat, Agril-ife Southeast Regional Program Director, to drive the county vehicle on the following from March 21- March 30, 2025. (VLL) Rage Lys;y epla�ned°and asked for phi rtnrssion RE$ULT' APPRZ?YED [IINAN11140 M�a/ Rs bavfd Half, oissiorie mm SWNDEs Rgnald Best,`Commissiaher Rct y ; , ,. Judge L�rssy,_omrnisloner HaU; Best, Behrens, I;ee�e 7. Consider and take necessary action to declare the attached list of items for the Calhoun County Constable PCT 4 as Waste. (VLL) Pass 8. Consider and take necessary action on Matagorda Bay Mitigation Trust, Contract No. 080 - Expansion of King Fisher Beach Park, and authorize Judge Lyssy to sign all documents. (GDR) RE�UL�'• � APPRbVED [.UNANI.MQUS] '_ MQYi~M �Gary'Reese, Commissioner Pct 4` S��QMDER Joel Behrens, Commissloner. Pet' 3 r R AYESk Judge Lyssy, Commissioner HBII'Best, Behrens, Geese v Page 2 of 7 NOTICE OF MEETING—1/22/2025 9. Consider and take necessary action to remove several vehicles from the Sheriffs Office Inventory. These items will be taken to auction. (VLL) a) 2013 FORD LL - VIN 1FM5KAR3DGC40454 b) 2017 FORD PK - VIN 1FTEWIEFOHKV33383 c) 2016 DODGE PK - VIN 1C6RR7XT1GS180682 d) 2004 CHEV PK - VIN 2GCEC19V041261267 e) 2020 CHEV TAHOE - VIN 1GNLCDEC4LR282083 f) 2017 LPR - VIN 1M9US0813HD597037 g) 2005 NISSAN PK -VIN IN9AA06B35N50847& RESULT; [UN14NNTOUS] M�1YER )0y Hal{, Commissioner Pct 1 ; r NLZER Caq.Reese„Commissi6erer Pct nudge Lyft Comml§5f ner Hall estr BeFlrensr Meese 10. Consider and take necessary action to approve a resolution expressing our support to provide parents with school choice options for the education of their students in K — 12 in Calhoun County. (VLL) 11. Consider and take necessary action to approve the contract with Rain Seal Master Roofing & Sheet Metal, Inc. for Bid No. 2024.10 — Annex Building Roof Improvements Project for Calhoun County, and authorize the County Judge to sign. (VLL) Page 3 of 7 NOTICE OF MEETING—1./22/2025 12. Consider and take necessary action to declare a Phaeton Auto OTF Knife for Calhoun County Constable Pct. 4, that was broken while on duty as waste. (VLL) 13. Consider and take necessary action to amend the District Attorney's 2025 Forfeiture Fund budget in the amount of $22,162.00. to cover salary supplements and FICA for William A. White and Trevor A. Finster for the period of January 1, 2025 through December 31, 2025 and consultation fees for Randy Crider for six months. Plus an additional $1000.00 to cover expenditures such as civil citation fees in asset forfeitures. (VLL) 14. Consider and take necessary action to issue a Credit Card with a limit of $2,000.00 to Debbie Vickery, County Judge Office Administrator. (VLL) 15. Consider and take necessary action on the contract amendment with G&W Engineers for engineering services for the Recycle Waste Transfer Station and authorize Commissioner Best to sign all necessary documents. The original agreement was for $45,000 with an estimated amount of $4,000 for the Geotech Study. The actual cost of the Geotech Study was $5,200.00; increasing the agreement to $46,200.00. (VLL) Page 4 of 7 NOTICE OF MEETING-- 1/22/2025 16. Hear report from Agri Life Extension Agents. (VLL) ��uatr�� Ha�l�� a�d,liare��ave uRdates on aet��ii�l�s alnd �rR�r��s ` �I�eyha�re besen�Vblvgc�,ln ancE�Manked the�co�lit`fQrth��r� 3g i� nt�n ulDus supNO 17. Consider and take necessary action to approve the Preliminary Plat of Stella Place in Port O'Connor, Texas. (GDR) 18. Consider and take necessary action to award the bid for Fly Ash — Road Material, Bid Number 2025.04 for the period February 12, 2025 through December 31, 2025 (VLL) 19. Consider and take necessary action to approve the infrastructure development plat (IDP) of Simply Stay, LLC #2 located in Calhoun County TX. (JMB) pass 20. Consider and take necessary action to declare Inventory Item 24-0214, Heater, as Waste and remove from Precinct 4 Road & Bridge inventory. (GDR) - �#E�U�T• 3� ' APPR�dED[I�NI#Ni<II!IOUS]- : f� i MO�Vi[i� 5ei Behrens,ornrnissi�ner P� �(ERarytaeser G4mmislrEier Pct} A1�-ES ��r fudge Lyssy, Commisstnl��r HaIE,: l3esC Behi��ns �t�ese Page 5 of 7 NOTICE OF MEETING-- 1/22/2025 21. Consider and take necessary action to transfer Inventory Item 402-0020, 2 Walnut padded chairs with arms from the County Judge Inventory to Road and Bridge Pct. 1. (VLL) -SIIILVTr IXPPROUED UNAN MOU jI 'M�3�t� David Hail,�i�mmissioner�� 1' ` RtiiNQER _ Ponald 13est,Commissioner pc.2 z �Udge Lys' w%Commissioner )� jl, *t, 8:ehrens, Reese 22. Consider and take necessary action to approve the contract with Weaver & Jacobs Constructors, Inc. for Bid No. 2024,06 — Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) pass 23. Consider and take necessary action to approve Amendment #1 to the Short Form of Agreement Between Owner and Engineer for Professional Services with G&W Engineers, Inc., in connection to the Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) pass 24. Accept Reports from the following County Offices: a) District Clerk — July, 2024 Supplemental to Revised b) District Clerk — August, 2024 Supplemental to Revised c) District Clerk — September, 2024 Supplemental to Revised RESULT APPROVED [UNANIMOUS] `Q MOVQR J'ef Behrens; .Commissioner or - SECOV 0ky keels, Commissioner Pt- Ailf€S: 1'6 Ly sy, Commissioner HalWSesE, Behrens, Reese s. 25. Consider and take necessary action on any necessary budget adjustments. (VLL) Page 6 of 7 I NOTICE OF MEETING — 1/22/2025 26. Approval of bills and payroll. (VLL) q-u Z!Jt; Jig lit -F ROY U'N A NU K 0XV61, z-- OftONRAR: C P t 4-�� Reese, Commissioner c AYES.- Judge Cdm n s8 oner Hall, A 4:2024 CO tit ,M Reese 2025Z ont'-.A RESULT. 4SA se, N M-1 Adjourned 10:53am Page 7 of 7 # 06 NOTICE OF MEF..1 ING—1/29/2025 6. Consider and take necessary action to approve a resolution recommending support for the advancement and funding of advanced nuclear technology by the 89t" Legislature of the State of Texas. (VLL) Heather Lyons with DOW explained the advancement and asked the court for support. Court approved the resolution. RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: David Hall, Commissioner Pct_I AYES: Judge Lyssy, CommissionerHall, Best, Behrens, Reese Page 3 of 20 01/29/2025 Vern L. Lyssy County fudge David ]Hall, Commissioner, Precinct I Ronald Best, Commissioner, Precinct 2 Joel ]Behrens, Commissioner, Precinct 3 Gary Reese, Commissioner, Precinct 4 A RESOLUTION OF THE COMMISSIONERS COURT OF CALHOUN COUNTY, TEXAS, RECOMMENDING SUPPORT FOR THE ADVANCEMENT AND FUNDING OF ADVANCED NUCLEAR TECHNOLOGY BY THE 89th LEGISLATURE OF THE STATE OF TEXAS. WHEREAS, the Texas Public Utility Commission, on November 18, 2024, published the "Deploying a World Renowned Advanced Nuclear Industry in Texas" report. WHEREAS, the Commissioners Court of Calhoun County supports the development and scaling of the advanced nuclear technology industry in Calhoun County and the State of Texas. WHEREAS, the advanced nuclear technology industry offers significant potential for economic growth, job creation, and energy security through the provision of clean, reliable, and dispatchable energy sources, and WHEREAS, Calhoun County is uniquely positioned with its strategic location and existing infrastructure to become the site of the first advanced nuclear technology project in the State, and WHEREAS, the State of Texas has a long-standing tradition of leadership in energy innovation and is committed to fostering a diverse energy portfolio that includes advanced nuclear technologies, and WHEREAS, collaboration between local, state, and federal entities, as well as private sector stakeholders, is essential to the successful development and implementation of advanced nuclear technologies, NOW THEREFORE, BE IT RESOLVED that the Commissioners Court of Calhoun County hereby expresses its full support for initiatives aimed at developing and scaling the advanced nuclear technology industry in Calhoun County and the State of Texas, and encourages continued investment, research, and collaboration in this vital sector and recommends that the 891h Legislature of the State of Texas take action to implement the recommendations of the Texas Advanced Nuclear Reactor Working Group. Page 1 of 2 01/29/)0)5 Adopted the 29th day of January, 2025. rn L. Lyssy, Cou y Judge I10C1 � aL0 - Joel ehrens Commissioner, Precinct 3 Attest: Anna Goodman, County Clerk aDeputy y- Clerk Ronald Best Commissioner, Precinct Gary Re se Commissioner, ecinct 4 Page 2 of 2 Collaboration Is Key Momentum toward these impressive outcomes began when the DOE selected X-energy to develop, license, build, and demonstrate an operational advanced reactor and fuel fabrication facility by the end of the decade. Timeline For more information, contact: Sam Gammage, Government Affairs Director, Dow North America Government Affairs sgammageftdow.com 9 energy Eo CC igy Oemonevetlov 0 Scan the QR code at left to find more detailed information about the Xe 100 technology. WTM Trademark of Dow a an affiliated company of Dow The future of safe, clean power and steam is being developed at a Dow facility in Seadrift, Texas. Dow and X-Energy Reactor Company, PLC (X-energy), a leading developer of technology for clean energy generation, have begun site work for the installation of a commercial- and industrial -scale small modular reactor (SMR) complex that will use innovative nuclear fuel to meet all the site's needs for electricity and industrial - grade steam without any carbon emissions Recognizing the potential of SMR technology, the U.S. Department of Energy (DOE) named Dow a sub-awardee under X-energy's Advanced Reactor Demonstration Program (ARDP) Cooperative Agreement, Dow and X-energy will demonstrate the viability of SMR technology to transform the way industrial operations are powered. A New Path Forward The technology that will be utilized in Seadrift is unlike anything ever employed. X-energy's groundbreaking Xe-100 reactor is powered by fuel pebbles, roughly the size of a billiard ball, that are embedded with 18,000 trisoparticles, each containing a minute uranium kernel enveloped by three carbon layers. This greatly enhances safety, because the trisofuel itself acts as a containment vessel. — careo� _ s�wpawa• Heat from the reactor produces steam that drives electric generators and can `•'°° also be used for industrial processes. Four Xe-100 reactors will be installed awa in Seadrift, with capacity to generate up to 320 MW of electricity and all the ^"' —,.steam Dow needs. R.10. — Expansive Impacts The Seadrift project is intended as a demonstration of the SMR technology, opening the way for other facilities, within Dow and beyond. "Our advanced nuclear project is another example of Dow leading the way and showing industry the path toward a lower carbon future," said Jim Fitterling, Dow chairman and CEO. "Alongside Dow's key decarbonize and grow projects in Alberta and Terneuzen, as well as our circularity projects around the globe, we are positioned to drive growth by delivering sustainable products." NOTICE OF MEFTING — 1/29/2025 7. Consider and take necessary action to approve the UniFirst Customer Service Agreement for Uniforms for Calhoun County Building Maintenance Employees. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES:Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 4 of 20 PAGE I OF 2 UniFirst NEW ACCOUNTS EXISTNGACCOUM❑ INSTALLATION DATE mruonnvw CUSTOMER SERVICE AGREEMENT COMPANY NAME (Cusmmer) Colhoun CountyCourthouse LAC. NO. 815 ADDRESS 211 S. Ann St. ROUTE NO,, Port Lavaca, Tx, 77979 DATE ! If 2'I /-�-G✓ ^ PHONE 361-553-4499 SIC/NAICS The undersigned (the "CUSTOMER"I orders from UniFirst Corporation and/or UniFirst Holdings, Inc. d.b.s. UniFirst and/of UniFirst Canada LTD. I"UNIFIRST") the rental service(s) et the prices and upon the conditions owlined: I a IDST7 NO.OF TOrALND.OF PRICEFER SFANDARDI ITEM DESCRIPTION DAMAGED SERVICE PENSONSI CHANGES/ CHANOW NON. TOTAL FULL TOTAL REPLACEMENT FREQUENCY ISSUE PER PIECES PIECE eTANDAnDr SERVICE VALU LEASED CHARGE PERSON 0102(09) 65135 Work Shirt 9 11 .22 S 21.7E 10A1(31)65/35 Work Cargo Pant 9 11 All S 39.60 Weekly Total tv/Garment Loss Protection: 75.24 Minimum weakly thorgo applies, equal to 75% of the Initial weekly install value. 10.00 Garment preparation per piece 1.25 Non -stock sizes per piece Name emblem per piece 2.00 Special cute per place 2100 Company emblem per piece 3.75 Restock/Excharigs per piece Direct Embroidery: Wearer name per piece Company name per piece 3.75 Automaticfter Replacement 5.35 Automatic Linen Replacement GLP: 0102 Work Shirt .05 DEFE (See description on reverse side) 9.00 PAYMENTTERMS: C,O,D.❑ E.F.T.❑ Approved Charge'❑ Gmblam charge solved for initial install GLP@0102-Work Shirt=9,00, 10AI-Work Pant=13.86 'TOTAL Weeklywith DE+PP.: InKM Approved Strange: CUSTOMER agrees to make payments within 30 days of Theunderstgnedagrees the Customer ServiceAgreamsntlbnnsand invoice receipt. A late charge of l lhY par mrY f187o par year) forany amount eneststohavelhe the toe xe Gla r thenamed CUSTOMER and to appos use In errors Dust be applle& ,ram ofarywour EFoe n—i kll ablandidenti8es—Ihathte,baenr uesGd. g SALES REP: PipXSumme t'I L/ ACCEPTED: EPIPINI N,MeI WE 7 a"� 'CLSTr1Mka@ignalWal ' TE ACCEPTED': i Z � L' L "V MM' ml5lnax m) CAPql nMEglPrvrl WmoeNTi el lason Koehler /'/�. btt LCPAiIONMnNFGFP p'tlm Nemso q EMML r Du5svK 010Me1wlsealarvlarE MtlC191s1500re tl00 RStlIe bo NOn Sbntla,tl MeeQiandsO. °Mlle WTKtlredsactltletline0c10tliV0Bhilfalm au4jecl to s35 pe[essinelse. °MOMYMUa WNJI aVdW4N5eJi9 nq[Ieasetl by U,srilsl anUA9feamenl iselfecrire oMyupol K[eplencahy UnlFl,stlMaean MaNgar. ° bw9ealeWs [orNrgent urynwnWuiryTONil NtlnlJneas arW mry ba,ewked er UNFeaI§tllattetion PONT&SION IRI COPIES ON IEGALSRENIVx 14')MPER1 0 LOCAL UNIFIRST COPY VSCANNEDCOPVID CORPORATE OPPCs) OCUSTOM96COPY PmmpIJSaPPer.OSCa PAGE 2 OF 2 CUSTOMER SERVICE AGREEMENTTERMS cruces. watomeroeerertomumYlml Gary.Merchandileerenleigamlenlallof Customeremequire entsmomfdlnlhisAgmes an (upon M Wises and related pie W forth ry heentl maintenance aewicas ices reueted by with min;erballyOr Inw6dinfor allot Customersrequirements Ihent. at the pacesantluponmeteens and coerne s set thee hereto.of Unl nail canoes requested by Ct IS not k verbally or in waling, will also be covered by thisder pgrmullid. All rental Merchandise sent Mir e Suaomerre aliristhe Merchandise orry ofices cov red. erwarrenis that It is nail subject to, and that this Agreement does not lnledere orcomlidwith, any misting egreemenlfwlhe supply of the Merchandise or Services covered. PERFORMANCE GUARANTEE. UNIFIRST GUARANTEES TO DELIVER HIGH -QUALITY SERVICE ATALLTIMES. All Items of Merchandise cleaned, finished, Inspected repalred, and delivered by UnlFlrel will meet or exceed Industry Standards, or non-cordonNng items will be replaced by the next scheduled delivery day at no cast to Custamec Items aRemal Merchandise requiring replacement One to normal wear and marvAil be replaced! at re costle, Customer, save ferany spplleabie parsonegaalkn and se sp charges. are prat mass in among IS UnlFlrel which set forty the precise nature of any degdenaes; (2, UnlFlrel is afforded at least 60 days to mrrecl any defidencles complalned of, and (3) UNFImt falls o mrrect pose deticlencle, complained of Mihin 6g days. In the event Customer compllas with the foregoing and UnlFlrel fails to cored such deficiencies, Customer may terminate this Agreement by written notice to UNFIrsT pmvrfrn, that all previous balances due to UNFlrst have been pad In full and that ell ether conditions to terminate have peen salsfied. Any delay or Ntenupilom of the Services provided for in this Agreement by reason of ads of God, fires, explosions, strikes or other industrial disturbances, or any other cause net within the central of Unfil shall net be doomed a breach allolatlon of this Agreement TERM AND RENEWAL. TiMAgreemem Is effective when signed by both the Customer and UniFlst Locetion Manager and continues In effect fw60 months afterinstalagon of Merchandise (far new customers) or any renewal data. This Agreement will be renewed automatically and conlinuausly for multiple successive 60anonlh periods unless Customer or UnlFksl gives written miles of non -renewal to the other at least 90 days prior to the next expiration date. PRICES AND PAYMENTS, prices are bassi tom 52 weak. of service per year. Any increase(s)to Service Frequency could result In addsonal charges. On an annual basis, the paces then In aped will be Increased by the greater of the annual percent Increase in the Consumer Place Index -All Urban Consumers, Series ID: CUURCOOGSAG, other pay _-6argasand_ .._erein peke Incuaving, UnlFlrel they plot; an e t Agreement. III OIW r aeo a fieea to pay the other charges and or pays g for my charge harem andis eIs Charges t Individual. ndng to a weassirlAny Merchandise Customers employ can n tent to by ee a tre notice thereof to cement and (2) then In are paying far any consent need Customer issued to that Individu Out Any Merchc receive eand acknowledge requireowledg puM1v ry to er Agreement will be at the replacement to make men In aged hereunder. If an abhotlzetl later who represead s. Is col available b receNe end acknowlatlpe delivery of Merchandise, Customer authorizes UNFImI to make delivery and asstma6 responsibility for ralaletl chargesgnvalces. If Customer fags to make timely payment, UnlFlrst may, at any time am In its sole dlsaeliorb terminate this Agreement by giving wagon Miles o Customer, whether or not UnlFlrel has previously amcpy enforced Customer's abllgalton to make timely, payments. Customer agrees to pay, and will pay, all applicable seise, use persona property, and other taxes and Measurements edging out of this Agreement. DEFE CHARGE. Customers invoices may also Include a DEFE charge to cover ail or portions d' certain expenses Including: D = DELIVERY, or expenses associated with the actual delivery of Services and Merehandlrs to Customer's place at business, primarily Route Sales Represenellver commissions, management ealedeS, vehicle depredefloa, equipment maintenance, Insurance mad use charges and Iowa access fees. E = ENVIRONMENTAL, or expenses (past, present, and future) UnlFlrsl absorbs misted to wastewater lesting, pudril of glen control, solids disposal, supplies and equipment for pollution controls and energy conservation, and overall regulatory compliance. F = FUEL, or the gas, diesel fuel, all, and lubricant expenses associated with keeping UmFirsrs fleet vehicles an the road and seMdng its customers. E = ENERGY, primarily the natural gas UNFIra uses to inn bolters and gas dryers, plus other Ideal utility charges, MERCHANDISE. Customer acknowledges and agrees to notify all employees that Merchandise supplied Is for general occupational use and, except as expressly specified below,.fiords W scandal user Drolectlons. Customer furtheraAnnwnd.n rbel. Nb 1—in•so1,.a=.,aie,e..•n.........w -a.. -._.—..___-,.- Scope a all Merchandise to be used and Lee; (3) UnlFlrel makes no undeeenlation, warranty, at covenant regarding the perfomnance of the Memhandee (Including wilhoul limilallon Flame Resislenl antl VtsNUly Memhandlse); and (4) UNFIMt shall in no way be responaiWe w liable for any Injury or harm eufiered by any Customer employees while weaning or using any Merchandise. Customer agrees to Indemnify and hold harmless UNFirsI and Its employees and agents fram and against all dams, Iyudes, or damages to any person or property (sealing Man Customer's or Cuakmefs employee use ohhe Merchandise, whether or not such claims, Injured or damages ease from any alleged deeds in the Merchandise. Frame Resistant ('FR') Mamhanmse supplied hereunder is intended only to prevent Ilte Ignition and burning of fable away from the point of high heal impingement and to be sel extingulshing upon removal of the ignition source, FR Items will rim provide significant protection from bums In the immediate area of high heat contact due to thermal transfer through the fabric anNw destruction of the fabric In the area of such exposure. FR game are designed for continuous wear as only a secondary level of protection. Primary protection Is still required for work activities where amid or Significant exposure to heat or open flame Is likely to occur. 16"IlyMerchoral is lnlended to pms1tle Improved conspkully of the wearer under daylight donations and when illuminated by a light source ofauRdent candepowaat night. It Is Customers responsibility to determine the level of comploity named by wearers under maclik work conditions. Further Customer same. del Ualhllaa Mambama'm ninon Heallhcem,food-Relaed Customer acknowledge s thel: (1) Unirkst does not guarantee arwarranl mat Ne Merchandise 6olecled by Cuelomar or Thal processed garments delivered by UnlFlrel will be appropriate or suglneed to provide a hygienic level adequate for Individual Customer's needs; and (2) optional poly-baill is recommended to reduce the Oak of crossaontsminallen of Merchandise, and the failure to win. such serves may adversely affect the efficacy of UnlFbat's hygienic cleaning process, (• roryaea:w,xrne moweaauanw mo.6os1 If any Merehandlea supplied hereunder is Merchandise that (1) UnlFlrel does not stock for whatever reason including due to style, caner, size or bared); (2) consists of non-UNFifsl manU(Wured or customized FR Merchandise; or (3) cambia of Merchandise that has been permenenpy personalized (in all cases known as "Non -Staff Merchandlsa'y, then, upon the discontinuance of any Service flesiuroer at any time for any reason. Including manager, taminelion, or canOrflaffon of this Agreement, with or without cause, defelon of any NonSlandatl Merchandise from Customers Service Pregrem, or due to employee reductions (In each case a-Dlscominuanee of SeMcew), Customer will purchase at the time of such Diseentinuenea of Sealm all affected NonSlandard Merchandise Items than In UmFlrst's inventory (In-servim, shelf, as "I as any OBLIGATIONS AND REMEDIES. If Cancmr, Performance guarantee described Shove). Ouster all to cModels with reasonable cenanly) an of weeks remaking In the currant lams These dal Merchandise or payment of replacement charges, This Agreement shall be govemeel by Massachus thereof at any time, the purges will gran attempt I, (misled as sa'ilemenl regulations. Any matter not In the capital city of the state where Customer has Arbitration Rulas of the Annamm Arollragan Assoc upon one (1) Ammeter to mall& the conlrweray or ANIVaIcrloud) shall recover all of its mate and ex In and as a pan of the judgment or sword renders a Ignore the Provisions hereof; and. the dSol Stan 0 with respect to ell such aspule S. It he s voluntarily: of any other peens or as a member of any class Ittlgalon is rued to be unenforceable for any reset MISCELLANEOUS. The panles agree that this My lima, none of the standard pre -gamed terms a UnlFlrel may, In Its sale dlsaegm, assign this Ag the event it Salts or transfers its brultmea, it will n assumption shall not mileva Customer of its lialvit breech and may tma nnilion of IMsAgmemenl tee Incidental, consequential, special. OrpunlAve damn paid by Cuslamer to UMFwt. In the event my per balance will remain In effect. Ali wMan nice. pro UnlFirsl'a business is conducted by, and the term' metals, Solvents, inks, ales this Agreement before the expiration date for any reason (other th as liquidated damages and not as a penalty (the parfies acknowledge percent of the average weekly amounts Involoed In the producing 26 r ilia to all other obligations air amounts Wed by Customer To UnlFlrel, any Nonstandard Merchandise items as set font herein. 1 choice of law). It a dispute areas from or Minim in any way to this A r aspule by negotiation A agreed fime(s) and Mesdm(s). Ail neil l act negotiations wilNn 30 days shall he resolved exclusively by final at ay prooeeding, than the prohibition against class Illigagon shag b !menl represents the mitre agreement between them. In the M efflons therein shell have any application to NIe Agreement or a M. Customer may not assign this Agreement without the paw the puchmer or transferee to assume all obligations and reap sunder and provided lumber that any [allure by a purchaser or fir n the obligation to pay all amounts on account themofas eel food] e no event Shall WHOM'. eggregale IleNllly to Customer fur any INS Agreement Is held by a court of competent jurisdiction or bl a UnlFlrel must be Sent by mnifred mail to the attention of the Le Was used herein means, UnlFlrel Holdings, Inc. d.b.a. UnlFkst. assume for whatever reason, Customer n farUNFlmes failure under the I 11 a actual damage. would be Oaks, multiplied by the number hduding the retain of Standard Ireement at any alleged breach ,no are confitlentiel and will be c bindkg arellrellon, conducted .died Rules of the Commercial herewith. The partes will agree le Thereof (as determined by the Is, all of which shag be Included ,nor shall have no power to vary '. Customer acknowledges that, ss litigation as a represenellve If this prohibition against class and eged In that proceeding, a purchase order to UnlFbsl at ring pursuand hereto wlherelo. IFlud. Customer agrees that In Agreement, provided that such IS Agreement shell canoe(. a :Ilhw pany will be liable for any the sum of all amounts actually linger to be unenforceable, the ses and Ordain other fractions. fir-ilai a'-siou Farm �%9 Request for Taxpayer (Rev.March 2024) Identification Number and Certification I ury Internaall RReevenue Seervkant of the e Bo to www.Im gov1FbrmW9 for instructions and the latest information. Before you begin. For guidance Give form to the requester. Do not send to the IRS. 1 Name of enllty/Mdividual. An entry Is required. (For a sole proprietor or disregarded entity, enter the owner's narne online 1, and enter the business/disregarded endys name on line 2.) UniFirst Holdings Inc 2 Business namefdxregarded entity name, indifferent from above. 38 Check the appropriate box for federal lax classification of the entityrodhidual whose name Is entered on line 1. Check 4 Exemptions (codes apply only to a* one of are following seven boxes, certain entities, not Individuals; e ❑ Indhidrallsols proprietor [a C corporation ❑ 8 corporation ❑ Partnership ❑ TnreVestate see instructions on page 3): 0 n Qr� ❑ U.C. Enter the tax classification (C = C corporation, 8 = S corporation, P = Partnership) . , . . Exempt payee code (if arty) i Note: Check 6te'LLC" box above and, In the entry space, enter the oppropriale code (C S, orP) forthe tux classification of the LLC, unless It Is a disregarded entity. A disregarded entity should Instead check the Exemption from Foreign Account Tax o appropriate box for the tax classification of Its ovmar. Compliance Act (FATCA) reporting C £ ❑ Other (see instructions) code (t any) a (APPNss to accountsmai+rtafned 3b Ilan tine 3a you checked'Parinership• or'TrusVestate,• w checked °LLC' and entered 'P' es He tax ctassificatton, and you are providing iNe form to a partnership, trust, or estate In which youhave an ovxrership Interest, check outside the un/fedState&) this box it you have any foreign partners, owners. or beneficiaries, See instructions . . ❑ S Address (number, street, and apt, er suite no.). Sea Metructkms. Requester's nanre rid address (opflanal) 1201 N John Stockbauer Drive 6 City, state, mdZlPcode Victoria TX 77901 7 List account number(s) here (optional) Taxpayer Identification Number IN Enter your TIN in the appropriate box, The TIN provided must match the name given on one 1 to avoid social asoudty number s this Is your security number Gate). However, fora backup withholding. For tndir,or di resident alien, sole propr(otor, or disregarded anllty, see the insiructions for Part I, later. For other d entity, a Instructions _ m - entities, it is your employer identification number (EIN). If you do not have a numbFFM er, sea Now to get a or TIN, later. Note: If the account Is in more than one name, see the instructions for Title 1, See also What Name and Number To Give the Requester for guidelines on whose number to enter. F71 4 - 2 8 8 1 9 8 1 __.. Under Penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be Issued to may, and 2.1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (0) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA cods(s) entered on this form (d any) Indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subjact to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition orabandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and, generally, payments other than Interest and dividends, you are not required to sign the certification, but You must provide Your correct TIN. See the instructions for Part It. later. Here I U 5. peraonf 6 c4 General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest Information about developments related to Form W-9 and its Instructions, such as legislation enacted after they were published, go to wmY1rs,gov1FormW9. What's New Une 3a has been modifted to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax Classification of its owner. Otherwise, it should check the "LLC" box and enter its appropriate tax classification. Date �'��L{ 2— L� New line 3b has been added to this form. A flow -through entity Is required to complete this line to Indicate that it has director Indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another Sow -through entity In which it has an ownership Interest. This change Is Intended to provide a flow -through entity with Information regarding the status of Its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an Information return with the IRS Is giving you this form because they Cat. No, 102M Forth W-9 (Rev. 3-2024) CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos. i -4 and 61f there are interested parries. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6If there are no interested parties. CERTIFICATION OF FILING certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entlty's place of business. 2025-1261084 UniFjrst Corporation Victoria, TX United States Date Piled: 01/2V2025 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Calhoun County Courthouse Date Acknow edged: i�Pi�% � a Y'' 3 Provide the identification number used by the governmental entity or state agency to track or identify the tontract, And provide a description of the services, goods, or other property to he provided under the contract. NA Uniform rental services 4 Name of Interested Party City, State, Country (place of business) Nature of Interest (check applicable) Controlling Intermediary 5 Check only If there is NO Interested Party. ❑ X 6 UNSWORN DECLARATION ^�,(/,, My name is .J91/� [ �h7Q�f[y� and my date of birth is Allow 1�_ My address is �. 0 5�iril/��G(�(.�( �, t ' '9 l 77-ly / , _&:• (street) (city) (state) (Apcode) (country) 1 declare under penalty of perjury that the foregoing is true and correct. �( '�—'� lam} 1,� Exe Ccunty, State of �' ` , on the / . I day of I�' ? J . Crystal oo a orm 0(month)My Commission ExPlras (year) 1110/13/2027 Notary 10129450BB4 Signature of authorized agent of contracting business entity (� (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V4.1,05dd2ace2 ' NOTIC1 OF MEETING -- 1/2-9/2025 8. Consider and take necessary action to declare Inventory Item 665-0209, Manitowoc Indigo Ice Machine and Storage Bin, Serial Number 1120018694/1101322954, as waste and remove from Calhoun County Extension Office Inventory. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct`4 SECONDER: Joel, Behrens, Commissioner Pct 3 AYES: Judge Lyssy,`Commissioner Hall, Best, Behrens, Reese Page 5 of 20 Calhoun County, Texas WASTE DECLARATION REQUEST FORM Department Name: 110 —County Extension Requested By: Ellen Heiman/Karen Lyssy Inventory Number Description Serial No. Reason for Waste Declaration 665-0209 Manitowoc Indigo Ice 1120018694 / Leaking, Parts are obsolete Machine and Storage Bin Bin-1101322954 Commissioners' Court Agenda January 29, 2025 # 09 NOTICE OP MEETING—1/29/2025 9. Consider and take necessary action to approve the contract with Weaver & Jacobs Constructors, Inc. for Bid No. 2024.06 — Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) Pass Page 6 of 20 #10 NOTICE.. OF MEETING:;—1/29/2025 10. Consider and take necessary action to approve Amendment #1 to the Short Form of Agreement Between Owner and Engineer for Professional Services with G&W Engineers, Inc., in connection to the Memorial Medical Center HVAC & Roof Improvements for Calhoun County, and authorize the County Judge to sign. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Vern Lyssy, County Judge SECONDER: Gary Reese, Commissioner Pct 4 AYES:Judge Lyssy, Commissioner' Hall, Best, Behrens, Reese Page 7 of 20 Memorial Medical Center — HVAC & Roof Improvements AMENDMENT THIS AMENDMENT, entered into this x2 day of January 2025, by and between CALHOUN COUNTY, hereinafter called the "Owner", and G&W ENGINEERS, INC., hereinafter called "Engineer", W ITN ESSETH THAT: WHEREAS, Owner desires to amend an existing Short Form of Agreement Between Owner and Engineer for Professional Services effective as of August 12, 2021 for Owner's Memorial Hospital Roof and HVAC Engineering and Design ("Project'); and WHEREAS, Owner desires to engage Engineer to render additional certain services in connection with and related to the Project. NOW THEREFORE, the parties do mutually agree to add and/or modify the existing contract as follows: Engineer's Services AMENDMENT 1 Original Scope (Remains UNCHANGED): • Engineer's Services under this Agreement are generally identified as follows: ENGINEERING ("Services") Additional Scope Part 1: Bid Phase Services. This shall include preparation of bid package, coordinate county reviews and incorporate necessary/requested changes, preparation of technical specifications, attend workshop meetings, conduct pre -bid meeting, answer bid period questions, issue necessary addendums, attend bid opening, review of bids and prepare recommendation of award. Attendance at Commissioners' Court Meeting(s). Additional Scope Part 2: • Updating Contract Plans and Specifications to include new chillers to comply with refrigerant law changes between the lapse of time of signed plans (2022) to 2024, revise floor plans, schedules, specifications and details as needed as these items relate to HVAC. Verify power requirement of new chillers and design electrical circuity as needed. Specify carbon monoxide monitoring/shutdown for boilers as required per Texas Administrative Code Changes. Additional Scope Part 3: • Provide support and oversite as it relates to contract negotiation and value engineering. Attend workshop(s) and coordinate the negotiation process. Correspondence to Owner and Bidder and review of alternatives presented from an engineering perspective and provide recommendation as it relates to alternatives. Prepare a final recommendation of award and attendance at Commissioners' Court meeting(s). Additional Scope Part 4: Assist/Submit anew Texas Health and Human Services (THHS) (State Permit) Major Permit to the State. This shall include support as it relates to the permit paperwork itself during the course of construction and any necessary revisions/modifications. All application fees, permit fees and inspection fees to be paid for by Owner/Hospital separately as they relate to THHS. Additional Scope Part 5: Assist with Building Permit through the City of Port Lavaca. This scope shall include delivery of hard copies (if required) and digital, inquiry of status of permit and formally addressing any questions of the reviewing authority (City) or its contracted reviewing representative. All application fees, permit fees and inspection fees to be paid for by Owner/Hospital separately as they relate to City of Port Lavaca. (i.e. not included in this contract.) Additional Scope Part 6: Provide construction phase services. These services include the following Work Steps: 1.) Reviewing submittals and shop drawings and; o reviewing of material testing reports (provided by others(contractor)) (i.e. weld testing results, mortar/concrete strength results, roof assembly pull test results, etc.) o performing close out documentation review 2.) Project Meetings and; o conducting a pre -construction meeting (including scheduling), o general project coordination and participating in project meetings, o participation in THHS meetings and inspections (as many as necessary). 3.) Performing onsite construction inspections and site visits 4.) Review and approval of contractor pay applications 5.) Responding to contractor RFI's throughout the construction period 6.) Reviewing and routing appropriate change order requests as a result of substitution request or alternative methods 7.) Services also include TDI Windstorm engineering inspections and providing paperwork to TDI. 8.) Project reporting including providing monthly updates of the project at Commissioner's Court Meetings. This includes monthly written reports as requested required. 9.) Services also include contracting a subconsultant and having this firm execute an onsite limited asbestos testing and report (Level 1). Limited asbestos survey for suspect asbestos -containing material (ACM) to determine homogenous areas and sampling protocol. All labor, travel, equipment, materials, and shipping will be provided. A final report documenting sampling locations, methods, digital photos, and laboratory results is included. Additional recommendations regarding the survey will be provided as needed. Includes sample costs and a total of 40 samples based upon the scope of construction. Level 2 survey not included and the need/cost for level 2 is contingent upon the results of the level 1 survey. Calhoun County — G&W Engineers, Inc. Amendment I See Appendix 2 for a detailed listing of suggested possible tasks and fee estimates for these services. The term estimate is defined as estimated effort for each task, but it is understood that in no -case the cost should exceed the Not -to -exceed agreed price for the overall scope as defined. Reference Basis of Payment 2.02a for terms. This scope is understood to cover engineering expenses for a construction period of twenty four (24) months or 104 weeks. The construction period is as provided by the contractor. Should the construction warrant additional time, this will increase the amount of effort upon engineer and therefore warrant additional fees and expenses to be incurred by County as a result of an extended construction period. Any work performed at client's request outside the work described in the above Work Plan Summary (e.g., Asbestos Level 2 Survey, Change Order(s) requested by contractor/owner at no fault of ENGINEER, resulting in engineering design changes, etc.) will be billed on a time and materials reimbursable basis separately from the above work steps and according to the attached Standard Rate Schedule. 2.02 Basis of Payment— Lump Sum AMENDMENT 1 2.02 Basis of Payment —Lump Sum A. Owner shall pay Engineer for Services as follows: 1. A Lump Sum amount of $682,000.00. Six Hundred and Eighty -Two Thousand Dollars & Zero Cents for Original Scope & Additional Scope Part 1 through Part 4. NOTE: Additional Scope Part 5 & Part 6 shall be provided under a new additional section (2.02a Basis of Payment — Cost Not -To -Exceed incorporated into this amendment.) a. Original Fee (Signed Design Plans and Technical Specifications) $605,000.00 b. Bid Phase Services (Additional Scope Part 1) (Authorized in Court on September 27, 2023 in accordance with contract in place for hourly rate as needed per contract. Later clarified/approved in court on November 22, 2023 to be $50,000.00 c. Update Contract Plans and Specifications (Additional Scope Part 2)—$15,000.00 d. Value Engineering & Contract Negotiations (Additional Scope Part 3)- $7,000.00 e. THHS Major Permit Support (Additional Scope Part 4) - $5,000.00 2. In addition to the Lump Sum amount, reimbursement for the following expenses: None B. The portion of the compensation amount billed monthly for Engineer's Services will be based upon Engineer's estimate of the percentage of the total Services actually completed during the billing period. Calhoun County — G&W Engineers, Inc. Amendment I 2.02a Basis of Payment — Cost Not -To -Exceed AMENDMENT a. City Permitting Assistance & Printing (Additional Scope Part 5) — N.T.E. $5,000.00 b. Construction Phase Services (Additional Scope Part 6)—N.T.E. $792,000.00 1) To be billed on a monthly basis. Engineer will include task, man-hour, and fee information with each invoice reflecting fee estimates as provided in Appendix 2. All time (manhour) estimates for each work step are APPROXIMATE. Many unknowns may affect the level of effort required to complete this work within each work step. G&W Engineers, Inc. will bill on a time and materials reimbursable basis with a cost not -to - exceed as stated in this agreement. Budgets/manhour estimates may be shifted from one Work Step to another Work Step depending upon the level of effort requested/required throughout the project. In no case shall the client be billed above the agreed amount unless due, justified and agree to in writing. AMENDMENT 1 The appendix 1 shall be modified and agreed upon in the amount as indicated in the 2024 rate schedule for G&W Engineers, Inc. Also added to Appendix 1 shall be the classification and rate schedules for G&W's sub -consultants (Amtech Solutions, Inc., & Calculate Legacy Consulting Engineers, LLC.) The original appendix 1 with the G&W 2021 rate schedule shall be considered obsolete. Rate Schedules for G&W Engineers, Inc. and its sub -consultants shall be "locked in" throughout the two-year construction duration. Appendix 2 AMENDMENT 1 The appendix 2 attached hereto shall be incorporated into the agreement. Other Terms Unchanged. All other terms and conditions of the Agreement shall remain unchanged. IN WITNESSETH HEREOF, the parties have hereunto set their hands and seals. CALHOUN OUNTY G&W ENGINEERS, Inc. BY: BY: d Vern Lyssy, County ud a Brian P. Novian, P.E./President NOTE: Thisdocument has important legal consequences. Please consult with your legal counsel with respect to its completion or modification. Calhoun County — G&W Engineers, Inc. Amendment I AMENDED APPENDIX 1 G & W ENGINEERS, INC. 205 W. Live Oak Port Lavaca, Texas 77979 (361) 552-4509 Fax (361) 552-4987 TBPE Firm Registration No. F04188 • TBPLS Firm Registration No. 10022100 G&W ENGINEERS, INC. RATESCHEDULE (Effective January 1, 2024 — December 31, 2024) OFFICE PERSONNEL / SURVEY CREWS Principal Registered Professional Engineer / PM Registered Professional Land Surveyor Staff Engineer/Specialist Project Coordinator Programmer / I&E Tech. Engineering Designer Draftsperson/CARD Tech. Engineering Assistant/Secretarial Construction Manager Construction Inspector Two Man Survey Crew Three Man Survey Crew Senior GPS Operator GPS Operator Survey/Drone Technician REIMBURSABLE EXPENSES Travel (Airfare, Room, Board) Mileage Per Diem as per current General Services Agreement (GSA) rate Outside Consultants Survey Stakes, Lathes, Iron Rods, and Other Direct Expenses 4800 Trimble Total Station (Base and One Rover) 4800 Trimble Total Station (Base and Two Rovers) 14' Aluminum Survey Boat 16' Aluminum Survey Boat Drone Equipment Computer / Plot Time STANDARD BILLING RATE OVERTIME BILLING RATE $194.25/1-1r. See Note 3 $157.50/11r. See Note 3 $131.25/11r. See Note 3 $130.20/11r. See Note 3 $110.25/11r. $148.84/11r. $102.90/11r. See Note 3 $89.25/14r. $120.49/Hr. $73.50/Hr. $99.23/11r. $57.75/Hr. $77.96/14r. $141.75/14r. See Note 3 $105.00/Hr. See Note 3 $141.75/Hr. $191.36/14r. $183.75/11r. $248.06/Hr. $120.75/1-1r. $163.01/11r. $73.50/Hr. $99.23/1-fr. $78.75/Hr. $106.31/11r. Actual Cost $0.68/Mile Cost + 10% Cost + 15% $367.50 / Day $551.25 / Day $210.00 / Day $262.50 / Day $350.00 / Day $8.40/Hr. NOTES: 1. Travel time is billed per rates indicated above, according to classification. A minimum of two (2) hours survey crew time charge will be accessed for show -up time and return to office, resulting from inclement weather conditions, etc. 2. When overtime is specifically requested and authorized by client, an overtime -premium multiplier of 1.35 will be applied to the standard billing rate of hourly non-exempt personnel for all hours worked in excess of 40 hours in a calendar week. 3. Professional staff members noted as exempt will be invoiced at the Standard Billing Rate. 4. Charges will be billed monthly and are due upon receipt of the invoice unless otherwise agreed. Interest will be charged at the rate of 1.5% per month for invoices not paid within 30 days unless otherwise agreed. Engineering Consulting Planning Surveying APPENDIX 1, PAGE 1 AMTE G H Amtech Proposal No. CPS.2024.001038 SOLUTIONS MMHC Construction Phase Consulting 2024 FEE SCHEDULE Personnel Rate PRINCIPAL, per hour............................................................................... $ 401.00 SENIOR REGISTERED PROFESSIONAL, per hour ........................................$ 278.00 REGISTERED PROFESSIONAL, per hour ....................................................$ 269.00 SENIOR PROJECT MANAGER, per hour ....................................................$ 265.00 PROJECT MANAGER, per hour................................................................ $ 253.00 PROJECT PROFESSIONAL, per hour..........................................................$ 221.00 STAFF PROFESSIONAL, per hour..............................................................$ 195.00 TECHNICIAN, per hour............................................................................$ 163.00 DESIGNER / CADD, per hour................................................................... $ 113.00 ADMINISTRATIVE / CLERICAL / MARKETING, per hour .............................$ 101.00 Field Personnel - Services of field personnel or project site visits by personnel will be invoiced from portal to portal. The hourly rate for field technical personnel will be increased to 1.5 times the indicated rate for work performed between 6:00pm and 6:00am, over eight hours per day, or on weekends or holidays. Litigation - Services related to Depositions and Expert Testimony will be billed at twice the standard unit rate. Escalation - Contract unit rates shall increase by 4% per year unless specifically agreed otherwise, and shall become effective on January 1't of each year that the contract is in effect. Expenses TRAVEL AND PER DIEM: Travel expenses will be invoiced at our direct cost, plus 20 percent. Amtech follows the IRS guidelines for mileage reimbursement and regional per diem allowances. Mileage charges will be adjusted based on the prevailing IRS reimbursement rate. OTHER EXPENSES: Other direct expenses such as subcontracts, mailing, delivery, printing, copying, or telephone charges will be invoiced at our direct cost, plus 20 percent. APPENDIX 1, PAGE 2 Calculated Legacy Consulting Engineers, LLC 7700 Torino, Suite 120 San Antonio, Tx 78229 2024 RATE 210.614.1110 SCHEDULE PERSONNEL CLASSIFICATION: HOURLY RATE Principal $245.00 Project Manager (P.E.) $210.00 Engineer II (P.E.) $190.00 Engineer I (P.E.) $170.00 Engineer -in -Training (E.I.T.)/Graduate Engineer II $140.00 Engineer -in -Training (E.I.T.)/Graduate Engineer I $ 120.00 Commissioning Agent $200.00 Senior Technician $140.00 Technician $ 105.00 Construction Administrator $ 105.00 CAD Drafting $ 80.00 Clerical $ 75.00 Ground Travel (outside of San Antonio Metro Area) $ .60/Mile Air Travel, Car Rental, Food, Lodging Cost Printing -Reproduction -Plotting Expenses & Delivery Cost Charges Consultants Cost + 10% Escalation for multiple year contracts is calculated by the Consumer Price Index per year. APPENDIX 1, PAGE 3 Calculated Legacy Consulting Engineers, LLC Firm Registration #24898 Appendix 2 Company Name Total Budget % of Total G&W,Engineers, Inc. $342,005.00 43.20%, Work Steps 1-8 M; E,Environmental (Umited,,. estos Survey) " $3,600 00 u'O 45% Work Step 9 Steps 1-8 Steps 1-8 TOTAL UWivtn: Lamoun county ENGINEER: G&W Engineers, Inc. Project: Memorial Medical Center- Roof & HVAC Improvements Project Date of Document Rendition: 1/17/2025 Page 1 APPENDIX 2, PAGE 1 G&W ENGINEERS, INC. -WORK STEP T&M ESTIMATE (Hrs/Wk) Hours Rate Total %of Total Work Step 1.) Review sp mittal data and shop;drawings. Registered Professional Engineer/ PM 1.00 104 $157.50 $16,390.00 Project Coordinator 3.25 338 $110.25 $37,264.50 15.68% 2 )"Project meetings &General Coordination. •" Registered Professional Engineer/ PM 1.50 156 $157.50 $24,570.00 Project Coordinator 4.25 442 $110.25 $48,730.50 21.43% 3,),Cgnstructlortiospect�on's/sitewsifs4. r u Registered Professional Engineer/ PM 2.00 208 $157.50 • $32,760.00 Construction Inspector 8.00 832 $105.00 $87,360.00 35.12% iprrtr#tor pa ,k pplication'.z,=._" Registered Professional Engineer / PM 0.50 52 $157.50 $8,190.00 Project Coordinator 0.75 -78 $110.25 $8,599.50 4.91% 'RFI^s' ., f r H'� ��• Registered Professional Engineer/ PM 0.50 52 $157.50 $8,190.00 Project Coordinator 1.00 104 $110.25 $11,466.00 5.75% JAIlenge ,.,.�.; n Registered Professional Engineer/PM 0.50 52 $157.50 $8,190.00 Project Coordinator 1.25 130 $110.25 $14,332.50 6.58% 7.)Windstorm/MIDI,' Registered Professional Engineer / PM 1.00 104 $157.50 $16,380.00 4.79% #�8.) Project reportr�gr4� n �-,. x�r �� ..�.. �� st•" s :. t� P"r r •i� cea n#.xq �, ��F,•` � ,. Registered Professional Engineer / PM 0.50 52 $157.50 $8,190.00 Project Coordinator 1.00 104 $110.25 $11,466.00 5.75% �� "NP ,, 0 .;- Wa,x,'xH Y., r7otals ;,>ii= �,=2808 ,= a <r.,". F 3,2-06TW 10000` This scope is understood to cover engineering expenses for a construction period of twenty four (24) months or 104 weeks. The construction period is as provided by the contractor. Should the construction warrant additional time, this will increase the amount of effort upon engineer and therefore warrant additional fees and expenses to be incurred by County as a result of an extended construction period. Any work performed at clients request outside the work described in the above Work Plan Summary (e.g., Asbestos Level 2 Survey, Change Order(s) requested by contractor/owner resulting in engineering design changes, etc.) will be billed on a time and materials reimbursable basis separately from the above work steps and according to the attached Standard Rate Schedule. To be billed on a monthly basis. Engineer will include task, man-hour, and fee information with each invoice reflecting fee estimates as provided in Appendix 2. All time (manhour) estimates for each work step are APPROXIMATE. Many unknowns may affect the level of effort required to complete this work within each work step. G&W Engineers, Inc. will bill on a time and materials reimbursable basis with a cost not -to -exceed as stated in this agreement. Budgets/manhour estimates may be shifted from one Work Step to another Work Step depending upon the level of effort requested/required throughout the project. In no case shall the client be billed above the agreed amount unless due, justified and agree to in writing. Should the project warrant additional employee classification(s) at a rate lowerthan the ones classified in the above table by G&W, then the table shall be updated and reflected in the billing/invoice. Such use of employees shall beat the descretion of G&W and in no case shall these modifications effect the overall cost not to exceed as agreed upon in this amendment number 1, section 2.02a. Rates for other classifications as per Appendix 1. Page 2 APPENDIX 2, PAGE 2 Fee Estimate Project Name: Calhoun County Memorial Hospital Roof and Strucutral - Const. Phase Proposal Number: CPS.2024.001XXX Location: Corpus Christi, TX Client: G&W Engineers Project Manager: James Robbins Personnel Task Units Unit Rate ;Hours Total 2024 Senior PM Proposal per hour $265 2 $530.00 Principal Proposal Review per hour $401 0.5 $200.50 Admin Admin/Accouting Dept (invoicing, etc.) per hour $101 1 $101.00 Subtotal $831.50 CONSTRUCTION PHASE SERVICES. JAR(SPM) Pre -Construction Meeting per hour $265 3 $795.00 WM(SRP) Pre -Construction Meeting per hour $278 3 $834.00 KG(PP) Submittal Review - Roof per hour $221 20 $4,420.00 RC(SRP) Submittal Review - Windows per hour $278 20 $5,560.00 WM(SRP) Submittal Review - Structural per hour $278 20 $5,560.00 JAR(SPM) Submittal Response Review per hour $265 8 $2,120.00 RC(SRP) Asbestos Report Review and Rec per hour $278 3 $834.00 JAR(SPM) Asbestos Report Review and Rec per hour $265 3 $795.00 JAR(SPM) Virtual Planning meeting (1/wk for 4 months) per hour $265 32 $8,480.00 JAR(SPM) Virtual OAC meetings (2/month for 2 years per hour $265 104 $27,560.00 KG(PP) Construction Observation Site Visits per hour $221 70 $15,470.00 JAR(SPM) Construction Observation Site Visits per hour $265 20 $5,300.00 WM(SRP) Construction Observation Site Visits per hour $278 5 $1,390.00 KG(PP) Construction Observation Report per hour $221 42 $9,282.00 JAR(SPM) Construction Observation Report per hour $265 12 $3,180.00 WM(SRP) Construction Observation Report per hour $278 3 $834.00 JAR(SPM) RFIs and Substitution Requests - roof/windows per hour $265 20 $5,300.00 WM(SRP) RF1s and Substitution Requests - structural per hour $278 4 $1,112.00 RC(SRP) RFls and Substitution Requests - roof/windows per hour $278 4 $1,112.00 JAR(SPM) Punch List Inpsection and Final per hour $265 12 $3,180.00 WM(SRP) Punch List Inpsection and Final per hour $278 12 $3,336.00 RC(SRP) Pay App Review per hour $253 12 $3,036.00 BV(Admin) Administrative efforts perhour $101 48 $4,848.00 Subtotal I 1 1 $114,338.00 REPORT ;- RC(SRP) ReportReview per hour $253 0 $0.00 JAR(SPM) Assesement Report per hour $241 0 $0.00 JAR(SPM) Cost Estimate per hour $241 0 $0.00 Subtotal $0.00 DESIGN Registered Prof Details and Specs per hour $180 0 $0.00 Designer/CADD Plans and Details per hour $80 0 $0.00 Principal Principal Review per hour $220 0 $0.00 Subtotal $0.00 PROJECT AND CLIENT MANAGEMENT Senior PM Post Report - Phone Call / meeting per hour $210 0 $0.00 Senior PM Site visit meeting with owner/manufactuere per hour $180 0 $0.00 Subtotal $0.00 EXPENSES APPENDIX 2, PAGE 3 James 4ileage (100 miles e/w @ 24 trips) Per Mile $0.680 4800 $3,264.00 lotel Per Night $200.000 2 $400.00 rental car ($100/day+1.00 per mile+200ins) Per Mile $0.690 0 $200.00 rental Car Insurance Per Day $17.000 0 $0.00 rental Car Gas Lump Sum $50.000 0 $0.00 'light (to/from Dallas - Corpus, Texas) Lump Sum $500.000 2 $1,000.00 larking at Airport Per Day $40.000 1 $40.00 deals Per Day $50.000 24 $1,200.00 ;quipment maintenance Lump Sum $1,000.00 0 $0.00 :IT Level 1 Training Lump Sum $3,000.00 0 $0.00 Subtotal 1 1 $6,104.00 Total including 20% Mark -Up on all expenses 1.2 $7,324.80 sub total $122,494.30 add 4% ins $4,899.77 TOTAL $127,394.07 SAY , $130,000.0,0 APPENDIX 2, PAGE 4 o00000000 000 V o w ` n U "A m 00000a000 000 o ar m � ❑ m o O O O ... 00 O O O o fA a N U � ......... ... _ 0 m N F 0 o O o 0 0 o O o O O O U Q V N L fn V q y y �. 000000000 000 00 d d I g N fJ v N t O O O O O O O O O O O O _ d O f9 C ry 2 w c U _ N o m o. o 0 0 0 00 0 C C Q Oi vdj W v _. _e9 _�. �._ y •�- o v Z U r `o n u C E_ Q o o o o o 0 0 o o o Qm m O .- v w w o 0 O W � N O f0 00 'CJ l00 f00 COS m pO L = ep d p V `m f9 dy E W `a rna E n m Q MNf`O'1Ng.m gON Q a w v g _� o00000000 000 0 v v nv o w a _ N E � avi c > � w o w 2 F �> ol rn a o�ad v=v �� aqa �Eu O d Q 0 0 U' O a 0-6— N r V ina� F❑ I�-0=U aim �i 2 w LL NOTICE. OF MFF FING - 1/29/2025 11. Acknowledge the corrected Fuel baseline price for the Fly Ash Road Material Bid Tabulation. The gasoline price of $2.665 on January 13, 2025 was used instead of the diesel price of $3.321,(VLL) RESULT: APPROVED [UNANIMOUS]'` MOVER: David Hall, Commissioner Pct 1 SECONDER: Ronald Best, Commissioner Pct 2 AYES: Judge Lyssy,;Commissioner Hall, Best, ,Behrens, Reese Page 8 of 20 #12 NOTICE OF MEETING — 1/29/ 025 12. Consider and take necessary action to authorize Commissioner Behrens to sign the 2025 maintenance Contract with Hurts Wastewater Management for Precinct 3 septic system. (JMB) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: David Hall, Commissioner Pct AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 9 of 20 Joel Behrens Calhoun County Commissioner, Precinct 3 24627 State Hwy. 172—Olivia, Port Lavaca, Texas77979 - Office (361) 893-5346 — Fax (361) 893-5309 Email: ioeLbehrens(daalhouncotx.org Honorable Vernon Lyssy Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: Agenda Item Dear Judge Lyssy: Please place the following item on the Commissioner's Court Agenda for January 29, 2025. Consider and take necessary action to authorize Commissioner Behrens to sign the 2025 maintenance Contract with Hurts Wastewater Management for Precinct 3 septic system. Sincerely, Joel Behrens Commissioner Pct. 3 Date: 12/312024 To: Calhoun County Pct3 24627 St Hwy 172 Port Lavaca, TX 77979 Hurt's Wastewater Management, Ltd. P.O. Box 662 / 321 Hwy 172 Ganado, TX 77962 County, Calhoun Installer. Colin Marshall Agency: Victoria County Health Dept. Mlg,3rand:-NOweco 960-600 gbd. Phone: (800) 841-3447 Fax: (361) 771-3452 www.hurtswastawater.com Contract Period Customer ID StertDate:2M2M025 2832 End irate: 2 I212026 Site: 24627 St Hwy 17Z Port Lavaca, TX 7?3 g `rnaa: Ioel,behMrsQmlhounoobr.: Permit• 2008=173 Installed: 6/42008 Hurft Wastarz's; Nanage n, 2r2nty Expke& 6142010 3vsit peryear-one VM4 months mironmemal Subdivision: Map Rey. Terms of Maintenance Contract 1.) Three (3) inspections per year (at least one every 4 Months). Inspections include adjustment and servicing of the — mechanicai, electrical and other applicable components to ensure proper function. This includes inspecting the control pane:. aerators and filters. Replacement/repair costs will be charged directly to the homeowner. A Hurrs Wastewater Management, Ltd. employee will visit the site within 48 hours Of a problem being reported. Inspections may be performed anytime durin_r_;:;e month they are due, with a two week grace period before and after the month the inspections are due. 2.) The homeowner is responsible for maintaining chlorine residual of at least 1.0 mg/L in the treatment system. This can be accomplished by using chlorine (calcium hypochiorite) tablets for systems designed with a tablet chlorinator. Swimming - pool tablets must not be used in the aerobic system designed for chlorine tablets because they cause corrosion of the components of the system. At the time of a service inspection, the service representative will inform the homeownerif the chlorinator does not contain sufficient tablets or liquid chlorine (whichever is applicable) to effectively disinfect the wastewater_ 3.) The required routine reporting Of system operation andfunction to the local authority, as required by OSSF regulation, will be covered by the policy. Any additional visits, inspections or sample collections required by specific County Agencies, TCEO or any other regulatory agency in yourjurisdicdon will not be covered by the policy. 4.) The contract may be voided if NON -BIODEGRADABLE MATERIALS are used in the system. 5.) All Commercial systems will have a BOO and TSS test performed annually. Additional charges will be charged to owner for BOD and TSS testing. Tnis warranty is strictly limited' the above terms and does not include the cost of replacement components, chlorine or Pumping of sludge build-up. The maintenance policy includes labor charges only for normal routine inspec ors and maintenance Additional service calls are not covered by the policy. Service determined to be caused by abuse or neglect's' = not vO.dcovconred ra the policy. Failure 3o pay for service call, labor, and/or replacement components not covered under warrant, 140 vCid contract V OLA T IONS include shutting off the electric current to the system for more than 24 hours, disconnecting the alarm system, restricting ventilation to the aerator, overloading the system above its rated capacity, introducing excessive amour:; of harmful matter Into the system, or any other form of unusual abuse. The homeowner, agrees to provide Hurrs Wastewater Management Ltd. with all gate combinations, keys, etc. necessary to gain access to the system for the purpose of conducting routine inspections or service calls prior to the start date of this contract and notry Hurrs Wastewater Management immediately with any changes and provide the new combinations or keys. By signing this form, both maintenance orovider and homeowner agree to the terms of this policy. I HIS POLICY DOES NOT INCLUDE PUMPING SLUDGE FROM UNIT IF NECESSARY. Please check your contact preference: 00.00 Service contact only, no chlorine (homeowner must install own chlorine) 5.85.00 Service contract with chlorine provided Home Owner- Y K� Date: �7 z,� (� —P3 ._ elf /_ Phone. r Hurts Wasewater anagement Ltd.: Date: %� CERTIFICATE OF INTERESTED PARTIES FoRM 1295 loll Complete Nos. 1- a and 6 if there are interested patties _ OFFICE USE ONLY Complete Nos 1, 2, 3, 5, and 6d there are no interested Pardee. CERTIFICATION OF FILING CerriTimte Number 1 Name of business entity filing form, and the city, state and country of the business emhys place of business. 2075-1254178 Hurts Wastewater Management, LLC Ganado, TX United States Date Fled: 03107/2025 2 Name of governmental entuy or state agency that is a party to the contract for which the form is being filed. Calhoun County Pot 3 ,,,, n / Date edged: RI S 3 Provide the Identification numberused by the governmental endlyorstate agetuyto track oride"tha 6ontractland provide description of the services, goods, or other propertyto be provided under the contract 320733573 Septic System Maintenance 4 Name of Interested Party City, State, Country (place of business) Nature of interest (cheek applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. ❑ X 6 NNSWORN DECLARATION My name is Khloe Parks and my date of birth is My address is _ us (street) (ah') (elate) (zip code) (country) I declare under penalty of perjury that the foregoing is true and conecL Executed in Jackson County, State of Texas .on the day of January 25.. j (Month) (Year) j )A, r dgnt f Ngliature of aulhohmecontracting business entity Pediment) Forms erovided by Texas Fth)rs Cnmm'recinn CALHOUN COUNTY, TEXAS BID TABULATION FLY ASH ROAD MATERIAL BID NUMBER: 2025.04 For the Period Beginning February 12, 2025 and Ending December 31, 2025 Corrected Base Line Price 3 j8 Ll BASELINE PRICE ON JANUARY 13, 2025 FOR DIESEL FUEL ADJUSTMENT ON DELIVERY PRICE (www.eia.gov/petroleum/gasdiesel) (Gulf Coast Area) i.. MINIMUM BIDDER LOCATION Unit MATERIAL DELIVERY TOTAL LOAD/ORDER AND REMARKS, IF ANY Precinct 1 I Ton 1 $ 60.00 1 $ 120.00 1 $ 180.00 1 25 TON MIDTEX MATERIALS, LLC Remarks: Precinct 2 1 Ton 1 $ 60.00 1 $ 120.00 1 $ 180.00 1 25 TON Precinct 3 1 Ton 1 $ 60.00 1 $ 120.00 1 $ 180.00 1 25 TON Total Pluuss Fuel Surcharge - Precinct 4-P 1 Ton 1 $ 60.00 1$ 120.00 1 $ 180.00 1 25TON I Precinct 4-S 1 Ton 1 $ 60.00 1 $ 120.00 1 $ 180.00 1 25 TON Demi Cabrera From: eia_elists@eia.gov (U.S. Energy Information Administration) <eia elists@eia.gov> Sent: Tuesday, January 21, 2025 3:38 PM To: peggy.hall@calhouncotx.org Subject: Today's Diesel Prices U'rl ON: the sender and know the content is safe. . LJ.pr.:�7.n!.`.m!Lfie•. uid Anuly.. • U.S. Energy Information ei a Administration On -highway diesel prices, by week and PADD (Selfservice cash price in dollars per gallon,. including taxes) Do not click links or open attachments unless Date 01106/25 01/13/25 01/20125 U.S. 3.561 3.602 3.715 PADD1 - East Coast_ 3.634 3.718 3.820 PADD I -New England 3.771 3.821 3.944 PADD 1 b - Central Atlantic 3.801 3.876 3.976 PADD 1c-Lower Atlantic 3.559 3.649 3,750 PADD 2 - Midwest 3.530 3.532 3.648 PADD 3 -. Gulf Coast 3.269 3.321. 3.455 PADD 4 - Rocky Mountain 3.430 3.399 3,485 PADD 5 - West Coast 4.147 4.213 4.302 PADD 5b - West Coast less CA 3.739 3.776 3,865 California 4.618 4.716 4.807 Data source: Gasoline and Oiesel Fuel Update PADD=Petroleum Administration for Defense District Like EIA on Facebook �i Follow us on Twitter .:_ Watch EIA on YouTube nl Follow EIA on Linkedln Got this as a forward? Sign up to receive our future emails 0,S. Energy Information Administration i 1000 Independence Avenue, SW, Washington, DC 20585 1 CALHOUN COUNTY, TEXAS BID TABULATION FLY ASH ROAD MATERIAL BID NUMBER: 2025.04 For the Period Beginning February 12, 2025 and Ending December 31, 2025 Corrected Base Line Price 3.321 BASELINE PRICE ON JANUARY 13, 2025 FOR DIESEL FUEL ADJUSTMENT ON DELIVERY PRICE (www.eia.gov/petroleum/gasdiesel) (Gulf Coast Area) > as r FLY�ASH�R,O�►D M TERI `B d ,tMIN r� rn L ed ouu alert )15, 1pil; 3 d BI meem , I em 265 2�2 F�sh�or E//�u�i le t . . {; , ��,� � � oniSpeo,Class Fly Ash with olf o t t reat�erthan 6% Dertivere I ne k atic,t nker with s readery'a�r � �` '` .A'Y ",<. LOCATION Unit MATERIAL DELIVERY TOTAL MINIMUM BIDDER LOAD/ORDER AND REMARKS, IF ANY 1 ' Precinct 1 I Ton 1 $ 60.00 1 $ 120.00 1 $ 180.00 1 25 TON MIDTEX MATERIALS, LLC Remarks: Total Plus Fuel Surcharge 1 Precinct z Ton ' $ 60.001$ 120.00. $ 180.00 ; 25 TON 1 1 Precinct 3 ; Ton $ 60.00 ; $ 120.00 1 $ 180.00 ; 25 TON Precinct 4-P Ton ; $ 60.001 $. 120.00 ; $ 180.00 ' 25 TON 1 i Precinct 4-S 1 Ton 1 $ 60.00 1 $ 120.001s 180.00 1 25 TON Demi Cabrera From: eia_elists@eia.gov (U.S. Energy Information Administration) <eia_elists@eia.gov> Sent: Tuesday, January 21, 2025 3:38 PM To: peggy.hall@calhouncotx.org Subject: Today's Diesel Prices 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. fndepend.w Sid?hNi n andAndyIIn p• U.S. Energy Information i At tninistratian On -highway diesel prices, by week and PADD (Self service cash price in dollars per gallon, including taxes) Date 01/06/25 01/13/25 01/20/25 U.S. 3.561 3.602 3.715 PADD 1 - East Coast 3.634 3.718 3.820 PADD 1a - New England 3.771 3.821 3.944 PADD 1 b - Central Atlantic 3.801 3.876 3.976 PADD 1 c -Lower Atlantic 3.559 3.649 3.750 PADD 2 - Midwest 3.530 3.532 3.648 PADD 3 - Gulf Coast 3.269 3.321 3.455 PADD 4 - Rocky Mountain 3.430 3.399 3.485 PADD 5 - West Coast 4.147 4.213 4.302 PADD 5b - West Coast less CA 3.739 3.776 3.865 California 4.618 4.716 4.807 Data source: Gasoline and Diesel Fuel Update PADD=Petroleum Administration for Defense District Like BA on Facebook � Follow us on Twitter Watch EIA on YouTube An; Follow EIA on Unkedin Got this as a forward? Sign up to receive our future emails. U.S. Energy Information Administration 1 1000 Independence Avenue, SW, Washington, DC 20585 1 #13 NOTICE OF MEETING — 1/29%1025 13. Consider and take necessary action to declare the attached list of items for the Calhoun County Constable PCT 4 as Waste. (GDR) pass Page 10 of 20 #14 NOTICE OF MEETING 1/29/2025 14. Consider and take necessary action to issue a Credit Card with a limit of $2500.00 for Racheal Crober, Lieutenant, at the Calhoun County Detention Center. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 11 of 20 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: VERN LYSSY, COUNTY JUDGE SUBJECT: CREDIT CARD DATE: JANUARY 29, 2025 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR JANUARY 29, 2025 * Consider and take necessary action for Racheal Crober, Lieutenant; at tlic Calhoun CGuiiiy .`�vetcntioil �n.,ciitc^r tv ilc issued a county credit Gard. Sincerely, 1 n obbie Ylckeiy Calhoun County Sheriff #15 NOTICE OF MEETING -- 1/29/2025 15. Consider and take necessary action to change the position title, job description and pay from salary to hourly for jail administration. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct;4 AYES: `. Judge Lyssy,Commissioner Hall, Best, Behrens, Reese Page 12 of 20 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: VERA.' LYSSY, COUNTY JUDGE SUBJECT: CHANGING JAIL ADMIN JOB DESCRIPTIONS DATE: JANUARY 29, 2025 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR JANUARY 29, 2025 Consider and take necessary action to change the name, description and iid'y' a vttt �aat y w uvuuy. tvl. Litt fait auutILIDu auutt. See aLLaVlteU yapet wot n. Sincerely, r, � MN �� W ` �i�! f .I$/W Robbie 'v ickery Calhoun County Sheriff Calhoun County Job Description 011 CU��` Department: Calhoun County Adult Detention Center Position Title: Lieutenant FLSA: Non - Exempt Job Description: Assists with overseeing daily operations of the Jail Division, including supervising employees and overseeing the care of inmates. Organizational Relationships: 1. Reports to: Adult Detention Center Captain 2. Directs: Correction Officers and Jail Cook 3. Has frequent contact with other law enforcement agencies, judges, attorneys, other departments, county officials, criminals, crime victims and the general public. Required Knowledge, Skills and Abilities Knowledge of Jail standards and procedures; civil and case law pertaining to jail/detention liability issues; standard office practices and procedures; principles of supervisory management; departmental policies and procedures; first aid and medical procedures; and the use and care of vehicles, firearms and specialized equipment. Experience and Training • Requires High School diploma or GED • 'Requires two years of law enforcement experience, including supervision; or equivalent combination of experience and training which provides the required knowledge, skill and abilities Certificates and License Required • Jail certification by the Texas Commission on Law Enforcement Officer Standards and Education,(TCLEOSE); valid Texas driver's license. Calhoun County Human Resources Revised: January 2025 Duties and Responsibilities • Supervises Correction Officers and Jail Cook, including assigning and reviewing work and recommending such personnel actions has hiring, firing, and disciplining employees; • Oversees inmate care, including feeding and ensuring safety and security of inmates; • Performs inmate intake functions, including booking, classifying, and fingerprinting new inmates; • Transports inmates to and from various locations; • Assists with preparation of monthly division work schedule, including ensuring proper staffing and supervision of all shifts; • Supervises trustees, including assigning daily work tasks; • Orders groceries and commissary supplies for Jail Division; • Maintains commissary funds, including preparing daily deposits and determining proceeds of commissary sales; • Prepares various required statistical reports; • Assists with the preparation of paperwork for Texas Department of Corrections; • Releases inmates; • Handles violent inmates as necessary; • Performs other duties as assigned • Acts as Administrator in the Captain's absence Calhoun County Human Resources Revised: January 2025 Calhoun County Job Description Department: Calhoun County Adult Detention Center Position Title: Captain FLSA: Non -Exempt Job Description: Oversees daily operations of the Jail Division, including supervising employees, ensuring that jail operations comply with established legal standards, ensuring proper staffing and supervision of shifts and overseeing the medical condition and treatment of inmates. Organizational Relationships: 1. Reports to: Chief Deputy Sheriff 2. Directs: Lieutenant and has overall responsibility of jail personnel 3, Has frequent contact with other law enforcement agencies, judges, attorneys, other departments, county officials, criminals, crime victims and the general public. Required Knowledge, Skills and Abilities Knowledge of Jail standards and procedures; civil and case law pertaining to jail/detention liability issues; standard office practices and procedures; principles of supervisory management; departmental policies and procedures; first aid and medical procedures; and the use and care of vehicles, firearms and specialized equipment. Experience and Training • Requires High School diploma or GED • Requires four years of law enforcement experience, including supervision; or equivalent combination of experience and training which provides the required knowledge, skill and abilities Calhoun County Human Resources Revised: January 2025 Certificates and License Required Jail certification by the Texas Commission on Law Enforcement Officer Standards and Education (TCLEOSE); valid Texas driver's license. Duties and Responsibilities • Supervises Jail Lieutenant, Correction Officers, and Jail Cook, including assigning and reviewing work, conducting performance evaluations, and recommending such personnel actions as hiring, firing, transferring, promoting, and disciplining employees • Ensures that jail operations comply with established legal standards, including preparing for annual inspection; • Prepares monthly division work schedule, including insuring proper staffing and supervision of all shifts • Performs routine checks of jail facilities, equipment and vehicles; • Oversees medical condition and treatment of inmates, including ensuring security of inmate property, tending to inmate medical needs as necessary, and responding to inmates' family request as necessary; • Prepares, reviews, and files various reports and correspondence • Knowledge of computer equipment and related software applications to include word, excel • General knowledge of business letter writing, grammar, and report preparation. • Proficient knowledge of telephone etiquette. • Proficient knowledge of customer relations. • General knowledge of basic record keeping and filing procedures. • Monitors employee certification status, including scheduling training as needed; • Monitors inmate intake activities, including ensuring that all inmates are properly classified; • Schedulesinmate transports to and from various facilities as necessary; • Purchases various supplies; • Responds to inmate grievances; • Makes arrangements for inmate contract housing as necessary; • Approves various inmate services, including food, religious education, and counseling; • Handles violent inmates as necessary; • Serves warrants and civil papers to inmates • Performs other related duties that may be assigned Calhoun County Human Resources Revised: January 2025 #16 NOTICE OF MEETING — 1/29/2025 16. Consider and take necessary action to approve the contract with MidTex Materials, LLC for Fly Ash — Road Material, Bid Number 2025.04 for the period February 12, 2025 thru December 31, 2025 and authorize the County Judge to sign all necessary documents. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER:: Gary Reese, Commissioner Pct'4 AYES:Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 13 of 20 Debbie Vicke From: demi.cabrera@calhouncotx.org (demi.cabrera) <demi.cabrera@calhouncotx.org> Sent: Thursday, January 23, 2025 11:45 AM To: 'Debbie Vickery' Subject: Agenda Item Attachments: Contract for Fly Ash -Road Materials - Midtex Materials, LLC.PDF Can you please place the following on the agenda for court January 29, 2025: • Consider and take necessary action to approve the contract with MidTex Materials, LLC for Fly Ash —Road Material, Bid Number 2025.04 for the period February 12, 2025 thru December 31, 2025 and authorize the County Judge to sign all necessary documents. I will bring the necessary copies for both agenda items Thank you @ flQmi Cabrera Calhoun Countg assistant qluditor 361-553-4615 361-5.55-4614 (fax) Calhoun County Texas 1 CONTRACT �9 THIS CONTRACT, made and entered into this A-dayof j t4?1i" 20 --a by, and between the County of Calhoun (hereinafter called "County") and Aa,ru (hereinafter called"Contractor/Hauler"). WITNESSETH: WHEREAS, the Contractor/Hauler did on January 16, 2025 submit a BID for Supply Contract for FLY ASH - ROAD MATERIAL, Bid Number 2025.04 to be used by County Precincts in Calhoun County, Texas. NOW, THEREFORE, in consideration of the following mutual agreement and covenant, it is understood and agreed by and between the parties hereto as follows: a) The Contractor/Hauler is hereby granted the sole and exclusive right and privilege within the territorial jurisdiction of the County and shall furnish all personnel, labor, equipment, trucks, and all other items necessary to perfbrm all of the work and to deliver the Road Materials as described in the Contract Documents. b) The Contract Documents shall include the following documents, and this Contract does hereby expressly incorporate same herein as if fully set forth verbatim in this Contract: I. Invitation to Bid, Instructions and Term of Contract; ii. General Conditions; Ili. Bid Specifications and Conditions; iv. Bid Form; V. This instrument; and vi. Any addenda or changes to the foregoing documents agreed to by the parties hereto. c) All provisions of the Contract Documents shall be strictly complied with and conformed to by the Contractor/Hauler, and no amendment to this Contract shall be made except upon the written consent of the parties and approved by Calhoun County Commissioners Court. No amendment shall be construed to release either party from any obligation of the Contract Documents except as specifically provided for in such amendment. INITIALS OF AWARDED CONTRALTO HAULER (IN INK): %2 DATE: l/i�fiS INITIALS OF COUNTY (IN INK): l DATE: /J�� d) This contract is entered into subject to the following conditions: 1) The Contractor/Hauler shall procure and keep in full force and effect throughout the term of this Contract all of the insurance policies specified in, and required by, the Contract Documents, 2) The Contractor/Hauler shall not be liable for the failure to wholly perform his duties if such failure is caused by force majeure, "Force Majeure" means a delay encountered by the Contractor/Hauler in the performance of its obligations under this Contract which is caused by an event beyond the reasonable control of the Contractor/Hauler, Without limiting the generality of the foregoing, "Force Majeure" shall include, but not restricted to the following types of events: acts of God or public enemy; acts of governmental or regulatory authorities; fires, floods, epidemics or serious accidents; unusually severe weather conditions; strikes, lockouts, or other labor disputes; and defaults by subcontractors, Any event constituting a Force Majeure must be reported by the Contractor/Hauler to the County in writing, within twenty-four (24) hours, and disclose the estimated length of delay, and cause of the delay. 3) The Contractor/Hauler, when required, must deliver all materials ordered by the County within twenty-four (24) hours from the time of the order or the date and time specified by the County. In the event the Contractor/Hauler is unable to deliver the material(s) ordered within twenty-four (24) hours from the time of the order or the date and time specified by the County, the County reserves the right to cancel the order and re -order the said material(s) from the vendor which submitted the next lowest bid and can deliver within twenty-four (24) hours or the date and time specified by the County. 4) In the event that any provision or portion thereof of any Contract Document shall be found to be invalid or unenforceable, then such provision or portion thereof shall be reformed in accordance with the applicable laws. The invalidity or unenforceability of any provision or portion of any Contract Document shall not affect the validity or enforceability of any other provision or portion of the Contract Documents. INITIALS OF AWARDED CONTRAC�T/OR�HAULER (IN INK): DATE: % s INITIALS OF COUNTY (IN INK): G _ DATE: - y IN WITNESS WHEREOF, THE COUNTY AND CONTRACTOR/HAULER, have caused this Contract to be executed by their authorized agents in one original. Additional copies of the original executed Contract will be distributed to all appropriate parties. The effective date of this Contract will begin on February 12, 2025 and end on December 31, 2025. COUNTY: CALHOUN COUNTY By: Honorable Vern L. Lyssy Calhoun County Judge Calhoun County Courthouse 211 S Ann Street 3rd Floor, Suite 301 Port Lavaca TX 77979 CONTRACTOR/HAULER: By: ✓�_ Print Name: 1�*I'k Title: /1 's Address: /-1/ ATTEST: CALHOUN COUNTY CLERK ANNAGOODMAN By: Print Name: Title:}- Fa?yel;?'r-//Q,, 2 �6�17%� CERTIFICATE OF INTERESTED PARTIES FORM 1295 Intl Complete Nos. 1- 4 and 6 if there are interested parries. OFFICE USE ONLY Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place Certificate Number: of business. 2024-1252108 Midtex Materials LLC FAYETTEVILLE, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 12/26/2024 being filed. Calhoun County, Texas Date Acknowledged: rX� «tJ g Provide the identification number used by the governmental entity or state agency to track or identify the con ract, and provide a description of the services, goods, or other property to be provided under the contract. 2025.04 Supply Contract for Fly Ash - Road Material 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Midtex Materials, LLC Fayetteville, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION �^ My name is f/14e& JG'fi``fyi7%^ and my date is �' -ooff-birth My address is _ _ _ , Ti^ .w?7P %F� / Jl r (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. �f; Executed in 79� 1 County, State of P lqS , on thea*D day z,zeM� (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V4.1.0.502ace2 ® CERTIFICATE OF LIABILITY INSURANCE Wv�1 UATEtMMIDDiYYYY) 1/30/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ANCO Insurance PO Box 3889 Bryan TX 77805 NAMEr T Evelyn Stein PHONE IAC , 979-774.8212 F'c No:979.774.5372 E-MAIL ADD Es : steln@anco.com INSURERSAFPORDINGCOVERAGE NAICd INSURER A: Acully A Mutual Insurance Comp 14184 INSURED MID4AT-01 Mid -Tex Materials LLC INSURERS: Texas Mutual Insurance Company 22945 K3 Transport LLC INSURER C: PO Box 187 INSURERD: INSURER E: Fayetteville TX 78940 INSURER F: COVERAGES CERTIFICATE NUMBER: 1726916266 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPEOFINSURANCE ADDL SVSR POLICY NUMSER MMI00 EFF MMldOY E%P LIMITS A X I COMMERCIALOENERALUAa1LITY Z00831 21512024 2/5/2025 EACH OCCURRENCE $1,000,000 CL4IMS-MADE L OCCUR E T pREM18ESLEa aaurtenca $260,000 MEDEXP(Anyeneperson) $10,000 - PERSONAL &ADV INJURY $1,000,0U0 GEN'LAGGREGATE LIMITAPPUES PER: GENERALAGGREGATE $3,OD0,000 PRODUCTS -COMP/OP AGG $3,000,000 X POLICY❑PRO- LOC $ OTHER: A AUTOMOSILEUABIUTY ZQ0831 2/5/2024 2/5/2026 COMBINED SINGLE LIMIT 1E5-Jeede0 $1,000,000 BODILY INJURY (Per person) S ANY AUTO OWNED X AUTOS SCHEDULED AUTOS ONLY HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (PeracdtleM) $ PROPERTYOAMAGE or acoidnnt $ $ A X UMBRELLALIAB X gCCUR ZQ0831 2/5/2024 2/5/2025 EACHOCCURRENCE $3,DOD,000 AGGREGATE $ 3,000,000 EXCESS LIAB nczMADE DEO I 'Y I RETENTION$ 1, Derr $ e WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORFARTNEWEXECUTWE YIN OFFICERIMEMSEREXC W DEDi (Mandatory in NH) NIA OOD1208761 2/8/2024 2/8/2025 X STATUT I ERH STATUTE ELEACHACCIDENT $1,000,000_ E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 If yee, describe antler DESCRIPTION OF OPERATIONS hel. A Equipment Roarer ZQ0831 2/51ZD24 215/2025 Equipment 46,442 A Motor Ceyo ZQ0831 2/5/2024 2/5/2025 Cargo 902,500 DESCRIPTION OF OPERATIONS LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) The general liability and automobile policies include a blanket additional insured endorsement that provides addi8Dna1 insured status to the cerOficate holder only when there is a written cantmCt between the named Insured and tha certificate holder That requires such status. The general liability, automobile and workers' compensa0on policies include a blanket waiver of subrogation that provides this feature only when there is a "rum Contract beiween the named insured and the cedificate holder that require$ it. See air had Endorsement Forms: CG-2033(6.13); CG•7277; CG-7301 (12-19) CA-7214 (10-98); CA-7247(10-16); VJC420304B CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Calhoun County, TX ACCORDANCE WITH THE POLICY PROVISIONS. 202 South Ann street, SteB AUTHORREOREPRESENTATNE Port Lavaca TX 77979 USA— (2) 19BU-2015 AOOKD CUKPUKA IIUN. AU ngms reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD #17 NOTICE OF MEF_TING—1%2.9%2025 17. To acknowledge and accept the correction of Judge's name on the resolution for Lone Star Grant 2025 #5183101 and allow Judge Lyssy to sign. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Joel Behrens, Commissioner Pct 3 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 14 of 20 CALHOUN COUNTY, TEXAS COUNTY SHERIFF'S OFFICE 211 SOUTH ANN STREET PORT LAVACA, TEXAS 77979 PHONE NUMBER (361) 553-4646 FAX NUMBER (361) 553-4668 MEMO TO: JUDGE VERN LYSSY, COUNTY JUDGE SUBJECT: CORRECTION OF COUNTY JUDGE'S NAME ON RESOLUTION FOR LONE STAR GRANT 2025 #5183101 DATE: JANUARY 23,2025 Please place the following item(s) on the Commissioner's Court agenda for the date(s) indicated: AGENDA FOR JANUARY 29, 2025 * To acknowledge and accept the correction of Judge's name on the Resolution for Lone Star Grant for 2025 #5183101 and allow Judge Lyssy to sign. Sincerely, Bobbie Vickery Calhoun County Sheriff I 01/29/2024 Lone Star Grant Resolution CALHOUN COUNTY, TEXAS WHEREAS, Calhoun County finds it in the best interest of the citizens of Calhoun County, Texas that the Operation Lone Star Grant be operated for the Grant# 5183101, be operated for the fiscal year 2025; WHEREAS, Calhoun County agrees to provide applicable matching funds for the said project as required by the Operation Lone Star Grant application; and WHEREAS, Calhoun County agrees that in the event of loss or misuse of the Office of the Governor funds, Calhoun County assures that the funds will be returned to the Office of the Governor in full. WHEREAS, Calhoun County designates County Judge Vern Lyssy as the grantee's authorized official. The authorized official is given the power to apply for, accept, reject, alter or terminate the grant on behalf of the applicant agency. NOW THEREFORE, BE IT RESOLVED that Calhoun County approves submission of the grant application for the Operation Lone Star Grant to the Office of the Governor. Grant Number: 5183101 P sed and approved this 29th Day of January, 2025 Signed by: Calhoun County 4Jude, n Lyssy Attest: Anna Goodman, County Clerk By: Deputy Clerk Page i of 1 #18 NOTICE OF MEETING 1/29/2025 18. Consider and take necessary action to receive the Petition for the creation of the Calhoun County Hospital District. (VLL) Anne Marie Odefey explained the process of moving forward. Court approved to accept the petition. RESULT: APPROVED [UNANIMOUS]" MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese` Page 15 of 20 MEMORIAL MEDICAL CENTER So Much... So Close! 815 N. Virginia St. Port Lavaca, Texas 77979 January 24, 2025 The Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St, Suite 301 Port Lavaca, TX 77979 Re: Petition to create the Calhoun County Hospital District Dear Judge Lyssy, Attached is a petition signed by greater than 3% of registered voters in the county to support the creation of a hospital district. If everything is in order, we request this petition be filed with the County Clerk and then presented to the Commissioners Court at the next regularly scheduled Commissioners Court meeting. Thank you for considering our petition, and if there is anything else needed throughout this process, please do not hesitate to contact me. Sincerely, .-tl� 0'" Erin Clevenger, BSN, RN, CRHCP Chief Executive Officer Memorial Medical Center Phone:361-552-0222 AT �O FILED r JAPE 2 7 2025 BY: CLERK, CALHgUN COUNTY, TEXAS G�our,� G/tick GUIDELINES FOR PETITIONS (SIGNATURES 1-49) Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. 3. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47833556.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District"). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286,041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place #1 2) Kelly Staloch Place #2 3) Jessie Rodriguez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place #6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial term of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (1.49) Puge 2 of 13 PD.47833556.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP Calhoun County _ISQ Plan A Modified pla TX Tiff mM'. v 14 ((•. aora 1-� k,'4 ?'�? r V, :354Sn , soar 10 r � Q yas X •1 4 'k, $ r' z.,r„ p?, t Calhoun laOPlennaalnw •.a> 06ar1 t♦ �� / y ^"'^�'� S- Wag all TX `st ®a ia�t�,4�} gk'�� • 11r '�no.ao-v„wrv.aeuw h01A �q 5��,_ I�iS„�«.�k; �• HaHda - ach TX. r(„ 'aaa(i ark% L >f' d Petition to Create Calhoun County Hospital District (1.49) Page 3 of 13 PD.47833556.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my supla fo petition. 1 understand that the following information is required for a petition signature to a }� 1. A. Signature: B. Printed Na n Q s7 n a Wfa v-e r C. Date of Signature: 1.16 , 7,19 Z S-- D. Mailing Address (including city):3(a �� Py--)- La ya ['a 7X 7 71 7 j E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 2. A. B. C. D. E. (1) Residence Address (including city) and Date of Birth: (2) Voter 3. A. Signature:." B. Printed Name: f Ar ig -e AfctaliZ (9 0 C. Date of Signature: - 'I p t D. Mailing Address (including city): t 6 i:� i' r 77c'l '-7' E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 4. A. Signature: B. Printed Name �r C. Date of Signature: D. Mailing Address (including city): ' r E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Petition to Create Calhoun County Hospital Disvict (1-49) Page d of 13 PD.d]833556.1 S. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT (1) Residence Address (including city) and Date of Birth: (2) Voter Registration �ntyGoupty`Qf Rettig: 6. A. Signature: O�it�il/�i�.�i(�� e�-+�VJJ.0k,c]•s�hh B. Printed Name: _7'hq i M . ,f% ✓%a n iA A to C. Date of Signature: t Z D. Mailing Address(includingctty): 3t /-Ivpp1 r>y^{- 1a1i'A6t.2—'Tx 71179 E. Either (1) or (2): (1) Residence Address (' cludin city) and Date of Birth:�lf t �1 l S% 3S f ie. Muth r 1— l�cyctEcz�. .77!�7 y (2) Voter Registration i V6grj 6Rkgi�rIr}oL 7. A. Signature: �11 �xC i B. Printed Name: C. Date of Signature: _— D. Mailing Address (inclucf ng city): G' CCACq E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County Of Rwisteatioa; n 8. A. Signature-- ld iA fA 19 B. Printed Name: YWMLl:IA- K OC',J jLJQ C. Date of Signature: L IL 2s125 D. Mailing Address (including city): t" N obl Rd, 1 I a1 R E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration,# and faounty ofRegistrationK _ n , _ . _ `1 9. A. Signat Fe' B. PrintediVarty2r r. t C. Date of Signature: — 1 D. Mailing Address (including city): L Et E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regist106#6t`ill fT€.la3egistr�i K Petition to Create Calhoun County Hospital District (1-49) Page 5 of 13 PD.47833556.1 10. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # 11. A. Signature: tZY B. Printed Name: MQ g a r e i !k Y o y C. Date of Signature: 1-a D. Mailing Address (including city): 303S- PM a143� 6i�- LQ.yd.eR 7`G 77R�i E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 12. A. Signatur$r B. Printed Nathe:y l.+t ya q, r n a 1 yN C. Date of Signature: t --a2 • �5 p L y D. Mailing Address (including city):,';9�05'76LG Saly S� 1-D(T dJaCdt 1/` �J�/�l?Q E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # an¢,Cpup1y pf $egistratign: IA 'Ti.Ti a�i 14MIM 6 r ' ,a l 4m E. Either (1) or (2): (1) Residence Address (including city) and Date 14. A. B. C. D. E. (2) Voter (1) Residence Address (including city) and Date of Birth: (2) Voter Petition to Create Calhoun County Hospital District J-49) Page 6 of 13 PD.47833556.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 15. A. Signature:`' B. Printed Name: Ayton [Yl (rtQl GtO� C. Date of Signature: D. Mailing Address (including city):45i-i2Clc Cr" SE �--f-I IG.UC4cq E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # artACjgtMty of RegiWatign . .� 16. A. Signature B. Printed Name: U KfVVN',12ja , ' C. Date of Signature: j-4 D. Mailing Address (including city): -I 5 : LTV A ((A, � x %1 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 17. A. B. C. D. E. 18. A. B. C. D. E. 19. A. B. C. D. E. (2) Voter Registration # and County of Date of Signature: Mailing Address (including city): Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Date of Signature:_ l� 3 d/ a 4 S Mailing Address (including city): /O 7 Z& 4 nr Either (1) or (2): (1) Residence Address (including city) and Date of v itner (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Petition to Create Calhoun County Hospital District (1.49) Page 7 of 13 PD.47833556.1 Ie) PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 20. A. Signature: <�_ B. Printed Name: I - Ke.,o �� C. Date of Signature: / - 7-7- -2 J D. Mailing Address (including city): / o0 3. .ti .-A..u---,L L GF v i y 7? 4 2 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratio # �o of Registr ion 21. A. Signature: I/��'� B. Printed Name. C. Date of Signature: oy y D. Mailing Address (including city),-.' E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Counjy gfRegjs fom 'innr� "I L 9b p ojq Am 22. A. Signature B. Printed Name:' ' 7! n t 4 C. Date of Signature: I D. Mailing Address (including ci ):O 1 iJ�7G E. Either (1) or (2): 1 (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #and n: 23. A. Signature: kId'dn V M ^moo^lR f (Y%yl B. Printed Name: KkAda , UmLieo C. Date of Signature: I I cZ I A 5 ( D. Mailing Address (including city): IA/ Si (Oki f . orb i! 6tvwwt ` t�C 779 7ej E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # apdiCoufaN pf 1j;gWrptjgn: _ 24. A. Signature: B. Printed Name: Pdm^ fJ%PL5tv% C. Date of Signature: 22 25, D. Mailing Address (including city): 111 bilaid E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # altotttx�ipn: Petition to Create Calhoun County Hospital District (I-49) Page 8 of 13 PD.47833556.1 25. A. B. C. D. E. 26. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed IIJadie: Q(2m(e_ 1)2X, r, Ali a Date of Signature: (23 2 S t Mailing Address (including city):I Ike oto� dam- ( IQCD 77�j i Either (1) or (2): (1) Residence Address (including city) and Date of Birth (2) Voter Printed Date of Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # and CCougty f jegys tion• 27. A. Signature: B. Printed Name: C. Date of Signature: - -2 D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registj�i—{ ttkIR1 12 28. A. Signature:? ap k � pt tom( at a B. Printed Name^� ly:c; r� LET f \A �C11� C. Date of Signature: 4- l D. Mailing Address (including city)Q tt N E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter 29. A. Signature: ✓d�// �"� B. Printed Name: Q QI 6 d Q r C. Date of Signature: / 2 D. Mailing Address (including city): 3/8 Hg&Oe. E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Petition to Create Calhoun County Hospital District (1.49) Page 9 of 13 PD.47833556.1 W1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 30. A. Signature• B. Printed ame: 3 S _ l/UiX C. Date of Signature: �3 i✓ ,�pp ryy D. Mailing Address (incl ding city: Ls 1 G3 S /N�L�wacR I� Y�St E. Either (l) or (2): T-- f (1) Residence Address (including city) and Date of Birth: (2) Voter 31. A. Signature B. Printed Narvff. 9 ycl,,, 0. G/1 �J C. Date of Signature: I — 33 - ao a D. Mailing Address (including city): a74DA A). Vi ra: E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration #and Cou ty 9f Ijggi (roB; 32. A. Signature: (J V B. Printed Name: Ffej CAA1,07- C. Date of Signature: -2' D. Mailing Address (includingcity wh filat-tiVaer4ste 8#4-Lays,s E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # Ltd �M of,�teg s t1T( 33. A. Signature: B. Printed Name: i C. Date of Signature: I / D. Mailing Address (including city): e E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # and 34. A. Signature: w B. Printed Name. C. Date of Signatu D. Mailing Address (including city): ZIJ rAYfAWffJl /� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Rfgistt6tios �M Co y'ofnegi r do IA Petition to Create Calhoun County Hospital District (1.49) Page 10 of 13 PD.47833556.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 35. A. Signature: r / B. Printed Name: C. Date of Signature: n2s - /tea D. Mailing Address (including city): ILI 5 14 14! Y C E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RegistrajV T (ogy�p£ gi rat' 36. A. Signature: r / B. Printed Name: . S_ Sm c7G�tB K C. Date of Signature: 1�K� v2 + D. Mailing Address (including city): trac, E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration 6a d Co y f Re istratio : 37. A. Signature:« B. Printed Name: C. Date of Signature: - S 't Q D. Mailing Address (including city): 5t Q Y g f�, —12( L 1-1 R p E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # �pj Cqupjx of Regystrat 38. A. Signature: \ U B. Printed Name: C. Date of Signature: D. Mailing Address (including city): V. Qhq E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and County of Registration 39. A. Signature: B. Printed Name: U S C. Date of Signature: 1 I 23 1 TG D. Mailing Address(includingcity): G0O V l.i 'c P-Ctd-.Yi-R TX ti'1�1g3 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #and Coun of Registratio : 11I R � Cat niUr- Petition to Create Calhoun County Hospital District (1.49) Page 11 of 13 PD.47833556.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 40. A. Signature:.1✓ UJ B. Printed N 1 C. Date of Signature: 23 ty �f D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratir #,arvMufygf Ijegistratio : COW 41. A. B. C. D. E. 42. A. B. C. D. E. Printed Name: YYl L 1110 Z Date of Signature: Mailing Address (including city): Q \ to Either (1) or (2): (1) Residence Address (including city) and Date of Either( l) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # Ind County of Registration: 1-4 o �� 43. A. Signature:-" A Ai_zkAl� k N\,\_ 1A B. Printed Name: K Y� S }I ✓ 1 K v 1 n e,tr C. Date of Signature: 9 a D. Mailing Address (includingcity),I g1, C col }-t f I1 VCU-a,TX I-+Gi111 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Cgwty of Registtotion: 44. A. Signature: AA11 Dl L/ 7, B. Printed Name: C. Date of Signature: D. Mailing Address (including city : q1L K) Ann E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and Cg1,Inty of Petition to Create Calhoun County Hospital District (1-49) Page 12 of 13 PD.47833556.1 0 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 45. A. Signature. B. Printed Name; Civ� C. Date of Signature: I — 23- 2S' D. Mailing Address (including city): 9,o. ca E. Either (1) or (2): (1) Residence Address (includin35g city) and /3,1 544� 9±±, % Al , (2) Voter Registration # and CoPnty of 1. eg 46. A. Signature: B. Printed Name: ZQ C. Date of Signature: /-2A-2—Jq D. Mailing Address (including E. Either (1) or (2): pa ( �pt �ru et , :�}51-9 (1) Residence Address (including city) and Date of Birth: 47. A. B. C. D. E. 48. A. B. C. D. E. (2) Voter Registration # a; ¢ (�Tj gf $egi�tg�tjo Printed Nathe: Date of Signature: O G Mailing Address (including city) , T A OrILL- /L C�cc Either (1) or (2): (I) Residence Address (including city) and Date of Birth (2) Voter Registration # a �l qunty�o egist�atton:: Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of R gig stration 49. A. Signature: B. Printed Name: C. Date of Signature: 2 D. Mailing Address (including city):tjgi E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration 10nd tultyQtiRlgiLstration:K A Petition to Create Calhoun County Hospital District (1-49) Page 13 of 13 PD.47833556.1 GUIDELINES FOR PETITIONS (SIGNATURES 50-99) Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. 3. The information indicated is considered necessary to verify signatures. There must be the following: (l) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. 5. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47844329. t PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County .fudge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District"). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place#1 2) Kelly Staloch Place #2 3) Jessie Rodrieuez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philins Place #6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial tern of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (50-99) Page 2 of 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP Petition to Create Calhoun County Hospital District (50-99) Page 3 of 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: 50. A. Signature:1/(��-� B. Printed Name: C. Date of Signature: ! D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 51. A. B. C. D. E. 52. A. B. C. D. E. 53. A. B. C. D. E. (2) Voter Date of Signature: V - I V - Mailing Address (including Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 24 1 (.k 5 j S?J'rt LL6V61CGi lk Tit1�1 =i��10 (2) Voter Regist C fg' trati Signature VIA VJ Cif Printed Name: '6 A Las Date of Signature:- MailingAddress(including ity): uwRPA ix 11��1 Either (1) or (2): () Residence Address (including city),apd Date of Birth: l ZS -A= 4 (2) Voter Registration # Date 4Signature: 1 .10 -` 4 Mailing Address (including city): ADj 7, C T1 Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter 7 ,Y/ _6 Petition to Create Calhoun County Hospital District (50-99) Page 4 of 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 54. A. Signature: B. Printed Name: 4br4,L C. Date of Signature: / g3 3 D. Mailing Address (including city): 291A, RV A Lava(' a TK �S E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: err 55. A. B. C. D. E. 56, A. B. C. D. E. (2) Voter Registration Date of Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re istration #0n n lL sr o7 L Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration 57, A. Signature: f�((/LCa_ /L�'7y1 B. Printed Name: Fops: C. Date of Signature: D. Mailing Address (including city): 29 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth (2) Voter 58. A. Signature: I Uw B. Printed Name: SOh�OL W�t�r C. Date of Signature: :- - pp (� D. Mailing Address (includin�cin): (r { E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) VoterRegistratig( (1,�l Cofai}t Ft5i� •a Petition to Create Calhoun County Hospital District (50-99) Page 5 of 14 PD.47844329.1 59. A. B. C. D. E. 60. A, B. C. D. E. 61. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Date of Signature: ' / - 2 Mailing Address (including city):_ Either (1) or (2): (1) Residence Address (inchu (2) Voter Registration # and Printed Name: r' 6 , vl Date of Signature: 1 - 9- Mailing Address (including Either (1) or (2): (1) Residence Address( /-30'/H4-q (2) Voter Registration # and Date of Birth: 2 c' c' ` ,1c I 7 z-7:Tcr- city) and Date of Birth: �/ q 60 ot, . �a r�i ✓aca 7v Printed Name: �li$psh S �Awsxiu Date of Signature: f 1 -�� Mailing Address (in cludingctty): �I�P t)Y Pc - LlC,VeC, re'i fj Either (1) or (2): (1) Residence Address (including city) and Date of Birth: \ G� jet �, c� 1 Ty i cR') 'PC' %`I 30i,j�-r3 -11s1 (2) Voter Registration # and CountHbRRisttrtion: .: - ,v-.. 1 'n I I, 62, A. Signature:.Z22: � B. Printed Name: t m'11 -3 Q i �enr- Cvolhowt C. Date of Signature: O 1 1 3125 d D. Mailing Address (including city):2O0 WtlrC%UtLe2 S4 Qn i�f1yQLGl .Tx 11�1 ) E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:? jt 0 W q�.hottSe- c_4 �ir1-1 a aca a`F,r . 1191q O9lo2,Iclu (2) Voter Registration �n¢,C4,,4 {�i,Regi��atio . 63. A. Signature: t - ``hht-q t�Vj f ) B. Printed Name: 5 ' C. Date of Signature:0 D. Mailing Address (including city): 3 F7 11G 1q E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: -61:K 5.5� (2) Voter Registration # Petition to Create Calhoun County Hospital District (50-99) Page 6 or 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 64. A. Signature: B. Printed Name: t 5 C. Date of Signature: D D. Mailing Address (including city): kLeV01 FRAL-7P, E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Regist=6 �t¢,C,eytlty of Re�s�tr ton: 65. A. Signature: 6 b�J6 IJI�I B. Printed Name: A+j ¢„ a--, 4 C. Date of Signature: D. Mailing Address (including city): J to 3 o,v.t' 6, ;Pv. t E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registraiff6�a1 uUV�fRg,istation• 66. A. Signature: 1 B. Printed Name: C. Date of Signature: D. Mailing Address (including city):-`'tb2 t�,Ak 6�tz. otr-4 laaaatatiM��9��i E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration,q a)td,Coymty of Registratigp:n , 67. A. Signature: l w C — B. Printed Name: 124 C. Date of Signature:I - 7L' 6S' , D. Mailing Address (including city): IID vNt fi, VA64 E. Either( 1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratif M jd fgq jR) girfatj n: 68. A. Signature: 191 UK hN A iV k VkA VV%J B. Printed Name: vvrUa C. Date of Signature: D. Mailing Address (inclu ing city): E. Either (1) or (2): (1) Residence Address (including city) and Date of B (2) Voter Regi$tr,0tign N 4YA"ounty of Registration: Petition to Create Calhoun County Hospital District (50.99) Page 7 of 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 69. A. Signature: '- _ B. Printed Name:_ Qi C. Date of Signature: ' 2 D. 'M,,� Mailing Address(includingcityp a bq-y1ja701 E. Either (1) or (2): (1) Residence Address (including city) and Date ofBirth: _2AM4.. (2) Voter Registration( ��¢,C,qupt}Folj�giktrQ 1 K �6 fj �J 1✓j�J 70. A. Signature: (1 R o B. Printed Name: 1.In I ea r(}t A ]J(�y' C, Date of Signature: 1 A- 2023- D. Mailing Address (including city): 4Q363E4n ile7T 4P3(a t6V4,1A 5? ? 79 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 94 (2) Voter RegistrationLnd ty trat'on: T 411i 71. A. Signature:_ - B. Printed Name: J 1 WIytl C. Date of Signature: ?f, D. Mailing Address (includingcity):� hP(nl Dy li((1C} rnyatn E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Ga /VL w -27-93 (2) Voter Registration #,grACqugty gf.(tegi§kKatigp: 72, A. Signature -G C-ZA J -C17 rl LcvtLQ . B. Printed Name:Fi^g roe 'r-vTAV1(d2 C. Date of Signature:_ S D. Mailing Address (including city): '( r. 0k f tztV LcAa motl5 E. Either (1) or (2): p pp (1) Residence Address (including city) and Date of Birth: 73. A. B. C. D. E. Printed Name': Date of Signatun Mailing Address Either (1) or (2): (1) RRsiden ce Address (includi� city �a-✓nd/Rr{��aNto of Birth: OtI 16mq / 0, r lNV nra� 11 X2 eS (2) Voter Registration # and County of Registration:,__ Petition to Create Calhoun County Hospital District (50-W) Page 8 of 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 74. A. Signature B. Printed Name: a C. Date of Signature: 1%2� D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re istration #and County of Registration; 21 [a 5anq n ��t�� 75. A. Signature: 14-644^ B. Printed Name: C. Date of Signature: 2 . D. Mailing Address (including city): 13 I E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vote,[ Registration # and County of Registration:_ 76. A. Signature: (� ` 'ill B. Printed Name: f hYLGI- C. Date of Signature: 1 17 2 1 Sgts D. Mailing Address (including city): 520 -f XVA E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and 77. A. Signature: �n 7. v`"<L,''V e(_i B. Printed Name: f4 G— iY es> C. Date of Signature: - - D. Mailing Address (including city): o �9F yiVGCC E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 78. A. B. C. D. E. (2) Voter Re istration # and County of Re istration: 21�p43lt2I1� �Ftm� Signature: Printed Name: Date of Signature: 1 2. Mailing Address(includingcity): "lq Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Petition to Create Calhoun Count% Hospital District (50-99) Page 9 of 1=1 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 79. A. Signature: �� (yVuVlt%31^ B. Printed Name: --FP- r47EN SfAViHohA C. Date of Signature: - D. Mailing Address (including city):'f o. 224 0)rf 0 <owNoa, N 77 J1Lq E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration' �pd �pygty�o�s�ra� pn •G 80, A. Signature: s= ✓�� .__ B. Printed Name: e4p,/1;7h 67VC67O2Y C. Date of Signature: �I `23-T_Q D. Mailing Address (including city): O 3 22 / iii DCor�r1 r 1� 7799E E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratio�l#1a){d-T I o ��sY 0 81. A. Signature:-Lt/ B. Printed Name: ✓7PG>;_<-�� d/ C. Date of Signature: � ( o d D. Mailing Address (including city): ZD AaL %t 3 oCtr Oio �� ..?%<1�L E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regijt tyj ay tGna IResist ion 82. A. Signature: / Gr B. Printed Name:� PbwGG C. Date of Signature: /.—tea )— D. Mailing Address (including city): P O 5 Zx 7 4'> °o c E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth (2) Voter Registration # 1t}�) �(i�o�lty o Registr ti 83. A. Signature: B. Printed Nam :�gAn�f 4 __ C. Date of Signature: I I �h R D. Mailing Address (including city):--CJ G �j NI U Cr, NNvd2 /;9 111-,9 � E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:, (2) Voter RegkstGatiP11 �anl �f t�a iot Petition to Create Calhoun County Hospital District (50-99) Page 10 of 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 84. A. Signature: J B. Printed Name: t 2oY E W C. Date of Signature; 0I 2 3 - 2 D. Mailing Address (including city); (-')DV 77S ditO6-)A r ri 779bZ E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratyptt.�tjn�CpujjoftVfist(aj{oyt: 85. A. Signature:_ w �Y B. PrintedName:—� Fztc ' Ng.idwiA/3 C. Date of Signature: 2o2S' D. Mailing Address (including city): 81-7 Ort n CoV1ftOY, 77diZ E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #q�Csugiy af�R gsSrfrt on: 86. A. Signature: B. Printed Name:_) iC,-4 W IS�� C. Date of Signature: I I,, D. Mailing Address (including city):_ E. Either (1) or (2): (1) Residence Address (including city) and Date of B (2) Voter Registration # and Co ntv of �} strrntjq 87. A. Signature: ll JJ GG B. Printed Nam . C. Date of Signature: O 1-2 3 -2o2S— D. Mailing Address (including city): c5 r E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # anda I � (�tU tgafiop: akh m 88. A. B. C. D. E. Date of Signature: ! - Mailing Address (including Either (1) or (2): (1) Residence (2) and Date of Birth: .2 " 2 J? " 147 Petition to Create Calhoun County Hospital District (50-99) Page 11 of 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 89, A. Signature: B. Printed Name;! C. Date of Signatur D. Mailing Address E. Either (1) or (2): (1) Residern iSQ-4 (2) Voter Re 90. A. B. C. D. E. 91. A. B. C. D. E. 92. A. B. C. D. E. ltl Printed Name: `1 sp L, o VIA i Date of Signature: I Mailing Address (including c ty): P. _ & 1 Either (1) or (2): (I) Vsid Ze Address (including city) and Date of Birth: 1 5 (2) Voter Registration # and MIT of BOg1s tioh:�(—"T r/ Printed Name: Date of Signature: l — 01 — d -a 5 Mailing Address (including city): O CO n (\l s ILK 77 9 $ = Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter,Registration # and County of Registration: 10 0 O 9 S 7 a '7 D'Covi01yv 5 W• �a✓ri5p� I�VG' J, annoy Y-7-iA$2 (2) Voter ReIisV iu tdt`�tC/lstration: 93. A. Signature: B. Printed Name: C. Date of Signature: '2 , �� D. Mailing Address (including city) e Z.•F-7 7 E. Either (1) or (2): Gt— LkovA (1) Residence Address (including city) and Date of Birth:_ (2) Voter Registration # and Cou R t ra on: PrintedNalne:Wq tetri G NG6✓kJ/—J Date of Signature: - 2 -2 Mailing Address (including city): Y. v - n Either (1) or (2): (1) Residence Address (including city) and Date of Petition to Create Calhoun County Hospital District (30-99) Page 12 or 14 PD.47844329.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 94. A. Signature:-�G�� sZ B. Printed Name: A,(,z C. Date of Signature: D. Mailing Address (including city) o q gL E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: -a n s Sr per! l © e-O 1Ll o r� :2!?`'�'�i (2) off' ter Registratii `1 # > 1 t otW1- gistyal y, 95. A. Signature-y-�� j-1 I na,,XCL B. Printed Name:_ ilmg� w c_\ of C. Date of Signature: - neci- D. Mailing Address (includitv): lVaN -Ne!)X S11 13COA ti'R -7-79t. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:a,2'1 ei-sle 'S S (2) Voter Registratioq #rr ac4 �ouWypf RegistliatAn:_� 96. A. B C. D. E. 97. A. B. C. D. E. 98. A. B. C. D. E. Date of Signature: Mailing Address (includingcity): 10 1 b 12Vi 1) (AA • �,M ZJ 9- Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RegiT1,T "616ylGatigt9 RYirtio Printed Name: Date of Signature: Mailing Address(includingeity): 9 hI/�/02 %C Either (1) or (2): (1) Residence Address (including city) and Date of Birth: $D $4 (2) Voter Registration # andCoynt� oj:,Rggistratttwn: Printed Date of Mailing Address (including Eithe-'' ` --' (1) (2) Petition to Create Calhoun County Hospital District (50-99) Page 13 of 14 PD.47844329.1 77 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 99. A. Signature B. Printed Name: U t' I t tz Coy-Cj t7V Gl C. Date of Signature: n I J 2 3 d 5 D. Mailing Address (including city): 55 �oCetc) Drtfe o w,l0.Ca I %X E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter `��f Registration # and y ion: II�0�is at Petition to Create Calhoun County Hospital District (50.99) Page 14 of 14 PD.47844329.1 GUIDELINES FOR PETITIONS (SIGNATURES100-149) 1. Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. 3. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. 1'D.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District'). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place#1 2) Kelly Staloch Place #2 3) Jessie Rodriguez. III Place 93 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place 46 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial term of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial tern of two (2) years. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (I00.149) Page 2 of 14 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP 4alnoun uounty16U Flan A Modified 'T .' aou yes 1 CDIi ' oroe ' o00o a crosF wx •�. hia OTX aoie + qr Is oln(' f il7C C p'1 l . r rfllooFlil ion T%y . 'e) �f�Dsl Br 1 !sail xkn� WIPr }�r oar ��iooa h y 1pat9` rv\ rx ^"'^N•\- �..1 '16^vr� L...l'rN *161 ul{5`4�k'�1 eF{yi FY�t .. �: v,fx1 �i�y a cei i r 1 9cIMnn 139PIenAYntlprtl `c OOIA �' .r��iij ,. F.s �, mt An 'ai1TX .r �. �Wf,, R.wn � awa qay 5'N x�ih +ieb n �nwcminarmcV»'.Y 091A l nJ N9na y ' 4T% / om, mne 7 m z 'r :.. F+H Petition to Create Calhoun County Hospital District (100-149) Page 3 of 14 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: 100. A. Signature: MV B. Printed Name: AAV1V101 01 VOIVI C. Date of Signature: I M0101.5 D. Mailing Address (including city): 111S V0111, 9t. P62.1 I,d aV A- .IX'71111 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:1113 VAIL Li - PORT LAVACA/V '7101l6[ JurlC 11,11.11 Either (1) or (2): (I) Residence Address (including city) and Date of Birth: (2) Voter 102. A. Signature:'CAJlN✓ B. Printed Name: 5.�r(n CV- all' C. Date of Signature: I - I U - ao a5 D. Mailing Address (including city): `Q-n E. Either (1) or (2): (I) Residence Address (including city) and Date of (2) Voter 103. A. Signature B. Printed Name: ' v- C. Date of Signature: 'I t'7 /a. _ D. Mailing Address(includingciiy): 9-9; 'p Qa r — Lwl&c-c�T)c E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter I �s�Vl , U1 g �C�unty_ Re ilA on: Petition to Create Calhoun County Hospital District (100.149) Page 4 of 14 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 104. A. Signature: I --VV t B. Printed Name: C. Date of Signature: l ?D D. Mailing Address (including city): DAAMCM6 POTh UMOLC4, E. Either (1) or (2): (I) Residence Address (including city) and Date of Birth: (2) Voter Registrati 72n ld�C�tly�ofJt�gjstratio rl U t%� IISS �l 105. A. Signature: 'MieF c B. Printed Nadi': avrcad } Icz 0. C. Date of Signature: f — rJ —: S I D. Mailing Address (including city): �Z 6 F Je, r G�itC h act ZZC211 /aviLco- E. Either (1) or (2): TX (1) Residence Address (including city) and Date of Birth: (2) Voter Registration# and County of Registration: 106. A. Signature: �l-s( ///', B. Printed Name: Gt 36 t o a C. Date of Signature: D. Mailing Address (including city): Cf-ae4e7TST ar+ LA✓h-Q4 TA ?7-77 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #,and Goupty of [tegistration: 107. A. Signature: B. Printed Name: Cl I" C. Date of Signature:yy iZO D. Mailing Address (including city): 163 e E. Either (1) or (2): (1) Residence Address (including city) and Date of B (2) Voter RReeeg jra(ioq#�gdt�ffLrgi i 108. A. Signature:.. Aew z, &6a�rlPDil"1 B. Printed N : G 1Ot2i A N.tek--;ok C. Date of Signature: .Z S D. Mailing Address (includinl; 5t—y): C/]ecJ2s d onf l`6Z/j4oa %Y E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regist-t)rajont#jqd �gytl�x of,�ti atio Petition to Create Calhoun County Hospital District (1GO- 149) Page 5 of 14 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 109. A. Signature: Q ' L B. Printed Name. V ' C. Date of Signature: I -�O D. Mailing Address (including city): U R p rlc E. Either (1) or (2): (1) Residence Address (including city) and Date 110. A. B. C. D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratio t� a Cpunt of Re 'stra 'on: A. Signature: �J �J B. Printed Name: C+o C. Date of Signature: 1 - V - 20 25 D. Mailing Address (including city): Q aej P n➢tr tPbr+ LA E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # �Md �ountytion:—IA O'B. l-7a.`1 112. A. Signature:_ C 9A �`v �- B. Printed Name: C4�r 3 ay4fQk C. Date of Signature: \ - 2- 'aS D. Mailing Address (including city): 30 l I2 - hl E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:_ (2) Voter Regitspoft # tACotytty 9� Registration: 113. A. Signature: W1OMl \JU B. Printed Name: >L C. Date of Signature: - ?,,2 'Zv L D. Mailing Address (including city): a E. Either (1) or (2): 0 (1) Residence Address (including city) and Date of (2) Voter RegistrT # aPdG 2MMisttttoR: Petition to Create Calhoun County Hospital District p 00-149) Page 6 of 14 PD.47844835.1 `11 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 114. A. Signature:1 B. Printed Name: (eh 4' rA 4 i )l')/) C. Date of Signature: F- -z i D. Mailing Address (including city): E. Either (1) or (2): ^� (1) Residence Address (including city) and Date of Birth: oC (2) Voter Registration # argltknlytgf8ggj�;�tj n: r ' . m p 115. A. Signature: W 08 V 6 V 6 B. Printed Name: �J ✓� o iL� C. Date of Signature: l 9 e- /��j D. Mailing Address (including Ic ry): to 5N %jiAa�t��_ L-AJ E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 1 0L/«*z7 (2) Voter RegistratioAi and County of Registration: 116. A. Signature: Wf� B. Printed Name: S C. Date of Signature: / D. Mailing Address (including city): $/ 6,4- LALft ' T—k E. Either (1) or (2): Residence Address (1) (including city) and Date of Birth: (2) Voter Reg Try (i 11 a� C�t4nty� f ljjis( Mad l I�IP J �t ((�Ild l( U 2-, 117. A. Signature: B. Printed Name: r-167AAC jW6&J C. D. Date of Signature: // Z 2 /1 y Mailing Address (including city): 21/ acAlt Rir y, P'!r <9Y � /y E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # i nd f unty o=io 7-771 (1) Residence Address (including city) and Date of Birth: set L/� 2 (2) Voter Petition to Create Calhoun County Hospital District (100-149) Page 7 of 14 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 119. A. Signature: B. Printed Name: (AI�U (vr7 C. Date of Signature: I - 11 - 15 ��t�� '�" D. Mailing Address (including city): 141 i N �ttit C. �0 k°ait VlWt rX E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registr�tj hajqMy, e Yi rn- mo 120. A. Signature: �QP, B. Printed Name: \VLa- al.t.7s1'� C. Date of Signature: 1 D. Mailing Address (including city) : t�OP�UI( 9Z1 oJ{(l'(nvt110r, TX-1- 2- E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) VoterRegistrat' dtjnly� Re is ion: 121. A. Signature: f B. Printed Name: C. Date of Signature: 111 2 S D. Mailing Address (includingcity): VGC�tTy E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # an 1 n�,tyg f i�,t'r�atip 7,� G) t�-�` J 122. A. Signature:15 It B. Printed Name:l3rz�i-1aN-A lZuklicK C. Date of Signature: I u I x5 D. Mailing Address (including city):7_210 Tod(sr)n St. E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registr't4 f Ud0Coyynty o Fyistrrqtiorn 123. A. Signature: Tz)"i.(G ) 1cWLq W4 L J B. Printed Name: Q t1 L6f? it i C C. Date of Signature:all/ Q 09Z D. Mailing Address (in ludi gcity): P.P- Box 135 E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Regjs� Petition to Create Calhoun County Hospital District (100-149) Page 8 of 14 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 124. A. Signature: f1 ate(- ZWO' "`w B. Printed Name: 1 C. Date of Signature: I i D. Mailing Address (inc city):PbbOX aaC F ari O'hoV{mil 1Z°i`6� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re�i�t{�jioyT�agd_C� r �Q �ki� j p 125. A. B. C. D. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration 11 aVVjj j//tration: 126. A. Signature: 1A wev B. Printed Name: v -evS C. Date of Signature: D. Mailing Address (includi f ciri)' :�O P�ux v ✓4-6, r Kv,cv tTgva 3 -1717C2 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration nd C j of'�g atigg: - f � � 127. A. B. C. D. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: 128. A. Signature-IVOM'4, LA ftAoo't B. Printed Name: in (r C. Date of Signature: I I'►( (� D. Mailing Address (including city):'t//1,01 _ rwy\ QY , t pooli-La✓&tA (t r � � GI•'� cj E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regis(r�tjo�(t�ggd,�glfgtyrqf Petition to Create Calhoun County Hospital District (100-149) Page 9 of t4 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 129. A. Signature: i' t[ �L B. Printed Name:' Iti akj,L V C. Date of Signature: 1,1l 2I D. Mailing Address (including city): I U E E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter RegistratiW # and County of 6et?istration 130. A. Signature: B. Printed Name: 11011, C. Date of Signature: D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter 131. A. Signature: W\)/V IY4 I B. Printed Name: Hantlatl He C. Date of Signature: n I - a I -rn? ri D. Mailing Address (including city)j� SUhI E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # and County of_tegistrpt rt- -ix -�'A s' Z- 132. A. Signature:6✓h B. Printed Name:_ (%.1�✓) C. Date of Signature:Iml as D. Mailing Address (including city): fO qQ E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 133. A. B. C. D. E. Mailing Address (including city): Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: Petition to Create Calhoun CountyHospital District (100-149) Page 10 of 14 PD.47844835.1 I 134. A. B. C. D. E. 135. A. B. C. D. E. 136. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Date of Signature: 1 Mailing Address (incl di g cit zc�o 1%ty1— i Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and Printed Name: Date of Signature: 1 T,�z 49 Ci Mailing Address (including city): 2jQ L) i0i,41 o, o, /VF Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # 137. A. Signature: B. Printed N e: C. Date of Signature: i D. Mailing Address (including i E. Either (1) (2) 138. A. B. C. D. E. Printed Name: Date of Signature: 2-1 S Mailing Address (including city): VI &b V1 bty+ Qd SP[YiYlf� .TX 'I"19g3 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: OLP t (2) Voter Petition to Create Calhoun County Hospital District (100-149) Page 11 of 14 PD.47844835.1 139. A. B. C. D. E. 140. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Name: 1.' ! Date of Signature: - Mailing Address (including city): f Either (1) or (2): (1) Residence Address (including city) and Date of Date of Signature: t - 7--2--2- Mailing Address (including city): iai rdWll v r7 1,e-7r9j7�} Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # 141. A. Signature: k/ 41 B. Printed Name: C. Date of Signature: - D. Mailing Address (including city): PJ 4 aY E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # 142. A. Signature B. Printed Name; Q-7,5-W j)i fne Y C. Date of Signature: (- t 2 - 2': D. Mailing Address (including city): PQ ROY- 5 1U T 1L �1PI E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration 4.and,gc&Mof egisitratygn: 143. A. Signature: B. Printed N e:ThA DCJIPAr T� C. Date of Signature: - 2 �Z - to _4 D. Mailing Address (including city): SSL Sea i•:+'•FMI 77y85 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration# g11d ICo)a?tgfMion Petition to Create Calhoun County Hospital District (100-149) Page 12 of 14 PD.47844835.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 144. A. Signature: B. Printed Nal T v _ C. Date of Signature: AT— D. Mailing Address (including c ty): ,& E. Either (1) or (2): (1) Residence Address (including city nd Date of (2) Voter Registration # and County of,RggjqtrAtiW 145. A. Signature: B. Printed Name:_ "4 hk .re) C. Date of Signature: / 2.q D. Mailing Address (including city): -Z/4 14 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth (2) Voter Registration an r lP 146. A. Signature: / ✓ B. Printed Name: C. Date of Signature: i D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration #�a�td fofyity gf �,egiati is 147. A. Signature: ` t B. Printed Name: Fi:S xkor C. Date of Signature: t D. Mailing Address (including city): 1' CX-tt. E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration 148. A. Signature: B. Printed Na C. Date of Signature: D. Mailing Address (including cityj LAVA-- E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth (2) Voter Registration # ani Tty PfPgl pr . Petition to Create Calhoun County Hospital District (100-149) Page 13 of 14 PD.47844835.1 0 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 149. A. Signatu=— /,ki, B. Printed Name ex f P A /C 05 C. Date of Signature: 3 41{,I D. Mailing Address (including city): A 3' % J�C a l- 4'lt ' "r d E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RegV6,lion6 al IT ,( of L Tis!tl� n Petition to Create Calhoun County Hospital District (100449) Page 14 of 14 PD.47844835.1 GUIDELINES FOR PETITIONS (SIGNATURES 150-199) Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2, if multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47844900.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District"), 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place 41 2) Kelly Staloch Place #2 3) Jessie Rodriltuez, III Place 93 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place #6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial term of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. Norte of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (150-199) Page 2 of 14 PD.47844900.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP Petition ro Creale Calhoun County Hospital District (I50-199) Page 3 of 14 PD.47g44900.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: - /J 150. A. Signature: -b6Wbi Q a '_ B. Printed Name: ac (R� 'oro r C. Date of Signature: I-1? 2ozS D. Mailing Address (including city): kl l ouslon Sf. 1001-f 14 %11r �949 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 09 - 3 c0 - tq qL 11 kiouSf- s{- Pori C.4V4eA 7jc-qq+9 (2) Voter Reegistration # and County of Registration: I l S 5 S 1A ) % y we Ocn 1 e 151. A. Signature: B. Printed Name: IlAlec 0 /e C. Date of Signature: l' l ' D. Mailing Address(includinacity): /% /I /'nn Bff E. Either (1) or (2): f Birth: (1) Resipnce Address (including city);n _ /Cyr die°I T�( 7 21 (2) Voter Registration` # and County of Registration: 1 DO-1 'Aa 5 oZ 2'1 152. A. � �-�lo . r . x 1 Signature:-- 21 B. Printed Name: /., ., C "� C. D. Date of Signature: - 7 - 2 cot 6` Mailing Address (including city): �% 33S n G� ��f �u�ey %,Y'/' Nel E. Either (1) or (2): (1) Residencp A4dress ((mcludin city and Date of Birth: t IJOsS 1�7 -Ia -574 (2) Voter Registration # and County of Registration: Its 1 `S a.37- 153. A. B. C. D. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Ole t (2) Voter Registration # and County of Registration: D a 13� OCa 3 Petition to Create Calhoun County Hospital District (150-199) Page 4 of PD.47944900.1 q `I ` PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 154. A. Signature: B. Printed Name: C. Date of Signature: D. Mailing Address (inclu ingcity) �i5� rgc1,— gc`ttTs t 1�r�� J E. Either (1) or (2): (I) Residenccddress (includin�io (ig cit S y)pnd Date of Birth: 011ii'-\�d3hR l c� r e �/ (2) Voter Registration # and County of Registration: C) 0'if rd 155. A. Signature: "IYI l` B. Printed Name:_YV QnIP o. (A-r' C. Date of Signature: 1- I - 2,5 D. Mailing Address (including city): 1I•-1 rial L� r i et o! r date Tye 7797 E. Either (1) or (2): (1) Residence Address (i{�cluding city) and Date of Birth: 09 jo31 ki I t 4 Sulta.f tl _Wor lqd kC a ,Y 7g7cI (2) Voter Registration # and County of Registration: 100 0<&r-, L-1O q ;K 156. A. B. C. D. E. 157. A. B. C. D. E. 158. A. B. C. D. E. tuner (1) or (z): (1) Residence Address(includi city)andD�e of Birth: (9,�'t75 Qa� N.1tUntU t�rLf�i a�ca Tx�117�7— (2) Voter Registration # and County of Registration: I0 k l Lo 0�-t 2 3 Date of Signature: l 1%X 7� %� Mailing Address (including city): I Q I off �ir ✓••� f Either (1) or (2): (1) Residence Address (including city) and Date of Birth: ZZ4 8pt ✓i t S j' lo..{tw••. %f �l�I J (2) Voter R/ration # and County of Registration:_ b1 l3S{Q D °d K 3 Printed Name:_ it;Iae/ b 4 e v /z D / Date of Signature: /. My- 5 Mailing Address (including city):- oZ z 9 f111,61 Qr),-{ Either (1) or (2): (1) Resi�egceAddress(includingcity)andDateofBirth:S'Me y?I - /7 - Ilea (2) Voter Registration # and County of Registration: Petition to Create Calhoun County Hospital District (I SO.199) Page 5 of 14 PD.47844900.1 159. A. B. C. D. E. 160. A. B. C. D. E. PETITION TO CREATE THE CAAL�HOUN COUNTY HOSPITAL DISTRICT Ci onnn ire• Y� h, 4 1 Date of Signature: - - Y y Mailing Address (including city):1b33 0211 r �1c,fr Either (1) or (2): (1) Residence Address (including city) and Date of Birth: S-a o e n�tat (1 ?LJ [lcaSS ",3 (2) Voter Registration # and r9unty of Registration: 10 oD q -,� O o0 b Date of Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration #pnd County of Printed Name: Date of Signature: Mailing Address(includiety): Either (1) or (2): (I) Residence Address (including city) and Date (2) Voter Registration # and County of 162. A. Signature: B. Printed Name: (` C. Date of Signature: 19' D. Mailing Address (including city): /LL j e 4 G S E. Either (1) or (2): (1) Residence Address (including city) and Date of Bi (2) Voter # and County of Registration:_ %Registration 163. A. Signature: rC/ B. Printed Name: li"Ie e c C. Date of Signature: o S D. Mailing Address (including city): //, l R•S E. Either (1) or (2): (1) Residence Address (including city) and Date of Bi dcn < es mc"/,r (2) Voter Registration # and County of Registration:- C, t H7,.11+^1 oG//, - " 611)n IIA L cvF C, rfcra< <i�t%1/:y 1,2 Petition to Create Calhoun County Hospital District (I50-199) Page 6 of 14 PD.47844900.1 7 SS 164. A. B. C. D. E. 165. A. B. C. D. E. 166. A. B. C. D. E. 167. A. B. C. D. E. 168. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Date of Signature: — Mailing Address (including city): /D % Either (1) or (2): f, (1) Residence Address (including city) and Da a of Birth; n1 6 �97/1 1 ! �n (2) Vote0 [t gyst tjeq}li Coy�nt of Red iation: Signature:�rr/ v^ / e n.l OlJtd l n Printed Name: ey /! /9.v e ✓ L� Date of Signature: /- 9 Mailing Address (including cityl• G s OS— / r1 -/J,-vG7 7g�� Either (1) or (2): (1) Residence Address (including city) and Date of Birth: /O - (2) Voter Registration # and Count of Re istration: 10 0 U1 ?.5?,Zt (e Qxlh6U.t�1 Printed Name: - ) 45c � CS (. - /LA/'t2l��d �i7 SAL Date of Signature:- - Mailing Address (including city): 5 3 S"�/_I 4% Either (1) or (2): _ (1) Residence Address (including city) and Date of Birth: 1? —C/— l Tfrvt� qs h.[[n/6 t (2) Voter R istration # and County of Registration: 1 14 �I ffm rn IhnkA-) Date of Signature:L Mailing Address (including city) Either (1) or (2): (1) Residence Address (incli SEdI (2) Voter Registration # and a of -1 Printed NamQ / a tpe- A jjr ( e. Date of Signature: ' I - I !I - '7 c , Z 5 Mailing Address (including city)::IWPil� W Iue U✓✓fca ,4•77979 Either (l) or (2): `XC O Ve L\,:�l tv�c t i4C� (1) Residence A,dresstt(incl d.' cit f)p?c)�ate of Birth:_ Se 17 J d l> (2) Voter Re istration # �ian Count of Registration: 7�o�n4�tntoC.��icsual . Petition to Create Calhoun County Hospital District (150-199) Page 7 of 14 PDA7844900.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 169. A. Signature: 19 A 2 k rf -Ltn ( P 5 YA v IS B. Printed Name: A • L(`..L<l > C. Date of Signature: D. Mailing Address (including city): Y R F&I AZ 3 -jvy t LLkA E. Either (1) or (2): (1) Residence A3ldress (including city and Date of Birth: I I O - lie `s 4;t,- adVc-r% (2) Voter Registration # and County o Registration: 170. A. Signature: B. Printed Name: Caz . 61,0,4 C. Date of Signature: /-/4- W45- D. Mailing Address (including city): 91'/ 34k /l o /f3SA/ Orr E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 44,.e of ma.l.. 8- 3 7 /SiJ g (2) Voter Registration # and County of Registration: 171. A. Signature: ✓ mly 1 B. Printed Name: C. Date of Signature: - C r D. Mailing Address (inc uding city): / / 3`�� 1 / � E. Either (1) or (2): O �� (1) Residence Address (including city) and Date of Birth: JlD Yl @ l 172. A. B. C. D. E. 173. A. B. C. D. E. Date of Signature: Mailing Address (including city): 6 00 44,w c, rx Either (1) or (2): (1) Residence Address (includin city) and Date of Birth: S' < ••i CJ . ✓< n jo._j;i iY )g (2) Voter Registration # and County of Registration: Either (1) or (2): /�� ) (1) Residence Address (including city) and Date of Birth; d*4 (2) Voter Registration # and County of Petition to Create Calhoun County Hospital District (150-199) Page 8 of 14 PD.47844900.1 174. A. B. C. D. E. 175. NMI A. B. C. D. E. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Either (1) or (2): (I) Residence Address (including city) and Date of Birth: rr7� /1 S� (2) Voter Registration # C Printed Name: c ¢ P —1 L-/h1/ ivy o d Date of Signature: l /Q — MailingAddress(inciud gci : 6y7 4elwe&&Either( I) or (2): (1) Residence Address (including city) and Date of Birth: :�4t2 06 4, fie J, dljj, (2) Voter Registration # Printed Name: Date of Signature: - ` Mailing Address (including city): Either (I) or (2): /l / (1) R'side� �e Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration 177. A. Signature: B. Printed Name:_ C. Date of Signatu D. MailingAddres E. Either (1) 178. A. B. C. D. E. (2) Printed Name: R y 1j Date of Signature: Mailing Address (including city): p, t 51 ti G-[t' Either (I) or (2): (1) Residence Address (including city) and Date n( r-� (2) Voter Registration # and County of Registration: 0 v/r e, i J. t rk 121 W -? Petition to Create Calhoun County Ilospital District (150-199) Page 9 of 14 PD.47844900.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 179. A. Signature: A rQLA a B. Printed Name: Xa., C. Date of Signature: C ! _ p - 7 e a <- D. Mailing Address (including city): y /• G ay r c R o/ �'e ✓, ,' 1' E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: O )? (2) Voter Registration # and County of Registration: I 180. A. Signature: lJ t (t - l B. Printed Name: I r� yE j t cl`2c� C. Date of Signature: f - " '7 ;t ^ D. Mailing Address (including city): f C' o E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:�J „t, :t,v ix-ri,'h�; 606 ocI -06- 1n4 (2) Voter Regi{tut n#anOun_ty�fRegiastr�a,`tion: i 181. A. Signature: B. Printed N e:_T - C. Date of Signature. /J / — iy- z o zS D. Mailing Address (including city): r q,? • , x 7 R cf €„t ck_itr Tk . E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: rrcrs� /.a�Yr .ed (2) Voter IegVV ist;'yUt C0lu�nty of stra 182. A. Signature: CC 11JJ B. Printed Name:. Lloyd C-A_ V C. Date of Signature: ! - ! 9 - a 012 S D. Mailing Address (including city): Q0 . % 0X 56 '7 .S F_ Air; f fi TN E. Either (1) or (2): (1) Residence Address i4chiding city) and Date of Birth: `` 5 S G14Esc! s' AdctFr lt- as- lg�/ (2) Voter 183. A. Signature: / (.7f/C. ( Cc B. Printed Name: I Q01 w ci [ C. Date of Signature: 1l6 1 ` D. Mailing Address (including city): � 1 X 5G-7 CICi j -j ct } 3 E. Either (1) or (2): !� (1) Residen Addr ss(' cludin c1 )andDateofBirth:_ M3 �� f�ca C�j (2) Voter Regist rD Rn # a`nd� yln 0 R�egist�ra�tl�; n�l Petition to Create Calhoun County Hospital District (150-199) Page 10 of 14 PD.47844900.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 184. A. Signature: B. Printed Name: y r, Muhl tG C. Date of Signature: ` D. Mailing Address (including city):_ 96/ L oenin4e 5 ��Ff� %Y%%!ry% E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: la me N5 1115GH-e- (2) Voter Registration # at0 County of Registration: 185. A. Signature B. Printed Name:. " -e �-A C. Date of Signature: 0-2 D. Mailing Address (including city): l 5,3 6/ ,4w -5 )» it mek (/ I ) jS !'2 E. Either (1) or (2): (1) Residence Address (incly�ing city and Date of Birth: S ,,, q c /) fr•c'c 186. A. B. C. D. E. 3 ctmer ( t) or (z): (1) Residence Addrksa4ln(L(uding city) and Date of Birth: 60,ft�e gt) OL t)-& (2) 187. A. Signature:< V B. Printed Name: C. Date of Signature: 0 b D. Mailing Address (including city): 1 L 5f M 1 P G '1C1 1�1 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: SnM� r. a.S cd bev e 01.11 I (2) Voter Registration # and Count of Registration: 10t��ol� C��hb 188. A. Signature: L I B. Printed Name: C. Date of Signature: -- D. Mailing Address (including city): TbWQ MflikVANil VkVk&-7'% , • ej E. Either (1) or (2): (' (1) Residence Address (including y) and Date of Birth: 2$ UO T/.1i I% W .16ty&ca- U ')II01M S Lb ?cits' (2) Voter Registration # andounty of Registration: Petition to Create Calhoun County Hospital District (150-199) Page 11 of 14 PD.47844900.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 189. A. Signature: V VV- VCi B. Printed Name:yy�( C. Date of Signature:3ifdyEla1l20 D. Mailing Address (including city):__ G$ ($_ KAAS �6 t- LA UA(4 .0 9jg741 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: &VKG t LoZJ o ( 3 (2) Vote str�tipVjnd C t f Registration: 190. A. Signature: B. Printed Name: 15N E LLy CROW C. Date of Signature:'So1 1j, 2l7 Z 5 D. Mailing Address (including city): lelb FtA ZZ E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Re istrationn # and County of Registration 191. A. Signature: B. Printed Name: elni) Aw%v% FR Gbh, tAD C. Date of Signature: 3� ILA ZM, D. Mailing Address (including city): ';03 WtV OWbtnd TX - 11r E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth _aME 12.122.179 (2) Voter Reg isjna[iott # apd 6ony�f Registration:�l t (tB(1 hj L� 192. A. Signature: B. Printed Name: _\�_Taaa"m cTedl i r, ;q C. D. Date of Signature: I- I q - a6. S Mailing Address (including city): Qtq 17t) i llnw ha ho r• Porgy' �-AM-U, tT[ '717 E. Either (1) or (2): ' (1) Residence Address (including city) and Date of Birth: Sab tee_gd W\(G 9x�A ix rAzb 3-I _ l9>•F9 (2) Voter R y rat n # and Co nt of Registration: o ) .�r �t�nm�� 193. A. Signature: 4i B. Printed Name: v' c'4 C. Date of Signature: - - S D. Mailing Address (including city): aic) W,tlnt.;-he-y%eR l�r_ I� Ybr'i) Gtlut<i I X ` 12c E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Savre ASyy%c` ljjnj adore (2) Voter ge is ation #and County of�Re�istration: t � 0 °I D�tzn to a t'hfiln 1, Petition to Create Calhoun County Hospital District (150.199) Page 12 of 14 PD.47844900.1 194. A. B. C. D. E. 195. A. B. C. D. E. 196. A. B. C. D. E. 197. A. B. C. D. E. 198. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Date of Signatur Mailing Address Either ( I � — 0%- (1) (2) Printed Name: U11y Date of Signature: o ,fin Mailing Address (including Either (1) or (2): (1) Residence Address( Gffmw i = (2) Voter Itggi%ration # Printed Name: /7 Gt /-5 1L2 // L Gt Lk Y Date of Signature: i -- 2/0 — = Mailing Address(includingcity): /� 2 C2 XFf f X Either (1) or (2): (1) Resid nce Address (mcludin$ city) and Date of Birth: rple el-9 (2) Voter RegistrattiioA# and County of Registr4(ion Date of Signature: I W Mailing Address (including Either (1) or (2): (1) Residence Address (2) Voter Registration t Printed Name: K-Y Date of Signature: —Am Mailing Address (including Either (1) or (2): (1) Residence Address (2) Voter Registration i Petition to Create Calhoun County Hospital District (150-199) Page 13 of 14 PD.47844900.1 7 I� PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 199. A. Signature: — A ( /'/ 7K— x „%lL B. Printed Name: 4Z C. Date of Signature:_ 'v D. Mailing Address (including city% S'r Fc 4 « i% �,�!,1 �., TY 19,19 7 E. Either (1) or (2): (1) Residence Address (including city) and Date of 3irth:5 r� �� A; �/ 2 Sc«c -3 _Kij"`t) " r, 'Pi/ (2) Voter Registration # and Count of Registration: t o tig ob � Petition to Create Calhoun County Hospital District (150-199) Page 14 of 14 PD.47844900.1 GUIDELINES FOR PETITIONS (SIGNATURES 200-249) Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.4784494I . I PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District (`District'). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place #1 2) Kelly Staloch Place #2 3) Jessie Rodriguez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place 46 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial terns of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (200-249) Page 2 of 14 PD.47844941.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP Calhoun County_ ISD - Plan A Modified t- ow. �4* Ala oTX t:r— oaos ef`r o—s i' o°3° �rnloor� tort TX� .B ...`1 \antN TX wo aor:- 1, 021 0307- 4 X 1 ° �'A%' `oml`po 4. T , rx cmxwn no w.rnuoun.a �u M a I M2 _ +rkt{H� t ti y; e11 TX r & `j mm� t . .....) . s J "wck-'sz1 ,'W—lnuanvr<� +•uaa own HyN�a a,<h TX n is ocm,l uwr Syria -(R M3',.. s ..:,✓ Petition to Create Calhoun County Hospital District (200-249) Page 3 of 14 PD.47844941.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. 1 understand that the following information is required for a petition signature to be valid: 200. A. Signature: B. Printed Nat C. Date of Signature: I D ) D. Mailing Address (inc udingc$: i3q E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # a i u 5n of j ' trJV: 201. A. Signature: �j / l? B. Printed Name: C. Date of Signature: 1 2 � D. Mailing Address (including city): t{' Qf ' ShIIlA -DYjVe. P0r�OtVdc E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Cc t of Re istration: 202. A. Signature. `CL` -li� B. Printed Name: Kvkci, C. Date of Signature: tlud` e _ q D. MailingAddress (inc ingcity):lrlt`InCP, ° _t) \"k wk- la—k) i1C� 1 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration# edOCogyfflegist�r/jn: `:— ll11q�'"' It GG � 203. A. Signature: --I� 'E�i _ YAr) c1 B. Pnnted Name<k%4 l >iv. C. Date of Signature: i ?I Cv7 C D. Mailing Address (mcludmg city): / /,7 / SiL cn s o n F E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RegistrTicbO td,Colytly oL[;eg�pr on: Petition to Create Calhoun County Hospital District (200.249) Page 4 of 14 PD.47844941. t SIf 204. A. B. C. D. E. 205. A. B. C. D. E. 206. A. B. C. D. E. 207. A. B. C. D. E. 208. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Cout)(y of R i ajiop: Signature:i Cf"vt Printed Name: 1L Date of Signature: , ;� .5 Mailing Address (including city): `i'�ULA 5�Lt i w3 W lei,: t �..aVci[4�r 7 jqjw Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Count�Jy Signatu Printed Name: Date of Signature: 1 Zo Z i Mailing Address (including city): l -1,19 I C1 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #and CQuttly�of� a istra[ion: Signature t Printed Name: 7 Date of Signature: ' . ` )&9 Mailing Address (inc uding city): Aholy1ft Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # a d County of Registration: Signature: 0 v Printed Name: ov __ Date of Signature: of I )3 Mailing Address (including city): PU C7o , iNq Lk Lmiv ka k -R -rynh Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # Petition to Create Calhoun County Hospital District (200-249) Page S of 14 PD.47844941.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 209. A. Signature B. Printed Name: (v�S C. Date of Signature: D. Mailing Address (including city): 't:.-) 6 1 0 - -f, `?hf-f � l /I � E. Either (1) or (2): ` (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # arltl Tr` o�I�gi t tion: IU l lP / , 210. A. B. C. D. E. nnner (1) or (z): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration ; U ddo Qdl gtic ofC eq, ja11 n: 211. A. Signature: -, . k QY ix� ��JJII� B. Printed Name: C. Date of Signature: / - 3 - zi D. Mailing Address (including city): E. Either (1) or (2): "7797q (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: -2, CA 212. A. Signature: ozgz em&&1ff2C-/ B. Printed Name: C. Date of Signature: D. Mailing Address (including city) / ?. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Count, ; 0,)1getst�r1a ion: 213. A. Signature: B. Printed Name: y�i (.�tl4Edtn�h C. Date of Signature: C / �'� J D. Mailing Address (including city):_[ -1 i� I E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # Petition to Create Calhoun County Hospital District (200-249) Page 6 of 14 PD.47844941.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 214. A. Signature: B. Printed Name:_C. Date of Signature: D. Mailing Address (including city):_ ti 34 CI mY ., -. t- i r �3, \ to E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: 215. A. Signature: 4, Sri 'IGY B. Printed Name: % C. Date of Signature: D. Mailing Address (including city):;1'LGII!CtCtl E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RReOegis'�traa�tiioon # andCopunts t)5Rjgy�tr tion: lJ�lr7v XwJ`i 216. A. Signature:i� (�YV� B. Printed Name: ��2 `� cz�- A�e c C. Date of Signature: 0-a — D. Mailing Address (including city): /ad / E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # at)�Cpunty, o�R�i�ation• I lX `t `f lP 217. A. _ Signature: B. Printed N C. Date of Signature: Z D. Mailing Address (including city): ZeY 7790'3 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #and County of Registration: 00 218. A. Signature: 9 B. Printed Name: `c 0 t/af C. Date of Signature:_ - 3-� D. Mailing Address (including city): S 0� �� 7 -y� y 7g;q E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # an CoufRnt oegistration: O b �1 nl� of n Petition to Create Calhoun County Hospital District (200-249) Page 7 of 14 PD.47844941.I PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 219. A. Signature: B. Printed Name: �LyrJ1C. attdl0� C. Date of Signature: 1- A 3 - A S D. Mailing Address (including city): 51 R Veshw,a E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration #rand C9yrVW 9f Regjctrat 220. A. Signature B. Printed Name: Cr AVb c pd Jt C- C. Date of Signature: / /zS D. Mailing Address (including city): & I E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration #,and County of Registration 221. A. Signature: " or. �f' B. Printed Name: b i L� L%6� ✓Z C. Date of Signature: 2 "1 ' _ D. Mailing Address (including ci ): L E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # and County, of ggistrat 222. A. Signature: lC� cu�i Y-- B. Printed Name: Al7 r C. Date of Signature. ( - — -_ D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration )#,gd,Cej7 fa �R F tra(Son: 223. A. Signature:f ` l�t,Grl `? B. Printed N C. Date of Si nat re• / — 2 3 _ 2r> L 5 D. Mailing Moss (including city): �, 5 9 / a1 r ta✓ 1 12v� E. Either (1 �(2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regisjra6oV ad�quRty pf�e ' Iration: Petition to Create Calhoun County Hospital District (200-249) Page 8 of 14 PD.47844941.1 M PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 224. A. Signature: «Ily AZI-� B. Printed Name:y1, C. Date of Signature: - D. Mailing Address (including city): PO 6u� E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # al CQugty ot;Regi!2' 2'25. A. Signature: P-ALA.- -I).#- 1yy B. Printed Name: 1=6 iA-VL ) \ Le.or C. Date of Signature: Ot 127125 D. Mailing Address (including city): 11U sand bot1aV Ur. E. Either (1) or (2): (1) ResidenceAddress (including city) and Date of Birth: l I4 S o �, rl D all a. U r- YM1Y� Love"I (2) Vo Registration # and Countx of Rai;tratjon:� 226. A. Signature: l G B. Printed Name: C. Date of Signature: 0 I /.13 2 D. MailingAddress(inclu ingcity): 11 by i�rL/ YYNe E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # andl ounpy J�giftrfirp: 227. A. Signature: f //u� ! Pi B. Printed Na jilit4tl..t.. Md7 C. Date of Signature: I -L3. 21 D. Mailing Address (including city): 3 atP E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:_ (2) Voter Registration'#t!my I RegiVn: r TA. Signature: " L.&-VTA417� B. Printed Name: MA 9YS 'LS C. Date of Signature: d l-a3-25: D. Mailing Address (including city): S16kViketoC E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth (2) Voter Registration iVVatld,cffn� Me�i�ttptioy 11 lP (� ctXii/L Petition to Create Calhoun County Hospital District (250-299) Page 01 of 14 PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 229. A. Signature: B. Printed Name: tJ t c o .l I S�x 4t ' C. Date of Signature: a 'Lo X D. Mailing Address (including city): Ou V S DO,h iJ; S 1 17 7 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #18 a d Count oion: b� �Q��f R istrat2�a 230. A. Signature:. @ l_�--- B. Printed Name: 'W\ ykk rAnV S C. Date of Signature:D. Mailing Address (including city): IM �j NI91� h�Y�LAU/n(C.ITL 1111� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Coyntyti ?istration: �V Ci 3 231. A. Signature: ._.< B. Printed Name: J"7;Y Fiez f C. Date of Signature: l / ,22/ 2o2S D. Mailing Address (including city):loi AIAi£ [ 4,, ,!a'zr LRv9tn , rk 77979 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # a2- rty pf�eg�stCr),atl ion: 4 m t 232. A. Signature: ft� Jdr0u", B. Printed Name: Ivoo vAp C'1of eS C. Date of Signature: 1- Z z P oiS D. Mailing Address (including city): 101 Jaye-W Wckj, lrrl I E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:_ (2) Voter Registration # and County of Restration: p I 0 uo �� I 233. A. Signature: �-ntilu no AAtJ B. Printed Name: M 0r a -YAnG C. Date of Signature: D. Mailing Address (including city): 4D 0 cU(1f(, %7�17% E. Either( I) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # an Co nt of Registration: �0�� t��scllD Petition to Create Calhoun County Hospital District (200-249) Page 10 of 14 PD.47844941.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 234. A. Signature:,Ov&�� B. Printed Name: P�qe j Gigs C. Date of Signature: D. Mailing Address (including city): /Loam E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County Qf Regitration: 235. A. Signature: t_1 k kz— B. Printed Name: E C. Date of Signature: // � D. Mailing Address (including city : WVkG�� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Count of Registration: 236. A. Signature: Y�(C:L� B. Printed Name: Cows Rt 6io C. Date of Signature: 2 � D. Mailing Address (including city): � 00 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration 2 # and County of Registration: 13 Cam{- 12� ttip 237. A. Signature: 64Ws ro 6-, u oTab B. Printed Name: AAzrp ffr�edor ill rL• C. Date of Signature: ' D. Mailing Address (including city): Lt CGS E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter ReegistratiTla6d, TtylG of eg stratC(A n "� 238. A. Signature B. Printed C. Date of Signature: o/ d3 • o ? D. Mailing Address (including city): 'Jy fea /oT s/� en i �c rr ca %r E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratiolbt C',on Regisroan n Petition to Create Calhoun County Hospital District (200-249) Page 11 of 14 PD.47844941.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 239, A. Signature: I MWaUaj - B. Printed Name: i C. Date of Signature: 1 D. Mailing Address(inclu ingcity): i�q (A Dt) 01 U E. Either (1) or (2): 11 (1) Residence Address (including city) and Date of (2) Voter 240. A. Signature: B. Printed Name: Alt ez C. Date of Signature: Ci S �j D. Mailing Address (including city): /Z OD?_�?tip, E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratio #and ot1 of R istration: Ctt SEEo�� 241. A. Signature: - f-" B. Printed Name: cc 1 WY1 G.�rt C. Date of Signature: D. Mailing Address (including city): \\o } E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration and Co it of Re istrafio,: 242. A. Signature:,IIJJ B. Printed Name: i C. Date of Signature: i D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: Ibun SC(y�All12 t 243. A. Signature: l t `✓ ,=41 B. Printed Name: 1�Lti hei r C. Date of Signature: - , ; Ja D. Mai IingAddress (in cludingcity): v OI);Tr Sri } PCi Y t f { Ty E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Re is ration: lob 0 Q (� I4(00 Petition to Create Calhoun County I-lospital District (200-249) Pape 12 of 14 PD.47844941.1 244. A. B. C. D. E. 245. A. B. C. D. E. 246. A. B. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Nam 0402•. YOS OI'r Date of Si ature: -A21-a02l5 _ r 't Mailing Address (including city): O . 0K oa ♦ Ay- I \ � 1 VLO Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratioq #�,U n(y �J of �Sr t: 1 l.P _R Signature: Printed Nt Date of Signature: - 0 5 Mailing Address (including city): 11o`I i 11 4 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Printed C. Date of Signature: l nl'�"rr55 - D. Mailing Address (including cityy): 1b�UW-Mw,i E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) 247. A. B. Voter Registration # C. Date of Signature: D. Mailing Address E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registratio # a Cou t f R gistration 248. A. Signature: V _ B. Printed Name: C. Date of Signature: Q 1 2 2 D. Mailing Address (including city): E. Either (1) or (2): bY+- LoU.CLC2a "M -7-7�l (1) Residence Address (including city) and Date of Birth: (2) Voter Registration a`Tw4attra ion: Petition to Create Calhoun County Hospital District (200-249) PD.47844941.1 PETITION TO CREATE. THE CALHOUN COUNTY HOSPITAL DISTRICT 249. A. Signatu B. Printed C. Date of D. Mailing Address (including city): VU n !AC>y5`i j E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and County of Petition to Create Calhoun County Hospital District (200-249) Page 14 of 14 PD.47844941.1 GUIDELINES FOR PETITIONS (SIGNATURES 250-299) Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. 3. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. 5. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District"). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place#1 2) Kelly Staloch Place 42 3) Jessie Rodriguez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place #6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial term of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. 7. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (250.299) Page 2 of 14 PD.47844966.1 Flan H Modmed ZAIr-��aa — am aaov a„n olnI 1'r tl TT(- PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP uamoun -youncy_ i �;- aal= OOIc me_ Hla oTX ;•. la rAloolp' Ion TX, NO G. o,ta W)] •1 4 r,. ',fx Celaoan 140 Plm hgwm.0 ��RR WIA �. nlrvl, MN Auslvl;ell TX rvs•1� N t' �nn>a>nl nasiv.�vura ONA l Hdiday; ach TX oom,l "cone i. or jfx aarwd Tk Petition to Create Calhoun County Hospital District (250-299) Page 3 of 14 PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: 250. A. B. C. D. E. tamer (t) or (zy (1) Residence Address (including city) and Date of Birth: (2) VotIn A 4� R istration1 andCounXottRegi�alioon: 251. A. Signature: Qx om "z- 1u tlh y l V l txst B. Printed Name:T)iQnviP_ VtSOY) C. Date of Signature: t I 1c, 1 t-o z-S D. Mailing Address (including city): 100 bilQX . Polk 1.. QQ cx,- ,-(k -Yl4i'79 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re tstration #and County of Registration: 1010 �0C) In `1 Cad ko� ., Cow^-rw-- 252. A. Signature: B. Printed Name: Q i t) mUV Cyl Cv- C. Date of Signature: I - 'M- '1: D. Mailing Address (including city): I'4,U `-o!Aa.A. Yid P,y} l n.\)aCoL, TX 7 7 q'I q E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration:'dal P) Y1 4i3'A 0 253. A. Signature: G \ \I B. Printed Name: cl('—Ps1GS C. Date of Signature: 20 D. Mailing Address (including city): V. o . O b C✓eND 1 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re istr lion #an (11d County of Registration: S S fuOUt\l UViU Petition to Create Calhoun County Hospital District (250-299) Page 4 of 14 PD.47844966.1 254. A. B. C. D. E. 255. A. B. C. D. E. 256. 257 258. A. B. C. D. E. A. B. C. D. E. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Name JCLy-ia 1, Kolb D Date of Signature: t 12'D 1 20 2c- Mailing Address (including city): 212fec�er FFd , Pa + vcr� Ix 11y� z Either (1) or (2): (1) Residence Address (including city) and Date of Birth (2) Voter Registration # and County of Registration: 2 1 2 to8lP4 `r a �a Cou Date of Signature: D t 20 2 Mai IingAddress (includingcity):�(.A► AvalonAvw- e✓I- lAvAcAL) -P)T) Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County Date of Signature: of 20 J ZDO S Mailing Address (including city): tt>1 P49ca✓wuo&A Pt. i64-IAuaLr, A -nci'14 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: 10aDt%-S0a4ifr\ Printed Name: C /► ! , i 1 r Date of Signature: J pA Mailing Address (including city): 0) Y Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Printed Name? Date of Signature:�I - Mailing Address (including city): 13 i Either (1) or (2): (1) Residence Address (including city) and Date of Bi (2) Voter Registration # and County of Registration: 1 D b $ 4) ( �i1 .� Vl;u of h Petition to Create Calhoun County Hospital District (250.299) Page 5 of 14 PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 259. A. Signature: B. Printed Name: JefjK Va jwb "f C. Date of Signature: / - ZU - 2!;- D. Mailing Address (including city); 2-70 ( //d,; E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) VoterAegiggation # and County of Registration: / GOa `T 04«f / % 260. A. Signature: 0-4n eAj W C- B. Printed Name: C. Date of Signatu D. Mailing Address (including city): fj3 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #and County of Registration: Cal fork N 261. A. Signature: " J"n" — B. Printed Name: R a, V bra r'a -Fa. Z 11 C. Date of Signature: �10 _'t a 1 S— D. Mailing Address (including- city): o� 7 7 ✓r[ e r(. /4l S r.", Y � E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: l V 6) 9 -z 1 t o cc rt 262. A. Signature: B. Printed N e: 5a s• Lo yA C. Date of Signature: 1-3Q'95- D. Mailing Address (including city):- Sod 44kc� lzef\a 1Ra,4r U\/0.u, r 1)C E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: a 16 y a 8 4 (0 13 Calm vn 263. A. Signature: B. Printed Name: C. Date of Signature: /- zo - Z S- D. Mailing Address (including city): PD•Qax ///7 E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and County of Registration: l o0o R6 z 6 0 c4/hem r Petition to Create Calhoun County Hospital District (250-299) Page 6 of 14 PD.47844966.1 264. A. B. C. D. E. 265. A. B. C. D. E. 266. A. B. C. D. E. 267'. A. B. C. D. E. 268. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Name: YXymce AtjyU ar— Date of Signature: I ' Mailing Address (including city): - 0 • C l Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # and County Date of Signature: 1'' C ' ail Mailing Address (including city): 1 1 M . r nm199F K`y- TFA ?bc-J ki a;U r7 l'7cil y Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re istration # and Coun of Registration: Co 1 5' IC 45 l tti�u 1 Signature: Printed Name: no,.,a Qa�lcn�5 Date of Signature: Mailing Address (including city): Q)oI Try-Pb?fain Or i7ol�Cte.xrg 1x -7-2;'4 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #and County of Registration: I C>(7GIG(D�.�C7 GG��nrxn.� Signatu : Printed ame: Date of Signature: 2� Mailing Address (including city a Ln, VA6� TA 7 '-Iq -T��j Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 771?, Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: Petition to Create Calhoun County Hospital District (250-299) Page 7 of 14 PD.47844966.1 269. A. B. C. D. E. 270. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT W Date of Signature: Mailing Address (including city): ) h S ) 1 i IlOL) j (1L 1� • 0 fj(A TY �� Either (1) or (2): (I) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: Date of Signature: /- Zo ZS Mailing Address (including city): -713 zjWArrbn /X T7.9 7 Either (1) or (2): (1) Residence ddress (including city) and Date of Birth;3/3 d4f�O466 (2) Voter Registration # and County of Registration: /4,0o96 271. A. Signature: U%yl l/1 (c C-41 ?, ��r e< PG B. PrintedName: �ovtic� cc CGc`lif C. Date of Signature: -AS' D. Mailing Address (including city): !0� 1pc," I ✓ CGt tr4 % 77% 7% E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: /O05 j c (& 6n77 - 272. A. Signature: B. Printed Name: C. Date of Signature: D. Mailing Address (incl tdin city): E. Either (1) or (2): (1) Residence Address (including city) and Date of B (2) Voter/�Rge��istration # and C unty of Registration: 273. A. Signature: GAL+ r B. Printed Name: ' C. Date of Signature: - D. Mailing Address (including city): IR 7;179 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voi/Rstris-#sd Conyof Registration: ue> e e , Petition to Create Calhoun County hospital District (250-299) Page 8 of l4 PD.47844966.1 PETITION TO CR E THE CALHOUN COUNTY HOSPITAL DISTRICT 274. A. Signature: B. Printed Name: DAPe, DworltSA C. Date of Signature: L 2 y D. Mailing Address (including city): ay 5 ec a r • T + 1C 1 g E. Either (1) or (2): (1) ResidWce Address (including city) and Date of firth: 3 $Cadl✓��r fro gA8) I�(�64 (2) Voter Registration # anl��nty 275. A. Signature: B. Printed Name: C. Date of Signature: 1 2- D. Mailing Address (including city): 22 E. Either (1) or (2): (1) Residence Address (including city) and Date 276. A. B. C. D. E. 277. A. B. C. D. E. (2) Voter Registrifyot},#ea Cr�jnt,, ff fegjstra i n: Printed Date of (including Either (1) or (2): U (3 (1) Residence Address (including city) and Date of Birth: Date of Signature: 1, " 2 Mailing Address (including city):? C> o X 795 Din Co M1O� { Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter UQ Oaco , 278. A. Signature: Y ufr1CIQ 14tarty B. Printed Name: i r, La C. Date of Signature: - a3 -a S D. Mailing Address (including city): �(, i u ��ertiv� ! v Tt9(� �a✓A Ca E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Petition to Create Calhoun County Hospital District (250.299) Page 9 of 14 PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 279. A. Signature: u rW V B. Printed Name: NV C. Date of Signature: 6( ? a D. Mailing Address (including city): 'oL E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Reg:g atio�# jnfl urhTI Rrgistr�tio 280. A. Signature: WLAItj A 044A.. B. Printed Name: Flora W r n l h a rg C. Date of Signature: 1-03-aS D. Mailing Address (including city):733 Vooyhollo Y )ot-t�goacglTX 71971 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 281. A. B. C. D. E. 282. A. B. C. D. E. 283 A. B. C. D. E. (2) Voter Signature: I-jF.w,.-r)111 Ld. Printed Name: )-le-leal Mnrole5 Date of Signature: - - S Mailing Address(includingcity):-) 7N 77933 Either (I) or (2): (1) Residence Address (including city) and Date of Birth: -7d(ohl,`f�S+, Sendr,f�TK 7-s20-1(?67 (2) Voter Mrqop # anM=% Printed Date of Signature: /-2-2. Mailing Address (including Either (1) or (2): (1) (2) Signature: lv#01421 d &15-7�1% Printed Name: Date ofSignature: (" ,0 Mailing Address (including city): Either (1) or (2): (1) Residence Address (incu ing ci!jandDate a Birth: e 30% LA S/l Sods zAvfl< (2) Voter Registration # Petition to Create Calhoun County Hospital District (250-299) Page 10 of 14 PD.47844966. t 284. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT tuner l i) or it): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: 285. A. Signature: %y) .4. to pa Din e034, ( B. Printed Name: ma cip.ei is rl 11 C. Date of Signature: ! u312 5 /r�.. D. Mailing Address (including city): -101 !—QZq (Ltne. lsi� uu Q cnTx. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # nmm �dlM�n�tly'of i�is do 286. A. Signature: (1/l 4 �.,: N i B. Printed Name: MXrcti(A Lo7-aM C. Date of Signature: D. Mailing Address (inch ding city): .0 lueckusonrk fir. Qmk I.Ayara r TX E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 287. A. B. C. D. E. 288. A. B. C. D. E. (7 Date of Signature: /. oZ3• 02 �r Mailing Address (including city):�oi Lem C.�. Either (1) or (2): (1) Residence Address (including city) and Date of B (2) Voter Registration Date of Signature: c Mailing Address (includinecity )PO1I ppy\ ny-. (h ln\ma Either (I) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and 71 9 Petition to Create Calhoun County Hospital District (250.299) Page 11 of 14 PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 289. A. Signature: B. Printed Name: C. Date of Signature: 'VV ZS' D. Mailing Address (including city): IDS Dft%v7'-r0h'& TtAtvN "m E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) VoterRegiinffio It%C��nty�ofI?� tst ti 290. A. Signatu I U 4 `l ((�A bU V B. Printed Name: C. Date of Signature: (• 23.2 y D. Mailing Address (including city):gq-1-k -PSh RlfiYd�t Dr: Poch( rlalrarT]/ 7%I E. Either (1) or (2): (1) Residence Addr 2sessw �4 (including city) and Date of Birth:SQWeY oq-- (2) Voter Registration # and County of Registration: 291. A. Signatu B. Printed Nhme: C. Date of Signature: / D. Mailing Address (including city): '/11Z RGiYPQ Dj tbH L.f_W/ly 77979 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Rego' r iot #(pd �� y K R ist ion: 292. A. Signatum —V� ^ � 1`I B. Printed Name: 5 C. Date of Signature: D. Mailing Address (including city): 1 E. Either (1) or (2): (1) Residence Address (including city) and Date of 293. A. B. C. D. E. (2) Voter Re� y�ttiffj F d 9ugty of i ti / tsnner (I) or (z): (1) Residence Address (including city) and Date of Birth: _ -6yne, (2) Voter Petition to Create Calhoun County Hospital District (250-299) Page 12 of 14 PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 294. A. Signature B. Printed Name: ins tafeAA- PW' l i g— C. Date of Signature: 1 `20.25 D. Mailing Address (including city): jjjc it !bt-o E. Either (1) or (2): (1) Residence Address (including city) and Date of 295. A. B. C. D. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registrati, n,l(q ,�tj- tEtq;gi;t1n 296. A. Signature: :' e tom- L B. Printed Name: �> / 1N C. Date of Signature: s - D. Mailing Address (including city): /" ✓ J E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter 297. A. Signature: A. !u.._ yd B. Printed Name: Al ad t &wa C. Date of Signature: '/V& D. Mailing Address (including city): Zit SFivii Is aue E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registr'U`1(_a� C,pupn ist tiQon: 298. A. Signature: 4s!-" B. Printed Name: :!:"o olze Ob C. Date of Signature: D. Mailing Address (including city): 725 a rir && E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter RegistraUnr4 !jCQ tVg� jtrat n: Petition to Create Calhoun County Hospital District (250-299) Page PD.47844966.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT KU3 W B. Printed Name: k�m4 ) VlIVfQ e'S C. Date of Signature: D. Mailing Address (including city): 22`I E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and County of Registration: Z7-OR2 ) 254 Zi 1 Ca.-hown Petition to Create Calhoun County Hospital District (250-299) Page 14 of 14 PD.47844966.1 GUIDELINES FOR PETITIONS (SIGNATURES 300-349) Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. 5. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District'). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place # I 2) Kelly Staloch Place #2 3) Jessie Rodriguez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place #6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial term of one (I ) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. 7. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (300-349) Page 2 of 14 PD.47845035.1 M � xl Y Y M C�P►iIY�Z�TYo7:Y11 �ilY,' lDLdl_IIsC1�1►[K�111►I111'�[1b9 aJll24�) ��I Y:� C9LY DISTRICT ELECTION PLACE MAP Petition to Create Calhoun County Hospital District (300-349) Page 3 or 14 PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: 300. A. Signature: B. Printed Name: (i.7dt<,J C. Date of Signature: l 'S' D. Mailing Address (including city):. 2,2,.3y L t: . wLi Lulu,✓Cd, 7.t. 7? i7�L E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re i tration # and County of Registration: t0��g0�}OCi% CAAIQA,l� 301. A. Signature: i B. Printed Name C. Date of Signature: / )-C - Zc 2 s - D. Mailing Address (including city): 2 2 C E. Either (I) or (2): (I) Residence Address (including city) and Date of Birth:_ (2) Voter Regisjat of �Md Colmy r Re ig stratio U LZ.� ,f l6 Ul 302. A. Signature: B. Printed Name: kGi,{-ri ,n l'ok IL,CO-, C. Date of Signature: C I - � I- �2 C.� i D. Mailing Address (including city): -x C2 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Reg , ption # a�of�Regigtrhati 303. A. Signature: x4WO�)-1 `a B. Printed Name: �>4 -Z< 1VwM C C. Date of Signature: V,11- 70? D. Mailing Address (including city): O D� 2 Yt T T -719K 3 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter l�epiMll:I# V ognZy oft anon: Petition to Create Calhoun County Hospital District (300-349) Page 4 of 14 PD.47845035.1 304. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registrfo ppd Cquµyjf eQisqj 305. A. Signature: --- Q —_. B. Printed Name: (' 4, _: F ;, C of ,," C. Date of Signature: 1 -.'1-25 D. Mailing Address (including city): 21a nc.1r ;t.,, h/7 Fa. y /W ,, 5, 7?Ii7<i E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 306. A. Signature:_,�� B. Printed Name: lkl Lo .. C. Date of Signature: / J= i r D. Mailing Address (including city): ��/ I}✓�'�� h Z E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 307. A. Signature: VJ-7-ya, Ulf t B. Printed Name: b G ✓ C. Date of Signature: 2 I' Z C D. Mailing Address (including city):.� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 308. A. Signature: ln� B. Printed Name: C. Date of Signatu . J -d 1- D. Mailing Address (including city): r o t (3 ✓a 17' Ca !8, c E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter'Re ttra7i �pc( C_yunty of �e isig r do Petition to Create Calhoun County Hospital District (300-349) Page 5 of 14 PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 309. A. Signature: B. Printed Name: riel S(JQLJJW C. Date of Signature: 215 D. Mailing Address (inclu ing cup): E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration #TMQypty of 310. A. Signatur B. Printed Name: C. Date of Signature: t ? c]J D. Mailing Address(includingcity):1 S Sdn 4 E. Either (1) or (2): (1) Residence Address (including city) and Date of 312. A. B. C. D. E. (2) Voter Registration Printed We: 'fiktx Icl+er Date of Signature: / Rv �oR Mailing Address (including city): jhyt L6 4,1AyALA +X 1797' Either (1) or (2): v (1) Residence Address (including city) and Date of Birth: r,nner (t) or (t): (1) Residence Address (including city) and Date of Birth: E 1 W71 (2) Voter Registration # and County of Registration: 313. A. Signature: B. Printed Name:friWU C. Date of Signature:�20�2025 D. Mailing Address(includingcity):Z.5M MGA2jjjtr90K DI' r+ tauaea +X,"," E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regist tio� apd �n�y� �I�eg�tr�atiQn Petition to Create Calhoun County Hospital District (300.349) Page 6 of 14 PD.47345035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 314. A. Signature:_ R-ec " -- B. Printed Name: C. Date ilingAddress( city): D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # and County of 315. A. Signature: VV O B. Printed Name: IP/ t ,21�e 41tes C. Date of Signature: D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter RegSsiwat�t# and Coun of Registration: 316. A. Signature: lt1) B. Printed N re IQ C. Date of Signature: 1- us - 2 D. Mailing Address (including city): ♦AM17•1 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: 317. A. Signature: / B. Printed Name: Aare=oZu C. Date of Signature: I - 20 -;2 D. Mailing Address (including city): O E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter ReAgistratiion# and County of Registration: r 318. A. Signature: O",ae-, B. Printed Name: " &h CAM-W C. Date of Signature: 1• D� s- D. Mailing Address (including city): UM Vai 1 or Rrl, wyAe,p TY -i-i 911 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vo�isflagn 11 4yt unty of ,alio ALI- Petition to Create Calhoun County Hospital District (300.349) Page 7 of 14 PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 319. A. Signatur B. Printed Nameture: Y C. Date of Signature: 2 20L D. Mailing Address (including city): Ym E E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Vote g�tr1t n a my o 'stratio -rr � 320. A. Signature: B. Printed Name: 0 C. Date of Signature: - D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter i tration #and oust of Registration: �Re 321. A. Signatt e: B. Printed Name: u ' C. Date of Signature: - - D. Mailing Address (including ci . 7e) 6 - ij//1pCP I E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: C (2) Voter Registr on #and Count of Re tstration: "� _ rz( I n 21 G 322. A. Signature: 7--- B. Printed Name: t 72jeAffh2 C. Date of Signature: /-21- 25" D. Mailing Address (including city): l0 2 0 tJuG2Bs Sr E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re istrat' #�ndCounty of Re 'stration: 323. A. Signature: ' b' B. Printed Name: I G C. Date of Signature: I a l - 5 D. Mailing Address (including city): F 'Ihny)i '6 fir (OLti�) �� y �` E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Register( j #land. qfn of Rc�stratipn:�� Petition to Create Calhoun County Hospital District (300-349) Page 8 of 14 PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 1 324. A. Signature: B. Printed Name: I` C. Date of Signature: ��— 1 v Z - D. Mailing Address (including city):,<<r- E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #`an4 Vo jtx q 4jstration: 325. A. Signature: '�( .VU B. Printed Name: j4Lw vu vt 14 fVylw aL C. Date of Signature: 1 / 71 &S D. Mailing Address (including city 5 La✓a.Gq. Pe✓ LaVatA E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RegistratioVnOdGqunty of Regist ration: 326. A. Signature: B. Printed Name: C. Date of Signature: i I ) / /a D. Mailing Address (including city): /) /4 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 327. A. Signature: 75 B. Printed Name:_ La t rt/r. C. Date of Signature: Z-.-1-1 ' :7 D. Mailing Address (including city): 7,40'„ E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Reg Trtia ; # ayd�C�upty _lRe�lstr 328. A. Signature: O J It (( j�j C-��V *-Y C( XXCC B. Printed Name: " Ct1\1 � -(1-i) N C. Date of Signature: �!7 ( 2 D. Mailing Address (includingcity): J.1.(Y VCU r+ Lcw ,�,-� —Cy- 1h`�7 1 E. Either(]) or (2): (I) Residence Address (including city) and Date of Birth: O I V1 1qc,) CQ (2) Voter Registlr� q #�rtd Cgynt�ofJtegi�st�tjln• Petition to Create Calhoun County Hospital District (300-349) Page 9 of 14 PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 329. A. Signature: B. Printed lfame: ,J v... R .x.. C. Date of Signature: c) J; . t 7 z s D. Mailing Address (includ g city): Z Z0 ? E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 330. A. Signature B. Printed Name: (]ArAJ7 6U4W1n f C. Date of Signature: / -�V - � 5 D. Mailing Address (including city)JA0(o V1.01 Dr. PDT¢ ldllallQ 7X 994'79 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and Cougty.of Registration: 331. A. Signature: 4✓` B. Printed Name: C. Date of Signature: D. Mailing Address (including city):.;? oe e/,"'.' E. Either (1) or (2): f (1) Residence Address (including city) and Date of Birth: (2) Voter Regis(ration k and County of &egigration: 332. A. Signature:i/ C6. c-- B. Printed Name: L r z d t o/ [' Cs '.s✓ C. Date of Signature: -L - Z n LS D. Mailing Address (including city): 5Z q E Ur -St U &? 4',( 4. %X 7U%7 l E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # a d aunty of Re lstration: i non R � ff1P,�i0�ct 333. A. Signature: B. Printed Naine: C. Date of Signature: Z3 D. Mailing Address (including city). ��Grf dl E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RegifStfPtipry(J Pn¢,Cgt q o l�eg�sjratk� Petition to Create Calhoun County Hospital District (300-349) Page 10 PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 334. A. Signature: ) B. Printed Name: 7IewC /CZIIJ C. Date of Signature: I /Zr/e 5 - D. Mailing Address (including city):. ?c7 YWJTEf 1e,Q7lau..4ri Tr 774Z3 E. Either (l) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RegiT) 6 I a�d�o)yrlty yf Ristr`raattio 335. A. Signature: B. Printed Name: oei i n C. Date of Signature: ' . z. 2 D. Mailing Address (including city): u 511 4 I )� ) L` `` ` I A 7 6% i E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # an¢.County_ of Registration: 336. A. Signature: B. Printed N e: iarlar" �. C. Date of Signature: ZZ - 27 D. Mailing Address (including city): Z I C91 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re 'st ation # n j y�pf Re ist ion: 337. A. Signature: '' Y L Ir B. Printed Name: DWAF, S C. Date of Signature: - ' O D. Mailing Address (including city): 40 i L bQ ( E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 338. A. Signature B. Printed Name: ",-; lalk..a. S.4, of C. Date of Signature: D/�22 /2 S' D. Mailing Address (including city):. AT sots .Se E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Petition to Create Calhoun County Hospital District (300.349) Page 11 of 14 PD.47845035.1 339. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Signa Print( Date Maili Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and County of 340. A. Signature: -er— '-- B. Printed Name:61D1 E d�J C. Date of Signature: — 99 D. Mailing Address (including city): 10 e E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registra[io LL ' T Cgn6 R�igstratio�n: 341. A. Signature: A12 B. Printed Name: C. Date of Signature: ! - 2l S D. Mailing Address (including city): /O f {!wb>r Di. ,�A i LiovcG�t T i49 st Y E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # atld,S:qptl y pf R,egisttation: -� 342. A. Signature: t ' 1OD�ZADC_�A B. Printed Name Mayvlt 5 C. Date of Signature: D. Mailing Address (including city): 13S E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration 4,aI(d County of Registration: 343. A. Signature: (a(_r( "" I y B. Printed Name: U.. ' e " C. Date of Signature: ".11"LJr D. Mailing Address (including city): P149 E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter .Regif tiq{6ilM16g)sjrtation: Petition to Create Calhoun County Hospital District (300.349) Page 12 of 14 PD.47845035.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 344. A. Signature B. Printed Name✓ 1. G-,. " /,/"t z C. Date of Signature: /- �o 2 5" D. Mailing Address (including city): 3445 TI-xi E. Either (1) or (2): (1) Residence Address (including city),,gndDate ofBirth: /r/' 79 (2) Voter Regi Itutjptt #�an��nt�of I�g�ivii i U//lP�� l 345. A. Signature: "4c" B. Printed Name: env E1 , AIPr. C. Date of Signature: (-Dc-2�- D. Mailing Address(including city): I1I(7Y 1.On,, Ilz1 \N WWVA E. Either (I) or (2): (1) Residence Address (including, city) and Date of Birth: fU 2--30 (2) Voter 346. A. Signature: B. Printed Name: 1' o,, 4� - r l 1 i\l Y- 7 C. Date of Signature: 1 - -fin ri D. Mailing Address (including city): `S�l 3 C lv w 10 h E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter 347. A. Signature:- A B. Printed Name: C. Date of Signature: I ;Ai D. Mailing Address (including E. Either (1) or (2): (1) Residence Address 348. A. B. C. D. E. (2) Voter Registration # and County of of Birth: `3 - )�)- 1 `I Date of Signature: ) - Zo • L / Mailing Address (including city): 2 2 L� O r, Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 2 2 2 19 6 9 - e 7_- t n- n_ ., i (2) Petition to Create Calhoun County Hospital District (300-349) Page 13 of 14 PD.47845035.1 349. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Date of Mailing Address (including Either (1) or (2): ``/- Address (including city) and Date of Birth: 2-y S `�M � aS1 A 't C,-, CS (1) (2) Voter Petition to Create Calhoun County Hospital District (300-349) Page 14 of 14 PD.47845035.1 GUIDELINES FOR PETITIONS (SIGNATURES 350-399) Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. 5. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47845062.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vem Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District"). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors ofthe District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place #1 2) Kelly Staloch Place #2 3) Jessie Rodriguez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place #6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial tern of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. 7. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (350-399) Page 2 of 14 PD.47845062.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP Calhoun County ISD - Plan A Modified Hla 7X Qm koinl U 11 TX � Blooml Ion TX - "BAB aofA -_t re i son ,.r J "P 1fk ,> ,. � 4 •.• �_; � 16 ,� IV W- ; ...! ?� j .li ii� r 0XV 2y' fx n�noun lao Fl.n�Noan.a rw ^'a , Adsinbem%es r'fi Pao tXoao] FbXdX� achL TX Op]a) M4 ( ar' X Sysld •TX ] '.. Petition to Create Calhoun County Hospital District (350-399) PD.47845062.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: 350. A. Signature"& —r/1'W- j y B. Printed Name: ! t , )1-/9' C. Daze of Signature: I iZt 17, D. Mailing Address(including E. Either (1) or (2): (1) Residence Address (2) Voter 351, A. Signature: W� B. Printed Name: C. Date of Signature: D. Mailing Address (including E. Either (1) or (2): (1) RgjiAenjeMtlress (2) Voter 352. A. Signature: A 1• i B. Printed Name: C. Date of Signature: t QLS D. Mailing Address (including city): 1 E. Either( I) or (2): (I) Residence Addres§,(including city) 353. A. B. C. D. E. and Date of Birth:DO(3' ollluUhnl (2) Voter Registration # an1 bounty of j,gtispr ion: 9I6 Printed Name: " 1 \Wfi imp Date of Signature: i �J Mailing Address (including city): f Either( I) or (2): (1) Residence�ltl,s' (tcluding city) and Date of Birth: �3 `�iGt/Jy4 l (2) VM I glss)rla�o��#�(nd �our}{y o e istration: Petition to Create Calhoun County Hospital District (350-399) Page 4 of 14 PD.47845062.1 354. A. B. C. D. E. 355. A. B. C. D. E. 356. A. B. C. D. E. 357. A. B. C. D. E. 358. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Name: -✓OS I" "A f L µQ D T-O rre S Date of Signature: 01 f a n [ ;0,2S Mailing Address (including city): W1 Tir441.f0/1LaV0(a,7k7-n Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Q �44g,Por+'0yaca,n-179'1q-Do 01 �1 C'04 (2) Voter Registratio 2 agnd �T2y4J 6i�ratiom , U `t(pO Printed Name: Date of Signature: _ Mailing Address (including city): 1 Either (1) or (2): (1) ednAAddre�sT(incldngydDateofBirth: AVp1cakw.-W1ayk rA\t(xuIOi�- ,13a810ab (2) Voter Re tstr [i ount of Regi tration: 9 �n C� Printed Name: \Ildnnq I)J WneDII Date of Signature: 1 J ao/a 5 Mailing Address (including city):84d nIp Dr a "WA ��tllcl Either (1) or (2): (1) Residence AddresSi cludingcity) and Date ofBirth:9y�QCail)fCtd0'L14 Otk�ttvQ(Cj 1gl1q-l1. 6�1� MD (2) Voter Registratiy}h # and County_ of Registration Printed Nam Date of Sig -re' Mailing Address (i Either (1) or (2): (1) Residence 1?i7' (2) Voter Reg Printed Name:4 Date of Signature: Mailing Address (including Either (1) or (2): (1) Residence Address (2) Voter S. NAwAA Dow Ukvw, TV llliq city) and Date of Birth:U h S - hbe' O A SL PU ft LxVO COL Petition to Create Calhoun County Hospital District (350-399) Page 5 of 14 PD.47845062.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 359. A. Signature: B. Printed Name: 3[-1 wu vaC' (, C. Date of Signature: `• 01- a D-,� LJ D. Mailing Address (including city):_] Q.-I , JSW W0110 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 360. A. Signature: t %1 ' B. Printed Name: !) CI k-_ C. Date of Signature: I — 20 - %7 D. Mailing Address (including city): S'A> ie�t aC-jCAUtiL4. TV 9.1W nq E. Either (1) or (2): n O t (1) Res en a ddress (including city) and Date of Birth; bl`] Si )D{ 19(1 T U f1 �Y l%EL« f l� �'�c1 t 1�i n 2- 629 9 (2) Voter Registration # and County of Registration: 361. A. B. C. D. E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re ist o # an C u y of Registratio 362. A. Signature: rfl7tz jLn B. Printed Name:— 1f iff i U I\Ll ,." C. Date of Signature: 12✓/ -t D. Mailing Address (including city): it � ifstrtio✓ 144 E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter 363. A. Signature: B. Printed Name: Gt m( I n t1 v t C. Date of Signature: 0l - D. Mailing Address (including city): ��t4�jgSF n cv i2d z�1 179b3 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 64 �t('- 0 jf;51lCY,7l.g (2) Voter Reijr�a�Registr: Petition to Create Calhoun County Hospital District (350-399) Page 6 of 14 PD.47845062.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 364. A. Signatur : dl B. Printed Name: C. Date of Signature: i !? D. Mailing Address (in luding city): IL ) E. Either (1) or (2): Pottiallat!at (1) ReeJ{dgP� dress (including city) and Date of Birth: or) Fe �f A II (( fJllff r' <� (2) Voter ftegistration # and County of Registration: 365. A. Signature: B. Printed Name: C. Date of Signature: 1 25 D. Mailing Address (inc uding city): E. Either (1) or (2): (1) Residence Address (includi�77gg�c�uy)) and Date of Birth: 52( TOPVIi'Ylu nP • ht�`CLQ12Ifn� (2) Voter RegistmtioK # and County of Registration: 366. A. Signature: B. Printed Name: (� C. Date of Signature: D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (i cl ing ity) and Date of Birth: (2) Voter e t r�tigalto �ntrfCgis ion• 11 �"1 367. A. Signature. 1 B. Printed Name:-f';,cvihp C. D. Date of Signature: o 0 a Mailing Address (including city). m stmdri x i79$3 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: a�� rr,oc�i nth �e.ru sco.drie+ fy -ngBA 7 6 gg (2) Voter Registration j and County of Registration: 368. A. Signature: ,, B. Printed Name: AJ, I I (/�� C. Date of Signature: D. Mailing Address (including city): 1 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:�Z/�l� % (2) Voter Registration # a County f Registrati n; i (�,gi 42l i ti toy Petition to Create Calhoun County flospital District (350-399) Page 7 of 14 PD.47845061I 369. A. B. C. D. E. 370. A. B. C. D. E. 371. A. B. C. D. E. 372. A. B. C. D. E. 373. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Date of Signature: i / 2 i Mailing Address (including Either( I) or (2): (1) Residence Address 3M eerkeeef (2) Voter Registration ( Date of Signatur Mailing Address Either (1) H: Printed Name: -1 Got Date of Signature: I Mailing Address (including Either( I) or (2): (1) Residence Addr ss N 1 6{ (2) Voter Registration Printed Name: l oW�Wt. Date of Signature: 01 - i Mailing Address (including Either (1) or (2): (1) Residence Address I oy 1-CL (2) Voter Registration! Printed Name: fA L Date of Signature: I — Mailing Address (including < Either ( I (1) (2) city) and Date of B and Date of city) and Petition to Create Calhoun County Hospital District (350-399) PD.47845062.1 lad a 3 Page 8 of 14 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 374. A. Signature B. Printed Name: i C. Date of Signature: D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration #and C0Qunty of Regi tration: 1151, 375. A. Signature B. Printed Name: ezGg C. Date of Signat re: z i D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Add ss (inc}.{, ding city) and Date of Birth: 56, .� S a /70 (2) Voter Regi tratign, anj Cynty of iAgigtrration: 376. A. Signature: / B. Printed Name: t I % C. Date of Signature: '2 D. Mailing Address (including city): l E. Either (1) or (2): t, (1) estdence Address (including city) and Date of Bpirth: � a i P, Feuo MQ(A KGL . (2) Voter Registration # and County of Registration: 377. A. Signature:_ 1 LL B. Printed Name: C. Date of Signature: D. Mailing Address (including E. Either (1) or (2): (1) ResidepctlAddfess (2) Voter Registration 378. A. Signature: Y 1 h I-cyFvr -' B. Printed Name: tk pPrJ C. Date of Signature: -22- y- D. Mailing Address (including city): Iq I Sw401t orr., ✓-r Lswk 'a E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: .S4M•- OSJ2y) q8j (2) Voter Regi t ton # an u ty of egistration: M= t� K. Petition to Create Calhoun County Hospital District (350-399) Page 9 of 14 PD.47845062.1 379. A. B. C. D. E. 380. A. B. C. D. E. 381. A. B. C. D. E. 382. A. B. C. D. E. 383. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Date of Signature: T !T; I2tl?_ Mailing Address (including city):- 405 M cpnt atr Gc , t Qo Gig � Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Q•tP5 M'D>Nalq I�1 ,�nt2�tA.V01u ia. �('1°I'1% (2) Voter RegistrationA,and 0Ou+1IXof Registration: Printed Name: t i F Date of Signature: �t ti� Mailing Address (includingcity):5-1 H-AI,,U(itIf.t_�La Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 51 k(G mj of iDArU t 0001LG, 1111cl1ci — (2) Voter R�gktration #and County of Registration: Signature: It we S Printed Name: (A 0( N 0 Date of Signature: Mailing Address (includingcly): 51 C* (. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 5� 4Fm�k�Ptwt n(. path- l a)(At( 1111(,\-I (2) Voter Registration#,An1(CoaujjyJ,f_Regiwation:. Date of Signature: m al `I Mailing Address (including city): Either (1) or (2): (1) Residence Address (inch. W), to Col h i M v t' (2) Voter Registr4tionj aµdt Date Date of Signature: Mailing Address (including city):^ ST 7N4 i" Tt Either (1) or (2): p (1) Residence Address (including city) and Date of Birth:,_y(� (2) Voter Regif�tMt#T7&Tjty of•Rpgistrtiot 1 Petition to Create Calhoun County Hospital District (350-399) Page 10 of ld PD.47845062.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 384. A. Signature B. Printed Name: i� a n2e h.�� C. Date of Signatty . I a 3 -as D. Mailing Address (including city):51�I 5 a Si- `I VX LcyeLeCi E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:rr (2) Voter Registrat V gild Con gf�gisttratio Q� 385. A. Signature{ V 1 I/1u(d� d- i LIALGi. B. Printed Name: MPff.CL1CZ ��{�t�C� C. Date of Signature: 3'�5 D. Mailing Address (including city): U ) I 0 in 0 rl- TX 110) 10 E. Either (1) or (2): (1) Residence Address (mcludin city) and D e of Birth: aO1 gCN S DisiYIf COM�fo 774 D°I �L1 1 �11e (2) Voter Registration # County of Registration: )� �� 1141�2 a C� 386. A. Signature: B. Printed Name: � (AkAktge r 1 VtS C. Date of Signature: L-ZS-2S D. Mailing Address (including city): 90 Ock I obb 90y-+ L rAvc-- Cp.- Tt -11 M I E. Either (1) or (2): (1) Residence Address(includin city) and Date of Birth:, SotuS S-t. i�DIYI'F Lo Wbr-I , Ti r)"I � I0,o31'I6 (2) Voter Registration t e i tration: i it o 'lo" r A 0 1- 387, A. Signature:' V-v " U B. Printed Name: NOX W N 6 C. Date of Signature: D. Mailing Address(includingcity); hykl vq vtiv uwktk E. Either (1) or (2): (I) esldence Address mcludin city) and Date of Birth: (2) Voter lkegistratimj #ey;q t c, ira-y ql; PAgistr�tion: L 388. A. Signature: wyc� "i B. Printed Name: -e)/t- �r1r- L Chi y'oR- C. Date of Signature:jj-� D. Mailing Address (including city): i'n 0 24?y a!'C( 1ytl-W tS-77 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: '2-1 w to 51 poy —1 (2) Voter Registrptioar # and County of Registration Petition to Create Calhoun County Hospital District (350-399) Page Il or 14 PD.47845062.1 771276 389. A. B. C. D. E. 390. A. B. C. D. E. 391 0*14 393 A. B. C. D. E. A. B. C. D. E. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Name: ) (t P Date of Signature: Mailing Address (including i Either (1) or (2): (1) Residence Address( lL�(t ,Ik,.- (2) Voter Registration # Printed Name: N2Vti4 Date of Signature: I — a.0 Mailing Address (including Either (1) or (2): (1) Residence iAiddren�ssr. CD " I (,1' J1. (2) Voter RegistratioA Printed Name: Date of Signature: Mailing Address (including Either (1 ) nr 0V (1) (2) Printed Name: tr,1 r_hA e 15h Date of Signature: I - • 0 ' , i Mailing Address (including city) Either (1) or (2): (1) '�jJjenceAddress (incli (2) Voter Registration #, and r, and Date of Birth: t",7 city) and Date of Birth: 101 V F j A_ �,u tv of Registration: P &I kru � C-, DateofBirth: b'�1 Either (1) or (2): I/ (1) Residence Address (inc uding city) and Date of Birt ,�� fna,SI �crr (cuao9 T 11 (2) Voter Registration # and County of Registration: I I a I 1a -776')9 C Petition to Create Calhoun County Hospital District (350-399) Page 12 of H PD.47845062.1 394. A. B. C. D. E. 395. A. B. C. D. E. 396. A. B. C. D. E. 397. A. B. C. D. E. 398. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Date of Signature: I- YC ' Mailing Address (including Either (1) or (2): (1) Residence Address. (2) Voter Signature:( AkV a .. Printed Name: Date of Signature..—,--:.0 Mailing Address (including Either (1) or (2): (1) Residence Address (2) Voter Printed NaiVeSignature: ign: ti�' 1ti Date of Signature:: Mailing Address (including Either (" (1) (2) Date of Signature: I ' () — ` Mailing Address (including city): Either (1) or (2): (1) Residence Address (including (2) # and t and Date of Birth: Z1453'4`h3b / ' Signature: Printed Name: _ i7JtLar� ' 7_arn ran �) Date of Signature: - -2 Mailing Address (including city): /40S f/o//umim Pbp-/-4,;war a TX 77479 Either (1) or (2): (I ) estdence Address (including city) and Date of Birth: (3bS Ho(( crry erg (Zr� (2) Petition to Create Calhoun County Hospital District (350.399) Page 13 of 14 PD.47845062.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 399. A. Signature: B. Printed Name: Q n LtA /t a C. Date of Signature: 1 D. Mail ing Address (including city):. 515 JA!hh Pot-• LxVACa,TX-T7,97cl E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: S(wng _ as ainn✓G. (2) Voter Petition to Create Calhoun County Hospital District (350-399) Page 14 of 14 PD.47845062.1 GUIDELINES FOR PETITIONS (SIGNATURES 400-449) 1. Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. 3. The information indicated is considered necessary to verify signatures. There must be the following: (1) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as mailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be filled in by someone else. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District ("District"). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place #1 2) Kelly Staloch Place #2 3) Jessie Rodriguez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place #6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial tern of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (400-449) Page PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELECTION PLACE MAP Petition to Create Calhoun County Hospital District (400-449) Page 3 of 14 PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: 400. A. Signature: B. Printed Name: M'Ifb.0. r.A,r WA C. Date of Signature: 11,20 1 20 2 5 D. Mailing Address (includingcity): 1)2 W1 Mow h, Ury tmncoi t -fX h°I-79 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: 1 1 U9 00 401. A. Signature: a &tj B. Printed Name: f4t0ijl)� C. Date of Signature: 112011(1�� D. Mailing Address(includinecitv): Al PAMA1116 ✓ AVACA E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re IOI�t IiiQ2 # ahaf Registration: 402. A. Signature: 1 —c f (mac B. Printed Name: S C. Date of Signature: 1 D. Mailing Address (including city): AVtAAYIGi E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Registration # and Co my of Registration: 21te 2 C g 403. A. Signature: B. Printed Name: 11 MM r C. Date of Signature: 0 20 Ca D. Mailing Address (includutQcity niPaYK1m(,A Pl Lava E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vote � ration # arrn^^d11Coun� of Registration: Ud,�,� Petition to Create Calhoun County Hospital District (400-449) Page 4 of kl PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 404. A. Signature: a J— B. Printed Name: U fl mA R. C-Am,, C. Date of Signature: 01/2ol96aS D. Mailing Address (including city): III net, MRR tM PeaT wWRcq,-Tx-nci-ii E. Either (I) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: 111oiloo14 (a1h r. Cn.n\a T 405. A. Signatur B. Printed N u.l. C. Date of Signature: D. Mailing Address (including city): Z4 YQUAa_q l{ 1 8&LO.,L(A E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vo ter �tegis�t tion # a unty of Registration: �j 61hY1 406. A. Signat .&a B. Printed Name: �=2a/a-vDo �2 /fit C. Date of Signature: D. Mailing Address (including city):_ E. Either (1) or (2): LAVA Ca (1) Residence Address (including city) and Date of Birth: (2) - Voter Registration #.analCountDjo e is�at�, 1 GGII�� 407. A. Signatu • B. Printed Name: 'D Vt. t C. Date of Signature: vG(CA D. Mailing Address (including city): lix E. Either (1) or (2): (I) Residence Address (including city) and Date of Birth: (2) Voter Re lstration # and County of Registration: 0 10 \0. CetQ61M 1 408. A. Signature: B. Printed Nam : �her[5d 0,jpt Lnyrr_ C. Date of Signature: D. Mailing Address (including city): E. Either (1) or (2): Dt'• (1) Residence Address (including city) and Date of Birth: �oyhy o�Af Rrelgistration: (2) V't`r ]teg t tt4A �Ad Petition to Create Calhoun County Hospital District (400-449) Page 5 of 14 PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 409. A. Signature:" 1 At,:h B. Printed Name: WZ C. Date of Signature: Z"> ski D. Mailing Address (includley): 1 190 S aco\ E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vo er Re Istmtion #and Count of Registration: i00%trig �d c hIR 410. A. Signature: / a B. Printed Name: i r C. Date of Signature: D. Mailing Address (including city): VCUV 1/61 CVJ E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) vot'rh bbrg� CiCJd4;nFi lr)gispartilon: 411. A. Signature: B. Printed Name:- C. Date of Signature: tlZs 2� 2 D. Mailing Address (includin ty): VO b Q)d 110, 7M A\iCA,Ca) E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vo er Reei r tion # nd C unt of Registration: o]]u o �t� i �o_ �uA 412. A. Signature: 1-a-ucu'�,t (�'1/tt.n ,K itiTt�` B. Printed Name: L) J ,(., l,_i �_� �� r� c- 1 C C. Date of Signature: 11 23125 D. Mailing Address (including city): Pp 601 �b Ij PiY't WVR(:A E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration: _I)13�a2aU7 CRIh6un 413. A. Signature: `-11 ItWtylCl Y,LU, B. Printed Name: Mtlh)}tci PerrZ!' C. Date of Signature: 1' 2.3 S D. Mai ling Address (including city): fib 3 INUMAck Qk. Pat LAVOlCOV E. Either (1) or (2); (1) Residence Address (including city) and Date of Birth: (2) Voter Re istration # and County n of Registratio: I I(Z3 la 2 %`7 C�I.P�t Petition to Create Calhoun County ttospitat District (400-449) Page 6 of 14 PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 414. A. Signature:_ j l B. Printed Name: ({ k Rt dYrtZ C. Date of Signature: 2 74t D. Mailing Address (including city): CYUL E. Either ( l) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and. County, of Registration 415. A. Signature: 1C z reK B. Printed Name: C. Date of Signature: D. Mailing Address (including city): ' LAV ACC E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vote,,Peg8t%i;4 � unty of Registration: 416. A. Signature: B. Printed Name: C. Date of Signature: 49, h»5 D. Mailing Address (including city): Ci (.G1lM �m f fd�UGICGV E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regi Itra4tiy? aanddIDLUA— d�unty ot'Registration: 417. A. Signature: almAd `C B. Printed Name ( I C. Date of Signature: I D. Mailing Address (including city): 6 l} LtV ACC, E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: Z I ZGI I �U (2) Vojef registration # and County, of Registration: 418. A. Signature:A B. Printed Na C. Date of Signature: D. MailingAddress(including ity): E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Petition to Create Calhoun County Hospital District (400.449) Page 7 of 14 PD.47845099.1 419. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Signs Print Date Maili Eithe. ,., _. (1) Residence Address (including city) and Date of (2) Voter �gistration # and County of Re istrat 420. A. Signature: B. Printed Name: C. Date of Signature: D D. Mailing Address (including city): UVJ E. Either (1) or (2): </ (1) Residence Address (including city) and Date of Birth: Gam" U i (2) Voter Regyst lul #, rqd un� of Rggistrati nn: (u�' r I ``ii LL``TT JJ��jj 't1' 421. A. Signature: B. Printed Name: CU C. Date of Signature:_' D. Mailing Address (including cl E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth:...... I t (2) Voter fistration # and County of Registration: 422. A. Signature.✓ B. Printed Name: C. Date of Signature: .7 D. Mailing Address (including city): 0 I,U/U,"t �U E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registratiok#qj County oIIItion: Cf Jill 423. A. B. C. D. E. Printed NanWi J D ,22 Date of Signature: -_2 3 ' 0rt_ Mailing Address (including city):. VQ e7 0 X 1061 Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Re istration I.and County of Registration: g R 8i %i i I CLAJ11 � ltS1 dY1 J Petition to Create Calhoun County Hospital District (400-449) Page PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 424. A. Signature: _ B. Printed N. 7 .t C. Date of Signature: r G D. Mailing Address (includingcity):IP l C E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter 425. A. Signature: B. Printed Name: N , �1 Uk' t\1e.i� C. Date of Signature: 1 ' ' ` _ pp D. Mailing Address (including city):_1 U. l i' E. Either (1) or (2): Al (1) Residence Address (including city) and Date of Birth: (2) jleer� egisCatihon�#'n�d County of Registration: II jj �lpP �S , ��i� r� 426. A. Signature: �nL,,.i',�pON�t »/ B. Printed Name: Vtrq- C. Date of Signature: �.I92 9.ro D. Mailing Address (includi g city): 110 1SGrNMZ., Si P6V-t" (A\fA-COI E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter RC�e/g(is�tra,��nQ# an� un-RQeg'isltration: 427. A. Signature: `0" """`-'-"'"—'�`-�— B. Printed Name: (J C. Date of Signature: D. Mailing Address(includingcity): ?-A/)J) FM IqD S D6i�" l aVGIG� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vgt�r R(egistr�ati�on # an o�u7nty�of Registration: 428. A. Signat T UU� 5 B. Printed Name: C. Date of Signature: D. Mailing Address (me uding city):'Z2-64:2 t() F-M 15 C1 c S PSVf- LgVAcc'u E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vo er Registrati n #and Count of Registration: 1�U0��i1n5`I C`a� �a� Petition to Create Calhoun County Hospital District (400-449) Page 9 of 14 PD.47845099.1 429. 430. 431 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT A. Signature B. Printed Name: CtWdn Mi nZ,12 C. Date of Signature: - 2- 2025 D. Mailing Address (including city): 201 ChuA'h'll� Xn, PO( E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth A. B. C. D. E. A. B. C. D. E. (2) Voter Registration # and County of Registration: 11620 4303 7 -Ca )tioan Printed Name: Date of Signature: Mailing Address (including t Either (1) or (2): (1) Residence Address( (2) Voter city) and Date of B Printed Name: `/oio+rce. C `o Date of Signature: Mailing Address (including city):__ �C Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter i r and County of Registration: 432. A. Signature: B. Printed Name: C. Date of Signature: I • 22 •2o25 D. Mailing Address (including city): 55 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Registration:_ 433. A. Signature: % ..ez v - B. Printed Name: C. Date of Signature: D. Mailing Address (including city): dT3 Mavig E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and County of Petition to Create Calhoun County Hospital District (400-449) Page 10 of 14 PD.47845099.1 19 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 434. A. Signature. �I B. Printed Na : J2 Si 2re� �ayoYr,�n C. Date of Signature: 1 / 22" r 7•c>yg- D. Mailing Address (including city): ZO(p Scu)t�,. QoSc �or}'lcyc a TK 11�17� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter eit )togaq niW� oC0.gilrat6ionn:: 435. A. Signature ✓I , �J L B. Printed Name? ` Ir i I t Vetg 2/_a_ C. Date of Signature: I. 2 2 2 C) t) D. Mailing Address (including city):T.D.LPN X 213 ' r_TEa,)e-C.-TX lZ`l lei E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re istratie�� on # and ou of Registration: I/21 ��1m _ �6ltirl 436. A. Signatur6Z2,.,-\�-.------ B. Printed Name: 1�tzrn� �cct C. Date of Signature: I1717S D. Mailing Address (including city) e_l t \6�� may} �a,•t(Af� 6K "1��I �l E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Ejegi rat{op k an CQu y of R%Eion: Yl �� 1e 437. A. Signature: lFl(!�t�G(.1/��V� B. Printed Name: e }1Z_ia s 1) 6y_xV_x C. Date of Signatur I —DO C D. Mailing Address (including city)•g v I Ck l)0.PA tT `1'lGl lq E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) V to stration #and County of Registration: P f t ., _ 438. A. Signature:c--)"A 0A Val \`O(3,AA B. Printed Name: vo r M . l�o-)r �AAAp ? ` C. Date of Signature: 1' -W Zb 2F D. Mailing Address (including city): 22 E. Either (1) or (2): (1) Residence Address (including city) and Date (2) Vqt Registration,#,and Coy(�ty of Registration: �29(brb(000q_ ('(AI-k>glXl Petition to Create Calhoun County Hospital District (400.449) Page 11 of 14 PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 439. A. Signature: B. Printed Name: t. S C. Date of Signature: % 'A �2- _ D. Mailing Address (including city):. - o E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vo�6 YV114 61 Con GII � Re�gisltiation: 440. A. Signature'" 7 B. Printed Name: cf-yo r K nsteC C. Date of Signature: D. Mailing Address (including city):.324Ftistef f-are, 5eactr;P-F-T 1 7798 E. Either (1) or (2): (1) Residence Address (includigg city) and Date of Birth: Scm e a5 abavC (2) VoterlljegyitjV TIT CoCunJy oDistration: 441. A. Signature: B. Printed Name: `[6rt v, rt 1 -T)LLAtYI C. Date of Signature: D. Mailing Address (including city) E. Either( l) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Ragistration # an¢ County of Registration: IQl5l(n52ol calh6wi 442. A. Signature: B. Printed Name: C. Date of Signature: D. Mailing Address (including city): 6kk Igor) D- E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vot r R t o #and County of Registration: I� K j�b to o j Co 1�1 443. A. Signature: kc B. Printed Name:)ioYl1 PFT�2. C. Date of Signature: 1- 2.2 - `Z 5 D. Mailing Address (including city):- 11c2.1 Ri)rkeri E. Either (1) or (2): (1) Residence Address (including city) and Date So (2) Voter Registration # and County of Registrat Petition to Create Calhoun County Hospital District (400-449) Page 12 or 14 PD.47845099.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 444. A. Signature: w 4v VI B. Printed Name: C. D. Date of Signature: 1' Mailing Address (including city): E G' 1oywWnll 'n•' �r L �� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) VO er l�e istra'on # and �l my of Registration: V1 445. A. Signature: � B. Printed Name: C. Date of Signature: 3 D. Mailing Address (mcludingclk ): (aVaC�� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Vmer Re¢istral # d County of Registration: 0 1210 07�1 � %LLvt-� 446. A. Signature: `d ( B. Printed Name: isy)il; ffoVtt`L C. Date of Signature: 1 2 % C D. Mailing Address (including crty): T % PJ) � 'DY al 4- E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regif t rt# aye �n�y of Registration: L�T' 447. A. Signature: —JLZ B. Printed Named VjVo C. Date of Signature: - 2—'LL1Z� Sb S.) 1 �GtJsc �X %77,C11 D. Mailing Address (including city): o(n of+ t E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) VotP. ^ ^ c r rin^+ rnin,ry of a istration: 448. A. ignature: B. _ Printed Name: Y-1 r C. Date of Signature: / e D. Mailing Address (including city): E. Either (1) or (2): (I) Residence Address (including city) and Date of Birth: (2) Voter.Re istrati n #and County of Registration: n o g�a 11 �,� �,�ccln >>, Petition to Create Calhoun County Hospital District (400.449) Page 13 of 14 PD.47845099,1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 449. A. Signature: JV I OLAX a) B. Printed Name: Muio, C. Date of Signature: Wt D. Mailing Address (including E. Either (1) or (2): (1) Residence Address (2) Voter city) and Date of Birth:6ame as clove Petition to Create Calhoun County Hospital District (400-449) Page 14 of 14 PD.47845099.1 GUIDELINES FOR PETITIONS (SIGNATUREs450-499) I. Only registered voters residing within the boundaries of the proposed district (Calhoun County) can sign the petition. The signatures of voters outside the proposed boundaries will not be counted toward the statutorily required rule of signatures needed. 2. If multiple copies of the petition are circulated, each copy should contain the full introductory portion. There may be multiple signature pages stapled to the introductory portion, but each one should be titled "Petition to Create the Calhoun County Hospital District" and should clearly state the information required with the signature. 3. The information indicated is considered necessary to verify signatures. There must be the following: (I) signature, (2) printed name, (3) the date of signature, (4) mailing address (including city), and (5) either (a) residence address (including city) and date of birth or (b) voter registration number and county of registration. A P.O. Box is generally not acceptable as a residence address. A P.O. Box is, of course, an acceptable mailing address. If a person has the same mailing and residence address, they can simply write "same as (nailing" under the section for residence address. 4. Only the signature is required to be in the voter's handwriting. The other information may be tilled in by someone else. 5. A petition may not be signed by an agent. Each person signing the petition must sign for himself or herself. One spouse cannot sign for another. PD.47845151.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT To: Honorable Vern Lyssy Calhoun County Judge 211 S. Ann St., Suite 301 Port Lavaca, TX 77979 We, the undersigned registered voters of Calhoun County, do hereby petition for the creation of a hospital district under the following terms and conditions pursuant to Section 286.021, et seq., of the Texas Health and Safety Code: The name of the proposed district shall be: Calhoun County Hospital District (`District'). 2. The District is to be created and is to operate under Article IX, Section 9, of the Texas Constitution. 3. The Commissioners Court of Calhoun County, Texas, shall appoint the following individuals to serve as temporary directors of the District until such time as the elected directors take office pursuant to §§ 286.041- 286.050 of the Texas Health and Safety Code: 1) Michael Chavana Place#1 2) Kelly Staloch Place #2 3) Jessie Rodriguez, III Place #3 4) Stephen Mutchler Place #4 5) Shelia Dierschke Place #5 6) Sherry Philips Place#6 7) Dallas Franklin At Large 4. The District shall impose a property tax, and the maximum ad valorem tax rate that may be adopted by the District shall not exceed forty cents ($0.40) on the $100 valuation of all taxable property in the District. 5. The District shall not impose a sales and use tax. 6. Seven (7) permanent directors shall be elected as follows: Six (6) directors shall be elected by place. One director shall be elected from each of the six (6) Calhoun County Independent School District Places. The directors elected from Places, One Three and Five shall serve an initial term of two (2) years. The directors elected from Places, Two, Four and Six shall serve an initial term of one (1) year. The remaining (1) director shall be elected from the County at large and shall serve an initial term of two (2) years. The boundaries of the District shall be coterminous with the boundaries of Calhoun County, Texas. 8. None of the territory in the District is included in another hospital district established pursuant to the laws of the State of Texas. Petition to Create Calhoun County Hospital District (450.499) Page 2 of 14 PD.47845151.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT DISTRICT ELLCpION PLACE MAP Petition to Create Culhoun County Hospital District (a50.499) Page 3 of 14 Pn.a�aas t s t. t PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT I am a registered voter of Calhoun County, Texas, and a resident of the proposed District, and, by my signature below indicate my support for this petition. I understand that the following information is required for a petition signature to be valid: 450. A. Signature:--044" 171iGAZ-V B. Printed Name: 4-i-bil�il A loos C. Date of Signature: 0 I •yam ,moo D. Mailing Address (including city): I W NIA,YS N W E. Either (I) or (2): (1) Residence Address (including city) and Date of (2) Voter Re iVaV8 I and Count f Registration: 451. A. Signature: 0/( B. PrintedNfrffe: MoLrVivt ICo5 7r. C. Date of Signature: 1 22/25 D. Mailing Address (including city):134 Ivlard OW FFK I RV eOtt Fu % 7y % of E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regifr-a1fionU1V Vd ygpltty6f RegiC atilo / 452. A. Signature: /Gvr"vr w16L� B. Printed Name: otoert W. I+akrt C. Date of Signature: - 2- t- 2-5 D. Mailing Address (including city): 2) 1 I+A hn Rdd Porf Laing , T-A -11 "l l 19 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter R'Ti¢tlatigq titnj �y11 453. A. Signature: B. Printed Name: C. Date of Signature: /— D. Mailing Address (including city): cAll 7797e E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Rell O tM4-7 ff EC t}ty�o�Repistrati m V �l"JU. ( Petition to Create Calhoun County Hospital District (450-499) Page 4 of 14 PD.47845151. t PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 454. A. Signature B. Printed Natfie: Za,.w 7r. femme rY C. Date of Signature: vi l e y Jas D. Mailing Address (including city):p, t?2cnZ re e+ E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: /0Ac.h y 455. A. B. C. D. E. 456. A. B. C. D. E. 457. A. B. C. D. E. 458. A. B. C. D. E. (2) Voter R ��tstration # (uanlld Cou5nty of a ist tion: 1 �� l c Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter Birth: Printed Name: I4 Date of Signature: ) Mailing Address (including Either ( I � ^r 11" (1) (2) Date of Signature: 112112031S Mailing Address (including city): 5W t\]. tAGl;kVk-j ( l n . Po r+ f gyc5 G1 Either (1) or (2): (I) Residence Address (incjudin city) and Date of Birth: p 1! J� 7 (n Ai crq (2) Voter Regi[13tionAabld u ty Re ist� ration: Petition to Create Calhoun County Hospital District (450.499) Page 5 of 14 PD.47845151.1 459. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT A. Signature B. Printed N C. Date of S D. Mailing? E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter RegisaaFiga#qy��rju fe istra ion: 460. A. Signature: e > B. Printed Name: 3�oRO4 ••( j/� u. /19/9 ,� C. Date of Signature: A,5� D. Mailing Address (including city): E4.t/ QR_ AORl ZAMOA.V E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regis a ton # and Countyof Registration: 461 462. A. B. C. D. E. A. B. C. D. E. 463. A. B. C. D. E. Either (1) or (2): (1) Signature: a:u o µS Printed Name: l mer'a Ak,kQnS Date of Signature: I - Tb - 7-0L 5 Mailing Address (including city): ?j Q 111 LAXccYi 5 i • Ptxt Lava C1t , I k ' Either (1) or (2): (1) Residence Address (including city) and Date of Birth: 3�t 1 st t t�C o a 4(y ! (Q'Z- (2) Voter Registration # d o y of R is ation: Printed Name: Date of Signature: - Mailing Address (including city):- 13 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: L3g .l w Voter Registration # and County of Registration: (2) Petition to Create Calhoun County Hospital District (450-499) Page 6 of 14 PD.47845151.I v PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 464. A. Signature:', B. Printed Name C. Date of Signature: D. Mailing Address (inclu ing city): "' O V A 1C% Y l- E. Either (1) or (2): (1) Residence Address (including city) and Date of 465. A. B. C. D. E. 466. A. B. C. D. E. 467. A. B. C. D. E. 468. A. B. C. D. E. (2) Voter of Printed Name: Emilio Wiilcau Date of Signature: t ��, 75 tt Mailing Address (including city): 21(t 6OWtf5F ark ILWA .-R 1' O S Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regi tr 1 d ount of Registration: �� 3b� Signature: -fie :. 4^_-� %- ( J Printed Name: k O e1viAr;e 14)Paper Date of Signature: 1 - 2 2- - ?.y Mailing Address (including city): _ 22. f 5 F•.w is a Aol -Lo vary 7`1,-- -7 1 `7 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter R istr/antio/�n!#S �� lJ IJ X i ad County of Re istra ion: Signature: C Printed Name: C2rr�G Y Date of Signature: Mailing Address S�T Either( I) or (2): (1) Residence Address (including city) and Date of Birth: (2) VoterRlslraf;onf a d,CIqL (Jyr egtgtrat' � Signature: �QOL44 aa,- PrintedNameG VL,1vv l M" Date of Signature: -' Mailing Address(includingciri) ?SrD Idric(ae �°c1 CrtaGiri FTti r7i� Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regist`atj #rd�C �ty�of _yistratio Petition to Create Calhoun County Hospital District (450-499) Page 7 0£ 14 PD.47845151.1 7S PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 469. A. Signature:l--'� B. Printed Name:�PANioo 2�,r✓�ltr�I C. Date of Signature: /�Jzsl D. Mailing Address (including city):/�/L A✓.fib✓ iow/� E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voterjt�tsttipn #8ttd Cpu�nty of Re i tr ion: L L L U U4 470. A. B. C. D. E. 471. A. B. C. D. E. 472. A. B. C. D. E. Date of (including 71 Either (1) or (2): (1) Residence Address (including city) and Date of Birth: SFa- Cs G-6o V - nS- t1-- IQ VI (2) Voter Date of Signature: " l`oi n ''dO Mailing Address (including city): ITM ykl r (dYyt S� Either (1) or (2): (1) Resident:DG Address(iQnclu{I4gg c>pand pate oBirt h: (2) Voter Registration # and County of Registration Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter RegiltUoC�O��ofRegistr�ti�on)�� — _ �� C^-PiLV 473. A. Signature: B. Printed Nam L C. Date of Sign re: D. Mailing Address (including city): E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Rej�tOratiq �# _ _ C�Tj of� t�ratio�� Petition to Create Calhoun County Hospital. District (450-499) Page 8 of 14 PD.47845151.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 474. A. Signature: aZ�c w Lu rL B. Printed Name: C. Date of Signature: l - ,2 .:2 — 2 i D. Mailing Address (including city): �%{ E. Either (1) or (2): (1) Residence Address (including city) and Date 4- jw (2) Voter Registration # a d Co y�nty of Registrar 1 UUY C, 1oci-7, 475. A. Signature:_-&'ati/L( B. Printed Name: t�✓l�P Ii�G C. Date of Signature: D. Mailing Address (including city): V:4-4L E. Either (1) or (2): (1) Residence Address (including city) and Date of Bird �2 -,2- (2) Voter gegi%rajlon # and County of Registration:_ 476. A. Signature: VA B. Printed Name: ✓) C. Date of Signature: D. Mailing Address (including city): E. Either (1) or (2): (7 (1) Residence Address (including city) and Date of Birth:6��1� (2) Voter Registration # agd Cyunty of Registration: 477. A. Signature: B. Printed Name: NA.104v In C. Date of Signatur : If 3-21 n D. Mailing Address (including city): 0 t Q I CDYiYIOY �� t E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regis{ratio and County of Registration: 478. A. Signature:42�(01� B. Printed Name: A 1,1 t4 C. Date of Signature: D. Mailing Address(includingcity): E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Re is ra 'o # nd Cou ty of Registration: Petition to Create Calhoun County Hospital District (450.499) Page 9 of 14 PD.47845151.1 U PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 479. A. Signature: ti ° i tir B. Printed Name: C. Date of Signature: ',i - 9 — ERIQ D. Mailing Address (including city)W/.4,, ' E. Either (1) or (2): (1) Residence Address (including city) and Date of B A. B. C. D. E. 511111 11 B. C. D. E. (2) Voter Ref ts1 (2) Voter Date of Signature: / .� �'/ Mailing Address (including city): Either (1) or (2): (1) Residence Address (including city) and Date of 482. A. B. C. D. E. (1) Residence Address (including city) and Date of Birth: Printed Name: C' Date of Signature: l LS✓LS Mailing Address (incudt gcity) O• �, DE077-1 Z Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter 483. A. Signature: 7`b B. Printed Name: 4 P C. Date of Signature: D. Mailing Address (including ci . d- G E. Either (1) or (2): (1) Residence Address (including city) and Date of (2) Voter Registration # and County of Registration: Petition to Create Calhoun County Hospital District (450-499) Page 10 of 14 PD.47845151.1 PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT 484. A. Signature: AeIZK�oz B. PrintedNa n C. Date of Signature: / X) D. Mailing Address (including city): 1214 Fce 1c I J /a✓*Ccyaca ,I->( 77975 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of 485. A. Signature: IgWq B. Printed Name:114 C. Date of Signature: Z 2 _ D. Mailing Address (including city): e/ sKa / %% 9 7 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regigtratigo and Copn)y of l egistratiop: 486. A. Signature: c" B. Printed Name: 3CO C. Date of Signature: /— a o2 -- ;W - D. Mailing Address (including city): 1,2? {rig ,o� l�I ra® r' E. Either (1) or (2): (I) Residence Address (including city) and Date of Birth: (2) Voter Registratiop # and County of Rgistration:T 487. A. Signature: V t I t\ B. Printed Name: >✓ 0 e C. Date of Signature: 1 a -Aa p D. Mailing Address (including city): 1-0 VC 4.v%t, 1 0 P Q01, c q E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) VoterRegijm,, �%Cqugtylo! �egistratjo : 488. A. Signature:..(( UU -1_ B. Printed Nae .7tu#wA- laAwJ C. Date of Signature: 112%Izs D. Mailing Address (including city): Zit IkAyW Ro .N2C LAmL* E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Repisy tion4#8iq luFF Petition to Create Calhoun County Hospital District (450.499) Page 11 of 14 PD.47845151.1 489. A. B. C. D. E. 490. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT Printed Name: !!V94W MO W(k 41 Date of Signature: 112312°) Mailing Address (including city): -JQ1 IWVirbuK- LV� 00Y{- LGVkr q 1Y 9161 ? l Either (1) or (2): (1) Resdenc�eAddress qqoi`(i cludiggcK ng ty) and Date of Birth: INI 6,10,00yDULI\ POYYI-6tr�pt (2) Voter Registration# and,CopptA of [registration Date of Signature: DI 1 Mailing Address (including city): o Either (1) or (2): (1) Residence Address (including city) and Date (2) Voter 491. A. Signature: e.�-- B. Printed Name: W�cR 0 C. Date of Signature: 1 3 202 D. Mailing Address (including city): ,30 E. Either (I) or (2): (1) Residence Address (including city) and Date of 492. A. B. C. D. E. 493. A. B. C. D. E. Date of Signature: 1— Z 9— a *,a 4z Mailing Address (including city): r L Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Printed Name: S Date of Signature:YGGIf. i L" Mailing Address (including city): Either (I) or (2): (1) Residence Address (including city) and Date of (2) Voter i egis�tra4q gryougty ;of Reg=: d� Petition to Create Calhoun County Hospital District (450-499) PD.47845151.1 F%fA 1 K 494. A. B. C. D. E. PETITION TO CREATE THE CALHOUN COUNTY HOSPITAL DISTRICT timer ( i) or t Ly (1) Residence Address (including city) and Date of Birth: (2) Voter Reg4r'ation_ to aunt oX f J2egi trati n: 1S �lJ��l 495. A. Signature:- B. B. Printed Name: C. Date of Signature: D. Mai IingAdd ress(incIudingcity): 11 h2fi 'r iFr- LIWV &kZ ZA11Ae h E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: oln (2) Voter RegilatiV!c� � f Repis�tion: 496. A. i?�r]d3C /i Signature: (1�(! leyio B. Printed Name: �f \ k f' C. Date of Signature: - - D. Mailing Address(includingcity): 14.2q )Ua-nj- N Ili" URitAVACA -,,X 1191 E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Reftti nlCo(Rgstration: a_j �(Ckn4A 497. A. SignatureJAi7WL/ C',;611eW0 B. Printed Name: I. &WE (fASrZCLO C. Date of Signature: - 'U ,f 4AVA4j"X 77%� D. Mailing Address (including city): / I Zvi /)JnhrH 0c:- 4U l0a, E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Registration # and County of Re is lion: 498. A. Signature:_" ' C_ B. Printed Name: C. Date of Signature: l 2Y r w Lk D. Mailing Address (including city): 2 E. Either (1) or (2): tlrj`J9 (1) Residence Address (including city) and Date of Birth: (2) Voter Regi ration # and C only of Registration: 00� I ,, c�cPV),ry Petition to Create Calhoun County Hospital District (450-499) Page 13 of 14 PD.47845151.1 PETITION TO CREATE THE, CALHOUN COUNTY HOSPITAL DISTRICT 499, A. Signatt B. Printed C. Date of D. Mailing Address (including hy): W. 4j OX Y/$- fbiaa cma 644 Z E. Either (1) or (2): (1) Residence Address (including city) and Date of Birth: (2) Voter Regiy tj lr4,1 C71jf Registration: stralZ � Petition to Create Calhoun County Hospital District (450.499) Page 14 of 14 PD.47845151.1 #19 NOTICE OF MEETING—1/29/2025 19. Consider and take necessary action to Accept grant from the Matagorda Bay Mitigation Trust in the amount of $249,926.00 for the replacement of the Little Chocolate Bayou restrooms and authorize all appropriate signatures on Contract number 077. (DEH) RESULT: APPROVED [UNANIMOUS] 'MOVER: David Hall, Commissioner Pct 1' SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 16 of 20 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann �Oj,,; O,, (361)552-9242 Port Lavaca, TX 77979 Y^ Fax (361)553-8734 Honorable Vern Lyssy Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Lyssy, Please place the following item on the Commissioners' Court Agenda for January 29th, 2025. Consider and take necessary action to Accept grant from the Matagorda Bay Mitigation Trust in the amount of $249,926.00 for the replacement of the Little Chocolate Bayou restrooms and authorize all appropriate signatures on Contract number 077. Si erel David E. Hall DEH/apt 0 MATAGORDA DAY MITIGATION TRUST . Steven J. Raabe, P.E., Trustee P.O. Box 1269 Poth, Texas 78147-1269 Trustee@m bmTru st. com January 21, 2025 Commissioner David Hall Calhoun County 305 Henry Barber Way Port Lavaca, TX 77979 Email david.hall@calhouncotx.org Re: Little Chocolate Bayou Park Restrooms Dear Commissioner Hall, The Matagorda Bay Mitigation Trust (Trust) is pleased to inform you that your proposal titled "Little Chocolate Bayou Park Restrooms" has been selected for award. The Trust received 60 proposals in response to the Request for Proposals issued on Septembers, 2024 totaling $27.3 million. The Trust has selected 30 projects totaling $14.6 million for award. I look forward to working with you and your organization on this exciting project. This award is contingent on executing a contract between your organization and the Trust. 1 will be reaching out to you in the near future to finalize your contract. Please let me know if you have any, questions. Sincerely, Steven J. Raabe, P.E. Trustee, Matagorda Bay Mitigation Trust MATAGORDA BAY MITIGATION TRUST CONTRACT COVER/SIGNATURE PAGE TITLE OF CONTRACT No. 077: Little Chocolate Bayou Park Restrooms This Contract is entered into by the Matagorda Bay Mitigation Trust (herein referred to as "the Trust") and the following named Recipient: THE TRUST: RECIPIENT: Matagorda Bay Mitigation Trust Calhoun County P. O. Box 1269 211 S. Ann Street Poth, Texas 78147-1269 Port Lavaca, Texas 77979 Email: Trustee@mbmtrust.com Email: vern.IvssvCa calhouncotx.org Contact Person: Steven J. Raabe, Trustee David. haIIgcalhouncotx.org Contact Person: Judge Vern Lyssy and Commissioner David Hall The Recipient ("Recipient") agrees to provide Mitigation Project Work and Services ("Mitigation Project") in compliance with this Contract ("Contract") and all applicable federal and state laws, regulations, and rules. In accordance with the General Terms & Conditions, it is understood and agreed by both parties hereto that the Trust's obligations under this Contract are contingent upon Recipient's compliance with this Contract and federal and state law regulations and rules. This Contract, which constitutes promised performances by the Recipient, consists of the following documents: Contract (Cover Sheet/Signature Page) General Terms and Conditions' Statement of Mitigation Project (Attachment A) Budget (Attachment B) Invoice Format (Attachment C) The Recipient hereby acknowledges that it has read and understands this entire Contract. All oral or written agreements between the parties hereto relating to the subject matter of this Contract that were made prior to the execution of this Contract have been reduced to writing and are contained herein. The Recipient agrees to abide by all terms and conditions specified herein and certifies that the information provided to the Trust is true and correct in all respects to the best of its knowledge and belief. CONTRACT PERIOD: FROM: March 1, 2025 UNTIL: March 31, 2026 FUNDING: This Contract may not exceed $249,926.00 ("funds"). APPROVED: MATAGORDA BAY MITIGATION TRUST BY.. NAME: Steven J. Raabe TITLE: Trustee DATE: January 21, 2025 1 BY: NAME: Vern Lyssy TITLE: County Jud S� DATE: GENERAL TERMS AND CONDITIONS I. PARTIES A. Trustee of the Matagorda Bay Mitigation Trust herein referred to as "Trustee" or "Trust" as applicable and "Recipient," have made and entered into this Contract herein referred to as "Contract." B. Recipient represents and guarantees that it possesses the legal authority to enter into this Contract, receive the funds authorized by this Contract, and to perform the work and services described on Attachment "A" comprising the Mitigation Project ("Mitigation Project'). The Recipient has obligated itself to perform under this Contract, including subsequent contract amendments or modifications. As may be applicable to Recipient, the Recipient shall comply with appropriate federal and state licensing or certification requirements. C. The persons signing this Contract on behalf of the parties hereto warrant that they are the duly authorized representatives authorized to execute this Contract and to validly bind their respective parties to all terms, conditions, performances and provisions herein set forth. II. PURPOSE This Contract sets forth the terms and conditions upon which the Trust agrees to provide funds ("funds") to the Recipient to perform the Mitigation Project. III. RECIPIENT AS INDEPENDENT CONTRACTOR A. It is understood and agreed by both parties that the Trust is contracting with Recipient as an independent contractor and that Recipient is and shall be liable to its own employees and is responsible for its own risk of loss. B. The Recipient agrees to repay the Trust for all disallowed cost or other claims which may be declared by the Trustee occurring in connection with the Mitigation Project to be performed or administered by the Recipient under this Contract. C. Employees of Recipient are not employees or agents of the Trust. Employees of Recipient are subject to the exclusive control and supervision of Recipient and Recipient is solely responsible for employee payroll and claims arising therefrom. IV. FUNDS A. Funds and Payment Disbursements Trust agrees to pay Recipient in accordance with the approved budget structure set forth in Attachment B and other provisions of this Contract and such payment shall not exceed the amount specified in the Contract Cover/Signature Page. Recipient agrees that it shall not utilize funds for administration or overhead expenses in an amount that exceeds fifteen percent (15%) of the approved budgeted project salaries of Recipient. Recipient shall ensure salary amounts charged to the project are reasonable and solely for the project(s) identified. 3. Funds will be disbursed to Recipient as follows: a. Mitigation Project Work Plan. The work plan for the execution of the Mitigation Project is described in Attachment A and includes the following: i. Details regarding the specific work and services to be performed; ii. A schedule of estimated time to perform each stage of the Mitigation Project; iii. A budget to perform the Mitigation Project as shown in Attachment B; and iv. Such other information requested by Trustee. b. Invoicing. Upon completion of each stage of the Mitigation Project or as otherwise agreed, the Recipient shall electronically submit an invoice to the Trust with details about the work and services performed, the date(s) performed and a list of all expenditures in the format shown on Attachment C and such other information requested by the Trust. Trustee may approve payment of the invoice or upon review request additional information the Trustee deems necessary for clarification or other purposes prior to payment. Trustee may withhold payment until satisfied that the invoice represents accurately the contents therein. Prior to, during, or subsequent to approval of payment of invoices to Recipient, the Trustee shall have the right to conduct an audit or investigation regarding such invoices or other information provided by Recipient. c. Progress Reports. Recipient shall provide Trust with a progress report with each invoice detailing the Mitigation Project activities performed to date together with a list of all expenditures with supporting documentation such as paid invoices, copies of subcontracts, reports maintained internally by Recipient, such reports to include information regarding potential issues that affect the Mitigation Project and reports submitted to Recipient's governing body and such other information requested by Trustee. d. Final Report. Recipient shall provide Trust with a final report detailing the Mitigation Project as completed which shall include copies of all reports maintained internally by Recipient, such reports to include information regarding the resolution of issues that affected the Mitigation Project and reports submitted to Recipient's governing body reflecting the completion of the Mitigation Project and such other information requested by Trustee. e. Additional Reports. Recipient agrees to provide follow-up information and documentation to any report submitted to Trust as Trustee deems reasonable and necessary and such other information requested by Trustee from time to time. 4. Recipient agrees to return, refund, or repay to Trust any sum which Trustee determines represents an overpayment to Recipient or represents funds not used in accordance with the terms of this Contract. Trustee's determination of overpayment or funds not used in accordance with the terms of this Contract shall constitute an event of potential default more fully described in Section XIV hereinafter. 5. Trustee may withhold funds to Recipient if Trustee determines that Recipient has not complied with the terms of this Contract. Trustee's determination to withhold funds due to Recipient's failure to comply with the terms of the Contract shall constitute an event of potential default more fully described in Section XfV hereinafter. 6. Recipient agrees that it will not receive duplicate funds from another source for any of the items included in the budget set forth in Attachment B. Following Trustee's approval of the Final Report, any portion of the funds not expended or obligated in accordance with this Contract shall be returned to the Trust by Recipient. 8. This Contract shall not be construed as creating any future financial obligation or debt of or on behalf of Trust. It is understood and agreed that funds may be provided to Recipient only from funds allocated for this Mitigation Project which shall be distributed subject to compliance with this Contract and upon such timing as deemed reasonable by the Trustee. V. RECORDS MANAGEMENT A. Recipient shall maintain all books, records, documents, papers, and other evidence related to Mitigation Project implementation, including financial records, reports maintained internally by Recipient and reports submitted to Recipient's governing body, and Mitigation Project performance information, in accordance with generally accepted business and accounting practices, consistently applied. Recipient shall also maintain the financial data used in the preparation of support for any cost (direct and indirect) information or analysis for the Contract or for any negotiated subcontract. Recipient shall also maintain a copy of any negotiated subcontract. Recipient shall also maintain a copy of any cost information or analysis submitted to Trustee. Recipient agrees to the disclosure and access of Trustee, or any authorized representative of Trustee to all such books, records, documents, papers, and other evidence for the purposes of review, inspection, audit, excerpts, transcriptions and copying during normal business hours. B. Recipient understands that acceptance of funds under this Contract acts as acceptance of the authority of the Trustee or his authorized representative, to conduct an audit or investigation in connection with those funds. Recipient further agrees to fully cooperate with the Trustee, or his authorized representative in the conduct of the audit or investigation, including providing all records requested. Recipient shall ensure that this clause concerning the audit of funds accepted under this Contract is included in any subcontract it awards. C. Recipient shall maintain such records and be subject to these audit requirements during the performance under this Contract for a period of five years after Trustee provides written approval of the Final Report. However, if Recipient is aware of any litigation, claim, negotiation, audit, cost recovery or other action, including actions concerning costs of items to which an audit exception has been taken, relating to the Mitigation Project that started before the expiration of the five-year record retention period, Recipient shall maintain all records and be subject to such audit requirements until completion of the action or resolution of all issues which arise from any litigation, claim, negotiation, audit, cost recovery or other action, or until the end of the five-year record retention period, whichever is later. The Trustee will have access to records at any reasonable time for as long as the records are maintained by Recipient. Recipient agrees to transfer records in its custody to Trustee upon his request. This paragraph survives termination of this Contract. D. Failure to comply with all records management and reporting requirements of this Contract shall constitute an event of potential default more fully described in Section XIV hereinafter. VI. FINANCIAL MANAGEMENT Recipient shall have a financial management or accounting system which accounts for costs in accordance with generally accepted accounting standards and principles. Recipient shall allow Trustee's review of the adequacy of the financial management system. Failure to maintain the financial accounting requirements shall constitute an event of potential default more fully described in Section XIV hereinafter. The accounting requirements shall include: A. Provide for the identification of costs in accordance with the approved project budget (Attachment B) and segregation of Mitigation Project costs between the budget categories; VII. B. Maintain records which adequately identify the source and application of funds provided under this Contract. Such records must contain information pertaining to awards and authorizations, obligations, unobligated balances, assets, liabilities, outlays or expenditures, and income; C. Provide internal control by maintaining effective control and accountability for all cash, real and personal property and other assets paid for under this Contract. All such property acquired with Project funds must be adequately safeguarded and used solely for authorized purposes; D. Provide budget control by comparing outlays and expenditures with budgeted amounts for the funds provided by the Trust both by category and by task as shown in Attachment C; E. Support accounting records with source documentation, including cancelled checks, paid invoices, payrolls, time and attendance records, and subcontract documents; F. Permit the tracing of funds to a level of expenditures adequate to establish that such funds have not been used in violation of this Contract or applicable statutes; and G. Permit preparation of reports required by this Contract or requested by Trustee. A. Recipient may subcontract all or any portion of the Mitigation Project for purposes of this Contract. B. Recipient shall be responsible for all acts and omissions of all subcontractors performing or furnishing any portion of the Mitigation Project under a direct or indirect contract with Recipient to the extent provided under applicable laws and regulations. Nothing in this Contract shall create for the benefit of any such subcontractor any contractual relationship between Trust and any such subcontractor, nor shall it create any obligation on the part of Trust to pay or to see to the payment of any money due to any such subcontractor. C. Recipient shall be solely responsible for scheduling and coordinating the work of subcontractors performing or furnishing any portion of the Project under a direct or indirect contract with Recipient. Recipient shall require all subcontractors performing or furnishing any portion of the Project who desire to communicate with Trustee to communicate through Recipient with Trustee. D. All work performed for Recipient by a subcontractor shall be pursuant to an appropriate written contract between Recipient and the subcontractor which is not inconsistent with the terms and conditions of this Contract. Each subcontractor shall be provided a copy of this Contract prior to initiating any portion of the Project. VHL PUBLICATIONS, NEWS RELEASES, AND OTHER PUBLIC All public reports, news releases, other publicity, and other materials prepared for publication pursuant to or as a result of this Contract shall acknowledge the Matagorda Bay Mitigation Trust as the funding source. Public reports or other publications, news releases, and other publicity issued by Recipient about the Mitigation Project shall be provided to Trustee. IX. RIGHTS IN DATA AND OTHER MATERIALS A. Recipient and the Trust agree that any data collected as a result of this Contract shall be jointly owned by Recipient and the Trust. Recipient and Trust agree that each shall have complete and unlimited access and use to all data collected as a result of this Contract. Further, at the termination of the Trust, or at such other time deemed appropriate by Trustee, the Trustee has the right, but not the obligation to transfer any interest in the data to Recipient. B. Recipient shall act to ensure all subcontractors used for this Mitigation Project are advised of the rights in data and other materials described herein and that the subcontractors are prohibited from asserting any rights at common law or in equity or otherwise seeking to establish any claim to statutory copyright in any data, material or information developed under this Contract. C. Recipient and the Trust agree that in addition to the joint ownership by Recipient and the Trust of any data collected as a result of this Contract, that in the event any invention or intellectual property is created as a result of this Contract in which the Recipient retains title, Trust shall have a non-exclusive, nontransferable, irrevocable, paid -up license to practice or have practiced the subject invention throughout the world. Materials developed as a result of this Contract will be made available to the Trustee in written and electronic formats upon request under the non-exclusive, nontransferable, irrevocable, paid -up license. D. The Recipient has the responsibility to obtain from its subcontractors all data and rights therein necessary to fulfill the Recipient's obligations to the Trust under this Contract. If a subcontractor refuses to accept terms affording the Trust's such rights, the Recipient shall promptly bring such refusal to the attention of the Trustee. E. Recipient shall place a section in all subcontractor contracts that complies with Section IX. X. AGREEMENT TO HOLD HARMLESS AND INDEMNIFICATION A. TO THE EXTENT PERMITTED BY APPLICABLE LAW, RECIPIENT AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE TRUST, TRUSTEE AND AGENTS, EMPLOYEES, CONSULTANTS, ACCOUNTANTS, ATTORNEYS AND OTHER PROFESSIONALS AND REPRESENTATIVES ENGAGED OR EMPLOYED BY THE TRUST TO THE FULL EXTENT PERMITTED UNDER FEDERAL AND STATE LAW FROM AND AGAINST ANY AND ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION TO THE EXTENT ARISING FROM THE MISCONDUCT, NEGLIGENCE, OMISSIONS, OR RECKLESS ACTS OF RECIPIENT OR ITS EMPLOYEES, OFFICERS, OFFICIALS OR AGENTS OR ITS SUBCONTRACTORS IN CONNECTION WITH THE PERFORMANCE OF SERVICES OR WORK BY RECIPIENT UNDER THIS CONTRACT. THE PROVISIONS OF THIS PARAGRAPH SHALL SURVIVE TERMINATION OF THIS CONTRACT. B. TO THE EXTENT PERMITTED BY APPLICABLE LAW, THE RECIPIENT AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE TRUST, TRUSTEE AND AGENTS, EMPLOYEES, CONSULTANTS, ACCOUNTANTS, ATTORNEYS AND OTHER PROFESSIONALS AND REPRESENTATIVES ENGAGED OR EMPLOYED BY THE TRUST TO THE FULL EXTENT PERMITTED UNDER FEDERAL AND STATE LAW FROM ANY AND ALL CLAIMS AND LOSSES ACCRUING OR RESULTING TO RECIPIENT AND TO ANY AND ALL SUBCONTRACTS, MATERIALS, PERSONS, LABORERS AND AN OTHER PERSONS, FIRMS OR CORPORATION, FURNISHING OR SUPPLYING WORK, SERVICES, MATERIALS, OR SUPPLIES IN CONNECTION WITH THE PERFORMANCE OF THIS CONTRACT. XI. CONFLICT OF INTEREST A. Recipient shall maintain an internal policy regarding conflicts of interest and shall adhere to said policy with respect to any potential or actual organizational or personal conflict of interest between Recipient and its employees or any 9 subcontractor with respect to this Contract. Further, such internal policy shall include a prohibition that funds received by Recipient from the Trust shall not be used to pay, reimburse or otherwise give in any manner or for any purpose to the Plaintiffs and Defendants in Cause No. 6-17-CV-00047, hi San Antonio Bay Estuarine Waterkeeper and S. Diane Wilson vs. Formosa Plastics Corp., Texas, and Formosa Plastics, Corp., U.S.A., in the United States District Court for the Southern District of Texas, Victoria Division. B. Recipient shall notify Trustee regarding any potential or actual organization or personal conflict of interest involving Recipient's employees or subcontractors and shall keep the Trustee informed regarding any actions taken or decisions made in connection with such employee or subcontractor. In the event that the organizational or personal conflicts of interest does not become known until after performance on the Contract begins, Recipient shall notify Trustee of the conflict and any action taken as soon as Recipient becomes aware of the conflict. C. Trustee has sole discretion to make the final determination as to whether an organizational or personal conflict of interest exits, and if the conflict of interest requires action beyond the action taken by Recipient, whatever action that may be. Trustee may request Recipient to terminate any subcontractor in whole or in part, if Trustee deems such termination necessary to avoid an organizational or personal conflict of interest. D. If Recipient was aware of an actual organizational or personal conflict of interest prior to award or discovered an actual conflict afterward and did not disclose it or misrepresented relevant information to Trust, Trustee, at his sole discretion, may terminate this Contract for default or pursue such other remedies as may be permitted by law or this Contract. E. Recipient shall place a section in all subcontractor contracts that complies with Section XI. XIL VENUE Recipient acknowledges and agrees that this Contract is being performed in Calhoun County, Texas. Recipient agrees that any permissible cause of action involving this Contract arises solely in Calhoun County. XIII. ENTIRE AGREEMENT This Contract constitutes the entire and full agreement between the Recipient and the Trust, and all previous oral or written agreements relating to the subject matter of this Contract between the Trust and Recipient have been superseded, reduced to written form, and are incorporated herein. Recipient and Trust expressly agree and understand that all future, oral agreements, representations or modifications shall not have any legal binding effect unless and until reduced to writing and executed by both Recipient and Trustee, except for amendments by operation of law as provided in Section XVII in this Contract. XIV. DEFAULT AND REMEDIES A. Recipient shall be considered in default under this Contract if any one or more of the following events occur, provided that Recipient has received written notice of such potential default from Trustee and has failed to cure the potential default within thirty days from the date of said notice. If Recipient has begun a good faith effort to cure the potential default within the thirty -day period, Recipient may be allowed additional time, if deemed reasonable by Trustee in his sole discretion, as needed to cure the potential default. B. Event of Potential Default. Trustee will, in his sole discretion, determine if an Event of Potential Default exists. Each of the following shall constitute an Event of Potential Default under this Contract: 1. If Recipient makes an assignment for the benefit of creditors or takes any similar action for the protection or benefit of creditors. 2. If at any time Recipient knowingly, negligently, or intentionally makes any representation to Trustee which is incorrect in any material respect. 3. If Recipient knowingly, negligently, or intentionally submits any request for payment to Trust which is incorrect in any material respect. 4. If Recipient knowingly, negligently, or intentionally submits any report or certification to Trust related to the Mitigation Project which is incorrect in any material respect. 5. If Recipient utilizes funds which Trustee determines represents an overpayment to Recipient or represents funds not used in strict accordance with the terms of this Contract. 6. If Recipient fails to perform the Mitigation Project described on Attachment A in any material aspect. 7. If Recipient fails to comply with the reporting and invoicing requirements under this Contract. 8. If Recipient fails to maintain the records management requirements under this Contract. 9. If Recipient fails to maintain the financial accounting requirements under this Contract. 10 10. If Recipient fails to maintain the insurance requirements under this Contract. It. If Recipient fails to comply with any term or provision contained in this Contract. C. Remedies. Upon the occurrence of any such Event of Potential Default and failure of Recipient to cure such potential default as provided above, Trustee may declare Recipient in default in writing and may, as Trustee determines appropriate, withhold payments to Recipient or require Recipient to return, refund or repay any payments received prior or subsequent to the event of default. In addition, Trustee may terminate this Contract and avail himself of any appropriate legal remedies, including recovery of attorney's fees and expenses incurred in enforcing any such legal remedies, if so awarded by a court of competent jurisdiction. D. No Waiver. A waiver of any Event of Potential Default shall not be considered a waiver of any other or subsequent Event of Potential Default, and any delay or omission in the exercise or enforcement of the rights and powers of Trust shall not be construed as a waiver of any rights or powers. XV. USE OF FUNDS AND LIMITATIONS ON EXPENDITURES Funds distributed or allocated to Recipient under this Contract, or any modification thereto, shall not be used to support other programs operated by the Recipient under a different contract. Nor can such funds be carried over to a new contract or amended contract without the written permission of the Trustee. XVI. LIMITATION ON LIABILITY The Recipient understands and agrees that the Trust shall not be liable for expenditures made in violation of terms of this Contract, any laws, regulations, rules, or policies, or any other laws or regulations applicable to the Mitigation Project performed under this Contract. The Recipient also agrees that the Trust shall not be liable for any cost incurred by Recipient which exceeds the funding amount provided hereinabove. The Recipient shall be liable for such funds and shall repay such funds even if the improper expenditure, if any, was made by a subcontractor of the Recipient. XVII. AMENDMENTS BY OPERATION OF LAW Any alterations, additions, or deletions to the terms of this Contract which are required by changes in Federal law, State law, by regulations, are automatically incorporated into this Contract as if set forth fully, without written amendment hereto, and shall become effective on the effective date designated by such law, regulation, or policy. 11 XVHI. COMPLIANCE WITH LAW. Recipient covenants and agrees to comply with all applicable Federal, State and local laws, and all applicable Federal and State regulations. Recipient shall also be responsible to ensure that its' subcontractors shall comply with applicable Federal, State and local laws, and all applicable Federal and State regulations. XIX.PATENT INDEMNITY The Recipient shall include a provision in all of its contracts with contractors and subcontractors that the contractor and subcontractor will indemnify the Trustee, the Trust and its consultants, agents, attorneys, and employees against liability, including costs, for infringement of any United States patent (except a patent issued upon an application that is now or may hereafter be withheld from issue pursuant to a Secrecy Order under 35 U.S.C. §181) arising out of the manufacture or delivery of supplies, the performance of services, or the construction, alteration, modification, or repair of real property under this Contract, or out of the use or disposal by or for the account of the Trust of such supplies or construction work. XX. DISCLOSURE OF INTEREST Recipient represents and warrants that the Trustee, the Trust or its' consultants, agents or attorneys have no ownership or beneficial interest of any kind in Recipient or Recipient's subcontractors. Further, Recipient shall ensure subcontractor's compliance with Section XX. XXI. SEVERABILITY If for any reason any section, paragraph, subdivision, clause, phrase, word or provision of this Contract shall be held invalid or unconstitutional by final judgment of a court of competent jurisdiction, it shall not affect any other section, paragraph, subdivision, clause, phrase, word or provision of this Contract for it is the definite intent of the parties that every section, paragraph, subdivision, clause, phrase, word or provision hereof be given full force and effect for its purpose, so long as the invalidated matter does not substantially deprive a parry of the benefit of this Contract. /'AVtff1►9119N sl Recipient shall maintain during the term of this Contract and shall provide Trustee with proof of insurance in amounts sufficient to cover the Recipient's liability subject to applicable constitutional and statutory limitations of liability. 12 1. The Trust shall not be responsible for the payment of premiums or assessments on such policies. 2. Proof of insurance showing such coverages as required herein shall be submitted to Trustee within 20 days of contract execution. 3. In the event any insurance policy as specified herein is cancelled or in the event Recipient fails to maintain the minimum insurance limits as specified herein or in the event recipient fails to provide certificates of insurance, such event shall constitute an event of potential default more fully described in Section XIV hereinabove. XXIII. ASSIGNMENT XXIV. This Contract shall be binding on and inure to the benefit of the Trust and Recipient and their respective successors and permitted assigns. This Contract may not be assigned by Recipient without the prior written consent of the Trustee. All notices, communications, and requests given to or made upon the Trust and Recipient hereto shall, except as otherwise specified herein, be in writing and shall be delivered or mailed to such parry at the notice addresses specified on the Contract Cover/Signature Page. The Trust and Recipient may change their notice addresses but shall provide immediate notice to the other and shall provide such notice in writing to the other parry. XXV. DISPUTES In the event a Recipient has a dispute with the Trust or in the event any Recipient seeks to file a claim or lawsuit, the Recipient's sole recourse shall be by informal dispute resolution between the Recipient and the Trust and if such informal dispute resolution is not resolved, then the Recipient may seek the alternative dispute resolution as provided herein. The alternative dispute resolution process shall consist of a Mediated Settlement Conference in Calhoun County, to be conducted with the Recipient and the Trust and their legal counsel. The mediator shall be selected by agreement of the Recipient and the Trustee. Should the parties fail to agree on a mediator, an attorney mediator shall be selected by the Director of Calhoun County Dispute Resolution Services. The decision made by a Mediator shall be binding on the Recipient and the Trust, and there shall be no further appeal but the decision shall be enforced, if necessary, by the District Court of Calhoun County. The Recipient agrees to submit to such binding alternative dispute resolution as provided herein. Further, Recipient's sole remedy under the informal dispute resolution and under the binding alternative dispute resolution shall be limited to all, none or part of the remaining balance, if any, of Funds allocated to it under the terms of this Contract with the Trust; however, the Trust may recoup any Funds distributed to the Recipient through the same alternative dispute resolution procedure described herein. Any remedy under the mediation shall be sole province of the Mediator unless the Recipient and Trustee agree otherwise. In no event shall a Recipient be entitled to any other remedy; including, but not 13 limited to, actual damages, compensatory damages, punitive damages, exemplary damages, interest, costs of court, actual expenses and attorneys' fees. These procedures shall be binding on Recipients notwithstanding any conflict with any law or regulation. XXVI. PERIOD OF CONTRACT This Contract will remain in effect until the termination of the CONTRACT PERIOD as defined above, unless extended, modified, or terminated by written agreement of the Parties or terminated as provided herein with the exception of the five-year records retention provision in Section V. This provision shall survive termination of this Contract. END OF TERMS AND CONDITIONS 14 Matagorda Bay Mitigation Trust ("Trust") ATTACHMENT A STATEMENT OF MITIGATION PROJECT* Calhoun County, Texas ("Recipient") 211 S. Ann Street Port Lavaca, Texas 77979 Little Chocolate Bayou Park Restrooms Calhoun County seeks to repair the public restrooms (built in the early 1980's) at Little Chocolate Bayou Park. The County has received funding for improvements from the Texas General Land Office, but the funds will not cover the necessary demolition and restoration of the park's restrooms. The restrooms' current condition poses a danger of contamination to Little Chocolate Bayou and limits accessibility to visitors with physical disabilities. Addressing this issue will enable visitors to continue enjoying the park's amenities while protecting the waterbodies and ecosystems within and downstream of the park's restrooms. The goals and objectives of the proposed project: 1. Providing adequate restrooms for the public, advocacy groups, and schools to use during visits to the park. 2. Prevent contamination from the restrooms into the bodies of water in or around the park. 3. Provide another amenity to attract more visitors. Permits: We will ensure that any permits are obtained in a timely manner and as required. This project site was previously reviewed through a federal environmental review as part of the GLO funding received for the park. Task 1: Pre -Construction Deliverables: 4. Meetings 5. Pre -construction surveying Task 2: Prepare Final Design and Bidding Documents Deliverables: a) Final design b) Bidding phase Task 3: Contractor Award and Project Construction Deliverables: a) Construction contract b) Begin construction c) As-builts d) Project Closeout Report 15 Budget: Demolition - $ 7,800.00 Electrical - $ 8,900.00 Plumbing- $ 1,150.00 Pre -Fab Restroom Building- $217,076.00 Concrete - $ 15,000.00 Total - $249,926.00 16 Matagorda Bay Mitigation Trust ("Trust") ATTACHMENT B BUDGET* Calhoun County ("Recipient') 211 S. Ann Street Port Lavaca, Texas 77979 Contract Budget Construction $ 249,926.00 Total Contract Budget $249,296.00 RECIPIENT WILL SUBMIT INVOICES TO TRUST (mark appropriate option): OR X Monthly Quarterly 17 Matagorda Bay Mitigation Trust ("Trust") ATTACHMENT C INVOICING INSTRUCTIONS Below are the instructions on how to complete and submit your invoice. All invoices must be submitted electronically. You do not need to submit a hard copy unless specifically requested to do so. Invoices that don't balance or that lack proper supporting documentation will be delayed, so please ensure that your invoice is in order prior to submission. The Recipient's Contract includes the budget and invoice form (Attachment C). The Contract's budget is tracked in two ways: Budget by Contract Category and Budget by Task. Each invoice submitted for payment must track the project costs in compliance with the Recipient's Contract as outlined in Attachment C. Each field at the top and bottom of the Invoice form must be completed and the invoice must be signed and dated by the person authorize to certify that the invoice is true, correct and complete and in accordance with the Contract. Each invoice should have the amounts being billed for the current billing period ("This Invoice" columns) and the accumulated amount billed for this Contract to -date, including the current billing period ("Contract To -Date" columns). Please take special note that the two budgets — Budget by Contract Category and Budget by Task — must always equal. Supporting documentation must be attached to the invoice for each line item being billed in the sequence such items appear in the Budget by Contract Category section. Each supporting document must be clearly labeled and in the proper budget sequence in order allow our audit of the invoice and its approval for payment. Failure to properly label or sequence the supporting documentation will cause a rejection of the invoice, so this is very important. All invoices are to be submitted electronically (email) to: Trustee@mbmTrust.com. If a Recipient has any questions whatsoever about invoicing procedures, please feel free to contact the Trust office at 361-200-1456 or write to Administrator@mbmTrust.com. Effective Date: June 1, 2020 im Invoice to Matagorda Bay Mitigation Trust Date of Invoice: Recipient Name: Calhoun County - Billing Period This Invoice: Contract N: 077 From To Contract Amount: $ 249,926.00 Invoice Amount: $ Payment Request No: - Is this a final payment application? Y N INVOICE RECAP* BUDGET BY CONTRACT CATEGORY BUDGET BY TASK Category This Invoice Contract To -Date Total Budget Task This Invoice Contract To -Date Total I Budget Construction 249,926.00 N/A 0.00 Total 249,926.00 -Please see invoicing instructions Total N/A Remittance Address: 202 S. Ann Street, Suite A, Port Lavaca, Texas 77979 Name of Payment Contact Person and contact. information: Commissioner David Hall Certification: I certify that the amounts being invoiced are true, correct, and complete in every material respect. Signature and Title of Authorized Representative. Date Signed - For Office Use Only Print Name and Title of Authorized Representative CERTIFICATE OF INTERESTED PARTIES 1295 FORM lotl Complete Nos. 1 .4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 2, 3, 5, and 5 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2025-1259152 Matagorda Bay Mitigation Trust Poth,:TX United States Date Piled: 01/2112025 2 Name of governmental entity or state agency that Is a party tot the contract for WhIcR the form is being filed. Calhoun County Date AcknooRwl dged�: U (b li 3 Provide the identification number used by the governmental entity or state agency to track or identify the c mract, and provide a description of the services, goads, or other property 'to -be provided under the contract. Little Chocolate Bayou Park Little Chocolate Bayou Park Restrooms A : Nature of interest Name of Interested Party City, State, Country (place of business) (check applicable) Controlling I Intermediary Raabe, Steven Poth, TX United States X Aguirre, Robert Pipe Creek, TX United States X Wood Boykin Wolters. Corpus Chi lsti, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION St t'l✓G�� et be, My name is `� 6C and my date of birth is �/ My address is POLr ir' 1..�� t%.'1• � '� � / 14 S 4 :(street) (city) (state) :(zip code) (country) declare under penalty of perjury that the foregoing is true and correct. Executed in w ' so °^ County. State of �i`-G-�, on the 1' day of20 25. .(month) (year) Signatureqf4tuthorized agent of contracting business entity - .(Declarant) I-orms provided by I exas Ethics commission vwm.etncs.state.tx.us Version V4.1.D.SDULaOeL # 20 ' NOTICE OF MEETING 1J29/2025 20. Consider and take necessary action to approve attached surplus salvage for 2016 Bomag BW138D Serial Number 101650341034 to be used for trade for purchase of 2019 Bomag BW211ZD serial number 101586081540 and approve all appropriate signatures. (DEH) RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct SECONDER: ` Joel Behrens, Commissioner Pct 3 AYES: Judge Lyssy,'Commissioner Hall, Best, Behrens, Reese Page 17 of 20 David E. Hall Calhoun County Commissioner, Precinct #1 202 S. Ann Port Lavaca, TX 77979 Honorable Vern Lyssy Calhoun County Judge 211 S. Ann Port Lavaca, TX 77979 RE: AGENDA ITEM Dear Judge Lyssy, (361)552-9242 Fax(361)553-8734 Please place the following item on the Commissioners' Court Agenda for January 29th, 2025. Consider and take necessary action to approve attached surplus salvage for 2016 Bomag BW138D Serial Number 101650341034 to be used for trade for purchase of 2019 Bomag BW211ZD serial number 101586081540 and approve all appropriate signatures Sqerel , David E. Hall DEH/apt Calhoun County, Texas SURPLUS/SALVAGE DECLARATION REQUEST FORM Department Name: RB1-540 Requested By: Commissioner David Hall Inventory Number 21-0263 Description 2016 Bomag tandem roller Serial No. 101650341034 Reason for Surplus/Salvage Declaration for trade a , PRICING QUOTE -SHEET FOR STANDARD Board EQUIPMENT PURCHASES ANDERSON b ,J The following detlpls shall be provided with any BuyBaod purchase order (Email Ober to joshCo:amrotx.rom) Prepared By: Joshua Smith BuyBoard Vendor: Anderson Machinery Company Vendor Phone: 230-561-2366 [Address P.O. to:] PO BOX 200380 Vendor Fax: 210-661-4971 San Antonio TX 78220 Vendor Toll Free Date Prepared 1/15/2025 Government Agenry: Calhoun Cc Pot Gov.Agenry Calhoun Co Pct2 [Ship to:] Anderson Machinery -Victoria [Bill to:] Calhoun Co PCt2 5309USHwy59N Victoria TX77905 20250uthAnn St Pon UWMU77979 Contacts Name: Gov. Agn. Phone No: - G. A. Fax No: Product Description: One (2) USED 2029 Somag BW213D, B4" Single Drum Roller, SN: 101586081540, w/ approx 3,380 his I: Bu7Bcard Contract 0685.22, Effective till Nov. 30th 2025 Price List: USED Base Price $ 82,087.91 II: Base Bid Options: (Itemize Below) • Canopy Included • And all standard equipment Included r s ♦ s ♦ r + r ♦ Subtotal $ Subtotal $ Contract List Price Total $ Ili: Subtotal of l+11 => $ 82,087.91 IV: Discount: 2% BuyBoard Contract Price: $ 80,446.15 V: Non -Base Options (Itemim below) NON -BASE = 0.00% % • FOB AMCO Victoria Subtotal $ Subtotal $ VI Unpublished Options added to Contract Price (Subtotal of Co.1 & Col 2) $ VR: Total of IV+VI $ 80,446.25 VIII: Quantity Ordered Units: 1 X "E" $ 80,446.25 IX: Trade-in or other Credit(s) One (2) Used 2016 Somag BW138AD, SN: 101650341034 w/ 452 hrs $ (20,000.00) x: TOTAL PURCHASE PRICE INCLUDING VIII +IX $ 60,446.15 • Warranty Terms: NO WARRANTY, UNIT SOLD AS IS " Quote Good Till: 2/15/2025 " Availability: Currently available, subject to change #21 NOTICE OF MEETING,-1/29/2025 21. Consider and take necessary action on any necessary 2024 budget adjustments. (VLL) RESULT: APPROVED [UNANIMOUS] MOVER: Gary Reese, Commissioner Pct 4 SECONDER: Joel Behrens, Commissioner Pct 3 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Page 18 of 20 z 3 m m z A� O 3 c z a O z v C N_ O z a m a 3 m z I z C) N N m O A W C 0 z a mm z 0 m 0 1 a r 0 0 w N W O N O -i m co � z a O a m z O a zz l m a z n m O O O � o > co) )c n v or im i 0 0 mm D e� ZLe m X v m z m J f00 ) O D i -ZI � z i c z �i m r r Z n m m m a r c O .4 H u J Ol O N N R A CD woes O N M (D W. y N 0 O W N O O O O N p <c Kfnn mzycA = T n -0 m 00-1,o-:E m m m m Cl) Zmps DZ z Z z a M� m� M m z M m z n O 3 C z a 0 z da�q ffl O W O to fA fA fA fA T O O O O O O 0 0 0 0 0 0 A _ T p O O Ov 01 O N O O O O O I n m m m n r c 0 F l�J O 0 &§ V 0 � k \ # I i§§ § | § ,c z ! » . \; }\M Z § / < /� ; m R ■ ; |§§ § ' | ;§ e . )2 4 ;5� � ■ # I a I d§§ §| SA■ § § \m /\ m.� )°- @| ® § § m ■ � ; §■ §' | 6 2 k k � A O A a Q c C N y 0 m 0 0 m m 0 Z 0 N 0 a r O,OI O A 0 '<_ m � z m Z n m m a am�oz 0 ozz 300 �zz � a i a 3 a' m! z z Mal 3 a; m �! z x 3! m! m z! y -I! 0 z 3 o m; c v n m m m n c z 0 k 0 0 # 22 NOTICE OF MEETING—1/29/2025 22. Consider and take necessary action on any necessary 2025 budget adjustments. (VLL) No action taken Page 19 of 20 # 23 NOTICE OF MFETINC, —1/29/2025 23. ADDroval of bills and oavroll. (VLL) MMC Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER:. Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Indigent Health Care:' RESULT: APPROVED'[UNANIMOUS] MOVER: David Hall, Commissioner Pct SECONDER: Gary Reese, Commissioner Pct 4 AYES: Judge Lyssy, Commissioner Hall, Best,; Behrens, Reese 2024 County Bills: RESULT: APPROVED [UNANIMOUS] MOVER: David Hall, Commissioner Pct 1 SECONDER: Gary Reese, Commissioner Pct 4 AYES:Judge Lyssy, Commissioner Hall, Best, Behrens,' Reese 2025 County Bills: RESULT: APPROVED" [UNANIMOUS]' MOVER: David Hall, Commissioner Pct' 1 SECONDER: Gary,Reese, Commissioner Pct4 AYES: Judge Lyssy, Commissioner Hall, Best, Behrens, Reese Adjourned 10:43am Page 20 of 20 b ia b9 b9 Vi fA fA 69 A A O O 00 00 01 � b 0 e N O W N o 0 0�0 N MEMORIAL MEDICAL CENTER COMMISSIONER$ GbURT'APPROYALLIST•FOR=-.lanuarv-29'2025 INDIGENT HEALTHCARE FUND: INDIGENT EXPENSES SUBTOTAL Memorial Medical Center (indigent Healthcare Payroll and Expenses) Co -pays adjustments for December 2024 Reimbursement from Medicaid ur by:CT 0.00 4,166.67 Subtotal 4,166.67 0.1i0 0.00 COUNTY, TEXAS DATE: CC Indigent Health Care VENDOR # 852 ACCOUNT NUMBER DESCRIPTION OF GOODS OR SERVICES QUANTITY UNIT PRIC TOTAL PRICE 1000-800-98722-999 Transfer to pay bills for Indigent Health Care $4,166.67 approved by CommisSiniiers Covzt'ion O1/29.J2025 1000-001-46010 DeoembeT 31. 20247nteresi ($8.69) $4,157.98 COUNTY AUDITOR APPROVAL ONLY THE ITEMS OR SERVICES SHOWN ABOVE ARE NEEDED IN THE DISCHARGE OF MY OFFICIAL DUTIES AND I CERTIFY THAT FUNDS ARE AVAILABLE TO PAY THIS OBLIGATION. CERTIFY THAT THE ABOVE ITEMS OR SERVICES WERE RECEIVED SY ME IN GOOD COND TION AND REQUEST THE COUNTY TREASURER TO PAY THE AHO OB IGATIO . BY: 1/29/2025 JAN 2 9 2025^� G ggyY ccppuu��77�yy qq�� 77��pq CALH0%?? OUNTI') %S DEPARTMENT HEAD DATE °IHS Source Totals Report Issued 01/23/25 Calhoun Indigent Health Care Batch Dates 01/01/2025through 01/01/2025 For Source Group Indigent Health Care For Vendor: All Vendors Source Description Amount Billed Amount Paid Expenditures 0.00 0.00 Reimb/Adjustments Grand Total NO INVOICES FODND FOR THIS TIME FRAME! Expenses 4,166.67 Co -Pays < 0.00> 4,166.67 APPROVED ON JCApN,NN2 8 2025 CAM CpU, is °I"s Source Totals Report Issued 01/27/25 Calhoun Indigent Health Care Batch Dates 02/01/2024 through 01/01/2025 For Vendor., All Vendors Source Description Amount Billed Amount Paid 02 Prescription Drugs 120.90 107.25 08 Rural Health Clinics 240.00 240.00 14 Mmc - Hospital Outpatient 7,033.00 3,643.32 Expenditures 7,418.78 4,015.45 Reimb/Adjustments _24.88 _24 88 Grand Total 7,393.90 3,990.57 Expenses 50,000.04 Co -Pays a 20.00> 53,970.61 Bill To: Calhoun County SIS N. Virginia St, Pon Lavaca, Texas 77979 (361) 552-6713 Date: 1/20/2024 Invoice # 403 For: Dec-24 DEBCiIPTI AM6UNT s Funds to cover Indigent program operating expenses. $ 4,166.67 APPROVED ON gy JANuN2 8 2025 CAROUoN CO AB Total S 4,166.67 Michelle Cumberland Controller Cristina Tuaon From: mesmiante@mmcportlavaca.com (Monica Escalante) <mescalante@mmcportlavaca.com> sent: Monday, January 27, 2025 4:54 PM To: Cristina Tuazon Subject: FW: December Indigent Report Attachments. Active.Client.List.pdf, COUNTY INDIGENT CASELOAD 2024.x1sx: Source.Totals_ YTD.pdf, December Source Totals.pdf Hi, I just realized I should have attached our expense amount at least since there were no claims to process I'm also attaching the usual YTD Report. Thanks, Monica From: Monica Escalante Sent: Friday, January 10, 2025 9:57 AM To: 'Cristina Tuazon' <Cristina.Tuazon@calhouncotx.org> Subject: December Indigent Report Good morning! Hope you're staying warm! 1 just wanted to let you know that I do not have any outstanding claims to process for Indigent Care for this report month. At this time I only have one Indigent Client Active on the Program. I have attached the Client Active list as well as the Caseload totals. Please let me know if there is anything else you need. Have a great weekendl Thanks, 1071-1VC1 I1 ejoaaGmcI Pi CIHCP Coordinator Memorial Medical Center 815 N. Virginia St. Port Lavaca, TX 77979 0: 361-552-0340 F: 361-552-0338 tmesca law+ea'>wl!mcpDrtic!ygca.covl� Calhoun County Indigent Care Patient Caseload 2024 Approved Denied Removed Active Pending January 0 3 2 1 7 February 0 3 0 1 5 March 0 4 0 1 4 April 1 0 0 2 0 May 1 6 0 3 0 June 0 1 0 3 2 July 0 1 1 2 2 August 0 0 0 3 2 September 0 2 0 3 2 October 0 0 1 2 4 November 0 1 1 1 3 December 0 5 0 1 1 26 5 23 32 Monthly Avg 0 2 0 2 3 December 2023 Active 4 Number of Charity patients 219 Number of Charity patients below 50% FPL 113 Number of Charity patients who meet State Indigent Guidelines 103 Calhoun County Pharmacy Assistance Patient Caseload 2024 Approved Refills Removed Active January 6 18 0 7 February 0 0 0 10 March 3 9 0 17 April 5 15 0 20 May 5 15 0 22 June 1 3 0 26 July 2 6 0 28 August 1 3 0 29 September 0 3 0 30 October 1 3 0 32 November 7 23 0 35 December 5 16 0 38 Value $0.00 $8,345.67 $8,332.53 $13,588.44 $3,567.00 $2,872.47 $1,706.64 $5,169.00 $936.69 $14,419.44 $17,327.25 YTD PATIENT SAVINGS $85,927.28 Monthly Avg 3 10 25 $7,160.61 December 2023 Active 36 V16 r r PROSPERITY BANK Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13163 12/31/2024 """"4551 Page 1 of 2 12/01/2024 Beginning Balance $9,673.17 1 Deposits/Other Credits + $8.69 2 Checks/Other Debits $4,179.05 12/31/2024 Ending Balance 31 Days in Statement Period $5,502.81 Total Enclosures 2 DEPOSITS/OTHER CREDITS 12/31/2024 Accr Earning Pymt lidded to �l E Fk -kA Check Number Date Amount Check Number Date Amount 12652 12.11 $4,166.67 12653 12.11 $12.38 ov. -`d��7n"s'tr �'ir 13V.�UlaOat DAILY ENDING BALANCE Date Balance Date Balance Date Balance 12.01 $9,673.17 12-11 $5,494.12 12-31 $5,502.81 EARNINGS SUMMARY '• Below Is an itemization of the Earnings paid this period. " Interest Paid This Period $8.69 Annual Percentage Yield Earned 1.51 % Interest Paid YTD $127.26 Days in Earnings Period 31 Earnings Balance $6,842.20 MEMBER FDIC fay �ewI oca NYSE Symbol "PB" v*, PROSPERITY BANK? Statement Date Account No THE COUNTY OF CALHOUN TEXAS CAL CO INDIGENT HEALTHCARE 202 S ANN ST STE A PORT LAVACA TX 77979 13092 11/30/2024 "4551 Page 1 of 2 11/01/2024 Beginning Balance $5,506.52 3 Deposits/Other Credits + $8,376.16 2 Checks/Other Debits - $4,209.51 11 /3012024 Ending Balance 30 Days in Statement Period $9,673.17 Total Enclosures 4 . •OCREDITS Date Descriot3on Amount 11/14/2024 Deposit $4,199.99 -SQ0 11/27/2024 Deposit $4,167.34 OC'r 11/30/2024 Accr Earning Pymt Added to Account $8.83 Sc�2 yt CHECKS L Check Number Date Amount Check Number Date Amount 33 12650 11-22 $4,166.67 12651 11-22 $42.84 DAILY ENDING BALANCE Date Balance Date Batance. Date Balance 11-01. $5,506.52 11-22 $5,497.00 11-30 $9,673.17 11-14 $9,706.51 11-27 $9,604.34 o� A� EARNINGS SUMMARY g M Below is an itemization of the Earnings paid this period. g= Interest Paid This Period $8,83 Annual Percentage Yield Earned 1.51 % Interest Paid YTD - $118.57 Days in Earnings Period 30 Earnings Balance $7,179.31 MEMBER FDIC NYSE Symbol'PB" ... I.R NOGR MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR ---January 29, 2025 TOTALS TO BE APPROVED -TRANSFERRED FROM ATTACHED PAGES TUTAL.PAVABLES EAYROLLAN6ELECfRONIC BANK PAYMENTS: _ $ 910l246d1 TOTALTRANSFERSf6ETUVEEN FUND5$ 1�019y112:3'6' TOTAL ,,NURSIN, HOME.U,P,LEX0,E0$F5 TOTAI:;INTER CiOVERNNII:NT�TRAN5FER6 _..... _..... _. $, _.- GItA-tl,DTOTAL'DISBUBSEMeNTSAPP,ROVEDJa11u2ty 29; 2026 $2,815519:93- MEMORIAL MEDICAL CENTER COMMISSIONERS COURT APPROVAL LIST FOR --January 29, 2025 PAYABLES AND PAYROLL 1/23/2025 Weekly Payables 343,746.26 1/27/2025 McKesson-34011 Prescription Expense 3,682.08 1/27/2025 McKesson-3406 Prescription Expense 4,621.67 1/27/2025 Amerisource. Bergen-34011 Prescription Expense 1,914.25 2/27/2025 Amerisource 13ergen-3408 Prescription Expense 2,219.25 1/27/2025 Amerisource. Bergen-340B Prescription Expense 279.38 1/27/2025 Amersource Bergen-34013 Prescription Expense 2,740.20 1/27/2025 Payroll Liabilities -Payroll Taxes 134,049A6 1/27/2025 Payroll 414,887.85 Prosperity Electronic Bank Payments 1/27/2025 Expert Pay -Child Support 570.69 2/27/2025 Pay Plus -Patient Claims Processing Fee 456.56 1/27/2025 Zelis 1.48 1/27/2025 Health Equity -HSA Contributions 1,077.00 TOTAL'�AVABLEs`^:P.%lyROyL}ANt1ELEGTftONIGeAiVICPAtMENfS $ 91pj46,21;: TRANSFERS BETWEEN FUNDS-MMC 1/27/2025 Transfer from Prosperity Money Market to Operating Account 1,000,000.00 TRANSFER BETWEEN FUNDS FROM MMC TO NURSING HOMES 1/23/2025 MMC Operating to Broadmoor-Correction of insurance payment deposited into MMC Operating in error 1,241.02 1/23/2025 MMC Operating to The Crescent -Correction of insurance payment deposited into MMC Operating in error 2,400.00 1/23/2025 MMC Operating to Golden Creek Healthcare -Correction of insurance payment deposited into MMC Operating in error 2,457.39 1/23/2025 MMC Operating to Tuscany Village -Correction of insurance payment deposited into MMC operating in error 13,013.95 'OT/iLT�tANSF,RS'.Tjf,�Nifl1N;UY _ $ NURSING HOME UPL EXPENSES 1/2712025 Nursing Home UPL-Cantex Transfer 181,325.79 1/27/2025 Nursing Home UPL-Nexion Transfer 211,956.27 1/27/2025 Nursing Home UPL-HMG Transfer 2,572.32 1/27/2025 Nursing Home UPL-Tuscany Transfer 482,779.97 TRANSFER OF FUNDS BETWEEN NURSING HOMES 1/27/20255olers to Tuscany Tuscany insurance paymentdeposlted Into Solera in error 1,602.81 1/27/2025 Crescent to Tuscany -Tuscany insurance payment deposited into Crescent in error 5,924.30 TOTA4,iNlIRSING�H.4.M€fUP3gftp,EN5faS,-,....... XOTALIN'CfRGiii�Weli�fENY'�i3AFjst?€R$ '$ _ GR{1l�ji�YdTALd15BUItSEtrAENti5Y7�PPIt�VE�lanua 29,-30,25, � - $ 28'T5ja_1$93 RECEIVED BY THE COUNTY AUDITOR ON JAN 2 3 2025 MEMORIAL MEDICAL CENTER 01/23/2025 0 Y2:22 AP Open Invoice List ap_open_invoice.template CALHOUN COUNTY, TEXAS Due Dates Through: 02/06/2025 Vendor# Vendor Name Class Pay Code A1680 AIRGAS USA, LLC-CENTRAL DIV M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 5513390269 011231202 01/30/202 02/011202 - 885.23 0.00 0.00 585.23 , r' Vendor Totals: Number Name Gross Discount No -Pay Net A1680 AIRGAS USA, LLC - CENTRAL DIV 685.23 0.00 0.00 585.23 Vendor# Vendor Name Class Pay Code 14028 ( AMAZON CAPITAL SERVICES invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 1GG7JCHRQFJC 01/081202 01/06/202 01/31/202 608.73 0.00 0.00 608.73 Vendor Totals: Number Name Gross Discount No -Pay Net 14028 AMAZON CAPITAL SERVICES 608.73 0.00 0.00 608.73 Vendor# Vendor Name Class Pay Cade 16052 Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net CALANN0001 01120120201/10120202/06/202 15.00 0,00 0.00 15.00 Vendor Totals: Number Name Gross Discount No -Pay Net 16052 15.00 0.00 0.00 15.00 Vendor# Vendor Name Class Pay Cade 12800 AUTHORITYRX, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 7000076507 01120/202 011031202 02/061202 6,592.11 0,00 0.00 6,592.11 Venclor Totals: Number Name Gross Discount No -Pay Net 12800 AUTHORITYRX, LLC 6,592.11 0.00 0100 6,592.11 Vendor# ' Vendor Name Class Pay Code B11504 BAXTER HEALTHCARE W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay, Net 83365835 01/23/20201/02/20201/271202 3.071.40 0.00 0.00 3,071 A0 - 83364321 01/23120201102120201127/202 631.20 0.00 0.00 631.20 Vendor Totals: Number Name Gross Discount No -Pay Net B1150 BAXTER HEALTHCARE 3,702.60 0.00 0.00 3,702.60 Vendor# Vendor Name Class Pay Code 81220 BECKMAN COULTER INC M Invoice# Comment Tran Dt Inv 01 Due Dt Check Dt Pay .Gross Discount No -Pay Net 111783449. 12131/20201/08Yt0202102/202 3,283.38 0.00 0.00 3,283.38 111779311 011011202 01106/202 01/311202 180.26 0.00 0.00 180.26 111778556 011081202 01/05/202 011301202 64.39 0.00 0.00 64.39 -. 111785422 01115120201/08120202/02/202 174,54 0.00 0.00 174.54 111795431 01/20120201/13/20202106/202 5,016.58 0.00 0.00 5,016.58 .r 111780308A 0IM120201I07/20202101/202 5.759.11 0.00 0.00 5,759.11 . Vendor Totals: Number Name Gross Discount No -Pay. .Net 81220 BECKMAN COULTER INC 14,478.26 0.00 0.00 14,478.26 Ventlor# Vendor Name Class Pay Code B1320 - BEEKLEY CORPORATION M Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net MIN0173170 01/15/20201/01/20201/01/202 597.00 0.00 0.00 597.00 Vendor Totals: Number Name Gross Discount No -Pay Nei B1320 BEEKLEY CORPORATION 597.00 OAO 0.00 597.00 Vendor# Vendor Name. Class Pay Code 13972 BEYER MECHANICAL LTD Involce# Comment Tran Dt Inv Ot Due 0t Check Dt Pay Gross Discount No -Pay Net ,. IN046117 01/20/20201/17/20202/061202 1,940.50 0.00 0.00 1.940.50 Vendor Totals: Number Name Gross Discount No -Pay Net 13972 BEYER MECHANICAL LTD 1,940.50 0.00 0.00 1.940.50 Vendor# Vendor Name Class Pay Code 16096 Invoice# Comment Tran. Dt Inv Dt Due Dt Check Dt Pay Gress Discount No -Pay Net MCNB0B0001 01/20120201/10120202t06/202 14.00 0.00 0.00 14.00 Vendor Totals: Number Name Gross Discount No -Pay Net 16096 14.00 0.00 0.00 14.00 Ventlor#- Vendor Name Class Pay Code 16148�� Invoice# Comment TranDt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net FALBRY0001 01/20/20201/10/20202/06/202 19.11 0.00 0.00 19.11 Vendor Totals: Number Name Gross Discount No -Pay Net 16148 19.11 0.00 0.00 19.11 Vendor# Vendor Name Class Pay Code 14260 CAREFUSION SOLUTIONS, LLC Invoice# Comment Tran DI Inv Dt Due Dt Check 01 Pay Gross Discount No -Pay Net 10024342180 01123120201/OB/20201/=02 2.00 0.00 0.00 2.00 10024342172 01/23/20201/08/202011231202 1,788.00 0.00 0.00 1.788.00 Vendor Totals: Number Name Gross Discount No -Pay Net 14260 CAREFUSION SOLUTIONS, LLC 1,790.00 0.00 0.00 1,790,00 Vendor# Vendor Name Class Pay Code 16112 Involce# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net ROBCAR0004 01/20/20201/10/20202/06/202 40.00 0.00 0.00 40.00 Vendor Totals: Number Name Gross Discount No,Pay Net 16112 40.00 0.00 0.00 40.00 Vendor# -Vendor Name Class Pay Cade 16060 "- Invoice# Comment Tran Dt Inv DI Due Ot Check Dt Pay Gross Discount No -Pay Not COBCAT000/ 01/20/20201/10120202/061202 120.00 0.00 0.00 120.00 Vendor Totals: Number Name Gross Discount No -Pay Net 16060 120,00 0.00 0.00 120.00 Ventlor# ;'Vendor Name Class Pay Code C1992 CDW GOVERNMENT, INC. M Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net AC1 S13U 011081202 12126/202 01/251202 1,011.67 0.00 D.00 1,011.67 Vendor Totals: Number Name Gross Discount No -Pay Net C1992 CDW GOVERNMENT, INC. 1,011,67 0.00 0.00 1,011.67 Vendor#, Vendor Name Class Pay Code 12768- CHEMAQUA Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 8992451 01/23/20201/10/20201/20/202 593.69 0.00 0.00 593.69 Vendor Totals: Number Name Gross Discount No -Pay Net 12768 CHEMAQUA 593,69 0.00 0.00 59169 Vendor# ;Vendor Name Class Pay Coda C1166 -. COASTAL OFFICE SOLUTONS W Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net IN6758 01/23/20201/20120201/301202 8.536.96 0100 0.00 8,536.96 Vendor Totals: Number Name Gross Discount No -Pay Net 01166 COASTAL OFFICE SOLUTONS 8.535.96 0.00 0.00 81535.06 Vendor# Vendor Name Class Pay Code 13336 -. COCA COLA SOUTHWEST BEVERAGES Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net .� 45056519013 12/31/20201108/20202/06/202 557.47 0.00 0.00 557,47 Vendor Totals: Number Name Gross Discount No -Pay Net 13336 COCA COLA SOUTHWEST BEVERAGES 557,47 0.00 0.00 557.47 Vendor# . Vendor Name Class Pay Code 15110 COMPUGROUP MEDICAL -EMDS INC. Invoice# Comment Tran Ot Inv Dt Due Ot Check Ot Pay Gross Discount No -Pay Net ' 9090094408 011201202 01/16/202 021061202 5.332.46 0.00 0.00 5,332.46. Vendor Totals: Number Name Gross Discount No -Pay Net 15116 COMPUGROUP MEDICAL - EMDS INC. 5,332,46 0.00 0.00 6,332.46 Vendor#- Vendor Name Class Pay Code 16068. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net FLODAN0002 OMO/202 01/101202 02106=2 11.00 DAO 0A0 11,00 Vendor Totals: Number Name Gross Discount No -Pay Net 16066 11.00 0.00 0.00 11.00 Vendor#� Vendor Name Class Pay Code 16100, Invoice# Comment Tran Dt Inv Dt Due Dt Check Di Pay Gross Discount No -Pay Net KOLDAR0003 01/20120201/10120202/06/202 15.00 0.00 0.00 15,00 Vendor Totals: Number Name Gross Discount No -Pay Net 16100 15.00 0.00 0.00 15.00 Vendor# Vendor Name Class Pay Cade 16072- Invoice# Comment Tran Ot Inv Dt. Due DI Check Dt Pay Gross Discount No -Pay Net FIU13DER000I 011201202 011101202 00061202 11.49 0.00 0.00 11.49 Vendor Totals: Number Name Gross Discount No -Pay Net 16072 11,49 0.00 0.00 11.49 Vendor# li Vendor Name Class Pay Code 10368 DEWITT POTH $ SON Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 7794910 01122/202 01/061202 011311202 607.22 0.00 0.00 607.22 Vendor Totals: Number Name Grass Discount No -Pay Net 1D368 DEWITT POTH B. SON 607.22 UD 0.00 607.22 Vendor#., Vendor Name Class Pay Code 14800 DIRECTV ENTERTAINMENT HOLDINGS Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 250112 01/23/20201/30120201/23/202 489.85 0.00 0.00 489.85 Vendor Totals: Number Name Gross Discount No -Pay Not 14800 DIRECTV ENTERTAINMENT HOLDINGS 489.85 0.00 0.00 4B9.85 Vendor# Vendor Name Class Pay Code 10789 :., DISCOVERY MEDICAL NETWORK INC Invoice# Comment Tran Dt Inv DI Due Dt Check DI Pay Grass Discount No -Pay Net MMC011626 01/20/2020//15/20202/06/202 60,455.52 0.00 0.00 60,455.62 Vendor Totals: Number Name Gross Discount No -Pay Net 10789 DISCOVERY MEDICAL NETWORK INC 80,455.52 0.00 0.00 80,455.52 Vendor#- Vendor Name Class Pay Code 14832-,, DR JOHN CLINTON Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net. 011324A c1/20/20201113/20202106/202 11500.00 0.00 0.00 1,500.00 . Vendor Totals: Number Name Gross Discount No -Pay Net 14832 DR JOHN CLINTON 1,500.00 0.00 0.00 1,500.00 Vendor# Vendor Name Class Pay Code 14924, DR. TIMU KWI Invoice#. Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net E 011324 01120/20201/13/2020PJ061202 1.600.00 0.00 0.00 t,5o0.00 Vendor Totals: Number Name Gross Discount No -Pay Net 14924 DR. TIMU KWI 1,500.00 0.00 0.00 11500.00 Vendor# 'Vendor Name Class Pay Code 15240 <S ECLINICAL WORKS LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check. Dt Pay Gross Discount No -Pay Nat 0003126186 12/31/202 011021202 02/01/202 468.95 0.00 0.00 468.95 Vendor Totals: Number Name Gross Discount No -Pay Net 15240 ECLINICAL WORKS LLC 468.95 0.00 0.00 468.95 Vendor# Vendor Name Class Pay Code 16092 -J:- fnvolce# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net GAMER10002 01 /20/202 01/101202 02106/202 13.73 0.00 0.00 13.73 Vendor Totals: Number Name Gross Discount No -Pay Net 16082 13.73 0.00 0.00 13.78 Vendor# " Vendor Name Class Pay Code 16116 , Invoice# Comment Tran of Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net HERFEL0003 01/20/20201/10/20202/06/202 25,00 0.00 0.00 25.00 Vendor Totals: Number Name Gross Discount No -Pay Net 16116 25.00 0,00 0.00 25.00 Vendor# l,Vendor Name class Pay Cade F1400- 'FISHER HEALTHCARE M Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount NmPay Net 7898732 12/17/202 01/03/202 02/02/202 7924111 01 /15/202 01 /06/202 01 /311202 7953051 01 /151202 01 /07/202 02/01 /202 i 7953050 01/15/202 011071202 02101/202 7986862 01/15/20201/08/20202/02/202 7986861 01/16/20201108/202 02/02/202 8054058 01115/202 01110/202 02104/202 7824042 01/22/20212JP7120201/21/202 6735491 01 /23/20211 /07/202121021202 I 6801308 01/23120211/11/20212/06/202 . 6801307 01/23120211/11/20212O61202 j 6838300 01/23/20211112/20212107/202 ' 6836299 - 01/23/20211/12/20212/07/202 6671970 01/23/20211113120212108/202 6871971 01/23/20211/13/20212/08/202 6939809 01/23/20211/15/20212110/202 .' 7007361 Of/23120211/19/20212/141202 7046905 01/23/20211120120212/15/202 7119290 01/23/20211/22/20212/17/202 7154082 01/23/20211125/2021PJ201202 1 7188715 01/231202 11126/202 12121/202 Vendor Totals: Number Name F1400 FISHER HEALTHCARE Vendor# Vendor Name Class Pay Code 11183 _ ' FRONTIER - Invoice# Comment Tran Dt Inv Dt Due Ot Check Of Pay 010225 01123120201/02/20201/23P202 Vendor Totals: Number Name 11183 FRONTIER Vendor#:Vendor Name Class Pay Code 11078 i FUSION MEDICAL STAFFING, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay ,INV787531 01/20/20201/11120202/06/202 314.74 0.00 0.00 314.74 1,763.00 0.00 0.00 1,763.00 5,179.52 0.00 0.00 5,179.62 748.75 0.00 0.00 748.75 681.44 0.00 0.00 681.44 3,490.10 0.00 0.00 3,490.10 82.99 0.00 0.00 82.99 , 308.34 0.00 0.00 308.34 70.24 0.00 0.00 70.24 5,646.92 0.00 0.00 5.646.92 1,248.36 0.00 0.00 1,248.36 10,878.72 0.00 0,00 10,878.72 -.. 21,96 0.00 0.00 21.96 258.90 0.00 0.00 258.90 584.86 0.00 0.00 584,86 .,• 465,87 0.00 0.00 465.87 198.48 0.00 0.00 198.48 f 185.83 0.00 0.00 185.83 117.96 0.00 0.00 117.96 1,248.36 0.00 0.00 1.248.36 1.653.95 0.00 0.00 1.653.05 Gross Discount No -Pay Net 35,149.29 0.00 0.00 $5,149.29 Gross Discount No -Pay Net. 1,263.01 0.00 0.00 11263.01 Gross Discount No -Pay Net 1,263,01 0.00 0.00 1,263.01 Grass Discount No -Pay Net 3,320.00 0.00 0.00 31320.00 Vendor Totals: Number Name Gross Discount No -Pay NGI 11078 FUSION MEDICAL STAFFING, LLD 3,320.00 0.00 0.00 3,320.00 Vendor# Vendor Name Class Pay Code 12404 ' GE PRECISION HEALTHCARE, LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Not 6002846119 12/31/20201101/20201131=2 61.67 0.00 0.00 61.67 6002846117 12/31/20201/01/20201/31/202 86.67 0.00 0.00 86,67 i 6002846430 01/14/20201/01/20201131/202 216.10 0.00 0.00 216.10 , i 6002846116A 01115/202 011011202 011311202 2,422.50 0.00 0.00 2,422.50 i 6002846121A 01/15/202 01/01/202 01/311202 5,665.03 0.00 0.00 5,665,83 ; 6002846116 01/20/20201/01/20202/06/202 3,588.58 0.00 0.00 3.588.56 Vendor Totals; Number Name Gross Discount No -Pay Net 12404 GE PRECISION HEALTHCARE, LLC 12.041.35 0.00 0.00 12,041.35 Vendor# Vendor Name. Class Pay Code 13456 .,; Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net WARGE00001 01120/20201/10/20202/061202 96.51 0.00 0.00 96.51 Vendor Totals: Number Name Gross Discount No -Pay Net 13456 96.51 0.00 0.00 96.51 Vendor# Vendor Name Class Pay Coda 10956-., GETINGE USA. SALES LLC Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 6992772603 01/08/20212/17/20212126/202 65.43 0.00 0.00 65.43 Vendor Totals: Number Name Gross Discount No -Pay Net 10956 GETINGE USA SALES LLC 65.43 0.00 0.00 65.43 Vendor# Vendor Name Class. Pay Code 16088 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net BRIGRA0001 011201202 011101202 02/06/202 13.51 0.00 0.00 13.51 Vendor Totals: Number Name Gross Discount No -Pay Net 16088 13.51 0.00 0:00 13.51 Vendor# 'Vendor Name Class Pay Code 16108 ''- Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net KINGRA0001 01120120201/10/20202/061202 32.30 0.00 0.00 32.30 Vendor Totals: Number Name Gross Discount No -Pay Net 16108 32.30 0.00 0,00 32.30 Vendor# Vendor Name Class Pay Code W1300 _ ! GRAINGER M Invoice# Comment Tran Dt Inv Dt Due Dt Check Of Pay Gross Discount No -Pay Net 9364707811 01/23/20201/08/20202/02/202 175.11 0.00 0.00 175.11 ' Vendor Totals: Number Name Gross Discount No -Pay Net W1300 GRAINGER 175.11 0.00 0100 175.11 Vendor#,Vendor Name Class Pay Code G1210 ,,_ GULF COAST PAPER COMPANY M Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 2603614 011221202 12117/202 01/161202 167.45 0.00 0.00 167.45 2606477 01/22/20212131120201/301202 908.48 0.00 0.00 908.46 „ 2608109 01 /22/202 01/07/202 02/06/2D2 46.29 0.00 0.00 46.29 ' Vendor Totals: Number Name Grass Discount No -Pay Net G1210 GULF COAST PAPER COMPANY 1,122,22 0.00 0.00 1,122.22 Vendor# Vendor Name Class Pay Code H0031. HEB CREDIT RECEIVABLES DEPT308 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Nei 122724 01116/202 121271202 02101/202 706.75 0.00 0.00 706.75 - Vendor Totals: Number Name Gross Discount No -Pay Net H0031 HEB CREDIT RECEIVABLES DEPT308 706.75 0.00 0.00 706.75 Vendrn# ' Vendor Name Class Pay Code 14916 -' HEWLETT-PACKARD Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay Gross Discount No•Pay Net 100000770016 01120/202 01/15/202 02106/202 573.53 0.00 0= 573.53 ' Vendor Totals: Number Name Gross Discount No -Pay Net 14916 HEWLETT-PACKARD 573.53 0.00 0.00 573.53 Vendor# 'Vendor Name Class Pay Code 10530 HUMANA Invoice# Comment Tran Ot Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net WESAND00D1 01120/202 01/131202 02/06/202 52.52 0.00 0.00 52.52 Vendor Totals; Number Name Gross Discount No -Pay Net 10630 HUMANA 52.52 0.00 0.00 52.52 Vendor# Vendor Name Class Pay Code 13876 I INQUISEEK, LLC Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net h INV0953 911201202 0 1 /1 W02 021061202 450.00 0.00 D,00 450.00 Vendor Totals: Number Name .Gross Discount No -Pay Net 13876 INQUISEEK, LLC 450.00 0.00 0.00 450,00 Vendor# Vendor Name Class Pay Code 16140 : Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net MARISM0001 01120/20201109/20202/06/202 40,00 0.00 0.00 40,00 Vendor Totals: Number Name Gross Discount No -Pay Net 16140 40.00 0.00. 0.00 40,00 Vendor#: Vendor Name Class Pay Code 11108 ITERSOURCE CORPORATION Invoice# Comment Tran Dt Inv Ot Due Dt Check Dt Pay Gross Discount No.Pay Net 711842 01/22/20212/17/20201122/202 9.357.82 0.00 0.00 9,357.82 Vendor Totals: Number Name Gross Discount No -Pay Net 11108 ITERSOURCE CORPORATION 9,357.82 0.00 0.00 9.357.82 Vendor# Vendor Name Class Pay Code 16056- 1 - Involce# Comment Tran Dt Inv Dt Due Ot Check Ot Pay Gross Discount No -Pay Net 1 ONEJEN0001 01/20/20201/10/20202/061202 15.00 0.00 D.00 15.00 Vendor Totals: Number Name 16066 Vendor# Vendor Name Class Pay Code W1372 JOHN B WRIGHT LLG Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay 011324 01/20/202 01/13/202 02106/202 Vendor Totals: Number Name W1372 JOHNS WRIGHT LLC Vendor' , Vendor Name Class Pay Code 16104 ` JOHN R: FALCON Invoice#. Comment Tran D1 Inv Dt Due Dt Check Dt Pay FALJOH0001 01 /20/P02 01/10/202 02/06/202 Vendor Totals: Number Name 16104 JOHN R. FALCON Vendor# 'Vendor Name Class Pay Code 16064_ Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay �. HOEKAT001 01/20120201/10120202106/202 H0EKAT001A 01/20/202 011101202 02/06/202 Vendor Totals: Number Name 16064 Vendor#t Vendor Name Class Pay Code 16124_.,}- Invoice# Comment Tran Dt Inv Ot Due Dt Check DI Pay TAKEL0002 011201202 01110/202 021061202 Vendor Totals: Number Name 16124 Vendor#:: Vendor Name Class Pay Cade 16044 Invoice* Comment Tran Dt Inv Dt Due Dt Check Dt Pay MCNKEN0001 01 /20/202 01 /131202 02/06/202 Vendor Totals: Number Name 16044 Vendor#,' Vendor Class Pay Code 11275.f Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay DANKYL0001 01/20/202 01/10/202021061202 Vendor Totals: Number Name 11275 Vendor# Vendor Name Class Pay Code 161132 _''i Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay DRELE00001 01/20/202 01 /091202 02/06/202 Vendor Totals: Number Name 16132 Vendor# Vendor Name Class Pay Code 16008 LOPEZ TREE SERVICE Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net 15.00 0.00 090 15.00 Gross Discount No -Pay, Net 4,600.00 0.00 0.00 4,600.00 Gross Discount No -Pay Net 4,500.00 0.00 0.00 4,500.00 Gross Discount No -Pay Net 55.84 0.00 0.00 55.84 Gross Discount No -Pay Net 55.84 0.00 0.00 55.84 Gross Discount No -Pay Net 10.00 0.00 0.00 10.00 10.00 0.00 0.00 10.00 . r Gross Discount No -Pay Net 20.00 0.00 0.00 20.00 Gross Discount No -Pay Net 13.48 0.00 0.00 13.48 Gross Discount No -Pay Net 13.48 0.00 0.00 13.48 Gross Discount No -Pay Net 73.34 0.00 0.00 73.34 Gross Discount No -Pay Net 73.34 0.00 0.00 73.34 Gross Discount No -Pay Net 19,11 0.00 0.00 19.11 Gross Discount No -Pay Net 19.11 0.00 0.00 19.11 Gross Discount No -Pay Net 40.00 0.00 0.00 40,00 Gross Discount No -Pay Net 40.00 0.00 0.00 40.00 Gross Discount No -Pay Net INVO794 011201202 01/161202 02/06/202 7,000.00 0100 0.00 7,000.00 Vendor Totals: Number Name Gross Discount No -Pay Net 16008 LOPEZ TREE SERVICE 7,000.00 0.00 0.00 7,000.00 Ventlor# � Vendor Name Class Pay Code L1640 LOWE'S BUSINESS ACCT/SYNCB W - Invoice# Comment Tram Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 010225 01/23/202011021202 o1/02/2o2 1,467.75 0.00 0.00 1,467,75 Vendor Totals: Number Name Gross Discount No -Pay Net L1640 LOWE'S BUSINESS ACCT/SYNCB 1,467.76 0.00 0.00 1,467.75 Ventlor#; Vendor Name Class Pay Code 15200...,. MANAGED CARE PARTNERS INC. Invoice# Comment Tram Dt Inv Ot Due Dt Check Dt Pay Gross Discount No -Pay Net 6622 01/201202.02/01120202/06/202 515.00 0.00 0,00 515100 FEB 2025 PROFESSIONAL FEES , Vendor Totals: Number Name Gross Discount No -Pay Net 15200 MANAGED CARE PARTNERS INC. 515.00 0.00 0100 515,00 Vendor# Vendor Name Class Pay Code M2178 j MCKESSON MEDICAL SURGICAL INC Invoice# Comment Tran Ot Inv 01 Due Dt Check Dt Pay Gross Discount No -Pay Net 23117238 Ot/15/20201103120201118/202 889.28 0.00 0.00 889.28 ,. 23163034 01/22(202 011131202 01128/202 394.94 0.00 0100 394.94 Vendor Totals: Number Name Gross Discount No -Pay Net M2178 MCKESSON.MEDICAL SURGICAL INC 1,284.22 0.00 D.00 1.284.22 Vendor# `Vendor Name Class Pay Cade 12588 MEDICAL TECHNOLOGY ASSOCIATES Invoice# Comment Tram Ot Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net INV255713 Ot/15/20212131/20201/25/202 1.071.68 0.00 0.00 1,071,66 Vendor Totals: Number Name Gross Discount No -Pay Net , 12588 MEDICAL TECHNOLOGY ASSOCIATES 1,071.66 0.00 0.00 1,071.06 Vendor# Vendor Name Class Pay Code M2470MEDLINE INDUSTRIES INC M Invoice# Comment Tram Dt Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net 2352013082 01/15/202 01/08/202 02/02/202 270.35 0.00 0.00 270.35 ,r 2352013085 01/15/20201/08120202(02(202 11873.06 0.00 0.00 1,873.06 2352D13084 01/151202 01/08/202 02102/202 68.69 0.00 0.00 68.69 2352013087 01/15120201/081202021021202 57,78 0.00 0= 57.78 2352013083 01/15/20201/08/2D202102/202 179.38 0.00 0.00 179.38 - 2352200242 (11/15120201/09/20202(03/202 15.123.76 0.00 0100 15,123.76 ' 2360248798 01116/20201/15/20202/05/202 638.46 0.00 0.00 638.46 Vendor Totals: Number Name Gross Discount No -Pay Net M2470 MEDLINE INDUSTRIES INC 18,211.47 0.00 0.00 18,211.47 Ventlor#; Vendor Name Class Pay. Code 10536•. MORRIS & DICKSON CO, LLC Invoice# Comment Tram 01 Inv Dt Due Dt Check DI Pay Gross Discount No -Pay Net 2880183 01/22120201/05/202011151202 $1.39 0.00 0.00 31.39 2882479 01/221202 01/051202 01115/202 8529 0.00 0.00 85.29 { 2882478 01/22/202 01/051202 01,'15/202 68.19 0.00 0.00 68.19 " f 2880182 01/22/20201/05/20201/15/202 0.29 0.00 0.00 0.29 2882477 01/22/20201105/20201115/202 85.22 O.OD 0.00 85.22 y / 2880184 01/22120201/05120201/15/202 25.61 0.00 0.00 25.61 l 2882480 0122/20201/05/202011151202 $89.09 0.00 0.00 389.09 CM78074 01122/202 01/06/202 01116/202 -34.05 0.00 0.00 -34.05 " 2884219 01122/202 011061202 01116/202 179.89 0.00 0.00 179.89 r 2884220 01/22120201/06/20201/16/202 61.47 0.00 0.00 61.47 J 2887648 01/22/202 01106/202 01/161202 411.94 0.00 0.00 411.94 � 2893490 01122/202 01/071202 01/17/202 654.18 0.00 0.00 654.18 --. 2889966 011221202 01/07/202 01117/202 22.21 0.00 0.00 22.21 2891553 01/221202 01/07/202 01/17/202 185.28 0.00 0.00 185.28 t 2891554 01/22/202 011071202 011171202 148.22 0.00 0.00 148.22 .1 2898321 01/22/202 01108f202 01/181202 64.64 0.00 0.00 64.64 2898667 01/22/202 01/081202 01/18/202 1,041.19 0.00 0.00 1,041.19 !, i ` 2895726 011221202 01/08/202 01/18/202 2.410.20 0.00 0.00 2,410,20 r i 2895724 01/22/20201/08/202011181202 92.64 0.00 0.00 92.64 2898322 01122/20201108120201/18/202 60.24 0.00 0.00 60.24 , !` 2898566 01/22/20201/08120201118f202 43.39 0.00 0.00 43.39 .• 2897135 01/22/20201/08/20201/18/202 35.20 0.00 0.00 35.20 2901496 01 /22J202 011091202 01/191202 58.00 0.00 0.00 58.00 1` 1 2901495 01/22120201/09120201A 9/202 25.84 0.00 0.00 25.84 2901494 011221202 01/09/202 01/191202 38.99 0.00 0.00 38,99 ' 2901493 0 1/221202 01/09/202 01119/202 155.94 0.00 0.00 155.94 2901492 011221202 01109/202 01/19/202 92.64 0.00 0.00 92.64 2902467 01 /22/202 01/09t202 01/191202 24.54 0.00 0.00 24.54 2909425 01/22120201112120201122/202 530.96 0.00 0.00 530.96 2909428 01/22/202 01/12/202 01/22/202 2,012.40 0.00 0.00 2,012A0 ; ' 2909427 01/221202 01/12/202 011221202 11.25 0.00 0.00 11.25 - 2909424 01/22/20201/121202011221202 8.68 0.00 0.00 8.68 2909426 01/221202 01/12(202 0112M02 16.31 0.00 0.00 16.31 2915751 01/22/20201/13/20201/23/202 64,40 0100 0.00 64.40 2913006 01/22(20201/13120201/23/202 890.69 0.00 0.00 899.69 ' 2913008 011221202 01/131202 011231202 180,22 0.00 0.00 180.22 2915752 01/221202 01/131202 01/23/202 5.25 0.00 0.00 5.25 4284 01122/20201113/20201123/202 -108.64 0.00 0.00 -198.64 2913009 01/221202 01/13/202 01/231202 182.08 0.00 0.00 182.08 2913010. 01/22/20201113120201/231202 1,036.07 0.00 0,00 1,036.07 2913007 01122/202 01113/202 01123/202 10.04 0.00 0.00 10.04. 2922171 01/22/202 01/14/202 01/241202 998.52 0.00 0.00 998.52 CM80627 01/22/20201/14/20201/24/202 -66.19 0.00 0.00 -66.19 .. 2922170 01122/20201/14/20201/24/202 180.18 0.00 0.00 le0J8 2918608 01/22120201114/20201/24/202 6476 0.00 0.00 84.76 2920648 011221202 01/14/202 02/061202 58,42 0.00 0.00 58.42 Vendor Totals: Number Name Gross Discount No -Pay Net 10536 MORRIS & DICKSON CC, LLC 12,450.07 0.00 0.00 12,450,07 Vendortk Vendor Name Class Pay Code 16144 - Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No•Pay Net EVANAN0001 01/20/20201/10/20202/061202 17.11 0.09 0.00 17.11 t Vendor Totals: Number Name Gross Discount No -Pay Net 16144 17,11 0.00 0.00 17.11 Vendor# , Vendor Name Class Pay Code 12388, j NATIONAL FARM LIFE INSURANCE Invoice# Comment Tran Ot Inv Dt Due Dt Check DI Pay Grass Discount No -Pay Net 4394315 01/231202 01123/202 02/01/202 5.321.08 0:00 0.00 6,321.08 Vendor Totals: Number Name Gross Discount No•Pay Net 12388 NATIONAL FARM LIFE INSURANCE 5,321.08 0.00 0.00 5,321.08 Vendor# ( Vendor Name Class Pay Code 15984 -- NORTHERN SPEECH SERVICES Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1396371 01/22/20201/07/20201/22/202 237.05 0.00 0,00 237.05 Vendor Totals: Number Name Gross Discount No -Pay Net 15984 NORTHERN SPEECH SERVICES 237.05 0.00 0.00 237.05 Vendor# Vendor Name Class Pay Code N1800 . i NURSES CHOICE CORPORATION W Invoice# Comment Tran Dt Inv Dt Due Dt Check Of Pay Gross Discount No -Pay Net 0175579IN 01/231202 01/091202 01/231202 121.61 0.00 0.00 121.61 Vendor Totals: Number Name Gross Discount No -Pay Net N1800 NURSES CHOICE CORPORATION 121.61 0.00 0.00 121.61 Vendor# Vendor Name Class Pay Code 11472 .j OCCUPRO LLC Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 38339 01/09/20201/07/2022 02/061202 486.68 0.00 0.00 466.68 Vendor Totals: Number Name Gross Discount No -Pay Net 11472 OCCUPRO LLC 486.68 0.00 0.00 486,68 Vendor# Vendor Name Class Pay Code 16128 Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt. Pay Gross Discount No -Pay Net LONPA00002 01/20/20201/09/20202106/202 37.72 0.00 0.00 37.72 ' Vendor Totals: Number Name Gross Discount No -Pay Net 16128 37.72 0.00 0.00 37.72 VendoM Vendor Name Class Pay Cade 10032 ,' PHILIPS HEALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 9027180008 01/15120201/10/20202/041202 135.80 0.00 0.00 135.80 Vendor Totals: Number Name Gross Discount No -Pay Net 10032 PHILIPS HEALTHCARE 135.80 0.00 0.00 135.80 vendor#. Vendor Name Class Pay Code 12706 POC ELECTRIC, LLC Invoice# Comment Tran Of .Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 4220AS 01/201202 011011202 02/06/202 2124.85 0.00 0.00 2,124.65 - 4267 01/201202 01/161202 02/061202 4.500.00 0.00 0,00 4.500.00 Vendor Totals: Number Name Gross Discount No -Pay Net 12708 POC ELECTRIC, LLC 6,624,65 0.00 0.00 6.624.65 Vendor#;'Vendor Name Class Pay Code 11080-- RADSOURCE Invoice# Comment Tran Of Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net :i PS1004456 01110/202 01/121202 02/06/202 1.791.67 0.00 0.00 1.791.67 PS1004533 01/20/20201/16/202.02/061202 1,708.33 0.00 0.00 11708.33 - Vendor Totals: Number Name Gross Discount No -Pay Net 11080 RADSOURCE 31500.00 040 0.00 3,500.00 Vendor# ;. Vendor Name Class Pay Code 15264= REPUBLIC PAIN SPECIALISTS Invoice# Comment Trani Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 42A 01/07/2020110PJ20202102/202 5,000.00 0.00 0.00 5,000.00 Vendor Totals: Number. Name Gross Discount No -Pay Net - 15264 REPUBLIC PAIN SPECIALISTS 5,000.00 0.00 0.00 5.000.00 Vendor# :Vendor Name.. Class Pay Code 14920 , REPUBLIC SERVICES, INC. Invoice# Comment Tran Dt Inv Di Due DI Check Dt Pay Gross Discount No -Pay Net 0847001374639 011231202 01115/202 01/231202 1,105.43 0,00 0.00 1,105.43 Vendor Totals: Number Name Gross Discount No -Pay Net 14920 REPUBLIC SERVICES, INC. 1,105.43 0.OD 0.00 1,105.43 Vendor# Vendor Name Class Pay Code 16084 - Invoice# Comment Tran Ot Inv Dt Due Ot Check Dt Pay Gross Discount No -Pay Net PERRAY001 01120/202 01110/202 02/06/202 26.96 0.00 0.00 26.96 Vendor Totals; Number Name Gross Discount No -Pay Net 16084 26.96 0.00 0.00 26.96 Vendor# t Vendor Name Class Pay Code 16076 - Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1CRIRON0001 01120/20201/10/20202O61202 13.30 0.00 0.00 13.30 VendorTotals: Number Name Gross Discount No -Pay Not 16076 13.30 0.00 0.00 13.30 Vendor# 'Vendor Name Class Pay Code 160BO Invoice# Comment Tran Dt Inv DI Due Dt Check Dt Pay Gross Discount No -Pay Net RESSAB0002 011201202 01/10/202 021061202 16.42 0.00 0.00 16.42 ' VendorTotals: Number Name Gross Discount No -Pay Net 16080 16.42 0.00 0.00 16.42 Vendor#:Vendor Name Class Pay Code 16048 -- Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount Nu -Pay Net LINSH00001 01/20/20201/1020202/06/202 19.11 0.00 0,00 19.11 VendorTotals: Number Name Gross Discount No -Pay Net 16048 19.11 0.00 0100 19.11 Vendor# Vendor Name Class Pay Code S2270 SMILE MAKERS M ' Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1 9595318 01/23/20201/23/20202/01/202 104.89 0.00 0.00 104.89 Vendor Totals- Number Name Gross Discount No -Pay Net $2270 SMILEMAKERS 104.89 0.00 0100 104.89 Vendor# r Vendor Name Class Pay Code 11296 SOUTH TEXAS BLOOD & TISSUE CEN .. Invoice# Comment Tran Dt Inv Dt Due Ot Check Dt Pay Gross Discount No�Pay Net CM13821 12/17/20212115/20201/31/202 -1.710.00. 0,00 0.00 -1,710.00 CM14091 01120/202 01115/202 02/06/202 •1,405.00- 0.00 0.00 -1,405,00 -.. 107046897 01120120201115/20202/06/202 4,747.00 0.00 0.00 4,74Z00 Vendor Totals: Number Name Gross Discount No -Pay Net 11296 SOUTH TEXAS BLOOD & TISSUE CEN 1,632.00 0.00 0.00 1,632.00 Vendor# Vendor Name Class Pay Code 15236 SPECIALTY PROFESSIONAL Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1240001670 01/20/202 12/13IZ02 021061202 4,560.00 O.OD 0.00 4,560.00 1240001688 01120120212120120202/06/202 3.562.50 0.0D 0.00 3,562.50 1240001719 01/20/202 1PJ271202 02/06/202 3,681.25 0.00 0.00 3.681,25 1240001748 011201202 01103/202 02/061202 3,610.00 0.00 0.00 3.610.00 , Vendor Totals:. Number Name Gross Discount No -Pay Net 15236 SPECIALTY PROFESSIONAL 15,413.75 0.00 0.00 15,413.75 Vendor# 'Vendor Name Class Pay Code S2694 •i STANFORD VACUUM SERVICE M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 730562 01/20/202 01116/202 02/061202 550.00 0.00 0.00- 550.00 Vendor Totals: Number Name Gross Discount No -Pay Net S2694 STANFORD VACUUM SERVICE 550.0D 0.00 0.00 550.00 Vendor# Vendor Name Class Pay Cade S3960._1 STERICYCLE, INC Invoice# Comment Tran Dt Inv Dt Due Dt Check Ot Pay Gross Discount No -Pay Net 8009618819 01120120201/18/20202/06/202 3,076.66 0.00 0.00 3,076.66 Vendor Totals: Number Name Gross Discount No -Pay Net , S3960 STERICYCLE, INC 3,076,66 0.00 0.00 3,076.66 Vendor#, Vendor Name Class Pay Code 83940 j STERIS CORPORATION M Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 13311652 011231202 01/16/202 02/01/202 218.40 0.00 0.00 218.40 Vendor Totals: Number Name Gross Discount No -Pay Net $3940 STERIS CORPORATION 218.40 0.00 0.00 218.40 Vendor# {Vendor Name Class Pay Code 16136 Invoice# Comment Tran Dt Inv Dl Due Ot Check Dt Pay Gross Discount No -Pay Net JEFSUS0001 01120/20201/09/20202105/202 80.00 0.00 0.00. 80.00 Vendor Totals: Number Name Gross Discount No -Pay Net 16136 80.00 0.00 0.00 80.00 Vendor# Vendor Name Class Pay Code T2539 . T-SYSTEM; INC W . Invoice# Comment Tran Ot Inv Dt Due Dt Check Dt Pay -Gross Discount No -Pay Net _ 2013234 01/22/20212/31/20201/30/202 6,130.42 0.00 000 6,130A2 DECEMBER Vendor Totals: Number Name Gross Discount No -Pay Net T2639 T-SYSTEM, INC 6,130.42 0.00 0.00 6,130,42 Ventlor# ' Vendor Name Class Pay Code 15488 " TEXAN FLOOR SERVICE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 126191 01/22/202 01/14/202 011221202 8,089.20 0.00 0.00 8.089.20 Vendor Totals: Number Name Gross Discount No -Pay Not 15488 TEXAN FLOOR SERVICE 8.089.20 0.00 0.00 6,089.20 Vendor# ;'Vendor Name Class Pay Code 14856 s TEXAS A&M HEALTH SCIENCE CENTE Invoice# Comment Tran Dt Inv Dt. Due Dt Check DI Pay Gross Discount No -Pay Net H184405 011201202 01/161202 02106/202 6,825.00 0.00 0.00 6,825.00 Vendor Totals: Number Name Gross Discount No -Pay Net 14856 TEXAS A&M HEALTH SCIENCE CENTS 6,825.00 0.00 0.00 6,825,00 Vendor# . Vendor Name Class Pay Code T1880 I TEXAS DEPARTMENT OF LICENSING PJP Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 10184150 01120/202 11105/202 02/061202 70.00 0.00 0.00 70.00 INSPECTION DATE 11/01/24 Vendor Totals: Number Name Gross Discount No -Pay Net T1880 TEXAS DEPARTMENT OF LICENSING 70.00 0.00 0.00 70.00 Vendor# Vendor Name Class Pay Code 10598 „-; TEXAS DEPT OF STATE HEALTH SRV Invoice# Comment Tran Dt Inv Dt Due Or Check Dt Pay Gross Discount No -Pay Net 010125 01/14/20201/01/20201/31/202 2,035,00 0.00 0.00 2.035.00 Vendor Totals: Number Name - -- Gross Discount No -Pay Net 10698 TEXAS DEPT OF STATE HEALTH SRV 2,035.00 0.00 0.00 2,035.00 Vendor# Vendor. Name Class Pay Code 10758 ,, TEXAS SELECT STAFFING. LLC Invoice# Comment Tran Dt Inv Dt Due Dt. Check Dt Pay Gross Discount No -Pay Net 0024871 01/20/20201116/20202106/202 3,659.00 0.00 0.00 3,659.00 Vendor Totals: Number Name Gross Discount No -Pay Net 1D758 TEXAS SELECT STAFFING, LLC U59.00 0.00 0.00 31659.00 Ventlor# .Vendor Name Class Pay Code C2510 ,' TRUBRIDGE M . Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net 1027547 01/141202 01/13/202 02106/202 152.10 0.00 0.00 152.10 T2501171378 01/20/202011171202021061202 8.068.22 0.00 0.00 5,068.22 Vendor Totals: Number Name Gross Discount NO -Pay Net C2510 TRUBRIDGE 8,220,32 0.00 0.00 8,220.32 Vendor# Vendor Name Class Pay Code U1064 . UNIFIRST HOLDINGS INC Invoice# Comment Tran Dt Inv Dt Due Dt Chock Dt Pay Gross Discount No -Pay Net 2921049481 12/27120212119120202/05/202 162.14 0.00 0.00 162.14 2921050689 01/01/20201/06/20201/31/202 2,350.54 0.00 0100 2,350.54 ' 2921050690 01/01/20201106/20201131/202 96.58 0.00 0.00 96.58 2921051011 01114/20201/09/202021031202 77.65 0.00 0.00 77.85 2921061013 01/14120201109/20202/03/202 162.14 0.00 0.00 162.14 2921051015 01/14/20201/09/202021031202 132.59 0.00 0.00 132.59 2921051014 01/14=201/09120202103/202 181.78 0.00 0.00 181.78 2921051012 01/14120201/09/20202/03/202 379.22 0.00 0.00 379.22 2921051010 01/14/202011091202021031202 2,144.20 0.00 0.00 2,144.20 2921051008 01/14/20201/09/20202/03/202 102.11 0.00 0.00 102.11 2921051208 011201202 01/13/202 02/06/202 2,677.54 0.00 0,00 2,677.54 •. 2921051207 011201202 01/13/202 021061202 140.37 0.00 0.00 140.37 2921051209 01/20120201/13/20202/06/202 103.29 0.00 0.00 103.29 , 2921051513 01 /20/202 011161202 02/061202 100.84 0.00 0,00 100.84 2921051540 01 /20/202 01/16/202 02/061202 375.30 0.00 0.00 375,30 -` i 2921051548 01/20/20201/16/20202/06/202 181.78 0.00 0.00 181.78 ,l 2921051546 01/20/20201/16120202/06l202 162.14 0.00 0.00 162.14 2921051528 0 11201202 01/16/202 02/06/202 1,965.38 0.00 0.00 1,965.38 2921051551 01/20/202 01/10/202 02/06/202 132.59 0.00. 0.00 132.59 , 2921051519 01/201202 01116/202 02106/202 173.09 0.00 0.00 173.09, 2921051534 O7l20120201/16/20202106/202 64.90 0.00 0.00 64.90 2921051009A 01/23I20201/09120202/03/202 169.69 0.00 0.00 169.69 . Vendor Totals: Number Name Gross Discount No -Pay Net U1064 UNIFIRST HOLDINGS INC 12.035,86 0.00 0.00 12,035.86 Vendork, Vendor Name Class Pay Code U2001 US POSTAL SERVICE W. Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Grass Discount No -Pay Net 01142005 07/23/20201/10./20201123/202 2,200.00 0.00 0.00 2,200.00 Vendor Totals: Number Name Gross Discount No -Pay Net U2001 US POSTAL SERVICE 2,200.00 0.00 0.00 2,200.00 Vendor# Vendor Name Class Pay Code 15616 UTHEALTH COHII Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Not 3158 01/20/209 01/171202 02/061202 900.00 0100 0.00 900,00 Vendor Totals: Number Name Gross Discount No -Pay Nei 15616 UTHEALTH COHII 900.00 0.00 O.OD 900.00 Vendor# : Vendor Name Class Pay Code 16120- Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net HAHVER0001 01/20/20201/10/20202/06/202 40.00 0.00 0.00 40.00 Vendor Totals: Number Name Gross Discount No -Pay Net. 16120 40.00 0.00 0.00 40.00 Vendor# Vendor Name Class Pay Code 10556 WOUND CARE SPECIALISTS Invoice# Comment Tran DI Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net WCS00007120 01120/20201/01/20202/06/202 6,975.00 0.00 0.00 6,975,00 Vendor Totals: Number Name Gross Discount No -Pay Net 10556 WOUND CARE SPECIALISTS 6,975.00 0.00 0.00 6,975.00 Grand Totals: Gross Discount No -Pay Net 343,746.26 0.00 0.00 343,746.26 APPROVED ON JAN 2 3 2025 CALLHOt1N COLIAM&S MSKESSONSTATEMENT As of: 01/24/2025 Page: 002 To anon proper or set to your eamam, tletaalt orM ralom We come>^n eao4 mmt with your norfla nee MWORIAL MEDICAL (M C OC: 6115 Coetomer 1NV SapplD: As al: 01/24/2025 Pa 002 No to Cane 8000 AP AMT DUE REhI TTLD VIA ACH OMIT Temtory. 615 N VIRGINIA STREET 51at¢menl tar informsem only AMT DUE HFAf nED VIA ACH DMT Statement for infanallo. anly PORT LAVACA T% 77979 Colhoo , 632536 Data. 01124/2025 CusU 632536 RUEASE CNSCS ANY Oatm 01/24/2025 1TE91S NGT PAID (v) fi0irg Due Neuiaebl tbnM A000um 94ve _...Cyh Amount P Amoum P INsaNebk Date 0. mN.Mtwdoew Nelererwe DeaclplNn Oixount (gnus) F (rmt) F Numher FF --w-- legemt: P = Pam Due Ilan, _ F • Future Due Item, blank = Currant Due Item TOTAL "Most Aeet 632536 MEMORIAL MEDICAL CE9DE91 Sublold. 3.757.24 USG Frame ass: 0.00 Past Due: It Pala By 01/2912025, 0.00 Pay TNs Amount: Led Paym9m 2.451.97 If Pont After 01/2912025, 09/07/2017 Pry this Amuumi 3t680. 84 + 1.24 + 3+682=08 o Duo D Pell On Time: USD 3,662.00 3.682.08 USD Dlse lost 0 pall let.. 76.16 Due N Pml We: 3,757.24 USD USD 3,757.24 APPAOM ON JANt422 7 20255 CAB5yUUpNN rOUf�Ri£. AS For AR Inquiries please contact 800-867-0333 MSKESSONSTATEMENT As W: 01/24/2026 Page: 001 To arrow Proper ererM to your .ecmoo, a„eeh en6 ret. Nee umwnr:.... Met, WNh vol, mmlmme 00: 8115 WAIMANT 1098/MR4 M® MS Customer INV SWPID: qe of; 01/24/2025 Pegs: 001 Mao t0: Core: 800 MER ORAL M®ICAL CENTOs AMT DUE RBHITTI2] VIA ACH DOM TerMory: 7001 VICKY KAUSIX Statement for information only ANT DUE HB4ITTED VIA ACH OMIT 815 N ST Cw... 256342 Statement for Information only AVACVIMNfA PORT tAVgCA TX 77e79 gate: 01/24/2025 Cod: 256342 PLEASE CHECK ANY Date: 01/24/2026 I111915 NOT PAID (.r) B1Ikm Ow ry 4atlanai Account �r6 Date - Data Number Reference Cash an.,"[. Omsowl Amount P (arose) F Amount P Roomette (nd). F Number Cost. Number 256342 WAWART 1090INI M Mat PHS 01/18/2025 01/26/2025 7545]]2944 215407103 1161nveice 01/20/2025 01/28/2025 7546026806 224524628 1161mak:e 01/21/2025 W=/2D25 7546272397 224613209 115Inv9ica 0112V2025 01128/2025 7546272398 220800513 11shunno. 01/21/2025 0112MG26 7646272399 222464408 1151nvol.e 01/22/2025 01/28/2025 7546588514 223395906 1151nvulce 01f23/2025 OV28M025 7646886560 221495451 1151nvoice 01/24/2025 0IM8/2025 ]54]t32934 223452202 1151nvoice OV24/2025 0V2812026 7547132935 216962649 1/51rmotce 01/24MG25 01/28/2025 7647132936 224988710 1151nvoics 01/24/2025 01/08/2025 7547132937 216962649 11shwed.e PF column hgeml: P = Pad Dw Item, F = Roma Uw gem, plank = Covent Dw Nam TOTgL• Codamer Number 266342 WALMART 1098/MM MED PHS Sumdeh: Put. D. 0.00 If Pam By 01/211=25, Rest Ow: 0.00 Pay This Amount: lad Payment 4,621.67 If Pam After 01/28M629, 01/2=025 PAY this A.I! 4.95 0.02 0.01 22.53 22.53 6.26 0.03 1.92 0.34 0.02 17.52 247.70 1.06 0.32 1,126.30 1.196.36 262.98 1.48 95.00 16.86 0.95 878.10 242.75 1.04 0.31 1,103.83 1,103.83 257.72 1.45 93.88 16.52 0.93 858.59 7545]]2944 7546026086 7546272397 7546272398 '. 7546272399 7646588514 7546885560 - 7547132934 - 7547132935 :' 7547132936 7547132937 3,]55.9] USD 3,680.84 USO APPRN�W pNUSD JAN 2 / 20?5 %A8F10UNUCOIINTV. TEY S For AR Inquiries please contact 800-867-0333 Ow D Pem on Tins: U913 3.680.84 Dive lost If Pam wt.: ]5.13 Ow It Pew Eels: USD 3,755.97 MWESSON STATEMENT As o1: 01/242025 Page 00, anweareaolvd,d� e®[mmM ac .ewes: e000 pole 1v0h from relnitlanm DC: 8116 HEPHCY WHSSMM MED PNS Cupomer INY supplD: As of: 01/24/2025 Page: 001 Mpl to: Come; 8000 MENIORIAL MEDICAL CENTER AMT DUE RtAIITTED VIA ACH DEBIT Teaeory: 7001 VICKY KALISS( Statement for Information only ANIT D nE AGAITTED VIA on ACy DEBIT IS N VIRGINIA ST Custamer. 820405 PORT IAVACA TX 77979 Data: 01f2412025 Curt: 820405 PUDUIE CNEDK ANY Dale. 01/24/2025 IT50S NOT PAID (✓) DIIIr18 Due ReceivaNSNatbrml Account fib Geh Amount P Amolmt P 11a4aivatla Data Oate Number We. Description Dlsommt (9mae) F (net) F Number 17 Coal. Number 820405 H® ANDY WHIRGMSA MED PHS 01/23/2025 0112SM025 7546667428 82501ASS-187806 1151moiee 0.03 1.27 1.24 .i( 7546667428 O PF column leg"; P e Pap Due Item, F = Future Due Item, blank a Cement Ous Item TOTAL- Dean., Number 820405 H® PNDY WNSSSIM MED PHI; SuMpW: 1.27 USD Rid. Due: 0.00 Duo II And Da Tbna: II Paid B/ 01/2812025, USD 1.24 Pap Dun: 0.00 Pry This Amount: 1.24 USD Dee lop N pap late. 0.03 tap Prym5M 0,821.67 If Pent After 01128/2023, Due It Paid fateArt, fhAA 01120/2025 Pab Amount: 1.27 USD USD 127 APPROVED ON JANy2 7 20250 CAWOIPN COUNTY 7 XAS R For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT As of: 0111712026 MW. 002 To seems, me1Mr eredD to yew aeeomD, dNae11 aw rNaln tM. o.emit,: mac stet, with your "I' alKa IMMORAL MEDICAL CENI'M DC: 8115 Curt.mer INV Sp lD: As of: 01/17n025 Page: 002 Mao to: Cmna 8000 AP AMT DUE REMITTED VIA ACH OMIT To"Nory: 615 N VIRGINIA STRFEr Statement for Information only ANT DUE REMITTED VIA ACH DOM statement for Information only P011r LAVACA TX 77979 Customer. 632535 DOW 01 ele: /16/2025 Cost: 632536 PLEASE CNEDK ANY Dme: 01/16n025 BBAS NOT PAID (�) &HMO Due ppcoN.iatianel Account WEPS Cash Amaze t P Amount P NeceteaM, DRa net. Number Refemnce Deacdptfen Discount (grow) F (ref) F Numher PF soften "ME P = Pent Due Dam, F = Future Due it=, Meant = Curmnt Due Item TOTAL Notfml Acct 632536 MWOWAL MEDICAL CENTER Suhtoteln 4,7tS.97 USD Future Due: 0.00 R Pau By Ol/2In025. Part Due: 0.00 Fay This Amount: 4.621.67 USD loft Payment 2.451.97 If PaM After 01121n025, O8/O7n017 Pay this AmmPd: 4715.97 USD 4+597.21 + 13.87 + 6.94 + 3.65 + 4+621.67 0 APPROVED ON JAN 2 7 2025 CAID.EulOUf4UFOU TEXAS For AR Inquiries please contact 800-867-0333 Due D Paid On Time: use 4,621.67 Dix tort K peM fete. 94.30 Diu D Paid We. USD 4.715.97 WOO MEKESSON campm,r e4aa WALMANT 109QNW M® WS MEN ONIAL M®ICAL CENT94 VICKY KAUSEK 815 N VINDINIA ST PONE IAVACA TX 77979 STATEMENT ANT DUE ITBAITTED VIA AM OMIT Statement for Intonation only At W: 01AM025 PAP: 001 To anwm paper eoda to Your aeowM, deteM am admen tbia .Gal, tape Yome amillenw DC: 8115 As o/: 01/1712025 Page; 001 Tenet I70 9upp10: Mali tm Camp: 8000 rwKarv: 7691 ANT DUE Ink a VIA AM DEBIT Cupomfor inloec 256342 Statement la lmalion only Date: 01/18/2025 Curt: 256342 PLEASE CHECK ANY Dale: 01/18/2025 ITEMS NOT PAID () D at Out NeoeNahl�piolNl Aaoent t96 Dean Allmunt P Ameum P Melve6le Dote Date Number me. DMdpuom Discount (poise) F (tat) F Nomber Copemar Number 256342 WAWA" 1098/M3A MED Me 0111IM025 01M/2025 7544310642 218027069 1151nvoice 5.26 262.98 267.72 7544318642 01/11/2025 01/21/2025 75443IB643 223395906 1151moice 5.26 262.98 257J2 7544310643 01/13Y2025 01/2V2025 7544561516 217964752 I151nvoloe 0.01 0.63 0.02 7544661516 01/13/2026 01/21/2025 7644561517 219304373 115Nv0ice 0.01 0.63 0.02 1 7544561517 01/1312025 O1/21/2025 7644561518 220000513 1151nvoke 22,53 1,126.3E 1,103.83 c .7544561518 0111=025 0112112026 7544561519 215102283 1151nvoee 2.02 100.89 98.87 7544561519 01/14/2025 OV2112025 7544871166 223339419 1151amiae 22.54 1,127.14 1.104.50 ; 75g4B]1188 01/14/2025 01/2112025 7544971167 216280350 1151nVome 0.48 9.20 9.02 f 7644871167 01/14/2025 01/21/2026 7544871168 223892664 1151m01ce D.02 0.95 0.93 .`' 7544871168 O1/t6A025 01/21/2025 7545158637 224094410 1151moice 6.09 404.57 396.48 7545158637 01/16/2025 01RIM025 7545403457 222651928 1151moice 1.80 90.21 89.41 �, 7545403457 01/1612025 01/21/2025 7545403458 223452202 1151nvolm, 3.83 191.59 187.7E J. ]545403458 01/16/2025 0112112US 7545403459 216208227 1151taolce 0.04 2.12 2.08 , ,7546403459 01/16/2025 01/2112025 7545413214 215634016 1151nv0ic0 2.24 111.89 109.65 :� 7645413214 01/17/2025 01M/2025 7645647696 216208227 11510voiea 17.52 076.10 858,58 4 754SG47696 01(1]/2025 01/21/2025 7545641897 215461080 1151mvice 1.23 81.39 60.16 . 7545647697 01/17/2025 01M/2025 7545647698. 216534016 1151mo14e 1.23 6t.39 60.16 7546647698 FF oolam n N9erp: P = Pap D. Item, F = Mum Ow Item, 64nk = Cmerent Om Item TOTAL CuManer Number 256342 WALNARf 1096lNBB M® 1,115 Subtotelp 4,691.02 USD Folum Due: 0.00 Due 11 PuiO On Tkrle: Pap Due: It Wd EY 01/21/2025, USD 4.597.21 0.00 Pry Tlie Amount: 4.597.21 USD Bloc late D to Ws p�T/��e (W 93,81 Led PaYnlarM1 7.47S�4 f n Paw Aft" 01/21n025, Due D flaw W. CM3/2025 iAN2722025 Pay Into Aamed: 41691.02 U5D USD 4,691.02 CALH0OpryUD1WL For AR Inquiries please contact 800-867-0333 MSKESSON STATEMENT f pey: e000 HEL PHCY WHSEMEM MED ME AMT DUE PBMITTED VIA ACH OMIT MEMORIAL MEDICAL CENTER Statement for information only VICKY KALISEt 915 N VIRGINIA ST PORT LAVACA TX 77970 As p: 01/17/2025 DC: 8115 Customer INV Slppl0: Territory: 7001 Customer. 820406 Date: 01/18/2025 Papa: 001 To wave paper marHt to yeW souse. Hetach ptl me. iMe pub wOh Year rpr4 area As 0: 01/1712025 Page: 001 Mall to: Camp: 5000 AMT DUE FEMITT ) VIA ACH OMIT Statement for information only Cup: 820405 PLEASE CHECK ANY Ope: 01/18/2025 nB1S NOT PAID (1) NeceivablllnLiorW Account WI`/Y6 Ceps Amount P Amount P fletthebk WI� Olae umber Reference OewHptfon Oiwaunl (9.) F (WI F Numbm Customers, N.W 820405 H® PHCY WHSEMEA M® ME; 01116/2025 01/21/2025 7545208354 MSOI-055-187210 1151nvoice 0.28 14.15 13.87 7545208354 O PF Column legend: P = Net Due Hem, F = FLlue pee Ham, blank = Cumam Ous Item TOTAL Customer Number 820405 H® PHCY WNSEMEM MED MS SUMmalc 14.15 USD Fut. one: 0.00 If Peip BY 01/2112025, Not oua: 0.00 Pay Thla Amount: Lap Payment 1."9.41 it Pant After 01M2112025, 01113/2025 NY this Anmum: APPROVED ON JApNry2 7 2015ap CAINUUNUCn ARITEY.AS One 11 Pant On TIrIM: USD 13.57 13.87 USD Disc by H pp0 late: 0.28 0w H PNH W. 14.15 USO USO 14.15 For AR Inquiries please contact 800-867-0333 m_RC,DVIY STATEMENT Aa 01: 01/1T/2025 Ms.: 001 To Assumeprefer cteAl to Your sectors, dataolt and Men, this 0;mnw: e0e0 stub with yam mm111uKo DC: ails As of: 01/17/2025 Page: MEMOPoAL 001 CVS PHOY MEDICAL Cu Comer INV SUMID: Mai to: Crony. 6000 MEMG PHS ANT DUE NBA11TED VIA ACH OMIT TeMtM: 7001 G134THi Statement for inlonnotion only AMT DUE SE81TTm VIA ACH D®IT VICKV KADSEK 6C CUM.. 835437 Statement for inlmmation only 815 N VImUNIA ST PORT IAVACA TX 77979 Date: 01/1 B/2026 CUM: 835437 PIFASE CHECK ANY Date: 01/18/2025 ITBAS NOT PAID (w) Dlgrm Due A.M bWG Cash Annexed P ArnmaA P AacaNeble Date Dale Number Net... Desorellon Dlseaurd (gross) F (m) F Nemher CuMamm Number 835437 CVS PNCY 74161MB1 MC tens 01/15n025 01/21/2025 7545173905 3810020 1151nuoice 0.14 7.08 6.94 7545173906 Q PF column legend: I'm Pael OUe Hem,. F = FNwa Dome Ham, honk = Curmnl Due seem TOTAL Cugemer Numbet 835437 CVS PNCY T416/N@A MC WE Subtotal.. 7.08 USED IRA. We: 0.00 Dee N Mid On Tlme: D Mid BY 0112112025, USD 6.94 PeM Due. 0.00 Pay TIYc Am01mG 6.94 USD Dlee IO H paid Wt. 0,14 tart ftyrno t 1.449A1 N Pattl After Olni/2025, Due If Mid late: 01/13/2025 Pry this Arivem 7.00 U50 USD 7.08 APPROVED ON JCCANNry2 7pt21p0255 Bg CAIHnUNU(; UP4WITOK 5 For AR Inquiries please contact 800-867-0333 MSKESSONSTATEMENT A. of: 0111712025 P+Be: 001 To«Mm,.'raw data,to your account, 58taM am mtum that 0emwnr: eo.o dub aAN your mm8lenco DC: 8115 CVS PRAY PHS Cusloned INV S.00: As d: 01/17/2025 Page: 001 fault le: Coma BOOR E MEDICAL CE4TBi MEDICAL AMT DUE R ITTED VIA ACH DWT TaNBory: loot VICVICKY KAL KAUSB( Statement for informdion only AMT DUE REPOTTED VIA ACH DEEIT Statement for information only 815 N 815 N VVACAA ST Cautioned 835438 PORT LAVACA T% ]]9)9 Data; Oi/18/2025 W2025 Cud: 835438 RE1SE CHECK ANY Onto: 01/18/2025 BRAS NOT PAID (�) BMnB 0. — SemivaM{Hmlorel Aemaum 9/i5 Ces, Amount P Amount P Read don I Oat. Data Number Relenmcs Downtime Dl.moula (BED®) F (fret) F Number ' Cue. Numbar 835438 CVS PHCY 74751141194 MC PHS 01/15/2025 01/21/2025 7545178828 3811629 1151nvoioe 0.07 3.72 3.65 ,.r ]5451]8820 O PF Column IeBmW: P = Pad Dun Nam. F = Mum Cue NdA Mark = CurmrB Dua Item TOTAL Cad.mar Nomher 835438 CVS MCV 74751MEM MC PNS subtotals: 3.72 USD Muse Due: 0.00 Due N Add On Tim.: If Pam 9y 0112112025. USD 3.65 Pad Due; 0.00 Any This Amount: 3.65 USD nine led N Add mt. lad /.155.95 N Pata aNar 025. 0.0] Dun N Pam lam: 12024Measure l2/3vzgz4 P.y this Amoum: ure: 3.72 USD usD saz APPROVED ON JAN 2 7 202' i RRyy��c;;y211'�t�pTY �TNyT[y; CAUT011hT(.nl)A TEAS For AR Inquiries please contact 800-867-0333 STATEMENT Statement Number: 69033676 AmerisourceBergen- Date: 01-24-2025 l of AMERISOURCEBERGEN DRUG CORP WALGREENS #12494 34GB 100IM284IM70WISS 12n7 W. AIRPORT BLVD. MEMORAL MEDICAL CENTER SUGAR LAND TR 77478-6101 1302 N VIRGINIA ST PORT LAVACAU 779793509 sal-F#Daem7a.ya DEA: RA0289278 8BB451-9655 AMERISOURCEBERGEN PO Boa W5223 Not Yet Due: 0.00 CHARLOTTE NC 28290-5223 Curren: 1.914.25 Part Due: 0.00 TOUT Due: 1.914.26 Ac=nt Balance: 1,914.25 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Dale Date Number Number Type Amount 01-20.2W5 01-31-2025 3203100139 7008712004 [Md. 678.29 0.00 670.29 01-28-2025 01.31-2025 3203101350 7008MMU ImOice 108.83 0.00 108.83 01-20.2025 01-31-2025 3203101351 7WS7221164 Imdce 2.90 am 2.96 01-20.20n 01-31-2025 3203101352 7GO733190 IM01ce 1,021.57 0.00 1.021.57 01-21-2025 01-31-2025 3203258944 7008739814 Invoice 3.94 O.W 3.04 01-242025 01-31.2025 320W20089 7OM750191 1m01ce 99.86 0.00 98.86 Curtenl 145 Days 16.30 Days 31-BOOays et-90 Days 91420 Days Over 120 Days 1.914.25 0.00 0.00 0.00 0.p0 G.00 0.00 You for Your Payment Reminders �Thank Date Amount APPROVED ON Due Date Amount 6144-2025 (3,019.58) 01-314M 1,94.25 JAN 2 7 2025 Total Due: 1,914.25 CC IN.�TMpp��TTpppp GtiUN'I`7.1T9yA5 CPLHOUON STATEMENT statement Number: 69051359 AmensourceBergerr Date: 01-24-2025 i oft AMERISOURCESERGEN DRUGCORP WALGREENS CENTRAL FILL a21373 3408 am PATRIOT PARMNAY MEMORIALMEDICALCENTER 100SN35611OM63H ROANOKETX 762624338 410D DALE EARNHARDT WAY 2W NORTHLAKE TX 76262-2389 Set - Fri Due In T days DEA: RA0316958 868-051-9655 AMERISOURCEBERGEN PO Box 978740 Not Yet Due: 0.00 OALLAS TX 753974740 Cueenl: 2,219.23 Past Due: 0.00 Total Due: 2219.23 Awned Balance: 2,219.23 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Recelved Balance Date Date Number Number Type Amount 01.202025 01-31-2025 320307003e M57224V InvOlm 87.27 am 87.27 Ot-20-2025 01-31-ZUS 3203IU212 7ON7397W Invoice %80 0.00 14.e0 01-21-2025 01-31-2025 32W304459 70087512N Invoice 1,113.69 0.00 1,113.69 01-22-2026 0141.2025 3203"M7 7008757264 Invoice 8.52 0.00 9.52 044-2025 01-31-2025 3203743165 mG9774924 Invdce 994.95 0.00 994.95 Current 145 Days 16J0 Days 31-60 Days 61-90 Days 91-120 Days Over 120 Days 2,219.23 0.00 0.00 0.00 0.00 0.00 0.p0 APPROVED ON Reminders JAN Z ��5 Due Date Amount 0141-2025 2,21923 Total Due: 2,219.23 gY COUNTY NTY"TW CAR OC N COUNTY. TEXAS a,L STATEMENT Statement Number: 69023586 AmensourceBergen- Date: 01-17-2025 i of AMERISOURCEBERGEN DRUG CORP WALGREENS CENTRAL FILL 821373340E 10056W56 1100566356 501 PATRIOT PARKWAY MEMORIALMEDICALCENTER ROANOKE T% 76262-6336 41M DALE EARNHARDT WAY 200 NORTNLAI E T% 76262.2369 Sat - Fri Due in 70ays DEA: RA0318958 666451-9655 AMERISOURCESERGEN PO Box 978740 Net Yet Due: 0.00 DALIASTX 753974740 Cueenl: 279.36 Fes Due: 0.00 T41e1 Me: 279.38 A..18eNnce: 279.W Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 01-1Y2025 01-24-2025 3202206178 70086,17299 Invoice 104.73 0.00 J. 104A3 01-13-2026 01-24-2025 3202206540 7000656670 Invace 3247 0.00 32.07 m-M2025 01242025 320nolkIl1 70WBBM05 Invoice 6.51 0.00 1 6.61 01-13.2025 01-2420W 32023338M 9008673186 Mercies W.57 0.00 66.67 01-143025 01-24-2025 3202508681 7MBM756 Inwice 4.03 0.00 �' 4.00 01-16-2025 01- 1-2025 320W91=6 7000695W7 Imoloe 55.37 0.00 0.37 Current 1.15 Days 16.30 Days 31.60 Days 61.90 Days 91420 Days Over 120 Days 279.38 0.00 0.00 0.00 0.00 0.00 0.09 APPROVED ON Reminders JAN 2 7 2025 Due Date �0144-2025 Amount 279.38 Total Due: 279.36 o�IN q1}� W RTENAS CAI.VIOUN GOUt4n'. - IN STATEMENT Statement Number. 69005851 AmensourceBergen• Date: 01-17-2025 1 of 1 AMERISOURCESERGEN DRUG CORP WALGREENS612494340B 1001352 1037028IN 12727 W. AIRPORT BLVD. MEMORIAL MEDICAL CENTER SUGAR LAND TX 77478.6101 13N N MRGINIA ST PORT IAVACA TX 779798509 Sat-Fu 0uem 7dava DEA: RA0289276 $66-451.9655 AMERISOURCEBERGEN PO aoa 905223 Not Yet Due: 0.00 CHARLOTTE NC 2WOO.6223 CuaenO 2,740.20 Peat Due: 0.00 Total Due: 2.740.2D Aaount Balance: 2,740.20 Account Activity Document Due Reference Purchase Order Document Original Last Receipt Amount Received Balance Date Date Number Number Type Amount 01-1a2025 01-2a=5 32a2266265 M8646e14 Imdce 67.07 0.00 57.m 01-13-2025 01-24.2025 3202266266 7008656684 1mroVc 1.116.64 0.00 _' 1.115b 0143.2025 01-24-2025 3202266267 7W8656664 Inww 13.34 0.00 13.34 01A1 2025 01-242025 3202266M 7MM3760 Invoice 414.65 6.00 414.65 01-14-2025 01-2 2025 3212 1042 7008673305 Invoice 14.16 0.00 ! 14.16 01-15.2025 01-24.2025 3202616462 7006664240 lnvdcce 24.0 0.00 24.59 01-1542023 01-2 2025 3202616483 7006664147 Invoice 29.44 0.00 - 28M. 01-16-2025 01-24.2025 320V74WO 7MM0730 Inwice 1,047.45 0.00 J 1,047.45 01-16-2025 01-242025 3202774079 700NS5868 Invoice 20.10 0.00 20.10 01-17.2025 01-2M2025 3202938285 7008704151 Invades 1.76 0.00 1.76 0147-2025 01-24-2025 3202938285 7006704151 Itlwice 1.00 am 1.00 Current 146 Days 1630 Days 31.60 Days 61-9B Days 91-120 Days Over 120 [)aye 24740.20 0.00 0.00 DAB am 0.00 0.00 Thank You for Your Payment JAN 2 7 2025 Reminders Date Amount Due Date �01-24-2025 Amount m-n4a25 (z,655F6) pp�7pp Y CQUNbyL)h 1T€Ah9 CA HDuR COONfY T€A 2.740.20 Total Due: 2,748.20 TOLL FEE PHONE NUMBER: 1-800-555-3453 (EFTPS TUTORIAL SYSTEM: 1-800-572-8683) "ENTER 9-DIGITTAXPAYER IDENTIFICATION NUMBER" "ENTER YOUR 4-DIGIT PIN" "MAKE A PAYMENT, PRESS 1" "ENTER THE TAX TYPE NUMBER FOLLOWED BY THE # SIGN" F"IF FEDERAL TAX DEPOSIT ENTER 1" "ENTER 2-DIGIT TAX FILING YEAR" "ENTER 2-DIGITTAX FILING ENDING MONTH" 1ST QTR - 03 (MARCH) -Jan, Feb, Mar 2ND QTR - 06 (JUNE) - Apr, May, June 3RD QTR - 09 (SEPTEMBER) -July, Aug, Sept 4TH QTR -12 (DECEMBER) - Oct, Nov, Dec "ENTER AMOUNT OF TAX DEPOSIT - FOLLOWED BY # SIGN" "1 TO CONFIRM" "ENTER W/CENTS AMOUNT OF SOCIAL SECURITY" "ENTER W/CENTS AMOUNT OF MEDICARE" "ENTER W/CENTS AMOUNT OF FEDERAL WITHHOLDING" ❑ "6-DIGIT SETTLEMENT DATE" "1 TO CONFIRM" ACKNOWLEDGEMENT NUMBER CALLED IN BY: CALLED IN DATE: CALLED IN TIME: ENTER: ### F— "�' 941 # U $ 134,049.46 1 $ 68,160.58 $ 15,940.64 $ 49,948.24 III S:%Flma Share1AP•Payroll Fleswayroll Taxes@02SW3 R1 MMC TAX DEPOSIT WORKSHEET 01.23.25 1127/2025 941 RECITAX DEPOSIT FOR MMC PAYROLL -E PAY PERIOD: BEGIN 1H012026 ys PAY PERIOD: END PAY DATE: GROSS PAY: S 549,681.16 DEDUCTIONS: AIR S 276.00 ADVANC BOOTS MUTUAL CRITICAL ILLNESS MUTUAL ACCIDENT IRS TAX MUTUAL SHORT TERM DIS MUTUAL VISION CAFE-D CAFE-H 3 S CAFE - CANCER CHILD S 570.68 CLINIC S 380.00 COMBIN CREOUN 5 DENTAL $ DEP-LF MUTUAL TERM LIFE MUTUAL HOSP INDEM FED TAX 5 49,948.24 FICA-M S 7,970.32 FICA•O S 34,080.29 FICA-M ADDITIONAL FIRST C FLEX S FLX-FE S - GIFTS $ 199.26 MUTUAL CRITICAL ILLNESS MUTUAL ACCIDENT MUTUAL SHORT TERM DIS LEGAL OTHER S 3,638.76 NATIONAL FARM LIFE MEDSURCHARGE Blank RELAY REPAY STONEOF STONE STONE 2 STUDEN TSA-R S 37730.75 UWIHOS S TOTAL DEDUCTIONS: 5 134793.31 S NET PAY: S 41 887.86 S _aw-to ,c_. IB�OaF'�' &.__. TOTAL CAFE 125 PLAN: $ - Let S 1GR1"+ahb4e12»EPR,9et--pgE4p�KE,1WERePt - S S TAXABLE PAY: S 649,681.16 S S49,881.16 ••CALCULATED" FMMMMCR. oe DlRerence FICA-MED(ER) LQT S 7,970.38 FICA-MED(EE) use $ 7,970.38 $ 7,970.32 $ 0.06 FICA. SOC SEC (ER) emE $ 34,080.23 F A-SOC SEC(EE) eMM $ 34,080.23 $ 34,080.29 $ (0.06) FED WITHHOLDING S 49,948.24 S 49.948.24 TAX DEPOSIT. 5 134,049.46 134,049.48 4 FICA -MEDICARE ,. $ 15,940.76 $15,940.64 FICA -SOCIAL SECURITY 124m $ 68,16OA6 $68,160.58 PREPARED BY: FED WITHHOLDING s 49,948.24 $49,048.24 PREPARED DATE: TOTAL TAX: S 134.049.46 $134,049.46 $ - P3 Rl MMC TAX DEPOSIT WORKSHEET 012325: TAX DEPOSITWORKSHEET 1/279025 REVISED 3/182014 L+1 TOTALS $ 540.881.16 $ 279.00 570.69 380.00 49,946.24 7,970,32 34,080,29 199.26 3,638.76 P S 5 37.730.76 S - S 134,793.31 S 414.887.85 Exempt Amt; Employees over FICA -SS Cap: Paysode S - Employee Relmb.: TOTAL: $ Sadah Rubio 1272025 Run Date: 01/24/25 MEMORIAL MEDICAL CPHTER Page 108 Tine: 17:2I Paroll Register i Hi -Weekly I ?2RIN Pay Period 01/10/25 - 01/23/25 Ru➢8 1 Final Sumary .-- P a PayCd y C o d e S u m m a r y------------------------------------------- Description D e d u c t i o n s s u m m a r Y ------------- + Era JOTISNIRBIHOICB1 Gross I Code Aoma1: ----------- -................................................ 1 REGULAR PAY-Sl 9618.50 N ...... N 11 ......... j ---...-... 2262:3.30 A/A 275.00�/92 A/R3 I REGULAk PAY-31 1750.00 N N N H 87703.46 AUVANC AWARDS BCDSVI 1 REGULAR PAY.S1 301.00 Y R N 11016.92 8OOT5 CAFE H CAPE-1 2 REGULAR PAY-S2 2530.50 N N N 71404.49 CAFE-2 CAFE-3 CAFE-4 2 REGULAR PAY-S2 $9.75 Y N N 3962.07 CAFE-5 CAFE-C CAFE-D 3 REGULAR PAY.S3 1560.50 N N H 54OB0.04 CAP;-F CAFE-H CAFE -I 3 REGULAR PAY-83 121.50 Y N 11 7217.61 CAPE-. CAFE-P CANCER 4 CALL BACK PAY 12.00 N 1 N H Y 674.24 C91LD 570.69AINIC 380. D0ytGUIN 4 CALL BACK PAY SAO N 2 N ID Y 247.5D CREUJV DD ADV DENTAL 4 C CALL BACK PAY CALL PAY 2.00 2266.00 N N 3 N N Y I N N 75.04 4532.00 DEP-LF MATCH ➢jj S-LF 40.00„bt`EDTAX T 49848.2�CA-M 7970.32� D DOUBLE TIME 30.75 N 1 N N 2321.64 FICA-0 34080.2ris1RSTC FM S D DOUBLE TIME 2..50 N 2 N N 1104.79 FLX FE FORT D FUTA D DOUBLE TIME 8.00 N I N It 697.92 GIFT S 199.2&AjR T GRP-IN D DOUBLE TIME Sc Y 2 N N 60.96 GTL HOSP-T NSA D DOUBLE TIE 8.25 Y 3 N N 1030.59 1D TIT IRSTAX LEAF E EXTRA. WAGES N N N N 27848.46 LEGAL HASP. HMB 3598.76✓ E EXTRA WAGES N 1 N 11 N 2275.25 4LR46 RISC MISC/ K EKTIRIDED-ILLNESS-RANK 451.00 N 1 N 11 12772.15 4LMC8HR MDDACC MOGILL P PAID -TIME -OFF 78.78 R N N N 1366.65 N0.7IND ROOLIF MO053➢ P PAID -TIME -OFF 1161.00 N 1 N 11 31959.28 MWVIS NATWI DIRER X CALL PAY 2 144.00 N 1 A 11 288.00 PHI PHI.*. PR FIN Z CALL PAY 3 48,00 N I N N 144.00 RELAY REPAY SAMS SCRUBS SIGNOR ST-TX BLOWUP SIGNS STONE2 BIDDEN SUNACC SUNILL SONIND. DONLIE SUNSTD SIONIS SURENG TSA-1 TSA-2 TSA-C TSA-P TSA-R 37730.75�&- ION UNIFOR UVROS -- ----------------- Grand Totals: 20224.53------- I Gross: 549681.16 1 Deductions: 134793.311/ Net: 434887.851 - iJ Checks Couni:- BT 202 IT 11 Other 42 Ferale 227 Nile 29 Credit OcerAnr 15 Zeroket Tem Total: m ------------------------------- Y MEMORIAL M EOICIR CENTEN PROSPERITY:9ANR ELEMONICTRANSFERS FOR OPERATING ACCOUNT —Jan 17, 2025-Jan 26. 2025 w 2219 naow esanen �Me xeNf [PD Amount Chexd dnen uMa^a 1/31(2025 PAVPWSAENTmns$19>R2M1D16LI06%183%2P -3r8 PaNV Payw Eee a38.97. 01538 I/37/208 NEAUHFDORYINEReaRM1Egp 13568889108Wi> -EmpDedust/En,IW rCod1r16M 11077-w R- %OS% 1/17/2025 E%PERTPAYWERTPAY74GOW41191000012622135 {MR15uppomp"Went .bip69•.. M567 1/17/2025 ALAERI$OMCE0ERGPAYMENM0lM7769210M02 .3403ow Pea6mm Expense 265S.76 :; 'Sam V17/M25 MEMORIAL MEOICALP4VROl4746p0341111SUMSO -Payroll 356.355.M .:-. 1/21/Wn2 la AtMrm S5 862M1DOR69799t759 -3NPa"P3vm Fee 1.48- 901539 1121IM25 WEBFAE TAR PYMT DD903nB01263021OJ0021661 -Sales Tax 1,158.72 �,.h. IM149 1/21/M15 MCRE%ON ORUGAUTO ACNACH0435e3699100001W - 340B Or, Program Expense a 4.631.67 5505% t/21/204 IRS USATA2PYMT27gU2m2549>2610360IM2969 -Payroll Taxes 121,7M.94 ,. 81r0568 1/23=5 PAYPWSACNTrdnc5248Q334ID1L0969icaty TP 3N Party Payer iee %IS42 1/23/2o25 U5 ACRTmpn52onMend10I00%I312203P ..3N Party Paynr Pee 47.84 .002.M Mm RPM 1/23/M25 RPIIGIICPTUsr7AMerIV.lnIPODWI9122G5001 -31d"ln4umnmee Payrpnnls 83.801.40 i, % ransWwilmvi0r YU25ACROEMIIMME 10100%92365>87P -3r0 PdM PaYttiep 169A7 12 ]/24/2025M1fNSOUNCe BF0.G PAYMENI5010009))fi821NW2 W4=5 AM -340B OruOPragrem Evperpze a 3,01958 55p55) S5057 566.1"AN, lanuary3),2025 MenennalmadimlGenttt PAOSPERITYBASIR {� a. 1 4 7° 8 4 t E1£CMONICTRANSF6RSf0AGPEPAIINDAC000NT-ISTIMAIEDgO15 1 69 ° 47 + Date Besepisse. MMMH , pm9uM 4 56 ° 56 Q: 570.69 + 1.071.00 - aa9 570.69 IS 655.76 _ Ianuary27;M25 '"'. °-. .20 - p u' Steve B.k,cPD 1•48 + memonalmealolfiente. I C68 77_ - 1 • 48 9N r,.e?1, 67 - I1i 75.f;-n4 .- 456.56 + APPROVED ON _..i•40 _ -- 5 7 0• 69 + JAN272025 1+028.73 0 1.48 + ,028.73 0 1.028. 7i - g L1N CANC COUm.i MS 0 • 0 0 0 Plan StartDate ER Per Pay Cost EE Per Pay Cost 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $30.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $137.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $25.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $50.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $50.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $25.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $175.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $0.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $50.00 2025 Heath Equity Health Savings Account 1/1/2025 $25.00 $10.00 $525.00 $552.00 Total $1,077.00 Memorial Medical Center Transfer Request 1,000,00D.00 Date: 1/27/2025 Prosperity Money Market AUPROVEp OV Operatla� CCJn�AN 2 �qq��1�25 OAIHOUNN�OUN' j)IRAc TRANSFER FUNDS FROM PROSPERITY MONEY MARKET TO PROSPERITY OPERATING by: CaRlIllInn Clevenger Date: IQ7l202S by: �+—� ..? Date: RECEIVED BY THE COUNTY AUDITOR ON 01/22/2025 JAN232ac� MEMORIAL MEDICAL CENTER 19:24 AP Open Invoice List CALHOUN COUNTY, TEXAS Due Dates Through: 02107/2025 Vendor# Vendor Name Class Pay Code 11832. BROADMOOR AT CREEKSIDE PARK Invoice# Comment Tran Dt Inv Dt Due Dt Check DI Pay 011525 01/22/20201/15/20202/07/202 -j 012125 011221202 011211202 02/07/202 Vendor Totals: Number Name 11832 BROADMOOR AT CREEKSIDE PARK GrandTclals: APPROVED ON Gross Discount 1,241.02 0.00 JAIN 2 3 M5 CABLHOUN('OU&ITOR S 0 ap_open_invoice.template Grass Discount No -Pay Net 1,224.00 0.00 0.00 1,224.00 17.02 0.00 0.00 17.02 .f Gross Discount No -Pay Net 1,241,02 0.00 0.00 1,241.02 No -Pay Net 0.00 1,241.02 RECEIVED BY THE COUNTY AUDITOR ON JAN 2 3 MEMORIAL MEDICAL CENTER 01/22/2025 18:25 AP Open Invoice List CALHOUN COUNTY, TEXAS Due Dates Through: 02/07/2025 Vendor r Vendor Name Class Pay Code 11824 ; THE CRESCENT InvolceR Comment Tran Dt Inv Dt Due Dt Check Dt Pay 011625 01122120201/16/20202107/202 Vendor Totals: Number Name 11824 THE CRESCENT Grand Totals: Gross Discount .APPROVED ON 2,400.00 0.00 JAN 2 3 2025 CAVH& CB'U .'T&S 0 ap_opsn_i nvoice.template Gross Discount No -Pay Net 2,400.00 0.00 0.00 2.400.00 Gross Discount No -Pay Net 2,400.00 0.00 0.00 2,400.00 No -Pay Net 0.00 2,400.00 RECEIVED BY THE COUNTY AUDITOR ON 01/22/2025 JAN 2320^� MEMORIAL MEDICAL CENTER 19:25 AP Open Invoice List r�p� Due Dales Through: 02/07/2025 COUNl'Y, TEXAS Class Pay Code Vendor# Vendor Na Class 0 ap_open_fnvolce.[emplate 11836 i GOLDENCREEK HEALTHCARE Invoice# Comment Tran Dt Inv Dt Due Dt Check Dt Pay Gross Discount No -Pay Net D11525 01122/20201/15/20202/071202 397.74 0.00 0.00 397.74 .= j 011625A 01/22/20201/15/20202/07/202 1,246.60 0.00 0.00 1,246.60 .. 012125 01/22/202 01/21/202 02/07/202 813.05 0.00 0.00 813.05 Vendor Totals: Number Name Gross Discount No -Pay Net 11836 GOLDENCREEK HEALTHCARE 2,457.39 0.00 0.00 2,457.39 Grand Totals: Gross Discount No -Pay Net 2,457.39 0.00 0.00 2,457.39 APPROVED ON JANM2 3g22002T5pp ggyy CALHOI. VCO 1NT'Y.IT?LS RECEIVED BY THE COUNTY AUDITOR ON JAN 23 %,1 %: MEMORIAL MEDICAL CENTER 01N22/2025 1927 � AP Open Invoice List CALHOUN COUNTY, TEXAS Due Dates Through: 02/07/2025 Vendortt Vendor Name Class Pay Code 13004 TUSCANY VILLAGE J InvoiceN Comment Tran Dt Inv Dt Due Dt Check Dt Pay j 011525 01122/202 01115/202 021071202 011625 01122/202 01116/202 02/07/202 Vendor Totals: Number Name 13004 TUSCANY VILLAGE Grand Totals: Gross Discount 13,013.95 0.00 :APPROVED ON JAN 2 3 202` gY COUNTY gqUD)TpR CALHOUN COUNT' TEXAS 0 ap_open_lnvolce.template Gross Discount No -Pay Net 6,953.95 0.00 0.00 6,953.95 ..; 6,060.00 0.00 0.00 6,060.00. Gross Discount No -Pay Net 13,013.95 0.00 0.00 13,013.95 No -Pay Net 0.00 13,013.95 M... rhl MadW Qnlnr NurNnB Nome VPL WLLhIyUmLYTranshr vmWemySatunu ' 1/27/2025 Smn. e.eY+er Sae hJxe e.a+e nnwmxm,.e.wnee Uw3 u,anl e5un] eSAstn ..�• e... e.wn u.ux.n v.nnv wwlnewx. Imm S,Mm m.�w rmw,..uYm nSa.vn remewe ];Lfl.]9 IL99I.N b,9W9 1151HI99 IIN]Y99 WK. 85e012.77 + 25,915.59 + 5815LI.46 + 11.855.97 + 181t325x79 o a.yew,pwt�. rvnw.xxrou.nx.xro.. rwe3. raT emn, n.aNx eNm y3lmzaexK www x wnsmna �vwm.wmw.nw,un n.n,mlxww WxIV,Y mlr,wxw..nmuw nyu.emn,.N.me,.. SAL" e5aas9 eSn.e.unn n.tus9 VULn,. Wn NMluu )WW YauneWVNh.n.4, h,S Alm, l e.n .,Us" y V...n,. wnemwn Imm dMhnEMSY..11sTuunY 9,91U0 UW,Ie.luMramWMt Y,yiSf x.SY.N en9uum xsecu Vn4iae W..N4Yiw imm SelunhVnn/fnn,IxMl LSSe.Y hnSWnn II.SSL]S Y.Nnu lemin S.4u. IYIm U.haYnn.M.MMTuun] 1.SOx.BI uAsss 'i 5e'�LK J I"%x APPROVED ON gg JANN2 7p220p2rr5ppqq CALHO COUNTYRPA9 e¢anetl.nr?reml✓M, )IAitn er aMAUL sle9e Lrmlt RO 1122/mi! lax...W u.,... opwNeuvmlq.eNmSylxunp0p+rvwC 1¢E5-IEn PaYI MMCPRRII(IX Ilx14^.ml] L}9fYClR OMp/Gm 1 m%/GmpS mvv/GmN m%/fimplBY)4 m%T XNIRHryON YSIIM15 MPeR S.iNW � L]]f C0 Yll/]mS XHe�CfXO H(CWNiMf4MpHLLMOLWE]W]] 11.ML55 3i,301.55 YELM131WtMMnMuu IXfYINVMSE<I®IIl IM1N 315M1 )1SW YAINPS MNSHOGXOMit]56MNSPMM#ll al 16,9M.n 36,9M.N L1I/bK WVRKSp111WXX[<WMPNfS15MlfEaWn1 i1,1t1A2 E7.3IL82 Y1uwMpS.mNpmnu N([WMSMCI4NYIl1ta)4 SAMDI 3.O6aW LEVmPo3s NNL[IMON((UIMPMf>fWN114WW111]W _ VLW IA.W e]»T.ea -- wnaa MMCvm3rlml m%/Gmp L3 T^^J/.1C9v3 } n.ye m)I/mmpl l4pM m%GmN mrc/GHMf{fL]M OV9T NH MMTOH ]WO5v ulymn - uM]K U.]SxA3 0.- E.0 H.MmfMl..pit u3UW]S NNB-[SNO SMlI 9S5.3I mRMT51f0. CmfmuASM59] u W1]E WfGN1m H[MTH WICCmI[MYI IE,HI.If . VlYnK NXB•F(NON6IAWPMfnI00MLL4xtlptfSML umn •,_ IOL9) - 101.93 am.?, E59659 =.9I959 mmcmIIIIm1 W%/GMp i)f ]n�fn 5 r�i Si T.,p m%/GrM1 sum mpptf 3 m%/ NNp3x VxVM]S MNIIOFMIxM[In5]M16PNNfMQQryYYJ]1Y]I - wom 59WW V21/pES 1gVrtM 50lU]IONIKKWMMAt616M3piAWl9l - I,p'4.93 7AS93 Vx)/N390]WRO NG4111VNC[WNPM]]1WG5614 ),e)9.IR SMOpO 3m mow 'f VW= vmmn 3" 35]KG vv/ross wRLaurfKRm x[KTxfKf([ITfum %,eu.m � _ , un/Mn MM110tYNxtn3YMt6pMMMWM'Atxean xsuu - MW93 Y3YPoIS MUMYMxISfO NC[GIMIM36YltMOIIOttM%3 xLMW - M.3WLO Vx3]TLSW D HEALTHPMMMIM] 2ING1MM355 H151SW - E0,575W LL6,S1099 60.1aS.Tb aA16i 16 MMc.Rxnox mpNGmsi]a e TTj nl ll. a[i. [pp$$SpJp m%/G 1 \Y OpP GmN m%/C41MfN+0u gRvll xN pOFROH ni V3nuabm _ MMCPoIIIIOX mrr/Gmp L3a imxRM'M MI/Gmpl tYMp qM9/mmp3 mN/CaWfNSW QWpT HN90q]Im1 yM/10E MVRKSOWgN N[U/JMpM56]Ulupp0A1R - I,1Ay ]I!3/]mS NNB fiNONft41MIMf]I69SITYINWWf9p5% - y9M iz me• 3181] VIYAK MIV Supplemn4 XLO}IMpMf IIiWMLL VIIY ' 6.]]Olq $5]p Op I%Tuu a, rwR INsr62_ 9�tiR Balances Overview Account Name *4357 MEMORIAL MEDICAL- $845,995.12 $883,923.34 $845,995.12 $1,090,416.63 OPERATING *4381 MEMORIAL MEDICAL INH $85,112.77 $90,067.77 $85,112.77 $50,567.22 ASHFORD *4403 MEMORIAL MEDICAL/NH $26,015.69 $36.560.59 $26,015.59 $1,157.16 BROADMOOR *4411 MEMORIAL MEDICAL/NH $64,565.76 ..; $74,166.76 $64,565.76 $50,819.83 CRESCENT *4438 MEMORIAL MEDICAL I SOLERA @ $13,558.78 i $13,558,78 $13,558.78 $9.278.44 WEST HOUSTON *4446 MEMORIAL MEDICAL I NH FORT $2,686.88 $2,686.88 $2,686.88 $2,686.88 BEND *4454 MEMORIAL MEDICALIR GOLDSN CREEK GOLDE $212,056.27 $212,066.27 $212,056.27 $89,945.78 HEALTHCARE *4551 CAL CO INDIGENT $5,493.98 $5,493.98 $5,493.9B $5,493.98 HEALTHCARE *5433 MMC -NH GULF POINTE PLAZA- $2,672.32 $2,672.32 $2,672.32 $2,672.32 PRIVATE PAY *5441 MMC-NHGULF POINTE PLAZA - $110.63 $110.63 $110.63 $110.63 MEDICAREIMEDICAID *5506 MMC •NH BETHANY SENIOR $456.32 $37,060.38 $456.32 $456.32 LIVING *3407 MMC TUSCANY VILLLLAGE TUSC $482,879.97 $483,869.87 $482,879.97 $347,938.00 *2998 MARKET FUND MMC -MONEY MAR - $2,058,288.95 $2,058,288.95 $2,058,288.95 $2,058,288.95 *7168 MEMORIAL MEDICAL CENTER- LOCKBOX MONEY $39,70 $39.70 $39.70 $39.70 MKT Total Balance $3,799,933.04 $3,900,556.22 $3,799,933.04 $3,709,871.84 Report generated an 0112712025 09:13:23 AM CST Page 2 of 2 Memorial Medical Center Nursing Home UPL Weekly Neaion Transfer Prosperity Acmunts 1/27/2025 ` 1 1 PreNeua i Atwunt teHnnint Penenl Te0atif 0etlnnln8 Amount to ea TraMmnd to Nurpnt Nun Nome Num6tl Bala.! Mmhrveut TrarAem. B alo 60lmce Hame samommmwm 31,16J99 31.0[0.89 211.956.27 212A56.21 -._ 211,996X/.,� dank BPlame 211,056.37 Vanarc BwrMe ln(armotron Wr GaW�n beet Nopn Heeeh of eeWen Geef V/Nh farpo Bonk NA. Nere: NA, beramn /esrr 55,="IN "a If rred to the nvmn9heme. N0tr2:Exhn¢oant h. a bars bok.ef$100 Notmmc hpmlted re epenenaunr. APPROVED ON JAN 2 7 2025 CALHOUNOCOUNiv?'WS cSNHWgMy TrmtrortINHUPtaranNNremmaq1202S\NHVPlTomrer5umma 1.21.15 leaveln Babnpe ]00A0 "twt Balanu/Tr..du Amt 11195a31 NO..& SJ 5[eYe Brvtli, [PO Im/leis FYAfwFnUN aw/aXN rnn iM rgps,.in «mv/tampl arv/unol aro/mms u+oY ann rm wanaX - UEN9EL9 - Iiio9t 8S ' I.L99M L191.W 111291 - i9.WF19 - )9.SY.14 3),IYiIY')� Mulms o.r=Xq . Y1410191w/IMM{IRfI[FN9V HI6NfYOOVa3 MM9191M/IYN991L[Yf09[9 YNY99YI69Vq 1/iJ/Mi9 NM-[LNJ M[IFW9NI1LImN31YmLlYY) M9I1019 XOVRF930WTOXX(LIMM9MIYNIIiIRfIgW IpYM19 WIYYUTM[LgX M0.M 0/1q 400MfRllk Nf MMR19 RvfRMXf91RAfFf0Y9Y1W995fR9V11 ;NI01 - 4.9W. U.M. bYf/IYMIIRI[[FLO R[9NIYL99YlN9)L9 I.q'�O4 . <.99X.W 1' PAfOd9 1I39Y.11 J VL99FV Balances Overview Account Name '4357 MEMORIAL MEDICAL- $845,995.12 $883,923.34 $845,995.12 $1,090,416.63 OPERATING '4381 MEMORIAL MEDICAL/NH $85,112.77 $90,067,77 $85,112.77 S50,567.22 ASHFORD '4403 MEMORIAL MEDICAL/NH $26,015.59 $36.560.59 $26,015.59 $1,157.16 SROADMOOR '4411 MEMORIAL MEDICAL/NH $64,565.76 $74,166.76 $64,565.76 $50,819.83 CRESCENT %438 MEMORIAL MEDICAL I SOLERA@ $13,558.78 $13,558.78 $13,558.78 $9,278.44 WEST HOUSTON `4446 MEMORIAL MEDICAL I NH FORT $2,686.88 $2,686.88 $2,686.88 $2,686.88 BEND '4454 MEMORIAL MEDICAL / GOLDEN CREEK $212,056.27 $212,056.27 $212,056.27 $89,945.78 HEALTHCARE '4551 CAL CO INDIGENT $5.493.98 $5,493.98 $5,493.98 $5,493.98 HEALTHCARE '5433 MMC •NH GULF POINTE PLAZA- $2,672.32 $2,672.32 $2,672.32 $2,672,32 PRIVATE PAY •5441 MMC -NH GULF POINTEPLAZA- $110.63 $110.63 $110.63 $110.63 MEDICAREWEOICAID '5506 MMC -NH BETHANY SENIOR $456.32 $37,060.38 $456.32 $456,32 LIVING TUSCANY VILLAGE TUSC NY VILLAGE $482,879.97 $483,869.87 $482,879.97 $347,938.00 *2998 MMC -MONEY MAR MARKET FUND $2,058,288.95 $2,058,288.95 $2,058,288.95 $2,058,288.95 '7168 MEMORIAL MEDICAL CENTER - LOCKBOX MONEY $39.70 $39.70 $39.70 $39.70 MKT Total Balance $3,799,933.04 $3,900,556.22 $3,799,933.04 $3.709,871.84 Report generated on 0112712025 09:1323 AM CST Page 2 of 2 Memorial Medical Center Nlrrsing Home UPL Weekly HMG Transfer Prosperity Accounts 1/27/2025 I BrtNm MmM MtlnNq e., TnNl.l-0N TMN1. 11 anus no NMIR 4N &Isu nrNno rawN wunn SOUS J looao ' i .Wµ.1 e.Ivy.R..Mn Mt 3ATi.3i r� rwnuNme. eeuunt O.U... Ymtior NUJ x IBnnM. inN1.Mu1 Tnmf A Wtln tl b lu T MI.M N"ra. . NYMI{NMI 1101, II063 tb.6l I' 4nY 0.unn tlp.63 I V.Mnte x.n: JnvrMaNn Nowrfs.a3oKYe<InNlrmarouemrnnvA>,n. Nevi: cnwv.mnt Nrovonwrmx.as3oomnarnlcarpruaroe�.nntwnc APPROVED ON JAN 2 7 2025 CAeHY0% f CO NAVY? TEXAS I:Wxwvxr".mnnvNurtn.N�UsummmuonWnurvrs�ms.mm.n I. n.is IMM eNUr unn.Rnmmlanl laAl TOTIL1MMr[0.4 i3p,y6 eovNwd: 3o-n.ML RO IMAMS 1/i1/17/2022025 HN9-ECHO HCCWMPMTP4E00341144WMT02M530 HNB-ECHO HCCMP)060034114W DDD231330 1/I7/2025 NN3-FCHO HCCWMPMTi43pW111410000230622 MMC PORTION OIPP/temp NPP/CMP4 Trensfer.pm I Trend,4n I OIPP/COmpi 1 OIPP/C O Wpe OIPPTI NH PORTION 49 M - 49.00 22.00 7 - 72.00 145." t - 149.77 MMC PORTIIN OPP/Comp wP/ComP4 Tmm6n-0et T.W.M. gIPP/Compl 2 QIPI/Cpmp3 6Ypn O@PT1 NNPOINION 170.71 200.71 Balances Overview Account Name •4367 MEMORIAL MEDICAL- $846,995.12 $883,923.34 $845,995.12 $1,090,416.63 OPERATING •4381 MEMORIAL MEDICAL/NH $85,112.77 $90,067.77 $85,112.77 $50,567.22 ASHFORD *4403 MEMORIAL MEDICAL/NH $26,015.59 $36,560.59 $26,015.59 $1,157.16 BROADMOOR *4411 MEMORIAL MEDICAL/NH $64,565.76 $74,166.76 $64,565.76 $50.819.83 CRESCENT •4438 MEMORIAL MEDICAL I SOLERA @ $13,558.78 $13,558.78 $13,558.78 $9.278.44 WEST HOUSTON •4446 MEMORIAL MEDICAL I NH FORT $2,686.88 $2,686.88 $2,686.88 $2,686.88 BEND *4454 MEMORIAL MEDICAL GOLDSN CREEK GOLDE $212,056.27 $212,056.27 $212,056.27 $89,945.78 HEALTHCARE *4551 CAL CO INDIGENT $5,493.98 $5,493.98 $5,493.98 $5,493.98 HEALTHCARE *5433 MMC -NH GULF POINTE PLAZA • $2,672.32 $2,672.32 $2,672.32 $2,672.32 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA- $110.63 $110.63 $110.63 $110.63 MEDICARE/MEDICAID `5506 MMC •NH BETHANYSENIOR $456.32 $37,060.38 $456.32 $456.32 LIVING USCMMC NH USC TANY VILLAGE VILLAGE $482,879.97 $483,869.87 $482,879.97 $347,938.00 *2998 MMC -MONEY MAR MARKET FUND $2,058,286.95 $2,058,288.95 $2,058,288.95 $2,058,288.95 `7168 MEMORIAL MEDICAL CENTER - LOCKBOX MONEY $39.70 $39.70 $39.70 $39.70 MKT Total Balance $3,799,933.04 $3,900,556.22 $3,799,933.04 $3,709,871.84 Report generated on 01127/2025 09:13:23 AM CST Page 2 of 2 Memorial Medical Center Nursing Home UPL Weedy Tuscany Transfer ProsperityAccounts url/2025 j w«im. r umuniroe. Ramona aHinnlnt IMtlN9 Tran](mNto NuaJn Nm. ttlaw Tc] -0 T i A 6y a wIY TOtl •a N 4Wm NY n Nwn. / 195,911.12 19Y.PLR 4a3,]]9.97 bSJ]9.9] /bar]i9.9] ;I sank Balance 4el)79.0"+f VImM. L. In Wan. now /ANtleaNn.01-Ift1 ma uxme] nnn:e,N]ml,,,..W«�Sxmcwun. wnMrrrnaiRue«oM9nem. n99.«m: �1 N.r.):cwn wa«mnm aww nmm�e/5lwrnm M.usemeor.amoy.n ono.nr. •.i urv. wmk s/n/lo]s �r L JAN 2 7 2025 CALHOW&A RA5 1/24/2029 0aposlt 1/24/2025 a4pZ: 1/23/2025 HNB•ECHOHMwMPMT7460034114400001945BT 1/23/2015 HNB•ECHOHMMM9MT74M0341144000p294667 11221202: WINEOUTVIOAGEPOSTAWTEHEALTH SERVICE 1/22/2025 Oepo"t 1/22/2025 HNB-ECHO HCCIAIMPMT746003411 440 24630 1/22/2025 NOVOASSOLUTIONHCCe IMPMT6762014100001n 1/21IM25 HNB•ECHOHCCIAIMPMT746003411440000279S68 1(21/2025 HNB-CO4O CLlAIMPMT74600342IMa000279938 1/21/2025 NOVITASSOLUOON HCC MPMT676201420000185 1/17/2025 HN8-ECHOHCC MPMT746003411440000230601 2/17/2025 NOOTASSOLUTION HCOAIMPMT676MI420 163 MMCPORTION Q1PP/Camp QIPP/ComP2, QIPP/Comp QIPP/Comp Innsfet•Out Tnns(er•In 2 34&Lapse 3 4&Lapse QIPPTI "PORTION MAS.77 - 125,589.77 9,351.20 - 9,352.20 14,361.01 - 14,38I.01 • 6,851.42 - 6,851.42 y 195.871.72 46,MBA9 - 46,348.89 18,930A5 - 18,910.05 7,723.20 - 7,723.10 6,123.17 8111317 8,230AS - 8,230.88 23,45444 23,454.04 17,462A5 - 17,462.45 196,362a9 - 195,,362.89 195.871.72 482,77937 482 A9.9] Balances Overview Account Name `4357 MEMORIAL MEDICAL- $846,995.12 $883,923.34 $845,995.12 $1,090,416.63 OPERATING `4381 MEMORIAL MEDICAL/.NH $85,112.77 $90,067.77 $85,112.77 $50,567.22 ASHFORD `4403 MEMORIAL MEDICAL/NH $26,015.59 $36,560.59 $26,015.59 $1,157.16 BROADMOOR '4411 MEMORIAL MEDICAL/NH $64.565.76 $74,166.76 $64,565.76 $50,819,83 CRESCENT *4435 MEMORIAL MEDICAL /SOLERA @ $13,558.78 $13,558.78 $13,558.78 $9,278.44 WEST HOUSTON `4446 MEMORIAL MEDICAL / NH FORT $2,686.88 $2.686.88 $2,686.88 $2.686.88 BEND *4454 MEMORIAL MEDICAL/ GOLDE GOLDSN CREEK $212,056.27 $212,056.27 $212,056.27 $89.945.78 HEALTHCARE `4551 CAL CO INDIGENT $5,493.98 $5,493.98 $5,493.98 $5,493.98 HEALTHCARE *5433 MMC -NH GULF POINTEPLAZA- $2,672.32 $2,672.32 $2,672.32 $2,672.32 PRIVATE PAY `5441 MMC -NH GULF POINTEPLAZA- $110.63 $110.63 $110.63 $110.63 MEDICARE/MEDICAID `5506 MMC -NH BETHANY SENIOR $456.32 $37,060.38 $456.32 $456.32 LIVING *3407 TUSC MMC -NH TUSCANY VILLAGE $482,879.97 $483,869.87 $482,879.97 $347,938.00 *2998 MC -MONEY MARKET FUND MARKE $2,058,288.95 $2.058,288.95 $2,058,288.95 $2,058,288.95 *7168 MEMORIAL MEDICAL CENTER - LOCKBOX MONEY $39.70 $39.70 $39.70 $39.70 MKT Total Balance $3,799,933.04 $3,900,556.22 $3,799,933.04 $3,709,871.84 Report generated on 0112712025 09:13:23 AM CST Page 2 of 2 Memorial Medical [enter Nursing Home UPL Weekly HSLTransfer Prosperity Accounts 1/27/2025 i w n. a[uuM eMn.N{ .e ' ra tl . Nnwneae.TnMm.IM M Xene MuNn M3}}3p M. Tnnrt�bW Tn 11") [YtOnM Nt Td4 .0 i .51.32 }6, }}}}O )5G31 1513, NOTMH$RX B.nkWmn <f63} xen: murowwn,YlYrofAmewemYm.J.nm i.wnN,.nrmn.. n.na: r.deminrmt.m..mumgfrmn,erawra.mm.Ynnnn•=<}wm. APPROVED ON JAN 2 7 2025 tl'Vx VNnMrnmm�wxonn.minLm+.mW35wx MTIIIIeIL u}n Vatlan lea'rtin la4nte lm.m �I Fyun M4nr.Rnn,In Nnt }H]} wN: Ss r6� }R}Rms [PoIRION imr13!9W.,j LwQetlN mn/mei51 Cron/mmpt mMMnlmmos mn/mniWupu morn xx roml0x 1pl/lOS WP[OYf PE4lnW Ppfe YC 36}31- ull/rols xuMw.siuroxccwMvrmu3usasiw5asw - I I sse.0 1 356.3I M}Y3 - 356]3 3%JL Balances Overview Account Name *4357 MEMORIAL MEDICAL- $845,995.12 $883,923.34 $845,995.12 $1,090,416.63 OPERATING *4381 MEMORIAL MEDICAL/NH $85,112.77 $90,067.77 $85,112.77 $50,567.22 ASHFORD *4403 MEMORIAL MEDICAL/NH $26,015.59 $36,560.59 $26,015.59 $1,157.16 BROADMOOR *4411 MEMORIAL MEDICAL / NH $64,565.76 $74,166.76 $64,565.76 $50.819.83 CRESCENT *4438 MEMORIAL MEDICAL /SOLERA@ $13,558.78 $13,558.78 $13,558.78 $9,278,44 WEST HOUSTON *4446 MEMORIAL MEDICAL / NH FORT $2,686.88 $2.686.88 $2,686.88 $2,686.88 BEND %454 MEMORIAL MEDICAL / GOLDEN CREEK $212,056.27 $212,056.27 $212,056.27 $89,945.78 HEALTHCARE *4551 CAL CO INDIGENT $5,493.98 $5,493.98 $5,493.98 $5,493.98 HEALTHCARE *5433 MMC -NH GULF POINTE PLAZA- $2,672.32 $2.672.32 $2,672.32 $2,672.32 PRIVATE PAY *5441 MMC -NH GULF POINTEPLAZA- $110.63 $110.63 $110.63 $110.63 MEDICAREIMEDICAID *5506 MMC -NH BETHANY SENIOR $456.32 $37,060.38 $456.32 $456.32 LIVING *3407 TUSCANY VILLAGE TUSCA Y VILL $482,879.97 $483,869.87 $482,879.97 $347,938.00 *2998 MMC -MONEY MAR MARKET FUND $2,058,288.95 $2,058,288,95 $2.058,288.95 $2,058,288.95 *7168 MEMORIAL MEDICAL CENTER • LOCKBOX MONEY $39.70 $39.70 $39.70 $39.70 MKT Total Balance $3,799,933.04 $3,900,556.22 $3,799,933.04 $3,709,871.84 Report genera led on 01/27/2025 09:13:23 AM CST Page 2 of 2 P A Y E E AMOUNT: MEMORIAL MEDICAL CENTER CHECK REQUEST Tuscany Village : Date Requested: 2/27/2025 APPROVED ON N 2 7 2025 ,..�Y GQ�C UNT�I r?R AS FOR ACCT USE ONLY ❑ Imprest Cash ❑ A[P Check ❑ Mail Check to vendor ❑ Return Check to Dept S 1,602.81 GA NUMBER: 21400007 EXPLANATION: Claim pymnts owed from Solera to Tuscany i REQUESTED BY: Caitlin Clevenger AUTHORIZED BY: MEMORIAL MEDICAL CENTER CHECK REQUEST P Tuscany Village Date Requested: 1/27/2025 A y E APPgOVED ON E AN 2 7 2025 qquu qq BYCC UN7YDIT�XAS FOR ACCT USE ONLY ❑ Imprest Cash ❑ A/P Check E. Mail Check to Vendor ❑ Retum Check to Dept AMOUNT: $ 5,924.30 ' G/L NUMBER: 21400007 EXPLANATION: Claim pymnts owed from Crescent to Tuscany 1 REQUESTED BY: Caltlin Clevenger AUTHORIZED BY:. s c 0 O 0n z3 �n 03 3w 3aS w oy oa g a y y-, Hy ma p vm3 yrC- 7m7��3 yc o n n ti y zp zc�i oz oz m m m m n z� wm zn tim ti m z m r � O N O W p J O b n �5 U O N O O O A 3 O Z Z� yy Zd z° m yy p m mr mr O m n O O O C C w C C r C m n N m P N P O P 00• P P PP P P O P S P O P O r O N R x m 8 n n n n 10 O •nn O O +� O 'n Q z 8 r n om a y o > a n a n a n a < < z m < a a a a a 9 Y 9 D D m m m m O O O O O A S O ooe W w w w o S S 3 � �paomwa <o coti c � �y a £ En -3x zn oz zo oz zn oz zna oz n r A W UX X. _ d, m� yr m3 dr m d m� Ha 3: oz _ o, apw gw om ol AO w p F "I F ON ON O� w C m C W 9 m j \ W W w N A AO aG G mr w n r n w r Fri O w m e n 0 u A 9 O O O O O O O O ( ) ! 2§ \0 xo§ § § w (\ �§ ) oz 2 2 ) ; E a R / E § { k ® ( § § 2 k )\ \ \ 2 §§ §� �\ �/ 0 )2 �� 7 § 2 �) (§) (\( !% / \\ \ � «z §/ / { ! 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